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  • Patient Dies by Suicide After ‘Insurance Issue’ Delayed Medicine for Lung Disease Flare-Ups

    Patient Dies by Suicide After ‘Insurance Issue’ Delayed Medicine for Lung Disease Flare-Ups

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

    KYLE, Texas — Kenney Blewett was diagnosed with lung disease more than a decade ago but started experiencing flare-ups this year that made him feel like he couldn’t breathe.

    Blewett described those flare-ups as “the scariest thing in the world,” said his wife, Cindy, adding that while the episodes typically lasted no more than a few minutes, they had become more frequent.

    On top of that, simple tasks, like taking out the trash, left Blewett winded. He rarely left the house and had recently lost 45 pounds. “That sounds like cancer,” Cindy remembered one of his doctors said. It was clear, she said, that her husband’s poor health, tied to decades of smoking, was getting worse.

    That’s why, on June 2, Blewett’s pulmonologist wrote him a prescription for a new medication to improve the terrifying breathing issues caused by chronic obstructive pulmonary disease, or COPD. But the prescription wasn’t immediately filled. Two days after that doctor appointment, Blewett received an email from Walgreens explaining that, “due to an insurance issue that we’re working to resolve,” the medication was delayed.

    “He was hopeful that it would work,” Cindy said of the drug, two months after her husband’s death. “I wish we had the chance to find out.”

    Insurance delays and denials have become an infamous feature of the American healthcare system, with nearly 7 in 10 adults calling them “a major problem,” in a January KFF Health Tracking Poll.

    In June 2025, six months after UnitedHealthcare’s CEO was shot in New York, the Trump administration announced a highly publicized industry pledge, signed by dozens of major health insurers, to remove some of the barriers that block or delay patients from accessing doctor-recommended care. And yet that pledge was voluntary, and it carries no penalties if companies fail to comply. Indeed, a report published by KFF Health News in July found that some insurers that signed the pledge would not implement all the promised initiatives as originally outlined.

    Insurers Hedge on Trump-Backed Pledge To Improve Denials Process

    Last year, the Trump administration announced a voluntary pledge by dozens of insurers to improve prior authorization, which often requires patients to seek approval before treatments. But prior authorization remains commonplace, and there’s no evidence the government is trying to hold insurers to account.

    In recent years, lawmakers in most states, including Texas, have attempted to address delays and denials by regulating the insurance industry in the absence of substantial federal reform. But most health insurance plans, including traditional Medicare policies and employer-sponsored offerings, which together cover more than half of all Americans, typically aren’t under state jurisdiction.

    Even some medical office staff and pharmacy employees find the patchwork of state and federal insurance rules and regulations confusing, a problem that is poised to become more complicated as artificial intelligence plays a larger role in approving and processing claims.

    “It’s just gotten completely out of hand,” said Matt Toresco, CEO of Archō, a patient advocacy and consulting company. He argued that patients need more assistance facing insurance hurdles.

    The Blewetts’ story illustrates how navigating these complexities remains a herculean task for patients and their caregivers.

    Cindy has sought answers from Medicare; Kenney’s private Part D drug plan; his pulmonologist’s office; and Walgreens. She still has questions about who was responsible for the medication delay and how the holdup could have been prevented.

    If the COPD flare-up Blewett experienced on the afternoon of Sunday, June 7, could have been avoided, she wondered, would he still have chosen to die by suicide that night?

    A photo of a man standing in the woods seen on a laptop.
    Kenney Blewett, who was diagnosed with lung disease more than a decade ago, died by suicide in June. The Blewetts celebrated their 60th wedding anniversary earlier this year. (Callie Richmond for KFF Health News)

    ‘Complex and Convoluted’

    During that first week of June, Cindy said her husband repeatedly asked if his prescription — a liquid medication meant to be inhaled through the nebulizer machine Kenney owned — was ready to be picked up from Walgreens.

    Cindy said she wasn’t initially surprised or worried by the delay. Since its acquisition by a private equity firm last year, Walgreens has cut thousands of jobs across the country, according to the Private Equity Stakeholder Project. Cindy said in August that their Walgreens pharmacy in Kyle seemed to her to have been understaffed for months, and that prescriptions were being filled more slowly.

    When Cindy called the pharmacy a few days after Kenney’s appointment to find out more about the insurance delay, she said, a Walgreens employee told her the prescription required prior authorization. Also called preapproval or precertification, prior authorization is a practice widely used by health insurers that requires medical providers to seek permission before their patients may receive covered treatment.

    But Cindy didn’t know which of Kenney’s insurers required prior authorization for this medication.

    For years, she had helped manage multiple policies on behalf of her husband. Kenney was insured by Medicare parts A and B, the federal health insurance program for people 65 and older or with disabilities. But he also had a private Part D plan to cover drug costs through Wellcare Value Script, as well as a Medicare supplement plan through Blue Cross and Blue Shield of Texas — also called a “Medigap” plan — that paid for other out-of-pocket costs.

    Initially, Cindy assumed that Kenney’s Part D plan had invoked prior authorization for his new medication. But because it was a liquid that is inhaled through a nebulizer machine, this drug was one of relatively few covered by Medicare Part B’s durable medical equipment benefit, not Part D.

    The federal government had no record showing that this prescription had been billed to Kenney’s Part B policy, the Medicare agency told Cindy over the phone, she said.

    Sarah Tanner and Myriea Amaya, spokespeople for Centene, Wellcare Value Script’s parent company, would not answer questions for this article.

    After Kenney’s death, when Blewett sought clarification at the Walgreens pharmacy, she said the employee “kept saying different things.” She recalled his explaining that the prescription was submitted to Medicare Part B but without a necessary diagnostic code that the doctor should have included.

    Carmen Lopez, a spokesperson for Walgreens, told KFF Health News in late September that the company “cannot comment on matters involving specific individuals.”

    Subsequently, Cindy said, a district pharmacy supervisor for Walgreens reached out by phone, and told her the pharmacy tried to process the prescription through Part B on June 2, the same day as the pulmonologist appointment, but that the prescription was missing a diagnostic code from the physician. The supervisor said Walgreens sent a request for that code to the pulmonologist’s office later that day, Cindy recalled.

    Kenney’s pulmonologist — Rajesh Shetty of LungDocs — did not respond to phone or email messages from KFF Health News. But Cindy said an employee at the practice told her they did not see a fax from Walgreens asking for a diagnostic code for the prescription.

    Meanwhile, it couldn’t have been an issue with Kenney’s Medigap plan, since those policies don’t require prior authorization.

    “Short of getting attorneys involved,” Cindy said, “I’m not sure how to find out what really happened.”

    Cindy Blewett stands on her porch in front of her home. Foliage and plants from her garden on seen to the left.
    Cindy Blewett tried to figure out which of her husband’s insurers required prior authorization for his medication. (Callie Richmond for KFF Health News)

    More Red Tape Ahead

    Confusion surrounding these Part B and Part D distinctions is common, said Mike Hess, senior director of advocacy and regulatory affairs at the nonprofit COPD Foundation. “Medicare has gotten to be so complex and convoluted over the years,” he said, that even medical office staff and pharmacy employees often misunderstand the nuances.

    And with the introduction of AI to the preapproval process, navigating insurance hurdles will likely get more complex for Medicare beneficiaries, doctors say.

    Historically, traditional Medicare, unlike Medicare Advantage, used prior authorization sparingly. But in January, Medicare launched a pilot program in six states — Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington — testing the use of AI to preapprove some healthcare services.

    It is intended to “root out waste in Original Medicare,” CMS Administrator Mehmet Oz has said, but physicians and patients say the program is creating more red tape for Medicare beneficiaries and leading to inappropriate denials. The pilot program does not currently impose prior authorization requirements on COPD medications, but industry experts expect the scope of the initiative will grow to include more services and states.

    On the night of June 7, hours after her husband’s last COPD flare-up, Cindy Blewett was sitting on their back porch when she heard a loud noise. She assumed a picture had fallen off the wall in the living room. In fact, it was a gunshot. She discovered Kenney’s body in their bedroom.

    “I can’t tell you how horrible it was,” Cindy said.

    She said her husband had struggled with his mental health for a long time and had attempted suicide once before, years ago. His deteriorating health only made things worse, she said.

    Kenney confirmed that much in a note he left. He told Cindy that she was a wonderful wife, mother, and grandmother but that his health was too poor to continue living.

    A photo of a dark blue urn on a black table. A glass goblet is seen behind the urn.
    Cindy Blewett keeps an urn of her husband’s ashes. (Callie Richmond for KFF Health News)

    A second COPD medication, which his pulmonologist ordered directly from the drug manufacturer during the June 2 appointment, arrived several weeks after Kenney’s suicide, she said.

    “Perhaps, just perhaps,” Cindy said, “if he had received both medications in a timely manner, he would be here today, and we would have had many more years together.”

    Do you have an experience with prior authorization you’d like to share? Click here to tell KFF Health News your story.

    [Correction: This article was revised at 11 a.m. ET on Oct. 2, 2026, to correct the description of Mike Hess’ role at the COPD Foundation.]

  • STAT+: NIH awarded all its grant funding, but delayed and opaque decisions stymied researchers

    STAT+: NIH awarded all its grant funding, but delayed and opaque decisions stymied researchers

    A STAT analysis of National Institutes of Health spending shows that in the 2026 fiscal year, which ended Wednesday, the agency continued reducing grant awards involving health disparities, race, and ethnicity but made little progress toward other Trump administration priorities, including disbursing funds more evenly across the country and expanding support for early-career scientists.

    While the agency, like last year, spent its entire external grants budget of roughly $34 billion after a slow start, the manner in which it did so is sowing deep uncertainty among researchers. In a survey and interviews, they said delays in the grant review process are slowing down the pace of their work, and making it difficult for them to propose and conduct the sort of innovative, impactful science that the NIH exists to support.

