“The first time, it’ll ring interminably. Next time, it’ll go to a voice mail that just hangs up on you,” said the 48-year-old, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”

She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.

Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.

Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.

Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.

Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.

Â鶹ŮÓÅ Health News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.

The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.

States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”

Long Wait Times for Help

Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.

The Congressional Budget Office would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.

Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.

The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.

In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.

CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.

In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.

In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and lost their benefits.

Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.

“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.

After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride (D-Del.). McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.

Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.

“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.

Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.

States Short-Staffed for Medicaid

Some states told Â鶹ŮÓÅ Health News in late March that they’ll need more staff to roll out the work rules effectively.

Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.

As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.

Missouri’s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made in November.

“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”

States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.

“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

States are paying government contractors millions of dollars to help them comply with the new federal law.

Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.

During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.

Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told Â鶹ŮÓÅ Health News.

The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.

Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.

People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.

“The human stakes of this are people’s lives,” she said.

Â鶹ŮÓÅ Health News correspondents Katheryn Houghton and Samantha Liss contributed to this report.

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The , the public health insurance program that pairs state and federal money. Federal officials have announced unprecedented actions in Minnesota this year, declaring they could withhold over $2 billion in payments slated for the state and claw back nearly $260 million from last year.

The actions in Minnesota came as part of the administration’s declared crackdown on fraud, but critics have likened them to using a bludgeon instead of a scalpel, probably harming patients who rely on Medicaid for care but are not responsible for fraud in the program.

“It’s going to hurt a lot of people if they end up going through with this,” said Sumukha Terakanambi, a 27-year-old who has Duchenne muscular dystrophy and works as a public policy consultant with the Minnesota Council on Disability.

“Of course we support going after fraud,” Terakanambi said, but “this overly aggressive action is missing the point. It’s not punishing fraudsters. It’s punishing the people.”

Longtime Medicaid observers also doubt the federal actions will achieve their purported objective. , a senior managing director with the consulting firm Manatt, that actions of this magnitude by the federal government are unprecedented, partly because punitive measures against states have “really never been an effective way to address fraud.”

Meanwhile, fraud prosecutions as the U.S. attorney’s office there grapples with the exodus of nearly half its attorneys and a surge in cases from the Trump administration’s immigration crackdown.

Despite these concerns, Centers for Medicare & Medicaid Services head Mehmet Oz said the techniques the federal government is using in Minnesota could be applied to other states, and he has launched social media campaigns alleging high-dollar public benefit fraud in , , , and . And a February release of by the Trump administration’s Department of Government Efficiency appears to be part of a campaign to paint the program as riddled by fraud, Guyer said.

, a research professor at Georgetown University’s Center for Children and Families, said that campaign by the administration seems particularly focused on services designed to keep people with disabilities out of institutions, and he described withholding $2 billion from Minnesota’s Medicaid program as “.”

A ‘Political Football’

Scrutiny of Minnesota’s public benefit programs began early in the Biden administration, years before the most recent investigations. The spotlight on the state’s Medicaid system grew after FBI raids in December 2024.

The following May, an into Medicaid housing stabilization services in Minnesota prompted further scrutiny from federal prosecutors, and from Gov. Tim Walz.

Under the Democratic governor, the state launched investigations into 85 autism providers, ordered a third-party audit of 14 types of Medicaid services deemed to be “high-risk” for fraud, and delayed payments for those services for up to 90 days. Many of the services are ones people with disabilities receive at home, making them more difficult to monitor.  

Terakanambi worried the state’s “heavy-handed approach” would destabilize the entire home care system. While his own care was not disrupted — his parents provide the 10 hours of daily personal care he qualifies for through Medicaid — other Minnesotans with disabilities have said they experienced interruptions and .

In December, one man was after losing his in-home care services amid the crackdown.

“We’re losing sight of the people that have done nothing wrong, that rely on these supports and services to live in the community,” said Sue Schettle, chief executive of , a Minnesota nonprofit that represents organizations supporting people with disabilities. “It becomes a political football.”

Schettle said she took her concerns about the crackdown to state officials, who have since met routinely with her and other advocates. The subsequent federal actions, however, have left her “shell-shocked,” she said.

The ‘Nuclear Option’

In December, a , with help from state Republicans, supercharged the issue in Minnesota, alleging widespread fraud in child care centers owned by members of the Somali community. A follow-up state investigation of the child care centers that were featured in the video determined that all were “.”

On Jan. 6, CMS’ Oz sent Walz a letter alleging Minnesota’s Medicaid program was out of compliance with federal rules on fraud, waste, and abuse, setting the stage for the Trump administration’s move to withhold over $2 billion in federal Medicaid funds to Minnesota this year, about 18% of what the state received the year before.

Minnesota is appealing.

The Republican-aligned Paragon Health Institute, a think tank that recently published a calling for similar enforcement actions across the country, applauded the federal moves.

“That will spur states to take necessary action, thus ensuring that Medicaid funds go to those who are truly eligible,” said , a legal research analyst who co-authored the brief.

Georgetown’s Schneider questioned the necessity and effectiveness of withholding the money.

“I don’t see any relationship between that and actually reducing fraud against the Minnesota Medicaid program, given the state has already taken a lot of action,” he said.

In late February, Oz went further, announcing that on top of withholding $2 billion in future payments to Minnesota, the administration was in federal Medicaid payments to the state.

“We have notified the state that we will give them the money, but we are going to hold it and only release it after they propose and act on a comprehensive corrective action plan to solve the problem,” Oz said at with Vice President JD Vance.

Minnesota the deferment in court.

“We’re waiting for feedback from CMS on our corrective action plan, which is why we were surprised and confused when Dr. Oz said in a news conference with the vice president last week that we needed to provide one,” Minnesota Medicaid director John Connolly said at a March 3 news briefing.

‘Another Minnesota’

Oz and Vance both said during the February news conference that they are not specifically targeting Democratic-led states. Oz noted Florida has a “big fraud problem” and in mid-March sent a letter to state officials with a list of questions about their Medicaid program. Until then, the letters and most of Oz’s social media videos had been limited to California, Maine, and New York, all led by Democrats.

“We might have another Minnesota on our hands,” Oz said in posted the same day as sent to Maine Gov. Janet Mills, a Democrat, requesting information on how the state was addressing Medicaid fraud.

“And if we’re not satisfied with their progress, we reserve the right to cut off payments entirely,” Oz said in the video.

The video and letter were prompted by a in Maine that found the state had made at least $45.6 million in improper Medicaid payments. Similar audits in , , and had comparable findings.

In , Mills called Oz’s letter a “pretense to send ICE and other weaponized federal agents into states led by Democrats.”

CMS spokesperson Chris Krepich said the agency does not take funding actions lightly. “The focus is on strengthening oversight, improving accountability, and ensuring that vulnerable patients receive the services they are entitled to,” Krepich said.

But Terakanambi said it’s not difficult to see how federal actions like those in Minnesota could put services in jeopardy. The amount of money Minnesota could lose from the CMS actions announced this year is already equivalent to about two-thirds of the state’s rainy-day fund.

Many states are looking to reduce or even eliminate funding for home care services over much smaller budget shortfalls. And further cuts are anticipated, with congressional Republicans’ One Big Beautiful Bill Act, signed into law last year, expected to reduce federal Medicaid spending by more than $900 billion over the next decade.

“People will die,” Terakanambi said. “People will lose critical supports and will no longer be able to participate in their community the way they want to.”

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Oz, who heads the U.S. Centers for Medicare & Medicaid Services, there was approximately $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone. “This administration under President [Donald] Trump is not going to tolerate taxpayer dollars being stolen because people aren’t paying attention anymore. We’re focused on this,” . He claimed the fraud was largely orchestrated by the “Russian, Armenian mafia” and said that most of the money spent on home and community-based services across California “might be fraudulent.”

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But there’s a catch: If people want to move to original Medicare and buy a supplemental Medigap insurance plan to cover some out-of-pocket costs, they may not be able to. Medigap insurers can generally refuse coverage to applicants whose medical history or current health problems might make them expensive to cover, a process called medical underwriting.

“We really want people to factor that in,” said , managing policy attorney at the Center for Medicare Advocacy. “If someone is in a Medicare Advantage plan for several years and then wants to switch to original Medicare, they may find they can’t switch and also get a Medigap plan.”

There are many reasons people might want to trade their MA plan for traditional Medicare. Although MA managed-care plans are typically cheaper and offer benefits not available in original Medicare, such as coverage for vision and hearing services, they have smaller provider networks than the original program and, sometimes, extensive prior authorization requirements.

