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

The Trump administration has conceded in court documents that it used purely political considerations to cancel grant funding previously approved by Congress. But that has provoked a surprisingly muted response from lawmakers, who under the Constitution control the power of the purse.

Meanwhile, Republicans in the Senate summoned former National Institutes of Health and White House official Anthony Fauci to testify — again — about his handling of the covid pandemic. Fauci, however, refused to answer questions, citing the advice of his attorneys.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Bloomberg News, Shefali Luthra of The 19th, and Liz Essley Whyte of The Wall Street Journal.

Panelists Rachel Cohrs Zhang Bloomberg News @rachelcohrs Read Rachel's stories. Shefali Luthra The 19th @shefali.bsky.social Read Shefali's stories. Liz Essley Whyte The Wall Street Journal @l_e_whyte Read Liz's stories.

Among the takeaways from this week’s episode:

• Recent court filings shed light on how the Trump administration has used politics to justify its decisions to cancel federal grants. While similar revelations may have been explosive under other presidents, the filings have triggered muted, if any, responses from lawmakers.
• The Trump administration announced this week that it would end the temporary Medicare Part D subsidies, introduced under the Biden administration, that help lower the monthly premiums older Americans pay for drug coverage. While next year’s premiums probably would have increased anyway, the change — which many will notice when they shop for plans later this year, shortly before the midterm elections — may not help Republicans in the voting booth.
• Meanwhile, Sen. Rand Paul (R-Ky.) brought Fauci before the committee he chairs to address accusations related to his role in the nation’s covid response as a key adviser to Presidents Donald Trump and Joe Biden. But little of substance was said, with the hearing quickly devolving into political grandstanding as Fauci asserted his constitutional right not to self-incriminate.
• An FDA advisory panel voted to recommend the agency make it easier for Americans to obtain several previously banned compounds known as peptides — even as FDA staff caution that there’s no evidence they are safe. The panel included members who stand to profit from expanded access to peptides.

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

Julie Rovner: The Arkansas Times’ “Postpartum Women Go Without Care as Arkansas Holds Out as Lone State To Deny Them Medicaid,” by Byron Tate.  

Rachel Cohrs Zhang: KFF Health News’ “Trump Administration Demands Hospitals Share Emergency Room Records,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir.  

Liz Essley Whyte: Stat’s “E-Bikes, E-Scooters Are a Burgeoning Pediatric Public Health Emergency,” by J. Todd R. Lawrence and Madison A. Kesler.  

Shefali Luthra: The Washington Post’s “The Problem With RFK Jr.’s Crusade Against Antidepressants,” by Aaron E. Carroll.  

 Also mentioned in this week’s podcast:

• The New York Times’ “Trump Administration Admits Canceling Grants to States That Did Not Vote for Him,” by Tony Romm and Brad Plumer.
• CalMatters’ “White House Admits It Used Keywords To Kill Billions Worth of California Research Grants,” by Mikhail Zinshteyn.
• The Wall Street Journal’s “Trump Turns Up the Heat on RFK Jr. To Cut Back Childhood Vaccines,” by Liz Essley Whyte.
• Bloomberg News’ “From TV Doctor to Power Broker: Dr. Oz Thrives on Trump’s Team,” by Rachel Cohrs Zhang.
• KFF Health News’ “Trump Has Quietly Throttled an Agency Devoted to the Safety of American Healthcare,” by Arthur Allen.
• The Washington Post’s “Peptide Boom Has States Scrambling To Protect Consumers, Post Investigation Finds,” by Lauren Weber.
• Politico’s “Activists ‘Throwing Everything’ They Can Against Abortion Turn to Wastewater Data,” by Alice Miranda Ollstein and Ariel Wittenberg.

Click to expand the transcript Transcript: The Politics of Grant Cuts

[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, July 30, 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 Rachel Cohrs Zhang of Bloomberg News. 

Rachel Cohrs Zhang: Hi, everyone. 

Rovner: Liz Essley Whyte of The Wall Street Journal. 

Liz Essley Whyte: Hello. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: No interview this week, but more than enough news, so we’ll get right to it. I want to start with a story that I feel like is getting a little bit buried because it broke last Friday. The New York Times reported on a federal court filing in which the Trump administration admitted that it canceled $7.5 billion in clean-energy grants solely because they were located in states represented by Democrats that voted for Kamala Harris in 2024. In other words, the actions were purely political. Now, this is before the administration finalizes proposed rules that would give political appointees still more power over how grant funding is distributed. I heard one pundit say on cable news that in any other administration, this sort of information would lead to an immediate impeachment inquiry. But these days, it’s just another day that ends in “y.” Is the lack of public outcry about this because everyone already assumes that everything this administration does is political? Or is this considered just too inside baseball for most voters?  

Whyte: Well, I was gonna say I think this has long been people’s suspicions about why certain grants are cut in the way that they are, or some of these Medicare/Medicaid investigations are the way that they are. And so I think maybe the lack of outcry was just people shrugging their shoulders and saying, I mean, yeah, we guessed that, you know. I don’t know. 

Cohrs Zhang: It was really chaotic too, and hard to keep track of all these different things for people whose job it is to do so. So I feel like the fact that this is protracted for so long, we’re like, which DOGE [Department of Government Efficiency] cuts were those? And I think it is important, certainly, and I’m glad there’s been coverage of it, just for the record, and just kind of for history purposes and just understanding the limits of that kind of change to government at that speed. But yeah, I think it is just hard to break through in this news cycle, and it was very chaotic and confusing for everyone.  

Luthra: One thing I have been thinking about, though, is when you think about these states where grants were canceled, there are a lot of people who live there who did, in fact, vote for Donald Trump. And depending on the size of the state, you probably have members of Congress who are actually in Republican districts. And that, I think, is really interesting. And I just wonder if eventually there is some sort of conversation. Those are probably in some cases members who might be a little bit more on the defensive in other ways, just given the political environment we are in. And is this an issue that Democrats can talk about and highlight and sort of bring to voters and say, you know, your representative is not here defending your interests because of these broader sort of punitive measures being taken by the White House. I think that’s an interesting thing that we don’t know the answer to yet. 

Rovner: I know I keep saying this, but I can’t believe that Republicans on the [Senate] Appropriations Committee aren’t being louder about this. This is the one power that they have. It’s why you get on the Appropriations Committee, is you get to steer money to your state or your district. That is the great perquisite of being in Congress, and the administration is basically taking it away. And they’re just letting them. I mean, Susan Collins told Politico, quote, “I obviously think that’s wrong.” But she doesn’t seem willing to do anything about this. I mean, she’s the chairman of the Senate Appropriations Committee! 

Cohrs Zhang: I think we’re, like, testing the checks-and-balances system to its fullest extent. This administration. They can only pick so many fights, you know. 

Whyte: Yeah, Susan Collins, especially, this whole administration has had to choose about when to say something and when to push behind closed doors, push publicly. I mean, there’s been lots of stuff that she hasn’t liked. 

Rovner: Yeah, for sure. Well, this is not the only case where the government has admitted to canceling grants for political reasons. In a case brought by researchers from the University of California, the administration confirmed it canceled some grants because they contained keywords like “diversity,” “gender,” and “vaccine hesitancy” to cut off funding. The plaintiffs in that case argue that it’s a First Amendment violation. Again, we’ve known for some time that this has been happening. Are the courts just too slow to be able to deal with it, Rachel? That’s kind of what you were intimating. This has been dragging out, sort of bit by bit by bit. 

Cohrs Zhang: Yeah, I think it’s hard. And I — just like with these grants dragging out too, it has impact for the people who are supposed to be receiving this funding and how their cycles work and hiring and just all the … that grant process. But I think it’s hard to make that connection, back to the individual voter. And I think that’s just a tough hill to climb in terms of public communications. So I think, yeah, we’re seeing these similar themes play out. 

Luthra: And one thing that I think is really relevant that I keep coming back to is we did see a test run of this with the USAID [United States Agency for International Development] cuts at the beginning of the administration. Those happened very quickly. The courts took a very, very long time, and by the time there was any kind of real momentum in any direction, it was too late. People did not have money, firms had downsized, people had left their jobs, left the industry altogether. And, at the time, that seemed to me like a really striking test. If this is able to happen here, and it shows that things just continue, why not happen in other areas as well, where you have these grants being put out there that have maybe ideological tension with where the administration wants to be going? 

Rovner: So I wanted to talk about some specific impacts on health policy, notably AHRQ, the Agency for Healthcare Quality and Research, which, like USAID, the administration has all but eliminated, despite the fact that it was appropriated nearly $350 million for this year in a bill signed by President Trump. AHRQ, which is down to a fraction of its original staff and hasn’t funded any grants in more than a year, is actually a completely bipartisan creation from the 1990s. It was established to study healthcare quality and access issues, many of which go neatly hand in hand with the “Make America Healthy Again” agenda. Earlier this month, the administration stopped funding more than 100 grants, and an HHS [Department of Health and Human Services] spokeswoman told my KFF Health News colleague Arthur Allen only that the agency plans to establish a new, quote, “framework,” which I thought was the job of Congress. Again, too small to attract much notice? 