    Overall, the agency funded around 58,000 projects, a slight drop from the 61,000 awarded during the 2025 fiscal year and well below the roughly 63,700 grants awarded annually in the years before the second Trump administration. Though this number may increase somewhat in the coming weeks because of reporting lags in the NIH grants database, the smaller number of grants potentially resulted from the White House’s push to fully fund more multiyear grants in advance, which meant that there was less funding on hand to issue new awards. 

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  • The MAHA Metamorphosis

    The MAHA Metamorphosis

    [Editor’s note: This transcript was generated using transcription software. It has been edited for style and clarity.] 

    Julie Rovner: Hello, from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for KFF Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, Oct. 1, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. 

    Today we are joined via videoconference by Rachel Roubein of The Washington Post. 

    Rachel Roubein: Hey, everybody. 

    Rovner: Shefali Luthra of The 19th. 

    Shefali Luthra: Hello. 

    Rovner: And my KFF Health News colleague Rachana Pradhan. 

    Rachana Pradhan: Hi, Julie. 

    Rovner: Later in this episode, we’ll have my interview with Dr. Aaron Carroll of AcademyHealth about the undoing of the federal Agency for Healthcare Research and Quality, AHRQ, where most of the staff has been laid off or retired, and hundreds of grants have been canceled midcycle. But first, this week’s news. 

    So we haven’t talked about the Make America Healthy Again movement in a while. It was a big week for MAHA here in Washington, D.C., with a gigantic summit at what used to be the Trump [International] Hotel, down the street from the White House. But it was hardly the event you’d expect if you still think of MAHA as moms who want their kids to have access to healthier food grown with fewer pesticides. Rather, this event featured representatives from health companies with business before the federal government, paying sponsorships of up to $300,000 each to sit on panels with officials from said government to talk about everything from the use of psychedelic drugs to fraud-fighting to wearables and AI [artificial intelligence]. The panel featuring Medicare and Medicaid chief Dr. [Mehmet] Oz was somewhat bizarrely moderated by comedian Russell Brand, who’s awaiting trial on sexual misconduct charges back in England. What was this event supposed to accomplish? 

    Roubein: I think you kind of hit the nail on the head in terms of just thinking about the MAHA movement and sort of where it’s going next, because you had some people, more sort of MAHA activists, who were upset that it didn’t talk about some of the core issues of the MAHA base, like vaccines, like pesticides. There have been some influential MAHA activists who’ve been upset at the administration and disillusioned that it hasn’t done more to crack down on pesticide use, etc., have been upset at the Trump administration, and have been saying just weeks before the midterm elections that Republicans may lose some of these votes, and some so-called MAHA moms might sit out the elections. And I don’t think this summit did anything to persuade them to go and vote Republican in the midterms. 

    Rovner: Yeah, it did seem, it seemed a great get-together if you wanted to sort of commune with the people who regulate your products, on a public stage. But both the president and Health and Human Services Secretary Robert F. Kennedy Jr. have felt free of late to talk about vaccines, although obviously not at this summit. But it seems that the issue that had united most of MAHA that we were just talking about, pesticides and ultraprocessed food, have been back-burnered by the White House. Rachel, you wrote a story about this. What happened to the food agenda? 

    Roubein: Pretty notably, one of the big potential parts of the food agenda is this petition that was filed by David Kessler. He’s the former head of the FDA [Food and Drug Administration] under both Republican and Democratic administrations. And his petition, essentially — I talked to food safety experts about it — could have launched a process that could have forced the industry to reformulate some ultraprocessed foods eventually. So that could have been a big deal. The status of it: It was filed August 2025, and Kennedy earlier this year had done a response to it, where he wanted to have food companies produce any detailed safety studies showing that certain ingredients common in ultraprocessed foods are generally safe. And what I had heard from talking to people is that that potential push had been slow-walked at the White House. I obtained a March draft of the letter that Kennedy sent to the White House for review. Now, HHS pushed back on the assertion that it was slow-walked, but this isn’t the first time that administration officials had wanted to and planned to announce something. They had been working on a definition of ultraprocessed foods that they wanted to release back in August, and that was delayed at the last minute, them just putting out more information about this draft definition. 

    Rovner: I feel like there’s this tension between the MAHA movement, which started as a grassroots movement to crack down on corporate power, and the White House is sort of wanting to deregulate everything. Those two things seem to be kind of at loggerheads, and it looks for now like the corporations are winning. We saw this with the pesticides earlier in the year, with glyphosate, that the agricultural community fought back and said, You can’t make us stop using it, because we need it to produce food. And now it seems that the food producers are saying: You have a deregulatory agenda. Why are you talking about regulating us more? Is that, am I reading this right that the corporate power is winning, at least so far? 

    Pradhan: It’s still a Republican administration, right? Regardless of Secretary Kennedy’s sort of mandate and passions, he’s still working with and for people who do not like to use government to restrict or regulate or ban things. Even, if you think about, we’ve come a long way since this point. But when former first lady Michelle Obama tried to put healthier foods in schools, she was roundly criticized for embodying a nanny state and all these things. And now, the political winds have shifted. But I still think to go up against the party’s kind of traditional views on regulating business and corporate interests, it’s a swamp. What are you going to do? They’re not going to want to regulate a lot. And like you said, Julie, there are ample actions to date that show that there isn’t necessarily a desire to impose more regulations. It’s also an election year. They may not want to antagonize corporate interests when you’re trying to not see huge losses, especially in potentially the House and maybe even the Senate. 

    Rovner: Yeah, they have enough people who are mad at them. They don’t want to add to it. 

    Pradhan: Exactly. 

    Rovner: Well, of course, with every political split comes a new political opportunity. In Michigan, Democratic Senate nominee Abdul El-Sayed, who’s a prominent supporter of “Medicare for All,” is now trying to grab back some of those Democrats who gravitated to MAHA by unveiling something he’s calling the “Building a Healthier America” agenda, focusing on fewer pesticides, cleaner water, and healthier food. Rachel, you wrote about this. Might it work? Might Democrats be able to sort of reclaim some of these people who drifted to the Republicans along with RFK Jr.? 

    Roubein: I think it’s something that particularly some progressive Democrats are looking to, and they might look to do if they win back the House. In the Farm Bill, you saw Republicans and — some Republicans — and Democrats push back against giving pesticide makers immunity liability shields. But I think it remains an open question. And I think it also depends on the different groups, in terms of MAHA. Tony Lyons at MAHA Action has said that they want there to be an alliance with Republicans. But you also see this with Rep. Alexandria Ocasio-Cortez trying to court some MAHA activists her way. So I think it’s an open question in terms of how this movement unfolds and whether there are any deviations towards the left. But it is a hard sell in some ways. Vaccines are a big part of a lot of people in the MAHA base. And when I asked El-Sayed about this, he said they’re, like, We’re going to agree to disagree on vaccines. 

    Rovner: Yeah, he’s trained as a doctor and he does believe in vaccines. And he was the head of public health at the city of Detroit. He’s definitely not with the anti-vaccine types. But it’s important to remember that the original anti-vax movement was a combination of people from the far right and from the far left. So there have always been a lot of Democrats in the anti-vax movement, and this has been a group that’s been kind of up for grabs. And we will, I guess we’ll see how it will all shake out. 

    Roubein: And some of the things on food Sen. Bernie Sanders has said for a long time, too. So there has always sort of been some of that intersection on certain issues. 

    Rovner: Yeah. Well, originally RFK Jr. was running as a Democrat before he took up with the Trump team. All right. Moving on. Today is Oct. 1, the start of the fiscal year. Happy FY 2027, everyone. The Trump administration marked the day a little early, informing Congress last Friday that it was declining to spend more than $800 billion, in what’s called a pocket rescission. That’s when an administration declines to spend money appropriated by Congress so close to the end of the fiscal year that it basically can’t be spent at all and Congress doesn’t have time to disapprove it. The majority of this funding is from HHS, largely for programs to help noncitizens and for what the administration calls, quote, “overfunded and unaligned” HHS research programs. That includes many related to minority health. Congressional spending leaders, including Senate Appropriations Chair Susan Collins of Maine, complained that pocket rescissions are illegal under a law called the Impoundment Control Act, and the Government Accountability Office issued an opinion this week backing that claim up. But, as we know, this administration likes to dare courts to stop it from doing things that just about everybody else acknowledges is illegal. And I guess that’s where we are here? 

    Luthra: No, I was just thinking, right? It’s October. Everything that happens now, we also think about in the context of an election, and I think a dynamic that we have talked about a lot is this effort by the administration to just sort of do what it would like to do with funding, even when many people might say that is not how the laws and separation of powers are supposed to work. And I think something really interesting for us to consider is whether those dynamics do, in fact, change in the new year. Given what Rachana mentioned earlier, there is a very good chance that Democrats control both chambers of Congress, not just one. And [does] that possibility of conflict with another branch in Washington change what behavior we see from the White House? I think that’s a really interesting question and something that we should be thinking about as the election gets closer, and then again depending on what the results end up being. 

    Rovner: Yeah, one of the really weedy issues here is who gets to sue the administration to say that, Hey, you’re not allowed to not spend money that we’ve appropriated. It was important that they came out and said that this was illegal, because the GAO, under the law, has standing to sue. But they don’t have a confirmed leader at this point, and Susan Collins was asked about this and said they may be a little bit wary to kind of get out in front of Congress. But I think it’s probably fair to say that if Democrats take back the House and Senate, that they would be more likely to want to either — I think that the Congress itself can sue the administration, can go to court and say, Hey, you can’t do this, which obviously the Republican Congress hasn’t wanted to do. But a Democratic Congress might. 

    Pradhan: What — has GAO ever been known to sue? 

    Rovner: That’s a good question. I can’t remember. We’ve had fights about rescissions before. 

