October 27, 2026
Rose
As health care workers fought to control the latest outbreak this year, they got crucial aid from churches in beating back fear and misinformation.
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October 27, 2026
Rose
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Dr. Jennifer Shuford, a respected former Texas health official, had been appointed by President Trump to help steady the agency.
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- October 27, 2026
- Rose
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This article was produced in partnership with The Trace, a nonprofit newsroom covering gun violence in America. Sign up for its newsletters here.
JACKSONVILLE, Fla. — In a Florida county with a startling rate of child firearm injuries, a boarded-up elementary school named for famed educator and civil rights activist Mary McLeod Bethune sits in a 250-acre site once called “Brown’s Dump.”
The dump emerged in an era of redlining, systematic racism that divided American cities large and small. From the late 1940s until the mid-1950s, the city operated a landfill here, heaping toxic ash from nearby municipal incinerators.
The Duval County School Board in the 1950s built a school there. On the surrounding land, developers built homes and apartment complexes.
Generations of Black children lived, learned, and played on the polluted land. It was first assessed as a potential Superfund site in 1985. In 1999, the federal government and state of Florida said the soil at Brown’s Dump “posed a potential public health hazard.”
The school closed in 2001. And eight years later, officials finally began the process of cleaning up lead, arsenic, and other contaminants.
But the poisons had seeped into the lifeblood of residents. The harm to their physical and mental health is tied today to another public health crisis: high rates of gun violence.
A study led by researchers at the University of Wisconsin-Milwaukee found that lead exposure in the first six years of life was positively associated with an increased risk of firearm violence in early adulthood. And across the nation, people living in neighborhoods that were long ago segregated face a higher risk from gun violence today than residents in other neighborhoods, research shows.
“It’s the legacy of segregation and redlining,” said Lindsay Emer, lead author of the Wisconsin study. “It’s a huge environmental injustice to our African American population.”
That legacy has shaped a tragic disparity in Jacksonville, which has three of the 10 worst ZIP codes for child firearm injury rates in Florida, according to an analysis of hospital claims data obtained by KFF Health News and The Trace.
Hospital billing data obtained from the Florida Agency for Health Care Administration shows that from 2018 to 2024 more than 4,000 children in the state were hospitalized for firearm injuries — about 1.5 a day.
The data was obtained exclusively for this reporting on firearm injury hospitalizations in the state. The newsrooms spent more than a year analyzing the records, which did not identify patients. The data contained patients’ residential ZIP code, age, race, and other demographic information.
At least 375 children under age 18 in Jacksonville have been hospitalized for firearm injuries since 2018 and at least 150 from ZIP codes 32206, 32208, and 32209 — where Brown’s Dump is located.
“We have to work hard to make sure our kids get home safe,” said A.J. Jordan, a community organizer who has worked with families of gunshot victims. “Anytime we let them out in this society, they could be killed.”
Jacksonville has a rich history of Black culture and community that stretches from the early days of Reconstruction through the Civil Rights Movement to present-day environmental justice activism. But the city, rooted in the Deep South, falls under the long shadow of its legacy of racism.
In the 1930s, the federal government deemed parts of Jacksonville and nearly 240 other U.S. cities undesirable for mortgage lending because Black people lived there. Officials color-coded maps, marking mostly white areas green and predominantly Black districts red, a signal to lenders to avoid investing in those neighborhoods.
Around the country, local authorities then disproportionately permitted solid waste incinerators, oil and gas facilities, and other industries linked to toxic pollution to be built in or near communities of color.
Redlining was outlawed nearly 60 years ago, but the U.S. Justice Department alleged that it was practiced in Jacksonville’s minority neighborhoods in recent years.
In 2023, it announced a $9 million settlement with Ameris Bank, which it accused of redlining predominantly Black and Hispanic portions of the city.
In a news release at the time, Ameris CEO Palmer Proctor said, “We strongly disagree with any suggestion that we have engaged in discriminatory conduct.” The bank agreed to set up a loan subsidy fund, enhance outreach and community partnerships, and open its first branch in a minority neighborhood. It reported nearly $26 billion in assets under management at the time of the settlement.
To this day, redlining shortens lives.
Black neighborhoods north and northwest of downtown Jacksonville endure poverty, pollution, and high incidences of lead poisoning, cancer, and other diseases — and hundreds of shootings involving children.
Jeffrey Goldhagen, a professor emeritus of pediatrics at University of Florida Health Jacksonville and a former county health director, has studied the link between lead exposure and high firearm injury rates.
“If somebody came to me,” he said, “and said, ‘What’s among the most important things you can do to impact gun violence on the Black community,’ I’d say, ‘Get the lead out of the environment.’”
Public health experts, grieving parents, and activists say the violence has created a collective trauma in neighborhoods where people brace for the next shooting death.
So many Jacksonville children are lost to gun violence that a “Wall of Compassion” memorializes them. When organizers ran out of room, they stood up a second wall in a nearby parking lot.
Not far from the memorial, Jacksonville has opened a new medical examiner’s office and morgue across the street from a school, a move denounced by neighbors.
Anthony Brown, founder of the Red Alliance for Justice, a community group, said protests over the morgue, the history of redlining, and ongoing gun violence are interconnected. Brown said the City Council spent more than $60 million to build the morgue but has not created a dedicated funding source to make life better in redlined neighborhoods.
“We need something that has teeth,” Brown said. “We want some tangible action.”
The Morgue
In 2024, the Jacksonville City Council unanimously approved a resolution to “redress the effects of redlining still felt today.”
Two years later, there is little evidence of progress, according to public health experts, doctors, and grieving parents and community activists.
Wells Todd, a community activist, noted the city is named for Andrew Jackson, the seventh U.S. president and a wealthy slaveholder who is honored in the city’s downtown waterfront with a larger-than-life bronze statue.
“Sometimes living here is like being in a time capsule,” Todd said. “This is about white supremacy.”
On a sidewalk in front of City Hall last fall, a small group marched during the lunch hour to protest the construction of the medical examiner’s office and morgue in Brentwood, a predominantly Black neighborhood north of downtown.
Protesters carried signs that read “Jax still has racism in: Housing, education, policing, healthcare and city hall.” Some wore T-shirts with the words “Dream,” “Resist,” and “Flourish.”
Residents had pleaded for an urgent care center or a pharmacy on the site. Instead, in 2024, city officials allowed the project to move forward. Today the morgue serves five counties.
For some locals, the decision was a slap in the face.
It’s across the street from a public charter school, which neighbors say makes it a symbol of both the city’s abysmal firearm injury rate for kids and systemic racism.
Lydia Bell, a lifelong resident, said the morgue felt like a second wave of redlining.
“They have so much disrespect for Black people,” she said.
Jacksonville once fought to keep Black people from moving into Brentwood.
Bell said she believes the city placed the morgue in the neighborhood because more than 80% of its residents now are Black. She said its presence could send a negative message to children about the worth of the lives in the neighborhood.
