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Updated: 11 hours 46 min ago

KHN’s ‘What the Health?’: Boosting Confusion

November 18, 2021

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

With covid caseloads rising across much of the country, several governors and mayors are unilaterally expanding access to booster shots, getting out ahead of federal health officials.

Speaking of federal health officials, President Joe Biden has finally selected a nominee to head the Food and Drug Administration. If confirmed by the Senate, it would be Dr. Robert Califf’s second stint at the agency that oversees an estimated one fifth of all products sold in the United States. Califf previously served — for less than a year — under President Barack Obama.

Califf’s nomination, however, could be complicated by the news of a dramatic increase in Medicare premiums for 2022, prompted largely by the FDA’s approval of a controversial drug to treat Alzheimer’s disease not yet been proved effective.

This week’s panelists are Julie Rovner of KHN, Tami Luhby of CNN, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

  • Democratic leaders in the House say they expect to vote soon on a bill funding Biden’s climate change and social policy agenda. Even some moderates, who have been concerned about the price tag, suggest that passage looks likely. But the Congressional Budget Office has not yet released its full estimates of the cost of some of the more controversial health items in the bill, and those numbers could prompt calls for revisions.
  • Califf appears on track for Senate confirmation because he is expected to get support from most Democrats and some Republicans. Several Democrats, however, have already criticized the nomination, complaining the FDA was not tough enough on the drugmakers behind the opioid epidemic and needs a leader who will change that culture.
  • At the Department of Health and Human Services, at least three Senate-confirmed positions dealing with social services remain unfilled. Those include the assistant secretary for the Administration for Children and Families, a commissioner for the Administration for Native Americans and a commissioner for that agency’s children, youth and families bureau.
  • Medicare officials announced the standard monthly premium for the Part B program, which covers doctor and other outpatient medical services, would rise next year by more than $20. Part of that increase is a hedge in case Medicare decides to cover the cost of a new controversial Alzheimer’s drug, Aduhelm.
  • Aduhelm is priced at $56,000 a year and involves other costs related to testing for side effects. Although the drug would likely be used by a small number of beneficiaries, its high cost influenced the sharp increase in premiums, Medicare officials said.
  • If Medicare opts not to cover Aduhelm, it’s not clear if or how beneficiaries might recoup the money spent on the premiums.
  • The FDA appears to be moving toward the Biden administration’s desire to make all American adults eligible for additional covid vaccine shots, known as boosters. Some scientists within the administration have been reluctant to take that step, but new evidence provided by the drugmakers bolsters the effort to get younger people extra doses.
  • The move by states and cities to make younger adults eligible for the boosters may not be legal under the special-use authorization the FDA gave several of the vaccines. But it hasn’t been challenged.
  • Confusion over who is eligible for the shots may undermine the federal government’s efforts to assure the country that the covid vaccines are effective and a good choice. Still, people hesitant to get the shots do not appear to be convinced by many arguments.
  • Biden’s order that large workplaces establish vaccine mandates is on hold as it is being challenged in federal court. The issue will likely end up before the Supreme Court, and some advocates for workers fear that the justices could use the case as an opportunity to roll back federal protections in the workplace.

Also this week, Rovner interviews Dan Weissmann, host of the “An Arm and a Leg” podcast, about his new project, a “first-aid kit” newsletter to help consumers make better decisions about their own health care.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Atlantic’s “Why Health-Care Workers Are Quitting in Droves,” by Ed Yong.

Also, Stat’s “The Catholic Hospital System Ascension Is Running a Wall Street-Style Private Equity Fund,” by Rachel Cohrs.

Tami Luhby: Politico’s “‘We Don’t Fix This Because We Just Don’t Care About Old People,’” by Joanne Kenen.

Sarah Karlin-Smith: KHN and InvestigateTV’s “As Big Pharma and Hospitals Battle Over Drug Discounts, Patients Miss Out on Millions in Benefits,” by Sarah Jane Tribble and Emily Featherston.

Rachel Cohrs: Modern Healthcare’s  “Why the Justice Department Is Targeting Private Equity,” by Tara Bannow.

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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California Plans for a Post-Roe World as Abortion Access Shrinks Elsewhere

November 17, 2021

SACRAMENTO — With access to abortion at stake across America, California is preparing to become the nation’s abortion provider.

