CMS, HHS, Medicare, Medicare costs

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]

Appeals, CMS, Medicare Advantage

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]

 

Drugs, FDA, The Lancet

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.] 

EPA, Medicare costs, The Lancet

Health organisations welcome US climate crisis law

Volume 400, Issue 10354
3 September 2022 

 

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.] 

Affordable Care Act, CMS, Drugs, Medicare costs, The Lancet

US Congress lets Medicare negotiate lower drug prices

Volume 400, Issue 10352
20 August 2022 

 

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.

Shattering decades of opposition from the pharmaceutical industry and its allies, slim Democratic majorities in the US House of Representatives and Senate have passed landmark legislation to begin to control runaway drug prices for almost 50 million older Americans with Medicare’s pharmaceutical benefit. The bill also provides the largest federal investment in US history—US$370 billion—to slash greenhouse gases by 40% below 2005 emissions and respond to the devastating effects of climate change…. The legislation also ensures that no Medicare beneficiary pays more than $2000 a year for drugs. “That means you will have more money in your pocket”, said Tatiana Fassieux, education and training specialist at California Health Advocates. [Continued here.]
FDA, HHS, The Lancet

“Chaos” for patients and providers after US abortion ruling

Volume 400, Issue 10346
9 July 2022 

 

WORLD REPORT  A patchwork of state laws replace abortion rights once guaranteed by Roe v Wade. Susan Jaffe reports from Washington, DC.

The US Supreme Court’s bombshell decision overturning Roe v Wade on June 24, 2022, assures Americans that each state can choose whether and under what conditions its residents have a right to a safe and legal abortion. So far, the result is an incoherent and volatile jumble:16 states have severely restricted or banned the procedure and bans in ten more states are likely to take effect in a matter of weeks. [Continued here.]  

 

FDA, HHS, The Lancet

Federal abortion rights end, but not legal challenges

Volume 400, Issue 10345
2 July 2022  

WORLD  REPORT  The US Supreme Court’s decision to overturn Roe v Wade is due to spark further court cases. Susan Jaffe reports from Washington, DC. 

The Supreme Court’s momentous decision to abolish the half-century-old federal right to abortion not only rapidly reconfigures the political and legal landscape in the USA, threatening a host of other long-held personal freedoms. The seismic shift also ignites new legal battles within states that ban or severely restrict abortions, only 4 months before the mid-term elections that will establish which party controls Congress for the next 2 years.  Put simply, the ruling is “the legal equivalent of a nuclear bomb”, according to legal affairs correspondent for National Public Radio and veteran Supreme Court observer, Nina Totenberg. [Continued here.] 

 

Affordable Care Act, CMS, Long term care, Medicaid

Medicaid Weighs Attaching Strings to Nursing Home Payments to Improve Patient Care

By Susan Jaffe  | Kaiser Health News | June 10, 2022 | This KHN story also ran on Fortune logo

The Biden administration is considering a requirement that the nation’s 15,500 nursing homes spend most of their payments from Medicaid on direct care for residents and limit the amount that is used for operations, maintenance, and capital improvements or diverted to profits.

If adopted, it would be the first time the federal government insists that nursing homes devote the majority of Medicaid dollars to caring for residents.

“The absolutely critical ingredient” for good care is sufficient staffing, Dan Tsai, a deputy administrator at the Centers for Medicare & Medicaid Services and Medicaid director, told KHN. [Full story in Kaiser Health News, Fortune, Yahoo News and St. Louis Post-Dispatch]  

 

 

FDA, The Lancet

US Infant formula crisis increases scrutiny of the FDA

Volume 399, Issue 10347
11 June 2022 

 

WORLD REPORT Both Republican and Democrat legislators have called for changes following a shortage of breastmilk substitute. Susan Jaffe reports from Washington, DC..  

The leading US producer of infant formula resumed partial operations on June 4 following a 4-month shutdown, but it may take several more weeks before supplies return to normal, along with the shortage-induced panic and desperation of American parents. When the US Food and Drug Administration (FDA) can regain trust in its ability to police the nation’s food manufacturers is another matter.

The agency’s failure to respond quickly to health hazards at the Abbott Nutrition facility in Sturgis, MI, that released potentially contaminated formula across the country has provoked rare bipartisan outrage in Congress and equally rare apologies from the manufacturer. The shutdown and resulting shortage have also prompted calls for major changes in the FDA’s food safety division, along with questions about why one supplier dominates the market. [Continued here.]  

