What Good Is Health Plan Cost-Sharing When Persons Can’t Afford to Access Care?

Increasing numbers of persons challenged by cost-sharing options only adds to the growing tally of persons struggling with social determinants of health and mental health; this counters efforts to attain wholistic health equity.

Researchers analyzed data from the 2019 Survey of Consumer Finances with telling results:
• High percentages of non-elderly households lack sufficient assets to meet typical plan cost-sharing amounts.
-45% of single-person non-elderly households unable to pay average cost-sharing amounts of $2,000 annually; low income households were in the same boat
-63% could not pay over the higher plan amounts of $6,000.
• Available liquid assets for single-person non-elderly households with incomes <150% of the federal poverty level (FPL) were limited; available assets averaged $577 vs $1,753 for those between 150% and 400% of FPL, and $13,243 for those above 400% of FPL.
• Median available liquid assets among multi-person households were $698 for those below 150% of poverty compared to $2,996 for households between 150% and 400% of poverty, and $23,439 for households with incomes of 400% of poverty or more.
• 84% of multi-person households with incomes <150% of the FPL lack $4,000 in liquid assets
• 50% of households could not afford a basic employer insurance plan deductible ($2000)
• 2:3 households lacked funds to covered a high-end deductible ( $6000)

Deductibles, co-pays, co-insurance are common means of health plan cost-sharing. However, what happens when healthcare consumers are unable to pay them? A recent study by the Kaiser Family Foundation revealed the sorry truth: health plan enrollees are too often unable to access the care they need, or forced into medical debt and bankruptcy to do so. In a time when strong efforts are in play to bridge healthcare disparities and ease access to care, that reality remains an elusive butterfly for too many individuals.

Most households lack sufficient liquid assets to meet an out-of-pocket maximum. Some might recall that the Affordable Care Act limited out-of-pocket maximums for most private health insurance plans: $8700 for single coverage, $17,400 for family coverage. This is appalling considering the Affordable Care Act set out-of-pocket minimums, yet the average out-of-pocket maximum for single coverage in 2021 was $4272.

Rising Medical Debt
Amid the pandemic, high numbers of persons faced emergency medical bills from care, whether related to COVID-related costs, or deferred health and behavioral issues. Roughly 62% of households with incomes between 150% and 400% of the poverty level were unable to afford care or access the approximately $3000 needed to cover urgent care costs.

Recent reports show dismal results for persons dealing with psychosocial challenges, as well as rising medical debt:
• >50% of Americans experience medical debt
• >57% owed over $1000
• 40% had problems paying medical bills or affording premiums
• 65% who earned <$40,000 and 51% earning $40,000 to $75,000 could not afford premiums despite having employer-sponsored coverage.

• >51% of persons with employer-sponsored plans reported someone in their household delayed or skipped care, or filling a prescription due to the associated expense
• 26% of adults with an employer-sponsored plan had to cut spending on food, clothes, or other household items to pay their health-related expenses.
• 20% took on an additional credit card debt to pay their expenses

The rising numbers of persons challenged by cost-sharing options must be resolved. This reality only adds to the growing tally of persons struggling with social determinants of health and mental health, countering efforts to attain health equity. More must be done to enhance access to care for every person across the wholistic health landscape of physical, behavioral, and psychosocial health.

Managing the Doomscrolling Dichotomy

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope. The dynamic is impacting rising numbers of persons across the globe, along with their physical and behavioral health; this includes the professional workforce. Here are 5 ways to manage the doom scrolling dilemma.

A versions of this article was initially published by the CGI Newsletter, and appears with permission.

You have a break in the day and decide to catch up on your favorite social media feeds;  suddenly it’s 30 minutes later. What began as a look at your BFFs Facebook feed spiraled to viewing headlines, graphics, and disturbing images of recent events. You are sucked into a vortex of posts across platforms and apps, distracted from everything on your calendar: social, occupational, or education activities. Emotions bubble up: anger, bewilderment, frustration, rage, sadness. You become unable to focus, sleep, and feel crispy around the edges. Welcome to the world of doomscrolling: a dynamic impacting rising numbers of persons across the globe.

