Category: Health Policy

A $2,000 Voucher and 600 Patients: The Math Behind Fixing Care

Jan 20, 2026

When I was at HLTH last October Bradley Bostic invited me on his BoomBostic Health podcast. I was in the mood for ranting about the health care system and promoting my desire for getting everyone concierge level primary care. Bradley was very generous in giving me a mike and a lot of rope. I am embedding the youtube version and if you want just audio it’s here. (I was also losing my voice so there’s a cleaned up transcript below)–Matthew Holt

Bradley:

Well, hello and welcome back to another episode of Boombostic Health in the Wild here at HLTH 2025 in Las Vegas. I’m thrilled to have Matthew Holt with me, who is the leader at The Health Care blog, a blog I follow, and I appreciate you being here, Matthew.

Matthew

Bradley, thank you very much. I count my readers, you know, on about two hands, so I want to keep you in good health. I have a little joke. We used to have a podcast that actually wasn’t that well-followed called the THCB gang and one of my colleagues on THCB gang was at a conference and a guy in the row behind him said “oh I recognize your voice, my father used to listen to the podcast but then he died.” When my colleague told me the story I said, we don’t have enough listeners and subscribers to lose them like that – we’ve got to keep them alive in order to keep the podcast going!

Bradley

Well, Boombostic Health was really born out of my pension for building companies in the health tech world and investing in companies. When we first started this. I wasn’t sure if anybody would listen to it. My mom passed away from cancer 25 years ago. So, I knew she wouldn’t be listening to it unfortunately. But that was a big thing that inspired me to get into healthcare. And lo and behold, there is a really interested audience out there that wants to know how innovation is transforming our broken health care system. And clearly with your background with Health 2.0 and The Health Care Blog, this is an area that you’re focused on. And I think you said you have two easy steps. Oh no, two steps, not necessarily easy to fix healthcare.

Matthew

So the preamble to this is I’ve been doing this for a long time. I came to America in 1989.

Hospitals can soften the blow of Medicaid’s retroactive coverage change, if they choose to

Jan 16, 2026

By BRIAN STANLEY

Patients waiting on Medicaid enrollment face more bills, while Congress touts that as cost savings. Hospitals need to choose their stance.

Medicaid covers the lion’s share of short- and long-term health care expenses for low-income, older, and/or disabled Americans. Until now, the program paid for care received up to three months before someone filed for Medicaid, as long as the person was eligible at the time. That grace period has long been a safety net for people who fall ill before navigating the maze of Medicaid enrollment.

In a quiet change tucked into the “Big Beautiful Bill,” lawmakers shrunk that window by one to two months, depending on the state.

Now, for adults in Medicaid expansion programs, retroactive coverage stops at one month before enrollment. For traditional Medicaid enrollees, it’s two months.

The Congressional Budget Office estimates this change will “save” the government billions over the next decade. But those “savings” don’t reflect fewer illnesses or better care. Instead, they are unpaid bills and costs that move downstream to patients, nursing homes, and other parts of the health care system.

These changes can impact any of us.

Any health event can set off a chain of care – hospitalization, rehab, then long-term nursing home placement – that easily stretches past 30 or 60 days. Under the new rules, that early care will fall outside Medicaid’s reach: the first month or two of costs now sit squarely with the patient or facility.

Still, this change is especially harmful for dual eligible beneficiaries. Americans on Medicare who become eligible for Medicaid enrollment – think older adults or people with disabilities – are at particular risk.

This scenario plays out often: a person has Medicare and then experiences an illness or injury that drives their assets down. They then become eligible for Medicaid, in addition to holding their Medicare enrollment. For these Americans, the shift in the “Big Beautiful Bill” means that they face significant bills while they wait for their Medicaid enrollment to be completed.

We know that this population, and realistically, all Americans, suffer when retroactive coverage is taken away from them.

It’s Only a Subsidy If You’re Poor

Jan 15, 2026

By KIM BELLARD

Even though most ACA enrollees/would-be enrollees have made their 2026 enrollment decisions assuming the expanded premium subsidies are not going to be renewed, the renewal of those subsidies is not entirely dead. Last week the House narrowly passed an extension, relying on a discharge petition and 17 Republican Congressmen willing to go against their leadership. Meanwhile, in the Senate, Senator Bernie Moreno (R-OH), of all people, is leading an effort to come up with a bill to expand them as well.

