Health and Fitness Tips

As Kennedy Turns From Vaccines, MAHA Allies See a ‘Betrayal’

As the midterm elections approach, the health secretary is focusing on “real food.” Anger is rising among some of his supporters.

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States Move to Limit Access to H.I.V. Treatment

Citing shortfalls in federal support, about 20 states are toughening eligibility requirements for patients in drug assistance programs.

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Medicaid Is Paying for More Dental Care. GOP Cuts Threaten To Reverse the Trend.

Star Quinn moved to Kingsport, Tennessee, in 2023, the same year the state began covering dental costs for about 600,000 low-income adults enrolled in Medicaid.

But when Quinn chipped a tooth and it became infected, she could not find a dentist near her home who would accept her government health coverage and was taking new patients.

She went to an emergency room, receiving painkillers and antibiotics, but she remained in agonizing pain weeks later and paid a dentist $200 to extract the tooth.

Years later, it still hurts to chew on that side, she said, but Quinn — a 34-year-old who has four children and, with her husband, earns about $30,000 a year — still can’t find a dentist nearby.

“You should be able to get dental care,” she said, “because at the end of the day dental care is health care.”

The federal government has long required states to offer dental coverage for children enrolled in Medicaid, the joint state-federal health program for people who are low-income or disabled. Paying for adults’ dental care, though, is optional for states.

In recent years, several states have opted to expand the coverage offered by their Medicaid programs, seeking to boost access in recognition of its importance to overall health. So far, increasing adult dental care is a work in progress: In a sampling of six of those states by KFF Health News, fewer than 1 in 4 adults on Medicaid see a dentist at least once a year.

But under congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last year, the federal government is expected to reduce Medicaid spending by more than $900 billion over the next decade. The expected 10-year losses for individual states range from about $184 million for Wyoming to about $150 billion for California.

State Medicaid programs typically expand or reduce benefits depending on their finances, and such massive federal cuts could force some to shrink or eliminate what they offer, including dental benefits.

“We will lose all the gains we have made,” said Shillpa Naavaal, a dental policy researcher at Virginia Commonwealth University in Richmond.

Tennessee’s Medicaid program, for instance, spent nearly $64 million on its dental coverage in 2024 and saw a 20% decrease in dental-related ER visits, said Amy Lawrence, the program’s spokesperson.

But under the new law, Tennessee is projected to lose about $7 billion in federal funding over the next decade.

As of last year, 38 states and the District of Columbia offered enhanced dental benefits for adult Medicaid beneficiaries, according to the American Dental Association. Most of the others offer limited or emergency-only care. Alabama is the only state that offers no dental coverage for adult beneficiaries.

Since 2021, 18 states have enhanced their coverage to include checkups, X-rays, fillings, crowns, and dentures, while loosening annual dollar caps for benefits.

Use of dental benefits in states with the enhanced benefits is greater than in states with only limited or emergency coverage, though still low overall, according to an ADA report with the latest data as of December. No more than a third of adult Medicaid recipients saw a dentist in 2022 in any state.

To review more recent progress, KFF Health News asked one-third of the states that have expanded their benefits in the past five years for their most recent data on the percentage of adults on Medicaid who visit a dentist at least once a year:

Maryland — 22% (in 2024)
Oklahoma — 16% (in 2025)
Maine — 13% (in 2025)
New Hampshire — 19% (in 2025)
Tennessee — 16% (in 2024)
Virginia — 21% (in 2025)

In comparison, about 50% to 60% of adults with private dental coverage see a dentist at least once a year, according to the ADA.

Nationwide, 41% of dentists reported participating in Medicaid in 2024, a share that has remained stable over the past decade despite the dental benefit expansions in many states, the ADA says. Many participating dentists, though, limit the number of Medicaid enrollees they treat, and some will not accept new patients on Medicaid.

Reimbursement rates have not kept up with costs, deterring dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president at the ADA Health Policy Institute.

Because of a lack of dentists who take Medicaid in southwestern Virginia, the Appalachian Highlands Community Dental Center in Abingdon sees patients who travel more than two hours for care — and must turn many away, said Elaine Smith, its executive director.

The center’s seven residents treated about 5,000 patients last year, most of them on Medicaid. About 3,000 people are on its waitlist, waiting up to a year to be seen.

“It’s sad because they have the means now to see a dentist, but they still don’t have a dental home,” Smith said.

Low-income adults face other barriers to dental care, including a lack of transportation, child care, or time off work, she said.

The inability to see a dentist has consequences broader than tooth pain. Poor dental health can contribute to a host of other significant health problems, such as heart disease and diabetes. It can also make it harder to do things like apply for jobs and generally lead a healthy life.

Robin Mullins, 49, who has been off and on Medicaid since 2013, said a lack of regular dental visits contributed to her losing her bottom teeth. Unable to find a dentist near her home in rural Clintwood, Virginia, she drives almost 90 minutes to Smith’s clinic — that is, when she can afford to get time away from driving for DoorDash or find help watching her daughter, who has special needs.

She gets by with partial dentures but misses her natural teeth, she said. “It’s absolutely horrible, as you can’t chew your food properly.”

In New Hampshire, though, the challenges have more to do with low demand than a low supply of dentists, said Tom Raffio, chief executive of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added new dentists to its list of participating providers, along with two mobile dental units that traverse the state, he said.

Raffio said Northeast Delta Dental also has publicized the state benefits using radio advertising and social media, among other efforts.

Until 2023, New Hampshire Medicaid covered only dental emergencies.

“Culturally, it’s going to take a while,” he said, “as people just are used to not going to the dentist, or going to the ER when have dental pain.”

Brooks Woodward, dental director at Baltimore-based Chase Brexton Health Care, called Maryland’s rate of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 “pretty good” considering the benefits had been enhanced only since 2023.

Woodward said many adults on Medicaid believe that you go to a dentist only when you’re in pain. “They’ve always just not gone to the dentist, and that’s just the way they had it in their life,” he said.

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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How the Psychedelic Drug Ibogaine Changed Me Forever

Veterans and others who have suffered trauma and injuries are flocking to clinics around the world to take ibogaine. My own reason was deeply personal.

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Elite Doctors Served Jeffrey Epstein While Treating His ‘Girls’

A small stable of doctors gave V.I.P. medical services to the sex offender and the women around him. Some doctors bent or broke the ethical rules of their profession.

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Banks Are Becoming Bulwarks for Vulnerable Seniors

Older Americans are losing billions of dollars annually to financial exploitation. Banks and investment firms are training employees to spot red flags and stop the transactions.

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ICE, ALS, Addiction Medicine, and Robotic Ultrasounds: Journalists Sound Off on All That and More

KFF Health News Southern California correspondent Claudia Boyd-Barrett discussed how family members and lawyers of those in Immigration and Customs Enforcement custody are struggling to find them in California hospitals on CapRadio’s Insight With Vicki Gonzalez on Feb. 25.

Click here to hear Boyd-Barrett on Insight With Vicki Gonzalez.
Read Boyd-Barrett’s “‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees.”

Céline Gounder, KFF Health News’ editor-at-large for public health, discussed the neurodegenerative disease ALS on CBS News’ CBS Mornings on Feb. 20.

Click here to watch Gounder on CBS Mornings.

KFF Health News senior correspondent Aneri Pattani discussed Elyse Stevens, a New Orleans doctor who faced investigation because of her patient-centered approach to substance use disorders, on The Lens’ Behind The Lens podcast on Feb. 20.

Click here to hear Pattani on Behind The Lens.
Read Pattani’s “Inside the Battle for the Future of Addiction Medicine.”

KFF Health News chief rural correspondent Sarah Jane Tribble discussed major cuts to Medicaid on WBUR’s Here & Now on Feb. 19. Tribble also discussed Alabama’s plan for robotic ultrasounds on The Daily Yonder’s The Yonder Report on Feb. 19.

Click here to hear Tribble on Here & Now.
Click here to hear Tribble on The Yonder Report.
Read Tribble’s “Alabama’s ‘Pretty Cool’ Plan for Robots in Maternity Care Sparks Debate.”

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Iris Cantor, Philanthropist and Art Collector, Dies at 95

She and her husband, the financier B. Gerald Cantor, amassed one of the largest private collections of Rodin artworks, donating much of it to museums around the world.

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A Canadian Hospital Scoops Up Nurses Who No Longer Feel Safe in Trump’s America

Last year, as the California hospital where she worked was appeasing the Trump administration by erasing words like “equity” and “diversity” from its paperwork, Brandy Frye had seen enough.

Frye, an emergency room nurse with 25 years of experience, felt that ignoring inequality’s role in health and sickness was an affront to the compassionate soul of the nursing profession.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Now Frye has found a new place to belong. She is part of a surge of American nurses and other health care workers moving to Canada — specifically, British Columbia — to escape the policies of President Donald Trump. Frye settled in Nanaimo on Vancouver Island, where the local hospital has hired 20 American nurses in less than a year.

