Fentanilo en la escuela secundaria: una comunidad de Texas se enfrenta al mortal opioide

Desde julio, cuatro estudiantes del Distrito Escolar Independiente Consolidado de Hays, al sur de Austin, han muerto por sobredosis de fentanilo.

KYLE, Texas – Los pasillos de la escuela secundaria Lehman lucían como cualquier otro en un día reciente de otoño. Sus 2,100 estudiantes hablaban y reían mientras se apresuraban a ir a sus clases en medio de paredes cubiertas de afiches que anunciaban eventos del baile de bienvenida, clubes y partidos de fútbol americano. Sin embargo, junto a esos afiches había algunos con un sombrío mensaje que advertía a los estudiantes de que el fentanilo es extremadamente mortal.

Esos carteles no estaban allí el año pasado.

Justo antes de que comenzara el año escolar, el Distrito Escolar Independiente Consolidado de Hays, que incluye a Lehman, anunció que dos estudiantes habían muerto después de tomar pastillas con fentanilo. Fueron las primeras muertes de estudiantes relacionadas con el opioide sintético en este distrito escolar del centro de Texas, que tiene campus de secundaria en Kyle y Buda, una ciudad cercana.

En el primer mes de clases, se confirmaron otras dos muertes.

La reacción de las autoridades escolares, empleados, estudiantes y padres ha sido intensa, una mezcla de angustia y terror con ira y ganas de actuar. La comunidad, al parecer, está dispuesta a contraatacar. El sistema escolar ha dado prioridad a su actual campaña educativa contra las drogas. Los estudiantes hacen frente a sus conductas de riesgo y a la presión de sus compañeros. Y los padres intentan iniciar conversaciones difíciles sobre las drogas con sus hijos.

Están “cogiendo el toro por los cuernos”, dijo Tim Savoy, jefe de comunicaciones del distrito escolar.

Pero también hay dudas sobre si esos esfuerzos serán suficientes.

El problema de sobredosis que afronta el distrito, que está justo al sur de Austin y a una hora al noreste de San Antonio, imita una tendencia nacional.

Según los Centros para el Control y Prevención de Enfermedades, en 2021 murieron más de 107,000 personas por sobredosis, todo un récord. La mayoría de esas muertes —7,238 de ellas— estuvo relacionada con el fentanilo y otros opioides sintéticos. La Administración para el Control de Drogas ha advertido que el fentanilo se encuentra cada vez más en “píldoras de recetas falsas” que son “fácilmente accesibles y a menudo se venden en las redes sociales y plataformas de comercio electrónico”.

El jefe de policía de Kyle, Jeff Barnett, dijo que eso es un problema que afronta en su comunidad. “Probablemente podrías encontrar una píldora con fentanilo en cinco minutos en las redes sociales y probablemente organizar un encuentro en una hora” con un traficante, dijo Barnett.

La amenaza del fentanilo ha hecho que los estudiantes de secundaria sean más propensos a conseguir las píldoras letales. Pueden creer que están consumiendo drogas para fiestas que, aunque son ilegales, no son -por sí solas- tan mortales como el fentanilo.

Los chicos “no están comprando fentanilo intencionadamente”, indicó Jennifer Sharpe Potter, profesora de psiquiatría y ciencias del comportamiento en UT Health San Antonio, en un testimonio durante una audiencia celebrada en septiembre ante la Cámara de Representantes de Texas. No saben qué hay en las pastillas que compran, añadió, y describió el problema como la “tercera ola de la crisis de sobredosis”.

Kevin McConville, de 17 años, un estudiante de Lehman que murió en agosto, parece ser una de las víctimas de esta ola. En un vídeo producido por el distrito, los padres de Kevin explican con una inmensa tristeza en sus ojos que, tras la muerte de su hijo, se enteraron por sus amigos de que tenía dificultades para dormir. Tras tomar pastillas que creía que eran Percocet y Xanax, no se despertó.

Historias como esta han llevado al distrito escolar a emitir la siguiente advertencia en su página web: “El fentanilo está aquí. Tenemos que hablar del fentanilo. Y el fentanilo es mortal”. Es 100 veces más potente que la morfina y 50 veces más potente que la heroína, según la DEA, y dos miligramos son potencialmente letales.

El distrito ha puesto en marcha la campaña “Lucha contra el fentanilo”, que cuenta con la colaboración de la policía municipal y de los servicios médicos de urgencia. Hay un “HopeLine” al que los alumnos pueden enviar anónimamente información sobre compañeros que puedan estar consumiendo drogas ilícitas. A partir de sexto grado, los alumnos deben ver un vídeo de 13 minutos en el que se recalca lo peligroso y mortal que es el fentanilo y se explica cómo identificar si un compañero puede tener una sobredosis.

“Estamos reclutando a los estudiantes para que nos ayuden a ser los ojos y los oídos si están en una fiesta o en casa de un amigo”, dijo Savoy.

El sistema escolar también espera concienciar a los estudiantes de los riesgos que afrontan. No se puede confiar en ninguna píldora, sea cual sea, que no proceda de una farmacia: “Es como jugar a la ruleta rusa”, dijo Savoy.

El mensaje parece que está llegando. Sara Hutson, alumna del último año del instituto Lehman, dice que compartir pastillas que se venden sin receta, como Tylenol y Motrin, solía ser habitual, pero ya no lo considera seguro. Ya no confía.

Pero otros estudiantes no son tan precavidos. Lisa Peralta compartió en un post de Facebook en septiembre que su hija, que está en séptimo grado, admitió haber comido una “gomita para la ansiedad” que le dio su amiga. “Tengo miedo porque mi hija se deja llevar por sus amigos”, escribió la residente de Kyle. “No confío en que no lo vuelva a hacer si se siente presionada”.

Por muy claros que sean los mensajes del distrito y de los padres, a Savoy le preocupa que nunca sean suficientes porque los estudiantes son muy aventureros. “Es simplemente la mentalidad adolescente”, dijo. “Piensan: ‘Somos invencibles; a mí no me va a pasar’. Pero está pasando en nuestra comunidad”.

Aun así, los sentimientos de descontento y dolor son a veces palpables. Los estudiantes se pelean más en la escuela, dijo Jacob Valdez, un estudiante de décimo grado de Lehman que conocía a dos de los estudiantes que murieron. Eso puede estar pasando, añadió, porque “todo el mundo está angustiado”.

La tensión no se limita a los estudiantes de intermedia y secundaria. También se ha vuelto muy real para los padres de los niños de primaria, desde que la DEA advirtió al público en agosto sobre las píldoras con fentanilo que parecen caramelos de colores brillantes. El distrito escolar de Hays también está colgando carteles de advertencia dirigidos a los estudiantes más jóvenes.

Jillien Brown, de Kyle, dijo que está preocupada por sus hijas, Vivian, de 5 años, y Scarlett, de 7. “Les hemos dicho que están ocurriendo cosas aterradoras, que la gente se está poniendo muy enferma y está muriendo por tomar lo que creen que son caramelos o medicamentos”, indicó Brown. “Utilizamos la palabra ‘veneno’, como cuando Blancanieves mordió la manzana”.

Pero la conversación debe ser continua, dijo Brown, porque al día siguiente de hablar con sus hijas, “un niño pequeño en el autobús les dio un caramelo y se lo comieron”.

Del mismo modo, April Munson, residente en Kyle y antigua profesora de primaria, considera que todo es “desgarrador”. Le mostró a su hijo de 9 años, Ethan, fotos de las píldoras multicolores de “fentanilo arco iris”. “Es una conversación difícil de tener, pero las conversaciones difíciles son a menudo las más importantes”, dijo. “Y, realmente, no puedes permitirte dejar de hablar del tema”.

Y mientras los padres y los funcionarios escolares intentan evitar que el fentanilo vuelva a castigar, llega otro golpe de realidad.

El año pasado, el distrito escolar comenzó a almacenar en cada escuela un suministro de naloxona, el fármaco para revertir sobredosis, también conocido como Narcan. En lo que va de semestre, a pesar de todo lo que ha pasado, lo han tenido que utilizar para salvar a otros cuatro estudiantes, dijo Savoy. En un caso, los socorristas tuvieron que usar tres dosis para reanimar a un estudiante: el fentanilo “era así de fuerte”, agregó.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Journalists Dig In on the Fiscal Health of the Nation and Hospital Closures in Rural Missouri

KHN and California Healthline staff made the rounds on national and local media this week to discuss their stories. Here’s a collection of their appearances.

KHN chief Washington correspondent Julie Rovner discussed health care costs and the fiscal health of Medicare and Social Security on C-SPAN’s “Washington Journal” on Sept. 28. She also discussed President Joe Biden’s comments about the covid-19 pandemic being “over,” as well as health inflation, the government funding bill, and other domestic news on WAMU/NPR’s “1A” on Sept. 23.

KHN senior correspondent Sarah Jane Tribble discussed the collapse of two rural Missouri hospitals on The Eagle 93.9-KSSZ’s “Wake Up Mid-Missouri” on Sept. 26.

KHN senior correspondent Julie Appleby discussed the legal challenge to the Affordable Care Act provision that guarantees free preventive care benefits on Texas Public Radio’s “The Source” on Sept. 21.

