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Where Did Dr. Google Get Her Medical Degree?

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The flippant title aside, according to a 2012 Pew Research survey 35% of adults in the U.S. have gone online to diagnose a medical condition.  Another study found that of the 60% of adults aged 55 and older who reported using the internet in 2012, 80% looked for health information online.

It’s no surprise that using the Internet for health information has increased over time. This is true across the board even though there continue to be differences in Internet use by age, education, and income. This use of online sources is likely to continue so it’s worthwhile learning more about it.

What does health-related information use look like?

One of the nice things about Pew is that you can download their data and play with it yourself. (Those of you have followed this blog in the past know that I love to play with data).  So I did.

The Pew Research  September 2012 Health Tracking survey

The sample for this survey included 3,014 adults in the US. Their age ranged from 18 to 99 with an average of 53.  Over half were married or living with a partner. About a quarter had never been married and the remainder were divorced, separated, or widowed.  A small proportion had less than a high school education, half had a high school degree or some college, and 37% a college degree or higher. Almost three-quarters were White, 19% Black/African American, 3% Asian/Pacific Islander, 1% Native American/American Indian, and 3% identified as mixed race. Over half had less than $50,000 in family income.

The survey includes a range of questions about health, caregiving, and Internet use.  I focused on the Internet use questions that seem most relevant to my interests of older adults and caregivers, although here I look at the full sample, not just older adults.

Communicating with others

  • Among those with a serious health issue, about three-quarters reported getting information from a health professional, 62% got information and support from family and friends, and 24% got information from others with the same condition.
  • Most people made these contacts offline. However almost one-third used both on and offline methods with family and friends or with others with the same condition.
  • More of those without a chronic illness used both on and offline methods to get info from family, friends, and others with the same condition. It seems like people with more health issues are more likely to stick to traditional offline communication and information gathering.

Caregivers

  • Over half of the sample reported providing unpaid care to an adult relative or friend in the past 12 months. Sixty percent of those said the Internet was helpful in providing care overall and half said that the Internet helped them cope with the stress of caregiving.

Types of information

% who said they looked for different kinds of health-related information on line

67% of the sample said they looked online for some type of information. Looking online for information about a specific disease or medical problem or certain treatments or medical procedures were most common. Not surprisingly, a higher proportion of people who had a chronic illness or were caring for someone reported looking online for information across all categories.

It seems like Dr. Google has a pretty good practice going.  That is not necessarily a bad thing as long as people pay attention to the sources they are pulling information from and evaluate the quality of that information.  Of course, we all know how easy it is to find unreliable and inaccurate information online and sorting out what’s credible and what’s not can be hard.  Going to sources like the Mayo Clinic and the National Institutes of Health or organizations that focus on a particular illness, such as the National Stroke Association, can be one way to insure you’re getting solid information.

Talk with your doctor about medical information you gather online.

Of the people who said they went online specifically to figure out what medical condition they might have, half said the information convinced them they needed to see a doctor.  Of those 67% said they actually talked with a medical professional about what they found. That was actually more than I would have guessed, but still raises questions for me about how people are evaluating and using medical information they find online.

What do you think? Do you use Dr. Google? If so, how?

What Medicaid covers and what the Republican plan will change

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Medicaid is not part of the Affordable Care Act. It’s been around since 1965 when President Johnson signed both the Medicaid and Medicare bills into law.  It’s future, however, has become tied to that of the ACA because of Medicaid expansion.  That’s the part of the ACA that gave states the option of expanding who qualified for Medicaid. In the 32 states that did this, 11 million newly eligible adults gained coverage.

Medicare, Medicaid, the Children’s Health Insurance Program, and Affordable Care Act marketplace subsidies together accounted for 25% of the budget in 2015. About 2/3 of this went to Medicare which provides health coverage to people over 65 and those with disabilities.

The Republican health care plan would shift Medicaid funding to a block grant model that would cap the amount of federal funding each state gets. These caps would not take into account state level differences in things like population demographics or health care prices.  This means states will have less flexibility than they currently have in who they fund and at what levels and states will be less able to respond to changing needs. This effects a significant number of our fellow citizens.

Medicaid provides health coverage for 1 in 5 Americans.

This includes:

  • Children
  • Pregnant women
  • Parents of dependent children
  • Other adults with disabilities or other long-term care needs

Eligibility ranges from less than 50% of the federal poverty level depending on which of these groups you fall into and what state you live in.  The federal poverty level for a family of three in 2017 is $20,420.

Chart depicting percent of different populations with Medicaid coverage

Medicaid is the main source of financing for long-term care in the United States.

This can include older adults as well as people with disabilities and chronic health conditions that limit their daily functioning.  Long-term care services help with daily self-care like eating and dressing and household activities like meal prep, cleaning, and managing medications.

Long term care may be provided in an institution like a nursing facility or a group home, but can also be provided in the individual’s home. In fact, most long-term care is provided by unpaid caregivers like family members with the help of home and community-based services.  These esrvices keep people who would otherwise be in nursing homes living independently in the community.

In 2015, the typical cost of a year in a nursing facility was $91,000.

The number of people needing long-term care is growing.

So what is likely to happen under the Republican plan?

A number of things are likely to happen as state budgets feel more pressure from the federal caps.

  • Reduced coverage and access to care for low-income people
  • Higher out-of-pocket costs
  • Increased uncompensated care costs for hospitals and other providers which will be passed on to other health care consumers
  • Reduced access to long-term care for older adults and people with disabilities.

