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July 20, 2026
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No commentsJuly 20, 2026RoseHealth News, KFF Health NewsNo commentsBELZONI, Miss. — Harmony Ball-Stribling’s path to pregnancy had been turbulent, from an endometriosis diagnosis to an arduous in vitro fertilization process and sky-high blood pressure. But as her due date approached in the summer of 2021, her health improved and those storm clouds seemed to scatter.
“It was just too perfect,” said her mother, Shenelle Ball-Green, of those calm, hot weeks.
Then, early on July 5, four days shy of her scheduled cesarean section, Ball-Stribling began experiencing complications from preeclampsia, a potentially life-threatening blood pressure disorder. Speeding up to 110 mph, her husband drove her to the nearest hospital 25 miles away from their home in Belzoni, a Mississippi Delta town of about 1,900 people.
Minutes before reaching the facility, Ball-Stribling suffered a seizure in the passenger seat. Her husband pulled her from the car and performed CPR on the side of the road. It was too late. She and the couple’s unborn daughter, Harper, died on the side of U.S. Route 49.
The tragedy might have had a different outcome if the hospital in Belzoni, a five-minute drive from Ball-Stribling’s home, hadn’t closed 13 years ago. Today, Humphreys County has no hospital, no emergency room, no urgent care clinic, and no county health department. It is one of more than 100 rural hospitals in the U.S. that have fully closed since 2005.
In Belzoni, self-proclaimed “The Heart of the Delta,” and its surrounding area, communities are close-knit, and Harmony’s story is well known. Now, her death has galvanized local and state leaders determined to bring a hospital back to the county that has suffered without one.
“It was a tremendous eye-opener for this community,” said state Rep. Timaka James-Jones, a Democrat who represents the district that includes Belzoni and is Ball-Stribling’s aunt. “It brought to light how we are so without.”
Poverty often shapes the health disparities Humphreys County residents experience. Approximately 1 in 7 Humphreys County residents under age 65 lack health insurance coverage, compared with about 1 in 11 people nationwide. Humphreys County also has the highest rate of Medicaid enrollment of any Mississippi county, reflecting the economic challenges many residents face. These disparities are evident in the county’s infant mortality rate, which is among the highest in the state at roughly 15 deaths for every 1,000 births.
James-Jones has watched these circumstances influence the lives — and deaths — of her loved ones. She said she wants to see a hospital reestablished before her four-year term is up in early 2028.
But that may be easier said than done. In Belzoni, local leaders hoping to restore healthcare services face a tangled web of policy challenges that are especially demanding for a small town with limited resources. Its story reflects what many healthcare policy experts warn: Once a rural community loses a hospital, bringing it back can be nearly impossible.
Humphreys County’s Healthcare Losses
Humphreys County Memorial Hospital opened in Belzoni in 1951 as part of a nationwide hospital building boom fueled by a Truman-era law called the Hill-Burton Act. The legislation provided billions of dollars in grants and loans to build and modernize healthcare facilities. At the time, roughly 40% of all U.S. counties had no hospital. When the building boom began to subside by 1970, all but seven counties in Mississippi had at least one hospital.
But by the 2000s, many rural hospitals in the U.S. confronted financial difficulties. Low patient volumes, an increase in outpatient care, and meager revenues left many on precarious footing. Many had high rates of uninsured patients or those covered through government programs such as Medicaid, which typically reimburse providers at lower rates than commercial insurers.
Humphreys County’s hospital was among those struggling facilities. It was burdened with millions of dollars in debt, and county officials sold it in 2008 to a private company. It was renamed the Patients’ Choice Medical Center. The hospital shut down five years later after Ray Shoemaker, the company’s CEO, was convicted on healthcare fraud charges related to another hospital he owned.
“I do hope they reopen,” Shoemaker wrote in a recent text message to Mississippi Today. “The community needs a hospital.” He said he stepped down from the company before going to prison in 2012.
In 2017, the University of Mississippi Medical Center partnered with the county supervisors and U.S. Rep. Bennie Thompson, a Democrat whose district includes Humphreys County, to secure a nearly $1 million grant from the U.S. Department of Agriculture to open an after-hours acute care clinic in Belzoni. The clinic shut down in 2020, and UMMC officials declined to say why.
G.A. Carmichael Family Health Center, a Canton-based federally qualified health center with five other locations in Mississippi, took it over but did not maintain the extended hours, again leaving Humphreys County residents without after-hours care. Other public health services in the county have closed outright. Three years ago, the county’s health department stopped providing clinical services, said Greg Flynn, a spokesperson for the Mississippi State Department of Health. The county department closed entirely last year, citing staffing shortages and low patient volumes.
In the years since the hospital closed, the county has lost a fourth of its population, falling to 7,000 people, according to census data. James-Jones said she does not believe the community can experience growth until healthcare services are reestablished.
“I don’t know how I can see us growing any other way,” she said.
‘Something’s Way Better Than Nothing’
Months after losing her daughter and unborn granddaughter, Ball-Green climbed the steps of the stately, tan, brick Humphreys County Courthouse to attend a crowded Board of Supervisors meeting.
She stood at the dais and urged the supervisors to reestablish emergency healthcare services in the county to protect other residents from the fates of her loved ones.
“I wanted to let them know at any given moment that could be your child, your mother,” she said. “We’re a small town. Everyone knows everyone.”
She remembered the disappointment she felt when the supervisors told her there was nothing they could do. But when the board’s makeup changed after the 2023 elections, she said, she saw these attitudes shift.
Among the newly elected officials was Reggie Pinkston, who is now the president of the board and previously worked as an EMT when the hospital was open. His own family has suffered the consequences of limited healthcare access. A cousin living in Louise, a town about 20 miles south of Belzoni in the county, had a stroke in 2021 and waited an hour for an ambulance to arrive. She died two days later.
Pinkston said witnessing residents’ delays in care has made expanding access to healthcare services one of his priorities.
“We’re losing too many people in our county because of lack of healthcare,” Pinkston said.
The board enlisted several consultants to develop a strategy for expanding healthcare access and identifying funding sources to support these efforts. In late 2025, Thompson secured approximately $1 million for Humphreys County through the congressional Community Project Funding process, which allows lawmakers to request federal support for specific projects.
The funds will be used to expand services at G.A. Carmichael’s Belzoni location in a county-owned building on U.S. Route 49, Pinkston said. Expansion plans include extending its hours of operation overnight to 5 a.m., purchasing equipment, and a possible renovation of the facility. It could begin its expanded operations by September, said James Coleman Jr., the health center’s CEO.
Establishing an after-hours urgent care clinic is a starting point toward reestablishing emergency care services or a hospital, James-Jones said.
“Something’s way better than nothing,” she said.
‘Not for the Faint of Heart’
Despite that encouraging first step, Humphreys County faces steep obstacles to opening a hospital.
At the University of North Carolina-Chapel Hill, George Pink is a senior research fellow at the Cecil G. Sheps Center for Health Services Research and tracks rural hospital closures across the U.S. He said he’s aware of only a few communities that have successfully reopened a hospital after it closed.
“I can count that on one hand,” said Pink, who knows of roughly five such examples.
Communities face significant hurdles to reestablishing a hospital, including securing financing for construction or renovation, recruiting qualified staff, and covering substantial operating expenses during the licensing process before the facility can treat patients and generate revenue, said Brock Slabach, the National Rural Health Association’s chief operations officer and a former rural hospital administrator in southwestern Mississippi.
