Who Really Collects in the Wage Garnishment Game?

I was a consumer bankruptcy attorney for years during the global financial crisis of 2008 (pre-Affordable Care Act). Around 40% of the bankruptcies were caused by medical debts uncovered by insurance. With the effectiveness of the ACA, the number of bankruptcies in Colorado plummeted.

My comment on “State Lawmakers Seek Restraints on Wage Garnishment for Medical Debt” (Feb. 20)? BC Services acts as if it is garnishing these wages to keep rural hospitals, medical providers, etc. in business. The likely reality is that BC Services (and other collection operations) takes “90-day-overdue” bills — which may or may not have ever been delivered to the patient; usually disregards whether the hospital has offered the patient a reasonable repayment schedule; and then keeps 50% or more of the debt, along with its attorneys’ fees and costs. The medical provider receives very little of the money sent to collections.

— Bill Myers, Denver

On Work Requirements: Working Out Solutions

Eighty hours a month works out to about 20 hours a week, and I think if people can work or study from home, they should be able to meet the requirements (“New Medicaid Work Rules Likely To Hit Middle-Aged Adults Hard,” Feb. 11). More importantly, though, “navigators” will help people get exemptions if they qualify. I wonder why there is so much moaning about the law and nothing about the means to fix the problems it creates. It seems like a lot of hot air. We know it’s a problem. So how about exploring solutions?

— Therese Shellabarger, North Hollywood, California

The Flip Side of a Drug’s Benefits

I read Phillip Reese’s report on anti-anxiety medications, adults who take them, and their concerns about this administration’s policies regarding them (“As More Americans Embrace Anxiety Treatment, MAHA Derides Medications,” Feb. 23). If the anti-anxiety medications provide solace to adults such as Sadia Zapp — a 40-year-old woman who survived cancer — then she should be able to continue them. Unfortunately, the same is not true for many other people, particularly patients such as myself.

When I was 16, I went through an unnecessarily painful and traumatic year. I was sent away from home three times, sent to a wilderness therapy “troubled teen industry” camp that has now been shut down, sent to a new boarding school that I hated, and was away from my family for many months. Of course, I felt depressed and anxious, so my psychiatrist at Kaiser prescribed citalopram. At first, it caused extreme agitation and violent ideation, stuff that is commonly reported to the point it has an . Thankfully, it calmed down. And when I lowered the dose, my life was calm, stable, and productive.

Unfortunately, that did not last long. Over time, the effects wore out, so I tried to go off. I was not given any safety instructions on how to taper slowly and safely, so I went off multiple times. Each time caused extreme withdrawal symptoms, including self-harm, crying spells, and worse depression than ever before. Also, the sexual “side effects” persisted and even worsened upon cessation to this day. It is a , and it is very rarely covered. While the worst symptoms of withdrawal went away, I still live with a worsened sexuality than a young adult my age is supposed to have.

Back to the article, which seems to focus on adults. Its only named profile is Zapp, and when it cites statistics, it begins at age 18. Solely showing statistics of adults is unethical because it obscures the high and rising prescription rates among minors. Minors are also more likely to suffer permanent developmental damage to their sexualities and experience suicidal ideation. This is a major problem that warrants further conversations.

When covering the downsides of SSRIs, the article mentioned only mild side effects, like upset stomach, decreased libido, and mild discontinuation effects, without covering the major concerns of suicidal ideation, akathisia, PSSD, and severe withdrawal. I believe that framing antidepressants as an unequivocal good is equivalent to framing them as an unequivocal evil; both misguide patients through harm and deception.

Lastly, I want to finish on this by the brilliant psychiatrist Awais Aftab.

— Eli Malakoff, San Francisco

A Rigged System?

Insurers pay these exorbitant amounts because they set them in the first place (Bill of the Month: “Even Patients Are Shocked by the Prices Their Insurers Will Pay — And It Costs All of Us,” March 3). They have been doing this for years. I learned this over 15 years ago, when I dislocated and broke my elbow. I had no insurance and, as a “self-pay” patient, paid the surgeon, hospital, and radiology center myself. They set the prices high enough that people will buy insurance out of fear, ensuring they make a profit.

The first thing I learned was that there is not a set price for all; for the insured, it is a fixed system controlled by contracts and codes. As a self-pay patient, the cost may vary.

It was late in the evening and I tripped over a snow shovel, slammed my arm up against a gate post, and it was hanging like a puppet without a string! I called an ambulance and, at the hospital, they strapped me up and told me that I must see the orthopedic surgeon the next day. He sent me to a radiology facility for an X-ray; I paid for it and took it to the surgeon. When I received a bill from the radiology center, I called to say that I had paid. They said it was for the radiologist (who, as far as I knew, never analyzed it). The contract with the insurance company required that every patient had to be billed, whether or not a radiologist reviewed scans. If not, they would lose their contract.

My elbow was dislocated, with a fracture, and I needed surgery. The surgeon’s office called the hospital for pricing, and he told me it would be about $2,000 for outpatient surgery. I called the hospital to confirm the appointment for outpatient surgery, and they wanted $8,000! When I objected, and told them what the surgeon had quoted, they checked. “Oh, you are a self-pay!” Cost would be $2,000. I gave them my card number and prepaid it before they could change their minds.

I had a friend in New Jersey who had the very same injury and surgery. She had insurance through her employer, and she paid more in copays than I paid when paying directly.

Insurance companies are SHARKS!

— Stephanie Hunt-Crowley, Chamberet, Nouvelle Aquitaine, France (formerly Frederick, Maryland)

US vs. Canada

Re: the article about nurses moving to Canada (“‘You Aren’t Trapped’: Hundreds of US Nurses Choose Canada Over Trump’s America,” Feb. 26). You neglect the “rest of the story” — or maybe you don’t know it? I had my medical office in Los Angeles for about 30 years and had dozens of Canadians come to L.A., where some had to self-pay for care, but chose to because of the superior level of medicine available. One man, a son of a gynecologist in Canada, had a draining abscess from a years-old appendectomy. The reason was, after investigation, that the Canadian practice had used silk suture (organic material), which can harbor microbes and carry a greater risk of infection. The trend has been to discontinue silk in favor of nylon. The Canadians were obliged to “use up” the silk suture they had before switching to nylon. The surgeons at my hospital were astounded.

— Kathryn Sobieski, Jackson, Wyoming

On the NET Recovery Device’s Track Record — And Detractors

I read your piece about the NET Recovery device with interest (Payback: Tracking Opioid Cash: “Maker of Device To Treat Addiction Withdrawal Seeks Counties’ Opioid Settlement Cash,” March 18), and I am grateful to you for pointing to one of our many success stories — the story of Michelle Warfield, whom the NET device helped get off opioids.

I also wanted to note a couple of instances where I see the facts differently than they were portrayed in your piece. Your piece seemed to imply that the NET device is new, and I wanted to note that the device has been around for decades (it helped Eric Clapton and members of The Who and the Rolling Stones get sober back in their heyday), and is based on a proven technology that stimulates both the brain and the vagus nerve to help patients with their cravings and withdrawal. There are countless studies that prove the power of neurostimulation, including that showed significant reductions in opioid and stimulant use without medication for a polysubstance population receiving at least 24 hours of stimulation.

I also noted you quoted detractors of our device, and I’d simply urge anyone looking at the issue of opioid addiction abatement to consider who those detractors are; organizations that now find themselves competing for grant dollars from counties increasingly choosing to fund innovation. It is not surprising that those with the most to lose financially would prefer the status quo. But the counties and jails leading this charge are doing so because they have seen what works, and their constituents, real patients, are the proof.

The success stories of our patients speak for themselves, and our only motivation at NET Recovery is to help as many people as possible get truly clean and sober by helping to break that initial grip the opioids have on them. When the NET device works, and it works an astounding 98% of the time (producing a clinically meaningful reduction in opioid withdrawal symptom severity in one hour), our patients are experiencing the return of choice and true freedom.

Thank you for your interest in our work and for the coverage you provide.

— Joe Winston, NET Recovery CEO, Costa Mesa, California

Education Is the First Step in Lowering Health Care Prices

After reading this article about making hospital prices more transparent, I realized the information alone could help drive medical prices down (“Trump Required Hospitals To Post Their Prices for Patients. Mostly It’s the Industry Using the Data,” Feb. 17). Your publication shows good use of evidence-based research — it’s timeless and informative.

As a student at Thomas Jefferson University on the path to serving in the health care arena, I understand the struggles and complexities of medical decision-making. In the medical setting, the topic of price is always overshadowed by patient care and clear communication on the part of both professionals and patients, and it does not reflect how patients would navigate comparison-shopping for care. Almost every patient relies on the help of a physician or gets help from an insurance network and not from online price matching.

I believe that many people should engage with this article even if they aren’t entering the health profession; it would benefit everyone. Although price transparency may help insurers and care providers more than patients, if their goal is to lower prices, they must look beyond the simple posting or sharing of prices. I appreciate the effort to try to bring awareness to this major issue and encourage thoughtful policy discussion about lowering medical prices.

— Jan Rodriguez, Philadelphia

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They worked for a bit. But by 2011, Warfield struggled to walk.

And “by that time, I was addicted,” said Warfield, now living in Shelbyville, Kentucky.

After she lost her health insurance, Warfield started buying pills on the street. She tried to quit several times, but the debilitating withdrawal — so bad she couldn’t get out of bed, she said — kept driving her back to drug use.

Until last year.

Through her church, Warfield learned about the NET device. It’s a cellphone-sized pack connected to gel electrodes placed near the ear that deliver low-level electrical pulses to the brain.

“Once I got set up on the device, within 30 minutes, I didn’t have any cravings” for opioids, Warfield said.

After three days on the device in August, she stopped using drugs altogether, she said.

Warfield’s treatment was paid for with her county’s opioid settlement dollars — money from pharmaceutical companies accused of fueling the overdose crisis.

State and local governments nationwide are receiving over nearly two decades and are meant to spend it treating and preventing addiction.

Warfield wants them to allot a good chunk to the NET device, which costs counties about $5,500 a person. The pitch is gaining traction. , which makes the device, said it has signed about $1.2 million in contracts with more than a dozen counties and cities in Kentucky.Ìý

But some researchers and recovery advocates say the company’s rapid consumption of opioid dollars raises red flags. They see the NET device as the latest in a series of products that have been overhyped as the solution to the addiction crisis, preying on people’s desperation and capitalizing on the windfall of opioid settlements. Many of these products — from to body scanners for jails — have little evidence to back their lofty promises. That has not stopped sales representatives from repeatedly pitching elected officials or circulating ready-made templates to request settlement money for the companies’ products.

In fact, a device similar to NET called the Bridge gained popularity several years ago, receiving more than $215,000 in opioid settlement cash nationwide. But about the study backing its effectiveness, and the device is currently off the market.

