California Insurance Commissioner Dave Jones on Wednesday slammed UnitedHealth Group — the nation’s largest private insurance company — over its decision to cut benefits and raise premiums for health plans used by close to 5,000 California small businesses. The combination of cuts and hikes would amount to a nearly eight percent rate hike for small business owners and their employees.

“At a time when small businesses are struggling to survive, UnitedHealthcare’s rate increase is just one more unwarranted economic burden on California’s small business owners and their employees,” said Jones. He estimated that close to 45,000 small business employees could be affected by the hikes.

Jones’ comments were quickly dismissed by UnitedHealth, as a spokesman argued that the annual increase would merely be two percent for customers. But that two percent figure likely only take into account the requested premium rate hike, not the cuts to benefits provided on relevant health plans. Previous, seemingly-arbitrary rate hikes by UnitedHealth and other insurers have led Jones to become a vocal advocate for greater insurance commission authority on the issue, and he has been pushing for the passage of a 2014 popular referendum that would “grant state officials the power to reject unreasonable rate increases for health coverage.”

This certainly isn’t the first time that UnitedHealth has engaged in profit-seeking behavior at the expense of government and employer health expenditures and workers’ benefits. The company recently complained that it wasn’t receiving enough government money despite massive profits and favorable Medicare reimbursement rates, and is one of several companies using Obamacare as a scapegoat for its extravagant rate increases.

In fact, arbitrary rate increases were par-for-the-course long before Obamacare’s passage, and the reform law actually contains protections against sticker shock and fallback measures for Americans who cannot afford private insurance coverage. But given UnitedHealth’s and other insurers’ quests for ever-increasing profits, many state insurance commissioners are looking to more closely scrutinize rate requests to see if they are reasonable.

Last month’s bombings at the Boston Marathon left three people dead and about 260 people injured, including about 25 victims who had to get limbs amputated. Initial estimates suggested that the total medical costs of treating the survivors could exceed $9 million. Luckily, in order to help ensure that the survivors can afford their treatment, insurance companies and hospital administrators have announced they will help out by waiving most of the medical costs for them.

And now, the bombing victims with particularly serious injuries may also get some relief for their artificial prosthetics — which aren’t necessarily completely covered by insurance. The American Orthotic and Prosthetic Association, a trade group that represents companies that make artificial limbs, has promised to provide some prosthetics free of cost to the people who underwent amputations after the bombings:

The association’s offer, announced on a conference call with reporters under the name Coalition to Walk and Run Again, will only cover a portion of the expected costs for amputees. Victims who lost both legs face estimated medical bills of $450,000 over the next five years, said Tom Fise, executive director of the association, citing a Department of Defense and Veterans Affairs study.

The association estimates that at least half the Boston Marathon amputees lack enough insurance to cover their prosthetic costs as some policies provide as little as $1,000 per device or only provide one artificial limb. Many prosthetics need replacing every five to seven years.

“The last thing that someone should have to worry about when they lose … a leg is to have adequate insurance coverage for a prosthetic device,” said Kendra Calhoun, president of the Amputee Coalition, an organization supporting the estimated 2 million amputees in the United States.

Since the attacks at the Boston Marathon, support has poured in for the victims, many of whom had their lower extremities blown off by the explosions. The One Fund, a relief group established by Massachusetts Gov. Deval Patrick and Boston Mayor Tom Menino, has collected about $27 million in donations that it plans to distribute to the survivors and their families. Upcoming marathons in other cities are planning to organize donations for the One Fund. There are also several other celebrity-backed general funds soliciting aid for the victims, as well as individual efforts to raise money for particular survivors with serious injuries.

The GOP-controlled Florida state house on Friday passed a Medicaid “expansion” bill that would substantially burden the state’s budget by rejecting any federal funding. It would open up private insurance access to a very select pool of Florida’s low-income residents — but it could force these vulnerable Americans to forgo care, despite their new coverage, by giving them insufficient subsidies and making them choose between private high-deductible health plans (HDHPs) that also come with costly premiums.

Unlike its companion bill in the Senate — which has been endorsed by both Gov. Rick Scott (R) and the Obama Administration — the House’s bill would expand coverage to a mere one-tenth of the 1.1 million poor Floridians who would have gained access under a more expansive effort. That’s because the bill only addresses Americans living at or below the Federal Poverty Level (FPL), instead of Obamacare’s more ambitious limit.

