Who Really Collects in the Wage Garnishment Game?

I was a consumer bankruptcy attorney for years during the global financial crisis of 2008 (pre-Affordable Care Act). Around 40% of the bankruptcies were caused by medical debts uncovered by insurance. With the effectiveness of the ACA, the number of bankruptcies in Colorado plummeted.

My comment on “State Lawmakers Seek Restraints on Wage Garnishment for Medical Debt” (Feb. 20)? BC Services acts as if it is garnishing these wages to keep rural hospitals, medical providers, etc. in business. The likely reality is that BC Services (and other collection operations) takes “90-day-overdue” bills — which may or may not have ever been delivered to the patient; usually disregards whether the hospital has offered the patient a reasonable repayment schedule; and then keeps 50% or more of the debt, along with its attorneys’ fees and costs. The medical provider receives very little of the money sent to collections.

— Bill Myers, Denver

On Work Requirements: Working Out Solutions

Eighty hours a month works out to about 20 hours a week, and I think if people can work or study from home, they should be able to meet the requirements (“New Medicaid Work Rules Likely To Hit Middle-Aged Adults Hard,” Feb. 11). More importantly, though, “navigators” will help people get exemptions if they qualify. I wonder why there is so much moaning about the law and nothing about the means to fix the problems it creates. It seems like a lot of hot air. We know it’s a problem. So how about exploring solutions?

— Therese Shellabarger, North Hollywood, California

The Flip Side of a Drug’s Benefits

I read Phillip Reese’s report on anti-anxiety medications, adults who take them, and their concerns about this administration’s policies regarding them (“As More Americans Embrace Anxiety Treatment, MAHA Derides Medications,” Feb. 23). If the anti-anxiety medications provide solace to adults such as Sadia Zapp — a 40-year-old woman who survived cancer — then she should be able to continue them. Unfortunately, the same is not true for many other people, particularly patients such as myself.

When I was 16, I went through an unnecessarily painful and traumatic year. I was sent away from home three times, sent to a wilderness therapy “troubled teen industry” camp that has now been shut down, sent to a new boarding school that I hated, and was away from my family for many months. Of course, I felt depressed and anxious, so my psychiatrist at Kaiser prescribed citalopram. At first, it caused extreme agitation and violent ideation, stuff that is commonly reported to the point it has an . Thankfully, it calmed down. And when I lowered the dose, my life was calm, stable, and productive.

Unfortunately, that did not last long. Over time, the effects wore out, so I tried to go off. I was not given any safety instructions on how to taper slowly and safely, so I went off multiple times. Each time caused extreme withdrawal symptoms, including self-harm, crying spells, and worse depression than ever before. Also, the sexual “side effects” persisted and even worsened upon cessation to this day. It is a , and it is very rarely covered. While the worst symptoms of withdrawal went away, I still live with a worsened sexuality than a young adult my age is supposed to have.

Back to the article, which seems to focus on adults. Its only named profile is Zapp, and when it cites statistics, it begins at age 18. Solely showing statistics of adults is unethical because it obscures the high and rising prescription rates among minors. Minors are also more likely to suffer permanent developmental damage to their sexualities and experience suicidal ideation. This is a major problem that warrants further conversations.

When covering the downsides of SSRIs, the article mentioned only mild side effects, like upset stomach, decreased libido, and mild discontinuation effects, without covering the major concerns of suicidal ideation, akathisia, PSSD, and severe withdrawal. I believe that framing antidepressants as an unequivocal good is equivalent to framing them as an unequivocal evil; both misguide patients through harm and deception.

Lastly, I want to finish on this by the brilliant psychiatrist Awais Aftab.

— Eli Malakoff, San Francisco

A Rigged System?

Insurers pay these exorbitant amounts because they set them in the first place (Bill of the Month: “Even Patients Are Shocked by the Prices Their Insurers Will Pay — And It Costs All of Us,” March 3). They have been doing this for years. I learned this over 15 years ago, when I dislocated and broke my elbow. I had no insurance and, as a “self-pay” patient, paid the surgeon, hospital, and radiology center myself. They set the prices high enough that people will buy insurance out of fear, ensuring they make a profit.

The first thing I learned was that there is not a set price for all; for the insured, it is a fixed system controlled by contracts and codes. As a self-pay patient, the cost may vary.

It was late in the evening and I tripped over a snow shovel, slammed my arm up against a gate post, and it was hanging like a puppet without a string! I called an ambulance and, at the hospital, they strapped me up and told me that I must see the orthopedic surgeon the next day. He sent me to a radiology facility for an X-ray; I paid for it and took it to the surgeon. When I received a bill from the radiology center, I called to say that I had paid. They said it was for the radiologist (who, as far as I knew, never analyzed it). The contract with the insurance company required that every patient had to be billed, whether or not a radiologist reviewed scans. If not, they would lose their contract.

My elbow was dislocated, with a fracture, and I needed surgery. The surgeon’s office called the hospital for pricing, and he told me it would be about $2,000 for outpatient surgery. I called the hospital to confirm the appointment for outpatient surgery, and they wanted $8,000! When I objected, and told them what the surgeon had quoted, they checked. “Oh, you are a self-pay!” Cost would be $2,000. I gave them my card number and prepaid it before they could change their minds.

I had a friend in New Jersey who had the very same injury and surgery. She had insurance through her employer, and she paid more in copays than I paid when paying directly.

Insurance companies are SHARKS!

— Stephanie Hunt-Crowley, Chamberet, Nouvelle Aquitaine, France (formerly Frederick, Maryland)

US vs. Canada

Re: the article about nurses moving to Canada (“‘You Aren’t Trapped’: Hundreds of US Nurses Choose Canada Over Trump’s America,” Feb. 26). You neglect the “rest of the story” — or maybe you don’t know it? I had my medical office in Los Angeles for about 30 years and had dozens of Canadians come to L.A., where some had to self-pay for care, but chose to because of the superior level of medicine available. One man, a son of a gynecologist in Canada, had a draining abscess from a years-old appendectomy. The reason was, after investigation, that the Canadian practice had used silk suture (organic material), which can harbor microbes and carry a greater risk of infection. The trend has been to discontinue silk in favor of nylon. The Canadians were obliged to “use up” the silk suture they had before switching to nylon. The surgeons at my hospital were astounded.

— Kathryn Sobieski, Jackson, Wyoming

On the NET Recovery Device’s Track Record — And Detractors

I read your piece about the NET Recovery device with interest (Payback: Tracking Opioid Cash: “Maker of Device To Treat Addiction Withdrawal Seeks Counties’ Opioid Settlement Cash,” March 18), and I am grateful to you for pointing to one of our many success stories — the story of Michelle Warfield, whom the NET device helped get off opioids.

I also wanted to note a couple of instances where I see the facts differently than they were portrayed in your piece. Your piece seemed to imply that the NET device is new, and I wanted to note that the device has been around for decades (it helped Eric Clapton and members of The Who and the Rolling Stones get sober back in their heyday), and is based on a proven technology that stimulates both the brain and the vagus nerve to help patients with their cravings and withdrawal. There are countless studies that prove the power of neurostimulation, including that showed significant reductions in opioid and stimulant use without medication for a polysubstance population receiving at least 24 hours of stimulation.

I also noted you quoted detractors of our device, and I’d simply urge anyone looking at the issue of opioid addiction abatement to consider who those detractors are; organizations that now find themselves competing for grant dollars from counties increasingly choosing to fund innovation. It is not surprising that those with the most to lose financially would prefer the status quo. But the counties and jails leading this charge are doing so because they have seen what works, and their constituents, real patients, are the proof.

The success stories of our patients speak for themselves, and our only motivation at NET Recovery is to help as many people as possible get truly clean and sober by helping to break that initial grip the opioids have on them. When the NET device works, and it works an astounding 98% of the time (producing a clinically meaningful reduction in opioid withdrawal symptom severity in one hour), our patients are experiencing the return of choice and true freedom.

Thank you for your interest in our work and for the coverage you provide.

— Joe Winston, NET Recovery CEO, Costa Mesa, California

Education Is the First Step in Lowering Health Care Prices

After reading this article about making hospital prices more transparent, I realized the information alone could help drive medical prices down (“Trump Required Hospitals To Post Their Prices for Patients. Mostly It’s the Industry Using the Data,” Feb. 17). Your publication shows good use of evidence-based research — it’s timeless and informative.

As a student at Thomas Jefferson University on the path to serving in the health care arena, I understand the struggles and complexities of medical decision-making. In the medical setting, the topic of price is always overshadowed by patient care and clear communication on the part of both professionals and patients, and it does not reflect how patients would navigate comparison-shopping for care. Almost every patient relies on the help of a physician or gets help from an insurance network and not from online price matching.

I believe that many people should engage with this article even if they aren’t entering the health profession; it would benefit everyone. Although price transparency may help insurers and care providers more than patients, if their goal is to lower prices, they must look beyond the simple posting or sharing of prices. I appreciate the effort to try to bring awareness to this major issue and encourage thoughtful policy discussion about lowering medical prices.

— Jan Rodriguez, Philadelphia

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

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

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

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

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

Here’s what to know.

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

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

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

Mental Health Matters, Too

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

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

Work With a Doctor To Closely Monitor Your Dosage

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

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

People and Policy

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

Katherine Ruppelt at Nashville Public Radio contributed to this report.

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

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

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

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

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

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

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

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

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

Then the bill came.

The Medical Service

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

The Bill

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Resolution

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

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

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

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

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

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

The Takeaway

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

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

Patients with public insurance, such as Medicare and Medicaid, are not permitted to use the cards, because the government considers them �����Ի�����that dissects and explains medical bills.��Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share?��Tell us about it!

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“Every little ache, like my knee hurts,” she said, made her worry that “this is the end of the road for me.”

So Zapp, a 40-year-old communications director in New York, became one of millions of Americans to start taking an anxiety medication in recent years. For her, it was the serotonin-boosting drug Lexapro.

“I love it. It’s been great,” she said. “It’s really helped me manage.”

