Therapy by AI holds promise and challenges : Shots

Therapy by AI holds promise and challenges : Shots
Some companies and researchers think smart computers might eventually help with provider shortages in mental health, and some consumers are already turning to chatbots to build "emotional resilience."
Some companies and researchers think smart computers might eventually help with provider shortages in mental health, and some consumers are already turning to chatbots to build "emotional resilience."

Just a year ago, Chukurah Ali had fulfilled a dream of owning her own bakery — Coco’s Desserts in St. Louis, Mo. — which specialized in the sort of custom-made ornate wedding cakes often featured in baking show competitions. Ali, a single mom, supported her daughter and mother by baking recipes she learned from her beloved grandmother.

But last February, all that fell apart, after a car accident left Ali hobbled by injury, from head to knee. “I could barely talk, I could barely move,” she says, sobbing. “I felt like I was worthless because I could barely provide for my family.”

As darkness and depression engulfed Ali, help seemed out of reach; she couldn’t find an available therapist, nor could she get there without a car, or pay for it. She had no health insurance, after having to shut down her bakery.

So her orthopedist suggested a mental-health app called Wysa. Its chatbot-only service is free, though it also offers teletherapy services with a human for a fee ranging from $15 to $30 a week; that fee is sometimes covered by insurance. The chatbot, which Wysa co-founder Ramakant Vempati describes as a “friendly” and “empathetic” tool, asks questions like, “How are you feeling?” or “What’s bothering you?” The computer then analyzes the words and phrases in the answers to deliver supportive messages, or advice about managing chronic pain, for example, or grief — all served up from a database of responses that have been prewritten by a psychologist trained in cognitive behavioral therapy.

That is how Ali found herself on a new frontier of technology and mental health. Advances in artificial intelligence — such as Chat GPT — are increasingly being looked to as a way to help screen for, or support, people who dealing with isolation, or mild depression or anxiety. Human emotions are tracked, analyzed and responded to, using machine learning that tries to monitor a patient’s mood, or mimic a human therapist’s interactions with a patient. It’s an area garnering lots of interest, in part because of its potential to overcome the common kinds of financial and logistical barriers to care, such as those Ali faced.

Potential pitfalls and risks of chatbot therapy

There is, of course, still plenty of debate and skepticism about the capacity of machines to read or respond accurately to the whole spectrum of human emotion — and the potential pitfalls of when the approach fails. (Controversy flared up on social media recently over a canceled experiment involving chatbot-assisted therapeutic messages.)

“The hype and promise is way ahead of the research that shows its effectiveness,” says Serife Tekin, a philosophy professor and researcher in mental health ethics at the University of Texas San Antonio. Algorithms are still not at a point where they can mimic the complexities of human emotion, let alone emulate empathetic care, she says.

Tekin says there’s a risk that teenagers, for example, might attempt AI-driven therapy, find it lacking, then refuse the real thing with a human being. “My worry is they will turn away from other mental health interventions saying, ‘Oh well, I already tried this and it didn’t work,’ ” she says.

But proponents of chatbot therapy say the approach may also be the only realistic and affordable way to address a gaping worldwide need for more mental health care, at a time when there are simply not enough professionals to help all the people who could benefit.

Someone dealing with stress in a family relationship, for example, might benefit from a reminder to meditate. Or apps that encourage forms of journaling might boost a user’s confidence by pointing when out where they make progress.

Proponents call the chatbot a ‘guided self-help ally’

It’s best thought of as a “guided self-help ally,” says Athena Robinson, chief clinical officer for Woebot Health, an AI-driven chatbot service. “Woebot listens to the user’s inputs in the moment through text-based messaging to understand if they want to work on a particular problem,” Robinson says, then offers a variety of tools to choose from, based on methods scientifically proven to be effective.

Many people will not embrace opening up to a robot.

Chukurah Ali says it felt silly to her too, initially. “I’m like, ‘OK, I’m talking to a bot, it’s not gonna do nothing; I want to talk to a therapist,” Ali says, then adds, as if she still cannot believe it herself: “But that bot helped!”

At a practical level, she says, the chatbot was extremely easy and accessible. Confined to her bed, she could text it at 3 a.m.

“How are you feeling today?” the chatbot would ask.

“I’m not feeling it,” Ali says she sometimes would respond.

The chatbot would then suggest things that might soothe her, or take her mind off the pain — like deep breathing, listening to calming music, or trying a simple exercise she could do in bed. Ali says things the chatbot said reminded her of the in-person therapy she did years earlier. “It’s not a person, but, it makes you feel like it’s a person,” she says, “because it’s asking you all the right questions.”

Technology has gotten good at identifying and labeling emotions fairly accurately, based on motion and facial expressions, a person’s online activity, phrasing and vocal tone, says Rosalind Picard, director of MIT’s Affective Computing Research Group. “We know we can elicit the feeling that the AI cares for you,” she says. But, because all AI systems actually do is respond based on a series of inputs, people interacting with the systems often find that longer conversations ultimately feel empty, sterile and superficial.

While AI may not fully simulate one-on-one individual counseling, its proponents say there are plenty of other existing and future uses where it could be used to support or improve human counseling.

AI might improve mental health services in other ways

“What I’m talking about in terms of the future of AI is not just helping doctors and [health] systems to get better, but helping to do more prevention on the front end,” Picard says, by reading early signals of stress, for example, then offering suggestions to bolster a person’s resilience. Picard, for example, is looking at various ways technology might flag a patient’s worsening mood — using data collected from motion sensors on the body, activity on apps, or posts on social media.

Technology might also help improve the efficacy of treatment by notifying therapists when patients skip medications, or by keeping detailed notes about a patient’s tone or behavior during sessions.

Maybe the most controversial applications of AI in the therapy realm are the chatbots that interact directly with patients like Chukurah Ali.

What’s the risk?

Chatbots may not appeal to everyone, or could be misused or mistaken. Skeptics point to instances where computers misunderstood users, and generated potentially damaging messages.

But research also shows some people interacting with these chatbots actually prefer the machines; they feel less stigma in asking for help, knowing there’s no human at the other end.

