HUNTINGTON — Thomas Hart can’t remember the last time he got a pay raise, but he says his health care costs continue to rise every year.
“My cost for my insurance goes up, my deductible went up and my out-of-pocket costs are up, too, but my pay is the same,” he said recently. “It’s like I have been getting a pay cut over the past several years.”
Hart didn’t want to name his employer and understands it is just passing increasing costs along to employees, while the company he works for continues to see its health care costs for employees increase as well.
Overall, health care costs are growing at a faster rate than wages or inflation, according to a recently released report from the Kaiser Family Foundation (KFF).
Annual family premiums for employer-sponsored health insurance rose 5% to an average of $20,576 this year, according to the 2019 benchmark KFF Employer Health Benefits Survey.
The report says while wages and inflation have cumulatively increased 26% and 20%, premiums are cumulatively up 54% over the past decade, while deductibles have skyrocketed 162%.
“The single biggest issue in health care for most Americans is that their health costs are growing much faster than their wages are,” KFF President and CEO Drew Altman said. “Costs are prohibitive when workers making $25,000 a year have to shell out $7,000 a year just for their share of family premiums.”
The report said on average, workers in 2019 contributed $6,015 toward the cost of family coverage, with employers paying the rest.
Currently, 82% of covered workers have a deductible in their plan, similar to last year.
“The average single deductible now stands at $1,655 for workers who have one, similar to last year’s $1,573 average, but up sharply from the $826 average of a decade ago,” the report said.
Meanwhile, more than a quarter, or 28%, of all covered workers, including nearly half, or 45%, of those at small employers with fewer than 200 employees, are now in plans with a deductible of at least $2,000, almost four times the share who faced such deductibles in 2009. One in eight, or 13%, now faces deductibles of at least $3,000.
“Employer-sponsored coverage doesn’t come cheap for employers or workers, and many who work at low-wage firms or small business likely find it too costly to cover their families,” said Gary Claxton, a KFF senior vice president and director of the Health Care Marketplace Project, and the lead author of the study.
When it comes to the Affordable Care Act (ACA), also known as “Obamacare,” the average monthly cost of health insurance in the marketplace for West Virginia residents is $666 a month, or $7,992 a year, which represents an 18% increase from 2018, according to the 2020 Health Insurance report from ValuePenguin.com by LendingTree.
“Additionally, we found that Bronze policies saw the largest percentage premium increase of 21%, or an average of $101 per month,” the report said. “Catastrophic policies, which had the lowest rate change, cost $36 more on average in 2020.”
Jessica Ice, executive director of West Virginians for Affordable Healthcare, says options exist for trying to fix health care issues.
“Options such as taking a serious look at well-designed, single-payers or universal coverage systems and increasing regulation of the health care industry,” she said. “Right now, we are experiencing unsustainable cost growth in health care, making affordable access a challenge for millions of Americans. It is important to advance the understanding of health care costs for consumers in order to understand the different Medicare for All and other proposals that build toward universal coverage as well as the fiscal implications around each of these policies.”
Ice said other ways to increase regulation of the health care industry could help tremendously.
“We understand the need to regulate power and utilities, at least to some extent; health services are just as vital,” she said. “Yet we take a hands-off policy approach.”
Kat Stoll, policy director for West Virginians for Affordable Healthcare, said lower wage workers cannot shoulder the burden of rising out-of-pocket health care costs.
In a conversation with Ice, Stoll said lower wage workers are less likely to have insurance through their employer and as premiums rise.
“They are forced into plans with less coverage or they can afford no coverage at all,” Stoll said. “The Affordable Care Act’s premium subsidies have helped here, but we still lightly regulate insurance company profits or do a good job at looking at premiums taken in versus actual health services provided.”
Both Ice and Stoll say employers are not really the problem or the bad guys.
“We need to remember the most common scenario, people with employer-based health insurance. Employers are shifting costs to workers in order to continue to be able to afford to offer health insurance coverage,” Stoll said. “They are reacting to the problem of high health care cost growth by shifting costs through higher deductibles and co-pays to workers.”
What drives underlying health care cost increases in the U.S.?
“The same causes have been in place for decades, and yet we fail as a nation to create policies that can address some of these drivers,” Ice said.
Ice says pharmacy costs are also skyrocketing.
