An Arm and a Leg

Hey, first!  If you value what we do, this is the best-ever time to support our work:  This month, every donation gets matched two-for-one.   We have SO much work ahead in 2026. Donate here — and get your money matched two-for-one. It’s probably fair to say: this is the worst year ever for picking health insurance. Premiums are skyrocketing – whether you get insurance through work or from the Obamacare marketplace.  And with enhanced subsidies almost definitely expiring, millions of people with Obamacare plans are grappling with drastic changes to their household budgets.  We’re our own case study: You’ll hear us sorting through our own options. None of them are pretty, but because we know how to read the fine print, we figured out: Some are way, way less awful than others.  And to help you do the same: We’ve boiled down our fine-print-reading expertise in this starter pack on how to pick insurance.  Also in this episode: we talk with a listener who wonders: is paying for health insurance even worth it at this point? (Her ultimate answer: Yes, but argh.) Read Julie Appleby’s reporting for KFF Health News about what could happen if Congress changes course and extends the subsidies.  Here’s a transcript of this episode.  Send your stories and questions! Or call 724 ARM-N-LEG. And, again… we’d love for you to support this show. See omnystudio.com/listener for privacy information.

Hey, first!  If you value what we do, this is the best-ever time to support our work:  This month, every donation gets matched two-for-one.   We have SO much work ahead in 2026. Head to https://armandalegshow.com/support/ to donate — and get your money matched two-for-one. This statement might shock you: some actual good things happened in 2025. Or, at least things that did not totally suck.  Stuff like: new limits on the hoops insurance companies can make you jump through, and new protections from predatory debt collectors..   These are just a couple examples of what state governments have been up to this year – in red, blue, and purple states alike.  State governments can’t do it all, but across a couple of episodes, we’ll dive into a handful of meaningful wins, and learn how they came to pass.  Today’s episode takes us to Nebraska, where the state passed aggressive new restrictions on prior authorization.  And Virginia, where lawmakers banned wage garnishment for lots of medical debts. Here's a transcript of this episode.See omnystudio.com/listener for privacy information.

Economist Vivian Ho has been researching the US health care system for four decades. These days she focuses on what she describes as the biggest burden on the average American: runaway hospital prices and rising health insurance premiums. (You know, Arm and a Leg stuff.)  And she’s developed a strategy for addressing high insurance premiums – one based on a real-life success story. So when she asked us to help her gather data for a new study, we were intrigued. We break down Vivian’s theory of change, and how sharing your medical bills with her team could help build a data arsenal for the fight ahead.  Want to share your documents with Vivian and her team?  You can find all details about how to send them here.   Here’s a transcript of this episode. Send your stories and questions! Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

A listener named Thomas Sanford wrote to us earlier this year, asking for help with a little DIY project. And it’s turned into the most encouraging thing we’ve seen all year. With input from the Arm and a Leg community — specifically folks who get our First Aid Kit newsletter — Thomas has drafted a one-page handout, packed with resources for anyone who needs help with medical bills. It’s ready for you to use, and he wants your help making it better.  You’ll hear all about Thomas’s story — he’s a medical resident, who started out just wanting something to hand to his own patients — in today’s mini-episode. And now you can get involved. Thomas’s current version is great — and there’s also tons of room to improve it, with your help. Print out the current version and pass it around: Download it right here. Make suggestions for the next version: Anybody can comment on this Google doc. Volunteer to pitch in: Got design skills? Editorial chops? Language skills, to translate it? Other ideas?  Here’s a sign-up form. And you can make your own adaptations! Thomas has registered it with a Creative Commons license.  This project has been incubating in our First Aid Kit newsletter. If you’re not subscribed, this is a great time to sign up.  Here’s a transcript of this episode.  Send your stories and questions! Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

For the first time, our senior producer, Emily, has to sign up for Obamacare. And it turns out, it’s one heck of a year to do that.  A recent headline from KFF Health News reads: “Insurers and customers brace for double whammy to Obamacare premiums.” We break down what those “whammies” might mean in dollars and cents for Emily and the millions of others signing up for Obamacare in 2026.   Plus, we cover what’s happening with ACA navigators – the people charged with helping you sign up for Obamacare, and what to expect in November when open enrollment kicks off.   Learn more about what’s coming in 2026 in our First Aid Kit newsletter.  Check out KFF’s Obamacare premium calculator.  Learn whether your state funds its own navigator program.  Read a transcript of this episode. Send your stories and questions! Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

