Vince Lahey of Carefree, Arizona, embraces chatbots. From Big Tech products to “shady” ones, they offer “someone that I could share more secrets with than my therapist.”

He especially likes the apps for feedback and support, even though sometimes they berate him or lead him to fight with his ex-wife. “I feel more inclined to share more,” Lahey said. “I don’t care about their perception of me.”

There are a lot of people like Lahey.

Demand for mental health care has grown. Self-reported poor mental health days rose by 25% since the 1990s, analyzing survey data. According to the Centers for Disease Control and Prevention, suicide rates in 2022 that hadn’t been seen in nearly 80 years.

There are many patients who find a nonhuman therapist, powered by artificial intelligence, highly appealing — more appealing than a human with a reclining couch and stern manner. with begging for a therapist who’s “not on the clock,” who’s less judgmental, or who’s just less expensive.

Most people who need care don’t get it, said Tom Insel, former head of the National Institute of Mental Health, citing his former agency’s research. Of those who do, 40% receive “minimally acceptable care.”

“There’s a massive need for high-quality therapy,” he said. “We’re in a world in which the status quo is really crappy, to use a scientific term.”

Insel said engineers from OpenAI told him last fall that about 5% to 10% of the company’s then-roughly 800 million-strong user base rely on ChatGPT for mental health support.

Polling suggests these AI chatbots may be even more popular among young adults. A KFF poll found about 3 in 10 respondents ages 18 to 29 for mental or emotional health advice in the past year. Uninsured adults were about twice as likely as insured adults to report using AI tools. And nearly 60% of adult respondents who used a chatbot for mental health didn’t follow up with a flesh-and-blood professional.

The App Will Put You on the Couch

A burgeoning industry of apps offers AI therapists with human-like, often unrealistically attractive avatars serving as a sounding board for those experiencing anxiety, depression, and other conditions.

Ñî¹óåú´«Ã½Ò•îl Health News identified some 45 AI therapy apps in Apple’s App Store in March. While many charge steep prices for their services — one listed an annual plan for $690 — they’re still generally cheaper than talk therapy, which can cost hundreds of dollars an hour without insurance coverage.

On the App Store, “therapy” is often used as a marketing term, with small print noting the apps cannot diagnose or treat disease. One app, branded as OhSofia! AI Therapy Chat, had downloads in the six figures, said OhSofia! founder Anton Ilin in December.

“People are looking for therapy,” Ilin said. On one hand, the product’s name ; on the other, it warns in that it “does not provide medical advice, diagnosis, treatment, or crisis intervention and is not a substitute for professional healthcare services.” Executives don’t think that’s confusing, since there are disclaimers in the app.

The apps promise big results without backup. its users “immediate help during panic attacks.” it was “proven effective by researchers” and that it offers 2.3 times faster relief for anxiety and stress. (It doesn’t say what it’s faster than.)

There are few legislative or regulatory guardrails around how developers refer to their products — or even whether the products are safe or effective, said Vaile Wright, senior director of the office of health care innovation at the American Psychological Association. Even federal patient privacy protections don’t apply, she said.

“Therapy is not a legally protected term,” Wright said. “So, basically, anybody can say that they give therapy.”

Many of the apps “overrepresent themselves,” said John Torous, a psychiatrist and clinical informaticist at Beth Israel Deaconess Medical Center. “Deceiving people that they have received treatment when they really have not has many negative consequences,” including delaying actual care, he said.

States such as Nevada, Illinois, and California are trying to sort out the regulatory disarray, enacting laws forbidding apps from describing their chatbots as AI therapists.

“It’s a profession. People go to school. They get licensed to do it,” said Jovan Jackson, a Nevada legislator, who co-authored an enacted bill banning apps from referring to themselves as mental health professionals.

Underlying the hype, outside researchers and company representatives themselves have told the FDA and Congress that there’s little evidence supporting the efficacy of these products. What studies there are — and some companion-focused chatbots are “consistently poor” at managing crises.

“When it comes to chatbots, we don’t have any good evidence it works,” said Charlotte Blease, a professor at Sweden’s Uppsala University who specializes in trial design for digital health products.

The lack of “good quality” clinical trials stems from the FDA’s failure to provide recommendations about how to test the products, she said. “FDA is offering no rigorous advice on what the standards should be.”

Department of Health and Human Services spokesperson Emily Hilliard said, in response, that “patient safety is the FDA’s highest priority” and that AI-based products are subject to agency regulations requiring the demonstration of “reasonable assurance of safety and effectiveness before they can be marketed in the U.S.”

The Silver-Tongued Apps

Preston Roche, a psychiatry resident who’s , gets lots of questions about whether AI is a good therapist. After trying ChatGPT himself, he said he was “impressed” initially that it was able to use techniques to help him put negative thoughts “on trial.”

But Roche said after seeing posts on social media discussing people developing psychosis or being encouraged to make harmful decisions, he became disillusioned. The bots, he concluded, are sycophantic.

“When I look globally at the responsibilities of a therapist, it just completely fell on its face,” he said.

This sycophancy — the tendency of apps based on large language models to empathize, flatter, or delude their human conversation partner — is inherent to the app design, experts in digital health say.

“The models were developed to answer a question or prompt that you ask and to give you what you’re looking for,” said Insel, the former NIMH director, “and they’re really good at basically affirming what you feel and providing psychological support, like a good friend.”

That’s not what a good therapist does, though. “The point of psychotherapy is mostly to make you address the things that you have been avoiding,” he said.

While polling suggests many users are satisfied with what they’re getting out of ChatGPT and other apps, there have been about the service or encouragement to self-harm.

And or have been filed against OpenAI after ChatGPT users died by suicide or became hospitalized. In most of those cases, the plaintiffs allege they began using the apps for one purpose — like schoolwork — before confiding in them. These cases are being .

Google and the startup Character.ai — which has been funded by Google and has created “avatars” that adopt specific personas, like athletes, celebrities, study buddies, or therapists — are settling other wrongful-death lawsuits, .

OpenAI’s CEO, Sam Altman, has said up to may talk about suicide on ChatGPT.

“We have seen a problem where people that are in fragile psychiatric situations using a model like 4o can get into a worse one,” Altman said in a public question-and-answer session reported by , referring to a particular model of ChatGPT introduced in 2024. “I don’t think this is the last time we’ll face challenges like this with a model.”

An OpenAI spokesperson did not respond to requests for comment.

The company has said it on safeguards, such as referring users to 988, the national suicide hotline. However, the lawsuits against OpenAI argue existing safeguards aren’t good enough, and some research shows the problems are . OpenAI its own data suggesting the opposite.

OpenAI is , offering, early in one case, a variety of defenses ranging from denying that its product caused self-harm to alleging that the defendant misused the product by inducing it to discuss suicide. It has also said it’s working to .

Smaller apps also rely on OpenAI or other AI models to power their products, executives told Ñî¹óåú´«Ã½Ò•îl Health News. In interviews, startup founders and other experts said they worry that if a company simply imports those models into its own service, it might duplicate whatever safety flaws exist in the original product.

Data Risks

Ñî¹óåú´«Ã½Ò•îl Health News’ review of the App Store found listed age protections are minimal: Fifteen of the nearly four dozen apps say they could be downloaded by 4-year-old users; an additional 11 say they could be downloaded by those 12 and up.

Privacy standards are opaque. On the App Store, several apps are described as neither tracking personally identifiable data nor sharing it with advertisers — but on their company websites, privacy policies contained contrary descriptions, discussing the use of such data and their disclosure of information to advertisers, like AdMob.

