HEALTH CARE un-covered

HEALTH CARE un-covered critically examines the U.S. healthcare system, particularly the impact of Medicare Advantage plans and the practices of major health insurers. It highlights issues like aggressive marketing, profit-driven decision-making, and the effects on patients' access to care and costs. The series advocates for transparency, regulation, and reform.

Medicare Advantage Plans Health Insurance Practices Healthcare Costs Patient Access to Care Healthcare Regulation Political Influence Healthcare Reform

The hottest Substack posts of HEALTH CARE un-covered

And their main takeaways
479 implied HN points 15 Sep 23
  1. Health insurers are charging patients much more for generic drugs, even when those drugs are supposed to be cheap. This makes it hard for patients, especially those with serious health issues, to afford their medications.
  2. Researchers suggest that proposed Congressional reforms may not effectively lower drug costs because pharmacy benefit managers (PBMs) could find new ways to maintain their profits.
  3. The market for PBM services is very concentrated, giving a few companies a lot of power. More competition could help lower drug prices, but eliminating PBM profits might only reduce overall spending by a small amount.
519 implied HN points 28 Aug 23
  1. Elevance is a health insurer with high denial rates for claims, affecting patients' access to necessary treatments. Many poor Americans are struggling because of this.
  2. In Ohio and Virginia, there's a conflict between Elevance and a major hospital system, leading to unpaid claims amounting to $100 million. This dispute means Medicaid patients may need to find different hospitals for care.
  3. Lawmakers need to step in and address the unfair practices of health insurers like Elevance. This is crucial for protecting low-income Americans who rely on Medicaid services.
339 implied HN points 30 Nov 23
  1. Health insurers often ignore laws meant to help patients get crucial medical care. This can result in patients not receiving life-saving treatments they need.
  2. Many patients don’t complain about insurance denials because they are overwhelmed during difficult times. This makes it hard for regulators to catch insurers doing wrong.
  3. State insurance departments are usually underfunded and struggle to enforce laws, which allows insurers to keep profiting while patients suffer.
399 implied HN points 31 Oct 23
  1. The Nuka System of Care in Alaska has dramatically improved healthcare by focusing on community-based support and engaging Alaska Natives directly in their health journeys. This system results in happier patients and better health outcomes.
  2. Since the Nuka System started, emergency room visits and hospital admissions have dropped significantly. It also emphasizes personal relationships and understanding each patient's unique needs, leading to high satisfaction rates.
  3. The approach integrates modern medical practices with the values of Alaska Native culture. This has made it a model for healthcare systems worldwide, with many organizations studying its success to learn how to improve their own care.
499 implied HN points 31 Aug 23
  1. The U.S. healthcare system has changed a lot since 2008, making it hard for providers and giving payors like UnitedHealth advantages. They manage profits by combining health services and insurance.
  2. Big insurers can keep costs low for themselves while paying their own providers well, which puts pressure on other healthcare providers. This may lead some to sell their practices to these larger companies.
  3. There is increasing tension between healthcare providers and payors due to strategies that payors use to reduce coverage and costs. Providers need to understand these changes to negotiate better.
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359 implied HN points 14 Nov 23
  1. There is a growing crisis in American hospitals, especially with large hospitals making a lot of money while smaller ones struggle and close down.
  2. The documentary 'American Hospitals: Healing a Broken System' highlights these issues and features experts sharing insights on the hospital situation.
  3. Some lawmakers are starting to pay more attention to the hospital industry's problems and are encouraging changes to make healthcare more fair and accessible for everyone.
419 implied HN points 28 Sep 23
  1. Children's Hospital of Philadelphia (CHOP) is growing and investing in new facilities, but this has left smaller community hospitals struggling to survive. This expansion is happening in wealthy suburbs while local hospitals face closure.
  2. Many small rural hospitals in the U.S. are in financial trouble because they don't get paid enough for the care they provide. This leads to closures, making it hard for people in those areas to get medical help.
  3. There are concerns about how nonprofit hospitals are defined and whether they are truly serving their communities. A group of senators is pushing for clearer rules to ensure these hospitals meet their obligations to provide care to those in need.