Now that the bill has passed, a showdown between the House and Senate is likely. Although both bills would privatize Florida’s Medicaid program, the Senate’s version would insure all poor Floridians up to 138 percent FPL. The House version, on the other hand, will concentrate on extending insurance to poor single moms, poor working parents, and disabled adults by giving them a flat $2,000 per year subsidy — but would not extend coverage to poor working adults in general. Although Republicans insisted the pared down bill was necessary to contain rising health costs, critics argued that it is unfair to ask the poorest Americans to pay over three times the monthly premium as state workers and legislators, pointing out that there is bipartisan support for the Senate’s alternative bill:

The House plan would use $237 million in state funds to give recipients $2,000 a year to choose their own private insurance plans. The plans would require a $25 monthly premium and likely have high deductibles, which Democrats said many families would not be able to afford.

In contrast, House members covered by the state insurance plan spend $8 a month.

“There’s very little you can buy,” said Rep. Mia Jones, D-Jacksonville. “This population will not be able to take this product that has been crafted for them and not be able to do anything of value with it.”

House Democratic Leader Perry Thurston warned that members were missing a chance for bipartisanship, noting the Senate had already put aside their differences.

“We have a governor who has disagreement with the president of the United States but they came to a bipartisan resolution and put aside those differences,” Thurston said. “Why? Because of the importance of saving lives.”

As Jones points out, since this bill would provide Floirida’s uninsured with insurance that they still won’t be able to use, the $237 million price tag is largely a waste. The average annual deductible in HDHPs has been rising steadily as more employers rely on them, ranging anywhere from $1,100 for an individual to $2,500 for a family in 2012. By contrast, the average annual out-of-pocket health care costs for American households is expected to exceed $3,000 by 2014. So the $2,000 annual subsidy wouldn’t end up going very far at all. This would present a problem for any family trying to afford health coverage — but for the particularly vulnerable populations that the Florida House’s bill seeks to cover, it could be catastrophic. Low-income Americans have specialized health care needs that, in many cases, are simply not covered by cheaper private health plans.

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A group of over 100 doctors who specialize in chronic myeloid leukemia (CML) published a detailed editorial in the medical journal Blood on Friday that slams pharmaceutical companies for jacking up cancer medication prices to unaffordable degrees. The open letter also calls for immediate reform to help patients access drugs that mean the difference between life and death for millions of Americans.

The doctors argue that, despite the creativity and innovation involved in creating cancer drugs, pharmaceutical companies still charge far more than they are objectively worth, knowing that patients have no other choice than to pay the prices they dictate. The writers then urge an all-in approach to reforming the U.S. medical culture that facilitates price-gouging at the expense of Americans’ physical and financial health:

If drug price reflects value, then it should be proportional to the benefit to patients in objective measures, such as survival prolongation, degree of tumor shrinkage, or improved quality of life. For many tumors, drug prices do not reflect these endpoints, since most anti-cancer drugs provide minor survival benefits, if at all. For example, in pancreatic cancer, where the median survival is 6 months, a new drug that may prolong survival by 2 months, and is priced at $100,000 per year, will cost $67,000 over 8 months survived, or $33,500 per additional month lived, equivalent to $400,000 per additional year lived. [...]

As physicians, we follow the Hippocratic Oath of “Primum non nocere”, first (or above all) do no harm. We believe the unsustainable drug prices in CML and cancer may be causing harm to patients. Advocating for lower drug prices is a necessity to save the lives of patients who cannot afford them. Pricing of cancer and other drugs involves complex societal and political issues which demand immediate attention, and which will need to consider many factors and involve many constituencies…We propose to begin the dialogue by organizing regular meetings, involving all parties concerned, to address the reasons behind high cancer drug prices and offer solutions to reduce them. For CML, and for other cancers, we believe drug prices should reflect objective measures of benefit, but should also not exceed values that harm our patients and societies.

The doctors’ assertions are borne out by the facts. The high costs of treating chronic conditions causes one in four American seniors to go bankrupt. With regard to cancer specifically, the trend is even more pronounced. One study conducted over 14 years in Washington state found a clear relationship between cancer registry data and bankruptcy court records. “Patients diagnosed with cancer may face significant financial stress due to income loss and out-of-pocket costs associated with their treatment,” said health care economist and study author Dr. Scott Ramsey. “On average, bankruptcy rates increased fourfold within five years of diagnosis.”

Pharmaceutical companies often argue that the bloated costs are necessary to cover the substantial research investments and trials-and-error of creating a successful drug. But that logic is undermined by these same companies’ profit-maximizing gimmicks, such as adding inactive ingredients to pills so as to extend expensive brand name drugs’ patents, and paying kickbacks to pharmacies and generic drug manufacturers in exchange for higher market share.

