Health Costs: Bill of the Month, 'unwinding' Medicaid, Dying Broke, unnecessary medical care, the costs of autoimmune diseases, and more. 

A monthly round-up of KFF Health News' original coverage on health care coverage and costs.
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Thursday, November 30, 2023
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Health Care Costs

BILL OF THE MONTH

By Rachana Pradhan

Reesha Ahmed was on cloud nine.

It was January and Ahmed was at an OB-GYN's office near her home in Venus, Texas, for her first prenatal checkup. After an ultrasound, getting anti-nausea medication, and discussing her pregnancy care plan, she said, a nurse made a convenient suggestion: Head to the lab just down the hall for a standard panel of tests.

The lab was inside Texas Health Hospital Mansfield, which opened in December 2020 in a Dallas-Fort Worth suburb. Ahmed, just eight weeks pregnant, said the doctor told her everything about the visit was routine. "Nothing really stood out," Ahmed said. "And, of course, there's just a lot of excitement, and so I really didn't think twice about anything."

Her blood tests checked for multiple sexually transmitted infections, her blood type, and various hormones. Within days, Ahmed began bleeding and her excitement turned to fear. A repeat ultrasound in early February showed no fetus.

"My heart kind of fell apart at that moment because I knew exactly what that meant," she said. She would have a miscarriage.

Then the bills came. Read more here

•••

Medicare

Hospitals and Doctors Are Fed up With Medicare Advantage
By Julie Appleby
Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF's count. But among doctors and hospitals, it's a different story.

•••

Medicaid and Medi-Cal 

Medicaid's 'Unwinding' Can Be Especially Perilous for Disabled People
By Rachana Pradhan
Earlier this year, Beverly Likens thought she'd done everything she needed to do to keep her Medicaid. Then came an unwelcome surprise: Ahead of surgery to treat chronic bleeding, the hospital said her insurance was inactive, jeopardizing her procedure. Likens had just been diagnosed with severe anemia and given a blood transfusion at the emergency room. 

1 in 3 People Dropped by Utah Medicaid Left Uninsured, a 'Concerning' Sign for Nation
By Phil Galewitz
About a third of the 130,000 people Utah has dropped from Medicaid this year say they now lack health insurance. It's a glimpse into the fate of people caught up in Medicaid's "unwinding."

Lost in the Mix of Medicaid 'Unwinding': Kentucky Cut Off Her Health Care Over a Clerical Error
By Rachana Pradhan
The state canceled Beverly Likens' coverage — days before surgery — without considering other ways she qualified for Medicaid, which experts say violated federal regulations.

Beyond Insulin: Medi-Cal Expands Patient Access to Diabetes Supplies
By Angela Hart
California's Medicaid program is making it easier for people with diabetes to obtain the supplies and equipment they need to manage their blood sugar, partly by relaxing preauthorization requirements that can cause life-threatening delays.

•••

Special Project: Dying Broke 

01-Reiners_01

  (TIM GRUBER FOR THE NEW YORK TIMES)

Extra Fees Drive Assisted Living Profits
By Jordan Rau
The add-ons pile up: $93 for medications, $50 for cable TV. Prices soar as the industry leaves no service unbilled, out of reach for many families.

Facing Financial Ruin as Costs Soar for Elder Care
By Reed Abelson, The New York Times and Jordan Rau
The United States has no coherent system of long-term care, leading many to struggle to stay independent or rely on a patchwork of solutions.

Why Long-Term Care Insurance Falls Short for So Many 
By Jordan Rau and JoNel Aleccia
The private insurance market has proved wildly inadequate in providing financial security for millions of older Americans, in part by underestimating how many policyholders would use their coverage.

A Guide to Long-Term Care Insurance
By Jordan Rau
Deciding when, or whether, to buy long-term care insurance can be complex. Here's what to know.

What Long-Term Care Looks Like Around the World
By Jordan Rau
Most countries spend more than the United States on care, but middle-class and affluent people still bear a substantial portion of the costs.

•••

Health Care Costs 

Why It's So Tough to Reduce Unnecessary Medical Care
By Markian Hawryluk
Treatments that don't help patients, and may even harm them, are difficult to eliminate because they can be big sources of revenue.

Why Do We Pay For so Much Worthless Health Care?
By Markian Hawryluk
Medical advances are expensive. Take Wegovy, the wildly successful obesity drug that we learned last week may also reduce the risk of heart disease. If just 10 percent of Medicare beneficiaries start taking the drug, taxpayers could be on the hook for nearly $27 billion a year. 

