Medicaid Archives - Ñî¹óåú´«Ã½Ò•îl Health News /topics/medicaid/ Ñî¹óåú´«Ã½Ò•îl Health News produces in-depth journalism on health issues and is a core operating program of KFF. Fri, 12 Jun 2026 20:32:52 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.5 /wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=32 Medicaid Archives - Ñî¹óåú´«Ã½Ò•îl Health News /topics/medicaid/ 32 32 161476233 Final Rules for Medicaid Work Requirements Are Out. Here’s What You Need To Know. /medicaid/medicaid-work-requirements-final-rules-exemptions-trump-cms/ Fri, 12 Jun 2026 09:00:00 +0000 /?p=2249726 The Trump administration has issued final rules on how states should ensure that millions of Medicaid enrollees prove they’re working or completing other activities, such as job training, volunteering, or being enrolled in an educational program.

The Centers for Medicare & Medicaid Services released on June 1. That deadline was set last year in the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which established a work requirement for certain people enrolled in Medicaid, the state-federal health insurance program for people with low incomes or disabilities.

Medicaid agencies are scrambling to rework IT systems and make sure they have staff to effectively enforce the rules, while also keeping enrollees from losing coverage for administrative reasons, such as difficulty navigating state eligibility portals.

The newly announced regulations offer a clearer picture of what roughly will have to do to prove they qualify for benefits.

Jim Torres, who helps people enroll in health coverage at the Samuel U. Rodgers Health Center in Kansas City, Missouri, said a “very small percentage” of his clients have heard of the changes coming to Medicaid.

“These folks have very busy lives. They’re doing the best they can to get by,” he said. “It’s just not a top-of-mind thing for most of them.”

Health policy researchers and consumer advocates said enrollees should keep a few things in mind as the Jan. 1, 2027, rollout approaches in most states.

1. The work rules won’t apply to everyone.

The new rules will apply to people covered through what’s known as . Since 2014, more than 40 states and the District of Columbia have decided to allow more people into their Medicaid programs, generally low-income adults without dependents. Georgia and Wisconsin offer coverage to some people in this group, so they’ll be subject to the rules.

Most States Will Have To Implement Medicaid Work Rules (Choropleth map)

Children and pregnant people, as well as individuals with disabilities who receive Social Security payments — all groups that already qualify for Medicaid — won’t be subject to the rules. Nor will people determined to be “medically frail,” or too sick to work.

People subject to the work rules are “crowding out” people in the Medicaid program who are “truly in need,” CMS Administrator Mehmet Oz claimed during a June 1 press call. “Work requirements are going to turn this around, we hope.”

The rules are set to take effect in most places in January. Nebraska started enforcing them in May. Montana plans to start in July but won’t kick people off until October. Arkansas will do a in July — it will start enforcing the rules but with no penalties until next year.

2. States will take your word that you’re too sick to work. For now.

Federal officials have stressed that states should make the process of reporting hours and requesting exemptions as simple as possible for Medicaid enrollees by creating automated systems and using existing data sources, such as unemployment and education records.

If states cannot determine you’re performing 80 hours of qualifying activities a month using those data sources, you may be allowed to “self-attest” to that in 2027, health policy researchers said.

People will also be allowed to “self-attest” that they are too sick to work in 2027, and do so one time in 2028. Then states will start asking for proof, if they can’t find it through available data.

But after the initial rollout, the burden of proof is likely to still fall on many enrollees, said researchers and consumer advocates.

People may need to dig up pay stubs, medical records, and doctors’ notes and submit them for state review, said Morgan Henderson, who has studied Medicaid work programs in Georgia and Arkansas at The Hilltop Institute, a research center at the University of Maryland-Baltimore County.

“The higher this manual reporting burden, the less people are going to do it,” he said. “That means that we’re going to see coverage drop-offs.”

3. The rules are tougher than expected for people too sick to work.

One of CMS’ primary goals has been to “protect vulnerable populations” through “strong exemptions to make sure people who can’t reasonably be expected to work are not subject to the requirements,” Dan Brillman, a deputy administrator at the agency, said during the June 1 press call.

Consumer and patient advocates, however, said the final rules’ exemptions are more restrictive than expected. Enrollees will eventually have to provide documentation, such as a statement from a medical professional, to prove that a health condition keeps them from working. And each individual state will have to determine the severity of beneficiaries’ medical conditions.

“Someone could be medically frail in Nebraska but not medically frail in Delaware,” said Carolyn Sheridan, associate director of state policy for the National Organization for Rare Disorders, which lobbies for patients with rare diseases. She said her group had hoped the rules would offer a standardized definition of who counted as medically frail and not leave the decision up to states.

Trump administration officials have publicly crusaded against fraud in government health programs, such as Medicaid, and states could face financial penalties for incorrectly granting people exemptions from the work rules, said Jennifer Tolbert, who researches Medicaid at KFF, a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl Health News.

“States may be more cautious,” she said. “That will likely lead to people losing coverage who may still be eligible.”

4. Only certain qualifying activities count.

Enrollees can satisfy the rules by working 80 hours a month. They can also be enrolled in college courses, volunteer through a community organization, or do “in-kind” work that doesn’t result in pay.

The rules set out, in detail, how many academic credit hours translate to 80 hours a month — students need to be enrolled in six credit hours per semester to meet the “half-time” requirement. An unpaid internship can count toward the 80 hours.

People can also prove they’re volunteering with “a document from a community service organization.”

Consumer advocates say it might be hard for people to obtain proof they’re performing these kinds of informal activities. But supporters of the rules say volunteerism can already be tracked.

“If you run into trouble with the law and the judge says, ‘Hey, you need some volunteering and community service to serve your time,’ there are already ways that we verify that,” said Niklas Kleinworth, who works on state health policy for the conservative Paragon Institute.

5. You have time to prepare.

Make sure your state Medicaid agency has your current mailing address and keep your eye on your mailbox, said researchers and consumer advocates. State Medicaid agencies must inform you in two ways if you’ll be subject to the rules — by either regular mail or email, and by one other form of communication, such as a text or phone call or by posting a notice online.

“The important stuff comes by mail,” Henderson said.

And check in with your state Medicaid agency, said researchers and advocates. Some states, including , , and , have already posted information about the work rules on their websites. If you can’t find what you’re looking for there, visit or . A caseworker should be able to tell you whether you’ll be subject to the rules.

“Get ahead of this,” said Joan Alker, who is executive director of the Georgetown University Center for Children and Families and studies Medicaid. “So that you don’t end up going to the pharmacy one day and they say, ‘Oh, you’re not insured anymore’ when you’re trying to get your prescriptions refilled.”

Ñî¹óåú´«Ã½Ò•îl Health News correspondent Samantha Liss and senior correspondent Rachana Pradhan contributed to this report.

Have you tried to prove your eligibility for Medicaid under new rules that require people to show they are working, going to school, or participating in another qualifying activity? Click here to contact Ñî¹óåú´«Ã½Ò•îl Health News.

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

This <a target="_blank" href="/medicaid/medicaid-work-requirements-final-rules-exemptions-trump-cms/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2249726&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2249726 The Drip, Drip, Drip of Declining Coverage /podcast/what-the-health-450-aca-enrollment-drops-june-11-2026/ Thu, 11 Jun 2026 18:56:29 +0000 /?p=2249320&post_type=podcast&preview_id=2249320 The Host
Julie Rovner photo
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.

When Congress failed to extend the covid-era enhanced subsidies for the Affordable Care Act, many experts predicted millions of people would lose coverage because they would be unable to make payments toward the higher premiums. It has taken a few months, but that prediction seems to be coming true.

Meanwhile, controversy in the medical community about how — or whether  â€” to work with the Trump administration burst into the open at the annual meeting of the American Diabetes Association, as members who were handing out an editorial criticizing the administration’s cuts to biomedical research were evicted from the event, prompting a backlash.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Lizzy Lawrence of Stat, Sandhya Raman of Bloomberg Law, and Lauren Weber of The Washington Post.

Panelists

Lizzy Lawrence photo
Lizzy Lawrence Stat
Sandhya Raman photo
Sandhya Raman Bloomberg Law
Lauren Weber photo
Lauren Weber The Washington Post

Among the takeaways from this week’s episode:

  • A from The Commonwealth Fund highlights enrollment declines in Affordable Care Act marketplaces, a trend experts predicted when Congress did not renew the enhanced ACA tax credits at the end of 2025. As consumers continue to struggle with rising costs for groceries, gas, and other expenses, individuals who lost that additional financial assistance to purchase health insurance may be facing higher premium costs and more out-of-pocket expenses.
  • Concerns over the difficulty of implementing the administration’s Medicaid work requirements, along with potential legal challenges, may mean the regulations could be delayed or even reversed. For example, doctor and patient groups contend that the requirement that physicians determine whether each individual can work the required 80 hours per month will create unintended consequences, such as paperwork and bureaucratic hassles, for patients and their doctors, rather than decrease fraud in the program.
  • On Capitol Hill, fewer days in session and more days on the midterm campaign trail, plus a lack of bipartisanship, likely mean that lawmakers may be less willing to find a path forward to strengthen the financial solvency of the Medicare and Social Security trust funds. The programs’ annual trustees’ report found that the two entitlement programs, which provide benefits to millions of people, will technically become insolvent in 2033. In recent years, lawmakers have been inclined to act only when facing an imminent deadline rather than taking action to avoid a future problem.
  • Leaders of the American Diabetes Association apologized for having security escort several doctors and researchers, including the editor-in-chief of the association’s flagship medical journal and a past president of the ADA, from the group’s annual research meeting for distributing a journal editorial criticizing the administration’s cuts to biomedical research. The incident highlighted how fearful some nonprofit leaders are of taking on the Trump administration.

Also this week, Rovner interviews KFF’s Tricia Neuman, who is retiring this month as a senior vice president and the executive director of the Program on Medicare Policy. 

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

Julie Rovner: Ñî¹óåú´«Ã½Ò•îl Health News’ “Anguished Parents. Doctors in Tears. Utah’s Long Measles Outbreak Takes a Toll,” by Amy Maxmen.

Sandhya Raman: CIDRAP’s “,” by Liz Szabo.

Lizzy Lawrence: The Chicago Tribune’s “,” by Christy Gutowski and Gregory Royal Pratt.

Lauren Weber: ProPublica’s “,” by Annie Waldman.

Also mentioned in this week’s podcast:

  • Politico’s “,” by Alice Miranda Ollstein and Robert King.
  • The New York Times’ “,” by Sheryl Gay Stolberg.
  • MedPage Today’s “,” by Kristina Fiore and Kristen Monaco.
  • Stat’s “,” by Anil Oza.
  • Fierce Healthcare’s “,” by Paige Minemyer.
  • Stat’s “, Federal Investigators Find,” by Casey Ross and Bob Herman.
Click to open the transcript Transcript: The Drip, Drip, Drip of Declining Coverage

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 11, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. Today, we are joined via video conference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Lizzy Lawrence of Stat News. 

Lizzy Lawrence: Hi there. 

Rovner: And Sandhya Raman of Bloomberg Law. 

Sandhya Raman: Hello, everyone. 

Rovner: Later in this episode, we’ll have my interview with my colleague Tricia Neuman, who’s stepping down from her post here as KFF senior vice president and executive director of the Program on Medicare Policy, after a long and distinguished career shaping and analyzing the nation’s most prominent health insurance program. But first, this week’s news. I want to start this week with kind of a slow-motion news story that I want to make sure doesn’t get overlooked. It’s the continuing signals of declining health insurance coverage in the U.S. The Commonwealth Fund reports this week that state Affordable Care Act marketplaces are seeing the predicted shedding of policies by consumers who can’t make their premium payments. In Maryland, for example, 13% of enrollees fell off their plans between open enrollment and April of this year. That’s compared to just 3% last year. At the same time, more people are becoming underinsured because they, quote, “bought down” coverage from gold- or silver-level policies to bronze, leaving them with lower premiums but often multi-thousand-dollar deductibles. Meanwhile, three Democrat-led cities and a Democrat-led county have sued the Department of Health and Human Services over the regulation governing sign-ups for next year’s Affordable Care Act plans, charging that changes like allowing non-network plans and still higher out-of-pocket caps violate the terms of the ACA itself. So what is the outlook for the ACA, now that it’s June and it seems pretty clear that Congress is not going to extend those additional subsidies that expired at the end of last year? 

Weber: I’d say it’s not looking good, Julie, the way you just laid it out. I mean, I think the bottom line is this is a train wreck we’ve been watching in slow motion for many, many months, in the sense that you’re going to see a lot of people lose coverage. This is not exactly happening during a booming economic time, so you’ve got people cutting back because of high grocery bills, high etc., and then they see their health care go up tremendously, and they can’t cut it. And then they end up in plans that could leave them with massive bills at the end of the day. I do think this will lead to more of a groundswell of outcry, because it’s hitting folks â€” most affected, as The Commonwealth Fund pointed out, are not those in the lowest category; it’s the folks â€¦ where the subsidies ran out kind of in the mid-tier. And so you’re getting some more middle-class or lower-middle-class folks that are seeing some very, very steep health care bills. 

Rovner: Yeah, and as you point out, at the same time they’re seeing their gas bills go up, and their grocery bill’s up and basically prices for everything else. But I mean, I think there was a lot of like real sticker shock with the insurance, because you know, well, you know, gas is up $1 a gallon, and it hurts to go from paying, you know, $25 or $30 to fill your tank to $45 or $50, it’s not like saying, Hey, you’re going to go from paying $300 a month to paying $1,300 a month, which is what we saw from a lot of people.  

Meanwhile, both doctor and patient groups are up in arms over the new Medicaid work rules issued by the Trump administration last week. Rather than allowing states to automatically exempt from the work requirement people with certain conditions that would qualify them as, quote, “medically frail,” the rules stipulate that beginning in 2028 Medicaid recipients will have to prove at least twice a year not just that they have a condition, but that that condition prevents them from working. Patient groups say that will result in people who most need health insurance losing it and possibly getting sicker. Doctors, including the American Medical Association, which was conveniently having one of its meetings this week, worry that the burden of making that determination is going to fall on them, and that doctors aren’t trained for these things. They also point out that many chronic conditions fluctuate, leaving people sometimes able to maintain daily activities, like working, and sometimes not. Might this get changed due to the outcry? I think the administration, so far, seems to be saying that not doing it this way lets too many people off the hook. 

Lawrence: Yeah, I mean, I think that this is one of those things â€” again, it’s starting in January 2028. There’s sort of a year tail. I’m curious&²Ô²ú²õ±è;…&²Ô²ú²õ±è;there’s enough time that this could keep getting pushed down the road and possibly reversed, and you know, there’s also legal challenges. I know that my colleagues wrote about the Legal Action Center saying that CMS [the Centers for Medicare & Medicaid Services] is exceeding its authority here, so definitely we should be watching to see what happens with that. 

Rovner: Like many people, I was surprised at the rules as they came out. But I’m also a little bit taken aback at how broad the backlash is, particularly to this part â€” to the really, you’re going to require people with cancer to prove that they can’t meet work requirements? And how are they going to do that? And are people on Medicaid really going to be able to get doctors to, like, write them notes to say this person should be exempted? I mean, it just, it seems like a huge bureaucratic morass. 

Lawrence: Absolutely. 

Raman: Oh, I was just gonna say, from all sides, you know, if you are on Medicaid, and maybe there’s the burden of just transportation to get to that appointment, and, you know, having the time and the energy if you have a chronic illness, but then also we’ve heard time and time again how workforce issues, doctors are already overworked and don’t have the time to do so many of the things they already have to do. This is another burden for them to be able to have to eventually do this with the limited time they do have. 

Rovner: Lauren. 

Weber: It also seems incredibly subjective. I mean, I know they said that they’re trying to get to it through the codes, but, as  [Miranda Ollstein], I mean, how does one even really evaluate that? And people can work in different stretches. Also, with the flexibility many people have now to work from home, there is an opportunity for some folks maybe to be able to work, depending on what their job is. It’s just a minefield of unintended consequences, probably. So we’ll see how that goes. 

Rovner: I’ll say, this has a long way to play out. Well, along similar lines, there are also concerns that the new crackdown on fraud that’s being spearheaded by the Trump administration is threatening people’s coverage as well. In Ohio, lawmakers rushing to address home healthcare fraud tried to speed through a bill that included a provision to ban family members from qualifying as care providers for people with disabilities. That was ultimately removed from the bill when it was pointed out that such a change could result in more people having to be institutionalized, costing the state far, far more than paying family members to help people. I’m sure we’re going to see similar efforts to crack down on fraud in more states, because the federal government is threatening to take away money. Although, as administration officials continue to claim widespread fraud throughout the home health and hospice care systems, I imagine that we’re going to see more give-and-take on this one too. 

Weber: It seems like another example of shoot first, look later. I mean, in general, that clearly would have been a very bad provision to keep in the bill. If you know anything about home healthcare, you know that most of the time it is a family member giving up much of their time and effort to keep a loved one in the home. And so wild that that was even in there to start with. I think in general this goes to this long-running conversation around fraud. Again, there is a lot of healthcare fraud. I think we should all be very clear. There’s a lot of fraud that needs to be addressed. But you can say a lot of things about fraud obliquely, but then when you get to the brass tacks, you got to be careful about what you’re doing. So this is just another example of that, and how we’ve seen the Trump administration move on this that may or may not end up in problematic outcomes. 

Rovner: Yeah, Dr. [Mehmet] Oz [the CMS administrator] keeps talking about, you know, family members who are helping carry in groceries or driving people to doctors’ appointments. That’s not what these paid caregivers are doing. These are people who are basically unable to work because they need to be with this person that they are caring for 24/7, 365. I mean, there’s a lot of work involved here that’s way more than I think a lot of people who are in Washington or, I guess in this case, in Baltimore writing these rules sometimes realize. And I think that was brought home rather vividly in Ohio when they tried to do this and then were suddenly given the facts on the ground and said, Oops, maybe we should try this another way. But Lauren, you’re right, it’s not to say that there isn’t plenty of fraud to be fought. 

