Millions of Americans who have waited decades for fast internet connections will keep waiting after the Trump administration threw a $42 billion high-speed internet program into disarray.
The Commerce Department, which runs the massive Broadband Equity, Access, and Deployment Program, announced new rules in early June requiring states — some of which were ready to begin construction later this year — to solicit new bids from internet service providers.
The delay leaves millions of rural Americans stranded in places where health care is hard to access and telehealth is out of reach.
"This does monumental harm to rural America," said Christopher Ali, a professor of telecommunications at Penn State.
The Biden-era program, known as BEAD, was hailed when created in 2021 as a national plan to bring fast internet to all, including millions in remote rural areas.
A yearlong KFF Health News investigation, with partner Gray Media's InvestigateTV, found nearly 3 million people live in mostly rural counties that lack broadband as well as primary care and behavioral health care providers. In those same places, the analysis found, people live sicker and die earlier on average.
The program adopts a technology-neutral approach to "guarantee that American taxpayers obtain the greatest return on their broadband investment," according to the June policy notice. The program previously prioritized the use of fiber-optic cable lines, but broadband experts like Ali said the new focus will make it easier for satellite-internet providers such as Elon Musk's Starlink and Amazon's Kuiper to win federal funds.
"We are going to connect rural America with technologies that cannot possibly meet the needs of the next generation of digital users," Ali said. "They're going to be missing out."
Republicans have criticized BEAD for taking too long, and Commerce Secretary Howard Lutnick vowed in March to get rid of its "woke mandates." The revamped "Benefit of the Bargain BEAD Program," which was released with a fact sheet titled "Ending Biden's Broadband Burdens," includes eliminating some labor and employment requirements and obligations to perform climate analyses on projects.
The requirement for states to do a new round of bidding with internet service providers makes it unclear whether states will be able to connect high-speed internet to all homes, said Drew Garner, director of policy engagement at the Benton Institute for Broadband & Society.
Garner said the changes have caused "pure chaos" in state broadband offices. More than half the states have been knocked off their original timeline to deliver broadband to homes, he said.
The change also makes the program more competitive for satellite companies and wireless providers such as Verizon and T-Mobile, Garner said.
Garner analyzed in March what the possible increase in low-Earth-orbit satellites would mean for rural America. He found that fiber networks are generally more expensive to build but that satellites are more costly to maintain and "much more expensive" to consumers.
Commerce Secretary Lutnick said in a June release that the new direction of the program would be efficient and deliver high-speed internet "at the right price." The agency overseeing BEAD declined to release a specific amount it hopes to save with the restructuring.
More than 40 states had already begun selecting companies to provide high-speed internet and fill in gaps in underserved areas, according to an agency dashboard created to track state progress.
In late May, the website was altered and columns showing the states that had completed their work with federal regulators disappeared. Three states — Delaware, Louisiana, and Nevada — had reached the finish line and were waiting for the federal government to distribute funding.
The tracker, which KFF Health News saved in March, details the steps each state made in their years-long efforts to create location-based maps and bring high-speed internet to those missing service. West Virginia had completed selection of internet service providers and a leaked draft of its proposed plan shows the state was set to provide fiber connections to all homes and businesses.
Sen. Shelley Moore Capito (R-W.Va.) praised removal of some of the hurdles that delayed implementation and said she thought her state would not have to make very many changes to existing plans during a call with West Virginia reporters.
West Virginia's broadband council has worked aggressively to expand in a state where 25% of counties lack high-speed internet and health providers, according to KFF Health News' analysis.
In Lincoln County, West Virginia, Gary Vance owns 21 acres atop a steep ridge that has no internet connection. Vance, who sat in his yard enjoying the sun on a recent day, said he doesn't want to wait any longer.
Vance said he has various medical conditions: high blood sugar, deteriorating bones, lung problems — "all kinds of crap." He's worried about his family's inability to make a phone call or connect to the internet.
"You can't call nobody to get out if something happens," said Vance, who also lacks running water.
KFF Health News, using data from federal and academic sources, found more than 200 counties — with large swaths in the South, Appalachia, and the remote West — lack high-speed internet, behavioral health providers, and primary care doctors who serve low-income patients on Medicaid. On average, residents in those counties experienced higher rates of diabetes, obesity, chronically high blood pressure, and cardiovascular disease.
The gaps in telephone and internet services didn't cause the higher rates of illness, but Ali said it does not help either.
Ali, who traveled rural America for his book "Farm Fresh Broadband: The Politics of Rural Connectivity," said telehealth, education, banking, and the use of artificial intelligence all require fast download and upload speeds that cannot always be guaranteed with satellite or wireless technology.
It's "the politics of good enough," Ali said. "And that is always how we've treated rural America."
Fiber-optic cables, installed underground or on poles, consistently provide broadband speeds that meet the Federal Communications Commission's requirements for broadband download speed of 100 megabits per second and 20 Mbps upload speed. By contrast, a national speed analysis, performed by Ookla, a private research and analytics company, found that only 17.4% of Starlink satellite internet users nationwide consistently get those minimum speeds. The report also noted Starlink's speeds were rising nationwide in the first three months of 2025.
In March, West Virginia's Republican governor, Patrick Morrisey, announced plans to collaborate with the Trump administration on the new requirements.
Republican state Del. Dan Linville, who has been working with Morrisey's office, said his goal is to eventually get fiber everywhere but said other opportunities could be available to get internet faster.
In May, the West Virginia Broadband Enhancement Council signaled it preferred fiber-optic cables to satellite for its residents and signed a unanimous resolution that noted "fiber connections offer the benefits of faster internet speeds, enhanced data security, and the increased reliability that is necessary to promote economic development and support emerging technologies."
Nurse practitioners are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines.
This article was published on Wednesday, June 18, 2025 in KFF Health News.
On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient's home to the next, seeing eight in all. Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff, and pulse oximeter.
Forget a lunch break; she often eats a sandwich or some nuts as she heads to her next patient visit.
On a gloomy Friday in January, Johnson, a nurse practitioner who treats older adults, had a hospice consult with Ellen, a patient in her 90s in declining health. To protect Ellen's identity, KFF Health News is not using her last name.
"Hello. How are you feeling?" Johnson asked as she entered Ellen's bedroom and inquired about her pain. The blinds were drawn. Ellen was in a wheelchair, wearing a white sweater, gray sweatpants, and fuzzy socks. A headband was tied around her white hair. As usual, the TV was playing loudly in the background.
"It's fine, except this cough I've had since junior high," Ellen said.
Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. Before the surgery, Ellen was always colorful, wearing purple, yellow, blue, pink, and chunky necklaces. She enjoyed talking with the half dozen other residents at her adult family home in Washington state. She had a hearty appetite that brought her to the breakfast table early. But lately, her enthusiasm for meals and socializing had waned.
Johnson got down to eye level with Ellen to examine her, assessing her joints and range of motion, checking her blood pressure, and listening to her heart and lungs.
Carefully, Johnson removed the bandage to examine Ellen's toes. Her lower legs were red but cold to the touch, which indicated her condition wasn't improving. Ellen's two younger sisters had power of attorney for her and made it clear that, above all, they wanted her to be comfortable. Now, Johnson thought it was time to have that difficult conversation with them about Ellen's prognosis, recommending her for hospice.
"Our patient isn't just the older adult," Johnson said. "It's also often the family member or the person helping to manage them."
Nurse practitioners are having those conversations more and more as their patient base trends older. They are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines. The Health Resources and Services Administration projects a 50% increase in demand for geriatricians from 2018 to 2030, when the entire baby boom generation will be older than 65. By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7,600, with relatively few young doctors joining the field.
That means many older adults will be relying on other primary care physicians, who already can't keep up with demand, and nurse practitioners, whose ranks are booming. The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors, a recent study in JAMA Network Open found.
According to a 2024 survey, of the roughly 431,000 licensed nurse practitioners, 15% are, like Johnson, certified to treat older adults.
Johnson and her husband, Dustin, operate an NP-led private practice in greater Seattle, Washington, a state where she can practice independently. She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every five to six weeks. Visits typically last 30 minutes to an hour, depending on the case.
"There are so many housebound older adults, and we're barely reaching them," Johnson said. "For those still in their private homes, there's such a huge need."
Laura Wagner, a professor of nursing and community health systems at the University of California-San Francisco, stressed that nurse practitioners are not trying to replace doctors; they're trying to meet patients' needs, wherever they may be.
"One of the things I'm most proud of is the role of nurse practitioners," she said. "We step into places where other providers may not, and geriatrics is a prime example of that."
Practice Limits
Nurse practitioners are registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests, and prescribe medicine. Their growth has bolstered primary care, and, like doctors, they can specialize in particular branches of medicine. Johnson, for example, has advanced training in gerontology.
"If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution," Wagner said, "but there are a lot of barriers in place."
In 27 states and Washington, D.C., nurse practitioners can practice independently. But in the rest of the country, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at 85% of the amount it pays physicians.
Last year, in more than 40 states, the American Medical Association and its partners lobbied against what they see as "scope creep" in the expanded roles of nurse practitioners and other health workers. The AMA points out that doctors must have more schooling and significantly more clinical experience than nurse practitioners. While the AMA says physician-led teams keep costs lower, a study published in 2020 in Health Services Research found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one published in 2023 in the journal Medical Care Research and Review, have found health care models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without an NP.
"I would fully disagree that we're invading their scope of practice and shouldn't have full scope of our own," Johnson said.
She has worked under the supervision of physicians in Pennsylvania and Washington state but started seeing patients at her own practice in 2021. Like many nurse practitioners, she sees her patients in their homes. The first thing she does when she gets a new patient is manage their prescriptions, getting rid of unnecessary medications, especially those with harsh side effects.
She works with the patient and a family member who often has power of attorney. She keeps them informed of subtle changes, such as whether a person was verbal and eating and whether their medical conditions have changed.
While there is some overlap in expertise between geriatricians and nurse practitioners, there are areas where nurses typically excel, said Elizabeth White, an assistant professor of health services, policy, and practice at Brown University.
"We tend to be a little stronger in care coordination, family and patient education, and integrating care and social and medical needs. That's very much in the nursing domain," she said.
That care coordination will become even more critical as the U.S. ages. Today, about 18% of the U.S. population is 65 or over. In the next 30 years, the share of seniors is expected to reach 23%, as medical and technological advances enable people to live longer.
Patient and Family
In an office next to Ellen's bedroom, Johnson called Ellen's younger sister Margaret Watt to recommend that Ellen enter hospice care. Johnson told her that Ellen had developed pneumonia and her body wasn't coping.
Watt appreciated that Johnson had kept the family apprised of Ellen's condition for several years, saying she was a good communicator.
"She was accurate," Watt said. "What she said would happen, happened."
A month after the consult, Ellen died peacefully in her sleep.
"I do feel sadness," Johnson said, "but there's also a sense of relief that I've been with her through her suffering to try to alleviate it, and I've helped her meet her and her family's priorities in that time."
Jariel Arvin is a reporter with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. He reported this article through a grant from The SCAN Foundation.
Without enhanced subsidies, ACA insurance premiums would rise by more than 75% on average.
This article was published on Tuesday, June 17, 2025 in KFF Health News.
MIAMI — Josefina Muralles works a part-time overnight shift as a receptionist at a Miami Beach condominium so that during the day she can care for her three kids, her aging mother, and her brother, who is paralyzed.
She helps her mother feed, bathe, and give medicine to her adult brother, Rodrigo Muralles, who has epilepsy and became disabled after contracting covid-19 in 2020.
"He lives because we feed him and take care of his personal needs," said Josefina Muralles, 41. "He doesn't say, 'I need this or that.' He has forgotten everything."
Though her husband works full time, the arrangement means their household income is just above the federal poverty line — too high to qualify for Florida's Medicaid program but low enough to make Muralles and her husband eligible for subsidized health insurance through the Affordable Care Act marketplace, also known as Obamacare.
Next year, Muralles said, she and her husband may not be able to afford that health insurance coverage, which has paid for her prescription blood thinners, cholesterol medication, and two surgeries, including one to treat a genetic disorder.
Extra subsidies put in place during the pandemic — which reduced the premiums Muralles and her husband paid by more than half, to $30 a month — are in place only through Dec. 31. Without enhanced subsidies, Affordable Care Act insurance premiums would rise by more than 75% on average, with bills for people in some states more than doubling, according to estimates from KFF, a health information nonprofit that includes KFF Health News.
Florida and Texas would be hit especially hard, as they have more people enrolled in the marketplace than other states. Some of their congressional districts alone, especially in South Florida, have more people signed up for Obamacare than entire states.
Like many of the more than 24 million Americans enrolled in the insurance marketplace this year, Muralles was unaware that the enhanced subsidies are slated to expire. She said she cannot afford a premium hike because inflation has already eaten into her household's budget.
"The rent is going up," she said. "The water bill is going up."
Low-income enrollees like the Muralles couple would see the biggest percentage increases in premiums if enhanced subsidies expire.
