A Few Good Issues From 2025 (Actually)

Dan Weissmann

Huge cuts to medical analysis and Medicaid. Waves of layoffs throughout the Division of Well being and Human Providers. Ongoing uncertainty round federal subsidies to purchase medical insurance on Reasonably priced Care Act marketplaces. 2025 has been a tough yr for federal well being packages.

However in the meantime, within the states, there have been some wins for well being care entry. “An Arm and a Leg” host Dan Weissmann examines how lawmakers from throughout the political spectrum achieved significant reforms. This episode takes listeners to Nebraska, which instituted aggressive new restrictions on prior authorization, and Virginia, the place lawmakers banned wage garnishment and capped rates of interest for sure medical money owed.

Dan Weissmann

@danweissmann

Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought-about, Market, the BBC, 99 % Invisible, and Reveal, from the Heart for Investigative Reporting.

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Emily Pisacreta
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Transcript: A Few Good Issues From 2025 (Actually)

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Dan: Hey there, you don’t want me to let you know. 2025 has been loads.

I imply, simply with well being care: As I report this, the US authorities has been shut down for greater than a month over whether or not to increase medical insurance subsidies that greater than 20 million individuals depend on.

I imply, if Congress resolves this tomorrow– and I’m not holding my breath–it’s nonetheless gonna be an enormous mess.

And I may positively go on. However I’m not gonna do this.

As an alternative, I’ve been spending my time these previous few weeks what’s occurred this yr that didn’t suck and what we will be taught from that.

And it seems, on the state stage, there’s loads to take a look at.

All around the nation, state governments took motion this yr to make issues suck rather less — on issues like medical debt and medical insurance and the value of medicine.

And it occurred dozens of occasions this yr in numerous states.

Nebraska Newscaster: New tonight, new Nebraska laws will make it simpler for sufferers to entry healthcare.

Maine Newscaster: We’re in your aspect tonight as a brand new regulation aimed toward defending Maine shoppers from the impacts of medical debt goes into impact.

Virginia newscaster: Virginians are just one medical disaster away from chapter in response to advocates. That’s why the Common Meeting handed a invoice to create some protections for individuals dealing with medical debt.

Dan: And I’ve been speaking with individuals who helped get new non-sucky legal guidelines handed this yr. In pink states, blue states, purple states.

And I can’t wait to start out introducing you to a few of these people and to share what I’ve discovered about what they obtained completed — and possibly most essential: how they did it…’trigger we want extra non-sucky legal guidelines handed in as many locations as potential.

That is An Arm and a leg, a present about why well being care prices so freaking a lot, and what we will possibly do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So the job we’ve chosen on this present is to take one of the crucial enraging, terrifying, miserable components of American life and produce you a present that’s entertaining, empowering, and helpful.

Right here. Let me introduce you to anyone.

Eliot Bostar: My identify is Eliot Bostar and I’m a legislator in Nebraska. I signify Legislative District 29, which covers primarily South Lincoln, our capital metropolis.

Dan: I assumed Nebraska was fascinating. One ’trigger it’s a state we don’t hear from as typically. It’s not a blue coastal state.

Eliot Bostar: Regardless of the reverse of that’s, that’s what we’re. Sure.

Dan: And Eliot Bostar sponsored and handed laws this yr imposing new guidelines on prior authorization.

That’s the place your physician or your supplier tells you you want one thing, a drug, a check, a process, and the insurance coverage firm comes again and says, yeah, not so quick. Your supplier has to point out us why that’s essential.

And look, simply to zoom out:

There’s an argument right here that not all the pieces that will get prescribed or ordered is definitely essential and even acceptable. However in observe, prior authorization may end up in therapy getting delayed or denied in ways in which appear arbitrary and unreasonable and which have massive penalties.

In a latest survey from the American Medical Affiliation, nearly 30% of docs stated issues with prior authorization had led to a affected person getting hospitalized or turning into completely disabled, or sustaining different everlasting harm, or nearly dying, or truly dying.

Amy Killelea is a professor with Georgetown College’s Heart on Well being Insurance coverage Reforms.

They’re a part of a analysis staff monitoring prior authorization, and at any time when they provide a chat to school college students, to coverage nerds, to teams of sufferers with circumstances like diabetes, they’ll say this.

