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.

Imbalance of Power — And Healthcare

Why can members of Congress remain on full taxpayer-funded salaries during prolonged medical absences while millions of working Americans cannot afford to get sick? (Kennedy, Oz Contend Fraud Crackdown, Not Skyrocketing Prices, Led Millions To Leave Obamacare, Aug. 3.) Sen. Mitch McConnell’s current extended medical absence brings that disparity into sharp focus. He has missed dozens of Senate votes while continuing to receive his $174,000 taxpayer-funded salary.

Meanwhile, I have a friend who works two jobs and still cannot afford her mortgage and utilities without a roommate. She does not even have basic medical insurance. She earns too much to qualify for government assistance but not enough to comfortably afford insurance along with the basic cost of living. What happens if she gets seriously ill?

She doesn’t have the luxury of taking months off to recover while her income continues. She could lose her income, her home, and everything she has worked for simply because she got sick. Yet she is one of the taxpayers providing that financial security to members of Congress.

McConnell’s situation is particularly striking because of his long legislative history of opposing or limiting federal family and medical leave protections.

If continuing someone’s income while they recover from a serious illness is reasonable and humane when that person is a member of Congress, why isn’t it reasonable and humane for the Americans paying their salaries?

Americans should not face financial ruin because they get sick while their elected representatives enjoy protections unavailable to the people they serve.

— Ruth Bower; Salem, Oregon

Hospice Saga Hits Home

I could really have used the information in the article “My Husband Was Kicked Out of Hospice for Dying Too Slowly” (Aug. 14) before it happened to me. I was notified on a Monday morning by my husband’s residential hospice agency that I needed to find a new place for him ASAP, and “here’s a list of places.” I asked what it would cost for him to stay a day or two — saying I would pay it myself, just tell me how much. They didn’t. So I got on the phone, and it was a hectic and horrifying day calling around for a new place.

My husband had been home twice between hospital stays, had fallen both times, requiring me to call 911, and then he was rehospitalized. I’m 64, and there was no way I could lift my 300-pound husband if he fell again. Even a half-dozen firefighters had trouble.

I spent most of his final day calling hospice agencies, and a representative from one even showed up to visit (uninvited and unexpected). It was scary how little oversight or medical professionalism there was. His life ended about 7 p.m. that evening. We had already stopped his pacemaker a few days before.

I will never forget or forgive that I wasted my last day with him because he was not dying quickly enough for the hospice. He never saw a doctor once he enrolled in hospice. There are great nurses in hospice — I’ve met a few — but there are a lot of places for which this is just an easy revenue stream, and they seem to be in it just for the money.

— Debbie Bond; Corpus Christi, Texas

On Improving the Hospice Experience

Thank you for publishing the article on hospice. As a hospice clinician and leader who has been providing hospice education for over 20 years, I, too, continue to see the need for increased awareness around hospice in our communities. This story is similar to many I have recently collected from families who are searching online, using AI tools that fall short of accuracy, and expressing they are overwhelmed.

As the article states, they were given a list of hospices to pick from; that is common and can be a major cause of panic for families. The article provides nice tips on choosing a hospice, but there is so much more to it. Picking a hospice that aligns with your values is a good first step, but we cannot overlook the idea that people and families need help walking this journey, help with exploring their care goals and wishes.

I recently took on a mission to enhance and make hospice education more accessible. In doing so, I launched an app, myHospice Companion, focused on helping people and families learn about hospice before they need it; what hospice is and how it works, when they are ready; and what to understand and expect, all the way to the end. Two important articles were posted this year: a recent one entitled “The Hospice Conversation Starts Too Late,” by Kurt Merkelz, and a staggering article published by Hospice News about how the Centers for Medicare & Medicaid Services could save $1.5 billion annually if hospice were elected just five days sooner.

The data supports that people and families are looking for reliable sources of education. However, the hospice industry as a whole has focused on providing that information once someone is admitted, which is too late.

Educational leaders in our communities need to work together to enhance end-of-life knowledge. Our mission is to give them a tool to make a meaningful impact.

— Jason Kimbrel; Columbus, Ohio

Common Ground: The Height of Folly?

Whoever is investigating common ground between the major political parties (KFF Health News’ series “Common Ground”) clearly isn’t interviewing or polling Republican members of Congress — although there are probably a few Democrats in Congress who’ve gone along with making cuts to Medicaid and the Supplemental Nutrition Assistance Program, who don’t want to tax the rich more to keep the Social Security trust funds solvent, and who would never, ever vote for national healthcare systems similar to any of those in Western Europe or the Scandinavian nations.

I’ve yet to read that any members of Congress have seriously analyzed how nations with “universal” healthcare coverage manage such a system, and how much it would cost to implement in the United States. That demonstrates that neither party is truly committed to finding a better way to provide healthcare for all of us.

Too many GOP members of Congress have, for many years, tried to privatize Medicare (with some success), cater to healthcare insurers, and in every way demonstrate that they do not share what’s supposedly a general concern: improving the healthcare system in the U.S. and improving access for anyone not superwealthy to good quality healthcare. They should not only be making it more affordable, but making pre-med training and obtaining a doctor or nurse practitioner degree far, far, far more affordable than good programs for obtaining those degrees currently are.

