Larry Levitt
@larry_levitt
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Executive Vice President for Health Policy, @KFF . Cal Bear.
Oakland, CA
Joined June 2009
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A health policy and journalism community is building rapidly over on Threads.
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It looks like Democrats are on their way to giving the government the authority to negotiate the prices of certain drugs in Medicare and enhancing ACA affordability.
This would be the biggest health reform since passage of the ACA itself over 12 years ago.
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Fact check: Mary Lou Retton's pre-existing conditions would not make her ineligible for health insurance or increase her premium. That's been prohibited under Obamacare since 2014.
Mary Lou Retton opens up about why she didn't have health insurance in an exclusive interview with Hoda Kotb.
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I was just looking through an insurance underwriting manual from before the ACA. You know what would have gotten you denied individual insurance? Using hydroxychloroquine in the previous 12 months.
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To be clear, the Affordable Care Act requires insurers to cover pre-existing conditions. President Trump is arguing before the Supreme Court that the ACA be overturned.
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Every time I help a family member or friend enroll in Medicaid, I come away amazed at how many people actually manage to succeed in navigating the application process.
We focus a lot on eligibility for public benefits and not nearly enough on the complexity of accessing them.
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New: 83% of the public supports having the federal government negotiate drug prices, even after hearing arguments for and against the idea.
We didn't poll on baseball, motherhood, and apple pie, but I'm not sure they would score much higher.
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Starting July 1, people who have received any unemployment benefits during 2021 can get no premium health insurance on for the rest of the year. This could be a big source of coverage, if people hear about it.
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After trying for decades, Democrats are finally succeeding at giving the federal government authority to negotiate drug prices.
This is not the sweeping drug pricing measure originally envisioned, but it is the biggest political loss the pharmaceutical industry has suffered.
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Under the ACA people with incomes up to 150% of poverty pay an average deductible of $255. In the Senate hill bill it would be over $6,000.
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New: Suicide death rates vary tremendously by state, and that variation is due largely to suicides by firearms.
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If you've forgotten what a pre-existing condition is, here's a list of conditions that got you rejected in one pre-ACA insurance policy.
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The significance of passing drug price negotiation over the objection of the pharmaceutical industry cannot be overstated. Pharma does not lose often on Capitol Hill.
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The average cost of a hospitalization for COVID-19 could top $20,000 for someone with private insurance, with patient-of-pocket costs of at least $1,300. The economic consequences for patients is a particularly American challenge.
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CBO estimate of the ACA deductible for someone making $26,500 in 2026: $800
Under the BCRA: $13,000, a 1525% increase.
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Today the Biden Administration restored funding cuts to ACA navigators.
It has also:
Reopened ACA enrollment.
Stopped Medicaid work requirements.
Started to reverse the domestic "gag rule" for family planning clinics.
Ended expansion of the public charge rule for immigrants.
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Biden has had a very consequential first term on health care:
More affordable ACA premiums, record enrollment, and the lowest uninsured rate ever.
Government negotiation of drug prices in Medicare for the first time, a cap on drug costs, and a $35 limit on insulin copays.
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The revised Graham-Cassidy bill is in effect federal deregulation of the insurance market.
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This likely won't get much attention nationally given the news of the day, but a Missouri judge has ordered that the voter-approved Medicaid expansion in the state be implemented.
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As bad as the coronavirus stories are out of other countries ahead of us in epidemic, you don’t hear about people not getting treated or getting big medical bills because they’re uninsured. We’re going to be hearing more stories like this here in the U.S.
Teen Who Died of Covid-19 Was Denied Treatment Because He Didn't Have Health Insurance
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Australia has a 0% uninsured rate. Under the ACA the U.S. uninsured rate has dropped to 8.8%. Under the AHCA, it would likely almost double.
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The ACA marketplaces weren't collapsing, but they could be made to collapse through administrative actions.
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Two big health coverage proposals in Biden's emergency relief package:
An increase in ACA subsidies and extension to the middle class by capping premiums at 8.5% of income.
A temporary subsidy of COBRA continuation coverage for people who have lost job-based insurance.
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There is a provision in the Build Back Better Act directly targeted at inflation:
Capping price increases for drugs at inflation in both Medicare and private insurance plans.
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I feel like the pandemic has been one giant math lesson: Denominators, exponents, log scales, rates of growth, lagged indicators, etc.
Kids: Yes, you will use math in the real world. Pay attention in class (even if it's on zoom).
.
@jonathanvswan
: “Oh, you’re doing death as a proportion of cases. I’m talking about death as a proportion of population. That’s where the U.S. is really bad. Much worse than South Korea, Germany, etc.”
