��ϳԹ�� News

Backed by Threat of Clawbacks, Feds Wield Tight Grip on $50B Rural Health Fund

Sarah Jane Tribble — Tue, 16 Jun 2026 09:00:00 +0000

In Maine, state health officials hoped to steer a slice of $190 million in new federal rural health funding to shield hospitals and clinics from the fallout caused by cuts to federal health programs.

Their plan would have helped pay to treat low-income, uninsured patients.

But federal leaders overseeing the five-year, $50 billion Rural Health Transformation Program said no.

“It was not our decision,” said Lisa Letourneau, a senior adviser at Maine’s health department.

Letourneau told an audience of healthcare providers, advocates, and community groups during a March webinar that the change was “disappointing.”

Maine isn’t alone in having to make changes to plans pitched to win a share of the Trump administration’s new rural health fund.

Centers for Medicare & Medicaid Services Administrator Mehmet Oz when announcing the rural health program awards last year and said his agency would help states “turn their ideas into lasting improvements for rural families.”

But state officials and healthcare leaders said it’s also clear the agency wants to encourage specific policy changes and hold states accountable to the promises they made and rules they agreed to follow.

During the past six months, as states raced to meet the program’s looming federal deadlines, CMS staffers worked with state health departments to make a flurry of changes, including scrapping some initiatives. The federal agency to rescind existing funding — or reduce future awards — if states don’t follow rules or meet their goals. “We will take the money back” if states “don’t abide by what they wrote, if they don’t do a good job,” Oz said at an event this month in Washington, D.C.

Congressional Republicans created the Rural Health Transformation Program as a last-minute sweetener in their One Big Beautiful Bill Act last summer. The funding was intended to offset concerns about the anticipated in rural communities from the law, which is expected to reduce Medicaid spending by more than $900 billion over a decade.

Read an excerpt from the One Big Beautiful Bill Act.

Early-Onset Cancers Are on the Rise. Knowing Your Family History Is Crucial.

Cara Anthony — Tue, 16 Jun 2026 09:00:00 +0000

0:00 0:00

Produced in partnership with:

Volume Speed

Embed this player

Listen in and play along as hosts Cara Anthony and Blake Farmer test their knowledge with a HealthQ quiz on detecting early-onset cancers.

(Candice Evers for WPLN and ��ϳԹ�� News)

Bryce Ramsey of Madison, Mississippi, was 33 when she was diagnosed with colorectal cancer. Upon noticing blood in her stool, she blamed the hemorrhoids she’d developed after delivering her son eight years earlier.

Ramsey didn’t initially link her symptoms to cancer.

“But I had just kind of made a deal with myself because the blood was starting to become more frequent,” she said. “I was like, ‘If this happens the next time I go to the bathroom, I’m going to make a call.’”

She saw more blood, and she reached out to a gastrointestinal clinic to get it checked out, just in case. Her doctor said she normally wouldn’t scope someone Ramsey’s age, “‘but something in my gut is just telling me I need to do so,’” Ramsey recalled. “And thank God she did because she found a 5-centimeter polyp.”

Ramsey had surgery, endured chemotherapy, and survived stage 3 colon cancer. Now 40, she volunteers for the Colorectal Cancer Alliance, a nonprofit advocacy group, to raise awareness of early-onset colorectal cancer.

Stories like hers are becoming increasingly common: In the U.S., more than a dozen kinds of cancer are on the rise in adults under 50. , colorectal and breast cancers have increased the most, and colorectal cancer is now the deadliest cancer for Americans ages 18 to 49.

Here’s what to know about detecting early-onset cancers.

1. Family history is one of the most important risk factors.

Researchers have not been able to find a single cause for the rise in early-onset cancers. Instead, research suggests a myriad of factors play a role, including obesity, heavy alcohol use, environmental factors such as microplastics, and disruptions to gut health.

Doctors generally follow population-level guidelines for routine screenings — such as recommending mammograms starting at age 40 to screen for breast cancer — but physicians might recommend some patients get screenings as early as in their 20s. Doctors weigh a patient’s personal risks, including their family history of cancer.

Ramsey learned only after her diagnosis that her grandfather previously had colorectal cancer. “If I would’ve known that I had a significant family history, I would’ve been scoped a lot younger,” she said. “My doctor said my tumor had probably been growing for seven to 10 years.”

After her diagnosis, she encouraged her father, aunt, and brother to get screened. All three were diagnosed with colon cancer, too, and survived after receiving treatment.

Ramsey said it can be uncomfortable to urge family members to get tested or to talk with them about private health information, but those conversations are worth having to save a life.

“Just ask the question or make a joke about it. And sometimes just little icebreakers will help,” she said.

2. Report unusual symptoms as quickly as possible.

Being vigilant about unusual body changes or symptoms — and reporting those to your physician — gives doctors the information they need to determine your personal risk for cancer.