NET Recovery’s activity “fits the national trends of these industry money grabs,” said , a national expert on opioid settlements based in Tennessee. The device “could be helpful for some,” she said. “But it’s being sold as a silver bullet.”

This year, 237 organizations working to end overdose — including Christensen’s consulting company — to guide officials in charge of opioid settlement money. In it, they called the NET device an example of problematic spending on unproven treatment.

Treating Withdrawal or Addiction

The FDA has for a specific use: reducing drug withdrawal symptoms. It has not approved the device to treat addiction.

That’s a crucial distinction, said , executive director of the Institute for Research, Education and Training in Addictions. He co-authored evaluating the evidence on neuromodulation devices like NET.

“The term ‘treatment’ becomes confusing,” Hulsey said. “These devices were cleared to treat opioid withdrawal symptoms, not to treat an opioid use disorder.”

NET Recovery CEO said the company adheres to FDA rules and advertises the device only for withdrawal management. But “we are finding that physicians are prescribing this to folks for long-term behavior based on the results of our study.”

He’s referring to that he co-authored and the company funded, in which researchers followed two groups of addiction patients in Kentucky for 12 weeks. The first group received the NET device for up to seven days, while the second group received a sham treatment.

The study found no significant difference between the groups’ outcomes. Participants who got the NET device were similarly likely to use illicit drugs after treatment as those who got the fake.

Hulsey, who was not affiliated with the study, said the takeaway is clear: “They didn’t find that was effective.”

A subgroup of participants who chose to use the device for more than 24 hours consecutively, however, went on to use illicit drugs less often than other participants.

As the researchers acknowledged in their paper, that subgroup might simply have been more motivated to engage with any form of treatment. The results don’t necessarily show that the device is making a difference, Hulsey said.

Rapid Growth

Winston had a different take. He said the success of the subgroup is “intriguing and outstanding.”

So outstanding, in fact, that the company this month is opening a brick-and-mortar location in Miami, where the device will be available to anyone who can pay $8,000 out-of-pocket. (The cost is higher for individuals than for county governments.) It has also applied for opioid settlement dollars from the state of Kentucky to conduct a larger research study and aims to bring the NET device into metro areas such as Louisville and Lexington.

Last year, NET Recovery hired a magistrate in Franklin County, Kentucky, to head up its operations in the state. (Magistrates function as county commissioners.) , who is also a mental health clinician, travels to different counties, extolling the benefits of the device and encouraging officials to contract with the company.

Her county to NET Recovery prior to her joining the company. Moving forward, Dycus said, she would recuse herself from any contract votes in her county.

Christensen, the national expert on opioid settlements, called Dycus’ new role “extremely strategic” for the company and “an obvious conflict of interest” for a public official.

Giving People Choice

More options for people to enter recovery is generally good, said Jennifer Twyman, who has a history of opioid addiction and now works with , a nonprofit that advocates to end homelessness and the war on drugs.

But settlement funds are finite, she said, and when counties invest in the NET device, that leaves less money to support options like mental health treatment, housing, and transportation programs — critical for many people who use drugs.

“People slip through these big, huge gaps we have and they die,” Twyman said, pointing to photos of dead friends that line her office wall.

She added that people should have the option of taking medications such as methadone and buprenorphine — for treating opioid addiction. only 1 in 4 people with opioid addiction get them.

Many people can’t afford them, find a doctor willing to prescribe them, or get transportation to appointments, Twyman said. against those who use medications, with detractors saying they’re not truly abstinent or clean.

Companies like NET Recovery sometimes lean into that stigma, Twyman said.

For instance, Scott County, Kentucky, jailer — whom the company considers a key champion for its device — to other county officials that medication treatment is just “swapping one drug for another.” It’s a common refrain from critics that .

Winston told ºÚÁϳԹÏÍø News his company is supportive of all types of recovery but that the NET device can help the “underserved population” of people who don’t want medication.

Longtime addiction researcher has led studies for NET Recovery and consults for , one of the leading producers of medications for opioid use disorder. He said he sees value in both approaches. It just depends on whom you’re trying to treat.

For people injecting drugs or accustomed to high doses of fentanyl, who are more likely to return to using drugs after residential treatment, “I would hesitate to recommend the device,” he said. Abstinence-based approaches can . But for people who are “highly motivated to stay abstinent,” the NET device may be a good fit.

“Giving people choices is the right thing to do,” he said.

Community as Part of Recovery

Warfield, who has not used opioids since August, credits not just the NET device with her recovery but her community too.

“It’s not a miracle cure,” she said of the device. “You still have to manage your triggers, but it’s easier.”

She regularly attends individual and group therapy to address childhood trauma. She’s found close friends within her church and has reconnected with her daughter. She installed a car seat in her vehicle so she can drive her grandson to preschool.

Warfield explained her hope for opioid settlement money to reach others in her community simply: “I want people to get as much help as they can.”

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“Many of my patients are messy, the ones that don’t know if they want to stop using drugs or not,” said Stevens, a primary care and addiction medicine doctor.

While other doctors avoided these patients, Stevens — who was familiar with the city from her time in medical school at Tulane University — sought them out. She regularly attended 6 a.m. breakfasts for homeless people, volunteered at a homeless shelter clinic on Saturdays, and, on Monday evenings, visited an abandoned Family Dollar store where advocates distributed supplies to people who use drugs.

One such evening about four years ago, Charmyra Harrell arrived there limping, her right leg swollen and covered in sores. Emergency room doctors had repeatedly dismissed her, so she eased the pain with street drugs, Harrell said.

Stevens cleaned her sores on Mondays for months until finally persuading Harrell to visit the clinic at University Medical Center New Orleans. There, Stevens discovered Harrell had diabetes and cancer.

She agreed to prescribe Harrell pain medication — an option many doctors would automatically dismiss for fear that a patient with a history of addiction would misuse it.

But Stevens was confident Harrell could hold up her end of the deal.

“She told me, ‘You cannot do drugs and do your pain meds,’” Harrell recounted on a Monday evening in October. So, “I’m no longer on cocaine.”

Stevens’ approach to patient care has won her awards and nominations in , , and . Instead of seeing patients in binaries — addicted or sober, with a positive or negative drug test — she measures progress on a spectrum. Are they showering daily, cooking with their families, using less fentanyl than the day before?

But not everyone agrees with this flexible approach that prioritizes working with patients on their goals, even if abstinence isn’t one of them. And it came to a head in the summer of 2024.

“The same things I was high-fived for thousands of times — suddenly that was bad,” Stevens said.

Flexible Care or Slippery Slope?

More than who need substance use treatment don’t receive it, national data shows. Barriers abound: high costs, lack of transportation, clinic hours that are incompatible with jobs, fear of being mistreated.

Some doctors had been trying to ease the process for years. Covid-19 accelerated that trend. Telehealth appointments, fewer urine drug tests, and medication refills that last longer became the norm.

The result?

“Patients did OK and we actually reached more people,” said , immediate past president of the American Society of Addiction Medicine. The organization supports continuing flexible practices, such as helping patients avoid withdrawal symptoms by of addiction medication and focusing on recovery goals .

But some doctors prefer traditional approaches that range from zero tolerance for patients using illegal drugs to setting stiff consequences for those who don’t meet their doctors’ expectations. For example, a patient who tests positive for street drugs while getting outpatient care would be discharged and told to go to residential rehab. Proponents of this method fear loosening restrictions could be a slippery slope that ultimately harms patients. They say continuing to prescribe painkillers, for example, to people using illicit substances long-term could normalize drug use and hamper the goal of getting people off illegal drugs.

Progress should be more than keeping patients in care, said , a Stanford psychologist, who has treated and researched addiction for decades and .

“If you give addicted people lots of drugs, they like it, and they may come back,” he said. “But that doesn’t mean that that is promoting their health over time.”

Flexible practices also tend to align with harm reduction, a divisive approach that proponents say keeps people who use drugs safe and that critics — — say enables illegal drug use.

The debate is not just philosophical. For Stevens and her patients, it came to bear on the streets of New Orleans.

‘Unconventional’ Prescribing

In the summer of 2024, supervisors started questioning Stevens’ approach.

In emails reviewed by ºÚÁϳԹÏÍø News, they expressed concerns about her prescribing too many pain pills, a mix of opioids and other controlled substances to the same patients, and high doses of buprenorphine, a medication considered to treat opioid addiction.

Supervisors worried Stevens wasn’t doing enough urine drug tests and kept treating patients who used illicit drugs instead of referring them to higher levels of care.

“Her prescribing pattern appears unconventional compared to the local standard of care,” the hospital’s chief medical officer at the time wrote to Stevens’ supervisor, . “Note that this is the only standard of care which would likely be considered should a legal concern arise.”

Springgate forwarded that email to Stevens and encouraged her to refer more patients to methadone clinics, intensive outpatient care, and inpatient rehab.

Stevens understood the general practice but couldn’t reconcile it with the reality her patients faced. How would someone living in a tent, fearful of losing their possessions, trek to a methadone clinic daily?

Stevens sent her supervisors of and backing her flexible approach. She explained that if she stopped prescribing the medications of concern, patients might leave the health system, but they wouldn’t disappear.

“They just wouldn’t be getting care and perhaps they’d be dead,” she said in an interview with ºÚÁϳԹÏÍø News.

Both University Medical Center and LSU Health New Orleans, which employs physicians at the hospital, declined repeated requests for interviews. They did not respond to detailed questions about addiction treatment or Stevens’ practices.

Instead, they provided a joint statement from Richard DiCarlo, dean of the LSU Health New Orleans School of Medicine, and Jeffrey Elder, chief medical officer of University Medical Center New Orleans.

“We are not at liberty to comment publicly on internal personnel issues,” they wrote.

“We recognize that addiction is a serious public health problem, and that addiction treatment is a challenge for the healthcare industry,” they said. “We remain dedicated to expanding access to treatment, while upholding the highest standard of care and safety for all patients.”

Not Black-and-White

ºÚÁϳԹÏÍø News shared the complaints against Stevens and the responses she’d written for supervisors with two addiction medicine doctors outside of Louisiana, who had no affiliation with Stevens. Both found her practices to be within the bounds of normal addiction care, especially for complex patients.

, an addiction medicine doctor and the , said doctors running pill mills typically have sparse patient notes that list a chief complaint of pain. But Stevens’ notes detailed patients’ life circumstances and the intricate decisions she was making with them.

“To me, that’s the big difference,” Loyd said.

Some people think the “only good answer is no opioids,” such as oxycodone or hydrocodone, for any patients, said , an addiction medicine doctor and associate professor at Michigan State University. But patients may need them — sometimes for things like cancer pain — or require months to lower their doses safely, she said. “It’s not as black-and-white as people outside our field want it to be.”

