As enrollment for Medicare Advantage begins this month, older Americans are confronting fewer options because insurers are discontinuing coverage in many areas.
New details have emerged about an initiative that starts in December to fast-track the vaccines, similar to the successful push for the Covid-19 vaccine.
A cadre of elite techies, financiers, and high-level Trump administration officials have spent a year quietly charting an extraordinary and rapid campaign to persuade Americans to use apps and other artificial intelligence-powered tools to manage their healthcare and medical records.
As that campaign has unfolded, administration officials have granted tech companies an unusual opportunity to nudge the nation’s health department toward a loosely regulated future for AI health apps in which the government reimburses them for services as it does medical professionals.
In February, federal health officials invited those businesses — including tech giants Microsoft, Anthropic, OpenAI, Apple, and Google — to a listening session on conversational AI products for patients, such as chatbots. Representatives from at least 35 industry organizations attended the meeting held by the Food and Drug Administration, which is responsible for regulating health apps as medical devices. Companies were prompted in advance to explain their AI products and how they access patients’ sensitive medical information.
But the meeting did not appear on the FDA’s public calendar or regulatory notices, nor was the public invited. Rather, the invitation for a select group to help shape federal policy governing AI in healthcare was extended in a chat room on the messaging service Slack.
“This is a great opportunity to support HHS’ goals and share your state-of-the-art understanding of safe Conversational AI development and monitoring to help FDA shape future guidance,” CMS senior policy adviser Morgan Taylor wrote in the Slack workspace.
The Centers for Medicare & Medicaid Services has not formally announced the chat room through federal regulatory channels, though CMS officials have talked about it at industry conferences. Legal experts said the chat room resembles a federal advisory panel, which would be required to operate in public view.
KFF Health News reviewed thousands of Slack messages, meeting transcripts, and video recordings that reveal how the Trump administration has granted the industry a direct line to top government officials — including former head of the Department of Government Efficiency Amy Gleason.
The conversation took place behind the scenes as federal health officials publicly worked to integrate AI and other technology into nearly every aspect of healthcare, a plan they’ve branded the “Health Technology Ecosystem.”
“We wanted to give industry a chance to play in the sandbox of government-supported healthcare,” CMS Administrator Mehmet Oz said in September at the public launch of an initiative that allows health apps to bill Medicare for AI services such as wearable device tracking. Last week, Health and Human Services Secretary Robert F. Kennedy Jr. delivered an enthusiastic endorsement of AI in healthcare, claiming it is “much better informed than any doctor in the country.”
Meanwhile, HHS staff even promised that a recently launched Medicare App Library would serve as a lucrative pipeline for those businesses to get new users. The library’s webpage currently promotes only two dozen commercial apps to millions of American seniors and those with disabilities.
As Trump officials sell it, Americans will get easier access to their medical records so apps can swiftly provide health or wellness advice. In practice, however, so will the tech companies.
Doctors, meanwhile, are increasingly worried about how patients use and share their medical records with the nascent technology.
“Some of these tools just aren’t ready for primetime,” said John Whyte, CEO of the American Medical Association. “We don’t have enough data about them. We don’t understand how they work, how they’re using the information. There’s no liability if these tools get things wrong.”
CMS officials declined to answer several questions about the Slack workspace, including about its legality.
“CMS is focused on giving Medicare beneficiaries greater access to their health information and useful digital tools while promoting an open, interoperable healthcare system,” Gleason, now chief product officer for the newly created Office of Health Technology and Products at CMS, wrote in an emailed statement. “The Health Technology Ecosystem is an open, voluntary technical collaboration. CMS will continue working with patients, providers, payers, technology organizations, and other stakeholders to make health information more accessible and useful to the Americans it serves.”
The FDA did not respond to a request for comment.
The Conversation Begins
The behind-the-scenes effort to funnel more Americans to AI-powered health apps began in August 2025 in the Slack workspace.
“Welcome all!” Gleason wrote. “Please be sure to read the Code of Conduct and see the Channel list as well to help you find channels that are relevant to you.”
Gleason is best known for serving as the acting administrator of Elon Musk’s Department of Government Efficiency, as it gained access to millions of Americans’ sensitive personal and financial data, including at the Social Security Administration.
As her work with DOGE wound down last year, Gleason welcomed a variety of tech leaders, investors, and entrepreneurs to the chat room.
The Slack workspace’s participants include representatives from major digital wellness companies like Oura Health, AI companies like Palantir, and investment outfits like 8VC, a venture capital firm associated with Kennedy’s son Finn. While the Slack’s member count has ballooned to 1,700 over the past year, only a handful of patient advocates, doctors, and hospital representatives are in it.
The code of conduct Gleason shared on Slack in August 2025 documented that CMS had quietly established a technology working group.
Documents have been reproduced from the CMS Health Tech Ecosystem Slack and highlighted by KFF Health News.
The document also set ground rules for the Slack workspace, noting that the group does not constitute an “advisory committee,” nor would it be used “to obtain advice or recommendations for HHS, CMS, or any HHS/CMS officials.” The code also advises that federal employees “are prohibited from endorsing any product, service, or enterprise.”
Joseph Daval, a former FDA lawyer who is now a research specialist at Harvard Medical School, reviewed messages from the Slack workspace at the request of KFF Health News. He said the chat room in some ways resembles a federal advisory committee — an independent panel that can be formally stood up by an agency head, Congress, or the president to ensure agencies act in the best interest of the public rather than industry.
The law on advisory committees “was passed in part out of a concern about interest group capture, about anticompetitive capture of agency policymaking, about corruption,” he said.
Daval said the chat group looks like a committee, with members interacting with one another and building consensus on preferred courses of action.
If it were a formal advisory committee, though, Daval said, it would be subject to certain “membership requirements having to do with independence and fair balance.”
A ‘Sales Engine’
Over a series of video calls, CMS officials promised tech leaders participating in the Slack workspace that the agency would promote their health apps.
Jacob Shiff, the chief AI and technology officer at CMS’ Innovation Center, told industry representatives in a Zoom meeting in February that he hoped the agency’s work would be a “sales engine” for the health apps.
“We’re going to have a directory of all the organizations,” Shiff said in a video recording reviewed by KFF Health News. “The people on this call who hopefully will have amazing solutions that work will be the winners, and you have every incentive to obviously drive down your costs so you can be extremely profitable and scale. So hopefully we’re selling — or enabling you guys to thrive.”
A recording of the call had been publicly available through a Google Drive link but was made private the day after KFF Health News asked about comments made during the meeting.
CMS did not respond to queries about how the agency has decided which AI-powered health apps appear in the Medicare App Library or why federal employees have promised to promote the products.
Days before publicly launching the Medicare App Library, CMS officials promised AI tech leaders during an informal meeting that the new webpage would become an important distribution channel for health apps because Medicare enrollees would place trust in products listed on the CMS website.
“If medicare.gov is promoting it, for lack of a better word, then yeah, it would be an app that I would trust and explore,” CMS’ Taylor said during the April 7 meeting, channeling enrollees, according to a transcript of the call.
The Medicare App Library’s webpage encourages older and disabled Americans to manage health conditions such as obesity, cancer, or diabetes using two dozen AI-driven apps developed by some of the world’s largest corporations, including Microsoft and Google. Many of the apps promise in their product descriptions to give insight, perform analyses, or develop plans that will help patients lose weight or manage diabetes.
CMS officials have suggested to tech representatives during at least two meetings this year that those apps will be prioritized for a new agency program that reimburses companies for AI chatbot advice or wearable device tracking, according to video recordings.
