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David Machledt

@machledtdc.bsky.social
244 followers 295 following 149 posts

Give me a bike, time to adventure, and family and friends to share it with. Also, a lot of health policy, but the views here are my own.

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Reposted by David Machledt
ProPublica @propublica.org · 02/10/2026
We're continuing to report. To understand how apps like DraftKings and FanDuel respond to their users’ betting behavior, we need your help 👇
propub.li
Help ProPublica Report on Sports Betting by Sending Us Your App Data
If you’ve bet on sports with FanDuel or DraftKings, you can help ProPublica understand how these apps respond to their users’ betting behavior. Use our browser extension to download your betting…
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Kevin M. Kruse @kevinmkruse.bsky.social · 29/09/2026
When they get back in power, Democrats need to go all-in on higher education. We need a campaign of reinvestment in public universities across the country that makes the Morrill Land-Grant Act look like nothing by comparison *and* a GI Bill of Rights-style program of tuition grants.
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Joan Alker @joanalker1.bsky.social · 28/09/2026
Tennessee letter is here: www.medicaid.gov/medicaid/sec...
medicaid.gov
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Democrat House Committees (mirror) @demhousecomms.govpeeps.us · 27/09/2026
Ways and Means Democrats tweeted: Instead of approving $73 billion for Trump’s war in Iran, Republicans could’ve extended ACA premium tax credits, lowering health care costs for 20 million people – and still had $42 billion to spare.
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KFF @kff.org · 25/09/2026
A KFF analysis finds that 28.5 million people in the U.S. have limited English proficiency. People with limited English proficiency are over 3x as likely to be uninsured as people who are English proficient and report greater challenges accessing care. on.kff.org/4xFLrV1
Chart showing health coverage distribution among individuals by English proficiency. English proficient: 36% Medicaid or other public, 57% private, 7% uninsured. Limited English proficient: 40% Medicaid or other public, 37% private, 23% uninsured. Source: KFF, ACS 2024 data.
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Asawin Suebsaeng @swin24.bsky.social · 21/09/2026
“Today at 12:30, Wilber called his wife to tell her that he had been shot,” Lincoln-Goldfinch said in an earlier interview late Sunday. “And he was yelling in agony, and the call cut off. That was all she knew.”
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KFF @kff.org · 21/09/2026
Amid uncertainty, Elevance Health said they may exit certain Medicaid markets in the coming months. Our new policy watch examines recent and anticipated Medicaid managed care rate setting challenges and the potential implications of MCO exits: on.kff.org/4hEOmbK
The image is a pie chart titled "Five For-Profit, Publicly Traded Companies Have Almost Half of the Medicaid MCO Market." It shows the share of total comprehensive Medicaid managed care organization (MCO) enrollment as of July 1, 2024. The chart is divided into sections: Centene (18%), Elevance Health (11%), UnitedHealth Group (9%), Molina (7%), Aetna/CVS (3%), 10 Other Multi-State Parent Firms (15%), and 121 Local/Regional MCOs (36%). The total MCO enrollment is 66.5 million. The source is KFF.
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Ernesto Castañeda @drernestocast.bsky.social · 21/09/2026
Proposed census changes imply that "foreign-born immigrants, even if they have a visa here, are working, even if they have children who are U.S. citizens, literally this would mean that they do not count,” said Ernesto Castañeda spectrumlocalnews.com/us/snplus/po...
spectrumlocalnews.com
Census changes could reshape congressional representation, federal funding
The public has less than 30 days to comment on two major proposed changes
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Joan Alker @joanalker1.bsky.social · 18/09/2026
A second lawsuit has been filed with respect to the Trump Administration's flawed interpretation of the medically frail provision of the Medicaid work reporting requirement coming to a neighborhood near you on 1/1/27. Thank you to the plaintiffs and litigators!
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Joan Alker @joanalker1.bsky.social · 18/09/2026
New blog from me and Aubrianna Osorio on Census data that came out this week. We're still missing key data. ccf.georgetown.edu/2026/09/18/c...
ccf.georgetown.edu
Census Bureau Releases Some New Data on Child Uninsured Rate, but Questions Remain
This week the U.S. Census Bureau released the Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC) data, which examine poverty, income, health insurance and other trends for ca...
