The thrill of delivering newborns helped pull Dr. Jack Feltz into the field of obstetrics and gynecology. More than 30 years later, he still enjoys treating patients, he said. But now, Feltz is also working to change the way doctors are paid for maternity care. Feltz’s New Jersey-based practice, Lifeline Medical Associates, recently partnered with the insurer UnitedHealthcare to test a new payment model. The insurer sets a budget with the practice to pay doctors one lump sum for prenatal services, delivery and 60 days of care afterward.
When Santa Barbara lawyer-turned-activist Ady Barkan settled in to watch the second round of the Democratic presidential primary debates late last month, he had no idea his story would be part of the heated discussion. Barkan, 35, who has amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease, watched from his wheelchair as Massachusetts Sen. Elizabeth Warren described how he and his family had to raise money online to help pay for roughly $9,000 a month in health care costs not covered by his private health insurance. https://twitter.com/AdyBarkan/status/1156365277749305344
“The basic profit model of an insurance company is taking as much money as you can in premiums and pay out as little as possible in health care coverage,” Warren said. “That is not working for Americans.”
But for Barkan, the moment was not about him. “Elizabeth Warren’s point wasn’t just to mention my name, it was to call attention to the ways our broken health care system is hurting people across the country,” he said in an email interview.
A growing number of expectant mothers are among the migrants pouring in daily from Honduras, Guatemala, El Salvador — even Haiti — to more than 30 already overflowing shelters in Tijuana, Mexico. “More women are arriving pregnant or with babies,” said pastor Gustavo Banda of the Embajadores de Jesús (Ambassadors of Jesus) church, which operates a shelter in Cañón del Alacrán (Scorpion’s Canyon) on the outskirts of Tijuana. “We have a lot of Haitian women and some Central American.”
Some women also get pregnant while they wait. These pregnant women are stuck here because the Trump administration’s “Remain in Mexico” program requires some U.S.-bound asylum applicants to register at ports of entry and then return to Mexican border cities to wait as their claims are processed. It’s a period of great anxiety, if only because many want their children born in the United States.
On any given day, more than 4,000 people pass through the library at California State University-Los Angeles. On April 11, one of them had measles. The building has only one entrance, which means that anyone who entered or exited the library within two hours of that person’s visit potentially was exposed to one of the most contagious diseases on Earth. It’s the stuff of public health nightmares: Everyone at the library between 11 a.m. and 3 p.m. that day had to be identified, warned and possibly quarantined. Measles is so contagious that up to 90% of people close to an infected person who are not protected by a vaccine or previous case of the disease will become infected.
Surprise medical bills — those unexpected and often pricey bills patients face when they get care from a doctor or hospital that isn’t in their insurance network — are the health care problem du jour in Washington, with congressional lawmakers from both sides of the aisle and the White House calling for action. These policymakers agree on the need to take patients out of the middle of the fight over charges, but crafting a legislative solution will not be easy. A hearing of the House Ways and Means health subcommittee Tuesday, for example, quickly devolved into finger-pointing as providers’ and insurers’ testimony showed how much they don’t see eye to eye. “I’m disappointed that all participants that are going to be here from critical sectors of our economy could not come to find a way to work together to protect patients from these huge surprise bills,” Rep. Devin Nunes (R-Calif.), the ranking Republican on the subcommittee, said in his opening statement. As Congress weighs how to address the problem, here’s a guide to the bills and what to watch.
The health care debate has Democrats on Capitol Hill and the presidential campaign trail facing renewed pressure to make clear where they stand: Are they for “Medicare for All”? Or will they take up the push to protect the Affordable Care Act? Obamacare advocates have found a powerful ally in House Speaker Nancy Pelosi, who in a recent “60 Minutes” appearance said that concentrating on the health law is preferable to Medicare for All. She argued that since the ACA’s “benefits are better” than those of the existing Medicare program, implementing Medicare for All would mean changing major provisions of current Medicare, which covers people 65 and up as well as those with disabilities. This talking point — one Pelosi has used before — seems tailor-made for the party’s establishment.
The first congressional hearing on a “Medicare-for-all” bill in at least a decade took place Tuesday, but without the usual phalanx of T-shirted supporters — or even the presidential candidates — who have been pushing the bill. That’s because the hearing took place not at one of three major committees that oversee health policy in the House, but in the ornate — and comparatively miniature — hearing room of the House Rules Committee. That panel’s primary role is to set the terms for House floor debates, and its hearing room can seat about 50 people in the audience, compared with hundreds in the larger rooms of the Capitol complex’s office buildings. Also, members of the public cannot easily access the room on the third floor of the Capitol as they can the House office buildings across the street. That arrangement was no accident — the Rules Committee is often called the “Speaker’s Committee” because it is so closely aligned with the speaker’s goals and is more heavily populated with members of the majority party than the usual committee breakdowns.
ByShefali Luthra, Kaiser Health News and Anna Maria Barry-Jester |
PROVIDENCE, R.I. — The Trump administration is pushing ahead with its reproductive health agenda. It has rolled out changes to the Title X program, which funds family planning services for low-income people, that are designed to have a chilling effect on organizations that provide abortions or include this option in counseling. It also has nominated federal judges widely believed to support state-level abortion restrictions. Against that backdrop, Planned Parenthood, known as a staunch defender of abortion rights, is working to recast its public image. Under its president, Dr. Leana Wen, who took office in November, the nation’s largest reproductive health provider is highlighting the breadth of care it provides — treating depression, screening for cancer and diabetes, and taking on complex health problems like soaring maternal mortality rates.
A casual observer of Wednesday’s House Energy and Commerce subcommittee hearing might think insulin prices just go up by themselves. After all, the key industry executives filed opening statements to the congressional panel outlining patient-assistance programs, coupons and discounts — a range of price reductions that might make one think this life-or-death diabetes medication is easily affordable to the patients who need it. In fact, the price of insulin nearly doubled from 2012 to 2016 alone, triggering national headlines about the resulting hardships — sometimes deadly — suffered by people with the Type I-version of the condition who are left to ration insulin because it is too expensive for them to use as prescribed. The three drug manufacturers that make insulin — Eli Lilly, Novo Nordisk and Sanofi — joined three pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — to testify before the Oversight and Investigations panel at its second hearing probing the corporate maneuvers behind the skyrocketing costs. Pharmacy benefit managers, or PBMs, are the go-between companies that negotiate with drugmakers on which medicines will make insurance plans’ lists of covered drugs and how much insurers’ plans will pay for them.
Among the first things Democrats did after officially taking control of the House was to express support for efforts to appeal a Texas district court decision declaring the Affordable Care Act unconstitutional.