“I saw this as a child,” Bell said, “and now I am fighting it when I’m supposed to be enjoying being a grandmother.”
A spokesperson for Jacksonville Mayor Donna Deegan declined to answer questions about gun violence and racial inequality.
Of 19 members of the Jacksonville City Council, only Council members Jimmy Peluso and Ju’Coby Pittman responded to requests for comment.
The city’s north side “has really kind of been ravaged over the years,” Peluso said, “and I feel like it’s not given the proper opportunity to kind of stand on both feet.”
The Cleanup
Spencer Fletcher, who has worked to save 26 bungalows in a historically Black Jacksonville neighborhood, said the stories he hears at community meetings are disturbing.
Children played on playgrounds where workers dumped toxic incinerator ash, Fletcher said. People were told it was good for potting soil, so some used it in their gardens, he said.
That part of the city’s history — and its health effects — are often downplayed, Fletcher said.
“It’s like it never happened,” he said.
Incinerator ash can be highly toxic and contain high concentrations of lead, mercury, arsenic, and cadmium. Rain can cause contaminants to leach into groundwater, and studies have linked exposure to cancer, kidney damage, and developmental problems in children. The federal government banned lead in house paint in 1978.
A December 2024 Environmental Protection Agency report said much of the Brown’s Dump site had been cleaned or covered with enough new soil to reduce exposure to people and protect groundwater in the area.
The EPA also reported that year that authorities were cleaning a second Superfund site on the city’s north side called the Jacksonville Ash Site. The three parcels covering more than 1,100 acres include a 250-acre park, with residential and commercial areas occupying the former sites of municipal incinerators.
EPA officials wrote that the contamination no longer threatens people living or working near them.
But Goldhagen, the professor emeritus at UF Health Jacksonville, said severe damage had already been done.
Jacksonville has one of the highest lead poisoning rates in Florida. There is no known safe amount of lead for humans, and even small amounts can impair cognitive development, attention, and behavior in kids. Black children, other people of color, and those living in low-income households are at the greatest risk, studies show.
Goldhagen and other public health leaders say lead exposure early in life can affect brain development and impulse control as children grow older. He noted the Wisconsin study by Emer and her colleagues.
Emer’s research team studied more than 89,000 people in Milwaukee who were tested for lead exposure by age 6. Even after controlling for other factors such as race, sex, and neighborhood socioeconomics, they found that lead exposure increased the risk of becoming a perpetrator or victim of firearm violence.
The results show “the potential importance of lead exposure reduction in firearm violence prevention efforts,” the researchers said.
Sara Baldwin is a forensic social worker who researches a defendant’s medical and social background to present mitigating factors that can reduce sentencing in criminal cases in Florida and other states.
“I always say the school-to-prison pipeline is lined with lead,” Baldwin said.
Teri Sopp, an assistant public defender for the state’s Fourth Judicial Circuit, which includes Jacksonville, said it’s unsurprising that so many children suffer gunshot injuries. People grew up swimming in lead-contaminated creeks, she said.
Local officials have long been aware of anecdotal evidence that lead poisoning caused violence, but failed to seek remedies, Sopp said.
“There needs to be a large-scale assessment of the situation,” she said.
Once the federal government, the state, and the city began efforts to clean the sites, the county health department under Goldhagen began to examine the effect of lead exposure and other environmental hazards in these communities.
“We tested hundreds and hundreds of kids from the community,” he said. “We really couldn’t find it, because the ash was buried under dirt that had accumulated over the years. But yes, I think it did have an impact.” He added that “the impact of lead-based paint in homes was greater than the lead in the ash.”
Goldhagen said testing was an effort to address one of the “root causes” of gun violence. But he said that in the last 20 years, local and state leaders have largely abandoned a public health approach to gun violence.
“This is a disease,” he said, “and we need to use rigorous public health approaches to address it.”
Goldhagen, who led Duval County’s health department from 1993 to 2005, said Florida’s statewide system of county health departments has been hollowed out by years of staff and budget cuts, diminishing their ability to address public health crises.
A KFF Health News-Associated Press analysis of state data found that the health department in Duval County had the equivalent of 852 full-time employees and spent about $91 a person in 2008 but by 2019 had only 422 workers and spent $34 a person.
“There was a commitment to public health in the state,” Goldhagen said, “but that commitment has been slowly and under [Republican Florida Gov. Ron] DeSantis rapidly dismantled so the public health departments in each of the counties are a shadow of what they were.”
The State Health Improvement Plan, a set of goals developed by the state health department and an advisory committee, does not mention guns, the toll they take on children, or efforts to reduce firearm deaths and injuries to young people.
“This is a story the government doesn’t want told,” said Baldwin, the mitigation specialist. “We would get these cases and everyone in this person’s family has been incarcerated. Why did this whole family go to prison? Well, let’s look at where they lived.”
Jacksonville Councilwoman Pittman, whose district includes the Brown’s Dump site, said the city, state, and federal governments have made progress cleaning up contaminated areas. But more needs to be done, she said.
“Remediation of contaminated soil does not, by itself, repair generations of neighborhood disinvestment,” she said, adding that a long-term solution will require sustained spending on housing, public health, education, and economic development.
Pittman said the legacy of Brown’s Dump is “especially troubling” because of the burdens it placed on those who lived nearby.
“The history matters,” she said, “but our responsibility today is to determine what we are going to do about the conditions that continue to affect our youth and families.”
Documents from the 1930s showed a federal government appraiser discouraged investment in some areas north of downtown Jacksonville, saying the residents were Black people and the neighborhoods lacked sufficient sewer and water infrastructure, sidewalks, and roads in good condition.
“It listed all these things back in 1934 as reasons not to invest, to provide private capital into these neighborhoods,” said Peluso, who co-sponsored the City Council’s redlining resolution. “And if you look today, a lot of those areas that were redlined — you could say the exact same thing.”
KFF Health News data editor Holly K. Hacker contributed to this report.
This report was produced by KFF Health News, The Trace, and Action News Jax.
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- October 27, 2026
- Rose
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Gina Conley, an Army veteran in Aberdeen, North Carolina, knew she wanted a low-intervention birth for her first child. But her plan started to go off the rails as soon as she got to the hospital.
“Everything that I did not want to happen had happened,” she said. “And I just remember that feeling of being just so utterly defeated.”
Her cervix wasn’t dilating quickly, and Conley said her midwife insisted that she take Pitocin to speed up the labor. Later, when she was nearly fully dilated, the midwife asked to break Conley’s amniotic fluid sac, another intervention used to move labor along.
Conley agreed to that step, reluctantly. But looking back, she said she didn’t feel comfortable with many of the decisions that day. And Conley doesn’t feel that her providers were fully hearing her.
