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She Owed Her Insurer a Nickel, So It Canceled Her Coverage

Elisabeth Rosenthal — Mon, 30 Mar 2026 09:00:00 +0000

Last summer, Lorena Alvarado Hill received a series of unexpected medical bills.

A teacher’s aide in Melbourne, Florida, Hill is a single mom who works shifts at J.Crew on the weekends to send her daughter to college. Hill and her mother, who lives with her, had been enrolled in an insurance plan through HealthFirst.

Hill paid nothing toward the premiums for the government-subsidized plan, which previously had covered her scans and other appointments.

Then the bills came.

Hill was on the hook for a $2,966.93 MRI, as well as more than half a dozen doctor visits costing about $200 or $300 each. Without that kind of money on hand, Hill said, she put a few of the bills on payment plans and tried to figure out what had gone wrong.

She discovered, to her surprise, that her insurance had been canceled for “non-payment of premiums.”

The Medical Service

A health insurance plan purchased through the Affordable Care Act federal exchange, healthcare.gov.

The Bill

A monthly premium bill for 1 cent, which in the following months increased incrementally to 5 cents.

The Billing Problem: Small Bill, Big Consequences

Premium subsidies for ACA plans are automatically recalculated every time coverage is changed because of a life event, such as marriage, a change of job, or a child turning 26. In June, Hill removed her mother from the family’s group plan because she turned 65 and became eligible for Medicare and Medicaid.

The change triggered a recalculation of Hill’s monthly premium contribution, increasing it from $0 to 1 cent. She said she thought the amount was so small that she couldn’t pay it with her credit card.

Hill acknowledged she had received some bills that noted, “You may lose your health insurance coverage because you did not pay your monthly health insurance premium.”

But she said that her doctors collected the usual copayments during subsequent visits and that her insurance broker told her not to worry, reassuring her that the plan was “active.” Hill figured the 1-cent monthly premium was probably a rounding error that couldn’t result in termination, she said.

On Nov. 22, she got a letter marked “Important: Your health insurance coverage is ending.” It listed the last day of coverage as July 31, nearly four months before.

“I panicked,” Hill said. “I didn’t sleep that night.”

On Nov. 22, 2025, Hill got a letter informing her that her health insurance had been canceled — listing the last day of coverage as July 31. The terminated policy left her on the hook for thousands of dollars in bills. “I didn’t sleep that night,” she said. (Michelle Bruzzese for �鶹Ů�� Health News)

She made an appointment the next day with her broker, who called HealthFirst for clarification. The news was even worse: Not only had her insurance been canceled, but the 5-cent bill could be sent to a collection agency.

Hill takes out loans to pay her daughter’s college expenses. “I couldn’t have my credit ruined,” she said.

Others have lost their coverage over owing small amounts, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “This woman’s situation is not so unusual with the enhanced subsidies,” she said.

The American Rescue Plan, passed in 2021, increased the amount of government assistance available to ACA plan holders. Those enhanced subsidies, which Congress let expire at the end of last year, meant enrollees with lower incomes had to pay little or nothing toward their premiums.

The Biden administration found that, in 2023, about 81,000 subsidized ACA insurance policies were terminated because the enrollee owed $5 or less. Nearly 103,000 more were canceled for owing less than $10.

To prevent that kind of coverage loss, most likely hitting people with little income, Biden administration health officials to allow ACA enrollees to retain coverage if they owed less than $10, or less than 95% of premium costs.

Insurers were required to keep insurance active for a 90-day “grace period” to give enrollees time to respond. That’s why Hill’s doctors initially took her copayments and sent no bill, as if nothing had changed.

That Biden administration “flexibility” rule took effect Jan. 15, 2025, though not every insurer opted to offer leniency to those owing small amounts.

The Trump administration removed the rule on Aug. 25, eliminating the protection entirely in the name of combating fraud and abuse.

The Resolution

Alarmed by the cancellation, the thousands of dollars in bills, and the threat of collections over 5 cents, Hill researched insurance law and fought back.

She filed a complaint in December with HealthFirst and the Florida Department of Financial Services asking for a write-off of her 5-cent balance and retroactive restoration of her policy, citing state and federal laws that seemed to apply to her situation.

In particular, she wrote, “creditors are not required to collect, and consumers are not required to pay, credit-card balances of $1.00 or less,” adding that “all major insurers and payment processors in Florida follow a 1-cent write-off policy.”

She noted that HealthFirst’s policy was to respond to complaints in 30 days.

Thirty days came and went, but Hill said she heard nothing in response — and new bills from her canceled policy kept coming.

Despite her frustration, Hill said, all her doctors were contracted with HealthFirst, so she reenrolled for 2026.

Lance Skelly, a spokesperson for HealthFirst, initially said the case “is still in the appeals/grievance process.” In a follow-up email, he said HealthFirst had in canceling Hill’s policy.

“Stepping back from what’s legal, this is just ridiculous,” Corlette said.

Weeks after a reporter’s query to the insurer, Hill said she looked at her billing statements for all the medical services she received in 2025 and was pleasantly surprised that the balances owed had been adjusted to $0.

But she said she would also like HealthFirst to cover what she had paid and still owed toward the bills she’d put on payment plans.

Hill and her mother were enrolled together in a health plan purchased through the federal Affordable Care Act exchange. Hill removed her mother from the plan when she became eligible for Medicare and Medicaid, but the change triggered a recalculation of her monthly premium contribution, increasing it from $0 to 1 cent. She said the amount was so small that she couldn’t figure out how to pay for it with her credit card. (Michelle Bruzzese for �鶹Ů�� Health News)

The Takeaway

Even small bills can have major consequences.

With the automation of more health billing decisions, irrational results have become increasingly common.

“One cent?!” Hill said. “No human would do this!”

It can be tempting to dismiss the notice of a tiny debt, but it’s important to take it seriously. Contact the insurer and get a human involved.

And while insurance policies have grace periods allowing coverage to remain in place if you miss a payment, some are not very long. For subsidized ACA marketplace plans, the period is 90 days, but others last just 30 or 45.

Missing one payment can mean losing coverage. So it’s important to keep a close eye on premiums to make sure they’re paid.

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

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

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‘They Tricked Me’: A Father Was Chained After He Went to ICE To Reunite With His Kids

Claudia Boyd-Barrett — Tue, 24 Mar 2026 09:00:00 +0000

Carlos arrived at an Immigration and Customs Enforcement office in New Mexico in December, believing he was one step closer to reuniting with his children. By that point, his 14-year-old son and 16-year-old daughter had been in a federal shelter in Texas for nearly a year after crossing the border to be with him.

“I feel like I’m suffocating inside this shelter, trapped with no way out,” Carlos’ son said, according to one of the teens’ attorneys, when asked to describe how he felt after months at the Houston-area facility. “Every day, the same routine. Every day, feeling stuck. It makes me feel hopeless and terrified.”

During daily video calls, Carlos, who had temporary protected status, urged the siblings to be patient, to trust the process. Federal officials had vetted Carlos before he could be granted custody and told him his case was complete. He believed he would soon be back with his children, who, like him, had sought refuge from political violence in Venezuela.

An immigration officer called Carlos on a Friday and asked him to attend a meeting at an ICE office the following Monday to discuss reunification with his children. Once Carlos arrived, officers tried to force him to sign documents he said he didn’t understand. When he refused, they stripped off his clothes, seized his ID and belongings, and chained him by the neck, waist, and legs.

“They tricked me,” Carlos said in a phone call from an immigration detention center in El Paso, Texas, where he was held for several months. “They used my children to grab me,” he said.

In reporting on the family’s story, �鶹Ů�� Health News reviewed court documents, spoke with the family’s immigration attorneys, interviewed Carlos, and reviewed statements from his children, translated from Spanish. Carlos is a pseudonym, being used at the request of attorneys concerned that speaking out could jeopardize Carlos’ immigration case or further delay his reunion with his family.

Using Children to Arrest Parents

Since 2003, the Department of Health and Human Services’ Office of Refugee Resettlement has cared for immigrant children under 18 who arrive in the country without their parents, often fleeing violence, abuse, or trafficking. The office, which in February had more than 2,300 children in shelters or with foster families across the country, is supposed to promptly release them to vetted caregivers, typically parents or other family members already living in the country.

Congress placed this responsibility with the health agency over 20 years ago to prioritize the well-being of unaccompanied children and separate their care from immigration enforcement priorities.

Now the second Trump administration is using migrant children held by the resettlement office to lure their parents, such as Carlos, whether or not they have a criminal record. A �鶹Ů�� Health News investigation found the resettlement office, , coordinates with the Department of Homeland Security to arrest people seeking custody of migrant children.

Arrest documents show Homeland Security Investigations, the arm of the agency that normally focuses on organized criminals and traffickers, will interview parents or other caregivers then arrest them if they are in the country illegally. Before Donald Trump returned to the White House, the resettlement office prohibited data sharing and collaboration with immigration enforcement, and it did not deny caregivers custody of children solely because of their immigration status. Those last year.

It’s unclear exactly how many caregivers have been baited into arrest. LAist indicating more than 100 have been arrested while trying to get their kids out of detention, but �鶹Ů�� Health News could not independently verify that number with federal agencies.

Since February, the Department of Health and Human Services, Department of Homeland Security, and Justice Department have not responded to questions about caregiver arrests. Prior to leaving DHS last month, Assistant Secretary Tricia McLaughlin said the administration protects children from being released to people who shouldn’t care for them. Andrew Nixon, an HHS spokesperson, referred questions related to immigration enforcement to DHS.

