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Insurers say prior authorization requirements are intended to reduce wasteful and inappropriate health care spending. But they can baffle patients waiting for approval. And doctors say that insurers have yet to follow through on commitments to improve the process.
Covid cases are again climbing, but you wouldn’t know it from the behavior of public health and elected officials, much less the general public, all of whom seem to want to put the pandemic in the rearview mirror. Meanwhile, the fallout over the leaked Supreme Court draft opinion on abortion continues even as the Senate fails — again — to muster the votes to write abortion rights into law. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists suggest their favorite health policy stories of the week they think you should read, too.
Only 15 states require insurance to cover in vitro fertilization, a common path to parenthood for people who have trouble getting pregnant. And even for those whose insurance covers IVF, the expensive procedures and required drugs can lead to unexpected bills.
Even the savviest Medicare drug plan shoppers can get a shock when they fill prescriptions: That great deal on medications is no bargain after prices go up.
Starting May 1, low-income unauthorized immigrants over age 49 became eligible for full Medicaid health coverage, a significant milestone in California’s effort to expand coverage.
The Fierro family owed a Yuma, Arizona, hospital more than $7,000 for care given to mom and dad, so when a son dislocated his shoulder, they headed to Mexicali. The care was quick, good, and affordable.
Federal funding that paid for covid testing, treatment, and vaccines for uninsured people has run out. While some states struggle to make up the difference, California is relying on other state and local programs to continue free testing.
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.
Amid covid-19, the potential overturn of Roe v. Wade, and a war in Europe, the Affordable Care Act has been flying under the radar in 2022. But this will be a pivotal year for the federal health law. Unless Congress acts, millions of Americans could see their costs for coverage rise dramatically as expanded subsidies expire. At the same time, the end of the public health emergency could boost the uninsured rate as states disenroll people from Medicaid. Peter Lee, who recently stepped down as the first executive director of the largest state-run ACA insurance marketplace, Covered California, has thought long and hard about how the ACA came to be, how it’s been implemented, and what should happen to it now. He joins host and KHN chief Washington correspondent Julie Rovner for a wide-ranging discussion on the state of the ACA.
Drug copayment assistance is a form of profitable charity — and, yes, that’s an oxymoron. Amid skyrocketing drug prices, it's understandable that patients desperately need help affording medicine, especially when their health is on the line. But these programs create a mirage that perpetuates our health care system’s reckless spending.
The WA Cares Fund program, which would provide workers in the state a lifetime benefit of $36,500, was set to begin collecting money through a payroll tax in January, but it was delayed while lawmakers made adjustments to address equity problems. Now the payroll deductions will begin in July 2023, and benefits will become available in 2026.
Congress is in recess, so the slower-than-average news week gives us a chance to catch up on underreported topics, like Medicare’s coverage decision for the controversial Alzheimer’s disease drug Aduhelm and ominous new statistics on drug overdose deaths and sexually transmitted diseases. Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, and Alice Miranda Ollstein of Politico join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.
Michael Hunn left the clergy and became a hospital and health system executive. He’s been named CEO of CalOptima, Orange County’s Medi-Cal health insurance plan for low-income residents, and his spiritual background is helping him guide the publicly run plan into the future.
As states prepare for the end of the covid public health emergency, they are making plans to reevaluate each Medicaid enrollee’s eligibility. They will rely primarily on mail and email because not many states can text enrollees.
The company awarded the state’s Medi-Cal Rx contract was taken over by another company, Centene. That left the state with a contractor it didn’t pick — one that has been accused of overbilling nine other state Medicaid programs and is now under investigation by California.
President Joe Biden welcomed former President Barack Obama back to the White House this week to announce a new policy for the Affordable Care Act that would make subsidies available to more families with unaffordable employer coverage. Meanwhile, Congress struggled to find a compromise for continued federal funding of covid-19 vaccines, testing, and treatments. Tami Luhby of CNN, Shefali Luthra of The 19th, and Jessie Hellmann of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more.
It is a perilous time to throw low- and middle-income Americans off the insurance cliff: A new omicron subvariant is spreading, and a program that provided coronavirus testing and covid-19 treatment at no cost to the uninsured has expired.
The Biden administration unveiled a new special enrollment option aimed at signing up low-income Americans for Affordable Care Act coverage — even if it is outside of the usual annual open enrollment period. But insurers are cutting broker commissions at the same time.
The pandemic crisis has overwhelmed understaffed state Medicaid agencies, already delaying access to the insurance program in Missouri. As the public health emergency ends, low-income people nationwide could find it even harder to have coverage.
In his proposed budget, President Joe Biden called for a boost in health spending that includes billions of dollars to prepare for a future pandemic. But that doesn’t include money he says is needed immediately for testing and treating covid-19. Also this week, federal regulators authorized a second booster shot for people 50 and older yet gave little guidance to consumers about who needs the shot and when. Amy Goldstein of The Washington Post, Jennifer Haberkorn of the Los Angeles Times, and Rachana Pradhan of KHN join KHN’s Mary Agnes Carey to discuss these issues and more. Plus, Julie Rovner interviews KHN’s Julie Appleby, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a very expensive air ambulance ride.
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