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Physician Assistants Want a New Name and More Power. Not Everyone Is Happy.

How increased responsibilities and a push to be called “physician associates” are raising tensions with doctors.

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“No sabemos dónde están”. Abogados y familiares enfrentan obstáculos para encontrar a detenidos por el ICE hospitalizados

Lydia Romero se esforzaba por escuchar la voz débil de su esposo al teléfono.

Una semana antes, agentes de inmigración apresaron a Julio César Peña delante de su casa en Glendale, California, y se lo llevaron. Ahora estaba en un hospital, después de haber sufrido un mini derrame cerebral. Le dijo a Romero que lo tenían esposado a la cama, de una mano y un pie, y que había agentes en la habitación escuchando la llamada. Tenía miedo de morir y quería que su esposa estuviera con él.

“¿En qué hospital estás?”, le preguntó Romero.

“No te puedo decir”, respondió él.

Viridiana Chabolla, abogada de Peña, tampoco pudo obtener una respuesta. El oficial de deportación asignado al caso y la empresa médica contratada en el Centro de Procesamiento del ICE en Adelanto se negaron a decirle dónde estaba internado. Frustrada, intentó llamar a un hospital cercano, el Providence St. Mary Medical Center.

“Me dijeron que aunque tuvieran bajo su cuidado a una persona detenida por el ICE, no podrían confirmar si estaba allí o no, que solo el ICE puede darme esa información”, contó Chabolla. El hospital confirmó esa política a KFF Health News.

Familiares y abogados de personas internadas tras ser detenidas por autoridades federales de inmigración dijeron que enfrentan grandes obstáculos para localizar a los pacientes, saber cómo están de salud y brindarles apoyo legal y emocional.

Aseguran que muchos hospitales se niegan a dar información o permitir el contacto con las personas detenidas. En cambio, dejan que los agentes de inmigración decidan cuánto contacto se permite, si es que se permite alguno. Esto, según los abogados, les arrebata a los pacientes su derecho constitucional a recibir asesoría legal, y los deja vulnerables a abusos.

Los hospitales dicen que buscan proteger la seguridad y privacidad de los pacientes, el personal y las autoridades, aunque empleados de centros de salud en Los Ángeles, Minneapolis y Portland, Oregon —ciudades donde el ICE ha realizado redadas— afirman que eso les ha dificultado su trabajo.

Algunos hospitales aplican lo que llaman “procedimientos de apagón” o blackout —a veces llamado “código negro”— que pueden incluir registrar al paciente con un seudónimo, eliminar su nombre del directorio del hospital o prohibir al personal confirmar si la persona está hospitalizada.

“Sabemos de varios casos en los que se usó este procedimiento de apagón en hospitales del estado, y es muy preocupante”, dijo Shiu-Ming Cheer, subdirectora de justicia migratoria y racial en el California Immigrant Policy Center, una organización de defensa de los inmigrantes.

Estados gobernados por demócratas, como California, Colorado y Maryland, han aprobado leyes para proteger a pacientes de operativos de inmigración dentro de hospitales. Sin embargo, esas leyes no cubren a quienes ya están bajo custodia del ICE.

Más detenidos hospitalizados

Peña es una de las más de 350.000 personas arrestadas por autoridades migratorias desde que el presidente Donald Trump regresó a la Casa Blanca.

A medida que aumentan los arrestos y detenciones, también lo hacen los reportes de personas trasladadas a hospitales por agentes de inmigración debido a enfermedades o lesiones, ya sea por condiciones preexistentes o derivadas del arresto o la detención.

El ICE ha recibido críticas por utilizar tácticas agresivas y mortales, y por reportes de maltrato y atención médica deficiente en sus centros de detención. El senador Adam Schiff, demócrata de California, dijo el 20 de enero, en una conferencia de prensa, frente a un centro de detención en California City, que habló con una mujer con diabetes detenida allí que no había recibido tratamiento en dos meses.

No hay estadísticas públicas sobre cuántas personas enferman o se lesionan bajo custodia del ICE, pero comunicados de prensa de la agencia indican que 32 personas murieron bajo custodia migratoria en 2025.

En lo que va del año, han muerto seis más.

El Departamento de Seguridad Nacional, que supervisa al ICE, no respondió a solicitudes de información sobre sus políticas ni sobre el caso de Peña.

Según las propias directrices del ICE, las personas bajo su custodia deben tener acceso a un teléfono, visitas de familiares y amigos, y consultas privadas con sus abogados.

La agencia puede tomar decisiones administrativas, incluyendo el tema de las visitas, cuando un detenido está hospitalizado; pero, según las directrices, debe respetar las políticas del hospital para contactar a familiares si la persona está gravemente enferma.

Consultado sobre las prácticas hospitalarias con personas bajo custodia migratoria, y sobre si existen protocolos recomendados, Ben Teicher, vocero de la Asociación Estadounidense de Hospitales, no quiso comentar.

David Simon, vocero de la Asociación de Hospitales de California, expresó que “en algunos casos, a pedido de las autoridades, los hospitales mantienen la confidencialidad de los nombres de los pacientes y otra información que los identifique”.

Aunque las políticas varían, por lo general cualquier persona puede llamar a un hospital y preguntar por un paciente dando su nombre, y con frecuencia se le transfiere la llamada a la habitación, dijo William Weber, médico de emergencias en Minneapolis y director médico de Medical Justice Alliance, una organización que defiende los derechos médicos de personas bajo custodia.

Los familiares y personas autorizadas por el paciente pueden visitarlo. El personal médico también suele llamar a los familiares para informarles que alguien está hospitalizado o para pedir información que ayude en su atención.

Pero cuando se trata de personas bajo custodia de autoridades, los hospitales frecuentemente acceden a restringir el acceso y dar información, señaló Weber.

El argumento es que estas medidas evitan que personas no autorizadas amenacen al paciente o al personal, ya que los hospitales no tienen la infraestructura de seguridad de una cárcel. Algunos pacientes famosos también solicitan este tipo de medidas.

Abogados y trabajadores de salud cuestionan que esas restricciones sean realmente necesarias. La detención migratoria es una detención civil, no criminal. Aunque el gobierno de Trump afirma que su prioridad es arrestar y deportar criminales, la mayoría de los detenidos no tiene antecedentes penales, según datos del centro Transactional Records Access Clearinghouse y varios medios de comunicación.

Detenido delante de su casa

Según su esposa, Peña no tiene antecedentes penales. Llegó a Estados Unidos desde México cuando cursaba sexto grado, y tiene un hijo adulto en el ejército estadounidense. Tiene 43 años, padece enfermedad renal terminal y sobrevivió a un infarto en noviembre. Camina con dificultad y tiene pérdida parcial de la vista, explicó Romero. Fue detenido el 8 de diciembre, mientras descansaba en el exterior de su casa tras un tratamiento de diálisis.

Al principio, Romero logró ubicar a su esposo con el sistema en línea para localizar detenidos del ICE. Lo visitó en un lugar de detención temporal en el centro de Los Ángeles, donde le llevó sus medicinas y un suéter. Luego vio que lo trasladaron al centro de detención en Adelanto. Pero después de que fue hospitalizado, ya no apareció en la base de datos.

Cuando ella y otros familiares fueron al centro de detención para preguntar por él, les negaron el acceso. Romero recibía llamadas ocasionales de su esposo desde el hospital, pero duraban menos de 10 minutos y estaban monitoreadas por el ICE. Ella quería saber en qué hospital estaba para poder estar con él, tomarle la mano, asegurarse de que lo atendieran bien y darle ánimos.

Dijo que mantenerlo esposado y sin ver a su familia era injusto e innecesario.“Está débil”, dijo Romero. “No existe riesgo de que pueda escaparse”.

Las directrices del ICE indican que debe permitirse el contacto y las visitas de familiares “dentro de las limitaciones de seguridad y operativas”. Las personas detenidas tienen derecho constitucional a hablar en privado con su abogado. Weber explicó que las autoridades migratorias deben informar a los abogados dónde están sus clientes y permitirles hablar con ellos en persona o mediante una línea telefónica sin vigilancia.

Sin embargo, los hospitales están en una zona gris respecto a cómo hacer cumplir estos derechos, ya que su enfoque principal es la atención médica, dijo Weber. Aun así, agregó, deben asegurarse de que sus políticas estén alineadas con la ley.

Familia sin acceso

Varios abogados de inmigración han pasado semanas intentando localizar a clientes detenidos por el ICE, y en ocasiones sus esfuerzos han sido frustrados por los hospitales.

