that — , in general — are among top concerns cited by likely voters. Much attention has been focused on mounting costs and declining enrollment in Affordable Care Act plans, the insurance used by roughly 19 million people who buy their own. But work-based plans are adding financial pressure for the more than covered through their jobs.

One of the biggest changes this year, for instance, came in the amount workers pay toward their own coverage, rising an average of 9% to $7,471 annually for a family, according to a broad annual Oct. 22 by KFF, a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News. That’s up from the 7.6% jump seen from 2024 to 2025.

Their employers, too, faced additional costs, with the average family coverage premium rising 5% to hit $28,303, according to the survey.

In response to that increase — which comes on the heels of a 6% increase the previous year — 44% of large employers, with at least 200 employees, said they upped what workers had to pay toward coverage.

“When we start to see higher use or higher prices, there are only a limited number of things employers can do” to try to slow premium increases, said Matthew Rae, associate director of the Program on the Health Care Marketplace at KFF.

Employers reported taking other actions in the past year to hold down their costs, such as increasing deductibles (the amounts people pay toward their care before insurance pitches in), changing insurers, adding preapproval for some services, or offering workers a narrower choice of healthcare providers, the KFF report said.

Workers’ earnings rose an average of 3.7% this year, the survey found, while overall inflation was 2.7%.

People who work for small companies, with fewer than 200 employees, paid more for healthcare than their counterparts at larger companies.

For example, health plans at large companies had a $1,772 average annual deductible for an individual employee, while small workplaces averaged $2,624.

Overall, though, the share workers pay toward the total premium across all companies ticked up only slightly from the previous year, hitting 27% of the cost for family coverage and 18% for individual coverage, with employers picking up the remainder.

Driving Up Costs

Other groups have recently posted projections of what employers might face next year.

, for example, projected employers could pay 9.5% more next year, the fourth consecutive year of big increases, while a similar company, Marsh, , the highest jump since 2003. Costs are going up for many reasons, from people utilizing more services to skyrocketing prices of prescription drugs and rapidly rising hospital prices, the reports say.

Also helping drive up costs is artificial intelligence, say other reports, including , a membership organization of self-insured employers. The report said hospital systems and other medical providers use the technology to maximize insurer and patient billing.

The business group predicted a median premium increase of although employers might reduce that by making benefit changes.

Until recently, employers absorbed the lion’s share of cost increases, “but that’s starting to change a bit,” said Jim Winkler, chief strategy officer for the group. “When open enrollment starts, most people will see their out-of-paycheck costs and probably their out-of-pocket costs going up.”

Looking ahead, the group suggests employers take further action to forestall increases in 2028, Winkler said. One idea is to offer lower copayments for some health providers based on their prices or quality, similar to “tiered networks,” a strategy employers and insurers have tried, with only 4% of companies sticking with it, according to the KFF survey. “What’s old is new again,” Winkler noted, saying it might work better now because it’s easier than ever for apps to show consumers the providers with the lowest copayments, which would be set by an employer or insurer.

Overlooked in much of the discussion on rising health costs, said , president and CEO of the large employer organization Purchaser Business Group on Health, is the role played by the healthcare industry — from hospitals to drugmakers to insurers.

She asked: Why are the customers — the employers, in this case — being asked what they are doing about it? “The industry is doing absolutely nothing to control costs, as evidenced by the relentless growth in costs,” she said.

Businesses are using new pricing information made available under federal rules to contract directly in some cases with hospitals and other providers and to invest in primary care.

Mitchell and others say Congress should also get involved. at Georgetown University, for example, suggest capping annual deductibles, setting hospital price caps, and extending lower drug prices negotiated by Medicare to the private sector.

Keeping Costs Flat

Not all companies saw an increase this year.

Take KFF survey respondent , a company based in Tuscaloosa, Alabama, that makes insect screens and precision woven products, such as outdoor furniture fabric. Its health costs remained flat this year, likely because it has put a strong focus in recent years on providing zero-cost primary care to its workers through on-site clinics and direct contracts with doctors’ offices, said Russell DuBose, the company’s vice president of human resources.

Only 7% of companies in the KFF survey reported having an on-site clinic, although 24% said they had one on-site or nearby.

Workers get in quickly to see a primary care doctor, DuBose said, and that can help with both prevention of disease and catching problems early. The company also directly contracts with other types of specialists.

“We steer plan members to the best providers that we can find,” DuBose said. “When we do that, we’re paying a more reasonable price.”

The company is self-insured, like many employers. That means it pays all the bills itself and buys what’s called stop-loss insurance to help with very high bills. That coverage has also jumped in price, DuBose said.

He often gets calls from other employers asking about his company’s strategy — and how to control costs. Now, far more so than in recent years, he said, employers are nervous, worried about costs continuing to rise and what that would mean.

“The worry is ‘Could the rising cost of healthcare be the next job killer?’” he said.

Among other findings from the annual KFF report:

• Twenty-nine percent of all companies surveyed said covering GLP-1s, a new class of weight loss drug, had a “significant” effect on their drug costs.
• Many companies — about 29% of large ones — reported difficulty getting information on how much their plans paid for medical care or price comparisons among providers.
• About 9% of companies with 50 or more workers buy prescription drugs from outside the U.S. to save money.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

The Ñî¹óåú´«Ã½Ò•îl Health News Minute is available every Thursday via direct download or the RSS feed.

Oct. 22

Jackie Fortiér [FOR-tee-ay] reads the week’s news: Support for “Medicare for All” is at its highest in at least a decade, even though many don’t understand the specifics. Plus, celebrities are getting full-body medical scans, but more screening might not be a good thing.

Can’t see the audio player? Visit kffhealthnews.org to listen.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

A chunk of the $50 billion available to states through the five-year is partly contingent on policy commitments. The administration told states it would score their applications higher if they walked back their , which give a state approval authority over the expansion or construction of any healthcare facility. Six states indicated plans to revisit their laws in their applications.

Certificate of need laws, which require that a healthcare provider prove a community need for a new service, were intended to curb monopolies and rising costs. But critics of the laws say they’ve instead raised healthcare prices, stalled needed facilities, and barred rural patients from new technology. More than 30 states, plus Washington, D.C., enforce some sort of certificate of need law, according to the National Conference of State Legislatures.

Legislators in several states to end the laws, which have faced scrutiny for decades — under Republican and Democratic administrations. But the Trump administration’s aggressive approach to tie the policies to funding has forced states to reckon with their laws quickly.

The Rural Health Transformation Program was added to President Donald Trump’s signature One Big Beautiful Bill Act as an initiative to modernize healthcare in remote areas. The Centers for Medicare & Medicaid Services, in its notice to states , called certificate of need laws “an additional expense and burden on rural facilities” and explained how states with fewer certificate of need rules would get higher scores.

“It’s not the first time the federal government used funding as a state carrot (versus using a stick) to encourage alignment on an administration’s policy goal,” , a researcher at the National Academy for State Health Policy, said in an email. She noted that President Barack Obama’s administration included millions of dollars for states that made it easier for children to enroll in federally funded health insurance.