Ali says that as odd as it might sound to some people, after nearly a year, she still relies on her chatbot.

“I think the most I talked to that bot was like 7 times a day,” she says, laughing. She says that rather than replacing her human health care providers, the chatbot has helped lift her spirits enough so she keeps those appointments. Because of the steady coaching by her chatbot, she says, she’s more likely to get up and go to a physical therapy appointment, instead of canceling it because she feels blue.

That’s precisely why Ali’s doctor, Washington University orthopedist Abby Cheng, suggested she use the app. Cheng treats physical ailments, but says almost always the mental health challenges that accompany those problems hold people back in recovery. Addressing the mental-health challenge, in turn, is complicated because patients often run into a lack of therapists, transportation, insurance, time or money, says Cheng, who is conducting her own studies based on patients’ use of the Wysa app.

“In order to address this huge mental health crisis we have in our nation — and even globally — I think digital treatments and AI can play a role in that, and at least fill some of that gap in the shortage of providers and resources that people have,” Cheng says.

Not meant for crisis intervention

But getting to such a future will require navigating thorny issues like the need for regulation, protecting patient privacy and issues of legal liability. Who bears responsibility if the technology goes wrong?

Many similar apps on the market, including those from Woebot or Pyx Health, repeatedly warn users that they are not designed to intervene in acute crisis situations. And even AI’s proponents argue computers aren’t ready, and may never be ready, to replace human therapists — especially for handling people in crisis.

“We have not reached a point where, in an affordable, scalable way, AI can understand every sort of response that a human might give, particularly those in crisis,” says Cindy Jordan, CEO of Pyx Health, which has an app designed to communicate with people who feel chronically lonely.

Jordan says Pyx’s goal is to broaden access to care — the service is now offered in 62 U.S. markets and is paid for by Medicaid and Medicare. But she also balances that against worries that the chatbot might respond to a suicidal person, ” ‘Oh, I’m sorry to hear that.’ Or worse, ‘I don’t understand you.’ ” That makes her nervous, she says, so as a backup, Pyx staffs a call center with people who call users when the system flags them as potentially in crisis.

Woebot, a text-based mental health service, warns users up front about the limitations of its service, and warnings that it should not be used for crisis intervention or management. If a user’s text indicates a severe problem, the service will refer patients to other therapeutic or emergency resources.

Cross-cultural research on effectiveness of chatbot therapy is still sparse

Athena Robinson, chief clinical officer for Woebot, says such disclosures are critical. Also, she says, “it is imperative that what’s available to the public is clinically and rigorously tested,” she says. Data using Woebot, she says, has been published in peer-reviewed scientific journals. And some of its applications, including for post-partum depression and substance use disorder, are part of ongoing clinical research studies. The company continues to test its products’ effectiveness in addressing mental health conditions for things like post-partum depression, or substance use disorder.

But in the U.S. and elsewhere, there is no clear regulatory approval process for such services before they go to market. (Last year Wysa did receive a designation that allows it to work with Food and Drug Administration on the further development of its product.)

It’s important that clinical studies — especially those that cut across different countries and ethnicities — continue to be done to hone the technology’s intelligence and its ability to read different cultures and personalities, says Aniket Bera, an associate professor of computer science at Purdue.

“Mental-health related problems are heavily individualized problems,” Bera says, yet the available data on chatbot therapy is heavily weighted toward white males. That bias, he says, makes the technology more likely to misunderstand cultural cues from people like him, who grew up in India, for example.

“I don’t know if it will ever be equal to an empathetic human,” Bera says, but “I guess that part of my life’s journey is to come close.”

And, in the meantime, for people like Chukurah Ali, the technology is already a welcome stand-in. She says she has recommended the Wysa app to many of her friends. She says she also finds herself passing along advice she’s picked up from the app, asking friends, “Oh, what you gonna do today to make you feel better? How about you try this today?”

It isn’t just the technology that is trying to act human, she says, and laughs. She’s now begun mimicking the technology.

Obamacare hits a record number of signups : Shots

Obamacare hits a record number of signups : Shots
An illustration of cookie jars labeled "HMO" and "PPO."
An illustration of cookie jars labeled "HMO" and "PPO."

The Inexpensive Treatment Act health coverage marketplaces just hit a report: Nearly 16 million persons signed up for the insurance policies also regarded as Obamacare.

That is about a million a lot more individuals than signed up for ACA overall health insurance policy final yr, and enrollment is even now open up on Health care.gov and in most point out marketplaces right up until Sunday, January 15. (Enrollment is open up until January 31 in California, Washington, D.C., New Jersey, New York and Rhode Island. In Massachusetts, it is open right until January 23.)

What’s driving the upward development? The huge explanation is that the designs are more cost-effective for folks than they used to be. The federal authorities has pumped billions of pounds in new years into subsidies to keep prices down for shoppers. Health officers say 4 out of 5 enrollees qualify for plans that price $10 or much less for every thirty day period. And 5 million persons who are uninsured qualify for zero greenback high quality plans, according to a modern investigation from the Kaiser Relatives Foundation.

A further reason why extra people are signing up is very likely due to the fact there is certainly far more logistical aid. The Inexpensive Treatment Act developed a software of “navigators” – persons throughout the place who are skilled to assist buyers comprehend their alternatives and get signed up for a wellness prepare. It’s a provider paid via authorities grants.

The Trump administration slashed the funding for this method. The Biden administration shored it up. Katie Roders Turner is government director of the Household Health care Foundation. Her business is aspect of the Tampa Bay Navigator Venture in Florida, which went from having a workforce of 16 navigators to 35 this yr – more than double the workers.

“This year we definitely caught our stride,” Roders Turner suggests. “We’ve been really ready to distribute out the have to have and the desire among all those navigators.”

Satisfied tears in central Florida

A person of the folks her firm assisted in new months was Erin Dimmig. She and her husband, Tyler, are 30 decades aged and they dwell in Plant Town, Florida. Proper now, she describes herself as “very expecting” – she’s due with her to start with little one in February.

