Preliminary analyses of the 2010 U.S. Census indicated that less than one in ten American seniors live in poverty. But a new and more nuanced “supplemental” poverty metric finds that number may actually be closer to one in seven seniors when accounting for their out-of-pocket medical bills.

The “original” poverty metric has been used since the 1960s. But some argue that it’s an archaic measuring stick, since health care costs and — consequently — out-of-pocket spending on medical services have exploded in the ensuing decades. That means that, despite access to relatively generous health coverage through Medicare (another 1960s-era program), seniors have been forced to pay an increasing share of their retirement income on hospital and drug bills over the last 50 years. And seniors who suffer from costly, chronic medical conditions such as cancer and Alzheimer’s are especially burdened by those escalating costs.

Since the new measure takes these contemporary expenses into account, it provides a more accurate picture of the American poverty landscape. And as a state-level analysis of the numbers by the Kaiser Family Foundation highlights, things don’t look very good:

The share of seniors living in poverty is higher in every state under the supplemental measure than under the official measure, and at least twice as high in 12 states: California, Colorado, Connecticut, Hawaii, Massachusetts, Maryland, Minnesota, New Hampshire, New Jersey, Nevada, Wisconsin, and Wyoming.

The share of seniors living in poverty under the supplemental measure is especially high in some areas. Based on the supplemental measure, about one in four seniors (26%) are living in poverty in DC and roughly one in five seniors are living in poverty in six states: California (20%); Hawaii, Louisiana, and Nevada (19%), and Georgia and New York (18%).

One possible reason that senior poverty rates in the aforementioned states are so high when taking medical expenses into account is that hospitals in those regions charge more money for drugs and medical services — certainly a possibility considering that U.S. medical prices are essentially arbitrary. Another potential explanation is that these states have more seniors who are less likely to be eligible for Medicare due to immigration or citizenship status, and a higher number of poor seniors with chronic medical conditions.

But the key takeaway from the numbers is that, despite many seniors’ access to generous public health entitlements, they still can’t afford the associated costs of their medical care. And that means that efforts to reduce the federal deficit through cuts to health care programs amounts to putting more fiscal strain on a vulnerable population that can’t even afford treatments under the status quo.

Yet, the congressional GOP — and some Democrats — has vehemently encouraged such cuts. For instance, Republicans insisted on raising the Medicare eligibility age from 65 to 67 during budget negotiations in February, even though such a move would only net $5.7 billion in federal savings while shifting double that amount in costs onto seniors.

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A pill bottle that glows blue when it’s time to take another dose, and red when you’ve accidentally forgotten to take one. Pills embedded with sensors that allow doctors to track who’s swallowing them. A pill bottle that starts to grow spots, like an overripe banana, when the medicine has expired.

Insurers and pharmacies are increasingly investing in these kind of start-up ventures, hoping to develop new technologies that can help Americans stick to their medication regimens. But why is this area of innovation becoming a top priority? It’s largely because the Americans who fail to take their medication as directed contribute to billions of dollars in wasteful health care spending every year. People who skip doses, take pills that have expired, or lapse too long between refills often experience health complications that lead to unnecessary hospital and doctor visits, ultimately costing insurers an estimated $290 billion each year.

Pharmacy-benefit programs like CVS Caremark have typically relied on robo-calls and mailers to remind their patients to take their pills as directed. But the old tricks aren’t working. “After six months’ time, only half of people taking prescription medicines are taking them as directed,” said Troyen Brennan, the chief medical officer of CVS Caremark Corp., explained to the Wall Street Journal.

So they’re trying to step their efforts up a notch. CVS is pilot-testing a new technology that will allow them to better track the patients who have track records of failing to adhere to their medication schedules. And other companies are working on developing apps that will reward patients who take their pills on time with gift certificates and coupons. And they continue to evaluate a range of other innovative ideas to accomplish the same goals, like new high-tech pill bottles.

