Category: Federal agencies

Harris or Trump? Health in the US election

Volume 404, Issue 10464
2 November 2024 
WORLD REPORT  Aside from abortion, health issues have largely been neglected in the run-up to the Nov 5 election. What have the candidates proposed to improve health? Susan Jaffe reports.

As election day approaches on Nov 5, the US presidential race remains a tense and close competition despite unprecedented events—the Democratic candidate was  replaced in August, and two attempts have been made to assassinate the Republican candidate. And despite the sharp contrast between former President Donald Trump, a Republican, and Democrat Vice President Kamala Harris, neither has so far managed to emerge as the frontrunner as The Lancet went to press. [Here‘s what the candidates say they would do on abortion, Affordable Care Act and other key health issues.]…

Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More. 

Improvements to Medicare drug coverage required by the  IRA are the most sweeping changes since Congress added  the benefit in 2003, but most voters don’t know about them. And some beneficiaries may be surprised by a downside: premium increases.

By Susan Jaffe | KFF Health News | October 21, 2024

When Pam McClure learned she’d save nearly $4,000 on her prescription drugs next year, she said, “it sounded too good to be true.” She and her husband are both retired and live on a “very strict” budget in central North Dakota.
By the end of this year, she will have spent almost $6,000 for her medications, including a drug to control her diabetes.
McClure, 70, is one of about 3.2 million people with Medicare prescription drug insurance whose out-of-pocket medication costs will be capped at $2,000 in 2025 thanks to the Biden administration’s 2022 Inflation Reduction Act….
“It’s wonderful — oh my gosh. We would actually be able to live,’’ McClure said. “I might be able to afford fresh fruit in the  wintertime.”    [Continued in KFF Health News, CBS NEWS, Los Angeles Times, and The Atlanta Journal-Constitution.]
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Why aren’t the Republicans talking about health?

Volume 403, Issue 10450
27 July 2024 

WORLD REPORT  Health-care issues were conspicuously absent from the 4-day party convention culminating in Donald Trump’s nomination as the Republican 2024 presidential candidate. Susan Jaffe reports.

Former US President Donald Trump spent 93 minutes accepting the Republican Party’s nomination for president last week, exceeding his own 2016 record for the longest acceptance speech at a political convention. But there was no time to mention major health-care issues such as abortion, the COVID-19 pandemic, medical research funding, the Affordable Care Act (ACA), or the opioid epidemic, to name a few. Yet domestic and global healthcare spending consume the largest part of the US budget. [Continued here.]…

Dr. Mandy Cohen’s first year as Director of the Centers for Disease Control and Prevention


23 July 2024 

PROFILE  Mandy Cohn: public health advocate and CDC director

“My North Star has been about building healthier communities”, Dr. Cohen said. “Sometimes that’s about access to doctors and hospitals and sometimes that’s about larger issues, and how we build healthier communities where we live, work, play, and pray.” That goal has motivated Cohen throughout her career. “I loved being a physician, but I’m always thinking about the broader context in which my patients live.” [Full article here.]

 

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US Supreme Court protects access to abortion medication

Volume 403, Issue 10445
22 June 2024 

WORLD REPORT  Justices did not address claims that mifepristone endangered patients and that its approval by the FDA was flawed. Opponents vow to continue the legal fight. Susan Jaffe reports [continued here].

 

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Biden Plan to Save Medicare Patients Money on Drugs Risks Empty Shelves, Pharmacists Say

  • From left, pharmacists Brent Talley of North Carolina, Scott Pace of Arkansas, and Clint Hopkins of California. (ELIZABETH TALLEY; KORI GORDON; JOEL HOCKMAN)

    By Susan Jaffe  | KFF Health News | June 11, 2024 

Months into a new Biden administration policy intended to lower drug costs for Medicare patients, independent pharmacists say they’re struggling to afford to keep some prescription drugs in stock.

This story also ran on Fortune

“It would not matter if the governor himself walked in and said, ‘I need to get this prescription filled,’” said Clint Hopkins, a pharmacist and co-owner of Pucci’s Pharmacy in Sacramento, California. “If I’m losing money on it, it’s a no.”

A regulation that took effect in January changes prescription prices for Medicare beneficiaries. [Full story from KFF Health News, Fortune and Yahoo Finance]

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10 years on: the legacy of the Flint water crisis

Volume 403, Issue 10437
27 April1 2024 

WORLD REPORT  The exposure of residents to lead in drinking water caused a national outcry, prompting requirements to update infrastructure and tighten water quality standards. Susan Jaffe reports.  

