April Health And Fitness Tips.
Enter April Health And Fitness Tips.
April Health And Fitness Tips.
March 25, 2026
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NYT > Health, Health - The New York Times
No commentsMarch 25, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 25, 2026Rose KFF Health News, Health NewsNo commentsHealth 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.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.
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March 24, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 24, 2026Rose KFF Health News, Health NewsNo commentsEn 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”.
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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March 24, 2026Rose KFF Health News, Health NewsNo commentsCarlos 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.”
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 story can be republished for free (details).
March 24, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 23, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 23, 2026Rose KFF Health News, Health NewsNo commentsJohn 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.
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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March 22, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 22, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 21, 2026Rose KFF Health News, Health NewsNo commentsKFF Health News senior correspondent Renuka Rayasam discussed the KFF Health News series “Priced Out,” which focuses on the health insurance crisis, on An Arm and a Leg on March 19.
KFF Health News rural health reporter Andrew Jones discussed the spread of measles across the Carolinas on WUNC’s Due South on March 17.
Céline Gounder, KFF Health News’ editor-at-large for public health, discussed on CBS News 24/7’s The Daily Report on March 16 how U.S. hospitals and insurers are turning to AI to settle disputes over medical claims and payments. On March 17, she outlined the court ruling blocking the Trump administration’s vaccine policy changes for children on CBS News’ CBS Mornings. Gounder also discussed Susie Wiles’ decision to stay on as White House chief of staff amid breast cancer treatment on CBS News 24/7’s The Takeout on March 16.
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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March 20, 2026Rose KFF Health News, Health NewsNo commentsLISTEN: Fewer breakthroughs. Weaker responses to public health crises. That’s what some former National Institutes of Health scientists predict for the agency as thousands of researchers leave. Workers from the Washington, D.C., region spoke with KFF Health News senior correspondent Rachana Pradhan, and she appeared on WAMU’s “Health Hub” on March 18 to explain what’s behind the exodus.
The past year has been rough for the National Institutes of Health, which underwent cuts to its workforce and research funding. Now, the NIH is facing a new challenge: brain drain.
Thousands of employees totaling about 20% of the agency’s staff have left in the tumult of President Donald Trump’s second term. Some scientists fear this exodus will mean fewer new treatments and diminish the government’s ability to respond to disease outbreaks and other public health crises.
KFF Health News senior correspondent Rachana Pradhan appeared on WAMU’s “Health Hub” to explain why some scientists decided to quit or retire early, and what it could mean for the future of biomedical research in the United States.
Katheryn Houghton contributed reporting.
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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March 20, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 20, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 19, 2026Rose KFF Health News, Health NewsNo commentsOn What the Health? From KFF Health News, distributed by WAMU, chief Washington correspondent and host Julie Rovner sat down with Drew Altman, president and CEO of KFF, to talk about the likelihood of a national health care debate to rein in costs.
As the midterm elections approach, the cost of health care is the public’s top economic concern, Altman said. Although past reforms have significantly increased the number of people with health insurance, they have not successfully addressed affordability, he said.
Altman said the U.S. health system poses two major problems: Americans’ concerns about how to pay for their own medical care, and the significant share of national spending it consumes.
Rovner and Altman also discuss the downstream effects of change, including the impact of the Trump administration’s cost-cutting on states, employers, and individuals, and lessons learned from past attempts at government reform.
This is the first in a new interview series, “How Would You Fix It?” In the months to come, Rovner will interview experts and decision-makers from a variety of backgrounds and perspectives, asking each how they would repair the health care system.
An abbreviated version of this interview will air on What the Health? From KFF Health News.
Altman’s “Beyond the Data” columns — including the column discussed in this interview, “Our Darwinian Approach to Health Care Costs” — can be read here.
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 story can be republished for free (details).
March 18, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 18, 2026Rose NYT > Health, Health - The New York TimesNo commentsMarch 18, 2026Rose KFF Health News, Health NewsNo commentsLOUISVILLE, Ky. — In the early 2000s, Michelle Warfield worked at a factory, hauling heavy seats for Ford trucks on and off an assembly line. To suppress daily aches in her back and hips, her doctor prescribed opioid painkillers.
