HealthCare, Medicare, Medicaid, and Social Security

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AG Moody’s MFCU Investigators Uncover Medicaid Fraud Scheme Impacting Thousands Leading to Arrest of Florida Dentist and Husband

TALLAHASSEE, Fla.—Attorney General Ashley Moody today announced the arrest of a Florida dentist and her husband, a co-owner of a dental practice. Marianna Zadov, DDS, and Shimon Leizgold, also known as Simon Leizgold, own and operate at least seven dental offices located throughout Florida’s southeast and southwest coasts. Investigators with Attorney General Moody’s Medicaid Fraud Control Unit discovered that, for a period of years, Zadov and Leizgold systematically engaged in a scheme to defraud and steal from Florida Medicaid and thousands of recipients.

https://www.myfloridalegal.com/newsrelease/ag-moodys-mfcu-investigators-uncover-medicaid-fraud-scheme-impacting-thousands-leading

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An Insurance Giant Stalls Mental Health Care Reform

As mental health advocates pushed for a bill to expand insurance coverage, Blue Cross Blue Shield of Michigan lobbied against it.

https://www.levernews.com/an-insurance-giant-stalls-mental-health-care-reform/?

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Insurance Executives Refused to Pay for the Cancer Treatment That Could Have Saved Him. This Is How They Did It.

A Michigan law requires coverage of cancer drugs. One insurer came up with a “defensible” way to avoid paying for treatments that offered Forrest VanPatten his last chance for survival. “We crossed the line,” says a former executive.

https://www.propublica.org/article/priority-health-michigan-cart-insurance-vanpatten-denials?

Find out why your health insurer denied your claim.

ProPublica’s Claim File Helper lets you customize a letter requesting the notes and documents your insurer used when deciding to deny you coverage. Get your claim file before submitting an appeal.

https://projects.propublica.org/claimfile/?

Big Insurance Met Its Match When It Turned Down a Top Trial Lawyer’s Request for Cancer Treatment

Blue Cross and Blue Shield denied payment for the proton therapy Robert “Skeeter” Salim’s doctor ordered to fight his throat cancer. But he was no ordinary patient. He was a celebrated litigator. And he was ready to fight.

https://www.propublica.org/article/blue-cross-proton-therapy-cancer-lawyer-denial?

I Set Out to Create a Simple Map for How to Appeal Your Insurance Denial. Instead, I Found a Mind-Boggling Labyrinth.

I spoke with more than 50 insurance experts, patients, lawyers, physicians and consumer advocates about building a tool anyone could use to navigate insurance appeals. Nearly everyone said the same thing: Great idea. But almost impossible to do.

https://www.propublica.org/article/how-to-appeal-insurance-denials-too-complicated?

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Health Insurers Have Been Breaking State Laws for Years

In North Carolina, lawmakers outraged that breast cancer patients were being denied reconstructive surgeries passed a measure forcing health insurers to pay for them. In Arizona, legislators intervened to protect patients with diabetes, requiring health plans to cover their supplies. Elected officials in more than a dozen states, from Oklahoma to California, wrote laws demanding that insurance companies pay for emergency services.

https://www.propublica.org/article/health-insurance-denials-breaking-state-laws?

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Florida leaves $800 million on the table for disability services, advocates say

TALLAHASSEE — Florida officials responsible for providing services to people with lifelong disabilities have allowed nearly $800 million in state and federal matching funds to fall through the cracks in the past two years, according to a budget analysis by a statewide advocacy group.

https://www.orlandosentinel.com/2023/11/17/florida-leaves-800-million-on-the-table-for-disability-services-advocates-say/?

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🏥 Trump "seriously looking" at Obamacare alternatives

Illustration: Maura Losch/Axios

Trump revealed yesterday that he's "seriously looking at alternatives" to the Affordable Care Act, calling the failure to repeal and replace Obamacare during his administration "a low point for the Republican Party." Why it matters: Ahead of last year's midterms, Republicans effectively gave up on campaigning to kill the ACA — acknowledging that the program was popular and fully embedded in the U.S. health care system. Flashback: Despite having full control of the White House and Congress, Republicans' long-running efforts to repeal and replace the ACA were defeated in 2017 when Sen. John McCain (R-Ariz.) delivered his famous thumbs-down vote on the Senate floor. Democrats went on to make health care a defining issue of the 2018 midterms, powering a "blue wave" election in which the party decisively won back the House majority. Republicans — including the current presidential field — have since had little to say about the Affordable Care Act or major health care reforms, even as the cost of care continues to rise. What they're saying: "The cost of Obamacare is out of control, plus, it's not good Healthcare," Trump wrote in a post on Truth Social. "We had a couple of Republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!" Biden campaign spokesman Ammar Moussa drew attention to Trump's comments on X, suggesting Democrats would be happy to make relitigating the ACA an issue in the 2024 election.

