Insurance, Coverage & Costs: June 23, 2022

Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?
By Michelle Andrews Preventive care, like screening colonoscopies, is supposed to be free of charge to patients under the Affordable Care Act. But some hospitals haven’t gotten the memo.

Upended: How Medical Debt Changed Their Lives
By Noam N. Levey and Aneri Pattani and Yuki Noguchi, NPR News and Bram Sable-Smith People talk about the sacrifices they made when health care forced them into debt.

100 Million People in America Are Saddled With Health Care Debt
By Noam N. Levey The U.S. health system now produces debt on a mass scale, a new investigation shows. Patients face gut-wrenching sacrifices.

Five Quick Takeaways From a Yearlong Investigation of Medical Debt in America
By Kathleen Hayden Today, debt from medical and dental bills touches nearly every corner of American society.

Medical Bills Can Shatter Lives. North Carolina May Act to ‘De-Weaponize’ That Debt.
By Aneri Pattani Medical debt is most prevalent in the Southeast, where states have not expanded Medicaid and have few consumer protection laws. Now, North Carolina is considering two bills that could change that, making the state a leader in protecting patients from high medical bills.

Preventive Care May Be Free, but Follow-Up Diagnostic Tests Can Bring Big Bills
By Michelle Andrews Under the Affordable Care Act, insurers cannot charge consumers for various preventive services that have been recommended by experts. But if those screenings indicate more testing is needed to determine whether something is wrong, patients may be on the hook for hundreds or even thousands of dollars for diagnostic services.

Watch: Still Paying Off Bills From Twins’ Birth. The Kids Are 10 Now.
Marcus and Allyson Ward explain to "CBS Mornings" how the premature birth of their twins left them with $80,000 in medical debt. A new KHN-NPR investigation reveals they are among 100 million people afflicted financially by the U.S. health system.

Watch: She Almost Died. The $250K Debt Took Their House.
CBS Evening News spotlights Jim and Cindy Powers, who faced crippling medical debt.

They Thought They Were Buying Obamacare Plans. What They Got Wasn’t Insurance.
By Bram Sable-Smith Some consumers who think they are signing up for Obamacare insurance find out later they actually purchased a membership to a health care sharing ministry. But regulators and online advertising sites don’t do much about it.

Computer Glitches and Human Error Still Causing Insurance Headaches for Californians
By Bernard J. Wolfson Covered California and Medi-Cal share a computer system for eligibility and enrollment. Nearly a decade since the Affordable Care Act expanded coverage options in the state, enrollees can be diverted to the wrong program — or dropped altogether — if erroneous information gets into the system.

States Extend Medicaid for New Mothers — Even as They Reject Broader Expansion
By Sam Whitehead Most of the dozen states that haven’t fully expanded eligibility for Medicaid have extended or plan to extend the postpartum coverage window for new mothers. That could mean improved maternal health, but it’s only part of the puzzle when it comes to reducing the number of preventable maternal deaths in the U.S.

A Proposal to Import Drugs from Other Countries Creates an Unusual Alliance in the Senate
By Victoria Knight As a Senate committee considered legislation to reauthorize the FDA’s user fee program, Sens. Bernie Sanders and Rand Paul agreed on a proposed amendment related to importing drugs from Canada, the U.K., and other nations.

AARP’s Billion-Dollar Bounty
By Fred Schulte With its latest venture into primary care clinics, is America’s leading organization for seniors selling its trusted seal of approval?

Buy and Bust: When Private Equity Comes for Rural Hospitals
By Sarah Jane Tribble Noble Health swept into two small Missouri towns promising to save their hospitals. Instead, workers and vendors say it stopped paying bills and government inspectors found it put patients at risk. Within two years — after taking millions in federal covid relief and big administrative fees — it locked the doors.

For Many Low-Income Families, Getting Formula Has Always Been a Strain
By Christina Szalinski Finding formula for children with allergies and other dietary restrictions was challenging even before the current shortage for families who rely on the Women, Infants, and Children (WIC) food assistance program.

New Weight Loss Treatment Is Marked by Heavy Marketing and Modest Results
By Julie Appleby Approved as a device, not a drug, Plenity contains a plant-based gel that swells to fill 25% of a person’s stomach, to help people eat less. Results vary widely but are modest on average.

Despite a First-Ever ‘Right-to-Repair’ Law, There’s No Easy Fix for Wheelchair Users
By Markian Hawryluk Colorado lawmakers approved a measure that will make it easier for people to fix their power wheelchairs when they wear out or break down, but arcane regulations and manufacturers create high hurdles for nationwide reform.