In addition, as Medicare Advantage plan in recent years, a growing number of plans are pulling out of areas they used to serve, leaving members with fewer options. This year, an estimated 1 in 10 MA plan members will be forced out of their plans for this reason, according to a in February.

“We saw some Medicare Advantage plans that just left the market completely and stopped issuing plans,” said Emily Whicheloe, education director at the Medicare Rights Center.

For those considering a switch to original Medicare, getting a Medigap plan can be tricky. Federal law provides a one-time, for people 65 or older and newly covered by Medicare Part B to sign up for any Medigap plan without underwriting. After that initial sign-up period ends, however, there are fewer coverage guarantees.

But some do exist. Here are a few key circumstances and time frames when people are guaranteed a Medigap plan without having to undergo underwriting:

• People who live in Connecticut, Massachusetts, or New York can sign up for a Medigap policy without underwriting. In Maine, there is a one-month window each year when Medigap insurers must offer Plan A to all comers without underwriting. (Plan A provides less comprehensive coverage than some of the other standardized plan types.)
• People who sign up for a Medicare Advantage plan when they are first eligible for Medicare Part A at age 65 can switch to original Medicare within the first year and buy a Medigap plan too. This is sometimes called the “.”
• If a Medicare Advantage plan leaves Medicare or in an area, affected enrollees can switch to original Medicare and buy a Medigap plan either 60 days before or up to 63 days after their MA coverage ends. During this special enrollment period, they can’t be turned down or charged more based on their health.
• If an individual and no longer has access to their Medicare Advantage plan providers, they can switch to original Medicare and apply for a Medigap policy either 60 days before or up to 63 days after their MA coverage ends. That typically happens when someone notifies the plan of their permanent move or the plan discovers it, said , a training, policy, and technical assistance consultant at California Health Advocates who specializes in Medicare and Medigap coverage.

There are other circumstances when someone might qualify for a special enrollment period under federal rules, and states may have additional qualifying events that are more generous than federal standards.

Patient advocates emphasize that it’s often useful to work with a counselor at the , or SHIP, for free, unbiased help figuring out Medigap coverage options. SHIP counselors can help applicants identify potential avenues to qualify for Medigap coverage without underwriting at both the federal and state levels.

People who don’t qualify for a guaranteed right to a Medigap plan without underwriting may still be approved for coverage. Premiums may be higher, however, and plans may impose a waiting period of up to six months for coverage of preexisting medical conditions in certain circumstances.

Beware: More Underwriting

In recent years, some Medigap insurers have spent a growing percentage of premiums on medical claims, putting pressure on profits, Burns said. “Medigap insurers’ underwriting has tightened up considerably recently,” she said.

The list of health conditions that Medigap insurers might deny coverage for is long, including Alzheimer’s disease, asthma, cancer, congestive heart disease, diabetes with complications, end-stage renal disease, high blood pressure, and stroke, among others, according to a of leading insurers’ applications.

When people apply for a Medigap plan that will be medically underwritten, they will typically be asked to fill out a health questionnaire, said , a principal and consulting actuary at Milliman who is a Society of Actuaries fellow. Increasingly, insurers are requesting that people agree to a prescription drug background check, Ortner said.

“Oftentimes, that prescription drug history may be the primary driver of a decision as it relates to underwriting,” he said, rather than a physical exam or medical records review.

Insurers don’t all have the same underwriting rules, however. Here again, a SHIP counselor may be useful for pointing people to specific companies that accept applicants with a particular medical diagnosis, or have different waiting periods or coverage exclusions.

“They have access to a Medigap comparison tool in addition to what is existing on that can give you a very good estimate of what you may pay for those Medigap plans,” said , associate director of health coverage and benefits at the National Council on Aging.

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En pocos días, Reynolds estaba tan desesperada que ella y su esposo tuvieron que sujetar físicamente a Jonah para obligarlo a tomar el remedio, echándoselo en la garganta mientras él gritaba de dolor.

“Nos rompió el corazón”, contó Reynolds, que en ese momento vivía en Georgetown, Kentucky. “Y recuerdo que pensé que no debería tener que llegar a eso”.

Reynolds no pudo encontrar un dentista con una cita disponible que pudiera atender a Jonah, que es autista y a menudo se resiste a los exámenes dentales por hipersensibilidad y ansiedad. Durante cinco días, Reynolds llevó a Jonah dos veces a una sala de emergencias cercana, mientras el niño lidiaba con un dolor persistente y fiebre por lo que probablemente fuera un diente infectado con un nervio expuesto.

En la sala de emergencias no había dentistas; las dos veces la familia regresó a casa solo con analgésicos y una bolsa de hielo.

En todo el país, cada vez más niños llegan a las salas de emergencias por problemas dentales prevenibles. Dentistas, higienistas e investigadores atribuyen esa tendencia a la falta de profesionales de odontología pediátrica en zonas rurales y a un deterioro de la higiene bucal desde la pandemia de covid-19.

Decenas de miles de niños terminan en el hospital por emergencias dentales cada año, según Melissa Burroughs, directora sénior de políticas y defensa del paciente de la organización nacional sin fines de lucro CareQuest Institute for Oral Health.

Las visitas a salas de emergencias por problemas dentales no relacionados con lesiones físicas aumentaron en niños menores de 15 años entre 2019 y 2022, según un informe publicado a finales del año pasado por CareQuest.

Los datos locales reflejan esa tendencia nacional.

En el Hospital de Niños de Colorado, en el área de Denver, los casos dentales no traumáticos —como caries o infecciones de encías— atendidos en la sala de emergencias aumentaron un 175% entre 2010 y 2025, según Sarah Bonar, vocera del hospital.

En Kentucky, donde vive Jonah, las visitas de niños a salas de emergencia por problemas dentales aumentaron un 72 % entre 2020 y 2024, según los registros del estado.

Los cambios de política ejecutados por el gobierno de Donald Trump podrían empeorar la tendencia.

La ley de reconciliación presupuestaria federal de 2025 impulsada por el presidente, conocida como One Big Beautiful Bill Act, pidió recortes de miles de millones de dólares a Medicaid, lo que podría obligar a los estados a limitar o eliminar la cobertura dental del programa de salud pública para personas con bajos ingresos o con discapacidades.

Nuevos requisitos de elegibilidad de Medicaid en algunos estados podrían afectar el acceso de los niños a la atención dental, aunque el programa les garantiza esa cobertura. Investigaciones muestran que cuando los padres pierden Medicaid, incluso los niños que mantienen su cobertura tienen más probabilidades de tener y de ir al dentista.

La administración Trump también ha promovido el escepticismo sobre el flúor. muestran que el flúor en el agua potable y los tratamientos tópicos con flúor previenen y reducen de forma importante la caries dental.

En meses recientes, la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés) contra el uso de suplementos de flúor y la Agencia de Protección Ambiental (EPA, por sus siglas en inglés) sobre “posibles riesgos para la salud del flúor en el agua potable”.

El secretario de Salud y Servicios Humanos, Robert F. Kennedy Jr., ha llamado al flúor un “” y un “”. Un estudio de 2025 en JAMA Pediatrics vinculó niveles altos de flúor con un coeficiente intelectual más bajo en niños, pero solo con concentraciones del nivel recomendado en el agua potable pública.

, un dentista pediátrico en la University of Washington que estudia la reticencia al flúor, teme que las posturas anti flúor erosionen aún más la confianza en los tratamientos con flúor.

Desde el comienzo de 2026, legisladores en por lo menos 15 estados han presentado proyectos de ley para prohibir o limitar el flúor en el agua potable pública. Utah y Florida se convirtieron en 2025 en los primeros estados en aprobar esas prohibiciones.

“¿Eso va a tener un efecto en las tasas de caries? Absolutamente”, sostuvo Chi.

Aumentan los casos dentales graves

Las dentistas pediátricas Katherine Chin y Chaitanya Puranik dijeron que están atendiendo a más pacientes como Jonah en el hospital infantil de Colorado. Los casos graves también se han vuelto más frecuentes. Puranik agregó que antes, por lo general, veía pacientes con una sola caries, pero ahora a menudo llegan con caries en toda la boca.

Durante la pandemia, muchos consultorios dentales . Además, estudios muestran que los niños también , un factor de riesgo importante para los problemas dentales.

Las caries graves que llevan a la extracción de dientes pueden afectar el y, a veces, causar problemas a largo plazo para o .

Millones de personas viven en zonas de Estados Unidos donde , con pocos dentistas a una distancia razonable en auto. Además, según la American Dental Association, solo atiende a pacientes de Medicaid, debido a las bajas tasas de reembolso, que en promedio son de lo que cobran habitualmente.