In response to a request for comment, Apple spokesperson Adam Dema to the company’s App Store policies, which bar apps from using health data for advertising and require them to display information about how they use data in general. Dema did not respond to a request for further comment about how Apple enforces these policies.

Researchers and policy advocates said that sharing psychiatric data with social media firms means patients could be profiled. They could be targeted by dodgy treatment firms or charged different prices for goods based on their health.

Ñî¹óåú´«Ã½Ò•îl Health News contacted several app makers about these discrepancies; two that responded said their privacy policies had been put together in error and pledged to change them to reflect their stances against advertising. (A third, the team at OhSofia!, said simply that they don’t do advertising, though their app’s notes users “may opt out of marketing communications.”)

One executive told Ñî¹óåú´«Ã½Ò•îl Health News there’s business pressure to maintain access to the data.

“My general feeling is a subscription model is much, much better than any sort of advertising,” said Tim Rubin, the founder of Wellness AI, adding that he’d change the description in his app’s privacy policy.

One investor advised him not to swear off advertising, he said. “They’re like, essentially, that’s the most valuable thing about having an app like this, that data.”

“I think we’re still at the beginning of what’s going to be a revolution in how people seek psychological support and, even in some cases, therapy,” Insel said. “And my concern is that there’s just no framework for any of this.”

Ñî¹óåú´«Ã½Ò•îl 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 .

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State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly known as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a Ñî¹óåú´«Ã½Ò•îl Health News investigation showed.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax-and-spending law. The changes will add red tape and restrictions. They are coming at a steep price ― both in the cost to taxpayers and coverage losses ― according to state documents obtained by Ñî¹óåú´«Ã½Ò•îl Health News and interviews.

The documents showÌýgovernment agenciesÌýwill spend millionsÌýto saveÌýconsiderablyÌýmoreÌýbyÌýremovingÌýpeople fromÌýhealth benefits.ÌýWhile statesÌýsignÌýeligibility system contracts with companiesÌýandÌýwork with them to manageÌýupdates, the federal governmentÌýfootsÌýmost of the bill.

The law’s Medicaid policies will causeÌýÌýtoÌýbecome uninsuredÌýby 2034, according to the nonpartisan Congressional Budget Office.ÌýRoughlyÌýÌýwill loseÌýaccess toÌýmonthly cashÌýassistanceÌýforÌýfood, including those with children.Ìý

In five statesÌýalone,ÌýÌýfor state officialsÌýand reviewed by Ñî¹óåú´«Ã½Ò•îl Health NewsÌýshow that changesÌýwill cost at least $45.6ÌýmillionÌýcombined.Ìý

The lawÌýrequires most statesÌýtoÌýtieÌýMedicaid coverageÌýfor some adultsÌýtoÌýhavingÌýaÌýjob,ÌýandÌýimposes other restrictions that will make it harder forÌýpeopleÌýwith low incomesÌýto stay enrolled.ÌýSNAP restrictions began to take effect in 2025. Major Medicaid provisionsÌýbeginÌýlater this year.Ìý

DocumentsÌýprepared by consulting company DeloitteÌýestimateÌýthat a pair ofÌýcomputer systemÌýchangesÌýforÌýMedicaid work requirementsÌýin WisconsinÌýwillÌýÌý. Two other changesÌýrelatedÌýto the state’s SNAP program will cost an additional $4.2Ìýmillion, according to the documents, which for the Wisconsin Department of Health Services.

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Ñî¹óåú´«Ã½Ò•îl 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 .

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Ollie’s parents, who adopted her in 2020, tried to sign her up for a clinical trial using — which genetically reprograms a patient’s white blood cells to help them fight cancer — at UNC Health in Chapel Hill, North Carolina, an hour-and-a-half drive from their home in Eden.

Her mother, Britany Super, described it as Ollie’s “last option.”

But in early March, Super recalled, UNC Health’s financial office told them the bad news: The state’s new insurance for kids in foster care wasn’t going to pay for the treatment.

In December, Ollie became one of hundreds of thousands of kids nationwide enrolled in a special kind of public health insurance for people served by the foster care system. That insurance, known as a specialized managed care plan, is part of Medicaid, the federal-state program that covers health costs for people with low incomes or disabilities.

North Carolina is one of 14 states with such specialized foster care plans, according to the National Academy for State Health Policy. The plans differ by state, but each is meant to expand coverage for children in the foster care system — and for kids who were adopted out of it, such as Ollie and her siblings.

Yet, as in other states that have struggled when adding such plans, North Carolina families have faced hurdles obtaining care. Thousands of doctors whose services were covered under Medicaid were not included in the specialized plan — which is costing the state $3.1 billion over four years — when it rolled out on Dec. 1. That left guardians and parents of kids adopted out of the system scrambling to figure out whether they would have to find new health care providers or new insurance.

In North Carolina, the insurance plan’s stumbles have added another layer of complication around health care issues. The state — like many others — is already over expected Medicaid cuts in the wake of congressional Republicans’ One Big Beautiful Bill Act. A separate Medicaid funding shortfall also prompted a push to cut care providers’ reimbursement rates.

Texas, which established its plan 18 years ago, that its foster families also had a hard time finding doctors on the insurance. In Florida, researchers for the state reported as early as 2016 that there was .

Illinois’ plan by the Centers for Medicare & Medicaid Services over a lack of access to care. Research concluded that California’s plan children with adequate mental health services. Georgia’s access problems alarmed state officials enough to calling for children to be removed from the plan and put back on other Medicaid plans.

But such specialized plans for kids in foster care continue to gain traction. Four states have started their own plans in the past five years, said , the senior director of children and family health at the National Academy for State Health Policy, and she said it’s likely more will adopt them soon.

showing how these programs are faring, Medicaid policy analysts said. It’s therefore difficult to know why they’ve run into rollout problems or whether they’ve improved access to care. That makes the plans risky, said , a research professor at Georgetown University’s Center for Children and Families.

“The states that are going in this direction, unless they have data to support it, are experimenting,” Schneider said. “They’re putting all their eggs in one basket, so they need to pay close attention.”

Rough Rollout

North Carolina’s specialized insurance plan for foster kids experienced problems the day it rolled out.

The state automatically enrolled Ollie and about 32,000 other people in , called . North Carolina officials had said the program would improve health care access for foster children, who often have medically complex needs and move frequently.

But foster families quickly began hearing that their health care providers were not taking the insurance, according to several families who recounted their experiences fighting to get their children’s procedures covered under the plan.

UNC Health, a state-run health system that is , with nearly 4,400 physicians, initially, which is why it told Super that Ollie’s CAR T-cell treatment wouldn’t be covered.

After more than two months of limbo for families, UNC Health ultimately in mid-March with Blue Cross Blue Shield of North Carolina, which runs the plan.

But some North Carolina doctors still don’t accept Healthy Blue insurance.

, interim deputy secretary for North Carolina’s Medicaid program, said her office to expand its network, even though it already has what she called an “adequate” number of providers. North Carolina’s health department and Blue Cross Blue Shield did not answer Ñî¹óåú´«Ã½Ò•îl Health News’ questions about how many providers are covered by the new insurance.

“We welcome qualified providers who want to join,” said Blue Cross Blue Shield of North Carolina spokesperson Sara Lang.

Other problems . As thousands of health care records move over to a statewide database managed by Healthy Blue, children’s doctors are struggling to track their patients’ medical histories, said foster care advocates and pediatricians. Parents reported problems seeing health records, finding themselves locked out of online portals. Others couldn’t access prescriptions. Surgeries got delayed. Appointments were canceled.

“Network management for any plan is an ongoing process,” Lang said.

All this meant added red tape and heartache for the caregivers of children like Ollie with complex medical needs — those the .

