Photo: Debora Cartagena/CDC
Health care journalists covering addiction, overdoses, and the heroin epidemic are likely to learn that the health insurance system appears to be part of the problem. That’s what Terry DeMio found on her beat in southern Ohio and northern Kentucky. Since January 2016, DeMio has been the Cincinnati Enquirer’s heroin epidemic reporter.
Rather than paying for the best medications for drug addicts in need, health insurers often require patients to start with the lowest-cost drugs. Then if the lowest-cost prescription fails, insurers then pay for the next highest-cost drug. Called fail-first or step therapy, this process repeats until the patient finds one that works. Meanwhile, the patient suffers or could die, DeMio said. Continue reading
Medicare Advantage 2016 Spotlight: Enrollment Market Update, by Gretchen Jacobson, Giselle Casillas, Anthony Damico, Tricia Neuman and Marsha Gold for the Kaiser Family Foundation, May 11, 2016.
U.S. District Judge John D. Bates on Monday sided with the Department of Justice to block the merger of Aetna and Humana. The ruling is being called a victory for members of Medicare Advantage (MA) plans, since Aetna and Humana — two of the nation’s largest health insurers would, as a combined company, have owned the biggest share of the Medicare Advantage market, The Wall Street Journal reported.
For journalists covering health insurance in their cities and states, there’s a story on how the merger would have affected competition in states where the two companies compete. Continue reading
The potential benefits of genetic testing are widely touted and drive greater interest in these tests – even though the validity of the science behind such testing remains unclear.
Charles Piller, the West Coast editor for Boston-based online news site Stat, recently reported on the lack of a firm scientific basis for a test that Proove Biosciences in Irvine, Calif., has been marketing as an “opioid risk” detector. Continue reading
For three years, the Centers for Medicare & Medicaid Services (CMS) have penalized hospitals when the institutions show unacceptably high rates of potentially avoidable complications, such as blood clots, bed sores, and infections, Jordan Rau reported last month for Kaiser Health News.
The federal agency this year added penalties for two hospital-acquired infections that result from germs resistant to antibiotics: methicillin-resistant Staphylococcus aureus (known as MRSA) and Clostridium difficile (C. diff). Continue reading
A new Commonwealth Fund report provides a good New Year marker on the uninsurance rate as a result of the Affordable Care Act. It also in a way offers a challenge to those in Congress who would repeal and replace it.
By 2015, one year after the ACA went into effect, the percentage of uninsured working age Americans fell in every state and the District of Columbia, particularly among those with low incomes who need health insurance the most, the report showed. Continue reading