HHS launched a series of actions to strengthen how the federal government identifies, documents, investigates, and responds to health problems.

As Americans grow increasingly frustrated with their healthcare system, a proposal that has long been kicked around on the Democratic periphery is showing up in debates and on political platforms: “Medicare for All.”

According to a 2025 Economist-YouGov poll, nearly 60% of Americans favor a system of Medicare for All, while 85% of Democrats support it. For years, Democrats in Congress have proposed symbolic Medicare for All bills that have had no chance of passage but have been supported by dozens of members.

Democratic Sen. Chris Van Hollen of Maryland added his support in December. “I was listening to my constituents,” he said. “It’s just reached the complete breaking point. Our system is unaffordable and unsustainable with premiums going up, copays going up and up.”

At a time when more than 100 million Americans carry medical debt, it’s easy to get behind a promise of free, or free-ish, no-hassle health care. But turning an inspirational slogan into law gets gnarly. Those three words, Medicare for All — a pledge to bring universal healthcare to every American — mean not one thing to supporters but many. And all versions of such a system face considerable obstacles to enactment.

“Medicare for All is a slogan, not a concrete proposal, so it’s hard to have an opinion on,” said Amy Finkelstein, a Massachusetts Institute of Technology economist who, with Stanford’s Liran Einav, wrote We’ve Got You Covered, which laid out what the pair considered a realistic and fiscally responsible plan for providing basic insurance to every American.

“What we can afford is a basic plan — what we call a shack, not a chateau,” Finkelstein said. Its bedrock would be a government-funded skinny plan less generous than Medicare, with potential constraints such as a limited number of physical therapy visits or stricter criteria for getting a knee replacement, but guaranteed robust basic coverage for catastrophic medical conditions. She estimated that most Americans would opt for supplemental coverage.

The most high-profile political proponent of Medicare for All this election season is Abdul El-Sayed, the Democratic senatorial candidate in Michigan, who has made a more sweeping proposal central to his platform — far more chateau than shack. It would create one plan that covers a suite of medical needs with no cost to patients, including dental and vision care, which traditional Medicare doesn’t cover.

(Traditional Medicare has increasingly come to resemble private insurance with premiums and coinsurance, and, unlike standard commercial plans, it has no annual out-of-pocket maximum. To fill such gaps, patients buy separate Medigap and drug plans.)

“The most important thing is just to make Medicare whole — meaning no charge for medical care — rolling back the complexity and costs of the last 10 years,” El-Sayed told KFF Health News.

His program would start off covering children and adults five years younger than the current eligibility age for Medicare and close the gap over a period, he has estimated, of eight years. To ease the transition for the healthcare system, he would initially set the Medicare payment rates to mirror the totals doctors and hospitals receive now to avoid a “price shock” to their operations. Future increases would be limited to the rate of inflation.

One big question is how to make the financing work in a highly profitable industry. National health spending was projected to hit $5.7 trillion in 2025, or nearly 20% of the U.S. gross domestic product.

The United States spends twice as much on healthcare per person than many peer countries. And health insurance is often a company’s second-largest expense after payroll.

But how will the government divert financial outlays of employers and households into a new Medicare for All system without new taxes or massive government spending?

When polls ask voters whether they would support Medicare for All if it meant losing their insurance or paying new taxes, support often drops.

“You could decide to raise taxes and cover more,” Finkelstein said. “If you don’t want to cut current Medicare benefits, you could decide to bust the budget, which seems to be a common practice.”

Joe Biden said that, as president, he would veto any Medicare for All bill, given the cost, which was estimated at up to $40 trillion over 10 years. The bills in Congress don’t include very detailed financing plans.

Economists who have mapped out the possibilities are divided on a realistic path.

A group of Yale researchers estimated that converting to a Medicare for All program could save $450 billion annually. That’s in part because a government plan could negotiate — or simply set — far better prices for hospitals, doctors, drugs, and devices than private insurers. It would reduce the overhead created by private insurance with its army of negotiators, coders, and claim deniers — and reduce profits.

Strong forces are pushing back against such “rightsizing” of exorbitant prices, most notably: insurers, hospitals, and drug and device manufacturers. In 2022, they spent over $700 million on lobbying and have been a powerful force for job creation. But a grand Medicare for All proposal may simply be a strategy to open the debate to lesser possibilities. President Barack Obama’s initial Affordable Care Act proposal contained ambitious ideas — such as drug price negotiation — that fell by the wayside to get the votes for passage.

Texas Democratic Senate candidate James Talarico supports what he calls “Medicare for Y’all” — allowing people under 65 to buy into Medicare.

“There are versions of Medicare for All that could potentially include our proposal, and versions that could look extremely different,” Finkelstein said.

Support in some parts of the industry is growing.

According to one survey, more than half of all physicians have said they’d prefer some sort of single-payer system. Though the American Medical Association is opposed, its student and resident sections are pressing to overturn the opposition. The American College of Physicians, the nation’s second-largest physician group, also supports Medicare for All. Obama called the ACA a “starter house.” It was “an improvement, but it has not met the need,” Van Hollen said.

Now the growing number of Medicare for All proponents will have to define exactly what kind of new house they can accept and afford.

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.

LOS ANGELES — Every Tuesday, Naman Shah sees tuberculosis patients at a small public clinic in Los Angeles’ San Fernando Valley. Shah, a physician and epidemiologist at the Los Angeles County Department of Public Health, pores over images of battered lungs, listens to labored breathing, and checks medications.

It’s part of an initiative dating to the early 20th century to control infections so tuberculosis doesn’t spread. “We like doing things upstream,” Shah said, “meaning before they happen, not after the damage is done.”

Today, Shah and his colleagues are applying the same principle to medical debt. A key part of that effort is a new system to allow every hospital in Los Angeles County to easily screen patients for financial aid. The goal: to stop low-income families from getting a bill that buries them in debt.

Shah estimates this system could prevent several hundred million dollars of medical debt every year.

Vicious Cycle

Nationwide, an estimated 100 million adults have some form of healthcare debt. In Los Angeles County, the nation’s most populous, public health officials calculate that about 800,000 residents have medical bills they can’t pay.

“The impacts of medical debt were staggering,” said Shah, who used to staff a rural health clinic in India and, since 2023, has led a county initiative in Los Angeles to tackle the debt problem.

“People end up with credit card debt and then a vicious cycle of high interest rates and poverty,” he said. “People forgo their prescriptions. People forgo appointments. And then you get into worse health.”

Hospitals typically offer financial aid to patients with low incomes. But information about assistance is often hard for patients to get. Applying can be cumbersome. And many eligible patients never seek aid, research shows.

“Most people walk into the hospital and walk out without any knowledge of financial assistance,” said Jared Walker, founder of Dollar For, a nonprofit that helps patients nationwide apply for aid, often called charity care.

That’s fueling debt. It’s also driving costly collection efforts that even hospital officials acknowledge pointlessly target low-income patients who are unlikely to be able to pay.

“They’re turning their wheels trying to collect on debt that isn’t collectable,” said Adena Tessler, regional vice president for the Hospital Association of Southern California.

Naman Shah examines a patient at Monrovia Health Center, a Los Angeles County public health clinic in Monrovia, California. Shah says reducing medical debt in the community will depend on effective prevention strategies, just as stopping the spread of infectious disease does. (Lauren Justice for KFF Health News and Tradeoffs)   (Lauren Justice for KFF Health News and Tradeoffs)   (Lauren Justice for KFF Health News and Tradeoffs)

Presumptive Eligibility

One potential solution is a system that automatically screens and qualifies low-income patients for financial aid without requiring an application. This is called presumptive eligibility.

Some hospitals already use such systems, which rely on software that checks patient eligibility based on publicly available information such as credit history.

The strategy can be very effective. Shah said hospitals that have deployed presumptive eligibility systems have reported as much as a 50% increase in the amount of financial aid they give patients.

Under a state law passed last year, all California hospitals will have to start doing presumptive eligibility screening by next July.

But the systems can be expensive and difficult for smaller hospitals to implement. Only about 1 in 5 hospitals in Los Angeles County currently use them, Shah said.

Public health officials wondered if they could help more hospitals set them up.

The county, which, like many local governments, faces major fiscal challenges, couldn’t pay for this, Shah said. But the public health department could bring together healthcare and hospital officials in the county to figure out another solution.

“The beauty of government is not when it always has to do the work,” Shah said. “We have the ability to make sure that people cooperate.”

The Hospital Association of Southern California, initially wary of the county initiative, came to see improving hospital financial aid programs as beneficial to hospitals, many of which were wasting money on collections. “The billing process is cumbersome and costly,” said Paul Young, a senior vice president with the association.

The association agreed to procure a presumptive eligibility system and make it available to its members. This bulk-purchasing approach, which Young compared to “a Costco model,” would lower the cost for individual hospitals, he said.

At the same time, L.A. Care, a nonprofit health plan that administers Medicaid coverage for more than 2.5 million low-income county residents, committed $2 million to set up the system.

The investment reflected the safety net insurer’s mission to make medical care accessible to more people, said Melanie Fontes Rainer, who leads strategic planning for L.A. Care. “It’s going to make Los Angeles County better,” she said.

Making It Work

Getting the new system up and running by January, as the partners hope, faces challenges.

Hospital officials are figuring out how the system will be funded in the long term. And it’s unclear how many of the county’s 88 acute care hospitals will ultimately use it, even if it’s cheaper and easier to access.

The partners are also working to improve data that the system relies on to screen patients. One goal is to link the system to tax records maintained by the state of California. This would provide hospitals with more accurate information on patients’ income than current systems, which often rely on estimated income.

Walker, the patient advocate at Dollar For, said he’s heartened by the county’s effort. “I’m optimistic that we can make a better charity care system,” he said. “And the fact that hospitals in Los Angeles County are willing to be innovative and creative about ways we can do that is super encouraging.”

For his part, Shah said county public health officials recognize that a better screening system at hospitals won’t by itself eliminate medical debt. But he said the public health department couldn’t ignore a problem that affects more county residents than asthma or tobacco use.

“Prevention is our bread and butter,” he said.

“The impacts of medical debt were staggering,” says Naman Shah, who since 2023 has led a Los Angeles County initiative to tackle the debt problem. (Lauren Justice for KFF Health News and Tradeoffs)

This article is part of “Hidden Help,” an investigative series from Tradeoffs and KFF Health News about how hospitals can protect their patients from the life-altering harms of medical debt.

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.

LANSING, Mich. — Christina Starks-Clay doesn’t know how “Medicare for All” would work exactly, but she’s willing to bet it’d be better than what she has now.

Standing in line for U.S. Senate candidate Abdul El-Sayed’s town hall in the state’s capital in September, she whipped out her phone to pull up a screenshot. It was of the $1,000 cashier’s check she’d picked up at the bank that day to pay down a chunk of her son’s dental bills. An early childhood special education paraprofessional, she still owed $389, even with good dental insurance. Her own cleaning a few weeks before cost $600.

She tried to talk herself down at the bank, to focus on being grateful for what she could afford.

“I’m like, ‘Tina, OK, you were in a position for this moment to do this,’” she said. “A lot of people couldn’t do what I had to do today. I couldn’t do it. But I did it. So I need to hear, how are you going to make this better for everyone?”

Many who waited in the hot sun that afternoon in a line stretching blocks through downtown Lansing shared similar anxieties. A man ahead of Starks-Clay talked about watching his brother rack up thousands of dollars in medical debt. A professor emeritus at nearby Michigan State University worried aloud about his grandkids’ medical care, because his adult kids were struggling to meet a $9,000 insurance deductible. Healthcare workers who’d turned up for the event described patients choosing between affording medication or food, or how they themselves had been financially devastated by a medical crisis.

They all knew Michigan Democrat El-Sayed’s rallying cry by heart, chanting it when the candidate took the stage: “Money out of politics! Money in your pocket! Medicare for All!”

Abdul El-Sayed (D-Mich.) speaks at a rally in Detroit on Aug. 7. (Emily Elconin/Bloomberg via Getty Images)

Support for Medicare for All is at its highest in at least a decade, according to a new KFF poll. The survey found two-thirds of Americans now favor expanding the government health program that largely covers seniors (about half of whom are enrolled in private plans through Medicare Advantage).