“There are so many like-minded people out there,” said Justin Miller, another American nurse who started at Nanaimo Regional General Hospital this month. “You aren’t trapped. You don’t have to stay. Health care workers are welcomed with open arms around the world.”

More than 1,000 U.S.-trained nurses have been approved to work in British Columbia since April, when the province streamlined its licensing process for Americans, then launched an advertising campaign to take advantage of the “chaos and uncertainty happening in the U.S.” Nursing associations in Ontario and Alberta said they too have seen increased interest from American nurses in the past year.

“Some of them were living in fear of the administration, and they shared a sense of relief when crossing the border,” said Angela Wignall, CEO of Nurses and Nurse Practitioners of British Columbia. “As a Canadian, it’s heartbreaking. And also a joy to welcome them.”

The Trump administration, for its part, doesn’t seem concerned. When asked to comment, the White House dismissed accounts of nurses moving to Canada as “anecdotes of individuals with severe cases of Trump derangement syndrome.”

This aligns with an article we reported last year that found American doctors were also relocating north to get away from the Trump administration. According to the Medical Council of Canada, more than 1,200 American doctors created accounts on physiciansapply.ca in 2025 — typically the first step to getting licensed in Canada — compared with only about 300 in 2024.

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He Needs an Expensive Drug. A Copay Card Helped — Until It Didn’t.

Over the course of 2025, Jayant Mishra of Mission Viejo, California, progressively developed scaly, itchy red patches on his skin. Then came the pain and swelling in the joints of his hands, making it difficult to do his work at a bank.

His primary care doctor referred him to a rheumatologist, who diagnosed psoriatic arthritis. She advised Mishra that while there’s no cure, there were many new medicines that could keep the autoimmune disease in check, and she recommended one, Otezla.

At first, Mishra balked. He knew the medicines were expensive. He worried about side effects. He thought he could manage with over-the-counter drugs.

But by September he was in so much pain that he agreed to try a starter pack provided by Otezla’s manufacturer, Amgen. It worked: The skin lesions disappeared, and the joint pain that kept him up at night dissipated. He was sold.

His rheumatologist got approval for the drug from his insurer, UnitedHealthcare, and signed him up for Amgen’s copayment assistance program. Having enrolled other patients, she told Mishra the copay card, similar to a credit card, should last a year, he said, shielding him from the drug’s high list price: around $5,000 for a 30-day supply, according to GoodRx.

He said the doctor explained that, in her patients’ experience, insurers and their pharmacy benefit managers negotiated a deeply discounted price with Amgen — she estimated $1,400 to $2,200 a month. Patients paid a percentage of that amount, their “patient responsibility,” using the copay card.

Mishra said he was approved for a copay card covering $9,450 a year. “I was happy when I got the message,” he said.

He added that the doctor reassured him about the cost. “She said: ‘You shouldn’t have to pay anything out-of-pocket. Your copay card will cover this.’”

He started the medicine and, at first, paid nothing.

Then the bill came.

The Medical Service

Otezla, which comes in a pill, is approved to treat some autoimmune disorders, including psoriatic arthritis.

The Bill

$441.02, for the second month’s fill of the drug — before Mishra chose to ration rather than refill his prescription, because his copay card was empty.

The insurance statement from UnitedHealthcare’s pharmacy benefit manager, Optum Rx — another subsidiary of the same parent company, UnitedHealth Group — showed it did not provide a negotiated discount and covered just $308.34 of the full $5,253.85 charge for a 30-day supply. The charges for the second month depleted the copay card and left Mishra owing the balance.

The Billing Problem: Copay Card ‘Tug-of-War’

Copay assistance programs are part of a “tug-of-war between drug manufacturers and insurers,” said Aaron Kesselheim, a professor of medicine at Harvard Medical School who studies the pharmaceutical industry.

The value of drugmakers’ copay cards has become more unpredictable as insurers try to restrict their use. Many insurance plans, for instance, do not count the money from a copay program toward a patient’s deductible.

And patients who use a copay card can wind up paying full or nearly full price rather than the discounted rate negotiated by their insurer’s pharmacy benefit manager.

“When you purchased your medication a Manufacturer Coupon was used,” Mishra’s explanation of benefits statements read, in tiny letters. The amount the copay card covered “was not applied towards your Deductible and Out of Pocket Maximum.”

Caroline Landree, a spokesperson for UnitedHealthcare, said that “the copay card is an arrangement between the patient and the pharmacy. It is used outside of insurance.”

In an emailed statement, Elissa Snook, a spokesperson for Amgen, expressed a different view of who was responsible for Mishra’s dilemma: “Copay assistance programs are designed to help patients start and stay on prescribed therapy, but the value of that assistance can be exhausted more quickly when a health plan requires patients to pay the full list price of a medicine.”

Few patients can afford the list prices that pharmaceutical manufacturers charge in the United States for brand-name drugs.

Insurers insulate themselves and their customers from those higher prices through pharmacy benefit managers’ negotiated discounts. They might, for example, designate certain drugs as preferred medications for plan members in exchange for the manufacturer agreeing to a significant price reduction.

Manufacturers’ copay assistance programs offer another way for patients to avoid paying full price. The assistance is intended to encourage patients to choose an expensive, brand-name drug — not one that “treats the same condition that the insurer has gotten for a cheaper price,” said Fiona Scott Morton, an economist at the Yale School of Management who studies drug pricing.

The assistance also discourages patients from discussing with their doctor whether a cheaper, generic drug would do, drug industry researchers said.

While the Food and Drug Administration first approved a generic version of Otezla in 2021, Amgen has sued to block U.S. sales of its generic competitors, ensuring the brand-name drug has patent protection until 2028. Generic versions are available overseas and in Canada, where patients can purchase it in some cases for less than $100 a month.

Mishra said one of his children joked he could cover a trip to visit relatives in India simply by purchasing his medicine while he was there.

The Resolution

Mishra has a health plan with a $5,000 deductible and contributes to a tax-free health savings account.

In September, he paid for the first month’s supply of Otezla with the copay card. But paying for October’s supply emptied the card — which he originally expected to last a year — and he said he used his HSA to pay for the roughly $400 that remained.

But wary of what the drug would cost in November and December, Mishra said, he tried to spread out the pills he had left from the starter pack and the first two months’ supply. He skipped some days and took only half of the prescribed dose to stretch the supply for two more months, knowing he would get a new copay card with the new year. Many of his symptoms returned, he said.

In January, he got another copay card, good for $9,450, which again wasn’t sufficient to pay for two months’ supply. He again paid the remaining balance in February from his HSA to count toward his $5,000 annual deductible. This time he owed $550, he said.

Mishra said his symptoms have resolved. With no clue what he’d be charged for March’s supply, he called UnitedHealthcare in late February and was told he would need to pay $4,450 for the month to meet his out-of-pocket maximum, he said.

But he said he pressed the representative further, asking why UnitedHealthcare doesn’t have a negotiated price. It does, they told him. “Actual price is $6,995.36.”

The Takeaway

Copay cards and drugmaker programs that promise patients “you could pay $0” work in mysterious ways.

On the one hand, they encourage patients to use brand-name or expensive drugs that are off insurers’ formularies, or lists of preferred, covered drugs. On the other, many patients couldn’t afford prescribed medicines without them.

Patients with public insurance, such as Medicare and Medicaid, are not permitted to use the cards, because the government considers them an end run around its attempts to bring down drug spending.

Using a copay card has gotten trickier as insurers push back. First, patients need to understand whether there is an annual dollar or time limit on the card and how it works with their insurance. Otherwise, they risk ending up reliant on a drug they can’t afford.

Less expensive drugs often can suffice. For example, there are a number of medicines to treat psoriatic arthritis, some of which may be cheaper or have better coverage from a particular insurer. Patients should ask their doctors whether cheaper medicines will work.

It also can help patients to consider their prescriptions when they select a health plan. Landree, of UnitedHealthcare, said Mishra could have selected a plan for 2026 that would have covered Otezla for a $100 copay each month, though that would have meant a higher premium.

“Personally I’m not in financial distress — I can afford it,” Mishra said. “But it was sticker shock, and it just doesn’t seem right.”

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

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Cientos de enfermeros estadounidenses dejan atrás el Estados Unidos de Trump y eligen trabajar en Canadá

El mes pasado, Justin y Amy Miller colmaron sus autos con tres niños, dos perros, un dragón barbudo y todas las pertenencias que pudieron, y condujeron 2.000 millas desde Wisconsin hasta British Columbia, en Canadá, para dejar atrás los Estados Unidos del presidente Donald Trump.

Los Miller se establecieron en Vancouver Island, su refugio rodeado de paisajes naturales y accesible solo por ferry o avión. Justin comenzó a trabajar en la sala de emergencias del Nanaimo Regional General Hospital, donde se convirtió en uno más de los 20 enfermeros formados en Estados Unidos contratados desde abril.

El temor a Trump, dijeron algunos de los enfermeros, fue la razón por la que se fueron.

