Céline Gounder, KFF Health News’ editor-at-large for public health, discussed the cyclosporiasis outbreak on CBS News’ CBS Mornings on Aug. 5. Gounder discussed New Mexico’s measles outbreak on CBS News 24/7’s The Daily Report on Aug. 4. She also discussed peptides on Ideastream Public Media/WKSU’s Sound of Ideas on Aug. 3.

• Click here to watch Gounder on CBS Mornings.
• Click here to watch Gounder on The Daily Report.
• Click here to hear Gounder on Sound of Ideas.

KFF Health News chief Washington correspondent Julie Rovner discussed the end of a Biden-era Medicare Part D subsidy on WBUR’s Here & Now on Aug. 3.

• Click here to hear Rovner on Here & Now.

KFF Health News Southern correspondent Sam Whitehead discussed the new medical frailty work requirements on WUGA’s The Georgia Health Report on July 31.

• Click here to hear Whitehead on The Georgia Health Report.
• Read Whitehead’s “Doctors ‘Cringe’ at Possibility of Documenting Which Medicaid Enrollees Too Sick To Work.”

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Media round-up about the decertification of Network of Hope, the federally designated organ procurement organization.

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For years, Washington, D.C., has paid for Medicaid — the state-federal health insurance program for low-income people — out of its general budget. But next year, the city is shifting part of that recurring multimillion-dollar cost to a new funding source: opioid settlement dollars.

That’s raising red flags for addiction recovery advocates, people directly affected by the crisis, and the commission in charge of recommending how the city uses its share of the settlement money.

The opioid payouts come from a host of companies that made or distributed prescription painkillers and were accused of fueling the overdose crisis. State and local governments nationwide are set to receive more than $50 billion over almost two decades. Washington, D.C.’s cut is expected to exceed $100 million.

The money is meant to remediate the addiction crisis, often by increasing services or funding new programs.

But many states are facing increasing fiscal pressures as they are squeezed by inflation, federal funding cuts, and rising costs. Some officials have been tempted to turn to opioid settlement cash as a budget stopgap — an idea that can trigger opposition and outrage from recovery advocates and people who have struggled with opioid addiction and their family members.

“These funds were awarded to D.C. for very specific reasons and with a specific mandate, which are to remediate issues related to the opioid crisis in new and innovative ways,” said Queen Adesuyi, a partner at Reframe Health and Justice, a consulting group for community-based organizations, who is crying foul over the proposed fiscal year 2027 budget.

A document provided to KFF Health News shows line items in the district’s fiscal 2027 budget that would direct about $2.3 million in opioid settlement funds to help pay for the city’s Medicaid contribution and at least $5.5 million to support addiction treatment centers previously funded through the general budget. Substituting opioid settlement dollars for general funding keeps overall spending on treatment flat instead of increasing.

“Opioid settlement dollars are not meant to be a rainy-day fund for existing government obligations,” said Shelly Weizman, associate director of the Center on Addiction and Public Policy at Georgetown Law’s O’Neill Institute.

More than 80 individuals and 30 city organizations signed a letter protesting this use of settlement dollars, saying the district’s Department of Behavioral Health planned to spend opioid cash to “pay off its own debts.” The letter was sent to DBH Director Barbara Bazron; the chair of the D.C. Council’s Committee on Health, Christina Henderson; and Attorney General Brian Schwalb.

Chad Jackson, himself in recovery, chairs the district’s Opioid Abatement Advisory Commission, which was created to advise the city on how to spend its settlement dollars. Jackson called the latest move supplantation, a budgeting tactic that shifts money from one fund to another to free up dollars.

“If the opioid settlement funds were not there, I feel pretty confident that these things would have been funded, because they have to be funded,” Jackson said.

What’s happening now is against the district’s opioid litigation law, he said.

The law says that money from the district’s opioid abatement fund “shall supplement, and not supplant.”

“It’s a pretty tightly written law where the intent is very clear: Do not supplant,” Weizman said.

Adesuyi, an advocate for programs that help people who use drugs, said the council is flouting that law and that it’s a “slap in the face.”

Queen Adesuyi is a Washington, D.C.-based harm reduction advocate and partner at Reframe Health and Justice, a consulting group for community-based organizations. At the July 15 meeting of the Opioid Abatement Advisory Commission, they speak against the city’s use of opioid settlement dollars to fill budget holes. (Aneri Pattani/KFF Health News)

Councilmember Henderson and Attorney General Schwalb weighed in too.

“We are also concerned that DBH may be using the settlement monies for other unauthorized purposes,” they wrote in a July 17 letter to the department. They highlighted the $2.3 million used to cover the city’s Medicaid contribution and asked the department to explain by July 31 how it determined that was legal.

It’s unclear whether the Department of Behavioral Health met that deadline. DBH, Henderson’s office, and the attorney general’s office did not respond to that specific question.

However, DBH spokesperson Denise Reed said in a statement that the department is “committed to compliance with all statutory requirements governing opioid settlement funds.” The department’s general position has been that its budget was approved by the council, and that the funding supports efforts that counter opioid addiction.

The council in June “passed a legally-certified budget for the next fiscal year that makes the best use of all local resources, including the opioid settlement fund, to award grants to 17 community-based providers who last year served nearly 9,800 residents including 3,500 in medication-assisted treatment for opioid addiction,” Reed told KFF Health News.

The district’s budget is pending a 30-day “congressional review,” which is the last step in its annual budgeting process.

Still, some residents like Adesuyi want more accountability for how the opioid money is spent.

“The drug supply is getting a lot more unpredictable, which calls for some nimbleness, and it calls for interventions that are more courageous. Unfortunately, DBH is not meeting the mark when it comes to that,” Adesuyi said, adding, “It’s frustrating, it’s disappointing, and it’s enraging because people are dying unnecessarily in the district to overdose.”

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

The Host Julie Rovner KFF Health News @jrovner @julierovner.bsky.social Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF 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 KFF 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 KFF Health News.

Panelists Joanne Kenen Johns Hopkins University and Politico @JoanneKenen @joannekenen.bsky.social Read Joanne's bio. Alice Miranda Ollstein Politico @AliceOllstein @alicemiranda.bsky.social Read Alice's stories. Amanda Seitz KFF Health News @AmandaSeitz 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’ “Spotlight on Fauci Said To Boost Book Sales for Kennedy and His Publisher,” by Sheryl Gay Stolberg.  

Alice Miranda Ollstein: NOTUS’ “Rand Paul’s Fauci Diary Dump Exposed People’s Medical Histories,” by Margaret Manto.  

Joanne Kenen: The New York Times Magazine’s “The U.S. Relies on Family Caregivers. Millions of Them Are Kids,” by Helen Ouyang.  

Amanda Seitz: The Wall Street Journal’s “A Florida Surrogate, a Father in China, and the Babies Caught Between,” by Katherine Long.  

Also mentioned in this week’s podcast:

• The Bulwark’s “The ‘Medicare for All’ Test for Michigan Democrats,” by Jonathan Cohn.
• The New York Times’ “Uninsured Patients Rise Sharply, Hospitals Report, Citing Obamacare Cuts,” by Reed Abelson.
• Politico’s “Blanche Assures Anti-Abortion Supporters That Dobbs Will Be ‘Permanent in Every Single State,’” by Alice Miranda Ollstein and Josh Gerstein.
• Underlying Conditions’ “RFK Jr. on CNN: Fact-Checking the Measles and Autism Claims,” by Céline Gounder.

Credits Francis Ying Audio producer Taylor Cook Audio producer Emmarie Huetteman Editor

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, the NPR app, YouTube, Pocket Casts, or wherever you listen to podcasts.

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Proposed Rule Could Create Up to 268,000 New Slots While Strengthening Focus on Health and Nutrition

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 KFF 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, according to data from the Department of Housing and Urban Development. Last year, about 746,000 people were homeless.

Many, like Pugh, qualified for Medicaid, though the number of enrollees who are homeless is difficult to measure. In 2023, 55% of patients who received medical or behavioral health services through one of the nation’s roughly 300 Health Care for the Homeless 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/KFF 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 KFF 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 sued the Trump administration 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 more than 5 million 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/KFF 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/KFF 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/KFF 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.

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

In this “How Would You Fix It?” interview, Julie Rovner, KFF 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 has dubbed MediKids. 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.

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

HHS announced that Kentucky has become the latest state in the nation to achieve full participation in the Department’s Nutrition Education Initiative.

HHS began the decertification of Network for Hope, the federally designated organ procurement organization

Julie Rovner, KFF Health News’ chief Washington correspondent and host of the What the Health? podcast, joins An Arm and a Leg host Dan Weissmann to discuss the state of U.S. healthcare.

Rovner talks about the fallout from Trump administration cuts to Medicaid and Affordable Care Act subsidies. She also shares why she thinks healthcare will play a big role in the 2028 presidential election, and how she hopes her new podcast project — “How Would You Fix it?” — will contribute to the discussion.

You can hear “How Would You Fix It?” on Rovner’s weekly What the Health? From KFF Health News podcast, in which she speaks with newsmakers and journalists from top media outlets about the latest health policy headlines. 

Dan Weissmann @danweissmann @danweissmann.bsky.social Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on "All Things Considered," Marketplace, the BBC, "99% Invisible," and "Reveal," from the Center for Investigative Reporting. Credits Emily Pisacreta Producer Lynn Barbera Producer Adam Raymonda Audio wizard Ellen Weiss Editor Click to open the Transcript Transcript: Julie Rovner is worried: Checking in with a veteran DC reporter.

