BAKERSFIELD, Calif. — Ulises Hernandez has had health coverage through Medicaid for as long as he can remember. But he had never waited as long for care as he did in September after a dental crown slipped down his throat during a procedure. He spent eight hours in an emergency room waiting for care and more than two days without food.

Sitting in his wheelchair to protest looming federal Medicaid cuts outside Republican U.S. Rep. David Valadao’s Bakersfield office, Hernandez described his wait as a foreshadowing of what’s ahead.

“I couldn’t eat, I couldn’t drink, I couldn’t do anything, and I was in pain,” said Hernandez, who had been discharged from the hospital a few days before. “I’m livid.”

Hernandez, 41, said Valadao “should be ashamed of himself” for voting for the Republicans’ One Big Beautiful Bill Act. The law is expected to reduce Medicaid spending by more than $900 billion through 2034, with provisions such as stricter Medicaid eligibility rules and reducing federal money to states.

Hernandez plans to vote for challenger Randy Villegas in hopes that this Central Valley toss-up district, where roughly 6 in 10 of constituents are enrolled in Medicaid, can help give Democrats control of Congress.

Villegas, a political science professor, has embraced the progressive rallying cry for “Medicare for All” and called out Valadao for a vote “that is going to rip away healthcare from Valley families,” since many working-age adults may not satisfy new work requirements and twice-a-year eligibility checks that, by political design, start after the midterm elections.

Valadao defends his vote on the GOP bill. During a televised Oct. 6 debate, he said “there are no actual cuts” to Medicaid.

An estimated 60,000 more residents of his district could be without coverage by 2034 due to the tax and spending bill and the expiration of enhanced premium tax credits for Affordable Care Act insurance plans, according to the left-leaning Center for American Progress think tank.

Researchers estimate that those new rules will push more than 2 million Californians statewide off their coverage and that the state stands to lose about $30 billion a year, more than any other state.

A small group of protesters chanted that healthcare costs are too high, blaming Republican elected officials including U.S. Rep. David Valadao. (Jackie Fortiér/KFF Health News) Bakersfield resident Ulises Hernandez fears Medicaid cuts will lead to even longer wait times for care. (Jackie Fortiér/KFF Health News)

Fertile Ground, High Unemployment

Bakersfield is an oil town, and it wears that identity proudly. Pump jacks nod in the distance. Streets run wide. The Kern River’s bed lies dry, its water siphoned to feed the agricultural fields. Sitting partially in the southernmost portion of the contested congressional district, this city produces much from the land, but unemployment is high.

Democrats have outnumbered Republicans in voter registrations by double-digit percentage points in Valadao’s district since he was first elected to the U.S. House in 2012, yet he has won six of his seven congressional elections. He has survived by focusing on local issues such as water infrastructure and distancing himself from the Trump administration, said Jeffrey Cummins, a political science professor at California State University-Fresno. Valadao is the last Republican House incumbent who voted to impeach Trump after the Jan. 6, 2021, riot at the U.S. Capitol who is running for reelection to Congress.

“This is an area where, even when we see the registration advantage for Democrats, that they are moderate Democrats who tend to be concerned with agricultural issues, and Valadao in the past has successfully appeased those voters,” Cummins said.

But California’s congressional map was redrawn last year as part of a national mid-decade redistricting fight, and Valadao’s Central Valley seat is considered more favorable for Democrats than before. Cummins said a different mix of voters, coupled with anger toward incumbents, could flip the seat.

“Valadao knows that he’s on notice,” Cummins said.

Nationwide, healthcare costs remain a top affordability concern for voters, and they trust Democrats over Republicans by a 2-to-1 margin on the issue, according to a September KFF poll. Valadao lost in 2018, when Democrats targeted his votes to repeal the ACA, as well as his alliance with Trump. On Nov. 3, he faces Villegas, a populist backed by Sen. Bernie Sanders (I-Vt.) who favors a single-payer universal healthcare system.

“The system that we have now, we pay twice as much as other countries across the world, despite the fact that we have worse healthcare outcomes,” Villegas said during the debate.

U.S. Rep. David Valadao (right) introduces Speaker of the House Mike Johnson on Sept. 30. (Jackie Fortiér/KFF Health News)

No Mention of Healthcare

Valadao participated in a $1,000-a-ticket fundraiser on Sept. 30. He was joined by House Speaker Mike Johnson, who is campaigning across 22 states in six weeks as Republicans try to hold the chamber. Afterward, press were allowed at an invitation-only reelection event in Bakersfield, held in an office building just outside of the new district Valadao hopes to represent. Arches of red, white, and blue star-shaped balloons framed the small stage.

Neither lawmaker mentioned Medicaid or the rising cost of healthcare when they spoke to the audience. After brief speeches, Valadao repeatedly refused to answer KFF Health News’ questions about his vote for the One Big Beautiful Bill Act and its impact on his constituents’ Medicaid coverage, saying, “I think you are distorting the truth.”

Of the half dozen attendees KFF Health News approached among roughly 50 in the room, none lived in Valadao’s district.

Allison Brandt Oliver and her mother, Charlotte Brandt, hope Valadao wins his November congressional election. (Jackie Fortiér/KFF Health News)

They came anyway. Retired nurse Charlotte Brandt lives in the neighboring Republican-held district but follows Valadao’s votes closely. She called him “a hero for the Central Valley,” citing his work on water, oil, and agriculture, which she said sustain Kern County as the “breadbasket of the world.”

Her daughter, Allison Brandt Oliver, who also lives in Republican Vince Fong’s district, said she favored the stricter Medicaid eligibility rules Republicans put into place, saying her concern is whether spending is going to U.S. citizens who contribute to the economy.

A few days later during the televised debate, Valadao said he was among the negotiators who secured community engagement provisions in the law, which will require certain adults to prove they’re working or completing other activities such as job training or volunteering.

“It’s not an actual cut,” Valadao said. “We need people to actually put in and make a fair effort to try to cover their expenses and be a part of their community. This is not an unreasonable ask.”

About 50 people attended an invite-only campaign event with Valadao and Johnson on Sept. 30 in Bakersfield. (Jackie Fortiér/KFF Health News)

Millions in Ads, One Swing Seat

In a sign of how vital this district is, Republicans and Democrats had each booked more than $16 million in ads here through Election Day, according to data compiled by AdImpact.

“When you start getting over $10 million of spending total in the district, I would say that that’s pretty high,” Cummins said.

Some of the ads are reaching voters in unexpected ways.

Outside a local library, Seslie Maese, a stay-at-home mom from Bakersfield, said her 7-year-old, who often watches Lego videos on YouTube, runs to her whenever a certain ad plays. “David Valadago is going on vacation again, Mom,” he announces, mispronouncing the congressman’s name. Her son doesn’t realize the ad, paid for by a Democratic political action committee, means that as a criticism.

Maese is undecided. Even though she’s a registered Republican, she said what she has heard about Valadao doesn’t sound positive, such as that he went back on his pledge not to cut Medicaid for vulnerable populations by voting for the federal tax-and-spending law.

For Maese, a politician who says one thing and does another is a deal-breaker.

“He just hasn’t come through with anything he said,” she said, “especially since he cut off a lot of Medicaid.”

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.

Refugees. Sex-trafficking victims. People fleeing war. They’re among the hundreds of thousands of immigrants living in the country legally who no longer qualify for Medicaid. The change, in effect since Oct. 1, is part of the 2025 Republican tax law, which cuts Medicaid spending by an estimated $900 billion through 2034.

KFF Health News rural health reporter Andrew Jones joined WAMU’s Health Hub on Oct. 21 to explain which Medicaid enrollees are affected in the Washington, D.C., region and what other cuts to health services for immigrants are next.

US Poised To Boot Legal Immigrants From Medicaid, Including Refugees and Sex-Trafficking Victims

The Congressional Budget Office estimated 100,000 more immigrants will be uninsured by 2034 because of Medicaid eligibility changes under President Trump’s One Big Beautiful Bill Act that take effect Oct. 1. A KFF Health News survey of nine states found many more are at imminent risk of losing health coverage.

By Phil Galewitz, Andrew Jones, and Claudia Boyd-Barrett Sept. 30, 2026 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.

Consumers who buy Affordable Care Act health insurance are going to see changes both big and small as open enrollment for 2027 coverage kicks off. These include premium increases, possible additional identity checks, potential delays in working with a broker, and new limits on which immigrants can get subsidies.

Shoppers need to plan accordingly.

Open enrollment starts Nov. 1 in most states. Idaho, Connecticut, and Massachusetts start earlier, and some states are already allowing “window shopping” to check premium rates.

A continued decline in overall enrollment is expected, mainly because of the expiration of enhanced subsidies at the end of 2025. Policy experts say the end of those subsidies led millions to drop or lose coverage through the first few months of this year.

But the Trump administration sees victory in the falling enrollment, crediting its various efforts to reduce fraud, including the August cancellation of policies covering 760,000 enrollees suspected to be improperly signed up. A small number of those enrollees have regained coverage.

Have Your ID Ready

One of the biggest changes will be increased scrutiny of both consumers and agents via requirements aimed at thwarting fraud or improper enrollments. For consumers, it could slow the enrollment process.

The new rules, outlined in a Centers for Medicare & Medicaid Services FAQ, affect only consumers using agents or brokers to help them enroll through the federal marketplace, which serves 29 states. They do not apply to state-based exchanges, which have their own rules and have in most cases been more successful at preventing fraudulent sign-ups.

For starters, all consumers using an agent in the federal marketplace will need to get a one-time confirmation code or link to authorize a specific agent to enroll them or make changes on their behalf. It will be sent to consumers by text message, email, or an automated phone call from one of the private enrollment platforms used by their agent. Returning consumers who have incorrect or outdated contact information will first need to call the federal marketplace themselves or submit an application online to update it.

Additionally, consumers and policyholders deemed “high-risk” must verify their own identity before authorizing an agent. CMS defines as “high-risk” first-time applicants or those with existing coverage whose applications involve a change of state, as well as consumers working with a new or different agent or with a monthly premium payment of $30 or less.

Joshua Brooker, who oversees an insurance agency in Pennsylvania, said CMS appears to have selected people in those groups for greater scrutiny because “someone who is moving to a new state or switching brokers — that could be a broker trying to impersonate a consumer.”

