Hundreds of detainees across at least 33 states allege in federal suits that immigration detention facilities are failing to provide adequate medical care, an investigation by Ñî¹óåú´«Ã½Ò•îl Health News and The Associated Press found. Detainees say they didn’t get medications on time — or at all — for conditions including high blood pressure, diabetes, depression, epilepsy, Parkinson’s, and HIV. Requests for help went unanswered for weeks. Blood sugars rose. Infections festered. Cancers remained untreated. Detainees collapsed and had seizures.

U.S. jails and immigration detention centers have to meet the medical needs of the people in their charge. But the system is sagging under an influx of detentions since President Donald Trump returned to office: More than 75,000 immigrants were being detained by U.S. Immigration and Customs Enforcement , up from around 40,000 a year earlier.

Ñî¹óåú´«Ã½Ò•îl Health News and AP analyzed thousands of court cases filed since Trump’s second inauguration that use a legal route known as habeas corpus to argue people are being held illegally by ICE. The records offer a rare window into how those detained say, often under penalty of perjury, ICE is handling their medical needs. Reporters also interviewed more than 50 detainees, family members, and lawyers.

The investigation revealed that medical neglect is alleged across the sprawling detention system, including in offices not designed to house people, county jails, and quickly staged sites with nicknames such as “Alligator Alcatraz.”

ICE custody is deadlier than it has been in two decades, researchers wrote in April. The Department of Homeland Security reported 51 people had died in detention since the start of Trump’s second administration — with suicides .

Ñî¹óåú´«Ã½Ò•îl Health News and AP asked DHS to respond to the findings six days before publication, but it did not provide comment. The department’s acting chief medical officer, Sean Conley, has “it is both policy and longstanding practice for aliens to receive timely and appropriate medical care from the moment they enter ICE custody” and that the agency recruits healthcare professionals to maintain high standards. “This is better, more responsive healthcare than many aliens have ever received in their entire lives,” he has said.

Individual facilities and private prison companies contracting with DHS that responded to requests for comment said they follow ICE standards and detainees receive medical care when it is required. Some said they were unfamiliar with the allegations outlined in court documents; others blamed some detainees for lapses in their medical care.

“I have never seen such disregard or medical neglect like this anywhere,” Vardan Gukasian, a political dissident and former paramedic who spent years behind bars in Armenia, wrote in in March to contest his detention in Henderson, Nevada, as it stretched to 13 months despite health problems.

Madeleine Skains, a spokesperson for the city of Henderson, said medical care is always available at the facility and that the court had not ordered changes to his care.

Last June, as Gukasian experienced the symptoms of uncontrolled high blood pressure — dizziness, a nosebleed, and a headache — his cellmate banged on their door for help.

“When it did not arrive, the rest of the block banged on their doors,” he wrote. Gukasian was hospitalized that day.

‘Brazen Indifference to Really Obvious Problems’

The administration’s mass deportation effort has swept up during routine immigration check-ins, at traffic stops, at their homes, and in hospitals.

About have no criminal conviction. Their immigration proceedings are civil, not criminal.

“I couldn’t understand why they treated me so harshly,” said a father of six in Georgia. He said he was injured while shackled in custody when the vehicle transporting him to an Atlanta facility jolted, throwing him out of his seat and into a metal armrest. His wound became infected with E. coli, he said, because he had to sleep on a dirty concrete floor amid leaking toilets.

Like other detainees interviewed, he spoke on the condition of anonymity; they said they fear for their safety, for the safety of their families, or that speaking out would jeopardize their immigration cases. The AP and Ñî¹óåú´«Ã½Ò•îl Health News are not naming anyone identified in court documents without their consent.

Staffers at Stewart Detention Center in rural Lumpkin, Georgia, didn’t adequately respond to that man’s request for medical help, , until he passed out and was taken to a hospital about an hour away. There, he said, a doctor told him he’d narrowly escaped amputation of his left leg. Medical staff found no records of a case matching this description, according to Brian Todd, a spokesperson for CoreCivic, which runs the facility.

The 48-year-old, who moved to the U.S. from Guatemala more than two decades ago, was released in October and is now a legal permanent resident. But he is unsure if he’ll be able to return to his job in construction because, he said, he can no longer lift heavy things due to his injury.

Some detainees or their lawyers said even basic care was denied: gauze to protect an open foot wound, prenatal care for a high-risk pregnancy, a pillow to ease the pain of sleeping with advanced stomach cancer, sanitary pads for postpartum bleeding.

“I would like to believe the government has the best interest of those it holds in detention for whatever period of time,” Judge Benita Pearson, a federal judge in Ohio, said during a hearing in October concerning a 70-year-old who alleged the government lost her glasses during her arrest. “If one is unable to see due to the loss of glasses when detained, that should be fixed.”

, who worked for ICE and now serves as a special adviser to the American Bar Association, said case law requires the government to treat people in immigration detention with the same care it affords those in traditional jails awaiting trial. But administrators are granted discretion and medical care standards vary.

Detainees are frequently moved across the country, often without warning, interrupting treatment. A woman from El Salvador said she missed a week of HIV medication when she was transferred from Colorado to a county jail in Wyoming.

A Russian man wrote that, while detained in Texas, he saw a gastroenterologist about his painful gallstones and scheduled an appointment with a surgeon. “Unfortunately, I never got to see him, due to my being moved around various detention centers.”

Advocates say that even obvious disabilities, like legal blindness, are ignored.

A detainee who lost one eye and had severe glaucoma in the other required twice-daily drops to maintain what vision remained. But, he said, some days the drops never came.

“Now I can only see a little bit straight in front. It now often looks like I’m seeing through gauze,” the man wrote in a court declaration. “This makes me very afraid that one of these times I am going to open my eyes and not be able to see anything at all.”

He wrote that he was scared he wouldn’t be able to see his infant son grow up.

“It’s just sort of brazen indifference to really obvious problems, things you would have thought absurd a decade ago — like the fact that you can’t see,” the man’s attorney, Brian Hoffman, said. “Before, you could attempt to work with folks on the government side and maybe shame them into doing the right thing. Now, it’s sort of like anything you want done you have to go to court and sue over.”

Even court orders aren’t always enough. One California judge ordered the government to take a man showing signs of prostate cancer to a specialist for diagnosis and treatment. Records show they did not take him.

Lawyers representing ICE told the judge that officials missed the appointment because of an “internal scheduling error.” CoreCivic, which runs that facility, said it was unable to comment on active litigation.

A Surge in Cases

When immigrants file habeas corpus petitions, they exercise a right to challenge unlawful imprisonment that dates to .

More than 40,000 such petitions have been filed during Trump’s second term, fueled by decisions last year to deny bond to many people held on immigration charges. Judges are split on whether that’s legal; the question appears headed to the Supreme Court.

Many habeas claims , but judges typically cite reasons unrelated to the medical neglect described in the petitions, such as detainees’ being held too long before being deported.

The more than 300 medical neglect claims found in this investigation represent a fraction of the problem. The details of habeas corpus cases are often hidden due to a federal rule barring the public from viewing such documents online. Ñî¹óåú´«Ã½Ò•îl Health News and AP obtained some documents from courthouses and received records on 4,400 cases from , a project of the nonprofit Immigration Justice Transparency Initiative. But tens of thousands more remain largely inaccessible.

Some judges have written that the habeas process is not how to raise allegations of medical neglect and have declined to release detainees over those claims. Not every detainee who believes they experienced medical neglect files a habeas petition or cites their medical issues if they do.

Jose-Antonio Segismundo’s petition made no mention of being unable to see an oncologist for the cancer in his abdomen while detained for more than seven months at the Florida detention facility known as Alligator Alcatraz and Folkston D Ray ICE Processing Center in Georgia. Medical records in his court filings show he was arrested about five weeks before his scheduled appointment with a cancer specialist.

His wife, Maria Jose Gonzalez, said he didn’t receive any treatment even though she sent his medical records and explained his condition to officials at Folkston. When his stomach pain erupted, often suddenly and intensely, she said, they gave him Tylenol.

Geo Group, which runs Folkston, follows ICE standards and provides healthcare and access to off-site medical specialists when needed, spokesperson Christopher Ferreira said.

This spring, Segismundo, 48, was deported to Mexico, a country he left nearly 30 years ago, Gonzalez said. Now, she said, he will have to restart his search for care in the Oaxacan village where he grew up.

Watching Loved Ones Deteriorate

Detainees receiving inadequate healthcare have little recourse. The Department of Homeland Security last year gutted the Office of the Immigration Detention Ombudsman. In early May, it shut the office entirely, arguing that Congress didn’t fund it.

Previously, ombudsman staffers could help facilitate medical care or look into complaints of neglect, according to Matt Boles, an immigration attorney in Georgia. Now, he said, there’s no one to call.

Meanwhile, detainees’ families said they feel helpless, making desperate calls to facilities, the government, and their legislators while watching their loved ones deteriorate.

Riya Khan saw her mother get sicker at the California City Detention Facility, which is owned by CoreCivic. When she visited a week after her mother arrived at the facility in the Mojave Desert, Riya said, the 64-year-old woman stumbled into her seat. She was shaking and her breathing was labored.

Masuma Khan came to the U.S. from Bangladesh in 1997. She has no criminal history, her records say, and was detained in October when she showed up for her regular ICE check-in.

For the month she was detained, according to her daughter, she only intermittently received her medications for conditions including high blood pressure, hypothyroidism, and prediabetes. CoreCivic treats chronic conditions in line with applicable medical standards, Todd said.

“Nothing matters more to CoreCivic than the health, safety and well-being of the people in our care,” Todd said.

Khan said she got her asthma medication for the first time two days before she was released and that her eye drops for glaucoma never arrived. Staffers told Khan she needed to buy some of her medications from the commissary but it didn’t stock them, her daughter said.

Before ICE detained Masuma Khan, she made friends with everyone, her daughter said. She had worked for years at Lucky Boy, an iconic Pasadena fast-food restaurant, and in her free time fed birds and left out fruit for bees that visited her apartment’s balcony.

Now she’s too scared to go outside. She still must regularly check in with ICE, and she’s terrified each time.

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A Stroke on a Video Call

Previously, detainees with serious medical needs would likely have been released on humanitarian parole, in part to avoid the cost of their care, Vermont attorney Andrew Pelcher said.

