InsuranceCoverage&Costs 072821
Olympic Dream Dashed After Bike Crash and Nightmare Medical Bill Over $200K
Samantha Young
A bicyclist from California competed in a Pennsylvania race that could have landed him in this month’s Tokyo Olympics. Instead, a crash on the velodrome track landed him in two hospitals where his out-of-state, out-of-network surgeries garnered huge bills.
Pfizer Court Fight Could Legalize Medicare Copays and Unleash ‘Gold Rush’ in Sales
Jay Hancock
Pharmaceutical companies routinely cover the cost of patient copays for expensive drugs under private insurance. A federal judge could make the practice legal for millions on Medicare as well.
California Makes It Easier for Low-Income Residents to Get and Keep Free Health Coverage
Rachel Bluth
State lawmakers aim to expand Medicaid enrollment by dedicating billions of dollars in coming years to simplifying paperwork, extending pregnancy coverage and opening the program to thousands of new enrollees, including older unauthorized immigrants and people who need nursing home care.
Sign-Up Window for Free COBRA Coverage for Many Laid-Off Workers Closes This Week
Michelle Andrews
The most recent covid relief law offered federal funding to pay insurance premiums for workers who lost their jobs and opted to keep their workplace insurance through COBRA. But the window to take advantage of the subsidized coverage is closing: Many workers would need to enroll in the program by July 31.
Bye-Bye to Health Insurance ‘Birthday Rule’? Kansas Lawmaker Floats Fix
Cara Anthony
U.S. Rep. Sharice Davids (D-Kansas) introduced a bill to do away with a health insurance rule that dictates which parent’s plan becomes a new baby’s primary insurer. This could save some parents from unexpected, sometimes massive medical bills. Davids took up the issue after a KHN/NPR Bill of the Month story on one family’s unexpected $207,455 NICU bill.
Women Say California Insurer Makes It Too Hard to Get Drug for Postpartum Depression
April Dembosky, KQED
Brexanolone is a promising new treatment for postpartum depression. But one insurer's requirement that women try four other drugs and electroconvulsive therapy before the infusion means it is out-of-reach for millions of women.
The Pandemic Made Telemedicine an Instant Hit. Patients and Providers Feel the Growing Pains.
Hannah Norman
Patients seem to like remote visits, and health care providers now depend on them. But outages, freezing and other glitches cost time and money, and compromise quality of care.
Contraception Is Free to Women, Except When It’s Not
Michelle Andrews
The landmark federal health law required most commercial health plans to cover a comprehensive list of birth control methods approved by the Food and Drug Administration free of charge to female patients. But health plans don’t have to cover every option, and newer methods are not included in the federal list of covered services.
Facing Headwinds on New Alzheimer’s Drug, Biogen Launches Controversial Campaign
Julie Appleby
The makers of Aduhelm, a drug approved last month despite concerns raised by experts about its effectiveness, have launched a website and ads designed to urge people who are worried about their memory to ask doctors about testing. But some health advocates say it is misleading because some memory loss with aging is normal.
After 18 Months, Sutter Antitrust Settlement Finally Poised for Formal Approval
Jenny Gold
A year and a half after Sutter Health agreed to a tentative settlement in a closely watched antitrust case, the San Francisco judge presiding over the case indicated she would sign off on the terms, pending agreement on another contentious issue: attorney fees.
Biden’s July Executive Order Includes Drug Pricing Provisions. But Will They Do Enough?
Victoria Knight
The July 9 directive addresses the importation of prescription drugs and broader efforts to reduce the high cost of medicines.
Sen. Wyden: $3.5T Budget May Have to Trim but It Can Set a Path to ‘Ambitious Goals’
Michael McAuliff
Sen. Ron Wyden (D-Ore.), who is helping to negotiate the health care spending framework for the Democrats' budget plan, said lawmakers may have to settle for very basic versions of programs deployed in the package. But the key, he added, is to get the "architecture of these changes, bold changes," started and show people what is possible.
Hospital ‘Trauma Centers’ Charge Enormous Fees to Treat Minor Injuries and Send People Home
Jay Hancock
Only severely injured patients are supposed to be billed for “trauma team alert” fees that can exceed $50,000.