Los niños con discapacidades intelectuales o del desarrollo pueden tener aun más dificultades para acceder a atención dental de calidad.

Pocos dentistas generales tienen suficiente formación pediátrica para atender a niños con discapacidades como Jonah, que se agobian con facilidad o necesitan sedación para un examen, una organización sin fines de lucro de información de salud que incluye a Â鶹ŮÓÅ Health News.

tienen necesidades especiales de atención médica, y esos niños tienen de no tener cubiertas sus necesidades dentales. Sus padres también de tener problemas para .

Cuando era más pequeño, Jonah no dejaba que sus papás le cepillaran los dientes. Esto le generó caries en sus dientes de leche, explicó su mamá.

Después de la primera visita de Jonah a la sala de emergencias, Reynolds encontró un dentista general que tenía una cita disponible. Pero, a diferencia de un dentista pediátrico capacitado, dijo, el dentista no supo cómo examinar a Jonah de una forma que él pudiera tolerar y no estaba preparado para sedarlo. Jonah se fue sin tratamiento y pronto, cuando volvió la fiebre, regresó a la sala de emergencias.

Las salas de emergencias rara vez ofrecen soluciones

, pediatra en el condado de Washington, en Maine, aseguró que está viendo “las caries más horribles” en Down East Community Hospital.

Las salas de emergencia a menudo no están preparadas para tratar problemas dentales, explicó Weitz. Como a la que fue Jonah en Kentucky, Down East no tiene dentistas entre su personal. Weitz a menudo termina recetando antibióticos como medida temporal. “Pero un mes después, los pacientes regresan porque la situación vuelve a agravarse”, dijo Weitz.

Como posible solución, estados como Maine y Alaska están proponiendo usar fondos del , dotado con $50.000 millones, para desarrollar la fuerza laboral de salud bucal o crear centros especializados de atención dental que puedan atender mejor y más rápido a niños con necesidades especiales de atención médica.

Pero esas iniciativas no resolverán la pérdida de cobertura que se anticipa por  los recortes a Medicaid.

El año pasado, California otorgó $47 millones en subvenciones estatales para desarrollar o ampliar más de 120 centros odontológicos destinados a atender a pacientes con necesidades especiales de atención médica.

La emergencia dental de Jonah le costó a Reynolds una semana sin trabajar en su empleo como peluquera de perros y a Jonah tres días de tercer grado, además de los cientos de dólares que tuvieron que pagar de su propio bolsillo.

Finalmente, Reynolds encontró a un especialista en cirugía oral que le extrajo el diente. Pero incluso eso salió mal. Cuando Jonah se alteró por el pinchazo de una aguja, el cirujano amenazó con sujetarlo por la fuerza, contó Reynolds. Agregó que el profesional se fue rápidamente después del procedimiento sin darle un diagnóstico claro de qué había causado el dolor de Jonah.

La extracción terminó con el dolor de muelas, pero Reynolds opinó que más profesionales deberían saber cómo manejar casos como el de Jonah, con más sensibilidad hacia las familias.

Cuatro años después, todavía sigue fresco en su memoria el momento en que tuvo que obligar a Jonah a tomar el medicamento para el dolor. “Eso nunca se me va a olvidar”, concluyó Reynolds.

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Within a few days, Reynolds became so desperate that she and her husband had to physically restrain Jonah, dumping pain medication down his throat as he screamed in pain.

“It broke our hearts,” said Reynolds, who lived in Georgetown, Kentucky, at the time. “And I remember just thinking that it shouldn’t have to come to that.”

Reynolds couldn’t find a dentist with an opening who could treat Jonah, who is autistic and often resists dental exams due to hypersensitivity and anxiety. Over the course of five days, Reynolds took Jonah twice to a nearby emergency room as he struggled with persistent pain and a fever due to a likely infected tooth with an exposed nerve. The ER had no dentists; both times, the family was sent home with only pain medication and an ice pack.

Across the nation, more children are entering ERs for preventable tooth problems. Dentists, hygienists, and researchers attributed that trend to a shortage of pediatric dental care professionals in rural areas and worsening oral hygiene since the covid-19 pandemic. Tens of thousands of kids end up in the hospital for dental emergencies each year, according to Melissa Burroughs, senior director of policy and advocacy at the national health nonprofit CareQuest Institute for Oral Health.

ER visits for tooth problems unrelated to physical injuries for children under 15 years old from 2019 to 2022, according to a report released late last year by CareQuest. And local data reflects that national trend: At Children’s Hospital Colorado in the Denver area, nontraumatic dental cases, such as cavities or gum infections, in its ER increased 175% from 2010 to 2025, according to hospital spokesperson Sarah Bonar. In Kentucky, where Jonah lives, children’s visits to the ER for dental problems rose 72% from 2020 to 2024, according to the state.

Policy changes under the Trump administration are poised to worsen the trend. President Donald Trump’s 2025 federal budget reconciliation law, known as the One Big Beautiful Bill Act, called for billions in cuts from Medicaid, which may force states to limit or drop dental coverage from the public insurance program for those with low incomes or disabilities. New eligibility requirements for Medicaid in some states could affect kids’ access to dental care, even though children are guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even kids with coverage are more likely to have and to go to a dentist.

The Trump administration has also promoted skepticism about fluoride. show that fluoride in drinking water and topical fluoride treatments dramatically reduce tooth decay and prevent cavities. In recent months, the Food and Drug Administration against the use of fluoride supplements and the Environmental Protection Agency of “potential health risks of fluoride in drinking water.” Health and Human Services Secretary Robert F. Kennedy Jr. has called fluoride a “” and “.” A 2025 study in JAMA Pediatrics linked high levels of fluoride with lower IQ in children — but only at concentrations the recommended level in public drinking water.

, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that these anti-fluoride stances will further erode trust in fluoride treatment. Since the start of 2026, lawmakers in at least 15 states have introduced bills prohibiting or limiting fluoride in public drinking water. Utah and Florida in 2025 became the first states to enact fluoride bans.

“Will that have an effect on cavity rates?” Chi asked. “Absolutely.”

Severe Dental Cases Rise

Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More severe cases have become more common, too. Puranik said he used to typically see patients with only one cavity, but now his patients are often coming in with tooth decay throughout their mouth.

During the pandemic, many dental offices , and studies show children also increased , a major risk factor for cavities. Severe cavities that lead to tooth extraction can affect , sometimes causing long-term problems with or .

Millions of people live in in the U.S., with scant dentists within driving distance. On top of that, only treat Medicaid patients, due to low reimbursement rates, which are on average of their typical dental charges, according to the American Dental Association.

Children with intellectual or developmental disabilities may especially struggle to access quality dental care. Few general dentists have sufficient pediatric training to care for kids with disabilities such as Jonah, who are easily overwhelmed or need to be sedated for an exam, , a health information nonprofit that includes Â鶹ŮÓÅ Health News. Over have special health care needs, and those children are to have unmet dental needs. Their parents are also to finding a dentist.

When he was younger, Jonah would not let his parents brush his teeth, which led to cavities in his baby teeth, his mother said. After Jonah’s first visit to the ER, Reynolds found a general dentist with an opening. But unlike a trained pediatric dentist, she said, the dentist did not know how to examine Jonah in a way he could tolerate and wasn’t prepared to provide sedation. Jonah left without treatment and was soon back in the ER when his fever returned.

ERs Rarely Provide Solutions

, a pediatrician in Washington County, Maine, said he is fielding “the most horrifying cavities” at Down East Community Hospital.

ERs are often ill-equipped to treat dental concerns, Weitz said. Similar to the ER Jonah went to in Kentucky, Down East has no dentists on staff. Weitz often finds himself prescribing antibiotics as a temporary measure.

“But a month later, they’re back again because it’s flaring up again,” Weitz said.

As a potential solution, states such as Maine and Alaska are proposing to use money from the $50 billion to develop the oral health workforce or to create specialized dental care centers, which can better serve children with special health care needs on short notice. But those initiatives won’t address the loss of coverage anticipated from Medicaid cuts. California last year in state grants to develop or expand over 120 dental facilities to serve patients with special health care needs.

Jonah’s dental emergency cost Reynolds a week of work from her job as a dog groomer and Jonah three days of third grade, plus hundreds of dollars in out-of-pocket costs.

Eventually, Reynolds found an oral surgeon who extracted the tooth. But even that went poorly, she said. When Jonah became upset over a needle stick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left quickly after the procedure and never gave her a clear diagnosis of what caused Jonah’s pain. The procedure did resolve his toothache, but Reynolds said more professionals should know how to handle cases like Jonah’s, with sensitivity to the families. Four years later, forcing Jonah to take his pain meds still lives fresh in her memory.

