Some Medicaid Providers Borrow or Go Into Debt Amid ‘Unwinding’ Payment Disruptions
Used to operating with scarce resources, Montana Medicaid providers say gaps in state payments have left them struggling further.
Insurance
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Navigating Aging
The Burden of Getting Medical Care Can Exhaust Older Patients
It’s estimated that an older patient can spend three weeks of the year getting care — and that doesn’t count the time it takes to arrange appointments or deal with insurance companies.
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A Mom’s $97,000 Question: How Was Her Baby’s Air-Ambulance Ride Not Medically Necessary?
There are legal safeguards to protect patients from big bills like out-of-network air-ambulance rides. But insurers may not pay if they decide the ride wasn’t medically necessary.
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California’s Expanded Health Coverage for Immigrants Collides With Medicaid Reviews
A state policy to extend Medi-Cal to qualified Californians without legal residency is running up against a federal requirement to resume eligibility checks. The redetermination process is causing many Latinos, who make up a majority of Medi-Cal beneficiaries, to be disenrolled.
The ACA Turns 14
Episode 339Saturday marks the 14th anniversary of the still somewhat embattled Affordable Care Act. Health and Human Services Secretary Xavier Becerra joins host Julie Rovner to discuss the accomplishments of the health law — and the challenges it still faces. Also this week, Alice Miranda Ollstein of Politico, Tami Luhby of CNN, and Mary Agnes Carey of KFF Health News join Rovner to discuss what should be the final funding bill for HHS for fiscal 2024, next week’s Supreme Court oral arguments in a case challenging abortion medication, and more. Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too.
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KFF Health News & PolitiFact HealthCheck
Biden Said Medicare Drug Price Negotiations Cut the Deficit by $160B. That’s Years Away.
Savings estimated by the Congressional Budget Office from allowing the federal government to negotiate Medicare drug prices are based on a 10-year cumulative projection.
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Georgia’s Medicaid Work Requirements Costing Taxpayers Millions Despite Low Enrollment
Republican Gov. Brian Kemp’s Georgia Pathways to Coverage program has seen anemic enrollment while chalking up millions in start-up costs — largely in technology and consulting fees. Critics say the money’s being wasted on a costly and ineffective alternative to Obamacare’s Medicaid expansion.
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Covid and Medicare Payments Spark Remote Patient Monitoring Boom
Demand for help monitoring patients’ vital signs remotely has taken off since a Medicare change in 2019. Dozens of companies now push the service to help overburdened primary care doctors — and as a revenue stream. But some policy experts say its growth has outpaced oversight and evidence of effectiveness.
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Perspective
How Your In-Network Health Coverage Can Vanish Before You Know It
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.
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When Copay Assistance Backfires on Patients
Drugmakers offer copay assistance programs to patients, but insurers are tapping into those funds, not counting the amounts toward patient deductibles. That leads to unexpected charges. But the practice is under growing scrutiny.
Maybe It’s a Health Care Election After All
Episode 338Health care wasn’t expected to be a major theme for this year’s elections. But as President Joe Biden and former President Donald Trump secured their respective party nominations this week, the future of both Medicare and the Affordable Care Act appears to be up for debate. Meanwhile, the cyberattack of the UnitedHealth Group subsidiary Change Healthcare continues to do damage to the companies’ finances with no quick end in sight. Margot Sanger-Katz of The New York Times, Anna Edney of Bloomberg News, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News’ Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Kelly Henning of Bloomberg Philanthropies about a new, four-part documentary series on the history of public health, “The Invisible Shield.” Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too.
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A New $16,000 Postpartum Depression Drug Is Here. How Will Insurers Handle It?
A pill form of an effective drug for postpartum depression hit the market in December, but most insurers do not yet have a policy on when or whether they will pay for it. The hurdles to obtain its predecessor medication have advocates worried.
The Medicare Episode
Season 11, Episode 3On this episode of “An Arm and a Leg,” host Dan Weissmann breaks down the complicated and expensive world of Medicare with practical tips to pick the right plan and avoid penalties.
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Biden Said State of the Union Is Strong and Made Clear His Campaign Is Off and Running
President Joe Biden used his roughly 68-minute address to Congress to counter lackluster public approval ratings and draw clear contrasts between his administration’s policies and those of Donald Trump and some congressional Republicans. Abortion and health care were in the spotlight.
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Biden Team, UnitedHealth Struggle to Restore Paralyzed Billing Systems After Cyberattack
The cyberattack on a unit of UnitedHealth Group’s Optum division is the worst on the health care industry in U.S. history, hospitals say. Providers struggling to get paid for care say the response by the insurer and the Biden administration has been inadequate.
The State of the Union Is … Busy
Episode 337At last, Congress is getting half of its annual spending bills across the finish line, albeit five months after the start of the fiscal year. Meanwhile, President Joe Biden delivers his annual State of the Union address, an over-the-counter birth control pill is (finally) available, and controversy erupts over new public health guidelines for covid-19 isolation. Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet, and Sandhya Raman of CQ Roll Call join KFF Health News’ Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Neera Tanden, the White House domestic policy adviser, about Biden’s health agenda. Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too.
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Whistleblower Accuses Aledade, Largest US Independent Primary Care Network, of Medicare Fraud
A recently unsealed lawsuit alleges Aledade Inc. developed billing software that boosted revenues by making patients appear sicker than they were.
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Journalists Examine Medicaid Unwinding, Farmworkers’ Mental Health, and the Big Opioid Payback
KFF Health News 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.