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<ul class="summary-list"><li>Lisa Jolly pays less for her health insurance thanks to enhanced premium tax credits.</li><li>These subsidies aim to reduce the price of health insurance purchased through the ACA marketplace.</li></ul>When Lisa Jolly enrolled in the <a target="_blank" class="" href="https://www.businessinsider.com/biden-expanding-obamacare-without-congress-health-coverage-2022-4">Affordable Care Act</a> marketplace, it was a lifeline, she said.Jolly, 55, was diagnosed with type 1 diabetes when she was 32 years old. Since then, she's had compounding health concerns, including neuropathy, stage 3 kidney disease, and anemia.For most of her life, Jolly was insured through her ex-husband's employment. But when they <a target="_blank" class="" href="https://www.businessinsider.com/divorced-boomers-lower-retirement-savings-401ks-social-security-income-2024-10">divorced</a> in 2021, she lost that coverage."I was probably near tears every day, wondering what in the world I was going to do," she said.Jolly enrolled in the ACA marketplace the following year and qualified for enhanced premium tax credits, which aim to reduce the price of health insurance purchased through the ACA marketplace. She pays $96 monthly for healthcare coverage, according to documents reviewed by Business Insider."I just remember being extremely grateful and almost astounded that there was something out there that was going to help me be able to afford health insurance," she said.Jolly is among the millions of Americans who use the enhanced premium tax credits to afford healthcare coverage and who could see costs rise next year if the subsidies expire.According to the Center on Budget and Policy Priorities, <a target="_blank" class="" href="https://www.businessinsider.com/millions-americans-lose-health-insurance-subsidies-congress-presidential-election-2024-9">19.7 million ACA enrollees</a> qualified for enhanced premium tax credits this year, which is 92% of all ACA enrollees. Additionally, the enhanced premium tax credits cut consumers' costs by about 44%, saving the average enrollee $705 annually, according to a <a target="_blank" class="" href="https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/">report</a> published on July 26 by KFF, a nonprofit health policy group.The subsidies were introduced in 2021 as a temporary measure and expanded eligibility to include enrollees with incomes above 400% of the federal poverty line — which is $60,240 for one individual and $124,800 for a family of four. In 2022, the Inflation Reduction Act extended the subsidies through the end of 2025.According to a Center on Budget and Policy Priorities analysis shared with Business Insider, without the enhanced premium tax credits, Jolly's monthly payments could increase to $275, a roughly 186% jump."It would just have an enormous negative impact on my life," Jolly said.<h2 id="4569c228-efc2-46ce-bac2-07c53459536a">Subsidies helped Jolly afford healthcare coverage</h2>Jolly lives in Steubenville, Ohio — a city about 30 miles west of Pittsburgh — with her 24-year-old daughter, Jessica. Jolly bought a small house in September 2023, using the funds she received from her divorce settlement.Jolly receives a monthly spousal settlement payment, which is her only income. Due to her health complications, Jolly said she is unable to retain a full-time job. She said she is trying to land a part time job as a teaching assistant, but her health issues mean she is often faint and unable to concentrate for extended hours.Jolly said she isn't eligible for many social safety nets. Additionally, she said she's burned through her savings."I'm struggling," Jolly said. "When I combine rising grocery costs with rising insurance costs, it just becomes almost unbearable."<h2 id="ec005901-4bba-4522-bd8a-c2e31c9f82d3">The subsidies expiration could pose difficulties for millions of Americans</h2>The results of the November election could determine the fate of the enhanced subsidies. On September 25, Democratic Senators Jeanne Shaheen and Tammy Baldwin introduced the Health Care Affordability Act, which would make permanent enhanced premium tax credits. Rep. Lauren Underwood, another Democrat, introduced an identical bill in the House.The bills would have to pass both the Senate and the House and then be signed into law by the president to come into effect. It's <a target="_blank" rel=" nofollow" class="" href="https://www.washingtonpost.com/health/2024/09/25/aca-health-plan-subsidies/">unclear when a decision</a> on the tax credits will be reached.Republican lawmakers oppose the subsidies' cost to taxpayers. The Congressional Budget Office and Joint Committee on Taxation <a target="_blank" href="https://www.cbo.gov/system/files/2024-06/60437-Arrington-Smith-Letter.pdf">estimate</a> that making the policy permanent would increase the budget deficit by $335 billion over the next 10 years.Cynthia Cox, a vice president at KFF, previously <a target="_blank" class="" href="https://www.businessinsider.com/millions-americans-lose-health-insurance-subsidies-congress-presidential-election-2024-9">told</a> Business Insider that Congress might end up with a divided House and Senate after the election, making it difficult to pass a bill."There's a pretty significant chance that there's going to be a divided power in Washington, and then it's really anyone's guess what happens to these subsidies, but it would probably be an uphill battle to renew them," Cox said.The Congressional Budget Office estimates that 3.8 million people could become uninsured if the enhanced subsidies expire, according to <a target="_blank" href="https://www.reuters.com/business/finance/rate-us-uninsured-rise-89-next-decade-congressional-budget-office-says-2024-06-18/#:~:text=Enhanced%20subsidies%20for%20plans%20introduced,the%20expiration%20of%20marketplace%20subsidies.">Reuters</a>.For enrollees like Jolly, the hundreds of dollars saved each month have been crucial to affording coverage."If we didn't have them, I don't know how I would have survived day-to-day," Jolly said. "It just would have meant total ruin for myself, and I'm not even talking economically, but I mean health-wise, too."

