Health and Fitness Tips

Trump Team Claims Successes Against ACA Fraud While Pushing for More Controls

Complaints about enrollment fraud in Affordable Care Act health insurance coverage have bedeviled the federal marketplace for years.

Now, the Trump administration is claiming wins in reducing the problem while simultaneously saying more controls are needed.

It has proposed a sweeping set of ACA regulations for next year, including stepped-up requirements for some applicants to prove eligibility for subsidies or enrollment and new scrutiny of sales agents and marketing practices.

While there is a general acknowledgment that there is fraud in the ACA marketplace, some health policy analysts say these new requirements miss that mark and instead will make it harder for people who are eligible to enroll.

“There is a trade-off, particularly with the provisions focused on consumers, that maybe it will prevent some fraudulent enrollment, but also potentially a large number of valid applicants,” said Matthew Fiedler, a senior fellow with the Center on Health Policy at the Brookings Institution.

In its proposal, though, the administration expresses optimism that efforts already in place will continue to pay off, despite the fact that the number of complaints about unauthorized enrollment or switching rose to 341,906 in 2025, compared with 229,734 the year before Donald Trump took office. Still, according to the rule, “program integrity measures implemented during the past year,” along with the expiration of enhanced tax credits, “are likely to lead to a decrease” in complaints in 2026.

The end of those tax credits also means the amount people pay toward their coverage has increased. Data released Jan. 28 by federal officials showed a year-over-year drop of about 1.2 million enrollments across the federal healthcare.gov marketplace and those run by states. And a recent poll from KFF, a health information nonprofit that includes KFF Health News, found that of those who remained covered this year, 80% said their premiums or other costs are higher than they were last year, with 51% saying they are “a lot higher.”

Katie Keith, a director at Georgetown University’s O’Neill Institute for National and Global Health Law, said the administration was sending mixed messages, on one hand “talking about its fraud-fighting efforts” being successful, but releasing a proposed rule “that says we have to have all these restrictions on consumers because of fraud.”

Closing Consumer Windows

Last year, the Trump administration reversed some of the Biden administration’s ACA efforts, including eliminating a special enrollment period for low-income people that let them sign up year-round.

This year’s rule includes proposed changes aimed at preventing people from fudging their incomes — higher or lower — to qualify for subsidies.

For instance, applicants whose federal data shows they were previously below the poverty level — and thus not eligible for subsidies — would have to submit additional income verification to show they expect to earn above the poverty level in the coming year.

Another part of the proposed rule would require the federal marketplace, used by 30 states, to step up verification efforts for people who want to sign up outside of the ACA’s annual open enrollment period, for reasons including getting married, adopting a baby, or losing other coverage. Currently, the marketplaces conduct such reviews only when people say they qualify because they lost other insurance, according to an analysis of the proposal by Keith.

The income verification requirements “will be burdensome,” she said.

Some ACA applicants, especially those running small businesses or working several part-time jobs, find it more difficult to estimate or document their anticipated income and might find they’re prevented from getting subsidies, Keith and other analysts said.

These proposals are among policies reprised from last year’s ACA rule and initially intended to take effect in 2026. But several cities filed a lawsuit to challenge those regulations. The judge overseeing the case put the changes on hold pending its outcome.

In his order issuing a temporary stay, U.S. District Judge Brendan Hurson questioned whether the government adequately responded to questions about the accuracy of data it used in citing widespread fraud.

Additionally, many of the provisions purportedly targeting fraud are “unsupported by data showing that if enacted, they will, in fact, reduce any such fraud,” the judge wrote.

The proposal for 2027 has “new supporting information since the original policies were established” that includes clarifying what documentation is needed for some of the verification processes, Centers for Medicare & Medicaid Services spokesperson Catherine Howden said in an email. In addition, she said that CMS is now reviewing public comments that have been submitted before finalizing the provisions.

Targeting Fraud by Agents, Marketers

Critics of the ACA argue that more-generous subsidies put in place as a response to the covid pandemic, in addition to other changes during the Biden administration, led rogue brokers to enroll or switch people without their consent, seeking to collect commissions. That could be done easily, critics say, because with many plans, subsidies covered the entire premium. The lack of a monthly bill made it easier to sign people up without their knowledge — a long-running problem that ramped up in 2024. When that happens it can leave people unable to access their coverage or with tax bills they did not expect.

Those expanded subsidies have now expired, but the administration’s proposed rule would still add requirements for agents. For example, they would be barred from providing cash or most other freebies as incentives to enroll, have to use a standard consent form that must be signed by the consumer, and be held responsible if they hired a marketing firm that used questionable advertising to lure customers. That includes touting nonexistent gift cards or making websites look like official government ACA portals. Such websites would have to be removed.

“This would help ensure no additional consumers would see the advertisement and be misled,” the proposal says.

Insurance agents told KFF Health News that some of the proposals, such as delineating what counts as a misleading marketing effort, are good first steps but might not fully address concerns about unauthorized enrollment.

It doesn’t “address all the system vulnerabilities,” said Jason Fine, who runs a brokerage in Florida. He said he has filed more than 100 reports about unauthorized rivals accessing his clients’ coverage over the past two years but has yet to see any of those agents removed from the federal marketplace.

More than 850 agents had their certification suspended with little notice in late 2024 under the Biden administration, which said it was looking into complaints about them. The Trump administration told the Government Accountability Office in May that it had reinstated all or most of those agents to fulfill its “statutory and regulatory” responsibilities, according to a preliminary report from the independent oversight group. The report, which outlined long-running fraud problems in the ACA, noted that CMS would continue to monitor those agents and could take “further enforcement action” against them.

Another Biden rule, this one aimed at combating unauthorized sign-ups, remains in place and requires agents to have three-way calls with the client and a federal marketplace call center representative for some enrollments or plan changes.

But Fine and other agents said bad actors are finding ways around that requirement, including by faking that they are the customer during the calls. That contention is backed up in the administration’s new proposal, which notes that federal regulators have received reports that some brokers “may be using artificial intelligence to impersonate consumers and falsely attest to household income.”

Still, the proposal does not include some of the measures agents say would improve the situation.

Fine, for example, said the federal marketplace should more proactively flag unusual activity on consumer accounts, such as multiple agent changes or switches to new insurers within a short period of time, or changes made in the dead of night.

“Overnight is when a lot of this fraud occurs,” Fine said. “No one is changing their insurance at 4 a.m., and that should trigger an automatic fraud alert.” He also wants to see a proposal to rein in overseas call centers that contact U.S. residents — often repeatedly, sometimes making claims about free gift cards or other nonexistent perks — then send their information to agents looking to enroll them or switch their ACA plans.

Others, including Ronnell Nolan, president of Health Agents for America, have also long called for two-factor authentication, similar to what banks require, to confirm that enrollments or switches are approved by the consumer. The 20 states, plus the District of Columbia, that run their own marketplaces incorporate additional measures, including two-factor authentication, and have reported few of the types of problems that the federal market has seen, Nolan said. The administration’s proposed rule does not call for this protection.

A conservative think tank, the Paragon Health Institute, estimates there are several million fraudulent enrollments, but other groups — including the GAO, using a different methodology — have put the estimate far lower.

Based on its preliminary analysis, the GAO estimated there were “at least 160,000 applications in plan year 2024 that had likely unauthorized changes,” representing about 1.5% of all applications.

Meanwhile, Brookings’ Fiedler said the debate around the proposal highlights an ongoing question — not just how much fraud exists or what to do about it, but “how much government should help people get covered at all.”

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

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Kennedy’s Vaccine Agenda Hits Roadblocks, Diminishing His Clout

Health Secretary Robert F. Kennedy Jr.’s vaccine skepticism is posing challenges for the Trump administration. Top health jobs are unfilled, and a court has blocked his vaccine schedule changes.

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The Host

Julie Rovner KFF Health News @jrovner @julierovner.bsky.social Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

The Trump administration this week missed a deadline to nominate a new director for the Centers for Disease Control and Prevention. Without a nominee, current acting Director Jay Bhattacharya — who is also the director of the National Institutes of Health — has to give up that title, leaving no one at the helm of the nation’s primary public health agency.

