Insurance Archives - Ñî¹óåú´«Ã½Ò•îl Health News /topics/insurance/ Ñî¹óåú´«Ã½Ò•îl Health News produces in-depth journalism on health issues and is a core operating program of KFF. Fri, 14 Aug 2026 13:56:52 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.8 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Insurance Archives - Ñî¹óåú´«Ã½Ò•îl Health News /topics/insurance/ 32 32 161476233 Trump Team’s Use of Arcane Budget Rule Threatens Medicaid Coverage /medicaid/trump-cms-medicaid-expansion-1115-waivers-budget-neutrality-arkansas/ Fri, 14 Aug 2026 09:00:00 +0000 /?p=2273141 About 200,000 low-income Arkansans could see major changes to their health coverage next year after the Trump administration recently informed state officials it will not renew a key Medicaid agreement with the federal government.

The decision by federal officials, citing authority granted under President Donald Trump’s signature tax-and-spending law, suggests the GOP-led state’s predicament could foretell other repercussions in how states are allowed to run the program under federal waivers.

Nearly every state has at least one waiver to run its Medicaid program differently than required by federal law, such as allowing the use of private managed-care plans or expanding eligibility for mental health or long-term care services. Some Medicaid waivers have stretched decades, renewed by presidential administrations of both parties, effectively making the demonstration programs they created permanent.

Arkansas is one of a dozen states with a waiver expiring Dec. 31 that face the additional restrictions the Trump administration has placed on new or renewed waivers.

Though it has yet to finalize its decision, the federal Centers for Medicare & Medicaid Services said Arkansas’ 13-year-old waiver does not comply with new “budget neutrality” rules that take effect in January, said Gavin Lesnick, a spokesperson for the Arkansas Department of Human Services. The rules tighten a policy forbidding Medicaid waivers from increasing federal spending on the program beyond what it would have increased without the waiver.

The state is now seeking a two-year extension after hearing from CMS that its request for a five-year renewal would not be granted. If its Medicaid expansion waiver is not renewed, Arkansas officials have said they will continue offering expanded eligibility through existing Medicaid law, a change that could leave enrollees with access to fewer doctors and other health providers.

Rather than place more people in its traditional Medicaid program serving largely children, pregnant women, and disabled people, Arkansas obtained a waiver to buy Affordable Care Act marketplace policies from private insurers for adults covered by the Medicaid expansion. This “private option” gave enrollees greater choice of doctors and other health providers, because some doctors are more willing to see patients with private coverage, which generally pays more than regular Medicaid.

The move helped cut the state’s uninsured rate by nearly half, but it also ended up costing more than if beneficiaries were covered under Medicaid’s traditional, fee-for-service program.

Critics characterize the new waiver rules as part of a Trump administration effort to dramatically shrink Medicaid, the government program for those who are low-income or disabled, which grew rapidly under Presidents Barack Obama and Joe Biden.

“What we have here is a sneaky way to cut Medicaid expansion and the Medicaid program,” said Nicole Huberfeld, a professor of health law at Boston University.

Medicaid enrollees won’t know whom to blame if they lose coverage because the administration is using arcane regulatory processes to make the changes, Huberfeld said.

At issue are waivers granted by the government that allow states flexibility from existing Medicaid law in how they cover low-income residents, as long as the changes will not increase what Medicaid costs the federal government.

Pivoting from the long-standing practice of checking only retroactively whether states were keeping their budget promises, the Trump administration that it would not renew or approve any waivers unless CMS first certified that they would not increase costs to the federal government.

In its , the agency said the new waiver rules are expected to reduce federal spending.

“Characterizing enforcement of a statutory budget neutrality requirement as a cut misrepresents both the law and this guidance,” CMS spokesperson Timothy Foster said in an email to Ñî¹óåú´«Ã½Ò•îl Health News. The federal waivers are intended “to test innovative approaches to delivering care, not provide an open-ended mechanism for increasing federal spending.”

Other states with waivers expiring at the end of December include Georgia, which has added about 18,000 low-income people to Medicaid under its waiver, and California, which has used its waiver to expand coverage of social services including food and housing.

California and Georgia Medicaid officials told Ñî¹óåú´«Ã½Ò•îl Health News that they are still working with CMS in hopes of renewing their waivers. The loss of federal waiver approval could cause states to curtail benefits or eligibility expansions.

In Arkansas, it would mean redesigning the state’s Medicaid expansion program.

Arkansas’ initial waiver was granted in 2013, when its Democratic governor at the time worked with a Republican-controlled legislature to adopt a pioneering style of Medicaid expansion under the Affordable Care Act.

It was one of the first Southern states to expand Medicaid, granting coverage to many low-income residents. Forty states and Washington, D.C., have also fully expanded Medicaid to cover more low-income adults under the law also known as Obamacare.

The state’s Medicaid expansion enrollees were already facing a confusing time. Starting in January, they will need to prove they work or meet an exemption to be eligible for coverage under Trump’s law, the One Big Beautiful Bill Act. And one of the state program’s two private health insurers — Centene — announced in July that it was pulling out at the end of the year.

Sam Dubke, a spokesperson for Republican Arkansas Gov. Sarah Huckabee Sanders, told Ñî¹óåú´«Ã½Ò•îl Health News that the Sanders administration is trying to negotiate a temporary extension of its waiver “to ensure impacted Arkansans maintain access to quality, affordable healthcare during this transition period.”

“Looking ahead to the next legislative session, CMS has provided the state with an opportunity for bold, conservative healthcare reform, and the governor will work with her partners in the legislature to build a sustainable model that maintains the same high quality of care and saves taxpayer dollars,” Dubke said.

The Trump administration’s new restrictions on waivers, implemented under the same law that imposes work requirements as a condition of eligibility and reduces Medicaid spending by about $900 billion over a decade, could affect millions of enrollees and billions in spending. About a third of the almost $600 billion in federal spending on Medicaid and the Children’s Health Insurance Program in 2024 supported programs created by waivers, according to CMS.

In a , the Government Accountability Office found that the three-year spending limit the federal government approved for Arkansas’ Medicaid waiver was nearly $800 million more than what the state would have spent through its traditional Medicaid program.

Arkansas is one of several states that expanded Medicaid under the ACA using a waiver, with others including Indiana, Michigan, New Hampshire, and Iowa.

States will have to clear several more bureaucratic hurdles to retain waivers under the new CMS guidance, said Alice Lam, a managing director with consulting and legal firm Manatt. That could lead to fewer benefits or reduce the number of people eligible for Medicaid, she said.

Robert Nelb, director of policy at America’s Essential Hospitals, which represents safety net hospitals, said he and most experts believed when it passed that the One Big Beautiful Bill Act was merely codifying CMS policy on budget neutrality.

But the Trump administration has interpreted the law to restrict states’ use of waivers, he said.

Nelb said many long-standing waivers that have been renewed multiple times are now at risk and that the loss of state waivers could threaten money hospitals rely on to cover uninsured patients and improve care in their communities.

“There is a real concern that this will put added burdens on states up front and slow down new innovations in Medicaid,” Nelb said.

In 2025, the Trump administration told states it would no longer renew Medicaid waivers to help enrollees with job training or to allow continuous eligibility for adults and children for specific time periods without verifying their income eligibility.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

]]> 2273141 My Husband Was Kicked Out of Hospice for Dying Too Slowly /aging/hospice-eligibility-rebound-guide-discharge-appeals/ Fri, 14 Aug 2026 09:00:00 +0000 /?p=2269372 “No more operations,” he said.

It was mid-January 2026, and my then-73-year-old husband, Mike Salmon, had just started bouncing back from a three-month ordeal of three operations related to aortic aneurysms, sepsis, and a terrifying descent into delirium tied to a stay in the intensive care unit. Now, after another potentially fatal aortic aneurysm and ambulance ride, the doctors clustered around his hospital bed said the fix involved two more major, risky operations.

If Mike did nothing, the aneurysm or sepsis would likely kill him, they predicted. How soon? “Weeks,” one doctor said. “I’m astonished I’ve made it this far,” Mike said. So, abruptly, we were shunted onto hospice care — the dead-end spur of the American medical system.

Hospice agencies manage care for patients expected to die within six months. They don’t provide curative procedures or drugs. Instead, they aim to help families make terminally ill patients comfortable, typically at home, as an illness reaches its inevitable conclusion. Families provide most of the day-to-day care, and they are very satisfied with their hospice’s services, which include supplies of drugs and medical equipment, and visits from nurses, therapists, and aides.

More than 1.9 million Americans were enrolled in hospice in the last fiscal year. Over 80% of those patients stayed on hospice until they died — within four weeks, on average. But each year, about 6% of patients are kicked out because a hospice doctor decides they have stabilized or improved enough that they are no longer likely to die in the next six months.

In May, Mike joined that select group. His experience in and out of the hospice system revealed surprising lessons about how families can manage care. And getting removed from hospice revealed a little-known process that can represent a welcome respite for families like ours — but can be devastating for patients with serious chronic illnesses.

Here’s what we learned in our four months on and off hospice.

Check before you choose.

“Choose one.” A hospital nurse handed me a list of local hospice agencies. The sooner we signed up, the sooner Mike could go home. Stunned by the suddenness of Mike’s health emergency, I just pointed to the name at the top of the alphabetical list, assuming they were pretty much the same.

Big mistake. Medicare sets basic standards for the hospice agencies it reimburses, but some agencies are understaffed or poorly run. Amy Tucci, president of the Hospice Foundation of America, noted that some agencies provide extra therapy, aide support, and other services.

The problems with the organization I had chosen started immediately. Staffers were often late. They entered inaccurate medical information on Mike’s paperwork and didn’t make corrections when alerted. Medicare allows you to quit or change agencies, so I asked neighbors for recommendations.

That was a good start, but Kristina Newport, chief medical officer of the American Academy of Hospice and Palliative Medicine, said I should also have checked the quality ratings on and the . Those sites would have alerted me to our first agency’s low ratings. Ideally, Newport said, patients or caregivers should call their area’s top-rated agencies to find those that provide the services you need, such as staff members who speak the patient’s native language, provide spiritual care that aligns with the patient’s beliefs, or are stationed nearby to arrive quickly in an emergency.

The local, long-established nonprofit that neighbors recommended handled the transfer seamlessly. Its staff was punctual, accurate, and kind. The chef’s kiss after we switched: A nurse from the original company we chose called to say she hoped I hadn’t initiated the change because of “concerns about our care of your mother.”

Some people get better on hospice.

Research hasn’t yet fully explored why, but some people actually see their health improve under hospice care. Studies have found, for example, that hospice patients with congestive heart failure or lung cancer , on average, than similar patients in the standard medical system.

Terry Bertholet, who teaches courses on elder law and hospice care at the University of Connecticut, said many patients benefit from hospice’s careful pain management and from leaving hospitals, where they risk infection and overtreatment. Returning home allowed Mike to get up and walk without waiting hours for an overworked nurse to unplug a bunch of monitors, and to enjoy real food. Also, the hospice nurse gave him medicine to help him sleep through the night. He soon started regaining weight and strength.

You can flunk out of hospice for not dying quickly enough.

Medicare and many other insurers pay for hospice services only for patients whom physicians certify are likely to of the most recent assessment (not the date of enrollment), so hospice staffers regularly reassess patients. Medicare audits agencies to check for fraud and demands repayment of funds provided for care of patients its auditors deem have not proved to be terminal. Hospices, good and bad, worry about their bottom lines and Medicare’s fraud audits. They may feel pressure to discharge patients who threaten the organization’s finances, even though such discharges can remove important care. “Medicare is worried about fraud and abuse, not about people not getting enough care,” Bertholet said.

Especially for diagnoses with uncertain prognoses — such as dementia — if a patient improves or even stabilizes, hospice physicians might discharge the patient because they can no longer certify a likelihood of death within six months.

For some lucky reason, Mike’s aneurysm and sepsis held off. By early May, his wounds had healed, and his strength had improved enough that he returned to gardening, playing bridge, and whipping up his signature lattice-topped blueberry-cinnamon pies. While we appreciated the convenience of the nurse’s visits and the drug and medical supply delivery, we realized Mike no longer needed care, so we agreed with our agency’s decision to discharge him.

For patients suffering from more debilitating diseases, discharges can be a “nightmare,” said Krista Harrison, a hospice researcher at the University of California-San Francisco. Discharges often happen quickly. Medicare requires that patients be given a minimum of two days’ notice.

When Harrison’s father-in-law, suffering from a neurodegenerative disease similar to Parkinson’s, was discharged because his health seemed to plateau, the family scrambled to replace and pay for hospice-provided equipment such as a hospital bed and oxygen supply, and they had to quickly find and hire aides to replace the hospice aides. “Just getting his prescriptions reestablished and filled was a big deal,” she said. Her father-in-law died six weeks after discharge, she said.

Do your homework to ensure appropriate care.

Arming yourself with information about your risks and rights can help you get the hospice care you need when you need it.

  • Know your diagnosis. Discharges are unlikely for most cancer patients. But patients with dementia, heart disease, and Parkinson’s often plateau. So they are disproportionately likely to be discharged, UCSF’s Harrison said.
  • Choose a highly rated hospice. Research shows for-profit hospice agencies are more likely to discharge patients than nonprofits. Medicare’s Care Compare site will alert you to which is which.
  • Keep your own records. Caregivers who can document, say, a patient’s growing need for eating assistance can help hospice staff approve continuing care, or build a stronger appeal, UCSF’s Harrison said.
  • Keep your family doctor more informed. Doctors “don’t have the financial interest” the hospice faces and could help you dispute a discharge, Bertholet advised.
  • Appeal quickly. Hospice agencies must provide information on appealing a discharge. But you must file the appeal (online or by phone) by noon on the day before the termination date, which may mean you have only a few hours if you’ve been given the minimum two days’ notice, said Wey-Wey Kwok, a senior attorney for the Center for Medicare Advocacy.
  • Reenroll. Patients can try reenrolling in hospice at any time. Another hospice agency may take you immediately. Or you can wait until the patient’s health declines and try reenrolling with your original hospice agency, the Hospice Foundation’s Tucci advised.

That last option is our plan. For now, Mike and I are enjoying these unexpected bonus days. But whenever fate catches up with him, Mike said, he’s comforted to know he’ll get good care from the hospice’s staff. “They’ll try to improve the quality of what time I have left,” he said.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

]]> 2269372 Trump’s Vaccine Agenda /podcast/what-the-health-459-trump-childhood-vaccines-august-13-2026/ Thu, 13 Aug 2026 19:00:57 +0000 /?p=2272643&post_type=podcast&preview_id=2272643 The Host
Julie Rovner photo
Julie Rovner Ñî¹óåú´«Ã½Ò•îl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of Ñî¹óåú´«Ã½Ò•îl Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

President Donald Trump, apparently unhappy with the slow pace of efforts to change the federal government’s childhood vaccine schedule, issued a new executive order this week that would, if implemented, upend how children are protected from communicable diseases. But there are many obstacles to carrying out the president’s initiative, both legal and political.

Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. unveiled proposed new rules for food additives this week, but the rules don’t go as far as many health advocates had hoped.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Anna Edney of Bloomberg News, Maya Goldman of Axios News, and Sandhya Raman of Bloomberg Law.