Nicolas Thompson-Lleras, abogado de Los Ángeles que representa a personas en proceso de deportación, contó que, el año pasado, dos de sus clientes fueron registrados con nombres falsos en distintos hospitales del condado de Los Ángeles. Inicialmente, los hospitales negaron que los pacientes estuvieran ahí y no permitieron que el abogado los viera. También se les negó el acceso a los familiares.

Uno de esos clientes fue Bayron Rovidio Marín, trabajador de un negocio de lavado de autos, que resultó herido durante una redada en agosto. Agentes migratorios lo vigilaron por más de un mes en el hospital Harbor-UCLA, un centro público, sin presentar cargos.

En noviembre, la Junta de Supervisores del condado de Los Ángeles votó a favor de limitar el uso de políticas de apagón en hospitales públicos para pacientes bajo custodia civil de inmigración. En un comunicado, Arun Patel, director de seguridad del paciente y gestión de riesgos clínicos del Departamento de Servicios de Salud del condado, dijo que estas políticas buscan reducir riesgos para pacientes, médicos, enfermeros y agentes.

“En algunos casos, puede haber preocupaciones sobre amenazas al paciente, intentos de interferir con la atención médica, visitantes no autorizados o el ingreso de objetos prohibidos”, dijo Patel. “Nuestro objetivo no es restringir la atención, sino permitir que se brinde de forma segura y sin interrupciones”.

Pacientes más vulnerables

Thompson-Lleras expresó preocupación de que los hospitales estén colaborando con autoridades migratorias a costa de los pacientes y sus familias, lo que los deja vulnerables a abusos.

“Permite que las personas reciban atención deficiente”, dijo. “Permite que los traten de forma acelerada, sin supervisión, sin intervención familiar y sin defensa alguna. Estas personas están solas, desorientadas, siendo interrogadas —al menos en el caso de Bayron— bajo dolor y efectos de medicamentos”.

Estas situaciones también alarman al personal de salud. En Los Ángeles, dos trabajadores de hospitales —que pidieron no ser identificados por temor a sufrir represalias— dijeron a KFF Health News que el ICE y administradores de hospitales públicos y privados bloquean con frecuencia el contacto entre el personal médico y los familiares de personas detenidas, incluso para obtener información médica necesaria. Eso, afirmaron, va contra la ética médica.

Los procedimientos de apagón son otra preocupación.

“Facilitan, aunque no sea intencionalmente, la desaparición de pacientes”, dijo una de las personas, médica en el Departamento de Servicios de Salud del condado y parte de una coalición de trabajadores preocupados en la región.

En el Legacy Emanuel Medical Center, en Portland, enfermeras expresaron públicamente su indignación por lo que vieron como cooperación con el ICE y violaciones de los derechos de los pacientes. La red Legacy Health envió una carta al sindicato de enfermeras para que frenara esto, acusándolo de hacer declaraciones falsas o engañosas.

“Me dio asco”, dijo Blaire Glennon, una enfermera que renunció en diciembre. Afirmó que muchos pacientes fueron llevados por el ICE al hospital con lesiones graves sufridas durante la detención. “Sentí que Legacy estaba cometiendo enormes violaciones a los derechos humanos”.

Esposado estando inconsciente

Dos días antes de Navidad, Chabolla, la abogada de Peña, recibió una llamada de ICE con la información que ella y Romero llevaban semanas esperando. Peña estaba en el hospital Victor Valley Global Medical Center, a unas 10 millas de Adelanto, y estaba a punto de ser dado de alta.

Emocionados, Romero y su familia manejaron más de dos horas desde Glendale hasta el hospital para recogerlo.

Pero al llegar, encontraron a Peña intubado e inconsciente, todavía esposado de un brazo y una pierna a la cama. Había tenido una fuerte convulsión el 20 de diciembre, pero nadie informó a su familia ni a su abogada, dijo Chabolla.

Tim Lineberger, vocero del grupo KPC Health —propietario del hospital—, dijo que no podía comentar sobre casos específicos por razones de privacidad. Afirmó que las políticas del hospital sobre divulgación de información cumplen con las leyes estatales y federales.

Peña fue dado de alta finalmente el 5 de enero. Aún no tiene fecha de audiencia y su familia presentó una petición para modificar su estatus migratorio en función del servicio militar de su hijo. Por ahora, sigue en proceso de deportación.

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

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Blurry Line Between Medical and Vision Insurance Leaves Patient With Unexpected Bill

Barbara Tuszynski was concerned about her vision but confident in her insurance coverage when she went to an eye clinic last May.

The retiree, 70, was diagnosed with glaucoma in her right eye in 2019. She had a laser procedure to treat it in 2022, and she uses medicated drops in both eyes to prevent more damage. She is supposed to be checked regularly, she said.

During the May appointment, Tuszynski’s optometrist examined her eyes and reassured her that the glaucoma had not worsened.

Tuszynski, who lives in central Wisconsin, had looked up beforehand whether the clinic in nearby Madison participated in her insurance plan. The insurer’s website listed the optometrist’s name with a green check mark and the words “in-network.” She assumed that meant her policy would cover the appointment.

Then the bill came.

The Medical Procedure

An optometrist tested Tuszynski’s vision and took pictures of her optic nerves.

The Final Bill

$340, which included $120 for vision testing and $100 for optic nerve imaging.

The Billing Problem: Vision Coverage vs. Medical Coverage

Tuszynski’s UnitedHealthcare Medicare Advantage plan declined to pay for her eye appointment. “The member has no out of network benefits,” the company’s denial letter said.

Tuszynski felt like she was seeing double. How could an eye doctor be in-network and out-of-network at the same time? She said she sent the insurer a screenshot of its own webpage showing the clinic listed as in-network.

She said that after she complained, UnitedHealthcare representatives explained that the eye clinic was in-network under her vision plan, so her policy would cover the clinic’s services related to glasses or contact lenses. But they said the clinic was not in-network for her medical insurance plan, and glaucoma treatment is considered a medical issue.

Tuszynski was baffled that care for a patient’s eyes would not be covered by vision insurance. She said she didn’t realize that insurers can have contracts with eye clinics to provide some services but not others.

UnitedHealthcare spokesperson Meg Sergel said such arrangements are common, including with non-Medicare insurance provided by employers or purchased by individuals. “I looked up my eye doctor, and it’s the same thing,” she said in an interview with KFF Health News.

Sergel said she understood how a customer could mistakenly think vision insurance would cover all care for the eyes. She said UnitedHealthcare recommends that before undergoing treatment, patients ask care providers whether they are in-network for specific services.

Otherwise, she said, to know whether a test or treatment is covered by vision insurance, “you’d have to read the nitty-gritty” of a policy.

Leaders at Steinhauer Family Eye Clinic, where Tuszynski saw the optometrist, declined to comment.

Casey Schwarz, senior counsel for education and federal policy at the nonprofit Medicare Rights Center, said such complications frequently come up when Medicare Advantage members try to use their insurance at eye clinics or dental offices.

The federal government pays insurers to run Medicare Advantage plans for people who choose them instead of traditional Medicare. More than half of Medicare beneficiaries sign up for the private plans. Many offer routine vision and dental coverage that isn’t included with traditional Medicare.

“We hear from people who choose these plans because of those supplemental benefits, but there is not a lot of transparency around them,” Schwarz said.

The Resolution

After receiving the rejection letter, Tuszynski repeatedly contacted UnitedHealthcare to question the decision and filed an appeal with the company. Then, she said, she called a Medicare hotline to complain to federal officials. She also wrote to KFF Health News, which asked the insurer about the case.

UnitedHealthcare eventually agreed to cover the bill as if the service had been in-network. “In good faith, we made an exception,” Sergel said. However, Tuszynski was warned that if she received medical care from the clinic again, it would not be covered, because the clinic remains out-of-network for such services, Sergel said. “It doesn’t sound like that pleased her.”

Tuszynski confirmed that she is not pleased.

She said she lost sleep over the dispute and felt that it shouldn’t have taken so much effort to obtain a fair outcome. “It’s just been a horrible, difficult whirlwind,” she said.

The Takeaway

Schwarz said regulators should require insurance companies to clearly explain to customers and care providers how different procedures and services will be covered under vision, dental, and health plans. “They’re tricky,” she said.

In an ideal world, Schwarz said, Medicare would consider things like dental cleanings, eye checkups, and hearing aids as basic health care that would be covered in the same way as other medical care. But until that happens, she said, patients with any doubt should call their insurers beforehand to check whether services will be covered.

Tricia Neuman, a senior vice president with KFF, a health information nonprofit that includes KFF Health News, noted that Medicare’s website now includes a tool that can help people determine whether their doctors participate in a Medicare Advantage plan.