“Reopening a hospital is not for the faint of heart,” Slabach said. “Once they close, it’s very difficult to reopen them.”
To finance a potential hospital project in Humphreys County, local and state leaders said they plan to seek funding through the Rural Health Transformation Program, a federal initiative that will distribute $50 billion to states over five years. The federal government allocated Mississippi nearly $206 million in December for the program’s first year.
The program is meant to offset budget cuts passed into law last summer that could harm rural hospitals. Republicans’ One Big Beautiful Bill Act will cut the federal government’s Medicaid spending by $911 billion over 10 years and increase the number of uninsured people by 10 million, according to Congressional Budget Office estimates. Mississippi hospitals are projected to lose roughly $160 million annually beginning in 2029, according to Cindy Bradshaw, executive director of the Mississippi Division of Medicaid.
But according to federal guidelines, the program’s funding cannot be used for construction or major building expansions. Officials said the county will instead consider applying for funds through the program to support the recruitment of healthcare professionals.
The federal Rural Emergency Hospital designation is another way rural communities can keep emergency and outpatient services. Hospitals in that program receive over $3 million annually from the federal government and a higher Medicare reimbursement rate, but they cannot offer inpatient care.
Research by Pink’s team shows that many hospitals that converted to the model, which was established in 2023, saw an increase in profitability.
But there’s a catch. To receive the designation, a hospital must have been open in 2020, making Humphreys County ineligible. Mississippi’s junior U.S. senator, Republican Cindy Hyde-Smith, introduced legislation in 2024 to extend the cutoff to 2014, a threshold that would have still excluded Humphreys County.
James-Jones said county leaders have urged Hyde-Smith to amend the proposed legislation so Humphreys County could qualify. Hyde-Smith did not respond to a request for comment for this article.
For county leaders, the path to widening healthcare access means navigating a thicket of state and federal policies, funding streams, and regulatory hurdles.
Some recent state-level policy changes have created opportunities for healthcare expansion in Humphreys County. In March, Republican Gov. Tate Reeves signed legislation exempting Humphreys County from Mississippi’s certificate of need requirements, which are meant to prevent unnecessary healthcare expansions.
The exemption could make the county more attractive to prospective healthcare providers. But the financial challenges that contributed to the closure of Patients’ Choice Medical Center in 2013 remain, and Mississippi lawmakers have continued to reject Medicaid expansion, limiting a potential source of reimbursement for rural hospitals and clinics.
Industry officials expect hospitals’ financial pressures to intensify as Medicaid funding cuts take effect. The latest challenge is predicting how these cuts will affect the bottom lines of these facilities and whether additional cuts will come in the future, said Richard Roberson, president and CEO of the Mississippi Hospital Association.
“If someone’s trying to run a business, they’ve got to be able to know what those numbers look like,” Roberson said. “And it’s really hard to try to project that out right now.”
‘Now I Understand’
For Ball-Green, giving in to these obstacles would be a disservice to the Humphreys County residents who face health emergencies similar to the one her daughter experienced.
It has been five years since the funeral, but Ball-Green remembers it clearly. The day was stormy, but attendees brightened the gathering by wearing yellow, Ball-Stribling’s favorite color.
As friends and family gathered to pay their respects, her mother thought back on a relative’s funeral four months earlier. At that service, Ball-Stribling sang the gospel classic You Are My Strength to a roomful of mourners.
“She was singing, and she looked at me,” Ball-Green said, describing a peaceful but eerie expression on her daughter’s face in that moment — a sign of something to come, though she didn’t yet know what. “She turned around, and it was just that look, you know?”
Months later, as she sat at her daughter’s funeral, she began to interpret the foreboding glance differently. She came to believe it was a sign that Ball-Stribling’s gift for helping others by sharing her story would not end with her death.
That purpose had taken shape years earlier in her work as a teacher and continued as she shared candid social media posts about her fertility struggles and IVF journey in the final months of her life. Ball-Green said the community became deeply invested in her and Harper’s story.
In the years since, this gift has endured, she said. Ball-Stribling’s story has continued to resonate throughout Humphreys County, serving as a reminder of what residents stand to lose if they do not reopen the hospital.
“I think back on when she looked back at me,” Ball-Green said. “Now I understand.”
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.This <a target="_blank" href="https://kffhealthnews.org/rural-health/rural-mississippi-delta-hospital-desert-pregnant-woman-dies-emergency-services/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="https://kffhealthnews.org/?republication-pixel=true&post=2260851&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">July 19, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 18, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 18, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 17, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 17, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 17, 2026RoseHealth News, KFF Health NewsNo commentsOne year after the Trump administration announced that dozens of health insurers had signed a six-part pledge promising to reduce barriers to doctor-recommended care, some insurers now say they won’t implement all the promised initiatives.
Meanwhile, patients, their advocates, and clinicians say little has improved.
“It has never been this bad for patients,” said U.S. Rep. Greg Murphy (R-N.C.), a physician who co-chairs the GOP Doctors Caucus.
The overarching intent of the June 2025 pledge was to improve a controversial process called prior authorization, which regularly requires patients or someone on their medical team to seek approval from insurers before proceeding with treatment.
According to AHIP, the health insurance industry trade group, health plans have eliminated 6.5 million prior authorizations for patients — equal to an 11% reduction — since the announcement.
But critics remain skeptical. Sally Nix, a patient advocate who has a chronic disease, described the voluntary pledge as “performative.” And Murphy, who participated in the news conference with Health and Human Services Secretary Robert F. Kennedy Jr. announcing the pledge last year, said it has “no teeth.”
Voluntary insurer pledges rarely make things better for patients, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.
“In the absence of clear rules, policies, standards, and mandates,” she said, insurance companies are “going to do what makes sense for them to do financially.”
The Department of Health and Human Services did not respond to questions for this report. It isn’t clear how, or whether, the Trump administration is holding insurers accountable.
‘Zero Faith’
Prior authorization — sometimes called preauthorization or precertification — has been around for decades. The insurance industry has long argued that the practice, which varies by company, helps control costs, reduces waste and fraud, and prevents potential harm to patients. It’s regularly invoked for a huge swath of services, ranging from low-cost urgent care to expensive cancer treatment.
“Prior authorization is a vital patient safeguard,” said Chris Bond, a spokesperson for AHIP.
The 2024 killing of UnitedHealthcare CEO Brian Thompson sparked a national groundswell of anger about insurance denials, with patients and doctors becoming increasingly vocal about the tactics they say insurance companies use to boost profits at the expense of care.
Prior authorization reform is one of the rare healthcare issues Democrats and Republicans tend to agree on. On July 15, the House Ways and Means Committee unanimously advanced a bill that would force Medicare Advantage plans to provide to the federal government a list of all items and services that are subject to prior authorization, and to report data about denials and grievances, among other requirements.
Last year’s industry pledge was organized as a direct response to public anger, Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said when it was announced. “There’s violence in the streets over these issues,” he said.
“Americans are upset about it,” Oz said, later adding, “I’m looking forward to seeing the results.”
Mike Gartner, founder of Health Access Innovation, an organization that helps patients overturn insurance denials, said he doubts that insurance companies are changing their policies in meaningful ways. The 11% reduction in prior authorization cited by AHIP “hides a lot of nuance,” Gartner said.
Patients who need the costliest services, such as cancer treatment, are still being disproportionately denied access to doctor-recommended care, he said.