KHN correspondent Brett Kelman discussed a recent Supreme Court ruling that may affect doctors charged with overprescribing opioids on Apple News’ “Apple News Today” on Sept. 30.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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A Free-for-All From Readers and Tweeters, From Medical Debt to Homelessness

KHN gives readers a chance to comment on a recent batch of stories.

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

It is appalling that an article like this even has to be written. Our "healthcare" system is broken.How to get rid of medical debt — or avoid it in the first place https://t.co/EIo7lHps8k

— Karin Wiberg (@kswiberg) July 1, 2022

— Karin Wiberg, Raleigh, North Carolina

Lifesaving Information

I just want to thank you from the bottom of my heart for the work you do that exposes the utter brokenness of America’s health system (“Diagnosis: Debt: How to Get Rid of Medical Debt — Or Avoid It in the First Place,” July 1). You are helping to fix it!

— Ruth Worley, Athens, Ohio

Recovering from being sick or caring for a sick loved one should not ruin any American’s finances. Here are some tactics to navigate the system. https://t.co/ykvDkUecj0

— Bayeté (@BayeteKenan) July 10, 2022

— Bayeté Ross Smith, Harlem, New York

Patients Left Holding the Bag

Your “Diagnosis: Debt” articles are interesting and serve as further examples of how the health care industry is set up for the health care system and not the people who use it.

In the USA, medical debt should not be an issue, but we don’t teach people how to save or understand how to navigate the system. I am a nurse blogger/advocate and see the repercussions of what people go through who have inadequate insurance and lack savings or the ability to understand what is happening to them when they are thrust into the complex health care system. But, in reality, none of us really think about our health or the health care system till we are in the middle of a crisis. If we are honest, none of us are really prepared for a catastrophic event, and this is what we need to work on going further through education and advocacy.

I will continue to educate the public in my small way so people can understand their role in our health care system so they are prepared for a medical event and know that they can use their voice to speak up and advocate for themselves.

— Anne Llewellyn, Plantation, Florida

Portland has become a wasteland! Where are the environmentalists at least? Oh yeah, they're all in their gated communities, worrying about climate change and plastic straws for the rest of us. (hope you can see this LA Times article)https://t.co/WrboM9vtPs

— Bob Beddingfield (@bobbeddingfield) June 23, 2022

— Bob Beddingfield, Houston

Destination: Disaster

We visited Portland, Oregon, a year ago for a vacation and we will never go back: stores that don’t give baskets because people use them to steal. Stores that put poles on carts to keep people from racing out of the store with them full of merchandise. Closed storefronts. Homeless people everywhere (“Sobering Lessons in Untying the Knot of a Homeless Crisis,” June 21).

It was like a Third World country. I’m not a Republican, very far from it, but accepting the idea that anyone who wants can live on the streets, dump their trash, and get subsidized by the city cannot end well. And this problem is not limited to Portland. San Francisco is in a very similar situation with crime, drug abuse, and homelessness.

There is no one-size-fits-all solution. Throwing money at the problem and then ignoring the continuing unresolved problem hasn’t worked and, I think, never will.

The idea that a city can host an unlimited number of drug and alcohol addicts at public expense won’t work.

The idea that shoplifting, car break-ins, robberies, etc. are allowed, not arrested, not prosecuted, not punished can never work out well.

And people wonder why the Democrats are in such deep, deep trouble in spite of the horrible ideas the Republicans promote.

This will not end well.

— David Alexander, Palo Alto, California

Quite possible the best news story about our local homeless challenges I have read recently. 'Not safe anymore': Portland confronts the limits of its support for homeless services #homless #Portland https://t.co/Ujr5KzhYAi

— Ben Brown Jr. (@BenBrownJunior) June 22, 2022

— Ben Brown Jr., Beaverton, Oregon

On Wheelchair Repairs, Steering Clear of Error

As the CEO of National Seating & Mobility (NSM), I applaud the work of KHN in providing in-depth reporting about important issues in health care, including the complex rehabilitation technology (CRT) industry.

However, the recent article “Despite a First-Ever ‘Right-to-Repair’ Law, There’s No Easy Fix for Wheelchair Users” (June 2) presented several inaccuracies, misrepresentations, and errors in its characterization of NSM and our work.

The article stated that NSM and other CRT providers have limited their investments in service and repair to increase profits. NSM leadership has continuously invested in our service and repair business, including establishing a career path and certification program to professionalize the service technician role, improving onboarding and ongoing training programs, reorganizing our funding team to introduce repair-specific funding specialists to better assist clients in the repair process, investing in market analysis on competitive wages that resulted in a 15%-20% hourly pay increase for technicians, and more. In 2022, NSM has almost 500 service technicians on staff, which is 22% more technicians per count of client-delivered orders versus 2019. Our investment in service and repair is long-standing and will continue.

The article also suggested that Medicare’s use of competitive bidding favors large companies, often at the expense of quality and customer service. NSM was not part of the previous bidding session for durable medical equipment (DME) to establish current rates and was not awarded any Medicare contracts as a result. Most of the products we provide are considered CRT and are exempt from the competitive bid process and pricing. Due to section 16005 of the 21st Century Cures Act and House Bill H.R. 1865, product codes that can be used for CRT or basic DME are paid at the normal rate for CRT instead of competitive pricing.

Finally, the article makes false assumptions about our company: that we keep a limited inventory of parts, and we have little incentive to hire technicians or pay for training because we lose money with repairs.

Each mobility solution — and therefore each repair—is highly customized to a client’s needs. This customization means parts that are replaced less frequently across our client population aren’t likely to be stocked versus those parts that are frequently replaced. The current global supply chain disruption has also affected our inventory; the amount of stock we have on hand is entirely dependent upon availability. Additionally, the labor shortage our country is experiencing has created a challenge across all industries, ours included.

Repair reimbursement is a loss-leader for the CRT industry, exacerbated recently due to inflation in the supply chain and labor markets. While other companies are forced to turn down repairs due to these challenges, NSM continues to provide repairs because it is the right thing to do.

NSM is a customer service business, earning our business in every client interaction. We recognize improvements are needed, and we are committed to investing in advocacy, programs, and collaborative industry efforts to lead our industry in a new direction to improve the lives of those we serve.

— Bill Mixon, CEO of National Seating & Mobility, Franklin, Tennessee

This needs to change! It should not be so complicated to get simple repairs made to #wheelchairs!https://t.co/MpTAyeBEms via @KHNews #DisabilityRights

— W. Ron Adams (@WRonAdams) June 11, 2022

— W. Ron Adams, Erlanger, Kentucky

These folks have also worked so hard to get landmark legislation passed across the country, including a really important first step in Colorado on the right to repair wheelchairs: https://t.co/xaZPRnaYDD

— Hayley Tsukayama (@htsuka) June 3, 2022

— Hayley Tsukayama, San Francisco

Clearing the Air on Vaping vs. Smoking

I just listened to your piece on the FDA banning Juul (“KHN’s ‘What the Health?’: The FDA Goes After Nicotine,” June 23). One of your panelists mentioned she’d read (actually, she said she’d read only the headline) about diacetyl (she didn’t want to even try to pronounce this) and popcorn lung.

I believe it is irresponsible for so-called scientific experts to comment on things they haven’t read properly and things they clearly have no knowledge about. Diacetyl is present in cigarette smoke in concentrations hundreds of times higher than in vape products and yet there hasn’t been a single case of popcorn lung attributed to smoking. Anything to do with the toxicity of a chemical present must surely make reference to the concentrations, putting it in context. The fact that a chemical is detectable obviously doesn’t mean that it’s harmful in the concentrations present.

There is a terrible misunderstanding among consumers and indeed health care professionals regarding the relative harms of vaping vs. smoking — given that the vast majority of vapers are ex- or current cigarette smokers, this is the relevant point.

I suggest that the scientific credibility of your program is compromised by such sloppy and inaccurate commentary.

— Mark Dickinson, Twickenham, Middlesex, United Kingdom

Be wary when big companies come in to "save" local institutions, whether it be the hometown newspaper, local education or the hospital.https://t.co/gV4ZJDkR71

— Dave Gragg (@DaveGragg) June 15, 2022

— Dave Gragg, Republic, Missouri

Shoring Up Rural Care

Since 2010, 138 rural hospitals have closed, leaving many communities without access to health care. In rural areas, this can create a domino effect of other hardships — a hospital often serves as the largest employer, and when these facilities shut down, the hardware store or restaurants often face similar fates. Put simply, when a rural hospital shutters, it becomes harder for the town itself to survive (“Patients for Profit: Buy and Bust: When Private Equity Comes for Rural Hospitals,” June 15).

Then there is the most critical aspect: Without hospitals, rural Americans lose timely access to lifesaving medical care. On average, the distance between a rural hospital and the closest facility with 100 or more acute care beds is 28.9 miles. Preserving access to care in our rural communities and ensuring hospitals remain the cornerstone of the economy is essential. This is why addressing the hospital closure crisis must be a top priority in Congress.

To determine what needs to be done, it can be helpful to examine the cause of the crisis. Multiple factors have contributed to the high number of rural hospital closures over the past decade, with two major factors being slim or negative hospital operating margins and workforce shortages. The covid-19 pandemic has further strained the health care industry, leading to increased levels of provider burnout and perpetuating the workforce shortage.

