The Host Julie Rovner KFF Health News @jrovner 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.

Congress returns from spring break next week and will get to work crafting a bill that would cut taxes and boost immigration enforcement — but that also could cut at least $880 billion over the next decade from a pool of funding that includes Medicaid. Some Republicans, however, are starting to question the political wisdom of making such large cuts to a program that provides health coverage to so many of their constituents.

Meanwhile, the Supreme Court heard arguments in a case challenging the requirement that most private insurance cover certain preventive services with no out-of-pocket cost for patients.

This week’s panelists are Julie Rovner of KFF Health News, Sarah Karlin-Smith of the Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.

Panelists Sarah Karlin-Smith Pink Sheet @SarahKarlin Read Sarah's stories. Tami Luhby CNN @Luhby Read Tami's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories.

Among the takeaways from this week’s episode:

• On the hunt for ways to pay for an extension of President Donald Trump’s tax cuts, many congressional Republicans are choosing their words carefully as they describe potential cuts to Medicaid — cuts that, considering heavy reliance on the program, especially in red states, could be politically unpopular.
• Amid the buzz over Medicaid cuts, another federal program that helps millions of Americans afford health care is also on the chopping block: the enhanced government subsidies introduced under the Biden administration that help pay premiums for Affordable Care Act plans. The subsidies expire at the end of this year, and Congress has yet to address extending them.
• One little-discussed option for achieving deep government spending cuts is Medicare Advantage, the private alternative to traditional Medicare that offers a variety of extra benefits for those over 65 — but that also costs the federal government a bundle. Even Mehmet Oz, the new head of the Centers for Medicare & Medicaid Services who once pushed Medicare Advantage plans as a TV personality, has cast sidelong glances at private insurers over how much they charge the government.
• And the Supreme Court heard oral arguments this week in a case that challenges the U.S. Preventive Services Task Force and could hold major implications for preventive care coverage nationwide. The justices’ questioning suggests the court could side with the government and preserve the task force’s authority — though that decision would also give more power over preventive care to Robert F. Kennedy Jr., the health and human services secretary.

Also this week, Rovner interviews KFF Health News’ Rae Ellen Bichell about her story on how care for transgender minors is changing in Colorado.

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

Julie Rovner: MedPage Today’s “Medical Journals Get Letters From DOJ,” by Kristina Fiore.

Sarah Karlin-Smith: The Tampa Bay Times’ “Countering DeSantis, $10M Hope Florida Donation Came From Medicaid, Draft Shows,” by Alexandra Glorioso and Lawrence Mower.

Tami Luhby: Stat’s “In Ireland, a Global Hub for the Pharma Industry, Trump Tariffs Are a Source of Deep Worry,” by Andrew Joseph.

Alice Miranda Ollstein: The New York Times’ “A Scientist Is Paid to Study Maple Syrup. He’s Also Paid to Promote It,” by Will Evans, Ellen Gabler, and Anjali Tsui.

Also mentioned in this week’s podcast:

• Stat’s “New England Journal of Medicine Gets Swept Up in U.S. Attorney Inquiry Into Alleged Bias,” by Anil Oza.
• KFF’s “KFF Tracking Poll on Health Information and Trust: The Public’s Views on Measles Outbreaks and Misinformation,” by Alex Montero, Grace Sparks, Julian Montalvo III, Ashley Kirzinger, and Liz Hamel.
• Bloomberg News’ “Food Industry Says There’s No Agreement With US Health Agency to Cut Dyes,” by Rachel Cohrs Zhang.
• Politico’s “RFK Jr. Eyes Reversing CDC’s Covid-19 Vaccine Recommendation for Children,” by Adam Cancryn.
• The New Yorker’s “The Cost of Defunding Harvard,” by Atul Gawande.
• The Wall Street Journal’s “Trump’s FDA Sends a Bullish Signal to Biotech,” by David Wainer

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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

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

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

Overcome by worries, Lynette Isbell dialed a mental health hotline in April 2022. She wanted to talk to someone about her midlife troubles: divorce, an empty nest, and the demands of caring for aging parents with dementia.

“I did not want to keep burdening my family and friends with my problems,” Isbell said.

But she didn’t find the sympathetic ear she was hoping for on the other end. Frustrated, she hung up. Little did she know ending that call would set off events she would regret.

Police arrived at her home in Terre Haute, Indiana, handcuffed her, and had her committed to a hospital, records show, resulting in more than $12,000 in hospital charges.

“The whole thing was an absolute, utter, traumatic nightmare,” she said.

Isbell’s call for help represented the need for a new approach to crisis calls just as the nation was readying to flip the switch to a revamped response system for mental health. Using just three digits — 988 — people could call or text for help from anywhere at any time starting in July 2022. Federal officials viewed the launch of 988 “as the linchpin” to reenvision the mental health crisis system. The idea was to reduce the reliance on police and the burden on emergency rooms, while eliminating the stigma of seeking help.

But recent federal funding and staffing cuts undermine the future of the 988 program and threaten to erase progress made in Indiana and elsewhere, mental health advocates said.

The Trump administration cut staffing at the Substance Abuse and Mental Health Services Administration, the federal office that oversees 988, in recent weeks. It also ended $1 billion of its grants that a number of states relied on this year to help fund their 988 systems, said Stephanie Pasternak, state affairs director of the National Alliance on Mental Illness. While a judge temporarily paused grant cuts for 23 states that contested them, the trims to other states — including Indiana — have moved forward.

Between the SAMHSA cuts and potential reductions to Medicaid, another crucial funding stream for these services, Pasternak and others are concerned about what this means for 988’s future.

Any disruption to federal funding streams is “gravely impactful,” said Zoe Frantz, CEO of the Indiana Council of Community Mental Health Centers. “We have put a lot of time, talent, and treasure — from the state to providers — in trying to build the system,” Frantz said. “We can’t go back.”

After Isbell hung up her call, a member of the Suicide Prevention Hotline, the crisis line formerly available, phoned the Vigo County Sheriff’s Office and told a dispatcher Isbell was “thinking of committing suicide,” according to the sheriff’s report obtained by KFF Health News.

Years later, Isbell maintains she never said this. “I’ve never been actively suicidal.”

But two officers drove to Isbell’s home.

When they arrived, Isbell was sitting on her back porch on a sunny day with trees just starting to bud. The officer’s report alleged she admitted to thinking about driving her car into a tree, wanting doctor-assisted suicide, and fantasizing about a semitruck hitting her.

She contends active suicidal ideation with a plan is different than the overwhelmed feelings she had that day.

“It was like a childhood game of telephone, only not at all funny,” she said. What she said became distorted and left her no recourse.