But many people don’t actually know how to define Medicare for All. Traditionally, the idea has been to establish a single health insurance program, run by the federal government, that would guarantee coverage for Americans and minimize or even eliminate private insurance. How much people like the idea depends on what they’re told about it, pollsters have found.

Still, at a time when fewer than half of Americans say they can afford their healthcare, Medicare for All has become a progressive shorthand for radical, systemic change.

“Too many people don’t have health insurance, too many people who do have insurance can’t afford medical care, and many people are terrified about the costs of being sick,” said Jonathan Oberlander, a professor at the University of North Carolina-Chapel Hill who specializes in the politics of healthcare reform.

“And in an electorate that wants change, that is disenchanted with the status quo, Medicare for All is an important symbol,” he said.

That’s why Democrats running for Senate seats in the midterm elections in such states as Maine, Minnesota, and Florida tout their support for scrapping the current health insurance system in favor of broad Medicare coverage. But nowhere is the issue as central to a race as in Michigan, where Medicare for All has become synonymous with El-Sayed.

El-Sayed, who trained as a doctor and served as Detroit’s top public health official, has campaigned on Medicare for All since his unsuccessful bid for governor in 2018. To Starks-Clay, that means he has a plan and will “stick to it,” she said.

That’s appealing to voters right now, said Ashley Kirzinger, director of survey methodology at KFF, a health information nonprofit that includes KFF Health News. “When we ask people what do they want to hear from candidates in regards to healthcare, it’s a plan to bring down healthcare costs.”

American Dream or Pipe Dream?

Medicare for All has been the shiny object of progressive politics in previous campaigns, including Vermont Sen. Bernie Sanders’ 2016 presidential bid and the 2020 Democratic presidential primary. Its popularity rises and falls in cycles, Oberlander said. And today people are painfully aware their care is getting more expensive and harder to access.

In the first decade or so after the passage of the Affordable Care Act in 2010, the nation’s uninsured rate was cut nearly in half. Insurance companies could no longer deny people coverage based on preexisting conditions. Since then, to cover more people, 40 states plus Washington, D.C., have expanded Medicaid, the government health program for those with low incomes or disabilities.

Now it feels as if we’re moving backward, Oberlander said. “We are now, in the past two years, in an era where the Trump administration and congressional Republicans have reversed that progress.”

Michigan, a battleground state that President Donald Trump won in 2024, saw some of the steepest ACA plan enrollment drops after the GOP-controlled Congress allowed enhanced tax subsidies, which helped people afford their premiums, to expire at the end of last year. Insurance companies in Michigan hiked individual marketplace rates by an average of 20%. And up to 355,000 Michiganders are expected to lose their Medicaid coverage in 2028 because of cuts included in Trump’s signature law, the One Big Beautiful Bill Act, according to estimates from the Urban Institute, a left-leaning think tank.

At El-Sayed’s town hall in Lansing, Darleana Ash said patients at the medical diagnostics lab where she works are increasingly skipping tests because they can’t afford them. Others drive hours from rural areas because their local labs have closed or are no longer in their insurance networks. She worries about the patients who must choose between their medications and groceries some months.

“If you got somebody that’s 75, 80 years old, guess what? They’re going to go without the medication, because they got to eat,” she said.

Packed in near the front of the crowded town hall was Cindy Lou Coolich, a boisterous retiree wearing a campaign T-shirt and cowboy hat. She spent years working for a company that helped uninsured people enroll in coverage, until she got sick herself. A bout of sepsis nearly killed her and left her disabled. Suddenly, she was the one enrolling in Medicaid and living on $900 a month from Social Security.

She lost the 15-acre horse farm she’d owned, and then everything else, she said. “Except my car.” The saving grace, oddly, was the death of her ex-husband. Because they’d been married for more than 10 years, she could benefit from his Social Security benefits. “So now I’m doing quite well!” she laughed. But to her, it hardly seemed like the mark of a functioning healthcare system that someone had to die for things to get better.

A Universal Response

Democrats aren’t the only ones responding to voters’ healthcare discontent. Republican Mike Rogers, a former Michigan congressman and El-Sayed’s opponent, recently released a brief healthcare plan.

“I just can’t think of a more important issue to the people of Michigan than healthcare and costs, the rising costs,” he said. At a press conference announcing his health platform, he broadly attacked El-Sayed and Medicare for All.

“[If] the government’s going to give you something, they have to take it away from someone else,” Rogers said.

Mike Rogers (R-Mich.) at a rally in Sterling Heights, Michigan, on Aug. 31. (Sarah Rice/Bloomberg via Getty Images)

Under Medicare for All, millions of Michiganders with private health insurance would lose that coverage, he said. Pointing to estimates that Medicare for All would cost some $4 trillion per year, he said, “Guess what? People pay for that.” (A recent preprint study from Yale researchers found that the cost of implementing Medicare for All, estimated at $4.2 trillion, would save about $1 trillion in healthcare spending.) Rogers’ campaign declined an interview request from KFF Health News.

Concerns about increased taxation, disruption to the current system, and reduced access to services can make Medicare for All a political liability in a close election, Oberlander said. “It doesn’t matter if the fears that they’re spreading are actually accurate,” he said. “Politically, what matters is if they can scare people.”

But even if El-Sayed wins in November, the chances of Medicare for All replacing the current system “remain very remote in the short to medium term,” Oberlander said.

Given the staunch opposition from Republicans and many moderate Democrats, not to mention the lobbying power of the healthcare industry, massively overhauling the U.S. health system won’t suddenly be achievable because of a single Senate candidate.

Thomas “Jermaine” Carey knows this. A self-described activist, he attended a recent El-Sayed town hall in Detroit feeling “kind of sold out” by what he calls the “straight-ticket” Democratic Party. Medicare for All sounds good, he said. “Do I believe it?” He shrugged.

“It’s still America,” he said. “You still have super PACs, the lobbyists that control everything.”

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 related to HHS food policy reforms to advance President Trump’s MAHA agenda.

On Sept. 30, I was one of the seven media witnesses who observed Tennessee fail to execute convicted murderer Christa Pike, the first woman to face the death penalty in the state in almost 200 years.

From our previous reporting, each of us had an inkling that the lethal injection process might not go according to plan. Pike’s attorneys had asked the Tennessee Supreme Court to allow her to be hanged instead, citing concerns that a platelet disorder and small veins would make the actual injection not only painful but ineffective.

And Tennessee had already botched an execution attempt in May, when healthcare workers failed to establish complete IV access into Tony Carruthers, who was sentenced to death after being convicted for his involvement in the kidnapping and murders of three people in 1994.

Tennessee Gov. Bill Lee said after the failed execution of Carruthers, who has maintained he is innocent, that the state wouldn’t try again to kill him for at least a year. After Pike left the execution chamber in an ambulance on Sept. 30, Lee announced he would suspend lethal injections for the rest of the year.

The morning of Pike’s scheduled execution, I and the other media witnesses arrived at the Riverbend Maximum Security Institution in Nashville by 8:30 a.m. and waited to be ushered into the prison with nothing but our driver’s licenses in hand. The plan was to wait inside until Pike began her journey to the death chamber at 10 a.m.

But we didn’t make it that far.

Before the Department of Correction’s staffers began moving us away from the outdoor media tent and our belongings, the reporters’ phones all went off. A federal circuit court had stayed the execution. This was my fifth stint as a media witness to an execution, and I’d never seen a stay issued. We didn’t know what that would mean.

It turned out to mean waiting for nine hours at the prison, barred from leaving the grounds. We spent most of it in the boardroom where parole hearings take place.

Hours of Waiting. Then, ‘It’s a Go.’

Throughout the wait, the victim’s family often came up in conversation. In 1995, Pike, then 18 years old, killed Colleen Slemmer, who was 19. Slemmer’s family in Florida traveled to Tennessee for the execution with money raised through crowdfunding. It’s unclear where they waited while the last-minute legal wrangling played out.

Sometime around 6 p.m., the prison system’s communications director, Dorinda Carter, told us: “It’s a go.”

Tennessee had asked the U.S. Supreme Court to lift the stay, and it did. Carter read the ruling aloud to us.

For unknown reasons, it took another hour or so for the security team to usher us into the witness bay, an all-white cinder block room with black pleather chairs in two rows and a big window overlooking the death chamber. A loudspeaker pipes sound into the room from the chamber when the microphones are on.

A black curtain hangs in front of the window inside the death chamber. Department of Correction workers open it once IV lines are inserted into the condemned prisoner.

The curtain is there to obscure the workers who place the IVs, in order to shield their identities as required by state law. That process is enshrined in the “Lethal Injection Execution Protocol,” which is the guidebook the Department of Correction writes for itself. There is no other regulation over executions in the state.

My employer, the Nashville public radio station WPLN, is a party in a lawsuit challenging the state’s concealment of the IV insertion. When executions are botched, it’s often due to something going wrong while IVs are placed — or with the subsequent step if IVs fail, placing a central line in a deeper vein through the chest, neck, or groin.

A lower court ruled in favor of WPLN and other media plaintiffs in January, but the state appealed the order, and it has been halted while higher courts consider the case.

The Death Chamber

The American Medical Association officially bars doctors from participating in executions, and many other health professionals also consider assisting an execution to be unethical.

Outside of prison staffers and the execution team, only the prisoner’s spiritual adviser and attorney are allowed in the room with the prisoner while the IVs are inserted. So generally, attorneys’ descriptions are the only account of the procedure.

Under normal circumstances, witnesses sit in the bay for 10 or 15 minutes with the curtain closed. That’s how long it tends to take for the IV team to place a line and start running saline, to prepare for the 5 grams of the sedative pentobarbital that will be pumped in to kill the prisoner.

Once the lines are set, the execution team enters an adjacent, concealed room. The IV lines run through the wall into that hidden chamber, from which the drugs are administered.

But at Pike’s execution, we sat in the bay for 45 minutes with the curtain closed and the microphone turned off.

Until Carruthers’ failed execution, the Department of Correction kept the lights off in the witness bay during the wait. Witnesses at his execution said they sat in a dark room for an hour and a half as the execution team tried and failed to place an IV line. This time, the prison kept the lights on.

The clock we use to give a minute-by-minute account is in the death chamber, so we can’t see it with the curtain closed. John North, a reporter with the television station WBIR in Knoxville, was the only witness wearing a watch. The rest of us asked him over and over what time it was.

After half an hour, it was clear the IV team must have been struggling.

We wondered whether Pike’s execution would unfold similarly to Carruthers’. That time, the governor called and ordered the execution halted before the curtain ever opened.

But at 7:27 p.m., we heard the curtain being drawn away.

We saw Pike in profile, lying on the gurney, facing the window for the other bay, where the victim’s family and prosecutors sit.

We saw Pike’s spiritual adviser, Mikey Noechel, who wore a wine-red sash over his suit. Together, they sang and talked about Buddhist teachings. 

Under the state’s protocol, the spiritual adviser is allowed in the death chamber as the pentobarbital flow begins, though the attorneys are not.

There is no signal when the lethal drugs start flowing, but it’s assumed to begin after the prisoner delivers her final words. It’s typical for the spiritual adviser to offer prayers and other support, and for there to be a back-and-forth between the two.

Pike spoke.

“I just want to say that I’m going to leave this world the way I’ve spent most of my life, and that is with love,” she said.

She said that she had love for those who hate her, and that she was at peace with her death.

Moments later, Pike told Noechel her arm was burning. She said it was in one specific spot and asked corrections staff in the room whether that was normal.

Pentobarbital is alkaline, so it burns like drain cleaner if it touches skin. If the IV is administered correctly, that is unlikely to happen.

But Pike and Noechel chatted for what seemed a shocking amount of time. Prisoners tend to show signs of being sedated a few minutes in. Pike didn’t.

Something Is Wrong

The Tennessee Department of Correction uses an odd practice to announce the drugs have been fully administered. There’s a small, hinged door built into the wall between the concealed drug management room and the death chamber, with a platform beneath it. Once the drugs have completely flowed through the IV, the door is opened and a rock is placed on the platform. That initiates a five-minute waiting period, after which the curtain closes again to obscure a doctor, who enters the death chamber, checks the prisoner’s pulse, and certifies the death.