679 implied HN points 15 May 23
  1. Congress is looking into how Pharmacy Benefit Managers (PBMs) operate. They want to make sure these companies are not overcharging people for their medications.
  2. PBMs and insurance companies are causing more financial strain on patients by raising out-of-pocket costs. Many people are struggling to afford their medications because deductibles have doubled over the past decade.
  3. There are new bills being proposed to increase transparency and reform PBM practices. This could help ensure that savings from drug manufacturers are passed on to patients.
319 implied HN points 17 Nov 23
  1. Long-COVID patients often struggle to be understood by doctors, facing skepticism about their symptoms. Many doctors don't have clear guidelines for treating long COVID, which can leave patients feeling frustrated and ignored.
  2. Symptoms of long COVID can be very varied and affect many parts of the body. People report issues like extreme fatigue, brain fog, and pain, which can significantly change their daily lives.
  3. The cost of treatment can be a huge burden for long COVID patients, especially in the U.S., where many face denied claims for necessary medications. This financial strain adds to the challenges they already face in managing their health.
279 implied HN points 06 Dec 23
  1. Preventing opioid addiction is just as important as treating those who are already addicted. Focusing on prevention could help stop more people from becoming addicted in the first place.
  2. The U.S. prescribes a huge amount of opioids compared to other countries, which contributes to the addiction crisis. Many people who end up using heroin were first given opioids through prescriptions.
  3. State and federal policies should shift towards reducing unnecessary opioid prescriptions. Educating doctors and patients about pain management can help lower opioid use and its associated risks.
399 implied HN points 14 Sep 23
  1. Big health insurers are planning to cut costs and increase profits by negotiating harder with hospitals and cutting payments to doctors. This might mean less money for patient care.
  2. There may be layoffs and job losses as companies try to streamline operations and boost their financial performance. Together with potential cuts in benefits, employees could face job insecurity.
  3. Health insurance costs are expected to rise for consumers, along with reduced access to care. Insurers are looking to increase prices and tighten coverage to please investors on Wall Street.
439 implied HN points 15 Aug 23
  1. Nonprofit hospitals are supposed to help their communities, but many are not meeting their legal obligations for charity care and community spending. They're holding onto large amounts of cash instead.
  2. A group of senators is raising concerns about how some nonprofit hospitals are abusing their tax-exempt status. They want clearer rules and stronger oversight to ensure hospitals give back to the community.
  3. Some hospitals focus too much on profits and expensive projects instead of helping poor patients. This is causing problems for those who really need care but aren't getting the support they should.
419 implied HN points 17 Aug 23
  1. Elevance and other for-profit insurers are denying many care requests for Medicaid patients. In fact, Elevance has a denial rate over 34%, which is really high.
  2. Lawmakers are starting to investigate these denial practices more closely. Congress is looking into how insurers use 'prior authorization' to say no to needed treatments.
  3. In Ohio, Elevance is having contract disputes with hospitals, impacting Medicaid patients' access to care. This means patients might struggle to find alternative hospitals that will cover their treatments.
319 implied HN points 27 Oct 23
  1. Nonprofit hospitals are under scrutiny for not doing enough to help low-income patients afford care. Many have been accused of taking advantage of their tax-exempt status.
  2. A recent Senate report highlighted stories like that of Carrie Barrett, who faced huge medical bills from a nonprofit hospital despite her low income. This shows how unfair practices can lead to unbearable debt for patients.
  3. There's a growing push from Congress to make sure nonprofit hospitals meet their obligations to provide charity care. Lawmakers want to ensure these hospitals aren't just focused on profits.
619 implied HN points 04 May 23
  1. Health insurers have spent about $141 billion on buying back their own shares since 2007. This means money that could help lower premiums is going to make executives richer instead.
  2. As health insurers buy back shares, premiums and deductibles for customers have gone up a lot. Many people are struggling with high medical debts while companies focus on profits.
  3. There are efforts to change laws around stock buybacks, but so far, nothing has passed. Many believe that these buybacks hurt workers and families instead of helping them.
