Explanation of Healthcare Tax Subsidies in the USA-Medicaid-Insurance Exchanges-Group Insurance Programs-Medicare

 

Health Care is Not Free

In an election year, it is important to discern facts from fiction and this article addresses the subject of free or subsidized health care in the United States. First, there is no free health care, someone is paying for the care. For Medicaid eligible persons or families, the state and federal government do provide health care without an insurance premium to those who qualify. This does not mean there are no copayments for the Medicaid participants, but these are generally modest. Access to health care providers is not guaranteed, because many clinics and clinicians do not treat Medicaid patients or have a limit on the number they will accept. This is because of the low level of reimbursement from the government for providing care.

 Medicaid-Eligibility

Medicaid, also known as Apple Health, Medi-Cal or whatever label each state chooses, is a government run medical insurance program for low-income residents. To be eligible for Medicaid, the individual or family must meet certain criteria, for example, living within the United States for at least five years, having legal residency status, meaning a work permit, student visa, permanent resident status, or citizenship. Citizenship in the USA is based on birthright, taking the oath of citizenship, or marriage. The funding for the Affordable Care Act requires legal residency criteria, to control costs and to avoid adverse selection from potential high-medical-needs immigrants. There are exceptions to this, which are for immigrants who have refugee status for humanitarian reasons (torture), Protected Juvenile Status, Temporary Protected Status and Victims of Trafficking. Here is a complete list of the immigrant standards for qualification for Medicaid or government health care subsidies, like tax credits under the insurance exchange plans for the Affordable Care Act (Obamacare): https://www.healthcare.gov/immigrants/immigration-status/

 Finally, if someone is blind, disabled, pregnant, or caring for a child on public support (foster child) you may be eligible for Medicaid, if you meet the residency status requirements. In other words, people without means who are immigrants do NOT have unlimited access for free or subsidized health care. Wealthy people, including medical tourists with private insurance, who can pay, will be able to have carte blanche access to the US healthcare system.

 State Medicaid Eligibility Varies

Most states have now expanded their Medicaid eligibility to match the 2010 Patient Protection and Affordable Care Act standard of 133% of the federal poverty level (FPL). In 2024, this is $15,060 for a single individual and $31,200 for a family of four. So, the baseline for receiving medical insurance through a state Medicaid program which has chosen the Affordable Care Act standard and receives federal matching funds is: $20,030 for a single individual and $41,496 for a family of four. Some states, where the cost of living is very high, have more generous subsidies, like California, which offers pregnant women with incomes up to 208% of the FPL and children under 18 are covered up to 261% of the FPL.

Federal government handy interactive chart to determine your state’s Medicaid eligibility standards.

https://www.medicaid.gov/state-overviews/state-profiles/index.html

 The federal Children’s Health Insurance Plan or CHIP has been around since 1997 and was reauthorized by both Democrats and Republicans in 2009.This is a positive thing because it is good public health investment to make sure we are creating healthy children, which is after all our future work force. Investing in the health and well-being of our citizens is a public good. This is why we have parks and recreation, air and water quality standards, sanitation systems, and standards for food safety.

Tax Credits Under Affordable Care Act

All the insurance exchange enrollments require persons applying for medical insurance coverage to disclose their incomes, because the Affordable Care Act provides federal tax credits for the purchase of the insurance. The government is advancing an income tax credit, that you would be expected to receive upon filing your annual tax return. If your income varies from this declaration, the government will refund any unused tax credits or require you to pay back some of the advance credits you received. It is the onus of the insurance exchange participant to notify the agency of any material change while enrolled. The tax credits are not free, but reflect earned income federal taxes. If someone has no earned income and qualifies for some insurance subsidy, this is determined through the process.

 Tax Credits Under Employer Group Insurance Plans

The federal government provides significant tax incentives for employers to provide health insurance, by allowing a tax deduction for the entire expense which are paid by the company. Additionally, employees are often given the opportunity to use pre-tax income to pay for their covered dependents or elective benefits, through a Section 125 plan. These tax credits do not have to be repaid, as long as the programs are administered correctly.