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there. It was just a little more than a year ago, in May 2025, the last time I checked in with my colleague Julie Rovner. She’s the chief Washington correspondent for our pals at KFF Health News and in what I would call a normal world, like a little more than a year would be really, really soon to talk with her again on this show.

Cause when I started making An Arm and a Leg, I didn’t expect that trying to keep up with the news was gonna be anything I would really have to think about too much. Like, I was setting out to understand and explain a multi-trillion dollar chunk of the economy that isn’t the tech industry, so I was like, how fast could it possibly move? And Julie Rovner’s thing is fast-moving news. On her weekly podcast, What The Health?, she leads a round table of health policy experts and journalists, and pours over a steady stream of headlines. Like whatever happens, big or small, Julie is tracking it. 

And then came 2025, and suddenly there’s this avalanche of news, and it’s big. Like, the Trump administration was making these sweeping changes, cuts to federal health programs. It was a ton of change, and I wanted to talk to Julie to try and wrap my head around it. And she told me even she was struggling to keep up. 

Here’s what she said then.

Julie Rovner: I’m trying to keep a running list of what’s been cut and what’s been restored, yeah, and it’s virtually impossible because there’s 20 things every day.

Dan: Yeah. And a lot’s happened since then. Like, Congress has added work requirements to Medicaid. It allowed federal subsidies for Obamacare to expire for millions of people. And those are, like, the biggest picture items. The rest of it feels like a blur. So, pop quiz: do we have a permanent FDA commissioner, CDC director, surgeon general?

I looked it up. As of July 21 the answer is no, in all three cases. It is an avalanche. So I wanted to talk to Julie again to get a glimpse at that avalanche from, like, further up the mountain, so to speak. 

Julie, thank you so much for coming back.

Julie Rovner: Always a pleasure, Dan.

Dan: Well, we’ll see how much of a pleasure it is to talk about the American healthcare system, but let’s give it a shot. 

Dan: This is An Arm and a Leg, a show about why healthcare costs so freaking much and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter. I like a challenge, so the job we’ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful. This time with help from Julie Rovner. Here we go.

Julie, last time we talked, you were astonished and worried about the pace of change and, like, destruction given all the cuts at the Department of Health and Human Services. And here’s what you said then…

Julie Rovner: How I’ve been thinking about this is that our healthcare system is a giant Jenga tower and it’s a little wobbly and what holds it up is everything that happens from the Department of Health and Human Services and they’re yanking out sticks from this Jenga tower as fast as they possibly can and when the whole thing comes down, it’s gonna be very not pretty.

Dan: So you said that a year and change ago, and just like the news I’m seeing this week, we’re taping more than a week before we’re gonna publish this, but there’s been a huge public health story in the news. You know, this outbreak of a foodborne parasite called cyclospora that causes explosive diarrhea.

Boris Sanchez: a warning to more sensitive viewers, this next story is kind of gross.

Caitríona Perry: If you are about to tuck into a bowl of raspberries or a big plate of salad, we’re very sorry because we may be about to put you off your food.

Dr. Richard Smith: If you’re somebody that’s into going to salad bars on a weekly basis Just give that a rest for a week or two

Dan: Yeah again, we’re taping this in mid-July, so maybe this all gets cleared up by the time we publish, but right now, like, I’m personally having early COVID flashbacks trying to figure out what fruits and vegetables are safe to eat and how long I have to cook them.

And you know, sure enough, folks are pointing out that among last year’s many cuts at HHS was federal tracking of a half dozen foodborne pathogens, including this one, cyclospora. So I mean, it all feels a little on the nose. Julie, how are you seeing all this play out?

Julie Rovner: Yeah, it does feel very on the nose, if you will, um, because we’re, like, a month into this outbreak, and it’s a very big outbreak. But we still don’t know what’s causing it. So now we’re having, you know, I saw this morning, uh, a recommendation from a doctor said, “Just don’t eat any fresh fruits and vegetables for the next week or so,” um, because this is unfortunately a parasite that doesn’t –  you can’t necessarily get rid of by washing.

Which is not to say don’t wash your fruits and vegetables. Do wash your fruits and vegetables, but that’s not enough in this case. Um, but yeah, in an, in a normal world, we would know by now what it was, and nobody knows what’s safe to eat, and that’s what happens when you pull those pieces out of the Jenga tower.

Dan: Yeah. And again, like, a week from now when we publish this, who knows what we’ll know, who knows what we’ll be eating. But it seems symbolic.

Julie Rovner: Yeah, I think one of the things that’s going on, you know, last year when we had sort of DOGE cutting and, you know, there were headlines everywhere, and this, these many people were being laid off, and these many people were taking early buyouts and, you know, there was, there was all of this sort of coverage if you will, of all of these cuts.

Things are still not happening, and things are still getting cut, and it’s much quieter. You know, money that officials promised would get distributed as Congress ordered, um, is not getting distributed as Congress ordered. 

So, you know, there are people who are waiting for grants that have not come. Things are still getting cut. Um, political appointees are still making decisions that often, that in the past were always made by career professional scientists, um, doctors, um, people with long experience. As we know, we’ve seen large cuts at a lot of these agencies, so there’s a lot of expertise that’s walked out the door.

So even if there are people still there, they don’t necessarily know as much as they used to. Um, things are sort of going on at that lower level that are not making headlines, but that are still, for the people who are involved in them, or at least what they tell me, are not great.

Dan: Yeah. And what are you seeing play out as a result of the cuts that we’ve seen so far? Like, what are you hearing about that I – like, what do I not know that my neighbors might be experiencing, but I just don’t happen to be hearing about?

Julie Rovner: What you don’t know is how many people are not getting needed medical care because they can’t afford it, whether because they lost their subsidies for the Affordable Care Act and they couldn’t continue to afford their insurance, or in even more cases, their subsidies went down and they bought down into less generous policies and now they have, you know, five-figure deductibles, and so they have insurance, but they still can’t afford to get care.

Or they may be legal immigrants who lost their eligibility for health insurance that they used to have, um, or they may be part of a mixed-status family that dropped insurance because they were afraid of getting targeted by immigration authorities even though, you know, some, some people in the family, were perfectly eligible for these programs.

And we have seen states that are starting to cut back on Medicaid in anticipation of some of these federal cuts that mostly take effect next January, but that are starting to take effect in states already. 

Adam Atchison: Some individual caregivers in Colorado are about to see their Medicaid funding cut.

Michael Perchick: Tonight, the major question remains what can North Carolina do to make up for that major funding shortfall? 

Justin Corr: One of the biggest issues we knew the Idaho Legislature would debate this year. Now Medicaid cuts are moving forward.

Julie Rovner: And we’re seeing states that are cutting back on optional programs, which, you know, members of Congress last year when they were debating this bill said, “Oh, we’re not gonna go after people, you know, who are seniors or who have disabilities.”

Um, except those are the programs that are optional, and when states have to roll back their Medicaid programs, that’s what they roll back, and indeed, that’s what’s happening, and we’re seeing, you know, story after story. But again, these are happening a little more quietly, making fewer headlines. But for the people they’re hurting, they are really hurting.

Dan: Wow. Yeah, I mean, a couple of stories that I, you know, you’re reminding me of, right, that, um, new federal rules keep rolling out, and some of them include eligibility for Medicaid for, like, people giving care or, or what it means to be medically frail and not be able to work, right? Tightening those restrictions and saying, “Look, it’s, you’re gonna have to jump through a lot more hoops to prove that you can’t work.”

Julie Rovner: Yeah, almost all of these rules are being … Those are not finalized yet, but almost all of these rules are also being challenged in court, um, by states, by, uh, healthcare providers, who obviously wouldn’t get paid anymore for providing this care, um, and by patients. So we will see, you know, how these ultimately play out.

But there are, you know, a — this administration has been sort of cut first, answer questions later. That’s been kind of the theme from the beginning, and that is still what’s going on. You know, one of the things we’re gonna talk about, um, on our podcast this week, uh, are stories of family caregivers, people who are losing eligibility for their families, uh, to help take care of them. You know, and, uh, Dr. Oz, who’s the head of Medicare and Medicaid, you know, has been talking about people who are, you know, collecting money for, you know, going to the grocery store or bringing in the newspaper…

Dr. Oz: Something called personal care services. You’ve never heard of that. Personal care services, basically, you’re paying your kids to carry the groceries upstairs, but you’re not actually paying. The state’s paying, and then the federal government’s paying the state back.

Julie Rovner: That’s not what these people are doing. These are people who are changing feeding tubes and, you know, helping people who are not ambulatory in and out of bed and on and off the toilet. I mean, this is … these are very, very difficult jobs, um, that, yes, sometimes family members are paid to do, but if they make it impossible, a lot of these people don’t know where they’re going to get help, and in some cases, these patients are gonna end up in institutions, and that’s gonna end up costing the federal government and taxpayers even more money in the long run.

Dan: And, and these cutoffs are happening now? 

Julie Rovner: They are. 

Dan: Like, folks are, folks are getting notices or being told, like, “No, your check for taking care of mom isn’t coming this week. You’re not getting that.”

Julie Rovner: That’s exactly what’s going on. In, in, in my home state of Maryland, they are cutting off this program. I believe… I can’t remember the exact date. It may be, there may be another month or so, but it’s, you know, they are getting notices that these programs are ending and I think Maryland is one of a half a dozen states that’s doing that.

Dan: Wow. And it’s, it’s like you said, these huge stories, they’re not grabbing a lot of headlines. I mean, like recently on your show, you were like, “What was shocking last year is now kind of status quo,” like at least in terms of media attention. But you’re still tracking all of it. 