Well, moving on, this week we also got the annual report from the trustees of Social Security and Medicare. Not much has changed from last year as far as when the trust funds that support the programs will technically become insolvent. For Medicare’s Hospital Insurance Trust Fund, it’s still 2033, but a quarter earlier â€” so three months’ difference. Still, that’s only seven years away. In earlier times, I’ve been doing this a long time, seven years to insolvency would set off alarm bells in Congress and the administration, and would prompt action, or at least attempted action. Are we yawning our way into a very large financial crisis impacting one of the most popular health programs in the country? 

Raman: I think it’s a combination of things. A) I feel like every year we are more loose with deadlines. We address them in Congress closer and closer to them. So something that several years ago would be a big conversation ahead of time, we push it closer. And I think also the appetite in Congress to get things done right now is low, to find bipartisan agreement. And so getting something done on this would be quite difficult right now with all the other competing priorities there. 

Rovner: I think they were floating the idea of another budget reconciliation bill â€” “Reconciliation 3.0,” I guess they were calling it. And my reading of the consensus is that it is not happening. Whether there’s not enough appetite or not enough votes, or combination of those two, it doesn’t look like Congress is ready to take on something as big as Let’s make sure that Social Security and Medicare are there for the retiring baby boomers and Gen Xers, who are going to shortly follow. 

Raman: Especially in a midterms year where they’re not in as much as they might be at other times. 

Rovner: Yes, that’s right. They are definitely in and out. All right. Well, we’re going to take a quick break. We’ll be right back. 

Meanwhile, over at the Department of Health and Human Services, our podcast colleague  of Secretary RFK Jr. over last weekend, saying he has, quote, “shown little interest in managing the details of work in his department,” and that he, quote, “is single-mindedly focused on his top priorities, including food recommendations and pesticide exposures, and hunting for evidence to support his long-held beliefs that vaccines are harmful.” And, indeed, the big press event Kennedy had this week was to tout his effort to get medical schools to teach their students more about nutrition, something most medical schools had already been doing, I hasten to add. And, of course, there are still no confirmed, and in some cases even nominated, heads for some major HHS agencies, including the FDA, the Centers for Disease Control and Prevention, and the Administration for Strategic Preparedness and Response, which oversees things like the Ebola outbreaks. I would note that Kennedy responded to Sheryl’s story just Wednesday â€” so, like, five days after it appeared, basically saying he’s doing much more than she realizes. What are we to make of this whole thing? 

Weber: I would encourage everyone to read Kennedy’s response, and then I would also be curious if Kennedy would like to show me where his public calendars are that he talks about in his tweet, because I would love to look at them, and I’m sure Sheryl would too. But I thought Sheryl’s framing of the story was very clear-headed and accurate. I mean, look, the bottom line is the secretary has not been publicly engaged on the Ebola response at all, which is somewhat surprising. He does not have any of these people in place. I mean, take your pick. I mean, it’s all these agencies are rudderless currently, and he has very clearly expressed serious interest in his pet projects, but has not been as engaged, according to Sheryl and all of our reporting, in some of these other issues. And I think it’s a fair look at what that means for his legacy going forward, and what that will mean in the months to come. 

Rovner: Right. And you know what’s going on actually in health right now. Over at FDA, they’ve apparently begun the safety study of mifepristone, the abortion pill, that the administration has been promising anti-abortion groups for more than a year now. But it appears that study won’t be ready before the midterms, which is actually what Republican strategists had advised, so it wouldn’t further inflame the campaign season. This is up your alley. Is this FDA acting Commissioner Kyle Diamantas’ effort to win the permanent job, or is this the White House still trying to kind of placate both sides to the debate for as long as it can possibly get away with? 

Lawrence: Yeah, so Kyle Diamantas has said to many different people that he doesn’t want the job, including to me via an HHS media spokesperson, so I tend to believe him. Although it seems likely that he will be in this role for a while, because of how many leadership positions the HHS needs to fill, and how few days there are of Congress. With the mifepristone study, it seems like, yeah, I mean, I think the timing is not lost on anyone. This seems to have worked out politically pretty well for the Trump administration, where it’s a six-month study, they can kind of see what happens in the midterms, and see, because you know, [Sen. Bill] Cassidy, this is a huge issue for him. Any FDA commissioner they’re going to put in front of him, he’s going to be hammering on mifepristone, pro-life issues. So, as long as they can pursue the strategy that they have been pursuing, of sort of just waiting and seeing and saying that they’re working and pushing it out. I think that’s what they’re going to keep doing. 

Rovner: I guess there’s this continuing promise that the administration will try to sort of rein back in on the mail-order abortion drugs, which is, I guess, what’s really&²Ô²ú²õ±è;…&²Ô²ú²õ±è;I don’t think anybody thinks that they’re going to try to revoke the approval of mifepristone. I think what the anti-abortion folks are hoping now is that they’re going to revoke the mail-order ability of people to get mifepristone, which, of course, we’ve seen people using in abortion-ban states to basically evade those abortion bans. It’s obviously a big deal for both sides that the administration would like to keep under wraps as long as it possibly can. Is that a fair assessment? 

Lawrence: Absolutely. Yeah, and I mean, there’s no safety reason to do that, so&²Ô²ú²õ±è;…&²Ô²ú²õ±è;there will be huge blowback from pro-choice advocates, but also within the agency, I would imagine, this would be a huge turning point. 

Rovner: Well, that’s the FDA. Then there is the National Institutes of Health, which actually does have a Senate-confirmed leader, Jay Bhattacharya, although he’s currently doing double duty, also overseeing CDC. But apparently things aren’t so great over at NIH. Last June, 300 NIH staffers published something they called the “Bethesda Declaration,” named for the location of NIH’s main campus, in which they said that the new administration’s policies were undermining the agency’s mission, wasting public resources, and harming the health of Americans and people across the globe. Now, one year later, about 70 NIH’ers have , including one we talked about last week that would give political appointees far more say about who gets research grants and how those grantees can behave. And another policy that would strip civil service protections from many senior employees, so they could more easily be fired for not going along with the administration’s political priorities. I guess this is this week’s trend. What seemed kind of shocking last year is now kind of status quo, right? I saw very little attention to any of these stories that are enormous changes from how the nation’s science agencies have operated over Republican and Democratic administrations in the 40 years I’ve been doing this. 

Raman: I think that one thing we’ve really seen is just how much some of these science-oriented groups have mobilized over some of these issues, just, you know, kind of stating that researchers that have been doing this kind of work for 20, 30, 40 years, that this is so out of the realm of anything they’ve seen before. This would, you know, jeopardize their research and their stability and just the way that they have been doing work for so many years. And I think even with both of the rules that we, that you mentioned, that has been something that has been really amplified by them. But I think it has been, given the number of other things happening, this space not really trickled down to the broader set of folks to really, you know, tap into. We have Ebola, we have so many other things that people, I think, are a little bit more top of mind, even though this is a huge change that under normal circumstances would have more attention paid to it. 

Rovner: Yeah, I think that’s fair. This is sort of the continuing shock and awe that we see of the administration trying to make all of the changes that it wants at once, so nobody gets a chance to focus on any of them. In sort of what we would consider normal times, any one of these would be the overwhelming story of the day. 

Well, all of this brings us to what I consider the wildest story of the week. There was plenty of drama at, of all places, the annual research meeting of the American Diabetes Association in New Orleans. And props, by the way, to the website MedPage Today for breaking this within hours of its happening last Friday. I will just read the original headline: “.” So the keynote address to open the conference was supposed to be given by NIH Director Bhattacharya, but he dropped out at the last minute. While the audience was inside listening to a talk instead from NIH senior adviser Richard Wojcik, five doctors and researchers, including the editor-in-chief of the association’s flagship medical journal, as well as a past president of the ADA, were outside handing out a thousand copies of an editorial from the journal criticizing the administration’s cuts to biomedical research. At the direction of the organization, those protesters â€” can you even really call them protesters? â€” were escorted out by security and told they could not return to the conference. And from there the backlash began. Sixty-five hundred people signed a letter of complaint to the association. Two top officials resigned, and, finally, five days later, the CEO apologized to the “editorial hander-outers” via a video. But I want to pose a larger question. This was a real-world playing out of the tensions that we were just talking about are boiling within science. Should they try to work with this administration, or should they try to fight it? It would appear that the answer to that is kind of still up for grabs. Isn’t that what this demonstrates? 

Lawrence: Yeah, I mean, I think that it’s a clear tension between what the members of these major medical organizations want, which, like you said, 6,500 people signed that letter. There is a real appetite to try to fight back and push back, but there’s a real fear among leadership to do anything.&²Ô²ú²õ±è;…&²Ô²ú²õ±è;This was just mind-boggling, and my colleague Liz wrote about the backlash, and their decision to escalate the situation in this way brought so much more attention than, you know, five people handing out a journal editorial would initially. So fear can lead people to do things that ultimately don’t serve their purposes. 

Rovner: Yeah, I left out the part about the ADA leaders sort of over the weekend trying to justify the expulsion of the “editorial hander-outers,” as I will call them, by saying, Oh, it could affect our 501(c)(3) status, or they were violating the code of conduct, for, you know, for the meeting. But not only did those things not fly, they did seem to make things worse. Lauren, you wanted to add something. 

Weber: I just want to say that’s probably the most press an ADA meeting has ever gotten in its entire life. So, I mean, if they&²Ô²ú²õ±è;…&²Ô²ú²õ±è;

Rovner: Absolutely. 

Weber: At the end of the day, I mean, these, as you point out, Lizzy, I mean, this editorial guy read a lot more and got a lot more attention because of it, so we’ll see what happens from here. 

Rovner: Yeah, but I think it’s sort of a cautionary tale for leaders of these organizations who â€” do we want to fight or do we want to try to get along, and maybe you ought to ask your members first? We’ll see if this sort of comes out at other meetings. Now it’s the beginning of the summer, it’s when a lot of these scientific meetings happen. I’ll be watching more of them a little more closely. 

Well, finally, this week, it’s June, and that means it’s the season for working on the spending bills on Capitol Hill. This week we actually got a lengthy public markup of the bill that funds the majority of the Department of Health and Human Services. A reminder: FDA is funded in the Agriculture bill because food. Sandhya, how is the Labor-HHS bill shaping up? It looks like Congress isn’t going to go along with the big cuts proposed by the Trump administration, but that’s not saying there won’t be fights about funding, right? 

Raman: Yeah, so I would say you’re right. The big takeaway from this House markup is that it kind of bucked some of the White House’s suggestions on, you know, what to do with funding for this. They funded $111 billion for HHS, if this is made into law â€” so a much smaller cut&²Ô²ú²õ±è;…&²Ô²ú²õ±è;of what the White House was proposing. That included things like $100 million more for NIH, which has been something in the past worried about cuts; and funded some things that I think we’re interesting, you know, CDC’s office for smoking [Office on Smoking and Health], something that had been subject to the DOGE [Department of Government Efficiency] cuts last year; , something else that&²Ô²ú²õ±è;…&²Ô²ú²õ±è; 

Rovner: Yeah, I want to address that separate, I want to get to the amendments in a second. But I mean, just sort of in terms of funding, I mean, and we should point out that $100 million for NIH â€” NIH has a budget of like $40-some billion, so yeah, it’s not a big increase. It’s a rounding error increase, but it’s not a cut. 

Raman: Yes, not a cut. So the next step for this would be the House floor, but we might get kind of stalled there just because the issue on the Senate side is they’ve not agreed to top-line numbers for funding yet, and they need those in order to shape out the individual bills. So, without that, we’re kind of in a standstill, and it might be a little bit more like we’ve seen in some of the years past, where the House goes through, they make a bill, they vote on the bill, and then the Senate doesn’t publicly do theirs, but then we get to an agreement a little further down the line. But what Sen. Susan Collins, who heads the Senate Appropriations Committee, has been saying is that, you know, she wants more for NIH than what’s been presented here. But without those top lines, we don’t know. So, we’ll see, you know, in years past, we’ve really just, the funding year deadline has been pushed and pushed and pushed, so&²Ô²ú²õ±è;…&²Ô²ú²õ±è;

Rovner: Into the next funding year. Often. 

Raman: Yes, and I think, especially like I said, when it’s a midterms year, they’re going to be in far less than normal. It’s not clear when there’s going to be the appetite to get all of that done. 

Rovner: So, often these spending bills, when they move â€” and of course they haven’t moved when they were supposed to for the last however many years â€” but it does sometimes give a chance for lawmakers to express frustration or doubt or simply disapproval with things that the administration is doing. And one of the things that they seem to be expressing disapproval is the administration’s plan to use prior authorization, which is very controversial, in Medicare, and AI â€” in fact, an AI prior authorization in Medicare, and on a bipartisan basis. They voted to tell the administration, No, please don’t do this. I’m wondering, you know, it may not become law on this bill, but this does suggest that there is bipartisan concern in Congress about these efforts on behalf of Medicare, right? 

Weber: Well, I think this goes back to our Medicare insolvency conversation earlier. Who votes? It’s the people that are on Medicare. So, and how unpopular would it be if they were to be limited in what they can access for their health care services? So, I think at the end of the day, the reason that’s bipartisan is these lawmakers know who’s keeping them in office, and prior authorization has a very bad name. I mean, it’s very interesting, because CMS has said that this will help cut down costs, but also has, out of the other side of its mouth, in hearings and so on, Oz has decried insurers using prior authorization. So there’s a lot of “for thee but not for me” vibes going on here. But at the end of the day, it doesn’t seem like this will advance because of the bipartisan opposition. 

Rovner: And of course, Lizzy, your colleagues at Stat have talked about, you know, private companies using enhanced prior authorization, which nobody seems to think is a great idea, and now we have Medicare proposing it. 

Lawrence: Yeah, I was going to say prior authorization, already unpopular, add AI to the mix. I mean, there’s not&²Ô²ú²õ±è;…&²Ô²ú²õ±è;yeah, Bob and Casey, my colleagues, , but just, in general, there is not a lot of goodwill for the AI industry with data centers and all kinds of unpopular initiatives. So, yeah, it makes sense we’re seeing strong bipartisan disapproval of this.  

Rovner: If it doesn’t show up in this bill, I wouldn’t be surprised to see it show up in some other bill that’s more likely to make it to the finish line. All right, that is this week’s news. Now we’ll play my interview with KFF’s Tricia Neuman, and then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague and friend Tricia Neuman, who is retiring as KFF senior vice president and executive director of the Program on Medicare Policy, after a long and distinguished career here and on Capitol Hill, shaping, analyzing, and explaining Medicare policy to people like me, as well as to the nation’s decision-makers. Tricia, thanks for taking some time as you wrap things up. 

Tricia Neuman: Julie, thank you for having me. 

Rovner: So, let’s go back to the beginning, if you can remember that. What got you interested in pursuing Medicare as your health policy specialty? 

Neuman: You know, I didn’t think about it as Medicare, but I thought about it in the context of my family. I was&²Ô²ú²õ±è;…&²Ô²ú²õ±è;I remember watching my grandfather and seeing him struggle. He had Alzheimer’s, and he was trying to tie his shoe, and he couldn’t remember, and I somehow got interested in aging. And I was interested in government, and so I came to Washington ready to do policy, and I ended up at the Senate Aging Committee, which was perfect. And I got into Medicare because I had an older colleague who said, Look, you got to choose a specialty; you can do Social Security, pensions, retirement income, or you can do health and long-term care. Figure it out and go there. And so I did. 

Rovner: Yeah, and like me, you can stay forever if you want to. 

Neuman: And I seem to have stayed forever. 

Rovner: So, what’s the biggest misperception about Medicare as it exists today? People look at Medicare, and it’s like a chameleon. They see all these different things. 

Neuman: Boy, I could give you a few answers to that. I mean, one answer is people think Medicare is going broke. Medicare cannot go broke, but Medicare faces financing challenges. Interesting, you know, we talk about that today. Today’s the day that the “Medicare Trustees Report” came out, and actually, there wasn’t much of a change, a notable change. It was a slight tweak, but it’s still 2033 for the year that Medicare will be insolvent. What that means is that there won’t be enough money to pay all benefits, but it doesn’t mean the program is going broke. To me what it means is it’s time to think about how to finance care for an aging population, and what are the policy options that can do that. It’s generally reducing spending or finding new revenues, but it’s easier to do it in advance than&²Ô²ú²õ±è;…&²Ô²ú²õ±è;to wait until we’re at the precipice of a crisis. So that’s really what it signals to me. But it cannot go broke. 

Rovner: Over the years, Congress has dealt with these periodic, you know, predictions about Medicare insolvency in various ways that they have, you know, sometimes they’ve actually acted when insolvency has seemed relatively near, and sometimes they have acted to make insolvency closer. This Congress doesn’t seem to be as plugged into Medicare as many previous ones. Is that a fair way to put it? 

Neuman: I think it’s fair. Julie, when you and I were working on the Hill, as your beat at the time at the Ways and Means Committee, Medicare was front and center. Medicare was part of budget conversations. Medicare was part of legislation that we dealt with every year. And that meant every year members of Congress worked hard to tweak the program, achieve some savings, also make some improvements. But Medicare was the big story. Really, of late, really, since the ACA, the ACA has been the story, Medicaid has been the story, but Medicare, oddly, has been sort of a stepchild off to the side. 

Rovner: I like to describe Medicare as one of the biggest paradoxes in health policy. Simultaneously, it’s incredibly popular â€” I mean, one of the most popular programs ever created by the federal government â€” and yet it’s actually pretty lacking as a really comprehensive health coverage. I think if people actually had, quote-unquote, “Medicare for All” the way we have Medicare today, they wouldn’t be very happy with it. 