Meanwhile, a week after one federal judge blocked changes to the childhood vaccine schedule made by the Department of Health and Human Services, another blocked a proposed ban on gender-affirming care for minors.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Bloomberg News, Lizzy Lawrence of Stat, and Shefali Luthra of The 19th.

Panelists

Rachel Cohrs Zhang Bloomberg News @rachelcohrs Lizzy Lawrence Stat @LizzyLaw_ @lizzylawrence.bsky.social Ready Lizzy's stories. Shefali Luthra The 19th @shefali.bsky.social Read Shefali's stories.

Among the takeaways from this week’s episode:

A federal judge ruled against the Trump administration’s declaration intended to limit trans care for minors, though the ruling’s practical effects will depend on whether hospitals resume such care. And a key member of the remade federal vaccine advisory panel resigned as the panel’s activities — and even membership — remain in legal limbo.
Two senior administration health posts remain unfilled, after President Donald Trump missed a deadline to fill the top job at the Centers for Disease Control and Prevention — and the Senate made little progress on confirming his nominee for surgeon general.
The percentage of international graduates from foreign medical schools who match into U.S. residency positions has dropped to a five-year low. That’s notable given immigrants represent a quarter of physicians, many of them in critical but lower-paid specialties such as primary care — particularly in rural areas. Meanwhile, new surveys show that more than a quarter of labs funded by the National Institutes of Health have laid off workers and that federal research funding cuts have had a disproportionate effect on women and early-career scientists.
And new data shows the number of abortions in the United States stayed relatively stable last year, for the second straight year — largely due to telehealth access to abortion care. And a vocal opponent of abortion in the Senate, with his eyes on a presidential run, introduced legislation to effectively rescind federal approval for the abortion pill mifepristone.

Also this week, Rovner interviews Georgetown Law Center’s Katie Keith about the state of the Affordable Care Act on its 16th anniversary.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Stat’s “The Potential Loophole in Trump’s Plan To Get Other Countries To Pay More for Drugs,” by John Wilkerson.

Shefali Luthra: NPR’s “Yep. A Mom’s COVID Shot During Pregnancy Protects Her Baby, a Large Study Finds,” by Tara Haelle.

Lizzy Lawrence: The Atlantic’s “The Meme-Washing of RFK Jr.,” by Nicholas Florko.

Rachel Cohrs Zhang: The Boston Globe’s “‘We’re on the Inside Now’: Meet the Man Building a Political Empire Behind RFK Jr.” by Tal Kopan.

Also mentioned in this week’s podcast:

Stat’s “National Survey of NIH-Funded Researchers Shows Precarious State of U.S. Science — ‘This Is Like the Titanic,’” by Jonathan Wosen.
KFF Health News’ “Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare,” by Sam Whitehead.
Guttmacher’s “Full-Year 2025 Estimates Show Overall Stability in Abortion Incidence, Decreased Travel and Increased Telehealth Provision,” by Isaac Maddow-Zimet and Kimya Forouzan.
United for Medical Research’s “2026 Update: NIH’s Role in Sustaining the U.S. Economy.”

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How to Turn a Chicken Egg Into a Drug Factory

A biotech start-up is testing a novel way of efficiently producing pharmaceutical drugs.

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Taking a GLP-1? Doctors Say Not To Forget About Movement and Mental Health

LISTEN: Taking a GLP-1? Doctors say don’t forget to move your body and tend to your mental health, too.

Severe ankle pain drove Jelon Smart to start taking a weight loss injection a year and a half ago.

Smart was 285 pounds and worked as a caterer in Savannah, Georgia. After she’d been standing on her feet for long hours, her ankles would be “as swollen as a football,” she said. She was walking with a limp. An orthopedic doctor diagnosed her with Achilles tendinitis and recommended losing weight to mitigate the symptoms. Smart began taking the brand-name GLP-1 Ozempic.

The appetite suppression resulted in her shedding pounds quickly, at first.

“I lost 30 pounds initially without changing anything,” said Smart, 48. But then she found herself unable to shed additional pounds.

GLP-1s have quickly become one of the most popular types of weight loss drug in America. Nearly 1 in 5 people have taken them at some point, according to research from KFF, a health information nonprofit that includes KFF Health News. But doctors say it takes more than a regular shot for patients to achieve their weight goals in the long run.

Here’s what to know.

The Old-School Rules of Weight Loss and Health Still Apply

Regular exercise, smart food choices, plenty of sleep — those basic, healthy lifestyle choices are not only going to help you lose weight on a weight loss drug but also help you keep it off, said Dafina Allen, an obesity medicine physician who runs a clinic in Saginaw, Michigan. For example, some people find that they eat less on a GLP-1, “but they’re not improving their health because they’re not exercising. They’re not improving the quality of the food they’re eating,” Allen said. The path to weight loss is also guided by hormones, metabolism, and genetics.

After her weight loss on Ozempic plateaued, Smart realized she needed to start moving her body, too. “I’m in the gym now six days a week,” she said. “I went from 285 to 175” pounds. The swelling and pain in her ankle went away as well.

Mental Health Matters, Too

The mind and body are deeply connected. Food and body image can be especially emotional, Allen said. “I can tell you about the patients that I helped lose 50 pounds, that I helped lose 100 pounds, and they still look in the mirror and are not happy.”

The key is seeking help for mental health along the way, said Gerald Onuoha, who practices internal medicine in Nashville, Tennessee. “Making sure that you’re talking to people about your problems, whether it’s a family member or a licensed professional, I think goes a long way,” he said.

Work With a Doctor To Closely Monitor Your Dosage

Onuoha said people can run into serious problems if they increase their GLP-1 dosage too quickly or don’t follow the recommended schedule. He’s seen patients come to the hospital with pancreatitis, gallstones, or acute kidney injury. “I always ask patients that are on GLP-1s: How long have they been on them?” he said. “Are they adhering to the directions? Because those things determine whether or not you’re going to have those complications.”

Part of the issue, Allen said, is that GLP-1s are relatively easy to access — and often much cheaper — through online pharmacies or websites, but those providers may not educate patients about their dosage or side effects. “So they might just go online, find a random company that will ship it to their house, where they don’t even know what dose of the medication they’re taking, or even if the medicine is safe for them as the patient with the medical conditions they have,” she said.

People and Policy

GLP-1 drugs can be costly, and most insurance programs — public or private — don’t cover the medications for weight loss. Medicaid, the government program that covers 69 million Americans, covers GLP-1s for medically accepted conditions like diabetes, but only about a dozen state Medicaid programs cover GLP-1s for obesity treatment, according to KFF. For older Americans with Medicare, the federal government is planning to allow temporary coverage of GLP-1s for weight loss starting in July.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and KFF Health News.

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Florida Restores Access to Low-Cost H.I.V. Medications After Uproar

A short-term funding bill enacted this week will ensure that more than 12,000 Floridians do not lose access to a program that helps pay for H.I.V. medications.

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Two States Sue Cord Blood Bank Over False Advertisements

The attorneys general of Texas and Arizona contend that Cord Blood Registry, which stores umbilical cord cells, profited from misleading new parents.

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An Arm and a Leg: Steep Health Care Costs Steer Americans to Tough Decisions

Health insurance is out of reach for millions of Americans this year. Many are making difficult decisions about how to pay for coverage amid the loss of Affordable Care Act subsidies and nosebleed-high premiums.

Attorney Nicole Wipp and skate-shop owner Noah Hulsman tell An Arm and a Leg host Dan Weissmann how they tried to balance their financial and physical health when they couldn’t find good options.

Wipp and Hulsman first spoke with KFF Health News senior correspondent Renuka Rayasam for the series “Priced Out,” which tracks how people are responding to skyrocketing health insurance costs.

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

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Emily Pisacreta Producer Claire Davenport Producer Adam Raymonda Audio wizard Ellen Weiss Editor Click to open the Transcript Transcript: ‘Not workable’: How two Americans picked a plan this year — or didn’t

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

Dan: Hey there. About a dozen years ago, Nicole Wipp was trying to spend less time running her law firm and more time with her son, who was in preschool. ?It was a work in progress.

