Chronic Disease Care Archives - 麻豆女优 Health News /tag/chronic-disease-care/ 麻豆女优 Health News produces in-depth journalism on health issues and is a core operating program of 麻豆女优. Tue, 02 Jun 2026 17:57:49 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.5 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Chronic Disease Care Archives - 麻豆女优 Health News /tag/chronic-disease-care/ 32 32 161476233 Festering Infections to Untreated Cancer: ICE Detainees Describe Medical Neglect Across US /courts/ice-immigration-detention-medical-care-neglect-court-records-ap-investigation/ Tue, 02 Jun 2026 13:00:00 +0000 /?p=2243229 An Albanian man’s pain grew so unbearable, he said, he pulled out his own tooth as he languished for months in a New Mexico immigration detention center. A Honduran mother of two said she was hospitalized for a heart problem after she was denied blood pressure medications while held in Florida. A said his leg grew purple and swollen from flesh-eating bacteria when staffers at a Vermont facility did not bring him to a scheduled doctor appointment.

Hundreds of detainees across at least 33 states allege in federal suits that immigration detention facilities are failing to provide adequate medical care, an investigation by 麻豆女优 Health News and The Associated Press found. Detainees say they didn’t get medications on time 鈥 or at all 鈥 for conditions including high blood pressure, diabetes, depression, epilepsy, Parkinson’s, and HIV. Requests for help went unanswered for weeks. Blood sugars rose. Infections festered. Cancers remained untreated. Detainees collapsed and had seizures.

U.S. jails and immigration detention centers have to meet the medical needs of the people in their charge. But the system is sagging under an influx of detentions since President Donald Trump returned to office: More than 75,000 immigrants were being detained by U.S. Immigration and Customs Enforcement , up from around 40,000 a year earlier.

麻豆女优 Health News and AP analyzed thousands of court cases filed since Trump’s second inauguration that use a legal route known as habeas corpus to argue people are being held illegally by ICE. The records offer a rare window into how those detained say, often under penalty of perjury, ICE is handling their medical needs. Reporters also interviewed more than 50 detainees, family members, and lawyers.

The investigation revealed that medical neglect is alleged across the sprawling detention system, including in offices not designed to house people, county jails, and quickly staged sites with nicknames such as “Alligator Alcatraz.”

ICE custody is deadlier than it has been in two decades, researchers wrote in April. The Department of Homeland Security reported 51 people had died in detention since the start of Trump’s second administration 鈥 with suicides .

麻豆女优 Health News and AP asked DHS to respond to the findings six days before publication, but it did not provide comment. The department’s acting chief medical officer, Sean Conley, has “it is both policy and longstanding practice for aliens to receive timely and appropriate medical care from the moment they enter ICE custody” and that the agency recruits healthcare professionals to maintain high standards. “This is better, more responsive healthcare than many aliens have ever received in their entire lives,” he has said.

Individual facilities and private prison companies contracting with DHS that responded to requests for comment said they follow ICE standards and detainees receive medical care when it is required. Some said they were unfamiliar with the allegations outlined in court documents; others blamed some detainees for lapses in their medical care.

“I have never seen such disregard or medical neglect like this anywhere,” Vardan Gukasian, a political dissident and former paramedic who spent years behind bars in Armenia, wrote in in March to contest his detention in Henderson, Nevada, as it stretched to 13 months despite health problems.

Madeleine Skains, a spokesperson for the city of Henderson, said medical care is always available at the facility and that the court had not ordered changes to his care.

Last June, as Gukasian experienced the symptoms of uncontrolled high blood pressure 鈥 dizziness, a nosebleed, and a headache 鈥 his cellmate banged on their door for help.

“When it did not arrive, the rest of the block banged on their doors,” he wrote. Gukasian was hospitalized that day.

鈥楤razen Indifference to Really Obvious Problems’

The administration’s mass deportation effort has swept up during routine immigration check-ins, at traffic stops, at their homes, and in hospitals.

About have no criminal conviction. Their immigration proceedings are civil, not criminal.

“I couldn’t understand why they treated me so harshly,” said a father of six in Georgia. He said he was injured while shackled in custody when the vehicle transporting him to an Atlanta facility jolted, throwing him out of his seat and into a metal armrest. His wound became infected with E. coli, he said, because he had to sleep on a dirty concrete floor amid leaking toilets.

Like other detainees interviewed, he spoke on the condition of anonymity; they said they fear for their safety, for the safety of their families, or that speaking out would jeopardize their immigration cases. The AP and 麻豆女优 Health News are not naming anyone identified in court documents without their consent.

Staffers at Stewart Detention Center in rural Lumpkin, Georgia, didn’t adequately respond to that man’s request for medical help, , until he passed out and was taken to a hospital about an hour away. There, he said, a doctor told him he’d narrowly escaped amputation of his left leg. Medical staff found no records of a case matching this description, according to Brian Todd, a spokesperson for CoreCivic, which runs the facility.

The 48-year-old, who moved to the U.S. from Guatemala more than two decades ago, was released in October and is now a legal permanent resident. But he is unsure if he’ll be able to return to his job in construction because, he said, he can no longer lift heavy things due to his injury.

A man in the Atlanta area was injured while in U.S. Immigration and Customs Enforcement custody and developed an E. coli infection. “I couldn’t understand why they treated me so harshly,” says the father of six U.S. citizens, who is now a legal permanent resident but did not want to be named to avoid potential retaliation against his family. (Brynn Anderson/AP)

Some detainees or their lawyers said even basic care was denied: gauze to protect an open foot wound, prenatal care for a high-risk pregnancy, a pillow to ease the pain of sleeping with advanced stomach cancer, sanitary pads for postpartum bleeding.

“I would like to believe the government has the best interest of those it holds in detention for whatever period of time,” Judge Benita Pearson, a federal judge in Ohio, said during a hearing in October concerning a 70-year-old who alleged the government lost her glasses during her arrest. “If one is unable to see due to the loss of glasses when detained, that should be fixed.”

, who worked for ICE and now serves as a special adviser to the American Bar Association, said case law requires the government to treat people in immigration detention with the same care it affords those in traditional jails awaiting trial. But administrators are granted discretion and medical care standards vary.

Detainees are frequently moved across the country, often without warning, interrupting treatment. A woman from El Salvador said she missed a week of HIV medication when she was transferred from Colorado to a county jail in Wyoming.

A Russian man wrote that, while detained in Texas, he saw a gastroenterologist about his painful gallstones and scheduled an appointment with a surgeon. “Unfortunately, I never got to see him, due to my being moved around various detention centers.”

Advocates say that even obvious disabilities, like legal blindness, are ignored.

A detainee who lost one eye and had severe glaucoma in the other required twice-daily drops to maintain what vision remained. But, he said, some days the drops never came.

“Now I can only see a little bit straight in front. It now often looks like I’m seeing through gauze,” the man wrote in a court declaration. “This makes me very afraid that one of these times I am going to open my eyes and not be able to see anything at all.”

He wrote that he was scared he wouldn’t be able to see his infant son grow up.

“It’s just sort of brazen indifference to really obvious problems, things you would have thought absurd a decade ago 鈥 like the fact that you can’t see,” the man’s attorney, Brian Hoffman, said. “Before, you could attempt to work with folks on the government side and maybe shame them into doing the right thing. Now, it’s sort of like anything you want done you have to go to court and sue over.”

Even court orders aren’t always enough. One California judge ordered the government to take a man showing signs of prostate cancer to a specialist for diagnosis and treatment. Records show they did not take him.

Lawyers representing ICE told the judge that officials missed the appointment because of an “internal scheduling error.” CoreCivic, which runs that facility, said it was unable to comment on active litigation.

A Surge in Cases

When immigrants file habeas corpus petitions, they exercise a right to challenge unlawful imprisonment that dates to .

More than 40,000 such petitions have been filed during Trump’s second term, fueled by decisions last year to deny bond to many people held on immigration charges. Judges are split on whether that’s legal; the question appears headed to the Supreme Court.

Many habeas claims , but judges typically cite reasons unrelated to the medical neglect described in the petitions, such as detainees’ being held too long before being deported.

The more than 300 medical neglect claims found in this investigation represent a fraction of the problem. The details of habeas corpus cases are often hidden due to a federal rule barring the public from viewing such documents online. 麻豆女优 Health News and AP obtained some documents from courthouses and received records on 4,400 cases from , a project of the nonprofit Immigration Justice Transparency Initiative. But tens of thousands more remain largely inaccessible.

Some judges have written that the habeas process is not how to raise allegations of medical neglect and have declined to release detainees over those claims. Not every detainee who believes they experienced medical neglect files a habeas petition or cites their medical issues if they do.

Jose-Antonio Segismundo’s petition made no mention of being unable to see an oncologist for the cancer in his abdomen while detained for more than seven months at the Florida detention facility known as Alligator Alcatraz and Folkston D Ray ICE Processing Center in Georgia. Medical records in his court filings show he was arrested about five weeks before his scheduled appointment with a cancer specialist.

His wife, Maria Jose Gonzalez, said he didn’t receive any treatment even though she sent his medical records and explained his condition to officials at Folkston. When his stomach pain erupted, often suddenly and intensely, she said, they gave him Tylenol.

Geo Group, which runs Folkston, follows ICE standards and provides healthcare and access to off-site medical specialists when needed, spokesperson Christopher Ferreira said.

This spring, Segismundo, 48, was deported to Mexico, a country he left nearly 30 years ago, Gonzalez said. Now, she said, he will have to restart his search for care in the Oaxacan village where he grew up.

Maria Jose Gonzalez of Wimauma, Florida, holds a photo of her husband, Jose-Antonio Segismundo, who was detained in U.S. Immigration and Customs Enforcement custody for more than seven months in Florida and Georgia before being deported to Mexico. Medical records show he was arrested about five weeks before his scheduled appointment with a specialist to treat his abdominal cancer. (Chris O'Meara/AP)

Watching Loved Ones Deteriorate

Detainees receiving inadequate healthcare have little recourse. The Department of Homeland Security last year gutted the Office of the Immigration Detention Ombudsman. In early May, it shut the office entirely, arguing that Congress didn’t fund it.

Previously, ombudsman staffers could help facilitate medical care or look into complaints of neglect, according to Matt Boles, an immigration attorney in Georgia. Now, he said, there’s no one to call.

Meanwhile, detainees’ families said they feel helpless, making desperate calls to facilities, the government, and their legislators while watching their loved ones deteriorate.

Riya Khan saw her mother get sicker at the California City Detention Facility, which is owned by CoreCivic. When she visited a week after her mother arrived at the facility in the Mojave Desert, Riya said, the 64-year-old woman stumbled into her seat. She was shaking and her breathing was labored.