At the same time, the resettlement office has that make it harder for caregivers to gain custody of unaccompanied children. These include narrowing the range of accepted documents, requiring fingerprint-based background checks for every adult in the home and backup caregivers, and requiring in-person appointments to verify identification documents, sometimes with ICE agents present. The requirements keep “children safe from traffickers and other bad, dangerous people,” Nixon said.

As of January, the agency had detained at least 300 children already placed with vetted sponsors and asked their caregivers to reapply, according to the National Center for Youth Law and the Democracy Forward Foundation. The advocacy groups filed calling these actions “a quieter, new form of family separation.”

Reverse Separation

Dulce, a Guatemalan mother in Virginia, said her 8-year-old son was sent to a government shelter after he was detained during a traffic stop last summer while visiting family members in a different state.

At first, Dulce expected to get her son back within days — she had passed the government’s sponsorship requirements in 2024 and was reunited with him three weeks after he first crossed the border. But resettlement agency officials asked her to repeat the entire process and resubmit documents, Dulce said. It took eight months to get him back.

Dulce is a pseudonym being used at her request because she fears speaking out could get her deported.

At one point, Dulce was told to attend an interview at an ICE office to show her identification as part of the process of reuniting with her son. She refused out of fear that she too might be detained, because she doesn’t have legal status. She believes ICE agents visited her home at one point.

“I stopped going home,” Dulce said. “I lived with some of my friends for days.”

Even though she lived just 45 minutes away, Dulce was allowed to visit her son only twice a month.

Until recently, most unaccompanied children landed in government custody after being detained at the border. But border crossings started to fall in 2024, and the number of people coming to the U.S. has dropped precipitously in President Trump’s second term.

Now, hundreds of kids have been taken to government shelters after being swept up inside the country, often during immigration raids or traffic stops, according to the advocates’ lawsuit. Many were already living with relatives, including guardians already vetted by the resettlement agency.

Releases have grinded nearly to a halt. According to the resettlement office, children in its custody stayed in government shelters or foster care for an average of one month in 2024. As of February, that had jumped to more than half a year.

When children do get released, it’s often only after their attorneys file a lawsuit in federal court challenging their detention as unconstitutional.

Authorities released Dulce’s son to her in February after the boy’s attorneys filed such a petition. Dulce said she’s relieved to have him back but still anxious that ICE could show up at their house.

Immigrants at Risk

During Trump’s first term, his administration was criticized for of children who had been released from custody. President Joe Biden was blamed for how his administration processed a surge of unaccompanied children that peaked in 2021 with about 22,000 in the resettlement office’s custody. Though most children were placed with legitimate sponsors, some were placed with people who hadn’t cleared , putting them at risk of .

The Trump administration says it is checking on those , and the Justice Department has prosecuted . On March 1, Homeland Security Secretary Kristi Noem, who is set to leave her role at the , touted a , including the resettlement office, that DHS said had tracked down 145,000 unaccompanied children who had been placed with caregivers during Biden’s term.

Yet internal HHS reports about that initiative obtained by �鶹Ů�� Health News show that nearly 11,800 of those migrant children and nearly 500 of their caregivers were arrested as of Jan. 29. Only 125 of those migrant children and 55 of those caregivers were arrested for alleged criminal activity, suggesting the majority were for immigration violations.

HHS referred questions about the figures in the reports to DHS, which did not respond to requests for comment about the data. However, Michelle Brané, who was a DHS official in the Biden administration, said the figures show that most of the arrests were to detain and deport migrants. Previously, the administration targeted parents and caregivers who had paid for children to cross the border, trying to levy smuggling charges against them.

“They have really dropped that pretense in a lot of ways, and they are going for anyone openly,” Brané said. “These numbers clearly reflect that this is not about public safety or about safety of the children.”

Case on Hold

Carlos left Venezuela in 2022 because of death threats and, like thousands of others fleeing that country, was granted what’s called temporary protected status under the Biden administration. That protection for most Venezuelans by the Trump administration.

In January 2025, days before Trump was sworn in for his second term, Carlos’ children crossed the border from Mexico to the U.S., turned themselves over to border authorities, and were immediately placed in the resettlement agency’s custody. Carlos spent months submitting paperwork to reunite with them. He said he’s their only parent, because their mother left when they were toddlers.

Officials visited his home twice and determined he was fit to care for them, according to court documents petitioning for his release from detention. He passed DNA testing, proving he’s the biological father, one of his attorneys said. His arrest documents show he has “no criminal history.” In July, Carlos was told his reunification case was complete and being sent for approval. But then, with little explanation, the case was put on hold.

Before his arrest by ICE, Carlos said, he drove 14 hours each way from his home to visit his children. Once there, he could see them for only one hour. When he was in detention, he said, he spoke to them about every two weeks in quick, monitored phone calls.

He’s trying to stay hopeful, but it’s hard.

According to documents completed by ICE officers during his arrest and submitted in his court case, Carlos was arrested under an initiative called Operation Guardian Trace, which requires immigration officers to detain potential caregivers if they are in the country without legal authorization and recommend that they be deported.

“This operation is designed to force parents to make an impossible choice between reuniting with their children and seeking safety,” said one of Carlos’ attorneys, Chiqui Sanchez Kennedy of the Galveston-Houston Immigrant Representation Project, a nonprofit that helps low-income immigrants.

‘I’m Going to Wait’

In March, a federal judge said officials had unlawfully detained Carlos and he was released on bond.

But his children still face an uncertain future for now. Government shelters often lack sufficient resources, , and social workers say lengthy stays in these facilities can result in additional trauma.

“Not only is it bad, full stop, but the longer you’re there, the worse it gets,” said Jonathan Beier, associate director of research and evaluation for the Acacia Center for Justice’s Unaccompanied Children Program, which coordinates legal services for unaccompanied minors.

Carlos’ children could also be sent back to the country they fled. Because of his detention, Carlos will have to redo much of the process to reunite with them, according to an attorney for the children, Alexa Sendukas, also with the Galveston-Houston Immigrant Representation Project.

In statements shared through Sendukas, Carlos’ daughter said she no longer wants to be around others and spends most of the time in her room. His son, now 15, described having panic attacks and feeling that he’s missing out on life, whether it’s the opportunities he longs for — to learn English, to study science — or watching basketball with his family.

An attorney holds up a drawing of Rapunzel by Carlos’ daughter, who said she spends most of her time in her room, feeling isolated like the “Tangled” movie character. (Abigail Gonsoulin)

“I remember when I first arrived at this shelter, I was so hopeful and had faith that I would be reunited with my dad soon,” he said.

Carlos’ daughter spent the day crying in bed when the siblings learned their father had been detained. For days, they didn’t know where he was. Now, they fear the only way out is through adoption or foster care.

“I am afraid,” she said. “I’m going to wait for my dad forever.”

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As Health Companies Get Bigger, So Do the Bills. It’s Unclear if Trump’s Team Will Intervene.

Elisabeth Rosenthal — Mon, 10 Nov 2025 10:00:00 +0000

A cancer patient might live in a town with four oncology groups, but only one accepts his insurance — the one owned by his insurer. A young couple could see huge bills after their child is born, because their insurer agreed to the health system’s rates in exchange for a contract with obstetricians across the country. A woman might have to pay a big sum she can’t afford for basic lab tests at a hospital — inflated rates her insurer accepted so its customers have access to the system’s children’s hospital elsewhere in the state.

And even well-insured patients receive unaffordable bills in this era of high-deductible health plans, narrow insurance networks, and 20% cost sharing.

Health systems, doctor groups, and insurers are merging and coalescing into ever-bigger giants. While these mergers are good for business, studies show the escalating consolidation in health care is driving up prices, harming patient outcomes, and decreasing choice for people who need care. A recent study found that six years after hospitals acquired other hospitals, they had by 12.9%, with hospitals that engaged in multiple acquisitions raising their prices by 16.3%.

These new deals are “mutually enforced monopolization,” said Barak Richman, the Alexander Hamilton professor of business law at George Washington University. “It’s not competition. It’s more like collusion. They don’t care about price.”

Those market factors contributed to a landscape where a dose of the antiviral Paxlovid given in a hospital ; magnetic resonance imaging ; and joint replacements .

President Donald Trump has talked about the burden of health care costs since his first campaign, but he has signaled that his administration’s regulators are less inclined than his predecessor’s to intervene in health mergers.

This summer, President Joe Biden’s that all federal agencies make sure markets remain competitive, reversing course from Biden’s more expansive interpretation of antitrust law. And in a scathing statement upon taking over the Federal Trade Commission, Trump-appointed chair Andrew Ferguson , implying that she had overstepped the agency’s legal authority, as well as criticizing what he called her “clumsy” and “breathless” rhetoric and her focus on the incursion of private equity into health care.

What this will mean in practice is unclear.

In an interview with �鶹Ů�� Health News, Daniel Guarnera, the director of the FTC’s Bureau of Competition, said that the leadership at the FTC and the Justice Department has endorsed guidelines issued by the Biden administration, which he characterized as a “framing device” for companies contemplating a merger.

The expanded , issued in 2023, focused for the first time on a wide variety of new types of anti-competitive practices that had become common in health care, such as hospitals and private equity firms buying doctors’ practices and insurers owning what are known as specialty pharmacies to dispense complicated and often expensive drugs.

Guarnera noted that regulators’ strongest enforcement tool is convincing a judge that mergers violate the Clayton Antitrust Act, a statute that is the foundation of antitrust law. But administrations can interpret this statute differently, and it’s unclear what cases the Trump administration’s FTC will choose to bring.

