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At the height of the pandemic, many Americans are experiencing firsthand the flaws in the Affordable Care Act and the health insurance it guaranteed. They are also facing the possibility that even the protection it does afford may be stripped away. The fate of the Affordable Care Act (ACA), also known as Obamacare, is again uncertain. The 2010 law that began to whittle down the large number of uninsured Americans is back at the U.S. Supreme Court awaiting a decision most likely next year about whether it is constitutional. The court has uphe...
The headlines have been grim. Seventeen bodies piled up in the morgue at a New Jersey nursing home. Fifty-five residents dead in Brooklyn, N.Y. In one week, 104 residents dead in a facility in western Pennsylvania and 102 dead at a home in San Antonio. In Detroit 26 percent of nursing home residents and staff test positive for the coronavirus. Residents in nursing homes had been at risk long before I began reporting on them in the 1990s, and care facilities have continued to be the subject of press inquiry all across the country. Staffing...
As insurance companies push doctors to save money by switching their patients to generic drugs, complaints about those generics appear to be on the upswing. That’s the observation of journalist Katherine Eban, who has written a book, “Bottle of Lies,” that tells a very dark tale about the generic drug industry and the safety of generic drugs Americans are increasingly taking. “My inbox is full of communications from patients who were on a drug that worked but were switched to a generic that didn’t work,” she told me. “Patients find themselv...
If you’re buying health insurance on your own this year, the marketplace is more complicated – and dangerous – than ever. Dangerous? How can that be? This is health insurance we’re talking about, not some sketchy Internet site. But the reality is that the scam artists are out in full force, and anyone buying a policy by shopping online had better watch out. There’s a high likelihood you could buy something that won’t provide much coverage but will shortchange you mightily when you get sick. Pennsylvania Senator Bob Casey, a Democrat, w...
Is the U.S. ready for a discussion about paying for caregiving, an increasingly vexing and costly problem for a growing number of Americans? The answer may be “yes.” It has become obvious that long-term care insurance is not the answer to paying for nursing home and other kinds of care for the elderly. Sales for this product have been declining, the result of sky-high premiums, rate increases, and the difficulty of qualifying for a policy if you’re sick. But the elderly are not the only Americans needing care. At the other end of the age spect...
The Senate Special Committee on Aging has just released one of the most damning reports on the nation’s nursing homes that I’ve seen in a long time. The short document should be required reading for any family thinking of moving a relative to a nursing facility. Pennsylvania Senator Robert Casey, a Democrat, who is the ranking member on the committee along with Pennsylvania’s other senator Patrick J. Toomey, a Republican, recently revealed a special, but unpublicized program to flag and monitor the worst nursing homes in the country. Bad nursi...
Recently Peggy, an Indiana woman and reader of this column, sent me a lengthy email about her 94-year-old mother who is rapidly spending down her minimal savings to pay for prescription drugs. Peggy didn’t hold out much hope that prices would come down before it was too late for her mom. But she succeeded in lowering her mom’s drug costs and what she learned along the way can be helpful to others strapped by high pharmaceutical bills. Her mother is typical of many women in old age who have only a tiny financial cushion to absorb the con...
Medicare has just announced it is penalizing more than 700 of the nation’s hospitals because they have higher rates of patient safety mishaps, which the government and patient advocacy groups have been trying for years to prevent. What are those incidents that have resulted in a one percent cut in a hospital’s Medicare payments over the year? They are mistakes you wouldn’t want to have happen to you or a family member, things like infections caused by incisions made during colon surgeries and hysterectomies, by urinary catheters and by centr...
David Mitchell is a man with a mission. He is determined to stitch together a movement that will finally smash the power of the pharmaceutical industry and bring pocketbook relief to millions of Americans who need expensive drugs. Mitchell, a 68-year-old former Washington, D.C., communications executive, was diagnosed eight years ago with multiple myeloma, a blood cancer. Until recently, the disease has been held in check by drugs costing $325,000 a year. Medicare and a good Medigap policy have covered most of the expense. In 2016 Mitchell...
The other day came a lengthy report from the Centers for Medicare and Medicaid Services (CMS) announcing worrisome findings for anyone with a Medicare Advantage plan and anyone thinking about buying one in the future. The findings are also relevant to anyone buying any kind of health insurance this year. The ominous takeaway? The information given to consumers in the provider directories is deeply flawed, often misleading, inaccurate, and says CMS, “can create a barrier to care.” Imagine choosing a plan based on the information that your doctor...
The Food and Drug Administration just announced it would once again try to regulate tobacco products. This time the target of the agency’s regulatory hand is what it believes is the growing menace of flavored e-cigarettes and other tobacco products used by young people who’ve turned to vaping and smoking. The FDA said about 3.6 million kids under age 18 now admit they use e-cigarettes. That’s an alarming number and is worrisome because FDA commissioner Dr. Scott Gottlieb has noted that almost all current smokers started when they were kids....
Karen R., a 70-year-old Medicare beneficiary living in a mid-size town in Indiana, contacted me recently about her Part D drug coverage. She and her husband both have traditional Medicare, a Medigap policy, and what’s called a stand-alone plan for their drugs. For a long time, her stand-alone plan offered through Humana worked well for them. Her out-of-pocket costs for most drugs was only $8. This summer Karen, who takes 11 drugs for a variety of illnesses, including atrial fibrillation and kidney disease, was diagnosed with a new ailment – pso...
