Insurance, Coverage, and Costs: Sept. 19, 2024

California Medicaid Ballot Measure Is Popular, Well Funded — And Perilous, Opponents Warn
By Bernard J. Wolfson Proposition 35, which would use revenue from a tax on managed-care plans to raise the pay of health care providers who serve Medi-Cal patients, has united a broad swath of California’s health care, business, and political establishments. But a newly formed, smaller group of opponents says it will do more harm than good.

These Alabama Workers Were Swamped by Medical Debt. Then Their Employer Stepped In.
By Noam N. Levey A decades-old manufacturing company opened a clinic and made primary care and prescriptions free for employees and their families.

California May Regulate and Restrict Pharmaceutical Brokers
By Don Thompson California lawmakers are moving to rein in the pharmaceutical middlemen they say drive up costs and limit consumers’ choices. The bill sent to Gov. Gavin Newsom would require pharmacy benefit managers to be licensed in California and would ban some business practices. Newsom vetoed a previous effort three years ago.

Arkansas’ Governor Says Medicaid Extension for New Moms Isn’t Needed
By Sarah Varney Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days after delivery. Arkansas has not expanded what’s called postpartum Medicaid coverage, an option that gives poor women uninterrupted health insurance for a year after they give birth.

Tossed Medicine, Delayed Housing: How Homeless Sweeps Are Thwarting Medicaid’s Goals
By Angela Hart As California cities crack down on homeless encampments in the wake of a U.S. Supreme Court ruling authorizing fines and arrests, front-line workers say such sweeps are undercutting billions in state and federal Medicaid spending meant to stabilize people’s health and get them off the streets.

The First Year of Georgia’s Medicaid Work Requirement Is Mired in Red Tape
By Renuka Rayasam and Sam Whitehead Georgia must decide soon whether to try to extend a limited Medicaid expansion that requires participants to work. Enrollment fell far short of goals in the first year, and the state isn’t yet able to verify participants are working.

Trump, Harris Spar Over Abortion Rights and Obamacare in Their First Face-Off
By KFF Health News and PolitiFact staffs The generally combative face-off was marked by a series of false and sometimes bizarre statements from former President Donald Trump.

US Uninsured Rate Was Stable in 2023, Even as States’ Medicaid Purge Began
By Phil Galewitz About 8% of Americans lacked health insurance in 2023, the Census Bureau announced. But its report doesn’t capture the effect of states winnowing their Medicaid rolls by millions of people since the pandemic emergency ended.

Errors in Deloitte-Run Medicaid Systems Can Cost Millions and Take Years To Fix
By Samantha Liss and Rachana Pradhan As states wait for Deloitte to make fixes in computer systems, Medicaid beneficiaries risk losing access to health care and food.

Her Life Was at Risk. She Needed an Abortion. Insurance Refused To Pay.
By Sarah Varney Insurance coverage for abortion care in the U.S. is a hodgepodge. Patients often don’t know when or if a procedure or abortion pills are covered, and the proliferation of abortion bans has exacerbated the confusion.

For Pharma, Trump vs. Harris Is a Showdown Between Two Industry Foes
By Stephanie Armour Vice President Kamala Harris is seen as more aggressive than former President Donald Trump in taking on pharmaceutical companies, but Trump allies say he would also make lowering drug costs a top priority.

Turning 26 and Struggling To Find Health Insurance? Tell Us About It.
By Elisabeth Rosenthal KFF Health News and The New York Times are looking into a dreaded “adulting” milestone: finding your own medical insurance at 26.

An Arm and a Leg: Don’t Get ‘Bullied’ Into Paying What You Don’t Owe
By Dan Weissmann In this episode of “An Arm and a Leg,” host Dan Weissmann speaks with Caitlyn Mai, a woman in Oklahoma who received a six-figure bill for a surgery her insurance promised to cover. This episode is an extended version of the “Bill of the Month” series, produced in partnership with NPR.

Feds Killed Plan To Curb Medicare Advantage Overbilling After Industry Opposition
By Fred Schulte A private 2014 decision by the Centers for Medicare & Medicaid Services faces new scrutiny in a multibillion-dollar Justice Department fraud case against UnitedHealth Group.

ACA Enrollment Platforms Suspended Over Alleged Foreign Access to Consumer Data
By Julie Appleby Federal regulators provided more specifics about why they suspended two private sector Affordable Care Act enrollment sites, including concerns about potential overseas accessing of consumer data and suspicions of involvement in Obamacare enrollment and switching schemes. The companies reject the assertions.

Longtime Head of L.A. Care To Retire After Navigating Major Medi-Cal Changes
By Bernard J. Wolfson John Baackes, who steered Medi-Cal’s largest health plan following the Affordable Care Act expansion, and later prepared it for a state overhaul of Medi-Cal, will retire after this year. Baackes believes low payments to doctors and other providers, along with an acute labor shortage, hamper Medi-Cal’s success.

Journalists Talk Shooting’s Toll on Children and State Handling of Opioid Settlement Funds
KFF Health News and California Healthline staff made the rounds on national and local media in the last two weeks to discuss topical stories. Here’s a collection of their appearances.

Tennessee Tries To Rein In Ballad’s Hospital Monopoly After Years of Problems
By Brett Kelman Ballad Health, a 20-hospital system with the nation's largest state-sanctioned hospital monopoly, serves patients in Tennessee, Virginia, Kentucky, and North Carolina.

At Catholic Hospitals, a Mission of Charity Runs Up Against High Care Costs for Patients
By Rachana Pradhan Many Catholic health systems, which are tax-exempt, pay their executives millions and can charge some of the highest prices around — while critics say they scrimp on commitments to their communities.

