Latest news with #healthcarepolicy
Yahoo
a day ago
- Health
- Yahoo
‘Pause': Kaiser stops gender-affirming surgeries for patients under 19
( — Kaiser Permanente has announced it will be pausing gender-affirming surgeries for patients who are under the age of 19. Kaiser became the latest health care provider to change its gender-affirming care policy starting August 29, in response to efforts by the Trump administration to restrict access. 'After significant deliberation and consultation with internal and external experts, including our physicians, we've made the difficult decision to pause surgical treatment for patients under the age of 19 in our hospitals and surgical centers,' a Kaiser spokesperson told 'All other gender-affirming care treatment remains available.' Kaiser says there has been a huge focus by the federal government on gender-affirming care, especially for those who are under the age of 19. Ring app users report unauthorized access to their accounts 'We continue to meet with regulators as well as our clinicians, patients, their families, and the community with the goal of identifying a responsible path forward,' Kaiser officials said. According to the hospital, this includes an executive order that instructs federal agencies to take actions to reduce access and restrict funding for gender-affirming care, and hospital inquiries by the Centers for Medicare & Medicaid Services, and changes to coverage and border federal agencies review, which includes the Federal Trade Commission. A recent subpoena has also been issued by the U.S. Department of Justice to doctors and clinics that provided care to minors. 'We recognize that this is an extremely challenging and stressful time for our patients seeking care, as well as for our clinicians whose mission is to care for them,' Kaiser said. 'We will work closely with each patient to support their care journey.' State Senator Scott Wiener (D-San Francisco) stated this is 'straight up denial of care' to those who are under the care of a physician and parents who have permitted the treatments. 'Trump has declared war on trans people and trans kids and their families in particular,' Wiener said. 'Now is the time to have these kids' and these families' backs, not to fold under pressure from the most homophobic and transphobic Administration in modern history — an Administration that won't stop until LGBTQ people are entirely erased from public life.' reached out to some Republican senators and congressmen, but did not hear back in time for this article. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Medscape
5 days ago
- Health
- Medscape
Medicare at 60: Care, Cost, Control
This transcript has been edited for clarity. Jen Brull, MD: Sixty years ago, Congress passed legislation that created Medicare. In 1966, its first year of implementation, there were 19.1 million enrollees. Almost a decade later, enrollment had grown to 22.5 million. Today, 68.8 million Americans have Medicare coverage, with about half enrolled in Advantage plans. The original idea for this insurance program was even bigger. It started as a plan for all Americans, with President Harry Truman endorsing universal coverage in 1945. Today we'll take a look back at how we got there and look ahead to the next 50-60 years. How might the future of medicine be shaped by Medicare policy? I'm Jen Brull, MD, president of the American Academy of Family Physicians. We represent nearly 130,000 family physicians across the country, residents, and medical students. I'm also a senior advisor for clinical strategy and physician well-being at Aledade, where I help physicians in independent primary care succeed in the shift to value-based care. I'm delighted to be joined by three outstanding panelists. Dr Claudia Fegan recently retired as chief medical officer at Cook County Health in Chicago, the third largest public health system in the country, providing care for over 190 years. She is also the national coordinator of Physicians for a National Health Program, which advances a universal health system. Thank you for being with us, Dr Fegan. Dr Jonathan Gruber is joining us from the Massachusetts Institute of Technology in Cambridge, where he chairs the economics department. He previously consulted for the administration of former President Barack Obama in crafting the Affordable Care Act. He was also instrumental in creating Massachusetts 2006 health reform law, which led the state to the lowest uninsured rate in the nation. Dr Norman Ornstein is a retired scholar from the American Enterprise Institute and co-host of the podcast Words Matter . He has written extensively about Medicare, privatization, Part D, and the program's inability to negotiate drug prices. He's also the author of numerous books, including Intensive Care: How Congress Shapes Health Policy . Thank you all for being here today, and let's get started. Five years from now, the last of the baby boomers will turn 65 and 1 in 5 Americans will have Medicare coverage. Dr Fegan, I know that many physicians debate about opting out of taking Medicare and perhaps