Author: Avisoscuba
The current Affordable Care Act open enrollment season is the first big test of new federal guardrails against fraud. The rules aim to head off unauthorized ACA plan enrollments or switches by rogue agents and entities looking to make money via enrollment commissions. Such sign-ups triggered more than 274,000 consumer complaints through August this year. But some health insurance experts fear the new rules could slow consumer sign-ups and reduce the number who sign up for 2025 coverage. In most states, ACA open enrollment started Nov. 1 and extends through Jan. 15. Regulators “really have this tightrope to walk,” said…
GEO Group, one of the nation’s largest private prison contractors, filed a federal lawsuit last month against California officials to strike down a state law allowing local public health officials to inspect immigration detention facilities. The Florida-based company argued in a filing that California’s law, signed by Gov. Gavin Newsom in August, is unconstitutional because it steps on the federal government’s authority to manage detention centers. By extension, GEO claimed intergovernmental immunity as a contractor. “This case involves the latest in a string of attempts by the State of California to ban federal immigration enforcement in the state, or so…
In mid-May, Mandi Rokx had a 3-month-old baby and a letter from a Florida agency warning that they both would be cut from Medicaid, the health insurance program for people with low incomes or disabilities. Under a Florida law passed in 2021, Rokx was supposed to receive 12 months of continuous coverage after giving birth. But the letter from Florida’s Department of Children and Families said their coverage would end May 31. The explanation: “You failed to complete or follow through with your Medicaid renewal.” Rokx said she didn’t understand why the state was cutting coverage. She had provided everything…
Two rival hospitals in Terre Haute, Indiana, pulled back their merger application Monday, just days before the state was due to rule on the deal amid growing backlash to such medical monopolies. The proposed merger between Union Health and Terre Haute Regional Hospital, the only acute care hospitals in Vigo County, Indiana, would have left Terre Haute’s 58,000 residents and those in the surrounding region with a single hospital operator. Although federal laws prohibit monopolies, the hospitals sought the merger under a state provision known as a “Certificate of Public Advantage” law, or COPA. “Recognizing the COPA process is a…
Phil Galewitz, KFF Health News Casi un año después que la administración Biden diera luz verde a Florida para convertirse en el primer estado en importar medicamentos recetados más baratos de Canadá —un objetivo de muchos políticos de todas las tendencias, incluido el presidente electo Donald Trump— el programa aún no ha comenzado. El gobernador de Florida, Ron DeSantis, celebró en enero que la Administración de Alimentos y Medicamentos (FDA) aprobara su plan, calificándolo de victoria sobre la industria farmacéutica, que se opone a la importación alegando que provocaría un aumento de medicamentos falsificados. Un funcionario de salud de Florida,…
El regreso del presidente electo Donald Trump a la Casa Blanca podría envalentonar a los republicanos que quieren debilitar o derogar la Ley de Cuidado de Salud a Bajo Precio (ACA). Sin embargo, la aplicación de cambios tan drásticos aún exigiría superar obstáculos políticos y de procedimiento. Trump, que durante mucho tiempo se opuso a ACA, expresó durante la campaña su interés en modificar la ley de salud. Además, algunos legisladores republicanos de alto rango —que ahora tendrán el control tanto de la Cámara de Representantes como del Senado— han dicho que para ellos sería una prioridad renovar la histórica…
Los cambios no autorizados en los planes médicos de la Ley de Cuidado de Salud a Bajo Precio (ACA) parecen haberse reducido en las últimas semanas: reguladores federales informaron que hay menos quejas de los consumidores. Los Centros de Servicios de Medicare y Medicaid (CMS), que supervisan ACA, atribuyen esta reducción a las medidas adoptadas para prevenir problemas de inscripción y cambios de planes, que ya habían generado más de 274,000 quejas hasta agosto. Ahora, el período anual de inscripción abierta de ACA, que comenzó el 1 de noviembre, plantea una prueba en el mundo real: ¿lograrán estos cambios frenar…
Unauthorized switching of Affordable Care Act plans appears to have tapered off in recent weeks based on an almost one-third drop in casework associated with consumer complaints, say federal regulators. The Centers for Medicare & Medicaid Services, which oversees the ACA, credits steps taken to thwart enrollment and switching problems that triggered more than 274,000 complaints this year through August. Now, the annual ACA open enrollment period that began Nov. 1 poses a real-world test: Will the changes curb fraud by rogue agents or brokerages without unduly slowing the process of enrolling or reducing the total number of sign-ups for…
KFF Health News chief Washington correspondent Julie Rovner discussed President-elect Donald Trump’s announcement that he will nominate former TV host Mehmet Oz to lead the Centers for Medicare & Medicaid Services on WBUR’s “Here & Now” on Nov. 20. Rovner also discussed what it could mean for Robert F. Kennedy Jr. to run the Department of Health and Human Services on NPR’s “All Things Considered” on Nov. 15. Click here to hear Rovner on “Here & Now” Click here to hear Rovner on “All Things Considered” KFF Health News correspondent Cara Anthony discussed the “Silence in Sikeston” project on St. Louis…
Medicare officials are pushing back against a federal watchdog’s call to crack down on home visits by Medicare Advantage health plans — a practice the watchdog says may waste billions of tax dollars every year. In late October, a Health and Human Services inspector general audit found that the insurers pocketed $7.5 billion in 2023 from diagnosing health conditions that prompted no medical services — about $4.2 billion of it through the health assessments done in patients’ homes. Assistant Inspector General Erin Bliss told me the plans are raking in billions of dollars without providing any treatment for medical conditions the plans flagged during the visits, including serious diseases…
ATLANTA — Lloyd Mills was tired of being stuck in a small, drab hospital room. On a rainy mid-September morning, a small TV attached to a mostly blank white wall played silently. There was nothing in the space to cheer it up — no cards, no flowers. In February, the 32-year-old with autism, cerebral palsy, and kidney disease was brought to Grady Memorial Hospital from the group home where he had been living because he was having auditory hallucinations and suicidal thoughts, he said. “Being here is not helping me, mentally, physically, emotionally,” Mills said. He wanted to return to…
Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names. Relating to Relatives of Lonely Dementia Patients I was sent the article by Judith Graham on older adults with dementia living alone (“Going It Alone: Millions of Aging Americans Are Facing Dementia by Themselves,” Oct. 15). I appreciate this article. My mom lives alone with dementia. My son lives next door and checks on her, and my daughter comes when she is able to vacuum floors and to scrub the kitchen and bathroom. I handle the…
President-elect Donald Trump’s choice to run the sprawling government agency that administers Medicare, Medicaid, and the Affordable Care Act marketplace — celebrity doctor Mehmet Oz — recently held broad investments in health care, tech, and food companies that would pose significant conflicts of interest. Oz’s holdings, some shared with family, included a stake in UnitedHealth Group worth as much as $600,000, as well as shares of pharmaceutical firms and tech companies with business in the health care sector, such as Amazon. Collectively, Oz’s investments total tens of millions of dollars, according to financial disclosures he filed during his failed 2022…
The Host President-elect Donald Trump is continuing to staff his incoming administration, and his picks so far for key health policy positions are particularly polarizing. He said he’ll nominate prominent vaccine skeptic Robert F. Kennedy Jr. to head the Department of Health and Human Services and Mehmet Oz — a controversial heart surgeon, former Senate candidate, and TV host — to run the Centers for Medicare & Medicaid Services, which oversees coverage for more than 160 million Americans. Meanwhile, on Capitol Hill, the lame-duck Congress has just weeks to finish its work for the year, including health priorities such as…
Nearly a year after the Biden administration gave Florida the green light to become the first state to import lower-cost prescription drugs from Canada — a longtime goal of politicians across the political spectrum, including President-elect Donald Trump — the program has yet to begin. Florida Gov. Ron DeSantis hailed the FDA’s approval of his plan in January, calling it a victory over the drug industry, which opposes importation on the grounds that it would lead to a surge in counterfeit medications. A Florida health official familiar with the importation program told KFF Health News there was no planned date…
GLENWOOD, Iowa — Hundreds of people who were separated from society because they had disabilities are buried in a nondescript field at the former state institution here. Disability rights advocates hope Iowa will honor them by preventing the kind of neglect that has plagued similar cemeteries at other shuttered facilities around the U.S. The southwest Iowa institution, called the Glenwood Resource Center, was closed this summer in the wake of allegations of poor care. The last of its living residents were moved elsewhere in June. But the remains of about 1,300 people will stay where they were buried on the…
A California agency charged with slowing health costs has set a lofty goal for insurers to direct 15% of their spending to primary care by 2034, part of the state’s effort to expand the primary care workforce and give more people access to preventive care services. The board of the state Office of Health Care Affordability in October set its benchmark well above the industry’s current 7% primary care spending rate, in hopes of improving Californians’ health and reducing the need for costlier care down the road. “It’s ambitious but achievable,” said Elizabeth Landsberg, director of the state’s Department of…
President-elect Donald Trump’s return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles. Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers — who will now have control over both the House and the Senate — have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach. The governing trifecta sets the stage…
Almost all people have health insurance in Vermont, a state famed for its maple syrup and Ben & Jerry’s ice cream, yet residents pay the nation’s highest insurance premiums for individual coverage and endure months-long waits for care — and most hospitals here are losing money, according to state reports and interviews with residents and industry officials. For more than 15 years, federal and state policymakers have focused on increasing the number of people insured, which they expected would shore up hospital finances and make care more available and affordable. “Vermont’s struggles are a wake-up call that insurance is only…
William Lopez remembers clearly the day in June 2017 when he says he was asked to call the spouse of a college friend who had just died and ask for her eyes. The spouse hadn’t responded to calls from other employees at the Rocky Mountain Lions Eye Bank, he said. As Lopez recalled, his supervisor thought a friend’s personal number would have more success. Lopez refused. “I went for a walk,” he said. Even without Lopez’s help, the eye bank that procures corneas from deceased donors in Wyoming and Colorado eventually collected his friend’s corneas, Lopez said. Lopez, who had…
Jackie Fortiér After their younger son was bitten by a rattlesnake and ended up in the pediatric intensive care unit, a San Diego couple received a huge bill. Listen to hear why antivenom is so expensive. This spring, a San Diego toddler spent two days in a pediatric intensive care unit after a rattlesnake bit his hand in his family’s backyard. The bills that followed were staggering, with the lifesaving antivenom the 2-year-old needed accounting for more than two-thirds of the total cost — $213,000. Why is antivenom so expensive? One explanation is the markup hospitals add to balance overhead…
Indiana residents and federal officials are urging state health regulators to stop two rival hospitals in Terre Haute from merging. The deal, if approved, would leave residents with a hospital monopoly. Union Health, a nonprofit whose main hospital is licensed as a 341-bed facility, would buy the county’s only other acute care hospital, the 278-bed Terre Haute Regional Hospital, owned by for-profit chain HCA Healthcare and located 5 miles south across the city’s downtown area. Union says the merger to create one larger nonprofit health system would improve the area’s poor public health rankings. The Indiana Department of Health received…