What it Means

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope.  Society has been exposed to a pervasive cycle of negative news these past two years including the pandemic, cultural, racial, and ethnic disparities, and the recent Ukraine crisis. It becomes easy to get caught up consuming mass quantities of online news in a single sitting.

The impact of these events on our wholistic health is telling. Growing studies speak to rising incidence of severe anxiety, depression, and psychological distress from over-consumption of pandemic-related media (Bendau et al., 2021). Daily social and traditional (e.g., new portals, magazines) media use exacerbates onset and exacerbation of depression and post-traumatic stress disorder (Price et al., 2022). Poor mental health negatively impacts sleep, putting further stress on the immune system; the interconnection between psychopathology and chronic illness is well-documented in the literature (Isvoranu et al., 2021).

The professional workforce walks a slippery slope with the doomscrolling dilemma, particularly those in behavioral health, integrated care, and related roles. Practitioners are faced with increasing numbers of patients seeking treatment for anxiety, depression, insomnia, and other symptoms related to the negative news cycle. Yet, each practitioner, is also a human being, striving to set limits on their own over-exposure to the media. Balancing professional self-care with respect for patient autonomy and rendering of effective treatment becomes the sharpest of double-edged swords. Professionals must limit their (over) exposure and potential collective occupational trauma, while intervening effectively with patients: an ethical dilemma of its own!

Why We Do It

            One quick answer is, misery loves company. Reading about negative events validates negative feelings felt by individuals. The more one seeks to satisfy this need, the more doomscrolling advances to addictive habit. Striving to stay informed about current events devolves into a vicious cycle where stress increases and cortisol levels rise. A myriad of health issues can result: increased blood pressure and glucose levels, migraine headaches, insomnia, or autoimmune disorders (e.g., lupus, multiple sclerosis, rheumatoid arthritis, Sjögren’s syndrome).  

What to Do About It

Here are 5 strategies to inform your efforts:

  1. Limit Social Media Bandwidth: Read one article in the morning, listen to a podcast from that favorite platform (or news outlet) you trust. 
  2. Take Social Media Breaks: Don’t get sucked in or your energy will be sucked out. You may stay off social media certain times of the day, or for longer periods of time (e.g., during the workday, weekends, or for several months).
  3. Use Body Scanning, Breathing, and Other Trauma-informed Tactics: Doomscrolling can trigger prior traumas. A colleague recently shared how use of trauma-informed interventions made the difference, for both clinician and patient. Regular body scans are an asset: take that nice deep breath, then start at the top of your head and move down your body. Note any sensations that appear: ringing in your ears, pressure around or behind your eyes, a tight neck or back, tingling in your chest or gut. 4-7-8 breathing is an asset as well. 
  4. Sleep Hygiene Strategies: Doomscrolling and insomnia are a dyad. Sound strategies that address both disruptors include:
    • Declare a screen-free sleep space.
    • Keep traditional items nearby, such as a notepad or book. Jot down thoughts that wake you up or read to tire your eyes without using a digital screen.
    • Detox devices by turning off notifications and removing apps; block apps and distracting websites using Freedom or other like-platforms. 
    • Avoid heated or emotional posts within an hour of bedtime
    • Keep screen-free hours one hour prior to bedtime and over the sleep cycle.
  5. Stay Proactive and Consistent: It is easy to fall off the Doomscrolling wagon. Stay vigilant; like any addiction, it won’t take much to fall down the rabbit hole and re-engage. Take control of doomscrolling before it takes control of you!

Have other thoughts? Feel free to add them below!

Empowering Your Healthcare Entrepreneur Within

Being an entrepreneur takes passion, professional vision, and energy What else must you consider? Here are 11 entrepreneurial lessons to follow.