In fiscal year 2023 — before the detained population soared — ICE spent more than $390 million on healthcare for detained noncitizens, according to its to Congress. In May, Todd Lyons, then acting director of ICE, said at a conference that the agency had already spent “almost half a billion dollars” on detainee healthcare this year.

Now, under “mandatory detention,” people are staying locked up with serious — and expensive — conditions.

A Romanian citizen underwent several heart surgeries, including an emergency triple bypass in April 2025, before he was arrested in July. As part of his recovery, the 52-year-old was required to take 16 daily medications. While at an ICE field office in Baltimore, his court filings allege, he went two days without any medication before officials moved him to a facility in New Jersey.

He was hospitalized three times while detained, complaining of chest pains — in part, medical records and court documents say, because despite “countless requests,” the detention center did not provide all his medications. Hospital discharge papers cited by his lawyer show he received only eight of the 16 medications after his second release from the hospital.

“Can you please talk to the ICE facility to make sure they give him his medications?” his treatment providers wrote in medical records included in his court filings. “He was admitted last week for chest pain and today he was readmitted again for chest pain secondary to non compliance for medications.”

Several weeks later in August, he had a stroke while on a video call with his daughter, according to court filings. “He was struggling to breathe, and was pointing at his chest where he was again experiencing pain, and suddenly stopped speaking.” His daughter screamed for help through the video monitor, according to his petition. “Eventually an officer came in to assist him and cut the feed.”

The man lost his ability to speak for four days, the document says. He was returned to detention, where he remained until a federal judge ordered his release in November.

Impossible Choices

Cassandra Amador waits for the phone to ring every morning, desperate to ask her husband the question that’s woken her up every night for months: “Did you get your medicine?”

Her husband, Pedro Javier Amador Gutierrez, 36, has high blood pressure and depends on the state-run facility in Florida nicknamed “Deportation Depot” to administer the prescriptions that have kept him alive for years. Many mornings, he tells his wife he did not get them.

When she talks to him, she said, he sounds weaker and more scared every day, not like the upbeat man who would take her kids out for ice cream.

“You can hear in his voice how he feels,” she said.

Now, she said, he’s considering returning to Cuba, which he fled because of political persecution, out of fear that he will die in detention without his medicines. Amador and her children would go with him, she said, even though she was born in New Jersey, has never been to Cuba, and doesn’t speak much Spanish.

But he’s already collapsed twice at the Baker Correctional Institution in Sanderson, Florida, his wife said. She’s terrified that the next time, he won’t get up.

Methodology

Ñî¹óåú´«Ã½Ò•îl Health News and The Associated Press sifted through thousands of immigration habeas corpus claims to find allegations of medical neglect from people detained by U.S. Immigration and Customs Enforcement during the second Trump administration.

Without a comprehensive, publicly available dataset of medical complaints by those in ICE custody, we used immigration habeas corpus claims to identify detainees’ healthcare-related allegations raised in federal court. Although the intended purpose of habeas corpus is to challenge the legality of a petitioner’s detention — rather than conditions of their confinement — these filings sometimes include detainees’ claims of inadequate healthcare.

But habeas corpus filings are not always publicly available. Federal rules restrict how members of the public can access habeas petitions filed by people in immigration detention. For most of these cases, court websites publish only court orders and dockets describing other filings. The initial petitions are available only through in-person visits to federal courthouses across the country. Habeas Dockets, a project of the nonprofit Immigration Justice Transparency Initiative, coordinates a nationwide network of volunteers to gather these petitions and make them available online.

Ñî¹óåú´«Ã½Ò•îl Health News and AP analyzed the dockets of roughly 33,000 cases filed by detainees from Jan. 20, 2025, through March 2026. The vast majority of cases had only basic procedural information, like dates of court filings and rulings. Only about 4,400 included the original petitions.

We also gathered a few dozen case files from courthouses, lawyers, and the Massachusetts federal district court website, which posts most petitions under a unique standing order.

We ran keyword and semantic searches of court records, including petitions, motions, and orders, for terms and phrases potentially related to medical neglect, such as surgery, medications, inadequate medical care, and treatment for chronic conditions such as diabetes and high blood pressure.

We found about 500 cases potentially alleging medical neglect. At least two reporters reviewed each case manually, yielding more than 300 cases containing specific allegations in sworn filings of delayed, denied, or deficient healthcare.

To be conservative, we excluded dozens of cases that alleged inadequate medical care but lacked specifics, for example a petitioner writing, “I have been sick and don’t get proper treatment,” or a judge noting a petitioner “complains that ICE is ignoring his medical problems.” We also excluded cases in which petitioners claimed only that they were denied special diets, exercise, or other accommodations that they said were key to managing their health conditions, such as a petitioner writing, “I suffer from Parkinson’s and cannot properly exercise,” or claiming that the food provided was unfit for a person with diabetes.

The cases we analyzed were neither randomly selected nor representative of immigration habeas filings nationwide. The claims were not independently verified. Many filings are not publicly available, and not all detainees raise medical concerns in court, so our account of cases represents a limited window into the landscape of claims, rather than a comprehensive picture.

Associated Press journalists Garance Burke, Valerie Gonzalez, and Tim Sullivan as well as Ñî¹óåú´«Ã½Ò•îl Health News correspondent Kate Wells contributed to this report.

This report is a collaboration between The Associated Press and Ñî¹óåú´«Ã½Ò•îl Health News.

This <a target="_blank" href="/courts/ice-immigration-detention-medical-care-neglect-court-records-ap-investigation/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

The 31-year-old compliance consultant from Hendersonville, Tennessee, said she couldn’t stop vomiting.

“Sunday morning, it all hits,” McClain recalled, as she described what happened that weekend in January. “I can’t keep anything down.”

McClain said she thought the dosage the telehealth company had prescribed seemed too high. She tried to contact her doctor, but when she didn’t get an immediate response, she said she called the company and a “care team” representative confirmed the instructions — which said to inject 2.21 milligrams of the semaglutide medication once a week — were correct.

It turned out, however, that was nearly nine times the amount patients are typically told to take for their first dose.

Nearly a month after she was diagnosed with an overdose, McClain said she was “still dealing with the residual side effects,” including an elevated heart rate and vision problems she felt were tied to the medication.

Most patients who have taken a GLP-1 received their prescription through a primary care doctor or a specialist, shows. But as the uptake of telehealth has grown substantially since the start of the covid pandemic, McClain is one of millions of Americans who have used online companies to meet a variety of their medical needs.

Many of the companies have started offering GLP-1 medications for weight loss as demand for these drugs has exploded. But certain medication errors tied to GLP-1s have exploded too, according to a Ñî¹óåú´«Ã½Ò•îl Health News review of Food and Drug Administration data, and physicians and telemedicine researchers worry that adverse experiences tied to telehealth companies are becoming more common.

Bad outcomes aren’t unique to telehealth providers or to the compounded weight loss drugs many of them offer. In fact, product liability lawsuits alleging patient injuries have been filed overwhelmingly against pharmaceutical giants Eli Lilly and Novo Nordisk, which manufacture name-brand weight loss drugs, court data shows. The drugmakers have defended their products.

However, some critics are also concerned that getting a weight loss prescription online is usually much easier than getting one through an in-person appointment. Not only do many telehealth companies write quick prescriptions for GLP-1s, but they often sell the medications, too, allowing patients to bypass in-person pharmacy visits. This one-stop shopping isn’t necessarily a good thing, according to critics who say some telehealth providers are writing prescriptions for people who should not be taking GLP-1s and then providing little or no follow-up care.

“It gives a black eye to telemedicine,” said Elizabeth Krupinski, an experimental psychologist at Emory University who has conducted research on the effectiveness of telehealth.

Telemedicine stands to benefit “so many people,” Krupinski said, particularly when the technology is integrated within a larger healthcare system. That way, patients benefit from the convenience of telehealth while maintaining a connection with their in-person providers.

But some telehealth companies are marketing GLP-1s as an easy way to lose weight — sometimes with the help of paid celebrity endorsements — without emphasizing the importance of healthy eating and exercise, she said.

They may be following the letter of the law, Krupinski said. But writing prescriptions while skimping on care “is not in the Hippocratic oath.”

The Perfect Storm

Starting around 2020, many states loosened restrictions on telehealth, which allowed online companies to proliferate. This helped accommodate patients who could not, or chose not to, be seen in person at the height of covid transmission.

Expanded telehealth access was also intended to lower barriers in rural communities, as well as mitigate doctor and nurse shortages. In many places, telehealth doctors and nurses are legally allowed to treat patients across state lines. But the way telemedicine is practiced , and state laws largely dictate rules that telehealth providers must follow.

Some companies, such as Mochi Health, require patients to meet virtually with a provider, such as a doctor, nurse practitioner, or physician assistant, before they can get a GLP-1 prescription.

But others, including Ro, sometimes require nothing more of patients than an “asynchronous” evaluation, which does not include a live conversation with a healthcare provider. During this type of evaluation, customers are typically asked to fill out an intake form and answer a medical history questionnaire before they are evaluated for a prescription. Ro requires a conversation in real time when required by state law, or when requested by a patient or clinician, said Nicholas Samonas, a spokesperson for the company.

“Every patient is counseled by their provider on the potential benefits and risks of treatment based on their individual medical history,” Samonas said. Ro’s clinicians can order lab work when necessary and, when appropriate, may recommend patients seek in-person care, he said.

But some medical experts are concerned that virtual care may be insufficient for prescribing weight loss drugs.

Patients with a history of pancreatitis, for example, should be counseled about potential complications, medical studies show. The same goes for people with a condition called gastroparesis, which affects stomach nerves and muscles, and those susceptible to medullary thyroid cancer.

Some patients may also benefit from blood work or muscle mass screening before starting a GLP-1.

But not all telehealth companies are adequately evaluating patients before writing prescriptions, said Marc-Andre Cornier, an endocrinologist at the Medical University of South Carolina and the immediate past president of The Obesity Society.

When it comes to parsing the good from the bad, “whose job is it to police that?” he asked. The problem, he said, is there aren’t criteria written by a government agency or a medical society to determine which providers are treating patients appropriately and which aren’t.

While the first GLP-1 was approved by the FDA more than 20 years ago, to treat Type 2 diabetes, the use of these drugs took off in 2021 when Novo Nordisk received approval for a semaglutide drug to treat obesity, with the brand name Wegovy. In a 2025 KFF poll, said they had taken a GLP-1.