Humphreys, the Stanford psychologist, had a different take. He did not review Stevens’ case but said, as a general practice, there are risks to prescribing painkillers long-term, especially for patients using today’s lethal street drugs too.

Overprescribing fueled the opioid crisis, he said. “It’s not going to go away if we do that again.”

‘The Thing That Kills People’

After months of tension, Stevens’ supervisors told her on March 10 to stop coming to work. The hospital was conducting a review of her practices, they said in an email viewed by ºÚÁϳԹÏÍø News.

Overnight, hundreds of her patients were moved to other providers.

Luka Bair had been seeing Stevens for three years and was stable on daily buprenorphine.

After Stevens’ departure, Bair was left without medication for three days. The withdrawal symptoms were severe — headache, nausea, muscle cramps.

“I was just in physical hell,” said Bair, who works for the National Harm Reduction Coalition and uses they/them pronouns.

Although Bair eventually got a refill, Springgate, Stevens’ supervisor, didn’t want to continue the regimen long-term. Instead, Springgate referred Bair to more intensive and residential programs, citing Bair’s intermittent use of other drugs, including benzodiazepines and cocaine, as markers of high risk. Bair “requires a higher level of care than our clinic reasonably can offer,” Springgate wrote in patient portal notes reviewed by ºÚÁϳԹÏÍø News.

But Bair said daily attendance at those programs was incompatible with their full-time job. They left the clinic, with 30 days to find a new doctor or run out of medication again.

“This is the thing that kills people,” said Bair, who eventually found another doctor willing to prescribe.

Springgate did not respond to repeated calls and emails requesting comment.

University Medical Center and LSU Health New Orleans did not answer questions about discharging Stevens’ patients.

‘Reckless Behavior’

About a month after Stevens was told to stay home, Haley Beavers Khoury, a medical student who worked with her, had collected nearly 100 letters from other students, doctors, patients, and homelessness service providers calling for Stevens’ return.

One student wrote, “Make no mistake — some of her patients will die without her.” A nun from the Daughters of Charity, which ran , called Stevens a “lifeline” for vulnerable patients.

Beavers Khoury said she sent the letters to about 10 people in hospital and medical school leadership. Most did not respond.

In May, the hospital’s review committee determined Stevens’ practices fell “outside of the acceptable community standards” and constituted “reckless behavior,” according to a letter sent to Stevens.

The hospital did not answer ºÚÁϳԹÏÍø News’ questions about how it reached this conclusion or if it identified any patient harm.

Meanwhile, Stevens had secured a job at another New Orleans hospital. But because her resignation came amid the ongoing investigation, University Medical Center said it was required to inform the state’s medical licensing board.

The medical board began its own investigation — a development that eventually cost Stevens the other job offer.

In presenting her side to the medical board, Stevens repeated many arguments she’d made before. Yes, she was prescribing powerful medications. No, she wasn’t making clinical decisions based on urine drug tests. But national addiction organizations supported such practices and promoted tailoring care to patients’ circumstances, she said. Her response included a 10-page bibliography with 98 citations.

Liability

The board’s investigation into Stevens is ongoing. shows no action taken against her license as of late December.

The board declined to comment on both Stevens’ case and its definition of appropriate addiction treatment.

In October, Stevens moved to the Virgin Islands to work in internal medicine at a local hospital. She said she’s grateful for the welcoming locals and the financial stability to support herself and her parents.

But it hurts to think of her former patients in New Orleans.

Before leaving, Stevens packed away handwritten letters from several of them — one was 15 pages long, written in alternating green and purple marker — in which they shared childhood traumas and small successes they had while in treatment with her.

Stevens doesn’t know what happened to those patients after she left.

She believes the scrutiny of her practices centers on liability more than patient safety.

But, she said, “liability is in abandoning people too.”

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The Senate is scheduled to vote in the coming days on a Democrat-led plan to extend the temporary additional subsidies that have lowered out-of-pocket costs for Affordable Care Act health plans. But even with the vote approaching, Republicans in the House and Senate are divided over what, if any, alternative plan they should offer.

Meanwhile, anti-vaccine forces at the Centers for Disease Control and Prevention and the Food and Drug Administration have both agencies in disarray.

This week’s panelists are Julie Rovner of ºÚÁϳԹÏÍø News, Paige Winfield Cunningham of The Washington Post, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• Republican lawmakers are struggling to reach consensus on a health care plan as the Senate prepares to vote on the fate of enhanced ACA premium subsidies. Many broadly oppose Obamacare and argue Democrats deserve the blame for the rising cost of health care, while some Republicans facing tough reelection fights next year are advocating for renewing the more generous subsidies. New polling shows that even most supporters of President Donald Trump favor keeping the subsidies.
• It’s not just ACA plan-holders who are learning their out-of-pocket costs will rise next year. Premium payments for those who rely on the Federal Employee Health Benefits Program are going up again, with those plans among the many reporting out-of-pocket cost increases.
• The federal Advisory Committee on Immunization Practices is meeting this week. Earlier this year, Health and Human Services Secretary Robert F. Kennedy Jr. replaced the panel’s members, adding noted vaccine critics. At this meeting, the panel is discussing past recommendations on the birth dose of the hepatitis B vaccine and on the childhood vaccine schedule.

Also this week, Rovner interviews Aneri Pattani of ºÚÁϳԹÏÍø News about her project tracking the distribution of $50 billion in opioid legal-settlement payments.

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

Julie Rovner: The New York Times’ “,” by Sarah Kliff and Bianca Pallaro.

Joanne Kenen: Wired’s “,” by Emily Mullin.

Paige Winfield Cunningham: The New York Times’ “,” by Catherine Pearson.

Alice Miranda Ollstein: The Independent’s “,” by Kelly Rissman.

Also mentioned in this week’s podcast:

• Politico’s “,” by Alice Miranda Ollstein and Robert King.
• KFF’s “,” by Lunna Lopes, Grace Sparks, Mardet Mulugeta, Isabelle Valdes, and Ashley Kirzinger.
• ºÚÁϳԹÏÍø News’ “After Shutdown, Federal Employees Face New Uncertainty: Affording Health Insurance,” by Phil Galewitz.
• The Washington Post’s “,” by Paige Winfield Cunningham.
• ºÚÁϳԹÏÍø News’ “Trump Wants Americans To Make More Babies. Critics Say His Policies Won’t Help Raise Them.” By Stephanie Armour and Amanda Seitz.

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

Julie Rovner: Hello from ºÚÁϳԹÏÍø News and WAMU Public Radio in Washington, D.C.ÌýWelcome to “What the Health?”ÌýI’m Julie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News, and I’m joined by some of the best and smartest health reporters in Washington.ÌýWe’re taping this week on Thursday, Dec.Ìý4, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go.Ìý

Today, we are joined via video conference by Paige Winfield Cunningham of The Washington Post.Ìý

Paige Winfield Cunningham: ±á¾±,Ìý´³³Ü±ô¾±±ð.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAlice Miranda Ollstein of Politico.Ìý

Alice Miranda °¿±ô±ô²õ³Ù±ð¾±²Ô:Ìý±á±ð±ô±ô´Ç.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.Ìý

°­±ð²Ô±ð²Ô:ÌýHi, everybody.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýLater in this episode, we’ll have my interview with my ºÚÁϳԹÏÍø News colleague Aneri Pattani about her project tracking how the $50 billion in opioid settlement money is being spent. But first, this week’s news.Ìý

So, another week, another scramble by Republicans to find a health plan they can agree on before next week’s likely Senate vote to extend the ACA’s enhanced tax credits.ÌýThat’s the vote that was promised to Democrats in exchange for their votes to reopen the government last month. So far, Republicans can’t seem to reach agreement on whether to extend the credits — which, if allowed to expire, could balloon premium payments for lots of voters, including lots of Republican voters — or whether to stick to their guns in opposing the Affordable Care Act in general.Ìý on why Republicans might just be happy to let the extra credits expire. Tell us about it.Ìý

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýYeah.ÌýSo there’s less one overarching reason, and more of a grab bag of reasons. It depends who you ask. But suffice it to say, there are a lot of Republicans who would be fine with letting these subsidies die. If you wanted to nail down the most common reason we’re hearing right now, it’s just that they oppose Obamacare.ÌýThey’ve always opposed Obamacare.ÌýThey’re not about to suddenly become different people and start supporting it now. They voted a bazillion times to repeal it. They didn’t vote to create these subsidies in the first place, or to extend them the first time. And they’re not eager to suddenly start now. They say this is a problem of Democrats’ making. Democrats created this entire structure, and set the expiration date. We can talk about why they did that.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýBecause they didn’t have the votes to make it any longer.Ìý

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýYeah. And because it kept the cost down of the overall bill.ÌýThey say, Why should we bail out the Democrats? Now, of course, there are other Republicans who say, Look, this is going to hurt us politically.ÌýWe’re the party in power, and people are going to start getting these higher bills, and guess who they’re going to blame? They’re going to blame the party in power. And so there are a lot of divisions up on Capitol Hill right now, and [we’re] not really seeing any consensus emerge. It seems like the Democrats are going to put forward a clean extension that will fail and not pass. And the Republicans are either going to put up something that also won’t pass or they won’t put up anything.ÌýIt’s not really clear yet.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd just to clarify, because I feel like we have to say this every week, the base tax credits that were created by the Affordable Care Act are not going away.ÌýIt’s just these extra tax credits that were put into place in 2021 that are set to expire at the end of the year. But Alice, I would say I was really struck by something in your story where you said Republicans are more afraid of being punished by primary voters than punished by general-election voters if they vote to extend the subsidies as opposed to if they let them expire.Ìý

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýYeah.ÌýSo you have an interesting primary versus general election problem, which of course plagues both parties in every single election. But yes, there is a lot of fear of being primaried from the right, and being attacked for supporting Obamacare in any way, shape, or form, even if it’s a short-term extension with conservative reforms, which is what a lot of folks are talking about. There is more fear of that than of being attacked for allowing people’s premiums to rise by letting the subsidies expire. Of course, it totally varies by district. You have people in these very, very red districts who that’s what they’re more afraid of. And then you have these swing district folks who are more afraid of being punished by voters for letting the subsidies expire.ÌýSo it’s just really all over the place. You also have an interesting individual versus collective divide, where for some members it could be better just for their own personal political survival to let the subsidies die — even if the GOP as a whole party is worried about this.Ìý

