InsuranceCoverage&Costs 070121

A Hospital Charged $722.50 to Push Medicine Through an IV. Twice.
By Rae Ellen Bichell A college student never got an answer for what caused her intense pain, but she did get a bill that totaled $18,736 for an ER visit. She and her mom, a nurse practitioner, fought to understand all the charges.

Supreme Court Declines to Overturn ACA — Again
By Julie Rovner Justices rule that Republican state officials and individuals did not have standing when they brought a suit arguing that a change in the tax penalty for not having insurance invalidated the historic health care law.

Desperate for Home Care, Seniors Often Wait Months With Workers in Short Supply
By Phil Galewitz The covid pandemic and President Joe Biden's agenda — a planned $400 billion infusion of support — have focused national attention on the need to expand home- and community-based long-term care services designed to keep people out of nursing homes. But the need far outpaces the staffing.

States Step Up Push to Regulate Pharmacy Drug Brokers
By Katheryn Houghton In an ongoing effort to control prescription drug costs, states are targeting the companies that mediate deals among drug manufacturers, health insurers and pharmacies. The pharmacy benefit managers say they negotiate lower prices for patients, yet the nitty-gritty occurs largely behind a curtain that lawmakers are trying to pull back.

Change to Gilead Assistance Program Threatens PrEP Access, HIV Advocates Say
By Carmen Heredia Rodriguez Safety-net clinics especially are bracing for how the drugmaker’s policy shift could reduce their budgets and hamstring their ability to provide care to an at-risk population.

No Vacancy: How a Shortage of Mental Health Beds Keeps Kids Trapped Inside ERs
By Martha Bebinger, WBUR What's known as emergency room boarding of psychiatric patients has risen between 200% and 400% monthly in Massachusetts during the pandemic — and the problem is widespread. The CDC says emergency room visits after suicide attempts among teen girls were up 51% earlier this year as compared with 2019.

Thousands of Young Children Lost Parents to Covid. Where’s Help for Them?
By JoNel Aleccia More than 46,000 children in the U.S. have lost a parent to covid-19. Families say finding even basic grief counseling has been difficult and there’s been no coordinated effort to help these children access services or benefits.

Children and Covid: Journalists Explore Grief and Vaccine Side Effects
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.

KHN’s ‘What the Health?’: How to Expand Health Coverage
Democrats in Congress and the states are devising strategies to expand health coverage — through the Affordable Care Act, Medicare, Medicaid and a “public option.” But progress remains halting, at best. Meanwhile, lawmakers in Washington may have to agree on how to control prescription drug prices if they wish to finance their coverage initiatives. Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Shefali Luthra of The 19th join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Michelle Andrews, who reported and wrote last month’s KHN-NPR “Bill of the Month” episode about a very expensive sleep study.

At Texas Border, Pandemic’s High Toll Lays Bare Gaps in Health and Insurance
By René Kladzyk, El Paso Matters and Phil Galewitz and Elizabeth Lucas In Texas’ border communities, which are overwhelmingly Hispanic, covid-19 death rates for people under age 65 were double those in the rest of the state and three times the national average. They were also significantly higher than rates in New Mexico border areas.

Pandemic Swells Medicaid Enrollment to 80 Million People, a ‘High-Water Mark’
By Phil Galewitz More than 80 million Americans with low incomes were receiving health coverage through the federal-state program in January. The program now covers nearly 1 in 4 people nationwide.

Device Makers Have Funneled Billions to Orthopedic Surgeons Who Use Their Products
By Fred Schulte and Elizabeth Lucas Federal officials say that some of the money changing hands has corrupted doctors and endangered patients.

Doctor on Call? Lawmakers Debate How Much to Pay for Phone Appointments
By Rachel Bluth Phone visits became an option for many Medicare and Medicaid patients during the pandemic. Now policymakers are deciding whether they’re worth the money.

In Alleged Health Care ‘Money Grab,’ Nation’s Largest Hospital Chain Cashes In on Trauma Centers
By Jay Hancock HCA charges patients an “activation fee” of up to $50,000 for trauma teams at centers located in half its 179 hospitals — and they often don’t need trauma care, an analysis of insurance claims data shows.