@realdonaldtrump
: “You can’t do that.”
Swan: “Why can’t I do that?”
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The Trump administration is now arguing in court that the whole ACA should be thrown out, including pre-existing condition protections. The president’s budget also proposes repeal and replace of the ACA. This sets up a clear contrast for the 2020 general election on health care.
The DOJ’s letter in the affordable care act case in the Fifth Circuit.
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This is not exactly the picture of a collapse.
19 counties in Ohio once thought to be bare have been covered.
Now 19 counties in US (0.1% of enrollees) are at risk
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New: If health care under private insurance were provided using Medicare prices -- for example, through a public option -- spending would drop by 41%. Employers and individuals could save $352 billion.
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In the middle of a raging pandemic, the Supreme Court will hear a case Tuesday to overturn the entire ACA.
President-Elect Biden cannot unilaterally stop this case. But, a simple legislative fix could make it moot.
So, the ACA's fate could rest on two Georgia Senate runoffs.
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I'm not sure I've ever seen a joint statement like this from major physician, hospital, and insurance groups.
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If there was any question about Graham-Cassidy's removal of federal protections for pre-existing conditions, this new draft is quite clear.
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A new White House proclamation requires new immigrants to have health coverage.
While lawful immigrants qualify for ACA subsidies, they'll be stuck in a catch-22 because subsidized coverage does not qualify as insurance under the proclamation.
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Starting today, the Inflation Reduction Act requires pharmaceutical companies to pay penalties to the federal government if they increase prices for Medicare-covered drugs faster than inflation.
Seems like this should be getting more attention.
New HHS report: 1,216 drugs had price increases higher than inflation 2021-2022. And, that was a period of high inflation generally, averaging 8.5%.
Starting next month, drug companies will pay penalties for hiking prices faster than inflation.
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Some health policy trivia: The threat to withhold Medicare funding more than half a century ago forced America's hospitals to end racial segregation.
NEW: The federal government will direct all nursing homes to *require* their staff be vaccinated against Covid-19 in order to continue receiving Medicare and Medicaid funds, Biden administration officials tell CNN.
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3 things we learned about the ACA this year:
1. Medicaid has more support than many imagined.
2. Pre-existing conditions resonate personally and politically.
3. People really do want health insurance.
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A new bill would require insurers to guarantee access for people with pre-existing conditions and prohibit premiums based on health. But, it would allow insurers to exclude any coverage of the pre-existing conditions. A bit of a catch.
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Democratic control of the House, no matter what the margin is, means ACA repeal is dead in its tracks, at least for now.
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A big reason why the public overwhelmingly supports government negotiation of drug prices is that they don't buy the drug industry's arguments against it.
93% of people believe drug companies would still make enough to invest in research, even if prices in the U.S. were lower.
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In a remarkable symbol of how much has changed over the last few years, one item that appears to not be on the list of demands among the holdouts in the vote for Speaker of the House is repeal of the Affordable Care Act.
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As in any health plan, there are winners/losers in the draft GOP bill. Clear losers: Low-income people. Clear winners: High-income people.
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The ACA created an exchange to make buying insurance easier. People can also sign up with brokers or insurers.
Today the Trump administration approved a Georgia waiver to eliminate the exchange. This doesn't give people more options. It just makes getting insurance harder.
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With the COVID relief plan poised for final passage, the first significant enhancement of the Affordable Care Act is about to become law, more than a decade after it was enacted.
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Hard to imagine the Affordable Care Act would exist without Harry Reid, as well as Nancy Pelosi.
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The proposed Build Back Better Act would cap patient cost-sharing for insulin at $35 per month in ALL insurance plans, not just in Medicare.
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It would be hard to find a clearer example than this of the difference between government negotiation of drug prices and the private market.
Pfizer says it will quadruple the per-dose cost of COVID vaccines in a private market.
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For someone with poverty level income of $12,060, insurance with a $6,000 deductible as under the Senate bill isn't really insurance at all.
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This somewhat complicated chart from the body that advises Congress on Medicare (
@medicarepayment
) is quite stunning when you think about it.
It costs the government $83 billion more to provide coverage through private Medicare Advantage plans than in traditional Medicare.
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Under the Senate bill, low-income people would pay higher premiums for bigger deductibles.
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One challenge with addressing gun violence as a public health issue: We haven't been so good at addressing public health lately either.
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We now identify 26 states as COVID-19 hotspots.
Yesterday we counted 20.
Prepare for the U.S. to break all kinds of records on a daily basis.