CMS has not publicly divulged all the criteria it uses to decide which apps are listed in its library, but the webpage promotes apps still in their infancy.
Among them is Slothwise, a health app launched this year from a San Francisco apartment by a young, self-described biotech entrepreneur and triple citizen of Russia, Israel, and the U.S. The app says it “knows your whole health” by analyzing medical records and tracking health data for $9.99 a month. It has been reviewed on the Apple and Google app stores only a handful of times.
“I trusted slothwise with my health info because it was endorsed by medicare,” one reviewer wrote in a Google review in August. “Connecting info was smooth and I learned a lot about my health.”
In a statement, Slothwise CEO Sofia Sigal-Passeck did not answer questions about the size and medical expertise of her current team, nor about the availability of a doctor to consult with patients who use the app. The app, she said, is only “informational” at this time.
“I’ve spent years building at the intersection of AI and complex biological data,” Sigal-Passeck wrote in an email. “A small team is not the same thing as an inexperienced team. Slothwise is built by physicians, PhD researchers and engineers.”
‘No Regulation, No Rulemaking’
What’s often less clear — and buried deep in lengthy privacy policies — is that these apps are tapping into the intimate details of patients’ medical records to fuel their AI-driven analyses.
Tech vendors have lobbied the government to treat these apps, once they are vetted and authorized by a third-party organization, like a patient requesting records. That position gives apps sweeping access to pull sensitive health data from the national network through which providers electronically exchange medical records, called the Trusted Exchange Framework and Common Agreement, or TEFCA.
A small but influential group of those tech company executives directly made the case to federal health officials during a formal meeting in May, arguing that when health apps request medical records they should be treated as if they are standing “in the shoes” of a patient.
On Slack, tech vendors have lobbied for a “frictionless pathway” for verified users, after they’ve consented once, that allows the app to gain limitless access to patients’ medical records from the TEFCA network.
Ryan Howells, a healthcare management consultant who lobbies for a Washington, D.C.-based digital health tech organization called the CARIN Alliance, has spearheaded an effort for patients — vis-à-vis apps — to more easily access medical records. He has regularly noted in Slack that health apps accessing TEFCA must be vetted by a third-party organization — one of which he sits on the board of — and agree to a code of conduct, developed by the alliance he lobbies for.
“What more can you do to have trust in these apps?” he wrote in a March Slack message, responding to concerns about how much patient consent is needed for apps to access medical records on the network.
Kristen Valdes, the CEO of b.well, a company that also connects apps to the TEFCA network, made a similar argument.
“My opinion is that we need to stop protecting patients from themselves,” she wrote in the same message thread. “Full stop.”
Howells did not respond to an emailed list of questions from KFF Health News. In an interview, Valdes told KFF Health News that her comment reflected her frustration at the “paternalism” of the healthcare system, which she said has historically made it difficult for patients to access their records. Although, she said, “there are going to be good and bad apps.”
Other tech leaders worried in Slack about the approach.
One startup founder cautioned the group to think about the pitfalls of giving health apps broad leeway to pull medical records.
“We might all be good, honest actors here but security & privacy systems have to be designed around the presence of malicious actors – especially if we want this system to scale up to thousands of apps,” wrote Jason Kulatunga, who runs Fasten Health, a medical records management platform.
Gleason, the CMS official, has publicly championed the vision shared by Howells and Valdes. In her speeches, she frequently urges doctors to accept patient medical records directly from apps and calls on them to “Kill the Clipboard,” also the title of a 2025 white paper co-authored by Howells that urges doctors’ offices to abandon paper records.
Last month, Gleason spoke to a crowd gathered at a swanky hotel in Washington for an event hosted by the MAHA Institute, a think tank that supports Secretary Kennedy’s agenda. She laid out her work with tech companies over the past year as she discussed the Trump administration’s efforts to make medical records more digitally accessible.
As she told it, more Americans can now download an app and access their medical records.
“Once you’ve verified your identity you can just click a simple button and say, I’d like my medical records into whatever app I choose,” Gleason said.
She continued: “That was all done just — no regulation, no rulemaking — just by challenging industry to work together.”
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.
CHATHAM COUNTY, N.C. — Despite being in one of the nation’s fastest-growing states, this rural county of roughly 85,000 people is still brimming with red foxes, coyotes, white-tailed deer, and wild turkeys.
But in recent months, Enbridge Gas North Carolina’s proposed plans for a natural gas pipeline have exposed how population growth, here and across the nation, is driving a divide between wealthy newcomers and longtime residents.
Chatham has grown into one of North Carolina’s most affluent counties, fueled by an influx of new residents in its northeastern corner. Yet the pipeline would run from Moncure to Siler City, two communities where the per capita income is roughly $25,000 a year, or about half the income typical for the region.
And it’s raising familiar concerns. A 2020 report from the Chatham County Public Health Department stated that “unjust, unfair, and uneven distribution of social and economic resources” in the county, including exposure to environmental hazards, limited people’s “ability to achieve optimal health.”
In September, the Chatham County Board of Commissioners unanimously voted to oppose the project, saying that “protecting public health, safety, environmental resources, and private property rights remains a priority.” The resolution states that the proposed pipeline could affect areas occupied by vulnerable, low-income residents. Under state law, Enbridge could still attempt to take land through eminent domain, and low-income communities affected would have fewer resources available to fight back.
The state Department of Environmental Quality typically would review applications for permits to build a natural gas pipeline. That department has not yet received a permit application for the pipeline, said Onotse Omoyeni, senior press secretary for the office of Gov. Josh Stein. The North Carolina Utilities Commission declined to comment.
Enbridge says the 12-inch-diameter pipeline is needed to meet growing energy demands in the area, including Chatham, where the population has soared 21% since 2016, as well as neighboring Lee County.
Yet the proposed pipeline has set off protests at public meetings and attracted hundreds of people to a Facebook group to express their opposition, many of them small farmers, retirees, or their relatives. They argue the pipeline would pose an environmental threat to wells used for drinking water and expose people in less affluent areas to toxic pollutants that could increase the risks of cancer, preterm births, and asthma — all for the benefit of people who live nowhere near the proposed route.
“Nobody wants to be next to a pipeline,” Dorasue Burns Christian, a retired dental hygienist, told KFF Health News. She said the proposed route cuts across the roughly 22-acre farm where she has lived for more than 50 years. “I’m stressed and I can’t sleep at night. I have been pushed as far as I can be pushed.”
Enbridge Gas North Carolina is a subsidiary of the Canadian energy company Enbridge. Residents point to other communities in which Enbridge has operated — such as Marshall, Michigan; Romeoville, Illinois; and Danville, Kentucky — where oil spills and a natural gas pipeline rupture led to evacuations, injuries, and at least one death.
Enbridge declined an interview request to answer questions about the location of the North Carolina pipeline and the company’s safety record. In a statement, spokesperson Persida Montanez said the pipeline is needed to accommodate population and business growth in Chatham and neighboring Lee County.
A company website says safety will be prioritized during construction and operation, including monitoring, maintenance, and compliance with regulatory rules.
Many residents believe the company is attempting to profit from a proposed data center, which many also oppose. The company website says that Enbridge does not intend to use the pipeline for that purpose and that serving a data center would require a pipeline at least twice the size of the one planned for Chatham.
The pipeline would connect to existing natural gas infrastructure in Siler City and near Moncure, the company said.
Still, pipeline opponents say they are fed up.