Luthra: Probably. I mean, voters don’t know what AHRQ is. Like, we know about it because of our jobs, but this is not something people wake up and think about or talk to their neighbors about. It just feels very divorced from a lot of people’s realities. Even though, to your point, the consequences are far-reaching. They are long-term, and, also, the significance in terms of, as Rachel pointed out, separation of powers, checks and balances are also very striking.  

Rovner: I mean, AHRQ studies things like patient safety. I’m old enough to remember when the, you know, the big Institute of Medicine [now National Academy of Science] report came out that said how many people were injured by medical errors. It was a huge, huge issue. I mean, for years. And that’s basically what AHRQ does, and that’s what this administration says that they care about. They care about gold-standard science. They care about fraud. They care about making the health system safer. And yet, you know, AHRQ is just, well, we don’t know what it is, so we’re going to make it go away, basically. 

Whyte: Obviously, the HHS has not been as clear on this as you might hope and expect for the “most transparent administration in history.” But it is clear that, like, Kennedy is looking for pots of money to do the things that he wants to do. And it seems like this is one of the pots they’ve landed on as something that can be shifted around. 

Rovner: Yeah, so it does. Well, one cut that is likely to be noticed is the administration’s decision to end the temporary subsidy for Medicare Part D that prevented the addition of an out-of-pocket cap on how much enrollees have to spend each year on prescription drugs from spiking those monthly premiums. This will almost certainly raise premiums for many, if not most, of the 25 million seniors who have stand-alone Part D drug plans. And they will see those increases right before Election Day, because Medicare open enrollment starts Oct. 15. And, by the way, seniors vote in disproportionate numbers in midterm elections. If I was a political adviser for this administration, I don’t think I would have advised doing this. Am I missing something here? 

Cohrs Zhang: I think you are seeing there’s an interesting shift happening in terms of the power of the fiscal conservative wing of the administration. And I think we’ll continue to see that play out. I will say it’s unclear, like, how much premiums would have increased anyway without this subsidy program ending, given that the premium increases are capped by statute, in the Inflation Reduction Act through 2029. So, I mean, there is a chance that they might have gone up 6% anyway. We’re maxing out that increase. But the messaging certainly was not stellar for them. And I think we saw some cleanup efforts on that, for them trying to say that, you know, most seniors will see, you know, no increase or an increase of less than $10 a month. 

Rovner: Or they’ll have, I think Dr. [Mehmet] Oz said, they’ll still have an option for a cheaper plan. Of course, that cheaper plan might not cover all their drugs, but … 

Cohrs Zhang: Yes. So I think that’s just like a … this is one, I think, data point in this larger theme I’m thinking about. And how do we see — as we move past the midterm elections and affordability may not be top of mind if there’s no electoral accountability for it — how does that change what we’re seeing out of these agencies? 

Rovner: I’m just old enough to remember when, you know, you don’t raise costs for Medicare beneficiaries right before a midterm election, which is what this will do. Well, it isn’t all cuts. The administration this week finally released the $600 million that Congress had appropriated for the global Vaccine Initiative, Gavi. That was money for last year and this year. The funding had been blocked by HHS Secretary Robert F. Kennedy Jr. even though it goes through the State Department, not the Department of Health and Human Services. Kennedy had been concerned that Gavi was paying for vaccines containing the preservative thimerosal, which has been accused, and cleared, of causing autism. Do we know what finally sprung this money loose? 

Cohrs Zhang: I think there was a deadline of Sept. 30, and the funding would have expired. And we did see kind of an exchange with Secretary of State Marco Rubio and Susan Collins, where he said, “You know, I’m going to take ownership of this, and we’re going to get it done.” And so I think there was a push by administration officials to get this funding pried loose. And I think there are questions about whether Gavi was kind of heading this way already with some of these vaccines. I think they were starting the transition, but I think there … we’ll see how the implementation works on it. But I think there might be an argument that maybe this transition might have happened maybe faster … or to a broader degree. 

Rovner: The transition away from using thimerosal. 

Cohrs Zhang: Yes, the states … there’s one hexavalent vaccine where countries could already apply to transition to a different formulation without thimerosal starting in 2023. So, but maybe an option would be broader. Just there’s kind of a lot up in the air as to actually how this gets operationalized in the timeline. 

Rovner: Yeah, I was thinking, though, this might have been one of the cases where Congress complaining, both publicly and privately, did actually have some impact. But also, I know a lot of it was Marco Rubio stepping in and saying, “Hey, this is a State Department thing.” And finally, you know, I say a year and eight months later, the money gets distributed. All right, we’re going to take a quick break. We will be right back.  

Well, speaking of things that may or may not be good politics, Republican Sen. Rand Paul of Kentucky called former NIH [National Institutes of Health] and White House science official Tony Fauci before his Homeland Security Committee Wednesday to rake him over the coals again over his handling of the covid pandemic. Fauci, who received a preemptive pardon from President Joe Biden as Biden was walking out of the Oval Office door in 2025, did not take the bait. He pleaded the Fifth, lest anything he said be used for a new prosecution for lying to Congress. Meanwhile, Paul says he’ll try to find Fauci in contempt of Congress, which, by the way, would take 60 votes, which feels a little unlikely. Separately, several red-state attorneys general say they now want to investigate Fauci since his pardon doesn’t cover state prosecutions. First, prosecute him for what? And is relitigating covid origins and lockdowns really good politics for Republicans? I’m sure it riles up the base, but it’s hard to see them running on this as their health agenda. 

Whyte: So Rand Paul actually said on TV last night that he just thinks his committee needs to do the contempt of Congress vote, and then they can refer it to the DOJ [Department of Justice]. So they may not need 60 votes. So that will be interesting. Meanwhile, [Sen.] Ron Johnson [R-Wis.] has also threatened to subpoena Fauci. And the Florida attorney general is opening an investigation. And Alabama Sen. Tommy Tuberville says if he becomes governor, he’s going to try to figure out a way to prosecute Fauci in Alabama. So there’s definitely a lot of focus on Dr. Fauci. 

Rovner: I repeat, though, prosecute him for what? 

Whyte: Well, you know, before the hearing, Rand Paul was saying, Yeah, his preemptive pardon covers stuff in the past, but if he lies again at this hearing, then we will, you know, go after him or whatever. 

Rovner: Right, and that’s why he didn’t, that’s why he pleaded the Fifth.  

Whyte: Right, which is why it was viewed as an … entrapment situation that he should probably steer clear of, and why he would not even answer, like, what is the color of the carpet. 

Rovner: And what color his tie was, or was it Sen. [Josh] Hawley’s tie? 

Whyte: Yeah, and what day of the week it was, yeah. Whether it’s good politics for Republicans, I think we’ll have to see. There’s an Ohio candidate that they’ve tried to get for being, you know, covid czar or whatever, and that really hasn’t gone anywhere in Ohio. She’s polling OK. So I think that’s a good question on whether voters still care about this or not. I think obviously a lot of them do, but, like, the suburban women who are, you know, the famous swing voters, what do they think about Dr. Fauci? Will be interesting to see. 

Rovner: Yeah, I mean, I guess just for watching the questioning, it seemed that they’re trying to, you know, that we know that Democrats have more enthusiasm going into this midterm than Republicans. And it looked like the Republicans were trying to, you know, reactivate the angry covid base, if you will, to get them to come out and vote. It’s just hard to know how many people are angry enough to come out, you know, six years later.  

All right. Well, speaking of buzzy stories, Liz, you broke the buzzy story of the week about how Trump might be pushing RFK Jr. on childhood vaccine policy rather than what we all assumed was the other way around. So tell us about it. 

Whyte: Yeah, this is a bit of a counterintuitive news development for two reasons. One, because everybody thinks RFK Jr. is the big vaccine skeptic in the administration. And two, because the White House had, you know, is widely reported that they were telling HHS to “ix-nay on the accines-vay” ahead of the midterms — like, just dial it down a little bit because of polling they had from the winter that showed while food and ag [agricultural] stuff was really popular, the other MAHA stuff, vaccine skepticism, was not, and they kind of wanted to tone it down. But the president does what he wants. He does not always listen to the polling. And he has been telling Kennedy since at least May, why aren’t you doing more to probe the connection, in his mind, between vaccines and autism? And this took Kennedy aback, actually, at a golf course lunch in May. He was surprised because he was still under the impression they were supposed to be dialing back. And President Trump told him, “You have the yips,” which I just think is such a funny word. 

Rovner: It’s a golf term. 

