Multimedia Archives - Ñî¹óåú´«Ã½Ò•îl Health News /tag/multimedia/ Ñî¹óåú´«Ã½Ò•îl Health News produces in-depth journalism on health issues and is a core operating program of KFF. Fri, 18 Sep 2026 12:02:28 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.9 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Multimedia Archives - Ñî¹óåú´«Ã½Ò•îl Health News /tag/multimedia/ 32 32 257378068 Sticker Shock at the Doctor’s Office Could Motivate Midterm Voters /elections/healthcare-affordability-shapes-competitive-races-midterm-elections/ Fri, 18 Sep 2026 09:00:00 +0000 /?p=2284845&preview=true&preview_id=2284845 Healthcare prices are likely to next year. As midterm elections approach, candidates are laying out their plans to tackle these growing expenses.

Ñî¹óåú´«Ã½Ò•îl Health News chief Washington correspondent Julie Rovner joined WAMU’s Health Hub on Sept. 16 to explain how healthcare could play a critical role in the midterm elections. She said similar cost increases in the early 2000s led to the debate that became the Affordable Care Act. 

“We’re seeing people have to pay more in their — not just premiums — but their deductibles, how much they pay before their insurance kicks in, and how much they pay when they go to the doctor,” said Rovner, host of the What the Health? From Ñî¹óåú´«Ã½Ò•îl Health News podcast.

In recent years, it’s not uncommon for healthcare providers to ask for payment upfront. 

“Now you get there, and they say, ‘Can we have your credit card?’ before you even get to go in and get your care,” Rovner said.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2284845 Cost-Saving Medicaid Meal Deliveries Threatened by Cuts, Policy Uncertainty /medicaid/medicaid-meal-deliveries-food-nutrition-waivers-trump-massachusetts-north-carolina/ Fri, 18 Sep 2026 09:00:00 +0000 /?p=2279389

On a weekday morning in a quiet Boston neighborhood, a kitchen bustled with activity. Volunteers sliced chicken breasts, stuffed bell peppers, filled trays, and carefully labeled each item. It was part of an experiment to offer nutritious and medically tailored meals to Medicaid patients who are unable to shop for groceries and cook for themselves.

“Once I started to eat these meals that were geared toward my illness, I built up my muscle mass again, built up my strength, built up my confidence in myself,” said Vanessa Georges, who is in remission from throat cancer and said she would struggle to consume enough calories without the deliveries. “These meals have given me a second chance.”

Georges said she noticed another benefit from the meals: She spends less time at the doctor’s office.

Researchers have found evidence backing her observation. About 1,900 Massachusetts residents who, like Georges, received medically tailored meals for at least three months needed less medical care, according to published in the journal Nature Medicine. They had 20% fewer emergency department visits and 31% fewer hospitalizations than similar patients who did not receive meals.

“It actually saves the healthcare system money,” said , a cardiologist and professor at Tufts University who led the study. “That’s a really big deal, because most things in healthcare don’t.”

The research from Massachusetts that medically tailored meals could save states money — in addition to improving health. Yet such programs could land on the chopping block as states look to tighten spending under Trump administration budget cuts, even as federal officials argue that food is a critical component of health.

Medicaid Budget Cuts Loom

The 2025 law known as the One Big Beautiful Bill Act slashed projected Medicaid funding by more than $900 billion. Many Republicans who backed the bill believe federal health spending is too high and riddled with fraud. Sen. John Kennedy, a Louisiana Republican, for example, has accused California of “outrageous fraud” for using Medicaid dollars to fund housing and nutrition programs.

, a policy analyst at KFF, said states will have to make tough choices in the next few years as they figure out how to fill funding gaps. “If states are not able to offset the loss of federal funds with new taxes or reductions in other state spending, they may have to make program cuts,” she said. (KFF is a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.)

Thirteen states have received federal waivers to use Medicaid dollars to pay for meals — part of an approach known as “food is medicine.” Three other programs are awaiting federal approval.

President Donald Trump’s support for social services has wavered. While the first Trump administration allowed states to pursue medically tailored meals and other social supports, the second Trump administration for Medicaid initiatives that address social needs. It hasn’t detailed a new policy. Administration officials have warned that they will be more focused on the budget impacts of such initiatives.

“They signaled they’re going to be a lot more skeptical,” said , an assistant professor at the University of Massachusetts Chan Medical School who studies nutrition programs and helped lead the Massachusetts study. “Instead of using a broad-based approach nationwide, they’re going to make decisions on a state-by-state basis.”

At the same time, health leaders in Trump’s administration have made nutrition a major focus, including by promoting . Robert F. Kennedy Jr., who leads the Department of Health and Human Services, and Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, have to serve healthier foods to boost patient outcomes.

Trays of meals
Trays of stuffed peppers and carrots from Community Servings are ready to be sealed and delivered to Boston-area residents who receive medically tailored meals. (Robin Lubbock/WBUR)

The healthcare system is often willing to pay for surgeries, Oz said in a social media video in June, “but not always willing to pay for the nutrition that might help prevent those outcomes in the first place. That’s bothered me my whole career.” He added that the agency is , including medically tailored meals, to prevent illness and hospitalization. CMS officials did not respond to several emailed requests for comment for this article.

, who studies social determinants of health at Harvard Law School’s Center for Health Law and Policy Innovation, said the lack of federal guidance is stirring uncertainty for states that want to pursue nutrition programs in Medicaid. “We’re still waiting to see that big step forward around ‘food is medicine’ interventions,” she said. “We need to see that step forward to resolve some of the uncertainty.”

Lawmakers have had a hard time engaging administration officials on medically tailored meals, said U.S. Rep. Jim McGovern, a Massachusetts Democrat who sponsored a bill that would pilot meal deliveries for some . The legislation has yet to come up for a vote.

“I had thought, based on some of his rhetoric before he entered the Trump administration, that RFK Jr. would be a natural ally on this,” McGovern said. “But we can’t seem to get his attention.”

The Costs of Poor Nutrition

Some companies have been accused of for meals that were neither healthy nor nutritious, raising concerns about lax regulation of these programs.

But at in Boston, the food is prepared with specific attention to sugar, salt, fat, vitamins, and minerals and is based on a person’s health needs, said , chief executive of the nonprofit. Many recipients require food that is mild or low in fiber, for example.

“What we’re able to do is to work with your healthcare provider to understand your health realities — what your diagnoses are, what your medications are, side effects, food allergies, cultural norms — and then prescribe a diet for you that is scratch-made,” Waters said.

The Massachusetts researchers found that the meals — at a cost of $125 per person per week — essentially paid for themselves. Patients with heart disease used about $10,000 less in healthcare services over six months, and patients with kidney disease used $12,000 less in healthcare. There were also savings for people with diabetes, depression, and anxiety.

“Those are pretty big numbers when you think of how expensive those diseases can be and the prevalence in the population,” Waters said.

Nationally, , 10 million Americans would benefit from medically tailored meals, though only a small fraction are enrolled.

“Poor nutrition is the top cause of poor health in this country. It’s the top cause of preventable healthcare spending,” said Mozaffarian, director of the Food is Medicine Institute at Tufts. He has estimated that medically tailored meals could help patients avoid 1.6 million hospitalizations and in healthcare costs each year.

A Weekly Delivery That Makes a Difference

Steve Honyotski receives 10 meals at his Boston home each week, cooked fresh and delivered cold or flash-frozen. They’re ready to eat after just a couple of minutes in the microwave.

“The carrot ginger soup is my favorite,” Honyotski said.

Honyotski, 71, lives with several chronic conditions, including diabetes, obesity, and high blood pressure. He said he’s noticed improvements in his health since he started eating medically tailored meals. He needs less insulin to control his diabetes, and he’s lost enough weight to delay a knee replacement surgery.

The exterior of a building
Community Servings is a nonprofit that provides medically tailored meals in the Jamaica Plain neighborhood of Boston. (Robin Lubbock/WBUR)

For now, those meals will keep coming. And Massachusetts’ Medicaid director, Ryan Schwarz, said the state will seek federal approval to continue medically tailored meals in the coming years. “We feel very strongly committed to continuing these services,” he said.

In North Carolina, researchers found that food and housing supports lowered Medicaid spending over time. Yet even with federal approval for medically tailored meals, and evidence that the meals — along with housing and transportation support — were helping people, North Carolina state lawmakers suspended the services in 2025 over budget worries. After budget deliberations this summer, state legislators changed course and decided to the program.

“To me, that’s a signal of what might occur in other states as these Medicaid cuts hit,” said Hager, the UMass researcher. “Even though they have the authority to run these programs, it might be a lot harder for the states to actually implement them.”

This article is from a partnership that includes , , and Ñî¹óåú´«Ã½Ò•îl Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2279389 Listen to the Latest ‘Ñî¹óåú´«Ã½Ò•îl Health News Minute’ /news/listen-kff-health-news-minute-2026/ Thu, 17 Sep 2026 09:00:20 +0000

The Ñî¹óåú´«Ã½Ò•îl Health News Minute is available every Thursday via direct download or the RSS feed.

Sept. 17

Zach Dyer [DYE-er] reads the week’s news: The high cost of fertility treatment is making some Americans look abroad for help getting pregnant. Plus, a nonprofit in Austin, Texas, is trying to keep its city’s music scenes going by helping artists pay for health insurance.

Can’t see the audio player? Visit kffhealthnews.org to listen.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2242497 States Bet Big on Rural Health Startups, With a Silicon Valley Twist /rural-health/rural-health-tech-startups-funding-louisiana/ Wed, 16 Sep 2026 09:00:00 +0000 /?p=2279897 Your browser does not support the audio element.

Can’t see the audio player? Visit kffhealthnews.org to listen.

When Josh Fleig, Louisiana’s chief innovation officer, learned his state had set aside $20 million a year, for five years, to invest in startup rural health companies, his reaction was not surprising: “Wow!”

In rural America, where people are often reported to be sicker with poor access to healthcare, the cash influx is a relief. In the economic development space where Fleig operates, it’s an opportunity.

“Look, that’s a lot of money for what we do,” said Fleig, whose state-funded economic development office invests in corporate launches, ranging from software startups to shipbuilders.

A headshot of Josh Fleig.
Josh Fleig, chief innovation officer for the Louisiana Economic Development agency, says he’s excited to help fund startup technology companies that could improve the health of rural residents in the state. (Margot McNeely/Louisiana Innovation)

Louisiana and a handful of other states set aside money from their share of the $50 billion federal Rural Health Transformation Program to quickly invest in new technologies, mirroring private industry moves. Lawmakers added the rural health program to offset more than $900 billion in reduced Medicaid spending expected over 10 years from Republicans’ sweeping 2025 tax and spending law.

But rather than filling the budget hole, the rural program’s assignment is to find new approaches for revitalizing rural communities where doctors are in short supply and hospitals have been downsizing and closing for decades. The federal government doled out the first-year rural health program awards to states this year, with pots ranging from $147 million in New Jersey to $281 million in Texas.

Modernizing technology infrastructure is a key pillar of the federal rural health program, and the catalyst money epitomizes the administration’s strategy to move fast and experiment with untested technology — much like the “move fast and break things” mantra during the heyday of Silicon Valley.

Instead of breaking things, though, the goal is to “move fast, fast-fail, innovate quickly, and move to sustainability,” said Aaron Bujnowski, a managing director with the healthcare industry group at the consultancy Alvarez & Marsal. “This is a transformation that is still meant to serve the people.”

Rigorous Rules and Tight Deadlines

Beyond Louisiana, Timothy Foster, a spokesperson for the Centers for Medicare & Medicaid Services, confirmed that Delaware, Georgia, Massachusetts, Nebraska, South Carolina, Virginia, and West Virginia are also creating rural health tech catalyst funds.

Every year, states must compete for rural funding in the five-year federal program. Federal regulators will take money away from states that do not meet the goals promised in their applications, including whether they designated money to companies for tech innovations.

CMS, which is overseeing the program, released a seven-step for states to follow when creating the tech catalyst operations. No more than 10% of each state’s award can be spent on a rural tech catalyst fund.

States’ initial annual progress reports for the rural fund were due at the end of August. CMS has declined to publicly post those reports; it plans to publish an annual report on state progress. States must show that first-year funds will be obligated — but not necessarily spent — by Oct. 30, according to the CMS guidance document.

Daniel X. O’Neil, a technology consultant who advocates for open data and open government, created a and parsed the original state applications to find dozens that mention catalyst awards and technology funds.

O’Neil said he is “looking forward to the clawbacks and the craziness of October because, you know, that’s serious stuff.”

For the rural health catalyst funds, CMS requires states to submit the list of finalists “at least 15 business days” before announcing winners, along with “sufficient information” for the agency to “assess each proposed project,” according to the guidance document.

The document outlines intellectual property and federal rights but does not provide guidance or standards for patient rights or protections. CMS spokesperson Foster stated in an email that the technology investments must comply with federal “privacy, security, interoperability, and patient safety” requirements.

Protecting Patients

Maya Sandalow, director of the health program at the Bipartisan Policy Center and one of the leading analysts watching the rural fund, said the catalyst funds are “public dollars” and has called for more transparency in the overall rural health program. The center is a nonprofit think tank in Washington, D.C.

