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The federal government will soon announce its payment rates and policy changes for the Medicare Advantage program. Here's how you can influence their decision.

HEALTH CARE un-covered • 599 implied HN points • 26 Mar 24
🏥 Health Politics Medicare Policy change Insurance Health Outcomes
  1. The government will soon decide how much money to give to private Medicare Advantage insurers for 2025. People are encouraged to voice their opinions to influence this decision.
  2. Many Medicare Advantage plans cost taxpayers more money and often provide worse care than traditional Medicare. There's a call to demand better use of tax dollars.
  3. The marketing of Medicare Advantage plans can be misleading, impacting vulnerable seniors. It's important to push the government to avoid giving more funds to these insurers.

Hospitals across the country are dumping Medicare Advantage plans and canceling their contracts with insurers

HEALTH CARE un-covered • 1238 implied HN points • 07 Dec 23
🏥 Health Politics Medicare Insurance Healthcare access Patient rights Policy Reform
  1. Many hospitals are canceling their contracts with Medicare Advantage plans due to lower payments and extra work to get approvals. This creates difficulties for both hospitals and patients.
  2. Patients on Medicare Advantage plans may face delays in receiving care and might get stuck with high medical bills. This is because these plans often deny or delay necessary services.
  3. There's a growing concern about whether Medicare Advantage plans are good for seniors. People are questioning if these plans truly provide the best care or if they profit from denying treatments.

The PBM-insurer mafia comes for community pharmacies

HEALTH CARE un-covered • 579 implied HN points • 20 Mar 24
🏥 Health Politics Pharmaceuticals Healthcare Reform Insurance Regulations Public Health
  1. Big Pharmacy Benefit Managers (PBMs) like UnitedHealth and Cigna are pushing independent pharmacies out of business. They drop reimbursement rates, making it harder for these smaller pharmacies to survive.
  2. The financial troubles for independent pharmacies are linked to complex fees and lack of transparency from PBMs. Many pharmacies are struggling with fees that keep rising unexpectedly.
  3. Without independent pharmacies, people might face longer waits for medications and less personalized care. It's important for lawmakers to step in and make changes to support these community pharmacies.

DEATH BY PAPERWORK: Watch NYT Opinion video on health insurers' "prior authorization" practices

HEALTH CARE un-covered • 579 implied HN points • 15 Mar 24
🏥 Health Politics Insurance Healthcare Patient rights Bureaucracy Medical Ethics
  1. Prior authorization is a process where patients and doctors must get approval from insurance companies before certain treatments can be covered. This often causes delays and can lead to worsening health issues for patients.
  2. The process can be very frustrating and complicated, leading some patients to skip necessary care altogether. This can increase stress and harm their health further.
  3. Doctors and their staff spend a lot of time dealing with the paperwork required for prior authorization, which takes away from actual patient care and can lead to burnout among healthcare providers.
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UnitedHealth’s self-dealing is accelerating

HEALTH CARE un-covered • 899 implied HN points • 12 Jan 24
🏥 Health Politics Health care Insurance Policy Corporate ethics Financial Analysis
  1. UnitedHealth is increasingly making money through its own subsidiaries, which means it's doing more business with itself. This raises concerns about whether patients are getting the best options and quality of care.
  2. A significant portion of UnitedHealth's revenue comes from internal transactions with its subsidiary, Optum. This could limit competition and hurt other healthcare providers.
  3. Using its own doctors and services helps UnitedHealth avoid spending obligations meant for patient care, potentially leading to reduced quality for patients.

Have insurance? Good luck finding an in-network mental health professional.

HEALTH CARE un-covered • 659 implied HN points • 22 Feb 24
🏥 Health Politics Mental health Insurance Healthcare access Patient Care Legislation
  1. Finding an in-network mental health professional is really hard for people with insurance. Many providers are not actually accepting new patients or have left the network, making it feel like a waste of time for those seeking help.
  2. Even with insurance, many patients face high out-of-pocket costs. The average cost for therapy sessions can be over $174, creating a barrier for those who need mental health care.
  3. Insurance companies often make it tough to get claims approved by imposing complicated processes. This frustrates providers and leaves patients without the care they deserve.

Why US Health Insurance Companies are Hated

Erik Examines • 89 implied HN points • 11 Dec 24
🏥 Health Politics Health care Insurance Capitalism Public Policy Patient rights
  1. People in the U.S. often face a tough experience with health insurance companies, which frequently deny care instead of helping patients. This differs a lot from the experiences in countries with socialized healthcare systems like Norway.
  2. For-profit health insurance companies prioritize their profits over patient care. This leads to a system where they often refuse necessary treatments, pushing patients into stressful battles just to receive care that should be available to them.
  3. Health insurance companies in the U.S. have little incentive to promote preventative care because they risk losing patients. In contrast, public health systems are designed to encourage preventive care, as healthier citizens reduce overall costs.