Whyte: Yes, it’s a golf term. And that has continued to be, actually, a point of tension between the two men, with the president venting his frustration to Kennedy at a mid-June Oval Office meeting. And part of the reason we’re seeing some of this increased action, even if it’s not, you know, really talked about much, but appeals to the federal appeals court to speed up the decision for the key vaccine advisory panel of the CDC [Centers for Disease Control and Prevention], and then also there was that EO [executive order] in May that Trump put out on the childhood vaccine schedule, and just kind of general scrambling behind the scenes to figure out, like, what they can deliver for the president, who is, I’m told, a results guy and wants to see results and thinks, you know, it’s been a year and a half, and why aren’t there results? So, we’ll see where that leads. 

Rovner: Well, meanwhile, if this puts Kennedy in hot water with the president, Rachel, you this week write about what the newest, who the newest likely candidate is should RFK Jr. leave his post, either voluntarily or not so voluntarily. Tell us about your story. 

Cohrs Zhang: So I have been working on this story for a very long time. But I think we’ve seen kind of this surprise in Washington that Dr. Oz, who’s leading Medicare and Medicaid, has actually like navigated the Trump administration with great skill, and I think we were finally able to capture the scope of that, him translating that skill into personal relationships with the president, with the secretary, and getting himself a seat at the table on far more policy issues than a CMS [Centers for Medicare & Medicaid Services] administrator would normally get. And I think we saw, those of us who remember the first Trump administration, how ugly things got between HHS and CMS — was like very adversarial, like a really bad time in there, very toxic. But I think we’ve seen him take a more, like, cooperative approach. He wields his influence, is more explaining things. He is a medical doctor, his training, unlike the secretary. And I think there is just, like, a general trust and, like, personal friendship between the two of them that has translated into this interesting dynamic, where Dr. Oz kind of serves as a go-between on some of these issues between the White House and the secretary and gets everybody kind of to the place where they need to go. And he’s just a good communicator and has built a lot of trust and parlayed that into getting himself a seat at the table. 

Rovner: Yeah, and Liz … your story about Kennedy and Trump also suggested that Oz’s favor is rising, shall we say? 

Whyte: Yeah, the White House staff love Oz because they know they can send him to the Hill. They can put him on TV. Like, he’s going to do a great job. Rachel had this too. You know, the president calling and texting Oz and saying, you know, what about this issue? and it has nothing to do with CMS. He’s, you know, being called upon to do other stuff that is not in his portfolio. So yeah, every lobbyist is just, like, watching their clock and seeing when Oz takes over. I don’t know that it’s that straightforward. I think the president and secretary have a very warm friendship, and it took a lot for Kristi Noem to get let go, and I don’t think we’re anywhere near that. So we’ll have to see if the mood changes after the midterms. But it doesn’t seem to me that anything would be imminent. 

Rovner: I would add that I know Oz is the one person practically in the entire administration, not just at HHS, who actually does well when he goes to the Hill. Who, you know, is respectful and sort of understands how administration officials are supposed to conduct themselves when they are in front of the people who theoretically are responsible for them having their jobs.  

Whyte: Yeah, you’ll find the Democrat staffers are like, Oh, we actually like Oz, which is funny, I think.  

Rovner: He’s a good politician! What can I say? Rachel, do you want to add something? 

Cohrs Zhang: I will say, though, he did play a role in selling all these Medicaid cuts that are going to be coming down the pike. 

Rovner: He did. 

Cohrs Zhang: And so I think he is going to be the face of this when they actually go to implement it.  

Rovner: He will. 

Cohrs Zhang: So yeah, we’ll see how that goes.  

Rovner: We’ll see how that goes.  

Cohrs Zhang: What time frame they’ll be doing that in. But yeah, certainly. Yeah, it’s interesting. 

Whyte: They’ve kind of given up selling that, too. You know, it’s not something they’re being like, Oh, look at all the great stuff we did with Medicaid in the One Big Beautiful Bill. It’s very much pivoted to fraud.  

Rovner: Yeah, but when it starts, when it takes effect next year, I think there’s going to be, there will be lots of questions to answer. Shefali, do you want to add something before we move on? 

Luthra: The only thing that really just I keep thinking about is the long history of this relationship between Dr. Oz and the president, and, in particular, when during the 2016 campaign he was the one to talk about the president’s testosterone levels on TV and how they were excellent. And I just think it’s really special that we’ve come full circle in this way. 

Rovner: Yes, yes, it is, and we have. All right, moving on. One thing that Secretary RFK Jr. said this week that’s pretty clearly not true is that the department has the cyclospora parasite outbreak, quote, “under control.” A former deputy commissioner of food at the FDA under both the first Trump administration and President Biden told Politico this week that, quote, “it is starting to approach a catastrophic level in terms of how mismanaged it’s been on multiple fronts.” Rachel, you’re keeping an eye on this. What is the latest? What do we know about cyclospora and where it’s coming from? And are the recalls that are in existence enough to stop it? 

Cohrs Zhang: I don’t think they’re stopping it, by any means, especially with an incubation period of two weeks. I think we are continuing to see more cases reported, and I think, like you mentioned, there’s, I think, fingers pointing in all directions. Our team and others have done reporting on just how Taylor Farms has handled themselves behind the scenes. The public spat between Taylor Farms and the FDA was not something you usually see in an outbreak of this kind. It’s just worth probably pointing out that the FDA did DOGE much of its communications staff that has experience with this sort of outbreak. We have, you know, officials shifting around, and there’s some key vacancies at the FDA as well in a lot of these leadership positions. So I think there’s been complaints, certainly, at, like, the report you mentioned about the federal response, but also about the company and their speed and their clarity and communication, and whether that’s truly serving the public interest or not. And I think there are, if I’m not mistaken, some ongoing investigations into other potential causes. But we are seeing a lot of these cases tied back to lettuce from a specific part of Mexico. So I think they have gotten the word out now, but just the confusion and the back-and-forth. And I think former FDA commissioner Scott Gottlieb got on CNBC and said he would have expected more communication from the FDA on this issue. But it’s kind of a tough one when it’s a voluntary recall, and there’s a company, and they’ve used some restrictions, you know, and what they’re supposed to be talking about publicly. But I think there has just been so much consumer confusion, and that’s not in anyone’s interest. 

Rovner: And as we said, this is not a simple thing to track. It’s not like E. coli; you can’t really find it. Liz, you and your colleagues reported, though, on, you know, Taylor Farms going straight to the White House to try and sort of go over the heads of the FDA on this. 

Whyte: Yeah, Bloomberg and The Wall Street Journal had stories with different pieces of this, and it was, you know, in our story, you could see that they were trying to distance themselves from the outbreak before they got named publicly, which is kind of this new wild West of lobbying that we’re in, where it makes a lot of sense for companies to go straight to the White House and skip over dealing with career officials. And what was interesting was that the way all that played out with the communications is Taylor was able to say, FDA apologized to us, made this like really confusing statement. And the FDA, maybe because it didn’t have the comms folks with experience, like Rachel was talking about, at the FDA with, you know, various layers of people who have done this before, you know, it took them till the next day to say: By the way, our epidemiology on this is really good. It’s definitely still Taylor Farms. We just, like, had that one false positive. It was crazy to me how, like, twisted and turned that got. 

Rovner: It was not well handled from a public communications standpoint, shall we say? All right. Well, one thing that we know that RFK Jr. thinks highly of are peptides; those are the amino acids that wellness influencers say can build muscle, heal injuries, and burn fat, among other things. Last week, an FDA advisory committee voted, over the objections of FDA’s own scientists — who say evidence on the benefits of peptides is either skimpy or nonexistent — to nonetheless make it easier for compounding pharmacies to make and sell products containing several different specific peptides. Now, this is not just a scientific disagreement. Several members of this advisory panel are actual sellers of this product, right? 

Whyte: Yeah, the panel was a bunch of members who either worked for companies that sell peptides or had a clinic that offers them. And the HHS said these people went through a conflict process. It doesn’t seem like it could have been as rigorous as the previous conflict processes that were in place. I haven’t seen a ton of reporting on that. But, you know, predictably they greenlighted most of the peptides that they looked at over and against the strong recommendations from FDA staff scientists who said we don’t have evidence that these are safe. Like, this is kind of unprecedented. The argument in favor was, well, you know, we do something similar with supplements. You know, Secretary Kennedy has said people should be free to try these out, and you know he wants to end the war on peptides. And meanwhile, scientists with a traditional background in looking at risk and benefits are saying the risks are there, the benefits are not proven, and this almost creates a different paradigm for how we’re looking at medical interventions now. 

Rovner: Yeah, and I think we’ve seen this across the FDA and across HHS. I mean, this is basically what they’re, you know, calling gold-standard science. That there’s a lot of people … go ahead, Rachel. 

Cohrs Zhang: I was just gonna say, and I’m … I think, looking forward, this creates a split decision, right, between the FDA scientists and the ag comm, and that’s gonna put the FDA in a tough position as to who what they’re going to choose because former commissioner Marty Makary loved to say he was siding with the career scientists, and now we have this forum to hear what they actually think, like, presented to the public. So I think that’s going to be a tough decision ahead, and that’ll tell us how things are working inside. 