Accurate and timely reporting must be done to ensure “the necessary guardrails are in place” to protect patients, she said, adding that the innovation needs to be “tested in a way that’s safe for the patients that they are going to be used on.”

To apply, startups must be less than 10 years old and have raised less than $50 million in early funding. Companies that win a portion of state catalyst funds must meet predetermined milestones before being paid — and federal officials will make “targeted reviews as needed,” according to the guidance document.

Louisiana officials announced the state’s tech catalyst fund with an event in rural Natchitoches, known as the filming location of the 1989 film Steel Magnolias. The fund quickly drew more than 200 companies competing for between $250,000 and $3 million in seed money.

Tiny startup Greens Health was invited to the event. The 2-year-old company analyzes Medicare claims to identify patients with chronic diseases, such as diabetes, and works with local home health nurses and senior facilities to improve care.

“We’ve been looking for a way to launch in Louisiana,” said Kehlin Swain, co-founder and chief executive of Greens Health. The company serves about 100 patients across Texas, Alabama, and Florida and hopes to get a $250,000 investment from Louisiana.

Louisiana’s Fleig said his state is “at a really interesting turning point.” The state secured $208.4 million for the first year of the rural health program and quickly created its catalyst fund using the state’s already established innovation department.

At the same time, nearly 1.1 million people live in Louisiana’s rural parishes and the state ranks as the “least healthy” in the nation, according to its own application. State rates of diabetes, obesity, and cardiovascular disease are among the highest in the nation.

Fleig believes Louisiana is an ideal place to test technology solutions. So, while Silicon Valley has “not needed much of what Louisiana has had to offer” for much of its existence, it does now, he said.

Caret Health is one of those companies. Co-founders Riya Pulicharam, who is a physician-researcher, and Kevin Zhao, an engineer, met in Silicon Valley. Together, they created a technology platform that identifies patients who need help getting to their appointments, having scans done, or picking up prescriptions. That technology flags a human, who then contacts the patient with a call or text.

Zhao said Caret had successful pilots at large health systems, but those places also had other vendors and “it was a pretty big uphill battle” to get in and scale. Then, in 2024, the company began paying attention to rural places.

“There wasn’t a lot of existing infrastructure. And that was really good for us because we were able to come in very quickly,” Zhao said. “A lot of the hospitals really needed this kind of service.”

Fast-forward to 2026: Caret Health is about 4 years old and has contracted with about 60 hospitals in 16 states. Pulicharam and Zhao hope to win $3 million to expand into Louisiana.

Louisiana’s Fleig said the state will take an equity stake in each company it invests in. “The dream” is that selected startup companies will also help the state make money to reinvest. If some companies fail — or fail fast — that’s to be expected, but the state should still make money because of “the law of averages,” he said.

“If we are good, we’ll make more money than we spent,” Fleig said. “Either way, it’s going to go back into improving healthcare outcomes.”

Rural Tech-Catalyst Funds: Fast-Moving, High-Pressure

First-year progress reports were due at the end of August. Using the annual report, federal officials will recalculate and potentially claw back money from underperforming states, according to created by the Centers for Medicare & Medicaid Services, which oversees the program.

States will be scored on a multitude of initiatives and plans, plus whether they earmark their first-year spending by Oct. 30. Year 2 funding will be determined by the end of October.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2279897 The Meltdown in Employer-Sponsored Health Insurance /podcast/arm-and-a-leg-podcast-employer-sponsored-health-insurance-costs-businesses/ Mon, 14 Sep 2026 09:00:00 +0000 /?p=2282220&post_type=podcast&preview_id=2282220 Employer-sponsored health insurance covers more than 165 million Americans. It can entice someone to work at one company over another, or be a set of golden handcuffs that keeps them locked into a job they may not enjoy.

But rising costs are straining that system like never before. As premiums balloon, employers have started to pass on more costs to their workers, and the percentage of small businesses offering employees health insurance has dropped significantly.

Stat reporter Bob Herman has been covering this in his series “.” An Arm and a Leg host Dan Weissmann and Herman break down how businesses big and small handle the skyrocketing cost of providing health insurance and what it means for workers.

Dan Weissmann Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on "All Things Considered," Marketplace, the BBC, "99% Invisible," and "Reveal," from the Center for Investigative Reporting.

Credits

Emily Pisacreta Producer
Claire Davenport Producer
Adam Raymonda Audio wizard
Ellen Weiss Editor
Click to open the Transcript Transcript: System meltdown: employer-sponsored health insurance

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there. Rachel Bernier-Green runs Thrive-O Financial Advisory on Chicago’s South Side. She describes herself as a fractional CFO for small businesses, offering strategic financial advice along with accounting services. And she says employee health insurance was part of her business plan from the beginning.

Before she even had employees, she built extra money into her prices, and at first, she put that extra money into a rainy day fund. But by late 2024, she thought the time had come. 

Rachel Bernier-Green: I’d been in business for a while. I had a few team members, and things were moving along. 

Dan: She wanted to keep those team members around, and she knew health insurance would help do that

Rachel Bernier-Green: And so that’s when I actually started to think, “How do we actually get this in place?”

Dan: She says she moved quickly– and by January 2025, her six-person team had health insurance.  Then things got wobbly.

Early in the year, a major client left. Income took a hit, and by spring she could see big trouble coming toward her. Insurance for 2026 was going to be way more expensive. And she could tell because some of her clients were already seeing rate hikes from their health insurance companies.

They had policies that renewed early in the year, . And these were much steeper increases than they’d been expecting, so they came to Rachel, their fractional CFO, to help them figure out how to adjust, and Rachel knew she would have to do the same.

Rachel Bernier-Green: It was almost like standing on a train tracks and you’re just kind of staring down the impending doom because you know you’re going to be in the exact same situation in a couple of months.

Dan: She says she shared the bad tidings with her team as data came in right from the start, and she said she makes a practice of sharing the company’s finances, details and all, with her colleagues. She calls it open book accounting.

Rachel Bernier-Green: We have regular team meetings where we’re discussing these things and we could all look at the numbers and the writing was on the wall. So when we kind of got to the end of the road, it wasn’t me saying, “Surprise, here’s what’s going on with the health insurance.” It was more, okay, we’ve reached the point where we have to make a decision and call it.

Dan: They made the call at a regular team meeting, which doesn’t mean the meeting was routine.

Rachel Bernier-Green: My heart was just in my stomach. Um, Because like I knew what we needed to do and I just didn’t want to, want to do it. 

Dan: But they’d gotten their renewal notice for 2026. Health insurance was gonna go up by more than 10%. Rachel says everybody agreed the business couldn’t afford it. 

Rachel Bernier-Green: The numbers were pretty clear in black and white. the entire team was on the same page that what was most important was that the business continues to survive so that we could bring back those benefits in the future. 

The thing I remember the most is that another team member who relied on the insurance reassuring me that that was the right thing to do.

Dan: Even with that kind of consensus, and even with a plan in place to bring back those benefits for 2027, Rachel describes the whole episode as devastating. She’s gone on a plan from her husband’s employer. Some other colleagues have done the same, one has left the firm, and two are uninsured. Rachel and her colleagues aren’t alone.

They’re a case study. A reporter named Bob Herman featured them recently in a story for STAT — a news outlet dedicated to health and medicine.  The headline for Bob’s story: America’s Small Businesses are Giving Up on Health Insurance. And the crisis Bob is reporting on goes beyond small employers. That story kicked off an eight-part series called Out of Pocket, Out of Reach, with a subtitle that tells you how big and how deep this crisis goes.

It’s “How America’s Employer-Based Healthcare System Continues to Crumble in Slow Motion,” which sounds scary and absolutely sucks, but it’s the kind of big picture look we really need, and Bob is exactly the person to break it down. He’s the Business of Healthcare Reporter at Stat. He has done the most comprehensive reporting on the giant UnitedHealth Group.

And for years, he’s published a list of the top paid CEOs in healthcare. These compensation packages go to the hundreds of millions of dollars a year in some cases. It’s completely wild. And he knows how to bring a huge story down to earth. He’s coming right up. This is An Arm and a Leg, a show about why healthcare costs so freaking much and what we can maybe do about it.

I’m Dan Weissmann, I’m a reporter. I like a challenge, so the job we’ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful. Bob Herman joined me from a closet. One of his kids had a friend over, it was the quietest place in his house.

He was sitting on the floor. I should’ve been recording the whole time. But we did have the recorder on when I asked him, “How did you come to the conclusion that employer health insurance doesn’t just suck, it’s crumbling?”

Bob Herman: Well, here, maybe it’ll help if I explain kind of the origins of why we even started it. Um, so I’d gotten back from parental leave last year around November. My wife and I just had our second kid, and literally the first thing I have to do, both of us, we both have to do when we get back, is we have to figure out what health insurance plans we’re gonna enroll for the next year, which, as I’m sure you and every one of your listeners knows, is a miserable experience. Um, and I… And we cover healthcare, and it’s still miserable. It’s tedious but also it’s, it, it is high stakes. And at that time, we had seen all the headlines that employer-sponsored health insurance was experiencing double-digit increases ac- everywhere. It is one of the primary ways that Americans are covered, and we’re all getting slammed in the face with historically high premium increases. It turned into, like, this needs to be a project at Stat. Let’s go after it. Let’s figure out what’s going on. And I think it just became very clear that employer-sponsored health insurance is not, you know, the robust product that I think a lot of people think it is.

Dan: And your conclusion here is, like, there’s a structural problem here, starting with how fast the cost of employer-sponsored insurance is going up. 

There’s a, there’s a really big number in your story where you kind of compare how much more health insurance costs now than it did 40 years ago comparing it to the rate of inflation. And basically, health insurance prices have risen almost four times as much as inflation in general. 

Bob: ?Right. And like, you know, we’re talking over the past several decades, almost 1,000% increase versus wages that were much, much lower than that., 

Dan:  So, one takeaway there is:  This huge increase amounts to something like a hidden pay cut for all of us. 

Bob Herman: Hopefully that’s one thing that this series can accomplish is for all workers out there, when you enroll in your health plan every year, how your employer’s paying for it, how much is getting taken out of your own paycheck. These are things that ultimately affect how someone can pay for their day-to-day things, like groceries feel expensive, rent feels expensive. Why? I think part of it is because your employer health plan, it’s become such a financial burden for everybody

Dan: Yeah. Yeah. That is, I, yes. I mean, you, you’ve said to me, I, I think about all the time, which is like, even if your employer covers your health insurance, , like every dollar that your employer is putting toward health insurance is a dollar they could be paying you. It’s a dollar that’s on the budget line for your position

Bob Herman: It’s exactly right, Dan, and this is like, you know, it’s like an iceberg. I think a lot of people see, like, what’s, what gets taken out of their paycheck every month. Like, okay, I’m paying, you know, a couple hundred dollars toward my health- health insurance premium. That is only, like, 20 to 25% of what your actual premium is.

Your employer’s paying most of it. You just don’t see it. But, like, there is so, like, this big block of compensation that you get, a big and growing chunk of it is for the h- for your health plan, and it’s so hidden, and I think that’s what kind of makes the whole p- the, the whole thing so difficult, uh, for Americans to afford.

Dan: I mean the amounts are really striking. The average employer plan for a family now costs 27 thousand dollars a year. That’s average, not the most expensive. And that’s like? It’s a new car, right? These days it’s y- and not, I mean, not a top-of-the-line car, but a Toyota Corolla is, you know, a car yeah 

Bob Herman: Yeah, it, it’s that new, it’s that new car every year, but the employer’s paying the tens of thousands that makes up most of the car. That’s the part that is hidden and that’s what, you know, I think makes the healthcare system, you know, really take advantage of everything

Dan: And, um, you know I notice you’re saying that the fact that it’s hidden helps the health care SYSTEM take advantage of everything.  Not just the health insurance companies. Because they make profits, band they’re the conduit through which everyone else also gets paid.

Bob: You’re right, like it is the health, the health insurance company often takes some for itself, yes, but majority of that money is, it goes out the door to hospitals, to drug companies, to doctors, to device makers, drug distributors, whoever else. Like, all those different companies know that the employer-sponsored system is like their golden goose. 

Dan: So that wild inflation in health insurance premiums — it’s driven by how much more everything in health care costs. How much prices keep going up.  You’ve said — I mean, everybody knows — we pay more for health care in the US than anywhere in the world. Knee replacement, MRI, any meds you can name, we pay a lot more. And I hear you saying: The fact that some of these costs are hidden — they’re bundled into employer health plans — that actually creates opportunities for price gouging, for all kinds of gaming the system. 