In each of the executions I’ve witnessed, the prisoners look unconscious long before the rock comes out, and in the minutes following they’re presumed dead.

The rock came out at 7:41 p.m. At 7:44 p.m., Pike was still speaking quietly to Noechel.

My jaw dropped. It was clear to me then that something was very wrong.

Once the five minutes are up and the curtain closes to conceal the doctor, who confirms the time of death, the spiritual adviser moves into the witness bay and stays there until everyone leaves the facility.

But after Noechel entered the witness bay, staff came in and ordered him back into the death chamber. There was only one reason to do so: They were trying again.

The curtain reopened.

The state’s protocol dictates that, as a backup plan, prison staff can run a second round of pentobarbital. According to a statement from the Death Penalty Information Center, which tracks execution attempts and their outcomes, Pike is “the first person to survive after being injected with lethal doses of execution drugs.”

Eventually, Pike stopped talking. She started snoring.

She continued to snore after the rock was put out the second time and the curtain closed again. We continued to hear her snore over the loudspeaker.

The state’s protocol does not contemplate a second round of drugs failing to kill the prisoner, so there are essentially no rules for the situation the Department of Correction found itself in with Pike.

It’s unclear what was happening behind the curtain. Her lawyers later said they weren’t allowed in the death chamber.

The curtain closed at 8:16 p.m., and we listened to Pike’s snoring for nearly 40 minutes.

Tensions rose between the media witnesses and Carter, the Department of Correction’s communications director. I asked her: “Do they do a third round? Are you going to resuscitate her?” Carter didn’t have an answer. Another witness, Steven Hale of the Nashville Banner, asked why the curtain was closed. The doctor wasn’t certifying Pike’s death. We could all hear her breathing.

At 8:53 p.m., the prison warden, Kenneth Nelsen, came over the loudspeaker and said, “Media witnesses, please exit the area.”

‘Intubated, on a Ventilator’

We went out to the news conference, which the Department of Correction usually requires media witnesses to participate in. While one of us was speaking, several emergency vehicles arrived. We saw the caravan leave with its sirens on. That was our only insight into whether Pike was alive.

Pike’s attorneys later confirmed she was hospitalized. As of Oct. 1 she remained in critical condition at an undisclosed Nashville hospital, according to her attorneys.

Her lawyers, in an emergency filing with the Davidson County Chancery Court on Oct. 2, alleged that the execution team apparently didn’t “realize that the IV lines were not correctly placed or that the veins had blown” and that pentobarbital had “in whole or in part” entered her body instead of her veins.

Pike arrived at the hospital with both of her arms “swollen, burned, and blistered,” they wrote. “She is intubated, on a ventilator, and remains unconscious.”

Pike’s future, as well as that of lethal injection in Tennessee, is uncertain.

Lee, the Republican governor who has paused executions for the rest of the year, leaves office in January. The front-runner in the Nov. 3 election to replace him, U.S. Sen. Marsha Blackburn, has been a vocal supporter of the death penalty. After Pike’s failed execution, the Republican candidate posted her solution to X.

“Bring back the electric chair and deliver justice for these victims swiftly,” she wrote. “As your governor, I will do just that.”

The electric chair was last used in the U.S. in Nashville when Tennessee executed Nicholas Sutton in 2020. He was one of five prisoners who chose the electric chair over lethal injection in the state from 2018 to 2020.

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

(Maria Fabrizio for WPLN and KFF Health News)

When Lori Baute first learned about precautionary full-body MRI scans, she dismissed the idea.

“ I heard Kim Kardashian got one, and some other wealthy people,” Baute said. But at 59, she was worried about her long-term health. She has a family history of cancer, and she’s a critical caregiver for her aging mom and her adult brother with special needs.

After a close friend was diagnosed with bladder cancer, Baute decided to make an appointment with a clinic that offers full-body scans near where she lives in Ocala, Florida. Her results came back a week later. One major finding: She has lesions on her pancreas. “When I got that, I was really petrified,” she said.

Worried about pancreatic cancer, Baute shared the results with her gastroenterologist, who ordered a targeted MRI scan as a follow-up. That test showed the lesions were benign cysts.

Baute’s experience is becoming more common as companies pitch body scans directly to consumers as a way to detect cancer and other diseases early. But no major medical association — including the American Cancer Society and the American College of Radiology — recommends these scans for people without a very high risk of certain cancers.

And even medical screenings that doctors do recommend can carry some of the same reasons for caution.

The QTip:

Before saying yes to the test, ask about the risks and benefits — even if your doctor recommends it.

Here’s what to know:

1. Every Test Comes With Costs and Risks

At a minimum, a medical test will cost you time — and could mean a hefty medical bill. Many tests marketed directly to consumers, like full-body scans and at-home blood screening kits, are not covered by insurance, and some tests can cost several thousand dollars.

Some laboratory tests might involve only the discomfort of a blood draw or the awkwardness of collecting a urine or stool sample, but others carry the possibility of physical harm. For example, a small percentage of people who get CT scans each year will develop cancer because of the radiation exposure from the tests, according to estimates from the National Institutes of Health. Relatively simple procedures like a biopsy or an endoscopy come with the risks of pain, infections, tearing, a reaction to anesthesia, or further serious complications.

Plus, testing can cause anxiety and stress — as patients wait for results and if the results are inconclusive. “I see patients every week in my office who are tortured by the results of tests that they really didn’t need to ever have,” said Rita Redberg, a University of California-San Francisco professor and cardiologist and an advocate for less medical testing. For example, if you discover a cyst, then “you’re living for the next year, two years, three years getting repeated tests to figure out whether it’s benign or a cancer,” Redberg said. She cautions patients against testing unless they have specific symptoms.

2. Testing Often Leads to More Testing — And More Risk

A reality of getting a medical test is that the results often lead to additional, and potentially more invasive, testing. Doctors call this “diagnostic cascade.”

Baute, for example, plans to continue monitoring her pancreas with annual scans. To her, she said, the financial cost and anxiety are worth it if she can feel “like I’m in control of my health and I have knowledge.”

But Redberg points to a worst-case scenario, documented by JAMA Internal Medicine in 2011: After starting an exercise program, a 52-year-old woman experienced chest pain and went to see her doctor. Her exam suggested that her pain was muscular and she had a low risk for heart disease. Still, her doctor ordered a scan of her heart to reassure her. The results led her doctor to order another test, during which her artery was ripped. She had emergency bypass surgery, experienced complications, and ultimately, Redberg said, “she ended up with a heart transplant — all from this unnecessary scan just to reassure her.”

3. A Few Simple Questions Can Help You Decide

Before saying yes to the test, it’s important to know about the risks and benefits — even if your doctor recommends it, Redberg said. She suggests asking a medical provider and yourself questions like:

• What am I going to learn from this test?
• How is this test going to help in my care?
• Could I improve my health without doing this test?

She said many test results, especially in her field of cardiology, end up pointing patients back to the basics of a healthy lifestyle, like eating well, exercising, and not smoking. And those, she said, could be advised without a test.

People and Policy

If your health insurance covers a medical test, that means the test has most likely met vetted, scientific standards that demonstrate benefits to patients. Insurers must cover evidence-based services that have a rating of A or B from the U.S. Preventive Services Task Force. Private insurers, as well as Medicaid and Medicare plans, must cover the full cost of recommended preventive screenings. Many medical tests marketed directly to consumers are not covered by insurance.

Emily Siner at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable healthcare system. It’s a collaboration between Nashville Public Radio and 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.

HHS announced that Americans will have access to more reliable, accessible, and actionable information about their health coverage.

By Oct. 1, at least 2 million seniors will have received alarming notices: Their health plans — which they get through Medicare Advantage, the version of Medicare run by private health insurance companies — will disappear at the end of the year.

Many will be stuck without a lot of options. In some cases, no other companies in their area may offer Medicare Advantage plans to replace them. This isn’t the first time this has happened. Last year, almost 3 million seniors found themselves in similar situations.

An Arm and a Leg host Dan Weissmann and producer Emily Pisacreta looked into what happened when those cancellations hit Minnesota. The collapse of a major Medicare Advantage carrier there led to “total chaos,” according to the director of the state’s Medicare assistance agency. Everyday people stepped up to help one another in the fallout.

Plus, KFF Health News senior correspondent Julie Appleby joins to discuss the role of private health insurance companies in Medicare. She explains how these companies shape seniors’ choices, including in Medicare supplemental plans, whose premiums have skyrocketed.

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 Adam Raymonda Audio wizard Ellen Weiss Editor Click to open the Transcript Transcript: Medicare Is More Broken Than We Thought

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.

Please note that this transcript may include errors.

Dan: Hey there. In the first week of October last year, 2025 — a whole bunch of senior citizens in Minnesota got a letter with some bad news. 

Amy Hockert: A lot of changes coming in 2026. We know that at minimum 160,000 of you, absolutely have to pay attention to this,

Dan: Their health insurance through Medicare Advantage was going away. 

Erin: I was so mad. I was like, “No. Now what do I do?” And I look at my husband and said, “Now what?” “

Dan: Folks like Erin– who lives in small-town Cambridge,Minnesota–  were going to have to find a new plan by the end of Medicare’s annual open enrollment period, which would start in a couple weeks.

Up until now, Erin had been on a plan from a local nonprofit insurance outfit called U Care.

UCare offered some of the most generous and affordable plans in Medicare Advantage — the version of Medicare operated by private health insurance companies. 

But U Care was going belly up.

FOX 9: The collapse of UCare after 40 years in Minnesota has been swift and stunning.

Dan: Callers jammed the phonelines at Minnesota’s Aging Pathways hotline — thats the state agency that helps people with Medicare. Kelli Jo Greiner runs it.

Kelli Jo Greiner: I don’t know any other way to describe it other than total chaos. Our phones were ringing off the hook.

Dan: Meanwhile, in the Twin Cities suburb of Maple Grove, an insurance broker named Alison Ebert had been getting ready for her busy season, making appointments with her usual clients.

Alison Ebert: October 1st through October 14th, I always set my appointments with my clients. I always joke I get paid in cookies and coffee because I go to their homes, we sit down. I know their families, I know their kids, their grandkids

Dan: The day open enrollment started, she got 47 calls — from people she’d never met. People whose coffee and cookies she’d never tasted.  That was new. 

And more would call. Because more letters were starting to go out.

Not just from U Care. Other health insurance carriers were dropping out of the area. UnitedHealthcare, BlueCross, Aetna, Humana — all canceled Medicare Advantage plans in counties all over the state. Three counties were left with no Medicare Advantage plans at all. 

And… this wasn’t just something that was just happening in Minnesota. Almost 3 million seniors across the country had plans in 2025 that would stop being offered to them in 2026.

And that’s because at their headquarters, insurance companies had done their calculations, assessed their risks, and decided that offering plans to those people would no longer be profitable enough. So, seniors from Maine to California saw the number of available Medicare Advantage plans shrink by the dozen — leaving a lot of them confused, and with fewer, often worse and more costly health insurance options. 

It’s part of a big new trend — these disappearing acts  have been increasing in recent years, and insurance companies have already signaled that more are coming. Major insurers have already announced intentions to dump plans that currently cover more than two million seniors. 

We’ve spoken with folks in a dozen states — in rural places like Vermont and North Dakota, and in states with rural and urban centers like Maryland and Minnesota — about how it all went down last year — and what we can take away for this year.

My colleague Emily Pisacreta and our awesome summer intern Lynn Barbera made those calls. And Emily, you called that experience “eye opening.” 

Emily: Uh, yeah. We already knew from previous reporting that people had problems with Medicare Advantage. At first this story sort of seemed like one more thing people on Medicare Advantage had to worry about. But it turns out to be more than that. What happened last year — and is about to happen again this fall — showed us big problems, problems that affect everyone who’s on Medicare — or hopes to be one day. There are layers to this. 

Dan: And we’re gonna peel them back. Get ready for a big dose of Medicare.

This is An Arm and a Leg, a show about why health care costs so freaking much and what we can maybe do about it. I’m Dan Weissmann, I’m a reporter and I like a challenge. So our job on this show is to take one of the most enraging, terrifying, depressing parts of American life and to bring you a show that’s entertaining, empowering and useful.

