An Arm and a Leg

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.

Longtime listeners to this show know we’ve been talking about something called “charity care” for years. Federal law requires that all nonprofit hospitals have charity care policies – that is, financial assistance policies — to reduce or remove people’s medical bills.    The problem: people don’t know about it, and hospitals don’t always make it easy to access. New research suggests that the scale of this problem is huge: hospitals are failing to provide more than 14 billion dollars worth of charity care to people who qualify for it. Instead, that money becomes medical debt.   That research comes from the nonprofit Dollar For, an organization dedicated to helping people get charity care. We’ve been talking with Dollar For’s founder, Jared Walker, for years – following his team on their mission to crush medical debt, one charity care application at a time.    Jared brings us up to speed on Dollar For’s latest research, their efforts to reach hospitals, and how new programs targeting medical debt in places like North Carolina may change things.    That new program in North Carolina is estimated to wipe out $4 billion in medical debt. We look into how it took shape.    Plus, we meet Clara, a listener who used her impressive research chops to get charity care from a hospital in New York. In the process, she crafted an expert charity care appeal letter, and shared a template with us.    Use case: the hospital has denied you charity care after you applied, or offered you less than you need. Here’s the template.    Of course, Dollar For has tons of resources, including a tool to help you quickly figure out if you qualify for help. And staff to help if you get stuck. Start here: https://dollarfor.org/help/   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. This month, every dollar you give gets matched dollar-for-dollar, by NewsMatch, from the Institute for Nonprofit News."  See omnystudio.com/listener for privacy information.

Several listeners sent us an article with the headline Make your health insurance cry, about a new AI tool to fight health insurance. We had to learn more. Meet Holden Karau: a Bay Area software engineer who says she’s “trying to make health insurance suck a little bit less.”So she’s created an AI tool to appeal insurance denials.Her project, Fight Health Insurance, is a labor of love (she’s not earning money from it) and fueled by hatred (of insurance companies). It draws on her tech expertise and on her years of experience fighting health insurance: for gender-affirming care, for rehab after getting hit by a car, and even for her dog, Professor Timbit. We talked with Holden about what it took to build the tool, how it works, and what she hopes comes next.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. This month, every dollar you give gets matched dollar-for-dollar, by NewsMatch, from the Institute for Nonprofit News.See omnystudio.com/listener for privacy information.

Something different: We talk with journalist Cara Anthony about topics that don’t always come up in conversations about the cost of health care. For the last four years, she’s been reporting on the public health effects of racism, violence, and intergenerational trauma in a small Missouri town.. The result: A new documentary and podcast series called Silence in Sikeston.   She sat down with us to talk about the value of breaking silences and the possibility for healing. 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.

We're sharing an episode of “To See Each Other,” about a question that’s SUPER-relevant to this show:  How do we pay for long-term care, like nursing homes?  To See Each Other aims to complicate the narrative about small-town Americans. In this new season, host George Goehl heads to Lincoln County, Wisconsin — population, 28,000-and-some. And home to a publicly-run nursing home with a 5-star quality rating from the feds.  A conservative county board plans to sell the home to a private operator, but senior citizens aren’t having it. They show up to board meetings, march in the Labor Day parade, and fight with… their last breath.George goes deep into questions of aging in America, public versus private versions of long-term care, and the nuts and bolts of organizing. The show aims to put you in a fighting mood, and to think differently about aging.See omnystudio.com/listener for privacy information.