Hensley-Quinn said the funding “carrot” was an opportunity to take a hard look at whether policies like certificates of need were truly worth it.

“States need to carefully weigh the trade-offs of supporting a ‘voluntary’ federal policy no matter what,” she said, “and additional federal financing, especially in tight state budget years, can tip the scale.”

Obama, Trump on Same Page

Since the Rural Health Transformation Program became law last year, the most concrete action. , state lawmakers passed a bill that will unravel most of its remaining certificate of need rules over the next four years. Alaska, Connecticut, Delaware, Iowa, and Mississippi have also said they would consider ending or loosening their laws.

“If there’s an issue where you can have President Obama and President Trump in agreement on something, that tells you the idea probably has some merit,” Wes Climer, a Republican state senator in South Carolina, , supporting the repeal of that state’s certificate of need law. The legislature voted in 2023 to , and in January it will stop requiring certificate of need applications for new hospital construction or expansion, leaving them only for nursing homes.

Some certificate of need laws require approval for changes as minor as a new piece of expensive equipment. In North Carolina, a hospital that won a certificate of need to build a much-needed facility was mired in a court battle for three years before in 2026.

As more states consider removing their certificate of need laws, Hensley-Quinn warns of unintended consequences: Fewer records will exist that help states track hospital ownership.

Hensley-Quinn said frustrated state officials have come to her years after their states repealed certificate of need laws, saying that even with a licensure process, they don’t have insight into the financial state of their health systems or facilities, or how they’re managed. Certificate of need laws force companies seeking a new foothold in the state to submit voluminous applications. Once the laws are gone, few regulations force transparency. That leaves states unaware when a health system contracts with private equity to provide hospital services, for example.

“Without CON, without ownership reporting, and without an entity that monitors transactions or providers in that way, there’s no way for you to know,” Hensley-Quinn said.

Tennessee’s Certificate of Need Law

Tennessee lawmakers had pushed to change the state’s certificate of need law for years but didn’t pass sweeping legislation until it faced losing out on federal funding. , Tennessee is set to receive an equal share of half of the Rural Health Transformation Program’s grants, while the other $25 billion in funding is contingent on other factors, including states’ policy commitments.

In 2024, the state’s hospital association opposed a repeal effort penned by 12 hospital and health system leaders, many serving rural areas, though that more limited legislation passed anyway.

A repeal would harm vulnerable patients by driving up costs and thinning existing hospital staff, said Martin Chaney, CEO of Maury Regional Health, a system in rural Middle Tennessee south of Nashville. Ending the law would create rural healthcare deserts, Chaney wrote in the letter, because hospitals would choose to expand in areas that were already the most profitable, where residents had a range of health insurance providers.

“The premise that eliminating CON regulations will expand health care opportunities by increasing competition is not true for ALL Tennesseans,” Chaney wrote. “Instead, it would result in cherry-picking and increasing the gap in access to medical care in rural areas.”

A month later, TriStar Health — owned by the largest hospital company in the U.S., for-profit HCA Healthcare — applied for a certificate of need just 20 minutes north of Maury Regional Medical Center. Nashville-based HCA despite brief , the system led by Chaney.

HCA did not respond to requests for comment.

Local leaders are divided on what the new hospital would do to healthcare in the region. “Competition is good,” Maury County Commissioner told Ñî¹óåú´«Ã½Ò•îl Health News. Markham, like many in favor of the new hospital, said that patients should have options when it comes to choosing where they get hospital care.

But leaders of smaller hospital systems in Tennessee are worried. , a Williamson County commissioner and , another health system in the area, said ending certificate of need laws will prompt hospital closures. Big hospital systems will become the default for expensive procedures and dominate rural markets, while smaller hospitals that provided those procedures before will lose so much money, they’ll be forced to shutter or sell, Herbert reasoned, echoing the concerns of other advocates of the laws.

“Many challenges have emerged that place increasing pressure on healthcare organizations, especially independent nonprofits like Williamson Health,” that health system’s leadership said in an in July 2025, citing Tennessee’s intentions around certificates of need.

In July of this year, Williamson Health’s board voted to sell its network of clinics, diagnostic centers, and a more than 330-bed hospital in a with Ascension St. Thomas, part of one of the largest healthcare systems in the nation.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

Under the rule, Customs and Border Protection and the FDA will require coding on packages that makes it easier to know what’s in them. It is aimed at collecting tariffs on even low-value imports, and at catching illegal drugs like fentanyl. It will also add costs and complex paperwork to each order.

Now the regulation, which was set to start Oct. 22, until Jan. 20.

While it is illegal to import most FDA-approved prescription drugs, Americans to import legal medications in small quantities for personal use since 2003. The FDA rarely inspects the parcels.

“The information we have is there’s going to be a complete shutdown on Oct. 22,” Tim Smith, general manager of the Canadian International Pharmacy Association, said in an interview in early October. The 51 licensed in his organization urged their hundreds of thousands of U.S. customers to file extra orders before Oct. 9 to be sure as many medications as possible arrived before the clampdown, Smith said.

“These are people in every case who have gone to the doctor, gotten a prescription for whatever, gone to the pharmacy to fill the order, seen how expensive it’s going to be, and then looked for an alternative,” he said. “Those are the people who’ve been coming to us for years.”

As Donald Trump campaigned in 2016, allowing people to import drugs was part of his platform. In his first term, President Trump let states buy cheaper drugs from Canada. He told Floridians at 2020 rallies that their state could “go to Canada” to obtain drugs for them.

But while Florida and Colorado joined , neither state has brought in any drugs yet.

Patients have, however, and they flooded authorities with at least 109,000 letters urging the FDA to clarify that the rule won’t stop personal-use drug shipments, said Ken Hunter, executive director of the Campaign for Personal Prescription Importation. And Trump ally Laura Loomer called the rule a case of stupidity or sabotage, that asked, “So Why Is Someone in His Administration Trying To Make Prescription Drugs More Expensive Before The Midterms?”

Seventy-one congressional Democrats signed led by Reps. Jan Schakowsky of Illinois and Mark Pocan of Wisconsin to warn about the potential impact of the rule. Three House Republicans from Florida to CBP and the FDA, noting that Floridians, unlike Americans in Northern states, can’t easily drive to Canada to buy medicine.

By cutting off imports, Hunter said, “they are going to lose millions, maybe billions in tariff revenue.”

“Why would you want to cut off this massive revenue source?” he asked. “Why would they want to cut people off from lifesaving medications two weeks before midterms?”

Pressure by advocacy groups may have led the agency to back off, said Lucia Mueller, president of PharmacyChecker, which helps patients find legitimate pharmacies to obtain cheaper drugs.

“Loomer’s political argument is sound,” she told Ñî¹óåú´«Ã½Ò•îl Health News. “We know she’s had Trump’s ear before.”

The agency’s Oct. 14 news release on the delay said it would help “avoid disruptions to certain international postal shipments.” It didn’t specifically refer to drug imports.

“This is an important short-term success,” said Gabriel Levitt, founder of Prescription Justice, a nonprofit that advocates for more-affordable drugs. “However, the underlying threat to personal prescription drug importation remains, and the next 90 days will be critical.”