The $30-a-month cutoff may be tied to concerns that plans with no or low monthly premiums are easier for bad agents to target for unauthorized enrollments because the policyholder may never get a bill. Some rogue agents even pay the low monthly amount themselves and still make a profit from the commission, Brooker said.

The broad nature of the new rules, though, has Brooker concerned “that up to 1 in 5 consumers is going to have to do extra identity proofing” and may just give up and not get insured.

Consumers designated high-risk must prove their identity through a CMS-approved third party such as credit company Experian, which generally asks questions only the consumer should be able to answer. People who fail this test may be asked to call Experian’s help desk or submit their applications themselves by creating a healthcare.gov account, which requires them to upload identification such as a driver’s license, a passport, immigration papers, or another form of ID.

“Some people may have trouble not because they’re not real, but because they don’t have a credit file, or have moved, or have changed names,” said Stacey Pogue, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University.

She said the changes might “be an appropriate response by CMS that targets fraudulent enrollments but might also create extra hurdles.”

There May Be Fewer Brokers

CMS in September issued a rule that places a moratorium on brokers new to offering ACA coverage. Agents not registered with the federal marketplace in 2026 will not be allowed to assist with enrollments for 2027 until February at the earliest, past the end of open enrollment season.

CMS said it took this step because a disproportionate number of “significant compliance concerns” in 2026 came from newly registered agents or brokers. Additionally, the agency has kicked out “hundreds of non-compliant agents and brokers” this year.

Jason Fine, who runs a brokerage in Florida, said he agrees with the concept behind these changes. He has reported multiple times to CMS, for instance, that rogue agents have switched his clients’ coverage without authorization, wanting the agency to take action against them. But he said the updated rules also raise concerns.

“Everything they are doing in the long term makes sense,” he said. However, in the short term, “I don’t know if they care about the chaos it will cause.”

That’s because the moratorium will make it much harder for small brokers to help clients this year. His agency and others often pare their staffing after open enrollment but hire again toward the end of the year. He was planning to add up to 10 agents to his core staff of about five but has been told by recruiters that he’s unlikely to be able to find anyone who was registered for 2026 and is still available.

He suggested that the move unintentionally benefits larger call centers, some of which were doing much of the marketing that regulators feared led to unauthorized switching. Call centers often maintain larger staffs.

“They can afford to keep a staff of 25 or 40 people all year long,” Fine said.

Groups representing agents are very unhappy with the directive. One, the National Association of Benefits and Insurance Professionals, filed a lawsuit Oct. 15 against the Trump administration over the moratorium, saying it unfairly targets 19,000 agents who may want to sell ACA plans for next year.

“Just because you’re a new agent doesn’t mean you are fraudulent,” said Ronnell Nolan, president of Health Agents for America, another sales agent group, which on Oct. 21 filed suit seeking a temporary restraining order on the moratorium. “All these agencies who have trained new agents and paid thousands of dollars now have people who won’t be able to work.”

It all leads to an important piece of advice from Georgetown’s Pogue: Consumers should not delay making appointments. “If you rely on an agent or broker, and a lot of people do, their slots might fill up faster because there will be fewer of them to help with enrollment. I would reach out early.”

Costs Will Continue To Be an Issue

This year, after Congress did not renew the expiring enhanced subsidies, most people getting ACA coverage saw what they had to pay increase. Higher earners lost subsidies entirely. Add in double-digit premium increases, and most people had to pay substantially more for their coverage.

But most people who buy ACA coverage for next year will still receive a subsidy. It will just be less generous than it was before the enhancements expired at the end of 2025.

The subsidies are pegged to the premium costs of benchmark plans, the name given to the second-lowest-price silver-tier plan in an area.

This helps offset premium increases.

“For most folks, overall affordability will stay about the same,” said Louise Norris, a health policy analyst for HealthInsurance.org. “That’s not to say it’s great, but if you were able to manage the premiums this year, it should be similar to that.”

But there are other factors at work, too.

Last year’s average premium increase of 26% was the largest in years. It was driven in part by insurers’ fear that the expiration of subsidies would cause healthier people to drop out of the marketplace. Other drivers often cited for such increases include a rise in overall medical care costs, inflation, and labor shortages.

For the upcoming year, those dynamics remain a concern, with premiums slated for double-digit increases, although, at 15%, slightly lower than last year.

Subsidies are income-based and cut off for households earning more than four times the federal poverty rate. During this open enrollment season, that amount is $63,840 for a single person, $86,560 for a couple, and $109,280 for a family of three, for example.

“The biggest issue we will face is affordability,” said Anne Petry, who, with her father, owns Jaggi Petry Insurance & Investments in Forsyth, Illinois, and helps customers purchase health insurance, including ACA plans. “There definitely will come a breaking point for people.”

Agents and other experts say consumers should not allow their plans to automatically renew and should instead go online to compare premiums and coverage, which can change each year even for the same plan. There may be less expensive alternatives, including plans from new insurers, so they suggest looking at not just premiums, but also deductibles and other costs. At the same time, several insurers, including Cigna, have dropped all or part of their ACA coverage areas.

“If you just sit on the sidelines and let the policy auto-renew, you might miss out on what could be a better opportunity,” Norris said. She said it is important to check options because the cap on out-of-pocket maximums for ACA plans is also increasing.

That amount, which represents the most a consumer must pay toward deductibles, copayments, and coinsurance before the policy is expected to cover remaining in-network medical costs, was $10,600 for an individual and $21,200 for a family plan this year. In 2027, it will grow by 13% to $12,000 for an individual and $24,000 for family coverage. Lower caps on out-of-pocket maximums are set for households earning up to 2.5 times the federal poverty level.

The One Big Beautiful Bill Act, which Congress passed last year, also strips subsidy eligibility from many lawfully present immigrants, including people holding temporary H-1B work visas, refugees, asylees, people with temporary protected status, and those with pending green-card applications.

Three immigrant groups can still get ACA subsidies: green-card holders, who have permanent legal status; certain Cuban and Haitian immigrants; and citizens of Micronesia, the Marshall Islands, or Palau.

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 launched a six-month Healthcare False Claims Act Self-Disclosure Pilot Program for healthcare companies

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.

Healthcare issues continue to be front and center in the midterm campaigns. Democrats are hammering Republicans on the federal funding cuts to Medicaid included in 2025’s One Big Beautiful Bill Act, even before many of the reductions take full effect. Republicans, for their part, are accusing Democrats of failing to fight fraud and abuse in federal programs.

Meanwhile, President Donald Trump this week unveiled initiatives aimed at improving women’s health and rewarding whistleblowers who uncover fraud, despite the fact that there are long-standing federal programs addressing both issues. It’s unclear what’s new that the programs will bring to the table.

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Amanda Seitz of KFF Health News, and Liz Essley Whyte of The Wall Street Journal.

Panelists Alice Miranda Ollstein Politico @AliceOllstein @alicemiranda.bsky.social Read Alice's stories. Amanda Seitz KFF Health News @AmandaSeitz aseitz@kff.org Read Amanda's stories. Liz Essley Whyte The Wall Street Journal @l_e_whyte Read Liz's stories.

Among the takeaways from this week’s episode:

• As Election Day approaches, Democrats and Republicans are working to keep their healthcare messages front of mind for voters. Democrats, seeking to win control of Congress, are pointing fingers at the GOP for high health costs and insurance coverage losses, particularly among Medicaid enrollees. Republican candidates in turn are pointing to the rural health funding Congress approved alongside the Medicaid spending reductions, though their Democratic opponents note that the funding amounts to a fraction of the cuts.
• Meanwhile, Republicans are pushing their own message targeting fraud, waste, and abuse in federal healthcare programs. The Trump administration has announced another major deferment of federal Medicaid funding for California, citing dramatic growth in home care costs. Trump officials say that growth suggests potential fraud and warrants action, while California officials say it represents actual increases in costs and demand.
• In other administration announcements, Trump unveiled a new women’s health initiative with first lady Melania Trump by his side. Yet the initiative has no concrete policy goals or funding, leaving it unclear what exactly it will accomplish.
• New research is illuminating the inherent flaws in Health and Human Services Secretary Robert F. Kennedy Jr.’s push to stop recommending the birth dose of the hepatitis B vaccine. Plus, the board of the National Institutes of Health research hospital denounced the launch of Kennedy’s Vaccine Injury Center, accusing the health secretary of undermining trust in science.

Also this week, Rovner interviews Ollstein, whose new book, Side Effects: How Abortion Bans Impact Everyone’s Health, comes out Oct. 27.

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

Julie Rovner: Vox’s “America’s Next Big Healthcare Reform Might Already Be Underway,” by Rachel Cohen Booth. 

Alice Miranda Ollstein: Stat’s “I Was a Theranos Whistleblower. In ‘You Can See Everything,’ Elizabeth Holmes Is Still Lying,” by Tyler Shultz.

Liz Essley Whyte: Stat’s “How the No Surprises Act’s Nonprofit Arbitrators Are Operating Like ‘Mini Gods’ and Getting Rich Doing It,” by Tara Bannow.

Amanda Seitz: The New York Times’ “Why Drug Companies Are Rushing To Market Ketamine Medicines,” by Andrew Jacobs.

Also mentioned in this week’s podcast:

• Politico’s “Medicaid Cuts Haunt Republicans in Battleground States,” by Alice Miranda Ollstein.
• KFF Health News’ “After Booting 760K People From ACA Plans, Trump Administration Has Added Some Back,” by Julie Appleby.
• The New York Times’ “Kennedy’s Vaccine Plan Could Cause Surge in Hepatitis B, Study Finds,” by Apoorva Mandavilli.
• The New York Times’ “N.I.H. Hospital Board Rebukes Kennedy Over New Vaccine Injury Clinic,” by Sheryl Gay Stolberg.
• Bad Blood: Secrets and Lies in a Silicon Valley Startup, by John Carreyrou.

click to open the transcript Transcript: Medicaid Is Now a Campaign Issue

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

Julie Rovner: Hello, from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 22, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Liz Essley White of The Wall Street Journal. 

Liz Essley Whyte: Hi. 

Rovner: And my KFF Health News colleague Amanda Seitz. 

Amanda Seitz: Hey, thanks for having me. 

Rovner: Later in this episode, we’ll have my interview with Alice here, whose brand-new book, Side Effects: How Abortion Bans Impact Everyone’s Health, comes out officially next week. But first, this week’s news. 

