As health insurance costs continue to climb in the U.S., patients are sometimes left paying thousands of dollars out-of-pocket for needed care, posing a substantial financial burden that has left families across the country in difficult financial situations.
Health care providers in Rice and Steele counties have seen the effects of rising costs and are working to ease the burden posed to patients.
Northfield Hospital & Clinics President and CEO Steve Underdahl said the most significant change to health care over the last five years has been the shifting of the responsibility for the cost of care to patients and their families through high-deductible insurance plans, an issue he described as an “unintended consequence” of the decision. That model is seen as the dominant health care payment model locally.
The plans are seen as detrimental to lower-earning families who can end up paying thousands of dollars in out-of-pocket costs for medical care.
A decade ago, deductible costs were much lower, frequently leaving patients with no out-of-pocket cost for routine care. Deductible costs have grown disproportionately to wages. From 2008-18, deductibles grew more than 212 percent while wages rose 26 percent.
“This has been a dramatic shift from even 10 years ago,” Underdahl said of the pace of increased costs.
That reality has an effect on the health system. As people push off care because of high costs, they sometimes wait to get treatment and instead wind up in the Emergency Department. The work of the hospital has become less even.
Underdahl notices the fourth quarter of years is often the busiest because of patients responding to the demands of high-deductible plans. Debt for unpaid obligation for care at the hospital ranged between $1 million to $1.5 million from 2015 to 2018.
According to the Centers for Disease Control and Prevention, rising health care costs are being felt across the country. Per capita national health expenditures were $10,348 in 2016 and total national health expenditures totaled $3.3 trillion. Total national health expenditures as a percent of gross domestic product was estimated at nearly 18 percent.
To Underdahl, the high cost of health insurance means there are people who have insurance in theory, but not in practice.
He believes any solution moves to a larger, national discussion, but in the meantime, Northfield Hospital & Clinics is working with patients to ensure they can still receive care. Staff connect patients with government programs like Medicaid and MNsure, provide an interest-fee payment plan and help patients understand up front the costs of their pending care.
At the national level, Underdahl notices a growing urgency that the status-quo approach to paying for health care is not working. He noted it is difficult to tweak certain things relating to health care and anticipates that within the next decade, a “fairly significant overhaul” will take place.
Underdahl said the hospital does not want to be a part of a patient’s financial ruin and is interested in a better, fairer system. Although he did not take a detailed policy stance, he expects the landscape of the U.S. health care system to more closely align with other major Western countries, whether that is through universal health care exclusively from the government or through a private-public cooperation.
Patient volumes increase health care costs
District One and Owatonna Hospital President David Albrecht said as payers have tried to keep costs down, they have transitioned to higher-deductible plans.
A factor he cited as a reason for increased prices is a higher volume of patients going to the emergency room for non life-threatening situations. He said reasons for that could stem from a lack of access to regular physicians or a decision to not align with one physician and instead use urgent care and ER as sources of care.
He said the decision to not align with a physician sometimes comes because of a lengthy process to schedule an appointment or because of a shortage of community physicians.
To Albrecht, health insurance costs would decrease if patients decided to utilize primary care physicians to a greater extent.
To reduce patient retention rates, the Allina Health hospitals work with patients to help them understand the root causes of why they frequently need care.
Typically, approximately 75 percent of District One’s revenue comes from outpatient services. The Emergency Department sees approximately 13,000 patients annually, although Albrecht said that number is “really small” compared to outpatient visits.
“The cost of health care is completely unsustainable in this country.”
U.S. Rep. Angie Craig, DFL-Minnesota, who represents Northfield and portions of the south metro, does not expect health insurance costs to decrease until health care costs are reduced. She said she is aware of families paying $24,000 per year on the individual market with $12,000 deductibles. She has co-authored a bill that would allow people to buy into a Medicare-like plan to compete with large insurance companies.
She said there is a lack of transparency in the health insurance market and the current incentives for doctors/hospitals involve volume levels, when the emphasis should be on value-based and income-based approaches that are focused on preventive measures and social determinants of health.
She said the first step to addressing the problem is to stabilize the individual marketplace and make improvements to the Affordable Care Act signed into law by President Barack Obama in 2010. She spoke highly of provisions allowing children to remain on their parents’ health insurance plans until they are 26 and protecting pre-existing conditions. She predicted that if the law is repealed, uninsured rates will dramatically increase.
Craig took issue with the high cost of prescription drugs, adding she has introduced the PRICED Act, a bill that would shorten the market exclusivity for biologic drugs from 12 years to five years.
Following an academic year that included 10 school cancellations, the Faribault School Board wants to ensure students don’t miss out on learning when winter rears its ugly head.