On top of this, rural providers continue to feel the strain of Medicare sequestration, which reduces eligible payments to rural hospitals from Medicare by 2%. Relief from Medicare sequestration during the pandemic expired on April 1, contributing to the financial burdens rural hospitals already face. With many rural hospitals already operating on negative margins, these decreased reimbursements could be disastrous.

Further, due to recent statutory changes, provider-based rural health clinics affiliated with small rural hospitals are not eligible for cost-based reimbursement as they historically were. Unless Congress addresses this shortcoming, it may not be financially feasible for small rural hospitals to provide primary care in these settings, and care gaps in rural communities may widen.

Reps. Sam Graves, a Republican from Missouri, and Jared Huffman, a Democrat from California, worked together to introduce the Save America’s Rural Hospital Act. This legislation will help rural health care providers keep their doors open and ensure rural communities have access to the care they need and deserve.

For example, it will permanently eliminate Medicare sequestration for rural hospitals, allowing these facilities to be reimbursed for the entirety of their eligible cost. It will make permanent increased Medicare payments for ground ambulance services in rural and super rural areas. Further, this bill will reauthorize the Medicare Rural Hospital Flexibility Program to provide new grants to help eligible rural providers transition to new models and evolve to meet community needs in their changing health care environments.

To address potential primary care shortages, it will also create a voluntary quality measure reporting program for provider-based rural health clinics. If these facilities choose to participate, they will receive increased reimbursement in exchange.

Health care access is critical to preserving the rural way of life for more than 60 million rural Americans. This legislation must be considered to ensure stability in our communities, which will ultimately benefit the country as a whole.

— Alan Morgan, CEO of NRHA, Kansas City, Missouri

In short, our system is not set up for the unique needs of rural hospitals, making them financially stretched. Private equity swoops in, buys the hospital, takes the COVID-19 relief money, closes the hospital, then runs. #ruralhealth https://t.co/qZBHG7yeeH

— Whitney Zahnd (@WhitneyZahnd) June 15, 2022

— Whitney Zahnd, Iowa City, Iowa

A Pitch for Integrated Behavioral Health

I am a clinical psychologist who works at a large, safety-net academic health center in Colorado. I am writing about your recent article “Patients Seek Mental Health Care From Their Doctor but Find Health Plans Standing in the Way” (June 8). I appreciate the focus of this article on some of the barriers patients face in trying to access mental health care in the U.S. However, I was a little concerned that your article did not mention the rapidly growing field of integrated behavioral health. Although I understand that not all primary care providers’ offices employ an integrated behavioral health clinician, the numbers are growing quickly across the country. For example, in the hospital where I work, there is at least one IBH clinician in every community primary care center, and in most of the specialty clinics (e.g. oncology, OB-GYN) as well.

While I think PCPs are certainly able to dispense basic-level mental health advice (e.g., abdominal breathing exercises for anxiety), I don’t think the answer is to turn over mental health care to medical professionals, any more than I believe it would be a good idea to turn over a patient’s diabetes management to a psychologist, even if that psychologist had some basic training in how to treat diabetes. Instead, I believe it is in patients’ best interests to continue to advocate and nurture a team-based approach that includes both medical and mental health specialists within the same clinic.

— Trina Seefeldt, Denver

This madness must stop. Most of us in primary care do address/treat mental health problems. #insurance #healthcare #SinglePayer would solve this. Patients Seek Mental Health Care From Their Doctor But Find Health Plans Standing in the Way https://t.co/YyAzJ0GylL via @khnews

— Andrea DeSantis DO (@adesantisb) June 10, 2022

— Dr. Andrea DeSantis, Charlotte, North Carolina

In Defense of Free Clinics

I was reading with interest — and then dismay — at your article published June 23 on the Hispanic insurance gap (“Trump’s Legacy Looms Large as Colorado Aims to Close the Hispanic Insurance Gap”). In the opening paragraphs, you reference a man who had symptoms that “free clinics told him were hemorrhoids but were actually colon cancer.”

In that one phrase, you single-handedly and forcefully implied that free clinics deliver poor care and are not to be trusted. With the next sentence about his tragic death, you solidify that implication.

As a charitable clinic with more than 26 years of serving the uninsured in our community, I take great exception to this careless mischaracterization of a sector that has delivered high-quality care to millions of people who have fallen through the cracks.

Most free and charitable clinics care for people with absolutely no insurance. This can significantly limit the amount of outside testing and diagnostics that can be done with patients, even if they are symptomatic. Up until this year, our clinic had absolutely no option for sending someone to a gastroenterologist for a colonoscopy unless they were willing to pay out-of-pocket — upward of $5,000. We have to regularly tell people that we do not have any good options for them because we cannot access certain specialists or tests. Do they need it? Yes. Can we provide it to them? No. Does this incredible inequity and frustration with the health care system that prevents our patients from getting the advanced care they need weigh on us every day? Absolutely.

Free and charitable clinics are not part of the problem. They are part of the solution. And the broad generalization you made impacts how the public perceives this incredibly important piece of the health care sector.

For more information on free and charitable clinics, I invite readers to learn about the National Association of Free and Charitable Clinics at https://nafcclinics.org/.

— Suzanne Hoban, executive director of Family Health Partnership Clinic, Crystal Lake, Illinois

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).

Readers and Tweeters Weigh In on America’s Medical Debt, Obesity Epidemic, and Opioid Battles

KHN gives readers a chance to comment on a recent batch of stories.

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

So, you're American, you have a lousy health insurance plan, you get cancer. You survive cancer. But can you survive your massive medical $$$ debt?https://t.co/e6Jzw9W4SR

— Laurie Garrett (@Laurie_Garrett) June 17, 2022

— Laurie Garrett, New York City

Medical Debt as the Ultimate Medical Mystery

I read your investigation about health care and debt on NPR’s site (“Diagnosis: Debt: 100 Million People in America Are Saddled With Health Care Debt,” June 16). However, it seems the story’s focus is wrong. It shouldn’t be about how we pay for these astronomical medical bills but why are they so high to begin with? How do hospitals get away with their fees? For example, my daughter, who is 7, has been to the hospital/emergency room five times in her life. Each bill has been completely different with no rhyme or reason. The latest one was $7,000 for about a three-hour ER visit and for two IVs! It’s the highest bill we have ever seen, and that includes a two-night stay at a hospital. In addition to this bill, collections called us — and it hadn’t even been 60 days since our visit and had been only a few weeks since the hospital visit. So now our credit score could be affected, and we haven’t even had a chance to review or figure out how to pay this bill. Would love all this explained.

— Ilyssa Block, Kansas City, Missouri

A Hard-Learned History Lesson

Although I liked the article by Noam N. Levey and Aneri Pattani on people burdened by medical debt (“Diagnosis: Debt: Upended: How Medical Debt Changed Their Lives,” June 16), it uses the term “grandfathered in.” This term was used as a rule to prevent Black people from voting after the Civil War. Please make an effort to refrain from using this offensive term.

— MB Piccirilli, Portland, Oregon

Upended: How Medical Debt Changed Their Lives https://t.co/IbJwJoOt3N @khnews This has to stop! NFP healthcare systems destroying the lives of the people they are designed to serve?!? Unethical. STOP! #healthcare #UniversalHealthCare #MedicareForAll #bankruptcy

— Andrew Gallan PhD ⛳️🇺🇦 (@agallan) June 20, 2022

— Andrew Gallan, Boca Raton, Florida

Steering Clear of Predatory Billing

Every month I see and hear these “Bill of the Month” stories on NPR’s webpage or broadcast on the NPR affiliate station in my area (“Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?” May 31). Every month I pat myself on the back for having decided that there is no way I am ever going to put myself through so-called screenings, which are just one more avenue for the U.S. health delivery system to screw people over as that health delivery system is well aware that there is no oversight for this type of predatory billing. I can tell you at my age and with only Social Security retirement as sole income, I couldn’t ever hope to hire legal help to dispute a bill like those featured in “Bill of the Month” — a bill like that would either cause me to have an immediate heart attack or file bankruptcy or both. Nope. No screenings. I actually have decided that, if I have any choice in the matter, I will simply forgo any so-called medical care. Obviously, if I keel over and pass out and someone hauls my sorry self into the emergency room, I won’t have the choice (except to walk out once “revived”). Given the state of health care and the predatory behaviors of the bottom-lining money-hungry hospitals, clinics, and even just doctors, my choice is simply to opt out. KHN needs to use its voice to tell the U.S. medical community that people are so tired of the garbage that they simply refuse care.

— Jan Baldwin, Coburg, Oregon

First colonoscopy: $0Second colonoscopy: $2kAnother example of how the fine print can put patients on the hook for bills that should be covered, especially in this case of a preventative screening. Patients deserve better.https://t.co/v55XVdGAeB

— Terry Wilcox (@Terrilox) June 2, 2022

— Terry Wilcox, Vienna, Virginia

In Michelle Andrews’ story about unexpected costs after a polyp removal during a colonoscopy, she states the anesthesiologist “merely administers a sedative.” This is an understatement. Anesthesiologists perform a review of the patient’s chart, see the patient pre-procedure, monitor their vitals during the procedure, and assess them post-procedurally. Furthermore, anesthesiologists are prepared to manage unexpected emergencies, including unexpected aspiration, allergic reactions, cardiac arrest, etc. This is more than “merely administering a sedative.”

We keep folks from dying or having complications and train a long time to do so. The flippant manner in which our actions are framed in the article is unfortunate.