559 implied HN points 01 Jun 23
  1. Seven health insurance CEOs made a whopping $335 million in 2022, which is 18% more than the previous record. Most of their earnings came from big stock buybacks by their companies.
  2. Molina's CEO earned more than half of the total amount, making $181 million, while the smallest companies made most of their money from taxpayer-funded programs like Medicaid.
  3. The increase in CEO pay is concerning, especially since it has happened while many Americans struggle with high medical costs and debts, indicating a focus on profits over patient care.
519 implied HN points 20 Jun 23
  1. Big health insurers are using a group called PCMA to run ads in Washington to protect their profits in the pharmacy supply chain. They want everyone to think they're on the side of patients.
  2. Pharmacy Benefit Managers (PBMs) are making more money than traditional health insurance companies. They decide which medications people can access and how much they have to pay.
  3. The ads you're seeing about PBMs being beneficial are actually paid for by the insurers, meaning the costs are coming from the money you pay in premiums and taxes.
459 implied HN points 17 Jul 23
  1. UnitedHealth Group reported a big increase in revenue and profits, mainly from its pharmacy benefit business and taxpayer-funded programs. They made over $12 billion more than last year.
  2. The company saw significant growth in its Medicare and Medicaid programs, with enrollment in these government programs increasing faster than in traditional commercial plans.
  3. UnitedHealth's Optum division, which provides healthcare services, is growing rapidly, allowing the company to manage costs better and avoid paying out more in claims.
279 implied HN points 08 Nov 23
  1. The documentary 'Medicine Man: The Stan Brock Story' highlights the important work of Remote Area Medical, which helps people without access to healthcare, especially in underserved areas.
  2. Stan Brock has dedicated his life to providing medical care to those in need, and his story is a reminder of how one person can make a big difference in many lives.
  3. The film will be screened nationwide for one night only on November 14, 2023, offering people a chance to learn about this inspiring journey and the ongoing healthcare challenges in America.
299 implied HN points 03 Oct 23
  1. Walgreens is interested in hiring a former executive from Cigna/Express Scripts to help improve its business. They want someone with experience in pharmacy benefits to boost their competitiveness.
  2. Cigna has been fined $172 million for misleading the government about patient diagnoses in their Medicare Advantage program. They were accused of inflating seriousness of conditions to receive more funding.
  3. The pharmacy benefit management market is controlled by a few big companies, and Walgreens needs to strengthen its position to compete effectively against other large players like CVS and Amazon.
479 implied HN points 08 Jun 23
  1. CVS's Chief Financial Officer stated that the company will continue to find ways to profit even if regulations change. They seem more focused on profits than helping people with their healthcare needs.
  2. Pharmacy Benefit Managers (PBMs) like CVS's Caremark are very profitable, and they control a major part of the market. This has sparked concern among lawmakers about the fairness of their practices.
  3. The current healthcare system allows companies to prioritize profits over patients, leading to higher costs and medical debt for many Americans. Lawmakers need to take action to protect the public.
539 implied HN points 19 Apr 23
  1. UnitedHealth made a huge profit of $27.8 billion from the drug supply chain in just the first quarter of 2023. They also spent $3.5 billion buying back their own stock to increase value for shareholders.
  2. The company has dramatically increased its revenues and profits over the past decade, primarily from government programs like Medicare and Medicaid. Their pharmacy benefit manager, Optum Rx, has seen massive growth, capturing more money from patients.
  3. Despite their growth, the company's enrollment in commercial health plans has barely changed. Instead, more people are signing up for their Medicare Advantage plans, which suggests they are shifting focus to government-supported programs.
399 implied HN points 07 Jul 23
  1. Hospitals are focusing more on getting paid upfront from patients, even before care is provided. This shift is partly due to more people facing high medical costs because of their insurance plans.
  2. Many hospitals are using technology to remind patients of their bills and to ask for payments in advance. This creates a situation where financial discussions happen at the same time as medical care.
  3. The emphasis on collecting money may lead to less compassion in healthcare. Patients often feel pressured about their bills instead of receiving the support they need during tough times.