In a in The New England Journal of Medicine, physician Amanda Banks noted that the proportion of GLP-1 prescriptions written for people who were not diabetic, obese, or overweight increased from 4.5% in 2018 to 17% in 2023.

In the paper, Banks called it “troubling” how easy it is to obtain a prescription for weight loss drugs and worried they might exacerbate existing eating disorders or cause new cases, including of anorexia.

Cornier, who has received compensation from Novo Nordisk for serving as a consultant, echoed some of Banks’ concerns. “It’s not just filling out a form online and then having some random healthcare provider sign off on it,” he said. “There are concerns with some of these online programs that there’s not a proper evaluation, there’s not a baseline, and there’s not proper supervision.”

The American Telemedicine Association, which advocates for the expansion of “digitally enabled care,” has not addressed how telehealth providers prescribe GLP-1s, spokesperson Gina Cella said.

“This is a bit out of our scope,” Cella said, when asked if the association had addressed the topic of telehealth providers and GLP-1 prescriptions.

The lack of clarity makes choosing a company potentially confusing for patients, and the medical profession is partly to blame, said Jamy Ard, an obesity doctor and researcher at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

Doctors have historically done a bad job counseling patients about weight loss, and many people aren’t comfortable talking to their primary care doctor about it, Ard said. Patients think, “Why would I go to my doctor and have them say, ‘Eat less and move more,’ when I have heard that a million times and I don’t want to have that lecture again?” Ard said.

This problem, combined with past shortages of name-brand versions of GLP-1s, such as Ozempic, Mounjaro, and Trulicity, has created a “perfect storm” for telehealth companies to flourish, said Ard, who has received support from pharmaceutical and telehealth companies.

While some telehealth companies prescribe only name-brand weight loss drugs, many also offer cheaper, compounded versions. They act as intermediaries between customers and mail-order compounding pharmacies, which create GLP-1s by mixing active ingredients, such as semaglutide, with additives. The ingredients for compounded drugs are commonly sourced from overseas suppliers, and the formulations are not reviewed by the FDA for safety.

The environment is “very much uncontrolled and poorly, if at all, regulated,” Ard said. “There is just no standard of care.”

Emily Hilliard, a spokesperson for the Department of Health and Human Services, told Ñî¹óåú´«Ã½Ò•îl Health News that compounded drugs “should only be used in patients whose medical needs cannot be met by an FDA-approved drug.”

Hilliard said the agency urges “consumers to be vigilant and know the source of their medicine.”

Understanding the Risks

While weight loss drugs have helped millions of people lose weight, they’re not without risk, the data shows.

A Ñî¹óåú´«Ã½Ò•îl Health News data analysis of the FDA’s Adverse Event Monitoring System found that medication errors made by providers or patients with popular weight loss drugs exploded from just over 2,000 reports in 2020 to over 25,000 in 2025. Those self-reported events involved semaglutide, tirzepatide, dulaglutide, and liraglutide, the generic names for leading GLP-1s.

Among frequent issues cited in the adverse event reports were administration of an extra or incorrect dose, issues with communication about a product, and prescribing errors.

Since 2019, the National Poison Data System has fielded a related to overdoses or side effects from injectable weight loss drugs. The data does not distinguish between overdoses tied to a telehealth prescription and those stemming from an in-person medical appointment, but it is a reflection of how prevalent these drugs have become.

Yet data on potential medication errors and adverse reactions to GLP-1 medications is incomplete, because many issues are never reported to federal officials.

For example, in a , the FDA accused drugmaker Novo Nordisk, the maker of Wegovy and Ozempic, of failing to report some adverse events to the federal government, including suicidal ideation and death.

Nobody knows how often adverse events occur, said Kristen Nixon, a Johns Hopkins University researcher who has studied posts about weight loss drugs on Reddit, a popular online forum.

Her team analyzed hundreds of Reddit posts from 2020 through last August and identified frequent mentions of drug reactions and user errors, such as patients’ not knowing how to correctly dose and inject the medication.

But another finding also stood out to her.

“Wow, there are a lot of people talking about telehealth,” Nixon recalled thinking. Reddit commenters said they got GLP-1 prescriptions from scores of telehealth platforms, Nixon found. Commenters also mentioned several dozen compounding pharmacies — often in the same posts about telehealth.

Pharmacies are typically required to counsel patients on medications they receive. But Nixon’s research found that telehealth companies often mail the medications directly, meaning patients do not need to go to a pharmacy.

“Anecdotally, it seems like the telehealth companies are really facilitating access to compounded medications,” Nixon said.

Leslie Gammon, 54, an office manager from Wendell, North Carolina, said she turned to a telehealth company called Amble Health for a weight loss drug prescription. She was given a GLP-1 after filling out an online form, she said.

Like McClain, when she received her mail-order compounded medication in late October, she thought the dosage that accompanied it seemed too high. She’d received a box of semaglutide earlier in the month with a much lower dose. But the refill she received was a stronger formulation, and the instructions told Gammon to inject three times the volume she had been taking in previous weeks.

Even though she injected slightly less than that recommended amount before bed on a Sunday evening, she woke up in the middle of the night “throwing up every 20 to 25 minutes,” she said. And it didn’t stop until Tuesday. She was eventually admitted to a hospital in Raleigh and now owes the hospital over $9,000, a medical bill shows.

Amble Health did not respond to questions for this article.

The delivery system for injectable versions of weight loss drugs is more complicated than for a pill. In its National Poison Data System alert, America’s Poison Centers noted that some people reported “accidentally taking 10-times the recommended dose due to confusing measurement units while using a syringe.”

And people who are eager to lose extra weight — before a wedding or a vacation, for example — may choose to self-administer a higher-than-recommended dose, said Arthur Caplan, a bioethics professor at New York University’s Grossman School of Medicine.

Some telehealth companies aren’t doing enough, he said, to make sure patients understand the risks or the complex delivery system associated with the injectable drugs.

“The consent is not adequate,” Caplan said. “There’s no probing to see if you understood anything.”

Cella, with the American Telemedicine Association, said the group has not addressed the difficulty of educating patients about the risks of injecting weight loss drugs. But she pointed to the association’s “,” which states that telehealth business models “must put the patient first.”

Proceed With Caution

Pharmaceutical companies must list potentially harmful side effects when they advertise the name-brand versions of their FDA-approved medications. Potential include nausea, vomiting, changes in vision, low blood sugar, and, in rare cases, thyroid cancer. Meanwhile, telehealth companies have not historically followed the same rules that drugmakers have in disclosing medication risks in advertisements. But the FDA has started cracking down on misleading drug ads.

A national shortage of weight loss medications in 2022 opened the door for compounding pharmacies to manufacture these drugs. But since the FDA declared the shortage over last year, companies that offer compounded drugs are increasingly facing legal and regulatory challenges related to their marketing tactics.

Mounjaro manufacturer Eli Lilly and other drugmakers are suing multiple telehealth companies for promoting compounded versions of their drugs. In one legal complaint, Eli Lilly alleged Mochi Health had engaged in “deceptive” business tactics. In a motion to dismiss the lawsuit last year, lawyers for Mochi Health called the complaint part of a “nationwide campaign to bolster Lilly’s profits by dictating patient care through the elimination of compounded drugs as a treatment option for weight management.” The lawsuit is ongoing.

Eli Lilly spokesperson Michael Jamison said in a written comment that telehealth companies sued by the drug manufacturer threaten “patient safety by falsely promoting supposedly ‘personalized’ compounded tirzepatide” and mislead “consumers about the safety, clinical testing, and effectiveness of their compounded knockoffs.”

Meanwhile, Novo Nordisk has filed 130 lawsuits against “entities engaged in unlawful marketing and sale of knockoff semaglutide drugs,” said Liz Skrbkova, a spokesperson for the drugmaker.

She said the company is committed to “protecting patients from unapproved knockoff drugs made with foreign, inauthentic active pharmaceutical ingredients that pose significant safety and efficacy risks.”

The Trump administration sent a in September and February to online companies such as , , , and . The FDA said these and other companies had made false or misleading claims related to compounded versions of weight loss drugs.

“Your claims imply that your products are the same as an FDA-approved product when they are not,” the agency’s Center for Drug Evaluation and Research on Sept. 9. HHS later referred the company to the Department of Justice after it announced the launch of a $49 version of Novo Nordisk’s Wegovy pill.

When asked about the FDA warning, Abby Reisinger-Moley, a spokesperson for Hims & Hers, pointed to a announcing a shift away from compounded weight loss drugs. The company said in the press release that it had entered into an agreement with Novo Nordisk to sell name-brand versions.

Alex Smith, CEO of Join Josie, an online platform that helps women in menopause lose weight by prescribing GLP-1s, said his company also made changes in response to an FDA letter, to include removing Join Josie’s name from medication vials. “Which I agree with,” Smith said, “because you don’t want patients thinking you’re the compounding pharmacy.”

SkinnyRx and Genesis Health International did not respond to requests for comment.

But these warnings aren’t the first time the federal government has stepped in to ensure that telemedicine is being used appropriately, said Mei Wa Kwong, executive director of the Center for Connected Health Policy.

Prior cases involved attention-deficit/hyperactivity disorder medications and other controlled substances prescribed by telehealth providers, she said. While those drugs pose more risk to patients than GLP-1s, the companies were also accused of improperly screening potential customers.

The onus still falls on consumers to research companies before signing up for their services, Kwong said.

“Always approach anything on the internet with a hint of skepticism,” Kwong said.

‘Keeps Getting Worse’

McClain, the Tennessee woman hospitalized this year after a GLP-1 overdose, said she lost 50 pounds a few years ago by taking a name-brand GLP-1 prescribed by her doctor.

At the time, the medication was covered by her health insurance. This year, when she was ready to take a GLP-1 again following a pregnancy, the drug was no longer covered for weight loss.

To save money by obtaining a cheaper, compounded GLP-1, McClain signed up for Mochi Health after doing her own research. “That was just the most affordable option,” she said.

But within hours of her first dose, she said, she found herself on the phone with poison control.

After her overdose, McClain said, she spoke to a clinical director at Mochi Health, once by phone but mostly via email, about her lingering symptoms before communication paused.

David Pilip, a spokesperson for Mochi Health, said in a statement that the company would not discuss individual patients due to privacy obligations. But he said adverse events are “immediately flagged” and “investigated with extreme precision.”

“Mochi Health takes patient safety extremely seriously,” Pilip wrote in an email. “We promptly initiated a review and have been in direct and ongoing communication with the patient to reach a resolution. We remain committed to doing so.”