Emily, a while back, we looked at problems with Medicare Advantage. How about we do a little recap?

Emily: Yeah. 

Dan: We were taking our first deep look at Medicare itself, and as we said then, it kind of blew our minds. 

Emily: Before we did that story, I was under the impression that you wake up on your 65th birthday and never have to pay a medical bill again, never have to deal with health insurance companies again. In fact, that’s the dream of Medicare For All. 

Dan: But it’s not the reality of Medicare as it exists. For one thing, signing up means making a dizzying number of choices. 

And you basically never escape private insurance companies. No way. Turns out, they run a lot of Medicare — so you could see dozens of different plans offered by different companies. 

But here’s the most important part: You have to choose between what’s now called Traditional Medicare — run by the U.S. Government — and Medicare Advantage plans, run by private insurance companies. 

And they both have downsides. 

Traditional medicare doesn’t cover everything. For outpatient medical care — for doctor visits, outpatient procedures, infusions, physical therapy, X-rays and MRIs, you name it — Medicare only pays 80 percent of the bill.  

And those other things can get so expensive — the remaining 20 percent can run to thousands of dollars that most seniors don’t have. 

If you want that covered — and, I mean, you do — you actually have to buy a “supplemental” policy — people call them “Medigap” plans. They’re offered by private insurance companies. And you pay a premium. 

Oh, and did I mention that you’re already paying a premium to the feds for your Medicare? Yep. Exactly how much depends on your financial situation, but most people pay just over 200 bucks a month.

Medigap premiums – to the private companies – are on top of that. They vary a lot — by what plan you pick, and by where you live — but the average is another two-hundred and some every month. And that number goes up every year. 

So you’re paying all that but then you’ve still got another gap. Vision, dental, and hearing. Traditional Medicare doesn’t cover them at all. So Medigap plans generally don’t cover them either. 

The dark joke is that eyes, ears and teeth are “luxury organs”

Because who needs to see or hear or chew? 

So those are some BIG gaps.

A lot of Medicare Advantage plans offer to fill those gaps:

MA Ad 2: This card I’m holding in my hand, it’s an example of an all-in-one Medicare Advantage membership card.

Dan: Lots of them include what’s missing  

Woman in Ad2: That card helps me with my vision costs, my dental costs.

Dan: Some of them even subsidize the premium you’d be paying to the feds, even bringing it down to zero. You can see how appealing that is.

… and insurance companies hammer that appeal home with floods of TV ads

Plus direct mail, phone calls, and facebook ads out the wazoo. None of which mention the downsides to Medicare Advantage… 

 which are basically: All the downsides we’re all familiar with from dealing with insurance companies. 

Their network might not include your doctors and providers. It might not include very many providers near you at all. 

And once you find an in-network provider, the insurance company can make you jump through hoops like pre-authorization. Or deny a claim. And then you get to fight through an appeals process. 

I talked with a guy in Texas, Robert Wolpa. He’s got HIV, a pacemaker, other stuff. He said he felt like he was spending half his days on hold, waiting to talk with badly-paid, badly-trained people.

Robert Wolpa: I’m 71. I just turned 71 in November and I’ve got, I’ve got a little of the HIV cognizant crap. Like, my short term memory is gone. And I think to myself, what have I gotten myself into?

Dan: This is the thing: You can be 65 years old, in totally decent shape, playing pickleball or whatever, never seeing a doctor. 

But when you pick Medicare Advantage, most of the time you’re also choosing for an older, sicker version of yourself. Who may need to see specialists, and who may not have as much capacity to fight with insurance companies. 

I mean, most relatively young and healthy people have a hard enough time. 

This is where Traditional Medicare starts to look much more appealing. Practically every provider takes it, and denials are almost unheard of.

But for most people, if you’ve chosen Medicare Advantage, it’s a no-backsies situation. 

You can still sign up for Traditional Medicare, but you may not be able to get a Medigap policy. 

For one thing, it may not be in your budget. Robert Wolpa got a quote: Almost 500 bucks a month. Like a third of his social security check.

Robert Wolpa: And I said, okay. Next option.

Dan: And lots of people don’t have the option at all. In most states, if you don’t sign up at age 65, Medigap plans are allowed to reject you if you have… pre-existing conditions. 

Sarah Jane Tribble: It’s sort of shocking, actually, right? Like, the Affordable Care Act passes and makes it so that everybody with pre existing conditions can get insurance no matter what, but it leaves out the people who might need that the most, who are 65 and older. 

Dan: That’s the person who had introduced us to Robert Wolpa, and helped us understand this whole issue. Sarah Jane Tribble,a reporter with our pals at KFF Health News had just published her own story about the pitfalls of Medicare Advantage.

This comes as a big surprise to a LOT of folks — as Sarah Jane found out while she was reporting her story, and talking about it with friends.

With all of these… advantage — all the marketing, and all the gaps it fills– Medicare Advantage has grown by leaps and bounds in its 20-some years. 

At this point, the majority of seniors are on Medicare Advantage.

So, OK: Long recap, but. That’s what we KNEW a couple of years ago. 

And it turns out — based on what happened last fall, and what’s about to happen this year — the problems are way worse than we knew. 

Which brings us back to our friends in Minnesota. In early October 2025.

News anchor 1: In 90 days, thousands of Minnesotans will lose their Medicare Advantage coverage.

News anchor 2: Many major health care providers are dropping their Medicare Advantage plans in 2026. 

Dan: So, Emily. What the heck happened?

Emily: So that local nonprofit insurance company – UCare– they went broke, and all their Medicare Advantage plans got pulled from the market. Pretty quickly after that, UnitedHealthcare, Aetna, and others sent break up letters of their own to thousands of their beneficiaries.

Lots of people turned to insurance brokers for help. 

But many brokers weren’t calling them back. Because things had started going haywire for them too. Insurance broker Alison Ebert told us she was used to getting paid in cookies and coffee – and this time around, she would mean that literally — because in the days leading up to open enrollment she got an unusual call from her contact at UnitedHealthcare.

Alison Ebert: She said, “I just wanna let you know before you get the email, we’re not paying commissions this year.”

Emily No commissions. No payment from the insurance company for anyone she would enroll in their Medicare Advantage plans. Which is for health insurance brokers — the whole business model. 

Alison Ebert: And my heart just sunk. That was the first phone call, and one by one thereafter, all the major carriers except for Allina Health Aetna, followed suit.

Emily: Other brokers in Minnesota told me the same thing. I asked Alison: why do you think they cut commissions? She says a rep for one of the big companies told her the ugly truth. 

Alison Ebert: With UCare exiting the market,” she said, “Let’s face it, we don’t want everybody that sunk UCare on our plan. And so this is how we’re gonna c- curb enrollments.” 

Emily:  Alison got the message: These insurance companies wanted to curb enrollments. They specifically didn’t want to insure people who they tho  ught “sunk UCare” — meaning, people who used health care. Who filed claims. Who cost money.If brokers didn’t get commissions for selling plans to these folks, a lot fewer of them would sign up.  

Alison Ebert: Because they’ve always told us about 80% of the sales comes through brokers like us.

Emily: Now, a few weeks later, it was October 15, open enrollment was starting, and her phone was ringing off the hook. 47 people on day one. And more every day after that. Plus all her regular clients — the ones whose grandkids she knew by name.

 Alison had to decide what to do  — could she afford to help all those people for free? 

Alison Ebert: I have kids. I mean, I deserve to get paid. I need to put gas in my tank to go to these people’s homes.  

Emily: But Alison didn’t think it was right to leave people hanging.

Alison Ebert: I left a message on my answering machine saying, “You know, due to the fact that we’re not getting paid this season, a lot of brokers left the market and I’m just returning calls as they come. But just be aware that it might take me a couple weeks to get back to you.”

Emily: Instead of going to everyone’s house, she set up office hours at a coffee shop to be able to see as many people as possible.

Meanwhile… Kelli Jo Greiner and her colleagues at the state’s Medicare hotline were scrambling too.

Kelli Jo Greiner: We had wait times of two hours. Nobody wants to wait for even 10 minutes, let alone two hours

Emily: She and her team had to improvise.

Kelli Jo Greiner: We have staff that don’t usually do Medicare counseling. They help with, like, long-term care and other areas, and we even put those folks on the phones to help

Emily: And she wrangled a weekly spot on FOX 9 in the Twin Cities to answer big questions.

Amy Hockert: Medicare Monday is what we’re calling it. A lot of changes coming in 2026. Kelli Jo, thanks for joining us.

Kelli Jo Greiner: Well, thank you. I’m glad to be here again. 

Amy Hockert: All right. Well, let’s roll through it here.

Emily: Kelli Jo told viewers: The most important thing is to be proactive. If you don’t do anything, the system will put you into traditional Medicare — but without a Medigap plan. Oh, and by the way, she told them: Your drug plan will probably disappear too, unless you sign up for a new one.

So — she said, the good news, as far as it goes is: Right now you have a choice. And it’s just like the one you had when you were 65. You get to basically start over if you want, and get a Medigap plan even if you have a pre-existing condition. This is a special situation, they can’t reject you. 

And once you’re on they can’t tell you which doctors to see. Almost every doctor in the country takes traditional Medicare.   

Kelli Jo Greiner: And for many people that is a huge advantage,’cause we have a lot of snowbirds here that go south for the winter.

Emily: But she says most people she talked with decided they just couldn’t afford those Medigap premiums. They were stuck with Medicare Advantage. Only now they had fewer and crummier Medicare Advantage plans to choose from. 

Also, they were more expensive than these folks were used to. 

Kelli Jo says a lot of people had been on plans with no monthly premium — but now all those plans were gone.  

Kelli Jo Greiner: and so they ended up having to switch to a plan with a premium

Emily: And in a lot of cases, without some extra benefits that Kelli Jo says are a big draw. Like discounts on groceries — or free gym memberships, a feature called Silver Sneakers.

Kelli Jo Greiner: and I cannot even tell you how many people called us about Silver Sneakers. They were so upset about that change.

Emily: So people ended up paying more than they were used to —  and getting less. 

Dan: OK. So to recap: some Medicare Advantage plans disappeared.

Emily: Yes.

Dan: The remaining plans weren’t great.

Emily: Right.

Dan: And most people chose them anyway, because they couldn’t afford Medigap.

Emily: Correct. And we can expect more of the same this year– and for who knows how many years ahead.

Dan: So Medicare Advantage is getting shakier– even while it keeps growing. 

Coming right up: how the dynamics behind all of this add up to trouble for all of Medicare. And what we can maybe do about it.   .

This season of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News — that’s a non-profit newsroom covering health issues in America. Their reporters are amazing — you’re about to hear from another of them. We’re honored to be their colleagues.

Dan: Kelli Jo Greiner told us many folks who lost their Medicare Advantage plans  just couldn’t afford Medigap supplements. 

Which, as we’ve been learning, has been one of the big dynamics behind the growth of Medicare Advantage in the first place. 

Emily: Our colleague Julie Appleby found recently, that dynamic is getting starker.

Julie’s a senior correspondent with our pals at KFF Health News.  

Julie Appleby: I cover all things health insurance pretty much, uh, from the Affordable Care Act to Medicare, other kinds of health insurance programs, uh, that kind of thing. 

Emily: Earlier this year, Julie got a call from a broker in Illinois.

Julie Appleby: And he was telling me that more than, like, 80 of his customers were enrolled in a Medicare supplement,

Emily: A specific plan. One that usually had low premiums. 

Julie Appleby: But they suddenly raised their rates by 45%. And he said, “In my 49 years of doing business as a broker, I’ve never seen a premium increase be effective immediately on everyone. So I thought, “Hey, I’m gonna start looking into this.”

Emily:  She found some good data from a company called Telos Actuarial — which showed: this price hike was part of a trend.

Julie Appleby: There were increases going on kind of throughout the industry.

Emily:. On average, the data showed premiums on Medigap went up almost 17% from the previous year.

Not as high as that one plan with 45 percent increase, but still nothing to sneeze at. Brokers and other experts told her: That kind of increase used to be almost unheard of. But for the last bunch of years, it’s become a new normal. 

Julie sees a connection with the growth of Medicare Advantage. 

To understand it — and why everything about Medicare could be getting shakier and shakier — Julie’s gonna introduce us to a key term: Risk Pool. It’s a big part of how insurance prices get set.