The officers walked her to a squad car, where they handcuffed her before transporting her to Terre Haute Regional Hospital, according to dashcam video obtained from a public records request. Neighbors watched as she was taken away.

“I don’t know why I needed to be handcuffed,” she said. “It was demoralizing.”

The Vigo County Sheriff’s Office did not respond to requests for comment about Isbell’s case.

Isbell said being hospitalized against her wishes humiliated her and forced her to battle confusing medical bills for months. An itemized bill shows the hospital charged $12,772 for her overnight stay. After insurance, Isbell was on the hook for roughly $2,800. By comparison, a one-night stay in the presidential suite at the new Terre Haute Casino Resort is $2,471. Terre Haute Regional Hospital spokesperson Ann Marie Foote said Isbell’s bill was “discounted down” to $1,400.

“Our highest priority is always the safety and well-being of patients,” Foote said.

According to Isbell’s medical records, doctors there said “she was very stressed” and “just wanted to speak to someone” and reiterated “she was not suicidal.” They said her anxiety “is increased and made worse by being in here.”

She had “anxiety” and a “depressed mood,” and, according to medical records signed by a psychiatrist there, “she does not meet current criteria for involuntary hospitalization.” She was discharged the next day.

Upset by how she was treated, she contacted 988, the sheriff’s office, and the hospital.

In response to KFF Health News’ questions about Isbell’s experience, Michele Holtkamp, a spokesperson at the time for Indiana’s Family and Social Services Administration, said that before the launch of 988, “the state did not have oversight of individual crisis lines and how they responded.”

After 988 began, Isbell received a follow-up email from an executive with Mental Health America, introducing her to the director of Indiana’s 988 hotline, Kara Biro.

“I shared your story with her and we agree that we would love to get you to help with a training video,” wrote Brandi Christiansen, CEO of Mental Health America-Wabash Valley Region. She explained it would provide workers an opportunity to understand the real-life implications an “outcall can have on a human being.” The video has yet to happen, Isbell said.

The sheriff’s department also asked for her input to improve the process, she said.

Isbell saw those as signs of a turnaround. For mental health leaders in Indiana, 988 represented a “springboard to transform and build” a new response system, according to a 2022 Indiana Behavioral Health Commission report. Too often, the report said, Indiana’s “ineffective and inefficient” system had relied heavily on police and emergency rooms.

Before 988, the state hotline also relied almost entirely on volunteers, complicating efforts to standardize responses, said Jay Chaudhary, a former director of Indiana’s Division of Mental Health and Addiction, who led the state’s transition to 988.

“When somebody makes the really brave step to seek help with mental health care, that system better be ready to catch them,” he said.

Today, Indiana ranks among the 10 states with the highest 988 answer rates, a sign it can handle the demand, said Laurel Stine, chief advocacy and policy officer with the American Foundation for Suicide Prevention.

In Indiana, behavioral health professionals now lead the response via mobile crisis teams, not law enforcement, such as the officers who handcuffed Isbell.

As of July, mobile crisis teams were available to 4.8 million people living in 65 of Indiana’s 92 counties, reaching roughly 71% of residents, according to a 2024 report from the behavioral health commission. In the first half of last year, mobile crisis teams were dispatched 3,080 times for help. Law enforcement officers were involved in about 1% of those cases and roughly 10% resulted in a trip to the emergency room, according to the report.

Similar efforts have occurred nationwide since the 2022 launch. The 988 hotline received 4.8 million calls, texts, and chats during its first year, which is roughly nine times a minute, according to Substance Abuse and Mental Health Services Administration data.

But the federal government has terminated numerous grants earmarked for Indiana and other states to tackle mental health and substance use issues. Still, SAMHSA spokesperson Danielle Bennett said the 988 hotline is a “critical function” and that the federal government “will never compromise” protecting people experiencing a crisis. The hotline, Bennett said, “continues daily, life-saving work.”

The Indiana agency tasked with overseeing 988 had more than $98 million in SAMHSA grants but received 73% of that as of March 24, when the grants were terminated, according to a government list of cuts. That leaves Indiana $26 million short.

Some federal grants were passed through to local organizations, including one group that received grant money for “mobile crisis units,” according to an online grant summary. In a statement, Indiana Family and Social Services Administration spokesperson James Vaughn confirmed it received notice of the terminated SAMHSA grants but declined to provide details other than to say it is “working to minimize the impact to Hoosiers.”

Isbell hopes the 988 option doesn’t disappear for those who need a hand, not handcuffs.

She dealt with the fallout of that fateful call for a long time. After more than a year, she said, she paid the $1,400 bill to put the ordeal behind her.

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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Los despidos del presidente Donald Trump en el Departamento de Salud y Servicios Humanos (HHS) incluyeron a toda la oficina que establece las pautas federales de pobreza. Estas pautas determinan si decenas de millones de estadounidenses son elegibles para programas de salud como Medicaid, asistencia alimentaria, cuidado infantil y otros servicios, según dijo un ex funcionario.

El pequeño equipo, con experiencia en datos técnicos, trabajaba en la Oficina del Subsecretario de Planificación y Evaluación (ASPE) del HHS. Su despido se produjo de manera similar a otros: sin previo aviso y dejando a los funcionarios desconcertados sobre por qué fueron parte de la “RIF’ed”, como llaman a la “reducción de la fuerza de trabajo federal”, o sea, despedidos.

“Sospecho que hicieron una RIF en las oficinas que tenían la palabra ‘datos’ o ‘estadísticas’”, dijo uno de los empleados despedidos, un científico social a quien KFF Health News acordó no nombrar porque la persona teme nuevas represalias. “Por lo que sabemos, fue algo hecho al azar”.

Entre los despedidos estuvo Kendall Swenson, quien lideró el desarrollo de las directrices sobre pobreza durante muchos años y al que se considera un experto nacional sobre el tema, según el científico social y dos académicos que han trabajado en el equipo del HHS.

Los despidos y el cierre de la oficina podrían causar recortes en la asistencia a las familias de bajos ingresos el próximo año, a menos que la administración Trump restablezca los puestos o traslade sus funciones a otro lugar, expresó Robin Ghertner, director despedido de la División de Datos y Análisis Técnico, quien había supervisado las directrices sobre pobreza.

Estas directrices son “necesarias para muchas personas y programas”, dijo Timothy Smeeding, profesor emérito de economía en la Facultad de Asuntos Públicos La Follette, de la Universidad de Wisconsin. “Si piensas en alguien a quien despediste y que debería ser recontratado, Swenson sería un claro candidato”, añadió.

