Episode 94 Recap – What do Kamala Harris’ healthcare policies look like?

The Print version of the FLATLINING Podcast

In this week’s episode, our team discusses V.P. Kamala Harris’ healthcare policy history, Ron’s appearance in a New York Magazine article discussing medical denials, the No Surprises Act, and Explanation of Benefits (EOB) reform.

Matthew starts the discussion by asking Ron about 2020 candidate Harris’ previous support for Senator Bernie Sanders’ Medicare for All plan, and her track record on healthcare as a U.S. Senator. He asked if she would continue President Biden's healthcare policies.

Ron doesn’t think she is a staunch believer in Medicare for All, like Sen. Sanders. He feels she is more of a politician and her actions will depend on “Which way the winds are blowing.” Ron likened her approach to sailing, where you tack with the wind, changing your direction to get the best air. He said when you look at candidate Harris, she came out supporting Bernie Sanders’ Medicare for All program. Then when she realized that wasn’t working, she moved away from that program to a more left-center approach. He said, “There were items she tacked either way on.”  He thinks she would look at the make-up of the Congress, and what kind of mandate, if any, she gets from the general election to determine her approach on healthcare.  Barring any massive Democrat win, Ron thinks she will stick to Biden’s approach of not taking a hard stance anywhere on healthcare issues and remaining more left of center than Sanders would be on healthcare.

Matthew brought up candidate Harris’ program called “Kamala Care” and pondered if it would be resurrected. He described it as a plan that would be implemented over ten years, versus Sanders’ four years, and would include payers on some level. He pointed out that when she was the Attorney General of California, she filed several Amicus Briefs in support of the Affordable Care Act (ACA) when it was being attacked in the courts.

In a recent Forbes Magazine article, which detailed her “tacking” approach to healthcare policy, she co-sponsored Sanders’ Medicare for All bill but then developed her own version that included a Medicare Advantage type of program. Ron pointed out the ten-year implementation as a political move by Harris, giving her the option to say she passed universal coverage but doesn’t have to see it implemented in her tenure. Similar to the ACA where they passed it then had eight years to implement, he said.

Matthew asked if Harris is elected, “Can we give up any hope of the No Surprises Act (NSA) being enforced?”  Ron doesn’t see her stepping up to enforce NSA, mainly since it doesn’t do anything for her politically. He thinks that enforcement will be more based on lawsuits and the recent Chevron court decision. Ron thinks that “If Trump wins, they will enforce it.” Because it was a law passed under his administration, he said.

The discussion shifted over to the Biden Administration's approach to drug price capping. Matthew referred to a MedPage Today article and asked Ron if a Harris administration would like to continue this effort. Ron said he thought she would, since she has talked in the past about matching U.S. drug prices to what they are sold for overseas etc. The problem is going to be the recent Chevron decision, he said. Since these tactics are regulatory, which the Chevron decision affected, it is unlikely that she will get legislation passed that would accomplish her goals, Ron said.

Matthew noted that there has not been much if any discussion on healthcare policy so far in this election cycle. He said what we are likely to get from Harris is the typical talking points about “making it affordable for all Americans” and her support of the ACA. The kind of messaging we seem to get when there is no plan, he said. Matthew thinks that unless healthcare polls as a topic, we are not likely to hear more this election cycle. Ron agreed, saying healthcare is clearly not in the top ten of issues. He said that if there is a second debate, he would not be surprised if there is not a single question on healthcare. If there is, he said, it will be short. Matthew pointed out that the first debate did not have any healthcare questions.

Ron lamented that a topic that affects so much of the U.S. economy won’t be discussed. If it is, it will be likely about abortion or Roe v. Wade not discussion of healthcare at a cost level, he said. Ron predicts that the election will result in a divided Congress, making it very difficult to get things done on healthcare. He noted that we had not heard much in the way of plans from either party as we have in past elections.

Matthew asked Ron to tell us about a recent New York Magazine article he was in and what was the aim of the story. Ron said the article was centered around insurance company denials for medical treatment. Ron, as a former Cigna executive, has been a frequent source for stories on this topic. This most recent one also featured Wendel Potter, the former VP for Communications for Cigna who appeared in a recent FLATLINING Podcast. Ron said he is pleased that outlets are shedding light on this practice of using artificial intelligence and other methods to deny care and increase profits. He said he explained how this happens, but he also liked how New York Magazine showed how different people dealt with getting denied and how the average consumer fights back to get their claims paid or the care they need. Ron said he provided perspective on “How it happens, here’s what I think is wrong with it, and here’s what you need to do.”

The article highlighted several people’s successful pushback against insurance company denials. In light of this, Matthew pointed to several large lawsuits against the insurance companies on medical denials and asked Ron if we are likely to see “millions and millions of disputed claims” that will affect the current process. Ron doesn’t think that this is the answer, mainly because the insurance companies make the appeal process so difficult for the average consumer to navigate successfully. Additionally, he said, if it is still profitable for insurance companies to deny, they will. He provided a hypothetical that if only 10% of denials are appealed, and they are all awarded positively, then 90% of the denials were never paid out, then the insurance company still is profitable, he said.

The article touched on the NSA and according to Matthew, it seemed to indicate that its application of the law has improved. He asked if hospital-based non-participating physicians and the lack of residual enforcement are contributing to some patients still getting bills from providers when the care should have been covered by payers. Regarding the NSA, Ron said that he liked that patients were “pulled out of the middle.” One of the problems is enforcement he said, “When somebody is not playing by the rules, who enforces it?” Many state departments of insurance don’t enforce NSA stating that it is federal law, not state, and CMS doesn’t know how to enforce it, he said. “Hopefully that will get better over time.”, he said. It appears that there is more enforcement against the physician who bills inappropriately because the payers will enforce that, he said. For the payers that are not in compliance, Ron said he doesn’t know who is enforcing that. All this adds to the confusion for patients, he said.

Matthew interjected the issue of medical debt into this broader discussion of medical denials for reimbursement and asked if it could become moot if medical debt relief becomes the norm. Ron countered by emphasizing that the public needs to understand that one person’s debt is another person’s revenue. He said that you can’t continue to waive away debt because it will just grow back. Explaining that if someone provided a service, that service has actual physical costs, like medicines or salaries. So, when you waive the debt, you are hurting that service provider, who may in the future decide not to provide that service, he said. If you did this for Emergency rooms, for example, you would likely see hospitals stop providing emergency service if they were not going to get compensated for it, he said.

The article also discussed Explanation of Benefits (EOB) reform. The EOB are those confusing statements patients get that are supposed to explain the procedures and associated costs with your doctor visit. Matthew asked Ron to elaborate on what EOB reform is and if it will help with improper denials.  Ron explained that EOBs often read like Greek, full of codes no one understands and that is by design from the insurance companies he said. He said the first step is to make them understandable to the average person and if you don’t agree with them, clear instructions on how to appeal.

Ron said when we think about all the things we can do online in other industries that want to serve you as a customer, compared to your insurance company it’s hard to understand why we can’t do the same for EOBs. He compared it to Amazon, where I can see where my package is, but with my insurance company, I can’t see what step my appeal to a denial is at, or how much of my deductible is left. Ron pointed out that the insurance companies don’t want us to have that level of self-service online. This is because, which has been discussed before, is that the patient is not the customer, the employer is. Matthew wrapped up by pointing out that knowing what claim is being discussed in the EOB would be helpful as well.

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