— Dr. Elizabeth Leweling, Chicago

Preventive care, like screening colonoscopies, are free of charge to patients under the Affordable Care Act. @DrLindaMD @AlexMMTri @EvanKirstel @FriedbergEric @nkagetsu @rstraxMDhttps://t.co/qLP9l5SSPl

— Ian Weissman, DO (@DrIanWeissman) June 1, 2022

— Dr. Ian Weissman, Milwaukee

As president of the American Society for Gastrointestinal Endoscopy, I listened with interest to a recent segment on “All Things Considered” regarding patient cost sharing for a screening colonoscopy. The segment featured patient Elizabeth Melville, who received a bill for her screening colonoscopy that involved a removal of a polyp.

I was dismayed by the segment, which included several factually incorrect and misleading statements by Dr. Elisabeth Rosenthal, and which were incredibly damaging to efforts to eliminate impediments and misinformation about screening colonoscopy. ASGE has been at the forefront of policy efforts to eliminate patient out-of-pocket costs for screening colonoscopy, including those screenings that involve the removal of a polyp or other tissue. As the segment correctly noted, the Affordable Care Act provides for coverage without patient cost sharing of preventive services that have an “A” or “B” rating from the U.S. Preventive Services Task Force, which includes colorectal cancer screening. Recognizing that colonoscopy is the only cancer screening modality that also allows for actual removal of precancerous lesions in real time (and thus preventing the cancer), it is particularly important that patients and consumers understand the facts.

Following passage of the ACA, legislative and regulatory corrective actions have been necessary to ensure that patients who undergo a screening colonoscopy that includes a polyp removal are not stuck with a surprise bill. As noted, screening colonoscopy is a unique preventive service in that it not only detects cancer, but it can prevent it through removal of suspicious or potentially precancerous polyps or lesions. In 2020, Congress passed legislation that would phase out by 2030 cost sharing for Medicare beneficiaries when a screening colonoscopy turns diagnostic during the screening encounter. That means, if a Medicare beneficiary has a screening colonoscopy today and a polyp is removed, that patient is likely to have an out-of-pocket payment obligation.

The difference in cost-sharing rules for commercially insured patients and Medicare beneficiaries has created confusion for patients, and the changes in regulation have created complex billing scenarios. Dr. Rosenthal referred to billing for colonoscopy as a “gray area.” This is not a gray area to ASGE, as coding rules are clear. But there are scenarios that could impact whether a patient has an out-of-pocket obligation for a colonoscopy. For example, often insurers will not cover a screening colonoscopy without cost sharing if the screening occurs less than 10 years after the patient’s previous colonoscopy. These shorter screening intervals typically occur when a patient is considered high-risk, or if there was a finding during the previous colonoscopy, such as a polyp, as used in your illustration. Many insurers regard these colonoscopies as “surveillance” or “high-risk” colonoscopies and will not cover them as a preventive screening without cost sharing. This is not the decision of the physician or hospital; this is a decision made by the insurance company.

I was particularly struck by Dr. Rosenthal’s comment that “it is not OK to change the game in the middle of the test,” which leads to a patient getting a bill. I want to be very clear that when a patient is scheduled for a screening colonoscopy, the physician performing the colonoscopy has no idea whether a polyp or tissue will be found and will need to be removed. This is not a “gotcha” game that physicians are playing with patients, as insinuated by Dr. Rosenthal’s remarks; there are coding and billing rules that must be followed when facilities and physicians are submitting claims to insurance companies. ASGE continually works to ensure that we educate and promulgate coding rules and updated guidance for our 15,000 members worldwide.

The cost-sharing policy for colorectal cancer screening, and screening colonoscopy specifically, is complex and confusing. We are disappointed that NPR did not use the segment as an opportunity to work through the complexity to provide consumers with a better guide of questions to ask their insurance company before scheduling a colonoscopy, including whether a screening colonoscopy performed at an interval of less than 10 years will be covered under their health plan without cost sharing.

— Dr. Bret T. Petersen, ASGE president, Rochester, Minnesota

Great Bill of the Month reporting today by @mandrews110 for @KHNews. Nobody likes getting a colonoscopy. Patients shouldn't be penalized for doing the right thing and getting recommended cancer screenings: https://t.co/cNlEj85IZ4

— Ryan Holeywell (@RyanHoleywell) May 31, 2022

— Ryan Holeywell, Washington, D.C.

Taking the Doctor’s Advice

Dr. Taison Bell was wonderful to listen to (“Watch: UVA Doctor Talks About the State of the Pandemic and Health Equity,” May 26). I really appreciated his presentation and the valuable things he had to say. Thanks for including it in your KHN mailing!

— Jan McDermott, San Francisco

I spoke with ⁦@hnorms⁩ from ⁦@KHNews⁩ about the state of the pandemic and health equity. There is still a lot to be done to movement smart policies that help high risk communities of color. https://t.co/LAf2WCIN0X

— Dr. Taison Bell (@TaisonBell) May 26, 2022

— Dr. Taison Bell, Charlottesville, Virginia

Mad Over ‘New MADD’ Coverage

This article is grossly inaccurate and insulting (“The New MADD Movement: Parents Rise Up Against Drug Deaths,” May 23). Most fentanyl users are not all-star athletes or honor students. Their parents are not more educated than the parents of addicts. And the parents of addicts have been mobilized for years, with many feeling that the fentanyl movement has distracted attention away from needed health care. The article says that the drugs are being introduced by Mexican cartels that seek vengeance against low-level dealers, many of whom are just friends getting things for one another. The article distinguishes between drug users and fentanyl “victims,” creating and reinforcing the stigma these groups claim to be trying to eliminate. It does a great disservice to those of us who lost children to addiction and overdose, and is insulting to our children and to us as parents. Thank you.

— Susan Elamri, Detroit

Interesting read detailing the lack of accountability for drug dealers selling fentanyl laced counterfeit pills resulting in death/overdoses. Consequences and rehabilitation should not be mutually exclusive solutions, we can do both. https://t.co/KlvBH3O1kq

— Chief Paco Balderrama (@BalderramaPaco) May 23, 2022

— Paco Balderrama, chief of police, Fresno, California

When ‘Overweight’ Is ‘Normal’

Quoting from the article “‘Almost Like Malpractice’: To Shed Bias, Doctors Get Schooled to Look Beyond Obesity” (May 24): “Research has long shown that doctors are less likely to respect patients who are overweight or obese, even as nearly three-quarters of adults in the U.S. now fall into one of those categories.”

Perhaps the answer is to change the scale of weight. Why do 25% of adults get to be called “normal” and 75% of adults are “overweight”? Let’s base the decision on reality-based observation!

— Leslie Rigg, Lake Worth Beach, Florida

1) Anti-fat bias is real and certainly an issue. For physicians and others who treat people with #obesity, the question becomes where to draw the line. 'Almost Like Malpractice': To Shed Bias, Doctors Get Schooled to Look Beyond Obesity https://t.co/ap127widIs via @khnews

— Stewart Lonky, MD (@LonkyMD) May 24, 2022

— Dr. Stewart Lonky, Los Angeles

Innocent Until Proven Otherwise

I wanted to raise a concern about the story “‘Desperate Situation’: States Are Housing High-Needs Foster Kids in Offices and Hotels” (June 1) — and it’s certainly not unique to your story. It says:

“These children already face tremendous challenges, having been given up by their parents voluntarily or removed from their homes due to abuse, neglect, or abandonment.”

Sometimes, of course, that’s true. But no reporter would write that every person in jail is a criminal. Many are awaiting trial and can’t make bail. Similarly, children can be in foster care for weeks, even months before any court ever determines if they have been “abused” or “neglected.” Until then, they are in foster care because their parents have been *accused* of abuse or neglect.

(Also, by the way, neglect laws are so broad and vague that often what the parent really is guilty of is poverty — but that’s another issue.)

— Richard Wexler, executive director of the National Coalition for Child Protection Reform, Alexandria, Virginia

[Editor’s note: Thanks so much for your insight. The article has been updated to reflect that the parents are absent “due to accusations of abuse, neglect, or abandonment.”]

.@sclaudwhithead looks at "hoteling," Georgia's practice that makes high-need foster kids sometimes sleep in hotels or offices. The pandemic made the problem worse, but state lawmakers spent more to try to pay extra for foster parents to take kids. #gapol https://t.co/xRXbKCSVEM

— Jeff Amy (@jeffamy) June 1, 2022

— Jeff Amy, Atlanta

Key to Harm Reduction: Buy-In From People With Addiction

With overdose deaths skyrocketing to never-before-seen levels, the United States needs harm reduction strategies to protect the health and wellness of Americans. In 2020, 41 million Americans needed substance use treatment within the previous year; however, of those who needed such treatment but did not receive it at a specialty facility, a staggering 97.5% did not feel they needed it. Although America has a troubling treatment gap exacerbated by systemic legal and regulatory barriers to evidence-based addiction care, most people who need substance use treatment don’t want this treatment as it is currently being offered.

To support our friends and family members living with addiction, our system must also embrace harm reduction approaches that engage people who use drugs (PWUD) before they are ready for abstinence-based treatment (“As Biden Fights Overdoses, Harm Reduction Groups Face Local Opposition,” June 14).