Según un proyecto de ley de asignaciones de 1981, el HHS debe tomar anualmente las cifras de la Oficina del Censo sobre el umbral de pobreza, ajustarlas a la inflación y crear directrices que las agencias y los estados utilicen para determinar quién tiene derecho a diversos tipos de ayuda.

Hay una estrategia especial para crear las directrices que incluye ajustes y cálculos, dijo Ghertner. Swenson y otros tres funcionarios prepararían los números de forma independiente y los comprobarían juntos antes de su publicación cada enero.

Según Ghertner, al personal de su oficina se les comunicó a principios de abril, sin previo aviso, que entraban en licencia administrativa hasta el 1 de junio, cuando su empleo terminaría oficialmente.

“No hay nadie en el gobierno que sepa cómo calcular estas directrices”, explicó. “Y como tenemos bloqueadas nuestras computadoras, no podemos enseñarle a nadie a calcularlas”.

El ASPE tenía unos 140 empleados y ahora tiene cerca de 40, según un ex funcionario. La reorganización del HHS fusionó la oficina con la Agencia para la Investigación y la Calidad del Cuidado de la Salud (AHRQ), cuyo personal se ha reducido de 275 a unos 80 empleados, según un ex funcionario de la AHRQ que habló bajo condición de anonimato.

El HHS ha dicho que se despidió a unos 10.000 empleados y ha comunicado que, junto con otras medidas, como un programa para fomentar las jubilaciones anticipadas, su plantilla se ha reducido en unos 20.000 trabajadores. Pero la agencia no ha detallado dónde ha hecho los recortes ni ha identificado a los empleados que ha despedido.

“A estos trabajadores se les dijo que no podían regresar a sus oficinas, por lo que no hay transferencia de conocimiento”, afirmó Wendell Primus, quien trabajó en la ASPE durante la administración de Bill Clinton. “No tuvieron tiempo de formar a nadie, transferir datos, etc”.

El HHS defendió los despidos. El departamento fusionó la AHRQ y la ASPE “como parte de la visión del secretario Kennedy de racionalizar el HHS para servir mejor a los estadounidenses”, dijo la vocera Emily Hilliard. “Los programas críticos dentro de la ASPE continuarán en esta nueva oficina” y “el HHS seguirá cumpliendo con los requisitos legales”, comunicó Hilliard en una respuesta escrita a KFF Health News.

Después de la publicación de este artículo, el vocero del HHS, Andrew Nixon, llamó a KFF Health News para decir que otros funcionarios del HHS podrían hacer el trabajo del equipo de análisis de datos de la RIF’ed, que tenía nueve miembros. “La idea de que esto se detendrá es totalmente incorrecta”, dijo. “Ochenta millones de personas no se verán afectadas”.

El secretario Robert F. Kennedy Jr. se ha negado hasta ahora a testificar sobre las reducciones de personal ante los comités del Congreso que supervisan gran parte de su agencia. El 9 de abril, una delegación de 10 legisladores demócratas esperó infructuosamente una reunión en el vestíbulo de la agencia.

A la cabeza del grupo estaba Diana DeGette (demócrata de Colorado) miembro de alto rango del subcomité de salud de la Cámara de Energía y Comercio, quien dijo a los periodistas que Kennedy debe comparecer ante el comité “y decirnos cuál es su plan para mantener a Estados Unidos sano y para detener estos recortes devastadores”.

Matt VanHyfte, vocero del comité republicano, afirmó que los funcionarios del HHS se reunirían con el personal bipartidista del comité el 11 de abril para discutir los despidos y otros asuntos de la política de la agencia.

El ASPE sirve como un grupo de expertos para el secretario del HHS, dijo Primus, quien más tarde fue asesor principal de política de salud de la legisladora Nancy Pelosi durante 18 años. Además de las directrices sobre pobreza, la oficina establece cuánto dinero de Medicaid va a cada estado y revisa todas las regulaciones desarrolladas por las agencias del HHS.

“Estos recortes de personal del HHS, de hasta 20,000 trabajadores, son una locura”, dijo Primus. “Estas decisiones no las han tomado Kennedy ni el personal del HHS. Se están tomando en la Casa Blanca. No hay ni pies ni cabeza en lo que están haciendo”.

Los líderes del HHS pueden desconocer su obligación legal de emitir las directrices de pobreza, según Ghertner. Y agregó que si cada estado y agencia gubernamental federal establece sus propias directrices, podría crear desigualdades y dar lugar a demandas.

Y mantener el estándar de 2025 el próximo año podría poner en riesgo los beneficios de cientos de miles de estadounidenses, advirtió Ghertner. El actual nivel de pobreza es de $15.650 para una persona soltera y de $32.150 para una familia de cuatro.

“Si ganas $30.000 y tienes tres hijos, por ejemplo, y el año que viene ganas $31.000, pero los precios han subido un 7%, de repente tus $31.000 no te compran lo mismo”, explicó, “pero si las directrices no han aumentado, es posible que ya no seas elegible para Medicaid”.

El nivel de pobreza de 2025 para una familia de cinco miembros es de $37.650.

En octubre, unas 79 millones de personas estaban inscritas en Medicaid o en el Programa de Seguro de Salud Infantil (CHIP), ambos sujetos a comprobación de recursos y, por lo tanto, dependientes de las pautas de pobreza para determinar la elegibilidad.

La elegibilidad para los subsidios para ayudar a pagar las primas de los planes de seguro vendidos en los mercados establecidas por la Ley de Cuidado de Salud a Bajo Precio (ACA) también está vinculada al nivel oficial de pobreza.

Uno de cada ocho estadounidenses depende del Programa de Asistencia Nutricional Suplementaria, o cupones de alimentos, y el 40% de los recién nacidos y sus madres reciben alimentos a través del programa Mujeres, Bebés y Niños, que también utilizan el nivel federal de pobreza para determinar la elegibilidad.

Los ex empleados de la oficina dijeron que no fueron desleales al presidente. Sabían que sus trabajos les exigían seguir los objetivos de la administración. “Intentábamos apoyar el programa de MAHA”, dijo el científico social, refiriéndose a “Make America Healthy Again” (Hacer que Estados Unidos Vuelva a Ser Saludable) de Kennedy. “Aunque no se alineara con nuestras visiones personales del mundo, queríamos ser útiles”.

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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The Host Julie Rovner KFF Health News @jrovner 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.

A week into the reorganization of the Department of Health and Human Services announced by Secretary Robert F. Kennedy Jr., the scope of the staff cuts and program cutbacks is starting to become clear. Among the biggest targets for reductions were the nation’s premier public health agencies: the Centers for Disease Control and Prevention, the National Institutes of Health, and the FDA.

