HealthCare, Medicare, Medicaid, and Social Security

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Catch me up

Data: Centers for Medicare & Medicaid Services; Map: Axios Visuals 📈 Obamacare enrollment is surging, especially in red states, Axios' Jason Millman reports. 📺 Jon Stewart will host "The Daily Show" again, but only on Mondays, Axios' Sara Fischer reports. 🚙 The UAW endorsed President Biden for re-election after holding out for months over concerns about his EV policies, Axios' Nathan Bomey reports.

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🗺 Mapped: Obamacare enrollment surged in red states

Data: Centers for Medicare & Medicaid Services; Map: Axios Visuals Texas enrollment in the Affordable Care Act marketplaces increased by more than 1 million to 3.5 million this year. Driving the news: A record 21.3 million people signed up for Obamacare this year, with the largest enrollment increases tallied in red states, according to enrollment figures released by federal health officials last week. The 30.7% annual increase in ACA sign-ups comes as former President Trump's renewed calls for repeal have again raised doubts about the law's future, writes Axios' Jason Millman. Zoom in: Some of the enrollment surge can likely be attributed to a portion of the millions who've recently lost Medicaid coverage moving to the marketplaces. About 1.8 million Texans lost their health insurance since the state started removing people from Medicaid as federal pandemic rules ended, per KFF. About 68% of those removals were for clerical reasons. By the numbers: States with the largest year-over-year increase in sign-ups include West Virginia (80.2%), Louisiana (75.9%), Ohio (62.2%), Indiana (59.6%) and Tennessee (59.5%), according to data from the Centers for Medicare and Medicaid Services, which oversees the marketplaces. Texas is among the seven other states that had increases of 45% or more.

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Wall Street Wants To Keep Your Drug Prices High

As the Biden administration launches a long-awaited fight to lower prices of life-saving drugs developed with public funding, a formidable industry opponent of the effort has emerged: venture capital firms.

https://www.levernews.com/wall-street-wants-to-keep-your-drug-prices-high/?

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📝 Doctors add more fees for paperwork

Illustration: Shoshana Gordon/Axios

Doctors are increasingly charging their patients a fee for responding to emails, signing documents or writing notes to verify an illness, Axios' Tina Reed writes. "Basically, physicians are saying, 'The things that I used to do for free, I can't afford to do it now,'" Stanford University professor Robert Pearl told Axios. 🩺 Between the lines: A lot of patients started bombarding their doctors with emails during the pandemic, experts said. Charging for an answer allows doctors to monetize more of their time and may nudge patients to think twice about some of their less-urgent questions. More employers are also demanding doctors' notes from workers who take sick days, upping physicians' paperwork burden even more.

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Scientists have used cells from amniotic fluid to grow mini lungs and other organs Scientists have created miniorgans from cells floating in the fluid that surrounds a fetus in the womb – an advance they believe could open up new areas of prenatal medicine. Read more.

Why this matters: Miniorgans, or “organoids,” are tiny, simplified structures that can be used to test new medical treatments and study how real organs work. Researchers envision their approach could help doctors monitor and treat congenital conditions before birth and develop personalized therapies for a baby in the womb.   The tissue-specific stem cells collected were shed by the fetus, as normally happens during pregnancy. Collecting cells from amniotic fluid gets around regulations about taking stem cells directly from fetal tissue, allowing scientists to get cells into the latter part of pregnancy.

RELATED COVERAGE ➤ Why Missouri currently doesn’t allow pregnant women to be legally divorced   Mississippi passes quicker pregnancy Medicaid coverage to try to reduce deaths of moms and babies   Study raises questions about plastic pollution’s effect on heart health

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Pharma’s Secret Middlemen Are Poisoning Health Care

Following a lobbying blitz, Congress might punt all efforts to stop shadowy pharmacy benefit managers from inflating drug prices and killing small pharmacies.

https://www.levernews.com/pharmas-secret-middlemen-are-poisoning-health-care/?