This fall, “my partner bought a new position provide and that places him in a 90-day coverage hole, and we have been thanks in 60 days,” she points out. They couldn’t pay for to preserve having to pay for the coverage they’d had through his previous work – COBRA was heading to price tag them $1,600 a month.

She suggests she had no concept the place to start to appear for possibilities. She googled her way to Health care.gov, the federal marketplace, which Florida and 32 other states use. (Condition-centered sites can also be accessed through Health care.gov). She commenced to respond to queries like measurement of domestic, profits, and other information. “At the time you click on the ‘you’re pregnant’ button, there’s all types of bewildering thoughts, and I was certainly in about my head,” she claims.

She clicked more than to the listing to discover navigators in her area, and uncovered a area neighborhood heart on the checklist. “I called and they had been like, ‘Well, Jorge arrives in on Thursday.'”

So the Dimmigs went to see Navigator Jorge Masson at a nearby social services company. Likely in, Erin Dimmig anxious she would be uninsured when she went into labor.

“We walked by means of the total system with Jorge. He helped us select a prepare that labored for us. It in fact finished up operating out far better to split our insurance policy,” she says. “It will stop up preserving us about $9,000 with childbirth and all of that. I cried when we found out that we ended up going to be preserving a whole lot of dollars.”

The Dimmigs are not finished working with wellness insurance. Right after the baby’s born, they’ll will need to include the infant to their approach, and determine out regardless of whether to signal up for the new employer-based mostly prepare when her husband results in being qualified. But she’s not fearful. “Jorge reported that he would enable walk us through that,” she suggests.

A health insurance alternative left a pastor with a big hospital bill : Shots

A health insurance alternative left a pastor with a big hospital bill : Shots

Jeff and Kareen King received a hospital bill for $160,000 a few weeks after Jeff had a procedure to restore his heart rhythm.

Bram Sable-Smith/KHN


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Jeff and Kareen King received a hospital bill for $160,000 a few weeks after Jeff had a procedure to restore his heart rhythm.

Bram Sable-Smith/KHN

Kareen King calls it “the ultimate paradox”: The hospital that saved her husband Jeff’s heart also broke it.

What Happened Jeff King, of Lawrence, Kan., needed his heart rhythm restored to normal with a procedure called an ablation — sooner rather than later, his doctor said. Jeff asked the hospital for a cost estimate, but said he didn’t hear back before his scheduled surgery in January 2021 at Stormont Vail Health in Topeka, Kan.

The real pain came when the bill arrived in the mail a few weeks later. The Kings, who were uninsured at the time, were on the hook for nearly all of the cost.

Jeff King, 63, Lawrence, Kan.

Approximate Medical Debt: $160,000

Medical Issue: Heart ablation

Jeff and Kareen King received the bill for $160,000 a few weeks after Jeff had the procedure to restore his heart rhythm.

Instead of signing up for traditional health insurance, the Kings had joined what’s called a “medical cost-sharing plan” with a company called Sedera, which describes its service as a “refreshing non-insurance approach to managing large and unexpected health care costs.” With this alternative to health insurance, members agree to share one another’s expenses. The plans are often faith-based and have surged in popularity in recent years because they can be cheaper than traditional insurance — the Kings said their plan cost $534 a month, plus an additional $118 a month to join a direct primary care medical practice.

But the sharing plans offer fewer protections than insurance and come with provisos. The Kings said their plan did not fully cover preexisting conditions like Jeff’s heart condition for the first two years of coverage — and he needed the surgery after 16 months.

In a statement a Sedera spokesperson said it’s important that members understand the cost-sharing model and membership guidelines. “Sedera members read and agree to these prior to joining,” the statement read.

The Kings have dabbled in all sorts of health coverage in their 42 years of marriage. Jeff’s work as an evangelical pastor in his hometown of Osage City, Kan., almost never provided insurance for the couple or their five children, all of whom are now grown. The exception came during Jeff’s most recent stint leading a congregation, starting in 2015. Kareen remembered feeling “unworthy” of the $1,800 a month the congregation paid for their insurance.

“We certainly had never come up with those kinds of premiums ourselves,” she recalled.

But Jeff decided he had to leave that job in 2018. He said he felt forced out over differences with some of his congregants on eternal damnation (“As a loving parent, I could never punish my child forever”) and gay marriage (“Maybe God is a whole lot more inclusive than we are”).

After Jeff resigned, the Kings briefly bought insurance through the Affordable Care Act marketplace, but later dropped it because they weren’t eligible for subsidies and felt they couldn’t afford it.

That’s when they joined the Sedera plan. They knew the preexisting condition clause was a gamble, but medication had managed Jeff’s heart condition for years, and they didn’t expect he’d need medical procedures to address it.

What’s Broken: Without employer-sponsored insurance or federal subsidies to help fund their coverage, the Kings felt priced out of traditional insurance. But being uninsured left them exposed to hospital charges that ordinary patients typically never see.

Hospital charges are generally understood by health economists to bear little resemblance to the actual prices that are typically paid. Instead, they are more of an opening salvo in the high-stakes negotiations between hospitals trying to get as much money as they can for providing care and insurance companies trying to pay as little as possible.

But patients lack the bargaining power of large insurers, which may cover hundreds of thousands of patients in any given hospital’s catchment area. For patients like Jeff, the main recourse is to go through a hospital’s financial assistance program, although even with that help many patients can’t afford the bills hospitals send them.

Stormont Vail’s assistance program eventually knocked about $107,000 off Jeff’s original bill. Sedera provided a negotiator to help him haggle over costs.

Stormont Vail provided $19.5 million in financial assistance in tax year 2020 and wrote off about $13 million in bad debt, according to tax filings. Its net revenue from patient services was $838.7 million.

Bill Lane, a Stormont Vail administrator, said that in addition to providing financial assistance, the hospital works with patients facing high bills and offers payment plans with zero interest. Payments are often in the range of 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of a person’s monthly income,” Lane said. For some patients the hospital has a “catastrophic discount” program that caps their balance at 30{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their gross household income. The hospital also works with a local bank to provide loans to patients to pay their bills. And the hospital sometimes sends patient balances to debt collection agencies.