Conley went on to become a birth doula, in part to help other women have better experiences than she had. Her work is not about helping people avoid medical interventions, she said, but helping them engage in shared decision-making, a collaborative approach in which medical providers and patients talk through options and make a choice together. Studies show that patients who are involved in their medical decisions report higher satisfaction with their care and, in some settings, better outcomes. “How were you treated?” she said. “And how many decisions did you feel like you got to truly make?”
The QTip:
Even in a fast-paced medical setting, it’s OK to ask: “What happens if I do nothing right now?”
The Acronym To Remember: B.R.A.I.N.
Birth doulas, including Conley, often advise clients to use the acronym B.R.A.I.N. to ask questions of their medical providers:
- What are the benefits of this intervention?
- What are the risks?
- What are the alternative options?
- What does my intuition tell me?
- What happens if I do nothing right now?
“ It’s essentially a framework for talking to your healthcare provider when you’re coming to a decision or a pivot point,” said Margaret Buxton, a certified nurse midwife and vice president of clinical operations at Diana Health, a network of women’s healthcare practices in the South.
Listening to your intuition is particularly valuable, Buxton said: “You do experience emotions in your body, not just in your head.” Checking in with your intuition or gut can help you decide and ultimately feel more comfortable with a choice in front of you.
“We know that people who feel seen and heard in their healthcare visits, their anxiety goes down, their stress level goes down,” she said. “And their ability to process information, think and listen, all of that improves.”
When All Else Fails, Remember ‘N,’ for ‘Nothing’
If you don’t have time or energy to go through all five questions, you can ask the N in B.R.A.I.N.: “What happens if I do nothing right now?”
Doing nothing provides an opportunity to pause, talk through options with people you trust, and feel more active in the decision-making process, Buxton said.
Of course, there are moments when a medical emergency takes precedence. “ It’s pretty clear when it’s not a good time to talk, because people are ripping cords out the wall and they’re running you down to the OR,” Conley said. But generally, “there’s time for you to get to a point where you feel pretty comfortable and confident that this is a good decision.”
B.R.A.I.N. Won’t Replace a Compassionate Provider
Some patients feel uncomfortable questioning a doctor’s authority, because of the power dynamics in the room. “ Medicine was really set up to be top-down,” Buxton said. “There’s an expert, and there’s a recipient.”
Others fear being dismissed or not taken seriously. Research has shown that medical professionals are less likely to prescribe pain medication to women than men for the same symptoms and that Black women are three times as likely to die in childbirth than white women.
That’s why it’s important to find a provider you trust before a planned medical event, like childbirth, Conley said. Pay attention to how they respond to questions in appointments and whether they actively listen. And if they don’t, find a different person to oversee your care.
“We need to choose a provider that we can truly trust to share their expertise with us in a way that is not going to push us away from our personal preferences,” she said. “It’s definitely harder to have those conversations with an abrasive provider who is not interested.”
People and Policy
Medical professionals are both legally and ethically required to obtain “informed consent” from patients before most procedures. This means they have to give you accurate and complete information about the recommended treatment, typically in writing.
And nearly two decades ago, the American College of Obstetricians & Gynecologists’ ethics committee recommended that doctors go a step further and engage in shared decision-making, which involves discussing “the benefits and risks of available treatment options in the context of a patient’s values and priorities.” The Centers for Medicare & Medicaid Services has also started requiring shared decision-making as a condition for paying for a limited number of treatments.
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 healthcare system. It’s a collaboration between Nashville Public Radio and KFF Health News.
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- October 26, 2026
- Rose
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The Honolulu Museum of Art is showing how art can influence thinking, perspective and mood, in an exhibition that is part of a trend by museums to mix science and art.
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- October 26, 2026
- Rose
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Dianne Williams said she lost weight and lowered her blood pressure thanks to quarterly doctor appointments, monthly phone calls with a nurse, and a blood pressure cuff she uses at home that transmits data to her care team.
“It’s good to have somebody talk to you and tell you what your progress is like. And she’s a very nice person,” Williams said of her nurse.
Williams, who lives in rural Georgia, said these services — referred to as remote patient monitoring — encourage her to take her medication and inspired her to revamp her diet and exercise.
But many Medicare patients, especially those in rural areas like Williams, soon may no longer be able to use devices and receive coaching from the comfort of their homes.
That’s because a proposed federal rule would halt Medicare reimbursements for providers who use health technology companies to administer remote monitoring for their patients. Medicare would pay clinicians only when the service is provided by someone at the facility where they work.
The Centers for Medicare & Medicaid Services’ proposed rule is a response to reports on remote monitoring from the Department of Health and Human Services’ Office of Inspector General, an independent federal oversight agency. The 2024 and 2025 reports raised concerns about fraud, a lack of data collection, and patients’ not receiving treatment from the clinician who prescribed the device.
But Caroline Pearson, executive director of the nonprofit Peterson Center on Healthcare, said “the rule would virtually eliminate the use of remote monitoring services, or dramatically reduce the use,” for many Medicare patients.
“I think the rural communities will be some of the hardest hit,” said Pearson, whose organization focuses on healthcare affordability.
She said remote monitoring programs can be especially helpful in rural areas, where it can be difficult for patients to travel to in-person appointments. Most rural healthcare facilities that offer these programs use third-party vendors since they don’t have the capacity to launch and oversee their own, she said.
CMS spokesperson Timothy Foster said the agency “recognizes the important role that technology-enabled care can play in improving access to care, including in rural communities.” But more safeguards are needed, he said.
The proposed rule says outside vendors may “have little to no established relationship” with patients and their clinicians, which it says can “fragment care.” It also says the clinicians may not be involved enough to warrant being paid by Medicare. Pearson, other health policy experts, and vendors agree with the Trump administration that these programs need further regulation. But public comments show widespread strong disagreement with CMS’ approach.
The proposal “took us by such surprise,” said Andrew Van Ostrand, senior vice president at the Alliance for Connected Care, a group that advocates for wider adoption of health tech, including remote monitoring, on behalf of healthcare organizations and tech companies.
Van Ostrand said many vendors have already made changes inspired by the “very well-reasoned recommendations” from HHS’ Office of Inspector General and were surprised that the proposed Medicare rule didn’t mandate all its suggestions.
The proposed rule would apply only to patients enrolled in traditional Medicare, not those with privately run Medicare Advantage plans, which cover more than half of Medicare participants. But Van Ostrand and Pearson said Medicare Advantage plans, Medicaid programs, and private insurers could end up adopting the same change, further limiting access.
Van Ostrand said the vendor rule and other proposed changes — including a “draconian” cut in reimbursement rates — are in “deep misalignment” with one of President Donald Trump’s signature initiatives: the five-year, $50 billion Rural Health Transformation Program, which encourages states to adopt tech solutions to improve rural healthcare.
States have earmarked at least $240 million from their first-year rural health funding for remote monitoring, according to a report by the Alliance for Connected Care, which also wrote to CMS to oppose the rule change.
More than 230 health tech vendors, healthcare systems, and patient and medical advocacy groups had signed the opposition letter as of Sept. 14.