They worked for a bit. But by 2011, Warfield struggled to walk.
And “by that time, I was addicted,” said Warfield, now living in Shelbyville, Kentucky.
After she lost her health insurance, Warfield started buying pills on the street. She tried to quit several times, but the debilitating withdrawal — so bad she couldn’t get out of bed, she said — kept driving her back to drug use.
Until last year.
Through her church, Warfield learned about the NET device. It’s a cellphone-sized pack connected to gel electrodes placed near the ear that deliver low-level electrical pulses to the brain.
“Once I got set up on the device, within 30 minutes, I didn’t have any cravings” for opioids, Warfield said.
After three days on the device in August, she stopped using drugs altogether, she said.
Warfield’s treatment was paid for with her county’s opioid settlement dollars — money from pharmaceutical companies accused of fueling the overdose crisis.
State and local governments nationwide are receiving billions in opioid settlement cash over nearly two decades and are meant to spend it treating and preventing addiction.
Warfield wants them to allot a good chunk to the NET device, which costs counties about $5,500 a person. The pitch is gaining traction. NET Recovery, which makes the device, said it has signed about $1.2 million in contracts with more than a dozen counties and cities in Kentucky.
But some researchers and recovery advocates say the company’s rapid consumption of opioid dollars raises red flags. They see the NET device as the latest in a series of products that have been overhyped as the solution to the addiction crisis, preying on people’s desperation and capitalizing on the windfall of opioid settlements. Many of these products — from high-dose overdose reversal medications to body scanners for jails — have little evidence to back their lofty promises. That has not stopped sales representatives from repeatedly pitching elected officials or circulating ready-made templates to request settlement money for the companies’ products.
In fact, a device similar to NET called the Bridge gained popularity several years ago, receiving more than $215,000 in opioid settlement cash nationwide. But serious questions arose about the study backing its effectiveness, and the device is currently off the market.
NET Recovery’s activity “fits the national trends of these industry money grabs,” said Tricia Christensen, a national expert on opioid settlements based in Tennessee. The device “could be helpful for some,” she said. “But it’s being sold as a silver bullet.”
This year, 237 organizations working to end overdose — including Christensen’s consulting company — published a road map to guide officials in charge of opioid settlement money. In it, they called the NET device an example of problematic spending on unproven treatment.
Treating Withdrawal or Addiction
The FDA has cleared the NET device for a specific use: reducing drug withdrawal symptoms. It has not approved the device to treat addiction.
That’s a crucial distinction, said Eric Hulsey, executive director of the Institute for Research, Education and Training in Addictions. He co-authored a recent report evaluating the evidence on neuromodulation devices like NET.
“The term ‘treatment’ becomes confusing,” Hulsey said. “These devices were cleared to treat opioid withdrawal symptoms, not to treat an opioid use disorder.”
NET Recovery CEO Joe Winston said the company adheres to FDA rules and advertises the device only for withdrawal management. But “we are finding that physicians are prescribing this to folks for long-term behavior based on the results of our study.”
He’s referring to an October study that he co-authored and the company funded, in which researchers followed two groups of addiction patients in Kentucky for 12 weeks. The first group received the NET device for up to seven days, while the second group received a sham treatment.
The study found no significant difference between the groups’ outcomes. Participants who got the NET device were similarly likely to use illicit drugs after treatment as those who got the fake.
Hulsey, who was not affiliated with the study, said the takeaway is clear: “They didn’t find that was effective.”
A subgroup of participants who chose to use the device for more than 24 hours consecutively, however, went on to use illicit drugs less often than other participants.
As the researchers acknowledged in their paper, that subgroup might simply have been more motivated to engage with any form of treatment. The results don’t necessarily show that the device is making a difference, Hulsey said.
Rapid Growth
Winston had a different take. He said the success of the subgroup is “intriguing and outstanding.”
