Healthcare system and insurance news and discussion

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CVS and Express Scripts sue Arkansas over restriction on pharmacy benefit managers

https://apnews.com/article/cvs-express- ... 835662ba07

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LA Times- Gov. Newsom proposes ‘asset test’ for low-income and disabled Medi-Cal applicants. What does that mean?

https://archive.ph/Jdyl9

[caltrek]

He Died Without Getting Mental Health Care He Sought. A New Lawsuit Says His Insurer’s Ghost Network Is to Blame.
by Max Blau
June 2, 2025

Introduction:

(ProPublica) The mother of an Arizona man who died after being unable to find mental health treatment is suing his health insurer, saying it broke the law by publishing false information that misled its customers.

Ravi Coutinho, a 36-year-old entrepreneur, bought insurance from Ambetter, the most popular plan on HealthCare.gov, because it seemed to offer plenty of mental health and addiction treatment options near his home in Phoenix. But after struggling for months in early 2023 to find in-network care covered by his plan, he wasn’t able to find a therapist. In May 2023, after 21 calls with the insurer without getting the treatment he sought, he was found dead in his apartment. His death was ruled an accident, likely due to complications from excessive drinking.

Coutinho was the subject of a September 2024 investigation by ProPublica that showed how he was trapped in what’s commonly known as a “ghost network.” Many of the mental health providers that Ambetter listed as accepting its insurance were not actually able to see him. ProPublica’s investigation also revealed how customer service representatives and care managers repeatedly failed to connect Coutinho to the care he needed after he and his mother asked for help. The story was part of a yearlong series, “America’s Mental Barrier,” that investigated the ways insurers employed practices that interfered with their customers’ ability to access mental health care.

The lawsuit, filed on May 23 in Maricopa County by Coutinho’s mother, Barbara Webber, accused the insurer Centene, along with the subsidiary that oversaw her son’s plan, Health Net of Arizona, of publishing an “inaccurate and misleading” provider directory. The suit also accused the companies of breaking state and federal laws, including ones that require directories to be kept accurate.

Read more here: https://www.propublica.org/article/cen ... coutinho

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[caltrek]

Medicaid Cuts Would Result in More than 16,500 Medically Preventable Deaths
June 16, 2025

Introduction:

(Eurekalert) A new study published in Annals of Internal Medicine estimates the potential effects on Medicaid enrollment, uninsurance, financial strain, health care access, and health outcomes from potential Medicaid budget cuts being considered in Congress, including the House reconciliation bill advanced in May. Adam Gaffney, MD, MPH and colleagues identified six potential Medicaid cuts that the House of Representatives’ Budget Committee estimates would each reduce the Federal government’s Medicaid outlays by at least $100 billion over ten years: reduction of the Medicaid matching floor; reduced funding of the ACA Medicaid Expansion; Medicaid per capita caps; Medicaid work requirements; reduced Medicaid provider taxes; and repeal of the Biden-era Medicaid eligibility rule. They also assessed the overall effects of the current House bill, which includes three of the six options along with multiple smaller policy changes, such as shortening the duration of Medicaid’s retroactive coverage and increasing cost-sharing for some Medicaid enrollees. The researchers project that individually, these six Medicaid cuts would lead to an annual increase of between 651 and 12,626 medically preventable deaths. These cuts would increase the number of uninsured by between 600,000 and 3,900,000, and the annual number of persons foregoing needed medical care by 129,060 to 838,890. If the current House bill is enacted, the number of uninsured would rise by 7.6 million. It could lead to 1.9 million people losing their personal doctor, 1.3 million foregoing needed medications, 380,270 women going without a mammogram, and 16,642 preventable deaths. The authors warn that although these cuts are intended to offset tax cuts, they would also strip care from millions of low-income Americans and possibly lead to thousands of medically preventable deaths. They assert that policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would benefit mostly wealthy Americans.

Read more here: https://www.eurekalert.org/news-releases/1086942

Because of the ignorance and confusion shown by a certain U.S. Senator:

caltrek: Define medically preventable death.