The proportion of American adults who took anxiety medications jumped from 11.7% in 2019 to 14.3% in 2024, with most of the increase occurring during the covid pandemic, according to from the Centers for Disease Control and Prevention. That’s 8 million more people, bringing the total to roughly 38 million, with sharp increases among young adults, people with a college degree, and adults who identify as LGBTQ+.

Even as psychiatric medications gain public acceptance and become easier to access through telehealth appointments, the rise of a class of antidepressants called selective serotonin reuptake inhibitors, known as SSRIs, has triggered a backlash from supporters of the “Make America Healthy Again” movement who argue they are harmful. Doctors and researchers say medications such as Prozac, Zoloft, and Lexapro are front-line treatments for many anxiety disorders, including generalized anxiety disorder and panic disorder, and are being misrepresented as addictive and broadly harmful even though they’ve been proved safe for extended use.

Health and Human Services Secretary Robert F. Kennedy Jr. has decried broadening SSRI use. During his Jan. 29 confirmation hearing, he said he knows people, including family members, who had a than people have quitting heroin. More recently, he a possible link between the use of SSRIs and other psychiatric medications and violent behavior like school shootings.

Food and Drug Administration Commissioner Marty Makary that SSRI use among pregnant women could lead to poor birth outcomes.

SSRIs’ common side effects include . Some SSRIs also and cause other sexual side effects.

For many people, however, the side effects are mild and tolerable and the benefits of treating chronic anxiety are worth it, said , president of the Southern California Psychiatric Society. “The statements about SSRIs were just not grounded in any sort of evidence or fact,” Kelly said of Kennedy’s comments.

A showed that over half of people with generalized anxiety disorder taking an SSRI saw their anxiety symptoms reduced by at least 50%. Side effects prompted about 1 in 12 to stop taking an SSRI.

“When it’s being done right and when you’re also using appropriate therapy techniques, SSRIs can be really, really helpful,” said , a psychiatrist who practices in Los Angeles.

MAHA Blames Anxiety on Poor Diet, Lack of Exercise

Supporters of MAHA have partly blamed poor dietary choices and the increase of a sedentary lifestyle for the rise of a number of health problems, including anxiety, depression, and other mental health disorders. As a remedy, they have called for measures such as reducing consumption of ultraprocessed foods, which to depression and anxiety, and cutting back on screen time in favor of exercise.

Psychiatrists often encourage a and exercise as an for . Wood said those who can manage anxiety without medication should also consider talk therapy. The proportion of American adults using mental health counseling boomed from 2019 to 2024 as teletherapy grew in popularity, federal data shows. “Anxiety disorders are amongst our psychiatric disorders that really respond well to cognitive behavioral therapy,” she said.

But medication can help.

Studies show the risks of taking SSRIs during pregnancy for mother and child. By contrast, “depression increases your risk for every complication for a mother and a baby,” Wood said, adding that recent statements by government officials about SSRI use during pregnancy are “potentially leading to real harm for these women.”

Some people who stop taking antidepressant medication , especially if they quit suddenly. But “the concept of addiction simply does not apply to these chemicals,” Kelly said, a statement .

Addiction, though, is a possibility with benzodiazepines such as Xanax that are often a second line of treatment for anxiety. These controlled substances can also in patients taking both types of drugs. During congressional hearings last year, Kennedy also decried benzodiazepine overuse as a problem.

While benzodiazepines are effective for short-term use, they require monitoring and care, Wood said.

“Those are really great meds for acute anxiety and not great as long-term anxiety medications, because they are habit-forming over time,” Wood said. “If you’re taking them on a daily basis, you’ll need more and more to get the same effect, and then you have to come down from them in a tapered way.”

And an are also occasionally taking beta-blockers such as propranolol for anxiety. Some people use beta-blockers to prevent a racing heart before a public speech or other big moments, even though they are not FDA-approved for treating anxiety and are prescribed “off-label.”

Beta-blockers , but they are “nonaddictive, really helpful for bringing down the autonomic nervous system, going from fight or flight to something more neutral, and really safe,” Wood said.

Social Shifts Drive Increased Use of Anxiety Meds

A number of could explain why so many more people are taking anxiety medication, increased social media use, more isolation, and heightened economic uncertainty, physicians and researchers say.

Plus, the medicines are relatively easy to get. Many people obtain SSRI and benzodiazepine prescriptions from their primary care physician. Others obtain the medications .

Many social media influencers , easing some stigma among young people and encouraging them to get help. About a third of teens said they get mental health information via social media.

Still, increased access to anxiety medication can be a problem when combined with a trend of self-diagnosis based on social media trends. A Google search for “” leads to sponsored promises of same-day treatment, though fine-print disclaimers clarify that a prescription is not guaranteed.

“I think increased access is good, but that’s not the same thing as, you know, ordering Xanax online,” Kelly said.

Young adults are largely driving an increase in anxiety medication use. The proportion of Americans ages 18 to 34 taking anxiety medication rose from 8.8% in 2019 — the first year such survey data became available — to 14.6% in 2024. By contrast, the rate didn’t change much among adults 65 and older, CDC data shows.

The pandemic and covid lockdowns greatly increased stress among many American adults, .

And data shows more women than men take anxiety medication. , a department chair and professor of sociology at the University of Pennsylvania, said that’s because they’re more likely to need them. They are also likelier than men to report when they feel anxious, and doctors are “inclined or see anxiety more readily in their female patients than their male patients,” Schnittker added.

Broader trends could also be at work. Schnittker said studies have shown anxiety growing more prevalent among ensuing generations for much of the 20th and 21st centuries. Schnittker, author of , said growing income inequality could be partly to blame, with people feeling stress over improving their economic status. Social and religious activities have been replaced by more isolation. And people have become more suspicious of others, creating a sense of unease around strangers.

For Zapp, the cancer survivor, it took a few months on Lexapro before she started seeing clear results. When she did, she said, it felt like her mind was less noisy, making it easier to focus. She also underwent talk therapy, but now her chronic anxiety is stabilized on medication alone.

“It definitely helped me get back to my day-to-day in a way that was productive and not just riddled with my anxieties throughout the day,” she said.

�������ýҕ�l Health News’ Holly Hacker, Maia Rosenfeld, and Lydia Zuraw contributed to this report.

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Dijo que “cada pequeña molestia, como un dolor de rodilla, ��le hacía pensar: este es el final del camino para mí”.

Así que Zapp, de 40 años, directora de comunicaciones en Nueva York, se convirtió en una de los millones de estadounidenses que comenzaron a tomar medicamentos para la ansiedad (ansiolíticos) en los últimos años. En su caso, fue Lexapro, un fármaco que aumenta la producción de serotonina.

“Me encanta. Ha sido excelente”, dijo. “Realmente me ha ayudado a manejarla”.

La proporción de adultos en el país que tomaron medicamentos para la ansiedad aumentó de 11,7% en 2019 a 14,3% en 2024, y la mayor parte del incremento se registró durante la pandemia de covid, según de los Centros para el Control y la Prevención de Enfermedades (CDC).

Eso representa 8 millones de personas más, un total aproximado de 38 millones, con aumentos marcados entre adultos jóvenes, personas con título universitario y adultos que se identifican como LGBTQ+.

Aunque los medicamentos psiquiátricos han ganado aceptación pública y son más fáciles de conseguir mediante citas de telemedicina, el aumento en el uso de una clase de antidepresivos llamados inhibidores selectivos de la recaptación de serotonina, conocidos como ISRS, ha generado críticas de partidarios del movimiento “Make America Healthy Again” (MAHA), quienes sostienen que son perjudiciales.

Médicos e investigadores dicen que medicamentos como Prozac, Zoloft y Lexapro son tratamientos de primera línea para muchos trastornos de ansiedad, incluidos el trastorno por ansiedad generalizada y el trastorno de pánico, y que han sido presentados de forma incorrecta como adictivos y dañinos en general, a pesar de que se ha demostrado que son seguros para uso prolongado.

Robert F. Kennedy Jr., secretario del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), ha criticado el uso creciente de los ISRS. Durante su audiencia de confirmación el 29 de enero, dijo que conoce personas, incluidos familiares, a quienes les resultó que dejar la heroína. Más recientemente, afirmó que entre el uso de ISRS y otros medicamentos psiquiátricos y comportamientos violentos como tiroteos escolares.

Marty Makary, comisionado de la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés), que el uso de los ISRS en mujeres embarazadas podría provocar malos resultados en el nacimiento.

Los efectos secundarios comunes de los ISRS incluyen . Algunos también y causar otros efectos sexuales secundarios.

Para muchas personas, sin embargo, los efectos secundarios son leves y tolerables, y los beneficios de tratar la ansiedad crónica lo compensan, señaló , presidente de la Sociedad Psiquiátrica del Sur de California. “Las declaraciones sobre los ISRS simplemente no estaban basadas en ningún tipo de evidencia o hecho”, dijo Kelly sobre los comentarios de Kennedy.

mostró que más de la mitad de las personas con trastorno por ansiedad generalizada que tomaban un ISRS vieron reducidos sus síntomas de ansiedad al menos en un 50%. Los efectos secundarios llevaron a aproximadamente 1 de cada 12 personas a dejar de usar el medicamento.

“Cuando se hace de manera adecuada y también se utilizan técnicas de terapia apropiadas, los ISRS pueden ser realmente muy útiles”, dijo , psiquiatra que ejerce en Los Ángeles.

MAHA atribuye la ansiedad a una mala alimentación y a la falta de ejercicio

Los partidarios de MAHA han atribuido en parte el aumento de varios problemas de salud, incluidos la ansiedad, la depresión y otros trastornos de salud mental, a malas decisiones alimentarias y a un estilo de vida sedentario. Como solución, han propuesto medidas como reducir el consumo de alimentos ultraprocesados, que con la depresión y la ansiedad, y disminuir el tiempo frente a pantallas a favor del ejercicio.

Los psiquiatras suelen recomendar y ejercicio para . Wood dijo que los que pueden manejar la ansiedad sin medicamentos también deberían considerar la terapia de conversación. La proporción de adultos en Estados Unidos que utilizan consejería en salud mental aumentó entre 2019 y 2024 a medida que la teleterapia ganó popularidad, según datos federales. “Los trastornos de ansiedad están entre los trastornos psiquiátricos que mejor responden a la terapia cognitivo-conductual”, dijo.