Bob Herman: there’s all this money that employers are dumping into these, you know, health insurance premiums for their workers, and it is, it’s like a feeding frenzy. Uh, you know, years ago I remember going to JP, the JP Morgan conference, uh, out in San Francisco. It’s just like the confab where all the big healthcare industry players, you know, gush about how much money they’re making. And commercial insurance, the employer-based insurance is their golden goose, and they know it. And, I, I went around talking to people, and it’s not like they were dismissing that idea. They know that the commercial insurance market, the, what we get, what we all pay for and through our employers, that’s where they make hay. They could charge whatever they want, they being hospitals, doctors, drugs, doesn’t matter. They know that there’s that massive pool of money there. It is, you know, just imagine, like, Scrooge McDuck, right, where there’s this massive pile of coins, and he’s kinda swimming through it. And

Dan: That image has come up before on this show. 

Bob Herman: Yeah, it, it’s just that is, that is the employer market. And, you know, it’s, it’s a lot easier to make money when, you know, the people who are paying into it don’t understand how much they’re paying into it

Dan: Yeah. So you came into this project ’cause you cover the whole business of healthcare. You were already thinking like, “This is a huge story people need to know about. It’s a hidden pay cut. It keeps making insurance and healthcare more expensive every year. Keeps getting worse.” But it, it sounds like you didn’t realize at first the kind of trouble that small businesses were in

Bob Herman: As I was just doing research and talking with people and reading up, you know, there was a KFF employer health benefits survey, I and just buried deep th- within this, very detailed report, there was this chart showing for companies with 200 or fewer employees, you know, a little bit less than 60% of these small companies were offering health insurance now. Historic low, it’s the lowest it, it had ever been . And I was like, And I was like, oh my God, like, that is a shift. It’s this idea that small companies are giving up on this grand American idea of offering health insurance. It’s actually unraveling right now. 

Dan: and so, you concluded small businesses are giving up on health insurance what does that mean they’re actually doing?

Bob Herman: Yeah. I think when we think about employer-sponsored health insurance, companies do it because it’s a retention tool. And , it could be a deciding factor for an employee to come work for you, right?

Like, “Oh, my gosh,” like, “this health plan looks pretty good. Sign me up.” but if, if it’s actually eating into your bottom line, especially as a small business where you don’t have a whole lot of margin to begin with, like that is, that is huge.

 Small companies, they already kind of live on the bleeding edge, right? They just, you know, if you’re at a Fortune 100 company, you have more money than you know what to do with. If you’re a small company, just by your nature, you don’t, you know, your business is small. And it means that the cost of health insurance eat into your expenses so much more.

 And, you know, if you’re just a company of like, for example, 25 people, and you have one really big medical claim, your insurance company can, could come back to you next year and say, “We gotta raise rates 20% because of that one medical claim.”  and, and you know what the crazy thing is? It’s like a 20% is a, a g- gigantic amount, and it’s not, like, that uncommon for a small business to get slapped with that. Like, I, I spoke with, a business in Pennsylvania, and they were staring down the barrel of, like, a 50% increase.

 It’s not uncommon for premiums to, like, double, which, what are you gonna do then? You have to look for other options.

Dan: A-and what you knew when you started was things are getting bad, like rates have been going up even faster than we’re used to, right?

Bob Herman: And the, the past two years in particular have been really bad because, you know, insurers, like they endured a lot of losses. Not a lot of losses, but like they, this … The, the losses were more than they had expected over the past couple years, and so they’re making up for it now. They made up for it in 2026, and they’re making up for it again in 2027, and that’s exactly what you and others are feeling right now

Dan: C- I mean, they’re the house. It’s a casino and they set the odds, and the house never loses. Like, it’s, it’s made that way. Like, you can’t… Like, the, the bookmaker never loses. Like, , they employ a lot of actuaries, and actuaries are just bookmakers, right?

Bob Herman: Yeah. The actuaries, they are the, the very smart people that analyze, like, how much care everyone’s getting and how much they can predict that that will go up next year. , and they’re pretty good at it. And, you know, obviously the past couple years they were less good at it, but They know if there is a bad year, they can easily adjust the premiums to make up for that bad year. There is no, there’s no multiple years of losing money in health insurance. That, that just doesn’t happen

Dan: Unlike, unlike the rest of us. Yeah. So, if you’re really big, you’re spreading the risk out across a whole bunch of people, and you have reserves, and you have long-term plans.

 And if you’re a tiny little business you don’t have all of the tools to kind of sock money away for something or pull money out of your budget someplace else. Is that, is that basically the, the deal?

Bob Herman: I thi- yeah, I think you have it spot on. If you’re a big company, you can weather these things better.The more people you have, the more money you have to pay out when someone does have to file some kind of claim.

Dan: So but so what did your reporting show you about what small businesses are doing instead and what workers are doing instead?

Bob Herman: Yeah. I mean, none of it is ideal, right? ‘Cause, like, m- a lot of small businesses, they… The ones that I spoke with, and I think this is generally true, like, they wanna offer health insurance. And when they can’t do that, some are just saying, like, “You’re just gonna have to figure it out yourself,” which is, like, it’s a great way to lose an employee, right? Like, “Oh my God, I don’t have the safety net anymore.”

Others are doing, you know, maybe giving their employees extra cash that they can say, “Hey, go buy a health plan on the ACA marketplace.” And you know, it’s not ideal because if you think, you know, when, if you have a employer plan, usually it’s, you know, there’s a, a pretty big network or there’s, like, lower out-of-pocket costs, and when you go to the exchanges, it is a world of difference.

 Like, your doctor may or may not be in-network. Out-of-pocket costs and deductibles are generally much higher, and it’s just, it’s a completely different product. 

Dan: It’s worse. That what you find on the exchanges as an individual is worse than what you’d

Bob Herman: It is. 

Dan: I, I have, I, I, I know this firsthand. Like, the first episode of our podcast, I’m shopping on the exchange. I’m like, “This is bad.”

Bob Herman: Yeah, and like, don’t get me wrong, the ACA provided some kind of baseline level of protection for people who would otherwise be uninsurable. Like b- like, it’s crazy to think about 20 years ago, if you had some kind of preexisting condition, you just couldn’t get insurance. Like, sorry. And, um, but, uh, like the ACA plans are, they’re rough.

Like, it, like it’s, it almost… Like, if you have a $9,000 deductible, is that even insurance at that point? I think that’s a fair question to ask

Dan: And, a- and just to zoom out from there, like that chart you found, the one that showed smaller employers are down to just like 60% offering health insurance, it, it also showed that for larger employers, that number hasn’t changed much, right? It’s like still like 97%.

Bob Herman: Yeah, it’s, um, I think this question’s important because, um, it, it does kind of help explain the economy in terms of haves and have-nots, right? Where the biggest companies are always gonna be able to offer health insurance if they really want to. They just, they have the money to do it. Small businesses, like, we’re living in the shift right now where small businesses are not thriving anymore in terms of offering health insurance, . Well, guess what? Like, I don’t s- foresee this reversing course anytime soon. Ask any small business, and more of them are gonna be like, “You know, my time is, like, up.”

 And, you know, is it, does this, does this spur companies to shut down? I don’t know. Like, it’s totally plausible. Um, it’s not good. It’s not good for the economy, and it, there was even a recent survey that shows that it’s not good for workers either. Like, a lot of people just stick in their jobs, jobs that they hate, because they’re just doing it for the health insurance.

 Like, what kind of economy is that where you’re doing something, you’re collecting a paycheck really to just also get health insurance? It’s not, doesn’t feel particularly productive. So, like, these are all problems that are happening right now

Dan: The, I, I saw that survey and you wrote about it. Like twenty four percent of people in that survey said, “I would leave my job except for the health insurance.” A quarter of people

Bob Herman: Yeah. And what a term, right? Job lock. Like it’s, it’s this well-known economic term, job lock. Like you’re s- you’re locked into your job not because you want to, because, but because you feel like you need to. It’s, 

Dan: And you dug into some of those numbers. You were like, “Yeah, and job lock does not hit all people equally,” right? That people are… Who’s, who’s more vulnerable to job lock?

Bob Herman: It’s, it’s oftentimes it’s people who have more chronic health conditions, right? It’s like, “Oh my God, I know I’m going to be a user of my health insurance.” So like, that makes more s- like especially women because, um, you know, especially if, if you’re planning on having a baby or if you just have any kind of chronic condition, it’s like you are… If you know you’re gonna be using your health plan, you can’t afford to leave your job even if you think it sucks

Dan: , you said at the top of our conversation that, you know, this system is collapsing and that, that health insurance isn’t, employer health insurance is not the kind of robust product we thought it was. And not just for small businesses, even though it’s more obvious for them. But you did report this spring briefly on a survey that said, like, some large number of CFOs were like, “Yeah, we didn’t hire people,” or, “We raised our prices,” uh, because of the cost of health insurance, right?

Bob Herman: Yeah, this is still affecting larger businesses, and it’s happening in all the usual ways that we’ve seen over the past, you know, two decades. It’s making deductibles higher for employees. It’s making them contribute more from their paychecks. It’s changing the health plans. And, you know, I, I just spoke with someone the other day. They said that their out-of-pocket max, it’s the term like after you reach this amount, you don’t have to pay any more for the rest of the year, like it doubled. Like that is a health benefit design change where it actually functions like a wage cut too, right? So th- big companies will always be able to do it, but they have been making changes, and most of the times it just means that the worker and their dependents are taking it on the chin somehow.

Dan: Making health insurance worse. So, I mean, there’s a big story that’s just coming out right now: Did you see the story that Disney is saying, “Actually, your spouse can’t be on your plan anymore if they have an offer from their employer”?

Bob Herman: Yeah, , Disney’s basically saying if your spouse has an offer of insurance through their own employer, they have to take that. They can’t join the Disney plan, which is just, honestly, it’s batshit crazy.

For a company that is, like, supposed to be very family-friendly, this is a very anti-family-friendly thing that they’re doing

Dan: The analysis that I saw was like, look, uh, who chooses our insurance when they have an offer from their insurance? It’s somebody who thinks our insurance is better and is, and thinks they’re likely to use it.

Bob Herman: Right. 

Dan: We think we’re gonna be paying out claims. 

Bob Herman: Right. Yeah, I mean, if you think about it, um, if, if you are sick and you know you’re gonna use insurance, you’re gonna choose the plan that, uh, that offers you more protection. Um, so I mean, like actuarily, like it makes sense. Like they’re, they, they have data showing that like when people join or when dependents join the plan, it is costing them more money, and now they’re going to actively stop it. Like if, if the entire social fabric of employer-based insurance is you, if you have a job, you can get an offer of insurance and your, you and your family can join it, even that is starting to unravel. Like what happens if every other employer did this?

Dan: Yeah, it sounds like the idea you started with — that big employers will keep offering health insurance — they’re not gonna walk away but it sounds like you’re reconsidering this?

Bob Herman: I am kind of reconsidering, and honestly, it’s the GLP-1s that have really started making me reconsider this. Like, Pepsi just this week said, “We’re not offering GLP-1 coverage for weight loss anymore for our employees.” Like, it’s not to say, like, that big… I still think big companies are always gonna offer health insurance, but e- but something like GLP-1 coverage, where it is o- so much money and so many people are using it, 

[00:29:46] Even for that, they’re saying, “No, we can’t do it anymore.” they’re still gonna offer coverage that will, that will try to attract people that they wanna attract. But stuff like this shows that, and, like, it is very clear the employer-sponsored health insurance system is unraveling more than perhaps I’ve ever seen.

Dan:  And yet: The experts Bob talked to all said, they don’t expect this system to change anytime soon.  And Bob ended up with some pretty clear ideas about just why that is. That’s coming right up.

This episode of An Arm and a Leg is a co-production of Public Road Productions and Ñî¹óåú´«Ã½Ò•îl Health News. That’s a nonprofit newsroom covering health issues in America. It’s a newsroom full of superstar reporters; we are honored to work with them.. 

Dan: The sense I got, you know, from your reporting is it, like, big employers aren’t happy about it. They’re, they’re mad. Um, they’re unhappy, but that this system is not likely to go away, So, if everybody’s like, “This sucks,” why doesn’t somebody do something? And you had, like, you had a kind of analysis of like, who’s getting things out of it. Who’s benefiting from, from the way things are?And who would get hurt if, if things changed?

Bob Herman: Getting rid of the employer sponsored health insurance system is just vehemently opposed by big business. They know, especially the largest businesses, if they offer an attractive health plan, they could get anybody they want.And then going back to the job lock, those people could also stay with them for a long time because they know that they have the health plan. Um, and the, the largest tax break in the entire code is employer sponsored health insurance, so it’s great for, you know, middle and upper class p- you know, people. It’s great for the businesses. They don’t… Like, nobody pays any taxes on it. 

Dan: I was really struck by the note that it’s the biggest, it’s the biggest tax break in the entire tax code, , we’re talking hundreds of billions of dollars that otherwise would go into the federal kitty that don’t. Um, so businesses, they see all of these, things that are beneficial to them, and even though it costs them so much money, it is not worth giving that up. like, “We, we still have way too many advantages from it, even though it costs us an arm and a leg.” You had a specific example, but like the Affordable Care Act was, part of its design was like super suped up, workplace health plans would incur a tax, and that this did 

Bob Herman: Yes. I, I don’t know if you remember that debate, Dan, but it wa- it was called the Cadillac tax, and it was this idea that, you know, if it’s a really, really super generous plan, we’re gonna start to tax a little bit. Everyone lost their minds about it, and it was across the board. It was businesses, it was unions, who obviously fight very hard to, you know, to, to negotiate for their health plans. It was just universally reviled. But the idea was we need to start taxing these. It went terribly. It got killed, and that w- it was honestly, it was a pretty modest change, and look at, look what happened there

Dan: A- and so I think what, what that example shows is there are people with something to lose, and then of course there’s all the people who, uh, you know, make money in healthcare, not just insurance companies, right? 