“That will never leave my mind,” Reynolds said.

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But when Quinn chipped a tooth and it became infected, she could not find a dentist near her home who would accept her government health coverage and was taking new patients.

She went to an emergency room, receiving painkillers and antibiotics, but she remained in agonizing pain weeks later and paid a dentist $200 to extract the tooth.

Years later, it still hurts to chew on that side, she said, but Quinn — a 34-year-old who has four children and, with her husband, earns about $30,000 a year — still can’t find a dentist nearby.

“You should be able to get dental care,” she said, “because at the end of the day dental care is health care.”

The federal government has long required states to offer dental coverage for children enrolled in Medicaid, the joint state-federal health program for people who are low-income or disabled. Paying for adults’ dental care, though, is optional for states.

In recent years, several states have opted to expand the coverage offered by their Medicaid programs, seeking to boost access in recognition of its importance to overall health. So far, increasing adult dental care is a work in progress: In a sampling of six of those states by Â鶹ŮÓÅ Health News, fewer than 1 in 4 adults on Medicaid see a dentist at least once a year.

But under congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last year, the federal government is expected to reduce Medicaid spending by more than $900 billion over the next decade. The range from about $184 million for Wyoming to about $150 billion for California.

State Medicaid programs typically expand or reduce benefits depending on their finances, and such massive federal cuts could force some to shrink or eliminate what they offer, including dental benefits.

“We will lose all the gains we have made,” said Shillpa Naavaal, a dental policy researcher at Virginia Commonwealth University in Richmond.

Tennessee’s Medicaid program, for instance, spent nearly $64 million on its dental coverage in 2024 and saw a 20% decrease in dental-related ER visits, said Amy Lawrence, the program’s spokesperson.

But under the new law, Tennessee is projected to lose about $7 billion in federal funding over the next decade.

As of last year, 38 states and the District of Columbia offered enhanced dental benefits for adult Medicaid beneficiaries, according to the American Dental Association. Most of the others offer limited or emergency-only care. Alabama is the only state that offers no dental coverage for adult beneficiaries.

Since 2021, 18 states have enhanced their coverage to include checkups, X-rays, fillings, crowns, and dentures, while loosening annual dollar caps for benefits.

Use of dental benefits in states with the enhanced benefits is greater than in states with only limited or emergency coverage, though still low overall, according to with the latest data as of December. No more than a third of adult Medicaid recipients saw a dentist in 2022 in any state.

To review more recent progress, Â鶹ŮÓÅ Health News asked one-third of the states that have expanded their benefits in the past five years for their most recent data on the percentage of adults on Medicaid who visit a dentist at least once a year:

• Maryland — 22% (in 2024)
• Oklahoma — 16% (in 2025)
• Maine — 13% (in 2025)
• New Hampshire — 19% (in 2025)
• Tennessee — 16% (in 2024)
• Virginia — 21% (in 2025)

In comparison, about 50% to 60% of adults with private dental coverage see a dentist at least once a year, according to the ADA.

Nationwide, 41% of dentists reported participating in Medicaid in 2024, a share that has remained stable over the past decade despite the dental benefit expansions in many states, the ADA says. Many participating dentists, though, limit the number of Medicaid enrollees they treat, and some will not accept new patients on Medicaid.

Reimbursement rates have not kept up with costs, deterring dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president at the ADA Health Policy Institute.

Because of a lack of dentists who take Medicaid in southwestern Virginia, the Appalachian Highlands Community Dental Center in Abingdon sees patients who travel more than two hours for care — and must turn many away, said Elaine Smith, its executive director.

The center’s seven residents treated about 5,000 patients last year, most of them on Medicaid. About 3,000 people are on its waitlist, waiting up to a year to be seen.

“It’s sad because they have the means now to see a dentist, but they still don’t have a dental home,” Smith said.

Low-income adults face other barriers to dental care, including a lack of transportation, child care, or time off work, she said.

The inability to see a dentist has consequences broader than tooth pain. Poor dental health can contribute to a host of other significant health problems, such as heart disease . It can also make it harder to do things like apply for jobs and generally lead a healthy life.

Robin Mullins, 49, who has been off and on Medicaid since 2013, said a lack of regular dental visits contributed to her losing her bottom teeth. Unable to find a dentist near her home in rural Clintwood, Virginia, she drives almost 90 minutes to Smith’s clinic — that is, when she can afford to get time away from driving for DoorDash or find help watching her daughter, who has special needs.

She gets by with partial dentures but misses her natural teeth, she said. “It’s absolutely horrible, as you can’t chew your food properly.”

In New Hampshire, though, the challenges have more to do with low demand than a low supply of dentists, said Tom Raffio, chief executive of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added new dentists to its list of participating providers, along with two mobile dental units that traverse the state, he said.

Raffio said Northeast Delta Dental also has publicized the state benefits using radio advertising and social media, among other efforts.

Until 2023, New Hampshire Medicaid covered only dental emergencies.

“Culturally, it’s going to take a while,” he said, “as people just are used to not going to the dentist, or going to the ER when have dental pain.”

Brooks Woodward, dental director at Baltimore-based Chase Brexton Health Care, called Maryland’s rate of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 “pretty good” considering the benefits had been enhanced only since 2023.

Woodward said many adults on Medicaid believe that you go to a dentist only when you’re in pain. “They’ve always just not gone to the dentist, and that’s just the way they had it in their life,” he said.

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The legislation introduced in , , , , , , , and builds on efforts made in other states in past years. This latest push for patient protections comes as the Trump administration has backed away from federal debt protections, health care has become , and more people are expected to go without medical coverage or but riskier high-deductible insurance plans that could lead them into debt.

“In the wealthiest country on Earth, people are going bankrupt, suffering wage garnishment, just because they get sick,” said Colorado state Rep. , a Democrat who introduced legislation on Feb. 19 that would, among other measures, ban wage garnishment for medical debt.

That legislation is under consideration after a Â鶹ŮÓÅ Health News investigation found that courts approved wage garnishment requests in an estimated 14,000 medical debt cases a year in Colorado. The investigation also showed that it isn’t just urban hospitals or big health care chains allowing their patients’ wages to be garnished. It’s also small rural hospitals, physician groups, and public ambulance services, among other medical care providers. And the reporting showed that wage garnishment can erroneously target patients. For example, one family lost wages — and subsequently power to their home, because they couldn’t pay their electric bill — after an ambulance company incorrectly billed the family instead of Medicaid.

Wage garnishment is one tool creditors can use in most states to recoup money from people with unpaid bills. In many states, they can garnish someone’s bank account or put a lien on their home, too. To garnish a person’s wages, a creditor must typically get permission from a court to make the person’s employer hand over a piece of the debtor’s earnings.

“The creditor is taking the money directly out of somebody’s paycheck, and so it doesn’t leave people with any choice to say, ‘I need to prioritize food for my children,’” said , legal and policy director for the National Center for Access to Justice. The center, based at Fordham Law School, and the District of Columbia on how fair their laws are to consumers who get sued over debt.

It is legal to garnish patients’ wages for medical debt in all but a , according to the Commonwealth Fund, a nonprofit foundation based in New York focused on health care.

Now, lawmakers in additional states seek to ban the practice entirely. Others want to limit it by exempting debtors whose household income falls under a certain threshold or by upping the amount of earnings immune from garnishment.

Such policies on wage garnishment fit into a larger push around the country to address the effect of medical debt on people’s lives and finances. Those efforts include barring medical debt from credit reports, prohibiting liens on people’s homes, capping interest rates, and limiting the ability to file lawsuits against people with low incomes over unpaid medical bills.

Debt collectors have fought against such measures, arguing they don’t solve the problem of health care affordability and hurt the ability of medical providers to continue to provide care.

“The wage garnishment process is already highly regulated at the federal and state level and includes many consumer protection measures,” said Scott Purcell, chief executive of warning its clients that the legislation “poses an existential threat,” especially to rural health providers. And Bridget Frazier, a spokesperson for the , said Feb. 20 that the bill “could drive up costs and financial risk for health care providers, making it harder to keep hospitals sustainable and ensuring Coloradans have access to care when they need it most.”

The pending Colorado measure would ban wage garnishment for all patients. It also would limit bank garnishments, in which a patient’s financial institution must hand over a chunk of the money in the person’s account. Additionally, among other things, it would prevent payment plans from exceeding 4% of weekly net income, require creditors to check whether uninsured patients are eligible for public health insurance before collecting, bar creditors from collecting on bills that are more than three years old, and leave medical care providers liable to the patient for at least $3,000 if collectors don’t comply.