A found that 2.3 million Americans regularly imported medications from abroad, and some surveys show much higher numbers. About 4 in 10 Americans in a recent said cost had led them to not take medications as prescribed over the past year.

When he was diagnosed with atrial fibrillation years ago, Leslie Waters learned that a 90-day supply of the blood thinner Eliquis, or apixaban, would cost $486. “Holy crap!” said the retired computer scientist, who said he lives off a monthly $1,886 Social Security check. Waters, of San Jose, California, learned about the Canada option on the internet and has been buying 90-day supplies from a pharmacy there for $57, including shipping.

Under previous administrations, orders worth $800 or less weren’t taxed or saddled with extensive paperwork. The new rule will require shippers of even low-value international parcels to transmit detailed information about their contents to CBP, along with tariff payments, which must be transmitted through a licensed customer broker.

Zonos, a U.S.-based company that handles logistics for mail from Canada and other countries, told clients in early September that its understanding was that CBP would no longer allow in personal prescription drug packages after the rule took effect, said Smith, of the Canadian pharmacy trade group. In an Oct. 6 webinar, Zonos senior broker Angela Macke said that the company would continue to ship the drugs but that it didn’t know whether the agencies would let them reach patients.

The pharmacy announcements have frightened thousands of customers, said Bill Hepscher, whose company, Canadian Medstore, has six Florida storefronts that help patients import drugs.

“It’s really been hair on fire,” he said. “I could spend my entire day fielding phone calls from people saying: ‘Can I no longer get my Eliquis? I could have a blood clot or stroke!’”

Hepscher said about half his clients buy their drugs from Canada, with many of the others buying from Australia, New Zealand, the U.K., or Turkey. He said 2025 was his company’s busiest year ever — changes to Medicare drug plans and increased enrollment in high-deductible Affordable Care Act plans had led seniors and younger people facing higher costs and copays to seek Canadian drugs.

“I only have 23 days’ worth of pills,” Roland Hofferber told Ñî¹óåú´«Ã½Ò•îl Health News in early October. The retired supply chain engineer in Muscatine, Iowa, takes Jardiance, also known as empagliflozin, to slow his chronic kidney disease. “If I don’t get some through pretty soon, I’m going to have to cut back or quit.”

The drug would cost him $641 for three months in the U.S., he said. He buys a generic from an Indian pharmacy for $54.

The FDA “hasn’t given parameters as to what they will approve and what they won’t,” Zonos’ Macke said during the webinar. “We’ve been told there will not be a general ban. But we cannot reassure U.S. patients. We have to see how FDA applies. They could be lenient. They could be very strict.”

When asked whether patients could still import prescription medicines, CBP spokesperson Jessica Turner said that pharmaceuticals remained under the FDA’s jurisdiction and that the FDA “will continue to determine whether imported medication shipments are admissible.” Department of Health and Human Services spokesperson Emily Hilliard said the FDA would “continue to evaluate personal imports on a case-by-case basis.”

White House spokesperson Allison Schuster did not respond to questions about imports but said Trump “remains dedicated to lowering the cost of prescription drugs.”

Since summer 2025, patients have had to pay tariffs on brand-name medicine shipments. In 2022, the FDA said it typically checked about 1 in 2,000 medication packages passing through U.S. customs.

“A lot of products weren’t even looked at, because CBP and FDA didn’t have full visibility” into what entered the country, Prescription Justice’s Levitt said. The rule requires shippers to post a bond and fill in a complex data form for each package, he noted.

“Let’s say you’re importing 90 days’ worth of Eliquis,” Levitt said. “FDA can now look on a screen and see that. Do they let it in, or refuse it under law?”

“If they don’t, there’s going to be a cohort of people who cannot afford their drugs anymore,” he said. “And those people are going to suffer.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

Within months, the state enacted a that required hospitals to proactively screen patients and give financial aid to those who qualify for it. Oregon’s new rules, which took effect in July 2024, required hospitals to skip applications for nearly all patients — a rarity among hospitals nationwide.

“They will be told up front, Hey, we got you,” said Democratic Oregon state Sen. Lisa Reynolds, who introduced the legislation. “You are here at a very scary time in your life because of illness or injury, and we got your back.”

The law worked.

Oregon Health & Science University’s hospital, one of the largest in the state, saw 64% of its patients automatically qualify for financial assistance in the early months of the new law, up from 12% previously.

In their first full fiscal year under the law, spending by Oregon hospitals on financial assistance more than doubled, on average, according to federal financial reports from about two-thirds of the state’s hospitals. That’s compared with their last full year before the change.

For patients, the switch meant direct relief from high healthcare costs, advocates said.

“They don’t have to have the late nights being like, how am I going to afford my mortgage? How am I going to afford these medical bills?” said Adam Zarrin, a director of state government affairs for the advocacy group Blood Cancer United.

Hospitals in the state have pushed back on the requirements, saying they , and they face added financial strain from the Trump administration’s domestic policy agenda. Millions of people are health insurance in coming years under cuts to Medicaid pushed through by Republicans in Congress.

Oregon’s early success is the first big test of a new approach that more states are turning to, known as . Hospitals skip the applications and screen patients automatically to determine if they qualify for aid.

North Carolina this year to include patients with income up to triple the poverty line. and are requiring hospitals to automatically grant financial aid by July 2027.

A Promising Tool To Prevent Medical Debt

As many as 100 million adults in the U.S. have healthcare debt, according to a Ñî¹óåú´«Ã½Ò•îl Health News analysis. That financial burden can alter people’s lives, forcing them to skip prescriptions and follow-up care to avoid further bills.

Hospitals are a of that debt, and they have faced growing scrutiny over and billing practices.

Policymakers have focused specifically on nonprofit hospitals, which account for the sector. Nonprofit hospitals , in exchange for providing benefits to their communities — a vaguely defined standard under federal law. Many hospitals meet this requirement by providing free or discounted care to low-income patients.

That financial assistance, however, can be difficult to get. Applications can be onerous and confusing. Congress and state officials have spent years testing policies to and , with mixed results.

Research finds , as does the degree to which hospitals property, sales, or income taxes.

“Hospitals have been on the winning side of this deal for a long time,” said Reynolds, the Oregon lawmaker. “They enjoy millions and millions and millions of dollars in tax breaks, and that money is supposed to be then spent on poor people who can’t afford their care or even their copayments. It has not penciled out.”

Reynolds pressed for Oregon’s screening requirement, she said, to hold hospitals “accountable for what they should have been doing all along.”

Early evidence suggests the law is doing what Reynolds hoped. Oregon hospitals’ spending on free and discounted care increased to 2.7% of all operating expenses, on average, from 1.4%, among the roughly two-thirds of hospitals with available federal data.

That brings hospitals in Oregon closer to the national average for nonprofit hospitals, which from 2021 to 2024 was about 2.4%, according to an analysis by Johns Hopkins University researcher Hossein Zare, who studies the industry.

More Help for the Insured

Among those in Oregon who started to get more help: patients with health insurance.

