3+ hour, 32+ min ago (479+ words) As health care costs continue to soar across the U.S., a growing number of states are setting limits on how much hospitals can charge. These policies, known as hospital payment caps, aim to curb spending by tying hospital prices to Medicare rates, which are typically far lower than what commercial insurers pay. In 2019, Oregon became the first state to implement such a cap, applying it to the health plan covering state employees. Under the policy, hospitals cannot charge the state more than double the Medicare payments for the same service. For example, if Medicare pays $1,000 for a service, the state health plan would pay no more than $2,000 under this cap." The researchers looked at financial, staffing and patient experience data from 22 Oregon hospitals affected by the cap and compared them to similar hospitals in other states from 2014 through 2023. This included financial…...

3+ week, 1+ day ago (813+ words) And even well-insured patients receive unaffordable bills in this era of high-deductible health plans, narrow insurance networks, and 20% cost sharing. These new deals are "mutually enforced monopolization," said Barak Richman, the Alexander Hamilton professor of business law at George Washington University. "It's not competition. It's more like collusion. They don't care about price." Those market factors contributed to a landscape where a dose of the antiviral Paxlovid given in a hospital costs $4,500; magnetic resonance imaging costs $15,000; and joint replacements cost $100,000. President Donald Trump has talked about the burden of health care costs since his first campaign, but he has signaled that his administration's regulators are less inclined than his predecessor's to intervene in health mergers. What this will mean in practice is unclear. In an interview with KFF Health News, Daniel Guarnera, the director of the FTC's Bureau of Competition,…...

3+ week, 5+ day ago (1000+ words) John Cleveland is ready to pay a lot more for his health insurance next year. He hasn't forgotten the pile of hospital bills that awaited him after he had a seizure while tending to customers in his Austin, Texas, barbershop four years ago. Once doctors hurriedly removed the dangerous tumor growing on his brain, a weeklong hospital stay, months of therapy, and nearly $250,000 worth of medical expenses followed. The coverage he has purchased for years through the Affordable Care Act marketplace covered most of those bills. "That saved my ass," said Cleveland, who owns three barbershops across the city. Small-business owners are among those who stand to lose the most should Congress let the additional, generous federal subsidies put in place during the covid-19 pandemic lapse. The looming change threatens not only their own coverage but also that of their…...

3+ week, 6+ day ago (1872+ words) Economist Vivian Ho has been researching the U.S. health care system for four decades. These days, she's focused on what she thinks are the biggest burdens on the average American: runaway hospital prices and rising health insurance premiums. She has developed a strategy for addressing high insurance premiums " one that's based on giving patients reliable information about how much they, and their insurer, would have to pay for care. The system is already working in Massachusetts. Could it be a model for the rest of the country? Ho explains to Dan Weissmann, host of "An Arm and a Leg," why she thinks this approach could help curb high prices and how listeners can help prove it by sharing their medical bills. Dan Weissmann @danweissmann Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace…...

4+ week, 18+ hour ago (1214+ words) This year's Obamacare open enrollment period, which started Nov. 1 in most states, is full of uncertainty and confusion for the more than 24 million people who buy health insurance through the federal and state Affordable Care Act marketplaces. Even with sign-up season underway, the fate of the enhanced premium tax credits that make coverage more affordable for 92% of enrollees remains up in the air, with the prospect of significantly higher premiums looming. But there are steps marketplace shoppers can take to ensure they make the right choices for the upcoming plan year. 1. Understand how we got here In 2021, as part of a covid-era relief package, the ACA premium tax credits were enhanced to lower costs for previously eligible people and expand eligibility to people with incomes over 400% of the federal poverty level (which amounts to about $63,000 for one person in 2025). But…...

1+ mon, 4+ day ago (1320+ words) Last winter, Amber Wingler started getting a series of increasingly urgent messages from the local hospital in Columbia, Missouri, letting her know her family's health care might soon be upended. MU Health Care, where most of her family's doctors work, was mired in a contract dispute with Wingler's health insurer, Anthem. The existing contract was set to expire. Then, on March 31, Wingler received an email alerting her that the next day Anthem was dropping the hospital from its network. It left her reeling. "I know that they go through contract negotiations all the time " but it just seemed like bureaucracy that wasn't going to affect us. I'd never been pushed out-of-network like that before," she said. " The timing was awful. The query: When a Missouri mom's health insurance company couldn't come to an agreement with her hospital, most of her…...

1+ mon, 5+ day ago (1163+ words) One family in Virginia Beach, Virginia, just found out their health plan's deductible will jump from $800 to $20,000 next year. About 200 miles north, in Maryland, another household learned they'll pay $500 more monthly to insure their brood in 2026. And thousands of people in Idaho were greeted with insurance rates that'll cost, on average, $100 more every month. As shopping season opens for Affordable Care Act plans in some states, customers are confronting staggering costs for their health insurance next year. The extra federal subsidies put in place in 2021 that made coverage more affordable for millions of people will expire at the end of this year unless a gridlocked and idle Congress acts. With Democratic and Republican lawmakers at an impasse, the federal government shut down on Oct. 1, spurred by the need for an estimated $353 billion over a decade to continue providing enhanced ACA…...

1+ mon, 1+ week ago (721+ words) "The tax credits go to some people deservedly. And we think the tax credits actually go to a lot of waste and fraud within the insurance industry," said Vice President JD Vance during a recent interview on CBS News. "We want to make sure that the tax credits go to the people who need them." Key to the Republican argument of widespread fraud is a report published in August by the Paragon Health Institute, a Republican-aligned think tank. The report focuses on "phantom enrollees" in the ACA marketplaces. Paragon president Brian Blase said these "phantom enrollees," who don't use any medical care in a year, exceed the percentages of "what you would expect in a normal, functioning health insurance market." Blase and his team say they have quantified the percentage of zero-claim enrollees in the ACA marketplace by analyzing Centers…...

1+ mon, 1+ week ago (1203+ words) This summer, the state of Louisiana texted just over 13,000 people enrolled in its Medicaid program with a link to a website where they could confirm their incomes. The texts were part of a pilot run to test technology the Trump administration says will make it easier for some Medicaid enrollees to prove they meet new requirements " working, studying, job training, or volunteering at least 80 hours a month " set to take effect in just over a year. But only 894 people completed the quarterly wage check, or just under 7% of enrollees who got the text, according to Drew Maranto, undersecretary for the Louisiana Department of Health. "We're hoping to get more to opt in," Maranto said. "We plan to raise awareness." The clock is ticking for officials in 42 states " excluding those that did not expand Medicaid at all " and Washington, D.C., to figure…...

1+ mon, 1+ week ago (640+ words) With the federal shutdown entering its fourth week, spurred by a stalemate over the cost of health insurance for 22 million Americans on Affordable Care Act plans, a new report shows that over 154 million people with coverage through an employer also face steep price hikes " and that the situation is likely to get worse. Premiums for job-based health insurance rose 6% in 2025 to an average of $26,993 a year for family coverage, according to an annual survey of employers released Oct. 22 by KFF, a health information nonprofit that includes KFF Health News. It's the first time in two decades that the cost of covering a family of four has risen by 6% or more for three consecutive years, data from KFF shows. Over the last five years, the average premium for family coverage has increased by 26%, compared with a 29% increase in workers' wages and…...