Rovner: And of course, we only have an acting commissioner of FDA right now, so …  

Cohrs Zhang: Yes, with instructions to not make news. 

Rovner: Finally, this week, news on reproductive health — because there is always news on reproductive health. Shefali, we had a decision in one of the court cases challenging how the FDA regulates the abortion pill mifepristone, but it’s not the case that we’ve all been watching, right? 

Luthra: No, this was the Virginia case. And what it reminds us is that there’s actually a million different mifepristone cases because you have people looking for more restrictions on mifepristone, and you also have people looking for fewer restrictions on mifepristone. And a lot of the folks who provide the drug, the doctors and manufacturers, have argued that, in fact, there are more restrictions than are actually appropriate. That this is actually much safer, and it does not need to be so hard to get because, for all of the concerns from conservatives and abortion opponents, it actually is very difficult to prescribe and make mifepristone available without going through a lot of hoops of certification. And so we see, right, in some cases, like here, an effort to try and loosen those restrictions a bit and say this could be more available, especially, I mean, people when they have miscarriages, it is actually very hard to get mifepristone, even though it actually would be very beneficial for management. But I think what this does, practically, is again not much changes for now because we have so much going through so many courts in different ways. Realistically, I mean, access to the drug stays as what it is: available in some places, not available in others. And the big case that we’re all waiting for, the Louisiana one, that could possibly bring restrictions in, that very briefly did bring restrictions in mifepristone earlier this year — we’ll probably see more on that closer to the election. And that could be very interesting because, as we’ve talked about so many times, this is not really an issue the White House or a lot of Republicans, frankly, would like to be in the news, because they know that restrictions on abortion just remain so unpopular and continue to be for a long time. 

Rovner: And this is almost certainly heading for the Supreme Court, right? We now have a court, you know, a lower court saying that the Biden administration’s restrictions were too tight, and one assumes that coming out of Louisiana, we will have a decision that says that they’re not tight enough. 

Luthra: I would be stunned if the Supreme Court did not hear a mifepristone case in the coming few years. It just seems like we’ve been building in this direction for a very long time. You’re totally right. The split circuit looming makes that more likely. And I mean, realistically, if I supported abortion rights, if I wanted to make this pill more available, as the folks arguing against the Biden restrictions are, I don’t know that I would be thrilled about this being something before the Supreme Court because this is known to be a more conservative court. A lot of members who think abortion should be far less available than it is — this is the same court that overturned Roe v. Wade. And so I think there’s a real possibility that as we see more and more abortion decisions make their way to the Supreme Court, the restrictions we have become even more so, and where we are now becomes a baseline for making this even more difficult for people to obtain. 

Rovner: We will have to see. Meanwhile, our podcast pal Alice [Miranda] Ollstein has a co-bylined story at Politico this week about how anti-abortion groups are pulling out all the stops to try to show that the increased use of mifepristone is polluting the nation’s water supply. Now they have a study, commissioned by the group Students for Life, claiming that mifepristone is showing up in, quote, “significant levels” in waterways in Austin, Texas; Blacksburg, Virginia; and Carbondale, Illinois — all major college towns, not coincidentally. And while the science behind this remains questionable, the politics don’t, right? 

Luthra: Right. And this is a strategy they’ve been working on for quite some time, putting bills in state legislatures, talking to anyone who will listen about this, and saying, If we care about the environment, the left cares about the environment,why don’t we care about what they say is this mifepristone pollution in the water that they say is caused by medication abortions? And they want to use this argument as a different prong on the way to stop people from having mifepristone made available, of making medication abortions harder to obtain. We haven’t really seen this really yield fruit yet. However, this is part of, again, a longer-term strategy to lay groundwork. And studies like this, they create an intellectual groundwork as well. We saw that with the telehealth studies, the mifepristone safety and efficacy studies — and I perhaps should do “studies” in air quotes because a lot of mainstream researchers call these not very good science. But if you create a large-enough body to point to, then ultimately you can have people in positions of power say, “Well, we’ve looked at the evidence from all sides, and we see these real concerns, and we’re going to use them to inform policy.” I don’t know that that will happen anytime soon, but it’s certainly a goal that they’re building toward. 

Rovner: They’re talking points, basically. 

Luthra: Absolutely. 

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

Cohrs Zhang: Mine is from KFF Health News. The headline is “Trump Administration Demands Hospitals Share Emergency Room Records,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir. I think this is one installment, and that this broader arc of coverage that they have really owned — it’s so diffuse. There’s like states, and there’s providers, and there’s government officials involved, but I think it really illuminates kind of like where is the Trump administration looking for data? I think this is something that started during the DOGE era, where you had DOGE employees trying to get data from different government agencies. But you’re seeing it as, I think, we’ve talked about previously, like, there’s a desire for studies and, you know, things to move faster. Like, where are we looking for data? I think this whole arc of coverage has been really valuable in illuminating: Where are they looking. Is this precedented? Kind of how could these datasets be used? What are the patient potential issues? Are there privacy issues? Can this data be protected? That I think are going to be really important as we kind of look into the rest of this administration, because we’re only a year and a half in. Like, we got a ways to go. 

Rovner: And, oh I mean we say over many, many, many years it’s always been Republicans who have been, you know, very much into the federal government shouldn’t have its hands in people’s personal data, and yet here we have an administration that’s trying to get personal data from every single possible place. 

Cohrs Zhang: Right, it’s fascinating. And this just makes it so concrete. And I think it’s great accountability work, and they’ve clearly developed great sourcing on this. 

Rovner: Yeah. Liz. 

Whyte: Mine is a opinion piece in Stat by two doctors who are concerned about the burgeoning pediatric public health emergency, as they call it, about e-bikes and e-scooters. And I’ve been wondering about this for a long time because I see kids doing two, three kids on these scooters going so fast with no helmets. It’s always boggling my mind, but it’s apparently gotten really bad. They looked at data from 2020 to 2021 and saw an increase in injuries, up 71% in just one year — kid injuries with e-scooters and e-bikes. So that was 8,545 of those injuries in 2021. And the doctors discuss how, you know, these injury patterns that these kids get — I mean, they’re going up to like 28 mph — look very similar to when a child gets hit by a car. And that’s, it’s just real sad. So TBD on whether anybody does any kind of age-appropriate access standards or something like that that can help dial back these injuries. And then I guess I’m cheating Julie, but a shoutout to Lauren Weber’s great story, also in The Washington Post recently, about how peptide med spa clinics have less regulation at the state level than your local restaurant or hair salon. She contacted all 50 states, and I thought it was just a really good supplement to the peptide news that we saw recently. 

Rovner: It was, and … forgive me for not mentioning it, and we will link to that one too. But I’m so glad you did the e-bike thing because if you hadn’t done that, I was going to, because the number of kids just in my neighborhood, little kids on motorized vehicles, it’s like: Shouldn’t they have to have driver’s licenses to do this? Anyway. Shefali. 

Luthra: My piece is by Aaron Carroll. It is an op-ed in The Washington Post. The headline is: “The Problem With RFK Jr.’s Crusade Against Antidepressants.” And what he talks about, I think, is just so smart. It’s about how it actually would be great if we had better and more research on SSRIs. However, the point he makes is that the government is actually not really approaching this from that kind of vantage. And instead the idea is to try and just cut back access to SSRIs, rather than learn more about them, learn how to make them work better, if they are as effective as they want them to be. And the point that he gets at the end as well is that while it is really good and worthwhile to investigate and study how well SSRIs work, one thing that we are actually getting into, which is really problematic, is stigmatizing use of them. And he talks about why that’s actually not good, and that is not actually helpful when it comes to thinking about how to make treatment for depression better and better and better. And I love this framing because we should try and make medications better for people. We should always be looking at treatments we have and saying, yes, they work. But what if we made them work better and better? What if we had fewer side effects? What if we made them more effective? That would be awesome. And I really love that he is putting those questions out there in a way that is smart and productive and forward-looking. 

Rovner: And not partisan. This has never been partisan. This is just so …  it’s all so unprecedented. All right. My extra credit this week is from The Arkansas Times. It’s called “Postpartum Women Go Without Care as Arkansas Holds Out as Lone State To Deny Them Medicaid,” by Byron Tate. And it’s about exactly what the headline says. Since Congress gave states the option to extend Medicaid coverage to postpartum women for a full year after they give birth, 49 states have exercised that option — all but Arkansas, where that coverage still ends after 60 days. And Arkansas has one of the nation’s highest maternal mortality rates. So who’s against it? Apparently, the governor, Republican Sarah Huckabee Sanders, herself a mom. She says these women should be transitioning to other coverage, except apparently most of them are not. According to one study, 94% of those losing postpartum Medicaid are becoming uninsured instead. 