Harm reduction saves lives. Drug checking services and naloxone distribution prevent overdose deaths, while syringe and related service programs help stop the spread of infectious diseases such as HIV/AIDS and hepatitis. These are all worthy ends in themselves, but harm reduction has the further benefit of building a meaningful alliance between health care professionals and PWUD. With this therapeutic relationship, PWUD have facilitated access to high-quality, evidence-based treatment and services when they become ready for this help. It’s an obvious point, but too many people overlook the fact that a person can’t receive treatment or enter recovery if they’re dead.

As a physician, I swore an oath to do no harm — not to do nothing. Failing to embrace and expand harm reduction efforts, by definition, leaves too many of our friends, family members, and loved ones at an unacceptable risk of dying. The dichotomy between offering more addiction treatment and providing PWUD with the tools they need to live healthier lives is a false choice. The United States must simultaneously invest in treatment expansion and increase the availability of low-threshold harm reduction services; otherwise, I fear the country’s addiction and drug overdose crisis will continue to get worse.

— Dr. Brian Hurley, president-elect of the American Society of Addiction Medicine’s Board of Directors, Los Angeles

. @POTUS wants to expand #harmreduction programs as part of strategy to reduce #drug #overdose deaths, but idea faces complicated reality on the ground as programs operate on fringes of legality, w/ scant budgets, & fierce opposition. @renurayasam @khnews https://t.co/qbSBtMkn38 pic.twitter.com/pYV8mB1nEc

— Deni Carise (@DeniCarise) June 21, 2022

— Deni Carise, Philadelphia

How to Beat the Opioid Epidemic

Do you want to control the scourge of fentanyl in America (“The Blackfeet Nation’s Plight Underscores the Fentanyl Crisis on Reservations,” May 25)? There are two options:

1. Distribute the drug solely by the government, ensuring its purity, proper dosage, and safe setting for the user, providing real-time overdose care and optional consulting for anyone who wants to quit, all for free.

2. Make some nonaddictive antidepressants (generally SSRIs, or selective serotonin reuptake inhibitors) less restrictive. You know, how health care in your country is expensive, visiting a psychiatrist or psychologist, refilling, blah-blah. I know, the nation who can’t agree on banning AR-15s from being sold to 18-year-olds won’t agree on this.

What if you let people have some SSRIs over the counter? These are not recreational, are generally safe (way safer than opioids), and do help with anxiety. Hey, what drives people to opioids? Aren’t anxiety levels at their highest all across the globe?

Also, the drugmaker mafia will support it.

Just as we have embraced over-the-counter drugs for widespread diseases like colds, we might adopt the same concept in mental health care as well. Anxiety is becoming more widespread compared with colds (my gut says).

— Alireza Mohamadi, Tehran, Iran

Fentanyl spreads west, including to the Blackfeet Nation.https://t.co/ZrykuZQ06c

— Keith Humphreys (@KeithNHumphreys) May 25, 2022

— Keith Humphreys, Stanford, California

Dust-Up Over Pollution Coverage

This article appears written from a lopsided viewpoint (“Some People in This Montana Mining Town Worry About the Dust Next Door,” June 8).

Very few cities pass the World Health Organization’s unrealistic threshold of 5 micrograms per cubic meter, and why would you get a mechanical engineer to provide input on environmental issues? Why, because the real environmental specialist said this was not an issue? As for dust on a picnic table, that is a horrible example. We get dust on our picnic table anytime the wind blows, and we don’t live by a mine. Maybe WHO should recommend that the wind stop blowing because it causes dust.

From the WHO’s website: “In 2019, 99% of the world population was living in places where the WHO air quality guidelines levels were not met.” This is not a reasonable standard and was selected by bureaucrats that are out of touch with life and the real world. All of the real information and statistics say there is not a problem, but your article makes a problem where one does not exist and people who are not willing to fact-check you will think there is a problem. All these people with health issues are unfortunate and that’s very sad, but people everywhere have sad health issues. Stick to the scientific facts and real monitoring numbers, and don’t drag “The Sky Is Falling” people into news articles. Facts matter!

— John Utaz, Salt Lake City

Cultivating an interest in ‘dusts’ at the moment and this article includes extractive industries/ mining. https://t.co/JsXCA7rxkD

— Cat Rushmore (@CatRushmore) June 9, 2022

— Cat Rushmore, Glasgow, Scotland

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: Why Health Care Is So Expensive, Chapter $22K

Congress is making slow progress toward completing its ambitious social spending bill, although its Thanksgiving deadline looks optimistic. Meanwhile, a new survey finds the average cost of an employer-provided family plan has risen to more than $22,000. That’s about the cost of a new Toyota Corolla. Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Rebecca Adams of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Rebecca Love, a nurse academic and entrepreneur, about the impending crisis in nursing.

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Congress appears to be making progress on its huge social spending bill, but even if it passes the House as planned the week of Nov. 15, it’s unlikely it can get through the Senate before the Thanksgiving deadline that Democrats set for themselves.

Meanwhile, the cost of employer-provided health insurance continues to rise, even with so many people forgoing care during the pandemic. The annual KFF survey of employers reported that the average cost of a job-based family plan has risen to more than $22,000. To provide what their workers most need, however, this year many employers added additional coverage of mental health care and telehealth.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s episode:

  • Moderate Democrats who were worried about the price tag of the social spending bill said during negotiations last week that they wanted to see the full analysis of spending and costs from the Congressional Budget Office. But members of the House probably won’t get that score before voting on the bill. CBO instead is releasing its assessments piecemeal as analysts go through specific sections of the huge bill.
  • If the House passes the bill next week, which leadership is pledging, the legislation could still undergo major revisions in the Senate. Some provisions will be subject to the Byrd Rule, which says items in this type of bill must be related to the budget. Republicans are expected to challenge parts of the bill, and the parliamentarian will have to rule on whether their objections are valid.
  • Among the provisions that some moderate Democratic senators might object to are the paid family leave and the mechanism for lowering Medicare drug prices.
  • Congress is looking at a very busy end of the year, which could complicate passage of the social spending bill. Leaders already postponed a bill to raise the debt ceiling and the annual federal spending bills until early December.
  • A federal judge has blocked Texas Republican Gov. Greg Abbott’s order prohibiting mask mandates in schools. But a final resolution is likely some time away as the case is appealed. Disability rights groups, which had sued to stop the governor’s order, argued that the ban was keeping children with health problems who are at high risk from covid from coming to school.
  • Despite opposition from conservative leaders to vaccine mandates, the vast majority of workers have had their shots, either because they wanted them or their employer mandated it. Lawsuits brought against those workplace requirements may not signal a broad opposition among the population.
  • In its survey of employers’ health plans, KFF found that premiums are still increasing faster than wages as health costs continue to rise. Leaders of both political parties say they would like to reduce the cost of care, but no magic pill appears likely. Instead, lawmakers generally are more inclined to have the government pick up a bigger portion of the country’s health care costs when not finding a way to cut that spending.
  • One key challenge in addressing rising health care spending in Congress is the power of the health care industry. With the close political party margins on Capitol Hill, it is fairly easy for the industries to use their contributions to pick off a couple of members and keep major reform from passing.
  • The KFF survey also documented the wide expansion of telehealth coverage during the pandemic. Although employers and the government have been concerned that telehealth adds to spending because it duplicates services or allows doctors to charge for services they once performed over the phone without billing, it will be hard to put this genie back in the bottle. Consumers like the convenience. And some services, such as mental health therapy or medical consultations for rural residents, are much easier.

Also this week, Rovner interviews Rebecca Love, a nurse, academic and entrepreneur who has thought a lot about the future of the nursing profession and where it fits into the U.S. health care system

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Washington Monthly’s “The Doctor Will Not See You Now,” by Merrill Goozner.

Alice Miranda Ollstein: NPR’s “Despite Calls to Improve, Air Travel Is Still a Nightmare for Many With Disabilities,” by Joseph Shapiro and Allison Mollenkamp.

Rebecca Adams: KHN’s “Patients Went Into the Hospital for Care. After Testing Positive There for Covid, Some Never Came Out,” by Christina Jewett.

Anna Edney: Bloomberg News’ “All Those 23andMe Spit Tests Were Part of a Bigger Plan,” by Kristen V Brown.

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Watch: Going Beyond the Script of ‘Dopesick’ and America’s Real-Life Opioid Crisis

KHN teamed up with Hulu for a discussion of America’s opioid crisis, following the Oct. 13 premiere of the online streaming service’s new series “Dopesick.”

KHN and policy colleagues at our parent organization KFF teamed up with Hulu for a discussion of America’s opioid crisis, following the Oct. 13 premiere of the online streaming service’s new series “Dopesick.”

The discussion explored how the series’ writers worked with journalist Beth Macy, author of the book “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America,” and showrunner Danny Strong to create and fact-check scripts and develop characters. It quickly moved on to a deeper discussion of how the fictionalized version of the opioid epidemic portrayed in the Hulu series dovetailed with the broader reality KFF’s journalists and analysts have been documenting in their work for the past few years.

Providing perspective on the role of public health and treatment were KHN correspondent Aneri Pattani, who has reported extensively on opioid policy, substance use and mental health, and KFF senior policy analyst Nirmita Panchal, whose analytical work focuses on mental health and substance use.