We also need to pay registered nurses better than what they are being paid now, and support the National Science Foundation, the Centers for Disease Control and Prevention, the National Institutes of Health, et al., so that the U.S. continues to conduct medical research and fund the FDA so it can actually regulate the drug industry. We need an affordable drug system, too. Again, too many people in the U.S. can’t afford drugs that are affordable in other nations.

There’s no way the GOP in Congress will fix this. Republican presidents, from Ronald Reagan to the present, could’ve done so and did not. That the GOP has managed to propagandize so many people on vaccines, and toleration of increasingly expensive and poor-quality healthcare (and less access), just goes to show how many in the U.S. seem willing to effectively sabotage their lives — and the lives of their children.

— Susan Hogg; Newport, Oregon

Monopolies Hurt Healthcare Providers, Too

I am a recently retired health executive. I just read the article “Same Knee Surgery, Twice the Price: Hospital Monopolies Push Up Healthcare Costs” (Aug. 10). I loved the article. Very well written. Based on my experience, it is completely accurate. Well done.

However, you omitted a critical factor. During my approximately 40-year healthcare career, I saw the competitive landscape among health insurance companies shrink incredibly. One cannot discuss “merger mania” among hospitals and other medical institutions without acknowledging the negative impact that consolidation of health insurance carriers has had on the industry.

While the article made great points, it failed to articulate the effect insurance carrier consolidation has on healthcare providers’ bottom lines and their ability to negotiate reasonable fees. Your readers deserve to hear a balanced story.

— Quinten Davis; Randallstown, Maryland

Healthcare Students Clutching at Straws

Benjamin Pinckney’s story about the new federal student loan caps upending his dream of becoming a physician assistant is one that many students and prospective students unfortunately know all too well (“He Dreamed of Becoming a Physician Assistant. New Loan Rules May Thwart Him,” June 30). I’m a nurse practitioner and educator myself, and federal student loans were instrumental in my own educational journey. I might not be where I am today without them.

There are many bright, aspiring individuals seeking to become nurses to serve our nation’s growing patient needs. Yet the new federal loan caps have the healthcare workforce clutching at straws, as many students question their ability to pursue higher education. While the goal of lowering the cost of education is worthwhile, the rule risks forcing nursing students to choose between drowning in private, high-interest loans and abandoning their educational goals entirely. Either way, it will weaken our healthcare workforce at a time when the United States is expected to face worsening shortages of advanced practice providers and nursing faculty.

Just consider a few key data points: Demand for advanced practice nurses is projected to grow by 36%, much faster than the 3% average growth for all occupations. Over 1 million nurses are expected to retire by 2030, far outpacing the projected number of new nurse graduates. And 7.2% of faculty seats across the nation currently sit vacant, with about 81% of open positions requiring advanced degrees.

Fewer students can afford nursing education. Combined with fewer opportunities for clinical educators to pursue the advanced training needed to prepare future professionals, that equals a reduced ability of the nation’s healthcare system to meet Americans’ demand for high-quality care.

For now, the healthcare workforce is relieved that the rule has been paused in the courts. Looking ahead, we must actively work not only to control graduate education costs but also expand educational opportunities by championing legislation that designates advanced nursing degrees as professional degrees. Students who wish to become nurse educators and advanced practice registered nurses should be able to secure the federal financial aid they need, which is why legislation like the Nursing Is a Professional Degree Act, the Clarity in Professional Degree Act, and the Professional Student Degree Act are all so important.

I urge Congress to listen to stories like Pinckney’s and to the countless aspiring nurses across the nation who want to pursue careers that will strengthen our healthcare system but are being held back by loan policies that stand between qualified students and the workforce our country urgently needs.

— Lorie Hacker; Bargersville, Indiana

Rural Healthcare Needs AI That Earns Its Place

Rural patients’ skepticism of artificial intelligence raises an important point (“Patients Wary of Governments, Companies Pushing AI as a Rural Healthcare Solution,” Aug. 11). At this point, there’s not a “should” around AI adoption. It’s more about whether the technology can demonstrate enough value to earn the trust of patients and clinicians.

AI can and will help rural health systems facing staffing shortages, financial pressure, and limited technology resources. But the most meaningful opportunities may initially be behind the scenes. Reducing documentation burden, streamlining referrals, improving scheduling, and automating repetitive administrative work can give clinicians something rural communities urgently need: more time to care for patients.

That’s very different from asking patients to replace a trusted relationship with an AI avatar or chatbot.

Healthcare leaders should resist measuring success by how many AI tools they deploy or how many people use them. Rural AI investments should be judged by outcomes. Did clinicians save time? Did patients get appointments sooner? Did the technology reduce costs, improve efficiency, improve access, or produce better clinical results?

Because many AI tools have been developed using data and infrastructure from large health systems, rural organizations also need rigorous evaluation, strong governance, and reliable data before scaling them.

Patient skepticism is not an obstacle to innovation. It reminds us that technology earns trust through results. If AI gives rural clinicians more capacity to deliver human care — and health systems can prove it does — it can become part of the solution without pretending to be the solution itself.