“This is helpful and a step forward, but information about provider networks is not always correct,” Neuman said. “Errors can come at a cost to enrollees, unless they are willing and able to take on their insurer.”

Tuszynski worked for 30 years as a secretary in hospitals and at doctors’ offices, so she’s familiar with billing issues, she said. “If I can’t sort through all this, how can anybody else do it?”

She knows her $340 bill was much smaller than the medical debts many other people face. But she said it was a serious amount of money to her, and she was glad she objected to the insurer’s contention that the bill shouldn’t be covered.

“I have a strong feeling about right and wrong — and this is just wrong,” she said.

For 2026, she decided to shift out of her Medicare Advantage plan. She now is enrolled in traditional Medicare, plus a supplemental plan to help with copays and other costs. She pays $184 a month for that plan, compared with paying no separate premium for her old Medicare Advantage plan.

Now she won’t have to worry about private insurers’ limited networks of contracted care providers, she said. Her glaucoma treatment will be covered at the Madison eye clinic.

However, she no longer has insurance coverage for eyeglasses, just a discount plan if she buys glasses from certain stores. She used her Medicare Advantage insurance to buy new glasses shortly before switching. “Hopefully, those will last me a while,” she said.

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

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What It’s Like to Live With One of Psychiatry’s Most Misunderstood Diagnoses

Spurred by her past struggles with dissociative identity disorder, she has devoted her professional life to studying it.

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The Mushroom Gummies That Claim to Stimulate Your Brain

Fungal supplements are everywhere, promising happiness, energy, focus, you name it. But what they deliver is something else entirely.

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Medicare Advantage Insurers Face New Curbs on Overcharges in Trump Plan That Reins in Payments

Medicare Advantage health plans are blasting a government proposal this week that would keep their reimbursement rates flat next year while making other payment changes.

But some health policy experts say the plan could help reduce billions of dollars in overcharges that have been common in the program for more than a decade.

On Jan. 26, Centers for Medicare & Medicaid Services officials announced they planned to raise rates paid to health plans by less than a tenth of a percent for 2027, far less than the industry expected. Some of the largest, publicly traded insurers, such as UnitedHealth Group and Humana, saw their stock prices plummet as a result, while industry groups threatened that people 65 and older could see service cuts if the government didn’t kick in more money.

In Medicare Advantage, the federal government pays private insurance companies to manage health care for people who are 65 and older or disabled. But less noticed in the brouhaha over rates: CMS also proposed restricting plans from conducting what are called “chart reviews” of their customers. These reviews can result in new medical diagnoses, sometimes including conditions patients haven’t even asked their doctors to treat, that increase government payments to Medicare Advantage plans.

The practice has been criticized for more than a decade by government auditors who say it has triggered billions of dollars in overpayments to the health plans. Earlier this month, the Justice Department announced a record $556 million settlement with the nonprofit health system Kaiser Permanente over allegations the company added about half a million diagnoses to its Advantage patients’ charts from 2009 to 2018, generating about $1 billion in improper payments.

KP did not admit any wrongdoing as part of the settlement.

“I do think the administration is serious about cracking down on overpayments,” said Spencer Perlman, a health care policy analyst in Bethesda, Maryland.

Perlman said that while the Trump administration strongly supports Medicare Advantage, officials are “troubled” by plans that rake in undue profits by using chart reviews to bill the government for medical conditions even when no treatment was provided.

In a news release, CMS Administrator Mehmet Oz said curbing this practice would ensure more accurate payments to the plans while “protecting taxpayers from unnecessary spending that is not oriented towards addressing real health needs.”

“These proposed payment policies are about making sure Medicare Advantage works better for the people it serves,” Oz said.

Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, called the proposal “at least a mildly encouraging sign,” though he said he suspected health plans might eventually find a way around it.

Kronick has argued that switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in the government-run Medicare program, because of unbridled medical coding excesses. The insurance plans have grown dramatically in recent years and now enroll about 34 million members, or more than half of people eligible for Medicare.

David Meyers, an associate professor at the Brown University School of Public Health, called the proposed restriction on chart reviews “a step in the right direction.”

“I think the administration has been signaling pretty strongly they want to cut back on inefficiencies,” he said.

The outcry from industry, mostly directed at the proposal to essentially hold Medicare Advantage payment rates flat, was quick and sharp.

“If finalized, this proposal could result in benefit cuts and higher costs for 35 million seniors and people with disabilities when they renew their Medicare Advantage coverage in October 2026,” said Chris Bond, a spokesperson for AHIP, formerly known as America’s Health Insurance Plans.

CMS is accepting public comments on the proposal and says it will issue a final decision on the payment rates and other provisions by early April.

Meyers said health plans often claim they will be forced to slash benefits when they aren’t satisfied with CMS payments. But that rarely happens, he said.

“The plans can still make money,” he said. “They mostly are very profitable, just not as profitable as shareholders expected.”

The government pays Medicare Advantage plans higher rates to cover sicker patients. But over the past decade, dozens of whistleblower lawsuits, government audits, and other investigations have alleged that health plans exaggerate how sick their customers are to pocket payments they don’t deserve, a tactic known in the industry as “upcoding.”

Many Medicare Advantage health plans have hired medical coding and analytics consultants to review patients’ medical charts to find new diagnoses that they then bill to the government. Medicare rules require that health plans document — and treat — all medical conditions they bill.

Yet federal audits have shown for years that many health plans’ billing practices don’t hold up to scrutiny.

A December 2019 report by the Department of Health and Human Services inspector general found that the health plans “almost always” used chart reviews to add, rather than delete, diagnoses. “Over 99 percent of chart reviews in our review added diagnoses,” investigators said.

The report found that diagnoses reported only on chart reviews — and not on any service records — resulted in an estimated $6.7 billion in payments for 2017.

This week’s proposal is not the first time CMS has tried to crack down on chart reviews.

In January 2014, federal officials drafted a plan to restrict the practice, only to abruptly back off a few months later amid what one agency official described as an “uproar” from the industry.

The health insurance industry has for years relied on aggressive lobbying and public relations campaigns to fight efforts to rein in overpayments or otherwise reduce taxpayers’ costs for Medicare Advantage.

What happens this time will say a lot about whether the Trump administration is serious about cracking down on controversial, long-standing payment practices in the program.

Perlman, the policy analyst, said it is “quite common” for CMS to partially backtrack when faced with opposition from the industry, such as by phasing in changes over several years to soften the blow on health plans.

David Lipschutz, an attorney with the Center for Medicare Advocacy, a nonprofit public interest law firm, said finalizing the chart review proposal “would be a meaningful step towards reining in overpayments to Medicare Advantage plans.”

But in the past, he said, even a minor change to Advantage payments has led the industry to protest that “the sky will fall as a result, and the proposal is usually dropped.”

“It’s hard to tell at this stage how this will play out,” Lipschutz said.

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Angella Ferguson, a Leader in Sickle Cell Anemia Research, Dies at 100

A Black female doctor when that was rare, she developed a diagnostic test for the disease that is still a standard tool, as well as treatment guidelines.

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Texas Sues Delaware Nurse Practitioner for Mailing Abortion Pills to the State

The case is the latest action taken by a state with an abortion ban against providers in states that support abortion rights.

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With AlphaGenome, Researchers Are Using A.I. to Decode the Human Blueprint

AlphaGenome is a leap forward in the ability to study the human blueprint. But the fine workings of our DNA are still largely a mystery.

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When Suicidal Calls Come In, Who Answers? Georgia Crisis Line Response Rates Reveal Gaps

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

Kaitlin Cooke of Cartersville, Georgia, was contemplating suicide when she started calling a statewide mental health crisis line in 2018. She said she would sneak outside and call the hotline behind her car, where her boyfriend would not hear her.

The counselors who answered her calls were there for her when no one else was, she said. Each time she called, they spoke to her for at least 45 minutes. And they told her that life “does get better.”

“If it weren’t for this resource, I might have been a statistic,” said Cooke, now 31, who found a local therapist.

Starting in March, the call response record for that resource, the Georgia Crisis and Access Line, and its newer national counterpart, the 988 Suicide & Crisis Lifeline, plummeted in the state. The 988 line was created during President Donald Trump’s first term.

National data shows Georgia is one of several states that have struggled to keep their rates of disconnected or rerouted 988 calls low. Disconnected calls typically involve the caller hanging up, possibly after a long wait time. States are largely responsible for funding and staffing their 988 systems, with some money from the federal government. Mental health experts said proper funding for the 988 system in a state, through a well-staffed response network, can influence whether a caller is connected to a local counselor — or chooses to hang up.

