{"id":106,"help":"help","hero_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2019\/06\/hero-ideas.png","page_title_en":"Ideas","page_title_es":"Ideas","page_title_fr":"Id\u00e9es","page_content_en":"<p>We are dedicated to using evidence, research and data to establish reasonable, thoughtful approaches to issues surrounding health care costs and access. Browse our topics below and check back regularly for new briefs, podcasts and reports.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_es":"<p>Nos dedicamos a usar evidencia, investigaci\u00f3n y datos para establecer enfoques razonables y detallados para los problemas asociados con los costos y el acceso al cuidado de la salud. Explore nuestros temas abajo y revise regularmente para res\u00famenes de noticias, podcasts e informes.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_fr":"<p>Nous nous consacrons \u00e0 l\u2019utilisation de preuves, de recherches et de donn\u00e9es pour \u00e9tablir des approches raisonnables et r\u00e9fl\u00e9chies aux questions sur les co\u00fbts entourant les soins de sant\u00e9 et l\u2019acc\u00e8s. Parcourez nos rubriques ci-dessous, et v\u00e9rifiez r\u00e9guli\u00e8rement les nouvelles, les balados et les rapports.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_subheader_en":"Core to our mission is the pursuit and use of knowledge to help create long-term solutions to the affordability issues undermining good health.","page_subheader_es":"La esencia de nuestra misi\u00f3n es el desarrollo y el uso del conocimiento, para ayudar a crear soluciones a largo plazo a los problemas de asequibilidad que afectan negativamente la buena salud.","page_subheader_fr":"La qu\u00eate et l\u2019utilisation des connaissances sont au c\u0153ur de notre mission pour aider \u00e0 cr\u00e9er des solutions \u00e0 long terme aux probl\u00e8mes d\u2019abordabilit\u00e9 compromettant la bonne sant\u00e9.","tangle_title_en":"Learn more about our services, including our programs for nonprofits serving low-income populations.","tangle_title_es":"Obtenga m\u00e1s informaci\u00f3n sobre nuestros servicios, incluidos nuestros programas para organizaciones sin fines de lucro que atienden a poblaciones de bajos ingresos.","tangle_title_fr":"En savoir plus sur nos services, y compris nos programmes pour les organismes sans but lucratif au service des populations \u00e0 faible revenu.","tangle_link_title_en":"Access our services here","tangle_link_title_es":"Acceda a nuestros servicios aqu\u00ed","tangle_link_title_fr":"Acc\u00e9dez \u00e0 nos services ici","tangle_url":"services","seo_title_en":"Fair Play | Health costs research","seo_title_es":"Fair Play | Investigaci\u00f3n de costos de salud","seo_title_fr":"Fair Play | Recherche sur les co\u00fbts de la sant\u00e9","seo_description_en":"Fair Play conducts original research and economic analysis of health care costs and impact on low-income patients.","seo_description_es":"Fair Play realiza investigaciones originales y an\u00e1lisis econ\u00f3micos de los costos de atenci\u00f3n m\u00e9dica.","seo_description_fr":null,"featured_ideas":[{"slug":"how-poverty-can-kill-you","ideas_cat":"Fair Play Radio","main_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2019\/09\/poverty.jpg","page_title_en":"Poverty's death toll","page_title_es":"Tasa de muerte de la pobreza","page_title_fr":"Le bilan de la pauvret\u00e9","page_content_en":"<p>For its inaugural podcast, Fair Play founder Holly Lang talks the barriers low-income Americans face in the health system, first in a three-part series looking at poverty and health in North America.<\/p>\n<audio class=\"wp-audio-shortcode\" id=\"audio-106-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"https:\/\/fair-play-api.webworldnow.net\/wp-content\/uploads\/2019\/10\/Mix1.5.mp3?_=1\" \/><a href=\"https:\/\/fair-play-api.webworldnow.net\/wp-content\/uploads\/2019\/10\/Mix1.5.mp3\">https:\/\/fair-play-api.webworldnow.net\/wp-content\/uploads\/2019\/10\/Mix1.5.mp3<\/a><\/audio>\n<p>Transcript:<\/p>\n<p>Hi and welcome to Fair Play Radio.<\/p>\n<p>I\u2019m Holly Lang and I\u2019m the founder and managing director of Fair Play, a nonprofit health and economic research, policy and consulting group.<\/p>\n<p>At Fair Play, we think a lot about how costs and income impact a person\u2019s health.<\/p>\n<p>After all, if you struggle to afford necessary or preventable care, how can you stay healthy?<\/p>\n<p>This is an issue that faces all of North America \u2013 and the world. In our debut podcast, we\u2019re looking first at the United States, where the intersection of health and wealth often tend to be at odds.