The forum was moderated by Chaseedaw Giles, audience engagement editor and digital strategist at KHN who has written about hip-hop music’s relationship with opioid abuse. It was filmed in KFF’s Washington, D.C., conference center to an audience of no one (courtesy of covid-19).

You can read a transcript of the forum by clicking here.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: Abortion Politics Front and Center

The polarizing abortion issue threatens to tie up Congress, the Supreme Court and the states for the coming year. Meanwhile, Congress kicks the can down the road to December on settling its spending priorities. Joanne Kenen of Politico and the Johns Hopkins School of Public Health, Yasmeen Abutaleb of The Washington Post and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more.
Also this week, Rovner interviews KHN’s Aneri Pattani, who delivered the latest KHN-NPR “Bill of the Month” episode about a covid test that cost as much as a luxury car.

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Abortion, an issue that has mostly been simmering under the surface lately, is taking center stage in fights at the Supreme Court, in Congress and in the states, as the fate of legalized abortion in the United States hangs in the balance.

Meanwhile, Congress flirted with disaster as it appeared unlikely to meet deadlines to approve a series of budget bills, including an extension of the federal government’s lending authority. But lawmakers found ways to extend programs long enough to continue negotiating through the fall.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico and Johns Hopkins, Yasmeen Abutaleb of The Washington Post and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

  • As Democratic lawmakers seek to reduce the cost of the president’s $3.5 trillion plan to boost health and other domestic programs, they are wrestling with whether to cut the number of programs they fund but still give them full support or to keep a wider range of initiatives but fund them for fewer years or at lower levels. Supporters of the latter proposal contend that getting the programs started is important and, if they have a constituency, it will be hard for Congress in the future to cut the programs.
  • Sen. Joe Manchin (D-W.Va.), who has been at the center of the negotiations because he was refusing to support the package if it stayed at $3.5 trillion, has called for new initiatives to be means-tested so that benefits don’t go to higher-income Americans. Past experience suggests that can lower the popularity of the programs because it creates more bureaucracy to oversee the benefits and sometimes creates problems with getting voters to buy into the need.
  • As the negotiations drag on, it seems less likely that the Democrats will agree on a plan to rein in prescription drug prices. Leaders haven’t come to terms on how they would like to address the issue, and drugmakers have beefed up their advertising campaign to oppose any action that could threaten their profits.
  • Manchin may also throw a wrench into the negotiations if he goes forward with plans to seek a provision in the legislative package that makes the so-called Hyde Amendment permanent. The Hyde Amendment, which is commonly added to annual health spending legislation, bars most federal dollars from being spent on abortions. Progressive Democrats strongly oppose the Hyde Amendment, and they would like to remove it from the annual spending bill for the Department of Health and Human Services.
  • Pfizer on Thursday announced it is seeking authorization from the Food and Drug Administration for a covid vaccine for children ages 5 to 11. The agency has scheduled an advisory committee meeting already and a decision could come around Halloween. A decision on vaccines for children under 5, however, seems unlikely before the end of the year.
  • The recent controversy over whether the U.S. should authorize so-called vaccine boosters has focused attention on the lack of good national data on covid’s effects. Much of the argument for those additional shots was based on studies from Israel and Britain because U.S. health officials have not been collecting the same level of data about covid cases and outcomes. That is partly a reflection of the decentralization of the U.S. health system.
  • The Biden administration announced this week it is reversing a federal Title X rule that denied funding to organizations that counseled people about abortion or referred them to abortion providers. Planned Parenthood left the program after the Trump administration implemented that rule.
  • Abortion is teeing up to be a big issue before the Supreme Court this term. The justices had already agreed to hear a case opposing a Mississippi law restricting most abortions after 15 weeks, but cases involving a controversial Texas law that denies abortions after six weeks appear bound for the high court soon, too.
  • Abortion opponents are hoping the court will overturn the landmark Roe v. Wade decision legalizing the procedure. But that could also set the court up for a major backlash and complaints about its politicization.
  • Biden has another key health opening in his administration: the director of the National Institutes of Health. But it doesn’t seem likely to be as difficult to fill as the head of the FDA, which the White House has still not offered a nominee for.

Also this week, Rovner interviews KHN’s Aneri Pattani, who reported the latest KHN-NPR “Bill of the Month” feature about two similar jaw surgeries with two very different price tags. If you have an outrageous medical bill, you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The New York Times’ “A ‘Historic Event’: First Malaria Vaccine Approved by W.H.O.,” by Apoorva Mandavilli

Joanne Kenen: Vox.com’s “Why Merck’s Covid-19 Pill Molnupiravir Could Be So Important,” by Umair Irfan

Yasmeen Abutaleb: The Wall Street Journal’s “Why It’s So Hard to Find a Therapist Who Takes Insurance,” by Andrea Petersen

Sarah Karlin-Smith: The Washington Post’s “70 Years Ago, Henrietta Lacks’s Cells Were Taken Without Her Consent. Now, Her Family Wants Justice,” by Emily Davies

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: Delta Changes the Covid Conversation

With covid cases on the upswing again around the country, partisan division remains over how to address the pandemic. Meanwhile, the Biden administration proposes bigger penalties for hospitals that fail to make their prices public as required. Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Tami Luhby of CNN join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite stories of the week they think you should read, too.

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

The resurgence of covid cases in the U.S. — largely attributable to the much more contagious delta variant — has given policymakers the jitters. The Biden administration is redoubling efforts to get people vaccinated, and even some Republicans who had been silent or skeptical of the vaccines are encouraging the unvaccinated to change their status.

Meanwhile, it’s not just covid that’s shortening U.S. life expectancy. Nearly 100,000 people died of drug overdoses in 2020, according to the Centers for Disease Control and Prevention. This week a multibillion-dollar settlement among states, drugmakers and distributors could funnel funding to fight the opioid scourge.

This week’s panelists are Julie Rovner of KHN, Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Tami Luhby of CNN.

Among the takeaways from this week’s episode:

  • If lawmakers fail to craft a bipartisan deal on Capitol Hill on traditional infrastructure spending, Democrats’ plans for a second bill that incorporates significant health care programs may need to be scaled back. That’s because the Democrats have pledged to fund major improvements in infrastructure and they would need to add that to the second bill, which is being moved through a special procedure that keeps it from being stalled in the Senate by a Republican filibuster. Some Democrats are nervous about making that second bill too broad.
  • The momentum toward vaccinating the public has stalled abruptly in the past month or so, and reports of rising cases is causing concern among conservatives. Some high-profile Republicans — including Senate Minority Leader Mitch McConnell, Rep. Steve Scalise (La.) and Florida Gov. Ron DeSantis — have been out during the past week touting the vaccines’ successes.
  • The agreement reached this week between state officials and companies that made or distributed opioids will send billions of dollars to the states to fund prevention and treatment programs for people with addiction problems. Some advocates worry, however, that the funding — much like the landmark tobacco settlement of past years — will instead be absorbed by cash-strapped states for other uses.
  • The Biden administration proposed significantly increasing the fines for hospitals that do not make their prices easily seen online and understood for patients. Despite the widespread eagerness to establish transparency, there is little indication consumers are using such tools.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: NPR’s “The Life Cycle of a COVID-19 Vaccine Lie,” by Geoff Brumfiel

Stephanie Armour: The Washington Post’s “Biden Administration, Workers Grapple With Health Threats Posed by Climate Change and Heat,” by Eli Rosenberg and Abha Bhattarai

Tami Luhby: The Los Angeles Times’ “Same Hospitals but Worse Outcomes for Black Patients Than White Ones,” by Emily Alpert Reyes

Alice Miranda Ollstein: The 19th’s “Courts Block Laws Targeting Transgender Children in Arkansas and West Virginia,” by Orion Rummler

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: 100 Days of Health Policy

It’s 100 days into Joe Biden’s presidency and a surprisingly large number of health policies have been announced. But health is notably absent from the administration’s $1.8 trillion spending plan for American families, making it unclear how much more will get done this year. Meanwhile, the Centers for Disease Control and Prevention loosens its mask-wearing recommendations for those who have been vaccinated, but the new rules are confusing. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews KHN’s Julie Appleby, who reported the latest KHN-NPR “Bill of the Month” episode.

Can’t see the audio player? Click here to listen on SoundCloud.

It’s been a busy 100 days for the Biden administration on health policy. The promise Joe Biden made as president-elect to get 100 million covid vaccinations in arms was doubled, healthcare.gov reopened to those without insurance, and steps were taken to undo a raft of health policies implemented by President Donald Trump. The covid relief bill passed by Congress in March also boosted subsidies for those who buy their own coverage and provided incentives for the 12 states that have yet to expand their Medicaid programs under the ACA.