McClain anticipates her healthcare bills related to the hospital stay will total at least $900. She said that to get the $159 refund for her three-month membership and reimbursement for the hospital expenses, she has been asked to sign a document saying she won’t take legal action against the company. Her experience, she said, “just keeps getting worse.”

NBC News producer Jessica Herzberg and Ñî¹óåú´«Ã½Ò•îl Health News senior correspondent Fred Schulte contributed to this report.

Do you have an experience using an online company for healthcare services or medicinal products that you think others should know about? Click here to contact our reporting team.

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“I’m freaking out,” said Wood, who lives in a 1,700-square-foot home in Terryville, a village just outside Bristol, Connecticut. “I don’t understand it.”

Wood, 52, had weight loss surgery at Bristol Hospital in 2022, hoping it would help with her sleep apnea and the pain in her knees and back. Before scheduling the procedure, she checked with her insurer, she said, and was told the surgery would cost $5,000 out-of-pocket. She paid in advance.

More than six months later, Bristol sent Wood another bill that pushed the cost of her surgery to more than $17,000. Wood said she tried to dispute the charge. The hospital sued her.

“That’s ridiculous. I was told so many times by Aetna: ‘$5,000 out-of-pocket,’” Wood said. “I never would have had the surgery had I known it was going to cost almost 20 grand.”

Wood is among more than three dozen Connecticut patients the Connecticut Mirror and Ñî¹óåú´«Ã½Ò•îl Health News interviewed over the past year who were sued by their hospital or physician over unpaid bills.

The patients include teachers, small-business owners, a postal worker, a retired nursing home aide, a nurse, and a hotel bellhop. Most had jobs and health insurance. Nearly all said they wanted to pay what they owed.

Patients taken to court described baffling bills, confusing health plan rules, and frustrating and fruitless telephone calls to hospital billing offices and health insurers’ customer-service lines. Even when they tried to resolve their outstanding bills, many said they couldn’t get answers.

Their experiences encapsulate breakdowns in the healthcare system that trap patients in debt. Health insurance didn’t cover care for reasons they couldn’t understand. Several patients did not qualify for financial assistance from providers, despite modest incomes. If they committed to pay, patients were hit with liens on their homes or interest payments and court fees that piled new debt onto their medical bills.

The industry’s key players blame one another for a broken system. Providers say insurers’ saddle patients with massive bills even when they have coverage. Insurers say at rates that outpace inflation.

Meanwhile, patients are stuck with the fallout. In 2022, about carrying medical or dental debt.

“It’s bad enough that I have bad health and have to pay mountains of medical bills,” said Samantha Mantiera, whom Danbury Hospital sued in 2024 over $10,000 she said she was erroneously charged. “Then to constantly be dealing with incorrect bills and then a lawsuit on top of it took me over the top.”

Mantiera said she spent months trying to explain to the hospital and then a collection agency that her insurance statements indicated she owed just $260. She was sued anyway.

After Mantiera contested the lawsuit, Danbury Hospital withdrew it, court records show.

Mantiera said she and her husband now travel up to an hour from their Brookfield, Connecticut, home to avoid hospitals owned by Danbury’s parent company, now called Northwell Health.

Kathy Holt, who leads the state Office of the Healthcare Advocate, said that in the past several decades healthcare has only gotten harder for patients to navigate. The agency fields thousands of calls every year from residents looking for help with medical billing questions.

“I’ve talked to too many people who have just given up,” Holt said. “The system has been made so hard for them, and I feel like it’s deliberate.”

‘They Would Not Talk to Me’

Debt collection lawsuits against patients have declined in Connecticut since 2019, a CT Mirror-Ñî¹óåú´«Ã½Ò•îl Health News analysis of state court records found. And court records show most Connecticut hospital systems have stopped suing patients, including the state’s two largest systems, Yale New Haven Health and Hartford HealthCare.

Most hospitals stopped suing patients during the covid-19 pandemic as they reevaluated their collection practices, said Sarah Ginnetti, chief revenue cycle officer at UConn Health. The system ceased lawsuits in 2022, records show.

“In some of those circumstances, it just felt misaligned with our mission as an organization,” Ginnetti said. “For the small handful of cases that we might gain some type of legal victory, we really didn’t feel as though that would be our best path forward.”

Yale New Haven Health and Hartford HealthCare would not discuss why they stopped suing patients, instead issuing statements about their financial assistance programs.

Scores of medical providers — including physician groups, dentists, and hospitals — , data shows. The CT Mirror-Ñî¹óåú´«Ã½Ò•îl Health News analysis found more than 1,500 healthcare-related debt cases filed in Connecticut courts in 2024.

This included lawsuits by Bristol Health, an independent local health system that includes Bristol Hospital, and Nuvance Health, a chain of seven hospitals recently acquired by Northwell Health, a multibillion-dollar system based in New York.

Nuvance hospitals filed over 4,000 collection lawsuits from 2019 to 2024, records show. Over the five years, the health system accounted for more than a quarter of the roughly 16,300 medical debt collection lawsuits against patients identified in state court records.

Hospital officials and other medical providers say they try to work with patients who have trouble paying their bills. Nikki Schulz, chief revenue officer for Northwell’s Connecticut hospitals, said in a statement that years ago the system “eased” its collection practices, leading to a “precipitous decline” in medical debt referred to collections.

“We fundamentally retooled our approach to align with industry best practices,” Schulz said. Records show the health system sued about 200 patients in 2024, down from 2,200 in 2019.

Healthcare executives also say they have a responsibility to try to collect.

“I don’t have a choice,” said Bristol Hospital CEO Kurt Barwis. “What we’re trying to do is sustain a mission of taking care of this community.”

Bristol Health is one of Connecticut’s most financially strained systems, and executives are currently in talks with the administration of Democratic Gov. Ned Lamont about an . The proposed deal is, in part, an effort to keep the hospital afloat.

Barwis said the hospital has taken steps to help patients with unexpected bills, including enlisting financial counselors to reach out to patients before elective procedures to discuss cost and financial assistance.

But Wood, who was sued by Bristol, said no one from the hospital talked to her before her surgery. When she called the hospital after receiving the $12,000 bill, she said she was told there was nothing they could do because her insurance had denied the claim.

“They would not talk to me about it,” Wood said. “They wanted their money.”

Bristol spokesperson Albert Peguero also blamed Wood’s insurer and said the hospital worked with Wood as she went through numerous insurance appeals with Aetna.

Wood didn’t fare any better with Aetna. It turned out that her health plan covered only $15,000 worth of bariatric surgery, meaning she was responsible for any bills that exceeded that.

Aetna spokesperson Shelly Bandit said Wood had been notified of this provision, though Wood disputes this.

The back-and-forth with the hospital and the insurer enraged Wood. But after she was sued, she concluded she had no more options. She settled with Bristol, agreeing to pay the full balance on a payment plan of $150 a month, court records show. Under the agreement, it would take Wood almost seven years to pay off the debt.

Last year, Wood faced additional financial challenges after her mother died and her husband lost his job and was unemployed for six months.

Wood said she’s regained about a third of the 100 pounds she lost after her surgery because of the stress. Some months she pays Bristol less than $150. In January, the hospital placed a lien on her home.

“We don’t have savings. We don’t have the extra money. We’re living check by check,” Wood said. “We’re working-class people trying to make a living, trying to do the right thing. And we always get screwed.”

‘I Don’t Have Hours on End’

It’s difficult to know how many medical debt lawsuits arise from disputed bills. But most U.S. adults with healthcare debt say they’ve received a bill in the past five years that they thought contained an error, according to a .

The prevalence of disputed medical bills is one reason many advocates for patients say hospitals and other healthcare providers shouldn’t sue people they treat.

“Understanding insurance to begin with and then navigating denials or bills that are not plainly understood leaves patients stuck in an opaque system where they have the least leverage and power,” said Eva Stahl, a vice president of Undue Medical Debt, a nonprofit that has worked with states to buy and retire debt — including for more than 150,000 Connecticut residents.

“Patients understandably are left with questions and confusion,” Stahl said.

Timothy Bigham, who owns a construction company and was sued in 2023 by Danbury Hospital, said he never understood why he was billed more than $64,000 after he was hospitalized following a 2019 heart attack.

Bigham, who lives in Danbury, Connecticut, said he was insured at the time. But soon after he got home, Bigham began getting regular calls from the hospital. He was told his insurer wasn’t paying the bill because he refused to “release medical records,” he recalled.

“I had insurance when I had the heart attack, but it’s my job to get the insurance company to pay?” Bigham said. “I’m self-employed. I work in construction. I don’t have hours on end to sit on the phone trying to talk to somebody at an insurance company.”

Bigham said he ultimately “stopped dealing with it” because he didn’t know what else to do.

Then, in 2023, Danbury Hospital sued him. A judge dismissed the case in 2025, citing the hospital’s “failure to prosecute with reasonable diligence,” according to court records. But by then, the alleged debt had devastated Bigham’s credit score, tanking it by over 100 points, he said.

Northwell’s Schulz declined to comment on any specific patient cases, citing privacy laws.

Connecticut barring medical debt from consumer credit reports.

A handful of states have tried to protect patients from lawsuits through limiting when hospitals can pursue legal action. Illinois, for example, prohibits lawsuits against uninsured patients who prove they can’t afford their unpaid bills. Nevada, New York, North Carolina, Maryland, and Virginia prohibit liens and foreclosures for medical debt.

‘It Was a Nightmare’

Dominique Jean Pierre was equally surprised by the $20,000 bill he got after he was hospitalized at Norwalk Hospital with a urinary tract infection in July 2020.

Jean Pierre, 66, had worked for nearly two decades as a bellhop at a Hilton hotel in Stamford owned and operated by Atrium Hospitality, a Georgia-based company. When he got sick, the hotel was temporarily closed because of covid lockdowns.

What Jean Pierre didn’t realize, he said, was that the hotel had also cut off employee health benefits. He said he was told by the hospital that he’d be responsible for the bill.

“It was a nightmare,” he said.

Jean Pierre said he begged his manager for help but was told there was nothing the company could do. Atrium Hospitality did not respond to requests for comment.

Two years after Jean Pierre’s hospitalization, Norwalk Hospital sued him for more than $20,000, court records show.

Jean Pierre said he tried twice to apply for financial assistance, but the hospital told him he and his wife made too much to qualify, even though his medical bills totaled almost a quarter of their annual income of about $87,000.