“They chose this route because they probably thought people would not fight back,” said Amanda Clark, a protest organizer who grew up in Chatham. Her family roots in the county date to the 1700s. “In rural communities, we are seen as disposable.”
Research shows natural gas pipeline leaks are concentrated in low-income and minority communities where people experience higher rates of poverty and physical disabilities and have fewer means to respond to crises.
Nationwide, there were nearly 2,600 pipeline incidents from 2010 to 2021 that were serious enough that they were required to be reported to the federal government, including fires and explosions that killed 122 people and injured more than 600.
In 2019, one person died and six were injured in Kentucky when an Enbridge natural gas pipeline ruptured, according to a federal government report.
Enbridge reached a $177 million settlement with the federal government after the 2010 oil spills in Michigan and Illinois. In the Michigan spill, a pipeline discharged 1 million gallons of oil into Talmadge Creek, in one of the largest inland oil spills in U.S. history.
“No Pipeline. No Compromise,” read the red T-shirts worn by some of the more than 300 people who attended a Chatham County Board of Commissioners meeting in Pittsboro, North Carolina, in early August. Outside the building, they displayed signs that said “People NOT Pipelines” and “Save Our Farms.”
More than 300 people attended a Chatham County Board of Commissioners meeting in Pittsboro, North Carolina, in early August, many wearing T-shirts to protest a proposed natural gas pipeline. Speakers said they feared the pipeline would pose an environmental threat to the community, including to farms, waterways, and wildlife. (Fred Clasen-Kelly/KFF Health News)
Under North Carolina law, private utilities and pipeline companies can obtain property easements, which give them the right of way to construct, operate, and maintain pipelines without outright taking ownership.
Enbridge will propose the final route for the pipeline based on field surveys, environmental studies, and engineering analysis, Montanez said. “The utility is also focused on delivering safe, reliable natural gas service that supports long-term economic vitality,” Montanez said.
Some residents, like Clark, argue that while the pipeline would power more housing and business development in wealthier parts of Chatham, it would create a public health risk in rural, poorer areas.
Clark, who works as the drug and injury prevention manager for the public health office in nearby Guilford County, said her great-grandparents were full-time farmers and passed down land near Siler City where her grandparents, dad, aunt, and cousin live.
Her grandfather retired from a hosiery mill and farmed part-time. He gave land to his children when they married, Clark said, because it was the only major asset he owned.
Clark said she is now in line to inherit land from her family and wants to protect the legacy of people who worked as farmers, mechanics, and schoolteachers from profit-taking by a company.
“We’re the collateral damage,” Clark said. “It makes people feel like they don’t have value.”
Enbridge Gas has promised to prioritize safety during the construction and operation of a proposed natural gas pipeline in Chatham County, North Carolina. But residents point to other communities in which Enbridge has operated — in Michigan, Illinois, and Kentucky — where government reports say oil spills and a natural gas pipeline rupture led to evacuations, injuries, and at least one death. (Fred Clasen-Kelly/KFF Health News)
A Class Divide
Northern Chatham — which is an easy drive from major universities and Research Triangle Park, home to more than 250 companies — has seen a rush of newcomers.
Many have settled into places like Fearrington Village, a community with boutique shops, gardens, and homes that can cost nearly $1 million. Another master-planned community nearby, Chatham Park, is expected to bring up to tens of thousands of new residents over the next 20 years.
Not far outside the county’s borders are Chapel Hill, home to the University of North Carolina; the state capital of Raleigh, home to North Carolina State University; and Durham, home to Duke University.
As those places have grown more crowded, Chatham has become a cheaper alternative.
But prosperity is fleeting in many parts of the county. A quarter of residents are considered low-income, and on average there are 24 candidates for every job opening, according to a report released this year by the NC Budget and Tax Center.
Christian, an 85-year-old widow who lives a few miles south of Pittsboro, spends her days on her farm, raising hay and caring for chickens, birds, dogs, and cats. She has received letters from Enbridge saying the company wants to survey her property, where she lives with her 66-year-old son, who has a disability.
Christian said she needs money to care for her son and worries that she may one day need to move to a nursing home because of declining health. She said she has been diagnosed with macular degeneration, an eye disease that blurs straight-ahead vision, making it difficult to recognize faces or read.
She had planned to make ends meet by selling multiple parcels of land, but she said potential buyers backed out once they heard about the pipeline. At the Board of Commissioners meeting in August, she pleaded for local officials to try to stop Enbridge.
“They should be ashamed of themselves,” she told KFF Health News. “It’s disheartening. They are stealing from poor people.”
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.
LOS ANGELES — Every Tuesday, Naman Shah sees tuberculosis patients at a small public clinic in Los Angeles’ San Fernando Valley. Shah, a physician and epidemiologist at the Los Angeles County Department of Public Health, pores over images of battered lungs, listens to labored breathing, and checks medications.
It’s part of an initiative dating to the early 20th century to control infections so tuberculosis doesn’t spread. “We like doing things upstream,” Shah said, “meaning before they happen, not after the damage is done.”
Today, Shah and his colleagues are applying the same principle to medical debt. A key part of that effort is a new system to allow every hospital in Los Angeles County to easily screen patients for financial aid. The goal: to stop low-income families from getting a bill that buries them in debt.
Shah estimates this system could prevent several hundred million dollars of medical debt every year.
Vicious Cycle
Nationwide, an estimated 100 million adults have some form of healthcare debt. In Los Angeles County, the nation’s most populous, public health officials calculate that about 800,000 residents have medical bills they can’t pay.
“The impacts of medical debt were staggering,” said Shah, who used to staff a rural health clinic in India and, since 2023, has led a county initiative in Los Angeles to tackle the debt problem.
“People end up with credit card debt and then a vicious cycle of high interest rates and poverty,” he said. “People forgo their prescriptions. People forgo appointments. And then you get into worse health.”
Hospitals typically offer financial aid to patients with low incomes. But information about assistance is often hard for patients to get. Applying can be cumbersome. And many eligible patients never seek aid, research shows.
“Most people walk into the hospital and walk out without any knowledge of financial assistance,” said Jared Walker, founder of Dollar For, a nonprofit that helps patients nationwide apply for aid, often called charity care.
That’s fueling debt. It’s also driving costly collection efforts that even hospital officials acknowledge pointlessly target low-income patients who are unlikely to be able to pay.
“They’re turning their wheels trying to collect on debt that isn’t collectable,” said Adena Tessler, regional vice president for the Hospital Association of Southern California.
Naman Shah examines a patient at Monrovia Health Center, a Los Angeles County public health clinic in Monrovia, California. Shah says reducing medical debt in the community will depend on effective prevention strategies, just as stopping the spread of infectious disease does. (Lauren Justice for KFF Health News and Tradeoffs)
(Lauren Justice for KFF Health News and Tradeoffs)
(Lauren Justice for KFF Health News and Tradeoffs)
Presumptive Eligibility
One potential solution is a system that automatically screens and qualifies low-income patients for financial aid without requiring an application. This is called presumptive eligibility.
Some hospitals already use such systems, which rely on software that checks patient eligibility based on publicly available information such as credit history.
The strategy can be very effective. Shah said hospitals that have deployed presumptive eligibility systems have reported as much as a 50% increase in the amount of financial aid they give patients.
Under a state law passed last year, all California hospitals will have to start doing presumptive eligibility screening by next July.
But the systems can be expensive and difficult for smaller hospitals to implement. Only about 1 in 5 hospitals in Los Angeles County currently use them, Shah said.
Public health officials wondered if they could help more hospitals set them up.