Some developing nations have actually gone beyond the doctors’ suggestions and ruled against brand name cancer drug makers in favor of less costly generic drugs in an effort to help their poor populations access the critical medicines.

Trauma centers, the medical facilities that provide the full spectrum of emergency services at all times, are being forced to close their doors. In fact, between 1990 and 2005, over 300 of them were shuttered in states across the country. Considering the fact that last week’s events in Boston demonstrated the life-saving effects of emergency responders and trauma care — since the nearly 300 people who were injured in the bombings have all survived, an incredible feat for the city’s medical professionals — why are we limiting access to this type of emergency relief?

As the Atlantic details, it’s not because there are fewer emergencies. There’s still a big need for trauma centers and emergency departments, particularly since they aren’t just important for terrorist attacks like the bombs at the Boston Marathon; they also treat Americans who are injured in car crashes or other serious accidents. And these types of facilities are especially important for servicing vulnerable Americans, who tend to wind up in the ER at higher rates than more economically privileged people do.

In fact, researchers Renee Hsia and Yu-Chu Shen have found that emergency care is at risk largely because of financial pressures. Many trauma centers can’t afford to continue operating precisely because they’re serving low-income and vulnerable populations. The type of services that they provide are expensive, yet they’re more likely to provide care for Americans who can’t pay anything in return. Of course, those uninsured or Medicaid patients still need health services — so when trauma centers are forced to close, it hits them the hardest:

The populations associated with greater closure are the populations that need these services the most. Medicaid patients are more likely to use the emergency department than privately insured patients. But, contrary to conventional wisdom, these visits aren’t routine. A Center for Studying Health System Change research brief shows that Medicaid patients are three times more likely than privately insured patients to visit for complex or disabling needs. Sometimes there’s no other choice. In a study of physicians who accepted new patients in 2011, 31 percent were unwilling to accept new Medicaid patients.

We also know that African Americans tend to use emergency departments at twice the rate of whites and Hispanics. This difference is the product of other racial disparities in health care, especially insurance coverage. In 2010, 21 percent of African Americans relied on Medicaid programs. Nearly a quarter did not have employer-sponsored health insurance. And nearly one in five African Americans under the age of 65 are without insurance entirely. This is also the product of income disparities. By 2010, African Americans lived below the poverty level at nearly three times the rate of whites. These factors together help explain why African Americans are more likely to lack access to primary care specialists — and why they tend to rely on emergency departments.

This is why emergency departments are sometimes called the “safety net” of the health care system. What happens when the safety net moves farther and farther away from the people it’s supposed to catch?

Unfortunately, emergency care is becoming increasingly expensive for the low-income Americans who rely on it. The average trip to the ER costs 40 percent more than most Americans spend on monthly rent. In fact, medical costs continue to soar across the entire health care industry. Health costs have skyrocketed while workers’ wages have stagnated, and more than one in three people are forced to put off the health care they need because they can’t afford it.

Obamacare hopes to address some of these issues so that emergency care doesn’t have to serve as primary care for so many vulnerable Americans. By emphasizing preventative services, as well as vastly expanding the social safety net to allow states to add additional low-income residents to their Medicaid rolls, the health law seeks to ensure that Americans are regularly accessing care rather than allowing their health issues to devolve into more serious ailments. And Obamacare may also help ensure that trauma centers don’t continue providing essential services without any type of reimbursement, since about 30 million previously uninsured Americans are expected to gain coverage under health plans — and will therefore have some kind of means to pay their medical bills.

The total medical costs resulting from last week’s Boston Marathon attack are expected to top $9 million — and that could be a conservative estimate, since the bombings’ injury toll has just been revised up to nearly 300 people. Fortunately, however, the city’s largest health providers are stepping up to ensure that the victims won’t suffer under the full weight of those mounting costs.

The Boston Globe reports that the largest health insurers in Massachusetts are planning to eliminate out-of-pocket fees for the bombing victims who are receiving treatment for their injuries, and three of the city’s hospitals are promising to delay billing those patients. Fortunately, health care providers plan to address ongoing treatment for long-term health issues as well as the initial emergency room care that victims received in the immediate aftermath of the attacks. Tufts Health Plan — a Boston-based insurer whose corporate offices are actually located just blocks away from where the manhunt to capture the bombing suspects first began with a shoot-out on Friday morning — has announced that, in addition to waiving costs for physical treatment, it will also cover the cost of mental health care.