A few organizations largely support the proposed rule, including major health industry players Humana, Blue Cross Blue Shield Association, and Sutter Health, a large health system that offers its own remote monitoring program.
Remote Patient Monitoring 101
Remote monitoring can be used for patients who are in physical therapy, recovering from surgery or hospitalization, or living with a chronic condition such as diabetes or heart disease.
The idea is to help patients manage their health and prevent dangerous complications or pricey emergency room visits. Remote monitoring can also make it easier to obtain care for patients who struggle to travel to in-person appointments — such as those with disabilities, without cars, or from rural areas far from hospitals.
To track her blood pressure, Williams straps a cuff to her arm and presses a button. The device automatically sends her data to CoachCare, a private company whose staff monitor patients.
“I don’t have to wait until I go to the doctor’s office when I can do it every day,” Williams said.
Other patients are given devices such as scales, blood glucose monitors, and fitness bands that transmit data that’s monitored by nurses or other staffers, and, increasingly, with the help of artificial intelligence.
Some large academic health systems create their own devices or use their own employees to review data and check in with patients. But most health facilities contract with health tech companies.
If staff notice — or are alerted by AI to — patient data trending in the wrong direction, they can call patients to offer advice or schedule a follow-up appointment with their doctor. If vitals indicate life-threatening problems, staff urge patients to call 911.
Williams said she was frustrated when her medication wasn’t lowering her blood pressure. She said that’s when her CoachCare nurse suggested she start exercising and eating healthier.
“That made me feel better, because they gave me encouragement,” she said. “They just didn’t just take my blood pressure and that was it.”
Williams said she now walks at a local track each day and made diet changes, such as switching from fried to baked fish.
Edward Vance is the chief medical officer of Albany Area Primary Health Care, which includes Williams’ clinic. He said the health system, which serves many rural and low-income patients, couldn’t offer remote monitoring without an outside vendor.
“We already run at a borderline understaffed situation,” and many community health centers operate with “shoestring budgets,” Vance said.
Growing Pains
The federal government created Medicare billing codes for remote patient monitoring during Trump’s first presidency. That allowed providers to be reimbursed for initiating and overseeing such services. Health facilities often use part of that revenue to pay vendors for their devices and monitoring.
Only 1% of patients on traditional Medicare use remote physiologic monitoring, the more common type of remote monitoring, and the cost is a small fraction of overall spending. But both measures are rapidly growing.
The number of traditional Medicare patients enrolled in such programs grew tenfold from 2019 to 2023, while program spending on them increased from just under $7 million to more than $194 million, according to an April 2025 report from the Peterson Center on Healthcare.
Pearson said evidence shows remote monitoring is most helpful when providers use the data to inform how they treat patients — such as adjusting medications — and only until the patient is stabilized.
“We shouldn’t be paying for doctors to be reviewing huge numbers of readings, for years on end, for patients that have controlled blood pressure,” Pearson said.
“That doesn’t feel like a clinically driven decision. That feels like a revenue decision,” she said, adding that some vendors explicitly pitch their services as an opportunity for health facilities to generate income.
But traditional Medicare patients are enrolling in remote physiologic monitoring programs for longer periods of time. From 2019 to 2023, average duration increased from 1.7 months to 5.2 months, the Peterson report found.
Pearson said Medicare should limit how long patients can be prescribed remote monitoring unless there’s proof treatment is still needed. The agency also should require clinicians to report more data, including outcomes, she said.
She said Medicare should eventually transition to a reimbursement system that pays based on whether programs improve patients’ health. Pearson said CMS has already begun to do so through its new ACCESS program, which pays not only clinicians but also vendors.
But Pearson said the program, which launched in July, reimburses less than traditional models.
Williams said the government should keep remote monitoring accessible.
“It looks like they’re cutting off everybody, and that’s not right,” she said.
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- October 25, 2026
- Rose
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The United States spends a lot of money on healthcare. To better understand how much, who spends it, and what it’s spent on, we dug into the federal government’s data.
In 2024, the most recent year for which data was available, the U.S. spent $5.3 trillion on healthcare. That means an average of more than $14.4 billion was spent each day, and more than $10 million each minute.
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 article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- October 23, 2026
- Rose
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Beyond melanoma, scientists are studying cancer vaccines for glioblastoma, pancreatic cancer and more.
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- October 23, 2026
- Rose
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Consumers who buy Affordable Care Act health insurance are going to see changes both big and small as open enrollment for 2027 coverage kicks off. These include premium increases, possible additional identity checks, potential delays in working with a broker, and new limits on which immigrants can get subsidies.
Shoppers need to plan accordingly.
Open enrollment starts Nov. 1 in most states. Idaho, Connecticut, and Massachusetts start earlier, and some states are already allowing “window shopping” to check premium rates.
A continued decline in overall enrollment is expected, mainly because of the expiration of enhanced subsidies at the end of 2025. Policy experts say the end of those subsidies led millions to drop or lose coverage through the first few months of this year.
But the Trump administration sees victory in the falling enrollment, crediting its various efforts to reduce fraud, including the August cancellation of policies covering 760,000 enrollees suspected to be improperly signed up. A small number of those enrollees have regained coverage.
Have Your ID Ready
One of the biggest changes will be increased scrutiny of both consumers and agents via requirements aimed at thwarting fraud or improper enrollments. For consumers, it could slow the enrollment process.
The new rules, outlined in a Centers for Medicare & Medicaid Services FAQ, affect only consumers using agents or brokers to help them enroll through the federal marketplace, which serves 29 states. They do not apply to state-based exchanges, which have their own rules and have in most cases been more successful at preventing fraudulent sign-ups.
For starters, all consumers using an agent in the federal marketplace will need to get a one-time confirmation code or link to authorize a specific agent to enroll them or make changes on their behalf. It will be sent to consumers by text message, email, or an automated phone call from one of the private enrollment platforms used by their agent. Returning consumers who have incorrect or outdated contact information will first need to call the federal marketplace themselves or submit an application online to update it.
Additionally, consumers and policyholders deemed “high-risk” must verify their own identity before authorizing an agent. CMS defines as “high-risk” first-time applicants or those with existing coverage whose applications involve a change of state, as well as consumers working with a new or different agent or with a monthly premium payment of $30 or less.
Joshua Brooker, who oversees an insurance agency in Pennsylvania, said CMS appears to have selected people in those groups for greater scrutiny because “someone who is moving to a new state or switching brokers — that could be a broker trying to impersonate a consumer.”
The $30-a-month cutoff may be tied to concerns that plans with no or low monthly premiums are easier for bad agents to target for unauthorized enrollments because the policyholder may never get a bill. Some rogue agents even pay the low monthly amount themselves and still make a profit from the commission, Brooker said.
The broad nature of the new rules, though, has Brooker concerned “that up to 1 in 5 consumers is going to have to do extra identity proofing” and may just give up and not get insured.