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These unprecedented statements are becoming not so unprecedented.
Rare joint statement from doctors, hospitals, insurers, the U.S. Chamber of Commerce urging Congress to fund cost-sharing subsidies.
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I see frequent references to the high cost of Medicare-for-all, but that's a misnomer.
Medicare-for-all might not increase the total cost of health care, and could even decrease it.
What Medicare-for-all would do is shift costs from premiums and out-of-pocket expenses to taxes.
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We may have to once again get used to a world in which reports that the president is going to release a health care plan mean a health care plan will actually be released.
Biden slated to release more details on his COVID-19 vaccination plan Thursday per pool report. $PFE $MRNA $BNTX
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In Xavier Becerra, President-Elect Biden has selected a person who has been perhaps the biggest thorn in President Trump's side on the ACA, reproductive health, and immigrant rights. If confirmed, he will have an opportunity to overturn much of what Trump has done.
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Reminder: Before the ACA, pregnancy was considered a pre-existing condition that led to a denial of individual health insurance coverage.
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To be clear, when I said people who have received unemployment benefits can get “no premium” health insurance, I meant “ZERO premium.”
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The Biden Administration announced that 30 states were conducting Medicaid renewals incorrectly, and that nearly 500,000 people will have coverage restored, many of them kids.
It's not often that a government enforcement action has such sweeping effects.
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In addition to a Medicare-like public option, Joe Biden is now proposing to lower the age of eligibility for Medicare to 60. No one will be required give up their private plan, but this could draw more people into publicly-sponsored health coverage.
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When you hear an insurer is covering COVID-19 testing, here are some questions to ask:
What about the cost of the doctor or ER visit?
What about copays and deductibles?
Could there be surprise bills from out-of-network labs?
What about the 61% of workers in self-insured plans?
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The opposition of the American Dental Association to a universal dental benefit in Medicare is reminiscent of the AMA's initial opposition to Medicare itself.
@RepJohnYarmuth
Much of the health industry benefits from the current system, where seniors have to buy private or supplemental plans to get vision/dental/hearing benefits. And they're not taking the potential threat to their bottom line lightly.
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CHIP is now officially expired. Here is when states run out of federal money to cover kids if it's not renewed.
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The House Ways and Means committee has released it's COVID relief plan, with a substantial increase in ACA premium subsidies.
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I think we sometimes get numb to these numbers.
If you're a parent in a family of three in Texas and make more than $3,733 PER YEAR, you make too much to be eligible for Medicaid.
If you're an adult without kids in Texas who isn't elderly or disabled, you're ineligible, period.
In most states that have not implemented the ACA
#MedicaidExpansion
, eligibility for parents & other adults remains extremely low.
It ranges from 17% of the federal poverty level ($3,733 for a family of three) in Texas to 100% FPL ($21,960) in Wisconsin.
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@sarahkliff
Here's what happened to women's out-of-pocket costs for contraceptives after the ACA requirement went into effect.
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Low-income uninsured people in much of the country can get an ACA health insurance plan for free. They really need to know this.
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The president’s executive order suggests that the prices paid by Medicare should more closely match those paid by private insurers. That would increase the cost of Medicare enormously, since private insurers pay much higher prices than Medicare.
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The Trump administration is arguing in court that the ACA's protections for people with pre-existing conditions should be thrown out.
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If candidates say they support pre-existing condition protections, here are questions to ask:
Do insurers have to take everyone?
Can sick people be charged more?
Can coverage of pre-existing conditions by excluded?
Can benefits be limited?
Are annual or lifetime limits allowed?
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CBO on repealing the individual mandate ("skinny repeal"): 20% premium spike and 15 million uninsured increase.
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The American Dental Association is opposing a universal dental benefit in Medicare, which sounds a lot like when the American Medical Association originally opposed creating Medicare itself.
@bykowicz
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Cutting ACA outreach will result in fewer people insured, and those who fail to sign up will be the healthiest. That will push premiums up.
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The Trump administration just filed a brief with the Supreme Court calling for the ACA to be overturned. The president has not proposed a replacement plan. Trying to repeal the ACA, along with the response to COVID-19, will define President Trump on health care in the election.
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North Carolina will be the largest state to implement Medicaid expansion under the Affordable Care Act since Pennsylvania in 2015.
Finally expanding Medicaid in North Carolina is a monumental achievement that will give health care access to more than 600,000 people who need it. Today, Gov. Cooper and
@NCDHHS
Sec. Kinsley announced that Medicaid Expansion will launch on Dec. 1, 2023 in North Carolina.