The county, which, like many local governments, faces major fiscal challenges, couldn’t pay for this, Shah said. But the public health department could bring together healthcare and hospital officials in the county to figure out another solution.
“The beauty of government is not when it always has to do the work,” Shah said. “We have the ability to make sure that people cooperate.”
The Hospital Association of Southern California, initially wary of the county initiative, came to see improving hospital financial aid programs as beneficial to hospitals, many of which were wasting money on collections. “The billing process is cumbersome and costly,” said Paul Young, a senior vice president with the association.
The association agreed to procure a presumptive eligibility system and make it available to its members. This bulk-purchasing approach, which Young compared to “a Costco model,” would lower the cost for individual hospitals, he said.
At the same time, L.A. Care, a nonprofit health plan that administers Medicaid coverage for more than 2.5 million low-income county residents, committed $2 million to set up the system.
The investment reflected the safety net insurer’s mission to make medical care accessible to more people, said Melanie Fontes Rainer, who leads strategic planning for L.A. Care. “It’s going to make Los Angeles County better,” she said.
Making It Work
Getting the new system up and running by January, as the partners hope, faces challenges.
Hospital officials are figuring out how the system will be funded in the long term. And it’s unclear how many of the county’s 88 acute care hospitals will ultimately use it, even if it’s cheaper and easier to access.
The partners are also working to improve data that the system relies on to screen patients. One goal is to link the system to tax records maintained by the state of California. This would provide hospitals with more accurate information on patients’ income than current systems, which often rely on estimated income.
Walker, the patient advocate at Dollar For, said he’s heartened by the county’s effort. “I’m optimistic that we can make a better charity care system,” he said. “And the fact that hospitals in Los Angeles County are willing to be innovative and creative about ways we can do that is super encouraging.”
For his part, Shah said county public health officials recognize that a better screening system at hospitals won’t by itself eliminate medical debt. But he said the public health department couldn’t ignore a problem that affects more county residents than asthma or tobacco use.
“Prevention is our bread and butter,” he said.
“The impacts of medical debt were staggering,” says Naman Shah, who since 2023 has led a Los Angeles County initiative to tackle the debt problem. (Lauren Justice for KFF Health News and Tradeoffs)
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.
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.
The microbiome isn’t what it used to be in many parts of the world. The shift of species may be affecting the well-being of people in industrialized countries.
After President Donald Trump signed the One Big Beautiful Bill Act more than a year ago, enrollment in the federal food assistance program dropped rapidly across the nation as states enforced new restrictions and prepared to take on more of the costs.
Nationally, an estimated 5 million, or 13%, fewer people were enrolled in the Supplemental Nutrition Assistance Program, also known as SNAP or food stamps, this June than in July 2025, when the law was enacted. Louisiana saw one of the most precipitous declines, dropping about 170,000 people, or 21% of state enrollees, according to federal data.
“We haven’t seen a decline of this magnitude in about three decades,” said Joseph Llobrera, senior director of research on food assistance at the left-leaning Center on Budget and Policy Priorities, which did the analysis.
Meanwhile, food prices rose nearly 3% from August 2025 to this August, according to the U.S. Department of Agriculture.
Elected officials, policy analysts, and anti-hunger advocates are pressing Congress to delay provisions in the law that will cut federal funding for food benefits and steeply increase the cost for states. They want to insert the delay in the Farm Bill, which is pending in the Senate.
The provisions required states to start paying for 75% of the cost to operate SNAP on Oct. 1. Previously, the USDA and states split SNAP’s administration cost 50-50.
Beginning in October 2027, some states may also have to cover part of the cost of SNAP benefits that had been paid fully by the federal government. The amount that a state pays toward benefits will depend on its payment error rate, or how often it underpays or overpays enrollees. The higher the error rate, the higher the state’s share of SNAP benefit costs.
In Louisiana, the state may have to cover up to $199 million of the cost for benefits, according to an analysis by the Food Research & Action Center. Its error rate increased from 6.62% in fiscal year 2024 to 8.14% in FY 2025, the most recent data available.
Many states, including Louisiana, have placed pressure on applicants to submit more information more often to verify their eligibility to reduce the state’s payment error rate and limit how much the cost of benefits shifts to the state.
“It’s been a race to drive down those error rates,” Llobrera said.
He said the challenge of implementing new program restrictions and requiring more documentation has increased the burden on applicants and state agencies. The agencies have to process more paperwork on a tight timeline without enough staff. This can increase the likelihood of errors when processing applications, potentially leading to rejection of benefits for more people. It’s also harder for applicants to meet additional verification requirements.
The One Big Beautiful Bill Act expanded work requirements for SNAP, made it harder for states to waive the work requirements, and revoked access for many noncitizens with legal status.
The Louisiana Department of Health did not respond to requests for comment.
Tia Fields, the safety net policy analyst for the nonpartisan Invest in Louisiana think tank, said the cost increase to the state has contributed to two crises: a projected shortfall in the state budget and eligible families’ losing access to help.
In Louisiana, state data shows that 75% of people who lost SNAP from July 2025 to June 2026 did so for procedural reasons. When the program’s strict deadlines for documentation and verification aren’t met, applications and renewals are closed.
Tia Fields, a policy analyst for the nonpartisan Invest in Louisiana think tank, says covering federal cuts to the Supplemental Nutrition Assistance Program will contribute to a shortfall in Louisiana’s state budget. One Big Beautiful Bill Act restrictions on the program could also lead eligible families to lose access to food aid. (Christiana Botic/Verite News and CatchLight Local/Report for America)
Fields said applicants may miss forms and interviews or fail to recertify or report changes in their status. Other times, the problem is on the state’s side. Agency notices may reach applicants past the deadline due to mail delays, they may be sent to the wrong address, or caseworkers may have backlogs in processing paperwork.
“Families are still hungry, and they’re actually eligible for the program,” Fields said. “This is a tax bill that we really cannot afford.”
The additional administrative burden and the financial penalties tied to having a high payment error rate give states an incentive to deny more applications, Llobrera said.
“The pressure that states feel now to really get their error rates down is pushing states to just ask for a lot more verification and more frequently,” Llobrera said.
Anti-hunger advocates say the need for food assistance has increased as barriers to SNAP have grown.
A Steadily Increasing Need
Aaranika Macon and her son received SNAP benefits for more than three years, continuing when she began nursing school last year. But she no longer qualified when she took a job in healthcare. After three months of trying to juggle work and school, her grades started to slip and she quit the job to focus on school.
So she reapplied to SNAP in February but did not receive benefits until April.
“I’m waiting, like, two months with nothing, because I stopped working,” Macon said. “Usually when you fill out, they’ll get back with you in, like, two weeks.”
According to the Food and Nutrition Act of 2008, SNAP-eligible households are required to receive benefits within 30 days of application.
Macon at her home in LaPlace, Louisiana. (Halle Parker/Verite News)
When Macon’s SNAP application was finally processed, she received less assistance than she previously did. She was deemed ineligible as a student, though she’s taking the same number of classes as she did last year when she was considered eligible. In Louisiana, higher education students are eligible for SNAP if they attend school at least half-time and meet other requirements.
Only her 11-year-old son was approved for benefits. Instead of the roughly $500 a month for two people that she received previously, she said, the $298 for her son feeds them both.
She said she had to stretch a $5 balance in her SNAP account over six days at one point this summer.
“I’m in the same position as before the job. So, why is it cut?” Macon said. “You’ve got to fight to communicate with them.”