    Pradhan: Yeah. 

    Rovner: But it’s — Russell Vought, the head of the White House Office of Management and Budget, says publicly that he thinks that the Impoundment Control Act is unconstitutional and therefore they don’t have to obey it. That’s clearly something for a court to determine. That’s clearly something for the Supreme Court to determine. We haven’t gotten there yet, but most of the time, I think, we’ve had lower courts that have warned the administration: Um, hey, there’s this law that says you can’t do that. You have to spend money the way Congress says you should spend money. The last time we had a pocket rescission, I looked it up, was last year when this administration did the same thing. That was the USAID [U.S. Agency for International Development] money. So before that, I’m not sure when. I may go back and have a look. Shefali, to your point, that was my next question anyway. It’s like, I would think that the one thing that is likely to change if the Democrats take Congress — obviously, we have two more years of the Trump administration — but I would think they would be a lot more zealous in guarding their spending power than this Congress has been. 

    Luthra: One would imagine. It seems hard to abdicate the power that one might want. That’s how separation of powers, in theory, is supposed to work. 

    Rovner: And it is kind of written into the Constitution. 

    Pradhan: I do wonder, though, if they think that, if they wouldn’t get a good, friendly decision from a court … 

    Rovner: The Supreme Court. Yeah. 

    Pradhan: Yeah. That could be far more damaging in the long term, right? 

    Rovner: Yes. There is the concern that the Supreme Court would agree with Russell Vought that the Impoundment Control Act … 

    Pradhan: Right. 

    Rovner: … is unconstitutional. That is a risk that they would run. 

    Pradhan: Right. 

    Rovner: Well, that will happen. We will see what happens with that. All right. So, obviously these latest cuts aren’t the only ones to HHS that have been made since [President Donald] Trump returned to office in 2025. We will talk more about what’s happened at the Agency for Healthcare Research and Quality in this week’s interview, but I want to talk a little bit right now about the Centers for Disease Control and Prevention, whose workforce we now know is down by almost a third, according to The New York Times. Quote: “The changes have hindered the C.D.C.’s ability to respond to outbreaks as measles spreads at home and Ebola abroad,” while, quote, “entire divisions have been shuttered, including teams that worked on smoking, sexual violence, child abuse and falls among older adults.” Separately, but not really separately, the CDC’s advisory committee on vaccine practices has ground to a halt after a judge struck down Kennedy’s replacement members as unqualified. Medical societies have stepped in with their own vaccine recommendations for this fall, but the official CDC guidance is already out of date because there’s no ACIP [Advisory Committee on Immunization Practices] to make recommendations. This is all going to come home to roost the next time we have a bad flu season, I imagine. 

    Pradhan: Yeah, I think that the Times, the New York Times, story, what I thought was really, kind of what they led with, was that even though last year you had these widespread firings across HHS and different agencies, including the CDC — the CDC at that time we know lost about 1 in 5 workers — but really the true scale of the losses is much higher. It’s about 30% fewer employees. But the CDC has really had a rough go of it. I think it probably was the — it was the poster child for everything that went wrong during the pandemic, in Republicans’ view. And so they’ve been very keen on dismantling a lot of that agency, more so than the FDA and more so than the NIH [National Institutes of Health], for example, even though they’ve also seen a lot of staff reductions. But CDC, I think, has been so crippled for so long, both because of the staff reductions and just the awful morale at the agency because of everything that the current political leadership has done since. Yeah. 

    Rovner: I would say, and the politicization of its leadership, things that were long run by career scientists in Democratic and Republican administrations that are now being run by political appointees, who are rather pointedly not scientists … 

    Pradhan: Yeah. 

    Rovner: … running this very scientifically driven agency. And of course we’ve had a fifth measles death in Pennsylvania now, that apparently the CDC is still not acknowledging the measles deaths in Pennsylvania. So there are still a lot of questions. The CDC does have, unlike several of the other HHS agencies, does have a Senate-confirmed leader. But so far, we haven’t heard very much from her. I guess we are all still sort of waiting to see what happens, but in the meantime, I can just imagine if we have a bad flu season or some other respiratory ailment that could have been prevented if CDC had been up to date with its vaccine recommendations, things could get rather loud and nasty later this winter. 

    Roubein: Some of the vaccine recommendations, some of this is very much tied into the lawsuit, just like the high-level ACIP not putting more vaccine recommendations out. And this part has had somewhat of a snowball effect, like the Vaccines for Children Program, giving out free vaccines to uninsured, underinsured kids, that was held up for about a month. That is now going through, but they had to kind of work through: What are the recommendations going to be? And they ended up going with prior recommendations because there is not an ACIP to meet. So some of this has been tied up in legal limbo. And yeah, on the measles deaths, CDC is now acknowledging two out of the five that Pennsylvania has reported. 

    Rovner: There we go. We’re finally hearing something. All right, we’re going to take a quick break. We will be right back. 

    Turning to reproductive health, the Hyde Amendment — that’s the annual appropriations rider that bars federal funding for abortion in most cases — turns 50 this week, which, as one abortion rights group pointed out, means that the ban itself has now been in effect longer than Roe v. Wade was in force. Shefali, what’s been the impact of the Hyde Amendment on the ground? What does it actually mean for people who are seeking reproductive care? 

    Luthra: It’s a bit more complicated than I think people might initially realize. The Hyde Amendment prohibits the use of federal funds to pay for abortion — functionally, Medicaid. And so Medicaid programs are jointly funded by state governments and federal governments. If you are in a state where the state government does not want to put money into paying for Medicaid coverage of abortion, your abortion will not be covered, especially if you are low-income. Most people who get abortions are people who cannot afford another child. They are parents already. They are largely people who are low-income and rely on something like Medicaid. However, there are states, the Californias, etc., of the world, that have made a point of putting state funds into their Medicaid programs. So in some states, you can get Medicaid to cover your abortion. That’s really helpful. It makes this procedure much more affordable. It can cost hundreds of dollars, sometimes a lot more, depending on where you are in your pregnancy, to get an abortion. But, of course, the fact that this has existed for so long has absolutely made it harder for people, often those who are most financially vulnerable, to get abortions. What you often hear from those patients, though, when I speak to them, is, like, This is something I really can’t afford right now, but I will pay for it anyway because I really can’t afford another child. I think the Hyde Amendment is really striking in that it makes this thing much harder to get. But for a lot of people, it doesn’t necessarily stop them from getting it, because it is just so important to them. 

    Rovner: It’s ironic that something that has to, literally Congress has to pass every year — it is a rider on a spending bill. Democrats have tried various ways to get rid of it, always failed. Even when we had a Congress that supported abortion rights, they could not get this out. It is just sort of part of the landscape now, isn’t it? 

    Luthra: And part of it is, I think, demonstrative of one of the more effective anti-abortion lines a lot of Republicans have. Abortion public opinion is very complicated. And people support abortion rights in the abstract, but when you get into more specifics, their views become more complicated. And one framing a lot of the GOP has really found success with is saying, We don’t support taxpayer funding of abortion. And that really works because people will hear that and they say: Oh, well, that sounds very extreme. I support this for other people, but, like, my tax dollars, they can’t fund that. And that is the line that has been used to keep Medicaid from paying for abortions, to keep the Hyde Amendment intact, and to keep other federal programs as well from making this more available. And I think it’s perhaps more politically complicated than first blush at abortion polling data might suggest to undo something like this, 

    Rovner: I absolutely agree. Well, still, anti-abortion forces remain intent on cutting off the main remaining source of access to abortion, the abortion pill mifepristone. This week, the attorneys general of Louisiana, Alabama, and Arkansas filed suit in federal district court — not at the Supreme Court, which the group’s press release says — to strike down the shield laws in New York, Massachusetts, and California. Those are the laws that enable doctors in those states to provide telehealth appointments to people in ban states seeking to terminate their pregnancies. Shefali, there’s already a lawsuit on mifepristone making its way through the courts, and it’s from Louisiana. How is this one different? 

    Luthra: This one is different because it specifically goes after shield laws and it challenges their constitutionality. That is a different argument. It is more sweeping. It could be the thing that finally gets the Supreme Court to weigh in on this issue. Right? It’s a very, very big legal question, something that constitutional scholars have believed, since the enactment of shield laws will ultimately be settled by the Supreme Court. However, I think it’s really important for us to take this suit with context. As you mentioned, there are so many cases making their way through the courts right now around how people get abortions, the provision of mifepristone, shield laws, etc., etc. We don’t know which one will end up at the Supreme Court. We don’t know how courts will rule. This is just one more quiver in the bow that abortion opponents are trying to use to stop this telehealth model that has found quite a bit of success. We will see which one lands. It very well could be this one, but, at this point, we just don’t know. 

    Rovner: Yeah, and I should point out that the other Louisiana case is about FDA and its approval of mifepristone to be prescribed via telehealth. So, and of course, we’re also waiting for the administration to do, to finish its FDA safety review, which we expect to see sometime after the election. Speaking of which, abortion is not quite the high-profile electoral issue this year that it was in 2024, but there’s still several abortion-related ballot initiatives to be voted on this year. Shefali, any that you’re watching particularly closely? Or any of the others of you? 

    Luthra: I am personally very interested in the Idaho measure and the Missouri one. I spent a bit of time in both of those states learning about what’s happening there over the past month. I think it’s really fascinating. In Missouri, it’s a very strange case. Two years ago, voters amended their constitution and said, We will protect abortion rights. Abortion is now legal in Missouri, a state run by very, very anti-abortion lawmakers. Those same lawmakers were horrified by this finding, and so they have put forth a new ballot measure that would overturn the 2024 result, and it would amend the state constitution to ban abortion. And if that passes, Missouri’s constitution would be the only state constitution to explicitly ban abortion. That’s a really big deal. If this passes, it could set an example to other states where voters have said, We support abortion rights and lawmakers have felt very frustrated by that. Polling right now is a very even split. There is a lot of money. We will see what happens. But I think this is a really interesting case for us to be following. 

