Podcast appearances and mentions of sarah kliff

As House Republicans prepare to begin voting on their big policy blueprint this week, one of the programs they're targeting for major cuts is Medicaid. The federal healthcare program covers around 80 million Americans, mostly people living near or below the poverty line. While President Donald Trump has endorsed the House's budget plan, he has also said that Medicaid is 'not going to be touched.' Sarah Kliff, investigative health care reporter for The New York Times, explains what the proposed Medicaid cuts would mean for actual people.And in headlines: Trump had an awkward meeting with French President Emmanuel Macron over Ukraine, Trump officials continued to sow confusion over an email demanding federal workers justify their jobs, and the president picked right-wing podcaster Dan Bongino as the next FBI deputy director.Show Notes:Check out Sarah's work – https://www.nytimes.com/by/sarah-kliffSubscribe to the What A Day Newsletter – https://tinyurl.com/3kk4nyz8Support victims of the fire – votesaveamerica.com/reliefWhat A Day – YouTube – https://www.youtube.com/@whatadaypodcastFollow us on Instagram – https://www.instagram.com/crookedmedia/For a transcript of this episode, please visit crooked.com/whataday

In this episode, Dr. Rebecca Dekker and investigative journalist Sarah Kliff of The New York Times explore the intricate world of cord blood banking. Sarah shares insights from her article, "Promised Cures, Tainted Cells," which explored cord blood banking practices, their marketing claims, and the stark contrast between public and private banking systems.   Together, they discuss: The differences between public and private cord blood banks Marketing tactics and their impact on parents The decline in the medical utility of cord blood over the last decade Ethical concerns, such as contamination, low stem cell counts, and hidden collection fees Sarah also shares the stories of families who invested in private banking, only to find their samples unusable when needed. This episode sheds light on the decisions surrounding cord blood banking and provides a look at the system's pitfalls.   Join us at the EBB Conference (virtually) this March by registering here! You can also see if the EBB Pocket Guide to Newborn Procedures is in stock here.    (00:05:56) Paid vs. Donated Cord Blood Storage (00:08:06) Stem Cell Storage for Future Medical Use (00:09:32) "Cord Blood Marketing: Promises and Concerns" (00:21:44) Rising Financial Burden of Cord Blood Storage (00:25:46) Unregulated Growth in Private Cord Blood Banking (00:26:14) Quality Control Concerns in Private Cord Blood Banking (00:34:48) Cord Blood Banking Implications in Delayed Clamping (00:41:52) Unregulated Risks of Cord Blood Storage   Resources: Read "Promised Cures, Tainted Cells" here Check out the American Academy of Pediatrics recommendations on cord blood banking here For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

The murder of UnitedHealthcare's CEO exposed widespread public anger over insurance claim denials and the overall state of medical care in the U.S. And it's not just social media venting: a recent Gallup survey reveals that “Americans' positive rating of the quality of healthcare in the U.S. is now at its lowest point” since 2001. We'll talk with New York Times investigative health care reporter Sarah Kliff about why patients are fed up and what they can do to protect themselves and best navigate a broken system. Guests: Sarah Kliff, investigative healthcare reporter, The New York Times

Cesarean sections to deliver babies are among the most common surgical procedures in U.S. hospitals. A new study from the National Bureau of Economic Research found that Black women are almost 25 percent more likely than white women to have unnecessary C-sections, putting them at risk of surgical complications. John Yang speaks with New York Times investigative reporter Sarah Kliff to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders

Cesarean sections to deliver babies are among the most common surgical procedures in U.S. hospitals. A new study from the National Bureau of Economic Research found that Black women are almost 25 percent more likely than white women to have unnecessary C-sections, putting them at risk of surgical complications. John Yang speaks with New York Times investigative reporter Sarah Kliff to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders

After an assassination attempt last weekend sent former President Donald Trump to the hospital with minor injuries, the Republican National Convention went off with little mention of health care issues. And Trump's newly nominated vice presidential pick, Sen. J.D. Vance of Ohio, has barely staked out a record on health during his 18 months in office — aside from being strongly opposed to abortion. Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News' Julie Rovner to discuss these stories and more. Also this week, Rovner interviews KFF Health News' Renuka Rayasam, who wrote June's installment of KFF Health News-NPR “Bill of the Month,” about a patient who walked into what he thought was an urgent care center and walked out with an emergency room bill. Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too: Julie Rovner: Time magazine's “‘We're Living in a Nightmare:' Inside the Health Crisis of a Texas Bitcoin Town,” by Andrew R Chow.Joanne Kenen: The Washington Post's “A Mom Struggles To Feed Her Kids After GOP States Reject Federal Funds,” by Annie Gowen.Alice Miranda Ollstein: ProPublica's “Texas Sends Millions to Crisis Pregnancy Centers. It's Meant To Help Needy Families, But No One Knows if It Works,” by Cassandra Jaramillo, Jeremy Kohler, and Sophie Chou, ProPublica, and Jessica Kegu, CBS News.Sarah Karlin-Smith: The New York Times' “Promised Cures, Tainted Cells: How Cord Blood Banks Mislead Patients,” by Sarah Kliff and Azeen Ghorayshi. Hosted on Acast. See acast.com/privacy for more information.

Brad examines a New York Times article by investigative reporter Sarah Kliff about a recent study of patients whose debt was eliminated by RIP Medical Debt. Researchers say the results surprised them.   Also in this episode: The cover story in the May issue of hfm magazine focuses on a South Dakota health system that developed a new process to identify charity care patients. HFMA Policy Director Shawn Stack discusses why good financial assistance policies and process are essential to patient care. Sources: Paying off people's medical debt has little impact on their lives, study finds Medical debt relief: How helpful? The inconvenient truth about medical debt relief

A New York Times investigation finds Manhattan's Bellevue Hospital rushes patients into bariatric surgery, performing a record 3,000 weight-loss surgeries per year. Newsline with Brigitte Quinn spoke with NYT Investigative reporter Sarah Kliff, who broke the story.

It's Obamacare open enrollment season, which means that, for people who rely on these plans for coverage, it's time to shop around. With enhanced premium subsidies and cost-sharing assistance, consumers may find savings by switching plans. It is especially important for people who lost their coverage because of the Medicaid unwinding to investigate their options. Many qualify for assistance. Meanwhile, the countdown to Election Day is on, and Ohio's State Issue 1 is grabbing headlines. The closely watched ballot initiative has become a testing ground for abortion-related messaging, which has been rife with misinformation. This week's panelists are Mary Agnes Carey of KFF Health News, Jessie Hellmann of CQ Roll Call, Joanne Kenen of Johns Hopkins Bloomberg School of Public Health and Politico, and Rachana Pradhan of KFF Health News. Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too: Mary Agnes Carey: Stat News' “The Health Care Issue Democrats Can't Solve: Hospital Reform,” by Rachel Cohrs. Jessie Hellmann: The Washington Post's “Drugstore Closures Are Leaving Millions Without Easy Access to a Pharmacy,” by Aaron Gregg and Jaclyn Peiser. Joanne Kenen: The Washington Post's “Older Americans Are Dominating Like Never Before, but What Comes Next?” by Marc Fisher. Rachana Pradhan: The New York Times' “How a Lucrative Surgery Took Off Online and Disfigured Patients,” by Sarah Kliff and Katie Thomas. Hosted on Acast. See acast.com/privacy for more information.

The bipartisan deal to extend the U.S. government's borrowing authority includes future cuts to federal health agencies, but they are smaller than many expected and do not touch Medicare and Medicaid. Meanwhile, Merck & Co. becomes the first drugmaker to sue Medicare officials over the federal health insurance program's new authority to negotiate drug prices. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Lauren Weber of The Washington Post, and Jessie Hellmann of CQ Roll Call join KFF Health News' chief Washington correspondent, Julie Rovner, to discuss these issues and more. Also this week, Rovner interviews KFF Health News senior correspondent Sarah Jane Tribble, who reported the latest KFF Health News-NPR “Bill of the Month” feature, about the perils of visiting the U.S. with European health insurance. Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too:Julie Rovner: The New York Times' “This Nonprofit Health System Cuts Off Patients With Medical Debt,” by Sarah Kliff and Jessica Silver-Greenberg. Jessie Hellmann: MLive's “During the Darkest Days of COVID, Some Michigan Hospitals Made 100s of Millions,” by Matthew Miller and Danielle Salisbury.Joanne Kenen: Politico Magazine's “Can Hospitals Turn Into Climate Change Fighting Machines?” by Joanne Kenen. Lauren Weber: The Washington Post's “Smoke Brings a Warning: There's No Escaping Climate's Threat to Health,” by Dan Diamond, Joshua Partlow, Brady Dennis, and Emmanuel Felton. Hosted on Acast. See acast.com/privacy for more information.

In this episode, Dr. Camille Clare, the Chair of the Department of Obstetrics and Gynecology at SUNY Downstate College of Medicine, joins Drs. Mark Hoffman and Amy Park to discuss social determinants of health in the field of OB/GYN. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/WSaAqq --- SHOW NOTES Dr. Clare identifies social determinants of health as factors that prevent patients from accessing healthcare multiple times. She describes examples as housing (e.g., safe environments to live and raise families, school district locations), access to transportation, and occupation. The physicians discuss the impact of social determinants of health in the field of OB/GYN, involving how certain conditions (i.e., rates of preterm birth, infertility, and cancer) present. The group also acknowledges the concept of “political determinants of health,” which involves policies that lead to certain health outcomes, such as redlining and how it has contributed to food insecurity and many other negative effects. The physicians also discuss how groups are addressing the downstream effects of health inequities. Dr. Clare is personally involved in lobbying and encourages those around her to advocate at the local, state, and federal levels to improve policy. In addition, Dr. Clare utilizes social media as a way to promote health equity and empower students/trainees to make positive impacts on their communities. The episode ends with Dr. Clare expressing current improvements among the medical community when it comes to addressing social determinants of health and health inequities. Ultimately, Dr. Clare is grateful that the medical community is now more open to discuss difficult conversations that focus on improving patient care. She has also appreciated the active effort to make the medical school recruitment process more inclusive in order to diversify the future physician workforce. --- RESOURCES Dr. Camille A Clare: @cclareMDMPH (https://twitter.com/cclareMDMPH) Claire Cain Miller, Sarah Kliff, Larry Buchanan. “Childbirth Is Deadlier for Black Families Even When They're Rich, Expansive Study Finds” The New York Times. https://www.nytimes.com/interactive/2023/02/12/upshot/child-maternal-mortality-rich-poor.html

This week, Lindsay Langholz speaks with Jessica Mason Pieklo from Rewire News Group to pull the curtain back on the anti-abortion movement. They discuss the pending lawsuit in federal district court that could result in abortion pills being banned, the concerted effort to target hormonal birth control, and much more. Join the Progressive Legal Movement Today: ACSLaw.org Today's Host: Lindsay Langholz, Senior Director for Policy and Program Guest: Jessica Mason Pieklo, Senior Vice President and Executive Editor, Rewire News Group Link: "Biden administration braces for ruling that could ban abortion pills,"  by Alice Miranda Ollstein and Adam Cancryn Link: "Is the Right to Birth Control Next on the Chopping Block?" by Thalia Charles, Rewire News Group Link: "‘Crisis Pregnancy Centers' Are Deceptive. Why Aren't There More Alternatives?" by Garnet Henderson Link: "Childbirth Is Deadlier for Black Families Even When They're Rich, Expansive Study Finds," by Claire Cain Miller, Sarah Kliff, and Larry Buchanan Visit the Podcast Website: Broken Law Podcast Email the Show: Podcast@ACSLaw.org Follow ACS on Social Media: Facebook | Instagram | Twitter | LinkedIn | YouTube ----------------- Production House: Flint Stone Media Copyright of American Constitution Society 2023.