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Blood tests could become a new option to screen for colon cancer A new blood test, examined in a study published Wednesday, is already for sale in the U.S. for $895, but it has not been approved by the Food and Drug Administration and most insurers do not cover it. The maker of the test, Guardant Health, anticipates an FDA decision this year. Read more.

Why this matters: The test looks for DNA fragments shed by tumor cells and precancerous growths and, in the study, caught 83% of such cancers. But it did not spot many of the precancerous growths that would be found by a colonoscopy, the gold standard for colon cancer screening.   Colorectal cancer is the second leading cause of cancer deaths in the United States and the third worldwide. “The best test is the one someone will actually complete,” said Dr. Douglas Corley, chief research officer for Kaiser Permanente, who was not involved in the study.

RELATED COVERAGE ➤ A new strategy to attack aggressive brain cancer shrank tumors in early tests   50 years later, Tommy John surgery remains a game-changer   U.S. federal officials are investigating a massive health care hack

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State Medicaid offices target dead people’s homes to recoup their health care costs

Sandy LoGrande thought it was a mistake when, a year after her father’s death, the state of Massachusetts billed her $177,000 for her father’s Medicaid expenses and threatened to sue for his home if she didn’t pay up quickly.    But it wasn’t a mistake. It was part of the federal government’s routine process that requires every state to recover money from the assets of dead people who relied on Medicaid, the taxpayer-funded health insurance for the poorest Americans. Read more.

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This New Lawsuit Could Rescind Your Health Care Benefits

Right-wing federal appeal judges signal they support repeal of the no-cost preventive care mandate, all but guaranteeing a Supreme Court showdown.

https://www.levernews.com/this-new-lawsuit-could-rescind-your-health-care-benefits/?

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The New War Over Generic Drugs

As the price of prescription medications rises, generic drugs offer a way for consumers to save money. Although generics have the same active ingredients as brand-name drugs and result in the same clinical effect, they typically cost up to 85 percent less. 

https://www.levernews.com/the-new-war-over-generic-drugs/?

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💊 Mental health's drug puzzle

Illustration: Aïda Amer/Axios

Despite decades of research and millions of dollars in investment, one-size-fits-all treatments for complex psychiatric disorders are coming up short. Why it matters: There's been limited success treating depression, bipolar disorder, schizophrenia and other disorders — and the burden of these conditions on society has continued to grow, Axios' Caitlin Owens and Alison Snyder report. 👀 What we’re reading: A study published this week in JAMA Psychiatry looked at patterns in the prevalence of treatment resistant depression among the entire population of Taiwan. It found those with a family history of this type of depression were at an increased risk of having it and disorders. The findings underscore something neuroscientists and researchers have recognized for some time: Mental health disorders manifest differently in people, and more effective treatments may hinge on better understanding their biology rather than just their symptoms. 🔭 What’s next: Small biotechs and larger drug companies alike are investing in precision psychiatry, which aims to develop and match drugs to specific patients who will benefit from them.

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FACT SHEET: 80% of House Republicans Release Plan Targeting Medicare, Social Security, and the Affordable Care Act, Raising Costs, and Cutting Taxes for the Wealthy

On Wednesday, the Republican Study Committee – which represents 100% of House Republican leadership and nearly 80% of their members – just proposed yet another budget that would cut Medicare, Social Security, and the Affordable Care Act , as well as increase prescription drug, energy, and housing costs – all while forcing tax giveaways for the very rich onto the country. Their plan would even raise the Social Security retirement age.

https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/21/fact-sheet-80-of-house-republicans-release-plan-targeting-medicare-social-security-and-the-affordable-care-act-raising-costs-and-cutting-taxes-for-the-wealthy/

New GOP House Speaker Mike Johnson has proposed trillions in cuts to Social Security and Medicare

The newly elected Republican speaker of the U.S. House of Representatives has previously proposed trillions of dollars in cuts to Social Security, Medicare, and Medicaid and suggested that slashing the programs should be the top priority of Congress.

https://www.salon.com/2023/10/26/new-speaker-mike-johnson-has-proposed-trillions-in-cuts-to-social-security-and-medicare_partner/

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The Patterson Test

Before 2017, I would have struggled to pick out Jim Patterson in the Alabama House of Representatives.

https://alabamareflector.com/2024/04/15/the-patterson-test/?