OHSU’s spending on help for insured patients reached about $39 million in the first year under the law, federal data shows, about five times as much as in previous years.

Lawrence Furnstahl, then OHSU’s chief financial officer, said in a public meeting in January 2025 that, before the law, insured patients often didn’t apply for help and instead paid their share of the bills. The new automatic screening often wiped out or reduced what they owed — including for large deductibles that patients have to meet out-of-pocket before insurance will kick in.

Patients who pay hospital bills often still carry medical debt, surveys show, because many use from family, friends, or banks to afford their care.

A from the Commonwealth Fund found that 1 in 3 adults with private insurance have medical debt.

“It defies the purpose of health insurance coverage, which is to enable people to get healthcare when they need it and protect them from serious costs,” said Sara Collins, an economist and senior scholar with the Commonwealth Fund.

‘A Very Different World’

For hospitals, the new requirements come as healthcare costs are climbing and federal support for the safety net is shrinking. Nationally, an estimated will be uninsured in 2034 as a result of President Donald Trump’s signature tax-and-domestic-spending law and the expiration of enhanced Obamacare subsidies that Republican lawmakers allowed to lapse at the end of last year.

Hospitals supported Oregon’s new presumptive eligibility law, said Sean Kolmer, an executive vice president for the Hospital Association of Oregon. But they’re feeling more financial pressure, with the organization expecting the state’s uninsured rate to 10% or higher in coming years, he said, up from about 3% .

“That’s a very different world,” he said.

OHSU saw costs rise rapidly. “It is a good thing, but it is an expensive thing,” Furnstahl said in a public meeting as he gave an update on the first months under the law.

In the first year under the new law, OHSU spent about $64 million on free and discounted care — of what it spent on operations that year.

The true cost of more up-front screening is hard to quantify, medical debt experts said. It must also take into account how many people would have never paid their bills anyway and how much hospitals save by not chasing payments.

Lawmakers said hospitals pressed them for relief, and in April, Oregon to ease the state’s screening requirement.

The original law required hospitals to screen everyone on Medicaid or who was uninsured and anyone who owed $500 or more. Lawmakers raised the monetary screening threshold for a single visit . The Medicaid or uninsured requirement remains.

Reynolds, who spearheaded the original law, was unsympathetic to hospitals’ cost concerns. But she agreed to the rollback because she wanted hospitals to have some relief as they fine-tuned their screening process. Oregon hospitals reported that their screening data was less accurate for patients with higher incomes, leading some people who didn’t qualify for help to receive financial assistance.

OHSU studied economic data for Oregon’s residents and reported that about 57% likely had incomes that qualified them for its financial assistance, slightly under the 64% of patients who were receiving help.

Hospitals’ warning of increasing financial stress was a motivator for Democratic Rep. Rob Nosse, who chairs the healthcare committee in the Oregon House of Representatives.

“I don’t want any suburban or rural hospitals to close on my watch,” Nosse said.

People who are no longer automatically eligible can still apply for help with bills less than $1,500, he said.

“I’ve got to make it more expensive for someone to get healthcare so that the hospitals can stay in business,” he added. “What a country.”

This article is part of “,” an investigative series from and Ñî¹óåú´«Ã½Ò•îl Health News about how hospitals can protect their patients from the life-altering harms of medical debt.

is a nonprofit newsroom reporting on healthcare’s toughest choices. to get the latest stories every Thursday morning.

Tradeoffs’ reporting for this series was supported, in part, by the California Health Care Foundation, the National Institute for Health Care Management Foundation, and the Solutions Journalism Network.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

The labor and delivery unit where she used to work in this rural northeastern Georgia community is no longer open. So, she asked former co-workers to be on standby around her anticipated due date. She and her midwife mapped out emergency rooms along the more-than-50-mile trek to the hospital in Greenville, South Carolina, where she planned to give birth. And, to prepare for a worst-case scenario, she curated items to keep in the car in case she went into labor en route.

“That’s a horrible place to put a pregnant woman in,” said Holden, who on Oct. 11 made the painful, hourlong trip to Greenville Memorial Hospital to deliver her son Tucker.

Holden lives roughly midway between Athens and Greenville, two of the nearest cities with labor and delivery units. Owing partly to Medicaid cuts from President Donald Trump’s One Big Beautiful Bill Act, St. Mary’s Sacred Heart Hospital in Lavonia nearly a year ago. Its closure is part of a trend touching rural communities nationwide. From South Dakota to and from to , low Medicaid reimbursement and dwindling birth rates are pushing hospitals to shutter these services. Today, of rural hospitals offer labor and delivery services.

In Georgia, only 36% of rural hospitals have a labor and delivery unit, and four have closed since 2020, according to data from the .

To address the challenge the closings pose to patients seeking care, the state — which ranks among the for maternal health outcomes — has turned to federal money from the $50 billion . This fund was created by congressional Republicans to offset concerns about the outsize fallout Trump’s signature legislation would have in rural communities.

More than $12 million — out of the nearly $219 million approved for Georgia in the program’s first year — will be allocated toward placing obstetric carts in 43 rural hospitals without labor and delivery units. The carts will be outfitted with supplies needed for a birth or obstetric emergency. For example, they’ll have neonatal resuscitation tools, thermal blankets, and essential medications such as oxytocin, which stimulates contractions, and magnesium sulfate, used to treat seizures in pregnant people with high blood pressure.

The delivery carts sound fine, in theory, said Justin Peterson, an OB-GYN who practices in southern Georgia and has seen the pressures rural health institutions face providing maternal care.

Like Holden, Peterson worries that the carts, while helpful, will put supplies in the hands of ER doctors lacking extensive obstetric experience. Instead, he wants the state to fill coverage gaps by investing more to prevent the closure of labor and delivery units in rural areas.

“You’re putting a band-aid on a hemorrhage,” he said.

‘Can’t Practice Scared’

Brittany Mitchell was about seven months pregnant when Sacred Heart’s labor and delivery unit closed. She was reassigned to an OB-GYN in Athens, even though the nearly 50-mile drive from Lavonia was stressful and inconvenient.

That OB-GYN wanted to see Mitchell weekly after finding high levels of protein in her urine — a warning sign of preeclampsia, which can cause organ damage, seizures, and other complications. To make it to those prenatal appointments, she routinely gave up a day of work as a home health aide, a job she said already didn’t pay much.

But if Mitchell were to have another baby, she said, she’d still prefer to drive to Athens to see an OB-GYN than be treated by an ER doctor. When she had her first child nine years ago, the local OB-GYN had to act quickly when her daughter briefly lost oxygen.

“If they were in that situation,” she wondered of ER doctors, “would they know how to do all that?”

In written responses to Ñî¹óåú´«Ã½Ò•îl Health News, Lauren Williams, director of communications for the Georgia Department of Community Health, said that training ER medical staff is the main goal of the obstetric cart initiative. The rollout will include simulation drills, during which ER staff will practice high-risk procedures.

The Georgia Hospital Association will procure and distribute the carts. When exactly that will happen is unknown, but the grant funding must be spent by Sept. 30, 2027, said Anna Adams, the organization’s chief government relations officer.

