Did Your Health Plan Deny You Care? Fight Back.

June 15, 2019, KHN, Bernard J. Wolfson - Have you ever stepped up to the pharmacy cash register only to learn your new prescription will cost you hundreds of dollars - instead of your typical $25 copay - because your insurance doesn’t cover it? Or received a painfully high bill for a medical test because your health plan didn’t think it was necessary? Most people have, but only a tiny fraction ever appeal such decisions. In 2017, for example, enrollees in federally run Affordable Care Act marketplace plans appealed fewer than one-half of 1% of denied medical claims, according to an analysis by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) If you do appeal, your chance of getting the health plan’s decision overturned is a lot better than you might think. “About half of appeals go in favor of the consumer,” says Cheryl Fish-Parcham, director of access initiatives at Families USA, a health care consumer advocacy group.

Biden unveils health care plan: Affordable Care Act 2.0

July 15, 2019, Politico, Dan Diamond -  Democratic front-runner Joe Biden today will unveil a health plan that’s intended to preserve the most popular parts of Obamacare - from Medicaid expansion to protections for patients with pre-existing conditions - and build on them with a new government-run public insurance option. Biden would also empower Medicare to directly negotiate drug prices, allow the importation of prescription drugs from abroad and extend tax credits to help tens of millions of Americans buy lower-priced health insurance. The plan - which the campaign says will cost $750 billion over a decade, to be paid for by reversing some of the Trump administration’s tax cuts - is less transformative than the “Medicare for All” proposal advanced by Sen. Bernie Sanders (I-Vt.) and supported by some other Democrats, which would effectively do away with private insurance and shift all Americans to government-run health care.

Amid funding decreases, mental health workers call for diverse treatment options

July 14, 2019, Daily Journal, Taylor Vance- Paul Callens wants to see a day where wait lists are eliminated from mental health care hospitals - but today is not that day. Callens is the director of the North Mississippi State Hospital, located in Tupelo, and said the facility has 150 beds for patients with mental illness. All of them are full. There are 23 people on a waiting list trying to get into the facility. Of those 23, only “a couple” are waiting in local jails, he said.  Even though this may not seem like progress, Callens said the hospital has made great strides in reducing wait lists. He hopes the facility will one day eliminate the wait lists and have beds available whenever patients need treatment.

At least 220,000 Tennessee kids faced loss of health insurance due to lacking paperwork

July 14, 2019, Tennessean, Brett Kelman and Mike Reicher, Nashville Tennessean -  When the leukemia was finally gone, Tricia Sewell thought her family’s nightmare was over. It was October of last year. Sewell’s 5-year-old son, Abel, had just finished three years of chemotherapy, all of which had been covered by Tennessee’s state Medicaid program, known as TennCare. Chemo was successful, but now Abel needed monthly blood tests to check if the cancer ever came back. At the doctor’s office, something went wrong. The staff discovered Abel’s TennCare had vanished. His mom paid out of pocket for the blood test. Then she realized she’d pay again next month. And the following month. And months and months after that. “I was livid because I knew the costs,” Sewell said. “In the back of my mind, I always knew what this all costs.”

CMS seeks to reduce state reporting on Medicaid access, pay cuts

July 11, 2019, Modern Healthcare, Harris Meyer -  The CMS wants to lower states’ requirements for showing that their Medicaid fee-for-service payment rates are adequate to enlist enough providers to offer beneficiaries satisfactory access to care. The rule proposed Thursday would rescind a 2015 Obama administration rule requiring states to file an access monitoring review plan and update it at least every three years. The CMS said the proposed rule would save states money, and that it would issue a separate guidance reminding them that they must ensure beneficiaries have adequate access to care. The public will have 60 days to comment.

Trump’s Assault On Obamacare Could Undermine His Own Health Initiatives

July 11, 2019, The New York Times, Margot Sanger-Katz - In court, the Trump administration is trying to get all of Obamacare erased. But at the White House, President Trump and his health officials are busily using the law to pursue key proposals. Last week, the president highlighted a policy in the works meant to narrow the gaps between what drugs cost in the United States and overseas. On Wednesday, he signed an executive order to transform care for patients with kidney disease. Both measures were made possible by a provision in the Affordable Care Act, and both would be effectively gutted if the administration’s position prevailed in court.