States Get in on the Prior Authorization Crackdown

Last month, my colleague Lauren Sausser told you about the Biden administration’s crackdown on insurance plans’ prior authorization policies, with new rules for certain health plans participating in federal programs such as Medicare Advantage or the Affordable Care Act marketplace. States are getting in on the action, too. Prior authorization, sometimes called pre-certification, requires patients […]

States Target Health Insurers’ ‘Prior Authorization’ Red Tape

Doctors, patients, and hospitals have railed for years about the prior authorization processes that health insurers use to decide whether they’ll pay for patients’ drugs or medical procedures. The Biden administration announced a crackdown in January, but some state lawmakers are looking to go further.

KFF Health News' 'What the Health?': Health Enters the Presidential Race

New Hampshire voters have spoken, and it seems increasingly clear that this November’s election will pit President Joe Biden against former President Donald Trump. Both appear to be making health a key part of their campaigns, with Trump vowing (again) to repeal the Affordable Care Act, and Biden stressing his support for contraception and abortion rights. Meanwhile, both candidates will try to highlight efforts to rein in prescription drug prices. Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News, and Jessie Hellmann of CQ Roll Call join KFF Health News chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Sarah Somers of the National Health Law Program about the potential consequences for the health care system if the Supreme Court overturns a key precedent attempting to balance executive vs. judicial power.

The Colonoscopies Were Free. But the ‘Surgical Trays’ Came With $600 Price Tags.

Health providers may bill however they choose — including in ways that could leave patients with unexpected bills for “free” care. Routine preventive care saddled an Illinois couple with his-and-her bills for “surgical trays.”

New York Joins Local Governments in Erasing Billions in Medical Debt

New York City is the latest jurisdiction to buy and forgive a backlog of unpaid medical bills for its residents. Local governments across the country, including in the Chicago area, are doing the same to reduce debt burdens for lower-income residents.

KFF Health News' 'What the Health?': The Supreme Court vs. the Bureaucracy

The Supreme Court this week heard oral arguments in a case that could radically alter the way federal agencies — including the Department of Health and Human Services — administer laws passed by Congress. A decision in the case is expected this spring or summer. Meanwhile, the Biden administration is struggling over whether to ban menthol cigarettes — a move that could improve public health but also alienate Black voters, the biggest menthol users. Joanne Kenen of Johns Hopkins University and Politico Magazine, Lauren Weber of The Washington Post, and Rachel Cohrs of Stat join KFF Health News chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Darius Tahir, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature about a lengthy fight over a bill for a quick telehealth visit.

Federal Program to Save Rural Hospitals Feels ‘Growing Pains’

Fewer than two dozen rural hospitals were converted into Rural Emergency Hospitals in the program’s first year. Now, advocates and lawmakers say tweaks to the law are necessary to lure more takers and keep health care in rural communities.

Hoping to Clear the Air in Casinos, Workers Seek to Ban Tobacco Smoke

Casinos in several states are fighting efforts to ban smoking, and trying to roll back existing anti-smoking laws. One planned facility even moved outside a city’s limits because of voter-approved smoking restrictions.

States Begin Tapping Medicaid Dollars to Combat Gun Violence

The Biden administration is allowing states to use money from the insurance program for low-income and disabled residents to pay for gun violence prevention. California and six other states have approved such spending, with more expected to follow.

Listen to ‘Tradeoffs’: How the Loss of a Rural Hospital Compounds the Collapse of Care

Six years ago, the hospital in Fort Scott, Kansas, shuttered, leaving residents in the small community without a cornerstone health care institution. In the years since, despite new programs meant to save small hospitals, dozens of other communities have watched theirs close.

The Year in Opioid Settlements: 5 Things You Need to Know

In the past year, opioid settlement money has gone from an emerging funding stream for which people had lofty but uncertain aspirations to a coveted pot of billions being invested in remediation efforts. Here are some important and evolving factors to watch going forward.

What a Bison Goring Can Teach Us About Rural Emergency Care

Millions of Americans live in “ambulance deserts” — areas that are more than a 25-minute drive to the nearest emergency medical services (EMS) station. The most rural areas can be more than an hour away from help.   These sparsely populated communities can have trouble sustaining ambulance services, if small patient volumes and low reimbursements […]