President Biden proposes $2,000-a-year limit on prescription drugs

HEALTH CARE un-covered • 519 implied HN points • 08 Mar 24
🇺🇸 U.S. Politics Health care Legislation Insurance Public Policy Government Action
  1. President Biden wants a yearly cap of $2,000 on prescription drug costs for everyone, not just seniors. This could help many people afford their necessary medications.
  2. This proposal builds on a previous law that already caps costs for Medicare recipients, showing a commitment to reducing healthcare expenses for all.
  3. The success of this plan relies on public support and overcoming resistance from insurance companies, who may argue it could lead to higher costs elsewhere.

BETWEEN YOU AND YOUR DOCTOR: How Medicare Advantage care denials affect patients

HEALTH CARE un-covered • 499 implied HN points • 04 Mar 24
🏥 Health Politics Healthcare policy Medicare Insurance Patient rights
  1. Medicare Advantage plans are often denying care for patients, which can lead to serious health issues. Insurers like UnitedHealth prioritize profits over patient care, creating barriers for those who need treatment.
  2. The process of 'prior authorization' used by these insurers causes significant delays in receiving necessary medical care. This system can sometimes result in life-threatening situations for patients who are waiting for approval.
  3. Organizations like People’s Action are working to help patients navigate the complicated insurance system and advocate for fair treatment. They aim to expose the challenges faced by patients and push for changes to the healthcare system.

Mapping UnitedHealth’s consumption of our health care system – from the ‘70s to today

HEALTH CARE un-covered • 759 implied HN points • 20 Dec 23
🏥 Health Politics Health care Insurance Policy Acquisitions Corporate Power
  1. UnitedHealth has grown significantly by acquiring many health companies since the 1970s. This has made it one of the biggest and most influential health care companies in the U.S.
  2. Their acquisitions have changed how health care is managed, often focusing more on profit rather than patient care. Some companies they've bought have faced criticism for denying necessary treatments.
  3. UnitedHealth's size allows it to impact many areas of health care, from insurance to the providers of medical services. This has raised concerns about its influence over patient care and competition in the market.

How Employers Can Easily Bend the Rx Cost Curve

HEALTH CARE un-covered • 259 implied HN points • 24 Apr 24
🏥 Health Politics Healthcare Costs Prescription drugs Insurance Legislation
  1. Employers can save money on prescription drugs by creating a competitive environment for pharmacy benefit management (PBM) contracts. This means they should compare prices from various PBMs to find the best deal.
  2. Using objective pricing metrics helps employers understand exactly how much they are paying for drugs. By focusing on all costs including fees and ensuring transparency, they can cut down unnecessary expenses.
  3. Employers should keep track of their spending regularly and adjust as needed. This ongoing management can lead to significant savings for both the employer and employees without limiting access to necessary medications.

Disaffected, Episode 154

Disaffected Newsletter • 499 implied HN points • 15 Jan 24
🎙 Podcasts Mental health Crime Politics Insurance News
  1. There is a real difference between bipolar disorder and borderline personality disorder, and understanding this can help clarify some public misconceptions.
  2. An update on a recent shooting shows that the shooter, who was initially labeled a right-wing hate criminal, had a different background and mental health issues, challenging assumptions about such incidents.
  3. Infrastructure issues are more than just physical repairs; applying for health insurance can be frustrating and complicated, highlighting the broader problems in the system.

Reports and lawsuits allege UnitedHealth uses AI algorithms to cut off care for the elderly and disabled

HEALTH CARE un-covered • 699 implied HN points • 15 Nov 23
🏥 Health Politics Health care Insurance Medicare Regulation Legal issues
  1. UnitedHealth is accused of using AI to deny necessary care for elderly and disabled patients. Some families have filed lawsuits claiming that these algorithms lead to severe treatment cut-offs.
  2. Employees at UnitedHealth face pressure to deny care based on algorithmic targets, which can lead to risky patient outcomes. Many fear losing their jobs if they do not comply.
  3. There is concern about the partnership between UnitedHealth and AARP, especially during Medicare open enrollment. Ads promoting these plans often do not mention the potential dangers of enrolling in private Medicare plans.

