Maurice Handy of Charlotte, North Carolina, was diagnosed with stage 4 medullary thyroid cancer. Following surgery, he needed chemotherapy for life. He had no insurance to cover treatment at an estimated cost of $10,000 monthly. Although he was a veteran and the VA was willing to treat him, it wouldn’t cover the cost of chemotherapy unless the cancer was deemed service-related.

Many doctors and oncologists explained that all they could do was keep me comfortable until I transitioned, said Handy, known professionally as DJ Peer Pressure. “I couldn’t help but wonder whether not having insurance played a part in their lack of aggressiveness in treating my cancer.”

Handy eventually turned to his former employer, a large pharmaceutical company, which covered the cost of the drugs. Nevertheless, he owes $10,000 for medical expenses. Without the company’s assistance, that sum would be closer to $1.2 million.

On any given day, as many as 3 million Americans hold medical debt exceeding $10,000. Black Americans, particularly young adults and low-income people, are disproportionately saddled with such debt, finds a new report by the National Consumer Law Center. Those who live in states without expanded Medicaid are significantly more likely to incur medical debt.

Despite the Affordable Care Act, 31 million people remain uninsured. And of those with insurance, an estimated 23% are underinsured. Black Americans are more than twice as likely as white Americans to have no insurance or inadequate coverage. Their options when they get sick: Forgo medical care, even life-saving treatment, or take on debt.

Given the well-known racial disparities in income and wealth, many Black households have little cushion when they incur medical debt. In 2019 the median white household held $188,200 in wealth, nearly 8 times that of the average Black household, at $24,000.

Compounding the burden, debt collectors are known to be particularly aggressive in their efforts to recover money from people of color. Collection agencies and hospitals are far more likely to push for wage garnishments and report a Black patient’s medical debt to credit bureaus while working with white patients to minimize monthly payments or even write off portions of the debt.

In April, Vice President Kamala Harris laid out the Biden administration’s four-step plan to address medical debt, acknowledging the outsized impact on people of color. The plan includes provisions to:

1. Hold medical providers and debt collectors accountable for harmful practices;

2. Reduce the role that medical debt plays in determining whether people can access personal or business loans;

3. Help over half a million of low-income veterans get their medical debt forgiven; and,

4. Inform consumers of their rights.

“It is imperative to acknowledge and address historical drivers that can lead to such disparities in unmet medical debt, said Vabren Watts, director of health equity for Health Affairs. “These include racial discrimination in hiring and employment practices that has stymied wage growth for many Black Americans, as well as discriminatory housing policies that have prevented many Black Americans from achieving and sustaining homeownership. All of these mentioned, including being pigeonholed in jobs with less generous employee health benefits, can hinder wealth accumulation and result in higher amounts of past-due medical debt for some racial and ethnic minority households.”

Rooted in systemic racism

Before civil rights legislation outlawed racial segregation throughout the United States, hospitals were allowed to refuse treatment and upcharge for medical services for Black people.

“I was a nurse in a Birmingham, Alabama, hospital providing care to Black people,” recalls Barbara Rupert, 80, who now lives in Colorado Springs, Colorado. “Health insurance may have existed in pockets around the country, but it wasn’t available for us colored folks, especially in the Deep South. I remember that white patients were charged considerably less than Black folks for the exact same procedures. Charitable organizations designed to help poorer patients were created, but there’s a longstanding history of not offering those services to people of color.”

She continued, “I watched and was powerless as hospitals routinely turned away colored folks — even those with life-threatening conditions. It’s no longer legal to refuse to provide medical services to Black people, but we know it still happens. Nowadays, it feels like the way to continue marginalizing us is to provide the services but force us into medical debt.”

For many people, the fear of mounting debt and the inability to take time off from work lead to dangerous delays in medical care. By the time someone sees a doctor, the ailment has often advanced beyond the easily treatable stage. All these factors combine to drive racial disparities in cancer, diabetes and other diseases, widening already shameful gaps in health and wealth.

How debt drives inequality

Maurice Handy has been paying on his debt for years. But with interest, administrative fees and never-ending bills for non-chemo-related treatment, he has not managed to wipe the ledger clean. He has worked out a payment plan and so far his credit report hasn’t been affected. But that’s not the norm.

In 2016, doctors recommended that Tonya Scott of Delaware undergo gastric sleeve surgery. A surgical error required nine corrective surgeries, including gastric bypass. Today Scott’s stomach is the size of a golf ball, which puts her at risk for malnutrition and other complications.

“It’s been painful enough that I have to fight to remove every bill I’m sent that arose out of the subsequent surgeries, but the hospital is now making notations on my credit report,” Scott said. “I watch my credit report like a hawk and fight every entry.”

Medical debt has long-term consequences well beyond the drain on finances. It can hinder the ability to obtain credit of finance a home mortgage, car or business. With lowered credit scores, finance charges are high, making something seemingly inexpensive out of reach. All of this can lead to long-term financial insecurity and make it extremely expensive to be poor.

“The finance charge on my car is definitely higher, thanks to my lowered credit score,” said Scott.

Motivated by his own experience and stories like Scott’s, Handy has become a patient advocate. “Nobody should die because of lack of access to expensive treatments or go into massive debt to stay alive.”