Consumers designated high-risk must prove their identity through a CMS-approved third party such as credit company Experian, which generally asks questions only the consumer should be able to answer. People who fail this test may be asked to call Experian’s help desk or submit their applications themselves by creating a healthcare.gov account, which requires them to upload identification such as a driver’s license, a passport, immigration papers, or another form of ID.
“Some people may have trouble not because they’re not real, but because they don’t have a credit file, or have moved, or have changed names,” said Stacey Pogue, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University.
She said the changes might “be an appropriate response by CMS that targets fraudulent enrollments but might also create extra hurdles.”
There May Be Fewer Brokers
CMS in September issued a rule that places a moratorium on brokers new to offering ACA coverage. Agents not registered with the federal marketplace in 2026 will not be allowed to assist with enrollments for 2027 until February at the earliest, past the end of open enrollment season.
CMS said it took this step because a disproportionate number of “significant compliance concerns” in 2026 came from newly registered agents or brokers. Additionally, the agency has kicked out “hundreds of non-compliant agents and brokers” this year.
Jason Fine, who runs a brokerage in Florida, said he agrees with the concept behind these changes. He has reported multiple times to CMS, for instance, that rogue agents have switched his clients’ coverage without authorization, wanting the agency to take action against them. But he said the updated rules also raise concerns.
“Everything they are doing in the long term makes sense,” he said. However, in the short term, “I don’t know if they care about the chaos it will cause.”
That’s because the moratorium will make it much harder for small brokers to help clients this year. His agency and others often pare their staffing after open enrollment but hire again toward the end of the year. He was planning to add up to 10 agents to his core staff of about five but has been told by recruiters that he’s unlikely to be able to find anyone who was registered for 2026 and is still available.
He suggested that the move unintentionally benefits larger call centers, some of which were doing much of the marketing that regulators feared led to unauthorized switching. Call centers often maintain larger staffs.
“They can afford to keep a staff of 25 or 40 people all year long,” Fine said.
Groups representing agents are very unhappy with the directive. One, the National Association of Benefits and Insurance Professionals, filed a lawsuit Oct. 15 against the Trump administration over the moratorium, saying it unfairly targets 19,000 agents who may want to sell ACA plans for next year.
“Just because you’re a new agent doesn’t mean you are fraudulent,” said Ronnell Nolan, president of Health Agents for America, another sales agent group, which on Oct. 21 filed suit seeking a temporary restraining order on the moratorium. “All these agencies who have trained new agents and paid thousands of dollars now have people who won’t be able to work.”
It all leads to an important piece of advice from Georgetown’s Pogue: Consumers should not delay making appointments. “If you rely on an agent or broker, and a lot of people do, their slots might fill up faster because there will be fewer of them to help with enrollment. I would reach out early.”
Costs Will Continue To Be an Issue
This year, after Congress did not renew the expiring enhanced subsidies, most people getting ACA coverage saw what they had to pay increase. Higher earners lost subsidies entirely. Add in double-digit premium increases, and most people had to pay substantially more for their coverage.
But most people who buy ACA coverage for next year will still receive a subsidy. It will just be less generous than it was before the enhancements expired at the end of 2025.
The subsidies are pegged to the premium costs of benchmark plans, the name given to the second-lowest-price silver-tier plan in an area.
This helps offset premium increases.
“For most folks, overall affordability will stay about the same,” said Louise Norris, a health policy analyst for HealthInsurance.org. “That’s not to say it’s great, but if you were able to manage the premiums this year, it should be similar to that.”
But there are other factors at work, too.
Last year’s average premium increase of 26% was the largest in years. It was driven in part by insurers’ fear that the expiration of subsidies would cause healthier people to drop out of the marketplace. Other drivers often cited for such increases include a rise in overall medical care costs, inflation, and labor shortages.
For the upcoming year, those dynamics remain a concern, with premiums slated for double-digit increases, although, at 15%, slightly lower than last year.
Subsidies are income-based and cut off for households earning more than four times the federal poverty rate. During this open enrollment season, that amount is $63,840 for a single person, $86,560 for a couple, and $109,280 for a family of three, for example.
“The biggest issue we will face is affordability,” said Anne Petry, who, with her father, owns Jaggi Petry Insurance & Investments in Forsyth, Illinois, and helps customers purchase health insurance, including ACA plans. “There definitely will come a breaking point for people.”
Agents and other experts say consumers should not allow their plans to automatically renew and should instead go online to compare premiums and coverage, which can change each year even for the same plan. There may be less expensive alternatives, including plans from new insurers, so they suggest looking at not just premiums, but also deductibles and other costs. At the same time, several insurers, including Cigna, have dropped all or part of their ACA coverage areas.
“If you just sit on the sidelines and let the policy auto-renew, you might miss out on what could be a better opportunity,” Norris said. She said it is important to check options because the cap on out-of-pocket maximums for ACA plans is also increasing.
That amount, which represents the most a consumer must pay toward deductibles, copayments, and coinsurance before the policy is expected to cover remaining in-network medical costs, was $10,600 for an individual and $21,200 for a family plan this year. In 2027, it will grow by 13% to $12,000 for an individual and $24,000 for family coverage. Lower caps on out-of-pocket maximums are set for households earning up to 2.5 times the federal poverty level.
The One Big Beautiful Bill Act, which Congress passed last year, also strips subsidy eligibility from many lawfully present immigrants, including people holding temporary H-1B work visas, refugees, asylees, people with temporary protected status, and those with pending green-card applications.
Three immigrant groups can still get ACA subsidies: green-card holders, who have permanent legal status; certain Cuban and Haitian immigrants; and citizens of Micronesia, the Marshall Islands, or Palau.
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 article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- October 22, 2026
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Could the geometry of our brains increase the risk of Alzheimer’s disease? It’s a provocative question, but one that some scientists are beginning to explore.
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- October 22, 2026
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Days before it was to go into effect, the Trump administration pushed back a U.S. customs rule threatening the supply of vital prescription drugs imported by millions of Americans.
Under the rule, Customs and Border Protection and the FDA will require coding on packages that makes it easier to know what’s in them. It is aimed at collecting tariffs on even low-value imports, and at catching illegal drugs like fentanyl. It will also add costs and complex paperwork to each order.
Now the regulation, which was set to start Oct. 22, is delayed until Jan. 20.
While it is illegal to import most FDA-approved prescription drugs, the U.S. has allowed Americans to import legal medications in small quantities for personal use since 2003. The FDA rarely inspects the parcels.
“The information we have is there’s going to be a complete shutdown on Oct. 22,” Tim Smith, general manager of the Canadian International Pharmacy Association, said in an interview in early October. The 51 licensed retail pharmacies in his organization urged their hundreds of thousands of U.S. customers to file extra orders before Oct. 9 to be sure as many medications as possible arrived before the clampdown, Smith said.