Subsidies help a 55-year-old pay $96 a month for health insurance. Her costs could increase 186% if they expire next year.

<ul class="summary-list"><li>Trump said he plans to change the Affordable Care Act, which provides healthcare for 45 million Americans.</li><li>His past actions include ACA opposition. He has flip-flopped on Medicaid and Medicare cuts.</li></ul>Donald Trump's return to the Oval Office could mean changes to Americans' healthcare coverage, based on his previous comments and actions while president.During his recent campaign, Trump promised to <a target="_blank" class="" href="https://www.businessinsider.com/what-us-economy-would-look-like-with-trump-biden-presidency-2024-5">make changes to the Affordable Care Act</a>, colloquially called Obamacare, but did not give specifics."If we can come up with a plan that's going to cost our people, our population less money and be better healthcare than Obamacare, then I would absolutely do it," Trump said at the presidential debate in September.As president, he will also have the power to influence America's healthcare landscape, including insurance coverage, drug price negotiations, government <a target="_blank" class="" href="https://www.businessinsider.com/fluoride-in-water-why-it-is-controversial-risks-benefits-2024-11">health and safety regulations</a>, and reproductive healthcare access.Trump has a <a target="_blank" class="" href="https://www.businessinsider.com/healthcare-investors-torn-on-trump-second-term-2024-11">mixed record</a> on supporting government health insurance policies like the ACA, which the Department of Health and Human Services estimated covers 45 million people in health plans like <a target="_blank" class="" href="https://www.businessinsider.com/medicare-changes-increase-costs-deductibles-prescription-drugs-premiums-copays-2024-10">Medicare</a> and Medicaid. Also in the hot seat: the enhanced federal ACA subsidies, which are <a target="_blank" class="" href="https://www.cbsnews.com/news/trump-aca-subsidies-health-insurance-affordable-care-act-congress/">set to expire</a> at the end of next year.If Trump doesn't extend the enhanced subsidies policy, which helps many low- and middle-income Americans pay for medical care, the Congressional Budget Office estimated that <a target="_blank" href="https://www.cbo.gov/system/files/2024-07/60523-2024-07-premium-tax-credit.pdf">nearly 4 million people </a>will lose their coverage in 2026 because they won't be able to afford it.Trump's transition team told Business Insider in a statement that he will "strongly protect" Medicare in his second term — although he has <a target="_blank" class="" href="https://www.businessinsider.com/trump-cutting-medicare-social-security-benefits-2024-3">previously suggested cuts</a>. Any changes to Medicaid and Medicare under Trump could also cause those with ACA insurance see a reduction in their care options.<h2 id="69e6831b-4c89-4dd9-8ec0-501ab8666185">Medicare, Medicaid, and preexisting conditions</h2>Trump has not provided specifics about his affordable healthcare policies, beyond saying he has "concepts of a plan" at the September debate.During his first term, Trump backed a rejected Supreme Court case to overturn the Affordable Care Act, which former President Barack Obama passed in 2010 and that expanded Medicaid coverage for low-income Americans and Medicare coverage for older Americans. ACA's other marquee change required insurance companies to cover care for individuals with preexisting conditions, like asthma, heart disease, and diabetes.Yunan Ji is an assistant professor and economist at Georgetown University with an expertise in healthcare policy. She told BI that reducing or repealing ACA coverage — which Trump proposed during his first-term — could be detrimental to Americans with preexisting conditions, who may lose their coverage or have to pay more for healthcare."We purchase insurance to protect against future risk," Ji said. "If we make people go into a different risk pool when they require care for some medical condition, that defeats the purpose of insurance."Trump has also voiced support for privatizing more of the healthcare sector. This could mean some Americans on ACA plans could face higher out-of-pocket costs and fewer in-network care options.President Joe Biden's <a target="_blank" class="" href="https://www.businessinsider.com/house-passes-inflation-reduction-act-sending-it-to-biden-2022-8">Inflation Reduction Act</a> also took steps to lower the cost of prescription drugs and cap out-of-pocket costs for Medicare beneficiaries. The legislation <a target="_blank" href="https://www.axios.com/2024/02/07/trump-medicare-price-negotiations-executive-power">requires</a> Trump to continue existing drug price negotiations through at least the end of 2025.