Insurance, Coverage and Costs: Oct. 20, 2022
Turned Away From Urgent Care — And Toward a Big ER Bill
Sam Whitehead
Russell Cook was expecting a quick and inexpensive visit to an urgent care center for his daughter, Frankie, after she had a car wreck. Instead, they were advised to go to an emergency room and got a much larger bill.
$80,000 and 5 ER Visits: An Ectopic Pregnancy Takes a Toll Despite NY’s Liberal Abortion Law
Michelle Andrews
If an embryo has implanted in a fallopian tube, ending the pregnancy is imperative to protect the patient’s life. Women’s health advocates have raised concerns that the needed treatment may be hampered by restrictive abortion laws in some states. Yet women seeking treatment in states with more liberal abortion laws may still find the process expensive and harrowing.
Shattered Dreams and Bills in the Millions: Losing a Baby in America
Lauren Weber
On top of fearing for their children’s lives, new parents of very fragile, very sick infants can face exorbitant hospital bills — even if they have insurance. Medical bills don’t go away if a child dies.
Watch: Their Baby Died. The Medical Bills Haunted Them.
Sterling Raspe lived just eight months. In this KHN video, her father shows the 2-inch stack of medical bills generated by Sterling’s care.
Listen: Grieving Families Face the Cruelest Bills
KHN Midwest correspondent Lauren Weber talks with NPR's "Consider This" podcast about her reporting on families confronted with medical bills while grieving the loss of a baby who received expensive hospital care.
Medical Debt Sunk Her Credit. New Changes From the Credit Reporting Agencies Won’t Help.
Aneri Pattani
New policies to prevent unpaid medical bills from harming people’s credit scores are on the way. But the concessions made by top credit reporting companies may fall short for those with the largest debt — especially Black Americans in the South.
Listen: Medical Bills Upended Her Life and Her Credit Score
Aneri Pattani
Penny Wingard, 58, of Charlotte, North Carolina, worries she won’t ever get out from under her medical debt despite new policies that are supposed to prevent medical debt from harming people’s credit scores.
Baby, That Bill Is High: Private Equity ‘Gambit’ Squeezes Excessive ER Charges From Routine Births
Rae Ellen Bichell
Hospitals, boosted by private equity-backed staffing companies, have embraced a new idea: the obstetrics emergency department. Often, it is just a triage room in the labor-and-delivery area, but it bills like the main emergency department.
Kids’ Mental Health Care Leaves Parents in Debt and in the Shadows
Yuki Noguchi, NPR News
A youth mental health crisis and a shortage of therapists and other care providers who take insurance are pushing many families into financial ruin. But it's rarely acknowledged as medical debt.
New Generation of Weight Loss Medications Offer Promise — But at a Price
Julie Appleby
People now have at their disposal more medicines that are effective at reducing weight, but none can counter obesity alone. One big problem: Insurance coverage remains spotty, and the costly drugs may be needed long term.
BMI: The Mismeasure of Weight and the Mistreatment of Obesity
Julie Appleby
The human body mass index — a simple mathematical equation — is tied to a measure of obesity invented almost 200 years ago. On the downside, it can stand between patients and treatment for weight issues. It particularly mismeasures Black women and Asians.
After Congress Fails to Add Dental Coverage, Medicare Weighs Limited Benefit Expansion
Susan Jaffe
Medicare can pay for some dental care if it is medically necessary to safely treat another covered medical condition, and federal officials have asked for suggestions on whether that list of conditions should be expanded.
Say What? Hearing Aids Available Over-the-Counter for as Low as $199, and Without a Prescription
Phil Galewitz
The cheaper over-the-counter aids are for adults with mild to moderate hearing loss — a market of tens of millions of people, many of whom have until now been priced out because prescription devices can cost thousands of dollars.
Lawsuit by KHN Prompts Government to Release Medicare Advantage Audits
Fred Schulte
The lawsuit was filed three years ago to learn about vast overcharges by the popular health plans that are detailed in audits the government refused to release to the public.
Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers
Susan Jaffe
Private Medicare Advantage health plans are increasingly ending coverage for skilled nursing or rehab services before medical providers think patients are healthy enough to go home, doctors and patient advocates say.
Health Plan Shake-Up Could Disrupt Coverage for Low-Income Californians
Bernard J. Wolfson
Four managed-care insurance plans may lose contracts with California’s Medicaid program, which would force nearly 2 million low-income residents to switch their health plans — and possibly their doctors. The plans are fighting back.
Buy and Bust: After Platinum Health Took Control of Noble Sites, All Hospital Workers Were Fired
Sarah Jane Tribble
Two Missouri towns are without operating hospitals after private equity-backed Noble Health left both facilities mired in debt, lawsuits, and federal investigations. The hospitals’ new operator, Platinum Health, agreed to buy them in April for $2 and laid off the last employees in early September.
‘Separate and Unequal’: Critics Say Newsom’s Pricey Medicaid Reforms Leave Most Patients Behind
Angela Hart
MLK Community Hospital in South Los Angeles is surrounded by poverty, homeless encampments, and food deserts. Even though California Gov. Gavin Newsom is funneling billions of taxpayer money into an ambitious initiative to provide some low-income patients with social services, hospital executives and other critics say it won’t improve access to basic care.