Panelists

Anna Edney photo
Anna Edney Bloomberg News
Maya Goldman photo
Maya Goldman Axios
Sandhya Raman photo
Sandhya Raman Bloomberg Law

Among the takeaways from this week’s episode:

  • Trump unveiled a new executive order demanding restrictions on childhood vaccine recommendations, among other changes. The main impact of his order so far is confusion, leaving parents with little information on the science that may be informing his policy pronouncements. Meanwhile, Texas Attorney General Ken Paxton — also the Republican candidate for U.S. Senate in the state — is investigating the American Academy of Pediatrics over its vaccine positions.
  • The Senate confirmed Trump’s nominee to lead the Centers for Disease Control and Prevention, Erica Schwartz. And during a meeting with CDC workers, Kennedy expressed distrust of career scientists — another blow to staff morale.
  • The Trump administration finalized a rule that would strip federal Medicaid funding for states that provide certain care to transgender minors, putting added financial pressure on states. And several GOP-controlled states are passing on the federal government’s self-attestation grace period for Medicaid work requirements, forcing enrollees to start immediately proving with documentation that they qualify for an exemption to the requirements.

Also this week, Rovner interviews Ñî¹óåú´«Ã½Ò•îl Health News’ Paula Andalo, who wrote the latest “Bill of the Month,” about a medical tourist who searched for a better price for elective surgery abroad before finding it out-of-state. If you have a bill that’s outrageous, inscrutable, or just plain infuriating, you can share it with us here.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Health Affairs’ “,” by Mollyann Brodie.

Anna Edney: CBS News’ “,” by Julia Ingram.

Sandhya Raman: NOTUS’ “,” by Margaret Manto.

Maya Goldman: The New York Times’ “,” by Mark Arsenault.

Also mentioned in this week’s podcast:

  • MedPage Today’s “,” by Anonymous.
  • The Wall Street Journal’s “,” by Liz Essley White.
  • Politico’s “,” by Alice Miranda Ollstein and Robert King.
click to open the transcript Transcript: Trump’s Vaccine Agenda

[Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.] 

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 13, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Anna Edney of Bloomberg News. 

Anna Edney: Hi, everybody. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my “Bill of the Month” interview with Paula Andalo. But first, this week’s news. We’ll start this week with vaccine policy — more specifically, vaccine policy being made from the Oval Office. On Monday, President [Donald] Trump, surrounded by HHS [Department of Health and Human Services] Secretary Robert F. Kennedy Jr., and other health officials, signed an executive order calling for “gold-standard” childhood vaccine recommendations. The order calls for the current federal childhood vaccine schedule to be divided into three parts: one with a shorter list of shots recommended for all children, another list for high-risk populations, and a final list of vaccines to be given as a result of “shared decision-making” between doctors and parents. The president also wants to separate the combination measles, mumps, and rubella vaccine into three separate shots, which don’t actually exist in the U.S. at the moment. That would necessitate more visits for parents and more individual sticks for kids. While the order itself has no force of law, it does direct each executive department and agency to “take [any] appropriate steps to advance them, to the fullest extent allowable by law.” So, what’s the immediate impact of this? Besides a whole lot of confusion, because when RFK Jr. tried to do essentially this, back last year, it was blocked by a federal judge. 

Edney: Yeah, I think confusion is the main impact of this right now. You know, this comes in the news every so often because President Trump has not wanted to let this go, even though we kind of thought he was — or at least RFK Jr. was — directed to let it go because of the midterms and how that was looking. But this is something that President Trump has really had on his agenda and not let go. And I think that there is not really a possibility for an immediate impact, say, with breaking up the shots. Like it doesn’t, like you said, it doesn’t exist here. Merck, which is a company that makes these MMR shots, said that could take up to 10 years. It’s not just a simple thing for them to do. So, in the meantime, you have some parents who are wondering, Well, is this bad? Like, what should I be doing? How … you know. So I think confusion is the No. 1 impact here. 

Rovner: Yeah, I want to break this down into sort of what it means for health and what it means for policy and what it means for politics. So, in terms of health, the U.S. is already in the midst of its worst measles outbreak since 1991, and we’re seeing more cases of other vaccine-preventable diseases, including whooping cough and even tetanus. And pediatricians are already slammed. How are they ever going to make room for all these extra appointments and parent discussions of these vaccines that used to be sort of generally recommended and now are going to have to be the subject of individual discussions? Anna, you’re the mom on the panel. 

Edney: Yeah, I was thinking that from the parents’ side, but yes, from the pediatricians’ side as well. I mean, they’re already overwhelmed. They already have a huge list of patients trying to get in for many things. And from the parents’ side and the child’s side, this is, like you had mentioned, more sticks. … The children will have to be given more shots in this case, and a lot of times that can mean missed shots because going once kind of gets everything done. We all like to have a one-stop shop versus having to go to a bunch of different times. And so, besides the confusion, [it] could decrease vaccine adherence because people just might miss those shots. You know, they’re going into the first year of childhood, so many parents, even in the first couple weeks or months, are back at work and are having to carve out time for this. So it could, you know, it could really overwhelm the physician, the pediatricians’ offices, with these conversations, and you know, kind of just lead to actually less protection for children. 

Rovner: And hence, I’d say, the increase in vaccine-preventable diseases that we’re actually seeing. Go ahead, Maya. 

Goldman: I was just going to say there are also all these other logistical concerns — like we mentioned, these shots don’t even exist yet in the U.S. So that’s, you know, step one. But then you need more storage at the pediatrician’s office for a shot that’s three separate shots instead of one combination. You need more people working at the office to accommodate all the extra appointments that are already in a shortage of pediatricians in a lot of places in the country, and healthcare support workers. And so it’s just this huge cascade of side effects. 

Edney: Yeah, and I think we should add to that: When President Trump talked about this from the Oval Office, he linked wanting to separate these shots to the rise in autism, and there is evidence that’s showing that that is an issue, and that the shots should be separated for that reason. 

Rovner: And just last week, we had another large-scale study that showed no increase in autism due to childhood vaccines. I want to talk about policy, too. There’s one particularly ominous phrase in the EO [executive order] that says that states, who set the rules on which vaccines are required for school attendance, are “advised to review” the recommendations and “consider updating relevant laws and regulations that define the scope of immunization requirements.” On a brief call with reporters on Monday, one administration official suggested that newly sworn-in Attorney General Todd Blanche could go after states that don’t provide enough exceptions to their immunization policies with violating federal religious freedom laws. Is this really good policy or good politics? I mean, most states — I did go back and look — most states have exceptions, have medical exceptions; obviously, if a kid can’t take a shot, a kid can’t take the shot. Most of them also have religious exceptions. But it’s not clear how broad this administration wants those exceptions to be, and what it might do about states that don’t allow exceptions. I would note that one of the few states that has almost no exceptions is West Virginia, which is a very red state. 

Raman: I think this is really the area to watch on this. I mean, a lot of the other pieces of this executive order are broader, and I think a little bit more, you know, messaging to the political base based on some of these logistical issues that we’ve outlined. But this is a direct action to three different agencies, you know, to look at these exemptions. And this is already something that they’ve been investigating … there are already some lawsuits about some of these exceptions in the five states that don’t have, as you know, the same exemptions as other states. So I think here is really the area to look, especially with Blanche now confirmed, and just keeping an eye on some of the existing cases that are already there challenging some of these exceptions. Because this is really where we could see movement, or, just even on the state level, for them passing additional laws. You know, that was something mentioned in the presser too, that they were going to encourage states to do this. So I think state level is somewhere to really look, especially … vaccine requirements come down to schools, and those are on a state-by-state level done by [the Department of] Education, not HHS. So that’s where I would be watching. 

Rovner: Yeah, there’s more to come, I suspect, here. Before we leave this, though, I want to talk a little bit about the politics. I mean, Anna, you mentioned this. There were polls that showed that going after vaccines was not very popular with Democrats or Republicans, and that Secretary Kennedy was told earlier this year to focus on other things instead. Why is Trump bringing this up two months before the midterms? I mean, who — what politics is this aimed at? I guess is my question, because I certainly don’t know. 

Edney: From the reporting that I’ve read, and you know, , and Politico. This is just something that Trump himself believes and does not want to let go. He’s talked to the HHS secretary about it time and time again, saying, you know, basically needling him to get on it, even though others have told him not to do that. And so it seems like something that the president really wanted to happen. And just given this discussion we just had, I think it’s pretty evident that most of it is kind of a “We let him do his thing.” He got to talk about it in the Oval Office, and, like, hopefully he’ll shut up about it now, and nothing will actually happen. I think that that is a possibility. 

Rovner: We’ll see if nothing actually happens. But one more thing before we leave the vaccine wars topic, a story from last week that caught my eye: Texas Attorney General Ken Paxton, who is also Texas Republican Senate candidate Ken Paxton, announced in his AG role that he has opened an investigation into the American Academy of Pediatrics. That’s the group that’s led the charge to preserve the immunization schedule, according to, you know, science. Paxton, in a press release, says his office is looking into “concerns that the organization may be promoting and recommending childhood vaccines for financial gain.” Now, given that most pediatricians lose money on giving vaccines, that feels like a bit of a stretch. Or am I missing something here? 

Goldman: Yeah, I think, what I interpreted from that announcement was, you know, he’s concerned about the organization of AAP, which has some big funders in the pharmaceutical companies. So maybe he’s claiming that the organization is worried they’re going to lose that funding, as opposed to individual pediatricians making money off vaccines. But I think it’s really from AAP’s perspective: damned if you do, damned if you don’t, right? This is something that they have done the science on, looked into, and that’s what their basis is. Be very interesting to see if this actually goes to court and if there’s, you know, a legal argument to be made here. I think this is, like, something that is just starting to unfold. 

Raman: What struck me was it’s similar to what we’ve seen in other areas as well. It’s the same kind of rationale we’ve had going after some of the transgender medical professional groups. You know, saying that they’ve made various recommendations about gender-affirming care for financial gain, and questioning some of those decisions. So in that way it’s not unique, especially since Texas has kind of led the charge on some of those. But I do think it’s interesting that we’re going after some of the same organizations for this again and again. 

Rovner: Yeah, I’m wondering sort of the political benefit for Paxton of going after the American Academy of Pediatrics, but we shall see. All right, speaking of politics, the Centers for Disease Control and Prevention got a new director this week — at least according to its website; I have not seen that she’s actually been sworn in — a year after its old director was ousted for refusing to rubber-stamp Secretary Kennedy’s handpicked vaccine advisers’ recommendations. Erica Schwartz, a former deputy surgeon general, told the Senate HELP [Health, Education, Labor, and Pensions] Committee during her confirmation hearings that she supports the vaccine schedule and would “never betray the science.” She’s about to get tested on that, isn’t she? 

Raman: I think it was a really interesting choice they didn’t swear her in before they held that event and bring her out there. You know, we did have [Jay] Bhattacharya as the acting official, but they could have easily brought her in there to speak on that, and they didn’t. I think that was a conscious decision. 

Goldman: I was just going to say they waited until she got confirmed. 

Rovner: I would say she got confirmed last week, and the event was on Monday, so they could have sworn her in in time for the event. 

Goldman: Right, they did the event after they confirmed her, but before they swore her in. 

Rovner: Right. 

Goldman: To shore up support in the Senate. 

Rovner: Fair point. Yes, rather than rub it in [Sen. Bill] Cassidy’s face right before he voted to confirm her; that is an excellent point in terms of the timing. Well, meanwhile, things at the CDC are still apparently not great. It’s been almost exactly a year, not just since the last director was ousted, but since a gunman literally shot up the building, killing a security officer because the gunman’s father said he believed that the covid vaccine had made him suicidal. Secretary Kennedy went to visit the CDC campus in Atlanta for a memorial for the officer last week and held a fireside chat with CDC staff, who were, shall we say, not very impressed with his fireside manner. Among other things, according to a transcript of the meeting, he repeated that scientists are not trustworthy. All this comes at a time when CDC is fighting an Ebola outbreak in Africa, several foodborne outbreaks here in the U.S., and the aforementioned spike in vaccine-preventable diseases. It’s not a great time for the CDC, is it? 

Goldman: It’s really not. And there’s a this week by an anonymous CDC staffer that sort of outlines all of the different things that, you know, I’ve even forgotten the CDC has gone through in the last year — thinking about Ebola and funding cuts and just, this person said, that they can still see damage from the bullet holes when they’re sitting in their office it hasn’t been fixed. And you really have to feel for these workers that are trying to do their best but not being given the resources or support to do it. 

Rovner: Yeah, and I will say, you know, after decades of covering the CDC, the people who work for CDC are, you know, among the most mission-driven people in healthcare. I mean, they toil in sort of the, you know, most difficult parts of the healthcare system and are, like, constantly fighting uphill battles and not getting a lot of support, I would suggest, from the current administration. Well, meanwhile, the never-ending Medicaid news keeps on coming. This week, the Trump administration issued final rules banning certain gender-affirming care for minors. Now, this is separate from its rules for hospitals, right, Sandhya? You wrote about this, yes? 

Raman: Yeah. So the rule this time is related to Medicaid for under 18, and for states that also fund the CHIP [Children’s Health Insurance Program], under 19 they would also have to comply with this rule. And kind of what struck me was that we, you know, just on this podcast, I think, maybe a month or so ago there was this, you know, is the administration going to pull this back or not? And there had been reporting saying that they were, and then HHS said, Yes, we are still going ahead with this rule. So indeed, they did. I think this is part of the broader framework, like you said, of different things related to them wanting to emphasize biological sex in their various rulemaking. 

Goldman: Yeah, I think an important distinction about this particular policy is that it strips federal funding, federal Medicaid funding, from states to cover gender-affirming care for minors. So states can still use their own state dollars if they choose to. Private insurance can still cover this, no problem. This is not a ban on gender-affirming care, but it will certainly make things more difficult for children on Medicaid who need this care, want this care. And, especially as states are facing so many other cost pressures, it’s going to be hard to come up with money to patch this hole if they want to do that. 

Rovner: And, to be clear, we’re not talking about surgery here. I mean, we’re talking about all kinds of care, including counseling, right? 

Goldman: Counseling actually is not included in this one. 

Rovner: Oh, OK. 

Goldman: They can still use federal Medicaid funding to cover counseling. 

Rovner: But not other forms of nonsurgical gender-affirming care. 

Goldman: Yes, hormone therapy, puberty blockers, exactly, which are recommended for kids with gender dysphoria by most major medical associations. 

Rovner: Including the aforementioned American Academy of Pediatrics. All right, next in the Medicaid realm: those work requirements that begin next January. We’ve talked at some length about how the federal government is going to give people an extra year to self-attest that they are too sick to work before they have to get proof from a medical professional. But points out that some states aren’t taking that option. Eight Republican-dominated states, including Arkansas, Idaho, Ohio, and Indiana, are declining that grace period and making their work rules even stricter than the administration is otherwise requiring. What’s the likely impact of this? That in January they’re going to have to start proving immediately that they’re either too sick to work or they could lose their Medicaid. 

Edney: Well, I think the, usually, at least the point of doing a rollout, I guess, is giving states time to figure it all out and giving people time to understand what they need to do. So those states are choosing not to do that. So it seems like this could create a lot more chaos than even was anticipated in the first place, and maybe potentially a lot more people coming off the rolls than when maybe they shouldn’t have been, just because of paperwork errors or misunderstandings and things like that. 

Rovner: And much like pediatricians who are worried about having to break up vaccine appointments into multiple appointments, doctors are kind of freaked out about having to see all these patients so they can, you know, write them notes to excuse them from the work requirements, which is another burden that I don’t know that Congress really fully accepted when it was deciding, and the administration was deciding, how to implement these work rules. 

Edney: You know, that’s not something they normally do assess, whether someone can go back to work. So I’m sure they would probably prefer not to be doing that, but if they, you know, without the time and the ability to figure this out, it could be even tougher, and people will be trying to rush to get in there to get this done. 