Lindsay Hendrix, chief impact officer for Second Harvest Food Bank in southern Louisiana, said the organization has seen the need for food increase steadily for several years. Even before the passage of the SNAP changes last year, anti-hunger advocacy group Feeding America documented a 14% increase in food insecurity in Louisiana from 2022 to 2024.
“What we’re seeing is actually that more of our neighbors are coming to the food pantries longer than they used to before,” Hendrix said, and “the frequency of their visits have increased.”
Hendrix said last year’s government shutdown — which halted federal SNAP distributions and left states scrambling to fill the gap — illustrated the necessity of the food assistance program.
“Every politician was like, ‘Oh, just go to your food bank,’” Hendrix said. “And all of us working in food banks just around the country were like, ‘We will run out of food.’”
Instead, some states, including Louisiana, ensured SNAP benefits weren’t disrupted by distributing the benefits themselves until the federal government reopened and the agencies could be reimbursed. Hendrix said food banks complement SNAP and can’t compare with the scale of the program.
“We could not absorb that level of need without that program operating at its best, most effective level,” Hendrix said.
Lindsay Hendrix, chief impact officer for Second Harvest Food Bank in southern Louisiana, says food insecurity in the area has increased and that the organization has seen people visit more frequently than in past years. (Halle Parker/Verite News)
Cushion Against Higher Costs for States
Policy advocates and anti-hunger groups have been pressuring legislators in Congress to amend the latest Farm Bill or appropriations bill to delay any new costs to the states for SNAP by two years.
“We’re asking for every state to be able to have that cushion to try to get their systems in order, lower their error rate, and then give us time to reset, so that we’re not penalized for not yet having a strong enough system in place,” Fields said.
In September, the Senate Committee on Agriculture, Nutrition, and Forestry sent a new Farm Bill to the full Senate that would give states another year before they may have to help pay for SNAP benefits. The cost would shift to — and penalties would be set in — 2028 instead of 2027. The legislation would still require states to start paying more for the cost of administering the program this year starting in October.
Sen. Amy Klobuchar (D-Minn.) and other Democrats on the committee have pushed for a two-year delay.
The committee chair, Republican Sen. John Boozman of Arkansas, told an Arkansas Farm Bureaupodcast in September that he expects negotiations on the bill to continue in October, with the goal of having legislation that can pass the House and Senate by the end of the year.
Anti-hunger advocates say a one-year delay isn’t enough. Jordan Baker, a spokesperson for the Food Research & Action Center, said the financial strain of the impending administrative costs could eventually cause some states to opt out of SNAP altogether. Four states said they might withdraw from or pause the program if they have to start paying for benefits, according to a spring survey by the American Public Human Services Association.
Fields and Hendrix said it’s unlikely that Louisiana would completely drop SNAP. Hendrix said Louisiana’s SNAP program has been understaffed for a long time, straining the state’s ability to administer the program and do community outreach. That’s why Second Harvest’s food banks also help people with their SNAP applications. Fields said she also believes the state Department of Health is doing the best it can under a tight deadline.
“We just have to work out the kinks again,” Fields said. “That’s why we’re asking for that cost shift delay, so that the agency can have the opportunity to get it right and to keep the families fed here in Louisiana.”
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.
The son of Cindy Crawford, who died last month, left behind a trove of first-person testimonials about years of drug use, trying to stay clean and his mental health.
The son of Cindy Crawford, who died last month, left behind a trove of first-person testimonials about years of drug use, trying to stay clean and his mental health.
On Sept. 30, I was one of the seven media witnesses who observed Tennessee fail to execute convicted murderer Christa Pike, the first woman to face the death penalty in the state in almost 200 years.
From our previous reporting, each of us had an inkling that the lethal injection process might not go according to plan. Pike’s attorneys had asked the Tennessee Supreme Court to allow her to be hanged instead, citing concerns that a platelet disorder and small veins would make the actual injection not only painful but ineffective.
And Tennessee had already botched an execution attempt in May, when healthcare workers failed to establish complete IV access into Tony Carruthers, who was sentenced to death after being convicted for his involvement in the kidnapping and murders of three people in 1994.
Tennessee Gov. Bill Lee said after the failed execution of Carruthers, who has maintained he is innocent, that the state wouldn’t try again to kill him for at least a year. After Pike left the execution chamber in an ambulance on Sept. 30, Lee announced he would suspend lethal injections for the rest of the year.
The morning of Pike’s scheduled execution, I and the other media witnesses arrived at the Riverbend Maximum Security Institution in Nashville by 8:30 a.m. and waited to be ushered into the prison with nothing but our driver’s licenses in hand. The plan was to wait inside until Pike began her journey to the death chamber at 10 a.m.
But we didn’t make it that far.
Before the Department of Correction’s staffers began moving us away from the outdoor media tent and our belongings, the reporters’ phones all went off. A federal circuit court had stayed the execution. This was my fifth stint as a media witness to an execution, and I’d never seen a stay issued. We didn’t know what that would mean.
It turned out to mean waiting for nine hours at the prison, barred from leaving the grounds. We spent most of it in the boardroom where parole hearings take place.
Hours of Waiting. Then, ‘It’s a Go.’
Throughout the wait, the victim’s family often came up in conversation. In 1995, Pike, then 18 years old, killed Colleen Slemmer, who was 19. Slemmer’s family in Florida traveled to Tennessee for the execution with money raised through crowdfunding. It’s unclear where they waited while the last-minute legal wrangling played out.
Sometime around 6 p.m., the prison system’s communications director, Dorinda Carter, told us: “It’s a go.”
Tennessee had asked the U.S. Supreme Court to lift the stay, and it did. Carter read the ruling aloud to us.
For unknown reasons, it took another hour or so for the security team to usher us into the witness bay, an all-white cinder block room with black pleather chairs in two rows and a big window overlooking the death chamber. A loudspeaker pipes sound into the room from the chamber when the microphones are on.
A black curtain hangs in front of the window inside the death chamber. Department of Correction workers open it once IV lines are inserted into the condemned prisoner.
The curtain is there to obscure the workers who place the IVs, in order to shield their identities as required by state law. That process is enshrined in the “Lethal Injection Execution Protocol,” which is the guidebook the Department of Correction writes for itself. There is no other regulation over executions in the state.
My employer, the Nashville public radio station WPLN, is a party in a lawsuit challenging the state’s concealment of the IV insertion. When executions are botched, it’s often due to something going wrong while IVs are placed — or with the subsequent step if IVs fail, placing a central line in a deeper vein through the chest, neck, or groin.
A lower court ruled in favor of WPLN and other media plaintiffs in January, but the state appealed the order, and it has been halted while higher courts consider the case.
The Death Chamber
The American Medical Association officially bars doctors from participating in executions, and many other health professionals also consider assisting an execution to be unethical.
Outside of prison staffers and the execution team, only the prisoner’s spiritual adviser and attorney are allowed in the room with the prisoner while the IVs are inserted. So generally, attorneys’ descriptions are the only account of the procedure.
Under normal circumstances, witnesses sit in the bay for 10 or 15 minutes with the curtain closed. That’s how long it tends to take for the IV team to place a line and start running saline, to prepare for the 5 grams of the sedative pentobarbital that will be pumped in to kill the prisoner.
Once the lines are set, the execution team enters an adjacent, concealed room. The IV lines run through the wall into that hidden chamber, from which the drugs are administered.
But at Pike’s execution, we sat in the bay for 45 minutes with the curtain closed and the microphone turned off.
Until Carruthers’ failed execution, the Department of Correction kept the lights off in the witness bay during the wait. Witnesses at his execution said they sat in a dark room for an hour and a half as the execution team tried and failed to place an IV line. This time, the prison kept the lights on.