Middle-income enrollees who earn more than four times the federal poverty line would no longer be eligible for subsidies at all. Those middle-income enrollees (who earn at least $62,600 for a single person in 2025) are disproportionately older, self-employed, and living in rural areas.
The Congressional Budget Office estimated that letting the enhanced subsidies expire would, by 2034, increase the number of people without health insurance by 4.2 million. In tandem with changes to Medicaid in the House of Representatives' reconciliation bill and the Trump administration's proposed rules for the marketplace, including toughening income verification and shortening enrollment periods, it would increase the number of uninsured people by 16 million over that time period.
A study by the Urban Institute, a nonprofit think tank, found that Hispanic and Black people would see greater coverage losses than other groups if the extra subsidies lapse.
Fuentes noted that about 5 million Hispanics are enrolled in the ACA marketplace, and that Donald Trump won the Hispanic vote in Florida in 2024. He hopes the president and congressional Republicans see extending the enhanced subsidies as a way to hold on to those voters.
"This is probably a good way, or a good start, to possibly grow that base even more," he said.
Enrollment in the marketplace has grown faster since 2020 in the states won by Trump in 2024. A recent KFF survey found that 45% of Americans who buy their own health insurance identify as or lean Republican, including 3 in 10 who identify as Make America Great Again supporters. Smaller shares identify as Democrats or Democratic-leaning independents (35%) or do not lean toward either party (20%).
Kush Desai, a White House spokesperson, said the rules proposed by the Trump administration, combined with the provisions in the House-passed budget bill, would "strengthen the ACA marketplace." He noted that the CBO projects the legislation would reduce premiums for some plans about 12% on average by 2034 — but out-of-pocket costs would rise or remain the same for most subsidized ACA consumers.
"Democrats know Americans broadly support ending waste, fraud, and abuse, as The One, Big, Beautiful Bill does, which is why they are desperately trying to change the conversation," Desai said.
But Lauren Aronson, executive director of Keep Americans Covered, a group in Washington, D.C., representing health insurers, hospitals, physicians, and patient advocates, said it is critical to raise awareness about the likely impact of losing the enhanced subsidies, which are also known as advanced premium tax credits. She is encouraged that Democrats have proposed legislation to extend the enhanced tax credits, and that some Republican senators have voiced support.
What worries Aronson most is that the Republican-controlled Congress is more focused on extending tax cuts than enhanced subsidies, she said. The current bill extending the 2017 tax cuts would increase the federal deficit by about $2.4 trillion over the next decade, according to the CBO, while making the enhanced subsidies permanent would increase the deficit by $358 billion over roughly the same period.
"Congress is moving forward on a tax reconciliation package that purports to benefit working families," Aronson said. "But if you don't take care of the tax credits, working families will be left holding the bag."
Brian Blase, president of Paragon Health Institute, a conservative health policy think tank, said the enhanced subsidies were supposed to be a temporary measure during the covid-19 pandemic to help people at risk of losing coverage.
Instead, he said, the enhanced subsidies facilitated fraud because enrollees did not need to verify their income eligibility to receive zero-premium plans if they reported incomes at or near the federal poverty level.
The enhanced subsidies also worsen health inflation, discourage employers from offering health insurance benefits, and crowd out alternative models, such as short-term insurance and Farm Bureau plans, Blase said.
"Permitting these subsidies to expire would just be going back to Obamacare as it was written," Blase said. "That is a more efficient program than the program that we have now."
New rules for the marketplace proposed by the Trump administration in March are already designed to address fraud, said Anna Howard, a policy expert with the American Cancer Society Cancer Action Network, which advocates for increased health insurance coverage. Howard said extending the enhanced tax credits would help ensure that people who are legitimately eligible for coverage can get it.
"We don't want to see over 5 million people be kicked off their health insurance coverage out of fears of fraud when the policies being proposed don't necessarily address fraud," she said.
Without affordable premiums, many consumers will turn to short-term health plans, health care cost-sharing ministries, and other forms of coverage that do not have the benefits or protections of the health law, she said.
"These are plans that don't provide coverage for prescription drugs, or they have lifetime and annual limits," she said. "For a cancer patient, those plans don't work."
Though the enhanced subsidies do not expire until the end of the year, the Blue Cross Blue Shield Association would prefer Congress to act by fall to avoid confusion during open enrollment, said David Merritt, a senior vice president. Insurers are preparing rates to meet state deadlines. By October, consumers will receive 60-day plan renewal notices with their 2026 premiums.
Without enhanced subsidies, Merritt said, competition in the marketplace will wither, leading to fewer coverage options and higher prices, especially in states that have not expanded Medicaid eligibility and where Obamacare enrollment spiked during the past four years, like Florida and Texas. "Voters and patients are really going to see the impact," he said.
Republican and Democratic representatives for some of the Florida congressional districts with the highest numbers of people in the marketplace did not respond to repeated interview requests.
Muralles, of North Miami, Florida, said she wants her representatives to work in the interest of constituents like herself, who need health insurance coverage to care for their families.
"Now is the time to prove to us that they are with us," Muralles said. "When everybody's healthy, everybody goes to work, everybody can pay taxes, everybody can have a better life."
Nearly two-thirds of adults oppose President Donald Trump's "One Big Beautiful Bill" approved in May by the House of Representatives, according to a KFF poll released Tuesday.
And even Trump's most ardent supporters like the legislation a lot less when they learn how it would cut federal spending on health programs, the poll shows.
The KFF poll found that about 61% of Republicans and Republican-leaning independents — and 72% of the subset who identify with Trump's "Make American Great Again" movement — support the bill, which would extend many of Trump's 2017 tax cuts while reducing spending on domestic programs, including cutting billions from Medicaid.
But when pollsters told survey respondents about the bill's consequences for health care, opposition grew, including among MAGA supporters.
For example, after being told that the bill would decrease funding for local hospitals and increase the number of people without health insurance, support among those who back MAGA dropped more than 20 percentage points — resulting in fewer than half the group still backing the bill.
Ashley Kirzinger, KFF's director of survey methodology and associate director of its Public Opinion and Survey Research program, said it's no surprise polling shows that party affiliation affects how most of the public views the bill.
"But the poll shows that support, even among MAGA supporters, drops drastically once the public hears more about how the bill could impact local hospitals and reduce Medicaid coverage," she said.
"This shows how the partisan lens wears slightly when the public learns more about how the legislation could affect them and their families."
KFF is a health policy research, polling, and news organization that includes KFF Health News.