Gearing Up

Cancer has been part of Ollie’s life since she was 2. She was in the process of getting adopted out of foster care when she began chemotherapy and radiation treatments, then received two stem cell transplants, Super recalled.

Surgeons installed temporary tubes in a vein near her heart and a feeding tube in her abdomen. Her hair fell out as the treatment intensified, and a thin layer of skin peeled off, forcing her new family to wear surgical gowns and gloves when they wanted to be close.

“She doesn’t remember life outside of going to doctors and being in a hospital,” Super said.

Ollie still has a port in her chest ready for whenever she needs intravenous medicine, and her monthly doctor appointments are about to become weekly. During an emergency room visit in mid-March, doctors told Super her daughter’s cancer had spread. Ollie will need more chemotherapy before her body is ready for the more advanced treatment.

But the Supers, thrown into uncertainty for more than two months, still feel some relief. They’re preparing for back-and-forth drives for the CAR T-cell therapy treatments in Chapel Hill. And they’re grateful, even if it means Ollie will spend at least five more weeks in and out of a hospital.

Reliable health insurance will be vital for Ollie, and Healthy Blue leaders said they are talking with doctors, parents, and others to make sure the plan is working. Her procedures carry multimillion-dollar price tags, her mother said, but having her bills seamlessly covered allows the family to focus on Ollie’s treatment.

“The biggest challenges for her will be in the first few months of the study,” said Super, who knows the therapy’s side effects include fever, fatigue, and confusion. “But I’m hoping that after that, the CAR T-cells will do their job and fight the cancer and she can continue to have a playful, active life.”

That means, they hope, the girl could be at home more often with her five siblings and the three family dogs, including Remy, a border collie mix who is Ollie’s favorite.

Super relishes those precious moments for her daughter — “being a kid and doing kid things.”

Ñî¹óåú´«Ã½Ò•îl 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 .

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State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a Ñî¹óåú´«Ã½Ò•îl Health News investigation showed.

These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat — or going without.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price — both in the cost to taxpayers and coverage losses — according to state documents obtained by Ñî¹óåú´«Ã½Ò•îl Health News and interviews.

The documents show government agencies will spend millions to save considerably more by removing people from health benefits. While states sign eligibility system contracts with companies and work with them to manage updates, the federal government foots most of the bill.

The law’s Medicaid policies will cause to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly will lose access to monthly cash assistance for food, including those with children.

In five states alone, for state officials and reviewed by Ñî¹óåú´«Ã½Ò•îl Health News show that changes will cost at least $45.6 million combined.

“This is a pretty big payday,” said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard’s T.H. Chan School of Public Health.

The law, which grants tax breaks to the nation’s wealthiest people, requires most states to tie Medicaid coverage for some adults to having a job, and imposes other restrictions that will make it harder for people with low incomes to stay enrolled. SNAP restrictions began to take effect in 2025. Major Medicaid provisions begin later this year.

Documents prepared by consulting company Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will . Two other changes related to the state’s SNAP program will cost an additional $4.2 million, according to the documents, which for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, , a consulting company that operates the state’s eligibility system.

Optum — which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act — to evaluate and incorporate new health coverage restrictions.

Initial changes in Kentucky, which has had a contract with Deloitte since 2012, . And in Illinois, will cost at least $12 million.

A Historic Mandate

For six decades after President Lyndon Johnson created the government insurance program in 1965, Congress had never mandated that Medicaid enrollees have a job, volunteer, or go to school.

That will change next year. The tax and spending law enacted by Trump and congressional Republicans requires millions of Medicaid enrollees in 42 states and the District of Columbia to prove they’re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. The CBO projected, based on an early version of the bill, that 18.5 million adults would be subject to the new rules — .

Vermont Medicaid officials expect it will cost $5 million in fiscal 2027 to implement changes in response to the federal law, said Adaline Strumolo, deputy commissioner of the Department of Vermont Health Access. About $1.8 million is for Optum to make eligibility system adjustments. Optum is a subsidiary of UnitedHealth Group.

The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements — about a third of the state’s enrollees.

The law forced the state “to essentially drop everything else we were doing,” Strumolo said in an interview. “This is a big, big lift.”

Optum’s contract with the state was as of October.

of adult Medicaid enrollees nationally are already working, according to KFF. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they’re complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.

An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the .

In Wisconsin, state officials estimate could lose coverage after work requirements take effect. Not covering those people would in Medicaid spending for one year.

Wisconsin’s eligibility system for Medicaid and SNAP — known as CARES — in 1994, and initially was a transfer system from Florida, according to a 2016 state document.

Deloitte submitted its cost estimates for Medicaid and SNAP changes to the state in September and December. Elizabeth Goodsitt, a spokesperson for the Wisconsin Department of Health Services, declined to answer questions about whether additional changes will be needed, how much it will cost to make all eligibility system changes to comply with the new federal law, and whether the state negotiated prices with Deloitte.

Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested “very little” to help people navigate the Medicaid eligibility process, which soon will become more difficult.

“But they’re very willing to throw $6 million to their contractors to create the bells and whistles,” Peterson said. “That’s where I feel a sense of frustration.”

New Hurdles for Vets and Homeless People

Medicaid work requirements are only one change required by Trump’s tax law that will make it harder to obtain safety-net benefits.

Starting in October, the law prohibits several immigrant populations from accessing Medicaid and ACA coverage, including people who have been granted asylum, refugees, and certain survivors of domestic violence or human trafficking. Beginning Dec. 31, states must verify eligibility twice a year for millions of adults — doubling state officials’ workload. And the law restricts SNAP benefits by requiring more adult recipients to work and by removing work exemptions for veterans, homeless people, and former foster youth.

Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state’s integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year . , initial changes costing $1.6 million were labeled a “high priority” and approved on an “emergency” basis, with some of the changes to the nation’s largest food aid program going into effect almost immediately.

Officials with Kentucky’s Cabinet for Health and Family Services declined to answer a detailed list of questions, including how much it will cost to make all the modifications needed.

Deloitte spokesperson Karen Walsh said the company is working with states to implement new requirements but declined to answer questions about cost estimates in several states. “We are delivering the value and investments we committed to,” Walsh said.

In most states, government agencies rely on contractors to build and run the systems that determine eligibility for Medicaid. Many of those states also use such computer systems for SNAP. But the federal government — that is, taxpayers — to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.

“Five, 10 years ago, I’m not sure if you would hear much mention of SNAP from a Medicaid director,” Melisa Byrd, Washington, D.C.’s Medicaid director, said in November at an annual conference of Medicaid officials. “And particularly for those with integrated eligibility systems — as D.C. is —­ I’m learning more about SNAP than I ever thought.”

The federal law was the topic du jour at last year’s gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.

Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference’s corporate sponsors, emblazoned its logo on hotel escalators. Companies set up booths with materials promoting how they could help states and handed out snacks and swag.

“Conduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,” read one such handout from another contractor. “Together, we can better serve residents at every step of their health journeys.” Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to Ñî¹óåú´«Ã½Ò•îl Health News.

In handouts, Deloitte touted its role in “building a new era in state health care” and as “a national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.” Ñî¹óåú´«Ã½Ò•îl Health News found that Deloitte, a global consultancy that generated in revenue in fiscal 2025, dominates this slice of government business.

“With Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,” added another brochure. “Deloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.”

A $20.3 Million Bill in Iowa

Before Trump signed the One Big Beautiful Bill Act, Iowa lawmakers wanted to impose their own version of work requirements. They would have applied to 183,000 people before any exemptions. The new law would necessitate a change to Iowa’s Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa’s system through a .