And, all this reminded me of what you said when I talked with you the first time last year. So our Zoom meeting started, we started rolling tape. I said, “How are you?” And this is what you said:

Julie Rovner: I have a shirt that says, “Up and not crying.” I also have a shirt that says, “This is not normal.”

Dan: And I wanted to ask you, like, how are you doing now? Are y- d- are those shirts still in your wardrobe?

Julie Rovner: They are, and I have another one that says, “This is my living in unprecedented times shirt.” And I kind of rotate them.

Dan: And, and how, because many of us have the option, I always figured I did, of like, “Yeah, I’m gonna, I’m gonna titrate my exposure to news. I’m gonna calibrate, like this is how much I, you know, is good for me, is healthy for me to have right now.” And you know, some people turn it off altogether. And you do not have that option, unless you choose to do something entirely different. But like, I wanna ask you personally, like what is that like for you? 

Julie Rovner: It’s exhausting. 

Dan: Yeah.

Julie Rovner: I mean, I, and I worry. I worry about people, um, who need healthcare and aren’t getting it. I worry about students who, um, are trying to decide whether they can actually pursue their dreams of becoming a healthcare practitioner or a scientific researcher who are seeing sort of their pipelines cut off. That’s, that’s a big concern for me right now.

And I see things like Ben Sasse, the former senator who was very near death from pancreatic cancer, suddenly being able to take a new drug. And he said that, you know, his cancer is 99% gone. I mean, you see these medical breakthroughs that frankly government-sponsored research has helped bring to us, um, and I worry about whether they’re gonna be there for the next generation.

I mean, that’s something that’s, that’s really sort of jumping out at me. It’s like, look at all the things that we can do. Do you know why we’ve been able to do this? We’ve had this bipartisan agreement that investing in science and medicine is a good thing. That’s separate and apart from the fact that our healthcare system is messed up and costs too much, which I know is what you concentrate on – thank you very much. Um, but, you know, both of them are in trouble right now. And as I say, it’s not so much … You know, last year it was all the headlines. Now it’s just sort of, as I said, it’s kind of become the status quo that things are crumbling, and that worries me even more than when it was all over the headlines.

Dan: Coming up, I get Julie’s take on what’s happening to the Affordable Care Act and what she thinks is gonna happen in 2028 and beyond. That’s next

Dan: This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom covering health issues in America.

The folks at KFF Health News are amazing journalists like, you know, today’s guest, Julie Rovner. Their work wins all kinds of awards every year, and we are honored to work with them

Dan: So, Julie, you know, since the last time we talked, as you noted: some Obamacare subsidies ended, and premiums went through the roof. Millions of people have dropped their insurance. And lots have signed up for cheaper plans that cover less.

And now, the Trump administration has been rewriting the rules for next year to encourage more people to sign up for plans that would cover a lot less, like including plans that require you to spend $30,000 or more to cover your family before insurance kicks in at all. And, you know, like, the two pillars of the Affordable Care Act were, like, let’s use subsidies to make non-crummy private insurance affordable for most people, and let’s expand Medicaid.

So, Republicans kept saying they just wanted to repeal the ACA, but, you know, they never did. And now I’m wondering, like, are we seeing something that’s, like, effectively kind of a slow motion repeal of the ACA by other means?

Julie Rovner: Oh, absolutely. No question about it. Um, most of the Affordable Care Act has been dismantled over, you know, th- th- this was … Several people have written this story. It’s like, you know, Republicans failed on their repeal and replace when they called it repeal. But basically, over the last 10 years, look at all the things we’ve taken away.

All the taxes that supported the financing of this have gone away. So the supporting taxes which were on mostly individ- you know, they were on health insurers, and drug companies, and, and large businesses, most of those have been, have gone away. Thank you lobbyists, you know, who came and said, “We don’t wanna pay these taxes.” Um, so basically the money’s just coming out of the treasury now. 

The- one of the things that the Republican budget bill did last year um, it didn’t roll back the explicit, expansion of Medicaid, but now we’re gonna have these work requirements, which, what we know from other states that have done work requirements end up, yes, taking off people who are, who simply refuse to work, but also because of the bureaucracy involved, end up cutting off people who are working, and who are eligible, and who do need the, the health insurance coverage. We have seen this.

You know, most of the people who end up getting kicked off the program get kicked off for what are called administrative reasons, which means they just could not navigate all of the required paperwork and bureaucracy. Um, so I mean, we really are seeing a slow motion repeal of the Affordable Care Act.

Dan: And so what might happen? I mean, Like, you’ve been looking at this for 40 years, and I’m, I am old enough to remember as a young person noticing that, like, when Bill Clinton ran for president in the early 1990s, you know, a big piece of the pitch was like, “Healthcare costs too much. Not enough people have insurance. We gotta do something about it.” And it, you know, they weren’t able to pass a law. But where might things go?

Julie Rovner: So let me tell you one of the things that kind of freaks me out. Um, would, and you go back to sort of the Affordable Care Act. I covered the Clinton health plan, and it- it died, as I like to describe, because, you know, everybody, all of those special interests wanted to cut off just one finger of it, and in the end, the patient bled to death. That’s sort of been my go-to metaphor for the Clinton healthcare plan. 

So what happened when they tried to put together the Obama healthcare plan is it like- like rather than have all of the special interest outside of the tent, let’s get all the special interest into the tent, and one of the ways they did that is said, “Look, if more people are insured, then you’re gonna get more of your bills paid.”

And particularly, you know, the hospitals and the drug companies said, “Yeah, that sounds good. We would like people to be able to pay for the things that we provide.” Um, well, so what are we doing now? We’re taking this apart, and we’re having people not be able to pay for things, and we’re having states not be able to pay for things.

States had used what was called creative financing for their portion of Medicaid, which remember, is a shared expense between the federal government and the states. So now you’ve got hospitals freaking out, and you also … I mean, we’re seeing hospitals close. It starts with rural hospitals. But, you know, I- I like to say it’s not just people without insurance who are gonna be impacted by this.

If health providers can no longer keep their doors open, then even if you have insurance, you may not have any place to go to get it. We’re already seeing healthcare deserts in, you know, less populated parts of the country. What is this gonna do when you see fewer people with health insurance, fewer people with Medicaid, fewer people with the Affordable Care Act?

Dan: Umm. Wow. 

Julie Rovner: Sorry, I’m just a continuing ray of sunshine.

Dan: No, no, no. No, no, you’re, you’re like– I’m asking you what might happen, you’re like, “Well, here’s the worst that might happen.” But, um, you know, what might a path look like to changing course?

Julie Rovner: Well, I feel like, you know, and when it comes to healthcare, the left is moving to the left and the right is moving to the right. Um, you know, we’ve always in, in the 40 years I’ve been doing this, um, and even going back to things like Medicare in 1965, what has gotten things done is when people, is when the two sides come together in a compromise. Those are the only big achievements in healthcare. Um, with the possible exception of the Affordable Care Act, which Republicans say, you know, “Oh, that wasn’t, you know, that w- that was only, that passed only with Democratic votes,” but it was a Republican idea. It was pulled from what Mitt Romney did in Massachusetts in 2006. So it was intended as a compromise, um, even if in the end the Republicans … The Republicans started moving right, I think, before the Democrats started moving left. 

But now you’re seeing, you know, most of the Democratic candidates, I’m looking in the midterms, you know, are, are back to the mantra of Medicare for All. Joe Biden was one of the few candidates in 2020 who did not endorse Medicare for All. He wanted to just expand the Affordable Care Act. That’s what was seen as a middle ground. 

Now nobody seems to want a middle ground. You know, the right wants to just take everything apart and get government out of healthcare in general and let people, you know, sort of give people a little bit of money and have them, you know, have the free market take over. And the left wants Medicare for All, which is, you know, the, the U.S. has tried to, to do what every other country has done and have universal coverage, and has so far not really succeeded at that. Although I will say at its peak, the, when the Affordable Care Act had the expanded subsidies, we were down to about an 8% uninsurance rate, which was the lowest since anybody had been keeping track. So it was, it was getting closer. 

Um, but now I see the parties moving apart. Will they move back together again at some point? I don’t know. Um, but, but for, I think, the immediate future, we’re seeing them retreat to their corners. And in healthcare that really, even though sometimes at the 30,000-foot level they’ve been fighting about that, at the 5,000-foot level they’ve been able to get together and do things. Um, a good example is the No Surprises Act, you know, the let’s get rid of surprise bills. 

Um, I’m not sure I even see them coming together on sort of the little stuff right now. Everybody is just very, very, very unhappy with everybody else.

Dan: Wow. Well. Okay. Uh, it’s not the cheerfulest thing I ever

Julie Rovner: You look like you’re, you’re processing that.

Dan: I am. I am. I am. I am. And of course, you know, as you say, during this period when people had, when the, the greatest proportion of people had insurance, uh, you know, I’m still doing this show. I mean, people have insurance, but having insurance doesn’t necessarily mean you have healthcare that you need and can afford.

Julie Rovner: Yes, everything. We will both be employed for as long as we want talking about the foibles of the U.S. healthcare system.

Dan: I mean…

Julie Rovner: That I am con- that prediction I am very confident of

Dan: I will never run out of material – that’s the crappy thing. But things are, like we said, they’re accelerating, they’re different, and I’m wondering how is all this changing how you see your job going forward?