Rovner: Well, I guess we’ll be watching these as “the early states,” when this all begins. All right, we’re going to take a quick break. We’ll be right back. 

So, the vaccine executive order from the president very much overshadowed what I think HHS Secretary Kennedy had hoped would be the big HHS story this week: the unveiling of proposed new standards for food additives that have been deemed “generally recognized as safe,” or GRAS. The rules, which have been a long time coming, as in several administrations long, wouldn’t so much make it harder for companies to use food additives like thickeners and stabilizers that are often seen in highly processed foods, but it would require companies to tell the FDA how it’s using those substances. And it stops well short of what former Republican FDA commissioner David Kessler had been urging in a citizen petition, that he filed more than a year ago, that would have made companies actually prove that those products are safe before they can put them in the food supply. Why are these rules so timid? Isn’t, you know, making the food supply safer Kennedy’s, one of his biggest MAHA [Make America Healthy Again] goals? 

Edney: It seemed to me that the way the FDA put it was that they needed Congress basically to step in to boost their ability maybe to do more. Sometimes that’s an excuse not to do more. Sometimes it really is true that they could really open themselves up to challenges from Big Food and court challenges that they don’t want to fight. And so they do the thing that they think they’re able to, and then tell Congress, you know, we need you to go the rest of the way. 

Rovner: Interesting, because they don’t seem to be afraid of court challenges or, you know, stepping on Congress’ toes on lots of other things. I mean, is this really just emblematic of the power of Big Food? I mean, we’ve already seen, you know, Kennedy be sort of squashed by the power of Big Pesticide. 

Edney: Yeah, I think that that’s absolutely the case — that Big Food, you know, they put their lobbying to work, and they talked about how this could stop them from being able to innovate and being able to get newer things into our food, and that basically we should trust them — what they’re putting in there is safe. And so that has had some sway. Particularly, there have been a lot of industries that have been able to go to the White House and make those cases and kind of water down things that RFK or, like you said, former FDA commissioner [Marty] Makary had said they were going to do. 

Goldman: I’ve also seen some statements from, quote-unquote, “Big Food” lobbying groups arguing that this is an affordability issue. You know, if they have to comply with all these extra rules and regulations and pre-market reviews, that could tank the president’s affordability agenda, is something that I saw. 

Rovner: I would say we’re all still waiting for the new definition of highly processed food, so we will see what that ends up. On another subject regulated by HHS, Secretary Kennedy also announced major action to start the process of decertifying the organ procurement organization that coordinates organ transplants for the region that includes Kentucky and parts of Indiana, Ohio, and West Virginia. OPOs are the go-betweens between medical professionals who care for patients who become organ donors and those who care for the transplant recipients. There’s been a lot of attention to some pretty big failings in the organ transplant network over the past couple of years. This case cites instances where potential donors were not yet dead. That’s a big problem. But you have to wonder if the public is going to wonder whether dramatic action like this is warranted because the OPO really is deficient, or whether it’s political, since we’ve seen this administration going after some states and some organizations for what they say is fraud that looks like it might more be about electoral politics. 

Raman: I think this is a little different. With this organization, Network for Hope, we’ve had a lot of action over the past year or so on this organization in general. We had congressional hearings about it. We had letters from lawmakers with concerns about this, and it’s not the first time that they’ve moved to decertify. You know, there was a division of University of Miami Health System that they decertified last year. Again, documented problems about this, and even if you listen to some of the statements from Democratic lawmakers, they are not against this. I think that, you know, it’s a recognized problem across political lines, which is a little different than some of the issues where fraud is being, you know, viewed more through one lens than another. 

Rovner: There is a point at which HHS is supposed to regulate organizations. I mean … when they find evidence of an organization not doing what it’s supposed to, they’re supposed to take action. That’s kind of how the government works. Sorry. 

Edney: You know, The New York Times has done a lot of great reporting on the organ procurement system and showing many, many flaws. But I think for this one, specifically, when I read about what made HHS look into it, it is shocking and a little scary. So I do understand. You know, what happened was there was a man who overdosed and he wasn’t quite dead, but they were starting the procurement process, and he was waking up. And it just seemed like they kept going on this a little too far. He survived; they didn’t get any organs out of him. But if you sign that form that says you’re an organ donor, it’s not something you want to think about: If something happens to you and you’re not quite dead, that they might decide to go ahead. And then HHS did find that this had happened on many occasions. So I think that it seems like something that the government should have stepped in on. 

Rovner: Yeah, there were some pretty serious deficiencies here. All right, well that is this week’s news, or at least as much as we could get to. Now we’ll play my “Bill of the Month” interview with Paula Andalo, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague Paula Andalo, who reported and wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” Hi, Paula. 

Paula Andalo: Hi. How are you? 

Rovner: So this month’s patient is kind of a success story, right? Someone with a nonemergency condition and no health insurance who was nonetheless able to shop around for the best price? Tell us who he is, where he lives, and what kind of care he needed. 

Andalo: Yeah, his name is Ronmel Rangel, and he’s from Venezuela. He moved to the U.S. in 2019 to live with one of [his] daughters that live[s] in Portland, Maine, and he has been living there since. 

Rovner: And then he got sick and needed …  

Andalo: So it was interesting because 25 years ago he had an inguinal hernia and he had surgery in Venezuela. And at the end of last year, he began to feel a pain on the other side of the body. Again, it was a hernia, so he needed surgery. 

Rovner: So he’d been through this before. 

Andalo: Yeah, yeah, in a different health system. So he doesn’t have insurance, although he’s a green-card holder, so he can have insurance. But when he moved here — now he’s 64, so it was six, seven years ago — and he was looking around, you know, the Obamacare and all the stuff. But he realized that for his age, the prices were crazy. He’s a pretty healthy person, so he decided to not have insurance. Instead, he began to see a doctor in a concierge medicine. You know these kind of practices that charge as little as $70 per month to unlimited visits and some small procedures like stitches or …  

Rovner: But not hernia repair. 

Andalo: Not hernia. So at that moment he needed surgery. 

Rovner: Right. So he did the medical tourism thing, looking both here in the U.S. and in some other countries, where he had family that he could stay with. And, a bit surprisingly to me, at least, he found the best price here in the U.S.? 

Andalo: Yeah, it was like a miracle. Yeah, he looked in Oklahoma, but it was far away. Also, he has a daughter living in Santiago, in Chile, and he looked there, and it was very expensive, adding also the cost of traveling to Chile. So, he finally found his place in Maryland. In Rockville, Maryland, in a place called Affordable Surgery Center. He had his procedure in April. 

Rovner: And how much did he end up paying — I guess both for the travel and for the hernia repair? 

Andalo: Well, the first estimate that he had was in his state in a big health system, and at that moment the estimate was $23,000 for a laparoscopic procedure. In this center in Maryland, the total cost, including anesthesia, was $2,900. 

Rovner: Wow. 

Andalo: So, adding the cost of tickets for him and his wife and one night of hotel, etc., it was less than $5,000. 

Rovner: Wow. So that’s a whole lot less, even than he could have gotten at home in Maine. 

Andalo: Yeah, exactly. 

Rovner: So what’s the takeaway here, other than that medical tourism doesn’t have to mean a trip to another country to find the most cost-effective care? 

Andalo: Well, the takeaway is that you can shop around, especially if you have an elective procedure, so you have time. Because if you have an emergency, you don’t have time. But with these kinds of procedures that are pretty common, and there are different options to do it, you can shop around and look for the best place. He had the help of his family doctor — that was very helpful, you know, helping him with lists of places. But he has had time to shop around, to look for prices, and to take care of his hernia. 

Rovner: And I guess it’s important to remember that the most expensive isn’t always the best, but the cheapest also isn’t always the best. 

Andalo: Exactly. So one advice is, the expert says, that you need to look at the reviews of the place and do your homework to realize that if it’s a good place. Although the research says that sometimes higher prices doesn’t mean better care, but in these kinds of procedures, you can pay much less if you shop around. 

Rovner: Well, nice to have a happy ending for a change. Paula Andalo, thank you so much. 

Andalo: Thank you. 

Rovner: OK, we’re back. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Maya, why don’t you go first this week? 

Goldman: Sure. My extra credit this week is an article titled “.” This one is in The New York Times by Mark Arsenault. I am a University of Michigan alum, just like Julie, and so this one caught my eye. But it’s also very interesting to hear what, you know, universities are taking student mental health seriously to the point where they’re making big policy changes or, at least in this case, piloting policy changes to try to get at the root of the problem. I have my own skepticism that this is, you know, the root of the problem. Academic pressures are certainly a big stressor for students adjusting to college, and so maybe this could help. But I think that this is a multifaceted problem, and I’m interested to see how they’re going to measure the success of this. But this isn’t the first university to have done it. There are a couple others: MIT, Brown. The University of Michigan is a massive school with a lot more students, though, so I think it’ll be interesting to see if other schools of that ilk follow suit. 

Rovner: I would just point out that I went to the University of Michigan in the 1970s, and even then we could take classes pass/fail if we wanted to. It’s not really all that new. But yes, I’ve seen a lot of rolled eyes this week about this story. Anna, why don’t you go next? 

Edney: Mine is from CBS News by Julia Ingram: “.” I thought it was a smart thing to look at, that this farm had not been inspected since 2019. And not just that, but that the FDA has been really lagging on all of their foreign food safety inspections, not even meeting 10% of the goal that Congress had set for them about a decade ago. And I thought that was just a great way to get into this story and talk about inspections and how the FDA is struggling. They’ve struggled for a while to meet these kinds of mandates, but showing how it’s now gotten even worse since there have been lots of cuts within the agency. 

Rovner: Yep, that we’ve been talking about, and these are the result of those cuts. Sandhya. 

Raman: My pick this week comes from NOTUS, and it’s from Margaret Manto, and it’s called “.” I am from West Virginia, so was a reason why I was really intrigued by reading this story. But it’s really good. It looks at the work of a pediatrician in the small town of Summersville, and West Virginia has some of the highest childhood vaccine rates in the U.S. And the county where Summersville is has some really high rates compared to some of the more populous counties that are around it. This is a county that voted three times for President Trump. And just looking a lot at the changing climate regarding, you know, vaccination and attitudes there, and, you know, rural health more broadly. 

Rovner: It’s a really good story. Well, my extra credit this week is from the journal Health Affairs by my soon-to-be boss here at KFF, Mollyann Brodie. It’s a to one of her, and my, health policy heroes, Bob Blendon, the Harvard health policy professor who passed away earlier this summer. Molly was lucky enough to have studied under Bob, which I never got to do. But I still feel like one of his students, as he was always so generous with his time and so very quotable, and contributed so much to my personal understanding of the intersection of health policy and politics, which I try to share with all of you every week. We miss Bob already. May his memory be a blessing, and may he live on in those that he taught. 

All right, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , or on Bluesky . Where are you guys hanging these days? Maya? 

Goldman: I’m mostly hanging out on under my name. 

Rovner: Anna? 

Edney: , , @annaedney. 

Rovner: Sandhya. 

Raman: I’m on and on @SandhyaWrites. 

Rovner: We’ll be back in your feed next week. Until then, be healthy. 

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Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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]]> 2272643 Readers Speak Out on Work Requirements, Federal Data Grab, Opioid Payback Cash /letter-to-the-editor/readers-work-requirements-federal-data-grab-opioid-payback-cash-prior-authorization-august-2026/ Thu, 13 Aug 2026 09:00:00 +0000 /?p=2270816&preview=true&preview_id=2270816 Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Work Requirements Unfairly Burden Medicaid Applicants

Great story (“A Deloitte-Run System Denied Medicaid Benefits for Michigan’s Disabled. Now Trump’s Law Piles On,” July 21). However, a key point was missed. The wrongly denied recipients have the burden of proving their entitlement. This can cost thousands. They have no money with which to finance the carrying of that burden of proof. Additionally, how does one prove that they cannot do any work? Doctors generally say: I will just provide their work restrictions (e.g., 10-pound lifting restrictions), but I’m not a vocational expert, so I’m not going to opine on “employability” or “non-employability.” Moreover, it takes many months to go through reconsiderations and appeals, so even if the worker wins, they will have lost everything by then. Finally, under the doctrine of “exhaustion of remedies,” the recipient must suffer through the administrative steps before asking a court to help. And even then, the court will defer to the administrative agencies’ findings of fact (i.e., the department’s hired doctor over the treating doctor).

Bottom line: Once there is an incorrect/wrongful denial, it is an unjust horror show that literally destroys lives — all because far-right politicians have stereotyped Medicaid recipients, painting them all as presumptively people who could work but would rather just unjustly receive benefits — a totally false and ignorant paradigm. A partial solution would include placing the burden of proof on the state to prove the recipient can work and that suitable work is available, and to enact a presumption that when a treating doctor has credibly explained a substantial disability, the department must presume qualification absent clear and convincing proof to the contrary.

— N. Dean Nasser Jr.; Sioux Falls, South Dakota

A Reckless Data Grab?

The Office of Personnel Management has already suffered massive data breaches affecting millions of employees and their families.

I am a retired federal civil servant and one of the many whose data was .

The (“Trump’s Personnel Agency Says It Will Remove Some Identifying Info as It Sweeps Up Medical Records,” July 22) raise the question of how the requested massive dump of health data any better than the personnel records previously affected.

— Kathryn Edgecomb; Vancouver, Washington

States Need More Than Money To Fight the Opioid Crisis

New Mexico offers a compelling case study in the national conversation about opioid settlement accountability (“Leadership Vacuum: Agencies in New York and Beyond Pass the Buck on Opioid Cash Oversight,” July 21). While much of the public attention has focused on whether settlement dollars are being misspent, the New Mexico Office of the State Auditor’s review of local governments found a different problem: Large amounts of opioid remediation funding remain unspent years after settlements were reached and funds were distributed. The state auditor’s transparency review identified more than $100 million in opioid settlement funds held by local governments, with many entities reporting little or no expenditures as of fiscal year 2025.

That outcome does not point to widespread misuse. Instead, some local officials repeatedly cited workforce shortages, provider capacity constraints, procurement hurdles, and long-term sustainability concerns as barriers to moving dollars into prevention, treatment, and recovery programs.

While these barriers are significant, New Mexico has built structures that may be worth watching. A state law established dedicated opioid settlement funds and a framework intended to ensure resources are used for opioid remediation purposes. State agencies, local governments, behavioral health providers, and policymakers are now working through how best to coordinate spending, measure outcomes, and communicate progress to the public. The New Mexico Office of the State Auditor will continue to provide transparency, reporting on who is spending, what is producing results, and where bottlenecks exist.

The lesson for other states is clear: Securing settlement dollars creates an unprecedented opportunity to remediate harms resulting from the opioid crisis, but it is only the first step. States also need the workforce, infrastructure, and coordination to turn that money into treatment, recovery services, prevention programs, and fewer overdose deaths.

The core question is no longer just where the money is. It is whether states have built the systems to translate settlement dollars into measurable public health gains.

— New Mexico State Auditor Joseph Maestas; Santa Fe, New Mexico

Progress on the Prior Authorization Front

Health plans continue to make steady progress implementing the to simplify prior authorization. The article “Insurers Hedge on Trump-Backed Pledge To Improve Denials Process” (July 17) paints an incomplete picture of this ongoing work, particularly related to supporting for patients and for prior authorization requests.

Participating health plans committed to implementing aimed at reducing administrative burden and accelerating access to care on a transparent timeline, and that work is on track. In April 2026, participating health plans announced and a for submitting electronic prior authorization requests for most medical services starting in 2027.