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Reposted by David Machledt
Kathleen Bachynski @bachynski.bsky.social · 14/09/2026
The multifront effort at HHS “has raised concerns among some officials over the past few months that change is moving too quickly, with inadequate evidence of the technology’s safety and effectiveness… They also worry about outsized influence of Silicon Valley investors”
nytimes.com
Trump Administration Moves to Integrate A.I. Into Medical Care Despite Concerns
Federal projects are rolling out A.I. agents that offer therapy and prescribe medicine, raising concerns about safety and the influence of venture capital investors.
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National Health Law Program @nhelp.bsky.social · 14/09/2026
NHeLP is pushing back against a proposed rule that could make it harder for people to get and keep health coverage. healthlaw.org/resource/nhelp-commen…
healthlaw.org
NHeLP Comments on Provider Tax Proposed Rule (Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes)
NHeLP submitted comments opposing this proposed rule, which goes far beyond statutory requirements and would substantially restrict access to care for both Medicaid beneficiaries and consumers with other forms of health care.
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Ernesto Castañeda @drernestocast.bsky.social · 07/09/2026
Those who sent remittances contributed over $2.7 trillion, which is 10% of the US GDP in 2023. Remittances represent only 3.5% of all the wealth created by immigrant workers in the U.S., underscoring how much more immigrants give to the US economy than they send abroad. scholars.org/contribution...
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Jason Rosenbaum @jasonrosenbaum.bsky.social · 03/09/2026
BREAKING: The Missouri Supreme Court has placed the redistricting referendum on the ballot. It has also barred the use of the 2025 map in the general election. The 2022 map that almost guarantees Emanuel Cleaver's victory will be in effect. ENORMOUS
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National Health Law Program @nhelp.bsky.social · 02/09/2026
Thousands of people have wrongly lost Medicaid due to errors in automated eligibility systems. NHeLP’s new map tracks state contracts behind these systems, bringing greater transparency to decisions that affect people’s health coverage. healthlaw.org/medicaid-eligibility-…
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Josh Marshall @joshtpm.bsky.social · 01/09/2026
👇
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Ernesto Castañeda @drernestocast.bsky.social · 30/08/2026
The policy most likely to help many states gain the workers they need is also the one many of their elected officials are most likely to resist: more immigration. A new study estimates that a 1% increase in a state’s population from increased immigration would raise private-sector GDP by 1.5 %
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Lambda Legal @lambdalegal.org · 28/08/2026
“I ran from bullies as a kid. Many of us did. What 36 years of this fight have taught me is that the bluster is the act itself. [They] never actually chased me. They were [just] hoping I wouldn't turn around and push back.” – James Dale, Lambda Legal board member and former client via @usatoday.com
tinyurl.com
Hegseth bullied Scouting America. One lawsuit made him fold. | Opinion
Secretary of Defense Pete Hegseth said he forced Scouting America, formerly Boy Scouts, to purge 'an insidious, radical, woke ideology.' I sued.
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Lpags03 @lpags03.bsky.social · 27/08/2026
We’ve loved this program, and our daughter knows the books come from “Miss Dolly”. We are about to age out but it’s a wonderful way to introduce your kids to the wonders of reading. Thank you Miss Dolly, your legacy lives on in all of us.
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VL-ADventitious. @adventitiouswords.bsky.social · 26/08/2026
Is it possible for one charity to get a billion dollars in donations in 24 hours? This is our best shot to find out. imaginationlibrary.com
imaginationlibrary.com
Dolly Parton's Imagination Library | USA, UK, IE, CA, AU
Dolly Parton’s Imagination Library is a book gifting program that mails free books to children from birth until they begin school in participating areas.
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Seung Min Kim @seungminkim1.bsky.social · 25/08/2026
NASHVILLE (AP) — Dolly Parton, iconic songwriter, singer and actor, has died at 80.
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@NewsJennifer (Jennifer Schulze) @newsjennifer.bsky.social · 24/08/2026
Republican led Indiana has left Gary- a majority Black city- without power for nearly TWO WEEKS.
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Kevin J. Kircher @kevinjkircher.com · 24/08/2026
Underappreciated: US farmland *already substantially produces energy, not food*, and does so very inefficiently. Corn ethanol (~40% of all US corn) requires about 100 times more land per vehicle-mile driven than solar photovoltaics -> electric vehicles. Shifting corn to solar *would free up land*.
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Reposted by David Machledt
National Health Law Program @nhelp.bsky.social · 18/08/2026
When algorithms determine Medicaid funding, transparency matters. Nebraska uses interRAI, a set of assessment tools that evaluates a person’s needs, strengths, and preferences to determine a score that helps set funding levels for people with disabilities. omaha.com/news/state-r...
omaha.com
Nebraska's new disability assessment tool causing troubles for some families
Some families in Nebraska's disability community are frustrated with interRAI, a tool to assess individuals with intellectual or developmental disabilities. Changes from the assessment have been disru...