Democratic Gov. Gavin Newsom and legislative leaders have asked a group of reproductive health experts to propose policies to bolster the state’s abortion infrastructure and ready it for more patients. Lawmakers plan to begin debating the ideas when they reconvene in January.

Abortion clinics are already girding themselves for a surge in demand.

Janet Jacobson, medical director of Planned Parenthood of Orange and San Bernardino Counties, said three or four out-of-state patients visit her clinics each day — about double the number that sought treatment before a near-total ban on abortion took effect in Texas in September.

While the nine clinics can absorb that slow trickle, they expect up to 50 out-of-state patients a week if the U.S. Supreme Court’s conservative majority guts abortion rights nationally, Jacobson said. She bases her estimate on new data from the Guttmacher Institute, a research organization that supports abortion and reproductive health rights.

She is adding staff members and appointment capacity, hoping to accommodate everyone.

“We have to make sure we can still continue to care for all of our California patients,” Jacobson said. “We don’t want them getting squeezed out” of appointments.

The Texas law banned nearly all abortions after about six weeks of pregnancy and empowered private citizens to sue anyone who performs or “aids and abets” an abortion after that time. The Supreme Court heard arguments in that case on Nov. 1 and is expected to announce a ruling on its constitutionality in June. Nonetheless, Florida and Ohio have announced plans for copycat laws.

Next month the high court will hear another abortion case with even broader implications, Dobbs v. Jackson Women’s Health Organization, a lawsuit challenging the constitutionality of a 2018 Mississippi law that prohibited abortion after 15 weeks. If the court sides with Mississippi, its decision could overturn existing abortion rights set by the landmark Roe v. Wade case.

Should that happen, reproductive rights experts predict, 26 states will ban the procedure altogether and states with stronger protections for abortion, like California, will draw even more patients. There could be up to a 3,000% increase in people who “may drive to California for abortion care” each year, according to the Guttmacher data.

In 2017, the most recent year for which data is available from Guttmacher, California — by far the nation’s most populous state — had more abortion providers than any other state, with 419 hospitals, clinics or doctors’ offices performing the procedure. The next highest were New York, with 252, and Florida, with 85. Neighboring Arizona and Nevada each had 11. Of the 862,320 abortions performed in the U.S. that year, 132,680, about 15%, were in California.

Planned Parenthood clinics in California say they already serve about 7,000 out-of-state patients a year and are expecting a surge of new ones, especially in travel hubs like the Los Angeles area.

In September, Planned Parenthood and groups such as Black Women for Wellness convened the California Future of Abortion Council with backing from influential Democratic leaders including Newsom, state Senate leader Toni Atkins and Assembly Speaker Anthony Rendon.

Atkins, who was the director of a San Diego women’s health clinic in the 1980s, said she spent time with women from states where it was hard to get an abortion. She said California is committed to ensuring abortion access in the state and beyond.

The council is focused on increasing funding for abortion services, providing logistical and financial help for women who need to travel, increasing the number of health care providers who perform abortions and strengthening legal protections for them.

Increasing capacity could mean licensing more practitioners to provide abortions or pumping more resources into telehealth so people can see a doctor online to prescribe pills for a medical abortion — a service California doctors currently can provide to patients only in California.

The most important thing the state should do is fix its shortage of providers, especially those who perform second-trimester abortions, which are more expensive and complicated than first-trimester abortions, said council member Dr. Daniel Grossman, director of the Advancing New Standards in Reproductive Health program at the University of California-San Francisco.

It’s not feasible to place an abortion provider in every corner of the state, Grossman said. Instead, the council should focus on creating “hubs that can provide abortion care for large numbers of people” in easy-to-get-to locations.

California already struggles to provide abortions to all who seek them, especially low-income women covered by Medi-Cal, California’s Medicaid program. For example, 28 counties — home to 10% of Medi-Cal recipients of childbearing age — don’t have facilities that provide abortions to Medi-Cal patients.

A medical abortion, in which pills are used to terminate a pregnancy, costs California patients an average of $306 out-of-pocket, according to an analysis by the California Health Benefits Review Program, but isn’t available after 10 weeks. After that, the only option is a surgical abortion, which costs an average of $887 out-of-pocket in California.

One of the council’s recommendations will likely be to increase the rate Medi-Cal pays for abortions so more providers will perform them, said council member Fabiola Carrión, interim director for reproductive and sexual health at the National Health Law Program.