“The Biden administration tried to be more innovative,” said a professor of health services, policy, and practice at Brown University’s School of Public Health. “The Trump administration has signaled a more traditional approach — that it’s unwilling to push the envelope.”

In the battle for profits between insurers and providers, each side insists it needs to grow bigger to hold sway in the negotiations that determine health care prices. But evidence shows the prices that make sense in industry-level dealmaking have little to do with the actual value of the services involved. Instead, they’re merely a data point in large-scale calculations that, at best, reflect the power balance between opposing parties.

Under Trump, the FTC has already sued to block two mergers of medical-device makers and has continued the Biden administration’s challenges of individual drug patents.

“Helping improve the health care system though ensuring that there is more and better competition are very, very high priorities for us at the FTC,” Guarnera said, noting that health care has “enormous effects on both Americans’ pocketbooks as well as well-being.”

But it is far more difficult to take on the more massive entities, and though the number of new mergers dipped as companies navigated the uncertain effects of tariffs and interest rates, consolidation continues.

A recent identified “28 large health systems growing bigger,” noting, “This is not an exhaustive list.”

For example, in May, Northwell Health of New York Connecticut’s Nuvance to become a 28-hospital behemoth with over 1,000 outpatient clinics. That was a more traditional merger, where hospitals in the same region joined to extend their reach and increase their market power.

Meanwhile, companies are creating powerhouses not previously seen in health care, by racking up smaller purchases that aren’t expensive enough to trigger federal review. They include what are known as vertical mergers, which combine companies that provide different functions in the same industry — most commonly, hospital systems or insurers buying doctors’ practices or specialty pharmacies.

For instance, UnitedHealth Group, the , now owns health insurance plans; physician practices and other providers; data and analytics services; payment processors; a pharmacy benefits manager; and pharmacies themselves. Jonathan Kanter, the competition czar in Biden’s Justice Department, has likened the UnitedHealth amalgamation to Amazon.

Likewise, hospital systems and private companies — often private equity firms — are increasingly expanding their reach to different regions, gobbling up hospitals, medical practices, and surgery centers. This kind of consolidation, known as a , allows companies to accumulate huge collections of doctors — and significant market power — across the country in particular specialties, such as gastroenterology, ophthalmology, pediatrics, or obstetrics.

Research shows a change in ownership means a change in prices. While pediatrics and obstetrics have traditionally been poorly paid specialties, for instance, they represent a land of opportunity to investors because parents are willing to pay more when it comes to care for their kids.

It used to be relatively simple for regulators to discern when a hospital that merged with its nearby competitor gained monopoly power, rendering it anti-competitive and driving up prices. Health researchers say these new, more complicated types of deals, creating a more complex interplay between insurers and medical providers, have made that tipping point to define.

In health care, even more traditional, vertical consolidation can be problematic, Richman said. “Economic theory says it could be innocuous, like a suit manufacturer opening a store, even though studies show in health care it’s dangerous — higher prices, poorer quality, less choice,” he said.

For example, patients who have Cigna health plans and need an array of more expensive, often injectable prescriptions must use Accredo, the specialty pharmacy in 2018, even though a different pharmacy may have a better price.

Economists have developed computer modeling to predict when patients will experience higher prices and less choice because of these new types of consolidation. But judges who could nix the transactions are so far “not convinced,” said Daniel Arnold, a health economist at Brown’s School of Public Health.

Experts such as Fuse Brown say new laws and enforcement tools are needed.

“The old laws,” she said, “are just not calibrated to the complexity and novel types of mergers.”

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Guns, Race, and Profit: The Pain of America’s Other Epidemic

Fred Clasen-Kelly — Tue, 19 Aug 2025 09:00:00 +0000

BOGALUSA, La. — Less than a mile from a century-old mill that sustained generations in this small town north of New Orleans, 19-year-old Tajdryn Forbes was shot to death near his mother’s house.

She found Forbes face down in the street in August 2023, two weeks before he had planned to move away from the empty storefronts, boarded-up houses, and poverty that make this one of the most troubled places in the nation.

Naketra Guy thought about how her son overcame losing his father at age 4 and was the glue of the family. She called him “humble” and “respectful,” a leader in the community and on the football field, where he shined.

Yet he could not outrun the grim statistics of his hometown. Bogalusa posts some of the worst health outcomes and poverty in Louisiana, a state that routinely ranks among the worst nationally in both. And Bogalusa has endured another indicator of poor public health: high levels of gun violence.

Since the beginning of the covid-19 pandemic, gun violence has shattered any sense of peace or progress here. Louisiana suffers the nation’s second-highest firearm — and Bogalusa, a predominantly Black community with 10,000 residents, has seen dozens of shootings and a violent crime rate approaching twice the national average.

A nearby team refused to play football at Bogalusa High School in fall 2022, .

Boarded-up buildings in downtown Bogalusa, Louisiana. Once known as “the Magic City” because of its giant mill and fast growth, the town now struggles with empty storefronts and blight. (Fred Clasen-Kelly/�鶹Ů�� Health News)

Bogalusa’s mayor, Tyrin Truong, was elected in 2022 at age 23 on his promises to fix entrenched challenges: few youth programs and good jobs, and perpetual crime and blight.

“I ran for mayor because I got sick of seeing our city painted as mini-New Orleans,” he said, “due to the high levels of youth gun violence.”

In January, the Louisiana State Police , accusing him of soliciting a prostitute and participating in a drug trafficking ring that allegedly used illicit proceeds to buy firearms. He has . “I still haven’t been formally arraigned,” he told �鶹Ů�� Health News in late July, “and I haven’t been charged with anything.”

Every year tens of thousands of Americans — — are killed by gun violence on the scale of a public health epidemic.

Many thousands more are left to recover from severe injuries, crushing medical debt, and the mental health toll of losing loved ones.

Most headlines focus on America’s urban centers, but the numbers also reflect the growth of gun violence in places like Bogalusa, a pinprick of a town 75 miles north of New Orleans. In 2020, the gun violence death rate for rural communities than in large metropolitan areas, according to Johns Hopkins University.

Firearms are the No. 1 killer of children in the U.S., and no group suffers more than . More Black boys and men ages 15 to 24 in 2023 than from the next 15 leading causes of deaths combined. Though overall U.S. homicides after the pandemic ended, adolescent gun deaths climbed even higher in the years after, according to , an associate professor in the School of Public Health at Boston University.

“It has all the markers of an epidemic. It is a major driver of death and disability,” Jay said. “Gun violence does not get the attention it deserves. It is underrecognized because it disproportionately impacts Black and brown people.”

Rather than bolstering efforts to save lives, federal, state, and local government officials have undermined them. �鶹Ů�� Health News undertook an examination of gun violence since the pandemic, a period when firearm death rates surged. Reporters reviewed government reports and academic research and interviewed dozens of health policy experts, activists, and victims or their relatives. They reviewed corporate earnings reports from gun manufacturers and to politicians.

In polling published in 2023 by �鶹Ů��, said they or a family member had been impacted by gun violence such as by seeing a shooting or being threatened, injured, or killed with a gun.

American politicians and regulators have put in place laws and practices that have helped enrich firearm and ammunition manufacturers — which tout — even as already damaged by white flight, systemic disinvestment, and other forms of racial discrimination.

President Donald Trump championed gun rights on the campaign trail and has from the National Rifle Association, , “No one will lay a finger on your firearms.” His administration has rolled back efforts under President Joe Biden to address the rise in gun violence.

Emboldened in his second term, Trump to in schools, weaken federal oversight of the gun industry, override state and local gun laws, permit sales , and cut funding for violence intervention.

Trump to review all Biden administration actions that “purport to promote safety but may have impinged on the Second Amendment rights of law-abiding citizens.”

The Biden administration said “” during the pandemic took its greatest toll on racially segregated and high-poverty neighborhoods.

Black youths in four major cities were as white ones to experience a firearm assault, research showed. Gun suicides reached an all-time high, and for the first time the firearm suicide rate among older Black teens surpassed that of older white teens.

In Bogalusa, the pandemic gun violence spread fear. Among the victims killed were a 15-year-old attending a birthday party and a 24-year-old nationally known musician. Thirteen people were injured at a memorial for a man who himself had been shot. Residents said neighbors stopped sitting in their yards because of stray bullets.

Researchers say communities like Bogalusa endure a collective trauma that shatters their sense of safety. Two years after , his mother says that when she leaves home her surviving children worry that she, too, might get shot.

Repercussions from the surge will last years, researchers said: Exposure to shootings increases risk for post-traumatic stress disorder, anxiety, suicide, depression, substance abuse, and poor school performance for survivors and those who live near them.

“We saw gun violence exposure go up for every group of children except white children, in the cities we studied,” Jay said. “Limits on government funding into gun violence research may stop us from ever knowing exactly why.”

Politics of Pain

The year before Forbes died in Bogalusa, Biden signed into law the Bipartisan Safer Communities Act, considered the in decades.

In a matter of months, Trump has systematically dismantled key provisions.

Efforts to regulate guns have long proven ineffective against the power of political and business interests that fill the streets with weapons. In 2020, the number of guns manufactured annually in the U.S. hit 11.3 million, more than double a decade earlier, according to . In 2022, the United States had nearly 78,000 , more than its combined number of McDonald’s, Burger King, Wendy’s, and Subway locations, according to Everytown for Gun Safety, an advocacy group.

