HealthCare, Medicare, Medicaid, and Social Security

[phkrause]

This Little-Known Appeal Could Force Your Insurer to Pay for Lifesaving Care. Here’s How to File It.

When a health insurance company refuses to pay for treatment, most people begrudgingly accept the decision.

https://www.propublica.org/article/health-insurance-denial-external-review?

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Social Security recipients get a 2.8% cost-of-living boost in 2026, average of $56 per month

WASHINGTON (AP) — The Social Security Administration’s annual cost-of-living adjustment will go up by 2.8% in 2026, translating to an average increase of more than $56 for retirees every month, agency officials said Friday.

https://apnews.com/article/retirement-social-security-trump-bessent-0be15d5f1285cd1b774a8f5c59167b90?

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Health insurance

Open enrollment is underway for 2026 health insurance under the Affordable Care Act as Congress remains deadlocked over whether to extend Obamacare's enhanced premium subsidies. Without the subsidies — set to expire in December — many Americans will see steep increases in next year's premiums. Congressional Democrats insist that any federal funding package contain an extension of the beefed-up subsidies. Republicans say they'll only discuss the matter after the government reopens. The monthly premium for the benchmark plan on healthcare.gov will soar 30%, on average, according to an analysis by the health policy research group KFF.

[phkrause]

Who will get hit hardest by ACA premium increases in four charts

Open enrollment for 2026 coverage on the Affordable Care Act exchanges is underway. And millions of consumers are now seeing just how expensive their health insurance policies will be without the enhanced premium subsidies that have been in place since 2021.

https://www.cnn.com/2025/11/07/politics/aca-premium-increases-subsidies-charts-vis

[bonnie1962]

On 11/9/2025 at 12:40 PM, phkrause said:

Who will get hit hardest by ACA premium increases in four charts

Open enrollment for 2026 coverage on the Affordable Care Act exchanges is underway. And millions of consumers are now seeing just how expensive their health insurance policies will be without the enhanced premium subsidies that have been in place since 2021.

https://www.cnn.com/2025/11/07/politics/aca-premium-increases-subsidies-charts-vis

Wonder what the response would be if instead of the sanitized "enhanced premium subsidies" it was said a little more bluntly. "The money taken from you(taxpayer)"by demand is called subsidies for others"

A medical specialist I have been seeing for awhile made a statement that applies here very well.. Your body has robed Peter to pay Paul for some time, Peter is now bankrupt and Paul's  source has dried up

 

 

 

 

Let’s talk about why Republicans rejected the ACA subsidy extension inside the shutdown bill…without emotion, without headlines, just facts.

Senator Schumer has suggested extending the temporary ACA subsidies for another year as part of the bill to reopen the government….

But here’s the part that most headlines leave out:

To extend those subsidies for one year, the government would have to send ~$35 billion directly to health insurance companies…with no requirement that premiums go down.

That means:

• Taxpayer money goes to insurers

• Insurance companies keep their profit structure

• And your premiums and deductibles may not change at all

So when Republicans say “not like this,” that’s what they’re talking about.

This is not about “not wanting healthcare for Americans.”

It’s about refusing to approve $35 billion in payments to insurance corporations without any commitment to lower actual costs for families…

And here’s the second piece:

Republicans said:

Reopen the government first.

Then debate healthcare separately, in the open, where everyone can see the details.

Democrats said:

No…the government stays shut until the subsidies are included….

So the shutdown isn’t about:

• Who cares more

• Who is compassionate

• Who is cruel

It’s about leverage…

And while both sides negotiate strategy…

• Service members are going without pay

• Federal workers are missing checks

• Veterans’ housing programs are stalled

• Early childhood education (Head Start) is at risk

• Rural hospitals are losing support

All of that could be funded right now with a clean bill…

No one is saying the ACA subsidies can’t be debated…

Republicans are saying don’t tie them to keeping the government open…

Fund the government.

Pay our people.

Then debate the long-term healthcare solutions transparently…not under shutdown pressure.

This isn’t extreme.

It’s reasonable governance.

Faith. Family. Freedom.

And accountability…no matter which party you vote for.