The future of mental health services appears uncertain amid massive changes from the Trump administration, including Medicaid cuts that could limit access to care. The cuts could also lead states to consider reducing their allocations to crisis lines, said Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News.

The stakes couldn’t be higher for callers experiencing severe mental health crises.

“Some of the callers are actively experiencing suicidal thoughts,” Saunders said. “Sometimes they actively have a suicide plan and it’s a very urgent situation.”

Alarm About Call Abandonment Rate

Georgia has contracted with Carelon Behavioral Health, a unit of insurance giant Elevance Health, to run its crisis lines. When Carelon dropped a subcontractor that managed staffing the lines, performance plunged. Abandoned calls spiked, which means more callers were hanging up or disconnecting before a counselor answered the phone, Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, pointed out in a letter to Carelon.

The state requires a call abandonment rate of 3% or less, and, Tanner wrote, the current rate was 18%. After sending the letter, the state narrowed its definition of abandoned calls, lowering the current rate. The state now counts only calls disconnected after being on hold for more than 30 seconds and not those rerouted to backup centers.

Carelon officials have acknowledged the dip in performance. They said it reflected a “necessary” transition from the company’s vendor and that they were hiring more staff to ensure the crisis lines could handle the demand. Carelon spokesperson Hieu Nguyen said the company is “committed to ensuring that every Georgian in crisis can access help through 988,” noting that calls not answered locally are routed to national backup centers.

With the help of some federal funding, Georgia is paying Carelon $17 million annually to manage 988 and its predecessor, the Georgia Crisis and Access Line, which is still operating. Crisis calls go to the same response team, whether someone calls 988 or the original state line. Carelon and state officials declined to disclose how much of the money went to the subcontractor, Behavioral Health Link, with Carelon saying it is proprietary information. The state can extend its contract with Carelon to 2032.

Camille Taylor, a spokesperson for the state Department of Behavioral Health and Developmental Disabilities, said in December that Carelon had improved its call response performance but that the state continues to monitor the company’s answer rates.

‘Enormous’ Staffing Challenges

Launched in 2022, the national 988 Suicide & Crisis Lifeline connects people experiencing mental health problems, emotional distress, or alcohol or drug use concerns to trained counselors. The free hotline, with the three-digit number mirroring the ease of dialing 911, aims to help avert mental health crises and reduce suicide risk. It also supports people who call for someone they care about.

“All behavioral health is having enormous challenges in terms of staffing,” said Margie Balfour, an Arizona psychiatrist and a member of a national 988 advisory committee. Being a crisis line counselor “is a very stressful job,” she said. “You’re talking to people at the peak of their crisis.”

In December, Georgia ranked near the bottom of the 50 states in percentage of calls answered that it kept in state, according to Vibrant Emotional Health, which administers the 988 line nationally. A high number of Georgia calls were routed to national call centers, data showed.

The latest national data also showed how different the response times to a 988 call can be. In December, it took one second on average if someone called from Mississippi. It took 74 seconds for a caller from Virginia.

While the unofficial industry target rate for answering in-state calls is 90%, more than half the states fell below that mark in December, according to the national data. In Georgia, the tracking data for 988 showed that more than 80% of crisis calls were answered within the state — until March, when the number dropped to 73%. Then it fell again in April, to 62%. The rate rose to 72% in October and reached 79% in December.

Local counselors “should be more familiar with the state infrastructure, mental health system, and resources that are available to people who live in the state,” said Saunders of KFF.

Pierluigi Mancini, interim president and CEO of Mental Health America, said it’s unlikely that an out-of-state counselor would know much about that state’s mental health system and providers. The service also sends many predominantly Spanish-speaking callers to out-of-state call centers, possibly hindering their connection to local help, Mancini said.

Since the 988 rollout, the volume of calls, texts, and chats to the crisis line totaled more than 19 million by November, according to the Substance Abuse and Mental Health Services Administration. A study found that with the national predecessor to 988, the National Suicide Prevention Lifeline, most suicidal callers who were later interviewed said their call helped stop them from killing themselves.

More than 49,000 Americans died by suicide in 2023. Nearly 17 million Americans ages 12 and older said in 2024 they had seriously thought about suicide in the previous year, according to the National Survey on Drug Use and Health.

For Generation Z adults, the oldest of whom are now reaching their late 20s, suicide is taking more lives than a decade ago when millennials were the same age, according to a Stateline analysis of federal death statistics. The largest increase in suicide rates for the age group was in Georgia, which jumped 65% from 2014 to 2024.

Mike Hogan, a consultant who ran mental health systems in three states, said recent Georgia data reflects “a bungled transition. It looks like performance fell off a cliff.”

For people calling a crisis line, he said, “counselors, with the right training, can talk people down and away from the suicidal crisis.”

Balfour noted that 988 has bipartisan support. The system can be improved, she said, emphasizing that it’s still an important resource that’s effectively helping people in crisis.

“988 is a success,” Balfour said. “And it’s work in progress.”

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

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Watch: A Strange Checkup Bill Revealed a Firefighter’s Kids Were Mistakenly Uninsured

After Susannah Reed-McCullough’s husband died in 2018, she and their young daughters continued to receive health insurance through his job as a firefighter in Maryland.

Then, in 2024, she got an unexpected medical bill: $377 for a checkup for one of her children the previous fall. Reed-McCullough said she called the doctor’s billing department and learned the insurance company had dropped the children’s coverage.

The drop turned out to be a mistake. But Reed-McCullough said she was forced to act as the go-between for her late husband’s human resources department and their insurer — all while worried about her daughters’ being uninsured.

In this installment of InvestigateTV and KFF Health News’ “Costly Care” series, Caresse Jackman, InvestigateTV’s national consumer investigative reporter, explores how administrative errors can leave patients on the hook for medical bills they shouldn’t owe, sometimes with few options to correct a problem they didn’t create.

Jackman interviewed Elisabeth Rosenthal, senior contributing editor at KFF Health News, who said accidental coverage drops are “a common problem” in need of attention from state regulators.

“People make mistakes, systems make mistakes, and they should be held responsible for them, not the patient,” Rosenthal said.

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Cansados de pelear con las aseguradoras, hospitales ofrecen sus propios planes Medicare Advantage

Desde que Larry Wilkewitz, de 79 años, se jubiló de una empresa de productos de madera, hace más de 20 años, ha tenido un plan comercial de Medicare Advantage ofrecido por la aseguradora Humana.

Pero hace dos años, escuchó sobre Peak Health, un nuevo plan Advantage creado por el Sistema de Salud de la Universidad de West Virginia, donde atienden sus médicos. Era más económico, ofrecía una atención más personalizada y brindaba beneficios adicionales, por ejemplo, una asignación para productos de farmacia de venta libre.

Esas ventajas son más importantes que nunca, comentó Wilkewitz, quien está recibiendo tratamiento contra el cáncer.

“Decidí probarlo”, dijo. “Si no me gustaba, podía volver a Humana o a cualquier otro plan después de un año”.

Pero ha decidido mantenerse en Peak Health. Consumidores con Medicare Advantage —una alternativa privada al programa Medicare del gobierno— pueden cambiar de plan hasta finales de marzo.

Ahora, al comenzar su tercer año, Peak Health ha triplicado el número de afiliados respecto al año pasado, “superando los 10.000”, dijo su presidente, Amos Ross. La cobertura se amplió de 20 a 49 condados y, por primera vez, llegó a algunas zonas del oeste de Pennsylvania.

Aunque los planes administrados por hospitales representan solo una pequeña porción del mercado de Medicare Advantage, su número de afiliados sigue creciendo, en línea con el aumento general de beneficiarios de ese sistema.

De las 62,8 millones de personas con Medicare que pueden inscribirse en un plan Advantage, el 54% lo hizo el año pasado, según KFF.

Aunque el número de planes Advantage operados por sistemas hospitalarios se ha mantenido relativamente estable, organizaciones como Mass General Brigham en Boston están ampliando sus áreas de cobertura y creando nuevos tipos de planes.

Los sistemas de salud llevan años incursionando en el negocio de los seguros, pero no es una opción para todos. MedStar Health, que opera en el área metropolitana de Washington D.C., informó que cerró su plan de Medicare Advantage a fines de 2018, alegando pérdidas financieras.

“Es muchísimo trabajo”, dijo Ross, quien se desempeñó durante más de una década en la industria de seguros de salud comerciales.

Al igual que cualquier otra aseguradora, los hospitales que entran en este negocio necesitan una infraestructura administrativa para inscribir pacientes, contratar proveedores, surtir recetas, procesar reclamos, contratar personal y, lo más importante, demostrar a los reguladores estatales que cuentan con reservas financieras suficientes para pagar los servicios.