So outstanding, in fact, that the company this month is opening a brick-and-mortar location in Miami, where the device will be available to anyone who can pay $8,000 out-of-pocket. (The cost is higher for individuals than for county governments.) It has also applied for opioid settlement dollars from the state of Kentucky to conduct a larger research study and aims to bring the NET device into metro areas such as Louisville and Lexington.
Last year, NET Recovery hired a magistrate in Franklin County, Kentucky, to head up its operations in the state. (Magistrates function as county commissioners.) Kelly Dycus, who is also a mental health clinician, travels to different counties, extolling the benefits of the device and encouraging officials to contract with the company.
Her county awarded $75,000 to NET Recovery prior to her joining the company. Moving forward, Dycus said, she would recuse herself from any contract votes in her county.
Christensen, the national expert on opioid settlements, called Dycus’ new role “extremely strategic” for the company and “an obvious conflict of interest” for a public official.
Giving People Choice
More options for people to enter recovery is generally good, said Jennifer Twyman, who has a history of opioid addiction and now works with Vocal-KY, a nonprofit that advocates to end homelessness and the war on drugs.
But settlement funds are finite, she said, and when counties invest in the NET device, that leaves less money to support options like mental health treatment, housing, and transportation programs — critical for many people who use drugs.
“People slip through these big, huge gaps we have and they die,” Twyman said, pointing to photos of dead friends that line her office wall.
She added that people should have the option of taking medications such as methadone and buprenorphine — the gold standard for treating opioid addiction. National data shows only 1 in 4 people with opioid addiction get them.
Many people can’t afford them, find a doctor willing to prescribe them, or get transportation to appointments, Twyman said. There’s also discrimination against those who use medications, with detractors saying they’re not truly abstinent or clean.
Companies like NET Recovery sometimes lean into that stigma, Twyman said.
For instance, Scott County, Kentucky, jailer Derran Broyles — whom the company considers a key champion for its device — said in a public meeting to other county officials that medication treatment is just “swapping one drug for another.” It’s a common refrain from critics that many researchers and clinicians refute.
Winston told KFF Health News his company is supportive of all types of recovery but that the NET device can help the “underserved population” of people who don’t want medication.
Longtime addiction researcher Mark Greenwald has led studies for NET Recovery and consults for Indivior, one of the leading producers of medications for opioid use disorder. He said he sees value in both approaches. It just depends on whom you’re trying to treat.
For people injecting drugs or accustomed to high doses of fentanyl, who are more likely to return to using drugs after residential treatment, “I would hesitate to recommend the device,” he said. Abstinence-based approaches can increase their risk of dying. But for people who are “highly motivated to stay abstinent,” the NET device may be a good fit.
“Giving people choices is the right thing to do,” he said.
Community as Part of Recovery
Warfield, who has not used opioids since August, credits not just the NET device with her recovery but her community too.
“It’s not a miracle cure,” she said of the device. “You still have to manage your triggers, but it’s easier.”
She regularly attends individual and group therapy to address childhood trauma. She’s found close friends within her church and has reconnected with her daughter. She installed a car seat in her vehicle so she can drive her grandson to preschool.
Warfield explained her hope for opioid settlement money to reach others in her community simply: “I want people to get as much help as they can.”
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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March 17, 2026Rose KFF Health News, Health NewsNo commentsAmanda Miller tenía 30 años y estaba embarazada de su segundo hijo en Hershey, Pennsylvania, cuando desarrolló depresión. Después de dar a luz, su afección empeoró. Se sumó a una serie de problemas de salud inexplicables.
Miller, quien es neurocientífica, dijo que consultó a varios psiquiatras y recibió receta tras receta de distintos medicamentos. Durante dos años, probó cuatro antidepresivos y dos antipsicóticos. Nada de eso ayudó hasta que su doctor de atención primaria notó niveles altos de un marcador autoinmune en su sangre.
Un especialista luego le hizo “todas las pruebas posibles”, dijo Miller. Finalmente, la diagnosticaron con la enfermedad autoinmune lupus y le recetaron un esteroide para reducir la inflamación. Algunos de sus síntomas mejoraron en cuestión de horas. Su depresión disminuyó poco después.
