Unbiased Analysis of Today's Healthcare Issues
That is the question a new paper by Chambers et al. (2025) aims to answer. The authors use data from the Specialty Drug Evidence and Coverage (SPEC) Database, which contains coverage policies related to specialty pharmacy for a large number of US health plans, to examine how n=25 cell and gene therapies are being covered…
Michael Cannon makes the convincing case that the answer is a resounding ‘no’. Those who say that private health insurance companies are evil entities that profit from denying health care to patients fail to appreciate that private health insurance companies are in fact a wondrous force for good.Outrageous? Not at all. Health insurance companies get…
From the Peterson-KFF Health System Tracker: Most ACA Marketplace insurers are requesting premium increases in the 10-20% range for 2026. But more than a quarter (27%) of insurers are proposing premium increases of 20% or more for 2026. What individuals will pay for this insurance, however, is much higher because of the expiration of the…
This is a question I can’t answer with certainty. Patients often believe that since I’m part of the health-care system, I would know. But I don’t, not as a doctor — and not even when I’m a patient myself. In the United States, health insurance is so extraordinarily complicated, with different insurers offering different plans,…
It looks like the answer is ‘yes’. KFF reports that Holden Karau, a software engineer from the San Francisco Bay Area, created an AI tool to help appeal insurance denials. She calls it: Fight Health Insurance, How does it work? You’ve gotta make a scan of the denial letter from your insurance company, and run…
According to a recent paper by Lennon et al. (2023), about half of the increase in health insurance exchange coverage due to ACA was from individuals who otherwise would have purchased private insurance. The study abstract is below. The Affordable Care Act (ACA) provided funding to help states expand Medicaid eligibility to those earning up…
Adverse selection is a classic problem in health insurance. If you offer insurance to individuals, you may want to set the premiums based on the average price of the population you plan to cover. At this price, however, the sickest patients are the ones most likely to take up insurance and the health insurer’s expenses…
A paper by Hanson et al. (2023) summarizes the Congressional Budget Office’s projections around US health insurance coverage between 2023-2033. They find that low rates of uninsurance due to provisions enacted to combat COVID-19 will not be sustained as these provisions expire: Temporary policies enacted in response to the COVID-19 pandemic have increased Medicaid and…
According to a 2022 CBO report, healthcare spending per person is much higher for commercially insured individuals than those insured by Medicare and this difference is largely drive by price differentials. Why are the outstanding research questions related to the prices commercial insurers pay providers? That is the topic of a recent Health Affairs article…
For many individuals with employer-provided health insurance, a recent paper by Liu and Sydnor (2022) find that this is indeed the case. The authors use data from the 2011-2016 Kaiser Family Foundation (KFF) Employer Health Benefits Survey (EHBS). The authors examine the maximum out-of-pocket cost (including both premiums and maximum cost-sharing) as well as whether…