Una vez que obtienen una licencia estatal de seguros, deben recibir la aprobación de los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés) para vender pólizas Medicare Advantage. Algunos sistemas se asocian con aseguradoras o crean una subsidiaria, mientras que otros gestionan el proceso directamente.

Kaiser Permanente, el sistema de salud sin fines de lucro más grande del país en términos de ingresos, inició un plan experimental de Medicare en 1981 y ahora tiene cerca de 2 millones de afiliados en decenas de planes Advantage en ocho estados y el Distrito de Columbia.

El 14 de enero, el Departamento de Justicia anunció que Kaiser Permanente aceptó pagar $556 millones para cerrar el caso por las acusaciones de haber facturado fraudulentamente al gobierno cerca de $1.000 millones a lo largo de nueve años.

El año pasado, UCLA Health lanzó dos planes Medicare Advantage en el condado de Los Ángeles, el más poblado del país. Otros nuevos planes propiedad de hospitales han surgido en áreas rurales menos rentables.

“Las aseguradoras han tenido muchas dificultades para ingresar a esas comunidades”, dijo Molly Smith, vicepresidenta del área de políticas públicas de la Asociación Americana de Hospitales (American Hospital Association).

Pero los planes Advantage ofrecidos por hospitales tienen un nombre ya conocido, que resulta confiable. No necesitan “llegar” a una comunidad, porque los hospitales —sus propietarios— nunca se fueron.

Separaciones complicadas

Los planes Medicare Advantage generalmente suelen limitar a sus afiliados a una red de doctores, hospitales y otros profesionales de salud con quienes tienen contratos.

Pero si los hospitales y las aseguradoras no logran renovar esos contratos, o surgen disputas —a menudo debido a retrasos en pagos, rechazos de cobertura o reglas engorrosas de autorizaciones previas—, los proveedores pueden abandonar la red.

Estas rupturas, junto con cancelaciones programadas y recortes en las áreas de cobertura, obligaron en 2025 a más de 3,7 millones de afiliados de Medicare Advantage a tomar una decisión difícil: encontrar un nuevo seguro para este año que sus médicos aceptaran o, de ser posible, conservar su plan pero cambiar de proveedores.

Cerca de un millón de estos pacientes afectados estaban cubiertos por United Healthcare, la aseguradora más grande del país. En una actualización financiera en julio, el director financiero John Rex atribuyó el retiro de la empresa a los hospitales, donde “la mayoría de los servicios se están volviendo más complejos y costosos”.

La inestabilidad en el mercado de seguros comerciales ha afectado tanto a pacientes como a proveedores. A veces, las disputas contractuales se ventilan públicamente, con los pacientes angustiados y recibiendo advertencias de ambos lados: cada parte culpa a la otra por la inminente pérdida de cobertura.

Cuando Fred Neary, de 88 años, se enteró de que sus médicos del sistema Baylor Scott & White Health, en el centro y norte de Texas, dejarían de estar en su plan Medicare Advantage, temió que lo mismo pudiera ocurrir si se cambiaba a otra aseguradora comercial. Luego descubrió que ese sistema, que cuenta con 53 hospitales, tenía su propio plan Medicare Advantage. Se inscribió en 2025 y decidió conservarlo este año.

“Para mí era muy importante no tener que preocuparme nunca por cambiarme a otro plan porque no aceptaran a mis médicos de Baylor Scott & White”, dijo.

Eugene Rich, investigador principal de Mathematica, una organización de investigación en políticas de salud, señaló que los planes Medicare Advantage operados por sistemas hospitalarios ofrecen “mucha estabilidad para los pacientes”.

“No vas a descubrir de repente que tu médico de atención primaria o tu cardiólogo ya no están en el plan”, explicó.

Un estudio publicado en julio en la revista Health Affairs del cual Rich fue coautor verificó que, por primera vez en 2023, la afiliación a planes Advantage propiedad de hospitales creció más rápido que la afiliación al Medicare tradicional, aunque no tan rápido como el aumento general de todos los planes Advantage.

El extenso sistema UCLA Health lanzó sus dos planes Advantage en el condado de Los Ángeles en enero de 2025, a pesar de que los pacientes ya contaban con más de 70 planes Advantage disponibles.

Antes de lanzar el plan, la Junta de Regentes de la Universidad de California discutió sus méritos en una reunión de noviembre de 2024. Las actas de esa reunión ofrecen una visión poco común de un debate que, en sistemas hospitalarios privados, suele ocurrir a puertas cerradas.

“A medida que un número creciente de pacientes de Medicare se vuelca a nuevos planes Medicare Advantage, la experiencia de UC Health con estos planes ha resultado insatisfactoria, tanto para los pacientes como para los proveedores”, señalan las actas, al resumir los comentarios de David Rubin, vicepresidente ejecutivo de UC Health.

Las actas también contienen los aportes de Jonathon Arrington, director financiero de UCLA Health. “A lo largo de los años, para poder atender a pacientes de Medicare Advantage, UCLA ha firmado numerosos contratos con aseguradoras, y estos contratos, en general, no han funcionado bien”, dijo.

Y agregó que “cada dos o tres años, UCLA ha rescindido un contrato y firmado uno nuevo”. Los pacientes, sin embargo, se han mantenido fieles a UCLA, y algunos han atravesado hasta tres rondas de cancelaciones de contratos con tal de seguir atendiéndose en UCLA Health.

Costos para los contribuyentes

Los CMS pagan una cantidad fija mensual a los planes Advantage por cada afiliado, según su condición de salud y ubicación.

En 2024, el gobierno federal destinó a estos planes un estimado de $494.000 millones para la atención de los pacientes, según la Comisión Asesora de Pago de Medicare (Medicare Payment Advisory Commission), que supervisa el programa para el Congreso.

La comisión indicó que proyecta que en 2026 las aseguradoras recibirán un 14% más —unos $76.000 millones— de lo que le habría costado a Medicare tradicional atender a los mismos pacientes.

Muchos legisladores demócratas han criticado estos pagos excesivos a aseguradoras de Medicare Advantage, aunque el programa cuenta con el apoyo de demócratas y republicanos en el Congreso debido a su creciente popularidad entre los beneficiarios de Medicare, quienes a menudo se sienten atraídos por servicios como atención dental y otros no incluidos en el Medicare tradicional.

Cada vez que el Congreso plantea posibles recortes, las aseguradoras insisten en que estos generosos pagos federales son esenciales para mantener a flote los planes Advantage. Según las actas de la junta, los planes Advantage de UCLA Health necesitarán al menos 15.000 afiliados para ser financieramente sostenibles. Pero los datos de los CMS indican que en 2025 se inscribieron en ellos 7.337 personas.

Un estudio publicado en JAMA Surgery de agosto comparó a los pacientes de Medicare Advantage comercial que se sometieron a cirugías mayores con los afiliados a planes Advantage propiedad de hospitales. Este último grupo tuvo menos complicaciones, indicó el coautor Thomas Tsai, profesor asociado del Departamento de Políticas y Gestión de Salud en la Escuela de Salud Pública T.H. Chan de Harvard.

Smith, de la Asociación Americana de Hospitales, no se sorprende. Cuando aseguradoras y hospitales no están en lados opuestos, la atención médica puede ser más fluida, dijo. “Hay más flexibilidad para administrar el dinero de las primas y cubrir servicios que tal vez de otra forma no se cubrirían”, agregó.

Pero Tsai advierte a los adultos mayores que los planes Medicare Advantage propiedad de hospitales funcionan bajo las mismas reglas que los administrados por aseguradoras privadas. Señala que los pacientes deberían evaluar si los beneficios adicionales de estos planes “valen la pena frente al costo de tener redes de proveedores potencialmente más limitadas y un mayor control del uso de servicios que el que ofrece Medicare tradicional”.

En Texas, Neary espera que la relación más cercana entre sus médicos y su plan reduzca la posibilidad de que le nieguen pagos por su atención médica.

“No creo que enfrente una situación en la que no me brinden cobertura si uno de sus propios profesionales lo recomienda”, dijo.

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An Arm and a Leg: Charity-Care Nonprofit Scales Up and Doubles Down

As premium payments for Affordable Care Act insurance plans soar and cuts to Medicaid start to affect hospitals and patients, many people in 2026 will need help paying medical bills. And charity care may be a solution.

One group working on this is Dollar For, a nonprofit focused on helping people access the financial assistance that hospitals are legally required to offer patients who make less than a certain amount.