“The physical injuries are easier to determine, but the mental health component is important,” a Tufts spokeswoman told the Boston Globe. “Six months down the road, someone may have a hard time dealing with these issues.” The insurance company has already contacted over a thousand mental health providers to make sure they will be available to take on the extra caseload that may arise as bombing survivors cope with potential post-traumatic stress disorder.

Although other insurers, like Blue Cross and Harvard Pilgrim, have not committed to completely cover all physical and mental health costs, they will review patients’ cases individually to make sure that none of them are struggling to afford their care. And some hospitals have decided to continue billing insurance companies, but refrain from sending bills to patients. “The focus is clearly on getting well and getting the treatment they need, and this is a small act of kindness,” a Harvard Pilgrim spokeswoman explained.

Fortunately, thanks to Massachusetts’ health care system, most of the state residents already have health insurance. But the cost of treating serious injuries, particularly amputations, can still be exorbitant. Some of the bombing victims have already resorted to online fundraising to help raise the anticipated costs for their recovery.

In the immediate aftermath of last week’s attacks at the Boston Marathon, estimates calculated that about 170 people suffered injuries from the bombings. But according to the Boston Public Health Commission, that estimate should be revised to about 282 as more people are now coming forward to seek treatment in local hospitals.

Nick Martin, a spokesman for the health commission, explained to the Boston Globe that the injury count has sharply risen because many people initially delayed medical care. Although those people hoped their injuries would heal on their own, that hasn’t been the case, and they’re now checking themselves into one of the 27 hospitals in the area that are treating the bombing victims:

“One of the best examples is hearing issues,” Martin said. “People might have first thought their hearing problems would be temporary.” Instead, hearing loss or continuous ringing or buzzing in their ears remained. Others sought delayed care for minor shrapnel wounds. [...]

The number of injuries could continue to climb if more people seek treatment. And health officials are monitoring whether there was any significant increase in heart attacks or strokes that could have resulted from Marathon Monday. Studies suggest that stress-related heart emergencies increase in the first few weeks after a traumatic event such as an earthquake or terrorist attack.

There’s little doubt, however, that more injured victims would have died had they not received optimal treatment, on the scene and at hospitals, for wounds that led to the loss of copious amounts of blood.

Thanks to Boston’s large hospital network and well-equipped first responder teams, the city’s medical professionals were able to save an impressive number of lives over the past week — partly because the conflicts in Iraq and Afghanistan have taught doctors how to effectively stem the flow of blood that results from these type of lower-extremity wounds. Thankfully, all of the people who have been treated for injuries have survived.

But as the injury toll rises, so does the cost burden resulting from the bombings. Initial estimates projected that the medical costs resulting from the Boston bombings would likely top $9 million. With about 100 more injured people to treat, however, that figure may be an underestimation. Some of the victims who underwent amputations — which can be especially expensive to treat, requiring an initial surgery, a prosthetic, hours of rehabilitation therapy, and often home remodeling — are already online fundraising to help pay for their medical bills. Insurance companies and hospital administrators could also do their part to make sure that victims can afford the treatment they need by eliminating or reducing some of their hospital costs.

Forget congressional quibbling in Washington. One of the most telling fights over the future of U.S. health care is actually taking place right now in Louisiana.

Last week, the Louisiana House Committee on Health and Welfare advanced HB 527 to consideration by the full House. If passed, the controversial and heavily-lobbied legislation would redefine “optometrists” — who are primary care eye doctors — as “optometric physicians,” giving them expanded authority to prescribe medications and perform minor eye surgeries that they wouldn’t have been allowed to conduct before. Unlikely though it may sound, the future of American health care largely depends on whether or not bills like this can expand access to quality care while lowering costs — or whether they will instead make common medical procedures more dangerous, and ultimately more costly.

HB 527′s most ardent opponents are a different group of eye doctors — ophthalmologists — who are specialists in eye-related surgeries. Ophthalmologists wearing lab coats branded with “Oppose 527″ testified against the bill, asserting that its passage would open up Louisiana residents to a “blatant expansion of [optometrists'] services without training.” “The problem is, the optometrists want … this designation as a physician and yet, when it comes to oversight they want to be designated as an optometrists. Well, you cannot have it both ways,” said former Louisiana congressman and ophthalmologist John Cooksey.

Optometrists disagree. “In the end, this bill is about access, access to quality eye care for all the people of Louisiana,” said James Sandefur, executive director of the Optometry Association of Louisiana. “Our patients, and especially those in the rural areas, do not have access to these procedures. This bill would give them the access they deserve.” What Sandefur doesn’t mention is that having certain surgical procedures provided by optometrists would actually also lower health care spending, since optometrists wouldn’t be billing as much for their services. And the combination of these two factors — increased access to medical care for vulnerable populations and lowering costs — are really the cornerstones of health care reform.