Medi-Cal pays $354.43 for a second-trimester abortion. A 2020 study in the journal Contraception found that states paid between $79 and $626 for a second-trimester abortion in 2017.

Increasing Medi-Cal rates won’t help patients traveling from outside California. Generally, private insurance doesn’t cover out-of-state abortions, so most women will be on the hook for the full cost, and those enrolled in other states’ Medicaid programs must pay out-of-pocket, too.

The council hopes to reduce costs for state residents and visitors, said Brandon Richards, director of communications for Planned Parenthood Affiliates of California. “It’s about making it easy for people to access abortion in California, whether they reside here or are coming in from out of state,” he said.

One way to target costs is by funding the practical support, like helping to pay for transportation, child care, hotels or time off work, said council member Jessica Pinckney, executive director of Access Reproductive Justice, a fund that helps people pay for abortions.

Pinckney said she’s working with Los Angeles County to set up a public abortion fund to cover some of those costs for anyone seeking an abortion in the county. It would be modeled after similar pots maintained by the cities of New York; Austin, Texas; and Portland, Oregon, and could eventually be a template for the first statewide fund, Pinckney said.

Most Texans seeking abortions since that state’s law took effect are going to nearby states like Colorado, New Mexico and Oklahoma, said Sierra Harris, deputy director of network strategies for the National Network of Abortion Funds. Women in those states, in turn, are having trouble getting care and are looking to California for appointments.

Practical support is important for out-of-state patients, said Alissa Perrucci, operations manager at the Women’s Options Center at Zuckerberg San Francisco General Hospital, one of five abortion clinics inside California hospitals.

Perrucci’s clinic is focusing on telemedicine, phone counseling and other ways to save time so it can add appointments for out-of-state patients if necessary.

But more slots are useless if women can’t make it to California. The clinic has booked about 10 appointments for Texans since the state’s ban went into effect, but only half have shown up, mostly women with family connections in California.

“Most people just don’t have the money to get here,” she said. “If the burden of abortion was borne predominantly by the wealthy, yeah, they’d just fly here.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Missouri’s Thin Dental Safety Net Stretched Amid Medicaid Expansion

November 16, 2021

At the Access Family Care clinics in southwestern Missouri, the next available nonemergency dental appointment is next summer. Northwest Health Services, headquartered in St. Joseph, is booked through May. The wait is a little shorter at CareSTL Health in St. Louis — around six weeks.

Roughly 275,000 Missourians are newly eligible this year for Medicaid, the federal-state public health insurance program for people with low incomes, and they can be covered for dental care, too. Missouri voters approved expansion of the program in 2020, the latest of 39 states to do so as part of the Affordable Care Act, but politics delayed its implementation until Oct. 1. Adults earning up to 138% of the federal poverty level — about $17,774 per year for an individual or $24,040 for a family of two — can now get coverage.

But one big question remains: Who will treat these newly insured dental patients?

Only 27% of dentists in Missouri accept Medicaid, according to state data, one of the lowest rates in the country. Many of them work at what are known as safety-net clinics, such as Access Family Care, Northwest Health Services and CareSTL Health. Such clinics receive federal funds to serve uninsured patients on a sliding scale and was experiencing huge demand for dental services before expansion.

The reason so few Missouri dentists accept Medicaid is simple, according to Vicki Wilbers, executive director of the Missouri Dental Association: The state’s program pays dentists extremely poorly compared with private insurance or what a dentist could charge a patient paying cash. Adding to the strain, said Wilbers, dentists who do accept Medicaid often must deal with the state plus private insurers that administer Medicaid through a program known as managed care.

“You have more people on the rolls, you still don’t have reimbursement rates increase,” Wilbers said. “And it’s cumbersome.”

Still, for these new patients, the coverage can be life-changing.

Only 37% of adults in the state with incomes under $15,000 per year saw a dentist in 2018 compared with 76% of adults earning over $50,000, according to a state report. A survey by the American Dental Association found 53% of low-income Missourians have difficulty chewing, 43% avoid smiling because of the condition of their mouth and 40% experience pain.

“I just don’t think those stories are told enough,” said Steve Douglas, spokesperson for Access Family Care in Neosho.

Douglas described a patient of the clinic who believes his so-far-unsuccessful quest for higher-paying work has been hindered by the appearance of his teeth.

“We’re hoping that with the Medicaid expansion we can get him in for some care,” Douglas said. “He would like to save some of his teeth and not go to full dentures.”