 

Uncategorized

Raj Panjabi: bringing a global outlook to the US pandemic response

Volume 399, Issue 10338 
14 May 2022

 

PROFILE  Raj Panjabi 

In February, 2022, US President Joe Biden appointed global health physician and epidemiologist Raj Panjabi as a Special Assistant to the President and Senior Director for Global Health Security and Biodefense at the White House National Security Council in Washington, DC, which advises Biden on foreign policy and security issues.[Continued here.]

CMS, Drugs, Medicare, Medicare costs

Medicare Surprise: Drug Plan Prices Touted During Open Enrollment Can Rise Within a Month

By Susan Jaffe  | Kaiser Health News | May 3, 2022 | This KHN story also ran on

Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall’s enrollment period and when she tried to fill her first prescription in January.

She picked a Humana drug plan for its low prices, with help from her longtime insurance agent and Medicare’s Plan Finder, an online pricing tool for comparing a dizzying array of options. But instead of the $70.09 she expected to pay for her dextroamphetamine, used to treat attention-deficit/hyperactivity disorder, her pharmacist told her she owed $275.90.

“I didn’t pick it up because I thought something as wrong,” said Griffith, 73, a retired construction company accountant who lives in the Northern California town of Weaverville.  “To me, when you purchase a plan, you have an implied contract,” she said. “I say I will pay the premium on time for this plan. And they’re going to make sure I get the drug for a certain amount.”

But it often doesn’t work that way.  [Full story in Kaiser Health News, NPR  and Tampa Bay Times]  

 

 

The Lancet

Health organizations fear effects of US abortion ruling

Volume 399, Issue 10338
14 May 2022 

 

WORLD REPORT Health and human rights groups are concerned that many states would outlaw abortion if the Supreme Court topples Roe v Wade. Susan Jaffe reports. 

Protests and celebrations erupted across the USA following the unprecedented leak of a draft Supreme Court decision that would overturn the court’s 1973 landmark Roe v Wade ruling establishing a woman’s right to a safe and legal abortion. …“States are already working together to create enormous abortion deserts that many people will not be able to cross”, said Nancy Northup, president and CEO of the Center for Reproductive Rights. [Continued here.]

 

CMS, Drugs, FDA, Medicare costs

Medicare covers new Alzheimer’s drug, but there is a catch

Volume 399, Issue 10335
23 April 2022 

 

WORLD REPORT  The federal health plan for older Americans will pay for the controversial new drug aducanumab only for patients participating in clinical trials.  Susan Jaffe reports.  

The Biden administration’s long-awaited decision to pay for a controversial new Alzheimer’s disease treatment, aducanumab, will not make it easier for many older Americans with Medicare health insurance to get it. [Continued here.] 

 

CDC, Drugs, FDA, The Lancet

Califf takes the helm at the US FDA, again

Volume 399, Issue 10330
19 March 2022 

WORLD REPORT   Robert Califf will have to face several controversial health issues in his second tenure as commissioner. Susan Jaffe reports from Washington, DC.  

Califf takes over amid a lull in the COVID-19 pandemic and an array of hotly debated issues 9 months before a congressional election. The
election results could shrink, if not eliminate, the Democratic majority President Joe Biden needs to propel his health agenda, including the relaunched cancer moonshot and the Advanced Research Projects Agency for Health that would accelerate the development of medical treatments. [Plus new COVID-19 tests and treatments, opioid misuse, accelerated approval process, abortion pill conflict, continued here.] 
CMS, Long term care, Medicare, Medicare Advantage

Seeking to Shift Costs to Medicare, More Employers Move Retirees to Advantage Plans

By Susan Jaffe  | Kaiser Health News | March 3, 2022 | This KHN story also ran in Fortune and The Dallas Morning News.

As a parting gesture to a pandemic-ravaged city, former New York Mayor Bill de Blasio hoped to provide the city with a gift that would keep on giving: new health insurance for 250,000 city retirees partly funded by the federal government. Although he promised better benefits and no change in health care providers, he said the city would save $600 million a year.

Over the past decade, an increasing number of employers have taken a similar deal, using the government’s Medicare Advantage program as an alternative to their existing retiree health plan and traditional Medicare coverage. …Scores of private and public employers offer Medicare Advantage plans to their retirees. Yet the details — and the costs to taxpayers — are largely hidden. Because the federal Centers for Medicare & Medicaid Services is not a party to the negotiations among insurers and employers, the agency said it does not have details about how many or which employers are using this strategy or the cost to the government for each retiree group. [Full story in Kaiser Health News, Fortune and The Dallas Morning News]