Compensation Is Key to Fixing Primary Care Shortage
By Michelle Andrews
Many proposals have been floated about how to address the nation's primary care problem. They range from training slots to medical school debt forgiveness but often sidestep comprehensive payment reform.

•••

Government Policy

Biden Administration's Limit on Drug Industry Middlemen Backfires, Pharmacists Say
By Arthur Allen
A rule taking effect Jan. 1 was intended to stop one set of abuses by pharmacy benefit managers, or PBMs, but some pharmacists say it's enabling these price brokers to simply do new things unfairly.

Health Care Is Front and Center as DeSantis and Newsom Go Mano a Mano
By Daniel Chang and Angela Hart
Florida's Republican Gov. Ron DeSantis and California's Democratic Gov. Gavin Newsom will square off in a first-of-its-kind debate on Nov. 30. KFF Health News compared the political rivals' health care positions, showing how their policies have helped — or hindered — the health of their states' residents.

•••

Autoimmune Diseases

2023-11-01_Thyroid_Woes-otempest

  (OONA TEMPEST / KFF HEALTH NEWS)

Many Autoimmune Disease Patients Struggle With Diagnosis, Costs, Inattentive Care
By Andy Miller
Despite the prevalence of autoimmune conditions, like the thyroid disease Hashimoto's, sometimes finding help can prove frustrating as well as expensive. There are often no definitive diagnostic tests, so patients may rack up big bills as they search for confirmation of their condition and for treatment options.

How the Thyroid Gland Mystifies Doctors and Patients
By Oona Tempest and Andy Miller
This illustrated report has been adapted from a KFF Health News article, "Among Hurdles for Autoimmune Disease Patients: Diagnosis, Costs, Inattentive Care" by Andy Miller, with artwork by Oona Tempest.

•••

KFF Health News on Air 

'An Arm and a Leg' Podcast: To Get Health Insurance, This Couple Made a Movie
By Dan Weissmann
On this episode of "An Arm and a Leg," hear how a couple wrote and directed a short film, starring one of them — just to maintain health insurance through the actors union.

KFF Health News' 'What the Health?' Podcast: For ACA Plans, It's Time to Shop Around
It's Obamacare open enrollment season, which means that, for people who rely on these plans for coverage, it's time to shop around. With enhanced premium subsidies and cost-sharing assistance, consumers may find savings by switching plans. It is especially important for people who lost their coverage because of the Medicaid unwinding to investigate their options. Many qualify for assistance. Meanwhile, the countdown to Election Day is on, and Ohio's State Issue 1 is grabbing headlines. The closely watched ballot initiative has become a testing ground for abortion-related messaging, which has been rife with misinformation. This week's panelists are Mary Agnes Carey of KFF Health News, Jessie Hellmann of CQ Roll Call, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachana Pradhan of KFF Health News.

KFF Health News' 'What the Health?' Podcast: Congress Kicks the (Budget) Can Down the Road. Again.
Congress narrowly avoided a federal government shutdown for the second time in six weeks, as Democrats came to the rescue of divided House Republicans over annual spending bills that were supposed to be finished by Oct. 1. But the brinksmanship is likely to repeat itself early in 2024, when the next temporary spending patches expire. Meanwhile, a pair of investigations unveiled this week demonstrate how difficult it still is for seniors to get needed long-term and rehabilitation care. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News' Julie Rovner to discuss these issues and more.

Journalists Delve Into Open Enrollment, School Nurse Shortages, and More
KFF Health News and California Healthline staff made the rounds on national and local media this week to discuss their stories. Here's a collection of their appearances.

•••

Noticias En Español

Noticias en español es una sección de KFF Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos.

"Peor de lo que la gente cree", cambios en Medicaid crean caos en los estados
By Phil Galewitz and Katheryn Houghton and Brett Kelman and Samantha Liss
Tanto beneficiarios como defensores de pacientes dicen que los funcionarios de Medicaid enviaron formularios de renovación obligatoria a direcciones viejas, calcularon mal los niveles de ingresos e hicieron malas traducciones de los documentos.

Nueva ley de California ofrece protección contra facturas por viajes en ambulancia
By Bernard J. Wolfson
En California, casi tres cuartas partes de los traslados de emergencia en ambulancia generan facturas fuera de la red. La factura sorpresa promedio es de $1,209, la más alta del país

La atención de salud, en el centro del debate entre DeSantis y Newsom
By Daniel Chang and Angela Hart
El candidato presidencial republicano Ron DeSantis y el gobernador demócrata Gavin Newsom —rivales políticos y representantes de la América roja y azul— se enfrentarán en un debate sin precedentes el 30 de noviembre en Georgia.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. (c) 2023 KFF Health News. All rights reserved.

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