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Some providers and patients have encountered much frustration from the challenges of prior authorization and other cost-saving measures of insurers. KFF Health News published an article of how enough people in Montana have been exasperated by insurers' practices that the there is now bipartisan legislation being considered to regulate different aspects of prior authorization.

Some providers and patients have encountered much frustration from the challenges of prior authorization and other cost-saving measures of insurers. KFF Health News published an article of how enough people in Montana have been exasperated by insurers' practices that the there is now bipartisan legislation being considered to regulate different aspects of prior authorization.

In principle, prior authorization helps protect against fraudulent providers who bill for unnecessary procedures by giving insurers a way of preemptively denying certain treatments that they deem unnecessary. However, the cost of prior authorization (paperwork and delays) is borne by many physicians and patients, not just ones that try to cheat the system. Additionally, others have noted that some insurers spend very little time reviewing decisions, adding costs to the system by asking doctors to appeal denials. In the article, one doctor is quoted as saying that she spends twelve hours a week on prior authorization -- which seems excessive.

Proposed remedies include eliminating "retroactive denials -- when insurers refuse to pay for treatment they'd authorized" (unclear why that practice is allowed) and prohibiting requiring prior authorization for most generic drugs. Although not proposed in the article, perhaps another way of handling the issue is to set up an state-level arbitration committee, and make it easy for doctors to appeal to them, potentially trigger fines for insurers when the committee rules in favor of the patient. It is understandable that more patient-friendly practices will result in higher costs, but perhaps there could be some system-level savings when doctors and insurers need not spend as much time arguing about approval for specific treatments.

KFF Health News published a profile piece of one woman, Gloria Sachdev, who has worked over the years to reduce the growth of healthcare costs in Indiana. She pushed to get a baseline of how healthcare costs in Indiana compared to those of other states: "Rand published a study in 2019 that analyzed the prices paid by private health plans to more than 1,500 hospitals across the nation. ... Indiana landed at the top of the list, with the highest hospital prices among the 25 states initially studied." Since then, the state legislature "enacted laws to combat consolidation, banning large hospital systems from tacking on extra fees, restricting employers from imposing non-compete contracts on primary care physicians, and requiring health care companies to report pending mergers to the state's attorney general." Since then, "Indiana had fallen from the top spot to the state with the ninth-highest prices."

KFF Health News published a profile piece of one woman, Gloria Sachdev, who has worked over the years to reduce the growth of healthcare costs in Indiana. She pushed to get a baseline of how healthcare costs in Indiana compared to those of other states: "Rand published a study in 2019 that analyzed the prices paid by private health plans to more than 1,500 hospitals across the nation. ... Indiana landed at the top of the list, with the highest hospital prices among the 25 states initially studied." Since then, the state legislature "enacted laws to combat consolidation, banning large hospital systems from tacking on extra fees, restricting employers from imposing non-compete contracts on primary care physicians, and requiring health care companies to report pending mergers to the state's attorney general." Since then, "Indiana had fallen from the top spot to the state with the ninth-highest prices."

It seems that the fight against consolidation of hospitals and health systems is a major factor in the apparent success. Consequently, the legislature is now considering repealing its Certificate of Public Advantage law, which apparently allows proposed mergers to be "shielded from federal anti-monopoly restrictions."

KFF Health News reported on some current differences between telehealth and traditional medicine. On one hand, in areas that might not have as many providers, telehealth might offer some convenient options. On the other hand, one patient that turned to telehealth for mental health noted that "There is no comforting face to validate you."

KFF Health News reported on some current differences between telehealth and traditional medicine. On one hand, in areas that might not have as many providers, telehealth might offer some convenient options. On the other hand, one patient that turned to telehealth for mental health noted that "There is no comforting face to validate you."

One professor of public health suggested that telehealth might work better for situations in which the patient already knows what he or she wants (e.g. birth control), and seeks a prescription. In that case, the healthcare professional can help ensure medication safety. Critics of telehealth warn that telehealth offerings "may shortchange patients in need of close, sensitive attention."

Telehealth still seems relatively new as an industry. It may indeed turn out that telehealth can fill certain niches, just as clinics at pharmacies might fill. Or, perhaps telehealth will turn out to be more broadly effective.

KFF Health News published an article about how the new White House administration may allow current insurance premium subsidies to expire and the effect that decision might have on those who buy insurance from California's health insurance marketplace. According to some researchers, "Covered California premiums for subsidized enrollees would soar by an average of $967 a year beginning in 2026, and an estimated 69,000 Californians would lose their insurance." Tragic as that might seem, the underlying issue appears to be the cost of healthcare, which in turn, drives up premiums. For context, "California took its own steps last year to make coverage more affordable, eliminating deductibles and reducing other out-of-pocket costs on all mid-tier policies."

KFF Health News published an article about how the new White House administration may allow current insurance premium subsidies to expire and the effect that decision might have on those who buy insurance from California's health insurance marketplace. According to some researchers, "Covered California premiums for subsidized enrollees would soar by an average of $967 a year beginning in 2026, and an estimated 69,000 Californians would lose their insurance." Tragic as that might seem, the underlying issue appears to be the cost of healthcare, which in turn, drives up premiums. For context, "California took its own steps last year to make coverage more affordable, eliminating deductibles and reducing other out-of-pocket costs on all mid-tier policies."

The article explains, "While federal and state subsidies have significantly boosted the amount of assistance available, the underlying cost of insurance has continued to go up. Covered California premiums are up by 7.9% on average for 2025, but the extra subsidies shield most enrollees from the increase." So the government subsidies certainly help individuals in the short term, but do not do anything to slow the growth of healthcare costs in the whole system.

KFF Health News reported on a long-term trend that the US lacks enough primary care doctors: "The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care doctors by 2036. This means many Americans will lose out on the benefits of primary care, which research shows improves health, leading to fewer hospital visits and less chronic illness."

KFF Health News reported on a long-term trend that the US lacks enough primary care doctors: "The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care doctors by 2036. This means many Americans will lose out on the benefits of primary care, which research shows improves health, leading to fewer hospital visits and less chronic illness."

The article explains that other specialties pay more (in the case of orthopedics and dermatology, about twice as much), and that other specialties garner more respect. The salary differential could be meaningful for some who start their careers heavily in debt because of medical school. Some medical schools now eliminate tuition, which might give some students more freedom to choose. However, free tuition seems unlikely to be enough to balance out the field. Instead, a professor of medicine conveyed that "the U.S. health care system must address the low pay and lack of support."