“For example, a lump in the breast, abdominal pain, changes in bowel habits that really are not going away,” said oncologist Veda Giri, director of the Early Onset Cancer Program at Yale Cancer Center. “Certainly blood in the stools. Sometimes even symptoms such as unusual fatigue that doesn’t seem to go away.”

“It’s incredibly important to bring symptoms to your doctor,” Giri said.

3. Talk, then test, then talk again.

Ads for at-home cancer tests are everywhere, so you might be tempted to use a screening kit instead of going in for an office visit or a standard screening, like a colonoscopy.

But not all tests are created equal, Giri said. It can be hard for laypeople to understand the accuracy of at-home screening kits, so they should talk to their doctor first.

“Some of these tests could lead to a false sense of either reassurance or false anxiety and alarm,” she said.

For people who decide to move forward with an at-home test, experts say they still need to consult with a physician. If you get any sort of abnormal result, your doctor is going to want to follow up with additional testing, such as a colonoscopy. Sharing your results, regardless of outcome, will help inform your care.

People and Policy

The U.S. Preventive Services Task Force recently changed the recommended age for women to begin mammogram screenings for breast cancer from 50 to 40. But there’s a difference of opinion among national advocacy and medical groups about whether regular screenings should happen every year or every other year.

In 2021, the same task force lowered the recommended age to 45 for a first colonoscopy for colon cancer detection for people with average risk. Establishing a relationship with a trusted medical practitioner can help patients assess personal risk and sort through new information as research and public health guidance evolve.

If you feel uncertain about your personal risk for cancer or when you should start cancer screenings, one of the best ways to advocate for your health is to establish a relationship with a medical practitioner you trust and ask specifically about your cancer risk. You can also ask to consult with a genetic cancer risk specialist, a type of medical provider who helps patients evaluate their cancer risk, often with genetic testing.

This installment is part of HealthQ’s reporting on caregiving among the sandwich generation. For more, check out the series archive.

Katherine Ruppelt and Emily Siner at Nashville Public Radio contributed to this report.

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

��ϳԹ�� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article/news/healthq-early-onset-cancers-family-history/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2249637&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Long-Awaited Rule Aims To Boost ACA Choices While Embracing Higher Deductibles

Julie Appleby — Mon, 15 Jun 2026 09:00:00 +0000

The Affordable Care Act seems to always be in a policy tug-of-war as its backers and critics spar over how it should work and who can qualify for coverage. This year is no different, with the Trump administration embracing standards it says will reduce fraud as well as steps that could further erode national enrollment.

Wide-ranging ACA changes pushed by the administration , including new offerings such as plans with 30% higher out-of-pocket costs, and others with no set networks of doctors and hospitals.

The administration says such plans expand consumers’ choices and may carry lower premiums.

The rule stated, though, that the combined effect of the new provisions could not only , but also reduce enrollment by up to an additional 2 million next year. That would come on top of this year because of higher premiums and smaller subsidy payments.

Over time, lower enrollment can boost premiums if insurers suspect their costs are rising because healthier people drop coverage more than sicker members do.

Some policy experts fear the changes will erode the ACA and make it more expensive, particularly for those whose subsidies have shrunk or disappeared.

“Even more people will lose coverage as healthcare costs and administrative burdens rise,” said Katie Keith, director of the Center for Health Policy and the Law at the Georgetown University Law Center, on changes to the ACA. “All of this comes at a time when millions of consumers are already experiencing a healthcare affordability crisis.”

The lengthy payment rule is an annual exercise in which the Centers for Medicare & Medicaid Services, which oversees the ACA, can set new standards for coverage. The rule for next year is more ambitious than in past years, with changes to how plans are designed, eligibility verification, and adjustments needed to implement congressional legislation, along with technical updates.

Here are some of its biggest changes.

Non-Network Plans

Starting in 2028, some Affordable Care Act consumers may be able to pick plans that don’t have dedicated networks of doctors and hospitals, which patients use to qualify for negotiated in-network payment rates.

Under this new model, enrollees would seek out providers willing to accept the amount their insurer will pay toward whatever nonemergency care they need, such as a sore throat, a doctor visit, or childbirth.

The rule requires insurers to have “a sufficient choice of providers that accept the non-network plan’s benefit amount as payment in full.”

Regulators say the policy aims to by getting consumers to “shop for lower prices and negotiate directly with providers.”

But how the plans will work — and how they will be monitored for having enough practitioners — isn’t yet clear, and that has raised concerns with some experts who say non-network plans might chip away at ACA safeguards intended to ensure enough medical providers are available in a given area. Patients could also find themselves on the hook financially when they find their doctor or hospital charges more than the insurer will reimburse.

Economist Matthew Fiedler, a senior fellow at the Brookings Institution, pointed out another potential pitfall with this approach.

“ whether enough providers are willing to accept the plan’s rates,” he wrote in a comment letter to regulators. “If this is the case, non-network plans likely would offer lower premiums, mainly by paying lower prices for care and making accessing care harder.”