Masuma Khan came to the U.S. from Bangladesh in 1997. She has no criminal history, her records say, and was detained in October when she showed up for her regular ICE check-in.

For the month she was detained, according to her daughter, she only intermittently received her medications for conditions including high blood pressure, hypothyroidism, and prediabetes. CoreCivic treats chronic conditions in line with applicable medical standards, Todd said.

“Nothing matters more to CoreCivic than the health, safety and well-being of the people in our care,” Todd said.

Khan said she got her asthma medication for the first time two days before she was released and that her eye drops for glaucoma never arrived. Staffers told Khan she needed to buy some of her medications from the commissary but it didn’t stock them, her daughter said.

Before ICE detained Masuma Khan, she made friends with everyone, her daughter said. She had worked for years at Lucky Boy, an iconic Pasadena fast-food restaurant, and in her free time fed birds and left out fruit for bees that visited her apartment’s balcony.

Now she’s too scared to go outside. She still must regularly check in with ICE, and she’s terrified each time.

Masuma Khan (center) waits in line with her attorney Laboni Hoq (left of Khan) to enter a federal building in Los Angeles for an appointment on April 21. (Jae C. Hong/AP)
Khan (second from right in the front row) and her daughter, Riya (fourth from right in the front row), pose with supporters outside a federal building in Los Angeles on April 21. (Jae C. Hong/AP)
Khan (right) came to the U.S. from Bangladesh in 1997 and was detained for a month after she showed up for a regular check-in with U.S. Immigration and Customs Enforcement in October. Here, she hugs her daughter, Riya (left). (Jae C. Hong/AP)
A “Welcome Home” balloon that was left at the front door of Khan’s apartment in Altadena, California, after she was released from an immigration detention facility. (Jae C. Hong/AP)
Khan’s daughter says that her mother has nightmares and is scared to go outside after being held at an immigration detention facility for a month in 2025. (Jae C. Hong/AP)

    A Stroke on a Video Call

    Previously, detainees with serious medical needs would likely have been released on humanitarian parole, in part to avoid the cost of their care, Vermont attorney Andrew Pelcher said.

    In fiscal year 2023 鈥 before the detained population soared 鈥 ICE spent more than $390 million on healthcare for detained noncitizens, according to its to Congress. In May, Todd Lyons, then acting director of ICE, said at a conference that the agency had already spent “almost half a billion dollars” on detainee healthcare this year.

    Now, under “mandatory detention,” people are staying locked up with serious 鈥 and expensive 鈥 conditions.

    A Romanian citizen underwent several heart surgeries, including an emergency triple bypass in April 2025, before he was arrested in July. As part of his recovery, the 52-year-old was required to take 16 daily medications. While at an ICE field office in Baltimore, his court filings allege, he went two days without any medication before officials moved him to a facility in New Jersey.

    He was hospitalized three times while detained, complaining of chest pains 鈥 in part, medical records and court documents say, because despite “countless requests,” the detention center did not provide all his medications. Hospital discharge papers cited by his lawyer show he received only eight of the 16 medications after his second release from the hospital.

    “Can you please talk to the ICE facility to make sure they give him his medications?” his treatment providers wrote in medical records included in his court filings. “He was admitted last week for chest pain and today he was readmitted again for chest pain secondary to non compliance for medications.”

    Several weeks later in August, he had a stroke while on a video call with his daughter, according to court filings. “He was struggling to breathe, and was pointing at his chest where he was again experiencing pain, and suddenly stopped speaking.” His daughter screamed for help through the video monitor, according to his petition. “Eventually an officer came in to assist him and cut the feed.”

    The man lost his ability to speak for four days, the document says. He was returned to detention, where he remained until a federal judge ordered his release in November.

    Khan holds medication she takes daily. While detained, she says, she only intermittently received her medications for multiple conditions including high blood pressure, hypothyroidism, and prediabetes. (Jae C. Hong/AP)

    Impossible Choices

    Cassandra Amador waits for the phone to ring every morning, desperate to ask her husband the question that’s woken her up every night for months: “Did you get your medicine?”

    Her husband, Pedro Javier Amador Gutierrez, 36, has high blood pressure and depends on the state-run facility in Florida nicknamed “Deportation Depot” to administer the prescriptions that have kept him alive for years. Many mornings, he tells his wife he did not get them.

    When she talks to him, she said, he sounds weaker and more scared every day, not like the upbeat man who would take her kids out for ice cream.

    “You can hear in his voice how he feels,” she said.

    Now, she said, he’s considering returning to Cuba, which he fled because of political persecution, out of fear that he will die in detention without his medicines. Amador and her children would go with him, she said, even though she was born in New Jersey, has never been to Cuba, and doesn’t speak much Spanish.

    But he’s already collapsed twice at the Baker Correctional Institution in Sanderson, Florida, his wife said. She’s terrified that the next time, he won’t get up.

    Methodology

    麻豆女优 Health News and The Associated Press sifted through thousands of immigration habeas corpus claims to find allegations of medical neglect from people detained by U.S. Immigration and Customs Enforcement during the second Trump administration.

    Without a comprehensive, publicly available dataset of medical complaints by those in ICE custody, we used immigration habeas corpus claims to identify detainees’ healthcare-related allegations raised in federal court. Although the intended purpose of habeas corpus is to challenge the legality of a petitioner’s detention 鈥 rather than conditions of their confinement 鈥 these filings sometimes include detainees’ claims of inadequate healthcare.

    But habeas corpus filings are not always publicly available. Federal rules restrict how members of the public can access habeas petitions filed by people in immigration detention. For most of these cases, court websites publish only court orders and dockets describing other filings. The initial petitions are available only through in-person visits to federal courthouses across the country. Habeas Dockets, a project of the nonprofit Immigration Justice Transparency Initiative, coordinates a nationwide network of volunteers to gather these petitions and make them available online.

    麻豆女优 Health News and AP analyzed the dockets of roughly 33,000 cases filed by detainees from Jan. 20, 2025, through March 2026. The vast majority of cases had only basic procedural information, like dates of court filings and rulings. Only about 4,400 included the original petitions.

    We also gathered a few dozen case files from courthouses, lawyers, and the Massachusetts federal district court website, which posts most petitions under a unique standing order.

    We ran keyword and semantic searches of court records, including petitions, motions, and orders, for terms and phrases potentially related to medical neglect, such as surgery, medications, inadequate medical care, and treatment for chronic conditions such as diabetes and high blood pressure.

    We found about 500 cases potentially alleging medical neglect. At least two reporters reviewed each case manually, yielding more than 300 cases containing specific allegations in sworn filings of delayed, denied, or deficient healthcare.

    To be conservative, we excluded dozens of cases that alleged inadequate medical care but lacked specifics, for example a petitioner writing, “I have been sick and don’t get proper treatment,” or a judge noting a petitioner “complains that ICE is ignoring his medical problems.” We also excluded cases in which petitioners claimed only that they were denied special diets, exercise, or other accommodations that they said were key to managing their health conditions, such as a petitioner writing, “I suffer from Parkinson’s and cannot properly exercise,” or claiming that the food provided was unfit for a person with diabetes.

    The cases we analyzed were neither randomly selected nor representative of immigration habeas filings nationwide. The claims were not independently verified. Many filings are not publicly available, and not all detainees raise medical concerns in court, so our account of cases represents a limited window into the landscape of claims, rather than a comprehensive picture.

    Associated Press journalists Garance Burke, Valerie Gonzalez, and Tim Sullivan as well as 麻豆女优 Health News correspondent Kate Wells contributed to this report.

    This report is a collaboration between The Associated Press and 麻豆女优 Health News.

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/courts/ice-immigration-detention-medical-care-neglect-court-records-ap-investigation/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2243229&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2243229     Kennedy Swaps Vaccine Rhetoric for Story Time but Can鈥檛 Quite Change the Subject /public-health/the-week-in-brief-rfk-jr-ohio-visit-maha-rhetoric/ Fri, 15 May 2026 18:30:00 +0000 /?p=2238096&preview=true&preview_id=2238096 Here in Washington, we’ve been hearing about tensions between the White House and one of its most controversial 鈥 but, at least in some circles, most popular 鈥 figures: Robert F. Kennedy Jr.

    Polling of likely voters indicates that the Health and Human Services secretary can be an asset to Republicans when he’s talking about improving the nation’s food supply or labeling ultraprocessed foods. But when he’s talking about removing recommendations for routine childhood vaccinations, he can be a detriment.

    So, when I learned Kennedy would be taking his show on the road to my home state of Ohio, where populist figures tend to perform well, I knew I had to be there.

    How would a politician who built his reputation seeding widespread doubts about routine childhood immunizations stay away from one of the core messages he’s preached for years?

    Well, it turns out, he starts by reading a book about a trash truck to preschoolers.

    The trip took us across northern Ohio, from a regenerative farm in Huron owned by two brothers who grow colorful vegetables to听the Cleveland Clinic, where Kennedy masked up听entering an operating room听of听a heart surgery patient.

    In the end, though, Kennedy couldn’t escape the vaccine talk.

    Speaking at the City Club of Cleveland, Kennedy raised doubts about the safety of vaccines that had been 鈥 up until last year 鈥 universally recommended to prevent hepatitis B, an incurable disease.

    He called for parents to “be given that choice” on听administering听the vaccine听to newborns,听a remark that gave way to cheers and applause听from听half the room.

    The other half groaned and booed.

    When I sat down with the health secretary for a few minutes in an Ohio farmhouse, Kennedy ticked off his accomplishments during his first year in office; redesigning federal nutrition guidelines and defining ultraprocessed foods for the American public were among them.

    As his list grew longer, I thought about the mothers I’d talked to over the last year who had become increasingly nervous about taking their infants out in crowded places amid a raging measles outbreak and the growing threat from other infectious diseases.

    What was his message for those parents, I asked?

    “I would say everybody should be vaccinated 鈥 against measles,” Kennedy told me. “But we need to pay more and more attention to chronic disease. All of the vaccine-preventable, infectious diseases put together kill probably 10,000 Americans a year.” 

    The number of deaths is , according to scientific researchers.

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/public-health/the-week-in-brief-rfk-jr-ohio-visit-maha-rhetoric/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2238096&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2238096     She Survived 2 Shootings. Research Helps Explain Why Her听Pain Persists Years Later. /public-health/gun-violence-survivor-phantom-pain-research-minnesota/ Mon, 04 May 2026 09:00:00 +0000 /?p=2233469 In 2019, Mia Tretta, then a high school freshman at Saugus High School in Santa Clarita, California, was struck in the stomach by a round from a .45-caliber semiautomatic handgun fired by a schoolmate. Two students were killed during the attack, including her best friend, and two others were injured.