Julie Rovner: Well, one thing that I’m, working towards myself, is I am predicting that we are going to have another major political throw down over healthcare in the coming years. Not necessarily next year, but probably, you know, the … I think this will be a big focus of the 2028 presidential campaign, and in 2029 we’re gonna have a big debate.

Are we gonna solve anything? I have no idea. But in preparation for that debate, I feel like there’s a whole generation that sort of didn’t live through the Clinton health plan, and that didn’t even live through the fight over the Affordable Care Act, and that one of the things that I would like to do as sort of a public service, um, is throw all of the options back on the table for people to see that, you know, that if this was easy, we would’ve solved it a long time ago. 

So I am … One of the things that we’re doing as part of our podcast is a special project called How Would You Fix It? I am sort of calling every smart person I know from across the ideological spectrum and asking them, “Okay, how would you fix it?”

I mean, I’m nearing retirement myself. I feel like I have this obligation to kind of, you know, shepherd the people who wanna learn through another round of this, um, so that we can have an educated debate and decide what we as a society wanna do about healthcare.

Dan: Wow. You think there will be a great big conversation, there will be a great big change. 

Julie Rovner: Uh, I think there will be a great big conversation. I don’t know that I think there will be great big change. I’ve, I’ve, I have covered enough of unsuccessful ones of these. I, I am not predicting its success, I am simply predicting the fight.

Dan: Fair, fair, fair. But, uh, even so, um, having a big public conversation seems better than not. 

Julie Rovner: As a journalist, I would think that. As somebody, and who’s … As somebody who cares about the, the, the sorry state of our healthcare system, I, I think it would be — I think it’s time.

Frankly, one of the reasons I think this is about to happen is that when in the early 2000s, when we were sort of building up to the fight over the Affordable Care Act, you could sort of see it coming because everybody was unhappy, and everybody wanted to sue for peace.

Um, you know, that the, the hospitals were unhappy, the drug companies were unhappy, the doctors were unhappy. You know, the, the employers were unhappy. The labor unions were unhappy. I feel like that is true again, and it’s more true.

And now even the haves, what we call them, the people who have insurance and don’t want, you know, are afraid of change, even the haves are unhappy. Everybody thinks they’re paying too much, which is why I’m predicting we’re gonna have another big public debate about this in the next four or five years.

Dan: I think the prospect of having a big public debate about a big public problem also strikes me as like an optimistic stance for anyone who cares about, you know, living in a democracy where people have a say in, in democracy where people have a say in what happens.  

Julie Rovner: It is, I, I’m sort of clinging to it as a, as a hope

Dan: Mm-hmm. I, uh, I just really appreciate that.

Julie Rovner, thank you so much for joining me. It’s been such a pleasure. Um, till next time, I’ll be listening to “How Did You Fix It?”

Julie Rovner: Thank you, Dan. And see, talking to you makes me feel better.

Dan: All right. That’s what I’m going for. That’s what I’m going for. Let, let’s stay in touch. 

Julie Rovner: We will. 

Dan: All right. Great. Take care. 

Julie Rovner: Thanks, Dan. 

Dan: Bye-bye. 

Dan: Okay, so I asked Julie Rovner how the avalanche of change has her thinking about her job description these days, and I wanna share how I’ve been thinking about mine.

You might have noticed over the last couple of months we’ve taken a break from producing podcast episodes, and here’s why. Basically, in April a few family health issues blossomed all at once. And as I turned my attention there, I realized I had some health issues of my own that needed attention. 

I started making this show eight years ago. I’ve been running it on a shoestring ever since, and that has meant running myself a little ragged sometimes. Honestly, too often and for too long. That’s not good for my health, and it’s not good for An Arm and a Leg, ’cause a ragged version of me does not make the best version of this show.

I needed some time just to break some habits — I called it detox from workaholism — and I needed to attend to my own health.

Like, earlier this year, I’d scheduled a little surgery, and I put it off ’cause I got sick from — you guessed it — running myself so ragged. And of course I was still trying to run so hard, I couldn’t imagine when I might reschedule it. So honestly, it wasn’t until I put myself on break for a minute that I even thought, “Oh yeah, I, I could do that surgery now.”

So surgery happened in early June. I’m all healed up, and I’ve been working with a really excellent therapist, and I’ve been incredibly grateful to my colleagues for their patience and for keeping things running. And together, we are starting to put together some new ways of doing things. It’s gonna be a work in progress.

There are so many things we wanna do. But I can’t be a workaholic anymore. So for our next episode, we’re gonna bring back one more favorite from our archives, give ourselves a running start, and then we’ve got some incredible, important stories and projects we just can’t wait to get back to. For now, thank you so much for sticking with us. It is a privilege to get to do this work, make this show for you, and to work with my incredible colleagues.

I will catch you soon. Till then let’s all take care of ourselves.

This episode of An Arm and a Leg was produced by Emily Pisacreta, with help from our summer intern, Lynn Barbera (welcome, Lynn!) — and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

Claire Davenport is our engagement producer.

Amanda Boyd is our Operations Manager. Bea Bosco is our consulting director of operations. 

An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show.

An Arm and a Leg is distributed by KUOW, Seattle’s NPR news station.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially.

You can join in any time at arm and a leg show, dot com, slash: support.

An Arm and a Leg is a co-production of KFF Health News and Public Road Productions.

For more from the team at An Arm and a Leg, subscribe to its weekly newsletter, First Aid Kit. You can also follow the show on Facebook, Instagram, LinkedIn, and Bluesky. And if you’ve got stories to tell about the healthcare system, the producers would love to hear from you.

To hear all KFF Health News podcasts, click here.

And subscribe to An Arm and a Leg on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Vanessa Barahona received a call this past spring from Angelica at Kern Family Health Care in Bakersfield, California, telling her it was time to renew her coverage under Medi-Cal, the state’s version of Medicaid.

Angelica helped Barahona, 41, schedule an appointment to complete her paperwork in person at Kern Family’s offices before she submitted it to Kern County officials for approval. When Barahona had a conflict with her office-cleaning job, Angelica rescheduled the appointment. Barahona finished the process a little later than she’d planned but early enough to avoid an interruption in her coverage.

“It was easy. The fact that Angelica spoke Spanish when we were on the phone made it better,” Barahona, whom KFF Health News met through Kern Family Health Care, said via a translator. “It felt like I was talking to a real person.”

She definitely wasn’t.

“Angelica” is the name assigned to an AI program deployed last year by Kern Family Health Care, the largest provider of Medi-Cal services in Kern County. An estimated 52% of residents there rely on the safety net program for health coverage, among the highest enrollment rates in the state.

Kern Family has spent about $370,000 on the software from Careforce, a San Francisco startup, to facilitate rapid and repeated outreach to members when it’s time to renew their coverage — a process that is about to become more complex under new Medicaid eligibility rules established under Republicans’ One Big Beautiful Bill Act, signed into law last year by President Donald Trump. Mandatory work requirement documentation will take effect nationally beginning in 2027, and under the GOP’s new rules, most Medicaid patients will now have to renew their enrollment twice a year, rather than once a year.

Kern Family and other similar health plans have an interest in keeping people enrolled, since they’re paid through managed care contracts with Medi-Cal. They can also save money by using AI software to do what Kern says would otherwise require it to hire 40 full-time workers. Angelica does it at a fraction of the cost and without increasing payroll — or requiring Kern Family to navigate workers’ rights issues or government-mandated workplace protections.

Although Kern Family officials say no workers have lost jobs, the health plan, which is not unionized, estimated it would have had to spend $2.4 million in staffing costs to match the program’s more than 800,000 calls to its 387,000 members since Kern Family began using Angelica late last year.

As the federal government ended pandemic-era protections and states resumed screening people for Medicaid eligibility, health plans such as Kern Family began looking to technology to keep eligible people enrolled. Kern Family officials say that Angelica helps people, in their preferred language, set up appointments with the plan’s staffers, who make sure that applications are filled out correctly and delivered to county health officials for verification and processing.

Careforce CEO Huzaifa Sial said Kern Family is one of a few health insurers using his company’s software to help boost its Medi-Cal enrollment, and the company is also working with the Central California Alliance for Health in much the same way. “Most people don’t know what they need, and if they do, they have a hard time getting there,” Sial said. “That’s the hidden execution problem that nobody sees.”

“Angelica” is the name assigned to a conversational AI program deployed last year by California’s Kern Family Health Care, the largest provider of Medi-Cal services in Kern County. Kern Family has spent about $370,000 on the software by Careforce, a San Francisco startup, to facilitate rapid and repeated outreach to members when it’s time to renew their coverage. (Screengrab of Careforce.ai)

The rise of AI in the healthcare industry has prompted worries about who’s overseeing these tools and whether people are being improperly denied treatments or cut off from care. Unions have raised concerns about workplace surveillance and the prioritizing of savings over safety. Polling shows widespread fear over AI-driven job losses and growing income inequality, while health policy researchers have also raised red flags about algorithmic biases, transparency, data privacy, and safety risks.

Mark Duggan, a Stanford University economics professor who has studied the Medicaid system for 30 years, said one long-standing fear is that insurers could use such software to cherry-pick patients for coverage.

“When you have a new technology like this, you need to police it,” Duggan said.

Complying With Regulations

California health plan regulators say they are tracking AI use closely, and the state attorney general’s office has sent reminders to healthcare entities about their obligation to follow consumer protection rules.

Anthony Cava, a spokesperson for the state’s Department of Managed Health Care, said Medi-Cal health plans have flexibility in how they handle member renewals, including with the use of AI tools. But plans are responsible for ensuring that technology complies with state and federal regulations, including patient privacy and data security, he said.