AHIP said its data included reductions in prior authorization for medical services, not prescription medicines. The trade group didn’t provide details explaining which services have been dropped from prior authorization or how those reductions differ across individual insurers.
Last year, Oz said the federal government would be “evaluating progress” toward the pledge and “driving accountability,” and he foreshadowed “public dashboards.” But no such dashboards exist, and federal officials did not respond to questions about how they’re holding companies accountable.
Murphy, the North Carolina congressman, said he has “zero faith” in the industry policing itself.
He didn’t believe insurance companies then, he said, “and I don’t believe them now.”
‘At War’ With an Insurer
In February, days after Betsy Adler and Justin Young’s daughter Coco was born with a serious heart defect, the Stillwater, Minnesota, family received paperwork showing they were racking up out-of-network costs.
During Adler’s pregnancy, the family had switched insurers, moving to Medica, a for-profit company based in Minnetonka, Minnesota, and one of many insurers that initially signed the industry pledge. Adler said she’d checked with her employer’s human resources department and on Medica’s website to make sure her maternal-fetal specialists and hospital were in-network before their new health plan went into effect earlier this year.
But then, the insurance company started processing some claims as out-of-network. By mid-March, the family had accrued more than $4,000 in out-of-network charges, on top of more than $3,000 for in-network bills. And the bills kept coming.
When Adler, a psychotherapist, called to figure out what was going on, she said, an insurance company representative said she hadn’t submitted a referral from her primary care provider beforehand. Attempts to fix the problem went nowhere. At one point, Adler said, Medica required her to visit a clinic she’d never been to before to obtain a referral. But she said a Medica representative told her the referral was never received, because the insurer’s fax machine was down.
“I have a critically ill child,” Adler remembered thinking shortly after Coco was discharged from the cardiovascular intensive care unit. “I can either spend my emotional energy at war with Medica, or I can let it go and just enjoy my time with my daughter.”
Medica spokesperson Greg Bury said he wouldn’t discuss the case, citing patient privacy rules. In an emailed statement, he wrote the company is “committed to working with her to ensure she understands what is covered under her benefits and our responsibilities.”
One of six specific promises all insurers made when they signed the pledge was to honor a 90-day grace period when patients switch insurance plans, starting Jan. 1 of this year. Often called “continuity of care,” this grace period allows patients to temporarily continue receiving services and medications that were authorized under a previous insurer.
But that applies only in some circumstances, Georgetown’s Corlette said. The wording of the pledge suggests that insurance companies aren’t obligated to honor another company’s network parameters. When Adler and Young switched insurers, for example, Medica was not obligated to cover the cost of out-of-network providers as if they were in-network, even though they were in-network under the family’s old plan.
Adler and Young switched insurance companies again when Coco was a month old, to avoid accruing more out-of-network costs.
Denial After Approval
The percentages cited by AHIP don’t tell the whole story, said Nix, the patient advocate. Insurers are “not including the data for the loopholes they create,” she said.
For example, nothing in the pledge prevents insurance companies from retroactively denying payment, even when care is preapproved. “Patients are going to see a lot more retroactive denials,” said Nix, who recently had her insurer process, then later deny, a claim for injections to relieve her nerve pain.
Something similar recently happened to Jocelyn Austin, 49, of Amherst, New York. Over the course of nearly 20 years, she developed an addiction to sleeping and anxiety pills prescribed to her by a doctor. Last year, she spent weeks at an inpatient treatment center for substance abuse. Her insurer, Independent Health, had approved the admission. Austin said she has been substance-free since her discharge.
But the facility sent her a bill for more than $12,000 in December showing her insurer had not paid for the treatment she received, according to documents Austin shared with KFF Health News. This was in addition to the $10,000 she paid at the beginning of her treatment to satisfy her out-of-network deductible. The approval letters from Independent Health had specified that “authorization is not a guarantee of claim payment.”
Frank Sava, a spokesperson for Independent Health, said a denial was issued and upheld in this case because the services provided “were inconsistent with the care that was authorized” and “the medical record did not sufficiently support what was billed.” He said those findings were reviewed and confirmed by an outside consultant.
An explanation of benefits issued by the insurer last summer indicated the “provider,” not the patient, was responsible for the cost of her treatment. And yet the treatment facility has continued to pressure her for payment, she said.
Austin, who has not paid her outstanding bill, said insurance companies “should be held accountable.”
‘Significant Work Ahead’
Another one of the six commitments insurers made last year was to adopt new technology that would standardize the electronic submission of prior authorization requests. During the news conference announcing the pledge last summer, Chris Klomp, the director of Medicare and a deputy CMS administrator, said more than 50% of prior authorizations are still paper-based and processed by phone or fax machine.
In April, AHIP released an update related to that technology initiative, explaining that participating insurers would adopt the new standards on a rolling basis. Health insurers agreed to implement the pledge’s various commitments by predetermined deadlines, and this initiative is scheduled to be operational by Jan. 1, 2027. But eight insurers that initially signed the pledge last year didn’t sign the technology update when it was announced in April, AHIP told KFF Health News.
Those insurers are Alignment Health Plan, EmblemHealth, HealthFirst, Independent Health, Medica, MVP Health Care, Point32Health, and SummaCare. Their beneficiaries span the country, from California to New York. None of those eight insurers agreed to interviews for this report, but most sent KFF Health News emailed statements indicating that they remain committed to prior authorization reform.
AHIP’s approach to continuity of care “would have required the transfer of confidential member health information through a non-standardized process involving third-party participation,” wrote Jerry Slowey, a spokesperson for Alignment Health, which offers Medicare Advantage policies in Arizona, California, Nevada, North Carolina, and Texas. “We do not believe that level of data sharing was contemplated in the original commitment.”
Bury, the spokesperson for Medica, which covers beneficiaries in Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, and Wisconsin, said the company “supports the goal of these standardization efforts.” But the April update “raised a significant technical and operational hurdle that we are not able to commit to at this time,” he said.
Alex Gomez, a spokesperson for EmblemHealth, said in late June the company “will sign onto the commitment” after KFF Health News posed questions about why it had not endorsed the April update.
“We anticipate more plans will be added over the coming months,” said Bond, the AHIP spokesperson. Health plans are “working continuously to implement their commitments to simplify and improve the experience.” He acknowledged that “there is still significant work ahead.”
The original pledge also included a promise that insurance companies would enhance transparency and use “clear, easy-to-understand explanations” when communicating to patients — something they were already supposed to be doing under the Affordable Care Act.
Yet companies still regularly neglect to explain why care has been denied, and their communications often contain “inconsistent and contradictory information,” said Gartner, of Health Access Innovation. He and Murphy also said they suspect insurance companies are increasingly using artificial intelligence to generate denials.
“They craft the pathways to basically deny things immediately with the hope that people will give up,” Murphy said.
The congressman said he wishes President Donald Trump would sign executive orders addressing some of these issues. “The problem is the insurance industry is the strongest lobby in this town.”
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This <a target="_blank" href="https://kffhealthnews.org/insurance/prior-authorization-insurance-denials-reform-pledge-year-later/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="https://kffhealthnews.org/?republication-pixel=true&post=2261522&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">July 16, 2026RoseHealth News, KFF Health NewsNo commentsErica Schwartz, President Donald Trump’s nominee to lead the Centers for Disease Control and Prevention, expressed support for vaccines — including mRNA-based covid shots — in a Senate hearing on Wednesday, though she didn’t dispel concerns the agency has lost any independence from the White House.
