Insurance, Coverage, and Costs: Nov. 27, 2024
A Toddler Got a Nasal Swab Test but Left Before Seeing a Doctor. The Bill Was $445.
Bram Sable-Smith
A mom in Peoria, Illinois, took her 3-year-old to the ER one evening last December. While they were waiting to be seen, the toddler seemed better, so they left without seeing a doctor. Then the bill came.
Toddler’s Backyard Snakebite Bills Totaled More Than a Quarter Million Dollars
Jackie Fortiér
For snakebite victims, antivenom is critical — and costly. It took more than $200,000 worth of antivenom to save one toddler’s life after he was bitten by a rattlesnake.
Listen: A Tussle With a Rattlesnake Can Take a Bite Out of Your Wallet
Jackie Fortiér
Listen to KFF Health News' Jackie Fortiér recount how a backyard snakebite led to a harrowing hospitalization — and big bills — for a San Diego family.
Florida’s Deloitte-Run Computer System Cut Off New Moms Entitled to Medicaid
Daniel Chang and Samantha Liss
Florida discovered a glitch in its Deloitte-run Medicaid eligibility system. The problem, alleged in court testimony, led to new mothers wrongly losing their insurance coverage.
Anti-Fraud Efforts Meet Real-World Test During ACA Enrollment Period
Julie Appleby
The federal government put guardrails in place to limit unauthorized plan sign-ups and switches. But the changes could prove to be a burden to consumers.
TV’s Dr. Oz Invested in Businesses Regulated by Agency Trump Wants Him To Lead
Darius Tahir
Celebrity doctor Mehmet Oz recently held broad investments in health care, tech, and food companies. Were he confirmed to run the Centers for Medicare & Medicaid Services, his job would involve interacting with giants of the industry that have contributed to his wealth.
Presidential Election Puts Affordable Care Act Back in the Bull’s-Eye
Stephanie Armour
The outcome of the upcoming presidential election could affect the number of insured Americans, the fate of premium-reducing subsidies, the shape of Medicaid, and the cost of coverage for tens of millions of people.
Black Americans Still Suffer Worse Health. Here’s Why There’s So Little Progress.
Fred Clasen-Kelly and Renuka Rayasam
The United States has made almost no progress in closing racial health disparities despite promises, research shows. The government, some critics argue, is often the underlying culprit.
Washington Power Has Shifted. Here’s How the ACA May Shift, Too.
Stephanie Armour and Sam Whitehead and Julie Rovner
With a new Trump administration poised to move into the White House and Republicans set to control both chambers of Congress, party leaders are making a to-do list for the Affordable Care Act.
Florida Gov. DeSantis’ Canadian Drug Import Plan Goes Nowhere After FDA Approval
Phil Galewitz
Florida sued the FDA over what it said was a “reckless delay” in approving its drug importation plan. Now, nearly a year after the FDA gave the state the green light, the program has yet to begin.
California Sets 15% Target for Primary Care Spending Over Next Decade
Vanessa G. Sánchez
The state Office of Health Care Affordability has set a goal for insurers to direct 15% of their spending to primary care by 2034, part of a push to expand preventive care services. Health plans say it’s unclear how the policy will mesh with the state’s overarching goal to slow spending growth.
Fight Health Insurance — With Help From AI
Dan Weissmann
Meet the tech worker on a quest to use artificial intelligence to combat denials for coverage from patients’ health plans.
After Congress Ended Extra Cash Aid for Families, Communities Tackle Child Poverty Alone
Kate Wells, Michigan Public
The child tax credit passed by Congress at the height of covid has expired, but states and localities are trying to fill the gap with their own programs and funding. In Michigan, Rx Kids already covers every family with a new baby in Flint. Now, other communities aim to follow.
Social Security Tackles Overpayment ‘Injustices,’ but Problems Remain
David Hilzenrath and Jodie Fleischer, Cox Media Group
With his term soon to expire, Social Security chief Martin O’Malley’s efforts to address the agency’s overpayments to beneficiaries remain incomplete.
‘Dreamers’ Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way
Julie Appleby
Nineteen states are seeking to stall a Biden administration rule that would allow recipients of the Deferred Action for Childhood Arrivals program to enroll in ACA coverage and qualify for subsidies. DACA provides work authorization and temporary deportation protection to people brought to the U.S. as children without immigration paperwork.
For People With Opioid Addiction, Medicaid ‘Unwinding’ Raises the Stakes
Kim Krisberg, Public Health Watch and Stephanie Colombini, WUSF
Medications such as methadone can cut the risk of a fatal opioid overdose in half. Medicaid covers the medication. But as state Medicaid programs reevaluated coverage of each enrollee following a pause in disenrollments during the covid-19 pandemic, some patients lost a crucial pillar of their sobriety.
Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby
Renuka Rayasam
Pregnant women are being asked to make large cash payments months before they deliver their babies. Some patient advocates worry this billing practice allows providers to hold treatment hostage.
Trump’s White House Return Poised To Tangle Health Care Safety Net
Stephanie Armour
The new Trump administration is likely to reduce subsidies for Affordable Care Act insurance plans and roll back Medicaid coverage. Public health authorities worry that anti-vaccine activist Robert F. Kennedy Jr. will be empowered.
Trump Wants Harris To Pay a Political Price for Generous Immigrant Health Policies
Joanne Kenen
Several Democratic-led states have expanded public insurance programs to cover immigrants in the U.S. regardless of legal status. Donald Trump is trying to blame Kamala Harris for the policies.
In Montana, Conservative Groups See Chance To Kill Medicaid Expansion
Katheryn Houghton
Conservative groups are working to undermine support for Montana’s Medicaid expansion ahead of a political fight over whether to keep the program.