But those actions may prove the high point for health policy this year. Administration officials initially promised that health would be a major part of the president’s $1.8 trillion American Families Plan, but major changes, particularly those addressing prescription drug costs, were nowhere to be seen when the plan was unveiled Wednesday.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet

Here are some takeaways from this week’s podcast:

  • Among the Trump administration health policies the Biden administration has moved to reverse are those on women’s reproductive health and Medicaid work requirements. Some experts suggest that Democratic officials pushed forward on this with good speed because the past administration’s health policies were easier to disentangle than its rules on environment, where Biden also wants to make changes.
  • Democratic lawmakers had seemed eager to use Biden’s family plan to expand Medicare or drive down prescription drug prices. It likely signals that while health care is a key issue for Democrats on Capitol Hill, it is not as big a priority in the White House. Biden, who did mention those policies favored by progressive lawmakers in his speech to Congress on Wednesday, seems to be putting his emphasis on strengthening the Affordable Care Act.
  • Right now, the pharmaceutical industry is scoring high with voters and politicians because of the successes of the covid vaccines. So, getting Senate approval of a bill to allow Medicare to negotiate drug prices is likely to be difficult. Those odds get even tougher without pressure from the White House.
  • Biden may also have shied away from the drug pricing initiative in his formal plan for helping families because he was concerned that it could divide the Democratic caucus and imperil the overall initiative.
  • The administration is gearing up to provide India with help to fight the pandemic. Public health officials point out that although the vaccination effort in the U.S. is going well, it is imperative to tamp down the virus in other countries so variants that could evade the vaccines don’t develop. However, there is already a debate about how much U.S. vaccine to ship abroad before authorities determine how to vaccinate children here.
  • Federal health officials have lifted the pause on using the Johnson & Johnson covid vaccine, but that decision has been controversial and some scientists question whether there was enough study or it was the right move.
  • The Centers for Disease Control and Prevention loosened its mask-wearing recommendations for people who have been vaccinated, but the new rules are confusing and even sparked some jokes among late-night TV comedians.
  • As the vaccination efforts in the U.S. gain steam, interest is growing among people with long-term cases of covid-19. A hearing on Capitol Hill this week looked at some of the issues, such as what sorts of disabilities these patients face and what workplace accommodations are necessary.
  • The National Institutes of Health is beginning major studies of “long covid” and its myriad symptoms. Although health officials do not yet have a clear definition of long covid, they are generally not dismissing patients’ complaints about the disorder. That differs from some mysterious ailments in the past.
  • The Biden administration has loosened the rules governing who can prescribe the drug buprenorphine, a controversial but effective treatment for opioid addiction. The policy eliminates a training requirement and seeks to allow medical professionals other than doctors to prescribe the drug. But hurdles to its use remain, leading some to question how much more widely the drug will be used as a result of the new policy.

Also this week, Rovner interviews KHN’s Julie Appleby, who reported the latest KHN-NPR “Bill of the Month” feature — about the intersection between car insurance and health insurance. If you have an outrageous medical bill you’d like to share with us, you can do it here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: This American Life’s “The Herd,” by Ira Glass, Anna Maria Barry-Jester and David Kestenbaum. Also, KHN’s “We’re Coming for You’: For Public Health Officials, a Year of Threats and Menace,” by Anna Maria Barry-Jester.

Joanne Kenen: The New Yorker’s “How Vaccine Hesitancy Is Driving Breakthrough Infections in Nursing Homes,” by Masha Gessen.

Mary Ellen McIntire: CQ Roll Call’s “FEMA’s Tasks Pit COVID-19 Vaccinations Against Hurricane Prep,” by Emily Kopp.

Sarah Karlin-Smith: The Pink Sheet’s “Conflicts Galore: Upcoming Accelerated Approval Cancer Panel Includes Many Industry Relationships,” by Sarah Karlin-Smith.

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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: Open Enrollment, One More Time

Keeping a campaign promise, President Joe Biden has reopened enrollment for health coverage under the Affordable Care Act on healthcare.gov — and states that run their own health insurance marketplaces followed suit. At the same time, the Biden administration is moving to revoke the Trump administration’s permission for states to impose work requirements for some adults on the Medicaid health insurance program. Alice Miranda Ollstein of Politico, Kimberly Leonard of Business Insider and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews medical student Inam Sakinah, president of the new group Future Doctors in Politics.

Can’t see the audio player? Click here to listen on SoundCloud.

An estimated 9 million Americans eligible for free or reduced premium health insurance under the Affordable Care Act have a second chance to sign up for 2021 coverage, since the Biden administration reopened enrollment on healthcare.gov and states that run their own marketplaces followed suit.

Meanwhile, Biden officials took the first steps to revoke the permission that states got from the Trump administration to require many adults on Medicaid to work or perform community service in exchange for their health coverage. The Supreme Court is scheduled to hear a case on the work requirements at the end of March.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Kimberly Leonard of Business Insider and Rachel Cohrs of Stat.

Among the takeaways from this week’s podcast:

  • The Biden administration said it will promote the special enrollment period, a stark change from the Trump administration, which dramatically limited funding for outreach. But navigator groups, whose workers help individuals find and sign up for coverage, say they haven’t yet heard whether the federal government will be offering to pay them to help people during this three-month sign-up period.
  • The House appears poised to pass a bill next week that would fund the covid relief measures President Joe Biden is seeking, as well as major changes to the ACA. Senate staffers are working with the House to align legislation from both chambers as much as possible. With little or no Republican support and only razor-thin majorities in both the House and Senate, Democrats will need to find common ground among their caucus to push the bill through.
  • Congress has a firm deadline on the covid relief bill since many current programs, such as the expanded unemployment funding, expire March 14.
  • CVS announced this week that its insurance subsidiary, Aetna, will be participating in the ACA marketplaces in the fall, another sign that those exchanges are growing in acceptance.
  • The Biden administration’s effort to walk back Medicaid work requirements appears to be an effort to head off the arguments at the Supreme Court. Democrats fear that even if they stop the program through administrative action now, a high-court ruling saying the effort was legal could open the door for future Republican administrations to restore work requirements.
  • The federal government is pushing hard to get more covid vaccine shots in arms around the country and last week reported that 1.7 million doses had been distributed. But it is a race against the emerging threat of covid virus variants, which are even more contagious than the original coronavirus.
  • Among hurdles in the vaccination effort is hesitancy among certain groups to get the shot. There have been reports that 30% of military personnel refused to accept the vaccine and some high-profile athletes in the NBA don’t want to be in public service announcements promoting it. Groups opposed to vaccines in general are posting misinformation online that may also be a source of concern.
  • The latest controversy over New York Gov. Andrew Cuomo’s policies on counting deaths among nursing home residents with covid-19 has consumed Albany and led to inquiries by legal authorities. It also raises questions about whether politics — Cuomo, a Democrat, and President Donald Trump regularly sparred about covid policies — influenced public health decisions.

Also this week, Rovner interviews medical student Inam Sakinah, president of the new group Future Doctors in Politics.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Stat’s “Hospitals’ Covid-19 Heroics Have Them Poised for Power in the New Washington,” by Rachel Cohrs

Rachel Cohrs: KHN’s “As Drug Prices Keep Rising, State Lawmakers Propose Tough New Bills to Curb Them,” by Harris Meyer; and Stat’s “States Still Can’t Import Drugs From Canada. Now, Many Are Seeking to Import Canadian Prices,” by Lev Facher

Alice Miranda Ollstein: Politico’s “How Covid-19 Could Make Americans Healthier,” by Joanne Kenen

Kimberly Leonard: The New Republic’s “The Darker Story Just Outside the Lens of Framing Britney Spears,” by Sara Luterman

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Readers And Tweeters Dive Into Debate Over ‘Medicare For All’

Kaiser Health News gives readers a chance to comment on a recent batch of stories.

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


Savings For All?

Your criticism about former Vice President Joe Biden’s “Medicare for All” cost estimates is spot-on but leaves out important savings (“KHN & PolitiFact HealthCheck: Would ‘Medicare For All’ Cost More Than U.S. Budget? Biden Says So. Math Says No,” Feb. 14). Under Biden’s plan, private insurance stays intact, meaning there are premiums and point-of-service costs that do not appear as taxes but are added to the nation’s health care expense. Medicare for All, on the other hand, is zero at the point of service, meaning Americans would have no financial qualms seeking comprehensive care. Public options add bureaucratic costs, are subject to personal income fluctuations and have deductibles and copays. We depend on organizations like yours to present the full picture. Here’s hoping you will, in the public’s interest.

― Dr. Donald Green, Pennington, New Jersey


— Manuel Freire, Fort Lauderdale, Florida


For Alzheimer’s Patients Like Me, Knowing Is Half The Battle

I want to thank Judith Graham for her piece discussing the uncertainty and fear patients feel when faced with the potential onset of Alzheimer’s disease or dementia (“Stalked By The Fear That Dementia Is Stalking You,” Feb. 21).

As an Alzheimer’s patient with a confirmed diagnosis, I know all too well how unsettling it can be to suffer from cognitive decline without knowing the nature of your condition. For me, it started with little things like forgetting a name or misplacing a set of house keys. Still, it wasn’t until I applied to participate in an Alzheimer’s clinical trial and received a PET scan identifying amyloid protein buildup in my brain did I definitively know I had the disease.

Like many of the patients discussed in the article, dealing with these early warning signs can be an enormous source of anxiety — especially when it’s unclear whether or not the cause is Alzheimer’s or another cognitive issue. That’s why getting a precise diagnosis was such a critical step for myself and my husband, Jim.

As mentioned in the article, amyloid PET scans are not fully covered by Medicare, a critically important detail, which I believe must be remedied. As the prevalence of Alzheimer’s continues to grow as our population ages, expanding access to diagnostic tools that can identify this disease will become ever more critical. I remain optimistic that our representatives in Washington can come together and address this issue ― so more patients like me don’t have to live under a cloud of uncertainty.