“Somos muchos los que pensamos igual”, dijo Justin, quien ahora trabaja codo con codo con otros estadounidenses en Canadá. “No estás atrapado. No tienes que quedarte. A los trabajadores de salud los reciben con los brazos abiertos en todo el mundo”.

Los Miller forman parte de un nuevo y creciente número de enfermeros, doctores y otros trabajadores de salud estadounidenses que se mudan a Canadá, y en particular a British Columbia, donde más de 1.000 enfermeros y enfermeras formados en Estados Unidos han recibido autorización para trabajar desde abril pasado.

Mientras el gobierno de Trump implementa políticas de extrema derecha, cada vez más autoritarias, y reduce el financiamiento para la salud pública, los seguros y la investigación médica, muchos profesionales de enfermería se han sentido atraídos por la política progresista de Canadá, su reputación de país acogedor y su sistema de salud universal.

Además, algunos enfermeros se indignaron el año pasado cuando el gobierno de Trump dijo que reclasificaría la enfermería como un título no profesional, lo que impondría límites federales estrictos a los préstamos que los estudiantes de enfermería podrían recibir.

Canadá está listo para sacar partido de esta situación. Dos de sus provincias más pobladas, Ontario y British Columbia, han simplificado el proceso de obtención de licencias para enfermeros estadounidenses desde que Trump regresó a la Casa Blanca.

British Columbia también lanzó una campaña publicitaria de $5 millones —“aprovechando la oportunidad” creada por el “caos e incertidumbre que ocurren en Estados Unidos”— para contratar enfermeros de California, Oregon y Washington.

Temores hechos realidad

Amy Miller, enfermera practicante, dijo que ella y su esposo estaban decididos a sacar a sus hijos del país porque sentían que el segundo mandato de Trump inevitablemente derivaría en violencia.

Primero, los Miller obtuvieron licencias de enfermería en Nueva Zelanda, pero cuando la búsqueda de empleo tomó demasiado tiempo, cambiaron su plan hacia Canadá.

A Justin le ofrecieron un trabajo en cuestión de semanas.

Amy encontró uno en tres meses.

Así que se mudaron. Y solo unos días después, los Miller observaron con horror desde la distancia cómo sus temores se hacían realidad. Mientras fuerzas federales de inmigración se enfrentaban con manifestantes en Minneapolis el 24 de enero, agentes federales dispararon y mataron a un enfermero de cuidados intensivos, Alex Pretti, cuando filmaba un enfrentamiento y parecía intentar proteger a una mujer que había sido empujada al piso.

El video del asesinato mostró a los agentes fronterizos inmovilizando a Pretti en el suelo antes de confiscarle su pistola oculta, para la cual tenía licencia, y dispararle.

El gobierno de Trump calificó rápidamente a Pretti como un “terrorista doméstico”. Esa acusación fue cuestionada por videos de testigos que circularon en redes sociales y generaron indignación, incluso entre enfermeros y organizaciones de enfermería, algunos de los cuales mencionaron el deber de la profesión de cuidar a las personas vulnerables.

“No quiero decir que era algo esperado, pero por eso estamos aquí”, dijo Amy Miller. “Incluso nuestra hija mayor dijo: ‘Está bien, mamá, porque ya no estamos allá. Aquí estamos seguros’. Ella lo entiende y ni siquiera está en la escuela media”.

Tanto Estados Unidos como Canadá tienen una gran necesidad de enfermeros. Se proyecta que Estados Unidos tendrá un déficit de unos 270.000 enfermeros registrados, además de al menos 120.000 enfermeros practicantes con licencia, para 2028, según estimaciones recientes de la Administración de Recursos y Servicios de Salud (HRSA, por sus siglas en inglés).

En Canadá, las vacantes de empleo en enfermería se triplicaron entre 2018 y 2023, cuando alcanzaron casi 42.000, según un informe reciente del Montreal Economic Institute, un centro de análisis canadiense.

Consultada para comentar, la Casa Blanca señaló que datos del sector muestran que el número de enfermeros con licencia en Estados Unidos aumentó en 2025. Y desestimó los relatos de enfermeros que se mudan a Canadá como “anécdotas de personas con casos graves del síndrome de trastorno por Trump”.

“La fuerza laboral de salud estadounidense es la mejor del mundo y sigue creciendo bajo el presidente Trump”, dijo Blanca Kush Desai, vocera de la Casa. “Las oportunidades de empleo en el sistema de salud estadounidense siguen siendo sólidas, con posibilidades de avance profesional y salarios que superan ampliamente a los de otras naciones desarrolladas”.

“Una sensación de alivio”

No se sabe con precisión cuántos enfermeros estadounidenses se han mudado al norte desde que Trump regresó al cargo, porque algunas provincias canadienses no registran o no publican esas estadísticas.

Desde que el proceso simplificado entró en vigencia en abril de 2025 hasta enero, la provincia de British Columbia, que ha hecho más esfuerzos para contratar estadounidenses, había aprobado las solicitudes de licencia de 1.028 enfermeros formados en Estados Unidos, según el British Columbia College of Nurses and Midwives. En todo 2023 y 2024, solo se habían aprobado 112 y 127 solicitudes de estadounidenses, respectivamente, informó la agencia.

El aumento del interés de enfermeros estadounidenses también fue confirmado por asociaciones de enfermería en Ontario y Alberta, así como por la Canadian Nurses Association a nivel nacional.

Angela Wignall, CEO de Nurses and Nurse Practitioners of British Columbia, dijo que antes los enfermeros estadounidenses se mudaban al norte porque se habían enamorado de Canadá (o de un canadiense). Pero más recientemente, afirmó, ha conocido a enfermeros que temían que la Casa Blanca fomentara la violencia y la vigilancia, en particular contra familias que incluyen parejas del mismo sexo.

“Algunos vivían con miedo al gobierno y compartieron una sensación de alivio al cruzar la frontera”, dijo Wignall. “Como canadiense, es desgarrador. Y también es una alegría darles la bienvenida”.

Vancouver Island, que tiene una población de unas 860.000 personas, ha incorporado a 64 enfermeros formados en Estados Unidos desde abril, incluidos los del Nanaimo Regional, dijo Andrew Leyne, vocero de la autoridad de salud de la isla.

Una de las enfermeras fue Susan Fleishman, una canadiense que se mudó a Estados Unidos cuando era niña y luego trabajó durante 23 años en salas de emergencias antes de dejar el país en noviembre.

Fleishman dijo que la retórica de odio de Trump ha alimentado una división que ha permeado y deteriorado la vida en el país.

“No fue una mudanza fácil; eso es seguro. Pero creo que definitivamente vale la pena”, dijo, ya de regreso en Canadá. “Siento que aquí hay mucha más amabilidad. Y creo que eso hará que me quede”.

Brandy Frye, quien también trabajó durante décadas en salas de emergencias estadounidenses, contó que se mudó a Vancouver Island el año pasado tras esperar a ver si Mark Carney se convertiría en primer ministro de Canadá. El ascenso de Carney fue ampliamente visto como un rechazo al trumpismo.

Mientras tanto, dijo Frye, el hospital de California donde trabajaba había estado eliminando de sus documentos palabras asociadas con diversidad y equidad para complacer al gobierno de Trump. No pudo tolerarlo.

“Lo vi como un paso en contra de todo en lo que creo”, señaló Frye. “Y ya no me sentía parte de ese lugar”.

Como muchos de los enfermeros estadounidenses que se han mudado a Vancouver Island, Frye se sintió atraída por primera vez a la zona gracias a un video viral que estaba destinado al turismo, pero que terminó logrando mucho más.

Hace aproximadamente un año, Tod Maffin, creador de contenido en redes sociales y ex presentador de CBC Radio, invitó a estadounidenses a la ciudad portuaria de Nanaimo para un fin de semana de “infusión” diseñado para compensar el impacto de los aranceles de Trump en la economía local.

Maffin dijo que alrededor de 350 personas asistieron al evento en abril.

“Muchos eran trabajadores de salud que buscaban una ruta de escape”, dijo Maffin. “Estaban allí para apoyar nuestra economía, pero también para explorar Canadá”.

Maffin vio una oportunidad. Reutilizó el sitio web del evento como herramienta de reclutamiento y lanzó una sala de chat en Discord para ayudar a estadounidenses a mudarse.

Maffin dijo que cree que la campaña ayudó a unos 35 trabajadores de salud a mudarse a Vancouver Island. Voluntarios en más de 30 comunidades canadienses han replicado su sitio web para atraer a sus propios enfermeros y doctores estadounidenses.

“Hay comunidades en todo Canadá donde la sala de emergencias cierra por la noche porque falta un enfermero. Así de apretado está el personal”, dijo Maffin.

“Un nuevo enfermero en un pueblo pequeño, o en una ciudad mediana como Nanaimo hace la diferencia”, agregó.

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New A.C.A. Plans Could Increase Family Deductibles to $31,000

The Trump administration is proposing Obamacare plans that it says will lower health insurance premiums. But critics warn they would make care unaffordable.