“No one is saying, ‘Don’t get paid for your services.’ We’re saying getting health care should not lead to financial ruin for people,” said Dana Kennedy, co-executive director at the Denver-based , a health advocacy group that has been working with lawmakers on the Colorado measure.

Kennedy said that Â鶹ŮÓÅ Health News’ investigation drove home how many kinds of Colorado health care facilities are willing to let this collection practice happen to their patients, and that the people whose wages are being garnished are often working at Family Dollar, Walmart, Amazon, or gas stations and restaurants.

“Medical debt is typically different from other forms of indebtedness,” said Colorado state Sen. , a Democrat co-sponsoring the legislation. “You could choose to keep driving your old car or buy a new one and take on debt for that. You could upgrade your home. You could buy consumer appliances. There’s not usually that voluntary element in a health care context.”

, a senior attorney with the National Consumer Law Center, said broad laws that don’t require patients to jump through hoops to access protections are the most likely to be effective. Because of that, she and other consumer advocates prefer state policies that get rid of wage garnishment for all debtors and all types of debt.

“It can be hard to identify medical debt as medical debt,” Carter said. “For example, if you have a medical debt and you put it on your credit card, it’s not going to be easy for a court system to identify that debt as medical debt.”

She said another reason is that complexity is the enemy of effectiveness. Carter pointed to a showing that even though people in the state can keep $10,000 in their bank accounts safe from garnishment, few consumers take advantage of the protection. They must know the protection exists, know where to find the relevant form, get the form notarized, file it, and mail copies to creditors. The same report found that garnishments can also be burdensome for employers, who must process garnishments and can find themselves in court if they make an error.

Jones, at the National Center for Access to Justice, said outlawing wage garnishment fully, rather than limiting it, has other benefits. “It’s also to protect people’s jobs, because in most states, if somebody has two or more orders of garnishment, they can lose their job for it,” she said.

Still, some lawmakers are pushing for the intermediate route. In Washington state, Democratic state Sen. is spearheading legislation to rope off a larger portion of low-wage earnings from garnishment. So, for example, a person making $1,000 a week would be able to keep their whole paycheck, as opposed to the $800 that the law would currently protect.

Mindy Chumbley, owner of a Washington-based collections company and an ACA International board member, testified against the bill on Feb. 2. “Washington has made sweeping changes to medical debt policy year after year without pausing to study the cumulative impact,” she told lawmakers. “Our clients are reporting clinic closures, urgent care centers shutting down, staffing shortages, and rural facilities struggling to stay open.”

The Washington State Hospital Association said it is neutral on the legislation. The American Hospital Association said it does not take positions on state policies.

Liias told Â鶹ŮÓÅ Health News that lawmakers need to ensure health care providers can recoup their costs while also protecting patients. “We don’t want families either to be driven into bankruptcy or to be driven into under-the-table work to avoid these garnishment thresholds,” he said.

Liias said his measure follows the lead of Arizona, which passed similar consumer protections in 2022. “Obviously, the health care system is still functioning in Arizona, and folks are able to make it work.”

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Those preliminary numbers from the open enrollment period that ended in January are less than a third of what state officials had projected. Nevada is the third state so far to launch a public option plan, along with Colorado and Washington state. The idea is to offer lower-cost plans to consumers to expand health care access.

But researchers said plans like these are unlikely to fill the gaps left by sweeping federal changes, including the expiration of enhanced subsidies for plans bought on Affordable Care Act marketplaces.

The public option gained attention in the late 2000s when Congress considered but ultimately rejected creating a health plan funded and run by the government that would compete with private carriers in the market. The programs in Washington state, Colorado, and Nevada don’t go that far — they aren’t government-run but are private-public partnerships that compete with private insurance.

In recent years, states have considered creating public option plans to make health coverage more affordable and to reduce the number of uninsured people. Washington was the first state to launch a program, in 2021, and Colorado followed in 2023.

Washington and Colorado’s programs , including a lack of participation from clinicians, hospitals, and other care providers, as well as insurers’ rate reduction benchmarks or lower premiums compared with other plans offered on the market.

Nevada law requires that the carriers of the public option plans — Battle Born State Plans, named after a state motto — lower premium costs compared with a benchmark “silver” plan in the marketplace by 15% over the next four years.

But that amount might not make much difference to consumers with rising premium payments from the loss of the ACA’s enhanced tax credits, said Keith Mueller, director of the Rural Policy Research Institute.

“That’s not a lot of money,” Mueller said.

Three of the eight insurers on the state’s exchange, Nevada Health Link, offered the state plans during the open enrollment period.

Insurance companies plan to meet the lower premium cost requirement in Nevada by , which prompted opposition from insurance brokers in the state. In response, Nevada marketplace officials told state lawmakers in January that they will give a flat-fee reimbursement to brokers.

The public option has faced opposition among state leaders. In 2024, a state judge dismissed a lawsuit, brought by a Nevada state senator and a group that advocates for lower taxes, that challenged the public option law as unconstitutional. They have appealed to the state Supreme Court.

Federal Policy Impacts

Recent federal changes create more obstacles.

Nevada is consistently among the states with the of people who do not have health insurance coverage. Last year, in the state received the enhanced ACA tax credits, averaging $465 in savings per month, according to Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News.

But the enhanced tax credits expired at the end of the year, and it that lawmakers will bring them back. Nationwide ACA enrollment has decreased by so far this year, down from record-high enrollment of 24 million last year.

About 4 million people are expected to lose health coverage from the expiration of the tax credits, according to the . An additional 3 million are because of other policy changes affecting the marketplace.

, an associate research professor at the Center on Health Insurance Reforms at Georgetown University, said the changes to the ACA in the Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will make it more difficult for people to keep their coverage. These changes include more frequent enrollment paperwork to verify income and other personal information, a shortened enrollment window, and an end to automatic reenrollment.

In Nevada, the changes would amount to an losing coverage, according to Â鶹ŮÓÅ.

“All of that makes getting coverage on Nevada Health Link harder and more expensive than it would be otherwise,” Giovannelli said.

State officials projected ahead of open enrollment that about 35,000 people would purchase the public option plans. Of the 104,000 people who had purchased a plan on the state marketplace as of mid-January, 10,762 had enrolled in one of the public option plans, according to Nevada Health Link.

Katie Charleson, communications officer for the state health exchange, said the original enrollment estimate was based on market conditions before the recent increases in customers’ premium costs. She said that the public option plans gave people facing higher costs more choices.

“We expect enrollment in Battle Born State Plans to grow over time as awareness increases and as Nevadans continue seeking quality coverage options that help reduce costs,” Charleson said.

According to Â鶹ŮÓÅ, nationally the enhanced subsidies an average of $705 annually in 2024, and enrollees would save an estimated $1,016 in premium payments on average in 2026 if the subsidies were still in place. Without the subsidies, people enrolled in the ACA marketplace could be seeing their premium costs more than double.

Insights From Washington and Colorado

Washington and Colorado are not planning to alter their programs due to the expiration of the tax credits, according to government officials in those states.

Other states that had recently considered creating public options have backtracked. Minnesota officials a public option in 2024, citing funding concerns. Proposals to create public options in Maine and New Mexico also sputtered.

Washington initially saw meager enrollment in its Cascade Select public option plans; only 1% of state marketplace enrollees chose a public option plan in 2021. But that changed after lawmakers with at least one public option plan by 2023. Last year the state reported that 94,000 customers enrolled, accounting for 30% of all customers on the state marketplace. The public option plans were the lowest-premium silver plans in 31 of Washington’s 39 counties in 2024.

found that since Colorado implemented its public option, called the Colorado Option, coverage through the ACA marketplace has become more affordable for enrollees who received subsidies but more expensive for enrollees who did not.

Colorado requires all insurers offering coverage through its marketplace to include a public option that follows state guidelines. The state set premium reduction targets of 5% a year for three years beginning in 2023. Starting this year, premium costs are medical inflation.

Though the insurers offering the public option did not meet the premium reduction targets, enrollment in the Colorado Option has increased every year it has been available. Last year, the state saw record enrollment in its marketplace, with purchasing a public option plan.

Giovannelli said states are continuing to try to make health insurance more affordable and accessible, even if federal changes reduce the impact of those efforts.

“States are reacting and trying to continue to do right by their residents,” Giovannelli said, “but you can’t plug all those gaps.”