Health plans will continue adopting common data standards on a rolling basis as the standardization commitment is fully implemented, starting in 2027. As more providers move away from manual, error-prone processes and adopt electronic prior authorization, this standardized approach will mean faster answers, a more consistent experience, and less friction for everyone.

in place to support member transitions between insurers during an active course of treatment. Under the voluntary commitments, when a patient with an approved authorization for in-network care switches health plans, the previous plan’s authorization is honored for 90 days. Health plans can implement several data exchange options to support patient transitions, and plans are not required to use a specific method to meet the commitment.

The series of voluntary commitments made by the industry requires substantial work, meaningful investment, and strong partnerships. Health plans are making steady progress in meeting these commitments and will continue to do so until they are fulfilled.

— Mike Tuffin; AHIP president and CEO; Washington, D.C.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

]]> 2270816 People With Disabilities Say Medicaid’s Limits on Income Stifle Career Advancement /insurance/medicaid-disabled-work-requirements-income-limits-iowa/ Thu, 13 Aug 2026 09:00:00 +0000 /?p=2269888 MACY, Neb. — Erica Carter is passionate about her job, and she has seven acres of flowers and vegetables to show for it.

Carter’s specialty is reeling in grants to support students in the Omaha Nation school district, where she is a finance manager. One paid for the garden that sits next to the district’s campus. Another allowed the school system, in one of Nebraska’s lowest-income counties, to pay students to maintain it.

“They’re out in the sun. They’re watering plants,” she said. “It’s the first time they get a paycheck in their life.”

Carter, 41, is paralyzed from the chest down, an injury she’s lived with since a fall in her early 20s. It didn’t slow her down as she built her accounting career and got a master’s degree in human resource management.

But in November 2023, Carter — who lives in Sioux City, Iowa — got a letter from Iowa’s Department of Health and Human Services. It said that her income was too high for her to stay on Medicaid and that she might lose her benefits in two weeks if she didn’t take action.

States are scrambling to get ready for a new federal requirement to double-check that many people on Medicaid qualify for the benefit, by showing they are working, volunteering, or studying at least 80 hours per month. Politicians’ focus on requiring work has angered many people with disabilities who have Medicaid and say current policies that apply to them have the opposite effect — making them choose between working or receiving benefits.

‘I Have No Options’

When Carter got the letter, she was making $110,000 a year, well above Iowa’s 2023 income limit for working people with disabilities: $36,450 for a household of one.

“I had no time at all to prepare,” she said. “I had a decision to make.”

At the time, Carter got her health coverage through Iowa’s , a buy-in program that allows working disabled Iowans to pay part of their income to the state to maintain access to Medicaid benefits. Forty-seven states offer , but eligibility through limits on income and assets.

For years, disability rights advocates have pushed state legislatures to change the limits, arguing they prevent people like Carter from accepting raises or building savings, for fear of losing crucial medical benefits. Massachusetts, Minnesota, New Jersey, and Rhode Island have eliminated such limits over the past five years.

To keep her Medicaid coverage, Carter would’ve had to find a job paying her far less than she was making. Or she could drop her Medicaid coverage and enroll in the school district’s health plan. But that plan didn’t cover many of the disability-related expenses that Medicaid did.

Carter decided to keep her job and leave the Medicaid buy-in program. In the end, the decision felt like a no-brainer, she said.

“I like getting up and going to work every day, and I really like what I do,” she said. “Why would I throw that away?”

Erica Carter in her wheelchair seated next to a playground.
Carter says she has helped write grants for projects such as a student-run garden and a new playground for the Omaha Nation public school district in Nebraska. She chose to give up her Medicaid coverage rather than quit her job as a district finance manager when her income surpassed the cap allowed for beneficiaries in an Iowa program for workers with disabilities. (Natalie Krebs/Iowa Public Radio)

But it’s been hard on her finances. Carter said she now spends about $35,000 a year out-of-pocket for expenses her old plan covered, such as the nurse who visits her three times a week, modifications to her car, and wheelchair repairs.

“I had the motors go out on my wheelchair,” she said. “So that was like $4,000 to fix.”

Over the next year, Carter picked up extra jobs and cashed in some of her retirement savings.

“I want to pay my own way. I don’t mind paying taxes,” she said. She doesn’t want to hide her income, either. “I just want an option,” she said. “I have no options right now.”

A Program Intended To Encourage Work

Congress to create Medicaid buy-in programs in the 1990s, intending to incentivize more people with disabilities to work. Iowa was one of the first states to adopt the program.

According to state data, 11,640 Iowans were participating in the buy-in program as of late January, or 1.7% of all Medicaid recipients in Iowa.

The income caps have inched up since Carter got her letter. , set at 250% of the federal poverty level, is $39,900 for a household of one this year.

The rules also restrict recipients from accumulating too much in assets. The is $12,000 for an individual or $24,000 for a married couple, excluding some assets, such as a primary home or vehicle.

Carlyn Crowe, the public policy manager at the , said the limits can prevent disabled Iowans from reaching their goals. “Work full-time and be able to buy a house, live in the community, buy a car,” she said. “Those limits placed on what they can earn and save are keeping them from doing that.”

Crowe’s organization, which has counterparts in every state, is and advocates for people with disabilities. In Iowa, such advocates have asked legislators to drop the hard limits on income and assets. Instead, they suggest that disabled Iowans pay 6% of their income to buy into the Medicaid program, an approach modeled after a 2024 that created a Medicaid buy-in program with no income and asset limits. (Tennessee is waiting on federal approval before starting its program.)

In recent years, these efforts have built bipartisan support and gained traction. An Iowa House committee unanimously in 2025 to remove the income and asset caps, but the bill died after failing to move forward during this spring’s legislative session.

State legislatures now in Medicaid spending estimated at more than $900 billion over 10 years, as part of the One Big Beautiful Bill Act.

, an associate director of KFF’s Program on Medicaid and the Uninsured, said the specific worry is that buy-in programs, though they’re a small part of the larger Medicaid system, could increase overall Medicaid spending if eligibility changes.

“The premiums charged in buy-in programs are nowhere near close to the expected costs of covering people,” Burns said. (KFF is a health policy research, polling, and news organization that includes Ñî¹óåú´«Ã½Ò•îl Health News.)

Focusing on initial cost increases is myopic, said , the director of disability policy at at Iowa’s Drake University. More workers mean additional income tax revenue for states. It also enables some people with disabilities to earn enough to transition off other government assistance programs, such as the Supplemental Nutrition Assistance Program.

“Three, five, seven years from now, you may be recouping those expenses by having people be able to work their way off,” Van Sant said.

Falling Through the Cracks

Iowa lawmakers tried a more modest adjustment during this year’s legislative session. Instead of removing the income limit entirely, they introduced legislation that would raise the cap to 300% of the federal poverty level and exempt pension accounts and a spouse’s income, among other things, from the asset cap.

In the end, the provision was stripped from a wide-ranging public assistance bill. If it had passed, the new income limit would have been one of the for a buy-in program, according to KFF.

, a former City Council member in Sioux City who was paralyzed from the chest down after a diving accident, told state lawmakers during a hearing in February that the proposal was a step in the right direction, but not enough.

“I fear that we’re going to lose people to other states,” said Watters, who added that he was considering moving to Minnesota, which never had an income cap and eliminated asset caps for its in 2024.

Even if Iowa had raised its income limit, Carter would still have been ineligible.

Carter remains committed to her primary job at the school district. She plans to keep working there and taking on additional jobs, seven days a week, so she can pay for her medical needs and continue helping students.

Erica Carter is seen next to the cafeteria in a school building.
Carter makes her way through the cafeteria at the Omaha Nation Public Schools campus, where she works as a finance manager. (Natalie Krebs/Iowa Public Radio)

This article is from a partnership that includes , , and .

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

]]> 2269888 Hospital Prepayment Requirements Add New Wrinkles to Patients’ Financial Responsibility /health-care-costs/hospital-prepayment-requirements-upfront-patient-insurance-deductible/ Wed, 12 Aug 2026 09:00:00 +0000 /?p=2270427 Thomas Zordani flew from his home in Denver to Phoenix for a consultation with a Mayo Clinic neurosurgeon, hoping to find out what could be done to treat his debilitating headaches after worrisome brain scan findings.

When making the appointment, Zordani said, he’d been told the clinic was in his insurer’s network. Upon arrival, Zordani was summoned to the clinic’s financial office and told he had to make a $5,000 preservice deposit, because Mayo had since determined it did not accept his insurance. He was automatically designated “self-pay,” even though his plan had out-of-network benefits.

Not having that kind of cash on hand — and angry on principle — he refused. His appointment was canceled.

“I was so livid,” Zordani said, recalling that day in early April 2024. He later learned that Mayo had sent a message to him in his insurance carrier’s patient portal shortly before his visit with an estimate of the cost: $565, not the larger amount it later demanded.

Traditionally, patients usually receive bills for their share only after getting treatment. But what Zordani faced is becoming increasingly common — hospitals or other medical providers seeking prepayments.

“We regret that this individual’s experience did not meet the high standard of communication we strive to provide when helping our patients understand their insurance coverage and financial responsibility,” Andrea Kalmanovitz, Mayo’s communications director, said in an emailed statement. “When prospective patients don’t have clarity that Mayo Clinic is not in-network with their health plan, unexpected pre-service deposit requests may result.”

says it requires prepayments in a variety of cases, including for “noncontracted” — also known as out-of-network — insurance plans.

The trend of hospitals asking for money up front represents a double whammy for patients.

Medical providers are collecting larger shares of what patients might owe at a time when rising deductibles mean patients are owing more for care. The preservice charge could be all or part of a remaining deductible, for example, or a sizable percentage of what the visit or treatment might cost. Those deductibles go up when hospital prices, drug costs, and labor expenses increase, as insurers try to slow premium growth by shifting more costs to patients.

People are “basically being asked to self-insure,” said Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an organization for finance professionals.

As that happens, hospitals figure more patients will have trouble meeting those deductibles, so they want to get as much up front as possible.

“Things like preservice deposits and those kinds of moves are probably going to become more and more likely,” said Chip Kahn, a visiting senior fellow at KFF and the American Enterprise Institute and former president and CEO of the Federation of American Hospitals. “That will make it harder on the provider, the clinician, and harder on the patients.”

The deposits can’t be viewed in isolation, Gundling said: It’s a bigger issue than just hospitals asking for money up front. The challenge, he said, is: “How do we maintain access to care when more patients can’t absorb the level of out-of-pocket costs?”

Already, consumers are increasingly worried about paying for healthcare. A recent found that lower out-of-pocket costs ranked as the top change insured adults would like to see from their coverage plans. KFF is a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.

The average deductible in family coverage offered by employers is $3,762 per person, , while the average deductible in Affordable Care Act plans to a similar amount, $3,786.

A Consumer Concern

, a health insurance consumer assistance program in New York state, hears from people who are concerned about prepayments, said Diane Spicer, a supervising attorney.

“We see this mostly with insured folks who are seeking out-of-network care but who have out-of-network coverage,” Spicer said, “and also sometimes for care that is not covered.”

Just how many hospitals collect what are often called point-of-service payments is not known, according to Kodiak Solutions, a technology company that provides services to health systems to help manage their revenue.

“But it is becoming more and more the center of many of our conversations with health systems,” said , a vice president leading Kodiak’s revenue cycle intelligence team.

In addition to Mayo, Baltimore-based says that “it is our policy to collect all amounts owed before services are rendered” for non-emergency care. University of Texas-affiliated in Houston, one of the nation’s premier cancer treatment centers, says patients who pay for their own care “will be asked to pay an initial deposit determined by the care center, based on the type of cancer.”

On average, hospitals collect about a quarter of what they expect the patient will owe, Szaflarski said, based on what they estimate the insurer will pay — a percentage that has grown in recent years.

For example, if a person is coming in for imaging and the insurer will reimburse $1,000 for that scan, the hospital will seek $250 from the patient up front, he said. “That used to be closer to $150.”

It also varies by hospital, and sometimes by state.

“The state of Indiana has some of the lowest cash collections in the country. They are Midwest nice,” Szaflarski said. He added that California and Texas are among those that collect more.

Even as hospitals increasingly collect more upfront payments, however, their uncollected debt is also rising, according to data Kodiak collected from more than 2,300 hospitals nationwide.

said that’s because of a “fundamental shift” in coverage as plans “increasingly feature higher deductibles, greater coinsurance, and more complex cost-sharing structures: all elements that increase the nominal patient responsibility without improving—and often reducing—the probability of collection.”

While many hospitals are doing fine, some, especially in rural areas, have thin margins — and things could soon tighten further as cuts to ACA and Medicaid funding lead to more people being uninsured.

As a result, hospitals “have to be concerned” about every cost-sharing dollar, Kahn said.

After Zordani returned to Denver, he said, it took a while to find another specialist. He eventually had a procedure in late June 2024, at a Denver hospital not affiliated with Mayo, to fix a .

The following fall, he filed a in Arizona civil court. He was awarded $47,500 in economic damages and attorney fees after an arbitrator in September 2025 determined Mayo violated a state consumer fraud law because it failed to reach him to say that his plan was not in-network before he traveled. Mayo’s statement to Ñî¹óåú´«Ã½Ò•îl Health News did not include any reference to the settlement.

“Had they notified me in timely fashion as required, I would not have flown there,” Zordani said. He’s still angry that the clinic didn’t ask his permission before designating his care as self-pay, which meant he wasn’t going to use his insurance, and he’s still unclear on how they calculated the $5,000 preservice amount.

When Do Consumers Have to Make Preservice Payments?

There is one clear rule: In emergency situations, hospitals that accept federal Medicare financing cannot, , demand upfront payment before stabilizing a patient who arrives at an ER, said , a senior fellow and health policy researcher at the Brookings Institution.

Other consumer protections are less clear.

Patients who get in-network care may have some recourse in their contracts with their insurers, so they should check the fine print, experts told Ñî¹óåú´«Ã½Ò•îl Health News.

“In out-of-network settings, I’m not aware of any barriers that would prevent a provider from doing this,” Fiedler said of preservice deposits.

How those amounts are calculated also appears widely up to the provider and can be opaque.

“They could just say $1,500 and you’d be like, ‘Oh, is that 10%, or is that how much is left on my deductible?’” said , senior director of healthcare campaigns at PIRG, a national federation of independent consumer advocacy groups.

Yet, she added, the patient might be scheduling three months in advance, so the provider wouldn’t know how much was left on the deductible. She recommends consumers ask for an itemized bill and call their insurer to find out whether it has rules regarding the charges.

Also unclear are how and when patients get their money back if they overpay.

Overpayments can happen if patients don’t require the services originally estimated or when insurers pay other bills first, such as the anesthesiology cost or a surgeon’s fees. If those payments are counted toward a patient’s deductible, yet the patient had already made a prepayment to the hospital for the expected deductible, to the hospital.

How soon they get their money back can vary and can depend on state laws, though a small number of states directly address the issue. As of this year, medical providers to reimburse patients within 30 days of a determination of an overpayment. Some states, including Maryland, prohibit certain hospitals from requiring prepayment simply to avoid offering financial assistance.

After alleging that some patients had to wait more than a year to get reimbursed, Arizona Attorney General Kris Mayes recently under state consumer protection laws against SimonMed Imaging, which has 170 locations in 10 states.

, SimonMed agreed to issue refunds within an average of 60 days.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

]]> 2270427 The Return of ‘Medicare for All’ /podcast/what-the-health-458-michigan-el-sayed-midterms-medicare-for-all-august-6-2026/ Thu, 06 Aug 2026 19:23:58 +0000 /?p=2269812&post_type=podcast&preview_id=2269812 The Host
Julie Rovner photo
Julie Rovner Ñî¹óåú´«Ã½Ò•îl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of Ñî¹óåú´«Ã½Ò•îl Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

Democratic primary voters in Michigan chose former Detroit public health director Abdul El-Sayed as their Senate nominee this week. El-Sayed is one of several high-profile candidates around the country who have been pushing “Medicare for All,” again elevating the issue, at a time when millions of Americans are losing their health coverage because of high costs.

