HealthCare, Medicare, Medicaid, and Social Security

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California strikes huge deal unlocking billions for health care

SACRAMENTO, Calif. — Major players in California’s health care field have reached a deal on how they want the state to spend $19 billion in proceeds of a renewed tax on insurance plans plus the federal funds that go with it — a development that followed months of private negotiations between bitter industry rivals, state lawmakers and the governor’s office.

https://www.politico.com/news/2023/06/24/california-strikes-huge-deal-unlocking-billions-for-health-care-00103476?

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Care Denied: The Dirty Secret Behind Medicare Advantage

As Medicare becomes increasingly privatized, patients are speaking up about these for-profit insurers’ widespread practice of denying treatments they need.

https://www.levernews.com/care-denied-the-dirty-secret-behind-medicare-advantage/?

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How Often Do Health Insurers Say No to Patients? No One Knows.

Insurers’ denial rates — a critical measure of how reliably they pay for customers’ care — remain mostly secret to the public. Federal and state regulators have done little to change that.

https://www.propublica.org/article/how-often-do-health-insurers-deny-patients-claims?

Health Insurance Claim Denied? See What Insurers Said Behind the Scenes

Learn how to request your health insurance claim file, which can include details about what your insurer is saying about you and your case.

https://www.propublica.org/article/find-out-why-health-insurance-claim-denied?

Do You Have Insights Into Health Insurance Denials? Help Us Report on the System.

Insurers deny tens of millions of claims every year. ProPublica is investigating why claims are denied, what the consequences are for patients and how the appeal process really works.

https://www.propublica.org/getinvolved/insurance-denial-health-care-investigation?

How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said.

https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims?

UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.

After a college student finally found a treatment that worked, the insurance giant decided it wouldn’t pay for the costly drugs. His fight to get coverage exposed the insurer’s hidden procedures for rejecting claims.

https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis?

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Justice Department charges 78 people with $2.5 billion in health-care fraud

The Department of Justice announced Wednesday that it has recently charged 78 people with $2.5 billion in separate health-care fraud and opioid abuse schemes.

https://www.cnbc.com/2023/06/28/doj-charges-78-people-with-2point5-billion-in-health-care-fraud.html?

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How Often Do Health Insurers Say No to Patients? No One Knows.

It’s one of the most crucial questions people have when deciding which health plan to choose: If my doctor orders a test or treatment, will my insurer refuse to pay for it?

https://www.propublica.org/article/how-often-do-health-insurers-deny-patients-claims?

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Biden administration to crack down on ‘junk’ health insurance plans, surprise billing

WASHINGTON — The Biden administration announced new initiatives Friday that could reduce health care costs, though none will take effect immediately.

https://floridaphoenix.com/2023/07/08/biden-administration-to-crack-down-on-junk-health-insurance-plans-surprise-billing/?

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Bipartisan health care bills spearheaded by North Carolina, Virginia members of Congress

WASHINGTON — Top lawmakers on the U.S. House Education and Workforce Committee Tuesday unveiled a bipartisan health care legislative package that would require accurate billing practices by hospitals, price transparency and hidden fee disclosures.

https://floridaphoenix.com/2023/07/11/bipartisan-health-care-bills-spearheaded-by-north-carolina-virginia-members-of-congress/?

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Higher taxes on the wealthy would bolster Social Security, U.S. Senate Dems argue

WASHINGTON — U.S. senators debated Wednesday how best to resolve a funding cliff within Social Security that will lead to a quarter reduction in benefits in about a decade, absent action from Congress.

https://floridaphoenix.com/2023/07/13/higher-taxes-on-the-wealthy-would-bolster-social-security-u-s-senate-dems-argue/?

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Top Arkansas psychiatrist accused of falsely imprisoning patients and Medicaid fraud

At least 26 former patients have sued Dr. Brian Hyatt, alleging they were held against their will in his unit.

https://www.nbcnews.com/news/top-arkansas-psychiatrist-accused-falsely-imprisoning-patients-medicai-rcna93430?