There will likely be variation by state in how such plans must prove they have an adequate number of care providers willing to accept amounts as payment in full, said Louise Norris, a health policy analyst for healthinsurance.org, a consumer information and referral website affiliated with Trove Group.

“I would put a big buyer-beware notice on non-network plans,” she told ��ϳԹ�� News. “Consumers will need an understanding of how this will work, and also it puts the onus on the consumer to find out what the provider is charging.”

But other viewpoints, including from the Paragon Health Institute, a conservative think tank, consider the non-network plans a step forward for transparency and competition because they empower consumers.

“When consumers can see what the plan will pay and how provider prices vary, they have incentives to shop,” noted .

It will take time and more federal guidance, though, before it becomes clear what additional requirements these plans will face and how many insurers will decide to offer them. Some clues can be found in non-network plans sold by Ohio-based Sidecar Health, which offers such coverage in Ohio, Florida, Georgia, and Texas with enrollees in 48 states — but only for employer plans.

Click to read more about how this kind of coverage works Non-Network Plans: A Real-Life Example

They’re Uninsured After Obamacare Became Too Costly. And They’re Far From Alone.

Andrew Jones — Mon, 15 Jun 2026 09:00:00 +0000

SUGAR GROVE, N.C. — Year after year, Ross and Rebecca Tobiassen saw their healthcare costs rise, having relied on the Affordable Care Act for federally subsidized health insurance since its start in 2014. Year after year, the couple in western North Carolina kept their coverage, believing the peace of mind was worth the cost.

But in December, that changed. The Tobiassens decided to cancel their insurance when Rebecca saw the cost of their monthly premiums would jump from $130 to more than $550.

“It makes no sense,” she said. “It’s not worth it anymore.”

The couple own and are the only employees of a small auto shop just west of Appalachian State University in the North Carolina mountains. Rebecca worries about her husband, whose work as a mechanic can be dangerous. A spring once shot a metal ball joint into their garage wall like a gun. A heavy object crushed Ross’ thumb. In 2020, Ross became mostly blind in one eye after repeatedly getting metal shards in it and developing an infection in his cornea.

The Tobiassens are among the Americans who canceled their ACA coverage after Congress allowed enhanced tax credits that helped pay for insurance plans to expire at the end of 2025. The Tobiassens benefited from those tax credits — like expected to drop or be dropped from their coverage as the year progresses, unable to keep up with the higher costs.

Established by the Biden administration’s American Rescue Plan Act during the covid pandemic, the expanded subsidies reduced monthly premiums for many families and prompted a tidal wave of new sign-ups, doubling ACA enrollment to .

The Centers for Medicare & Medicaid Services is expected to on how many people are no longer covered under the ACA, but an , citing Wakely Consulting Group research, showed enrollment could drop from over 22 million at the end of 2025 to as low as 16.5 million in 2026.

In North Carolina, individual ACA sign-ups for 2026 were down 22% compared with the year before, a greater drop than any other state, amounting to a decrease of more than 213,000 people, . While the Tobiassens’ two teenage daughters remain on Medicaid, Rebecca said the new prices showed that the federal government doesn’t care about families like hers.

“We’ve known that you don’t care about us,” she said, “but you’re making it plain and simple now.”

Ross Tobiassen became mostly blind in his left eye after repeatedly getting metal shards in it while at work in his auto shop and developing an infection in the cornea. (Andrew Jones/��ϳԹ�� News)

The couple’s insurance hadn’t helped them cover all their medical needs. When the pain from Ross’ eye infection worsened five years ago, Rebecca insisted he go to a specialist, who told them that fixing the eye through cornea replacement surgery and require Ross to take six months off.

Ross chose a less expensive treatment to kill nerves in the eye instead.

The couple know they’re taking a risk by not being insured. If something were to happen, they could face an enormous medical bill.

Ross, 47, said the blindness in the one eye doesn’t significantly affect his job. He works long hours, sometimes into the night to keep up with demand.

“I try not to think about it too much,” he said. “I just work.”

Uninsured, With No Backup Plan, After Obamacare Became Unaffordable

Rebecca Tobiassen, 44
Sugar Grove, North Carolina

Rebecca Tobiassen owns a small auto repair shop with her husband, Ross, in the western North Carolina mountains. She says their family could no longer afford Affordable Care Act insurance after tax credits expired last year and their monthly premiums shot up from $130 to more than $550. They have no immediate plans to sign up for coverage elsewhere and are saving up for out-of-pocket expenses instead. “We just need to be able to afford to get help when we seriously hurt ourselves,” she said of the U.S. healthcare system.

Katie Alexander oversees volunteers for Pisgah Legal Services, a western North Carolina nonprofit that helps low-income people secure health insurance. Alexander has helped North Carolina and Tennessee residents try to get ACA marketplace plans since Obamacare’s launch. She said she’s never seen anything like this year.