— Jason Griffin; Missouri City, Texas

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.

By the time Democrat Xavier Becerra left Washington, D.C., more Americans than ever had health insurance, owing partly to his work over the years to pass, defend, and expand the Affordable Care Act.

It’s an achievement the former congressman and former U.S. secretary of Health and Human Services often touts as he campaigns for California governor against Republican Steve Hilton, a former Fox News commentator.

But should Becerra cruise to victory in November, as polling suggests, he will face what may be the steepest decline in health insurance coverage in a generation, one that will land especially hard in his home state.

By 2030, the number of uninsured Californians under 65 is expected to nearly double from 2.4 million to 4.6 million, as recently enacted state and federal cuts to Medicaid and ACA marketplaces begin to roll back historic gains in health coverage, according to a May analysis by the University of California-Berkeley Labor Center. The anticipated rise in the uninsured population could have broad implications for hospital systems, insurers, and the economy.

In February, Miranda Dietz, the labor center’s healthcare program director, told legislators the changes could end up costing California about 200,000 jobs, mostly in the healthcare industry.

Hospital executives have begun reporting more unpaid medical bills, and experts warn health plans will raise premiums further as they’re left with enrollees who are, on average, sicker and more expensive to cover.

“It’s triage,” said Jessica Altman, executive director of Covered California, the nation’s largest state-run health insurance marketplace. “That’s what the next governor is walking into.”

California achieved one of the most dramatic drops in its uninsured population in the nation, largely credited to the state’s robust adoption of the ACA. If tapped to lead the wealthy, progressive state, Becerra would wrestle with how uninsured Californians get care and who pays as the Trump administration shrinks a federal safety net he once oversaw.

Becerra has some experience pushing back against Washington, D.C. As California attorney general, he successfully defended many provisions of the Affordable Care Act, including access to birth control.

Becerra said he would issue an executive order to keep those affected by federal cuts insured. But he has not detailed how the state would backfill as much as $30 billion in federal funding California stands to lose annually.

At a policy forum hosted by Politico last month, Becerra promised Californians would not lose health coverage despite federal cutbacks, saying he would push the industry to eliminate waste from “attorneys, accountants, pencil pushers” that cost consumers billions.

“I’m going to ask them to help me extract some of that waste and put it into healthcare, which helps us cover the cost of keeping Californians insured,” he said.

His opponent, Hilton, is trying to appeal to voters opposed to President Donald Trump, despite receiving the president’s endorsement, and has stumped on cutting off coverage for Californians without legal status, which is paid for with state funds. Hilton has vowed to use those savings to issue state income tax breaks, calling it an immediate antidote to high costs.

“We all understand that the healthcare system is a mess and needs major reform,” Hilton said in an interview. “The quickest thing we can do on healthcare costs is actually to tax people less.”

Left Behind?

In 2010, Becerra was part of U.S. House Speaker Nancy Pelosi’s leadership team and helped whip up votes to pass the law. He also had a hand in crafting it, though his attempt to include a government-backed coverage option failed.

A decade later, when lawmakers considered him for the nation’s top healthcare job, Becerra said his primary mission would be to carry out President Joe Biden’s vision to expand access and cut costs under the Affordable Care Act.

Before the ACA, some 50 million Americans — roughly 1 in 6 — were uninsured. Within a few years of the law’s passage in 2010, its expansion of Medicaid eligibility and financial aid to lower-income marketplace enrollees helped slash the U.S. uninsured rate by nearly half.

Millions more gained coverage during the covid-19 pandemic after Becerra implemented a freeze on Medicaid disenrollment and administered generous but temporary tax credits that put the cost of Obamacare plans within reach for more people.

As Biden’s health secretary, Becerra launched aggressive public awareness campaigns, loosened enrollment rules, and distributed hundreds of millions in grants to pay consumer assistants, also known as healthcare navigators, to help enrollees wade through paperwork.

“One of the common things we would hear from him as a leader was, ‘Who’s being left behind?’” said Benjamin Sommers, a Harvard health policy professor who was a deputy assistant secretary under Becerra.

Under Biden and Becerra, the percentage of people with health insurance reached a historical high of 92%, or 310 million Americans having health coverage in 2024.

Republican Response

But conservatives said those policies inflated enrollment by attracting fraudulent and wasteful coverage. In response, the second Trump administration has tightened enrollment windows and toughened income reporting.

“It’s simple and easy to say, well, the numbers are up so the program must be working,” said Edmund Haislmaier, a senior research fellow at the Heritage Foundation, a conservative think tank. “My argument would be that’s the wrong metric.”

Last summer, the GOP-led Congress passed Trump’s One Big Beautiful Bill Act, which Republicans argued preserves Medicaid for those who need it most while rooting out fraud and waste. Altogether, the law is expected to cut Medicaid spending by $900 billion-plus over a decade.

Congress also allowed enhanced premium tax credits for Obamacare plans to expire last year, spiking premium payments for middle-income Americans and driving down enrollment by nearly 3 million this year.

“We are now witnessing almost a wholesale reversal of pretty much all those policies” that helped cover millions more Americans, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.