    Rovner: And it’s super confusing because they just voted on this. 

    Luthra: It’s so confusing. And it’s called Amendment 3. If you look at two years ago, the abortion rights measure was also called Amendment 3, and so you might be like: Well, I just voted on Amendment 3. I voted for it. I should vote for it again. And in fact, that would be the opposite. And I’ve spoken to people … 

    Pradhan: That’s very confusing. That’s very confusing. How are people supposed to keep up with all this? I can barely keep up with it. 

    Luthra: How are they supposed to keep up with all of it? That’s such a good question. 

    Pradhan: It’s a lot. 

    Luthra: But no, and I’ve spoken to people who work in politics in the area, and they had no idea this was even on the ballot. And I was like, That’s also really striking that abortion has faded from a lot of the political consciousness. But actually there’s this measure that could have really sweeping consequences and really inspire similar action in other states. And the Idaho measure, I think, also very interesting. That would actually not amend the constitution. It would just pass a law that would overturn Idaho’s very, very strict abortion ban, which has sparked all these headlines — women being airlifted to Utah for medical emergencies, doctors leaving, labor and delivery wards shutting down because the law is so strict there. It’s really an open question, but there is some polling that suggests that this could pass. They have gotten a lot of support from Democrats, but also independents, also Republicans. A lot of people in Idaho who were never really politically engaged very deeply are, because this abortion ban has been so sweeping, affected so many of them so personally. If it passes, the legislature could vote to overturn it, and we’ve seen that happen in states around the country. But I think we don’t know, A) if it will pass and, B) if it did how lawmakers might react. There’s a real chance — right? — that they are just so surprised that this happens that maybe you do reconsider the politics of instituting an abortion ban when voters rejected one. But absolutely worth following and seeing what happens in this case, for political reasons but also because a lot of people’s lives could be really, really fundamentally changed as a result of it. 

    Roubein: Missouri sounds like such an interesting test case, because I remember back in 2022, after the Supreme Court decision, abortion rights groups were really grasping for a strategy, so they were throwing a bunch of different things at the wall, lawsuits, and then they tried the ballot measures, and it just seemed to work and take off steam. So that’s pretty interesting. 

    Rovner: Yeah, and of course, as you pointed out, Missouri has some of the most strident anti-abortion lawmakers in Congress. Josh Hawley, the senator whose wife is one of the lawyers for the anti-abortion, for the main anti-abortion legal group. So Missouri is one of those states that’s got all of the poles represented, and we will have to see how that all comes out. 

    Pradhan: Can I make one last addendum on the abortion thing, which is because I’m a Virginia resident? Actually, I was talking to my husband the other day. I said, “Oh, this is how you know that Democrats are in charge,” or we have a relatively new Democratic governor. So now there’s a proposed constitutional amendment on the ballot to amend the state constitution to codify abortion being legal until 28 weeks, so basically through the first two trimesters. Which, you know, Virginia is interesting. I’m biased because I live here, but it’s, of course, trended blue with many prior elections, like leading up to now. But parts of the state are very, very conservative. 

    Rovner: Yeah, Virginia is still the South in a lot of ways. 

    Pradhan: Yeah. Oh, yeah. And it doesn’t take you long to figure that out once you leave the D.C. area, and there’s a lot of religious-based opposition to abortion. So I’m not sure how it’ll do, whether people will support it or not. 

    Rovner: I’m curious whether — if we really are looking at a blue wave, and we certainly see a lot of Democrats in unlikely states who seem to have at least a chance of getting elected because of the frustration, mostly with the economy — whether that will bring along some of these other issues in a way that it might not have. Because, as we say all the time, midterms are about turnout, and it looks like the motivated voters this time are bluer than redder. But I guess that’s another thing that we will have to wait and see. 

    All right, that is this week’s news. Now we’ll play my interview with Aaron Carroll of AcademyHealth, and then we will come back and do our extra credits.  

    I am pleased to welcome back to the podcast Dr. Aaron Carroll, president and CEO of AcademyHealth, which supports the health services research community. Aaron Carroll, thank you so much for being here. 

    Aaron Carroll: Always a pleasure. 

    Rovner: So I’ve asked you here to talk about the Trump administration’s effective dismantling of the Agency for Healthcare Quality and Research, which even many of our very nerdy listeners might not have heard of. But first, tell us what health services research is and how it differs from the biomedical research that most people are more familiar with. 

    Carroll: I think everybody really gets what we might call discovery research, which is about learning new things at a cellular, molecular, you know, body level — the creation of drugs, the creation of new procedures. You know, everybody sort of understands why we need to do that. But that’s only part of the problem. The bigger problem is how do we actually get that to where people are? So health services research focuses on: How do we improve the access, the quality, and the cost of a healthcare system? Another way I like to think about it is that everything that people hate about healthcare is what health services research focuses on. It costs too much? Yeah, that’s health services research. You can’t get in to see the clinician you want? Wait times are too long? That’s health services research. You feel like you’re not getting the quality that you should, or you’re worried that you know chronic diseases on …? That’s health services research. We spend very little time and very little money, unfortunately, on that type of research. But it’s just as important as discovery research, and I think that one of the reasons why we continue to be so dissatisfied with the healthcare system is because we’re not committed to studying and improving those things in the same way we are discovery. 

    Rovner: So how does AHRQ facilitate that, or how has AHRQ facilitated that? 

    Carroll: Sure. So, I mean, some of it is by creating and maintaining some of the big databases that people use to study the healthcare system, things like MEPS or other related databases. 

    Rovner: MEPS is the Medical Expenditures … 

    Carroll: Medical Expenditure Panel Survey. Yes, but I think the bigger way is that they give out independent investigator grants the same way that the NIH does. It just focuses more on health services research, and sometimes they have, you know, different areas that they choose to focus on, depending on the administration, because every administration should get to set priorities or, you know, decide what they think are most important. But they usually give out lots of grants, and I’ve had some over my career, that allow you to do all kinds of research to try to examine how you might improve the way that people receive care or pay for care or get care. 

    Rovner: And some of that research has actually created improvements in the healthcare system, is that fair to say?  

    Carroll: Absolutely. Yeah, I mean, the reason that, like, we landed on, say, $35 for insulin is because of health services research. It’s because of research that was done that found that that was sort of the inflection point. That when out-of-pocket costs got above that amount, people stopped taking their insulin as they should. And I understand the need for some copays — and obviously, we have a healthcare system. … But it’s, like, finding that kind of stuff out is health services research. And, you know, even some of the grants that were canceled this year would make sense to any, everyday Americans. Like, how do we improve the way that hospitals use antibiotics so we get less resistance, or how do we improve care using telehealth so that kids can get better asthma care or autism diagnoses? These are not discoveries in the sense of new medications, but they are things that we need to learn how to do to make the healthcare system work for everyone. 

    Rovner: So I actually covered the creation of not just AHRQ, but of its predecessor agency, the Agency for Health Care Policy and Research, way back in 1989, when I was a baby healthcare reporter. It was not just a bipartisan agency. Its creation was spearheaded by Republicans who wanted to know, basically, which medical interventions worked and whether the U.S. was getting its money’s worth on medical procedures. The reinvention of the agency 10 years later was led by Sen. Bill Frist, a Republican former transplant surgeon who later served as the Senate’s majority leader. So, how did the Trump administration come to view this agency as so “woke” that it basically needed to be disassembled? 

    Carroll: I don’t know. And again, if you don’t like the research priorities, it is perfectly reasonable for an administration to say, Let’s change them. And if they decided they wanted to focus on cost, OK. If they decided they wanted to focus on access, OK. There’s so many different ways to do this, but what they’ve done instead is apparently cancel a ton of grants that were already ongoing — and I’d be happy to talk about more specifics about that — but also they just are not spending the money. In fiscal year 2025, there was a significant amount of money that wasn’t spent. Many believe that’s an illegal impoundment, and there’s a case working its way through the courts right now, led by the Society for General Internal Medicine and Public Citizen, and they actually folded in some of the cancellation grants. But in fiscal year 2026, almost no money has been given out for new grants. Today, as we’re taping this, it is the last day of the fiscal year. I have no idea how possibly they’re going to spend the $345 million that was appropriated in 2026. A lot of that is not going to go out the door. In answer to that, they have said that 97% is being on track to be spent. I don’t know how that’s possible. And it’s very, very likely, again, we’re going to see a ton of money unspent, and I imagine lawsuits and more yelling will follow. 

    Rovner: So, Congress appropriated this money. The president signed the appropriations bill. What can Congress do, and why isn’t Congress doing something? 

    Carroll: So I ask those same questions every day. I don’t understand how Congress is not out of its mind. I mean, this is not something, again, from the “woke” Biden administration. This is this Congress, this House, this Senate passed a budget in a bipartisan manner, that was then signed by the president of the United States — this president — into law. The money’s been appropriated. … In fact, there was specific language in the budget that required HHS to staff up to make sure that they could spend this money. They have not staffed up. They have not spent the money. I don’t know how Congress is not losing their minds. It is an absolute ignoring the law. It is absolutely ignoring Congress’ will. I know there’s a GAO investigation. I know questions have been asked, and I don’t think answers have been given. It makes no sense whatsoever. I don’t know, again, why Congress isn’t screaming and yelling and taking action. Now, what action should they take? Hearings, oversight, make sure that all of this happens. Haul people in to session and find out why are they not following the law, and force the executive branch, as the legislative branch should do, as an equal part of our government, to follow the law. 

    Rovner: And it’s not just the grants. I mean, most of the staff has now been basically terminated. 