A new survey from the Centers for Disease Control and Prevention finds that teenagers, particularly girls, are reporting all-time high rates of violence and profound mental distress. Meanwhile, both sides in the abortion debate are anxiously waiting for a district court decision in Texas that could effectively revoke the FDA's 22-year-old approval of the abortion pill mifepristone. Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico join KHN's chief Washington correspondent, Julie Rovner, to discuss these issues and more. Click here for a transcript of the episode.Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:Julie Rovner: NPR's “Is the Deadly Fungi Pandemic in ‘The Last of Us' Actually Possible?” by Michaeleen Doucleff. Alice Ollstein: The New York Times' “Childbirth Is Deadlier for Black Families Even When They're Rich, Expansive Study Finds,” by Claire Cain Miller, Sarah Kliff, and Larry Buchanan. Interactive produced by Larry Buchanan and Shannon Lin. Joanne Kenen: NPR's “In Tennessee, a Medicaid Mix-Up Could Land You on a ‘Most Wanted' List,” by Blake Farmer. Sandhya Raman: Bloomberg Businessweek's “Zantac's Maker Kept Quiet About Cancer Risks for 40 Years,” by Anna Edney, Susan Berfield, and Jef Feeley. Hosted on Acast. See acast.com/privacy for more information.

The year-end spending bill passed by Congress in late December contains a wide array of health-related provisions, including a structure for states to begin to disenroll people on Medicaid whose coverage has been maintained through the pandemic. Meanwhile, the Biden administration is taking steps to make the abortion pill more widely available. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Rachel Cohrs of Stat, and Rachel Roubein of The Washington Post join KHN's chief Washington correspondent Julie Rovner to discuss these topics and more. Also this week, Rovner interviews Mark Kreidler, who reported and wrote the latest KHN-NPR “Bill of the Month” feature about a billing mix-up that took about a year to sort out.Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:Julie Rovner: The New York Times' “The F.D.A. Now Says It Plainly: Morning-After Pills Are Not Abortion Pills,” by Pam BelluckJoanne Kenen: Politico Magazine's “Racist Doctors and Organ Thieves: Why So Many Black People Distrust the Health Care System,” by Joanne Kenen and Elaine BatchlorRachel Cohrs: The New York Times' “‘Major Trustee, Please Prioritize': How NYU's E.R. Favors the Rich,” by Sarah Kliff and Jessica Silver-GreenbergRachel Roubien: KHN's “Hundreds of Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds. Does Yours?” by Noam N. LeveyClick here for a transcript of the episode. Hosted on Acast. See acast.com/privacy for more information.

As many as two million Irish people relocated to North America during the Great Hunger in the mid-19th Century. Even after the famine had ended, Irish families continued to send their teenaged and 20-something children to the United States to earn money to mail back to Ireland. In many immigrant groups, it was single men who immigrated to the US in search of work, but single Irish women, especially young women, came to the US in huge numbers. Between 1851 and 1910 the ratio of men to women arriving in New York from Ireland was roughly equal. Irish women often took jobs in domestic service, drawn by the provided housing, food, and clothing, which allowed them to send the bulk of their earnings back home to Ireland.   Joining me to discuss Irish immigrant women in the late 19th Century is Irish poet Vona Groarke, author of Hereafter: The Telling Life of Ellen O'Hara. Our theme song is Frogs Legs Rag, composed by James Scott and performed by Kevin MacLeod, licensed under Creative Commons. The transitional audio is “My Irish maid,” composed by Max Hoffmann and performed by Billy Murray; Inclusion of the recording in the National Jukebox, courtesy of Sony Music Entertainment. The episode image is: “New York City, Irish depositors of the Emigrant Savings Bank withdrawing money to send to their suffering relatives in the old country,” Illustration  in: Frank Leslie's illustrated newspaper, v. 50, no. 1275 (March 13, 1880), p. 29; courtesy of the Library of Congress Prints and Photographs Division; no known restrictions on publication. Additional Sources: “Immigration and Relocation in U.S. History: Irish,” Library of Congress. “The Great Hunger: What was the Irish potato famine? How was Queen Victoria involved, how many people died and when did it happen?” by Neal Baker, The Sun, August 25, 2017. “The Potato Famine and Irish Immigration to America,” Constitutional Rights Foundation, Winter 2020 (Volume 26, No. 2).   “Immigrant Irishwomen and maternity services in New York and Boston, 1860–1911,” by Ciara Breathnach, Med Hist. 2022 Jan;66(1):3–23. “‘Bridgets': Irish Domestic Servants in New York,” by Rikki Schlott-Gibeaux, New York Genealogical & Biographical Society, September 25, 2020. “The Irish Girl and the American Letter: Irish immigrants in 19th Century America,” by Martin Ford, The Irish Story, November 17, 2018. “Who's Your Granny: The Story of Irish Bridget,” by Lori Lander Murphy, Irish Philadelphia, June 26, 2020. “The Irish-American population is seven times larger than Ireland,” by Sarah Kliff, The Washington Post, March 17, 2013. “Irish Free State declared,” History.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

Is it possible for a health care company to make enough people mad about their billing practices that it hurts their business? For one genetic testing company, maybe so. An Arm and a Leg listener Jessica got a test that's become routine in early pregnancy: non-invasive prenatal testing. It was supposed to be $99. But then — after she took the test — that turned into $250. And when she asked questions, she was told it could go up to $800 if she didn't pay up quick. , Jessica looked up the testing company, and found out that lots of people experienced what she called “the genetic testing bait-and-switch.”And she's not the only one who noticed.When some guys on Wall Street, plus New York Times reporter Sarah Kliff, started hearing about those bills, the company found itself in some hot water. Here's a transcript of the episode. Bonus reading:Sarah Kliff and Aatish Bhatia's reporting on non-invasive prenatal testingA scorching report on Natera from Hindenburg ResearchAndrew Rice's story on Hindenburg Research: "The Last Sane Man on Wall Street" Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we'd love for you to support this show. See acast.com/privacy for privacy and opt-out information.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: The accidental experiment that saved 700 lives (IRS & health insurance), published by Lizka on April 19, 2022 on The Effective Altruism Forum. From Lizka: I really enjoy the blog, "Statistical Modeling, Causal Inference, and Social Science." Andrew Gelman, one of the authors of the blog, has given me permission to cross-post this post, which I thought some Forum readers might find interesting. As an aside, I like many other posts on the blog. Two examples are "Parables vs. stories" and "The social sciences are useless. So why do we study them? Here's a good reason:." Paul Alper sends along this news article by Sarah Kliff, who writes: Three years ago, 3.9 million Americans received a plain-looking envelope from the Internal Revenue Service. Inside was a letter stating that they had recently paid a fine for not carrying health insurance and suggesting possible ways to enroll in coverage. . . . Three Treasury Department economists [Jacob Goldin, Ithai Lurie, and Janet McCubbin] have published a working paper finding that these notices increased health insurance sign-ups. Obtaining insurance, they say, reduced premature deaths by an amount that exceeded any of their expectations. Americans between 45 and 64 benefited the most: For every 1,648 who received a letter, one fewer death occurred than among those who hadn't received a letter. . . . The experiment, made possible by an accident of budgeting, is the first rigorous experiment to find that health coverage leads to fewer deaths, a claim that politicians and economists have fiercely debated in recent years as they assess the effects of the Affordable Care Act's coverage expansion. The results also provide belated vindication for the much-despised individual mandate that was part of Obamacare until December 2017, when Congress did away with the fine for people who don't carry health insurance. “There has been a lot of skepticism, especially in economics, that health insurance has a mortality impact,” said Sarah Miller, an assistant professor at the University of Michigan who researches the topic and was not involved with the Treasury research. “It's really important that this is a randomized controlled trial. It's a really high standard of evidence that you can't just dismiss.” This graph shows how the treatment increased health care coverage during the months after it was applied: And here's the estimated effect on mortality: They should really label the lines directly. Sometimes it seems that economists think that making a graph easier to read is a form of cheating! I'd also like to see some multilevel modeling—as it is, they end up with lots of noisy estimates, lots of wide confidence intervals, and I think more could be done. But that's fine. It's best that the authors did what they did, which was to present their results. Now that the data are out there, other researchers can go back in and do more sophisticated analysis. That's how research should go. It would not make sense for such important results to be held under wraps, waiting for some ideal statistical analysis that might never happens. Overall, this is an inspiring story of what can be learned from a natural experiment. The news article also has this sad conclusion: At the end of 2017, Congress passed legislation eliminating the health law's fines for not carrying health insurance, a change that probably guarantees that the I.R.S. letters will remain a one-time experiment. But now that they have evidence that the letters had a positive effect, maybe they'll restart the program, no? Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org.

COVID testing—the kind they send to a lab— is supposed to be free in the U.S. But it's never been quite that simple. We're revisiting our sadly-still-relevant interview with Sarah Kliff from the New York Times, who joined us in November 2020 to share what she learned from reading hundreds of COVID testing bills. Her advice? Avoid the ER, do some research ahead of time, and ask if they're going to do any other tests (which may not be covered 100%). We summed up some of her advice in a recent First Aid Kit newsletter, and then added some more COVID-test advice in this week's First Aid Kit.Here's a transcript for this episode.Got a story to tell, or a wild bill to share? Get in touch.We can only make this show because listeners like you support us. Wanna pitch in? See acast.com/privacy for privacy and opt-out information.

Modern prenatal blood tests that screen for a range of fetal abnormalities are billed by their Silicon Valley creators as reliable and accurate, designed to bring peace of mind to anxious parents. But a New York Times investigation has found that positive results on those tests are inaccurate roughly 85 percent of the time. We'll talk to Times investigative journalist Sarah Kliff about what she uncovered.