Last year, the agency, foreseeing the huge volume of reenrollments that were going to be required in the state, began allowing managed care plans to contact members about renewals. State rules still prohibit Medi-Cal health plans from soliciting new enrollees, and only county health officials determine eligibility.

Emily Duran, CEO of Kern Health Services (which administers Kern Family), said that the plan worked closely with the Kern County Department of Human Services to obtain some data, allowing Kern Family to know when a member’s Medi-Cal eligibility will expire.

The health plan, in turn, lets the county know anytime it receives updated demographic or contact information for its Medi-Cal members. And the county has stationed workers inside Kern Family Health Care’s main facility in Bakersfield to answer enrollment questions for people who walk in to finish their paperwork.

“They have a leadership group that is very innovative and forward-thinking,” Vanessa Frando, the chief deputy director of Kern County Human Services, said of Kern Family. The agency also works closely with other Medi-Cal providers in the county, Frando said.

Duran said the health plan was initially concerned about how Angelica would be received.

“We had to set the tone to really be open to the idea, because you hear ‘AI’ and you’re like, ‘Oh, yeah, Jeff Bezos laid off 100,000 people because of that,’” Duran said. “But we are already stretched thin. We need this functionality to be much more effective and augment our efforts.”

Duran said Kern Family’s leadership and staff bought in after seeing a demonstration.

Today, it would take 40 Kern Family employees, each working 40 hours a week, to match Angelica’s calls to remind people to reenroll and talk them through what is involved, according to Jackie Byrd, a spokesperson for the health plan. The AI program’s settings are constantly adjusted to match the capacity of Kern Family’s full-time staff.

Full Conversations With AI

Barahona said she received a Medi-Cal packet in the mail but didn’t think about it until Angelica called days later. That exchange highlights one of local and state health officials’ biggest concerns — that people who’ve grown accustomed to automatic renewals aren’t aware of the reenrollment requirements.

Angelica speaks more than 30 languages and can answer lengthy questions. In samples of actual conversations provided to a reporter, Angelica sounded lifelike at first, although more than once cross-talk with a patient caused the program to pause suddenly. Barahona said it took her a minute before she realized she wasn’t speaking with a human, but she ended up having a full conversation with Angelica.

Duran said Kern Family was able to redirect full-time staff to focus on the more complex parts of the Medi-Cal process, such as making sure the patients’ information is complete and up to date. The Angelica software also operates at all hours, making it easier for patients to call back at their convenience. Another version, David, is used internally to help staffers navigate the technology.

“This will always be, in my opinion, an AI-human combination,” said Careforce’s Sial. Working with AI solutions for more than a decade at UnitedHealthcare and Optum, Sial said, he saw an opportunity to improve the enrollment process by helping people organize their paperwork.

Kern Family’s Medi-Cal renewal rate in April was 94.9%, delighting the plan’s officials, who feared a significant drop-off from patients who’d gotten used to being automatically renewed over the past several years. By comparison, Duran said that about 80% of enrollments had automatically renewed under federal pandemic-era rules, but that figure was cut in half as those protections began to expire.

Kern Family officials say there could be other uses for Careforce’s software in the future; Angelica, like other generative-AI large language models, can learn and adapt to new situations and requests.

Cesar Delgado, Kern Family’s chief information officer, said Angelica is already being used to make general greeting calls to new members and can discuss plan benefits and answer basic questions. But Kern Family officials say the program’s primary purpose, for now, is limited to contacting patients whose Medi-Cal eligibility is coming up for review.

Duggan, the Stanford professor, said Angelica could help Kern Family minimize the number of Medi-Cal enrollees who lose coverage as federal requirements take effect.

“The best-case scenario is helping people to stay on when they don’t realize that things are changing,” Duggan said. “It’s not an easy program to navigate.”

This article was produced in collaboration with Capital & Main, an independent, California-based nonprofit investigative news publication that reports on inequality, climate change and other issues.

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

HHS Secretary Kennedy traveled to southwest Virginia as part of his “Take Back Your Health” tour.

HRSA-Funded Health Centers Served More Americans Than Ever in 2025 while Expanding Access to Primary Care, Mental Health, Dental Care, and Preventive Services.

HHS Secretary Kennedy announced the launch of The Real Food Show, a new cooking series designed to help Americans prepare healthy, affordable meals.

The Trump administration credits its fraud control efforts for the disappearance of millions of people from Obamacare rolls rather than a sharp rise in premiums — a claim disputed by policy experts that glosses over the reality that many more Americans now find themselves without health insurance.

Enrollment in Affordable Care Act plans fell by nearly 3 million this year to about 19.2 million, following steep premium increases by insurers and the Republican-led Congress’ unwillingness to extend more generous premium subsidies. On average, ACA customers pay $178 a month in premium payments this year, a 58% increase from 2025, according to KFF, while their deductibles — the amount consumers must pay annually before insurers pick up their share — have climbed 37% to nearly $3,800 a year.

“These are real people who are now forced to make impossible choices,” said Annalyse Keller, a spokesperson for Keep Americans Covered, a large coalition of lobby organizations for the healthcare industry, including insurers and patient advocacy groups.

But a Department of Health and Human Services report released in June, written mostly by President Donald Trump’s political appointees and allies, asserts that 5.6 million people were fraudulently enrolled in ACA plans in 2025, and that the Trump administration removed 2.9 million of them — the same number as the 2026 drop in enrollment.

There’s little dispute that the ACA suffers from some fraud, as do most government programs. The administration said it has taken actions to tighten the enrollment process to thwart brokers who fraudulently enroll people without their knowledge.

For example, the administration in August 2025 halted a Biden-era initiative that allowed low-income people to sign up for coverage year-round. Regulators also have removed 1.5 million people since 2025 for reasons such as not meeting a requirement to file their taxes over two years or being concurrently enrolled in another health program, such as Medicaid, which is not allowed.

But health policy experts say that the administration is overstating the extent of ACA fraud and that the HHS report relies on debatable assumptions, such as that all sign-ups under the year-round enrollment program for low-income people were potentially fraudulent. ACA enrollment fell off a cliff because of escalating prices for insurance plans, policy analysts say, which the administration’s done nothing to stem.

“The top-level claim” that all the decline in enrollment since 2025 is because of improper or fraudulent enrollees leaving the market “is not remotely credible,” said Matthew Fiedler, a senior fellow at the Brookings Institution. “We know that lots of people have seen higher premiums, and there’s really good evidence that when premiums go up, people drop coverage.”

Healthcare costs are a big concern for voters ahead of November’s midterm elections, and both Democrats and Republicans are trying to spin the issue to their advantage. Democrats argue more needs to be done to make insurance less expensive for consumers, while Republicans are trying to focus on the need to save taxpayer dollars from fraud.

A recent KFF poll found that voters trust Democrats over Republicans to address healthcare costs (37% vs. 26%). The poll also found, though, that 55% of Republican voters consider it extremely important for candidates to address healthcare fraud, more than any other issue, showing that the White House’s effort to shift focus from costs has had some success with its own supporters.

But Jonathan Oberlander, a professor of health policy and management at the University of North Carolina, questioned whether the fraud narrative will hold up as voters continue to struggle with rising costs.

“It will be cold comfort to the very real persons who could no longer afford coverage and dropped their plans,” he said in an email to KFF Health News.

How We Got Here

Under President Joe Biden, Congress passed a law that included more generous tax subsidies for people enrolled in Obamacare, starting in 2021. Those enhanced subsidies lowered premium payments, with millions qualifying for a large enough tax credit to reduce their monthly payment to zero. The Biden-era law also allowed wealthier households to get assistance.

ACA coverage essentially doubled, from just over 11 million Americans in 2021 to more than 22 million in 2025, according to the HHS report.

Republicans and conservative groups argue that the growth wasn’t driven only by people newly enrolling because of lower premiums. Instead, they say, the enhanced subsidies, along with other Biden-era policies — including easing income verification requirements for some enrollees — invited fraud. Unscrupulous, commission-seeking insurance brokers found it easier to sign people up for coverage, often without their knowledge, while ordinary consumers could more easily fudge their income and qualify for the largest subsidy possible.

The conservative Paragon Health Institute’s president, Brian Blase, wrote in a recent webpost that the HHS report’s conclusion on the scope of improper enrollment is likely an undercount. He remains unconvinced by the arguments that rising premiums are to blame for the sharp drop in ACA enrollment, saying subsidies remain generous for many people.

The Administration’s Current Targets

The debate will continue as more enrollment data emerges from the federal marketplace and the exchanges run by states. Some policy experts — including the consulting group Wakely — expect the year to end with the number of ACA policyholders down by as much as 26% from last year.

Trump’s regulators will likely connect further drops with anti-fraud efforts. The HHS report alleges there are potentially millions more who remain improperly enrolled. The report’s authors noted that some of the administration’s anti-fraud proposals have been blocked by court rulings.

In a video HHS released June 27, HHS Secretary Robert F. Kennedy Jr. pats Mehmet Oz, the head of the Centers for Medicare & Medicaid Services, on the back for the number of canceled ACA plans so far. Oz threatens potential ACA hucksters: “Don’t walk away from us, run! Because we are going to find you.”

In an email responding to KFF Health News’ questions, CMS spokesperson Christopher Krepich said his agency this summer will block ACA applications made by brokers that lack a Social Security number. By open enrollment this fall, CMS plans to require more identify-proofing when brokers enroll people and will limit a broker’s access to accounts until that person “has been authorized by the consumer to work on their behalf.”