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National Health Law Program @nhelp.bsky.social · 17/08/2026
“For 61 years, Medicaid has been a lifeline for millions of Nebraskans and our hospitals in our state,” said Sarah Maresh, Health Care Access Program Director at neappleseed.org NE Appleseed. “Nebraskans just can't afford this.” #Medicaid #ProtectMedicaid nebraskapublicmedia.org/en/news/news...
nebraskapublicmedia.org
Nebraska becomes first state to disenroll Medicaid recipients under new work requirements
The first work requirement-related disenrollments begin in Nebraska on Saturday. While the state Medicaid director estimates this will impact 200 Nebraskans, advocates are concerned that the number wi...
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KFF @kff.org · 17/08/2026
Here are the 8 states that could see the biggest reductions in Medicaid payments to hospitals: CA ($7.4B), IL ($4B), KY ($3.9B), TB ($3.5B), NC ($3.4B), LA ($3.3B), AZ ($3B) and MI ($2.6B). More in our new analysis: on.kff.org/4fYwfgh
At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits. The KFF map shows states with SDPs for hospital services that are likely to decrease because current payment policies exceed limits in the 2025 reconciliation law.
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Joan Alker @joanalker1.bsky.social · 17/08/2026
Very interesting. Georgia is requesting the full 90% Medicaid expansion match w/o full expansion. Both Obama and Trump 1 administations said no to similar requests. Georgia officials say new federal Medicaid rules threaten state’s partial expansion program georgiarecorder.com/2026/08/14/g...
georgiarecorder.com
Georgia officials say new federal Medicaid rules threaten state’s partial expansion program • Georgia Recorder
New federal guidelines would make the state’s Medicaid program financially unsustainable, state health officials said.
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Alt National Park Service @altnps.bsky.social · 02/08/2026
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Julia Métraux @juliametraux.bsky.social · 29/07/2026
RFK Jr. and Oz attacked California for its Medicaid home care, citing growth as proof of fraud. For @motherjones.com, I reported on how the growth isn't proof of fraud, and growth of participants is proof the program is more accessible than in other states. www.motherjones.com/politics/202...
motherjones.com
California does Medicaid home care well. They're being punished for it.
Republicans are deferring $850 million from the state because of unfounded fraud claims.
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States Newsroom @statesnewsroom.com · 29/07/2026
Trump’s changes to SNAP and Medicaid, including new eligibility and work requirements, are poised to cost states billions and have heightened fears that more Americans will lose access to the nation’s safety net. Visit our dedicated trend page for more.
newsfromthestates.com
Medicaid/SNAP | News From The States
The Trump administration’s tax and spending plan, signed last year, made major changes to the Supplemental Nutritional Assistance Program (SNAP) and Medicaid, including new eligibility and work…
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Adrianna McIntyre @adrianna.bsky.social · 06/07/2026
Devastating story about what can happen when switching insurance plans disrupts access to care (this particular case isn't about marketplace coverage, but that's probably where we see these switches happen most frequently)
cbsnews.com
Switching to a cheaper health plan delayed a man's access to vital medicine: "He didn't deserve to die like that"
A Florida man thought he had carefully planned for a seamless switch between health plans. It was anything but.
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KFF @kff.org · 03/07/2026
A new CMS rule includes HIV/AIDS among 19 examples of “serious or complex” conditions that could trigger a person’s exclusion from Medicaid work requirements. However, enrollees would have to show HIV impairs their ability to work: on.kff.org/4atK6bs
Bar graph titled "in Medicaid expansion states, six in 10 Medicaid enrollees with HIV have coverage through the expansion pathway." The chart shows Medicaid enrollees with HIV in expansion states compared to all Medicaid enrollees with HIV. Expansion states: 60% have coverage through expansion pathway, 29% adults based on disability, 11% other. All enrollees: 51% through expansion, 35% adults based on disability, 14% other. Source: KFF analysis of 2023 data.
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Martin Austermuhle @maustermuhle.bsky.social · 02/07/2026
NEWS: Wellpoint D.C., one of the three providers of Medicaid services in D.C., will be leaving the city as of August 1. It serves roughly 50k of the 250k Medicaid enrollees in D.C. It's contract, awarded in 2022, was set to run through 2028.