For Eric Maciel, the $800 monthly cost of a Covered California plan is too much. To avoid injury, the 28-year-old stays home more and rarely plays pickup soccer at the park — the other players, he added, can get pretty rough.

“That’s another car note,” Maciel said. “I’d be left with nothing.”

Health economists say Maciel is the type of customer insurers need to stabilize their risk pools: young, healthy, and less costly.

Hilton criticized state leaders for passing a revised provider tax he asserts will send premiums soaring and said he wants to inject more competition into California’s health insurance market — but he offered no specific ideas.

Playing Defense

Higher-than-expected state costs coupled with federal cuts have prompted California to retreat on healthcare coverage. Federal funds account for one-third of the state’s budget and more than 60% of spending by Medi-Cal, the state’s Medicaid program.

Gov. Gavin Newsom has frozen enrollment for immigrants without legal status, enacted monthly premiums for some, and plans to only temporarily backfill federal assistance for legal immigrants such as asylees and refugees.

Newsom and Democratic lawmakers agreed to delay some cuts until July 2027, leaving the next governor to weigh further rollbacks against increased taxes. Becerra, a California native born to Mexican immigrants, opposes what’s known as the billionaire tax, on November’s ballot. Last month, he said he supported legislative efforts to penalize large corporations whose workers rely on Medi-Cal, arguing that taxpayers are subsidizing employers’ low wages and paltry benefits.

County governments, which are legally required to provide healthcare to uninsured residents too poor to afford care, are lobbying lawmakers for funding to treat what they describe as a fresh deluge of patients who need free care.

“It’s a pretty big cliff if all this stuff goes into effect,” said Dietz, the labor center’s healthcare program director. “And there’s a choice whether to make it less bad and maintain coverage for folks.”

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

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

The Host Julie Rovner KFF Health News @jrovner @julierovner.bsky.social Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

Summer may be approaching its end, but the health policy stories that have marked the season continue. In Washington and across the country, public health officials are still struggling with outbreaks of vaccine-preventable diseases such as measles, while states and health systems are preparing for the impact of major federal funding cuts to their Medicaid programs.

This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Rachel Roubein of The Washington Post, and Margot Sanger-Katz of The New York Times.

Panelists Shefali Luthra The 19th @shefali.bsky.social Read Shefali's stories. Rachel Roubein The Washington Post @rachel_roubein Read Rachel's stories. Margot Sanger-Katz The New York Times @sangerkatz Read Margot's stories.

Among the takeaways from this week’s episode:

• More Americans are struggling to afford health coverage, even before some of the biggest GOP-initiated changes to Medicaid and Affordable Care Act plans take effect next year. And the federal government’s efforts to block coverage of drugs used in gender-affirming care and to claw back ACA subsidies are creating access issues for a wider pool of Americans.
• Pennsylvania health officials this week reported two measles-related deaths amid an ongoing outbreak and the national debate over vaccines. While many of the actions taken by the U.S. Department of Health and Human Services under Robert F. Kennedy Jr. remain held up in litigation, President Donald Trump has made his personal skepticism about vaccines known, including through his recent executive order. Meanwhile, the administration is scaling back enforcement of civil rights protections for people with autism.
• The Trump administration is inviting states to participate in price negotiations with manufacturers over GLP-1 drugs if the states opt to offer the drugs through their Medicaid programs. But, amid concerns over cost, only one state has taken the federal government up on its offer.
• And farewell to Dolly Parton, the superstar country music singer and songwriter, also known for her philanthropic work, who died this week at age 80. In addition to her donation in 2020 supporting the development of the mRNA-based covid vaccine, Parton funded pediatric infectious disease research, a women’s health center in the Tennessee county where she was raised, and training for pediatric medical professionals.

Also this week, Rovner interviews Dean Rosen about his work for former Sen. Nancy Landon Kassebaum, a Kansas Republican and the first woman to lead a major Senate committee, who died last week at age 94.

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

Julie Rovner: The Washington Post’s “Why We Should Stop Eating Lettuce, Cyclospora or Not,” by Tamar Haspel.  

Margot Sanger-Katz: Stat’s “Comments on OMB Research Rule Mysteriously Removed From Federal Website,” by Anil Oza.  

Rachel Roubein: The New York Times’ “Americans Encounter Risks at Psychedelic Clinics Abroad,” by Noah Daly and Andrew Jacobs.  

Shefali Luthra: The Washington Post and KFF Health News’ “Why Some Couples Are Combining a European Vacation With Their IVF Treatments,” by LJ Dawson.

Also mentioned in this week’s podcast:

• Stat’s “How Trump’s Cuts Are Reshaping America’s Health System,” by Daniel Payne.
• Modern Healthcare’s “Insurers Defend ‘No Claims’ Members as Feds Cut Exchange Rolls,” by Nona Tepper.
• Stat’s “Medicaid Transgender Care Rule Sets Precedent That Could Restrict Coverage of Other Drugs,” by John Wilkerson.
• The Washington Post’s “Fighting Measles Is Expensive. See What It Cost To Contain 10 Cases,” by Naema Ahmed, Lena H. Sun and Aaron Steckelberg.
• CIDRAP’s “mRNA Covid Vaccine Linked to Lower Risk of Myocarditis in Teens, Young Adults,” by Meghan Holohan.
• Stat’s “Newer Shingles Vaccine Linked to Lower Heart Disease Risk, ‘Natural Experiment’ Shows,” by Elizabeth Cooney.
• Politico’s “Trump Offered State Medicaid Programs Lower Prices on Weight-Loss Drugs. Most Are Rejecting the Deal,” by Kelly Hooper.
• KFF Health News’ “Trump Puts Autistic Kids in the Spotlight and Cuts Agencies Built To Protect Them,” by Claire Sibonney.