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‘Kind of Morbid’: Health Premiums Threaten Their Nest Egg. A Terminal Diagnosis May Spare It.

COLUSA, Calif. — Early on, Jean Franklin got some career advice she followed religiously: “Pay yourself first.” So she did, socking away hundreds of thousands of dollars in retirement savings by the time she became a stay-at-home mom at age 41.

She and her husband, Charles, a former high school teacher who goes by Chaz, planned to retire comfortably in the three-bedroom house where they raised their kids about 60 miles northwest of Sacramento.

But early last year, the 63-year-old became unsteady on her feet. One morning in May, she woke up with slurred speech and landed in the hospital, then rapidly lost the ability to move the right side of her body.

In August, as doctors continued to puzzle over a possible diagnosis, the couple received a notice saying that on Jan. 1 their combined health care premium payments through the state insurance exchange would shoot up from $540 a month to $3,899 a month. The reason: Federal enhanced premium subsidies expiring at the end of last year would no longer offset their payment.

They immediately canceled a monthlong cruise they’d been planning with friends and looked through their retirement accounts.

“Now, instead of thinking about where we can go in our retirement, we’re asking the question, ‘Are we still going to be able to stay where we are because of the health care costs?’” said Chaz, who retired in 2021 at age 59.

Then they received more bad news. In October, at the age of 63, Jean was diagnosed with ALS, a debilitating disease that will eventually leave her unable to speak, swallow, or breathe on her own. But Jean’s condition allowed her to enroll in Medicare, the federal health insurance program that covers adults 65 and older and people with disabilities. The diagnosis saved them roughly $1,600 a month in premiums — little comfort as Jean lost her ability to walk, bathe, and dress herself.

“It’s kind of morbid that, because of my diagnosis, I got put on Medicare right away, so at least we don’t have to pay that out-of-pocket,” Jean said, sitting in a wheelchair in her living room, a quilt draped over her legs to guard against the intense chills she now often gets. “We’re not going to get buried under this.”

Yet the premiums for Chaz’s plan and her Medicare remain a significant strain on their finances. The $2,300 a month they now owe, which includes roughly $342 in premium payments for Jean’s Medicare supplemental insurance, is higher than their monthly mortgage and eats up more than a quarter of their budget.

The Franklins are among the 22 million people across the nation facing greater financial pressure after Congress chose not to extend 2021 enhanced federal subsidies. That assistance helped more than double enrollment in Obamacare plans to over 24 million.

The Congressional Budget Office estimated in 2024 that, without an extension of the tax credits, the number of uninsured Americans would climb by 2.2 million this year alone. As of January, nationwide enrollment in ACA plans was down about 1.2 million year over year, though experts say it could be months before the full effects of rising premiums are known, as people miss payments and lose coverage.

The groups hit hardest will be early retirees, middle-income earners, and people living in high-cost states, said Stacey Pogue, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University. The Franklins are all three.

“They fell off what we call a subsidy cliff,” Pogue said. “It’s very, very shocking, the amount that a person would have to absorb.”

That’s because the expanded tax credits made the biggest difference for people nearing retirement age who sat just above previous income eligibility thresholds, Pogue said. People such as the Franklins, who likely wouldn’t have qualified for financial help before expanded credits were implemented, are now losing that support at a time when insurers have responded to the uncertainty by dramatically raising rates.

Roughly half of people who were expected to lose eligibility for premium tax credits were ages 50 to 64, according to an analysis by KFF, a health information nonprofit that includes KFF Health News.

Republicans who opposed the extension have said the premium assistance went directly to insurance companies rather than consumers, incentivizing fraud and wasteful coverage. They also say the enhanced subsidies, which had no upper income limit for eligibility, were far too generous in capping premium payments at 8.5% of income, no matter how much an enrollee made.

“Most Americans would agree that taxpayers should not be subsidizing the health insurance of someone making $250,000,” U.S. Rep. Ken Calvert, a California Republican who voted against an extension in January, wrote in an Orange County Register op-ed. “I cannot accept the simple extension of a program that will line the pockets of insurers and is riddled with fraud at the expense of the American taxpayer.”

Patient advocates say the premium increases and expiration of subsidies have forced people into difficult choices. “The young people who are healthy are the first to say, I’m going to roll the dice” and forgo coverage, said Rebecca Kirch, executive vice president of policy and programs at the National Patient Advocate Foundation. “Those who are remaining in the system — because they have no choice — are holding off care, they’re holding off their meds, they’re going without necessary food.”

While the Franklins are getting by, they have relied on their sons to pay for a motorized recliner to assist with lifting Jean and a handicap van to transport her. Chaz, who broke a tooth a year ago, delayed fixing it because a crown would cost him $1,000.

This year, the couple will draw $36,000 more than they had anticipated from their retirement savings, most of it to cover Chaz’s insurance premiums.

“I have a nest egg,” Chaz said. “But there’s a lot of people around here who don’t.”

For a while, he was outraged.

“I wish Congress would get off their butts and solve this issue,” said Chaz, who is a registered Republican but blames both sides of the aisle. “You’re so busy bickering over stupid crap and it’s both parties pointing fingers and blaming. Where was this discussion two years ago?”

Now, Chaz said, he’s focused on making Jean, his wife of 27 years, as comfortable as possible.

Before she got sick, they did practically everything together — hiking, traveling, tai chi, amateur photography, and bug-hunting. One of her favorite specimens was the rain beetle, a fuzzy scarab-like insect that can’t feed as an adult, relying solely on fat stores from its larval stages.

In the mornings, Chaz and their sons, Charlie and Louis, take turns lifting Jean, dressing her, and helping her use the bathroom. It’ll be fodder for the counselor, she jokes to her sons, when they inevitably need therapy later in life.

Most days, Jean’s outdoor adventures rarely extend beyond being wheeled to her back patio, where she loves to watch their backyard chickens bobble around. Chaz’s stubbornness makes him a great patient advocate. Charlie always seems to know exactly when she needs a big hug, and Louis tells jokes that can still make her snort with laughter.

“I don’t know what I would do without my boys making me laugh,” she said.

In December, Chaz will turn 65, old enough to qualify for Medicare himself. “After this year — knock on wood — we should be OK,” Jean said, before pausing and shooting her husband a wry smile.

“Well, you’re gonna be OK.”

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En batalla por fondos, demócratas denuncian falta de atención médica para detenidos por el ICE

Fernando Viera Reyes necesitaba una biopsia por un posible cáncer de próstata cuando el gobierno de Trump lo envió a un centro de detención de inmigrantes en el desierto de Mojave, en California.

Allí, esperó. Reyes, ahora de 51 años, solicitó reiteradas veces el procedimiento, según una demanda presentada en noviembre contra el gobierno federal, pero pasaron meses, aunque había sangre en su orina, una señal de que el cáncer podía haberse propagado.

“Puede haber pasado de ser muy tratable a estar metastásico”, dijo Kyle Virgien, quien, como abogado del Proyecto Nacional de Prisiones de la Unión Americana de Libertades Civiles (ACLU, por sus siglas en inglés), está involucrado en la demanda.

“Hay poblaciones vulnerables; está abarrotado. No hay atención médica suficiente para manejar el aumento en el número de personas enfermas”, dijo Virgien.

El esfuerzo de deportación masiva del presidente Donald Trump ha llevado a un número récord de inmigrantes detenidos en centros federales, cárceles locales y prisiones privadas. La situación pone en riesgo la salud de los detenidos.

El Servicio de Inmigración y Control de Aduanas (ICE) está violando normas que garantizan que los inmigrantes reciban exámenes médicos iniciales, atención de rutina y respuestas oportunas a quejas físicas, según una revisión de más de 200 páginas de demandas de detenidos, informes de investigación independientes y académicos publicados, e investigaciones recientes del Congreso realizadas por demócratas.

Las quejas sobre la atención médica inadecuada en los centros de detención podrían aumentar la reacción política que enfrenta Trump por su campaña agresiva de deportación, incluido el asesinato de dos ciudadanos estadounidenses en Minneapolis.

Miembros demócratas del Congreso han insistido en limitar a los agentes federales de inmigración como parte de un proyecto de ley de gastos de 2026 para el Departamento de Seguridad Nacional (DHS, por sus siglas en inglés), un estancamiento que amenaza con cerrar en gran medida la agencia.

Voceros del ICE y del Cuerpo de Servicios de Salud del ICE (IHSC, por sus siglas en inglés), del DHS y de la Casa Blanca no respondieron a solicitudes repetidas de comentarios para este artículo. El IHSC evalúa la salud para la deportación, supervisa las normas médicas en instalaciones contratadas y reembolsa la atención médica fuera de los centros.

Sin embargo, en el sitio web del IHSC, el director asistente Stewart Smith dijo que el cuerpo “mantiene las normas de atención médica en todas las instalaciones propias y contratadas por el ICE y garantiza la prestación de la atención médica requerida para los extranjeros detenidos”. Por su parte, el sitio web del ICE señala que “muchos extranjeros pueden no haber recibido tratamiento médico reciente o confiable para condiciones existentes antes de ingresar bajo custodia de ICE. Para algunas personas, esta puede ser su primera oportunidad de acceso a atención médica integral”.