How some suspicious enrollments will be removed is spelled out in emails sent in June to insurance carriers and obtained by KFF Health News.

CMS told insurers that the agency will send them files for ACA accounts it believes are potentially unauthorized. Each flagged consumer account will have used a sales broker to enroll, be in a zero-premium plan, and lack a Social Security or an immigration documentation number — which Kennedy said in the video is a glaring sign of fraud.

Insurers must try to contact the enrollees to verify that they signed up for coverage. After 60 days, insurers must report policies they were unable to verify to CMS, which will cancel them.

Krepich wrote that carriers are cooperating with efforts to investigate accounts with missing or unverified information.

Policy experts, including Fiedler, note that the absence of a Social Security number doesn’t automatically prove fraud. While it could indicate a fake enrollee, a missing Social Security number might also be a simple oversight by the consumer or their broker, for example, or a newborn added to a parent’s account at birth, before they’ve received a number.

“That the administration put it in a report and did not summarily terminate these enrollments suggests they believe there is some mix of different circumstances,” Fiedler said.

The administration report singles out another segment of enrollments as suspicious: very low-income, subsidy-eligible people who shifted to plans that carry no monthly premium, suggesting “fraudulent agents and brokers are moving them to keep gaining commissions and avoid detection.” The report also cites ACA enrollees who file no medical claims as suspicious.

Policy experts question the assumptions behind those concerns.

Younger or lower-income people use healthcare less often, for example, which can explain why they may make no claims — particularly when they must first spend thousands of dollars out-of-pocket to meet high deductibles.

And very low-income people may switch to plans with higher deductibles in exchange for making no premium payment because they struggle to come up with the $50 or $80 monthly share that other plans might require.

“People are hurting for money,” said Florida insurance agent Jason Fine. “I literally have people who can’t afford to pay $15. I would not immediately assume that a person who went from a silver plan to a bronze plan, that it’s fraud,” referring to two types of ACA plans.

Fine said the administration needs to focus on better enforcement of existing rules, saying he has reported to regulators dozens of unscrupulous agents who have switched clients without authorization, yet none were barred from selling ACA policies.

He and other agents continue to push for adding multifactor identification, as banks and other financial institutions use, to the federal ACA marketplace. Some states that run their own exchanges have two-factor authentication or other types of ID verification and have not reported problems with unauthorized switching.

CMS — under both Biden and Trump — has not added two-factor authentication to the federal marketplace, healthcare.gov.

Rep. Glenn Grothman (R-Wis.) introduced legislation to require it in June, but its prospects are murky.

“It will help reduce fraud,” said Ronnell Nolan, who leads Health Agents for America, a lobbying group that has long urged CMS to add the feature. Grothman’s legislation, she said, might “encourage CMS to do it themselves.”

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Amanda DeSimone-Shabrack relies on a home healthcare aide to help her high-needs autistic 12-year-old son. Virginia’s Medicaid program covers the assistance, enabling her to work as both an education technology specialist and a professor, run errands, and keep Mason in the home.

That could change. In June, the Department of Justice issued a legal opinion saying federal disability rights laws don’t require states to provide services that allow people with disabilities to remain in their homes rather than institutions.

It’s a sharp reversal from 1999, when a landmark Supreme Court ruling held that unjustified institutionalization constituted discrimination under the Americans with Disabilities Act. Previous administrations have relied on that ruling to enforce civil rights for disabled people, but the Trump administration says that long-held interpretation is wrong.

Advocacy groups say legal protections for about 40 million adults and 5 million children who have disabilities could be undermined, and they worry that the new interpretation may herald a return to forced institutionalization.

The stage is also now set for a legal fight between advocates, states, and the federal government. Some states with ongoing lawsuits challenging disability rights requirements are already citing the DOJ opinion in hopes it will help them prevail.

In a case in Texas, for example, some Republican-led states are arguing that a rule instituting a 1973 civil rights law that led to community and home integration of people with disabilities is costly and infringes on states’ rights.

People like DeSimone-Shabrack are especially worried because, they say, the opinion follows a spate of White House and Republican-led initiatives that have already begun eroding hard-won protections for people with disabilities.

“I’m worried. Am I going to have to put him in an institution, and what’s that going to be like for him?” said DeSimone-Shabrack, whose personal home care help was recently reduced from 30 to 18 hours a week by the state. “As he gets older, am I going to be able to care for him without this support?”

The Department of Health and Human Services remains steadfast in enforcing federal civil rights laws, agency spokesperson Emily Hilliard said in an email.

“Our commitment to ensuring that individuals with disabilities are treated with dignity, afforded equal opportunity, and are able to meaningfully access community services remains unchanged,” she said.

But advocacy groups say the DOJ opinion could have sweeping repercussions. The opinion doesn’t change existing law, but advocates worry that HHS and the DOJ could begin rescinding guidance and regulations that mandate integration for people with disabilities.

They’re concerned that agencies will stop enforcing disability laws that ensure people aren’t unnecessarily institutionalized. HHS, for example, has historically investigated disability discrimination claims at hospitals and in states that get federal funding, enforcing compliance with home and community integration through voluntary agreements. Disability rights experts say those agreements could now be imperiled.

And some states facing financial pressures may roll back Medicaid services that enable people with disabilities to stay in their homes and communities — a trend that’s already happening following last year’s passage of the One Big Beautiful Bill Act, which cuts a projected $900 billion-plus from the safety net program over a decade.

Democrats are seizing on the opinion, which was released in a DOJ memo, to portray President Donald Trump and Republicans as a threat to people with disabilities. Sen. Tammy Duckworth (D-Ill.) and other Senate Democrats led the introduction of a resolution calling on the DOJ to rescind the opinion.

“The Trump Administration’s memo is an outrageous attack on the rights and independence of the disability community,” Duckworth said in a statement.

The DOJ didn’t return emails seeking comment.

According to the DOJ’s interpretation, regulations that give disabled people the right to demand certain services for daily living — bathing, mental health counseling, and financial budgeting help, for instance — and that require states to extend community-based services to mentally disabled individuals are unlawful, a view the agency acknowledged “is out of step with the common understanding of that decision within the federal courts.”

States may have legitimate reason to treat mentally disabled people in institutions, “including resource constraints, capacity limitations in community-based facilities, and safety concerns for both the patient and the community,” the memo reads.

The Supreme Court case, Olmstead v. L.C., has long shaped federal policy. And while it remains to be seen how courts will respond to the DOJ, some states seeking to curtail disability protections see the opinion as significant.

Consider the 2024 lawsuit in federal court in the Northern District of Texas by Republican-led states arguing that an HHS rule about the integration mandate is unlawful. The lawsuit began with broader claims and 17 state plaintiffs. Following significant advocacy from the disability community, only Texas, Alaska, and Florida remain.

Following the new DOJ interpretation, the states filed documentation to inform the court about the memo as a new and relevant development. Similar documentation citing the memo has been filed in disability rights cases in Florida and New Hampshire, according to The Arc of the United States, a disability advocacy group.

Advocates for people with disabilities say the speed at which plaintiffs are citing the opinion underscores how it may be used to justify the erosion of protections.

“The administration’s attempt to dismantle decades of progress in community integration is alarming and inconsistent with federal disability rights laws and Supreme Court precedent as well as the critical enforcement work of prior administrations,” said Shira Wakschlag, senior executive officer of legal advocacy and general counsel at The Arc.

Forced institutionalization led to human rights violations, segregation, and a eugenics movement in the late 19th and early 20th centuries that included involuntary sterilization.

Exposure of the abuses, legal battles, and an independent living movement caused a major shift toward integration. Fewer than 1% of people with intellectual or developmental disabilities lived in state-run facilities in 2021, down from almost 30% in 1967, according to data from the University of Minnesota’s Residential Information Systems Project, which maintains metrics on such long-term services and supports.

The Trump administration has already taken steps to reverse that trend, advocates say.

Trump signed an executive order last year that addresses homelessness by expanding involuntary treatment and institutionalization, reversing a “housing first” approach championed by the Biden administration.

Much of the special education program office is moving from the Department of Education to HHS, raising concerns among advocates that the administration is reverting to a view that disabilities are a medical issue to be fixed rather than differences that can be accommodated.

And cuts in federal funding for Medicaid, a federal-state insurance program for people with low incomes or disabilities, also portend fewer resources and services. States have responded by reducing some optional benefits such as home health aides and support. In addition, qualifying for an exemption from the program’s work requirements, which take effect Jan. 1 in most states, will pose significant hurdles for people with disabilities.

The June DOJ opinion, advocates say, could accelerate the shift and result in court rulings that chip away at disability rights.

“While it doesn’t overnight change the law, it’s very troubling and very dangerous,” said Zoe Brennan-Krohn, director of the Disability Rights Program at the American Civil Liberties Union. “It reflects a really deeply held disrespect for disabled people from this administration and a total lack of awareness of the lived experiences of people with disabilities who are living in their homes.”

Data shows there can be benefits to involuntary institutionalization. Relative to those voluntarily admitted, people with psychiatric illness who were involuntarily admitted “experienced greater improvements in symptoms and function,” according to a September 2024 review in Psychiatry, Psychology and Law, a peer-reviewed academic journal.

Deinstitutionalization has created new challenges. More hospitals have been forced to board people with psychiatric illness in emergency rooms because of a dearth of available beds. And moving people into home- and community-based living was supposed to be accompanied by an increase in outpatient care and treatment that never materialized, creating gaps in support.