Cigna said to be going after Humana to buy its way into Medicare Advantage

HEALTH CARE un-covered • 519 implied HN points • 28 Nov 23
💼 Business Healthcare Mergers Acquisitions Insurance Finance
  1. Cigna is looking to acquire Humana to strengthen its position in the Medicare Advantage market. This is important because Medicare Advantage is a growing and profitable area in health insurance.
  2. If the deal goes through, Cigna and Humana together would have around 30 million health plan enrollees in the U.S., but they would still be smaller than their main competitor, UnitedHealthcare.
  3. Cigna's focus on this acquisition shows that they see it as a strategic move to grow, especially since both companies are shifting away from their commercial insurance businesses.

You should get a pre-nuptial agreement

Something to Consider • 79 implied HN points • 18 Jun 24
💰 Finance Insurance Contracts Marriage Investment Risk management
  1. Getting a pre-nuptial agreement is like buying insurance for your marriage. It protects both partners in case things don't go as planned.
  2. Many people think a prenup shows distrust, but it actually helps avoid messy court battles later. It's about planning for the future.
  3. Not having a prenup means accepting a default contract from the state. It's better to negotiate your own terms when you both feel good about each other.

Private Medicare blitz: for-profit health insurers are pressing hard for new enrollees in their taxpayer-supported Medicare businesses in 2024

HEALTH CARE un-covered • 519 implied HN points • 20 Nov 23
🏥 Health Politics Medicare Insurance Healthcare Costs Consumer Rights
  1. Private Medicare plans are trying hard to gain new members, often using appealing offers like gym memberships and grocery cards to entice seniors.
  2. Many seniors who switch to these plans may face unexpected costs, like high deductibles, and risk being denied coverage for essential medical services.
  3. It's important for seniors to carefully consider the long-term impact of switching to private Medicare plans, especially if they have serious health needs.

Ticker Take: a weekly newsletter on investing.

Jon’s Newsletter • 119 implied HN points • 19 May 24
💰 Finance Investing Stock Market Economics Insurance Cryptocurrency
  1. Investing in utilities could be a smart move as demand for power grows due to the rise of AI and data centers.
  2. The stock market has shown strong recent performance, with predictions of further gains this year based on solid earnings and market momentum.
  3. There's a noticeable trend in retail investors participating in meme stocks, indicating a lasting shift in how a generation approaches investing in the stock market.

Without health insurance, poverty is just a medical bill away

American Inequality • 609 implied HN points • 12 Jul 23
🏥 Health Politics Insurance Medicaid Medical Debt Healthcare system
  1. Lack of health insurance leads to inequalities and higher child mortality rates.
  2. High costs hinder insurance enrollment, with many uninsured Americans being from low-income households.
  3. Employer-based health insurance in the U.S. has roots in historical events and presents challenges like 'job-lock' and lack of coverage for gig-workers.

First half of 2023: 7 big health insurers pulled in $683 billion in revenues – largely through taxpayer-supported programs and the pharmacy supply chain

HEALTH CARE un-covered • 619 implied HN points • 06 Sep 23
🏥 Health Politics Insurance Healthcare Policy Economics Regulation
  1. In the first half of 2023, seven major health insurance companies made over $683 billion in revenue, mainly from government programs like Medicare and Medicaid. This shows a lot of reliance on taxpayer-supported programs.
  2. Despite these huge profits, Wall Street is not satisfied with the health insurers. Investors believe the companies are not raising premiums enough to keep up with demand for healthcare after pandemic delays.
  3. To please investors, these insurers may increase premiums for customers and limit coverage for medical care. This trend highlights the struggle between corporate profit motives and patient care.

The LOOP NOW Coalition sent a letter to Congressional leaders asking them to introduce bipartisan legislation to begin reducing Americans’ exposure to absurdly high out-of-pocket requirements.

HEALTH CARE un-covered • 719 implied HN points • 21 Jul 23
🏥 Health Politics Healthcare policy Medical Debt Legislation Insurance Economic Impact
  1. Many Americans, even those with health insurance, are struggling with high medical debt. This situation affects around 100 million people.
  2. The LOOP NOW Coalition is urging Congress to pass laws that lower out-of-pocket costs for healthcare. They want to limit annual expenses for medications and treatments.
  3. Currently, out-of-pocket health costs can reach over $9,000 for individuals, which makes it tough for families to afford necessary care. The coalition is working with lawmakers from both parties to tackle this issue.