    Carroll: Yeah. Well, that’s what I mean. And there are now minimum staffing requirements in the law, and those are not being followed. I mean, depending upon whose estimates you believe, somewhere between 75% and 90% of AHRQ staff have either been let go or have left the organization. We can’t get exact numbers because they won’t release them. But there aren’t enough people even to process or put the money out the door. Even if they decided today we’ve got to get all the money, it’s not possible. There just aren’t people there to fill out the forms, check the budgets, do all the due diligence, administer the grants, oversee it. There’s no one there, and it’s an absolute abdication of their responsibility to enact the budget and the law as Congress has appropriated and put forth. 

    Rovner: Last question: What would it mean — I mean, what would the loss, basically, of what AHRQ has been doing for these last 26 years mean — to the healthcare system and how it runs? 

    Carroll: I mean, we spend $40-some billion a year on the NIH — I think about $47 billion. AHRQ, again, is $345 million. So we have been massively underspending on sort of what I would call “delivery” research on how the healthcare system works. And it’s one of the reasons why Americans are getting angrier and angrier every year because they’re, like, Why won’t things get better? Well, we’re not funding it enough. We’re not doing enough. And then, what little we were doing, they canceled in July and refused to spend now. So, what’ll happen? We will remain just as angry, if not angrier, about how much we’re paying for healthcare. We will remain just as angry, if not angrier, about how we can’t get what we need, and we’ll remain just as angry, if not angrier, about the fact that we can spend all this money that we do, $5 trillion-plus, and still feel like we’re not getting the quality, and continue to complain about how unhealthy we all are. AHRQ is the solution to a lot of these problems, and, for some reason, we just won’t use it. 

    Rovner: Aaron Carroll, we will stay on top of this. We will revisit it. I promise. 

    Carroll: I’m glad to hear that. 

    Rovner: Thank you. 

    Carroll: Thank you. 

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

    Roubein: My extra credit is headlined “Once Described as Obesity Medicines for ‘Patients,’ GLP-1s Are Increasingly Lifestyle Drugs for ‘Customers.’” It was in Stat by Elaine Chen. I thought it was a really fascinating story because we’ve all seen the cultural shift toward GLP-1s, and we’ve all heard the drugs praised as a way to address obesity as a medical issue. But Elaine reports that the drugs are now being increasingly marketed as a way to look and feel better. I thought there were some notable examples. The story explored how Novo Nordisk, which is one of the drugs’ makers, has particularly leaned into the shift. For instance, the company had advertisements this summer with slogans that include “live lighter” and “a summer glow-up.” And instead of labeling the drug as a drug for weight management, it sometimes is referring to it as a weight loss drug. And Elaine talked to some doctors and patient advocates that think the drug’s being talked about more as a retail product, run against the industry’s sort of initial goals of trying to convince the greater public that obesity is a disease and that the drug should be covered by insurance. For Novo Nordisk’s part, a spokeswoman told Elaine that how people expect to access and experience care has changed in recent years, and the company recognizes that healthcare needs to become more responsive, relevant, and easier to fit into everyday life. 

    Rovner: I would just note, and it’s a very good story, that if the drugmakers lowered the price of the drugs, it would be easier to get it covered by insurance. But that’s just an aside. Shefali. 

    Luthra: My story is from The Atlantic by Caitlin Dickerson. The headline is “The Babies Left Behind in America.” It’s a great story. It is about when parents are deported without their children, what happens to those children? This is the kind of reporting that is really hard to do because you have to spend time with children who have lost their parents. But I think it’s really important, especially as we see this uptick in detaining and deporting, in particular, people with children. I’ve spoken to a lot of mothers who have been deported when they had children here, and the consequences will last probably people’s whole lives. There are health consequences, especially when you have young children. There is PTSD, and I think Caitlin Dickerson has done some of the best reporting on immigration in the past decade, maybe longer. And this is absolutely an essential addition to that canon. 

    Rovner: It is indeed. Rachana. 

    Pradhan: My story is a trifecta from my colleagues Phil Galewitz, Andrew Jones, and Claudia Boyd-Barrett, who wrote a story about, as of today, hundreds of thousands likely of immigrants who are lawfully present in the United States but who have low incomes are now no longer eligible for Medicaid. This is part of President Trump’s signature One Big Beautiful Bill Act, which will enact greater coverage reductions next year, starting in 2027. But this group of people is now no longer eligible for Medicaid. It includes refugees, some people who have been granted asylum, and also, you know, victims of domestic violence and/or human trafficking. So the story gets into how we have our beloved Congressional Budget Office here in Washington that sort of estimates the impacts of tons of legislation. And they estimated previously that about 100,000 immigrants would be uninsured by 2034 because of this provision. But based on figures that my three colleagues got from state governments or state Medicaid agencies, the figure is likely to be higher of the numbers of immigrants with legal status who are going to now not be able to receive Medicaid. So yeah. So it’s a great read, and I know Julie will put the link in the podcast and in the comments. 

    Rovner: I will indeed. Yes, there’s the continuing, you know, “immigration is a health issue, too” theme that we have this week. All right, my extra credit is actually an update to an extra credit from last month. Like last month’s story, it’s from The New York Times, and it’s called “U. of Michigan Halts New Grading Plan After Backlash From Critics,” by Madaleine Rubin. And it seems that my alma mater — also, full disclosure, the alma mater of my editor and several of our panelists — has rethought the idea of letting incoming freshmen complete their first semester without letter grades to ease them into college life. According to a statement from interim university president Domenico Grasso, there was concern that students would be, quote, “unfairly portrayed as coddled or unprepared for the demands of a rigorous Michigan education.” Yeah, I would add that a lot of the backlash came from my fellow alums, and that even though I attended Michigan well back in the 20th century, even in the olden days, we had the option to take classes pass/fail if we wanted to. Although I would note that under the original proposal here, the students wouldn’t have failed, but they would either have gotten a pass or a “no credit.” Good job rethinking this, guys, and Go Blue. 

    OK, that is this week’s show. Thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X @jrovner, or on Bluesky @julierovner. Where are you guys hanging about these days? Shefali. 

    Luthra: I guess I’m on Bluesky @shefali, but you can also email me. 

    Rovner: There you go. Rachana. 

    Pradhan: @rachanadpradhan, both on Bluesky and on X, and you can always email me at RachanaP@kff.org. 

    Rovner: Rachel. 

    Roubein: Yes. X: @rachel_roubein; Bluesky: @rachelroubein; and Signal is always good too: RachelRoubein.28. 

    Rovner: Great. Thank you all. We will be back in your feed next week. Until then, be healthy. 

  • Top journal’s special issue on women’s health casts spotlight on menopause and pain

    Top journal’s special issue on women’s health casts spotlight on menopause and pain

    Ovulation. Endometriosis. And especially: menopause. These once taboo words — among others — have become part of our daily vocabulary and conversations, a sign of greater interest in, and knowledge of, women’s health. 

    Yet even as women’s health has been receiving more attention than perhaps ever before, women remain poorly represented in clinical trials, and female health poorly understood compared to male health. Much of the attention remains focused on the reproductive aspects of women’s health.

    This led the journal Science to plan a special issue dedicated to women’s health, published Thursday. “Biomedical science has come a long way over the years, and it has become increasingly clear that there are sex-dependent differences in many diseases that do not involve reproduction and that occur at all ages,” according to the introduction. 

    The issue was edited by an all-female team (Yevgeniya Nusinovich, Sacha Vignieri, Joana Osório, and Sarah Ross), which named political attacks on women’s rights and health care, as well as funding cuts affecting research in this area, as urgent motives behind their planning.

    “The importance of doing clinical trials specifically in women has gained recognition over the years, and it’s something that should continue to be elevated, including as research funding cuts are targeted at this and other women-specific research, threatening the quality of women’s future healthcare,” they said. 

    Beyond reproductive health

    The issue features reviews of research that aim to highlight recent findings on the impact of sex-dependent biological differences beyond reproduction, as well as deep dives into the latest discoveries about menopause and the pregnant body.

    Women experience functional pain at about twice the rate of men, with persistent pain in the pelvic area often becoming a debilitating factor in their daily lives. The issue takes stock of recent research that identified sex-specific mechanisms of pain. The review highlights the impact of sex hormones, immune-neural interactions, the gut microbiome, and the role of ovarian hormones in pain, though it also highlights the deficit in efforts to understand female pain.

    “Women are desperately waiting for concrete answers that might help eliminate the common ‘all in your head’ approach to their illnesses,” the authors of the review wrote. 

    Another review focuses on the impact of XX and XY chromosomes on aging and disease, making the argument that their impact is so significant that sex chromosomes should always be considered when developing precision medicine strategies. 

    Other contributions do take on issues of reproductive health. They call for a rethinking of menopause research and treatment, with an approach more tailored to the individual; investigating the immune system’s role in preparing for and carrying out a pregnancy; and considering the role of the ovary’s postmenopausal function.

    Nusinovich, a senior editor at Science, said she considers research on post-reproductive health to be different from reproductive investigations “because the focus here is not on improving reproductive success but on considerations for a woman’s own health.” She said she considered including other medical conditions unrelated to reproduction in which sex differences play a role, such as cardiovascular and metabolic disease, “but it didn’t seem like there would be enough new biological insights (with mechanisms, not just clinical observations) for entire coherent review articles.” 

    The dearth of this research highlights the existing gaps. “We tend to focus on women in their reproductive years, and a lot of that I do think is driven by what institutions are willing to fund,” said Tiarney Ritchwood, a professor in the department of public health at Wake Forest University School of Medicine who focuses on health equity. “But I do think that the greater discussion on women outside of the reproductive years is really important.”

    For other experts, however, including a strong focus on reproductive health is inevitable. 