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Trump's Obamacare gift

Illustration: Aïda Amer/Axios

Christmas has come early for Democratic campaign staffers, courtesy of former President Trump's vow over the holiday weekend to "never give up" on repealing and replacing the Affordable Care Act (ACA). Why it matters: Democrats are eager to revive their health care playbook from 2018, when the party rode a "blue wave" to the House majority by aggressively campaigning on Republican attempts to gut Obamacare. In fact, the Biden campaign has already altered its plans for this week in the wake of Trump's comments and will air TV ads contrasting the president's health care agenda with Trump's proposal to repeal the ACA. "My predecessor, once again — God love him — called for cuts that could rip away health insurance from tens of millions of Americans," Biden said in remarks from the White House today. "They just don't give up." The big picture: Despite having full control of the White House and Congress, Republicans were unable to repeal and replace the ACA in 2017 — a failure Trump called "a low point for the Republican Party" on Saturday. In 2021, just months into President Biden's term, the Supreme Court rejected Republican efforts to strike down the entire ACA and saved the law for the third time. Since then, Republicans have largely accepted that the ACA is here to stay and stopped campaigning on "repeal and replace," recognizing the issue as a political loser. Polls appear to back that consensus: Nearly 60% of Americans had a favorable view of the ACA as of May 2023, with support steadily rising from 50% at the start of the pandemic, according to KFF tracking surveys. The ACA's protections for people with pre-existing conditions have proved especially popular, with 79% of Americans — including 66% of Republicans — saying in 2020 that they did not want the Supreme Court to overturn those protections. Voters overwhelmingly trust Republicans to do a better job on border security (50%-20%), crime (46%-20%) and the economy (49%-28%), but Democrats still maintain a distinct advantage on health care (45%-22%), according to a September NBC News poll. Driving the news: Trump's claim in a Truth Social post that he's "seriously looking at alternatives" to the ACA drew attacks today from the Biden campaign, the DCCC, House Majority PAC and others — with more certain to come. Between the lines: Trump has often been ridiculed by Democrats for his recurring pledge to unveil a new health care plan in a matter of "weeks," which he made at least five times in 2020. While his Obamacare alternative has not materialized, conservative policy groups staffed by Trump alumni have been openly sketching out health care plans for the next Republican administration all year. With Trump and the Biden campaign officially throwing down the gauntlet, a robust debate on addressing soaring health care costs may actually be on the table in 2024.

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Trump says he will renew efforts to replace ‘Obamacare’ if he wins a second term   After failing to repeal it while in the White House, the former president threatened over the weekend that he was “seriously looking at alternatives.” The comments drew rebuke from Democratic President Joe Biden's campaign. Read more.

Why this matters: Health care has generally been a better issue for Democrats than Republicans, who have largely abandoned efforts to repeal the Affordable Care Act in recent years. The back-and-forth points to what could be a key issue in a general election rematch between Trump and Biden if both win their parties’ nominations, as is widely expected.    Biden, in particular, has begun painting a vision of a catastrophic future if Trump wins — a strategy that could motivate lukewarm Democratic voters who may be driven more by a desire to stop Trump than to deliver a second term to Biden amid lingering concerns over high inflation, the direction of the country and his age.   Biden’s campaign quickly seized the opportunity. Beyond the new ads, the campaign will host a press call today with former House Speaker Nancy Pelosi and North Carolina Gov. Roy Cooper to highlight the potential impact of repealing the law, while state Democratic parties in swing states will host their own events.

Related coverage ➤ Biden says he’s an optimist. But his dire warnings about Trump have become central to his campaign  Trump’s plans if he returns to the White House include deportation raids, tariffs and mass firings

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Why Drugs Are Disappearing From Your Insurance Coverage

Powerful companies are removing hundreds of medicines from insurance plans — and they’re spending millions to stop attempts at reform.

https://www.levernews.com/why-drugs-are-disappearing-from-your-insurance-coverage/?

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Artificial Intelligence Is Denying Americans Health Care

On this week’s episode of Lever Time, producer Frank Cappello and senior editor and reporter Andrew Perez are joined by health care journalist Bob Herman, who recently co-authored a report for health care industry news organization STAT detailing how the country’s largest health insurer has used artificial intelligence to deny rehabilitation services for older and disabled Americans.

https://www.levernews.com/lever-time-artificial-intelligence-is-denying-americans-health-care/

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New survey of Florida Latino voters say 79% want Medicaid expansion

A new survey of Latino voters in Florida shows that a large majority – 79% – want the state to expand Medicaid. That includes 72% of Republican voters.

https://floridaphoenix.com/2023/11/30/new-survey-of-florida-latino-voters-say-79-want-medicaid-expansion/?

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Florida Medicaid, SNAP overhaul may hurt recipients, advocates warn

Florida says it’s about to become easier to apply for and renew government assistance. Advocates say coming changes may do the opposite.

https://www.orlandosentinel.com/2023/12/01/florida-medicaid-snap-overhaul-may-hurt-recipients-advocates-warn/?

