Health Costs: Bill of the Month, ACA, dental care, prepaying for childbirth, Canadian drug imports, Medicare, Medicaid expansion, Dr. Oz, letters to the editor, and more

A monthly round-up of KFF Health News' original coverage on health care coverage and costs.

Not a subscriber? Sign Up Wednesday, November 27, 2024 Visit KFF Health News for the latest headlines Health Care Costs BILL OF THE MONTH A Toddler Got a Nasal Swab Test but Left Before Seeing a Doctor. The Bill was $445. (RON JOHNSON FOR KFF HEALTH NEWS) By Bram Sable-Smith Ryan Wettstein Nauman was inconsolable one evening last December. After being put down for bed, the 3-year-old from Peoria, Illinois, just kept crying and crying and crying, and nothing would calm her down. Her mother, Maggi Wettstein, remembered fearing it could be a yeast or urinary tract infection, something they had been dealing with during potty training. The urgent care centers around them were closed for the night, so around 10:30 p.m. she decided to take Ryan to the emergency room at Carle Health. The ER wasn't very busy when they arrived at 10:48 p.m., Wettstein recalled. Medical records indicate they checked in and she explained Ryan's symptoms, including an intermittent fever. The toddler was triaged and given a nasal swab test to check for covid-19 and influenza A and B. Wettstein said they sat down and waited to be called. And they waited. As Wettstein watched Ryan in the waiting room's play area, she noticed her daughter had stopped crying. In fact, she seemed fine. So Wettstein decided to drive them home. Ryan had preschool the next day, and she figured there was no point keeping her awake for who knew how much longer and getting stuck with a big ER bill. There was no one at the check-in desk to inform that they were leaving, Wettstein said, so they just headed home to go to bed. Ryan went to her preschool the next day, and Wettstein said they forgot all about the ER trip for eight months. Then the bill came. → More Bill of the Month coverage:   Toddler's Backyard Snakebite Bills Totaled More Than a Quarter Million Dollars By Jackie Fortiér For snakebite victims, antivenom is critical — and costly. It took more than $200,000 worth of antivenom to save one toddler's life after he was bitten by a rattlesnake. Listen: A Tussle With a Rattlesnake Can Take a Bite Out of Your Wallet By Jackie Fortiér Listen to KFF Health News' Jackie Fortiér recount how a backyard snakebite led to a harrowing hospitalization — and big bills — for a San Diego family.  ••• Affordable Care Act Presidential Election Puts Affordable Care Act Back in the Bull's-Eye By Stephanie Armour The outcome of the upcoming presidential election could affect the number of insured Americans, the fate of premium-reducing subsidies, the shape of Medicaid, and the cost of coverage for tens of millions of people. Washington Power Has Shifted. Here's How the ACA May Shift, Too. By Stephanie Armour and Sam Whitehead and Julie Rovner With a new Trump administration poised to move into the White House and Republicans set to control both chambers of Congress, party leaders are making a to-do list for the Affordable Care Act. 'Dreamers' Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way By Julie Appleby Nineteen states are seeking to stall a Biden administration rule that would allow recipients of the Deferred Action for Childhood Arrivals program to enroll in ACA coverage and qualify for subsidies. DACA provides work authorization and temporary deportation protection to people brought to the U.S. as children without immigration paperwork. Anti-Fraud Efforts Meet Real-World Test During ACA Enrollment Period By Julie Appleby The federal government put guardrails in place to limit unauthorized plan sign-ups and switches. But the changes could prove to be a burden to consumers. ••• Health Care Costs and Coverage Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby By Renuka Rayasam Pregnant women are being asked to make large cash payments months before they deliver their babies. Some patient advocates worry this billing practice allows providers to hold treatment hostage. Dentists Are Pulling 'Healthy' and Treatable Teeth To Profit From Implants, Experts Warn By Brett Kelman and Anna Werner, CBS News Illustration by Oona Zenda Americans are getting dental implants more than ever — and at costs reaching tens of thousands of dollars. Experts worry some dentists have lost sight of the soul of dentistry: preserving and fixing teeth. California Sets 15% Target for Primary Care Spending Over