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, and on Bluesky @julierovner. Where are you folks hanging on socials these days? Rachel? 

Cohrs Zhang: I’m on X @rachelcohrs and also on LinkedIn. 

Rovner: Shefali. 

Luthra: On Bluesky @shefali. 

Rovner: Liz. 

Whyte: I am on X @l_e_whyte — with a “Y,” W-H-Y-T-E — and @lizessleywhyte.bsky. You can Google me. 

Rovner: I’m sure people can find you. All right, we’ll be back in your feed next week. Until then, be healthy. 

Credits Francis Ying 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.

Shirley Jennett, a retired nurse, loves her spacious ranch-style house in Denver, with its big backyard and gazebo.

“I want to stay here,” she vowed. “And die here.”

She might pull that off. In relatively good health, Jennett still drives to lunch with friends, does her own housekeeping and grocery shopping, and plows through a book a day, usually a mystery. But her children worry about her living alone at 89, especially after she has had a couple of falls.

Enter her new housemate, Susan Beese. Despite working four days a week in retail, Beese could no longer afford her nearby one-bedroom apartment as the rent topped $1,500 a month. She moved out, first staying with friends and then in what she delicately called “a senior women’s facility.”

Now Beese, who is 79, pays Jennett $800 monthly for a bright two-bedroom space, with a bath and a kitchen, on the lower level of her house. As part of the agreement the housemates worked out, she helps plant and water Jennett’s garden, takes out the trash, and cooks occasional meals.

“It’s been a lifesaver,” Beese said. Jennett even welcomed her dog.

Meet the real-life Golden Girls. In the much-loved 1980s sitcom, still in perpetual reruns, the four wisecracking women who share a house in Miami met through an ad on a supermarket bulletin board.

In Denver, the housing matchmaker was Sunshine Home Share Colorado, a local nonprofit that Alison Joucovsky, a senior services administrator, founded in 2016 when the problem became urgent. “My phone was ringing off the hook,” she said, recalling anxious pleas from older residents spending most of their Social Security checks on rising rent or facing years-long waiting lists for subsidized senior housing.

Home sharing “is a really efficient way to create affordable housing and to support older people who want to age in place,” Joucovsky said. Carefully vetting both “home providers,” who may be rattling around in family houses now too big and too empty, and “home sharers” seeking reasonable rents, Sunshine facilitated 31 shares last year, a record for the nonprofit.

“The cost of developing and building new housing is astronomical, and so is the length of time it takes,” said Laura Fanucchi, president of the National Shared Housing Resource Center and an administrator with HIP Housing, a home-share organization in San Mateo County, California. “Why not make use of existing housing stock?”

About 55 organizations around the country offer these services — and demand is growing, driven by housing shortages, rising rents, and sales prices that affect both the old and the young. Legislators in several states are working to promote home sharing as an option. (Personal care is not part of these arrangements.)

The need is acute. About a third of households headed by someone 65 or older were “cost-burdened” in 2024, according to an analysis by the Harvard Joint Center for Housing Studies. That means they spent more than 30% of their income on housing.

Although nearly 80% of those people were homeowners, the center found, an increasing proportion are still paying off mortgages or home equity loans, and most contend with higher taxes, utility and maintenance costs, and insurance premiums.

“A lot of the people calling me to complain about property taxes and inflation are senior citizens on fixed incomes whose children have left, and maybe their spouse has died,” said Pennsylvania state Rep. Abby Major, a Republican co-sponsor of a bill that would facilitate home sharing. “They’re a single older adult living in a four-bedroom house.”

Yet most don’t want to relocate. Even if they do, many older adults will find that downsizing has also become prohibitively expensive as home prices rise and very low interest rates become a memory.

Younger people are similarly cost-burdened, including 37% of those age 25 to 34 and 31% of those 35 to 44, the Joint Center has reported. Home sharing can benefit both older homeowners who need income and people of any age in search of lower-cost housing.

To help increase their reach, some home-share programs now supplement or replace the traditionally labor-intensive matching process with online platforms. (For-profit companies like Nesterly or roommates.com also facilitate shared housing.)

“It’s like online dating, except that people who have rooms can meet people who need rooms,” said Candice Smith, executive director of HomeShare Oregon. “And it’s a lot more secure.” HomeShare’s online platform has drawn close to 7,000 providers and seekers over five years.

Further support has come from the city of Portland, which this year announced a pilot program to pay $1,000 to homeowners who make a spare room available (or $1,500 for two rooms) through qualified home-share programs.

In addition, legislators in several states have introduced or passed bills that prohibit municipalities from unduly restricting homeowners who want to rent spare rooms to nonfamily members. Sponsors in Pennsylvania and Connecticut actually call them Golden Girls bills, and they’ve drawn bipartisan support.

“So many young people have basically given up on buying a home,” said Colorado state Rep. Manny Rutinel. The Democrat helped pass a 2024 law prohibiting cities and counties from limiting the number of unrelated people who could live together in a single dwelling.

In Pennsylvania, state Rep. Tarik Khan steered a similar bill through the House in June; it awaits a Senate vote. “It doesn’t make sense that your cousin can move in but someone unrelated to you can’t,” said Khan, a Democrat.

The Pennsylvania bill caps the number of nonfamily occupants in a home at five; Connecticut’s limit would be three. That bill passed the Senate in April and then died without a vote in the House. But the bill sponsors plan to reintroduce it next session.

Home sharing can’t solve the housing crisis, its fans acknowledge. But it could make a dent, potentially unlocking thousands of spare bedrooms across the country without requiring new construction that would change the character of neighborhoods.

Admittedly, matching homeowners with those who want to rent a room becomes a delicate process. Home-share staff members typically interview the individual parties, run background checks, verify incomes, coordinate initial phone calls and meetings, and mediate if problems later arise.

They also help applicants sift through the myriad lifestyle preferences that can torpedo a match. “Living together isn’t easy,” Fanucchi said. Will the home provider accept smokers, pets, visitors? Does the sharer work from home? Or need to park a car? Who sets the thermostat?

Sometimes the agreement includes a “service exchange,” in which the newcomer does a few hours of chores like snow shoveling, shopping, or some meal preparation in return for reduced rent.

Jenlyn and Larry Boyer, for instance, have lived in their ranch house in suburban Broomfield, Colorado, for 31 years and never want to leave. But Jenlyn, who is 80, has “gotten unsteady” and uses a walker. Her husband, 70, suffers chronic fibromyalgia pain and needs a wheelchair.

Because they now pay for tasks that they used to undertake themselves, and because inflation has undermined their finances, “I had an epiphany,” Jenlyn said. “We need more help and we need more money.”

Six months ago, through Sunshine Home Share, they met a 46-year-old graduate student whose monthly rent had doubled to an unmanageable $2,000.

The student moved into their furnished downstairs bedroom/family room with a bathroom, a small refrigerator, and a microwave. In exchange for about 10 hours of dishwashing a month, she pays a reduced rent of $600.

The additional income has helped the Boyers cover expenses like van repairs and wheelchair batteries. But they also enjoy chatting with their new housemate.

“She turns out to be just a gem,” Jenlyn said. “We laugh together a lot.”

The New Old Age is produced through a partnership with The New York Times.

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 is forging ahead with a controversial plan to collect the medical records of millions of federal workers and retirees, as well as their family members.

The Office of Personnel Management said in a notice posted last month that it will begin routinely collecting identifiable, personal health information on more than 8 million people — despite concerns from privacy advocates and Democrats, who have demanded the agency drop the plan. The notice will go into effect July 24, allowing OPM to begin its collection at any point afterward.

In reaction to privacy concerns raised by insurers and others, OPM now says the identities of enrollees will be “pseudonymized” — meaning names, addresses, and Social Security numbers will be removed — before the agency’s analysts review the massive new health datasets it will soon begin receiving.

Birth years of enrollees will be retained, and the agency’s “technical staff” will receive member IDs that it will scramble into different, unique numbers before releasing them to other staffers, according to the notice.

But the notice also specifies that OPM retains the right to reidentify the records.

Sixty-five insurance companies will be required to routinely send OPM detailed data — including names, addresses, doctor information, diagnoses, prescriptions filled, and payment details — on health care services paid through the Federal Employees Health Benefits and Postal Service Health Benefits programs.

In a change to its original proposal, first reported by KFF Health News, the agency says it also wants to peek at records kept by Medicare, the federally funded health insurance for older and disabled Americans, to examine claims from federal employees and retirees, and their families, who depend on both programs.

In its latest notice, OPM argues that the vast trove of data is necessary to ferret out fraud and overpayments in the FEHB and PSHB programs. Those programs cost roughly $80 billion a year, with about $50 billion covered by the federal government and $30 billion funded by enrollees. The Trump administration has ramped up efforts, led by Vice President JD Vance, to curtail what it says is rampant fraud and misuse of publicly funded health benefits.

The effort still faces criticism that it doesn’t go far enough to protect the privacy of federal workers and their families.