“And we do not really regulate or negotiate to achieve better prices,” she said. “We don’t even demand to understand how drugs are priced and who is making money in the distribution chain, from manufacturers down to consumers, with players in the middle.”
Ice says the national expectation is that cost should not be a factor in care decisions.
“Yet our health care system is not designed to truly share costs across all Americans regardless of income or health status,” she said. “Our health system is overall not prevention driven. We treat health problems — we don’t prevent them from happening.”
Ice says West Virginians are growing older and sicker and the state faces a rise of chronic illness and obesity.
“And we still often pay doctors, hospitals and other medical providers for doing more, rather than being efficient. We do not pay for results,” she said. “There are multiple drivers of rising health care costs and no magic bullet to fix them.”
￼UNTINGTON — A lot has happened in the Tri-State in the past 12 months. Various sections in today’s edition of The Herald-Dispatch offer a look back at the events that helped shape 2019 in business and sports, as well as the notable deaths that occurred over the past year. A look back at the year in news was featured in our Christmas Day edition last week.
The first one occurred 19 days into the new year when a man used an ax to kill four family members including his infant daughter. Five months later, 12 people were killed in a workplace shooting in Virginia. Twenty-two more died at a Walmart in El Paso in August.
A database compiled by The Associated Press, USA Today and Northeastern University shows that there were more mass killings in 2019 than any year dating back to at least the 1970s, punctuated by a chilling succession of deadly rampages during the summer.
In all, there were 41 mass killings, defined as when four or more people are killed excluding the perpetrator. Of those, 33 were mass shootings. More than 210 people were killed.
Most of the mass killings barely became national news, failing to resonate among the general public because they didn’t spill into public places like massacres in El Paso and Odessa, Texas; Dayton, Ohio; Virginia Beach, Virginia; and Jersey City, New Jersey.
The majority of the killings involved people who knew each other — family disputes, drug or gang violence or people with beefs that directed their anger at co-workers or relatives.
In many cases, what set off the perpetrator remains a mystery.
That’s the case with the very first mass killing of 2019, when a 42-year-old man took an ax and stabbed to death his mother, stepfather, girlfriend and 9-month-old daughter in Clackamas County, Oregon. Two others, a roommate and an 8-year-old girl, managed to escape; the rampage ended when responding police fatally shot the killer.
The perpetrator had had occasional run-ins with police over the years, but what drove him to attack his family remains unknown. He had just gotten a job training mechanics at an auto dealership, and despite occasional arguments with his relatives, most said there was nothing out of the ordinary that raised significant red flags.
The incident in Oregon was one of 18 mass killings where family members were slain, and one of six that didn’t involve a gun. Among other trends in 2019:
James Densley, a criminologist and professor at Metropolitan State University in Minnesota, said the AP/USA Today/Northeastern database confirms and mirrors what his own research into exclusively mass shootings has shown.
“What makes this even more exceptional is that mass killings are going up at a time when general homicides, overall homicides, are going down,” Densley said. “As a percentage of homicides, these mass killings are also accounting for more deaths. ”
He believes it’s partially a byproduct of an “angry and frustrated time” that we are living in. Densley also said crime tends to go in waves, with the 1970s and 1980s seeing a number of serial killers, the 1990s marked by school shootings and child abductions and the early 2000s dominated by concerns over terrorism.
“This seems to be the age of mass shootings,” Densley said.
He and James Alan Fox, a criminologist and professor at Northeastern University, also expressed worries about the “contagion effect,” the focus on mass killings fueling other mass killings.
“These are still rare events. Clearly the risk is low but the fear is high,” Fox said. “What fuels contagion is fear.”
The mass shootings this year include the three in August in Texas and Dayton that stirred fresh urgency, especially among Democratic presidential candidates, to restrict access to firearms.
While the large death tolls attracted much of the attention, the killings inflicted a mental and physical toll on dozens of others. The database does not have a complete count of victims who were wounded, but among the three mass shootings in August alone, more than 65 people were injured.
Daniel Munoz, 28, of Odessa, was caught in the crossfire of the shooting that took place between a 10-mile stretch in West Texas. He was on his way to meet a friend at a bar when he saw a gunman and the barrel of a firearm. Instinctively, he got down just as his car was sprayed with bullets.
Munoz, who moved to Texas about a year ago to work in the oil industry, said he had actually been on edge since the Walmart shooting, which took place just 28 days earlier and about 300 miles away, worried that a shooting could happen anywhere at any time.