“These are people in every case who have gone to the doctor, gotten a prescription for whatever, gone to the pharmacy to fill the order, seen how expensive it’s going to be, and then looked for an alternative,” he said. “Those are the people who’ve been coming to us for years.”
As Donald Trump campaigned in 2016, allowing people to import drugs was part of his platform. In his first term, President Trump let states buy cheaper drugs from Canada. He told Floridians at 2020 rallies that their state could “go to Canada” to obtain drugs for them.
But while Florida and Colorado joined the importation program, neither state has brought in any drugs yet.
Patients have, however, and they flooded authorities with at least 109,000 letters urging the FDA to clarify that the rule won’t stop personal-use drug shipments, said Ken Hunter, executive director of the Campaign for Personal Prescription Importation. And Trump ally Laura Loomer called the rule a case of stupidity or sabotage, under a headline that asked, “So Why Is Someone in His Administration Trying To Make Prescription Drugs More Expensive Before The Midterms?”
Seventy-one congressional Democrats signed an Oct. 1 petition led by Reps. Jan Schakowsky of Illinois and Mark Pocan of Wisconsin to warn about the potential impact of the rule. Three House Republicans from Florida wrote separately to CBP and the FDA, noting that Floridians, unlike Americans in Northern states, can’t easily drive to Canada to buy medicine.
By cutting off imports, Hunter said, “they are going to lose millions, maybe billions in tariff revenue.”
“Why would you want to cut off this massive revenue source?” he asked. “Why would they want to cut people off from lifesaving medications two weeks before midterms?”
Pressure by advocacy groups may have led the agency to back off, said Lucia Mueller, president of PharmacyChecker, which helps patients find legitimate pharmacies to obtain cheaper drugs.
“Loomer’s political argument is sound,” she told KFF Health News. “We know she’s had Trump’s ear before.”
The agency’s Oct. 14 news release on the delay said it would help “avoid disruptions to certain international postal shipments.” It didn’t specifically refer to drug imports.
“This is an important short-term success,” said Gabriel Levitt, founder of Prescription Justice, a nonprofit that advocates for more-affordable drugs. “However, the underlying threat to personal prescription drug importation remains, and the next 90 days will be critical.”
A 2020 study found that 2.3 million Americans regularly imported medications from abroad, and some surveys show much higher numbers. About 4 in 10 Americans in a recent KFF survey said cost had led them to not take medications as prescribed over the past year.
When he was diagnosed with atrial fibrillation years ago, Leslie Waters learned that a 90-day supply of the blood thinner Eliquis, or apixaban, would cost $486. “Holy crap!” said the retired computer scientist, who said he lives off a monthly $1,886 Social Security check. Waters, of San Jose, California, learned about the Canada option on the internet and has been buying 90-day supplies from a pharmacy there for $57, including shipping.
Under previous administrations, orders worth $800 or less weren’t taxed or saddled with extensive paperwork. The new rule will require shippers of even low-value international parcels to transmit detailed information about their contents to CBP, along with tariff payments, which must be transmitted through a licensed customer broker.
Zonos, a U.S.-based company that handles logistics for mail from Canada and other countries, told clients in early September that its understanding was that CBP would no longer allow in personal prescription drug packages after the rule took effect, said Smith, of the Canadian pharmacy trade group. In an Oct. 6 webinar, Zonos senior broker Angela Macke said that the company would continue to ship the drugs but that it didn’t know whether the agencies would let them reach patients.
The pharmacy announcements have frightened thousands of customers, said Bill Hepscher, whose company, Canadian Medstore, has six Florida storefronts that help patients import drugs.
“It’s really been hair on fire,” he said. “I could spend my entire day fielding phone calls from people saying: ‘Can I no longer get my Eliquis? I could have a blood clot or stroke!’”
Hepscher said about half his clients buy their drugs from Canada, with many of the others buying from Australia, New Zealand, the U.K., or Turkey. He said 2025 was his company’s busiest year ever — changes to Medicare drug plans and increased enrollment in high-deductible Affordable Care Act plans had led seniors and younger people facing higher costs and copays to seek Canadian drugs.
“I only have 23 days’ worth of pills,” Roland Hofferber told KFF Health News in early October. The retired supply chain engineer in Muscatine, Iowa, takes Jardiance, also known as empagliflozin, to slow his chronic kidney disease. “If I don’t get some through pretty soon, I’m going to have to cut back or quit.”
The drug would cost him $641 for three months in the U.S., he said. He buys a generic from an Indian pharmacy for $54.
The FDA “hasn’t given parameters as to what they will approve and what they won’t,” Zonos’ Macke said during the webinar. “We’ve been told there will not be a general ban. But we cannot reassure U.S. patients. We have to see how FDA applies. They could be lenient. They could be very strict.”
When asked whether patients could still import prescription medicines, CBP spokesperson Jessica Turner said that pharmaceuticals remained under the FDA’s jurisdiction and that the FDA “will continue to determine whether imported medication shipments are admissible.” Department of Health and Human Services spokesperson Emily Hilliard said the FDA would “continue to evaluate personal imports on a case-by-case basis.”
White House spokesperson Allison Schuster did not respond to questions about imports but said Trump “remains dedicated to lowering the cost of prescription drugs.”
Since summer 2025, patients have had to pay tariffs on brand-name medicine shipments. In 2022, the FDA said it typically checked about 1 in 2,000 medication packages passing through U.S. customs.
“A lot of products weren’t even looked at, because CBP and FDA didn’t have full visibility” into what entered the country, Prescription Justice’s Levitt said. The rule requires shippers to post a bond and fill in a complex data form for each package, he noted.
“Let’s say you’re importing 90 days’ worth of Eliquis,” Levitt said. “FDA can now look on a screen and see that. Do they let it in, or refuse it under law?”
“If they don’t, there’s going to be a cohort of people who cannot afford their drugs anymore,” he said. “And those people are going to suffer.”
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 article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- October 21, 2026
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As several states report surges in animal cases, federal officials are warning about an apparent increase in human exposures.
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- October 21, 2026
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More Americans are rejecting everything they’ve been taught about food.
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- October 21, 2026
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Four years ago, Oregon hospitals were under fire from state authorities and patient advocates. Hospitals, critics said, had made it too hard for patients to apply for and receive help paying their bills.
Within months, the state enacted a sweeping law that required hospitals to proactively screen patients and give financial aid to those who qualify for it. Oregon’s new rules, which took effect in July 2024, required hospitals to skip applications for nearly all patients — a rarity among hospitals nationwide.
“They will be told up front, Hey, we got you,” said Democratic Oregon state Sen. Lisa Reynolds, who introduced the legislation. “You are here at a very scary time in your life because of illness or injury, and we got your back.”
The law worked.
Oregon Health & Science University’s hospital, one of the largest in the state, saw 64% of its patients automatically qualify for financial assistance in the early months of the new law, up from 12% previously.
In their first full fiscal year under the law, spending by Oregon hospitals on financial assistance more than doubled, on average, according to federal financial reports from about two-thirds of the state’s hospitals. That’s compared with their last full year before the change.
