Insurance, Coverage, and Costs: Aug. 3, 2023

His Anesthesia Provider Billed Medicare Late. He Got Sent to Collections for the $3,000 Tab.
By Phil Galewitz Medicare was supposed to cover the entire cost of his procedure. But after the anesthesia provider failed to file its claims in a timely manner, it billed the patient instead.

A Mom Owed Nearly $102,000 for Hospital Care. Her State Attorney General Said to Pay Up.
By Fred Clasen-Kelly As politicians bash privately run hospitals for their aggressive debt collection tactics, consumer advocates say one North Carolina family’s six-figure medical bill is an example of how state attorneys general and state-operated hospitals also can harm patients financially.

KFF Health News' 'What the Health?': Another Try for Mental Health ‘Parity’
President Joe Biden is kicking off his reelection campaign in part by trying to finish a decades-long effort to establish parity in insurance benefits between mental and physical health. Meanwhile, House Republicans are working to add abortion and other contentious amendments to must-pass spending bills. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Anna Edney of Bloomberg, and Sarah Karlin-Smith of the Pink Sheet join KFF Health News’ chief Washington correspondent, Julie Rovner, to discuss these issues and more. Also this week, Rovner interviews KFF Health News’ Céline Gounder about her podcast “Epidemic.” The new season focuses on the successful public health effort to eradicate smallpox.

Hospitals Ask Congress to Delay ACA Medicaid Funding Cuts — For the 14th Time
By Phil Galewitz Congress has until October to avert cuts to a Medicaid program intended to support safety-net hospitals that, in practice, improves the bottom lines of other hospitals, too. Hospital leaders say now is not a good time for the cuts — which lawmakers have so far postponed 13 times.

Everything Old Is New Again? The Latest Round of Health Policy Proposals Reprises Existing Ideas
By Julie Appleby House Republican legislation promises more health insurance options but fewer protections, even as the Biden administration seeks to rein in short-term plans, which were expanded in the Trump era.

With More People Giving Birth at Home, Montana Passed a Pair of Laws to Make It Easier
By Keely Larson The state now requires Medicaid to cover midwife services and has expanded the list of prescription drugs midwives can administer.

Medi-Cal’s Fragmented System Can Make Moving a Nightmare
By Bernard J. Wolfson When Medi-Cal beneficiary Lloyd Tennison moved last year from Contra Costa County to San Joaquin County, he was bumped off his managed care plan without notice before his new coverage took effect. His case highlights a chronic issue in California’s fragmented Medicaid program.

KFF Health News' 'What the Health?': The Long Road to Reining In Short-Term Plans 
President Biden made good on a campaign promise this week with a proposal that would limit short-term health insurance plans that boast low premiums but also few benefits. Meanwhile, the Supreme Court’s decision to outlaw affirmative action programs could set back efforts to diversify the nation’s medical workforce. Alice Miranda Ollstein of Politico, Amy Goldstein of the Washington Post, and Rachel Cohrs of Stat News join KFF Health News’ chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KFF Health News’ Bram Sable-Smith, who reported the latest KFF Health News-NPR “Bill of the Month” about how a hospital couldn’t track down a patient, but a debt collector could.

Be Aware: Someone Could Steal Your Medical Records and Bill You for Their Care
By Michelle Andrews Consumers should know that this type of fraud can happen, whether from a large-scale breach or theft of an individual’s data. The result could be thousands of dollars in medical bills.

A Plan to Cut Montana’s Medicaid Waiting List Was Met With Bipartisan Cheers. Then a Veto.
By Mike Dennison Republican Gov. Greg Gianforte’s veto disappointed and bewildered those seeking to address low-income residents’ long wait for assisted living or in-home care.

Sen. Sanders Says Millions of People Can’t Find a Doctor. He’s Mostly Right.
By Michelle Andrews The Vermont senator sees beefing up the primary care workforce as a critical step in expanding Americans’ access to health care.

Once the New Over-the-Counter Birth Control Pill Is Available, What About Cost and Coverage?
By Michelle Andrews The Food and Drug Administration’s approval is viewed as groundbreaking, but many details still must be figured out.