 Medicare Eligibility

For persons reaching age 62, their eligible spouses, and certain disabled people, the federal government provides Medicare, which has components which are fully paid by the government, Part A for hospitalizations and Part B, which is for outpatient care and requires an insurance payment monthly. There is also a prescription drug program which requires an insurance premium, unless the enrollee chooses a Medicaid Advantage Plan with an integrated drug program.  And there are Medicare supplements, which cover the many deductibles and co-payments that Medicare requires.

 Obtaining age 62, 65, or 70 does not automatically mean that person is enrolled in Medicare. The individual must apply for Social Security Benefits first, and that process takes two months. During this time, the Social Security Administration will verify residency status, address, and determine the number of quarters the applicant paid the necessary payroll taxes to qualify. Social Security is NOT FREE, the applicant must have earned wages and paid payroll taxes for Social Security and Medicare for no less than ten years. Some, myself included, think this is too liberal, because what other entity, government or private provides a pension after only a decade? Social Security is financed through a trust fund and current payroll taxes from employees and the self-employed whom are still working.

 In addition to the age qualification, Social Security is eligible to persons who have end-stage renal failure (kidney) and are on dialysis and for those who are blind. It is possible for other individuals with disabilities to qualify for benefits, but this is not easy and is not guaranteed.

 Conclusion

The United States does not offer FREE HEALTH CARE, rather it provides various targeted programs for enrollment, based on eligibility. These standards require individual tax contributions at all levels, based on the Internal Revenue Service Code. Only billionaires and a few hedge funders seem to manage tax exemptions. If you earn wages in the U.S.A. you will pay into the Social Security and Medicare programs. Residents in the country may be eligible for Medicaid or Insurance Exchange subsidies based on the duration of their residency and their immigration status. Americans are raised with the ethos that we work and earn that which we acquire and utilize. Though our tax code is arcane, it does provide incentives for programs the nation is trying to encourage and those it discourages. Universal healthcare is a myth, for even in countries with national health systems (France, Germany), there are populations whom are not covered under the safety net, primarily based on residency status.  Where the US goes off the rails is in the affordability of health care, ranked as the most expensive health care in the world. And of course, there are more persons without medical insurance and access to care in the US than in other nations with national healthcare systems. That said, this bellicose nation does not appear ready to move away from its current system in the near future.

 And this is the healthpolicymaven signing off, encouraging you not to sign blanket releases when you agree on a surgical procedure or a hospitalization, do specify that for which you agree and decline. It is best to do this with an Advanced Medical Directive or a POLST agreement. Make sure your emergency contact is aware of this document and be prepared to present to healthcare administrators.

 Roberta Winter is an independent healthcare analyst and journalist who receives no money from any sector of US healthcare. She is the author of Unraveling US Healthcare-A Personal Guide, published by Rowman & Littlefield in 2013. She has been a speaker at international and national healthcare events.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

Should Your Hospital Get Nonprofit Status If It Doesn't Provide Enough Health Care for the Poor?

Nonprofit 501C-3 hospitals can lose their nonprofit status if they do not contribute enough of their revenue to charitable care in the communities they are supposed to serve. In 2017, a nonprofit hospital lost its tax-free status because it did not provide enough community benefit according to the Affordable Care Act Standards. The hospital, which was not named by the IRS, was deemed to have willfully flaunted the requirement that it maintain nonprofit status. (Wyland, 2017) Worse yet, this hospital was designated a disproportionate share facility, a designation which receives further federal government funding because they are located in communities with large populations of impoverished people. Disproportionate share hospitals are found in inner cities and include; Cook Hospital in Chicago, Harborview in Seattle, and Bellevue Hospital in New York City. Unfortunately, in this situation a nominal fine of $50,000 was levied to this hospital group, because that is all the statue allowed, which is coffee money for hospital corporations. Opportunism in large hospital corporations is a growing trend, but at least the Affordable Care Act finally provided some standards of proportionality for charitable care in order to actually be a nonprofit, nontax paying entity.