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A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.

Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” Day said.

https://www.propublica.org/article/cigna-medical-director-doctor-patient-preapproval-denials-insurance?

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Biden administration to issue rule expanding DACA health care access

WASHINGTON — The Biden administration will publish a final rule Friday that will allow about 100,000 uninsured people in the Deferred Action for Childhood Arrivals program to enroll in state-run or private health insurance plans provided under the Affordable Care Act, administration officials said.

https://floridaphoenix.com/2024/05/03/biden-administration-to-issue-rule-expanding-daca-health-care-access/?

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Medicare and Social Security go-broke dates are pushed back The go-broke dates for Medicare and Social Security have been pushed back five years to 2036 as an improving economy has contributed to changed projected depletion dates, according to the annual Social Security and Medicare trustees report Monday. Still, officials warn that policy changes are needed or the programs will become unable to pay full benefits to retiring Americans. Read more.

Why this matters: Medicare covered more than 66 million people last year, with most being 65 and older. Once the fund’s reserves become depleted, Medicare would be able to cover only 89% of costs for patients’ hospital visits, hospice and nursing home stays or home health care.   Lawmakers have for years kicked Social Security and Medicare’s troubling math to the next generation. Social Security benefits were last reformed roughly 40 years ago, when the federal government raised the eligibility age for the program from 65 to 67.   President Joe Biden responded to the report by saying that “as long as I am president, I will keep strengthening Social Security and Medicare.” The future of Social Security and Medicare has become a top political talking point as President Joe Biden and Republican former President Donald Trump both campaign for reelection this year.

RELATED COVERAGE ➤ Medicare can pay for obesity drugs like Wegovy in certain heart patients   Man confesses to killing hospitalized wife because he couldn’t afford to care for her, police say   Biden says that all 10 drugs targeted for the first Medicare price negotiations will participate

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Medicaid removals exceed projections

Illustration: Maura Losch/Axios

Texas removed far more children from its Medicaid rolls last year than observers expected, per a new report. State officials say the numbers are in line with their projections. Why it matters: Even brief gaps in insurance can disrupt care and worsen health outcomes — especially for children, per an Urban Institute analysis. In Texas, many children and adults lost coverage for procedural reasons like missed paperwork — not necessarily because they were ineligible. Catch up quick: States paused regular Medicaid eligibility checks during the pandemic, allowing people to keep coverage. They began rechecking in April 2023. That led to a cascade of problems stemming from overwhelmed technology, outdated information about Medicaid recipients, and a lack of resources for state employees. State of play: Texas has removed more than 2 million people from its Medicaid program since last April, per the most recent state data. Zoom in: As of November, eight states — including Texas — disenrolled more than 100% of the Urban Institute's projected numbers over the last year. Texas' net overall disenrollment exceeded 117% of the think tank's projections — and exceeded projections by 178% for disenrollment of children alone. Threat level: "This suggests that many eligible people may be among those losing Medicaid and raises the possibility that this problem may increase," Matthew Buettgens, senior fellow at the Urban Institute, said in a statement. The other side: "Our Medicaid enrollment is in line with our ... projections and what we anticipated our disenrollments to be at this time," Texas Health and Human Services Commission spokesperson Tiffany Young tells Axios. What's next: Texas has until the end of the month to finish eligibility checks, Young says.