An Arm and a Leg host Dan Weissmann checks back in with Dollar For founder Jared Walker about how his small organization managed to help erase more than $55 million in medical bills last year while navigating difficult new funding challenges and ever-shifting political terrain.

Dan Weissmann @danweissmann @danweissmann.bsky.social Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.

Credits

Emily Pisacreta Producer Claire Davenport Producer Adam Raymonda Audio wizard Ellen Weiss Editor Click to open the Transcript Transcript: ‘Sh**’s wild’: Scaling up, doubling down, and buckling in

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

Dan: Hey there.

So, 2026! On New Year’s Day, pretty much every morning news show had a not-so-good news story ready to go.

News anchor: This morning, more than 20 million Americans…

News anchor: …will see healthcare premiums double, triple, or go even higher…

News anchor: …after Congress failed to extend certain subsidies under the Affordable Care Act.

Dan: A lot of people will end up without insurance. Or with much crappier insurance, because they can’t afford anything better. Or paying a lot more for insurance than they can afford. Or some combo platter.

And because employer plans got more expensive too — and a bunch of employers weren’t ready to pay more — lots of folks ended up with insurance from work that leaves them on the hook for more.

All of it leaves a lot more people a lot more vulnerable this year to overwhelming bills: for insurance premiums, for medical care, for medicine.

So: I thought it would be a good time to check in with one of the people who has given me the most inspiration, and has taught me the most about how we can push back against some of this.

That would be Jared Walker, the founder of the nonprofit Dollar For.

I first talked with Jared five years ago, right after he went super-viral on TikTok sharing a secret that was hiding in plain sight:

Jared Walker: Most hospitals in America are nonprofits, which means they have to have financial assistance or charity care policies. This is gonna sound weird, but what that means is that if you make under a certain amount of money, the hospital legally has to forgive your medical bills.

Dan: Millions of people kept watching as Jared quickly demonstrated how to apply — and then wrapped up with an offer:

Jared Walker: I run a nonprofit that does this, so, uh, DM me and I will actually do it for you. Let’s see if we can crush those medical bills.

Dan: Here’s what Jared said to me a couple weeks later about that offer.

Jared Walker: Yeah, that was, that really backfired. No, uh…

Dan: Thousands of people had gotten in touch to take him up on his offer. And Dollar For — a SUPER-tiny nonprofit that Jared had started to help people in his hometown of Portland, Oregon — suddenly had a bigger, national mission that Jared was scrambling to meet.

Jared Walker: ?I’m excited. We’re gonna help a lot of people and, uh, hopefully we can get some funding to scale what we’re doing because shit’s wild.

Dan: And it has been wild ever since.

Talking with Jared over the last five years — and watching the Dollar For team scale up their ambitions and impact — it’s been one of the most inspiring and eye-opening stories I’ve ever seen.

?So I was excited to talk with Jared a little after New Years, to hear how things were looking to him in 2026.

I’d already seen the numbers: They helped people wipe out 55 million dollars worth of hospital bills in 2025 — a huge increase from the year before.

Jared Walker: As far as impact goes, what we were able to do with the money that we raised, like we’re rolling, like Dollar For is killing it

Dan: So I was surprised when Jared said: 2025 had been tough.

Jared Walker: We started the year with two of our biggest donors, basically just backing out.

Dan: Some of the Trump administration’s early disruptive moves– like trashing foreign aid– had led those donors to re-think their priorities. Dollar For lost half a million dollars — almost a third of their budget. Suddenly Jared found himself scrambling to replace it.

Jared Walker: Just trying to, to make up that, $500,000, gap was, uh, fun.

Dan: He managed to make up about two hundred thousand dollars. He says Dollar For didn’t lay anybody off, but some people went to half time.

As the year went on, more political news forced Jared and Dollar For to re-think *their* strategy for 2025. It was another scramble.

Meanwhile, Dollar For kept setting new records — wiping out two-thirds more medical debt than the year before.

It’s left Jared and his colleagues thinking hard about how they chart their path in a world that’s still changing fast.

The story of where they’ve been in the last year — and what they’ve done across the last five years — continues to help me think about the big picture like nothing else. So it’s a great place for this show to kick off 2026.

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

To go back to the beginning for a minute. When I first talked with Jared five years ago, he was already looking at the big picture. How big a difference it would make if more people actually got the charity care they qualified for. Here he is in January 2021.

Jared Walker: We’ve had millions of people now that have declared bankruptcy over medical bills that they legally didn’t even have to pay if they knew about this. And that’s like – that should upset people.

Dan: This is one reason I find Dollar For’s work so compelling — along with their scrappy approach, and their accomplishments: from the start, they’ve always made the scope and the stakes of our health care system’s dysfunction so clear, so stark.

But — talk about scrappy — when I had that first talk with Jared, he was scrambling to respond to the messages pouring in — thousands of them. He was grabbing whoever he could for help.

Jared Walker: My niece is like 16. I was like, yo. Here’s my credentials. Get on here and start replying to people.

Dan: Then, by the time I talked with him just a few months later, in the summer of 2021, he had taken incredible steps to start scaling up Dollar For, with help from dozens of volunteers.

Including — especially — folks who heard about him on this show.

Jared Walker: I was just shocked at how many people were reaching out saying, I, I heard you on this podcast, I heard you – and I’m like, well, I’ve only been on one podcast, so I know it’s this one.

Dan: Honestly, this is another part of what makes Dollar For my favorite story. Because it shows how many people are ready to jump in and help.

And how much people are ready to contribute: In just a few months, Jared and a volunteer army — including generals, a couple of wildly qualified folks who put in close to full-time hours for a while — had done something incredible.

They’d built Dollar For a website where anyone, anywhere in the country, could check to see if they qualified for financial assistance, and ask for help applying.

Because every hospital sets its own criteria for who qualifies, setting up that system meant grabbing the charity-care policies from more than two thousand different hospitals, and coding all of the criteria into a database.

The website with that database went live in the summer of 2021 — less than six months after Jared first went viral on TikTok.

He and his colleagues have been building and refining their operation ever since. And working towards making a big-picture difference.

Last time I checked in with Jared, it was late 2024. Dollar For had put out a couple of research reports estimating the size of that big picture:

They found that less than a third of the people who qualified for charity care actually got their bills forgiven.

If all of those people actually got the charity care they qualified for, Dollar For found that would mean 14 billion dollars in hospital bills, in medical debt, would vanish.

14 billion dollars that hospitals could be forgiving under their own policies, every year.

Jared definitely noticed that that number, 14 billion dollars, dwarfed the amounts Dollar For had been able to address by working case by case. Like, they were closing in on clearing 32 million dollars in hospital bills that year. Which is a LOT for a tiny organization. Jared was like…

Jared Walker: It sounds great, and then you see the 14 billion number and you’re like, oh, shoot. What are we doing? What are we doing?

Dan: Jared and his colleagues had started a strategic planning process that would lead them to say: Let’s focus on making a dent in that 14 billion dollars by advocating for new policies. Laws to make hospitals at least check to see if people are eligible for charity care before chasing them for bills they can’t pay.

And while they were planning, the ground beneath them started to shift.

The Trump administration took office and among other things, immediately started slashing foreign aid.

?Newscaster 1: President Trump says he wants U-S-A-I-D, the relief agency, helping millions of people around the world to be shut down.

Newscaster 2: Just yesterday, U-S-A-I-D employees in Washington were told to stay home.

Jared says some of his donors reset their priorities — to fill in gaps internationally. One of them finalized their decision just as Dollar For was wrapping up their first board meeting of 2025.

Jared Walker: I get this email from our biggest donor saying, hey, we’re gonna cut the 300K.

Dan: Oh wow.

Jared Walker: Um, and my board chair goes, Jared, what happened to your face? Is everything okay? And I was like, am I gonna tell my whole board right here right now that we just lost our biggest funder?

Dan: I asked Jared later by email: Hey, so did you spill the beans then? His response:

“lol. I did not tell them in that moment. My thought process was ‘ I don’t want to end our first board meeting of the year with this bomb. We are all hyped on the new year… let’s keep that energy. The board can’t change this email”

Jared filled them in later, and started hustling to fill the budget gap. They kept working on their strategic plan through the first few months of 2025.

By the spring, they were putting finishing touches on it — and then the news cycle intervened again.

Jared Walker: We went into 2025 with this idea of we are going to do more policy work, we’re going to push more policy, we’re going to advocate for better charity care laws, and then… Medicaid cuts, right?

Dan: The Trump administration’s big legislative proposal — the “One Big Beautiful Bill” — aimed to offset big tax cuts in part with big cuts to Medicaid spending.

Newscaster: Republicans are looking to slash two trillion dollars – with a T– in long term spending. And Medicaid could be a target.

