HealthCare, Medicare, Medicaid, and Social Security

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One month into Obamacare enrollment, Florida leads the nation in sign-ups

Florida leads the nation in Obamacare enrollment after a month of open enrollment.

https://floridaphoenix.com/2024/12/04/one-month-into-obamacare-enrollment-florida-leads-the-nation-in-sign-ups/?

ps:What's new here?

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Anthem Blue Cross Blue Shield reverses decision to put a time limit on anesthesia

One of the country’s largest health insurers reversed a change in policy Thursday after widespread outcry, saying it would not tie payments in some states to the length of time a patient went under anesthesia.

https://apnews.com/article/anthem-blue-cross-anesthesia-insurance-coverage-c8233db68f76342c4e794320f151a926?

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Health care vibes hit all-time low

Data: Gallup. (Respondents who rated either metric "excellent" or "good.") Chart: Axios Visuals Americans' view of health care quality is at a record low, a new Gallup poll finds. ? Just 44% of adults said the quality of U.S. health care is excellent or good — the smallest share since Gallup's tracking started in 2001. Many factors are fueling Americans' dim views of the health care system, including: ?High and unpredictable costs. Unexpected medical bills top Americans' financial concerns. ? Longer wait times. Patients are waiting longer for less face time with their doctors. ? Insurance frustrations. This week's brazen murder of UnitedHealthcare CEO Brian Thompson unleashed a torrent of long-simmering rage. ?? Yes, but: People generally feel good about their own care and coverage. 71% of Americans say their care is either good or excellent, per Gallup. 65% say the same about their coverage — complicating the politics of any major changes. ? What's next: President-elect Trump's picks for key health-care roles — including RFK Jr. for HHS and Dr. Oz as head of the Centers for Medicare and Medicaid Services — have left the health world bracing for an unpredictable and potentially chaotic shake-up.

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Big Insurer Sets Time Limits On Anesthesia Coverage During Surgeries

One of the country’s largest health insurance companies says it will no longer automatically pay for patients’ anesthesia if a medical procedure takes longer than a predetermined time limit, regardless of complications or other factors that impact operation time.   

https://www.levernews.com/big-insurer-sets-time-limits-on-anesthesia-coverage-during-surgeries/

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? Public still trusts government on health

Data: Axios-Ipsos American Health Index. Chart: Axios Visuals The public trusts Anthony Fauci more than President-elect Trump and his incoming health team as a source of medical information, Axios' Adriel Bettelheim writes from the latest Axios-Ipsos American Health Index. Why it matters: The survey shows the public still sees a significant role for government in health care. ? Zoom in: 60% or more of respondents say they have at least a fair amount of trust in information from the FDA, CDC or NIH. 45% report trusting information from Fauci. Fewer say they have the same amount of trust in information on health topics from Trump (32%), Robert F. Kennedy Jr. (30%), Elon Musk (25%), Mehmet Oz (23%) or others Trump has nominated to lead federal health agencies. ? Reality check: RFK Jr.'s focus on safe food and nutrition clearly resonates with many Americans. They see chemicals and unsafe additives as a bigger health risk than climate change or infectious diseases. But support for his other positions is low. Just over a quarter of the public (29%) supports removing fluoride from water supplies. About 1 in 5 (18%) back ending vaccine requirements for attending public schools. There's lingering dissatisfaction with health industries: 59% support banning TV pharma ads and 64% want insurers to cover prescription weight-loss drugs like Ozempic and Wegovy.

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Millions of people may get expanded Social Security benefits. Who are they and how would it happen?

ATLANTA (AP) — Nearly 3 million people could receive a boost in Social Security payments under legislation set for a final Senate vote in the coming days.

https://apnews.com/article/social-security-changes-congress-pensions-3a8d55e0d236d2ee01abce6d94a60d0c?