Campaigning Ramps Up as South Dakota Voters Decide on Medicaid Expansion
Arielle Zionts
A broad coalition of Medicaid expansion supporters faces off against a smaller group of opponents as early voting begins on a constitutional amendment that would increase coverage under South Dakota’s program.
Britain’s Hard Lessons From Handing Elder Care Over to Private Equity
Christine Spolar
Four Seasons Health Care collapsed after years of private equity investors rolling in one after another to buy its business, sell its real estate, and at times wrest multimillion-dollar profits from it through complex debt schemes. The deal-making failed to account for the true cost of senior care.
Pharma-Funded FDA Gets Drugs Out Faster, But Some Work Only ‘Marginally’ and Most Are Pricey
Arthur Allen
Since pharmaceutical companies started funding their FDA drug applications 30 years ago, the agency’s reviews have gone much faster — perhaps too fast.
Centene Gave Thousands to Georgia Leaders’ Campaigns While Facing Medicaid Overbilling Questions
Maya T. Prabhu, Atlanta Journal-Constitution and Andy Miller
Centene is trying to settle accusations of Medicaid pharmaceutical overcharging in Georgia, and the St. Louis-based company has been giving thousands of dollars to the campaigns of the state attorney general and the governor.
Centene Agrees to Pay Massachusetts $14 Million Over Medicaid Prescription Claims
Andy Miller and Samantha Young
Massachusetts is the latest state to settle with St. Louis-based Centene Corp. over allegations that it overcharged Medicaid prescription drug programs.
As Giant Hospitals Get Bigger, an Independent Doctor Feels the Pinch
Fred Clasen-Kelly
Independent medical practices keep closing as doctors join behemoth hospital groups or leave the field. Research suggests that’s bad news for patients. Studies repeatedly conclude that consolidation in the health care industry is driving up costs while showing no clear evidence of improved care.
‘American Diagnosis’ Episode 12: When Indigenous People Move to Cities, Health Care Funding Doesn’t Follow
When Indigenous people started moving to cities in large numbers after World War II, many found hardship and discrimination there … but not the health care they were entitled to. Episode 12, the season finale, explores the efforts of urban Indian health providers to close those gaps by providing affordable, culturally competent care.
‘An Arm and a Leg’: Checking Up on California’s DIY Insulin Project
Dan Weissmann
California put up $100 million to produce its own insulin. How did this plan come to be, and what might stand in the state’s way?
KHN’s ‘What the Health?’: Finally Fixing the ‘Family Glitch’
The Biden administration has decided to try to fix the so-called “family glitch” in the Affordable Care Act without an act of Congress. The provision has prevented workers’ families from getting subsidized coverage if an employer offer is unaffordable. Meanwhile, Medicare’s open enrollment period begins Oct. 15, and private Medicare Advantage plans are poised to cover more than half of Medicare’s 65 million enrollees. Margot Sanger-Katz of The New York Times, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these topics and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read.
KHN’s ‘What the Health?’: Looking Ahead to the Lame-Duck Session
Congress won’t be back in Washington until after Election Day, but lawmakers have left themselves a long list of items to finish up in November and December, including unfinished health care policies. Sandhya Raman of CQ Roll Call; Jessie Hellmann, also of CQ Roll Call; and Mary Agnes Carey of KHN join KHN’s Julie Rovner to discuss these topics and more. Also this week, Rovner interviews KHN’s Sam Whitehead, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a family who tried to use urgent care to save money, but ended up with a big emergency room bill anyway.
KHN’s ‘What the Health?’: On Government Spending, Congress Decides Not to Decide
Congress has once again decided not to decide how to fund the federal government in time for the start of the fiscal year, racing toward a midnight Sept. 30 deadline to pass a stopgap bill that would keep the lights on for two more months. However, it does appear the FDA’s program that gets drugmakers to help fund some of the agency’s review staff will be renewed in time to stop pink slips from being sent. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Victoria Knight of Axios join KHN’s Julie Rovner to discuss these topics and more. Also this week, Rovner interviews filmmaker Cynthia Lowen, whose new documentary, “Battleground,” explores how anti-abortion forces played the long game to overturn Roe v. Wade.
KHN’s ‘What the Health?’: Biden Declares the Pandemic ‘Over’
President Joe Biden, in an interview with CBS’ “60 Minutes,” declared the covid-19 pandemic “over,” stoking confusion for members of his administration trying to persuade Congress to provide more funding to fight the virus and the public to get the latest boosters. Meanwhile, concerns about a return of medical inflation is helping boost insurance premiums even as private companies race to get their piece of the health pie. Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Lauren Weber of KHN join KHN’s Julie Rovner to discuss these issues and more. Also, for extra credit, the panelists suggest their favorite health policy stories they think you should read, too.
Journalists Dig In on the Fiscal Health of the Nation and Hospital Closures in Rural Missouri
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.
Readers and Tweeters Take a Close Look at Eye Care and White Mulberry Leaf
KHN gives readers a chance to comment on a recent batch of stories.
Índice de masa corporal: una medida errónea del peso que afecta el tratamiento de la obesidad
Julie Appleby
Los tratamientos actuales para la obesidad y los trastornos alimentarios, y sus costos, muchas veces se basan en esta medida que no está amparada en la ciencia.