Lane said he generally recommends that patients carry traditional insurance. He also said the hospital offers a “patient estimates module” and suggests patients wait to schedule surgery, if possible, if they want an estimate “to make an informed decision.”

What’s Left: Despite Sedera’s two-year waiting period to cover preexisting conditions, the plan did give Jeff $15,000 to help with his bills. After Jeff paid that to the hospital and then negotiated for several months, his final balance was reduced to $37,859.34 in November 2021.

For his payment plan, Jeff said he was told the hospital would accept no less than $500 per month — the equivalent of an additional mortgage payment for the Kings. Jeff estimates it will take the family more than six years to pay it off.

“I never expected this to not cost me anything,” Jeff said, “but I wasn’t expecting what it turned out to be either.”

The Kings are piecing together the funds to pay what they owe the hospital. A few months after Jeff’s ablation, they sold their home in Osage City — where they raised five children and where Jeff grew up — and bought a smaller house in Lawrence. They had hoped to use that money to build their retirement account, since Jeff’s decades of pastoral work didn’t include a pension or 401(k).

Instead, the home sale is helping pay Jeff’s medical debt. Kareen has part-time jobs, and the couple leveraged their life insurance policy, as well.

Jeff began work as a hospice chaplain — for the extra income, but especially to qualify the couple for health insurance. That meant less time for his passion project, running a nonprofit called Transmuto through which he provides spiritual guidance.

In February, Kareen checked again on whether the couple could afford Affordable Care Act insurance so Jeff could get back to Transmuto full time. Her Google searches for the federal government’s health insurance marketplace (HealthCare.gov) instead unwittingly landed her on websites that sell consumer information to insurance brokers. Speaking to one of those brokers on the phone, she bought what she said she was told was an Aetna plan. But it turned out to be a membership in a cost-sharing plan with a company called Jericho Share, which has received over 160 complaints on the Better Business Bureau website in the past year.

Jericho Share spokesperson Mark Hubbard said in a statement that the organization is “issuing full refunds when there is consumer confusion” and is continuing to “evaluate and update our marketing efforts to increase transparency and awareness.”

Hubbard also said Jericho Share is cooperating with regulators in California and New Hampshire that have questioned whether the organization meets state requirements of a health care sharing ministry. California is also questioning whether Jericho Share has indeed received 501(c)(3) nonprofit status from the IRS.

After canceling that plan and getting their money back, the Kings eventually did sign up for an ACA marketplace plan. Jeff has reduced his hours as a chaplain, freeing up more time for Transmuto. All in all, the couple feels pretty fortunate.

“It’s just so tragic the way our system is,” Jeff said. “It puts so many people into impossible financial straits.

KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).

Investigation: Jail guards use force against prisoners with mental illness : Shots

Investigation: Jail guards use force against prisoners with mental illness : Shots

An investigation of records from 25 county jails across Pennsylvania shows that nearly 1 in 3 “use of force” incidents by guards involved a prisoner who was having a psychiatric crisis or who had a known mental illness. Guards used weapons like stun guns or pepper spray to subdue prisoners who may have been unable to understand what was going on.

Ibrahim Rayintakath for NPR


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Ibrahim Rayintakath for NPR


An investigation of records from 25 county jails across Pennsylvania shows that nearly 1 in 3 “use of force” incidents by guards involved a prisoner who was having a psychiatric crisis or who had a known mental illness. Guards used weapons like stun guns or pepper spray to subdue prisoners who may have been unable to understand what was going on.

Ibrahim Rayintakath for NPR

When police arrived on the scene, they found Ishmail Thompson standing naked outside a hotel near Harrisburg, Pa., after he had just punched a man. After they arrested him, a mental health specialist at the county jail said Thompson should be sent to the hospital for psychiatric care.

However, after a few hours at the hospital, a doctor cleared Thompson to return to jail. With that decision, he went from being a mental health patient to a Dauphin County Prison inmate. Now he was expected to comply with orders — or be forced to.

Thompson soon would be locked in a physical struggle with corrections officers — one of 5,144 such “use of force” incidents that occurred in 2021 inside Pennsylvania county jails.

An investigation by WITF and NPR looked at 456 of those incidents from 25 county jails in Pennsylvania, during the last quarter of 2021.

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Nearly 1 in 3 “use of force” incidents involved a person who was having a mental health crisis or who had a known mental illness. In many cases, guards used aggressive — and distressing — weapons like stun guns and pepper spray to control and subdue such prisoners, despite the fact that their severe psychiatric conditions meant they may have been unable to follow orders — or even understand what was going on.

For Ishmail Thompson, this played out within hours of returning to jail from the hospital. Records show that when he ran away from jail staff during a strip search, an officer pepper-sprayed him in the face and then tried taking him to the ground. According to the records, Thompson fought back and additional officers flooded the area, handcuffing and shackling him.

An officer covered Thompson’s head with a hood and put him in a restraint chair, strapping down his arms and legs, according to the records, and about 20 minutes later, an officer noticed something wrong with Thompson’s breathing. He was rushed to the hospital.

Five days later, Thompson died. The district attorney declined to bring charges.

The DA, warden, and county officials who help oversee the jail did not respond to requests for interviews about Thompson’s treatment, or declined to comment.

Most uses of force in jails don’t lead to death. In Thompson’s case, the immediate cause of death was “complications from cardiac dysrhythmia,” but the manner in which that occurred was “undetermined,” according to the county coroner. In other words, he couldn’t determine whether Thompson’s death was due to being pepper-sprayed and restrained, but he also didn’t say Thompson died of natural causes.

Dauphin County spokesman Brett Hambright also declined to talk about Thompson, but says nearly half of the people at the jail have a mental illness, “along with a significant number of incarcerated individuals with violent propensities.”

“There are always going to be use-of-force incidents at the prison,” Hambright says. “Some of them will involve mentally ill inmates due to volume.”

But the practices employed by corrections officers every day in county jails can put prisoners and staff at risk of injury and can harm vulnerable people who may be scheduled to return to society within months.