How ERs Fail Patients With Addiction: One Patient’s Tragic Death
Aneri Pattani
Two intractable failings of the U.S. health care system — addiction treatment and medical costs — come to a head in the ER, where patients desperate for addiction treatment arrive, only to find the facility may not be equipped to deal with substance use or, if they are, treatment is prohibitively expensive.
As Congress Wrestles With Plans to Expand Medicare, Becerra Says Any One Will Do
Julie Rovner
In an interview for KHN’s “What the Health?” podcast, HHS Secretary Xavier Becerra says the administration is eager for Congress to make changes to Medicare that will provide more benefits and make more older adults eligible for the program. He also said a priority will be making permanent the enhanced premium subsidies for Affordable Care Act marketplace plans.
Why We May Never Know Whether the $56,000-a-Year Alzheimer’s Drug Actually Works
Elisabeth Rosenthal
It could take years for follow-up studies to prove Aduhelm slows the disease — or doesn’t. Meanwhile, its maker will profit.
Effort to Decipher Hospital Prices Yields Key Finding: Don’t Try It at Home
Bernard J. Wolfson
Your dutiful columnist tried to make use of a federal “transparency” rule to compare the prices of common medical procedures in two California health care systems. It was a futile exercise.
Drugmakers’ Spending on Stock, Dividends and Executive Pay Exceeds Research, Democrats Say
Michael McAuliff
The pharmaceutical industry argues that large profits are needed to fund extensive research and innovation. But Democrats on the House Oversight and Reform Committee, seeking to bolster their effort to let Medicare negotiate drug prices, say major drug companies plow more of their billions in earnings back into propping up their stock and enriching executives and shareholders.
Rural Ambulance Services Are in Jeopardy as Volunteers Age and Expenses Mount
Aaron Bolton, MTPR
Experts say rural communities must find new models to keep emergency services afloat as more 911 calls go unanswered.
‘An Arm and a Leg’: Tips for Fighting Medical Bills from ProPublica’s Marshall Allen
Dan Weissmann
Veteran health journalist Marshall Allen has been exposing health care grifters for years. Now he’s written a book about how to fight them. Host Dan Weissmann spoke with Allen about some of the best tips from “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.”
Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess.
Julie Appleby
A Trump administration rule mandating that hospitals disclose true prices on their websites took effect this year. But compliance is spotty and even when the data is public, it’s hard to find and understand.
KHN’s ‘What the Health?’: Un-Trumping the ACA
The Biden administration is moving to undo many of the changes the Trump administration made to the enrollment process for the Affordable Care Act to encourage more people to sign up for health insurance. Meanwhile, Congress is opening investigations into the controversial approval by the Food and Drug Administration of an expensive drug that might (or might not) slow the progression of Alzheimer’s disease. Joanne Kenen of Politico, Kimberly Leonard of Insider and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Marshall Allen of ProPublica about his new book, “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.”
KHN’s ‘What the Health?’: Delta Changes the Covid Conversation
With covid cases on the upswing again around the country, partisan division remains over how to address the pandemic. Meanwhile, the Biden administration proposes bigger penalties for hospitals that fail to make their prices public as required. Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Tami Luhby of CNN join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite stories of the week they think you should read, too.
KHN’s ‘What the Health?’: Here Comes Reconciliation
Democrats in Congress reached a tentative agreement to press ahead on a partisan bill that would dramatically expand health benefits for people on Medicare, those who buy their own insurance and individuals who have been shut out of coverage in states that didn’t expand Medicaid. Meanwhile, controversy continues to rage over whether vaccinated Americans will need a booster to protect against covid-19 variants, and who will pay for a new drug to treat Alzheimer’s disease. Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews KHN’s Rae Ellen Bichell, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a mother and daughter who fought an enormous emergency room bill.
KHN’s ‘What the Health?’: Becerra Urges Congress to Expand Medicare, Address Rx Prices
Health and Human Services Secretary Xavier Becerra is the special guest for this bonus episode of KHN’s “What the Health?” podcast. He and host Julie Rovner discuss a breadth of topics the secretary oversees, including covid-19, prescription drug prices, Medicare, Medicaid and the Affordable Care Act.
Readers and Tweeters Connect the Dots on Topics From Vaccine Development to Long Covid
Kaiser Health News gives readers a chance to comment on a recent batch of stories.
Journalists Tackle Delta Variant, Hospital Prices and Public Health Spending
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.