Nearly 100 Pisgah clients, out of about 700 that Alexander’s team worked with during open enrollment, decided to drop insurance this year, and many others chose cheaper ACA plans with less coverage, Alexander said.

Alexander said the people who have dropped their coverage include Lyft and Uber drivers. They’re trying to start their own businesses. They are artists and people who can work only part-time, because they’re chronically ill. Some are unable to get insurance through their employers, or they make too much to be on Medicaid.

“Even for folks who don’t have chronic illnesses,” Alexander said, “there’s just this nagging at the back of your mind, kind of constantly, of: ‘Don’t get hurt. Don’t get sick. Because you can’t afford that.’”

ACA premiums and deductibles steadily increased for years starting in 2022, then spiked during the enrollment period for 2026 plans, . The Tobiassens have seen every dip and rise in plan costs since 2014 when the plans launched. They joined immediately and paid about $30 a month, Rebecca Tobiassen said.

“You actually felt like you were benefiting,” she said.

But through the years as the marketplace became more expensive, the couple made concessions, switching at one point from a silver plan — historically the — to a bronze. The plan mostly provided for the couple’s basic needs.

As they saw their deductibles and premiums rise over more than a decade, Rebecca feared the day would come when they could no longer afford even the cheapest plan.

“Plans are unaffordable, no matter how you cut it,” said , a healthcare policy researcher at the University of Colorado Anschutz School of Medicine. “It’s just who is shouldering the unaffordability.”

Ross Tobiassen built his auto shop, which he owns with his wife, next to his home on his property in western North Carolina. (Andrew Jones/��ϳԹ�� News)

Ross Tobiassen says his job as a mechanic can be dangerous — he works late into the evenings sometimes to keep up with demand. (Andrew Jones/��ϳԹ�� News)

Gidwani and health economist , in a , found that most bronze plans, the cheapest ACA options for many, would be unaffordable without subsidies for the average person using the federal healthcare coverage.

Without subsidies, many families using these plans don’t make enough to afford premiums or deductibles, Gidwani’s research shows.

People who drop health insurance also change what’s known as the “risk pool,” Gidwani said, when a group of people share financial hazards.

If healthier people drop out of the risk pool, fewer people subsidize the people who get sick, Gidwani said. That means premiums for the people who get sick will increase again in the future, she added.

“That becomes what we call a death spiral,” Gidwani said.

Even if the subsidies hadn’t expired, taxpayers would have borne an estimated over the next decade to cover them, Gidwani’s study noted.

After dropping coverage they’d relied on for 11 years, the Tobiassens have no plans to return to the ACA marketplace. They looked into alternative options through a faith-based healthcare organization but decided to go without.

For now, they don’t have a plan B. They’ve set aside some money for a medical emergency. And if their savings run out, Rebecca Tobiassen said, they have a couple of last resorts to lean on: credit cards or family members.

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact ��ϳԹ�� News and share your story.

This article/insurance/uninsured-obamacare-affordable-care-act-aca-canceled-coverage-north-carolina/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2248771&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Journalists Highlight Medical Neglect in ICE Detention, RFK Jr. Antidepressant Comments

Sat, 13 Jun 2026 09:00:00 +0000

��ϳԹ�� News chief Washington correspondent Julie Rovner discussed Health and Human Services Secretary Robert F. Kennedy Jr.’s position on antidepressants on WAMU’s 1A on June 10.

��ϳԹ�� News journalist Rae Ellen Bichell discussed, on WBUR’s Here & Now on June 10, a recent investigation that found immigration facilities aren’t providing adequate medical care.

.
Read Bichell’s “Festering Infections to Untreated Cancer: ICE Detainees Describe Medical Neglect Across US,” reported with Maia Rosenfeld and Renuka Rayasam and in collaboration with The Associated Press.

��ϳԹ�� News national public health correspondent Amy Maxmen discussed the Ebola outbreak in the Democratic Republic of Congo on WNYC’s The Brian Lehrer Show on June 9.

.
Read Maxmen’s “‘We Live With Fear’: In Congo, Doctors Face Ebola With Little Protection.”

Céline Gounder, ��ϳԹ�� News’ editor-at-large for public health, discussed on Fox’s LiveNow on June 8 how public health experts are preparing for the World Cup.

Elisabeth Rosenthal, ��ϳԹ�� News’ senior contributing editor for health news analysis and author of the bestseller An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, discussed the challenges of reforming the American healthcare system on NBC’s Dateline on June 5.

This article/on-air/on-air-june-13-2026-antidepressants-ice-medical-neglect-ebola-world-cup/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2249751&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

California Health Worker Union, Hospital Association Tout Dueling Ballot Initiatives

Bernard J. Wolfson — Fri, 12 Jun 2026 18:30:00 +0000

The issue of affordability has reignited a long-simmering 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 future political initiatives by requiring a union’s rank-and-file membership to approve any spending of at least $1 million on statewide measures or $100,000 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 failed proposals to cap healthcare executive compensation.