As more and more people gain access to insurance under Obamacare, the assumption is that they will begin to consume more health care services. That means that more medical workers will be needed to provide care for these newly-insured populations — many of which will be poor, rural, or some other combination of vulnerable and secluded. The vast majority of care consumption isn’t the expensive kind; it’s the preventative and primary care kind, like doctor’s check ups and minor outpatient procedures. That has led some to worry that there won’t be enough primary care doctors to meet the increased demand once Obamacare is in full effect, and that the U.S. health care sector will be overwhelmed.

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In the aftermath of the Boston Marathon bombings on Monday, Jeff Bauman’s image was seared into the American consciousness. An extremely graphic photo of Bauman being escorted in a wheelchair with most of his legs blown off quickly went viral. Public admiration for Bauman rose even further after reports surfaced that he had looked into the eyes of one of the bombing suspects minutes before the explosion, and that the moment he awoke from emergency care, he gave law enforcement critical information that substantially narrowed their field of suspects. But while police continue to scour the streets for at-large suspect Dzhokhar Tsarnaev, the 27-year-old Bauman is scouring the internet for donations to help pay for his outsized medical bills.

Bauman’s friends created the page “Bucks For Bauman!” on the gofundme.com crowdfunding service. The money raised through donations to the site are meant to help Jeff and his family pay the exorbitant costs of his surgeries, ongoing medical care, and physical therapy. Since Tuesday, when the site was launched, Americans from across the country have poured in $158,294 in donations — over half of the overall $300,000 goal.

Bauman has been fortunate enough to receive an impressive number of donations to help him pay his bills, and his uncle plans to buy him his first pair of prosthetic legs. But many other victims in the Boston bombings may not be as fortunate. The cost of treating the bombing survivors’ injuries is expected to exceed $9 million. The out-of-pocket costs associated with that treatment could bury many of the victims financially, even if they do have insurance — unless hospitals, insurers, and charitable foundations swoop in to help, as they did after the mass shooting in Aurora, Colorado.

You can donate to Jeff Bauman’s recovery fund here.

By all appearances, UnitedHealth Group is having a stellar year. The mammoth company, which is the largest health insurer in America and the biggest manager of private Medicare Advantage plans, announced on Thursday that despite a 14 percent decline in earnings, it had still made a profit of $2.1 billion — and that was just in the last fiscal quarter. UnitedHealth also won a major policy victory at the beginning of this month when the Obama Administration reversed course on its plan to cut reimbursements to Medicare Advantage plan providers by two percent. In fact, the Administration went the entirely opposite direction and announce it would raise these rates by 3.3 percent — a swing of 5.3 percent in UnitedHealth’s favor. Apparently, that isn’t enough for the insurance company. UnitedHealth is now threatening to reduce its involvement in managing Medicare plans, claiming that its government reimbursements are still too low.

“We did not expect the fastest growing, most popular and most effective Medicare benefit option serving America’s seniors to be underfunded to this extent in 2014,” UnitedHealth Group CEO Stephen Hemsley said on a conference call with investment analysts. He went on to clarify that the company will likely have to pull out of the Medicare market as it “reshape[s] Medicare networks and benefits to respond to the continuing underfunding of this [Medicare Advantage] program.” But Hemsley’s claims conflict with the company’s own earnings report, as well as the questionable performance of private insurance plans that service Medicare beneficiaries.

Conservatives often claim that having private insurers, rather than a public entity, manage programs like Medicare helps cut costs and make care more efficient. That’s why they have held up programs like Medicare Advantage and used it as a model for dismantling traditional Medicare to turn the public entitlement into a private insurance voucher. But as numerous studies and government reports have shown, private insurers game the Medicare Advantage program as much as they can by encouraging seniors to cherry-pick their health plans relative to their health. That allows companies like UnitedHealth to pay out less in benefits by offering healthier seniors alluring rates — but it raises prices for everybody in the traditional Medicare program by siphoning off less costly beneficiaries. And yet, Medicare Advantage still consistently comes in over-budget while regular Medicare manages to save money. Profit-motivated announcements like UnitedHealth Group’s today help explain why that is.

Obamacare contains cuts to these excess payments to private providers, consequently preserving the more generous and efficient traditional Medicare program. While those cuts are likely the source of Hemsley’s ire, he shouldn’t fret too much. Since Obamacare’s began being implemented, enrollment in Medicare Advantage has actually gone up, while seniors’ premiums have gone down.