It's 2022 and the covid-19 pandemic is still with us, as are congressional efforts to pass President Joe Biden's big health and social spending bill. But other issues seem certain to take center stage on this year's health agenda, including abortion, the state of the health care workforce, and prescription drug prices.Tami Luhby of CNN, Alice Miranda Ollstein of Politico and Mary Ellen McIntire of CQ Roll Call join KHN's Julie Rovner to discuss these issues and more.Also this week, Rovner interviews KHN's Victoria Knight, who reported the latest KHN-NPR “Bill of the Month” episode.For extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:Julie Rovner: The Washington Post's “Men Across America Are Getting Vasectomies ‘as an Act of Love,'” by Emily Wax-ThibodeauxTami Luhby: The Washington Post's “Nursing Home Staff Shortages Are Worsening Problems at Overwhelmed Hospitals,” by Lenny Bernstein and Andrew Van DamAlice Miranda Ollstein: The 19th's “ACA Health Insurance Plans Need More Protections for LGBTQ+ People, White House Says,” by Orion RummlerMary Ellen McIntire: The New York Times' “When They Warn of Rare Disorders, These Prenatal Tests Are Usually Wrong,” by Sarah Kliff and Aatish BhatiaClick here for a transcript of the episode. See acast.com/privacy for privacy and opt-out information.

Guests: Tim Alberta, Katie Benner, Philip Rucker, Sarah Kliff, JRTonight: Trump's greatest defender is cashing out as one of his colleagues diagnosis the larger problem. Then, an ultimatum from the January 6th committee to Mark Meadows: show up or face charges. Plus, as the ribbon cuttings begin one Republican's creative way of taking credit for a law that no Republicans voted for. And my interview with the incredible artist JR about his new documentary "Paper & Glue." 

For Matt's last episode of The Weeds, Ezra Klein and Sarah Kliff return for a look at why health care and drug costs in the US keep rising, how subsidizing industries leads to higher consumer costs, and what both political parties can do about it. It gets real nerdy just as fast as the last time these three co-hosted. We also learn about the first print piece Matt ever published, and he shares some feelings about pseudo-Cyrillic.  Resources: “How the US made affordable homes illegal” by Jerusalem Demsas (Vox Media; Aug 17, 2021) “Building housing — lots of it — will lay the foundation for a new future” by Matt Yglesias (Vox Media; Sep 23, 2020) “The true story of America's sky-high prescription drug prices” by Sarah Kliff (Vox Media; May 10, 2018) "The real reason American health care is so expensive" by Liz Scheltens, Mallory Brangan, and Ezra Klein (Vox Media; Dec 1, 2017) White Paper: “Cost Disease Socialism: How Subsidizing Costs While Restricting Supply Drives America's Fiscal Imbalance” by Steven Teles, Samuel Hammond, Daniel Takash (Niskanen Center; Sep 9, 2021) Guest: Ezra Klein (@ezraklein), Columnist, The New York Times Sarah Kliff (@sarahkliff), Investigative Reporter, The New York Times Host: Matt Yglesias (@mattyglesias), Slowboring.com Credits: Ness Smith-Savedoff, Producer & Engineer Erikk Geannikis, Producer, Talk Podcasts Sofi LaLonde, Producer, The Weeds Efim Shapiro, Engineer As the Biden administration gears up, we'll help you understand this unprecedented burst of policymaking. Sign up for The Weeds newsletter each Friday: vox.com/weeds-newsletter. The Weeds is a Vox Media Podcast Network production. Want to support The Weeds? Please consider making a contribution to Vox: bit.ly/givepodcasts About Vox Vox is a news network that helps you cut through the noise and understand what's really driving the events in the headlines. Follow Us: Vox.com Facebook group: The Weeds Learn more about your ad choices. Visit podcastchoices.com/adchoices

“My entire politics is premised on the fact that we are these tiny organisms on this little speck floating in the middle of space,” Barack Obama told me, sitting in his office in Washington, D.C.To be fair, I was the one who had introduced the cosmic scale, asking how proof of alien life would change his politics. But Obama, in a philosophical mood, used the question to trace his view of humanity. “The differences we have on this planet are real,” he said. “They’re profound. And they cause enormous tragedy as well as joy. But we’re just a bunch of humans with doubts and confusion. We do the best we can. And the best thing we can do is treat each other better, because we’re all we got.”Before our interview, I’d read “A Promised Land,” the first volume of Obama’s presidential memoirs. It had left me thinking about the central paradox of Obama’s political career. He accomplished one of the most remarkable acts of political persuasion in American history, convincing the country to vote, twice, for a liberal Black man named Barack Hussein Obama during the era of the war on terror. But he left behind a country that is less persuadable, more polarized, and more divided. The Republican Party, of course, became a vessel for the Tea Party, for Sarah Palin, for Donald Trump — a direct challenge to the pluralistic, democratic politics Obama practiced. But the left, too, has struggled with the limits of Obama’s presidency, coming to embrace a more confrontational and unsparing approach to politics.So this is a conversation with Obama about both the successes and failures of his presidency. We talk about his unusual approach to persuasion, when it’s best to leave some truths unsaid, the media dynamics that helped fuel both his and Trump’s campaigns, how to reduce educational polarization, why he believes Americans have become less politically persuadable, the mistakes he believes were made in the design of the 2009 stimulus and the Affordable Care Act, the ways in which Biden is completing the policy changes begun in the Obama administration, what humans are doing now that we will be judged for most harshly in 100 years, and more.References: “Why Obamacare enrollees voted for Trump” by Sarah Kliff, Vox“By 2040, two-thirds of Americans will be represented by 30 percent of the Senate” by Philip Bump, The Washington Post “Advantage, GOP” by Laura Bronner and Nathaniel Rakich, FiveThirtyEightBook recommendations: The Overstory by Richard PowersMemorial Drive by Natasha Tretheway Thoughts? Guest suggestions? Email us at ezrakleinshow@nytimes.com.“The Ezra Klein Show” is produced by Annie Galvin, Jeff Geld and Rogé Karma; fact-checking by Michelle Harris; original music by Isaac Jones; mixing by Jeff Geld. Special thanks to Shannon Busta and Kristin Lin.

This week, we’re talking about upcoding, and how it can lead to $11,000 COVID tests, $629 bandaids, and mothers waiting within sprinting distance to the hospital. America has some of the best doctors and hospitals in the world, but many patients are too afraid to walk through the doors for fear of going into unnecessary debt. Dr. Zachary Sussman, New York Times journalist Sarah Kliff and ProPublica journalist Marshall Allen, who investigate medical billing for a living, join David to shed some light on surprise bills. Keep up with David on twitter @CHIDavidSmith. Resources from the episode: Share your coronavirus medical bills with Sarah Kliff & the New York Times: https://www.nytimes.com/2020/08/03/reader-center/coronavirus-medical-bills.html?smid=rd Learn more about the $629 band-aid on The Impact, a podcast created and formerly hosted by Sarah: https://podcasts.apple.com/us/podcast/the-curious-case-of-the-%24629-band-aid/id1294325824?i=1000393574994 Read Marshall’s article about Dr. Zachary Sussman’s $10,984 COVID test: https://www.propublica.org/article/how-a-covid-19-test-led-to-charges Pre-order Marshall’s book, Never Pay The First Bill: https://www.marshallallen.com/ Check out Marshall’s Top Doctor award: https://www.instagram.com/lemonadamedia/ Become a better health care consumer with the help of ProPublica’s voices of patient harm: https://www.propublica.org/article/patient-safety-voices-questionnaire-results and Sarah’s reporting for Vox: https://www.vox.com/2019/3/22/18261698/how-to-fight-expensive-medical-bill Learn more about your surgeon before an operation with ProPublica’s Surgeon Scorecard: https://projects.propublica.org/surgeons/ Keep up with David on twitter @CHIDavidSmith. Have you been hit with a surprise bill or had an infuriating run-in with the health care system? If you want to submit a patient story, email us at costofcare@lemonadamedia.com or leave us a voicemail at 833-453-6662. Support for this episode of The Cost of Care comes from Healthline.com, America’s leading digital health brand. Visit healthline.com/costofcare now, and stay connected by following @healthline on Instagram, Facebook and Twitter. Healthline: Powering healthy actions and supporting you on your journey to well-being. Support for this podcast comes from The Commonwealth Fund, a health care research foundation working to improve the U.S. health system. Visit commonwealthfund.org/costofcare, and stay connected by following us on Twitter, LinkedIn, and Instagram. Commonwealth Fund: Affordable, quality health care. For everyone. You can click this link for a full list of current sponsors and discount codes for this show and all Lemonada shows. To follow along with a transcript and/or take notes for friends and family, go to https://www.lemonadamedia.com/show/thecostofcare/ shortly after the air date. Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.See omnystudio.com/listener for privacy information.

Sarah Kliff, an investigative reporter for The New York Times, offers her thoughts on health care reform, coronavirus, journalism in a time of misinformation, and the relationship between healthcare and public health.

Surprise medical bills occur when a patient goes to a hospital or an emergency room believing their insurance will cover their treatment. But if they get care from someone outside their insurance network they could unexpectedly be charged hundreds or thousands of dollars. A new law passed Monday aims to change those practices. New York Times reporter Sarah Kliff joins William Brangham to discuss. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

Surprise medical bills occur when a patient goes to a hospital or an emergency room believing their insurance will cover their treatment. But if they get care from someone outside their insurance network they could unexpectedly be charged hundreds or thousands of dollars. A new law passed Monday aims to change those practices. New York Times reporter Sarah Kliff joins William Brangham to discuss. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

They're supposed to be free. And usually they are. But sometimes... things happen. Here's how to keep them from happening to YOU.New York Times reporter Sarah Kliff has been asking readers to send in their COVID-testing bills. She's now seen hundreds of them, and she runs down for us the most common ways things can go sideways, and how to avoid them.Here's Sarah's NYT story that inspired this episode.Support us: During November and December 2020, your donation counts for DOUBLE, thanks to a campaign called NewsMatch. So cool. You can make a one-time donation OR make an ongoing monthly pledge. Here's the link: https://armandalegshow.com/support/Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEG See acast.com/privacy for privacy and opt-out information.