“I have been vaccinating people throughout my entire career in uniformed services. I believe in vaccines,” Schwartz said at the hearing. “I do believe that mRNA technology is safe and effective.”
Her position contrasts with that of Health and Human Services Secretary Robert F. Kennedy Jr., who ousted Trump’s previous CDC director, Susan Monarez, after she sparred with him over vaccines. Kennedy, a longtime anti-vaccine activist, has baselessly called mRNA vaccines the deadliest ever made.
Schwartz “has dedicated her career to protecting the health of the American people.” Emily Hilliard, an HHS spokesperson, said in an emailed statement. “The president nominated her because of that exemplary record, and Secretary Kennedy looks forward to working with her to advance the Administration’s public health priorities.”
The CDC has had a Senate-confirmed leader for only about one month during Trump’s second term, and the agency has been roiled over the administration’s cuts to public health funding, firings of scientists and other career employees, and efforts to scale back childhood vaccines and access to covid shots.
Schwartz, who was deputy surgeon general in Trump’s first administration and is a former chief medical officer for the Coast Guard, has support in the public health community, where it’s hoped she can restore credibility at the agency she would lead.
“I will follow the science wherever it leads,” Schwartz told senators. “My first priority will be restoring trust in public health institutions.”
Democrats and some Republicans have expressed doubt that Schwartz will maintain any more independence from Kennedy than Monarez, who has said she was fired in August after refusing to sign off on changes Kennedy demanded to vaccine recommendations and personnel cuts. In a series of emails released by Sen. Bernie Sanders (I-Vt.), it was revealed Kennedy had pressured Monarez to change CDC guidance regarding the universal childhood flu vaccine.
Monarez “refused to act as a rubber stamp for Secretary Kennedy’s very dangerous agenda,” Sanders said July 15 at the Health, Education, Labor and Pensions Committee’s confirmation hearing for Schwartz. “Frankly, she stood up for protecting the well-being of the American people.”
The chairman of the HELP Committee, Sen. Bill Cassidy (R-La.), pressed Schwartz on whether she would push back against rhetoric or policies not based in science.
“We need unbiased leaders who make decisions based upon science, not politics or ideology,” Cassidy said. “This is not a theoretical.”
Cassidy, a physician, has also quarreled with Kennedy over vaccines. He lost a Republican primary for reelection in May after Trump endorsed one of his opponents. Despite his rupture with the White House, Schwartz almost certainly needs Cassidy’s support to win confirmation. That requires publicly committing to support vaccination and mainstream science.
Schwartz told the committee she would “never compromise” on science.
“The president would never ask me to not follow the law,” she said. “But I will always follow the law.”
Many Democrats on the committee raised concerns about the administration’s politicization of public health. Sen. Tammy Baldwin (D-Wis.) asked about the “political scrubbing” of research grants. Trump officials have canceled many research grants under the CDC and the National Institutes of Health for political reasons, including targeting diversity, equity, and inclusion efforts.
“Restoring trust to the CDC is my No. 1 priority,” Schwartz said. “Scientific integrity is core.”
The American Public Health Association’s CEO, Georges Benjamin, endorsed Schwartz in April, saying she “possesses the medical background and public health knowledge to understand that the Centers for Disease Control and Prevention must be guided by evidence-based science.”
The APHA has fought many of Trump’s initiatives on public health. After Monarez’s resignation, the organization issued a news release titled “Kennedy’s attack on public health must be stopped.”
Schwartz told the committee that if she is confirmed, she is committed to “radical transparency” and modernization.
Schwartz expressed support for one Kennedy initiative: She told senators she believes nutrition education and physical fitness assessments are important.
“I am all in on the Make America Healthy Again agenda,” she said.
At the July 15 hearing, Schwartz faced questioning alongside Trump’s pick for HHS assistant secretary for preparedness and response, Sean Kaufman.
Cassidy called out Kaufman for past comments casting doubt on the efficacy of vaccines. The senator raised his voice as he accused Kaufman of spreading “those damn lies.”
Kaufman was conciliatory. “Let me be clear: Vaccines save lives,” he said. “They are safe and effective.”
If confirmed by the Senate, Schwartz will replace Jay Bhattacharya, who is performing the duties of CDC director but is not officially the acting director. Bhattacharya is also the director of the NIH.
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.This <a target="_blank" href="https://kffhealthnews.org/public-health/cdc-director-nominee-erica-schwartz-confirmation-hearing-vaccines-rfk-kennedy/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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A Tragic, Deadly Denial
I read your article in The Washington Post about the woman whose Humana policy required prior authorization for a drug she’d been taking (Bill of the Month: “She Struggled To Get a Lifesaving Drug Even After Insurers Vowed To Help,” June 29).
My husband, Kenney, had chronic obstructive pulmonary disease. On June 7, he fatally shot himself after a COPD exacerbation event.
His pulmonologist had prescribed two new nebulizer prescriptions on June 2. One was a specialty medication that would come directly from the drug company. A couple of days later, we called Walgreens to see why the other one hadn’t been filled. Turns out it required prior authorization.
Why the doctor who prescribed it needed to tell his health insurer that he really did think his patient needed it, I will never understand. The pharmacist said she would send the request to the doctor. And why she hadn’t already done that, again, I do not understand. By June 7, of course, it still wasn’t filled.
That day, a Sunday, Kenney experienced the flare-up when I was out mowing the yard. How terrifying it must have been for him to be unable to breathe and me not being there at least to hold his hand. That night he killed himself, leaving a note saying that he hated to leave me but that he couldn’t keep living like that — with the constant anxiety of not knowing when he wouldn’t be able to draw a breath.
Not long ago, a “welcome” packet came in the mail about the other nebulizer treatment — 25 days after it had been prescribed.
Admittedly, my husband’s health was not great. He did have COPD, but we still went out to eat once in a while, and he didn’t have to take his oxygen on those trips. He rarely used it just walking around the house.
He did make a serious suicide attempt six years ago (our daughter and granddaughter had died), but after seeing what it did to me and our son, he promised he’d never do it again. It was only when these exacerbation/flare-up events started this year that he indicated life was getting bad.
Perhaps, just perhaps, if he had received both medications in a timely manner, he would be here today, and we would have had many more years together. We met when we were 16 and had been together ever since. He was 78 when he died.
— Cindy Clements Blewett; Kyle, Texas
Navigating GLP-1 Coverage
Sydney Lupkin’s thoughtful article about the obstacles in obtaining weight loss drugs was interesting (Healthcare Helpline: “Trouble Getting Weight Loss Drugs Covered by Insurance? Here’s What To Know,” June 26). It would have been more helpful had it included a discussion of Medicare’s decision to cover these drugs as of July 1, 2026, and how to navigate the rocky shores of obtaining a prescription that won’t be denied.
— Sharie Hartman; Manteca, California
Beyond the Veil of Pregnancy Centers
I would like to address the article about a pregnancy resource center providing prenatal care in Sandpoint, Idaho (“Religious Anti-Abortion Center Finds Opportunity in Town Without OB-GYNs,” May 20). It is unfortunate that many still do not understand what pregnancy resource centers do, nor the high-quality care they provide. While there are some “crisis pregnancy centers” that provide limited offerings, most centers are aligned with a national organization like the National Institute of Family and Life Advocates, the Heartbeat Pregnancy Center, or Care Net. All these organizations require centers to have a medical director (a licensed healthcare practitioner) and require that the nurses who perform the ultrasounds have appropriate training. While I am not affiliated with 7B Care Clinic, I am concerned that the article may not have accurately reflected what is provided in such clinics. I offer my experiences to bring further clarity.