Patients Seek Mental Health Care From Their Doctor but Find Health Plans Standing in the Way
By Aneri Pattani Despite a consensus that patients should be able to get mental health care from primary care doctors, insurance policies and financial incentives may not support that.

Lawmaker Takes on Insurance Companies and Gets Personal About His Health
By Samantha Young State Sen. Scott Wiener opens up about a weeklong stint in the hospital last year and what it’s like to live with Crohn’s disease. The San Francisco Democrat is pushing a bill that would require insurance companies to cover certain medications while patients appeal denials.

Medicaid Weighs Attaching Strings to Nursing Home Payments to Improve Patient Care
By Susan Jaffe The Biden administration is considering whether Medicaid, which pays the bills for 62% of nursing home residents, should require that most of that funding be used to provide care, rather than for maintenance, capital improvements, or profits.

Covid Funding Pries Open a Door to Improving Air Quality in Schools
By Liz Szabo Researchers say the billions in pandemic funding available for ventilation upgrades in U.S. schools provides a once-in-a-generation opportunity to combat covid-19, as well as making air more breathable for students living with allergies, asthma, and chronic wildfire smoke.

California Wants to Slash Insulin Prices by Becoming a Drugmaker. Can It Succeed?
By Angela Hart Gov. Gavin Newsom proposed spending $100 million to make insulin affordable to millions of people with diabetes under a new state generic drug label, CalRx. But state officials haven’t said how much the insulin will cost patients or how the state will deal with distribution and other challenges.

Medi-Cal Will Cover Doulas at More Than Twice California’s Initial Proposed Rate
By Rachel Bluth Under a budget passed by California lawmakers, the state will pay nonmedical workers who assist in pregnancy and labor up to $1,154 per birth through Medi-Cal, which is up significantly from Gov. Gavin Newsom’s initial offer of $450. Though it’s more than what most other states pay, many doulas say it falls short of the $3,600 they sought.

‘An Arm and a Leg’: Good News for Your Credit Report
By Dan Weissmann In July, credit reporting bureaus will start taking paid medical debt off people's credit reports. Here's what you need to know.

‘An Arm and a Leg’: Private Equity Is Everywhere in Health Care. Really.
By Dan Weissmann Private equity companies are the house-flippers of the investment world, and they’ve found their way into many areas of our lives — including your local gastroenterologist's office.

KHN’s ‘What the Health?’: Washington’s Slow Churn
Stemming gun violence is back on the legislative agenda following three mass shootings in less than a month, but it’s hard to predict success when so many previous efforts have failed. Meanwhile, lawmakers must soon decide if they will extend current premium subsidies for those buying health insurance under the Affordable Care Act, and the Biden administration acts, belatedly, on Medicare premiums. Margot Sanger-Katz of the New York Times, Sandhya Raman of CQ Roll Call, and Rachel Cohrs of Stat News join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Michelle Andrews, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a too-common problem: denial of no-cost preventive care for a colonoscopy under the Affordable Care Act.

Journalists Dig Deep on Medical Debt and the Boundaries of AI in Health Care
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.

Journalists Delve Into Vaccine Mandates and Surprise Billing
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.

Más de 100 millones de estadounidenses viven acosados por las deudas médicas
By Noam N. Levey La investigación revela un problema mucho más extendido de lo que se había informado anteriormente. Esto se debe a que gran parte de la deuda que acumulan los pacientes figura como saldos de tarjetas de crédito, préstamos familiares o planes de pago a hospitales y otros proveedores médicos.

California quiere producir su propia insulina para bajar su alto costo, ¿lo conseguirá?
By Angela Hart La administración del gobernador Gavin Newsom señaló que aproximadamente 4 millones de californianos han sido diagnosticados con diabetes, una enfermedad que puede destruir órganos, la vista y llevar a amputaciones si no se controla. La meta es prevenirlo con insulina más económica.

Fallas informáticas y errores humanos en la cobertura de seguros siguen siendo un dolor de cabeza para los californianos
By Bernard J. Wolfson Es cierto que pequeños cambios en los ingresos pueden hacer que la elegibilidad cambie, pero si se ingresa información incorrecta en un sistema informático compartido por Covered California y Medi-Cal, o se elimina información precisa, eso les puede causar grandes dolores de cabeza a los afiliados.

Para familias sin recursos, conseguir fórmula para bebés siempre ha sido un problema
By Christina Szalinski La continua escasez de leche de fórmula ha causado un tremendo estrés a las familias de todo el país, especialmente a las que dependen del programa WIC. Oara este grupo de mamás, la dificultad para conseguirla no es algo nuevo.