But advocates for the disabled community say involuntary institutionalization strips people of their autonomy and poses a higher risk of neglect and abuse.

Jennifer Kucera, 57, of Cleveland, spent two years in a nursing home. She has spinal muscular atrophy, a genetic disease that kills motor neurons, leaving her able to move only part of her left arm and her head.

At the institution, she said, she felt bored and trapped and developed intense itching from scabies, which is caused by microscopic mites.

For more than a decade, however, she has lived in an apartment with the help of caregivers who come in the morning to get her dressed and ready and return to put her to bed. She works at a disability rights group, and her care is covered by Medicaid.

“The two years I lived in the nursing home, it was the most horrible time in my life,” said Kucera, who worries about the DOJ opinion on Olmstead. “My future is a shaking floor beneath me. With the stroke of a pen, they could get rid of everything I’ve built for myself.”

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

A century-old hospital near Michigan’s southern border was one of the nation’s first to convert into a new emergency-focused model Congress created to save rural care.

Afterward, though, use of Sturgis Hospital’s emergency department fell, according to data collected at the state level. In June, three years after taking the federal lifeline, the hospital closed, leaving residents of Sturgis, a town of about 11,000 people, without critical healthcare. Its leaders had tried “every reasonable option” to remain open, including seeking a buyer, according to a hospital news release.

The closure “could be kind of a canary in the coal mine” for rural healthcare, said Lauren LaPine-Ray, the vice president of policy and rural health at the Michigan Health & Hospital Association.

Federal leaders have spent decades trying to prop up rural hospitals, which face persistent staffing shortages, low federal payment rates, and declining patient numbers.

About 1,700 hospitals nationwide are eligible to convert to the stripped-down Rural Emergency Hospital model. So far, more than 50 rural hospitals in over 20 states have signed on, but LaPine-Ray and other hospital leaders nationwide fear Sturgis’ failure is a sign the new model won’t be enough to keep doors open when the anticipated federal funding losses arrive from President Donald Trump’s signature One Big Beautiful Bill Act.

Last year, the survival of rural hospitals became a central negotiating point as Congress debated the massive tax and spending law, which is expected to reduce Medicaid funding by more than $900 billion over 10 years. The reductions are expected to have a substantial impact in rural areas that often have high Medicaid enrollment. Republicans added the new $50 billion Rural Health Transformation Program to win votes from a few holdouts in their ranks.

Sturgis’ facility is the only rural U.S. hospital to completely close in 2026. The day before it shuttered, four senators — including Maine Republican Susan Collins, an architect of the rural health fund — sent a letter to Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. The letter said the way his agency structured the fund “may unintentionally disadvantage many of the rural hospitals and clinics the program was intended to support.”

Congress created the emergency hospital model, which took effect in 2023, as “a whole new way of providing care,” said George Pink, a senior research fellow at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill. The Sheps Center tracks rural hospital closures and conversions, and Pink recently released early research showing converted hospitals reporting improved finances, though some are not yet in the black.

Hospitals that convert to the emergency model get a 5% boost in Medicare payments plus an extra monthly facility payment, totaling about $3.6 million a year, according to the Rural Health Redesign Center. In return, the hospitals must offer emergency services and give up their inpatient beds. They can continue offering outpatient services.

Janice Walters, CEO of the Rural Health Redesign Center, which has received federal funding to help hospitals change to the new model, said dozens of hospitals had reached out about converting during the first five months of 2026. It’s reasonable, she said, to presume that 10 or 11 might convert this year.

‘No Easy Answers’

More than 40% of all rural hospitals lose money, and hundreds have eliminated obstetrics, general surgery, and chemotherapy services, according to the healthcare consulting group Chartis.

Sen. Chuck Grassley (R-Iowa) sponsored the legislation that created the emergency hospital model. He touted the program last fall, pointing to hospitals such as Landmann-Jungman Memorial Hospital Avera in South Dakota, which he said would be able to use the model to enhance local health services.

Melissa Gale, the chief executive of the Scotland, South Dakota, hospital, said the facility averaged less than one inpatient a day and was “a little above or below break-even year-over-year for decades.”

Today, with additional federal funding from the emergency model, Gale said, the hospital could try to draw in more patients for mammograms and may add a wound care program. In the past year, the hospital has improved employee benefits and reinvested in the building, upgrading plumbing and the heating and air conditioning, she said.

“No one wants to see rural health fail,” Gale said, adding, “There’s no easy answers.”

Federal lawmakers have tried, and thus far failed, to update the emergency hospital model. One proposal, which is expected to be reintroduced, would allow converted hospitals to offer new services, such as beds for patients who need short-term recovery and in-house obstetric labor and delivery units. Another, which is in committee, would allow hospitals to use a federal drug discount program that many facilities use to generate revenue.

The current law is a “critical start, but it must evolve,” said Carrie Cochran-McClain, the chief policy officer for the National Rural Health Association, whose members include hospitals and clinics.

Residents of the southeastern Iowa town of Keokuk continue to hope their shuttered hospital will reopen under the program. The effort has been plagued by delays.

The Keokuk hospital went out of business in 2022 and was later purchased by a Michigan company that pledged to reopen it.

“It’s been a slower process than we envisioned,” said Insight Health Systems Vice President Dayne Walling. Many of the delays have been related to improvements needed to the aging building, he said. Without the emergency hospital model, Walling said, his company would not see a realistic path to reviving the hospital.

Walling said the emergency model would be even better if Congress approved the bill that would allow hospitals to make extra income from prescription medications.

Dierdra Sorrell, the CEO of Clifton-Fine Hospital in Star Lake, New York, said converting to an emergency hospital was not a “silver-bullet, magic pill.” But it “put us in a much better place.”

The 20-bed hospital lost more than $2.5 million annually before 2024, when it became New York’s first emergency hospital, Sorrell said. While converting, the hospital shut down inpatient beds and cut 20 employees.

The first year, Clifton-Fine lost only $600,000, and its emergency patient visits were “rock solid,” Sorrell said. The hospital also won state grant money to update its two-bed emergency room and pay for additions that could house visiting specialty doctors or new lines of services, such as a dental hygienist.

If Clifton-Fine had not converted, Sorrell said, anticipated Medicaid losses could have “put us under.”

‘One Important Tool’

Timothy Foster, a spokesperson for the Centers for Medicare & Medicaid Services, said the emergency model is “one important tool” for rural hospitals, “but each facility must determine whether this care model is appropriate.” Foster also said that the new five-year, $50 billion rural health fund was created to support “innovative, system-wide reforms” that strengthen the rural healthcare delivery system.

Of the 56 hospitals that have converted to the rural emergency model, two have closed, and three remain open but have changed what services they offer, according to Sheps.

In Holly Springs, Mississippi, Alliance HealthCare System was one of the first to convert to the emergency hospital designation, laying off staff and shutting down inpatient beds.

Then, federal officials said they made a mistake and required the hospital to recertify as a new hospital, a delay that cost an estimated $1.5 million in federal reimbursement, CEO Kenneth Williams said.

The hospital is “a shell of what it once was,” Williams said. The ER remains closed.

“We have survived, but survival has come at a tremendous cost,” he said.

Williams said he is closely watching the impact of upcoming Medicaid changes because cuts in insurance coverage or payments “ultimately affect patient access,” he said.

Sen. Josh Hawley (R-Mo.), who voted for the One Big Beautiful Bill Act — which included both the rural health fund and the Medicaid spending reductions — has asked for more support for rural hospitals. Ten full-service rural hospitals in Missouri have closed in the past 12 years, according to the Sheps Center.

Last year, Hawley introduced legislation to repeal the future Medicaid spending cuts. This June, he held a news conference to announce that he wanted to pay rural hospitals $1 million annually, or more if needed, to keep emergency rooms operating. A spokesperson said the bill would apply to all rural hospitals, including those using the emergency model.

Michigan’s Sturgis Hospital faced “some significant challenges” in 2023 when it converted to the emergency hospital model, said LaPine-Ray, of the state hospital association. In the news release, hospital officials said the closure was due to declining reimbursement rates, rising costs, and declining patient numbers. Bobby Morin, a former chief operating and financial officer at the hospital, declined to comment.

The hospital’s ER patient volume dropped 13% in the two years after it converted, LaPine-Ray said. Five rural hospitals have closed in the past 20 years in Michigan, and LaPine-Ray said she doubts the rural health fund Congress approved last year will stop the closures. The association, which worked with the governor’s office on the funding, expects less than 10% of Michigan’s $173 million in first-year rural health funding to trickle down to rural hospitals.

That money will pay for “very specific programs where rural hospitals have to create basically a new program and implement it with no funding on the front end,” LaPine-Ray said.

At the same time, she said, the association expects Michigan hospitals to lose $6 billion in Medicaid payments over the next decade because of the One Big Beautiful Bill Act.

“What’s it going to look like in the coming years?” LaPine-Ray said.

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

HHS announced awarded $73.2 million in grants to strengthen children’s mental health services, suicide prevention programs.

LUMBERTON, N.C. — Soybean fields surround Angie Lowery’s home in Robeson County, on a plot of rural land in southeastern North Carolina. Dozens of antique gas station signs, 20 feet tall, dominate her front yard. A framed re-creation of The Last Supper, Lone Ranger posters, and a 3-foot-wide tobacco harvesting basket adorn the walls of her home. A collector, Lowery over the years has amassed remnants of her region’s past.

But behind the house, the 44-year-old’s backyard garden showcases her goals for the future, one that involves a long, healthy life with her kids: collard greens, bell peppers, onions, tomatoes, red and white potatoes, kale.