“Flint is making an impact beyond Flint”, said Mona Hanna-Attisha, a Flint paediatrician who collected data on children’s lead blood levels in 2015. “We’re sharing those big lessons—the need to respect science, the need to invest in prevention, the need to pay attention to things like infrastructure and inequities, but also the really amazing lesson of doing something about it.”. [Continued here]…

Your Doctor or Your Insurer? Little-Known Rules May Ease the Choice in Medicare Advantage

By Susan Jaffe, KFF Health News | March 29, 2024

Bart Klion (Hans Pennink for KFF Health News)

Bart Klion, 95, and his wife, Barbara, faced a tough choice in January: The upstate New York couple learned that this year they could keep either their private, Medicare Advantage insurance plan — or their doctors at Saratoga Hospital.

The Albany Medical Center system, which includes their hospital, is leaving the Klions’ Humana plan — or, depending on which side is talking, the other way around. The breakup threatened to cut the couple’s lifeline to cope with serious chronic health conditions.

Klion refused to pick the lesser of two bad options without a fight.

..With rare exceptions, Advantage members are locked into their plans for the rest of the year — while health providers may leave at any time. …But a few years ago, CMS created an escape hatch by expanding special enrollment periods, or SEPs, which allow for “exceptional circumstances.” Beneficiaries who qualify can request SEPs to change plans or return to original Medicare. [Continued on KFF Health News]…

Volume 403, Issue 10427  ♦  17 February 2024

 

PROFILE  Dr. Monica Bertagnolli, Director of the National Institutes of Health  

“I imagine a health-care system where clinical decisions are informed in real time by current research data,” the new National Institutes of Health director tells The Lancet. “And one where patients have the opportunity to both contribute their data for research and get back research results so that they can experience the best that science has to offer.” [Susan Jaffe reports here.]…

Imported drugs unlikely to lower US prices any time soon

Volume 403, Issue 10423
20 January 2024 

WORLD REPORT  Americans pay some of the highest prices in the world for prescription drugs, but the decision by the US Food and Drug Administration to allow Florida to import cheaper medications from Canada won’t cut prices any time soon. Although the ruling represents a shift in the decades-long fight for drug importation, opposition from the US pharmaceutical industry, Canadian health officials, and others is expected to block implementation at every stage. [Susan Jaffe reports, here]…

Dodging the Medicare Enrollment Deadline Can Be Costly

By Susan Jaffe, KHN  | December 7, 2023 | This story also ran on  

Angela M. Du Bois, a retired software tester in Durham, North Carolina, wasn’t looking to replace her UnitedHealthcare Medicare Advantage plan. She wasn’t concerned as the Dec. 7 deadline approached for choosing another of the privately run health insurance alternatives to original Medicare.

But then something caught her attention: When she went to her doctor last month, she learned that the doctor and the hospital where she works will not accept her insurance next year.

Faced with either finding a new doctor or finding a new plan, Du Bois said the decision was easy. “I’m sticking with her because she knows everything about me,” she said of her doctor, whom she’s been seeing for more than a decade.

Du Bois isn’t the only one tuning out when commercials about the open enrollment deadline flood the airwaves each year — even though there could be good reasons to shop around. But sifting through the offerings has become such an ordeal that few people want to repeat it. Avoidance is so rampant that only 10% of beneficiaries switched Medicare Advantage plans in 2019.

Once open enrollment ends, there are limited options for a do-over….  [Continued on Kaiser Health News and NPR]…

Uncle Sam Wants You … to Help Stop Insurers’ Bogus Medicare Advantage Sales Tactics

By Susan Jaffe, KHN  | November 30, 2023 | This story also ran on  

People gathered at the U.S. Capitol in Washington, D.C. in July protested denials and delays in private Medicare Advantage plans. (Alex Wong/Getty Image)

After an unprecedented crackdown on misleading advertising claims by insurers selling private Medicare Advantage and drug plans, the Biden administration hopes to unleash a special weapon to make sure companies follow the new rules: you.

Officials at the Centers for Medicare & Medicaid Services are encouraging seniors and other members of the public to become fraud detectives by reporting misleading or deceptive sales tactics to 800-MEDICARE, the agency’s 24-hour information hotline. Suspects include postcards designed to look like they’re from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties.

The new rules, which took effect Sept. 30, close some loopholes in existing requirements by describing what insurers can say in ads and other promotional materials as well as during the enrollment process. [Continued on Kaiser Health News and NPR]…

Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients

By Susan Jaffe, KFF Health News | October 5, 2023

This article also ran in The Washington Post.

Judith Sullivan was recovering from major surgery at a Connecticut nursing home in March when she got surprising news from h when she got surprising news from her Medicare Advantage plan: It would no longer pay for her care because she was well enough to go home.