only seeing patients with other insurance or going the direct primary care route. Paying the Doctor Brull: Can physicians survive without taking Medicare patients? Do you think more physicians will do so in the next decades? Claudia Fegan, MD: I think that the advancement of concierge medicine, where physicians are entering into direct financial agreements with the patients they're seeing, as opposed to using Medicare as a payer, is a trend. However, the majority of physicians in this country today are in an employment arrangement as opposed to being in private practice, which is where the majority of us were, say, 40 years ago. I would say that those large groups, as well as hospitals, cannot survive without Medicare. The majority of people over the age of 65 use Medicare as their insurance. As you pointed out, the majority of Medicare recipients today are now in Medicare Advantage plans, which are private plans. But without Medicare, I don't think it's economically feasible for the majority of physicians to survive. There will always be some who are catering to a group of patients who have the financial wherewithal to afford their care. But that is not the majority of Americans in this country. And more importantly, I would say that the majority of hospitals and large outpatient facilities cannot survive without payments or reimbursements from Medicare. Shaping Care Brull: Dr Gruber, you've done a lot of research on insurance policy design, like the use of copayments and formularies and decreasing utilization of unnecessary care and specific services that patients receive. How has Medicare policy impacted the types of drugs, imaging, and treatments that physicians can prescribe or perform? Jonathan Gruber, PhD: That's a great question. Thanks for having me here. Medicare influences [coverage] a lot through the copayments that they charge. Remember, Medicare, at least 30 years ago, was not actually that great of insurance. Most employer plans had very low copayments and deductibles. Medicare actually had relatively high copayments and deductibles. Today, Medicare looks more like a typical employer-provided health insurance plan in imposing copayments and deductibles on people using services. There is mixed evidence on the implications of that. My general read is that when you impose a copayment or deductible, people use less of all services, both necessary and unnecessary. But there does not look to be enormous evidence that, at least at the level of current Medicare copayments, it significantly impacts their health to be using less of those services. But then there's the long run, which is when Medicare covers services; it changes the shape of innovation in the United States. If Medicare says, "We're covering this surgery," people are going to innovate and create surgeries covered by Medicare. Setting Prices Brull: Medicare has a huge impact on the long-run structure of what is provided by healthcare in the United States, and that's important to consider as well. As a follow-up for anyone on the panel: As technological innovation in medicine advances, how might the program manage patient access and costs? Fegan: I think it's important to use data to make these decisions, and as clinicians, we appreciate — for example — peer-reviewed articles which compare whether something is a useful or beneficial service or not. You know the slogan about when you have a hammer in your hand, everything looks like a nail? When there's a new innovation, there's an inclination to want to use it. But I think the most important way to make these decisions is to do studies where we look at whether there's a real benefit to the innovation. And when clinicians use studies and examine outcomes, they make better decisions than just what happens to be the most exciting or innovative approach. Gruber: I want to strongly endorse that comment.I think we are facing what I call sort of a tsunami of incredibly effective but incredibly expensive new treatments, from GLP-1s for weight loss to new cell and gene therapies. Society is going to have to face a choice of how much we're willing to pay for those. And the only way to make that choice is not to leave it to the free market, because the free market is broken in healthcare. I teach basic economics, and I teach the reasons why the free market might not work. As Kenneth Arrow wrote in 1963, every one of those reasons applies to healthcare. Healthcare is a broken market. The government needs to be involved in setting prices, but the only way it can do so is with evidence on what works and what doesn't. This is what the rest of the world does. Norman Ornstein, PhD: Those are hard questions to ask, and we need to really invest resources in asking them. Let me just add that we don't know what impact artificial intelligence (AI) is going to have on the practice of medicine, at least not entirely. Something like 25 years ago, I went to a series of conferences with healthcare providers and talked about how I expected that within a short period of time — just as we saw with automobiles where you could plug something