    “There is still so much we don’t know about women’s health simply because sex is often considered an extraneous variable,” said Nicole Woitowich, executive director of the Northwestern University Clinical and Translational Sciences Institute who did not take part in the issue. “For many years, women’s health was synonymous with reproductive health. I’m glad we’ve broadened this perspective to consider the influence of sex across human physiology. Yet, pregnancy and menopause, for example, remain unique aspects of women’s health and we are just beginning to understand how these events can shape our long-term health and well-being.” Woitowich recently researched the reporting of sex differences in NIH-funded papers. 

    The attention to menopause is especially welcome, said Omisade Burney-Scott, a menopause justice advocate pushing to make menopause care inclusive through her platform, the Black Girl’s Guide to Surviving Menopause. Still, Burney-Scott said, the journal article is lacking some perspectives — including discussion of early menopause due to gender-affirming care, or a medical intervention — that shows the limitations of current research. “We must take into account the significant impact of environmental factors, such as systemic oppression (racism, classism, homophobia, transphobia, carcerality) on menopause health outcomes,” said Burney-Scott, who was not involved in the issue. 

    Women’s health needs funding, not just attention

    For the editors, the value of the issue also resides in showing how much there is to learn about women’s health. “Out of all the special issues I’ve encountered, this one stood out to me as highlighting a ton of open questions and things that are just beginning to be studied, especially in the article on chronic pain, pointing to many opportunities for future productive research,” said Nusinovich.

    The experts STAT spoke with agreed that a high-profile journal such as Science dedicating an issue to women’s health sends a strong signal to the scientific community. “It will contribute to increased awareness and even potentially increase research in this area, hopefully in the years beyond the reproductive ones,” said Ritchwood, “but none of this goes anywhere if there’s no funding dedicated to it.”

    Unless there is a broader dissemination of these findings — and, just as importantly, a clear call to fund women’s health research — the impact will remain limited, she said. “The public is not reading Science, so it can’t just be something that we just communicate to ourselves. … Are we going to see it in Vogue, or something that the public is actually looking at?” she said.

    Paula Schneider, the CEO of the Institute Advancing Women’s Health, a global nonprofit that focuses on improving women’s clinical care in midlife and after, noted that there is a lag in adopting new knowledge in clinical practice.

    “Research is only half the equation. Even the evidence we already have on women’s midlife health too often doesn’t make it into clinical practice,” she said. “We need to close the gap between what’s known and what’s done, so that as discoveries like these arrive, women know what to ask, doctors know how to answer, and the system knows what to do next.”

  • STAT+: A major insurer on how it may replicate Medicare’s chronic-care experiment

    STAT+: A major insurer on how it may replicate Medicare’s chronic-care experiment

    You’re reading the web edition of STAT’s Health Tech newsletter

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    Mario covers technology in health care, including FDA regulation of artificial intelligence; how Medicare pays for health tech; the use of AI in clinical care; mental health chatbots; and consumer wearables. He’s also the co-author of the free, twice weekly STAT Health Tech newsletter. You can reach Mario on Signal at mariojoze.13.

    You’re reading the web edition of STAT’s Health Tech newsletter, our guide to how technology is transforming the life sciences. Sign up to get it delivered in your inbox every Tuesday and Thursday.

    Blue Shield of California is one of 17 major health plans that has committed to adopting payment models inspired by the Medicare Innovation Center’s ACCESS Model.

    The insurer’s chief medical officer Ravi Kavasery told me that it’s still figuring out details of what this will look like, including whether it will adopt CMS payment amounts and what organizations it will work with. He said Blue Shield of California, which serves 6 million members, expect to launch similar models in commercial plans in 2027. 

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    1. Health Tech Correspondent

      Mario covers technology in health care, including FDA regulation of artificial intelligence; how Medicare pays for health tech; the use of AI in clinical care; mental health chatbots; and consumer wearables. He’s also the co-author of the free, twice weekly STAT Health Tech newsletter. You can reach Mario on Signal at mariojoze.13.

  • Hospitals Have a Little-Known Tool To Prevent Medical Debt. Here’s How It Works.

    Hospitals Have a Little-Known Tool To Prevent Medical Debt. Here’s How It Works.

    If you have medical debt, there’s a good chance you owe money to a hospital.

    One way patients can avoid medical debt is through hospital financial assistance, also known as charity care. Most of the nation’s hospitals offer free or discounted medical care to patients with very high medical debt or low incomes.

    Getting financial assistance, however, can be challenging. Many patients don’t know that hospitals offer financial help, surveys show, and complex application forms leave others stymied.

    Hospitals often demand that applicants turn over bank statements, pay stubs, tax returns, divorce filings, or other materials, and submit their applications in person, by mail, or by fax.

    “They don’t make it easy,” said Neale Mahoney, a Stanford University economist who studies medical debt.

    Such hurdles leave many patients with unpaid bills they should never have had to pay in the first place. In a single year, hospitals and health systems billed patients for at least $2 billion that they likely didn’t owe, one analysis found.

    As healthcare costs climb and more people lose their coverage, states and hospitals are testing an emerging approach to fix this problem: automatically screening patients to see if they qualify for assistance and proactively wiping out debt when they do. This is known as “presumptive eligibility.”

    Under this approach, patients may have the cost of their care wiped out before they see any bills — but not always. Hospitals differ on when, how, and for whom they use auto-enrollment, potentially impinging on patients’ finances.

    Here’s what you need to know about how auto-enrollment works.

    What is hospital financial assistance?

    In many states, hospitals set their own criteria for whom they provide financial aid. Eligibility is typically based on income for the patient’s entire household. The closer patients are to poverty, the less they have to pay. Patients with middle incomes and insurance are sometimes eligible for discounts, especially if their bills would gobble up a big chunk of what they earn.

    At least 11 states require hospitals to wipe out bills for low-income patients, though income cutoffs vary. Georgia, for example, mandates free care for anyone with income slightly above the federal threshold for poverty. In several states — including Oregon, North Carolina, and Maryland — patients can earn double that amount and still get free care.

    But in most states, many patients must complete applications to receive assistance.

    Several states in recent years have launched investigations and passed legislation designed to make it easier for people to get help. Research into medical debt, however, suggests gaps persist.

    How many hospitals use auto-enrollment?

    Nearly all nonprofit hospitals say they screen and automatically reduce bills for certain patients.

    Under the Affordable Care Act, nonprofit hospitals must make reasonable efforts to find people who are eligible for help before they take patients to court, sell their debt to collection agencies, or ding their credit over bills. Presumptive eligibility is one way hospitals can comply with the regulation, which took effect in 2016.

    In the first year under the new rules, about 70% of tax-exempt hospitals nationwide said they screened patients and proactively reduced bills, according to an analysis of federal data for Tradeoffs by the independent research institute RTI International. As of 2022, that figure was nearly 90%.

    The federal law doesn’t apply to for-profit and public hospitals, which don’t have to report the actions they take before going after patients for unpaid bills.

    In six states, policymakers require hospitals to use presumptive eligibility and skip applications for certain patients. Those states are California, Delaware, Illinois, Maryland, North Carolina, and Oregon.

    Who is eligible to be automatically enrolled in financial assistance?

    In most states, hospitals decide which patients can skip the application.

    Common groups automatically screened include people who are homeless, deceased, or already enrolled in state or federal programs to help low-income households with housing, food, or prescriptions. Other hospitals have more unique criteria, like Christus Health, which will write off bills for anyone in a religious order who took a vow of poverty.

    Eligibility criteria are often buried in official policies and hard to find or decipher. Some hospitals share little to no public information about whom they will proactively screen. Thirteen hospitals owned by Ascension, one of the nation’s largest Catholic health systems, state only that they may screen patients “with a sufficient unpaid balance.”

    Across the half-dozen states with presumptive eligibility mandates, eligibility rules vary. Maryland, for example, requires hospitals to proactively wipe out bills only for patients who already get government help for food or utilities but are ineligible for Medicaid. In Illinois, lawmakers created less-stringent requirements for rural hospitals compared with urban facilities.

    In Oregon, starting in 2024, hospitals had to screen anyone who owed more than $500 and every patient on Medicaid or who is uninsured. In 2025, roughly 80% of Oregon patients who got financial help with bills never filled out an application, based on data shared publicly by the first 26 hospitals to do so. The state’s legislature this year raised the screening threshold to include patients who owe at least $1,500 for a single visit.

    Without an application, how do hospitals figure out who gets help?

    Hospitals have several ways to find patients eligible for financial assistance.

    Typically, hospitals turn to public records, any information patients have previously volunteered, or tools from consumer credit companies to estimate whether patients qualify to have bills reduced.

    For example, if a hospital sees that a patient lives in a high-poverty ZIP code or has no address listed, that could be enough to deem them eligible. Many pay companies to run employment and credit checks on patients to determine whether they qualify for free care.

    Hospitals may also consider how likely patients are to pay bills, regardless of how much they earn. This is called “propensity to pay.” California and Oregon prohibit its use, concerned that hospitals may try to collect more often from people who dutifully pay their bills even though their incomes qualify them for financial assistance.

    When do hospitals screen patients for financial aid?

    It depends.

    Illinois, North Carolina, and Oregon require hospitals to screen certain patients before they send any bills. California hospitals will have to do the same starting in 2027.

    Some hospitals voluntarily screen patients before sending bills; others try to collect money from patients first. As long as they screen patients before suing them for very overdue bills, hospitals can stay within the letter of the federal law that pushed many of them to embrace presumptive eligibility.

    For example, the policy of Christus Health is to screen patients only “after all other eligibility and payment sources have been exhausted.”

    Anna Stelter, vice president of policy for the Texas Hospital Association, said hospitals want to investigate other options for payment — like Medicaid or county safety net programs — before they give out financial assistance.

    “We do want to make sure that whoever is financially responsible for that care is identified and pays,” Stelter said. “Charity care is the relief of last resort.”

    Hospitals’ publicly posted policies may also be fuzzy about when they will screen for patients likely eligible for help. For example, Cook Children’s Health Care System in Fort Worth, Texas, says its goal is to determine a patient’s eligibility “as soon as sufficient information is available.”