359 implied HN points 01 Aug 23
  1. Elevance Health is denying a lot of care for Medicaid patients, with one in three requests being turned down. This high denial rate has raised concerns about access to necessary medical treatments.
  2. A big reason Elevance is profitable is that it receives a steady amount of money for each Medicaid beneficiary, which can lead to denying care to keep costs low. This model focuses on profits rather than patient needs.
  3. Federal investigators are calling for more oversight of how these private insurers operate. They found that many states are not closely monitoring the care denials, which could hurt vulnerable patients who rely on Medicaid.
359 implied HN points 20 Jul 23
  1. Elevance's profits for the second quarter were better than expected, making Wall Street investors very happy. The company is on track to earn even more this year than previously thought.
  2. The company spent less on patient care compared to previous years, which boosted their profits. However, this came at the expense of providing necessary care for low-income and vulnerable populations.
  3. Elevance is growing mainly through its Medicare and Medicaid programs, while its private insurance enrollment is declining. The growth in revenue comes from premium increases and government subsidies.
399 implied HN points 15 Jun 23
  1. Health insurance companies often deny crucial medical claims, even when doctors say treatment is a matter of life or death. This can leave patients in distress, struggling to access the care they desperately need.
  2. Many people don't know they have the right to challenge claim denials. Even if they do, insurers often make it difficult to win these appeals.
  3. Campaigns like Care Over Cost show that collective action can help patients get the care they deserve. By uniting and raising awareness, patients can hold insurers accountable and fight for their rights.
419 implied HN points 24 May 23
  1. Health care costs are rising rapidly, putting financial pressure on employers. Many companies might struggle to afford these increased costs, which could lead to bigger changes in the health care system.
  2. The recent health care law aims to make pricing and quality data more accessible. This means employers can now better compare health care providers and make informed choices about where to direct their health care spending.
  3. There's a shift towards valuing better health outcomes rather than just more services. This change could transform the health care industry by encouraging competition based on quality and efficiency.
239 implied HN points 27 Sep 23
  1. Medicare Advantage ads are misleading, and there is an effort by the government to make them more transparent. Consumers need to be careful and do their research before signing up for these plans.
  2. In 2024, health insurers are planning significant rate hikes that could affect employers and consumers. This could lead to higher overall healthcare costs and impact inflation.
  3. There is increasing pushback from employers against these rate hikes. They are using new transparency rules to negotiate better deals with health insurers.
539 implied HN points 27 Feb 23
  1. Big insurance companies made a lot of money in 2022, reaching $1.25 trillion in revenue. They mainly got this money from managing drug benefits and government health programs.
  2. Pharmacy Benefit Managers (PBMs) are becoming really important for these insurers, as they now make up a huge portion of their profits. They control a lot of the drug pricing and decide which pharmacies patients can use.
  3. Most growth for these companies is coming from government programs like Medicare, while their commercial insurance business is struggling. Many people are now finding it harder to afford their healthcare costs.
299 implied HN points 03 Aug 23
  1. Many people, even with health insurance, struggle to pay medical bills. High deductibles and out-of-pocket costs can make accessing healthcare really stressful.
  2. State and local governments are starting to help by abolishing medical debt for residents, providing immediate relief. This makes a huge difference in people's lives and encourages them to seek necessary healthcare.
  3. While local actions are positive, more federal support is needed to truly tackle medical debt. There’s a call for Congress to lower out-of-pocket costs and improve insurance protections so that medical debt doesn't become a lasting issue for many families.
499 implied HN points 16 Feb 23
  1. Traditional Medicare lets you see almost any doctor or hospital in the U.S., while Medicare Advantage usually limits you to a specific network of providers.
  2. Medicare Advantage plans sometimes deny necessary care, while traditional Medicare generally ensures full coverage for services recommended by your doctor.
  3. You might save money with Medicare Advantage in the short term, but if you need expensive care later, it could cost you much more than traditional Medicare.
479 implied HN points 24 Feb 23
  1. The CEOs of Cigna and CVS made a staggering $632 million while many Americans struggle with medical debt. This highlights a big gap between executive pay and the financial struggles of everyday people.