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Claire Heyison @claireheyison.bsky.social · 01/07/2026
New CMS data confirms large enrollment drops after Congressional Republicans and President Trump let PTC enhancements expire last year. ~3 million people dropped coverage between 2025 and 2026. More will likely follow suit as premiums stack up throughout the year. www.cbpp.org/blog/nearly-...
cbpp.org
Nearly 3 Million Fewer People Secured Marketplace Coverage After Republican Health Care Cuts, New Data Show
This is the largest drop in effectuated enrollment since the ACA marketplaces were established.
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Ernesto Castañeda @drernestocast.bsky.social · 28/06/2026
Last fall, schools reported international student enrollment had dipped 17%, according to NAFSA, an education nonprofit. Declining tuition spending translated to $1.1 billion in lost revenue for universities, and almost 23,000 fewer jobs. fortune.com/2026/06/24/i...
fortune.com
Trump's immigration crackdown is causing the U.S. to lose its best STEM talent—and it cost the economy almost $500 billion | Fortune
Half of America’s STEM workers with PhDs are foreign-born, a talent pipeline that is quickly drying up.
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Julia Métraux @juliametraux.bsky.social · 25/06/2026
Scoop: @duckworth.senate.gov is introducing a resolution calling on DOJ’s pro-institutionalization memo to be rescinded. “This is taking us back to a time when there were forced lobotomies in this country,” Duckworth told me. “We just cannot let that happen.” www.motherjones.com/politics/202...
motherjones.com
Senate Democrats rally against pro-institutionalization DOJ memo
The memo—allegedly Stephen Miller's passion project—"is taking us back to a time when there were forced lobotomies," Sen. Tammy Duckworth said.
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Abbey @abbeyarletto.bsky.social · 23/06/2026
When reality surpasses fiction! Top: fictional forecast for August 2050, broadcast by French TV in 2014 to warn about the consequences of global warming. Bottom: Real French forecast for yesterday, June 22, 2026.
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Julia Métraux @juliametraux.bsky.social · 18/06/2026
Trump's DOJ released a dubious legal memo this morning that signals the Trump admin wants to force more people into psychiatric institutions via bad faith and incorrect interpretations of ADA, Section 504, and Olmstead. New from me at @motherjones.com. www.motherjones.com/politics/202...
motherjones.com
Trump DOJ outlines dubious path to force people into psychiatric institutions
"This administration is trying to take away one of the most fundamental rights that people with disabilities have fought for."
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KFF @kff.org · 15/06/2026
Annual federal spending on state directed payments (SDPs) is highest in CA (an estimated $10.6 billion) — followed by TX ($6.3 billion), NC ($5.2 billion), and IL ($5.1 billion). Learn more about how SDPs are used and forthcoming reductions in their funding: on.kff.org/4ebzLmL
KFF figure is a map of 50 states and DC showing levels of federal spending on state-directed payments (SDPs). 8 states have more than $4 billion in yearly spending while 11 states have less than $500 million. 9 states have no MCOs and 2 states have no SDPs.
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asparagusnextleft @asparagusnextleft.bsky.social · 09/06/2026
It can be eradicated. publichealthscotland.scot/news/2024/ja...
publichealthscotland.scot
No cervical cancer cases detected in vaccinated women following HPV immunisation - News - Public Health Scotland
An exciting new study from PHS, in collaboration with the Universities of Strathclyde and Edinburgh, shows that no cervical cancer cases have been detected in women vaccinated at age 12-13 since the H...
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National Health Law Program @nhelp.bsky.social · 09/06/2026
Recent federal and state Medicaid cuts are threatening 15 million Californians on Medi-Cal—but we created an Advocates Guide to help everyone access the care we all deserve. Our updated Guide covers how to access benefits, community support services, policy advocacy resources, and more.
Graphic Title Text: What you need to Know: Medi-Cal + California: Medi-Cal Services guide for all 
Chart Title Text: Medi-Cal Services: What You Should Know
Chart Subtitle Text: 15 million Californians rely on Medi-Cal for essential care. 

The background of this graphic is a solid dark blue gradient with the titular text in large font and a paper-shaped graphic containing a chart detailing what will stay the same and what changes are ahead. 