“Some mentally ill prisoners are so traumatized by the abuse that they never recover, some are driven to suicide, and others are deterred from bringing attention to their mental health problems because reporting these issues often results in harsher treatment,” says Craig Haney, a psychology professor at the University of California, Santa Cruz who specializes in conditions in correctional facilities.

What records reveal about “use of force” in jails

Corrections experts say the use of physical force is an important option to prevent violence between inmates, or violence against guards themselves. However, records kept by correctional officers at the 25 Pennsylvania county jails show that just 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of “use of force” incidents were in response to a prisoner assaulting someone else. Another 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} describe a prisoner threatening staff.

WITF found that 1 in 5 uses of force — 88 incidents — involved a prisoner who was either attempting suicide, hurting themselves or threatening self-harm. Common responses by jail staff included the tools used on Thompson — a restraint chair and pepper spray. In some cases, officers used electroshock devices such as stun guns.

In addition, the investigation uncovered 42 incidents where corrections staff noted that an inmate appeared to have a mental health condition — but guards still deployed force after the person failed to respond to commands.

Defenders of these techniques say they save lives by preventing violence or self-harm, but some jails in the U.S. have moved away from the practices, saying they’re inhumane and don’t work.

The human costs can extend far beyond the jail, reaching the families of prisoners killed or traumatized, as well as the corrections officers involved, says Liz Schultz, a civil rights and criminal defense attorney in the Philadelphia area.

“And even if the human costs aren’t persuasive, the taxpayers should care, since the resulting lawsuits can be staggering,” Schultz says. “It underscores that we must ensure safe conditions in jails and prisons, and that we should be a bit more judicious about who we are locking up and why.”

“All I needed was one person”

For Adam Caprioli, it began when he called 911 during a panic attack. Caprioli, 30, lives in Long Pond, Pa., and has been diagnosed with bipolar disorder and anxiety disorder. He also struggles with alcohol and drug addiction.

When police responded to the 911 call in the fall of 2021, they decided to take Caprioli to the Monroe County Correctional Facility.

Inside the jail, Caprioli’s anxiety and paranoia surged. He says staff ignored his requests to make a phone call or speak to a mental health professional.

After several hours of extreme distress, Caprioli tied his shirt around his neck and choked himself until he passed out. When corrections officers saw this, they decided it was time to respond.

Adam Caprioli remembers how jail guards responded when he experienced a psychiatric crisis inside the Monroe County Correctional Facility in Pennsylvania. Official records from the facility confirm he was subdued by four guards and shot in the back with a pepper ball launcher.

Jeremy Long/WITF


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Jeremy Long/WITF

Prison staff often justify their use of physical force by saying they’re intervening to save the person’s life, says Alan Mills, an attorney who has litigated use of force cases and who serves as executive director of Uptown People’s Law Center in Chicago.

“The vast majority of people who are engaged in self-harm are not going to die,” Mills says. “Rather, they are acting out some form of serious mental illness. And therefore what they really need is intervention to de-escalate the situation, whereas use of force does exactly the opposite and escalates the situation.”

After they saw Caprioli with his shirt around his neck, officers wearing body armor and helmets rushed into his cell.

The four-man team brought the 150-pound Caprioli down to the floor. One of them had a pepper ball launcher — a compressed air gun that shoots projectiles containing chemical irritants.

“Inmate Caprioli was swinging his arms and kicking his legs,” a sergeant wrote in the report. “I pressed the Pepperball launcher against the small of Inmate Caprioli’s back and impacted him three (3) times.”

Caprioli felt the pain of welts in his flesh. Then, the sting of powdered chemicals in the air. He realized nobody would help him.

“That’s the sick part about it,” Caprioli says. “You can see I’m in distress. You can see I’m not going to try and hurt anyone. I have nothing I can hurt you with.”

Eventually he was taken to the hospital — where Caprioli says they assessed his physical injuries — but he didn’t get help from a mental health professional. Hours later, he was back in jail, where he stayed for five days. He eventually pleaded guilty to a charge of “public drunkenness and similar misconduct” and had to pay a fine.

Caprioli acknowledges that he makes his problems worse when he uses alcohol or drugs, but he says that doesn’t justify how he was treated in the jail.

“That’s not something that should be going on at all. All I needed was one person to just be like, ‘Hey, how are you? What’s going on?’ And never got that, even to the last day.”

Monroe County Warden Garry Haidle and Monroe County District Attorney E. David Christine Jr. did not respond to requests for comment.

Jails unequipped to cope with psychiatric pain

Jail is not an appropriate setting for treating serious mental illness, says Dr. Pamela Rollings-Mazza. She works with PrimeCare Medical, which provides medical and behavioral services at about 35 county jails in Pennsylvania.

The problem, Rollings-Mazza says, is that people with serious psychiatric issues don’t get the help they need before they are in crisis. At that point, police can be involved, and people who started off needing mental health care end up in jail.

“So the patients that we’re seeing, you know, a lot of times are very, very, very sick,” Rollings-Mazza says. “So we have adapted our staff to try to address that need.”

PrimeCare psychologists rate prisoners’ mental health on an A, B, C and D scale. Prisoners with a D rating are the most seriously ill. Rollings-Mazza says they make up between 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} and 15{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the overall jail population. Another 40{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of people have a C rating, also a sign of significant illness.

She says that rating system helps determine the care psychologists provide, but it has little effect on jail policies.

“There are some jails where they don’t have that understanding or want to necessarily support us,” she says. “Some security officers are not educated about mental health at the level that they should be.”

Rollings-Mazza says her team frequently sees people come to jail who are “not reality-based” due to psychiatric illness, and can’t understand or comply with basic orders. They are often kept away from other prisoners for their own safety and may spend up to 23 hours a day alone.

That isolation virtually guarantees that vulnerable people will spiral into a crisis, said Dr. Mariposa McCall, a California-based psychiatrist who recently published a paper looking at the effects of solitary confinement.

Her work is part of a large body of research showing that keeping a person alone in a small cell all day can cause lasting psychological damage.