For patients, the switch meant direct relief from high healthcare costs, advocates said.
“They don’t have to have the late nights being like, how am I going to afford my mortgage? How am I going to afford these medical bills?” said Adam Zarrin, a director of state government affairs for the advocacy group Blood Cancer United.
Hospitals in the state have pushed back on the requirements, saying they need better screening tools, and they face added financial strain from the Trump administration’s domestic policy agenda. Millions of people are projected to lose health insurance in coming years under cuts to Medicaid pushed through by Republicans in Congress.
Oregon’s early success is the first big test of a new approach that more states are turning to, known as presumptive eligibility. Hospitals skip the applications and screen patients automatically to determine if they qualify for aid.
North Carolina this year expanded its screening requirement to include patients with income up to triple the poverty line. California and Delaware are requiring hospitals to automatically grant financial aid by July 2027.
A Promising Tool To Prevent Medical Debt
As many as 100 million adults in the U.S. have healthcare debt, according to a KFF Health News analysis. That financial burden can alter people’s lives, forcing them to skip prescriptions and follow-up care to avoid further bills.
Hospitals are a major source of that debt, and they have faced growing scrutiny over their prices and billing practices.
Policymakers have focused specifically on nonprofit hospitals, which account for about half the sector. Nonprofit hospitals typically don’t pay taxes, in exchange for providing benefits to their communities — a vaguely defined standard under federal law. Many hospitals meet this requirement by providing free or discounted care to low-income patients.
That financial assistance, however, can be difficult to get. Applications can be onerous and confusing. Congress and state officials have spent years testing policies to promote the help and make it easier to receive, with mixed results.
Research finds hospital financial aid spending varies, as does the degree to which hospitals benefit by not paying property, sales, or income taxes.
“Hospitals have been on the winning side of this deal for a long time,” said Reynolds, the Oregon lawmaker. “They enjoy millions and millions and millions of dollars in tax breaks, and that money is supposed to be then spent on poor people who can’t afford their care or even their copayments. It has not penciled out.”
Reynolds pressed for Oregon’s screening requirement, she said, to hold hospitals “accountable for what they should have been doing all along.”
Early evidence suggests the law is doing what Reynolds hoped. Oregon hospitals’ spending on free and discounted care increased to 2.7% of all operating expenses, on average, from 1.4%, among the roughly two-thirds of hospitals with available federal data.
That brings hospitals in Oregon closer to the national average for nonprofit hospitals, which from 2021 to 2024 was about 2.4%, according to an analysis by Johns Hopkins University researcher Hossein Zare, who studies the industry.
More Help for the Insured
Among those in Oregon who started to get more help: patients with health insurance.
OHSU’s spending on help for insured patients reached about $39 million in the first year under the law, federal data shows, about five times as much as in previous years.
Lawrence Furnstahl, then OHSU’s chief financial officer, said in a public meeting in January 2025 that, before the law, insured patients often didn’t apply for help and instead paid their share of the bills. The new automatic screening often wiped out or reduced what they owed — including for large deductibles that patients have to meet out-of-pocket before insurance will kick in.
Patients who pay hospital bills often still carry medical debt, surveys show, because many use credit cards or loans from family, friends, or banks to afford their care.
A 2025 survey from the Commonwealth Fund found that 1 in 3 adults with private insurance have medical debt.
“It defies the purpose of health insurance coverage, which is to enable people to get healthcare when they need it and protect them from serious costs,” said Sara Collins, an economist and senior scholar with the Commonwealth Fund.
‘A Very Different World’
For hospitals, the new requirements come as healthcare costs are climbing and federal support for the safety net is shrinking. Nationally, an estimated 14 million more people will be uninsured in 2034 as a result of President Donald Trump’s signature tax-and-domestic-spending law and the expiration of enhanced Obamacare subsidies that Republican lawmakers allowed to lapse at the end of last year.
Hospitals supported Oregon’s new presumptive eligibility law, said Sean Kolmer, an executive vice president for the Hospital Association of Oregon. But they’re feeling more financial pressure, with the organization expecting the state’s uninsured rate to climb to 10% or higher in coming years, he said, up from about 3% before Oregon’s screening law passed.
“That’s a very different world,” he said.
OHSU saw costs rise rapidly. “It is a good thing, but it is an expensive thing,” Furnstahl said in a public meeting as he gave an update on the first months under the law.
In the first year under the new law, OHSU spent about $64 million on free and discounted care — about 1% of what it spent on operations that year.
The true cost of more up-front screening is hard to quantify, medical debt experts said. It must also take into account how many people would have never paid their bills anyway and how much hospitals save by not chasing payments.
Lawmakers said hospitals pressed them for relief, and in April, Oregon enacted a new law to ease the state’s screening requirement.
The original law required hospitals to screen everyone on Medicaid or who was uninsured and anyone who owed $500 or more. Lawmakers raised the monetary screening threshold for a single visit to $1,500. The Medicaid or uninsured requirement remains.
Reynolds, who spearheaded the original law, was unsympathetic to hospitals’ cost concerns. But she agreed to the rollback because she wanted hospitals to have some relief as they fine-tuned their screening process. Oregon hospitals reported that their screening data was less accurate for patients with higher incomes, leading some people who didn’t qualify for help to receive financial assistance.
OHSU studied economic data for Oregon’s residents and reported that about 57% likely had incomes that qualified them for its financial assistance, slightly under the 64% of patients who were receiving help.
Hospitals’ warning of increasing financial stress was a motivator for Democratic Rep. Rob Nosse, who chairs the healthcare committee in the Oregon House of Representatives.
“I don’t want any suburban or rural hospitals to close on my watch,” Nosse said.
People who are no longer automatically eligible can still apply for help with bills less than $1,500, he said.
“I’ve got to make it more expensive for someone to get healthcare so that the hospitals can stay in business,” he added. “What a country.”
This article is part of “Hidden Help,” an investigative series from Tradeoffs and KFF Health News about how hospitals can protect their patients from the life-altering harms of medical debt.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- October 21, 2026
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LAVONIA, Ga. — It had been a decade since Kara Holden last had a baby. But as the former obstetric nurse prepared for her fourth child, her head was swimming with contingency plans.
The labor and delivery unit where she used to work in this rural northeastern Georgia community is no longer open. So, she asked former co-workers to be on standby around her anticipated due date. She and her midwife mapped out emergency rooms along the more-than-50-mile trek to the hospital in Greenville, South Carolina, where she planned to give birth. And, to prepare for a worst-case scenario, she curated items to keep in the car in case she went into labor en route.
“That’s a horrible place to put a pregnant woman in,” said Holden, who on Oct. 11 made the painful, hourlong trip to Greenville Memorial Hospital to deliver her son Tucker.