Amy Killelea: Increase your hand when you’ve ever had an issue or um, an emotional response to prior authorization, and each hand within the room goes up. It’s so ubiquitous. It’s one thing that everyone can relate to on like a elementary, visceral stage.

Dan: Amy Killelea says this type of anger is beginning to present outcomes. The Georgetown Heart tracks state legal guidelines on prior authorization.

In 2024 they know of 10 that handed.

In 2025, to date, they’ve logged 20.

And looking out over their checklist, a few issues stand out. One is these are 20 politically various states. Alaska, Rhode Island, Arkansas, California, Montana.

You get the concept. The opposite factor that stands out is this stuff they’re regulating usually make you go, wait. There was no regulation towards that earlier than?

I imply, Nebraska’s new regulation regulating prior authorizations is about as aggressive as something I’m seeing on this checklist. And the outcomes are simply, like, frequent sense.

Like for one massive instance: if an insurance coverage firm denies your prior authorization request, or an attraction, that denial now has to come back from a licensed clinician with related expertise.

And once I talked with Eliot Bostar, I used to be like, wait, like this wasn’t required earlier than?

Eliot Bostar: You’d be stunned. So, I’ll provide you with an instance. A neurosurgeon was making an attempt to get approval for fusing of a cervical disc within the backbone, proper? There was an individual that was vulnerable to actually paralysis and obtained an preliminary denial, appealed, and obtained one other denial. And that denial got here from a pediatrician.

Dan: Like a normal…

Eliot Bostar: Common observe pediatrician.

Dan: How outdated was the affected person?

Eliot Bostar: An grownup.

Dan: Okay. Not, not, not, not a candidate for pediatric care. All proper.

Eliot Bostar: Or, a request is put in for a drugs by a prescribing doctor and a denial comes again from a dentist.

Dan: Yeah. None of that was unlawful below Nebraska regulation, till now.

And never simply Nebraska. 4 different states handed comparable guidelines simply this yr

And there are extra what I’ll name, “wait, what?” sort of provisions in Nebraska’s new regulation.

Prefer it units a deadline for a way lengthy your insurance coverage could make you await a sure or no on prior authorization, or like, they’ll’t make you await prior authorization to approve an ambulance trip to the ER.

And Nebraska’s regulation additionally incorporates a technical provision that I don’t assume anyone would’ve imagined a number of years in the past.

It outlaws the usage of AI as the only foundation for denying protection.

And Eliot Bostar says insurance coverage firms don’t say they’re doing that, however he’s seen examples that look loads prefer it.

Eliot Bostar: Physicians placing in a request by way of a digital platform, um, placing in all the data, hitting submit, after which immediately getting a denial. There’s not numerous methods that may occur, proper? It’s not that there was a human who sat there and browse all of it and was considerate, analyzed the case, and made a dedication of denial inside half a second. So one thing else occurred in that point, and so that ought to not occur anymore.

Dan: Two different states, Maryland and Texas restricted the usage of AI this yr, in response to that cheat sheet I obtained from Georgetown.

So, Elliot Bostar and his colleagues obtained a giant win. He says the state medical society, Nebraska’s chapter of the American Medical Affiliation and the state hospital affiliation have been massive allies.

However medical insurance firms are highly effective opponents. Eliot says, in earlier years, he and his allies had tried taking smaller swings at prior authorization– and gotten swatted away. This time, they went massive.

Eliot Bostar: The choice was made that we have been gonna, we have been gonna actually go in any case of it. We’re gonna go in any case of it.

Dan: He says numerous that call got here right down to sheer frustration and a little bit little bit of political calculation. An enormous swing can rally individuals to you and provides the opposite aspect good motive to take you significantly.

Eliot Bostar: I believe it’s essential to clarify that we’re not going to place up with a system that’s this damaged, any longer. You will be actually direct. So you may inform the insurance coverage firms, we’re gonna do one thing. And you may both sort of work with us on how to try this or, or not.

Dan: After which he got down to divide and conquer.

Eliot Bostar: If insurance coverage firms themselves don’t essentially agree with one another, or they’re not totally aligned on a invoice or on a coverage, that may successfully neutralize the trade.

Dan: I requested him:, how’d you determine who you would possibly be capable of choose off?