A customer looks at a handgun at a gun shop in Capitol Heights, Maryland, in 2023. (Andrew Caballero-Reynolds/AFP via Getty Images)

The Biden administration it would attempt to reduce gun violence by adopting a “zero tolerance” policy toward firearm dealers who committed violations such as failing to run a required background check or selling to someone prohibited from buying a gun.

The federal Bureau of Alcohol, Tobacco, Firearms and Explosives, or ATF, which licenses gun dealers, has the authority to enforce laws meant to prevent illegal gun sales. In issuing an executive order, the Trump administration , under Biden, the agency targeted “mom-and-pop shop small businesses who made innocent paperwork errors.”

From October 2010 to February 2022, the agency conducted more than 111,000 inspections, recommending revocation of a dealer’s license only 589 times, about 0.5% of cases, an inspector general’s report said. Even when it cited serious violations, the ATF rarely shut dealers down.

ATF leaders that recommendations for license revocations increased after Biden’s zero-tolerance policy was implemented. In April, the Trump administration .

Surgeon General Vivek Murthy last year declared firearm violence a public health crisis. Within weeks of Trump’s inauguration, the advisory. Of the 15 leading U.S. causes of death, firearm injuries received less research funding from the National Institutes of Health for each person who died than all but poisoning and falls, according to in 2024 by Brady, an anti-gun violence organization. that funding, too.

Trump’s Department of Justice abruptly cut 373 grants in April for projects worth about $820 million, with a large share from gun violence intervention.

“We are going to lose a generation of community violence prevention folks,” said Volkan Topalli, a gun violence researcher at Georgia State University. “People are going to die, I’m sorry to say, but that is the bleak truth of this.”

Asked about its policies, the White House did not address questions about public health considerations around gun violence.

“Illegal violence of any sort is a crime issue, and President Trump has been clear since Day One that he is committed to Making America Safe Again by empowering law enforcement to uphold law and order,” White House spokesperson Kush Desai said.

President Donald Trump gives his inaugural address after being sworn in on Jan. 20. (Rosa Pineda/U.S. Senate)

Trump administration officials “want safer streets and less violence,” Topalli said. “They are hurting their cause.”

Garen Wintemute, an emergency medicine professor who directs the violence prevention program at the University of California-Davis, was among the first in the nation to consider guns and violence as a public health issue. He said race plays a significant role in perceptions about gun violence.

“People look at the demographic risk for firearm homicide and depending on the demographics of the people in the audience, I can see the transformation in their faces,” Wintemute said. “It’s like they’re saying, ‘Not my people, not my problem.’”

Eroding Gun Restrictions

Trump’s incursions against public health efforts to contain gun violence are backed by lobbying power.

Firearm industry advocacy groups made millions of dollars in political donations in recent years, mostly to conservative causes and Republican candidates. That includes $1.4 million to Trump, , which tracks campaign finance data.

The assassination of civil rights icon the Rev. Martin Luther King Jr. helped lead to the passage of the federal , which imposed stricter licensing rules and outlawed the sale of firearms and ammunition to felons.

While it remains the law of the land, over time, federal and state government actions have significantly weakened its protections.

Most states now concealed weapons without a permit or background check, even though the practice can increase the risk of firearm homicides.

In Louisiana, Democratic former Gov. John Bel Edwards, in office from 2016 to 2024, that would have allowed people to carry concealed firearms without a permit.

Elected in 2023, Republican Gov. Jeff Landry to allow any person over age 18 to conceal-carry without a permit.

The Trump administration has created his executive order to end most gun regulations and which would allow more people with criminal convictions, including for domestic abuse, to own guns.

Figures vary, but some researchers estimate as many as 500 million guns circulate in the U.S. Sales reached during the pandemic and publicly traded firearm and ammunition companies saw .

Donald Trump Jr. this summer of GrabAGun, an online gun retailer that went public in July under the stock ticker PEW. In a , the company, which markets guns to people ages 18 to 44, cited “ organizations that oppose sales of firearms and ammunition” as threats to its sales growth.

Donald Trump Jr. is a board member of GrabAGun, an online gun store that went public on the New York Stock Exchange under the ticker PEW. (Michael Nagle/Bloomberg via Getty Images)

Dave Workman, a gun rights advocate with the , said firearms are not to blame for the surge in pandemic shootings.

“Bad guys are going to do what bad guys are going to do regardless of the law,” Workman said. “Taking away gun rights is not going to reduce crime.”

David Yamane, a Wake Forest University sociology professor and national authority on guns, said the U.S. firearm debate is complex and the industry is often “painted with too broad a brush.”

Most guns will never be used to kill anyone, he said. Americans tend to buy more guns during times of unrest, Yamane added: “It’s part of the American tradition. Guns are seen as a legitimate tool for defending yourself.”

‘A Low Level of Hope’

Once called “,” Bogalusa has become a grim symbol of deindustrialization.

Bogalusa emerged as Black people formed their own communities in the time of Jim Crow racial segregation at the turn of the 20th century.

Racism concentrated Black people in neighborhoods that , reflected in high rates of cancer, asthma, chronic stress, preterm births, pregnancy-related complications — and, over recent decades, .

Thousands flocked to Bogalusa after the Great Southern Lumber Company built one of the world’s biggest sawmills, establishing Bogalusa as a company town. Racial tensions .

Racial tensions followed the growth of Bogalusa in the 20th century. Charles Sims, a leader in the Deacons for Defense and Justice, a civil rights group, holds up replicas of Ku Klux Klan attire in Bogalusa in 1966. (Bettmann/Getty Images)

Members of the local gained national attention in the 1960s for protecting civil rights organizers from the Ku Klux Klan, that burned houses and churches, terrorizing and killing Black people.

As the mill changed hands over the decades, Bogalusa’s fortunes slid. In the mid-20th century, the population surpassed 20,000, but it is now about half that.

International Paper, based in Tennessee, runs the mill as a containerboard factory, employing about 650 people. In 2021, the state announced incentives for the company that included a $500,000 tax break, saying the move would help bring “prosperity.”

International Paper, a Fortune 500 company, operates a containerboard mill in Bogalusa that was once one of the largest sawmills in the world. (Fred Clasen-Kelly/�鶹Ů�� Health News)

A few blocks from the containerboard mill, the main drag in Bogalusa is littered with empty storefronts and boarded-up buildings. (Fred Clasen-Kelly/�鶹Ů�� Health News)

Businesses remain boarded up along the main drag. Houses still bear damage from Hurricane Katrina, and many streets are eerily quiet.

Nearly 1 in 3 people in Bogalusa live in poverty — 2½ times the national average.

Bogalusa’s violent gun crime rate people in 2022, higher than Louisiana’s and 1.7 times the national one, according to the nonprofit Equal Justice USA, citing FBI Uniform Crime Reporting data.

In many rural towns across the South, “there is a level of desperation that is more apparent” than in other parts of the U.S., said , a of social justice and public policy.

“They don’t have the same infrastructure to have robust social services. People are like, ‘What are my life chances?’” Shaefer said. “People feel like there is nothing that can be done. There is a low level of hope.”

Bogalusa emerged as a battleground for civil rights in the 1960s. James Farmer (far right), national director of the Congress of Racial Equality, walks in a Bogalusa protest in 1965. (Bettmann/Getty Images)

Missed Opportunities

Mayor Truong lamented the violence in Bogalusa after Forbes was killed, , “When are we as a community going to come together and decide enough is enough?”

The federal government had offered one path forward.

The Biden administration provided billions of dollars to local governments through the American Rescue Plan Act during the pandemic. Biden urged them to deploy money to community violence intervention programs, shown to by as much as 60%.

A handful of cities seized the opportunity, but most did not. Bogalusa has received since 2021. None appears to have gone toward violence prevention.

Abandoned houses dot parts of Bogalusa. Mayor Tyrin Truong, who was elected in 2022 at age 23, has promised to reduce crime and blight that plague parts of this community 75 miles north of New Orleans. (Fred Clasen-Kelly/�鶹Ů�� Health News)

The Louisiana legislative auditor, Michael Waguespack, found that Bogalusa used nearly $500,000 for employee bonuses, which his report said may have violated state law. In some cases, says, payments were not tied to work performed.

Bogalusa officials did not respond to a public records request from �鶹Ů�� Health News seeking detailed information about its ARPA money.

Former Mayor Wendy O’Quin-Perrette, who served from 2015 through early 2023, told Waguespack that the city used ARPA money to improve streets and pay the bonuses. “We would not have done it without being sure it was allowed,” she said.

O’Quin-Perrette did not respond to requests for comment.

In a to Waguespack, O’Quin-Perrette’s successor, Truong, wrote that Bogalusa officials didn’t know how the federal money was spent. When he took office, Truong alleged, officials discovered “tens of thousands of dollars of checks and cash” stashed “in various drawers and on desks” in city offices.

Truong defended his stewardship of ARPA funds, saying that about $1 million remained when he assumed office but that the money was needed for more urgent sewer infrastructure repairs. “I wish we could have invested more, invested any money in gun violence prevention efforts,” he said.

In an interview, Truong said the city has been “intentional” about bringing down gun violence, including through a summer jobs program. He pointed to statistics that show homicides decreased from nine in 2022 to two in 2024. “If you keep them busy, they won’t have time to do anything else,” he said.

Asked about his January arrest, Truong said he has political enemies.

“I’m the only Democrat in a very red part of the state, and, you know, I’ve made a lot of changes at City Hall, and that ticks people off,” Truong told �鶹Ů�� Health News. He said that he ended long-standing city contracts with local businesspeople. “When you’re shaking up power structures, you become a target.”