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FL health and human services agencies head to court over transgender care, Medicaid

Florida state agencies will face legal challenges to health care policies on the same day next week — a trial on the state’s transgender care ban and a hearing in a lawsuit seeking Medicaid eligibility for thousands of Floridians.

https://floridaphoenix.com/2023/12/07/fl-health-and-human-services-agencies-head-to-court-over-transgender-care-medicaid/?

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Latest report of Medicaid coverage loss shows fewer than five million Floridians are still eligible

Fewer than five million Floridians are still receiving free and low-cost healthcare through Medicaid as the wave of coverage loss continues, according to the latest report from the Florida Agency for Health Care Administration.

https://floridaphoenix.com/blog/latest-report-of-medicaid-coverage-loss-shows-fewer-than-five-million-floridians-are-still-eligible/?

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Feds “deeply alarmed” after 360k Florida kids lose Medicaid, CHIP coverage

New figures show that 360,000 fewer Florida children were enrolled in subsidized health insurance plans this fall than earlier in the year, leading federal officials to blast the state for its management of Medicaid and the Children’s Health Insurance Program.

https://www.orlandosentinel.com/2023/12/19/feds-deeply-alarmed-after-360k-florida-kids-lose-medicaid-chip-coverage/?

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Grassroots groups help Medicaid recipients regain lost coverage

Across 21 states, including FL, nearly 40% of those who lost Medicaid coverage are children.

https://floridaphoenix.com/2023/12/22/grassroots-groups-help-medicaid-recipients-regain-lost-coverage/?

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When increased 2024 Social Security payments will arrive

Increased Social Security retirement and disability benefits for 2024 will start to roll out for millions of Americans as early as Friday and throughout January.

https://www.axios.com/2023/12/29/social-security-benefits-2024-increase-cola?

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The Case Of The Missing Health Care Providers

For the past 24 years, Sarah has operated a physical therapy clinic in a small town in Boulder County, Colorado. Her clinic is in-network with health insurance giant UnitedHealthcare, though Sarah’s reimbursement rate paid by the insurer for each patient visit has not increased once over the past quarter century. Meanwhile, the cost of running a business has skyrocketed.

https://www.levernews.com/the-case-of-the-missing-health-care-providers/?

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Insulin costs now capped for more Americans

More patients on insulin will pay less for the drug this year after a leading manufacturer joined rivals in curbing monthly costs or lowering prices.

https://www.axios.com/2024/01/03/insulin-price-cap-sanofi?

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Florida can import prescription drugs from Canada, US regulators say

WASHINGTON (AP) — The Food and Drug Administration on Friday cleared the way for Florida’s first-in-the-nation plan to import prescription drugs from Canada, a long-sought approach to accessing cheaper medications that follows decades of frustration with U.S. drug prices.

https://apnews.com/article/florida-canada-prescription-drug-imports-c2893394e952754c3d2a5a19b0edb8bd?

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‘Obamacare’ sign-ups surge to 20 million, days before open enrollment closes

WASHINGTON (AP) — Some 20 million people have signed up for health insurance this year through the Affordable Care Act marketplaces, a record-breaking figure.

https://apnews.com/article/obamacare-medicaid-health-insurance-open-enrollment-0f6625a01338687eb055d7a3e0a84da4?

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Social Security Proposal Could Boost Income for Thousands

Republican Governor Jim Justice has proposed a complete axing of Social Security taxes in West Virginia.

https://www.newsweek.com/social-security-proposal-boost-income-1861143

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💊 Mapped: Ozempic America

Data: PurpleLab HealthNexus database. Map: Axios Visuals New weight-loss drugs are especially popular in the South, Axios' Tina Reed writes from new insurance claims data provided by health analytics company PurpleLab. 21 out of every 1,000 Kentuckians have been prescribed Ozempic or a similar weight-loss drug. Explore the data.

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FL Senate sends healthcare initiative to state House with reduced price tag

The Florida Senate on Thursday approved the bulk of the ‘Live Healthy’ initiative spearheaded by Senate President Kathleen Passidomo, although senators cut tens of millions of dollars from the proposals aimed at innovating the health care industry and growing its workforce.

https://floridaphoenix.com/2024/01/18/fl-senate-sends-healthcare-initiative-to-state-house-with-reduced-price-tag/?

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🩺 How AI will (and won't) change health care

Illustration: Sarah Grillo/Axios

AI has the potential to vastly improve the quality of health care and trim waste, Axios' Caitlin Owens reports. Why it matters: For now, we're talking efficiency, not a revolution. There's lots of talk about AI's potential in biotech to discover more drugs, speed up the development process and better match drugs to patients. Other commonly discussed uses include improving diagnostics, reducing providers' paperwork hassles and streamlining billing. 🥊 Reality check: AI breakthroughs are coming up against a system that's very resistant to change. It's heavily regulated, and trillions of dollars are at stake for incumbents. "I don't have any hopes that within the next three to five years, these technologies are going to be transformative in terms of patient interaction with the clinician," says Dan Mendelson, CEO of Morgan Health, a unit of JPMorgan Chase. Go deeper.