Pero los medicamentos pueden ayudar.

Estudios muestran que los riesgos de tomar ISRS durante el embarazo para la madre y el bebé. En contraste, “la depresión aumenta el riesgo de casi todas las complicaciones para la madre y el bebé”, expresó Wood, y agregó que declaraciones recientes de funcionarios del gobierno sobre el uso de ISRS durante el embarazo “podrían estar causando un daño real a estas mujeres”.

Algunas personas que dejan de tomar antidepresivos , especialmente si los suspenden de forma repentina. Pero “el concepto de adicción simplemente no se aplica a estos medicamentos”, dijo Kelly, una por .

La adicción sí es posible con benzodiacepinas como Xanax, que a menudo son un tratamiento de segunda línea para la ansiedad. Estas sustancias controladas también pueden aumentar el en pacientes que toman ambos tipos de medicamentos. Durante audiencias en el Congreso el año pasado, Kennedy también criticó el uso excesivo de benzodiacepinas como un problema.

Aunque las benzodiacepinas son efectivas a corto plazo, requieren supervisión y cuidado, dijo Wood.

“Son medicamentos muy útiles para la ansiedad aguda y no son adecuados como tratamiento a largo plazo, porque pueden generar dependencia con el tiempo”, explicó Wood. “Si se toman a diario, se necesita cada vez más para lograr el mismo efecto y luego hay que reducir la dosis de manera gradual”.

también toma ocasionalmente betabloqueantes como el propranolol para la ansiedad. Algunas las usan para prevenir el ritmo cardíaco acelerado antes de un discurso público u otros momentos importantes, aunque no están aprobadas por la FDA para tratar la ansiedad y se usan por fuera de lo que indica la receta.

Los betabloqueantes , pero “no generan adicción, son útiles para reducir la activación del sistema nervioso autónomo, pasar de la respuesta de lucha o huida a un estado más neutral y son seguros”, dijo Wood.

Cambios sociales impulsan el aumento en el uso de estos medicamentos

Un número de podrían explicar por qué muchas más personas están tomando medicamentos para la ansiedad, un mayor uso de redes sociales, más aislamiento y mayor incertidumbre económica, según médicos e investigadores.

Además, los medicamentos son relativamente fáciles de obtener. Muchas personas reciben recetas de ISRS y benzodiacepinas de su médico de atención primaria. Otras, .

Muchos influencers en redes sociales sus de , lo que ha reducido el estigma entre los jóvenes y los anima a buscar ayuda. Aproximadamente un tercio de los adolescentes en dijo que busca información sobre salud mental a través de redes sociales.

Aun así, el mayor acceso a medicamentos para la ansiedad puede ser problemático cuando se combina con una tendencia a autodiagnosticarse basada en información en redes sociales. Una búsqueda en Google de “” muestra promesas patrocinadas de tratamiento el mismo día, aunque la letra pequeña aclara que no se garantiza una receta.

“Creo que un mayor acceso es algo positivo, pero no es lo mismo que, por ejemplo, pedir Xanax por internet”, dijo Kelly.

Los adultos jóvenes impulsan en gran medida el aumento en el uso de medicamentos para la ansiedad. La proporción de estadounidenses de 18 a 34 años que los toman aumentó de 8,8% en 2019 —el primer año en que estos datos estuvieron disponibles— a 14,6% en 2024. En contraste, la tasa cambió poco entre los adultos de 65 años o más, según datos de los CDC.

La pandemia y los confinamientos por covid aumentaron de forma importante el estrés entre muchos adultos, .

Los datos también muestran que más mujeres que hombres toman medicamentos para la ansiedad.

, jefe de departamento y profesor de Sociología en la Universidad de Pennsylvania, dijo que esto se debe a que es más probable que los necesiten. También es más probable que las mujeres digan cuando se sienten ansiosas, y los médicos “tienden a identificar la ansiedad con mayor facilidad en sus pacientes mujeres que en sus pacientes hombres”, añadió Schnittker.

También podrían influir tendencias más amplias. Schnittker señaló que estudios han mostrado que la ansiedad se ha vuelto más común entre generaciones sucesivas durante gran parte del siglo XX y el siglo XXI. Autor de , dijo que el aumento de la desigualdad de ingresos podría ser un factor, ya que las personas sienten presión por mejorar su situación económica. Las actividades sociales y religiosas han sido reemplazadas por un mayor aislamiento. Y las personas se han vuelto más desconfiadas de los demás, lo que crea una sensación de inquietud frente a extraños.

Para Zapp, sobreviviente de cáncer, pasaron algunos meses tomando Lexapro antes de notar resultados claros. Cuando ocurrió, dijo, sintió que su mente estaba menos saturada, lo que le facilitó concentrarse. También recibió terapia, pero ahora su ansiedad crónica está estabilizada solo con el medicamento.

“Definitivamente me ayudó a volver a mi rutina diaria de una manera productiva y no simplemente llena de ansiedad durante todo el día”, dijo.

Holly Hacker, Maia Rosenfeld y Lydia Zuraw, de �������ýҕ�l Health News, contribuyeron con este artículo.

�������ýҕ�l 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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This story can be republished for free (details).

“I was kind of a mess,” recalled Abrams, 69. Trying to cope, “I was eating myself into oblivion.” As her weight hit 270 pounds and her blood pressure, cholesterol, and blood glucose levels climbed, “I knew I was in trouble health-wise.”

What came to mind? “Oh, oh, oh, Ozempic!” — the from television commercials that promoted the GLP-1 medication for diabetes. The ads also pointed out that patients who took it lost weight.

Abrams remembered the commercials as “joyful” and sometimes found herself humming the jingle. They depicted Ozempic-takers cooking omelets, repairing bikes, playing pickleball — “doing everyday activities, but with verve,” she said. “These people were enjoying the hell out of life.”

So, just as such ads often urge, even though she had never been diagnosed with diabetes, she asked her doctor if Ozempic was right for her.

Small wonder Abrams recalled those ads. Novo Nordisk, which manufactures Ozempic, spent an estimated $180 million in direct-to-consumer advertising in 2022 and $189 million in 2023, according to MediaRadar, which monitors advertising.

By last year, the sum — including radio and TV commercials, billboards, and print and digital ads — had reached an estimated $201 million, and total spending on direct-to-consumer advertising of prescription drugs topped $9 billion, by MediaRadar’s calculations.

Novo Nordisk declined to address those numbers.

Should it be legal to market drugs directly to potential patients? This controversy, which has simmered for decades, has begun receiving renewed attention from both the Trump administration and legislators.

The question has particular relevance for older adults, who contend with more medical problems than younger people and are more apt to take prescription drugs. “Part of aging is developing health conditions and becoming a target of drug advertising,” said Steven Woloshin, who studies health communication and decision-making at the Dartmouth Institute.

The debate over direct-to-consumer ads dates to 1997, when the FDA loosened restrictions and allowed prescription drug ads on television as long as they included a rapid-fire summary of major risks and provided a source for further information.

“That really opened the door,” said Abby Alpert, a health economist at the Wharton School of the University of Pennsylvania.

The introduction of Medicare Part D, in 2006, brought “a huge expansion in prescription drug coverage and, as a result, a big increase in pharmaceutical advertising,” Alpert added. A study she co-wrote in 2023 found that pharmaceutical ads in areas with a high proportion of residents 65 and older.

and have shown that ads influence prescription rates. Patients are more apt to make appointments and request drugs, either by brand name or by category, and doctors often comply. may ensue.

But does that benefit consumers? Most developed countries take a hard pass. Only New Zealand and, despite the decadelong , the United States allow direct-to-consumer prescription drug advertising.

Public health advocates argue that such ads encourage the use and overuse of expensive new medications, even when existing, cheaper drugs work as effectively. (Drug companies don’t bother advertising once patents expire and generic drugs become available.)

In a 2023 study in JAMA Network Open, for instance, researchers analyzed the “” of the drugs most advertised on television, based on the assessments of independent European and Canadian organizations that negotiate prices for approved drugs.

Nearly three-quarters of the top-advertised medications didn’t perform markedly better than older ones, the analysis found.

“Often, really good drugs sell themselves,” said Aaron Kesselheim, senior author of the study and director of the Program on Regulation, Therapeutics, and Law at Harvard University.

“Drugs without added therapeutic value need to be pushed, and that’s what direct-to-consumer advertising does,” he said.

Opponents of a ban on such advertising say it benefits consumers. “It provides information and education to patients, makes them aware of available treatments and leads them to seek care,” Alpert said. That is “especially important for underdiagnosed conditions,” like depression.

Moreover, she wrote in a recent , direct-to-consumer ads lead to increased use not only of brand-name drugs but also of non-advertised substitutes, including generics.

The Trump administration entered this debate last September, with calling for a return to the pre-1997 policy severely restricting direct-to-consumer drug advertising.

That position has repeatedly been urged by Health and Human Services Secretary Robert F. Kennedy Jr., who has charged that “pharmaceutical ads hooked this country on prescription drugs.”

At the same time, the FDA said it was issuing about deceptive drug ads and sending “thousands” of warnings to pharmaceutical companies to remove misleading ads. Marty Makary, the FDA commissioner, in an essay in The New York Times.

“There’s a lot of chatter,” Woloshin said of those actions. “I don’t know that we’ll see anything concrete.”

This month, however, the that the agency had found its TV spot for a new oral version of Wegovy false and misleading. Novo Nordisk said in an email that it was “in the process of responding to the FDA” to address the concerns.

Meanwhile, Democratic and independent senators who rarely align with the Trump administration also have introduced legislation to ban or limit direct-to-consumer pharmaceutical ads.

Last February, independent Sen. Angus King of Maine and two other sponsors prohibiting direct-to-consumer ads for the first three years after a drug gains FDA approval.

King said in an email that the act would better inform consumers “by making sure newly approved drugs aren’t allowed to immediately flood the market with ads before we fully understand their impact on the general public.”