Meanwhile, Kennedy did not show up as invited to testify before the Senate Health, Education, Labor and Pensions Committee, known as HELP, but he did visit families in Texas whose unvaccinated children died of measles in the current outbreak and called for an end to water fluoridation during a stop in Utah.

This week’s panelists are Julie Rovner of KFF Health News, Victoria Knight of Axios, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

Panelists Victoria Knight Axios @victoriaregisk Read Victoria's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Sandhya Raman CQ Roll Call @SandhyaWrites Read Sandhya's stories.

Among the takeaways from this week’s episode:

• Amid a dearth of public information about federal health cutbacks, HHS employees currently on administrative leave report they were given no opportunity to hand off their responsibilities, suggesting important work will simply be discontinued. Critical staff members have been cut from the FDA offices funded by user fees, for instance — affecting the drugmakers that pay the fees in exchange for timely evaluation of their products, as well as the patients hoping for access to those drugs. Even if the cuts were reversed, the damage could linger, especially in areas where there will be gaps in data such as disease surveillance.
• Meanwhile, the temporary public communications freeze implemented in the Trump administration’s early days apparently has not ended. State officials, desperate for information from federal health officials about ongoing programs, are receiving no response as they seek guidance from offices in which most or all staffers were laid off.
• President Donald Trump issued an executive order this week that instructs federal department heads to summarily repeal any regulation they deem “unlawful.” The order threatens to effectively short-circuit the federal regulatory process, which involves public notices and opportunities to comment. Businesses rely on that process to make decisions, and Trump’s order could create further instability for health care and other industries.
• And Kennedy traveled West this week, using his public appearances to call for removing fluoride from the water supply and to discuss the measles outbreak. He issued his strongest endorsement of the measles vaccine yet, but he also praised doctors who have used alternative and unapproved remedies to treat measles patients. Senators had called him to testify before Congress this week about the ongoing upheaval at HHS, but the hearing was canceled.
• Legislators in a growing number of states are introducing abortion bans that would punish women seeking abortions as well as abortion providers, suggesting a long game for abortion opponents that goes well beyond overturning a nationwide right to the procedure.

Also this week, Rovner interviews Georgetown Law School professor Stephen Vladeck about the limits of presidential power.

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

Julie Rovner: The New York Times’ “Why the Right Still Embraces Ivermectin,” by Richard Fausset.  

Victoria Knight: Wired’s “Dr. Oz Pushed for AI Health Care in First Medicare Agency Town Hall,” by Leah Feiger and Steven Levy.  

Alice Miranda Ollstein: The Guardian’s “‘We Are Failing’: Doctors and Students in the US Look to Mexico for Basic Abortion Training,” by Carter Sherman.  

Sandhya Raman: CQ Roll Call’s “In Sweden, a Focus on Smokeless Tobacco,” by Sandhya Raman. 

Also mentioned in this week’s podcast:

• The New York Times’ “The Three States That Are Especially Stuck if Congress Cuts Medicaid,” by Sarah Kliff and Margot Sanger-Katz.
• The AP’s “Ex-Official Says He Was Forced out of FDA After Trying To Protect Vaccine Safety Data From RFK Jr.,” by Matthew Perrone.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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

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

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This story can be republished for free (details).

Underscoring the massive scale of America’s medical debt problem, a New York-based nonprofit has struck a deal to pay off old medical bills for an estimated 20 million people.

Undue Medical Debt, which buys patient debt, is retiring $30 billion worth of unpaid bills in a single transaction with Pendrick Capital Partners, a Virginia-based debt trading company. The average patient debt being retired is $1,100, according to the nonprofit, with some reaching the hundreds of thousands of dollars.

The deal will prevent the debt being sold and protect millions of people from being targeted by collectors. But even proponents of retiring patient debt acknowledge that these deals cannot solve a crisis that now touches around 100 million people in the U.S.

“We don’t think that the way we finance health care is sustainable,” Undue Medical Debt chief executive Allison Sesso said in an interview with KFF Health News. “Medical debt has unreasonable expectations,” she said. “The people who owe the debts can’t pay.”

In the past year alone, Americans borrowed an estimated $74 billion to pay for health care, a nationwide West Health-Gallup survey found. And even those who benefit from Undue’s debt relief may have other medical debt that won’t be relieved.

This large purchase also highlights the challenges that debt collectors, hospitals, and other health care providers face as patients rack up big bills that aren’t covered by their health insurance.

Pendrick’s chief executive, Chris Eastman, declined several requests to be interviewed about the debt sale, which has not been previously reported. But Eastman acknowledged in a 2024 podcast episode that collecting medical debts has grown more challenging as regulators have restricted how collectors can pursue patients.

Pendrick has now shuttered, which Sesso said provided strong motivation for this deal. “This was a really great opportunity to get a debt buyer out of the market,” she said.

Undue Medical Debt pioneered its debt relief strategy a decade ago, leveraging charitable donations to buy medical debt from debt trading companies at steeply discounted prices and then freeing patients from the obligation to pay.

The nonprofit now buys debts directly from hospitals, as well. And it is working with about two dozen state and local governments to leverage public money to relieve medical debt in communities from Los Angeles County to Cleveland to the state of Connecticut.

The approach has been controversial. And Undue Medical Debt’s record-setting purchase — financed by a mix of philanthropy and taxpayer dollars — is likely to stoke more debate over the value of paying collectors for medical debts.

“The approach is just treating the symptoms and not the disease,” said Elisabeth Benjamin, a vice president at the Community Service Society of New York, a nonprofit that has led efforts to restrict aggressive hospital collections. Benjamin and other advocates say systemic changes such as ensuring hospitals offer sufficient financial aid to patients and reining in high medical prices would be more valuable in preventing people from sinking into debt.

But many government officials see retiring people’s unpaid medical bills as part of a larger strategy to make it easier for patients to avoid debt in the first place.

“Turning off the tap is what’s really important in the long run,” said Naman Shah, a physician who directs medical affairs at the Los Angeles County Department of Public Health. The county is working to improve local hospital financial aid programs for patients. But Shah said debt relief is key, as well.

 “It’s easy to criticize band-aids when you’re not the one who’s cut,” he said. “As a physician, I take care of people who have cuts, and I know the importance of stitching them back up.”

Undue Medical Debt’s latest deal, which it is spending $36 million to close, will help patients nationwide, according to the nonprofit. But about half the estimated 20 million people whose debts Pendrick owned live in just two states: Texas or Florida.

Neither has expanded Medicaid coverage through the 2010 Affordable Care Act, a key tool that researchers have found bolsters patients’ financial security by protecting them from big medical bills and debt.

The patients eligible for debt relief have incomes at or below four times the federal poverty level, about $63,000 for a single person, or debts that exceed 5% of their incomes.

