Volume 403, Issue 10445
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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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
Volume 403, Issue 10437WORLD 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]…
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 couple 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]…
“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.]…
Volume 403, Issue 10423WORLD 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]…
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]…
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]…
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.]…
Volume 402, Issue 10399
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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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.
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]…
Volume 401, Issue 10385
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.]…
Volume 401, Issue 10383
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.]…
Volume 401, Issue 10375
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.] …
Volume 400, Issue 10369
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.]…
Volume 400, Issue 10365
WORLD REPORT An independent review made several recommendations for improving the public health agency. Susan Jaffe reports from Washington, DC.
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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Volume 400, Issue 10362
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.]
…Volume 400, Issue 10354
WORLD REPORT The recently passed Inflation Reduction Act will provide billions of dollars of incentives to reduce greenhouse gas emissions. Susan Jaffe reports.
There are no emission limits or pollution penalties in the landmark Inflation Reduction Act that Congress approved in August. Instead of forcing cuts, the climate change and healthcare law provides US$370 billion worth of incentives to ratchet down the planet-warming greenhouse gases from fossil fuels that have caused record-breaking heat waves, wild fires, droughts, and floods. …The law provides $60 billion for communities that have been disproportionately affected by toxic hazards and the consequences of climate change. [Continued here.]
…Volume 400, Issue 10352
WORLD REPORT A new law also targets climate change in a major victory for Democrats and President Joe Biden. Susan Jaffe reports from Washington, DC.
Volume 400, Issue 10346
WORLD REPORT A patchwork of state laws replace abortion rights once guaranteed by Roe v Wade. Susan Jaffe reports from Washington, DC.
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Volume 400, Issue 10345
2 July 2022
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