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 that he and his colleagues need to do their jobs.

But that’s not how hospital officials see it. 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.

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. SEIU-UHW does not have an estimate of the amount the initiative would claw back from pay packages that exceed the limit. And the initiative does not stipulate how dollars diverted from payroll must be spent.

The union has dubbed the 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.

And Glenn Melnick, a healthcare economist at the University of Southern California, said that even if the initiative were fully implemented, he doubts it would reduce patients’ healthcare costs.

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.

Looming Medicaid Cuts Supercharge California’s Latest Labor-Industry Fight

One of California’s largest healthcare unions is sponsoring two initiatives that would regulate community clinics and cap executive and managerial pay at hospitals and physician groups. In the most recent eruption of a long-standing feud, the measures have drawn fierce opposition from a wide swath of the medical industry.

By Bernard J. Wolfson June 10, 2026

This article/health-industry/the-week-in-brief-california-dueling-ballot-initiatives-union-hospital-association/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2249686&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

1 in 4 Covered California Enrollees Could Get State Aid Under Newsom Proposal

Christine Mai-Duc — Fri, 12 Jun 2026 09:00:00 +0000

0:00 0:00

Produced in partnership with:

Volume Speed

Embed this player

When Congress allowed covid-era subsidies for health insurance to expire, California used its own funds to offset the hike in Obamacare premium costs for residents with low incomes.

But the reach has been limited.

As Gov. Gavin Newsom negotiates his last budget with the legislature, the Democrat wants to offer financial help to more than 1 in 4 enrollees in Covered California, the nation’s largest state-run health insurance marketplace. Democratic lawmakers, who hold a supermajority, are still debating the plan.

“My budget proposal would KEEP $0 monthly plans for low-income Californians to help clean up the financial disaster Trump created,” Newsom , where he often chides the president and GOP Congress.

have put up their own funds to keep Affordable Care Act plans affordable and residents insured as the rising cost of healthcare has emerged as a among voters. Newsom’s $300 million proposal would make California’s program among the most generous, but even the nation’s richest state can’t patch a left by the expiration of enhanced subsides at the end of last year.

“The gap between what people can pay in their monthly budget and what health insurance costs is so big that it’s a lot for states to take on,” said , a senior research fellow at the Center on Health Insurance Reforms at Georgetown University. “They’re going to have to figure out how they can finance that.”

New Mexico lawmakers have of the lost federal subsidies with state money. It seems to have worked; New Mexico saw in marketplace enrollment this year, but state analysts that the subsidy program isn’t sustainable.

and , which, like California, tax residents , are also spending hundreds of millions of dollars to try to keep premium payments low. Their hope, healthcare experts say, is to avoid the exodus seen in states such as Georgia that didn’t offer enrollees help.

Since the enhanced subsidies expired, have seen their premium payments increase by $65 a month on average.

Conservatives including have long argued that the subsidy expansion was too generous to high-income enrollees and .

“There are never enough subsidies to make health insurance affordable because subsidies are the problem,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute. “They are causing people to turn a blind eye to fraud and waste and excessive prices because it’s someone else’s money that they’re spending, not their own.”

Helping the Poorest?

People who earn too much to qualify for Medicaid got relief starting in January after Newsom and legislators softened the blow for about 300,000 of the lowest-income enrollees. They offset lost federal premium tax credits for individuals who last year and partially filled the gap for those who earned up to $25,823.

The governor now wants to expand subsidies to those who earn up to $31,920 this year for an individual and $66,000 for a family of four — an estimated 218,000 additional people.

Veronica and William Walter, who live in the San Francisco Bay Area, earn less than $40,000 a year in one of the nation’s most expensive regions. They’re counting on a more generous state healthcare tax credit if they have to pay for health insurance next year.

Veronica Walter says she wouldn’t be able to afford the nearly $200 monthly premium for health insurance that she and her husband would likely pay on Covered California, even after a proposed expansion of state subsidies. (Christine Mai-Duc/��ϳԹ�� News)

A car accident two years ago left William temporarily disabled, qualifying the couple for Medi-Cal, the state’s Medicaid program.

Now he’s back at work as a security guard, and Veronica said she’s worried they’ll be kicked off Medi-Cal. She’s even more worried about how they’ll get by with federal premium tax credits not nearly as generous as before.

“Without it, we’re going to be facing worse problems than we have now,” she said. Under Newsom’s proposal, Veronica and others in the highest eligible income bracket could receive an average monthly subsidy of $36 a person.

“For them, $36 a month is the sort of thing that can make a difference between keeping coverage and losing coverage,” said Peter Lee, former executive director of Covered California. “We can’t fix everything with that gap, but we can focus the dollars on those who need it most.”

The Walter family, though, may still face a nearly $200 monthly premium payment to cover both of them, $130 more than they previously paid for healthcare and prescriptions through Covered California.