Let’s start with Medicaid. Election Day is less than two weeks away, and, despite the fact that Republicans tried to backload the Medicaid cuts in their 2025 budget bill so that most of them wouldn’t start until next year, Democrats appear to be making some headway using them as a campaign issue already this year. Alice, you wrote about this. Start us off. 

Ollstein: Yeah. So the cuts are hitting people already. People are already feeling them, and that’s for a few different reasons. One, some states have decided to pull the trigger early on work requirements, and even those that are waiting until the congressionally set January deadline, they’re already receiving notices, and so they’re freaked out about their coverage. Also, even though the cuts are not taking effect, states have to make their budgets in advance to prepare for them. Hospitals need to make their budgets in advance to prepare for them. And so you’re already seeing cutbacks in other areas — in services, in programs — and so people are feeling that. And the impact is happening way outside Medicaid as well: People on private insurance, whether they get it on the individual market or through their job, are seeing really big increases in costs. And Democrats are capitalizing on that and are connecting what the pain people are feeling to Republicans’ basically one major piece of legislation that they passed over their two years in power, which is the quote-unquote “One Big Beautiful Bill” that had all these healthcare provisions tucked into it. And so I found that in basically every single Senate debate that I’ve been watching in these battleground states, there was almost identical exchanges, where Democrats attacked about the Medicaid cuts, Republicans responded by pointing to the rural health funding in the bill and saying, You know, I fought for that, and I guess you hate rural health because you criticize this bill. Then Democrats responded, OK, the rural health funding is great, but it’s just a fraction of what states are losing on other federal health funding. And so this is just playing out again and again and again — in Michigan and Maine and Alaska and all of these states that have these close races. 

Rovner: Yeah, and we’ll talk about this more next week. But the KFF annual employer survey is out just this morning, and it shows not only, I mean, what we already knew, which is that premiums are going up, but it also shows that employers are starting to pass along the cost of those increased premiums to their employees. So it kind of balloons the idea that people are really feeling the increases in healthcare costs. 

Seitz: Yeah, I think the issue is less about the Medicaid cuts themselves and more about that idea that healthcare costs are rising at every level, and no one has offered a solution to really fix that. If you recall, President [Donald] Trump said that he had “concepts of a plan” to fix the ACA [Affordable Care Act]. Well, instead, all we got were cuts to Medicaid, higher ACA premiums, higher premiums for private insurance. So I think that people see there’s kind of no real road map being offered here to get out of this situation of continuously rising costs and access to care becoming increasingly more difficult. But I think the hard part now for Democrats, in particular, becomes OK, what is your plan? And they have not offered a clear, unified vision for what they will do. We’re still kind of waiting to see what that might be. So if they do succeed in taking back control of Congress, for example, that’s going to be a real challenge for them to quickly come up with a plan so they’re not in the same position two years from now. 

Rovner: Right. I mean, at some point they’re going to have to fight about what it is they want to do. But right now, they could just point to what the Republicans have done. Well, meanwhile, the Trump administration this week is doubling down on its healthcare fraud fight, announcing it will freeze another $1.2 billion in federal Medicaid funding to California. That’s on top of the $2.2 billion already withheld this year, mostly about home care programs. The administration says the program’s rapid growth signals something fraudulent, although it hasn’t provided evidence. California says it’s just responding to growing demand, and that, by the way, providing home care is actually cheaper than paying for institutional care that patients might otherwise need. How’s the whole fraud thing playing with voters? Is there any traction, and does it make, I wonder, an impact that they seem to be mostly going after blue states — first Minnesota, California, apparently now New York? 

Ollstein: I see this as sort of under the umbrella of “things that have long been popular in theory becoming less popular once people see the impact in real life.” And so I think that has also been true of the concept of Medicaid work requirements. When people were polled about it before, in theory, people are, like, “Yeah, you should have to work, etc.” And now, when they’re seeing people losing their insurance who are working or have a legitimate health issue, that popularity is crashing. And I think the same is true of these fraud crackdowns, where they are popular when polled on, you know, the general concept of them. But these cuts are hitting a lot of real patients, and, like you noted, it has the appearance of being very politicized because it’s mainly been targeting California, Minnesota — states run by Democratic governors, and not just any Democratic governors, but those that have clashed with the administration very openly. 

Rovner: Yeah, I think the other thing is when you get into the details of some of this, you know, they say when they’re talking about fraud, you know, Oh well, these are people who are carrying groceries and doing things that family members should be doing for free. But in a lot of these cases, when you’re paying a family member for care, they’re doing things like changing IV lines and helping people go to the bathroom. It’s not just running errands. This is, in many cases, real medical care that family members are providing in lieu of going to other jobs. And it’s basically, as I said, keeping people out of institutions, which, in the long run, is a lot cheaper to pay somebody to care for their own loved one than it is to put them in a nursing home. I just, I feel like this is sort of being missed in this whole fight. 

Seitz: I also think that it’s really hard for this to resonate when, frankly, people aren’t seeing any result from this fraud push. Their taxes aren’t necessarily going down as a result of these busts. The federal deficit is continuing to skyrocket in this administration, as we talked about: Healthcare costs are rising. So it’s like, as Alice was saying, it’s a really good talking point, especially for conservatives who oppose big government. But I don’t know that it’s going to move the needle if voters aren’t seeing any change in their daily life. 

Rovner: Yeah, that’s a good point. 

Whyte: I do think Republicans think it’s worth spending time on because we’re seeing near-daily announcements about some kind of fraud crackdown from CMS [Centers for Medicare & Medicaid Services] or DOJ [Department of Justice] or Vice President [JD] Vance’s task force. I mean, it’s a deluge of these announcements, including the one yesterday about New York’s adult daycare program, which Dr. [Mehmet] Oz called “a plague to the state.” 

Rovner: Yeah, they are definitely playing it up. It seems to be their major campaign issue. … This is all goes with the whole “drain the swamp” thing. Well, in a preview of what we can expect if Democrats retake the majorities in the House and/or Senate, three top senators on the Senate Finance Committee that oversees Medicare and Medicaid are calling for the administration to impose more standards on the private contractors who run most state Medicaid eligibility computer systems. The systems — say possible incoming Finance chair Ron Wyden of Oregon, along with Elizabeth Warren of Massachusetts and Raphael Warnock of Georgia — have already demonstrated that they don’t always accurately reflect who is and isn’t eligible for Medicaid, and that the coming implementation of the work requirements in January could mean that millions of people could be bounced off their health insurance wrongly. I would think this would be something to watch pretty closely come January. I think no matter who is in charge of Congress, this is, I know, a big concern. You know, the administration keeps saying, “Oh, we’ve got these computer systems, and they’re going to do all of this in the background, and everything’s going to be fine.” And you know, I know, Alice, I keep asking you to reiterate this, but the last time we tried this in 2018 with the work requirements, things were not so fine with the eligibility systems.  

Ollstein: That’s right. So the states that had a sort of pilot version of this before it became mandatory for everyone found that the work requirements did not increase employment. It did not cause more people to get off the couch and work, and, you know, which is sort of how it’s been framed in the public discourse. Instead, it led to a lot of people who should have been eligible — either because they were working or they had a legitimate claim on one of the exceptions: caregiving, going to school, having a medical condition, etc. — they lost their insurance because they were unable to navigate the bureaucracy, not because they were not actually eligible. And so that is what is predicted to happen again on a much bigger scale now. 

Rovner: Well, this is definitely one to watch, and I would think that even if Republicans keep the Senate, they’re going to have to keep a wary eye on this because if things go sideways, they will say that is not what they intended. Meanwhile, over at the White House, President Trump, with first lady Melania Trump at his side, signed an executive order on Monday establishing a White House Women’s Health Task Force and a, quote, “new” Women’s Health Division at the National Institutes of Health. Except the NIH has had an Office of Women’s Health since 1990. I covered its creation, which came after a gigantic bipartisan effort by women members in the House and in the Senate. The office was codified in legislation that was passed in 1993, and women’s health offices intended to address disparities in research and treatment into women’s health ailments were further expanded in the Affordable Care Act in 2010. Does President Trump really think that insisting something is his idea will automatically get people to believe him? Are people believing him that this has never existed before, and that he thought of it, or I guess that Melania thought of it? 

Seitz: Well, I think we can look back to November of 2023, when Jill Biden rolled out a similar measure, and I don’t know that it had any impact on how people felt about the election. I thought the timing of this was also really interesting because the administration has sort of lost its MAHA Mom momentum, and that effort also fizzled out. I mean, you had, at one point, you had all these high-level people in the administration meeting for these MAHA Mom meetings, and then you had “The MAHA Report.” But, like, we didn’t really see a lot of outcome from that. We didn’t see anything happen from that. So I think it will be interesting to see if this task force tries to veer into that direction at all, if it touches on some of the things that we’ve seen, you know, the MAHA crowd focus on — for example, like increasing the fertility rate, educating people on how to get pregnant, menopause research, weaning off of antidepressants, like that’s been the focus. So I’m very curious to watch how much it goes in that direction. 

Rovner: It also goes directly against the whole DEI thing because, you know, diversity, equity, and inclusion includes minorities, but it’s also included women over the years. I’m still sort of shaking my head at the whole thing because it’s just sort of the polar opposite of a lot of what this administration has been working towards for its first two years. Or is it just me? 

Whyte: When I talked to sources about this, it was clear it was a Melania-driven initiative, and even health officials weren’t really sure what it was going to accomplish. I mean, this was while it was being developed, so maybe they have a clearer picture now. But it didn’t seem like they thought it would be substantively impactful. 

Rovner: Also, there’s no money attached to it. 

Ollstein: I was just gonna say that. I think that’s really the biggest tell here. There’s no new funding. In fact, many programs that focus on women’s health have been cut significantly by this administration. Grants have been canceled, etc. Some grants focused on women’s health have been canceled because they’ve been labeled DEI, as you noted, and there’s also no deadline for any kind of delivery from this initiative. And so I kind of think of it in a similar category as the fertility announcements, which talked a big game and didn’t have a lot of new funding or meaningful programs behind it. 