Dan: And a ton of those Medicaid dollars go to hospitals.

Jared Walker: And when you are getting every single headline is ‘Woe is me, we’re a hospital, we’re not gonna make it. You’re gonna bankrupt hospitals…’

Dan: That was gonna make pushing new rules for hospitals — forcing them to be more generous — a tougher sell.

And here’s where these two stories — Dollar For gets hit by big, fast-moving changes in 2025, and two: Dollar For wipes out a lot more medical debt than ever before in 2025 — we’re gonna see where they intersect.

That’s coming right up.

This episode of An Arm and a Leg is a co production of Public Road Productions and KFF Health News. That’s a nonprofit newsroom covering health issues in America.

With all of these big-picture changes — like cuts to Medicaid –Dollar For decided to pivot.

Jared Walker: we kind of slowed down and said, okay, if people are gonna lose Medicaid, if people are gonna, if their insurance premiums are gonna go up, if all these things, what we need to do is we need to double down on direct service and help more as many patients as we can because the appetite for policy change might not be there.

Dan: They had a communications and marketing team who had planned to spend the year pushing Dollar For’s policy message.

Instead, they focused on spreading the word about charity care and Dollar For. Pitching Jared to reporters. It worked. He says he was featured in more than 90 news stories before the year was out.

Jared Walker: I was on more podcasts than I’ve ever been on, ever, doing local news stuff. So the marketing team was cooking pretty good as far as getting the word out.

Dan: That meant more folks coming to Dollar For looking for help with charity care. Which is one thing that drove up the number of people Dollar For was able to help.

The other was the payoff on a long-term investment.

In the spring of last year they finished a project they’d been working on for a long time: Making it easy for patients to fill out a charity care application directly on Dollar For’s website.

Jared Walker: A patient goes to dollarfor.org. They fill out household size income, what hospital it tells ’em if they’re eligible. If they are, it bounces them right into a digital application. They can do that on their phone, tablet, computer. They’re filling it out and it is automatically mapping their data into the correct hospital form.

Dan: This is the big upgrade: I don’t have to follow a link to the hospital’s website and find their form. I don’t have to print anything out.

I’m staying on Dollar For’s user-friendly site, answering questions from my hospital’s application form — because every hospital’s form is different, and some ask for more information than others, the back-end work by Dollar For to give me the right questions? That’s a big deal.

And: The Dollar For team is putting those questions to me in plain, user-friendly English. Which not every hospital form necessarily does. If I get stuck, I message the Dollar For team to get help, directly.

When I’m done, it shows me the results and says:

Jared Walker: Here’s your completed application. Does everything look good? thumbs-up it, we submit it to the hospital, and then we do follow up from there

Dan: Jared says they also created a portal where patients can check on the status of their application, and jump right into a chat with a patient advocate.

I was like: You know, that’s pretty impressive. Your year did not totally suck.

Jared Walker: Yeah. It is honestly like, you’re like reminding me of, I’m like, oh yeah, we did some, we did some really cool stuff last year.?

Dan: And he sees room for new tech to help them get even more efficient — yes, with help from AI.

Jared Walker: ?And like, we’re very much in the camp of this is a great tool, it’s not gonna solve all of our problems

Dan: But he does see a few areas where it could help.

Including — helping his team do something they actually haven’t had the capacity, like the time, to do yet: quality control on the documents patients submit with their applications– like proof of income.

Jared Walker: Sometimes people accidentally upload a, you know, a picture of their cat instead of their, you know, W2 or, or whatever. So if we could have an AI tool, scan the document and make sure that it matches with what they said…

Dan: And flag situations where a human at Dollar For should take a look before sending it in…

Jared Walker: that would also save us a bunch of back and forth with the hospital and the patient

Dan: In other words, save time for everyone. And maybe help Dollar For’s rep with hospitals.

Jared Walker: It kind of makes us look bad if we send documents to a hospital and it’s a photo of somebody’s cat, you know?

Dan: That would cost money – Jared estimates a quarter of a million dollars, including the cost of adding Dollar For’s first full-time CTO.

Meanwhile, they haven’t stopped pushing for policy change. In 2025, Dollar For published a study that kind of turned the telescope around on the question it had addressed the year before. If hospitals gave financial assistance to everyone who qualified, they’d found it would save patients 14 billion dollars a year.

This time, they asked: how much of a hit would that 14 billion dollars be to the bottom line for America’s hospitals? How much of their income would they be losing?

Dollar For’s answer: zero point seven percent.

Jared Walker: Like, this is like a fraction of, a fraction of what these hospitals bring in.

Dan: Not all hospitals, as Jared is quick to note.

Jared Walker: Like, there’s, you know, 8,000 hospitals in America and they’re not all equal. There are big hospitals, there are small hospitals. Obviously, it’s very hard to, you know, generalize these things.

Dan: Like we’ve talked about here before: Some hospitals really ARE on the verge of going under. And some have profit margins of more than thirty percent. And there’s everything in between.

But here’s the number that really jumped out at me from that Dollar For report. It’s not just the amount of charity care that hospitals withhold is basically tiny compared to their overall revenue.

The total amount of income hospitals get directly from patients’ pockets — all the bills I hear about on this show, and that we all know are out there, the bills that drive people into debt, into bankruptcy…

All of that money, all of that suffering represents just 2.5% of what hospitals get paid for care, according to KFF data that Dollar For cites Two point five percent.

I don’t have a really deep insight here, but this number jolts me back to awareness of how big this health-care industrial complex is. And how much its dysfunction costs our whole society.

Like, zoom out. We spent five TRILLION dollars a year on this stuff — and so many people still don’t get the health care they need.

It reminds me that — along with understanding ways we can help ourselves and each other — individual, day-to-day ways — it’s important to understand why health care costs so freaking much. Where all that money goes, what we can maybe do about it.

Meanwhile, back to Jared and how he sees things going in 2026.

Jared Walker: Health care is going to get worse. Health care is going to be more unaffordable than it was. Health care is going to put more people into bankruptcy, more people into a bad financial situation.

Dan: Which makes the need for Dollar For’s work more obvious. Dollar For isn’t in danger of going away.

But all of the rapid change in the last year — the accomplishments and the setbacks — has Jared thinking hard about how to keep moving forward over the long haul.

Jared Walker: Dollar For has just been so scrappy. We’ve just been so scrappy, you know. I don’t want to be the, you know, the unpaid intern organization that’s just like, you know, burning everybody out. I want to be able to pay people well. I wanna be able to provide incredible healthcare benefits. I wanna be able to have a 401k match. Like, I want people to thrive at Dollar For.

Dan: That’s how you make sure people can stick around and keep growing, and figuring out how to make the biggest impact in a wild environment.

As we wound up our conversation, I wanted to tell Jared about how An Arm and a Leg’s 2025 had gone. Partly because I thought it might cheer him up a little bit.

So I told him about how a medical student named Thomas Sanford had put together a resource guide for patients based on our reporting, and started handing it out. How other listeners had been helping refine it.

How we’d put a version on our website — prompted by Thomas’s idea that health care workers could decorate the “badge reels” on their lanyards with a QR code patients could scan.

Jared Walker: Yeah. Putting it on the lanyard. I love it. And it is just something that we need more of is like, how do we empower the patient and the healthcare worker and the people that are, you know, up to fight it.

Dan: That’s it right there. The place we’re in right now — just with health care, the big picture can look really scary. Trying to take on the whole thing — heck, just trying to take in the whole thing, the big picture– it’s a lot.

And it doesn’t mean we stop trying. But we’re not individually responsible for fixing the whole thing right away. And we can find things to do — ways to help ourselves and each other IN THE MEANTIME.

Like by using the kinds of things we learn here to take a little more control over our own lives — and helping other people take control over theirs.

We spent a lot of the last couple of months asking you to help us keep doing our work– and you really came through. A lot of you included notes with your donations, incredible, heartening notes.

I’m gonna share one here — we actually shared it in the First Aid Kit newsletter last week — but I’m repeating it because it illustrates something:

“This amount, $85.23, is the amount I avoided paying because you taught me how to take notes when speaking to my insurance company, always getting the name of the representative and the call reference number.”

And here’s what I take from that: Every time any of us gets back a little capacity — saves a little money, saves some worry — from a system that threatens to overwhelm us…

That’s capacity we can put to use. To nourish ourselves and each other. To bank some new strength. And things that seem small — saving 85 dollars. Telling someone about Dollar For and helping them connect to charity care. There’s no way to know if they’ll add up to ENOUGH to move ourselves toward the structural change we need. But every bit truly does count.