    Who pays the bills when patients get free care?

    In one sense, we all do. Taxpayers cover some or all of the cost of financial assistance, though the amount varies by hospital.

    About half the nation’s hospitals are nonprofit and legally get a pass on paying most taxes. KFF estimates that nonprofit hospitals pocketed $24 billion in 2020 that they would otherwise have paid as income, sales, or property taxes.

    Government-owned and for-profit hospitals have their own sets of tax benefits to help offset costs for low-income patients. Government hospitals often get additional taxpayer support, and for-profit hospitals generally receive smaller government subsidies, like additional payments for caring for high numbers of uninsured and Medicaid patients.

    Whether taxpayer dollars fully cover hospitals’ costs for financial assistance depends on the amount of government support they receive — information often not publicly available. It also hinges on how many patients need help, how many meet hospitals’ criteria for assistance, and how many get through an application. Research shows hospitals spend widely different amounts on financial assistance, from less than 1% of yearly expenses to more than 7%.

    Philanthropy and hospitals’ income cover costs not absorbed by tax dollars.

    This article is part of “Hidden Help,” an investigative series from Tradeoffs and KFF Health News about how hospitals can protect their patients from the life-altering harms of medical debt.

    Melanie Evans is a reporter for Tradeoffs, a nonprofit newsroom reporting on healthcare’s toughest choices. Sign up for the weekly newsletter to get the latest stories every Thursday morning.

    Tradeoffs’ reporting for this series was supported, in part, by the California Health Care Foundation, the National Institute for Health Care Management Foundation, and the Solutions Journalism Network.

  • Opinion: Claude analyzed my genome in 30 minutes. Now we need standards for the results

    Opinion: Claude analyzed my genome in 30 minutes. Now we need standards for the results

    Unpacking from vacation a couple months back, I decided to give artificial intelligence a task. I paused folding my laundry, sat down with Claude, and asked it to analyze the entirety of my genome.

    Back in 2009, this was a task that quite literally took a village of 30 people — including me — working together to interpret the whole genome sequence of a colleague, friend, and fellow scientist named Stephen Quake. This endeavor brought together experts in genetics, computer science, pharmacology, and clinical medicine.

    We built an engine specifically designed for genome analysis, examined millions of genetic variants, reviewed the scientific literature, and debated which findings might matter most for his individual health circumstances.

    The resulting study, published in The Lancet in 2010, was among the first attempts to interpret the complete genome, and the first to translate that analysis into personalized medical recommendations. (About a year later, our team used a similar framework to analyze my own genome, though it was never officially published.)

    This month, Claude attempted the same task — sans the 30 people and nearly yearlong expenditure.

    In a prompt of 180 words, I asked Claude to follow the same framework our team had set forth back in 2009, probing it to identify rare variants that could cause an inherited disorder, genetic abnormalities that could impact my response to different medications, and whether it had enough data to estimate my risk for common diseases.

    Though it was a fairly simple prompt, the task was anything but. My genome file is more than a decade old, was generated using an earlier version of the human reference genome, and lacks information available in newer sequencing formats. These limitations could easily produce an analysis that is misleading or inaccurate.

    Despite that, Claude was able to re-identify many of the most important findings from our original analysis, including the most consequential result in my genome: I carry two copies of the APOE ε4 variant, which is associated with an increased risk of Alzheimer’s disease. It found no major gene-disrupting variant linked to a rare inherited disorder, matching the outcome reached by our original team. It also flagged variants in the DPYD and CYP2C19 genes, which can influence how we respond to certain medications. I asked it to calculate genetic risk scores for common diseases, but it rightfully warned me that my file did not contain enough information to do so reliably.

    Amazingly, this entire interaction used only around 400,000 tokens and cost approximately $5. Most of the half-hour was spent just waiting for scientific databases to load. All in all, a task that once took nearly a year and required a large, specialized team can now be attempted at home for roughly the price of a 2-liter bottle of soda.

    That accessibility opens doors once thought unimaginable. And as these doors open to the general public, the scientific community has a responsibility to develop clear standards for what makes up a medically reliable genome in the first place.

    A genome is not a definitive record

    It is tempting to think of a genome sequence as a permanent record that can be preserved forever after one read. In reality, though, every genome analysis is influenced by multiple factors, such as the reference genome used for comparison and the technology used to sequence the DNA itself.

    Sequencing technologies have seen enormous improvement over the past couple of decades. Scientists can now examine sections of DNA that were once inaccessible and detect forms of genetic variation that older methods may have missed.

    But limitations remain. Almost all existing genomes were produced using a technique called “short-read sequencing,” which breaks DNA into millions of fragments and uses software to reconstruct where these fragments belong. Though this approach works well across much of the genome, it can be less reliable in the regions where sequences can repeat, resemble one another, or contain large structural changes.

    Though difficult to sequence, those regions are by no means irrelevant: Disease-causing variants can occur where conventional sequencing struggles to pick them up. In turn, an interpretation may report that no concerning variant was found without making clear that the relevant gene was not fully examined.

    Another barrier is the reference genome itself. To date, most analyses have compared patients’ genomes against a standard DNA sequence constructed from a limited number of people. As it stands, that baseline does not adequately represent the full diversity or complexity of human genomes, making some variants more difficult to detect, especially in populations that remain under-represented in genomic datasets.

    Newer references now represent many different versions of the human genome through branching paths rather than forcing everyone’s DNA onto one template. This can improve variant detection, especially in complex regions and across diverse populations. Yet laboratories, databases, and clinical systems have not adopted them consistently.

    The call for clear standards

    Now, with the general public able to readily use AI for genomic interpretation that may impact the course of their life and future health decisions, we have never had a more urgent need to develop standards to determine what a high-quality medical genomic interpretation should actually include. 

    Current quality checks are efficient at detecting simple genetic changes, such as an altered DNA letter or a small piece of DNA that has been removed or added. Medically important changes, however, can be much trickier to detect. I liken it to proofreading a book: Finding a misspelled word is quite straightforward, while catching a sentence or paragraph that may not be in the right place takes a bit more nuance.

    A medical-grade genome test should therefore be evaluated on whether it can reliably detect the full range of genetic changes that may affect a person’s health, not only the simplest ones.

    This is an ask that will require a diverse set of exceptionally well-characterized genomes that laboratories, researchers, and AI developers can use as reference materials. These genomes should reflect the full sequence of both chromosome copies and the diversity of the global population, rather than relying on one person or one ancestral group as a universal standard.

    It is also important that the scientific community develops a shared, regularly updated catalog of medically significant genes that are historically difficult to sequence. For each gene, the catalog would ideally describe its technical complexity, identify which methods can reliably analyze it, and document when a specialized test is required.

    Standards must also reflect the task at hand. A test that is not sensitive enough can miss a finding entirely. For example, an inherited variant is present in nearly every cell, making detection fairly clear. Circulating tumor DNA, by contrast, may make up only a tiny fraction of the cell-free DNA in a blood sample. Each application therefore demands that clear minimum thresholds be set for what can be detected and how reliably, and what conclusions the result can support.

    The standards cannot lag behind the technology

    We are heading toward a world in which companies routinely give consumers access to their genomic data, including variant call files (digital files that list the genetic differences identified in a person’s DNA), that they can upload directly into systems such as Claude or ChatGPT.

    Consumer genetic testing was an important first step toward this kind of access, but the shift now is different in scale and interactivity. Services like 23andMe have largely focused on a relatively limited set of common genetic variants.

    A whole genome contains vastly more information. And with AI agents, consumers are no longer limited to a fixed interpretation of their results. They can ask follow-up questions, request additional analyses, and continue investigating particular findings. That kind of ongoing interaction with one’s own genomic data was simply not possible before.

    Now, imagine someone uploading their genome file into a system such as Claude or ChatGPT. Minutes later, alone at their laptop, they are told by AI that they may be at risk for Alzheimer’s disease or cancer.

    This may be true, but there is also the chance that the result is based on incomplete data, and the finding is much less definitive than the AI may suggest. Either way, they may feel completely blindsided, and there may not be a clinician available to talk through the result, whether it should be confirmed, or what the next steps should be.

    This is one of the most consequential challenges of accessible genomic interpretations. Interpretations are available before (or completely without) additional care and support.

    In my own experiment, Claude was able to recognize that my genome file did not contain enough information to make reliable conclusions regarding genetic risk scores for common diseases. This is encouraging — a trustworthy system should be able to pump the brakes and realize when data inputs are too unreliable to make accurate estimations. Even so, that judgment should also be governed by a shared medical standard, rather than left to the discretion of AI developers.

    Putting that standard into practice will require coordination across specialties. Professional societies and standards organizations will need to develop and regularly update the technical requirements. Labs and AI developers should have transparent disclosures on what their systems detect reliably, and which findings still require confirmation. Health systems, meanwhile, will need practical ways to support the increasing number of patients who may arrive with AI-generated results, including confirmatory testing and genetic counseling.

    In 2009, the scarce resources were expertise, time, and money. Today, however, what’s scarce may be reliability. As we embrace the new bioinformatics revolution, marked by incredible speed and accessibility in data interpretation, we must urgently work towards developing standards that increase the likelihood that a casual user can upload their genomic data into an AI system and receive a trustworthy response.

    Euan Ashley is chair of the Department of Medicine at Stanford University and a physician-scientist whose research spans genomics, precision medicine, digital health, and artificial intelligence. Rebecca Handler, a science writer and researcher at Stanford’s Department of Medicine, contributed to this piece.

  • STAT+: HHS announces new efforts to speed up, expand clinical trials with AI

    STAT+: HHS announces new efforts to speed up, expand clinical trials with AI

    WASHINGTON — The Department of Health and Human Services announced a set of new initiatives aimed at speeding up clinical trials by incorporating more artificial intelligence and computational models and moving away from sharply delineated trial phases. 