Neuman: I think that’s right. I mean, people I know on Medicare, and soon that will be me, are very happy with the program. They like the fact that&²Ô²ú²õ±è;…&²Ô²ú²õ±è;it’s reliable, they can count on it. There are some issues between people in traditional Medicare and Medicare Advantage. But it’s, you know, people are pretty happy. At the same time, there’s relatively high cost sharing, premiums are going up, and Medicare doesn’t cover some of the most expensive things for people as they grow older, such as dental, which is a big one, hearing aids, vision, which is to a lesser extent not quite as expensive. And the big one that nobody really wants to address is long-term services and support, home care for people who need help at home, assisted living, nursing home coverage, all of that is super expensive, and Medicare really doesn’t cover it. And that is a big surprise to families when all of a sudden they have a family member who needs this help and Medicare won’t pay for it. 

Rovner: Yeah, I feel like about every five years, another generation of health reporters discovers, Hey, Medicare doesn’t cover long-term care. I never knew that. 

Neuman: And a lot of time they’re discovering it because a family member of theirs needs long-term care. 

Rovner: So, I know you’re retiring, but I also know that you’re going to continue to stay engaged, because I know you. What do you think is the biggest challenge that you hope that lawmakers will address in Medicare in the next five, 10 years? 

Neuman: Oh, I have a wish list. I do hope that they’ll continue to put affordability at the top of the list. That means looking at these expenses that are not covered by Medicare, keeping an eye on premiums. Right now, 7 million people on Medicare pay more than 10% of their income on Part B premiums. That’s a big deal. So, keeping an eye on affordability is really important. I also think there should be some attention to simplification. Medicare used to be this easy program, you turned 65, you got on Medicare. It’s not so easy anymore. The average Medicare beneficiary has a choice of dozens of plans, the Medicare Advantage, prescription drugs. It’s too complicated. And it’s not like it’s a one-and-done decision when you turn 65. You really need to think about this each year, and I think that’s a tall order. And simplifying the program would make it a lot easier for our aging population. 

Rovner: Well, you may be retiring, but I’m still going to call on you as my Medicare expert. 

Neuman: Always. 

Rovner: Tricia Neuman, thank you so much. 

Neuman: Thank you, Julie. 

Rovner: OK, we’re back. Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Lauren, you snagged this week’s most popular story. Start us off. 

Weber: Hats off to Annie Waldman’s “,” which published in ProPublica. I was green with envy upon reading this story. It’s not only beautifully crafted, but it’s just an incredibly incisive takedown, really, of this raw milk farm and all of the people it’s harmed, and how the government has really not stepped in. It hits at so many themes in this MAHA [Make America Healthy Again] moment â€” of free speech and, you know, free medical access, but also the questions of: Do consumers know the amount of risks that they’re taking on? And what is regulators’ role when you have this farm led by this evangelist for raw milk that has been at least linked to over 220 people’s illnesses, some of which are very severe, and continues to produce not only raw milk but milk that it puts into raw cheese that makes people sick. And very sick. This is not just, like, slightly sick, I mean it’s likely that this has potentially sickened way more than the numbers that are captured. It’s a very well-done piece. I could not recommend reading it more. 

Rovner: Lizzy. 

Lawrence: My piece that I chose for this week was from the Chicago Tribune: “,” by Christy Gutowski and Gregory Royal Pratt. Kind of similar to what Lauren was talking about, this is a story about regulatory failure, but in this case with a plastic surgeon operating in Chicago who has killed at least eight women during procedures like tummy tucks and liposuction&²Ô²ú²õ±è;…&²Ô²ú²õ±è;all women of color. He’s operating in a predominantly Latino neighborhood. And Chicago authorities started looking into him to try to revoke his license in 2020, but more than five years later nothing has happened. This was a truly horrifying story, and just major kudos to the reporters, for really, you know, they tracked down all of these women’s families. And in one case there was a complaint that the surgeon, you know, not only allegations that he killed people, but that he had carved his initials into someone. So it’s a really insane piece that I think, yeah, everyone should read. 

Rovner: Yeah. Sandhya. 

Raman: So I picked the story “, and it’s in CIDRAP from Liz Szabo. And this piece is part of a larger series for the 20th anniversary of the HPV [human papillomavirus] vaccine. But Liz just does a beautiful job juxtaposing, you know, one sister who battles and eventually, you know, lost a heartbreaking battle with cervical cancer, and how her sister was in the first batch of folks to get the HPV vaccine 20 years ago. And then, you know, the sister is talking about the importance of wanting her sons to get it that are pretty young. And it just really does a good job of showing the trajectory of how effective the vaccine has been in reducing cervical cancer since its rollout. 

Rovner: Yeah, this is one of the great medical miracles that’s suddenly become controversial again. It’s really good. You should read the whole series. I will post links to it. My extra credit this week is from my Ñî¹óåú´«Ã½Ò•îl Health News colleague Amy Maxman. It’s called “Anguished Parents. Doctors in Tears. Utah’s Long Measles Outbreak Takes a Toll.” Amy went to Utah and found that measles is taking a stronghold there for a whole variety of reasons, including the strength of the supplement industry that teaches residents to suspect mainstream medicine. It’s a really good read that shows the challenges public health still faces in things that we thought we had overcome years, if not decades, ago, like how to prevent childhood diseases like measles. 

All right, that is this week’s show. Thanks to our editor this week, Mary Agnes Carey, and our producer-engineer, Francis Ying. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , and on Bluesky . Where are you guys hanging these days? Sandhya? 

Raman: I’m at  and on  @SandhyaWrites. 

Rovner: Lauren. 

Weber: I’m on  and on  as @LaurenWeberHP. The HP is for health policy. 

Rovner: Lizzy. 

Lawrence: I’m on  as @LizzyLaw_ and on  and  (Lizzy Lawrence). 

Rovner: We will be back in your feed next week. Until then, be healthy. 

Credits

Francis Ying Audio producer
Mary Agnes Carey Editor

Click here to find all our podcasts.

And subscribe to “What the Health? From Ñî¹óåú´«Ã½Ò•îl Health News” on , , , , , or wherever you listen to podcasts.

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

This <a target="_blank" href="/podcast/what-the-health-450-aca-enrollment-drops-june-11-2026/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2249320&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2249320 Looming Medicaid Cuts Supercharge California’s Latest Labor-Industry Fight /medicaid/seiu-uhw-union-healthcare-industry-california-ballot-initiatives-clinic-executive-pay/ Wed, 10 Jun 2026 09:00:00 +0000 /?p=2245967 The looming impact of federal Medicaid cuts has reignited a long-simmering, costly battle between California’s medical industry and one of its largest health worker unions.

, with approximately 120,000 members, has put forward two ballot initiatives to cap the pay of medical executives and require community clinics to spend the vast bulk of their revenues on patient care.

The California Hospital Association has responded with its own ballot proposal that would make it tougher for unions to spend money on political initiatives in the future. It would require approval by a union’s rank-and-file membership for any spending of $1 million or more on statewide measures, or $100,000 or more on local ones.

The competing measures, which have drawn enough verified signatures to qualify for the November ballot, come at a time when the rising cost of healthcare is emerging as a .

The Service Employees International Union affiliate has seized upon affordability angst to resurrect a proposal for a cap on healthcare executive compensation, which it has failed to achieve multiple times before. The proposed measure garnered more than 1 million petition signatures.

“This initiative reflects the serious crisis we face and that affordability is a real thing,” said Vikas Saini, president of the Lown Institute, a Massachusetts-based healthcare think tank. “I think it also reflects grassroots anger and a desire to do something.”

Mikey Vaughn, a certified nursing assistant at Cedars-Sinai Medical Center, said that the Los Angeles hospital, despite its reputation as the go-to place for the rich and famous, often lacks supplies and staffing levels that he and his colleagues need to do their jobs effectively and without undue stress.

“The executive pay initiative would, I hope, be used to hire staff and to actually provide better resources for our patients,” said Vaughn, a member of SEIU-UHW’s executive board and political committee.

Thomas Priselac, then-president and CEO of Cedars-Sinai Medical Center, in fiscal year 2024, according to the organization’s most recent available federal tax filing. Kaiser Permanente’s CEO, Gregory Adams, made . Warner Thomas, head of Sutter Health, made .

Cedars-Sinai spokesperson Duke Helfand said if the measure passed, the hospital would be unable to recruit and retain physicians, nurses, and specialists, dramatically impairing its ability to provide healthcare.

“Such a scenario would be disastrous not only for Cedars-Sinai but for hospitals across Los Angeles and California,” Helfand said.

The union wants to cap compensation at $450,000 a year for senior hospital and medical group executives, as well as other administrative and managerial staff. However, the initiative does not stipulate how dollars diverted from payroll must be spent.

The union has dubbed the latest proposal the “Health Care Executive Compensation Act of 2026.” A heavyweights opposing it — hospitals, physicians, and clinics, among others — has rebranded it the “Health Care Endangerment Act.”

Carmela Coyle, CEO of the hospital association, called the measure a cynical political ploy. “It’s bad policy and it’s going to have bad consequences across California,” she said.

Glenn Melnick, a healthcare economist at the University of Southern California, said that even if the initiative were fully implemented and pay cuts enacted, he doubts it would reduce the cost of healthcare for patients.

SEIU-UHW does not have an estimate of the total amount the initiative would claw back from pay packages that exceed the limit.

Opponents of the initiative note that it doesn’t target only executive pay but would affect medical practitioners who are also managers. That could include chief medical officers and chief nursing officers, as well as heads of surgery, emergency rooms, oncology, obstetrics, cardiology, and other specialties, they say.

It would be up to each hospital, health system, and physician group to report which staff members exceed the cap and by how much.

Ultimately, who is subject to the pay cap “probably will have to be battled out in court,” said the hospital association’s Coyle. “That’s why we are throwing everything we can at it.”

The second SEIU-UHW ballot initiative, on community clinics, is already in court. , which represents clinics, filed a federal lawsuit in April seeking to invalidate it before it reaches the November ballot.

The proposed measure would require to spend at least 90% of their revenues on activities directly related to their mission of providing care for low-income populations. If it were to pass, over 90% of those clinic organizations would be on the hook for penalties totaling $1.7 billion in the first year alone and “would face similarly crippling penalties every year,” commissioned by the primary care association and conducted by the Berkeley Research Group, an international consulting company.

Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County, said many pivotal services the clinics provide — translation and transportation, for example — would likely not be counted toward the spending requirement.

“They are targeting a group of what they see as employers and we see as the safety net,” she said.

The lawsuit cites the harm to clinics and claims the proposed spending requirement would interfere with federal authority.

Renée Saldaña, a spokesperson for SEIU-UHW, characterized the lawsuit against the initiative as “a really desperate attempt by the clinic industry to try and avoid accountability.”

SEIU-UHW, , is also behind a controversial proposal that would impose a one-time 5% levy on California residents with fortunes over $1 billion to backfill the funding gap created by federal cuts coming down the pike under Republicans’ One Big Beautiful Bill Act. The law, passed last July and signed by President Donald Trump, is projected to squeeze over $900 billion from the Medicaid health coverage program for low-income people by 2034, including as much as in California.

The hospital association, the community clinic group, and the California Medical Association, which represents physicians, oppose the wealth tax proposal. But Saldaña said all three of the union’s ballot proposals tie into an overarching strategy to counter the widening healthcare disparities caused by the federal law. Referring to the proposed pay cap, she said, “We believe the primary concern of healthcare providers, including executives, should be to serve the community, heal patients, and not be in healthcare just to enrich themselves.”

Over the years, the union has submitted dozens of local and statewide ballot initiatives, including ones to cap the pay of hospital executives, regulate dialysis clinics, and raise the minimum wage of healthcare workers.

The hospital association calculates that SEIU-UHW has spent nearly $125 million on local and statewide initiatives since 2012. But healthcare industry groups have spent far more opposing them. The hospital association data shows that the union spent nearly $36 million on three ballot proposals to regulate the dialysis industry, but dialysis companies poured in $302 million to defeat them, according to state campaign finance records.

The union’s ongoing political efforts “threaten patient access to quality health care,” according to the hospital association’s ballot initiative, which could limit how much unions spend on future ballot measures.

Saldaña hinted at a possible lawsuit should that measure pass, saying that “we don’t see the legal viability” of it. The proposal, she said, is an attempt “to silence the front-line healthcare workers.”

Ultimately, a ballot initiative won’t cure the ills that plague healthcare in the United States, said the Lown Institute’s Saini. What’s needed, he said, is “an evaluation and reimagination of healthcare.”

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

This <a target="_blank" href="/medicaid/seiu-uhw-union-healthcare-industry-california-ballot-initiatives-clinic-executive-pay/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2245967&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2245967 Millions of Kids Could Lose Insurance as GOP Healthcare Cuts Start To Bite /insurance/health-hub-kids-lose-insurance-coverage-gop-healthcare-cuts/ Fri, 05 Jun 2026 09:00:00 +0000 /?p=2244771&preview=true&preview_id=2244771
0:00 0:00
Produced in partnership with: Download
Speed
Embed this player

have lost insurance since President Donald Trump took office in 2025. Another million could lose it amid the Trump administration’s immigration crackdown and new Medicaid eligibility rules. On WAMU’s Health Hub on June 3, Ñî¹óåú´«Ã½Ò•îl Health News chief Washington correspondent Julie Rovner explained how fear and confusion complicate access to health coverage.

A image of the healthcare.gov website on a laptop screen.
(Stefani Reynolds/Bloomberg via Getty Images)

Last year’s big cuts to federal healthcare programs in the Republicans’ One Big Beautiful Bill Act created an affordability crunch for many Americans. They’ve ushered in higher health insurance premiums and confusion about who’s covered under new Medicaid rules.

Another result has been falling enrollment in Affordable Care Act plans and Medicaid. That’s leaving uninsured, according to an analysis by the Georgetown University McCourt School of Public Policy’s Center for Children and Families. Ñî¹óåú´«Ã½Ò•îl Health News chief Washington correspondent Julie Rovner appeared June 3 on WAMU’s Health Hub to explain who’s vulnerable to losing coverage and what it all could mean for the prices Americans pay for health insurance next year.

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

This <a target="_blank" href="/insurance/health-hub-kids-lose-insurance-coverage-gop-healthcare-cuts/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2244771&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2244771 Medicaid Work Rules Surprise States /podcast/what-the-health-449-medicaid-work-rules-exemptions-june-4-2026/ Thu, 04 Jun 2026 18:30:00 +0000 /?p=2244767&post_type=podcast&preview_id=2244767 The Host
Julie Rovner photo
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.

New rules out this week from the Trump administration for implementing work requirements for adult Medicaid recipients surprised many state officials. The rules make it more difficult for states to determine who should be exempt from the requirements, including by stipulating that having a serious condition such as HIV or cancer does not automatically excuse an enrollee from having to engage in 80 hours per month of paid work, volunteering, or school attendance.

Meanwhile, a separate rule would give political appointees far more power over who gets health and science grant funding, and what political activities grant recipients can participate in. This would be a dramatic change — currently most decisions are made by career scientists and outside peer reviewers and based solely on scientific merit rather than whether they advance an administration’s political agenda.

This week’s panelists are Julie Rovner of Ñî¹óåú´«Ã½Ò•îl Health News, Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Liz Essley Whyte of The Wall Street Journal.

Panelists

Margot Sanger-Katz photo
Margot Sanger-Katz The New York Times
Alice Miranda Ollstein photo
Alice Miranda Ollstein Politico
Liz Essley Whyte photo
Liz Essley Whyte The Wall Street Journal

Among the takeaways from this week’s episode:

  • The Medicaid work requirement was pitched as a massive money-saver for the federal government because, supporters argued, it will keep people who shouldn’t be eligible for the program from being on the rolls. But it is becoming clear that implementing the policy is going to cost states tens of millions of dollars in new hires, contracts, communication campaigns, and tech systems. State officials say this is coming when budget pressures are already high.
  • The White House has advanced long-anticipated draft regulations designed to give political appointees the final word on federal research grants. The regulations, which have been close to the heart of Office and Management and Budget Director Russell Vought and were included in Project 2025, would empower the federal branch to pull back funding if political appointees find grantees doing work at odds with the president’s agenda.
  • In a move that went somewhat unnoticed, President Donald Trump on Friday gave his official endorsement to a study by the Department of Health and Human Services that calls for cutting the number of vaccines recommended for every American child. It’s not clear what impact Trump’s action will have — the changes that Health and Human Services Secretary Robert F. Kennedy Jr. tried to make have been put on hold by federal courts.
  • A final rule issued this past week for the No Surprises Act makes changes designed to improve communication between insurers and providers. The rule does not, however, get at what’s emerged as the law’s biggest problem: When disputes between doctors and insurers reach arbitration, doctors are the overwhelming winners. And it is costing millions. Fixing the underlying issues would probably require legislative attention.

Also this week, Rovner interviews Ñî¹óåú´«Ã½Ò•îl Health News reporter Lauren Sausser, who wrote the latest “Bill of the Month,” about a patient with a temporary memory problem and a less forgettable $59,000 hospital bill. If you have an outrageous or inscrutable medical bill you’d like to share with us, you can do that here.

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

Julie Rovner: Ñî¹óåú´«Ã½Ò•îl Health News and The Associated Press’ “Festering Infections to Untreated Cancer: ICE Detainees Describe Medical Neglect Across US,” by Rae Ellen Bichell, Claire Galofaro, Maia Rosenfeld, Renuka Rayasam, Aaron Kessler, and Byron Tau.

Liz Essley Whyte: The Wall Street Journal’s “,” by Christopher Weaver and Anna Wilde Mathews.

Alice Miranda Ollstein: The New York Times’ “,” by Simar Bajaj.

Margot Sanger-Katz: ProPublica’s “,” by Alec MacGillis and Ken B. Morales.

Also mentioned in this week’s podcast:

  • Politico’s “,” by Robert King and Alice Miranda Ollstein.
  • The New York Times’ “,” by Margot Sanger-Katz and Sarah Kliff.
  • The Washington Post’s “,” by Lauren Weber.
click to open the transcript Transcript: Medicaid Work Rules Surprise States

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, June 4, at 10:30 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. Today, we are joined via video conference by Margot Sanger-Katz of The New York Times. 

