Category: Health Care Costs

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.

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.

Insulin Copay Cap Passes House Hurdle, But Senate Looks for a Broader Bill

Sens. Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.) are seeking to craft a compromise that members from both parties could accept. Their plan, still being ironed out, would not guarantee a specific limit on out-of-pocket costs but seeks to roll back insulin prices by barring rebate payments to pharmacy benefit managers.

Record Fines Might Mean California Is Finally Serious About Improving Medi-Cal

California regulators issued record fines against L.A. Care, the state’s largest Medi-Cal managed-care plan, for providing inadequate care to its enrollees. But whether the penalties are a sign that the state will make a more forceful effort to improve Medi-Cal’s overall quality of care remains to be seen.

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.

‘An Arm and a Leg’: A Fight for the Right to Help

It’s illegal for a person who isn’t a lawyer to give even basic legal advice to people being sued for medical debt. Two New Yorkers are suing to change that.

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.

KHN’s ‘What the Health?’: The ACA Turns 12

Although its fate was in doubt more than a few times, the Affordable Care Act turned 12 this week. Year 13 could be pivotal in determining how many Americans receive ACA health insurance, and at what price. Meanwhile, three leading credit bureaus agreed to stop using most medical debt to measure U.S. consumers’ creditworthiness. Anna Edney of Bloomberg News, Rachel Cohrs of Stat, and KHN’s Mary Agnes Carey join KHN’s Julie Rovner to discuss these issues and more.

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.

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.