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

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In Maine, lawmakers unanimously voted to remove medical debts from credit reports. While a nationwide court ruling has cast doubt on the new law’s future, a consumer rights attorney tells Weissmann why she remains optimistic.

And a law in Oregon aims to prevent corporations and private equity firms from gobbling up medical clinics, raising prices, and, sometimes, delivering worse care.

Plus, the team behind An Arm and a Leg has some good news of its own to share.

Credits

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there–

It has been a long year, and yes, 2026 is shaping up to be a doozy.

As I record this, it’s looking like any hope that Congress will extend certain     Obamacare subsidies for next year are looking like a long shot. Experts say millions of people could lose insurance coverage.

And– not to rub it in– but the federal government actually backtracked this year on another issue we’ve talked about here: Keeping medical debts off of people’s credit reports.

The Biden administration spent years crafting a rule to establish that protection.

The Trump administration has actually said recently: those protections are ILLEGAL.

But states have been enacting laws of their own this year … which means lots of people are still protected. 

And this is where we pick up a series we started a few weeks ago — looking at things that DID NOT SUCK in 2025.

Cuz not only did some states fill in holes left by the feds .Other states were staking out new ground. 

For example, a new law in Oregon goes hard at a core reason why health care keeps costing more all the time: 

Big corporations and investors keep gobbling up more and more medical practices— jacking up prices and  (at least sometimes) delivering significantly crummier care.

Oregon’s new law aims to slam the brakes on that.

In fact, lots of states have done lots of things that did not suck this year.

A few weeks ago, we looked at state laws that push back against some ways insurance companies delay and deny care. 

And new state laws that protect people from getting their homes and their paychecks taken away because of medical debt.

Laws like these passed in lots of states — red states, blue states, purple states. With bipartisan support.

So did laws restricting middleman companies like pharmacy benefit managers from jacking up what people pay for drugs. And laws restricting price-gouging by hospitals.

We’re digging into these few examples to look at how laws like this get made– and defended. 

They take a combination of political work and some hard-core nerding out. And when they pass, laws like Oregon’s become models other states can pick up on.

So, let’s go.

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

Of the half-dozen states that passed laws to keep medical debts from dinging people’s credit, most of them look “blue” on a political map: New Jersey, Rhode Island, California.

But Maine is a little more purple. And Maine’s law passed unanimously.

Here’s State senator Donna Bailey, who sponsored it.

Donna Bailey: I don’t remember a lot of heavy pushback, which was pleasantly surprising to me, quite honestly.

Dan: Surprising because it’s not like just saying “let’s help people with medical debts” guarantees success in Maine. 

Donna Bailey: We did have a bill last session that did not go through and did not have bipartisan support.

Dan: Donna Bailey had sponsored that one too. This time, she was determined to win. When she campaigned for re-election, she promised to go for it. She says her previous bill had been more complicated. This one had a single focus. 

And when it came up in committee, her colleagues heard some compelling testimonies.

Patty Kidder: We pay our mortgage on time every month. But because of unpaid medical bills, we were unable to just go buy a new or used car when the engine blew in our only working vehicle…

Andrea Steward: I began accumulating my own medical debt at 17 when I discovered, which I only discovered on my credit report, when I was trying to purchase my first home in 2022…

Dan: But legislators also heard hard numbers. Fresh numbers, released that very day

From a survey showing that almost half of Mainers were carrying medical debt.

A lot of them wound up with dings on their credit because of it. Which meant — as they said in the survey — medical debt on credit reports was causing them real problems.

Ann Woloson: It’s affecting their ability to get jobs. It’s affecting their ability to buy a car. It’s affecting their ability to rent an apartment. Something needs to be done about it.

Dan: That’s the person who commissioned the survey.

Ann Woloson: I’m Anne Woloson and I’m executive director for Consumers for Affordable Healthcare, a nonprofit, nonpartisan advocacy organization based in Maine.

Dan: How long has the organization been around?

Ann Woloson: We’re gonna be celebrating our 40th anniversary next year.

Dan: Wow. And you haven’t solved the problem of affordable healthcare in 40 years.

Ann Woloson: Nope. Unfortunately. I guess I’m not doing a very good job. Right.

Dan: Well, there might be some countervailing forces.

Dan: Hearing the story behind this bill, I don’t think Ann Woloson is bad at her job.

For years, she’s convened a strategy meeting on Thursday mornings at 9am. Consumer advocates, health care advocates. 

Ann Woloson: We used to meet at the State House pre pandemic, but now we meet over, we meet over Zoom slash telephone. However. Whatever’s easy. Sometimes people are in their car.

Dan: She says in fall 2024, the group started looking ahead to the next legislative session. 

Ann Woloson: We were starting to talk about like what more can we do with medical debt? And somebody probably said, well, I’ve been talking to Senator Bailey and she’s interested in submitting a bill to address the reporting of medical debt to creditors. And we’re all like, oh, that sounds like a great idea. That’s something we can get behind. 

Dan: Ann Woloson found some money in her budget to run a survey — like twelve thousand dollars.

Ann Woloson: Which maybe doesn’t sound like a lot, but for a small nonprofit, that’s a, that’s a lot of money.

Dan: I don’t have it in my pocket. Right? It’s money.

Dan: Ann Woloson says: this was a strategic investment.

Ann Woloson: We will frequently hear from industry representatives that such and such. This is not really a problem. I don’t know where this is coming from.

Dan: And they dismiss individual testimony as a few isolated hard-luck stories.

Ann Woloson: Well, here we have this survey that shows, yeah, medical debt is a problem. So it’s not just something that we’re pulling out and saying is a problem.

Dan: Nobody voted against the bill. Not in committee. Not on the Senate floor, not in the House. It was a better return on investment than Ann Woloson had hoped for. 

Ann Woloson: So there was, I would say, almost a unanimous feeling out there that something needed to be done about this. I wasn’t really expecting that.

Dan: State Senator Donna Bailey says she thinks — along with the survey — the Biden administration’s push on the issue helped. Partly because it raised the issue’s profile.

And partly because the actual rule– finalized just before Biden left office — may have left opponents thinking the stakes were lower. 

Donna Bailey: Some politicians who may have been opposed, were just like, well, it doesn’t matter if we pass something on the state level. It’s already, you know, forbidden at the federal level, so going to put their energies elsewhere.

Dan: On the other hand, advocates like Ann Woloson were looking at something else: The 2024 election results. Joe Biden may have pushed through this rule before leaving office, but he was still… leaving office. 

Ann Woloson: It was in the back of my mind and probably several other people’s minds, that were working on this um, that we needed to codify something in Maine in case something changed at the, at the federal level. 

Dan: Which of course, something did. Within weeks of taking office, the Trump administration effectively shuttered the agency behind the rule: the Consumer Financial Protection Bureau.

By that time, the collections industry had already sued to invalidate Biden’s medical-debt rule.

The Trump administration ?didn’t do much to fight that lawsuit, and over the summer a federal judge found the rule illegal. Donna Bailey and her allies were definitely watching. 

Donna Bailey: We’re like, wow. You know, thank goodness we put something in law at the state level.

Dan: But there was a new potential threat. The judge who zapped the federal rule went farther.

In his ruling, he wrote that not only did the Biden rule violate a law called the Fair Credit Reporting Act– but that same federal law would pre-empt state laws like Maine’s, and nullify them.

Then, a few months later, in October, Trump’s CFPB issued its own legal opinion — basically elaborating on the judge’s reasoning, arguing that, yep: State laws like Maine’s should be tossed.

Which definitely sounds like it sucks.

But here’s where things get good and nerdy.

I don’t think anybody’s been pushing on this issue of medical debts and credit reports longer — or nerding out harder — than Chi Chi Wu. She’s an attorney with the National Consumer Law Center. You’ve heard from her before on this show.

She’s not thrilled about the judge’s ruling, but she says it did not suck as much as news reports at the time suggested. 

Chi Chi Wu: The judge did not quote, unquote, rule that state laws were preempted. 

Dan: She uses a nerdy legal word to describe the judge’s statement about pre-emption: Dicta. Meaning, if I’ve got this right, just talking. Not actually making law on this issue of pre-empting state measures.

Chi Chi Wu: It wasn’t central to the ruling. It wasn’t briefed. He didn’t do any analysis. I mean, preemption under the Fair Credit Reporting Act is really complicated. A little bit head spinning. There’s some case law out there and he didn’t consider any of it because frankly the issue wasn’t really before him. So, that’s the part that didn’t suck as bad as you might think.

Dan: Basically, Chi Chi Wu says, to get rid of those state laws, plaintiffs would have to challenge them in court, one at a time. For the record, she thinks the arguments against those laws are weak.