“Clearly, this administration has not earned our trust with Americans’ sensitive data,” Sen. Mark Warner (D-Va.) said in an emailed statement to KFF Health News. “If OPM wants to work in good faith to reduce fraud, they should come to Congress, including to folks like me who are engaged on this issue and represent many federal workers and retirees and their families, and work to build consensus and trust before implementing these sweeping changes.”

The original notice, posted in December, sparked concerns in part because it did not specify what the Trump administration planned to do with the sensitive health information it receives — and did not instruct insurers to redact identifying information.

OPM General Counsel Kurt Dykstra said the detailed records are critical to the administration’s mission of rooting out fraud and could help identify fraud perpetrated not only by medical providers but also by enrollees.

But when pressed for instances of workers, retirees, or their relatives committing such fraud, Dykstra only noted generally that healthcare fraud does occur.

The information could demonstrate “potential anomalies in usage patterns that could be related to the individual, but really also could be related to the provider, the treater, the clinic — whoever it is that’s actually providing the care,” Dykstra told KFF Health News in an interview.

Records deemed suspicious by OPM’s data analysts could then be referred to the agency’s Office of the Inspector General for further investigation, which could include “determining who’s involved and what the potential issues are, what the ramifications look like,” Dykstra said.

OPM’s plan to collect and analyze medical records has prompted unease among unions and federal workers, who have been subjected to mass firings and layoffs — in some cases, they say, driven by political retribution — since President Donald Trump took office.

Health privacy lawyers say, too, that while pseudonymizing workers’ details is a step in the right direction, it might not go far enough to protect their privacy.

OPM’s notice mostly complies with the Health Insurance Portability and Accountability Act, the federal law commonly called HIPAA that protects sensitive health data from being shared, said Matt Fisher, a health privacy lawyer. But he noted one exception: The member ID that insurers provide enrollees can be used to identify them.

“The described process arguably comes down to trusting internal controls in OPM to ensure that data is walled off as proposed,” Fisher said in an email. “The ideal would be for only truly de-identified information to be shared in the first place.”

Insurers regularly share information about claims with employers who offer health plans to employees, in efforts to control costs. But since employers themselves are not covered by HIPAA, large datasets are typically de-identified, meaning the insurers remove identifying information such as employees’ names or addresses, to comply with the law.

Employers, too, have been accused of using health information to target employees for dismissals. Most recently, a group of Meta employees filed a lawsuit accusing the tech giant of using artificial intelligence to target for layoffs those who had taken medical or family leave.

Pseudonymizing details such as names or addresses would go only so far to protect privacy, since medical conditions in particular can make it very easy to identify certain employees, said Joseph Lorenzo Hall, a technologist at the Center for Democracy & Technology, a nonprofit that advocates for data privacy.

“The richer the data, the more likely it is going to be identifying,” Hall said.

“In this case, you may be the only person in a region that has that particular kind of medical procedure, condition, or even prescription,” he said. “All of those things can be extremely identifying, even when you remove or obfuscate or pseudonymize direct identifiers.”

Most federal retirees decide to continue with FEHB plans and enroll in Medicare once they turn 65, which provides more comprehensive coverage and allows family members to remain enrolled in FEHB plans, said John Hatton, the staff vice president for policy and programs at the National Active and Retired Federal Employees Association.

OPM wants to analyze medical records for those dual enrollees as well. The agency is asking for all of their cost and service use records from the Centers for Medicare & Medicaid Services.

Still, Hatton said, OPM’s latest notice provides more details about how the agency says it will use the sensitive health information it receives and safeguard it.

“It’s a big improvement over the last notice, which was very lacking in detail and explanation for why they wanted all the medical claims data and how they’re going to protect the privacy of the data,” Hatton said.

“We’d be open to seeing even more security around the privacy of the data so there really is a clear wall,” he added.

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.

Kelly Haggett figures that a mandatory surcharge added to Washington state’s payroll tax cost her about $500 last year. But she doesn’t really mind.

“On a scale of 1 to 10 of my annoyance with taxes in general, this one is about a 2,” she said. “I see the benefits.”

The small surcharge on wages provides the funding for Washington Cares, the nation’s first state-operated program for long-term care insurance. It was set to begin distributing benefits July 1.

If Haggett, 67, a systems administrator who lives in Auburn, Washington, needs help with daily activities as she ages — bathing, dressing, grocery shopping, managing medications — she’ll be able to use the benefit she has accrued through WA Cares, as the program is known.

About 3.7 million workers participated last year, paying an additional 0.58% in payroll taxes. Those who contribute for 10 years will qualify for a lifetime benefit of $36,500. The amount will rise with inflation: A 36-year-old now earning about $50,000 a year who contributes $291 a year for a decade will have a projected $98,000 benefit if she needs assistance at age 75.

Both the WA Cares mandatory premiums and eventual benefits are modest. But for older adults and people with disabilities, they can help pay for a variety of services: home care, transportation, adult day programs, home modifications like ramps and grab bars, compensation for family members who assist them, or assisted living facilities and nursing homes.

Haggett had looked into private long-term care insurance to cover those needs, but she balked. “It’s crazy expensive,” she said. And since premiums can rise, and frequently have, “you’re basically saying, I’ll pay whatever, whenever.”

Haggett knows that WA Cares can’t cover all her long-term care costs. In fact, because she was already in her 60s when payroll deductions began in 2023, and because she is planning to retire in two years, she’ll receive only half the lifetime benefit.

But “if I required care and it would protect my wife from having to spend our savings, $18,250 is not meaningless,” she said.

Washington has been working toward implementing WA Cares for a decade; the program has survived two statewide votes aimed at overturning or weakening it. Now, other states will be paying attention.

‘Most People Have Nothing’

An estimated 70% of Americans will need long-term care at some point in their lives, but “they haven’t planned for it or saved for it,” said Cathleen MacCaul, advocacy director for AARP Washington State, which supported the legislation that created WA Cares.

“People are under the misconception that Medicare will pay for this,” MacCaul said. In fact, while Medicare pays for healthcare, it rarely covers long-term care, either at home or in facilities.

Medicaid does cover long-term care, but it involves such strict limits on income and assets that “most middle-class people are left out, or they have to impoverish themselves” by spending nearly all their assets to qualify, said Richard Frank, director of the Center on Health Policy at the Brookings Institution. Those who are eligible often face lengthy waiting lists for care at home.

“Long-term care is the largest area of unprotected health risk in the United States,” Frank said. “Most people have nothing.”

Previous efforts to establish public long-term care protections have foundered. In 2010, the Affordable Care Act included the CLASS Act, a legacy of Sen. Ted Kennedy that would have created a voluntary long-term care insurance program. The Obama administration eventually deemed it unworkable, and “it never saw the light of day,” Frank said.

The private market has also contracted. Most of the largest companies selling long-term care insurance — Genworth, John Hancock, MetLife — have exited the market. The return on their investments plummeted when interest rates fell after the Great Recession, and the number of insured people who abandoned their policies — a profitable development for insurers — was far below projections.

“The psychology of the industry was: Holy smokes, we’re losing money! We’re getting out,” said Claude Thau, who directs the annual Milliman Long-Term Care Insurance Survey. As the losses mounted and premiums spiked, consumers such as Haggett stopped buying policies. Moreover, Thau estimated, 1 in 6 applicants are unable to get coverage for health reasons.

Thus, fewer than 35,000 Americans bought stand-alone policies in 2024, compared with about 235,000 in 2010, according to a report from LIMRA, a trade association. The average 60-year-old purchaser would, at age 80, receive a projected maximum benefit of $369 a day, Milliman reported. But the average annual premium on new stand-alone policies in 2024 — $3,265 — can seem daunting to someone close to retirement.

As the purchase of stand-alone policies has dropped, insurance companies have turned to policies bundling some long-term care benefits with life insurance or annuities. Those sales figures are climbing. Still, the association notes, only 3% of Americans age 50 or older have any long-term care insurance.

‘A Five-Alarm Fire’

That has prompted a recent spate of proposals to find public ways to protect Americans from ruinous costs that can continue for years. “This is a five-alarm fire,” said a letter sent in May by U.S. Sen. Ron Wyden of Oregon and 16 fellow Senate Democrats to their colleagues.

The letter, more a statement of purpose than a specific legislative plan, proposed a “home care guarantee” for Medicare beneficiaries, among other efforts. Proponents expect to issue a more detailed report in the fall and to introduce a bill early next year.

A Brookings report also proposed providing subsidized long-term care at home through Medicare, with beneficiaries making contributions according to their ability to pay. Like most of these programs, it would kick in when people need help with activities related to daily living or require supervision because of cognitive decline. The authors estimate that 8.2 million Americans will be eligible, far more than those who qualify for home-based care under Medicaid.

