Latest Morning Briefing Stories
Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients
The federal government wants to change the way health insurers use prior authorization — the requirement that patients get permission before undergoing treatment. Designed to prevent doctors from deploying expensive, ineffectual procedures, prior authorization has become a confusing maze that denies or delays care, burdens physicians with paperwork, and perpetuates racial disparities. New rules may not be enough to solve the problems.
Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias
Estos planes, muchos administrados por titanes de los seguros, incluidos UnitedHealthcare, Centene y Aetna, han visto aumentar sus ingresos en miles de millones a medida que su membresía aumentaba en millones.
La insulina representa lo perverso del sistema sanitario estadounidense, ya que los precios de venta de este medicamento centenario, del que dependen 8,4 millones de estadounidenses para sobrevivir, se quintuplicaron en dos décadas.
Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding
States are turning to the big health insurance companies to keep Medicaid enrollees insured once pandemic protections end in April. The insurers’ motive: profits.
Why Does Insulin Cost So Much? Big Pharma Isn’t the Only Player Driving Prices
Big Pharma may be moving on from squeezing diabetes patients on insulin prices, but it’s the arbitrators that jack up prices for those who can least afford them.
KFF Health News' 'What the Health?': March Medicaid Madness
President Joe Biden and Republicans in Congress spent last month sparring over whether to shield Medicare and Social Security from budget cuts — leading some to wonder if Medicaid was on the table instead. Biden and Democrats say no, but some Republicans seem eager to trim federal spending on the health program for Americans with low incomes. And ready or not, artificial intelligence is coming to medical care. Benefits, as well as unintended consequences, are likely. Alice Miranda Ollstein of Politico, Rachel Cohrs of STAT News, and Lauren Weber of The Washington Post join KHN’s chief Washington correspondent, Julie Rovner, to discuss these issues and more.
After People on Medicaid Die, Some States Aggressively Seek Repayment From Their Estates
States take drastically different approaches to recovering Medicaid money from deceased participants’ estates. Demands for repayment of Medicaid spending can drain the assets a person leaves behind, depending on where they lived.
California’s Massive Medicaid Program Works for Some, but Fails Many Others
Medi-Cal serves more than one-third of the state’s population — offering a dizzying range of care to a diverse population. In the new “Faces of Medi-Cal” series, California Healthline will assess the program’s strengths and weaknesses through the lives and experiences of its enrollees.
Idaho Dropped Thousands From Medicaid in the Pandemic’s First Years
The removals, detailed in emails between state and federal health officials, hinged on disagreements over how states could disenroll people during the public health emergency. Consumer advocates fear the alleged violation signals the mess to come on April 1, when the pandemic-era Medicaid coverage mandate ends.
Biden Promises to Fight GOP on ‘Gutting’ Medicaid. Budget Talks Seem Like Another Story.
As many lower-income Americans prepare to lose pandemic-era access to Medicaid, President Joe Biden vowed to stop Republicans from making deeper cuts to lower the national debt. Other changes may still be up for discussion.
Surprise-Billing Law Loophole: When ‘Out of Network’ Doesn’t Quite Mean Out of Network
Billing experts and lawmakers are playing catch-up as providers find ways to get around new surprise-billing laws, leaving patients like Danielle Laskey of Washington state with big bills for emergency care.
California Explores Private Insurance for Immigrants Lacking Legal Status. But Is It Affordable?
Nearly half a million Californians without legal residency make too much to qualify for Medicaid yet they can’t afford to buy coverage. A state lawmaker is proposing to open up the state’s health insurance exchange as a first step to providing them affordable insurance.
Readers and Tweeters Urgently Plea for a Proper ‘Role’ Call in the ER
KHN gives readers a chance to comment on a recent batch of stories.
A Bitter Battle Over the ‘Orphan Drug’ Program Leaves Patients’ Pocketbooks at Risk
Patients who depend upon special drugs to treat rare diseases are caught in the crossfire as drugmakers and the FDA battle over regulations that reward companies for developing treatments for relatively small pools of patients.
Proposed Medicare Advantage Changes Cannot Accurately Be Called ‘Cuts,’ Experts Say
CMS advanced two proposed changes that could affect Medicare Advantage plans. One would allow the government to recover past overpayments. As a result, it could reduce those insurers’ profits, leading them to increase enrollees’ out-of-pocket costs or reduce benefits. But it’s inaccurate to characterize the changes as “cuts.”
Watch: In Insurers’ Eyes, Not All Midwives Are Equal
The first installment of InvestigateTV and KHN’s “Costly Care” series explores one California mother’s experience struggling to get reimbursed for midwifery care and the differences between providers that may determine whether insurance covers them.
Se acaba la era de las vacunas y las pruebas gratuitas contra covid. ¿Quién va a pagar?
Las personas podrán obtener estas vacunas a bajo costo o sin costo mientras duren los suministros del gobierno. Luego, dependerá de su seguro de salud.
Era of ‘Free’ Covid Vaccines, Test Kits, and Treatments Is Ending. Who Will Pay the Tab Now?
Insurers, employers, and taxpayers will all be affected as drug manufacturers move these products to the commercial market.
KFF Health News' 'What the Health?': A Health-Heavy State of the Union
President Joe Biden’s 2023 State of the Union address leaned heavily on health care issues. Biden took a victory lap for recent accomplishments like capping prescription drug costs for seniors on Medicare. He also urged Congress to make permanent the boosted premium subsidies under the Affordable Care Act, and he sparred with Republicans on threats to cut Social Security and Medicare. Also this week, both sides in the abortion debate are bracing for a court decision out of Texas that could, at least temporarily, make the abortion pill mifepristone illegal nationwide. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Sarah Karlin-Smith of the Pink Sheet join KHN chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Kate Baicker of the University of Chicago about a possible middle ground in the effort to get universal health insurance coverage.
Centene Agrees to $215 Million Settlement With California for Alleged Medicaid Overbilling
The nation’s largest Medicaid insurer denies wrongdoing after the California attorney general’s office investigated it for inflating prescription drug costs.