About 62% of Missouri adults making under $15,000 per year have lost at least one tooth to decay or gum disease, and 42% of people 65 and older in that income range have lost all of them, according to the state report. For Missourians earning over $50,000, those rates are 34% and 8%, respectively.

Part of the dental care backlog at Access Family Care, which offers dental services at five locations around southwestern Missouri, is due to the pandemic. The clinic laid off all 95 of its dental staffers in March 2020 before gradually building back to full capacity. As with dental practices nationwide, many of their patients are now coming to get the dental work done that they delayed earlier over fears of exposure to the coronavirus.

But central to the huge demand is an overall need for more providers. Nearly 1.7 million Missourians live in a federally designated dental professional shortage area, one of the highest levels of unmet needs in the country. It’d take another 365 dentists to fill that void, at least one extra dentist for every 10 already practicing in the state.

“We could easily employ another four dentists and still have high demand,” Douglas said.

His clinic, Access Family Care, has indeed hired two new dentists to start in 2022. To manage the dental caseload until then, though, it had to temporarily stop seeing new patients.

In St. Louis, Dr. Elena Ignatova, director of dental services at CareSTL Health, had 18 patients scheduled on a recent Wednesday in November. About a quarter of them were insured through Medicaid.

By 10 a.m., she had cast a mold of one patient’s mouth to fit dentures, referred another to an oral surgeon for a root canal and prepped a fourth-year dental student for the extraction of a Medicaid patient’s remaining teeth. In Missouri, Medicaid covers simple tooth extractions for adults but not root canals or crowns.

“We remove teeth because the other treatment is too expensive and they cannot afford it,” Ignatova said. “Then it can take years for those patients to come up with the money for dentures.”

Ignatova is booked into February, but the clinic still takes walk-ins for dental emergencies. She’s also working her way through a waiting list of 39 patients who might be able to show up quickly if a cancellation or no-show opens a spot in her schedule.

There is easily enough demand for another dentist, but Ignatova said they’re still working on hiring the dental assistants and hygienists needed to reopen the school-based clinics for kids they operated before the pandemic. Those hirings are in the works, but it is slow going. As with many health care facilities, she and others said, President Joe Biden’s vaccine mandates have added an extra hurdle to recruiting and retaining staff.

One clinic that isn’t seeing a bottleneck of dental patients, though, is KC Care Health Center in Kansas City. Kristine Cody, the clinic’s vice president of oral health services, said a new patient could be seen there in about a week. The Kansas City region benefits from having the University of Missouri-Kansas City School of Dentistry, which offers reduced-cost care to patients at the clinic where its students are trained, plus several other safety-net clinics.

KC Care also added two dentists and extended its clinical hours in anticipation of Medicaid expansion.

“I just hope people look to use it,” Cody said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).

Medicare’s Open Enrollment Is Open Season for Scammers

November 11, 2021

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix.

Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured by questionable information — that may not cover their drugs or include their doctors. In response, the Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers.

The agency has also revised rules making it easier for beneficiaries to escape plans they didn’t sign up for or enrolled in only to discover promised benefits didn’t exist or they couldn’t see their providers.

The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. 15 and runs through Dec. 7. A common trap begins with a phone call like the one Linda Heimer, an Iowa resident, received in October. She won’t answer the phone unless her caller ID displays a number she recognizes, but this call showed the number of the hospital where her doctor works.

The person on the phone said she needed Heimer’s Medicare number to make sure it was correct for the new card she would receive. When Heimer hesitated, the woman said, “We’re not asking for a Social Security number or bank numbers or anything like that. This is OK.”

“I can’t believe this, but I gave her my card number,” said Heimer. Then the caller asked questions about her medical history and offered to send her a saliva test “absolutely free.” That’s when Heimer became suspicious and hung up. She contacted the 1-800-MEDICARE helpline to get a new Medicare number and called the AARP Fraud Watch Network Helpline and the Federal Trade Commission.

But later that morning the phone rang again and this time the caller ID displayed a number matching the toll-free Medicare helpline. When she answered, she recognized the voice of the same woman.

“You’re not from Medicare,” Heimer told her.

“Yes, yes, yes, we are,” the woman insisted. Heimer hung up again.