Winfield Cunningham: And well, just in the issue of [the] primaries thing they’re worried about is if they vote for extending the subsidies without the Hyde [Amendment] language, then the anti-abortion groups are all going to come out and say that they voted for taxpayer funding of abortion, which is not the message that you want to be up against if you’re running in a primary with [an] opponent to the right of you.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd just a reminder that the whole Affordable Care Act very nearly died over whether or not these subsidies could be used to pay for plans that include abortion coverage. And that was just Democrats fighting about it. But for Republicans, this is harder. Because it’s important to remember that the Hyde Amendment, as we think of it, is something that is renewed every single year in a spending bill in the Labor HHS [Health and Human Services] appropriations bill. Putting Hyde language into something like this would make it permanent. And that’s something that is a complete nonstarter for the Democrats. Joanne.Ìý

°­±ð²Ô±ð²Ô:ÌýThere are two things that occurred to me. The KFF poll that came out this morning on how people feel about these subsidies. It was really striking at how many Republicans actually do blame the Democrats. So as long as Republicans don’t think it’s their lawmaker’s fault, and they’re willing to accept that this is all [Joe] Biden legacy, or [Barack] Obama legacy, or whatever one is not theirs, that also makes it easier politically. But also the math. If you’re in a really, really, really, really red district, and you have a 25% margin, and some of your voters lose their insurance and get mad at you, you still can win. Whereas [with] the swing voters, it’s a lot tougher.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd yet we saw Marjorie Taylor Greene [Republican representative from Georgia], who of course is now leaving Congress.Ìý

°­±ð²Ô±ð²Ô:ÌýThere’s a lot of other things going on with Marjorie Taylor Greene.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýThat’s true. There are. But this was the thing that she mentioned.Ìý 

So about , I have some numbers.ÌýSeventy-two percent of Republicans, and 72% of self-described MAGA [Make America Great Again] supporters say they favor extending these additional tax credits. And more marketplace enrollees would blame President [Donald] Trump or Congressional Republicans if the additional subsidies expire than would blame Democrats, as Joanne just said. Is there any sign that folks are shifting as more people actually see how big these payment increases could be come January? I was on a call-in radio show earlier this week, and there was just a string of people from all kinds of different states with actual numbers of I’m paying $400 a month now, and it’s going up to $1,800 a month. At some point … even if, as you guys say, it’s only a minority of their voters, they’re going to have to respond to that.Ìý

°­±ð²Ô±ð²Ô:ÌýIn a House race, some of them can lose some voters. They want a big win. They want to be the less vulnerable, the better. But we also are so baked in that everybody blames everything on the other side. One of the problems has nothing to do with specifically this particular issue.ÌýIt’s that health care costs keep rising, and insurance — including outside. My premiums are going up next year, and actually my employer — I’m at Hopkins — they’re paying the bulk of it. But the cost of insurance is going up quite a bit again, and again, and again. So there [are] other issues about affordability — which is with the word of the day, or the word of the year, or whatever, that remains to be seen — that there’s a whole lot of layers of why costs are going up. Obviously, this is an acute piece of it. People who are losing subsidy is a tax credit is a big piece of it. But the whole issue of even if you’re not in the ACA, you’re going to see higher costs.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd we’ll get to that in a second. But before we do, Paige,  of the last two weeks on why the Republican’s favorite alternative — giving money that’s now going directly to insurance companies to the consumers directly — instead might not be the best answer. Tell us about that.Ìý

Winfield Cunningham: The HSA [health savings account] idea comes up over and over.ÌýYou guys all probably recall that both the House and Senate reconciliation bills in 2017 would’ve increased the amount of money people can contribute. I actually was going to say, from what I’m hearing on the Hill, it seems most likely that the Senate and maybe the House Republicans are going to vote on that bill I wrote about in the story, the [Louisiana Republican Sen. Bill] Cassidy proposal, which would basically take those extra subsidies and dump them into these tax-free individual accounts, these HSAs.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýHSAs stand for health savings accounts for those who don’t know.Ìý

Winfield Cunningham: Health savings accounts.ÌýThat’s right. And just on the politics of it, I was going to say, I think what they do — and I know it’s risky to predict anything on the Hill, so who knows? — but it’s seeming most likely right now that they vote on this bill to put the subsidies in the HSAs.ÌýIt gives them something next year. They can say, We passed a health care bill. Democrats didn’t join us in it. And then they go on to blame Obamacare for ruining health care and spiking costs, and that’s on the politics of it. But on the policy of it, I think that Republicans always run into problems because, fundamentally, they are less willing than Democrats to spend money on health care. And so what they revert to is just, Oh, let people use their own money, tax-free, the way that they want to so that they can shop around for health care.”Ìý

And in that way, you’re going to create incentives to lower costs, and people aren’t going to get unnecessary care. But the problem is that this is more of a little boost for people versus an overall solution for health care. Because if you don’t have the money to put into HSAs to begin with, then you’re not going to be able to afford the tens of thousands of dollars every year that you’re going to need if you develop cancer, or diabetes, or something like that. And then, of course, Republicans try to get their measure scored at the CBO [Congressional Budget Office]. And the CBO says, Guess what? Your bill’s actually going to result in fewer people having health coverage. And that doesn’t play politically very well either. But you see them returning to this again, because no one knows how to really solve the health care cost problem. And so Republicans return to their free-market solutions. But yeah, it’s more of a Band-Aid than anything else. But I wouldn’t be surprised if that’s what they end up voting on next week or the week after.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýWell, and as Joanne previewed, it’s not just Affordable Care Act premiums that are going up. My colleague Phil Galewitz has a story this week about an average 12% premium increase for federal workers and retirees, which I will link to in the show notes. Medicare Part B premiums are also rising next year from $185 a month to nearly $203 a month, starting in January, with even bigger boosts for those who earn more than $109,000 per year and are subject to the income-based additional premiums. And as we reported in October, KFF’s annual employer survey finds average family premiums in the private sector rising an average of 6%.ÌýIs Congress and the administration missing the forest for the trees here, focusing on this fight about the ACA when the real problem is rising health spending and prices across the board? 

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýWell, part of Republicans’ argument against the subsidies is that the subsidies expiring is only a small sliver of the overall insurance affordability problem. Now, of course, it compounds the other problems. So, people are both seeing their base premiums rise, but they’re also being exposed to more of that cost.ÌýThey’re less shielded from it because of the subsidies expiring. And so, these are things that augment each other and make it worse for a lot of people — like you said, including a lot of Republican voters. We saw huge increases in Obamacare enrollment in some of these Republican states that never expanded Medicaid, especially like Florida.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd Georgia and Texas.Ìý

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýYep. Yep.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýRight. Well, speaking of Medicare, while we’re hearing a lot about the Affordable Care Act these days and how much federal money is being shoveled to big insurance companies, the administration this week also quietly changed some Medicare Advantage rules that will — let me check my notes here — quietly shovel more federal money to big insurance companies, many of the same ones that are getting the ACA money. This is something that’s gone on for years now. Republicans complain about overpaying for ACA, which was passed with only Democrat support, but not for Medicare Advantage, which was passed with mostly Republican support. Well, Democrats complain about overpaying for a Medicare Advantage, but not for the ACA. I can’t help but think that we’re not going to solve the health spending problem until both parties realize they’re being at least a little bit hypocritical here.Ìý

°­±ð²Ô±ð²Ô:ÌýThe Medicare Advantage overpayment.ÌýMedicare Advantage, its predecessor was Medicare Part C or whatever it was called in the ’90s, and then it was relaunched as part of the Medicare drug bill in 2003, and I think it went into effect in 2006. That provision may have been a year earlier, I don’t remember. But roughly 20 years ago.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýYeah, that sounds right.Ìý

°­±ð²Ô±ð²Ô:ÌýAnd it was designed to create competition. And a lot of people like Medicare Advantage.ÌýThat’s a choice people are making.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýYes, they like it because the federal government is overpaying for it, so they offer extra benefits.Ìý

°­±ð²Ô±ð²Ô:ÌýBut the idea was [to] create two layers of competition: an alternative to compete with traditional Medicare, and then competition within the Medicare Advantage market, these private insurance plan markets. But from the beginning, Medicare Advantage was created to save money. But just to spell this out, they’re paying more per patient to the private insurers who run these Medicare Advantage plans than they are to traditional Medicare. This has been going on for approximately 20 years, and there’s no sign that they’re going to stop it. They are, in fact, giving our tax dollars to private insurance to cover Medicare patients — with high satisfaction rates in many cases — but for more money than they would have if they were just in plain old vanilla Medicare, which itself is pretty expensive when you add up all the things that the consumer — the patient — has to pay. So no, if you were coming at this for the first time — which we are not, and most of our listeners probably are aware of this — but it’s pretty high on the What? list of American health care.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýYeah. In the meantime, let us turn to vaccines. As we are taping this morning, the Centers for Disease Control and Prevention’s Advisory Committee on Vaccine [Immunization] Practices is getting underway with its latest meeting. You may recall that Health and Human Services Secretary RFK Jr.Ìý[Robert F. Kennedy Jr.] fired all the vaccine experts on the panel and replaced them with anti-vaccine activists, and vaccine skeptics. This meeting includes a discussion of the hepatitis B vaccine, which is currently recommended to be given at birth and which has been shown to lower the incidence of chronic hepatitis B, which in turn can cause cancer, and other liver disease in adolescents by 99% since 1991.Ìý

Vaccine opponents say there’s no point in giving a birth dose because hepatitis B is largely sexually transmitted, particularly if the mother’s already been tested and found negative. But those who back the vaccine say hepatitis B can also be spread through household contact, and its record of success is so strong, there’s no need to change it. Meanwhile, the panel’s also going to be looking at the entire childhood vaccine schedule writ large at this meeting.ÌýRight, Paige? 

Winfield Cunningham: Yeah. I was listening to some of the meeting this morning, and the members said that this is going to be a discussion of risks first versus benefits, which is true with any vaccine. But they had actually planned on voting on the hep B vaccine back in September, and then they said they needed to collect more data. And what I was struck by this morning is, there was this safety presentation by actually this anti-vaccine activist. And I didn’t get to watch all of it, but it sounds like they weren’t able to come up with any real evidence or examples of serious negative side effects for giving newborns this vaccine. And that’s what you hear over and over again when you talk to pediatricians and pediatric vaccine experts that they’ve administered thousands of these doses to newborns in the hospital. And it’s just a really, really safe vaccine.Ìý

So later today, they’re supposed to vote on removing that recommendation to get the vaccine if the mother is negative. Although it’s maybe under what’s called shared clinical decision making, which is where they would recommend that it would be a conversation between the doctor and the patient. But I think the other thing that’s interesting is the whole argument for lightening this requirement is made from a very individual perspective. The Kennedy supporters have argued that this is a one-size-fits-all policy, and there’s this deep frustration that you should be recommended to get this vaccine if you’re negative for hep B, because it is highly unlikely that your baby would get the virus. But that’s just not how public health recommendations are made.ÌýThey’re made by looking at, on the whole, what happens to infection rates if you institute this universal recommendation.ÌýAnd so that’s just not a perspective that I think a lot of members of this panel seem to be holding, at least from the discussion as it’s playing out today.Ìý

We’ll see what happens later on today. But there was a lot of resistance by [H.] Cody Meissner, one of the panel members who voted against changing the vaccine recommendations for a couple other vaccines in September.ÌýHe’s really been pushing back strongly against this suggestion that there’s any downside to giving newborns this vaccine.ÌýWe’ll see how it plays out for the rest of the day.Ìý

°­±ð²Ô±ð²Ô:ÌýAnd remember, it sort of gets lost in the conversation.ÌýIt’s a recommendation.ÌýIt’s not a requirement. There are families that opt out, or decide to wait. When you have an itsy-bitsy newborn, it is upsetting to parents.ÌýThat’s part of the emotional underplaying here, that the first thing they experience is a shot. The recommendations are science-based, but parents can in fact either delay it, or not have it.ÌýSo, the recommendation is because this protects a kid from a really bad disease.ÌýAnd that’s why the recommendation has been there. But it gets talked about as though it’s binding, and it is not binding.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd Paige, they’re going to talk about the rest of the childhood vaccine schedule also at this meeting, right? 