Chi Chi Wu: But they push it. I mean, they push it and they see if a court will buy their arguments. They often push theories that aren’t supported even by the text of the statute. And sometimes they get away with it, unfortunately. I mean, they have very expensive lawyers that, you know, this is how they earn their big bucks by pushing the law as much as they can in favor of their clients.

Dan: I actually talked with one of those high-priced lawyers recently. Who was not ready to claim victory– or accept defeat in advance. She was like, “These things have to be litigated.”

Which of course has started. Actually, in Maine. 

But Donna Bailey says — based on early proceedings in that case– she’s not worried: 

Donna Bailey: The interesting part was that the court did not put any stay on the legislation, so it was still allowed to go into effect.

Dan: That is, the court hasn’t granted a preliminary injunction, which would have prevented Maine from enforcing the law while the case plays out. Which will take … a while.

And if courts do eventually rule against states like Maine, Chi Chi Wu has legislative tweaks to suggest that could make state laws more lawsuit-proof. 

If you want to nerd out, we’ll have links in our First Aid Kit newsletter.

But now, we’ll look at a state that came out swinging this year in a big new fight:

Oregon passed a law to prevent big corporations and investors from taking over medical clinics and basically strip-mining them for profits.

That’s next. 

This episode of An Arm and a Leg is produced in partnership with Â鶹ŮÓÅ Health News. That’s a nonprofit newsroom covering health issues in America. These folks are amazing journalists. Their reporting wins all kinds of awards every year. We are honored to work with them.

Dan: In the spring of 2024, a news story broke in Oregon that eventually drew national attention. 

News anchor: You called and we listened. We have been getting all kinds of calls and emails from patients who were dropped without any warning. It is our top story tonight. KEZI 9…

Dan: These were patients at Oregon Medical Group, a chain of clinics in the Eugene area. And these patients had just gotten letters in the mail

News reporter: telling them their primary care provider is leaving the medical group and the need to find care somewhere else.

¶Ù²¹²Ô:ÌýOther patients only got the news when they called to make an appointment. 

Over the course of a couple years, more than thirty doctors had quit Oregon Medical Group — and left thousands of patients stranded.

A doctor at one area hospital told a local news outlet more and more Oregon Medical Group patients were starting to show up at the ER. 

Some of them just needed refills on prescriptions, since that their regular doctors were gone. Not fired, it turned out. Quit. 

Ben Bowman: Those doctors left because they didn’t agree with the way the practice was being run. This wasn’t what they signed up for when they went into medicine.

Dan: That’s Ben Bowman. He’s a democratic state rep from the Portland suburbs. 

He says he’s talked with some of those doctors personally. Others talked with reporters. 

They said they’d quit because the practice changed after a takeover by Optum. That’s a name that may sound familiar. Optum is a giant subsidiary of the even-more-giant UnitedHealth Group. 

We’ve talked about Optum more than once on this show because it’s got tentacles in just about every part of healthcare. 

Including running medical practices. These days more than 10 percent of ALL doctors in the US work for Optum. More than for anyone else by huge margins. 

Optum took over Oregon Medical Group in 2020, and — as doctors later told reporters– it ended up making big changes. Doctors said dictates from Optum had them spending less time with each patient, with more patients to see, and, after Optum cut staff, with a ton more paperwork to grind through themselves. 

To top it off, at least some of them said they got socked with pay cuts.

But quitting their jobs meant truly leaving their patients behind. Their contracts had non-compete clauses, so they couldn’t just see their patients somewhere else nearby.

Ben Bowman: Some of them went to work in other areas. Some of them left the state of Oregon. Some of them were so burned out. They said they’re done with medicine.

Dan: News reports say as many as 10,000 patients got left behind. And here’s why Ben Bowman was talking with those doctors — and why he’s the guy you’re hearing from:

By the time those stories hit the news, Ben Bowman and some allies had already been fighting for more than a year to fix what he and others say is the root cause of what happened in Eugene. 

Which is probably going to sound familiar.

Ben Bowman: Over the last 10 to 15 years, there’s been a rapid acceleration of corporate and private equity ownership over medical clinics. 

Dan: These are businesses that owe it to their investors to put profits first. But health care providers are supposed to put patients first. 

Ben Bowman: Those two things are inherently in conflict sometimes and we get to decide as a state: how are we going to resolve that tension? And in Oregon, we want the answer to be that the doctors are making the decision that’s in the best interest of their patient.

Dan: Ben Bowman’s saying “we get to decide as a state” and here’s what “we in Oregon want the answer to be” because this year he and his allies won a big legislative fight.

He talked about how they did it with this show’s senior producer, Emily Pisacreta. 

Ben Bowman: This is probably a much longer story than you’re asking for, but,

Emily: No, I love it. I love it. It’s great.

Dan: Emily? Really long?

Emily: I promise not too long. It starts with an intellectual puzzle. 

Bowman could see that big corporations and private-equity — PE for short — were taking over more and more medical practices. All over, including Oregon. 

Ben Bowman: Now, here’s where it gets weird. Oregon, like many states, most states, has long had a corporate practice of medicine law on the books.

Emily: …that basically says, to own a medical practice, you have to have a medical license. A corporation or group of investors can’t get one of those. 

Ben Bowman: But at the same time, we’re seeing this rapid increase in corporations and PE firms buying clinics. How is that possible if we have a law that says you can’t do that?

Emily: In 2023, Bowman read an article in the New England Journal of Medicine that seemed to offer some answers — and maybe a blueprint for building stronger guardrails. 

One of its authors is Erin Fuse Brown. 

Erin Fuse Brown: …and I am a Professor of Health Services, Policy, and Practice at the Brown University School of Public Health.

Emily: I met Erin back in 2022, when we looked at how private equity firms were buying up gastroenterology practices and raising the prices on colonoscopies. One investor was calling it ‘The Golden Age of Older Rectums.”

Dan: I still love that you found that quote. And Erin helped us with your next story about private equity. Where ER doctors in California were suing to kick a private-equity backed company out of emergency rooms there. 

Emily: The big issue in that case: California’s corporate practice of medicine law. Erin’s a lawyer by training. She was already chewing on this question 

Erin Fuse Brown: We have all these laws in the books. Well, why doesn’t the corporate practice of medicine prevent this?

Emily: And what I love is: That case in California helped her start to crack that question. 

Because she knew that the answers– what Erin calls the nitty gritty stuff — that’s all buried in contracts. Contracts she didn’t have access to. 

Erin Fuse Brown: They tend to be confidential. Um, they’re private contracts. It’s very difficult to see them.

Emily: But now those California contracts were evidence in a lawsuit. So she could study them.

Erin Fuse Brown: That litigation allowed us to get a, a sense of how these contracts are structured. 

Emily: And here’s the basic structure.

Erin Fuse Brown: An entity like a hospital or one Medical or Optum, stands up something called a management service organization.

Emily: A management service organization — MSO for short .

The MSO is ostensibly just there to take care of “back office” stuff — like billing or HR or compliance — to make the business run better. Here’s how they end up actually running the show. 

Erin and others call this the “friendly physician model.”

The MSO brings in a figure-head doctor — the friendly physician–  who works for them as an executive. 

Then the MSO fronts this friendly physician money to buy a majority stake in the practice, which puts the friendly physician in charge of the medical side. 

So on the one hand, they’re an OWNER. They own the practice — thanks to money from the corporate MSO.

And on the other hand, they’re an EMPLOYEE — working for the same corporate MSO. 

Which Erin says is a conflict of interest.?

Erin Fuse Brown: The conflict of interest is that they’re taking all of their marching orders from their ultimate boss, who is the MSO, right? They hit their numbers, then their compensation goes up from the MSO. So they’re really sort of like a business manager who happens to have an MD behind name. 

Emily: I think of it as kinda like… the CIA covertly installing its favored leader in a foreign country Except the leader openly, publicly taking a salary from the CIA. Oh, and maybe has maybe never even been to the country.

Erin Fuse Brown: Like the owner– who has an MD, who has a license and is therefore eligible to own the practice – they may live in a different state. They may never have stepped foot in the practice

Emily: And they start changing the way the practice is run in a way that makes the corporate entity the most money. Even if it’s not great for clinicians and patients. 

Erin Fuse Brown: You’re gonna see patients not in, you know, 15 minute appointments. You’re gonna see them in nine minute appointments.

Emily: And she says they ratchet up the pressure to do things like “upcode” — assign diagnoses with higher-priced billing codes. 