The concept of obstetric carts is great, said Justin Law, an emergency doctor with SouthlandMD, a physician-owned and -operated healthcare management and staffing company. Most items planned for the carts are already available in ERs. But having them in one organized spot will be helpful, he said.

Still, while ER doctors are more frequently positioned at the front lines as labor and delivery closures persist, advocates argue that they shouldn’t be used as a stopgap in obstetric care.

In the decade he’s worked across rural Georgia, Law said, he’s never delivered a baby in the ER even though he’s trained in emergency obstetrics and has experience delivering babies as a paramedic. When a mother needs an emergency cesarean section or has another high-risk complication, she would likely be transferred to a hospital with labor and delivery capabilities, Law said.

Holden, the former obstetric nurse, said familiarity with obstetric delivery practices and procedures is essential because some complications can’t wait for a transfer. “You’re not going to save anybody’s life just because you got access to some equipment,” she said.

Adams understands the concerns and acknowledged that the ER is not the ideal location for delivering a baby. “But sometimes things happen that are outside of our control,” she said. “And when it does, we want to make sure those hospitals are prepared.”

Robin Clyatt, maternal health community outreach coordinator for , said ER doctors have vast knowledge. But they might see someone with a major maternal health complication, such as a hemorrhage, only a few times a year, and therefore may lack the skills to act immediately, she said.

“You can’t practice scared when it comes to obstetrics,” Clyatt said. “And that’s important, because when you practice scared, you do stupid things.”

Ways To Keep Access

The labor and delivery unit at the Coffee Regional Medical Center in Douglas serves six counties in southern Georgia. The number of live births there increased from to , which shows the impact when nearby facilities close, said Peterson, who practices at the Coffee Regional Hospital Women’s Center.

While he understands that hospitals must consider their bottom lines, business decisions in recent years have often taken precedence over patient care, he said.

“They just say, ‘Oh, you know, the numbers aren’t there. We’re closing,’” he said, adding that when rural labor and delivery units shutter, the chance they’ll reopen is small.

Mark Ralston, public relations manager for St. Mary’s Health Care System, which owns Sacred Heart, did not respond to multiple requests to further discuss the unit’s closure. But in its announcement, the system said the decision followed “an extensive 18-month discernment process that included intensive efforts to recruit additional physicians, create new partnerships, and pursue incremental funding sources.”

Nationwide, states are attempting to narrow gaps in maternal healthcare using federal funds. will establish maternal health hubs to determine where resources are needed and help mothers navigate the health system. in rural communities.

In its proposal for federal rural transformation money, Georgia included incentives such as funding 75 new residency slots in various specialties and creating a grant program that would reimburse physicians up to $250,000 in relocation fees if they chose to practice in rural areas.

State legislators could incentivize doctors to stay in rural areas, offer higher reimbursement rates for hospitals, and provide loan forgiveness for physicians, Peterson said. Communities should also look to incorporate certified midwives and community health workers, Holden and Clyatt said, though for both groups to practice. Currently, certified nurse midwives are allowed to practice only in partnership with a physician, which maternal health advocates argue creates a .

Holden had the ability to send her vitals to her doctor and meet with them virtually for prenatal care.

As she adorned bookshelves in baby Tucker’s cozy, sage-green nursery with vintage trinkets and family heirlooms, she said she thought of less-resourced mothers in the area, who may be on Medicaid or not have the luxury to travel an hour for a prenatal appointment.

Holden worries that without prenatal care, conditions like preeclampsia could go undiagnosed more often. “They don’t make it, and their baby doesn’t make it, because they never got that diagnosed and managed,” she said.

People like to remain optimistic that everything will go as planned, but “there are so many things that can go wrong,” she said. “And they can go wrong really quick.”

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Three Democratic senators issued recommendations a year after launching an inquiry into companies — Deloitte, General Dynamics Information Technology, Gainwell Technologies, and Conduent — that are paid billions in taxpayer dollars to build or run eligibility systems for safety net health coverage. Those benefits, provided to the poorest Americans, can mean the difference between having medical care or going without.

A handful of states directly operate their Medicaid eligibility systems, but most rely on contractors to build and run them. Ñî¹óåú´«Ã½Ò•îl Health News found that Deloitte dominates this slice of government business. Deloitte-run systems have been plagued by errors that can result in eligible people losing their health coverage, previous Ñî¹óåú´«Ã½Ò•îl Health News investigations have shown. Malfunctions can cost millions of taxpayer dollars and take years to fix.

“Administrative errors in this line of work are not like errors in other fields,” the senators . “There are life-and-death consequences for sick Americans who seek care only to find that their Medicaid coverage has been terminated.”

President Donald Trump’s signature tax and domestic policy law has mandated Medicaid changes that are forcing states to adapt their computer systems on a compressed timeline. Medicaid policies under the One Big Beautiful Bill Act add red tape and restrictions that make it harder for people to stay enrolled.

Those include the first federally mandated work requirements in Medicaid’s history. Next year, to keep benefits, millions of adult Medicaid enrollees in more than 40 states must prove they’re working or doing a similar activity for at least 80 hours a month, unless they qualify for an exemption.

Democratic senators Ron Wyden of Oregon, Elizabeth Warren of Massachusetts, and Raphael Warnock of Georgia say the new restrictions — layered atop computer systems with histories of problems — will result in large numbers of people improperly losing health coverage.

State eligibility systems “have been built up, patched, and frankensteined for decades,” the senators said.

The senators sit on the powerful Senate Finance Committee, which oversees government health programs such as Medicare and Medicaid. Many of their recommendations target the Centers for Medicare & Medicaid Services. Their ideas face long odds at the moment. Republicans control executive branch agencies, and any potential legislation would need to advance in a Republican-controlled Congress.

That balance of power could shift if Democrats win a majority of Senate seats in November’s midterm elections. The three lawmakers called on CMS to establish mandatory standards in state contracts with companies so states can receive federal funds.

These companies sign contracts with state governments, but the federal government approves them and pays the bulk of the cost. The federal government covers 90% of state costs to develop and implement state Medicaid eligibility systems and 75% of ongoing maintenance and operations expenses, according to federal regulations.

The lawmakers also said CMS should publicize the contracts and contract amendments. Currently, those documents can be obtained from state governments, but accessibility varies significantly.

The senators also said CMS should publicly disclose companies’ performance data and change orders. Change orders are used to adjust computer systems, and states set aside millions of dollars for them. But systems may require fixes beyond the agreed-upon work.

“The millions of Medicaid enrollees who will be required to prove their eligibility every six months, to document every hour of work on a glitchy portal, to find a doctor willing to certify that their cancer or their chronic condition is bad enough to qualify for an exemption — deserve contractors who are accountable for what happens when the system fails them,” they wrote.

In October 2025, the three Democratic senators, as well as Sen. Bernie Sanders (I-Vt.), sent letters to several companies that CMS identified as eligibility system contractors. At the time, they wrote that it is each company’s responsibility to build functioning eligibility systems, “rather than to prioritize their bottom line.”

As of June, were enrolled in Medicaid, according to CMS.