— Geri Taylor, New York City


An Infusion Of Debt

Glad you are pointing this out (“Patients Stuck With Bills After Insurers Don’t Pay As Promised,” Feb. 7). It’s happening again, post-Affordable Care Act. For us, it’s my husband’s battle with multiple sclerosis, but more the battle with his insurer. It approved his treatment cost for a new drug, sent a letter saying everything was covered. Then, lo and behold, we get a bill for $4,000 that it said we had to pay. No reason or rationale given. So now we are on a payment plan with the hospital that gave him his infusion. Not sure why we even bother with paying our premiums in the first place, considering the out-of-pocket expense and worthlessness of preapprovals; it doesn’t really matter. Please keep writing these articles ― it helps.

― Margaret Paez, Los Angeles


When Choice Of Hospitals Is A Life-Or-Death Choice

Thanks so much for your coverage of death-with-dignity situations (“Terminally Ill, He Wanted Aid-In-Dying. His Catholic Hospital Said No,” Jan. 29). We all need to know as much as possible about the institutions and structures that may prevent patients from choosing a dignified death. Please consider linking to the Catholic ethics rules so readers can read them for themselves. Please make us a map of Colorado showing the hospitals that are abiding by these rules. Please explain that emergency services in rural areas may have no choice but to take patients to the nearest (possibly non-law-abiding) hospital. Rewired has written about Eastern hospitals where serious pregnancy issues were poorly treated by Catholic hospitals.

Many of us do not understand that hospital choice may become a life choice and doctor choice may also become a life choice. And, please, also feature regularly and loudly all the practitioners and organizations being formed to protect patients’ legal right to die. Thanks so much for the good work that you do.

― Diane Curlette, Boulder, Colorado


Taking Pains Over Statistics

In stories about the opioid crisis (“No Quick Fix: Missouri Finds Managing Pain Without Opioids Isn’t Fast Or Easy,” Feb. 13), I always see total death statistics but never a breakdown of how many of the fatalities represent responsible legal users vs. illegal users.

A lot of us elderly folks have a very hard time getting our pain meds nowadays. Thirty used to last me five to seven months, and I took them only when I couldn’t get to sleep due to pain throughout my body. We have discussed it on our seniors’ webpage in our rural area and many of us used to get them. Overdoses and addiction aren’t the norm and aren’t even in the realm of our experiences. Why do we have to pay for others’ mistakes? They don’t outlaw cars even though many people die from wrecks caused by bad drivers!

― William Scriven, Valley Springs, California


— Nicolas Terry, Indianapolis


Collateral Damage From Insurers’ Dispute

When I read Brian Krans’ article about the Dignity-Cigna dispute (“Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer,” Feb. 6), I was reminded of my own situation: In California, Oscar dropped coverage for all UCLA care facilities in its Covered California (Affordable Care Act) plans, as of this year. I don’t know how many people use Oscar, but the UCLA system is a major health care provider here in West L.A. There’s no indication that there’s a dispute — this is represented as a final decision. UCLA is gone!

I figured I could get similar care from the Providence network, but my first choice for a primary care physician proved a bit odd: On our first visit, he presented at least four ideas that seem outside the medical mainstream. With some embarrassment, I asked for a different PCP. That physician ordered lab work but said no one in the building was authorized by Oscar to do blood draws, so I was sent to a facility in another city … which turned out to be out of business. I was finally referred to a third facility, which turned out to be more convenient than the last ― but the inconvenient run-around for something as simple as a blood draw and the penny-pinching by my insurance company do not bode well for the future of American medicine.

This is the second disruption I’ve had in insurance providers since the ACA began, and another indication that our current health care system is still very broken.

— Gary Davis, Los Angeles


— Scott Gordon, Fennimore, Wisconsin


Raising A Red Flag On Animal Rights Group

As a registered dietitian, I do not promote the keto diet. Mentioned in the article “As VA Tests Keto Diet To Help Diabetic Patients, Skeptics Raise Red Flags” (Feb. 3) is the group Physicians for Responsible Medicine, which is an extreme animal rights group with ties to PETA. About 3% of its members are physicians. Attending a seminar on nutrition for cardiovascular disease, I was dismayed to see the speaker had ties to Physicians for Responsible Medicine. After hearing about all the terrible effects of eating animal products, when the speaker could no longer contain himself and shouted out, “You don’t eat dead animals, do you?” I walked out and called my professional association to complain. Please do not give credibility to this organization.

― Mary Lucius, Beavercreek, Ohio


— Nancy Coney, South Bend, Indiana


Price-Gouging At Its Core

I read your most recent story on surprise medical billing (“When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills,” Feb. 12) and found it to be largely one-sided against physicians and, somewhat, hospitals. Although private equity certainly is an influence in the conversation, very little to any time was spent discussing the efforts of insurance companies to continually drive down reimbursements. Furthermore, when we look at Medicare rates, which insurance companies rates are based on, the actual reimbursement has not significantly increased over the past few decades when you account for inflation or the consumer price index. So to paint the picture that physicians are trying to gouge patients does not seem very fair. While there are always a few bad apples and opportunists, the majority of physicians simply want to be paid fairly. Remember: Over the past few years, insurance companies have reported record profits — billions per fiscal quarter. Why are we not talking about why more of our premiums are not going to the provision of health care and instead to shareholders? I think the article fails to paint the entire picture for a lay audience. Nowhere does it report the amount of money spent on lobbying by the insurance industry.

― Dr. Shamie Das, Atlanta


— Gene Christian, Memphis, Tennessee


Health Care’s High-Cost Formula Goes Beyond Drug Prices

What patients care about more than drug prices is how much they have to pay out-of-pocket for their critical medications (“Watch: Let’s Talk About Trump’s Health Care Policies,” Feb. 4). Because of high-deductible health plans and tiered formularies, what patients pay at the pharmacy counter often has less to do with the list price of the drugs they need and more to do with the design of their health benefits. It is especially troubling that high-value drugs for chronic conditions like diabetes are often subject to unaffordable cost sharing that hits disproportionately at the beginning of the benefit year. Employers and health plans need to exempt these drugs from high deductibles as now permitted by the IRS. The same goes for Medicare Part D, which hugely penalizes seriously ill patients at the start of each year when they have yet to reach the catastrophic threshold.

Clearly, the problem of high drug prices needs to be addressed, but this will require a systematic and comprehensive approach that is certain to be resisted by one vested interest or another. In the meantime, patients need immediate relief from unaffordable out-of-pocket costs. Some steps that should be taken immediately include exempting high-value care from plan deductibles and capping and smoothing out-of-pocket costs in Medicare Part D. Much, if not all, of the cost associated with these measures can be offset by not paying for low- and no-value care that costs billions per year.

― Daniel Klein, president & CEO of the Patient Access Network (PAN) Foundation, Washington, D.C.


Cause For Investigation

The example you give presents an illegal activity by the home health agency (“Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients,” Feb. 3). At a minimum, that agency should have a complaint registered against them, if not investigated by the Office of the Inspector General. The agency lied about Medicare not covering the patient’s needs. And they should have had the patient sign an ABN/NOMNC (Advance Beneficiary Notice/Notice of Medicare Non-Coverage) and explained it to the patient as required, so he could choose to appeal with the Quality Improvement Organization (QIO) for coverage of medically necessary care.

Kaiser Health News needs to provide education for the elderly and families to make sure they don’t fall prey to this type of behavior. If the agency simply says “I don’t have the staff to cover you,” they are responsible to assist the patient in finding another agency. But they cannot elect to just stop providing a medically necessary service, just as they cannot keep seeing someone when it is not medically necessary. Key here is to get people to know their rights as a Medicare beneficiary.

― Edward Dieringer, Salt Lake City


— Tom Cassels, Arlington, Virginia


— Peg Graham, Washington, D.C.


Privacy Concern: I Lack Seamless Access To My Own Records

I work in a medical center and have taken HIPAA training repeatedly over the years. I have also noted the staggering amount of money spent on medical electronic records. Yet in four attempts over a 20-year period, I have yet to get my medical records sent from one doctor or practice to another. I could not get records of my husband’s hospital stay sent to his primary physician, dental records sent from one dentist to another and, this fall, the pertinent records when my rheumatologist changed practices. My insurance paid for blood tests four times a year and X-rays over a five-year period. I have contacted the facilities and submitted a complaint to HHS Office for Civil Rights, which appears to be the correct office.

I find it unacceptable that, with all the talk about how expensive medical care is, tests over time are not easily available to patients when requested. I read Kaiser Health News regularly and at least I feel informed about what can go wrong. Thank you.

— Susan Klimley, New York City


— Dr. Sarah Nguyen, Los Angeles

Listen: Missouri Efforts Show How Hard It Is To Treat Pain Without Opioids

KHN Midwest correspondent Lauren Weber was interviewed by KBIA’s Sebastián Martínez Valdivia to discuss the challenges Missouri faces in managing patients’ pain amid the opioid epidemic.

KHN Midwest correspondent Lauren Weber speaks with KBIA’s Sebastián Martínez Valdivia about the challenges Missouri faces in trying to treat chronic pain without opioids. Weber had reported that only about 500 of Missouri’s roughly 330,000 adult Medicaid beneficiaries used a new, alternative pain management plan to stem opioid overprescribing in the program’s first nine months. Meanwhile, 109,610 Missouri Medicaid patients received opioid prescriptions last year.

You can listen to the conversation on the KBIA website.