With nowhere to turn, Jean Pierre settled with Norwalk Hospital, now part of the Northwell system, in 2025, agreeing to pay the full bill in $100 monthly installments, records show. At that rate, he will be paying off the debt until 2042.

After the settlement, he said, the judge encouraged him to reach out to elected officials to try to get the debt canceled. Jean Pierre was exhausted.

“He says to me, ‘You have to go to your senators. Go to the governor.’ I said, ‘That’s too much. [I’m just going to] let it go.’”

Jean Pierre has left the Hilton and now works as a personal care attendant, as does his wife. But he said it still nags him that businesses and healthcare providers received millions of dollars in government aid during the pandemic, while he was left with $20,000 in medical debt.

“They gave money for the hotel. They gave money for the hospital. They gave money for a lot of stuff,” he said. “But we don’t see none.”

‘I’m Not Trying To Run Away’

Other patients said they felt trapped, even if they tried to do the right thing.

Deneen Brown, who runs a small daycare out of her home in Norwalk, was sued by Norwalk Hospital in 2024 for $7,200 over bills she allegedly incurred “on or about 2019 and 2020,” according to the lawsuit.

Brown said she was stunned by the lawsuit, as she believed she’d had health insurance at the time. But as a small-business owner who took pride in maintaining good credit and staying on top of her finances, she said she committed to taking care of it.

“I’m not trying to run away from something that may be my responsibility,” Brown said. “If you say I owe it, I’m going to figure it out, and I’m going to pay it.”

In January 2025, she agreed to a nearly 13-year payment plan of $50 a month, court records show. Often she pays more, she said.

The following month, the hospital placed a lien on her home. Brown said she never realized the hospital would continue to penalize her, even after she agreed to a payment plan.

“Had I known that, I would have never settled,” she said.

This article was produced in partnership with , a statewide nonprofit newsroom that covers public policy and politics.

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“Did we hike this morning?” she asked.

“Yes, we hiked,” said her husband, Steve Francks. “And you did really well.”

But 15 seconds later, she asked the same question: “Did we hike today?”

Anderson, 65, a retired finance executive, doesn’t remember any of it. She can recall what happened that afternoon only because her husband started recording her on his cellphone.

“I was just on this nonstop loop,” she said.

Almost immediately, Francks knew something was wrong. “Jan was out of it,” he said.

He took her to an emergency room in Sedona, where staff initially thought she might be having a stroke. Because the facility wasn’t fully equipped to evaluate or treat stroke patients, Francks said, she was airlifted to a Phoenix-area hospital, where she was admitted.

It turned out she wasn’t having a stroke. Her medical team eventually determined she was probably experiencing , a rare, temporary, and benign memory disorder.

The good news was that her symptoms didn’t last long, and she has suffered no long-term effects from the episode. It took about 24 hours before she was able to start forming new memories, and she was discharged the next day. Anderson and Francks, who split their time between Sedona and Edmonds, Washington, returned to the Pacific Northwest a few weeks later.

Then the bill came.

The Medical Service

The sudden confusion associated with transient global amnesia can also be a sign of a more common neurological condition, so it’s important to rule out other possible causes — such as a stroke, for which timely emergency care can spell the difference between life and death.

Anderson’s records show her care at Abrazo Health’s Arrowhead Campus in Glendale, Arizona, included an electrocardiogram, which can detect underlying cardiac abnormalities, and imaging, which would rule out any vessel blockages that might cause a stroke. She also underwent various lab tests commonly used to diagnose a stroke.

The Bill

$59,181: $35,302 for diagnostic/therapeutic imaging, $8,147 for laboratory services, $8,146 for a special care unit, $5,532 for EKG services, and $2,054 for pharmacy. Anderson’s first bill from Abrazo Health said she owed $15,312.43, citing an insurance adjustment of $43,868.57, even though her insurer had not covered any of the charges.

Anderson said her insurer covered separate charges for the ER and helicopter transfer.

The Billing Problem: Communication Breakdown

The federal No Surprises Act bans out-of-network bills for most emergency services, even if those services are received at an out-of-network facility and are not preapproved by the insurer.

That means the cost of Anderson’s hospital care should have been covered as though it were in-network. At the time, she was insured by Molina Healthcare, through a plan purchased on the federal Affordable Care Act marketplace.

But for a year, Molina declined to pay for her care in Glendale, at one point arguing that her hospital stay required authorization when, or even before, she was admitted.

“I can’t get anyone to resolve it,” Anderson said. “It’s almost $60,000 hanging over my head.”

The first problem arose about two weeks after she was discharged, when Abrazo Health sent Anderson a bill indicating she was a self-pay patient.

The hospital didn’t request her insurance information at any point during her stay, Francks said. He assumed, at the time, that his wife’s financial paperwork had been transferred from the ER in Sedona. It had not.

She called the Glendale hospital and corrected the error.

Then, in late June, Anderson received notice from the hospital indicating she was not a Molina member.

“Your insurance company notified our office that the patient was not a covered member for the services provided by Abrazo Arrowhead Campus on the above referenced service date(s),” the notice said. It showed the total charges for her stay exceeded $59,000.

But when Anderson called Molina to confirm her coverage, she said, the insurance company assured her the claim was being processed.

That didn’t mean Molina was willing to cover her hospital bill.

Anderson spent months trying to resolve the balance. She filed complaints with members of Congress, the Arizona Department of Insurance and Financial Institutions, and the Office of the Insurance Commissioner in Washington state.

In an October letter to Washington’s insurance commissioner, an appeal and grievance specialist for Molina wrote that the claim was denied because “inpatient stays require prior authorization, or notification at the time of admission. No notification of admission or prior authorization was received from the hospital, so the claim was denied.”

It continued: “Molina covers out of network emergency services but since this was an inpatient admission authorization is required.”

Nicole Broadhurst, who focuses on medical billing issues as CEO of a , said this dispute appears to rest between the insurer and the medical provider.

She said that Anderson’s insurance information should have been transferred between the first ER and the Glendale hospital. Since it wasn’t, Broadhurst said, Anderson shouldn’t be held liable for her hospital bill. (Broadhurst was not involved in efforts to resolve Anderson’s billing dispute.)

Unfortunately, Broadhurst said, these situations are “not uncommon, even though we have the No Surprises Act.”

The Resolution

Anderson said she was told by Abrazo Health for months that it was working with Molina to resolve the bill. She said she was also told that even if Molina did not cover the full cost of her hospital care, she would not be liable for the balance — but she never received that assurance in writing.

Meanwhile, Molina continued to uphold its decision to deny payment.

After Ñî¹óåú´«Ã½Ò•îl Health News contacted the insurer and the hospital with questions about her case, Molina told Anderson it had launched an internal review of her claim, and a revenue director with Abrazo Health told her the company was “treating this as a high-priority matter,” she recalled.

Anderson said the revenue director for the health system assured her that if Molina continued to deny payment, “the balance will be written off on the hospital’s end,” she said. “I will not be responsible for any balance” — not even the $15,312.43 the hospital initially billed her after the hospitalization.

Linda Nofer, a spokesperson for Abrazo Health, would not answer questions about Anderson’s bill. In a statement, she said the hospital system is “committed to working closely with our patients to resolve billing questions and concerns.”

Molina spokesperson Caroline Zubieta would not discuss or respond to questions about Anderson’s case on the record.

The Takeaway

The flurry of insurance paperwork and medical bills patients receive after a hospital stay can be overwhelming — and may sometimes appear contradictory.

Broadhurst said it’s important for patients to focus on the “patient responsibility” portion of an insurance document called an explanation of benefits.

Patients should not pay a bill if their explanation of benefits indicates they aren’t responsible for the amount charged.

In this case, Anderson had received a bill from the hospital saying she owed money. And her explanation of benefits from Molina confirmed she’d racked up more than $59,000 in hospital charges.

But that document also indicated her patient liability was “$0.00.” Anderson said the hospital was not pressuring her to pay the $15,312.43 bill or any of the charges tied to her account, but she was worried she would eventually owe a large sum because the charges remained unresolved for more than a year.

“The question I kept asking them was, ‘How much am I going to owe?’” said Anderson, who is now insured by Medicare. “It could be anywhere from that $15,000 adjusted amount to the full balance of $59,000.”

Broadhurst said she tells patients facing similar situations to “send the hospital a copy of the EOB and ask them to correct the account to $0 patient responsibility.”

“Even if no one is actively trying to collect, I’d still push for written closure so it doesn’t keep hanging over them,” she said.

Bill of the Month is a crowdsourced investigation by Ñî¹óåú´«Ã½Ò•îl Health News and that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

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Julie Rovner Ñî¹óåú´«Ã½Ò•îl Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of Ñî¹óåú´«Ã½Ò•îl Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

The One Big Beautiful Bill Act, passed by congressional Republicans in 2025, was supposed to backload cuts to health programs so they wouldn’t take effect until after the 2026 midterm elections. That’s not how things are working out, with numerous analyses showing insurance coverage is already starting to drop.

Meanwhile, the Trump administration claims that the coverage reductions prove its anti-fraud efforts are working. But those efforts are likely to affect far more people than just those who commit fraud against federal health programs.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Maya Goldman of Axios, Shefali Luthra of The 19th, and Lauren Weber of The Washington Post.

Panelists

Maya Goldman Axios

Shefali Luthra The 19th

Lauren Weber The Washington Post

Among the takeaways from this week’s episode:

• Amid a recent decline in the number of Americans with health insurance, one affected group in particular stands out: children. Many kids are falling off the Medicaid rolls, largely because of the chilling effects of the Trump administration’s immigration crackdown and broader confusion about eligibility requirements.
• Meanwhile, the high cost of health insurance is pressing people to seek alternatives, many of which offer few or no protections against large medical bills. On the campaign trail, high-profile Democrats are sounding the alarm about a problematic health ecosystem, even framing issues such as reproductive health in terms of affordability.
• The Trump administration is raising eyebrows with its response to the emerging Ebola crisis as it works to keep American citizens exposed to the disease out of the country entirely. Countering previous government approaches, which prioritized not only public safety but also offering the best care available to Americans, this approach also stands in stark contrast with President Donald Trump’s dismissal of masks, isolation, and other measures during the covid pandemic.
• And Trump declared himself healthy this week after undergoing his third physical exam in 13 months at Walter Reed National Military Medical Center. Trump’s resistance to answering specific questions, despite visible issues such as bruising and swelling, raises the point that a president’s health can be a public matter — especially for a president who is about to turn 80.