“I can’t afford that, not really,” said Veronica, a pet sitter who works part-time at a school. “A giant state like this with this many people, and this many resources? You can’t just leave the people with nothing for healthcare or healthcare they can’t afford.”

California policy researchers and health advocates acknowledge the limits of a partial subsidy but say that concentrating funds on those who earn less is the most efficient way to maximize impact. People who drop coverage are , healthier, and less likely to have high healthcare costs — all factors that help stabilize the insurance risk pool. Without coverage, Lee said, they’re also more likely to experience debt from medical emergencies or leave unpaid hospital bills that strain the .

Cary Sanders, senior policy director at the California Pan-Ethnic Health Network, a health advocacy group, said the state’s move last year kept low-income enrollment in Covered California steady and reduced racial disparities in coverage.

“It’s working; it’s just that it’s not enough,” Sanders said. “We need the federal subsidies back.”

Still No Help for Many

When Congress passed enhanced subsidies in 2021, it capped monthly premium payments for even the highest earners at 8.5% of income. Those temporary enhancements allowed about 8 million Americans to choose robust plans with no monthly premium payment last year and helped double Obamacare enrollment to of 24 million.

At the end of last year, 22 million of them lost that help when the GOP-led Congress blocked the extension.

The pressures on Obamacare enrollees don’t stop at premiums. Federal legislation Republicans passed last summer known as the also shortens enrollment windows, tightens income verification requirements for subsidies, and requires enrollees who earn more than they projected to pay back the full amount.

Even if Newsom’s proposal passes, most Covered California customers won’t get state help. Nearly 1 million enrollees — 52% — earn above the $31,300-a-year individual earning cutoff.

Victoria Garzouzi was one of many middle-income retirees hit with one of the most extreme premium increases: The monthly payment for her low-level bronze plan jumped eightfold to $1,600.

To make ends meet, she came out of retirement and dipped into her savings. “I’m working to pay for my insurance,” she said. “I am an army of one.”

Despite a $6,000 deductible, her health insurance premium payment is more than the mortgage on her two-bedroom house. She’s putting off a needed cataract surgery until October, when she turns 65 and qualifies for Medicare.

While GOP leaders have not publicly weighed in on the state subsidies, some Democratic lawmakers have questioned why more help hasn’t been proposed.

Assembly member Dawn Addis, who chairs the chamber’s budget subcommittee on health, suggested Newsom could tap an additional $230 million from a fund for healthcare cost relief — money raised from a state penalty levied on those who can afford to enroll in health insurance but choose not to.

Lawmakers have previously criticized state officials for socking away much of the penalty revenue, which was supposed to go toward healthcare affordability. After California discontinued its premium subsidies thanks to increased federal assistance, the Newsom administration said the state was saving to help consumers once those temporary subsidies expired. Instead, California borrowed from the subsidy fund to cover state budget shortfalls, to the tune of $771 million. Starting this year, the subsidy fund should see an influx of cash as the state pays back the loan.

At a May legislative hearing, Joseph Donaldson, then a Department of Finance analyst, said maintaining the reserve was a prudent and financially sustainable approach.

Dylan Roby, a public health professor at the University of California-Irvine who consults for Covered California, said the focus on lower-income enrollees is deliberate. They qualify for federal subsidies that higher earners don’t, maximizing federal investment and strengthening the broader system.

“You end up with more advanced premium tax credits flowing into the state that you would have been leaving on the table,” he said.

State lawmakers have until June 15 to pass a state budget. Then, Covered California’s board would decide eligibility and benefit amounts, a decision that could come this summer, with new subsidies starting Jan. 1.

Even with the extra help, Walter and her husband worry they won’t be able to afford a potential $200 monthly premium payment. Walter said she’d likely have to rely on free clinics or ration medications.

“I take so many pills, I rattle,” she said. “That, on top of the $200? For us, it really adds up.”

A pet sitter and part-time school employee, Veronica Walter is worried she and her husband wouldn’t be able to afford monthly health insurance premiums next year even with more generous state subsidies. (Christine Mai-Duc/��ϳԹ�� News)

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here  to contact ��ϳԹ�� News and share your story.

This article/insurance/covered-california-aca-obamacare-insurance-premium-subsidies-affordability/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2246828&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Final Rules for Medicaid Work Requirements Are Out. Here’s What You Need To Know.

Sam Whitehead — Fri, 12 Jun 2026 09:00:00 +0000

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.

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 ��ϳԹ�� 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.”

��ϳԹ�� 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 ��ϳԹ�� News.

This article/medicaid/medicaid-work-requirements-final-rules-exemptions-trump-cms/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2249726&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Listen to the Latest ‘��ϳԹ�� News Minute’

Thu, 11 Jun 2026 09:00:10 +0000

June 11

Sam Whitehead reads the week’s news: More Americans are getting access to physician-assisted suicide as states legalize the practice. Plus, hundreds of people allege medical neglect in ICE detention centers.