Margot Sanger-Katz: Hello, everybody. 

Rovner: Alice Miranda Olstein of Politico. 

Alice Miranda Ollstein: Hi, there. 

Rovner: And we welcome to our podcast panel this week Liz Essley Whyte of The Wall Street Journal. Happy to have you join us. 

Liz Essley Whyte: Thanks for having me, Julie. 

Rovner: Later in this episode, we’ll have my interview with my colleague Lauren Sausser, who wrote the latest Ñî¹óåú´«Ã½Ò•îl Health News “Bill of the Month.” It’s about a woman with a temporary memory problem who probably wishes she could forget about a $59,000 hospital bill. But first, this week’s news. 

So, it’s been almost a full year since President [Donald] Trump signed the big budget bill that would reduce Medicaid spending by nearly a trillion dollars over the next decade, and this week we got the much-anticipated regulation outlining what states have to do in order to implement the new Medicaid work requirements for low-income adults on the program by next Jan. 1. And it’s safe to say that these rules â€” which are interim final rules, by the way, so that means they technically take effect immediately â€” are not what states were expecting. I want to break this down in pieces, but first, let’s talk about what a heavy lift this was going to be for the 43 states that are required to put these rules into effect.  before the rules came out, right? 

Ollstein: Yes, this is being pitched as a massive money saver, that was how it was framed. It’s being scored that way in the original bill in order to pay for a bunch of other things: tax cuts, etc. 

Rovner: I would say it is a money saver for the federal government, right? 

Ollstein: Well, that is the promise, that it will save money by reducing the number of people covered by Medicaid. And so proponents of this frame it as cracking down on waste, fraud, and abuse, arguing that the only people who are going to get booted off of Medicaid are the people who deserve to be booted off of Medicaid, because in this piece of it they’re not working or volunteering or going to school or caring for a sick relative. We looked at, yes, this is aimed at saving federal money, but it is currently costing states millions or tens of millions of dollars to implement. It is extremely expensive to implement. States are having to hire a lot of people, they’re having to create, you know, brand-new tech systems that, or upgrade their old tech systems that they didn’t have before. And a lot of state officials told us that this is coming at really the worst time for them. They’re already losing other federal funding, they are really struggling, they’re having to make lots of cuts to social services. And so there just isn’t a lot of extra money to go around. And yet they have to spend all this money to implement these rules. And, especially, Democratic officials were telling us that, Look, we wouldn’t mind having to invest this money if it were going to lead to covering more people or offering people better, more comprehensive coverage. But they really resent having to spend this money in order to cover fewer people in the future.  

Rovner: So, let’s get to the rules themselves. As I like to explain, there are two big things that states are going to have to do here: first, to determine which Medicaid recipients are exempt from that community engagement requirement â€” to work, volunteer, or attend school 80 hours per month â€” and second, to determine if those who are not exempt are actually meeting the requirements. And these new rules make both of those harder for states, right, Margot? 

Sanger-Katz: Yeah, I think it’s been like this huge freak-out among states over these last few weeks, because there were a lot of rumors flying around, but I think there was just this concern, like, Whoa, if they make major changes right now, it’s going to be even harder for us to implement. And for states that were, as Alice said, some of these blue states that were trying to minimize the coverage losses under the Medicaid work requirement, I think they were worried, Well, they’re only going to make it stricter; they’re only going to make it harsher. Why would they be changing things now? And so, , it turns out that is, in fact, what they did, that there were a number of policy choices where they decided to apply a stricter standard than what states had been told before this week. 

So what are the biggest examples of this? I think there are two. One is that the work requirement doesn’t apply to everyone. The Republicans in Congress basically said we want people, adults without young children and without disabilities, to be engaged in their communities â€” to work, volunteer, go to school a minimum number of hours each month if they want to stay eligible for Medicaid. But we understand that there are certain people who are going to have trouble doing that, and so we want to have exceptions for those people. So not everyone has to do the work requirement, a bunch of people don’t have to. And the biggest category of this was a category that Congress called “medical frailty.” The idea was these are people who have medical problems that, like, might make it hard for them to work, or who might really suffer if they lost their health insurance. So, depending on who you talk to, that was what Congress was trying to protect with that exception. And what CMS [the Centers for Medicare & Medicaid Services] had been telling states over these last few months is: Put together a list of diagnoses of serious illnesses, and you can data match, you know, you have people in your Medicaid system already. OK, if they had cancer, if they have HIV, if they have Parkinson’s disease, that’s a serious illness. Those people are medically frail. You can just automatically exempt them, and then you don’t have to check their work hours. 

Rovner: That’s what Nebraska is already doing, right? Because they’re one of the states that have started this early. 

Sanger-Katz: Correct. Yeah, so Nebraska is already live with its work requirement. And, again, Nebraska, even more so than these other states, got tons of guidance from CMS, because they were so excited to go first, and they wanted to do everything right. They wanted to be a good example. And I think CMS wanted them to demonstrate, OK, you can like do this policy. Yeah, they had a list, I think they had like 300 pages of diagnostic codes, you know, like all these diseases. If you have these diseases, we’re gonna exempt you, then you don’t have to demonstrate work hours. If you don’t, OK, like, then you’re gonna have to prove that you’re working or volunteering or going to school. 

So what the rule said is, like, that’s not good enough. It is not good enough to have cancer â€” that in order to be exempted from having to demonstrate that you are working, you have to prove that you have cancer, and that your cancer is creating a problem that would make it hard for you to work. And the rule creates a standard where states are going to have to evaluate not just what diseases people have, which might be easy to do using medical records, for at least people who are already enrolled and who have been getting medical care, but instead that they have to make something like a disability determination, which is something that the states were really not ready for, that they don’t really have the staff to do or the training to do, and that cannot be easily automated on the back end right now. I think there’s not an easy way for them to go into the medical record and decide whether or not someone’s illness is serious enough that it would impair their ability to work. And the language that they use in the rule, the standard, is not actually really like the standard in other programs that have work requirements, so the states have no experience with the standard.  

And, as it turns out, doctors don’t really have any experience with this standard either. So, you know, when you are making a workman’s comp claim, for example, like the doctors have forms, there’s a system, they understand what it means to be too sick to work because of an injury that would preclude you from workman’s comp. And in SNAP [Supplemental Nutrition Assistance Program], it turns out, there’s also a standard if you’re unable to work, you could get out of the work requirements. But that is slightly different. And so I think there is this real concern by states that they just like actually don’t know how to do this. There might be some AI [artificial intelligence] solution where they’re data mining in the medical records and trying to figure out if they have these codes, and these codes, like, maybe there’s a way to prove that someone is sick enough. What most people that I’ve talked to said is that basically this is going to be a system that’s largely going to be achieved with doctors’ notes. Doctors have to be willing to do this thing that they’ve never done before, and they’re, you know, having to sign that someone can’t work, and that’s going to be a lot of frictions in that process. And then there’s going to have to be a caseworker on the other end who is going to have to look at those doctors’ notes and is going to have to read them and decide whether the doctor has specified the impairment such that it is in compliance with the work requirement. 

So this is just a lot of like administrative headache. I think there are reasonable arguments for wanting to have this standard given what Congress’ intent was, that they wanted to have a work requirement. The point was they wanted people who could work to work, and they wanted people to be exempted who could not work. I think not everyone in Congress agrees with that, but I think some of them do. But I think the reality of how you actually do this in real life is much, much more complicated than that. There is no, like, godlike state that can just see how sick you are and can make these determinations. And so I think that states are really worried about this. They’re worried about how they’re going to get in compliance with this, they’re worried about all the changes they’re going to have to make to the systems that they’ve already built. And I think that a lot of advocates for people with Medicaid, and a lot of disease groups, advocates for people with serious illnesses, are very worried that many, many more people are going to lose coverage, and particularly people who are medically frail. You know, if you think about, say, a person with HIV, they may be in treatment and getting their medicines, and they might even have undetectable levels of HIV in their blood, and they are perfectly capable of working right now. But if they lose their health insurance and they lose their access to their prescription drugs, they fall out of treatment, their health condition could worsen pretty substantially. And I think we can all think of lots of other diseases that are like that. I think cancer is a good example. You know, some people are living with cancer, and it’s kind of like a chronic disease, but it’s because they’re getting regular care. If they lose their treatment&²Ô²ú²õ±è;…&²Ô²ú²õ±è;they lose their treatment for many other diseases we can think of that are like this. Depression, you know, certain kinds of mental health problems, if people fall out of treatment, that actually could impair their ability to work, and that causality could run in the opposite direction. So, I think this is a big change. 

And then the other change that they made is more technical, but it was like, how are people going to prove various things under this law? And a lot of states were just expecting people would be able to sign a statement and say, I am caring for a disabled relative&²Ô²ú²õ±è;…&²Ô²ú²õ±è;you can trust me, I’m signing under penalty of perjury. This is what I’m doing. Or I volunteered 12 hours last month, you know, I’m just going to sign this under penalty of perjury. Because there’s not a good way to check. 

Rovner: And for the first year, that’s OK, right? They’re taking these attestations&²Ô²ú²õ±è;…&²Ô²ú²õ±è;

Sanger-Katz: For the first year, they’re going to allow it. And then after the first year, they’re going to allow it for medical frailty only â€” once. So if you sign up for Medicaid in 2028 and you claim that you’re too sick to work, you can sign a form that says that, but then, within the next six months, before you renew your coverage, you’re going to have to come back with some kind of medical record with some kind of doctor’s note that proves it. So you know these are some pretty big changes, and Trump administration officials said, you know, our view is this is consistent with [what] the law is for, which is to ensure that people are working and are engaged in their communities if they’re capable of doing it. They also said that this prohibition on people just signing statements is a way to avoid fraud, because why wouldn’t people just sign a statement saying that they didn’t have to do this work requirement if they could? But I think this is going to have real implications in the real world. It’s going to create a huge administrative headache for states. It’s probably going to impair a lot of people from getting coverage who would have otherwise been covered if CMS had stayed the course with what it had been telling states before. 

Rovner: So, I know my inbox is full of reactions from groups across the medical spectrum. Alice and Liz, I assume you guys are hearing lots of feedback about this, too. 

Ollstein: Absolutely. I mean, just like Margot said, there just isn’t really a good way to do this, trying to automate it and base it on medical claims, like 1) States don’t have that built yet, the different systems don’t, quote unquote, “talk to each other” in that way. But also, you know, just because someone used a certain number or kind of health services in a year doesn’t necessarily tell you whether they can work or not. You know, lots of people who are too sick to work maybe haven’t had the medical services, and someone who had a lot of medical services maybe can work fine. But then again, leaving it up to individual doctors who are not trained to make this determination, who don’t have the time to have a bunch of extra appointments just to do this, and who are more used to doing this for â€” Margot gave a few examples, but something some doctors brought up to me was like short-term disability, like evaluating, like, this is the number of weeks someone needs to recover from X surgery. So like that’s a determination a doctor feels qualified to make. Whether someone can work any job, I mean, that’s just not really something they can confidently say. I mean, working a job in a factory is not the same as working an email job, and what kind of jobs are available in this person’s area? It’s just a huge mess. 

Rovner: So, is there any chance the administration is going to back off? There is public comment being taken now until, I think, July. Or will Congress perhaps step in and say this is not what we intended, or does somebody get to sue here? I mean, or this is what’s called an interim, I’m saying, an interim final rule, so it’s not set in concrete yet. 

Sanger-Katz: I mean, I would not be at all surprised if we see lawsuits, but I think we’ll see something else happen first, which is: The law says the states have to get ready to go by&²Ô²ú²õ±è;…&²Ô²ú²õ±è;Dec. 31, 2026, to be ready to go live in January. But it says if they encounter a hardship, if they’ve been making good-faith effort towards getting ready for the work requirement, and they’ve encountered some hardship, and they, like, can’t make the deadline, they can apply for a waiver, basically a two-year extension from CMS. The Trump administration has been extremely clear to states about this all the way along, basically saying, You are not going to get these, we are not going to grant them, like, you know, maybe if there’s like a volcano that goes off in your state and the entire mainframe that holds your Medicaid enrollment system is melted, like, we’ll talk. But I think a lot of states now, especially some of these blue states that are really concerned about this stuff, I think that they are going to apply now, which they might not have done before. And I think if they are denied, I could see some lawsuits around that waiver process to just say, Look, like, you just changed the rules very late. There’s no practical way that we can get this done in time. We have been proceeding in good faith, and, you know, we need more time. So, I think that there could be litigation. I also think they did have this temporary policy for 2027 around self-attestation, which I think does help states get out of some of these, like, really tricky technical issues in the first year. I don’t know, like maybe there could be some further extension of that. But I don’t know. I’m curious, Alice, what, or Liz, what you think. But I am not holding out much expectation that Congress is going to make major changes here. 

Ollstein: Well, and because of the January deadline, making changes could solve one problem and create another. Because states already feel like they don’t have enough time, and they already feel like the rules of the game are being changed in the middle of the game. You know, what they had been spending months preparing for now has to change because of this guidance. If it changes yet again, and they have even less time to adapt and make a new change&²Ô²ú²õ±è;…&²Ô²ú²õ±è;like you said, they’re making hires, they’re trying to make contracts based on this, and so even as advocacy groups, and even states ask for additional changes, additional changes could make it even harder to implement in time. 

Rovner: All right, well, let us move on, because there’s lots more news. Speaking of new regulations, a proposed rule from the Office of Management and Budget would basically make all grant funding from the U.S. Treasury subject to political appointee approval. Currently, most grant-level awards are determined by career scientists and peer reviewers, who make decisions based on scientific merit. Under this new policy, grants would have to, quote, “demonstrably advance the president’s policy agenda.” At the same time, the new 400-page document includes many new rules for grant recipients, including universities and other entities, including limiting their ability to engage in so-called issue advocacy and allowing the revocation of grant funds if recipients take actions that are not deemed by administration political officials to be in, quote, “the public interest.” Now, all this isn’t totally new. Office of Management and Budget Director Russell Vought has been talking about this literally for years. It was laid out in Project 2025 as well as in several executive orders that have been issued by President Trump, which is why I think it’s getting relatively little attention, given the pretty earth-shaking changes that it envisions. Still, putting it out in an actual proposed regulation raises the stakes here, doesn’t it? 

Whyte: Yeah, I would echo that. This has been on Russ Vought’s radar for many years. If you talk to folks, you know, who know him and know his thinking, this all comes down to this thinking about the executive branch and its role in the Constitution, and how there shouldn’t really be independent agencies or branches of the executive branch that aren’t doing what the president wants. And so that is manifested in this regulation that says you can’t promote anti-American values, contribute to illegal immigration, things like that, that are policy priorities of this administration, and a new filter that’s going to be applied to all federal grant-making, once this is finalized. And it’s a distillation of that theory about the executive branch that is now coming out in practice. 

Rovner: Although going back to what we were just talking about with the Medicaid work requirements, I mean, the idea of having to have a political appointee involved at this extremely micro level in the hundreds of thousands of grants that the federal government issues every year. I mean, some of it is the ideology, but some of it is just the logistics. I know that this has been part of the problem of getting money out the door at the National Institutes of Health â€” is that normally money that just sort of flowed when it was approved by career workers now has to wait for the approval of a political appointee, and there are not enough political appointees to approve all of these things, and people aren’t getting their money. So, I mean, this is a logistical logjam, as well as an ideological one, right? 

Sanger-Katz: And we’ve seen some evidence of this. The Department of Homeland Security has had an informal policy like this, where the director was personally approving any expenditure, I think, more than 100 â€”now, I’m forgetting. 

Rovner: $100,000, yeah, I think it was. 

Sanger-Katz: There was some threshold, and it did lead to this huge backlog, because you know this is a busy person who has a lot of other things to do. And it was leading to a lot of money not getting spent that had been authorized by the staff members who thought it was appropriate. And I think there’s also potential for corruption with this kind of system, where you have these bottlenecks where very few people are making all the decisions about where money goes, because then there is an obvious focus on where you send your lobbying efforts to try to get favorable outcomes in contracting and in grant-making. 

Whyte: Yeah, the concern from the science and public health organizations is that the merit of the scientific grant will no longer matter, that how good the science is won’t be the chief thing. 

Rovner: Yeah, that this is all about, you know, promoting the president’s agenda. I’m just wondering what Republicans will feel about this when Democrats, you know, take back the administration and try to do the same thing. 

Whyte: I think that’s exactly the concern that a lot of conservatives on the Hill have, which is, you know, all of this is fine and well, but you’re not going to like it when the tables turn. 

Rovner: Yeah, that was â€” that’s what I said, you know, when the Affordable Care Act passed, I said, there’s an awful lot of places where it says the secretary shall, or the secretary may, or the secretary will. I said, you know, the secretary’s not always going to be somebody who supports this. That&²Ô²ú²õ±è;…&²Ô²ú²õ±è;turned out to be a correct prediction.  

Moving on, the idea of this administration playing down its vaccine skepticism was so last month. Last Friday, President Trump issued an executive order basically endorsing Health and Human Services Secretary [Robert F.] Kennedy [Jr.]’s revamp of the childhood vaccine schedule, and ordering the CDC [Centers for Disease Control and Prevention] to review it and, quote, “take any appropriate steps to update said schedule.” What happened to “This isn’t popular, so we’re not going to push it,” or is doing this on a Friday afternoon how the administration is trying to placate the MAHA [Make America Healthy Again] movement, but not really make big headlines here? I also â€” this is another story that I think kind of flew below the radar. 

Whyte: Yeah, it’s funny because HHS can’t really say anything about this executive order due to their litigation ongoing, and so it’s just kind of out there. But it’s totally unclear to everybody why or what it’s expected to do, given that the court has put everything regarding the Advisory Committee on Immunization Practices on hold, and there currently is no ACIP. So what exactly the White House was intending with this remains pretty opaque, I think. 