Bob Herman: Yeah. The healthcare industry is very powerful. If you look at like, like lobbying dollars, like healthcare companies and their trade groups are always at the top. And like, yeah, they want inertia. As they, you know, vacuum up another, you know, $6 trillion this year and exponentially more next yearIt is a feeding frenzy. And again, this was, this is money that otherwise would be in your paycheck.

Dan: Yeah. I mean, it’s just one of the things I think about of like, we become aware of how much things cost, a lot of us, when, like, we get a giant bill, or people we know, and we’re like, “That’s wild.” But as what you’re reporting is showing, like, no, all of this wildness is paid by all of us , a lot of us get insurance from our jobs, that’s money that could be our wages. We’re paying it there. Um, in places where the government pays for healthcare and it, we are paying that through our taxes. Um, and that is a part that I don’t think, I get to enough on this show, is that like, we’re vulnerable individually, but we’re also each of us individually paying a collective price.

Bob Herman: I remember years ago I was interviewing Don Berwick. He used to be the CMS administrator, uh, during President Obama’s term for a short while, and he made the good point that was like, workers pay for every dime of healthcare in this country, either through your wages or through what is owed to you through compensation or through taxes. Um, and I think if you, if your listeners just think of it that way, it’s actually pretty simple. Like, we’re all paying for this. It just doesn’t, it might not seem like it, but that is the reality

Dan: Um, this is a little bit risky, uh, just for our emotional health, but like, as a parent, as you report on these things, do you think about your kids as adults navigating an economy that’s another 20 and change years along this path?

Bob Herman: It’s, oh yeah. I mean, I’ve, uh, I, I don’t know. Maybe a lot of parents are worriers. I’m one of them. , I think about, like, my kids when they eventually have to go off our health insurance, right? When they have to find their own, and, you know, maybe they have their own healthcare needs at that point and they have to find something. Like, is it gonna be affordable for them? Are they gonna be one of those people who gets job locked, where they’re, they find a job but they absolutely hate every minute of it because they’re just doing it for the health insurance? Um, yeah. I, I mean, 20 years from now is a long time. Like, costs aren’t going down, and how will it affect their, you know, basic, uh, standards of living?

I have no idea. I, I mean, it’s hard not to think about it. Um, but it is far in the future, and I think that’s what also prevents people from changing things. Like, we know it’s bad, it’s gonna get worse, but, like, you know, when it’s that far in the future you can’t really address it right now. But I think that’s the perfect time to address, is before it gets so bad that our own kids can’t even, you know, afford their rent or their groceries or whatever else

Dan: I’m, I’m reminded, right, of the saying like, “The best time to plant a tree is 30 years ago, and the second best time to plant a tree is today.”

Bob Herman: Today. Exactly right 

 

Rachel Bernier-Green: I’m a little anxious about what we’ll be paying, but it, you know, it’s not keeping me up at night.

Dan: Back on the South Side of Chicago, Rachel Bernier-Green tells me she’s on track to bring insurance back for her team in 2027. She says changes they made to their business strategy last year have been paying off, so she’s got the money lined up

Rachel Bernier-Green: I mean, we hope that there are not, you know, more sky-high increases because yes, they do drastically, impact, um, our ability to operate the business But, ?I know that we’ll be well positioned to absorb the cost

Dan: as I, I’m preparing for today’s reporting, I’m like, “Oh yeah, this would be a good time for me to email our insurance broker and be like, ‘Hey Kurt, so what are we looking at for next year? Uh, I think it’s gonna be bad.’” And he’s like, “It’s gonna be bad.” He thinks for the plan that we’re on, which because of our needs for networks and stuff, is we don’t have a whole lot of choices. He’s like, “Yeah, you’re looking at like 14 to 18%, I think, for the next year.” 

Rachel Bernier-Green: Yeah. Yep Yeah. And, and the crazy thing is, like, I’m… Which sounds obscene, but I’m thinking is between 20 and 25%, um, that we need to be prepared for jumps of that magnitude. And I hope that that is not the case, but that’s what we are building into our, um, our models moving forward

Dan: And are you advising clients the same way?

Rachel Bernier-Green: Yeah. Yeah

Dan: I’m curious about, um, what it was like reading Bob’s story. What was it like, I mean, whether it was surprising or not, like what was it like seeing all of that kind of put together?

Rachel Bernier-Green: Oh, I was, um, just like silently cheering, um, because those are the, uh, exact conclusions that I, you know, I can’t inform the conclusions that he reaches, but that is exactly where, um, where I am. That the system is fundamentally broken and it is harming people in re- irreparable ways and that we need a significant overhaul,

Dan: Amen to that. Which is the thing about a story like this. On the one hand, it’s full of terrible news. On the other hand: Most of us — maybe all of us — are already experiencing the effects of all this terrible news. And I think it’s helpful, it’s good, to see it all tied together. To know:  We’re not alone. We’re not imagining things.  The whole system truly is completely broken — and as bob says, continuing to actually crumble.  

Even if we don’t have a *solution*, it’s good to know what we’re up against, to peel back the curtain.  

Next time on An Arm and a Leg, we take another look at Medicare Advantage. And, um… it’s more broken than we thought. 

News anchor: Many health insurance providers are dropping their Medicare Advantage plans.

Female voice: I heard that — I was just in tears.

Female voice 2: I don’t know any way to describe it other than total chaos. 

Dan: I’m hoping that you’re right here with me when I say:  It is so much better to know.  We do not want to get taken by surprise.

This episode of An Arm and a Leg was produced me, Dan Weissmann, with help from Emily Pisacreta — and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard.

Our music is by Dave Weiner and Blue Dot Sessions. 

Claire Davenport is our engagement producer.

Amanda Boyd is our Operations Manager. Bea Bosco is our consulting director of operations. 

An Arm and a Leg is produced in partnership with Ñî¹óåú´«Ã½Ò•îl Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

 Zach Dyer is senior audio producer at Ñî¹óåú´«Ã½Ò•îl Health News. He’s editorial liaison to this show.

An Arm and a Leg is distributed by KUOW, Seattle’s NPR news station.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially.

You can join in any time at arm and a leg show, dot com, slash: support.

An Arm and a Leg is a co-production of Ñî¹óåú´«Ã½Ò•îl Health News and Public Road Productions.

For more from the team at An Arm and a Leg, subscribe to its weekly newsletter, . You can also follow the show on , , , and . And if you’ve got stories to tell about the healthcare system, the producers would love to .

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Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2282220 A NY Hospital Tried To Close Its Birthing Center. This City United To Fight Back. /courts/troy-new-york-hospital-birthing-center-bipartisan-fight/ Wed, 09 Sep 2026 09:00:00 +0000 /?p=2281344 TROY, N.Y. — Like many residents of this aging industrial city on the Hudson River, Starletta Washington was stunned when she heard Troy’s last remaining hospital planned to close its birthing center.

“It was devastating,” said Washington, who heads the local YWCA. Washington was born at the hospital and had her children there. She couldn’t believe families would now have to get to a hospital half an hour away or face the prospect of an emergency delivery.

“Nobody else was going to be born in the city of Troy unless they were born on a city bus, in the back of a cab, or, disgustingly, on the side of the street?” Washington said. “Blew my mind.”

Troy wasn’t the first community to face this prospect. Since 2010, hospitals have as cities and towns shrink and hospitals consolidate into larger systems.

Troy found a more hopeful ending.

A group of women and one man stand holding signs that say "Save Burdett Birth Center" with a yellow "SAVED" sticker added to the front.
State Assembly member John T. McDonald III (center), a Democrat, worked to secure $5 million in state funding to help keep the Burdett Birth Center open in Troy, New York. (Katherine Bruno/Upper Hudson Planned Parenthood)
A woman in business formal attire sits at a desk with two American flags behind her.
Carmella Mantello, the Republican mayor of Troy, New York, says even nonprofit hospitals seem to have become more corporate. “The whole hospital scene has changed,” she says. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)
A woman wearing a black T-shirt looks towards the camera. She wears a necklace with a tiny star on it, with earrings to match.
Starletta Washington, who heads the YWCA in Troy, was born at the hospital where Burdett Birth Center is located. Like many in the community, she says she was blindsided by Trinity Health’s plan to close the center. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)

Elected officials from both major parties joined patient advocates, mothers, midwives, doulas, and community leaders like Washington to challenge Trinity Health, the large Catholic health system that owns Troy’s hospital and birthing center. The campaign even united Planned Parenthood and the .

“Whether you were Republican or Democrat, or if you didn’t vote, it literally brought everyone together,” said Carmella Mantello, the city’s Republican mayor. “Everyone just said, ‘We can’t let this happen.’”

Throughout the country, healthcare remains a flash point as politicians square off ahead of November’s elections. But in many places, Americans are also quietly finding common ground.

In this small city, residents were brought together by frustration over large, corporate health systems that can seem to put profits over patients. And they resolved to work together to keep critical medical services in their community.

A Community Institution

Babies have been delivered at Samaritan Hospital on a hill above Troy since this city’s once bustling factories produced most of America’s shirt collars a century ago.

More recently, Samaritan’s Burdett Birth Center had become a model for patient-focused care. Midwives and doulas work alongside OB-GYNs and support mothers who want to avoid a delivery by cesarean section unless necessary.

Patient safety advocates have pushed for years to reduce surgical deliveries, which can lead to complications. At Burdett, only about a quarter of newborns are delivered by C-section, compared with about a third statewide, according to 2025 hospital data. Burdett also had fewer preterm births and fewer babies with low birth weights.

“I wouldn’t go anywhere else,” said Lidia Zambrano-Madera, who gave birth to both her children at Burdett with the help of a midwife.

A woman who just gave birth holds her infant while lying in a hospital bed. Three adult family members and one child stand around her.
Lidia Zambrano-Madera, a Troy resident, gave birth to both her children at the Burdett Birth Center with the help of a midwife. “I wouldn’t go anywhere else,” she says. (Jayana Espinoza)

For Zambrano-Madera, who recently opened a children’s play center in Troy, Burdett offered another advantage: It was just five minutes from home.

But three years ago, Trinity Health, a multibillion-dollar Michigan-based hospital system, said the birth center was losing money and would close. Families from Troy and surrounding Rensselaer County would have to deliver at another Trinity hospital in Albany, up to a half-hour’s drive away. The hospitals are branded under St. Peter’s Health Partners in the Albany region.

“We’ve been frantic about trying not to cut the care at the bedside,” said Steven Hanks, a physician who oversees Trinity hospitals in New York and New England. “But, you know, you get to a point where you can only consolidate so much. You can only spread people so thin, and then you have to start taking harder looks at your actual services.”

Corporate Backlash

Trinity’s plans — news of which — came without warning, surprising the obstetrical staff and community leaders. They set off a firestorm.

Within days, midwives, mothers, community leaders, and politicians held a rally at the YWCA in downtown Troy. Others would follow. Volunteers led by doulas and midwives made T-shirts and handed out pink “Save Burdett” signs at the local farmers market.

Activists were outraged that the hospital hadn’t adequately assessed the impact of the closure, particularly on low-income families. They conducted a community survey that found 1 in 4 Troy residents didn’t have access to a car and would have trouble getting to Albany.

The campaign drew on deep connections that many residents had to Burdett. “They realized what a gem Burdett is, and what a great community service they provide,” said Jessica Hayek, a doula and birth educator who helped lead the campaign.

A woman stands beside a bed with a quilt looks away from the camera with a subtle smile.
Jessica Hayek, a doula and birth educator, helped lead the campaign to stop Trinity Health from closing the Burdett Birth Center. She says Michigan-based Trinity didn’t appreciate how important the center was to the Troy community. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)

Hayek and others also tapped into deep-seated frustration with Trinity, a healthcare behemoth that and last year recorded more than $25 billion in revenue and a healthy operating margin that topped 5%.

“Trinity Health is in the Midwest, and they are not in the community,” Hayek said. “So when you’re looking at just the numbers from an office in the Midwest somewhere, they’re not looking at the benefit that this place has on the community.”

Hayek describes herself as a liberal Democrat. But Trinity’s focus on its bottom line also irked many Republicans, including Mantello, who was the City Council president at the time.

“The whole hospital scene has changed,” Mantello said. “It was very personable. You had nurses and doctors who were able to give more care and spend more time with patients.” Now, by contrast, many hospitals have what she described as a “more corporate type of atmosphere.”

Even the Catholic bishop decried the planned closure of the birthing center as out of step with the values of his faith and the hospital system’s.

“Nothing is more central to the Catholic healthcare mission than supporting life and all those who bring it into the world,” Bishop Edward Scharfenberger said after Trinity announced the closure plan. Scharfenberger has since retired.