• DISCLAIMER: The opinions, beliefs and viewpoints expressed by the various author’s articles on this Opinion piece or elsewhere online or in the newspaper where we have articles with the header “COLUMN/EDITORIAL & OPINION” do not necessarily reflect the opinions, beliefs and viewpoints or official policies of the Publisher, Editor, Reporters or anybody else in the Staff of the Hemet and San Jacinto Chronicle Newspaper.

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This first-of-its-kind program focuses on retaining and training the best primary care residents in the IE by offering an unprecedented educational opportunity facilitated by physician leaders in the IEHP network. The program also offers loan forgiveness incentives to help reduce the pressures of student debt and eliminate the strain of low-paying fellowship programs.

“Being a physician is not an easy career path,” said Dolores Green, RCMA Executive Director. “However, by connecting physicians to the resources and support they need early on, we hope they will find more fulfilling and productive careers in the IE. We want them to reach their full potential as leaders and agents of change in the health care system.” To kick off the program in July-August 2021, two inaugural Fellows will work with two IE physicians from IEHP’s network. Dr. Ashley Molina will join the Arrowhead Family Medical Group with Dr. David Lanum, and Dr. Kacie Paik will join Dr. Tarek Mahdi at Riverside Family Physicians.

Barry Bittman, MD, Inland Empire Foundation for Medical Care’s Chief Population Health and Quality Officer and the fellowship’s faculty chair, says the unique program provides a strategic path for physician-led transformation that is critical to advance our healthcare system into the future. “Our conceptual framework has been built upon the premise that acquiring and putting into practice key population health perspectives and insights early on in one’s medical career is the best way to prepare physicians to become effective change agents,” says Dr. Bittman. “What’s truly unique about this fellowship is that our primary goal ultimately extends beyond physician practices — our aim is to positively transform the health of our communities.”

The need for quality physicians has never been greater in the region, which continues to face an immense provider shortage. According to the California Health Care Foundation, the Inland Empire has one of the lowest ratios of Primary Care Physicians (PCPs) and specialty physicians per 100,000 people in California.

To help address the provider shortage, the health plan has also started a Healthcare Scholarship Fund for 50 medical students in the IE who, upon graduation, will commit to serving in the region for at least five years.

“This is an exciting opportunity for physicians in our region and the community we so passionately serve,” said Jarrod McNaughton, IEHP’s chief executive officer. “Building a support system around our physicians early on and working with them to fill in the personal and professional gaps they face, will ensure better care and health for Inland Empire residents. Our physicians deserve to be taken care of the way they are expected to care for our Members, and we’re grateful to partner with such incredible organizations to do just that.”

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About IEHP

IEHP, Inland Empire Health Plan, is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. With a network of more than 6,400 Providers and more than 2,000 employees, IEHP serves more than 1.3 million residents in Riverside and San Bernardino counties who are enrolled in Medicaid or Cal MediConnect Plan (Medicare-Medicaid Plan). Through a dynamic partnership with Providers and Community, award-winning service and innovative products, IEHP is fully committed to advocating for our Members and providing them with quality, accessible and wellness-based health care services. For more information, visit iehp.org.

SOURCE Inland Empire Health Plan (IEHP)

Inland Empire Health Plan • Contributed

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U.S. Centers for Medicare & Medicaid Services

At Medicare, we understand you may have concerns about going to your doctor’s office during the 2019 Novel Coronavirus (COVID-19) pandemic. Like so many Americans, our Medicare beneficiaries are rightly observing social distancing guidelines to protect themselves and others from possible infection. We also recognize that our beneficiaries still need checkups, prescription refills, or other care from their doctors.

The good news is that President Trump dramatically expanded access to telehealth services for Medicare beneficiaries during the pandemic. Telehealth lets you communicate with your physician and other healthcare professionals using your phone, video chat, secure text messaging, email, or through a patient portal. That means you don’t have to leave your home and risk exposure to the virus.

Medicare is paying for our 62 million beneficiaries to have at-home access to a broad range of telehealth services. If you’re in a Medicare Advantage health plan, check with your plan. We recently authorized Medicare Advantage plans to offer expanded telehealth coverage to meet the needs of their enrollees. Telehealth can be used for routine office visits, preventive health screenings, mental health counseling, and care that ordinarily would require a trip to an outpatient clinic or hospital emergency room.

In fact, Medicare recently added 80 more telehealth services, including radiation treatment management, therapeutic exercises, prosthetic training, assistive technology assessments, group psychotherapy, inpatient neonatal and pediatric critical care, and end-stage renal disease care. So I encourage Medicare beneficiaries to take advantage of these great new services. Contact your doctor or health plan about available telehealth options. For people with Original Medicare, telehealth is covered under Part B.

President Trump is allowing healthcare providers to reduce or waive the usual Part B coinsurance and deductible for these services, if they choose. Doctors, nurse practitioners, clinical psychologists, licensed clinical social workers, and other clinicians are all eligible to provide telehealth services. Medicare also pays for phone calls with your doctor. You can even get telehealth from a doctor with whom you don’t have an established relationship. So please, if you’re a senior, follow the federal recommendations – “30 days to slow the spread.”

As President Trump has recommended, stay at home and away from other people for the next few weeks. This is especially important for older people with a serious health condition – such as heart or lung problems or a weakened immune system – that puts them at higher risk for the virus. Medicare is offering these new telehealth options during the pandemic so you can get the care you need, and the peace of mind that comes with it, from the comfort of your own home.

For more information on Medicare coverage of telehealth, please go to: https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak CMS actions in response to COVID-19 are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov.

For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

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