Holden lives roughly midway between Athens and Greenville, two of the nearest cities with labor and delivery units. Owing partly to Medicaid cuts from President Donald Trump’s One Big Beautiful Bill Act, St. Mary’s Sacred Heart Hospital in Lavonia stopped providing obstetric services nearly a year ago. Its closure is part of a trend touching rural communities nationwide. From South Dakota to Alabama and from Ohio to California, low Medicaid reimbursement and dwindling birth rates are pushing hospitals to shutter these services. Today, fewer than half of rural hospitals offer labor and delivery services.
In Georgia, only 36% of rural hospitals have a labor and delivery unit, and four have closed since 2020, according to data from the Center for Healthcare Quality and Payment Reform.
To address the challenge the closings pose to patients seeking care, the state — which ranks among the worst in the nation for maternal health outcomes — has turned to federal money from the $50 billion Rural Health Transformation Program. This fund was created by congressional Republicans to offset concerns about the outsize fallout Trump’s signature legislation would have in rural communities.
More than $12 million — out of the nearly $219 million approved for Georgia in the program’s first year — will be allocated toward placing obstetric carts in 43 rural hospitals without labor and delivery units. The carts will be outfitted with supplies needed for a birth or obstetric emergency. For example, they’ll have neonatal resuscitation tools, thermal blankets, and essential medications such as oxytocin, which stimulates contractions, and magnesium sulfate, used to treat seizures in pregnant people with high blood pressure.
The delivery carts sound fine, in theory, said Justin Peterson, an OB-GYN who practices in southern Georgia and has seen the pressures rural health institutions face providing maternal care.
Like Holden, Peterson worries that the carts, while helpful, will put supplies in the hands of ER doctors lacking extensive obstetric experience. Instead, he wants the state to fill coverage gaps by investing more to prevent the closure of labor and delivery units in rural areas.
“You’re putting a band-aid on a hemorrhage,” he said.
‘Can’t Practice Scared’
Brittany Mitchell was about seven months pregnant when Sacred Heart’s labor and delivery unit closed. She was reassigned to an OB-GYN in Athens, even though the nearly 50-mile drive from Lavonia was stressful and inconvenient.
That OB-GYN wanted to see Mitchell weekly after finding high levels of protein in her urine — a warning sign of preeclampsia, which can cause organ damage, seizures, and other complications. To make it to those prenatal appointments, she routinely gave up a day of work as a home health aide, a job she said already didn’t pay much.
But if Mitchell were to have another baby, she said, she’d still prefer to drive to Athens to see an OB-GYN than be treated by an ER doctor. When she had her first child nine years ago, the local OB-GYN had to act quickly when her daughter briefly lost oxygen.
“If they were in that situation,” she wondered of ER doctors, “would they know how to do all that?”
In written responses to KFF Health News, Lauren Williams, director of communications for the Georgia Department of Community Health, said that training ER medical staff is the main goal of the obstetric cart initiative. The rollout will include simulation drills, during which ER staff will practice high-risk procedures.
The Georgia Hospital Association will procure and distribute the carts. When exactly that will happen is unknown, but the grant funding must be spent by Sept. 30, 2027, said Anna Adams, the organization’s chief government relations officer.
The concept of obstetric carts is great, said Justin Law, an emergency doctor with SouthlandMD, a physician-owned and -operated healthcare management and staffing company. Most items planned for the carts are already available in ERs. But having them in one organized spot will be helpful, he said.
Still, while ER doctors are more frequently positioned at the front lines as labor and delivery closures persist, advocates argue that they shouldn’t be used as a stopgap in obstetric care.
In the decade he’s worked across rural Georgia, Law said, he’s never delivered a baby in the ER even though he’s trained in emergency obstetrics and has experience delivering babies as a paramedic. When a mother needs an emergency cesarean section or has another high-risk complication, she would likely be transferred to a hospital with labor and delivery capabilities, Law said.
Holden, the former obstetric nurse, said familiarity with obstetric delivery practices and procedures is essential because some complications can’t wait for a transfer. “You’re not going to save anybody’s life just because you got access to some equipment,” she said.
Adams understands the concerns and acknowledged that the ER is not the ideal location for delivering a baby. “But sometimes things happen that are outside of our control,” she said. “And when it does, we want to make sure those hospitals are prepared.”
Robin Clyatt, maternal health community outreach coordinator for Hope for Georgia Moms, said ER doctors have vast knowledge. But they might see someone with a major maternal health complication, such as a hemorrhage, only a few times a year, and therefore may lack the skills to act immediately, she said.
“You can’t practice scared when it comes to obstetrics,” Clyatt said. “And that’s important, because when you practice scared, you do stupid things.”
Ways To Keep Access
The labor and delivery unit at the Coffee Regional Medical Center in Douglas serves six counties in southern Georgia. The number of live births there increased from 551 in 2020 to nearly 1,000 in 2024, which shows the impact when nearby facilities close, said Peterson, who practices at the Coffee Regional Hospital Women’s Center.
While he understands that hospitals must consider their bottom lines, business decisions in recent years have often taken precedence over patient care, he said.
“They just say, ‘Oh, you know, the numbers aren’t there. We’re closing,’” he said, adding that when rural labor and delivery units shutter, the chance they’ll reopen is small.
Mark Ralston, public relations manager for St. Mary’s Health Care System, which owns Sacred Heart, did not respond to multiple requests to further discuss the unit’s closure. But in its announcement, the system said the decision followed “an extensive 18-month discernment process that included intensive efforts to recruit additional physicians, create new partnerships, and pursue incremental funding sources.”
Nationwide, states are attempting to narrow gaps in maternal healthcare using federal funds. South Dakota will establish maternal health hubs to determine where resources are needed and help mothers navigate the health system. Ohio is establishing birth centers in rural communities.
In its proposal for federal rural transformation money, Georgia included incentives such as funding 75 new residency slots in various specialties and creating a grant program that would reimburse physicians up to $250,000 in relocation fees if they chose to practice in rural areas.
State legislators could incentivize doctors to stay in rural areas, offer higher reimbursement rates for hospitals, and provide loan forgiveness for physicians, Peterson said. Communities should also look to incorporate certified midwives and community health workers, Holden and Clyatt said, though state law makes it difficult for both groups to practice. Currently, certified nurse midwives are allowed to practice only in partnership with a physician, which maternal health advocates argue creates a steep financial burden.
Holden had the ability to send her vitals to her doctor and meet with them virtually for prenatal care.
As she adorned bookshelves in baby Tucker’s cozy, sage-green nursery with vintage trinkets and family heirlooms, she said she thought of less-resourced mothers in the area, who may be on Medicaid or not have the luxury to travel an hour for a prenatal appointment.
Holden worries that without prenatal care, conditions like preeclampsia could go undiagnosed more often. “They don’t make it, and their baby doesn’t make it, because they never got that diagnosed and managed,” she said.
People like to remain optimistic that everything will go as planned, but “there are so many things that can go wrong,” she said. “And they can go wrong really quick.”
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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