<h2 id="1380ef19-42c4-43c1-841e-04dcb5227dd9">Reproductive and gender-affirming care</h2>Trump has said he would take steps to <a target="_blank" href="https://www.nbcnews.com/politics/2024-election/trump-vows-stop-gender-affirming-care-minors-re-elected-president-rcna68461">ban all gender-affirming healthcare and hormone therapies</a> for minors, which ACA plans cover in some states.<a target="_blank" href="https://www.businessinsider.com/what-is-project-2025-conservative-political-playbook-heritage-foundation-trump-2024-7">Project 2025</a>, a policy plan proposed by Trump allies, calls for significant national restrictions on abortion and birth control. Trump has expressed support for federal enforcement of the Hyde Amendment, a rule that prevents Medicaid from covering abortion pills and procedures. Among the <a target="_blank" class="" href="https://www.kff.org/womens-health-policy/dashboard/abortion-in-the-u-s-dashboard/">37 states and DC</a> that do not ban abortion, <a target="_blank" href="https://www.kff.org/medicaid/state-indicator/abortion-under-medicaid/?currentTimeframe=0&amp;sortModel=%7B%22colId%22:%22Follows%20Federal%20Standard,%20Funding%20Only%20Cases%20Involving%20Life%20Endangerment,%20Rape%20and%20Incest%22,%22sort%22:%22desc%22%7D">17 states and DC</a> currently follow the Hyde Amendment.Trump has called for federally-subsidized in-vitro fertilization — a proposal that is divisive among Republicans.<h2 id="f6dc24d6-1b01-41c0-99ba-9603db98ef3f">Insurance regulations and national health policy</h2>Ji said that Americans often focus on the sticker price of premiums in their healthcare plan — how much they are expected to pay out-of-pocket each month or year. But a Trump presidency would also shape rules and regulations for insurance companies. For example, companies are required to cover a wide range of providers, so someone with heart disease can find an in-network cardiologist in their area.Ji added that Trump's cabinet appointments will give insight into his second-term healthcare priorities. His leadership selections will determine federal investment in medical research, health and safety guidelines, insurance company regulations, and vaccines. Trump is expected to <a target="_blank" href="https://www.nbcnews.com/politics/2024-election/trump-banning-vaccines-president-rfk-fluoride-rcna178570">discourage vaccinations</a> and limit federal health and insurance regulations.Trump tapped <a target="_blank" class="" href="https://www.businessinsider.com/trump-robert-f-kennedy-jr-rfk-department-health-human-services-2024-11">Robert F. Kennedy Jr.</a> on November 14 to lead the Department of Health and Human Services, a decision that will require Senate approval. Kennedy has not outlined specific plans to increase healthcare affordability, but he would have some influence over the ACA in the role. The former presidential candidate is a vaccine-skeptic, who Trump hopes will "<a target="_blank" class="" href="https://www.businessinsider.com/how-rfk-jr-plans-to-make-america-healthy-again-2024-11">go wild</a>" on health, safety, and food protocols.Any major changes to healthcare policy and federal budgets would need to be approved by Congress. Trump will likely have the support of a Republican-led Senate and House."The American people re-elected President Trump by a resounding margin giving him a mandate to implement the promises he made on the campaign trail," Karoline Leavitt, a spokesperson for the Trump-Vance transition team, told BI in a statement. "He will deliver."Are you doing anything to prepare your finances or healthcare plan for Trump's second term? If so, please reach out to this reporter at <a target="_blank" class="" href="mailto:allisonkelly@businessinsider.com">allisonkelly@businessinsider.com</a>.