The lawmakers had asked the companies about their contracts, lobbying expenditures, and protocols for making changes in light of system errors, among other issues. The companies provided the lawmakers with some details but often did not answer their questions.

The companies said states are responsible for making the final call on whether a person receives benefits. State workers approve or deny eligibility, Deloitte said in its response letter, “not a private contractor or an automated system acting alone.”

The companies did not provide the senators with specific details about documents or processes they use to help states make eligibility determinations.

The companies also denied they have any financial incentives to remove people from Medicaid. Conduent said it gets paid less if enrollment drops.

The companies did not say whether states are on the hook for paying to fix the companies’ errors.

Deloitte, Gainwell, GDIT, and Conduent said it’s common for states to require that they meet certain performance metrics.

Gainwell told lawmakers, “We take seriously the issues raised.”

GDIT said it would answer additional questions from lawmakers and told Ñî¹óåú´«Ã½Ò•îl Health News that it “has a strong track record” of supporting Medicaid programs. In New York, GDIT said it has a “limited role” in determining eligibility because it relies on rules provided by the state. GDIT operates New York’s online Affordable Care Act marketplace, where New Yorkers can enroll in various health plans, including Medicaid.

Deloitte said in its response to the lawmakers: “We are proud of our work serving individuals and families across the U.S.”

CMS did not respond to a request for comment.

CMS takes steps to check whether Medicaid eligibility systems are working properly. As part of the process for certifying states’ systems, federal officials . They include whether states are correctly calculating people’s incomes, whether individuals are given timely eligibility decisions, and whether eligibility categories are accurate. However, it is rare for the federal government to withdraw federal money from states for falling short.

In August, CMS announced it intends to for Medicaid systems. The ultimate goal is to improve enrollees’ access to care and their experiences with these systems, CMS said. The agency also has said the standards will hold companies accountable to deliver systems that are “continuously improving” and have a “stronger capacity to implement critical policy changes.”

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But in January 2025, the city’s health systems had no good options for Debbie Doppelt, a 60-year-old jeweler with an unusual form of lung cancer that mostly afflicts nonsmokers like her. The Food and Drug Administration hadn’t yet approved sunvozertinib, a drug developed in China that targets the mutation driving Doppelt’s tumors. She had been through chemotherapy and surgery, but the cancer had now spread to her brain. And she didn’t qualify for the relevant clinical trials.

Then an option emerged, in an offhand remark.

“Too bad she’s not Chinese,” a doctor told her son Max Doppelt, who had organized his mother’s care since her 2023 diagnosis. “She could go to a pharmacy in China and buy it.”

Within hours, mother and son had reached out to friends and relatives, one of whom procured a small supply of sunvozertinib from a contact living in China. A few months later, Max flew to Shanghai to get a refill.

Other patients have followed. “No organization or doctor is guiding patients to China, but word gets out,” Max said. He said he knows of at least 30 Americans who’ve made the pilgrimage to obtain the drug, which the FDA licensed in July 2025 but wasn’t yet on the U.S. market as of mid-October of this year.

Sunvozertinib, made by Shanghai-based Dizal Pharmaceutical, isn’t the only treatment drawing patients to China. Americans, Europeans, and others are trekking there to enter clinical trials for CAR-T therapy, an area in which China is .

China, until recently known more as a supplier of drug precursor chemicals and generic medicines, has become a biotech powerhouse, accounting for of new drugs tested around the world in 2025. U.S. pharmaceutical companies are testing new therapies there and signing billion-dollar contracts with Chinese firms to develop and market their drugs.

China’s progress has alarmed some politicians, who warn of lost jobs and U.S. dependency on Chinese medicines. The Trump administration in June kicked off Operation TrialBlazer, aimed at speeding up some FDA regulatory processes to lure back more clinical trials.

China’s poor showing in vaccine and drug development during the covid pandemic prompted the country to overhaul its biotech sector, dramatically altering the global industry, said Sam Rasty, a veteran of small biotech companies who now leads one called FynderBio. Venture capital now flows heavily to early-stage clinical work in China and Australia, where regulatory systems enable key first-in-human studies much more quickly than in the United States.

Chinese companies are so much faster at this process that U.S. biotechs, which used to share early advances at conferences or funding meetings, now routinely conceal their progress out of fear that competitors will take their ideas and speed them to market, said Steve Potts, CEO of Breakthru Medicine, a small biotech.

At a meeting he attended in May, nearly all the 60 biotech CEOs in the room planned to run phase 1 trials in Australia, Europe, or China, Potts said. Five or 10 years ago, most of those trials would have been carried out in the U.S.

“Slow and prohibitive” FDA requirements are driving investment to more-nimble Chinese companies, President Donald Trump’s nominee to lead the agency, Heidi Overton, warned in her opening statement at her Sept. 24 confirmation hearing.

The movement of clinical trials overseas “should give pause to every American and those who serve on their behalf,” Overton said. “When we lose this advantage, we lose our health security. And when we lose our health security, we lose everything.”

Overton pledged to continue TrialBlazer, which mirrors Australian processes begun in 1991. It is aimed at accelerating clinical trials and approvals so patients do not feel compelled to seek treatment abroad, said Department of Health and Human Services spokesperson Emily Hilliard. It is sometimes legal to obtain medication abroad for personal use, but the FDA “cautions patients about potential safety and quality risks associated with treatments outside our regulatory system,” she added.

As the FDA moves to streamline drug development, members of Congress are trying to slow Chinese firms’ integration into U.S. biotech.

Rep. John Moolenaar (R-Mich.), who chairs the House Select Committee on the Chinese Communist Party, in June co-sponsored legislation with Rep. Debbie Dingell (D-Mich.) requiring all U.S. pharmaceutical deals with Chinese companies to be cleared by the Treasury Department.

Others see biotech protectionism as misguided. China’s focus on improved medicines can only help us, said Peter Kolchinsky, managing partner of RA Capital Management, which has Chinese investments in its biotech portfolio.

“We may be adversaries in many areas, but we’re not competing with them to cure cancer. We are collaborating with them to cure cancer,” he said. “There are things that are bigger enemies than any other nation on Earth.”

Cancer Knows No Boundaries

A minor but persistent cough led to the diagnosis of Debbie Doppelt’s cancer in late 2023. Chemo, immunotherapy, and surgery kept it at bay for months, but in December 2024, scans showed the cancer had spread to her brain, with 10 tiny tumors.

The FDA earlier that year had approved amivantamab, a drug that targeted the mutation driving Doppelt’s tumor, but Max was concerned about its toxicity. Also, several doctors he consulted told him that amivantamab might not penetrate brain tissue to fight cancer there.

Doppelt tried to enter a clinical trial at Memorial Sloan Kettering Cancer Center, where she was a patient, for zipalertinib, another drug that targeted her mutation. But in January 2025, the Doppelts learned that a slight scarring on her lungs had rendered her ineligible for the study.

That left sunvozertinib, which gained approval in China in 2023. It was also being tested in the U.S., but only in late-stage trials in which half the subjects received chemotherapy only. That risk was a nonstarter for Doppelt, whose cancer had already outsmarted chemo.