The clock we use to give a minute-by-minute account is in the death chamber, so we can’t see it with the curtain closed. John North, a reporter with the television station WBIR in Knoxville, was the only witness wearing a watch. The rest of us asked him over and over what time it was.
After half an hour, it was clear the IV team must have been struggling.
We wondered whether Pike’s execution would unfold similarly to Carruthers’. That time, the governor called and ordered the execution halted before the curtain ever opened.
But at 7:27 p.m., we heard the curtain being drawn away.
We saw Pike in profile, lying on the gurney, facing the window for the other bay, where the victim’s family and prosecutors sit.
We saw Pike’s spiritual adviser, Mikey Noechel, who wore a wine-red sash over his suit. Together, they sang and talked about Buddhist teachings.
Under the state’s protocol, the spiritual adviser is allowed in the death chamber as the pentobarbital flow begins, though the attorneys are not.
There is no signal when the lethal drugs start flowing, but it’s assumed to begin after the prisoner delivers her final words. It’s typical for the spiritual adviser to offer prayers and other support, and for there to be a back-and-forth between the two.
Pike spoke.
“I just want to say that I’m going to leave this world the way I’ve spent most of my life, and that is with love,” she said.
She said that she had love for those who hate her, and that she was at peace with her death.
Moments later, Pike told Noechel her arm was burning. She said it was in one specific spot and asked corrections staff in the room whether that was normal.
Pentobarbital is alkaline, so it burns like drain cleaner if it touches skin. If the IV is administered correctly, that is unlikely to happen.
But Pike and Noechel chatted for what seemed a shocking amount of time. Prisoners tend to show signs of being sedated a few minutes in. Pike didn’t.
Something Is Wrong
The Tennessee Department of Correction uses an odd practice to announce the drugs have been fully administered. There’s a small, hinged door built into the wall between the concealed drug management room and the death chamber, with a platform beneath it. Once the drugs have completely flowed through the IV, the door is opened and a rock is placed on the platform. That initiates a five-minute waiting period, after which the curtain closes again to obscure a doctor, who enters the death chamber, checks the prisoner’s pulse, and certifies the death.
In each of the executions I’ve witnessed, the prisoners look unconscious long before the rock comes out, and in the minutes following they’re presumed dead.
The rock came out at 7:41 p.m. At 7:44 p.m., Pike was still speaking quietly to Noechel.
My jaw dropped. It was clear to me then that something was very wrong.
Once the five minutes are up and the curtain closes to conceal the doctor, who confirms the time of death, the spiritual adviser moves into the witness bay and stays there until everyone leaves the facility.
But after Noechel entered the witness bay, staff came in and ordered him back into the death chamber. There was only one reason to do so: They were trying again.
The curtain reopened.
The state’s protocol dictates that, as a backup plan, prison staff can run a second round of pentobarbital. According to a statement from the Death Penalty Information Center, which tracks execution attempts and their outcomes, Pike is “the first person to survive after being injected with lethal doses of execution drugs.”
Eventually, Pike stopped talking. She started snoring.
She continued to snore after the rock was put out the second time and the curtain closed again. We continued to hear her snore over the loudspeaker.
The state’s protocol does not contemplate a second round of drugs failing to kill the prisoner, so there are essentially no rules for the situation the Department of Correction found itself in with Pike.
It’s unclear what was happening behind the curtain. Her lawyers later said they weren’t allowed in the death chamber.
The curtain closed at 8:16 p.m., and we listened to Pike’s snoring for nearly 40 minutes.
Tensions rose between the media witnesses and Carter, the Department of Correction’s communications director. I asked her: “Do they do a third round? Are you going to resuscitate her?” Carter didn’t have an answer. Another witness, Steven Hale of the Nashville Banner, asked why the curtain was closed. The doctor wasn’t certifying Pike’s death. We could all hear her breathing.
At 8:53 p.m., the prison warden, Kenneth Nelsen, came over the loudspeaker and said, “Media witnesses, please exit the area.”
‘Intubated, on a Ventilator’
We went out to the news conference, which the Department of Correction usually requires media witnesses to participate in. While one of us was speaking, several emergency vehicles arrived. We saw the caravan leave with its sirens on. That was our only insight into whether Pike was alive.
Pike’s attorneys later confirmed she was hospitalized. As of Oct. 1 she remained in critical condition at an undisclosed Nashville hospital, according to her attorneys.
Her lawyers, in an emergency filing with the Davidson County Chancery Court on Oct. 2, alleged that the execution team apparently didn’t “realize that the IV lines were not correctly placed or that the veins had blown” and that pentobarbital had “in whole or in part” entered her body instead of her veins.
Pike arrived at the hospital with both of her arms “swollen, burned, and blistered,” they wrote. “She is intubated, on a ventilator, and remains unconscious.”
Pike’s future, as well as that of lethal injection in Tennessee, is uncertain.
Lee, the Republican governor who has paused executions for the rest of the year, leaves office in January. The front-runner in the Nov. 3 election to replace him, U.S. Sen. Marsha Blackburn, has been a vocal supporter of the death penalty. After Pike’s failed execution, the Republican candidate posted her solution to X.
“Bring back the electric chair and deliver justice for these victims swiftly,” she wrote. “As your governor, I will do just that.”
The electric chair was last used in the U.S. in Nashville when Tennessee executed Nicholas Sutton in 2020. He was one of five prisoners who chose the electric chair over lethal injection in the state from 2018 to 2020.
This article is from a partnership that includes WPLN, NPR, and KFF Health News.
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.
Karl Deisseroth, Peter Hegemann and Georg Nagel were recognized for their work on light-gated ion channels and optogenetics, a technique that uses tiny lights to activate neurons in the brain.
More than a year into President Donald Trump’s sweeping immigration crackdown, a poll finds that voters in rural parts of the country are divided on whether those immigration policies have benefited or harmed their communities.
In the Associated Press-KFF survey of more than 2,000 rural voters in August, about a third said the Trump administration’s immigration enforcement had been positive for their community and about a third said it had been negative. The remaining 3 in 10, roughly, said it had no impact.
Trump promised tough enforcement on the campaign trail in 2024, and the survey highlights how a cornerstone of his base, rural supporters of his Make America Great Again movement, are especially likely to say they see a benefit where they live from the Republican president’s stringent immigration policies.
Yet many rural voters also say immigrants are a key part of their local economies, and some believe Trump’s immigration actions have gone too far.
Laura Leigh Taylor, a 37-year-old farmer who voted for Trump in 2024, said she disapproves of the wide-ranging scope of Trump’s immigration crackdown, which resulted in a friend’s hardworking father being deported.
“I understand getting rid of the rapists and the murderers,” she said. “But all the people that fell in between, that really weren’t doing nothing but taking care of their family, … they got torn from their families.”
Taylor now regrets her vote for Trump. As a resident of Smithville, Georgia, a town of about 600, Taylor thinks she will vote for Democratic Sen. Jon Ossoff in November because, she said, the Democrats have been the ones talking about families being uprooted by Trump’s immigration enforcement.
“Just because of that simple fact, I’m going to go with him,” Taylor said.
Taylor regrets voting for Trump in 2024. (Matt Odom for KFF Health News)
Most Rural Voters Want Politicians To Talk About Immigration
Roughly three-quarters of rural voters say it’s “extremely” or “very” important for midterm candidates to talk about immigration, though that’s lower than the share who want them to address the cost of living, fraud in government programs, or healthcare costs.