House Speaker Mike Johnson, a Louisiana Republican who won passage of the legislation in the chamber he controls by a single vote on May 22, has insisted the bill would not "cut Medicaid." The nonpartisan Congressional Budget Office, which calculates the effects of legislation on the nation's deficits and debt, says the measure would reduce federal spending on Medicaid by $793 billion over 10 years, resulting in nearly 8 million more people becoming uninsured.
The bill is encountering strident opposition from the health industry, most notably hospitals that expect to see large cuts in funding as a result of millions of people losing Medicaid coverage. The House-passed legislation would increase the frequency of eligibility checks and require that most nondisabled adults regularly prove they are working, studying, or volunteering at least 80 hours a month to keep their coverage.
"This is common sense," Johnson said May 25 on the CBS News program "Face the Nation." "And when the American people understand what we are doing here, they applaud it."
Critics say the bill marks the latest attempt by Republicans to roll back the Affordable Care Act.
As the Senate moves toward a possible vote on its version of the legislation before Independence Day, the KFF poll shows Medicaid and the ACA are more popular than ever.
About 83% of adults support Medicaid, including large majorities of Democrats (93%), independents (83%), and Republicans (74%). That's up from 77% in January, with the poll finding the biggest jump in favorability among Republicans.
Medicaid and the related Children's Health Insurance Program cover about 78 million people who are disabled or have low incomes.
About two-thirds of adults hold favorable views of the ACA, the most since the law's enactment in 2010, as recorded in KFF polls. The law has only been consistently popular with a majority of adults since about 2021.
Views of the ACA remain split along partisan lines, with most Republicans (63%) holding unfavorable views and most Democrats (94%) and independents (71%) viewing it favorably.
The poll found other indications that the public may not understand key provisions of the GOP bill, including its work requirements.
The poll finds two-thirds of the public — including the vast majority of Republicans (88%) and MAGA supporters (93%) and half (51%) of Democrats — initially support requiring nearly all adults on Medicaid to prove they are working or looking for work, in school, or doing community service, with exceptions such as for caregivers and people with disabilities.
However, attitudes toward this provision shifted dramatically when respondents were presented with more information.
For example, when told most adults with Medicaid are already working or unable to work, and that those individuals could lose coverage due to the challenge of documenting it, about half of supporters changed their view, resulting in nearly two-thirds of adults opposing Medicaid work requirements and about a third supporting them.
The poll of 1,321 adults was conducted online and by telephone June 4-8 and has a margin of error of plus or minus 3 percentage points.
BRIDGEPORT, W.Va. — By the time Eric Tennant was diagnosed in 2023 with a rare cancer of the bile ducts, the disease had spread to his bones. He weighed 97 pounds and wasn't expected to survive a year with stage 4 cancer.
Two years later, grueling rounds of chemotherapy have slowed the cancer's progress, even as it has continued to spread. But chemotherapy has also ravaged Tennant's body and his quality of life.
Recently, however, the 58-year-old had reason to hope things would improve. Last fall, his wife, Rebecca, learned of a relatively new, noninvasive procedure called histotripsy, which uses targeted ultrasound waves to destroy tumors in the liver. The treatment could extend his life and buy him more downtime between rounds of chemotherapy.
Early this year, Tennant's oncologist agreed he was a good candidate since the largest tumor in his body is in his liver. But that's when his family began fighting another adversary: their health insurer, which decided the treatment was "not medically necessary," according to insurance paperwork.
For months, Eric Tennant's health insurance refused to cover a cancer treatment recommended by his doctor, claiming the procedure was "not medically necessary," a common reason used by health insurers to deny care. (A portion of this photo is digitally blurred to protect patient privacy.)(NBC News)
Health insurers issue millions of denials every year. And like the Tennants, many patients find themselves stuck in a convoluted appeals process marked by long wait times, frustrating customer service encounters, and decisions by medical professionals they've never met who may lack relevant training.
Recent federal and state efforts, as well as changes undertaken by insurance companies themselves, have attempted to improve a 50-year-old system that disproportionately burdens some of the sickest patients at the worst times. And yet many doctors complain that insurance denials are worse than ever as the use of prior authorization has ramped up in recent years, reporting by KFF Health News and NBC News found.
When the Tennant family was told histotripsy would cost $50,000 and insurance wouldn't cover it, they appealed the denial four times.
"It's a big mess," said Rebecca Tennant, who described feeling like a pingpong ball, bouncing between the insurer and various health care companies involved in the appeals process.
"There's literally nothing we can do to get them to change," she said in an April interview with KFF Health News. "They're, like, not accountable to anyone."
While the killing of UnitedHealthcare chief executive Brian Thompson in December incited a fresh wave of public fury about denials, there is almost no hope of meaningful change on the horizon, said Jay Pickern, an assistant professor of health services administration at Auburn University.
"You would think the murder of a major health insurance CEO on the streets of New York in broad daylight would be a major watershed moment," Pickern said. Yet, once the news cycle died down, "everything went back to the status quo."
An Unintended Consequence of Health Reform?
Prior authorization varies by plan but often requires patients or their providers to get permission (also called precertification, preauthorization, or preapproval) before filling prescriptions, scheduling imaging, surgery, or an inpatient hospital stay, among other expenses.
The practice isn't new. Insurers have used prior authorization for decades to limit fraud, prevent patient harm, and control costs. In some cases, it is used to intentionally generate profits for health insurers, according to a 2024 U.S. Senate report. By denying costly care, companies pay less for health care expenses while still collecting premiums.
For most patients, though, the process works seamlessly. Prior authorization mostly happens behind the scenes, almost always electronically, and nearly all requests are quickly, or even instantly, approved.
But the use of prior authorization has also increased in recent years. That's partly due to the growth of enrollment in Medicare Advantage plans, which rely heavily on prior authorization compared with original Medicare. Some health policy experts also point to the passage of the Affordable Care Act in 2010, which prohibited health insurers from denying coverage to patients with preexisting conditions, prompting companies to find other ways to control costs.
"But we can't really prove this," said Kaye Pestaina, director of the Program on Patient and Consumer Protection at KFF, a health information nonprofit that includes KFF Health News. Health insurers haven't been historically transparent about which services require prior authorization, she said, making it difficult to draw comparisons before and after the passage of the Affordable Care Act.
Meanwhile, many states are looking to overhaul the prior authorization process.
In March, Virginia passed a law that will require health insurers to publicly post a list of health care services and codes for which prior authorization is required. A North Carolina bill would require doctors who review patient appeals to have practiced medicine in the same specialty as the patient's provider. The West Virginia Legislature passed bills in both 2019 and 2023 requiring insurers to respond to nonurgent authorization requests within five days and more urgent requests within two days, among other mandates.