    When she graduated from high school, she enrolled at Brown University, the scene of another shooting in December 2025, while she was studying for finals in her dorm room.

    As messages flooded in about an active shooter on campus, she felt pain where she had been shot in the stomach. The college junior experienced a phenomenon she called “phantom bullet syndrome,” similar to phantom limb syndrome, in which someone senses something is there that is not. It occurs whenever she feels extremely stressed, she said.

    “It’s crazy to say that the first time, I was the lucky one because though I got shot, I didn’t get killed,” said Tretta, now an anti-gun violence advocate who is studying public affairs and education. “And the second time, I was the lucky one because I was a few blocks away.”

    Tretta represents a cohort of young people who have lived through more than one shooting. She also embodies the findings of a recent study that links gun violence exposure to chronic pain.

    The study, in January, found that both direct and indirect exposure to gun violence are linked to higher rates of among American adults.

    Rutgers University researchers studied six types of gun violence exposure: being shot, being threatened with a gun, hearing gunshots, witnessing a shooting, knowing a friend or family member who was shot, and knowing someone who died by firearm suicide. Using a nationally representative survey of 8,009 people, they found that 23.9% had pain most days or every day, while 18.8% said they had a lot of pain.

    Daniel Semenza, the study’s lead author, told The Trace that whether someone has lost a person to gun violence or they’ve been shot themselves, their mental and physical health are inextricably linked.

    “Your body, through the experience of post-traumatic stress, is going to feel as if it’s happening over and over and over again,” said Semenza, the director of research at the New Jersey Gun Violence Research Center and an associate professor at Rutgers University.

    Tretta to remove the bullet, she said, and later received a nerve block to address ongoing pain from her injuries. But the bullet fragments remain in her body years later, she said.

    She was also diagnosed with psoriatic arthritis 鈥 a chronic disease causing swelling, pain, and stiffness in the joints.

    “I have dealt with chronic pain, immunodeficiencies, and bodily differences ever since the shooting happened,” Tretta said. “Every time I get a fever, it’s a completely different thing than anyone else I know, or even pre-shooting for me. I shake uncontrollably, and it hurts to even touch my arm.”

    The is one of the first to focus on outcomes like chronic pain as part of an emerging body of work on the physical health toll of gun violence exposure.

    “It highlights the fact that, for the thousands of people who are killed every year, there are lots of people who knew those folks,” Semenza said. “The toll of gun violence is much broader than we originally anticipated.”

    Efrat Eichenbaum, an inpatient psychologist who has treated gun violence survivors and their families at a Level 1 trauma center in north Minneapolis, said the study accurately reflects what she has seen in her clinical work.

    “You can plainly see the trauma that follows an event like that,” she said. “Not just for the survivors, but for their families. It does not even limit itself to family members. This is an issue that touches entire communities.”

    David Patterson, an emeritus professor at the University of Washington whose work focuses on pain, says the study shows, in particular, just how far the impact of gun violence fans out and how costly a problem it is for society.

    “Chronic pain is a major health problem in itself, and it because it’s very hard to manage,” he said. “You can’t cure it; it has to be managed.”

    Back in her dorm room at Brown, Tretta explained that medical care does not end when someone leaves the hospital after a trauma like hers. It goes on for years.

    “Your body will never be the same as it was before,” she said. “There’s no time that you can’t feel the 7 or 8 inches of scar tissue running through the middle of your stomach. It’s just a constant physical reminder, because you can’t leave your body.”

    This article was reported by The Trace, a nonprofit newsroom covering gun violence in America. .

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/public-health/gun-violence-survivor-phantom-pain-research-minnesota/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2233469&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2233469     Rural Nebraska Dialysis Unit Closes Despite the State鈥檚 $219M in Rural Health Funding /rural-health/dialysis-unit-closes-rural-transformation-health-fund-nebraska/ Wed, 15 Apr 2026 09:00:00 +0000

    HAY SPRINGS, Neb.鈥 The sun was just warming the horizon as Mark Pieper left his house near his cattle ranch on a crisp February morning.

    It’s not unusual for the rancher to wake up early to tend to livestock, but at 5:45 a.m. this day his cattle wouldn’t come first. For the past 3陆 years, three days a week, Pieper has made an early-morning commute to get dialysis at the nearest hospital.

    Pieper lives outside Hay Springs, which has 599 residents, according to a sign at the edge of town. He makes sure not to forget his chocolate-brown cowboy hat before starting up his pickup truck for the half-hour drive to Chadron.

    That February morning was one of his last dialysis sessions there before the hospital shuttered the service at the end of March.

    “I guess I’ll just bloat up and die in a month,” Pieper remembered thinking when he learned the center was closing, eliminating the only option near his home.

    He needs dialysis to survive after cancer treatment damaged his kidneys.

    Pieper and 16 other patients relied on Chadron Hospital for the life-sustaining therapy that filters waste and fluid from their blood 鈥 a job their failing kidneys could no longer do. Treatment lasts about four hours.

    An exterior shot of a hospital in Nebraska. A sign out front reads, "Chadron Community Hospital & Health Services." An American flag flies on a flagpole behind it.
    The closure of the dialysis unit at Chadron Hospital upended the lives of its patients in rural Nebraska. Some have moved to be closer to care. One is living in a rental in another city on weekdays. Another is driving more than four hours round-trip for care. (Arielle Zionts/麻豆女优 Health News)

    The closure is just one example of the long decline of health care services in rural America, where people have higher rates of many chronic conditions but less access to care than elsewhere.

    The Trump administration promised to address this problem, when it launched the $50 billion federal Rural Health Transformation Program in September. It may not be enough to stop the trend.

    “[President Donald] Trump says he is going to help the rural health care,” Pieper said. Dialysis “is one thing that we really need here.”

    Some patients have moved to live closer to care, including several nursing home residents. Their new facilities may be farther from their families.

    Others are making long drives to dialysis centers. Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region of western Nebraska. The hour-and-a-half drive will triple his time on the road to more than nine hours each week.

    Jim Wright and his wife reduced their drive time 鈥 but are spending more money 鈥 by renting a small home near Rapid City, South Dakota, and living there on weekdays so he can get dialysis. Wright said he understands that rural hospitals face financial challenges.

    “But we’re talking about something that’s lifesaving. It’s not a matter of, 鈥極h, I would like to be there’” getting treatment, he said. “It’s a case that if you don’t, you die.”

    An older couple stand outside a beige-colored house.
    Jim and Carol Wright rented this small house near Rapid City, South Dakota, to live there on weekdays so Jim can get dialysis in town. (Arielle Zionts/麻豆女优 Health News)

    An Influx of Money That’s Out of Reach

    Jon Reiners, CEO of the independent, nonprofit Chadron Hospital, wrestled with the decision to end dialysis services. He and several patients said that the closure was announced as the $219 million the state will receive in first-year funding from the .

    But the five-year program is aimed at exploring new, creative ways to improve rural health, not to help existing services stay afloat. States can use only up to 15% of their funding to pay providers for patient care.

    At least 11 states 鈥 Nebraska is not among them 鈥 have mentioned using funding for rural dialysis programs, according to a 麻豆女优 Health News review of applications. Their ideas include starting a mobile dialysis unit and helping people get treatment at home or in long-term care facilities.

    Reiners said Chadron Hospital lost $1 million a year on its dialysis service due to low reimbursement rates that didn’t cover operational costs.

    A photo of Jon Reiners standing by the now-shuttered dialysis unit at Chadron Hospital.
    Jon Reiners, CEO of Chadron Hospital in Nebraska, says the rural hospital could no longer afford to provide dialysis due to low Medicare reimbursement rates. (Arielle Zionts/麻豆女优 Health News)

    The facility is a critical access hospital, a designation that allows certain small, mostly rural hospitals to get increased reimbursement rates for their Medicare patients. While most of the affected patients were on Medicare, the critical access program doesn’t cover outpatient dialysis, Reiners said.

    Reiners said the hospital worked for more than a year to find solutions, such as reaching out to four private companies to potentially take over the center. But he said they all passed after realizing they would lose money.

    Nephrologist Mark Unruh said the dialysis closure in Chadron reflects a wider trend of staffing and funding challenges.

    “You do end up in situations where you have people who are displaced like this, and it’s just sad,” said Unruh, chair of the Internal Medicine Department at the University of New Mexico.

    People in rural America face significant disparities in kidney health and treatment, published in 2024 in the American Journal of Nephrology. They’re and face after diagnosis, according to data from the National Institutes of Health.

    The best way to address this is to focus on prevention, Unruh said. He pointed to a that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure.

    Another idea, Unruh said, is boosting the rate of kidney transplantation for rural patients. He’s looking at whether it’s helpful to “fast-track” tests patients need to get approved for a transplant by scheduling all of them over a couple of days to limit travel time.

    Unruh said the U.S. health system also needs to recruit more staff who can train patients and their caregivers to administer dialysis at home.

    Exploring the Option of Home Dialysis

    Rural dialysis patients are more likely than urban ones to get home dialysis, according to . In 2023, the rate was nearly 18% for rural patients and about 14% for urban ones.

    One type of home dialysis requires surgery to get a catheter placed in the abdomen and . The other kind requires . The nearest facility to Chadron that offers training for the first option is in Scottsbluff. The nearest that offers training for the latter kind is three hours away in Cheyenne, Wyoming.

    Pieper said doctors told him he’s not a candidate for home dialysis or a transplant. The Panhandle has a nonprofit, rural transit system, but its schedule won’t work for Pieper. He said that leaves him with no choice but to get treatment in Scottsbluff, a 200-mile round trip.

    It takes Linda Simonson even longer 鈥 more than four hours round trip 鈥 to drive her husband, Alan, from their ranch to his treatment in Scottsbluff.

    Linda sat in the waiting room with a yellow legal pad during one of Alan’s final treatments in Chadron. The paper was scrawled with phone numbers of politicians to call and driving distances to dialysis centers in the region. She said facilities closer to their ranch either don’t have room for new patients or lack good spots along the route to take a driving break in bad weather.

    “It’s just unreal,” she said.

    She said even if Alan took a bus, she’d have to ride along to support him during the trip and his treatment.

    Jim and Carol Wright, the couple staying near Rapid City on weekdays, said they can’t afford to rent a second home forever. Their weekly commute is already taking a physical and emotional toll. They said they’ll eventually have to move to a bigger city, giving up the house they love in the scenic Nebraska National Forest.

    Carol said she feels for the dialysis staffers in Chadron, who are wonderful.

    “It just doesn’t seem right to sacrifice one unit that’s so vital,” she said while standing next to a pile of moving boxes stacked inside their rental.