There have been other recent pushes to build a better pill bottle, too, but those have been focused on addressing a different issue with prescription drugs — the Americans who end up abusing them. In Utah, a group of college students built an electronic pill bottle that will only dispense the specific dosage that the pharmacist has prescribed, preventing their patients from taking too much of the drug or selling the pills to other people. And in New York City, the police force is currently experimenting with implanting GPS chips in pill bottles so they’ll be able to better track stolen drugs and illegal prescription stockpiles.

The chief executive of a Miami, Florida hospital has pledged to begin addressing one of the most dysfunctional aspects of the American health care system, according to MedCity News. He’s striving for greater price transparency — giving patients and doctors the ability to easily see, before purchase, just what hospitals charge Medicare and other insurers for a given procedure.

A recent report gave over half the states in the U.S. a grade of “F” when it comes to price transparency. And after the Center for Medicare and Medicaid Services recently provided a huge data dump on what hospitals charge government health care programs for common procedures, they found a staggering amount of variation across the country with no discernible justifications on economic or quality-of-care grounds. But the prices charged to private insurers still remain secret.

So in the wake of mounting pressure following the government’s data release, Steve Sonenreich — the chief executive of Mount Sinai Medical Center in Miami Beach — promised on a radio show on Monday that his hospital will reveal the contractual rates that it charges private insurers:

“We will post our prices relative to Blue Cross, and Aetna, our contractual prices, and we’ll challenge Baptist and the other systems in the community to do the same,” said Sonenreich, who made his pledge during a studio interview on WLRN 91.3-FM with host Tom Hudson.

Also in the radio studio was Brian Keeley, chief executive of Baptist Health South Florida, which manages seven hospitals in the region. Keeley declined to accept Sonenreich’s challenge for price transparency, but acknowledged “That’s where the whole industry is going, undoubtedly.”

It remains to be seen whether other hospitals will follow Sonenreich’s lead. But the inability of consumers, doctors, and even many insurers themselves to compare different rates and charges openly is one of the key factors hamstringing the American health care market. With greater price transparency, it’s possible health care could begin behaving a bit more like markets are traditionally supposed to behave, and drive down prices through open competition.

Which hospital in the United States charges its patients the highest bills for common medical procedures? It turns out that the nation’s most expensive hospital is located in Bayonne, NJ, where you’ll pay nearly $100,000 dollars to treat your case of chronic lung disease — five times as much as what others hospitals charge for the same procedure.

Last week, the Center for Medicare and Medicaid Services (CMS) released first-of-its-kind data detailing the prices that hospitals charge for common procedures. The new numbers revealed that there’s a huge range of price fluctuations between different hospitals, with no good reason for why some places are charging so much more than others. Bayonne Medical Center topped the list, billing at a rate more than four times the national average for the 100 most common types of medical treatments.

Does that mean that, since patients at Bayonne are paying extremely well for their time in the hospital, they’re receiving particularly good care? Not really. The New York Times points out that Bayonne Medical Center ranks about average in terms of the quality of its care, no better or worse than most other hospitals in New Jersey. That fits into the broader national trends regarding health costs and health quality — spending more on care isn’t actually correlated with better treatment.

The Obama administration, which is encouraging greater price transparency in the health care industry as one of the central tenets of Obamacare, hopes that making hospital costs public could help encourage Americans to shop around. If New Jersey residents decide they’d rather not receive the particularly expensive care at Bayonne Medical, maybe they’ll decide to go to a different hospital in the area — and maybe that will force Bayonne to lower its prices to stay competitive.

But addressing the United States’ sky-high medical costs isn’t just about better educating patients. In fact, there’s evidence that teaching doctors more about the actual costs of the procedures they’re recommending can also help. Studies have shown that doctors are less likely to order unnecessary tests and procedures when they know how expensive they are. And, in order to further continue to cut down on wasteful medical spending, the U.S. needs to do more research on which specific types of health spending could be pared down without sacrificing the quality of Americans’ health care.