About half the debts are also more than seven years old. These have been donated to Undue Medical Debt by Pendrick, the group reported.

The nonprofit plans to pay for the rest of the debts over the next year and a half, though all collections have stopped against patients. It also plans to spend an additional $40 million — or $2 a person — to process the debts, find patients, and inform them that their debts have been relieved.

Sesso, Undue’s chief executive, said she hopes the debt purchase will keep policymakers focused on enacting longer-term solutions to the nation’s medical debt crisis.

She applauded state leaders for taking steps to bar medical debts from their residents’ credit scores. But she said action is also needed in Washington, D.C. However, the Trump administration has suspended regulations enacted under former President Joe Biden that would have barred credit reporting of medical debt nationally, and congressional Republicans are now moving to revoke the new rules.

“There is a limit to what state and local governments can do to solve this problem,” Sesso said. “It’s really a national problem that has to be solved at the national level.”

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MANSFIELD, La. — When Desoto Regional Health System took out $36 million in loans last year to renovate a rural hospital that opened in 1952, officials were banking on its main funding source remaining stable: Medicaid, the joint federal-state health program for low-income people and the disabled.

But those dollars are now in jeopardy, as President Donald Trump and the GOP-controlled Congress move to shrink the nearly $900 billion health program that covers more than 1 in 5 Americans.

Desoto CEO Todd Eppler said Medicaid cuts could make it harder for his hospital to repay the loans and for patients to access care.

“I just hope that the people who are making these decisions have thought deeply about it and have some context of the real-world implications,” he said, “because it’s going to affect us as a hospital and going to affect our patients.”

One of the decision-makers is Eppler’s representative in Congress: House Speaker Mike Johnson, who lives about 35 miles north of here. He said he knows the Republican leader and his staff understand hospitals’ plight: The mother of Johnson’s chief of staff is CEO of a rural hospital in the district.

“I’ve never met a congressman yet that wanted a rural hospital in their district to close, and certainly Mike is no exception to that rule,” Eppler said.

Last year nearly 290,000 people in Johnson’s district were enrolled in Medicaid, about 38% of the total population, according to data compiled by KFF, the health information nonprofit that includes KFF Health News.

About 118,000 of them are in the program thanks to the Affordable Care Act, which allowed states including Louisiana to expand Medicaid to cover low-income adults, many of whom were working in low-paying jobs that don’t provide health insurance.

Louisiana ranks second in Medicaid enrollment, at nearly 32% — a reflection of the state’s high poverty rate. As Republicans weigh cuts, their actions could have dramatic consequences for their constituents here. Of the eight GOP-held House districts with the most Medicaid enrollees due to the expansion, four are in Louisiana. Johnson’s largely rural district ranks sixth in expansion enrollees.

Among them is Chloe Stovall, 23, who works in the produce aisle at the SuperValu grocery store in Vivian, Louisiana. She said her take-home wage working full time is $200 a week. She doesn’t own a car and walks a mile to work.

The store provides health coverage, but she said she won’t qualify until she’s worked there for a full year — and even then, it will cost more than Medicaid, which is free.

“I’m just barely surviving,” she said.

In February, Johnson pushed a budget resolution through the House that calls for cutting at least $880 billion over a decade from a pool of funding that includes Medicaid, to help fund an extension of Trump’s tax cuts and his border priorities. Republicans in Congress are now considering where to make cuts, and Medicaid is likely to take a big hit.

Defending the plan, Johnson said that Medicaid is “not for 29-year-old males sitting on their couches playing video games.”

Stovall said almost everyone she knows on Medicaid works at least one job. “I don’t even own a TV,” she said.

Contacted for comment, Johnson’s office pointed to his remarks at a conference in Washington last month. “We’re going to be very careful not to cut a benefit for anyone who is eligible to receive it and relies upon it,” Johnson said.

KFF Health News spoke with two dozen Medicaid enrollees in Johnson’s district. Most said they were unaware their congressman is leading the Republican charge to upend the program. Those informed of the Republican plan said it scares them.

Some GOP members of Congress want to eliminate the ACA’s Medicaid expansion funding, which led to 20 million working-age adults gaining coverage and helped slash the nation’s uninsured rate to its lowest level in history. Forty states and the District of Columbia have agreed to the change, which promised extra federal funding in exchange for expanding eligibility.

In this heavily Republican district, where Johnson won with 86% of the vote in November, 22% of residents live in poverty.

Like Trump, Johnson says he wants cuts to Medicaid but hasn’t elaborated other than saying the program should not cover “able-bodied” adults without imposing a work requirement.

“Everybody is committed” to preserving Medicaid benefits “for those who desperately need it and deserve it and qualify for it,” Johnson said at a news conference in February. “What we’re talking about is rooting out the fraud, waste, and abuse.”

Medicaid recipients in Johnson’s district, told about GOP plans to cut the program, said their lives are hard enough in a state where the minimum wage is $7.25 an hour. Without Medicaid, they said, they couldn’t afford health coverage.

In Vivian, near the borders with Arkansas and Texas, close to half of the 2,900 residents live in poverty. The main-street shops are mostly shuttered, except for a thrift store and a mom-and-pop restaurant that specializes in fried pork chops.

“Most everybody you know is on Medicaid here,” said Doris Luccous, 24.

Luccous said she makes $250 a week after taxes as a housekeeper at a nursing home while raising her 2-year-old daughter in her childhood home. While shopping with her father — who doesn’t work, because of a disability — she said she counts on Medicaid for her bipolar medicines and to pay for therapy appointments.

“I don’t know where I would be without it,” she said.

Neither Luccous nor Stovall said they voted in the last election, and neither knew that Johnson is their representative in Congress.

Vivian has few large employers, and most employers pay the minimum wage, which hasn’t changed since 2009. “We are just stuck,” Stovall said.

Still, she said, “it’s a community where everybody knows everybody, and people are always willing to lend a hand because so many are in difficult financial circumstances.”

Willie White is CEO of David Raines Community Health Centers, which operates six outpatient clinics in northwestern Louisiana that serve primarily Medicaid enrollees. He said that Louisiana already ranks among the worst states for people’s health and that Medicaid cuts would only worsen the situation.

“You cannot expect health outcomes to improve if people can’t afford to access care,” White said.

While the clinics provide primary and dental care on a sliding fee scale for uninsured patients, signing them up for Medicaid gives them better access to specialists and brings the health centers revenue to cover the cost of delivering care.

Many of the centers’ patients gained coverage through Medicaid expansion. Afterward, rates of screenings for colon and cervical cancer went from 10% to 50%, White said. 

But if Congress cuts Medicaid, the health centers would be forced to cut services, he said.