Whether it will eventually get passed is uncertain, as is how/when it might be reconciled with the House bill, and the President might just veto whatever extension might manage to emerge. The expanded subsidies aren’t dead yet, they’re just “mostly dead,” as Miracle Max would say.

The seeming indifference to the concerns of over twenty million ACA enrollees is appalling, but in character. This is an Administration and a Republican Congress that doesn’t like SNAP, Medicaid, school lunches, or aid to starving people in Third World countries, among other things. If you’re poor, they think, too bad; get a job, or a better job, and pull yourself up yourself. No handouts.

If they were against federal subsidies generally, out of fiscal prudence or other guiding principles, I could respect it. I wouldn’t agree with it, but it’d at least be intellectually honest. The trouble is, they’re not against subsidies per se; they just don’t like them going to poor people. I.e., the ones who need them most.

What set me off on this was a ProPublica/High Country News investigation into grazing on public lands. If you live in the East you probably don’t think much about either grazing or public lands, but if you live in the West you are probably very familiar with both. Almost 50% of land in Western states is federally owned. It ranges from 85% in Nevada to 4% in North Dakota. Almost half of California is federal land. You might be forgiven if you assume federal lands must be national parks, but they are small relative to land managed by the Bureau of Land Management (BLM), the U.S. Fish & Wildlife Service (FWS), and the U.S. Forest Service (USFS).

According to ProPublica: “The federal government allows livestock grazing across an area of publicly owned land more than twice the size of California, making ranching the largest land use in the West.” Well, you might think, that’s not inherently bad; we might as well use the land for something, maybe even make a little money from it. That’s the problem; the federal government is practically giving it away. Its analysis found that the grazing fees charged amount to a 93% discount relative to the market rate. You read that right: ninety three percent. That’s not a discount, that’s a giveaway.

OK, that’s eye-opening, but if it helps a bunch of ranchers who are struggling to survive, maybe that’s not so bad; ranching goes back to frontier days and has a certain cowboy appeal. Unfortunately, that stereotype isn’t quite true.

Even When Healthcare Has a Clear Price Tag, Are We Getting What We Pay For?

Jan 12, 2026

By OWEN TRIPP

Move over, GLP-1s. This year the healthcare spotlight is on alternative plan design. Alternative health plans offer cost transparency and a consumer-friendly shopping experience. But can the capabilities under the hood deliver on quality and value? Though it may not sound buzzworthy, it has the potential to trigger a seismic shift in the commercial insurance market.

After years of disappointing returns and unmet promises from traditional insurance models, innovators and big-name insurers themselves are doubling down on alternative plans aimed at reducing healthcare costs through preferred care pathways with transparent pricing. Though these plans come in many flavors, common features include tiered networks, variable copays, care steerage, and an emphasis on primary and virtual care — often packaged in a digital-first (and AI-powered) “shopping” experience.

Alternative plans seem like a win-win. For consumers struggling with surprise bills and medical debt, replacing confusing deductibles and coinsurance with predictable copays offers much-needed peace of mind. For employers facing the highest increase in healthcare costs in 15 years, getting their workforce on a trusted path to quality feels like a sure bet.

There’s a catch, though: Alternative plans won’t help much if they lead people to the same old, fragmented healthcare experience. Innovative cost-sharing and a slick front-end experience must be backed by high-quality clinical care, dynamic population health management, and personalized engagement that represent a significant upgrade from what’s been delivered to date.

Otherwise, signing up for an alternative plan will be a lot like buying a shiny new smartphone, only to discover that its operating system only supports a handful of outdated apps.

Alternative plans: what must be under the hood?

While cost transparency and a streamlined shopping experience offer immediate benefits to consumers, it’s the deeper capabilities and levers under the hood of alternative plans that will drive long-term value and create an alternative model worth embracing.

1. A primary care-led integrated care model

Most insurer-led alternative plans are built on top of existing care delivery networks (and existing provider contracts), often leading people to well-worn pathways and settings, including those that have produced status-quo outcomes for people and minimal cost improvement for employers.

Alternative plans need to create new dynamics around primary care, removing access barriers, creating flexibility and incentives, and repositioning expectations for provider interactions. Simply doing more of the same is inadequate. A true primary care-led plan is one that creates new channels and opportunities, dedicates time for immersive one-to-one discovery, and empowers physicians to lead people to quality across the network based on individual needs — supported by data, technology, and system-wide connections.