Rovner: Like a lot of things, although I have started to, you know, like, pay attention on Friday afternoons again. Meanwhile, our podcast colleague  about how the anti-vax movement is trying to achieve its goal through the courts by arguing that vaccine mandates that lack religious exemptions are unconstitutional. And one of those cases is likely to reach the Supreme Court at some point in the not-too-distant future. What would it mean to public health if the court were to actually strike down the ability of states to impose vaccine mandates, which is one of the possible outcomes here? Or, as the groups claim, is this just about getting the five states that don’t have religious exemptions from vaccines into alignment with the rest of the states? 

Sanger-Katz: I think there is pretty strong evidence from the studies of state policies over the years that having really limited exemptions on mandatory vaccination really increases the number of kids who get vaccinated, that the more ways there are to kind of wiggle out of the requirement, the more parents will choose one of those options. And the narrower the exceptions, the fewer will. So, there are clearly some parents who really, really care about this issue and who do qualify for one of these exemptions. But I think there’s a larger number of parents who are maybe ambivalent or have kind of weakly held preferences not to vaccinate; if they’re not really being forced to do it, they won’t do it. If they are really being forced to go through a lot of administrative burden to prove that they need an exception, then they tend to vaccinate. And so I think this is an exception that almost every state already has, but I think that the evidence is relatively clear that opening up more exceptions in those states that don’t have them now, probably on the margin, will lead to fewer kids getting vaccinated in those states. 

Whyte: Yeah, the five states that don’t allow religious exemptions to vaccine mandates are West Virginia, California, New York, Connecticut, and Maine. So that would be, you know, an immediate effect there. But then I think we can expect from a Supreme Court precedent, if one is set, that other states, state legislatures, local school districts would perhaps expand the religious exemptions they have now, or make them easier. We’ve seen that how much friction there is when you get a religious exemption really matters. So, like, do you have to just sign a form, click a box, or do you have to go meet with someone and prove that you, you know, have sincerely held beliefs on this matter? And those kind of friction points matter a lot too. 

Rovner: Yeah, I just, I couldn’t help thinking, as I was reading this story, about going back to the Dobbs case, the abortion case, which was not originally intended or filed as one that was going to overturn Roe, and makes me wonder what the Supreme Court might do, even if the question that’s raised is, you know, about these religious exemptions, could they go on and overturn â€” I think that precedent was from 1905 that said that states can have vaccine mandates â€” and wondering whether a) that’s possible, and b) that’s likely. 

Sanger-Katz: It’s always hard to predict what the Supreme Court is going to do. 

Rovner: Always. 

Sanger-Katz: It’s really up to them. They’re an idiosyncratic group of people who get the final say on a lot of things. 

Whyte: I thought it was interesting, Lauren’s story was great, and one of the things it pointed out is that what the Supreme Court did is specifically give instructions to this lower court to go back and look at this question about religious exemptions for vaccine mandates using a case that happened in Maryland, where the Supreme Court found that the school district could not mandate that kids participate in lessons with LGBTQ content that would conflict with their parents’ religious beliefs. So in other words, the families had a religious right to not have to participate into that in school. And the Supreme Court is asking, is there a similar right that a family would have to not have to participate in vaccination to attend school? So that’ll be an interesting question, and it could, as we said, you know, have big impacts across the states and how school districts handle vaccine mandates for kindergartners. 

Rovner: Although I think this will take a while to play out. And before we leave the subject of vaccines, an update to our discussion from a couple of weeks back about the global vaccine alliance known as Gavi, which the U.S. owes some $600 million appropriated by Congress. That’s money that’s been held up by HHS Secretary RFK Jr. At a hearing of the Senate Foreign Relations Committee on Tuesday, Secretary of State Marco Rubio said his agency, which has historically been in charge of Gavi for the U.S. government, said that it is, quote, “sort of at a stage where we are going to re-engage. We need to drive this to an outcome.” Was that his polite way of saying that he plans to give Gavi the money that Congress allocated to it, and RFK Jr.’s concerns be damned? 

Whyte: I think a lot of people are reading it that way. You know, the State Department has a very practical view on these things. I also thought the way that Rubio phrased how they were giving Secretary Kennedy a large amount of deference because of his strongly held views on this matter was a very interesting insight into how the Cabinet works and how Trump has instructed his top officials to work together. And I think part of the problem here is that they’re just running into the practicalities of not having an Ebola vaccine. And so the State Department is going to have to do what it feels must be done. 

Rovner: Yeah, it was just a little peek behind the curtain of this intra-agency squabble that’s going on. We’ll wait and see if that happens. 

Whyte: I should say that they don’t have a vaccine for this newest outbreak that is going on. They, you know, the older Ebola vaccine, it was not appropriate to treat this one or to prevent this. 

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

All right. Our theme this week seems to be federal rulemaking. So, here’s another one. The Trump administration has issued final rules attempting to fix the arbitration system created in the, quote, “No Surprises Act” â€” that it is safe to say has not worked as it was designed by Congress. Margot, remind us what went haywire with the process that’s actually in practice [to] dramatically increase what providers get paid, and will these new rules make it all better?  

Sanger-Katz: So this is a system supposed to solve the problem of surprise medical billing when you, say, go to the emergency room and some doctor treats you, and it turns out that that doctor didn’t take your insurance and sends you a huge bill. So the law did away with that, basically said no one is allowed to send you a huge bill in that situation, and then it created a system on the back end for the insurance company and the doctor to kind of fight it out and figure out what the doctor was going to get paid if they didn’t have a contract with that insurance company. And the expectation of Congress was that this is a system that would be used fairly rarely, that most of the time this would be negotiated between the parties; they would just decide on a price and work it out, but every once in a while there would be a rare case where they would need to litigate their dispute. And it would go, they set up this arbitration system where a neutral arbiter, usually a lawyer, but not always, would hear arguments from each side and decide who had the more reasonable position, and would have to choose between the two bids. They couldn’t negotiate any further, but, you know, the doctor would say, This was a very complicated case, I deserve $10,000. And the insurance company would say, No, no, no, like, normally for this kind of visit we pay $500. And the arbitrator would have to decide which is more reasonable: $10,000 or $500. 

What’s happened, I think, to the surprise of a lot of people, is that instead of 17,000 of these cases going to arbitration, which is what CMS expected when the law passed, more than a million are going through a year. There has just been an explosion of cases coming through the system. Lots and lots of medical disputes are now being decided using this process, and the doctors are winning almost all of the time. I think in the last quarter for which there is data, 88% of these arbitration claims are being decided in favor of doctors. And because of that, the doctors, in many cases, have started getting more aggressive in what they ask for. Because they keep winning, there is not really an incentive to say that price is normally $500. They’re much more likely now to ask for $10,000 than early on in the system, where maybe they were asking for $1,000. And so we’re seeing some really eye-popping awards. Not all of them; there are a fair number of awards that are, you know, within a reasonable number of multiples of what the normal price is. But there are an increasing number where doctors are just getting huge, huge, huge increases over what you would expect. And my colleague Sarah Kliff and I wrote a story a few weeks ago about a plastic surgeon in New York and New Jersey who was routinely collecting fees of hundreds of thousands of dollars for breast reduction surgeries that he had previously accepted payments of around $10,000 from the same insurer prior to this law going into place. So big problems. Lots of complaints from insurers, as you can imagine, and also from employers who, in many cases, are actually paying the bills for their workers’ health insurance directly, because they have these self-insured ERISA [Employee Retirement Income Security Act of 1974] plans. 

This rule that just came out is not getting at the real, like, meat of the system, how the arbitration works, and what&²Ô²ú²õ±è;…&²Ô²ú²õ±è;how the arbitrators make their decisions. But it’s dealing with, like, a lot of, like, technical issues about, you know, how do you submit paperwork? What kind of information do you provide? Is it all in one computer system? How can you make sure that you have identified the right insurance company? And what are the administrative fees that you pay when you want to initiate one of these claims? And so this is a very hot issue. I wrote this one story, and, like, everyone is just really worked up about it. The doctors are really worked up about it, the insurers are really worked up about it, the arbitrators are really worked, you know, everyone feels strongly about this law, and whether it’s going well or not well, or what changes or they want or don’t want. Everybody loved this rule. As far as I can tell, there have been, like, basically no complaints about this rule. The one complaint I’ve seen is that they lowered the fee to file a new case, and so I think people who feel like there are too many of these cases would like it to be a little harder to file a new case. But, in general, it seems like these were expected, helpful, technical upgrades that are just going to make the process work a little bit more smoothly and deal with some of the annoying administrative headaches. 

Rovner: But not address the deeper problem. 

Sanger-Katz: The bigger issues, I think, really do require the involvement of Congress. If Congress wants to revisit the law and change the way that this overall system is structured, they’re probably going to have to write new legislation. And I’m not sure how large the appetite is for that right now. 

Rovner: Yeah, I’m not going to hold my breath on that one. All right, that’s as much news as we have time for this week. Now, we will play my “Bill of the Month” interview with Lauren Sausser, and then we will come back and do our extra credits. 

I am pleased to welcome back to the podcast Ñî¹óåú´«Ã½Ò•îl Health News’ Lauren Sausser, who reported and wrote the latest “Bill of the Month.” Hi, Lauren. 

Lauren Sausser: Hi. 

Rovner: So, this month’s patient got caught in one of those fights between the insurance company and the hospital, and, of course, it turned out to be harder to untangle it than it should have been. Tell us who she was, what happened to her, what kind of care she needed. 

Sausser: Sure, so Jan Anderson is a 65-year-old woman who splits her time between Arizona and Washington state. And Jan was hiking with her husband about a year ago in Arizona. They were in Sedona. And later that afternoon â€” it might have even been pushing into early evening â€” she started repeating herself. So she asked her husband, Did we hike today? And he said, Yes, we hiked. And then a few seconds later she asked the exact same question, Did we hike today? And it was clear almost immediately that Jan needed to be seen. So her husband drove her to a freestanding ER in the Sedona area, and that facility assessed her but was not equipped to deal with patients who might be experiencing stroke. They didn’t know what was happening with Jan at this point, so she was airlifted to a hospital in the Phoenix area, where she was admitted. And they ran a bunch of different tests and images, and it turns out she wasn’t having a stroke, she was having, she was experiencing an episode of something that’s called temporary [transient] global amnesia â€” which, the good news is, is benign, and as the name suggests, temporary. But her hospital bill ended up being quite a lot, even though it was less of an emergency than they originally thought. 

Rovner: Well, of course, that’s what they always tell you: If you’re having symptoms, you should go to the emergency room. So, she did have insurance, right? So, why did the hospital in Phoenix think that she didn’t? And how much was the bill? 

Sausser: OK, so the total bill was $59,181. That’s just for the care she received at the hospital in the Phoenix area. She did have insurance. She was insured through Molina [Healthcare], and it was a plan that she had purchased through the federal healthcare.gov marketplace. For some reason, though, her insurance information was not transferred from that freestanding ER in Sedona to the facility where she was airlifted in the Phoenix area. So it was a mistake, but that second facility billed her as if she was a self-pay patient with no health insurance. 

Rovner: Now, once the hospital did figure out that she had insurance, why did the insurance company then still reject the claim? 

Sausser: It took a while to get some answers on this, but eventually Jan learned that Molina was not going to cover the cost of that care she received in Phoenix, because the Phoenix hospital had not sought prior authorization for her to be admitted. Now, under the federal No Surprises Act, emergency services are supposed to be paid for in-network without prior authorization. In this case, the insurer was saying Yes, we do cover emergency services without prior authorization, but in this case her care team was recommending that she be admitted. And the insurer argued that the insurance company needed to be notified before that happened. 

Rovner: So, I know I ask this question all the time: Why didn’t the No Surprises bill [Act] get the patient out of the middle of this obvious insurance company hospital dispute?  

Sausser: This&²Ô²ú²õ±è;…&²Ô²ú²õ±è;in this case, the No Surprises Act kind of worked. Jan received a bill pretty early on saying she owed about $15,000 of that $59,000 total charge. After she told the hospital that she did indeed have coverage, that bill was suspended. There was no one technically knocking on her door pressuring her to pay any amount of the charges she had accumulated in the Phoenix hospital. But every time she would log on to her patient portal, she would see these outstanding charges. The hospital didn’t understand why the insurance company wouldn’t pay. The insurance company was saying she needed to have had prior authorization, and these charges just weren’t disappearing, and so eventually she started reaching out to insurance commissioners, lawmakers, trying to get someone to pay attention, because she was worried at some point she might owe the hospital $59,000. She couldn’t get these charges resolved, and didn’t understand why. 

Rovner: And what eventually happened? 

Sausser: Well, she eventually contacted us. And, as is often the case when journalists get involved with these health insurance issues, the ball started moving. So Molina started talking to the hospital in the Phoenix area, the Phoenix-area hospital has assured Jan that she will not be billed for any of the $59,000. Even if Molina doesn’t pay, the hospital has assured her that they will write off the balance and that she will not be billed. Jan has asked for that assurance in writing. As of the last time I spoke to her, she hasn’t gotten that, but she has been told she will not have to pay any of it. 

Rovner: So, what’s the takeaway here? I mean, it sounds like, you know, she did everything right, and it seems to be resolved. 

Sausser: It seems to be resolved, although the last I heard the $59,000 in charges haven’t necessarily gone away. I spoke with a patient billing expert about this, and the advice that she gave in a situation like this, you know, when you have a hospital stay, you get all sorts of paperwork in the mail afterward. You get paperwork from the insurer, you get paperwork from the provider. This billing expert recommends that you look at the patient responsibility portion of your explanation of benefits. Now that’s a document that you will get from your insurance company. It should list the charges that the hospital has billed, but it should also list the portion of those charges that the patient is responsible for. In Jan’s case, her explanation of benefits clearly stated that she was not responsible for any of it. Now, that didn’t mean that those $59,000 in charges was automatically disappearing, as this story shows. More than a year later, it’s still not resolved. But it shows you that the insurance company is saying you are not responsible for this bill, in this case. The billing expert that I spoke to recommended that the patient mail or email the explanation of benefits from the insurer to the hospital and show that the patient responsibility is zero, in order to get that balance cleared.  

Rovner: We’ll see if this happens. Lauren Sausser, thank you so much. 

Sausser: Of course, thanks for having me. 

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

Ollstein: Yeah, I have a very interesting piece from The New York Times by Simar Bajaj, and it’s called “.” And it is about the trend we’re seeing under the MAHA movement, largely, you know, expressed by Secretary Kennedy, back towards putting a lot of focus on personal responsibility, personal lifestyle choices, and less focus on policy and environmental factors. And it’s, you know, digging into the history of that on a few different fronts, both with, you know, infectious diseases, but also with things like obesity. And it is talking about basically how we’re seeing a return to a system that didn’t really work before, which is, you know, basically browbeating and shaming people into healthier behaviors that did not work in the past. And yet we are sort of attempting to revive that, and part of that is a reaction to the fact that trying to move away from that also hasn’t seemed to work either. So it really explores these, the different history of these approaches in public health. 

Rovner: That’s why public health will continue to be studied. Margot. 

Sanger-Katz: I want to suggest an article in ProPublica from Alec MacGillis called “.” I’ve been interested in the public health problem of gun deaths for many years, and I have to admit that Alec in the story has tackled an issue that I just wasn’t watching. I think it’s, like, one of these other things that has a little bit slipped beneath the radar, because the Trump administration makes so much news. But they, through the ATF [Bureau of Alcohol, Tobacco, Firearms and Explosives], which regulates firearms and firearms dealers, has really loosened up a lot of the restrictions that the Biden administration had put in place to try to prevent the trafficking of illegal guns onto the streets of American cities, where a lot of crime happens. And the story sort of looks at those policy changes and what it means for gun dealers and for people who buy guns. And I think it is too soon to tell whether these policy changes will have an effect on violence and gun deaths on the streets. I think it takes, in many cases, a long time for illegal guns to kind of get out there and be used for crimes. But we have been in this period of really merciful reduction in the crime rate and the murder rate in many American cities for the last few years, and I do think that Alec raises the question that if we are seeing more guns on the streets of the future, whether those declines can be sustained.  

Rovner: Liz. 

Whyte: My choice is from my colleagues Anna Wilde Mathews and Christopher Weaver at The Wall Street Journal, and it’s entitled “.” And it’s a really great look at how there are all these providers that have really exploited this new and growing segment of therapy for kids with autism, which is obviously a growing diagnosis, such that you have, you know, this mom in New Jersey who hears that she can get a no-out-of-pocket-cost treatment for her son and has someone come a few days a week, three or four hours of therapy, and winds up with a bill for more than $900,000, which is obviously a nightmare. So we had previously looked, The Wall Street Journal had, [at] Medicaid billing abuse with these autism therapy services, and found that it was a huge issue. And then this is a look at kind of the private insurance sector, where all these providers are charging private insurance a lot, and when an insurer says, No, we’re not going to pay that, some of these bills end up falling on the families, which is really tragic. About 40 large employers, covering 3.5 million people, their expenses for autism therapy doubled from 2021 to 2025, to $108 million. The Wall Street Journal looked at a bill that was $30,000 for one kid to get autism therapy for one day; it’s actually quite insane. So, kudos to my colleagues for writing about this.  

Sanger-Katz: Can I share one fact from this article that really struck me? 

Rovner: Sure. 

Sanger-Katz: One of the things that these reporters did that I thought was so smart is they documented the growth in the autism services workforce. So, the number of people who are providing this kind of behavioral therapy to children with autism is now larger than the workforce of the U.S. Postal Service. That’s according to a tweet from Derek Thompson, who compared the numbers. But it is kind of astonishing, the growth, not just in the Medicaid spending, not just in private insurance spending, not just in some of these unjustifiable bills that individuals have faced, but also that this is now a huge part of the American workforce is serving in this specific industry right now.  