Adding the ability to verify work status would cost up to $7 million, . By July, the cost to implement the One Big Beautiful Bill Act’s work requirements and other Medicaid provisions . Accenture’s analysis said the federal law necessitated . Making employment a condition of Medicaid benefits could cause an estimated 32,000 Iowans to lose coverage, according to a

Cutting 32,000 people from coverage in one year, a fraction of the Iowa and the federal government spend on Medicaid in a given year.

In Cedar Rapids, most of Eastern Iowa Health Center’s patients rely on Medicaid, CEO Joe Lock said. He questioned the government’s logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.

Most of the health center’s patients live at or below the federal poverty level — currently .

“There is no benefit to this population,” Lock said.

Danielle Sample, a spokesperson for Iowa’s Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state’s separate SNAP eligibility system.

In Illinois, the state’s work this year is largely focused on meeting major provisions of the One Big Beautiful Bill Act. The state estimates that as many as 360,000 residents could lose Medicaid, largely due to the work requirements, said Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services.

Kula confirmed that — priced at $12 million — is related to Trump’s law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.

The Trump administration has acknowledged that the work is coming at a cost. In January, top officials for the Centers for Medicare & Medicaid Services said government contractors, including Deloitte, Accenture, and Optum, have and reduced rates through 2028 to help states incorporate system changes.

“The companies were extremely excited to do this,” , the top CMS Medicaid official. “Everyone’s really focused on getting to work.”

CMS spokesperson Catherine Howden declined to answer questions about the discounts.

Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky’s Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.

It’s unclear what discounts, if any, Deloitte and Accenture have offered to individual states. Walsh, the Deloitte spokesperson, declined to answer detailed questions about the discounts the Trump administration announced this year. Accenture did not respond to repeated requests for comment.

Strumolo, the Vermont health official, said state officials discussed the announcement with Optum “in detail.”

Optum for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean “moving to a new system when we don’t have to.” When asked about whether the company offered discounts, Strumolo said “not explicitly.”

In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements “with a range of options to meet their unique cost and policy needs.”

He declined to specify whether Optum discounted Vermont’s rates and how it calculated the costs of doing its work. “Optum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time — supporting better outcomes for individuals covered by Medicaid,” Mason said.

Strumolo said Optum’s initial changes in Vermont cover items that take effect this year and in 2027 — Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.

“There’s a lot more that could come,” she said.

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Estaba pensando en retrasar el estudio, contó, porque este año la prima mensual del seguro de Obamacare se le triplicó a $2.460, lo que es igual a cerca de un tercio de sus ingresos.

Con un deducible de $2.700, habría tenido que pagar de su propio bolsillo la mayor parte del examen diagnóstico, un golpe económico que aseguró no poder asumir.

Galvin vive en North Kingstown, Rhode Island, y se retiró recientemente como director de una empresa de equipos médicos. “La colonoscopía me iba a costar cerca de $3.000. Así que decidí postergarla”, explicó.

También Nancy, la esposa de Galvin, está retrasando una costosa tomografía computarizada por unos años, hasta que pueda aplicar a Medicare y que el programa federal de salud cubra el costo. Medicare ofrece cobertura para todos los estadounidenses de 65 años en adelante.

Las personas con planes de la Ley de Cuidado de Salud a Bajo Precio (ACA) que están cerca de la edad de jubilación fueron de las más afectadas por los aumentos de precios luego de la suspensión de los subsidios federales mejorados, a finales de diciembre.

Quienes tenían ingresos superiores al 400% del nivel federal de pobreza para una familia de dos miembros— habían estado recibiendo ayuda para pagar los planes desde que la administración Biden amplió los subsidios durante la pandemia de covid-19. Los adultos de 50 a 64 años representaban alrededor de en ACA.

Ahora, sin esa ayuda financiera, algunas personas en este grupo de edad dicen que están pensando si no les conviene retrasar la atención médica hasta que califiquen para Medicare.

Según defensores de pacientes, médicos y expertos en políticas de salud, esta decisión no solo puede poner en riesgo la salud, sino también generar mayores costos para el sistema. Al postergar la atención médica hasta alcanzar la elegibilidad para Medicare, muchas afecciones se pueden agravar, lo que termina trasladando el gasto a los contribuyentes.

“Habrá mucha demanda acumulada y necesidades no atendidas”, dijo , consultora de políticas de salud que trabajó en las administraciones de Barack Obama y Joe Biden. “Medicare va a tener que gastar mucho dinero cubriendo y manejando esos tratamientos”.

ACA ha sido una fuente clave de cobertura médica para personas de 50 a 64 años. El acceso a los planes del Obamacare ayudó a reducir a la mitad la tasa de personas sin seguro en este sector, un grupo de defensa que representa a adultos mayores.

Esto permitió que algunas personas se jubilaran antes manteniendo cobertura. También ha servido como red de seguridad para los dueños de pequeños negocios y para quienes tienen empleos que no ofrecen seguro médico.

El otoño pasado se produjo el cierre del gobierno más largo de la historia, en medio de un intento fallido de los demócratas por extender los subsidios mejorados. Los republicanos que se opusieron a la medida argumentaron que la ayuda beneficiaba a las aseguradoras e incentivaba el fraude y la oferta de cobertura innecesaria.

El tema seguirá siendo relevante en la política, especialmente ante las elecciones de medio término de este año, incluso entre los estadounidenses mayores, que votan de manera regular, dijo el estratega republicano , quien dirige Atlas Strategy Group.

“¿El costo de la atención médica va a ser un tema? Sin duda”, dijo. “¿Los precios de la atención médica influirán? Sí”.

Incluso antes de que expiraran los subsidios, los costos de la atención médica, los hogares de adultos mayores y los medicamentos recetados eran algunas de las principales preocupaciones de salud entre las personas mayores de 50 años, según .

Los adultos de mediana edad con planes del Obamacare sienten con más fuerza el impacto de la eliminación de estos subsidios, porque primas hasta tres veces mayores que a las de 20, ya que estas últimas, por lo general, usan menos servicios médicos.

Y muchos adultos de mediana edad ya estaban inscriptos en los planes de menor costo disponibles, lo que los deja sin opciones más baratas, señaló , analista de políticas en KFF, una organización sin fines de lucro de información en salud que incluye Ñî¹óåú´«Ã½Ò•îl Health News.

“Esto es muy grave para las personas mayores inscriptas en el mercado de seguros”, dijo.

Quienes ganan apenas unos dólares por encima del 400% del nivel federal de pobreza ahora quedan fuera de los subsidios, y en algunos estados las primas promedio para este grupo .

ÌýMuchas personas están viendo aumentos anuales de miles de dólares, con primas que pueden representar hasta una cuarta parte de sus ingresos.

, médico de atención primaria e investigador de políticas de salud en la Universidad de Michigan, contó que con frecuencia sus pacientes mayores le hablan de sus esfuerzos para afrontar el pago de su atención médica. Algunos, de poco más de 60 años, probablemente abandonen la cobertura de ACA debido al aumento, dijo.

“Es una apuesta arriesgada”, opinó.

Marci Heinbaugh podría verse obligada a asumir ese riesgo. La trabajadora social de 63 años, que vive en una zona rural de Illinois, contó que su prima mensual superó el doble de su valor, pasando de unos $1.100 a $2.333, por un plan con gasto máximo de bolsillo de $10.150.

Sabía que tendría que pagar más, dijo, pero no imaginaba un aumento de esa magnitud. Después de unos meses, ya no está segura de poder mantener el plan durante el resto del año y dijo que incluso podría quedarse sin seguro. “Me da pánico siquiera pensarlo”, confesó Heinbaugh.