Winfield Cunningham: Yeah. Tomorrow they’re supposed to discuss broadly the schedule at large, and I’m sure the idea will come up that we have too many vaccines. I would note that the agenda was posted last night, and it prompted a stronger condemnation by Sen.ÌýCassidy than we’ve ever seen before. Of course, he’s been the lone Republican who has called out Kennedy for some of these anti-vaccine views. And he wrote this morning that ACIP is totally discredited and not protecting children because Aaron Siri, who’s the top attorney for the anti-vax moment, apparently is going to be giving this two-hour presentation tomorrow to the panel.ÌýBut I think Joanne makes a really strong point.ÌýI don’t know that practically there’s going to be a huge effect from them tweaking the recommendations today, but I think the bigger effect is that parents do have a very emotional response to vaccines. And when they hear that the recommendation was rolled back, if they already had some fears about giving their newborn a shot, this may stoke those fears. And that’s what a lot of experts are worried about.Ìý

°­±ð²Ô±ð²Ô:ÌýAnd we’re just seeing more and more parents across the board opting out of vaccines.ÌýSo this is one more, and they’re opting out of recommended vaccines.ÌýAnd again, these recommendations have been tested over and over again.ÌýThese are not things that somebody just pulled out of the air yesterday. And that’s the fight.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýSo normally, ACIP recommendations go from the committee to the head of the CDC, who generally approves any changes that the committee recommends. But the CDC currently has no director after Susan Monarez was fired just before the last ACIP meeting for refusing to rubber-stamp the panel’s recommendations in advance. And the acting head of the CDC, Jim O’Neil, is neither a doctor nor a public health professional.ÌýHe’s actually the HHS deputy secretary.ÌýAre we reaching a point where the CDC’s official recommendations are going to be ignored, or even refuted by the rest of the medical community? I see my mailbox is full of all of these briefings by the American Academy of Pediatrics and other agencies basically saying, You know what the CDC is saying right now? They’re wrong. Ive been doing this 40 years, and I have never seen anything quite like this before.Ìý

Winfield Cunningham: Yeah, this is one of those things where there’s about 4,000% more people who want to talk to reporters about this than you even have time to talk to. But yeah, the American Academy of Pediatrics said this week that they’re going to maintain the current hep B recommendation regardless of what the panel does. And I think increasingly, when I talk to public health experts, they are just seeing CDC and ACIP as discredited and not legitimate. And I think the decision by the panel to invite some of the folks with anti-vax history to present both today and tomorrow is just going to heighten that criticism, and add fuel to the fire.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAll right. Well, we’re going to take a quick break. We will be right back.Ìý 

So, we’ve talked about the vaccine news from the CDC, but there’s vaccine news from the Food and Drug Administration, too. Vinay Prasad, who was the top FDA vaccine regulator, then he wasn’t, then he was again, sent a memo on the day after Thanksgiving asserting, without full evidence, that the covid vaccine caused the deaths of at least 10 children, and that as a result, the agency will change the way it regulates vaccines.ÌýThere’s not a lot of detail yet, but apparently the information comes from the FDA’s adverse event database, which anybody can file to without proof.ÌýIt’s supposed to be an early warning system for possible vaccine side effects.Ìý

So, doctors can put in reports, parents can put in reports if they see something that might need looking into. In response to this, 12 former FDA commissioners from both parties published an open letter in the New England Journal of Medicine pronouncing themselves, “Deeply concerned by sweeping new FDA assertions about vaccine safety and proposals that would undermine a regulatory model designed to ensure that vaccines are safe, effective, and available when the public needs them most.” The FDA regulates 25% of all products in the United States. At some point, aren’t the companies that it regulates going to stand up and say they can’t function if the FDA can’t function? I see frowning around the table.Ìý

°­±ð²Ô±ð²Ô:ÌýYes. People want products that are safe, right? Well, many people want products that are safe. Some people prefer to do their own research, as they say.ÌýBut basically, medications, vaccines, over-the-counter products, even all sorts of stuff, it’s food and drugs. This is a regulatory agency that is supposed to protect us.ÌýWhat’s come out about these supposed 10 deaths? It’s not that these kids may not have died, but from what? That’s the question. Was it the vaccine? I am not a biostatistician, and none of us are, but there’s some really easy questions to ask.ÌýFirst of all, was it caused by the vaccine? Because VAERS [Vaccine Adverse Event Reporting System] is not reliable. You don’t know that’s really what caused the death. So, we don’t know much about why the FDA is saying these deaths were caused by the vaccine.Ìý

But beyond that, 10 out of how many people had children [who] got the vaccine and it was safe — if it was even 10. And this whole thing I’m saying is: We don’t know how they’re defining the causation of those 10. How many lives were saved? How many kids, if there wasn’t vaccination, might have died? The whole sort of context of it, when you hear 10 dead kids, it’s scary. But they’re not in a vacuum. There [are] many questions about what does that number mean? 

¸é´Ç±¹²Ô±ð°ù:ÌýI’m really curious though.ÌýWe were just talking about the CDC and how the American Academy of Pediatrics, and other public health groups are stepping up. The companies that are regulated by the FDA basically can’t be in business unless the FDA functions properly.ÌýI’m not seeing the kind of reaction that I would expect to see from those regulated companies.ÌýMaybe they’re afraid of getting punished by the FDA if they speak up? 

Winfield Cunningham: I don’t know.ÌýThere’s a lot at stake here for them, obviously.ÌýI’m waiting on more details from the FDA about what this is going to mean. Talking to my colleagues who cover FDA more closely, it sounds like the thought is that this requirement for extra studies and evidence would apply to new drugs going forward. But my overall question, going at what Joanne said, is that the measurement of whether a vaccine should be recommended, did it cause any adverse events? Did fewer people die, or were harmed with the vaccine than without the vaccine? So let’s say hypothetically, maybe they’re right. What if the covid vaccine did cause 10 deaths? Even under that umbrella, you may not even have a strong case for rolling it back, because presumably, I don’t know how many deaths giving kids the covid vaccine prevented. I assume it’s more than 10.ÌýSo if that basic way of evaluating the effectiveness of a vaccine is changes, that I think is going to be really significant.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd we do know that there are risks with vaccines.ÌýThat’s why we have the vaccine compensation program that RFK Jr. is also trying to roll back, but there’s no news on that this week. I am curious.ÌýI’m seeing a lot of FDA reporters talking about this, and also about the continuing personnel carousel with people leaving and coming back, and leaving and coming back, and FDA not meeting its deadlines, and trying to basically oust career people.ÌýWe’ve talked about Marty Makary at FDA and RFK wanting to maybe bring somebody in to try to right the ship. If the FDA truly falls apart, that would be a very bad thing, I would think, for everybody involved.Ìý

°­±ð²Ô±ð²Ô:ÌýYou’re right, Julie.ÌýWe’re not seeing the industry pushback. We don’t know what’s being talked about, or planned, or done behind the scenes because we do live in a vituperative, retaliatory environment. I agree with the point you make: Where are they, and why aren’t we hearing from them? The FDA and the CDC have lost tons of people? It’s not just the people leaving and coming back. There are a lot of people just leaving, and many years of experience. Either they’ve been forced out, or some have just quit because they don’t feel like they can do their jobs. At the top leadership levels as well as rank and file, there’s just been a lot of tumult, and a loss of expertise.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd we will keep an eye on that.ÌýFinally this week, still more reproductive health news. The Supreme Court — remember the Supreme Court? — heard a case this week that made unlikely allies of pregnancy crisis centers, those anti-abortion agencies, and the American Civil Liberties Union. Alice, please explain.Ìý

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýThis was a case that was pretty narrow and wonky on the surface, but could have much broader implications.ÌýThis is about [the] New Jersey attorney general’s attempt to obtain documents and investigate this chain of crisis pregnancy centers. These are faith-based, anti-abortion clinics. Some offer legitimate health services, some don’t.ÌýIt’s a real variety around the country of these kinds of places. So, the New Jersey government was attempting to figure out if they were presenting misleading information both to their patients, and to their donors. And he was seeking the records of their donors. Now, the center wanted to challenge that investigation and stop it, and they wanted to do that in federal court, where they thought they would have a better chance than in state court. But this is drawing interest from groups like the ACLU [American Civil Liberties Union] and even a bunch of other progressive groups, because they say that upholding New Jersey’s ability to demand these documents could put all kinds of nonprofits around the country at risk, including those that are more progressive.Ìý

There could be demands for their donors from red state governments.ÌýThat was the concern there. And that did come up during the arguments. The ACLU and some of these progressive groups wrote amicus briefs. But I would say the point might be moot, because based on how the arguments went, it really does seem like the court is going to rule for the crisis pregnancy centers. And so those fears, in particular, might not be as immediate, although of course that opens up a whole other set of implications potentially for crisis pregnancy centers around the country and states’ ability to regulate them.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýYeah, we will see.ÌýWell, and there was lower federal court action this week, too. The on-again, off-again, on-again defunding of Planned Parenthood, at least in some states, is off again, right? What’s the latest on that? 