In this episode, I discuss the history of America's healthcare system, discuss problems within the system, and identify solutions to those problems. Griffin, Jeff. “The History of Medicine and Organized Healthcare in America.” JP Griffin Group | Employee Benefits Broker, www.griffinbenefits.com/blog/history-of-healthcare. “Health Coverage Protects You from High Medical Costs.” HealthCare.gov, www.healthcare.gov/why-coverage-is-important/protection-from-high-medical-costs/. Lockett, Eleesha. “Medicare for All vs. Public Option: How Do They Compare?” Healthline, 22 Apr. 2020, www.healthline.com/health/medicare/medicare-for-all-vs-public-option. Luhby, Tami. “Americans Are Still Pretty Happy with Their Private Health Insurance.” CNN, Cable News Network, 9 Dec. 2019, www.cnn.com/2019/12/09/politics/gallup-private-health-insurance-satisfaction/index.html. Picchi, Aimee. “A $500 Surprise Expense Would Put Most Americans into Debt.” CBS News, CBS Interactive, 12 Jan. 2017, www.cbsnews.com/news/most-americans-cant-afford-a-500-emergency-expense/. Problems of Health Care in the United States, saylordotorg.github.io/text_social-problems-continuity-and-change/s16-04-problems-of-health-care-in-the.html. Roosa Tikkanen and Melinda K. Abrams. “U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?: Commonwealth Fund.” U.S. Health Care from a Global Perspective, 2019 | Commonwealth Fund, 30 Jan. 2020, www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019. Sanger-katz, Margot. “Grading Obamacare: Successes, Failures and 'Incompletes'.” The New York Times, The New York Times, 5 Feb. 2017, www.nytimes.com/2017/02/05/upshot/grading-obamacare-successes-failures-and-incompletes.html. Sarah Kliff, Dylan Scott. “We Read 9 Democratic Plans for Expanding Health Care. Here's How They Work.” Vox, Vox, 13 Dec. 2018, www.vox.com/2018/12/13/18103087/medicare-for-all-explained-single-payer-health-care-sanders-jayapal. Sohn, Heeju. “Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course.” Population Research and Policy Review, U.S. National Library of Medicine, Apr. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5370590/. Tikkanen, Roosa. “Canada.” Commonwealth Fund, 5 June 2020, www.commonwealthfund.org/international-health-policy-center/countries/canada. Tikkanen, Roosa. “Denmark.” Commonwealth Fund, 5 June 2020, www.commonwealthfund.org/international-health-policy-center/countries/denmark. Tikkanen, Roosa. “Japan.” Commonwealth Fund, 5 June 2020, www.commonwealthfund.org/international-health-policy-center/countries/japan. Tikkanen, Roosa. “United States.” Commonwealth Fund, 5 June 2020, www.commonwealthfund.org/international-health-policy-center/countries/united-states.

There are few issues on which the stakes in this election are quite as stark as on health care. Democratic presidential nominee Joe Biden plans to pass (and Democrats largely support) a massive health care expansion that could result in 25 million additional individuals gaining health insurance. The Trump administration, as we speak, is pushing to get the Supreme Court to kill the Affordable Care Act, which would strip at least 20 million Americans of health care coverage.    There's no one I'd rather have on to discuss these issues than Sarah Kliff. Kliff is an investigative reporter for the New York Times focusing on health care policy, and my former colleague at the Washington Post and Vox where we co-hosted The Weeds alongside Matt Yglesias. She's one of the most clear, incisive health care policy analysts in media today and a longtime friend, which made this conversation a pleasure. We discuss:  The legacy of Obamacare 10 years later Why the fiercely fought over “individual mandate” isn’t all it’s cracked up to be  What Biden’s health care plan would actually do — and where it falls short  Whether a Biden administration would be able to pass massive health care reform — and why it might still have a chance even if the filibuster remains intact  The ongoing Supreme Court case to dismantle Obamacare  Whether Donald Trump has a secret health care plan to protect those with preexisting conditions (spoiler: he doesn’t)  The hollow state of Republican health care policy  The academic literature showing that health insurance is literally a matter of life and death  Which social investments would have the largest impact on people’s health (hint: it’s probably not expanding insurance)    And much more References: "If Trump wins, 20 million people could lose health insurance. If Biden wins, 25 million could gain it." by Dylan Scott, Vox “Obamacare Turns 10. Here’s a Look at What Works and Doesn’t.” by Sarah Kliff, et al. New York Times "The I.R.S. Sent a Letter to 3.9 Million People. It Saved Some of Their Lives." by Sarah Kliff, New York Times "Republicans Killed the Obamacare Mandate. New Data Shows It Didn’t Really Matter." by Sarah Kliff, New York Times "Without Ginsburg, Supreme Court Could Rule Three Ways on Obamacare" by Sarah Kliff and Margot Sanger-Katz, New York Times Book recommendations: The Healing of America by TR Reid  And the Band Played On by Randy Shilts  Dreamland by Sam Quinones  I Want My Hat Back by Jon Klassen Credits: Producer/Audio wizard - Jeff Geld Researcher - Roge Karma Please consider making a contribution to Vox to support this show: bit.ly/givepodcasts Your support will help us keep having ambitious conversations about big ideas. New to the show? Want to check out Ezra’s favorite episodes? Check out the Ezra Klein Show beginner’s guide (http://bit.ly/EKSbeginhere) Want to contact the show? Reach out at ezrakleinshow@vox.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Sarah Kliff, an investigative reporter for The New York Times, talks about her latest reporting around why some people are receiving bills for COVID-19 testing when Congress sought to ensure that patients would not face costs connected to the virus. Plus, why is it so hard to find tests for children?

As climate catastrophe marches apace and the nation's public health infrastructure continues to unravel, we take stock of how we got here and what it might be like to look back on this year in the future. Plus, the frightening encroachment of QAnon conspiracy theorists into mainstream politics. 1. David Roberts [@drvox], staff writer at Vox.com, on how "shifting baselines syndrome" clouds our perspective on climate chaos. Listen. 2. Sarah Kliff [@sarahkliff], investigative reporter at the New York Times, on the obstacles to effective sharing of health data, from politics to fax machines. Listen. 3. Anthea M. Hartig [@amhistdirector], director of the Smithsonian's National Museum of American History, on archivists' efforts to document 2020 in real time. Listen. 4. Alex Kaplan [@AlKapDC], senior researcher at Media Matters, on how fringe conspiracy theory QAnon rose to prominence and has consumed segments of the political right. Listen.

From data collection to insurance coverage: how our fragmented health care system complicates the country's ability to track the spread of Covid-19. And why the Trump administration's new rule change for how hospitals report information might make it worse. Diane talks to Sarah Kliff, investigative reporter for The New York Times.

This week we look into the costs of getting tested for COVID-19 and how insurance companies are exploiting Americans with short-term, limited-duration plans. Follow Jigsaw Politics on Facebook, Twitter, and Instagram @jigsawpolitics As always, you can email us at jigsawpoliticspod@gmail.com SOURCES: "Understanding Short-Term, Limited Duration Health Insurance" by Karen Pollitz, Michelle Long, Ashley Semanskee, and Rabah Kamal https://www.kff.org/health-reform/issue-brief/understanding-short-term-limited-duration-health-insurance/ "How Trump Gave Insurance Companies Free Reign to Sell Bad Health Plans" by Dylan Scott https://www.vox.com/2020/6/30/21275498/trump-obamacare-repeal-short-term-health-care-insurance-scam "Most Coronavirus Tests Cost About $100. Why Did One Cost $2,315?" by Sarah Kliff https://www.nytimes.com/2020/06/16/upshot/coronavirus-test-cost-varies-widely.html "A Miami man who flew to China worried he might have coronavirus. He may owe thousands." by Ben Conarck https://www.miamiherald.com/news/health-care/article240476806.html Our music is by Joakim Karud https://youtube.com/joakimkarud Jigsaw Politics will be back next Friday.

More than 30 million Americans without work, more states starting to open up and health experts warning of another wave of infections. We discuss the week's top stories in our news roundtable. Errin Haines, Ben White and Sarah Kliff join Jane Clayson.

More than 30 million Americans without work, more states starting to open up and health experts warning of another wave of infections. We discuss the week's top stories in our news roundtable. Errin Haines, Ben White and Sarah Kliff join Jane Clayson.

Just because we’re doing 10-minute daily dispatches doesn’t mean we’re stopping the regular weekly podcast. For this week’s deep-dive, we’re speaking with New York Times health care reporter Sarah Kliff about supply chains for masks and ventilators, the Defense Production Act and how Obamacare will fare in a recession. Plus, we hear from a listener who recovered from COVID-19 and another who does buying for grocery stores.

Taiwan’s system of electronic medical records lets them track diseases as they spread and makes healthcare more convenient for patients. So why isn’t the US system of medical records like this? Featured Guests @dylanscott LINKS: Listen to The Impact to hear more about Taiwan’s Medicare-for-All system. You can also read more of Dylan’s reporting from around the globe in his series, Everybody Covered.  For more on the history of electronic health records in the US, you can read Sarah Kliff’s deep dive into the subject, or listen to her Impact episode about it.  Host: Arielle Duhaime-Ross (@adrs), host and lead reporter of Reset About Recode by Vox: Recode by Vox helps you understand how tech is changing the world — and changing us. Follow Us: Newsletter: Recode Daily  Twitter: @Recode

Dylan Scott and special guest Sarah Kliff join Matt for a close look at health care in Taiwan, Australia, and the Netherlands. Recommended reading: "Everybody Covered" by Dylan Scott, Ezra Klein, and Tara Golshan, Vox "Taiwan’s single-payer success story — and its lessons for America" by Dylan Scott, Vox "Two sisters. Two different journeys through Australia’s health care system." by Dylan Scott, Vox "The Netherlands has universal health insurance — and it’s all private" by Dylan Scott, Vox Hosts: Matthew Yglesias (@mattyglesias), Senior correspondent, Vox Dylan Scott (@dylanlscott), National security reporter, Vox Sarah Kliff (@sarahkliff), Investigations and health policy, New York Times More to explore: Subscribe to Impeachment, Explained on Apple Podcasts, Spotify, Stitcher, Overcast, Pocket Casts, or your favorite podcast app to get stay updated on this story every week. About Vox Vox is a news network that helps you cut through the noise and understand what's really driving the events in the headlines. Follow Us: Vox.com Facebook group: The Weeds Our project, Everybody Covered, was made possible by a grant from The Commonwealth Fund. Learn more about your ad choices. Visit megaphone.fm/adchoices

Sarah Kliff returns for a farewell and a handoff to The Impact's new host, Jillian Weinberger, who has a preview of what's to come in our next season.  If you're not already, subscribe to The Impact on Apple Podcasts, Spotify, or your favorite podcast app to automatically get new episodes of the latest season each week. Featuring: Sarah Kliff, @sarahkliff Host: Jillian Weinberger, @jbweinz About Vox: Vox is a news network that helps you cut through the noise and understand what's really driving the events in the headlines. Follow Us: Vox.com  Newsletter: Vox Sentences Learn more about your ad choices. Visit megaphone.fm/adchoices

The rocketing cost of prescription drug prices makes the burdensome healthcare landscape more difficult to navigate for the millions of Americans that rely on a prescription. One thing that voters, regardless of party, have agreed on is that the cost of prescription drugs in the U.S. is way too high. Americans spend significantly more on prescription drugs when compared to any other country. But, why? Senator Amy Klobuchar joins Politics with Amy Walter to discuss her work in Washington on reducing the cost of prescription drugs. Sarah Kliff of The New York Times and Yasmeen Abutaleb of The Washington Post join us to discuss why there's been such little movement on this subject, even though there's broad support for reform. Finally, Nick Fandos, a congressional correspondent for The New York Times, joins us to discuss the House's vote to authorize a resolution to establish the next phase of the impeachment inquiry. 