Rovner: Or policy, for that matter. It’s just sort of statements of intent. Well, the president also this week “discovered,” air quotes, the idea of rewarding whistleblowers who help uncover fraud in federal programs, announcing something called the Fraud Whistleblower Incentive Program to crowdsource tips on federal program fraud. This is also something that is not new. The Federal False Claims Act actually dates back to 1863, during the Civil War, and, in fact, Republican Sen. Charles Grassley of Iowa has spent much of his career pushing for expansions to make it easier for whistleblowers to receive compensation for uncovering fraud. Now, this sounds great, and it does go hand in hand with the administration’s focus on fraud, but again, are voters actually going to believe that he’s the first person to think of this? 

Whyte: I don’t know if voters will believe that, but what I would more wonder is whether any of that is breaking through at all. I mean, the voters …  

Rovner: Yeah, are they even going to hear it? 

Whyte: Yeah, polls show affordability is at the top of voters’ minds. Fox News had a poll recently that said corruption was at the top of voters’ minds. They have bigger fish to fry, I think, when they’re going to the polls than whistleblower payments, regardless of whether it’s a good policy idea or not. 

Rovner: I did see a social media post that people have been flooding this new fraud whistleblower line with tips about corruption in the administration, which was not the intent, I don’t think. We’ll see how that plays out. All right. Next: news about the Affordable Care Act. You might remember that last month the administration announced it was dropping three-quarters of a million enrollees from ACA plans, saying that their enrollments were likely fraudulent and that they were likely not even real people. Now, according to my KFF Health News colleague Julie Appleby, they’re adding a, quote, “small number” back. Apparently, those are people who turned out not to be made-up ghosts after all, but actual enrollees whose applications might have lacked required information and who haven’t filed a claim. Now, it is not clear how many people are being added back. The Washington Post editorial page suggests that it’s only 51 people so far. But isn’t it possible that there are way more of those people who just don’t yet know they’ve lost their coverage because they’re healthy and they haven’t tried to use it? After all, the people who got cut off are people who, by definition, haven’t filed any claims. 

Seitz: Julie, you and I have talked about this, like, in the newsroom — just, you know, I didn’t even go to my primary care doctor until like a week or two ago, so that’s totally possible. I think what I find most interesting, though, about this is that there’s clearly a problem, right, with the broker system. 

Rovner: Absolutely. 

Seitz: And both sides of the aisle have raised concerns about insurance brokers. And in normal times, this would be kind of one of those issues that you might see some legislation on. But it seems they’re not really working toward any sort of thing around that, and it’s a missed opportunity, frankly, for folks to come together and look into regulating this industry a little tighter. 

Rovner: Yes, and another hat tip to Julie Appleby, who helped break some of the stories about the broker fraud. Indeed, they’re, you know, one of the problems when they created these zero-premium plans is that they actually gave brokers an incentive to switch people without their knowing it, or to sign up fake people so that they could get the commissions. It is a problem. Everybody acknowledges it’s a problem. But pulling off people who didn’t have their entire Social Security number, or, you know, they haven’t filed a claim. Not all those people are going to be fraudulent, and I’m just wondering if, yeah, if it’s only a couple of 100 people, there probably won’t be a backlash. But if there’s many thousands of these people who eventually discover that they are not covered and that they thought they were, there could be a backlash. I see nods. All right. Well, they’re talking, apparently, the administration is looking at another half a million enrollees with the intention of perhaps cutting them off. So we will see how this one plays out. All right. We’re going to take a quick break. We will be right back. 

Turning to news out of the Department of Health and Human Services, two new studies out this week suggest that Secretary Robert F. Kennedy Jr.’s policy change to stop recommending a birth dose of the hepatitis B vaccine could dramatically increase cases of the chronic disease that can cause liver cancer and other lifelong health problems. One study in the journal Annals of Internal Medicine modeled what could happen if the policy is changed from recommended to what’s called shared decision-making [and] found it could result in half of all children entering adulthood susceptible to the highly contagious virus, and a more than 80% increase in cases. The other study that was presented at an infectious disease meeting by Kaiser Permanente researchers found that most young children who were exposed to the virus were exposed by someone other than their mothers. That suggests that even if a mom is tested and tests negative, that doesn’t necessarily protect the baby. I don’t expect that these studies are going to change any minds, though, among the sort of anti-vaccine activists and the, I guess what we could call, the vaccine-skeptical and vaccine doubters, right? 

Ollstein: I do think it’s notable that The New York Times’ reporting specifically on these vaccine studies and policy considerations seems to really have hit a nerve with the administration because they are going all out on attacking the individual reporters, accusing them of having sources who are making up information, etc. And so that sort of shows that at least they are, you know, worried about this maybe hitting home for folks. 

Rovner: Maybe a little sensitive? 

Seitz: And Julie, I think that, too, I mean, it will help down the road, right? Because this is what we have heard from public health researchers or anyone who’s really worked in public health, doctors, is this exact concern: that this is how this would play out, reducing the recommendations. And … 

Rovner: Not to mention Senate HELP [Health, Education, Labor, and Pensions] Committee Chairman Bill Cassidy. 

Seitz: Yes, that was on my list as well — the liver doctor who warned that this is exactly what will happen. So it gives us, one, a road map to what our future will look like, and helps public health researchers prepare in that sense. And then also, it gives a lot of fodder down the road for We knew that this was going to happen, and here is, we predicted it would happen, and no one listened. So it really puts a lot of culpability in the administration’s hands. 

Rovner: Well, in related vaccine news, The New York Times reported that the board that oversees the hospital on the NIH campus here in Bethesda, Maryland, delivered a public rebuke of the secretary over his establishment of a new office to study vaccine injuries and accused the secretary of undermining trust in science. Now, this board is made up of people outside the government, so I imagine it’s easier for them to criticize the secretary without fearing for their jobs. But still, I can’t imagine they won’t be rather quickly replaced?  

Seitz: That was exactly my first thought: Is how quickly is Kennedy going to try and replace this board? And we know that the White House has been forcing Jay Bhattacharya into some very uncomfortable positions over the last couple weeks, and some very uncomfortable conversations with folks. So, you know, this is yet another one that he’s probably going to be tasked with tackling, I would guess.  

Rovner: I have to say, I live up the street from the NIH Clinical Center — I pass it multiple times week — I had no idea there was an independent board that oversees literally the running of the hospital and for safety and efficiency services. I mean, this is the large hospital on the NIH campus where people who are in clinical trials can be cared for. I mean, lots of people are in clinical trials in other places in the country, but there are some people who end up coming to NIH, and the Clinical Center is where they end up if they need to be hospitalized. So, I mean, it is a rather substantial-sized facility. I was just, I was surprised to see them, of all people, standing up and saying this is not necessarily a great thing to do. We will watch how that one plays out too.  

Well, finally this week the administration has delayed a policy change that was to take place today that would have made it harder for people to order cheaper drugs from licensed pharmacies in Canada and other countries that have, you know, price controls. While it’s always been technically illegal to buy drugs through the mail from other countries, U.S. officials have long looked the other way at small amounts that are imported for personal use. According to a study from 2020, more than 2 million Americans purchase their medications from other countries. Now, the administration isn’t canceling the policy change that’s going to make it basically impossible for people to get their drugs this way — it’s just pushing it back 90 days, so safely beyond Election Day. Still, it’s kind of hard to square this with the administration’s claims that drug prices are coming down, unless they say that drug prices are coming down enough that you don’t have to buy your medicine from Canada anymore, that it won’t be cheaper? 

Whyte: I think there’s enough people doing this that it just seems like it would actually be a bad move politically ahead of the midterms. You know, people are reliant on these cheaper drugs, and to have that pathway cut off, I imagine, would cause a kerfuffle. But, so it wasn’t surprising to see this delay. I was kind of surprised they were going to do it in the first place. 

Rovner: It’s funny. It’s been on the podcast rundown every week for, like, the last three weeks. I keep putting it off because it’s getting closer. And then, of course, last week at almost the very last minute, the administration announced, “Never mind, we’re not going to do this right now.” But yeah, also, I mean, all through August and September, people were starting to get these letters that said, “Hey, you know …” — when they were getting their drugs, it’s like: “You know, after Oct. 22, we’re not going to be able to do this anymore.” So now it’s going to be after January-something. I mean, I’ll be interested to see if they actually go through with this because I think you’re right, Liz. There are a lot of people who — and I’ve seen other estimates that it’s as many as 4 million people who are getting their drugs this way. And it is not a way to make friends and influence people, shall we say? Particularly when lowering drug prices is one of your administration’s big, you know, achievements, according to what the president keeps saying at all of these rallies. 

All right, that is this week’s news. Now we’ll play my interview with Alice about her book, and then we’ll come back and do our extra credits. 

I am pleased to welcome to the interview portion of the podcast my friend, colleague, and podcast panelist Alice Miranda Ollstein, whose brand-new book, Side Effects: How Abortion Bans Impact Everyone’s Health, comes out next week. Alice, thanks for being here. 

Ollstein: Thank you, Julie. 

Rovner: So, as our regular podcast listeners know well, you’ve been covering the impact of the Supreme Court’s overturn of Roe v. Wade since it happened. What made you want to take some extra time and write a book about it? 

Ollstein: Yeah, so over the course of my reporting for Politico, I was traveling all around the country, and readers of Politico know that the focus is politics. So it was a lot about the political impact of the Dobbs ruling and state abortion bans and how people were reacting to them, the ballot initiatives, the candidates, etc. But as I was doing that reporting, I kept hearing over and over from patients, from doctors, from medical researchers, from all kinds of people who are involved in the healthcare system in some way bringing up these impacts that they were seeing that I just thought were not getting enough attention. These were impacts not only on care for pregnant people but healthcare for everyone — for men, for people living in blue states, for people living in red states, for old people, for young people — and this just kept coming up over and over. And I really wanted to write this book to sort of capture that bigger picture and capture that even though these laws were tailored to really go after abortion, they were having these broader impacts across the healthcare system. And it’s just very, very hard to separate. 

Rovner: What’s the most unexpected consequence or far-flung consequence that you found after nearly half the states banned abortion? 