Las personas quieren comprar su propio seguro en el mercado y muchos adultos de mediana edad podrían pagarlo con un poco de ayuda financiera federal, dijo , vicepresidente senior de políticas públicas en AARP. Quienes abandonan la cobertura o retrasan la atención hasta cumplir 65 años pueden estar ahorrando dinero ahora, pero eso podría resultar más costoso para ellos —y para los contribuyentes— más adelante.

“Existe una probabilidad significativa de que los supuestos ahorros por reducir los subsidios a medida que las personas se acercan a la jubilación terminen convirtiéndose en mayores costos para Medicare”, señaló Weil.

Los afiliados a Medicare no están protegidos de los aumentos de costos. Por ejemplo, en enero, las primas estándar de la subieron de $185 al mes a casi $203.

Hasta que Galvin pueda inscribirse en Medicare, prevé gastar los $30.000 de su cuenta de jubilación para cubrir los pagos de primas y el deducible de su plan del mercado.

reveló que 1 de cada 5 adultos mayores de 50 años no tiene ahorros para la jubilación y que a 3 de cada 5 les preocupa no tener suficientes fondos para mantenerse.

La expiración de estos subsidios del Obamacare ejerce una presión financiera adicional sobre los estadounidenses a medida que se acercan a la jubilación, dijeron investigadores de políticas de salud.

“Están obligando a las personas a tomar decisiones imposibles”, dijo , directora de defensa federal en salud de la organización sin fines de lucro Justice in Aging.

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

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

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

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

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

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

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

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

Waiting for Medicare

John Galvin, 64North Kingstown, Rhode Island

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

— Sam Whitehead

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

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

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

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

And many middle-aged adults were already enrolled in the lowest-cost plans available, which leaves them without cheaper options to fall back on, said , a policy analyst with KFF, a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.

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

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

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

“That’s a gamble,” he added.

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

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

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

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

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

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

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

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

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

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

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Después de que Robert F. Kennedy Jr., secretario del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), despidiera a Susan Monarez, directora de los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglé), por negarse a lo que sus abogados calificaron , Newsom para ayudar a modernizar el sistema de salud pública de California.

También dio trabajo a Debra Houry, ex directora científica y médica de la agencia, quien había renunciado en protesta pocas horas después del despido de Monarez.

Newsom también se asoció con los gobernadores demócratas Tina Kotek, de Oregon; Bob Ferguson, de Washington; y Josh Green, de Hawaii para formar la , una agencia regional de salud pública.

Los gobernadores que sus recomendaciones “defenderán la integridad científica en la salud pública mientras Trump destruye” la credibilidad de los CDC. Newsom argumentó que crear la alianza independiente era vital mientras Kennedy lidera el retroceso de las recomendaciones nacionales de vacunación de la administración Trump.

Más recientemente, California se convirtió en el primer estado en de respuesta a brotes coordinada por la Organización Mundial de la Salud (OMS), seguido por Illinois y Nueva York. Colorado y Wisconsin indicaron que planean unirse.

Esto ocurrió después de que el presidente Donald Trump a Estados Unidos de la agencia, argumentando que la OMS “se ha desviado de su misión principal y ha actuado en contra de los intereses de Estados Unidos para proteger al público estadounidense en múltiples ocasiones”.

Newsom dijo que unirse al consorcio liderado por la OMS permitirá a California responder más rápido a brotes de enfermedades contagiosas y a otras amenazas a la salud pública.

Aunque otros gobernadores demócratas y líderes de salud pública han criticado abiertamente al gobierno federal, pocos han sido tan directos como Newsom, quien considera postularse a la presidencia en 2028 y está en su segundo y último mandato como gobernador.

Miembros de la comunidad científica han elogiado su esfuerzo por construir una defensa de salud pública frente a los recortes de financiamiento y la reducción de las recomendaciones de vacunas por parte del gobierno federal.

Lo que está haciendo Newsom “es una gran idea”, dijo Paul Offit, crítico de Kennedy y experto en vacunas que anteriormente formó parte del comité asesor de vacunas de la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés), pero fue removido bajo la administración Trump en 2025.

“La salud pública se ha puesto de cabeza”, dijo Offit. “Tenemos a un activista antivacunas y negador de la ciencia al frente del Departamento de Salud y Servicios Humanos. Es peligroso”.

La Casa Blanca no respondió a preguntas sobre la postura de Newsom y el HHS rechazó solicitudes para entrevistar a Kennedy.

En cambio, funcionarios federales de salud criticaron a los demócratas en general y argumentaron que los estados gobernados por demócratas están participando en fraude y mala administración de fondos federales en programas de salud pública.

Emily Hilliard, vocera del HHS, dijo que la administración está actuando contra “estados gobernados por demócratas que impulsaron confinamientos sin base científica, mandatos de máscaras para niños pequeños y estrictas tarjetas de vacunación durante la era del covid”. Señaló que esas medidas “han erosionado completamente la confianza del pueblo estadounidense en las agencias de salud pública”.

Salud pública guiada por la ciencia

Desde que Trump regresó al poder, Newsom ha criticado al presidente y a su administración por impulsar políticas que considera una amenaza para la salud y la seguridad públicas. Ha calificado a los líderes federales como “extremistas” que intentan “usar los CDC como arma y difundir desinformación”.

También a funcionarios federales por vincular erróneamente a las vacunas con el autismo y que la administración está poniendo en peligro la vida de bebés y niños pequeños al reducir las recomendaciones de vacunas infantiles. Además, argumentó que la Casa Blanca está generando “caos” en el sistema de salud pública de Estados Unidos al retirarse de la OMS.

El gobernador rechazó una solicitud de entrevista. Marissa Saldivar, vocera de Newsom, dijo que es una prioridad del gobernador “proteger la salud pública y brindar a las comunidades orientación basada en ciencia y evidencia, no en política ni conspiraciones”.

Las acciones de la administración Trump han generado incertidumbre financiera que, según funcionarios locales, ha reducido la moral dentro de los departamentos de salud pública y ha dejado a los estados menos preparados para brotes de enfermedades y .

El año pasado, la Casa Blanca propuso recortar el gasto del HHS en , incluidos . En enero, el Congreso rechazó en gran medida esos recortes, aunque para programas centrados en determinantes sociales de la salud, como el acceso a alimentos, vivienda y educación.

La administración Trump anunció que retiraría en fondos de salud pública de California, Colorado, Illinois y Minnesota, argumentando que los estados liderados por demócratas financiaban iniciativas “woke” que no reflejaban las prioridades de la Casa Blanca.

En cuestión de días, y un juez el recorte.

“De repente siguen cancelando subvenciones y luego se revierte en los tribunales”, dijo Kat DeBurgh, directora ejecutiva de la Asociación de Oficiales de Salud de California. “Gran parte del daño ya está hecho porque los condados ya dejaron de hacer el trabajo”.

Según un análisis de 2025 de KFF, una organización sin fines de lucro de información sobre salud que incluye a Ñî¹óåú´«Ã½Ò•îl Health News, el financiamiento federal representa de los presupuestos de los departamentos de salud estatales y locales en todo el país. Ese dinero se destina a combatir el VIH y otras infecciones de transmisión sexual, prevenir enfermedades crónicas y fortalecer la preparación en salud pública y la respuesta a enfermedades contagiosas.

Los fondos federales representan $2.400 millones del presupuesto de salud pública de $5.300 millones de California, lo que dificulta que Newsom y los legisladores estatales compensen posibles recortes. Ese dinero ayuda a financiar operaciones estatales y es vital para los departamentos de salud locales.