Josie Alexander, for , said city officials missed an opportunity when they didn’t use ARPA funds for gun violence prevention. “The sad thing is people here can now see that money was coming in,” she said. “But it just wasn’t used the way it needed to be.”

‘Too Much Trouble Here’

Truong said the city is still reeling from the . He said he was at Bogalusa High School’s homecoming football game in 2022 when one teen shot another. Shots rang out, Truong said, and he grabbed his 3-month-old son and “laid in the bleachers.”

“It’s not a foreign topic to hardly anybody in town, whether you’ve heard the gunshots in the distance, whether you have attended a funeral of somebody who passed due to gun violence,” he said. Many still grapple with trauma.

In December 2022, Khlilia Daniels said, she hosted a birthday party for her teenage niece, praying no one would bring a gun.

The hosts checked guests for weapons, she said.

Yet gunfire erupted, Daniels said. Three teens were shot, including , who died, according to police.

“When someone you know is killed, you never forget,” said Daniels, 32, who held Taylor until emergency responders arrived.

Khlilia Daniels tried to help save a 15-year-old boy who was fatally shot in Bogalusa in December 2022 at a birthday party for her niece. “When someone you know is killed, you never forget,” she says. (Fred Clasen-Kelly/�鶹Ů�� Health News)

Tajdryn Forbes was planning his future when he , likely because of a dispute that started on social media over lyrics in a rap song, Guy said.

In a in January, Bogalusa police said they had arrested someone in connection with Forbes’ killing. Authorities had the arrest of a teen in connection with the homicide.

Forbes had been a high school football standout, like his late father, Charles Forbes Jr., who played semipro. When Forbes scored a touchdown, he would look to the sky to honor his dad.

The school praised Forbes for his senior baseball season in : “This young man makes a difference on our campus and on the field with his strong character.”

When hopes for a college football scholarship did not pan out, Forbes worked as a deckhand for a marine transportation company. He saved money, looking forward to moving to Slidell, a suburb of New Orleans.

“He would always say, ‘There’s too much trouble here’” in Bogalusa, Guy recalled.

Tajdryn Forbes had been a high school football standout, like his late father, Charles Forbes Jr., who played semipro. When Forbes scored a touchdown, he would look to the sky to honor his dad. (Kevin Magee)

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Immigrant Kids Detained in ‘Unsafe and Unsanitary’ Sites as Trump Team Seeks To End Protections

Sandy West — Wed, 30 Jul 2025 09:00:00 +0000

A child developed a rash after he was prevented from changing his underwear for four days. A little boy, bored and overcome with despair, began hitting himself in the head. A child with autism and attention-deficit/hyperactivity disorder was forced to go without his medication, despite his mother’s pleas.

“I heard one officer say about us ‘they smell like sh–,’” one detained person recounted in a federal court filing. “And another officer responded, ‘They are sh–.’”

Attorneys for immigrant children collected these stories, and more, from youth and families detained in what they called “prison-like” settings across the U.S. from March through June, even as the Trump administration has requested a federal district court judge terminate existing protections that mandate basic rights and services — including safe and sanitary conditions — for children held by the government.

The administration argues that the protections mandated under what is known as the Flores Settlement Agreement encourage immigration and interfere with its ability to establish immigration policy. U.S. District Court Judge Dolly Gee, who is in California, is expected to issue a ruling on the request after an Aug. 8 hearing.

With the agreement in place, children are being held in “unsafe and unsanitary” U.S. Customs and Border Protection facilities such as tents, airports, and offices for up to several weeks despite the agency’s written policy saying people generally should not be held in its custody longer than , according to the from immigrants’ attorneys. In the U.S. Department of Justice’s May request to terminate the Flores consent decree, the attorneys demanded more monitoring for children in immigration detention.

“The biggest fear is that without Flores, we will lose a crucial line of transparency and accountability,” said , executive director of the California-based Center for Human Rights and Constitutional Law. “Then you have a perfect storm for the abuse of individuals, the violation of their rights, and the kind of treatment that this country doesn’t stand for.”

The has set minimum standards and oversight for detained immigrant children since 1997, when it brought an end to a decade-long lawsuit filed on behalf of unaccompanied immigrant minors who had been subjected to poor treatment in unsafe and unsanitary conditions without access to medical care. It is named for Jenny Lisette Flores, a 15-year-old from El Salvador who was taken into U.S. custody in the mid-1980s, subjected to strip searches, and housed alongside unrelated men.

The agreement established national standards for the protection of immigrant children detained by federal authorities, with requirements for safe and sanitary detention facilities, access to clean water, appropriate food, clothing, bedding, recreational and educational opportunities, sanitation, plus appropriate medical and mental health care. Children in immigrant detention range from infants to teens.

In 2015, Gee ruled that the agreement includes children accompanied by adults.

The Justice Department and the Department of Homeland Security, which includes both the Customs and Border Protection agency and Immigration and Customs Enforcement, declined to respond on the record to questions about the administration’s intent to end the Flores agreement or about the conditions in which kids are detained. In a , government attorneys argued, among other points, that the agreement improperly directs immigration decisions to the courts, not the White House. U.S. Attorney General Pam Bondi also that the Flores agreement has “incentivized illegal immigration,” and that Congress and federal agencies have resolved the problems Flores was designed to fix.

ICE detention facilities have the “highest standards,” Abigail Jackson, a White House spokesperson, said in an email to �鶹Ů�� Health News. “They are safe, clean, and hold illegal aliens who are awaiting final removal proceedings.”

Immigration lawyers and researchers have on the idea that the Flores agreement encourages migration, arguing that the conditions in people’s homelands are driving them to move.

Trump is not the first president to seek to modify, or end, the agreement.

In 2016, President Barack Obama’s administration unsuccessfully sought to exempt accompanied minors from the Flores agreement, arguing that an influx of immigrants from Central America had overwhelmed the system.

In 2019, following a , the first Trump administration announced it would replace Flores with new regulations to expand family detention and eliminate detention time limits. The courts rejected that plan, too.

In 2024, President Joe Biden’s administration successfully requested to remove the Department of Health and Human Services from the agreement after the Office of Refugee Resettlement incorporated some Flores standards into agency regulations.

Allegations of unsafe conditions under the agreement also predate this latest immigration crackdown under Trump. One court filing from 2019 said that attorneys visiting two Texas detention centers found at least 250 infants, children, and teens, some of whom had been held at the facility for nearly a month. “Children were filthy and wearing clothes covered in bodily fluids, including urine,” the filing said.

Seven children are while in federal custody from 2018 to 2019, according to media reports.

And in 2023, 8-year-old Anadith Danay Reyes Alvarez became while in Customs and Border Protection custody in Texas for nine days. Her parents had turned over medical records detailing the girl’s medical history, including diagnoses of sickle cell disease and congenital heart disease, upon their detention. Yet her mother’s repeated pleas for emergency medical care were ignored.

Her family filed a in May.

Advocates attributed the deaths partly to prolonged detention in increasingly crowded facilities and delayed medical care. Officials have said they and in the wake of the deaths.

But with the Trump administration’s unprecedented push to detain and deport migrants — including families — the threat to the health of children caught up in those sweeps is alarming child advocates.

“Very rarely do you have spikes in populations of detained folk that you don’t see a drastic decrease in the quality of their medical care,” said Daniel Hatoum, a senior supervising attorney at the , one of the groups that filed the wrongful death claim for Anadith’s family.

Recent reports from court-appointed monitors cite continued ; temperature extremes; recreational opportunities; and clothing; and an inability to dim lights to sleep.

Terminating the Flores agreement would remove all outside oversight of immigration detention facilities by court-ordered monitors and attorneys. The public would have to depend on the government for transparency about the conditions in which children are held.

“Our system requires that there be some oversight for government, not just the Department of Homeland Security, but in general,” Hatoum said. “We know that. So, I do not believe that DHS could police itself.”

In the months after Trump took office and the Elon Musk-led Department of Government Efficiency began cuts, DHS’ Office for Civil Rights and Civil Liberties, the Office of the Citizenship and Immigration Services Ombudsman, and the Office of the Immigration Detention Ombudsman, which were intended to add a layer of oversight. After a lawsuit, the Trump administration , but it is unclear how those offices have been affected by shifts in policy and cuts in staffing.

Leecia Welch, an attorney with the legal advocacy group , said the Flores agreement itself, or efforts to hold the government responsible for abiding by its requirements, are not rooted in partisan politics. She said she raised concerns about conditions during Biden’s administration, too.

“These are not political issues for me,” Welch said. “How does our country want to treat children? That’s it. It’s very simple. I’m not going to take it easy on any administration where children are being harmed in their care.”

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Trump Voters Wanted Relief From Medical Bills. For Millions, the Bills Are About To Get Bigger.

Noam N. Levey — Fri, 25 Jul 2025 09:00:00 +0000

President Donald Trump rode to reelection last fall on voter concerns about prices. But as his administration pares back federal rules and programs designed to protect patients from the high cost of health care, Trump risks pushing more Americans into debt, further straining family budgets already stressed by medical bills.

Millions of people are expected to lose health insurance in the coming years as a result of the tax cut legislation Trump signed this month, leaving them with fewer protections from large bills if they get sick or suffer an accident.

At the same time, significant increases in health plan premiums on state insurance marketplaces next year will likely push more Americans to either drop coverage or switch to higher-deductible plans that will require them to pay more out-of-pocket before their insurance kicks in.

Smaller changes to federal rules are poised to bump up patients’ bills, as well. New federal guidelines for covid-19 vaccines, for example, will to stop covering the shots for millions, so if patients want the protection, some may have to pay out-of-pocket.