    An older man stands indoors next to a pile of packed cardboard boxes.
    Jim Wright stands near some of the boxes he and his wife, Carol, packed from their home in Nebraska. The couple say they’ll eventually have to sell their Nebraska house and move to a new city to be closer to care. (Arielle Zionts/麻豆女优 Health News)

    The Wrights wrote letters to politicians and hospital leaders to share their concerns and ideas for keeping the unit open, including using the federal rural health funding.

    Simonson said she spoke with aides for the governor and her state representatives but none of the leaders called her back.

    “It feels like they don’t know that we exist at this end of the state,” she said.

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/rural-health/dialysis-unit-closes-rural-transformation-health-fund-nebraska/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2178069&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2178069     鈥楰ind of Morbid鈥: Health Premiums Threaten Their Nest Egg. A Terminal Diagnosis May Spare It. /health-care-costs/insurance-premium-payments-terminal-diagnosis-aca-subsidies-covered-california/ Thu, 26 Feb 2026 10:00:00 +0000 /?post_type=article&p=2159633 COLUSA, Calif. 鈥 Early on, Jean Franklin got some career advice she followed religiously: “Pay yourself first.” So she did, socking away hundreds of thousands of dollars in retirement savings by the time she became a stay-at-home mom at age 41.

    She and her husband, Charles, a former high school teacher who goes by Chaz, planned to retire comfortably in the three-bedroom house where they raised their kids about 60 miles northwest of Sacramento.

    But early last year, the 63-year-old became unsteady on her feet. One morning in May, she woke up with slurred speech and landed in the hospital, then rapidly lost the ability to move the right side of her body.

    In August, as doctors continued to puzzle over a possible diagnosis, the couple received a notice saying that on Jan. 1 their combined health care premium payments through the state insurance exchange would shoot up from $540 a month to $3,899 a month. The reason: Federal enhanced premium subsidies expiring at the end of last year would no longer offset their payment.

    They immediately canceled a monthlong cruise they’d been planning with friends and looked through their retirement accounts.

    “Now, instead of thinking about where we can go in our retirement, we’re asking the question, 鈥楢re we still going to be able to stay where we are because of the health care costs?’” said Chaz, who retired in 2021 at age 59.

    Then they received more bad news. In October, at the age of 63, Jean was diagnosed with ALS, a debilitating disease that will eventually leave her unable to speak, swallow, or breathe on her own. But Jean’s condition allowed her to enroll in Medicare, the federal health insurance program that covers adults 65 and older and people with disabilities. The diagnosis saved them roughly $1,600 a month in premiums 鈥 little comfort as Jean lost her ability to walk, bathe, and dress herself.

    Jean Franklin poses for a photo in her wheelchair. She is seen sitting next to many potted plants outside.
    Jean was diagnosed with ALS around the time she and Chaz were told their monthly health insurance premium payments would increase sevenfold. The diagnosis, which allowed her to enroll in Medicare, saved the couple roughly $1,600 a month. (Christine Mai-Duc/麻豆女优 Health News)
    A photo of Charlie Franklin assisting Jean Franklin get out of her wheelchair.
    Charlie Franklin helps his mother, Jean, out of her wheelchair. (Christine Mai-Duc/麻豆女优 Health News)

    “It’s kind of morbid that, because of my diagnosis, I got put on Medicare right away, so at least we don’t have to pay that out-of-pocket,” Jean said, sitting in a wheelchair in her living room, a quilt draped over her legs to guard against the intense chills she now often gets. “We’re not going to get buried under this.”

    Yet the premiums for Chaz’s plan and her Medicare remain a significant strain on their finances. The $2,300 a month they now owe, which includes roughly $342 in premium payments for Jean’s Medicare supplemental insurance, is higher than their monthly mortgage and eats up more than a quarter of their budget.

    The Franklins are among the across the nation facing greater financial pressure after Congress chose not to extend 2021 enhanced federal subsidies. That assistance helped more than double enrollment in Obamacare plans to over 24 million.

    The Congressional Budget Office estimated in 2024 that, without an extension of the tax credits, the number of uninsured Americans would climb by 2.2 million this year alone. , nationwide enrollment in ACA plans was down about 1.2 million year over year, though experts say it could be months before the full effects of rising premiums are known, as people miss payments and lose coverage.

    The groups hit hardest will be , , and people living in high-cost states, said , a senior research fellow at the Center on Health Insurance Reforms at Georgetown University. The Franklins are all three.

    “They fell off what we call a subsidy cliff,” Pogue said. “It’s very, very shocking, the amount that a person would have to absorb.”

    That’s because the expanded tax credits made the biggest difference for people nearing retirement age who sat just above thresholds, Pogue said. People such as the Franklins, who likely wouldn’t have qualified for financial help before expanded credits were implemented, are now losing that support at a time when insurers have responded to the uncertainty by dramatically raising rates.

    Roughly half of people who were expected to lose eligibility for premium tax credits were ages 50 to 64, according to an , a health information nonprofit that includes 麻豆女优 Health News.

    A Retired Couple Faced a Huge Health Premium Increase. Her Terminal Diagnosis Saved Them Money.

    Jean Franklin, 63, and Chaz Franklin, 64
    Colusa, California听

    Chaz and Jean听Franklin thought听they’d听saved enough to retire comfortably. But when they found out the premium payment for their “silver” Affordable Care Act plan would soon rise from $540 a month to $3,899, they had to reevaluate. A couple of months later, Jean was diagnosed with ALS, a debilitating neurodegenerative illness that qualified her for Medicare. Her premium payment dropped to $342 a month. The couple still pays a combined $2,300 a month in premiums, more than a quarter of their budget. “It’s the terrible irony that because my wife got a disorder, I’m saving money, and a lot of it,” Chaz said.

    Republicans who opposed the extension have said the premium assistance went directly to insurance companies rather than consumers, incentivizing fraud and wasteful coverage. They also say the enhanced subsidies, which had no upper income limit for eligibility, were far too generous in capping premium payments at 8.5% of income, no matter how much an enrollee made.

    “Most Americans would agree that taxpayers should not be subsidizing the health insurance of someone making $250,000,” U.S. Rep. , a California Republican who an extension in January, wrote in an . “I cannot accept the simple extension of a program that will line the pockets of insurers and is riddled with fraud at the expense of the American taxpayer.”

    Patient advocates say the premium increases and expiration of subsidies have forced people into difficult choices. “The young people who are healthy are the first to say, I’m going to roll the dice” and forgo coverage, said , executive vice president of policy and programs at the National Patient Advocate Foundation. “Those who are remaining in the system 鈥 because they have no choice 鈥 are holding off care, they’re holding off their meds, they’re going without necessary food.”

    While the Franklins are getting by, they have relied on their sons to pay for a motorized recliner to assist with lifting Jean and a handicap van to transport her. Chaz, who broke a tooth a year ago, delayed fixing it because a crown would cost him $1,000.

    This year, the couple will draw $36,000 more than they had anticipated from their retirement savings, most of it to cover Chaz’s insurance premiums.

    “I have a nest egg,” Chaz said. “But there’s a lot of people around here who don’t.”

    For a while, he was outraged.

    “I wish Congress would get off their butts and solve this issue,” said Chaz, who is a registered Republican but blames both sides of the aisle. “You’re so busy bickering over stupid crap and it’s both parties pointing fingers and blaming. Where was this discussion two years ago?”

    Now, Chaz said, he’s focused on making Jean, his wife of 27 years, as comfortable as possible.

    Before she got sick, they did practically everything together 鈥 hiking, traveling, tai chi, amateur photography, and bug-hunting. One of her favorite specimens was the rain beetle, a fuzzy scarab-like insect that can’t feed as an adult, relying solely on fat stores from its larval stages.

    In the mornings, Chaz and their sons, Charlie and Louis, take turns lifting Jean, dressing her, and helping her use the bathroom. It’ll be fodder for the counselor, she jokes to her sons, when they inevitably need therapy later in life.

    Chaz Franklin is seen practicing tai chi at a class in an auditorium.
    Chaz practices tai chi three times a week in the auditorium at Colusa City Hall. The exercise helps him deal with the financial and emotional stress of his wife’s illness and their soaring health care expenses. (Christine Mai-Duc/麻豆女优 Health News)
    A photo of Jean Franklin posing outside her house in her wheelchair. She is surrounded by three younger people: two of her sons and one of her son's girlfriend.
    Jean laughs with her sons, Louis (right) and Charlie, and Charlie’s girlfriend, Masha Billingsley. Charlie and Louis have helped their mother get dressed and get in and out of her wheelchair since she was diagnosed with ALS last year. (Christine Mai-Duc/麻豆女优 Health News)

    Most days, Jean’s outdoor adventures rarely extend beyond being wheeled to her back patio, where she loves to watch their backyard chickens bobble around. Chaz’s stubbornness makes him a great patient advocate. Charlie always seems to know exactly when she needs a big hug, and Louis tells jokes that can still make her snort with laughter.

    “I don’t know what I would do without my boys making me laugh,” she said.

    In December, Chaz will turn 65, old enough to qualify for Medicare himself. “After this year 鈥 knock on wood 鈥 we should be OK,” Jean said, before pausing and shooting her husband a wry smile.

    “Well, you’re gonna be OK.”

    Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here鈥痶o contact 麻豆女优 Health News and share your story.

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/health-care-costs/insurance-premium-payments-terminal-diagnosis-aca-subsidies-covered-california/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2159633&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2159633     Medicaid Tries New Approach With Sickle Cell: Companies Get Paid Only if Costly Gene Therapies Work /medicaid/sickle-cell-disease-gene-therapy-medicaid-vertex-bluebird-bio/ Wed, 21 Jan 2026 10:00:00 +0000 /?post_type=article&p=2141959 Serenity Cole enjoyed Christmas last month relaxing with her family near her St. Louis home, making crafts and visiting friends.

    It was a contrast to how Cole, 18, spent part of the 2024 holiday season. She was in the hospital 鈥 a frequent occurrence with sickle cell disease, a genetic condition that damages oxygen-carrying red blood cells and for years caused debilitating pain in her arms and legs. Flare-ups often would force her to cancel plans or miss school.

    “With sickle cell it hurts every day,” she said. “It might be more tolerable some days, but it’s a constant thing.”

    In May, Cole completed a several-months-long that helps reprogram the body’s stem cells to produce healthy red blood cells.

    She was one of the first Medicaid enrollees nationally to benefit from a in which the federal government negotiates the cost of a cell or gene therapy with pharmaceutical companies on behalf of state Medicaid programs 鈥 and then holds them accountable for the treatment’s success.

    Under the agreement, participating states will receive “discounts and rebates” from the drugmakers if the treatments don’t work as promised, according to the Centers for Medicare & Medicaid Services.