 

 

 

[phkrause]

Health insurance hikes could force North Dakotans to go uninsured

A financial and health care cliff lies just ahead for as many as 35,000 residents of our state. That’s significantly more people than the total population of most of our cities and towns, like Dickinson, Williston or Mandan, and more than the populations of Jamestown and Valley City combined.

https://www.newsfromthestates.com/article/health-insurance-hikes-could-force-north-dakotans-go-uninsured?

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Social Security's day of reckoning is nearly here

Illustration: Sarah Grillo/Axios

For decades, people have fretted that America's bedrock retirement income program would run out of money, Axios chief economics correspondent Neil Irwin writes. But Social Security's rocky fiscal future is an issue for the here and now. The big picture: The Social Security retirement fund — the government's pot of money for paying retirees — is set to be depleted in 2033. At that point, recipients would see a steep cut to their monthly checks absent congressional action. ⏰ U.S. Senate candidates in next year's midterms could face the looming insolvency at the end of their terms — putting the issue on the ballot just 11 months from now. ? "This is a tinderbox issue," Gopi Shah Goda, director of the Retirement Security Project at the Brookings Institution, tells Axios. "It's hard to deal with because it's a long-term problem — but that time is coming." Zoom out: This predicament has its roots in forces that have been known for decades. ? There were 3.4 workers — people earning an income and paying into the system — per Social Security beneficiary at the turn of the 21st century. That's down to about 2.7 now and on track to reach 2.3 in a decade. Reality check: "We have gone 40 years knowing exactly what was coming for us," said AEI's Biggs. "If you want to know where Social Security is today, read the New York Times from 1990." The problem is that the solutions are painfully zero-sum and politically unpalatable, with every dollar of benefits maintained for a recipient translating into a tax increase for someone else. The possible solutions fall into three buckets: ? Taxes can be raised. ✂️ Benefits can be cut. ⏲️ The structure of Social Security could be changed to delay the reckoning. The bottom line: The good news is there is no political appetite for large-scale cuts, and in some form, Social Security will almost certainly be there for you. The bad news is that America faces a costly and potentially tempestuous reckoning over how to make that the case. Go deeper.

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Affordable Care Act enrollment is slightly ahead of last year so far, despite expiring subsidies

NEW YORK (AP) — The number of Americans signing up for Affordable Care Act health insurance for 2026 is moderately higher than it was at a similar time last year, initial new federal data shows, even as subsidies set to expire at the end of 2025 will make the coverage more expensive for many.

https://apnews.com/article/affordable-care-act-enrollment-subsidies-health-90ad8b27a6693c5aa03a9ca841048479?

[phkrause]

Medicaid paid more than $207 million for dead people. A new law could help fix that

Medicaid programs made more than $200 million in improper payments to health care providers between 2021 and 2022 for people who had already died, according to a new report from the independent watchdog for the Department of Health and Human Services. The office recommends that the federal government share more information including a Social Security database known as the Full Death Master File, which has been tightly restricted due to privacy laws. Read more.

[phkrause]

Should high earners support scrapping Social Security’s cap on taxable earnings?

Earnings above a cap aren’t subject to the payroll taxes that fund Social Security. As a result, billionaires pay the same tax as someone earning $176,100 in 2025 (the cap is indexed to the average wage, so it changes every year).

https://www.epi.org/blog/should-high-earners-support-scrapping-social-securitys-cap-on-taxable-earnings/?

Raising taxes on the ultrarich

The public has supported raising taxes on the ultrarich and corporations for years, but policymakers have not responded. Small increases in taxes on the rich that were instituted during times of Democratic control of Congress and the White House have been consistently swamped by larger tax cuts passed during times of Republican control. This was most recently reflected in the massive budget reconciliation bill pushed through Congress exclusively by Republicans and signed by President Trump. This bill extended the large tax cuts first passed by Trump in 2017 alongside huge new cuts in public spending. This one-step-forward, two-steps-back dynamic has led to large shortfalls of federal revenue relative to both existing and needed public spending.

https://www.epi.org/publication/raising-taxes-on-the-ultrarich-a-necessary-first-step-to-restore-faith-in-american-democracy-and-the-public-sector/?

