Latest news with #Healthcare.gov
New York Times
5 days ago
- Business
- New York Times
Do You Have Obamacare? Tell Us About It.
President Trump's domestic policy bill would make deep cuts to Obamacare that are expected to leave millions uninsured. The changes would make it harder to enroll in coverage and, for many, make plans more expensive. Republicans say these changes are needed to combat fraud and ensure government dollars go only to those who are eligible. Critics of the policies say they are unnecessary red tape that will cause people to lose coverage just because they couldn't gather and verify the necessary documents in time. Times reporters want to hear from the people who use Obamacare for their health coverage to better understand what some of the Republicans' proposed changes would look like. If you buy health insurance through or a state-run marketplace (these all have different names depending on where you live), share what your experience has been so far — and any concerns you have about possible changes — in the form below. We will not publish anything you submit before reaching out to you first.
Yahoo
28-05-2025
- Business
- Yahoo
About 1,100 South Carolinians reported being victims of illegal health plan swapping last year
Director of Insurance Michael Wise testified in front of a House subcommittee on Tuesday, May 27, 2025, that cases where people's health insurance changed made up 22% of all fraud complaints last year. (Screenshot of SCETV legislative livestream) Insurance middlemen who switched South Carolinians' health care plans without telling them accounted for 22% of fraud cases reported to the state Department of Insurance last year, the agency director told legislators Tuesday. Of the 5,000 complaints of fraud reported throughout 2024, 1,100 came from people who signed up for insurance through the online marketplace — created by the Affordable Health Care Act also known as Obamacare — and said their health care plan was changed without permission. That's illegal, but the scam is relatively easy. All it takes is for a licensed broker to have the insured's name, date of birth and home state, said Michael Wise, director of the state Department of Insurance since 2023. The agent pockets the commission, while patients usually have no idea they've been had until they try to use their insurance card at a doctor's office or pharmacy, Wise told a House oversight panel. 'They might switch these policy orders a good many times. And so that has become a trend that we're looking out for,' he said, adding he's heard of plans being switched up to 16 times. It's a national problem, with agents often scamming people from multiple states. The Center for Medicare Services and Medicaid Services, the federal agency that oversees the online marketplace, received 73,884 complaints of unauthorized policy switching in the first six months of last year. That led to the agency announcing last July that it would no longer authorize changes from agents or brokers unless they were already associated with the person's enrollment. Any unassociated or new broker now has to do a three-way call with the customer and a federal call center. 'That has become a trend that we're looking out for. The federal government is too, and some things have been put in place to try to curb that,' Wise told the House subcommittee. In April 2024, KFF Health News reported that CMS emailed a plan to industry representatives to handle complaints from people who'd had their insurance switched. The scam became common enough to get its own acronym: UPS, for unauthorized plan switch. The slideshow says CMS found a 'large number of 2024 UPS cases' involving plans that were auto-renewed because the person was unaware. In South Carolina, cases are under investigation, but no one has been charged yet with a crime related to the scam, said Jason Spencer, a prosecutor for the Department of Insurance. He did not specify how many cases remain open. Spencer added that Florida seems to be a hotbed for agents doing this and he's in regular contact with that state's Department of Insurance. The scam involving health plans subsidized through the federal marketplace started popping up in 2022 and were initially sparse, Spencer told the SC Daily Gazette. By 2023, it had become a trend. Then in 2024, the complaints skyrocketed, he said, though he didn't have the exact numbers. 'It took a steep jump very quickly,' he said. Brokers typically make $20 to $25 for every person they enroll and can make that commission multiple times from the same person, according to KFF Health News. 'They could sign that same person up for another plan again, and that was how they were just continuing to churn commissions,' Spencer said. He explained that the scammer and victim often never talk to each other. A licensed broker can get information from the federal database. But sometimes the rogue agents will call their victims, claiming they're signing people up for a survey, saying they could win a potential prize, when they are actually gathering potential information to switch their insurance policies. 'They would be in contact with somebody that's advertising discount cards or gift cards — 'Oh, just sign up for this survey' — and they don't really pay attention to what they are signing up for,' Spencer said. 'The person who's actually supposed to be insured doesn't have any idea any of this is going on until they go to their doctor, and their doctor's like, 'Oh, well, where's your copay?'' Spencer said. Spencer's recommendation for avoiding the surprise: Read your mail, especially if it's from an insurance company. 'If you get something in the mail that looks like it's from some insurance company that you're like 'Oh, I don't have any business with them,' don't just assume it's junk mail and throw it away,' he said. 'Read that and make sure that you didn't accidentally get signed up for something.'