What’s at Stake: A Pivotal Election for Six Big Health Issues
Arthur Allen and Phil Galewitz and Julie Rovner and Daniel Chang
Health care has ebbed and surged as an election issue throughout the presidential campaign. Here are the ways some of the most consequential changes in health policies could hinge on whether Vice President Kamala Harris or former President Donald Trump wins.
Election Outcome Could Bring Big Changes to Medicare
Stephanie Armour
Democrats and conservatives are divided over whether the federal health program for people over 65 should be run almost entirely by the private sector. If Trump retakes the White House, the shift to Medicare Advantage may accelerate.
In Vermont, Where Almost Everyone Has Insurance, Many Can’t Find or Afford Care
Phil Galewitz
Vermont has one of the lowest uninsured rates in the U.S., even though its residents pay some of the highest health insurance costs. Still, most of its hospitals are losing money and patients often face long waits for care.
Readying for Republican Rule
With Republicans now set to control the White House, Senate, and House of Representatives starting in January, their health agenda remains unclear. What is clear, however, is that just about anything could be on the table, from Medicare, Medicaid, and the Affordable Care Act, to drug prices and public health. Meanwhile, anti-abortion groups are preparing to fight the implementation of abortion rights ballot measures just passed by voters in seven states. Rachel Roubein of The Washington Post, Anna Edney of Bloomberg News, and Lauren Weber of The Washington Post join KFF Health News’ Julie Rovner to discuss these stories and more. Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too.
Indiana Hospitals Pull Merger Application After Pushback Over Monopoly Concerns
Samantha Liss
Two Indiana hospital rivals withdrew their application to merge after facing pushback from the Federal Trade Commission and the public.
FTC, Indiana Residents Pressure State To Block Hospital Merger
Samantha Liss
Hundreds of people and the Federal Trade Commission weighed in on a proposed hospital merger in Terre Haute, Indiana, with most arguing that the creation of a monopoly would increase costs and worsen patient care.
Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn
Brett Kelman and Anna Werner, CBS News and Oona Zenda
Americans are getting dental implants more than ever — and at costs reaching tens of thousands of dollars. Experts worry some dentists have lost sight of the soul of dentistry: preserving and fixing teeth.
KFF Health News Sues To Force Disclosure of Medicare Advantage Audit Records
Fred Schulte
Freedom of Information Act case targets HHS inspector general’s reviews of billions of dollars in health plan overpayments.
Watchdog Calls for Tighter Scrutiny of Medicare Advantage Home Visits
Fred Schulte
Medicare officials defend the use of home visits that often spot medical conditions that are never treated.
California Expanded Medi-Cal to Unauthorized Residents. The Results Are Mixed.
Vanessa G. Sánchez
California this year completed its Medi-Cal expansion to include income-eligible residents regardless of their immigration status. This final installment of the “Faces of Medi-Cal” series profiles three of those newly eligible patients and how coverage has affected their health.
Journalists Examine Health Care for Native Americans and Recent Food Recalls
KFF Health News and California Healthline staff made the rounds on national and local media in recent weeks to discuss topical stories. Here’s a collection of their appearances.
Readers Embrace ‘Going It Alone’ Series on Aging and Chastise Makers of Pulse Oximeters
KFF Health News gives readers a chance to comment on a recent batch of stories.
Dicen que los esfuerzos contra el fraude en ACA han dado resultados. Pero hay que estar alerta
Julie Appleby
Los Centros de Servicios de Medicare y Medicaid atribuyen esta reducción a las medidas adoptadas para prevenir problemas de inscripción y cambios de planes, que ya habían generado más de 274,000 quejas hasta agosto.
El poder en Washington ha cambiado. ACA podría cambiar también
Stephanie Armour and Sam Whitehead and Julie Rovner
El futuro gobernante prepara el terreno para hacer cambios potencialmente sísmicos que podrían limitar la expansión de Medicaid, aumentar la tasa de personas sin seguro, debilitar las protecciones para los pacientes y elevar los costos de las primas para millones de personas.
Pagar primero, parir después: algunos servicios piden a las embarazadas que paguen fortunas antes del parto
Renuka Rayasam
Es difícil saber con qué frecuencia ocurre porque se considera una transacción privada entre el proveedor y el paciente. Por lo tanto, los pagos no se registran en los datos de reclamos de seguros y, por ende, los expertos no los analizan.
California amplió el Medi-Cal a todos los residentes más allá de su estatus migratorio. Los resultados son desiguales.
Vanessa G. Sánchez
Estos inmigrantes se han ido sumando al programa poco a poco, a medida que el estado fue eliminando el requisito de residencia legal.
El regreso de Trump a la Casa Blanca pondría en peligro la red de seguridad de atención médica
Stephanie Armour
El triunfo electoral del ex presidente Donald Trump y su regreso a la Casa Blanca probablemente traerán cambios que reducirían los programas nacionales de salud públicos, aumentando la tasa de personas sin seguro e imponiendo nuevas barreras al aborto y otros servicios de salud reproductiva.
Trump quiere que Harris pague un precio político por ofrecer salud a inmigrantes sin papeles
Joanne Kenen
Estados liderados por demócratas, como Illinois, están abriendo cada vez más programas de seguros públicos a inmigrantes sin papeles.
Ahora los “Dreamers” pueden inscribirse en planes de salud de ACA. Pero una demanda podría acabar con el sueño
Julie Appleby
Del medio millón de beneficiarios de DACA, el gobierno estima que alrededor de 100.000 que anteriormente no tenían seguro podrían inscribirse a partir del 1 de noviembre.