What does it mean to be an entrepreneur as a health care professional? What does it mean to put yourself out there with a business, where you brand your unique presence, products, and/or services? I’ve pondered this through my own journey these past 18 years, and know I’m not alone. I have at least one conversation weekly with other professionals and students about my entrepreneurial path , with curiosity about:

·       The role 

·       What it involves 

·       How to get started 

·       How to keep it going, and especially

·       How not to fail.

Amid the “Great Resignation”, or as fellow entrepreneur (and my esteemed professor) Dr. Fanike-Kiara Olugbala Young calls it, the “Great Awakening, the workforce is pondering new career paths and options. To this end, I want to share information and lessons to guide your entrepreneurial journey.

What’s an Entrepreneur?

The definition says it all: “a person who organizes and manages any enterprise, especially a business, usually with considerable initiative and risk.”

My fellow entrepreneur’s say, ‘I wanted to make a greater impact, or difference for the workforce”. For me, the journey began with a desire to provide colleagues necessary knowledge to be successful in the ever-changing industry. Being an entrepreneur involves energy, initiative, expertise, and creative vision. It also involves a comfort with taking risks; financial risk, and risk to professional reputation. Each type of risk influences the other; if you are unable to operationalize your vision successfully, you won’t earn money. Inversely, if you aren’t prepared to invest a little money, you won’t be able to clearly implement your vision. 

Traditional academic health and human service degrees don’t feed the entrepreneurial spirit. There are few, to any formal courses on ‘forging your passion’. In fact, the entrepreneurial spirit can be unintentionally discouraged in formal degree programs, at least until the budding professional gains experience. Many innovative minds enter colleges daily, yet required content defined by academic accreditation takes priority. As an educator, I value the importance of theory and application. Yet, the growth of non-traditional professional paths mandate a way to empower distinct talents of budding entrepreneurs, sooner than later. 

Starting the Entrepreneurial Journey

One of my favorite quotes is, “The light at the end of the tunnel isn’t an illusion, the tunnel is” (Author unknown). This sentiment perfectly addresses the transition from full-time employee to full-fledged entrepreneur. The journey starts with a traditional job; you graduate with your degree and start a career. Yet, the rigor and routine begin to weigh heavily, and take their toll. The once, enthusiastic health care professional gets the itch to shift gears.

Underneath your frustration, passion takes root, and you long to do more than your current position will allow. Passion flourishes as you write a blog, article, give a presentation or webinar on a unique project. Word spreads about your unique perspective! Engaging in a different focus ignites more passion than you ever thought possible, and attracts attention. Conversations with other entrepreneurs empower you to develop a business plan, market your vision and you’re off; Leaving your full-time gig goes from dream to reality

Ellen’s 11 Entrepreneurial Lessons

Here are 11 lessons to kick-start your efforts. I welcome all entrepreneurial colleagues to add to the list, and know they will! (hear that Michelle G. Rhodes, Deanna Cooper Gillingham, Thomas Dahlborg, Wilson Hurley!)

Lesson #1: Give yourself permission to be an entrepreneur-this is the toughest leap to make. Let’s face it, you need to earn a living. You may sit in your office and daydream for months, or years before taking the plunge. Don’t wait so long that someone else comes forth with your great idea. Give yourself permission to consider options beyond the safety net of your full-time job.

Lesson #2: Define and own your passion-You may have a clear sense of what you want to do. For others, the idea may come when least expected. For me, a switch went off one day in 2004. I saw my enthusiastic colleagues suddenly look fried to a crisp. Organizations were cutting professional education, taking away a vital benefit for the workforce. With many conversations about how to improve health care quality, I wondered; how could any quality care occur without a knowledgeable workforce. BOOM! As a result, every contract I take, every presentation or training I develop, every article or book I write, and class I teach is consistent with my vision. What fun to empower the knowledge-base of my colleagues each day, plus the students entering our ranks. Remember, if you have fun with what you do, you will never feel like you’re working! 

