Unless Congress comes to an agreement fast, federal funding for a program that provides health insurance to 2 million California children and pregnant women will run out around the end of the year.
After that, California could be on the hook for hundreds of millions of dollars because the state is required to offer the insurance even if the federal funds don’t show up.
Despite decades of bipartisan support, Congress didn’t renew its authorization to spend money on the Children’s Healthcare Insurance Program, which provides coverage for about 9 million poor children and pregnant women nationwide, before it expired at the end of September. Since then, states have relied on their reserves, or unspent money from previous years, as short-term fixes.
Alex M. Azar II, President Trump’s nominee to lead the Department of Health and Human Services, has expressed concern about the soaring cost of prescription drugs for many consumers. This week, Mr. Azar, a former pharmaceutical executive, is expected to face tough questions at a Senate confirmation hearing over why his own company raised prices.
Democratic senators say that, as a top manager at Eli Lilly and Company, he was responsible for steep increases on insulin and other drugs. How he would now tackle that problem as secretary, along with the future of the Affordable Care Act, promises to dominate the hearings.
Even Democrats who are unlikely to vote for Mr. Azar say that he will probably be confirmed, and that he would be more pragmatic and less ideological than the man he would succeed, Tom Price, who resigned in September under criticism for his use of private jets and military flights.
In early October, an executive at one of the nation’s largest physician-practice management firms handed her bosses the equivalent of a live grenade — a 20-page report that blew up the company and shook the world of managed care for poor patients across California.
For years, she wrote, SynerMed, a behind-the-scenes administrator of medical groups and managed-care contracts, had improperly denied care to thousands of patients — most of them on Medicaid — and falsified documents to hide it.
The violations were “widespread, systemic in nature,” according to the confidential Oct. 5 report by the company’s senior director of compliance, Christine Babu. And they posed a “serious threat to members’ health and safety,” according to the report, which was obtained by Kaiser Health News.
Eli Wheatley and Christian Guardino are among a growing number of patients whose lives are apparently being saved or radically improved by gene therapy.
Wheatley, 3, of Lebanon, Ky., and Guardino, 17, of Patchogue, N.Y., were both diagnosed with what were long thought to be incurable genetic disorders. In the past, Wheatley’s condition would have probably killed him before his first birthday. Guardino’s would have blinded him early in life.
But after receiving experimental gene therapies, both seem to be doing fine. “It’s a very exciting time for the field,” says Carrie Wolinetz, the associate director for science policy at the National Institutes of Health.
With just two weeks left before the Affordable Care Act’s fifth open enrollment period ends, roughly 2.8 million people had signed up for coverage through the federal insurance exchange as of Nov. 25, the CMS said Wednesday.That’s ahead of last year’s sign-ups, which totaled 2.1 million in the first four weeks. But 9.2 million people selected plans or were automatically enrolled through HealthCare.gov during last year’s three-month enrollment period, meaning the pace of sign-ups would have to accelerate rapidly before the shortened enrollment ends Dec. 15 to match last year’s numbers.
Call it the central dilemma of healthcare reform: a new survey, released by CVS Health at the Forbes Healthcare Summit, illustrates a vexing problem for those who want to change the way Americans get medical care. Most people in the U.S. do inded think the country’s healthcare system is headed in the wrong direction and in need of reform. But the vast majority of those who do have insurance are happy enough with the plan they have– and likely afraid of change.
The U.S. tax system and health care are deeply intertwined. The Republican tax bills hurtling through Congress would make significant changes in this relationship.
The proposed changes, primarily a large cut in the corporate tax rate from 35 to 20 percent, would benefit health care (and most other) companies.
But none of the changes would, in the long run, benefit consumers, the public good, or public health.
Need proof the Republicans in Congress are prioritizing the desires of their donors over the needs of everyone else?
Let’s check in with the sorry saga of the federal Children’s Health Insurance Program, better known as CHIP.
Senate Republicans, busy with tax reform, still somehow can’t make the time to reauthorize the program. And now thanks to their lack of action, millions of children might lose their access to medical care.