A Bipartisan Solution

Despite the backlash, Trinity Health executives for months insisted they had no choice. The system even sued the state to push through the closure.

Ultimately, though, powerful state officials, including New York Attorney General Letitia James, a Democrat, joined the fight to save the birthing center, launching an investigation into the proposed closure and hosting a daylong hearing in Troy.

State Assembly member John T. McDonald III, a Democrat who represents Troy, worked with Republican elected officials, including the county executive and the state senator representing Troy, to secure $5 million in state funding to help keep Burdett open.

 “You had a Democrat and a bunch of Republicans all working together on the same issue,” McDonald said, “because, at the end of the day, our job is to listen to what the public has to say.”

A crowd of people of various genders, ethnicities, and ages stand with signs that say "Save Burdett Birth Center."
Community leaders, politicians, midwives, doulas, and families from Troy rallied for months to stop the Burdett Birth Center from closing, including at the state Capitol in Albany. (Katherine Bruno/Upper Hudson Planned Parenthood)
A plastic lawn sign with white text and a bright pink background reads, "Midwives Save Lives / Save Burdett Birth Center / SAVED!"
Community volunteers in Troy celebrated the success of their campaign to save the Burdett Birth Center by adding a yellow tag to the pink protest signs. (Hannah Norman/Ñî¹óåú´«Ã½Ò•îl Health News)

Nearly a year after announcing the closure, Trinity reversed itself and said Burdett would remain open.

Lois Uttley, a New York City-based researcher and activist who has worked with communities facing hospital consolidation, said Troy’s success reflects a growing bipartisan suspicion of corporate healthcare organizations.

“The executives of these health systems will tell the community that joining a big health system will be good, that the quality of care will improve, that efficiencies will mean they can keep the costs low,” Uttley said. “But what I have seen over the last 30 years of work is that those promises often are broken.”

As hospitals close or downsize, she said, communities are catching on. “They’re becoming more skeptical.”

There’s another, more hopeful lesson in Troy’s success, said McDonald, the state lawmaker.

“If we take down our swords,” he said, “and put out our arms, maybe we can get something done.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2281344 A Camp for Children With Brain Injuries Zips Ahead, Despite Federal Uncertainty /news/children-with-brain-injuries-summer-camp-uncertain-federal-funding/ Thu, 27 Aug 2026 09:00:00 +0000 /?p=2277184

MILLVILLE, Pa. — In an open field, arrows whizzed through the humid June air and struck their targets. Campers and counselors cheered.

It was archery hour at . Operations director Drew Meyer watched, a few tears escaping from behind his dark sunglasses.

“They will surprise you, like, flat out,” he said of the campers, who have all survived brain injuries. “They’ll come out here, and they’ll shoot for three hours and start hitting the target.”

Campers, ranging in age from 10 to 21, have been coming to Camp Cranium in Pennsylvania’s rural Columbia County since 2008. Some of their brain injuries are so severe that they have to relearn basics, from talking to tying their shoelaces. Some use wheelchairs or crutches. But during a week at camp, they climb rock walls, swim, and whiz down a zip line through the lush forest.

The existence of Camp Cranium, and a handful of others like it, is a response to a decades-long national trend: More people, including children, now survive crises resulting in brain injury than did in the 1980s. The improvements in survival are largely due to seat belt laws and and trauma centers that can treat injuries quickly.

But recently, efforts to track and prevent one type of brain injury, traumatic ones, are in flux after Congress didn’t renew a and prevention of traumatic brain injuries, and the Trump administration fired hundreds of employees at the Centers for Disease Control and Prevention, including the team tracking traumatic brain injuries, or TBIs.

“Brain injury can happen to anybody,” said , executive director of the . “This community deserves more.”

A boy in a blue helmet sits in a harness and holds onto a colorful grip on a rock climbing wall.
Lucas Hardy uses a hoist to climb the 30-foot rock wall at Camp Cranium in Millville, Pennsylvania, in June. (Sarah Hofius Hall/WVIA News)
A girl in a wheelchair pulls an arrow against a bow while a young woman standing behind her helps position the arrow's aim.
Camp Cranium counselor Anvitha Tharra (right) helps participant Angelica Zander learn to use a bow and arrow. (Sarah Hofius Hall/WVIA News)

Tracking Brain Injuries

Lucas Hardy, 14, smiled at the encouraging crowd below. In a shady clearing in the woods, he climbed the 30-foot rock wall, aided by a hoist that pulled him out of his wheelchair and helped support his moves. Hardy suffered a traumatic brain injury at age 3, when a tree branch fell on him at a birthday party.

Annually, an estimated 2.8 million Americans experience a TBI — including about 475,000 children, according to the .

Recent data suggests those are undercounts. In 2018, a CDC team piloted a household survey asking about TBIs in a sample of U.S. children and adults. The results concluding that such injuries, which are often considered “hidden” because the damage is internal and unseen, are more widespread than hospitalization numbers suggest.

The mass firings at the CDC in early 2025 studying TBI, right before they were expected to launch a . A spokesperson for the Department of Health and Human Services, Emily Hilliard, did not respond to questions about the number of employees terminated, or if they were reinstated or replaced.

In a statement, she said: “The Trump Administration remains committed to supporting efforts to prevent traumatic brain injuries, improve surveillance, and ensure Americans have access to practical, evidence-based information that can help protect their health and safety.”

She said the agency’s TBI work is now handled by other staff members at the National Center for Injury Prevention and Control.

Hilliard said the CDC is deciding how to establish a cost-effective national concussion surveillance system within the bounds of current funding, and said the agency in 2026 dedicated funds to support, among other things, an about concussions, an , and concussion surveillance.

But Wolfkiel still worries about how the CDC firings and the impasse over federal funding will affect brain injury research and prevention efforts in the long term.

“The lack of resources and programs and information that’s out there is really just sort of appalling,” Wolfkiel said.

A man stands outside with his arm around the shoulders of his teenage son. Both smile at the camera.
Tony Sadowski (right) serves as executive director of Camp Cranium. He first learned about the camp when a speech therapist recommended it to his son, Bryan, who had suffered a brain bleed that caused a hemorrhagic stroke at age 6. Now 18, Bryan (left) is preparing to study occupational therapy at Elizabethtown College. (Sarah Hofius Hall/WVIA News)
A whiteboard on a wall with "Thursday" written at the top outlines the activities and times for two groups throughout the day.
Activities at Camp Cranium include time on a zip line, archery, and a dance. Sadowski says that the event helps campers and parents find community and combat social isolation. (Sarah Hofius Hall/WVIA News)

Federal Funding Uncertainty

Tony Sadowski, the camp’s , remembers when his son, Bryan, suffered a brain bleed that caused a hemorrhagic stroke at age 6. “You’re in the emergency room,” he recalled, “not knowing what version of your son’s going to wake up.”

Now 18, Bryan Sadowski has attended the camp for years.

“We’re very lucky to be able to be here,” the elder Sadowski said.

In 1996, before Bryan was born, Congress passed the Traumatic Brain Injury Act, which has provided many states with grants for TBI research, advocacy, and services. Since then, Congress reauthorized the act four times, largely with bipartisan support, until 2024.

It has remained lapsed since then. Trump’s secretary of the Department of Homeland Security, , supported when he was a senator. Congress is whether to reauthorize funding through 2030.

Despite the lapse in funding, money is still flowing to TBI programs at the CDC and in states, according to , president and CEO of the Brain Injury Association of America.

Congress did appropriate $8.25 million for TBI program activities through the . That’s far less than the $23 million Congress provided for each fiscal year, from 2020 through 2024, the last time it .

“The TBI Act is the only piece of federal funding for traumatic brain injury at the federal level,” Willis said. “We’re aiming to preserve what we have.”

The funding uncertainty has not affected the handful of brain injury camps, including Camp Cranium and in Alabama, because they are nonprofits that mostly rely on private donations.

A young woman with short hair leans over a table to look at a book that that another person holds out to show her.
Brianna Engleman (right) collects song requests for a dance scheduled that night at Camp Cranium. Engleman has been a camper since 2018 and says she plans to come back as a counselor to support other campers like herself. (Sarah Hofius Hall/WVIA News)

Back at Camp Cranium, bursts of laughter, whoops of delight, and distant chatter punctuated the humid summer air.

While her fellow campers did archery or art, Brianna Engleman moved between groups, collecting song requests for a dance that evening. When she was 5, doctors performed a to relieve her of debilitating seizures. But the surgery itself can injure other parts of the brain.

She lives in Northern Virginia and first attended Camp Cranium as a teen in 2018. It was her first time being around so many people like her, said Engleman, now 21.

“I’ve gotten more confident,” Engleman said. “It made me think, well, there’s actually good people out there.”

Next time she returns to camp, she said, she plans to do so as a counselor.

A boy in a blue helmet sits in a wheelchair in front of a rock climbing wall as two other people prepare ropes leading to the harness the boy is wearing.
(Sarah Hofius Hall/WVIA News)

This article is from a partnership that includes , , and Ñî¹óåú´«Ã½Ò•îl Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2277184 A State Gave Sheriffs 20% of Its Opioid Settlement Cash. We Followed the Money. /public-health/louisiana-sheriffs-opioid-settlement-spending-addiction-law-enforcement/ Thu, 27 Aug 2026 09:00:00 +0000 /?p=2277190

Ñî¹óåú´«Ã½Ò•îl Health News worked with three Louisiana news outlets — , , and — to ask all 64 sheriffs in the state how they’ve spent their opioid settlement funds. The responses were shared and presented in a data table for all four newsrooms to use. Reporters then conducted individual reporting for separate articles.

Every state is from companies accused of flooding the nation with prescription painkillers and fueling overdose deaths. But only one state is directing 20% of those payouts to sheriffs — the largest carve-out for law enforcement nationwide.

In Louisiana, sheriffs are elected, do not serve at the pleasure of another local official, and have independent budgets. They’re also not required to proactively report to the public or another authority how they spend billions in opioid settlement cash.

Short of filing public records requests or waiting for official audits, that has made it difficult for the average person to track the windfall. Many consider the dollars to be “blood money” and believe the spirit of the settlements is to spend it all on abating the addiction crisis.

Ñî¹óåú´«Ã½Ò•îl Health News worked with three Louisiana news outlets — , , and — to track those dollars. The newsrooms contacted all 64 Louisiana sheriffs over five months, often filing public records requests, to produce the first detailed accounting of millions spent.

The findings include:

  • Thirty-eight sheriffs reported spending more than $8.1 million total. Much of it went to crime-fighting equipment, such as surveillance cameras and drug detection products, though smaller amounts funded mobile apps, addiction treatment in jails, and educational programs for youth.
  • $5.4 million, about 66% of reported spending, was deemed inappropriate by a three-person review panel. The panel, assembled by Ñî¹óåú´«Ã½Ò•îl Health News and its partners, included a Louisiana resident in recovery who lost his son to a fentanyl overdose, an addiction medicine doctor, and a public health policy analyst who has been tracking settlement dollars since 2022. They judged the expenditures using their professional and personal expertise. Expenditures the panel disapproved of included salaries and overtime pay for homicide detectives and officers conducting jail shakedowns to find contraband.
  • $4.7 million, nearly 60% of reported spending, went to items or services that other states say should not be purchased with opioid cash. Six states have , such as technology to extract data from cellphones and automated external defibrillators, which are . Although Louisiana does not have its own “unallowable” list, the state’s — a five-member body that advises sheriffs and parishes but does not control the money — said it has shared the guidance from other states.
  • Nine sheriffs stood out for promising uses: All of their expenditures, totaling nearly $1.8 million, were deemed appropriate by the review panel and allowable in other states. These included providing addiction treatment in jail, training officers to respond to overdoses, and increasing public awareness of addiction resources.
  • Twenty sheriffs did not provide their expenditures, leaving roughly $10.7 million that hidden from public view. The Jefferson Parish Sheriff’s Office, which covers an area just outside New Orleans and was allotted the highest amount — nearly $4 million through 2025 — did not respond to more than a dozen calls and emails.

Nationwide, debates over law enforcement’s role with opioid settlement money have been underway since the funds began flowing significantly in 2022 and have continued as the pool of money has grown. Purdue Pharma, , finalized its this year, and various settlements are set to pay out for an additional decade-plus.

Since the earliest days, these dollars have been viewed across government agencies and the private sector as a pot of gold for which many are vying.

Law enforcement agencies are part of this scrum. They say seizing drugs and arresting dealers save lives, but that costs money and the addiction crisis has burdened their budgets. However, many recovery advocates staunchly oppose any opioid cash flowing to what they see as the .

Since there are few guardrails on how the money is spent, decisions often come down to how local politicians and residents see addiction and what type of approach they believe will be effective in combating it.

Louisiana provides a natural experiment to see which priorities prevail when money is handed directly to sheriffs.