Can a Subscription Model Fix Primary Care in the US?
By Bernard J. Wolfson Medical subscriptions, a $199 million CEO payday and the race to fix primary care in the U.S. One Medical is betting big that a subscription model can fix primary care. But the firm faces competition from CVS, Target and large hospital systems.

With Restrictions Tightening Elsewhere, California Moves to Make Abortion Cheaper
By Rachel Bluth California lawmakers are debating a bill that would eliminate out-of-pocket costs that often prevent people from obtaining abortions, proponents say.

Farmworkers Recall Mistreatment as Colorado Aims to Guarantee Medical Access
By Esther Honig and Rae Ellen Bichell Agricultural workers living in employer-owned housing can have trouble getting health care. It’s symptomatic of bigger gaps in worker protections that the pandemic spotlighted, say proponents of a newly passed Colorado bill for farmworker rights.

New Montana Laws Enshrine Health Care Alternatives, for Better or Worse
By Andrea Halland Direct primary care and health care sharing ministries can offer people more accessible or cheaper health care options, but they lack the benefits of traditional insurance and aren’t regulated.

Montana Med School Clash Revives For-Profit Vs. Nonprofit Flap
By Victoria Knight Two medical schools vie to open in Montana, highlighting the rapid spread of for-profit schools and their previously tarnished business model.

Journalists Follow Up on Unused Vaccines and For-Profit Medical Schools
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.

KHN’s ‘What the Health?’: The ACA Lives
In a surprisingly strong 7-2 decision, the Supreme Court turned back the latest constitutional challenge to the Affordable Care Act, likely heralding the end of GOP efforts to strike the law in its entirety through court action. Meanwhile, Democratic lawmakers are looking for ways to expand health benefits. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Andy Slavitt, who recently stepped down from the Biden administration’s covid response team, about his new book on the pandemic.

KHN’s ‘What the Health?’: Our 200th Episode!
The federal approval of a controversial drug to treat Alzheimer’s disease has reignited the debate over drug prices and the way the Food and Drug Administration makes decisions. Meanwhile, President Joe Biden seeks to gain goodwill overseas as he announces the U.S. will provide 500 million doses of covid vaccine to international health efforts. Sarah Karlin-Smith of the Pink Sheet, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Chiquita Brooks-LaSure, the new administrator of the Centers for Medicare & Medicaid Services. And to mark the podcast’s 200th episode, the panelists discuss what has surprised them most and least over the past four years.

‘An Arm and a Leg’: When Your Insurance Company Says No, How to Ask for a Yes
By Dan Weissmann Health care insiders get surprise medical bills, too. One of them shares tips for writing an insurance appeal.

Miles de niños perdieron a sus padres por covid. ¿Adónde está la ayuda?
By JoNel Aleccia Más de 46,000 niños han perdido a uno o ambos padres a causa de covid desde febrero de 2020. Los sobrevivientes luchan por conseguir ayuda médica y financiera para superar el duelo.

Pandemia eleva el número de beneficiarios de Medicaid a más de 80 millones
By Phil Galewitz Las últimas cifras de inscripción al Medicaid muestran que creció de 71,3 millones de miembros en febrero de 2020, cuando la pandemia comenzaba en los Estados Unidos, a 80,5 millones en enero, según un análisis de KFF de datos federales.

Mientras Colorado avanza una ley que garantiza su acceso a atención médica, trabajadores agrícolas recuerdan el maltrato que sufren
By Esther Honig and Rae Ellen Bichell Colorado está a punto de aprobar una ley para que los trabajadores del campo puedan acceder a atención médica, algo que muchos empleadores al parecer no permiten.

Corte Suprema se niega a revocar ACA, por tercera vez
By Julie Rovner Por 7 a 2 votos, los jueces ni siquiera llegaron a los méritos del caso, resolviendo que los estados e individuos demandantes, dos personas de Texas cuentapropistas, carecían de “argumentos” para llevar el caso a los tribunales.