Employers Haven’t a Clue How Their Drug Benefits Are Managed
The Big Three pharmacy benefit managers say they return nearly all the rebates they get from drugmakers to the employers and insurers who hire them. But most employers seem to doubt that.
Insurance
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What’s New and What To Watch For in the Upcoming ACA Open Enrollment Period
This year’s start date in most states is Nov. 1, and consumers may encounter new scams as well as important rule changes.
The Health of the Campaign
Episode 366The 2024 presidential race is taking on a familiar tone — with Democrats accusing Republicans of wanting to ban abortion and repeal the Affordable Care Act and Republicans insisting they have no such plans. Voters will determine whom they believe. Meanwhile, for the second time in a month, a state judge overturned an abortion ban, but few expect the decision to settle the matter. Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Anna Edney of Bloomberg News join ϳԹ News chief Washington correspondent Julie Rovner to discuss these stories and more. Also this week, Rovner interviews ϳԹ News’ Lauren Sausser, who reported and wrote the latest ϳԹ News-Washington Post “Bill of the Month,” about a teenage athlete whose needed surgery lacked a billing code.
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Harris Correct That Trump Fell Short on Promise To Negotiate Medicare Drug Prices
The former president instead favored a temporary model that could’ve brought down prices of some prescription drugs, but it was blocked by the courts.
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Vance-Walz Debate Highlighted Clear Health Policy Differences
The vice presidential debate showcased the very different views of Ohio Republican Sen. JD Vance, Donald Trump’s running mate, and Democratic Gov. Tim Walz, Kamala Harris’ VP pick, on health policies past and present.
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Some Employers Test Arrangement To Give Workers Allowance for Coverage
Employers are showing interest in a type of health reimbursement account that gives workers a contribution to choose and buy their own plans, rather than participating in group plans.
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The Medicare Advantage Influence Machine
New court filings and lobbying reports reveal an industry drive to tamp down critics — and retain billions of dollars in overcharges.
By Fred Schulte and Holly K. Hacker -
Journalists Weigh In on Racial Trauma, Medicaid Expansion, and Opioid Settlements
ϳԹ News and California Healthline staffers made the rounds on national and local media recently to discuss topical stories. Here’s a collection of their appearances.
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In Chronic Pain, This Teenager ‘Could Barely Do Anything.’ Insurer Wouldn’t Cover Surgery.
An Alabama teen was told he needed surgery for debilitating hip pain. But his family’s insurer denied coverage for the procedure, which lacked a medical billing code. Expected to pay more than $7,000, his father charged it to credit cards.
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Vance Rewrites History About Trump and Obamacare
During the Trump administration, enrollment in Affordable Care Act health plans fell by more than 2 million people and the number of uninsured Americans rose.
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California Medicaid Ballot Measure Is Popular, Well Funded — And Perilous, Opponents Warn
Proposition 35, which would use revenue from a tax on managed-care plans to raise the pay of health care providers who serve Medi-Cal patients, has united a broad swath of California’s health care, business, and political establishments. But a newly formed, smaller group of opponents says it will do more harm than good.
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These Alabama Workers Were Swamped by Medical Debt. Then Their Employer Stepped In.
A decades-old manufacturing company opened a clinic and made primary care and prescriptions free for employees and their families.
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California May Regulate and Restrict Pharmaceutical Brokers
California lawmakers are moving to rein in the pharmaceutical middlemen they say drive up costs and limit consumers’ choices. The bill sent to Gov. Gavin Newsom would require pharmacy benefit managers to be licensed in California and would ban some business practices. Newsom vetoed a previous effort three years ago.
By Don Thompson -
Arkansas’ Governor Says Medicaid Extension for New Moms Isn’t Needed
Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days after delivery. Arkansas has not expanded what’s called postpartum Medicaid coverage, an option that gives poor women uninterrupted health insurance for a year after they give birth.
By Sarah Varney -
Tossed Medicine, Delayed Housing: How Homeless Sweeps Are Thwarting Medicaid’s Goals
As California cities crack down on homeless encampments in the wake of a U.S. Supreme Court ruling authorizing fines and arrests, front-line workers say such sweeps are undercutting billions in state and federal Medicaid spending meant to stabilize people’s health and get them off the streets.
By Angela Hart -
The First Year of Georgia’s Medicaid Work Requirement Is Mired in Red Tape
Georgia must decide soon whether to try to extend a limited Medicaid expansion that requires participants to work. Enrollment fell far short of goals in the first year, and the state isn’t yet able to verify participants are working.
By Renuka Rayasam and Sam Whitehead -
‘What Happens Three Months From Now?’ Mental Health After Georgia High School Shooting
The recent shooting at Apalachee High School outside of Atlanta caused more than physical wounds. Medical experts worry a lack of mental health resources in the community — and in Georgia as a whole — means few options for those trying to cope with trauma from the shooting.
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Trump, Harris Spar Over Abortion Rights and Obamacare in Their First Face-Off
The generally combative face-off was marked by a series of false and sometimes bizarre statements from former President Donald Trump.