And then she started feeling— a little off. ?Tired. Out of breath. Her doctor thought it was stress.

Nicole didn’t think so, but she soldiered on. And got worse. For months. Until one day— when she told her husband she just couldn’t get off the couch — he was like, you’re going to urgent care. An x-ray showed her whole left lung totally blacked out.?

Next stop, emergency room.

Nicole Wipp: They put a huge needle and shoved it into my back and drew out two liters. Imagine a whole two-liter of pop – I’m from Michigan, so I say pop – from your body. They draw a whole two-liter of liquid. And I felt so much better immediately. I was like, wow, I can breathe. Like, wow, this is so cool. But, um, it was sort of horrifying.

Dan: Nicole says she eventually got diagnosed with a rare lung condition

Nicole Wipp: It’s called lymphangioleiomyomatosis — LAMB for short.

Dan: But not before she’d spent a month in hospitals — hospitals, plural — and had multiple expensive surgeries.

Nicole Wipp: Minimum — my husband and I tried to like tally it all up, like look at all the bills afterward — and it was, minimum, a half a million dollars.

Dan: Which, because her husband’s job at the time provided good health insurance, didn’t break them.

Nicole’s condition hasn’t bothered her for years. But it’s not cured. It’s incurable.

And yet. This year, Nicole and her husband didn’t sign up for health insurance.

For more than 20 million people on Obamacare plans, the price of health insurance changed dramatically this year. Premiums skyrocketed just as subsidies got sharply reduced.

Some people faced horrifically stark new circumstances:

People who needed insurance to cover ongoing treatment: for cancer, for diabetes — treatment they literally could not live without — saw premiums jump by thousands of dollars a month, more than they could possibly afford.

And millions more got stuck taking gambles. Making messy, unsatisfying choices.

Our partners at KFF Health News have been talking with lots of those people.

They introduced us to Nicole. She and her husband could have paid for health insurance. But when rates went up, they did the math and decided not to. They’re generally healthy, and honestly have more financial cushion than most people.

If they need medical care — ordinary medical care, anyway— they think they’ll be better off just paying cash.

But they know they’re gambling: that 2026 won’t be the year Nicole’s condition flares up, or that some other catastrophe hits.

Our pals at KFF Health News also introduced us to this man:

Noah Hulsman: My name’s Noah Hulsman. I own and operate Home Skateboard Shop here in Louisville, Kentucky.

Dan: It’s Louisville’s only skateboard shop. It’s kind of a family business, kind of a community center, kind of a place Noah’s spent most of his 37 years.

Noah’s still paying for insurance — paying for protection against catastrophe. But because all he can afford this year is a bare-bones plan, he doesn’t have a way to pay for ordinary medical care. Which he could actually really use.

Noah Hulsman: So I’m kind of in a position right now… I need my left shoulder looked at, but I have an $8,400 deductible. Yeah.

Dan: We’ll get into that — it sucks. But first: I really want you to hear about this skateboard shop.

Noah Hulsman: When I tell the story, it almost seems like a movie or something. Like, somebody made this up.

Dan: Let’s go.

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

Here’s how Noah ended up a skater for life.

Noah Hulsman: So my grandmother, she opened up a skateboard shop in 1988 here in Louisville. It was called Skateboards Unlimited. She had a little skate park also behind it called Ottoman Skate Park.

Dan: Noah’s grandmother was not a skater. She’d been a nurse — but she had five kids, and Noah says she ended up more of a stay-at-home mom.

Noah Hulsman: And then with all the commotion that was always occurring, with all the friends in and outta the house, with having five kids and all these skateboarders that just started popping up, she just decided, you know what? Let’s like have a place for you all to go.

Dan: She opened Skateboards Unlimited — and a skate park behind it.

When her youngest son finished high school — and moved to the West Coast as a professional skateboarder — it was the end of an era. And the beginning of another.

Noah’s grandma closed up Skateboards Unlimited.

Noah Hulsman: And uh, that’s when one of her employees was like, you know what? We gotta keep having a skate shop.

Dan: They called it Home Skate Shop. Noah became a regular customer, eventually an employee. And — ten years ago, when he was 27, — he took over the business.

Noah is as invested as anybody could possibly be.

Noah Hulsman: It’s everything. It’s my whole life. Yeah.

Dan: It’s doing OK. There were a few rocky years early on — Noah says he qualified for Medicaid. But things actually picked up when the pandemic started.

Noah Hulsman: Skateboarding was one of the only things that you do by yourself. You’re doing it outside. If I would’ve been able to get a hold of more product, we would’ve, we would’ve killed it.

Dan: Noah got an Obamacare plan, and he even bought a building — he leases out a couple of apartments, runs an air bnb in a third one, and says he breaks even on it, right now..

Noah Hulsman: They say, you know, real estate is a long term game.

Dan: Noah’s a long-term kind of guy.

\He and his girlfriend have been together for 16 years — even while she was away at veterinary school.

Noah Hulsman: She just finished up at Auburn this past year and moved back home and yeah, it’s been awesome.

Dan: Now they live together — with their four cats — in an apartment less than a mile from where his grandma started her skate shop.

But it’s not a cushy living. Noah says he takes odd jobs and gives skateboarding lessons to make ends meet.

Noah Hulsman: Every single day is a hustle. There is no day, like you can’t get sick, you can’t be– no downtime. If you take vacations, you’re still working from your phone, you’re checking in on the shop.

Dan: Noah says his income — all in — has been holding steady at around $33,000 a year. Last year, with a subsidy, he was able to get a gold plan for about a hundred and five dollars a month.

For 2026 — with premiums jacked up and subsidies cranked down — that gold plan would have cost him an extra $500 a month. That’s $6000 a year. Way more than he could afford.

Instead, he picked a Bronze plan. It leaves him paying pretty much exactly the same every month as he did last year, but it covers so much less.

Noah Hulsman: I don’t even know why I’m paying that. It’s useless really, unless I get into a car accident and I have $10,000 worth of bills.

Dan: Or a skateboarding accident. Or a serious illness. Anything.

He’s holding onto the plan as a backstop against a worst-case scenario, against ending up with more debt than he could ever pay back.

But having a backstop is not the same as having access to medical care.

A few months ago, Noah says his left shoulder started bothering him. He says it doesn’t stop him from day-to-day stuff, running the shop. But it does impose limits.

Noah Hulsman: It’s those like quick movements. It’s those like blast-off times like when I’m popping on my skateboard or when I’m like turning a certain like front side and like throwing all my weight that way.

Dan: His bronze plan — with its $8400 deductible — means he can’t afford to get it checked out.

Noah Hulsman: To go through, okay first you have to go see primary care, then they gotta do the x-ray. Then once you see the x-ray, oh, we can’t tell anything from the x-ray. Yeah, we know because it’s ligaments and tendons and muscles and things like, I’m not a doctor, but I’ve been through this a few times. So, okay, we’re gonna get you the MRI. All right. Here’s the MRI. None of that’s gonna be covered.

Dan: It sounds like thousands of dollars to Noah — to me too, really. And that’s before getting it treated, which could mean surgery.

Noah doesn’t have thousands of dollars lying around. If he did, he would’ve paid up for the gold plan.

So he’s avoiding tricks that could irritate the shoulder,

Noah Hulsman: I can still skateboard. I just have to choose what tricks or what obstacles. I don’t have like the freedom that I had when I used to ride my skateboard.

Dan: He’s hoping he can nurse the injury along till next year, when he thinks he could afford better insurance.

Noah Hulsman: What I’m kind of planning on doing is my, my shop vehicle is about to be paid off next year or like at, at the, I think it’s like middle of next year. And that payment is basically what that gold plan payment is.

Dan: Yeah, yeah,

Noah Hulsman: That’s what’s probably gonna happen. That’s my new car payment. New shoulder payment.

Dan: Man, that super sucks. I mean, grimly hilarious

Noah Hulsman: Yeah. Yeah. I mean, if this, you have to just laugh at how ridiculous the world is these days. There’s, I mean, if you just take it serious, doom and gloom all the time, it’s going to, you’re not gonna make it. You gotta just laugh these days. It’s so ridiculous.