Cancer patients are much more likely to go bankrupt than Americans who aren’t faced with a cancer diagnosis, a new study finds. Even the Americans who have access to health insurance aren’t necessarily safe from bankruptcy, since the high cost of treating cancer can still put an untenable strain their finances.

A team of researchers in Washington state collected data from nearly 400,000 adults, evenly split between those who had been treated for cancer and those who were cancer-free. After checking to see which of those adults had filed for bankruptcy between 1995 and 2009, the researchers found that cancer patients were 2.5 times as likely to go bankrupt in that period.

Although the study didn’t specifically look at insurance coverage, previous research has demonstrated that the Americans who cite major health issues as the reason they filed for bankruptcy are actually often insured. One 2006 study found that more than 60 percent of bankruptcies in the United States are due to high medical bills, and in those cases, three-quarters of those Americans had insurance when they got sick. NBC News interviewed one cancer patient who found herself in this situation, even though she was employed and insured when she first got her diagnosis:

That rings true for Janet Literski, 57, who had purchased health insurance as an independent contractor working in sales. When she was diagnosed with non-Hodgkin’s lymphoma in 2008 Literski discovered her insurance covered only part of her surgical costs and none of her diagnostic tests. Then there were co-payments and deductibles. By the time she was diagnosed with pancreatic cancer two years later, she was about $150,000 in medical debt.

In 2011, no longer able to work, Literski and her disabled husband filed for bankruptcy. “It was a gut wrenching decision because you feel like a personal failure, and that makes me angry because I had tried to do everything right,” Literski says. “I had health insurance, I was working.”

Literski is now covered by Medicaid and receives disability payments and though she hasn’t been told she’s in remission, she says she is “healthy enough.”

[The study's lead author, Dr. Scott Ramsey,] says cancer centers need to do a better job of assessing each patient’s financial status, offering credit counseling, and managing patient care.

Even bigger disparities emerged when the researchers broke down the cancer patients in their study by different demographics. The younger groups were up to 10 times more likely to go broke than the older patients, and non-white women were the most likely to run out of money.The cancer that is associated with the highest risk of bankruptcy is thyroid cancer — likely because that disease mostly affects younger women. On the other hand, older men with prostate cancer are the least likely to reach financial rock bottom.

Ramsey and his researchers first presented their research in 2011, and their final findings were published in the Health Affairs journal this week. The timing of the study’s release coincides with some recent pressure to help lower the cost of cancer drugs. Last month, a group of over 100 doctors criticized Big Pharma companies for making “life-saving” cancer drugs too expensive for Americans to afford. The doctors asserted that the “unsustainable drug prices” were “causing harm to patients,” and urged reforms in this area to ensure that cancer patients don’t have to go without the treatment they need.

Cancer patients have also been recently caught up in the budget battles resulting from sequestration. At the end of April, cancer clinics blasted Congress for taking legislative action to restore the sequester cuts that were causing airport delays rather than working to address the cuts that are undermining Americans’ chemotherapy treatment. As a result of the automatic budget cuts, some Americans are being forced to delay their chemotherapy, and some cancer clinics may even be forced to close their doors.

Doctors are reluctant to give nurses more authority to treat patients, according to findings in a New England Journal of Medicine study released on Wednesday. But doctors’ skepticism about nurses having expanded roles isn’t based on the facts — and it ignores the reality that nurse practitioners must take on such responsibilities if health care reform is to succeed.

The new study finds that many doctors don’t trust nurses to lead patient-centered “medical homes,” with only 17 percent of surveyed primary care physicians viewing it positively. “Medical homes” are arrangements encouraged by Obamacare in which nurses, doctors, pharmacists, and specialists work together to provide patients with better and more efficient care in a unified setting.

There is also a striking chasm between doctors and nurses on the issue of nurse practitioners’ ability to provide safe, quality patient care:

When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

Doctors also overwhelmingly disagreed with many nurses’ position that they should receive the same level of pay as doctors for performing similar services.