And in 2014, the South Carolina Department of Health and Human Services temporarily lifted all prior authorization requirements for Medicaid beneficiaries seeking rehabilitative behavioral health services.
Federal rules to modify prior authorization that were introduced by the first Trump administration and finalized by the Biden administration are set to take effect next year, with the aim of streamlining the process, reducing wait times, and improving transparency.
These changes were supported by AHIP, a trade group that represents health insurers.
'Sick With Little Recourse'
But the new federal rules won't prevent insurance companies from denying payment for doctor-recommended treatment, and they apply only to some categories of health insurance, including Medicare Advantage and Medicaid. Nearly half the U.S. population is covered by employer-sponsored plans, which remain untouched by the new rules.
For some patients, the stakes couldn't be higher.
On May 12, Alexander Schrift, 35, died at home in San Antonio, Florida, less than two months after his insurance company refused to cover the cancer drug ribociclib. It's used to treat breast cancer but has shown promise in treating the same type of brain tumor Schrift was diagnosed with in 2022, according to researchers at the Dana-Farber Cancer Institute in Boston and the Institute of Cancer Research in London.
But Schrift's insurance company refused to pay. The Right to Try Act, signed by President Donald Trump in 2018, entitles patients with terminal illnesses to try experimental drugs, but it does not obligate insurance companies to pay for them.
In May, Sheldon Ekirch, 30, of Henrico, Virginia, said her parents withdrew money from their retirement savings to pay for treatment denied by her health insurance company.
Ekirch, who was diagnosed with small fiber neuropathy in 2023, was recommended by her doctor to try an expensive blood plasma treatment called intravenous immunoglobulin to ease her near-constant pain. In April, a state agency charged with reviewing insurance denials upheld her insurer's decision. Out-of-pocket, the treatment may cost her parents tens of thousands of dollars.
"Never in a million years did I think I'd end up here," Ekirch said, "sick with little recourse."
Earlier this year, New Jersey congressman Jefferson Van Drew, a Republican, introduced a bill that would eliminate prior authorization altogether. But history suggests that would create new problems.
When South Carolina Medicaid lifted prior authorization for rehabilitative behavioral health services in 2014, the department's costs for those services skyrocketed from $300,000 to $2 million per week, creating a $54 million budget shortfall after new providers flooded the market. Some providers were eventually referred to the South Carolina Attorney General's Office for Medicaid fraud investigation. The state Medicaid agency eventually reinstated prior authorization for specific services, spokesperson Jeff Leieritz said.
What happened in South Carolina illustrates a common argument made by insurers: Prior authorization prevents fraud, reduces overspending, and guards against potential harm to patients.
On the other hand, many doctors and patients claim that cost-containment strategies, including prior authorization, do more harm than good.
On Feb. 3, 2024, Jeff Hall of Estero, Florida, became paralyzed from the neck down and spent weeks in a coma after he suddenly developed Guillain-Barré Syndrome. The cause of his illness remains unknown.
Hall, now 51, argued that the Florida Blue health insurance plan he purchased on the federal marketplace hindered his recovery by capping the number of days he was allowed to remain in an acute rehabilitation hospital last year.
Hall said that after he was forced to "step down" to a lower-level nursing facility, his health deteriorated so rapidly within six days that he was sent to the emergency room, placed on a ventilator, and required a second tracheostomy. Hall believes the insurance company's coverage limits set his recovery back by months — and, ironically, cost the insurer more. His wife, Julie, estimated Jeff's medical bills have exceeded $5 million, and most of his care has been covered by his insurer.
"Getting better is not always the goal of an insurance company. It's a business," Jeff Hall said. "They don't care."
In a prepared statement, Florida Blue spokesperson Jose Cano said the company understands "it can be a challenge when a member reaches the limit of their coverage for a specific service or treatment." He encouraged members affected by coverage limits to contact their health care providers to "explore service and treatment options."
A 'Rare and Exceptional' Reversal
Back in West Virginia, Eric and Rebecca Tennant say they are realistic about Eric's prognosis.
They never expected histotripsy to cure his cancer. At best, the procedure could buy him more time and might allow him to take an extended break from chemotherapy. That makes it worth trying, they said.
As a safety instructor with the West Virginia Office of Miners' Health Safety and Training, Eric Tennant is a state employee and is insured by West Virginia's Public Employees Insurance Agency.
As the Tennants pleaded with the state insurance agency to cover histotripsy, they faced a list of other companies involved in the decision, including UMR, a UnitedHealthcare subsidiary that contracts with West Virginia to manage the public employee plans, and MES Peer Review Services, a Massachusetts company that upheld the insurer's decision in March, citing that histotripsy is "unproven in this case and is not medically necessary."
None of their appeals worked. After KFF Health News and NBC News reached out to West Virginia's Public Employees Insurance Agency with questions for this article, the agency changed its mind, explaining the insurer had consulted with medical experts to further evaluate the case.
"This decision reflects a rare and exceptional situation" and does not represent a change in the Public Employees Insurance Agency's overall coverage policies," Director Brent Wolfingbarger said in a prepared statement to KFF Health News.
In a separate prepared statement, UnitedHealthcare spokesperson Eric Hausman said the company sympathizes with "anyone navigating through life-threatening care decisions."
"Currently, there is no evidence that histotripsy is as effective as alternative treatment options available," he said in late May, after the earlier insurance denials were reversed, "and its impact on survival or cancer recurrence is unknown."
MES Peer Review Services did not respond to a request for an interview.
Meanwhile, Rebecca Tennant worries it might be too late. She said her husband was first evaluated for histotripsy in February. But his health has recently taken a turn for the worse. In late May and early June, she said, he spent five days in the hospital after developing heart and lung complications.
Eric Tennant is no longer considered a viable candidate for histotripsy, his wife said, although the Tennants are hopeful that will change if his health improves. Scans scheduled for July will determine whether his cancer has continued to progress. Rebecca Tennant blames her husband's insurance plan for wasting months of their time.
"Time is precious," she said. "They know he has stage 4 cancer, and it's almost like they don't care if he lives or dies."
NBC News health and medical unit producer Jason Kane and correspondent Erin McLaughlin contributed to this report.
Major changes could be in store for the more than 24 million people with health coverage under the Affordable Care Act, including how and when they can enroll, the paperwork required, and, crucially, the premiums they pay.