in and get a complete readout of what the issues were with the car — it wouldn't be long before people would go to a nurse practitioner, put their finger into a little device attached to a computer, and get a readout. And that would make general practitioners almost obsolete, and they would go right to specialists if there were issues. Obviously, that hasn't happened, but AI could be a game changer in terms of both providing great opportunities where physicians might miss things because they're siloed but also where it will change the whole provider community. The Medicare Advantage Paradox Brull: Dr Gruber, in 1997, Congress created Medicare Advantage plans as a way to help curb growing expenditures. About half of all beneficiaries are now enrolled in this type of coverage. We know that Advantage plans are more aggressive in using prior authorization. As these plans grow, what are the implications for patients and physicians in the coming years? Gruber: Economists don't often come to a fairly consistent answer on a question, but there are a lot of studies which I think perhaps surprisingly show that Medicare Advantage saves money. These plans deliver care more and cost-effectively. Medicare Advantage doesn't save federal spending, and I'll come back to that, but it delivers care more cost effectively without actually harming health in a measurable way. I know people are upset about prior authorization and other things, and I'm not saying it doesn't have negative effects on people's mental health and well-being, but the truth is, there are a number of nicely done papers now which show that people in Medicare Advantage plans aren't in immeasurably worse health as a result. So, I think care management can be productive. The problem is, and Norm is the expert on this, that we set up a program which was originally designed to save money and took on a life of its own. Remember: When we set up Medicare Advantage, it paid at first 95% and then 90% of what Medicare paid. It then went up to 132% of what Medicare paid. How can a program save money if it's paying 132% of the alternative? The answer is, because it became a goal that people should have managed care, not that Medicare should save money — and that's the problem. I think Medicare Advantage can be a proper part of a well-functioning system, but we have to fix the reimbursement so we're not overpaying the plans, and this is becoming the major money maker for all insurance companies in America. Who's Overseeing Utilization Management? Fegan: One of the problems with Medicare Advantage is that the insurance companies have learned to game the system and figured out how to get better reimbursement. The other problem with prior authorization is that the Kaiser Family Foundation published a study that showed Medicare Advantage averaged two prior authorizations per enrollee at a time period when traditional Medicare averaged only one prior authorization for every 100 enrollees. While prior authorizations may have an appropriate place, they're designed to decrease utilization and decrease particular services. Patients who have a prior authorization denied, less than 10% of them appeal that denial. But on the other hand, when the denials are appealed, over 80% of the denials are overturned. The prior authorizations use AI. I think what happens with the appeal is that it goes to a physician who thinks this was a reasonable study or care to provide and therefore they're overturned. So prior authorizations may work in terms of decreasing the amount of more expensive care and studies and medications, but it's not clear to me that they meet the standard of care that most physicians would like to give. Brull: You read my mind in terms of our next question. You have written about the practice of Medicare Advantage companies using AI to deny claims. I wonder if we could go into that a little bit more deeply. [Centers for Medicare & Medicaid Services] recently said it's going to experiment with AI for this same use, but for its traditional fee-for-service Medicare members, starting next year. I wonder if you could talk a little bit more about that. Fegan: Traditional Medicare uses prior authorization, but as I pointed out, much less often than Medicare Advantage. As a result, when traditional Medicare denies a prior authorization, it's not overturned on appeal the majority of the time. It would seem that it's been a more appropriate use of the prior authorization. Traditional Medicare continues to use prior authorizations, but in a more judicious manner. I have concerns about the large number of prior authorizations, because for certain populations, that prior authorization is difficult for patients to navigate. Sometimes patients are missing out on things that we would think to be appropriate care. I have concerns about AI. I think there's a place for it, but we have to be careful in terms of the data we put in to arm the AI. And there should always be a backup in which experts who have experience in that particular field can have a say if they disagree with what would be in an algorithm.