Credits Taylor Cook Audio producer Emmarie Huetteman Editor

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

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

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BAKERSFIELD, Calif. — Carlos A. grew up in a family on Medicaid, which made healthcare an afterthought since the public insurance is free for low-income enrollees. But when he received a raise two years ago, he found himself earning too much to qualify for the safety net program. And when he browsed Covered California plans, he found that marketplace prices were still too steep for his comfort.

“It was a panic at first,” Carlos said.

He has a chronic immune condition that needs to be managed by regular medication. KVPR and KFF Health News agreed to withhold his diagnosis and last name to protect him from repercussions related to his health.

“I have to be able to afford my health insurance to go to the doctor, because if not, then there’s no peace of mind,” he added.

Now in his late 20s, he receives employer-based coverage through his job at an Amazon warehouse. In addition to adjusting to monthly premiums and copays for medical visits and prescriptions, he also learned he needs prior authorization for that medication he had been on for a decade. Without it, he could get only the generic version, which he’s nervous to try. He felt his insurer failed to justify the switch.

“I felt that this was a slap in the face because I’m paying for my premiums,” he said. “It’s a contract. I’m going to pay my premiums, you cover my insurance, and if there’s a copay to my medicine, I’ll pay it. So why are you playing funny business with my medication?”

Carlos is one of many voters weighing healthcare costs in California’s 22nd Congressional District, which stretches from Bakersfield up to parts of western Fresno County. It’s newly redrawn to improve Democrats’ chances, but it remains among the nation’s most competitive this cycle and could determine control of the U.S. House. It’s long been held by Republican Rep. David Valadao, who’s been voted into the seat in almost every election since 2012.

Rep. David Valadao (R-Calif.) at the U.S. Capitol on March 25, 2025. (Bill Clark/CQ-Roll Call, Inc via Getty Images)

Carlos was among dozens of people who attended a rally in Bakersfield this month in support of Democratic challenger Randy Villegas. Carlos said healthcare costs will be among the key considerations in his vote in this fall’s midterm election, calling it an issue that both candidates need to address.

“I do expect them to campaign on healthcare,” Carlos said. “They’d be very foolish not to.”

Democrats are calling out Valadao’s vote for HR 1, the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which cut billions in healthcare for poor people. The last time healthcare was on the ballot to this extent, Valadao lost his Central Valley seat in 2018 during a “blue wave” after the Republican lawmaker voted to repeal the Affordable Care Act. He retook his seat in 2020 by just 1,522 votes.

Valadao has said he voted for HR 1 because it protected Medicaid, known as Medi-Cal in California, for the most vulnerable, including children, pregnant women, disabled people, and seniors. He supported a rural health fund for hospitals in underserved areas. At the same time, he said the legislation’s work requirements for nondisabled adults were reasonable and would help maintain the program.

“Polling shows that the majority of Americans want us to have our programs to be sustainable,” Valadao told TV channel KERO in Bakersfield before the vote. “Sustainable means taking care of those who need it most, and those who should be working in part of society and being productive should be. And it’s not an unfair ask.”

The work requirement’s documentation mandate will take effect in 2027 for Medi-Cal enrollees. According to the California Health Care Foundation, an estimated 1.1 million people are expected to lose coverage by 2030 due to the eligibility and administrative changes.

Villegas, a populist who favors universal healthcare and is backed by Sen. Bernie Sanders (I-Vt.), has highlighted how Valadao’s HR 1 vote will be felt by low-income residents across the district. The Visalia school board member said he grew up as a Medi-Cal recipient. As of 2024, the current 22nd District, which has some overlap with its redistricted replacement, had the highest Medicaid enrollment rate — 64% — of any Republican-held seat in the nation, according to KFF, a health information nonprofit that includes KFF Health News.

Randy Villegas, a Democrat running for California’s 22nd Congressional District, campaigns in Bakersfield on May 23. (Myung J. Chun/Los Angeles Times via Getty Images)

“David Valadao voted to cut healthcare for nearly 70,000 people in the Valley to give tax breaks to billionaires and his wealthy donors,” Villegas said in a statement. “In Congress, I’ll fight to reverse those cuts and lower healthcare costs.”

Valadao’s office didn’t return requests for comment. His campaign touts his support for quality, affordable health coverage and maintaining access for the most vulnerable. Polling also finds that the Trump administration’s recent withholding of Medicaid funds from states is resonating with Republicans, with 55% saying it’s important for candidates to discuss fraud in government health programs. Republicans in swing districts, including Valadao, have begun airing ads emphasizing reform.