Payers offering insurance plans for the employer market need to provide flexible benefits and cost-saving strategies that create value for small businesses.
Small businesses are an excellent market opportunity for payers because health plans provide these businesses a recruiting tool for new employees, incentives to retain current employees, and ease the healthcare-related stressors of operating a business.
However, small businesses may not be encouraged to provide healthcare coverage for employees if they view a potential health plan as too costly, inefficient, or incompatible with the needs of a business’s employees.
Whether you call it single payer or Medicare for all, the idea of a government-sponsored universal health care system, no matter how contentiously debated, continues to infiltrate the health care discussion.
The idea of universal health care reemerged during the 2016 presidential primary campaign as one of Bernie Sanders’ main platforms. In September, Sanders, I-Vermont, introduced a “Medicare for All” bill into the Senate with the full knowledge it would likely go nowhere — for now. In August, Rep. John Conyers, D-Michigan, reintroduced an expanded and improved Medicare for All bill in the House.
As President Donald Trump talked tax reform on Capitol Hill Tuesday, Arkansas patient advocate Andrea Taylor was also meeting with lawmakers and asking them to save a corporate tax credit for rare disease drug companies.
Taking the credit away, Taylor said, “eliminates the possibility for my child to have a bright and happy future.”
Taylor, whose 9-year-old son, Aiden, has a rare connective tissue disorder, spoke as part of a small rally thrown together this week by the National Organization for Rare Disorders (NORD) — the nation’s largest advocacy group for patients with rare diseases.
There has been an uptick in the number of physicians making the leap to value-based care, but the majority of clinicians remain skeptical and reluctant to switch from traditional fee-for-service.Just 47% of clinicians surveyed for a joint American Academy of Family Physicians and Humana study on value-based payment are actively pursuing value-based purchasing opportunities, up 3 percentage points from their joint report two years ago, according to an analysis released Wednesday.A key barrier for providers is skepticism that the concept of care works compared to the standard fee-for-service scheme.
The use of pay-for-performance payment models could drive providers to turn away low-income patients with complex care needs, a new study suggests. The report, published this week in Annals of Internal Medicine, found practices that cared for high-risk patients were more likely to receive financial penalties under the CMS’ Value-based Payment Modifier program because their patients had higher rates of hospitalization, mortality and Medicare spending. The mandatory program penalized or rewarded physicians based on their quality outcomes and cost of care. The program was a precursor to and was replaced by the Medicare Access and CHIP Reauthorization Act (MACRA).
A doctor offers a surgical add-on that leads to a $1,877 bill for a young girl’s ear piercing. A patient protests unnecessary scans to identify and treat her breast cysts. A study shows intensive care-level treatment is overused.
ProPublica has been documenting the myriad ways the health system wastes money on unnecessary services, often shifting the costs to consumers. But there are ways patients can protect themselves.
We consulted the bill-wrangling professionals at Medliminal, one of a number of companies that negotiate to reduce charges for a share of the savings. After years of jousting with hospitals, medical providers and insurers, their key advice for patients and their families is to be assertive and proactive.
President Trump’s pick for the next secretary of Health and Human Services, Alex Azar, goes before the Senate Committee on Health, Education, Labor and Pensions (HELP) today. If confirmed as secretary, Azar will have a real opportunity to bolster health care in this country — but in an area that does not get the same kind of attention as the battle over the Affordable Care Act (ACA): that of employer-sponsored coverage.
The debate over the ACA has focused mostly on dealing with those who rely upon the individual market for coverage.
For years, Wendy Forman, considered how to make her wishes known if she became horribly ill and couldn’t speak for herself.
She prepared a living will refusing cardiopulmonary resuscitation.
She assembled orders instructing medical personnel to refrain from putting in a feeding tube or placing her on mechanical ventilation.
She told her husband and her daughters “no lifesaving measures” under any circumstances if she were unconscious and incapacitated.
“I was terrified of losing control,” this 70-year-old Philadelphia therapist said.