Hey first! We need your help: Financial help. Donations from listeners power this show, and we’ve got a goal: 100 people making their first-ever gift, this week.  If you haven’t chipped in before, this is a great time — just click here. OK, onwards… Sharing a favorite from our archive – with lessons that are as relevant as ever.  Laurie Todd calls herself The Insurance Warrior. She fights health insurance for a living. Her speciality: writing appeals when insurance companies deny high-stakes, high-dollar treatments. Her first victory was fighting to get coverage for her own life-saving cancer surgery – which we chronicled in an episode tracing her origin story.  Since then, she says she’s notched hundreds of other victories, and outlined her strategies in two books: Fight Your Health Insurer and Win and APPROVED: Win Your Insurance Appeal in 5 Days. In this episode, we go deep on one of Laurie’s early, super-instructive cases, that taught Laurie one of the weirder truths about health insurance in America: fighting your health insurance often means fighting… your employer.  And in this case, that employer was a $61 billion company.  Want more about winning insurance appeals? Here’s our starter pack. Here is a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG.See omnystudio.com/listener for privacy information.

When a New York couple purchased a health insurance plan from a telemarketer, everything sounded legit. Meds, doctors, tests?  All covered. But it didn't take long for them to realize they'd been “hustled” – ending up with bills for thousands of dollars, and leaving them no choice but to skip important medical care.  In their series “Health Care Hustlers,” Bloomberg reporters Zach Mider and Zeke Faux uncover the exact nature of the scheme – how this couple, as well as thousands of others, signed up for health plans by unknowingly agreeing to work “fake jobs.”   Zach and Zeke join us to unpack the many surprising layers to this business— involving a subculture of unscrupulous telemarketers, a TV-sitcom-writer-turned-investor who masterminded the idea, and the legal gray area that allows these plans to proliferate.  Reminder: If you need to sign up for health insurance, the place to go is healthcare.gov. (As we’ve warned before: Don’t even Google it.)  No matter what, shopping for insurance requires a ton of homework. We’ve got a guide for you in this Starter Pack. Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

As a follow-up to our series The Prescription Drug Playbook — all about how you can get the meds you need at a price you can (maybe) afford — we’re stepping back to look at the big picture.  From the start of this podcast, we’ve been trying to answer a major question: Why do my meds cost so freaking much? And we’ve highlighted the profit-seeking games that insurance, pharma, and middlemen play all around us in more than a half dozen episodes.  But there’s one set of players on the field that we’ve never talked about: drug distributors, and how they play a role in another reason you may not be able to get your medicine: drug shortages.  This story comes from our friends at Organized Money, a podcast about monopolies, from writers and journalists David Dayen and Matt Stoller.  We think you’re going to like it.  In the meantime, check out the latest installment of our First Aid Kit newsletter for a rundown of our previous coverage of drug costs.  Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

In February, we asked you, our listeners, to share the tips, tricks, and tactics you’ve learned for getting the medicine you need at prices you can manage.  And of course some of you work in health care and have insider knowledge. Which we’re passing along in this second episode of The Prescription Drug Playbook. We’ll hear from a listener who works to help seniors find healthcare, a pharma sales rep, an employee benefits advisor, and a battle-worn hospital caseworker – all bringing something a little surprising, and possibly even life-saving to the table.  Of course—for all their advice, there is a BIG caveat: there is no one solution for everyone. This is a set of patches, workarounds, bandaids. We deserve SO much better. But in the meantime, maybe some of these tips can help.  Here’s a link to the Find a Health Center Tool that we told you about in the episode—it’s worth checking out! And here's the full drug-price song by producer Claire Davenport and some robots Find the whole Prescription Drug Playbook series – including our First Aid Kit newsletters — at armandalegshow.com/drugs Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