Julie Appleby: Insurance is a giant pool, right? We all are in the pool, and everybody kinda shares the cost. The insurance company has to sit down and try to figure out, “Well, gee, I’ve got this pool of people. How sick are they? How, how often are they gonna go to the doctor? How often are they gonna be hospitalized?” And then calculate out, “Okay, so what might that cost me?”

Emily: So a lot depends on: Who’s in the risk pool for any given plan? If Medigap plans are more expensive than Medicare Advantage — but provide better coverage — then, who’s gonna choose the Medigap? People who think they’re gonna *need* that better coverage. Sicker people.

And with millions of people getting the chance at do-overs — because their Medicare Advantage plans got nuked — these Medigap insurers have a bunch of new customers, who — it seems reasonable to think — may be sicker.  

Julie Appleby: So these carriers are, then having to think, “Wow, I’m taking all these people on in this region, so I’m gonna have to raise my premiums to cover what might be those expected costs.” 

Emily : And as premiums grow and grow, what we could see is a kind of vicious cycle. Because as new people turn 65, they’re looking at Medigap premiums that are harder and harder to afford.

So more and more people are attracted to Medicare Advantage. I spoke with a researcher named Laura Skopec – she studies Medicare at the Urban Institute, an economic and social policy think tank. Here’s how she put it: If this trend continues — with Medigap prices driving more people to Medicare Advantage

Laura Skopec: We’re gonna see a traditional Medicare that is sicker and wealthier, which is sort of a weird combination, but it’s gonna be sort of the sickest people that really need good access to specialists, wanna be able to go to the cancer center, you know, any sort of doctor they wanna go to, and the people that can afford Medigap

Emily: Like, the sicker you are, the more you need this, and the more people who need it, the more expensive the supplements will be.

Laura Skopec: The risk pool just keeps on worsening.

Emily: So, expect Medicare Advantage to keep growing. And — as Laura points out — getting more expensive.

Laura Skopec: The Medicare Payment Advisory Commission says we spend about fourteen percent more for everyone who chooses Medicare Advantage over traditional Medicare, and that was really not the point of the Medicare Advantage program, right? It was supposed to use sort of private sector processes to lower costs in Medicare, and it has not done that. 

Emily: In fact, insurance companies are under increasing scrutiny for overcharging the government for Medicare Advantage. 

The feds have been trying to impose some rules to cut down on those extra profits – all very technical stuff which we could devote a whole episode to.     

Dan: Maybe we should

Emily: Yeah and crackdown may have played a role in insurance companies pulling some of these plans off the market. And they say they’re gonna keep yanking more plans off the market unless they get MORE federal dollars. 

Laura: They’re saying that their costs are going up for paying claims, which is probably true, and they point to market exits and other issues as, like, we need a pay bump here to stay in the market.

Emily: All of this — pulling plans off the market, reducing benefits, trying to control who enrolls in their plans — all of this stuff is likely to keep happening. 

So we should talk about what that looks like on the ground, and how seniors can navigate all these changes. 

Remember Erin in Cambridge, Minnesota? 

What happened to her really exemplifies how this kind of thing can play out. And how we can support each other.

So Erin had gotten kicked off her plan when the whole enterprise behind it, UCare, collapsed.

Erin had been really happy with UCare for the four years she was on one of their Advantage plans.

Erin: You call their customer service and they are very helpful. I loved it.

Emily:  she had access to specialists. 

Erin: A thoracic, a neurologist, a urologist, a nephrology. An ENT specialist. 

Emily: Erin had suffered four heart attacks in her late fifties. Because she couldn’t work, she started getting social security and Medicare early — when she was 58. She doesn’t really remember how she ended up picking Medicare Advantage over traditional Medicare.

But it was working for her. Until they pulled the rug out from underneath her.

Erin: I did not want them to go anywhere. I heard that, I was just in tears.

I was so mad. I was like, “No. Now what do I do?” And I look at my husband and said, “Now what?” “

Emily: And she says her husband had the answer immediately.

Erin:Well, we’ll just call Desi.”

Emily: We’ll just call Desi.

Dan: Wait a minute–  Who is Desi?

Emily: You gotta meet Desi. 

Desi Panek: I’m Desi Panek, and I work at the Seven County Senior Federation here in Mora, Minnesota.

Emily: That’s a member-led organization of seniors in eastern and central Minnesota who came together to advocate for themselves, and to help each other with transportation and other stuff seniors need. Including: signing up for — and dealing with — Medicare. 

I met Desi and her boss Lisa Krahn, the Federation’s director, as they were gearing up for this year’s annual enrollment period. 

Lisa: It can’t be as bad as it was last year 

Emily: Yeah yeah. 

Desi: We’ll find out soon. 

Lisa: Oh, God 

Emily: Yep, hold onto your hat. 

Emily: Yep, they’re still dealing with the fallout from last year. This is Lisa:

Lisa Krahn: Still quite a few people who show up, who are calling now, who don’t realize that they haven’t had a plan all year saying, “I just don’t have anything because my old plan left. Well, I wasn’t really paying attention to the mail they were sending me,” kind of a thing.

Emily: Some of those people only found out when they got a bill in the mail. Or when they tried to pick up a prescription, and had to pay out of pocket cuz they didn’t have a drug plan anymore. 

Luckily, Erin got the news before it was too late. She and her husband called Desi, and Desi helped them enroll in a new Medicare Advantage plan. Which Erin says, isn’t as good. 

Erin: Right now I’ve got $1,700 out of pocket going to a pair of hearing aids

Emily: She’s not a fan of the customer service. And she says she had to stop taking one of her preventative medications because her drug plan changed.

Desi and Lisa are operating very much at ground level helping people like Erin, but they definitely have thoughts about the big picture –especially the stark choice between Medicare Advantage and traditional Medicare.

Lisa Krahn: original Medicare is that thing you’ve been waiting your whole life to get. It’s good everywhere. And once you’re in, you’re in. 

Emily: But it’s become too expensive for most people. Meanwhile, Medicare Advantage can really limit people’s access to care.

Lisa Krahn: So, looking for a middle ground between those, it’s, it’s… There, there should be better choices, frankly, instead of such extreme ones.

Desi Panek: Extreme is a really good word for that. I agree. 

Emily: Extreme meaning there’s a big hole in one and there’s too many…

Lisa Krahn: Restrictions on the other. But all the millions we’re dumping into advertising and these private companies, that could have filled the holes on original Medicare a long time ago. And that’s just antithetical to the function and the existence of the insurance industry, which, like the monarchy, maybe we can stop believing in. I’m revealing myself as a single-payer Medicare for All advocate, but we need better Medicare, frankly, you know? It always been shortchanged.

Emily: Dan, speaking of Medicare For All.

Dan: Yeah we really shouldn’t do an episode like this without mentioning it. Especially because it’s been coming up so much in this year’s election season. In Michigan, Abdul El-Sayed won the Democratic Senate primary, and Medicare for All was his number-one pitch.

Abdul El Sayed: Yes, we really can guarantee healthcare in this country. Yes, we really can do it while spending a lot less and getting a lot more if our healthcare doesn’t still fund tens of millions of dollars in healthcare CEO, uh, salaries on top of it.

Emily: People like Lisa — and Abdul El-Sayed — think of Medicare for All as a way to also plug the holes in existing Medicare. 

Dan: Well, huh. OK, I mean, one thing I’m really tuning into is that all these big gaps in Medicare are all driven by the fact that ALL of Medicare — our big public benefit — is actually set up so it requires insurance companies to make a profit in order for it to function. Whether they’re selling Medicare Advantage plans, or Medigap policies.

But then, how do Medicare for All advocates say that spreading Medicare to everybody makes the math actually work better?

Emily: It’s all about that term Julie Appleby introduced us to:  Risk pool. How “risky” the people you’re insuring — the pool — are as a whole. Meaning, how much health care they need on average. The calculations change a lot when the pool is everyone, including people who are 25 as well as 65 and 95 — and when tax money funds health care directly instead of filtering it through private health insurance companies to administer and also take a profit.

In fact, a recent study out of Yale estimates that Medicare For All — that is a Medicare that is completely void of private insurance companies — would reduce annual health expenditures by 1 trillion dollars every year.

Dan: But that’s not just taking insurance companies out of Medicare — it’s taking them out of the whole U.S. health care system.

Emily: Right. In the meantime, some politicians in Washington are talking about tweaks — big and small — to just Medicare itself. 

Vermont Senator Bernie Sanders–

Dan: the original Mr. Medicare For All 

Emily: Yeah – in the meantime, he says we should extend traditional Medicare to cover vision, hearing, and dental. He’s introduced a bill in the Senate to do just that. 

And Oregon Senator Ron Wyden recently introduced a bill that would put an out-of-pocket max on traditional Medicare. That way, people wouldn’t need supplements as much, and Medicare Advantage wouldn’t look as tempting.

Both of those ideas would mean putting more federal money toward traditional Medicare.

Dan: Which doesn’t SEEM like something Congress is likely to do. But what this whole story shows is: it seems like it’s gonna cost us either way. Either we put more public dollars into traditional Medicare, or we keep paying higher prices, collectively and individually,

As for the here and now. If you have Medicare Advantage, but you don’t have a Desi or a Lisa to call, Emily, they gave you a breakdown of what you need to know.

Emily:Yep. Their first piece of advice: open every piece of mail from your insurance company. That’s where you’re going to find out whether your plan is being cancelled. Or where you might find out they’re trying to auto-enroll you into a new plan, which might not be the best one for you.

Desi Panek: The past couple of years we’ve had plans that end a specific plan, but will auto-enroll the e- the enrollee into another plan in the same company.

Lisa Krahn: Crosswalking

Desi Panek: Yes, so that’s a big deal. Pay attention to your mail. Um, you’re gonna get stuck with huge premiums if you just let it roll.

Emily: And find someone to talk to.

Remember Kelli Jo who runs the Medicare hotline for Minnesota? Every single state has one of those agencies. They’re called SHIP — S H I P — state health insurance assistance program. Google your state, SHIP, and Medicare

If you can’t get through, there’s always insurance brokers. Desi has some advice on measuring up whether a broker is trustworthy.

Desi Panek: Ask them if they sell every product available to you in your area. That’s one of the biggest things. I think that a lot of people just assume they’re gonna go to a broker or an agent and they’re gonna get the full scope, and that’s not necessarily true.

Emily: You might want someone who sells Medigap supplements as well as Advantage plans. Someone who does that may be less inclined to push you into whatever’s paying them the highest commissions.

Desi Panek: Word of mouth is a big deal for a lot of people, so asking your friends, your neighbors, uh, “Who did you work with? Are you happy? Are you unhappy? What was the experience like?”

Dan: Talking to your friends and neighbors. It’s like, we gotta rely on each other.

Emily: Which is why I’m kind of obsessed with this Senior Federation thing. People banding together to share information and resources to navigate this ongoing mess.

Desi and Lisa’s group has been operating since 1975. There used to be a robust network of similar groups across the state. Theirs is the last one, but Desi says they’re going strong.

Desi Panek: We’ve got our beautiful community and our thrift stores that keep our doors open and allow us to give that good information out, um, whether it’s what people wanna hear or not.

Dan: And it went by kinda fast but I think I heard her say thrift stores?

Emily: Yep! They have a side hustle. 

Lisa Krahn: We run two thrift stores, the One More Time stores, which give us financial independence. So we’re not dependent on just memberships and just counseling fees or service fees. 

Emily: That’s awesome, yeah, I’m dying to go to those thrift stores. I saw it on the website and I was like…

Desi Panek: Did you see that we won Minnesota’s best thrift store?

Emily: Stop it.

Desi Panek: I mean it.  

Emily: That’s so cool. Oh my God. 

Lisa Krahn: By the Minnesota Star Tribune, yes. It was a popularity contest.

Emily: Amazing. Wow.

Dan: Wow for sure. Emily, thank you so much for all of this reporting.

So here’s where we landed: Medicare is way more broken than we knew!  And we already knew it was kind of a confusing mess with a lot of holes. 

Fixing it will require a huge lift.  The kind of thing that hasn’t seemed like a political possibility. And everybody will have BIG differences of opinion about how a fix should work. There are people who think the government shouldn’t be involved in health care at all. 