I work at a life-affirming women’s clinic. I am a board-certified family physician. I have delivered approximately 1,000 babies in my career. I have been performing ultrasounds for my patients for over a decade, and fought for this ability under the scrutiny of maternal-fetal medicine specialists, spending time alongside their registered diagnostic medical sonographer technicians, and having my scans reviewed by maternal-fetal medicine physicians. I have practiced medicine in three states over three decades.
Second, while I am life-affirming, I am not “anti-abortion.” I happen to believe that there are better choices, and I know that some women will still choose abortion, even after hearing all their options. I will gladly see those women for follow-up to answer questions and evaluate for complications — something that the abortion clinics in my area apparently will not do. I say this because that is what the women I see tell me. The clinic that performed the procedure or gave them the pills will not see a patient after the abortion for any follow-up. I have always willingly seen patients for any reason, whether I was working at a private clinic or hospital-owned clinic. That is no different now that I work for a life-affirming women’s clinic.
We provide a variety of services — free of charge. We are also stepping up to provide prenatal care up to 20 weeks because there is a shortage of obstetrical clinicians in our county. We encourage women to see a clinic where they can be followed throughout the entire pregnancy, if possible, and we are in no way marketing ourselves as competition. We are stepping in to fill the large gap that exists.
Just because the clinic in Sandpoint chooses to respect life does not make it a fake clinic. This clinic seeks to bring in physicians to provide prenatal care. They are bringing in OB-GYNs from Washington state, which has no restrictions on abortion. With this information taken into consideration, I ask you to reconsider any concerns about a clinic bringing board-certified OB-GYNs into an area where there is a shortage.
— James Heid, Vancouver, Washington
The Root of All Good
The article Claudia Boyd-Barrett wrote about how immigrant parents’ arrests are creating a mental health crisis for children was moving and brought awareness to the mental health challenges faced by them (Growing Up Scared: “Arrests of Immigrant Parents Create Mental Health Crisis for Children,” June 18). It was important to note how every story was different but focused on how much children missed and yearned for their parents to come back home. You also wrote about how it affected them by not having a parental figure in the home. That really touched me. Specifically, Jacob’s story and when he listed all the things he missed about his mom but especially being close to her.
I am currently a master’s student in social work working to become a better ally to the Hispanic immigrant community. I’ve seen how being afraid and sad over the immigration policies has affected my friends in this community. Losing a close parent and not being able to have that security with them anymore is hard to go through, and trauma affects children as they grow.
In this article, you have recognized the worth of a person, which is a core principle in social work. These children are worthy and have the right to feel taken care of and secure.
I would love to see more mental health services accessible to immigrant communities and their families. This would benefit children as they learn to cope with their feelings and how to make sense of a new world.
— Stacy Xiong, Athens, Georgia
Bagging a Bargain
Author Susan Jaffe mentioned GoodRx in the article “Thousands of Medicare Beneficiaries Thought Their Drug Plan Was Free. Then They Lost It” (July 7), but she failed to mention a much better discount drug site, Mark Cuban’s costplusdrugs.com, where a 90-day supply of 2.5 milligrams of rivaroxaban, a generic for Xarelto, is available for under $50. This could help the thousands of people who lost coverage through unpaid premiums from Wellcare Value Script obtain their medications. The problem of yearly increasing penalties for losing Part D coverage is something that has to be addressed by the Centers for Medicare & Medicaid Services.
Thanks to KFF Health News for the relevant coverage.
— Jackie Button; Miami
Fleshing Out the Details
Your report identifying alpha-gal syndrome as a red meat allergy is accurate in that respect but inadequate in its breadth (“Would Hunters Take a Lyme Disease Vaccine? We Asked,” June 30). Alpha-gal is an allergic reaction to virtually all mammalian products. If you explore that, you’ll find an interesting story, as mammalian products are everywhere, including in pharmaceuticals, cosmetics, and other non-meat products. Alpha-gal is growing rapidly, and too many people, including doctors, do not realize that AGS is far worse than just a red meat allergy.
I suggest you help build understanding of the threat by describing the allergy in the future as an allergy to mammalian products. If you do not think your audience will understand that term, perhaps you can explain that it includes pork and anything derived from animals with hooves. As a former and now retired reporter, I encourage you to cover this allergy because its implications are surprising and scary.
— John Varner, Surry, Virginia
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.This <a target="_blank" href="https://kffhealthnews.org/letter-to-the-editor/reader-response-deadly-denials-pregnancy-centers-glp1-july-2026/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="https://kffhealthnews.org/?republication-pixel=true&post=2259597&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">July 15, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 15, 2026RoseHealth News, KFF Health NewsNo commentsAs the Trump administration’s January deadline looms for states to enforce new Medicaid work requirements, some state lawmakers are turning the tables by pushing to publicly name the largest companies that have employees enrolled in the government program covering low-income and disabled people.
California lawmakers seek to revive an expired law that would require the state to identify companies that employ 100 or more people and have employees enrolled in Medi-Cal, the state’s Medicaid program. Nevada has had a similar law in place since 2017, though a proposal for one in Oregon stalled when its legislative session ended in March.
The California bill author, Democratic state Sen. Lola Smallwood-Cuevas, said she is deeply troubled by what is going to happen when work requirements kick in. According to the state, nearly 5 million out of more than 14 million residents on Medi-Cal will be subject to the rule.
“We think this is a bill that’s about fairness,” Smallwood-Cuevas said. “It’s a basic principle that taxpayers deserve transparency about which large employers are shifting their healthcare costs onto the public.”
Large employers that regularly top Nevada’s list, such as Walmart and Amazon, have said that the state included part-time and seasonal workers in their counts and that their full-time hourly employees make too much to qualify for Medicaid.
Walmart spokesperson Katrina Proffitt said that the company offers affordable medical coverage to most employees, including eligible part-time workers, and that most of its plans include no-cost virtual care options.
“Healthcare affordability and access to quality care remain real barriers for many Americans, and Walmart continues to be committed to being part of the solution,” Proffitt said.
The push to name and shame companies reflects dueling narratives about the biggest abusers of the joint state-federal Medicaid program, which reached nearly $932 billion in government spending in 2024. The Trump administration, led by Centers for Medicare & Medicaid Services Administrator Mehmet Oz, has called out blue states for not doing enough to fight insurer fraud and abuse. State Democratic leaders, meanwhile, are pushing back by calling attention to big employers that don’t offer affordable health benefits, which leaves taxpayers subsidizing healthcare costs for the low-wage workforce.
Some states have considered financial penalties. Democratic New Jersey Gov. Mikie Sherrill signed a bill in June to fine businesses that have at least 50 Medicaid-enrolled employees. Companies with 50 to 249 workers on Medicaid will pay $325 a year per person, and those with at least 500 will pay $725.
Bills that would have penalized companies with workers enrolled in Medicaid failed in Washington state and Colorado this year.
In Sacramento, California, Democrats want to figure out a way to make large businesses pay for their employees’ health coverage. State lawmakers struck a deal with Democratic Gov. Gavin Newsom, who is contemplating a presidential bid as he wraps up his final year in the governor’s office, to explore tax options. Any tax hike would be up to the new governor.
States face losing billions of dollars under HR 1, the GOP tax-and-spending law known as the One Big Beautiful Bill Act, notably through a provision that requires nondisabled Medicaid enrollees ages 19 to 64 in most states to prove they are working, volunteering, or going to school at least 80 hours a month to keep their coverage.