But this position is an untenable one in the era of Obamacare, with more than 25 million Americans expected to gain health coverage in the coming decade. Since the bulk of these Americans are expected to consume primary care — rather than specialty — services, it’s important that the U.S. medical system have enough medical workers to serve them. And there simply aren’t enough primary care doctors to tackle that burden on their own.

Instead, nurse practitioners will have to take on additional responsibilities. There’s no reason to suspect that this will compromise patient care quality — in fact, multiple studies have shown that the quality of care that nurse practitioners provide for acute primary care is on par with doctors. One randomized trial comparing nurses’ versus doctors’ ability to manage complex care regimens for HIV-positive patients receiving antiretroviral therapy also found no evidence of professional inferiority. As David Hebert, CEO of the American Association of Nurse Practitioners, told Kaiser Health News, “[N]urse practitioners have been practicing safely and providing great outcomes for decades.”

Doctors — and patients — would be well served by an expanded role for nurse practitioners. Primary care doctors tend to be concentrated in urban areas, creating a major barrier to rural and isolated communities’ access to basic medical services. But nurses are more numerous and could have greater access to such populations, making them ideal candidates for heading medical homes and seeing to the day-to-day aspects of patient care.

In light of Republican-led states’ entrenched opposition to Obamacare’s Medicaid expansion, safety net hospitals around the country have expressed fears that they could go bankrupt as their government funding gets cut. On Monday, the Center for Medicare and Medicaid Services (CMS) announced that it would help these embattled hospitals by paring back planned cuts to their federal reimbursements.

In an attempt to cut government health expenditures, Obamacare included fairly deep cuts to so-called “disproportionate share” hospitals’ (DSHs’) — safety net facilities that cater mostly to the poor and uninsured — reimbursement payments. These cuts were intended to be offset by an influx of newly-insured Americans covered under the states’ expanded Medicaid programs.

But since the Supreme Court ruled the expansion optional, red states with a large number of low-income and uninsured residents have largely refused to take part in the Medicaid expansion, thereby creating a disastrous funding problem for safety net hospitals in these states. The CMS’s new proposed regulations represent an effort to avert those disastrous cuts as states get their acts together:

The Centers for Medicare & Medicaid Services proposed on Monday that for the next two years, the DSH dollars be reduced based partly on a state’s percent of uninsured residents (states with the lowest percent of uninsured receive larger reductions). CMS also seeks in the proposal to protect state DSH funding that is used to increase coverage under Medicaid demonstration waivers. [...]

“… since some states have yet to decide whether to expand Medicaid, this proposed rule will not discourage expansion, nor will it penalize hospitals in those states that have yet to make a decision,” [Rick Pollack, executive vice president of the American Hospital Association,] said.

However, CMS’s new proposal is a funding band-aid, not a permanent fix. The far more responsible and efficient way to take the heat off of America’s safety net hospitals — while securing low-income Americans’ medical and financial well-being — would be for highly uninsured states to accept the health law’s generous funding to expand Medicaid.

In fact, that’s exactly why some GOP governors such as Arizona’s Jan Brewer and Florida’s Rick Scott have reversed course and decided to endorse the Medicaid expansion — because hospital associations in their states have been warning that noncompliance in the face the upcoming payment cuts would cost them tens of billions of dollars and possibly force them out of business, leaving millions of America’s poor without recourse for medical care. Unfortunately, not all Republican state leaders and legislators seem to be swayed by that argument, forcing the CMS to take action and stave off safety net hospitals’ fiscal ruin.

But seeing as even the GOP governors who have endorsed expansion are struggling to convince skeptical legislators in their own party, the temporary fix is crucial to making sure that safety net hospitals — and the millions of poor Americans who rely on them — don’t end up as the collateral damage of a political fistfight over Obamacare. Arizona, Florida, Texas, and Louisiana — four GOP states that appear increasingly unlikely to expand Medicaid this year — have close to 12 million uninsured residents alone, approximately half of whom live below 138 percent of the Federal Poverty Level (FPL) and would likely gain Medicaid coverage under the expansion.