Eliot Bostar: So Blue Cross Blue Defend in Nebraska is only a Nebraska firm, proper? They’re a part of the bigger Blue Cross, you recognize, community, however they’re only a Nebraska firm versus United is just not.

Dan: He stated by the point the invoice got here up for a listening to, he’d been negotiating with insurance coverage firms for months and he didn’t get all the pieces he needed. However you recognize, it handed.

Eliot Bostar: I don’t assume anybody voted towards it.

Dan: Eliot Bostar says his technique obtained a lift from some specifics of Nebraska’s legislative construction.

Like there’s only one home, a Senate. 49 members smallest within the nation, and elections are nonpartisan. So issues work otherwise than they do in most locations.

Eliot Bostar: There’s no majority chief. There’s no whip, there’s no any of that.

Dan: He says that setup allowed him handy promote this proposal to at least one colleague at a time.

So some classes right here:

One, go massive. Why the heck not?

Two: Determine who you may choose off within the opposition.

Three: Nonetheless the political construction works in your state, work it.

As a result of, you recognize, lawmakers in 20 states made new guidelines on prior authorization this yr. They don’t all work like Nebraska.

One caveat right here, states don’t have all the facility. With medical insurance, that’s very true.

, we’ve talked about this earlier than. For those who get your medical insurance from work– particularly when you work for an excellent sized firm– your well being plan might be arrange in a manner the place state insurance coverage rules don’t apply.

However Eliot Bostar says he offers native employers a two-part pitch to supply their staff comparable protections.

One, they’ll get monetary savings as a result of delaying care now can imply more-expensive care later.

Two, as a result of new state protections increase all people’s expectations.

Eliot Bostar: And the way a lot of a unlucky disgrace can be if their workers didn’t obtain the identical advantages that maybe their neighbors are.

Dan: In different phrases, you need to piss off your staff? He says typically it really works.

Simply forward: In Virginia, a brand new regulation bans wage garnishment for medical money owed — and caps curiosity at simply three p.c. Democrats handed it. The Republican governor signed it. How’d they pull it off?

That’s subsequent.

This episode of An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nonprofit newsroom overlaying healthcare in America. These people are superb journalists. Their reporting wins every kind of awards yearly. We’re honored to work with them.

Okay, let’s meet a pair people from Virginia.

Amanda Gago Silcox: I’m Amanda Gago Silcox. I’m the training and useful resource supervisor right here at Virginia Poverty Regulation Heart.

Jay Speer: I’m Jay Speer. I’m the Govt director and client rights legal professional on the Virginia Poverty Regulation Heart.

Dan: Their group, VLPC, for brief, does a bunch of stuff.

Amongst different issues, they function toll free helplines for people struggling to pay utility payments. They coordinate with native authorized help places of work throughout the state and. They foyer within the state capital.

Medical debt is a giant situation for them, and this yr they helped move a regulation that can restrict how far Virginians can get chased for medical debt particularly, it caps curiosity on medical debt at 3%.

Amanda Gago Silcox: After which the invoice additionally bans garnishing the wages of anybody qualifying for monetary help.

Dan: …which looks as if frequent sense. like when you qualify for monetary help from a hospital, you have to be getting your invoice decreased or canceled, not getting cash grabbed out of your paycheck. Or having your house foreclosed on to pay a hospital invoice, which has additionally occurred, and which the brand new regulation can even ban. Together with … getting arrested over a hospital invoice. Yeah.

And there’s one other provision that VPLC actually pushed for on this invoice. It’s gonna sound technical, however that is massive.

Amanda Gago Silcox: It prohibits, the sale of medical debt to a debt purchaser except they observe principally the identical necessities as are required of medical collectors.

Dan: Right here’s why that’s massive. There are two sorts of assortment companies. There’s the type that work for a hospital or whoever and receives a commission principally on fee after which — as Jay explains– there debt patrons. These are completely different.

Jay Speer: They’re those that pay anyplace from one to five% of what’s owed after which sue you for the entire quantity. Debt patrons deal in quantity. They get, they purchase hundreds and hundreds of money owed they usually sue all people.

Dan:Yeah, Jay says VPLC has analyzed information from throughout the entire state courtroom system- and noticed simply what number of lawsuits debt patrons have been truly submitting.