Next Decade By Vanessa G. Sánchez The state Office of Health Care Affordability has set a goal for insurers to direct 15% of their spending to primary care by 2034, part of a push to expand preventive care services. Health plans say it's unclear how the policy will mesh with the state's overarching goal to slow spending growth. In Vermont, Where Almost Everyone Has Insurance, Many Can't Find or Afford Care By Phil Galewitz Vermont has one of the lowest uninsured rates in the U.S., even though its residents pay some of the highest health insurance costs. Still, most of its hospitals are losing money and patients often face long waits for care. FTC, Indiana Residents Pressure State To Block Hospital Merger By Samantha Liss Hundreds of people and the Federal Trade Commission weighed in on a proposed hospital merger in Terre Haute, Indiana, with most arguing that the creation of a monopoly would increase costs and worsen patient care. Indiana Hospitals Pull Merger Application After Pushback Over Monopoly Concerns By Samantha Liss Two Indiana hospital rivals withdrew their application to merge after facing pushback from the Federal Trade Commission and the public. ••• Race and Health   (GAVIN MCINTYRE FOR KFF HEALTH NEWS)  Black Americans Still Suffer Worse Health. Here's Why There's So Little Progress. By Fred Clasen-Kelly and Renuka Rayasam The United States has made almost no progress in closing racial health disparities despite promises, research shows. The government, some critics argue, is often the underlying culprit.  ••• Medicare Election Outcome Could Bring Big Changes to Medicare By Stephanie Armour Democrats and conservatives are divided over whether the federal health program for people over 65 should be run almost entirely by the private sector. When Trump retakes the White House, the shift to Medicare Advantage may accelerate. Watchdog Calls for Tighter Scrutiny of Medicare Advantage Home Visits By Fred Schulte Medicare officials defend the use of home visits that often spot medical conditions that are never treated. KFF Health News Sues To Force Disclosure of Medicare Advantage Audit Records By Fred Schulte Freedom of Information Act case targets HHS inspector general's reviews of billions of dollars in health plan overpayments. ••• Drug Prices Florida Gov. DeSantis' Canadian Drug Import Plan Goes Nowhere After FDA Approval By Phil Galewitz Florida sued the FDA over what it said was a "reckless delay" in approving its drug importation plan. Now, nearly a year after the FDA gave the state the green light, the program has yet to begin. ••• Child Poverty After Congress Ended Extra Cash Aid for Families, Communities Tackle Child Poverty Alone By Kate Wells, Michigan Public The child tax credit passed by Congress at the height of covid has expired, but states and localities are trying to fill the gap with their own programs and funding. In Michigan, Rx Kids already covers every family with a new baby in Flint. Now, other communities aim to follow.  ••• Medicaid and Medi-Cal   (DAVID STEELE FOR KFF HEALTH NEWS) Florida's Deloitte-Run Computer System Cut Off New Moms Entitled to Medicaid By Daniel Chang and Samantha Liss Florida discovered a glitch in its Deloitte-run Medicaid eligibility system. The problem, alleged in court testimony, led to new mothers wrongly losing their insurance coverage. In Montana, Conservative Groups See Chance To Kill Medicaid Expansion By Katheryn Houghton Conservative groups are working to undermine support for Montana's Medicaid expansion ahead of a political fight over whether to keep the program. For People With Opioid Addiction, Medicaid 'Unwinding' Raises the Stakes By Kim Krisberg, Public Health Watch and Stephanie Colombini, WUSF Medications such as methadone can cut the risk of a fatal opioid overdose in half. Medicaid covers the medication. But as state Medicaid programs reevaluated coverage of each enrollee following a pause in disenrollments during the covid-19 pandemic, some patients lost a crucial pillar of their sobriety. California Expanded Medi-Cal to Unauthorized Residents. The Results Are Mixed. By Vanessa G. Sánchez California this year completed its Medi-Cal expansion to include income-eligible residents regardless of their immigration status. This final installment of the "Faces of Medi-Cal" series profiles three of those newly eligible patients and how coverage has affected their health.   ••• The Trump Administration Trump's White House Return Poised To Tangle Health Care Safety Net By Stephanie Armour The new Trump administration is likely to reduce subsidies for Affordable Care Act insurance plans and roll back Medicaid coverage. Public health authorities worry that anti-vaccine activist Robert F. Kennedy Jr. will be empowered. TV's Dr. Oz Invested in Businesses Regulated by Agency Trump Wants Him To Lead By Darius Tahir Celebrity doctor Mehmet Oz recently held broad investments in health care, tech, and food companies. Were he confirmed to run the Centers for Medicare & Medicaid Services, his job would involve interacting with giants of the industry that have contributed to his wealth. ••• Social Security Social Security Tackles Overpayment 'Injustices,' but Problems Remain By David Hilzenrath and Jodie Fleischer, Cox Media Group With his term soon to expire, Social Security chief Martin O'Malley's efforts to address the agency's overpayments to beneficiaries remain incomplete. ••• KFF Health News on Air An Arm and a Leg: Fight Health Insurance — With Help From AI By Dan Weissmann Meet the tech worker on a quest to use artificial intelligence to combat denials for coverage from patients' health plans. KFF Health News' 'What the Health?': Readying for Republican Rule With Republicans now set to control the White House, Senate, and House of Representatives starting in January, their health agenda remains unclear. What is clear, however, is that just about anything could be on the table, from Medicare, Medicaid, and the Affordable Care Act, to drug prices and public health. Meanwhile, anti-abortion groups are preparing to fight the implementation of abortion rights ballot measures just passed by voters in seven states. Rachel Roubein of The Washington Post, Anna Edney of Bloomberg News, and Lauren Weber of The Washington Post join KFF Health News' Julie Rovner to discuss these stories and more. Plus, for "extra credit," the panelists suggest health policy stories they read this week that they think you should read, too. Journalists Examine Health Care for Native Americans and Recent Food Recalls KFF Health News and California Healthline staff made the rounds on national and local media in recent weeks to discuss topical stories. Here's a collection of their appearances. ••• Letters to the Editor Readers Embrace 'Going It Alone' Series on Aging and Chastise Makers of Pulse Oximeters KFF Health News gives readers a chance to comment on a recent batch of stories.   ••• 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.   Dicen que los esfuerzos contra el fraude en ACA han dado resultados. Pero hay que estar alerta By Julie Appleby Los Centros de Servicios de Medicare y Medicaid 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. El poder en Washington ha cambiado. ACA podría cambiar también By Stephanie Armour and Sam Whitehead and Julie Rovner El futuro gobernante prepara el terreno para hacer cambios potencialmente sísmicos que podrían limitar la expansión de Medicaid, aumentar la tasa de personas sin seguro, debilitar las protecciones para los pacientes y elevar los costos de las primas para millones de personas. Pagar primero, parir después: algunos servicios piden a las embarazadas que paguen fortunas antes del parto By Renuka Rayasam Es difícil saber con qué frecuencia ocurre porque se considera una transacción privada entre el proveedor y el paciente. Por lo tanto, los pagos no se registran en los datos de reclamos de seguros y, por ende, los expertos no los analizan. California amplió el Medi-Cal a todos los residentes más allá de su estatus migratorio. Los resultados son desiguales. By Vanessa G. Sánchez Estos inmigrantes se han ido sumando al programa poco a poco, a medida que el estado fue eliminando el requisito de residencia legal. El regreso de Trump a la Casa Blanca pondría en peligro la red de seguridad de atención médica By Stephanie Armour El triunfo electoral del ex presidente Donald Trump y su regreso a la Casa Blanca probablemente traerán cambios que reducirían los programas nacionales de salud públicos, aumentando la tasa de personas sin seguro e imponiendo nuevas barreras al aborto y otros servicios de salud reproductiva. Ahora los "Dreamers" pueden inscribirse en planes de salud de ACA. Pero una demanda podría acabar con el sueño By Julie Appleby Del medio millón de beneficiarios de DACA, el gobierno estima que alrededor de 100.000 que anteriormente no tenían seguro podrían inscribirse a partir del 1 de noviembre. KFF Health News 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) 2024 KFF Health News. All rights reserved. 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