Insurance, Coverage, and Costs: Dec. 15, 2022
An Unexplained Injury Discovered After Eye Surgery. What Should Happen Next?
Fred Clasen-Kelly
Some doctors and medical practices voluntarily give rebates on a bill if an injury occurs during a procedure, while others will not, an expert says. Here’s how patients can respond.
KHN Investigation: The System Feds Rely On to Stop Repeat Health Fraud Is Broken
Sarah Jane Tribble and Lauren Weber
A months-long KHN examination of the system meant to bar fraudsters from Medicaid, Medicare, and other federal health programs found gaping holes and expansive gray areas through which banned individuals slip to repeatedly bilk taxpayer-funded programs.
When Malpractice Occurs at Community Health Centers, Taxpayers Pay
Phil Galewitz and Bram Sable-Smith
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.
Schools, Sheriffs, and Syringes: State Plans Vary for Spending $26B in Opioid Settlement Funds
Aneri Pattani
The cash represents an unprecedented opportunity to derail the opioid epidemic, but with countless groups advocating for their share of the pie, the impact could depend heavily on geography and politics.
Hospital Financial Decisions Play a Role in the Critical Shortage of Pediatric Beds for RSV Patients
Liz Szabo
Yes, the U.S. is experiencing an unusual spate of childhood RSV infections. But the critical shortage of hospital beds to treat ailing children stems from structural problems in pediatric care that have been brewing for years.
Mistrust and Polarization Steer Rural Governments to Reject Federal Public Health Funding
Jazmin Orozco Rodriguez
As the covid-19 pandemic grinds on, Elko County, Nevada, still lacks a public health department. Yet its elected leaders rejected federal funds that could have helped it create one. Decisions like the one in Elko, and ones made by officials with other state and local governments, leave health experts concerned about whether the country's public health infrastructure will be prepared to handle future health challenges.
Trickle of Covid Relief Funds Helps Fill Gaps in Rural Kids’ Mental Health Services
Christina Saint Louis
Only a sliver of the funding given to state, local, and tribal governments through the American Rescue Plan Act has been steered to mental health nationwide, but mental health advocates and clinicians hope the money it provides will help address gaps in care for children. In Appalachian Ohio, the funding is helping expand services.
More States to Consider Extending Postpartum Medicaid Coverage Beyond Two Months
Matt Volz
Fifteen states haven’t moved to extend Medicaid coverage for new moms beyond the minimum of 60 days after birth. But at least four of those holdout states — Montana, Wyoming, Missouri, and Mississippi — are expected to consider proposals to extend coverage in their upcoming legislative sessions.
To Attract In-Home Caregivers, California Offers Paid Training — And Self-Care
Laurie Udesky
Turnover ails a program that allows low-income people who are older or disabled to age in place. To attract new workers and improve retention, the state is paying caregivers to develop new skills.
What Germany’s Coal Miners Can Teach America About Medical Debt
Noam N. Levey
Coal mining ended in Germany’s Saarland a decade ago, but the transition away from coal has been smoother than in West Virginia, which has more medical debt than any state in America.
In Rural America, Deadly Costs of Opioids Outweigh the Dollars Tagged to Address Them
Aneri Pattani and Rae Ellen Bichell
Some people say it’s reasonable for densely populated areas to receive more settlement funds, since they serve more of those affected. But others worry this overlooks rural communities disproportionately harmed by opioid addiction.
The Business of Clinical Trials Is Booming. Private Equity Has Taken Notice.
Rachana Pradhan
Private equity-backed Headlands Research heralded its covid-19 vaccine trials as a chance to boost participation among diverse populations, then it shuttered multiple sites that conducted them.
How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions
Fred Schulte and Holly K. Hacker
Facing rare scrutiny from federal auditors, some Medicare Advantage health plans failed to produce any records to justify their payments, government records show. The audits revealed millions of dollars in overcharges to Medicare over three years.
Journalists Explain Medicaid Work Requirements and Hospital Price Transparency
KHN 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.
Employers Use Patient Assistance Programs to Offset Their Own Costs
Julie Appleby
Some insurers and employers are tapping into assistance programs meant for individual patients. The concern: Some costly drugs could be harder for patients to access.
The Disability Tax: Medical Bills Remain Inaccessible for Many Blind Americans
Lauren Weber and Hannah Recht
Health insurers and health care systems across the country are violating disability rights laws by sending medical bills that blind and visually impaired people cannot read, a KHN investigation has found. By hindering the ability of blind Americans to know what they owe, some bills get sent to debt collections.
Colorado Option’s Big Test: Open Enrollment
Markian Hawryluk
Critics were ready to bury the state’s new health insurance plans, based on a public option, when 2023 rate hikes were announced, but officials are confident people will be drawn to the plans’ benefits.
Paxlovid Has Been Free So Far. Next Year, Sticker Shock Awaits.
Hannah Recht
The government soon will stop paying for the covid drug that has proved to be the most effective at keeping patients alive and out of the hospital.
Path Cleared for Georgia to Launch Work Requirements for Medicaid
Andy Miller and Sam Whitehead
Federal officials have apparently stopped fighting Georgia’s plan for a limited Medicaid expansion that includes work requirements. The plan, a key policy of Republican Gov. Brian Kemp’s, would cover a much smaller portion of the population: those who can work or volunteer 80 hours a month.
Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges
Fred Schulte and Holly K. Hacker
Taxpayers had to foot the bills for care that should have cost far less, according to records released after KHN filed a lawsuit under the Freedom of Information Act. The government may seek to recover up to $650 million as a result.
California Aims to Maximize Health Insurance Subsidies for Workers During Labor Disputes
Annie Sciacca
Workers who lose employer-based health coverage during a strike or lockout will have access to a full-subsidy plan through Covered California.
Journalists Discuss Medicaid Rules, Opioid Settlement Funds, and the Public Health Workforce
KHN 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.
‘An Arm and a Leg’: When Insurance Won’t Pay, Abortion Assistance Funds Step In
Dan Weissmann
Privacy concerns and coverage limits have long made insurance an unreliable option for abortion access. For decades, abortion funds have been stepping in to help people pay for what they see as essential health care.
‘An Arm and a Leg’: He Made a Video About Health Insurance Terminology That Went Viral
Dan Weissmann
A video producer’s quest for health coverage led him to create a video about insurance terminology. That video now has over a million views. Here’s how he did it.
Readers and Tweeters Decry Medical Billing Errors, Price-Gouging, and Barriers to Benefits
KHN gives readers a chance to comment on a recent batch of stories.