The rocketing cost of prescription drug prices makes the burdensome healthcare landscape more difficult to navigate for the millions of Americans that rely on a prescription. One thing that voters, regardless of party, have agreed on is that the cost of prescription drugs in the U.S. is way too high. Americans spend significantly more on prescription drugs when compared to any other country. But, why? Senator Amy Klobuchar joins Politics with Amy Walter to discuss her work in Washington on reducing the cost of prescription drugs. Sarah Kliff of The New York Times and Yasmeen Abutaleb of The Washington Post join us to discuss why there's been such little movement on this subject, even though there's broad support for reform. Finally, Nick Fandos, a congressional correspondent for The New York Times, joins us to discuss the House's vote to authorize a resolution to establish the next phase of the impeachment inquiry. 

With health care at the center of the Democrats' bid to unseat President Trump, Christiane Amanpour speaks to Andy Slavitt; Former Acting Administrator for Centers for Medicare & Medicaid Services, and Sarah Kliff; New York Times Investigative Reporter. Then, Professor of Government Minxin Pei unpicks the latest US-China trade talks. Hari Sreenivasan speaks with chef Kwame Onwuachi about his new book "Notes From a Young Black Chef".

Almost 40% of Americans WITH health insurance reported they had received a surprise medical bill in the past year from a doctor or hospital for a service they thought was covered by their insurance plan. Why is this happening? And what can we do about it?  Please Support Congressional Dish – Quick Links Click here to contribute monthly or a lump sum via PayPal Click here to support Congressional Dish for each episode via Patreon Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: 5753 Hwy 85 North, Number 4576, Crestview, FL 32536 Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Additional Reading Article: Went to the ER? You may be hit with a surprise medical bill by Tami Luhby, CNN, June 20, 2019. Press Release: House Supports Porter Amendment to Improve Affordable Care Act Enrollment by Representative Katie Porter, Porter House News, June 13, 2019. Article: Alexander-Murrary Bill, by Tammy Luhby, CNN, May 23, 2019. Bill: Bill S. 1531 Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 by Senator Bill Cassidy, Govtrack.us, May 16, 2019. Press Release: Trauma Coalition Press Release, by Trauma Association of America, May 16, 2019. Article: Trump calls for an end to surprise medical bills by Tami Luhby, CNN, May 9, 2019. Article: UnitedHealth's David Wichmann buys record $4.6 million worth of UNH stock by Alex Wittenberg, Biz Journals, May 7, 2019. Article: After Vox reporting, California moves forward on plan to end surprise ER bills by Sarah Kliff, Vox, April 24, 2019. Article: How to fight an outrageous medical bill, explained by Sarah Kliff, Vox, April 1, 2019 Bill: Bill S. 1266 Protecting Patients from Surprise Medical Bills Act 116th Congress, March 1, 2019. Bill: Bill H.R. 861 End Surprise Billing Act of 2019  116th Congress, January 30, 2019. Article: A $20,243 bike crash: Zuckerberg hospital’s aggressive tactics leave patients with big bills by Sarah Kliff, Vox, January 24, 2019.  Article: After Vox story, Zuckerberg hospital rolls back  by Sarah Kliff, Vox, January 24, 2019. Document: NBER Working Paper No. 23623 Surprise! Out-of-Network Billing for Emergency Care in the United States by Zach Cooper, Fiona Scott Morton and Nathan Shekita, NBER, January 2019 Article: LifePoint merges with RCCH, goes private by Ayla Ellison, Becker Hospital Review, November 16, 2018. Article: “It’s unacceptable”: Sen. Maggie Hassan explains her plan to end surprise ER bills by Sarah Kliff, Vox, October 29, 2018. Article: Gov. Rick Scott took responsibility? No, he took $300 million | Randy Schultz by Randy Schultz, Sun Sentinel News, October 2, 2018. Article: UnitedHealthcare issues warning to hospitals about out-of-network coverage for ER physicians by Susan Morse, Healthcare Finance News, September 25, 2018. Article: Three Ways Self-Insured Plans Can Leverage State Laws to Protect their Members from Balance Billing  by Matthew Albright, The Self-Insurer, September 2018. Article: The Last Company You Would Expect Is Reinventing Health Benefits  by Reed Abelson, NY Times, August 31, 2018. Article: As Health and Financial Challenges Grow, More Older Adults File for Bankruptcy by Lindsey Copeland, Medicare Rights Center, August 9, 2018. Article: A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill by Jenny Gold, Kaiser Health News and Sarah Kliff, Vox, July 20, 2018. Article: Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind  by  John Tozzi, Bloomberg News, June, 11 2018. Case Docket: Case Proceeding Air Medical Group, KKR North America, and AMR Holdco, In the Matter of Federal Trade Commission, May 3, 2018. Article: Are Physician Staffing Companies Killing the Patient Experience and Bottom Line? by Berta Bustamante, InsideArm, April 10, 2018. Press Release: Ambulance Companies Air Medical Group Holdings, Inc. and AMR Holdco, Inc. Agree to Divest Air Ambulance Services in Hawaii as a Condition of Merger  Federal Trade Commission, March 7, 2018. Document: Letter to Christopher Holden-President and Executive Officer for Envision Healthcare US Senate, September 20, 2017 Bill: California Assembly Bill 72 by Ann Whitehead,JD,RN.,CAP Physicians, August 30, 2017. Report: AIR AMBULANCE Data Collection and Transparency Needed to Enhance DOT Oversight  Government Accountability Office, July 2017. Article: The Company Behind Many Surprise Emergency Room Bills by Julie Creswell,Reed Abelson and Margot Sangor-Katz, NY Times, July 24, 2017. Article: AB 72: No More Balance Billing for Out-of-Network Care In-Network by Staff, Word&Brown, July 14, 2017. Report: Health Policy Report Up in the Air: Inadequate Regulation for Emergency Air Ambulance Transportation Consumer Reports, March 2017. Article: One In Five Inpatient Emergency Department Cases May Lead To Surprise Bills by Christopher Garmon and Benjamin Chartock, Health Affairs, January 2017. Article: Trauma fees growing across the nation at 'absurd' rate by Alexander Zayas and Kris Hunley, Tampa Bay Times, November 21, 2014. Article: 10 Things to Know About HCA Becker's Hospital Review, April 16, 2014. Article: HCA to Eliminate Trauma Fees for Uninsured Patients Becker's Hospital Review, April 10, 2014.   Resources Profile Link: Connie Potter Profile, RN, BSN, MBA-HCA Link  Linkedin. Profile Link: Sherif Zaafran Profile, MD, FASA  Linkedin. Contact Us: Physicans for Fair Coverage  End of the Insurance Gap.org About Us: Independence Company (IBX)  IBX.com Document: License Agreement: Use of Current Procedural Terminology, Fourth Edition ("CPT®")  Centers for Medicare and Medicaid Services 2013-2018 Contributor List: Sen. Rick Scott Election Contributor List   Opensecrets.org Campaign Money Data Table: David Wichmann Political Campaign Contributions 2016 Election Cycle  Campaign Money.com Online Review Score: Regence Health Plan Company Profile Review  BestCompany.com False Claims Act: Nation’s Largest Healthcare Fraud Settlement Doesn’t Stop Medical Behemoth, WhistleBlowerJustice.net Visual Resources   Sound Clip Sources Hearing: NO MORE SURPRISES: PROTECTING PATIENTS FROM SURPRISE MEDICAL BILLS, Not on C-Span, Committee on Energy and Commerce, June 12, 2019. Watch on Youtube Witnesses: Sonji Wilkes: Patient Advocate Sherif Zaafran, MD: Chair of Physicians for Fair Coverage Rick Sherlock: President and CEO of Association of Air Medical Services James Gelfand: Senior Vice President of Health Policy at The ERISA Industry Committee Thomas Nickels: Executive Vice President of the American Hospital Association Jeanette Thornton: Senior Vice President of Product, Employer, and Commercial Policy at Americas’ Health Insurance Plans Claire McAndrew: Director of Campaigns and Partnerships at Families USA Vidor E. Friedman, MD: President of American College of Emergency Physicians Transcript 47:54 CEO Rick Sherlock: Emergency air medical services are highly effective medical interventions appropriate in cases where getting a patient directly to the closest most appropriate medical facility can make a significant difference in their survival in recovery. Today, because of air medical services, 90% of Americans can reach a level one or level two trauma center within an hour. However, since 2010, 90 hospitals have closed in rural areas and an estimated 20% more are at risk of closing. Our members fill the gap created by closures, but this lifeline is fraying as 31 air medical bases have also closed in 2019. 48:31 CEO Rick Sherlock: Emergency or medical providers never make the decision on who to transport. That decision is always made by a requesting physician or medically trained first responder. Air medical crews then respond within minutes, 24 hours a day, seven days a week without any knowledge of a patient’s ability to pay for their services. 48:45 CEO Rick Sherlock: Our members are unique in the healthcare system. The services heavily regulated by the states for the purposes of healthcare, as ambulances and the federal government for aviation safety and services as air carriers. It is their status as air carriers that allow rapid transport of patients over significant distances. Over 33% of our flights cross state lines every day. For that reason, the Airline Deregulation act uniform authority over the national airspace is essential to the provision of this lifesaving service. Exempting air medical services from the ADA would allow states to regulate aviation services, including where and when they’re able to fly, limiting access to healthcare for patients in crisis. 49:54 CEO Rick Sherlock: To prevent balance billing, our members are actively negotiating with insurance companies to secure in-network agreements. One member alone has increased their participation from 5% to almost 43% in the last three years. Despite that, some insurers have refused to discuss in-network agreements. That hurts both patients and caregivers. 50:30 CEO Rick Sherlock: Uh, covering air medical services in full, represents about a $1.70 of the average monthly premium. 51:50 CEO Rick Sherlock: $10,199 was the median cost of providing a helicopter transport. While Medicare paid $5,998, Medicaid paid $3,463 and the uninsured paid $354. This results in an ongoing imbalance between actual costs and government reimbursement and is the single biggest factor in increasing costs. 53:45 Senior VP James Gelfand: We’re focused on three scenarios in which patients end up with big bills they couldn’t see coming or avoid. Number one, a patient receives care at an in-network facility, but is treated by an out of network provider. Number two, a patient requires emergency care, but the provider’s facility or transportation are out of network. And number three, a patient is transferred or handed off without sufficient information or alternatives. It’s usually not the providers you’re planning to see. It’s anesthesiologists, radiologists, pathologists, or emergency providers or transport or an unexpected trip to the NICU. Many work for outsourced medical staffing firms that have adopted a scam strategy of staying out of networks, practicing at in-network facilities and surprise billing patients. It’s deeply concerning, but the problem is narrowly defined and therefore we can fix it. 54:40 Senior VP James Gelfand: The No Surprises Act nails it. It takes patients out of the middle and creates a market based benchmark rate to pay providers fairly. The benchmark is not developed by government and it is not price setting. The committee might also consider network matching. It’s simple. If a provider practices at an in-network facility, they take the in-network rate or they go work somewhere else. Or base the benchmark on Medicare, you could set the rate higher, say 125% of Medicare and still make the system more affordable, sustainable and simpler. These approaches will eliminate the surprise bills. That’s a huge win for patients. 54:50 ** Senior VP James Gelfand: But not everyone wants to stop the surprise bills. Some provider specialties are saying, “let us keep doing what we’re doing, just use binding arbitration to make someone else pay these bills”. They’re asking for a non- transparent process that could force plans and employers to pay massive and fake medical list prices. It’s essentially setting money on fire. Funds that would have been used to pay for healthcare will instead be spent on administrative costs such as lawyers, arbitrators, facility fees, and on reasonable settlement amounts. Make no mistake, patients will pay these costs. 55:20 Senior VP James Gelfand: The ground and air ambulance companies are asking Congress to let them keep surprise billing too. Do nothing, wait for another study, another report, and there have already been four. They know patients cannot shop for them and many participate in no networks. State insurance commissioners are begging for help with air ambulances, but Congress has tied their hands. Employers think Congress should end this. Treat medical transport the same as emergency care. We should end surprise billing in the ER and on the way there. 56:30 Senior VP James Gelfand: Other providers figure they’re willing to stop surprise billing, but only if they can increase in-network rates. They’re calling for network adequacy rules to force insurers and employers to add more providers to their networks, even if those providers demand astronomical payments. Does anyone here actually believe that these hospital based doctors who services cannot be shopped for, who are guaranteed to see our patients, are begging to be included in our networks, but nobody will return their calls? That they have no choice but to go and join these out of network Wall Street owned firms? It doesn’t make sense. 57:00 Senior VP James Gelfand: Employers design health benefits to help our beneficiaries. We don’t sell insurance. We want networks that meet our patients’ needs. Why would we want to cover an operation, but leave out the anesthesia? We want our employees to be able to afford their health insurance too, and that means we must be able to say no when providers are gaming the system. 1:08:10 Dr. Vidor Friedman: Unlike most physicians, emergency physicians are prohibited by federal law from discussing with a patient any potential costs of care or insurance details until they are screened and stabilized. This important patient protection known as Emtala, ensures physicians focus on the immediate medical needs of patients. However, it also means that patients cannot fully understand the potential cost of their care or the limitations of their insurance coverage until they receive the bill. 1:10:40 Dr. Vidor Friedman: The goal should be a system in which everyone is in-network, or essentially that. That requires a level playing field between providers and insurers. Insurers are concerned that benchmarking the even median charges, favors providers. Providers are concerned that benchmarking the median in-network rates, favors insurer’s. What’s Congress to do? ACEP supports a system that has already proven to be balanced between insurers and providers. That is a baseball style independent dispute resolution process similar to that used in New York and noted in the legislative proposal put forth by Doctors, Ruiz Rowe and Busan. 2:02:30 Rep. Brett Guthrie: If there does become a federal arbitration system, what do you think congressional oversight should be? And I don’t know if that should be something that I’m supposed to talk about or…Sonji Wilkes: Well, I’ve been sitting here listening, thinking I pay my insurance premiums, I do my part and I expect the bill to be paid. I mean, there’s only so much I can do to control that and I don’t really care how the reimbursement works. And quite frankly, I think the insurance industry is doing probably better in their bottom line than my bottom line. Um, I want to go to the best provider possible and I want the best care possible. I don’t really care how the payment works. 2:34:50 Dr. Sherif Zaafran: Well, I can tell you that from the physician’s standpoint, for emergency room physicians for example; the average weighted cost of every visit is about $155. 3:49:00 CEO Rick Sherlock: The median cost of a helicopter air transport is $10,199 according to a study conducted in 2017. If you look at the cost of uncompensated care, because Medicare pays less than $.60 on the dollar of that 10,199. About $5,998, Medicaid pays significantly less than that. Less than $3,500 on average, and the uninsured pay about $350. Those make up…those three groups make up 70% of air medical transports. So when you take that cost of uncompensated care and you add it to the median cost of $10,200, that’s the average charge of $36,000 that the representative from New Mexico referenced earlier. When you…when those kinds of situations happen, no one in our industry wants to see a patient or their family placed in jeopardy because they’ve just had a health emergency. Our members will sit down with each individual and their families and work out a solution tailored for them. 3:54:30 Dr. Sherif Zaafran: Again, there is no such thing as an out of network provider. There is a provider who may happen to be out of network with that specific product. So the only one who knows what the product is, is of course the patient and the insurance carrier and they’re the only ones who really have the information as to whether they’re in-network or out of network. Hearing: The Need to Reauthorize the September 11th Victim Compensation Fund, June 11, 2019 Hearing: Hearing on September 11 Victims Compensation Fund, June 11, 2019 Hearing: Watch on CSPAN-Surprise Medical Bills House Ways and Means Subcommittee on Health-May 21, 2019 Committee website Watch on YouTube Witnesses: Rep. Katie Porter (CA) James Patrick Gelfand: Senior Vice President, Health Policy, ERISA Industry Committee Dr. Bobby Mukkamala: Board of Trustees, American Medical Association Tom Nickels: Executive Vice President, Government Relations and Public Policy, American Hospital Association Jeannette Thornton: Senior Vice President for Product, Employer, and Commercial Policy at America’s Health Insurance Plans (AHIP) Transcript *7:15 Chairman Lloyd Doggett (TX): Fortunately, there now appears to be a growing consensus. Most recently joined by president Trump that holding the patient harmless should form the foundation for any surprise billing proposal. Under the legislation that I advanced, patients would only be charged in network cost sharing rates in emergency situations and non-emergency situations out of network charges would be permitted only when the patient has agreed in advance after receiving effective notice regarding any providers and services together with estimated charges. No other bill addressing this issue has yet been filed here in the house, but there is a very useful discussion draft proposal that is being circulated on a bipartisan basis by the House Energy and Commerce Committee and there’s several proposals that have service in the Senate. While every proposal currently begins with the basic premise of the enterprise billing act, conflict remains over how to resolve insurer provider disputes. *13:40 Rep. Katie Porter (CA): I’m concerned about surprise billing, as someone who’s dedicated my life to protecting consumers, but also because I have had to fight my own battle with surprise billing. On August 3rd last year when I was on the campaign trail, I started to feel pain in my abdomen. At 1:00 PM I could not continue and I went home. At 4:31, I texted my campaign manager that I needed to go to the emergency room. I couldn’t safely drive through the pain and I remember sitting on my front porch, so if I lost consciousness, somebody might find me and I wouldn’t be home alone. I didn’t call an ambulance because I was concerned about the cost. I could not drive and I asked my manager to please take me to Hoag hospital. I chose that hospital even though it was farther away from other providers, because I knew Hoag was an in-network facility. When I got to the hospital, I waited six hours alone in the emergency exam room without treatment. When I finally went to surgery, my doctor told me it was nothing to worry about, just a routine appendectomy. I was given anesthesia and when I awoke, the team around me was panicking. They couldn’t get my temperature to drop and they couldn’t get my blood pressure to rise. My appendix had ruptured hours before causing an infection that was making my whole body very sick. I spent the next five days in the hospital receiving powerful IV antibiotics. A few weeks later, I received the bill from my insurance company. The idea of an astronomical hospital bill had weighed heavily on me and I was happy to see that the cost of my emergency room treatment and assessment and hospital charges, and nearly all of my inpatient services, were covered. I remember sitting at my kitchen table and taking a deep breath filled with relief, but a few days later I received another bill. This one from my surgeon. While the hospital I had gone to was in-network, the insurance company now claimed the surgeon was not, even though they had sent me a notification telling me that my surgeon was in-network . Enclosed in that bill for nearly $3,000, was a handout from my surgeon detailing the steps I would have to take while recovering in order to fight to have my insurance company cover the care. So many of his patients had been put in this situation, that this medical doctor had used his staff to address patient billing problems. That’s not what he trained for in medical school. Your so-called explanation of benefits and the surgeon’s handout explained that he was being treated as an out of network provider even though he was employed by and worked at an in-network hospital. As someone in an emergency situation, I had no ability to assess whether he was in or out of network, and in those cases insurers are supposed to cover the costs, but I got that bill because my insurer put profits before patients. I called insurance company to request an appeal. The benefits manager kept asking me questions to guide me and coach me towards saying that it was my surgeon’s fault to blame him for overcharging me. She asked me to call the surgeon and attack my doctor for his bill. Apparently, to Anthem Blue Cross, $3,000 was too high a price for saving my life. The tens of thousands in premiums I’d paid to that company over the years were not enough to have them, cause them to cover the lifesaving care. Nearly five months after I was hospitalized, the surgeon simply requested payment, and at that point I reached out to my employer of the University of California Irvine. That’s when I learned that U.C. Irvine has a designated patient advocate, a medical doctor, whose sole job is to help university employees get the health insurance that the university and the employees pay for. Can we just reflect on that for a moment? The university is paying a medical doctor to do nothing but navigate insurance. Finally, the patient advocate, invoking the fact that I had just been just elected to Congress, was able to get the insurance company to agree to pay my surgeon’s bill. But here’s what I learned from getting sick. I am well educated. I had an employer prepared to help me. I have professional experience fighting for consumer rights, but there are thousands of Americans with fewer resources than me who are surprised with bills far more devastating than mine. I’m here today because they refuse to accept this as the status quo. I refuse to stand idly by while families go bankrupt because of surprise medical bills. Any solution to this issue must rely, must not rely, excuse me, on the patient’s ability to go to war with the insurer or with their provider. That is not the solution. It’s time we start putting patients first. 