Meanwhile, we’ve got what we’ve got.  We’ve got each other. 

And… you just never know what might be possible.

Next time on An Arm and a Leg, we’ll hear about what might be the most radical health care experiment since Medicare itself. 

And the two guys — a Democrat and a Republican — who made it happen.

Till then, take care of yourself. 

This episode of An Arm and a Leg was produced by Emily Pisacreta, with help from our summer intern Lynn Barbera and me, Dan Weissmann— and edited by Ellen Weiss. Izabella Kulkarni provided additional production help.

Reporting for this story was supported in part by Arnold Ventures. Listeners like you are our biggest source of support, and we need you more than ever. If you like what you’re hearing and want it to continue, head to arm and a leg show dot com, slash, support.  

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

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. Listeners like you are our biggest source of funding.

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

Thanks! And thanks for listening

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.

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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 the appointment of Michael R. Caputo to the President’s Cancer Panel.

HHS announced in Houston, Texas that eight communities will receive funding through the new STREETS program.

Democratic congressional members and candidates are already planning to use any midterm election gains to expand health coverage, including boosting Affordable Care Act subsidies, reversing Medicaid cuts, and lowering the Medicare eligibility age.

But Democratic strongholds across the country — including Oregon, California, New York, and Washington — have more ambitious goals: single-payer, universal healthcare systems.

No state is closer to that goal than Oregon. A panel created by the state legislature in 2023 is slated to send lawmakers its proposal for a universal health plan by Dec. 1. The nine-person Universal Health Plan Governance Board seeks to establish, starting in 2032, medical, vision, dental, and mental health benefits for every state resident from cradle to grave — with no premiums, deductibles, or copayments. Lawmakers could vote on a plan during the 2027 legislative session or refer it to voters as a ballot measure in 2028.

If approved, the state would be the first in the U.S. to implement what’s called a single-payer health coverage system. It could serve as a model for other states — and potentially the nation.

Proponents of the proposal argue that the public supports universal healthcare more than ever as healthcare spending and complexity grow. Surveys show patients often delay care due to out-of-pocket costs. And medical debt remains a leading cause of bankruptcy in the nation.

States have often served as laboratories to test health policies later implemented nationally. The Affordable Care Act was modeled after Massachusetts’ attempt to achieve universal health insurance coverage, once single-payer efforts there stalled. And Canada’s universal healthcare system began with a provincial plan in Saskatchewan.

“In the short to medium term, there is no chance that ‘Medicare for All’ can be passed at the national level,” said Jonathan Oberlander, a University of North Carolina health policy professor. “That’s where the states come in. A state like Oregon provides a more hospitable political environment and a more realistic path to single-payer reform.”

But advocates of the plan expect a significant fight from healthcare behemoths, including large hospital systems, seeking to sour public opinion on making such widespread changes. Nine of the Fortune 500 companies are health insurers. The industry’s deep pockets have helped derail myriad universal healthcare efforts at the federal and state levels.

In 2011, the Vermont Legislature voted to implement a universal healthcare plan but, three years later, Democratic Gov. Peter Shumlin, who had campaigned on the promise of single-payer, pulled the plug, citing “potential economic disruption.”

States that took the issue directly to voters have fared no better. Ballot measures in Colorado in 2016, Oregon in 2002, and California in 1994 all failed by large margins.

“The aspirations of progressive reformers usually run smack into sobering political realities,” Oberlander said. “Translating a slogan into a legislative and political reality is a daunting task.”

Valdez Bravo, president of Health Care for All Oregon, speaks at the nonprofit’s annual garden party in Portland on Sept. 12. The state will soon consider a plan for universal health coverage that the state legislature ordered in 2023. (Christena Dowsett for KFF Health News)

Redirected Healthcare Dollars

Oregon’s proposal seeks to maintain the current level of spending on healthcare by government, business, and consumers with new corporate and personal taxes to replace insurance premiums and other out-of-pocket costs. Those would be combined with federal and state spending to create a single fund from which all hospitals, doctors, and other practitioners would be paid.

Board members said savings from cutting red tape, reducing fraud, and negotiating drug costs should allow the state to provide better benefits to more people.

In examples prepared for consumer focus groups, the board estimated that a 30-year-old making $55,000 and purchasing a benchmark silver-level plan through the Affordable Care Act now pays $5,478 a year for insurance premiums in Oregon, but instead could pay $2,331 in taxes under the proposed plan.

Someone making $55,000 a year with coverage through their employer now pays $3,063 in premiums and out-of-pocket costs. Under the draft plan, that person could pay nothing for health services and could see any doctor in the state.

Currently, many employers pay much of the health insurance costs for their workers. The plan seeks to maintain those contributions by establishing a corporate payroll tax for companies whose payrolls exceed $500,000. Their employees could receive a partial tax credit for the taxes their employers pay. As a result, 31% to 60% of Oregonians wouldn’t pay anything for health benefits.

More affluent people, however, could end up paying more than they do now. The exact numbers would depend on how lawmakers set tax rates and payment thresholds.

“What we are proposing is something very different,” said Miriam McDonell, executive director of the Oregon board. “Everyone contributes based on the amount that they are able to contribute and not based on utilization.”

A work group created by the state legislature in 2023 is slated to send lawmakers its proposal for a universal health plan by Dec. 1. Lawmakers could vote on the plan as soon as the next legislative session or refer it to a ballot measure in 2028. The nonprofit Health Care for All Oregon hosted a garden party on Sept. 12 ahead of the reveal. (Christena Dowsett for KFF Health News) Backers of the universal healthcare coverage plan will try to convince hospitals and health systems that they would benefit from reducing red tape and eliminating unpaid bills. (Christena Dowsett for KFF Health News)

Messaging Challenge Lies Ahead

The plan’s backers will try to convince hospitals and health systems that they would benefit from reducing red tape and eliminating unpaid bills. Currently, hospitals hire scores of workers to bill dozens of public and private health plans, each with its own coverage and billing rules. A single plan covering everyone in the state could streamline the process, saving billions.

Rural hospitals could gain financial stability. They now often struggle to stay afloat because they typically have higher rates of patients who are uninsured or on Medicaid, with its often low reimbursement rates.

Hospitals aren’t so sure.

“The universal health plan proposal preserves much of the broken, fragmented status quo and adds new taxes and complexity that Oregonians can’t afford,” said Becky Hultberg, president and CEO of the Hospital Association of Oregon. “With federal policy changes looming, we are entering a period of tremendous upheaval. This proposal could destabilize a system that is already struggling.”

Under the proposal, doctors and other practitioners would be paid somewhere between what Medicare pays on the low end and what private insurance pays on the high end. Although total payments to doctors would remain unchanged, rates would be negotiated with physician groups to shift more money into primary care and less into specialty services.

But it is unclear whether doctors would agree that more patient time, fewer administrative hurdles, and no more unpaid bills would be worth a payment structure that could cause specialists to lose out.

Rebecca Schoon, an associate professor at Pacific University who attended last month’s Health Care for All Oregon garden party, says that communicating what universal healthcare is will be one of the biggest challenges ahead for Oregon’s proposed plan. (Christena Dowsett for KFF Health News)

“There’s always winners and losers in designing something like this, and so how to distribute those is the hardest part,” said Rebecca Schoon, an associate health policy professor at Pacific University who is slated to join the Oregon board in January. “But the second-hardest part is, I think, messaging this.”

Courtni Dresser, vice president of government relations for the Oregon Medical Association, said her physicians group shares many of the board’s goals in improving access to care and reducing administrative burdens. But the group has yet to declare its support or opposition to the effort.

Health insurers haven’t formally weighed in on Oregon’s proposal either, but a single-payer system would, in essence, close off Oregon to any private healthcare plans.

“We expect insurance companies to put every ounce of money they can against this idea because our system is broken and they profit from it,” said Collin Stackhouse, communications coordinator for Health Care for All Oregon, a consumer group advocating for universal healthcare.

Wendell Potter, a former insurance company executive who now works to expose industry influence, said he expects health plans to hammer the Oregon proposal with claims of high taxes, loss of choice, and the specter of “socialized medicine.”

“Most people go year to year without testing the limits of their health insurance policy,” Potter said. “And so, they’re easily scared into thinking that something valuable will be taken away from them, and that they will have something that’s inferior in its place.”

Health insurers argue their health plans help shield consumers from the full impact of rising healthcare costs.

“Americans consistently report strong satisfaction with their health coverage, including more than 180 million covered through work and 36 million who choose Medicare Advantage,” said Chris Bond, a spokesperson for the health insurance trade group AHIP. “Policy solutions are needed to rein in the ever-higher prices charged by hospitals and drugmakers and make care more affordable for everyone.”

Volunteers converse at the Sept. 12 garden party in Portland. Oregon’s legislature created a work group in 2023 to draw up a plan to create universal healthcare in the state. The proposal is due Dec. 1. (Christena Dowsett for KFF Health News)

Federal Approval Needed

It’s unclear whether Oregon could secure federal approval to redirect Medicare and Medicaid dollars into its universal plan. Backers of the proposal do not expect the Trump administration to be receptive but say it will be years before approval is needed and hope the 2028 presidential election ushers in a more supportive administration. If federal waivers are not secured, Oregon could proceed in stages, starting with the non-Medicare population.

In California, Democratic candidates for governor are not debating whether to implement single-payer but how. New York lawmakers are debating a single-payer bill called the New York Health Act. And in Washington, state legislators have created a commission to design a universal healthcare plan.

The Oregon board has had regular contact with teams working on single-payer proposals in California and Washington, sharing approaches and looking for ways to collaborate, McDonell said.

Richard Bruno, an Oregon family physician and a member of Physicians for a National Health Program, said he could envision the other West Coast states joining Oregon in implementing single-payer, much as California, Washington, and Hawai‘i have in public health efforts to counter changes in federal vaccine recommendations.

“If our four states could do it,” he said, “that would be the momentum we would need to get it nationally.”

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.

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

KYLE, Texas — Kenney Blewett was diagnosed with lung disease more than a decade ago but started experiencing flare-ups this year that made him feel like he couldn’t breathe.

Blewett described those flare-ups as “the scariest thing in the world,” said his wife, Cindy, adding that while the episodes typically lasted no more than a few minutes, they had become more frequent.

On top of that, simple tasks, like taking out the trash, left Blewett winded. He rarely left the house and had recently lost 45 pounds. “That sounds like cancer,” Cindy remembered one of his doctors said. It was clear, she said, that her husband’s poor health, tied to decades of smoking, was getting worse.

That’s why, on June 2, Blewett’s pulmonologist wrote him a prescription for a new medication to improve the terrifying breathing issues caused by chronic obstructive pulmonary disease, or COPD. But the prescription wasn’t immediately filled. Two days after that doctor appointment, Blewett received an email from Walgreens explaining that, “due to an insurance issue that we’re working to resolve,” the medication was delayed.

“He was hopeful that it would work,” Cindy said of the drug, two months after her husband’s death. “I wish we had the chance to find out.”

Insurance delays and denials have become an infamous feature of the American healthcare system, with nearly 7 in 10 adults calling them “a major problem,” in a January KFF Health Tracking Poll.

In June 2025, six months after UnitedHealthcare’s CEO was shot in New York, the Trump administration announced a highly publicized industry pledge, signed by dozens of major health insurers, to remove some of the barriers that block or delay patients from accessing doctor-recommended care. And yet that pledge was voluntary, and it carries no penalties if companies fail to comply. Indeed, a report published by KFF Health News in July found that some insurers that signed the pledge would not implement all the promised initiatives as originally outlined.

Denied Insurers Hedge on Trump-Backed Pledge To Improve Denials Process

Last year, the Trump administration announced a voluntary pledge by dozens of insurers to improve prior authorization, which often requires patients to seek approval before treatments. But prior authorization remains commonplace, and there’s no evidence the government is trying to hold insurers to account.

By Lauren Sausser and Renuka Rayasam July 17, 2026

In recent years, lawmakers in most states, including Texas, have attempted to address delays and denials by regulating the insurance industry in the absence of substantial federal reform. But most health insurance plans, including traditional Medicare policies and employer-sponsored offerings, which together cover more than half of all Americans, typically aren’t under state jurisdiction.