But many in the electorate remain undecided in this district where nearly a quarter of voter registrations are nonpartisan. Some said they haven’t heard enough from candidates about affordability solutions, which they hope will change because healthcare costs top the list of their economic anxieties.

Matthew Depue, who lives in Hanford and has private health insurance through his employer, said he has been fortunate to have reliable coverage. His healthcare premiums affect his monthly budget, but he said he hasn’t had to delay care or choose between paying medical bills and other necessities.

Still, Depue said, rising healthcare costs are quickly becoming harder to ignore. Last year, federal lawmakers declined to extend enhanced tax credits, which state officials say contributed to an average 10% premium increase for Covered California plans.

He also sees how affordability is pushing people across borders to find cheaper treatments and medications.

“People go from here to Mexico to get stuff done because it’s so much cheaper,” Depue said.

Even though healthcare is important to him, it isn’t the only issue driving his vote. Depue, who doesn’t know whom he’ll vote for, said he would evaluate candidates based on everything they stand for, including their positions on things like taxes and the difficult job market. District 22’s voter registration is 42% Democratic, 26% Republican, and 24% no party preference, according to the California secretary of state’s May report, the latest available.

Hanford, with a population of roughly 62,000, is the seat of Kings County. (Cresencio Rodriguez-Delgado/KVPR)

For Hanford resident Patreza Newton, affording healthcare has become deeply cumbersome. She hopes that whoever wins the election will work to prioritize healthcare, saying the current health system is unaffordable.

She used to purchase her own plan under Obamacare and is now covered by her church’s insurance. But to keep monthly premiums affordable, she chose a high-deductible plan, which means she has to pay out-of-pocket for some prescriptions and specialist visits.

Newton said she falls into what she calls “the in-between,” people who earn too much to qualify for Medicaid but still struggle to afford coverage.

Years ago, Newton was hit with a hospital bill of roughly $65,000 after surgery and had to apply for financial hardship assistance because she couldn’t afford to pay the bill.

As she considers how to vote this fall, she said she isn’t looking for overwhelming promises but rather a leader who understands what families are experiencing. She’s undecided on a candidate, saying none has shown the initiative she is looking for.

“I do think there should be a way that people can afford it,” she said, “no matter who they are.”

This article is from a partnership that includes KVPR, an NPR affiliate in central California, and KFF Health News.

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

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

Last year, Stephanie Halver’s primary care doctor consulted a risk assessment tool to calculate her chances of one day developing breast cancer. Halver, now 43, remembered the likelihood “popped up really high.”

That’s partly because Halver’s mother and aunt have had breast cancer. Her age and dense breast tissue also put her at higher risk.

Halver, who lives in Vancouver, Washington, said her doctor recommended she get an annual breast MRI, six months after her yearly mammogram. The scan would serve as an additional safeguard, since breast MRIs can detect abnormalities that mammograms miss.

Case in point, actress Olivia Munn had a breast MRI in 2023 that detected an aggressive form of cancer in both breasts, even though a recent mammogram had been clear, she told People magazine. Like Halver, Munn said her doctor recommended the MRI after a risk assessment score showed she faced a greater-than-normal chance of developing breast cancer.

Catching breast cancer early, before it spreads, improves survival rates, according to the National Cancer Institute. After Halver’s insurer preapproved the scan, she scheduled the MRI for September.

“Luckily, they find nothing,” Halver recalled.

Then the bill came.

The Medical Service

A breast MRI — short for magnetic resonance imaging — is a preventive and diagnostic tool that captures pictures of breast tissue in higher detail than a mammogram. MRIs may be recommended for patients at an increased risk for breast cancer, including those with dense tissue, a family history of breast cancer, or certain genetic markers.

But the scans are generally not recommended for women considered at average risk, according to the American Cancer Society, because they can also yield false positives, subjecting patients to unnecessary follow-up tests and procedures.

Breast MRIs are also used to diagnose cancer when an abnormality is detected during a mammogram, and they can determine the cancer’s stage after diagnosis.

The Bill

$1,205: After an insurance payment of $13.90, the patient was responsible for $1,191.10. The clinic also charged $65.60 for “Injectable/Oral Med,” often used to keep patients still or less anxious during the scan. Halver’s insurance covered about half of that charge.

The Billing Problem: Not Always Preventive

When Halver received the bill from Vancouver Clinic, where the MRI was conducted on Sept. 26, she was confused.

She knew that the Affordable Care Act requires health plans to cover preventive care, such as Pap smears and mammograms, at no cost to patients.

What’s more, Halver’s breast MRI had been recommended by her doctor and preapproved by Blue Cross Blue Shield of Texas, of which she is a beneficiary through her employer-sponsored plan. The whole point of it was preventive. That’s why she assumed it would cost her nothing.

To make things more confusing, a state law in Washington requires many health insurers to cover breast MRIs.

“I’ve had many phone calls trying to understand” the bill, Halver said.

Halver thought her health insurance plan would pay for a breast MRI recommended by her doctor in 2025. Even though the scan had been preapproved, she ended up with a $1,200 bill. (Kristina Barker for KFF Health News)

It came down to this: The U.S. Preventive Services Task Force, a panel of outside experts that advises the federal government, is charged with recommending which screenings health insurers are required to cover at no cost to patients, and preventive breast MRIs don’t fall into that category.

