The Week in Review
It was a busy week for health and aging news, analyses, and investigative pieces.
Let’s begin with the formal end of the government’s Pandemic emergency health policies. You may have read about how this long-anticipated event may cause millions of people to lose access to Medicaid. But this is just one among many impacts across health care.
A Fortune piece by Richard Eisenberg looks at Medicare. Broader pieces can be found at USA Today, Reuters, and Modern Healthcare. Researchers at the Kaiser Family Foundation posted a comprehensive list of changes. Separately, Eisenberg also wrote a roundup story about government programs that help people with their Medicare expenses.
Lecanemeb, one of two antidementia drugs seeking government approval, would cost Medicare up to $5 billion a year, according to research from the Journal of the American Medical Association. Reuters covered this news, too. Traditionally, Medicare has covered new drugs approved by the government.
The medication would be administered in outpatient settings, meaning it would be covered by Part B of Medicare and could lead to higher Part B premiums for all Medicare beneficiaries. Original Medicare only pays 80 percent of Part B claims, explaining why many people get a private Medigap supplement plan. People with private Medicare Advantage plans also would face higher costs for the drug, but these plans do provide annual out-of-pocket limits on what people pay for Part B claims.
The New York Times did a roundup that paints a sobering picture of the extent to which private investors have assumed ownership of large parts of the U.S. health care system. Purchases of primary care practices are especially significant, since patients’ primary physicians influence access to most other health care providers and services.
Not all outside investments are successful. Envision Healthcare, whose backers include Kohlberg Kravis Roberts & Co., will file for bankruptcy, The Wall Street Journal reported. The story illustrates the friction between new entrants to health care and existing companies fighting back against perceived threats to their businesses.
The arcane and opaque world of pharmacy benefit managers (PBMs), the oft-maligned middlemen of the drug industry, was the focus of legislative hearings. It’s not clear whether a divided Congress will approve tougher PBM rules. KFF Health News explains the issues.
ProPublica, a nonprofit investigative journalism site, published an article explaining how consumers embroiled in health-insurance claims disputes can get access to detailed records about their claims. The story should be on your must-read list should you ever find yourself in this situation.
Real, perceived, and imagined threats of powerful artificial intelligence tools are everywhere. Four health experts take a look at how AI could affect health care. The Washington Post published a beginner’s guide to AI section that addresses broader issues.
Here are two stories about the implications of longer life spans: Paula Span, who covers aging issues for The New York Times, did a piece on changing views about treatment protocols among older men with prostate cancer. The Stanford Graduate School of Business review how longer life spans are changing viewpoints and behaviors among consumers and the businesses vying for their dollars.
For those whose longer life spans include more time for reading, here’s a series intended mainly for policymakers about the megatrends of health care by Ezekiel J. Emanuel, an influential health expert. It’s published in three parts on Health Affairs. The pieces discuss health system and payment reform, system reconfiguration, and patient care.
Until next week!
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Journalist Philip Moeller has written for newspapers and magazines and is the principal author of Simon & Schuster’s Get What’s Yours series of books about Social Security, Medicare, and health care. He is working on a new edition of his Medicare book.