If you want to understand the problem of "waste, fraud, and abuse" in federal health programs, you should read this great piece by @sarahkliff and @katie_thomas on scammy skin substitute comanies. @sarahkliff @katie_thomas As they report, the companies that make these skin substitutes--a fancy kind of bandage--have exploited loopholes in Medicare's pricing policies to charge high prices. Then they offer financial incentives to doctors to overuse them on patients. nytimes.com/2025/04/10/hea…

The Harris campaign is out today with a paper warning about what would happen if Trump repeals Obamacare. kamalaharris.com/wp-content/upl… Also, today, I published a story about what would happen to subsidies for about $20 million people if the next president and Congress simply do nothing. nytimes.com/2024/09/30/ups…

Medicare slowth: still going. One of the great (fortunate) mysteries of our time. @aliciaparlap @jshkatznytimes.com/interactive/20… @aliciaparlap @jshkatz First of all, credit to @ddiamond for coining the term "slowth," to mean slow growth.

When I was reporting on this story about the fiscal impacts of the GOP debt ceiling bill, I stumbled upon a provision that was getting very little attention but would be hugely consequential. nytimes.com/interactive/20… The provision is called the REINS Act, and is designed to get Congress more engaged in the details of how laws they pass get implemented--by forcing Congress to vote every major regulation up or down. nytimes.com/2023/05/12/ups…

Be sure to read @atmccann on the growing abortion pill underground, full of incredible details and never-before-collected data. nytimes.com/interactive/20… This channel has provided 50,000 pill packs to women since the Dobbs decision.

A technical Medicare Advantage model change, buried deep in the annual rate notice, has unleashed a lobbying frenzy. nytimes.com/2023/03/22/hea… @ReedAbelson There is tons of evidence that insurers in the program have been manipulating a program that pays them extra fees for enrolling customers with more illnesses. The change took away payments for some of diagnoses that are gamed the most.

Republicans in the House have been talking about balancing the budget. Since budget season kicks off this week, @aliciaparlap @jshkatz and I took a look at what that would take. nytimes.com/interactive/20… First of all, balancing the budget in a decade would be hard. It would involve reducing spending and/or raising revenue by $16 trillion. That's around a quarter of federal spending.

Last year, @ReedAbelson and I wrote about widespread fraud and overbilling in the Medicare Advantage program. The fraud we wrote about was in a system called "risk adjustment." nytimes.com/2022/10/08/ups… @ReedAbelson Medicare pays the private plans for every beneficiary they enroll. But it pays more to the plans for patients who are sicker. This makes sense, since their medical care is likely to be more expensive.

Private Medicare Advantage plans are on track to become the majority of Medicare next year. Nearly every big player in the industry has been accused of fraud. nytimes.com/2022/10/08/ups… w/the great @ReedAbelson We read the lawsuits so you don't have to--dozens of lawsuits, audits, reports and academic papers. Taken together, there is a lot of evidence of this widespread problem. nytimes.com/2022/10/08/ups…

New survey data from @CDCgov show the uninsured rate fell through the third quarter of last year in every income category. cdc.gov/nchs/data/nhis… @CDCgov I've been reporting a lot lately on record ACA marketplace enrollment. We also know Medicaid numbers are way up. But it now seems that the public programs are not just catching people losing other coverage--they are also pulling in the uninsured.

CMS reports that Obamacare enrollment for 2022 has reached 14.2m with a few days still to go. This number is substantially higher than in any previous year. Comparisons are a little tough to make, due to differences in dates, etc. but this is well over 2m more people than any previous year.

Democrats are getting closer on a deal on prescription drugs. Here's my story with @ESCochrane @jonathanweisman A few nerdy details to follow. nytimes.com/2021/11/01/us/… @ESCochrane @jonathanweisman The goal was always a three-part approach:
1) Lower out-of-pocket spending in Medicare
2) Limits on price increases
3) Direct price regulation for some expensive drugs
This story lays out how each might affect people taking really expensive cancer drugs.
nytimes.com/2021/10/27/ups…

Since Texas enacted the most strict abortion restrictions in the nation, the number of abortions there has fallen by half. NEW data here: nytimes.com/interactive/20… @clairecm @qdbui @clairecm @qdbui The goal of SB8 was to reduce the number of abortions in the state. These numbers are good news for its backers. nytimes.com/interactive/20…

If you’re a Medicare beneficiary taking expensive drugs, the prices themselves affect you—but so does Medicare’s benefit design. The combination means that some cancer patients are paying $15,000 a year for their drugs. nytimes.com/2021/10/27/ups… Everything is still being negotiated. But Democrats are looking to do three big things on drugs:
1) regulate prices for certain costly drugs 2) limit annual price increases 3) change the plans so there’s a limit on what patients are asked to pay directly nytimes.com/2021/10/27/ups…

The math problem Democrats face. nytimes.com/interactive/20… @aliciaparlap CBO still hasn't scored several key sections of the House social spending bill. But (with help from @DonFSchneider) we've compiled a complete set of estimates for the various parts of the package. nytimes.com/interactive/20…

The mouth is part of the body. But dentistry has been kept separate from the rest of medicine, and is almost always left out of health insurance. Congress is looking to start changing that--by adding a dental benefit to Medicare for the first time. nytimes.com/2021/08/29/ups… Tens of millions of Medicare beneficiaries are unable to get needed dental care. About half didn't go to a dentist at all in the last year. Nearly 1 in five have already lost all their teeth. nytimes.com/2021/08/29/ups…

Drug overdose deaths rose by nearly a third last year, setting several grim records. nytimes.com/interactive/20… @jshkatz @jshkatz This number is so big that it’s hard to fit the chart on a single screen. nytimes.com/interactive/20…

This creative study examining birthdays in health insurance claims shows how Covid was spreading a lot in small private gatherings last year. nytimes.com/2021/07/05/ups… This research was done last year. Things are obviously different now. There is less Covid. Many of you are vaccinated. The point of this paper (and my article) is not to rain on birthday parties.

Aduhelm, the controversial Alzheimer’s treatment recently approved by the FDA, could cost the federal government as much as it spends on NASA. nytimes.com/2021/06/22/ups… @jshkatz @sarahkliff @jshkatz @sarahkliff Here are two analyst estimates of Medicare spending on the new Alzheimer’s drug compared to spending on all existing Part B drugs. nytimes.com/2021/06/22/ups…

Nearly a year ago, @clairecm @qdbui and I asked a group of epidemiologists when they thought it would be safe to hug again. Depressingly, many said more than a year—and some said never again. nytimes.com/interactive/20… Since then, we have all learned that epidemiologists are a cautious group. But we have a new survey out today, and many of them say they are hugging again. nytimes.com/2021/05/12/ups…

Healthcare.gov has been updated. If you you are uninsured—or already have an Obamacare plan, or buy your own insurance elsewhere—you can now see new discounts brought by the stimulus bill. nytimes.com/2021/04/01/ups… @sarahkliff This piece can give you a sense of the discounts involved--and the sticker prices. Millions of Americans can now get a free plan with a low deductible. Millions more can get new subsidies that never existed for them before. nytimes.com/2021/03/10/ups… @KevinQ