Trump's plans to change healthcare could slash insurance for some low-income Americans and retirees

<ul class="summary-list"><li>Many companies don't have cyber insurance because of costs, but the market is growing.</li><li>Cyber insurance can help companies recover financially from cyberattacks and data breaches.</li></ul><a target="_blank" href="https://www.businessinsider.com/guides/tech/what-is-a-cyber-attack">Cyberattacks happen every day</a>, and any company that relies on technology to conduct business is at risk. But one way leaders can minimize the impact of <a target="_blank" class="" href="https://www.businessinsider.com/how-companies-can-respond-to-cybersecurity-risks-after-layoffs-2024-9">losses from a cybersecurity incident</a> is by getting cyber insurance."All companies can benefit from having cyber insurance," said Shruti Engstrom, the senior vice president of errors and omissions/cyber at the risk-mitigation company Aon. "This is a risk that's here to stay."Cyber insurance helps organizations recover the costs of a cybersecurity incident, the global average of which IBM estimates is about <a target="_blank" href="https://www.ibm.com/reports/data-breach">$4.9 million</a>. Engstrom told Business Insider that these expenses might include shutting down production lines, computer systems, or other operations, as well as the fallout of customer information being released."If something bad happens — there's a data breach or ransomware attack — and it costs you a lot of money, you have coverage to help with that," <a target="_blank" href="https://fletcher.tufts.edu/people/faculty/josephine-wolff">Josephine Wolff</a>, an associate professor of cybersecurity policy at Tufts University, said.The cyber-insurance <a target="_blank" href="https://content.naic.org/sites/default/files/inline-files/Final%202023%20Cyber%20Report.pdf">market is growing</a>, Wolff said, but many companies still lack coverage. Here's what business leaders should know about cyber insurance.<h2 id="e78eaf2c-45e6-4e54-9e2e-14bdcdc2b1ad">The benefits of cyber insurance</h2>Cyber insurance can minimize the financial blow of a cyberattack, but it's not just about the money, said <a target="_blank" href="https://www.bitsight.com/about/our-team/stephen-boyer">Stephen Boyer</a>, a cofounder and the chief innovation officer at Bitsight, a cyber-risk-management company. Insurance also gives companies access to incident-response expertise, such as cybersecurity tools, legal assistance, and ransomware negotiation."If a company experiences a cybersecurity incident and has insurance, it can tap into a world of expertise that it may not otherwise know existed," Engstrom said.Cyber insurance is available as a stand-alone policy or incorporated into other business coverage. When a company purchases the insurance, it undergoes an application and <a target="_blank" href="https://www.usatoday.com/money/blueprint/insurance/what-is-insurance-underwriting/">underwriting process</a>, which helps leaders assess the health of their cybersecurity measures and ability to protect their firm from bad actors, Engstrom said.A better understanding of a company's risk is an important benefit of cyber insurance, Boyer said. But not enough companies, especially smaller ones, are getting the insurance, he added.One reason is the cost: The <a target="_blank" href="https://cyberreadinessinstitute.org/resources/cyber-insurance-faqs-for-small-and-medium-business/">Cyber Readiness Institute</a> estimates that cyber insurance can cost businesses $500 to $5,000 a year. But cyberattacks can be much more costly to an organization's bottom line and its reputation, Boyer said.<h2 id="c6454cb6-2ed4-4a3e-8923-2f759517c2ba">What cyber insurance does and doesn't cover</h2>Many policies offer first- and third-party coverage, and most companies need both, Engstrom said.While all policies are different, first-party insurance typically covers losses incurred because of a cyberattack. According to the <a target="_blank" href="https://www.ftc.gov/business-guidance/small-businesses/cybersecurity/cyber-insurance">Federal Trade Commission</a>, it can also cover costs such as legal counsel, forensic-investigation services, recovery of stolen data, communication with customers, fees and penalties to regulatory bodies, crisis management, public relations, and lost income.Some policies also cover ransomware negotiation and payments to hackers. However, Wolff said this is a controversial aspect of cyber insurance, as many believe it incentivizes criminals to continue launching attacks.Engstrom said third-party insurance covers legal fees and settlement costs when a customer, a vendor, or another third party seeks legal damages as a result of a cybersecurity incident."Companies that are at risk of a cybersecurity incident are almost always at risk of a related third-party conflict," she added.Boyer told BI that cyber insurance usually doesn't cover losses related to intellectual property or preexisting cybersecurity incidents. Acts of war or attacks related to terrorism, which typically affect high-level companies and organizations, are also not covered, Wolff said.Additionally, according to <a target="_blank" href="https://www.ibm.com/topics/cyber-insurance">IBM</a>, attacks caused by network failures, negligent or malicious employees, or social engineering, such as phishing scams, might not be covered.Engstrom said the policies also typically don't cover the cost of hiring more security or IT staff or upgrading cybersecurity systems to prevent attacks."Many don't realize that these long-term structural and preventative improvements are not covered under most cybersecurity-insurance policies," she added.<h2 id="3ec2bff8-ffa8-4c28-9e6a-8cdb3b73a14a">What to look for in a cyber-insurance policy</h2>Policies differ depending on the insurer, Wolff said, and companies can sometimes negotiate their coverage. So it's crucial to ask a lot of questions before signing on."One really important thing to go through with your carrier is the specific exclusions in your policy," she added. "The more you can get into the specifics of that, the less likely you are to be taken by surprise when you're trying to file a claim."Basically, make sure the policy adequately covers your level of risk, Engstrom said.Wolff suggested discussing how pricing is determined and which cybersecurity measures insurers require companies to have — some might offer lower pricing for companies with upgraded cybersecurity infrastructure.Some insurance companies also offer training or support to educate an organization's staff on cybersecurity best practices, Engstrom added.She said to also find out about the claims process: "If a company experiences a cybersecurity incident, they must understand how their insurer steps in and what kind of support is provided. Leaders need to know that their insurance company is there for them every step of the way."Ultimately, companies should understand their cyber risks and know what protection they need when purchasing insurance, Boyer said."What are you trying to protect, and what's the risk transfer?" he said. "It obviously depends on your business — some businesses are just more exposed to this sort of risk and could really have some sort of payout."