The task force has determined “the current evidence is insufficient to assess the balance of benefits and harms” of breast MRIs for women with dense breast tissue “on an otherwise negative screening mammogram.”

The federal guidelines are different for patients whose mammograms detect an abnormality, said Cathy Peters, senior director of state and local campaigns at the American Cancer Society Cancer Action Network.

In these cases, Peters said, guidelines published by the federal Health Resources and Services Administration specify that additional imaging, such as ultrasounds and MRIs, are preventive.

After an abnormal mammogram, these services are recommended “to address findings on the initial screening mammography” and to “complete the screening process for malignancies,” according to HRSA.

Those guidelines are a step in the right direction, but women who have not had an abnormal mammogram may end up “running into a big bill,” Peters said. This can be a deterrent when it comes to future screenings, she said, because when “you get hit with that once, you’re going to be very careful the next time you go.”

Some states have enacted laws that require insurers to cover breast MRIs, Peters said, but they generally don’t benefit patients like Halver who are enrolled in large, employer-sponsored insurance plans. These “self-insured” plans are regulated by the federal government, not by state lawmakers.

“Sadly, these state-by-state laws,” Peters said, don’t “fix the federal problem.”

The Resolution

Blue Cross Blue Shield of Texas declined to answer questions about Halver’s benefits or bill.

Halver appealed the insurer’s coverage determination, and in July she received a letter indicating that her appeal was denied.

Halver said she contacted her employer’s human resources department earlier this year and learned that mammograms are covered as a preventive screening under her health plan but breast MRIs are not. That means her annual breast MRI will be subject to deductibles, coinsurance, and other cost-sharing requirements.

In this case, the cost of Halver’s breast MRI was applied to her $3,300 annual deductible, an explanation of benefits from her insurer showed.

“I think I’m on the hook for this bill,” she said.

And because her risk of breast cancer is high, she said, “that’s a guaranteed bill every year.”

Halver learned that mammograms are covered as a preventive screening under her health plan but breast MRIs are not. (Kristina Barker for KFF Health News)

The Takeaway

If your doctor or medical provider recommends an annual breast MRI in addition to an annual mammogram, consider researching your state’s coverage rules on the DenseBreast-Info website. The nonprofit organization maintains a map with up-to-date information on state laws about breast cancer screenings. Depending on where you live and what type of health plan you have, preventive breast MRIs might be covered at no cost.

If it turns out you could be on the hook for a future bill, there are a few things you can do beforehand to potentially lower your out-of-pocket costs.

Ricki Fairley, co-founder of Touch, the Black Breast Cancer Alliance, recommended first finding a patient navigator at the hospital or cancer center to assist you.

She urged women to seek out resources in their communities or through national advocacy groups, including Touch, to find ways to lower screening costs. Programs funded by some states can help offset the cost of breast cancer screenings for low-income patients, Fairley said.

Beyond that, shop around for the best price. Freestanding imaging centers may charge less for a preventive breast MRI than a hospital. If possible, also consider scheduling the MRI at the end of your health plan’s deductible year. If you’ve already met your deductible, you could end up owing less out-of-pocket.

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

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

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

In January, Jeff La Marca got a prescription for the popular weight loss drug Zepbound. But he couldn’t afford the $750 monthly price tag.

Then Medicare launched an 18-month pilot program that offers GLP-1 medications to some enrollees for only $50 a month. La Marca thought he might finally be able to afford the drug.

“I thought, ‘Thank God, there’s a path,’” said La Marca, who lives in Basking Ridge, New Jersey, and has tried numerous diets and exercise regimes.

But the 68-year-old’s celebration was short-lived.

His application to the pilot program was denied.

La Marca has severe obstructive sleep apnea, one of several diagnoses that exclude patients from the Bridge program’s $50 monthly price. The notification didn’t say why he was rejected. He thinks that if he didn’t have that diagnosis, he would qualify due to his weight.

“I’m obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I’m at risk for stroke. I’m prediabetic. And yet I can’t get it. I’m livid,” he said.

Jeff La Marca uses a machine to treat his obstructive sleep apnea. It adjusts his breathing with every breath. (Erica S. Lee for KFF Health News) La Marca, a retired professor living in Basking Ridge, New Jersey, is among an estimated 5.9 million Medicare enrollees excluded from a GLP-1 discount program because they have a medical condition such as Type 2 diabetes or sleep apnea. (Erica S. Lee for KFF Health News)

A Temporary Patch for a Long-Standing Gap

About 1 in 5 American adults have taken a GLP-1 medication, and most of them, including those with health insurance, say the drugs are difficult to afford. Federal law has long barred Medicare from covering drugs prescribed solely for weight loss, which is why the Medicare GLP-1 Bridge program made a big splash when it launched in July.

It’s a short-term pilot program in which Medicare is offering coverage of three GLP-1s for weight loss and management, to see if that would save Medicare money later. Eligible patients must be enrolled in Medicare Part D, a prescription drug coverage add-on to Medicare. Even though people must have Part D insurance to qualify, the preauthorization request doesn’t go through the insurer; it’s instead submitted to a separate system run by a contractor for the Centers for Medicare & Medicaid Services.