Algunos legisladores demócratas han exigido informes de autopsia de detenidos que murieron bajo custodia y han acusado públicamente al ICE de negar a los inmigrantes el acceso a atención. La representante Kelly Morrison (demócrata de Minnesota) dijo que un centro de detención que visitó en el histórico Fort Snelling del estado no tenía normas médicas ni “atención médica real” en el lugar.

“Hace sonar alarmas desde una perspectiva médica y de salud pública”, dijo Morrison, quien es doctora, a KFF Health News. “No hay camas, no hay mantas, hay comida mínima. Hace mucho frío. Todos están con grilletes en las piernas. Es caótico, desorganizado y, francamente, peligroso”.

La representante Jasmine Crockett (demócrata de Texas) denunció recientemente la atención médica de los detenidos en una conferencia de prensa que realizó después de visitar a Liam Conejo Ramos, un niño de 5 años en Minneapolis que fue enviado al Centro de Procesamiento de Inmigración de Dilley, en el sur de Texas. Crockett fue al centro luego de informes de medios que señalaban que el niño había desarrollado fiebre y estaba en mal estado de salud.

“El trato que estas personas están sufriendo en este momento es peor que el de quienes son acusados y a veces incluso condenados por delitos. Así de grave es”, dijo.

El DHS cerró Dilley este mes después de que dos detenidos contrajeran sarampión. El centro también alberga a niños que son vulnerables a complicaciones graves de la enfermedad, como inflamación cerebral.

El senador Chris Murphy (demócrata de Connecticut) acusó el 1 de febrero al gobierno de negarle la entrada a Dilley a finales de enero para ocultar el brote de sarampión.

Y recientemente se reportaron tres casos de sarampión en un centro en Florence, Arizona.

La preocupación pública está aumentando, con casi el 60% de los votantes que dicen desaprobar cómo Trump ha manejado la inmigración, según una encuesta reciente realizada por la Universidad de Siena y The New York Times.

El tipo y el alcance de los servicios de salud que deben recibir los inmigrantes adultos dependen en parte de dónde estén detenidos. Las normas de detención de ICE se aplican a centros específicos, como prisiones privadas que albergan tanto a reclusos como a detenidos, mientras que se requieren normas separadas en instalaciones que generalmente alojan a detenidos inmigrantes adultos.

A pesar de las diferencias, se esperan ciertos estándares básicos. Los inmigrantes deben recibir una evaluación médica, dental y de salud mental cuando llegan, y deben tener acceso diario a consulta médica por enfermedad, atención de emergencia las 24 horas y otros servicios, incluida atención preventiva, exámenes, diagnóstico y tratamiento.

Las normas existen para “garantizar que los detenidos sean tratados de manera humana; que se los proteja de daños; reciban atención médica y de salud mental adecuada; y reciban los derechos y protecciones a los que tienen derecho”, según las normas nacionales del ICE, revisadas el año pasado.

Pero el incumplimiento de la agencia de sus propias normas está dejando a los detenidos inmigrantes en riesgo de emergencias médicas y muerte, complicaciones por afecciones crónicas no tratadas e infección con enfermedades contagiosas, según demandas de defensores, investigaciones del Congreso realizadas por demócratas e informes estatales.

El DHS ha criticado algunas de las investigaciones como falsas, incluido un informe del senador Jon Ossoff (demócrata de Georgia) sobre mujeres embarazadas y niños en detención.

“Los centros de detención del ICE tienen normas más altas que la mayoría de las prisiones en EE.UU. que detienen a ciudadanos estadounidenses. Todos los detenidos reciben atención médica integral y comidas adecuadas”, dijo Tricia McLaughlin, vocera del DHS, en una declaración de agosto. El 17 de febrero, McLaughlin anunció que dejaría su cargo.

Supervisión debilitada, menos infraestructura

El acceso a servicios de salud adecuados se ha visto amenazado por el aumento del número de detenidos, la falta de supervisión del gobierno de Trump y un retraso en el procesamiento de reclamos médicos que ha puesto en riesgo la atención, dicen defensores, abogados y algunos doctores.

“Los desafíos se han agravado porque el ritmo de las expulsiones no ha seguido el ritmo de las detenciones. Eso agrava el problema”, dijo Drishti Pillai, directora asociada de KFF (organización sin fines de lucro de la que KFF Health News es parte). “Hay más problemas de salud pública cuando los centros están abarrotados”.

El número de inmigrantes en detención aumentó de unos 40.000 en noviembre de 2023 bajo el ex presidente Joe Biden a un récord de 73.000 personas a mediados de enero, según el American Immigration Council, un grupo que se enfoca en litigios e investigación.

Al mismo tiempo, el gobierno de Trump ha debilitado la supervisión de las condiciones y los servicios de salud en los centros de detención. Redujo el personal en la oficina del Defensor del Pueblo para la Detención de Inmigrantes del DHS, lo que en la práctica cerró la mayoría de sus operaciones, según un análisis de KFF y el Economic Policy Institute, una organización sin fines de lucro de investigación económica.

La misión del defensor del pueblo ha sido “examinar de manera independiente la detención de inmigrantes para promover condiciones seguras y humanas”, según la agencia. Actualmente, el DHS enfrenta un cierre parcial del gobierno debido a la oposición de los demócratas a un proyecto de ley de financiamiento para la agencia. Tal como fue impulsada por los republicanos, la medida eliminaría por completo el financiamiento del defensor del pueblo.

También hay largos retrasos en el procesamiento de pagos de atención médica para detenidos a doctores y hospitales externos, un obstáculo que, según defensores y el gobierno federal, pone en riesgo la atención.

El Centro de Servicios Financieros del Departamento de Asuntos de Veteranos tuvo durante mucho tiempo un contrato con el ICE para procesar reclamos por atención fuera de los centros de detención, como tratamientos oncológicos o diálisis.

Republicanos en el Congreso criticaron el acuerdo y afirmaron que desviaba recursos de los veteranos.

En octubre, Asuntos de Veteranos dejó de procesar las reclamos de los detenidos. Documentos que el ICE publicó en un sitio web federal de contrataciones indicaron que esta terminación “creó una emergencia” al comprometer la capacidad de reembolsar a proveedores y dejó a la agencia sin un mecanismo para brindar servicios como pruebas de tuberculosis, transporte médico no urgente y compra de equipo médico.

“Es una emergencia absoluta que el ICE obtenga de inmediato apoyo para procesar reclamos porque la falta de este apoyo retrasará atención médica crítica … como diálisis, atención prenatal, oncología, quimioterapia, etc.”, según documentos parcialmente censurados publicados a finales de 2025 en Sam.gov, un sistema federal de datos de contratos.

Se ha contratado a un nuevo procesador de reclamaciones, Acentra Health, pero el ICE ha dicho en su sitio web que no se procesará ninguna reclamación hasta el 30 de abril. Defensores dicen que no está claro si los detenidos están recibiendo acceso a atención externa según sea necesario y señalan que los retrasos también están desalentando a proveedores médicos a ofrecer servicios a los inmigrantes.

“El DHS ha firmado un nuevo contrato para procesar estos reclamos y actualmente está incorporando al proveedor”, dijo Pete Kasperowicz , vocero de Asuntos de Veteranos. “Mientras tanto, el VA está apoyando esta transición hasta mayo para asegurar que las reclamaciones se procesen adecuadamente”.

Muertes bajo custodia

El ICE informa que seis detenidos han muerto bajo custodia en lo que va de 2026, con 32 muertes de detenidos en 2025 y 11 en 2024. Sin embargo, algunos defensores y legisladores cuestionan esas cifras y dicen que los totales excluyen a detenidos que murieron mientras eran arrestados o bajo el cuidado de la Oficina de Aduanas y Protección Fronteriza de Estados Unidos (CBP, por sus siglas en inglés).

Demócratas en la Cámara de Representantes, en el Comité de Seguridad Nacional, dicen que 53 personas han muerto bajo custodia del ICE o la CBP desde que Trump asumió el cargo. Están exigiendo información al DHS, incluidos informes de cada autopsia, requisitos de personal para profesionales médicos y grabaciones de video de un detenido que murió en Texas.

“Estamos indignados” por las muertes, según una carta del 22 de enero firmada por 13 legisladores. “Es evidente y trágico que el ICE no está dispuesto o no puede proporcionar atención básica a los detenidos”.

Los demócratas señalaron la muerte de Geraldo Lunas Campos, de 55 años, nacido en Cuba. Murió el 3 de enero en un centro de detención en Fort Bliss, Texas, después de que el ICE dijera que presentó una emergencia médica. Había sido detenido casi seis meses antes.

“En ningún momento durante la detención se niega atención de emergencia a un extranjero detenido”, dijo el ICE en una declaración del 9 de enero sobre esa muerte.