CNN
09-07-2025
- Health
- CNN
HHS abruptly calls off meeting of expert panel on preventive care, raising questions about its future
The US Department of Health and Human Services called off an upcoming meeting of expert advisers on preventive health care, raising questions about the future of the longtime, nonpolitical advisory group. An HHS spokesperson confirmed to CNN that the US Preventive Services Task Force — which has set recommendations for cancer screenings, STI testing and other preventive care — will not meet on Thursday as previously scheduled. A notice was sent Monday afternoon saying that the office of HHS Secretary Robert F. Kennedy Jr. is postponing the July meeting, according to a person familiar with the details who declined to be named because they weren't authorized to discuss the meeting publicly. 'Moving forward, HHS looks forward to engaging with the task force to promote the health and well-being of the American people,' the notice continued. But the cancellation also arrives as Kennedy pushes to reshape the health agencies and expunge them of what he has called longtime health-care industry influence on policies. Kennedy last month dismissed a 17-member US Centers for Disease Control and Prevention vaccine advisory committee and two days later named eight new picks to guide the Advisory Committee on Immunization Practices. Several of the new members have questioned vaccine safety; two have testified in court against vaccine manufacturers. 'There is extraordinary concern,' among those connected to the task force, 'that it's about to be dismissed, like ACIP was,' the person familiar with the meeting said. Kennedy's control over the task force was recently solidified by the US Supreme Court. Last month, in a case challenging a popular provision of the Affordable Care Act, the justices upheld the constitutionality of the task force that recommends preventive health care services that insurers must cover at no-cost. Both the Biden and Trump administrations argued that the task force was properly set up — and therefore, its recommendations should be upheld — because the Health and Human Services secretary was able to name and fire its members. The 16-member task force was set up in 1984 and provides recommendations about preventive services, such as screenings for cancer and various disorders and counseling, that help make Americans aware of illnesses and conditions earlier, when they can be easier and less expensive to treat. The Affordable Care Act mandates that those services are provided without charge to patients. While consumer advocates cheered the Supreme Court ruling, they cautioned that it gives Kennedy more power over preventive care recommendations. 'The big takeaway here is that the Task Force's recommendations are binding, just as the ACA's drafters intended,' Nicholas Bagley, a law professor at the University of Michigan, posted on X last month. 'BUT the scheme is constitutional only because Sec Kennedy can exercise near-complete control over Task Force recommendations. A mixed bag!' Thursday's meeting agenda was to include a discussion of recommendations around 'healthy diet, physical activity, and/or weight loss to prevent cardiovascular disease in adults,' focused on 'behavioral counseling interventions,' the person familiar with the meeting said. The panel typically meets in person three times a year, and Thursday's meeting was to be in person. In addition, they typically meet virtually every week. This is a breaking news story and will be updated.
Health Line
01-07-2025
- Health
- Health Line
Will Medicare Pay For a Home Blood Pressure Monitor?