Even some medical office staff and pharmacy employees find the patchwork of state and federal insurance rules and regulations confusing, a problem that is poised to become more complicated as artificial intelligence plays a larger role in approving and processing claims.

“It’s just gotten completely out of hand,” said Matt Toresco, CEO of Archō, a patient advocacy and consulting company. He argued that patients need more assistance facing insurance hurdles.

The Blewetts’ story illustrates how navigating these complexities remains a herculean task for patients and their caregivers.

Cindy has sought answers from Medicare; Kenney’s private Part D drug plan; his pulmonologist’s office; and Walgreens. She still has questions about who was responsible for the medication delay and how the holdup could have been prevented.

If the COPD flare-up Blewett experienced on the afternoon of Sunday, June 7, could have been avoided, she wondered, would he still have chosen to die by suicide that night?

Kenney Blewett, who was diagnosed with lung disease more than a decade ago, died by suicide in June. The Blewetts celebrated their 60th wedding anniversary earlier this year. (Callie Richmond for KFF Health News)

‘Complex and Convoluted’

During that first week of June, Cindy said her husband repeatedly asked if his prescription — a liquid medication meant to be inhaled through the nebulizer machine Kenney owned — was ready to be picked up from Walgreens.

Cindy said she wasn’t initially surprised or worried by the delay. Since its acquisition by a private equity firm last year, Walgreens has cut thousands of jobs across the country, according to the Private Equity Stakeholder Project. Cindy said in August that their Walgreens pharmacy in Kyle seemed to her to have been understaffed for months, and that prescriptions were being filled more slowly.

When Cindy called the pharmacy a few days after Kenney’s appointment to find out more about the insurance delay, she said, a Walgreens employee told her the prescription required prior authorization. Also called preapproval or precertification, prior authorization is a practice widely used by health insurers that requires medical providers to seek permission before their patients may receive covered treatment.

But Cindy didn’t know which of Kenney’s insurers required prior authorization for this medication.

For years, she had helped manage multiple policies on behalf of her husband. Kenney was insured by Medicare parts A and B, the federal health insurance program for people 65 and older or with disabilities. But he also had a private Part D plan to cover drug costs through Wellcare Value Script, as well as a Medicare supplement plan through Blue Cross and Blue Shield of Texas — also called a “Medigap” plan — that paid for other out-of-pocket costs.

Initially, Cindy assumed that Kenney’s Part D plan had invoked prior authorization for his new medication. But because it was a liquid that is inhaled through a nebulizer machine, this drug was one of relatively few covered by Medicare Part B’s durable medical equipment benefit, not Part D.

The federal government had no record showing that this prescription had been billed to Kenney’s Part B policy, the Medicare agency told Cindy over the phone, she said.

Sarah Tanner and Myriea Amaya, spokespeople for Centene, Wellcare Value Script’s parent company, would not answer questions for this article.

After Kenney’s death, when Blewett sought clarification at the Walgreens pharmacy, she said the employee “kept saying different things.” She recalled his explaining that the prescription was submitted to Medicare Part B but without a necessary diagnostic code that the doctor should have included.

Carmen Lopez, a spokesperson for Walgreens, told KFF Health News in late September that the company “cannot comment on matters involving specific individuals.”

Subsequently, Cindy said, a district pharmacy supervisor for Walgreens reached out by phone, and told her the pharmacy tried to process the prescription through Part B on June 2, the same day as the pulmonologist appointment, but that the prescription was missing a diagnostic code from the physician. The supervisor said Walgreens sent a request for that code to the pulmonologist’s office later that day, Cindy recalled.

Kenney’s pulmonologist — Rajesh Shetty of LungDocs — did not respond to phone or email messages from KFF Health News. But Cindy said an employee at the practice told her they did not see a fax from Walgreens asking for a diagnostic code for the prescription.

Meanwhile, it couldn’t have been an issue with Kenney’s Medigap plan, since those policies don’t require prior authorization.

“Short of getting attorneys involved,” Cindy said, “I’m not sure how to find out what really happened.”

Cindy Blewett tried to figure out which of her husband’s insurers required prior authorization for his medication. (Callie Richmond for KFF Health News)

More Red Tape Ahead

Confusion surrounding these Part B and Part D distinctions is common, said Mike Hess, senior director of patient outreach and education at the nonprofit COPD Foundation. “Medicare has gotten to be so complex and convoluted over the years,” he said, that even medical office staff and pharmacy employees often misunderstand the nuances.

And with the introduction of AI to the preapproval process, navigating insurance hurdles will likely get more complex for Medicare beneficiaries, doctors say.

Historically, traditional Medicare, unlike Medicare Advantage, used prior authorization sparingly. But in January, Medicare launched a pilot program in six states — Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington — testing the use of AI to preapprove some healthcare services.

It is intended to “root out waste in Original Medicare,” CMS Administrator Mehmet Oz has said, but physicians and patients say the program is creating more red tape for Medicare beneficiaries and leading to inappropriate denials. The pilot program does not currently impose prior authorization requirements on COPD medications, but industry experts expect the scope of the initiative will grow to include more services and states.

On the night of June 7, hours after her husband’s last COPD flare-up, Cindy Blewett was sitting on their back porch when she heard a loud noise. She assumed a picture had fallen off the wall in the living room. In fact, it was a gunshot. She discovered Kenney’s body in their bedroom.

“I can’t tell you how horrible it was,” Cindy said.

She said her husband had struggled with his mental health for a long time and had attempted suicide once before, years ago. His deteriorating health only made things worse, she said.

Kenney confirmed that much in a note he left. He told Cindy that she was a wonderful wife, mother, and grandmother but that his health was too poor to continue living.

Cindy Blewett keeps an urn of her husband’s ashes. (Callie Richmond for KFF Health News)

A second COPD medication, which his pulmonologist ordered directly from the drug manufacturer during the June 2 appointment, arrived several weeks after Kenney’s suicide, she said.

“Perhaps, just perhaps,” Cindy said, “if he had received both medications in a timely manner, he would be here today, and we would have had many more years together.”

Do you have an experience with prior authorization you’d like to share? Click here to tell KFF Health News your story.

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 released a memorandum detailing six documented forms of fraud perpetrated by various parties against the Unaccompanied Alien Children.

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.

The big “Make America Healthy Again” summit at a glitzy Washington, D.C., hotel this week highlighted a split in the movement between moms who want pesticides and artificial ingredients out of their kids’ food and wellness entrepreneurs who want to promote their products to government regulators.

Meanwhile, as the new fiscal year begins, the Trump administration is refusing for the second year in a row to spend hundreds of millions of dollars Congress approved for the Department of Health and Human Services — and daring lawmakers or the courts to try to do something about it.

This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Rachana Pradhan of KFF Health News, and Rachel Roubein of The Washington Post.

Panelists Shefali Luthra The 19th @shefali.bsky.social Read Shefali's stories. Rachana Pradhan KFF Health News @rachanadpradhan Read Rachana's stories. Rachel Roubein The Washington Post @rachel_roubein Read Rachel's stories.

Among the takeaways from this week’s episode:

• The transformation of the Make America Healthy Again movement was on display at a MAHA Institute meeting in Washington this week. The gathering featured wellness companies hawking their wares and largely steered clear of the movement’s core issues, such as vaccines and pesticides. Many MAHA adherents have expressed disillusionment with the Trump administration, seeing it as favoring corporate interests over their priorities, and some progressives are starting to make a play for the support of these disaffected activists.
• The Trump administration is again attempting to cancel some congressionally appropriated health funding via a controversial strategy known as a pocket rescission. The 2026 fiscal year concluded this week, effectively running out the clock for Congress to force the Trump administration to distribute that money — and with the House already recessed until after the midterm elections.
• And the Hyde Amendment turned 50 this week. The legislative measure prohibits federal funding from being used to pay for abortions, effectively banning Medicaid funding of pregnancy termination unless states opt to spend their own money to offer that benefit for those who are low-income or disabled.

Also this week, Rovner interviews Aaron Carroll, president and CEO of AcademyHealth, to discuss the Trump administration’s dismantling of the federal Agency for Healthcare Research and Quality.

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’ “U. of Michigan Halts New Grading Plan After Backlash From Critics,” by Madaleine Rubin.

Shefali Luthra: The Atlantic’s “The Babies Left Behind in America,” by Caitlin Dickerson.

Rachana Pradhan: KFF Health News’ “US Poised To Boot Legal Immigrants From Medicaid, Including Refugees and Sex-Trafficking Victims,” by Phil Galewitz, Andrew Jones, and Claudia Boyd-Barrett.

Rachel Roubein: Stat’s “Once Described as Obesity Medications for ‘Patients,’ GLP-1s Are Increasingly Lifestyle Drugs for ‘Customers,’” by Elaine Chen.

Also mentioned in this week’s podcast:

• The Washington Post’s “This Senate Democratic Candidate Is Making a Play for RFK Jr.’s MAHA Supporters,” by Rachel Roubein.
• The Washington Post’s “White House Has Not Acted on RFK Jr.’s Push for Proof Ultra-Processed Foods Are Safe,” by Rachel Roubein.
• The New York Times’ “‘Zombified’ C.D.C., Hobbled by Cuts, Struggles To Fulfill Scientific Mission,” by Apoorva Mandavilli.

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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 the Presidential Fitness School Innovation Challenge.

If you have medical debt, there’s a good chance you owe money to a hospital.

One way patients can avoid medical debt is through hospital financial assistance, also known as charity care. Most of the nation’s hospitals offer free or discounted medical care to patients with very high medical debt or low incomes.

Getting financial assistance, however, can be challenging. Many patients don’t know that hospitals offer financial help, surveys show, and complex application forms leave others stymied.

Hospitals often demand that applicants turn over bank statements, pay stubs, tax returns, divorce filings, or other materials, and submit their applications in person, by mail, or by fax.

“They don’t make it easy,” said Neale Mahoney, a Stanford University economist who studies medical debt.

Such hurdles leave many patients with unpaid bills they should never have had to pay in the first place. In a single year, hospitals and health systems billed patients for at least $2 billion that they likely didn’t owe, one analysis found.

As healthcare costs climb and more people lose their coverage, states and hospitals are testing an emerging approach to fix this problem: automatically screening patients to see if they qualify for assistance and proactively wiping out debt when they do. This is known as “presumptive eligibility.”

Under this approach, patients may have the cost of their care wiped out before they see any bills — but not always. Hospitals differ on when, how, and for whom they use auto-enrollment, potentially impinging on patients’ finances.

Here’s what you need to know about how auto-enrollment works.

What is hospital financial assistance?

In many states, hospitals set their own criteria for whom they provide financial aid. Eligibility is typically based on income for the patient’s entire household. The closer patients are to poverty, the less they have to pay. Patients with middle incomes and insurance are sometimes eligible for discounts, especially if their bills would gobble up a big chunk of what they earn.

At least 11 states require hospitals to wipe out bills for low-income patients, though income cutoffs vary. Georgia, for example, mandates free care for anyone with income slightly above the federal threshold for poverty. In several states — including Oregon, North Carolina, and Maryland — patients can earn double that amount and still get free care.

But in most states, many patients must complete applications to receive assistance.

Several states in recent years have launched investigations and passed legislation designed to make it easier for people to get help. Research into medical debt, however, suggests gaps persist.

How many hospitals use auto-enrollment?

Nearly all nonprofit hospitals say they screen and automatically reduce bills for certain patients.

Under the Affordable Care Act, nonprofit hospitals must make reasonable efforts to find people who are eligible for help before they take patients to court, sell their debt to collection agencies, or ding their credit over bills. Presumptive eligibility is one way hospitals can comply with the regulation, which took effect in 2016.

In the first year under the new rules, about 70% of tax-exempt hospitals nationwide said they screened patients and proactively reduced bills, according to an analysis of federal data for Tradeoffs by the independent research institute RTI International. As of 2022, that figure was nearly 90%.

The federal law doesn’t apply to for-profit and public hospitals, which don’t have to report the actions they take before going after patients for unpaid bills.

In six states, policymakers require hospitals to use presumptive eligibility and skip applications for certain patients. Those states are California, Delaware, Illinois, Maryland, North Carolina, and Oregon.