Like Lowery, many in the small towns of Lumberton and nearby Pembroke are citizens of the Lumbee Tribe who have dealt with heart conditions. The mother of four struggled with obesity and had to take insulin pills and shots daily. By when her first grandchild was born, in 2024, Lowery imagined her own life ending the way her biological father’s did: Daily insulin shots for diabetes. Kidney dialysis treatments at home. Dead of a heart attack at 63. She wanted her grandkids to remember her.

“If I don’t get this weight off me, if I don’t change my eating habits, it’s going to take me over,” she recalled thinking.

So, she expanded her garden. She cut fatty foods and sugary drinks out of her diet, stopped eating fried and fast food, and started moving more. She lost 120 pounds in two years and weaned herself off the daily insulin pills.

The Lumbee Tribe of North Carolina late last year became the 575th tribe to secure federal recognition as a sovereign nation, a milestone that leaders and citizens celebrated in tears. The designation provides federal funding for an array of services, including for healthcare. John Lowery, chairman of the tribe and a state representative, declared that “the biggest benefit” would be access to the Indian Health Service — its clinics and hospitals, as well as funding that it could provide for the tribe to create its own health system.

But Lumbee researchers and healthcare providers say that money won’t be enough. For decades, IHS has been chronically underfunded, with the agency’s budget workgroup estimating that it’s nearly $55 billion short of what it needs this year. And that was before the Trump administration’s cuts to other federal agencies further pinched IHS. Slashes to the Centers for Disease Control and Prevention last year initially included laying off nearly 1,000 IHS employees, and President Donald Trump’s proposed 2027 budget cuts more than $150 million for a program to address diabetes in Native American tribes.

The nearest IHS facility is more than a two-hour drive to another state for most of the 55,000 Lumbee citizens in Robeson County. The county is one of the poorest in the U.S. and has some of the worst health outcomes.

Robeson County is mostly rural, agricultural land. Most of the members of the Lumbee Tribe live in the small towns of Lumberton and Pembroke, both about a half-hour drive from the South Carolina border. (Andrew Jones/KFF Health News)

The Congressional Budget Office in 2022 estimated that the tribe could increase IHS spending by $247 million over four years.

The tribe will have to rely on other revenue sources that are now allowed through recognition, such as a casino, to reverse the health disparities their people have faced for decades, Lumbee researchers said.

“None of us can depend on IHS alone, because we just don’t have the resources within that system,” said Donald Warne, a physician, a researcher at the Johns Hopkins Center for Indigenous Health, and a member of the Oglala Lakota tribe. “But it’s a great starting point.”

The IHS did not respond to questions about plans for the tribe’s health system. John Lowery did not respond to requests for an interview or a list of questions, but he said on a June podcast that he expected healthcare to be the largest portion of the tribe’s budget.

Lowery makes beaded earrings, teaches culture classes, owns a gravestone business, and makes engravings in her Pembroke, North Carolina, shop. (Andrew Jones/KFF Health News) Antiques hang on Lowery’s walls at her home. She and her husband, Grant Hunt, are avid collectors. (Andrew Jones/KFF Health News)

‘Not Just Statistics’

Eighteen years ago, Andrea Blackburn, a doctor in Lumberton and a citizen of the tribe, was working at a nearby medical center. There, she said, she was taught that patients with certain last names “are often referred directly to cardiac catheterization,” a procedure to diagnose heart conditions.

Blackburn said she realized that common Lumbee surnames carried an expectation of disease.

“Nearly two decades later, I can tell you that reality has not changed,” she told assembled tribal leadership and citizens at a public hearing.

Robeson County’s rates of heart disease, diabetes, and risky substance use continue to rank among the highest in the state, Blackburn noted. In 2025, more than half of the county’s residents were Medicaid enrollees, the highest percentage of all counties in the state.

“But these are not just statistics to me,” she said. “These are my patients. These are our families.”

Andrea Blackburn, a citizen of the Lumbee Tribe, is a physician in Robeson County. (Andrew Jones/KFF Health News)

For Angie Lowery, breaking free from those statistics meant taking her health into her own hands.

She hopes a healthy diet is the answer to breaking her family’s cycle and living long enough to form relationships with her grandkids. And she brought the rest of the family with her. Her teenage daughter lost about 35 pounds. Two of her other children are now “health fanatics,” Lowery said.

Her granddaughter will be 2 in November. One Sunday morning in March, Lowery served up macaroni, cauliflower, and chickpeas for her as they spent the day together.

Lowery had supported building a casino, believing it would provide better education, infrastructure, and healthcare for her family.

“That vote, I’m thinking of my children’s future,” she said.

Lowery grows squash, onions, potatoes, and other produce in her backyard garden. Later this year, she’ll can some of the harvest for her family. (Andrew Jones/KFF Health News)

Casino Dreams in Limbo

Tribal citizens are deeply divided over how to reverse decades of economic decline that have led to poor living conditions, unaffordable health services, and chronic disease.

Four months after Trump signed the Lumbee Fairness Act — declaring “I love the Lumbee Tribe” — tribal leaders gathered at a business meeting to take the first steps toward building a casino and establishing gaming as a new revenue source. Hundreds of federally recognized tribes across 29 states have used gaming as a source of revenue, bringing in $43.9 billion in fiscal 2024, according to the latest report from the National Indian Gaming Commission.

The approach has been popular among tribal nations looking for more dollars to build up healthcare. The Choctaw Nation of Oklahoma in 1999 became the first tribe to build its own hospital, using roughly $25 million in gaming money, and the Eastern Band of Cherokee Indians in western North Carolina funded its own hospital in 2015 mostly with $82 million in gaming funds.

But the Lumbee Tribe’s effort to establish a casino collapsed in June.

More than 60% of voters rejected a Lumbee constitutional amendment that would have allowed tribal leaders to create infrastructure needed for a gaming business. John Lowery said on Facebook that he doesn’t plan on bringing back the initiative now that it was rejected “by the majority of Lumbee voters.” His term as chairman ends in two years.

A portrait of Lumbee Tribe Chairman John Lowery hangs beside a rendering of a proposed casino and resort meant to help bring in revenue for the newly federally recognized tribe. Citizens voted against the project. (Andrew Jones/KFF Health News)

Other funding sources to provide health services for the tribe could include gas stations or hotels, he said in a call with citizens before the vote.

Lumbee and other Native health researchers said they believe a twofold system — using IHS money and additional revenue — is necessary. Funds from gaming could compensate for what IHS can’t support.

Casinos’ impact on tribal health has been debated in research for decades. Studies show that the money from gaming helps tribes build more facilities, hire more doctors, and improve social services, but unhealthy substance use and smoking increase.

“There’s going to be negative impacts,” Brittany Locklear, a social work professor at the University of North Carolina and citizen of the Lumbee Tribe, said at a June panel discussion on gaming.

Ronny Bell, 62, a Lumbee citizen and a researcher studying Native health at UNC, said the community has felt ripple effects from systemic racism, having not been acknowledged as a tribal nation for so long, and the economic downturn following the loss of Robeson County’s manufacturing and tobacco jobs.

That history plays a part in the health statistics in Robeson today, Bell said. But with federal recognition, he said, the Lumbee people have achieved a victory they’ve fought for since 1888.

“I think about the resilience of the Lumbee people and how they’ve gone through this 100-plus-year fight for federal recognition,” Bell said. “I sort of see that as a continuation of this resilience, and how now we have this opportunity with federal recognition to bring in resources to help address those issues.”

The Lumbee Tribe government offices and citizen housing in Pembroke, North Carolina, stand amid long stretches of agricultural countryside. (Andrew Jones/KFF Health News)

Resolution and Uncertainty

Jada Brooks, a Lumbee citizen and UNC researcher who studies Indigenous health and lives in Robeson County, is conducting a study about heart health among Lumbee women. The initiative includes classes in which Lumbee women ages 18 to 50 signed up to discuss their health. That’s where she met Angie Lowery, who talked about her lifestyle changes with the group.

“I was just floored by, like, just the extent to which she went,” Brooks said.

She and other Lumbee researchers said federal recognition allows Lumbee citizens to be set apart in census data, paving a way to get clear information on heart health, cancer rates, diabetes diagnoses, and mental health risks.

“There’s challenges in even understanding the nuances of these complex health disparities, because a lot of data isn’t out there,” said Ryan Dial, a public health researcher at UNC and a member of the Lumbee Tribe.

But access and confidence may be the biggest barriers Lumbee people will have to overcome, Brooks said.

“I think what really matters is people feeling like they can trust the healthcare system.”

Brooks said she worried that a casino would encourage bad health habits, such as smoking and drinking.

“Let’s not create more problems for ourselves than we already have,” she said. She voted against the casino.

Like others in the tribe, Angie Lowery believes in her people’s power to help themselves, regardless of whether government steps in to help.

“Just because we’re federally recognized don’t mean that the doors are going to open up and money’s going to fall through the door like dirt,” she said.

Angie Lowery sits in her Ford F-250 reading the Lumbee Constitution on a hot June day. The tribe secured federal recognition in December 2025. (Andrew Jones/KFF Health News) KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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 “deadliest vaccine ever made.”

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 with investigations and a former Fauci adviser even facing criminal prosecution.

National polls show healthcare is top of mind 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

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 birth control.

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 televised debates, 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 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 “Wine With DeWine.” 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 thousands of people 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 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 had been gutted 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 KFF 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.”

KFF 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 KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.