Meanwhile, the Senate this week confirmed Erica Schwartz to lead the Centers for Disease Control and Prevention, which has been without a permanent leader for almost a year. But it remains unclear whether her support for childhood vaccinations will run afoul of her boss, Health and Human Services Secretary Robert F. Kennedy Jr.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, Alice Miranda Ollstein of Politico, and Amanda Seitz of Ñî¹óåú´«Ã½Ò•îl Health News.

Panelists

Joanne Kenen photo
Joanne Kenen Johns Hopkins University and Politico
Alice Miranda Ollstein photo
Alice Miranda Ollstein Politico
Amanda Seitz photo
Amanda Seitz Ñî¹óåú´«Ã½Ò•îl Health News Read Amanda's stories.

Among the takeaways from this week’s episode:

  • El-Sayed’s primary victory in Michigan means a vocal supporter of Medicare for All will be on the ballot this fall. Progressives again are rallying behind universal healthcare as costs spike and more people lose their coverage — although there are few details so far to explain how they would implement such a policy.
  • New polling shows more people are experiencing “job lock” because of limited options to obtain healthcare coverage outside employer-sponsored insurance. Meanwhile, more hospitals are reporting a sharp rise in the number of uninsured and in the costs to cover them.
  • A federal judge recently declined to halt the implementation of Medicaid work requirements while considering a case brought by several states challenging the policy’s burden on sick people. And early reports out of Nebraska, the first state to implement the work requirements, show eligible people are losing coverage for administrative reasons.
  • Kennedy sat down for an interview with CNN, during which he could not articulate specific plans to address disease outbreaks — as multiple outbreaks are ongoing. And a Senate committee voted along party lines Thursday to hold former public health official Anthony Fauci in contempt of Congress over his appearance before the committee last week.

Also this week, as part of the “How Would You Fix It?” series, Rovner interviews Sen. Andy Kim (D-N.J.), who has a new bill that would provide universal health coverage for all children.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: The New York Times’ “,” by Sheryl Gay Stolberg.  

Alice Miranda Ollstein: NOTUS’ “,” by Margaret Manto.  

Joanne Kenen: The New York Times Magazine’s “,” by Helen Ouyang.  

Amanda Seitz: The Wall Street Journal’s “,” by Katherine Long.  

Also mentioned in this week’s podcast:

  • The Bulwark’s “,” by Jonathan Cohn.
  • The New York Times’ “,” by Reed Abelson.
  • Politico’s “” by Alice Miranda Ollstein and Josh Gerstein.
  • Underlying Conditions’ “,” by Céline Gounder.
Click to expand the transcript Transcript: The Return of ‘Medicare for All’

[Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.] 

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Aug. 6, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hi, everybody. 

Rovner: And my Ñî¹óåú´«Ã½Ò•îl Health News colleague Amanda Seitz. 

Amanda Seitz: Hi, great to be here. 

Rovner: Later in this episode, we’ll have excerpts of my “How Would You Fix It?” interview with New Jersey Democratic Sen. Andy Kim, who’s proposing universal coverage starting with all American children. But first, the freight train of health news continues. 

We’re going to start this week in Michigan with that very closely watched Senate primary to fill the seat being vacated by the retiring Democrat Gary Peters. We’ve known for months the Republican candidate will be former congressman Mike Rogers, who narrowly lost to Sen. Elissa Slotkin two years ago. And now we know he will face Abdul El-Sayed, an MD epidemiologist and former public health director of Detroit. El-Sayed, who ran on a platform emphasizing “Medicare for All” and has even written a book about it, narrowly defeated four-term Democratic congresswoman Haley Stevens, who had a gigantic cash advantage, mostly provided by supporters of Israel. Now, the fight over Israel in Gaza is for some other podcast to get into, but I do think that this underscores the increasing popularity of Medicare for All in the base of the Democratic Party. What does El-Sayed’s primary win tell us? And can someone from the more progressive wing of the Democratic Party win in a very purple state like Michigan? 

Ollstein: Well, I also want to point out, like, this isn’t an outlier. It was really notable to me that during the Maine rushed, redo primary they just had for the Democratic Senate candidate to take on Susan Collins, everyone in that race was endorsing Medicare for All and calling for it. And Maine is also a very purple state with an older electorate, and, you know, not raging progressive. And so I think it is notable that this isn’t just in the big blue cities anymore. This is a growing drumbeat within the party, and, you know, of course it comes as we’re seeing a lot of people lose their health insurance, which we’re going to talk about. We’re seeing costs go way up, and so there’s just this wellspring of frustration that I think is fueling some of this. 

Seitz: Oh, I was just going to say I would caution, though, how big of a win this is for progressive Democrats. You know, they’ve won the battle, and I’ll say it has built quite a strong coalition. But this was a really narrow primary win, and that is not the situation you want to be in when you have two diametrically opposed candidates from the same party running in a primary in a very purple state headed into the midterm elections. 

Rovner: Yeah, well, let us talk a little bit more about Medicare for All because it’s a trendy moniker for something that’s not really all that specific. Some people think it’s just shorthand for “everyone gets government-provided health insurance.” Some think it’s actually socialized medicine. And some think it’s literally just an extension of today’s Medicare program, which is itself a very public-private hybrid. My friend Jonathan Cohn over at The Bulwark, who happens to live in Michigan, has a  that I will link to about how consideration of Medicare for All looks different in 2026 than it did in 2016 or even in 2009, when they were doing the Affordable Care Act. Where do you guys think we are on Medicare for All? I would remind that what was in the 2020 campaign, every candidate, every Democratic running except for Joe Biden said they were for Medicare for All, and yet Joe Biden is the one that came out of the primaries. 

Kenen: I think Kamala Harris was for “Medicare for All Who Wanted It.” She had some strange hybrid of it, but that is part of our past. I mean, Medicare for All is something you hear about from the Democratic Party, a segment of the Democratic Party, in pretty much every election with more or less intensity. And more so [with] Bernie Sanders running against Hillary [Clinton], it was a much more pronounced debate. In Michigan, I don’t think this is the defining issue. I mean, I think that global politics in the Middle East, and given the demographics of Michigan, and what the race is focused on, and points of contention are, it’s pretty easy to talk about wanting everybody to be covered, and it’s a lot harder to get there, as we all know, because we’ve been talking about it for decades. So I think you’ll hear about it from Democrats â€” I’m not sure in Michigan and elsewhere, but I’m not sure how specific a plan or a definition it is, sort of this holy grail that nobody knows quite what it looks like. 

Ollstein: But that also makes sense. I mean, it’s not really in their interest to put out detailed policy plans that people can pick apart at this phase of things. And so it makes sense that we’re in the grand, sweeping, dreams phase of things, and not in the â€¦ 

Rovner: We’re in the slogan phase. 

Ollstein: Exactly, exactly right. Because, you know, as soon as Democrats put out an actual bill, a draft bill, then the vultures will descend and point out all the downsides, and that doesn’t help them heading into, you know, a major midterm election. So we imagine that work is going on behind the scenes, because they want to have something ready to go if and when they have control in Congress. But what exactly that is, we don’t know. 

Kenen: But I also think there’s pressure for the Democrats to be â€” in the best-case scenario, if you had a united Democratic Party where they all wanted Medicare for All and they all agreed on what that meant, you don’t press a button and get there. It would be some kind of incremental phase, and it’s not going to be, like, OK, today we have this and tomorrow we have Medicare for All. So I think, in the short term, less controversial and maybe more urgent is affordability and access right this minute. We are going to talk about the coverage decline and affordability and just access on a day-to-day … even if you are able to afford your care and even if you have pretty good insurance, getting into a doctor when you need to has become really frustrating. Even if you’re sick and already know that doctor. So even if you’re a pretty health-savvy consumer, the way all of us are, we see this in our friends and family, and we understand the system â€” sort of, like “the system” in quotes. So I mean, I think there’s the Medicare for All, you know, Democratic dream, and it â€” I don’t mean it’s not sincere; I mean, that’s what many people want â€” but I also think you’re going to see a lot more nuts and bolts: What has happened in the last two years, and how do we fix it? 

Rovner: I’m interested in the fact that Republicans who are already sort of ginning up their talking points against the, you know, wave of progressive candidates like El-Sayed, although he’s not as progressive as, you know, the [Zohran] Mamdanis and, you know, some of the other avowed socialists. They’re talking about socialism and communism, and they’re talking about all kinds of things. They don’t seem to be talking about healthcare, which suggests to me that Republicans are kind of aware that things are not going well, and that, Joanne, as you point out, I mean, you know, it used to be let’s see if we can fix the health system without messing up the people who are happy. There are fewer and fewer people who are happy right now with how the health system is falling apart. 

Kenen: Including the doctors, right?  

Rovner: Right. Oh, absolutely. 

Kenen: Nobody’s happy. 

Rovner: Well, well, let us move on to all of the ways in which the healthcare system is falling apart. Item one is a new Gallup-West Health poll that found nearly a quarter of workers surveyed said they were staying in a current job that they otherwise wanted to leave only to retain their health insurance. That was up 8 percentage points since the last time they’d asked in 2021. Now “job lock,” as this is called, is something that HIPAA was supposed to address back in 1996. The “P” in HIPAA stands for Portability. It was the Health Insurance Portability [and Accountability] Act. How is this still a thing 30 years later, that people feel stuck because they can’t change health insurance? 

Ollstein: This was also a big driving force behind the argument for Obamacare. The argument was: We’re going to free up all these people by creating this individual market, we’re going to unleash American ingenuity, and we’re going to have entrepreneurs and people starting their own businesses and experimenting and trying things that they wouldn’t feel able to do because they’re so afraid of â€¦  

Rovner: Shark Tank for All! 

Ollstein: â€¦ losing their health insurance. And so I think the way the Trump administration has targeted some key pieces of Obamacare, you know, they obviously, as we know, failed to get rid of the whole thing, but they are chipping away at the subsidies, which has caused a lot of people to drop their coverage; they’re going after the Medicaid expansion piece of Obamacare, and so I think that’s driving some of this return to, you know, clinging to the job you have in order to maintain your health insurance. Although, going back to the point that nobody’s happy, employer health insurance, while it may be better than a lot of the other options, is, you know, people aren’t thrilled either. The costs are still quite high for both employers and employees. 

Rovner: And employers are looking for ways to cut back. Go ahead, Joanne. 

Kenen: I was also wondering, as I read those numbers about job lock â€” and we should also remember, even though it wasn’t in that particular story, there’s also something called “marriage lock,” where people stay in marriages they don’t really want to be in because they wouldn’t have, they fear they wouldn’t have coverage. But one thing I just sort of wondered about is I wonder how many people realize that they might, in fact, qualify for the Affordable Care Act. I think people are still confused about the ACA, as well as they’re confused about a whole laundry list of things that we could spend a year talking about. People aren’t always paying attention, so some of the people who are afraid that if they change jobs or think they have to stay in their job think that Obamacare is for somebody else. So I don’t know. 

Rovner: They wrongly think they’re in job lock. 

Kenen: Right, right. So, but it still affects the behavior. If you feel that way â€” you’re anxious and insecure and unhappy â€” then you’re anxious, insecure, and unhappy. Whether you are aware of there’s an alternative or not, it doesn’t affect how you feel now, which is, you know, grumpy. That’s not the right word, but you know what I mean. 

Rovner: I know what you mean. 

Seitz: Yeah, well, and I think that that’s what I found fascinating, too, is like when we look back at 2022, there was a lot of head-scratching as to how Democrats performed so well in the midterm elections. But you look back at that time, and people â€”it was the peak of the Great Resignation â€” people were leaving their jobs. They were able to get big raises for the first time in a while. Unemployment was extremely low, so you had, like, an electorate that was pretty happy and didn’t have that anxiety. And now you’re staring down a situation where people are afraid to leave their jobs. They’re afraid to lose their health insurance, and the social safety net is deteriorating at the behest of the Trump administration. And I think that’s not a very good situation to have a lot of Americans in, as you head to a midterm election. 

Rovner: Well, item two: Several outlets, , reported last week that hospital systems are seeing what the Times’ Reed Abelson described as, quote, an “unexpectedly sharp rise in uninsured patients and the costs associated with treating them.” We are starting to hear this in earnings reports from for-profit chains and anecdotally from nonprofits. Now, this was something that we saw coming. People can no longer afford their ACA plans and drop them, or as they can no longer afford the premiums without the expanded subsidies and had to buy down to less-generous plans with larger deductibles, which they then can’t cover when they end up in the hospital. This would suggest the Trump administration’s claim that the drop in ACA coverage is all due to fraudulently enrolled people with zero claims might not actually be the case. 

Seitz: I question how much, like, the Trump administration realizes they’re playing with fire here. And I think in part because during the first Trump administration, you saw a few hundred thousand people disenroll from the ACA. They kind of let it to languish, but there was also a lot of question about the ACA marketplaces’ ability to survive. This time around is so much different. You’re talking about millions of people losing coverage within the first year. The Trump administration came in; they had record enrollment in the program. So these are real losses. These are real hospitals, and these are going to be real headlines of real people experiencing these real misfortunes. And you’re going to have either taxpayers eating the cost of the care through emergency Medicaid, or you’re going to have people winding up with really big medical bills that they can’t pay. And again, those are going to be real stories. And the Trump administration is going to find that they can’t just continue to yell fraud to cover all that up. 

Ollstein: Yeah, to Amanda’s point, I think this message could definitely backfire politically. Nobody likes to be told that they are a fraudster or don’t exist when they are losing their health insurance. And this is hitting red-state hospitals just as much as blue states, if not more. And so, I think going into the midterm election, sticking by this line and not admitting who is being harmed is definitely risky. 

Rovner: Yeah, it’s worth pointing out that, I mean, it does hit red states harder because the red states that didn’t expand Medicaid ended up with bigger enrollment in the ACA when they expanded the subsidies â€¦ 

Seitz: Florida’s the biggest. 

Rovner: â€¦ and so those people are now losing coverage. Yeah, Florida, Georgia, Texas. Those are the places where the hospitals are going to see it first when people are showing up who can’t pay their bills. 

Kenen: And those are the states that already have a lot of rural hospital closures. There are rural hospital closures and hospital closures across the country, but the rate of closures is much more acute in the states that did not expand Medicaid. So now you’re going to have more hospitals in jeopardy. It is not a healthy situation. 

Rovner: Well, related to this, we have the impending cuts to Medicaid. A federal judge appointed by Bill Clinton declined to block the Medicaid work rules from taking effect as scheduled Jan. 1. This was in a lawsuit filed by Democrat-led states. But there could still be some delay, right? I know doctor groups are completely freaked out by having to potentially write notes for tens of thousands of patients who may or may not be too medically frail to work. There’s still a lot of sort of panic, if you will, in the states about what’s going to happen to people if they can’t meet these work requirements. 

Ollstein: Yeah, and I want to make sure people know that the judge [who] ruled in this case, he said you shouldn’t take this ruling to mean that I think the states are wrong in challenging this policy. They could very well prevail eventually and strike it down. He just said, basically, this isn’t ripe. You don’t have enough evidence right now of harm to the states because the policy hasn’t officially started yet. Although it has in a couple states that weren’t part of the lawsuit, which we can get into. But this particular piece of the story is not over. Also, people should know that what was being challenged in court was not the entirety of the work requirements; it was just the piece requiring sick people on Medicaid to prove that they are too sick to work, prove beyond just having a diagnosis of cancer or an autoimmune disease or something. Just the diagnosis is not enough; they have to have some kind of proof. It’s not totally clear what kind of proof will count. And, to your point, they’re worried that it’s going to end up being individual doctors’ notes, which will completely overwhelm the system. Doctors don’t have the capacity to see all these people to document this and provide care. 