Companies without cyber insurance could be making a costly mistake

When Josef Woodman's shoulder gave out in 2012 — strained from chopping firewood on his farm outside Chapel Hill, North Carolina — he said he was quoted between $2,400 and $3,200 for an MRI at Duke University Hospital.He didn't want to shell out the cost of a nice vacation just to find out he didn't need surgery, so he decided to wait, even as his mobility decreased to the point where he had to severely limit his farm work and could hold only one-third of the weight he normally could. Two years later, his patience was rewarded: While on a work trip to Bangkok, he got an MRI for just $460, landing an appointment two days after his consultation at a hospital."The results came back and they said, 'You don't need surgery. You've got a separated rotator cuff,'" Woodman said. The surgeon prescribed physical therapy, which he completed in the US. "The shoulder got way better," he told me. He was glad he waited.Like Woodman, millions of Americans travel abroad for medical procedures each year, saving anywhere from 40% to 90% on the services they receive. Many <a target="_blank" href="https://www.amjmed.com/article/S0002-9343(18)30620-X/fulltext">don't have health insurance</a> or don't get coverage for the procedures they seek out — dental work and cosmetic procedures like breast implants and liposuction are by far the most popular. There's also a small but growing market for people seeking thorough checkups and testing abroad. An ascendant medical-tourism industry is offering these types of screenings, including MRIs and electrocardiograms, in beautiful locations around the world and packaging them with transportation, accommodations, food, shopping, and sightseeing. And with an increasing obsession with "wellness" and celebrities like Kim Kardashian promoting full-body imaging, it's easy to see why more and more Americans are looking to pair cabanas with CAT scans."If you've got some kind of joint pain, or if you have some kind of condition that isn't progressing, incorporate that into your normal travel plans," Woodman, now 72, said. In 2007, he founded Patients Beyond Borders, a healthcare-consulting company that helps Americans plan medical vacations, after growing up taking trips to Mexico for dental work with his dad. "In any kind of industrialized nation, you'd be able to get access to good-quality screening and people who can interpret the results," he said.Medical tourism comes with risks; the American Medical Association recommends going only to medical facilities recognized by international accrediting bodies and following up testing with care at home. But a growing number of Americans are willing to take those risks, as suites of tests abroad are often cheaper and faster than just a single test in the US."We just don't have a preventative-oriented society here in the United States," Woodman said. "Our approach is reactive."In a July <a target="_blank" href="https://www.tiktok.com/@bryn.elise/video/7386406512593325355?lang=en">TikTok</a> that's amassed over 17 million views, Bryn Elise documented her experience at a Turkish hospital where she received over 30 scans and tests, including an EKG, chest X-ray, and abdominal and thyroid ultrasounds, in a single day. The bill? $830. Without insurance, the cost of an EKG alone in the US <a target="_blank" href="https://enhancehealth.com/blog/how-much-does-an-ekg-cost-at-urgent-care-without-insurance/#:~:text=The%20total%20cost%20of%20an,where%20you%20get%20the%20service.">can vary from $100 to $5,000</a>."Personally, I'd rather spend $700 on a flight to Turkey, get dozens of tests there, and take a whole vacation than spend the thousands that this would have cost in the United States," Elise said in the video, which also featured clips of her on a beach, poolside, and eating a spread of delicious-looking Turkish veggie bowls. The 29-year-old health- and beauty-tourism influencer said she booked the trip because she wanted to investigate some "mysterious ailments," including brain fog, vision problems, and heart palpitations, without paying America's sky-high healthcare costs. She told her followers she had struggled with an eating disorder for 10 years and that "since our US checkups are only a tap on the knee and a blood-pressure check, I've been low-key terrified that I've caused permanent damage to my body but would never find out until it's too late."Her tests unearthed an astigmatism, early signs of osteoporosis, and "critically low" levels of vitamin B12. "The feeling of impending doom I've had due to health concerns is gone," Elise said.She chose a hospital that had been accredited by the Joint Commission International, an Illinois-based organization that has accredited over 1,000 health facilities in more than 70 countries. Dr. Paulo Neno, an international-accreditation surveyor at the commission, told Business Insider the accreditation process takes up to two years to complete and is renewed every three years. It includes a 12-part evaluation, during which a team of doctors and nurses visit the medical facility and assess everything from its operating theaters and intensive-care units to its power and water systems."We are focused on understanding how they are providing safe care for high-risk patients," Neno said.It's unclear, though, how many medical tourists visit accredited facilities, and there's still the question of whether all these tests are useful for someone who is seemingly in good health. Woodman knew he had an issue that needed to be examined, but Elise