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Medicare should include dental coverage, dentists tell U.S. Senate panel

WASHINGTON — Dentists from throughout the country urged Congress to include dental coverage in Medicare during a hearing last week, saying that fewer than half of beneficiaries visit a dentist each year.

https://floridaphoenix.com/2024/05/19/medicare-should-include-dental-coverage-dentists-tell-u-s-senate-panel/?

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After the only hospital in town closed, a North Carolina city directs its ire at politicians

WILLIAMSTON, N.C. (AP) — Weeds have punctured through the vacant parking lot of Martin General Hospital’s emergency room. A makeshift blue tarp covering the hospital’s sign is worn down from flapping in the wind. The hospital doors are locked, many in this county of 22,000 fear permanently.

https://apnews.com/article/biden-rural-hospitals-closed-emergency-health-trump-51a70f7072d2414ce694ca536da83b80?

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Patronis says his office has opened more than 900 investigations into ACA fraud

Responding to complaints from Floridians who have either had their health care coverage added to the Affordable Care Act or switched without their consent, Florida Chief Financial Officer Jimmy Patronis has called upon Congress to crack down on allegedly fraudulent health insurance agents and brokers.

https://floridaphoenix.com/2024/05/21/patronis-says-his-office-has-opened-more-than-900-investigations-into-aca-fraud/?

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Black Americans are underrepresented in residential care communities, AP/CNHI News analysis finds Black Americans are about 9% of people older than 65 in the U.S. but make up just 4.9% of the population in residential care communities and are overrepresented in nursing homes at 16% of residents. The situation is flipped for white Americans, who make up 88% of the population in residential care communities. Read more.

Why this matters: Other ethnic and racial groups are underrepresented in assisted living facilities, too, but only Black Americans are also overrepresented in nursing homes. Older Black Americans may be left out of living situations that can create community, prevent isolation and provide help with daily tasks.   Experts say the reasons behind the disparity are complicated — driven in part by personal and cultural preferences, as well as insurance coverage and where facilities are located.   The share of the U.S. population older than 65 is rising and will for decades to come.

Related coverage ➤ Older Americans often don’t prepare for long-term care  Despite surging demand for long-term care, providers struggle to find workers  Adult day services provide stimulation for older Americans, and respite for full-time caregivers

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Judge tosses Florida lawsuit over mandated health care for kids

A Tampa judge dismissed Friday a lawsuit filed by Florida officials challenging the federal government’s 2024 mandate that most children in low-income families were entitled to subsidized health insurance for at least a year even if their parents stopped paying a small monthly premium.

https://www.orlandosentinel.com/2024/05/31/judge-tosses-florida-lawsuit-over-mandated-health-care-for-kids/?

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Medical debt

 

The Biden administration has proposed banning medical debt from credit reports. The move would raise the credit scores of more than 15 million Americans by an average of 20 points and lead to the approval of about 22,000 more mortgages annually, according to a fact sheet from the office of Vice President Kamala Harris. The proposed rule would also ban lenders from using medical devices such as wheelchairs or prosthetic limbs as collateral for loans, and bar them from repossessing the devices if patients are unable to repay the loans. The rule could be finalized early next year. Some 46 million people had medical debt listed on their credit reports in 2020, according to the fact sheet.

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The build-up begins to get Medicaid expansion on the ballot in FL

Andrea Dumala’s Honda Accord was idling at a red light on a Pasco County road in 2014 when it was violently rear-ended by a Ford Explorer moving at 50 miles per hour. The driver was later revealed to have been under the influence. 

https://floridaphoenix.com/2024/07/03/the-build-up-begins-to-get-medicaid-expansion-on-the-ballot-in-fl/?

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US judge blocks Biden rule adding gender identity protections to healthcare

July 3 (Reuters) - A U.S. judge on Wednesday blocked the Biden administration from enforcing a new rule against discrimination on the basis of gender identity in healthcare while he hears a lawsuit challenging it by 15 Republican-led states.

https://www.reuters.com/legal/us-judge-blocks-biden-admin-rule-against-gender-identity-discrimination-2024-07-03/?