31:00 Jeanette Thornton: We ask that federal legislation focus on four things. First, balanced billing should be banned in situations where inpatients are involuntarily treated by an out of network provider. This includes emergency health services at any hospital, any health healthcare services or treatment performed at an in-network facility by an out of network provider, not selected by the patient and ambulance transportation in an emergency. Second, health insurance providers should be required to reimburse out of network providers inappropriate and reasonable amount in those above scenarios. Third, state should be required to establish an independent dispute resolution process that works in tandem with the established benchmark. Fourth hospitals or other healthcare providers should be required to provide advanced notice to patients of the network status of the treating providers. We appreciate the health sub-committee chairman Lloyd Doggett has introduced legislation to end surprise billing act or HR 861, which would establish a role for hospitals in providing such notices, along with banning balanced billing. AHIP supports this bill. 46:00 Chairman Lloyd Doggett (TX): What I’m referring to is the difference… Dr. Bobby Mukkamala: Right. Chairman Lloyd Doggett (TX): …in charges and why one one price for those who are in network and another for those that are out. Dr. Bobby Mukkamala: Right. So there is a benefit for me to be in network with Blue Cross Blue Shield of Michigan for example. I get something from that. They sit with me, they show me their data. We had…we worked together on incentive programs to sort of curb costs. If there’s an insurance company that’s in town that does none of that activity to improve the care of the population in my town, but yet wants to benefit from the same rate of compensation to me, they’re doing nothing to earn that discount. Blue Cross sits across from me on a weekly or monthly basis to improve the care of my population. But Golden Rule insurance, that’s new in town for example, doesn’t do any of that work and yet wants to benefit from having the same provider rates. No, I mean, I take a discounted rate from Blue Cross because of all this other robust activity. But if you’re not offering me anything to participate in your network, then naturally, you should be expected to pay more for my services. Right? I get something from Blue Cross. I get nothing from Golden Rule. 53:05 Dr. Bobby Mukkamala: Medicare is usually sort of the foundation upon which all the other insurance companies tend to set their rates. So when I participate in network, like with Blue Cross Blue Shield of Michigan, it’s usually about 110/ 115% of Medicare rates. So that’s one step higher. If I don’t participate with Blue Cross Blue Shield of Michigan, then that rate is so I can get the assigned rate from them and then I have a choice about what to do with the balance. And usually in my practice, I write that off. I don’t balance bill the patient. Uh, but Blue Cross Blue Shield sort of sets their rate and that’s it. My point is that, if-in Blue Cross Blue Shield, I have a great relationship with, we do a lot of constructive work together. But if a new insurance company comes into town and puts up billboards and markets their product and says, here, come, come buy our policy, and then they get 15,000 patients to sign up, but has never come to my door to say, you know, when they have an ear, nose and throat problem, we’d like you to be in-network and provide their care. Why should they get the benefit of the in-network price that Blue Cross Blue Shield gets? So, my point, is that that out of network price for this new insurance company that wants me to take care of their patient, but never came to sit down with me to sign a contract, ought to be something that I negotiate with them, not something that’s dictated to me. 55:50 Rep. Mike Thompson (CA): A staff person of mine went to the emergency room. He has insurance. His insurance covered nearly everything, including a cat scan. But a few weeks later, he got two separate bills from physicians he never saw and didn’t ask to see. They reviewed some of his test results and the bill for those two physicians was larger than the bill for his total ER visit. 56:15 Rep. Mike Thompson (CA): It’s also alarming that, uh, according to one study, 20% of hospital visits, one of every five of those visits, uh, that began in the ER, resulted in a surprise bill. 58:30 Dr. Bobby Mukkamala: Uh, yes, sir. So, in answer to your question, there are multiple already cases documented of insurance companies shrinking their network in California because they can get the same service at that rate with physicians that are out of their network. And so, contracts are already not being renewed for physicians that have had contracts for 20 years, and then they go to renew it and they’re dropped from the network. 1:03:00 Dr. Bobby Mukkamala: My wife and I, we contract with probably about 30 insurance companies. When I take a kid’s tonsils out, one insurance company may be $200- may pay me $200, one pays me about $450 and everything in between. I can’t have a different fee in my fee schedule for each of those. So my fee for tonsillectomy is about $475, so that when I do it, I know that the highest paying payer, I’m still-they’re still within that threshold, right? Because if I charge $400, they’re not going to send me $450. They’re going to send me $400. 1:07:00 Jeanette Thornton: So it’s very interesting what we’ve seen and when it comes from a hospital perspective. It’s maybe only 15% of the hospitals nationwide that are causing this issue that results in, you know, 80% of the visits. One of the statistics had cited a lot that result in a surprise medical bill. So this is not every doctor. This is not every hospital that are resulting in these surprise medical bills. It’s really more of a targeted problem. 1:09:15 Tom Nickels: In terms of how much of this is really going on, I think there is a certain level of frustration. I don’t know that we all know with certainty. The only federal study that I’ve seen, that we’ve seen, is from the Federal Trade Commission, which basically said that they studied ambulances going to hospital emergency departments. 99% of hospital emergency departments in that study were in-network. So it’s not the hospital itself that is out of network. it is people, physicians who practice in our institution. 1:22:20 Tom Nickels: The federal government-state government need to acknowledge that they underpay. I mean, Medpack and others acknowledges that this isn’t just industries talking about ourselves. AMA has said the same thing on the physician side, but I think that the federal government and state governments have a responsibility to pay more adequately. The truth of the matter is, and we haven’t even talked about this, is the cost shift is that private insurers pay more than costs and the government pays less. That should end. The government should take responsibility. 1:38:00 Tom Nickels: We cannot force by law, physicians who are not employed by us to take in-network rates. That is-if we did that, um, we would be sued. It would be restraint of trade. Um, however, what we’re trying to suggest here and I think what the other panelists are trying to suggest, is we have a way to protect the patient from that surprise bill. To your question about who are these physicians that you don’t even know about who are treating you, if you come in in an emergency, you don’t know what’s going on. And you need to be taking care of it, who’s ever there is going to take care of you. The other situation which we’ve talked about is when you knowingly come into an inpatient in-network facility. You did all the right things, but an out of network physician, (anesthesiologists, perhaps radiologists, pathologists) takes care of you. And that’s where the, uh, the bill is generated from. So we cannot make people do that. We try to get physicians to be in our networks-in the same networks. But again, this is an issue of private contracting. 1:42:05 Rep. Mike Kelly (PA): I do agree with you. If there’s limited talent there to take care of that specific problem, there has to be a way of compensating for it. Because at the end of the day, it is a business. Dr. Bobby Mukkamala: Right. So the solution is if an insurance company is going to come into Flint, Michigan and sell insurance, they know that eventually they’re going to need a hand surgeon, right? How do they sell insurance to a town that’s an industrial based town, where there’s a lot of hand injuries and not have any hand surgeons in their network? When they put up the billboard saying, “we’re selling insurance here”, they should have at the same time look at their provider list and say, “you know what”?, we’re missing an orthopedic hand surgeon. "Let’s go find one and figure out how to get him in-network or get her in-network. Right? And that’s a step that’s skipped routinely, right? They’ll sell the product for years and then fill in this way with lack of a good provider network by trying to negotiate out of network rates that are the same as in-network because they’d skip that first step, right? Maintain a network adequacy-establish a network adequacy before you sell your product. 1:48:30 James Gelfand: Many of the hospitals are not doing what Zuckerberg hospital was doing. The hospital will be in-network, but they will have outsourced their emergency room to a Wall Street owned private company and that company won’t take insurance. And those guys are definitely making enough profits that Wall Street is suggesting that people should invest in those companies because of these relationships they have with the in-network hospitals and the out of network emergency rooms. Trump remarks on medical billing-Watch on C-SPAN, May 9, 2019 13:00 President Donald Trump: Today I’m announcing principles that should guide Congress in developing bipartisan legislation to end surprise medical billing. And these senators and congressmen and women that are with us today are really leading the charge. And I appreciate that they’re all here. Thank you all. Thank you all for being here. This is fantastic. And I think it’s going to be a successful charge. From what I understand, we have bipartisan support, which is rather shocking. That means it’s very important. That means it’s very good. But that’s great. First, in emergency care situations, patients should never have to bear the burden of out-of-network costs they didn’t agree to pay. So-called balance billing should be prohibited for emergency care. Pretty simple. Second, when patients receive scheduled, non-emergency care, they should be given a clear and honest bill upfront. That means they must be given prices for all services and out-of-pocket payments for which they will be responsible. This will not just protect Americans from surprise charges; it will empower them to choose the best option at the lowest possible price. Third, patients should not receive surprise bills from out-of-network providers that they did not choose themselves. Very unfair. Fourth, legislation should protect patients without increasing federal healthcare expenditures. Additionally, any legislation should lead to greater competition, more choice — very important — and more healthcare freedom. We want patients to be in charge and in total control. And finally, in an effort to address surprise billing, what we do is, all kinds of health insurance — large groups, small group, individual markets, everything. We want everything included. No one in America should be bankrupted and unexpectedly by healthcare costs that are absolutely out of control. No family should be blindsided by outrageous medical bills. And we’ve gone a long way to stop that. Examining Surprise Billing: Protecting Patients from Financial Pain-Not on C-SPAN, House Committee on Education and Labor, April 2, 2019 Watch on YouTube Witnesses: Christen Linke Young: Fellow at USC-Brookings Schaeffer Initiative on Health Policy Ilyse Schuman: Senior Vice President for Health Policy at American Benefits Council Frederick Isasi, Executive Director at Families USA Professor Jack Hoadley: Research Professor Emeritus at Georgetown University’s Health Policy Institute Transcript 7:15 Chairman Frederica Wilson (FL): This is the first hearing the United States Congress has held on surprise billing. 7:30 Chairman Frederica Wilson (FL): Surprise medical bills occur when patients covered by health insurance are subject to higher than expected out of pocket costs for care, received from a provider who is outside of their plan’s network. The victims of surprised medical billing often have no control over whether they’re medical provider is in or out of network. 8:15 Chairman Frederica Wilson (FL): A young San Francisco woman named Nina Dang suffered a severe bike accident. She was barely lucid when a bystander called an ambulance and took her to an emergency room at a nearby hospital. Before she knew it, doctors had done x-rays and scans and put her broken arm in a splint and then sent her on her way. A few months later, Nina was hit with a $20,000 medical bill because the hospital, which she did not choose, was an out of network facility. 8:30 Chairman Frederica Wilson (FL): But even patients who are able to take precautions to avoid out of network costs during a medical emergency, are not immune from surprise bills. Scott Cohan suffered a violent attack one night in Austin, Texas. He woke up in an emergency room with a broken jaw, a throbbing headache, and staples in his head. Despite his shock and immense pain, Scott took out his phone and searched through his insurer’s website to make sure he was laying in an in-network hospital bed. When he found out it was, he proceeded with unnecessary jaw surgery. Imagine Scott’s frustration and devastation when he received a surprise medical bill for nearly $8,000. It turned out that the emergency room was in his insurance network, but the oral surgeon who worked in the ER was not. 16:00 Rep. Tim Walberg (MI): 39% of insured working age adults reported they had received a surprise medical bill in the past year from a doctor, hospital, or lab that they thought was covered by their insurance. Of the 39% of individuals who received surprise medical bills, 50% owed more than $500. 27:05 Ilyse Schuman: While a number of states have sought to address this problem or risk that exempts self insured plans from State Insurance Regulations to ensure that national employers can offer uniform health benefits to employees residing in different states. Accordingly, the problem of surprise billing cannot be left to the states to solve. 33:20 Frederick Isasi: So what’s most important to remember about this issue? We are talking about situations in which families, despite enrolling in health insurance, paying their premiums, doing their homework and trying to work within the system, are being left with completely unanticipated and sometimes financially devastating healthcare bills. And this is happening in part, and I want to say this really clearly because hospitals, doctors and insurers are washing their hands of their patient’s interest. 33:50 Frederick Isasi: Take for example, one significant driver of this problem. The movement of hospitals to offload sapping requirements for their emergency departments to third party management companies. These hospitals very often make no requirements of these companies to ensure the staffing of the ED fit within the insurance networks that the hospitals have agreed to. As a result, a patient who does their homework ahead of time and rightly thinks they’re going to an in network hospital, received services from an out of network physician and a surprise medical bill follows. 34:20 Frederick Isasi: Let me give you one real world example. Nicole Briggs from Morrison, Colorado outside of Denver. Nicole woke up in the middle of the night with intense stomach pain. She went to a freestanding ER. She was told she needed an emergency appendectomy. She went to a local hospital. She did her due diligence. Confirmed repeatedly that the hospital and its providers were in network. However, months later she received a surprise bill from the surgeon who ended up, was out of network. The bill to Nicole was $5,000. Nicole tried to work it out with her insurance company, but within two years, a collection agency representing the surgeon took her to court and won the full amount, including interest. As a result, a lien was placed on her home and the collection agency garnished her wages each month. This came right before Nicole was about to deliver a baby and go on maternity leave. And by the way, this investigation found that there were over 170 liens placed on people’s homes in the Denver area by emergency department physicians. 38:05 Professor Jack Hoadley: Our research shows that today, 25 states have acted to protect consumers from surprise bills in at least some circumstances. Nine of these 25 meet our standards as offering what we consider to be comprehensive protection. For protections to be comprehensive, we look to number one, whether they apply in both emergency situations and an in-network hospital setting, such as electing an in-network surgeon, but being treated by another clinician who’s out of network. Second, that these laws apply to both HMO’s, PPO’s and all other types of insurance. Third, that the law does address both insurers by requiring them to hold consumer’s harmless from balanced bills and providers by barring them from sending balanced bills. And fourth, that the laws adopt some kind of a payment standard. Uh, either a rule to determine payment from insurance provider or an arbitration process to resolve payment disputes. Although these four conditions don’t guarantee complete protection for consumers, they combine to protect consumers in most emergency and network hospital settings that the states can address. But as you’ve already heard, state protections are limited by federal law, ERISA, which exempt states from state regulation’s, self insured, employer sponsored plans. 43:30 Chairman Frederica Wilson (FL): Under current law, who is responsible for making sure that a doctor or a hospital is in-network? Is it the doctor, the insurance company or the patient themselves? Frederick Isasi: Uh, chairman Wilson, thank you for the question. To be very clear, it is the patient themselves that has a responsibility and these negotiations are very complex. These are some of the most important and intense negotiations in the healthcare sector between a payer and a provider. There is absolutely no visibility for a consumer to understand what’s going on there. And so the notion that a consumer would walk into an emergency department and know, for example, that their doctor was out of network because that hospital could not reach agreement on an in-network provider for the ED is absurd, right? There’s no way they would ever know that. And similarly, if you walk in and you received surgery and it turns out your anesthesiologist isn’t in-network, there’s no way for the consumer to know that. Um, and I would like to say there’s some discussion about transparency and creating, you know, sort of provider directories. We’ve tried to do that in many instances. And what we know is that right now the healthcare sector has no real way to provide real actual insight to consumers about who’s in-network, and who’s out of network. I would-probably everybody in this room has tried at some point to figure out if a doctor’s in-network and out of network and as we know that system doesn’t work. So this idea that consumers can do research and find out what’s happened behind the scenes in these very intensive negotiations is absurd and it doesn’t work. 46:30 Professor Jack Hoadley: Provider directories can be notoriously inaccurate. One of the things that, even if they are accurate, that I’ve seen in my own family is you may be enrolled in Blue Cross-You ask your physician, "are they participating in Blue Cross? They say “yes”, but it turns out Blue Cross has a variety of different networks. This would be true of any insurance company, and so you know, you may be in this one particular flavor of the Blue Cross plan and your provider may not participate in that particular network. 47:30 Christen Linke Young: Notice isn’t enough here. Even if a consumer had perfect information, which is not a reasonable expectation, but even if they did have perfect information, they can’t do anything with that information. They can’t go across town to get their anesthesia and then come back to the hospital. Um, their-even with perfect information, they may be treated by out of network providers. And so we need to set a standard that limits how much providers can be paid in these out of network scenarios that makes it sort of less attractive for providers to remain out of network. And so instead, they are subject to more normal market conditions. 1:01:25 Rep. Phil Roe (TN): I’ve had my name in networks that I wasn’t in. That you-that you use, and many of those unscrupulous networks, will use that too to get people to sign up because this doctor, my doctor is in there when you’re really not. 1:10:25 Frederick Isasi: Um, there is a concept here, which is, what does in network mean, right? When you sit down with your husband or your partner and decide what kind of insurance do we want for our kids, right? We want to make sure that they can go to the ED if they’re playing soccer, they get hurt, all those sorts of things. The question is when you make that decision and you say, "Oh, look, this hospital is in-network, right? But what does that mean? If you can go to that hospital and all the services they’re providing are out of network, right? And I think as you’ve said, and as we’ve heard from other folks, the patient is not the person who should be responsible for that. It’s the folks who are negotiating. It’s the hospital, it’s the doc’s and the payers that should bear that responsibility. So let’s start by clarifying what does in-network mean, so that we have some way of making educated decisions about the insurance that we’re purchasing and putting our trust in. 1:29:30 Professor Jack Hoadley: There may be instances where consumers get bills sent to them, aren’t aware that they don’t need to pay them, so don’t start the process. And that goes to this sort of point of how do you really make sure it’s not the consumer’s responsibility to figure out that, oh, I don’t, by law, I don’t actually have to pay this bill. Now what do I do to make sure that happens? If you don’t know that, uh, that doesn’t really help you. And so what some other states like California has done, is to include a provision that says the provider really can’t send a bill and if they do end up sending a bill and the consumer pays it, there’s an obligation on that provider to refund the amount that was paid back to the consumer. And that’s something we haven’t seen in some of the other states. 1:39:15 Rep. Joe Courtney (CT): ERISA really has to be dealt with if we’re going to really have a comprehensive solution for America’s patients. Is that correct? Ilyse Schuman: That’s exactly right. Um, for the self funded plan too 60% of employer based plans that are not subject to these state laws, like in Connecticut or other states, we have to have a federal solution that addresses ERISA, so that we deal with this problem in a uniform nationwide way. Documentary: This is a clip from the documentary: 911, Toxic Legacy which aired on Canadian CBC 9/10.2006, September 10, 2006 Community Suggestions See Community Suggestions HERE. Cover Art Design by Only Child Imaginations Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)