was more interested in a holistic screening regimen. One person commented on Elise's TikTok, "The hypochondriac in me thinks this is the perfect vacation. I'd go every year."Since COVID-19 came into the picture, health screenings and extensive physicals have received some buzz. Last year, Kardashian got a full-body MRI done by Prenuvo, a US chain of diagnostic clinics that offers the service for $2,500. In an Instagram post promoting it, Kardashian described it as a "life saving machine" that could detect cancer or conditions like aneurysms in their earliest stages. Especially given the <a target="_blank" href="https://www.businessinsider.com/colon-cancer-cases-doubled-young-people-2024-5">rise in colon cancer</a> among young people — a disease that can spread with no or minimal symptoms — <a target="_blank" href="https://www.businessinsider.com/get-colonoscopy-colon-cancer-symptoms-colorectal-oncologist-2024-4">early screenings</a> are on more people's minds.But Arturo Vargas Bustamante, an associate professor of health policy and management at the University of California, Los Angeles, said these kinds of rigorous tests can often do more harm than good."You may get a lot of things that you may not need based on your age profile, or you may get screenings that ultimately would find something that could lead to treatment that may harm you," he said. US guidelines on which demographics should get tested are based on scientific evidence, he added, while clinics abroad may be more motivated by profit.If a test finds cancer at a very early stage when it's very slow-moving, Vargas Bustamante said, the patient may feel compelled to treat it immediately, subjecting themself to chemotherapy and radiation. But in reality, it's possible they could have gone years without needing to start treatment. "Sometimes knowing too much may not be that good for you," he said.Others, however, think that America's lack of access to robust preventive screening is a critical failure.Dr. Misael Uribe Ramos is the director of international medicine at Médica Sur in Mexico City, a Joint Commission International-accredited hospital that offers checkups with eight different specialists for $1,600. Uribe Ramos has seen interest in rigorous physicals boom since the outbreak of the COVID-19 pandemic — and he thinks it's a good thing.Often when you go to the doctor, it's to treat a specific issue or disease, he said. "But why is that? Because you don't have prevention," he said. "Prevention is the best way to be healthy."In America, chronic illnesses such as heart disease, diabetes, and cancer are leading causes of death and disability, driving the majority of the US's $4.5 trillion in yearly healthcare expenses, <a target="_blank" href="https://www.cdc.gov/chronic-disease/about/index.html">according to</a> the Centers for Disease Control and Prevention. These illnesses are largely preventable. The CDC also says that between 30% and 50% of cancers diagnosed today could be prevented by reducing risk factors (like not smoking and maintaining a healthy body weight) and getting recommended screenings and vaccinations. However, according to the <a target="_blank" href="https://health.gov/news/202401/prevention-still-best-medicine">US Office of Disease Prevention and Health Promotion</a>, only 5.3% of Americans 35 and older received all recommended clinical prevention services in 2020 — a number that dropped from 8.5% in 2015. Why? Simply put, many Americans aren't regular healthcare users. They often don't have a family doctor, they live too far from one, they don't have a way to get there, or they simply can't afford it, the Office of Disease Prevention and Health Promotion says. Meanwhile, preventive-care services aren't prioritized because healthcare providers are paid to treat diseases — not to prevent them by keeping people healthy. A 2020 study said the National Academy of Medicine <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309216/">estimated</a> that missed prevention opportunities cost the US $55 billion annually.Other countries take a different approach. In Japan, for instance, the most basic annual checkups include EKGs, chest X-rays, blood tests, eye and hearing tests, and stool and urine tests. And some residents require a more comprehensive version that includes cancer screening. Japanese employers are required to provide them for all of their employees. In 2019, about 74% of men and 66% of women in Japan completed some type of medical checkup, according to the country's Ministry of Health, Labour and Welfare.South Korea's regimen is similar to Japan's. On a work trip there in 2010, Woodman had extensive testing done, including an MRI and CT scan, as part of a "wellness preventative program" he tried out for work, he said. He was offered an endoscopy and colonoscopy as part of the package but declined."Testing in the United States is really kind of pathetic," Woodman said. "They weigh you. They take your blood test. 