At the time, she could not walk more than a few feet, even with assistance — let alone manage the stairs to her front door, she said. She still needed help using a colostomy bag following major surgery.

“How could they make a decision like that without ever coming and seeing me?” said Sullivan, 76. “I still couldn’t walk without one physical therapist behind me and another next to me. Were they all coming home with me?”

UnitedHealthcare — the nation’s largest health insurance company, which provides Sullivan’s Medicare Advantage plan — doesn’t have a crystal ball. It does have naviHealth, a care management company bought by UHC’s sister company, Optum, in 2020. NaviHealth’s proprietary “nH Predict” tool sifts through millions of medical records to match patients with similar diagnoses and characteristics, including age, preexisting health conditions, and other factors. Based on these comparisons, an algorithm anticipates what kind of care a specific patient will need and for how long. 

 

…Next year, the Centers for Medicare & Medicaid Services will begin restricting how Medicare Advantage plans use predictive technology tools to make some coverage decisions.[Continued on Kaiser Health News and The Washington Post.]…

US pharmaceutical companies sue to halt cuts in drug prices

Volume 402, Issue 10399
29 July 2023 

 

WORLD REPORT  Medicare will soon be able to negotiate some drug prices to reduce costs for patients and taxpayers. Susan Jaffe reports from Washington, DC.

The first set of ten drugs subject to price negotiations by the US Medicare programme will be unveiled on Sept 1, 2023, but some pharmaceutical companies and their allies are not waiting to find out which products will be on the list. So far, four manufacturers and two trade associations are suing to stop the process before it begins. [Continued here.] 

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US health experts divided on social media age restrictions

27 May 2023
Volume 401, Issue 10390 

WORLD REPORT  Some medical associations support restrictions on social media use to protect adolescent’s health, while others focus on making companies provide safer platforms. 

Laws intended to protect adolescents from the harms of social media are spreading across the USA but, among some of the nation’s leading medical and public health associations, there is not yet a consensus on limiting social media access for young people. Nearly two dozen states are considering legislation. Several have already enacted a patchwork of age restrictions and partial bans. [Continued here.]
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A Covid Test Medicare Scam May Be a Trial Run for Further Fraud

By Susan Jaffe, KHN  | May 18, 2023 | This story also ran on  

Medicare coverage for at-home covid-19 tests ended last week, but the scams spawned by the temporary pandemic benefit could have lingering consequences for seniors.

Medicare advocates around the country who track fraud noticed an eleventh-hour rise in complaints from beneficiaries who received tests — sometimes by the dozen — that they never requested. It’s a signal that someone may have been using, and could continue to use, seniors’ Medicare information to improperly bill the federal government. …One beneficiary in Indiana suspected something was amiss after receiving 32 unrequested tests over a 10-day period. [Continued on Kaiser Health News, NPR, Yahoo News, and St. Louis Post-Dispatch]…

Drug developers caution against US mifepristone ban

Volume 401, Issue 10385
22 April 2023 

 

WORLD REPORT     A lawsuit against the FDA embroils pharmaceutical companies in debates over access to
abortion. Susan Jaffe reports from Washington, DC.

Less than 1 year after the US Supreme Court ended its 1973 constitutional guarantee to an abortion and told state lawmakers that they could decide whether a person ends their pregnancy, abortion is now back before the court. But this fresh legal challenge has dragged the nation’s entire drug approval system along with it, rousing a powerful lobbying group and economic force that has mostly managed to avoid the fray—the pharmaceutical industry. [Continued here.]…

Hazardous train spills prompt calls for tougher safety rules

Volume 401, Issue 10383
8 April 2023 

 

WORLD REPORT  New bipartisan legislation has been proposed to protect health and safety following a train derailment in East Palestine, Ohio, USA. Susan Jaffe reports from Washington, DC.

A flammable brew of toxic chemicals from a freight train that went off the tracks in the Ohio village of East Palestine is no longer burning but the impact of the wreck is far from over. A massive clean-up continues along with water, soil, and air monitoring. Several government agencies are involved in recovery efforts and are investigating what went wrong. And in a rare show of bipartisanship, Democrats and Republicans in Congress have proposed legislation aimed at closing the gaps in rail safety rules that the accident exposed. The accident’s aftermath has also reached the courts. [Continued here.]…

US plan to shield science from “inappropriate influence”

Volume 401, Issue 10375
11 February 2023 

 

WORLD REPORT  The Biden administration is launching a new initiative on scientific integrity in federal agencies following multiple lapses. Susan Jaffe reports from Washington, DC.