WIRED
08-04-2025
- Health
- WIRED
Dr. Oz Pushed for AI Health Care in First Medicare Agency Town Hall
Apr 8, 2025 4:21 PM Dr. Oz, who now controls the Centers for Medicare and Medicaid Services and its $1.5 trillion budget, promoted the idea that AI avatars could replace frontline health care workers. Photo-Illustration: Wired Staff;Dr. Mehmet Oz, the new administrator for the Centers for Medicare and Medicaid Services (CMS), spent much of his first all-staff meeting on Monday promoting the use of artificial intelligence at the agency and praising Robert F. Kennedy Jr.'s 'Make America Healthy Again Initiative,' sources tell WIRED. During the meeting, Oz discussed possibly prioritizing AI avatars over frontline health care workers. Oz claimed that if a patient went to a doctor for a diabetes diagnosis, it would be '$100' per hour, while an appointment with an AI avatar would cost considerably less, at just '$2' an hour. Oz also claimed that patients have rated the care they've received from an AI avatar as equal to or better than a human doctor. (Research suggests patients are actually more skeptical of medical advice given by AI.) Because of technologies like machine learning and AI, Oz claimed, it is now possible to scale 'good ideas' in an affordable and fast way. CMS did not immediately respond to a request for comment. CMS has explored the use of AI for the last several years, according to archived versions of an agency website dedicated to the topic, and the agency released an updated 'AI Playbook' in 2022. But those efforts appear to have focused on finding ways to leverage vast CMS data sets, rather than involving AI directly in patient care. The Senate confirmed Oz as CMS's new administrator on April 3. CMS, which runs Medicare, Medicaid, and is part of the Department of Health and Human Services (HHS), where health care conspiracist RFK Jr. currently serves as department secretary. CMS spent more than $1.5 trillion in fiscal year 2024, which accounted for more than one-fifth of total government outlays. The agency employs nearly 7,000 employees, and provides health care coverage for almost half of the US. Current CMS employees describe the agency as 'the most policy-dense organization in government' where the administrator must make decisions on where to spend billions of dollars on certain treatments in a zero-sum environment. 'Please join incoming CMS Administrator Dr. Mehmet Oz and other senior leaders to learn more about his vision and priorities for CMS,' stated the meeting description, which was called for Monday at 1:00 pm EST. 'This is an internal event, and all CMS staff are invited to participate virtually. Staff who are onsite at CMS office locations should consider gathering in available offices or conference space.' Oz has seemingly never worked in health care policy before, but served as a physician for many years before becoming the star of The Dr. Oz Show. He has promoted a number of provably incorrect medical tips—including the use of hydroxychloroquine and chloroquine as a treatment for COVID—and weight-loss pills that Oz admitted in a 2014 Senate subcommittee hearing 'don't have the scientific muster to present as fact.' He also unsuccessfully ran for a Senate seat in Pennsylvania, losing against current senator John Fetterman. At the meeting, Oz spoke extensively about his family's history, the origins of his name, and his educational background at Harvard and the University of Pennsylvania (including his football career), before talking about CMS. Oz told CMS employees that it was their 'patriotic duty' to take care of themselves as it would help decrease the cost of health care, citing the costs of running Medicare and Medicaid throughout the country. (During his Senate confirmation hearing for CMS administrator, Oz also claimed 'it is our patriotic duty to be healthy,' connecting personal exercise to the overall reduction of expenses for Medicare and Medicaid.) Oz spoke at length during the meeting about "obesity" in the US and what it costs CMS, without citing any provable statistics. He said that addressing obesity was one of his top priorities. (The Biden administration had suggested that Medicare and Medicaid cover costs for weight loss drugs, an initiative that the Trump administration has so far declined to expand. Oz has repeatedly drawn criticism for promoting 'miracle' weight-loss cures on the Dr. Oz Show.) 'I'm not sure he knows what we do here,' said one CMS employee who listened to the call. 'He was talking about nutrition and exercise. That's not what Medicare does. We care for people in nursing homes. We deal with dying people.' When asked how he would prefer to be briefed on complex policy issues, Oz told staffers, You'll find that I am not purposely but deliberately naive about a lot of issues . Sources tell WIRED that this seemed to them like a roundabout way for Oz to say that he is focused not on personal or political motivations, but the facts. Oz also claimed that CMS needed to do a better job of addressing 'fraud and waste' at the agency, two purported targets of Elon Musk and his so-called Department of Government Efficiency. Oz also endorsed MAHA: Make America Healthy Again, an HHS priority that was originally a cornerstone of RFK Jr's 2024 presidential campaign. In the CMS meeting, Oz stated that MAHA is all about "curiosity." (Kennedy, who has championed MAHA, has also repeatedly and dangerously promoted anti-vaccine opinions, doctors, and activists.) 'Reinforcements are coming to the agency,' Oz said, speaking of doctors and clinicians he claims have been left behind or left out of CMS's work; or even those who wouldn't have previously wanted to work at CMS before. The idea of bringing new people to CMS, where hundreds of employees were recently fired as part of a sweeping reduction in force (RIF) at HHS, was upsetting to those who were present at the meeting. 'That was frankly insulting to the CMS staff,' says a source. 'We have incredible people here.'