First Public Look at How Louisiana Sheriffs Have Spent Over $8M in Opioid Settlement Cash

In Louisiana, sheriffs receive 20% of the state's opioid settlement cash — the largest carve-out for law enforcement nationwide. But since sheriffs are not required to proactively report how they spend the money, it's hard to track. Reporters from Ñî¹óåú´«Ã½Ò•îl Health News, The Current, Gulf States Newsroom, and Verite News contacted all 64 sheriffs to uncover spending details. <br><br> Click column headings to sort the table.

Note: In some cases, the amount of money spent exceeds the amount allocated because sheriffs may have reported spending that included their 2026 allocations or because sheriffs combined their opioid settlement dollars with the share received by parish governments or other funding sources. Descriptions of spending are based on emails or phone calls with the sheriffs' offices and have been lightly edited. <br> Source: The money allocated to sheriffs was obtained by summing values for years 1-5, representing 2021-2025, from the Louisiana Opioid Abatement Task Force’s <a href="; target="_blank" style="color:#0071ce">public spreadsheet</a>. Data on money spent was collected by Ñî¹óåú´«Ã½Ò•îl Health News, The Current, Gulf States Newsroom, and Verite News. • <a href="/download-the-data-louisiana-sheriffs-opioid-settlement-expenditures/&quot; target="_blank" style="color:#0071ce">Download the data.</a> <br> Credit: Ñî¹óåú´«Ã½Ò•îl Health News' Lydia Zuraw and Aneri Pattani, The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius

The state’s agreement with parishes and sheriffs receiving settlement cash contains broad categories for , including “law enforcement expenditures relating to the opioid epidemic.”

But even if the sheriffs’ spending is legal, that doesn’t mean it’s appropriate or effective, addiction and public health experts say.

“What’s happening here is they have a lot of money and they want to distribute it to all the wrong places,” said Danny Bolner Jr., a Jefferson Parish resident who has been in recovery from addiction for more than two decades and lost his 28-year-old son to a fentanyl overdose in 2016. On the panel that reviewed expenditures, Bolner represented the view of families who have lost loved ones to the crisis.

The purchase of drones and vehicles struck a nerve for him. He’d prefer for opioid cash to support programs that educate youth about healthy ways to process emotions, provide job training to people in recovery, and distribute overdose reversal medications.

“This money is what we have to save lives,” he said. If sheriffs use it in other ways, the finite pot “is going to be gone and then they won’t have nothing to help.”

A man in a beige brimmed hat and patterned blue short-sleeve shirt stands in a park near a lake and looks at the camera.
Danny Bolner Jr. is a Jefferson Parish, Louisiana, resident who has been in recovery from addiction for more than two decades. Bolner lost his 28-year-old son to a fentanyl overdose in 2016. (Christiana Botic/Verite News and CatchLight Local/Report for America)

A Safe, a Scanner, and Surveillance Cameras

For , a public health policy analyst and national opioid settlement expert who was a member of the review panel, determining if expenditures fit the spirit of the settlements often centered on whether they facilitated arrests or prevented overdoses.

“The impetus of this opioid settlement money is to spend on innovative ways to not let this happen again,” she said, referring to the overdose crisis that has claimed since 2000. She said sheriffs should be asking, “How could we use this to reinvest in the community, not just build up our office?”

Many of the sheriffs’ equipment purchases didn’t meet her bar.

For example, the East Baton Rouge Sheriff’s Office bought a safe to store evidence from opioid investigations and a scanner for their traffic division to identify narcotics in hidden compartments. The Terrebonne Parish Sheriff’s Office spent $465,000 on , which are automated license plate readers that capture data about passing vehicles and share them with law enforcement agencies nationwide. The Bossier Parish Sheriff’s Office purchased 130 body cameras and 50 dash cameras.

Sheriffs already receive taxpayer dollars and federal grants to buy law enforcement tools, Christensen said. Opioid cash, which is finite and has a specific purpose, should not be used for that, she and the other reviewers said. In fact, some states don’t allow it.

13 Louisiana Sheriffs Spent 100% of Opioid Settlement Money Inappropriately, per an Expert Panel

The expenditures were reviewed by Tricia Christensen, a public health policy analyst who has been tracking opioid settlement spending since 2022; Stephen Loyd, an addiction medicine doctor and a person in recovery who serves as West Virginia's drug czar; and Danny Bolner Jr., a person in recovery who lost his son to a fentanyl overdose and is raising his son’s daughter in Jefferson Parish, Louisiana. A majority vote determined which expenditures were appropriate. <br><br> The map depicts the percentage of money each sheriff spent on expenditures disapproved by the reviewers.

Note: The reviewers voted on the propriety of each expenditure based on their own views of the purpose of opioid settlement money. The rates of opioid-involved deaths are age-adjusted. Rates based on counts <5 were suppressed by the Louisiana Department of Health to protect privacy. "Opioid-involved deaths" include deaths in which opioids were present in the body and/or contributed to death, even if they were not the sole cause of death. <br> Sources: Settlement spending and reviewer opinions collected by Ñî¹óåú´«Ã½Ò•îl Health News, The Current, Gulf States Newsroom, and Verite News; opioid-involved death rates from the Louisiana Department of Health <br> Credit: Ñî¹óåú´«Ã½Ò•îl Health News' Lydia Zuraw and Aneri Pattani, The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius

But taxpayer money may not cover everything sheriffs need, said , executive director of the Louisiana Sheriffs’ Association. “Our budgets are overloaded,” he said.

Complex investigations to dismantle drug trafficking syndicates can require advanced equipment, , a spokesperson for the East Baton Rouge Sheriff’s Office, wrote in a statement.

“While treatment and recovery services are indispensable components of addressing opioid addiction, they address the consequences of addiction after these drugs have already reached our community,” she wrote. “Law enforcement has a different, but equally essential, responsibility: preventing those deadly drugs from reaching potential victims in the first place.”

First Lt. Blake Tabor, a spokesperson for the Terrebonne sheriff’s office, similarly wrote, “Our role as a law enforcement agency is primarily focused on disrupting the criminal activity that fuels addiction in our community.” That effort complements other entities’ work in prevention, treatment, and recovery, he added.

The Bossier Parish Sheriff’s Office declined to comment.

Where Public Health Meets Public Safety

Not all sheriffs spent the money on enforcement.

Acadia Parish Sheriff directed all his settlement cash to provide treatment in jail. He said he hopes to break cycles of addiction and crime.

“I want people back into society, being productive,” he said.

Research shows for opioid use disorder behind bars and .

In St. Martin Parish, settlement funds helped launch a of officers that connects people with substance use disorders or related mental illness to treatment, said Chester Cedars, chief legal counsel for its sheriff’s office. Officers also try to coordinate support services for family members and assist with questions around paying for care.

“We’re not clinicians,” Cedars said, but we “serve as a broker” between people who need services and those who provide them.

, an addiction medicine doctor and the West Virginia drug czar, who was the third member of the review panel, said he loved the comprehensive nature of the program. Addiction “is a family issue,” he said. “Every time that phone rings, it’s a potential family crisis.”

A view from above of a plaque in the ground just in front of a bench that reads "Spread your wings and look down upon us, Daniel. Maw maw & Papa Dan," with images of two praying angles, a tractor, and a pig. Two people sit on the bench to either side of the plaque and their feet are in the frame.
Bolner and his granddaughter sit on a bench dedicated to his son and her father, Daniel, at Lafreniere Park in Metairie, Louisiana. Daniel died of a fentanyl overdose in 2016 on his 28th birthday. (Christiana Botic/Verite News and CatchLight Local/Report for America)

It’s not a coincidence that these parishes earned top marks from the reviewers. Cedars is the former chair of the , and Gibson is the current chair. That’s the body meant to guide others on priority uses of settlement cash.

Cedars was clear that the St. Martin sheriff’s office was not using “one penny for any enforcement activity,” because that’s not what the settlement “intended to accomplish.”

Gibson was more hesitant, saying the legal guidelines are broad and “I’m not here to criticize anybody.”

He has advised about a dozen sheriffs who have reached out with questions, but he knows they’re not required to heed his guidance.

A from the Louisiana Legislative Auditor found that the task force has no teeth to enforce its recommendations.

If people want stronger guardrails on the opioid cash, state lawmakers need to enact new rules, Gibson said.

Stepping Up Oversight

The Louisiana state legislature in May calling for the legislative auditor to review how all parishes and sheriffs are handling their opioid settlement money and report to lawmakers prior to the 2027 legislative session.

State Sen. , a Republican who co-authored the resolution, said the goal is to shed light on where dollars are flowing, if jurisdictions are spending them at all, and which funded programs are effective.

With that information, Myers said, he and others could “absolutely” introduce bills “to tighten up how funding is spent.”

Louisiana Sheriffs Spent $4.7M in Opioid Settlement Cash on Items, Activities Deemed Unallowable in Other States

Six states — <a href="; target="_blank" style="color:#0071ce">California</a>, <a href="; target="_blank" style="color:#0071ce">Indiana</a>, <a href="; target="_blank" style="color:#0071ce">Kansas</a>, <a href="; target="_blank" style="color:#0071ce">Michigan</a>, <a href="; target="_blank" style="color:#0071ce">South Carolina</a>, and <a href="; target="_blank" style="color:#0071ce">Virginia</a> — have created lists of items and services that they say opioid settlement funds should not be spent on, including surveillance cameras and vehicles. Although Louisiana does not have its own "unallowable" list, the state's Opioid Abatement Task Force said it has shared other states' guidance with some sheriffs. Yet nearly 60% of the sheriffs' spending involves items found on such lists.

Note: Unallowable lists may not be legally binding in each state but are considered strong guidance. <br> Source: Data collection by Ñî¹óåú´«Ã½Ò•îl Health News, The Current, Gulf States Newsroom, and Verite News <br> Credit: Ñî¹óåú´«Ã½Ò•îl Health News' Lydia Zuraw and Aneri Pattani

Meanwhile, the Louisiana Opioid Abatement Task Force is trying to strengthen its oversight.

Curtis Nelson is executive counsel for the Louisiana Opioid Abatement Administration Corporation, a nonprofit that supports the task force. He said the body is seeking quotes from accountants to conduct ongoing forensic audits of parishes and sheriffs. The goal is to audit 10 to 15 entities annually, starting with those receiving the most money. If the audits turn up misuse, the task force could withhold future payments from those parishes or sheriffs, Nelson said.

The task force is also exploring creating its own unallowable list, like those in other states, Nelson said.

Louisiana Gov. Jeff Landry and Attorney General Liz Murrill did not respond to questions about whether they’d support an unallowable list or take other actions to address opioid settlement spending.

But many advocates are hopeful that an unallowable list could curb spending they found concerning.

“You’re keeping them on the track when you tell them what they can’t use it for,” said Bolner, the Jefferson Parish resident who lost his son to overdose and is raising his son’s daughter.

While he awaits greater oversight for sheriffs, Bolner plans to continue the work he’s been doing for years: distributing overdose reversal medications at schools, hospitals, and bars; participating in grief support groups with other families; and showing up at community events to raise awareness about addiction. He said he’ll keep speaking with sheriffs and parishes about what he considers the best use of settlement money.

“If I save one life, it’s accomplished,” he said.

Methodology

Reporters from Ñî¹óåú´«Ã½Ò•îl Health News, The Current, Gulf States Newsroom, and Verite News worked together to contact all 64 sheriffs’ offices in Louisiana and ask how they’d spent opioid settlement funds. The outreach involved dozens of emails and phone calls from March to July.

If a sheriff’s office did not respond or did not provide specific dollar amounts spent on programs or services, it was labeled “Did not provide expenditures.” All other responses were summarized in a data table.

The amount of settlement money each sheriff’s office received through 2025 was obtained from the Louisiana Opioid Abatement Task Force’s . Allocations for years 1 through 5 were summed, representing 2021 through 2025.

In the few cases in which a sheriff’s office reported spending more money than the task force said it had been allocated, it was often because the sheriff’s office had combined its share of opioid settlement dollars with the share received by the parish government or another funding source. Some sheriffs may have also reported money spent from their 2026 allocation.

Once all the data was collected, the reporters used two methods to analyze the results.

For the first, the reporters created an unduplicated list of expenditures and de-identified them by removing the sheriffs’ offices names. That list was shared with three reviewers: , a public health policy expert who has been tracking opioid settlement spending since 2022; , an addiction medicine doctor and a person in recovery who previously served as chair of Tennessee’s Opioid Abatement Council and is currently West Virginia’s drug czar; and Danny Bolner Jr., a person in recovery from addiction who lost his son to a fentanyl overdose and is raising his son’s daughter in Jefferson Parish, Louisiana.

Each reviewer voted on each expenditure description as an appropriate or inappropriate use of opioid settlement money. The majority vote determined the final designation.

Reporters calculated how much of the money spent by each sheriff’s office went to expenditures the review panel deemed inappropriate. This value was divided by the total spent to determine the percentage of expenditures deemed inappropriate by the panel. The second approach to analyzing the sheriffs’ spending was as follows: Six states (, , , , , and ) have created lists of items and services that they say opioid settlement funds should not be spent on, often known as “unallowable lists.” Ñî¹óåú´«Ã½Ò•îl Health News calculated how much money spent by each Louisiana sheriff’s office went to expenditures on one of these lists. This value was divided by the total spent to determine the percentage of expenditures that would have been unallowable or not recommended in one or more of these states.