Bing co-pilot: A medically preventable death refers to a fatality that could have been avoided through timely and effective medical intervention, such as vaccinations, screenings, treatments, or lifestyle modifications. These deaths often result from conditions where established medical care or preventive measures could have significantly reduced the risk of mortality.

For example, deaths caused by heart disease, cancer, stroke, chronic lower respiratory disease, and unintentional injuries are often considered preventable when appropriate medical care and public health strategies are applied. Additionally, preventable deaths can be linked to modifiable risk factors such as smoking, poor diet, physical inactivity, and inadequate access to healthcare.

[caltrek]

How the Senate’s Proposed Medicaid Cuts Could Deepen the Rural Hospital Crisis
By Berkeley Lovelace Jr.
June 17, 2025

Introduction:

(NBC) Rural hospitals across the U.S. — many already hanging by a thread — could take a serious hit if a proposed Medicaid cut in the Senate’s domestic spending bill is signed into law.

The provision, outlined in the 549-page bill released by the Senate Finance Committee on Monday, would gradually limit states’ use of Medicaid’s so-called provider tax.

Medicaid is jointly funded by the federal government and states. States cover the upfront cost of care and then are reimbursed by the federal government for at least 50%.

The provider tax is a state-imposed fee on hospitals and other health care providers to help fund a state’s share of the Medicaid program. When states use provider funds to boost their Medicaid spending, the federal government gives them more money because it's required to match it.

The tax must apply to all providers within a class — so if a state wants to tax hospitals, it must include all licensed hospitals. Most states have multiple provider taxes, including taxes for nursing facilities and ambulance services, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy who focuses primarily on Medicaid.

Read more here: https://www.nbcnews.com/health/health- ... twitter

[caltrek]

Congress Is Pushing for a Medicaid Work Requirement. Here’s What Happened When Georgia Tried It.
By Margaret Coker
June 26, 2025

Introduction:

(ProPublica) Congressional Republicans, looking for ways to offset their proposed tax cuts, are seeking to mandate that millions of Americans work in order to receive federally subsidized health insurance. The GOP tax and budget bill passed the House in May, and Senate Republicans are working feverishly to advance their draft of federal spending cuts in the coming days.

Georgia, the only state with a Medicaid work mandate, started experimenting with the requirement on July 1, 2023. As the Medicaid program’s two-year anniversary approaches, Georgia has enrolled just a fraction of those eligible, a result health policy researchers largely attribute to bureaucratic hurdles in the state’s work verification system. As of May 2025, approximately 7,500 of the nearly 250,000 eligible Georgians were enrolled, even though state statistics show 64% of that group is working.

Gov. Brian Kemp has long advocated for Medicaid reform, arguing that the country should move away from government-run health care. His spokesperson also told The Current and ProPublica that the program, known as Georgia Pathways to Coverage, was never designed to maximize enrollment.

Health care analysts and former state Medicaid officials say Georgia’s experience shows that the congressional bill, if it becomes law, would cost taxpayers hundreds of millions of dollars in administrative costs as it is implemented while threatening health care for nearly 16 million people.

Read more here: https://www.propublica.org/article/geo ... iful-bill

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Majority of Medicaid managed care plans cover opioid overdose reversal drug naloxone, but access barriers remain

https://medicalxpress.com/news/2025-06- ... ersal.html

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Retiring GOP senator savages Medicaid cuts in Trump's "big, beautiful bill"

Source: Axios

10 hours ago

Fresh off announcing he'll retire next year, Sen. Thom Tillis gave a lengthy floor speech Sunday night attacking cuts to Medicaid in the "big, beautiful bill."

Why it matters: The North Carolina Republican is accusing the GOP of breaking President Trump's campaign promises to protect Medicaid.

Tillis voted Saturday against starting debate on the bill, and has declared he'll vote "no" on the final version.



Zoom in: "I'm telling the president, you have been misinformed," Tillis said on Sunday night.