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Former first-round NBA draft pick is sentenced to 10 years in prison in $4M health care fraud

NEW YORK (AP) — A federal judge sentenced a former first-round NBA draft pick to 10 years in prison Thursday, saying he used his people skills to entice others to aid his $5 million health care fraud after he “frittered away” substantial earnings from his professional career.

https://apnews.com/article/nba-health-fraud-williams-96bd079c6a3632addecde71efaed74e7?

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Lauren Boebert voted to raise drug prices, cut funding for the Social Security Administration, and slash Veterans’ benefits. Boebert’s constituents need to know that she’s voting against their interests—that’s why we’re running a billboard in her district next week to coincide with a rally outside of her district office! We’re working to bring media attention to Boebert’s record of voting against seniors and veterans. The more funding we have for the billboard, the longer we can keep it running.     Thank you, Linda Benesch Social Security Works   Lauren Boebert wants to raise your drug prices. Next Wednesday, August 16th, is the one-year anniversary of President Joe Biden signing the Inflation Reduction Act (IRA) into law. The IRA finally gives Medicare the power to negotiate lower drug prices. That’s money that will stay in seniors’ pockets instead of going to greedy Big Pharma CEOs. Lauren Boebert voted against the IRA—along with every other Republican in Congress. How much does Boebert hate the idea of lower drug prices? She had her mic cut off on the House floor after calling supporters of the bill “insane”.1 We want to make sure that every voter in Boebert’s competitive House district knows about her vote to keep drug prices high.   The billboard at our August 16th protest outside of Boebert’s district office will provide a striking visual for local news. Then, the billboard will travel to senior centers and nursing homes across her district. Not only did Boebert vote to keep drug prices high, she also voted for the Default on America (DOA) Act—which would have slashed funding for the Social Security Administration and Veterans’ benefits. Thankfully, the DOA Act did not become law, but Boebert’s constituents still need to know about her vote. Thank you, Alex Lawson Social Security Works P.S. If you live in Boebert’s district, or know people who do, click here for details about the protest on August 16th.   1 https://www.thewrap.com/lauren-boebert-mic-cut-inflation-reduction-act/

Who We Are Social Security Works leads the fight every day to expand and protect our Social Security system. Become a member today. The Truth About Social Security From SSW's President, Nancy Altman, this book uses the words of the people who built our Social Security system to debunk myths and reveal the truth about the most popular and successful government program in our nation's history Order your copy today!

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Hospitals mark up medicine prices by 500%

It's no surprise that hospitals pay one price for medicines and charge patients another.

The proof: A new report shows hospitals often charge 5 times more than they paid for medicines, leading to higher costs for our health care system.

Get more details.

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The Hidden Fee Costing Doctors Millions Every Year

A powerful lobbyist convinced a federal agency that doctors can be forced to pay fees on money that health insurers owe them. Big companies rake in profits while doctors are saddled with yet another cost in a burdensome health care system.

https://www.propublica.org/article/the-hidden-fee-costing-doctors-millions-every-year?

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Bernie Sanders: Congress Must Address America’s Health-Care Crisis

Health care in the U.S. is broken, dysfunctional, and getting worse. New bipartisan legislation, if passed, would be an important step toward a more humane and rational system.

https://www.thedailybeast.com/bernie-sanders-congress-must-address-americas-health-care-crisis?

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Loss of Medicaid coverage in FL raises concerns, ‘possible violations,’ policy experts say

Over half of Floridians who have lost Medicaid coverage did so because of procedural reasons and not because they were ineligible, according to an analysis from the Georgetown University Center for Children and Families.

https://floridaphoenix.com/2023/08/15/loss-of-medicaid-coverage-in-fl-raises-concerns-possible-violations-policy-experts-say/?