[phkrause]

Health care sticker shock coming

Illustration: Sarah Grillo/Axios More than 20 million Americans who buy health insurance on Affordable Care Act marketplaces are set to see their premiums more than double next year, Axios Future of Health Care author Caitlin Owens writes. Why it matters: Enhanced ACA subsidies — which lower health insurance costs on marketplaces — will expire tomorrow. ? By the numbers: ACA insurers themselves are raising premiums by an estimated 26%, in part due to rising hospital costs, higher demand for pricey drugs and the threat of tariffs. But add in the loss of those federal subsidies, and the increase is 114% — or more than double what enrollees currently pay, according to KFF. 22 million out of 24 million marketplace enrollees now receive subsidies. Zoom out: Democrats are planning to hammer Republicans for high costs in all forms of health insurance ahead of next year's midterm elections. Go deeper.

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? Major health leaps

Data: Gallup. Chart: Axios Visuals Americans are getting healthier as researchers make major medical advances: Booze: American drinking hit a 90-year low. Just 54% of adults reported drinking liquor, wine or beer, Gallup found. High schoolers are drinking less too: 41% of 12th graders reported drinking in the past 12 months, down from 75% in 1997. Advancements in GLP-1s: More Americans use weight-loss drugs, including Wegovy and Ozempic, that show potential to lower the risk of everything from addiction to sleep apnea. The uptake coincides with a meaningful drop in America's obesity rate. CRISPR: A 9-month-old born with a rare genetic disorder became the first person successfully treated with personalized CRISPR gene editing therapy. COVID: Coronavirus deaths hit remarkable lows even compared to 2024. The virus fell out of the top 10 list for causes of death in the U.S.

[phkrause]

Health care policy

The Affordable Care Act's enhanced premium subsidies are set to expire after today, leaving millions of Americans facing higher health insurance costs in 2026. While the House is expected to vote in January on a Democratic proposal to extend them for three years, the effort faces significant hurdles in the Senate. This comes after Democratic lawmakers refused to fund the federal government this fall unless the subsidies were renewed, leading to a record-long shutdown that only ended in mid-November with an agreement to hold a vote in the Senate on the matter. Both Democratic and Republican health care bills failed to pass the chamber in mid-December.

[phkrause]

? 2026 Social Security changes

Illustration: Sarah Grillo/Axios Social Security retirement and disability benefits for 2026 will begin rolling out for millions of Americans starting this week, Axios' Kelly Tyko reports. ? Benefits are rising 2.8%, or about $56 a month for the average retiree. Higher Medicare premiums and tax rules will determine how much of that increase ends up in retirees' pockets. ? The adjustment is higher than 2025's 2.5% increase, but below the decade average of 3.1%. Go deeper.

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? Mapped: Healthiest states

Data: United Health Foundation. Cartogram: Axios Visuals A state-by-state health report card, out today from the United Health Foundation, finds an array of encouraging signs for America: Rates for premature death, drug deaths, firearm deaths and homicides all fell. Rates of cancer screenings, physical activity and volunteerism all increased. But rates of e-cigarette use and multiple chronic conditions increased. Homelessness and unemployment — socioeconomic factors that help determine the nation's health — rose. Why it matters: America's Health Rankings — from the United Health Foundation, established by UnitedHealth Group — synthesize 99 measures of health and well-being, drawn from 31 data sources, to produce a "comprehensive portrait of health at both the national and state levels." The five healthiest states, based on social and economic factors, physical environment, clinical care, behaviors and health outcomes: 1. New Hampshire ... 2. Massachusetts ... 3. Vermont ... 4. Connecticut ... 5. Utah. The least healthy states: 46. West Virginia ... 47. Alabama ... 48. Mississippi ... 49. Arkansas ... 50. Louisiana. Explore the data ... 2-page report cards for 50 states + D.C. ... PDF of report.

[phkrause]

? First AI drug prescriptions

Illustration: Gabriella Turrisi/Axios

Utah regulators are allowing AI to prescribe some drugs — the first prescriptions in the nation to be filled by a bot rather than a doctor, Axios Salt Lake City's Erin Alberty writes. Why it matters: Proponents say AI will save patients money and time, especially in rural areas, where physicians are few and far between. State officials launched the pilot program last month via New York-based tech startup Doctronic, which uses AI to refill certain prescriptions for patients with chronic conditions. 190 commonly prescribed drugs are eligible. Some medications, such as painkillers, injectables and ADHD drugs, are excluded. ? How it works ...