“Estaba convencida de que era un efecto placebo”, dijo Miller, “pero luego siguió funcionando”.
¿Había contribuido la inflamación a sus problemas de salud mental todo el tiempo? Miller cree que sí, aunque no puede saberlo con certeza. Sus psiquiatras nunca mencionaron esa posibilidad, dijo.
En la mayoría de las especialidades médicas, los doctores pueden confirmar si deben seguir un tipo de tratamiento mediante pruebas, como análisis de sangre, estudios de imagen y biopsias. Sin embargo, los trastornos mentales históricamente se han diagnosticado y tratado en base a síntomas visibles. Eso podría cambiar.
En un documento de enero, la Asociación Americana de Psiquiatría incluyó ideas sobre cómo podría incorporar biomarcadores —indicadores biológicos de enfermedad mental que pueden aparecer en pruebas diagnósticas— en futuras versiones de su Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM, por sus siglas en inglés).
El DSM, a veces llamado “la Biblia de la psiquiatría” por su influencia en el campo, proporciona criterios de diagnóstico. Lo utilizan clínicos que evalúan a pacientes y aseguradoras para decidir si cubren la atención.
Se necesita investigación “coordinada”
Los biomarcadores psiquiátricos aún no están listos para un uso generalizado, enfatiza el documento. Los científicos han investigado el tema por décadas, con pocos resultados. Se necesita más investigación para demostrar que estas mediciones son lo suficientemente válidas y confiables para usarse en la atención de pacientes, señala el documento de la asociación, y otros investigadores han planteado dudas sobre cómo su uso podría afectar los costos de la atención médica, la cobertura y la privacidad de los pacientes.
Agregar biomarcadores al DSM sería “algo muy importante”, dijo Jonathan Alpert, autor del documento de enero y vicepresidente del Comité Estratégico del Futuro del DSM de la asociación profesional.
El acceso a resultados de pruebas, junto con los síntomas, podría agilizar las decisiones de cobertura de seguros y ayudar a los clínicos a hacer diagnósticos y recomendaciones de tratamiento más rápidos y precisos, dijo. Si la biología de los pacientes sugiere que responderán mejor a un tratamiento que a otro, el doctor podría comenzar de inmediato con esa opción.
Actualmente, recetar medicamentos psiquiátricos puede ser “algo incierto”, ya que los clínicos no pueden predecir si funcionarán en un paciente en particular, dijo Matthew Eisenberg, director del Centro de Políticas de Salud Mental y Adicciones de la Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins.
En un ensayo esencial de principios de la década de 2000 financiado por el Instituto Nacional de Salud Mental, alrededor del 30% de los participantes con depresión vieron desaparecer sus síntomas con su primer tratamiento antidepresivo. Ese estudio sigue siendo uno de los ensayos más sólidos realizados sobre antidepresivos, aunque investigadores han indicado recientemente que menos personas se curan con estos medicamentos de lo que sugieren sus resultados.
Este enfoque de prueba y error puede llevar a recetas ineficaces e innecesarias, un tema criticado por defensores del movimiento Make America Healthy Again, encabezado por el secretario del Departamento de Salud y Servicios Humanos (HHS), Robert F. Kennedy Jr.
Kennedy ha sido especialmente crítico de los antidepresivos, al vincularlos con la violencia después de un tiroteo masivo sin evidencia y culpar a los doctores por recetar en exceso medicamentos a niños.
El HHS está analizando tendencias en diagnósticos y recetas psiquiátricas y evaluando enfoques alternativos de tratamiento en salud mental, con especial atención en niños, dijo la vocera Emily Hilliard en un comunicado. Hilliard no respondió a una pregunta sobre comentarios previos de Kennedy.
Los biomarcadores ya se utilizan para guiar tratamientos en otras áreas médicas, como la oncología. Arizona, Georgia, Kentucky, Texas y más de una docena de otros estados exigen que las aseguradoras cubran este tipo de pruebas. También se utilizan análisis de sangre y estudios de imagen para ayudar a diagnosticar la enfermedad de Alzheimer.