McCall worked for several years at state prisons in California and says it’s important to understand that the culture among corrections officers prioritizes security and compliance above all. As a result, staff may believe that people who are hurting themselves are actually trying to manipulate them.

Many guards also view prisoners with mental health conditions as potentially dangerous.

“And so it creates a certain level of disconnect from people’s suffering or humanity in some ways, because it feeds on that distrust,” McCall says. In that environment, officers feel justified using force whether or not they think the prisoner understands them.

In Chicago’s jail, a new approach to mental health

To really understand the issue, it helps to examine the decisions made in the hours and days leading up to uses of force, says Jamelia Morgan, a professor at Northwestern University Pritzker School of Law.

Morgan researches how a growing number of lawsuits are responding to the problem. Lawyers have successfully argued that demanding that a person with mental illness comply with orders they may not understand is a violation of their civil rights. Instead, jails should provide “reasonable accommodations” for people with a designated illness.

“In some cases, it’s as simple as having medical staff respond, as opposed to security staff,” Morgan says.

But individual cases can be difficult to litigate due to a complex grievance process that prisoners have to follow prior to filing suit, Morgan says.

WITF and NPR filed right-to-know requests with 61 counties across Pennsylvania and followed up with wardens in some of the counties that released use of force reports. None agreed to talk about how their officers are trained or whether they could change how they respond to people in crisis.

To solve the overall problem, wardens will need to redefine what it means to be in jail, Morgan says.

Some jails are trying new strategies. In Chicago, the Cook County Jail doesn’t have a warden. Rather, it has an “executive director” who is also a trained psychologist.

That change was one part of a total reimagining of jail operations after a 2008 U.S. Department of Justice report found widespread violations of inmates’ civil rights.

In recent years, the Cook County Jail has gotten rid of solitary confinement, opting instead to put problematic prisoners in common areas, but with additional security measures whenever possible, Cook County Sheriff Tom Dart says.

The jail includes a mental health transition center that offers alternative housing — a “college setting of Quonset huts and gardens,” as Dart describes it. There, prisoners have access to art, photography and gardening classes. There’s also job training, and case managers work with local community agencies, planning for what will happen once someone leaves the jail.

Just as important, Dart says, jail leadership has worked to change the training and norms around when it’s appropriate to use tools such as pepper spray.

“Our role is to keep people safe, and if you have someone with a mental illness, I just don’t see how Tasers and [pepper] spray can do anything other than aggravate issues, and can only be used as the last conceivable option,” Dart says.

Cook County’s reforms show that change is possible, but there are thousands of local jails across the U.S., and they depend on the local and state governments that set correctional policies, and that fund — or fail to fund — the mental health services that could keep vulnerable people out of jail in the first place.

In Pennsylvania’s Dauphin County, where Ishmail Thompson died, officials agree that the problem — and solutions — extend beyond the jail walls. County spokesman Brett Hambright says funding has remained stagnant amid an increase in people needing mental health services. That’s led to an over-reliance on jails, where the “lights are always on.”

“We would certainly like to see some of these individuals treated and housed in locations better equipped to treat the specificity of their conditions,” Hambright adds. “But we must play the hands we are dealt by the existing system as best we can with the resources that we have.”

Brett Sholtis received a 2021-22 Rosalynn Carter Fellowship for Mental Health Journalism, and this investigation received additional support from The Benjamin von Sternenfels Rosenthal Grant for Mental Health Investigative Journalism, in partnership with the Carter Center and Reveal from the Center for Investigative Reporting.

To learn more about how WITF reported this story, check out this explainer.

Carrie Feibel edited this story for Shots, and the photo editor was Max Posner.

Medicare Advantage plans overcharged Medicare by millions : Shots

Medicare Advantage plans overcharged Medicare by millions : Shots
A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that some health insurers issuing Medicare Advantage plans have tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.
A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that some health insurers issuing Medicare Advantage plans have tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

In April 2016, government auditors asked a Blue Cross Medicare Advantage health plan in Minnesota to turn over medical records of patients treated by a podiatry practice whose owner had been indicted for fraud.

Medicare had paid the Blue Cross plan more than $20,000 to cover the care of 11 patients seen by Aggeus Healthcare, a chain of podiatry clinics, in 2011.

Blue Cross said it couldn’t locate any records to justify the payments because Aggeus shut down in the wake of the indictment, which included charges of falsifying patient medical files. So Blue Cross asked the Centers for Medicare & Medicaid Services for a “hardship” exemption to a strict requirement that health plans retain these files in the event of an audit.

CMS granted the request and auditors removed the 11 patients from a random sample of 201 Blue Cross plan members whose records were reviewed.

A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that Blue Cross and a number of other health insurers issuing Medicare Advantage plans have tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013.

As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.

The hardship requests, together with other documents obtained by KHN through the lawsuit, shed light on the secretive audit process that Medicare relies on to hold accountable the increasingly popular Medicare Advantage health plans — which are an alternative to original Medicare and primarily run by major insurance companies.

Reacting to the audit findings, Sen. Chuck Grassley, R-Iowa, called for “aggressive oversight” to recoup overcharges.

“CMS must aggressively use every tool at its disposal to ensure that it’s efficiently identifying Medicare Advantage fraud and working with the Justice Department to prosecute and recover improper payments,” Grassley said in a written statement to KHN.

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people.

But federal officials rarely demand documentation to verify that patients have these conditions, or that they are as serious as claimed. Only about 5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of Medicare Advantage plans are audited yearly.

When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments.

Overall, CMS auditors flagged diagnostic billing codes — which show what patients were treated for — as invalid more than 8,600 times. The audits covered records for 18,090 patients over the three-year period.

In many cases, auditors found that the medical credentials of the health care provider who made the diagnosis were unclear, the records provided were unacceptable, or the record lacked a signature as required. Other files bore the wrong patient’s name or were missing altogether.

The rates of billing codes rejected by auditors varied widely across the 90 audits. The rate of invalid codes topped 80{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} at Touchstone Health, a defunct New York HMO, according to CMS records. The company also was shown to have the highest average annual overcharges — $5,888 per patient billed to the government.

By contrast, seven health plans had fewer than 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their codes flagged.