Dan: It is. Noah is far from alone. A Gallup poll taken in late 2025 found that more than a quarter of all Americans had postponed surgery or medical treatment because of cost.

Being insured and having access to medical care — for lots of people, they haven’t been the same for a long time.

This year, especially for people using Obamacare, that’s accelerating.

We don’t know yet how many people made choices like Noah’s, and moved to plans that cover less, in order to have a monthly payment they could kind of afford.

Federal numbers won’t be out for a while. But an analyst named Charles Gaba ran some preliminary numbers from a few states.

He found that the number of people in Silver and Gold and Platinum plans was down significantly. And the number of people in Bronze plans, the cheapest, was up dramatically.

And we do know that at least a million people have dropped Obamacare. Some have dropped insurance altogether. Including, of course, Nicole Wipp.

We’re coming back to her story, just ahead.

This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom reporting on health issues in America. The reporters at KFF Health News do amazing work — win all kinds of awards every year. And in a little while, you’ll meet the KFF reporter who introduced me to Noah Hulsman and Nicole Wipp.

Dan: Before Nicole Wipp knew that her Obamacare rates would be going up, she knew she was pissed at what she calls the insurance industrial complex.

Nicole Wipp: So my son. Just for example, we took him— called in advance, ‘do you take our insurance?’ Took him to get basic well child vaccines. Well, next thing I know, I got a bill for $4,000. I called them up and was like, what is this?

Dan: She says that was early 2025, and she’s been fighting ever since.

Nicole Wipp: They’ve cut it down to like 1200, but I’m like, no, no, no, no, no. It should be a hundred percent covered under our insurance, So that’s the thing is like, why would I participate in this?

Dan: And at least since her half-a-million-dollar medical adventure Nicole Wipp has been pretty determined to live life on her own terms.

Even before her illness, she had already been trying to spend less time running her law practice and more time with her family.

Then, after the illness, she more than doubled down on that. On her website, she says she went from working 80 hours a week to working just five days a month.

That’s the website for a new business she started after her recovery: a consulting and coaching practice that offers to help people achieve financial success on their own terms.

Nicole Wipp: Financial success for me is very much not just about money, it’s really more about quality of life and having enough money to have that quality of life.

Dan: So, for instance, about four years after her illness, Nicole’s family moved from Michigan to Hawaii.

Nicole Wipp: We said, we want to live in Hawaii because we wanna have a quality of life. And of course, living in Hawaii is not cheap. It’s one of the most expensive places in the United States to live.

Dan: But that’s what they wanted. And they made it work.

And then their son got into polo. Like, with horses. Which is harder to do in Hawaii— to do seriously, competitively — without a lot of traveling to the mainland. So they moved again, to South Carolina.

Nicole Wipp: And we did, by the way, when we moved back to the mainland, FedExed four horses from Hawaii

Dan: Oh my God.

Nicole Wipp: I know, and like when you say, all these things, it sounds insane, right? It is insane.

Dan: Since then, she says they’ve picked up another four horses.

Nicole Wipp: Now we have a total of eight, which is a lot, a lot by the way. Um, and so, you know, I say it out loud and I’m like, oh, I’m not proud of this, to be honest with you. But, but we have also though made other choices like we live in a smaller home than we would otherwise, so that we can do that.

Dan: And that home is in a part of South Carolina where houses aren’t super- expensive. So Nicole says the mortgage on their house is less than the $1400 they would’ve been paying if they’d kept their insurance this year.

The expensive horses, the less-expensive home…

Nicole Wipp: Like these are choices that we’ve made as a family that I understand very much that most people would never make these choices, but we’re doing it in as responsible of a fashion as we possibly can.

Dan: A few years ago, her husband changed careers— no more job-based health coverage. They started buying insurance on the Obamacare exchange.

But by mid-2025, it started looking like that insurance could get a lot more expensive. Not because they’d lose a subsidy — they hadn’t qualified for a subsidy to start with.

But if subsidies went away, she figured rates would go way up.

Nicole Wipp: I started bringing it up to my husband. Like, I don’t know what this is gonna look like. I’m very worried about it. And we may be in a situation where we need to make a choice

Dan: Could they contemplate doing without insurance?

Nicole Wipp: And so we had probably, you know, 20 conversations, at least, about it.

Dan: Before making a decision — even before 2026 rates got posted — Nicole and her husband started taking some steps. She scheduled a colonoscopy, and went to the dermatologist for a skin check. Her husband got some tests too.

If they didn’t have insurance next year, those tests wouldn’t be covered. And if any tests came back with scary results, insurance would be more important.

Obamacare premiums for 2026 got published. Their family’s rate would go up by about 50 percent.

Nicole Wipp: Once the numbers came out, I was like, I just don’t know if this makes sense.?But we were like, okay, we need to gather more information. We need to think about it some more.

Dan: Their tests had come back OK. And they felt fine. Maybe they wouldn’t need any medical care in 2026, or not much. But maybe they would. How might they pay the bills? They kept talking. And they identified some ideas.

For one thing, Nicole found some money socked away in a health savings account from her husband’s old job.

Nicole Wipp: It’s not a lot, but it was like, oh, that’s a nice little cushion. Like we could use that if we needed it.

Dan: Nicole figured, if they were paying cash, she’d be in a good position to negotiate with providers for discounts.

Nicole Wipp: Because I’m a lawyer and I’ve been around the block on these things, so I had a lot of faith that I could negotiate a bill.

Dan: And she had other ideas for finding deals.

Nicole Wipp: I was like, you know, depending on what the situation is, we could fly to another country, receive healthcare quality healthcare. It still would be less. And I am not above doing that.

Dan: And if all of that required more cash than they had lying around, Nicole figured, they still had options.

Nicole Wipp: We have certain assets that in an extreme emergency we could sell – I mean, because it’s not just the horses. We have horse trailers and like, you know, there’s a lot that goes along with all of that that isn’t just the horses by the way.

Dan: None of which made the decision easy. Nicole says she and her husband didn’t fully decide until the actual deadline came for signing up. Even then, they knew they were gonna keep their son insured.

Nicole Wipp: I would be in my opinion, not responsible as a mom, so… because he does play a very dangerous sport.

Dan: But for the adults, they weighed the risks, and decided to gamble.

Nicole Wipp: If I take that money and invest it instead of putting, I don’t know, am I gonna be out further ahead? I will if I don’t have a massive emergency and a half a million dollar illness. Um, right? And so it’s a gamble, like, right? All of this is a gamble, but it was a gamble that I was like, I just don’t want to participate in this any longer because this is not workable for almost anybody, but it certainly isn’t workable for me anymore mentally or emotionally.

Dan: Not workable for almost anybody.

[Music transition]

Renu Rayasam: I mean, I also think about this as a reporter. We have these individual stories. What do they mean? First of all, why is this system like this and what does it mean for everyone?

Dan: That’s Renu Rayasam. She’s a senior correspondent with our partners at KFF Health News. She introduced me to Nicole and to Noah. She and her colleagues have been talking with dozens of people about the choices they’ve been forced to make about insurance this year.

?And thinking about what those individual stories mean has led Renu to some big reflections.

Renu Rayasam: I think sometimes in the US you take for granted the way things are. Just you don’t, you don’t realize there is another way, you know? There is another way! And um, and that’s where everybody has health insurance and those costs are better spread out.

Dan: Renu is speaking in part from experience. She spent a half-dozen years living in Germany. We talked about her experience— and how it affects the way she sees stories like Nicole’s and Noah’s.

Renu Rayasam: ?Well first of all, it was kind of amazing to like never get a medical bill. Like that was like, like so mind blowing that you just, like, you go to the doctor and you never get a bill.

Dan: Not because the government pays for health care. But because the government requires everybody to have health insurance.

Renu Rayasam: People pay premiums. ?You have to pay into the system. And it’s not necessarily cheap either.??But then on the back end, you’re never worried about, oh, my shoulders hurt, I have to get this MRI and I’m gonna get a bill.