 Tracking Your Nonprofit Hospital’s Community Benefit

Boston-based Lown Institute even publishes an index that ranks community investments from hospitals and its’ latest report shows 72% of the 3.641 nonprofit hospitals  which participated actually received tax benefits in excess of their charity care and community investment. (Toleos, 2021) To determine how your local hospital ranked go to their site at https://lownhospitalsindex.org/rankings/

Lown Institute Rankings for Community Investment and Charitable Care (Lown Institute , 2022)

Standards	Hospital	Location
Most Charitable	Paradise Valley Hospital	National City, CA
2nd Most Charitable	Elmhurst Hospital Center	Elmhurst, NY
3rd Most Charitable	Queens Hospital Center	Jamaica, NY
3rd Least Charitable	University CA Medical Center	San Francisco, CA
2nd Least Charitable	New York Presbyterian Hospital	New York, NY
Least Charitable	Cleveland Clinic	Cleveland, OH

 Affordable Care Act Requirements for Nonprofit Hospitals

Under ACA mandates, hospitals must conduct a community health needs assessment (CHNA), create an action-based plan to meet objectives identified in the report, and widely disseminate the plan once it is approved. Additionally, the Internal Revenue Service has added section 501 (1) to the revenue code which has requirements for nonprofit hospital reporting and standards to demonstrate nonprofit status. (Internal Revenue Service, 2022) These requirements prohibit lobbying, political contributions, and election year issues. Further, if compensation paid to hospital executives is deemed excessive, they are taxed a 25% excise tax on each excess benefit, of which the executives are personally liable. The compensation deemed an excess must be paid back and if it is not, a 200% tax penalty is levied. A 10% tax may also be levied on the manager of the person(s) who are deemed to have received an excess benefit as well.  These penalties at least provide some teeth in the Revenue Service’s enforcement of tax code provisions which provide generous exclusions for nonprofit hospitals.

 Judge Ruled Hospital Corporation Is Non-Charitable Entity

Local communities have started to sue large hospital corporations and in Pennsylvania, a Chester County judge ruled that three local nonprofit hospitals, owned by Tower Health were not tax-exempt charities and thus subject to property taxes. This judge found these hospitals did not meet the 1997 statute for Institutions of Purely Public Charity Act. Further the court stipulated they did not provide adequate uncompensated care and declaring undercompensated care as charity care is not valid. This is a line in the sand which will reverberate throughout all nonprofit hospital groups, because they too use the undercompensated care standard tied to their “chargemaster.” This judge also decreed the chargemaster is meaningless because it has nothing to do with actual contracts or payment for services. (Johnson, 2022) As a former hospital finance department employee, I can state unequivocally that no one pays the charge master prices. Even the uninsured, who could be charged those rates can apply for charitable care or negotiate discounts. The chargemaster is in fact, a starting point in swap meet negotiation and hospitals never expect to receive reimbursements at those rates.

 Many municipalities and school districts are interested in taxing wealthy nonprofit organizations, whom may have extensive property in their communities. For example, in my state, the University of Washington is one of the largest real estate owners and landlords in pricey Seattle. Even in tiny Walla Walla, Whitman College is also one of the largest land owners in town. In the case of both of these educational institutions, they were established before Washington became a state and merely held onto their land grants.

 Communities can and should use the courts to redress exorbitant healthcare prices from hospital groups which pay no taxes and received a plethora of government financing. Perhaps when enough of the settlements cost enough money these money gouging hospital groups will start to care about the people in their communities more than their pocket books.

 And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when agreeing to health care procedures, do stipulate that for which you consent and for which you decline. Roberta Winter is a healthcare analyst and freelance journalist who accepts no money from any sector of the healthcare industry for publication of this column.