[phkrause]

🏥 Musk celebrates Medicaid win

Elon Musk took a victory lap yesterday as a DOGE team released a huge trove of Medicaid spending data he said the public could use to look for fraud themselves, Axios's Adriel Bettelheim and Maya Goldman write.

• Why it matters: The Trump administration often cites waste as justification for deep program cuts — including the nearly $1 trillion in reductions to federal Medicaid spending in last year's Republican budget bill.

Between the lines: The public release could make it possible to identify high-billing Medicaid providers and unusual patterns — including alleged fraudulent autism diagnoses and treatments in Minnesota that were billed by Medicaid providers, The Wall Street Journal wrote in an editorial (gift link).

• The administration used Minnesota's inability to rein in fraud in safety net programs as justification for freezing federal child care funding and launching the ICE enforcement surge that targeted the state's Somali community.

[phkrause]

Health care affordability

Tens of millions of Americans are making drastic budget sacrifices – like forgoing food, driving less or borrowing money – to cover their health care bills, according to a new survey by West Health-Gallup Center released today. It comes at a time when health care spending is on the rise, in part because the country’s health is on the decline, according to West Health, a nonprofit group focused on health care affordability.

[phkrause]

Health care's next revolution

Illustration: Sarah Grillo/Axios

One day, wearable health tech could save your life. Scientists are training AI algorithms on early disease detection and the identification of potentially fatal risks like sepsis and heart disease, Axios health care editor Adriel Bettelheim reports. ⚡️ State of play: AI underpins apps, wearables and Bluetooth-connected devices that help people manage chronic conditions like diabetes, recover from surgery, and treat depression and addiction. 👩🏻‍⚕️ For example: The FDA just greenlit an AI virtual care assistant for patients recovering from joint replacement surgery. It performs regular check-ins and can contact the physician if there are complications. The impact: These kinds of technologies could help close critical gaps in care, like the nation's shortage of behavioral health professionals. And AI can eliminate clinicians' near-total reliance on patients to report how they feel and whether they're really following their doctor's instructions.

[phkrause]

Why some people put relatives into poverty to pay for nursing homes Eldercare experts say an approach to consider, especially if the person needing care is middle-class or of modest means, is to deliberately, but systematically, put yourself or a relative into poverty so Medicaid picks up the costs of a nursing home or assisted living services sooner than later. This is known as a Medicaid “spend down” strategy. Read more.

Why this matters: The U.S. Department of Health and Human Services estimates that more than half of people over age 65 will need help with daily activities such as bathing, dressing or eating at some point, either for an extended period or the rest of their lives. Yet relatively few older Americans have private long-term care coverage. AHIP, a trade association representing the U.S. health insurance industry, estimates that only 3% to 4% of Americans over 50 have an active policy that covers extended care. Medicare, the main health insurance program for older Americans, generally does not pay for continuing support services in a nursing home or assisted-living community.   Deliberately reducing a person’s income and savings to qualify for Medicaid can sound daunting. But without planning, the high cost of long-term care can quickly drain savings anyway. Assisted living and nursing home care can cost thousands of dollars a month, often forcing families to exhaust their resources before qualifying for assistance. Due to the complicated nature of Medicaid eligibility, experts say it’s best to work with eldercare specialists to make sure an individual’s assets are used appropriately and you don’t inadvertently disqualify the person who needs assistance from accessing Medicaid.

RELATED COVERAGE ➤ As the US population ages, more employees are seeking caregiver benefits at work   Retirement savings plans can be used to fund a home down payment. But should you?

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Health plans are working to lower costs for everyone

Health care costs are rising faster than wages and inflation. Health plans negotiate lower prices from providers and drugmakers, protect consumers from unexpected medical bills and support common-sense solutions to tackle the drivers of high and rising costs. Learn more.