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? Who pays for health care

Data: Health Affairs; Chart: Axios Visuals The U.S. spent just under $5 trillion on health care last year, according to new federal data. ? Why it matters: Almost everyone in politics, from both parties, agrees that's too much. The U.S. spends about twice as much per person as other wealthy nations. Americans are less healthy than many of those countries' populations. ? Who pays: The federal government pays the biggest share of health care bills, at $1.6 trillion last year. But almost as much — $1.3 trillion — comes directly out of Americans' pockets and paychecks.

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Higher Social Security payments coming for millions of people from bill that Biden signed

WASHINGTON (AP) — President Joe Biden on Sunday signed into law a measure that boosts Social Security payments for current and former public employees, affecting nearly 3 million people who receive pensions from their time as teachers, firefighters, police officers and in other public service jobs.

https://apnews.com/article/social-security-retirement-benefits-public-service-workers-5673001497090043e786ade8a8d0fdb4?

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Medical debt

The Biden administration will finalize a rule today that will ban the inclusion of medical debt on credit reports. The rule will also remove an estimated $49 billion in medical bills from the credit reports of about 15 million people, the Consumer Financial Protection Bureau said. The rule bans lenders from using medical devices, such as wheelchairs or prosthetic limbs, as collateral for loans and bars them from repossessing the devices if patients are unable to repay the loans. The measure, which was proposed last June, takes effect 60 days after it is published in the Federal Register. Congress now has a limited period of time when it can review and rescind the final rules.

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Biden signs bill expanding Social Security benefits for retired teachers, public employees

WASHINGTON — President Joe Biden has expanded Social Security benefits for more than 2 million Americans by signing broadly bipartisan legislation that Congress approved late last year.

https://floridaphoenix.com/2025/01/06/dc/biden-signs-bill-expanding-social-security-benefits-for-retired-teachers-public-employees/?

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Florida leads the nation (again) In Obamacare enrollment

More than 4.6 million Florida residents enrolled in an Obamacare plan through the “Marketplace” for 2025 health insurance coverage.

https://floridaphoenix.com/2025/01/08/florida-leads-the-nation-again-in-obamacare-enrollment/?

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US recovers $31 million in Social Security payments to dead people

WASHINGTON (AP) — The U.S. government clawed back more than $31 million in Social Security payments that improperly went to dead people, a recovery that one official said Wednesday was “just the tip of the iceberg.”

https://apnews.com/article/social-security-biden-treasury-trump-doge-cc46365b82a32038123576502977dd26?

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Dozens of People Died in Arizona Sober Living Homes as State Officials Fumbled Medicaid Fraud Response

At least 40 Native American residents of sober living homes and treatment facilities in the Phoenix area died as state Medicaid officials struggled to respond to a massive fraud scheme that targeted Indigenous people with addictions.

https://www.propublica.org/article/arizona-sober-homes-deaths-medicaid-fraud?

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Wall Street Is Jacking Up The Cost Of Your Doctor Visits

It’s increasingly likely that your family doctor is now affiliated with the hospital conglomerates or Wall Street firms taking over the American health care system — and if so, new research suggests you’re likely being charged significantly more for your office visits than you would be at an independent practice. In total, health insurers are shelling out billions more annually for corporate-owned primary care providers, and they’re passing those costs on to you.

https://www.levernews.com/wall-street-is-jacking-the-cost-of-your-doctor-visits/

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$528 Billion

The amount of “administrative expenses we have under the current (health care) system that we would not have under single-payer.” (Source: People’s Policy Project analysis of Congressional Budget Office data).

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The Hidden Cost Behind Your “$0 Copay” Drug Assistance Program

Copay assistance programs are supposed to reduce drug costs and cover patients’ deductibles — so why are so many people getting stuck with a bill?

https://www.levernews.com/the-hidden-cost-behind-your-0-copay-drug-assistance-program/?

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What a $2 Million Per Dose Gene Therapy Reveals About Drug Pricing

Vincent Gaynor remembers, almost to the minute, when he realized his part in birthing the breakthrough gene therapy Zolgensma had ended and the forces that turned it into the world’s most expensive drug had taken over.

https://www.propublica.org/article/zolgensma-sma-novartis-drug-prices-gene-therapy-avexis?