Erin Fuse Brown: The MSO can send sort of notices to, it’s like high performing clinicians saying like, congrats, you get a bonus. Or reminders, like, you’re on the bottom of the list, you’re not hitting your targets. We need you to upcode more. Basically make us more money. And if you don’t, then we’re gonna punish you either by giving you worse scheduling times, we’re gonna dock your pay or, you know, or do other things.

Emily: And then… maybe there’s a non-compete, making it harder to leave, like at Oregon Medical Group.

So Erin and a pair of other researchers published that paper that said — and I’m oversimplifying a bit — that if you want a real ban on the corporate practice of medicine — you need take on these MSOs, and this friendly physician set-up.

After Ben Bowman read that paper, he got in touch with Erin and her colleagues, and eventually they sat down to work together. 

Going into the 2024 legislative session, Bowman had the blueprint. And he had allies — like former Oregon governor John Kitzhaber. Who used to be an ER doc himself.

He got co-sponsors from both parties. And they had a powerful coalition of outside supporters. 

Ben Bowman: We had patient advocacy groups, we had labor unions. We had the Oregon Medical Association. We had the Oregon Nurses Association.

Emily: Of course there were opponents.

Ben Bowman: You can imagine the interests who didn’t wanna see this happen, like basically any large corporation, which includes four of the six largest corporations in America…

Emily: Like UnitedHealth Group. Obviously. But also CVS. Amazon. Not to mention dozens of private equity firms you’ve never heard of. 

He says the bill looked like it would pass — but Republicans blocked it with a last-second parliamentary trick. So it didn’t get a vote. That was March, 2024.

Then, a few weeks later, Oregon Medical Group hit the headlines. 

Ben Bowman: You can imagine the feeling in Eugene. Ten thousand people who get this piece of mail saying you don’t have a doctor anymore, including elderly people who were relying on that primary care doctor to fill their prescriptions and to keep them healthy.

Emily: A few months later, a neighborhood group in Eugene hosted a town hall. 

Ben Bowman: It included legislators. It included leadership of the Oregon Medical Group. It included Optum Oregon leadership,

Emily: Yep, Optum Oregon showed up. And handed Ben Bowman and his allies a talking point. 

Ben Bowman: The head of Optum, Oregon said in that, in that town hall, this quote: 

Dr. Phil Capp, Optum Oregon: …the experiment of having physician directed healthcare in this country over the last 50 or 70 years didn’t work. It didn’t work. So we have to try a new way. 

Emily: Bowman says that line helped make the stakes really clear when he brought his bill back in 2025.

Ben Bowman: What is at stake in the corporate practice of medicine debate is do you want your healthcare decisions when you’re in an exam room being made by a doctor? Or do you agree with what Optum’s stated position was? Which is we think somebody else should be making that decision. Not physicians.

·¡³¾¾±±ô²â:ÌýAnd when the 2025 session started, he had another new advantage: his party tapped him to be majority leader.

Ben Bowman: I think that was really helpful, that this was no longer just like a freshman legislator’s bill. This was the house majority leader saying, this is really important to me and my constituents.

Emily: This time the bill passed by more than two-thirds. The final language has limits. It doesn’t apply to hospitals – which also gobble up tons of medical practices. It doesn’t apply to telehealth providers.  And doesn’t totally ban MSOs. But it makes really clear what MSOs are allowed to do– what kind of decisions they can make. For instance, they can’t limit how long a doctor spends with a patient.

Ben Bowman: a corporate owner, a non-physician, cannot dictate to a doctor “you can only see this patient for 15 minutes.”

Emily: And they can’t make clinicians sign non-compete clauses. Those doctors can fly free if they want. 

And crucially — the new law addresses the conflict of interest in that “friendly physician” figurehead setup. It limits how much control they can have in the medical practice if they’re really working for the MSO.

Erin Fuse Brown says this provision got the most pushback from the industry–– and it’s the one lobbyists are working to prevent in other states.

Erin Fuse Brown: And that’s telling, right? If the industry is most concerned about the dual compensation, dual ownership then that is where the rubber hits the road.

·¡³¾¾±±ô²â:ÌýAnd based on what she learned from Oregon, she’s put together model legislation for other states. 

Which, Ben Bowman says, is something his opponents were afraid of all along. He says out of state companies sent lobbyists to Oregon to fight his bill.

Dan: Whoa. Emily, thank you so much for that story. I love the idea that companies outside of Oregon are already scared that other states will adopt a version of this law. 

We’ll be watching both of these stories in 2026, and others — including stuff we just didn’t get to. 

I mentioned earlier that states moved to restrict pharmacy b  enefit managers, and to restrict price gouging by hospitals. But I don’t think I mentioned that the most aggressive laws on those topics were from two states that show up bright red on political maps: Arkansas and Indiana. 

We’ve gotta get around to that. 

Meanwhile, it was SO heartening to report these stories. Because that meant meeting advocates and legislators from around the country — folks I’d never heard of before, people I’m so glad to have met, because they’re doing so much smart, dedicated work to make things suck less.

Emily: 100% and I will add that I also got to talk with people in states like Colorado and California who have been doing incredible work to lower drug prices on things like insulin and the rheumatoid-arthritis drug Enbrel. 

Following up on what they’ve accomplished and getting those stories on the show is one of the things I’m especially looking forward to in 2026.

Dan: I am so looking forward to having you do that — and speaking of what you’ll be doing in 2026, Emily, I think we’ve actually saved the best news for last.

Anybody who’s been listening to our show recently knows: Like a lot of people, we’ve been SWEATING health insurance for 2026. 

Emily: I mean, I’ve been sweating bullets. I moved to an Obamacare plan this year, and without the enhanced subsidies that are set to expire, I didn’t know how I was supposed to afford those premiums.

Dan: I’ve been sweating too. Because if that happened: Could you afford to actually keep working here part-time? 

We’ve been exploring an alternative: Could you get insurance through An Arm and a Leg? It would be less expensive, and better insurance. 

But we’d need to increase your hours — from 20 hours a week to 30 or more.

Could An Arm and a Leg afford to do that? I didn’t know.

But I ran some numbers last week — looking especially at the donations people have been making since our fundraising season started in November.

And the answer is: YES. People have been so generous so far, I’m ready to make that commitment. 

Emily: We have the all-time greatest community of listeners.

Dan: Seriously. Don’t get me wrong: The numbers so far do not mean we are ALL SET for 2026. 

So, if you’re listening to this, and you’ve been considering making a gift — PLEASE DO IT. We are counting on you. 

Not only so Emily gets better, more-affordable health insurance. But so WE GET FIFTY PERCENT MORE EMILY.

Now, you’ve just heard Emily’s reporting right here. You’ve been hearing it. You know how amazing her work is.

But you may not know: Emily’s also the reason for a lot of OTHER stuff you’ve noticed. 

Like, we brought back our First Aid Kit newsletter this year, and made it weekly? 

You don’t see Emily’s byline on it– because she’s the EDITOR. You don’t wanna hear all the backstage work — on that project and others — but it’s been huge.

Having fifty percent more of Emily’s time is gonna power SO much new work in 2026. You’re going to absolutely love it.

And we definitely need your help to make it happen. 

To make that gift, just go to arm and a leg show dot com, slash support.

Arm and a leg show dot com, slash support.

You may be asking: Hey, Dan, will my gift be MATCHED? I’ve heard you talk about the NewsMatch campaign from the Institute for Nonprofit News. Is that still in effect?

And the answer is: Maybe, if you act fast. You all gave a lot more in November than we expected — which was AMAZING… and it means we have fewer matching dollars left at this point.There are still SOME — but they’re going fast. If you want your gift doubled, head NOW to arm and a leg show dot com, slash, support.

But no matter what, to make this plan work — fifty percent more Emily — every dollar you give us this month counts more than ever. 

Thank you SO much to everybody who’s already given, who’s allowed us to get here, to make this commitment. 

If you haven’t yet, now’s your time: The place to go is arm and a leg show dot com, slash support.

Thank you SO much! We’ll be back with one more episode before the end of the year.

Till then, take care of yourself.

This episode of An Arm and a Leg was produced by me, Dan Weissmann along with Emily Pisacreta — and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

Claire Davenport is our engagement producer.

Sarah Ballema is our Operations Manager. Bea Bosco is our consulting director of operations. 

An Arm and a Leg is produced in partnership with Â鶹ŮÓÅ Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at Â鶹ŮÓÅ, an independent source of health policy research, polling, and journalism.

 Zach Dyer is senior audio producer at Â鶹ŮÓÅ Health News. He’s editorial liaison to this show.

An Arm and a Leg is distributed by KUOW, Seattle’s NPR news station.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially.

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

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