La Asociación Americana de Psiquiatría incluyó en su artículo varias formas en que los biomarcadores psiquiátricos podrían usarse en el futuro, como pruebas de actividad cerebral, perfiles genéticos o marcadores inmunológicos asociados con ciertas condiciones psiquiátricas, incluidas la esquizofrenia y las adicciones.
En la depresión, por ejemplo, alrededor de una cuarta parte de los pacientes tiene niveles elevados de una proteína inflamatoria llamada proteína C reactiva, que puede detectarse mediante un análisis de sangre. Las investigaciones han mostrado que las personas con niveles altos de esta proteína parecen responder mejor cuando reciben medicamentos que modifican los niveles de dopamina en el cerebro, en lugar de usar solo inhibidores selectivos de la recaptación de serotonina (ISRS), un tipo común de antidepresivo.
La proteína C reactiva aún necesita ser “validada de manera sólida” como biomarcador, según el documento de la APA, pero es una de las opciones más prometedoras bajo estudio.
Se necesita un esfuerzo de investigación “coordinado y bien financiado” para lograr esa validación, escribió la asociación, lo cual es incierto ya que la administración Trump recortó el financiamiento para investigación.
Solo al Instituto Nacional de Salud Mental se le cancelaron en 2025 al menos 128 subvenciones, por un valor de casi $173 millones, según una carta de investigación en la revista JAMA. Aunque desde entonces algunas subvenciones han sido restauradas, los investigadores que dependen de fondos federales aún temen recortes.
“Hay una gran necesidad de financiamiento continuo y activo para la investigación relacionada con la salud mental”, dijo Alpert, pero los científicos tendrán que enfrentar “incertidumbres en el panorama de financiamiento”.
Efectos en cobertura y costos
Los costos de la atención médica tienden a ser más altos entre pacientes con enfermedades mentales mal controladas, debido a gastos como hospitalizaciones, consultas ambulatorias y medicamentos. Algunas investigaciones sugieren que las pruebas de biomarcadores podrían ahorrar dinero al encontrar tratamientos adecuados más rápido y evitar algunos de estos costos.
Un estudio de modelado estimó que las pruebas para identificar componentes genéticos que pueden influir en la efectividad de un medicamento podrían ahorrar al sistema de salud de Canadá $956 millones en 20 años si se aplican en adultos con depresión mayor en British Columbia. Otro estudio, de investigadores españoles, encontró que estas pruebas redujeron costos para la mayoría de los 188 participantes con enfermedad mental grave.
No se sabe si ocurriría lo mismo en el sistema de salud de Estados Unidos. A corto plazo, dijo Eisenberg, un enfoque que use biomarcadores podría aumentar el gasto en atención médica debido al costo de las pruebas.
Las aseguradoras podrían negarse a cubrir pruebas de biomarcadores costosas, agregó. “Toma tiempo demostrar que la nueva evidencia científica es segura y efectiva”, dijo Eisenberg. “Y una vez que lo es, las aseguradoras no la cubren de inmediato”.
Algunos investigadores han expresado preocupación de que aseguradoras o empleadores puedan discriminar a personas cuyos perfiles biológicos sugieren riesgo de desarrollar afecciones neuropsiquiátricas graves.
Es un “momento crítico” para considerar enfoques legislativos que protejan a los pacientes y capaciten a los clínicos sobre cómo usar estas herramientas de manera adecuada, dijo Gabriel Lázaro-Muñoz, miembro del Centro de Bioética de la Escuela de Medicina de Harvard.
“No creo que el campo de la psiquiatría esté listo en este momento para manejar esto”, dijo.
El sistema de salud mental no está listo para “avanzar por completo”, dijo Andrew Miller, profesor de psiquiatría y ciencias del comportamiento en la Facultad de Medicina de la Universidad Emory, quien estudia la depresión relacionada con la inflamación. Pero la adopción de biomarcadores por parte de la asociación de psiquiatría marca “el inicio de una revolución”, dijo.
“Esto es un reconocimiento… de que lo que hemos hecho hasta ahora no ha sido suficiente”, dijo Miller. “Y podemos hacerlo mejor”.
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 story can be republished for free (details).