 Works Cited

Internal Revenue Service. (2022, March 3). Non-profit Charitable Organizations Exemption Requirements. Retrieved from IRS.gov: https://www.irs.gov/charities-non-profits/charitable-organizations/exemption-requirements-501c3-organizations

Johnson, B. K. (2022, January 7). Non-Charitable Nonprofit Hospital Ordered to Start Paying Property Taxes. Retrieved from Bloomberg News.com: https://news.bloombergtax.com/tax-insights-and-community/non=charitable-nonprofit-hospital-ordered-to-start-paying-property-taxes

Lown Institute . (2022, March 3). Lown Institute Hospitals Index-2021 Rankings . Retrieved from Lown Hospitals Index.org: https://lownhospitalsindex.org/rankings/compare/?hospitals=050024,330128

Toleos, A. (2021, July 11). Most U.S. nonprofit hospitals neglect community investment obligation, analysis reveals. Retrieved March 3, 2022, from Lown Institute: https://lowninstitute.org/press-release-most-us-nonprofit-hospitals-neglect-community-investment-obligation-analysis-reveals/

Wyland, M. (2017, August 18). Hospital Loses IRS Tax Exemption for Noncompliance with ACA. Retrieved from Becker's Hospital Review: https://nonprofitquarterly.org/hospital-loses-irs-tax-exemption/

 

Trump Administration Seeks to Remove Protections for Pre-existing Conditions in Supreme Court November 10,2020

Balderdash and Trump Caring About Your Pre-existing Conditions

White House Press Secretary, Kayleigh McEnany’s heartfelt speech at the Republican semi-virtual convention reflected her complete suspension of reality because her anguish about almost having breast cancer isn’t the same as actually being treated for invasive cancer. You know what is really scary, being a widow with a six-year-old actually diagnosed with breast cancer for the second time while a graduate student. Though I didn’t have my dad, husband, or GOD at my side, I did have healthcare through Washington State’s Basic Health Plan. The reason I am alive today is because I had the good fortune to live in a state with sound governance which realized a decade before the Affordable Care Act that people needed healthcare access. Other states which enacted similar programs were Minnesota and Massachusetts. Essentially, the program was very similar to the ACA guidelines, if you were within 130% of the poverty guidelines you were eligible for medical insurance that was a hybrid of Medicare, paid for with premium contributions and state subsidies. Of course, since I already had a breast cancer history (stage II tumor age-35 and mastectomy) I would not have been able to obtain any other medical insurance.

Press Secretary McEnany’s concern for protection due to pre-existing conditions is disingenuous while she works for the Republicans whom have been actively trying to eliminate the Affordable Care Act. The Affordable Care Act affectionately known as Obamacare, was enacted in 2010, ensured that insurance companies would no longer be able to deny healthcare based on someone’s health status and provided a nationwide mechanism for people to obtain affordable medical insurance. That program was also revenue neutral, (unlike anything the Trump Administration has produced). However, the Republican Administration has eliminated the income tax penalties for people who don’t think they should be forced to obtain medical insurance and of course the 3% tax for medical devices which were financing the ACA subsidies for low and middle-income people to obtain medical insurance. None of these tax cuts made a difference to giant cardiac device manufacturers or artificial hip makers, but they did serve to undermine funding for the pillars of Obamacare.

How galling for the almost breast cancer novitiate to say that “Trump stands by people with pre-existing conditions” while his administration has an active lawsuit, at the Supreme Court to eliminate the Affordable Care Act and throw millions of people with active health conditions, like auto-immune diseases to the wolves. As recent as June of this year Trump said that Obamacare must fall. The Supreme Court will hear oral arguments November 10, 2020 by the Trump Administration and 19 Republican attorneys general to eliminate the Affordable Care Act and jettison medical insurance for twenty to thirty million people, me included. I cannot think of a more compelling reason to vote early if you are a vote-by-mail-state or in person if you are required.

I am a 27-year breast cancer survivor and the mother of a twenty-three-year-old son whom has spent the last twenty years working for healthcare reforms, spending ten to thirteen weeks a year working for free on advocacy initiatives to raise awareness of adverse policies which affect your health and promoting sound science to inform your decisions. No, I am not rich, nor is that my aspiration, but neither have I declared bankruptcy so that others could pay my bills, stiffed contractors who worked for me, or sought to undermine basic healthcare for millions.  Nor have I contributed to the unnecessary deaths of even more millions by patchwork state laws which deny access to care for so many hard-working residents of this nation. I choose not suspend reality by the miasma of the Trump Administration which pretends he cares about people with pre-existing conditions-where is the proof.