Left Side of Chart reads "stays the same" and contains:
Children 18 or younger
Adults 65 or older
People with disabilities
SSI / SSDI recipients
Pregnant people
Foster youth ≤25

Right Side of Chart reads "changes ahead" and contains:
Work reporting required
More frequent renewals
Higher cost-sharing
Immigrant exclusions
Family planning cuts
Reduced federal funding

At the bottom of the graphic is the NHeLP logo and a link to read the guide: https://healthlaw.org/resource/an-advocates-guide-to-medi-cal-services/
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Julia Métraux @juliametraux.bsky.social · 04/06/2026
Medicaid work requirements were always going to be cruel. Then, the White House intervened (likely) and made the definition of who can be exempt based on disabilities/health much stricter. This is going to kill people. New from me at @motherjones.com. www.motherjones.com/politics/202...
motherjones.com
The White House just made Medicaid work requirements even worse
"It’s hard not to think that the cruelty of the policy is the point."
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Matthew Cortland (they) @matthewcort.land · 21/05/2026
If you're someone who relies on Medicaid or you have family members/loved ones who rely on Medicaid, and you're interested in the most effective ways to talk about the vital program? This is also for you
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KFF Health News @kffhealthnews.org · 22/05/2026
A man died of a heart attack in a county with no hospital and no paramedics, about 20 miles from the nearest ERs. Can Republicans’ rural health fund help? Local leaders don’t think so. kffhealthnews.org/rural-health...
kffhealthnews.org
Trump’s $50B Rural Health Bet Meets a Healthcare Desert in North Carolina - KFF Health News
Republicans promise that $50 billion in new health funding will help rural America. But it’s not expected to aid the years-long effort in North Carolina’s Martin County to reopen its only hospital.
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KFF @kff.org · 22/05/2026
Many states impose cost sharing on certain Medicaid expansion adults and all expansion states will be required to do so by Oct 1, 2028. Studies show cost sharing reduces utilization of care, including medically necessary care: on.kff.org/4upuhuj
KFF bar chart shows the number of ACA expansion states that impose cost sharing, by service type as of January 2026. The top green bar represents "any cost sharing imposed", 19, and the blue bars below are as follows: "preferred brand-name drugs", 16, "generic drugs", 15, non-preferred brand-name drug", 15, "non-emergency ED visit", 12, ""outpatient hospital visit", 12, "non-preventative physician visit", 10, "inpatient hospital visit", 10, "physical therapy", 8, "dental services", 8 and "occupational therapy", 7.
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Spoooooky Pants 🧛‍♂️ @farnaby.xyz · 13/05/2026
I would love one for "oh it's windy as shit out" or "hey, I gotta look presentable at family dinner" or "I need to bring home 4 bags of groceries" or "I finish work at 4 and the event starts at 4:30" or any other reasons where it easily replaced a car trip.
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National Health Law Program @nhelp.bsky.social · 08/05/2026
Nebraska is using an algorithm assessment tool to cut Medicaid home-care services for people with disabilities, without explaining how or why. @nhelp.bsky.social's Elizabeth Edwards “A Medicaid agency cannot evade their responsibilities through the use of an algorithm” healthlaw.org/news/nebrask...
healthlaw.org
Nebraskan with Disabilities, Backed by Four Nonprofits, Sues State Over New Disabilities Assessment System - National Health Law Program
LINCOLN, NE — Legal Aid of Nebraska, joined by Nebraska Appleseed, the National Health Law Program, and TechTonic Justice, has filed a lawsuit against the Nebraska Department of Health and Human Servi...
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Rachel Sachs @rachelsachs.bsky.social · 08/05/2026
Now up at Health Affairs Forefront, @michaelannica.bsky.social and I analyze CMS's proposed rule regarding prior authorization for prescription drugs, contextualizing it as an extension of the 2024 prior auth rule and considering its broader implications. www.healthaffairs.org/content/fore...
healthaffairs.org
Understanding CMS’s Proposed Rule Regarding Prior Authorization For Drugs | Health Affairs Forefront
The proposed rule aims to improve prior authorization for prescription drugs by establishing and requiring electronic prior authorization, setting coverage decision deadlines, and promoting transparen...
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ProPublica @propublica.org · 07/05/2026
Dr. Debby Day said her bosses at Cigna gave her a stark warning: Work faster, or the company might fire her. She said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers.” (Published April 2024 w/ @capitolforum.bsky.social)
propublica.org
A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.
Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s ho...
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Matthew Gertz @mattgertz.bsky.social · 04/05/2026
We fought. We won. Others can too. www.mediamatters.org/angelo-carus...
mediamatters.org
Media Matters secures complete and total victory against the Federal Trade Commission
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