Medicare usually doesn't cover at-home blood pressure monitors, except for home dialysis or when renting an ambulatory monitor once a year under specific doctor recommendations. If your doctor recommends regular blood pressure checks, consider getting a home monitor. The two main types of monitors are a blood pressure cuff, commonly used in doctors' offices, and an ambulatory blood pressure monitor (ABPM), which automatically tracks your blood pressure for 24 hours. That said, Original Medicare (parts A and B) covers at-home monitors only in specific cases. Read on to learn about their Medicare coverage. Who is eligible for a free home blood pressure monitor through Medicare? Depending on the type of monitor, Medicare will only pay for an at-home blood pressure monitor in a few scenarios. Dialysis If you're on renal dialysis at home, accurate and regular blood pressure monitoring is crucial. When you have chronic kidney disease, high blood pressure can decrease your kidneys' ability to filter toxins out of your body. For this reason, it's important to know if your blood pressure is increasing. In this case, Medicare Part B will provide coverage for a manual blood pressure cuff and a stethoscope. White coat syndrome and masked hypertension There's a phenomenon called white coat syndrome, which occurs when a trip to the doctor's office—or just being in a doctor's office—raises one's blood pressure. Medicare Part B will also cover the rental of an ABPM once a year when your blood pressure is measured at 130/80 to 160/100 millimeters of mercury (mm Hg) during at least two visits, but consistently measures below 130/80 mm Hg outside the office. You can also experience masked hypertension, which means your blood pressure is lower in the doctor's office than during daily life. Part B will also pay to rent a monitor when your systolic or diastolic blood pressure is measured between 120 and 129 mm Hg or between 75 and 79 mm Hg on two separate office visits, but your out-of-office blood pressure is consistently measured at 130/80 mm Hg or higher. Other coverage Part B also covers blood pressure checks that take place in your doctor's office as long as your doctor is enrolled in Medicare. Your annual wellness visit should include a blood pressure check, which is covered under Part B as preventive care. If you have a Medicare Part C (Medicare Advantage) plan, your plan should generally cover blood pressure monitors for use at home under the same criteria. This is because Part C plans must provide the same benefits as Original Medicare. Some plans will cover extra benefits, which means they may pay for monitors under additional circumstances as well. If you have Medicare Part A, your benefits will cover any blood pressure monitoring needed while you're an inpatient at a hospital. How can I get a free blood pressure monitor? Medicare doesn't provide a home blood pressure monitor for free. Under Part B, Medicare will pay 80% of the cost of buying or renting either a manual monitor or an ABPM when you qualify for coverage under the approved criteria. You are then responsible for the remaining 20%. That said, you'll need to meet the Part B deductible of $257. You also have to pay a monthly premium, which starts at $185, depending on your income. If you need monitoring while hospitalized, you must meet a $1,676 deductible. Once you do, Part A should cover this. Most people have no premium for Part A. Part C plans are managed by private insurers and have different premiums, deductibles, and coinsurance, depending on your plan. How do I choose an at-home blood pressure monitor? Many people buy blood pressure monitors online, from a local store, or from a pharmacy. The American Heart Association (AHA) recommends using an automatic, cuff-style monitor on your upper arm (around the bicep area) for the most accurate readings. It's a good idea to research the manufacturers of cuffless blood pressure monitors, such as wrist and finger devices, as some brands may not be as reliable. It's important to make sure whichever device you use is properly validated. You can check whether a particular monitor brand is validated at It's also important to measure around your upper arm to ensure the cuff fits properly before making a purchase. It's also advisable to bring your new monitor to your next appointment so your healthcare professional can check its accuracy. Frequently asked questions Do you need a prescription for a blood pressure monitor at home? You can purchase an ordinary cuff monitor from a pharmacy without a prescription. However, to get the cost reimbursed by Medicare, you will need a prescription or a letter from your doctor stating that the monitor is medically necessary. You can purchase an ordinary cuff monitor from a pharmacy without a prescription. However, to get the cost reimbursed by Medicare, you will need a prescription or a letter from your doctor stating that the monitor is medically necessary. Will Medicare pay for an Omron blood pressure monitor? While Medicare does not guarantee coverage for any particular brand of blood pressure monitor, it is more likely to cover validated brands such as Omron. While Medicare does not guarantee coverage for any particular brand of blood pressure monitor, it is more likely to cover validated brands such as Omron. Does Medicaid cover blood pressure monitors? Whether or not you can get a home blood pressure monitor through Medicaid depends on your state. Whether or not you can get a home blood pressure monitor through Medicaid depends on your state. Takeaway Medicare does not pay for at-home blood pressure monitors unless you are undergoing renal dialysis in your home or if your doctor wants you to take your blood pressure somewhere other than a clinical setting. If you are on at-home renal dialysis, Medicare Part B will pay for a manual blood pressure monitor and a stethoscope. If you have white coat syndrome or masked hypertension, Medicare will pay for you to rent an ABPM once a year to monitor your blood pressure over about 24 hours. If you have a Medicare Advantage plan, you'll need to find out whether your plan covers at-home blood pressure monitors. Each plan is different. Taking your blood pressure home is a good idea, especially if you're concerned about hypertension. You can find inexpensive blood pressure cuffs with a wide range of features online or in retail stores.
