Insurance, Coverage and Costs: Nov. 30, 2023

Facing Financial Ruin as Costs Soar for Elder Care
By Reed Abelson, The New York Times and Jordan Rau The United States has no coherent system of long-term care, leading many to struggle to stay independent or rely on a patchwork of solutions.

What Long-Term Care Looks Like Around the World
By Jordan Rau Most countries spend more than the United States on care, but middle-class and affluent people still bear a substantial portion of the costs.

Uncle Sam Wants You … to Help Stop Insurers’ Bogus Medicare Advantage Sales Tactics
By Susan Jaffe The Biden administration wants to crack down on deceptive or misleading Medicare Advantage and drug plan sales tactics. It’s counting on beneficiaries to help catch offenders.

An Arm and a Leg: To Get Health Insurance, This Couple Made a Movie
By Dan Weissmann On this episode of “An Arm and a Leg,” hear how a couple wrote and directed a short film, starring one of them — just to maintain health insurance through the actors union.

Medicare Advantage Increasingly Popular With Seniors — But Not Hospitals and Doctors
By Julie Appleby Some hospitals and physician groups are rejecting Medicare Advantage plans over payment rates and coverage restrictions, causing turmoil for patients.

Hospitals and Doctors Are Fed up With Medicare Advantage
By Julie Appleby Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF’s count. But among doctors and hospitals, it’s a different story. Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans […]

Medicaid ‘Unwinding’ Makes Other Public Assistance Harder to Get
By Katheryn Houghton and Rachana Pradhan and Samantha Liss The bottleneck caused by states’ reevaluation of Medicaid enrollees has swept up low-income families that rely on other safety-net services.

Medicaid’s ‘Unwinding’ Can Be Especially Perilous for Disabled People
By Rachana Pradhan Earlier this year, Beverly Likens thought she’d done everything she needed to do to keep her Medicaid. Then came an unwelcome surprise: Ahead of surgery to treat chronic bleeding, the hospital said her insurance was inactive, jeopardizing her procedure. Likens had just been diagnosed with severe anemia and given a blood transfusion at the emergency room. “I […]

How the Thyroid Gland Mystifies Doctors and Patients
By Oona Zenda and Andy Miller This illustrated report has been adapted from a KFF Health News article, “Many Autoimmune Disease Patients Struggle With Diagnosis, Costs, Inattentive Care” by Andy Miller, with artwork by Oona Tempest.

A Guide to Long-Term Care Insurance
By Jordan Rau Deciding when, or whether, to buy long-term care insurance can be complex. Here’s what to know.

Why Long-Term Care Insurance Falls Short for So Many 
By Jordan Rau and JoNel Aleccia The private insurance market has proved wildly inadequate in providing financial security for millions of older Americans, in part by underestimating how many policyholders would use their coverage.

1 in 3 People Dropped by Utah Medicaid Left Uninsured, a ‘Concerning’ Sign for Nation
By Phil Galewitz About a third of the 130,000 people Utah has dropped from Medicaid this year say they now lack health insurance. It’s a glimpse into the fate of people caught up in Medicaid’s “unwinding.”

Many Autoimmune Disease Patients Struggle With Diagnosis, Costs, Inattentive Care
By Andy Miller Illustration by Oona Zenda Despite the prevalence of autoimmune conditions, like the thyroid disease Hashimoto’s, sometimes finding help can prove frustrating as well as expensive. There are often no definitive diagnostic tests, so patients may rack up big bills as they search for confirmation of their condition and for treatment options.

Why It’s So Tough to Reduce Unnecessary Medical Care
By Markian Hawryluk Treatments that don’t help patients, and may even harm them, are difficult to eliminate because they can be big sources of revenue.

Beyond Insulin: Medi-Cal Expands Patient Access to Diabetes Supplies
By Angela Hart California’s Medicaid program is making it easier for people with diabetes to obtain the supplies and equipment they need to manage their blood sugar, partly by relaxing preauthorization requirements that can cause life-threatening delays.

Lost in the Mix of Medicaid ‘Unwinding’: Kentucky Cut Off Her Health Care Over a Clerical Error
By Rachana Pradhan The state canceled Beverly Likens’ coverage — days before surgery — without considering other ways she qualified for Medicaid, which experts say violated federal regulations.

Out for Blood? For Routine Lab Work, the Hospital Billed Her $2,400
By Rachana Pradhan Convenient as it may be, beware of getting your blood drawn at a hospital. The cost could be much higher than at an independent lab, and your insurance might not cover it all.