In surveys, one in four Americans report having to skip their medications due to cost. We asked our listeners: what strategies have you used when you’ve been hit with pharmacy sticker shock?  We heard from a ton of you – with stories, strategies and workarounds that surprised and encouraged us. None of them will work for everybody. This is a set of patches and bandaids for a broken system. But if there’s one that’ll work for you, we want to help you find it. So we’re bringing you the most-complete, best-organized set of patches we can.   In this episode — the first of two episodes — a dad named Bob tells us how he learned some hard-earned lessons.  When Bob’s teenage daughter Mary was diagnosed with epilepsy, it took her doctors years of trial and error to find the right treatment. It finally worked, Mary's seizures stopped — and then, when Bob's insurance changed, the price tag for Mary's meds went through the roof. What Bob did next represents one possible journey through the dizzying (and often exasperating) maze of potential workarounds for getting your medicine at a price you can afford.  We’ve started compiling lessons from Bob’s story and others in our First Aid Kit newsletter.  Our first installment features a price comparison spreadsheet… inspired by Bob (who we’d like to nominate for Dad of the Year).  Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

What do the KGB and the former CEO of Cincinnati Children's Hospital have in common? At different times, they’ve each looked to a guy named Eugene Litvak for help. He only said yes to Cincinnati — but he saved that hospital more than a hundred million dollars a year. For the last few decades, Litvak – a Soviet émigré with a PhD in math – has been on a mission: save U.S. hospitals from financial ruin, and improve the lives of doctors, nurses, and patients. He says he has just the formula to do it, lots of prominent experts agree, and he’s documented impressive results so far: Financial savings, fewer hospital-related deaths, lower staff turnover, and shorter wait times. But Litvak and his allies are still struggling to convince more hospital CEOs to try his method.   We talk with Litvak about his wild life story and how he found the fix that he says could revolutionize American hospitals. And we speak with experts to determine why more hospitals don’t try it.  Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

With news blasting from Washington like a firehose, it feels impossible to take it all in — to stay on top of all the changes the Trump administration has been trying to make.  But for health care, one person is probably closer to anyone than to understanding the full picture: KFF Heath News Chief Washington Correspondent Julie Rover.     In this episode, Julie helps us see that picture, by telling us two stories: The first concerns a teeny part of the health care system — an obscure federal agency, one of many that the Trump administration has taken a chainsaw to. The other is anything but obscure: Possible cuts to Medicaid —which Julie thinks Republicans will actually find very difficult to make. Plus, reporting from Julie’s KFF Health News colleague Arthur Allen. And a cameo from one of Julie’s beloved corgis. Check out Julie’s weekly health policy news podcast: What the Health?  Read more from Arthur Allen on cuts to AHRQ in KFF Health News: What’s Lost: Trump Whacks Tiny Agency That Works To Make the Nation’s Health Care Safer Trump HHS Eliminates Office That Sets Poverty Levels Tied to Benefits for at Least 80 Million People Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

People who work in real-life emergency rooms have raved about how accurately the new drama The Pitt (Max) captures the dynamics and the medical details of their workplaces. Here at An Arm and a Leg, we’ve been nerding out about how the show depicts the financial forces that shape the ER’s day-to-day problems like crowding, eternal wait times, and scary bills.  For this episode, we got Dr. Alex Janke, an emergency medicine doctor and health policy researcher to nerd out with us.  Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

A few months ago, we got a note from a listener named Meagan, who wanted to thank us.  She said the stories she heard on this show had given her the advice and encouragement she needed to finally win a fight against a medical bill she didn’t owe — a battle she’d been waging for more than two years. As Meagan tells us, those two years were filled with wild twists and turns and a lot of disappointment. We hear what kept her motivated and encouraged despite all the setbacks – and after an insurance rep pointed her to a free legal resource — the tactic that finally led to a breakthrough.  Here’s a resource we mention — with a spoiler alert: It’s the sample cease-and-desist letter that a lawyer shared with Meagan.  We’ll break down the details — how a letter like this could work, in certain situations — in a future First Aid Kit newsletter. Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

A federal agency called the Consumer Financial Protection Bureau — CFPB for short — has taken big steps to help people with medical debt. In early February, the Trump administration moved to effectively shutter the agency.  We talked with credit counselor Lara Ceccarelli about how the CFPB has helped clients at the nonprofit where she works, and how she’s navigating the sudden change.  And consumer-rights advocate Chi Chi Wu — an attorney with the National Consumer Law Center — describes the court battle she and her colleagues are mounting to slow down the agency’s dismantling — and where things could go from here.  We’ll track this developing story in next week’s First Aid Kit newsletter, so if you’re not signed up, this is a great time to start: www.armandalegshow.com/firstaidkit. Here's a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

Hey – real quick: some big news from the team at An Arm and a Leg. Our First Aid Kit newsletter is going weekly! First Aid Kit brings you advice from our show and more on how to survive and navigate America’s health care system.  And allow us to introduce First Aid Kit’s new writer, Claire Davenport.  When she was our intern last summer, she reviewed An Arm and a Leg’s entire catalog of episodes, and took notes along the way. Now she’s bringing the practical lessons from all that reporting straight to your inbox, every week.  Get it while it’s hot: sign up for First Aid Kit here.  See omnystudio.com/listener for privacy information.