He remembers calling his mother after the El Paso shooting to encourage her to have a firearm at home or with her in case she needed to defend herself. He would say the same to friends, telling them before they went to a Walmart to bring a firearm in case they needed to protect themselves or others during an attack.
“You can’t just always assume you’re safe. In that moment, as soon as the El Paso shooting happened, I was on edge,” Munoz said.
Adding to his anxiety is that, as a convicted felon, he’s prohibited from possessing a firearm.
A few weeks later, as he sat behind the wheel of his car, he spotted the driver of an approaching car wielding a firearm.
“My worst nightmare became a reality,” he said. “I’m in the middle of a gunfight and I have no way to defend myself.”
In the months since, the self-described social butterfly steers clear of crowds and can only tolerate so much socializing. He still drives the same car, still riddled with bullet holes on the side panels, a bullet hole in the headrest of the passenger seat and the words “evidence” scrawled on the doors. His shoulder remains pocked with bullet fragments.
HUNTINGTON — Marshall Health and its university partners will begin new programs and grow existing ones in 2020 that assist pregnant and parenting people on the road to recovery.
The Centers for Medicare & Medicaid Services, or CMS, announced this month that it selected West Virginia as one of 10 awardees for the Maternal Opioid Misuse (MOM) model. West Virginia selected Marshall Health and the Marshall University Research Corp. as its care-delivery partner to implement the model.
According to a release from CMS, the MOM model is the next step in the Center for Medicare and Medicaid Innovation’s multi-pronged strategy to combat the nation’s opioid crisis. The model addresses fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder through state-driven transformation of the delivery system surrounding this vulnerable population. The goal is to improve quality of care and reduce costs for mothers and infants by supporting coordination of clinical care with other services.
“The MOM model is a unique opportunity for health care providers in West Virginia to improve care for mothers and infants affected by the opioid crisis, and the model represents another step in President Trump’s agenda to combat the opioid crisis through holistic, compassionate treatment and recovery services,” said U.S. Department of Health and Human Services Secretary Alex Azar in a release. “The model is aimed at promoting more coordination and integration of care, and we look forward to assessing West Virginia’s results as they work to support some of the most vulnerable mothers and their infants.”
The MOM model will have a five-year period of performance beginning in January 2020. Care delivery will begin in year two. Funding for care-delivery services not otherwise covered by Medicaid will be provided by Innovation Center funds. By year three, states must implement coverage and payment strategies.
At the same time, a two-year, $250,000 health grant from Hearst Foundations will support the development of a comprehensive system of care through the Marshall University Joan C. Edwards School of Medicine and Marshall Health for pregnant and parenting women with substance use disorder.
The project will grow family-centered recovery care in Cabell, Kanawha, Jackson and Putnam counties in West Virginia, the four counties currently served by the Great Rivers Regional System of Addiction Care initiative. These services will expand the efforts of Healthy Connections, which started serving pregnant and parenting mothers in 2017, through family navigation services. Family navigators work alongside a family to advocate for service access, treatment and recovery, and healthy family development. Funding from Hearst Foundations will bring family navigators into four more communities.
In addition to initiatives like the Maternal Addiction Recovery Center and Project Hope for Women & Children, which are already underway through the Marshall School of Medicine and Marshall Health, the funded project will leverage a number of existing partnerships and resources, including Great Rivers Regional System for Addiction Care, Healthy Connections and the Provider Response Organization for Addiction Care & Treatment (PROACT).
“Having a baby can be an overwhelming experience, only complicated by the disease of addiction,” said Lyn M. O’Connell, associate director of community services at Marshall Health, in a release. “Family navigators are an essential and unique support for pregnant and parenting women that promote recovery and encourage healthy relationships. This funding will allow us to support more children and families.”
In 2018, Marshall Health launched Great Rivers Regional System for Addiction Care thanks to funding from the Merck Foundation. The collaborative works with more than 70 organizations and agencies to build an infrastructure and strengthen community partnerships in communities and neighborhoods hit hardest by West Virginia’s opioid epidemic. This project will build on the collaborations developed in the first year of Great Rivers.
Since its inception, the Hearst Foundations have distributed more than 21,000 grants to nearly 6,000 organizations. The foundations’ goal is to “ensure that people of all backgrounds have the opportunity to build healthy, productive and inspiring lives.” This is the first award Marshall Health has received from the Hearst Foundations.