    That’s a stark difference from how Medicaid and other health plans typically pay for drugs and therapies 鈥 the bill usually gets paid regardless of the treatments’ benefits for patients. But CMS has not disclosed the full terms of the contract, including how much the drug companies will repay if the therapy doesn’t work.

    The treatment Cole received offers a potential cure for many of the 100,000 primarily Black Americans with sickle cell disease, which is estimated to shorten lifespans by more than two decades. But the treatment’s cost presents a steep financial challenge for Medicaid, the joint state-federal government insurer for people with low incomes or disabilities. Medicaid covers roughly half of Americans with the condition.

    There are two gene therapies approved by the Food and Drug Administration on the market, one costing $2.2 million per patient and the other $3.1 million, with neither cost including the expense of the long hospital stay.

    The CMS program is one of the rare health initiatives started under President Joe Biden and continued during the Trump administration. The Biden administration with the two manufacturers, Vertex Pharmaceuticals and Bluebird Bio, in December 2024, opening the door for states to join voluntarily.

    “This model is a game changer,” Mehmet Oz, the CMS administrator, said announcing that 33 states, Washington, D.C., and Puerto Rico had signed onto the initiative.

    Asked for further details on the contracts, Catherine Howden, a CMS spokesperson, said in a statement that the terms of the agreements are “confidential and have only been disclosed to state Medicaid agencies.”

    “Tackling the high cost of drugs in the United States is a priority of the current administration,” the statement said.

    Citing confidentiality, two state Medicaid directors and the two manufacturers declined to reveal the financial terms of agreements.

    Serenity Cole takes several medications after undergoing gene therapy for sickle cell disease. The therapy was covered under a new Medicaid program that allows the government to hold pharmaceutical companies accountable for the treatment’s success. “This model is a game changer,” says Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. (Judd Demaline for 麻豆女优 Health News)
    Cole says the gene therapy treatment has alleviated her pain and kept her out of the hospital. (Judd Demaline for 麻豆女优 Health News)

    New Therapies

    The gene therapies, approved for people 12 or older with sickle cell disease, offer a chance to live without pain and complications, which can include strokes and organ damage, and avoid hospitalizations, emergency room visits, and other costly care. The Biden administration estimated that sickle cell care already costs the health system almost $3 billion a year.

    With many more expensive gene therapies on the horizon, the cost of the sickle cell therapies presages financial challenges for Medicaid. Hundreds of cell and gene therapies are in clinical trials, and dozens could get federal approval in the next few years.

    If the sickle cell payment model works, it will probably lead to similar arrangements for other pricey therapies, particularly for those that treat rare diseases, said Sarah Emond, president and CEO of the Institute for Clinical and Economic Review, an independent research institute that evaluates new medical treatments. “This is a worthy experiment,” she said.

    Setting up payment for drugs based on outcomes makes sense when dealing with high treatment costs and uncertainty about their long-term benefits, Emond said.

    “The juice has to be worth the squeeze,” she said.

    Clinical trials for the gene therapies included fewer than 100 patients and followed them for only two years, leaving some state Medicaid officials eager for reassurance they were getting a good deal.

    “What we care about is whether services actually improve health,” said Djinge Lindsay, chief medical officer for the Maryland Department of Health, which runs the state’s Medicaid program. Maryland is expected to begin accepting patients for the new sickle cell program this month.

    Medicaid is already required to cover almost all FDA-approved drugs and therapies, but states have leeway to limit access by restricting which patients are eligible, setting up a lengthy prior authorization process, or requiring enrollees to first undergo other treatments.

    While the gene therapy treatments are limited to certain hospitals around the country, state Medicaid officials say the federal model means more enrollees will have access to the therapies without other restrictions.

    The manufacturers also pay for fertility preservation such as freezing reproductive cells, which could be damaged by chemotherapy during the treatment. Typically, Medicaid doesn’t cover that cost, said Margaret Scott, a principal with the consulting firm Avalere Health.

    Emond said pharmaceutical companies were interested in the federal deal because it could lead to quicker acceptance of the therapy by Medicaid, compared with signing individual contracts with each state.

    States are attracted to the federal program because it offers help monitoring patients in addition to negotiating the cost, she said. Despite some secrecy around the new model, Emond said she expects a federally funded evaluation will track the number of patients in the program and their results, allowing states to seek rebates if the treatment is not working.

    The program could run for as long as 11 years, according to CMS.

    “This therapy can benefit many sickle cell patients,” said Edward Donnell Ivy, chief medical officer for the Sickle Cell Disease Association of America.

    He said the federal model will help more patients access the treatment, though he noted utilization will depend in part on the limited number of hospitals that offer the multimonth therapy.

    Hope for Sickle Cell Patients

    Before gene therapy, the only potential cure for sickle cell patients was a bone marrow transplant 鈥 an option available only to those who could find a suitable donor, about 25% of patients, Ivy said. For others, lifelong management includes medications to reduce the disease’s effects and manage pain, as well as blood transfusions.

    About 30 of Missouri’s 1,000 Medicaid enrollees with sickle cell disease will get the therapy in the first three years, said Josh Moore, director of the state’s Medicaid program. So far, fewer than 10 enrollees have received it since the state began offering it in 2025, he said.

    Less than a year into the federal program, Moore said it’s too early to tell its rate of success 鈥 defined as an absence of painful episodes that lead to a hospital visit. But he hopes it will be close to the 90% rate seen over the course of a couple of years in clinical trials.

    Moore said the federal program based on how well the treatment works was preferred over cutting fees for a new and promising therapy, which would put the manufacturers’ ability to develop new drugs at risk. “We want to be good stewards of taxpayer dollars,” he said.

    He declined to comment on how much the state may save from the arrangement or disclose other details, such as how much the drug companies might have to pay back, citing confidentiality of the contracts.

    Lately Cole, who underwent gene therapy at St. Louis Children’s Hospital, has been able to focus on her hobbies 鈥 playing video games, drawing, and painting 鈥 and earning her high school diploma.

    She said she was glad to get the treatment. The worst part was the chemotherapy, she said, which left her unable to talk or eat 鈥 and entailed getting stuck with needles.

    She said that her condition is “way better” and that she has had no pain episodes leading to a hospital stay since completing the therapy last spring. “I’m just grateful I was able to get it.”

    Cole, who lives in St. Louis with her grandmother Theresa Cole, expects to earn her high school diploma this spring. Before she underwent treatment for sickle cell disease, flare-ups would often force her to cancel plans or miss school. (Judd Demaline for 麻豆女优 Health News)
    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/medicaid/sickle-cell-disease-gene-therapy-medicaid-vertex-bluebird-bio/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2141959&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2141959     Washington鈥檚 Homeless Hide in Plain Sight, Growing Sicker and Costing Taxpayers More /mental-health/washington-dc-homelessness-crackdown-hiding-plain-sight-street-medicine/ Thu, 18 Dec 2025 10:00:00 +0000 WASHINGTON 鈥 Every night, Abdullah Ibrahim retreats from the streets into a wooded stretch along the Potomac River.

    As night falls and temperatures drop, he erects a tent and builds a fire beneath a canopy of pine, hemlock, and cedar trees.

    He evades authorities by rotating use of three tents of different colors at three campsites. As day breaks, he dismantles his shelter, rolls up his belongings, and hides them for the next night. “They don’t see you if you’re in the woods,” the 32-year-old said. “But make sure it’s broken down by morning or they’ll find you.”

    During the day, he wanders, stopping at a public library to warm up or a soup kitchen to eat. What’s important is to not draw attention to himself for being homeless.

    “Police want us out of the way,” he said, dressed in a gray jacket and carrying none of his possessions. “Out of sight, out of mind.”

    Ibrahim has been deliberate about blending in since August, when President Donald Trump placed the district’s police under and ordered National Guard soldiers to patrol its streets. The president homeless people to leave immediately. “There will be no 鈥楳R. NICE GUY,’” .

    The Trump administration says encampment sweeps have reduced the visibility of homelessness, thereby enhancing the city. “There is no disputing that Washington, DC is a safer, cleaner, and more beautiful city thanks to President Trump’s historic actions to restore the nation’s capital,” White House spokesperson Taylor Rogers said.

    While there may appear to be fewer homeless people in the nation’s capital now, they have not disappeared.

    In interviews, homeless people said they are in a constant shuffle, hiding in plain sight. During the day, they stay on the move, grabbing meals at soup kitchens and resting on occasion in public libraries, on park benches, or at bus stops. At night, many unsheltered people bed down in business doorways, on park sidewalks, and on church stoops. Some ride the bus all night, while a few shelter in emergency rooms. Others find respite in the woods or flee to suburbs in Virginia or Maryland.

    A photo of people seated in a row at a church.
    Churches are safe ground for sheltering amid a widespread crackdown on street homelessness in Washington, D.C., homeless people say. As long as they stay off federal land, people are allowed to sleep and congregate at some churches during the day and at night. (Angela Hart/麻豆女优 Health News)
    The district is complying with the Trump administration’s push to aggressively remove homeless people and their tents from public spaces in the nation’s capital. This plot of land once housed a large encampment. (Angela Hart/麻豆女优 Health News)

    There are about 5,100 homeless people in Washington, D.C., including in temporary shelters, according to an . After Trump ordered the crackdown on public homelessness, people living in makeshift communities scattered and are now living in the shadows. City officials estimated in August that homeless people were living outdoors without tents or other shelter.

    As winter draws near, they are exposed to the elements and grow sicker as chronic ailments such as diabetes and heart disease go untreated. Street medicine providers say that, since the National Guard was deployed, they have faced enormous difficulty finding patients. Many caught up in sweeps have had their lifesaving medications thrown away, and they are more likely to miss medical appointments because they are constantly on the move. Street medicine providers say they can’t find their patients to deliver medication or transport them to medical appointments. The constant chaos can suck patients with mental illness and substance use deeper into drug and alcohol addiction, raising the risk of overdose.

    Caseworkers report similar disruptions, saying as clients get lost, they break connections essential for obtaining housing documents, particularly IDs and Social Security cards.

    District officials and health providers say this cascade will make homelessness worse, threatening public health and public safety and racking up enormous costs for the health care system.

    “It was already hard locating people, but the federal presence just made it worse,” said Tobie Smith, a street medicine doctor and the executive director of Street Health D.C.

    A photo of a doctor checking a homeless patient at a park in D.C.
    Tobie Smith, a street medicine doctor with Street Health D.C., checks a homeless person with a stethoscope in November. (Angela Hart/麻豆女优 Health News)

    The Homeless Shuffle

    Chris Jones was born and raised in Washington, D.C., but now is homeless, having been pushed out of his tent near the White House in the initial days of the federal homelessness crackdown. He said two of his tents were taken during sweeps. Now, sleeping on a sidewalk outside a church, he doesn’t bother trying to get another one. “Why? What’s the point? It’ll just get thrown away again.”