Emma Sandoe, a PhD student in Health Policy Political Analysis at Harvard University, joins us for a discussion of the Affordable Care Act. Prior to starting her PhD program, Emma spent six years in Washington, DC working on the passage and implementation of the ACA. She served as the spokesperson for Medicaid and HealthCare.gov at the Centers for Medicare & Medicaid Services and worked on ACA coordination at the HHS Budget Office. We start with an overview of the ACA and then review key players in the repeal and replace efforts thus far (5:25); the recent CBO report and the possibility of an insurance premium death spiral (15:00); the likelihood of Trump’s ability to keep his promise to retain the popular provisions of the ACA and what a replacement law might look like (18:00); the ACA’s flaws and some historic context for them (24:12); and give some well-hedged predictions for the coming weeks (32:05). We discuss a report released last week by the Congressional Budget Office projecting what might happen if the ACA is repealed without a replacement, and two articles from healthcare reporter Sarah Kliff looking at potential ACA replacement plans and a story about discontent with the ACA among beneficiaries. Here is a helpful article from New York Times reporter Margot Sanger-Katz looking at what President Trump’s executive order against the ACA might mean. You can find the resources for getting involved Emma mentioned here. Follow us and tweet us your thoughts @RoSpodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email us at contact@rospod.org. We’d love to hear from you. And thanks for listening