So Max flew to Shanghai, returning with 26 boxes of sunvozertinib in his luggage. The drugs cost about $10,000, he said.

“Getting on the plane and bringing the medicine home felt like my life’s purpose,” Max said. “The data was so clear that this drug had significant efficacy in the brain. Anything else she might do, she might not last a year.”

On Sept. 1 of this year, AstraZeneca signed an agreement with Dizal to distribute the drug worldwide, and it plans to make it available in the U.S. by the start of 2027, spokesperson Tara Parsell said.

Doppelt, who runs a diamond business with her husband, has tried to stay positive and healthy, scarcely missing a day of work since her 2023 diagnosis. She said she’s grateful she has a loving community and the means to afford the best available therapies.

“I think I’ve been pretty successful at having, actually, an amazing three years,” she said. “In some ways a better three years, with all of it, than the three years before, because you’re so appreciative of everything.”

Doppelt’s parents were Holocaust survivors. “They were always saying: ‘This piece of bread tastes so good! Do you know what it is to be hungry?’”

Searching for help for his mother gave Max, a 30-year-old computer engineer, an idea for helping patients find the right treatment — which, in cases of advanced cancers, may be a clinical trial.

A year ago, he quit his tech job and that uses artificial intelligence to combine data from research and drug company sites with a patient’s health records to help them find the right study.

Similar apps are being used to help drug companies and hospital systems increase the percentage of U.S. cancer patients who enter clinical treatment trials, currently . This will also strengthen the U.S. drug industry, said CEO Kent Thoelke, whose company offers an AI program designed to help hospitals and clinics enroll trial subjects.

About 300 patients have used Max’s app. So far his clients, whom he doesn’t charge, have all been lung cancer patients like his mom. Sunvozertinib seems to help about half those who take it, he said.

A 70-year-old woman whom Max had assisted got a six-month supply of the drug earlier this year from China, only to learn after three months that it wasn’t working. “My cancer had spread,” said the woman, whom Ñî¹óåú´«Ã½Ò•îl Health News agreed not to name, to protect sensitive health information.

‘I’ll Do Everything in Our Power’

Doppelt has done well on the drug. Some 19 months after starting on it, her cancer was still mostly kept at bay, with the help of a few radiation treatments and dose adjustments.

AstraZeneca’s plans to widely distribute sunvozertinib would mean no more trips to China. But Max had few illusions that the drug would work for his mom forever.

“She has a metastasizing cancer that will learn to bypass the drug,” he said. “At that point we’ll be dependent on the latest and greatest therapies. If they happen to be in China, I’ll do everything in our power to go there.”

At his Upper East Side apartment one recent afternoon, Max examined the current clinical trial outlook for his mother. He pulled up her profile on the app and scrolled down a list scoring available trial sites according to their fit and proximity.

“This one looks good,” he said, pointing to a clinical trial for firmonertinib, a drug China approved in 2021 that’s under study in the U.S. and elsewhere.

CAR-T therapy is another possibility, particularly a variety that the University of Colorado has developed to boost patients’ immunological attack on mutations like the ones driving Doppelt’s cancer.

But Kyle Concannon, a leader of the Colorado research team, said regulatory uncertainty has slowed his progress. As new tools enable sophisticated measures of things like toxicity and tissue distribution, they add time, cost, and risk to the therapy’s development. These technologies may be better at detecting possible harms, “which is good,” Concannon said, “but the alternative to a new medicine, with a natural disease like lung cancer, is the individuals will die from their disease.”

Max Doppelt and other patient advocates, while pushing for faster FDA processes, don’t want to rule out more Chinese medicine runs.

“When drugs are approved in China but not in the U.S., of course we will deploy the China option where necessary,” said Marcia Horn, CEO of the nonprofit International Cancer Advocacy Network. “Lives depend on it.”

Max would prefer to see the drugs his mother needs developed in the United States. But he, too, opposes any effort to freeze out the Chinese biotech industry.

The discovery of new life-preserving drugs “really brings us together,” he said. “We’re all humans at the end of the day.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

For nearly three years, Jonathan Bledsoe of Reading, Pennsylvania, took one prescription to stabilize his mood and one to keep his cholesterol in check, among a handful of other medications.

“You wouldn’t think you would have to be your own advocate and look out for yourself as far as managing your medications,” the Marine veteran said. “But when you wake up one morning and what you pee comes out the color of fresh brewed coffee, there’s an issue.”

He took his concerning symptoms back to his multiple doctors and learned the interaction between his medications was starting to damage his liver. After he changed medications, his liver and kidney function returned to normal.

Adverse drug interactions are becoming a bigger health concern as more people take multiple medications, said Amanda Mixon, a hospitalist and associate professor of bioinformatics at Vanderbilt University.

The percentage of Americans over 65 taking five or more medications, known as polypharmacy, nearly doubled from 2000 to 2020, according to a study published in . Now, more than a third of older adults are taking five or more medications a day.

Mixon said she sees older patients with an average of 16 medications, often from multiple prescribers and pharmacies.

“As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases,” Mixon said. “As these medications get added sort of progressively, that can accumulate over time, and then people are having more side effects.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

The administration of President Donald Trump has used claims of widespread wrongdoing to justify investigations, suspensions of billions of dollars in payments to states, and the cancellation of Affordable Care Act health coverage for hundreds of thousands of people.

has opened a broader political fight over the extent of fraud and the administration’s response to it. Republicans say they’re safeguarding taxpayer dollars by going after bad actors. Democrats contend the administration has relied on insufficient evidence to target blue states and cut programs Republicans have long tried to shrink. Meanwhile, Trump’s pardons of executives convicted of healthcare fraud, administration moves to weaken some protections against abuses, and a high-profile error by Trump regulators stand in contrast with the administration’s proclaimed fraud-fighting goals.

The dispute is becoming a talking point for both parties leading up to the November election.

Republican candidates are trying to win voters’ confidence by emphasizing their efforts to halt what they say is the misuse of taxpayer dollars in federal health programs.

“Going after fraud gives Republicans a healthcare message when they would otherwise just be defending cuts to Medicaid and the Affordable Care Act,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News. The approach, he said, helps “blunt” those attacks.

Democrats, however, traditionally have an advantage on healthcare in general, with are with such issues. Now Democrats are portraying Republicans’ fraud crackdown as a cover for the GOP’s weakening of safety net programs. But the GOP messaging could resonate at the ballot box.

About 44% of voters — and 54% of Republican voters — say fraud in government programs is “extremely important” for candidates to talk about, conducted in mid-September, suggesting the fraud focus might be connecting with the GOP base. Such fraud is also the top issue rural Republican voters want candidates to talk about, based on a by KFF and the Associated Press.

It’s an issue that is hardly new, and government watchdogs have repeatedly documented fraud by health providers and brokers, as well as improper enrollment in government health programs. A report by the in March warned that the “sheer amount of payments in the Medicare program creates significant fraud risks.” And in a , GAO investigators were able to get subsidized insurance for fake ACA enrollees.

What has changed is the prominence the issue now occupies in national politics.