Rovner: And if this story sounds familiar, it’s because we had a different autism therapy abuse story last week as one of our extra credits. It was written by Margot here, and Sarah Kliff. Yeah, a burgeoning source for reporters to plumb. My extra credit this week is a joint investigation between my colleagues here at Ñî¹óåú´«Ã½Ò•îl Health News and the AP. It’s called “Festering Infections to Untreated Cancer: ICE Detainees Describe Medical Neglect Across US.” The team of six reporters and analysts dug through court records to document that hundreds of immigration detainees in 33 states have filed suit, charging that they were denied adequate medical care. Quoting from the story, “Requests for help went unanswered for weeks, blood sugars rose, infections festered, cancers remained untreated, detainees collapsed and had seizures.” And there’s not even anyone to complain to. Officially, the administration shut down the office of the Immigration Detention Ombudsman earlier this year. The story is really infuriating and worth reading in its entirety. 

OK, that is this week’s news. Thanks to our editor this week, Stephanie Stapleton, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , or on Bluesky . Where are you guys hanging these days? Alice. 

Ollstein: I am on Bluesky , and on X . 

Rovner: Liz. 

Whyte: I am , and on X , and Signal: JournoLiz.80. 

Rovner: Margot. 

Sanger-Katz: I am @sangerkatz at , and on Signal. If you want to send me tips, I’m @sangerkatz.01. 

Rovner: We will be back in your feed next week. Until then, be healthy. 

Credits

Francis Ying Audio producer
Taylor Cook Audio producer
Stephanie Stapleton Editor

Click here to find all our podcasts.

And subscribe to “What the Health? From Ñî¹óåú´«Ã½Ò•îl Health News” on , , , , , or wherever you listen to podcasts.

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

This <a target="_blank" href="/podcast/what-the-health-449-medicaid-work-rules-exemptions-june-4-2026/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2244767&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2244767 Louisiana’s Reporting Law Chills Immigrant Medicaid Applications /medicaid/immigrants-medicaid-children-applications-louisiana-crackdown-citizenship/ Thu, 04 Jun 2026 09:00:00 +0000 /?p=2244790 Yolibeth’s 4-year-old daughter scrambled headfirst onto a cushy leather love seat at their home near New Orleans and pushed a hairbrush into the hands of Miriam Romero, a health coordinator who works with the family. Romero placed the girl in her lap and started brushing her dark hair.

Yolibeth, a 38-year-old single mother who moved to South Louisiana from Honduras 15 years ago, watched them, smiling. The daughter is the youngest of five children living in this mixed-status household. Yolibeth and her two oldest kids don’t have legal immigration status, but the other three — ages 4, 9, and 13 — were born in the U.S. and are citizens.

All of her U.S.-born kids were enrolled in Medicaid at birth, which made it affordable for her to take them to the doctor for regular checkups when they were little. Her oldest two, ages 15 and 17, have never had health insurance, so Yolibeth relies on low-cost community clinics when she can afford it.

But now she worries that healthcare access for all of her children is slipping away. Yolibeth has been waiting for months to hear whether any of her children’s Medicaid renewal applications  has been approved. She fears they will be denied because of a new Louisiana law targeting noncitizen Medicaid enrollees, even though she isn’t applying for herself. She worries particularly about her 4-year-old’s access to routine care and required childhood vaccines.

“ I cannot access the same services, and so my child is not getting what she needs to grow healthy,” Yolibeth said in Spanish as her daughter giggled on the love seat.

Verite News and Ñî¹óåú´«Ã½Ò•îl Health News agreed to not use Yolibeth’s full name, because she is worried about repercussions related to her immigration status.

Two women stand side-by-side, each with an arm around the other, and face away from the camera toward a building.
Romero (left) welcomes a community member to Familias Unidas en Acción’s office in New Orleans in April. (Christiana Botic/Verite News and CatchLight Local/Report for America)

Romero, who works for a local immigrant advocacy group, said that in a single week she received calls from eight immigrant families who had been denied after applying for Medicaid on behalf of children who are citizens.

“Because of the law that passed in Louisiana, children are losing their Medicaid every day,” Romero said in Spanish. “The more time that goes by, the more children are impacted by it.”

Romero said that all children from mixed-status families are likely to be denied Medicaid by the end of the year.

Missing Out on Care

Nationally, many immigrants said they skipped or delayed healthcare last year, citing issues including costs, struggles finding services, and fears about their or a family member’s immigration status, by KFF and The New York Times. Immigrants without legal status were the most likely to skip or delay care for themselves or their children. An increasing number of immigrants avoided applying for programs like Medicaid, too scared to risk drawing attention to their or a family member’s immigration status, even if they were eligible.

In Louisiana, where about a third of residents are enrolled in Medicaid, the has added to those fears. The law requires the Louisiana Department of Health to verify Medicaid applicants’ U.S. citizenship, terminate coverage for applicants with “unsatisfactory” proof of status, and report those applicants to U.S. Immigration and Customs Enforcement. Since the measure passed in Louisiana, similar bills have passed in North Carolina, Wyoming, Indiana, and Tennessee. At least three other states were considering similar measures this year.

State Rep. Chance Keith Henry, a Republican who sponsored the Louisiana bill, did not return calls or emails from Verite News seeking comment on the effects of the law. He said in last year’s state House floor debate that he didn’t anticipate any chilling effect on immigrants seeking healthcare. He also said that children born in the U.S. to parents without legal status would still receive Medicaid.

“This is making sure that American citizens and our taxpayers are taken care of and not illegal immigrants,” he said in the May 2025 floor debate.

State health officials said Medicaid applicants can’t be reported to ICE under the law without a formal investigation request by “the appropriate authorities.” Otherwise, reporting applicants without their consent would violate federal Medicaid and privacy laws.

But immigrant rights advocates say the law has had a chilling effect on applications and has led to immigrant families losing healthcare and resources they qualify for.

They said cutting off that access compounds the fear created by immigration enforcement crackdowns in states including and Minnesota, and by federal policy changes such as between ICE and the Centers for Medicare & Medicaid Services and for Medicaid.

Advocates said it’s unclear whether the new law has led to any detainments or deportations of people applying for Medicaid or other public benefit programs. But Aaron Moseley-Saldívar, a legal and public policy adviser with the Louisiana Organization for Refugees and Immigrants, said the legislative and policy changes act as a deterrent to immigrant families, even if they qualify for Medicaid as a legal resident, refugee, or asylum seeker, or have another form of legal status.

“ People are not applying for things that they probably otherwise would be eligible for, because they are intimidated by these laws and they’re worried that they’re going to get caught up in the system,” Moseley-Saldívar said. “ You have a large amount of people in Louisiana that are not leaving their homes at all, because they’re afraid of policies like this.”

Moseley-Saldívar said he believes the Louisiana law and similar policies are primarily aimed at removing people from state services. The state legislature passed a on May 27 to build on the 2025 law. It seeks to further narrow which noncitizens are qualified for public benefits in Louisiana, even though such restrictions for Medicaid are typically governed at the federal level.

The Louisiana Department of Health’s on the new law does not contain any data on applicants reported to ICE since the law took effect last August. But by February of this year, the state had terminated the coverage of 87% of enrollees who had unverified immigration or citizenship status as of June 2025.

From July 1, 2024, to June 30, 2025, according to the report, 1% of the 1.6 million people in Louisiana enrolled in Medicaid weren’t citizens, and fewer than 4,000 had an unclear immigration status.

A view from outside looking into a building through a door with screen where a woman stands with her hand to the door as if she's about to push it open.
Romero says that all children from mixed-status families in Louisiana are likely to be denied Medicaid by the end of the year. (Christiana Botic/Verite News and CatchLight Local/Report for America)

‘A Double-Edged Sword’

Late last year, more than 600 people lined up at 4 a.m. outside a Louisiana Organization for Refugees and Immigrants health fair, hoping to receive a free health checkup, said Sharon Njie, the nonprofit’s communications and strategic partners director. The fair was scheduled to begin at 9 a.m.

“ We had to start calling the doctors to see if they could come there at 7 a.m., because these people have been waiting for two hours in the cold,” Njie said. “We were so overwhelmed.”

Romero said some families in the New Orleans area have been waiting six months to vaccinate their children at one of the free events put on by healthcare providers. But she said fewer free health events for children have been scheduled, and even fewer for adults. For many of the residents she works with, Romero said, preventive care such as a Pap smear or prostate screening is out of reach.

“The challenge right now is a double-edged sword of people not going to the doctor out of fear but also ending up in an emergency that is too hard to treat,” Romero said. “It’s a life-or-death situation.”

For families with no other option, Njie and Romero try to connect people to doctors sympathetic to the immigrants’ plight and willing to absorb the cost of care or offer a discount, such as medical providers who are immigrants themselves.

But that does not address the systemic problems of immigrant access to healthcare created by the state law and federal immigration policies, or the lower quality of care for those who seek it. For example, one local New Orleans clinic, Luke’s House, caters to Spanish-speakers and immigrants, though it’s staffed largely by medical students, Romero said, so the level of care isn’t the same.

A close-up of hands holding several colorful brochures.
Romero says some families in the New Orleans area have been waiting six months to vaccinate their children at one of the free events put on by healthcare providers. (Christiana Botic/Verite News and CatchLight Local/Report for America)

While she waits for word on three of her kids’ Medicaid applications, Yolibeth secured a free insurance plan for them on the Louisiana Affordable Care Act marketplace, she said. But she hasn’t found any doctors who will accept the coverage, she said, leaving them effectively uninsured.

When her 13-year-old son recently fell ill, she wanted to take him to a pediatrician. But she said she couldn’t afford the $200 the appointment would have cost, plus any tests and medication.

Without a doctor’s note to provide proof of his illness, she said, she had to send her sick son to school, potentially exposing other children to a virus. Earlier in the school year, she was called into the school’s office after he missed five days because of illness. In Louisiana, truancy can be punishable with parental fines, community service, or jail.

Romero said if enough school is missed because of sickness, a criminal case could lead to family separation.

“That is unthinkable,” she said. “All because a family could not afford to take a child to see the doctor as opposed to these things being guaranteed to begin with.”

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

This <a target="_blank" href="/medicaid/immigrants-medicaid-children-applications-louisiana-crackdown-citizenship/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2244790&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2244790 Trump’s Medicaid Work Rules Force States To Scrap Plans and Rework Systems /medicaid/trump-law-medicaid-work-rules-states-overhaul-eligibility-systems/ Wed, 03 Jun 2026 19:53:14 +0000 /?p=2246301 The Trump administration’s rollout of a federal mandate that millions of Americans on Medicaid must work or risk losing health benefits will force states to scrap months of preparation, according to advocates for Medicaid enrollees and consultants advising states.

And they say an overhaul — less than seven months before states must start enforcing the requirement — will be costly.

by the Centers for Medicare & Medicaid Services dictate many granular details about how the new work requirements will play out. They cover how states should check whether Medicaid enrollees are following the rules, and how people can claim an exemption so that their health benefits don’t hinge on work, community service, or going to school.

Next year, President Donald Trump’s One Big Beautiful Bill Act could require roughly across 42 states and the District of Columbia who receive Medicaid benefits to prove they’re working or participating in a similar activity to keep their health coverage — unless they qualify for an exemption.

Much of the verification will run through state computer systems that assess whether low-income people qualify for Medicaid and other safety net programs — technology often built and run by private companies under contracts routinely worth hundreds of millions of dollars. Many of those systems have a history of errors that can cut off benefits to eligible people.

For months, states have been communicating with federal regulators and rushing to build systems to comply with the looming mandates, said Kinda Serafi, a partner at the Manatt Health consulting and legal firm. The rules released this week represent a “significant policy pivot” from what states were expecting, Serafi said.

“The administration has actually taken what we know to be a tough situation and has just made it even worse,” Serafi said. States had already committed to paying contractors tens of millions to adjust their systems.

After Trump signed his signature tax-and-spending bill into law last July, one of the most significant remaining questions was how much discretion the federal government would give states to define exemptions for people too sick to work. The “medical frailty” exemption allows a person to claim they have a health condition that prevents them from working at least 80 hours a month, as the law requires.

To qualify, a person generally must fit into at least one of five categories: They must be blind or disabled; have a substance use disorder; have a disabling mental disorder; have a physical, intellectual, or developmental disability that significantly impairs their daily life; or have a serious medical condition. States are not allowed to add categories.

Under the new regulations, CMS said having a medical condition alone isn’t sufficient to exempt someone from the work requirements. States must assess “the severity of an individual’s condition” to determine whether they can stay on Medicaid without working — a standard that makes it more difficult for enrollees to meet the criteria.

CMS officials did not list specific conditions that qualify for exemptions, but the agency did say homelessness can’t be a reason to claim that exemption because it is not a medical condition.

To implement the law, states “will have to undo work that they did,” said , deputy director of Princeton University’s State Health and Value Strategies program, which works with state governments on various health coverage issues.

The Trump administration previously acknowledged that the work to upgrade state Medicaid eligibility systems to comply with the law is coming at a cost. In January, top CMS officials said government contractors, including Deloitte, Accenture, and Optum, and reduced rates through 2028 to help states adjust their systems.

The discounts “may be helpful” in some states, but they’re “not going to be helpful across the board” due to variations in state contracts, said , director of the State Health and Value Strategies program.

“Anytime you have to go back and say, ‘Oops, we need to reprogram this one thing,’ there’s a cost,” Howard said.

States were prepared to create lists of conditions and diseases to qualify people for work requirement exemptions, according to health care experts advising them. Mining data to verify someone’s illness was already a tall order for states because the computer systems that determine whether someone is eligible for Medicaid often do not communicate with the systems that track medical claims.

America’s health care payment systems rely on a set of standardized codes that correspond to specific diagnoses.

But there’s no “code that designates that someone is too sick to work — that’s a subjective assessment,” said Rachel Klein, deputy executive director of , a nonpartisan advocacy group for people with HIV. “This is a recipe for disaster.”

The new federal standards pose immediate issues for Nebraska, which launched its Medicaid work requirement on May 1, eight months before the federally mandated deadline. Nebraska handles decisions on medical frailty differently than the Trump administration does.

Nebraska officials had already released a nearly of medical conditions that qualify as exemptions, such as types of cancer, dementia, autism, epilepsy, HIV, and Parkinson’s disease. The state, which relies on government workers to check Medicaid eligibility, doesn’t require a person to prove how sick they are.

But under Trump’s rules, people will have to show their qualifying illness is impeding their ability to work.

Now, Nebraska is “going to have to go back and figure out how to assess whether all of these people are too sick to meet the requirement,” Klein said.

Medicaid enrollees are slated to start losing coverage this summer under Nebraska’s early rollout.

Sarah Maresh, a program director with , an advocacy organization for people with low incomes, said the state should refrain from terminating people’s coverage until next year because of the changes it will need to make. State residents are already confused and scared, she said, and the new rule “makes matters much worse.”

In response to several questions, Jeff Powell, a spokesperson for Nebraska’s Department of Health and Human Services, said the state is reviewing the new federal regulation to determine potential impacts.

The new federal standards will limit people’s ability to attest that they are medically frail starting in 2028 and will require documentation as proof, another change states weren’t expecting, Meuse said. had planned to allow applicants and enrollees to declare conditions themselves to get exemptions, according to KFF.

Striking the right balance of flexibility was an important part of deliberations when crafting these rules, CMS Administrator Mehmet Oz said on a June 1 call with reporters. “The mantra we kept coming back to was that we’re forgiving, but we’re not foolish,” he said.

Trump officials wrote in the regulation that Medicaid work requirements have “the potential to empower Medicaid beneficiaries” by allowing them to “escape isolation and dependency, build confidence, achieve self-sufficiency and prosperity, and improve health.”

Stephanie Burdick, a leader of the Protect Medicaid Utah coalition, disputed the premise.

“If they want to improve work opportunities or connection and decrease isolation and loneliness, they would be starting job programs and volunteer service programs,” Burdick said. “They wouldn’t just be forcing more administrative burden onto people and then saying that it’s good for them.”

An estimated will become uninsured by 2034 due to Medicaid work requirements, according to the nonpartisan Congressional Budget Office.

But with the new regulations, Howard said, there’s a risk of “that number being even higher.”

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

This <a target="_blank" href="/medicaid/trump-law-medicaid-work-rules-states-overhaul-eligibility-systems/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2246301&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2246301 Budget-Strapped Montana Will Stress-Test Trump’s Medicaid Work Rules /medicaid/the-week-in-brief-montana-medicaid/ Fri, 29 May 2026 18:30:00 +0000 /?p=2244154&preview=true&preview_id=2244154 Montana will soon test whether cash-strapped and strained state health departments can carry out federal Medicaid work requirements without ending coverage for eligible adults. 

On July 1, Montana plans to become the second state after Nebraska to make Medicaid enrollees prove they’re working to keep their coverage. That’s six months ahead of the federal deadline for states to implement Medicaid work rules for millions of enrollees.  

That date is also the start of a new state budget year, as well as the deadline for Montana health officials to climb out of a previous Medicaid-driven spending deficit. Montana lawmakers underfunded the health agency when they set the state budget last year — before congressional Republicans passed President Donald Trump’s One Big Beautiful Bill Act. Health policy analysts say the state’s budget crunch is a hint of the challenges to come nationwide.  

That’s because the federal spending law requires states to check every six months whether millions of Medicaid enrollees work, go to school, or volunteer at least 80 hours a month, or qualify for an exemption. Those checks will take time and money. Simultaneously, the law is expected to reduce federal Medicaid spending — the largest pool of federal funding for states — by nearly $1 trillion over 10 years, shift more food assistance costs to states, and add tax breaks that could hit state budgets. 

“States are the ones that are gonna have to do the dirty work of implementing cuts,” said Joan Alker, a Georgetown University researcher focused on health coverage.  

Part of Montana’s proposed budget fix is to stall rate increases for healthcare providers that were due July 1. Clinicians told me they already struggle to afford hiring staff amid growing waitlists for care, which they blame on low Medicaid payments. 