Rural voters don’t overwhelmingly think Trump’s immigration policies have helped their communities, but they are also less likely than the general public to say that Trump has overstepped in his efforts, which have involved mass deportations and rapid deportations of immigrants to countries where they have no ties.
Only about 4 in 10 rural voters say Trump has “gone too far” in restricting legal immigration or deporting immigrants living in the U.S. without authorization, below the 55% of U.S. adults overall who said the same in a September AP-NORC poll.
John Thomas, a 55-year-old from Liberty, Kentucky, supports Trump’s efforts to deport people without legal status. Thomas, who has just been approved for disability benefits after injuring his back in 2008, believes they put too much of a burden on the healthcare system. Regulating immigration, he said, is a means of providing better healthcare to Americans.
“They’ve been taking from everybody,” Thomas said of immigrants. “People that really need this stuff can’t get it because of them.”
David Grabowski, a professor of healthcare policy at Harvard Medical School, said that research suggests immigrants use less healthcare than native-born Americans. “It is hard to argue that they are placing an undue burden on the system,” he said, because many immigrants work in healthcare and pay taxes.
Most Rural Voters See Immigrants’ Economic Importance
Immigrants often play key roles in sustaining local industries, including by filling jobs in manufacturing, healthcare, and agriculture. The survey suggests the vast majority of rural voters see immigrants in the country legally as an important part of their local economies.
Shannon Monnat, director of the Center for Policy Research at Syracuse University and president of the Rural Sociological Society, said immigration has been a demographic lifeline for much of rural America. Rural areas have been losing young adults for years, she said.
“For a lot of small towns, immigrants are the reason the school and hospital stayed open and the county didn’t shrink,” Monnat said.
About 7 in 10 rural voters see immigrants who are in the country legally as “very” or “somewhat” important to their local economies, and a similar share say the same about temporary or seasonal agriculture workers. Hundreds of thousands of immigrants take seasonal jobs on U.S. farms each year, with most of them coming from Mexico, on H-2A visas.
Rural voters with a connection to agriculture and farming are more likely than those without one to say that temporary or seasonal workers are “very important” to their local economies, the poll found.
Jeff Miller, a 56-year-old Republican hydro blaster and vacuum technician, has mostly been pleased with Trump’s agenda, and he believes things are “heading in the right direction.” The one thing Miller has struggled with is Trump’s aggressive immigration policy, which he blames for the deportation of a “really good worker” and friend, who was removed from the U.S. when his work permit expired.
Miller, from Racine, Ohio, said he would support exceptions for hard workers, or just a less aggressive approach.
“There’s kind of an up-and-down thing because I lost a really good friend over that,” Miller said.
Rural voters are much less likely to say immigrants who are in the country illegally are beneficial, but 45% say they are at least “somewhat” important to local economies.
Albert Martinez, a 70-year-old Democrat from San Diego, Texas, voted for Trump in 2016, but he now believes the Trump administration has “gone amok.” The Army veteran said he is a proponent of getting criminals out of the country, but that is not what he is seeing happening with current immigration enforcement.
“They started doing everybody across the board,” Martinez said. “Innocent kids and women, people who work in restaurants, people who work in hotels, people who are building homes, people who are doing masonry work, and innocent, good, taxpaying people. Taxpayers. It’s insane.”
Rural MAGA Voters Support Trump’s Immigration Policies
Some of Trump’s most loyal supporters — rural Republicans who consider themselves MAGA supporters — are about twice as likely as rural, non-MAGA Republicans to see a benefit to Trump’s immigration policies where they live.
Roughly 4 in 10 rural voters identify as MAGA Republicans, while about 1 in 10 are Republicans but not MAGA supporters.
About two-thirds of rural MAGA Republicans say Trump’s immigration policies have had a positive impact where they live. Roughly half say the Trump administration has “not gone far enough” on deporting immigrants in the country illegally, while about half say his actions have been “about right.”
Katherine Reed, a 27-year-old Republican who supports the MAGA movement, has been pleased to see the Trump administration’s deportation policies play out. The resident of Mount Pleasant, Texas, believes her community has always been safe but that the administration’s policies have had a positive impact by reducing violent crime nationwide, saying, “It’s made life for people a lot safer.”
She believes if someone comes to America, they should “respect the law of the land” and “do it legally.”
“I want really amazing people to become Americans,” Reed said. “That’s the whole point of America.”
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.
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.
Medications can snowball as we age. Pill organizers pile up. Prescriptions that are no longer necessary can mix with other drugs to create concerning side effects.
“Once you get to six or seven prescription medications, you get a nearly 100% chance of some sort of side effect or intolerance,” said physician K. Eric De Jonge, director of geriatrics at MedStar Washington Hospital Center.
Paula Span writes “The New Old Age” column for The New York Times and KFF Health News. She joined WAMU’s Health Hub on Sept. 30 to talk about common medications — from aspirin to benzodiazepines — that some older patients are overusing.
Span shared tips for keeping loved ones safe and said it’s important for patients and caregivers to be proactive.
“Doctors prescribe medicine based on the evidence available at the time. But science doesn’t stop,” Span said. “Your doctor might not be up on the latest research. And patients get into a routine. They may not question if they still need the drugs they’ve been taking.”
Experts and pharmacists say: Check with your doctor to make sure the meds you’re taking are still right for you.
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.
Small particulates sent up by wildfires are a well-documented health hazard. But recent research finds that ground-level ozone is now on the rise, too.
KFF Health News chief rural correspondent Sarah Jane Tribble discussed the findings of a KFF-Associated Press poll about rural support for the Make America Healthy Again movement on NPR’s Morning Edition on Sept. 30.
Céline Gounder, KFF Health News’ editor-at-large for public health, discussed a new GLP-1 weight loss drug on CBS News’ CBS Mornings and health secretary Robert F. Kennedy Jr.’s comments at a MAHA summit this week on CBS News 24/7’s Mornings, both on Sept. 30.
Gounder also discussed how Anthropic’s Claude agents might help develop new gene-editing technology on CBS News 24/7’s The Daily Report on Sept. 24.
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.
The discovery adds strong evidence that the outbreak that sickened thousands over the summer originated in the company’s fields or processing facility in northeastern Mexico.
Democratic congressional members and candidates are already planning to use any midterm election gains to expand health coverage, including boosting Affordable Care Act subsidies, reversing Medicaid cuts, and lowering the Medicare eligibility age.
But Democratic strongholds across the country — including Oregon, California, New York, and Washington — have more ambitious goals: single-payer, universal healthcare systems.
No state is closer to that goal than Oregon. A panel created by the state legislature in 2023 is slated to send lawmakers its proposal for a universal health plan by Dec. 1. The nine-person Universal Health Plan Governance Board seeks to establish, starting in 2032, medical, vision, dental, and mental health benefits for every state resident from cradle to grave — with no premiums, deductibles, or copayments. Lawmakers could vote on a plan during the 2027 legislative session or refer it to voters as a ballot measure in 2028.
If approved, the state would be the first in the U.S. to implement what’s called a single-payer health coverage system. It could serve as a model for other states — and potentially the nation.
States have often served as laboratories to test health policies later implemented nationally. The Affordable Care Act was modeled after Massachusetts’ attempt to achieve universal health insurance coverage, once single-payer efforts there stalled. And Canada’s universal healthcare system began with a provincial plan in Saskatchewan.