<\/p>\n<p>In what\u2019s considered one of the wealthiest countries in the world, 40 million Americans live in poverty.<\/p>\n<p>And if we talk about \u201cnear-poverty,\u201d or those that live pretty close to the edge, that number jumps to just at 100 million Americans.<\/p>\n<p>That\u2019s about 30 percent of the country, a significant number.<\/p>\n<p>That means nearly one in every three people live dangerously close to destitution, if they aren\u2019t already there.<\/p>\n<p>And that&#8217;s even with US guidelines for poverty, which are fairly low.<\/p>\n<p>As it stands, a family of four would have to have a total household income of less than about $26,000 a year to even be considered to be living in poverty.<\/p>\n<p>$26,000 for four people.<\/p>\n<p>When you consider the basics of life \u2013 rent, utilities, food, clothing \u2013 this is a pretty low threshold, even if you\u2019re in a community where the living is fairly cheap.<\/p>\n<p>And what if you get sick?<\/p>\n<p>Poorer people are more likely to get sick for a number of reasons, including certain socioeconomic factors that lead to substandard housing conditions, inadequate nutrition and poorer work environments.<\/p>\n<p>Poor people also tend to less access to health care.<\/p>\n<p>In theory, if you are poor, you\u2019d receive Medicaid, the public health insurance program for low-income Americans.<\/p>\n<p>But Medicaid varies from state to state and coverage isn\u2019t guaranteed, particularly in the south and parts of the Midwest.<\/p>\n<p>Many that are low-income are also either uninsured or underinsured, which severally limits your options.<\/p>\n<p>You may be able to access care through community-based services, like federally qualified health centers or a charitable clinic.<\/p>\n<p>But those have their limitations and aren\u2019t available in all communities, especially rural areas.<br \/>\nIf you need more intense care, like surgery or emergency services, you\u2019d likely be able qualify for a hospital\u2019s financial assistance policy, particularly if you have a not-for-profit hospital in your community.<\/p>\n<p>But there are barriers there too.<\/p>\n<p>Many hospitals require an in-person application, notarized forms and other documents that require travel.<\/p>\n<p>If you aren\u2019t in a metro area with public transportation, you\u2019ll need a car or a friend giving you a lift to get there, and you\u2019ll need a job that is fine with you missing daytime work, as you\u2019d likely need to adhere to someone else\u2019s office hours to pull everything together.<\/p>\n<p>And keep in mind \u2013 this mostly just applies to emergency and necessary inpatient care.<\/p>\n<p>Routine doctor visits, non-emergent care and preventative care is often a no-go unless you have insurance, be it private, like through an insurance company, or public, like Medicaid.<\/p>\n<p>In 36 states, Medicaid is available to most everyone living in poverty.<\/p>\n<p>But in the other 14 states, Medicaid eligibility doesn\u2019t adhere to a national standard and generally has a complicated set of eligibility standards that tend to exclude many residents.<\/p>\n<p>This often means that it\u2019s a combination of both a significant condition \u2013 like cancer \u2013 and extreme poverty that gets you covered.<\/p>\n<p>If you don\u2019t have insurance \u2013 like 27-and-a-half million Americans \u2013 you likely will struggle to pay not just for your care but for other critical things, like medication and necessary equipment, like blood pressure monitors and glucose monitors.<\/p>\n<p>And it\u2019s important to note that, in general, poorer people are sicker than their wealthier counterparts.<\/p>\n<p>Numerous studies have shown that those living at or near poverty are most likely to die from cancer, heart disease and diabetes.<\/p>\n<p>This is due to several factors that go beyond income, such as education, housing and simple geography, things commonly dubbed \u201csocial determinants of health.\u201d<\/p>\n<p>This means that factors outside your immediate physical self can play a huge role in your health, even including how long you live.<\/p>\n<p>In fact, life expectancy varies as much as 30 years between the richest and poorest U.S. counties.<\/p>\n<p>Sadly, this is getting worse.<\/p>\n<p>A 2016 study done by the research group the Brookings Institute, showed that the difference between rich and poor death rates has significantly grown over the last few decades.<\/p>\n<p>Right now, differences in income can account for more than a decade of life, according to another study by MIT.