The Dimensions of Artificial Intelligence in the Healthcare Industry

Jan 5, 2026

By STEVEN ZECOLA

On December 19th, the Department of Health and Human Services (“HHS”) issued a Request for Information seeking to harness artificial intelligence (“AI”) to deflate health care costs and make America healthy again.

As described herein, AI can be used in many dimensions to help lower healthcare costs and improve care. However, to achieve significant breakthroughs with AI, HHS will need to completely revamp the regulatory approach to drug discovery and development.

Dimension #1. Incorporation of AI into Drug Discovery

The biggest benefit to the healthcare industry’s performance from AI is achievable from drug discovery. Accounting for the costs of failures, the average FDA drug approval costs society almost $3 billion and takes decades to reach the market from its inception in the lab.

In contrast, AI identifies potential treatments much faster than traditional methods by processing vast amounts of biological data, uncovering hidden causal relationships, and generating new actionable insights.

AI is particularly promising for complex, multifactorial conditions – such as neurodegenerative diseases, autism spectrum disorders, and multiple chronic illnesses – where conventional reductionist approaches have failed.

In the short-run, HHS should direct its grants toward AI-generated basic research, with a particular emphasis on the hard-to-solve illnesses. At the same time, the FDA should be putting into place a new approval system for AI-initiated programs to enable breakthrough treatments in a compressed timetable.

Dimension #2. Incorporation of AI into the Drug Development Process

Simply relying on AI for drug discovery, while subjecting its advances to the current approval process would undermine the use of the technology.

Rather, improvements from AI can already be had in fulfilling the exhaustive regulatory documentation requirements, which today add up to as much as 30% of the cost of compliance.

Father Christmas Reminds Us We Can Do Better Than This

Dec 23, 2025

By MIKE MAGEE

The Ghost of Christmas Past, in the form of Surgeon General C. Everett Koop, has returned this season to torture one RFK Jr who refuses to fully share life saving vaccines with children. In the encounter, the ghostly Koop reviews a time 37 years ago when citizens came together to celebrate separating scientific fact from fiction with life-saving effects.

Beginning in 1988, the United States, along with the rest of the world, had formally acknowledged and celebrated World AIDS Day on December 1st each year – that is until 2025. At President’s Trump’s direction the State Department, and with HHS support, turned their back on an inconvenient truth – the Republican early record on HIV/AIDS. Let’s channel the truth-telling Surgeon General from Christmas past and remember this telling story.

On June 5, 1981, the CDC reported 6 cases of Pneumocystis carinii associated with a strange immune deficiency disorder in California men. Drs. Michael Gottlieb and Joel Weismann, infectious disease experts who delivered care routinely for members of the gay population in Los Angeles, had alerted the CDC. Inside the organization, there was a debate on how best to report this new illness in gay men.

The vehicle that the CDC chose was a weekly report called the Morbidity and Mortality Weekly Report or MMWR. So as not to offend, the decision was made to post the new finding, not on page 1, but on page 2, with no mention of homosexuality in the title. Almost no one noticed.

On April 13, 1982, nine months after the initial alert, Senator Henry Waxman held the first Congressional hearings on the growing epidemic. The CDC testified that tens of thousands were likely already infected. On September 24, 1982, the condition would for the first time carry the label, AIDS – acquired immune deficiency syndrome.

The new Surgeon General, C. Everett Koop’s focus at the time, along with the vast majority of public health leaders across the nation, was not on a new emerging infectious disease, but rather on the nation’s chronic disease burden, especially cardiovascular disease and cancer being fed by the post-war explosion of tobacco use. He had already surmised that the power of his position lie in communications and advocacy.

One month after his swearing in, he appeared on a panel to release a typically boring Surgeon General update report on tobacco. He was not intended to have a big role. When Koop rose to deliver what all thought would be brief, inconsequential remarks, he wasted no time disintegrating the lobbyist organization, the Tobacco Institute. For print journalists in the audience, he was clear, concise and quotable. For broadcast journalists, he was a dream come true – tall, erect with his Mennonite beard, in a dark suit with bow tie, exuding a combination of extreme confidence and legitimacy mixed with “don’t mess with me” swagger.

As Koop would later say, after that, “I began to be quoted as an authority. And the press from that time on was all on my side… I made snowballs and they threw ‘em.” The other thing that Koop noticed early was that the Reagan Administration didn’t shut him down. That was surprising since Koop’s major supporter in a year long confirmation battle (the AMA opposed his appointment) was NC arch-conservative Senator Jesse Helms.