 I encourage you all to vote this fall based on the evidence not false promises and sloppy rhetoric.

And this is the healthpolicymaven signing off encouraging you not to sign blanket medical release forms before submitting to medical procedures, do designate that for which you agree and for which you decline.

Roberta Winter is an independent journalist and health policy analyst and the author of Unraveling US Healthcare-A Personal Guide https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972#:~:text=Unraveling%20U.S.%20Health%20Care%20is,their%20health%20care%20decision%20making.

The Next Wave of the Pandemic Apocalypse

The Trump Administration have undermined the social safety net for most Americans with precision and a breathtaking ruthlessness over the past three years. Now you lose your job, then your healthcare and shortly thereafter, your credit rating which impacts your ability to get a job, obtain housing, or medical treatment. This negatively reinforcing loop doesn’t have to be that way and it isn’t in other industrialized countries.  Most Americans can’t make it more than a few months or even a few weeks on their disposable incomes. And our children, many of whom watched their parents grind it out through the mortgage meltdown of 2008 will be witnessing an even greater debacle. What does it mean for the survival of our nation if our young people feel hopeless?

This table lists components of the social safety network in a pre-Covid-19 pandemic state comparing the three-plus years under the Trump Administration to the state of the nation he inherited from in 2016.

Criteria	Trump Actions Since 2017	Impact on Individuals
Access to healthcare requires a nondiscriminatory environment, a national effort, and funding-All of which were provided under the Affordable Care Act known as Obamacare AND are also part of Medicare	Funding for the Affordable Care Act has been cut by reducing non-participation penalties and eliminating the 3% medical device tax; A Supreme Court case is pending regarding the legality of the act because the penalty for not having insurance was nullified in 2017. Republicans have stated their goal is to gut Obamacare	Affordable Care Act provides subsidized medical insurance to 8.6 million households, down from 9.6 in 2016; due to Trump’s cuts in promotion of the program and funding; Despite Trump actions more states have opted to expand Medicaid access to the ACA standard, which is 133% of federal poverty rate
Uninsured population	In 2016 the US Census found 27.3 million had no insurance; no action has been taken to provide affordable healthcare in the Trump Administration	In 2019, 30 million people were without insurance; health insurance gains are reversing
Employment security	Unemployment rate in 2016 was 4.7%	Unemployment was 4.4% in January and as of the end of March 2020 was 13.1%
People in Poverty	40.6 million in poverty in 2016; Trump cut funding for school lunches and made it harder for families to qualify; In 2016, 22.1 million children received subsidized school lunches	38.1 million in poverty in 2019; 29.7 million children and youth receive school lunch subsidies in 2020; school closures mean they don’t eat
Affordable housing	549,928 people were homeless in 2016	US Census for 2020 finds 3.5 million people are homeless

Looking at the trends from the corona virus Covid-19 pandemic this table shows the impact on social safety systems in the current state, which is the Trump Administration under the Covid-19 siege.

Criteria	Current state Trump Admin	Pandemic forecast
Access to healthcare	56% get health insurance through their employer; roughly 159 million people	For those who can’t afford to pay their COBRA or private healthcare premiums after job loss, this could result in another 47 million uninsured people
Uninsured population	30 million	Estimated to rise to 40 million
Unemployment rate	15% as of April	Expected to reach 30%, the question is for how long and how many businesses will go under
People living in poverty	38.1 million	This number will explode when unemployment benefits expire and there are no jobs
People who are homeless	3.5 million	This number will skyrocket once the evictions start