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýIt’s not off again quite yet.ÌýThere’s a window where the government can appeal — and probably will — and a higher court could step in and say, No, Planned Parenthood has to stay defunded.ÌýBut this is one of several cases about this.ÌýSo this one is coming from Democratic state attorneys general.ÌýThere’s another one pending coming from Planned Parenthood and some of its affiliates. And so there’s just going to be ping-ponging back-and-forth in the courts for a while on this of whether the defunding that was passed this past summer is allowed to be upheld. Now, a bunch of states have put up their own money to backfill the lost money.ÌýThey say that’s been a burden on them. They also say it’s a burden on the states to have to do the work of implementing the defunding, and ensure that no money goes to Planned Parenthood clinics.ÌýAgain, this is for non-abortion services, things like STI [sexually transmitted infection] testing, contraception for Medicaid recipients. I expect this will continue to go back and forth for a while.ÌýBut a point that I really wanted to make in my coverage of it is that even if Planned Parenthood prevails in the end, it’s too late for a lot of places. A lot of clinics have already shut down, and you can’t just reopen them at the drop of a hat even if the federal money is restored.Ìý

Winfield Cunningham: The only thing I’d add on that is that on July 1, the ban actually ends because Congress only did a one-year ban. And it seems highly questionable at this point that Republicans are going to be able to get together enough votes to do another reconciliation bill, and pass another ban. So maybe it ends on July 1. Alice said there’s been irreparable harm to them in having to close a lot of clinics, but the issue could to some degree be moot in July.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýYeah. We saw this back in, I think it was 2016, when Texas put in an early version of an abortion ban that was ultimately struck down. But so many clinics had closed at that point that they just never did reopen. So sometimes it’s easier to cut off money than to restart it. All right. Well, on the let’s-have-more-babies beat, this week computer billionaire Michael Dell and his wife Susan announced they’re donating $6 billion to help seed those Trump accounts for newborns.ÌýBasically, the Dells will be providing $250 each to 25 million children in addition to the $1,000 that President Trump is proposing.Ìý

But at the same time, my colleagues Stephanie Armour and Amanda Seitz have a story showing how the administration’s cuts to other programs that help care for moms and kids — including Medicaid, the Children’s Health Insurance Program, and Head Start — along with cuts to reproductive rights, like we were just talking about with Planned Parenthood, are doing more to deter women from having children than encouraging them to have more. Not to mention the increasingly out-of-reach costs for housing, food, and child care. This feels like a bit of an uphill battle here if the U.S.Ìýreally wants to increase the birth rate, right? 

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýWell, we’ve also seen in other countries that these kinds of arguably quite small financial incentives don’t really move the needle. Giving birth alone, let alone raising a child for more than a decade, costs just an unbelievable amount of money, as the parents on this very panel can attest.Ìý

°­±ð²Ô±ð²Ô:ÌýIt doesn’t stop when you think it should either.Ìý

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýAnd so even a few thousand dollars isn’t going to change a lot of minds on that front. It could make it easier for the people who already have decided to go ahead and have kids, but the experience of other countries that have piloted some of these programs have found that it doesn’t really make people want to have kids who are deciding not to.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýYeah. I think first they would like to be able to buy houses, many of them.ÌýAll right, that is this week’s news.Ìý

°­±ð²Ô±ð²Ô:ÌýWhich is one of the costs as a parent that you end up helping with if you can, right? 

Winfield Cunningham: Or you just put three children in one bedroom for a while, as we did. We live in a bigger house now, though.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAll right. That is this week’s news. Now we’ll play my interview with ºÚÁϳԹÏÍø News’ Aneri Pattani, and then we will come back and do our extra credits.Ìý 

I am pleased to welcome back to the podcast my ºÚÁϳԹÏÍø News colleague Aneri Pattani. Aneri has been tracking where those billions of dollars states are getting from the pharmaceutical industry for its culpability in the opioid crisis are going. Aneri, welcome back.Ìý

Aneri ±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýThanks for having me.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýSo it’s been a while since we last had you on. Remind us how much money we’re talking about, how these settlements came to be, and what the money is supposed to be spent for.Ìý

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýRight.ÌýSo we’re talking about more than $50 billion here.ÌýIt’s a good chunk. And it’s coming from lots of different companies that either made or distributed opioid painkillers. Purdue Pharma is really well-known, but there’s also Johnson & Johnson, Walgreens, CVS, several others.ÌýBasically, thousands of states, and counties, and cities sued these companies for aggressively marketing the pills, and claiming that they were not addictive when we know they were.ÌýThe companies basically settled, and now they’re going to be paying out for nearly two decades.ÌýGovernments are supposed to take that money and basically use it to address the problem, right? Do things that fix the current addiction crisis, or prevent a future one from happening.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýSo is there anyone who’s supposed to be keeping track of where this money is going, and how it’s being spent? I covered the similar settlements from the tobacco industry in the late 1990s and early 2000s. And there were lots of stories about that money being used for things that were completely unrelated to getting people to stop using tobacco products, things like paving roads and whatnot.Ìý

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýYeah.ÌýAnd essentially, no.ÌýThere’s not an entity to track this money, either.ÌýPeople are always surprised when I tell them there’s no federal agency or national entity in charge of overseeing this opioid settlement money, or making sure that it’s spent correctly. There are some guidelines out there. There are some states that have their own efforts, but they tend to be kind of small.ÌýWith the tobacco settlement, we saw the campaign for tobacco-free kids came in as this nonprofit to collect annual data and have some public information and accountability on the funds. And with the opioid settlement money, we essentially tried to replicate that.ÌýWe teamed up with researchers at the Johns Hopkins Bloomberg School of Public Health, and Shatterproof, which is this national nonprofit that works on addiction issues. And we gather data and create databases to show the public how this money is being spent across the country.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýSo we are the database.ÌýTell us about the database that we have built here at ºÚÁϳԹÏÍø News.Ìý

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýWe just published our second database. We do this hopefully every year. So far, we’ve done it two years. And basically this year we had more than 10,500 examples of how states or cities or counties have spent this money. We get all the information from public records — either they’re already online, state budgets, we put in record requests — and then we categorize each of the expenditures into things like prevention, or treatment. And that way we can give the public a bird’s-eye view of how this money is being spent.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd just to be clear, these 10,000 are not necessarily inappropriate ways. This is how the money is being spent.Ìý

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýExactly.ÌýThey’re just anywhere that we can find an example of the money being used.ÌýWe’re collecting it. It doesn’t mean it’s being used well. It doesn’t mean there’s research, or evidence to support it. It just means it’s being used.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýSo tell us about some of the things that you have found using the database.Ìý

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýI always want to start with the good news. And the good news is that lots of the money is going to stuff that addiction experts say is needed: treatment, housing for people with addiction, buying overdose reversal medications. But there’s also the not-so-great news, which is that there are spending examples that lots of people find questionable.ÌýThere are two big buckets of those. The first is law enforcement gear. We saw money being spent on gun silencers, drones, police cruisers, where the folks who are making those decisions say, Well, police and law enforcement are the front lines of the addiction crisis. But you have a lot of folks saying, We already invest a lot in that.ÌýIt hasn’t made a difference, and we need to be investing in medical and social services instead. Then you have my second questionable category, which is things aimed at preventing youth from developing addictions in the first place.Ìý

So I think really well-intentioned a lot of times. But researchers have looked at some of these examples and said, It’s just not going to do what you think it is. So one Connecticut town threw a ’50s-style sock hop where they had kids and seniors take pledges to be drug-free. A West Virginia community hired a drug-awareness magician.ÌýAnd there’s just no evidence that that’s actually going to do anything.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýBut I bet it was entertaining.Ìý

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýIt was entertaining to read about it, too.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýSo this money is obviously more important than ever in fighting addiction because of cuts to other government programs that were doing some of this work, right? 

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýAbsolutely. Medicaid is the biggest payer of addiction care in the country.ÌýWith the cuts that are coming forth for that, a lot of people are anticipating having trouble getting treatment.ÌýAnd so there’s a real need, but the opioid settlement money is also not anywhere near enough to fill that gap. We talked about … it’s more than $50 billion, but spread over two decades. Medicaid paid $17 billion for addiction care in one year alone.ÌýSo it’s not going to make the gap. And some people are worried that all the opioid settlement money will be poured into trying to fill up the federal gaps, leaving nothing for trying something new or being innovative.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýSo, some of this money is supposed to be used to compensate individuals who have been hurt by the opioid crisis. But that’s not always happening either, is it? 

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýUnfortunately not.ÌýMost of the people who were personally harmed are not getting any money. The way a lot of these settlements worked out is that they were directly with states. And so there wasn’t really an avenue for individuals to get paid. The few settlements that can pay people are giving out small amounts. I talked to one guy in Maine.ÌýHe had been prescribed painkillers, was addicted for then 10 years of these ups and downs. He was part of the Mallinckrodt settlement. He got a few hundred dollars from them. It wasn’t even enough for one month’s rent. Purdue Pharma, which just settled, is one of the bigger ones. Some individuals may get up to $16,000 from them. But you’re talking about $16,000, you take out the lawyer’s fees, you take out other things, it’s really minimal. And so I think that’s why people care so much about the money that the governments are getting, and how they use it, because that is the one opportunity to improve services, to improve the system of care.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýWhat’s next for this project? 

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýI am already filing public-records requests for how the money is being used for our next year of tracking.ÌýWe will have another annual report out next year talking about how this money continues to be spent, and hopefully providing some accountability for where it’s going.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAneri Pattani, thank you for staying on top of it.Ìý

±Ê²¹³Ù³Ù²¹²Ô¾±:ÌýThank you.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýOK.ÌýWe’re back.ÌýIt’s time for our extra credit segment.ÌýThat’s where we each recognize the story we read this week we think you should read, too.ÌýDon’t worry. If you miss it, we’ll put the links in our show notes on your phone, or other mobile device. Paige, why don’t you go first this week? 