Also this week, Rovner interviews Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health, Céline Gounder, to discuss the Ebola outbreak in central Africa. 

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

Julie Rovner: ProPublica’s “,” by Kavitha Surana.  

Lauren Weber: The New York Times’ “,” by Sarah Kliff and Margot Sanger-Katz.  

Shefali Luthra: The New York Times’ “,” by Sejal Hathi.  

Maya Goldman: The Texas Tribune’s “,” by Terri Langford and Colleen DeGuzman. 

Also mentioned in this week’s podcast:

• Axios’ “,” by Maya Goldman.
• The Georgetown University Center for Children and Families’ “,” by Joan Alker.
• Ñî¹óåú´«Ã½Ò•îl Health News’ “Cheaper, Alternative Health Plans Are Having a Moment, but Critics Urge Caution,” by Sarah Kwon.
• NPR’s “,” by Elena Moore.
• The Washington Post’s “,” by Lauren Weber.
• Ñî¹óåú´«Ã½Ò•îl Health News’ “Trump Bought Stock in Drugmaker as His Government Boosted Its Obesity Drugs,” by Darius Tahir.
• The Atlantic’s “,” by Jonathan Lemire.
• What I Can & Can’t Say on TV’s “,” by Céline Gounder.

Credits

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A patient from his rural Northern California county , a disease so rare there that many physicians have never treated a case.

While California has some of the strictest vaccine laws in the country, conservative Shasta County’s approach during the covid pandemic stood in stark contrast with the state’s guidance. Its local leaders opposed masking and vaccine mandates, and the county public health officer, who had sought to enforce those state policies and other safety measures.

A potential measles outbreak had “always been in my mind,” said Mu, an outspoken family physician who was to sign a opposing covid vaccine mandates. But Mu, the county’s current public health officer, said that when his department identified the first local measles case, it acted decisively: “We forgot about fear.”

They went to work, he and his team said, to painstakingly retrace the steps of sickened with measles, contacting more than 600 people who may have been exposed at Costco, a sushi restaurant, sporting events, a school, or a healthcare clinic. Just one of the nine contracted measles from one of those locations, while the others were characterized by the public health department as “close contacts.”

Two and a half months later, the Shasta County public health department had declared the measles outbreak over. Infectious disease experts say the rapid response executed in the mostly rural, vaccine-hesitant county offers a playbook for public health officers across the nation who are struggling to keep the highly contagious virus from spreading.

“To me, the story of Shasta is one of hope,” said Peter Chin-Hong, an infectious disease specialist at the University of California-San Francisco.

After more than a year of ongoing cases, measles has sickened more than in the U.S., according to the Centers for Disease Control and Prevention. For the first time in two decades, the U.S. is poised to lose its measles elimination status, a designation signaling that outbreaks are rare and rapidly contained.

673 measles cases as of late May while had seen at least 997, according to their state health departments. 74 cases.

Critical Rapid Response

In late January, when Shasta County identified the first case, Mu gathered with more than a dozen communicable-disease nurses, epidemiologists, and emergency and community relations staffers for an “initial threat assessment meeting.”

Measles is an that can linger in a room for two hours after an infected person leaves, so on-call nurses and responders faced a daunting task figuring out exactly when the patient was infectious and where they had been.

“Everything is about speed — speed in identifying the person and finding the sites where measles were occurring,” Chin-Hong said. “If you keep it down to a few cases, it’s much easier. If you wait just a little bit longer, those people would have been in contact with a lot more people.”

Roughly 9 in 10 unvaccinated people exposed to the virus become infected. All nine of Shasta County’s confirmed cases were people who were unvaccinated or had unknown vaccination status, according to the county’s public health department. Before the department called families who may have been exposed, county nurses sometimes enlisted school principals, church staff, clinic managers, or others to make first contact, said Daniel Walker, the county’s supervising epidemiologist.

Erika Piper, the head of Redding Christian School in Palo Cedro, talked to school families wary of requests by public health officials — and government in general — to provide immunization records or other personal information. She said she also had tough but respectful conversations with families to ensure exposed, unvaccinated kids stayed home from school, so their community could abide by public health guidance calling for .

“I would say to them: ‘That’s totally fine. You have a choice. You’ve made your choice. But there are still consequences to the choices we make,’” Piper said, referring to families who had opted not to vaccinate their children. “‘And so you can either be a willing helper and a partner with me in this, and we can make it work and get through it, or you can battle me on it. But either way, you can’t be in school.’”

She allowed work to be sent home to quarantined students and personally took daily attendance at the school to help ensure health guidelines were met.

The California Department of Public Health assisted with case investigation by making calls to exposed people at the county’s request and deployed a covid-era phone system, CalCONNECT, that automates symptom monitoring for exposed contacts.

Shasta officials warned people not to be wary of calls from contract tracers using a 279 area code, worrying they would dismiss them as scams.

Delicate Conversations

In Shasta County, the measles vaccination rate is just below the for community-level protection, but in pockets of the community the rates are lower and vary widely, according to . And in those vulnerable places, an outbreak can spread.

For example, more than a quarter of Shasta schools had rates below 95% in 2024-25, according to the latest state data available. Several were below 90%. Although Redding Christian School reported a kindergarten measles vaccination rate at or above 95% in 2024-25, it was 87.8% three years earlier.

When it came to talking to people who had been exposed to measles, Sharayne Loomis, a supervising public health nurse on Shasta’s communicable-disease team, described the department’s approach as “meeting people where they are.” That included nonjudgmental conversations that supported residents regardless of their stance on vaccination, Loomis said.

Mu said the same philosophy extended across the county’s health agencies, but he publicly “measles parties,” gatherings where unvaccinated children are intentionally exposed to build immunity. And he spoke against receiving high doses of vitamin A without medical supervision. Vitamin A has circulated as a measles treatment in vaccine-skeptical communities and was endorsed last year by Health and Human Services Secretary Robert F. Kennedy Jr., though the CDC website says that vitamin A “does not prevent measles and is not a substitute for vaccination.”

Some community members said Mu’s department could have been more proactive before the outbreak, imploring him to emphasize the importance of vaccination in public messaging.

“Clearly, when the situation was known to be coming into our communities, that would have been a time to advise for vaccines,” Steve Kahn told county supervisors at their February board meeting. “I think he was negligent in that.”

For years, public health has been a political flash point for the region. The Board of Supervisors fired the previous public health officer, Karen Ramstrom, in May 2022 after upset with her enforcement of state covid rules.

In an effort to reach vaccine-hesitant Californians, state officials have been working in a coalition called Public Health for All Californians Together and through an effort nicknamed that uses social media monitoring and other research to tailor messaging to skeptical viewers.

Erica Pan, director of the California Department of Public Health, said the state is preparing for measles to possibly surge when it hosts World Cup soccer matches starting in June, as well as with increased summer travel.

But when it comes to mitigating an outbreak in a community, public health officials say, residents — especially those skeptical of vaccines — need to hear from the people they know.

“Trust is very important for us,” Mu said. “It is critical in getting people to follow our guidance, especially during an outbreak.”

This <a target="_blank" href="/public-health/measles-outbreak-contained-vaccine-skeptical-california-shasta-county/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

LISTEN: After a guilty verdict for negligent homicide, a former nurse has found receptive audiences on the speaking circuit. She says she hopes her story can help shed light on problems in the healthcare industry.

When RaDonda Vaught got her first speaking request, it had been a year since that day in a Nashville courtroom, when she listened as a jury read her guilty verdict for negligent homicide and neglect of an impaired adult.

That was in 2022. Vaught was sentenced to three years of probation for administering the wrong medication and killing a patient at Vanderbilt University Medical Center in 2017.

She also lost her nursing license. So Vaught became a full-time farmer. She and her husband live on a in Bethpage, Tennessee, tucked in the rolling hills north of Nashville. They sell eggs at farmers markets on Saturdays and supply meat to local butchers and restaurants.

The controversial trial had been national news, and now the healthcare industry wanted to hear from her. So Vaught started giving speeches across the country about what happened that day in the hospital. She says her hope is that others in an industry increasingly turning toward automation and artificial intelligence can understand the multiple factors that contributed to the deadly medication mix-up.

She says she’s painfully aware that it could appear she is profiting from a tragedy of her making.

“It wasn’t something that I wanted to happen. It wasn’t even something that was on my radar to think about,” Vaught said of the speaking requests. “The opportunities just kept presenting themselves.”

The speaking engagements provide her with an income that replaces what she made as a nurse, a career she can never return to. Last year, she told her story more than 20 times, and she is paid $5,000 to $10,000 per event.

But her speaking engagements also provoke criticism. After she told her story at length on Nashville Public Radio’s in March, a retired nurse, Gary Wood, fired off an email to the station. Such medical mistakes could never be justified, he wrote: “It put a stain on a proud and dedicated profession.” Yet, Vaught often finds a receptive audience, eager to hear her perspective.

“I’ve seen her a few times now in person, and I’ve never seen RaDonda tell the story and not be upset,” said Charlene Verga, who invited Vaught to be the closing speaker at the ’s clinical nursing conference last year.

“RaDonda speaking the way she is, she literally is transforming her mistake into a teaching moment,” Verga said.

Vaught expected the speaking gigs would be short-lived. But the reviews were good. And she realized she was comfortable in front of a crowd.

“It was emotionally overwhelming and a little cathartic, but I’m going to tell you, you could have heard a pin drop,” Vaught said of her first talk in 2023 to hundreds of industrial professionals at a meeting organized by , a Knoxville, Tennessee-based company that specializes in root cause analysis.

Vaught has turned her story into a cautionary tale that she hopes will make hospitals safer. She says that humans are going to make mistakes and that systems in healthcare need to be designed so people can fail without killing someone.

“This whole mockery of our healthcare system — people feeling afraid to talk about mistakes and come forward when they happen — it doesn’t save people. It kills them,” she said in a presentation to the .

Onstage, Vaught confronts the painful and embarrassing details directly, often choking back tears when talking about the patient who died — Charlene Murphey.

It wasn’t just one mistake that led to the death.

A doctor had ordered a sedative called Versed to settle Murphey’s claustrophobia before an imaging procedure. Vaught typed “VE” into the search function to retrieve Versed from the electronic medicine cabinet. When it did not dispense, she overrode the system.