0:00 0:00

Volume Speed

June 4

Arielle Zionts [arr-ee-ELL ZY-ence] reads the week’s news: For some older adults, the risks of certain preventive screenings might outweigh the rewards. Plus, cost spikes for Obamacare plans have consumers seeking cheaper health coverage, which is often less comprehensive.

0:00 0:00

Volume Speed

May 28

Jackie Fortiér [FOR-tee-ay] reads this week’s news: Suicide prevention experts argue that improving Americans’ financial well-being could save lives. Plus, the Trump administration proposes looser artificial intelligence safeguards to speed innovation in healthcare.

0:00 0:00

Volume Speed

The ��ϳԹ�� News Minute is available every Thursday via direct download or the RSS feed.

This article/news/listen-kff-health-news-minute-2026/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2242497&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

Trump Bought Tobacco Stocks and Raked In Industry Donations as FDA Eased Standards

Darius Tahir — Thu, 11 Jun 2026 09:00:00 +0000

President Donald Trump, who once declared he had “saved” flavored vapes, grew his stock holdings this year to as much as $1.64 million in tobacco giant Philip Morris.

He also had holdings in Altria and a third leading tobacco company, though an apparent discrepancy in his disclosures clouds the extent of his investments. In 2025, tobacco interests donated $6 million to MAGA Inc., a super PAC that supports the president, and Trump’s inauguration. And, on April 30, a week before FDA guidance that provided a critical boost to the industry, Reynolds American dropped an additional $5 million into the super PAC’s coffers.

The stock trades and political contributions occurred as the Trump administration pursued a broadly pro-tobacco agenda: Its FDA piloted a fast-track program to approve nicotine pouches. It unveiled a program to allow vapes on the market more rapidly, despite resistance from career civil servants and leadership, culminating this year in guidance waving through flavored electronic cigarettes. It cut public health employees focusing on anti-tobacco policy. And it broadened enforcement against illicit e-cigarettes, competitors to the big industry players with a financial relationship to Trump.

It amounts to the most pro-tobacco, pro-nicotine presidency in some time — a remarkable policy given the tens of millions of deaths cigarettes caused during the 20th century. Even in recent years, anti-smoking groups say a half-million Americans a year die from cigarettes. Industry advocates say the toll helps justify a shift to e-cigarettes and nicotine pouches, which they say are less harmful. However, public health advocates say these products carry their own risks, such as addiction.

Lawmakers and public health leaders have criticized the recent FDA guidance and approvals as a “” that ignored scientific evidence to deliver what investment analysts have described as “very positive” steps for influential tobacco companies.

The scale of the money is “unprecedented and problematic,” said Brian King, who was pushed out of the FDA’s tobacco office last April and now works as an executive at the Campaign for Tobacco-Free Kids. He fears that steering public policy toward tobacco — still addictive and harmful to health — puts Americans at risk.

“It’s a gift on a platter with a side of public health malpractice,” he said.

The White House did not comment on the president’s investments or industry donations to MAGA Inc. Spokesperson Kush Desai said, “The only guiding factor behind the Trump administration’s health policymaking is Gold Standard Science. FDA’s regulatory treatment of nicotine pouches and vapes is rooted in recent evidence that has found that these products can help adults quit smoking.”

Philip Morris disputed any connection. Company representatives “regularly attend events and forums where we share our commitment to improving public health in the United States,” spokesperson Samuel Dashiell said, “starting with providing better options to America’s 45 million legal-age nicotine consumers.”

“We do not comment on individual engagements or on the personal financial matters or disclosures of public officials,” he added.

Other tobacco companies whose stock Trump has bought and sold during his second term or that donated to groups aligned with Trump — Juul, Reynolds American, and Altria — did not respond to requests for comment.

The financial stakes are huge. Investment analysts at Goldman Sachs say the newer products, touted as safer, make more money per sale than traditional cigarettes. Philip Morris expects Zyn pouches, for example, to make eight times the gross profits of its cigarettes, Goldman Sachs analysts said in March 2025.

When he ran for his second term, Trump promoted himself as a pro-tobacco candidate, posting that he had and that President Joe Biden and Democratic nominee Kamala Harris “want everything banned.”

Since late 2023, MAGA Inc. has received over $20 million in funding from the industry, federal campaign records show. Trump’s inauguration garnered nearly $4 million more. His ballroom project donations of an unknown amount from Altria and Reynolds American.

Recent Trump administration actions show he’s followed through with his campaign rhetoric. In May, the FDA released that allows manufacturers to market their vapes and nicotine pouches while awaiting agency approval. It also approved several vaping products. The month before, the Vapor Technology Association, which donated $1.25 million to Trump’s inauguration, it had met with the White House to discuss its concerns.

By that point, Trump had gone on a stock-purchasing spree. In March he made eight separate purchases of Philip Morris or Altria stock, worth as much as $275,000, according to a disclosure form that bears Trump’s signature.