Dan: ?Most people pay a government-set rate — about 15 percent of their income. Most insurance funds are non-profit. Everything’s highly regulated, and everybody gets the same benefits. Here, things are … more chaotic. Less predictable. People have to make hard choices— and those choices feed back into the chaos.

Renu Rayasam: So if somebody like Nicole opts out of health insurance, they’re not paying into this system and the people who are paying into the system are people who need care. And so that makes health insurance more expensive generally.

Dan: Because insurers set their rates based on how much they expect to pay out. When healthy people bail, the rates go up. And when rates go up, healthy people bail. They reinforce each other. It’s what experts call a death spiral.

As some of those experts told Renu, a version of that happened over the last year. ?It wasn’t a coincidence that insurers jacked up prices when subsidies were on the chopping block.

Renu Rayasam: Part of the reason that insurers raised their prices was because they expected people to drop plans and that fewer people would be paying their premiums and be paying into the system.

Dan: And people like Nicole and Noah ended up with lousy choices to make.

Noah chose to keep paying for insurance as a backstop against absolute financial catastrophe — even though the insurance he can afford doesn’t give him access to medical care he needs.

Nicole and her husband think they’ve got the resources to pay for ordinary medical care. Even maybe a big medical deal — as long as there was time to hop on a plane and get to a country where they could afford treatment.

But they’re not protected against the worst. Nicole knows bankruptcy is a real possibility.

Nicole Wipp: We don’t have a guarantee. And it still weighs on me every day that I made this choice because it feels fraught. Do I regret it? No, not at the moment. I don’t. Will I regret it? I hope not.

Dan: Hmm.

Nicole Wipp: I don’t know though.

Dan: Yeah, you’re not like, I did it. I’m free, you know, this is the best. It’s like, no, you’re not free of it.

Nicole Wipp: No, I don’t feel free at all.

Dan: I wish I had a snappier ending to this story. We are more stuck than ever — all of us — making messy choices, hoping for the best. So I’m gonna give Noah the last word here.

He’s taking his own advice: Taking things as they come, recognizing what’s ridiculous, and aiming to hang in there for the long term.

Noah Hulsman: ?Hopefully we, you know, get enough equity in this building that once it’s time to pass the skateboard shop on, maybe sell the building and hopefully that’s when we get to maybe cash out and go to the beach.

Dan: Wow.

Noah Hulsman: ?Maybe. Or maybe I’ll just get to pay off my medical debt that I’ve accrued over however many years at that point.

Dan: We’ll be back in a few weeks with a new episode. Till then, take care of yourself.

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

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions.

Claire Davenport is our engagement producer.

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

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

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

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

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

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

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

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

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

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“Me engañaron”: agentes encadenan a un padre que había ido al ICE a reunirse con sus hijos

En diciembre, Carlos llegó a una oficina del Servicio de Inmigración y Control de Aduanas (ICE) en Nuevo Mexico creyendo que estaba a un paso de reunirse con sus hijos. En ese momento, su hijo de 14 años y su hija de 16 llevaban casi un año en un albergue federal en Texas después de haber cruzado la frontera para reunirse con él.

“Se siente como si me estuviera asfixiando dentro de este albergue, atrapado sin salida”, dijo el hijo de Carlos cuando le pidieron describir cómo se sentía luego de meses en la instalación en el área de Houston, según contó uno de los abogados de los adolescentes. “Todos los días, la misma rutina. Todos los días, sintiéndome atrapado. Me hace sentir aterrado y sin esperanza”.

Durante llamadas diarias por video, Carlos, quien tenía estatus de protección temporal (TPS), les pedía a los hermanos que tuvieran paciencia, que confiaran en el proceso.

Funcionarios federales habían evaluado a Carlos antes de otorgarle la custodia y le dijeron que su caso estaba completo. Él creía que pronto estaría de nuevo con sus hijos, quienes, al igual que él, habían llegado a Estados Unidos huyendo de la violencia política en Venezuela.

Un oficial de inmigración llamó a Carlos un viernes y le pidió que fuera el lunes a una reunión en una oficina del ICE para hablar sobre la reunificación con sus hijos. Cuando llegó, los oficiales intentaron obligarlo a firmar documentos que dijo no entender. Cuando se negó, le quitaron la ropa, le confiscaron su identificación y sus pertenencias y lo encadenaron por el cuello, la cintura y las piernas.

“Me engañaron”, dijo Carlos en una llamada telefónica desde un centro de detención migratoria en El Paso, Texas, donde estuvo retenido durante varios meses. “Usaron a mis hijos para atraparme”, agregó.

Durante la cobertura de esta historia, KFF Health News revisó documentos judiciales, habló con los abogados de inmigración de la familia, entrevistó a Carlos y revisó declaraciones de sus hijos, traducidas del español.

Carlos es un seudónimo que se ha usado a pedido de los abogados: les preocupa que hablar públicamente pueda poner en riesgo el caso o retrasar aún más la reunificación familiar.

Usar a los hijos para arrestar a los padres

Desde 2003, la Oficina de Reasentamiento de Refugiados del Departamento de Salud y Servicios Humanos (HHS) ha cuidado a niños migrantes menores de 18 años que llegan al país sin sus padres, a menudo huyendo de la violencia, el abuso o el tráfico humano. La oficina, que en febrero tenía más de 2.300 niños en albergues o con familias temporales en todo el país, se supone que debe liberarlos rápidamente con cuidadores evaluados, generalmente padres u otros familiares que ya viven en el país.

El Congreso asignó esta responsabilidad a la agencia de salud hace más de 20 años para priorizar el bienestar de los niños no acompañados y separar su cuidado de las prioridades de control migratorio.

Ahora, la segunda administración de Trump está usando a niños migrantes bajo custodia de la agencia para atraer a padres, como Carlos, tengan o no antecedentes penales.

Una investigación de KFF Health News encontró que la oficina de reasentamiento, dirigida por una ex funcionaria del ICE, coordina con el Departamento de Seguridad Nacional (DHS) el arresto de personas que buscan la custodia de niños migrantes.

Documentos de arrestos muestran que Investigaciones de Seguridad Nacional (HSI), la división de la agencia que normalmente se enfoca en el crimen organizado y en traficantes, entrevista a padres u otros cuidadores y luego los arresta si están en el país sin autorización legal.

Antes del regreso de Donald Trump a la Casa Blanca, la oficina de reasentamiento prohibía compartir datos y colaborar con las autoridades migratorias y no negaba la custodia de niños únicamente por el estatus migratorio de los cuidadores. Esas restricciones fueron eliminadas el año pasado.

No está claro cuántos cuidadores han sido atraídos bajo falsos pretextos para ser arrestados. LAist obtuvo datos que indican que más de 100 fueron detenidos mientras intentaban sacar a sus hijos de la detención, pero KFF Health News no pudo verificar de manera independiente esa cifra con agencias federales.

El HHS, el DHS y el Departamento de Justicia (DOJ) no han respondido a preguntas sobre arrestos de cuidadores que se les han remitido desde febrero.

Antes de dejar el DHS el mes pasado, la subsecretaria Tricia McLaughlin dijo que la administración protege a los niños de ser entregados a personas que no deberían cuidarlos. Andrew Nixon, vocero del HHS, remitió las preguntas relacionadas con la aplicación de leyes migratorias al DHS.

Al mismo tiempo, la oficina de reasentamiento ha implementado nuevas reglas que dificultan que los cuidadores obtengan la custodia de niños no acompañados. Estas incluyen reducir el tipo de documentos que se aceptan, exigir verificaciones de antecedentes con huellas dactilares para todos los adultos que vivan en el hogar y para otros cuidadores, y requerir citas en persona para verificar documentos de identidad, a veces con agentes del ICE presentes. Estos requisitos mantienen a los “niños seguros de traficantes y otras personas peligrosas”, dijo Nixon.

Hasta enero, la agencia había retenido a al menos 300 niños que ya habían sido ubicados con patrocinadores evaluados y había pedido a sus cuidadores que volvieran a solicitar la custodia, según el National Center for Youth Law y la Democracy Forward Foundation. Estos dos grupos presentaron una demanda el 23 de febrero calificando estas acciones como “una nueva forma silenciosa de separación familiar”.