Rovner: And doctors don’t have the training to determine, you know, who’s disabled and who isn’t. That’s why we have these, you know, special masters for disability programs. Your average doctor is not really in a position to say, “Well, so-and-so can work this month but not next month.” Really, I mean, doctor groups really are legitimately worried about that this is going to fall to them. 

Kenen: And also, like, an awful lot of the people on Medicaid who would be affected â€¦ this is the Medicaid expansion population. It’s not all of Medicaid. But a lot of this population has chronic disease. And chronic disease is often sort of on and off, right? You’re doing OK for a while. You can work, and then kaboom, you have an exacerbation. You have a setback. You have an episode. Whatever your disease is, there are different things that happen, and then you can’t work. And doctors don’t know â€” I mean, mental illness is clearly one of the things where people could be stable for a long time and then crash and then recover and stabilize again. Cancer, you can be doing fine, on chemo for a certain amount of time, and then your body just says, you know, I’ve had enough chemicals pumped into it. Or you have â€¦ every chronic disease is pretty much â€¦ every one I can think of is an up-and-down, on-and-off â€¦ like how bad do you feel or how good you feel at any given time. And they certainly don’t have â€” then you’re out of compliance. You know, well, you’re healthy enough to work. Why aren’t you working? You know, bye-bye healthcare. So it’s really a complicated mess. The only little thing that may buy the states some time, in addition to whatever happens in the court, is for the first year and only the first year, people will be allowed to self-attest, meaning I’m just going up and saying I’m, you know, here’s my diagnosis, and I’m too sick to work. That is not likely to be extended. It’s unclear how that will play. I’ve written about it in somewhat detail about one state. I’m not exactly sure how it’ll run out in all 50, but it is part of the current rule that, this controversial rule that was dropped on June 1, that made this all sort of more complicated and more difficult. That self-attestation would be available on Jan. 1 for a limited period of time. 

Ollstein: But not in every state. So CMS [the Centers for Medicare & Medicaid Services], the federal government, said states can accept self-attestation. Several states are saying no thanks. We’re going to start requiring proof right away. No self-attestation allowed. So this is yet another sort of natural experiment where we’re going to see, you know, the differences between these states with these different policies, and how many people lose coverage as a result. 

Kenen: But it’s going to be way more than we thought at the beginning. I mean, the difference in this medical frailty rule versus what CMS was telling states until a few weeks ago versus, kaboom, on June 1, it is a much more cumbersome process. I mean, nobody thinks the old estimates of coverage loss are accurate anymore. I mean, there’s always a lot of guesswork in that, right? None of us know exactly how many people will lose coverage, but it looks like a lot more than we thought. 

Rovner: So we already have one of these natural experiments going on in Nebraska, which volunteered to implement its work rules first. The state is now getting ready to disenroll the first Medicaid patients who have failed to meet the requirements. Clearly, some of those people are still eligible, including a pregnant woman reported on by Nebraska Public Media who showed up for an appointment and was denied coverage because apparently the state missed the fact that she was pregnant and therefore eligible. I imagine we’re expecting more of this, right, Alice? We’ve seen this movie before? 

Ollstein: Yes, so we’re getting a sneak preview in Nebraska of what could happen in the rest of the states that expanded Medicaid come Jan. 1. A couple other states are also starting early, although they have different rules about when the penalties kick in and when the enforcement kicks in. But yes, you know we’re seeing a lot of confusion, people losing coverage who are technically eligible for coverage, and basically everything that providers and community groups and patient advocates predicted would happen. 

Kenen: And we know from Georgia, which does have work requirements already, they’re not a full-expansion state. They have their own version of a partial expansion, but it’s still, the law still applies to them. And they’ve had a lot of people losing coverage who probably are still eligible. We know from Arkansas’ experiment in, I believe was 2018, tons of people â€” I think it was 17,000 or 18,000 â€” who lost coverage, and most of them actually qualify. In fairness, the technology since 2018 and 2027 â€¦ and learning from Arkansas’ mistakes. â€¦ I think it’s important to be aware of how flawed and problematic Arkansas was. I don’t think it necessarily means that everything will be exactly that bad because, you know, there’s more broadband access in rural America, etc. We don’t have to go into all that. But it’s not a great precedent in terms of smooth rollouts. 

Seitz: And we also know it from the Medicaid unwind during the pandemic, too. We saw these errors and the initial estimates of how many people would be removed from coverage after the federal government said, OK, you can’t allow continuous enrollment anymore. They blew past those initial estimates. So, to your point, Joanne, earlier about how we are going to see much greater disenrollment than was initially predicted.  

Rovner: All right, we’re going to take a quick break. We will be right back. 

We are back, turning to abortion. Alice, you were part of a  about U.S. Attorney General nominee Todd Blanche and something he promised to anti-abortion groups. Tell us what he said. 

Ollstein: Yes, so this was on a private call that the White House Faith Office did with what they said were thousands of faith leaders around the country. And they, you know, said over and over on this call, this is private, this is off the record, this is not for the news, and then they posted it on YouTube for some reason and on some other places online. Explain that. Anyways, it’s been taken down since our story published, but we have the audio saved. So Blanche was basically promising that not only would he take action to restrict mail delivery of abortion pills and curbing abortion access in other ways, if confirmed, he sort of went beyond that and said that policies are already in the works. There’s already discussions going on between the White House, DOJ [Department of Justice], FDA, all of these different agencies sort of pledged to stop the ability of patients in red states to order abortion pills online and get them delivered by mail, which is, you know, a key line of access that patients have turned to in this post-Roe era of bans. It was not clear from the audio that we obtained how he plans to go about doing that. I also imagine if, you know, the FDA does come out and change its policy, that his remarks could be used to challenge that and say, you know, this was not based on science. This was based on ideology and religious opposition to abortion, which is not what the FDA is supposed to base its drug access policies on. So this was really fascinating, particularly because it did not really jive with what he said publicly in his confirmation hearing, where he sort of hemmed and hawed and said, “Oh, I can’t speak to that because there’s ongoing litigation,” and sort of made â€” yes, this was more specific promise of action than we’ve heard from him publicly. 

Rovner: And just to be clear, I think I have this right: Even if the FDA doesn’t change its policy, the DOJ could decide We’re going to enforce the Comstock Act â€” that 1873 law that bans the mailing of abortion drugs. And that would sort of leave FDA out of the entire equation, right? I mean, in theory, he could do that. 

Ollstein: Yes, and a lot of anti-abortion activists are very frustrated that the administration has not done that yet. They could have done that a year ago, theoretically put out a new OLC memo. Of course … 

Rovner: OLC, the Office of Legal Counsel. 

Ollstein: Yeah, which the Biden administration used to say that the Comstock Act cannot be used for cracking down on mail delivery of abortion pills. Of course, even if that happened â€” and there’s no sign that that’s necessarily imminent or something the administration would want to do ahead of the midterms potentially â€” but, you know, I think it’s notable to ask: How would they enforce that? This is private mail going to people’s private homes â€” short of mass surveillance and looking at everyone’s mail. I mean, logistically and constitutionally, it raises a lot of questions. 

Rovner: It does. Well, and now Sen. Susan Collins has cited it as one of the reasons that she’s going to vote against Blanche’s confirmation. Although I will quickly add that once Susan Collins announces she’s voting against something controversial, that usually means Republicans already have the votes they need and can let her go. â€¦ I see nodding. Do we think that’s the case here? 

Kenen: She’s always in tight races. For the past 30 years, she’s won. But you know, Maine is really obviously in play this year. None of us have a good enough crystal ball to know how this plays out. But the issue for her, in many ways, is just her [Supreme Court Justice Brett] Kavanaugh confirmation vote. So anything she does seen as further eroding abortion could really tip the election for her. So I’m not positive that this goes through. I think it’s likely, but [Sen. Bill] Cassidy, I don’t believe, has said what he’s going to do. [Sen. Lisa] Murkowski hasn’t said â€¦ if someone has more recent information, please update me. But my understanding …  

Rovner: As of this morning, Cassidy and Murkowski are still holdouts. 

Kenen: Right. And I’m not 100%, even though [Sen. John] Cornyn and [Sen. Thom] Tillis got him out of committee, they’re watching. They’re seeing, you know, what’s going on. Abortion is not the issue for them, but the weaponization, you know, what did he really mean by, you know, does his memo really stop it? What else are they going to do? I don’t think this is a done deal, as opposed to getting closer to being a done deal. But there’s no question that Collins had to vote against this. 

Rovner: We will see. All right. Well, over at the Department of Health and Human Services, things continue to be messy, which is also the description of an interview that Secretary Robert F. Kennedy Jr. gave to CNN’s Dana Bash on Sunday. Here’s how my colleague . I don’t think I can improve on this. “This morning, HHS Secretary Robert F. Kennedy Jr. sat down with Dana Bash on CNN’s State of the Union, and for 20 minutes it went about the way you’d expect. Both of them raised their voices, each accused the other of attacking them. He told her she’d committed press malpractice and that scaring people was the job of CNN. She told him he was causing inaccurate information to circulate. By 9:20 a.m. they were calling each other parrots.” By the way, this week saw publication of yet another large-scale study, 2.5 million children large, that found no association between autism and the measles, mumps, and rubella vaccine. But it raises the broader question: Does giving the secretary a mainstream platform like this actually make the media complicit in spreading the misinformation that he likes to spew? 

Ollstein: Things like this are such a Rorschach test because you had everyone on the left describing it as a crash out and, you know, a meltdown and something that made the secretary look really terrible, and you had people on the right who support him sharing it widely and saying, “Oh, he really gave it to the evil mainstream media.” And so, in terms of, you know, value to the public, I’m not sure. 

Seitz: I think you’re totally right, Alice. But what was really revealing is we have a health secretary who could not articulate what his plan is for any sort of outbreak, as there are multiple infectious disease outbreaks exploding throughout the country. And the one thing that he said he would do repeatedly was he would listen to doctors. Well, doctors on the front line of emergency rooms are saying, We are overwhelmed with measles. We are overwhelmed with infectious disease. Please, promote vaccines more. Please get your children vaccinated. So I think that was really just revealing. And again, it’s really troubling to see because everyone’s going to walk away from that conversation viewing it one way or the other, and not agreeing on anything, it seems. 

Rovner: Yeah, I will say, I mean, I watched it live. It was hard to watch. I don’t think it covered anybody with any kind of glory. Well, earlier this morning, speaking of breaking news, Kentucky Sen. Rand Paul’s Homeland Security and Governmental Affairs Committee voted to hold former NIH [National Institutes of Health] institute director and White House science adviser Anthony Fauci in contempt of Congress for pleading the Fifth, rather than answering their questions at a hearing last week. As former Trump surgeon general Jerome Adams quipped on X: “Your healthcare costs are exploding and the entire U.S. financing system is collapsing in real time… Meanwhile Congress is spending more energy debating whether to lock up an 85-year-old over his private journal entries about Barbra Streisand. Priorities.” At the same time, Politico is reporting that a top candidate for Fauci’s old job, running the National Institute of Allergy and Infectious Diseases, is a pharma executive who co-authored a book arguing that covid came from a lab leak and that fact was covered up by U.S. scientists. Steven Quay, who’s the nominee, has no training in infectious disease and was not selected for an interview by NIH staff for the NIAID job, but was instead handpicked by RFK Jr. Institute directors, I would hasten to add, are not usually political positions, unlike the director of NIH as a whole. So, what does this all suggest? 

Kenen: More of the same and worse. The Fauci situation is mind-boggling, even to people whose minds are now frequently boggles. Right? It’s â€¦ I think it’s safe to guess that he regrets writing certain things down on a government computer. And now they’ve got his phone. Sen. Johnson has his phone â€¦ or a copy of what his phone is. So I don’t know what’s going to come out about that, and how it will be interpreted. Remember that the measures that people are so angry about, several years later, were actually done during the Trump administration. They were not implemented by Biden. The national rules set at the, you know, the “six weeks to stop the spread” — that was Trump. Later regulations about opening restaurants and so forth, and other businesses and schools, and schools being the most contentious â€” churches are also contentious â€” that was done at the state level. Anthony Fauci did not go around the country locking churches. So public health made mistakes. But what people are forgetting about is that public health made mistakes dealing with a completely unprecedented and extremely complicated disease, which we still don’t understand all the sequel, all the stuff that people are still dealing with post-covid, right? And under emergency circumstances, in a politically volatile environment. And what we’re also forgetting is mistakes were made on the other side too. People were spreading quote-unquote “facts” that harmed people, that killed people. … I don’t mean they went out and murdered people, but things that led to unnecessary and avoidable deaths. So the whole debate, I mean, you can tell I’m â€” I’ll stop. Tony Fauci was not single-handedly making every decision, and the people trying to make public health decisions in a difficult environment were doing their best to save lives. And â€¦ it doesn’t matter what he said about Barbra Streisand. 

Rovner: And I would just add that it is Congress’ job to do things like examine the mistakes that were made and how things could have been done better, how communication could have been better. And I feel like, you know, Congress is just is so busy finding a scapegoat that it is not doing what could be a really useful exercise in an after-action report. Because there will be another pandemic, and, you know as we’ve said, we are having smaller-scale public health emergencies even as we speak, and nobody is dealing with it well. 

All right, moving on. Finally, this week, the House has decamped for its August recess, but the Senate is still here on Capitol Hill, trying to get a pretty ambitious list of things passed before it leaves at the end of the week, starting with a continuing resolution to keep the government open when the new fiscal year begins Oct. 1. The House passed a CR to run until after the midterms before it left in July. The Senate’s CR is similar with one big change that we have actually discussed lately. It would block, at least temporarily, a controversial rule from the Office of Management and Budget that would further politicize the grant-making process by allowing political appointees to decide whether individual grants conform to the president’s agenda. Can this get back through the House, assuming the Senate passes it when the House comes back in September? Or is this going to come down to the wire and we’re going to have a fight over it as we approach Oct. 1? 

Kenen: Well, the other question that some researchers, you know, when I when I talk to some people about, well, they â€” and remember they’re not killing this rule; they’re halting its implementation. 

Rovner: They’re delaying it, right? 

Kenen: Right. You know, one of the scientists’ first response was, “Yeah, well, just because Congress passes a law doesn’t mean the administration will respect it.” There are other ways to politicize, and I mean, they’ve been cutting funding and stopping grants and virtually shutting down agencies. Science has already been hurt. So whatever happens in the House, which, and I think Julie is right, I don’t think they just come back and say, “OK, we’re going to just agree.” I think there’ll be some kind of fight â€” how it fits into other trade-offs between the House and the Senate. And there are things other than health that we don’t pay as much attention to that are also out there, including a couple of wars. So yes, there’ll be some fighting about it. No, we don’t know how it turns out. But at the end of the day, if the administration really wants to further politicize an already politicized grant-making process, they will probably find a way of doing so. 

Rovner: Well, speaking of which, the administration has figured out other ways to effectively gut programs. Case in point: Head Start, which is a bipartisanly popular preschool education, nutrition, and healthcare program for low-income kids, just this morning, HHS is dropping new rules that would basically eliminate many of the required standards for Head Start programs, including things like teacher-to-student ratios. This administration is nothing if not creative, because this is not â€” you know, last year they were delaying the money going out for Head Start. Now they’re just going to say, Well, we’re just going to take away the rules, and you can sort of take this money and do whatever you want. Amanda, you’re nodding. 