La Oficina del Médico Forense del condado de El Paso determinó que la muerte fue un homicidio ocurrido después de que Campos fuera inmovilizado por las fuerzas del orden.

Mientras, otros inmigrantes siguen esperando atención. Reyes, quien necesitaba una biopsia por un posible cáncer de próstata, finalmente se realizó la prueba, pero a principios de febrero no había recibido resultados. “Está en un dolor constante y agonizante”, según la demanda presentada en el Distrito Norte de California.

El 10 de febrero, un juez federal ordenó al ICE y al DHS proporcionar atención médica adecuada a los detenidos y realizar supervisión externa, incluidas inspecciones en el lugar del centro de detención.

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Estados rojos y azules buscan limitar el uso de la inteligencia artificial en seguros de salud. Trump quiere lo opuesto

¿Cómo deben usar la inteligencia artificial (IA) las aseguradoras de salud? La respuesta a esta pregunta inusual de política pública, encuentra en un mismo bando al gobernador republicano Ron DeSantis, de Florida, y al gobierno demócrata de Maryland, los dos contra el presidente Donald Trump y el gobernador de California, Gavin Newsom.

La regulación de la inteligencia artificial, en especial su uso por parte de las aseguradoras de salud, se está convirtiendo en un tema que divide políticamente y altera las líneas partidarias tradicionales.

Quienes la impulsan, con Trump a la cabeza, no solo quieren insertar la IA de lleno en el gobierno, como en el experimento de Medicare que la utiliza en las autorizaciones previas (el proceso para autorizar ciertos tratamientos y medicamentos), sino que además buscan frenar a los estados que pretenden poner reglas y límites. Una orden ejecutiva firmada en diciembre busca invalidar la mayoría de los esfuerzos de los estados para regularla, al plantear que existe “una carrera con adversarios por la supremacía” en una nueva “revolución tecnológica”.

“Para ganar, las empresas estadounidenses de IA deben tener la libertad de innovar sin regulaciones engorrosas”, dice la orden de Trump. “Pero la regulación estatal excesiva frustra este imperativo”.

En todo el país, los estados se están rebelando. Al menos cuatro —Arizona, Maryland, Nebraska y Texas— aprobaron el año pasado leyes que limitan el uso de la IA en los seguros de salud. Otros dos, Illinois y California, habían aprobado leyes similares el año anterior.

Los legisladores de Rhode Island se proponen intentarlo de nuevo este año, después de que durante 2025 no lograran sancionar un proyecto que exigía a los organismos reguladores que recopilaran datos sobre el uso de las tecnologías. El año pasado, en Carolina del Norte, una iniciativa que exige que las aseguradoras no utilicen la IA como única base para decidir la cobertura generó interés entre legisladores republicanos.

DeSantis, ex candidato presidencial del Partido Republicano, ha presentado una “Carta de Derechos de la IA”, cuyas disposiciones incluyen restricciones a su uso en la tramitación de reclamos de seguros y el requisito de que un organismo regulador estatal inspeccione los algoritmos.

“Tenemos la responsabilidad de garantizar que las nuevas tecnologías se desarrollen de forma moral y ética, de modo que refuercen nuestros valores estadounidenses, no que los erosionen”, dijo DeSantis durante su discurso anual sobre la situación de su estado en enero.

Lista para regular

Las encuestas muestran que los estadounidenses desconfían de la IA. En diciembre, un relevamiento de Fox News encontró que el 63% de los votantes se describen como “muy” o “extremadamente” preocupados por la inteligencia artificial. La preocupación es mayoritaria en todo el espectro político. Casi dos tercios de los demócratas y poco más de 3 de cada 5 republicanos dijeron tener reparos sobre la IA.

Las tácticas de las aseguradoras de salud para reducir costos también preocupan a la población. Una encuesta de enero de KFF mostró un descontento generalizado en temas como la autorización previa.

En los últimos años, informes de ProPublica y otros medios han destacado el uso de algoritmos para rechazar rápidamente reclamos de seguros o solicitudes de autorización previa, al parecer con muy poca revisión por parte de un profesional de salud.

En enero, el Comité de Medios y Arbitrios de la Cámara de Representantes convocó a ejecutivos de Cigna, UnitedHealth Group y otras grandes aseguradoras para discutir preocupaciones sobre los altos costos de la atención médica.

Cuando se les preguntó directamente, los ejecutivos negaron o evitaron referirse al uso de la tecnología más avanzada para rechazar solicitudes de autorización o descartar reclamos.

La IA “nunca se utiliza para una denegación”, aseguró a los legisladores David Cordani, director ejecutivo de Cigna. Al igual que otras empresas del sector de seguros de salud, la compañía enfrenta demandas por sus métodos para rechazar reclamos, como destacó ProPublica. Justine Sessions, vocera de Cigna, dijo que el proceso de rechazo de reclamos de la empresa “no está impulsado por la IA”.

De hecho, las compañías insisten en presentar la IA como una herramienta de apoyo que no decide sola. Optum, parte del gigante de la salud UnitedHealth Group, anunció el 4 de febrero que implementaría autorización previa impulsada por tecnología, destacando que permitirá aprobaciones más rápidas.

“Estamos transformando el proceso de autorización previa para abordar los puntos de conflicto que genera”, dijo John Kontor, vicepresidente sénior de Optum, en un comunicado de prensa.

Aun así, Alex Bores, científico informático y miembro de la Asamblea de Nueva York, una figura clave en el debate legislativo del estado sobre la IA—que terminó en una ley integral para regular esta tecnología—, aseguró que la IA es un campo que, naturalmente, requiere regulación.

“Muchas personas consideran que las respuestas que reciben de sus aseguradoras son difíciles de entender”, dijo Bores, demócrata que compite por un escaño en el Congreso. “Agregar una tecnología que no puede explicar sus propias decisiones no ayudará a hacer las cosas más claras”.

Al menos una parte del ámbito de la salud —por ejemplo, muchos médicos— respalda a los legisladores y a quienes defienden las regulaciones.

La Asociación Médica Americana (AMA, por sus siglas en inglés) “apoya las regulaciones estatales que buscan más responsabilidad y transparencia de las aseguradoras comerciales que usan herramientas de IA y aprendizaje automático para revisar solicitudes de autorización previa”, dijo John Whyte, su director ejecutivo.

Whyte señaló que las aseguradoras ya utilizan IA y que “los médicos siguen enfrentando retrasos en la atención de los pacientes, decisiones poco claras de las aseguradoras, reglas de autorización inconsistentes y una carga administrativa abrumadora”.

Las aseguradoras responden

Con legislación aprobada o pendiente de aprobación en por lo menos nueve estados, aún no está claro el impacto real que tendrán esas leyes estatales, dijo Daniel Schwarcz, profesor de Derecho en la Universidad de Minnesota. Los estados no pueden regular los planes “autoasegurados”, que utilizan muchos empleadores; solo el gobierno federal tiene esa facultad.

Pero hay problemas más profundos, dijo Schwarcz: la mayoría de las leyes estatales que ha visto exigirían que un ser humano apruebe cualquier decisión propuesta por la IA, pero no especifican qué significa eso en la práctica.

Las leyes no ofrecen un marco claro para entender cuánta revisión es suficiente y, con el tiempo, los humanos tienden a volverse un poco descuidados y simplemente dan el visto bueno a cualquier sugerencia de una computadora, dijo.

Aun así, las aseguradoras ven esta ola de proyectos de ley como un problema.

“En términos generales, la carga regulatoria es real”, dijo Dan Jones, vicepresidente sénior de asuntos federales de la Alliance of Community Health Plans, un grupo comercial que representa a algunas aseguradoras de salud sin fines de lucro. Si las aseguradoras pasan mucho tiempo lidiando con un mosaico de leyes estatales y federales, agregó, eso significa que se dispondrá de “menos tiempo y recursos para enfocarnos en lo que se supone que debemos hacer: asegurarnos de que los pacientes tengan el acceso adecuado a la atención médica”.

Linda Ujifusa, senadora estatal demócrata en Rhode Island, dijo que las aseguradoras se opusieron el año pasado a un proyecto que presentó para restringir el uso de la IA en las denegaciones de cobertura. Fue aprobado en una cámara, pero en la otra no avanzó.

“Hay una oposición enorme” a cualquier intento de regular prácticas como la autorización previa, dijo, y también “una oposición enorme” a señalar a intermediarios —como las aseguradoras privadas o los administradores de beneficios farmacéuticos— “como parte del problema”.

En una carta en la que criticó el proyecto, AHIP, el principal grupo que representa a las aseguradoras, pidió “políticas equilibradas que promuevan la innovación y, al mismo tiempo, protejan a los pacientes”.

“Los planes de salud reconocen que la IA tiene el potencial de impulsar mejores resultados en la atención médica mejorando la experiencia del paciente, cerrando brechas en la atención, acelerando la innovación y reduciendo la carga administrativa y los costos para mejorar el enfoque en la atención al paciente”, dijo Chris Bond, portavoz de AHIP, a KFF Health News.