“Mike Johnson has been here and knows us, and he and his office have been responsive about our issues,” White said. “The message in prior years was, ‘We need additional funding,’ but now it is asking for no cuts.”

Community health centers, which in 2023 provided care nationally to more than 32 million mostly low-income people, have seen funding increases from Republicans and Democrats for decades.

“Everyone is supportive, but the question remains what that support will look like under the current administration,” White said. “If there are to be reductions, they need to be done with a scalpel.”

Expecting cuts, the health centers have already restricted travel and put a hold on filling vacant positions, White said.

Sitting in a David Raines clinic in Bossier City, Benjamin Andrade, 57, said having Medicaid has been a lifesaver since he needed heart surgery in 2020. Andrade is a chef and said he supports his wife and two children on $14 an hour.

He had not heard about any potential cuts to the program. Without Medicaid, he said, “it would be very hard for me to pay for all the medicines I take.”

Dominique Youngblood, 31, who was at the clinic for a dental checkup, said she’s had Medicaid most of her life. “Medicaid helps me so I don’t have to pay out-of-pocket going to the doctors,” she said.

Youngblood, who has two children, makes $12 an hour at a day care center. Asked about GOP efforts to scale back the program, she said, “It’s not fair, because it helps a lot of people who cannot afford medications and emergency room trips, and those are costs you can’t control.”

Back in Mansfield, Eppler’s hospital is more than just a health facility — it’s where many people in town come for lunch. The cafeteria was packed on a recent Friday as workers served boiled shrimp, fried okra, and baked fish.

Eppler said he’s aware Republicans in Congress are targeting a system of taxes that some states, including Louisiana, levy on hospitals and other health providers to draw down more federal Medicaid funding. That money helps finance what are known as supplemental payments to providers. Some conservatives belittle the extra funding as “money laundering.”

But that money accounts for about 15% of the DeSoto health system’s budget, said Eppler, a retired Air Force lieutenant colonel who has been CEO for a dozen years. “We are using that money to invest in the next 50 years of Desoto Parish, to build a hospital that they can have that will be sustainable,” he said.

The supplemental payments, for example, help pay to provide mental health services at three outpatient clinics. “If that $4 million went away, we would have to limit services — it’s just that simple,” he said.

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Subrayando la magnitud del problema de la deuda médica en el país, una organización sin fines de lucro con sede en Nueva York ha llegado a un acuerdo para liquidar viejas facturas médicas de aproximadamente 20 millones de personas.

Undue Medical Debt, que compra deudas de pacientes, está liquidando $30 mil millones en facturas impagas en una sola transacción con Pendrick Capital Partners, una empresa de comercialización de deuda con sede en Virginia. Según la organización, La deuda promedio de los pacientes que se liquida es de $1.100, y en algunos casos alcanza los cientos de miles de dólares.

El acuerdo evitará la venta de la deuda y protegerá a millones de personas de ser blanco de los cobradores. Pero incluso quienes defienden la liquidación de la deuda de los pacientes reconocen que estos acuerdos no pueden resolver una crisis que ya afecta a unas 100 millones de personas en Estados Unidos.

“No creemos que la forma en que financiamos la atención médica sea sostenible”, dijo Allison Sesso, directora ejecutiva de Undue Medical Debt, en una entrevista con KFF Health News. “La deuda médica genera expectativas desproporcionadas”, agregó. “Quienes tienen deudas no pueden pagar”.

Solo el año pasado, los estadounidenses pidieron prestado aproximadamente $74 mil millones para pagar la atención médica, según una encuesta nacional de West Health-Gallup. Incluso quienes se benefician de la reducción de deuda de Undue podrían tener otras deudas médicas que no se beneficiarán de este acuerdo.

Esta gran compra también resalta los desafíos que enfrentan los cobradores de deudas, los hospitales y otros proveedores de atención médica, ya que los pacientes acumulan facturas grandes que no están cubiertas por su seguro médico.

Chris Eastman, director ejecutivo de Pendrick, rechazó varias solicitudes de entrevista sobre la venta de deuda, que no se había informado previamente. Sin embargo, Eastman reconoció en el episodio de un podcast de 2024 que el cobro de deudas médicas se ha vuelto más difícil a medida que los reguladores han restringido la forma en que los cobradores pueden perseguir a los pacientes.

Pendrick ya ha cerrado, lo que, según Sesso, fue una fuerte motivación para este acuerdo. “Esta fue una gran oportunidad para sacar del mercado a un comprador de deuda”, afirmó.

Undue Medical Debt fue pionera en la estrategia de alivio de deuda hace una década, aprovechando donaciones benéficas para comprar deuda médica de empresas de comercialización de deuda a precios muy reducidos y liberando así a los pacientes de la obligación de pago.

La organización sin fines de lucro ahora también compra deudas directamente de los hospitales. Además, colabora con unas dos docenas de gobiernos estatales y locales para movilizar fondos públicos y aliviar la deuda médica en comunidades desde el condado de Los Ángeles hasta Cleveland y el estado de Connecticut.

El enfoque ha sido controversial. Y es probable que la compra récord de Undue Medical Debt, financiada con una combinación de filantropía y dinero de los contribuyentes, avive aún más el debate sobre la importancia de pagar a los cobradores por las deudas médicas.

“El enfoque se centra únicamente en tratar los síntomas, no la enfermedad”, afirmó Elisabeth Benjamin, vicepresidenta de la Sociedad de Servicios Comunitarios de Nueva York, una organización sin fines de lucro que ha liderado iniciativas para restringir la estrategia de cobros agresiva de deudas hospitalarias.

Benjamin y otros defensores aseguran que cambios sistémicos, como garantizar que los hospitales ofrezcan suficiente ayuda financiera a los pacientes y controlar los altos precios médicos, serían más valiosos para evitar que las personas se endeuden.

Pero muchos funcionarios del gobierno ven la eliminación de las facturas médicas impagas como parte de una estrategia más amplia para facilitar que los pacientes eviten las deudas en primer lugar.

“Cerrar el grifo es lo realmente importante a largo plazo”, dijo Naman Shah, doctor que dirige asuntos médicos en el Departamento de Salud Pública del condado de Los Ángeles. El condado está trabajando para mejorar los programas locales de ayuda financiera de los hospitales para los pacientes. Pero Shah afirmó que el alivio de la deuda también es clave.

“Es fácil criticar los vendajes cuando no eres tú quien se corta”, dijo. “Como médico, atiendo a personas con cortes y sé lo importante que es coserlos”.