Ollstein: Two things: one, the impact on healthcare for people with chronic conditions, pregnant or not, and then the other is the impact on medical research. How medical research, both on abortion, on pregnancy, on contraception, and on completely unrelated areas of healthcare were compromised. Some medical studies were delayed, some were made more burdensome and expensive, and some were scuttled altogether as a result of post-Dobbs restrictions. And that just kept cropping up in really interesting. In surprising ways. So, back to the care for people with chronic conditions, what happened after Dobbs is that in lots of different places — in states with bans, in states with abortion protections — patients who depend on certain medications to manage their chronic illnesses, drugs like methotrexate, which is sometimes used to terminate an ectopic pregnancy, and lots of different kinds of drugs — neurological drugs, drugs for autoimmune conditions that have the potential to cause a birth defect if you take them while pregnant. So doctors, pharmacists, insurers became a lot more scared of dispensing these drugs to patients with chronic conditions, even though they had completely valid diagnoses of lupus, Crohn’s, all kinds of conditions where they depend on these medications. 

Rovner: Yeah, rheumatoid arthritis is a big one, right? 

Ollstein: Mm-hmm. Absolutely. And so I just kept hearing about patients who, in some cases, had been taking these drugs for years and years and years, and really depended on them just to get through the day, honestly, and not experience, like, a flare-up of inflammation or other symptoms. And suddenly they were being, you know, grilled on what are you using this for? They experienced days of delays, and some of them were unable to get the medication altogether, and it really had an impact on their health. And so there were some lawsuits related to this, there were some advocacy campaigns related to this, the Biden administration took action on it, and the Trump administration rolled back those actions. And so I just really wanted to shine a light on how this was hitting people who aren’t even physically capable of being pregnant. In some of these medication-denial stories, I found, you know, it was happening to prepubescent children. In one of the circumstances, it happened to someone who had had a hysterectomy. So there’s no way an abortion could happen even accidentally. And you know, it happened to a lot of people who were taking contraception or who were just too chronically ill to sustain a pregnancy. And it still had this, you know, big impact because of the fear and confusion throughout the medical system. 

Rovner: And what about the research part? 

Ollstein: Yeah, absolutely. So that took a lot of different forms. So one category was research on abortion drugs specifically, to look into potential other uses for them. There are a lot of promising studies going on, some in the U.S. and a lot in other countries that don’t have the same restrictions about other uses of the drug mifepristone for cancer, for uterine fibroids, for all kinds of things. Some of those studies are still moving forward, but there were all kinds of delays and hurdles because they were taking place in a state with a ban, and the researchers had trouble even obtaining the medication. Even, in one circumstance I write about in detail, on a study that is only testing the medication on older male veterans of Operation Desert Storm. And still the researcher had a lot of trouble obtaining the drug, obtaining permission to do the study, obtaining funding, etc., and faced years of delays. And so these veterans that could really benefit from this medication, according to her research, still can’t get it. 

Rovner: I would say, people who are clearly not going to be using it to terminate a pregnancy. 

Ollstein: Exactly, these are older men. So those studies are still moving forward, but face years and years of delays. Other studies, including a study out of Indiana testing whether mifepristone could help people with breast cancer, especially people who were getting preventive mastectomies because they had the gene that put them at high risk, they were testing whether maybe taking mifepristone could help them avoid having to do that major surgery. That study was canceled altogether because the researcher was so concerned about losing access to mifepristone in the middle of the study and of, you know, facing potential legal consequences because she was based in a state with a ban that she just abandoned it altogether. In addition to the impact on studies on mifepristone, there’s all kinds of impacts that I found happening in the research space. It’s become harder to study abortion, even though we sort of need those studies more than ever because we want to know what are the medical and sociological and all kinds of impacts of these bans? You know, the government and the healthcare system can’t help people if they don’t know what’s happening. But those studies that depend on interviewing patients who are considering abortion to determine what factors push someone one way or another, those have become much harder because there is a fear among researchers that they could be charged under these so-called aiding and abetting laws in certain states. They don’t know if it could be considered aiding and abetting if they even talk to a study participant about what they’re thinking, and if that study participant goes on to get an abortion, you know, could they be charged? They’re not sure, and so those studies have become much harder to do. And I also found impacts on clinical trials that have nothing to do with abortion, nothing even to do with pregnancy. But there is a concern that representation of women of reproductive age in these clinical trials — which is already quite bad, women of reproductive age are really underrepresented in medical research, and only were included at all more recently. You know, we just don’t know if all kinds of drugs even work on women because they were only tested on men. And researchers are concerned now that we’re going to backslide on the little progress we have made on that front because they’re saying, look, how can a woman feel comfortable participating in a clinical trial of a new drug if, you know, that new drug could cause birth defects? She becomes accidentally pregnant during the course of the study, and she’s not able to get a termination based on what state she’s in. How can she feel comfortable participating at all? Meanwhile, bioethicists and experts told me that if research is only limited to states that allow abortion, that could completely skew the data because people have different health status, and those, you know, it’s important to study people in many geographic areas of the country in order to get good data, and now that’s under threat. 

Rovner: Lots of things that I think people didn’t anticipate. Another trend you highlight is the increased activism of the medical community itself. I always used to say that the American Medical Association was allergic to abortion, in that it never wanted to address the issue because it had members on both sides of a very hot topic and it didn’t want to anger any of its constituency. That’s changed, too, in the wake of the overturn of Roe, hasn’t it? 

Ollstein: Absolutely. So both these big national organizations, like the AMA, but also state-level organizations that also used to really try to steer clear of abortion because, you know, they didn’t want to alienate any of their members or their members’ patients. And it was just seen as this, you know, sort of political third rail. But as a result of seeing the impacts of these restrictions on their members’ ability to practice medicine, the organizations have decided to take a stronger stand. They’re writing amicus briefs. They’re passing resolutions. They’re lobbying their state and federal legislators.  

Rovner: Some of them are running for office.  

Ollstein: Exactly. So, I think combined with the institutions really changing their behavior, individual doctors are really changing their behavior. And, like you said, they’re running for office. They’re out on the campaign trail campaigning for the candidates they feel, you know, will uphold abortion access and keep the government from meddling in medicine in other ways. They are, you know, participating in lawsuits. You know, getting active in all kinds of ways we’ve never seen before. You know what I also found was that abortion providers, as a group, have been politically active and very vocal for a long time. You know, a lot of times they felt like they had to be. But what’s really new post-Dobbs is that physicians of lots of different specialties, including many that don’t have anything to do with abortion or pregnancy, have really come off the sidelines, and some of them told me that they were motivated to do so because they did see how this was impacting their work. It was, you know, for instance, going back to the chronic illness thing, you know, I talked to rheumatologists and oncologists who felt like they couldn’t have the conversations with patients freely that they used to be able to have. They couldn’t prescribe certain medications that they wanted to prescribe. But some told me that, Hey, I haven’t really felt the impacts of this at all personally, but I feel motivated to do something because I’m concerned that if the government can and feels emboldened to interfere in medicine in this way, like, what else could they do? What could they do next? And so they wanted to get involved in ballot initiative campaigns and other things to sort of draw that line in the sand. 

Rovner: Alice, lots of really interesting stuff. I think everybody should read the book. Congrats again, and thanks for joining us, as always. 

Ollstein: Thank you so much. 

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

Whyte: Sure. My extra credit is a Stat story by Tara Bannow [“How the No Surprises Act’s Nonprofit Arbitrators Are Operating Like ‘Mini Gods’ and Getting Rich Doing It”]. It’s a great investigation into the middlemen who are now in charge of doing the arbitration for the No Surprises Act, so it starts out with this amazing anecdote of this company that was thinking about getting acquired. I mean, it was really struggling financially, and now three years later has a 70% profit margin. Its revenue has grown thirteenfold. It’s just rolling in the dough, and it’s not alone. I mean, there’s all these middlemen now that are just raking in money from being arbitrators here in a way that is, really, you can’t object to it. I mean, she had a great quote from someone representing employers who referred to them as “mini gods.” And they’re siding with doctors in over 80% of cases. So the insurers and employers are really bent out of shape about this, and they’re also awarding huge sums of money. So she gave the example of a common spine surgery, typically costs $1,400 in-network, and now fetches $34,000 in arbitration at the median, with some providers getting over $100,000. So doctors are loving this, obviously. But there’s a number of lawmakers on the Hill who are looking at this and saying, “Ooh, we have a real problem here. This is not what we were going for.” And now there’s some possible solutions on the table for fixing it. 

Rovner: Yes. I think, of the things that I think that Congress is actually going to tackle at some point in the not-too-distant future, this is, like, pretty high on the list because this was not what they intended when they did the No Surprises Act. Alice. 

Ollstein: My piece is an op-ed in Stat by one of the whistleblowers from Theranos who helped expose Elizabeth Holmes as a fraudster, and the piece is called “I Was a Theranos Whistleblower. In ‘You Can See Everything,’ Elizabeth Holmes Is Still Lying.” This is his take on the movie. I hesitate to call it a documentary because it’s more of an art piece. But he’s pointing out that if you just watched the movie and you didn’t know anything else about the background of this case, you would not get an accurate picture of what happened. He notes that she shows pieces of a machine, and it’s not the machine she says it is. He notes that, you know, while this movie sort of poses the question: Did she intentionally lie, or is she just sort of this misunderstood, you know, neurodivergent genius who didn’t communicate things in the way other people did? And he notes that hard evidence came out in trial that she knew she was lying about certain things and very aggressively moved to cover it up and punish the people who tried to expose it. So I think it’s just a good supplement if people do end up watching that movie, which, according to my group chats, many, many people are fascinated and eager to see.  

Rovner: For the record, I am not. But as I said on social media, I’m not interested in hearing your takes on the movie unless you have read the book Bad Blood by John Carreyrou. And I will link to it in our show notes just in case people are more interested.  

Ollstein: And this whistleblower who wrote this op-ed was one of the sources for Bad Blood. 

Rovner: Yes, it was. Named. Tyler Shultz, so … 

Ollstein: Yes. 

Rovner: Amanda. 

Seitz: My extra credit this week is “Why Drug Companies Are Rushing To Market Ketamine Medicines,” by Andrew [Jacobs] for The New York Times. This piece looked at how companies are racing to develop new ketamine products to treat depression or substance use disorders in an effort that, as one person described, is feeling “unethical and cash-grabby,” which I just loved that quote. This ketamine arms race of sorts is being promoted, prompted in part by Secretary Kennedy’s embrace of psychedelics, but also the success of a ketamine-like drug developed by Johnson &  Johnson, which is this nasal spray that the FDA recently approved to be used for stand-alone treatment for depression. 