    Jones, 57, has a severe knee injury that prevents him from walking some days and said he was scheduled for a knee replacement in December. He said it’s important to stay where he is 鈥 he relies on a nearby drugstore to refill his medications for bipolar disorder, diabetes, and high blood pressure. When he’s hungry, he goes to a soup kitchen for a meal or tries to get a cheeseburger and a soda from a fast-food joint across the street.

    It’s important for him to stay outside the church, he said, so his case manager can find him when a permanent housing slot opens up. If it gets too cold, he said, he will cross the street and sleep in the doorway of a business, which can provide a bit more shelter. He wants to get indoors, but for now, he waits.

    A photo of Chris Jones seated on the steps of a church. Next to him is a small cart with his backpack in it.
    Chris Jones experienced the homelessness crackdown ordered by President Donald Trump in August, when authorities swept through Washington, dismantling homeless encampments and evicting people from their tents. (Angela Hart/麻豆女优 Health News)

    Since taking control of Washington’s police force, the Trump administration has on cities and counties across the nation to clear homeless encampments under threat of arrest, citation, or detention. It has ordered or threatened similar National Guard deployments in Los Angeles; ; and other cities with large homeless populations.

    Rogers, the White House spokesperson, said the president is maintaining National Guard and federal law enforcement presence in the nation’s capital “to ensure the long-term success of the federal operation.” Since March, city and federal officials have removed more than 130 homeless encampments, she said, though some local homelessness experts say that number could be inflated.

    The Supreme Court last year for elected officials and law enforcement to fine or arrest homeless people for living outside. Then, in July of this year, the president issued an executive order calling for a nationwide crackdown on urban camping, including a massive removal of people living outdoors and forced mental health or substance use treatment.

    Trump is also spearheading an overhaul of homelessness policy, moving to and services for homeless people. The move would limit the use of a long-standing federal policy known as “” that offers housing without mandating mental health or addiction treatment. The National Alliance to End Homelessness warns the move risks displacing in permanent supportive housing. The Department of Housing and Urban Development paused the plan on Dec. 8 to make revisions, which it “intends” to do, .

    City officials say they are complying with the Trump administration’s forceful campaign against homeless people sheltering outside. Pressured by the White House, local officials said they’ve gotten more aggressive in breaking up camps. Advocates for homeless people say some of the sweeps have been conducted at night and others with little or no notice to move. City leaders believe they could be done more compassionately by offering services and shelter.

    A photo of a D.C. street at night. Pedestrians walk past a set of military police officers in camouflage.
    Military police officers patrol the streets of Washington after Trump ordered military forces to deploy to the nation’s capital. (Angela Hart/麻豆女优 Health News)

    “We’ve pivoted from the notion of allowing encampments if they didn’t violate public health or safety to a position of, 鈥榃e don’t want you in the streets,’” said Wayne Turnage, deputy mayor for District of Columbia Health and Human Services, who oversees encampment cleanups. “It’s unsafe, it’s unhealthy, and it’s dangerous.” Yet he acknowledges the encampment sweeps can waste city resources as caseworkers and street medicine providers scramble to find their clients and patients.

    Advocates say the Trump administration is inciting fear and mistrust between homeless people and those working to help them while wasting taxpayer dollars used to provide care and place people into housing. There are, however, far fewer tents and large-scale encampments visible to tourists and residents.

    “People found safety in those communities and service providers could find them. Now there are people with guns and flashing lights dislocating folks experiencing homelessness without notice and just throwing stuff away,” said Jesse Rabinowitz, campaign and communications director for the National Homelessness Law Center.

    District officials say some people have accepted emergency shelter. But even as the city works to connect people with services and expand shelter capacity, officials acknowledge there isn’t enough permanent housing or temporary beds for everyone.

    And there will be fewer places for people living outside to go.

    The city, in its fiscal year 2026 budget, concentrated its homelessness funding on families, funding 336 new permanent supportive housing vouchers. Yet it cut funding for temporary housing for both families and individuals and provided no new permanent supportive housing vouchers for individuals. That means fewer housing slots for single adults, who make up most of those wandering the streets. City officials said, however, that they have slotted 260 more permanent housing units for homeless individuals or families into their construction pipeline.

    A photo of a homeless man in his tent.
    Lester Rowland refuses to leave his tent, even amid sweeps. “They can move me and rip my tent down, but I’m never going to leave,” he says. His tent remains clustered amid businesses in the Georgetown neighborhood of Washington. (Angela Hart/麻豆女优 Health News)

    Worsening Health Care

    The fallout is inundating local soup kitchens with demand, including Miriam’s Kitchen in Foggy Bottom. The local institution provides hot meals, housing assistance, and warm blankets to people in need.

    Caseworkers say it’s becoming increasingly difficult to help clients secure IDs and other documents needed for housing and other social services.

    “I’m looking everywhere, but I can’t find people,” said Cyria Knight, a caseworker at Miriam’s Kitchen. “Most of my clients went to Virginia.”

    It’s unclear how much of the district’s homeless population has fanned out to neighboring Virginia and Maryland communities. There were an estimated in the region in January, months before Trump’s crackdown. Four of six counties around Washington saw homelessness rise from 2024, while it .

    “I’m not seeing my patients for a month or more, and then when I do, their chronic conditions are uncontrolled. They’ve been in and out of the ER, and they’re more likely to be hospitalized,” said Anna Graham, a street medicine nurse practitioner for , a network of clinics in Washington. “It’s just setting us back.”

    Graham’s team stations its mobile medical van outside Miriam’s Kitchen at dinnertime to better find patients.

    Willie Taylor, 63, was figuring out where to sleep for the night after grabbing dinner from Miriam’s. He saw Graham to receive his medications for advanced lung disease, seizures, chronic pain, and other health disorders.

    A photo of woman showing a man a pill organizer.
    Willie Taylor, who lives outside and has difficulty walking, gets regular medical care for his chronic health conditions in a mobile medical van. Anna Graham, a street medicine nurse practitioner with Unity Health Care, helped him organize his bags of medication on a cold night in November. (Angela Hart/麻豆女优 Health News)

    He has difficulty walking and needs a wheelchair, which is complicated because he doesn’t have a permanent address. Taylor and his medical providers say his previous wheelchairs have been stolen while he slept outdoors at night. He uses a shopping cart to keep him steady, walking around all day, until nightfall.

    On a cold November night, Graham helped Taylor figure out his daily medications and checked his vitals. The team handed him a warm coat and hand warmers before sending him back outside.

    After walking for about 45 minutes, he found a piece of park pavement where he could build a bed out of tarps and sleeping bags.

    “My body can’t take this,” Taylor said, preparing to sleep. “There’s ice on the concrete. I’m in so much pain; it hurts so much worse when it’s cold.”

    Homeless people and cost the health care system more than housed people, largely because conditions go untreated on the streets, and when they do seek care, many go to the ER. Among Medicaid enrollees, homeless people have been estimated to incur $18,764 a year in spending, compared with $7,561 for other enrollees.

    Over at the So Others Might Eat soup kitchen earlier that day, Tyree Kelley was finishing his breakfast of a sausage sandwich and hard-boiled eggs. He was considering going into a shelter. The streets were becoming too dangerous for someone like him, he said, referring to the police and National Guard presence. He was feeling the loss of an encampment community that would watch his back.

    He’s been to the ER at least seven times this year to get care for a broken ankle he sustained falling off an electric scooter. The accident caused him to lose his job and health insurance as a garbageman, he said. His situation has caused him to sink deeper into a depression that began three years ago after his mother died, he said.

    Then his father and sister died this year. He began to numb his pain with beer.

    “You get so depressed, being out here,” said Kelley, 42. “It gets addictive. You start to not care about even changing your clothes.”

    His depression also led him to seek out marijuana. Then he smoked a joint laced with fentanyl. The overdose sent him to the hospital for days.

    “I actually died and came back,” he said, crediting other homeless people with administering naloxone and saving his life. “I need to get out of this, but I feel so stuck.”

    A few blocks west of the White House sits a vacant plot of land that earlier this year held more than a dozen tents. Workers in the area sense what they don’t always see.

    “I was here when this was all cleared. A bulldozer came in, and all their stuff was thrown in a garbage truck,” said Ray Szemborski, who works across the street from the now-empty lot. “People are still homeless. I still see them around underneath the bridge. Sometimes they’re at bus stops, sometimes just walking around. Their tents are gone but they’re still here.”

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/mental-health/washington-dc-homelessness-crackdown-hiding-plain-sight-street-medicine/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2129929&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2129929     While Politicos Dispense Blame, These Doctors Aim To Take Shame Out of Medicine /mental-health/shame-competence-medicine-doctor-training/ Wed, 05 Nov 2025 09:00:00 +0000 The distress that Will Bynum later recognized as shame settled over him nearly immediately.

    Bynum, then in his second year of residency training as a family medicine physician, was wrapping up a long shift when he was called into an emergency delivery. To save the baby’s life, he used a vacuum device, which applies suction to assist with rapid delivery.

    The baby emerged unharmed. But the mother suffered a severe vaginal tear that required surgical repair by an obstetrician. Soon afterward, Bynum retreated to an empty hospital room, trying to process his feelings about the unexpected complication.

    “I didn’t want to see anybody. I didn’t want anybody to find me,” said Bynum, now an at Duke University School of Medicine in North Carolina. “It was a really primitive response.”

    Shame is a common and highly uncomfortable human emotion. In the years since that pivotal incident, Bynum has become a among clinicians and researchers who argue that the intense crucible of medical training can amplify shame in future doctors.

    He is now part of an emerging effort to teach what he describes as “” to medical school students and practicing physicians. While shame can’t be eliminated, Bynum and his research colleagues maintain that related skills and practices can be developed to reduce the culture of shame and foster a healthier way to engage with it.

    Without this approach, they argue, tomorrow’s doctors won’t recognize and address the emotion in themselves and others. And thus, they risk transmitting it to their patients, even inadvertently, which may . Shaming patients can backfire, Bynum said, making them defensive and leading to isolation and sometimes substance use.

    The U.S. political environment presents an additional obstacle. Health and Human Services Secretary Robert F. Kennedy Jr. and other top Trump administration health officials have autism, diabetes, attention-deficit/hyperactivity disorder, and other chronic issues in large part on the lifestyle choices of people with the conditions 鈥 or their parents. For instance, FDA Commissioner Marty Makary suggested in a Fox News interview that diabetes could be better treated with cooking classes than “.”

    Even before the political shift, that attitude was reflected at doctors’ offices as well. A 2023 study found that when treating patients with Type 2 diabetes. About 44% viewed those patients as lacking motivation to make lifestyle changes, while 39% said they tended to be lazy.