El último acuerdo de Undue Medical Debt, en el que se están invirtiendo $36 millones, ayudará a pacientes de todo el país, según la organización sin fines de lucro. Pero aproximadamente la mitad de las cerca de 20 millones de personas cuyas deudas Pendrick poseía viven en solo dos estados: Texas o Florida.

Ninguno de los dos estados ha ampliado la cobertura de Medicaid a través de la Ley de Cuidado de Salud a Bajo Precio de 2010, una herramienta clave que, según han hallado los investigadores, refuerza la seguridad financiera de los pacientes al protegerlos de grandes facturas médicas y deudas.

Los pacientes elegibles para el alivio de la deuda tienen ingresos iguales o inferiores a cuatro veces el nivel federal de pobreza, aproximadamente $63.000 para una persona soltera, o deudas que superan el 5% de sus ingresos.

Aproximadamente la mitad de las deudas también tienen más de siete años. Estas han sido donadas a Undue Medical Debt por Pendrick, informó el grupo.

La organización sin fines de lucro planea pagar el resto de las deudas durante el próximo año y medio, aunque se han suspendido todos los cobros contra los pacientes. También planea invertir $40 millones adicionales, o $2 por persona, para procesar las deudas, localizar pacientes e informarles que sus deudas han sido condonadas.

Sesso, directora ejecutiva de Undue, expresó su esperanza de que la compra de deuda mantenga a los legisladores enfocados en implementar soluciones a largo plazo para la crisis de deuda médica del país.

Aplaudió a los líderes estatales por tomar medidas para excluir las deudas médicas de las calificaciones de crédito de sus residentes. Pero afirmó que también se necesitan medidas en Washington, D.C.

Sin embargo, la administración Trump ha suspendido las regulaciones promulgadas durante el gobierno del ex presidente Joe Biden que habrían prohibido la presentación de informes crediticios sobre deudas médicas a nivel nacional, y los republicanos del Congreso ahora están trabajando para revocar las nuevas normas.

“Hay un límite a lo que los gobiernos estatales y locales pueden hacer para resolver este problema”, dijo Sesso. “Es realmente un problema nacional que debe resolverse a nivel nacional”.

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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The Host Julie Rovner KFF Health News @jrovner 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 Department of Health and Human Services underwent an unprecedented purge this week, as thousands of employees from the National Institutes of Health, the FDA, the Centers for Disease Control and Prevention, and other agencies across the department were fired, placed on administrative leave, or offered transfers to far-flung Indian Health Service facilities in such places as New Mexico, Montana, and Alaska. Altogether, the layoffs mean the federal government, in a single day, shed hundreds if not thousands of years of health and science expertise.

Meanwhile, the Supreme Court heard a case about whether states can bar Planned Parenthood from providing non-abortion-related services to Medicaid patients. But by the time the case is settled, it’s unclear how much of Medicaid or the Title X Family Planning Program will remain intact.

 This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Bloomberg News, Sarah Karlin-Smith of the Pink Sheet, and Lauren Weber of The Washington Post.

Panelists Rachel Cohrs Zhang Bloomberg News @rachelcohrs Sarah Karlin-Smith Pink Sheet @SarahKarlin Read Sarah's stories. Lauren Weber The Washington Post @LaurenWeberHP Read Lauren's stories.

Among the takeaways from this week’s episode:

• As details trickle out about the major staffing purge underway at HHS, long-serving and high-ranking health officials are among those who have been shown the door: in particular, senior scientists at FDA, including the top vaccine regulator, and even the head veterinarian working on bird flu response.
• The Trump administration has also gutted entire offices, including the FDA’s tobacco division — even though the division’s elimination would not save taxpayer money because it’s not funded by taxpayers. Still, the tobacco industry stands to benefit from less regulatory oversight. Many health agencies have their own examples of federal jobs cut under the auspices of saving taxpayer money when the true effect will be undermining federal health work.
• Democratic Sen. Cory Booker of New Jersey set a record this week during a marathon, 25-hour-plus chamber floor speech railing against Trump administration actions, and he used much of his time discussing the risks posed to Americans’ health care. With Republicans considering deep cuts that could hit Medicaid hard, it’s possible that health changes could be the area that resonates most with Americans and garner key support for Democrats come midterm elections.
• And the tariffs unveiled by President Donald Trump this week reportedly touch at least some pharmaceuticals, leaving the drug industry scrambling to sort out the impact. It seems likely tariffs would raise the prices Americans pay for drugs, as tariffs are expected to do for other consumer products — leaving it unclear how Americans stand to benefit from the president’s decision to upend global trade.

Also this week, Rovner interviews KFF Health News’ Julie Appleby, whose latest “Bill of the Month” feature is about a short-term health plan and a very expensive colonoscopy. Do you have a baffling, confusing, or outrageous medical bill to share with us? You can do that here.

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

Julie Rovner: Stat’s “Uber for Nursing Is Here — And It’s Not Good for Patients or Nurses,” by Katie J. Wells and Funda Ustek Spilda.

Sarah Karlin-Smith: MSNBC’s “Florida Considers Easing Child Labor Laws After Pushing Out Immigrants,” by Ja’han Jones.

Lauren Weber: The Atlantic’s “Miscarriage and Motherhood,” by Ashley Parker.

Rachel Cohrs Zhang: The Wall Street Journal’s “FDA Punts on Major Covid-19 Vaccine Decision After Ouster of Top Official,” by Liz Essley White.

Also mentioned in this week’s podcast:

• Stat’s “Laid-Off HHS Leaders Offered Transfers to Remote Indian Health Service Regions,” by Usha Lee McFarling.
• The Washington Post’s “Fired Health Workers Were Told To Contact an Employee. She’s Dead.” By Lauren Weber.
• Georgia Recorder’s “Bill That Criminalizes Abortion, Undermines IVF Access Gets Georgia House Panel Hearing,” by Jill Nolin.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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

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

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Tina Ewing-Wilson remembers the last time major Medicaid cuts slashed her budget.

In the late 2000s, during the Great Recession, the pot of money she and other Medi-Cal recipients depend on to keep them out of costly residential care homes shrank.

The only way she could afford help was to offer room and board to a series of live-in caregivers who she said abused alcohol and drugs and eventually subjected her to financial abuse. She vowed to never rely on live-in care again.

Now the 58-year-old Republican from the Inland Empire is worried Medicaid cuts being mulled by her party in Washington could force her into another vulnerable spot.

“If they reduce my budget, that doesn’t change the fact that I need 24-hour care,” said Ewing-Wilson, who has struggled with seizures and developmental disabilities her entire life. “If they cut it too much, people will die or they’ll lose their freedoms.”