In the House, Rep. Tom Suozzi, a Democrat from New York, and Rep. John Moolenaar, a Republican from Michigan, have introduced legislation to create a catastrophic-insurance program for older people with disabilities. It would require them to pay for care out-of-pocket or with private insurance for the first several years before they would receive a monthly federal benefit.

Enacting federal initiatives in the current political climate seems unlikely, proponents acknowledge. The Trump administration’s plan to cut billions of dollars from Medicaid “has moved the needle backward on the accessibility of long-term care,” said Taylor Harvey, a spokesperson for the Senate Finance Committee.

So other states “are looking at what Washington is doing with a lot of interest,” said Norma Coe, who is an economist at the University of Pennsylvania and is tracking long-term care programs. Legislators have introduced bills in Illinois, Hawai‘i, and West Virginia; other states have task forces studying the issue.

“Long-term care is one of those conversations around every dinner table,” said Bea Rector, assistant secretary for the Department of Social and Health Services’ Home and Community Living Administration.

“Families step in,” she explained. Sometimes they can continue providing care, “but sometimes more formal care has to be put in place. That’s when people see the value of programs like this.”

Steven Russakoff knows the challenges of elder care, having provided years of support for his father, who died two years ago, and for his mother, who is now living in a nursing facility. “It’s brutal, it’s exhausting, and it’s extraordinarily expensive,” he said. The family has liquidated virtually all his parents’ assets to pay for their care.

Russakoff, who is 56 and lives in Shoreline, Washington, initially disliked WA Cares. He could handle the additional deductions (about $250 a year) from his paycheck as a director of university dining services, but he felt forced into a program he couldn’t use if he left the state to retire.

But WA Cares has already been amended several times and has become portable for many participants who move away, making him a convert. “It’s a good idea,” Russakoff concluded. “A necessary evil.”

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 <a target="_blank" href="https://kffhealthnews.org/syndicate/long-term-care-costs-washington-state-payroll-option/">article</a&gt; first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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Seasonal work. Inconsistent hours. Frequent moves. Cash payments and informal jobs. For farmworkers who rely on Medicaid, these common employment patterns could put their health coverage at risk.

It’s a heightened concern for the estimated million-plus farmworkers who are U.S. citizens or legal permanent residents, as new work requirements kick in for the federal-state healthcare program that serves low-income and disabled Americans.

Starting next year in most states, many adults enrolled in Medicaid will have to prove they work, are enrolled in college or vocational courses, volunteer, or do unpaid work for at least 80 hours a month.

Advocates say this could pose a significant challenge to Medicaid-eligible farmworkers, who frequently work more than 80 hours a month during harvest season but less in other months. What’s more, outside the harvest season, many workers take on informal jobs in construction, landscaping, or home repair for which they don’t receive formal paychecks that would prove their continuing Medicaid eligibility. Still, they can establish eligibility if they prove their average monthly income over six months is equivalent to at least 80 hours of work at the federal minimum wage.

“Having a work requirement — having to create more paperwork and more proof — is certainly extremely challenging for farmworkers and others who are low-income and who may especially have seasonal jobs, not year-round, and do have periods” when there is no work available, said Alexis Guild, vice president of strategy and programs at Farmworker Justice.

New Requirements, Additional Hurdles

Agriculture is a trillion-dollar industry, and Americans depend on an estimated 2.9 million farmworkers to put food on their tables. Nearly 60% of those workers are U.S. citizens or green-card holders, according to the U.S. Department of Agriculture. The remaining 40% lack legal status or are otherwise ineligible for Medicaid.

Even among farmworkers with citizenship or legal status, the uninsured rate is three times that of the general population, and most farmworkers with insurance are Medicaid beneficiaries, although participation rates vary by state. According to a new analysis, 71%-79% of eligible farmworker households report participation in Medicaid.

The new Medicaid work requirements were a key provision of the One Big Beautiful Bill Act signed last July by President Donald Trump. Under the federal law, 43 states and the District of Columbia must implement the requirements by Jan. 1. A few states have moved to implement the work rule early.

The 80-hour rule applies in states that expanded Medicaid, a process that began in 2014 and was tied to the Affordable Care Act. Following the initial expansions, agricultural workers with legal documentation became 24% more likely to have health insurance, according to a 2021 article in the American Journal of Agricultural Economics.

Immigration Anxieties

The work requirements are the latest in a long list of obstacles placed between workers and the healthcare they’re legally entitled to, Guild said. “Medicaid certainly helps because it alleviates the cost issue,” she said. “But there are still other barriers, such as transportation, taking sick leave, and finding time to visit a health center. All these factors can prevent them from actually receiving medical care.”

For farmworkers with green cards and naturalized U.S. citizens, there is another source of stress: the fear that signing up for Medicaid could put personal information in the hands of immigration authorities.

That’s what worries Luis, a 45-year-old green-card holder and Medicaid recipient who dreams of becoming a U.S. citizen. Luis — who asked to be identified by only his middle name — lives with his wife and daughter in North Carolina, where he has worked in agriculture for nearly a decade.

Speaking in Spanish, he said that when he learned about the work requirements, he knew it would be challenging for him to prove that he works 80 hours a month. “I only work on farms for six or seven months; the rest of the year I work in whatever I can find,” he said.

Republicans in Congress argue that work requirements will reduce federal healthcare spending, encourage nondisabled adults to enter the workforce, and preserve safety net resources for the most vulnerable populations.

Among Hispanic adults enrolled in Medicaid, 67% are already working, according to a 2025 KFF report.

The Centers for Medicare & Medicaid Services did not respond to requests for comment for this article. But in June, when CMS announced its “nationwide framework” to implement the Medicaid work requirements, Administrator Mehmet Oz said it would help beneficiaries “build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families.” Federal officials say the new requirements “could reduce poverty by as much as 2.9 million people.”

Chronic Illness

Agricultural work is one of the nation’s most dangerous occupations, and it is associated with long-term health impacts and high rates of chronic illness, including respiratory conditions. A 2021-22 California survey found that 37% of male farmworkers and 47% of female farmworkers in the state had at least one chronic health condition. The new work requirements present one more barrier for those seeking care, advocates said.

“People skip checkups and screenings, and conditions that could be caught early and treated cost-effectively” aren’t, said Adriana Cadena, executive director of Protecting Immigrant Families.

Emergency rooms often become the “natural” place to go for healthcare, Cadena added. “This drives up waiting times and costs for all of us. … And when people are sick enough that they miss work, it starts a vicious cycle of lost productivity and family economic instability that again threatens all of us.”

A Loss for Families and Children

The new federal rules also require beneficiaries to verify their eligibility at least twice a year, twice as often as previously, creating another potential obstacle.

“Letters can easily be missed, and forms may go unfilled. If people get caught up in the paperwork, they could lose coverage,” said Akeiisa Coleman, an assistant vice president at The Commonwealth Fund, a nonprofit that promotes an equitable healthcare system.

For farmworkers who travel from state to state, the process can be especially difficult.

“You have to find the time to transfer your coverage and probably find a person or organization that can help you — and that can be really hard when you’re constantly moving,” Cadena said.

The situation highlights the difficulties of navigating a complex system for individuals and families already struggling to make ends meet.

“The result,” Cadena said, “could be the loss of coverage not only for workers, but also for their families and children.”

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 <a target="_blank" href="https://kffhealthnews.org/insurance/agricultural-workers-medicaid-eligibility-immigration-food-harvest/">article</a&gt; first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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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.

As health costs rise and insurance coverage falls, Democrats appear to be doubling down on the healthcare issue as they press their case to take control of Congress in November’s midterm elections.

Meanwhile, on Capitol Hill, Republicans — and some Democrats — are taking aim at nonprofit hospitals and whether they are delivering enough “community benefit” to justify not having to pay taxes.

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

Panelists Shefali Luthra The 19th @shefali.bsky.social Read Shefali's stories. Victoria Knight Bloomberg Government @victoriaregisk Rachel Roubein The Washington Post @rachel_roubein Read Rachel's stories.

Among the takeaways from this week’s episode:

• Insurers say they’re expecting to hike premiums even more next year as Affordable Care Act plan enrollment continues to drop. The current decline comes after Congress allowed enhanced ACA subsidies to expire, with many Americans publicly saying they can no longer afford coverage — even as the Trump administration attributes the enrollment drop to a crackdown on fraud.
• Meanwhile, President Donald Trump has seized on the idea that medical providers should have end-of-life conversations with patients, even suggesting penalizing hospitals for not doing so. In 2009, a similar proposal in the ACA debate prompted the GOP to coin the term “death panels.”
• As the midterms approach, a top Senate Democrat has teed up a proposal to cap out-of-pocket costs in traditional Medicare, an idea that could gain even more traction should Democrats reclaim the Senate. Plus, lawmakers are proposing closer scrutiny of nonprofit hospitals, with a new bill proposing the collection of more information on their finances.
• Also, the GOP’s one-year ban on Medicaid funding for Planned Parenthood ended over the weekend, with little appetite in Congress for renewal. And separate pilot programs in Utah and traditional Medicare are testing the use of artificial intelligence in meting out healthcare.