Just a week after Joe Biden was sworn in as president in January, 2021, he created a multi-agency Task Force on Scientific Integrity to restore “trust in government through scientific integrity and evidence-based policy making”…Last month, the White House Office of Science and Technology Policy released A Framework for Federal Scientific Integrity and Practice, a follow-up to the task force’s 2022 recommendations that provides a blueprint for implementation. [Continued here.] …

Modest health goals for new US Congress

Volume 400, Issue 10369
17 December 2022 

 

WORLD REPORT  With Congress almost evenly split between Republicans and Democrats, consensus on any major health legislation is unlikely.  Susan Jaffe reports. 

When a new US Congress convenes in January, 2023, the slim Republican majority in the House of Representatives and the Democrats’ even smaller margin in the Senate will not enable either party to make major changes in the health-care system. With President Joe Biden promising to use his veto power to defend his health-care agenda, no significant fixes are expected. But there appears to be bipartisan support for some less ambitious legislation on issues that will overcome congressional gridlock.[Continued here.]…

US CDC begins agency-wide changes after pandemic failures

Volume 400, Issue 10365
19 November 2022 

 

WORLD REPORT  An independent review made several recommendations for improving the public health agency. Susan Jaffe reports from Washington, DC.

The US Centers for Disease Control and Prevention (CDC) is on a mission to reorganise and modernise itself, so that its mistakes during the pandemic will not happen again. The aim is to make the nation’s leading disease detective more nimble and accountable, and fortify its role as public health protector. But although some changes have been made, progress will be limited without support from Congress. [Continued here.] 
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Medicare Plan Finder Likely Won’t Note New $35 Cap on Out-of-Pocket Insulin Costs

By Susan Jaffe, KHN  | November 15, 2022 | This story also ran on

A big cut in prescription drug prices for some Medicare beneficiaries kicks in next year, but finding those savings isn’t easy.

Congress approved in August a $35 cap on what seniors will pay for insulin as part of the Inflation Reduction Act, along with free vaccines and other Medicare improvements. But the change came too late to add to the Medicare plan finder, the online tool that helps beneficiaries sort through dozens of drug and medical plans for the best bargain.

To fix anticipated enrollment mistakes, Medicare officials will give beneficiaries who use insulin a chance to switch plans next year. Typically, people are locked in for an entire year. [Continued on Kaiser Health News and US News & World Report]

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Medicare considers expanding dental benefits for certain medical conditions

By Susan Jaffe, KHN  | October 17, 2022 | This story also ran on

Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services, while falling short of the comprehensive benefits that many Democratic lawmakers have advocated.

That’s because, under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. In July, officials proposed adding conditions that qualify and sought public comment. Any changes could be announced in November and take effect as soon as January. The review by the Centers for Medicare & Medicaid Services follows an unsuccessful effort by congressional Democrats to pass comprehensive Medicare dental coverage for all beneficiaries, a move that would require changes in federal law. As defeat appeared imminent, consumer and seniors’ advocacy groups along with dozens of lawmakers urged CMS to take independent action. [Continued on Kaiser Health News and CNN]

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Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers

“The health plan can determine how long someone is in a nursing home typically without laying eyes on the person.”

By Susan Jaffe  | Kaiser Health News | October 4, 2022 | This KHN story also ran on Fortune logo

Amy Loomis (left) and Paula Christopherson (photo by Charles Christopherson)

After 11 days in a St. Paul, Minnesota, skilled nursing facility recuperating from a fall, Paula Christopherson, 97, was told by her insurer that she should return home.

“This seems unethical,” said daughter Amy Loomis, who feared what would happen if the Medicare Advantage plan, run by UnitedHealthcare, ended coverage for her mother’s nursing home care.  The facility gave Christopherson a choice: pay several thousand dollars to stay, appeal the company’s decision, or go home.

But instead of being relieved, Christopherson and her daughter were worried because her medical team said she wasn’t well enough to leave.

Health care providers, nursing home representatives, and advocates for residents say Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehabilitation services before patients are healthy enough to go home.  [Full story in and Fortune, Kaiser Health News, The Philadelphia Inquirer, and Yahoo News]

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FDA panel says preterm birth drug should be withdrawn

Volume 400, Issue 10362
29 October 2022 

 

WORLD REPORT  Makena has been given to hundreds of thousands of patients over the past 11 years. Susan Jaffe reports from Washington, DC.  

The only treatment in the USA to prevent premature births is ineffective and should be withdrawn from the market, according to the Food and Drug Administration’s (FDA) Obstetrics, Reproductive and Urologic Drug Advisory Committee. The recommendation has renewed scrutiny of a special drug approval process that raises patients’ hopes by allowing them to take medications that have not been fully tested for efficacy and safety [Continued here.] 

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