Lesson #3: You don’t have to go from 0-60! It is ok to start slowly. Perhaps you keep your full-time job and do consulting on the side. Get a sense of who you are, your unique talents, and how much time and energy you want to invest. You may not be ready to go, full-time entrepreneur. Write a blog on a topic of interest, or give a presentation. Who knows where it will lead!

Lesson #4: Organize and focus your efforts- Passion can easily run amuck and take us in many directions. I’ve seen colleagues embark on their entrepreneurial journey with all the passion and purpose in the world, though become overwhelmed as they try to tame their newly unleashed energy. Start small, define your professional identity and brand, then you go global. 

Lesson #5: Tout your clout!– Inform the industry who you are and what you do. Be organized and strategic. Create a website with clear messaging unique to you! Consider, how is what you do is different from others? Who is your target audience? What do you want them to know about you? Leverage social media, your messaging, and grow that presence!

In addition, since being an entrepreneur is not just any job, develop a 30 second elevator speech. When someone asks, ‘what you do you do?’, be prepared to respond. I often say, “I empower the health care workforce through professional training, mentoring, and consultation”; succinct and to the point. What would your elevator speech be?

Lesson #6: Being an entrepreneur takes a strong work ethicOrganization and consistency become your mantras; end of discussion.

Lesson #7: Never underestimate your value and worth-Consider what to charge for the services you offer. Ask around and investigate the competition. See what is realistic for your region, or specialty. You may decide to do a schedule of options, offer professional courtesy or pro bono opportunities; your business and vision are an extension of you!

Lesson #8: Develop, and maintain a network of mentors-Being an entrepreneur gets lonely. Surround yourself with colleagues you trust for their guidance, plus unconditional support. They have to be honest with you, even if you don’t like what they have to say. Also, join professional associations and networks that foster your connection with others with like minds!

Lesson #9: Set limits and a sound schedule-Once you find your passion and love what you do, it becomes tough to stop working. I remember hearing, I could work longer hours since I set my own hours; so very true. You can burn out as an entrepreneur, as readily as you can in a traditional role, so be mindful! Being an entrepreneur comes from the unique energy within you. Nurture that inner soul and energy so your passion, purpose, patience don’t fade. 

In addition, learn to say no, or negotiate the date of deliverables. Back to that financial risk topic; you get paid when you work, or engage in successful products that will reap royalties. Fiscal vulnerability can push you to take on too much work, or work that you wish you hadn’t. Practice saying, “NO”, or “I’d love to do that project for you, but can only do it in March vs. January.”, or, “I only want to give you a quality product, and will need an extra week to do that”. You are in charge of your reputation, and destiny!

Lesson #10: There will be peaks and valleys-Financial scheduling is important, so prepare for inconsistent income. Be proactive vs. reactive, so diversify your business to allow for different revenue streams. In my case, I have contracts of different types and payment schedules to provide a cushion when I need it. 

Lesson #11: Be open to all possibilities-Our passion is a blessing and curse; it can expand our opportunities, though also limit our scope. Opportunities that may at first, seem daunting, could turn into important projects.

I never thought of writing a book; articles, yes, but never a book. After co-authoring three articles on the same topic with a colleague, my mentor, Suzanne Powell said, “just write the book.” and we did!  COLLABORATE for Professional Case Management was born. My ethics and health equities core beckoned: I have now authored 3 books with next editions in the works: The Essential Guide to Interprofessional Ethics for Health Care Case Management (2019) the Social Determinants of Health: Case Management’s Next Frontier (2019) and End of Life Care for Case Management (2020). I’m writing my 5th book for publication in Winter, 2023: The Social Determinants of Mental Health: Advancing Wholistic Practice Excellence.

What else do I do? A Google search or glimpse at my LinkedIn Bio will fill you in; every day is different and uniquely inspiring. How high can you fly? That’s up to you. The world is your oyster: GO GRAB IT!

Have other entrepreneurial lessons to share? Add them below~

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