Separación a la inversa

Dulce, una madre guatemalteca en Virginia, dijo que a su hijo de 8 años lo enviaron a un albergue del gobierno después de ser detenido durante una parada de tráfico el verano pasado, mientras visitaba a familiares en otro estado.

Al principio, Dulce esperaba recuperar a su hijo en pocos días: había cumplido con los requisitos de patrocinio del gobierno en 2024 y se había reunido con él tres semanas después de que el niño cruzara la frontera. Pero funcionarios de la agencia de reasentamiento le pidieron repetir todo el proceso y volver a presentar documentos, dijo Dulce. Tardó ocho meses en recuperarlo.

Dulce es un seudónimo utilizado a petición suya porque teme que hablar públicamente la ponga en riesgo de deportación.

En un momento, le pidieron que fuera a una entrevista en una oficina del ICE para mostrar su identificación como parte del proceso de reunificación con su hijo. Ella se negó por miedo a que la detuvieran, ya que no tiene estatus legal. Cree que agentes del ICE visitaron su casa en algún momento.

“Dejé de ir a mi casa”, dijo Dulce. “Viví con algunos de mis amigos por días”.

Aunque vivía a solo 45 minutos, a Dulce solo se le permitió visitar a su hijo dos veces al mes.

Hasta hace poco, la mayoría de los niños no acompañados llegaban a la custodia del gobierno luego de ser detenidos en la frontera. Pero los cruces fronterizos comenzaron a disminuir en 2024 y el número de personas que llegan a Estados Unidos ha caído de forma importante durante el segundo mandato del presidente Trump.

Ahora, cientos de niños han sido llevados a albergues del gobierno después de ser detenidos dentro del país, en general durante redadas migratorias o paradas de tráfico, según la demanda de los grupos defensores. Muchos ya vivían con familiares, incluidos tutores previamente evaluados por la agencia de reasentamiento.

Ya casi no hay liberaciones. Según la oficina de reasentamiento, en 2024 los niños bajo su custodia permanecían en albergues o en cuidado temporal por un promedio de un mes. En febrero, ese tiempo había aumentado a más de medio año.

Generalmente se libera a los niños solo después de que sus abogados presentan una demanda en un tribunal federal impugnando su detención como inconstitucional.

Las autoridades liberaron al hijo de Dulce en febrero después de que los abogados del niño presentaron una petición de este tipo. La mujer dijo que se siente aliviada de tenerlo de vuelta, pero sigue con miedo de que el ICE pueda llegar a su casa.

Inmigrantes en riesgo

Durante el primer mandato de Trump, su administración fue criticada por perder el rastro de niños que habían sido liberados de custodia. El presidente Joe Biden fue cuestionado por la forma en que su administración manejó el aumento de niños no acompañados, que alcanzó un pico en 2021 con alrededor de 22.000 bajo custodia de la oficina de reasentamiento.

Aunque la mayoría fueron recibidos por patrocinadores legítimos, algunos fueron entregados a personas que no habían pasado controles de seguridad, lo que los puso en riesgo de explotación.

La administración Trump dice que está verificando el bienestar de esos niños y el Departamento de Justicia ha procesado casos de trata infantil.

El 1 de marzo, la secretaria de Seguridad Nacional, Kristi Noem, quien dejará su cargo a finales de mes, destacó un esfuerzo de varias agencias, incluida la oficina de reasentamiento, que, según el DHS, había localizado a 145.000 niños no acompañados que habían sido entregados a cuidadores durante el mandato de Biden.

Sin embargo, informes internos del HHS sobre esa iniciativa obtenidos por KFF Health News muestran que casi 11.800 de esos niños migrantes y cerca de 500 de sus cuidadores habían sido arrestados hasta el 29 de enero. Solo 125 de esos niños y 55 de esos cuidadores fueron arrestados por presunta actividad criminal, lo que sugiere que la mayoría fue detenida por violaciones migratorias.

El HHS remitió preguntas sobre esas cifras al DHS, que no respondió a solicitudes de comentarios. Michelle Brané, quien fue funcionaria del DHS durante la administración Biden, dijo que las cifras muestran que la mayoría de los arrestos fueron para detener y deportar migrantes. Anteriormente, CNN informó que la administración apuntó a padres y cuidadores que habían pagado para que los niños cruzaran la frontera, intentando presentar cargos de tráfico de personas contra ellos.

“Han abandonado esa estrategia en muchos sentidos y ahora van tras cualquiera abiertamente”, dijo Brané. “Estas cifras reflejan claramente que esto no se trata de seguridad pública ni de la seguridad de los niños”.

Caso en espera

Carlos salió de Venezuela en 2022 debido a amenazas de muerte y, como miles de otros que huían de ese país, recibió lo que se conoce como estatus de protección temporal durante la administración Biden. Esa protección fue posteriormente eliminada para la mayoría de los venezolanos por el gobierno de Trump.

En enero de 2025, días antes de que Trump asumiera su segundo mandato, los hijos de Carlos cruzaron la frontera desde México hacia Estados Unidos, se entregaron a las autoridades fronterizas y fueron puestos de inmediato bajo custodia de la agencia de reasentamiento.

Carlos pasó meses enviando documentos para reunirse con ellos. Dijo que es su único padre, ya que la madre los abandonó cuando eran pequeños.

Funcionarios visitaron su casa dos veces y determinaron que era apto para cuidarlos, según documentos judiciales que solicitaban su liberación. Pasó pruebas de ADN que confirmaron que es el padre biológico, dijo uno de sus abogados. Sus documentos indican que no tiene “antecedentes penales”. En julio, a Carlos le dijeron que su caso de reunificación estaba completo y en proceso de aprobación. Pero luego, sin explicación, el caso fue puesto en espera.

Antes de que el ICE lo arrestara, Carlos dijo que manejaba 14 horas de ida y 14 de vuelta desde su casa para visitar a sus hijos. Solo podía verlos durante una hora. Cuando estaba detenido, dijo que hablaba con ellos aproximadamente cada dos semanas en llamadas breves y supervisadas.

Intenta mantenerse la esperanza, pero es difícil.

Según documentos redactados por oficiales del ICE durante su arresto y presentados en su caso judicial, Carlos fue detenido bajo una iniciativa llamada Operation Guardian Trace, que exige a los oficiales migratorios detener a posibles cuidadores si están en el país sin autorización legal y recomendar su deportación.

“Esta operación está diseñada para obligar a los padres a tomar una decisión imposible entre reunirse con sus hijos y buscar seguridad”, dijo una de las abogadas de Carlos, Chiqui Sanchez Kennedy, del Galveston-Houston Immigrant Representation Project, una organización sin fines de lucro que ayuda a inmigrantes de bajos recursos.

“Voy a esperar”

En marzo, un juez federal determinó que Carlos había sido detenido de manera ilegal y fue liberado bajo fianza.

Pero sus hijos aún enfrentan un futuro incierto. Investigaciones muestran que los albergues del gobierno a menudo carecen de suficientes recursos y trabajadores sociales dicen que estadías prolongadas en estos lugares pueden causar más trauma.

“No solo es malo, sino que cuanto más tiempo estás allí, peor se vuelve”, expresó Jonathan Beier, director asociado de investigación y evaluación del programa para niños no acompañados del Acacia Center for Justice, que coordina servicios legales para estos menores.

Los hijos de Carlos también podrían ser enviados de regreso al país del que huyeron. Debido a su detención, Carlos tendrá que repetir gran parte del proceso para reunirse con ellos, según una abogada de los niños, Alexa Sendukas, también del Galveston-Houston Immigrant Representation Project.

En declaraciones compartidas a través de Sendukas, la hija de Carlos dijo que ya no quiere estar con otras personas y pasa la mayor parte del tiempo en su habitación. Su hijo, ahora de 15 años, describió tener ataques de pánico y sentir que se está perdiendo la vida, ya sean las oportunidades con las que sueña — aprender inglés, estudiar ciencia — o ver baloncesto con su familia.

“Recuerdo cuando llegué por primera vez a este albergue; tenía mucha esperanza y fe en que pronto me reuniría con mi papá”, dijo.