Los recortes afectan a todos

Barbara Ferrer, directora de salud pública del condado de Los Ángeles, dijo que si el gobierno federal logra recortar esos $600 millones, el condado —con casi 10 millones de residentes— perdería unos $84 millones en los próximos dos años, además de otras subvenciones para la prevención del VIH y otras infecciones de transmisión sexual.

Ferrer señaló que el condado depende de casi $1.000 millones en financiamiento federal al año para rastrear y prevenir enfermedades contagiosas y combatir problemas crónicos de salud, incluidos la hipertensión y la diabetes. El condado el cierre de que ofrecían vacunación y pruebas de enfermedades, en gran parte por pérdidas de financiamiento relacionadas con recortes a subvenciones federales.

“Es una estrategia mal informada”, dijo Ferrer. “La salud pública no se preocupa por si tu afiliación política es republicana o demócrata. No se preocupa por tu estatus migratorio ni por tu orientación sexual. La salud pública tiene que estar disponible para todos”.

Un solo caso de sarampión requiere que los trabajadores de salud pública rastreen a unas 200 personas que pudieron haber estado en contacto con el paciente, dijo Ferrer.

Estados Unidos , pero está cerca de perder ese estatus debido al escepticismo sobre las vacunas y a la desinformación difundida por sus críticos. El año pasado hubo , la mayor cifra desde 1991, con un 93% en personas no vacunadas o cuyo estado de vacunación era desconocido.

Este año, la enfermedad altamente contagiosa se ha reportado en , y en .

Funcionarios de salud pública esperan que la West Coast Health Alliance ayude a contrarrestar las políticas de Trump al generar confianza mediante recomendaciones de salud pública basadas en evidencia.

“Lo que estamos viendo del gobierno federal son políticas partidistas en su peor forma y represalias por diferencias sobre políticas públicas; esto pone en un riesgo extraordinario la salud y el bienestar del pueblo estadounidense”, dijo Georges Benjamin, director ejecutivo de la Asociación Estadounidense de Salud Pública (APHA, por sus siglas en inglés), una coalición de profesionales de salud pública.

Un calendario de vacunación más sólido

Erica Pan, principal funcionaria de salud pública de California y directora del Departamento de Salud Pública de California, dijo que la West Coast Health Alliance está defendiendo la ciencia al recomendar un calendario de vacunación más sólido que el del gobierno federal.

California forma parte de una coalición que por su decisión de retirar las recomendaciones de siete vacunas infantiles, incluidas las de la hepatitis A, la hepatitis B, la influenza y covid-19.

Pan expresó una profunda preocupación por la situación de la salud pública, especialmente por el aumento de casos de sarampión.

“Estamos retrocediendo”, dijo Pan sobre las inmunizaciones.

Sarah Kemble, epidemióloga estatal de Hawaii, dijo que el estado se unió a la alianza después de escuchar a residentes que apoyan las vacunas y quieren tener la seguridad de que seguirán teniendo acceso a ellas.

“Recibíamos muchas preguntas de personas con ansiedad que sí entendían las recomendaciones basadas en la ciencia, pero se preguntaban: ‘¿Todavía voy a poder ir a ponerme mi vacuna?’”, dijo Kemble.

Otros estados liderados principalmente por demócratas también han formado alianzas. Pennsylvania, Nueva York, Nueva Jersey, Massachusetts y varios otros estados de la costa este se unieron para crear el .

Hilliard, del HHS, dijo que aunque los gobernadores demócratas establezcan coaliciones asesoras sobre vacunas, el Comité Asesor sobre Prácticas de Inmunización federal “sigue siendo el organismo científico que guía las recomendaciones de vacunación en este país, y el HHS garantizará que la política se base en evidencia rigurosa y ciencia de alto nivel, no en la política fallida de la pandemia”.

Influencia en estados republicanos

Por su parte, Newsom aprobó una asignación anual recurrente de casi $300 millones para apoyar al Departamento de Salud Pública de California, así como a las 61 agencias locales de salud pública en el estado. El año pasado también que autoriza al estado a emitir sus propias recomendaciones de inmunización.

La ley exige que las aseguradoras de salud en California cubran las vacunas recomendadas por el estado, incluso si el gobierno federal no las recomienda.

Jeffrey Singer, doctor y investigador principal del Cato Institute, un centro de pensamiento libertario, dijo que la descentralización puede ser beneficiosa. Esto se debe a que las campañas informativas locales que reflejan distintas ideologías políticas y prioridades comunitarias pueden tener más posibilidades de influir en el público.

Un análisis de KFF encontró que algunos estados republicanos se están sumando a estados demócratas para desvincular sus recomendaciones de vacunación del gobierno federal. Singer dijo que doctores en su estado natal de Arizona están mirando a California, más liberal, para guiarse sobre consejos de vacunación.

“La ciencia nunca está completamente establecida y hay muchas áreas de este país donde existen diferencias de opinión”, dijo Singer. “Esto puede ayudarnos a cuestionar nuestras suposiciones y aprender”.

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After Health and Human Services Secretary Robert F. Kennedy Jr. fired Centers for Disease Control and Prevention Director Susan Monarez for refusing what her lawyers called “,” Newsom to help modernize California’s public health system. He also gave a job to Debra Houry, the agency’s former chief science and medical officer, who had resigned in protest hours after Monarez’s firing.

Newsom also teamed up with fellow Democratic governors Tina Kotek of Oregon, Bob Ferguson of Washington, and Josh Green of Hawaii to form the , a regional public health agency, whose guidance would “uphold scientific integrity in public health as Trump destroys” the CDC’s credibility. Newsom argued establishing the independent alliance was vital as Kennedy leads the Trump administration’s rollback of national vaccine recommendations.

More recently, California became the a global outbreak response network coordinated by the World Health Organization, followed by Illinois and New York. Colorado and Wisconsin signaled they plan to join. They did so after President Donald Trump officially from the agency on the grounds that it had “strayed from its core mission and has acted contrary to the U.S. interests in protecting the U.S. public on multiple occasions.” Newsom said joining the WHO-led consortium would enable California to respond faster to communicable disease outbreaks and other public health threats.

Although other Democratic governors and public health leaders have openly criticized the federal government, few have been as outspoken as Newsom, who is considering a run for president in 2028 and is in his second and final term as governor. Members of the scientific community have praised his effort to build a public health bulwark against the Trump administration’s slashing of funding and scaling back of vaccine recommendations.

What Newsom is doing “is a great idea,” said Paul Offit, an outspoken critic of Kennedy and a vaccine expert who formerly served on the Food and Drug Administration’s vaccine advisory committee but was removed under Trump in 2025.

“Public health has been turned on its head,” Offit said. “We have an anti-vaccine activist and science denialist as the head of U.S. Health and Human Services. It’s dangerous.”

The White House did not respond to questions about Newsom’s stance and HHS declined requests to interview Kennedy. Instead, federal health officials criticized Democrats broadly, arguing that blue states are participating in fraud and mismanagement of federal funds in public health programs.

HHS spokesperson Emily Hilliard said the administration is going after “Democrat-run states that pushed unscientific lockdowns, toddler mask mandates, and draconian vaccine passports during the covid era.” She said those moves have “completely eroded the American people’s trust in public health agencies.”

Public Health Guided by Science

Since Trump returned to office, Newsom has criticized the president and his administration for engineering policies that he sees as an affront to public health and safety, labeling federal leaders as “extremists” trying to “weaponize the CDC and spread misinformation.” He has for erroneously linking vaccines to autism, the administration is endangering the lives of infants and young children in scaling back childhood vaccine recommendations. And he argued that the White House is unleashing “chaos” on America’s public health system in backing out of the WHO.