It is difficult to be precise about Trump’s tobacco investments, because the financial disclosures show only ranges of investment amounts. They also have an apparent discrepancy. In January, the president sold $500,000 to $1,000,000 in Altria stock. But that’s confusing because previous disclosures didn’t show Trump held that much equity in Altria. The White House declined to comment on the matter.

The FDA’s May guidance and approvals drew condemnation from public health leaders, who worry that the agency is allowing products with flavors especially appealing to young people. “After years of recognizing the dangers flavored e-cigarettes pose to youth, it is deeply troubling to see FDA ignore the scientific evidence and reverse course,” American Lung Association CEO Harold Wimmer said .

“I think it’s blatantly illegal, both on its merits and also procedurally, because it was issued as a final guidance without even giving the public an opportunity to comment on it,” said Mitch Zeller, a former head of the FDA’s tobacco center.

A group of Democratic senators called the decision a “a free pass to addictive and harmful vapes” in letters to Reynolds American and Altria. It would lead to “a lucrative payday after years of unsuccessful legislative and regulatory efforts to weaken federal tobacco oversight,” they concluded.

Members of Congress are barred from insider trading, and many legislators would like to see trading of individual company stocks banned for all members. In the wake of Trump’s most recent financial disclosures, with revelations that he often traded in companies manufacturing GLP-1 drugs before his administration steered policy in a favorable direction, some members are calling for the president, too, to be barred from stock trading.

Trump’s tobacco policies have garnered favorable grades from investors. At Goldman Sachs, bankers described the May FDA guidance as “very positive” for Philip Morris and “a significant step in the FDA’s positioning toward enforcement and acceptance of nic pouch (as well as e-vapor) innovation generally.”

And Barclays analysts said the FDA’s guidance was good news for Juul, a leading vape producer. (In November, the company contributed $1 million to MAGA Inc.)

FDA resistance to speeding up approvals for these products reportedly contributed to the ouster of agency commissioner Marty Makary, who did not respond to requests for comment. According to and , the White House repeatedly intervened in the approval process.

“I served during the entire first Trump administration as center director, and there was never any pressure from any political appointee at FDA, at HHS, or the White House when it came to application review,” Zeller said.

But recent changes in FDA policy can be traced to the access tobacco firms have had to the White House, he said.

By and large, the Trump administration has delivered on industry priorities. Soon after the inauguration — which tobacco companies had donated heavily to — the administration withdrew a Biden-era proposal to ban menthol cigarettes. The administration has eased the path for nicotine pouches like Zyn, which were first approved under Biden. Investment analysts viewed government crackdowns on illicit e-cigarettes positively: Barclays wrote in January that “company commentary on enforcement has also been upbeat, suggesting that the tide could begin to turn in favour of the legal players in the market.”

What’s more, the Trump administration’s government layoffs have decimated public health’s tobacco control offices. The work of the Centers for Disease Control and Prevention’s office of smoking has been sharply curtailed; its flagship “Tips From Former Smokers” campaign, which seeks to persuade viewers not to smoke, has been off the air for months, King said.

“It’s not difficult to see that less dollars invested in prevention and control is going to lead to more tobacco product use and tobacco-related disease,” King said, especially given the government’s decades-long success in reducing cigarette usage.

The shift is particularly ironic given the administration’s focus — through its Make America Healthy Again slogan — on chronic disease. “Attempting to combat chronic disease without tobacco control is like attempting a triathlon without a bicycle: You are destined for failure before leaving the starting line,” King concluded.

This article/courts/fda-tobacco-vape-vaping-ecigarette-smoking-trump-investments-maga-donations/">article; first appeared on KFF" rel="nofollow">">KFF Health News and is republished here under a

/?republication-pixel=true&post=2249297&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">

���ϳԹ��� News

Backed by Threat of Clawbacks, Feds Wield Tight Grip on $50B Rural Health Fund

Early-Onset Cancers Are on the Rise. Knowing Your Family History Is Crucial.

Long-Awaited Rule Aims To Boost ACA Choices While Embracing Higher Deductibles

They’re Uninsured After Obamacare Became Too Costly. And They’re Far From Alone.

Journalists Highlight Medical Neglect in ICE Detention, RFK Jr. Antidepressant Comments

California Health Worker Union, Hospital Association Tout Dueling Ballot Initiatives

Looming Medicaid Cuts Supercharge California’s Latest Labor-Industry Fight

1 in 4 Covered California Enrollees Could Get State Aid Under Newsom Proposal

Final Rules for Medicaid Work Requirements Are Out. Here’s What You Need To Know.

Listen to the Latest ‘���ϳԹ��� News Minute’

Trump Bought Tobacco Stocks and Raked In Industry Donations as FDA Eased Standards

��ϳԹ�� News

Listen to the Latest ‘��ϳԹ�� News Minute’