Add to Jesse’s wrath, R.J. Reynold’s CEO, Edward Horrigan, complained directly to Reagan about Koop’s “increasingly shrill preachments. Cigarette consumption in the US was in free fall. By 1987, 40 states would have laws banning smoking in public places; 33 states had bans in public transportation; and 17 already had eliminated workplace smoking.

Still Reagan didn’t shut him down. Now everyone from public schools to medical groups to women’s associations to civic enterprises wanted him. And beginning in late 1982, he arrived in full regalia, in a magnificent Public Health Service, Vice-Admiral’s uniform with ribbons and epaulettes. And his aide, also in uniform, always carried with him a bag of buttons for distribution which read, “The Surgeon General personally asked me to quit smoking.”

But in the most pressing public health challenge of the day, HIV/AIDS, the department was AWOL. Koop was actively sidelined by top Administration officials. Not surprisingly, the situation deteriorated rapidly. Everyone was feeling the heat, including the CDC, who removed funding for AIDS education after being accused of promoting sodomy by conservatives.

To Improve Health, Design for Agency

Dec 19, 2025

By DAVID SHAYWITZ

Agency — the conviction I can shape my future — is a vital driver of human health and human potential.

It is also the factor overlooked by most digital health platforms.

University of Pennsylvania psychologist Martin Seligman, who has spent decades studying this, says agency boils down to the belief “I can make a positive difference in the world.” People with high agency believe there is something they can do next that might help – and then they actually try.

As Seligman emphasizes, the moments when we “try hard…persist against the odds…[and] make new, creative departures” are precisely when agency is at work. That extra effort and sustained determination — not just the mindset — shows up as improved performance, greater achievement, and enhanced health. It also manifests as resilience, enabling us not only to recover from adversity but (ideally) to bounce back as an even better version of ourselves.

GLP-1s highlight the power and promise of newfound agency. For many living with obesity, past attempts at weight loss reinforced a “cycle of despair” – trying harder mostly meant failing again. With the advent of GLP-1 medicines, many found that their weight would come down — and stay down. Oprah Winfrey called the feeling “a relief, like redemption, like a gift.”

The deeper change is psychological: for the first time in years, effort feels rewarded. GLP-1s unlock an agentic dividend: the motivational boost that comes from finally being able to take control of your health. That surplus sense of possibility can be channeled into the familiar health basics — moving more and sleeping better — but also, often more importantly, into how we show up in our relationships and communities, in the enthusiasm we bring to our hobbies and pursuits, into the totality of experiences that make life so meaningful.

Agency is the motivational currency of health, the ATP of behavior change – it lets success in one domain drive progress in others.

Connected fitness platforms have a similar opportunity. Each discrete achievement — finishing a class, riding three times in a week, noticing that the stairs feel easier or the back hurts less — is a small proof of “I can do this.”

Brown and Toland weighs in on the $34.94 Labcorp test. (Part 6)

Dec 18, 2025

By MATTHEW HOLT

I know you all care, so I am giving a 6th update on the telenovela about my Labcorp bill for $34.95.

The very TL:DR summary of where we are so far is that in May 2025 I had a lab test to go with the free preventative visit that the ACA guarantees, but I was charged for the lab tests and I was trying to find out why, because according to CMS I should not have been.

For those of you who have missed it so far the entire 5 part series is on The Health Care Blog (1, 2, 3, 4 & 5). Feel free to back and read up.

When we left the scene on Sept 9, Blue Shield of California had finished their 30 day investigation and their rep read me the letter they sent me (that I couldn’t open due to their secure email not working). The letter told me that Brown & Toland Physicians, the IPA that manages my HMO, was going to investigate. Today I got a text from Blue Shield alerting me to a secure email and I got all excited, but it was nothing to do with this. And of course I should have heard from Brown and Toland in October or November.

So I decide to pick it all up again, and I called Brown & Toland Physicians or actually Altais which is the holding company that owns them and Blue Shield. I got through the phone tree and eventually got, “leave your number and get a call back” which actually happened not too long later.

The very nice rep tried to figure out my case and told me this:

On 8/14/2025 Mike at Blue Shield called Brown and Toland and asked for the original claim to be reviewed (1430201). I am pretty sure Mike is the nice man from the Executive Admin office at Blue Shield we met in part 2 (or was it part 3?).