Yet federal work requirements are projected to increase the number of uninsured people nationwide by more than 5 million by 2034, according to the Congressional Budget Office. Nebraska and Montana have begun enforcing the rule.
One health policy researcher said employer Medicaid reports highlight the lack of affordable healthcare options available to low-wage workers. More than half of adults enrolled in Medicaid who don’t have dependent children already meet the 80-hour-a-month requirement or face challenges that would likely qualify them for an exemption, according to KFF.
“There’s a whole set of people who are working — they may not satisfy the work requirement provisions, they may not get the exemption that they’re qualified for, and they don’t have access to that employer-sponsored insurance either,” said Edwin Park, a research professor at the Center for Children and Families at Georgetown University.
Employers Push Back
While employer lists haven’t succeeded in bringing down Medicaid costs, supporters say measuring the burden can be the first step and help lawmakers make the case for further action.
In Nevada, Amazon has employed more Medicaid enrollees than any other company since 2020, according to the state’s report published in January. For state fiscal year 2025, Walmart, the Clark County School District, the state government, and Tesla rounded out the top five.
Employers have argued that the reports are misleading because they have included part-time and seasonal employees. The state’s latest report includes only full-time employees, plus those who could not be confirmed as either full- or part-time employees.
That came to 4,914 Amazon employees and 3,503 Walmart workers in Nevada on Medicaid in 2025.
There are no penalties for companies on the list.
Amazon said it pays its workers more than double the $7.25-an-hour federal minimum wage and noted that Medicaid eligibility is based on household income and size rather than an individual’s wage. That means two employees who earn the same pay may have different eligibility depending on whether they have children or live with parents.
“Pointing fingers at Amazon over Medicaid is a red herring,” said spokesperson Alisa Carroll. “What really needs to happen is a significant and large increase in the federal minimum wage — that would be a big boost for American families.”
Nevada Medicaid spent nearly $950 million on healthcare for more than 133,000 full-time employees and more than 140,000 of their dependents. While the total amount spent dipped in fiscal year 2025, the average cost per member per year increased by nearly 17%.
Yvanna Cancela, a former Nevada lawmaker who sponsored the legislation on Medicaid work reports, said the annual reports force an important conversation “about whether or not this is the kind of economy we want and whether or not it is right or just that people who work full-time don’t make enough to have health insurance.”
A Fraying Safety Net
Health researchers say that uninsured people delay or skip using healthcare and that their children may end up losing coverage, too.
One analysis found that more than 2 million fewer children were enrolled in Medicaid and the Children’s Health Insurance Program this April than in January 2025. California is among the states with the steepest enrollment losses among children.
The loss in healthcare coverage among residents will be compounded by the loss of public food assistance benefits, Smallwood-Cuevas said. Her bill is pending in the legislature.
She compared Medi-Cal to a trampoline that has become a “very tattered kind of fishnet” overwhelmed by people falling into it. President Donald Trump’s spending-and-tax law pulls and rips at the safety net, she said.
When people lose food assistance and health benefits, they must choose between paying for medicine and paying for rent, Smallwood-Cuevas said.
“We’re going to see more people in their cars, more people on the street, and a lot more people in the emergency room,” she said. “That is dangerous for all of California.”
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.This <a target="_blank" href="https://kffhealthnews.org/medicaid/medicaid-work-requirement-big-business-employee-enrollees-states-name-shame/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="https://kffhealthnews.org/?republication-pixel=true&post=2258056&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">July 15, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 14, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 14, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 14, 2026RoseHealth News, KFF Health NewsNo commentsWhen Gov. Gavin Newsom, using his executive power, refused to extradite a physician accused of prescribing and mailing abortion pills to a Louisiana woman, he said California would “not ever” allow “extremist politicians” to punish its doctors.
Newsom, who is considering a run for president, has long championed reproductive rights, but state lawmakers in the Democratically controlled California legislature know future governors might not have the same political beliefs.
Republican gubernatorial candidate Steve Hilton, a former Fox News host endorsed by President Donald Trump, has vowed to honor these types of extradition requests from other states if he’s elected, saying that Louisiana “is trying to uphold what its people voted for, and California is undermining it.” His opponent, Democrat Xavier Becerra, has said he would deny the requests.
Legislation advancing in Sacramento is the latest chapter in a tit for tat that’s been happening between conservative and liberal states since 2022, when the U.S. Supreme Court overturned Roe v. Wade, ending federal legal protections for abortion.
A bill by state Assembly member Rebecca Bauer-Kahan, which is being heard in committee, would take some decisions out of the governor’s hands, requiring governors to deny extradition requests for healthcare providers who prescribe abortion medication or administer gender-affirming care. It would also shield anyone in California who helped patients travel to California or another state to receive legal care. While opponents cast “shield laws” as an incursion on other states’ authority, supporters of the bill view it as insurance — even with Becerra leading Hilton 52% to 31%, according to May polling by the University of California-Berkeley Institute of Government Studies.
Newsom spokesperson Marissa Saldivar said the governor doesn’t comment on pending legislation. Hilton and Becerra didn’t return calls for comment.
“Protecting providers from prosecution should not rely on shifting political winds or a single person’s decision,” said Alyssa Sherer, a nurse practitioner who spoke in support of the bill at a Senate committee hearing in June. Sherer is also the medical director at Hey Jane, a telehealth medication abortion provider.
Thirteen states have banned abortion outright, and 28 other states ban abortion somewhere between six weeks and viability. At the same time, other states that allow abortion have enacted shield laws to protect doctors and nurses from liability when they prescribe across state lines.
People living in states with total abortion bans are increasingly getting abortion pills prescribed via telehealth, from 74,000 abortions in 2024 to 92,000 abortions in 2025, according to the Guttmacher Institute, citing numbers from its Monthly Abortion Provision Study.
Critics of shield laws say that states have a legitimate interest in enforcing their own statutes and that such laws represent an attempt by some states, like California, to nullify the legal decisions of others.
“If California says, ‘We’re not going to honor any other state’s laws. We’re going to ship abortion pills into your states. You can’t have a law that says abortion is illegal,’ I don’t know — that doesn’t seem like a workable situation,” said Greg Burt, who is vice president of the California Family Council and has spoken in opposition to shield laws at the State Capitol.
Twenty-one other states and Washington, D.C., have similar shield laws, but Arizona, California, Michigan, North Carolina, and Pennsylvania’s rely on an executive order, which could be reversed by a successor, according to the Guttmacher Institute.
Amanda Barrow, a senior staff attorney at the Center on Reproductive Health, Law, and Policy at UCLA Law, said passing extradition protections would put California on firmer footing, because an executive order “could be revoked by a governor who is anti-abortion or anti-gender-affirming-care.”
Hilton has said he would do just that if elected.
“Just as I wouldn’t want to see Louisiana coming in and undermining something that we voted for here in California,” the GOP candidate told KQED in January.
During a May gubernatorial debate, Becerra said he was strident about protecting reproductive rights as the state’s attorney general. “Absolutely no,” Becerra said of allowing California physicians to be extradited.
This year, Hawai‘i added gender-affirming care to its existing shield laws. And Oregon expanded extradition protections, including banning law enforcement from cooperating with out-of-state or federal investigations into care that’s legal in the state.
But Republican legislators in conservative states have cast telehealth visits as an end run around their laws. And some have moved to restrict abortion pill access.