The new tax cut legislation will also raise the cost of certain doctor visits, requiring copays of up to $35 for some Medicaid enrollees.

And for those who do end up in debt, there will be fewer protections. This month, the Trump administration secured permission from a federal court to that would have removed medical debt from consumer credit reports.

That puts Americans who cannot pay their medical bills at risk of lower credit scores, hindering their ability to get a loan or forcing them to pay higher interest rates.

“For tens of millions of Americans, balancing the budget is like walking a tightrope,” said Chi Chi Wu, a staff attorney at the National Consumer Law Center. “The Trump administration is just throwing them off.”

White House spokesperson Kush Desai did not respond to questions about how the administration’s health care policies will affect Americans’ medical bills.

The president and his Republican congressional allies have brushed off the health care cuts, including hundreds of billions of dollars in Medicaid retrenchment in the mammoth tax law. “You won’t even notice it,” at the White House after the bill signing July 4. “Just waste, fraud, and abuse.”

But consumer and patient advocates around the country warn that the erosion of federal health care protections since Trump took office in January threatens to significantly undermine Americans’ financial security.

“These changes will hit our communities hard,” said Arika Sánchez, who oversees health care policy at the nonprofit New Mexico Center on Law and Poverty.

Sánchez predicted many more people the center works with will end up with medical debt. “When families get stuck with medical debt, it hurts their credit scores, makes it harder to get a car, a home, or even a job,” she said. “Medical debt wrecks people’s lives.”

For Americans with serious illnesses such as cancer, weakened federal protections from medical debt pose yet one more risk, said Elizabeth Darnall, senior director of federal advocacy at the American Cancer Society’s Cancer Action Network. “People will not seek out the treatment they need,” she said.

Trump promised a rosier future while campaigning last year, and “expand access to new Affordable Healthcare.”

Polls suggest voters were looking for relief.

About 6 in 10 adults — Democrats and Republicans — say they are worried about being able to afford health care, according to , outpacing concerns about the cost of food or housing. And medical debt remains a widespread problem: As many as 100 million adults in the U.S. are burdened by some kind of health care debt.

Despite this, key tools that have helped prevent even more Americans from sinking into debt are now on the chopping block.

Medicaid and other government health insurance programs, in particular, have proved to be a powerful economic backstop for low-income patients and their families, said Kyle Caswell, an economist at the Urban Institute, a think tank in Washington, D.C.

Caswell and other , for example, that Medicaid expansion made possible by the 2010 Affordable Care Act led to measurable declines in medical debt and improvements in consumers’ credit scores in states that implemented the expansion.

“We’ve seen that these programs have a meaningful impact on people’s financial well-being,” Caswell said.

Trump’s tax law — which will slash more than $1 trillion in federal health spending over the next decade, mostly through Medicaid cuts — is expected to leave 10 million more people without health coverage by 2034, according to the from the nonpartisan Congressional Budget Office. The tax cuts, which primarily benefit wealthy Americans, will add $3.4 trillion to U.S. deficits over a decade, the office calculated.

The number of uninsured could spike further if Trump and his congressional allies don’t renew additional federal subsidies for low- and moderate-income Americans who buy health coverage on state insurance marketplaces.

This aid — enacted under former President Joe Biden — lowers insurance premiums and reduces medical bills enrollees face when they go to the doctor or the hospital. But unless congressional Republicans act, those subsidies will expire later this year, leaving many with bigger bills.

Federal debt regulations developed by the Consumer Financial Protection Bureau under the Biden administration would have protected these people and others if they couldn’t pay their medical bills.

The agency issued rules in January that would have removed medical debts from consumer credit reports. That would have helped an estimated 15 million people.

But the Trump administration chose not to defend the new regulations when they were challenged in court by debt collectors and the credit bureaus, who argued the federal agency had exceeded its authority in issuing the rules. A federal judge in Texas appointed by Trump ruled that the regulation should be scrapped.

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Trump’s ‘One Big Beautiful Bill’ Lands in Senate. Our 400th Episode!

Thu, 05 Jun 2025 18:30:00 +0000

The Host

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

After narrowly passing in the House in May, President Donald Trump’s “One Big Beautiful Bill” has now arrived in the Senate, where Republicans are struggling to decide whether to pass it, change it, or — as Elon Musk, who recently stepped back from advising Trump, is demanding — kill it.

Adding fuel to the fire, the Congressional Budget Office estimates the bill as written would increase the number of Americans without health insurance by nearly 11 million over the next decade. That number would grow to approximately 16 million should Republicans also not extend additional subsidies for the Affordable Care Act, which expire at year’s end.

This week’s panelists are Julie Rovner of �鶹Ů�� Health News, Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Panelists

Jessie Hellmann CQ Roll Call

Alice Miranda Ollstein Politico

Lauren Weber The Washington Post

Among the takeaways from this week’s episode:

Even before the CBO released estimates of how many Americans stand to lose health coverage under the House-passed budget reconciliation bill, Republicans in Washington were casting doubt on the nonpartisan office’s findings — as they did during their 2017 Affordable Care Act repeal effort.
Responding to concerns about proposed Medicaid cuts, Iowa Sen. Joni Ernst, a Republican, this week stood behind her controversial rejoinder at a town hall that “we’re all going to die.” The remark and its public response illuminated the problematic politics Republicans face in reducing benefits on which their constituents rely — and may foreshadow campaign fights to come.
Journalists revealed that Health and Human Services Secretary Robert F. Kennedy Jr.’s report on children’s health may have been generated at least in part by artificial intelligence. The telltale signs in the report of what are called “AI hallucinations” included citations to scientific studies that don’t exist and a garbled interpretation of the findings of other research, raising further questions about the validity of the report’s recommendations.
And the Trump administration this week revoked Biden-era guidance on the Emergency Medical Treatment and Active Labor Act. Regardless, the underlying law instructing hospitals to care for those experiencing pregnancy emergencies still applies.

Also this week, Rovner interviews �鶹Ů�� Health News’ Arielle Zionts, who reported and wrote the latest “” feature, about a Medicaid patient who had an emergency in another state and the big bill he got for his troubles. If you have an infuriating, outrageous, or baffling medical bill you’d like to share with us, .

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

Julie Rovner: �鶹Ů�� Health News’ “,” by Katheryn Houghton, Jazmin Orozco Rodriguez, and Arielle Zionts.

Alice Miranda Ollstein: Politico’s “,” by Alice Miranda Ollstein.

Lauren Weber: The New York Times’ “” by Emily Badger and Margot Sanger-Katz.

Jessie Hellmann: The New York Times’ “,” by Isabelle Taft.

Also mentioned in this week’s podcast:

NOTUS.org’s “,” by Emily Kennard and Margaret Manto.
The Washington Post’s “,” by Lauren Weber and Caitlin Gilbert.

click to open the transcript Transcript: Trump’s ‘One Big Beautiful Bill’ Lands in Senate. Our 400th Episode!

Future of Cancer Coverage for Women Federal Firefighters Uncertain Under Trump

Kylie Mohr — Fri, 28 Feb 2025 10:00:00 +0000

It took nearly three years to win presumptive workers’ compensation coverage for breast, cervical, and other cancers that firefighters who work for federal agencies may develop because of hazardous exposures on the job.

Now, just weeks after the Labor Department added coverage for those illnesses, firefighters worry the gains may be in jeopardy after the Trump administration deleted information about the expansion of coverage for cancers that mostly affect women and transgender firefighters from a federal webpage and ducked questions about whether it will uphold the policy change made in the waning days of the Biden administration.

“It’s really important to continue to focus on ensuring that those who devote their lives to protecting the public and communities continue to receive coverage through the special claims unit,” said Pete Dutchick, a federal firefighter and volunteer with the advocacy group Grassroots Wildland Firefighters.

The Labor Department’s special claims unit, , processes all federal firefighter claims and provides a streamlined path for those with covered conditions. Wildland firefighters and advocacy groups representing them celebrated that year when federal officials moved to expedite workers’ compensation coverage of cancers tied to their jobs. It was recognition that the dangers of battling wildfires extend long after a blaze is extinguished.

The list of cancers federal officials tagged for streamlined claims processes through the Labor Department’s Office of Workers’ Compensation Programs included esophageal, colorectal, prostate, testicular, kidney, bladder, brain, lung, thyroid, multiple myeloma, non-Hodgkin’s lymphoma, leukemia, mesothelioma, and melanoma.

But that initial jubilation soured when it became clear that breast, ovarian, cervical, and uterine cancers were excluded, creating a coverage gap for more than 2,700 people, or about 16% of the more than 17,000 federal wildland firefighters working for the Forest Service and the Interior Department. These are firefighters who are dispatched to federal lands, like in national forests and national parks, and sometimes , as they did when fires swept into Los Angeles in January.

“At first glance, we were ecstatic,” Dutchick said. “And then we’re like, ‘Well, where are the female cancers?’”

Dutchick, who has an 8-year-old daughter, was upset. “I certainly want her to have equal protections when it comes to health if she chooses to get into a field of public service,” he said.

Then this year, as the Biden administration wound toward a close, federal officials addressed the exclusion, adding the cancers to the list in a last-minute change before Donald Trump took office.

“This policy change acknowledges the unique occupational hazards faced by women firefighters and ensures they receive the care and support they deserve,” Christopher Godfrey, the now-former director of the workers’ compensation office, said in a Jan. 6 statement on the Labor Department’s website.