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This is the Medicare Advantage swindle. The privatized Medicare industry, which covers more than half of senior citizens, has spent more than $330 million in the last five years lobbying the federal government to keep funding its Medicare Advantage plans, according to a new report by advocacy group Public Citizen. These plans are a cash cow for insurers, returning higher profits than individual or employer-sponsored insurance plans. It’s all subsidized by the federal government, which paid Medicare Advantage insurers an estimated $462 billion last year from Medicare’s coffers, 84 percent of which went to just seven insurers. 

Insurers win, seniors lose. Research shows that Medicare Advantage plans deny claims at a higher rate than traditional Medicare. As The Lever reported, nearly one in five Medicare Advantage requests for pre-authorization were wrongly denied in 2019, leaving some 1.5 million claims in the lurch — and 13 percent of claims denied by Medicare Advantage plans would have been covered under traditional Medicare. 

Taxpayers lose, too. If the government redirected what it spends subsidizing Medicare Advantage plans to instead reduce premium costs, seniors could save more than  $1,800 a year. And because of consistent overcharging, the government ends up overpaying Medicare Advantage insurers as much as $140 billion a year. Researchers expect these overpayments to total over $1 trillion in the next decade, even without Trump’s plans to privatize Medicare. Enter Dr. Oz.

Oz wants Medicare Advantage For All. Trump’s pick to lead the Centers for Medicare and Medicaid Services, TV salesman and failed Senate candidate Dr. Mehmet Oz, is a major proponent of Medicare Advantage and has lobbied to “save” our health care system by privatizing Medicare completely — a plan he calls Medicare Advantage for All. Expanding the program could make Oz even richer: Financial disclosures reveal the good doctor and his wife own up to $600,000 worth of stock in UnitedHealth Group and CVS Health/Aetna, which offer Medicare Advantage plans. In all, the Ozes have at least $8.5 million in personal investments in the health care sector. Dr. Oz will answer questions about his conflicts of interest before the Senate Finance Committee tomorrow.

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Full Medicaid expansion in Georgia – more than 10 years overdue

“It is unconscionable for Governor Deal to stand in the way of the availability of health care… We are paying the overwhelming cost of this program already through our federal taxes… (Georgia resident’s) taxes will fund health care for people in…other states that have opted in. Does our governor listen to the people who cannot afford health care and to others who are concerned about those folks? Give him a chance — but make sure he hears from you”. – Atlanta Journal-Constitution reader Truman Moore in 2013 letter to the editor.

https://www.newsfromthestates.com/article/full-medicaid-expansion-georgia-more-10-years-overdue?

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Social Security Administration to require in-person identity checks for new and existing recipients In an effort to limit fraudulent claims, the Social Security Administration will impose tighter identity-proofing measures. Millions of recipients and applicants will be required to visit agency field offices rather than interact with the agency over the phone. Read more.

Why this matters: Beginning March 31st, people will no longer be able to verify their identity to the SSA over the phone. Those who cannot properly verify their identity over the agency’s “my Social Security” online service will be required to visit an agency field office in person to complete the verification process, agency leadership told reporters Tuesday.    Retiree advocates warn that the change will negatively impact older Americans in rural areas, including those with disabilities, mobility limitations, those who live far from SSA offices and have limited internet access. More than 72.5 million people, including retirees and children, receive retirement and disability benefits through the Social Security Administration.   The plan also comes as the agency plans to shutter dozens of Social Security offices throughout the country and has already set out plans to lay off thousands of workers. The DOGE website says that leases for 47 Social Security field offices across the country, including in Arkansas, Texas, Louisiana, Florida, Kentucky and North Carolina, have been or will be ended.