Y agregó que el sector necesita “un enfoque nacional coherente basado en un marco federal integral de políticas de IA”.

En busca de equilibrio

En California, Newsom ha promulgado algunas leyes que regulan la IA, incluida una que exige que las aseguradoras de salud garanticen que sus algoritmos se apliquen de manera justa y equitativa. Pero el gobernador demócrata ha vetado otras iniciativas con un enfoque más amplio, como un proyecto que imponía más requisitos sobre cómo debe funcionar la tecnología y que exigía revelar su uso a reguladores, médicos y pacientes cuando lo pidieran.

Según Chris Micheli, lobista de Sacramento, es probable que el gobernador quiera asegurarse de que el presupuesto estatal —que se mantiene fuerte gracias a las grandes ganancias de la Bolsa, especialmente de las empresas tecnológicas— no se resienta. Y para eso, dijo, hace falta equilibrio.

Newsom está tratando de “garantizar que ese flujo de dinero continúe y, al mismo tiempo, que haya algunas protecciones para los consumidores de California”, afirmó. Añadió que las aseguradoras consideran que ya están sujetas a una gran cantidad de regulaciones.

La administración Trump parece estar de acuerdo. La reciente orden ejecutiva del presidente propone demandar ante la Justicia y restringir ciertos fondos federales a cualquier estado que apruebe lo que caracteriza como una regulación estatal “excesiva”, con algunas excepciones, como las políticas destinadas a proteger a los niños.

Esa orden posiblemente sea inconstitucional, dijo Carmel Shachar, experta en políticas de salud de la Facultad de Derecho de Harvard. La autoridad para invalidar leyes estatales generalmente recae en el Congreso, explicó, y los legisladores federales consideraron en dos ocasiones, pero finalmente rechazaron, una disposición que prohibía a los estados regular la IA.

“Según nuestro conocimiento previo del federalismo y del equilibrio de poderes entre el Congreso y el Poder Ejecutivo, es muy probable que una impugnación tenga éxito”, dijo Shachar.

Algunos legisladores ven la orden de Trump con mucho escepticismo, y señalan que la administración ha eliminado controles y ha impedido que otros los establezcan, en un grado extremo.

“En este momento, no se trata de decidir si la regulación debe ser federal o estatal”, dijo Alex Bores. “La pregunta es si va a haber regulación a nivel estatal o directamente no va a haber ninguna”.

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Hospitals Fighting Measles Confront a Challenge: Few Doctors Have Seen It Before

ASHEVILLE, N.C. — At around 2 a.m., 7-year-old twin brothers arrived at Mission Hospital in Asheville. Both had a fever, a cough, a rash, pink eye, and cold symptoms.

The boys sat in one waiting room and then another. Two hours and 20 minutes passed before the two were isolated, according to Centers for Medicare & Medicaid Services records obtained by KFF Health News. Then two more hours ticked by.

As the sun rose, an emergency room doctor called the state epidemiologist and described the symptoms. The public health official told him to keep the kids in the hospital and quarantine them. Shortly after that call, the patients were diagnosed.

It was measles.

Hospital staff gave the father instructions on how to quarantine the family and sent them home.

The virus exposed at least 26 other people in the hospital that January day, federal investigators determined. Health inspectors for CMS investigated the measles infections and other failures in care and concluded that the twins’ symptoms should have triggered an isolation procedure for which Mission Hospital staffers had trained seven months earlier. CMS designated Mission in “Immediate Jeopardy” for the exposures and other unrelated issues, one of the most severe sanctions a hospital can face, threatening to pull federal funding unless it remedied the problems.

A spokesperson for Mission said its staff was trained to manage airborne sickness and is following federal rules.

As U.S. hospitals face an increasing risk of encountering measles, and pressure to immediately spot it, health care workers face an unusual barrier: Many don’t know what it looks like.

“There’s a word, ‘morbilliform’ — it means measles-like, and there are lots of viruses that can cause a rash that looks like a measles rash in children,” said Theresa Flynn, a pediatrician in Raleigh and the president of the North Carolina Pediatric Society. In 30 years in health care, she’s never seen a measles case, she said.

North Carolina has reported more than 20 cases since mid-December, and more than 3,000 people nationwide have been infected since the beginning of 2025.

Children in areas with low immunization rates have been especially susceptible to outbreaks, triggering public health campaigns to promote the measles vaccine. CMS Administrator Mehmet Oz encouraged vaccination in a CNN interview on Feb. 8.

With two doses of the measles, mumps, and rubella vaccine, a person has a 3% chance of getting the virus after exposure. If exposed, an unvaccinated person has a 90% chance of being infected, according to the CDC. It can take a week or two before someone infected with measles shows symptoms.

But for the past year, the Trump administration has sown doubt about vaccine effectiveness. Health and Human Services Secretary Robert F. Kennedy Jr. was a longtime anti-vaccine activist before taking office, and under his leadership the Centers for Disease Control and Prevention has reduced the number of shots recommended to children.

After measles erupted in West Texas last year, Kennedy publicly recommended unconventional and unproven treatments for the virus, including steroids, antibiotics, and cod liver oil.

Infectious disease experts and doctors said federal policies have left health care workers to lean on their own experience or guidance from their state public health systems to fight a disease that many are preparing to see for the first time and that initially may behave like the common cold.

“As measles becomes more common, all of us are leveling up in our ability to recognize and immediately respond to suspected measles,” Flynn said.

Three C’s

Officially, the U.S. has maintained “measles elimination status” since 2000, meaning the U.S. has avoided significant spread of the virus. After outbreaks in Texas, Arizona, Utah, and now South Carolina, the nation is on track to lose that designation before the year is out. Its own adopted regulations tie elimination status to a lack of a continuous viral spread persisting for 12 months.

One county in South Carolina, an hour’s drive from Asheville, has had more than 900 cases in the current outbreak — more than Texas reported in all of 2025.

Symptoms of measles, a virus that attacks the lungs and airways, can include fever, cough, a blotchy rash, and red, watery eyes. Researchers consider measles among the most contagious diseases, and the virus may remain active for up to two hours after an infected person leaves a room.

It can be lethal, with 1 to 3 deaths per 1,000 cases in children.

In 2025, two children in Texas and one adult in New Mexico died of measles.

Along with tracking data, the CDC provides detailed summaries on its website for diagnosing measles. State public health agencies and some counties have developed dashboards tracing the disease as it surfaces in such places as hospitals, schools, grocery stores, and airports. Large hospital systems developed staff training protocols last year and shared them with area clinics.

Look for the three C’s, that guidance said: cough, coryza (cold symptoms), and conjunctivitis (pink eye). According to CMS inspection records, HCA Healthcare, which owns Mission Hospital, trained Mission staff on the three C’s early last year. On top of failing to isolate the twin patients right away, Mission staff didn’t have a designated area for patients with respiratory symptoms, federal inspectors found.

The CDC advises health workers to immediately place patients with measles or suspicious symptoms in a special isolation room, where airflow is controlled inward. The Mission patients were separated from other patients only by plastic partitions, according to the CMS records.

Mission spokesperson Nancy Lindell said the hospital was equipped and staffed to manage airborne illnesses like measles.

“Our hospital has been working with state and federal health officials on proactive preparedness, and we are following guidance provided by the CDC,” Lindell said.

(Dogwood Health Trust, a private foundation established as part of HCA’s purchase of Mission Health, helps fund KFF Health News coverage.)

Most U.S. clinics and hospitals have never experienced measles cases, said Patsy Stinchfield, a former president of the National Foundation for Infectious Diseases and a nurse practitioner. She called CMS’ Immediate Jeopardy penalty for Mission “extreme,” given the virus can be so difficult to identify.

“In the middle of winter right now, measles looks like every other viral respiratory infection that kids come in with,” Stinchfield said.

The CDC has been less communicative in the past year with clinics about their response to outbreaks, said health workers and infectious disease experts. This disconnect began soon after Trump took office, according to a KFF Health News investigation finding that health officials in West Texas were unable to talk with CDC scientists as measles surged last February and March.

“We certainly do not feel the support or guidance from the CDC right now,” said Brigette Fogleman, a pediatrician at Asheville Children’s Medical Center, where staff members have come up with their own method of staving off the virus: screening patients over the phone and in their cars before a visit.

In response to questions about how the CDC is supporting health care organizations during the measles resurgence, spokesperson Andrew Nixon said that “state and local health departments have the lead in investigating measles cases and outbreaks” and that the CDC provides support “as requested.” He pointed to numerous guides and simulation tools the agency has developed as the virus has spread.

Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University, acknowledged that diagnosing measles is a major challenge, emphasizing that coordination among public health agencies is critical in overcoming that challenge.

Stinchfield attributed the spread of measles to CDC leaders’ lack of communication to clinics and to the public — no ads on buses, no social media campaigns, no sense of urgency. “When you are at the highest level of measles cases in 30 years, we should be seeing lots more from our federal government,” Stinchfield said. “And I think it’s harming kids and causing an inordinate amount of work and expense that really doesn’t belong in health care right now.”