La hija de Carlos pasó el día llorando en la cama cuando los hermanos se enteraron de que su padre había sido detenido. Durante días, no supieron dónde estaba. Ahora, temen que la única salida sea la adopción o el cuidado temporal.

“Tengo miedo”, dijo. “Voy a esperar a mi papá siempre”.

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‘They Tricked Me’: A Father Was Chained After He Went to ICE To Reunite With His Kids

Carlos arrived at an Immigration and Customs Enforcement office in New Mexico in December, believing he was one step closer to reuniting with his children. By that point, his 14-year-old son and 16-year-old daughter had been in a federal shelter in Texas for nearly a year after crossing the border to be with him.

“I feel like I’m suffocating inside this shelter, trapped with no way out,” Carlos’ son said, according to one of the teens’ attorneys, when asked to describe how he felt after months at the Houston-area facility. “Every day, the same routine. Every day, feeling stuck. It makes me feel hopeless and terrified.”

During daily video calls, Carlos, who had temporary protected status, urged the siblings to be patient, to trust the process. Federal officials had vetted Carlos before he could be granted custody and told him his case was complete. He believed he would soon be back with his children, who, like him, had sought refuge from political violence in Venezuela.

An immigration officer called Carlos on a Friday and asked him to attend a meeting at an ICE office the following Monday to discuss reunification with his children. Once Carlos arrived, officers tried to force him to sign documents he said he didn’t understand. When he refused, they stripped off his clothes, seized his ID and belongings, and chained him by the neck, waist, and legs.

“They tricked me,” Carlos said in a phone call from an immigration detention center in El Paso, Texas, where he was held for several months. “They used my children to grab me,” he said.

In reporting on the family’s story, KFF Health News reviewed court documents, spoke with the family’s immigration attorneys, interviewed Carlos, and reviewed statements from his children, translated from Spanish. Carlos is a pseudonym, being used at the request of attorneys concerned that speaking out could jeopardize Carlos’ immigration case or further delay his reunion with his family.

Using Children to Arrest Parents

Since 2003, the Department of Health and Human Services’ Office of Refugee Resettlement has cared for immigrant children under 18 who arrive in the country without their parents, often fleeing violence, abuse, or trafficking. The office, which in February had more than 2,300 children in shelters or with foster families across the country, is supposed to promptly release them to vetted caregivers, typically parents or other family members already living in the country.

Congress placed this responsibility with the health agency over 20 years ago to prioritize the well-being of unaccompanied children and separate their care from immigration enforcement priorities.

Now the second Trump administration is using migrant children held by the resettlement office to lure their parents, such as Carlos, whether or not they have a criminal record. A KFF Health News investigation found the resettlement office, headed by a former ICE official, coordinates with the Department of Homeland Security to arrest people seeking custody of migrant children.

Arrest documents show Homeland Security Investigations, the arm of the agency that normally focuses on organized criminals and traffickers, will interview parents or other caregivers then arrest them if they are in the country illegally. Before Donald Trump returned to the White House, the resettlement office prohibited data sharing and collaboration with immigration enforcement, and it did not deny caregivers custody of children solely because of their immigration status. Those restrictions were rescinded last year.

It’s unclear exactly how many caregivers have been baited into arrest. LAist obtained data indicating more than 100 have been arrested while trying to get their kids out of detention, but KFF Health News could not independently verify that number with federal agencies.

Since February, the Department of Health and Human Services, Department of Homeland Security, and Justice Department have not responded to questions about caregiver arrests. Prior to leaving DHS last month, Assistant Secretary Tricia McLaughlin said the administration protects children from being released to people who shouldn’t care for them. Andrew Nixon, an HHS spokesperson, referred questions related to immigration enforcement to DHS.

At the same time, the resettlement office has enacted new rules that make it harder for caregivers to gain custody of unaccompanied children. These include narrowing the range of accepted documents, requiring fingerprint-based background checks for every adult in the home and backup caregivers, and requiring in-person appointments to verify identification documents, sometimes with ICE agents present. The requirements keep “children safe from traffickers and other bad, dangerous people,” Nixon said.

As of January, the agency had detained at least 300 children already placed with vetted sponsors and asked their caregivers to reapply, according to the National Center for Youth Law and the Democracy Forward Foundation. The advocacy groups filed a Feb. 23 lawsuit calling these actions “a quieter, new form of family separation.”

Reverse Separation

Dulce, a Guatemalan mother in Virginia, said her 8-year-old son was sent to a government shelter after he was detained during a traffic stop last summer while visiting family members in a different state.

At first, Dulce expected to get her son back within days — she had passed the government’s sponsorship requirements in 2024 and was reunited with him three weeks after he first crossed the border. But resettlement agency officials asked her to repeat the entire process and resubmit documents, Dulce said. It took eight months to get him back.

Dulce is a pseudonym being used at her request because she fears speaking out could get her deported.

At one point, Dulce was told to attend an interview at an ICE office to show her identification as part of the process of reuniting with her son. She refused out of fear that she too might be detained, because she doesn’t have legal status. She believes ICE agents visited her home at one point.

“I stopped going home,” Dulce said. “I lived with some of my friends for days.”

Even though she lived just 45 minutes away, Dulce was allowed to visit her son only twice a month.

Until recently, most unaccompanied children landed in government custody after being detained at the border. But border crossings started to fall in 2024, and the number of people coming to the U.S. has dropped precipitously in President Trump’s second term.

Now, hundreds of kids have been taken to government shelters after being swept up inside the country, often during immigration raids or traffic stops, according to the advocates’ lawsuit. Many were already living with relatives, including guardians already vetted by the resettlement agency.

Releases have grinded nearly to a halt. According to the resettlement office, children in its custody stayed in government shelters or foster care for an average of one month in 2024. As of February, that had jumped to more than half a year.

When children do get released, it’s often only after their attorneys file a lawsuit in federal court challenging their detention as unconstitutional.

Authorities released Dulce’s son to her in February after the boy’s attorneys filed such a petition. Dulce said she’s relieved to have him back but still anxious that ICE could show up at their house.

Immigrants at Risk

During Trump’s first term, his administration was criticized for losing track of children who had been released from custody. President Joe Biden was blamed for how his administration processed a surge of unaccompanied children that peaked in 2021 with about 22,000 in the resettlement office’s custody. Though most children were placed with legitimate sponsors, some were placed with people who hadn’t cleared safety checks, putting them at risk of exploitation.

The Trump administration says it is checking on those children’s welfare, and the Justice Department has prosecuted child trafficking cases. On March 1, Homeland Security Secretary Kristi Noem, who is set to leave her role at the end of the month, touted a multi-agency effort, including the resettlement office, that DHS said had tracked down 145,000 unaccompanied children who had been placed with caregivers during Biden’s term.

Yet internal HHS reports about that initiative obtained by KFF Health News show that nearly 11,800 of those migrant children and nearly 500 of their caregivers were arrested as of Jan. 29. Only 125 of those migrant children and 55 of those caregivers were arrested for alleged criminal activity, suggesting the majority were for immigration violations.

HHS referred questions about the figures in the reports to DHS, which did not respond to requests for comment about the data. However, Michelle Brané, who was a DHS official in the Biden administration, said the figures show that most of the arrests were to detain and deport migrants. Previously, CNN reported the administration targeted parents and caregivers who had paid for children to cross the border, trying to levy smuggling charges against them.

“They have really dropped that pretense in a lot of ways, and they are going for anyone openly,” Brané said. “These numbers clearly reflect that this is not about public safety or about safety of the children.”

Case on Hold

Carlos left Venezuela in 2022 because of death threats and, like thousands of others fleeing that country, was granted what’s called temporary protected status under the Biden administration. That protection was later rescinded for most Venezuelans by the Trump administration.

In January 2025, days before Trump was sworn in for his second term, Carlos’ children crossed the border from Mexico to the U.S., turned themselves over to border authorities, and were immediately placed in the resettlement agency’s custody. Carlos spent months submitting paperwork to reunite with them. He said he’s their only parent, because their mother left when they were toddlers.

