States Get in on the Prior Authorization Crackdown

Last month, my colleague Lauren Sausser told you about the Biden administration’s crackdown on insurance plans’ prior authorization policies, with new rules for certain health plans participating in federal programs such as Medicare Advantage or the Affordable Care Act marketplace. States are getting in on the action, too. Prior authorization, sometimes called pre-certification, requires patients … Read more

The No Surprises Act Comes With Some Surprises

The No Surprises Act, the landmark law intended to protect patients from surprise out-of-network medical bills, has come with, well, some surprises. A little more than two years after it took effect, there’s good and bad news about how it’s working. First, it’s important to note that the law has successfully protected millions of patients … Read more

For the Love of Health Care and Health Policy

Nothing melts our hearts like a health policy valentine. Readers made us swoon this season, writing poetic lines about prescription drug pricing, medical debt, primary care shortages, and more.  Here are some of our favorites, starting with the grand prize winner and first runner-up, whose entries were each turned into a cartoon by staff illustrator … Read more

In Fight Over Medicare Payments, the Hospital Lobby Shows Its Strength

In the battle to control health care costs, hospitals are deploying their political power to protect their bottom lines. The point of contention: For decades, Medicare has paid hospitals — including hospital-owned physician practices that may not be physically located in a hospital building — about double the rates it pays other doctors and facilities … Read more

¿Ofrecer vivienda gratis es atención médica? Programas de Medicaid dicen que sí

Estados están invirtiendo miles de millones de dólares en un experimento de atención médica de alto riesgo: utilizar fondos ya escasos de seguros de salud públicos para proporcionar vivienda a los estadounidenses más pobres y enfermos. California está liderando esta tendencia, destinando gran parte de un presupuesto de $12 mil millones a una ambiciosa iniciativa … Read more

States Target Health Insurers’ ‘Prior Authorization’ Red Tape

Christopher Marks noticed an immediate improvement when his doctor prescribed him the Type 2 diabetes medication Mounjaro last year. The 40-year-old truck driver from Kansas City, Missouri, said his average blood sugar reading decreased significantly and that keeping it within target range took less insulin than before. But when his doctor followed the typical prescribing … Read more

Halfway Through ‘Unwinding,’ Medicaid Enrollment Is Down About 10 Million

Phil Galewitz, KFF Health News Halfway through what will be the biggest purge of Medicaid beneficiaries in a one-year span, enrollment in the government-run health insurance program is on track to return to roughly pre-pandemic levels. Medicaid, which covers low-income and disabled people, and the related Children’s Health Insurance Program grew to a record 94 … Read more