The pilot includes Wegovy, the KwikPen formulation of Zepbound, and the oral medication Foundayo.

Under the pilot, many Medicare beneficiaries with a body mass index of 35 or higher — the upper range of obesity — qualify for coverage of one of those drugs, if prescribed. Those otherwise eligible who have a BMI of 27 to 34 can qualify if they also have certain health conditions, such as prediabetes or cardiovascular disease.

But buried in the fine print is a distinction that’s tripping up patients like La Marca: The $50 price under Bridge applies only to people using the drug solely for weight loss. Anyone who has a qualifying medical condition that the Food and Drug Administration has approved GLP-1s to treat, such as Type 2 diabetes or moderate to severe obstructive sleep apnea, is instead routed back to their Medicare Part D prescription drug plan, which can require copays of hundreds of dollars a month for GLP-1s.

“The Bridge program was designed to target those people who can’t get GLP-1 coverage through Part D but would benefit from taking one for weight loss,” said Juliette Cubanski, who directs the Program on Medicare Policy at KFF, a health information nonprofit that includes KFF Health News.

The cost to Medicare of subsidizing the drugs will depend largely on how many people use the program, and the federal government hasn’t released an estimate.

Cubanski has estimated that 3.8 million people qualify and that, if a quarter of them enroll in Bridge and remain on treatment for the program’s full 18 months, it will cost Medicare about $3.3 billion. If three-quarters enroll, costs could rise to $10 billion.

If the government expanded the program to include the additional 5.9 million people who are overweight and already eligible for GLP-1 coverage through Medicare Part D, it would add billions more to the program’s cost.

The demonstration’s initial weeks have been positive, and most prior authorization requests have been completed in under 12 hours, CMS spokesperson Timothy Foster said.

“This has allowed thousands of eligible beneficiaries to access GLP-1 medications for weight loss at pharmacies nationwide,” Foster said.

“I’m obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I’m at risk for stroke. I’m prediabetic. And yet I can’t get it. I’m livid,” La Marca says, referring to the popular weight loss drug Zepbound. (Erica S. Lee for KFF Health News)

GLP-1s Aren’t Covered

Patients like La Marca are left in a tough spot, qualifying for Part D coverage of a GLP-1 but facing much higher cost sharing.

“‘Coverage’ doesn’t always mean ‘affordable,’” said primary care physician Taylor Lacy, who describes herself as a “big proponent” of GLP-1s and practices at Sunflower Medical Group in Roeland Park, Kansas.

The Bridge program is leaving behind patients with the greatest medical need, she said. She noted that many Medicare patients already must navigate prior authorization and spend months trying alternate, often cheaper treatments, a process known as step therapy, before finally getting approval — only to arrive at the pharmacy counter and discover that their GLP-1 copays will run them $200 to $600 a month, if not more.

Researchers studying how Medicare insurers cover GLP-1s have found that recipients have faced increases in out-of-pocket costs and that almost all plans now require prior authorization, which can make getting the drugs more difficult.

Chris Bond, a spokesperson for insurance industry trade group AHIP, blamed drugmakers’ prices, “which they alone set and they alone can lower.”

La Marca’s insurer declined to answer specific questions about La Marca’s case.

Left Waiting

For now, La Marca’s GLP-1 prescription remains unfilled. The severe sleep apnea diagnosis that helps establish his medical need is also what excludes him from the discount program that would bring the cost within his reach.

As he reflected on his appeals and the dead ends, La Marca paused, his eyes filling with tears of frustration.

“This is now my quest, because it’s my only chance to improve my health,” he said. “It’s the only thing left. I’ve tried everything.”

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

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

Céline Gounder, KFF Health News’ editor-at-large for public health, discussed the potential of Moderna’s melanoma vaccine breakthrough on CBS News 24/7’s The Daily Report on Aug. 19, drawing on her experience as a former melanoma patient.

• Click here to watch Gounder on The Daily Report.

KFF Health News senior correspondent Rachana Pradhan discussed how an issue with Deloitte-run information technology systems denied Medicaid coverage to disabled Michiganders on NPR’s Stateside on Aug. 18.

• Click here to hear Pradhan on Stateside.
• Read Pradhan’s “A Deloitte-Run System Denied Medicaid Benefits for Michigan’s Disabled. Now Trump’s Law Piles On,” with reporting from Samantha Liss and Kate Wells.

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• Click here to hear Rayasam on The Georgia Health Report.
• Read Andrew Jones’ “Hospitals Say They Found a Tool To Help Reduce Childbirth Risks: Wristbands.”

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• Click here to hear Rovner on What Next.
• Click here to hear Rovner on Attitude With Arnie Arnesen.

KFF Health News ethnic media editor Paula Andalo discussed how an uninsured patient saved thousands by shopping around for the best surgery price on Radio Bilingüe’s Línea Abierta on Aug. 12.

• Click here to hear Andalo on Línea Abierta, starting at the 31:21 mark.
• Read Andalo’s “Uninsured but Undaunted, a Surgical Patient Searched the Globe for a Deal.”

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.