Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

A registered nurse who works in New Jersey’s Matawan-Aberdeen Regional School District reacted on X, formerly known as Twitter, to KFF Health News’ investigative collaboration with Cox Media Group on the federal government’s attempt to claw back money it has overpaid to Social Security beneficiaries: “Social Security Overpays Billions to People, Many on Disability. Then It Demands the Money Back” (Sept. 15).

Can I just say to tell folks that they only have 30 days to pay back any overpayments that they likely were not even aware of until they received the notice, is crazy!https://t.co/CfaWrd9VVQ

— Sheila Caldwell (@SCaldwell7201) September 17, 2023

— Sheila Caldwell, Aberdeen, New Jersey

A law professor at the S.J. Quinney College of Law at the University of Utah also chimed in on X:

Important @KFF @KFFHealthNewsexposé on Social Security making errors and sending people ludicrous bills to to recover overpayments. One disabled woman got a bill for $60,175.90 out of the blue. The agency suffers from underfunding/understaffinghttps://t.co/0vNfROIVe9

— Daniel G. Aaron, MD, JD (@MedlawDan) September 18, 2023

— Daniel G. Aaron, Salt Lake City

For Shame, UnitedHealthcare

Thank you for shining a light on one of the most infuriating insurance barriers in all of medicine: prior authorization (“Doctors and Patients Try to Shame Insurers Online to Reverse Prior Authorization Denials,” Aug. 23).

During the pandemic, many people skipped or could not access routine medical care such as colonoscopies and endoscopies. Research has long shown that these services are underutilized, especially among communities of color, which is one reason for continued disparities in colorectal cancer and other gastrointestinal diseases.

As the demand for routine diagnostic and surveillance procedures grows, it is critical to ensure that patients are not caught up in bureaucratic red tape. Unfortunately, the nation’s largest and most profitable insurer, UnitedHealthcare, is slowly, quietly working to expand prior authorization to these key forms of gastrointestinal care.

While UHC publicly pledged to slash prior authorization, we must judge them by their actions, not their words. Since UHC made that promise this spring — a move welcomed by doctors and patients across the country — the insurer also announced troubling new prior authorization requirements for colonoscopies and endoscopies for its 27 million commercial beneficiaries. The insurer planned to begin implementing prior authorization for these vital procedures starting June 1 but temporarily halted the plan after major outcry from patients and gastroenterologists.

Yet, the threat lingers. Right now, UHC is asking doctors to participate in a burdensome “Advanced Notification program,” which forces physicians to submit all kinds of data that the insurer will use to inform its planned “Gold Card” prior authorization program in 2024.

Physicians see through this ruse. While UHC claims no patients are being denied the colonoscopies and endoscopies that could help save their lives, the administrative burden Advanced Notification causes is clogging already backlogged offices, especially small practices. Even worse, the gastroenterological community fears that millions of patients may face UHC’s prior authorization requirements in a matter of months — yet the insurer has failed to coordinate with specialty societies or transparently communicate how the program will operate or how UHC will ensure patient care is not disrupted.

This issue affects all of us. If UHC is allowed to deny or delay colonoscopies and endoscopies, where will it end? Diagnostic mammograms? Pap smears? Lung cancer screenings? And will other insurers follow suit with equally oppressive prior authorization policies?

UHC must immediately reverse course on its alarming policies to ensure streamlined access to care. In the meantime, gastroenterologists will continue to hold the line for our patients.

— Lawrence Kim, vice president of the American Gastroenterological Association, Lone Tree, Colorado

The branding director for Norwood, a health care staffing and consulting company in Texas, posted on X that publicly shaming insurers may prove a smart strategy.

Good; shameful practices deserve public shaming: Doctors and Patients Try to Shame Insurers Online to Reverse Prior Authorization Denials https://t.co/OvbTUXOkOR via @kffhealthnews

— Brian Murphy (@NorwoodCDI) August 23, 2023

— Brian Murphy, Austin, Texas

Reaction was also robust on Threads:

How New York Is Tackling Tobacco Use Among Youths

I just read Liz Szabo’s piece on child nicotine poisonings (“Doctors Sound Alarm About Child Nicotine Poisoning as Vapes Flood the US Market,” Aug. 3). The reporting illuminated a crucial yet lesser-known issue regarding the harms of these e-liquids. The response does call for a combined public health effort, so I wanted to share further information regarding New York state policy (mentioned in the piece) that has shown to be successful in reducing the sale and use of vapes and traditional, combustible cigarettes. This policy-level intervention’s results imply that fewer young children are being exposed to/have access to these products based on decreased rates of smoking and vaping use and initiation among older siblings or adults around them. I hope this information proves useful to your national audience who may consider these policies in the context of their state’s.

The New York State Department of Health released three new reports that indicate that the current tobacco control policies adopted in the state have helped effectively reduce tobacco use and initiation, including smoking and vaping. The evidence-based approaches bolstered ongoing decreases in youth vaping rates; between 2018 and 2022, rates declined by about 32%. Youth tobacco use (of any tobacco product) also declined by 32%, from 30.6% in 2018 to 20.8% in 2022. This significant decline brings New York closer to achieving the Prevention Agenda goal of decreasing high school youth tobacco use to 19.7% by 2024.

While this is great progress, tobacco still is the No. 1 cause of preventable disease in the United States — it is estimated that it kills 480,000 adults in the U.S. every year — and there are still issues with regulation and a lack of protective packaging on vapes.

NYC Treats Tobacco works with health care organizations in New York City to ensure they effectively screen and treat their patients for tobacco use.

— Avani B. Ansari, MPH, CHES, project coordinator for NYC Treats Tobacco, New York City

An organization that advocates for policies promoting opportunities and wellness for children posted this on X:

Thousands of kids a year are exposed to the liquid nicotine in e-cigarettes, also known as vapes. For a toddler, even a few drops can be fatal. Doctors sound alarm about child nicotine poisoning as vapes flood the US market: https://t.co/3IHV8L1UKX

— KY Youth Advocates (@KYYouth) August 14, 2023

— Kentucky Youth Advocates, Jeffersontown, Kentucky

And a Georgia state representative shared her two cents on X regarding Liz Szabo’s previous coverage on youth vaping:

Youth vaping is on the rise, with the industry marketing products blatantly targeted to kids + teens.The unregulated nicotine in e-cigs (⬆️ 76% over 5y) can addict kids in just days.My bills #HR43 and #HB192 aim to study + disincentivize youth vaping.https://t.co/p5NGJd8gAw

— Dr. Michelle Au (@AuforGA) June 27, 2023

— Michelle Au, Johns Creek, Georgia

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Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.