<\/p>\n<p>This means that the richer you are, the more likely you are to live longer.<\/p>\n<p>And the poorer you are, the more likely you are to die sooner.<\/p>\n<p>This is often from generally preventable diseases, like Type II diabetes or hypertension.<\/p>\n<p>This is significant.<\/p>\n<p>This proves that, in many ways, poverty is the deadliest health condition.<\/p>\n<p>But maybe none of this applies to you.<\/p>\n<p>You are, after all, listening to a podcast.<\/p>\n<p>This means a few things \u2013 you have access to a computer or a smart phone, you have access to<\/p>\n<p>the internet, you understand English well and you likely have at least a high school education.<\/p>\n<p>Already, you\u2019re in a better spot than many.<\/p>\n<p>So why should you care?<\/p>\n<p>Poverty impacts everyone, not just those unlucky enough to live in it.<\/p>\n<p>Think of your schools, your police and safety services, your community infrastructure, all of which are fueled by tax dollars.<\/p>\n<p>Think of what brings new business to a community, and what motivates people to move to a neighborhood.<\/p>\n<p>Think of how high school graduation rates lead to college, or jobs, and how a skilled workforce is much more likely to continue to invest in the community around them than someone barely able to scrape together money for their children to eat or are too sick to work regular hours.<\/p>\n<p>None of this includes vital safety net services often funded through state and federal tax mechanisms, like food stamps, utility assistance, school lunches and housing support.<\/p>\n<p>And keep in mind that if you\u2019re sick because you aren\u2019t able to get the care you need to get healthy, you\u2019re more likely to miss work.<\/p>\n<p>Often.<\/p>\n<p>And those who are at or below the poverty level work hourly wage jobs, meaning an hour missed is an hour you don\u2019t get paid.<\/p>\n<p>All this goes without diving into the ethical issues that surround health care, including debates of whether health care is a right or what role we all should play in the care for others.<\/p>\n<p>And there\u2019s another twist.<\/p>\n<p>According to a recent report issued by the U.S. Census, medical expenses were the number one reason more people fell into poverty.<\/p>\n<p>These expenses included costs of care, prescriptions drugs and insurance premiums.<\/p>\n<p>The Census reported that an additional 8 million people were pushed into poverty from their health care expenses.<\/p>\n<p>A staggering one-in-six Americans have past due health bills on their credit reports, totaling about $81 billion in 2016, according to a study published last year in policy journal Health Affairs.<\/p>\n<p>And that\u2019s just what we know.<\/p>\n<p>Health costs can be an invisible sort of debt at times, hidden in credit cards or short-term loans, including predatory payday loans.<\/p>\n<p>This means that while we have an idea of the impact of health costs, there\u2019s still a whole lot we do not know.<\/p>\n<p>And in the struggle to afford care, many people are being pushed into detrimental financial situations.<\/p>\n<p>It\u2019s important to note that while there are a few bad players, many of the issues are inherent in the U.S. health system overall, not just a particular hospital or provider.<\/p>\n<p>At the risk of being trite, the system itself is broken.<\/p>\n<p>So, what can we do?<\/p>\n<p>There is a lot of room to work on the social determinants of health we mentioned earlier.<\/p>\n<p>We could increase reimbursement for social support systems through Medicaid and Medicare, and push insurance companies to do the same.<\/p>\n<p>Think investments in safe housing and food access, two key areas for improvement in most US communities.<\/p>\n<p>Hospitals could partner with community-based groups to address these issues and would likely see a significant return on that investment in the mid- to long-term.<\/p>\n<p>After all, it\u2019s been proven time and again that it\u2019s cheaper to invest in local housing than it is to house a patient in a hospital bed.<\/p>\n<p>We could also improve how government looks addresses the issue.<\/p>\n<p>Certain payment models, such as capitation and value-based care, are meant to control costs and could be expanded to more areas of care.<\/p>\n<p>And price transparency would use basic market principles to lower prices. But that is in theory, as health care doesn\u2019t always adhere to textbook economic rules.<\/p>\n<p>Locally, hospitals could improve their processes.<\/p>\n<p>This should include ensuring that every low-income patient has access to financial assistance, including those who are underinsured.