Officials visited his home twice and determined he was fit to care for them, according to court documents petitioning for his release from detention. He passed DNA testing, proving he’s the biological father, one of his attorneys said. His arrest documents show he has “no criminal history.” In July, Carlos was told his reunification case was complete and being sent for approval. But then, with little explanation, the case was put on hold.

Before his arrest by ICE, Carlos said, he drove 14 hours each way from his home to visit his children. Once there, he could see them for only one hour. When he was in detention, he said, he spoke to them about every two weeks in quick, monitored phone calls.

He’s trying to stay hopeful, but it’s hard.

According to documents completed by ICE officers during his arrest and submitted in his court case, Carlos was arrested under an initiative called Operation Guardian Trace, which requires immigration officers to detain potential caregivers if they are in the country without legal authorization and recommend that they be deported.

“This operation is designed to force parents to make an impossible choice between reuniting with their children and seeking safety,” said one of Carlos’ attorneys, Chiqui Sanchez Kennedy of the Galveston-Houston Immigrant Representation Project, a nonprofit that helps low-income immigrants.

‘I’m Going to Wait’

In March, a federal judge said officials had unlawfully detained Carlos and he was released on bond.

But his children still face an uncertain future for now. Government shelters often lack sufficient resources, research shows, and social workers say lengthy stays in these facilities can result in additional trauma.

“Not only is it bad, full stop, but the longer you’re there, the worse it gets,” said Jonathan Beier, associate director of research and evaluation for the Acacia Center for Justice's Unaccompanied Children Program, which coordinates legal services for unaccompanied minors.

Carlos’ children could also be sent back to the country they fled. Because of his detention, Carlos will have to redo much of the process to reunite with them, according to an attorney for the children, Alexa Sendukas, also with the Galveston-Houston Immigrant Representation Project.

In statements shared through Sendukas, Carlos’ daughter said she no longer wants to be around others and spends most of the time in her room. His son, now 15, described having panic attacks and feeling that he’s missing out on life, whether it’s the opportunities he longs for — to learn English, to study science — or watching basketball with his family.

“I remember when I first arrived at this shelter, I was so hopeful and had faith that I would be reunited with my dad soon,” he said.

Carlos’ daughter spent the day crying in bed when the siblings learned their father had been detained. For days, they didn’t know where he was. Now, they fear the only way out is through adoption or foster care.

“I am afraid,” she said. “I’m going to wait for my dad forever.”

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Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare

John Galvin knows he needs a colonoscopy. But he’s waiting to schedule the procedure until December, when he turns 65 and qualifies for Medicare.

He was already thinking about delaying it — then his monthly Obamacare insurance premium payment tripled this year to $2,460, about a third of his income, he said. And with a $2,700 deductible, he’d be on the hook for most of the diagnostic exam, a financial hit he said he couldn’t stomach.

“It was going to cost close to $3,000,” said Galvin, who lives in North Kingstown, Rhode Island, and recently retired as director of a durable medical equipment company. “I put it off.”

Galvin said his wife, Nancy, is delaying a costly CT scan for a few years until she too qualifies for Medicare, so it can foot the bill. The federal health program offers coverage for all Americans 65 and older.

People on Affordable Care Act plans nearing retirement age experienced some of the largest price increases following the expiration of enhanced federal subsidies at the end of December. Those with incomes above 400% of the federal poverty level — $86,560 for a family of two — had been getting help paying for the plans since the Biden administration expanded the subsidies during the covid-19 pandemic. Adults ages 50 through 64 made up around half of those ACA enrollees.

Now, without that federal financial help, some in this age group say they’re wrestling with whether to delay care until they qualify for Medicare. Not only does that put their physical health at risk, said patient advocates, doctors, and health policy researchers, but it potentially just shifts the costs — and could lead to taxpayers’ footing even bigger bills to fix health issues that worsen amid the delays.

“There’s going to be a lot of pent-up demand and unmet need,” said Jessica Schubel, a health policy consultant who worked in the Obama and Biden administrations. “Medicare is going to have to spend a whole heck of a lot of money covering and dealing with their treatment.”

The Affordable Care Act has been a key source of health care coverage for people 50 through 64. Access to Obamacare plans helped cut the uninsured rate for this age group by half, according to AARP, a lobbying group that represents older adults. That allowed some people to retire early while keeping coverage. It also has provided a safety net for small-business owners and those with jobs that don’t offer health insurance.

Last fall, the longest-ever government shutdown occurred amid an unsuccessful effort by Democrats to extend the enhanced subsidies. Republicans opposing the extension had said the assistance went to insurers, incentivizing fraud and wasteful coverage.

Waiting for Medicare

John Galvin, 64North Kingstown, Rhode Island

John Galvin knows he needs a colonoscopy. But he’s waiting until he turns 65 in December to schedule it, so that Medicare will pick up the tab. His monthly Obamacare premium payment jumped this year — from $800 to more than $2,400 — so he’s burning through a $30,000 retirement account to cover the additional costs. And that’s for a plan with a $2,700 deductible, which means he’d be on the hook for most of the pricey diagnostic exam. “It was going to cost close to $3,000,” Galvin says. “I put it off.”

— Sam Whitehead

The issue will continue to have political relevance, especially in this year’s midterm elections, including among older Americans who reliably show up to the polls, said Republican strategist Gregg Keller, who runs the Atlas Strategy Group.

“Is affordability going to be an issue? Absolutely,” he said. “Are health care prices going to factor into that? Yes.”

Even before the subsidies expired, the costs of medical care, nursing homes, and prescription drugs were among the top health-related concerns for people over 50, a 2024 University of Michigan poll found.

Middle-aged adults with Obamacare plans acutely feel the pinch of the expired subsidies, because the ACA allows insurers to charge adults in their 60s up to three times as much for premiums as those in their 20s, who generally use fewer medical services.

And many middle-aged adults were already enrolled in the lowest-cost plans available, which leaves them without cheaper options to fall back on, said Matt McGough, a policy analyst with KFF, a health information nonprofit that includes KFF Health News.

“This is very dire for the older marketplace enrollees,” he said.

Someone making a few dollars over 400% of the federal poverty level earns too much to get a subsidy now, and in some states average premium payments were due to at least triple for this group. Many people are seeing yearly rate increases of thousands of dollars, with premium payments totaling as much as a quarter of their incomes.

John Ayanian, a primary care physician and health policy researcher at the University of Michigan, said he has regular conversations with older patients who are trying to figure out how to afford their medical care. Some in their early 60s are likely to drop ACA coverage because of rising premiums, he said.

“That’s a gamble,” he added.

Marci Heinbaugh may take that bet. The 63-year-old social services worker, who lives in rural Illinois, said her monthly premium payments more than doubled, from roughly $1,100 to $2,333, for a plan with a $10,150 out-of-pocket maximum.

She knew she’d be paying more, she said, but wasn’t anticipating that kind of increase. A few months in, she’s not sure if she’ll stick with the plan for the rest of the year. She said she may go uninsured.

“I’m petrified to even think about that,” Heinbaugh said.

People want to buy their own insurance on the marketplace, and many middle-aged adults could afford it with just a little federal financial help, said Alan Weil, senior vice president of public policy at AARP. Those who drop coverage or delay care until they reach age 65 might save money now, but that could be more costly for them — and taxpayers — later.

“There’s significant possibility that the purported savings associated with reducing subsidies as people approach retirement end up turning into higher utilization costs for Medicare,” Weil said.

And Medicare enrollees aren’t insulated from rising costs. In January, for example, standard Medicare Part B premiums rose from $185 per month to almost $203.

Until Galvin joins Medicare, he said, he expects to burn through a $30,000 retirement account to cover his marketplace plan’s premium payments and deductible.

A 2024 AARP survey found that 1 in 5 adults over 50 had no retirement savings and 3 in 5 were worried they wouldn’t have enough retirement savings to support themselves.

The expiration of these Obamacare subsidies puts additional financial pressure on Americans as they approach retirement, health policy researchers said.

“It’s forcing people to make impossible choices,” said Natalie Kean, director of federal health advocacy for the national nonprofit Justice in Aging.

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact KFF Health News and share your story.

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