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How Texas abortion law turned a pregnancy loss into a medical trauma : Shots

August 22, 2022 Dania

Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks.

Julia Robinson for NPR

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Julia Robinson for NPR

New, untested abortion bans have made doctors unsure about treating some pregnancy complications, which has led to life-threatening delays and trapped families in a limbo of grief and helplessness.

Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law.

She and her husband began trying in late 2021. They had bought a house in Kingwood, a lakeside development in Houston. Elizabeth was in graduate school for political science, and James taught middle-school math.

The Wellers were pleasantly surprised when they got pregnant early in 2022.

In retrospect, Elizabeth says their initial joy felt a little naive: “If it was so easy for us to get pregnant, then to us it was almost like a sign that this pregnancy was going to be easy for us.”

Things did go fairly smooth at first. Seventeen weeks into the pregnancy, they learned they were expecting a girl. They also had an anatomy scan, which revealed no problems. Even if it had, the Wellers were determined to proceed.

“We skipped over the genetic testing offered in the first trimester,” Elizabeth says. “I was born with a physical disability. If she had any physical ailments, I would never abort her for that issue.”

Elizabeth thought of abortion rights in broad terms: “I have said throughout my life I believe that women should have the access to the right to an abortion. I personally would never get one.”

And at this particular point in her life, pregnant for the first time at age 26, it was still somewhat abstract: “I had not been put in a position to where I had to weigh the real nuances that went into this situation. I had not been put in the crossroads of this issue.”

But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. There they found themselves pinned down, clinically and emotionally, victims of a collision between standard obstetrical practice and the rigid new demands of Texas law.

It was May 10, 2022. Elizabeth was 18 weeks pregnant. She ate a healthy breakfast, went for a walk outside and came back home.

In the nursery upstairs, they had already stashed some baby clothes and new cans of paint. Down in the kitchen, images from recent scans and ultrasounds

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Surprise medical bills are the target of a new law. Here’s how it works : Shots

February 7, 2022 Dania

The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

J. Scott Applewhite/AP

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J. Scott Applewhite/AP

The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

J. Scott Applewhite/AP

The new year brings new protections for patients with private health insurance who will no longer be blindsided by “surprise” medical bills when they unknowingly receive out-of-network care.

The No Surprises Act, passed by Congress in 2020 as part of the coronavirus relief package, takes effect Jan. 1.

It generally forbids insurers from passing along bills from doctors and hospitals that are not covered under a patient’s plan — such bills have often left patients to pay hundreds to tens of thousands of dollars in outstanding fees. Instead, the new law requires health care providers and insurers to work out a deal between themselves.

Here’s how the law will work and how it might affect insurance premiums and the health care industry.

It may slow premium growth

Some observers have speculated that the law will have the unintended consequence of shifting costs and leading to higher insurance premiums. But many policy experts told KHN that, in fact, the opposite may happen: It may slightly slow premium growth.

The reason, said Katie Keith, a research faculty member at the Center on Health Insurance Reforms at Georgetown University, is that a new rule released Sept. 30 by the Biden administration appears to “put a thumb on the scale” to discourage settlements at amounts higher than most insurers generally pay for in-network care.

That rule, which provides more details on the way such out of network disputes will be settled under the No Surprises Act, drew immediate opposition from hospital and physician groups. The American Medical Association called it “an undeserved gift to the insurance industry,” while the American College of Radiology said it “does not reflect real-world payment rates” and warned that relying on it so heavily “will cause large imaging cuts and reduce patient access to care.”

In early December, the AMA, joined by the American Hospital Association, filed a lawsuit challenging a part of that rule that outlines the factors that arbitrators should consider in determining payment amounts for disputed out-of-network bills. The case does not seek to halt the entire law, but does want changes to that provision, which it says unfairly benefits insurers. Later in the month, groups representing emergency physicians, radiologists and anesthesiologists filed a similar lawsuit.

Such tough talk echoes comments made while Congress was hammering out the law.

Doctors are mad about surprise billing rules. Becerra says stop gouging patients

Unsettled bills will go to arbitration

The No Surprises Act takes aim at a common practice: large, unexpected “balance bills” being sent to insured patients for services such as emergency treatment at out-of-network hospitals or via air ambulance companies. Some patients get bills even after using in-network facilities because they receive care from a doctor there who has not signed on

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New CA law takes aim at long wait times for mental health care : Shots

November 24, 2021 Dania

When Greta Christina heard that Kaiser Permanente mental health clinicians were staging a protest on Oct. 13, 2019, over long wait times for therapy, she made her own sign and showed up to support them. She’s had to wait up to six weeks between therapy appointments for her depression.

Ingrid Nelson

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Ingrid Nelson

When Greta Christina fell into a deep depression five years ago, she called up her therapist in San Francisco — someone she’d had a great connection with when she needed therapy in the past. And she was delighted to find out that he was now “in network” with her insurance company, meaning she wouldn’t have to pay out of pocket anymore to see him.

But her excitement was short-lived. Over time, Christina’s appointments with the therapist went from every two weeks, to every four weeks, to every five or six.

“To tell somebody with serious, chronic, disabling depression that they can only see their therapist every five or six weeks is like telling somebody with a broken leg that they can only see their physical therapist every five or six weeks,” she says. “It’s not enough. It’s not even close to enough.”

Then, this summer, Christina was diagnosed with breast cancer. Everything related to her cancer care — her mammogram, biopsy, surgery appointments — happened promptly, like a “well-oiled machine,” she says, while her depression care stumbled along.

“It is a hot mess,” she says. “I need to be in therapy — I have cancer! And still nothing has changed.”

A new law signed by Gov. Gavin Newsom in October aims to fix this problem for Californians. Senate Bill 221, which passed the state Legislature with a nearly unanimous vote, requires health insurers across the state to reduce wait times for mental health care to no more than 10 business days. Six other states have similar laws limiting wait times, including Colorado, Maryland, and Texas.

Unequal access to behavioral health care is pervasive

Long waits for mental health treatment are a nationwide problem, with reports of patients waiting an average of five or six weeks for care in community clinics, at the VA, and in private offices from Maryland to Los Angeles County. Across California, half of residents surveyed said they have to wait too long to see a mental health provider when they need one.

At Kaiser Permanente, the state’s largest insurance company, 87% of therapists said weekly appointments were not available to patients who needed them, according to a survey by the National Union of Healthcare Workers, which represents Kaiser’s therapists — and was the main sponsor of the legislative bill.

“It just feels so unethical,”

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