‘Conscience’ Bills Let Medical Providers Opt Out of Providing a Wide Range of Care
By Carly Graf Opponents of the wave of state legislation say the measures place health providers’ preferences over patients’ rights.

The Real Costs of the New Alzheimer’s Drug, Most of Which Will Fall to Taxpayers
By Arthur Allen The annual cost of lecanemab treatment quadruples if the expense of brain scans to monitor for bleeds and other associated care is factored in. The full financial toll likely puts it beyond reach for low-income seniors at risk of Alzheimer’s, experts say.

Bankrupt California Hospital Receives Lifeline From Adventist, Report Says
By Jonathan Weber The Fresno Bee reports that Madera Community Hospital has reached an agreement with Adventist Health to take over the bankrupt facility and avoid liquidation.

Pain Clinic Chain to Pay $11.4M to Settle Medicare and Medicaid Fraud Claims
By Don Thompson The owner of one of California’s largest chains of pain management clinics has agreed to pay California, Oregon, and the federal government to settle Medicare and Medi-Cal fraud allegations.

Industry Groups in California Vie for New Medicaid Money
By Angela Hart and Samantha Young State officials have promised to boost funding for California’s Medicaid program by $11.1 billion starting next year, with most of that money earmarked for higher payments to doctors, hospitals, and other providers. But the details have yet to be worked out, and powerful health industry groups are jockeying for position.

Doctors Created a Primary Care Clinic as Their Former Hospital Struggled
By Cecilia Nowell With the community’s help, former co-workers came together to fill gaps in care left by the loss of doctors and departments at a Gallup, New Mexico, hospital.

Repeating History: California County Plugs Budget Gap With Opioid Settlement Cash
By Aneri Pattani State attorneys general vowed that opioid settlement funds — unlike the tobacco settlement of the 1990s — would go toward tackling the underlying crisis. But in Mendocino County, officials have found a way to use some of its share to help fill a budget shortfall — a throwback to what agreement architects hoped to avoid.

Congress Considers Easing Regulations on Air Transport of Donated Organs
By Colleen DeGuzman A little-noticed provision of sweeping legislation to reauthorize the Federal Aviation Administration would make it easier to fly human organs from donor to recipient.

New Weight Loss Drugs Carry High Price Tags and Lots of Questions for Seniors
By Judith Graham Although nearly 40% of Americans 60 and older are obese, Medicare doesn’t cover weight loss medications. Meanwhile, studies haven’t thoroughly examined new drugs’ impact on older adults.

Giant Health System Almost Saved a Community Hospital. Now, It Wants to ‘Extract Every Dollar.’
By Bernard J. Wolfson and Melissa Montalvo, The Fresno Bee A bankruptcy judge will soon decide whether a Central Valley hospital needs to liquidate to repay its creditors. Its largest creditor, St. Agnes Medical Center, is the very entity that backed out of purchasing the Madera Community Hospital last December.

Medical Debt Is Making Americans Angry. Doctors and Hospitals Ignore This at Their Peril.
By Noam N. Levey Doctors and hospitals hold an exalted position in American life, retaining public confidence even as other institutions such as government, law enforcement, and the media are losing people’s trust. But with health care debt out of hand, medical providers risk their good standing.

Covered California to Cut Patient Costs After Democratic Lawmakers Win Funding From Gov. Newsom
By Angela Hart California’s health insurance exchange will reduce how much some patients pay for care next year, including hospital deductibles, appointment copays, and prescription drugs. Lawmakers pressed Gov. Gavin Newsom to make good on a four-year-old pledge to use proceeds from a tax penalty on uninsured people to help people pay for treatment.

Journalists Discuss Abortion Lawsuits and the Pros and Cons of Health Care Sharing Plans
KFF Health News and California Healthline staff made the rounds on national and local media this week to discuss their stories. Here’s a collection of their appearances.

¿Cuánto costará la píldora anticonceptiva de venta libre? ¿La cubrirán los seguros?
By Michelle Andrews Los defensores de la salud reproductiva celebraron esta histórica aprobación como un paso que puede ayudar a millones de personas a evitar embarazos no deseados, que ocurren casi la mitad de las veces en los Estados Unidos.