E-Learning days, also known as flexible learning days, count as full school days in the event of school cancellations. The online system makes it possible for students to complete assignments at home electronically and can save the district the trouble of scheduling make-up days later in the school year.
Since E-Learning days can’t be approved mid-year, the board plans to approve the system at its August meeting. Staff has already reserved time in early November for flexible learning planning.
Ryan Krominga, director of teaching and learning for the district, prepared a presentation on E-Learning days for the Monday School Board meeting. In developing the presentation, Krominga said he opened discussion within other districts that already use a form of E-Learning days. He also collected overall positive responses from 31 staff members in the Faribault district.
With the E-Learning days in place, the first two snow days that occur in an academic year would be missed and not rescheduled since the district already builds two missed days into the calendar. After that, E-Learning days would be determined before 6 a.m. on the day of a school cancellation and communicated to impacted families. After five E-Learning days, any more missed school days would need to be rescheduled.
As illustrated in his presentation, Krominga explained that E-Learning looks different depending on the grade level. While introducing E-Learning days requires no major shift in technology for the district, he said the elementary schools plan to use the Seesaw app this year to help parents stay informed about their students’ curriculum and assignments. In a similar way, upper grade teachers use the Schoology app to improve communication with parents. These apps will both be instrumental for E-Learning.
All students are presumed present during E-Learning days, unless they fail to complete their assigned tasks by the established deadline. If weather conditions result in a poor internet connection for families, students have the opportunity to reclaim their “present” status by talking to their teachers once school resumes.
Krominga said for the most part the expectations enforced through E-Learning days will be similar to those in the classroom. If a student has no internet access, teachers can give them worksheets to complete instead.
School Board member Courtney Cavellier asked Krominga if he gathered parent feedback as he developed his presentation.
While Krominga has not yet surveyed parents on their opinions of E-Learning Days, he plans to release a survey after each E-Learning day that occurs in 2019-20.
Faribault Middle School calendar
Another change going forward in the Faribault School District applies to the middle school specifically. Rather than holding Parent Night Sept. 12 as originally planned, the board approved an open house Aug. 28.
“The idea is we’re trying is to get more parents involved,” said Interim Superintendent Todd Sesker.
Apart from increased parent involvement, the open house scheduled before the first day of school gives sixth-graders a chance to ease into a new building as they prepare for a transition year. Sixth-graders also start school Sept. 3, one day earlier than seventh- and eighth-graders.
Rice County prosecutors are asking the state Court of Appeals to overturn a district court judge’s decision suppressing the confession of a murder suspect Judana Catherine Williams.
Judge Christine Long, in a July 2 order, suppressed statements Williams made to a Faribault police investigator during three interviews immediately following the Sept. 7, 2018 stabbing death of Williams’ boyfriend, Michael Bongers. Long found that in one conversation the detective, Joshua Alexander, spoke with Williams without adequately letting her know that she wasn’t then a suspect in Bongers’ death and that in doing so should have read her her Miranda rights.
In the other two, Long said that though Alexander read Williams her rights prior to questioning, he violated those rights by failing to clarify whether Williams was in fact asking to have an attorney present during questioning.
While it’s an unusual step, Rice County Attorney John Fossum said that the appeal can be filed prior to trial if the judge’s decision would have a “critical impact” on the case’s outcome.
“Thus, respondent’s suppressed statements are significant to the state’s burden of proving respondent’s state of mind,” wrote Rice County Chief Assistant County Attorney Terence Swihart in a July 24 filing. “Accordingly, suppression of the Sept. 7, 2018 statements would significantly reduce the likelihood of a successful prosecution, and therefore the district court’s order will have a critical impact on the case.”
Swihart argued that the test Judge Long used to determine whether Williams was in custody during her first interview with police, was incomplete. Though the detective questioned Williams at the police station, she was not handcuffed and transcripts of the interview show she was told the door was unlocked and that she was not a suspect.
Though Long asserted that the circumstances of the first interview would cause a reasonable person to believe he or she was not free to leave, Swihart says the test is more thorough, and that by using all possible factors, the district court should have concluded that no Miranda warning was required.
The district court’s rationale for suppressing Williams’ statements in the second and third interviews are also incorrect and should be overturned, prosecutors find, using case law to show that law enforcement aren’t required to clarify unclear requests for counsel.
“The U.S. Supreme Court has stated that custodial interrogation must cease only if a suspect’s invocation of his right to counsel is clear and unequivocal,” Swihart wrote in the filing.
In Williams’ case, she asked the detective, “Can I have an attorney present” and “Do I need a lawyer?” Following the first question, Alexander read Williams her rights. The second, prosecutors say, was an inquiry as to whether she ought to have an attorney and that anything following that was not a violation of Williams’ rights.
A plea hearing in the case set for next week will likely be postponed until the appellate court makes a ruling. That could take until early winter, Fossum said.