Headlines About Medical Studies May Be More Enthusiastic Than Accurate “Lowering Your Blood Pressure Could Stave Off Dementia,” heralded the headline from Bloomberg, which was not alone in delivering the “good” news. Time advised, “There May Finally Be Something You Can Do to Lower Your Risk of Dementia.” Reuters’ headline was even more definitive. “Lowering Blood Pressure Cuts Risk of Memory Decline: US Study.” Readers can be forgiven if they rushed to their doctors to discuss more aggressive blood pressure treatment. Who wouldn’t want to...
Two years ago in this space I told the story of a Mississippi woman, Katherine Green, who got caught in the unsavory business practices of the air ambulance industry that has trapped many more Americans since then. Green, a college history professor, chose to fight the company that transported her late husband to a Jackson hospital after he suffered a fatal fall in their home. The ambulance company Rocky Mountain Holdings, a subsidiary of Air Methods, billed her $50,950. Her husband’s insurance company, Blue Cross & Blue Shield of M...
This fall the House of Representatives is likely to take up legislation passed by the Senate that gives terminally ill patients the right to try unproven, experimental drugs that are not yet on the market. Thirty-seven states have already passed similar legislation. All this may sound like terrific news for very sick patients with few or no treatment options left, but the issue deserves a much deeper look thanks to its potential impact on people’s pocketbooks and health. “The public has no idea this is not a good thing,” says Alison Batem...
What should you expect now that the drive to repeal and replace the Affordable Care Act appears dead – at least for the moment? Given how legislation gets made in Washington, I wouldn’t be surprised to see some elements of the repeal and replace bill surface again, possibly tacked onto what’s known as must-have legislation. All that, though, is speculation at this point! What’s more important to millions of families who must buy health insurance for next year is how much will it cost and what will it cover? It’s safe to say that Obamacare...
One thing I haven’t heard much in this latest healthcare debate is that the U.S. has the best health system in the world. That’s different from the last two times around. When the nation debated the Clinton health plan in 1994 and the Affordable Care Act in 2009-2010, a huge talking point for politicians and special business interests opposed to reform was, “The American system is so good, why change it?” It’s different this year. Maybe that’s because the public realizes America doesn’t have the best, and their own interactions with what Ame...
Recently I heard from a woman in rural Nebraska who told me about her 76-year old father, who in late April had a lemon-size cancerous mass removed from his brain. The man chose to have his chemotherapy and radiation treatments at a hospital close to his home instead of at one of the larger hospitals farther away. Not surprisingly he wanted family nearby. Nearly two months later, in mid-June, his treatments finally began. Why the delay? His daughter told me the nearby hospital “had no record of two appointments they had made with my dad and r...
Older Americans may be in for a rough ride if the changes Washington politicians are considering come to pass. Because good, explanatory journalism is in short supply and TV shouting matches don’t tell you much, I decided to use this space to discuss some of the possible changes that could soon affect millions of people in their 60s and older. First, let’s consider Medicaid, the federal-state program that finances healthcare for the poor and long-term care for the middle class. Virtually all the talk about cutting Medicaid by more than $800 bil...
Federal funding for meals on wheels is on the chopping block. The Trump administration budget blueprint released in March calls for the elimination of two federal block grants: That’s money the federal government gives the states for social welfare programs, and those programs include home-delivered meals and meals served in senior centers. Most of the nation’s 5,000 meal programs also rely on money from the Older Americans Act passed in 1965 to fund about 35 percent of the cost of the meals they serve. Those funds are also in jeopardy. The...
Turning healthcare consumers into educated shoppers has long been a goal of employers who foot the bill for most care, politicians and some consumer organizations that believe that someday shopping for care should be as easy as comparing brands of canned soup. All it takes are some clear disclosures of prices, ingredients and whatever else seems comparable in a product or service coupled with a bit of education in how to make the shopping trip fruitful, and the healthcare system will transform itself like magic. It will become competitive,...
Over the past few months, these columns have raised plenty of questions about Medicare, present and future, and I’ve received many responses to those questions from readers. Today’s column addresses some of readers’ concerns about Medicare, a complicated program. Q: Why do you refer to Social Security as social insurance? This continues to baffle me just as those who continually refer to SS as a handout. It’s not a handout. That money has been taken out of every one of my paychecks since I was 16. This is my money. A: Social insurance is group...
When you fill a prescription at your local pharmacy, you assume the medicine you receive is safe and won’t interact badly with other drugs you’re taking. That’s not an unreasonable assumption, considering that pharmacists enjoy a positive reputation among the public. A recent Gallup poll found that pharmacists are among the most trusted professionals ranking second only to nurses. But pharmacists’ reputations as patient guardians may be unwarranted. The results of an investigation published by the Chicago Tribune before Christmas showed...
What’s going to happen to Medicare? That’s not an insignificant question given the political shift in Washington. Now, with Republicans controlling the presidency and both houses of Congress, some ideas they’ve been pushing for years have a chance of passing. Those ideas would drastically change the way Medicare works for those already on it and those joining in the next few years. Medicare is wildly popular, but that popularity doesn’t necessarily translate into understanding of a very complex program, what’s happened to it, and what may...
Anyone facing a hospital stay for themselves or a family member should look at new data the government released right before Christmas showing that it penalized 769 of the nation’s hospitals for having high rates of patient injuries. The monetary penalties – a reduction for the year in their reimbursement for treating Medicare patients – do bite. Larger teaching hospitals could lose as much as $1 million or more. This is the third year the government has penalized hospitals in an effort to prevent avoidable patient deaths in hospitals, which...