A driver behind these changes is the "One Big Beautiful Bill," the name given to spending and tax legislation designed to advance the policy agenda of President Donald Trump. It passed the House on May 22 and is pending in the Senate.
Combined, the moves by Trump and his allies could "devastate access" to ACA plans, said Katie Keith, director of the Center for Health Policy and the Law at the O'Neill Institute, a health policy research group at Georgetown University.
States that run their own Obamacare marketplaces and the National Association of Insurance Commissioners have also raised concerns about added costs and reduced access. But House Republicans and some conservative think tanks say the ACA needs revamping to rein in fraud, part of which they pin on certain Biden administration changes the measures would undo.
Senate Republicans must now weigh whether to include the House's proposals in their own bill, with the aim of getting it through the chamber by July 4.
Here are four key ways Trump's policies could undermine Obamacare enrollment and coverage.
More than 90% of ACA enrollees receive tax credits to defray monthly premiums for their coverage. There are two key provisions for them to watch.
One would end automatic reenrollment for most ACA policyholders each year. More than 10 million people were automatically reenrolled in their coverage for the 2025 plan year, with their eligibility for tax credits confirmed via a system that allows ACA marketplaces to check government or other data sources.
The House bill would instead require every new or returning policyholder each year to provide information on income, household size, immigration status, and other factors, starting in 2028. If they don't, they won't get a premium tax credit, which could put the price of coverage out of reach.
"Everyone who wants to either purchase or renew a marketplace plan will have to come with a shoebox filled with documents, scan in and upload them or mail them in, and sit and wait while someone reviews and confirms them," said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.
She and other policy experts fear that many consumers will become uninsured because they don't understand the requirements or find them burdensome. If too many young and healthy people, for example, decide it's not worth the hassle, that could leave more older and sicker people for ACA insurers to cover — potentially raising premiums for everyone.
But supporters of the House bill say the current approach needs changing because it is vulnerable to waste, fraud, and abuse.
"This would ensure that enrollees need to return to the exchange to update their information and obtain an updated eligibility determination for a subsidy — best protecting the public against excess subsidies paid to insurers that can never be recovered," the conservative Paragon Institute wrote in an April letter to top Department of Health and Human Services officials.
Having a Baby? Getting Married? Expect Coverage Delays
Today, people who experience life changes — losing a job, getting married or divorced, or having a baby, for instance — are considered provisionally eligible for tax credits to reduce their premiums if they sign up or change their ACA plans. That means they would be eligible to receive these subsidies for at least 90 days while their applications are checked against government data or other sources, or marketplaces follow up with requests for additional information.
The House bill would end that, requiring documentation before receiving tax credits. That could create particular hardship for new parents, who can't confirm that babies are eligible for premium subsidies until they receive Social Security numbers weeks after they're born.
Policy experts following the debate "did not expect the end to provisional eligibility," Corlette said. "I don't know what the reaction in the Senate will be, as I'm not sure everyone understands the full implications of these provisions because they are so new."
It can take up to six weeks for the Social Security Administration to process a number for a newborn, and an additional two weeks for parents to get the card, according to a white paper that analyzed provisions of the House bill and was co-authored by Jason Levitis, a senior fellow at the Urban Institute, and Christen Linke Young, a visiting fellow with Brookings' Center on Health Policy.
Without a Social Security number, any application to add a newborn to an ACA policy would automatically generate a hold on premium tax credits for that family, they wrote — increasing their out-of-pocket costs, at least temporarily.
"It puts consumers on the hook for any delays the marketplace is taking," while the Centers for Medicare & Medicaid Services, which administers the ACA marketplaces, "is cutting staff and adding a lot more paperwork to burden the staff they have," Levitis said.
Provisions in the House bill that would require ACA enrollees to provide information each year that they reenroll — or when seeking to add or change a policy due to a life circumstance — would increase the number of people without health insurance by 700,000 in 2034, according to the latest CBO estimate.
Less Time To Sign Up
The House bill would turn into law a Trump proposal to shorten the ACA open enrollment period. The start date would continue to be Nov. 1. But the window would be shortened by about a month, with an end date of Dec. 15. This affects people in states that use the federal marketplace as well as the 19 states and the District of Columbia that run their own, most of which offer open enrollment into at least mid-January.
Also, as soon as the end of this year, a special enrollment period the Biden administration created would be done away with. It allowed people with lower incomes — those who earn up to 1.5 times the 2024 federal poverty level, or about $38,730 for a family of three — to sign up anytime during the year.
Critics, including the Paragon Institute, argue that this enrollment opening led to fraud, partly blaming it for a steep increase last year in instances of insurance agents seeking commissions by enrolling or switching consumers into plans without their consent, or fudging their incomes to qualify them for tax credits so large they paid no monthly premiums at all.
But supporters — including some states that run their own ACA exchange — say there are other ways to address fraud.
"We anticipate that much of the improper activity can be prevented by security and integrity upgrades to the federal marketplace, which we understand the Centers for Medicare and Medicaid Services (CMS) is implementing," the National Association of Insurance Commissioners wrote in a May 29 letter to congressional leaders.
Premiums and Out-of-Pocket Costs Will Likely Increase
The reason? Enhanced tax credits created during the pandemic expire at the end of the year. The House bill doesn't extend them. Those more generous payments are credited with helping double ACA enrollment since 2020.
The CBO estimates that extending the subsidies would cost $335 billion over 10 years. The House bill instead funds an extension of Trump's tax cuts, which largely benefit wealthier families.
If the enhanced credits are allowed to expire, not only would premium subsidies be smaller for many people, but there would also be an abrupt eligibility cutoff — an income cliff — for households above four times the federal poverty rate, or about $103,280 for a family of three for this plan year.
Taking into account the smaller subsidies and the cliff, KFF estimates a national average premium increase of 75% for enrollees if the enhanced subsidies expire. The CBO expects that about 4.2 million more people will be uninsured in 2034 as a result.
Responding to charges that President Donald Trump's tax and spending bill would cut Medicaid coverage for millions of Americans, Trump administration officials misleadingly counter that it targets only waste, fraud, and abuse.
During an interview on CNN's "State of the Union," Russell Vought, the administration's director of the Office of Management and Budget, framed Medicaid as sagging under the weight of improper payments.
An "improper" payment refers to payments made erroneously to beneficiaries and their providers or without sufficient documentation.
Pressed June 1 by CNN host Dana Bash about concerns that low-income Americans would suffer if the bill becomes law, Vought called such arguments "totally ridiculous."
"This bill will preserve and protect the programs, the social safety net, but it will make it much more commonsense," Vought said. "Look, one out of every $5 or $6 in Medicaid [payments] is improper."