Then, in June, he and independent Sen. Bernie Sanders of Vermont proposed entirely. That might prove difficult, Woloshin said, given the Supreme Court’s Citizens United ruling .

Moreover, direct-to-consumer ads represent only part of the industry’s promotional efforts. Pharmaceutical firms actually spend than to consumers.

Although television still accounts for most consumer spending, because it’s expensive, Kesselheim pointed to “the mostly unregulated expansion of direct-to-consumer ads onto the web” as a particular concern. Drug sales themselves are bypassing doctors’ practices by moving online.

Woloshin said that “disease awareness campaigns” — for everything from shingles to restless legs — don’t mention any particular drug but are “often marketing dressed up as education.”

He advocates more effective educational campaigns, he said, “to help consumers become more savvy and skeptical and able to recognize reliable versus unreliable information.”

For example, Woloshin and Lisa Schwartz, a late colleague, designed and tested a simple “,” similar to the nutritional labeling on packaged foods, that summarizes and quantifies the benefits and harms of medications.

For now, consumers have to try to educate themselves about the drugs they see ballyhooed on TV.

Abrams read a lot about Ozempic. Her doctor agreed that trying it made sense.

Abrams was referred to an endocrinologist, who decided that her blood glucose was high enough to warrant treatment. Three years later and 90 pounds lighter, she feels able to scramble after her 2-year-old grandson, enjoys Zumba classes, and no longer needs blood pressure or cholesterol drugs.

So Abrams is unsure, she said, how to feel about a possible ban on direct-to-consumer drug ads.

“If I hadn’t asked my new doctor about it, would she have suggested Ozempic?” Abrams wondered. “Or would I still weigh 270 pounds?”

The New Old Age is produced through a partnership with��.

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This story can be republished for free (details).

The Food and Drug Administration is back in the headlines, with a political appointee overruling agency scientists to reject an application from the drugmaker Moderna for a new flu vaccine, and FDA Commissioner Marty Makary continuing to take criticism from anti-abortion Republicans in the Senate for alleged delays reviewing the safety of the abortion pill mifepristone.

Meanwhile, in a very unlikely pairing, Sen. Elizabeth Warren, the Massachusetts Democrat, and Sen. Josh Hawley, the conservative Republican from Missouri, are co-sponsoring legislation aimed at breaking up the “vertical integration” of health care — when a single company owns health insurers, drug middlemen, and clinician practices.

This week’s panelists are Julie Rovner of �������ýҕ�l Health News, Jackie Fortiér of �������ýҕ�l Health News, Lizzy Lawrence of Stat, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• A top FDA official overruled agency staff in refusing to consider Moderna’s application for a new flu vaccine. The rejection, which Moderna is challenging, comes after the company consulted with the agency under President Joe Biden on how to develop the clinical trial for the vaccine and then spent considerable time and money. Clear, consistent federal guidance is important to maintaining the drug development ecosystem, and the decision stands as a warning to other companies developing new treatments.
• With measles cases rising and trust in federal vaccine recommendations falling, the Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research & Policy, and the American Medical Association are launching their own vaccine review process — a parallel vaccine recommendation project offering an alternative to what are seen as ideologically driven federal recommendations.
• President Donald Trump unveiled the new TrumpRx website, billed as helping people save money on prescription drugs. But the site’s offerings are limited and offer limited benefits: It serves only those trying to buy drugs without insurance coverage, and some of the biggest savings are on popular obesity drugs rather than other commonly needed treatments. Nonetheless, it offers Trump a chance to stamp his name on an effort to lower drug prices.
• And more reporting is illuminating the health-related side effects of Trump’s immigration crackdown, including infectious disease outbreaks at detention centers. While at least some of the problems are not new to immigration enforcement, the large numbers of people being detained are intensifying the problems.

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

Julie Rovner: ProPublica’s “,” by Mica Rosenberg.����

Alice Miranda Ollstein: Politico’s “,” by Amanda Chu.����

Lizzy Lawrence: �������ýҕ�l Health News’ “US Cancer Institute Studying Ivermectin’s ‘Ability To Kill Cancer Cells,’” by Rachana Pradhan.����

Jackie Fortiér: Stat’s “,” by Ariana Hendrix.����

Also mentioned in this week’s episode:

• Stat’s “,” by Lizzy Lawrence.
• �������ýҕ�l Health News’ “Public Health Workers Are Quitting Over Assignments to Guantánamo,” by Amy Maxmen.
• �������ýҕ�l Health News’ “‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees,” by Claudia Boyd-Barrett.

[Editor’s note:��This transcript��was generated��using both transcription software and a human’s light touch. It has��been edited��for style and clarity.]��

Julie Rovner:��Hello from �������ýҕ�l Health News and WAMU��public radio��in Washington, D.C. Welcome to��What the Health?��I’m��Julie Rovner, chief Washington correspondent for �������ýҕ�l Health News, and��I’m��joined by��some of��the best and smartest health reporters covering Washington.��We’re��taping this week on Thursday, Feb. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So,��here we go.��

Today,��we��are joined��via��videoconference by Alice Miranda��Ollstein��of Politico.��

Alice Miranda��Ollstein:��Hello.��

Rovner:��Lizzy Lawrence��of��Stat��News.��

Lizzy Lawrence:��Hi.����

Rovner:��And up early to join us from California, my �������ýҕ�l Health News colleague��Jackie��Fortiér. Welcome, Jackie.����

Jackie��Fortiér:��Hey,��everyone.��

Rovner:��No interview this week, but��plenty of��news.��So��let’s��jump right in. We will start this week at the Food and Drug Administration, where things are��— why��don’t��we call it��—��newsmaking. The biggest FDA story that broke this week was controversial vaccine chief Vinay Prasad outright rejecting an application for a new flu vaccine from��Moderna, maker of the mRNA covid vaccine that so many anti-vaxxers have criticized. Lizzy, you��. Congratulations. What happened exactly?��And why is this��such a big deal��beyond the flu vaccine?��

Lawrence:��This��is a big deal��because to refuse to file is a pretty rare occurrence in general, because in general the FDA and industry like to have agreed-upon standards for clinical trials before companies embark on them and��pour millions of dollars into them. So that was surprising. And then—��

Rovner:��And refuse to file means that they said that��they’ve��got the application and said:��Yeah,��we’re��not accepting that.��We’re��not going to review this.��Right?��

Lawrence:��Yes, yes. And Prasad wrote that the��grounds��for this was that it��wasn’t��an adequate, controlled trial. Well,��Moderna is saying that��actually the��FDA greenlit this trial back under the Biden administration in 2024. They acknowledged that there was��basically a��control vaccine that the FDA��say��they��would prefer that��Moderna use for the older population. But they said, however,��it’s��acceptable if you��don’t��do that.��

Rovner:��And I want to make sure I understand this. The complication here is that this is supposed to be a better vaccine for older people, but right now there’s vaccines for older people that start at age 65 and this is a vaccine��that’s��supposed to start at age 50, right?��So��it was unclear who they were going to��test��it against, whether it was going to be the 50-to-64s or the 65s and older. Because there��isn’t��a vaccine right now��that’s��approved for 50 and up, right?��

Lawrence:��Exactly, exactly. So it was there’s the high-dose vaccine, which��is recommended��for the above-65s,��but that��is not recommended��for the 50-to-64,��which is part of why��Moderna didn’t use that high-dose vaccine, because the population that they were studying was broader than this over-65s. So anyway, so��yeah, so refusing to file is already rare, and then for there to be an overriding refuse to file, where the,��I��was told, basically, while��there may have been individuals who agreed with Dr.��Prasad’s��assessment, the review team,��every discipline,��thought that it was reviewable. And the head of vaccines wrote a memo explaining why he thought it was��viable, so that the career staff��kind of documented��their thoughts here.��It’s��not clear whether this will��be made��public ever, but one would hope,��with radical transparency, but��we’ll��see. Despite that, Dr.��Prasad still refused to review��Moderna’s application.��

Rovner:��So obviously��it’s��a big deal for the flu vaccine, but��it’s��a big deal beyond this. Moderna’s��CEO was on cable news this morning, said that, as you said, after consulting with the FDA officials about the trial, they spent a billion dollars on this trial. How do we expect companies to invest in new medicines like this if the FDA is��basically acting��on vibes?��

Lawrence:��I��don’t��know.��Yeah. And��it’s��interesting. It��doesn’t��seem like��there’s��a ton of sympathy��from��this administration. Even back last year,��[FDA]��Commissioner��[Marty]��Makary tweeted something��— this was when they were limiting, wanted to require more data for covid vaccines for the under-65 crowd. And��I think he��said something like:��Our goal is not to save companies money.��That’s��not something��we��—��which��of��course that��isn’t.��The FDA’s��goal is to promote public health. But��it’s��definitely a��change in tune. I think that in the past, the FDA has understood that you’re��really only��going to get innovation if you have clear, consistent guidance and that it’s a��really worst-case��scenario for a company to spend a billion dollars on a clinical trial and then there’s nothing to show for it and nothing for it to benefit patients,��either. So.��

Rovner:��Is this over? What��happens��now?��

Lawrence:��So now��Moderna has requested a meeting to challenge this decision, and now there begins a kind of negotiation. It might be possible��that��the FDA would, in fact,��would review��at��least the 50-to-64 cohort, because they��don’t��have any objections��there, seemingly. But��we’ll��have to see. On a call yesterday, a senior FDA official talked about��Moderna��kind of coming��to the agency with humility and acknowledging that the FDA had recommended this high-dose vaccine. And��so��I��don’t��know.��I think companies��are definitely��—��it’s��a lesson that��they’re, especially if��you’re��in the vaccine space, you��have to��tread very carefully.��

Rovner:��Yeah. And I would��think��others in the drug space,��too.��It’s��not just��—��that’s��the point of this��—��it’s��not just vaccines.��Alice, you wanted��to say something.��

Ollstein:��Oh,��yeah.��Not only the monetary investment, which��we’ve��touched on a bunch, but��companies spend years.��So��it’s��the��time investment as well. And why would you dedicate years of effort to something that��you’re��not sure if a political appointee is going to swoop in and override career scientific officials’��assessment, if��you��can’t��trust the regulatory system to work as��it’s��always worked. There really is just��a lot of��risk there, and you��might see people not making these submissions on all kinds of fronts.��Of course, this is coming as we’ve had a��really bad��flu season.��I’ve had people in my life get��really sick��and say it’s been really,��really bad.��So��the prospect of having something that works better to prevent,��or even just make it milder,��not coming to fruition��is rough.��

Rovner:��Yeah. And this year, as we know, this year’s flu vaccine was not very well matched to the strains that ended up circulating. And that’s��kind of the��point of this��Moderna vaccine, this mRNA vaccine, is that they say it would be much faster for them to match strains to��what’s��going around. If it works as the clinical trials suggest it would��actually be��a better flu vaccine than we have now.��

Well, meanwhile, cases of measles are also continuing to multiply, as they do when people��aren’t vaccinated, and not just in the places we’ve talked about, like Texas and South Carolina, but also all around us here in the nation’s capital, apparently,��as a result of��people traveling here for the anti-abortion March for Life in January. There have been more than 730 confirmed cases of measles in the U.S.��already this year.��That’s��four times more than have been typical for a full year, and��it’s��not yet the middle of February. Yet that��doesn’t��seem to be deterring the administration from its anti-vaccine activities. So now, the American Medical Association and the University of Minnesota��Vaccine��Integrity��Project have announced��they’ll��convene��a parallel group of experts to make vaccine recommendations,��basically saying��they��are done��following the Centers for Disease Control and Prevention. This has been brewing for a while.��Right,��Lizzy?��

Lawrence:��Yes. As soon as the secretary fired��all of��the experts who served��on the advisory panel to the CDC on vaccines, I think��there’s��been unease. And now, as you said,��there’s��an active parallel public health establishment��that’s��trying to spread credible information and provide an alternative resource, because��it’s��clear that HHS��[the Department of Health and Human Services]��has become compromised when it comes to vaccine recommendations. And yet,��you’re��seeing the spread of infectious diseases right now.��

Fortiér:��Having��kind of this��rival court is not surprising, because��they’ve��refused to��participate��in any of the Advisory Committee on Immunization Practices meetings for��months and months. I do wonder if this will��maybe change��some of��the tone. We do have an upcoming ACIP meeting in February. Normally we would have��a��agenda out by now.��Before Secretary��[Robert F.]��Kennedy��[Jr.]��we would have them weeks in advance,��and we haven’t seen one yet, so we’re��really not��totally sure��what they’re going to be talking about.��But Dr.��[Mehmet]��Oz did say this week that he finally��advised people��—��he’s��the CMS��[Centers��for��Medicare & Medicaid Services]��director—��to take the vaccine.��And��there’s��been over 933��cases in just South Carolina during this outbreak that started last October. And so when I talk to people on the ground who are treating folks in South Carolina and have been treating them for months, and they’ve been doing vaccine clinics and things like that, they��were just so fed��up with Dr.��Oz and the administration, because they partially blame them for these various outbreaks. And I had one of them tell me, like, well,��it’s��like a band-aid on a bullet hole. Like, now��they’re��finally encouraging people to get vaccinated when we could have had this months ago.��

Rovner:��And,��of course, the CDC��doesn’t��have a director��at the moment,��because the Senate-approved director��was summarily fired��and/or quit, not clear��which,��after refusing to��basically rubber-stamp��the immunization panel’s recommendations that had not��been made��at the time.��So��the American Academy of Pediatrics is suing to stop this February ACIP meeting. I did not hear what the last decision was on that, but I know that��there’s��still��a lot of��movement around here.��I guess the big worry��is:��Who should the public trust now? Is it going to be this��sort of grouping of medical societies led by the AMA, or the CDC, which people and doctors��are used��to following the advice of?��

Ollstein:��And��there’s��all these state alliances forming to do the same thing. And��so��I think,��yeah, the more competing recommendations��the average person��hears, the more they just��sort of throw��their hands up and say:��I��don’t��even know who to trust anymore.��I’m��not listening to any of these people.��And the trust that’s eroded in the federal government,��that’s going to be��really hard��to recuperate in the future.��You��can’t��just flip a switch and say:��OK,��it’s��a different government. We trust them again.��Once those seeds of doubt��are planted��in people’s minds, it’s��really hard��to unearth.��And so, if not permanent damage, all of this is doing at least very long-term damage to the idea of��expertise��and authoritative information.��

Rovner:��And science, which this administration insists it wants to follow. Well, turning to FDA-related��“MAHA” [“Make America��Healthy��Again”]��news, the agency said last week it would relax enforcement of its food additive regulations to make it easier for manufacturers to say��they’re��not using artificial dyes. Now this was a huge deal when the agency announced the phaseout of artificial coloring. Looking at you,��fancy-colored Froot Loops. Now the administration says��it’s��going to allow��foodmakers��to say��they’re��not using artificial colors as long as��they’re��not using petroleum-based dyes.��Apparently, natural��dyes are��OK. But even that is controversial, and��it appears that this whole effort��really relies on manufacturers’��willingness to comply rather than, you know, actual regulation, which is��kind of what��the FDA does for a living.��It’s��a regulatory agency.��

Ollstein:��Well, every time the word��“natural”��comes up, I always laugh because there is no definition of that. And there are��plenty of��things that are natural that could kill you or hurt you very badly. And there are��plenty of��things that��are��synthetically manufactured��that are helpful and fine for you. And��so��it has this veneer of safety, veneer of health with no actual substance.��So��my red flags go up whenever I hear that word, and I think everyone should be skeptical.��

Rovner:��But it goes with RFK Jr.’s quest now that you should,��quote,��“eat real food.”��

Lawrence:��Right.��Yeah.��I was going to��say same with��“chemical.”��I feel like,��“chemical”��abortion drug,��“chemical.”��And��it’s��like,��a lot of��things are chemicals.��That’s��not—��

Ollstein:��Yeah, like in your own body, naturally.��

Lawrence:��Yeah.��

Ollstein:��You have chemicals.��

Lawrence:��We are chemicals.��

Ollstein:��We are chemicals.��

Rovner:��You guys are all too young to remember the Dow Chemical advertising line��“Better Living Through Chemistry,”��which at the time,��in the��’60s and��’70s, was true.��There was,��there��—��we’ve��had��a��lot of��better living through chemistry. And��some of��it has turned out to be��maybe not��so good for us, but��a lot of��it has turned out to be pretty darn good for us.��

Well, finally, in FDA��land,��Commissioner Marty Makary this week met with anti-abortion senators about that ongoing review of the abortion pill��mifepristone, which senators want the FDA to remove from the market. Alice,��how’d��that meeting go?��

Ollstein:��Not great for the FDA,��from what I��was told.��I got on the phone with Sen.��Josh Hawley after it, and he was extremely frustrated. He said he��didn’t��get answers to any of the questions��he’s��been sending in public letters to the FDA for months and now asking in this briefing behind closed doors that they held��on��Capitol Hill this week.��He said he��didn’t��get answers about what the timeline is for this review of the abortion pill mifepristone, what the review consists of,��whether��it’s��even begun, really, whether��it’s��even underway. And��so��he is��sort of concluding��that this is not going anywhere, and he wants Congress to step in and��take action.��Now,��Congress has tried to step in and��take action��before.��They’ve��tried to put restrictions on mifepristone in the FDA funding bill.��That��didn’t��pass.��So��I��don’t��know if this is even plausible in this environment where Congress��can’t��really pass much of anything anymore.��

But��Hawley��is��not just another Republican senator. He is very intertwined with the anti-abortion movement. His wife is an��extremely prominent anti-abortion lawyer��who’s��led��a lot of��the major cases trying to restrict or ban mifepristone. They founded their own anti-abortion advocacy group. And��so��it really shows that the��tensions,��clashes, whatever we want to call them, between the anti-abortion movement and the Trump administration, so after backing the Trump administration for years and years,��they’re��really��getting fed��up. And��they’re��fed up that even after they achieved their grand goal of overturning��Roe v.��Wade, there are��actually more��abortions happening now than before, and��that’s��largely through��these pills and people’s ability to get them. And��so��they’re��getting increasingly impatient with the Trump administration, who has been��sort of stringing��them along and saying:��Yeah,��we’re��working on it.��We’re��working on it.��But they want to see��results. Now, of course, if there were��some��sort of restrictions imposed, that could have a big political effect. And��so��a lot of��Republicans are very torn about that. But not Sen.��Hawley. Sen.��Hawley��wants to see it.����

Rovner:��That’s��right. Well, moving to what I call FDA-adjacent news, one of the��many��thorny��issues that FDA has been dealing with is the compounding of those��very popular��and very pricey obesity drugs. When the drugs were in shortage, it was legal for compounders to make their own copies. But now the shortage for��both of the leading��medications��—��semaglutide, made by Novo Nordisk,�����Ի���tirzepatide, made by Eli Lilly��—��is over, and those cheaper copycats were supposed to��be pulled��from the market.��So��it was a bit of a surprise when the company Hims, one of those direct-to-consumer drug sites, announced the unveiling of a semaglutide tablet just weeks after the first such drug��was approved��by the FDA, by Novo Nordisk. The FDA promptly referred the company to the Justice Department for��possible violation��of federal drug laws, after which��Hims��said,��Oh,��maybe we��won’t��start selling the drug after all.��Oh, and Novo is��suing for��patent infringement. But I would think that the war over the��“fat”��drugs, as President��[Donald]��Trump likes to call them, is likely to lower prices just as effectively as government regulation might. Or am I misreading that? Lizzy, this has been quite the sideshow, if you will.��

Lawrence:��Yeah. It might. I think that the compounding,��the FDA’s crackdown on��Hims was��very interesting��to me because I think before the commissioner had come into his role, there was��some��speculation.��He had worked for a telehealth company that prescribed compounded drugs. And��there’s��also, I think��compounders have tried to tap into a little bit of the MAHA medical freedom aspect. But clearly��that’s��not been��the case, at��least at the FDA. They are clearly��very upset��about this�����Ի���mean business, and I think��it’s��tying��into their crackdown on direct-to-consumer drug advertising as well. But as far as��price,��yeah. I think the deals that Trump has managed to strike with the companies��could��actually be��reducing price for patients. I think��we’ll��have to see.��I know there’s obviously drug pricing programs��as well that��they could pursue. So,��yeah,��we’ll��have to see.����

Rovner:��All right. Well,��we’re��going to��take a quick break. We will be right back.��

OK.��We’re��back.��And speaking of President Trump,��there’s��also��drug news this week��that’s��not��directly related��to the FDA.��That’s��the official unveiling of��TrumpRx, the website the��president says will lower drug prices like no one’s��“ever seen before.”��That’s��a direct��quote, by the way. Except it turns out��that’s��not quite the��case. First, these discounts are only for people who are paying out-of-pocket, not those with insurance, which makes them valuable mostly for people who have no coverage or people who take drugs that insurance often��doesn’t��cover, like those for obesity or infertility. Yet of the 43 drugs so far that��are promoted��on the��TrumpRx��website, about half already have cheaper generic copies available through sites like��GoodRx��and Mark Cuban’s��Cost��Plus��Drugs. And really, the website just points people to already existing manufacturer websites that were already offering those lower prices.��So��what is the point of��TrumpRx?��

Lawrence:��Great question.��Yeah.��This administration has been��very focused��on, obviously, media and wins�����Ի���attaching President Trump’s name to things.��So��it��accomplishes��that goal.��Maybe it��does raise awareness for these other sites that already exist. But that’s a theme of��a lot of��the movement on health��care so far,��has been��—��there’s been��a lot of��chaos, and then there’s also sometimes things that they announce as like a grand,��brand-new,��no-one’s-ever-thought-of-it-before policy, but then there are already, of course, existing programs or avenues for that.��

Rovner:��And to be fair, Trump has��jawboned��down��some��prices, including��some��prices for the obesity drugs,��by��basically dragging��in the CEOs of these companies and saying,��You��will lower prices.��

Lawrence:��Yeah,��yeah. The dealmaking has been effective. And��I think the question��is: Will this last beyond his administration? Will there be a legacy there?��

Ollstein:��I think��there’s��also��some��danger in��overpromising, because��he’s��out there saying things that��don’t��comport with how math works.��He’s��basically suggesting��prices will come down so many percents that��we’ll��be getting paid to take drugs, because��that’s��what more than 100%��is. And people who are hearing that, voters who are hearing that, if they aren’t seeing that show up in their bills, if they’re not actually seeing those drastic, drastic drops that they’re��being promised��by the��president,��are they going to get upset? And is that going to��impact��how they vote? So yes, there has been��some,��on��the��margins,��improvements, but when��you’re��out there promising 600% reductions��and not delivering,��there’s��a risk to that.��

Rovner:��Jackie, you wanted to add something.��

Fortiér:��Well, I was going to��say, I think it’s also confusing for a lot of people, from a consumer perspective, because��you log on and I think people, they hear these huge promises, like Alice is talking about, and then they think that they can, necessarily, buy the drugs through there and��immediately get them shipped, what these third parties like��Hims and Weight Watchers are doing a lot of��with the GLP-1s. And��that’s��not how this works.��You still have another step of getting a prescription and then going to the pharmacy and��using these to potentially get��discounts��and lower prices,��in the same way that��these have been available from pharmaceutical manufacturers and other things like��GoodRx��for years. But it’s that disconnect between, even if you can get a discount,��actually getting��the discount and crediting the Trump administration for that that I think is going to be��really difficult��for��a lot of��voters to make that connection in the way that the administration wants them to.��

Rovner:��And this was ever the case with rebates��—��for other consumer products, not just talking about drugs.��We’ll��give you a $15 rebate, but you��have to��fill out 87 forms and��send it to this place and get it exactly right, do��it before the end date, and��we’ll��send you back $15.��Because they count on most people not being able or willing to follow��all of��the various steps. So instead of giving everybody the discounted price, they make you��really basically��work for your discount, which is a consumer thing, but it’s��pretty popular��in��the drug��space as well. Rather than just lowering prices,��they’re��going to say,��We��will give you a discount, but��you’re��going to have to do this, that,��and the other thing��in order to��get it.��

Fortiér:��Right.��But when��you’re��president and you want credit for it,��it’s��going to be a little more��—��it’s��harder��in order to��make that connection. Sorry.��

Rovner:��Yes,��that’s��true. That is a good point. All right,��moving��on. We have talked��a lot��about consolidation in the health��care industry, particularly companies like UnitedHealthcare, which used to be just an insurer, now owns its own PBM��[pharmacy benefit manager], its own claims processing company, and��thousands��of medical practices around the country. Well, now an extremely unlikely pair in the Senate, Massachusetts Democrat Elizabeth Warren and Missouri Republican Josh Hawley,��have joined to introduce something called the��Break��Up��Big��Medicine Act, which would��basically outlaw��so-called vertical integration, like that of��United and,��to a��somewhat lesser��extent, Cigna and CVS Health, which owns Aetna, the insurer.��Some��are referring to this as the health version of the 1932 Glass-Steagall Act, which separated commercial from investment banking��— and,��side note, whose repeal in 1999��is considered��a major factor setting off the��financial crisis��of 2008.��But that was a��risk��thing. It��was done��to prevent another stock market crash like the one in 1929.��This is a��cost��thing. This is to go after high health care costs. Could it work? Could it pass? And is this the beginning of the next��big thing��in health reform?��

Lawrence:��Perhaps.��Yeah. Last year,��I��worked with my colleagues on����kind of examining UnitedHealth Group and the effects of consolidation on doctors and patients. And at the time, I think,��there were��some��vocal lawmakers on either side of the aisle who were criticizing this, especially in the wake of the murder of the UnitedHealth CEO, and which had a surprising��—��the public sort of had this reaction�����Ի���to—��

Rovner:��Not in United’s favor.��

Lawrence:��Not in United’s favor. And so��I think that there��is, this is a political issue that affects��everyone, Republican and Democrat, the,��well,��cost in general, but I think there’s��a lot of��resentment and anger, and it seems like that is bringing together these��unlikely and pretty powerful senators.��I’m��not an expert on��the��Hill. I��don’t��know if this has a chance. Especially,��it’s��targeting massive, powerful companies with hands in every part of the health care system.��So��it’s��something that you would imagine the entire health��care industry would fight against. But,��yeah, I��don’t��know.��

Rovner:��And I will point out that Sen.��Josh Hawley, in addition to all his anti-abortion activities, last year, when Congress was debating the Medicaid cuts, kept vowing not to vote for those Medicaid cuts.��So��he’s��—��which, of course, in the end, he did��—��but��he’s��been��sort of��on��the consumer side of health��care for a while now.��It’s��just��this is not brand new to him.��

Lawrence:��Right.��And��I’m��not sure how��many��other Republican senators would follow him down this path.��But it’s��definitely a��noteworthy development,�����Ի���curious to see where it goes.��

Rovner:��Yeah,��I’m��curious to see sort of if the��populist part of health care costs sort of rises to the fore.��We’ll��have to, we will have��to watch that space. Well, finally this week, more on the impact of the Trump administration’s immigration crackdowns and health.��My��KFF��Health��News colleague Amy��Maxmen��has��a story��about health professionals in the U.S.��Public Health Service Commissioned��Corps��actually resigning��rather than accepting postings to Guantánamo Bay,��Cuba, where some immigrants are being detained in prisons that used to hold al-Qaida suspects. Another���������ýҕ�l Health News��story��by Claudia Boyd-Barrett describes how when people detained by ICE��[Immigration and Customs Enforcement]��end up in the hospital, often their immediate families and their lawyers��aren’t��even allowed to know where. And remember, last week we talked about cases of measles in��some��immigration detention facilities. Well, now there are two confirmed cases of tuberculosis at the��ICE��facility at Fort Bliss in El Paso,��Texas.��I’m��thinking��maybe the��health part of this is starting to��kind of get��to people as��much��as the whole depriving-civil-liberties part.��

Fortiér:��Yeah, and��there’s��also been cases of covid-19, which makes sense.��You’re��going to have respiratory viruses as you get hundreds of people grouped together. That makes sense. A judge in California a couple��days��ago ordered that there had to be adequate health provided to detainees in one specific California��— it was a prison and now��it’s��an��ICE��detainee facility.��That’s��specific to��there, but it’s��—��more and more��senators, I think, are also looking at this and pointing out that��they’re��just not providing the health facilities that people need. And especially ongoing care��—��a��lot of��folks need diabetes treatment, and that treatment just��isn’t��really happening in��many��cases.��

Rovner:��Yeah,��we’ve��talked about this at��some��length, over��many��weeks, that people in detention are not getting health care, even though it��is��required,��that we keep hearing stories about people not getting needed health care. I��didn’t��know until I read this story that people who��actually end��up��being hospitalized, that their family members��are not allowed��to know.��That’s��allegedly, well, it is because of security, because the idea is that if somebody��who’s��in detention is in a hospital, you��don’t��necessarily want bad people knowing that and being able to come to the hospital. But these are people��often��who are,��as we have documented at length, do not have criminal records, and��it’s��hard to find out where they are. Alice, you wanted��to add something.��

Ollstein:��Yeah. So there was a recent GAO��[Government Accountability Office]��report about this, and it found that��people were not getting evaluated when they entered a facility to see if they were medically vulnerable and at risk of having��a really bad episode or emergency, and that even��children, pregnant women, vulnerable populations weren’t getting that��initial evaluation, which then led to problems down the road. And it also said that people upon their release��—��either deportation or release within the United States if��that’s��what��a court ordered��—��they��weren’t��being given��their medical records, their prescriptions. And��so��the continuity of care��was disrupted. And��it’s��important to note that that GAO report was about��a few��years ago under the Biden��administration.��So��this��isn’t��new. These problems��aren’t��new, but��they’re��getting��much��worse, because the number of people detained is at record levels and so��everything’s��just getting multiplied.��

Rovner:��Yeah, it is. Well, we will keep watching that space. OK, that’s this week’s news. Before we��get to our��extra credits, I am pleased to present the winner of our annual���������ýҕ�l Health��News��Health��Policy Valentine contest.��It’s��from��[Andrew Carleen]��of Massachusetts, based on a story about Medicare Advantage overpayments. And it goes like this:��“I thought it was love. My heart felt spring-loaded. Turns out our relationship was significantly��upcoded.” Congratulations,��and happy Valentine’s Day to all.��

OK, now��it’s��time for our��extra-credit��segment.��That’s��where we each recognize��a��story we read this��week��we think you should read,��too.��Don’t��worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week?��

Ollstein:��Sure.��So��I have a kind of fun story��[“”]��from my co-worker Amanda Chu about how the��Oura ring has taken over D.C. They have been heavily lobbying the Trump administration and Congress to prevent tough regulations.��Basically, there’s��a debate about whether it should��be regulated��as a medical device or not.��

Rovner:��Tell us again what it does.��

Ollstein:��It’s��a ring you wear��on your finger that��monitors��different health metrics. And��so��the Trump administration��MAHA��movement has gone all in on this. They love it. The Pentagon has a huge contract with them. Other government agencies are looking at it,��too. I think��it’s��interesting because it is this very sort of conservative mindset of individual responsibility in health care��and, oh, if you could just��track your own metrics and do the right things.��That’s��an approach that is��sort of counter��to the idea of public health��and government protecting your health through policy.��

Rovner:��And we know HHS Secretary Kennedy is��a big fan��of wearables.��

Ollstein:��Exactly, and this is one of the most popular ones right now. And��so��this story does��a good job��digging into all the lobbying��and also��into concerns about data privacy and pointing out that��these technologies are moving much faster than government can regulate them. And that is leaving��some��lawmakers really concerned about who could have access to this data.��

Rovner:��Jackie.��

Fortiér:��Mine is��by Ariana Hendrix.��She’s��a writer based in Norway.��It’s��entitled��“.”��It��was published��in��Stat. And she writes eloquently��about being a parent in Norway and knowing that her children��wouldn’t��go to day��care until they were about 16 months old, because Norway has paid parental leave. And she points out, beyond the vaccine debate��there’s��a bigger issue,��that the U.S.��lacks universal health care and federal paid parental leave.��So��changes in infant vaccines in the U.S.��have a large effect, because babies in the U.S.��often go to day��care,��when��they’re��around��a lot of��other kids when��they’re��just��a few��weeks old.��So��she points to the,��in January, the infant RSV��[respiratory syncytial virus]��vaccine��was moved��to the high-risk category of shots, so now it��isn’t��routinely recommended��for all babies in the U.S. And RSV, of course, is the most common cause of hospitalizations for infants, and that’s��due to the fact that��they’re exposed to the virus in day��care��a lot��earlier than other children in other countries like Norway and Denmark whose vaccine schedules U.S.��officials are now��kind of trying��to emulate.��So��she does a really��great job��of laying out how families face greater health and financial risks in the U.S.��without the same safety net that other countries have.��

Rovner:��Or just the same social policies that other countries have.��

Fortiér:��Yeah,��it reminded��me—��

Rovner:��It’s��hard to,��right,��it’s��hard to import another country’s��—��part of another country’s��—��policies without importing all of them. It is��really��good story. Lizzy.��

Lawrence:��Yeah. So my piece is by Rachana Pradhan and��KFF��Health��News, and it’s about the��“US Cancer Institute Studying Ivermectin’s ‘Ability To Kill Cancer Cells.’”��And I thought this piece was very interesting, just because in general I’ve been fascinated by��—��politicization of medicine isn’t new��—��but just like right-wing-coded products and left-wing-coded products. And in this piece,��Rachana��talks about NIH��[National Institutes of Health]��Director Jay Bhattacharya��kind of talking��about how,��It’s��the people’s NIH and if��a lot of��people are using it, well, we want to investigate it.��So��she��just, she��does a really��good job��of kind of unpacking why this is problematic, that��they’re��kind of just��choosing a random medication and��there’s��not really any scientific reason to be investing in it as much as they are. And she��got a response from NIH after the fact as well, kind of where they were trying to defend this decision to pour this��much��investment.��And so,��yeah, I think it’s just��a really interesting��development in NIH land.��

Rovner:��It is.��My extra credit this week��is from ProPublica,��by Mica Rosenberg, and��it’s��called��“.”��It’s��about what immigration detention looks like from the point of view of children��being held��at a family facility in Dilley, Texas.��That’s��the one where the two cases of measles��were diagnosed��earlier this winter. The story includes��some��pretty wrenching letters and video calls from kids who were living elsewhere in the U.S., while their parents were mostly working within the immigration system. And these kids had��been ripped��from their daily lives, their other parents and siblings in��some��cases, their��schools��and their classmates, and in��many��cases, from��hope itself. Wrote��one��14-year-old from Hicksville, New York, quote: “Since I got to this��Center all you will feel is sadness and mostly depression.”��It��really is��a must-read story.��

OK. That is this week’s show. As always, thanks to our editor,��Emmarie Huetteman,��and our producer-engineer, Francis Ying. A��reminder:��What the��Health?��is now available on WAMU platforms, the NPR app,��and wherever you get your podcasts, as well as, of course,��kffhealthnews.org.��Also, as always, you can email��us��your comments or questions.��We’re��at��whatthehealth@kff.org. Or you can find me on��X,��, or on Bluesky,��.��Where are you folks hanging these days? Jackie.��

Fortiér:��Bluesky mainly,��.��

Rovner:��Alice.��

Ollstein:��Mainly on��Bluesky,��,��and still on��X,��.��

Rovner:��Lizzy.��

Lawrence:��On��X,��. On��Bluesky,��.��

Rovner:��We’ll��be back in your feed next week. Until then, be healthy.��

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Billing mistakes. Stigma. Doctors who aren’t keeping up with the latest research. Those are just some of the hurdles that keep HIV prevention medication out of reach for many Americans.

The Centers for Disease Control and Prevention estimates more than 2 million Americans could benefit from a treatment known as PrEP, but only a quarter of them are getting a form of the drug. Zach Dyer appeared on WAMU’s “Health Hub” on Feb. 4 to share tips patients can use to avoid those pitfalls and find a doctor who knows more about PrEP.

�������ýҕ�l 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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This story can be republished for free (details).

Health policy changes in Washington will ripple through the country, resulting in millions of Americans losing their Medicaid or Affordable Care Act coverage. But there are still ways to find care.

Over the next decade, the GOP’s One Big Beautiful Bill Act is expected to slash nearly $1 trillion in spending from Medicaid, the state-federal program for people with low incomes and disabilities. The implementation of new work rules will cause some beneficiaries to lose their Medicaid coverage.

Millions of Americans are facing enormous increases in their out-of-pocket costs for ACA coverage. So far, 1.2 million fewer people have signed up for Obamacare plans compared with last year, and health policy analysts estimate more will lose coverage as they fail to pay their premiums.

Health costs are a top concern for Americans. Two-thirds of the public say they are somewhat or very worried about affording health care, more than express the same worries about utilities, food, housing, or gas, according to a , a health information nonprofit that includes �������ýҕ�l Health News.

“All of this pain just doesn’t have to be there,” said Cheryl Fish-Parcham, director of private coverage at the health consumer group Families USA.

Doctors and health policy researchers say health coverage, of any kind, is the best protection against major medical debt.

Caitlin Donovan, a senior director at the Patient Advocate Foundation, recommends exhausting every available option for health coverage before going uninsured.

Even a high-deductible plan can protect patients from medical bankruptcy “if the absolute worst-case scenario happens,” she said.

Here are five ways that the uninsured can find affordable care.

1. Don’t be afraid to talk with your doctor about money

Patients can be hesitant to tell their doctors they’re uninsured or be wary of expressing concern about being able to afford care.

But some hospitals, physicians, and other providers offer cheaper cash pay options, said Cynthia Cox, a senior vice president and the director of the Program on the ACA at KFF.

Often prices are negotiable. “Always ask,” she said.

Health care providers can make adjustments if they know patients are worried about money, said Ateev Mehrotra, a doctor and researcher at Brown University.

“If my patient tells me, ‘Doc, I’m gonna have to pay for this out-of-pocket,’ I’m gonna make a different risk calculus,” Mehrotra said.

That doesn’t mean a patient won’t get the care they need, he said. A doctor, for instance, might order an ultrasound instead of an MRI, which is more expensive.

2. Search for providers that specifically work with uninsured patients

If your usual provider won’t budge on prices, then search for providers that cater to patients without insurance.

Federally qualified health centers, or FQHCs, and other community clinics offer routine and non-emergency care, such as treatment for flu or infection, for low-income residents and the uninsured. Community health centers charge based on a sliding scale and see annually in some of the country’s most underserved areas, according to the National Association of Community Health Centers.

The Trump administration has made funding cuts that might lead some of the country’s approximately 1,500 FQHCs to close or cut services. But the administration still maintains .

Planned Parenthood also accepts uninsured patients. Its centers test for sexually transmitted diseases, provide birth control options, and offer postpartum and gender-affirming care .

And the National Association of Free & Charitable Clinics also offers to help people find free or low-cost care.

Most community clinics don’t offer specialty care, but they can usually refer patients who need more intensive services to providers willing to work with uninsured patients.

And academic medical centers tend to have more charity care programs that help uninsured patients lower their bills.

“If you’re uninsured or even underinsured, you might be able to qualify for a significant discount on the cost of your care,” Cox said.

Still, be wary of heading to the emergency room, which is the most expensive place to get care. While ERs are federally required to stabilize all patients regardless of their ability to pay, they can still leave you with a big bill — and often do.

3. Call your local health department

Health services vary widely from county to county, but many offer free vaccinations, family planning services, and testing for sexually transmitted infections, as well as for flu, covid, and tuberculosis.

Some county health departments also offer more advanced care, such as dental services and mental health or substance abuse programs. And some states have consumer assistance programs that can guide residents in finding care, Fish-Parcham said.

In addition, the Centers for Disease Control and Prevention’s makes free or low-cost breast and cervical cancer screenings available to low-income women in all states and territories. And some states cover screenings for other types of cancer as well.