Health Care Is Front and Center as DeSantis and Newsom Go Mano a Mano
By Daniel Chang and Angela Hart Florida’s Republican Gov. Ron DeSantis and California’s Democratic Gov. Gavin Newsom will square off in a first-of-its-kind debate on Nov. 30. KFF Health News compared the political rivals’ health care positions, showing how their policies have helped — or hindered — the health of their states’ residents.

New California Law Offers Fresh Protection From Steep Ambulance Bills
By Bernard J. Wolfson The law, which takes effect Jan. 1, prohibits out-of-network ground ambulance operators from billing patients more than they would pay for in-network rides. It also caps how much the uninsured must pay.

From Hospital to Hospitality: Spin Doctors Brand Getting Sick as an Adventure. It’s Not.
By Elisabeth Rosenthal At $1,000 a night for a private room, medical centers are offering fancy food and casting health care as a “journey.” Instead of creature comforts, how about helping us feel better?

Biden Administration’s Limit on Drug Industry Middlemen Backfires, Pharmacists Say
By Arthur Allen A rule taking effect Jan. 1 was intended to stop one set of abuses by pharmacy benefit managers, or PBMs, but some pharmacists say it’s enabling these price brokers to simply do new things unfairly.

Compensation Is Key to Fixing Primary Care Shortage
By Michelle Andrews Many proposals have been floated about how to address the nation’s primary care problem. They range from training slots to medical school debt forgiveness but often sidestep comprehensive payment reform.

Why Do We Pay For so Much Worthless Health Care?
By Markian Hawryluk Medical advances are expensive. Take Wegovy, the wildly successful obesity drug that we learned last week may also reduce the risk of heart disease. If just 10 percent of Medicare beneficiaries start taking the drug, taxpayers could be on the hook for nearly $27 billion a year.  So how can the country afford the latest […]

What to Know About Assisted Living
By Jordan Rau The facilities can look like luxury apartments or modest group homes and can vary in pricing structures. Here’s a guide.

What the Health? From KFF Health News: Congress Kicks the (Budget) Can Down the Road. Again.
Congress narrowly avoided a federal government shutdown for the second time in six weeks, as Democrats came to the rescue of divided House Republicans over annual spending bills that were supposed to be finished by Oct. 1. But the brinksmanship is likely to repeat itself early in 2024, when the next temporary spending patches expire. Meanwhile, a pair of investigations unveiled this week demonstrate how difficult it still is for seniors to get needed long-term and rehabilitation care. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News’ Julie Rovner to discuss these issues and more.

Extra Fees Drive Assisted Living Profits
By Jordan Rau The add-ons pile up: $93 for medications, $50 for cable TV. Prices soar as the industry leaves no service unbilled, out of reach for many families.

What the Health? From KFF Health News: For ACA Plans, It’s Time to Shop Around
It’s Obamacare open enrollment season, which means that, for people who rely on these plans for coverage, it’s time to shop around. With enhanced premium subsidies and cost-sharing assistance, consumers may find savings by switching plans. It is especially important for people who lost their coverage because of the Medicaid unwinding to investigate their options. Many qualify for assistance. Meanwhile, the countdown to Election Day is on, and Ohio’s State Issue 1 is grabbing headlines. The closely watched ballot initiative has become a testing ground for abortion-related messaging, which has been rife with misinformation. This week’s panelists are Mary Agnes Carey of KFF Health News, Jessie Hellmann of CQ Roll Call, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachana Pradhan of KFF Health News.

Journalists Delve Into Open Enrollment, School Nurse Shortages, and More
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.

“Peor de lo que la gente cree”, cambios en Medicaid crean caos en los estados
By Phil Galewitz and Katheryn Houghton and Brett Kelman and Samantha Liss Tanto beneficiarios como defensores de pacientes dicen que los funcionarios de Medicaid enviaron formularios de renovación obligatoria a direcciones viejas, calcularon mal los niveles de ingresos e hicieron malas traducciones de los documentos.

La atención de salud, en el centro del debate entre DeSantis y Newsom
By Daniel Chang and Angela Hart El candidato presidencial republicano Ron DeSantis y el gobernador demócrata Gavin Newsom —rivales políticos y representantes de la América roja y azul— se enfrentarán en un debate sin precedentes el 30 de noviembre en Georgia.

Nueva ley de California ofrece protección contra facturas por viajes en ambulancia
By Bernard J. Wolfson En California, casi tres cuartas partes de los traslados de emergencia en ambulancia generan facturas fuera de la red. La factura sorpresa promedio es de $1,209, la más alta del país