On 8/29/2025 the benefits department at Brown and Toland finished their review and reported that the original lab test wasn’t coded as preventative lab services by One Medical, so that the co-pay of $34.95 was correct. ($34.95 was the total agreed payment for all the tests, charged at a total of $322.28. And as it was less than my $50 copay, LabCorp only charges the patient for the total, not the $50!)

Meanwhile, that 30 day Blue Shield investigation was still going on. It ended up with them asking Brown and Toland to investigate. Presumably as a direct result of that, on 9/9/2025 Kelly from Blue Shield called Brown and Toland and sent them the $34.94 claim asking them to review it. (Again, as it turns out, as they just had reviewed it on 8/29/2025).

“So what happened?” I asked today.

My rep told me that whomever at Brown and Toland spoke to Kelly on 9/9/2025 didn’t get or didn’t put in correctly the claim reference number, and so when they passed it on to the adjuster in the benefits department it couldn’t be worked on, and so nothing happened since then. So much for their 30 day investigation!

However my nice rep today told me the results of the 8/29/2025 benefits analysis which as previously mentioned was that when Labcorp got this claim submitted it was NOT coded as preventative. So the solution is that One Medical needs to change the diagnosis or CPT codes and resubmit the corrected order at Labcorp so that Labcorp can bill Brown and Toland for these as preventative services, and presumably get its $34.95 directly from them. As of now, that’s it.

I am of course girding my loins and preparing to ask One Medical to re-submit that lab claim with the preventative codes.

Meanwhile, I mentioned to my nice rep that I had two subsequent tests that I was not billed for. One was a Fit test in which One Medical sent me home with a kit to scoop my poop. That seems definitely to be preventative as it was to test for colon cancer. The other was a set of tests for low iron ordered during my preventative care visit because my iron levels looked a little low. My guess is that doesn’t fit the preventative category and I should have paid for that.

You may recall that iron test was billed at $0 and neither me nor the Labcorp rep who was working the case with me quite understood why.

Turns out Brown and Toland think that I should have paid a co-pay for both of those tests. The Fit test billed on 5/18/25 was $15.60 (1537124). By the way, Brown and Toland is getting a good deal as the cash price Labcorp charges consumers for that is about $90! The iron test was billed at $60.79.

You’ll recall my lab copay is $50, so Labcorp should have been charged me the lower of the copay or the actual total. Which is $15.60 for the Fit test and $50 for the iron test.

I got no charge for either.

By the way, I would like to show you the EOB from Blue Shield, but as they cancelled and reinstated my insurance last month, their online site has wiped all my EOBs!

So I agreed with the Brown and Toland rep when she suggested that they investigate the $15.60 bill for the Fit test to see if there should be a co pay, and I may hear from them in 30-45 business days.

And just to square the circle I will (probably) ask One Medical to resubmit the claim!

And yes this is all totally ridiculous and it all indicates why health care is so overly complex and why no consumer can figure out what is going on.

CODA: Meanwhile I was contacted by a journalist asking about ChatGPT being used to to sort out and protest medical bills. So I went down that rabbit hole a little too.

Matthew Holt is the founder and publisher of THCB

Let’s get moving on AI-discovered treatments

Dec 11, 2025

By STEVEN ZECOLA

Recursion Pharmaceuticals announced results today for one its AI-discovered treatments. I was pleased to see the large, sustained reduction in polyps attributable to its treatment for Familial Adenomatous Polyposis. Recursions’ oral medication will be viewed by the traditional scientific and regulatory community as “promising”.

On the other hand, I was disappointed not to see/hear any reference to the savings of the cost to society from this treatment and a vague reference to working with the FDA in 1H2026. Quite frankly, the urgency seemed to be lacking.

Currently, treating FAP is an expensive, lifelong endeavor for the 50,000+ survivors. Early detection strategies cost $10k+ and late detection $37k+. The cost to treating metastatic colorectal cancer (for which FAP predisposes) can be extremely high, up to $300,000. Overall, the cost to society from FAP easily exceeds $1 billion per year, or more than $15 billion on a present value basis.

This medication should not be subject to any further regulatory delay. There is enough information now on efficacy and safety to have Recursion more forward with a broad application of this treatment, while continuing test dosage levels and stratifying the patient population. The alternative is more needless cost and suffering.