That would mean Medicaid's improper payment rate is 16% to 20%.
In a 2024 report covering the years 2022, 2023, and 2024, Medicaid's parent agency — the Centers for Medicare & Medicaid Services — said the rate was about 5.1%.
One conservative group, the Paragon Health Institute, said the agency has been using an incomplete calculation method and that the percentage could be as high as 25%. Other experts told PolitiFact that the actual numbers could be higher than what the federal government reports, although not as high as Paragon's estimate.
The White House did not respond to an inquiry for this article.
How High Is the Medicaid Improper Payment Rate?
Medicaid and its closely related Children's Health Insurance program provides health care and long-term care to roughly 83 million lower-income beneficiaries, accounting for about one-fifth of health care spending overall. It is funded through a mix of federal and state money and is administered by states under federal government rules.
Every year, the Centers for Medicare & Medicaid Services publishes official numbers for the share of improper Medicaid payments, and in other federal health insurance programs the agency oversees.
In a 2024 review of payments made in 2022, 2023, and 2024, the agency found that 5.09% of Medicaid payments totaling $31.10 billion were improper.
The 5.09% rate represented a decrease from the 8.58% rate cited in its 2023 report, which was also based on a three-year time span. The 2024 figure represented the third consecutive annual decline.
Are These Numbers Complete?
In March 2025, Brian Blase, a conservative health policy analyst and president of Paragon Health, a health policy think tank, co-authored a report that said the official CMS improper payment rate figures were unrealistically low for eight of the past 10 years, because in some years the agency failed to undergo widespread auditing of its beneficiaries' Medicaid eligibility.
From 2017 to 2019, during Trump's first term, Blase served as Trump's special assistant for economic policy. Before that, he served as a health policy analyst for the Senate Republican Policy Committee and has worked for the Heritage Foundation, a conservative think tank.
The report said if the agency's analysis had looked at eligibility checks every year, more ineligible beneficiaries and payments on their behalf would have been discovered. The report said this might have increased the improper payment rate as high as 25%, based on the rates found in 2020 and 2021, when a high number of eligibility checks were included in the agency's methodology.
However, it's hard to confirm whether lack of eligibility auditing caused higher improper payment rates in 2020 and 2021, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities, a liberal think tank.
Wagner said Medicaid enrollment procedures have fluctuated, which could help explain the higher rates in some years rather than others. Using two years of data to generalize about trends across a decade, she said, is not necessarily valid.
Robert Westbrooks, the federal Pandemic Response Accountability Committee executive director who worked in government oversight roles during Democratic and Republican administrations, told PolitiFact it's plausible that the officially reported improper payment rates for Medicaid could be too low.
However, Westbrooks said pinpointing how much higher the rate is in reality is a speculative process. "I don't believe anyone can credibly quantify the [difference]," he said.
What Is an Improper Payment?
Health care experts emphasized that improper payments are not the same thing as waste, fraud, or abuse.
Fraud: "When someone knowingly deceives, conceals, or misrepresents to obtain money or property from any health care benefit program."
Waste: "Overusing services or other practices that directly or indirectly result in unnecessary costs to any health care benefit program. Examples of waste are conducting excessive office visits, prescribing more medications than necessary, and ordering excessive laboratory tests."
Abuse: "When health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program," which can include overbilling or misusing billing codes.
By contrast, an improper payment "includes any payment to an ineligible recipient, any payment for an ineligible good or service, any duplicate payment, any payment for a good or service not received, and any payment that does not account for credit for applicable discounts," KFF, a health information nonprofit that includes KFF Health News, wrote this year.
"Although all fraudulent payments are improper, not all improper payments are fraudulent," said Jessica Tillipman, associate dean for government procurement law at George Washington University's law school. "Most providers identify the improper payments and return them knowing how aggressively enforced" the legal provisions are. "When they don't, they open the door to significant liability."
This typically involved cases in which a state or provider missed an administrative step, and it did not necessarily indicate fraud or abuse, the agency said. Instead, it could be an accidental oversight or mistake.
In other words, it was rare for ordinary beneficiaries to be scamming the government. "The vast majority of fraud in Medicaid is committed by providers or other actors, not enrollees," Wagner said.
Our Ruling
Vought said that "one out of every $5 or $6 in Medicaid [payments] is improper."
The official improper payment rate calculated by the Centers for Medicare & Medicaid Services in 2024 was about 5%, smaller than the 16% to 20% rate Vought described.
A health policy analyst and former Trump adviser said methodological shortcomings in the agency's analysis could mean the rate is as high as 25%. Although it's possible the rate is higher than the 5% the government reported, how much higher is speculative.
The statement contains an element of truth but ignores critical facts, namely the federal government's own data. We rate the statement Mostly False.
Email interviews with Tammie Smith and Craig Palosky, spokespersons for KFF, June 2, 2025.
Email interview with Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities.
Email interview with Jessica Tillipman, associate dean for government procurement law at George Washington University's law school, June 3, 2025.
Email interview with Robert Westbrooks, Pandemic Response Accountability Committee executive director who worked in government oversight roles during Democratic and Republican administrations, June 3, 2025.
Esther Bejarano's son was 11 months old when asthma landed him inhh the hospital. She didn't know what had triggered his symptoms — neither she nor her husband had asthma — but she suspected it was the pesticides sprayed on the agricultural fields near her family's home.
Pesticides are a known contributor to asthma and are commonly used where Bejarano lives in California's Imperial Valley, a landlocked region that straddles two counties on the U.S.-Mexico border and is one of the main producers of the nation's winter crops. It also has some of the worst air pollution in the nation and one of the highest rates of childhood asthma emergency room visits in the state, according to data collected by the California Department of Public Health.
Bejarano has since learned to manage her now-19-year-old son's asthma and works at Comite Civico del Valle, a local rights organization focused on environmental justice in the Imperial Valley. The organization trains health care workers to educate patients on proper asthma management, enabling them to avoid hospitalization and eliminate triggers at home. The course is so popular that there's a waiting list, Bejarano said.
But the group's Asthma Management Academy program and similar initiatives nationwide face extinction with the Trump administration's mass layoffs, grant cancellations, and proposed budget cuts at the Department of Health and Human Services and the Environmental Protection Agency. Asthma experts fear the cumulative impact of the reductions could result in more ER visits and deaths, particularly for children and people in low-income communities — populations disproportionately vulnerable to the disease.
"Asthma is a preventive condition," Bejarano said. "No one should die of asthma."