Colossal Job Loss

Large businesses (airlines,Boeing) are currently being offered federal subsidies to try and stave off job loss, thanks to the Democrats who argued for these provisions in the federal lifeline. Initially Treasury Secretary Mnunchin wanted to offer funds without strings or public transparency. Small businesses are only being offered loans which they must pay back and their ability to do so is vague at best. Small businesses can’t go for months without normal operations, let alone take on a new debt. Small businesses employ more people than large corporations, so this could have a devasting impact on employment throughout the country. Also, small businesses lack access to affordable capital and typically invest their life savings to start their enterprises. Small businesses finance themselves at much less attractive rates than large corporations, who get a point-over-prime versus the small ones who use their credit lines at 10% or worse yet, take on credit card debt at 25% APR. Whereas, large companies rely on equity markets, meaning other people invest in their organization, they do not risk their own capital. Corporate executives don’t lose their homes, they may lose a bonus.

Impact on the Self-Employed

There are at least thirty million self-employed people in the US, which is a result of the decades long corporate gutting of jobs, to be replaced by workers who have no protections, no unemployment compensation, and no healthcare. (Microsoft started this trend and ended up settling a Department of Labor action because of it). Contract workers do increase profitability for companies, but at their own peril. Democrats argued for inclusion of self-employed workers in the pandemic unemployment compensation, which will help hourly wage earners, like Uber drivers, but won’t help small business owners who draw 1099 self-employment compensation. If you are a small business, like a C or LLC Corporation, nonpaying customers doesn’t mean you, as owner are unemployed. I suppose if a business lost all of its customers then the owner would be considered unemployed.

Irreparable Financial Devastation for Many

Only 10% of the iceberg is visible above the water line and there are pillars of the US financial system which depend on stability and these are the pension funds and a huge swath of private employer healthcare plans, which are self-insured.

Potential Failure of State and City Pension Plans

Pensions require financial solvency to pay their future obligations to retired workers and if entire industries fail, this ability could be destroyed. The Pension Benefit Guaranty Corporation, which is a US mandated watchdog for pension solvency, has a limited amount of funds to cover bankrupt pensions and it would not be able to withstand massive industry failure. In other words, pensioners may receive reduced benefits or stop receiving them.

Solvency of Self-Insured Medical Plans

For self-insured health plans, which have been purchased by firms with as few as fifty employees, the ability of those businesses to pay escalating medical claims when they are experiencing severe business downturns is questionable. Self-insured health and welfare plans are exempt from state regulation because of a 1976 federal law called ERISA, which means employees have no state protection agency to help them with late paid or unpaid medical bills.

Down Stream Impact

Any significant impact on the healthcare safety net impairs services for a community and Covid-19 is vividly illustrating the communities which were prepared and those that were not. Since the US healthcare system is based on a pay-for-service unrationed reimbursement methodology, all healthcare decisions are determined based on who pays. In the early weeks of the Covid crisis President Trump expressed concern about who pays for the testing, which delayed testing for weeks, dramatically increasing the spread of the airborne disease. In Korea, Australia, and Germany the question wasn’t who pays, because they have national healthcare systems. Those nations coordinated national efforts to arrest the disease quickly and as a result are not experiencing the job losses of the US. Further, in other advanced industrialized nations it is unthinkable for companies to be able to fire their workers to improve profitability. These nations require private companies to pay into job retraining funds, severance, and other social benefits to provide employment stability. The US has chosen to have an unstable workplace because it benefits Wallstreet, not the workers. If you look at real increases in household income, the increases are fractionally higher than they were forty years ago. Inflation adjusted gains in household income have decreased under the Trump Administration from a high of 5.2% of 2015 to 1.7% in 2017. Meanwhile the top 5% have experienced explosive income growth. The CIA Factbook ranks the US 40^th in income inequality worldwide and at the bottom for industrialized nations.

It is easy to see why Elizabeth Warren and Bernie Sanders have such a strong following among reform minded voters, because nothing illustrates the inequities of the US financial system and the tattered social safety net than the Covid-19 pandemic, which has been mismanaged by the Trump Administration from the start. As King Louie said, “heads will roll,’’ hopefully with the 2020 election.