Winfield Cunningham: I was struck by a story that is quite personal to me because I have an 11-year-old, and it is called “”Ìýat The New York Times by Catherine Pearson.ÌýShe addresses this question that I think a lot of parents have, which is what is the correct age for kids to get a smartphone? She cites this study published this week that showed … there was a correlation between having a cell phone by age 12 and having higher risk of depression, obesity, and insufficient sleep. And it seems like this is piled onto the mounting pile of evidence that giving your kid a smartphone has a lot of negative drawbacks.Ìý

The thing my husband and I have been talking about is: A lot of parents, they know the negative effects of phones, but they start feeling a lot of pressure from other parents. Because if other kids at their school have the smartphone, then their kid is feeling left out of things. So, I really feel like for things to change, parents and schools are going to have to band together, and recognize that this is having a real toll on kids. And we’ve already seen some schools — I know at least in northern Virginia — have instituted a no-cell-phones policy.ÌýAnd I just have to think that that’s probably going to have long-lasting health benefits.ÌýI thought this was a really important article for discussing that.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýYeah, I did, too. Joanne.Ìý

°­±ð²Ô±ð²Ô:ÌýThis is from Emily Mullen in Wired: “,”ÌýSo it’s still quite preliminary. There are some scientific questions … that they still have to establish that it’s safe and effective.Ìý… Yes, it’s a vaccine, which as we’ve been talking about, is a whole other issue. So first of all, if it works in these trials, and it doesn’t interfere with painkillers, or anesthesiology, or things like that of people who may need that, there are a lot of questions about who gets it, and when.ÌýIt’s going to be a whole bioethics debate, and a political debate. And there’s a debate over harm reduction, per se, but it’s actually really an interesting scientific tool that even if we fight about if it does work — and this is a trial to see — could be another tool in saving lives if we can ever agree on all the fighting about who would get it and when. But it’s interesting.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýAnd get it through ACIP.Ìý

°­±ð²Ô±ð²Ô:ÌýRight. It wouldn’t be for kids. It would be for — 

¸é´Ç±¹²Ô±ð°ù:ÌýFor adults.Ìý

°­±ð²Ô±ð²Ô:ÌýIt could be for teens, I suppose. But it’s an interesting scientific development with potential. If we can stop the fighting, it could save lives.Ìý

¸é´Ç±¹²Ô±ð°ù:Ìý´¡±ô¾±³¦±ð.Ìý

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýI have a pretty harrowing story from The Independent by Kelly Rissman [“”]. It is about the rise in detentions of pregnant women for immigration violations. And reports from attorneys and human rights groups of really abysmal conditions that women are being held in that in some cases they’ve documented have caused miscarriages. People are not getting adequate food.ÌýThey’re being kept in very cold, or very hot conditions.ÌýThey’re not being given access to medical care when requested, and/or they’re being subject to medical exams that they don’t consent to.ÌýThey’re not being provided translators, so they don’t know what’s going on. Really scary stuff. And something I thought the article should have mentioned, but didn’t, is that ICE [Immigration and Customs Enforcement] has dismantled some of its own internal oversight offices that maybe would’ve looked into and addressed some of this stuff in the past.ÌýSo I think there’s an ongoing lawsuit over those oversight bodies.ÌýThat’s one place to pay attention to on this unfolding story.Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýWell, I have actually a little bit of good news for a change from the reproductive health realm.ÌýIt’s from our former podcast panelist Sarah Cliff, along with Bianca Pillaro at The New York Times, and it’s called “.”ÌýIt’s about just that: how some hospitals are bucking the trend of rising surgical baby deliveries with some deceptively small changes, including using more midwives, changing financial incentives to deliver via C-section, and reminding doctors and nurses that labor often takes longer for first time moms.ÌýIt’s one of those relatively small but ultimately really important cultural shifts that can make health care both safer and cheaper.ÌýSee? There are people working to make the system better.Ìý 

All right, that is this week’s show. Thanks as always to our editor, Emmarie Huetteman, and our producer engineer, Francis Yang. A reminder: “What the Health?”Ìýis now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, at kffhealthnews.org.ÌýAlso, as always, you can email us your comments or questions.ÌýWe’re at whatthehealth@kff.org. Or you can find me still on X , or on Bluesky .ÌýWhere are you folks hanging these days? Alice? 

°¿±ô±ô²õ³Ù±ð¾±²Ô:ÌýI’m mostly on BlueSky , and also on X .Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýJoanne.Ìý

°­±ð²Ô±ð²Ô:ÌýI’m on X . And I’m using .Ìýmore, also .Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýPaige.Ìý

Winfield Cunningham: ±õ’³¾Ìý´Ç²ÔÌý³ÝÌý, and I’m also on BlueSky .Ìý

¸é´Ç±¹²Ô±ð°ù:ÌýWe will be back in your feed next week. Until then, be healthy.Ìý

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This story can be republished for free (details).

• Read Pattani’s “From Narcan to Gun Silencers, Opioid Settlement Cash Pays Law Enforcement Tabs” and “Sock Hops and Concerts: How Some Places Spent Opioid Settlement Cash.”

ºÚÁϳԹÏÍø News Southern correspondent Sam Whitehead discussed government claims that new technologies will help Medicaid recipients comply with new work requirement rules on WUGA’s “The Georgia Health Report” on Oct. 31.

• Read “Officials Show Little Proof That New Tech Will Help Medicaid Enrollees Meet Work Rules,” by Whitehead and ºÚÁϳԹÏÍø News Colorado correspondent Rae Ellen Bichell

ºÚÁϳԹÏÍø News Southern California correspondent Claudia Boyd-Barrett discussed the presence of Immigration and Customs Enforcement agents in and around health care facilities such as hospitals and community health centers on Radio Bilingüe’s “Línea Abierta” on Oct. 30.

• Read Boyd-Barrett’s “California Faces Limits as It Directs Health Facilities To Push Back on Immigration Raids.”

ºÚÁϳԹÏÍø News executive editor Alex Wayne discussed the federal government shutdown and rising Affordable Care Act premiums on Sirius XM’s “The Smerconish Podcast” on Oct. 30.

ºÚÁϳԹÏÍø 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 .

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This story can be republished for free (details).

The purchases varied widely but they all came from the same source: opioid settlement money.Ìý

The cash, which comes from companies accused of fueling the overdose crisis, was used in more than 10,500 ways last year, according to an investigation by ºÚÁϳԹÏÍø News and researchers at the and , a national nonprofit focused on addiction.Ìý

The money is expected to over nearly two decades, paid by companies that sold prescription painkillers. State and local governments are meant to spend most of it combating addiction. The settlement agreements even and established other guardrails to limit unrelated uses — as the Tobacco Master Settlement Agreement of the 1990s.Ìý

But there’s still significant flexibility, and what constitutes a good use to one person can be deemed waste by another.Ìý

“People died for this money. Families were torn apart for this money. And to not spend it to try to make our system better, so that people don’t have to experience those losses going forward, to me, is unconscionable,” said , an addiction medicine doctor who was once addicted to opioids and has served as an expert in several opioid lawsuits.Ìý

To compile the most comprehensive national database of settlement spending, ºÚÁϳԹÏÍø News and its partners filed public records requests, scoured government websites, and extracted expenditures, which were then sorted into categories, such as treatment or prevention. The findings include: 

• States and localities spent or committed nearly $2.7 billion in 2024, according to public records. The bulk went to investments addiction experts consider crucial, including about $615 million to treatment, $279 million to overdose reversal medications, and $227 million to housing-related programs.Ìý

• Smaller, though notable, amounts funded law enforcement gear, such as night vision equipment and Tasers.Ìý

• Many places funded prevention efforts that experts called questionable, such as a and a , at which kids and seniors , posed with inflatable guitars, and pledged to remain drug-free.Ìý

• Some jurisdictions paid for basic government services, such as .Ìý

• The money is controlled by different entities in each state, and about 20% of it is untrackable through public records.Ìý

Explore the database here.Ìý

ºÚÁϳԹÏÍø 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 .

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This story can be republished for free (details).

Bre Dolan, a 35-year-old resident of Hardy County, West Virginia, understands why. Throughout her childhood, when her dad had addiction and mental health crises, police officers were often the first ones to respond. Dolan calls them “good men and women” who “care about seeing their community recover.”

But she’s skeptical that they can mitigate the root causes of an addiction epidemic that has racked her home state for decades.

“Most of the busts that go down are addicts,” she said — people who need treatment, not prison.

Dolan’s father was one of them. And so was she.

Now 14 years into recovery, she’s been surprised to see many local officials spending opioid settlement money — an influx of cash from companies accused of fueling the overdose crisis — on police Tasers, cruisers, night vision gear, and more.

“How is that really tackling an issue?” Dolan said. “How will it help families battling addiction?”

Nationwide, more than $61 million in opioid settlement funds were spent on law enforcement-related efforts in 2024, according to a yearlong investigation by ºÚÁϳԹÏÍø News and researchers at the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a national nonprofit focused on addiction. That included initiatives that public health experts largely support, such as hiring social workers to accompany officers on overdose calls, as well as actions they’re more skeptical of, such as beefing up police arsenals.

Over nearly two decades, state and local governments are set to receive in opioid settlement money, which is intended to be used to fight addiction. The settlement agreements even and established other guardrails to limit unrelated uses of the funds — as the Tobacco Master Settlement Agreement of the 1990s.

But there’s still significant flexibility with these dollars, and what constitutes a good use to one person can be deemed waste by another.

To , an addiction medicine doctor who was once addicted to opioids and has served as an expert in several opioid lawsuits, some law enforcement expenses fall into that second category.

and are not “in the spirit of what we wanted to use the money for when we were fighting for it,” Loyd said.

“People died for this money. Families were torn apart for this money. And to not spend it to try to make our system better, so that people don’t have to experience those losses going forward, to me, is unconscionable,” he said.

As part of this investigation, ºÚÁϳԹÏÍø News and its partners compiled the most comprehensive national database of opioid settlement spending to date, featuring more than 10,500 examples of how the money was used (or not) last year. The team filed public records requests, scoured government websites, and extracted expenditures, which were then sorted into categories, such as treatment or prevention. The findings include:

• Nearly $2.7 billion — that’s the amount states and localities spent or committed in 2024, according to public records. The lion’s share went to investments addiction experts consider crucial, including about $615 million to treatment, $279 million to overdose reversal medications and related training, and $227 million to housing-related programs for people with substance use disorders.
• Smaller, though notable, amounts funded law enforcement initiatives — such as creating a shooting range and tinting patrol car windows — and prevention programs that experts called questionable, such as putting on a fishing tournament.
• Some jurisdictions paid for basic government services, such as firefighter salaries.
• The money is controlled by different entities in each state, and about 20% of it is untrackable through public records.

This year’s database, including the expenditures and untrackable percentages, should not be compared with the one ºÚÁϳԹÏÍø News and its partners compiled last year, due to methodology changes and state budget quirks. The database cannot present a full picture because some jurisdictions don’t publish reports or delineate spending by year. What’s shown is a snapshot of 2024 and does not account for decisions in 2025.

Still, the database helps counteract the in charge among those tracking it.

‘How My Population Would Like Me To Vote’

Dolan has seen intergenerational addiction up close. When her father was high, he sometimes kicked teenage Dolan out of the house with her toddler siblings. She started drinking early and progressed to other drugs, eventually landing in prison.

Although she managed to find recovery on her own, even landing a job as an EMT, she wants to make the path easier for others.

If settlement money were used to hire social workers or build family recovery programs, it could change the course of a kid’s life, she said.

“Maybe people could have helped my dad get into recovery and gave him therapy,” she said. “Anything could have happened.”

But many local officials say law enforcement is one of the few tools they have, especially in rural areas. And their constituents believe it’s effective.

“If the goal was treatment and prevention, it would have been better to throw [the money] into a big grant system and give it to treatment centers,” said , city manager of Oak Hill, West Virginia, which for a drone and surveillance cameras for its police department. “Unfortunately, local governments are really not set up to do that.”

Clarkdale, Arizona, Town Manager said her town bought because they help with enforcement — such as recording crime scenes and conducting search-and-rescue operations — as well as education, when officers interact with kids at community events.