    The centerpiece five-year program, dubbed SURPASS — “Simulation-augmented, Real-time Platform Adaptive Seamless Trials” — will kick off later this fall by accepting “ground-breaking ideas from cross-disciplinary teams in statistics, AI, and clinical trial design, operations, and regulation,” reads a website about the program. 

    HHS is launching the program through the Advanced Research Projects Agency for Health. The initial announcement did not note how much funding was designated for the new initiatives, nor did it provide details on whether participants would be offered more flexibility or resources.  

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  • STAT+: What health tech leaders are talking about in Washington policy circles

    STAT+: What health tech leaders are talking about in Washington policy circles

    You’re reading the web edition of STAT’s AI Prognosis newsletter

    STAT/Adobe

    Brittany Trang, Ph.D., covers AI in health and medicine: Does it actually work? Who benefits, or might be harmed? She writes the weekly AI Prognosis newsletter. Follow her on Threads, Mastodon, and Bluesky. You can reach Brittany on Signal at btrang.01.

    This is the web edition of STAT’s AI Prognosis newsletter, our guide to artificial intelligence in health care and medicine. Sign up to get it delivered in your inbox every Wednesday. 

    It never crossed my mind that there would be a Cookie Monster AI satire piece in the New Yorker, but it does exist and I love it so much. h/t to my colleague Sarah Todd for sharing “Cookie Monster Tries to Meet His A.I. Mandate.”

    News I missed, story tips, comments: [email protected]

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    1. Brittany Trang, Ph.D., covers AI in health and medicine: Does it actually work? Who benefits, or might be harmed? She writes the weekly AI Prognosis newsletter. Follow her on Threads, Mastodon, and Bluesky. You can reach Brittany on Signal at btrang.01.

  • Rural MAHA Followers Say Trump Health Policies Haven’t Reached Their Communities

    Rural MAHA Followers Say Trump Health Policies Haven’t Reached Their Communities

    About half of rural voters identify with Make America Healthy Again, a sprawling political movement championed by the Trump administration, but most said President Donald Trump’s healthcare policies have not benefited their communities, according to a new poll from The Associated Press in partnership with KFF.

    About 8 in 10 rural voters — an important voting bloc for Trump and fellow Republicans in recent elections — said the Trump administration’s policies have had a negative effect or no impact on the health of people where they live. Most MAHA supporters, 68%, also feel this way, according to the national survey of more than 2,000 rural registered voters.

    The findings signal an apparent disconnect between the Trump administration’s MAHA-branded policy priorities and rural America’s perception of their reach and effectiveness.

    Iowa pastor Mike Jager, 58, is a registered Republican and considers himself part of the MAHA movement. The Trump administration’s health policies have had “minimal” impact on the health of his community, Jager said, but he added that Trump’s health secretary, Robert F. Kennedy Jr., is moving the needle “in the right direction.”

    “It’s a beginning,” Jager said. “It’s a big ship to try and turn around and course-correct.”

    Kennedy has used the MAHA label to support various agendas, including abandoning long-standing vaccine guidance, researching ultraprocessed foods, and investing in regenerative agriculture.

    Jager lives in Sumner, Iowa, “less than a quarter mile from where the corn ends and the city begins.” He’s seen family members and neighbors develop diseases that he believes resulted in part from exposure to agricultural chemicals and consumption of unhealthy, processed foods.

    In the June Republican primary for governor, Jager voted for Zach Lahn, a businessman and farmer, who ran on a MAHA platform and beat out Trump-backed U.S. Rep. Randy Feenstra. He plans to vote for him again in November.

    A photo of Mike Jager standing in front of an altar inside of a church.
    Jager said that President Donald Trump’s health secretary, Robert F. Kennedy Jr., is moving the needle “in the right direction.” (Miriam Alarcón Avila for KFF Health News)

    Many Rural Voters Are Prioritizing Health Issues

    About two-thirds of rural voters who support MAHA said it’s “extremely” or “very” important to them to vote for a candidate who does, too, while only 4 in 10 rural voters overall said the same.

    Trump sought to seize on MAHA support during his campaign for another term two years ago. Now, amid tight midterm races, Kennedy has campaigned to galvanize the movement’s support. In May, he attended a MAHA bill signing with Iowa Republican Gov. Kim Reynolds, and in August, he went fishing with Lahn, posting about it on social media.

    Yet the survey indicates voters are noticing “this weird split in the Trump administration” between what Kennedy messages and what Trump says and does, said David Peterson, a political science professor at Iowa State University.

    “It’s this mix of things coming out of D.C., out of different pieces of the administration, that’s confusing people,” Peterson said.

    In Iowa, concerns about what’s causing rising cancer rates are “a big deal,” he said. For many people who identify with MAHA, being healthy includes taking on corporate agriculture and pharmaceutical companies that they think cause cancer, he added.

    “The sort of populist messaging around that is appealing right now,” Peterson said.

    In the poll, views on healthcare access and costs largely diverged along party lines. Most Democratic and independent voters said the Trump administration’s healthcare policies have had a negative impact on their healthcare costs and the health and well-being of people in their communities. Republicans were likelier to say there hasn’t been an impact.

    Talking on the phone from her 200-acre farm in Carroll County, Iowa, 71-year-old Donna Klocke said that her husband had died from cancer and that she has neighbors who also have cancer.

    “It’s just very prevalent,” Klocke said. “We’re in a farming community. We use chemicals and pesticides and all kinds of things that aren’t necessarily good for us.”

    Klocke, a Democrat, said the MAHA movement is a good idea because she cares about being healthy, but she does not consider herself part of it and will not be voting for a candidate who represents the movement.

    Kennedy, who was an anti-vaccine activist before entering politics and has sent mixed messages to Americans about getting the measles vaccine, scares her.

    “Measles are coming back and polio,” Klocke said. “It’s the measles that really gets me. It’s like, do you not understand how dangerous it is?”

    A photo of Donna Klocke standing in front of a cornfield in Iowa.
    Donna Klocke cares about being healthy but does not consider herself part of the Make America Healthy Again movement. Her husband died from cancer after a life spent farming the family’s 200 acres in Carroll County, Iowa. (Kathyrn Gamble for KFF Health News)

    Survey Reflects Angst Over Healthcare

    About half of rural voters said their communities don’t have enough doctors or other healthcare providers, and even more said there aren’t enough mental health workers specifically. The share of rural voters who said their community does not have enough hospitals increased to 35% from 21% in a similar question asked in a KFF-Washington Post survey in 2017.

    And as with the general population, healthcare, gas, and grocery costs are top pain points. More than 6 in 10 rural voters said they were worried about healthcare costs.

    The level of worry varied based on coverage, with rural voters enrolled in employer plans or Medicare less likely to be worried. The survey found that 80% of working-age rural voters on Medicaid were very or somewhat worried about healthcare costs. Last year, Republicans passed a tax and spending bill that cut over $900 billion in projected Medicaid spending over a decade and mandated new eligibility requirements.

    Among rural voters who purchase their own insurance, such as the individual coverage plans available on Affordable Care Act marketplaces, 77% said they were worried.

    In the tiny community of Lipan, Texas, west of Dallas, Kim Solis and her husband have a handyman-and-home-remodel business and get their insurance on the marketplace. Since Trump was elected again, their premium payment jumped from zero to $166 a month. Their copays went up, and their deductibles each increased by $2,000.

    Solis, 62, said she worries what will happen if they get a big medical bill.

    “Certainly, we’d be in a world of hurt trying to take money out of savings or getting it out of our 401(k) just to be able to do something about it,” she said.

    Most MAHA Voters Are Also MAGA — But Not All

    Like the general population, rural voters said they trust their own doctors and healthcare providers for health information over government agencies or officials, according to the poll.

    Trust in Kennedy and Trump fell largely along partisan lines. About 10% of rural Democratic voters reported having a “great deal” or “fair amount” of trust in Kennedy, compared with 74% of rural Republican voters. About 5% of rural Democrats and 69% of rural Republicans said they trust Trump a “great deal” or “fair amount” for reliable health information.

    While Make America Great Again and MAHA identities are “linked in a lot of ways,” the rising costs of healthcare and groceries pose a challenge for those committed to the MAHA principles that Kennedy promotes, said Peterson, the Iowa State professor.

    Buying healthy food “becomes, ‘I can’t afford to do that because of Trump’s policies,’” he said.

    In Stamping Ground, Kentucky, Alma Johnson, 65, works as night security at a horse farm. Johnson said gas had gone up but her overall cost of living had decreased since Trump took office.

    Johnson voted for Trump in 2016, 2020, and 2024 and said she “pretty much” likes how Trump is running the country. But she said she is not a MAGA devotee, preferring to “think for myself.”

    MAHA, however, is an easy sell for Johnson because, she said, she doesn’t think people should be able to buy junk food through the Supplemental Nutrition Assistance Program, or SNAP.

    Still, she said she hasn’t seen much impact from the Trump administration’s healthcare policies, including the new food pyramid.

    “It takes a long time to change people, their habits, their thoughts, or the things they do,” Johnson said.

    About the Poll

    The KFF-AP Rural Voters Survey was conducted online and by telephone Aug. 12-24, 2026, among 2,241 registered voters living in rural areas, defined as census tracts that fall within codes 5-10 of the U.S. Department of Agriculture’s 2020 Rural-Urban Commuting Area codes. Voters were reached through a combination of the probability-based SSRS Opinion Panel and a registration-based sample from the L2 voter file. Overall results have a margin of sampling error of plus or minus 3 percentage points, including design effects due to weighting. Error margins are larger for subgroups. In collaboration with the AP, KFF researchers worked to design the survey sample and questionnaire and analyze and report findings.

    This report is from a collaboration between KFF Health News and The Associated Press.