This article was written by Roberta Winter, a healthcare analyst and freelance journalist and author of Unraveling US Healthcare-A Personal Guide. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

Rheumatoid Arthritis-Impacting 10% of the U.S. Population, Treatment, and Research

Treatment and Research for Rheumatoid Arthritis and Other Autoimmune Diseases

Rheumatoid Arthritis (RA), the first time I heard of this disease as a college sophomore, I was amazed it affected young people. The treatment used to be loads of steroids, which have plenty of side-affects including weight gain. My little-league-pitching nephew, Sebastian was struck with this dreaded youth flaying arthritis when he was twelve years old. I went to one of his games and yelled, “Swing batter” or “Knock the cover off”, not PC at all, but I am so glad I did it. His diagnosis was a slow process and needless to say, it ended his pitching career. When Sebastian came to visit me for one of our camping expeditions, I took him to a Mariners game (at his request). After sitting through all of the innings, he could barely get up and drag himself the few blocks to the car. It was as if his limbs were numb. This disease affects 10% of our nation, 1 in every 100 people.[1]

21^st Century Treatments

Flash forward to the advent of two important innovations in the 21^st century, first the introduction of the arthritis treatment, etanercept, was approved for treatment of RA in 1998, and became ubiquitous for treatment a few years later. When Enbrel was launched by Amgen, the price of the drug was $1,500 a month per patient or $18,000 a year, in 2008. The current price of this medication is about $40,000 per patient per year in the U.S. In 2015, Canadians paid about $20,000 per patient per year for the same medication, no wonder they are so pleasant up north.

How Do People Pay for this Drug?

One giant leap forward for humanity in 2010, when the Patient Protection and Affordable Care Act mandated that insurance companies could no longer discriminate on the basis of health. This law made it much easier for Sebastian and others like him to gain access to affordable health insurance and thus, treatment. With the medicine he has been able to thrive, working for the same employer for five years, working out at a gym, and welcoming the birth of his second child. It is doubtful this would have been possible without access to health care. Employers frown on employees who are tired or move a bit stiffer than the others, even if they are in their twenties and this is what life was like without his medication.

As of this year, there are three biologic drugs approved by the Federal Drug Administration, all of which will compete with Enbrel, so that should soften the price somewhat. Of course the way our nation pays for drugs without negotiating effectively with their largest customer (the government) is the antithesis of good stewardship.

New Horizons for researching a cure for Rheumatoid Arthritis

The Benaroya Institute, long noted for its research to cure type 1 diabetes and global leader of the Type 1 Diabetes Trial Net study to identify those at risk of diabetes, which is funded by the National Institutes of Health, is also studying the cellular behavior of people with RA compared to the non-RA population. This approach is to detect those vulnerable to this debilitating disease earlier and pre-treat the condition before full blown symptoms occur. The Benaroya Research Institute has also been awarded an 8 million-dollar grant from the National Institute of Allergies and Infectious Diseases to study the lung epithelium cells, which provide the main response to allergens. [2] The foundation’s research shows that multiple autoimmune diseases are often more likely to occur in family populations with an existing autoimmune disease, such as RA. If you are interested in learning more about current research on cellular behavior to identify, pre-treat, and eventually cure autoimmune diseases like Rheumatoid Arthritis or Type 1 Diabetes, join the scientists at the foundation’s annual outreach luncheon to learn more. This year’s event will be held at the Fairmont Hotel in Seattle on October 28, 2016. To participate in the event, find more information at this link:

http://connect.virginiamasonfoundation.org/bri-illuminations-luncheon

This article was written by Roberta E. Winter, using the trademark healthpolicymaven, and may be shared virally. Winter is the author of https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972 as well as 97 articles on healthcare systems and resourcing better health care.

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[1] https://www.benaroyaresearch.org/what-is-bri/disease-information/rheumatoid-arthritis#.V-sWiSTRuts

[2] https://www.benaroyaresearch.org/news/press-releases/national-institutes-health-awards-benaroya-research-institute-8-million-lead-new-asthma-and-allergic#.V-rGaCTRutv