KFF Health News' 'What the Health?': Live from Austin, Examining Health Equity
The term “health equity” means different things to different people. Beyond guaranteeing all Americans access to adequate, affordable medical care, the pursuit of equity can include addressing social determinants of health, such as housing, education, and environment. Systemic and historical racism — manifested in over-policing or contaminated drinking water, for instance — can negatively affect health. In a live taping at the Texas Tribune Festival, special guests Carol Alvarado, the Texas state Senate’s Democratic leader, and Ann Barnes, president and CEO of the Episcopal Health Foundation, along with KFF Health News’ Sabriya Rice and Cara Anthony, join KFF Health News’ Julie Rovner to discuss addressing health inequities.

With TV Drug Ads, What You See Is Not Necessarily What You Get
By Elisabeth Rosenthal The pharmaceutical industry has invented a new art form: finding ways to make their wares seem like joyous must-have treatments, while often minimizing lackluster efficacy and risks.

Amid Medicaid ‘Unwinding,’ Many States Wind Up Expanding
By Phil Galewitz The end of pandemic-era Medicaid coverage protections coincided with changes in more than a dozen states to expand coverage for lower-income people, including children, pregnant women, and the incarcerated.

New Lines of Attack Form Against the Affordable Care Act
By Julie Appleby While fighting potential fraud in government programs has long been a conservative rallying cry, recent criticisms of the Affordable Care Act represent a renewed line of attack on the program when repealing it is unlikely.

KFF Health News' 'What the Health?': Happy 50th, ERISA
What does a law to protect worker pensions have to do with how health insurance is regulated? Far more than most people may think. The Employee Retirement Income Security Act, or ERISA, turns 50 in September. The law fundamentally changed the way the federal and state governments regulate employer-provided health insurance and continues to shape health policy in the United States. In this special episode of “What the Health?”, host and KFF Health News chief Washington correspondent Julie Rovner speaks to Larry Levitt of KFF, Paul Fronstin of the Employee Benefit Research Institute, and Ilyse Schuman of the American Benefits Council about the history of ERISA and what its future might hold.

Harris Did Not Vote To ‘Cut Medicare,’ Despite Trump’s Claim
By Jacob Gardenswartz Former President Donald Trump’s claim that Vice President Kamala Harris voted to “cut Medicare” is false, experts say.

Patient Underwent One Surgery but Was Billed for Two. Even After Being Sued, She Refused To Pay.
By Tony Leys A collection agency sought court authority to garnish a patient’s wages to pay a disputed surgery bill. But after the patient showed up in court to argue the bill was bogus, the judge declined to let the bill collector seize her money.

Biden Administration Blocks Two Private Sector Enrollment Sites From ACA Marketplace
By Julie Appleby Regulators have been under the gun to curb unauthorized Obamacare enrollment and switching of plans. Separately, a pending lawsuit was amended with additional defendants and new allegations regarding tactics to garner greater ACA sales commissions.

‘What Happens Three Months From Now?’ Mental Health After Georgia High School Shooting
By Sam Whitehead and Renuka Rayasam and Andy Miller The recent shooting at Apalachee High School outside of Atlanta caused more than physical wounds. Medical experts worry a lack of mental health resources in the community — and in Georgia as a whole — means few options for those trying to cope with trauma from the shooting.

UCSF Favors Pricey Doctoral Program for Nurse-Midwives Amid Maternal Care Crisis
By Ronnie Cohen UC-San Francisco is pausing its long-running master’s program in nurse-midwifery and plans to shift to a lengthier, costlier doctoral program. Midwives criticized the move and questioned the university’s motivations at a time of serious shortages of maternal care workers.

Boom, Now Bust: Budget Cuts and Layoffs Take Hold in Public Health
By Jazmin Orozco Rodriguez State leaders are cutting public health spending and laying off workers hired during a pandemic-era grant boom. Public health officials say the bust will erode important advancements in the public health safety net, particularly in rural areas.

Patients Suffer When Indian Health Service Doesn’t Pay for Outside Care
By Arielle Zionts and Katheryn Houghton The Indian Health Service has a program that can pay for outside appointments when patients need care not offered at agency-funded sites. Critics say money shortages, complex rules, and administrative fumbles often block access, however.

En su primer cara a cara, Harris y Trump se enfrentan por el Obamacare y el aborto
By KFF Health News and PolitiFact staffs Los dos candidatos presidenciales abordaron una amplia gama de temas, desde cifras de empleo e inflación hasta el aborto y la inmigración, en intercambios marcados por ataques personales.

La tasa de personas sin seguro médico se mantiene estable, a pesar de la purga de Medicaid
By Phil Galewitz Aproximadamente el 8% de los estadounidenses no tuvieron cobertura en 2023, un aumento estadísticamente insignificante de solo 0.1 puntos porcentuales con respecto al año anterior.

Cuando la aseguradora se niega a pagar un aborto que es médicamente necesario
By Sarah Varney En el país, la cobertura para la atención del aborto es laberíntica. A menudo, los pacientes no saben cuándo un procedimiento, o las píldoras abortivas, están cubiertas, si es que lo están; y la proliferación de prohibiciones ha exacerbado la confusión.

Para las farmacéuticas, la pelea entre Trump y Harris es entre dos enemigos de la industria
By Stephanie Armour Legisladores de ambos partidos atacan cada vez más a la industria, por los precios de los medicamentos que la mayoría de los estadounidenses consideran irrazonables.

En los comerciales de medicamentos en TV, lo que ves no siempre es lo que es
By Elisabeth Rosenthal Los anuncios de medicamentos han sido omnipresentes en la televisión desde finales de la década de 1990 y se han extendido a internet y las redes sociales. Pocas naciones en el mundo los permiten