Administration’s Fraud Targets

Trump administration authorities have this year charged hundreds of people, , in alleged billing schemes. It has announced and increased scrutiny of enrollment in federal programs, withholding in federal Medicaid payments over claims of lax oversight — with what Democrats say is a laser focus on blue states despite a lack of evidence.

The administration’s more expansive claims about fraud — and the actions it has taken in response — have generated fierce political clashes.

Most recently, the Centers for Medicare & Medicaid Services canceled ACA enrollments covering 760,000 people. While Democrats have questioned the methods that found them to be fraudulent, federal officials said they included nonexistent consumers whose applications were submitted by brokers or agents who can earn commissions from insurers.

CMS Administrator Mehmet Oz that the cancellations included people who had coverage through the ACA but hadn’t used it. He also said some had no Social Security numbers, calling that evidence of problems.

“About 35% of current people on the Obamacare system — 35%, more than a third — had never used the program. They haven’t bought a prescription medication. They haven’t seen a doctor. That just is not possible,” Oz said. “So we know there is fraud.”

Democrats and some health policy analysts challenge that conclusion. They say that younger and healthier people are much less likely to use their insurance and that not using their coverage doesn’t mean they were improperly enrolled. Critics also say the absence of Social Security numbers doesn’t necessarily establish fraud; for example, newborns can be added to their parents’ plans before receiving a number.

“This is yet another attempt by the Trump administration to kick hundreds of thousands of vulnerable Americans off their healthcare,” on the social media site X. “Millions are already struggling to access healthcare—and this is their plan?”

There are political risks for the GOP as well. The disenrollment of alleged phantom accounts is likely to ensnare legitimate consumers, say health analysts and ACA advocates, leading to a potential backlash against Republicans if scores of people lose coverage just before the midterm elections.

States that tend to deliver for GOP candidates will be hit especially hard, they say, because ACA enrollees are concentrated in those states. The 4.5 million people in Florida and 4.1 million in Texas who have marketplace coverage account for nearly 40% of the country’s ACA enrollment, according to .

Conservative health policy advisers say the administration took multiple steps to avoid canceling legitimate coverage, including attempts to contact consumers and requirements that additional criteria be met before coverage was terminated.

“Those criticizing the action either don’t understand it or see some political advantage in mischaracterizing it,” said Brian Blase, president of Paragon Health Institute and a former Trump health policy adviser.

Democrats, meanwhile, highlight inconsistencies in the administration’s broader anti-fraud campaign.

They note that the Department of Health and Human Services last year of insurance brokers and agents who had been suspended in 2024 by the Biden administration for suspected fraud or abuse. The Trump administration also laid off from involved in regional oversight of the ACA marketplace.

On Oct. 3, to pass legislation with mandatory prison terms for defrauding Medicare and Medicaid, eliminating probation as an option.

But Trump has also pardoned health industry executives convicted of major fraud schemes, including people who are connected to his political allies or who spent heavily on lobbying on their behalf. The pardons included a sentenced to three years in prison for a nearly $40 million tax scheme and, in Trump’s first term, convicted for Medicaid fraud.

Trump’s pardons in 2021 of executives who profited from massive public healthcare fraud spurred criticism from the National Health Care Anti-Fraud Association. Critics now say the administration is portraying cuts to Medicare and Medicaid as necessary for weeding out waste, fraud, and abuse while exonerating criminals who have engaged in some of the biggest schemes in federal health programs.

Blue State Allegations

HHS has raised concerns about Medicaid fraud and program integrity in several states, and the administration has deferred or threatened to cut federal Medicaid funding while disputes are investigated.

Democrats say the administration is itself engaging in fraud by using unsubstantiated allegations of abuse to politically target blue states.

One of the most striking clashes occurred in New York.

Federal officials launched an investigation of the state’s Medicaid program after claiming that personal care services — including help with bathing, dressing, and meal preparation — had been provided to more than 5 million people, which would have amounted to roughly three-quarters of the state’s Medicaid population — an almost impossibly large proportion.

“It is time for New York to come clean about its Medicaid program,” CMS’ Oz .

CMS its calculations were wrong. The agency said that it had misunderstood the state’s billing codes and that the actual number of beneficiaries who received the services was closer to 450,000. The administration continued its scrutiny of the New York program, however, and later suspended millions of dollars in federal funding for the state’s Medicaid fraud unit, wasn’t producing enough indictments.

The administration also withheld about from California, citing concerns about program integrity and oversight of some home medical services. State officials deny the allegations, saying has grown because of factors such as higher wages for home health aides and an increase the number of older people receiving care.

The White House announced plans to in federal funds from Minnesota, claiming the state had failed to protect its Medicaid program from abuse. State officials have and gone to court to challenge the decision.

Vice President JD Vance, who chairs Trump’s Task Force to Eliminate Fraud, and other administration officials announced the state deferrals at the White House, giving what traditionally would have been technical disputes between state and federal health officials a much higher political profile. Vance’s office did not respond to Ñî¹óåú´«Ã½Ò•îl Health News questions about the administration’s anti-fraud activities related to healthcare.

“I’ve never seen anything like this,” said , a Georgetown University research professor and a senior adviser at CMS during the Obama administration. “It’s a deferral, not a finding of fraud. This is being elevated by political decision-makers.”

Republican candidates have pounced on the investigations and allegations. In Minnesota, Republican gubernatorial candidate , who is speaker of the Minnesota House, released claiming that her Democratic opponent, U.S. Sen. Amy Klobuchar, “has never done anything to stop the fraud here in Minnesota.” Klobuchar has said that as governor she would “launch a top-to-bottom audit of state government to root out fraud.”

In New York, , a Democrat whose office runs the Medicaid fraud unit, criticized the decision to withhold funds and said weakening the operation would benefit criminals. Her Republican challenger in the November election, , has cited the Trump administration’s claims , telling Fox News Digital that James is “totally failing to prosecute Medicaid fraud.”

The administration says its actions are necessary because fraud diverts taxpayer money from people who legitimately qualify for government programs.

“The fraud doesn’t just steal money — it steals our trust,” Oz said in August on .

Democrats and healthcare advocates say the White House’s anti-fraud crusade is being used by Republicans to distract from criticisms over its to Medicaid, the ACA, and other federal health programs.

Republican-backed legislation enacted last year is projected to reduce federal Medicaid spending by hundreds of billions of dollars over a decade.

Congressional Republicans also declined to extend enhanced ACA premium subsidies that expired , increasing premium costs for many people who buy insurance through the marketplaces. Enrollment has since declined by millions.

Overall, the combined effect of GOP-led changes will result in more uninsured people by 2034, according to an analysis by the Congressional Budget Office.

Those changes have given Democrats an opening to campaign on protecting healthcare coverage and affordability while Republicans seek to shift some of the debate toward fraud and government spending.

“It’s really a way to distract and reframe the cuts in a different way, to say it’s part of an anti-fraud effort,” said Anthony Wright, executive director of Families USA, an advocacy group focused on expanding health coverage. “Fighting fraud shouldn’t result in people losing coverage.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .