Alex Hoagland, University of Toronto and Michal Horný, UMass Amherst

Even though preventive care is supposed to be free by law for millions of Americans thanks to the Affordable Care Act, many don’t receive recommended preventive services, especially racial and ethnic minorities and other at-risk patient groups.

The Affordable Care Act exempted preventive services from patient cost-sharing for large chunks of the population. This means that if you receive preventive screening and have private insurance, including through the ACA Marketplace, there should be no copay at time of service, and you shouldn’t get a bill later on. Easy enough, right?

Wrong. Our team of health economists has shown that patients spend millions of dollars every year on unexpected bills for preventive care. The main reason for this is that no specific regulations were put in place to determine exactly which services should be exempted, or for whom, or how often. This omission has left many people on the hook to pay for valuable health care they thought would be free.

Now, in our recently published research in the journal JAMA Network Open, we’ve found that the burden of paying for what should be free preventive care disproportionately falls on some patient groups.

Inequitable claim denials

Looking at data from over 1.5 million patients, our study demonstrates that insurers deny preventive claims for patients from marginalized communities at higher rates than for those from majority groups.

For example, low-income patients were 43% more likely than high-income patients to have their claims denied. In addition, Asian, Hispanic and non-Hispanic Black patients were each roughly twice as likely as non-Hispanic white patients to have claims denied.

Not only were these patients denied routine benefits, but they also saw large differences in rates of billing errors. For example, patients with a high school diploma or less experienced denials due to this kind of billing error almost twice as often than patients with college degrees. All of these services should have been covered by an insurer.

Research on preventive care access is commonly based only on claims data, which doesn’t typically have information on patient demographics. This limits a study’s ability to detect differences across patient groups. Our study, however, uses a combination of linked claims data, remittance data containing information on why claims were denied and whether they were resubmitted, and demographic data from self-reports, purchase transactions and voter registries. Together, this richer dataset allowed us to examine differences in denials based on race and ethnicity, education and income, including reasons why patients were denied care.

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Preventive care is essential

Equitable access to preventive health care is about more than just physicals, although those are important, too. Preventive health care includes key screenings for cancers, cardiovascular disease and diabetes, access to contraceptives, and mental health checkups, among other services. Ensuring that insurers provide equal coverage for these services for all patients is important to improve health outcomes and quality of life for everyone while reducing future health care costs.

Our results paint a picture of the kinds of hurdles patients face when they seek health screenings. Patients from underrepresented groups were not only more likely to be told their care wouldn’t be covered. They were also more likely to have their claims processed incorrectly, leading to more frequent denials and, ultimately, larger medical bills. https://www.youtube.com/embed/Uc2uG6LhFQQ?wmode=transparent&start=0 Few patients appeal claim denials, even though rejections may be unjustified.

Unexpected bills can affect both a patient’s current health and their future use of health care services. These hurdles can exacerbate an already tenuous trust in a fragmented health care system, making patients less likely to return for follow-up screenings.

Stacked coverage denials for patients who live with multiple marginalized identities or who are less able to advocate for themselves can further entrench racial and socioeconomic inequities.

Ensuring equitable access

Our study paints a compelling picture of where different patients may face hurdles for getting preventive care, but more research is necessary to identify how to ensure equitable access.

As our study looked only at preventive services, we will also need to see how our findings generalize to other forms of health care. More research is also needed to understand how other vulnerable patient groups, such as LGBTQ+ patients or patients with multiple chronic conditions, fare when trying to access care.

Our team is currently studying how actual bills for care differ across patient groups and how patients respond when bills arrive. In our study, more than two-thirds of denied claims were never resubmitted to insurers, meaning that many billing errors go uncorrected at patients’ expense.

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Equitable policy on multiple fronts can help rectify the way preventive care is inconsistently and inequitably provided. These include uniform coverage of preventive care by insurers, standardized billing practices for physicians and improved means for patients to advocate for themselves. This can help ensure that everyone has appropriate access to lifesaving health care.

Alex Hoagland, Assistant Professor of Health Economics, University of Toronto and Michal Horný, Assistant Professor of Health Policy and Management, UMass Amherst

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Inflating Essential Pricing

In a tense federal courtroom in downtown Portland, the spotlight was on Kroger executives as they faced sharp scrutiny over allegations of inflating prices on essential staples such as eggs and milk. This courtroom drama unfolded against the backdrop of Kroger’s proposed national merger with supermarket behemoth Albertsons — a move Kroger claims is vital for their competitive edge in the retail market.

Outside, the drama resonated, with Kroger-owned Fred Meyer’s workers, represented by UFCW Local 555, actively striking across Portland. Their signs, a vivid display of protest against unfair labor practices, underscored a deepening divide between corporate profits and workers’ lived realities.

The union drew a connecting line, spotlighting Kroger’s courtroom admission as emblematic of a broader corporate disregard for both consumer and employee welfare. “Kroger’s exposed strategy of upping prices on basics like milk and eggs only intensifies our drive for equitable labor terms,” the statement from UFCW Local 555 forcefully articulated.

Central to the courtroom revelations was an internal company email, wielded by FTC lawyers, authored by Kroger’s senior director for pricing, Andy Groff. The email candidly noted that the retail price upticks on milk and eggs were “significantly higher than cost inflation,” laying bare a strategy to offload elevated costs onto consumers. This disclosure stirred a noticeable reaction among courtroom attendees, piercing the veil typically shrouding corporate decision-making.

Kroger countered, urging the email’s context be considered as isolated rather than reflecting their broader price strategy. “The email in question does not define our company’s enduring commitment to compress margins and competitively price our goods,” defended a Kroger spokesperson, emphasizing ongoing responses to erratic pricing landscapes since 2020 and maintaining that their pricing aligns competitively with industry leaders like Walmart.

Simultaneously, the ongoing strike at Fred Meyer accentuated community solidarity and frustration concerning soaring living costs, linking the in-court disputes to palpable systemic issues. “It’s as if there’s ‘big corporations’ on one end and ‘everyone else’ on the other,” voiced Justin Godoy, echoing a common sentiment among shoppers disillusioned by perceived corporate avarice overshadowing basic needs.

From the corporate side, Fred Meyer linked the strike’s timing to the pivotal merger, framing the union as pivotal in safeguarding the fate of unionized grocery stores across America. “The merger underscores our commitment to the future of unionized grocery stores,” the company declared, steering the conversation towards a favorable merger outcome.

With the strike poised to continue until the following Tuesday disrupting operations across 28 stores, and an impending decision on the Kroger-Albertsons merger, the issues of corporate stewardship, labor rights, and consumer advocacy hung in balance — unresolved yet deeply interwoven. Community backing for the strikers was palpable, and the reverberations from these intertwined disputes were set to resonate well beyond Portland, casting a long shadow over the national conversation around corporate integrity and economic justice.

Further reading, check out these links.

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https://www.koin.com/news/portland/kroger-albertsons-merger-price-gouging-ftc-allegations-fred-meyer-workers-strike

https://www.commondreams.org/news/kroger-egg-prices

https://www.msn.com/en-us/money/companies/kroger-executive-confesses-to-excessively-raising-prices-beyond-inflation/ss-AA1pDO4b

STM Daily News is a vibrant news blog dedicated to sharing the brighter side of human experiences. Emphasizing positive, uplifting stories, the site focuses on delivering inspiring, informative, and well-researched content. With a commitment to accurate, fair, and responsible journalism, STM Daily News aims to foster a community of readers passionate about positive change and engaged in meaningful conversations. Join the movement and explore stories that celebrate the positive impacts shaping our world.

https://stmdailynews.com/category/stories-this-moment

Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.

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Inflation remains one of the most discussed and misunderstood economic issues affecting the United States today. With rising prices impacting everything from grocery bills to gas stations, understanding the underlying causes, ongoing impacts, heresies and speculations, and possible solutions is essential. In this blog, we delve into the complexities of inflation and examine the role of government actions, particularly under the Biden Administration, in managing this economic challenge.

What Causes Inflation?

Inflation can arise from several sources, categorized mainly into three types: demand-pull inflation, cost-push inflation, and built-in inflation.

• Demand-pull inflation occurs when the demand for goods and services exceeds their supply.
• Cost-push inflation is caused by an increase in the costs of production, such as raw materials and wages.
• Built-in inflation emerges from the expectation of future price increases, leading workers to demand higher wages, which companies pass on to consumers as higher prices.

Understanding these mechanisms is crucial to addressing inflation effectively, as each type may require different policy responses.

Current Causes of Inflation in the US

Today, the US economy faces inflation driven largely by post-pandemic economic recovery dynamics. Key factors include supply chain disruptions, increased consumer spending, substantial government stimulus measures, and global economic pressures. Each of these factors has combined in unique ways to push prices upward, albeit hopefully temporarily.

Heresies, Speculations, and Truths

A significant point of contention and speculation revolves around the concept that corporations are exploiting these turbulent times to increase prices disproportionately, thereby boosting profits at the expense of consumers. While businesses are indeed facing increased costs, the extent to which these are being passed on to consumers varies by industry and firm, leading to debates over potential price gouging.

This raises an essential question: Are current inflation trends purely the result of macroeconomic factors, or are they exacerbated by strategic corporate pricing behaviors? The truth likely lies somewhere in between, reflecting the complex interplay of cost-driven pricing adjustments and market power.

Policy Responses and Actions by the Biden Administration

Addressing inflation requires a combination of monetary policy, fiscal adjustments, and targeted interventions.

• Monetary Policy: Traditionally managed by the Federal Reserve, this includes manipulating interest rates and controlling the money supply to temper economic overheating.
• Fiscal Policy: Here, government spending and taxation play roles—areas where the administration has significant influence.
• Regulatory Measures: The government can enforce antitrust laws, monitor unfair pricing practices, and ensure a competitive market environment.

Under President Biden, the Inflation Reduction Act represents a broad policy measure ostensibly designed to tackle inflation by making long-term investments in energy infrastructure, healthcare, and tax reforms. While its name suggests an immediate reduction in inflation, its actual impacts are geared more towards future economic stability and growth.

Furthermore, the administration can support the economy through social programs, wage supports, and direct financial aid, which can alleviate the burden on consumers and help stabilize demand.

Something to Think About

While inflation remains a pressing issue, it is clear that no single policy or action can completely address its varied causes. A balanced approach that includes responsible monetary policy, prudent fiscal management, and firm regulatory oversight is essential. Moreover, clear communication and strategic planning by the administration can help set realistic expectations and guide the economy toward a more stable future.

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In tackling inflation, understanding its roots, dispelling myths, and implementing a holistic strategy are vital steps forward for the Biden administration and other stakeholders. As we navigate these economic challenges, staying informed and engaged is crucial for all citizens.

References and Resources

Understanding inflation involves a multi-faceted approach, taking into account economic theories, current events, and policy impacts. Here are some resources that can provide a well-rounded view of the ongoing discussions and analyses regarding inflation in the current US economy:

1. Federal Reserve Economic Data (FRED) – St. Louis Fed

• Website: FRED – Economic Data
• Description: Access a wealth of data on inflation, interest rates, employment, and more. An invaluable tool for analyzing economic trends.

1. Bureau of Economic Analysis (BEA)

• Website: BEA – U.S. Economic Accounts
• Description: Find detailed economic analyses and data on GDP, consumer spending, and corporate profits, all of which tie into broader inflation discussions.

1. The Economist – Finance and Economics Section

• Website: The Economist
• Description: Offers insightful articles on global and US economic conditions, including expert analyses on inflation and government policies.

1. “The Causes and Consequences of Inflation” – Brookings Institution

• Website: Brookings
• Description: Brookings provides thorough research articles and papers on economic topics, including detailed discussions on inflation causes and effects.

1. “Inflation Dynamics and Monetary Policy” by the International Monetary Fund (IMF)

• Website: IMF Publications
• Description: This paper discusses inflation dynamics and the impact of monetary policy, offering a global perspective that can also be applied to the US context.

1. Wall Street Journal – Economy Section

• Website: WSJ – Economy
• Description: Regular updates on economic trends, inflation rates, and Federal Reserve actions, with professional commentary.

1. “Principles of Economics” by N. Gregory Mankiw

• Where to find: Amazon or your local bookstore
• Description: Although not an article, this textbook provides a solid foundation in economic principles, including detailed discussions on how inflation works.

1. National Bureau of Economic Research (NBER)

• Website: NBER
• Description: A wealth of research papers on economic topics, including inflation studies that help explain current trends in the US.

By exploring these resources, you can gain a deeper insight into how inflation is currently affecting the US economy, what the potential future trends could be, and how policy decisions influence the economic outlook.

STM Daily News is a vibrant news blog dedicated to sharing the brighter side of human experiences. Emphasizing positive, uplifting stories, the site focuses on delivering inspiring, informative, and well-researched content. With a commitment to accurate, fair, and responsible journalism, STM Daily News aims to foster a community of readers passionate about positive change and engaged in meaningful conversations. Join the movement and explore stories that celebrate the positive impacts shaping our world.

https://stmdailynews.com/category/stories-this-moment