Rovner: It’s quite the eye-opening story. All right, my extra credit this week is from Rachel Cohen Booth at Vox. It’s called “America’s Next Big Healthcare Reform Might Already Be Underway.” It’s about Colorado, which is one of three states that have used the Affordable Care Act’s waiver authority to create a so-called public option health plan — that’s the unicorn that Democrats have talked about for most of this century. Today, roughly half of Colorado’s marketplace customers are now in so-called Colorado option plans, which are state-designed but privately run, and they’re saving roughly $100 per month in premiums for mid-tier coverage, which isn’t a ton of money, but it also isn’t nothing. It hasn’t been smooth sailing, but I think more and more people are now looking at what Colorado and Washington and now Nevada are doing, and it is well worth a read. 

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

Seitz: I’m on X @AmandaSeitz. 

Rovner: Alice? 

Ollstein: On X @AliceOllstein and on Bluesky @alicemiranda. 

Rovner: Liz. 

Whyte: I am on X @l_e_whyte and on Bluesky, @lizessleywhyte. Just Google it; it’s too long to say. 

Rovner: You’re findable. We will be back in your feed next week. Until then, be healthy. 

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HHS announced the 2026 Update to the National Plan to Address Alzheimer’s Disease and Related Dementias.

Rising healthcare costs aren’t a problem just for those who buy their own health insurance. Increases hit employers and their workers this year, too, and more are expected for 2027 plans — adding to growing concerns about affordability heading into the midterm elections.

Polls show that healthcare costs — and affordability, in general — are among top concerns cited by likely voters. Much attention has been focused on mounting costs and declining enrollment in Affordable Care Act plans, the insurance used by roughly 19 million people who buy their own. But work-based plans are adding financial pressure for the more than 150 million Americans covered through their jobs.

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

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

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

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

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

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

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

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

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

Driving Up Costs

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

Consulting firm AON, for example, projected employers could pay 9.5% more next year, the fourth consecutive year of big increases, while a similar company, Marsh, estimated 8.2%, the highest jump since 2003. Costs are going up for many reasons, from people utilizing more services to skyrocketing prices of prescription drugs and rapidly rising hospital prices, the reports say.

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

The business group predicted a median premium increase of 9.2% next year, although employers might reduce that by making benefit changes.

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

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

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

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

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

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

Keeping Costs Flat

Not all companies saw an increase this year.

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

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

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

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

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

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

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

Among other findings from the annual KFF report:

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

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

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

The Trump administration has hinged federal funding for states on whether they end or loosen powerful but controversial laws that regulate the construction of new hospitals — with a handful of states poised to comply.

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

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

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

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

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

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

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

Obama, Trump on Same Page

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

“If there’s an issue where you can have President Obama and President Trump in agreement on something, that tells you the idea probably has some merit,” Wes Climer, a Republican state senator in South Carolina, said in 2021, supporting the repeal of that state’s certificate of need law. The legislature voted in 2023 to end most rules in the law, and in January it will stop requiring certificate of need applications for new hospital construction or expansion, leaving them only for nursing homes.

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

Hospital construction underway in Weaverville, North Carolina, in October. The project had been delayed three years, tied up in the state’s certificate of need process. (Andrew Jones/KFF Health News)

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

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

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

Tennessee’s Certificate of Need Law

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

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

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

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

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

HCA did not respond to requests for comment.

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

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

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

In July of this year, Williamson Health’s board voted to sell its network of clinics, diagnostic centers, and a more than 330-bed hospital in a $900 million deal with Ascension St. Thomas, part of one of the largest healthcare systems in the nation.

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.

More patients and doctors could spend less time navigating faxes, phone calls, and paperwork as leading employers work to expand electronic prior authorization

Four years ago, Oregon hospitals were under fire from state authorities and patient advocates. Hospitals, critics said, had made it too hard for patients to apply for and receive help paying their bills.

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

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

The law worked.

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

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

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

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

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

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

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

A Promising Tool To Prevent Medical Debt

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

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

Policymakers have focused specifically on nonprofit hospitals, which account for about half the sector. Nonprofit hospitals typically don’t pay taxes, in exchange for providing benefits to their communities — a vaguely defined standard under federal law. Many hospitals meet this requirement by providing free or discounted care to low-income patients.

That financial assistance, however, can be difficult to get. Applications can be onerous and confusing. Congress and state officials have spent years testing policies to promote the help and make it easier to receive, with mixed results.

Research finds hospital financial aid spending varies, as does the degree to which hospitals benefit by not paying property, sales, or income taxes.

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

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

Lisa Reynolds, a pediatrician and Oregon state senator, pushed legislation to require Oregon hospitals to proactively screen nearly all patients for financial aid and provide it to those who are eligible. The law has led to a significant increase in the number of patients receiving assistance. (Kristina Barker for KFF Health News and Tradeoffs)

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

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

More Help for the Insured

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

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

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

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

A 2025 survey from the Commonwealth Fund found that 1 in 3 adults with private insurance have medical debt.

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

Oregon Health & Science University spent about $64 million on financial assistance in the first year of new state requirements to proactively screen patients for eligibility and award them help. “This is going to our patients,” said OHSU’s chief financial officer at the time, Lawrence Furnstahl, at a public meeting. “It is a good thing, but it is an expensive thing.” (Kristina Barker for KFF Health News and Tradeoffs)

‘A Very Different World’

For hospitals, the new requirements come as healthcare costs are climbing and federal support for the safety net is shrinking. Nationally, an estimated 14 million more people will be uninsured in 2034 as a result of President Donald Trump’s signature tax-and-domestic-spending law and the expiration of enhanced Obamacare subsidies that Republican lawmakers allowed to lapse at the end of last year.

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

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

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

In the first year under the new law, OHSU spent about $64 million on free and discounted care — about 1% of what it spent on operations that year.

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

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

The original law required hospitals to screen everyone on Medicaid or who was uninsured and anyone who owed $500 or more. Lawmakers raised the monetary screening threshold for a single visit to $1,500. The Medicaid or uninsured requirement remains.

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

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

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

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

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

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

This article is part of “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.

LAVONIA, Ga. — It had been a decade since Kara Holden last had a baby. But as the former obstetric nurse prepared for her fourth child, her head was swimming with contingency plans.

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

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

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

Kara Holden welcomed her fourth child, Tucker, on Oct. 11. Holden lives roughly midway between Athens, Georgia, and Greenville, South Carolina, two of the nearest cities with labor and delivery units. She traveled more than 50 miles to Greenville Memorial Hospital to give birth. (Kara Holden)

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

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

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

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

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

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

St. Mary’s Sacred Heart Hospital in Lavonia, Georgia, stopped providing labor and delivery services in October 2025. Hospital leadership cited Medicaid cuts in the One Big Beautiful Bill Act as the final straw. (Briah Lumpkins/KFF Health News)

‘Can’t Practice Scared’

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

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

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

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

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

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

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

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

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

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

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

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

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

When Holden was pregnant with her other children, the OB-GYN was only a five-minute drive away. But after the local hospital cut its labor and delivery service, she took extra precautions to ensure she was logistically prepared for the arrival of “baby Tucker.” (Briah Lumpkins/KFF Health News) Holden adorned a nursery with vintage trinkets and family heirlooms in anticipation of the arrival of Tucker. (Briah Lumpkins/KFF Health News)

Ways To Keep Access

The labor and delivery unit at the Coffee Regional Medical Center in Douglas serves six counties in southern Georgia. The number of live births there increased from 551 in 2020 to nearly 1,000 in 2024, which shows the impact when nearby facilities close, said Peterson, who practices at the Coffee Regional Hospital Women’s Center.

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

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

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

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

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

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

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

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

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

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

Lavonia is a small city near the Georgia-South Carolina border. The local St. Mary’s Sacred Heart Hospital stopped providing obstetric services in October 2025, citing Medicaid cuts. Two of the nearest cities with labor and delivery units are each about an hour away. (Briah Lumpkins/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 seven awards through its new Sickle Cell Disease Regional Care Excellence (SoRCE) Program.

HHS launched the Kidney Care National Plan, a coordinated department-wide strategy focused on revitalizing American kidney care.

A group of Democratic senators is demanding that the federal agency overseeing Medicaid — the health coverage program for people with low incomes or disabilities — institute tougher standards for government contractors running complex computer systems that millions of people rely on to get benefits.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As of June, 66 million people were enrolled in Medicaid, according to CMS.

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

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

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

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

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

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

Gainwell told lawmakers, “We take seriously the issues raised.” GDIT said it would answer additional questions from lawmakers.

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

CMS did not respond to a request for comment.

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

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

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.

Until recently, a Manhattanite might venture no more than a few dozen blocks to find the world’s most sophisticated cancer treatment. Cutting-edge American medicines have helped reduce the U.S. cancer death rate by about a third since 1990, and New York City hospitals deliver some of the best care in the country.

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

Then an option emerged, in an offhand remark.

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

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

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

Max Doppelt has organized care for his mother, Debbie Doppelt, since her cancer diagnosis in 2023. (The Doppelt family)

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

China, until recently known more as a supplier of drug precursor chemicals and generic medicines, has become a biotech powerhouse, accounting for as much as 46% of new drugs tested around the world in 2025. U.S. pharmaceutical companies are testing new therapies there and signing billion-dollar contracts with Chinese firms to develop and market their drugs.

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

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

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

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

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

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

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

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

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

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

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

Cancer Knows No Boundaries

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

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

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

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

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

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

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

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

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

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

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

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

Similar apps are being used to help drug companies and hospital systems increase the percentage of U.S. cancer patients who enter clinical treatment trials, currently at about 7%. This will also strengthen the U.S. drug industry, said Paradigm Health CEO Kent Thoelke, whose company offers an AI program designed to help hospitals and clinics enroll trial subjects.

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

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

‘I’ll Do Everything in Our Power’

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

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

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

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

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

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

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

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

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

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

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

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.

President Donald J. Trump signed an executive order, Advancing Women’s Health to Improve Outcomes in All Phases of Life.

Heading into the midterm elections, high healthcare costs rank among voters’ biggest concerns. But lately, there’s a twist giving the issue new momentum on campaign agendas: a focus on fraud in government health programs.

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

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

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

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

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

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

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

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

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

Administration’s Fraud Targets

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

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

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

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

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

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

“This is yet another attempt by the Trump administration to kick hundreds of thousands of vulnerable Americans off their healthcare,” Rep. Melanie Stansbury (D-N.M.) posted on the social media site X. “Millions are already struggling to access healthcare—and this is their plan?”