Yahoo
10-03-2025
- Health
- Yahoo
After a record flu season, cases are beginning to decline in Wisconsin
Wisconsin's current flu season has been one of its worst in the past decade, though recent Wisconsin Department of Health Services data shows statewide activity is beginning to decline. The severe flu season follows a nationwide trend. Lagging vaccination rates, more severe viral strains and holiday travel are all to blame for the record spread, experts say. All regions across the state are still experiencing high flu activity, though DHS' surveillance measures are showing a "gradual decline," DHS Respiratory Disease Epidemiologist Tom Haupt told the Journal Sentinel in an email Wednesday. For the week ending March 1, DHS data shows a similar trend for general respiratory illness activity levels statewide. DHS laboratory test data for the week of Feb. 16 to Feb. 22 showed 4,899 positive flu tests — 29% of the 16,895 total tests run. The following week, from Feb. 23 to March 1, there were 4,567 positive tests, or 25.2% of the 18,108 tests run. There were 533 reported hospitalizations for the week ending March 1, down from 653 reported for the week ending Feb. 22, according to the new DHS hospitalization data webpage. Haupt confirmed influenza type A is still the dominant viral strain spreading in Wisconsin. Here's what to know: The two most common — and most severe — flu strains are A and B, the U.S. Centers for Disease Control and Prevention says. Type A is known to cause more severe illness. Flu A typically starts in the fall and peaks around February or March, though it can last through April. More: Flu cases are high in Wisconsin. What's the difference between flu A and flu B? Here's a look at influenza activity by region, according to DHS data: Northeastern region: Very high activity but decreasing Northern region: High activity but decreasing Southeastern region: High activity but decreasing Southern region: High activity but decreasing Western region: Very high activity but decreasing More: Wisconsin is seeing among its worst flu seasons of the past decade. Here's why Haupt emphasized it is "never too late" to get vaccinated against the flu and COVID-19, as well as RSV for infants — and adults meeting eligibility requirements. To schedule a vaccination appointment, you can reach out to your primary care provider, local or Tribal health departments and community clinics. You can also visit or call 211 or 877-947-2211. If you don't have health insurance, you can check your eligibility for the state's free vaccine programs for children and adults, according to DHS. You can also visit for more options. To protect yourself from such illnesses, you should also: Wash your hands often with soap and warm water for 20 seconds or use an alcohol-based hand sanitizer Clean and disinfect frequently touched surfaces Avoid being around those who are ill Gather outside when possible Wear a high-quality mask In addition to the above, if you end up catching a respiratory illness, DHS says you should: Cover your mouth and nose with a tissue when coughing or sneezing, then disposing of the tissue Stay home when symptomatic, except if you need medical care Maia Pandey contributed to this report. More: Two states have reported recent measles outbreaks. Is Wisconsin at risk? This article originally appeared on Milwaukee Journal Sentinel: Flu season 2025: Activity is still high, but decreasing in Wisconsin
Yahoo
06-03-2025
- Business
- Yahoo
How 18F transformed government technology − and why its elimination matters
the government health insurance marketplace website, launched in October 2013 only to buckle under the weight of just 2,000 simultaneous users. As millions of Americans stared at error messages and frozen screens, a political crisis unfolded, but so did a new era of government technology. The result was 18F, an in-house digital services consulting agency that brought Silicon Valley expertise to government, challenging decades of outdated procurement practices and introducing a radical new approach to building digital public services. Founded on March 19, 2014, by Presidential Innovation Fellows, 18F was housed within the Technology Transformation Services department of the General Services Administration, or GSA. The name 18F was derived from the address of GSA headquarters: 1800 F Street. On March 1, 2025, just a few weeks shy of 18F's 11th anniversary, the Trump administration eliminated the agency and laid off its staff. As a researcher who studies public administration and technology, I have observed the transformational role 18F played in government digital services. The unit's elimination raises the question of what the future of those services will look like. 18F served a unique role as an in-house digital consultancy for the U.S. government, drawing on innovative strategies to improve public service through technology. Within 18F, teams consisting of designers, software engineers, strategists