Who is eligible to be automatically enrolled in financial assistance?

In most states, hospitals decide which patients can skip the application.

Common groups automatically screened include people who are homeless, deceased, or already enrolled in state or federal programs to help low-income households with housing, food, or prescriptions. Other hospitals have more unique criteria, like Christus Health, which will write off bills for anyone in a religious order who took a vow of poverty.

Eligibility criteria are often buried in official policies and hard to find or decipher. Some hospitals share little to no public information about whom they will proactively screen. Thirteen hospitals owned by Ascension, one of the nation’s largest Catholic health systems, state only that they may screen patients “with a sufficient unpaid balance.”

Across the half-dozen states with presumptive eligibility mandates, eligibility rules vary. Maryland, for example, requires hospitals to proactively wipe out bills only for patients who already get government help for food or utilities but are ineligible for Medicaid. In Illinois, lawmakers created less-stringent requirements for rural hospitals compared with urban facilities.

In Oregon, starting in 2024, hospitals had to screen anyone who owed more than $500 and every patient on Medicaid or who is uninsured. In 2025, roughly 80% of Oregon patients who got financial help with bills never filled out an application, based on data shared publicly by the first 26 hospitals to do so. The state’s legislature this year raised the screening threshold to include patients who owe at least $1,500 for a single visit.

Without an application, how do hospitals figure out who gets help?

Hospitals have several ways to find patients eligible for financial assistance.

Typically, hospitals turn to public records, any information patients have previously volunteered, or tools from consumer credit companies to estimate whether patients qualify to have bills reduced.

For example, if a hospital sees that a patient lives in a high-poverty ZIP code or has no address listed, that could be enough to deem them eligible. Many pay companies to run employment and credit checks on patients to determine whether they qualify for free care.

Hospitals may also consider how likely patients are to pay bills, regardless of how much they earn. This is called “propensity to pay.” California and Oregon prohibit its use, concerned that hospitals may try to collect more often from people who dutifully pay their bills even though their incomes qualify them for financial assistance.

When do hospitals screen patients for financial aid?

It depends.

Illinois, North Carolina, and Oregon require hospitals to screen certain patients before they send any bills. California hospitals will have to do the same starting in 2027.

Some hospitals voluntarily screen patients before sending bills; others try to collect money from patients first. As long as they screen patients before suing them for very overdue bills, hospitals can stay within the letter of the federal law that pushed many of them to embrace presumptive eligibility.

For example, the policy of Christus Health is to screen patients only “after all other eligibility and payment sources have been exhausted.”

Anna Stelter, vice president of policy for the Texas Hospital Association, said hospitals want to investigate other options for payment — like Medicaid or county safety net programs — before they give out financial assistance.

“We do want to make sure that whoever is financially responsible for that care is identified and pays,” Stelter said. “Charity care is the relief of last resort.”

Hospitals’ publicly posted policies may also be fuzzy about when they will screen for patients likely eligible for help. For example, Cook Children’s Health Care System in Fort Worth, Texas, says its goal is to determine a patient’s eligibility “as soon as sufficient information is available.”

Who pays the bills when patients get free care?

In one sense, we all do. Taxpayers cover some or all of the cost of financial assistance, though the amount varies by hospital.

About half the nation’s hospitals are nonprofit and legally get a pass on paying most taxes. KFF estimates that nonprofit hospitals pocketed $24 billion in 2020 that they would otherwise have paid as income, sales, or property taxes.

Government-owned and for-profit hospitals have their own sets of tax benefits to help offset costs for low-income patients. Government hospitals often get additional taxpayer support, and for-profit hospitals generally receive smaller government subsidies, like additional payments for caring for high numbers of uninsured and Medicaid patients.

Whether taxpayer dollars fully cover hospitals’ costs for financial assistance depends on the amount of government support they receive — information often not publicly available. It also hinges on how many patients need help, how many meet hospitals’ criteria for assistance, and how many get through an application. Research shows hospitals spend widely different amounts on financial assistance, from less than 1% of yearly expenses to more than 7%.

Philanthropy and hospitals’ income cover costs not absorbed by tax dollars.

This article is part of “Hidden Help,” an investigative series from Tradeoffs and KFF Health News about how hospitals can protect their patients from the life-altering harms of medical debt.

Melanie Evans is a reporter for Tradeoffs, a nonprofit newsroom reporting on healthcare’s toughest choices. Sign up for the weekly newsletter to get the latest stories every Thursday morning.

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

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 Robert F. Kennedy, Jr. today released a new episode of The Real Food Show with Lori Taylor, founder of The Produce Moms.

HHS, through ARPA-H, launched a major effort to transform how clinical trials are designed and conducted through new SURPASS program.

About half of rural voters identify with Make America Healthy Again, a sprawling political movement championed by the Trump administration, but most said President Donald Trump’s healthcare policies have not benefited their communities, according to a new poll from The Associated Press in partnership with KFF.

About 8 in 10 rural voters — an important voting bloc for Trump and fellow Republicans in recent elections — said the Trump administration’s policies have had a negative effect or no impact on the health of people where they live. Most MAHA supporters, 68%, also feel this way, according to the national survey of more than 2,000 rural registered voters.

The findings signal an apparent disconnect between the Trump administration’s MAHA-branded policy priorities and rural America’s perception of their reach and effectiveness.

Iowa pastor Mike Jager, 58, is a registered Republican and considers himself part of the MAHA movement. The Trump administration’s health policies have had “minimal” impact on the health of his community, Jager said, but he added that Trump’s health secretary, Robert F. Kennedy Jr., is moving the needle “in the right direction.”

“It’s a beginning,” Jager said. “It’s a big ship to try and turn around and course-correct.”

Kennedy has used the MAHA label to support various agendas, including abandoning long-standing vaccine guidance, researching ultraprocessed foods, and investing in regenerative agriculture.

Jager lives in Sumner, Iowa, “less than a quarter mile from where the corn ends and the city begins.” He’s seen family members and neighbors develop diseases that he believes resulted in part from exposure to agricultural chemicals and consumption of unhealthy, processed foods.

In the June Republican primary for governor, Jager voted for Zach Lahn, a businessman and farmer, who ran on a MAHA platform and beat out Trump-backed U.S. Rep. Randy Feenstra. He plans to vote for him again in November.

Jager said that President Donald Trump’s health secretary, Robert F. Kennedy Jr., is moving the needle “in the right direction.” (Miriam Alarcón Avila for KFF Health News)

Many Rural Voters Are Prioritizing Health Issues

About two-thirds of rural voters who support MAHA said it’s “extremely” or “very” important to them to vote for a candidate who does, too, while only 4 in 10 rural voters overall said the same.

Trump sought to seize on MAHA support during his campaign for another term two years ago. Now, amid tight midterm races, Kennedy has campaigned to galvanize the movement’s support. In May, he attended a MAHA bill signing with Iowa Republican Gov. Kim Reynolds, and in August, he went fishing with Lahn, posting about it on social media.

Yet the survey indicates voters are noticing “this weird split in the Trump administration” between what Kennedy messages and what Trump says and does, said David Peterson, a political science professor at Iowa State University.

“It’s this mix of things coming out of D.C., out of different pieces of the administration, that’s confusing people,” Peterson said.

In Iowa, concerns about what’s causing rising cancer rates are “a big deal,” he said. For many people who identify with MAHA, being healthy includes taking on corporate agriculture and pharmaceutical companies that they think cause cancer, he added.

“The sort of populist messaging around that is appealing right now,” Peterson said.

In the poll, views on healthcare access and costs largely diverged along party lines. Most Democratic and independent voters said the Trump administration’s healthcare policies have had a negative impact on their healthcare costs and the health and well-being of people in their communities. Republicans were likelier to say there hasn’t been an impact.

Talking on the phone from her 200-acre farm in Carroll County, Iowa, 71-year-old Donna Klocke said that her husband had died from cancer and that she has neighbors who also have cancer.

“It’s just very prevalent,” Klocke said. “We’re in a farming community. We use chemicals and pesticides and all kinds of things that aren’t necessarily good for us.”

Klocke, a Democrat, said the MAHA movement is a good idea because she cares about being healthy, but she does not consider herself part of it and will not be voting for a candidate who represents the movement.

Kennedy, who was an anti-vaccine activist before entering politics and has sent mixed messages to Americans about getting the measles vaccine, scares her.

“Measles are coming back and polio,” Klocke said. “It’s the measles that really gets me. It’s like, do you not understand how dangerous it is?”

Donna Klocke cares about being healthy but does not consider herself part of the Make America Healthy Again movement. Her husband died from cancer after a life spent farming the family’s 200 acres in Carroll County, Iowa. (Kathyrn Gamble for KFF Health News)

Survey Reflects Angst Over Healthcare

About half of rural voters said their communities don’t have enough doctors or other healthcare providers, and even more said there aren’t enough mental health workers specifically. The share of rural voters who said their community does not have enough hospitals increased to 35% from 21% in a similar question asked in a KFF-Washington Post survey in 2017.

And as with the general population, healthcare, gas, and grocery costs are top pain points. More than 6 in 10 rural voters said they were worried about healthcare costs.

The level of worry varied based on coverage, with rural voters enrolled in employer plans or Medicare less likely to be worried. The survey found that 80% of working-age rural voters on Medicaid were very or somewhat worried about healthcare costs. Last year, Republicans passed a tax and spending bill that cut over $900 billion in projected Medicaid spending over a decade and mandated new eligibility requirements.

Among rural voters who purchase their own insurance, such as the individual coverage plans available on Affordable Care Act marketplaces, 77% said they were worried.

In the tiny community of Lipan, Texas, west of Dallas, Kim Solis and her husband have a handyman-and-home-remodel business and get their insurance on the marketplace. Since Trump was elected again, their premium payment jumped from zero to $166 a month. Their copays went up, and their deductibles each increased by $2,000.

Solis, 62, said she worries what will happen if they get a big medical bill.

“Certainly, we’d be in a world of hurt trying to take money out of savings or getting it out of our 401(k) just to be able to do something about it,” she said.

Most MAHA Voters Are Also MAGA — But Not All

Like the general population, rural voters said they trust their own doctors and healthcare providers for health information over government agencies or officials, according to the poll.

Trust in Kennedy and Trump fell largely along partisan lines. About 10% of rural Democratic voters reported having a “great deal” or “fair amount” of trust in Kennedy, compared with 74% of rural Republican voters. About 5% of rural Democrats and 69% of rural Republicans said they trust Trump a “great deal” or “fair amount” for reliable health information.

While Make America Great Again and MAHA identities are “linked in a lot of ways,” the rising costs of healthcare and groceries pose a challenge for those committed to the MAHA principles that Kennedy promotes, said Peterson, the Iowa State professor.

Buying healthy food “becomes, ‘I can’t afford to do that because of Trump’s policies,’” he said.

In Stamping Ground, Kentucky, Alma Johnson, 65, works as night security at a horse farm. Johnson said gas had gone up but her overall cost of living had decreased since Trump took office.

Johnson voted for Trump in 2016, 2020, and 2024 and said she “pretty much” likes how Trump is running the country. But she said she is not a MAGA devotee, preferring to “think for myself.”

MAHA, however, is an easy sell for Johnson because, she said, she doesn’t think people should be able to buy junk food through the Supplemental Nutrition Assistance Program, or SNAP.

Still, she said she hasn’t seen much impact from the Trump administration’s healthcare policies, including the new food pyramid.

“It takes a long time to change people, their habits, their thoughts, or the things they do,” Johnson said.

About the Poll

The KFF-AP Rural Voters Survey was conducted online and by telephone Aug. 12-24, 2026, among 2,241 registered voters living in rural areas, defined as census tracts that fall within codes 5-10 of the U.S. Department of Agriculture’s 2020 Rural-Urban Commuting Area codes. Voters were reached through a combination of the probability-based SSRS Opinion Panel and a registration-based sample from the L2 voter file. Overall results have a margin of sampling error of plus or minus 3 percentage points, including design effects due to weighting. Error margins are larger for subgroups. In collaboration with the AP, KFF researchers worked to design the survey sample and questionnaire and analyze and report findings.

This report is from a collaboration between KFF Health News and The Associated Press.

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.