Health insurers had a wide range of excuses for why records couldn’t be turned over to auditors

One Medicare Advantage health plan submitted 57 hardship requests, more than any other insurer, though CMS approved only six. In three cases, the health plans said the records were destroyed in floods. Another cited a warehouse fire, and two said the records couldn’t be turned over because a doctor had been convicted for his role in illegally distributing millions of oxycodone pills through his network of pain clinics.

Other Medicare Advantage health plans argued they had no luck retrieving medical records from doctors who had moved, retired, died — and in some cases been arrested or lost their licenses for misconduct.

CMS found most excuses wanting, telling health plans they granted exceptions only in “truly extraordinary circumstances.” CMS said it receives about 100 of these requests for each year it audits and approves about 20{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of them.

The Medicare Advantage plan issued by Minnesota Blue Cross won its appeal after it relied on Aggeus Healthcare for diagnoses of vascular disease for 11 of its patients who got podiatry care..

Dr. Yev Gray, a Chicago podiatrist who owned the Aggeus chain that operated in more than a dozen states, was indicted on federal fraud charges in Missouri in October 2015.

The indictment accused him of creating an electronic medical record that fraudulently added billing codes for treatment of medical conditions patients didn’t necessarily have, including vascular disease.

Gray pleaded guilty in May 2017 to charges of conspiracy to defraud the United States and making false statements related to health care matters. He was sentenced to 90 months in prison.

Blue Cross said it “terminated” its network agreements with Aggeus about two weeks after learning of the indictment. Jim McManus, director of public relations for Blue Cross and Blue Shield of Minnesota, had no comment on the case but said the insurer “is committed to investigating credible cases of fraud, waste, and abuse.”

Dara Corrigan, a CMS deputy administrator, said that as a “general matter,” its Medicare Advantage audits “are not designed to detect fraud, nor are they intended to identify all improper diagnosis submissions.”

Protecting taxpayers: ‘That is money that should be recovered’

The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans. CMS has estimated the total overpayments to health plans for the 2011-2013 audits at $650 million, yet how much it will eventually claw back remains unclear.

Payment errors continue to be a drain on the government program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses at $11.4 billion for 2022.

“This isn’t a partisan issue,” said Sen. Sherrod Brown D-Ohio. “I’ve requested a plan from CMS as to how they plan to recoup these taxpayer-funded overpayments and prevent future overbilling.”

Leslie Gordon, an acting director of health care for the Government Accountability Office, said CMS needs to speed up the audit and appeals process to get quicker results.

“That is money that should be recovered,” Gordon told KHN.

As Medicare Advantage faces mounting criticism from government watchdogs and in Congress, the industry has tried to rally seniors to its side while disputing audit findings and research that asserts the program costs taxpayers more than it should.

AHIP, an insurance industry trade group, criticized KHN’s reporting on the newly released audits as “misleading,” while the pro-industry group Better Medicare Alliance said the audits were “in some cases, more than a decade old.”

Jeff De Los Reyes, a senior vice president at GHG Advisors health care consulting group, said he believes the health plans have improved their documentation in recent years. But, he said, “coding is never 100{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} perfect and there will be errors despite the best of intentions.”

Rep. Katie Porter, a Democrat from Southern California and a critic of Medicare Advantage, countered: “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).

What’s new for ACA health insurance open enrollment : Shots

What’s new for ACA health insurance open enrollment : Shots
Illustration of a group of people putting together a large scale puzzle on the floor. The image on the puzzle is the health care cross. Medications surround the people putting the puzzle together.
Illustration of a group of people putting together a large scale puzzle on the floor. The image on the puzzle is the health care cross. Medications surround the people putting the puzzle together.

It’s fall again, meaning shorter days, cooler temperatures, and open enrollment for Affordable Care Act marketplace insurance — sign-ups begin this week for coverage that starts Jan. 1, 2023. Even though much of the ACA coverage stays the same from year to year, there have been a few changes you’ll want to take note of this fall, including those that might help you even if you don’t usually buy ACA insurance, but have been having trouble finding an affordable health plan through your employer.

In the past year, the Biden administration and Congress have taken steps — mainly related to premiums and subsidies — that will affect 2023 coverage, and could reduce your cost. Meanwhile, recent court decisions have triggered questions about what sorts of preventive care or abortion services each plan covers.

So, what’s new, and what should you know if you’re shopping for a health plan? Here are six things to keep in mind.

1. Sign up soon

Open enrollment for people who buy ACA health insurance via HealthCare.gov or one of the state exchanges begins Tuesday, Nov. 1 and, in most states, lasts through Jan. 15. To get coverage that begins Jan. 1, enrollment usually must occur by Dec. 15.

2. Your family might now qualify for a subsidy

One big change is that some families who were barred in past years from getting federal subsidies to help them purchase ACA coverage may now qualify.

A rule recently finalized by the Treasury Department aims to address what has long been termed the “family glitch.” The change expands the number of families with job-based insurance who can choose to forgo their coverage at work and qualify for subsidies to get an ACA plan instead. The White House estimates that this adjustment could help about 1 million people gain coverage or get more affordable insurance.

Before, employees could qualify for a subsidy for marketplace insurance only if the cost of their employer-based coverage was considered unaffordable based on a threshold set each year by the IRS. But that determination took into account only how much workers would pay for insurance for themselves. The cost of adding family members to the plan was not part of the calculation, and family coverage is often far more expensive than employee-only coverage. The families of employees who fall into the “glitch,” either go uninsured or pay more through their jobs for coverage than they might if they were able to get an ACA subsidy.

Now, the rules say eligibility for the subsidy must also consider the cost of family coverage.

“For the first time, a lot of families will have a real choice between an offer of employer-sponsored coverage and a marketplace plan with subsidies,” says Sabrina Corlette, a researcher and co-director at Georgetown University’s Center on Health Insurance Reforms.

Workers will now be able to get marketplace subsidies if their share of the premium for their job-based coverage exceeds 9.12{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their expected 2023 income.