An epidemic of medical debt is devastating American families as health insurers ratchet up out-of-pocket demands

HEALTH CARE un-covered • 439 implied HN points • 20 Oct 23
🏥 Health Politics Medical Debt Insurance Healthcare Costs Consumer Advocacy Public Health
  1. Many American families are struggling with medical debt because health insurance companies are making them pay more out of pocket before they get any help. This leaves lots of people feeling like they don't have any insurance for most of the year.
  2. The rise in medical costs is leading to serious financial problems, with a large number of people owing money due to health care expenses. This debt crisis affects millions, and many people feel they might never fully pay it off.
  3. The way healthcare is organized forces people to pay higher costs for their care, often putting them in tough situations where they can't afford necessary treatments. Despite promises of affordable care, the system still seems to favor higher spending on healthcare.

Health insurers find new way to drain the bank accounts of Americans with chronic conditions

HEALTH CARE un-covered • 459 implied HN points • 26 Sep 23
🏥 Health Politics Insurance Legislation Chronic Conditions Healthcare Costs Patient Advocacy
  1. Health insurers are changing rules that make it harder for people with chronic illnesses to pay for their medications. This is causing patients to spend much more money out-of-pocket.
  2. Copay accumulators are a new tactic where insurance companies do not count discounts from drug manufacturers towards patients' out-of-pocket limits, making medications even more expensive.
  3. Legislation is being introduced to help protect patients. Bills are being considered at both state and federal levels to ensure that all payments count towards out-of-pocket expenses.

Thanks to reporters at ProPublica and Scripps News, we are learning more about how health insurers cheat patients out of life-saving care

HEALTH CARE un-covered • 339 implied HN points • 30 Nov 23
🏥 Health Politics Insurance Healthcare Patient rights Regulations Legislation
  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.

On Insurance

Something to Consider • 59 implied HN points • 03 Jun 24
💰 Finance Insurance Risk management Economic Policy Behavioral Economics
  1. Moral hazard happens when people take more risks because they have insurance, like thinking they can be careless if they have fire insurance. This means insurance can't cover every behavior to keep premiums fair.
  2. A better way to provide insurance is to focus on events that you can't control, like natural disasters, rather than paying out for specific losses. This keeps people motivated to protect their property since their actions impact their safety.
  3. Government assistance can be more effective if it's tied to things outside a person's control, like race or family status, rather than just income. This way, people are still encouraged to work hard because their benefits don’t change based on their work efforts.

Elevance and other for-profit insurers find new scrutiny from lawmakers over their denials of care for Medicaid patients

HEALTH CARE un-covered • 419 implied HN points • 17 Aug 23
🏥 Health Politics Healthcare Policy Insurance Medicaid Legislation
  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.

$335 million take-home: here are the 7 health insurance CEOs who made it big in 2022

HEALTH CARE un-covered • 559 implied HN points • 01 Jun 23
🏥 Health Politics Healthcare Insurance Medical Debt Government programs
  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.

#24: Insurance for AI: Easier Said than Done

Loeber on Substack • 40 implied HN points • 04 Nov 24
💼 Business Insurance AI Risk management Technology Entrepreneurship
  1. Insurance for AI risks is a complex topic due to the unpredictable nature of AI outputs, making it hard to find solid coverage options. Businesses want protection from costly mistakes by AI, but actual insurance products may be limited.
  2. The market for existing software error insurance is quite small, which raises questions about how large the market for AI error insurance could be. With many companies not even aware of current insurance options, it's a niche field.
  3. Insurers face challenges in accurately assessing AI risks due to information gaps and the rapid evolution of AI technology. This could lead to difficulties in creating effective insurance policies for AI applications.

UnitedHealth Group's Q2 2023 earnings report shows billion dollar gains in pharmacy benefit business, tax-funded programs

HEALTH CARE un-covered • 459 implied HN points • 17 Jul 23
💰 Finance Healthcare Investments Earnings Reports Insurance Market Trends
  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.

Walgreens said to be courting a former Cigna/Express Scripts executive to turn the company around

HEALTH CARE un-covered • 299 implied HN points • 03 Oct 23
🏥 Health Politics Healthcare policy Pharmaceuticals Insurance Regulations Corporate strategy
  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.

Amid Congressional PBM scrutiny, CVS/Aetna CFO assures investors of continued profits, even at expense of employers and taxpayers

HEALTH CARE un-covered • 479 implied HN points • 08 Jun 23
🇺🇸 U.S. Politics Healthcare Insurance Legislation
  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.

BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers' pockets

HEALTH CARE un-covered • 539 implied HN points • 27 Feb 23
🏥 Health Politics Insurance Medicare Pharmaceuticals Government programs Healthcare Costs Regulation
  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.