Steve Zecola sold his web application and hosting business when he was diagnosed with Parkinson’s disease twenty three years ago. Since then, he has run a consulting practice, taught in graduate business school, and exercised extensively

Health Insurance Cancel Culture

Dec 8, 2025

By MATTHEW HOLT

Strap in for a dramatic tale in which our hero battles bureaucracy and logic to try to get his health insurance back.

About 20 years ago lots of Americans, especially Californians who bought health insurance from Blue Shield of California, found that their coverage was cancelled without them knowing about it. That practice called “recission” got lots of attention during the run up to the ACA, and was banned by it. Now if you want to buy insurance and you pay for it, the insurance company has to sell it to you and can’t cancel it after the fact.

Or so I thought.

Post ACA most people who don’t get their insurance through an employer, or Medicare or Medicaid, now buy it via a very regulated “individual market” on a state-based or Federal exchange. Generally, the insurance they buy is heavily standardized (with bronze, silver or gold levels) and what they pay for insurance is heavily subsidized based on income. It’s those subsidies that were increased in the pandemic and extended in the Inflation Reduction Act (IRA) during the Biden administration. The subsidies were the topic–still unresolved–of the latest government shutdown. (Yes, yes, I know the shutdown is over—for now).

It’s pretty much impossible to buy individual insurance outside the exchange, although if you have Scott Galloway levels of wealth you can avoid buying insurance altogether and pay cash and you might be better off, or you can join some quasi-religious health share organization and take your chance. But for most people you are way better off buying on the exchange because that’s the only way you can get those subsidies.

I live in California and remain an under-employed blogger, and a few times in my recent life I have not been married to someone with health insurance provided by their employer. It happened in 2016-17 and again two years ago. No, not what you’re thinking. I didn’t get kicked to the curb by my wife, but in 2022 she got laid off by her employer and decided not to get another job. For the first year of that period (2023) we did not buy via the exchange, but used COBRA. That means we bought into her previous company’s insurance using our own money because it was cheaper than buying on the exchange. Two reasons for this. First, she got a severance package that made our combined incomes too high to get a subsidy and secondly, the ACA plans charge by age, whereas employers pay a flat fee for all employees. That made the exchange plan more expensive than the employer plan. (No prizes for guessing who in our family is old and expensive!)

But COBRA only lasts a year, and then it was time to head back to Covered California.

This starts a process where you try to figure out which plan offered is the cheapest, yet includes your and your family’s doctors, and which one has the lowest associated fees for the stuff you use the most (usually pediatric visits in our case). Turns out that in our case is the Blue Shield Trio 73 HMO. My inability to understand why it’s called Trio 73 reveals why no one calls me a marketing genius.

The other thing you have to figure out is what level of subsidy you get. As mentioned, the IRA passed in 2022 extended the pandemic emergency increase in subsidies for people with higher incomes. But then again, you have to figure out what your income will be when you sign up. Like the audience laughing at an obvious punch line a comedian hasn’t gotten to yet, those of you running ahead of me will have worked out a slight problem here.

I was signing up for a 2024 health plan in 2023. But I had to guess what my 2024 taxable income would be. Like many self-employed people with extremely variable income I had no idea what that final income would be until I filed my 2024 taxes in October 2025 (given I take the IRS extension). In other words, almost two years after I chose the plan. It turns out that in California, the people who track your income are not your health plan, nor the exchange but instead your local county health department. So in November 2023 I guessed my 2024 income and had to tell the local county what that guess is via some affidavit. The county health department actually called me to check that my estimate was correct. Or at least was what I told them it was. Remember this for later.

Meanwhile I sign up on what I regard to be a very complex web site run by Covered California, and select the aforementioned Blue Shield HMO. It covers One Medical and UCSF theoretically via the Brown & Toland IPA, and leads to lots of fun and games in terms generating much content for me on this blog and Linkedin.

As it turns out, I was sent for an echocardiogram by my primary care doctor this past summer to check if I had a heart. While many of you were surprised at the answer (yes, I do), apparently it’s got a congenital disorder that needs a little help.

This gets us to November 2025 (last month!) with your brave hero going back onto the Covered California exchange trying to figure out whether the cardiologist recommended by my primary care doc is covered by the 2026 version of the Blue Shield plan I am on, or whether I need to switch. I could now digress and tell you the late Ian Morrison’s formula for choosing a health plan but I will hold that for the next telenovela article as of course that process is a fricking mess too!

In order to try to do that I login to the Covered California site and see I have a notice that I am not eligible for health insurance. I am confused.