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27% of non-elderly adults have pre-existing conditions. Arguing in court that protections for them should be eliminated, as the Trump administration is now doing, could provoke a backlash in an election year.
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If you want to protect people with pre-existing conditions in a private insurance system, you need to do all of these things:
1. No denial based on health.
2. Community rating.
3. Benefit requirements.
4. No pre-existing condition exclusions.
5. No annual or lifetime limits.
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So much of the debate over the Build Back Better package has been on new spending and the overall price tag.
The provision that could prove to be among the most popular -- negotiation of drug prices -- saves money for both the government and patients.
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The enhanced ACA premium assistance will still be a ticking time bomb, expiring at the end of 2025. But, a big premium shock for next year will be averted.
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President Biden has called for regulations requiring larger employers to ensure that workers are vaccinated OR get tested weekly.
Whether you support or oppose this idea, it is not a vaccine mandate.
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The new House Republican Study Committee budget plan would:
Convert Medicaid to a block grant and cut funding by $4.5 trillion over a decade.
Eliminate the ACA's prohibition on premium surcharges for pre-existing conditions.
Repeal government negotiation of drug prices.
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My final thought for the night: The insurance market under the ACA has been stabilizing, not failing.
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I know I'm repeating myself, but apparently it's necessary.
President Trump supports a lawsuit to overturn the ACA, including pre-existing condition protections. He hasn't released a replacement plan.
He also expanded short-term plans that do not cover pre-existing conditions.
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Missouri is not implementing the Medicaid expansion approved by voters because the legislature has not provided the $130 million in funding for next year.
Under the American Rescue Plan, Missouri would receive $1.1 billion in extra federal funds over two years if it expands.
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I think I’ve said this a gazillion times.
Alexander-Murray would do nothing to offset premium increases from individual mandate repeal.
Collins-Nelson reinsurance would mostly blunt premium increases, if it passes.
Neither bill would offset any increase in the uninsured.
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A 280 character PSA:
ACA open enrollment ends December 15 in most states.
All of the law's benefits are still in place.
The individual mandate penalty remains in effect.
Many low-income uninsured people can get insured for $0.
Make sure to compare premiums and plans carefully.
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There are a lot of important health care provisions in the end-of-year spending bill.
One big thing not in it: Funding to buy COVID vaccines, treatments, and tests.
The commercialization of our COVID response is coming, and people who are uninsured will be most vulnerable.
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Shoutout to exhausted government officials, public health workers, epidemiologists, health care workers, first responders, and journalists everywhere.
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As more employers require COVID-19 vaccination, they might also consider offering paid time off for workers to get vaccinated and recover from any side effects.
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Biggest loser under "skinny" repeal: middle class people who buy their own insurance without subsidies and would see big premium hikes.
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If you want to protect people with pre-existing condition, you need to ensure:
1. No denial based on health.
2. Community rating.
3. Benefit requirements.
4. No pre-existing condition exclusions.
5. No annual or lifetime limits.
6. Subsidies to encourage healthy people enroll.
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Is the finale of
#MareOfEasttown
going to reveal why DJ wasn't on Medicaid or CHIP, making it necessary to scrape together money for his ear surgery?
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There is nothing in Joe Biden’s plan that would terminate private insurance.
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There's a big emphasis on mental health in President Biden's budget, including a plan to ensure that networks of behavioral health providers in private insurance are adequate.
Inadequate provider networks have long meant that mental health parity is more a theory than a reality.
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There’s so much confusion about the ACA’s cost-sharing reduction (CSR) payments. Let me try to clear some things up in a thread.
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Breaking: Obamacare prohibits insurance companies from denying coverage for people with pre-existing conditions. And, it subsidizes premiums based on income.
@Julie_appleby
@KFFHealthNews
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A Medicare for all plan could be designed so that many people, including those who are middle class, pay less in taxes than they are paying now in premiums, deductibles, and copays. It depends entirely on the details.
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The American Rescue Plan temporarily subsidizes 100% of COBRA premiums for laid off workers.
COBRA is expensive because private insurance is expensive.
Private insurance is expensive because health care prices are high -- higher than Medicare and higher than in other countries.
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It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively.
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And then there was one...
Wisconsin's insurance department has confirmed all counties will be covered, leaving just Paulding, Ohio as bare.
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As
@EricTopol
discusses here, we have really confused people about what fully-vaccinated means. Especially for people who are older and at greater risk, a recent booster isn't a nice add-on, it's key for adequate protection from severe COVID-19 illness.
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In addition to all kinds of health conditions and medications, certain occupations also got people routinely denied individual insurance before the Affordable Care Act.
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