Medicare Surprise: Drug Plan Prices Touted During Open Enrollment Can Rise Within a Month
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.
Insurance
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California Opens Medicaid to Older Unauthorized Immigrants
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.
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After Medical Bills Broke the Bank, This Family Headed to Mexico for Care
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.
By Paula Andalo -
Despite Losing Federal Money, California Is Still Testing Uninsured Residents for Covid — For Now
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.
By Rachel Bluth -
Journalists Cover the Gamut, From Rising Insulin Costs to Delays in Autism Care for Children
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.
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KHN’s ‘What the Health?’: A Conversation With Peter Lee on What’s Next for the ACA
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.
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Perspective
Is My Drug Copay Coupon a Form of Charity — Or a Bribe?
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.
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Washington State Retools First-in-the-Nation Long-Term Care Benefit
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.
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KHN’s ‘What the Health?’: News You Might Have Missed
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.
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How a Former Catholic Priest Is Navigating a California Medicaid Plan Through Big Changes
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.
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Who Doesn’t Text in 2022? Most State Medicaid Programs
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.
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California Handed Its Medicaid Drug Program to One Company. Then Came a Corporate Takeover.
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.
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KHN’s ‘What the Health?’: Finally, a Fix for the ‘Family Glitch’
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.
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The End of the Covid Emergency Could Mean a Huge Loss of Health Insurance
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.
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ACA Sign-Ups for Low-Income People Roll Out Amid Brokers’ Concerns About Losing Their Cut
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.
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Patients’ Perilous Months-Long Waiting for Medicaid Coverage Is a Sign of What’s to Come
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.
By Bram Sable-Smith and Rachana Pradhan -
KHN’s ‘What the Health?’: Funding for the Next Pandemic
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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The Case of the $489,000 Air Ambulance Ride
Diagnosed with aggressive leukemia on a Western trip, a young man thought his insurance would cover an air ambulance ride home to North Carolina. Instead, questions about medical necessity left him with an astronomical bill.
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How to Avoid Surprise Bills — And the Pitfalls in the New Law
The No Surprises Act offers protection from many surprise medical bills — but that protection may be only as good as a patient’s knowledge of the law and ability to make sure it’s enforced. Here’s what you need to know.
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Want Vulnerable Californians to Have Healthier Pregnancies? Doulas Say the State Must Pay Up.
California was supposed to start paying doulas this year to help Medicaid enrollees have healthy pregnancies. But the benefit has been delayed because doulas feel lowballed by the state’s proposed reimbursement rate, which is below what most other states pay.
By Rachel Bluth