and product managers worked together with federal, state and local agencies to not only fix technical problems but to build, buy and share technology that helped to modernize and improve the public's experience with government services. Over nearly 11 years, 18F built an impressive portfolio of successful digital projects that transformed how people interact with the U.S. government. Even if the average person is unfamiliar with 18F, the odds are quite high that they have at least encountered one of its many products or services. For example, 18F supported the Internal Revenue Service in creating IRS Direct File, a free online tax filing tool that provides taxpayers with a simplified filing process. As of today, IRS Direct File is available in 25 states and is expected to serve 30 million eligible taxpayers during the 2025 tax filing season. 18F has been pivotal in modernizing and securing digital systems to help create more streamlined and secure user experiences for the public. For instance, is a secure single sign-on platform that simplifies access to multiple government services for users. Perhaps the most notable of 18F's modernization efforts that touches nearly every aspect of government today is the U.S. Web Design System. The comprehensive design system was developed in collaboration with the U.S. Digital Service in 2015. It helps support dozens of agencies and makes nearly 200 websites more accessible and responsive to user needs. What set 18F apart was its approach. Rather than spending years on giant information technology contracts that often failed to deliver, 18F championed agile development. Agile and lean methodologies have been popular in Silicon Valley startups and software companies for decades due to their flexibility and focus on rapid iteration. By applying agile development principles, 18F focused on breaking down large projects into manageable pieces with incremental improvements based on frequent user feedback. This approach allowed continuous adaptation spurred by user feedback and changing requirements while reducing risk. Another cornerstone of 18F's innovative approach was its focus on user-centered design. By focusing on the needs of the people who actually used government services, 18F was able to go beyond merely satisfying technical requirements to design digital products that were more accessible and user-friendly. The idea was to understand the end users and the problems they encountered in order to effectively design products and solutions that addressed their needs. It also aimed to provide a consistent user experience and earn the users' trust in the services. By prioritizing open-source development and collaboration, 18F also helped to make government IT more affordable. Making project code transparent meant that agencies could reuse the code and reduce the cost of duplicate development efforts across agencies and levels of government. 18F also had a hand in helping agencies develop their own technology capacity, whether by teaching them how to build software using open-source development and agile methodologies or by teaching agencies how to hire and oversee technology vendors themselves. This model was especially beneficial for state and local agencies following 18F's expansion in 2016 to provide services to state and local government agencies that receive federal funding. The elimination of 18F marks the end of an era, raising concerns about both current and future technology projects. As of now, there does not appear to be a succession plan, leaving many federal agencies without ongoing support for their digital transformation efforts. Critics also argue that the loss of 18F means the loss of significant technical expertise within the government. These changes come at a time when agencies are experiencing substantial personnel shifts, rendering digital services potentially even more critical. As agencies brace for more personnel cuts, the public may need to rely more on digital services to fill the gap amid growing staffing shortages. Since the news was announced, current and former 18F team members as well as advocates of the unit have taken to social media platforms, including X (formerly Twitter), Bluesky, and LinkedIn, to share stories of its successes, honor its legacy and share 18F resources. This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Kayla Schwoerer, University at Albany, State University of New York Read more: Efficiency − or empire? How Elon Musk's hostile takeover could end government as we know it Is DOGE a cybersecurity threat? A security expert explains the dangers of violating protocols and regulations that protect government computer systems President Trump promises to make government efficient − and he'll run into the same roadblocks as Presidents Taft, Roosevelt, Roosevelt, Truman, Eisenhower, Carter, Reagan, Clinton and Bush, among others Kayla Schwoerer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