It’s been only two weeks since Heimer disclosed her Medicare number to a stranger and, so far, nothing’s gone wrong. But armed with that number, scammers could bill Medicare for services and medical supplies that beneficiaries never receive, and the scammers could sign seniors up for a Medicare Advantage or drug plan without their knowledge.

In California, reports of deceptive sales practices for Medicare Advantage and drug plans have been the top complaints to the state Senior Medicare Patrol for the past two years, said Sandy Morales, a case manager for the group. The patrol is a federally funded program that helps seniors untangle insurance problems.

Nationwide, the Senior Medical Patrol has sent 74% more cases in the first nine months of this year than in all of 2020 to CMS and the Health and Human Services Inspector General for investigation, said Rebecca Kinney, director of the Administration for Community Living’s Office of Healthcare Information and Counseling at HHS, which oversees the patrols. She expects more complaints to come in during Medicare’s open-enrollment period.

And last month, CMS officials warned the private insurance companies selling Medicare Advantage and drug plans that federal requirements prohibit deceptive sales practices.

Kathryn Coleman, director of CMS’ Medicare Drug and Health Plan Contract Administration Group, said in a memo to insurers that the agency is concerned about ads widely promoting Advantage plan benefits that are available only in a limited area or to a restricted number of beneficiaries. CMS has also received complaints about sales information that could be construed as coming from the government and pressure tactics to get seniors to enroll, she noted.

Coleman reminded the companies they are “accountable and responsible for their marketing materials and activities, including marketing completed on a MA plan’s behalf” by sales representatives. Companies that violate federal marketing rules can be fined and/or face enrollment suspensions. But a CMS spokesperson could not provide examples of recent violators or their penalties.

If beneficiaries discover a problem before March 31, the date the three-month disenrollment period ends each year, they have one chance to switch to another plan or to original Medicare. (Those who choose the latter may be unable to buy supplemental or Medigap insurance, with rare exceptions, in all but four states: Connecticut, Maine, Massachusetts and New York.) After March, they are generally locked into their Advantage or drug plans for the entire year unless they’re eligible for one of the rare exceptions to the rule.

CMS this year spelled out another remedy for the first time.

Officials can grant a “special enrollment period” for people who want to leave their plan because of deceptive sales tactics. These include “situations in which a beneficiary provides a verbal or written allegation that his or her enrollment in a MA or Part D plan was based upon misleading or incorrect information … [or] where a beneficiary states that he or she was enrolled into a plan without his or her knowledge,” according to the Medicare Managed Care Manual.

“This is a really important safety valve for beneficiaries that clearly goes beyond just the limited opportunity to switch plans when someone feels buyer’s remorse,” said David Lipschutz, associate director of the Center for Medicare Advocacy. To use the new option, beneficiaries should contact their state’s health insurance assistance program at www.shiphelp.org/.

The option to leave is also available if a significant number of plan members are unable to access the doctors or hospitals that were supposed to be in the provider network.

Nonetheless, the scams continue around the country, experts say.

A misleading television commercial in the San Francisco area has enticed seniors with a host of new benefits including dental, vision, transportation benefits and even “money back into your Social Security account,” said Morales. Beneficiaries have told her group that when they called for information they were “erroneously enrolled into a plan that they never gave permission to enroll into,” she said.

In August, an Ohio senior received a call from someone telling him Medicare was issuing new cards because of the covid-19 pandemic. When he wouldn’t provide his Medicare number, the caller became angry and the beneficiary felt threatened, said Chris Reeg, director of the Ohio Senior Health Insurance Information Program.

Reeg said another senior received a call from a salesperson with bad news: She wasn’t getting all the benefits from Medicare she was entitled to. The beneficiary provided her Medicare number and other information but didn’t realize the caller was enrolling her in a Medicare Advantage plan. She found out when she visited her doctor, who did not accept her new insurance.

In western New York, the culprit is an official-looking postcard, said Beth Nelson, the state’s Senior Medicare Patrol director. “Our records indicate … you may be eligible to receive additional benefits,” it says, enticingly. When Nelson’s client called the number on the card in September for more details, she provided her Medicare number and later ended up in a Medicare Advantage plan without her consent.

Heimer’s scammer was persistent. When the stranger tried to reach her a third time, Heimer said, the caller ID displayed the phone number of another local hospital. She told the woman she had reported the calls to CMS, the AARP Fraud Watch Network Helpline and the FTC. That finally did the trick — the woman abruptly hung up.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).