4. It’s easier to shop around for drugs than doctors

Don’t just fill your prescription at the closest pharmacy. Instead, research generic drug options and look around for the best price on brand names.

A handful of sites such as and offer comparison shopping tools and information on other ways to get drug discounts.

And some retailers offer low-cost access to common prescription drugs — at prices cheaper than you would find if you had insurance. Walmart, for instance, sells 90-day prescriptions of of drugs for $10. As do , , and a new site called the .

Many drugmakers also offer patient assistance programs, coupons, and rebates on some medications. Check their websites for details on how to apply.

States also offer drug assistance programs. The steps to qualify and types of drugs vary, but has a list of programs and how they work.

Joining a clinical trial is another way to access treatment. The and its have lists, but patients must first meet the criteria. Clinical trials aren’t necessarily free, even with insurance, Donovan said, so be sure to ask about any associated costs.

5. Your diagnosis might lead you to specialized resources

Patients with a specific diagnosis might have additional options for specialty treatment.

For example, someone with breast cancer should check with the and the nonprofit , Cox said.

The Patient Advocate Foundation hosts that can help offset the cost of medical bills and provide other resources such as transportation and lodging, Donovan said. Just type in basic information such as age, location, and diagnosis to see what is available.

Disorder-specific foundations, such as those for lupus or irritable bowel syndrome, can also steer patients to free or low-cost resources or cover some costs of care, Donovan said.

“Everything is out there,” she said.

As you research affordable care options, don’t be tricked by plans that look like health insurance but don’t offer guaranteed protection against big bills.

Some short-term plans and health care sharing ministries might seem like good deals, but read the fine print. Some red flags to look for: too-good-to-be-true monthly payments; no coverage for preexisting conditions; morality clauses such as those prohibiting the use of alcohol or drugs; or a lack of coverage for benefits such as mental health counseling that are required in ACA plans.

�������ýҕ�l Health News correspondent Sam Whitehead contributed to this report.

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Durante la próxima década, se espera que la ley republicana llamada One Big Beautiful Bill Act recorte casi $1.000 millones del gasto en Medicaid, el programa estatal-federal que brinda atención sanitaria a personas con bajos ingresos y con discapacidades. La implementación de nuevos requisitos de trabajo hará que algunos beneficiarios pierdan su cobertura de Medicaid.

Millones de personas también enfrentan aumentos enormes en los costos de bolsillo de los planes de ACA. Hasta ahora, la inscripción en planes del Obamacare registra 1,2 millones de personas menos que el año pasado. Analistas de políticas de salud estiman que serán aún más los que perderán su cobertura porque no podrán pagar las primas mensuales.

El costo del cuidado de salud es una de las principales preocupaciones de la gente. Dos de cada tres personas aseguran que están algo o muy preocupadas por el costo de la atención médica y por si podrán afrontarlo. Según una , una organización sin fines de lucro que provee información sobre salud y que incluye a �������ýҕ�l Health News, esa preocupación es más frecuente aún que la que generan los gastos en servicios públicos, alimentos, vivienda o gasolina.

“Todo este sufrimiento no tiene por qué existir”, dijo Cheryl Fish-Parcham, directora de cobertura privada en la organización de consumidores de salud Families USA.

Médicos e investigadores de políticas de salud afirman que contar con cobertura médica, de cualquier tipo, es la mejor protección contra una deuda médica importante.

Caitlin Donovan, directora sénior de la organización Patient Advocate Foundation, recomienda agotar todas las opciones disponibles de cobertura.

Incluso un plan con deducible alto puede proteger a los pacientes de quedar endeudados de por vida “si ocurre el peor escenario posible”, dijo.

Los siguientes son cinco consejos para que las personas sin seguro encuentren atención médica accesible:

1. No tengas miedo de hablar con tu médico sobre dinero

A veces, los pacientes dudan en decirles a sus médicos que no tienen seguro o les da miedo expresar que les preocupa no poder pagar la atención médica.

Pero algunos hospitales, médicos y otros proveedores ofrecen opciones más baratas si se paga en efectivo, señaló Cynthia Cox, vicepresidenta sénior y directora del Programa sobre ACA en KFF.

Con frecuencia, las tarifas son negociables. “Siempre hay que preguntar”, agregó.

Los proveedores pueden hacer ajustes si saben que el paciente está preocupado por el dinero, expresó el doctor Ateev Mehrotra, investigador de la Universidad Brown.

“Si mi paciente me dice: ‘Doctor, tengo que pagar esto de mi bolsillo’, yo hago un cálculo de riesgos diferente”, explicó Mehrotra.

Eso no significa que el paciente no recibirá la atención que necesita, dijo. Por ejemplo, el profesional podría pedir una ecografía en lugar de una resonancia magnética, que es mucho más costosa.

2. Busca proveedores que trabajen específicamente con personas sin seguro

Si tu proveedor habitual no quiere bajar los precios, busca opciones que atiendan a personas sin seguro.

Los centros comunitarios de salud calificados a nivel federal (FQHC, por sus siglas en inglés) y otras clínicas ofrecen atención médica básica y no urgente —como tratamiento para gripe o infecciones— a personas de bajos ingresos y sin seguro.

Estos centros cobran de acuerdo con una escala ajustada a los ingresos y atienden a al año en algunas de las zonas más desatendidas del país, según la Asociación Nacional de Centros de Salud Comunitarios (NACHC, por sus siglas en inglés).

La administración Trump ha recortado fondos que podrían llevar a que algunos de los aproximadamente 1.500 centros calificados del país cierren o reduzcan servicios. Sin embargo, el gobierno mantiene un sitio web donde es posible .

Planned Parenthood también acepta pacientes sin seguro. Sus centros ofrecen pruebas para enfermedades de transmisión sexual, opciones para control de la natalidad, atención posparto, atención médica de afirmación de género para personas trans y .

La National Association of Free & Charitable Clinics, una asociación de instituciones que ofrecen atención sin cargo, también brinda una para ayudar a las personas a encontrar atención médica gratuita o de bajo costo.

La mayoría de estas clínicas comunitarias no ofrece atención especializada, pero suelen derivar a los pacientes que necesitan servicios más complejos a proveedores dispuestos a atender a personas sin seguro.

Además, los centros médicos universitarios suelen tener más programas de caridad que ayudan a reducir los costos para pacientes sin seguro.

“Si no tienes seguro o incluso tu seguro no es sólido, podrías calificar para un descuento significativo en tu atención médica”, informó Cox.

Sin embargo, hay que tener cuidado con ir a la sala de emergencias, que es el lugar más caro para recibir atención.

Aunque, por ley federal, las salas de emergencia deben estabilizar a todos los pacientes sin tener en cuenta su capacidad de pago, están habilitadas para generar cuentas muy elevadas… y a menudo lo hacen.

3. Llama al departamento de salud de tu condado

Los servicios de salud varían mucho entre condado y condado, pero muchos ofrecen vacunas gratuitas, servicios de planificación familiar y pruebas para detectar enfermedades de transmisión sexual, gripe, covid y tuberculosis.

Algunos también brindan atención más avanzada, como servicios dentales y programas de salud mental o de tratamiento por adicciones. Además, algunos estados tienen programas de asistencia al consumidor que pueden ayudar a las personas a encontrar atención médica, explicó Fish-Parcham.

También está el de los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés), que ofrece exámenes gratuitos o a bajo costo a mujeres de bajos ingresos en todos los estados y territorios. Algunos estados también cubren exámenes para otros tipos de cáncer.

4. Es más fácil comparar precios de medicamentos que tarifas médicas

No compres tus medicamentos recetados en la primera farmacia que veas. Es mejor buscar versiones genéricas y, en el caso de los medicamentos de marca, comparar los precios porque varían en diferentes farmacias.

Algunos sitios web, como y , ofrecen herramientas para comparar precios y tienen información sobre otras formas de obtener descuentos en medicamentos.

Además, algunas cadenas ofrecen medicamentos recetados comunes a precios incluso más bajos que los que se encuentran con seguro médico. Walmart, por ejemplo, vende recetas de 90 días de por $10. Lo mismo hacen , y un nuevo sitio web llamado .

Muchos fabricantes de medicamentos también ofrecen programas de asistencia al paciente, cupones, reembolsos y descuentos en algunos de sus productos. En sus sitios web es posible obtener más información sobre cómo solicitarlos.

Los estados también tienen programas de asistencia. Si bien los requisitos y los medicamentos que cubren varían, este tiene una lista de los programas disponibles y cómo funcionan.

Otra opción para acceder a tratamientos es participar en un ensayo clínico.

Los Institutos Nacionales de Salud y el Instituto Nacional del Cáncer tienen listas de estos ensayos, aunque los pacientes deben cumplir con ciertos criterios para que los acepten. Los ensayos clínicos no siempre son gratuitos, ni siquiera para quienes disponen de seguro, aclaró Donovan, así que es importante preguntar sobre los posibles costos asociados.

5. Tu diagnóstico podría darte acceso a recursos especializados

Las personas con ciertos diagnósticos pueden acceder a opciones adicionales de tratamiento especializado.

Por ejemplo, alguien con cáncer de mama debería consultar a la r (American Cancer Society) y con la organización sin fines de lucro , recomendó Cox.

La Patient Advocate Foundation ofrece una que pueden ayudar a cubrir gastos médicos y brindar otra ayuda como transporte y alojamiento, explicó Donovan. Solo se necesita ingresar información básica como edad, lugar de residencia y diagnóstico para ver qué recursos están disponibles.

Fundaciones centradas en enfermedades específicas, como el lupus o el sindrome de intestino irritable, también pueden ayudar a los pacientes a encontrar recursos gratuitos o de bajo costo, o a cubrir algunos gastos de atención médica, agregó Donovan.

“Todo está disponible”, dijo.

Sam Whitehead, corresponsal de �������ýҕ�l Health News, colaboró en este informe.

¿Tienes dificultades para pagar tu seguro médico? ¿Has decidido renunciar a la cobertura? Haz clic��aquí��para contactar a �������ýҕ�l Health News y compartir tu historia.

�������ýҕ�l 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 .

USE OUR CONTENT

This story can be republished for free (details).