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Inflation Reduction Act 1-Year Anniversary

Last August, the Biden Administration passed the Inflation Reduction Act (IRA), a wide-reaching piece of legislation that ushered in sweeping changes to everything from climate and industrial policy to healthcare. The Inflation Reduction Act introduced a number of policies lowering healthcare costs and expanding access. As the law has begun to take effect over the past year, how has the IRA has improved healthcare for Americans?

https://healthcareeducationproject.org/inflation-reduction-act/

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10 drugs targeted for Medicare price negotiations as Biden pitches cost reductions

WASHINGTON (AP) — President Joe Biden touted the potential cost savings of Medicare’s first-ever price negotiations for widely used prescription drugs on Tuesday as he struggles to convince Americans that he’s improved their lives as he runs for reelection.

https://apnews.com/article/medicare-prescription-drug-negotiations-biden-inflation-2bf6775c3431111a2cd03fd033caefa7?

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Biden Administration Adds Insulin to Drug Price Negotiation List in Major Blow to Big Pharma

“This was an unexpected victory in a long fight against an illegal cartel of three corporations who have raised their insulin prices in lockstep.”

https://theintercept.com/2023/08/29/insulin-medicare-drug-price-negotiation/?

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Social Security cost-of-living adjustment could be bigger than expected next year

Social Security recipients will soon find out the 2024 cost-of-living adjustment

https://www.foxbusiness.com/money/social-security-cost-living-adjustment-could-be-bigger-expected-next-year

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Hospitals plead with Congress to avert $8 billion in cuts in Medicaid funding

WASHINGTON — Health care representatives from across the United States are urging Congress to halt cuts to funding that helps hospitals care for uninsured or low-income patients who rely on Medicaid.

https://floridaphoenix.com/2023/09/14/hospitals-plead-with-congress-to-avert-8-billion-in-cuts-in-medicaid-funding/?

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Many states are expanding their Medicaid programs to provide dental care to their poorest residents

NASHVILLE, Tenn. (AP) — For months, Carlton Clemons endured crippling pain from a rotting wisdom tooth. He couldn’t sleep, barely ate and relied on painkillers to get by.

https://apnews.com/article/medicaid-dental-care-adults-low-income-tennessee-c45d52fc9f7e24adf877a3063b086da4?

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🩺 Women pay billions more for care

Reproduced from Deloitte. Chart: Axios Visuals At every age, women have higher out-of-pocket expenses for their health care than men despite having similar health insurance, Axios' Tina Reed writes from a Deloitte report. Why it matters: Much has been made about a "pink tax" on women's consumer products. The new analysis argues there's a similar burden for health coverage. 🧮 By the numbers: Even removing maternity care from the equation, women each year pay $15.4 billion more out of pocket for health care, according to Deloitte's actuarial analysis of more than 16 million people who have employer-sponsored coverage. 🧠 What's happening: The authors said this may be partly explained by the different kinds of care recommended for women, such as earlier annual checkups and gynecological examinations. They also cited the relatively high cost of breast cancer imaging compared to screening for other cancer types, and costs associated with the effects of menopausal transitions.

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Insurers Are Gaming Medicare — To The Tune Of $140 Billion

The federal government is losing as much as $140 billion per year by subsidizing private Medicare Advantage plans, according to a bombshell new report. In the groundbreaking investigation, health care researchers identified the four major ways that private insurers systematically exploit the taxpayer-funded national health insurance program while denying care to the nation’s most vulnerable patients.

https://www.levernews.com/insurers-are-gaming-medicare-to-the-tune-of-140_billion/

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Social Security benefits will increase by 3.2% in 2024 as inflation moderates

WASHINGTON (AP) — Millions of Social Security recipients will get a 3.2% increase in their benefits in 2024, far less than this year’s historic boost and reflecting moderating consumer prices.

https://apnews.com/article/social-security-cost-of-living-adjustment-cola-ef9255c0da3c3d2391dadac4515db2e7?

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10 Medicaid holdout states scramble to improve health coverage

But such efforts are more expensive and help fewer people, critics say; FL still hasn’t fully expanded Medicaid

https://floridaphoenix.com/2023/10/22/10-medicaid-holdout-states-scramble-to-improve-health-coverage/?