In a statement to �鶹Ů�� Health News four days later, Godfrey said the policy change resulted in immediate action for firefighters with new claims.

But in the early days of the Trump administration, the January press release announcing the cancer coverage expansion was deleted from the Labor Department website. When asked whether claims were still being processed for the four recently added cancers, a spokesperson for the workers’ compensation office, Frances Alonzo, told �鶹Ů�� Health News, “We do not have any additional updates regarding your inquiry.”

Formalizing the policy change through rulemaking will take months and support from Congress.

Kaleena Lynde is among a generation of women firefighters who developed cancer before streamlined coverage for workers’ compensation claims existed. In 2006, Lynde, then 22, was diagnosed with small cell ovarian cancer during her third fire season on the Shasta Lake Hotshots, an elite crew of firefighters in Northern California. Doctors removed a 5.4-pound tumor almost immediately that year. She’s now cancer-free, but only after multiple surgeries, chemotherapy, and an additional cervical cancer diagnosis three years later. Lynde has since gone on to work various jobs for the Forest Service, including 16 years at Eldorado National Forest doing fire investigation, fire prevention, and dispatch center jobs. She now coordinates wildfire apprenticeships for the agency’s Pacific Southwest region.

A friend recently sent her a link to the , a database tracking the prevalence of diseases among all firefighters, both structural and wildland. It made Lynde wonder — could her cancers be connected to her work on the fire line?

“I just thought I had bad luck,” Lynde said.

Seeking to fix the omission, more than 15 wildland firefighter advocacy groups, representing Hotshot crews, smokejumpers, and others, signed a September letter to Julie Su, the acting labor secretary at the time. They pointed out that other countries, , already included presumptive coverage for cervical, ovarian, uterine, and breast cancers.

The Labor Department implemented that eased the requirements for covering wildland firefighters’ cancer-related workers’ compensation claims in April 2022 through a Federal Employees’ Compensation Act bulletin. The rules were codified in December 2022 when President Joe Biden signed the National Defense Authorization Act.

To qualify, firefighters must have worked for at least five years and be diagnosed within 10 years of their last exposure. Those with unlisted cancers could still file claims through a special unit but wouldn’t receive the same streamlined adjudication for compensation. By September 2024, the workers’ compensation office had received 91 claims for qualifying cancers and heart and lung conditions. Of those, 89 were adjudicated through the special claims process and 84, or 94%, were accepted. Godfrey said that prior to the legislation, only 29% of occupational disease claims for firefighters were accepted.

Rachel Granberg, a wildland firefighter in Washington state, said streamlined processing and reimbursements are important. “It really gives people more bandwidth to worry about how they’re going to manage their life after a cancer diagnosis, rather than just fighting for basic health care.”

Too often firefighters end up crowdsourcing for financial support after cancer diagnoses, she said.

George Broyles, retired firefighter and Forest Service researcher, said that health risks are too often seen as part of the job. “Hazard pay is not going to stop cancer,” he said. Broyles wants federal firefighting agencies to be honest about cancer risks when hiring young workers and then educate them on ways to protect themselves.

The recent policy change meant claims for federal wildland firefighters with ovarian, breast, or uterine cancer were immediately directed to the special claims unit and expedited processing.

The Labor Department’s decision to change course and expand presumptive coverage to female reproductive cancers was sudden. In December, the agency released a statement to �鶹Ů�� Health News saying such a change was unwarranted.

Three weeks later — without pointing to any new published research — the agency changed course, citing additional consultation with the National Institute for Occupational Safety and Health and with Steven Moffatt, a doctor who specializes in firefighter illnesses. The agency conducts periodic reviews to consider adding new conditions to its coverage.

The Labor Department’s initial exclusion of female reproductive cancers illuminated the repercussions of research on wildland firefighter health in which women are understudied. that only three out of 20 studies evaluated women firefighters’ cancer risk.

But research has confirmed for years that firefighters are exposed to toxic dangers. A Florida firefighters for almost 20 years in the 1980s and 1990s found that firefighting increases the overall cancer risk in female firefighters. In 2022, the International Agency for Research on Cancer as a cancer-causing occupation.

Recent research contributed to the agency’s inclusion of female reproductive cancers, Godfrey said. In 2023, a link between perfluorononanoic acid, a type of PFAS, and uterine cancer. PFAS, which stands for per- and polyfluoroalkyl substances, are a category of chemicals that in the protective gear worn by wildland firefighters. has also linked PFAS exposure to an increase in melanoma. in September identified 12 chemicals that firefighters are exposed to on the job linked to breast cancer.

But now, it’s unclear whether the Trump administration will roll back the new coverage, leaving some federal firefighters unsure whether exposures on the job will leave them scrambling for care.

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Biden Rule Cleared Hurdles to Lifesaving HIV Drug, but in Georgia Barriers Remain

Rebecca Grapevine, Healthbeat — Thu, 06 Feb 2025 10:00:00 +0000

ATLANTA — Latonia Wilkins knows she needs to be on PrEP due to her non-monogamous lifestyle. But the 52-year-old Atlanta mother has faced repeated challenges getting the lifesaving drug that can prevent new HIV infections.

Years ago, Wilkins was dating a man newly diagnosed with HIV and went to get tested, she said, but was not offered PrEP.

Since then, Wilkins said, doctors either have told her she doesn’t need the drug or were reluctant to prescribe it. Her insurance through work would not cover a long-acting injectable form that tends to have better results than the original pill form. Getting to appointments across Atlanta for the pills was a challenge. She is now enrolled in a drug trial for a promising PrEP injection but worries about future access and cost.

Preexposure prophylaxis, known as PrEP, reduces the risk of new HIV infections through sex by 99% and among injectable drug users , according to the Centers for Disease Control and Prevention.

Among states, Georgia has the of new HIV infections, but residents — especially women and Black patients like Wilkins — are often not getting PrEP, data shows.

A rule enacted by the Biden administration that took effect for many Affordable Care Act plans on Jan. 1 should make it easier for people like Wilkins to get long-acting PrEP injectable drugs.

A new Trump administration adds an X factor to this and other federal health programs. On Jan. 27, the White House announced a federal funding freeze, which sent shudders through health agencies and nonprofits. By Jan. 29, it had reversed the order.

Federal initiatives like the and HIV prevention funding seemed to be affected — and “blocking access to PrEP would have deadly consequences,” said Wayne Turner, a senior attorney at the National Health Law Program.

Georgia has big in PrEP uptake, said Patrick Sullivan, who is an epidemiology professor at Emory University and leads AIDSVu and PrEPVu, which track HIV data and access to the drug — work that is backed by Gilead Sciences, a PrEP drug manufacturer.

Public health experts use what’s called a “PrEP-to-need ratio” to measure how many people at risk of HIV are getting the drug. A higher number is better. In Georgia for 2023, the statewide ratio was 6, while it was nearly 167 in Vermont, .

While the ratio for white people in Georgia was roughly 22, it was about 3 for Black people and just over 3 for Hispanic people. And while it was 7 for men, it was just over 2 for women.

“Black people generally are underserved by PrEP, and women are underserved by PrEP relative to men,” Sullivan said.

Increasing PrEP uptake would help the state cut its new HIV diagnoses, said Dylan Baker, associate medical director at Grady Health’s HIV Prevention Program.

Georgia’s rate of new HIV diagnoses was 27 per 100,000 in 2022, according to the most recent available data. That’s second only to Washington, D.C., and more than double the national rate of 13 per 100,000. That amounts to about 2,500 new cases diagnosed in Georgia in a year.

Globally about 3.5 million people used PrEP in 2023, up from 200,000 in 2017 but short of the United Nations’ 2025 target of 21.2 million people, by the United Nations Program on HIV/AIDS.

PrEP users in Atlanta report many challenges in getting the drug, including cost, medical providers who don’t prescribe it, stigma, a lack of inclusive marketing, and transportation. Wilkins said she has run up against all of those.

“Here I am telling you that I’m here to get tested because I have come into contact with someone who was living with HIV, and we had a sexual relationship, and you’re not even mentioning PrEP to me,” Wilkins said. “That was a disservice.”

Insurers Now Required To Cover PrEP

Cost has long been a barrier. The Biden administration last fall requiring most insurers to cover the full cost of all forms of PrEP, without prior authorization, along with certain lab work and other services. This includes pills as well as Apretude, an injection given every two months.

That means insured PrEP users should not face , said Carl Schmid, executive director of the , which lobbied for the rule.

It applies to those on the federal marketplace plans and most large private health plans. A similar rule exists for Medicare and Medicare Advantage plans.

Schmid said he does not think the Trump administration will repeal the rule, but he is concerned the U.S. Supreme Court could end coverage for preventive services, including PrEP, when it issues a decision in , anticipated this summer.

The rule will not help the uninsured. In Georgia, which did not expand Medicaid under the ACA, about are uninsured.

“The cost is also a struggle, especially given different people are part of the gig economy, a lot of folks don’t always have access to health insurance,” said Maximillian Boykin, an Atlanta PrEP user.

Expanding Medicaid would help. States that have done so, Sullivan said, “have higher levels of PrEP uptake.”

Winning the PrEP Lottery

Since getting on PrEP in 2019, Wilkins has encountered two doctors who did not want to prescribe it.

One female OB-GYN told her “‘Girl, at our age, we should know better.’” Wilkins said , telling her that such comments are stigmatizing.

When Wilkins moved, she looked for a nearby primary care provider so she would not have to pay for transportation to get PrEP.

But the doctor she found, Wilkins said, told her to find an infectious disease specialist for PrEP.