The governor declined an interview request. Newsom spokesperson Marissa Saldivar said it’s a priority of the governor “to protect public health and provide communities with guidance rooted in science and evidence, not politics and conspiracies.”

The Trump administration’s moves have triggered financial uncertainty that local officials said has reduced morale within public health departments and left states unprepared for disease outbreaks and . The White House last year proposed cutting HHS spending , including . Congress largely rejected those cuts last month, although funding for programs focusing on social drivers of health, such as access to food, housing, and education, .

The Trump administration announced that it would claw back in public health funds from California, Colorado, Illinois, and Minnesota, arguing that the Democratic-led states were funding “woke” initiatives that didn’t reflect White House priorities. Within days, and a judge the cut.

“They keep suddenly canceling grants and then it gets overturned in court,” said Kat DeBurgh, executive director of the Health Officers Association of California. “A lot of the damage is already done because counties already stopped doing the work.”

Federal funding has accounted for of state and local health department budgets nationwide, with money going toward fighting HIV and other sexually transmitted infections, preventing chronic diseases, and boosting public health preparedness and communicable disease response, according to a 2025 analysis by KFF, a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.

Federal funds account for $2.4 billion of California’s $5.3 billion public health budget, making it difficult for Newsom and state lawmakers to backfill potential cuts. That money helps fund state operations and is vital for local health departments.

Funding Cuts Hurt All

Los Angeles County public health director Barbara Ferrer said if the federal government is allowed to cut that $600 million, the county of nearly 10 million residents would lose an estimated $84 million over the next two years, in addition to other grants for prevention of HIV and other sexually transmitted infections. Ferrer said the county depends on nearly $1 billion in federal funding annually to track and prevent communicable diseases and combat chronic health conditions, including diabetes and high blood pressure. Already, the the closure of that provided vaccinations and disease testing, largely because of funding losses tied to federal grant cuts.

“It’s an ill-informed strategy,” Ferrer said. “Public health doesn’t care whether your political affiliation is Republican or Democrat. It doesn’t care about your immigration status or sexual orientation. Public health has to be available for everyone.”

A single case of measles requires public health workers to track down 200 potential contacts, Ferrer said.

The U.S. but is close to losing that status as a result of vaccine skepticism and misinformation spread by vaccine critics. The U.S. had , the most since 1991, with 93% in people who were unvaccinated or whose vaccination status was unknown. This year, the highly contagious disease has been reported at , , and .

Public health officials hope the West Coast Health Alliance can help counteract Trump by building trust through evidence-based public health guidance.

“What we’re seeing from the federal government is partisan politics at its worst and retaliation for policy differences, and it puts at extraordinary risk the health and well-being of the American people,” said Georges Benjamin, executive director of the American Public Health Association, a coalition of public health professionals.

Robust Vaccine Schedule

Erica Pan, California’s top public health officer and director of the state Department of Public Health, said the West Coast Health Alliance is defending science by recommending a vaccine schedule than the federal government. California is part of a coalition over its decision to rescind recommendations for seven childhood vaccines, including for hepatitis A, hepatitis B, influenza, and covid-19.

Pan expressed deep concern about the state of public health, particularly the uptick in measles. “We’re sliding backwards,” Pan said of immunizations.

Sarah Kemble, Hawaii’s state epidemiologist, said Hawaii joined the alliance after hearing from pro-vaccine residents who wanted assurance that they would have access to vaccines.

“We were getting a lot of questions and anxiety from people who did understand science-based recommendations but were wondering, ‘Am I still going to be able to go get my shot?’” Kemble said.

Other states led mostly by Democrats have also formed alliances, with Pennsylvania, New York, New Jersey, Massachusetts, and several other East Coast states banding together to create the .

HHS’ Hilliard said that even as Democratic governors establish vaccine advisory coalitions, the federal “remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and gold standard science, not the failed politics of the pandemic.”

Influencing Red States

Newsom, for his part, has approved a recurring annual infusion of nearly $300 million to support the state Department of Public Health, as well as the 61 local public health agencies across California, and last year authorizing the state to issue its own immunization guidance. It requires health insurers in California to provide patient coverage for vaccinations the state recommends even if the federal government doesn’t.

Jeffrey Singer, a doctor and senior fellow at the libertarian Cato Institute, said decentralization can be beneficial. That’s because local media campaigns that reflect different political ideologies and community priorities may have a better chance of influencing the public.

A KFF analysis found some red states are joining blue states in decoupling their vaccine recommendations from the federal government’s. Singer said some doctors in his home state of Arizona are looking to more liberal California for vaccine recommendations.

“Science is never settled, and there are a lot of areas of this country where there are differences of opinion,” Singer said. “This can help us challenge our assumptions and learn.”

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When federal immigration agents descended on their city, officers deported Gabi’s father and detained her aunt.

Gabi was born in the U.S. and is an American citizen. Her best chance to stand, or even walk, someday is a complex surgery on her legs and feet that was scheduled for January. But her mother, too terrified to take out the garbage let alone venture through the city to a hospital, canceled the procedure. Ñî¹óåú´«Ã½Ò•îl Health News agreed to only partially identify the patients and their families in this article because they fear becoming targets of President Donald Trump’s immigration crackdown.

“I want more than anything for my baby to walk,” her mother said in Spanish, as Gabi cooed and wriggled in her arms, a feeding tube snaking from her stomach to an IV pole. “But with the situation that’s happening, I canceled the surgery and all the physical therapy appointments” that would have followed. “Because I’m afraid to leave.”

The Department of Homeland Security has declared an end to what it called Operation Metro Surge, carried out by officers with the Immigration and Customs Enforcement and Customs and Border Protection agencies. Even so, health care workers say, immigration agents are still camping out in hospital parking lots. And drones fly overhead in agricultural areas beyond Minneapolis, where Somali and Latino immigrants have settled in recent years.

The Minnesota crackdown revealed the sweep of the surveillance and capture system the Trump administration is using to uproot immigrant communities in the United States, and the effect of its powerful brake on the medical system.

Similar health crises surfaced wherever immigration officers massed in the past year. In Dallas, public health clinics administered about 6,000 vaccinations to Latinos last August, half as many as during a similar program a year earlier. In Chicago, doctors rerouted patients daily from clinic to clinic depending on ICE activity. Across the country, crackdowns suppressed immigrants’ health care visits.

In Minnesota, medical systems have reported cancellation and no-show rates of up to 60% since December.

Tricia McLaughlin, a spokesperson for the Department of Homeland Security, blamed protesters for the disruption. “If anyone is impeding Americans from making appointments or picking up prescriptions,” she said, “its [sic] violent agitators who are blocking roadways, ramming vehicles, and vandalizing property.”

While Minnesotans rose up to oppose the surge in the streets, doctors and nurses have quietly operated informal, underground medical networks, dodging detection to care for patients at home.

“I used to look somebody in the eyes and say, with good faith, ‘You will be fine at the hospital,’” said Emily Carroll, a nurse practitioner at HealthFinders Collaborative, a community clinic in Faribault, some 50 miles south of Minneapolis. “But now, I can’t make that guarantee.”

As thousands of federal agents move on from Minneapolis, other communities need to prepare, said Minnesota Democratic state Sen. Alice Mann, a physician.

“I know it sounds crazy,” she said, but health care providers “need to start an underground network of how to get people care in their homes. Because letting people die at home or come close to death because they are terrified to go into the hospital, in 2026, is outrageous.”

The Surge Delivers Harm

Home visits, clinicians say, may be the only way to reach those who still feel under siege. In Los Angeles, starting last June, St. John’s Community Health brought medical care to some 2,000 immigrant families too frightened to leave home during an immigration sweep after the clinic’s no-show rates ballooned to more than 30%, said Jim Mangia, the organization’s president.