'How tall are you?' And that's pretty much it."Americans seeking better preventive screening tend to visit South Korea, Thailand, and the United Arab Emirates, while Mexico, Barbados, and Thailand are popular for genetic and fertility testing, as well as testing related to gender-affirming care, medical-tourism advocates told BI.Many of these countries have hospitals that cater to foreigners. In Mexico, Médica Sur's checkups take about five hours, with screenings across disciplines such as internal medicine, cardiology, gynecology, and ophthalmology. (In the US, a typical physical takes less than an hour.) Packages include breakfast, transportation, accommodation, menus catering to dietary restrictions, discounted sightseeing for an extra cost, and concierge staff who help patients coordinate their stay and remain by their side for the duration. The hospital is also connected to a Holiday Inn if visitors want to stay on-site.Results are available within two weeks, at which point the patient can discuss the findings with a doctor in person or remotely; a checkup three months later is also included in the price. If, for example, the screenings indicate a malignant tumor, Uribe Ramos said, doctors will explain to a patient which follow-up tests they need, either in their home country or at Médica Sur. He recommends getting a thorough exam once a year.Since opening its international-medicine wing in 2019, the hospital has seen 5,000 foreign patients, most of them American and Canadian, Uribe Ramos said.Imani Bashir was living in Cancún three years ago when she felt what she thought was a lump in her breast. At the time she was 34 — <a target="_blank" href="https://www.cancer.org/cancer/screening/screening-recommendations-by-age.html#:~:text=Women%20ages%2040%20to%2044,should%20get%20mammograms%20every%20year.">young</a> to be receiving a mammogram — but her family had a history of the disease, so she booked an appointment anyway. In the US, the median <a target="_blank" href="https://ascopubs.org/doi/10.1200/JCO.2023.41.16_suppl.e18917">cost</a> of a mammogram ranges from $140 to $360 for women who aren't insured. In Mexico, it was under $50. As a Black woman who grew up in the US without health insurance, the 37-year-old communications director found the experience especially validating."When we go to the doctor and say that we're in pain, it's kind of just shooed away, like it's not a big deal," Bashir said. In Mexico, the medical center didn't question her. Now that she's living in Washington, DC, she continues to travel to Mexico for both her and her son's dental appointments and other medical issues because it's cheaper and easier to get appointments. "It always feels good when you feel like you can take care of yourself, and financially, it's not going to be a detriment to your life and your health," she says.Given how many people experience difficulty navigating the American healthcare system, it's no surprise that the medical-tourism market is growing rapidly. Patients Beyond Borders estimates the industry is growing between 15% and 25% each year. And 2022 <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9104082/#:~:text=The%20increase%20in%20medical%20tourism,other%20time%20in%20the%20past.">research</a> found that the increase in international tourism had helped fuel the trend. As <a target="_blank" href="https://www.businessinsider.com/travel-agents-back-gen-z-millennials-vacation-planning-overseas-resorts-2024-6">more people spend time abroad</a>, it becomes easier to tack a few small medical tests onto your trip.Vargas Bustamante thinks traveling internationally for rigorous testing probably most benefits healthy people who just want "peace of mind." Despite the risk factors, the industry's growing appeal illustrates the limitations of American healthcare."Why would someone have to buy a plane ticket to go all the way on the other side of the world just for an adequate amount of healthcare? It's nuts," Bashir said. "But if people have the privilege, if people have the money to be able to do so, then I say, yeah."<a target="_blank" class="" href="https://www.businessinsider.com/author/manisha-krishnan">Manisha Krishnan</a> is an Emmy award-winning journalist who covers healthcare. She is based in Brooklyn.

Mojitos and an MRI: Meet the Americans who are getting health screenings on vacation 

<ul class="summary-list"><li>The giant health insurers Cigna and Humana are reportedly considering a merger.</li><li>While they offer different kinds of health insurance, the deal is likely to face antitrust scrutiny.</li></ul>Cigna and Humana, two of the biggest, richest health insurers, are considering merging in a monster deal that would have seismic implications for US healthcare, Reuters, Bloomberg and The Wall Street Journal reported this week.But antitrust experts say such a merger would have a hard time standing up to the scrutiny of a Department of Justice that's arguably stronger than the one that <a target="_blank" href="https://money.cnn.com/2017/02/14/investing/aetna-humana/index.html">blocked</a> previous proposed insurance megamergers six years ago.A deal between Cigna and Humana would create a healthcare conglomerate worth about $140 billion, based on their combined market caps, and help it compete with the nation's largest healthcare company UnitedHealth Group, which has a market value of about $500 billion.Cigna, which boasted revenue north of $180 billion in 2022, primarily administers health plans for large employers. Combining with Humana, with annual revenue of about $93 billion, would give Cigna a powerful presence in Medicare Advantage, the lucrative, private health-plan market for people 65 and older.Combined, they serve about 37 million people in health-insurance plans. Both companies also own large pharmacy-benefit managers that administer prescription-drug plans.Equity analysts at BofA wrote in research notes that Cigna and Humana have little business overlap in insurance, and where they do, they may be able to divest some assets to alleviate antitrust concerns. Still, analysts at several investment firms warned the merger would throw together two large PBMs, which is bound to invite significant scrutiny.Antitrust experts said that even with divestitures the insurers would face an uphill battle convincing skeptical antitrust enforcers that their combination won't harm competition and consumers."The parties have an incredibly daunting task ahead of them. The agencies are much stronger enforcers than they were back in 2016. They are much more skeptical about some of the arguments that will be crucial to the merging parties, such as the role of efficiencies," said David Balto, a consumer advocate and the former policy director of the Federal Trade Commission.