Meanwhile, there are some red flags in the state’s Medicaid data from recent years: People often face long waits to access public assistance, and many can lose coverage at renewal time because of paperwork issues. 

All these problems reflect a national challenge to connect people to care through strained public assistance programs. Our reporting has long shown how states have struggled to process Medicaid applications. 

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

State officials have said they’ll scan existing data to try to automatically confirm whether people meet the work rules. And they’ve been building up their public assistance team for months.  

But they’ve had to wait on unanswered questions from the federal government that are key to exempting especially vulnerable people from the incoming rules. And now, they’ve got a lot more work to do with less money. 

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

This <a target="_blank" href="/medicaid/the-week-in-brief-montana-medicaid/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2244154&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2244154 More Kids Without Coverage /podcast/what-the-health-448-republicans-midterms-children-losing-insurance-may-28-2026/ Thu, 28 May 2026 18:50:15 +0000 /?p=2242581&post_type=podcast&preview_id=2242581 The Host
Julie Rovner photo
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 photo
Maya Goldman Axios
Shefali Luthra photo
Shefali Luthra The 19th
Lauren Weber photo
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:

Click to open the transcript Transcript: More Kids Without Coverage

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

Julie Rovner: Hello, from Ñî¹óåú´«Ã½Ò•îl Health News and WAMU Public Radio in Washington, D.C. Welcome to What the Health? I’m Julie Rovner, chief Washington correspondent for Ñî¹óåú´«Ã½Ò•îl Health News. And, as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Thursday, May 28, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. Today, we are joined via video conference by Lauren Weber of The Washington Post. 

Lauren Weber: Hello, hello. 

Rovner: Maya Goldman of Axios News. 

Maya Goldman: Great to be here. 

Rovner: And Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Later in this episode, we’ll have my interview about the ongoing Ebola outbreak with Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ public health editor-at-large and, conveniently for us, an infectious disease specialist. But first, this week’s news. I want to start this week with more of a trend than actual news, and that is the continued decline in health insurance coverage in the U.S.  on the number of children falling off the Medicaid rolls. It’s down about 1.75 million from the beginning of Trump 2.0 through this past January. Now, I thought we were told that none of the Medicaid cuts that Congress made last year would affect the core Medicaid constituencies: pregnant women, children, seniors, and people with disabilities. What’s happening here? 

Goldman: So, the law does exempt kids and parents of young kids from the eligibility and enrollment changes, work requirements, more frequent eligibility checks. That doesn’t mean that there aren’t going to be spillover effects, and we’re seeing that already, Absolutely, even though most of these provisions haven’t gone into effect. And there are a couple of reasons for that, including chilling effects from immigration enforcement and people who are in mixed-status households maybe not feeling comfortable enrolling their children in public benefits, even though their children would qualify, or also just confusion around who’s eligible for what. Often kids are eligible for Medicaid and Children’s Health Insurance Program â€” its sister program, CHIP â€” at a much higher income level than their parents, and that’s not communicated well to parents very often. And so one theory&²Ô²ú²õ±è;…&²Ô²ú²õ±è;is that this year, when a lot of parents maybe saw how much their ACA [Affordable Care Act] premiums were going up and decided that they couldn’t afford health coverage anymore, they were just pulling their whole family out of health insurance, even though their kids might still actually be eligible for Medicaid. And&²Ô²ú²õ±è;…&²Ô²ú²õ±è;there are a lot of other trends percolating in this, but I think it’s concerning to see this, these figures, even before this has really started. 

Rovner: Yeah, it’s funny, when you’re applying for health insurance, they’ve set it up so that you get funneled to the right place for which you’re eligible. But when you’re dropping your health insurance, there’s no funnel to say, hey, your kids might still be eligible for this, even though you’re no longer going to be getting Affordable Care Act insurance. 

Goldman: Exactly, and navigators for ACA coverage have also â€” funding for those programs have been cut, and so that’s harder, even harder for that process to actually work. 

Rovner: Yeah, I’ve also noticed in the states that are starting things like their work requirements early, there was kind of a shocking anecdote  â€” one of the states that’s starting early â€” who’s blind, has multiple health problems, and a chemotherapy port, who was told that she might be required to work under these rules and was seeing about getting her port taken out when finally another person told her, No, you’re exempt. So, I mean&²Ô²ú²õ±è;…&²Ô²ú²õ±è;in some of the states that are speeding this up, there’s a lack of knowledge among the state workers, which I think was one of the big concerns about people who are going to be dropped off the rolls, not because they’re no longer eligible, but because of mistakes. 

Weber: We also know that, in general, Medicaid enrollment is a tricky process. Typically, there’s paper forms that may get lost in the mail. Parents may not get the forms for their kids. This was very eloquently actually described on The Pitt â€” which, shoutout for getting this part of health policy correct. Although I’m still irritated about their Medicare-Medicaid mix-up in one of the other episodes, but we’ll get over it. 

Rovner: Yeah, me too. There were two of those. 

Weber: Yes, but very eloquently show[ed] how a mom who had moved and missed some Medicaid paperwork was now really in a hole financially. And so, as Maya has reported out, you know, more of these children falling off the rolls really could lead to some dire consequences for the families to which they belong. 

Goldman: Yeah, and I think one important thing to mention is that a lot of these kids that are uninsured are still eligible, and when they go to the hospital, the hospital can help them enroll in retroactive Medicaid coverage, but they’re not getting their yearly checkup, or maybe, like in The Pitt, they miss their asthma medication, and so now they’re in the hospital, and costs are just going up for the whole health system. 

Rovner: Well, along those same lines, we have another story in our Ñî¹óåú´«Ã½Ò•îl Health News series called “Priced Out” about how people who can no longer afford comprehensive coverage are patching together other forms of insurance, or in some cases not even actual insurance, that leaves them on the hook for thousands of dollars if they end up needing actual medical care, which kind of raises the perennial question with our health system: Is it better to have bad insurance and not know it, or to have no insurance, so at least you know that you’re not prepared if something happens. 

Weber: I thought what was so striking in that story was it led off with a retired teacher who said, I recognize I am gambling. I mean, that’s what she said, she’s very clear. But to her, I think her cost had risen something like $900-something a month, and the other plans that she cobbled together were $300 a month, and so to her the short-term risk was worth it. But as we all know, hospital stays can run you several thousand dollars and, you know, you can get hit by a car. You may be a very healthy person, but something bad can happen, and you are left with large, large medical debt. And I think it seemed like the folks interviewed in the story were at least clear that these plans were less favorable, but I do think there is also this submarket where a lot of folks think that the health ministry plan that they’re in is going to save them in case of an issue. And we have found over and over again, and KFF, in particular, has found over and over again in reporting, that’s just not the case. And so this whole question of Is a bad plan better than no plan? I don’t know, but it’s striking to see people say I’m willing to take the gamble, because this is just what these increases in premiums have meant for me. 

Luthra: I just think what’s so interesting about these, these health shares, in particular, is when I’ve talked to people who’ve used them or considered them, they know these are not insurance, but I don’t think they always fully understand just how restrictive they are, and how often medical needs will be dismissed as lifestyle choices. I mean, obviously, often contraception is not covered, but something related to drug or alcohol use might not be covered, because that’s immoral, right? Let’s say the ministry says, “Oh, well, this accident you got into, maybe that’s because of alcohol use.” That’s a huge expense that you just might not have realized wouldn’t be covered at all. And the other thing that I was just so struck by is very often childbirth isn’t covered. Or you have to be enrolled for a very long time before childbirth is covered, which health insurance is required to cover childbirth. It is very, very expensive. It’s fascinating, also, because a lot of these [sharing ministries] are so religiously aligned and ostensibly pro-family, etc. And yet this, in particular, is just something where people will opt for this instead because it looks more affordable than insurance. But very often you end up paying a not-zero amount of money, and ultimately getting basically nothing for very expensive, even bankrupting medical needs. 

Rovner: Or you’re gambling, you know, maybe, maybe you’ll get reimbursed, and maybe you won’t. Although these days people feel that way about their health insurance. Maya, you want to say something? 

Goldman: I think a lot of young people also take for granted that health insurance will cover preexisting conditions. If you’ve come up, you know, post-ACA, and certainly I do. I’m 28, and that’s, like, something that never even crossed my mind that I would need to consider, and that really struck me in this article. A lot of these alternative plans are not bound to those requirements. 

Rovner: Well, Shefali, I wanted to ask you in particular about  about how abortion rights supporters are trying to adapt reproductive health to fit under the bigger affordability umbrella that seems to be the theme of this year’s midterm campaigns â€” that things like whether or not to get pregnant or whether to get unpregnant, that those are all wrapped up in all sorts of financial issues, as you just mentioned. Is this a natural fit, or do you think they’re kind of forcing it here? 

Luthra: I think it really depends on how you talk about it, and the context of where you are. And after the mifepristone case was before the Supreme Court, I spent a lot of time looking at different Senate campaigns and examining how they’re talking about it. And one example is Jon Ossoff in Georgia actually has a really interesting example where he talks about access to abortion and healthcare as part of this larger argument around the state of reproductive healthcare, talking about hospital closures, talking about Medicaid cuts, and putting all of this together as this broader policy ecosystem that is making your healthcare harder to come by and ultimately threatening your life. I think that’s very interesting. It could work. It makes sense logically to me. The other one that does come to mind â€” and this is not abortion, but it’s related â€” is in Maine, Graham Platner talking about IVF [in vitro fertilization] in the lens of affordability, saying, Oh, I couldn’t afford it in America. I traveled to Norway to try and get fertility treatments. Those are fascinating approaches, and a lot of people who work in abortion rights advocacy will say this has long been an economic argument, and many of them will look at polling and put it out that says when you frame this as an economic story, voters really, really do appreciate it and resonate with it. I think sort of the question is whether we actually see these candidates â€” and it’s not lost on me the two who I mentioned are both men â€” actually talk about the word “abortion” specifically, rather than saying “reproductive healthcare” more broadly. And you know those are very different, and they just register with voters differently when you single out something as specific as abortion versus whether you don’t. 

Rovner: And Graham Platner, for those who don’t know, is going to be the Democratic candidate running against Susan Collins in Maine. Jon Ossoff is the incumbent Democrat in Georgia, which always feels weird to say. There haven’t been a lot of Democratic senators from Georgia, but right now there’s two. 

So, moving on, the Trump administration says the declines in health insurance coverage are fine because they’re more about fraud and kicking people off of public health insurance rolls who aren’t actually eligible or â€” in the case of Affordable Care Act broker fraud â€” who don’t even know they’re covered. But a lot of the tools in last year’s big budget bill are pretty blunt, and they’re going to impact both those who maybe shouldn’t be there and those the administration says it wants to keep serving. This week’s example is a newly proposed rule to implement that law’s cap on something called state-directed payments, which is, in fact, a key way many states help ensure adequate funding for hospitals, nursing homes, and other healthcare providers. Now, this isn’t fraud, but it is what analysts like to call creative funding, and Congress has every right to limit it. But that’s not to say that it won’t have an impact on healthcare at the delivery level, right? It’s not just going to impact people that the administration says don’t deserve to be covered. 

Goldman: Yeah, this came up when I was talking to children’s hospitals for the story on children’s coverage that I wrote this week. They’re saying, you know, this is going to affect all kids that we can care for. This is going to mean less money into our funds, and, you know, a lot of people argue that hospitals have enough money, but hospitals will say, “No, we don’t, not to take care of all the people that we need to take care of.” And this is going to be less money. And then it’s not just kids who are on Medicaid who are struggling, it’s all kids. And I think another interesting thing about this proposed rule is that it’s significantly more federal savings than was estimated originally. I think CBO, Congressional Budget Office, originally estimated that the state-directed payments provision would save about $150 billion, and this rule would save about $510 billion in federal funding. So hospitals are concerned. 

Rovner: Yes, this is always the issue. Are we overpaying hospitals? But when you take money out of it, what does that mean for the health system writ large? Which I imagine is going to continue to be a theme as we go forward. Well, the Trump administration is also going very high-profile in its health fraud-fighting effort. The president has put Vice President JD Vance in charge. Earlier this month, he announced that the administration will be withholding $1.3 billion in federal Medicaid funding from California, because, said the vice president, the state has not taken fraud very seriously. This is the second Democrat-led state the administration is taking the nearly unprecedented step of withholding funding from in advance, after Minnesota. California has responded that one reason the state’s home health bill has gone up is that it has raised wages for home healthcare workers, and it has expanded eligibility. It’s not because of fraud. Again, while there obviously is fraud â€” not just in Medicaid, but in all health programs, public and private, because there is so much money there â€” these blunt tools, I think, will probably punish more than just those who are defrauding the program. Right? 

Weber: I mean, absolutely. At the end of the day&²Ô²ú²õ±è;…&²Ô²ú²õ±è;look, it’s no coincidence that California is a blue state that seems to be getting targeted with that amount of cash. But let’s be very honest, there is a lot of fraud. I mean, all of us here have written stories about healthcare fraud. There is a lot of fraud to root out. So, to be very clear, I don’t think anyone should be upset about actual fraud being targeted. But there’s also a question of: What are the numbers? [Centers for Medicare & Medicaid Administrator Mehmet] Oz has gotten the numbers wrong before. The AP [Associated Press] had a great story on that a couple weeks ago. Show us the fraud, like, I want to see the actual fraud that we’re talking about. And, in addition, this reminds me of how the administration continuously says that they’re investing the most money in rural healthcare when they have this $50 billion rural healthcare fund. Well, the Medicaid cuts that [President Donald] Trump led is going to cut like triple that almost out of rural areas. So is this a talking point? Show us the money. I need to better understand what’s behind it. 

Rovner: Yeah, so far they’re doing well with a lot of very high-profile news events. We’ll see how much fraud they are actually able to ferret out. All right, we’re going to take a quick break, we will be right back. 

Let’s talk about Ebola. As you will hear later in this episode from our in-house expert, Dr. Céline Gounder, this is not likely to become the next covid or even a pandemic. But this administration, having hollowed out the Centers for Disease Control and Prevention and obliterated the U.S. Agency for International Development, is addressing this outbreak with many fewer arrows in its quiver. Lauren,  about someone close to this outbreak. Tell us about it. 

Weber: Yes, I was able to speak with an American missionary physician who was exposed to Ebola and actually evacuated to Prague and is sitting in basically like a bubble room waiting to see if he tests positive for Ebola. And what traumatizes him, as he was telling me, was that he’s sitting there, there’s all these people with endless gloves that are tending to him, he’s been evacuated, and stretchers with all this plastic and all these measures, and his colleagues that he worked alongside in the Congo are â€” you know, one died while we are in the middle of an interview, he learned of their death. And, in addition, they’re filling the hospitals themselves, that they say they don’t have enough gloves, they don’t have enough PPE [personal protective equipment]. There’s no vaccine to fight this current form of Ebola, and they’re in an environment in which people are very mistrustful. Ebola looks like malaria until it’s Ebola. And so you could send a family member into the hospital thinking it’s malaria, which is common in this part of the world, and then suddenly be told your relative has Ebola and died. A lot of people don’t believe it, and it’s leading to violence. And the usual public health measures and efforts by the international community to get in there are somewhat hampered. And Part Two, by the fact that this outbreak is happening in a really insecure region, where there’s roving militias and other violence. And there’s just a lot of concern that they caught this late, this could continue to explode, and case counts could really go up. But it was very humanizing to speak with this American missionary who obviously really put himself on the line to help these folks and is heartbroken to kind of be watching from afar as this continues to go poorly. 

Rovner: Well, meanwhile, the U.S. is banning foreign nationals who’ve been in any of these countries from entering the U.S. and also U.S. green-card holders who’ve been in countries where the virus is spreading. Not only that, but they’re not allowing exposed U.S. citizens to return, even though the U.S. has multiple facilities to care for exactly these types of patients. We have seen this before, just in the last 15 years. What happened to the medical freedom that this administration has been touting so much? 

Weber: It’s a real plot twist. I mean, these are the folks that said that they were the contrarians that oppose quarantine and mask mandates, and they are strictly having the hantavirus folks in Nebraska. They’re signing off on travel bans that go further than other administrations, and not allowing Americans back in and sending them to Kenya if they’re exposed. My colleague Lena Sun and I had a report a week ago about how the White House didn’t want exposed Americans back in the U.S., but the Kenya step is another step in that direction. Is really could have huge ramifications for the response as a whole, because it will likely limit the number of people that want to go. If you know that you’re not going to be able to be sent back, we saw, I think, yesterday the State Department union was like, look, our foreign service officers were sent here under the impression that they would be able to come back. I mean, this is somewhat completely uncharted territories in the vein of how they’re handling this. So we’ll see. 

Goldman: I’m very curious to see what the MAGA [Make America Great Again] base and the MAHA [Make America Healthy Again] base that were so anti-mask mandates and things like that during covid, like, what are they going to say? Are they going to say anything? Is it partially our responsibility as the media to point out this contradiction? 

Rovner: Yeah, and obviously there’s also so much else happening right now. It’s interesting that the hantavirus, which turned out to not be such a big deal, got so much play, and yet this, which could be a much bigger deal, is getting so much less attention. 

Weber: Do we think there’s maybe a reason for that? Let’s all be honest. The hantavirus cruise was a lot of wealthy, some Americans on a cruise sailing around Argentina and Antarctica. And then this outbreak is happening in Africa, and I think there’s less interest from the general public, as they feel like hantavirus is novel, whereas Ebola, they’ve heard about it before, so a depressing reality of some of that. 

Rovner: Yes, and also, you know, Americans and Europeans versus Africans. 

Weber: Yes, yes, exactly. 