Also this week, Rovner interviews KFF Health News’ Samantha Liss, who wrote the latest “Bill of the Month” report, about a Medicare Advantage patient who changed plans and got a lot of trouble in return. If you have a medical bill that’s confusing, infuriating, or inscrutable, you can share it with us here.

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

Julie Rovner: Axios’ “Chinese Fentanyl Makers Find New U.S. Market in Peptides,” by Tina Reed.  

Shefali Luthra: Stat’s “Online GLP-1 Prescriptions Are Often Fast, Easy — And Low on Clinical Oversight,” by Katie Palmer.  

Rachel Roubein: The New York Times’ “Efforts To Help Smokers Quit Stall Under Trump,” by Chistina Jewett.  

Victoria Knight: Stat’s “Booze Schmooze: The Alcohol Industry, Frazzled by Headwinds, Wields Its Power Behind the Scenes,” by Isabella Cueto and Lev Facher.  

Also mentioned in this week’s podcast:

• Stat’s “America’s Small Businesses Are Giving Up on Health Insurance,” by Bob Herman.
• KFF Health News’ “Medicare’s AI Push Snarls Patients and Doctors in Errors and Delays,” by Darius Tahir.  

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

Click here to find all our podcasts.

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

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

This <a target="_blank" href="https://kffhealthnews.org/podcast/what-the-health-454-democrats-midterms-nonprofit-hospitals-july-9-2026/">article</a&gt; first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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By the time Derion Blackman collapsed in front of a Dollar General in Kissimmee, Florida, in March, he had been waiting two months to regain access to some of the vital medications he’d been taking since undergoing a heart transplant two years ago.

“He was on a nasty, dirty ground in front of a store,” recalled Sonja Smith, who is enraged about the circumstances that led to her husband’s heart failure. “He didn’t deserve to die like that.”

Problems started last year when the couple learned the monthly premium payment for their Federal Employees Health Benefits plan would more than double to $307 and their deductible would also go up. They decided to switch Blackman’s primary coverage to CHAMPVA, a health benefits program for dependents of disabled veterans, which had no premium and a $3,000 deductible.

Smith thought she and Blackman had carefully prepared so that the transition between health plans would be seamless. It was anything but.

After the new health plan became active in January, Smith said, Blackman faced one hurdle after another getting approval for the antirejection medications needed to prevent his body from attacking his transplanted heart. Patients who rely on these drugs can develop severe and life-threatening heart issues if they miss even a few days. She said Blackman had enough medication to last only about a month into the new plan year. He told her just before his death that he had run out.

“I screamed at CHAMPVA. I screamed at the Trump administration. I screamed at the overall healthcare system in this godforsaken country,” she said. “Everybody played a part in what happened to my husband.”

Derion Blackman pictured with his wife, Sonja Smith. Blackman died from heart failure after waiting two months for his new insurer to approve the expensive medications he had needed to take daily since undergoing a heart transplant two years ago. (Sonja Smith)

The Department of Veterans Affairs declined to comment on the record about Blackman’s case.

While the couple’s situation was extreme, their challenge of trying to continue a treatment is faced by many who shop for cheaper options as health insurance costs have soared across the country. The United States already has a fragmented health system, in which insurers, clinicians, and drugmakers are largely left on their own to hash out the cost of each medication or service. That lack of standardization leads to layers of bureaucracy for patients; moving to a new plan can ensnare patients in a thicket of red tape, keeping them from care.

Making matters more challenging, Congress didn’t renew covid pandemic-era subsidies that helped lower premiums for Affordable Care Act marketplace plans before this year. The Trump administration is also adding hurdles for people to access Medicaid, a state-federal health insurance program for Americans with low incomes or disabilities, so more people may lose their current coverage.

“We’ve basically set up a series of cracks in our healthcare system that we ask people to jump over,” said Adrianna McIntyre, an assistant professor of health policy at the Harvard T.H. Chan School of Public Health. “But if you don’t jump over those cracks, you can lose coverage, or lose access to your doctor, or lose access to your medications.”

‘This Is a Lot’

Insurers calibrate plan prices by negotiating rates with individual clinicians, hospital systems, and drugmakers, leading to varying levels of coverage. Plans with lower monthly costs often have narrower networks of doctors and hospitals, and less generous drug coverage.

As a result, when patients choose an insurer — or even a new plan with the same insurer — they may lose access to medications or doctors that they have had for years, said Sabrina Corlette, a research professor in health policy at Georgetown University. There are so many ways “patients could get tripped up,” she said. “When you switch to a new insurance company, they’re going to apply their rules.”

In a pledge announced by the Trump administration last year, many insurers voluntarily agreed to reduce some red tape by honoring existing prior authorizations for 90 days when a patient switches health plans. As required by law, they also offer resources such as plain-language plan descriptions and searchable online clinician directories to help patients coordinate care, according to AHIP, the main health insurance industry trade group.

“The goal is to ensure every member understands their benefits and can access the care they need without interruption,” said Conner Coles, an AHIP spokesperson.

But patients say understanding their benefits can still be a challenge.

Monique Acosta, 54, had to navigate two health insurance changes after she was laid off from her job at a disability nonprofit in October. The heart transplant recipient and cancer survivor said she paid nearly $900 a month to continue her employer coverage under COBRA, the Consolidated Omnibus Budget Reconciliation Act. Then, in January, the Woodbridge, Virginia, resident switched to Medicaid.

During the transitions, Acosta said, she lost coverage for a postchemotherapy drug. So, she changed her care team to qualify for lower-cost medications through a local hospital’s charity program. Then one of her new doctors reduced the frequency of an injection she had gotten for years. During that time, she said, her red and white blood cell counts plummeted and she struggled to recover from a heart catheterization procedure.

Eventually, her new physician upped the frequency of her injections back to twice a month. “He needed to document it so he could see it himself,” Acosta said. “I was very, very fatigued, very weak, and it’s unnecessarily so.”

Acosta said she is putting off a mammogram until she can better understand her Medicaid plan or find a job with better benefits. “This is overwhelming,” she said. “This is a lot.”

Burden on the Patient

Federal regulations, 43 states, and Washington, D.C., have continuity of care protections that require health plans to continue covering doctors and drugs when there is a network change, like when a clinician or hospital that a patient goes to is terminated from the insurer’s network of providers.

But Corlette said that not all the protections address the trip wires people face when they switch insurers on their own, such as during open enrollment or after a major life change.

Still, people can be proactive in a few ways about maintaining care when they change plans, said Shelli Quenga, an insurance agent in South Carolina.

She advises patients to keep written records of their medical and drug history for new providers. Quenga tells her customers to get their new insurance information to their doctors as soon as they switch, not to wait until an appointment. In addition, she said patients can request a case manager with their insurer so they don’t have to repeat their concerns to different staffers.

Even when a patient does homework, doctors can drop out of a network and insurers can change the contours of their plans, McIntyre said.

“Nobody has an incentive to make it make sense,” she said. “This puts a lot of burden on the patient.”

They Switched to a Lower-Cost Plan. Then the Bureaucracy Battle Began.

Sonja Smith, 50 
Kissimmee, Florida 

Sonja Smith and her husband, Derion Blackman, switched insurers last year when the premium payments for their previous plan were set to more than double. The couple planned to make the transition seamless. But after the new health plan became active in January, Smith said, Blackman faced one hurdle after another getting approval for the antirejection medications needed to prevent his body from attacking his transplanted heart. In mid-March, Blackman collapsed and died.  

“I screamed at the overall healthcare system in this godforsaken country,” Smith said. “Everybody played a part in what happened to my husband.” — Renuka Rayasam 

The cost-sharing program Blackman was part of, which has about 1 million enrollees, doesn’t work like traditional insurance. It has no networks or third-party appeals process, according to Caira Benson, a staffer at Code of Support Foundation, an organization that supports veterans. Instead, the program covers part of a patient’s cost of care.

Blackman qualified for the program because Smith was declared permanently disabled due to physical and mental injuries she sustained following an assault on an Air Force base during her service. CHAMPVA was Blackman’s secondary insurance previously.

One of his medications was about $800 a month, more than half his disability check. Knowing that these heart medications were crucial, Smith said, the couple in November called CHAMPVA, which she said confirmed it would cover the drugs. But they still got caught in red tape.

CHAMPVA had Blackman’s previous insurance listed as his primary, even though he had canceled that plan. That took six weeks to resolve. Some but not all of his medications came, because the health plan said his provider needed to clarify his prescriptions.

“Now I’m left here trying to piece together all the things that happened,” Smith said.

And she is full of regrets, too.

“I would have kissed him one more time before he walked out the door,” she said through sobs. “I feel so cheated.”

KFF Health News South Carolina correspondent Lauren Sausser contributed to this report.

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact KFF Health News and share your story.

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

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