In Settling Fraud Case, New York Medicare Advantage Insurer, CEO Will Pay up to $100M
By Fred Schulte
December 20, 2024
KFF Health News Original
A whistleblower suit alleged a health insurer bilked Medicare by exaggerating how sick patients were.
Trump HHS Eliminates Office That Sets Poverty Levels Tied to Benefits for at Least 80 Million People
By Arthur Allen
Updated April 11, 2025
Originally Published April 11, 2025
KFF Health News Original
Recent cuts eliminated a small, specialized workforce that sets the poverty standards determining who is eligible for Medicaid as well as assistance with food, home heating, child care, and more.
The Court Case That Could Upend Access To Free Birth Control
By Sam Whitehead
July 12, 2024
KFF Health News Original
A lawsuit winding its way through the courts could undermine the power of federal agencies to mandate the services health insurance providers must cover. And that could threaten access to free birth control for millions of Americans. The case is called Braidwood Management Inc. v. Becerra, and it was brought by plaintiffs looking to strike […]
Deny and Delay? California Seeks Penalties for Insurers That Repeatedly Get It Wrong
By Christine Mai-Duc
February 18, 2025
KFF Health News Original
A state lawmaker wants health insurers to disclose denial rates and explain those denials as anger grows over rising costs and uncovered medical care. If the bill is signed into law, health experts say, it could be one of the boldest attempts in the nation to rein in denials.
Vance-Walz Debate Highlighted Clear Health Policy Differences
By KFF Health News and PolitiFact staffs
October 2, 2024
KFF Health News Original
The vice presidential debate showcased the very different views of Ohio Republican Sen. JD Vance, Donald Trump’s running mate, and Democratic Gov. Tim Walz, Kamala Harris’ VP pick, on health policies past and present.
What’s New and What To Watch For in the Upcoming ACA Open Enrollment Period
By Julie Appleby
October 8, 2024
KFF Health News Original
This year’s start date in most states is Nov. 1, and consumers may encounter new scams as well as important rule changes.
Trump Vowed To End Surprise Medical Bills. The Office Working on That Just Got Slashed.
By Noam N. Levey
Updated March 5, 2025
Originally Published March 4, 2025
KFF Health News Original
The Trump administration’s first round of sweeping staff cuts to federal agencies eliminated dozens of positions at the Center for Consumer Information and Insurance Oversight, which is tasked with implementing the No Surprises Act.
Amid Medicaid ‘Unwinding,’ Many States Wind Up Expanding
By Phil Galewitz
October 2, 2024
KFF Health News Original
It was expected that the past year and a half would be a fraught time for Medicaid, the workhorse of the nation’s health system, which covers more people than any other government health insurance program. In April 2023, states resumed screening people for Medicaid eligibility and terminating coverage for those they said no longer qualified […]
Rage Has Long Shadowed American Health Care. It’s Rarely Produced Big Change.
By Noam N. Levey
December 18, 2024
KFF Health News Original
The outpouring of anger at health insurers following the killing of UnitedHealthcare CEO Brian Thompson continues a cycle of rage that dates back decades.
Medicare Advantage Is Popular, but Some Beneficiaries Feel Buyer’s Remorse
By Sarah Jane Tribble
January 23, 2024
KFF Health News Original
Medicare Advantage plans are booming — 30.8 million of the 60 million Americans with Medicare are now enrolled in the private plans rather than the traditional government-run program. But a little-known fact: Once you’re in a Medicare Advantage plan, you may not be able to get out. Traditional Medicare usually requires beneficiaries to pay 20 […]
The First Year of Georgia’s Medicaid Work Requirement Is Mired in Red Tape
By Renuka Rayasam Sam Whitehead
September 13, 2024
KFF Health News Original
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.
How Your In-Network Health Coverage Can Vanish Before You Know It
By Elisabeth Rosenthal
March 15, 2024
KFF Health News Original
One of the most unfair aspects of medical insurance is this: Patients can change insurance only during end-of-year enrollment periods or at the time of “qualifying life events.” But insurers’ contracts with doctors, hospitals, and pharmaceutical companies can change abruptly at any time.
Sign Here? Financial Agreements May Leave Doctors in the Driver’s Seat
By Katheryn Houghton
April 30, 2024
KFF Health News Original
Agreeing to an out-of-network doctor’s own financial policy — which generally protects their ability to get paid and may be littered with confusing insurance and legal jargon — can create a binding contract that leaves a patient owing.
Under Fire for Massive Health System Hack, Biden Team Leans on Insurers
By Darius Tahir
March 19, 2024
KFF Health News Original
The Biden administration has hit on a strategy to deal with the massive, industry-paralyzing cyberattack on a UnitedHealth Group unit: pressuring insurers to fix it. Federal officials have been in constant conversation with senior leaders at UnitedHealth and across the industry, including at a Monday meeting where Department of Health and Human Services and White […]
Will CMS Crack Down on Prior Authorization?
By Lauren Sausser
January 9, 2024
KFF Health News Original
There’s the Idaho doctor whose infant daughter developed a brain tumor. A woman in Southern California who waited months for an MRI before dying in the hospital. And a North Carolina patient who has trigeminal neuralgia — a condition so painful it’s commonly called the “suicide disease.” They all have something in common, aside from […]
The Ranks of Obamacare ‘Fixers’ Axed in Trump’s Reduction of Health Agency Workforce
By Julie Appleby
April 22, 2025
KFF Health News Original
These fixers, officially known as caseworkers, unraveled complex and arcane health insurance rules to solve people’s coverage issues. They worked in a little-known federal department with which most consumers never interact — until they need help.
Oregon Senator Proposes Criminal Charges and Fines for Rogue Obamacare Agents
By Julie Appleby
July 24, 2024
KFF Health News Original
Oregon Sen. Ron Wyden introduced legislation intended to curb a growing problem in which consumers, without their consent, are enrolled in Affordable Care Act plans or their coverage is switched.
An Arm and a Leg: Fight Health Insurance — With Help From AI
By Dan Weissmann
November 13, 2024
Podcast
Meet the tech worker on a quest to use artificial intelligence to combat denials for coverage from patients’ health plans.
CDC Firings Fray Lifelines to Local Health Departments
By Rachana Pradhan
March 7, 2025
KFF Health News Original
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Washington Power Has Shifted. Here’s How the ACA May Shift, Too.
By Stephanie Armour Sam Whitehead Julie Rovner
Updated November 22, 2024
Originally Published November 21, 2024
KFF Health News Original
With a new Trump administration poised to move into the White House and Republicans set to control both chambers of Congress, party leaders are making a to-do list for the Affordable Care Act.