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

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

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

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

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

They note that the Department of Health and Human Services last year recertified hundreds of insurance brokers and agents who had been suspended in 2024 by the Biden administration for suspected fraud or abuse. The Trump administration also laid off about 200 employees from a CMS office involved in regional oversight of the ACA marketplace.

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

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

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

Blue State Allegations

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

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

One of the most striking clashes occurred in New York.

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

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

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

The administration also withheld about $2 billion in Medicaid funding from California, citing concerns about program integrity and oversight of some home medical services. State officials deny the allegations, saying spending on home services has grown because of factors such as higher wages for home health aides and an increase the number of older people receiving care.

The White House announced plans to defer more than $500 million in federal funds from Minnesota, claiming the state had failed to protect its Medicaid program from abuse. State officials have defended their oversight and gone to court to challenge the decision.

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

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

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

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

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

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

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

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

Congressional Republicans also declined to extend enhanced ACA premium subsidies that expired at the end of 2025, increasing premium costs for many people who buy insurance through the marketplaces. Enrollment has since declined by millions.

Overall, the combined effect of GOP-led changes will result in 16 million more uninsured people by 2034, according to an analysis by the Congressional Budget Office.

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

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

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.

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Not-So-Great Healthcare

Why doesn’t world-class medicine produce world-class health?

Hayat Norimine’s reporting gets at something that has bothered me for a long time about American healthcare (Priced Out: “As Health Insurance Costs Soar, Healthcare Workers Also Feel the Pinch,” Sept. 22).

We are very proud of U.S. medicine, and we should be. We are at the forefront of new treatments, our clinician workforce is unmatched, and we deploy technologies that seemed impossible just a few years ago. Yet we are in the middle of the pack compared with other countries, in terms of healthy lifespan and many markers of quality care.

At the same time, the cost of accessing care has become outrageously high. When clinicians stop getting health insurance for themselves and their families, you know something is deeply broken.

What good is our health system if most people cannot afford to use it?

One family in Norimine’s story went without insurance when their premiums climbed. Another person kept her coverage but waited weeks to see a doctor because of a $10,000 deductible. These are different problems, but both expose the distance between the care we can provide and the care people can actually access.

Insurance is supposed to help people get the care they need to stay healthy, not just when they are at death’s door. Yet the way insurance is designed can discourage someone from seeing a clinician early, filling a prescription, or following up before a problem gets worse. A clinician may say, “This is what you should do next,” while a person’s coverage gives them a reason to wait or decline.

That tension is not an accident. It is how the system was built. Doctors design care. Insurers design coverage. The two are put together in separate rooms by different teams, measured on different things, then handed to the same person as if they were one plan. No physician would design a $10,000 deductible; it just blocks people from investing in prevention and getting care early. But no physician was in the room when that threshold was set.

Making coverage affordable is essential. So is asking what that coverage enables people to do. If better health is the goal, the people responsible for a person’s health need a hand in shaping what their coverage pays for and when. Design coverage and care together, and it gets easier for people to get the care we know works while avoiding waste.

— Clay Johnston; Austin, Texas

On Dementia, Violence, and Sedation

Reading “Drugs Are Widely Used To Sedate Dementia Patients. Her Sons Wanted To Keep Her Off Them” (Sept. 30) inspired me to share my own experience.

My husband died of dementia about two years ago at age 86. It was not an easy journey. Dementia made him agitated for the same reason it does to others: People with dementia cannot tolerate being told “no.”

So when I had to tell him to stop driving, he became violent. I was told by an eldercare specialist that if my husband remained at home, he might kill me. So it was off to a memory care center, a really good and really expensive one. And he became violent and agitated there because he couldn’t come home, which was what he wanted, and which I could not safely handle. I was also aware that if he couldn’t make it at the memory care center, there was virtually no other place that would take him.

So did I say yes to medication? I did indeed. Even with the antipsychotic, my husband would become out of control. He often tried to “abscond,” as they say in memory-care speak. I also paid through the nose for one-on-one care, which kept him sort of safe. But one night, he fell in the bathroom and broke his hip. A hip replacement was suggested. He was suffering, he had absolutely no quality of life, and I turned the offer down. He was transferred to palliative care and died peacefully about five days later.

There is no solution to this problem that I can see other than medical aid in dying, which he probably would have refused. Me — I will not refuse. My current terror is that I might do this to my remaining family.

— Nora Staffanell; Monroe, New York

The issue is appropriate treatment, not simply drug avoidance.

Jordan Rau’s report rightly highlights the danger of using sedating medications simply to make people with dementia easier to manage. But inappropriate chemical restraint should not be confused with medically appropriate treatment of serious neuropsychiatric symptoms.

Psychosis, agitation, and aggression are distinct. Before prescribing medication, clinicians should identify the target symptom and look for reversible contributors such as pain, infection, medication effects, constipation, sleep disruption, sensory impairment, fear, environmental overstimulation, or the way personal care is being delivered.

Nonpharmacological, person-centered interventions should generally come first. The American Psychiatric Association recommends antipsychotics, outside of emergencies, only when agitation or psychosis is severe, dangerous, or causes substantial distress and after nonpharmacologic approaches have been assessed. When used, treatment should begin at a low dose and aim for the minimum effective dose.

However, nonpharmacological measures do not always suffice. In 2026, the APA reaffirmed that antipsychotics can benefit some older adults with behavioral and psychological symptoms of dementia when used judiciously within a comprehensive treatment plan. Brexpiprazole, for example, received FDA approval in 2023 for agitation associated with Alzheimer’s dementia.

These drugs carry real risks, including increased mortality, sedation, orthostasis, extrapyramidal symptoms, cerebrovascular events, and falls. But untreated severe agitation or aggression also carries risks: distress, injury, emergency transfers, hospitalization, caregiver breakdown, and loss of placement.

The responsible question is therefore not whether antipsychotics are dangerous, but whether, for a particular patient and target symptom, likely benefits outweigh risks after reversible causes and nonpharmacological measures have been addressed.

Good dementia care means neither reflexive prescribing nor reflexive withholding. It means careful diagnosis, person-centered care, informed risk-benefit discussion, lowest effective dosing, close monitoring, and periodic attempts to reduce or discontinue medication when appropriate.

— James Ellison; Philadelphia

Decoding ER Bills

Autumn Daniels was billed $410 for an emergency room visit in which no clinician evaluated her (Bill of the Month: “She Left After Waiting Hours in the Emergency Room. The ER Billed Her Anyway,” Sept. 29). She received registration, vital signs, and a single question, then sat in the waiting room for four hours and left.

Carle Health billed CPT code 99281, an evaluation and management service. The American Medical Association’s CPT guidelines, quoted in your article, state that triage alone is not an evaluation and management service and cannot be reported with that code. Carle’s own email confirms the problem by defining “care” to include registration and nursing assessment. That’s triage under another name.

Billing for a service that was not performed is the most important reason insurers deny hospital claims, and it’s what physicians are trained to recognize as fraud. Daniels’ insurer denied the claim under “against medical advice,” a label that cannot apply to a patient no clinician ever saw. The right response is a written refusal to pay, addressed to the hospital, stating that the billed service was never rendered.

I spent 20 years in clinical medicine and over a decade as a health insurance medical director reviewing exactly this question. Daniels should owe nothing.

— Virgie Bright Ellington; New Rochelle, New York

This article goes much deeper than simply exploring lack of treatment in the emergency room. It’s about callous treatment, which is unacceptable on many levels. The ER provided poor care and wasn’t busy, but because the unseen patient was only feeling unwell and not bleeding from every orifice, she wasn’t taken seriously as a priority, so she left. Yet despite not being seen by a doctor, a miscellaneous bill — over $400 — was submitted for payment.

What is pain anyway — feeling uncomfortable? Pain is people dying from triggers in the body. Therefore, treating people like a business by these corporate hospitals is extremely concerning. A person feeling ill, receiving no treatment after four hours of waiting, then leaving the ER with a chronic headache  — which could be anything from a brain injury, an upcoming stroke, or a hemorrhage — should not be charged. And certainly a miscellaneous code should not have been applied for the pleasure of pain, waiting, and the five minutes it took to take her temperature.

No, the insurance company should not pay, and it should also let the hospital know that it will be booted from the network for false claims — spending less-than-adequate time with a patient and then submitting bills.

Laws need to be mandated, and advocates must demand optimum care, with healthcare providers abiding by the Hippocratic oath.

People are not stick figures to be treated carelessly and then charged fully. Every time a baseless claim is submitted by the hospital to the insurance company, there’s a trickle-down effect, and rates go up.

It’s akin to being charged for walking on the sidewalk outside a grocery store, checking the fruit stands, getting help from the outside clerk, and then being charged by the store — despite not making a purchase.

Bad service serves no one and will backfire on the provider in the end. How many times do we have to check management at the door for not understanding that very concept? Far too often. We need to show that medical disregard and abuse are not tolerated. It’s essential to pursue change at the federal and state level. Why? Because, ultimately, hospitals are taking advantage of people. They’ve forgotten why they exist.

— Tiff Gadison; Sacramento, California

Living Under the Government’s Thumb

It’s not a good feeling to know that the government has the upper hand and pulls the strings (Health Hub: “Sticker Shock at the Doctor’s Office Could Motivate Midterm Voters,” Sept. 18). Here it is, 2026, and this single mother still struggles — but even more so with talks of cuts and funding to programs I and so many others depend on.

I was interviewed back in November 2018 about an absurd medical bill I received and was expected to pay, even though I have Medicare and Medicaid. Jay Hancock wrote my story, which aired on All Things Considered (Bill of the Month: “Chronically Ill, Traumatically Billed: The $123,000 Medicine for MS,” Nov. 28, 2018). It also appeared on CBS Mornings with Gayle King.

Things definitely haven’t gotten any better for me. I worry about not only my health insurance and my medication but the fact I am on permanent disability. The state of the nation under the current administration is pretty frightening. My Social Security/SSI is my only means of getting by. I receive EBT (electronic benefits transfer for food assistance), and I have a family to feed. I live in government-subsidized housing, based on my income. So pretty much my whole life is controlled by the actions of folks who probably have zero clue how it is to live on a fixed income and with a chronic health condition, one in which stress exacerbates the symptoms, as well as being a single parent.