For the first time in decades, U.S. prescription drug spending dropped last year — a phenomenon largely stemming from the fact that, faced with spiraling health costs, Americans are being forced to cut back on their care wherever they can.

According to a new report from IMS Institute for Healthcare Informatics, the nation’s total spending on prescription medications dropped from $329.2 billion in 2011 to $325.8 billion last year. Similarly, the average amount that each American spent on their medications in 2012 fell to $898, representing a decline of $33. This is the first time the IMS has recorded a drop in drug spending in the 58 years that the institute has been monitoring the data.

Part of the decline is due to more cheaper, generics drugs entering the market, a positive trend that helps Americans better afford their medication and ultimately lowers health costs. But that’s not the whole story. According to the IMS’ director of research, Michael Kleinrock, many Americans are skipping out on their prescriptions because they’re struggling to afford all of their medical costs, and are therefore being forced to ration their health care:

IMS found affordability of health care remains a big problem for many Americans, with growing out-of-pocket costs forcing people to go without needed doctor visits, medicines and other treatments.

For some, that was because they lost jobs or homes during the worst recession in decades. But higher costs also are hitting many employed people who have health insurance.

Employers have been raising health costs for their workers well above the inflation rate, through higher copayments, premiums and deductibles. Many commercial insurance plans now have annual deductibles — the amount a patient must pay before insurance kicks in — that exceed $1,000, Kleinrock said. [...]

“Even patients with insurance are feeling the pinch and have been reducing their use of health care,” Kleinrock said.

IMS’ findings are consistent with other studies that have found that low-income Americans are forgoing their medication because they can’t afford it. One out of every five Americans has asked their doctor to prescribe a cheaper medication in order to lower their prescription costs — and, compared to wealthier people, poorer patients are more than twice as likely to avoid taking their medication as directed in order to save money.

Of course, as Americans continue to struggle to afford their prescription drugs, Big Pharma is reaping the benefits. The 11 largest drug companies’ profits have been soaring for the past eight years, and they raked in almost $85 billion in 2012.

Unfortunately, profiting at the expense of workers isn’t exclusive to Big Pharma. As Kleinrock notes, even the Americans who currently have insurance are now being forced to cut back on their care, since their employers continue to shift more of their health care costs onto them. Across the country, employees’ contributions to their health insurance plans have skyrocketed at the same time as those workers’ wages have stagnated. That’s especially true for the low-wage workers who are employed by large chain companies in the restaurant industry, whose CEOs have repeatedly complained about the cost of providing adequate health benefits under Obamacare — and keep attempting to find unscrupulous ways to circumvent the health reform law.

Looks like Obamacare is more “on track” than “train wreck.”

In a striking illustration of the promise that the health law holds for consumers, two Oregon private insurers vying to sell coverage on the state’s Obamacare insurance marketplace this October are reevaluating their opening bids for the plans’ monthly premiums. The reason? A side-by-side regional comparison of all proposed 2014 premiums for Oregon marketplace plans became public on Oregon’s marketplace website Thursday, and showed that the two insurers’ planned monthly premiums were far higher than other proposals. That raised fears among the companies’ officials that their plans wouldn’t be competitive on the market later this year, leading them to proactively request a rate reduction — and as more of Obamacare is implemented, state insurance commissioners expect that trend to continue:

“Posting rate comparisons company-by-company is a taste of what is to come,” says Cheryl Martinis of the Oregon Insurance Division.

Judging by the reaction, there’s already an impact.

Providence Health Plan on Wednesday asked to lower its requested rates by 15 percent. Gary Walker, a Providence spokesman, says the “primary driver” was a realization that the plan’s cost projections were incorrect. But he conceded a desire to be competitive was part of it.

A Family Care Health Plans official on Thursday said the insurer will ask the state for even greater decrease in requested rates. CEO Jeff Heatherington says the company realized its analysts were too pessimistic after seeing online that its proposed premiums were the highest.