Similar stories have already surfaced in GOP-held swing districts nationwide where activists have been applying political pressure to sway vulnerable House members from supporting $880 billion in cuts that health experts say would almost certainly hit safety net programs. But in California, which sends more Republicans to Congress than any state west of Texas, consumer groups and health industry giants are joining forces in a quieter campaign to lobby lawmakers in solidly red districts, some of which they say would be disproportionately affected if those cuts materialize.

Organizers are trying to highlight a thorny fact that faces many conservative members as they navigate a complex decision: The scale of spending cuts top GOP leaders are demanding is nearly impossible to achieve without slashing Medicaid funds to states, which are a lifeline for their largely poor, rural districts. In Rep. Doug LaMalfa’s northern Sierra district stretching to the Oregon border, for example, some 43% of residents are enrolled in Medi-Cal, while 48% of residents in Rep. Jay Obernolte’s district, centered on San Bernardino County, rely on Medi-Cal.

“The hospitals, the health plans — we don’t always get along with those folks,” said Dustin Corcoran, CEO of the powerful California Medical Association, which represents more than 55,000 doctors and encouraged its members to call their representatives. “On this, there’s not a lot of daylight. It will take strange bedfellows, for sure.”

The California Hospital Association has sent letters to Republican lawmakers and encouraged executives of its more than 400 member hospitals to reach out or provide tours to them. Consumer advocates and patient groups have protested outside members’ district offices and community health center CEOs have requested private meetings.

The House of Representatives in February approved a budget framework tasking the committee overseeing Medicaid to cut $880 billion over 10 years. While there are still no specific provisions cutting Medicaid, Medicare, or other safety net programs, health care analysts say the magnitude of the spending reductions means they’re inevitable. They could force millions of Californians off Medi-Cal (the state’s Medicaid program covers roughly 15 million people), reduce benefits for those still enrolled, and lower reimbursement rates for physicians at a time of acute provider shortages, said Kristof Stremikis, director of market analysis and insight for the California Health Care Foundation, a nonprofit that advocates on health care policy.

“What you’re talking about at the end of the day is reductions in funding that the states, including California, are in no position to make up,” Stremikis said. “You see that reflected in the different groups that have come together to talk about how important this program is.”

Even before Congress approved its controversial budget plan, Corcoran said, doctors and other industry representatives had been holding weekly calls for months to discuss how to protect Medicaid funding following Republicans’ substantial wins in November. Corcoran has also rallied physicians’ groups out of state, sending a joint letter to House leaders in February. The group has asked individual doctors to call or write their congressional representatives as well.

Many Republican lawmakers appear to be lying low while home after House leadership advised GOP members against holding in-person town halls, blaming Democratic activists for “hijacking” the events. A viral clip showed Obernolte getting booed down by constituents at a district event.

Meanwhile, LaMalfa said on the House floor in February that the spending resolution, which all nine California Republicans voted for, does not cut Medicaid, Medicare, or other social safety net programs.

“Any claim to the contrary is actually fearmongering, plain and simple, or I guess in my neighborhood it would be known as a lie,” he said.

Neither LaMalfa nor Obernolte responded to requests for comment.

Jo Campbell, who runs a federally qualified health center in LaMalfa’s district, said she has invited the lawmaker to join her and other local clinic executives to explain how the federal government can cut the $880 billion without touching funding crucial to health centers like hers.

“We all kind of live financially on a knife’s edge,” said Campbell, CEO of Hill Country Community Clinic, roughly half of whose patients rely on Medi-Cal. “It could mean the difference of whether or not we keep our doors open.”

Campbell hasn’t heard back from LaMalfa’s office.

Executives at Adventist Health, which has 23 hospitals across California, have met with Central Valley Republican Reps. Vince Fong and David Valadao and have requested a meeting with LaMalfa, with whom they worked closely after one of its hospitals burned in the 2018 Camp Fire.

“They’re all at different places,” said Adventist spokesperson Julia Drefke. “I think they understand what it means for their community. What that translates to in terms of their vote could be a different thing.”

In 2023, Medi-Cal made up more than 80% of patient revenue at Surprise Valley Community Hospital in LaMalfa’s district, for example, and 64% of patient revenue at Loma Linda University Children’s Hospital, in Obernolte’s district, came from Medi-Cal, according to a CHCF analysis of state data.

Sabrina Epstein, a policy analyst with Disability Rights California, said she’s encouraging local activists, no matter where they live, to engage with California’s congressional Republicans.

“It only takes a few votes to keep Medicaid going, to protect it in Congress,” she said. “We don’t know where those votes are going to come from.”

Republicans — swing district or not — will now have to weigh the popularity of Medicaid among their constituents with pressure from national Republicans who see a once-in-a-generation opportunity to shrink the size of government and have shown little mercy for party members who fall out of line. More than three-quarters of Americans have a favorable opinion of Medicaid, according to a January KFF poll.

Complicating that calculation is the recent revelation by Gov. Gavin Newsom’s administration that California’s Medi-Cal program is billions of dollars short and relying on a loan to cover the overrun. Republican state legislators have singled out California’s decision to cover low-income residents regardless of legal status, although other factors have also contributed.

“The majority party decided to add billions of dollars to the cost of Medi-Cal and it was so nonsensical,” said GOP Assembly member Joe Patterson. “That’s a self-inflicted wound.”

Jenny McLelland, whose 13-year-old son has a breathing disability that requires round-the-clock care, said cutting benefits for immigrants would end up costing taxpayers more, when they show up in emergency rooms with more complicated ailments.

“I don’t buy the argument that other people are any less deserving of care than my son,” said McLelland, who lives in Clovis, part of Fong’s district. For her son, Medi-Cal is “a matter of life and death,” she added.

She believes if Fong understood how vital Medi-Cal is to families, he would work to make the system better.

It remains to be seen whether targeting House Republicans will change minds when a final budget package is voted on. Two vulnerable members — Valadao and Young Kim, who represents a district east of Anaheim — have signaled they’ll oppose major cuts to Medicaid. Rep. Ken Calvert, whose Palm Desert district office was targeted by protesters during the spring recess, said in a statement that he favors work requirements and would not support Medicaid cuts for “mothers, children, disabled, and low-income Americans.”

In Valadao’s district, state data shows, two-thirds of residents rely on Medi-Cal, which is the single biggest payer for all five general acute care hospitals there. That includes Adventist Health Delano, which derives two-thirds of patient revenue from Medi-Cal, according to the CHCF analysis.

Most other GOP House members remain silent.

Ewing-Wilson voted for Obernolte, who won reelection by 20 percentage points and is in little danger of losing. She’s been trying for weeks to get a meeting with him. If he votes to cut Medicaid, she said, “I will be very disappointed in him, because I voted for him, expecting that he would care about all of his constituents.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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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