RNZ News
19-06-2025
- Health
- RNZ News
Private hospitals' use of publicly-funded cancer drugs will widen inequities, warn doctors
Under 'transitional access' private patients won't have to shift to the public system for 12 months. Photo: 123RF A move to allow private patients to access publicly-funded cancer drugs threatens to increase wait times for those in the public system, warn senior doctors. Under "transitional access", which comes into effect on 1 July, private patients who are already receiving treatment - or about to start treatment - with a newly funded medicine will not have to shift to the public system for 12 months. Associate Health Minister David Seymour, who has championed the rule change, said it would lessen stress on private patients by enabling continuity of care, and pressure on the public system which would no longer have to deal with a sudden influx of patients. However, the move has been criticised by opposition politicians as "a subsidy for private insurers", which already cover the cost of medicines newly funded by Pharmac, and of little benefit to patients. The Association of Salaried Medical Specialists, which represents 6500 senior hospital doctors and dentists, said its members working in oncology and haematology had "significant concerns" the change would widen inequities for patients. In a letter on June 13 to Pharmac's acting chief executive Brendan Boyle, the union's director of policy and research, Harriet Wild, quoted a briefing to the minister saying the policy change "would not increase volumes of cancer medicines provided in New Zealand, as only the location of treatments will change". "It will simply shift some of the existing capacity to the private system, where patients will need to fund infusion costs out-of-pocket," Wild wrote. "There will be pressure on the public system to ensure a smooth transition in treatment regime, which may mean delaying treatment for other people already waiting on the public list and unable to self-fund to start in private. "This potentially creates a two-tier waiting list and a system where those with more financial resources, will be prioritised for treatment." Furthermore, the shift of resources and inevitable increase in demand was likely to speed up the exodus of staff to the private sector, making public waiting lists even longer. A "back-pocket Q&A" provided to Seymour ahead of a Cabinet meeting on April 7 noted that the current eligibility criteria in the Pharmaceutical Schedule (excluding patients in private settings) was "designed to ensure public funding for medicines was prioritised for those managed in the public health system for cancer treatment, assessed by need, rather than public funding supporting those who chose to access treatment in private facilities. "Often the private treatment is funded from private health insurance that people have paid premiums into." In the same document, the minister said there was no plan to expand the policy to include other types of medicines or treatments "at this stage". "With that said, I've asked the Ministry [of Health] to do further work in this area to explore the possibility of broadening access to all publicly-funded medicines in private facilities - not just newly funded cancer medicines. "I encourage the private health providers and insurance companies to work closely with the ministry to support their understanding of how this might work in practice." Wild said opening access to publicly-funded drugs even wider would pull more staff away from the public system, reducing access for the majority who relied on it. "That would establish a system where a patient's ability to receive timely cancer care would depend on whether they could afford the out-of-pocket infusion costs." The government's 2024 Budget boost to Pharmac to widen access to medicines for patients had not been accompanied by extra resources for Te Whatu Ora to deliver the treatments, when public oncology services were already swamped with demand, Wild said. "Our members are increasingly needing to manage deteriorating patients, who are unable to access chemotherapy infusions in clinically acceptable timeframes. "This is unacceptable and represents a significant failure to invest in a planned and co-ordinated way to enable the public system to meet the needs of cancer patients, including those eligible for newly funded cancer medicines. "Whenever a new cancer drug is funded, it must be accompanied by an increase in the full package of care (staffing, infusion space, pharmacy) so that patients can actually receive the medicines within clinically acceptable timeframes." The Health Minister and David Seymour's office have been approached for comment. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