In Vaught’s trial, fellow nurses testified that during a time when the hospital was upgrading some of its technology, they could use overrides to bypass delays.

When Vaught took that step, one of the drug options available was vecuronium, a powerful paralytic. Vaught overlooked multiple warnings about the danger of vecuronium, including on the bottle’s cap, which said “Warning: Paralyzing Agent,” according to court records.

Vaught administered the vecuronium and also left the patient alone.

While not disputing most of the facts, Vaught pleaded not guilty to all charges, claiming there were other factors, such as a new electronic health record system that was causing widespread problems in the hospital. A lead investigator for the prosecution testified in the criminal case that Vanderbilt also shared some responsibility.

As previously reported by Ñî¹óåú´«Ã½Ò•îl Health News, Vanderbilt did not initially report the error to regulators as required and told the medical examiner that the patient died of natural causes. The medical center fired Vaught and negotiated a settlement with the Murpheys that keeps the family from talking publicly about her death.

Once the case became a criminal matter, though, the details entered the public record. Vaught is not bound by the hospital’s settlement, allowing her to share whatever she feels comfortable sharing with whomever she wants.

Vanderbilt spokesperson Craig Boerner declined to comment about Vaught’s public speaking or what the medical center learned from the incident.

The two largest companies that make drug-dispensing cabinets, Omnicell and BD, have updated their machines with recommendations from the . One update requires the user to type in more than the first two letters of a medication to pull up a list of options.

Many hospitals also tweaked their drug administration protocols, such as by requiring wristband barcode checks anywhere a patient gets medication in a hospital.

Reacting to Vaught’s case, the state legislature in Kentucky that became law in 2024 providing immunity for on-the-job healthcare mistakes. Support wasn’t just bipartisan. It was unanimous.

Nursing consultant went to nursing school with Vaught and has worked directly with her as a nurse. Vaught’s criminal case inspired him to go to law school, he said. He now plans to help other nurses defend themselves in similar cases, even though he sees the need for accountability.

If it had been up to him, he also would have fired Vaught, Garvey said. He also thinks that the Tennessee Board of Nursing should have taken action immediately. Only after the patient’s death escalated to a criminal matter did the board revisit the case and revoke Vaught’s license.

But the defendants’ side of the story is rarely ever told, Garvey said, because they are advised by their lawyers not to talk.

Now that she has a platform, Garvey said, it’s therapeutic for Vaught. Her talks resonate with anxious nurses across the nation, he said, and promote a much-needed discussion about collective responsibility.

“We can’t change what happened. We can only change what we do moving forward,” Garvey said. “Having the individual who can tell you the play-by-play — that was there when it actually happened — is incredibly valuable.”

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

This <a target="_blank" href="/syndicate/nurse-drug-errors-hospital-safety-radonda-vought-tennessee/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Clinicians and patient advocates say the incoming changes will deliver a twofold blow: They expect the work requirements to kick more patients off Medicaid, meaning fewer can afford care, while the health department’s budget problems make it harder for doctors to serve those who keep the coverage.

It’s a tumultuous time for state health departments. Additional federal changes are forcing states to perform more checks on who qualifies for food assistance, better monitor doctors’ compliance with Medicaid rules, and set up new programs to access a share of $50 billion in federal funds meant to improve rural health services.

“Our concern is, is the department ready?” said Jean Branscum, CEO of the Montana Medical Association. “Does the capacity exist for all this to be done right and ensure that patients don’t pay the price?”

Already, some Montanans struggle to access the government health coverage amid state backlogs. Meanwhile, clinicians struggle with staffing, attributing the issue to low Medicaid payments. Those problems reflect a national challenge to connect people to care through strained public assistance programs.

The Montana Department of Public Health and Human Services didn’t respond to a list of questions, instead directing Ñî¹óåú´«Ã½Ò•îl Health News to the latest information on the state’s website detailing Medicaid changes, at .

Health policy analysts have said Montana’s challenges offer an early glimpse at what states must navigate to comply with congressional Republicans’ One Big Beautiful Bill Act. Signed by Trump last year, the federal tax and spending law requires millions of Medicaid enrollees to prove they’re working or attending school for 80 hours each month, unless they’re eligible for an exemption. States also will be required to evaluate enrollees’ eligibility every six months instead of annually, which will take more time and money. Some states already don’t have enough staff to quickly process Medicaid applications or answer enrollees’ phone calls.

On July 1, Montana is scheduled to become the second state, after Nebraska, to implement Medicaid work requirements. That’s six months ahead of the Jan. 1 federal deadline to do so for the 42 states, along with the District of Columbia, that expanded Medicaid to cover more low-income people. Montana health officials say they’ve had time to plan for that shift. The state mandated work rules in 2019 but hadn’t gained federal approval to move ahead until now.

More states are likely to face a budget crunch soon, said Joan Alker, a Georgetown University researcher focused on health coverage.

The One Big Beautiful Bill Act is expected to reduce federal Medicaid spending — the biggest pool of federal cash states receive — by nearly $1 trillion over 10 years. The law also left states with a bigger share of the cost to run food assistance programs, while creating tax breaks that could lower states’ bottom lines.

“States are the ones that are gonna have to do the dirty work of implementing cuts,” Alker said.

Withholding Medicaid Provider Rate Increases

On top of federal changes, Montana lawmakers underfunded the health department in its two-year budget in 2025, the result of cuts and an underestimate of Medicaid enrollment. The state also overestimated how much the federal government would contribute toward Montana’s Medicaid costs this year.

That resulted in a $183 million shortfall in state and federal funds, requiring the health department to borrow from next year’s budget. To partially offset those costs, the department wants to withhold a 3% Medicaid provider rate increase approved by the legislature and governor last year. State officials have said they’re trying save money without unraveling services.

Health organizations have pushed against the plan, saying that Montana’s Medicaid payments already don’t cover the cost of care and that health businesses can’t afford wages that attract workers.

Matt Bugni, head of the statewide nonprofit Aware, which provides behavioral health and disability services, said the organization was counting on incoming increases to keep existing employees amid a staff shortage. Bugni said Aware has more than 70 group-home beds it’s been unable to fill, because it’s down roughly 15% of its workforce.

“There are waiting lists,” he said. “We just can’t staff it.”

Montana health organizations said they’re still recovering from 2017 budget cuts that buckled services. The largely disappeared, more than half of Montana’s public assistance offices , and mental health crisis centers closed.

“We still are struggling,” said Sierra Riesberg, head of the Montana Behavioral Health Alliance, a nonprofit advocacy group.

In 2023, Montana Gov. Greg Gianforte, a Republican, signed into law a investment to repair the state’s behavioral health and disability services. He also created an initiative to use Medicaid funding to fill in gaps in addiction treatment programs.

But Riesberg said that, despite improvements, some beds created through those initiatives remain empty because low Medicaid reimbursement rates make it hard to recruit staff.

The stalled increases would especially hit community-based services such as mental health treatment and developmental disability services. They wouldn’t affect physician services or federally funded health centers that offer care based on what patients can afford. But Lander Cooney, an executive vice president at One Health, which has rural clinics in rural Montana and Wyoming, said low reimbursement rates can hurt their patients who need care elsewhere, as more healthcare providers decide they can’t afford to accept Medicaid.

Montana’s Legislative Finance Committee recommended the state’s leadership find a way to cut costs without stalling the increases. Gianforte will have the final say. He must make that decision before the state begins its new budget year on July 1, the same day Medicaid work requirements begin.

Medicaid enrollees will have three months to show they’re working before the state begins dropping people for noncompliance in October. That gives the state time “to work out the bugs,” said state Rep. Ed Buttrey, a Republican who is also president of the Montana Hospital Association.

‘Completely in the Dark’

The work requirements won’t apply to everyone. There are exemptions for people who are severely sick, children, adults older than 64, and Native Americans, among others. Even so, most people will have to submit proof that For some, how to do that remains murky.

Health officials don’t have clear-cut definitions for medical conditions on the exemption list. They’re also awaiting federal guidance on what documents someone needs to prove a hardship that temporarily prevents them from working. “Providers are completely in the dark as to how we reduce the administrative burden,” said Shawna Yates, a family medicine doctor in Butte and president of the Montana Medical Association’s executive committee.

Health officials have said implementing work requirements early means figuring out some details as they go.

Montana’s Medicaid enrollment is at its lowest point in roughly a decade, , a consulting firm that has studied the state’s Medicaid program for years. Enrollment plummeted amid states’ scramble to determine whether tens of millions of people still qualified for Medicaid when the federal government lifted a pandemic-era disenrollment freeze in 2023.

Many primarily because of rather than ineligibility. National health advocates worry similar administrative problems will arise with implementing work requirements.

In Montana, the state’s Medicaid data signals continued red flags, according to a by the nonprofit Montana Budget and Policy Center. That includes long waits to access public assistance and low renewal rates due to paperwork issues.

Julie Anderson, a mental health and addiction counselor in Livingston, Montana, helps people navigate public aid at a food bank. She said she recently spent three hours on hold on the state’s public assistance helpline, trying to help a patient with limited cellphone minutes troubleshoot a Medicaid application. Anderson said she had to hang up to help other people before anyone answered.

“It’s already a cumbersome system,” she said. Once the new requirements go in place, Anderson added, “it’s going to be a nightmare.”

The health department has worked for months to expand its public assistance team. As of early March, Montana had filled 39 of 59 new positions state officials projected are needed for the intensified Medicaid eligibility checks.

“The problem with that is that it takes a lot of training to get caseworkers up to speed,” said Kim Winchell, who helps people enroll in health coverage at Glacier Community Health Center in Cut Bank.

State officials said they’ll try to automatically confirm through existing data whether people are exempt or meet the rules. When that doesn’t work, applicants will have 30 days to provide proof of eligibility.

Charlie Brereton, director of the Montana health department, told lawmakers in May that the agency considered a public service campaign to get the word out. But he said the state’s budget problems curtailed that idea.

Brereton said the state could reevaluate that option, “depending on how implementation goes.”

This <a target="_blank" href="/medicaid/medicaid-work-requirements-trump-montana-budget-shortfalls/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

On the Road To Find Out

Your article “Efforts To Understand the Nation’s Drugged Driving Problem Stall Under Trump” (May 19) missed the mark.

There is a real lack of data on drug-impaired driving across the country, but it’s not due to federal policy. The fact is, science has not yet found a simple, accurate way to measure if someone is too high to drive. And many local police departments just lack the resources to test drivers for drugs.