The governors of Mississippi, Oklahoma, and South Dakota have signed bills this year that criminalize the sale, purchase, or distribution of medication that induces an abortion. Those states make it a felony to provide medication abortion drugs to people who are seeking to end a pregnancy. The laws impose up to 10 years in prison with potentially tens of thousands of dollars in fines.
Mississippi amended the state’s controlled substances code to add abortion pills as a criminal category. Although the state already prohibits abortion broadly, the measure specifically addresses distribution, which could subject out-of-state providers to prosecution.
In January, Louisiana tried to extradite a California doctor, Remy Coeytaux, accused of mailing abortion pills to a patient. Newsom denied the request. Likewise, New York Gov. Kathy Hochul denied Louisiana’s February 2025 extradition request for a doctor in her state.
Texas has taken a slightly different legal tact. Attorney General Ken Paxton, a Republican running for the U.S. Senate, obtained a default judgment of more than $100,000 against the New York doctor targeted by Louisiana, but a judge dismissed it, citing New York’s shield law. Neither Paxton nor Louisiana Attorney General Liz Murrill responded to requests for comment.
Fear of being charged with a crime for providing quality medical care is contributing to physicians leaving medicine, said Sacramento emergency room doctor Kamara Graham, who is vice president of the California chapter of the American College of Emergency Physicians, which is supporting the bill.
“It’s really conflicting and hard for us to weigh that concern of: Will I get extradited and charged and potentially be taken away from my family? Or do I do the right thing for my patient?” Graham said.
The availability of medication used in most abortions could soon change nationwide. Under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., the Food and Drug Administration recently confirmed it is conducting a safety review of mifepristone, one of two medications in pill form that is used in most U.S. abortions. The FDA maintains the drug is safe and effective.
If the FDA were to decide that mifepristone is not safe, such a ruling would supersede state laws, even in states where abortion is legal. If mifepristone is restricted, many telehealth groups have said they would switch to using only the other medication, misoprostol.
“The elephant in the room is whether the Trump administration, particularly after the midterms, makes some kind of move to put national limits on access to abortions,” said Mary Ziegler, a law professor at UC-Davis who has written several books on reproductive health law.
“Not everything is something that the legislature can solve for,” Ziegler said, “because there’s some uncertainty about how the federal courts are going to react to all of this.”
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.This <a target="_blank" href="https://kffhealthnews.org/courts/shield-laws-abortion-pills-extradition-doctors-governor-california-newsom-hilton-becerra/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="https://kffhealthnews.org/?republication-pixel=true&post=2257779&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">July 13, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 13, 2026RoseHealth - The New York Times, NYT > HealthNo commentsJuly 13, 2026RoseHealth News, KFF Health NewsNo commentsSACRAMENTO, Calif. — Sen. John Kennedy of Louisiana is taking aim at California’s Medicaid program for providing housing assistance, food, and other social services to high-need, low-income patients who tend to rack up big healthcare costs and, he argued, strain taxpayer funds.
The Republican blasted California during back-to-back political attacks in May, saying the heavily Democratic state is committing “outrageous fraud” and “stealing” by spending state and federal Medicaid money meant for basic medical treatment on unconventional services such as housing and nutrition assistance, gym memberships, and even tribal prayers and, he claimed, exorcisms.
“The California Medicaid program will pay for herbal medicines, meal deliveries. They’ll pay for housing,” Kennedy said. “I don’t know what housing has to do with healthcare.”
“California, they’re just setting all kind of records,” he added. “They’re wild people.”
Despite criticism from congressional Republicans and growing scrutiny from the Trump administration, Gov. Gavin Newsom, a Democrat considering a presidential run, said he’s proud of California’s spending on social services in Medi-Cal, the state’s Medicaid program. It’s a multibillion-dollar experiment to help medically frail patients meet their housing, food, and other social needs that Newsom says is not only legal but also a more cost-effective and evidence-backed approach to providing healthcare for Californians with complex health conditions. He counters that investing in services outside clinical settings can help people avoid emergency rooms and hospital admissions, improve their long-term health, and ultimately save taxpayers money.
“It’s about whole-person care,” Newsom said, adding that he hopes President Donald Trump’s administration sees California’s leadership and agrees with the “reforms we’re advancing as national best practices.”
Now one of the governor’s marquee health initiatives is at the center of an intensifying partisan battle with Republicans in Washington, D.C., who have moved to rein in billions in healthcare spending on low-income and disabled people across red and blue states. It’s a philosophical divide: Conservatives say social services are a financial strain on Medicaid and shouldn’t be considered healthcare, while liberals argue that investing in prevention ultimately saves money. While experiments proliferated across the country under President Joe Biden, the Trump administration has rescinded federal policy encouraging state Medicaid programs to address health-related social needs.
The Medicaid fight is putting patients in limbo.
Lucy Rodriguez teaches Mexican folk dancing in the town of Hollister, in California’s Central Coast region. She said her life turned around this year once an intensive case manager with Titanium Healthcare, which contracts with health insurers to provide services, began helping her manage her chronic diseases and stay on top of her medical appointments and prescriptions, even picking up free food boxes for her. The 73-year-old is on Medicare and Medi-Cal, which offers more extensive benefits. The low-income health program has helped pay her utility bills, and she was recently approved for home-delivered meals.
“This has been a godsend,” said Rodriguez, who has diabetes, high blood pressure, and kidney disease. “I was getting so stressed out and depressed. It’s really hard when you’re on a fixed income. Groceries are so expensive, and with summer, electricity gets even more expensive. But this is really improving my life.”
She worries the Trump administration will cut benefits to low-income older people.
Last year, the Centers for Medicare & Medicaid Services warned states that federal funding for social services would be determined on a case-by-case basis. CMS spokesperson Christopher Krepich said the agency is not ending current agreements, known as waivers, that grant states temporary permission to provide social services, which are paid for with state and federal dollars. But future applications, for new services or to extend existing initiatives, could be at risk if they veer too far from traditional healthcare.
“Moving forward, CMS will work with states on innovative waivers that address core healthcare needs, as consistent with evidence-based approaches tied to clinical diagnoses and services, to the goal of ultimately improving health outcomes in the Medicaid population,” Krepich said in a statement.
In a further escalation, the Justice Department put out a recent memo allowing states to institutionalize people with disabilities and severe mental illness instead of providing community-based care. Republicans have also targeted states, mostly blue ones, for what they say is a failure to go after waste, fraud, and abuse in Medicaid. In May, CMS Administrator Mehmet Oz stood alongside JD Vance as the vice president announced the deferral of $1.3 billion in Medicaid money to California over suspicions of fraud.
California Attorney General Rob Bonta said Republicans are simply trying to score political points while ignoring the healthcare needs of poor people. “The federal government wants to politicize fraud,” Bonta said, “and use it, unfortunately, as a bludgeon and a cajole to beat up on blue states.”
Social Healthcare
Health policy researchers say roughly 80% of health outcomes are linked to socioeconomic, environmental, and behavioral factors, such as housing instability, homelessness, food insecurity, and exposure to violence, whereas 20% is associated with medical care delivered in hospitals and clinics. That evidence fueled the Biden administration’s efforts to tackle social services.
At least 24 states use their own money while drawing federal Medicaid funds for social healthcare experiments. Colorado, Massachusetts, New York, North Carolina, Oregon, and Pennsylvania are among those that provide housing and nutrition assistance.
