HealthCare, Medicare, Medicaid, and Social Security

[phkrause]

A journey through time: The history of Social Security

In the fabric of society, few programs have woven themselves as deeply into the American culture as Social Security. The economic devastation of the Great Depression further exposed society’s vulnerabilities, with millions of older Americans in poverty and many more at risk of financial ruin. In response, the Social Security Act was signed into law to better ensure a measure of income security for older Americans in retirement.

https://nebraskaexaminer.com/2024/07/05/a-journey-through-time-the-history-of-social-security/?

[phkrause]

Texas Sends Millions to Crisis Pregnancy Centers. It’s Meant to Help Needy Families, But No One Knows if It Works.

Year after year, while Roe v. Wade was the law of the land, Texas legislators passed measures limiting access to abortion — who could have one, how and where. And with the same cadence, they added millions of dollars to a program designed to discourage people from terminating pregnancies.

https://www.propublica.org/article/texas-funding-anti-abortion-crisis-pregnancy-centers?

[phkrause]

Social Security announces big change for millions of recipients

The Social Security Administration is making a big change impacting how millions of people access their information.

https://www.al.com/news/2024/07/social-security-announces-big-change-for-millions-of-recipients.html?

[phkrause]

Florida ranks among worst states for women’s healthcare, new study says

Florida ranks the worst in the country for prenatal care, as many women miss medical visits in their first three months of pregnancy, according to a new report on women’s healthcare released this week.

https://www.orlandosentinel.com/2024/07/19/florida-ranks-among-worst-states-for-womens-healthcare-new-study-says/?

[phkrause]

Florida wrongly kicked postpartum women and their newborns out of Medicaid

JACKSONVILLE — The trial in the federal class action filed by Medicaid patients against the Florida agencies that handle the subsidized health care program resumed on Monday, with an employee acknowledging the state had mistakenly ended coverage for postpartum women and newborn children.

https://floridaphoenix.com/2024/07/29/florida-wrongly-kicked-postpartum-women-and-their-newborns-out-of-medicaid/?

[phkrause]

? CA among states writing rules for AI in health care

By Maya Goldman

Illustration: Maura Losch/Axios

In the absence of federal guardrails on artificial intelligence in health care, state governments are figuring out their own rules of the road. Why it matters: Artificial intelligence is health care's biggest wild card. But it's drawing hundreds of millions of dollars in investments, and health providers and drug developers are already using it — essentially without oversight. Driving the news: In California, a state bill's proponents have worked through health insurers' concerns. But it could still be held up because of the added cost to the state's managed-care fund. State Sen. Josh Becker (D) told Axios that Senate appropriators will decide whether to allocate money for the policy this week. State of play: Colorado in May enacted one of the first comprehensive state AI laws, limiting AI use in "consequential decisions," including in health care. Utah, New York, Pennsylvania, Oklahoma and Georgia are all tackling the issue, too. Yes, but: State proposals outnumber enacted policies, said Valerie Rogers, senior director of government relations at the Healthcare Information and Management Systems Society. She expects policymaking on AI and health to pick up in 2025. The big picture: States can often make policy quicker than the federal health bureaucracy, and with specific community needs in mind. But a state-by-state solution could create a patchwork that's difficult for users and developers. What to watch

[phkrause]

Drugs to treat diabetes, heart disease and blood cancers among those affected by price negotiations

The Biden administration says Medicare recipients will save about $1.5 billion on out-of-pocket costs for medications to treat diabetes, heart disease, types of arthritis and other ailments under new prices negotiated with drug companies that will take effect in 2026.

https://apnews.com/article/drug-prices-negotiations-medicare-biden-costs-savings-787789a17301b8320100b68bc0ccafea?

 

Drug costs

 

President Joe Biden and Vice President Kamala Harris made a joint appearance in Maryland on Thursday at an event focused on prescription drug costs. The Biden administration announced the results of historic Medicare drug price negotiations that will save an estimated $6 billion when lower prices take effect for some medicines in 2026. The negotiation program has been a central talking point of the White House's efforts to lower the cost of living for more Americans — including senior citizens, a key voting bloc. The powerful pharmaceutical industry, which has long fought against allowing Medicare to negotiate prices, has been trying to stop the negotiation process, filing multiple lawsuits in federal courts across the US contending that the program is unconstitutional in various ways.

[phkrause]

Drug trial

Good news for people struggling with obesity or early symptoms of diabetes: A new study by drugmaker Eli Lilly found that tirzepatide, a medication frequently used for weight loss, significantly reduces the risk of progression to diabetes.

[phkrause]

It’s not just IUDs. Gynecologists and patients are focused on making procedures less painful

Federal officials affirmed this month that the pain people might feel when getting an IUD can be more than doctors’ promises of “just a pinch.”

https://apnews.com/article/iud-pain-lidocaine-gynecologist-f25a198bada157a53514e84dbf57c5a7?

[bonnie1962]

10 minutes ago, phkrause said:

It’s not just IUDs. Gynecologists and patients are focused on making procedures less painful

Federal officials affirmed this month that the pain people might feel when getting an IUinsignificentD can be more than doctors’ promises of “just a pinch.”

https://apnews.com/article/iud-pain-lidocaine-gynecologist-f25a198bada157a53514e84dbf57c5a7?

Really, I have had two. The pinch was insignificant. Quite sure it is of minor concern compared to having an abortion

[phkrause]

⏳ Patients wait more for less

Illustration: Sarah Grillo/Axios

The U.S. spends more on health care than almost any other country. But patients increasingly are getting less in return, and enduring long waits to get less face time with their clinician, Axios' Tina Reed writes. Why it matters: Shrinkflation is hitting a sector that accounts for almost one-fifth of the economy — eroding the doctor-patient relationship, and leaving many turning to urgent care clinics or telehealth services. The trend is being felt especially in primary care, but also in many specialties. An Axios-Ipsos survey last month found that nearly 1 in 5 respondents said they had to wait more than two months to see a primary care physician or specialist, with waits trending longest in the Midwest. The most frequently cited specialties with long wait times included neurology (26%); ear, nose, and throat (26%); psychiatry (20%); and OB/GYN (17%). Primary care stood at 19%, per electronic health records company Tebra. ? The big picture: There's been across-the-board growth in patient volumes, largely from pent-up demand for services many put off during the pandemic. At the same time, tens of thousands of doctors have left the field due to burnout and other factors, and surveys indicate even more plan to retire early.

[phkrause]

“I Don’t Want to Die”: Needing Mental Health Care, He Got Trapped in His Insurer’s Ghost Network

Ravi Coutinho bought a health insurance plan thinking it would deliver on its promise of access to mental health providers. But even after 21 phone calls and multiple hospitalizations, no one could find him a therapist.

https://www.propublica.org/article/ambetter-ghost-network-consequences?

[phkrause]

New Biden Administration Rules Aim to Hold Insurers Accountable for Mental Health Care Coverage

The Biden administration announced on Monday that it has finalized new regulations to strengthen protections for mental health care coverage and hold insurance companies accountable for unlawfully denying it.

https://www.propublica.org/article/biden-administration-strengthens-mental-health-care-protections?

[phkrause]

Florida faces $40M in fines for failing to submit Medicaid reports

Florida could be forced to pay $40 million in fines to the federal government over its handling of the state’s Medicaid program.

https://floridaphoenix.com/2024/09/20/florida-faces-40m-in-fines-for-failing-to-submit-medicaid-reports/?

High-ranking Florida Medicaid official resigns post

One of Florida’s top Medicaid officials has resigned.

https://floridaphoenix.com/briefs/high-ranking-florida-medicaid-official-resigns-post/?

[phkrause]

Medicare Advantage shopping season arrives with a dose of confusion and some political implications

Thinner benefits and coverage changes await many older Americans shopping for health insurance this fall. That’s if their plan is even still available in 2025.

https://apnews.com/article/medicare-advantage-part-d-harris-biden-2799d3a55a4ab87fd6adbf592bca8536?

[phkrause]

Social Security COLA raise: How much will recipients get in 2025?

The Social Security Administration is less than a week away from announcing its cost of living adjustment (COLA), the percent increase in recipients’ payments designed to offset inflation.

https://www.newsbreak.com/news/3621529660348-social-security-cola-raise-how-much-will-recipients-get-in-2025?

[phkrause]

Tips for shopping for Medicare Advantage plans

Shopping season for Medicare coverage is about to begin. With it comes the annual onslaught of TV ads and choices to consider.

https://apnews.com/article/medicare-advantage-enrollment-help-435f0d0f17b5f679e0cf6cfbc38dcaac?

ps:Tis the season! I dislike this time of year! The phone calls are endless for sure!!

[phkrause]

Social Security’s scheduled cost of living increase ‘won’t make a dent’ for some retirees

WASHINGTON (AP) — Sherri Myers, an 82-year-old resident of Pensacola City, Florida, says the Social Security cost-of-living increase she’ll receive in January “won’t make a dent” in helping her meet her day-to-day expenses.

https://apnews.com/article/social-security-cost-of-living-inflation-7c116e6de82bfe3903b1c625d39547eb?

[phkrause]

Medicare

Medicare Advantage enrollees are encouraged to review their plans during open enrollment, which begins today and runs until December 7. Health experts say insurers are making a flurry of changes that could leave some senior citizens hunting for new policies, paying more out of pocket or getting skimpier supplemental benefits. For example, more than 16 million enrollees this year are in plans with no deductible for any drug. But in 2025, more than 45% of these members will be subject to a deductible for at least some drugs — particularly brand-name or specialty medications — if they stay in the same plan. Some insurers are also cutting back on allowances for dental, hearing and vision benefits.

[phkrause]

“Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.

https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations

[phkrause]

‘Obamacare’ enrollment opens, as Republicans threaten the health insurance program used by millions

WASHINGTON (AP) — Americans can start signing up Friday for health care coverage offered through the Affordable Care Act marketplace for 2025, days before a presidential election that could threaten eligibility and raise costs for millions of those in the program.

https://apnews.com/article/obamacare-affordable-care-act-harris-trump-kamala-9ac518845f3fd085bc68dcceed16b2c1?

[phkrause]

How Lincare Became a Multibillion-Dollar Medicare Scofflaw

For Lincare, paying multimillion-dollar legal settlements is an integral part of doing business.

https://www.propublica.org/article/lincare-medicare-lawsuit-settlements-oxygen-equipment?

[phkrause]

Social Security Although President-elect Donald Trump has often promised to protect Social Security, he has not explained exactly how he would save the beloved — but financially troubled — entitlement program. Nor did he take any meaningful steps to shore up Social Security during his first term in the White House. Moreover, several of his recent campaign pledges — including to eliminate taxes on Social Security benefits — could wind up costing seniors in coming years. The program's funds are expected to run dry in 2035 without congressional intervention, according to the latest Social Security trustees' report. After that, payroll tax revenue and other income would only be able to cover 83% of benefits owed. It remains to be seen whether the incoming GOP-controlled Congress will delve into the controversial issue anytime soon.

[phkrause]

Biden proposes Medicare and Medicaid cover costly weight-loss drugs for millions of obese Americans

WASHINGTON (AP) — Millions of Americans with obesity would be eligible to have popular weight-loss drugs like Wegovy or Zepbound covered by Medicare or Medicaid under a new rule the Biden administration proposed Tuesday morning.

https://apnews.com/article/ozempic-biden-rfk-jr-trump-antiobesity-drugs-caaa2f888435af1d32bedb83e9ddbc0a?

[phkrause]

Anti-obesity drugs

Millions more senior citizens and lower-income Americans could obtain coverage for costly anti-obesity drugs under a proposal unveiled Tuesday by the Biden administration. Some 3.4 million Medicare beneficiaries and about 4 million Medicaid recipients would gain access to these medications, which can cost as much as $1,000 a month for the uninsured. Some Medicare enrollees could see their out-of-pocket costs drop by as much as 95%. Although Medicare by law is not allowed to cover drugs for weight loss, the Centers for Medicare and Medicaid Services says it is proposing to reinterpret the statute to allow coverage for the treatment of obesity as a chronic disease. The expanded coverage could potentially go into effect in 2026.