So: Thank you again. For listening. For sharing what you know — I learned about Dollar For because listeners to this show saw Jared’s TikTok and made sure to tell me about it. And for doing what you can for yourself, and your family, and the people around you.

We’ll have a new episode for you in a few weeks.

Till then, take care of yourself.

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

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions.

Claire Davenport is our engagement producer.

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

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

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

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

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

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

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

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

[Names redacted for web transcript.]

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

For more from the team at “An Arm and a Leg,” subscribe to its weekly newsletter, First Aid Kit. You can also follow the show on Facebook, Instagram, LinkedIn, and Bluesky. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all KFF Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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Céline Gounder, KFF Health News’ editor-at-large for public health, discussed a year of changes at the Department of Health and Human Services and its Centers for Disease Control and Prevention on NPR’s 1A on Jan. 22. On CBS News 24/7’s The Daily Report on Jan. 16 and CBS Saturday Morning’s HealthWatch on Jan. 17, Gounder also discussed a study that found no link between acetaminophen use during pregnancy and autism or attention-deficit/hyperactivity disorder. She also commented on rising measles cases and decreasing vaccination rates on CBS News 24/7’s The Daily Report on Jan. 15.

KFF Health News California correspondent Christine Mai-Duc discussed the expiration of enhanced Affordable Care Act subsidies on LAist’s AirTalk on Jan. 20.

Click here to hear Mai-Duc on AirTalk (begins ~18:00).

KFF Health News chief rural correspondent Sarah Jane Tribble discussed the new Rural Health Transformation Program on Community Health Center Inc.’s Conversations on Health Care on Jan. 8.

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These 3 Policy Moves Are Likely To Change Health Care for Older People

Month after month, Patricia Hunter and other members of the Nursing Home Reform Coalition logged onto video calls with congressional representatives, seeking support for a proposed federal rule setting minimum staff levels for nursing homes.

Finally, after decades of advocacy, the Biden administration in 2023 tackled the problem of perennial understaffing of long-term care facilities. Officials backed a Medicare regulation that would mandate at least 3.48 hours of care from nurses and aides per resident, per day, and would require a registered nurse on-site 24 hours a day, seven days a week.

The mandated hours were lower than supporters hoped for, said Hunter, who directs Washington state’s long-term care ombudsman program. But “I’m a pragmatic person, so I thought, this is a good start,” she said. “It would be helpful, for enforcement, to have a federal law.”

In 2024, when the Centers for Medicare & Medicaid Services adopted the standards, advocates celebrated. But industry lawsuits soon blocked most of the rule, with two federal district courts finding that Medicare had exceeded its regulatory authority.

And after the 2024 elections, Hunter said, “I was concerned about the changing of the guard.” Her concerns proved well founded.

In July, as part of Republicans’ One Big Beautiful Bill Act, Congress prohibited Medicare from implementing the staffing standards before 2034. Last month, CMS repealed the standards altogether. They never took effect.

“It was devastating,” Hunter said.

As with environmental law and consumer protections, the Trump administration’s enthusiasm for deregulation has undone long-sought rules to improve care for the aged. And it has introduced a Medicare experiment for prior authorizations, now getting underway in six states, that has alarmed advocates, congressional Democrats, and a good number of older Americans.

Taken together, the moves will affect many of the facilities and workers providing care and introduce complications in health coverage in several states.

On the nursing home front, “it’s clear CMS has no interest in ensuring adequate staffing,” said Sam Brooks, the director of public policy for the National Consumer Voice for Quality Long-Term Care.

“They’re repealing a regulation that could have saved 13,000 lives a year,” he added, citing an analysis by University of Pennsylvania researchers.

Industry groups argued that nursing homes, with high rates of staff turnover, were already struggling to fill vacancies.

The staffing mandate “was requiring nursing homes to hire an additional 100,000 caregivers that simply don’t exist,” said Holly Harmon, a senior vice president at the American Health Care Association.

The organization had brought one of the suits that largely vacated the rule. “Facilities would have been forced to limit admissions or downsize to comply with the requirements, or close altogether,” Harmon said.

For supporters, the action is now likely to shift to updating requirements in 35 states, along with the District of Columbia, that have already established some nursing home staff standards, and to developing them in those that haven’t.

Rules for Home Help

A second rescinded regulation, this one more unexpected, brought about upheaval in July, when the Labor Department announced a return to a policy excluding home care workers from the federal Fair Labor Standards Act.

Some history: Dating back to the New Deal, the FLSA mandated that workers receive the federal minimum wage (currently $7.25 an hour) and overtime pay. It exempted most “domestic service workers” until 1975, when a new Labor Department regulation included them — with the exception of home care workers.

“There was a misinterpretation of home care work as being casual, nonprofessional, non-skilled,” the equivalent of teenage babysitting, said Kezia Scales, a vice president at PHI, a national research and advocacy organization. “Just someone popping into your mother’s house now and then and keeping her company.”

For almost 40 years, workers and their supporters lobbied to change the rule, seeing it as a contributor to the low wages and meager benefits of a swiftly growing workforce, one made up primarily of women and minority groups, with many immigrants.

In 2013, the Labor Department responded with a rule that brought home care workers under the labor act, entitled to minimum wage, time and a half for overtime work, and payment for travel time between clients.

After industry lawsuits failed to overturn it, “everything settled down,” Scales said. “It was in place successfully for a decade.”

Home care workers brought hundreds of compliance complaints annually. In 87% of them, the Labor Department found violations of the labor act, according to a 2020 Government Accountability Office report.

Since 2013, home care agencies have paid about $158 million in back wages, PHI has calculated.

Then in July, the Labor Department abruptly announced that it would return to the 1975 regulations and stop enforcing the 2013 rule, which it said “had negative effects on the ground” and hindered consumer access to care.

The agencies employing most home care workers, primarily funded through Medicaid, would agree. “Many workers never got any benefit from this,” said Damon Terzaghi, a vice president at the National Alliance for Care at Home.

“States made a lot of moves to essentially absolve themselves of any responsibility,” he said. A 2020 federal report, for example, found that 16 states had capped Medicaid-covered home care hours at 40, thus averting overtime payment.

The alliance, which estimates that the number of impacted agencies and businesses has declined by 30% since 2013, supported the rescission. Scales, who hopes for congressional action, called it “a shocking step backward.”

Where they concur is that the United States has never really committed to sufficiently funding long-term care at home. With the July legislation setting the stage for a $914 billion cut to Medicaid over the coming decade, that seems unlikely to change anytime soon.

Medicare’s AI Referee

Beyond rolling back policies for care of the aged, the Trump administration has established a pilot program to introduce one to traditional Medicare: prior authorization, using artificial intelligence and machine learning technologies.

Touting it as a boon to taxpayers, Medicare calls it WISeR — Wasteful and Inappropriate Service Reduction.

Prior authorization, in which private insurers review proposed treatments before agreeing to pay for them, is widely used in Medicare Advantage plans despite its unpopularity with patients, doctors, and health care organizations. It has rarely been used in traditional Medicare.

This month, however, WISeR debuts in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, Washington) in a six-year trial to determine whether review by tech companies can reduce costs and improve efficiency, while maintaining or improving quality of care.

Initially, WISeR targets 17 items and services that CMS said “historically have had a higher risk of waste, fraud and abuse.” The list includes knee arthroscopy for arthritis, electrical nerve stimulation devices for several conditions, and treatment for impotence.

The pilot program excludes emergency services and inpatient hospital care, or care where delay poses “a substantial risk.” Algorithmic denials will trigger review by “an appropriately licensed human clinician.” The tech companies get “a share of averted expenditures.”

“It injects some of the worst of Medicare Advantage into traditional Medicare,” said David Lipschutz, co-director of the Center for Medicare Advocacy. The six vendors that approve or reject treatments “have a financial stake in the outcomes,” he said, and therefore “an incentive to deny care.”

Moreover, the CMS Innovation Center overseeing the pilot could theoretically bypass Congress and expand prior authorization to include more medical services in more states.

The agency did not respond to questions about what kind of human clinicians would review denials, except to say that they would have “relevant experience” and that tech companies would be “financially penalized for inappropriate denials, high appeal rates or poor performance.”

It plans an “independent, federally funded evaluation” and will release public reports annually.

Democrats in Congress have introduced bills in both houses to repeal WISeR. “We should be reducing red tape in Medicare, not creating new hurdles that second-guess health care providers,” said Rep. Suzan DelBene of Washington, one of the bill’s sponsors.

For now, though, WISeR has opened for business, receiving prior authorization requests through its electronic portals.

“The New Old Age” is produced through a partnership with The New York Times.

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