Seitz: Yeah. Well, I found this really striking because I was with Secretary Kennedy a few months ago at a Head Start in Toledo, [Ohio], where he talked about the importance of the program, that it was inspired by his uncle, and he he said he really stood up against the White House to make sure â€¦ it was still funded last year, and he demanded that. And the other thing that really struck me about that visit is the Head Start’s owner had flown in from New York in this tailored suit to take photos with Kennedy and greet him personally. And I was a little confused why this person from New York is owning this Head Start. And it turns out a lot of private equity firms have been buying up daycares across the country, and this was the case for this Head Start. So, you know, pulling back the regulations of Head Start around class sizes â€” that seems like it would benefit more the private equity firms than the teachers and the children in the classrooms. 

Rovner: Fancy that! All right. Well, finally, finally, one of the things the Senate has managed to do this week is confirm Erica Schwartz as the director of the Centers for Disease Control and Prevention. That agency has been operating without a Senate-confirmed head since the departure of Susan Monarez last August, just weeks after she had been confirmed over differences with Secretary RFK Jr. over vaccine policy. How confident are we that Dr. Schwartz, who is a retired rear admiral in the U.S. Public Health Service Commissioned Corps and a self-proclaimed vaccine supporter, will last longer than her predecessor? 

Seitz: I think that is a huge question. I mean, we’re now on our third CDC nominee of this administration, second confirmed candidate, and we know that Secretary Kennedy and Susan Monarez never really got along. It was not, she was not his first choice. That has been made very clear with Schwartz as well, when he said that he was not even consulted really about the pick. So I think the big question is: Can these two work together, and how quickly will that potentially deteriorate? 

Rovner: Yeah, well, the clock is about to start. I guess as soon as she is sworn in. â€¦ She was just confirmed on Wednesday, so I don’t think she’s been sworn in yet. Alice, you want to add something? 

Ollstein: Yeah, I did think it was interesting, though. On Capitol Hill, you heard from some senators that, you know, they did have concerns about her ability to stand up to RFK and advocate for evidence-based medicine science, you know, particularly on the vaccine front. But because there hasn’t been a leader at this crucial agency for a year now, they wanted to vote to confirm her just for some stability and some leadership. I mean, look, we’ve got diarrhea lettuce, we’ve got salmonella eggs, we’ve got measles. We’ve got a lot of problems, and it’s never a great time to not have a leader of the CDC, but right now is really not a good time to not have a leader of the CDC. 

Rovner: Yeah, I think that’s what Tim Kaine of Virginia, a Democrat, said. I think he was the only Democrat that voted for her. More important to have somebody at the CDC leading it. 

All right, that is this week’s news, or as much of this week’s news as we could get to. Now we’ll play my “How Would You Fix It?” interview with New Jersey Democratic Sen. Andy Kim. Then we’ll come back with our extra credits. 

I am pleased to welcome New Jersey Democratic Sen. Andy Kim to “How Would You Fix It?” Sen. Kim’s a member of the Senate Health, Education, Labor, and Pensions Committee, and just introduced legislation to guarantee health coverage to every child up to age 26. Sen. Kim, welcome. 

Andy Kim: Yeah, thanks for having me. It’s a pleasure. 

Rovner: As I hope this series is highlighting, it appears the country is moving, albeit kind of slowly, towards another major debate over healthcare coverage and cost. What made you decide to step into these very choppy political waters? 

Kim: Well, first of all, I’ll say it is because of healthcare that I ran for Congress to start with. So, you know, eight years ago or so, when I first started running, it was because I had a little baby boy who had some real health issues right there as he was born, and I was one of those very scared, anxious parents trying to figure out what kind of care could my kid get. Meanwhile, we saw a debate in Congress where the Republican-led Congress in 2017 was trying to gut the Affordable Care Act. So that was why I actually got engaged in politics, [because] my congressman was leading that charge on trying to cut preexisting condition protections.  

The other aspect of this is right now things are just moving in the wrong direction. We have upwards of, you know, 1.75 million to 2 million more kids losing Medicaid over the last year and a half. We see the numbers already atrocious. You know, 4.4 million children in this country without health insurance, 23 million kids that are underinsured, which means they have coverage that doesn’t cover their full needs. I’m appalled by that. I’ll be honest with you. Like, you know, we’re the richest, most powerful country in the world. I’m here at the Capitol, where we’re right now having these debates about, you know, a $1.5 trillion defense budget and other things that, you know, just are pushing forward. Yet we are just for some reason just OK with, or at least just allowing this type of void when it comes to our healthcare. I just find it to be â€” I mean, just appalling and a real dereliction of our duty that we have not found a way to be able to ensure that every child is able to go see a doctor when they need to without breaking the bank. So I think, for me, this has just been years in the making, and right now I wanted to introduce this because I can’t just be talking about what I’m against. I have to be talking about what I’m for. What is the vision for this country? Not just to reverse things that I think are wrong from what this administration has done, but I owe it to my constituents and to the American people to lay out a vision forward for us to try to think through where we go from here. 

Rovner: So, how would this bill work? 

Kim: First of all, the bill is called MediKids. So, as you said, it would be a guarantee of healthcare from birth to 26. I think one of the more novel parts of this that is different from what we see right now is that there’s an automatic enrollment upon birth into MediKids, which is a foundation built upon Medicaid. So the idea right now is we’re seeing so many kids and families losing Medicaid or potentially losing Medicaid in part because of just the onerous paperwork, the bureaucracy, the different types of things that are meant right now, just the twice-annual requirements to be able to recertify. That’s what’s standing in the way here and preventing so much of the progress that we need. So I wanted to really tackle that and be able to make sure that people can be able to get the care that they need.  

And another part of it is that I chose to put the platform upon Medicaid because Medicaid, in many ways, was designed for kids. You know, when it comes to the early and periodic screenings and diagnostics and treatment, that whole system is, as I’ve looked at it, really the most comprehensive system for kids. What healthcare experts have really shared with me over the years, as I taught talk them, is we can’t just think of kids as little adults. But instead, like, having a system that is designed for kids, that is designed to be able to have the screenings at the appropriate times and age intervals, to be able to have that requirement, to be able to treat any and all problems that are determined, and to think about this as comprehensively â€” not just like healthcare here, dental and vision, but to think about it across all of it. All of that is necessary for kids because their bodies are developing, their brains are developing well into their 20s, which is why, again, I pushed meta kids out into the 20s. It’s like you want to make sure that all of these kids are able to get the care that they need, and that you don’t see the kind of withdrawal of or restriction of care that could have real consequences down the road. So that’s really what we were trying to do. 

Rovner: So, as you well know, Democrats have been fighting for decades now over whether to try for a really comprehensive overhaul of the nation’s healthcare system or something more incremental. Obviously, the Affordable Care Act was something more incremental, but also fairly comprehensive. Is that how you envision this? Where do you fall on the “Let’s pull it up and start over from scratch,” and the “Let’s try to fix it one step at a time” debate? 

Kim: Well, yeah. Well, look, I want to be bold, and I want something that can really push forward. Because look, I’ll be honest: The American people want something bold. Like, the problems that we are facing are enormous. No one is happy with the status quo, so we need to have that change. But I was also thinking through how to design something that I think will have enormous impact upon healthcare, but doing it in a way that is implementable. You know, so with MediKids, I’m not creating some new bureaucracy. I’m not creating some new agency or new department. I am taking something that is already, frankly, covering a large percentage of children in this country already, and I’m trying to make it available for everybody through that automatic enrollment, and taking something that is proven to be able to have that comprehensive approach and use that as a foundation. I really tried to design this in a way that is implementable. As I’ve been in Congress now for eight years, I see the types of bills that can get through parliamentarians and get through into passage, and I’ve really tried to design something that hits that sweet spot while still fundamentally reshaping how healthcare in this country will be attained by people. And I really do think that it will have a sizable impact tremendously. Not just in terms of providing that care for kids, but everyone knows healthier kids means healthier adults, which means a healthier workforce, which means a stronger economy, which means lower healthcare costs. The knock-on effects are so strong. So many of the challenges that we see amongst adults when it comes to chronic illnesses and other challenges are often things that have been exacerbated because of the lateness of diagnosis or the lack of treatment early on. So those are the things that we’re really trying to think through when it comes to this approach. 

Rovner: Back in 1994, when the Bill Clinton plan went down, the first big health reform that I covered, there was an effort, mostly spearheaded by Sen. Tom Harkin of Iowa, that they called “Kids First.” They said, well, let’s just cover kids. It still took three years, a lot of fighting, and sort of they luckily found a tobacco tax to help pay for it. But it was bipartisan. Do you have any thoughts that Republicans are going to maybe have some renewed interest in increasing healthcare coverage? 

Kim: Well, what I will say is, first of all, if ever there was an issue that should be bipartisan or, frankly, nonpartisan, it should be about our kids, right? And that’s why I wanted to focus on this too. I think it’s the strongest argument that we have in our country when it comes to guaranteed healthcare. I get it, eyes wide open, I was on the Senate floor last year when I saw my colleagues vote to cut Medicaid at such a dangerous level, so I have my eyes wide open. But what I will say is, I’ve gone around the Senate over the last period of time, like the last two weeks since I’ve introduced, is that it is sparking that conversation. And whether or not my colleagues on the other side of the aisle or both sides of the aisle agree with all the different principles and proposals that I have in MediKids, it is creating this dialogue and this debate about healthcare for our kids. And that’s what I want. Yeah, that’s what I want us to be able to do. And you’re right. Like, we’ve seen bipartisan support in the past for CHIP [the Children’s Health Insurance Program], for healthcare for kids in different ways, and I just saw that going in the wrong direction last year, which is why I wanted to release this now to try to move it back into the fold. I saw a real deprioritization of concerns raised by parents of kids with disabilities that were worried about how these Medicaid cuts would affect them. It’s not good enough for them to just get, like, a wink and a “trust us” type of message. We really need to make sure that we just never have parents with that type of anxiety about whether or not they’re going to lose care for their child. So, well, we’ll see going forward. But at least my early conversations with my colleagues from both sides of the aisle, certainly around the overarching principles of care for kids, is promising. And I’m hopeful to be able to make some gains as we move forward in both the Senate, as well as in the House, as we start to push forward on that debate there too. 

Rovner: Well, we’re all about keeping the conversation going forward. Sen. Andy Kim, thank you so much. 

Kim: Yeah, thanks so much for having me. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Joanne, why don’t you go first this week? 

Kenen: OK. This is a story that’s up online in The New York Times, and I believe it’ll be in the Sunday Magazine this weekend. It’s by Dr. Helen Ouyang, whose name I don’t know how to pronounce, so I’m just going to apologize for not knowing how to pronounce it. The story is “.” For me, it’s not great because I was working on the same story, talking to some of the same people, and you know that’s not going to happen now. But something like she used the number 4 million, and it’s probably closer to 6 million, kids, between roughly the ages of like 10 and 18 or 19, are in fact the major caregiver for a sick parent or grandparent, and they are trying to juggle some kind of attendance at school and then doing medically complicated things, plus the psychological burden and not being able to be a normal teen. And these are largely poor kids. They are disproportionately Black and Hispanic kids. We do not have a system for helping them. The answer is not let them be caregivers because no one would be a caregiver. The person would have no care. The question is, really, how do we support them? Make it easier. Make sure they’re connected to whatever community resources or state resources or health resources that are available. Make sure they’re maxing out on that. But it’s a really disturbing and very moving story what these kids go through, because even those of us who are adults who’ve taken care of grandparents or parents, it’s really hard. And if you’re 15 or 10, it’s even harder. 

Rovner: Yeah, and taking care of siblings too in a lot of cases. Amanda. 

Seitz: My pick this week is “,” by Katherine Long of The Wall Street Journal. This is a story about a surrogate who agreed to carry what ended up being triplets for a father overseas in China. What I just found really remarkable about the reporting is that it takes this really horrible case â€” these children have essentially been left in the U.S. with the surrogate mother because the father from China hadn’t been able to come over due to visa issues. And, but it takes this really complicated story and looks at just the overall perils of the surrogacy industry that has exploded while being completely unregulated, and how all of these cases are largely playing out in courts and being complicated by the immigration policies of the Trump administration. So it was just a really fascinating read. 

Rovner: Other things that policymakers could be doing with their time. Alice. 

Ollstein: My pick is from NOTUS. It is called “.” So we talked about the vote to hold Fauci in contempt, but this is a look at what inadvertently, I guess, happened as a result of Rand Paul, who, let’s remember, is a doctor himself as well as a senator, releasing a huge tranche of private documents from Fauci and not redacting people’s personal medical information about their diagnoses. And this article talks about how that happened and how little recourse the people involved have about their information being exposed, and how this is a pattern with the administration of failing to redact people’s sensitive information when they do these big document dumps. 

Rovner: Oops. Yeah. Well, my extra credit this week is also about the Fauci affair. It’s from our podcast pal Sheryl Gay Stolberg at The New York Times, and it’s called “.” And wouldn’t you just know it, but it turns out that HHS Secretary RFK Jr. and one of his sons, and Kentucky Republican Sen. Rand Paul, have all published books accusing Tony Fauci of various crimes and misdeeds, and that after last week’s hearing, sales of those books jumped. Wrote Sheryl, “Ethics experts say that Mr. Kennedy, his son and Mr. Paul did not cross any legal or ethical lines, but several said the secretary and the senator did cross a threshold for hypocrisy by using their platforms to sell books about Dr. Fauci while accusing the scientist of profiting from his own public service.” I will let you all draw your own conclusions. 

All right, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , or on Bluesky . Where are you folks hanging these days. Alice? 

Ollstein: On Bluesky , and on X . 

Rovner: Joanne. 

Kenen: I’m mostly on  and on  . 

Rovner: Amanda. 

Seitz: And I am still tweeting from X on . 

Rovner: We’ll be back in your feed next week. Until then, be healthy. 

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]]> 2269812 Medicaid Work Rule Leaves Homeless People in the Cold /medicaid/medicaid-work-requirements-rules-montana-homeless-people-exemption/ Thu, 06 Aug 2026 09:00:00 +0000 /?p=2266625 MISSOULA, Mont. — Tywon Pugh has seizures that make it hard to find and keep a job.

“They called me a ‘liability to the job site,’” Pugh said, recalling the words of his manager when a seizure cost him his last job at a fast-food restaurant in this western Montana city.

When the 46-year-old lost work in the past, his wife of 10 years covered their rent and he tended to their home until he found another job. But his wife died last year. Soon after, Pugh became homeless. His problem with alcohol became worse, which made managing his seizures more difficult.

“When she died, my whole base was depleted,” Pugh said.

Medicaid pays for the prescriptions that keep Pugh’s seizures at bay. The government-subsidized health coverage would also pay for an addiction treatment program that Pugh said he has tried to get into, but he was told there’s a waitlist.

Pugh’s goal has been to get healthy enough to work again. But he’s worried about being able to keep the Medicaid coverage he needs to get to that point.

Early Embrace of New Rules

In the spring, the federal government finalized regulations requiring millions of people who receive Medicaid benefits to prove they’re working, volunteering, or going to school to keep their coverage. States have until January to begin those checks. Montana, Arkansas, and Nebraska have already started implementing them.

The Trump administration’s federal work requirements exempt certain groups of people: those with disabilities, those older than 64, pregnant people and Native Americans, among others. To receive an exemption, anyone without a clear-cut qualification — such as through their age or disability status — will have to prove they’re too sick to work.