RELATED COVERAGE ➤ Top House Democrats seek DOGE details, questioning if it operates ‘outside the bounds’ of US law   Violent attacks on Tesla dealerships spike as Musk takes prominent role in Trump White House   Rep. Mike Flood of Nebraska is the latest GOP member of Congress to face angry crowds back home

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A list of the Social Security offices across the US expected to close this year

Dozens of Social Security Administration offices across the country are slated to close this year due to actions taken by Elon Musk’s Department of Government Efficiency as part of the Trump administration’s unprecedented effort to shrink the size of government. Read More.   California has a $6.2 billion Medicaid funding gap partly due to expanding immigrant coverage The shortfall comes a year after California launched an ambitious coverage expansion to provide free health care to all low-income adults regardless of their immigration status. That’s costing far more than the state projected. Read More.

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The Affordable Care Act’s 15th birthday. Yesterday, former President Barack Obama celebrated the 15-year anniversary of Democrats using their public mandate to block a public, single-payer health insurance option. The law included some long-overdue reforms but it also strengthened the financial and political power of insurance companies.

The death of the public option. Obama campaigned for the U.S. Senate as a proponent of single-payer health care, promising that such a system would be possible once Democrats won power. However, he backed off once elected and pretended he didn’t just campaign on that promise, telling The Lever’s David Sirota he was concerned about protecting insurance industry jobs, and ultimately killing off a public option that could compete with private insurers. Then in 2009, Obama’s new presidential administration officially declared that any single-payer proposals would not be considered in the health care policy debate.  

A plan that originated at the Heritage Foundation. Obama boasted that the ACA was rooted in ideas from Sen. Mitt Romney (R-Utah) and the conservative Heritage Foundation. After the law passed, the Heritage Foundation joined with Republicans in pushing to repeal the ACA while attacking its most valuable parts, including the expansion of Medicaid.

Today’s results are, ahem, mixed. Since the ACA’s passage, the number of uninsured Americans has been nearly halved. Simultaneously, the largest insurers have raked in $371 billion of profits as the average employer-based premium for a family has jumped to $26,000 per year — far outpacing increases in workers’ wages. Insurance plans purchased on the ACA exchanges are denying one out of every five medical claims. Moreover, Obamacare has ushered in the consolidation of health care industry conglomerates, giving them more power to fleece consumers on insurance, hospital services, and prescription drugs. 

Even Obama knows the ACA is inadequate. Obama this week asserted that the “ACA is like a starter house: it was a big step forward, but still just a first step.” Two years after he left office, he touted his party’s support of single-payer, saying “Democrats aren’t just running on good old ideas like a higher minimum wage, they’re running on new ideas, Medicare for All.” In his 2020 campaign, former President Joe Biden took up Obama’s promise to create a public option, but once elected, he never mentioned the idea in public again.

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Social Security

The Social Security Administration has decided to backtrack on its plan to require all applicants filing for benefits to complete their claims in person or online. Now, only people applying for retirement, survivors or family benefits will have to do so after April 14. Those applying for disability benefits, Supplemental Security Income and Medicare will continue to have the option of filing claims by phone. At a time when the SSA is planning to eliminate 7,000 jobs — or about 12% of its staff — and close some local offices, this new policy could force people to travel long distances and wait longer for service or payments.

 

Are you worried about the changes at the Social Security Administration? Share your thoughts here.

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Social Security Administration backtracks on some ID requirements after backlash The Social Security Administration is partially backtracking on a plan that would require all new and existing beneficiaries to travel to a Social Security field office to verify their identity. Read more.

What to know: The Social Security Administration on Wednesday said that people applying for Social Security Disability Insurance, Medicare, or Supplemental Security Income who are not able to use agency’s online portal can complete their claim entirely over the phone instead of in person. Other SSA applicants will still be required to verify their identities at a field office.

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Many Social Security recipients will have to confirm identity in person to receive benefits

Using phone services to verify identity will no longer be available beginning April 14, 2025.

Claim:

Many new and existing Social Security beneficiaries will be able to verify their identities only by using an online system or going to a Social Security office.

Rating: True

Context

The change applies to new Social Security beneficiaries and those seeking to change their direct deposit information. Those who cannot verify their identity through the online "my Social Security" system will have to do so in person at a Social Security office. The Social Security Administration initially announced this change would take place after March 31, 2025, but later said it would go into effect April 14, 2025.