Thanks to the change in the rules, two calculations now will occur: the cost of the employee-only coverage as a percentage of the worker’s income and the cost of adding family members. In some cases, the worker may decide to remain on the employer plan because his or her payment toward coverage falls below the affordability threshold, but the family members will be able to get a subsidized ACA plan.

Previous legislative efforts to resolve the family glitch failed, and the Biden administration’s use of regulation to fix it is controversial. The move might ultimately be challenged in court. Still, the rules are in place for 2023, and experts, including Corlette, say families who could benefit should go ahead and enroll.

“It will take a while for all that to get resolved,” she says, adding that it unlikely that there would be any decision in time to affect policies for 2023.

An Urban Institute analysis published last year estimated that the net savings per family from this change in regulations might be about $400 per person, and the cost to the federal government for new subsidies could be $2.6 billion a year. Not every family would save money by making the change, so experts say people should weigh the benefits and potential costs.

3. Preventive care will still be covered everywhere without a copay, but abortion coverage will vary

Many people with insurance are happy when they go in for a cancer screening, or seek other preventive care, and find they don’t have to pay anything out-of-pocket. That comes from a provision in the ACA that bars cost sharing for a range of preventive services, including certain tests, vaccines, and drugs. But a September ruling by U.S. District Judge Reed O’Connor in Texas led to confusion about what might be included in that category next year. The judge declared unconstitutional one method the government uses to determine some of the preventive treatments that are covered without patient cost sharing.

Ultimately, that might mean patients will have to start paying a share of the cost of cancer screenings or pay part of the cost of drugs that prevent the transmission of HIV. The judge has yet to rule on how many people the case will affect. But, for now, the ruling applies only to the employers and individuals who brought the lawsuit. So, your no-cost screening mammogram or colonoscopy is still no-cost. Whatever the judge decides, his ruling is likely to be appealed, and no decision is expected before the start of the 2023 coverage year.

The other court decision that has raised questions is the Supreme Court ruling that overturned the constitutional right to an abortion. Even before that decision was announced in June, coverage of abortion services in insurance plans varied by plan and by state.

Now it’s even more complicated as more states move to ban or restrict abortion.

State insurance rules vary.

Twenty-six states restrict abortion coverage in ACA marketplace plans, while seven states require it as a benefit in both ACA plans and employer plans purchased from insurers, according to KFF. Those states that require abortion services to be covered are California, Illinois, Maine, Maryland, New York, Oregon and Washington.

If in doubt, employees and policyholders can check their insurance plan documents for information about covered benefits, including abortion services.

4. Premiums are going up, but that might not affect most people on ACA plans

Health insurers are raising premium rates for ACA plans and for employer coverage. But most people who get subsidies for their ACA health insurance won’t feel that pinch.

That’s because the subsidies are tied to the cost of the second-cheapest “silver” plan offered in an ACA marketplace. (Marketplace plans are offered in colored “tiers,” based on how much they potentially cost policyholders out-of-pocket.) As those baseline silver plans increase in cost, the subsidies also rise, offsetting all or most of the premium increases. Still, shop around, experts advise. Switching plans might prove cost-effective.

As for subsidies, passage this summer of the Inflation Reduction Act guaranteed that the enhanced subsidies that many Americans have received under legislation tied to the COVID-19 pandemic will remain in place.

People who earn up to 150{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the federal poverty level — so make up to $20,385 for an individual and $27,465 for a couple — can get an ACA plan with no monthly premium. Consumers who earn up to 400{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the federal poverty level — or $54,360 for an individual and $73,240 for a couple — get sliding-scale subsidies to help offset premium costs. And the premiums for ACA plans purchased by people who have higher incomes than that are also capped; according to the rules, they will need to pay no more than 8.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their household income toward premiums.

For workers with job-based insurance, employers generally set the amount they must pay toward health coverage. Some employers may pass along their rising insurance costs by increasing the amounts taken out of paychecks to go toward premiums, setting higher deductibles or changing the health care benefits they offer. But anyone whose share of their job-based coverage is expected to exceed 9.12{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their income in 2023 can check now to see whether they qualify for a subsidized ACA plan instead.

5. Debts owed to insurers or to the IRS won’t stop coverage

Thank COVID-19 for this one. Typically, people who get subsidies to buy ACA plans must prove to the government in their next tax filing that they received the correct subsidy, based on the income they actually received. If they failed to do that reconciliation with the IRS, policyholders would lose eligibility for the subsidy the next time they enrolled. But, because of ongoing COVID-related problems in processing at the IRS, those consumers will get another reprieve, continuing an effort set in place for tax year 2020 by the American Rescue Plan Act.

Also, insurers can no longer deny coverage to people or employers who owe past-due premiums for previous coverage, says Karen Pollitz, a senior fellow at KFF. This follows a reexamination of a wide variety of Medicare and ACA rules prompted by an April executive order from President Joe Biden.

“If people fell behind on their 2022 premiums, they nevertheless must be allowed to reenroll in 2023,” Pollitz says. “And when they make the first-month premium payment to activate coverage, the insurer must apply that payment to their January 2023 premium.”

6. Comparison shopping will likely be easier

Although ACA plans have always been required to cover a wide range of services and offer similar benefits, variation still existed in the amounts that patients paid for office visits and other out-of-pocket costs. Starting during this year’s open enrollment, new rules are taking effect that aim to make the comparison of plans easier. Under the rules, all ACA health insurers must offer a set of plans with specific, standardized benefits. The standard plans will, for example, have the same deductibles, copays, and other cost-sharing requirements. They will also offer more coverage before a patient has to start paying toward a deductible.

Some states, such as California, already required similar standardization, but the new rules apply nationally to health plans sold on the federal marketplace, HealthCare.gov. Any insurer who offers a non-standard plan on the marketplace must now offer the standardized plans as well.

Under a different set of rules, starting Jan. 1, all health insurers must make available cost-comparison tools online or over the phone that can help patients predict their costs for 500 “shoppable services,” such as repairs to a knee joint, a colonoscopy, a chest X-ray or childbirth services.

KHN (Kaiser Health News) is an editorially independent, national program of the Kaiser Family Foundation {KFF).