Jay Speer: In Virginia final yr, they filed 45% of the lawsuits in Virginia. Um, so it’s an enormous quantity.

Dan: 45% all lawsuits, like..?

Jay Speer: …of all lawsuits have been filed by debt patrons.

Dan: The brand new regulation goals to place the brakes on that, not less than from medical money owed.

Jay Speer: It says when you promote the debt to a debt purchaser, it’s a must to have an settlement with that debt purchaser that they’ll observe these guidelines.

Dan: That’s, they gained’t cost greater than 3% curiosity. No garnishing wages, no foreclosing on properties, no arrests. Jay thinks requiring these sorts of agreements may principally imply suppliers simply gained’t be capable of promote to debt patrons. ‘Trigger he’s been finding out how that complete aspect of medical debt truly works.

Jay Speer: I’ll let you know proper now, there isn’t a such factor as these agreements between suppliers and debt patrons.

Dan: Hmm.

Jay Speer: All debt patrons purchase is a spreadsheet with names and numbers on it. They’re not gonna enter into these agreements. Possibly I’m fallacious. I imply, they might change their complete observe, however I’d be stunned.

Dan: That’s the sort of perception VPLC dropped at the push for this regulation. However Amanda admits that push wasn’t a part of some grasp plan.

Amanda Gago Silcox: And you recognize, I want that we had deliberate many, many days and months, to work on this invoice, nevertheless it sort of fell in our laps.

Dan: She says late final yr, she heard from an advocate with a nationwide group known as Blood Most cancers United– they advocate for most cancers sufferers, not most cancers–with a pitch for the concept.

Amanda Gago Silcox: I’ll be fairly trustworthy, I used to be like, wow, that is actually aggressive. I don’t learn about this.

Dan: Jay was skeptical too. Getting a invoice like this handed can be one factor, even with Democrats holding majorities in each legislative homes, however then Republican Governor Glenn Youngkin would want to signal it.

Jay Speer: And the governor additionally has a historical past of vetoing tons and tons and tons of payments, 5 occasions greater than some other governor’s ever vetoed. And in order that’s hanging over the entire thing.

Dan: However Amanda says The parents at Blood Most cancers United have been very gung-ho. They promised to carry sufferers with highly effective tales to inform

… they usually thought VPLC’s technical experience, together with their analysis on debt patrons, would add loads.

And so they’d already lined up a sponsor: Delegate Carrie Delaney, who had simply succeeded in passing a invoice to maintain medical money owed off of credit score reviews.

Jay Speer: So we knew she was severe about it. I imply, that’s all the time a consideration whenever you’re occupied with laws is, who’s your patron? Are they actually severe about it?

Dan: VPLC determined to hitch up. Amanda took level on their lobbying, she says. It wasn’t simple.

Amanda Gago Silcox: I bear in mind there being a day the place it simply felt like we have been giving up little items right here and there, and I used to be like, I simply don’t know if what we’re gonna get out of that is value it. We’ve given up all the pieces. This doesn’t even do something anymore.

Dan: Particularly, she says the cap on curiosity seemed prefer it was gone.

Amanda Gago Silcox: Yeah. I assumed we have been gonna have to provide that up.

Dan: By some means the curiosity cap got here again in. Amanda obtained her religion again.

And he or she says there have been additionally moments that gave her confidence, like simply making the rounds of legislators places of work to drop off data and join a time to satisfy with the lawmakers.

Amanda Gago Silcox: After we have been speaking to their administrative assistants and we talked about that we have been there to speak about medical debt and lots of, most of the administrative assistants talked about, oh yeah, like my husband had most cancers and we had X, Y, Z, Or I had a good friend who had breast most cancers and she or he had this occur to her. So it actually resonated with, with legislators’ workers, with the parents that they’re surrounded with. So I believe that actually helped us proceed pushing.

Dan: And so they gained. Each homes. Now It was the governor’s transfer.

Jay Speer: So Virginia has a bizarre course of. The place they ship the payments to the governor. The governor both indicators the payments, vetoes the payments, or makes a quote advice. On this case, he made a advice.

Dan: He needed to weaken the invoice, in order that sends it again to the legislature.