“That was my question when I saw the rates was, ‘Can we go in and refile these?’” he said. “We’re going to try to get these to a competitive range.”

Although some insurers have been using Obamacare as an excuse to hike premiums despite record profits, such rate hikes have been rarer — and less extreme — since the law’s passage. And to emphasize, this is all happening before the state has had a chance to review and approve initial plan rates — much less launch the actual marketplace. After the exchange opens up, consumers will have even more detailed information about marketplace plans, including the ability to compare — not just rates — but actual benefits offered on the plans side-by-side.

That’s particularly significant because much of the current variation in health plan premiums stems from rampant health care price opacity and wildly divergent benefits offered on different health plans — a status quo that won’t last in the Obamacare era since the law requires qualifying insurance plans to offer a base level of ten “essential health benefits,” including prescription drug, mental health, and maternity services. That means that Americans will be able to go online and figure out whether a plan costs more because it actually provides more robust benefits, or because an insurance company is just trying to gouge prices and maximize profits. Insurance offered on the marketplaces will be separated into Bronze, Silver, and Gold plans based on how generous their offered coverage is, making consumer comparisons between similar health plans simple.

As Thursday’s development shows, that public information empowers consumers by forcing insurers to compete with one another to attract customers. Or to put it another way — and contrary to conservative fear-mongering about the law — Obamacare is working exactly as it was intended to. And with 24 million Americans expected to gain coverage through the marketplaces by 2016, that’s great news for Americans’ pocketbooks — as well as their health.

One of the most important ongoing stories in the realm of budgets and health care economics is the remarkable drop in how much health care costs are projected to grow over the next decade. Back in March, David Cutler and Nikhil Sahni released some preliminary work arguing that, thanks to this slowdown, projections of government spending on health care for the next decade were overshooting by hundreds of billions of dollars. Now they’ve released a more complete paper (gated) with a specific number: if the lower growth rate continues, the federal government could save $770 billion by 2021. Furthermore, Cutler and Sahni concluded that as much as 55 percent of the slowdown has been driven by factors other than the recession.

That last point is especially important. If the slowdown in growth is due to the recession, then it’s temporary. Health care costs will once again rise at their previous rate once the economy recovers, driving health-related spending to ever greater heights and further straining the budgets of both the government and American families. But if the slowdown is due to deeper, structural changes in health care markets, then at least some portion of the slowdown may be long-term. And the government’s projections of future debt and deficits rely heavily on those previous assumptions of high health care cost growth. So if the slowdown sticks, the outlook for America’s fiscal future could improve radically, all without lawmakers cutting a dime.

Here’s Bloomberg with a nice summary:

Cutler’s research compared the U.S. government’s growth projections for health spending from 2004 to 2012 with actual increases in the period. It found that the real growth rate was about half of the government’s prediction, leading to a gap of more than $500 billion in 2012 between the projections and spending.

The paper calculates that the recession accounted for about 37 percent of the slowdown in health costs from 2003 to 2011. Declining private insurance coverage and cuts in payments byMedicare, (USBOMDCR)the government health plan for the elderly and disabled, accounted for another 8 percent and the remaining 55 percent is “unexplained,” Cutler wrote. That’s where the structural changes come in, he said.

If the current lower-than-expected rate of growth continues, the country may reap savings of as much as $770 billion through 2021, the research found.

As always, there’s a lot of uncertainty built in here. Another recent study by Kaiser, for instance, suggested that as much as 77 percent of the slowdown is a temporary result of the recession. Also, there’s a lot of complexity in the category of “structural” changes. Some of it’s improvements in the efficiency of health care delivery, quite possibly thanks to reforms in Obamacare that encourage providers to change the way they do business. Other parts of it may be one-time shifts in the market, such as the rise of generic drugs to replace more high-cost brand-name medicines.

The broader point, however, is that there are more ways to balance the budget than just slashing the aid and benefits Americans need to buy. A better-designed health care system could very well deliver lower and more efficient government spending than austerity ever could.