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The No Surprises Act, which was signed in 2020 and took effect in 2022, was heralded as a landmark piece of legislation that would protect people who had health insurance from receiving surprise medical bills. And yet bills that take patients by surprise keep coming.
For-profit hospitals provide most inpatient physical therapy but tend to have worse readmission rates to general hospitals. Medicare doesn鈥檛 tell consumers about troubling inspections.
A proposed work requirement would make Medicaid expansion enrollees prove they鈥檙e working or meet other criteria. Most already work, but millions are expected to lose coverage if the provision passes, many from red tape. A Missouri mother who cares for her disabled son would probably be subject to the rule.
Dozens of health insurance companies pledged on Monday to improve prior authorization, a process often used to deny care. The announcement comes months after the killing of UnitedHealthcare executive Brian Thompson, whose death in December sparked widespread criticism about insurance denials.
Republican proposals to tighten the use of special taxes to fund Medicaid programs could deprive states of billions of dollars for safety net health care. In California, any such limit would come on top of Medicaid cuts proposed by California Democrats in response to a $12 billion state deficit.
The vast majority of improper payments stem from documentation mistakes and do not fit the definition of waste, fraud, or abuse. They also typically stem from health care providers鈥 actions, not beneficiaries鈥 abuse.
This fall, the U.S. Government Accountability Office expects to release a report on how much it costs to run Georgia Pathways to Coverage 鈥 the country鈥檚 only active Medicaid work requirement program 鈥 as other states and Congress consider similar programs.
Breakups between health providers and Advantage plans are increasingly common. The Centers for Medicare & Medicaid Services has allowed whole groups of patients to leave their plans.
When Congress returns next week, it will be writing a budget reconciliation bill that鈥檚 expected to cut taxes but also make deep cuts to Medicaid. But at least some Republicans are concerned about cutting a program that aids so many of their constituents. Sarah Karlin-Smith of the Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico join 吃瓜不打烊鈥 Julie Rovner to discuss this story and more. Also, Rovner interviews 吃瓜不打烊鈥 Rae Ellen Bichell about her story on how care for transgender minors is changing in Colorado.
These fixers, officially known as caseworkers, unraveled complex and arcane health insurance rules to solve people鈥檚 coverage issues. They worked in a little-known federal department with which most consumers never interact 鈥 until they need help.
Health care price transparency is one of the few bipartisan issues in Washington, D.C. But much of the information that hospitals and health plans have made available to the public is not helpful to patients, and there鈥檚 no conclusive evidence yet that it鈥檚 lowering costs or increasing competition.
It鈥檚 the Trump administration vs. the federal courts, as the Department of Government Efficiency continues to try to cancel federal contracts and programs and fire workers. But in the haste to cut things, jobs and programs are being eliminated even if they align with the new administration鈥檚 goal to 鈥淢ake America Healthy Again.鈥 Jessie Hellmann of CQ Roll Call, Sarah Karlin-Smith of the Pink Sheet, and Rachel Roubein of The Washington Post join 吃瓜不打烊鈥 Julie Rovner to discuss these stories and more.
Rep. Ro Khanna of California warned of Trump administration 鈥渃uts鈥 to Medicare telehealth access hitting March 31. But if Medicare recipients lose telemedicine benefits that day, it will be because Congress failed to act.
The Senate Finance Committee questioned Mehmet Oz, President Donald Trump鈥檚 nominee to lead the Centers for Medicare & Medicaid Services. 吃瓜不打烊 reporters discussed the biggest takeaways from the hearing.
Unnecessarily high radiation doses in scans have been linked to cancers. Under new federal rules, doctors and imaging centers have to more closely track and report the doses of radiation that patients receive.
Some of the Trump administration鈥檚 dramatic funding and policy shifts are facing major pushback for the first time 鈥 not from Congress, but from the courts. Federal judges around the country are attempting to pump the brakes on efforts to freeze government spending, shut down the U.S. Agency for International Development, eliminate access to health-related webpages and datasets, and limit grant funding provided by the National Institutes of Health. Meanwhile, Congress is off to a slow start in trying to turn President Donald Trump鈥檚 agenda into legislation, although Medicaid is clearly high on the list for potential funding cuts. Shefali Luthra of The 19th, Jessie Hellmann of CQ Roll Call, and Maya Goldman of Axios News join 吃瓜不打烊鈥 Julie Rovner to discuss these topics and more. Also this week, Rovner interviews Mark McClellan, director of the Duke-Margolis Institute for Health Policy and a former health official during the George W. Bush administration, about the impact of cutting funding to research universities.
A whistleblower suit alleged a health insurer bilked Medicare by exaggerating how sick patients were.
The number of new and returning enrollees using healthcare.gov 鈥 the federal marketplace that serves 31 states 鈥 is well below last year鈥檚 as of early December. Also, a Biden administration push to give 鈥淒reamers鈥 access to Obamacare coverage and subsidies is facing court challenges.
Georgia鈥檚 ability to process applications for Medicaid and other public benefits has lagged since the launch of Republican Gov. Brian Kemp鈥檚 鈥淧athways鈥 Medicaid work requirement, leaving Georgia with persistently slow Medicaid application processing times.
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