Asthma can block airways, making it hard to breathe, and in severe cases can cause death if not treated quickly. Nearly 28 million people in the U.S. have asthma, and about 10 people still die every day from the disease, according to the Asthma and Allergy Foundation of America.
In May, the White House released a budget proposal that would permanently shutter the Centers for Disease Control and Prevention's National Asthma Control Program, which was already gutted by federal health department layoffs in April. It's unclear whether Congress will approve the closure.
Last year, the program allotted $33.5 million to state-administered initiatives in 27 states, Puerto Rico, and Washington, D.C., to help communities with asthma education. The funding is distributed in four-year grant cycles, during which the programs receive up to $725,000 each annually.
Comite Civico del Valle's academy in Southern California, a clinician workshop in Houston, and asthma medical management training in Allentown, Pennsylvania — ranked the most challenging U.S. city to live in with asthma — are among the programs largely surviving on these grants. The first year of the current grant cycle ends Aug. 31, and it's unknown whether funding will continue beyond then.
Data suggests that the CDC's National Asthma Control Program has had a significant impact. The agency's own research has shown that the program saves $71 in health care costs for every $1 invested. And the asthma death rate decreased 44% between the 1999 launch of the program and 2021, according to the American Lung Association.
"Losing support from the CDC will have devastating impacts on asthma programs in states and communities across the country, programs that we know are improving the lives of millions of people with asthma," said Anne Kelsey Lamb, director of the Public Health Institute's Regional Asthma Management and Prevention program. "And the thing is that we know a lot about what works to help people keep their asthma well controlled, and that's why it's so devastating."
The Trump administration cited cost savings and efficiency in its April announcement of the cuts to HHS. Requests for comment from the White House and CDC about cuts to federal asthma and related programs were not answered.
The Information Wars
Fresno, in the heart of California's Central Valley, is one of the country's top 20 "asthma capitals," with high rates of asthma and related emergencies and deaths. It's home to programs that receive funding through the National Asthma Control Program. Health care professionals there also rely on another aspect of the program that is under threat if it's shuttered: countrywide data.
The federal asthma program collects information on asthma rates and offers a tool to study prevalence and rates of death from the disease, see what populations are most affected, and assess state and local trends. Asthma educators and health care providers worry that the loss of these numbers could be the biggest impact of the cuts, because it would mean a dearth of information crucial to forming educated recommendations and treatment plans.
"How do we justify the services we provide if the data isn't there?" said Graciela Anaya, director of community health at the Central California Asthma Collaborative in Fresno.
Mitchell Grayson, chair of the Asthma and Allergy Foundation's Medical Scientific Council, is similarly concerned.
"My fear is we're going to live in a world that is frozen in Jan. 19, 2025, as far as data, because that was the last time you know that this information was safely collected," he said.
Grayson, an allergist who practices in Columbus, Ohio, said he also worries government websites will delete important recommendations that asthma sufferers avoid heavy air pollution, get annual flu shots, and get covid-19 vaccines.
Disproportionate Risk
Asthma disproportionately affects communities of color because of "historic structural issues," said Lynda Mitchell, CEO of the Asthma and Allergy Network, citing a higher likelihood of living in public housing or near highways and other pollution sources.
She and other experts in the field said cuts to diversity initiatives across federal agencies, combined with the rollback of environmental protections, will have an outsize impact on these at-risk populations.
In December, the Biden administration awarded nearly $1.6 billion through the EPA's Community Change Grants program to help disadvantaged communities address pollution and climate threats. The Trump administration moved to cut this funding in March. The grant freezes, which have been temporarily blocked by the courts, are part of a broader effort by the Trump EPA to eliminate aid to environmental justice programs across the agency.
In 2023 and 2024, the National Institutes of Health's Climate Change and Health Initiative received $40 million for research, including on the link between asthma and climate change. The Trump administration has moved to cut that money. And a March memo essentially halted all NIH grants focused on diversity, equity, and inclusion, or DEI — funds many of the asthma programs serving low-income communities rely on to operate.
On top of those cuts, environmental advocates like Isabel González Whitaker of Memphis, Tennessee, worry that the proposed reversals of environmental regulations will further harm the health of communities like hers that are already reeling from the effects of climate change. Shelby County, home to Memphis, recently received an F on the American Lung Association's annual report card for having so many high ozone days. González Whitaker is director of EcoMadres, a program within the national organization Moms for Clean Air that advocates for better environmental conditions for Latino communities.
"Urgent asthma needs in communities are getting defunded at a time when I just see things getting worse in terms of deregulation," said González Whitaker, who took her 12-year-old son to the hospital because of breathing issues for the first time this year. "We're being assaulted by this data and science, which is clearly stating that we need to be doing better around preserving the regulations."
Back in California's Imperial Valley — where the majority-Hispanic, working-class population surrounds California's largest lake, the Salton Sea — is an area called Bombay Beach. Bejarano calls it the "forgotten community." Homes there lack clean running water, because of naturally occurring arsenic in the groundwater, and residents frequently experience a smell like rotten eggs blowing off the drying lakebed, exposing decades of pesticide-tinged dirt.
In 2022, a 12-year-old girl died in Bombay Beach after an asthma attack. Bejarano said she later learned that the girl's school had recommended that she take part in Comite Civico del Valle's at-home asthma education program. She said the girl was on the waiting list when she died.
"It hit home. Her death showed the personal need we have here in Imperial County," Bejarano said. "Deaths are preventable. Asthma is reversible. If you have asthma, you should be able to live a healthy life."
What do the KGB and the former CEO of Cincinnati Children's Hospital have in common?
Eugene Litvak.
The Soviet intelligence agency and the children's hospital have each separately looked to the Ukrainian émigré with a PhD in mathematics for help. He turned down the KGB, but Litvak saved Cincinnati Children's Hospital more than $100 million a year.
For decades, Litvak has been on a mission to save U.S. hospitals money and improve the lives of doctors, nurses, and patients. He says he has just the formula to do it.
Prominent experts vouch for his model, and he has documented impressive results so far: financial savings, fewer hospital-related deaths, lower staff turnover, and shorter wait times. Still, Litvak and his allies have struggled to persuade more hospitals to try his method.
Host Dan Weissmann speaks with Litvak about his unique life story, how he found the fix that he says could revolutionize American hospitals, and why he won't stop fighting for it.
Millions of rural Americans live in counties with doctor shortages and where high-speed internet connections aren't adequate to access advanced telehealth services. A KFF Health News analysis found people in these 'dead zones' live sicker and die younger on average than their peers in well-connected regions.
The video was posted on Tuesday, June 3, 2025 in KFF Health News.
