Paying Billions for Controversial Alzheimer’s Drug? How About Funding This Instead?
By Judith Graham
July 6, 2021
KFF Health News Original
Aduhelm, approved by the Food and Drug Administration last month despite questions about its efficacy, could be prescribed to at least 1 million patients a year, for a price tag of about $56 billion. Experts suggest there might be better ways to spend that money.
Lobbyists In ‘Frenzy’ Over White House Plan To Target Medicare Fraud
March 23, 2023
Morning Briefing
The New York Times explains a furor among Washington lobbyists over the Biden administration’s plans to cut Medicare fraud by “billions,” including efforts to influence public opinion. The Nevada Independent notes Medicare Advantage may be a marquee issue in the state’s 2024 Senate race.
Billing Arbitration Comes To An End After Changes To No Surprises Act
August 8, 2023
Morning Briefing
Last week, a court ruling saw parts of the surprise billing law vacated, and this has now resulted in the federal government stopping processing payment disputes between providers and insurers over out-of-network bills, Modern Healthcare reports. Axios notes insurers sometimes pay double for the same procedure versus Medicare Advantage prices.
KFF Health News' 'What the Health?': SCOTUS Rejects Abortion Pill Challenge — For Now
June 13, 2024
Podcast
The Supreme Court has dismissed a challenge to the FDA’s approval of the abortion pill mifepristone, ruling unanimously that the anti-abortion doctor group that filed the suit lacked standing. But abortion opponents are expected to pursue other strategies to ban or restrict the medication. Meanwhile, the Biden administration moves to stop the inclusion of medical debt on individual credit reports, and former President Donald Trump tries to claim credit for $35 insulin. Anna Edney of Bloomberg News, Rachana Pradhan of KFF Health News, and Emmarie Huetteman of KFF Health News join KFF Health News chief Washington correspondent Julie Rovner to discuss these stories and more. Also this week, Rovner interviews KFF president and CEO Drew Altman about KFF’s new “Health Policy 101” primer.
Insurers Say Medicare Advantage Saves Money. Experts Say No
September 26, 2022
Morning Briefing
Stat says while the insurance industry is still trying to convince the public Medicare Advantage saves taxpayer money, experts point to federal data proving the opposite. Also: CommonSpirit Health’s loss of $2 billion, a hospital chain making money off a poor neighborhood, more.
No Changes To Alzheimer’s Drug Restrictions Planned: CMS
February 23, 2023
Morning Briefing
Reuters reports that a request from the Alzheimer’s Association to reduce coverage limits on Alzheimer’s treatments has been turned down by the Centers for Medicare and Medicaid Services. Separately, the debt ceiling fight is being used to “fend off” changes to private Medicare Advantage plans.
Medicare Stumbles Managing a Costly Problem — Chronic Illness
By Phil Galewitz
April 24, 2024
KFF Health News Original
Nearly a decade ago, Medicare launched a program to help the two-thirds of beneficiaries with chronic conditions by paying their doctors an additional monthly fee to coordinate their care. The strategy has largely failed to live up to its potential; only about 4 percent of potentially eligible beneficiaries in the traditional Medicare program are enrolled, […]
UnitedHealthcare Will Ax Around 20% Of Existing Prior Authorizations
March 30, 2023
Morning Briefing
The changed policy, which will affect commercial, Medicare Advantage, and Medicaid members, will begin in the third quarter and will mean providers merely have to notify the insurer about pending care. Among other news, a debate over how to fund the 988 crisis line amid growing demand.
Walmart Health To Nearly Double Its In-Store Clinics In 2024
March 3, 2023
Morning Briefing
The big retailer is “eyeing more Medicare Advantage business,” Axios says, with 28 additional health clinics to go into select Walmart stores — including in Missouri and Arizona. Reuters reports that electronics retailer Best Buy also has its eye on the health care market.
House Passes Medicare Advantage Reform Bill; It Now Heads To Senate
September 15, 2022
Morning Briefing
The Improving Seniors’ Timely Access to Care Act strives to make it easier for seniors to get care and to modernize the process of prior authorizations. For example, the current process often still requires using fax machines to send documents to insurance companies.
House Speaker Says Medicare Cuts Off The Table In Debt Ceiling Negotiations
January 27, 2023
Morning Briefing
House Speaker Kevin McCarthy has assured that Medicare and Social Security will no longer be Republican targets in talks to strike a debt ceiling deal. In related news, a Republican study group eyes potential Medicare changes. And secret audits found millions in Medicare Advantage plan overpayments.
Bright Health Pulls Insurance, Medicare Advantage Plans From 9 States
October 12, 2022
Morning Briefing
The insurtech company says it will only operate in Florida and California in order to reduce costs and settle medical liabilities.
Elevance Health Must Face $100 Million Medicare Advantage Fraud Case
October 5, 2022
Morning Briefing
Judge Andrew Carter ruled Elevance, formerly Anthem, must face a Department of Justice lawsuit alleging the insurer submitted fraudulent patient information. In other news, a Bay Area hospital is sued over a $6,000 urine test, and John Muir Health is sued for allegedly overcharging patients.
KHN’s ‘What the Health?’: Delta Blues
August 5, 2021
KFF Health News Original
Covid is back with a vengeance, with some people clamoring for booster shots while others harden their resistance to getting vaccinated at all. Meanwhile, the Food and Drug Administration is pushing hard on drugmaker Pfizer’s request to upgrade the emergency authorization for its vaccine and give it final approval. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite health policy stories of the week they think you should read, too.
Humana Reveals Plans To Exit Employer-Based Insurance Market
February 24, 2023
Morning Briefing
News outlets report on a new strategy from health insurer Humana: it will take up to two years to exit the employer-based insurance business, and instead focus on government-backed programs like Medicare Advantage. Amazon, SimpliFed, DaVita, Teledoc, and more are also in the news.
3 States Limit Nursing Home Profits in Bid to Improve Care
By Susan Jaffe
October 25, 2021
KFF Health News Original
Following the devastating impact of covid-19 on nursing homes, state lawmakers want to be sure that government and private payments primarily go to improve care and staffing.
CMS Eyes Mandating Electronic Prior Authorization Systems By 2026
December 7, 2022
Morning Briefing
The proposed rule calls for Medicare Advantage, Medicaid, and some other health insurance exchanges to update prior authorization processes. Among the potential mandates are for payers to respond to “urgent” requests within 72 hours, justify denials, and report decisions.
3 More Top Medical Schools Withdraw From US News Rankings
January 25, 2023
Morning Briefing
Following Harvard University, three more top-10 medical schools — at the University of Pennsylvania and at Columbia and Stanford universities — have now also withdrawn their data from the U.S. News list. Audits of Medicare Advantage insurers, clawbacks, and price transparency are also in the news.
Officials Spotlight Abuses Of Medicare Advantage Coding
May 19, 2022
Morning Briefing
The coding process in private Medicare plan options need to be reformed, former and current officials have said, noting that health insurers’ use of coding to get higher payments is a problem. Also: Cerebral replaces its CEO, patient risks from ransomware attacks, and more.
KFF Health News' 'What the Health?': All About the (Government) Funding
January 11, 2024
Podcast
With days to go until a large chunk of the federal government runs out of money needed to keep it operating, Congress is still struggling to find a compromise spending plan. Meanwhile, the Supreme Court agreed to hear — this year — a case that pits federal requirements for emergency treatment against state abortion bans. Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet, and Tami Luhby of CNN join KFF Health News chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews American Medical Association President Jesse Ehrenfeld about the choppy waters facing the nation’s physicians in 2024.