The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius contributed to the database featured in this article.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2277190 Where Florida’s Gun Violence Exacts Its Biggest Toll on Black and Latino Children /public-health/florida-gun-violence-kids-data-analysis-jacksonville-black-latino-disparities/ Tue, 25 Aug 2026 09:00:00 +0000 /?p=2278230 JACKSONVILLE, Fla. — Just west of the St. Johns River, which divides this sprawling city racially and economically, 2-year-old A’mahri Robinson was murdered in his mother’s arms.

Ladonna Johnson was rocking A’mahri to sleep in March when he was shot in the head with a gun she kept for protection.

A’mahri loved going outdoors and taking rides in his pull-along wagon. His mother called the toddler “sweet” and “affectionate.” When he was around, she said, “you just felt love.”

The child was close with Steven Dodson Jr., his mother’s boyfriend, who had reached for the gun during an argument. Dodson, 21, in June to murder and aggravated child abuse and was sentenced to life in prison.

A’mahri died in one of Florida’s most violent places for children: Jacksonville. This city has three ZIP codes that rank among the 10 worst in the state for firearm injuries involving children.

A photo of a two-year-old standing outside.
Two-year-old A’mahri Robinson was murdered while in his mother’s arms in March. (Ladonna Johnson)

Every year, hundreds of children are hospitalized in Florida with gunshot wounds, and overwhelmingly, they come from a tiny number of ZIP codes, an exclusive analysis of hospital data by Ñî¹óåú´«Ã½Ò•îl Health News and The Trace found.

Hospital billing data obtained from the Florida Agency for Health Care Administration shows that from 2018 to 2024 more than 4,000 children 17 or younger were hospitalized for firearm injuries — a rate of about 1.5 a day.

The newsrooms gathered data that the state’s hospitals use to collect payments from insurance companies or the government. The information does not identify patients but includes details about where they lived and their age, race, and other demographics.

The number of children killed in Jacksonville has grown so large that , Families of Slain Children, built a “Wall of Compassion” memorial listing hundreds of people killed by gunfire in the city. Memorial organizers have stood up a second wall nearby that is filling with names.

A photo shows a length of white wall on a square of grass. Crosses line the top of the wall. Names are written on the wall.
The Jacksonville nonprofit Families of Slain Children has built a memorial called the “Wall of Compassion” that lists the names of hundreds of people who have been killed by gun violence in the city. (Daniel Chang/Ñî¹óåú´«Ã½Ò•îl Health News)

The numbers reflect how Florida’s long history of racial discrimination and permissive gun laws undermine public health, said researchers, public officials, community activists, and grieving parents.

Jacksonville kids were shot most often in racially segregated neighborhoods — a legacy from the early 20th century of state-sanctioned discrimination in housing, banking, and investment. These areas today are plagued by pollution from defunct city-run trash incinerators, garbage-strewn lots, dilapidated housing, poverty, and other problems that local leaders have been promising to fix for more than 50 years.

Nearly all the Florida ZIP codes with the highest rates of firearm injuries for children have large Black or Latino populations.

Perhaps nowhere is the toll of gun violence more evident than at UF Health Jacksonville, a safety net hospital and the only Level I trauma center in northeastern Florida.

As chief of acute care surgery, sees firsthand the toll exacted by guns.

“You see it day in and day out,” Madbak said. “I’m working tonight, and I suspect I’ll see a couple victims.”

A table of Florida zip codes with city and county columns, ranked by the number of under-18 gunshot wound patients from 2018 through 2024. A column of the rate of U18 GSW patients per 100k children per year is shaded blue, darker for higher rates, lighter for lower ones.

Florida ZIP Codes With Highest Youth Gunshot Wound Hospitalizations

A table of Florida zip codes with city and county columns, ranked by the number of under-18 gunshot wound patients from 2018 through 2024. A column of the rate of U18 GSW patients per 100k children per year is shaded blue, darker for higher rates, lighter for lower ones.

ZIP codes with 1-10 youth GSW hospitalizations over the 2018-2024 period are omitted due to privacy laws.<br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

, a UF Health pediatrician and former health director for Duval County, which includes Jacksonville, said state and local leaders have failed to address what he called the “root causes” of preventable firearm injuries and deaths, such as poverty, lack of opportunity, and neglect.

“The bottom line is nobody gives a flying f— about these young men,” Goldhagen said.

Gun violence victims and their families of depression, anxiety, post-traumatic stress disorder, and other mental health problems.

Throughout U.S. history, local governments have pushed industrial plants, , and highways through Black neighborhoods even as to increased risks of cardiovascular and respiratory diseases, cancer, preterm births, and gun violence.

But the Florida Department of Health does not focus on gun violence as a public health threat, Goldhagen said, despite its being the nation’s for children and teens.

The , a set of goals developed by the health department and an advisory committee, does not mention guns, the toll they take on children, or efforts to reduce firearm deaths and injuries to young people.

Instead, its goals include preventing or reducing sudden unexpected infant deaths and youth drownings, emergency room visits for motor vehicle crashes, and hospitalizations for traumatic brain injuries.

And yet, no one with the authority to address this public health crisis would agree to talk to Ñî¹óåú´«Ã½Ò•îl Health News about gun violence and its toll on Jacksonville’s children — not the Florida health department, Gov. Ron DeSantis, Mayor Donna Deegan, or 18 of 19 members of the Jacksonville City Council.

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Only Council member Jimmy Peluso responded. Peluso said the city has long ignored the needs of neighborhoods with high rates of firearm injuries among children.

“A lot of these neighborhoods have just felt like the wealth has left them,” he said, “and the city didn’t come in to put in the amount of work they needed to.”

DeSantis, a Republican, in public comments has called for few limits on how people purchase or carry firearms. He to allow Floridians to carry concealed weapons without a permit.

When then-U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis in 2024, DeSantis called the advisory an “.”

DeSantis said Florida would not follow the advisory, which recommended policies including universal background checks for gun purchases and requirements for secure storage.

DeSantis spokesperson Molly Best declined an interview request and to answer questions about the governor’s gun policies.

“There isn’t an agenda to end gun violence in the state of Florida,” said Jean Francis, a former pediatric nurse who leads the Jacksonville chapter of Moms Demand Action, part of a nonprofit that advocates for stronger firearm laws.

Research has linked increases in pediatric gun deaths from 2011 to 2023 to state-level gun policies.

States with permissive gun policies, such as “stand your ground” and open carry laws, reported higher rates of firearm deaths among children than states with strict regulations, such as weapon and age restrictions, according to a .

The study ranked Florida among a group of 30 states with the most permissive gun policies. Four states with comparatively strict gun laws — California, Maryland, New York, and Rhode Island — saw a decrease in pediatric gun deaths over the same time period.

prevents cities and counties from enacting stricter gun safety measures.

kids in disadvantaged neighborhoods are up to 20 times more likely to suffer firearm injuries than their peers in the most advantaged areas.

“It’s disheartening,” Madbak said. UF Health Jacksonville treated 255 patients for gunshot wounds in 2024, including 32 who were 17 or younger, he said.

A zip code choropleth map of Florida shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

In Some Florida Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of Florida shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Broward County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Fort Lauderdale area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Duval County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Jacksonville area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Miami-Dade County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A ZIP code choropleth map of the Miami area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Orange County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Orlando area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21,21-44,44-79,79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Palm Beach County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Palm Beach area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with fewer than 10 hospitalizations are suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Escambia County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Pensacola area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Manatee and Sarasota County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Sarasota area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Pinellas County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Saint Petersburg area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Leon County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Tallahassee area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In Some Hillsborough County Neighborhoods,<br>Child Gunshot Hospitalizations Are Common

A zip code choropleth map of the Tampa area shaded in blue by gunshot hospitalizations per 100k children. Shade buckets are: No cases, 0-7, 7-21, 21-44, 44-79, 79-140, Population too small. Click the city names to visit those regions and see zip codes with smaller geographic areas.

ZIP codes with 1-10 hospitalizations have data suppressed or represented as ranges to comply with privacy laws. <br><br>GSW = gunshot wound<br><br>

Florida Agency for Health Care Administration

In 2025, the hospital treated 269 patients for firearm injuries, including 22 who were under 18, according to Dan Leveton, a hospital spokesperson. As of Aug. 19, the hospital has treated 137 patients for gunshot wounds this year, including 18 who were 17 or younger.

Preventing gun violence “shouldn’t be a political issue, even though it is,” Madbak said, adding that there is a lot of room for more effective advocacy for violence prevention.

“It’s really an American issue,” Madbak said, “and our state has been impacted tremendously by this kind of violence.”

The Pain of Mothers, Grandmothers, and Aunts

A white woman stands outside by a tree surrounded with flowers.
Kim Crow, grandmother of Bryce Williams, who died at age 17 from being shot in a neighborhood park in an Orlando suburb in 2018. Crow says her grandson’s death has left a void in her life. “I’m not me anymore,” she says. (WFTV)

In Orlando, one ZIP code — 32805 — had the state’s highest rate of children under 18 hospitalized for a gunshot wound from 2018 through 2024, with a total of 25 children, or 125.8 per 100,000.

On New Year’s Day 2018, Bryce Williams, 17, was in Casselberry, an Orlando suburb. He was found dead after crashing his blue Kia into a home near the park.

Williams’ death devastated his family, his grandmother Kim Crow told WFTV in Orlando.

“First off, you can’t believe that someone is taken from you so violently,” Crow said. “It’s heartbreaking.”

In April, Daesean Moctezuma Orland, 18, was while attending a house party outside Orlando. Two others wounded in the shooting were taken to the hospital. Police arrested a 16-year-old boy about a month after the shooting and charged him with Moctezuma Orland’s death.

Moctezuma Orland’s grandmother Iveliz Moctezuma told WFTV that a friend of her grandson’s called her and daughter Noemi Moctezuma to tell them that he had been shot. The women drove to four hospitals, including one in Tampa, searching for him.

A Latina woman sits for a television interview in her home. She is tearing up.
Iveliz Moctezuma, grandmother of Daesean Moctezuma Orland, who was shot and killed at age 18 at a house party in Davenport, Florida, in April. “It was the hardest night of my life,” she says. “They ripped him away from us.” (Keary Croskrey/WFTV)

“My every day is crumbled,” Iveliz Moctezuma said. “It’s hard to work. You sit there and you watch the news. You’re like, oh my God, there goes another kid getting killed by gun violence.”

“It’s a hole in my chest, a hole in my mind,” Noemi Moctezuma said. “It’s like the biggest void that you could ever possibly imagine, that not even the happiest moments can fill a void like that.”

Jacksonville, a city of about 1 million, is particularly treacherous for children living in areas north and west of downtown.

The victims include a gunned down while playing in front of a house, a fatally wounded coming home from a football tryout, and a killed by a stray bullet as she sat in a parked car.

Advocates for victims said that gun violence has ripped any sense of normalcy from families and entire neighborhoods. Grieving mothers fear fireworks and other loud noises that sound like gunshots. Grappling with their own emotions, they said, they sometimes struggle to help their surviving children cope with the loss.

“When you hear their stories, you think, ‘This is the worst thing I have ever heard,’” Francis said, “until you hear the next one.”

Hours after graduating from Jacksonville’s Raines High School in May 2022, , 18, was shot and killed while arriving at a friend’s celebration. Fields was walking into the party when a car pulled up and opened fire, his mother, Yvonne Fields, told Action News Jax in an interview.

A defensive lineman on his high school football team, Fields had been offered a full scholarship to play for Keiser University in West Palm Beach. His parents were planning a party for the following day to celebrate his graduation.

“Everybody loved him,” Yvonne Fields said of her youngest son, calling him “the life of the party.”

A Black woman sits for a TV interview indoors.
Yvonne Fields of Jacksonville talks about the death of her son, Rashaud Fields, 18, who was shot and killed in May 2022 at a high school graduation party. (Kevin Jordan/Action News Jax)

“Rashaud loved to dance. He was a joke teller. He was funny,” Fields said.

At the time, Rashaud Fields was at least the ninth 17- to 19-year-old homicide victim in the city that year, according to the , the local newspaper. Yvonne Fields said she has kept her son’s room exactly as he left it the day he was killed. She smells his shirt every day.

“I know he’s not coming back,” she said, “but I can feel the spirit.”

Two days after celebrating his 18th birthday, Maurice Hobbs was fatally shot in January 2017 as he waited for his mother to pick him up.

“I was not even a block away,” Latasha Hobbs said to Action News Jax.

A photo shows a white woman being hugged outside in the evening at a gathering.
Latasha Hobbs receives a hug at a gathering to end gun violence in Jacksonville on Aug. 27, 2018. Her son, Maurice Hobbs, was shot and killed two days after celebrating his 18th birthday in January 2017. (Joe Raedle/Getty Images)

A singer, rapper, and poet, Maurice Hobbs wanted to perform and launch a clothing line. He dreamt of making enough money to give homes to everyone in his family so they could all live on the same street.

His mom recalled celebrating his birthday with cake and dancing in the kitchen and his reaction to turning 18.

“He was like, ‘Oh my God, Mom, I made it to 18,’” Latasha Hobbs said. “So it’s hard to swallow knowing that my baby didn’t make it to 19. It’s not fair. My baby deserves to be here.”

Pamela Howard has struggled for nearly two decades with the pain of the killing of her son Derrell Baker at age 17.

Howard, a mother of five, called her son energetic and an anchor for his younger siblings. Baker excelled at football, she said, and was on track to graduate high school despite having severe attention-deficit/hyperactivity disorder.

Someone shot Baker in September 2008 as he walked to school. A passerby found him by the road.

A Black woman sits outside as she holds two framed photos of her son.
Pamela Howard has spent nearly two decades trying to help police find the person who killed her son Derrell Baker, 17, as he walked to school in 2008. (Malcolm Jackson for Ñî¹óåú´«Ã½Ò•îl Health News)

Howard said she thought Baker was at school and later football practice. The family learned something might be wrong only when a sibling heard that Baker had been shot.

Howard called area hospitals in search of her son. By the time she found him at UF Health Jacksonville, it was too late, she said: He had died hours earlier.

“I don’t remember anything after they told me” he was dead, Howard said. “My friends say they just heard me scream.”

For the mothers Fields, Hobbs, and Howard, the sudden, unexpected death of their children cut deep. The lack of closure is painful. Police have not made an arrest in any of the cases.

“When I get justice,” Yvonne Fields said, “maybe I’ll be a little at peace.”

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Leading Cause of Death

, chief of pediatric surgery and trauma at Children’s Hospital of Philadelphia, said there has to be an appetite in state capitals to regulate firearms and protect children from gun violence.

Nance co-authored a in JAMA Pediatrics finding that the number of states where guns were the leading cause of death for children and teens increased from zero over the period 2004 to 2008 to 24 from 2019 to 2023.

Motor vehicle deaths among children, once the leading cause of death in that group, have declined primarily because of safety interventions undertaken by governments and car manufacturers, he said, from seat belt laws and speed limits to air bags and antilock brakes.

“That progress has been pretty universal across the U.S.,” he said, “but firearm stuff is just all over the map.”

Guns don’t have federal safety standards, Nance noted. They aren’t regulated by the Consumer Product Safety Commission, a federal agency that protects the public from dangerous products, and they can’t be recalled the way unsafe toys or cars can be.

“We’ve really done almost nothing to change the trajectory of firearm injuries in kids,” Nance said.

Goldhagen, the UF Health pediatrician, said Jacksonville leaders tried to address gun violence through the Jacksonville Journey, an initiative launched in 2008 — when Duval County was the murder capital of Florida — under former Mayor John Peyton.

The program for children at risk of violence provided mentorship, summer camps, job training, and nonpolice strategies such as neighborhood beautification projects and community center programs. The Journey also partnered with the Jacksonville Sheriff’s Office on gang intervention focused on young people.

Officials credited the effort with a nearly 40% reduction in homicides in Duval County in its first four years.

After Peyton left office in 2011, program spending of about $15 million was slashed to $8.6 million in 2012 and about $2.3 million in 2014. The scaled-back program was eventually combined with another children’s initiative to form the , which uses city, state, and federal grants to fund youth services and intervention programs.

Duval County is the only large county in Florida that does not have a child services tax dedicated to programs for children, including efforts to reduce youth crime.

City leaders believe “public safety is about fire and police, but not social services,” said Vicki Waytowich, executive director of the , a nonprofit funded through grants and contracts that provides health and juvenile justice services for children and families in Jacksonville.

“There is absolutely zero political will to do anything that remotely resembles a child services tax,” she said.

In 2024, on a gun violence prevention program called Cure Violence, which tried to squash beefs between youths before they escalated to shootings. A city Office of Inspector General report and sound financial practices.

“We have a public health system that doesn’t focus on this as a public health or population health issue,” Goldhagen said.

Waytowich said crime is a symptom of much deeper problems on the north side of Jacksonville, from neighborhood decay to generational trauma and lack of job opportunities.

“We don’t really have the funds to address the root causes,” she said. “What we’re doing is slapping a band-aid on things.”

Unlike in Mandarin, a predominantly white neighborhood on the south side of Jacksonville with easy access to about seven grocery stores, children of the city’s north side have poor nutrition, Waytowich said, and many walk more than a mile to get to school.

“We can see that kids don’t have hope,” Waytowich said. “When kids believe they’re going to die at 21, then what’s the use of goal-setting and résumé-building workshops?”

In 2025, Jacksonville Mayor Deegan launched a program to address gun violence called .

But like its predecessor, Journey Forward does not have a dedicated, ongoing source of funding.

Hard Memory

On March 22, Ladonna Johnson said, she broke up with Dodson because she saw that he was sharing location information with other women on his cellphone.

She said she went into a bedroom where A’mahri and his sister were watching television and put her son on her lap. Dodson followed Johnson into the room, she said, then went into a closet and retrieved the gun.

“He just kept asking me, ‘What are we doing?’” Johnson said.

Moments later, Johnson said, she heard a loud bang. Her daughter started to cry.

They will both need therapy, she said. She is dedicated to preserving A’mahri’s memory: “I want people to know how adorable and sweet my son was.”

Still, she said, “I feel like I will never be OK.”

Methodology

To find that more than 4,000 children under 18 had been treated in Florida hospitals for gunshot wounds from 2018 to 2024, The Trace and Ñî¹óåú´«Ã½Ò•îl Health News analyzed two datasets obtained from the Florida Agency for Health Care Administration via a data request:

  • In the emergency department file, which contained records of 67,565,314 ER visits that did not result in an inpatient admission, we identified 37,415 gunshot wound cases using the Centers for Disease Control and Prevention’s .
  • In the inpatient file, which contained records of 21,857,664 hospital visits in which patients were admitted, we identified 28,149 gunshot wound cases using the CDC definition.

We defined children as 17 and under and filtered the patient age column to find that 2,340 children had been treated in ERs and 1,684 admitted to hospitals with gunshot wounds. To avoid double-counting, we excluded patients from the emergency department file whose records indicated that they were transferred to a different inpatient facility.

Demographic breakdowns were generated using the race and ethnicity columns in the datasets.

To examine the geographic distribution of the burden of gun violence, we grouped child gunshot wound victims by the ZIP code provided. Importantly, this ZIP code is the location not of the shooting but of the child’s residence. A small number of children in the data had out-of-state ZIP codes, or placeholder ZIP codes indicating they were homeless or from a foreign country. These children are included in statewide totals as children treated in Florida hospitals but not in ZIP-level results.

This data does not include children who were shot but died at the scene or before reaching the hospital or who never received medical treatment.

Ñî¹óåú´«Ã½Ò•îl Health News data editor Holly K. Hacker contributed to this report.

This report was produced by Ñî¹óåú´«Ã½Ò•îl Health News, The Trace, Action News Jax in Jacksonville, and WFTV in Orlando.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

]]> 2278230 The Medicare GLP-1 Discount Has One Big Catch: Some Sick Patients Don’t Qualify /aging/medicare-glp1-bridge-weight-loss-drugs-coverage-exceptions-cost-access/ Tue, 25 Aug 2026 09:00:00 +0000 /?p=2272688 In January, Jeff La Marca got a prescription for the popular weight loss drug Zepbound. But he couldn’t afford the $750 monthly price tag.

Then Medicare launched an 18-month pilot program that offers GLP-1 medications to some enrollees for only $50 a month. La Marca thought he might finally be able to afford the drug.

“I thought, ‘Thank God, there’s a path,’” said La Marca, who lives in Basking Ridge, New Jersey, and has tried numerous diets and exercise regimes.

But the 68-year-old’s celebration was short-lived.

His application to the pilot program was denied.

La Marca has severe obstructive sleep apnea, one of several diagnoses that exclude patients from the Bridge program’s $50 monthly price. The notification didn’t say why he was rejected. He thinks that if he didn’t have that diagnosis, he would qualify due to his weight.

“I’m obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I’m at risk for stroke. I’m prediabetic. And yet I can’t get it. I’m livid,” he said.

A medical device used for obstructive sleep apnea sits on a table.
Jeff La Marca uses a machine to treat his obstructive sleep apnea. It adjusts his breathing with every breath. (Erica S. Lee for Ñî¹óåú´«Ã½Ò•îl Health News)
An older man puts on an oxygen mask that is connected to a medical device for sleep apnea.
La Marca, a retired professor living in Basking Ridge, New Jersey, is among an estimated 5.9 million Medicare enrollees excluded from a GLP-1 discount program because they have a medical condition such as Type 2 diabetes or sleep apnea. (Erica S. Lee for Ñî¹óåú´«Ã½Ò•îl Health News)

A Temporary Patch for a Long-Standing Gap

About 1 in 5 American adults have taken a GLP-1 medication, and most of them, including those with health insurance, say the drugs are . Federal law has long barred Medicare from covering drugs prescribed solely for weight loss, which is why the Medicare GLP-1 Bridge program made a big splash when it launched in July.

It’s a short-term pilot program in which Medicare is offering coverage of three GLP-1s for weight loss and management, to see if that would save Medicare money later. Eligible patients must be enrolled in Medicare Part D, a prescription drug coverage add-on to Medicare. Even though people must have Part D insurance to qualify, the preauthorization request doesn’t go through the insurer; it’s instead submitted to a separate system run by a contractor for the Centers for Medicare & Medicaid Services.

The pilot includes Wegovy, the KwikPen formulation of Zepbound, and the oral medication Foundayo.

Under the pilot, many Medicare beneficiaries with a body mass index of 35 or higher — the — qualify for coverage of one of those drugs, if prescribed. Those otherwise eligible who have a BMI of 27 to 34 can qualify if they also have certain health conditions, such as prediabetes or cardiovascular disease.

But buried in the fine print is a distinction that’s tripping up patients like La Marca: The $50 price under Bridge applies only to people using the drug solely for weight loss. Anyone who has a qualifying medical condition that the Food and Drug Administration has approved GLP-1s to treat, such as Type 2 diabetes or moderate to severe obstructive sleep apnea, is instead routed back to their Medicare Part D prescription drug plan, which can require copays of hundreds of dollars a month for GLP-1s.

“The Bridge program was designed to target those people who can’t get GLP-1 coverage through Part D but would benefit from taking one for weight loss,” said Juliette Cubanski, who directs the Program on Medicare Policy at KFF, a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.

The cost to Medicare of subsidizing the drugs will depend largely on how many people use the program, and the federal government hasn’t released an estimate.

Cubanski that 3.8 million people qualify and that, if a quarter of them enroll in Bridge and remain on treatment for the program’s full 18 months, it will cost Medicare about $3.3 billion. If three-quarters enroll, costs could rise to $10 billion.

If the government expanded the program to include the additional 5.9 million people who are overweight and already eligible for GLP-1 coverage through Medicare Part D, it would add billions more to the program’s cost.

The demonstration’s initial weeks have been positive, and most prior authorization requests have been completed in under 12 hours, CMS spokesperson Timothy Foster said.

“This has allowed thousands of eligible beneficiaries to access GLP-1 medications for weight loss at pharmacies nationwide,” Foster said.

An older man wearing a plaid shirt with suspenders sits on his front porch with his hands resting on his cane.
“I’m obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I’m at risk for stroke. I’m prediabetic. And yet I can’t get it. I’m livid,” La Marca says, referring to the popular weight loss drug Zepbound. (Erica S. Lee for Ñî¹óåú´«Ã½Ò•îl Health News)

GLP-1s Aren’t Covered

Patients like La Marca are left in a tough spot, qualifying for Part D coverage of a GLP-1 but facing much higher cost sharing.

“‘Coverage’ doesn’t always mean ‘affordable,’” said primary care physician , who describes herself as a “big proponent” of GLP-1s and practices at Sunflower Medical Group in Roeland Park, Kansas.

The Bridge program is leaving behind patients with the greatest medical need, she said. She noted that many Medicare patients already must navigate prior authorization and spend months trying alternate, often cheaper treatments, a process known as step therapy, before finally getting approval — only to arrive at the pharmacy counter and discover that their GLP-1 copays will run them $200 to $600 a month, if not more.

Researchers studying how Medicare insurers cover GLP-1s that recipients have faced increases in out-of-pocket costs and that almost all plans now require prior authorization, which can make getting the drugs more difficult.

Chris Bond, a spokesperson for insurance industry trade group AHIP, blamed drugmakers’ prices, “which they alone set and they alone can lower.”

La Marca’s insurer declined to answer specific questions about La Marca’s case.

Left Waiting

For now, La Marca’s GLP-1 prescription remains unfilled. The severe sleep apnea diagnosis that helps establish his medical need is also what excludes him from the discount program that would bring the cost within his reach.

As he reflected on his appeals and the dead ends, La Marca paused, his eyes filling with tears of frustration.

“This is now my quest, because it’s my only chance to improve my health,” he said. “It’s the only thing left. I’ve tried everything.”

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

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