Don’t even mention being able to afford the price of gas; my car will sit more than go now. I have to pick and choose when to run errands, usually on a day I already have a scheduled appointment. That not only causes me lots of anxiety, but the fatigue is relentless! This is a very stressful, unnerving way to live.

— Shereese Hickson; Niles, Ohio

Uniting for Good

I’m writing on behalf of students with the American Lung Cancer Screening Initiative (ALCSI). Our team recently came across Noam N. Levey’s Common Ground article “‘Cancer Doesn’t Care’: Citizen Lobbyists Unite To Push Past Washington’s Ugly Politics” (Oct. 21, 2025), and its message about cancer bringing people together across political divides strongly resonated with our team.

I wanted to share a recent development in California that reflects a similar idea. A lung cancer screening awareness bill that began as an idea from a small group of California college students was signed into law by Gov. Gavin Newsom on Sept. 28, after receiving support from legislators of both parties.

As students passionate about lung cancer screening awareness, our team began exploring legislative action to improve screening rates. In March 2025, we developed the initial proposal that ultimately became California SB 1124 and continued advocating for the bill throughout the legislative process until it was signed into law.

Lung cancer is the leading cause of cancer-related death in the United States. Screening can catch the disease at an earlier, more treatable stage, but many people eligible for lung cancer screening don’t know they qualify or that screening is available to them. SB 1124 addresses that gap by requiring tobacco retailers across California to post signage about lung cancer screening at the point of sale, reaching people where they already are rather than relying on them to seek out the information. Considering that California has historically been one of the states with the lowest lung cancer screening rates, this action is crucial.

The bill was introduced by Sen. Bob Archuleta (D–Pico Rivera). Through grassroots outreach, students involved with this bill initiative helped build a coalition of support from organizations across California and the country, including the California Academy of Family Physicians, the American College of Surgeons, and the NAACP California Hawai‘i State Conference, among dozens of others.

Our experience really echoed what stood out to us in Levey’s article: that cancer can bring together people who may disagree on plenty of other issues. We also hope our experience shows that young people can have a meaningful voice in that process and contribute to bringing people together around a shared public health goal.

— Elaine Dong; Los Angeles

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.

Experimental peptides have become darlings among influencers, chiropractors, and doctors focused on longevity, antiaging, or “body optimization,” even though the FDA hasn’t approved them for safety or effectiveness. Health secretary Robert F. Kennedy Jr. and other leaders of the Make America Healthy Again movement have pushed to make unproven peptides more accessible — and they’ve gained traction.

On Oct. 14, a temporary “access policy” appeared on a White House docket, proposing to allow licensed pharmacies to make and sell certain unapproved peptides to people. Scientists at the FDA had advised against the measure at a meeting in July, warning that the drugs hadn’t been adequately vetted in clinical trials.

A panel that advises the FDA disagreed, however, voting to loosen restrictions. Many of the panel members are new appointees with financial stakes in the peptide industry. In an email, Department of Health and Human Services spokesperson Emily Hilliard said that every committee member satisfies the FDA’s ethics requirements.

“I voted ‘yes’ for patient safety, the greater good, and medical freedom,” Haleem Mohammed, one of the new committee members, said at the FDA meeting. He’s the chief medical officer of a men’s clinic that sells peptides, Gameday Men’s Health.

To make good decisions, consumers need to rely on accurate information, but much of the hype around peptides is misleading. KFF Health News flags four misleading phrases commonly used by those promoting peptides — and one truth.

Red Flag: Peptides aren’t drugs.

Gary Brecka, a co-chair of the MAHA Action committee, says peptides aren’t drugs in this episode of his podcast. He talks about using them to “help regulate cortisol, improve circulation, all kinds of things.” When peptides are used to treat, prevent, or cure conditions, or to affect the body’s function, they are, by definition, drugs.

“Peptide” is a general term for substances that are smaller than proteins but made of the same building blocks. Humans make many peptides, including insulin. Insulin is a drug when people inject it to regulate blood sugar.

“Most of the drugs we have had some antecedent in nature,” said Jacob Sherkow, a professor of law specializing in biotechnology at the University of Illinois Urbana-Champaign. “Heroin is natural. No one in their right mind would call it not a drug.”

Brecka did not respond to requests for comment, but Chris Woodward, a public relations representative for him, said in an email that the health issues discussed on Brecka’s podcast do not constitute medical advice.

Red Flag: Peptides are safe because they’re natural.

Peptide promoters have suggested that peptides are safe because they’re natural. This clip of Brecka’s discussion with Brigham Buhler, a co-author of The Peptide Revolution and owner of a compounding pharmacy that sells peptides, is an example. Some influencers go further, saying that peptides are safe because they’re made by the human body. Buhler did not respond to requests for comment.

It’s murky territory. One of the most popular experimental peptides, BPC-157, was developed by Croatian scientists who isolated what they called “body protective compound” from gastric juices in the stomach lining. However, researchers have been unable to find a trace of BPC in the human genome, meaning it’s not made by humans, said Katrin Svensson, a peptide scientist at Stanford University. Researchers in Taiwan suggest the peptide is produced by stomach microbes, according to Undark magazine.

Even if BPC-157 and other peptides exist in nature, Svensson said, “natural things can be toxic.” People have died from taking too much insulin, for example. And drugs considered safe can still make people feel ill. To learn about safety, and whether the benefits of a drug offset the side effects, researchers conduct placebo-controlled trials. These reveal problems that might not be obvious in the short term, such as liver damage, as well as underlying conditions that could turn minor issues into something serious.

The FDA is considering lowering restrictions on BPC-157 and five other experimental peptides that have not undergone high-quality clinical trials and are not FDA-approved. “I am excited about peptides too,” said Svensson, whose lab studies several peptides that she hopes to develop into drugs. “But,” she added, “you need to show they’re not harmful.”

Red Flag: These peptides treat illnesses and heal injuries.

Kris Wusterhausen, one of the new appointees to the FDA advisory panel, has said that the experimental peptide BPC-157 “can reduce [acid] reflux disease” and treat “neurologic disorders.” He’s the founder of an antiaging company that sells the peptide and advertises “clinically guided peptide treatments.” He did not respond to requests for comment.

Such claims are common among peptide promoters who say that various experimental peptides treat muscle injuries, covid, inflammatory bowel disease, and more. But vanishingly few clinical trials have been conducted.

A summary of a small clinical trial testing BPC-157 as a treatment for inflammatory bowel disease was published in 2005, but it lacked critical details about how the study was conducted. FDA scientists who reviewed the summary called it “inadequate.”

Another small study concluded that BPC-157 relieved knee pain for 14 of the 16 patients involved, but it lacked a control group, meaning the participants might have felt better because of other factors, or their pain simply resolved over time.

In a 2025 review of research on BPC-157 as a treatment for musculoskeletal injuries, researchers warned that it should be “approached with caution” because of a lack of evidence. Flynn McGuire, a physical rehabilitation doctor at the University of Utah and an author of the review, said anecdotes about people having miraculous recoveries are even less reliable.

He has told patients he won’t prescribe BPC-157 until quality studies are conducted. “People want new things quickly,” he said, “but medicine and science just don’t work fast.”

Peptide enthusiasts also tout laboratory studies, such as a particular peptide stimulating blood vessel growth. Such research is critical, but it doesn’t speak to safety, efficacy, or off-target effects in people, like fueling cancerous growths. Human biology is complicated, which is why most substances that show promise in early experiments fail in clinical trials.

Red Flag: Peptides can’t be patented.

Before taking the helm of the Department of Health and Human Services, Robert F. Kennedy Jr. posted about peptides on X. (Screen grab of X)

A few months before Kennedy took charge at HHS, he suggested on the social media platform X that the FDA hindered access to peptides and other alternative therapies because they couldn’t be patented. It’s a common misconception about peptides: In an analysis of Reddit posts about the drugs, researchers found many posts suggesting that mainstream medicine has sidelined peptides because pharmaceutical companies cannot patent the substances and therefore can’t turn a profit.

Yet hundreds of peptide patents are listed in the U.S. Patent and Trademark Office database. A patent on an early formulation of BPC-157 is for sale.

“One cannot obtain a patent on the natural thing itself,” Sherkow said, “but if you slightly modify it, link it to something that allows me to inject it, formulate it to be more stable, all of that stuff is patentable and is being patented.”

Peptide patents can be lucrative. Pharmaceutical companies are suing one another over patents surrounding GLP-1 peptides, the basis of Ozempic and other such weight loss drugs. The market for those medicines is projected to reach $190 billion within the next decade, according to the investment bank Morgan Stanley.

So why haven’t pharmaceutical companies invested in clinical trials on popular peptides? Clinical trials cost millions of dollars, so companies first must be convinced the drugs look promising enough for FDA approval, as well as have an edge over current medications.

Companies conduct experiments before investing big bucks. They may have done so for certain peptides and been discouraged by the results, Svensson said.

Pinchas Cohen, a gerontology scientist at the University of Southern California, said investors backed out of funding trials on a peptide he helped discover, MOTS-c, because they worried its use overlapped with GLP-1 medications. “Investors felt we couldn’t compete with that,” he said.

Kennedy’s push to make experimental peptides more accessible might make clinical trials even more unlikely, researchers say, because compounding pharmacies wouldn’t need FDA approval to sell the drugs for human use.

In a letter to the FDA, the pharmaceutical trade organization PhRMA advised against easing restrictions on unapproved peptides, saying it would “erode incentives for manufacturers to undertake the substantial time and cost required for FDA approval.”

True: Americans aren’t as healthy as they could be.

Kennedy and other leaders of the MAHA movement are right when they say the U.S. spends more on healthcare per person than any other nation and ranks below all other wealthy nations in life expectancy. They also rightly note the high cost of treatment. Six in 10 U.S. adults said they worried about affording prescription drugs in a recent KFF poll, with 4 in 10 saying they’ve skipped doses or taken other measures because of the price.

Researchers have outlined policies to lower healthcare costs and improve public health, such as limiting drug monopolies and improving access to healthy food. What’s not on the list: skipping clinical trials to sell unproven treatments that could harm people.

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. released a new episode of The Real Food Show with Lou Ferrigno (The Incredible Hulk), Dean Cain (Superman), and Kyle Reyes.