Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding
States are turning to the big health insurance companies to keep Medicaid enrollees insured once pandemic protections end in April. The insurers’ motive: profits.
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Despite Pharma Claims, Illicit Drug Shipments to US Aren’t Full of Opioids. It’s Generic Viagra.
The FDA has long blocked the importation of cheap medicine, agreeing with pharmaceutical manufacturers that it opens the door to opioids. The agency’s own data shows that rarely happens.
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After Staying Away During Pandemic, Doctors Return to Lobby Congress
Hundreds of physicians came to Washington this week to lobby Congress about their “recovery plan” for physicians, which includes a Medicare pay boost and an end to some frustrating insurance company requirements.
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As Pandemic-Era Medicaid Provisions Lapse, Millions Approach a Coverage Cliff
States are trying to reach millions of Medicaid enrollees to make sure those still eligible remain covered and help others find new health insurance.
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After Tuition, Books, and Room and Board, Colleges’ Rising Health Fees Hit a Nerve
Many colleges require students to have health insurance coverage, and the college option can be costly. In addition, some schools mandate that students pay a fee to cover health services on campus.
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States Challenge Biden to Lower Drug Prices by Allowing Imports From Canada
Colorado has joined Florida, New Hampshire, and New Mexico in seeking federal permission to import prescription drugs from Canada. President Joe Biden endorsed the approach in his 2020 campaign but has yet to approve any state plan.
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When Malpractice Occurs at Community Health Centers, Taxpayers Pay
Federally funded clinics and their doctors are protected against lawsuits by federal law, with taxpayers footing the bill. The health centers say that allows them to better serve their low-income patients, but lawyers say the system handcuffs consumers with a cumbersome legal process and makes it harder for the public to see problems.
By Phil Galewitz and Bram Sable-Smith -
How Optimism Can Close the Medicaid Coverage Gap
Low-income residents in states that haven’t expanded Medicaid are in a tough spot: They don’t qualify for the subsidies that people with slightly higher incomes get to buy marketplace plans because of a glitch in the federal health law. But a court decision last year makes it easier for them to make good-faith estimates of a pay increase, and there is no financial penalty if they don’t hit that figure.
By Phil Galewitz and Daniel Chang -
Stopping the Churn: Why Some States Want to Guarantee Medicaid Coverage From Birth to Age 6
Oregon has become the first state to allow kids to stay in the government health care program from birth to age 6, no matter if their household income changes. California, Washington, and New Mexico are pursuing similar policies.
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Say What? Hearing Aids Available Over-the-Counter for as Low as $199, and Without a Prescription
The cheaper over-the-counter aids are for adults with mild to moderate hearing loss — a market of tens of millions of people, many of whom have until now been priced out because prescription devices can cost thousands of dollars.
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Hospitals Divert Primary Care Patients to Health Center ‘Look-Alikes’ to Boost Finances
Medicare and Medicaid pay “look-alike” health centers significantly more than hospitals for treating patients, and converting or creating clinics can help hospitals reduce their expenses.
By Phil Galewitz Photos by Heidi de Marco -
Community Health Centers’ Big Profits Raise Questions About Federal Oversight
Nonprofit federally funded health centers are a linchpin in the nation’s health care safety net because they treat the medically underserved. The average profit margin is 5%, but some have recorded margins of 20% or more in three of the past four years.
By Phil Galewitz and Bram Sable-Smith -
States Have Yet to Spend Hundreds of Millions of Federal Dollars to Tackle Covid Health Disparities
A year ago, the Centers for Disease Control and Prevention awarded states and local health departments $2.25 billion to help people of color and other populations at higher risk from covid. But a KHN review shows public health agencies across the country have been slow to spend it.
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Even When IVF Is Covered by Insurance, High Bills and Hassles Abound
Only 15 states require insurance to cover in vitro fertilization, a common path to parenthood for people who have trouble getting pregnant. And even for those whose insurance covers IVF, the expensive procedures and required drugs can lead to unexpected bills.
By Phil Galewitz Illustration by Oona Tempest -
Who Doesn’t Text in 2022? Most State Medicaid Programs
As states prepare for the end of the covid public health emergency, they are making plans to reevaluate each Medicaid enrollee’s eligibility. They will rely primarily on mail and email because not many states can text enrollees.
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As US Nears 1 Million Covid Deaths, One Hard-Hit County Grapples With Unthinkable Loss
The United States is nearing 1 million deaths from covid — an almost incomprehensible number of lives lost that few thought possible when the pandemic began. Pennsylvania’s Mifflin County offers a snapshot into how one hard-hit community, with over 300 dead, is coping.
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Senators Ask GAO to Examine Medicaid’s Low Covid Vaccination Rates
Sens. Robert Casey Jr. and Ron Wyden want a probe into what barriers are keeping Medicaid plans from reaching enrollees.
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Medicare Advantage Plans Send Pals to Seniors’ Homes for Companionship — And Profits
Many Medicare Advantage plans send caregivers to the homes of seniors periodically to help with housework and provide companionship. But the workers may also prod seniors into activities that boost the plans’ Medicare ratings and federal reimbursements.
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From Alabama to Utah, Efforts to Vaccinate Medicaid Enrollees Against Covid Run Into Obstacles
Inoculation rates remain low despite massive outreach efforts and incentives from federal and state programs and Medicaid plan operators, leaving many low-income people vulnerable to the virus.
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Missouri Takes Months to Process Medicaid Applications — Longer Than Law Allows
Missouri has more people waiting to have their Medicaid applications processed than it has approved since the expansion of the federal-state health insurance program. Although most states process Medicaid applications within a week, Missouri is taking, on average, more than two months. Patient advocates fear that means people will stay uninsured longer, leading them to postpone care or get stuck with high medical bills.
By Bram Sable-Smith and Phil Galewitz
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