鈥楧ark Money鈥 Group Angles for Higher Medicare Advantage Payments
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Medicare
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Medicare Advantage 鈥楧ark Money鈥 Group Attempts To Win Higher Payments for Insurance Companies
Medicare Advantage insurers say a proposal by the Trump administration to keep their payments nearly flat next year may lead to service cuts that harm seniors struggling to afford health care. A decision is due by early next month.
RFK Jr.鈥檚 Very Bad Week
Episode 437HHS Secretary Robert F. Kennedy Jr. had another tough week. In addition to Kennedy having rotator cuff surgery, the nomination of his ally to become surgeon general is teetering, the controversial head of the FDA's vaccine center is resigning next month, and a new survey shows Americans trust government health officials less than they do former Biden official Anthony Fauci. Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Shefali Luthra of The 19th join 51视频 Health News鈥 Julie Rovner to discuss these stories and more.
40 Years of Health Policy
Episode 436This month is 40 years since host Julie Rovner, chief Washington correspondent for 51视频 Health News, began reporting on health policy in Washington. To mark the anniversary, Rovner is joined by two longtime sources to discuss what has 鈥 and has not 鈥 changed since 1986.
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Even Patients Are Shocked by the Prices Their Insurers Will Pay 鈥 And It Costs All of Us
Health care prices are on the rise, and patients are flummoxed that even insurance companies aren鈥檛 doing more to control costs.
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鈥楰ind of Morbid鈥: Health Premiums Threaten Their Nest Egg. A Terminal Diagnosis May Spare It.
Chaz and Jean Franklin were facing a sevenfold increase in their health premium payments with the expiration of enhanced federal subsidies for Affordable Care Act plans at the end of 2025. Then Jean received a crushing diagnosis that will claim her life but save the couple money.
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When It Comes to Health Insurance, Federal Dollars Support More Than ACA Plans
Questions of fairness came up in last year鈥檚 congressional debate about extending Obamacare鈥檚 enhanced subsidies. Critics wondered why the federal government should underwrite coverage costs for people with ACA coverage. In truth, though, almost all health insurance in the U.S. comes with some federal help.
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Trump Required Hospitals To Post Their Prices for Patients. Mostly It鈥檚 the Industry Using the Data.
Politicians have pushed for price transparency in health care. But instead of patients shopping for services, it鈥檚 mostly health systems and insurers that are using the information, as fodder for negotiations over pay.
By Darius Tahir -
New Medicaid Work Rules Likely To Hit Middle-Aged Adults Hard
Republicans have said new rules requiring many Medicaid participants to work 80 hours a month will pinpoint unemployed young people who should have jobs. Policy researchers say the rules are more likely to disrupt coverage for middle-aged adults, harming their physical and financial health.
By Samantha Liss and Sam Whitehead -
Blurry Line Between Medical and Vision Insurance Leaves Patient With Unexpected Bill
A Wisconsin retiree with glaucoma needed her eyes examined. Her Medicare Advantage plan from UnitedHealthcare listed her optometrist鈥檚 clinic as in-network, but she learned the hard way that a clinic can be in-network and out-of-network at the same time.
By Tony Leys The Hazards of ICE for Public Health
Episode 431The Trump administration鈥檚 immigration crackdown is not just roiling politics but also directly affecting the provision of health care, medical groups say. Meanwhile, in Washington, federal spending bills have been stalled by the fight over immigration enforcement funding after the shooting death of a second person in Minneapolis this month. Maya Goldman of Axios, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post join 51视频 Health News鈥 Julie Rovner to discuss those stories and more.
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Medicare Advantage Insurers Face New Curbs on Overcharges in Trump Plan That Reins in Payments
Proposed Trump administration changes to federal Medicare Advantage payments would stop health insurers from mining patient data for extra medical diagnoses that generate more bills to taxpayers even without treatment.
By Fred Schulte -
Sick of Fighting Insurers, Hospitals Offer Their Own Medicare Advantage Plans
Breakups between insurers and health systems, on top of plan cuts, left more than 3.7 million Medicare Advantage enrollees facing a tough choice last year: find new insurance or new doctors. But hospital systems say their Advantage plans can avert such upheaval, giving patients peace of mind.
By Susan Jaffe -
These 3 Policy Moves Are Likely To Change Health Care for Older People
Two Trump administration regulatory rollbacks affect nursing home staffing and home care workers, and a new AI experiment in Medicare has alarmed eldercare advocates and congressional Democrats.
By Paula Span -
Kaiser Permanente To Pay $556 Million in Record Medicare Advantage Fraud Settlement
Kaiser Permanente agrees to pay $556 million to settle allegations of billing the government for conditions patients didn鈥檛 have.
By Fred Schulte -
The New Old Age
Older Americans Quit Weight Loss Drugs in Droves
In some studies, half of patients stopped taking GLP-1s within a year despite the benefits, citing the expense and side effects.
By Paula Span -
Watch: What Do Republicans Really Want on Health Care?
On 鈥淲hat the Health? From 51视频 Health News,鈥 distributed by WAMU, chief Washington correspondent and podcast host Julie Rovner sat down with Avik Roy, a GOP health policy adviser, to talk about how health care has evolved as a Republican Party issue.
By Julie Rovner -
Republicans Left Tribes Out of Their $50B Rural Fund. Now It鈥檚 Up to States To Share.
The Trump administration has championed its Rural Health Transformation Program as an investment in American families who have been left behind. But Native American tribes, whose communities have a significant presence in rural America and have some of the greatest health needs, are ineligible to apply directly for funding.
The GOP Circles the Wagons on ACA
Episode 423Republicans are solidifying their opposition to extending pandemic-era subsidies for Affordable Care Act plans and seem to be coalescing around giving money directly to consumers to spend on health care. Meanwhile, HHS Secretary Robert F. Kennedy Jr. continues to leave his mark on the agency, with the CDC altering its website to suggest childhood vaccines could play a role in causing autism. Paige Winfield Cunningham of The Washington Post, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Shefali Luthra of The 19th join 51视频 Health News鈥 Julie Rovner to discuss those stories and more. Also this week, Rovner interviews Avik Roy.
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Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
Health systems drop out of Medicare Advantage plans all the time. Yet government documents obtained by 51视频 Health News show that federal regulators rarely warn plans that their networks of health providers are so skimpy they violate legal requirements.
By Susan Jaffe