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While legislation is critical in preventing health plan barriers, consumers also play a role. By knowing their rights, appealing denials, and fighting back, patients can stand up for themselves. But first they need to know that is an option. A recent Kaiser Family Foundation report looked at data on claim denials and appeals from the Centers for Medicare and Medicaid Services. Among other findings, the report showed that consumers rarely appeal claims that have been denied. In 2017, 121 major health insurance issuers denied a total of more than 42 million claims. Consumers appealed less than 200,000 (0.05%) of these denials. Although consumers have the right to bypass their insurer’s internal appeals process and go directly to an external review, this happens in fewer than 1 in 11,000 denied claims (0.009%). (Liz Helms, 5/17)

Surprise medical bills are in the news almost daily. Last Thursday, the White House called for legislation to protect patients from getting surprise doctor bills when they are rushed to the emergency room and receive care from doctors not covered by insurance at an in-network hospital. The financial burden on patients can be substantial — these doctor charges can amount to hundreds or even thousands of dollars.  What’s behind this explosion of outrageous charges and surprise medical bills? Physicians’ groups, it turns out, can opt out of a contract with insurers even if the hospital has such a contract. The doctors are then free to charge patients, who desperately need care, however much they want. (Eileen Appelbaum, 5/16)

As calls for radical health reform grow louder, many on the right, in the center and in the health care industry are arguing that proposals like “Medicare for all” would cause economic ruin, decimating a sector that represents nearly 20 percent of our economy. While exploring a presidential run, the former Starbucks chief Howard Schultz called Medicare for all “not American,” adding, “What industry are we going to abolish next — the coffee industry?” He said that it would “wipe out the insurance industry.” (Elisabeth Rosenthal, 5/16)

In 2015, after extensive public and congressional pressure, the National Institutes of Health (NIH) cut funding for experiments on chimpanzees and began retiring them to sanctuary. Now, in a historic move, Congress is asking the NIH to begin to do the same for the thousands of other primates in its taxpayer-funded laboratories, and it’s about time. Last year, approximately 7,000 baboons, marmosets, macaques and other primates were confined and experimented on by the NIH. Unfortunately, primate research at the NIH is growing despite policies requiring the reduction and replacement of animal testing. (Stacy Lopresti-Goodman, 5/16)

A national for-profit marijuana industry is expanding substantially in the United States. Thirty-three states have legalized medical marijuana, 10 of which (where 1 in 4 individuals reside) have also legalized recreational marijuana. Sales of marijuana are projected to increase from $8.5 billion to $75 billion by 2030, rivaling current tobacco sales ($125 billion). The initial marijuana marketplace was limited to a few states, but emerging brands have developed sophisticated national marketing campaigns that could potentially have an effect across state lines. This marketplace expansion, along with questionable marketing practices, introduces a need for federal action. (John W. Ayers, Theodore Caputi and Eric C. Leas, 5/16)

Health care is lagging behind other industries in its approaches to data science, in part because it is relatively new to big data. By learning from the intelligence community, the health sector can accelerate progress and capitalize on existing innovations. (Kevin Vigilante, Steve Escaravage and Mike McConnell, 5/16)

Underfunding the public defender is politically popular because it’s hard to find much sympathy for people who get arrested. But a fair criminal justice system does more than prosecute the guilty. It also protects the innocent, which means all of us. (5/15)