But the administration decided that being homeless isn’t a medical condition and can’t count as an automatic out from having to meet the new requirements. Many conservative policymakers support work requirements, and some states have attempted to implement such rules for years. At least four states — Montana, Arizona, Kentucky, and Utah — previously proposed policies that included homelessness as an exemption.

But federal officials have said that’s not allowed. In an email to Ñî¹óåú´«Ã½Ò•îl Health News, the Centers for Medicare & Medicaid Services declined to provide a comment on the record. But the agency confirmed that states must stick to the federal government’s list of exemptions. Homelessness in the U.S. increased by 27% from 2013 to 2025, from the Department of Housing and Urban Development. Last year, about 746,000 people .

Many, like Pugh, qualified for Medicaid, though the number of enrollees who are homeless is difficult to measure. In 2023, who received medical or behavioral health services through one of the nation’s roughly 300 programs were enrolled in Medicaid.

“My Medicaid is still active, but when are they gonna cut that off from me? I can’t get employed,” says Tywon Pugh, who been homeless in Missoula since his wife’s death in 2025. The federal government does not exempt people who are homeless from Medicaid work requirements. (Katheryn Houghton/Ñî¹óåú´«Ã½Ò•îl Health News)

Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured, said the federal regulations are a lot stricter than many states had expected, even those on board with work requirements. (KFF is a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.)

“It took everyone by surprise,” Tolbert said.

Mehmet Oz, who leads CMS, touted the regulations as a “path to prosperity” during a press conference in June.

“We need to get people to try to work,” Oz said. In June, 25 mostly Democratic-led states over the regulations, arguing the medical frailty standard would be too hard for enrollees to meet — and for states to assess. The work requirements are projected to increase the number of uninsured people nationwide by by 2034, according to the Congressional Budget Office.

Most states will begin to implement the Medicaid work requirements in January. 

Montana plans to begin booting Medicaid enrollees from coverage this October if they can’t prove they’re in compliance with the work requirement.

“My Medicaid is still active, but when are they gonna cut that off from me?” Pugh said. “I can’t get employed. How am I supposed to survive?”

The differences between the states’ and federal government’s exemption lists don’t end with people who are homeless. In Montana, lawmakers also planned to excuse people fleeing domestic violence and caregivers of hospitalized family members — two other groups left off the federal exemption list.

“These are simply parties that, due to a number of conditions, cannot meet those requirements,” Republican state Rep. Ed Buttrey said in 2019 when the Montana Legislature passed its first Medicaid work requirement bill. Buttrey did not comment for this article.

Federal officials have said many people who are homeless could fall under another exemption, such as being too sick to work. But, like many states, Montana’s system to automatically conduct those checks through existing medical records isn’t ready, though health department spokesperson Jon Ebelt said it should be in place by October. Anyone not automatically exempted by the state would have 30 days to prove their case.

Flyers at Partnership Health Center locations in Montana announce eligibility changes to Medicaid. (Katheryn Houghton/Ñî¹óåú´«Ã½Ò•îl Health News)
Partnership Health Center is one of roughly 1,400 health centers nationwide that receive federal funding to serve patients based on what they can afford. (Katheryn Houghton/Ñî¹óåú´«Ã½Ò•îl Health News)

A Possible Exemption for Health

Pugh might qualify for a pass due to his seizures. But getting to doctor appointments the past year has been hard for him.

The anniversary of his wife’s death just passed. Typically, Pugh has to find a new place to sleep outside each night. One night while camping, Pugh lost his wallet and important documents. And with the addiction treatment centers that accept Medicaid patients overbooked, Pugh has had to rely on willpower to avoid drinking.

“I’m taking it one day at a time,” he said.

A little over two hours north, in Kalispell, Dustin Goss, a case manager at a homeless shelter called Samaritan House, said Pugh’s experience reflects why he’s worried that people who qualify for an exemption will get tangled in bureaucratic tape.

“You can’t really worry about getting paperwork done when you don’t know where you’re eating today,” Goss said.

Cassidy Kipp, who heads Samaritan House, said once people find shelter and start to stabilize, they typically find work. But even then, meeting the new requirements can be challenging. Clients often start with temporary and informal jobs — such as cleaning out a storage unit — that don’t come with a pay stub, Kipp said. 

Kaitlyn Bosshardt, a social worker at Partnership Health Center, a health clinic in Missoula, has seen more people priced out of longtime rentals as housing costs outpace people’s paychecks. Meanwhile, affordable housing and rental aid are limited.

Kaitlyn Bosshardt, a social worker at Partnership Health Center in Missoula, counts letters about Medicaid that the state’s health department sent to clinic patients who don’t have a steady address. (Katheryn Houghton/Ñî¹óåú´«Ã½Ò•îl Health News)

Partnership Health is one of roughly 1,400 health centers nationwide that receive federal funding to serve patients based on what they can afford — meaning even those who lose Medicaid can receive care. But organizations representing health centers have said if too many patients lose the coverage, some clinics won’t be able to fill the financial hole.

The other problem is that these clinics generally don’t provide specialty care.

One day in June, as temperatures hovered around 90,  Pugh visited Watershed Navigation Center, a refuge run by Partnership for people without steady housing to have a meal or see a doctor. His doctor, Atarah Sidey, told Pugh that the neurology clinic that managed his seizures had dismissed him from their care after he missed three appointments.

She referred Pugh to the other neurologist in town and talked about trying to find treatment for his addiction.

“It’s just that if I don’t make the effort at changing, it ain’t gonna happen and I’m gonna end up found on the side of the road somewhere,” Pugh told Sidey.

“You got this, though, Tywon,” she responded as Pugh nodded his head. “You can do this.”

Pugh has connected with a social worker for help keeping his Medicaid. By late July, he was waiting for space to open at a Missoula addiction treatment center and waiting on responses from two job applications.

In the hard moments, Pugh imagines his wife telling him to stay calm, that things will get better.

“I just don’t wanna lose hope in the meantime,” he said.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

]]> 2266625 Watch: Democratic Senator Proposes a Fix for American Healthcare — Covering All Kids /health-care-costs/interview-senator-andy-kim-healthcare-fix-children-coverage/ Thu, 06 Aug 2026 09:00:00 +0000 /?p=2268722&preview=true&preview_id=2268722 In this “How Would You Fix It?” interview, Julie Rovner, Ñî¹óåú´«Ã½Ò•îl Health News’ chief Washington correspondent and host of the What the Health? podcast, sat down with Sen. Andy Kim, a New Jersey Democrat, to discuss his proposal to grant all kids access to health coverage.

Kim, who serves on the Senate Health, Education, Labor and Pensions Committee, said it is “a real dereliction of our duty that we have not found a way to be able to ensure that every child is able to go see a doctor when they need to without breaking the bank.”

Under the senator’s proposal, children would be automatically enrolled at birth in the public program, which he . Parents would have the option to opt their kids out, though they could reenroll them at any time until age 26, Kim told Rovner.

“You want to make sure that all of these kids are able to get the care that they need as their bodies are and their brains are developing and that you don’t see the kind of withdrawal of or restriction of care that could have real consequences down the road,” he said.

Kim said offering comprehensive, universal coverage to American children would help them avoid chronic conditions in adulthood, in addition to providing broader societal benefits, such as a healthier workforce.

He added that he hopes his idea could gain traction should Democrats claim a majority in Congress in the midterm elections, as well as foster an important discussion about healthcare in the 2028 presidential race.

An abbreviated version of this interview aired Aug. 6 during Episode 458 of What the Health? From Ñî¹óåú´«Ã½Ò•îl Health News: “The Return of ‘Medicare for All.’”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

]]> 2268722 They Worked To Protect Public Health. Now They Want the Public’s Votes. /elections/election-midterms-candidates-becerra-acton-el-sayed-california-ohio-michigan/ Fri, 31 Jul 2026 09:00:00 +0000 /?p=2265943 A handful of former public health officials are campaigning for top statewide offices across the country, testing whether their experience with covid and other hot-button health issues will appeal to voters in November.

The officials, all Democrats, are running at a time when the Trump administration is reducing government funding for scientific research, restricting access to some vaccines, and making it more difficult for some Americans to obtain health insurance.

Shaughnessy Naughton, president of 3.14 Action, a political action committee that recruits Democratic candidates with science and health backgrounds, said it is unusual to see so many public health leaders running for office.

“But it’s not surprising given the moment we are living in, with an arsonist running HHS working to undermine the vaccine schedule and public health at large,” she said.

Health and Human Services Secretary Robert F. Kennedy Jr. is a longtime anti-vaccine activist who disparaged public health measures implemented during the pandemic, going as far as calling the covid vaccine the “.”

Neither HHS nor the White House responded to requests for comment.

Several of the candidates benefit from name recognition built during the covid pandemic, political science scholars say, when daily news briefings from local health officials became must-see-TV for many citizens sheltering in place from the novel virus. But that cuts two ways.

While many Americans regarded public health officials as offering prudent advice and a steady voice, others criticized them for pushing school closures, mask mandates, and new, quickly created vaccines. The attacks have escalated under President Donald Trump, with Republicans targeting pandemic-era public health leaders such as Anthony Fauci and a former Fauci adviser even facing .

National polls show healthcare is for many voters this year, with Democrats most worried about costs and Republicans about fraud. But that’s no guarantee of victory. Nirav Shah, an epidemiologist who led Maine’s top public health agency through the pandemic, lost a narrow Democratic primary in the state governor’s race in June.

Here are some of the public health officials on the ballot this year:

Xavier Becerra, Running for Governor in California

A photo of former HHS Secretary Xavier Becerra speaking in front of news reporters' microphones.
Xavier Becerra speaks to reporters in Los Angeles on Jan. 9. (David Crane/MediaNews Group/Los Angeles Daily News via Getty Images)

Becerra, who served as HHS secretary under President Joe Biden, is the highest-ranking former health official running this cycle. He won a crowded and expensive open primary and now faces Republican Steve Hilton, a British-born former Fox News host, in the general election.

Mark Peterson, a public policy professor at the UCLA Luskin School of Public Affairs, said with the pandemic in the rearview mirror, any judgment voters may have about the federal government’s response is more likely to reflect on Biden rather than Becerra, who has no medical background and maintained a low profile as HHS secretary.

Leading the nation’s health department as the pandemic lingered, Becerra focused more on expanding access to the Affordable Care Act and Medicaid, overseeing record numbers of people enrolled in the publicly financed programs during his tenure. He did face criticism over the processing and placement of a massive influx of migrant children at the U.S.-Mexico border, as well as his agency’s response to a baby formula shortage brought on, in part, by major product recalls.

Becerra has said he now wants to be California’s “healthcare governor,” a mantle outgoing Gov. Gavin Newsom tried to claim upon taking office in 2019.

Becerra’s campaign did not respond to a request for comment.

Before becoming HHS secretary, Becerra served as California’s attorney general and sued the first Trump administration more than 100 times, leading a coalition of states against GOP efforts to gut the ACA. He also started a unit in his office focused solely on healthcare. During Becerra’s tenure, his office reached a $575 million antitrust settlement with the California hospital system Sutter Health, pursued pharmaceutical companies that delayed generic drugs, and helped block a Trump administration rule that let employers choose whether to cover .

Voters often regard decades of experience in government as a negative, Peterson said. But for the job of running the nation’s most populous state and the world’s fourth-largest economy, he added, “I think there are a lot of people out there who would like to have somebody who actually has run a big enterprise.”

In , Becerra has said California should maintain state-funded Medicaid coverage for immigrants without legal status. He is also a longtime supporter of implementing single-payer healthcare, though in recent interviews he has said it needs to be addressed at the federal level.

Amy Acton, Running for Governor in Ohio

Amy Acton stands, speaking to a crowd with a microphone. Around her, supporters hold signs that read, "Dr. Amy Acton for Governor."
Amy Acton addresses attendees at a campaign rally in Cincinnati on April 28. (Jon Cherry/Getty Images)

Acton ran Ohio’s health department from February 2019 to June 2020.

During the first months of the pandemic, Acton appeared at daily news conferences with the state’s Republican governor, Mike DeWine, that were jokingly dubbed “.” She earned fans with her calm and positive demeanor while explaining her approach to keeping covid at bay.

But she also attracted critics with her recommendations to stay at home, mask up, and shut down some businesses to curb the virus’ spread. Protesters even showed up at her home.

Acton’s Republican opponent in the governor’s race, Vivek Ramaswamy, has labeled her “Dr. Lockdown” on social media. His criticism of her role in shutting down businesses could prove effective with the economy at the top of many people’s minds, said Christopher Devine, a University of Dayton political science professor.

“It’s a double-edged sword, because she also really upset some people,” Devine said of Acton’s time as the health director during the pandemic.

He said that is a tricky attack for Ramaswamy to pursue, though, because DeWine — still the sitting governor and a popular conservative figure — endorsed the covid measures Acton recommended, granting her emergency powers to sign the orders, and has since said he takes all responsibility for those actions.

For her part, Acton has done little on the campaign trail to highlight her time as the state’s public health director. Instead, she has focused more on healthcare affordability, highlighting the Trump-led cuts to Medicaid and the scaled-back subsidies for ACA plans that have resulted in dropping coverage in the state.

“I hear from families across Ohio that healthcare costs are rising and they just can’t keep up,” Acton said in an emailed statement. “That’s why I will fight to protect and expand access, reduce the price of prescription drugs, forgive medical debt holding Ohioans back, and lower premiums.”

Abdul El-Sayed, Running for U.S. Senate in Michigan

Abdul El-Sayed speaks on-stage at a venue. Behind him is a backdrop that reads, "Abdul for US Senate." Blurred in the foreground are the silhouettes of two heads of people watching El-Sayed speak.
Abdul El-Sayed at a campaign event in Ferndale, Michigan, on July 25. (Emily Elconin/Getty Images)

El-Sayed — who ran the health departments in the city of Detroit and Wayne County, Michigan — is one of two leading Democratic candidates for Senate. The primary is Aug. 4.

El-Sayed, a progressive, is facing off against Haley Stevens, a four-term congresswoman. They are vying to run against Republican nominee Mike Rogers, a former congressman, for the Senate seat held by retiring Democrat Gary Peters.

From 2015 to 2017, El-Sayed ran the Detroit Health Department, which and privatized as part of the city’s 2013 bankruptcy. In his role, he led efforts to test Detroit schools for lead in the wake of the Flint water crisis and provide free eyeglasses to children in public schools.

From 2022 until 2025, he ran the health department in Wayne County, the state’s most populous county, which includes Detroit. In that job, he initiated a program to retire medical debt for thousands of residents and make naloxone available in public areas to reverse the effects of opioid overdoses.

In an interview with Ñî¹óåú´«Ã½Ò•îl Health News, El-Sayed said his public health experience helped him become an effective communicator and challenge corporations and the role they play in healthcare.

“Politics have become overrun by big money and corporations, and my training and background in public health has taught me to think about that and push back against it,” he said.

El-Sayed, who did not practice medicine after completing his residency and is not licensed to do so, has faced criticism from some in his party for calling himself a doctor.  

El-Sayed, who has endorsements from Sen. Bernie Sanders (I-Vt.) and U.S. Rep. Alexandria Ocasio-Cortez (D-N.Y.), supports “Medicare for All,” a policy favored by many progressives that would make more people eligible for the federal health program for people who are 65 and older or disabled.

David Dulio, a professor of political science at Oakland University in Rochester, Michigan, said that the broader economy, Trump’s tariffs, and trade are eclipsing healthcare this year as top concerns for voters in the state. But he added that “progressive stances such as Medicare for All are attractive in the Democratic primary electorate.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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

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