The National Highway Traffic Safety Administration under the Trump administration has prioritized countering drug-impaired driving. The agency continues to be a leading funder of drug-impairment research. To address state and local enforcement shortfalls, NHTSA provides ongoing funding, training, and resources. Unlike the previous administration, we’ve vigorously engaged with law enforcement to encourage road stops to combat drug-impaired driving. And, while some employees voluntarily left the agency last year, NHTSA has ensured that staff resources remain focused on this priority.

— Jonathan Morrison, administrator of the National Highway Traffic Safety Administration; Washington, D.C.

Shining Light on Suicide Rates and Poverty

I am a professor of risk and policy analysis at Indiana University who recently read Aneri Pattani’s piece entitled “Low Wages, Empty Plates, Heavy Toll: Rethinking Suicide Prevention” (May 12). I found it gracefully written and emotionally moving in its use of real-world stories. But I think the scientific foundations of your piece are, at best, murky. Please let me explain why.

There is no question that when we compare households of different income levels, the suicide rate is much higher in low-income households than in higher-income households. It is tempting to conclude that people living in a low-income household may be inclined to die by suicide because they lack sufficient resources to access life’s necessities. This is what I take to be the premise of your piece, linking suicide prevention to the minimum wage law and policy around the Supplemental Nutrition Assistance Program.

Scientifically, the cross-sectional household comparison does not establish a causal relationship between poverty and risk of suicide. The obvious reason is that there are many other possible explanations for the association: higher rates of mental illness in low-income households, higher rates of substance misuse in low-income households, lower levels of educational attainment in low-income households, and so forth. Poverty itself may be a causal factor, but these other variables matter and may be much more important than poverty per se.

If poverty is a powerful cause of suicide, we should be able to discern changes in the rate of suicide during periods when the rate of poverty changes substantially. Take the period 2010 to 2019, when the U.S. poverty rate declined steadily and substantially (the period of recovery from the financial crisis and the Great Recession of 2007-09). In 2019 (the last year before the covid-19 pandemic), the overall poverty rate, 10.5% — and the elevated rates among Blacks and Hispanics — were the lowest recorded since federal poverty statistics began in 1960 (when it was about 22%). Yet the decade from 2010 to 2019 saw a surge in the nation’s suicide rate. In fact, if you take the longer period of 2000 to 2022, you find steadily rising rates of suicide in the United States, yet virtually no change in overall poverty rates.

Such temporal comparisons do not prove that poverty does not cause suicide. What they show is that poverty is not a highly potent cause of suicide. My guess is that poverty per se is a relatively minor cause of suicide, but even a minor causal role does not suggest that an increase in SNAP or Temporary Assistance for Needy Families benefits would reduce suicide.

One final point is about the large means-tested safety net in the United States. You are on firm ground in raising questions about what the Trump administration is doing to the safety net. But your readers need to appreciate that U.S. taxpayers are supporting a $1 trillion-a-year suite of anti-poverty programs, excluding Social Security and Medicare. The largest of those programs are Medicaid, coupled with the Children’s Health Insurance Program, and SNAP. But there are also the Affordable Care Act premium subsidies, the state block grants for TANF, childcare, job training, the Department of Housing and Urban Development’s rental vouchers, Pell Grants, federal student loans, and more. The means-tested safety net is much larger than the defense spending and growing rapidly as a share of the federal budget.

My view is that these programs are largely worthwhile, but not because they have played a powerful role in preventing suicide. A few budget numbers on the size of the safety net would have strengthened your piece and signaled to readers that you appreciate our country’s major investment in safety net programs.

Obviously, your piece stimulated me, which is a good thing.

— John D. Graham; Bloomington, Indiana

Single-Payer vs. All-Payer

I’m curious why Xavier Becerra — or any of the other California gubernatorial candidates, for that matter — aren’t talking about an “all-payer” model, similar to what was in place in Maryland (“In California Governor Race, Single-Payer Is a Litmus Test. There’s Still No Way To Pay for It,” May 8). There are many reasons a single-payer model wouldn’t work in one state, only one of which is the difficulties in figuring out reimbursement for people who travel out of state and receive healthcare while traveling. The all-payer model, which is being replaced by the AHEAD (Achieving Healthcare Efficiency through Accountable Design) model from the Centers for Medicare & Medicaid Services, is something worth considering in California. With the sheer size of the population, having unified billing, coding, and metrics across all payers could save millions in administrative costs.

We need to start with ideas that are feasible and then work our way toward something bigger. Let’s at least have a conversation about something that is possible to do.

— Kathryn Peisert; San Rafael, California

Bolstering the Home Care Workforce

This is another instance of money not being used wisely. In the article “Kids Keep Getting Stuck in Hospitals, Even After Being Cleared for Discharge” (May 18), pediatrician Elaine Lin noted a shortage of home care aides. In some states, private businesses provide home care services. Due to a profit incentive, these businesses often pay home care aides low wages.

This is one of the factors driving worker shortages. Why not try transferring a portion of the money now spent on high-cost hospital stays to better-trained and better-paid home care aides? Of course, each state has its own laws, regulations, and funding sources to navigate. However, it seems the willpower to collaborate is a necessary piece to solve this problem.

Some children could benefit from receiving care in a group home setting or at home with family members. If money can be better spent, let’s start with creating a system to increase the pay of better-trained and better-paid home care aides — a system that should increase the quality of services at reduced costs.

— Russell Anthony; Nashville, Tennessee

Essential Help While We Age

Your recent article “The Help That Many Older Americans Need Most” (April 27) captures something the healthcare system has been slow to accept: What happens to older Americans’ health is determined less by what happens in the clinic than by what happens at home, in the neighborhood, and at the kitchen table.

The evidence is stark. Nearly older adults live in poverty, and persistent food insecurity. These challenges reinforce one another in a devastating cycle: Loneliness worsens food insecurity, food insecurity accelerates functional decline, and functional decline deepens isolation.

Community health workers are doing essential work to interrupt these cycles. But too much of that work remains invisible. Providers refer patients to community resources with no way of knowing whether anyone followed up. Community organizations serve people without a consistent way to report back. The result is a system that means well but cannot learn from itself, and older adults, especially those in rural areas, are left to navigate the challenges alone.

Technology can change that. Leaders nationwide are turning to closed-loop referral networks that enable community health workers and clinical providers to connect individuals with food assistance, transportation, housing support, behavioral health services, and other essential resources. Importantly, technology helps them track whether those services are actually received.

Beyond the initial referral, these networks monitor improvements in specific health metrics, like A1c levels and hospital readmissions. By identifying unmet needs early and coordinating timely support, they help prevent health crises and alleviate

Both Oregon and Missouri offer strong examples of what this looks like at scale. In Oregon, statewide closed-loop referral technology, available across all 36 counties, served . It also delivered $29 million in health-related social needs (HRSN) benefits to 15,000 Medicaid clients under Medicaid’s 1115 waiver last year alone.

In Missouri, the has seen its participating hospitals and clinics achieve a 19.6% increase in individuals with controlled blood pressure and an 18% increase in behavioral health follow-up after visits to the emergency department.

The Rural Health Transformation Program offers a concrete opportunity to build on this model. Policymakers should seize the opportunity to invest in infrastructure that makes social care coordination real: not just referrals sent, but services confirmed, outcomes tracked, and communities strengthened.

For an older adult in rural America, the difference between knowing where to turn and not knowing can be the difference between staying home and ending up in the emergency room. That’s the gap these systems can close.

— Halima Ahmadi-Montecalvo, vice president of research and evaluation for Unite Us; Washington, D.C.

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The 59-year-old retired teacher, who recently moved from Ohio to Michigan, now pays $341 a month for a pair of plans, one that covers routine and urgent care and another that pays fixed amounts for hospital stays. Neither meets federal standards for comprehensive coverage.

Though she practices yoga and is healthy, Miller said she still feels “vulnerable.” If she lands in the hospital, her plan pays a flat $2,000, a fraction of the of an average hospital stay.

“I don’t gamble. But I may as well,” she said. “This is gambling.”

Congress’ decision late last year not to extend enhanced marketplace tax credits has boosted the appeal of alternatives to comprehensive insurance — plans like Miller’s, which have lower premiums but don’t meet ACA standards for coverage or consumer protections. Unlike plans sold on the exchanges, these options — some sold by major insurers, others by small companies or nonprofits — can deny claims with few or no legal rights for consumers to appeal. The plans are not required to cover “essential health benefits,” such as preventive care, and can impose annual or lifetime caps on benefits.

There is debate over whether these options help or harm patients. Consumer advocates dismiss them as “junk insurance,” while proponents say restricting alternatives to pricey marketplace plans risks driving up the number of uninsured. Some states, including Kansas and Florida, and the federal government itself have eased regulations on such plans or created incentives to join them, while other states, including California and Massachusetts, have tried to deter enrollment in alternative insurance. Those regulatory guardrails, however, are now being stress-tested as premiums blow out household budgets.

Alternative insurance takes many forms, including short-term policies, which were designed to bridge temporary gaps in coverage and often exclude preexisting conditions, and fixed-indemnity plans, which pay a flat rate per service regardless of how high costs go and are intended for supplemental use. Arrangements in which people pool their money to cover one another’s bills, including faith-based “healthcare sharing ministries,” also provide a cheaper alternative to the marketplace options. Because they are not considered insurance under federal or state law, they are not legally bound to pay for even .

Enrollment data for alternative plans is mostly confidential, but several indicators point to shifts in the market. Recent estimates suggest marketplace enrollment from 2025, and a of people on the exchanges last year found that 5% switched to private, nonmarketplace individual coverage, including plans that don’t comply with the ACA. Covered California, the state’s marketplace, plans to survey former enrollees to find out where they went.

Insurance industry insiders also report that, amid the expiration of subsidies, alternative plans are making a marketing push. Colorado insurance broker Samantha Albritton said that before ACA open enrollment, she saw more marketing from fixed-indemnity plans than in previous years. One healthcare sharing plan, Zion HealthShare, had more than 75,000 members in February — a 50% increase since last June, it said in a statement.

Critics of these alternative plans say the major issues occur when people use them as primary insurance and don’t realize the coverage is inadequate until they need it most. “Humans have bodies that can fail them,” said Amy Killelea, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms.

This <a target="_blank" href="/health-industry/alternative-health-plans-growth-sharing-ministries-short-term-aca-premiums/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">