"What do I tell 663,000 people in two years, three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding's not there anymore," Tillis asked.
He compared Trump's promise on Medicaid to former President Obama's "if you like your health care plan, you can keep it" quote on the Affordable Care Act.
The Senate's version of the "big, beautiful bill" would result in 12 million more people without health insurance in 2034 than today, the Congressional Budget Office projects.

Read more: https://www.axios.com/2025/06/30/thom-t ... tiful-bill

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More on that by Nebraska Public Media:

https://nebraskapublicmedia.org/en/news ... r-funding/

[caltrek]

House Republican Reportedly Informed Oblivious Trump That the ‘Big, Beautiful Bill’ Cuts Medicaid
By Michael Luciano
July 2, 2025

Introduction:

(Mediaite) During a meeting with congressional Republicans on Wednesday, President Donald Trump appeared unaware that the spending legislation he has been working to pass contains massive cuts to Medicaid.

Trump has long warned Republicans not to undercut Medicaid, the government program that provides healthcare coverage to lower-income Americans. However, the “big, beautiful bill” he has touted would cut Medicaid by $1 trillion and kick an estimated 11 million Americans off the program.

On Wednesday, NOTUS reported that Trump hosted several moderate GOP lawmakers to hear their concerns and tried to sell the legislators on the bill. At one point, the president reportedly demonstrated he does not know that the bill cuts Medicaid:

• But Trump still doesn’t seem to have a firm grasp about what his signature legislative achievement does. According to three sources with direct knowledge of the comments, the president told Republicans at this meeting that there are three things Congress shouldn’t touch if they want to win elections: Medicaid, Medicare and Social Security.

• “But we’re touching Medicaid in this bill,” one member responded to Trump, according to the three sources.

Read more here: https://www.mediaite.com/politics/trum ... medicaid

caltrek's comment: This opens up an intriguing possibility. If Trump truly is ignorant of the devastating effects of his bill on Medicaid, perhaps further legislation softening its impact might be agreed upon in some sort of bipartisan fashion. Two obstacles would have to be overcome:

1. How to finance the measure. It would be difficult for Republicans to agree to any new taxes that would be needed in such a reform.

2. The by now longstanding reluctance to engage in any bi-partisan legislative efforts. Republicans who do so risk angering their base, even with Trump providing cover.

[caltrek]

Trump’S Budget Will Devastate Health Care for Rural Families Like Mine
By Ta'Kyla Bates
July 2, 2025

Introduction:

(Other Words) For generations, my family has lived in a rural Alabama county with just one community hospital, with 107 beds to service 60,000 people. Among those 60,000, 19 percent of individuals are covered by Medicaid — including my mom, sisters, aunts, and uncles.

The hospital was at least a 20-minute drive away from where we lived when I was growing up. And that’s hardly unusual. Pew Research found that on average, it takes people living in rural communities 17 minutes to get to their nearest hospital.

Those minutes can mean life or death in an emergency. And looming Medicaid cuts could make the situation even deadlier for rural Americans, who are at risk of losing both their health coverage and their nearest hospitals.

According to the 2020 census, roughly 66 million Americans live in rural areas, and about 16 million of those individuals are covered by Medicaid. But in the next decade, nearly 2 million rural Americans — and 17 million overall — could be at risk of losing their health care.

Why? Because of President Trump and his allies in Congress.

Read more here: https://otherwords.org/trumps-budget-w ... e-mine/

[weatheriscool]

US judge grants Trump admin request to scrap Biden-era medical debt rule

Source: Reuters

July 11, 2025 6:13 PM EDT Updated 11 hours ago

WASHINGTON, July 11 (Reuters) - A federal judge in Texas on Friday granted a request from the Trump administration and industry groups to scrap regulations adopted during the final days of Joe Biden's presidency that would have removed consumers' medical debts from their credit reports, court papers showed.