  2. One of the main issues is that many in the U.S. have extremely high deductibles, which means they take on a lot of out-of-pocket expenses before getting any help from insurance.
  3. There is a huge disparity in pay between these executives and their employees, with ratios reaching as high as 458 to 1. This raises questions about how fairly companies value their workers compared to top management.
419 implied HN points 07 Mar 23
  1. Traditional Medicare can be expensive upfront due to high out-of-pocket costs, especially if you need supplemental coverage. Many people choose Medicare Advantage for its lower immediate costs and out-of-pocket limits.
  2. Companies often push retirees into Medicare Advantage plans because they save money and get better benefits for these groups. However, retirees might lose important access to doctors and hospitals by switching.
  3. Medicare Advantage plans may advertise extra benefits, but these can come with hidden costs. People often struggle to access the care they need due to strict rules and limited provider networks.
419 implied HN points 06 Mar 23
  1. The Big Seven health insurers spent $26.2 billion on buying back their stocks in just one year, which mostly benefited wealthy shareholders and CEOs.
  2. Despite making over $69 billion in profits in 2022, many Americans are struggling with high medical debt due to high-deductible insurance plans.
  3. Instead of helping patients, the focus remains on increasing share prices, leading to calls for legislation that could tax stock buybacks and support patients with their medical expenses.
399 implied HN points 08 Mar 23
  1. The claims by pharmacy benefits managers (PBMs) about making prescription drugs safer and more affordable are often misleading. Even though they say they help, the reality is much more complicated.
  2. PBMs profit from selling more drugs, not necessarily from helping patients save money. Instead of focusing on what’s best for patients, their main goal can be to keep their own profits high.
  3. The healthcare system in the U.S. is fragmented and expensive, leading to a push for universal coverage. There is a belief that a single-payer system could make healthcare more inclusive and affordable for everyone.
419 implied HN points 20 Feb 23
  1. Medicare can't negotiate drug prices, which means taxpayers often pay more than necessary for medicines. It doesn't seem fair that businesses get better deals than we do.
  2. The 340B Drug Pricing Program was created to help hospitals get lower drug prices, but it has grown too big and complicated. Now, many hospitals may be making more money from these discounts than they should.
  3. There is a lack of transparency regarding how much hospitals charge for drugs compared to their purchase prices. This raises concerns about fairness and accountability in the healthcare system.
359 implied HN points 14 Mar 23
  1. The healthcare system in America is often driven more by profits than by providing good care to patients. This needs to change for the health of everyone.
  2. There are many ways to improve healthcare, such as making it affordable and accessible for all. Countries like the UK and Canada show that universal healthcare can work.
  3. Young health professionals can be the change-makers. They need to fight for justice in healthcare and challenge the current system that prioritizes money over lives.
419 implied HN points 11 Jan 23
  1. People from different political sides are coming together in New York to oppose a plan to move retirees from traditional Medicare to a private insurance plan. This shows that healthcare issues can unite folks regardless of their politics.
  2. The mayor's proposal could harm retirees financially, pushing them to a private plan with higher costs and less freedom in choosing doctors. Many might not truly have a choice once they face increased costs to stay in their current Medicare plan.
  3. There's growing awareness about how private insurers are negatively affecting Medicare. More people, including those in government, are recognizing the problem and starting to speak out against it.
339 implied HN points 16 Mar 23
  1. Having health insurance isn't always enough. Many people still face huge costs and hardships despite having coverage.
  2. Medical bills can lead to severe financial strain and even bankruptcy, impacting people's lives deeply.
  3. Advocacy for better healthcare systems is crucial, and personal stories highlight the struggles that many individuals endure with the current system.
319 implied HN points 15 Mar 23
  1. Many large nonprofit hospitals behave like people who often go bankrupt. They spend a lot on fancy buildings and high salaries without really understanding their finances.
  2. These hospitals sometimes close services in poorer areas while investing heavily in more affluent locations. This hurts communities that need healthcare the most.
  3. Just like how a judge talks to people who are bankrupt about their spending, hospital systems also need honest discussions about their financial habits to avoid future problems.