    “We don’t like feeling shame. We want to avoid it. It’s very uncomfortable,” said , a nurse at the University of Wisconsin-Madison, who has of related studies, published in 2024. And if the source of shame is from the clinician, the patient may ask, “鈥榃hy would I go back?’ In some cases, that patient may generalize that to the whole health care system.”

    Indeed, Christa Reed dropped out of regular medical care for two decades, weary of weight-related lectures. “I was told when I was pregnant that my morning sickness was because I was a plus-size, overweight woman,” she said.

    Except for a few urgent medical issues, such as an infected cut, Reed avoided health care providers. “Because going into a doctor for an annual visit would be pointless,” said the now 45-year-old Minneapolis-area wedding photographer. “They would only just tell me to lose weight.”

    Then, last year, severe jaw pain drove Reed to seek specialty care. A routine blood pressure check showed a sky-high reading, sending her to the emergency room. “They said, 鈥榃e don’t know how you’re walking around normal,’” she recounted.

    Since then, Reed has found supportive physicians with expertise in nutrition. Her blood pressure remains under control with medication. She’s also nearly 100 pounds below her heaviest weight, and she hikes, bikes, and lifts weights to build muscle.

    , a California psychiatrist, is among a group of physicians trying to bring attention to the detrimental effects of shame and develop strategies to prevent and mitigate it. While this effort is in the early stages, she co-led a session on the spiral of shame at the American Psychiatric Association’s annual meeting in May.

    If physicians don’t acknowledge shame in themselves, they can be at risk of depression, , sleeping difficulties, and other ripple effects that erode patient care, she said.

    “We often don’t talk about how important the human connection is in medicine,” Woodward said. “But if your doctor is burned out or feeling like they don’t deserve to be your doctor, patients feel that. They can tell.”

    In a survey conducted this year, 37% of graduating students at some point in medical school. And nearly 20% described public humiliation, according to the annual survey by the Association of American Medical Colleges.

    Medical students and resident physicians are already prone to perfectionism, along with an almost “masochistic” work ethic, as Woodward described it. Then they’re run through a gantlet of exams and years of training, amid constant scrutiny and with patients’ lives on the line.

    During training, physicians work in teams and make presentations to teaching faculty about a patient’s medical issues and their recommended treatment approach. “You trip over your words. You miss things. You get things out of order. You go blank,” Bynum said. And then shame creeps in, he said, leading to other debilitating thoughts, such as “鈥業’m no good at this. I’m an idiot. Everyone around me would have done this so much better.’”

    Yet shame remains “a crack in your armor that you don’t want to show,” said , a family medicine physician at the University of Utah who has taught medical students about the potential for shame as part of a broader ethics and humanities course.

    “You’re taking care of a human life,” she said. “Heaven forbid that you act like you’re not capable or you show fear.”

    When students are taught about shame, the goal is to help future physicians recognize the emotion in themselves and others, so they don’t perpetuate the cycle, Pippitt said. “If you felt shamed throughout your medical education, it normalizes that as the experience,” she said.

    Above all, physicians-in-training can work to reframe their mindset when they receive a poor grade or struggle to master a new skill, said Woodward, the California psychiatrist. Instead of believing that they’ve failed as a physician, they can focus on what they got wrong and ways to improve.

    Last year, Bynum started teaching Duke physicians about shame competence, beginning with roughly 20 OB-GYN residents. This year, he launched a larger initiative with , a research and training partnership between Duke University and the University of Exeter in England that he co-founded, to reach about 300 people across Duke’s Department of Family Medicine and Community Health, including faculty and residents.

    This sort of training is rare among Duke OB-GYN resident ’s peers in other programs. Dancel, who completed the training, now strives to support students as they learn skills such as how to suture. She hopes they will pay that approach forward in “a chain reaction of being kind to each other.”

    More than a decade after Bynum experienced that stressful emergency delivery, he still regrets that shame kept him from checking on the mother as he usually would following delivery. “I was too scared of how she was going to react to me,” he said.

    “It was a little devastating,” he said, when a colleague later told him that the mother wished he had stopped by. “She had passed a message along to thank me for saving her baby’s life. If I had just given myself a chance to hear that, that would have really helped in my recovery, to be forgiven.”

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/mental-health/shame-competence-medicine-doctor-training/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2104282&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2104282     The Nation鈥檚 Largest Food Aid Program Is About To See Cuts. Here鈥檚 What You Should Know. /health-care-costs/snap-food-stamps-cuts-shutdown-states-lawsuits-groceries-healthy-eating/ Fri, 31 Oct 2025 19:29:14 +0000 /?post_type=article&p=2108057 The Trump administration’s overhaul of the nation’s largest food assistance program will cause millions of people to lose benefits, strain state budgets, and pressure the nation’s food supply chain, all while likely hindering the goals of the administration’s “Make America Healthy Again” platform, according to researchers and former federal officials.

    Permanent changes to the Supplemental Nutrition Assistance Program are coming regardless of the outcome of at least two federal lawsuits that seek to prevent the government from cutting off November SNAP benefits. The lawsuits challenge the Trump administration’s refusal to release emergency funds to keep the program operating during the government shutdown.

    A federal judge in Rhode Island ordered the government to use those funds to keep SNAP going. A Massachusetts judge in a separate lawsuit also said the government must use its food aid contingency funds to pay for SNAP, but gave the Trump administration until Nov. 3 to come up with a plan.

    Amid that uncertainty, food banks across the U.S. braced for a surge in demand, with the possibility that millions of people will be cut off from the food program that helps them buy groceries.

    On Oct. 28, a vanload of SpaghettiOs, tuna, and other groceries arrived at Gateway Food Pantry in Arnold, Missouri. It may be Gateway’s last shipment for a while. The food pantry south of St. Louis largely serves families with school-age children, but it has already exhausted its yearly food budget because of the surge in demand, said Executive Director Patrick McKelvey.

    A white van with the words "Gateway Food Pantry" in green on the side
    Gateway Food Pantry prepared for a surge in demand amid uncertainty about whether the federal government shutdown would halt funding for the nation’s largest federal food aid program. (Samantha Liss/麻豆女优 Health News)

    New Disabled South, a Georgia-based nonprofit that advocates for people with disabilities, announced that it was offering one-time payments of $100 to $250 to individuals and families who were expected to lose SNAP benefits in the 14 states it serves.

    Less than 48 hours later, the nonprofit had received more than 16,000 requests totaling $3.6 million, largely from families, far more than the organization had funding for.

    “It’s unreal,” co-founder Dom Kelly said.

    The threat of a SNAP funding lapse is a preview of what’s to come when changes to the program that were included in the One Big Beautiful Bill Act that President Donald Trump signed in July take effect.

    The domestic tax-and-spending law cuts $187 billion within the next decade from SNAP. That’s a nearly 20% decrease from current funding levels, according to the Congressional Budget Office.

    The new rules shift many food and administrative costs to states, which may lead some to consider withdrawing from the program, which helped about 42 million people buy groceries last year. Separate from the new law, the administration is also pushing states to limit SNAP purchases by barring such things as candy and soda.

    All that “puts us in uncharted territory for SNAP,” said Cindy Long, a former deputy undersecretary at the Department of Agriculture who is now a national adviser at the law firm Manatt, Phelps & Phillips.

    The country’s first food stamps were issued at the end of the Great Depression, when the poverty-stricken population couldn’t afford farmers’ products. Today, instead of stamps, recipients use debit cards. But the program still buoys farmers and food retailers and prevents hunger during economic downturns.

    The CBO estimates that will lose food assistance as a result of in the budget law, including applying work requirements to more people and shifting more costs to states. Trump administration leaders have backed the changes as a way to limit waste, to , and to .

    This is the biggest cut to SNAP in its history, and it is coming against the backdrop of rising food prices and a fragile labor market.

    The exact toll of the cuts will be difficult to measure, because the Trump administration that measures food insecurity.

    Here are five big changes that are coming to SNAP and what they mean for Americans’ health:

    1. Want food benefits? They will be harder to get.

    Under the new law, people will have to file more paperwork to access SNAP benefits.

    Many recipients are already required to work, volunteer, or participate in other eligible activities for 80 hours a month to get money on their benefit cards. The new law to previously exempted groups, including homeless people, veterans, and young people who were in foster care when they turned 18. The expanded work requirements also apply to parents with children 14 or older and adults ages 55 to 64.

    , if recipients fail to document each month that they meet the requirements, they will be limited to three months of SNAP benefits in a .

    “That is draconian,” said Elaine Waxman, a senior fellow at the Urban Institute, a nonprofit research group. About 1 in 8 adults reported having lost SNAP benefits because they had problems filing their paperwork, according to .

    Certain refugees, asylum-seekers, and other lawful immigrants are cut out of SNAP entirely under the new law.

    A shopping cart inside a food pantry with aisles lined with cans and boxes of goods
    A shopping cart inside the pantry. Patrick McKelvey, executive director of the pantry, exhausted the last of its annual food budget to help meet demand, which has surged amid expected losses of federal food aid. (Samantha Liss/麻豆女优 Health News)

    2. States will have to chip in more money and resources.

    The federal law drastically increases what each state will have to pay to keep the program.

    Until now, states have needed to pay for only half the administrative costs and none of the food costs, with the rest covered by the federal government.

    Under the new law, states are on the hook for 75% of the administrative costs and must cover a portion of the food costs. That amounts to an estimated median cost increase for states of more than 200%, according to by the Georgetown Center on Poverty and Inequality.

    A 麻豆女优 Health News analysis shows that a single funding shift related to the cost of food could put states on the hook for an additional $11 billion.

    All states participate in the SNAP program, but they could opt out. In June, nearly wrote to congressional leaders warning that some states wouldn’t be able to come up with the money to continue the program.

    “If states are forced to end their SNAP programs, hunger and poverty will increase, children and adults will get sicker, grocery stores in rural areas will struggle to stay open, people in agriculture and the food industry will lose jobs, and state and local economies will suffer,” the governors wrote.

    3. Will the changes lead to more healthy eating?

    The Trump administration, through its “Make America Healthy Again” platform, has made healthy eating a priority.

    Health and Human Services Secretary Robert F. Kennedy Jr. has championed the restrictions on soda and candy purchases within the food aid program. To date, to limit what people can buy with SNAP dollars.

    Federal officials previously blocked such restrictions, because they were difficult for states and stores to implement and they boost stigma around SNAP, according to . In 2018, the first Trump administration to ban sugar-sweetened drinks and candy.

    A store may decide that hassle isn’t worth participating in the program and drop out of it, leaving SNAP recipients fewer places to shop.

    People who receive SNAP are no more likely to buy sweets or salty snacks than people who shop without the benefits, . Research shows that encouraging healthy food choices is than regulating purchases.