“‘You’re not treating an infectious disease,’ I say. ‘This is preventive care,’” Wilkins recalled.

Wilkins’ fortunes turned when she was selected to join a study for a twice-yearly injectable form of PrEP.

Latonia Wilkins, an Atlanta mother, has faced several challenges accessing PrEP, an HIV prevention drug. (Darriyhan Edmond)

Lenacapavir, already approved for HIV treatment, showed promising results for HIV prevention in . Wilkins is part of a trial in Atlanta including about 250 cisgender women nationally who have sex with men.

It’s much better than a daily pill or even a shot once every two months, Wilkins said.

She hopes to stay on the drug, but the U.S. list price for lenacapavir as an HIV treatment averages about $40,000 a year.

Gilead last year announced it signed royalty-free licensing agreements with six manufacturers to make generic lenacapavir for 120 primarily low- and lower-middle-income countries.

It’s not clear where it falls with the Biden rule. “We believe it should be covered,” Schmid said, “but want the federal government to state that clearly.”

For many patients, challenges remain. Most people are willing to travel about 30 minutes for routine health care, Sullivan said, but in cities like Atlanta, those relying on public transportation may face longer commutes to PrEP providers. Some who need PrEP have unstable housing without firm mailing addresses.

Privacy is another concern. “Everybody should be able to find a place that’s comfortable,” Sullivan said. “More of that can go on in primary health care.”

Others agree that public health messaging around PrEP services should target more diverse audiences. Dázon Dixon Diallo is the founder of , an HIV, sexual, and reproductive health organization focused on Black women in the Southeast.

“You’re not going to get to us by giving us a 3-second cameo in a commercial about PrEP,” she said. “There’s no story in there for me, right?”

Healthbeat is a nonprofit newsroom covering public health published by and . Sign up for its newsletters .

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Creating Chaos at HHS

Thu, 23 Jan 2025 20:30:00 +0000

The Host

The second Trump presidency launched with a bang at the Department of Health and Human Services, where a traditional pause on public communications was expanded to an effective stoppage of scientific work, as health agencies were ordered to cancel meetings, travel, and efforts on outside publications. It is unclear how long the order will stay in effect; President Donald Trump’s nominee to run the department, Robert F. Kennedy Jr., won’t go before Senate committees for his confirmation hearings until the end of the month.

Meanwhile, starting on his first day in office, the new president issued a raft of executive orders aimed at reversing Biden administration policy — but, notably, none directly addressing abortion, which has been a traditional focus every time the White House changes parties.

This week’s panelists are Julie Rovner of �鶹Ů�� Health News, Alice Miranda Ollstein of Politico, Rachel Roubein of The Washington Post, and Rachel Cohrs Zhang of Stat.

Panelists

Alice Miranda Ollstein Politico

Rachel Roubein The Washington Post

Rachel Cohrs Zhang Stat News

Among the takeaways from this week’s episode:

The Trump administration took a very firm grip on federal agencies this week, sowing uncertainty with blanket cancellations of upcoming meetings and travel — as well as by implementing a broad pause on external communications. The cancellations reached deep into agencies’ core functions, affecting, for instance, meetings to review grant applications for federally funded research.
Kennedy’s confirmation hearings to be Health and Human Services secretary are scheduled for Jan. 29 and 30. Yet questions remain about his nomination, including more recent revelations about conflicts of interest — such as his financial stake in ongoing litigation with Merck & Co. related to the HPV vaccine.
Trump issued a slew of executive orders this week. (It is worth noting that executive orders largely instruct federal agencies to start making a change, rather than constituting the change themselves.) Of note on health, Trump’s orders instructed the removal of the U.S. from the World Health Organization; revoked a Biden administration order to reduce drug prices; and laid the groundwork to undermine health care for transgender people. Notably, though, none of the orders directly addressed abortion.

Also this week, Rovner interviews Rodney Whitlock, a consultant with McDermott+ and an adjunct faculty member at the George Washington University Milken Institute School of Public Health. Whitlock is a former House and Senate staffer and provides a primer on how Congress’ convoluted budget reconciliation process is supposed to work.

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

Julie Rovner: CNN’s “,” by Brenda Goodman.

Rachel Roubein: The Washington Post’s “,” by Caroline Kitchener.

Rachel Cohrs Zhang: The Washington Post’s “,” by Fenit Nirappil.

Alice Ollstein: The Los Angeles Times’ “” by Karen Garcia and Tony Briscoe.

Also mentioned in this week’s podcast:

The Texas Tribune’s “,” by Eleanor Klibanoff.

Click to open the transcript u003cstrongu003eTranscript: Creating Chaos at HHSu003c/strongu003e

She Owed Her Insurer a Nickel, So It Canceled Her Coverage

Khnkytjaw — Mon, 30 Mar 2026 09:00:00 +0000

Last summer, Lorena Alvarado Hill received a series of unexpected medical bills.

Hill paid nothing toward the premiums for the government-subsidized plan, which previously had covered her scans and other appointments.

Then the bills came.

She discovered, to her surprise, that her insurance had been canceled for “non-payment of premiums.”

The Medical Service

A health insurance plan purchased through the Affordable Care Act federal exchange, healthcare.gov.

The Bill

A monthly premium bill for 1 cent, which in the following months increased incrementally to 5 cents.

The Billing Problem: Small Bill, Big Consequences

Hill acknowledged she had received some bills that noted, “You may lose your health insurance coverage because you did not pay your monthly health insurance premium.”

On Nov. 22, she got a letter marked “Important: Your health insurance coverage is ending.” It listed the last day of coverage as July 31, nearly four months before.

“I panicked,” Hill said. “I didn’t sleep that night.”

Hill takes out loans to pay her daughter’s college expenses. “I couldn’t have my credit ruined,” she said.

That Biden administration “flexibility” rule took effect Jan. 15, 2025, though not every insurer opted to offer leniency to those owing small amounts.

The Trump administration removed the rule on Aug. 25, eliminating the protection entirely in the name of combating fraud and abuse.

The Resolution

Alarmed by the cancellation, the thousands of dollars in bills, and the threat of collections over 5 cents, Hill researched insurance law and fought back.

She noted that HealthFirst’s policy was to respond to complaints in 30 days.

Thirty days came and went, but Hill said she heard nothing in response — and new bills from her canceled policy kept coming.

Despite her frustration, Hill said, all her doctors were contracted with HealthFirst, so she reenrolled for 2026.

Lance Skelly, a spokesperson for HealthFirst, initially said the case “is still in the appeals/grievance process.” In a follow-up email, he said HealthFirst had in canceling Hill’s policy.

“Stepping back from what’s legal, this is just ridiculous,” Corlette said.

But she said she would also like HealthFirst to cover what she had paid and still owed toward the bills she’d put on payment plans.

The Takeaway

Even small bills can have major consequences.

With the automation of more health billing decisions, irrational results have become increasingly common.

“One cent?!” Hill said. “No human would do this!”

It can be tempting to dismiss the notice of a tiny debt, but it’s important to take it seriously. Contact the insurer and get a human involved.

Missing one payment can mean losing coverage. So it’s important to keep a close eye on premiums to make sure they’re paid.

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‘They Tricked Me’: A Father Was Chained After He Went to ICE To Reunite With His Kids

Khnkytjaw — Tue, 24 Mar 2026 09:00:00 +0000

“They tricked me,” Carlos said in a phone call from an immigration detention center in El Paso, Texas, where he was held for several months. “They used my children to grab me,” he said.

Using Children to Arrest Parents

Congress placed this responsibility with the health agency over 20 years ago to prioritize the well-being of unaccompanied children and separate their care from immigration enforcement priorities.

Reverse Separation

Dulce is a pseudonym being used at her request because she fears speaking out could get her deported.

“I stopped going home,” Dulce said. “I lived with some of my friends for days.”

Even though she lived just 45 minutes away, Dulce was allowed to visit her son only twice a month.

When children do get released, it’s often only after their attorneys file a lawsuit in federal court challenging their detention as unconstitutional.

Immigrants at Risk

Case on Hold

He’s trying to stay hopeful, but it’s hard.

‘I’m Going to Wait’

In March, a federal judge said officials had unlawfully detained Carlos and he was released on bond.

An attorney holds up a drawing of Rapunzel by Carlos’ daughter, who said she spends most of her time in her room, feeling isolated like the “Tangled” movie character. (Abigail Gonsoulin)

“I remember when I first arrived at this shelter, I was so hopeful and had faith that I would be reunited with my dad soon,” he said.

“I am afraid,” she said. “I’m going to wait for my dad forever.”

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As Health Companies Get Bigger, So Do the Bills. It’s Unclear if Trump’s Team Will Intervene.

Lydia Zuraw — Mon, 10 Nov 2025 10:00:00 +0000

And even well-insured patients receive unaffordable bills in this era of high-deductible health plans, narrow insurance networks, and 20% cost sharing.

Those market factors contributed to a landscape where a dose of the antiviral Paxlovid given in a hospital ; magnetic resonance imaging ; and joint replacements .

What this will mean in practice is unclear.

Under Trump, the FTC has already sued to block two mergers of medical-device makers and has continued the Biden administration’s challenges of individual drug patents.

A recent identified “28 large health systems growing bigger,” noting, “This is not an exhaustive list.”

Experts such as Fuse Brown say new laws and enforcement tools are needed.

“The old laws,” she said, “are just not calibrated to the complexity and novel types of mergers.”

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Guns, Race, and Profit: The Pain of America’s Other Epidemic

Khnfredck — Tue, 19 Aug 2025 09:00:00 +0000