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Medicine goes off-script

Illustration: Brendan Lynch/Axios. Stock: Getty Images

Your doctor's new prescription might be for a fishing rod, or other goods or services you won't find at a pharmacy, Axios' Natalie Daher writes. With the rise of "social prescribing," physicians are sending patients to choirs, art studios, walking clubs and lakesides. Why it matters: Overstretched health systems and a worsening loneliness epidemic are forcing a hard look at how social interventions can improve mental and physical health. 🏥 "The hope is that the care might not merely help address crises such as hospital waitlists and overreliance on prescription medications, but also tackle broader problems including social isolation," Andrew Dickson writes for Bloomberg (gift link). 🎨 Social prescribing can include helping people get affordable produce, or directing patients to paint or volunteer. Zoom in: The U.K. has been leading the charge globally. The National Health Service (NHS) has offered social prescribing since 2019, as part of a $6 billion primary care expansion. That push has produced more than 5.5 million referrals in England over five years — far exceeding the original 900,000 target. Social prescribing started in impoverished areas to help people with complex medical needs who also faced social and economic obstacles. The most common prescriptions still are for housing advice and debt counseling. But nature activities and arts engagement are also common, according to the umbrella organization National Academy for Social Prescribing. 🎣 Case in point: A small nonprofit in Kent, England — Cast a Thought — has hosted 280+ participants on fishing outings funded by a mix of NHS and charitable support. Participants may arrive with all types of overlapping conditions, including PTSD, depression and hypertension. Evidence of health benefits from social prescribing is growing: A large English cohort study cited by University College London's Daisy Fancourt found that people who engage in creative activities at least monthly are roughly half as likely to develop depression. A 2020 global meta-analysis found that surgical patients who listened to music used fewer opioids and reported less pain. 📊 Smaller efforts are spreading elsewhere: The Netherlands has offered "well-being prescriptions" for more than 15 years, subsidizing activities like cycling clubs, museum visits and tai chi. Social Prescribing USA, a nonprofit, is aiming for nationwide access to services like art or music therapy, dance classes and outdoor activities for every American by 2035. The bottom line: If a day of fishing leads to one less pang of loneliness, that's a win.

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Health plans are advocates for affordability

U.S. health care spending hit $5.3 trillion in 2024, driven by rising prices for hospital care, doctors’ visits and prescription drugs. With prices rising faster than wages and inflation, health plans are working to make quality health care more affordable and accessible for patients. See how.

[phkrause]

🏥 Mapped: Doula care coverage

Adapted from National Health Law Program; Map: Axios Visuals In the map above, "in process" states have a defined path toward Medicaid doula coverage but aren't reimbursing yet. "Adjacent action" states have taken steps to support doula care, Chen says. For example, they may have set up a statewide doula certification process but don't offer Medicaid reimbursement.

[phkrause]

Doulas reshape birth care

Doula Melina Laverde, left, performs cranial sacral therapy on Sanaai Lynae during a postpartum checkup on Destyni McClain in Houston in 2025. Photo: Ashleigh Lucas/Houston Chronicle via Getty Images Doula care is becoming more mainstream — fast. Why it matters: More than half of the states now cover doula services through Medicaid, a major shift for a once-niche birth option that's tied to better outcomes for moms and babies. Zoom in: Doula support is linked to lower C-section rates and fewer preterm births — while potentially lowering overall health system costs. 🩺 A new review of clinical trials published today in JAMA Network Open found doula support was most consistently associated with less maternal anxiety, greater breastfeeding initiation and better postpartum follow-up care. How it works: Doulas provide continuous, nonmedical support — emotional coaching, advocacy and physical comfort — distinct from midwives, who perform clinical tasks. That can include offering encouragement and helping with position changes during labor and delivery, and advocating for the patient's wishes in the hospital, says Nicole Sessions, an experienced doula and maternal mental health researcher. Doulas also provide emotional and informational support during pregnancy and postpartum. 💰 By the numbers: 26 states and D.C. are actively reimbursing for Medicaid coverage of doula care, according to the National Health Law Program. Before 2020, only Oregon and Minnesota offered Medicaid coverage for doula services. That's "a lot of progress" in a few years, says Amy Chen, senior attorney at the National Health Law Program. The latest: UnitedHealthCare recently announced it would allow for coverage of doula care in employer-sponsored programs nationwide. Only a few states require or will soon mandate doula coverage as part of private insurance plans. 👶 Zoom in: During her first birth, Chen says her doula helped her and her partner advocate to avoid an unwanted incision. Chen's positive doula experience led to her later work on Medicaid coverage for doula care. She had a doula for her next two births. Reality check: Even as doula care spreads, Sessions worries it's becoming "a band-aid" — absorbing pressure that should be driving deeper reform of the overall obstetric system. 🌱 The bottom line: Doula care is expanding quickly. But without adequate reimbursement, hospital integration and systemic reform, the benefit may exist on paper more than in practice.