    When people have less money to spend on food, they often resort to cheaper, unhealthier alternatives that keep them sated longer rather than paying for more expensive food that is healthy and fresh but quick to perish.

    A man unpacks boxes from the back of a white van
    McKelvey and volunteer Nora Lane unload a vanload of groceries, including SpaghettiOs and tuna, which arrived Oct. 28. The pantry largely serves families with school-age children. (Samantha Liss/麻豆女优 Health News)

    4. How will SNAP cuts affect health?

    Advocacy organizations working to end hunger in the nation say the cuts will have long-term health effects.

    Research has found that kids in households with limited access to food to have a mental disorder. Similarly, food insecurity is linked to .

    Working-age people with food insecurity to experience chronic disease. That high blood pressure, arthritis, diabetes, asthma, and chronic obstructive pulmonary disease.

    Those health issues come with costs for individuals. Low-income adults who aren’t on SNAP more a year on health care than those who are.

    lived in households with limited or uncertain access to food in 2023.

    5. What does this mean for the nation’s food supply chain?

    SNAP spending directly boosts grocery stores, their suppliers, and the transportation and farming industries. Additionally, when low-income households have help accessing food, they’re more likely to spend money on other needs, such as prescriptions or car repairs. All that means that every dollar spent through SNAP generates at least $1.50 in economic activity, .

    A report by associations representing convenience stores, grocers, and the food industry estimated it to comply with the new SNAP restrictions.

    Advocates warn stores may pass the costs on to shoppers, or they may close.

    麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

    This <a target="_blank" href="/health-care-costs/snap-food-stamps-cuts-shutdown-states-lawsuits-groceries-healthy-eating/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

    <img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2108057&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]>     2108057     Chronically Ill? In Kennedy鈥檚 View, It Might Be Your Own Fault /news/maha-movement-chronically-ill-blame-game/ Thu, 31 Jul 2025 09:00:00 +0000 On a recent weekday evening, helped her 13-year-old son, Case, with homework. He did math problems and some reading, underscoring how much he’s accomplished at his school for children with autism.

    Richards has heard Trump administration officials suggest that and cause autism and ADHD. That stance, she said, unfairly blames parents.

    “There’s no evidence to support it,” said Richards, 44, a marketing director in Richmond, Virginia. “As a parent, it’s infuriating.”

    In their zeal to “Make America Healthy Again,” Trump administration officials are making statements that some advocacy and medical groups say depict patients and the doctors who treat them as partly responsible for whatever ails them.

    Health and Human Services Secretary Robert F. Kennedy Jr. and agency leaders have attributed a panoply of chronic diseases and other medical issues 鈥 such as autism, attention-deficit/hyperactivity disorder, depression, diabetes, and obesity 鈥 to consumers and their lifestyle choices, according to a review of 15 hours of recorded interviews, social media statements, and federal reports.

    He said at a news conference on April 16 that and that rates are rising because of toxic substances in the environment, despite a lack of evidence there is any link.

    “These are kids who will never pay taxes. They’ll never hold a job. They’ll never play baseball. They’ll never write a poem. They’ll never go out on a date,” he said. “Many of them will never use a toilet unassisted.”

    The vast majority of people on the spectrum do not have those severe challenges.

    The statements are more than rhetoric. These attitudes, ranging from judgments about individual behaviors to criticism of the chronically poor, are shaping policies that affect millions of people. The sentiments have been a factor behind decisions to cut Medicaid, keep federal insurance programs from covering anti-obesity drugs, and impose new barriers to covid vaccines for healthy people, say public health leaders and doctors. GOP lawmakers and federal health officials, they say, hold a reproachful stance toward chronic illnesses and the estimated 129 million people in the U.S. affected by them.

    “This is at the heart of so much of our national problem with health,” said Robert Califf, who led the Food and Drug Administration during the Obama and Biden administrations. “It’s these two extreme views. It’s every health decision is up to the 鈥榬ugged individual,’ versus the other extreme view that it’s all controlled by environment and social determinants of health. The truth is, it’s on a continuum.”

    The Blame Game

    Self-reliance is a common theme among adherents of MAHA, an informal movement for which Kennedy has fashioned himself the figurehead that promotes medical freedom, skepticism of vaccines, and a focus on nontraditional medicine to treat disease.

    Taking medication to manage diabetes? FDA Commissioner Marty Makary suggested on in late May that it would be effective to “treat more diabetes with cooking classes” instead of “just throwing insulin at people.”

    People with Type 1 diabetes must take insulin because their pancreases don’t produce it, according to the , which also notes that many with Type 2 diabetes “need to take diabetes medicines as well.”

    Taking birth control pills? Casey Means, President Donald Trump’s nominee to be U.S. surgeon general, has said that’s a “disrespect of life” for short-term gain and efficiency.

    “We are prescribing them like candy,” she said last year on “,” adding that birth control medications “are literally shutting down the hormones in the female body that create this cyclical, life-giving nature of women.”

    Have a child on ADHD meds? , who is an adviser to Kennedy and is Casey Means’ brother, said on the same show that Adderall is prescribed as the standard of care when children get a little fidgety because they’re in sedentary environments with limited sunlight and eat too much ultraprocessed food.

    As a society, he said, “we’re really committing mass child abuse in many ways, and we’re normalizing that and we’re not speaking out about that. And then we’re giving people stimulants developed by Nazi Germany.”

    Calley Means was probably referring to Pervitin, a drug administered to Adolf Hitler’s forces in World War II. Adderall is a prescription drug containing amphetamine, a stimulant that’s as methamphetamine.

    The Department of Health and Human Services didn’t respond to messages seeking comment from Means.

    Some conservatives and MAHA adherents argue that people need to take more responsibility for their health. But comments that shift blame to patients and physicians risk perpetuating stigmas, fostering the spread of misinformation, and eroding trust in modern medicine, say medical groups, doctors, and patient advocacy groups.

    The statements assume consumers and patients have control over improving their health and preventing chronic disease when the reality is more complex, according to some public health leaders. Lower-income people, they say, often lack access to grocery stores and healthy food, may juggle too many jobs to have time to cook from scratch, and may live in dangerous areas where it’s harder to get outside and exercise.

    , surgeon general during the previous Trump administration, told 麻豆女优 Health News that he worries efforts to promote health will be undone by “the return of vaccine-preventable diseases, increasing mistrust in the health care system, and the tearing down of social supports which are critical for making healthy choices.”

    Tough Talk

    The attitudes held by top Trump health officials have affected policy decisions, some doctors and public health leaders say.

    Kennedy and other Trump administration health leaders have been especially outspoken, targeting issues they consider especially egregious in recent federal actions, research, or policy.

    For example, the Biden administration proposed in November that would let Medicare cover weight loss medications such as Wegovy and Zepbound. But Kennedy and other political appointees at HHS and its agencies have criticized the drugs and the people who take them.

    “I think it’s very dark,” Calley Means , referring to the weight loss drugs. “I think it’s a stranglehold on the U.S. population, almost like solidifying this idea that there is a magic pill.”

    He added: “Where is the urgency on saying 鈥楬ey parents, maybe we shouldn’t feed our kids toxic food?’”

    Kennedy, too, has criticized the medications and people who use them, saying in October on that drugmakers “are counting on selling it to Americans because we’re so stupid and so addicted to drugs.”

    In April, the Trump administration announced it would not finalize the Biden-era coverage rule.

    “It’s impacting the kind of care and treatments patients will have,” said Andrea Love, a biomedical scientist and founder of ImmunoLogic, a science communication organization. “It sends the message that it’s your fault. It’s very much victim-blaming. It creates the idea that scientific progress is the devil, demonizes things that aren’t individually harming health, while avoiding addressing systemic issues that play a much larger role in health.”

    Kennedy and HHS didn’t return messages seeking comment.

    Data shows that the medications are effective. People who took the in clinical trials lost an average of 48 pounds, and 1 in 3 on that dose lost more than 58 pounds, or 25% of their body weight.

    Kennedy and other agency leaders also oppose many covid-era health restrictions and rules. Some physicians and public health leaders note these officials downplayed covid risks while criticizing vaccines developed during the previous Trump administration.

    Kennedy has said that people who died from covid actually fell victim to chronic diseases such as obesity, diabetes, or asthma.

    “That’s really what killed them,” Kennedy said on “” in April. “These were people who were so sick they were basically hanging from a cliff, and covid came along and stamped on their fingers and dropped them off. But they were already living lives that were burdened by sickness.”

    Covid was the underlying cause of death for more than in the U.S. from Aug. 1, 2021, to July 31, 2022, according to a 2023 report in JAMA Network, an open-access journal on biomedical sciences published by the American Medical Association.

    Covid ranked first among deaths caused by infectious or respiratory diseases for youths under age 19, based on the report. Infants under a year old may be at higher risk of experiencing severe illness from covid compared with older children, , and risks are also higher for infants under 6 months and those with underlying medical conditions.

    “ can help protect infants after birth,” according to the CDC.

    But Kennedy announced in May that the federal government would no longer recommend covid vaccines for pregnant people and children who are healthy. Medical groups such as the American Academy of Pediatrics opposed this decision and filed a lawsuit. 

    Kennedy also helped promote beliefs that many childless adults on Medicaid, the federal-state program for low-income people, don’t work and thereby drain resources from the program.

    At a May hearing of the House Energy and Commerce Committee, Kennedy said the program was in jeopardy because of “all the able-bodied people who are not working [or] looking for jobs.”

    It’s a view embraced by Republican lawmakers who portrayed adults enrolled in Medicaid as lazy or shirking work as they advanced a budget bill estimated to cut federal spending on the program by about $1 trillion over a decade, in part by imposing work requirements on many adult beneficiaries.

    “Thirty-five-year-olds sitting at home playing video games, they’re going to now have to go get a job,” said House Majority Leader Steve Scalise of Louisiana.

    The legislation, which Trump signed into law this month, will cause about 10 million more people to be without health insurance by 2034, .

    Some health leaders who criticized the legislation say the statements inaccurately maligned Medicaid enrollees, who by law cannot hold high-paying jobs and remain in the program.

    Nonetheless, nearly two-thirds of adults ages 19 to 64 covered by Medicaid in 2023 were working. For about 3 in 10, caregiving responsibilities, an illness or disability, or school attendance prevented them from working, , a health information nonprofit that includes 麻豆女优 Health News.

    “It’s using anti-welfare tropes for something that is basic health care, not a cash benefit,” said Anthony Wright, executive director at Families USA, which supports the Affordable Care Act and expanded health coverage. He summarized the Republican message: “We’re going to make it harder to get the help you need by imposing a bunch of paperwork, and if you don’t get it, it’s your fault.”

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