Rovner: All right, moving on. I want to catch up on some drug price news, because there’s been a lot over the past few weeks. The Supreme Court earlier this month declined to hear a case challenging the Medicare drug price negotiation system that was implemented under the Biden administration, which ironically will probably redound to the credit of the Trump administration, even though it nominally opposed the Biden program. Also, earlier this month, the president announced a big expansion of his TrumpRx website, adding links to websites selling lower-cost generic drugs, including the site run by Mark Cuban, Cost Plus Drugs. But the most provocative drug price story I have seen this month came from my colleague Darius Tahir, noting that Trump himself was buying stock in drug companies just as he was negotiating with those companies to help bring drugs, particularly those GLP-1 medications that he likes to call “the fat drugs,” to more people. Now this isn’t technically illegal, although there are lots of efforts on Capitol Hill to outlaw individual stock trading by members. But I can’t help think if any other government official in any other administration ever did this, they would be out of a job instantly, if only for the appearance of the conflict of interest. This is just â€” Lauren, as you were saying â€” one in this whole long list of things that keeps happening, but every time I look at it, I’m like, he was doing what?! 

Weber: Julie, when I saw Darius’ story, I was blown away. First off, I feel like this should have been front-page news on every outlet. But secondly, it was a lot of money, it was like over $600,000. And now I understand they say that Trump himself, they don’t know whether he directed this or not. And in fairness, Trump’s not the only one. I mean, we’ve seen plenty of members of Congress that have done also questionable stock trades. But it is a very conflict-of-interest-looking-like thing, considering that CMS recently expanded massive access to these drugs. And so I do think conflicts of interest like this, especially in HHS [Department of Health and Human Services], which has constantly decried conflicts of interest, despite having many of them, are very important to highlight. And so, thank you to Darius for surfacing this. 

Rovner: Yes, we will never not have enough to do here as health reporters. Well, finally, this week I want to . President Trump this week had his third, quote, “annual” physical in the past 13 months â€” math does not math there â€” after which he said he checked out perfectly. But he is about to turn 80. He’s been caught on camera dozing off at public events in the Oval Office and has gone on hours-long social media rants in the wee hours of the night/morning. Now, much of this hasn’t been treated as news, because well, it’s pretty much par for the course for Trump, just more so. And therein lies the question: When does his increasingly aberrant behavior and obvious health issues, like visibly bruised hands and swollen ankles, become a public right-to-know issue? And is there a double standard for Trump compared to former President [Joe] Biden, when he began to show obvious signs of aging, and it was all over the news all of the time? I see raised eyebrows. 

Luthra: No, it’s such a good question. On the one hand, there was obviously a lot more scrutiny on Joe Biden’s age than there appears to be on Donald Trump’s. But part of it, I think, is that a lot of what you just highlighted, Julie, is out in the open. Everyone has seen the president dozing off on camera, whereas under the last administration, there were things that were not public that then became public, and that was obviously very important. That said, there’s certainly a level of focus on this issue that perhaps is lacking. Maybe it would be useful or newsworthy to put some more attention, even something that we already know, highlighting why it is important, putting together the fact that having this many physicals at this point in the presidency is actually more than normal. What could that mean, contextualizing it with everything we have seen publicly about the president’s sleep patterns, risk factors as you age, bruising, etc. But I think this kind of thing is complicated in terms of how you cover it appropriately and fairly, also just because you don’t want to assume things that you don’t have the evidence for. 

Rovner: And, in fair, I mean, Trump has not been transparent about his health, going back to when he was a candidate in 2016. He’s the only major presidential candidate, you know, he put out that, this famous letter from his personal doctor saying, you know, he’s the healthiest man I’ve ever seen. That’s pretty much what we get, having covered presidential health for a lot of administrations. We have much, much less information about Trump than we have had about previous presidents, which has been a continuing policy concern among doctors. I mean, this is not to single out Trump, who just happens to be president right now and turning 80. But this is, you know, an issue that goes back obviously to, you know, Dwight Eisenhower, to Woodrow Wilson, when he had a stroke, and they kept it a secret. Presidential health is a policy issue. 

Goldman: Yeah, I think that’s an important caveat, or note, I guess. Presidential health is not always as transparent as it claims to be, even going back, as you said. And so it’s not totally out of the ordinary that Trump wouldn’t be transparent about his health, even though, maybe ethically&²Ô²ú²õ±è;…&²Ô²ú²õ±è;presidents in general should be. 

Rovner: Obviously something else we will continue to watch. All right, that is this week’s news. Now we’ll play my interview with Céline Gounder. Then we’ll come back and do our extra credits. 

I am pleased to welcome back to the podcast my colleague, Dr. Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health, a CBS News medical correspondent, and an internist, epidemiologist, and infectious disease doctor. I can’t think of anyone I trust more to explain what’s going on with Ebola than Céline. So, thank you very much for doing this. 

Céline Gounder: Oh, it’s my pleasure to be here, Julie. 

Rovner: So, when everybody was covering the hantavirus outbreak on that cruise ship a few weeks ago, experts like you were saying it was a cause for concern, but not likely to become a serious problem. All of those same experts seem much more concerned about this latest Ebola outbreak in Central Africa. How is this different from what we were just talking about with hantavirus, and how is it different from previous Ebola outbreaks? This is not the first one. 

Gounder: Yeah, so to give you a sense of perspective, when I first heard the reports of a viral respiratory illness out of Wuhan in very late 2019, early 2020, I was terrified by what I was hearing. When I heard the reports of the hantavirus outbreak on the cruise ship, I was concerned for the other people on the cruise ship. I was not worried about a larger outbreak, and I would be very surprised, especially at this point, if we see any further cases. With respect to this Ebola outbreak, I am very concerned about a very large, huge, regional epidemic, where we may have some sporadic spread to other countries outside of the region. I am not worried about a pandemic. So, this is one difference: An epidemic is usually within a certain region. Pandemic is when it goes worldwide. So, I think this is going to be an epidemic in Central, possibly also East, Africa, but not going beyond that. 

Rovner: So, how is this different from&²Ô²ú²õ±è;…&²Ô²ú²õ±è;you worked in one of the past Ebola outbreaks. This one people seem to think is more serious than the last couple that we’ve seen. 

Gounder: Yeah, so I worked in Guinea during the 2014-2016 Ebola epidemic. I was there for two months. You have some of the same risk factors for a large epidemic, so you have urban areas affected, you have cross-border spread. There you had the epidemic start in Guinea, then move to Liberia, then Sierra Leone, then back to Guinea, and then you also had migrant workers that would go back and forth. And so you have those same, exact risk factors with this current outbreak, and then, secondly, you have large refugee populations in South Sudan. And so both of those issues also further complicate movement, both in and out of the area. Healthcare workers trying to get in to address issues. Healthcare workers being safe doing this kind of work, and also getting supplies, in particular, PPE â€” personal protective equipment â€” as well as tests into the area to help respond. 

Rovner: What about the U.S. pullback in foreign aid? We’ve obviously, you know, seen sort of the demise of USAID and a hollowing out of the CDC here. I imagine that’s impacting how we’re responding to this. 

Gounder: Yeah, so starting with USAID. So, USAID funded the people on the ground that would do the contact tracing, who might help set up Ebola triage, as well as treatment units. And that funding is gone. In fact, over the last week, I’ve been talking to some of the Congolese doctors who used to have jobs funded by USAID. And, in addition, USAID really supported the supply chain infrastructure for the area. So now you’ve seen a collapse of their ability to get personal protective equipment. There are shortages of this, which is also contributing to healthcare workers getting infected right now. And then also pharmaceutical supply chain. So, you know, even the most basic of medications is a challenge to get into the area. With respect to CDC, there have been tremendous layoffs related to the DOGE [Department of Government Efficiency] cuts from last year. We had the CDC shooting last August, and morale at the agency is&²Ô²ú²õ±è;…&²Ô²ú²õ±è;it’s horrible, it’s horrible. And just in the last day or so, Dr. [Jay] Bhattacharya, who’s the NIH [National Institutes of Health] director, and also, I guess he’s calling himself something else, because he can’t technically be acting CDC director anymore. But … 

Rovner: He’s nominally in charge of CDC, without being the acting director. 

Gounder: Right, exactly, whatever that means. But he has asked for CDC staff to volunteer to go over to Kenya, and staff a quarantine and, sounds like, treatment unit for any American healthcare workers who might get sick or be exposed while responding to the Ebola outbreak. And based on what we’re hearing, it sounds like they do not want anyone with Ebola coming back into the U.S., including the very people they’re asking right now to volunteer to go to this unit in Kenya. So I think that is also going to further complicate the response. You know, like, if you volunteer for the Marines, you enlist, and you get sent overseas, and you have an injury, you expect to be repatriated as quickly as is possible for treatment here in the United States, right? That is not the case. These are people who are similarly putting their lives on the line, who are responding to that call for help, and we are not seeing similar respect for that sacrifice. 

Rovner: And yet, I mean, the U.S. is set up to take care of people with seriously contagious diseases, right? 

Gounder: Oh, yeah, we have over a dozen units that were specifically created for this very purpose. Several of them have hands-on expertise, experience with this. So, in particular, Emory [University School of Medicine] in Atlanta, [NYC Health + Hospitals/] Bellevue in New York City, where I am, as well as University of Nebraska Medical Center. All three of those have experience with Ebola, not just having done preparations. And it’s really confounding why you would not want to make use of that. When somebody gets Ebola, particularly if you’re talking about an American, you know, who has put themselves in harm’s way â€” there are some real questions about fairness and equity of access to certain levels of care â€” but American aid workers, the expectation is that they would get the full-court press. And that might include being on a ventilator, that might include needing dialysis, for example, and to do those things when somebody has Ebola, and you need to do that in biosafety Level 4 conditions, I have a hard time seeing how they’re going to be able to put that together in Kenya on such short notice. 

Rovner: So we learned a lot of lessons from covid, not all of them good, obviously. You have a , which I will post a link to, about the psychology of pushback. Can you talk about that briefly? Because I think that has a lot to do with how the U.S. is responding to this. 

Gounder: Yeah, and I think a lot of people may actually identify with their own experiences during covid. You had a lot of people who didn’t want to wear a mask. In fact, we saw masks being burned, right? People not wanting to get vaccinated. And what happens is, when you have somebody who, for whatever reason, people don’t trust telling them to do something, they feel like they’ve been backed into a corner and they lash out. And so you tell them to do something, very often they want to do the exact opposite. And I saw this exact same thing when I was in Guinea over 10 years ago now. It was related to the presidential elections at the time, and it was a way of expressing dissent towards the current, at that time current, president and ruling party. And so, you know, for Ebola, the measures are pretty basic, particularly at that time: It really came down to contact tracing, testing, safe burials. And people would refuse to do some of those really basic things, and it was their way, what we called in Guinea and French, La réticence c’est la résistance, so reticence and resistance. And you saw that whole spectrum manifest there, and I think we’re seeing the same thing all over again, predictably so, in the DRC [the Democratic Republic of Congo] right now. 

Rovner: So, what could this administration be doing better, or be doing that they’re not doing that could maybe help us tamp this down, I mean, before it gets out of hand? 

Gounder: Well, I am concerned it’s already out of hand. They’re only following up on one out of every five contacts, so that means four out of every five contacts could be seeding new chains of transmission. So I think this is going to get a lot worse before things start to turn around. In fact, I would predict this is going to be a year or two to control. I mean, based on prior experiences with the 2018-2019 outbreak in the same area, as well as the 2014-2016 outbreak in West Africa. This has the potential to be even worse. What could the U.S. be doing? Well, we are currently adopting a very isolationist stance with respect to our public health policy. The dismantling of USAID is a big part of that, but it’s not the only thing. And I think what is happening now, frankly, gives me flashbacks to the 2014 Ebola news and midterm elections, and the way in which Ebola was politicized at that time. At that time, President Trump was not president; he wasn’t even a candidate yet, but he spoke very loudly about having travel bans. He called for President [Barack] Obama to resign because he allowed, in fact, facilitated the transport of infected Americans back to the U.S. for treatment. And so he’s on the record as having said he never wanted anybody with Ebola in this country. And I think the current policy that you’re seeing is consistent with that. We’re headed into midterm elections again. We’re seeing travel bans being instituted for real this time, not just talked about. And one of the other concerns around travel bans at that time, and again now, was what would it mean for healthcare workers and other aid workers, their willingness to volunteer to respond? And I remember Craig Spencer, a very good friend of mine, he was hospitalized at Bellevue with Ebola, and it was right around that time as well, Kaci Hickox, a nurse who had responded, she came back to Newark Airport. Chris Christie, as I recall&²Ô²ú²õ±è;…&²Ô²ú²õ±è;

Rovner: Then the governor of New Jersey. 

Gounder: Yeah, right, governor of New Jersey, Chris Christie, at that time mandated that she be quarantined. So she did not have symptoms, but that she be quarantined due to her work on, I think, it was the tarmac at Newark Airport with a Porta Potty and a tent, something along those lines. And I had a lot of friends at that time who pulled out of volunteering â€” between Craig getting sick and Kaci and the mandated quarantine really under inhuman[e] and humiliating conditions. And I think this time it’s going to be even worse because not only are you having to face potentially getting sick, but you may not get to come home. And it’s really unclear at what stage, if you get sick, would you be allowed home. Do you have to wait until you recover? And what if you die? What happens then? Does your body get repatriated? Does your family, right, get to receive the body? That’s a big deal for a lot of families to have that closure. So I know, even among my friends who, like me, are Ebola veterans, there’s a lot of hesitance about stepping up again. 

Rovner: Well, I hope we can call on you as this continues, alas. Thank you so much. 

Gounder: Oh, of course, Julie. 

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

Goldman: My extra credit this week is a story in The Texas Tribune by Terri Langford and Colleen DeGuzman titled “.” And you know, I think it’s obviously a very important political story in the fight over transgender rights, and specifically rights for transgender kids, and the medical practice around gender-affirming care. But one of the things that’s especially interesting to me about this settlement is that there’s not really demand for detransition services, at least at the level of having a dedicated clinic at a children’s hospital for them. And so this is basically a children’s hospital is going to put resources towards creating something that, or presumably put resources towards creating something that may not be used. And as hospitals are talking about how stressed they are for dollars, and just in general overextended, you know, I think this is a very interesting use of resources. 

Rovner: That’s one way to put it. Lauren. 

Weber: I have the New York Times investigation by Sarah Kliff and Margot Sanger-Katz â€” which, you know, as soon as you see those two names, you have to read it â€” titled “.” And it’s a great look and also builds upon, you know, some great reporting by The Wall Street Journal, I’ll have to shout them out as well in this area. But it details how, amid this focus on autism clinic fraud how&²Ô²ú²õ±è;…&²Ô²ú²õ±è;what that looks like on the ground. And it’s pretty terrible on the ground. A lot of these autism treatment clinics, the science is questionable on whether it really works. They’re encouraging people to send their kids there instead of to school.&²Ô²ú²õ±è;…&²Ô²ú²õ±è;There’s this horrific anecdote in the lede about how a child is woken up from a nap that can only last almost seven minutes, so they can bill more. I mean, it’s pretty gut-wrenching and gets at the clear issue in a lot of healthcare, which is that a lot of this is done to maximize profit and not necessarily for the patient. So it’s very well done. 

Rovner: Yeah, it is really scary. Shefali. 

Luthra: Mine is in the New York Times opinion section by Dr. Sejal Hathi. The headline is “.” She herself is a new mom, in addition to running the Oregon Health Authority, and she writes about how our postpartum care system is terrible. We do not care about new moms. We only care about infant checkups. We have very little medical care for people when they are postpartum, and that is not good, because pregnancy is really hard. You can have complications. Most pregnancy-related deaths happen after giving birth, not during. Most of them are preventable, and yet we don’t treat this as something that could be addressed, even though it very well could be, because in other countries they actually do make an effort to care about new moms. I love that she wrote about this from a personal and professional standpoint. I think it’s great, and I hope that it inspires some states to think about ways to improve postpartum health. 

Rovner: Yeah, that story made me so angry. Well, my extra credit this week is also about reproductive health. It’s from ProPublica by Pulitzer Prize-winning reporter Kavitha Surana. It’s called “.” And it’s about yet another case of a mom pregnant with her second child, a college-educated healthcare worker, whose membranes ruptured early, putting her at high risk of sepsis, but who couldn’t get the pregnancy terminated at the hospital where she worked, because the doomed fetus still had a heartbeat. This was a well-connected family. The patient’s father is a doctor. She was in the same sorority at the same college as Arkansas Gov. Sarah Huckabee Sanders, and she enlisted one of the top reproductive health lawyers in the country to plead her case with hospital officials. I won’t spoil the end for you, because you really should read the entire piece, but it underscores yet again that abortion bans can endanger people who don’t think they will ever want or need an abortion. 

All right, that is this week’s show. As always, thanks to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. We also had production help this week from Taylor Cook. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course, kffhealthnews.org. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me on X , and on Bluesky . Where are you guys hanging these days? Maya. 

Goldman: I am on LinkedIn under my name and on X . 

Rovner: Shefali. 

Luthra: On Bluesky . 

Rovner: Lauren. 

Weber: Still on  and  under @LaurenWeberHP. As I like to say, the HP is for health policy. 

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

Credits

Francis Ying Audio producer
Taylor Cook Audio producer
Emmarie Huetteman Editor

Click here to find all our podcasts.

And subscribe to “What the Health? From Ñî¹óåú´«Ã½Ò•îl Health News” on , , , , , or wherever you listen to podcasts.

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

This <a target="_blank" href="/podcast/what-the-health-448-republicans-midterms-children-losing-insurance-may-28-2026/">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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2242581&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2242581 Montana Hurries To Adopt Trump’s Medicaid Work Rules Amid Budget Woes /medicaid/medicaid-work-requirements-trump-montana-budget-shortfalls/ Wed, 27 May 2026 09:00:00 +0000 /?p=2239927 Montana plans to be one of the first states to enforce President Donald Trump’s work mandate for Medicaid enrollees, adding another challenge for state health officials trying to plug a massive budget hole.

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.”

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

This <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;">

<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2239927&amp;ga4=G-J74WWTKFM0&quot; style="width:1px;height:1px;">]]> 2239927