Insurance, Coverage, and Costs: June 8, 2023
He Returned to the US for His Daughter’s Wedding. He Left With a $42,000 Hospital Bill.
Sarah Jane Tribble
After emergency surgery, an American expatriate with Swiss insurance now carries the baggage of a five-figure bill. Costs for medical care in the U.S. can be two to three times the rates in other developed countries, so foreigners and expats with good insurance in their home countries need travel insurance to protect themselves from “crazy prices.”
As Medicaid Purge Begins, ‘Staggering Numbers’ of Americans Lose Coverage
Hannah Recht
In what’s known as the Medicaid “unwinding,” states are combing through rolls to decide who stays and who goes. But the overwhelming majority of people who have lost coverage so far were dropped because of technicalities, not because officials determined they are no longer eligible.
Thousands Face Medicaid Whiplash in South Dakota and North Carolina
Arielle Zionts
Thousands of South Dakotans are being knocked off Medicaid, only to be eligible to requalify several months later. Even more enrollees are likely to experience a temporary loss of coverage in North Carolina.
Are US Prescription Drug Prices 10 Times Those of Other Nations? Only Sometimes
Michelle Andrews
Sen. Bernie Sanders’ broad statement that some U.S. drug prices are 10 times those of other nations doesn’t paint the full picture. Studies we examined generally found that U.S. prices were two to four times those in other countries, not 10.
California Hospitals Seek a Broad Bailout, but They Don’t All Need It
Samantha Young and Angela Hart
As hospitals squeeze Democratic leaders in Sacramento for more money, health care finance experts and former state officials warn against falling for the industry’s fear tactics. They point to healthy profits and a recession-era financing scheme that allows rich hospitals to take tax money from poorer ones.
This Panel Will Decide Whose Medicine to Make Affordable. Its Choice Will Be Tricky.
Markian Hawryluk
Colorado’s new Prescription Drug Affordability Board could cap what health plans and consumers pay for certain medications starting next year. The process will pit patient groups against one another.
Personal Medical Debt in Los Angeles County Tops $2.6 Billion, Report Finds
Molly Castle Work
Medical debt is a leading public health problem, researchers say. Despite the county’s ongoing expansion of health coverage, the prevalence of medical debt remained unchanged from 2017 to 2021.
A Windfall in Health Insurance Rebates? It’s Not as Crazy as It Sounds
Julie Appleby
The billion-dollar amount cited by former Sen. Al Franken, while an estimate, is likely very close to what insurers will owe this year under a provision of the Affordable Care Act that compels rebates when insurers spend too little on actual medical care.
A Covid Test Medicare Scam May Be a Trial Run for Further Fraud
Susan Jaffe
Before the covid-19 public health emergency ended, Medicare advocates around the country noticed a rise in complaints from beneficiaries who received at-home covid tests they never requested. Bad actors may have used seniors’ Medicare information to improperly bill the federal government — and could do it again, say federal investigators.
How a Medical Recoding May Limit Cancer Patients’ Options for Breast Reconstruction
Rachana Pradhan and Anna Werner, CBS News and Leigh Ann Winick, CBS News
The federal government’s arcane process for medical coding is influencing which reconstructive surgery options are available, creating anxiety for breast cancer patients.
California Governor and Democratic Lawmakers at Odds Over Billions in Health Care Funds
Angela Hart
Gov. Gavin Newsom is getting pressure from his political allies to begin spending money on health care that the state raised by fining Californians who go without health insurance. But Newsom says the state can’t afford to.
Health Care Coalition Jockeys Over Medi-Cal Spending, Eyes Ballot Initiative
Angela Hart and Samantha Young
California Healthline has learned that a coalition of doctors, hospitals, insurers, and community clinics want to lock in a tax on health insurance companies to draw in extra Medicaid funding. It also wants to make the tax permanent.
Denials of Health Insurance Claims Are Rising — And Getting Weirder
Elisabeth Rosenthal
The Department of Health and Human Services is tasked with monitoring denials both by Obamacare health plans and those offered through employers and insurers. As insurers’ denials become more common, they sometimes defy not just medical standards of care but sheer logic. Why hasn’t the agency fulfilled its assignment?
A ‘Payday Loan’ From a Health Care Behemoth
Dan Weissmann
UnitedHealth Group is the largest health insurer in the United States. And it keeps growing. This has led some health care experts to call for antitrust regulation of this “behemoth” company.
The Debt Ceiling Deal Takes a Bite Out of Health Programs. It Could Have Been Much Worse.
Julie Rovner
A bipartisan deal to raise the government’s borrowing limit dashed Republican hopes for new Medicaid work requirements and other health spending cuts. Democrats secured the compromise by making relatively modest concessions, including ordering the return of unspent covid funds and limiting other health spending.
More States OK Postpartum Medicaid Coverage Beyond Two Months
Matt Volz
Montana, Alaska, Mississippi, Missouri, South Dakota, Texas, Utah, and Wyoming are among the latest states moving to provide health coverage for up to a year after pregnancy through the federal-state health insurance program for low-income people.
The Crisis Is Officially Ending, but Covid Confusion Lives On
The public health emergency declaration for covid-19 ends May 11, ushering in major changes in how Americans can access and pay for the vaccines, treatments, and tests particular to the culprit coronavirus. But not everyone will experience the same changes, creating a confusing patchwork of coverage — not unlike health coverage for other diseases. Meanwhile, outside advisers to the FDA formally recommended allowing a birth control pill to be sold without a prescription. If the FDA follows the recommendation, it would represent the first over-the-counter form of hormonal contraception. Margot Sanger-Katz of The New York Times, Tami Luhby of CNN, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico join KFF Health News’ Julie Rovner to discuss these issues and more. Plus for “extra credit” the panelists suggest health policy stories they read this week they think you should read, too.
Mental Health ‘Ghost Networks’ — And a Ghostbuster
Dan Weissmann
What should you do when your search for an in-network mental health care provider comes up empty? Abigail Burman has some expertise to share.
Our 300th Episode!
When KFF Health News’ “What the Health?” podcast launched in 2017, Republicans in Washington were engaged in an (ultimately unsuccessful) campaign to “repeal and replace” the Affordable Care Act. The next six years would see a pandemic, increasingly unaffordable care, and a health care workforce experiencing unprecedented burnout. In the podcast’s 300th episode, host and chief Washington correspondent Julie Rovner explores the past and possible future of the U.S. health care system with three prominent “big thinkers” in health policy: Ezekiel Emanuel of the University of Pennsylvania, Jeff Goldsmith of Health Futures, and Farzad Mostashari of Aledade.
Gobernador de California y legisladores demócratas discrepan sobre el uso de miles de millones de dólares en fondos de salud
Angela Hart
Los líderes demócratas dijeron que la táctica de Newsom de retener el dinero para el fondo general es una "estafa".
Estafas a Medicare con pruebas para covid pueden generar otros fraudes
Susan Jaffe
La cobertura de Medicare para las pruebas caseras de covid-19 finalizó hace pocos días, pero las estafas generadas por este beneficio temporal podrían tener consecuencias persistentes para las personas mayores.