We’re kicking off a new reporting project about how much we pay for our medicine — and what we can maybe do about it — and we want to hear your stories. Because: Getting a case of sticker shock with a prescription happens all the time.  So we’re asking: What have you done — or tried to do — to get the medicines you need at prices you can afford? And what did you learn that might be useful for other people to know? Maybe you learned a strategy that actually WORKED for you. Like using a coupon or ordering drugs from online pharmacies — even pharmacies in other countries. Maybe it was, “Man, I learned about a new way I’m getting screwed.”  However things went, tell us about it here: armandalegshow.com/drugs Your story can be short or long, scary or uplifting – whatever you’ve gone through to get your meds, whether it worked or not, we want to hear about it. The more we learn about these strategies, and about new ways we’re getting beat up, the more we can work together to do something about it.  And over the next couple of months, we’ll dig into everything you bring us, call up some experts, and start bringing you what we’re learning. Meanwhile, if you could use some tips right now for getting a better price for your prescription, we’ve just posted a batch to our First Aid Kit newsletter – check it out here. Fair warning: It’s a collection of band-aids — that’s what you find in a first aid kit — but it’s a start. Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

You remember a guy named Martin Shkreli? If his name rings a bell, it’s probably because back in 2015, he jacked up the price of an old drug — from around $13 a pill to $750. The media dubbed him “the pharma bro,” and he became a symbol of brazen pharmaceutical greed.  Now, he’s the namesake for the Shkreli Awards — a kind of Oscars for the most outrageous examples of greed, fraud, and general brokenness in American health care.  Every year, a health care think tank called the Lown Institute ranks the top ten worst stories and holds an award ceremony to “honor” the winners.  We’re bringing you highlights from this year’s ceremony – featuring things like human bones for sale without the consent of the deceased or their families, phantom urinary catheters, and so much more – and some reflections from the Lown Institute’s president, Dr. Vikas Saini.  “Showing all these stories together paints a picture of a health care system in desperate need of transformation,” Saini said at the ceremony. “Not just because the stories are shocking, but because often what they're depicting, like Martin Shkreli's infamous price hike, is perfectly legal.”  Here’s a transcript of this episode.  Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.

A few weeks ago, a listener sent us a note with a link to a news article about a new resolution that had recently been adopted by the American Medical Association – the largest group representing doctors in the US. The resolution said: hospitals need to do more to guarantee charity care to patients who qualify. Legislators and regulators should make them. Our listener was the author of that resolution, and he told us he first learned about charity care through this podcast. His name is Joey Ballard and he’s an internal medicine resident at the University of Illinois-Chicago (UIC).We talked with him about his early organizing as a medical student, bringing the resolution to the AMA, and the optimism he feels bringing the fight for charity care to the hospital he works at now.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And again... we’d love for you to support this show.See omnystudio.com/listener for privacy information.

Today we’re revisiting one of our favorite episodes from the archive – a story about giving – and bringing you an update.  In 1980, a young father named Denny Buehler was battling leukemia and needed to travel from Cincinnati to Seattle for treatment. To raise the money, his friends and family threw a softball tournament. Denny passed away a few months later. But his friends and family turned the softball tournament into a beloved tradition, and a chance to give back. For more than 40 years, they’d host the games and sell hot dogs to raise money for people in the area who needed help with medical expenses. Then in 2019, the Denny Beuhler Memorial Fund found a way to make the money they’d fundraise go a hundred times farther. Literally. Inspired by a segment on Last Week Tonight, they partnered with a group to buy up old medical debt – and erase it. Now in 2024, that group – now known as Undue Medical Debt – has grown its influence and helped crush billions (!) in debt.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And again — we’d love for you to support this show.See omnystudio.com/listener for privacy information.