There could also be negative effects on health care premiums more generally.  Marketplace premiums in states that expanded Medicaid are about 7% lower than in non-expansion states.  This may be because including a wider range of people in Medicaid changed the compensation of the risk pool in these states.

There you have it.  And because it is #justthefactsfriday and I don’t know everything, corrections, additions, and conversation are welcome.

What’s on the horizon for health care reform?

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Posters saying "Health Care for American Now!" and "Health Care Can't Wait!"There’s been lots of bluster about repealing and replacing the Affordable Care Act since the day it was enacted.  The reality of actually doing it is apparently turning out to be a bit more  . . . um . . . complicated than anticipated.   This week Senator Rand Paul engaged in a little theater with the Great Health Care Bill Hunt. It seems that either Republicans are being ridiculously secretive about what’s in the works – even with members of their own party – or there’s no viable legislation available to share.

In either case, the big talk without concrete details is making people nervous. The best guess of what proposed legislation would look like is Paul Ryan’s plan put forward in June 2016.  This plan would, among other things:

  • Remove individual mandates to have coverage, but continue to prohibit insurers from denying coverage based on pre-existing conditions. Without an individual mandate, premium costs are likely to increase dramatically because insurers are covering more sick people and therefore have more costs which they will need to pass on.  Or insurers will just bail and people will lose coverage entirely.
  • Provide a flat, age-adjusted tax credit for those without coverage through an employer, Medicare, or Medicaid. Flat means you get the same amount regardless of your income unlike the ACA where credits were paid on a sliding scale. So if my income is $1000 a month and your income is $4000 a month and we need to buy insurance that will cost us $300 a month we both get the same amount of credit.
  • Repeal ACA cost sharing subsidies that reduced deductibles, copays, and out-of-pocket limits for qualified households. So not only do you and I get the same amount of help with paying for premiums, but we also have the same deductibles, copays, and out-of-pocket limits despite our vastly different income.
  • Push the use of high deductible health plans. These plans have cheaper monthly payments, but require that you pay a lot up front when you need care.  Payments for out of network services do not count toward that deductible.  In 2017 the minimum annual deductible for high deductible plans is $1300 for an individual and $2600 for family coverage. The maximum annual out of pocket expense is $6,550 for individuals and $13,100 for families.
  • Push the use of health savings accounts. You put money in your account pretax and then draw on it for copays and other approved expenses. What expenses would qualify under Ryan’s plan isn’t clear. In 2017 the maximum annual contribution to a health savings account is $3400 for an individual and $6750 for a family so you better hope your expenses aren’t any more than that.

There are also lots of changes to both Medicare and Medicaid proposed that deserve individual posts of their own.

You can learn more through the Kaiser Family Foundation  or read Ryan’s policy paper.

And because it is #justthefactsfriday and I don’t know everything, corrections, additions, and conversation are welcome.

Mandate Schmandate

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I’m embarrassed to see that I’ve posted very little here since my post-election big words that I haven’t lived up to very well. I have lots of posts drafted. I even did a BlogoWriMo challenge in November with some friends and got twenty posts in various stages of done. But every time I sit down to actually post something I feel overwhelmed and underwhelmed all at once (is that even possible?!).

I started this website with the intention of sharing research on aging-related issues. I wanted to get evidence for good services for older adults and their caregivers out to a bigger audience than other academics. But, frankly, right now it seems so futile I lost my blogging mojo.  Evidence doesn’t really rule the day right now and there are others (Robert Reich, Ronni Bennett, Charles Blow to name a few) who are much more knowledgeable and eloquent about the current state of affairs than me.  Frankly, it’s easier to pass on their words than to put together my own.

But this isn’t the time for easy, is it?

So yesterday I started writing a post about the research on Health Saving Accounts. Do they work, for whom, etc.?  (Short story – they come and go in popularity, but do not appear to control health care costs as some argue they will and they increase the numbers of the uninsured because – duh – you have to have money to save money.  Poor people and sicker people get screwed. Again.)

In case you can’t tell, I quickly became overwhelmed again (at the complexity of the problems we face) and underwhelmed again (at the ability of my little 500 word blah blah blahs to make any difference).  Even as I started thing about HSAs again this morning I awoke to the news of the Senate passing budget legislation that starts the push to repeal the Affordable Care Act and my sense of the futility of it all grew.

This time, however, I poured some coffee, pulled a big old cat into my lap, and started writing this:

To the Republican talk of a mandate to repeal the ACA – I call bullshit.

They did not win the presidency in a landslide as much as someone likes to claim they did. The country is split pretty much evenly on their support for the ACA (not surprisingly those differences fall along party lines). And the budget legislation passed in the Senate in the week hours this morning by a small margin (51 to 48). There are Republicans in the House who aren’t entirely on board – at least not with a rushed repeal (January 27 is the current deadline) without a clear replacement.

There are millions of Americans currently covered by the ACA (whether they know it or not) and a big chunk of those people are in Republican Congressional districts.  What happens when those people no longer have coverage, I wonder?  And why the rush?

Map of enrollment in ACA by Congressional districts.

Kaiser Family Foundation

Could it be that Republicans realize that rather than a mandate they have an unpredictable and volatile President who just may do something wacky between now and the mid-term elections?  Could it be that they want to push through as much as they can before that happens?  After all, 33 seats will up for reelection in the Senate, all of the 435 seats in the House, and 36 states will have elections for Governor.

Senator Roger Wicker (R – MS) said yesterday of the rush to repeal the ACA, “This is our opportunity . . . to show to the American people that elections have consequences.”

Yes, they do Senator Wicker. Yes, they do.