<h2>Giant insurers' past attempts to combine failed</h2>Reports that Cigna and Humana want to pursue a merger are somewhat surprising given previous attempts between giant health insurers went up in flames, leading in one case to a prolonged, expensive legal battle. Still, Cigna and Humana did <a target="_blank" href="https://www.modernhealthcare.com/article/20150811/NEWS/150819988/how-humana-hitched-with-aetna-and-drove-cigna-to-anthem">toy with a deal</a> way back in 2014 before they pursued deals with other partners.In mid-2015, Cigna and Anthem said they would pair up in a $54 billion deal, while Aetna and Humana sought a $37-billion tie-up. But federal judges blocked both proposed mergers in 2017 after they were challenged by the Justice Department for threatening to harm competition in various insurance markets.Cigna and Anthem sued each other for billions, each arguing that the other had sabotaged the deal. Years later, in 2020, a Delaware court <a target="_blank" href="https://www.modernhealthcare.com/insurance/anthem-cigna-cant-collect-billions-damages-over-failed-merger">ruled</a> that neither of the companies could recover any damages.Later, to sidestep antitrust scrutiny, health insurers eyed mergers with other pieces of the healthcare system outside of insurance. In 2018, Cigna combined with the pharmacy-benefit manager Express Scripts and pharmacy chain CVS Health bought Aetna.Humana, meanwhile, pushed deeper into providing care directly to patients by acquiring home-health company Kindred and building primary-care clinics for seniors.<h2>Cigna and Humana would face a more skeptical Justice Department</h2>Any deal between health insurers the size of Cigna and Humana would have to get past the Justice Department's antitrust enforcers. That's not going to be easy.Not only are health-insurance markets already heavily consolidated, but antitrust enforcers under the Biden Administration have <a target="_blank" href="https://www.statnews.com/2023/07/19/antitrust-scrutiny-health-care/">adopted a more aggressive stance</a> toward all types of healthcare mergers in the past year. The FTC has also dialed up scrutiny of PBMs, and though the Justice Department likely would review an insurance merger, the two agencies often work together.Balto said the Justice Department is "vastly more sensitive" to whether mergers will harm consumers and healthcare providers, whereas in the past it focused on a merger's impact on businesses such as employers.<a target="_blank" href="https://healthpolicy.duke.edu/people/barak-richman-phd">Barak Richman</a>, law professor at Duke University, said that traditionally, antitrust enforcers took a narrow view of harm, scrutinizing overlap between businesses in specific geographic markets. But he said there's now a greater appetite to challenge mergers based on "more expansive theories of harm.""These are two large health-insurance companies. They offer insurance products all over the country. They engage with providers all over the country. They both have PBMs and provide pharmaceutical benefits all over the country. The analysis has to have a more wide-angle lens."<a target="_blank" href="https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2015_nov_1845_dafny_impact_hlt_ins_industry_consolidation_ib.pdf">Research</a> has shown that when insurers merge, health-plan premiums increase.The insurers may argue that they have little overlap between their businesses. Already, Cigna is considering selling its small Medicare Advantage business, Reuters <a target="_blank" href="https://www.reuters.com/markets/deals/cigna-explores-shedding-medicare-advantage-business-sources-2023-11-06/#:~:text=NEW%20YORK%2C%20Nov%206%20(Reuters,people%20familiar%20with%20the%20matter.">reported</a> earlier this month. And Humana in February <a target="_blank" href="https://press.humana.com/news/news-details/2023/Humana-to-Exit-Employer-Group-Commercial-Medical-Products-Business/default.aspx#gsc.tab=0">said</a> it was getting out of the commercial-insurance business over the next 18 to 24 months.But Matthew Cantor, an antitrust expert and partner at the law firm Constantine Cannon, said divestitures aren't always a sure fix. He pointed to the failed merger attempt between Aetna and Humana, in which the court <a target="_blank" href="https://www.healthaffairs.org/content/forefront/court-blocks-aetna-humana-deal-mega-mergers-meet-trump-administration-next">determined</a> that Aetna's plan to sell Medicare Advantage plans to Molina wouldn't help replace competition."All of this comes down to not only are they going to divest, but who's going to buy it?" Cantor said. "Are they a vibrant competitor? Or is it going to be that someone's going to buy this and not know how to run it and it's going to be run to the ground, and at the end of the day you're going to be left with a more powerful Cigna. That's going to be the question."

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