Jay Speer: And so they both settle for his advice, which places the invoice in, into regulation, or they reject it. Then it goes again to the governor. And the governor then has two decisions. He may veto it or signal it. So it’s a dangerous enterprise to reject his advice since you’re nearly taunting him to veto it.

Dan: So when legislators DID reject the governor’s advice, Jay and Amanda say they have been shocked.

Amanda Gago Silcox: We have been shocked when it went again to the governor and he did in truth signal it. I imply, I assumed we have been, it was gonna be vetoed.

Jay Speer: I used to be certain he was gonna veto it. I imply, like I stated, he’s vetoed like God 5 occasions extra payments than some other governor.

Jay Speer: I believe the one clarification is he’s nervous about this and it makes him look unhealthy to not assist individuals out with medical debt.

Dan: They didn’t get all the pieces they needed.

The regulation doesn’t take impact until July, 2026,, and it exempts bank cards, together with medical credit score merchandise like CareCredit, which points a plastic card– and fees 33% curiosity after a promotional interval.

Amanda Gago Silcox: So that is positively an space the place there’s some work to be completed.

Dan: Yeah, like me, these people are by no means gonna run outta materials. In the meantime, they gained a victory this yr. They actually didn’t assume they’d get. And speak about having numerous materials. I reported a complete story about how Maine handed a regulation to maintain medical money owed off of credit score reviews. State Senator Donna Bailey sponsored that invoice, which handed unanimously, and an analogous invoice had failed earlier than, however this time she says:

Donna Bailey: I don’t bear in mind numerous heavy pushback, which was pleasantly shocking to me, fairly actually.

Dan: We’ll get to that one.

By the best way, 5 different states did the identical factor this yr, complete of 15 since 2023, and a bunch of states handed new rules on pharmacy profit managers. Essentially the most aggressive was most likely Arkansas. So yeah, there’s extra information that didn’t suck coming.

And talking of issues that don’t suck as we carry you this episode, it’s November, which implies I get to check one thing I’ve been saying to my colleagues for a very long time. Reaching extra individuals with An Arm and a Leg is each our mission crucial, ’trigger we wanna be of probably the most use to the most individuals. And it’s our enterprise mannequin ’trigger the best way we’ve gotten this far is by asking you listeners, will you assist us maintain doing this? And a sure fraction of individuals have all the time stated sure. And I’ve stated, if we will attain extra individuals, effectively that’s extra individuals to say sure. And that can permit us to do extra and continue to grow. And this yr I get to check that as a result of Seattle’s Public Radio Station, KUOW, turned our distributor this yr, they usually’re serving to us attain much more individuals than we did a yr in the past, like twice as many.

And so I get to check this idea and below actually favorable circumstances as a result of. November is the start of a undertaking known as Information Match from the Institute for Nonprofit Information. Now information match matches particular person presents of as much as a thousand {dollars}. And this month by way of a particular reward from the Jonathan Logan Household Basis, particularly for an arm and a leg information match is double matching your presents.

So when you’ve been listening, you probably have discovered this present entertaining and empowering and helpful, when you assume it’s cool to listen to what states are doing to make issues suck much less and the way they’re doing it, when you discovered it helpful after we ran down methods to economize on prescribed drugs. For those who assume it’s superior that Arm and a Leg listeners have been coming collectively to construct instruments to assist people keep out of medical debt, then that is your probability to make much more of that occur. ’trigger each greenback you give us this month is matched two for one. You give us 50 bucks, it turns into $150. You give us 100, bam it’s 300.

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That’s armandaleg present.com/help and Information Match will make your reward depend for triple Your help turns into tremendous help.

I imply, let’s do that, Armand leg present.com/help.

Thanks a lot. We’ll be again earlier than Thanksgiving with our subsequent episode. Until then. Maintain your self.

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This episode of An Arm and a Leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta — and edited by Ellen Weiss.

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Periods.

Claire Davenport is our engagement producer.

Sarah Ballema is our Operations Supervisor. Bea Bosco is our consulting director of operations.

An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nationwide newsroom producing in-depth journalism about well being points in America and a core program at KFF, an impartial supply of well being coverage analysis, polling, and journalism.

Zach Dyer is senior audio producer at KFF Well being Information. He’s editorial liaison to this present.

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