State Prepares for More Measles Cases

In North Carolina’s Buncombe County, home to Asheville and Mission Hospital, health officials had counted seven measles cases by mid-February and anticipated many more, according to state epidemiologist Zack Moore. It’s unclear how many of those are connected to the Mission exposure.

“We are preparing for a future in which we follow a trajectory like South Carolina,” Moore said, “where we see sort of a gradual accumulation of cases, and then all of a sudden it reaches kind of a tipping point, and we see a more explosive growth in the outbreak and spread across the state.”

Fogleman, who is also a pediatrician, and Buncombe health department director Jennifer Mullendore spoke during a recent Facebook livestream hosted by the county, urging families to get their children vaccinated, debunking vaccine misinformation, and updating parents on local case numbers.

Days before, a local private school had quarantined about 100 students after an exposure. Only 41% of students there were immunized, according to state data.

At Fogleman’s clinic, parents are asked to wait in their vehicles with their children, and staffers come out to screen them there. Some parents resist vaccination and note recently weakened federal recommendations around measles vaccines for children under 4, she said.

Kennedy handpicked the committee members who made those recommendations, with several members having spread medical misinformation in the past.

One parent recently told a nurse, “It’s only measles. It doesn’t kill anybody,” Fogleman said.

That’s not true, her team must explain.

As the clinic holds families in the parking lot, trying to figure out whether symptoms point to the dangerous virus, it’s difficult to get the message across, Fogleman said, especially when the nation’s top disease agency hasn’t conducted a widespread information campaign about the risks from measles — or the vaccine’s ability to almost entirely prevent it.

“We can’t change the past,” Fogleman said. “All we can do is try to educate and move forward.”

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Another C.D.C. Vaccine Skeptic Steps Down

Dr. Ralph Abraham, the agency’s principal deputy director, has called the Covid vaccines “dangerous.” Other skeptics have recently left federal health roles.

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How a Horse Whinnies: With a Whistle and a Song

Horses, with their high-pitched whinnies, seemed to buck the trend of larger animals producing lower sounds, but a new study explains the mechanics behind the noises a horse makes.

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New Orleans Brings Back the House Call, Sending Nurses To Visit Newborns and Moms

When Lisa Bonfield gave birth to daughter Adele in late November, she was thrust into the new world of parenting, and faced an onslaught of challenges and skills to learn: breastfeeding, diapering, sleep routines, colic, crying, and all the little warning signs that something could be wrong with the baby.

But unlike parents in most of the U.S., she had extra help that was once much more common: house calls.

Adele was only a few weeks old when a registered nurse showed up at Bonfield’s door on Dec. 10 to check on them and offer hands-on help and advice.

As a city resident who had recently given birth, she was eligible for up to three home visits from Family Connects New Orleans, a program of the city health department.

She didn’t need to feed and change the baby before packing everything up for a car trip to the pediatrician or a clinic. It was a relief; Bonfield was exhausted and was still trying to figure out how to use the infant car seat.

“Everything is so abstract before you have a baby,” Bonfield said. “You are going to have questions you never even thought about.”

Louisiana is among the worst-performing states in maternal and infant health outcomes. So New Orleans is trying to catch health issues early — and get families off to an easier start — by adding health visits during the crucial first months of life.

The hope is that health outcomes can be improved by returning to the old-fashioned medical practice of house calls.

The Family Connects model has been tried in communities across 20 states. It began in Durham, North Carolina, in 2008, as a partnership with Duke University. In 2023, New Orleans’ health director, Jennifer Avegno, helped launch a local version of the program.

Avegno was concerned by Louisiana’s particularly grim statistics for maternal and infant health.

The state has some of the highest rates of preterm births, unnecessary cesarean sections, and maternal and infant deaths, according to the March of Dimes. A recent analysis from the United Health Foundation found that Louisiana was the “least healthy” state for women and children.

“We got to do some real things real differently, unless you like being No. 50 all the time,” Avegno said.

The home visits are free and available to anyone who has just given birth in a New Orleans hospital, no matter their insurance status or income level.

Avegno describes the home visits as going “back to the future,” replicating a practice that was far more common a hundred years ago.

“There is no more critical time and vulnerable time than right at birth and in the few weeks to months following birth,” Avegno said.

The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city.

They ask if the family has enough food, and whether there are guns in the house and how they’re stored, Avegno said.

In Bonfield’s case, the nurse stayed for over two hours. Bonfield especially liked their conversation about how to safely store breastmilk.

“I’ve never felt so well taken care of and listened to,” she said.

Broad Support

Louisiana has struggled a long time with poor maternal and infant health outcomes, but the problem has been complicated by the state’s strict abortion ban.

The 2022 law led to risky medical delays and unnecessary surgeries in obstetrical care, and confusion among doctors about what’s allowed in ending dangerous pregnancies or treating miscarriages.

Avegno opposes the state’s abortion policies, believing they are harmful to women’s health. But she says that Family Connects offers other ways to preserve and expand care for women. For example, the visiting nurse can check in with the mother about whether she needs help with birth control.

“We can’t give them abortion access,” she said. “That’s not the goal of this program, and that wouldn’t be possible anyway. But we can make sure they’re healthy and understand what their options are for reproductive health care.”

Abortion politics aside, the postpartum home visits seem to have bipartisan support in Louisiana, and state lawmakers want to expand their availability.

Last year, the Republican-dominated legislature passed a law requiring private insurance plans to cover the visits.

The new law is another way that Louisiana officials can be “pro-life,” said state Rep. Mike Bayham, who, as a Republican and an abortion opponent, sponsored the legislation.

“One of the slings used against advocates against abortion is that we’re pro-birth, and not truly pro-life,” Bayham said. “And this bill is proof that we care about the overall well-being of our mothers and our newborns.”

Improving Health and Help for Postpartum Depression

Two years in, there are already promising signs that the program is improving health.

Early data analyzed by researchers at Tulane University showed that families who got the visits were more likely to stick to the recommended schedule of pediatric and postpartum checkups. Moms and babies were also less likely to need hospitalization, and overall health care spending was down among families insured by Medicaid.

Research on Family Connects programs elsewhere has found similar results. In North Carolina, one study showed that three to seven home visits reduced trips to the emergency room by 50% in the year before a baby turned 1.

But the statistic that most excited Avegno related to the program’s role in screening mothers for postpartum depression.

The visiting nurses are helping spot more cases of postpartum depression — earlier — so that new moms can get treatment. About 10% of moms participating in the New Orleans program were eventually diagnosed with postpartum depression, compared with 6% of moms who did not get the visits.

Timely diagnosis is important to prevent depression symptoms from worsening, or leading to more severe outcomes, such as suicidal thoughts, thoughts of harming the baby, or problems bonding with their newborn.

Lizzie Frederick was one of the New Orleans mothers whose postpartum symptoms were caught early by a visiting nurse.

When she was pregnant, she and her husband took all the childbirth and newborn classes they could. They hired a doula to help with the birth. But Frederick still wasn’t prepared for the stresses of the postpartum period, she said.

“I don’t think there are enough classes out there to prepare you for all the different scenarios,” Frederick said.

When her son, James, was born in May, he had trouble breastfeeding. He was sleeping for only 90-minute stretches at night.

When the nurse arrived for the first visit a few weeks later, Frederick was busy trying to feed James. But the nurse reassured her that there was no rush. She could wait.

“I am here to support you and take care of you,” Frederick recalled the nurse saying.

The nurse weighed James, and Frederick was relieved to learn he was gaining weight. But for most of the visit, the nurse focused on Frederick’s needs. She was exhausted, anxious, and had started hearing what she called phantom cries.

The nurse walked her through a mental health questionnaire. Then she recommended that Frederick see a counselor and consider attending group therapy sessions for perinatal women.

Frederick followed up on these suggestions and was eventually diagnosed with postpartum depression.

“I think that I would have felt a lot more alone if I hadn’t had this visit, and struggled in other ways without the resources that the nurse provided,” Frederick said.

Home Visits Save Money

Melissa Goldin Evans, an assistant professor at Tulane’s School of Public Health, helped interview over 90 families participating in the Family Connects New Orleans program.

“It was overwhelmingly positive experiences,” she said. “This is like a gold-standard public health project, in my opinion.”

To operate, Family Connects costs the city about $1.5 million a year, or $700 per birth, according to Avegno. But the program also has the potential to save money: Research on North Carolina’s program found that every $1 invested in the program saved $3.17 in health care billing before the child turned 2.

That’s another reason to require the visits statewide, according to state Rep. Bayham.

“The nurses and medical practitioners will be able to monitor potential problems on the front end, so that they could be handled without a trip to the emergency room or something even more drastic,” he said.

Avegno is advocating that the program be included in Louisiana’s Medicaid program, since more than 60% of births in the state are covered by Medicaid. A recent legislative report made the same recommendation.

This article is from a partnership that includes WWNO, NPR, and KFF Health News.

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