Insurance Coverage & Costs: March 3, 2022
An $80,000 Tab for Newborns Lays Out a Loophole in the New Law to Curb Surprise Bills
Jay Hancock and Heidi de Marco
The insurance company said that the birth of the Bull family’s twins was not an emergency and that NICU care was “not medically necessary.” The family’s experience with a huge bill sent to collections happened in 2020, but it exposes a hole in the new No Surprises law that took effect Jan. 1.
Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead
Rachana Pradhan
State Medicaid agencies for months have been preparing for the end of a federal mandate that has prevented states from removing people from the safety-net program during the pandemic.
Missouri Takes Months to Process Medicaid Applications — Longer Than Law Allows
Bram Sable-Smith and Phil Galewitz
Missouri has more people waiting to have their Medicaid applications processed than it has approved since the expansion of the federal-state health insurance program. Although most states process Medicaid applications within a week, Missouri is taking, on average, more than two months. Patient advocates fear that means people will stay uninsured longer, leading them to postpone care or get stuck with high medical bills.
Skirmish Between Biden and Red States Over Medicaid Leaves Enrollees in the Balance
Phil Galewitz and Andy Miller
The Biden administration is getting rid of several policies implemented by Trump-era appointees that restricted enrollment. Federal officials now say states can no longer charge premiums to low-income residents enrolled in Medicaid and have ruled out work requirements.
Plan to Fix Postal Service Shifts New Retirees to Medicare — Along With Billions in Costs
Michael McAuliff
After a years-long bitter partisan fight over reforming the U.S. Postal Service’s finances and service, congressional leaders say they have a compromise. The bill, which has won endorsements from both Republicans and Democrats on Capitol Hill, would force future Postal Service retirees to use Medicare as their primary source of health coverage.
Health Care Paradox: Medicare Penalizes Dozens of Hospitals It Also Gives Five Stars
Jordan Rau
Among the 764 hospitals hit with a 1% reduction in Medicare payments this year for having high numbers of patient infections and avoidable complications are more than three dozen that Medicare also ranks as among the best in the country.
Other States Keep Watchful Eye on Snags in Washington’s Pioneering Public-Option Plan
Markian Hawryluk
Washington was the first state in the U.S. to introduce a public option for health insurance, but the rollout hasn’t been smooth. Other states with public options in the works are taking notice.
Demand for Service Dogs Unleashes a ‘Wild West’ Market
Markian Hawryluk
Service dogs can help people with ailments from autism to epilepsy, but a trained dog can cost up to $40,000 — and insurance won’t cover it.
Mental Health Therapists Seek Exemption From Part of Law to Ban Surprise Billing
Julie Appleby
Some practitioners object to the way upfront cost estimates are designed, saying they could affect access to care and are burdensome. Other experts disagree.
‘Injections, Injections, Injections’: Troubling Questions Follow Closure of Sprawling Pain Clinic Chain
Anna Maria Barry-Jester and Jenny Gold
In May 2021, Lags Medical Centers, one of California’s largest chains of pain clinics, abruptly closed its doors amid a cloaked state investigation. Nine months later, patients are still in the dark about what happened with their care and to their bodies.
Federal Investigation Into Spine Surgeries Uses Mob Laws to Target Health Care Fraud
Fred Schulte
Investigators allege a Texas company that arranges spine surgery and other medical care for people injured in car crashes accepted bribes in violation of 1960s-era racketeering law.
As Politics Infects Public Health, Private Companies Profit
Vignesh Ramachandran
Localities in California and Colorado are contracting with private companies to create their own health departments, spurred by a disregard for regional covid safety mandates.
Inside the Tactical Tug of War Over the Controversial Alzheimer’s Drug
Arthur Allen
An epic battle is playing out behind the scenes over whether the government should pay for Aduhelm, an FDA-approved Alzheimer’s drug that scientists say has not been proven to work.
What Are Taxpayers Spending for Those ‘Free’ Covid Tests? The Government Won’t Say.
Christine Spolar
Inquiries lead from one federal office to the next, with no clear answers. At one Army Contracting Command, a protocol office employee says that “voicemail has been down for months.” And the email address listed for fielding media inquiries? “The army stopped using the email address about eight years ago.”
This Doctor Thought She Could Navigate US Health Care. Then Her Autistic Son Needed Help.
Noam N. Levey
Dr. Mai Pham left her corporate career to spark change in a system that is failing millions of Americans with autism and other intellectual and developmental disabilities.
The Demise of Single-Payer in California Trips Up Efforts in Other States
Angela Hart
The failure of single-payer health care legislation in California casts doubt on the ability of other states to pass government-run, universal health care. But activists in New York, Washington state, and elsewhere say they are taking lessons from California and changing their tactics.
California Inks Sweetheart Deal With Kaiser Permanente, Jeopardizing Medicaid Reforms
Bernard J. Wolfson and Angela Hart and Samantha Young
The backroom deal with politically connected Kaiser Permanente, which infuriated other Medi-Cal health plans, allows the health care giant to continue selecting the enrollees it wants.
Look Up Your Hospital: Is It Being Penalized by Medicare?
Jordan Rau
Each year, Medicare punishes hospitals that have high rates of readmissions and high rates of infections and patient injuries. Check out which hospitals have been penalized.
Changes to Medi-Cal’s Troubled Drug Program Reduce Backlog in California, but Problems Persist
Samantha Young
After a troubled start to the new Medi-Cal prescription drug program, the state’s contractor has hired staffers to reduce wait times for medication approvals and patients seeking help. But some doctors and clinics report that patients continue to face delays.
‘Somebody Is Gonna Die’: Medi-Cal Patients Struggle to Fill Prescriptions
Samantha Young
Problems with California’s new Medicaid prescription drug program are preventing thousands of patients from getting their medications, including some life-saving ones. State officials say they’re working on fixes.
KHN’s ‘What the Health?’: Contemplating a Post-‘Roe’ World
In anticipation of the Supreme Court rolling back abortion rights this year, both Democrats and Republicans are arguing among themselves over how best to proceed to either protect or restrict the procedure. Meanwhile, millions of Americans are at risk of losing their health insurance when the federal government declares an end to the current “public health emergency.” Alice Miranda Ollstein of Politico, Shefali Luthra of The 19th, and Rachana Pradhan of KHN join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Jay Hancock, who wrote the latest KHN-NPR “Bill of the Month” episode about a couple whose insurance company deemed their twins’ stay in intensive care not an emergency.
KHN’s ‘What the Health?’: Paging the HHS Secretary
Health and Human Services Secretary Xavier Becerra is drawing criticism for his hands-off handling of the covid crisis even though the heads of the Centers for Disease Control and Prevention, National Institutes of Health, and FDA report to him. Meanwhile, the Department of Labor looks to enforce mental health “parity laws” that have failed to achieve their goals. Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Noam N. Levey, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a large emergency room bill for a small amount of medical care.
Readers and Tweeters Have Mental Health Care on Their Minds
KHN gives readers a chance to comment on a recent batch of stories.
La alta demanda de perros de servicio crea un mercado salvaje y a veces fraudulento
Markian Hawryluk
Estos perros aprenden a ayudar a los seres humanos, pero quedan atrapados en engaños. Muchos los usan para un mercado que abusa de los que tienen necesidades médicas.