Many of Minnesota’s large health institutions have relied on telemedicine and only dabbled in home care.

Not Munira Maalimisaq, co-founder of Inspire Change Clinic in Minneapolis’ Ventura Village neighborhood. After about one-third of her patients stopped showing up for appointments, “I was like, ‘We have to do something,’” the nurse practitioner said. So she called a physician friend. What if they just started seeing patients at home?

“And she’s like, ‘You know what? Let’s do it.’”

They now have about 150 doctors — a volunteer “rapid response” team that has made more than 135 home visits. The first call was a woman whose husband had been deported. She was home with her children, was 39 weeks pregnant, and was in labor. Maalimisaq called an obstetrician volunteer, and they rushed to the patient’s house.

“She was 8 centimeters dilated,” Maalimisaq said, “and did not want us to call an ambulance. She says, ‘Can I have the baby here?’”

The woman was not a good candidate for a home birth, Maalimisaq said. They persuaded her to ride to the hospital in Maalimisaq’s car, a “small Tesla, white seats. Everything that could go wrong was there.”

But they made it to the hospital in time, and the woman had a safe, healthy delivery. “If we were not there, I can only imagine what would have happened.”

Maalimisaq’s caregiving follows a Hippocratic logic: “Someone was in need. I cannot just do nothing. And we cannot call an ambulance against her will and have her shoved in there. We had no choice but to do something, and that was the only thing that we could do safely.”

In other visits, she has seen “people so stressed out they pulled the hair out of their skull.” She said she met a mother who’d been rationing her child’s seizure medicine despite the child having experienced “one seizure after another.”

The Trump administration says its Minnesota operation improved public safety. “Since Operation Metro Surge began, our brave DHS law enforcement have arrested over 4,000 criminal illegal aliens including vicious murderers, rapists, child pedophiles and incredibly dangerous individuals,” according to McLaughlin, the DHS spokesperson. DHS announced last month that McLaughlin was leaving her post.

Minnesota correctional officials say many people accused of crimes were released directly to ICE by state or county prisons and jails. And of people arrested by ICE nationwide in January had criminal convictions, according to DHS data. Far fewer were convicted of violent crimes.

Agents Outside Hospitals, Clinics

On the first day of his second term, President Donald Trump rescinded a 2011 policy that prohibited immigration enforcement in “sensitive locations” such as schools, hospitals, and churches.

In Northfield, about 45 miles south of Minneapolis, ICE agents have been sitting in their cars for hours at least twice a week outside health clinics, including one run by the local hospital, said Carroll, the nurse practitioner. Agents have made arrests in the area almost every day, Carroll and her colleagues said.

“ICE does not conduct enforcement at hospitals — period,” McLaughlin said.

One recent morning, three ICE vehicles sat in a Baptist church parking lot across the street from an elementary school in Northfield as volunteers ferried 35 children of immigrants back and forth to the school so their parents could avoid going out, Carroll said.

“ICE is not going to schools to arrest children — we are protecting children,” McLaughlin said.

Drones that Carroll and others believe are operated by immigration agents hover most nights, and sometimes during the day, over a trailer park that mostly houses immigrants who have moved to the area to work in agriculture and manufacturing over the past 15 years. Families paper over trailer windows, Carroll said.

“You cannot feel safe anywhere,” she said. “On the way to school, on the way to clinic, you might pass ICE. The sort of crushing fear and feeling of being trapped that these families are going through is outrageous.”

That fear means patients with diabetes and heart disease are missing blood sugar and blood thinner tests. Patients aren’t getting exercise, and the chronically ill are getting sicker, said Calla Brown, a Minneapolis pediatrician.

At the Faribault clinic where Carroll works, staff members deliver medicine, food, and other necessities to patients. A staffer drives 12 middle and high school kids to and from class every day in a clinic van.

Some patients are treated at home. Carroll recently diagnosed a baby with influenza, telling the parents it wasn’t an immediate threat — yet.

“‘If you see the baby struggling to breathe, if the baby’s not eating, if the baby isn’t making wet diapers, you have to go to the hospital,’” Carroll said she told them. “‘I cannot promise it’s safe. But you’ve got to go.’”

‘We’re Nice to Each Other’

In Minneapolis, nurse-midwife Fernanda Honebrink spends most of her daylight hours calling, coordinating, and shuttling between a ballooning group of fearful people stuck in their homes. She prefers not to call it a medical underground.

“It’s more like, that’s how we function in Minnesota,” said Honebrink, a U.S. citizen who emigrated from Ecuador 23 years ago. “We’re nice to each other.”

Honebrink spent a recent afternoon at the home of a family with a baby boy. His parents, Alex and Isa, desperately want him to receive vaccinations and blood tests at his one-year well-child appointment.

But they haven’t left their apartment for more than a month. “You don’t know what is most important: whether to go out for his well-being, or to go out and think that you might not come back,” Alex said.

The couple, who were interviewed in Spanish, entered the U.S. legally from Venezuela in 2024 under a program called Humanitarian Parole, which Trump ended in May. Since then, federal agents have detained and deported workers at a company where Alex, a mechanical engineer by training, worked in construction.

Alex and Isa have seen government vehicles outside their home. They knew of a man, they said, who had legitimate work papers but was picked up while walking to church one Sunday, flown to Texas, then put on a plane to Venezuela. It was a terrifying prospect for those who’ve fled that country’s dictatorship and economic chaos.

“It feels like a psychological attack,” Alex said. “The possibility of being separated from your family.”

Isa, a lawyer back in Venezuela, has endured postpartum depression, cooped up for weeks in their apartment. The state program that provided health insurance to all immigrants ended Jan. 1. A therapist checks in occasionally by phone, free of charge.

She has tried to keep the family afloat by selling homemade cakes and necklaces, and babysitting.

Her worst fear is being separated from her son, who was born in the U.S. and is a citizen. The possibility hadn’t occurred to her until an acquaintance urged her to to designate someone to have temporary custody if she were deported.

“It was something I never imagined,” said Isa, who sobbed as she recalled the moment. “He’s my baby! He’s not someone else’s! What? My baby would remain here with someone?’’

Honebrink suddenly piped up: “I will guarantee him. I’ll sign the form.”

She later told a reporter, “I told my husband I wouldn’t do that. I’ve already signed as a sponsor for four kids.”

As soon as she left the apartment, Honebrink jumped back on the phone and traded favors with local pediatricians, clinic schedulers, and volunteers. Within hours, she’d set up a new well-child visit for the baby and found a vetted driver to transport the family.

“A white person,” Honebrink explained.

Two days later, Honebrink sent a picture of her small victory: Alex and Isa’s baby boy with a Band-Aid on his legs. “He got his vaccines,” she said via text. “I’m so happy.”

But other medical needs cannot be as swiftly addressed. One February evening, Honebrink greeted Gabi and her mother with a trunk full of donated baby wipes, diapers, and toys.

Gabi’s surgery is rescheduled for August. Her mother said she hoped by then it would be safe to leave home.

“I used to take the kids to the park, but now we don’t leave at all,” she said. “They grab people, they mistreat them. How I wish it would end soon!”

Ñî¹óåú´«Ã½Ò•îl Health News’ Jackie Fortiér contributed to this report.

Ñî¹óåú´«Ã½Ò•îl 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 .

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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 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”, 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 , un relevamiento Ìýde 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 de KFF mostró un descontento generalizado en temas como la autorización previa.

En los últimos años, y 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 .

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 , 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 Ñî¹óåú´«Ã½Ò•îl 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”.

Ñî¹óåú´«Ã½Ò•îl 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 .

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