Vox's Sarah Kliff has been writing about surprise ER bills for a year, but the practices at Zuckerberg San Francisco General Hospital were unlike anything she had seen before. Her reporting changed them. Learn more about your ad choices. Visit megaphone.fm/adchoices

Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post join KHN’s Julie Rovner to discuss the latest version of a “Medicare-for-all” bill by Sen. Bernie Sanders (I-Vt.), a presidential hopeful, and Democratic and Republican reactions to it. They also discuss the latest on congressional efforts to rein in drug prices and another state effort to expand Medicaid — but not exactly in the way voters wanted. Also, Rovner interviews Ceci Connolly of the Alliance of Community Health Plans.

This week: We kick off our summer interview series with Sarah Kliff, senior policy correspondent at Vox. She discussed her years of U.S. health care coverage, how the GOP's Obamacare repeal attempts are going, and that time she dressed up as the Canadian health care system for Halloween.Catch us back in your feed on July 28.For more, visit buzzfeed.com/newsLearn more about your ad choices. Visit megaphone.fm/adchoices

Sarah Kliff from vox.comhttps://www.patreon.com/EmbraceTheVoidhttps://www.facebook.com/EmbraceTheVoidPod/https://twitter.com/ETVPod

Listen NowSince the remedy to the "fiscal cliff" did not include structural reforms to Medicare and Medicaid and since Congressional Republicans will call for entitlement savings during the upcoming debt ceiling debate and beyond, Ms. Sarah Kliff, Health Reporter for The Washington Post and Ms. Amy Lotven, Editor/Reporter for Inside Health Policy, discuss what reforms to Medicare and Medicaid are on the table during this session of the 113th Congress. During this 32 minute podcast raising the Medicare eligibility age from 65 to 67, Medicare means testing, the Medicare Independent Payment Advisory Board, the Medicare Sustainable Growth Rate (the "doc fix"), reforms to the Medicaid program and other related issues to reduce federal health care spending are discussed.Sarah Kliff covers health policy for the Washington Post. Previously, Sarah wrote for Politico, where she authored Politico Pulse. Prior to Politico, Sarah was a staff writer at Newsweek covering national politics. She is the recipient of fellowships from the Kaiser Family Foundation and USC Annenberg School of Journalism.Amy Lotven has been for the past five years a health policy editor and reporter at Inside Health Policy.  She has worked previously for newspapers in New Mexico, New York and North Carolina. She did her journalism training at Baruch College. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com