“In the short to medium term, there is no chance that ‘Medicare for All’ can be passed at the national level,” said Jonathan Oberlander, a University of North Carolina health policy professor. “That’s where the states come in. A state like Oregon provides a more hospitable political environment and a more realistic path to single-payer reform.”
But advocates of the plan expect a significant fight from healthcare behemoths, including large hospital systems, seeking to sour public opinion on making such widespread changes. Nine of the Fortune 500 companies are health insurers. The industry’s deep pockets have helped derail myriad universal healthcare efforts at the federal and state levels.
In 2011, the Vermont Legislature voted to implement a universal healthcare plan but, three years later, Democratic Gov. Peter Shumlin, who had campaigned on the promise of single-payer, pulled the plug, citing “potential economic disruption.”
States that took the issue directly to voters have fared no better. Ballot measures in Colorado in 2016, Oregon in 2002, and California in 1994 all failed by large margins.
“The aspirations of progressive reformers usually run smack into sobering political realities,” Oberlander said. “Translating a slogan into a legislative and political reality is a daunting task.”
Valdez Bravo, president of Health Care for All Oregon, speaks at the nonprofit’s annual garden party in Portland on Sept. 12. The state will soon consider a plan for universal health coverage that the state legislature ordered in 2023. (Christena Dowsett for KFF Health News)
Redirected Healthcare Dollars
Oregon’s proposal seeks to maintain the current level of spending on healthcare by government, business, and consumers with new corporate and personal taxes to replace insurance premiums and other out-of-pocket costs. Those would be combined with federal and state spending to create a single fund from which all hospitals, doctors, and other practitioners would be paid.
Board members said savings from cutting red tape, reducing fraud, and negotiating drug costs should allow the state to provide better benefits to more people.
In examples prepared for consumer focus groups, the board estimated that a 30-year-old making $55,000 and purchasing a benchmark silver-level plan through the Affordable Care Act now pays $5,478 a year for insurance premiums in Oregon, but instead could pay $2,331 in taxes under the proposed plan.
Someone making $55,000 a year with coverage through their employer now pays $3,063 in premiums and out-of-pocket costs. Under the draft plan, that person could pay nothing for health services and could see any doctor in the state.
Currently, many employers pay much of the health insurance costs for their workers. The plan seeks to maintain those contributions by establishing a corporate payroll tax for companies whose payrolls exceed $500,000. Their employees could receive a partial tax credit for the taxes their employers pay. As a result, 31% to 60% of Oregonians wouldn’t pay anything for health benefits.
More affluent people, however, could end up paying more than they do now. The exact numbers would depend on how lawmakers set tax rates and payment thresholds.
“What we are proposing is something very different,” said Miriam McDonell, executive director of the Oregon board. “Everyone contributes based on the amount that they are able to contribute and not based on utilization.”
A work group created by the state legislature in 2023 is slated to send lawmakers its proposal for a universal health plan by Dec. 1. Lawmakers could vote on the plan as soon as the next legislative session or refer it to a ballot measure in 2028. The nonprofit Health Care for All Oregon hosted a garden party on Sept. 12 ahead of the reveal. (Christena Dowsett for KFF Health News)
Backers of the universal healthcare coverage plan will try to convince hospitals and health systems that they would benefit from reducing red tape and eliminating unpaid bills. (Christena Dowsett for KFF Health News)
Messaging Challenge Lies Ahead
The plan’s backers will try to convince hospitals and health systems that they would benefit from reducing red tape and eliminating unpaid bills. Currently, hospitals hire scores of workers to bill dozens of public and private health plans, each with its own coverage and billing rules. A single plan covering everyone in the state could streamline the process, saving billions.
Rural hospitals could gain financial stability. They now often struggle to stay afloat because they typically have higher rates of patients who are uninsured or on Medicaid, with its often low reimbursement rates.
Hospitals aren’t so sure.
“The universal health plan proposal preserves much of the broken, fragmented status quo and adds new taxes and complexity that Oregonians can’t afford,” said Becky Hultberg, president and CEO of the Hospital Association of Oregon. “With federal policy changes looming, we are entering a period of tremendous upheaval. This proposal could destabilize a system that is already struggling.”
Under the proposal, doctors and other practitioners would be paid somewhere between what Medicare pays on the low end and what private insurance pays on the high end. Although total payments to doctors would remain unchanged, rates would be negotiated with physician groups to shift more money into primary care and less into specialty services.
But it is unclear whether doctors would agree that more patient time, fewer administrative hurdles, and no more unpaid bills would be worth a payment structure that could cause specialists to lose out.
Rebecca Schoon, an associate professor at Pacific University who attended last month’s Health Care for All Oregon garden party, says that communicating what universal healthcare is will be one of the biggest challenges ahead for Oregon’s proposed plan. (Christena Dowsett for KFF Health News)
“There’s always winners and losers in designing something like this, and so how to distribute those is the hardest part,” said Rebecca Schoon, an associate health policy professor at Pacific University who is slated to join the Oregon board in January. “But the second-hardest part is, I think, messaging this.”
Courtni Dresser, vice president of government relations for the Oregon Medical Association, said her physicians group shares many of the board’s goals in improving access to care and reducing administrative burdens. But the group has yet to declare its support or opposition to the effort.
Health insurers haven’t formally weighed in on Oregon’s proposal either, but a single-payer system would, in essence, close off Oregon to any private healthcare plans.
“We expect insurance companies to put every ounce of money they can against this idea because our system is broken and they profit from it,” said Collin Stackhouse, communications coordinator for Health Care for All Oregon, a consumer group advocating for universal healthcare.
Wendell Potter, a former insurance company executive who now works to expose industry influence, said he expects health plans to hammer the Oregon proposal with claims of high taxes, loss of choice, and the specter of “socialized medicine.”
“Most people go year to year without testing the limits of their health insurance policy,” Potter said. “And so, they’re easily scared into thinking that something valuable will be taken away from them, and that they will have something that’s inferior in its place.”
Health insurers argue their health plans help shield consumers from the full impact of rising healthcare costs.
“Americans consistently report strong satisfaction with their health coverage, including more than 180 million covered through work and 36 million who choose Medicare Advantage,” said Chris Bond, a spokesperson for the health insurance trade group AHIP. “Policy solutions are needed to rein in the ever-higher prices charged by hospitals and drugmakers and make care more affordable for everyone.”
Volunteers converse at the Sept. 12 garden party in Portland. Oregon’s legislature created a work group in 2023 to draw up a plan to create universal healthcare in the state. The proposal is due Dec. 1. (Christena Dowsett for KFF Health News)
Federal Approval Needed
It’s unclear whether Oregon could secure federal approval to redirect Medicare and Medicaid dollars into its universal plan. Backers of the proposal do not expect the Trump administration to be receptive but say it will be years before approval is needed and hope the 2028 presidential election ushers in a more supportive administration. If federal waivers are not secured, Oregon could proceed in stages, starting with the non-Medicare population.
In California, Democratic candidates for governor are not debating whether to implement single-payer but how. New York lawmakers are debating a single-payer bill called the New York Health Act. And in Washington, state legislators have created a commission to design a universal healthcare plan.
The Oregon board has had regular contact with teams working on single-payer proposals in California and Washington, sharing approaches and looking for ways to collaborate, McDonell said.
Richard Bruno, an Oregon family physician and a member of Physicians for a National Health Program, said he could envision the other West Coast states joining Oregon in implementing single-payer, much as California, Washington, and Hawaii have in public health efforts to counter changes in federal vaccine recommendations.
“If our four states could do it,” he said, “that would be the momentum we would need to get it nationally.”
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.
October 09, 2026
Rose