As the Trump administration pulls back on social services, states are rethinking how to fund benefits that have improved preventive care for low-income people. Some have launched new benefits under what’s known as a state plan amendment, a mechanism states use to modify their Medicaid programs that doesn’t need federal waiver approval. Michigan and Minnesota, for example, use this to add recuperative care for homeless patients after hospitalization. These short-term care facilities offer people the opportunity to recover, bridging the gap between hospital discharge and independent living.
This approach “has the advantage of establishing a permanent, statewide benefit that does not require ongoing federal renewals, offering greater stability and predictability,” said Lynn Sutfin, a spokesperson for the Michigan Department of Health and Human Services.
Other states, meanwhile, rely on federal waivers, which require renewal every five years, to provide social services. Arizona officials said the state intends to submit a request by the end of September to continue its program to provide housing and other services to homeless patients, or those at risk of homelessness, with a serious mental illness and a chronic health condition or recent incarceration.
“When members have access to stable housing and supportive services, they are more likely to engage in ongoing care and less likely to experience avoidable emergency department visits and inpatient admissions,” said Roberta Harrison, interim director of the Arizona Health Care Cost Containment System.
California, which has been the most aggressive state in adopting social services, has taken a two-pronged approach to keep its vast offerings funded past this year. The state is using its authority to make most of its existing social services and benefits permanent in Medi-Cal managed-care coverage. That regulatory maneuver bypasses federal waiver approval — a move that could attract further Republican scrutiny.
But not everything the state offers can be funded without permission from the federal government. As some services are made permanent, the Newsom administration is seeking new waivers to continue other social services, while also adding more.
It’s an ambitious approach that would expand California’s social healthcare experiment. Newsom said he’s worried that the federal government will decline the latest waiver request. “How could you not be with this administration?” he said. “I’m always concerned.”
New Front in Healthcare
California offers most of its health-related social services under Biden-era waivers within Medi-Cal, which has a proposed budget of $217 billion. Although there are more than 14 million residents on Medi-Cal, the state has been selective about who gets help from 15 types of social services in its program, called California Advancing and Innovating Medi-Cal, or CalAIM. Patients with complex needs can also receive help navigating their health and social needs from specialized social workers under a benefit known as enhanced care management.
Since 2022, California has been offering social services, spending nearly $12 billion in joint state and federal money, with the hope of reducing long-term Medi-Cal spending by keeping enrollees out of costly institutions including emergency rooms, jails, nursing homes, and mental health crisis centers.
CalAIM had provided social services to more than 528,000 patients as of September 2025, the most recent state data available. And nearly 453,000 low-income Californians have received intensive case management. Some patients receive both services.
Among the services California is making permanent: Homeless patients can get help finding an apartment, with Medi-Cal paying rental security deposits and six months of rent. Patients with chronic conditions such as diabetes and heart disease are eligible for home-delivered meals. Asthmatic patients can get mold removed from their homes to control flare-ups. Low-income seniors with disabilities can get a wheelchair ramp installed free of charge. And inmates leaving jail or prison can be connected immediately with primary care, mental health, and substance use treatment.
The social services — especially housing, food assistance, and home modifications — are already demonstrating success in stabilizing the health of the most complex patients, while achieving savings for Medi-Cal through reductions in emergency room visits and hospitalizations and less reliance on institutional care such as nursing homes, according to the state Department of Health Care Services.
In the Central Valley, for instance, Health Plan of San Joaquin CEO Lizeth Granados said CalAIM has helped place homeless patients who were routinely hospitalized into housing. And patients with uncontrolled diabetes saw their blood sugar drop after receiving nutrition counseling and home-delivered meals.
Overall, Granados said, the health plan has seen major improvements in chronic disease management and reductions in hospital stays, dropping to 44 inpatient hospitalizations per 1,000 members since it launched in 2022, down from 61 per 1,000 before CalAIM.
In Orange County, officials with CalOptima Health credited CalAIM housing services for contributing to a nearly 27% drop in unsheltered homelessness. “We’ve been able to expand our street medicine programs, too,” said Yunkyung Kim, the insurer’s chief operating officer.
Around the state, Medi-Cal health insurers said they’re optimistic that CalAIM will continue to save money and improve patient health. Yet, the fate of some services will be decided by the Trump administration.
California has asked CMS to continue enrolling jail and prison inmates in Medi-Cal 90 days before their release to maintain consistent treatment for substance use, mental disorders, or physical conditions, a CalAIM service still in its early stages.
The state has also proposed a new job assistance benefit that counties could opt into to help patients find and retain work in response to upcoming federal work requirements imposed by congressional Republicans’ One Big Beautiful Bill Act, signed by Trump last summer.
And the state wants to continue its array of traditional healers and natural helpers for Californians with tribal affiliations, including music therapy, dancing, drumming, and referrals to sweat lodges for mental health treatment and substance use recovery. While it covers spiritual services, such as ceremonies, rituals, and herbal remedies, state officials said Medi-Cal does not cover exorcisms.
Already, the Trump administration’s positioning has forced the state to eliminate room-and-board benefits, which is threatening local efforts to provide recovery beds.
The state is cutting short-term post-hospitalization housing, which was meant to prevent hospitals from dumping homeless patients or those at risk of homelessness onto the streets. The CalAIM service providing up to six months of temporary housing and ongoing care is ending at the close of this year. And the state is cutting recuperative care benefits, no longer paying for beds for patients to recover from illness or injury, instead offering only wraparound services.
In San Francisco, these beds have been crucial in reducing overdose deaths, helping transition homeless people off the streets and into housing, and reducing hospital bed usage, said Neal Sheran, a medical director with the city’s Department of Public Health. The city’s health plan operates a sobering center, and recuperative care facilities where patients can recover from hospitalizations.
“We’re concerned,” Sheran said. “Funding for the overnight piece of these programs is really crucial to their success.”
Cuts on the Horizon
Even without federal threats, state budget pressures have strained CalAIM financing. Newsom has proposed reducing funding for social services by $68.3 million this fiscal year. The cut will deepen next year and remain at $150.2 million per year beginning in 2028.
Providers worry that Medi-Cal patients will lose access. And services, such as home-delivered meals and housing assistance, will be further restricted.
“It’s moving us back to the old days where our healthcare system is more expensive and reactive, instead of investing in prevention,” said Anwar Zoueihid, a vice president and the chief strategy officer at the Los Angeles-based Partners in Care Foundation, a CalAIM provider. “It’s contradictory to Make America Healthy Again.”
To save money, the state is tightening eligibility to limit services and reduce inappropriate use. For instance, Medi-Cal patients with food insecurity would no longer be eligible for home-delivered healthy meals without a qualifying condition like diabetes. And a homeless patient would get capped at six months for help finding an apartment.
Some of the biggest providers of CalAIM say services should be continuously evaluated and curtailed if health plans were too permissive. In some cases, food and housing services were given to low-income patients who didn’t necessarily qualify as the highest-need.
“It’s important everybody takes a look with a very sober view at whether we’re truly benefiting people so we’re spending money in the right places,” said Charlie Robinson, the chief health equity officer at L.A. Care, one of the state’s largest Medi-Cal health insurers.
Dorothy Seleski, the Medi-Cal president for Health Net, said the health insurer isn’t deterred by state and federal cuts.
“Regardless of what happens at the federal level, we are committed,” she said. “This is a significant transformation of the healthcare system, and we are already seeing major reductions in avoidable emergency room trips, avoidable hospital admissions, and we’ve closed gaps in preventive care.”
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