<\/p>\n<p>This could also include better discharge protocols for patients who are likely to be lower income.<\/p>\n<p>For example, what\u2019s the point of telling someone to regularly monitor their blood pressure if they can\u2019t even afford the equipment to do so?<\/p>\n<p>Or how feasible is it to ask a patient to follow up with their cardiologist if they don\u2019t have affordable access to a specialist?<\/p>\n<p>Hospitals could also undertake referral partnerships with community health centers, Federally Qualified Health Centers and charitable care clinics.<\/p>\n<p>This could allow those doctors to refer into the hospital patients who have needs that go beyond what they\u2019re able to do in that setting.<\/p>\n<p>This is a great first step in many communities to extending care to those who otherwise wouldn\u2019t get it.<\/p>\n<p>But we also have to think big picture with this.<\/p>\n<p>There are some broad transparency standards being currently put in place on both a state and national level around prices that show a glimmer of promise.<\/p>\n<p>This is a critical first step, as most of us have no idea what a hospital visit, procedure or doctor appointment will cost us until at least a month after we\u2019ve received care, giving us little recourse.<\/p>\n<p>But these prices aren\u2019t the \u201creal\u201d prices, meaning what\u2019s posted isn\u2019t generally what anyone pays.<\/p>\n<p>And if you have no money, knowing the price in advance likely isn\u2019t going to help much.<\/p>\n<p>State and federal governments could increase their investment in social programs, such as stronger housing initiatives and programs like the supplemental nutrition assistance program.<\/p>\n<p>More states could expand Medicaid, and that\u2019s likely the most immediate \u2018big picture\u2019 fix we could undertake at this point.<\/p>\n<p>While many lawmakers balk at the price, the political tide is beginning to turn as more state governments see it as one of their only options in harnessing the harm caused by uninsurance.<\/p>\n<p>But we\u2019re seeing a trend of expansion coupled with requirements that would still place that option out of reach of most.<\/p>\n<p>Think work requirements, for example.<\/p>\n<p>Work requirements generally require beneficiaries to participate in certain activities, such as employment, a formal job search, or job training programs.<\/p>\n<p>As of now, Indiana is the only state doing this, though five more states have approved work requirement waivers and seven more have requested approval.<\/p>\n<p>On face value, many don\u2019t see this as an issue.<\/p>\n<p>After all, according to the Kaiser Family Foundation, most Medicaid adults are already working.<\/p>\n<p>But those that aren\u2019t working report barriers to work, including a lack of adequate opportunities, particularly for those without a high school or college diploma.<\/p>\n<p>And what if you are already too sick to work?<\/p>\n<p>Even when working, adults with Medicaid face disproportionately high rates of financial and food insecurity, as they are still living in or near poverty.<\/p>\n<p>So those problems of poverty we talked about at the beginning?<\/p>\n<p>Still an issue.<\/p>\n<p>In short, there\u2019s no silver bullet here.<\/p>\n<p>Without a doubt, poverty is the deadliest condition of all, and it will take federal, state and local communities working in concert to truly begin to make necessary changes that need to happen.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_es":"<p>El texto de este art\u00edculo a\u00fan no est\u00e1 disponible en espa\u00f1ol. \u00a1Por favor mant\u00e9ngase al tanto!<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_fr":"<p>Le texte de cet article n&#8217;est pas encore disponible en espagnol. S&#8217;il vous pla\u00eet restez \u00e0 l&#8217;\u00e9coute!<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_subheader_en":"Throughout North America - and the world - poverty remains one of the most deadly health conditions. We look at how this issue impacts Americans, and what solutions might be there. ","page_subheader_es":"En toda Am\u00e9rica del Norte, y en todo el mundo, la pobreza sigue siendo una de las condiciones de salud m\u00e1s mortales. Vemos c\u00f3mo este problema impacta a los estadounidenses y qu\u00e9 soluciones podr\u00edan existir.","page_subheader_fr":"En Am\u00e9rique du Nord et dans le monde entier, la pauvret\u00e9 reste l\u2019un des probl\u00e8mes de sant\u00e9 les plus meurtriers. Nous examinons l\u2019impact de ce probl\u00e8me sur les Am\u00e9ricains et les solutions qui pourraient y \u00eatre trouv\u00e9es."}]}