U.S. District Judge Sean Jordan, whom Trump appointed in 2019, agreed with current leadership of the Consumer Financial Protection Bureau and financial industry trade groups that the rule, adopted in January, exceeded the CFPB's legal authorities and should be vacated. Representatives of the CFPB, which ceased defending the rule after President Donald Trump took office this year, did not respond to a request for comment.

However, Dan Smith, head of the Consumer Data Industry Association, welcomed the decision, adding that medical debt helped indicate whether consumers could repay their debts. "This is the right outcome for protecting the integrity of the system," he said in a statement.

Former Vice President Kamala Harris had championed the regulation, citing CFPB research indicating that, because consumers incurred medical debts due to accidents and illnesses they did not choose to suffer, the information was of little value in determining whether they could afford to borrow for other reasons.

Read more: https://www.reuters.com/legal/litigatio ... 025-07-11/

[caltrek]

Catastrophic Federal Medicaid Cuts Loom on the Golden State’s Health Care Horizon
By Mark Kreidler
July 10, 2025

Introduction:

(Capital and Main ) For all the right reasons, the conversation about the Donald Trump-led budget reconciliation centers on massive Medicaid funding reductions and the long-term damage they’ll do to public health. With some 15 million Californians relying on Medi-Cal, the state’s version of Medicaid, to see a doctor, that’s no thought exercise — it’s an emergency. The misery hasn’t arrived yet, but it already feels real.

There is another program, though, that is in more immediate danger of losing its punch. Without an extension of federal subsidies that are scheduled to expire this year, people who shop on the Covered California exchange for their health insurance are going to absorb premium rate hikes in the painful-to-impossible range — 75%, by one estimate.

And they are going to leave the exchange, possibly by the hundreds of thousands.

And our state will become sicker — and poorer — for it. Covered California, imperfect though it is, keeps people in health plans on at least somewhat affordable terms, when their situations otherwise might preclude that and force them into mostly awful choices.

Read more here: https://capitalandmain.com/will-covere ... support

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Cost of Obamacare expected to soar as subsidies expire and insurers hike premiums

Source: NBC News

July 18, 2025, 5:00 AM EDT

People who get health insurance through the Affordable Care Act could soon see their monthly premiums sharply increase as subsidies expire and insurers propose a major premium hike for 2026.

Insurers that offer plans through the ACA are planning an average premium increase of 15% for 2026 — the largest increase in seven years, according to an analysis published Friday from KFF, a health policy research group. The analysis is based on filings from more than 100 insurers in 19 states and Washington, D.C.

The increase will likely come on top of the loss of enhanced subsidies that helped people pay for ACA health plans by capping the costs at a certain proportion of their income.

The finalized plans — including how much more people will be expected to pay each month — are usually published around August.

Read more: https://www.nbcnews.com/health/health-c ... rcna219440

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[caltrek]

Congressional Budget Office Confirms Trump Budget Law Will Trigger Over $500 Billion in Automatic Medicare Cuts
By Brad Reed
August 15, 2025

Introduction:

(Common Dreams) A report released on Friday confirmed what many Democratic lawmakers have long been warning about: Republicans' massive budget law will trigger significant cuts to Medicare.

The Congressional Budget Office (CBO) released its analysis of the GOP's budget package and acknowledged that it would be required to issue a sequestration, which is essentially a cancellation of budgetary resources.

The sequestration is required under the rules set out by the Statutory Pay As You Go Act of 2010 that requires spending cuts that are equal to a piece of legislation's negative impact on the budget deficit.

The only way to avoid these cuts, said the CBO, would be for Congress to pass "subsequent legislation that would
offset the deficit increase, waive the recordation of the bill's effects on the scorecard, or otherwise mitigate or eliminate the statutory requirements."

The CBO said that these cuts could take as much as $45 billion out of Medicare for fiscal year 2026. What's more, the amount cut from Medicare would increase in every subsequent year, resulting in total cuts of as much as $536 billion between 2026 and 2034.

Read more here: https://www.commondreams.org/news/cbo- ... -budget