Similar perspectives nationwide have led to spending that includes:

• About (also known as silencers) in Alexandria, Indiana.
• About in Mooresville, Indiana.
• About and Tasers in Hardy County, West Virginia.
• Nearly , to add a police officer to the county’s drug task force, replace that officer locally, buy guns and vehicles, and tint car windows.

Several elected officials said their choices reflect local politics.

That’s “how my population would like me to vote,” Hardy County Commissioner said of his commission’s goal to spend about a quarter of its settlement money on law enforcement.

Mooresville Town Council President told ºÚÁϳԹÏÍø News, “People have petitioned our government for less taxes but have never petitioned for less services” from the local police force. With federal and state budget cuts looming, the town must be resourceful, he said, adding that the Tasers were bought with a portion of settlement funds that have no restrictions.

After these purchases, an Indiana commission of law enforcement equipment that it cautioned against buying with restricted settlement dollars. , , and have released similar lists.

Research backs those restrictions. Studies have shown that drug busts and arrests can . Officers often , making people who use drugs or through police.

In contrast, equipping police officers with overdose reversal medications has been . That’s a key component of in Texas, the state with the highest percentage of reported law enforcement spending.

Police and Firefighter Salaries

Some places used settlement funds to maintain basic first responder services.

For example, Mantua Township, New Jersey, to “offset police salary and wages” and, according to its public spending report, . Township officials did not respond to requests for comment.

Los Angeles County to cover a portion of firefighter salaries and benefits last year and estimates it will use another $1 million this year.

County fire department spokesperson Heidi Oliva said opioid funds were used to fill a budget gap until revenue kicked in from a last November.

The use of funds was “appropriate,” she said in an email, because “the opioid crisis presents a significant burden to EMS response, from dispatch through arrival at hospitals, clinician mental health/burnout, and a variety of other factors.”

Using opioid money to replace other revenue is legal in most places. But it’s .

“I don’t want to see this money used to make up for stuff that would be paid for anyway,” said , chair of the FED UP! Coalition, a national advocacy organization representing many parents who’ve lost children to addiction.

Settlement dollars are “the only financial representation from the governments and from the drug companies” of families’ losses, Busch said. To see that money used to maintain the status quo is “painful” and “distressing.”

Busch fears this practice will become more common as states grapple with federal budget cuts.

Already in New Jersey, lawmakers in settlement funds to health systems to cushion against anticipated Medicaid losses — a move opposed by the state’s , , and .

However, some states are taking proactive steps.

Colorado this year against such actions.

“These dollars can’t be part of budget games where we simply backfill existing programs,” state Attorney General Phil Weiser told ºÚÁϳԹÏÍø News. “We have to build on whatever we’re doing because it hasn’t been enough.”

Other states, such as , , and , are newly requiring local governments to report how they spend the money, which may make it easier to spot disputed practices. Officials in Delaware, Hawaii, Massachusetts, and Missouri said they expect to revamp their public reporting systems to increase transparency by early 2026.

In Mississippi, which produced no substantive public reports last year, the attorney general’s office has that will host spending information after Dec. 1.

Jennifer Twyman is anxious to see some positive changes.

“We have people literally dying on our sidewalks,” said the Louisville, Kentucky, advocate.

Twyman struggled with opioid misuse for 20 years and now works with to end homelessness and the war on drugs. To her, any spending that doesn’t directly help people with addiction betrays the settlement’s purpose.

“It is the blood from many of my friends, people that I care deeply about,” she said. “That money could have been me, could have been my life.”

Read the methodology behind this project.

ºÚÁϳԹÏÍø News’ Henry Larweh; Shatterproof’s Kristen Pendergrass and Lillian Williams; and the Johns Hopkins Bloomberg School of Public Health’s Abigail Winiker, Samantha Harris, Isha Desai, Katibeth Blalock, Erin Wang, Olivia Allran, Connor Gunn, Justin Xu, Ruhao Pang, Jirka Taylor, and Valerie Ganetsky contributed to the database featured in this article.

The has taken a leading role in providing guidance to state and local governments on the use of opioid settlement funds. Faculty from the school collaborated with other experts in the field to create , which have been endorsed by over 60 organizations.

is a national nonprofit that addresses substance use disorder through distinct initiatives, including advocating for state and federal policies, ending addiction stigma, and educating communities about the treatment system.

Shatterproof is partnering with some states on projects funded by opioid settlements. ºÚÁϳԹÏÍø News, the Johns Hopkins Bloomberg School of Public Health, and the Shatterproof team that worked on this report are not involved in those efforts.

ºÚÁϳԹÏÍø 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 .

USE OUR CONTENT

This story can be republished for free (details).

In many cases, this type of community event would be unremarkable. But Irvington’s concerts stood out for their funding source: settlement money from companies accused of fueling the opioid overdose crisis.

As part of national settlements, more than a dozen companies that sold prescription painkillers are expected to pay state and local governments over nearly two decades. Governments are supposed to spend most of the windfall combating addiction. Officials who negotiated the settlements even and established other guardrails to avoid a repeat of the Tobacco Master Settlement Agreement of the 1990s, from which went to anti-smoking programs.

But there’s still significant flexibility with these dollars, and what constitutes a good use to one person can be deemed waste by another.

In Irvington, township officials said they used the money appropriately because the concerts reduced stigma around addiction and connected people to treatment. But acting state Comptroller called the concerts a “waste” and “misuse” of the settlements, which resulted from the overdose deaths of hundreds of thousands of Americans.

Similar disputes are intensifying nationwide as officials begin spending settlement money in earnest — all while grappling with slashed federal grants and looming cuts to Medicaid, the state-federal public insurance program that is for addiction treatment.

To shed light on these discussions, ºÚÁϳԹÏÍø News and researchers at the and , a national nonprofit focused on addiction, conducted a yearlong effort to document settlement spending in 2024. The team filed public records requests, scoured government websites, and extracted expenditures, which were then sorted into categories such as treatment or prevention.

The result is a database of more than 10,500 ways settlement cash was used (or not) last year — the most comprehensive national resource of its kind. Some highlights include:

• States and localities spent or committed nearly $2.7 billion in 2024, according to public records. The bulk went to investments addiction experts consider crucial, including about $615 million to treatment, $279 million to overdose reversal medications and related training, and $227 million to housing-related programs for people with substance use disorders.
• Smaller, though notable, amounts funded law enforcement gear, such as night vision equipment, and prevention efforts that experts called questionable, such as hiring a drug awareness magician.
• Some jurisdictions paid for basic government services, such as firefighter salaries.
• The money is controlled by different entities in each state, and about 20% of it is untrackable through public records.

This year’s database, including expenditures and untrackable percentages, should not be compared with the one ºÚÁϳԹÏÍø News and its partners compiled last year, due to methodology changes and state budget quirks. The database cannot present a full picture because some jurisdictions don’t publish reports or delineate spending by year. What’s shown is a snapshot of 2024 and does not account for decisions in 2025.

Still, the database helps counteract a tendency toward in charge of settlement money and confusion among people trying to track it.

More than $237 million — about 9% of all trackable spending in 2024 — went to efforts broadly aimed at preventing addiction, according to public records. These ranged from putting on community awareness events, like the concerts in Irvington, to hiring mental health counselors in schools.

Many of the examples raised red flags for researchers, including:

• Suffield, Connecticut, held a , at which kids and seniors , posed with inflatable guitars, and pledged to remain drug-free.
• Vernon, Connecticut, , at which a fighter spoke about his experience with addiction.
• Hardy County, West Virginia, to repair a school track.

“There is no evidence” to back those efforts, said , who leads prevention-oriented research at the nonprofit Partnership to End Addiction.

Elected officials like the events because “you can announce to the community that you did something,” she said. But unless they’re part of larger initiatives that incorporate other approaches, such as screening students for mental health concerns or supporting parents struggling with addiction, they’re unlikely to have lasting impact.

And when settlement funds pay for those one-offs, there’s less left “that we do know work,” Richter added.

School assembly speakers were also popular, with three Connecticut towns spending more than $30,000 total for former Boston Celtic Chris Herren to with students.

“You get 1,200 kids in the gym and you can hear a pin drop when he talks,” said Joe Kobza, superintendent of schools in Monroe. He described Herren’s talks to students and parents as “pretty impactful.”

But emotional impact isn’t necessarily effective, Richter said. Speakers often talk about drugs messing up their lives even though they’ve become wealthy celebrities. “The messages are so mixed,” she said.

Many local officials admitted their spending decisions weren’t evidence-based. But they meant well, they said. And they received little to no guidance on how to use the money.

Kelly Giannuzzi, Suffield’s former director of youth services, who organized the sock hop, said the goal was to raise awareness and combat loneliness.

Hardy County Commissioner said spending money on track repairs made sense, since he’d seen the positive impact the sport had on his son’s life. He wanted other kids to have the same opportunity.

David Owens, a spokesperson for Vernon, said the town’s mixed martial arts event was to , meant to show people that athletics can help them build connections and avoid drugs. The event brought out young men, who are often difficult to reach, he said.

But the town has no way of knowing if the event had lasting traction.

In New Jersey, acting Comptroller Walsh this summer calling on Irvington township officials to repay the settlement money spent on the concerts.

“If they’re going to hold big parties, that’s up to them and the taxpayers,” Walsh told ºÚÁϳԹÏÍø News. “But they can’t use opioid money for that.”

He also suggested the concerts were political rallies for the mayor, Tony Vauss.

Irvington officials strongly objected to the report and unsuccessfully sued Walsh to try to block its release. Vauss told ºÚÁϳԹÏÍø News it was “misleading and flat-out wrong.”

Vauss said the township distributed overdose reversal medications at the concerts and spread messages about seeking help. At least four people sought treatment on-site, the township said in .

“We felt as though we did everything correctly,” Vauss said.

However, some of the research Irvington cited in the lawsuit to support its case appeared irrelevant, such as a and a graduate thesis.

Irvington officials did not respond to questions about those citations.

As this dispute — and others like it nationwide — continue, people affected by the crisis say it’s crucial to remember the moral weight of these settlements.

It’s “blood money,” said , an addiction medicine doctor who was once addicted to opioids and has served as an expert in several opioid lawsuits.

He’s seen many family members lose parents, children, and siblings.

“I don’t know how I would look a family in the face” if this money isn’t used to prevent more losses, he said.

Read the methodology behind this project.

ºÚÁϳԹÏÍø News’ Henry Larweh; Shatterproof’s Kristen Pendergrass and Lillian Williams; and the Johns Hopkins Bloomberg School of Public Health’s Abigail Winiker, Samantha Harris, Isha Desai, Katibeth Blalock, Erin Wang, Olivia Allran, Connor Gunn, Justin Xu, Ruhao Pang, Jirka Taylor, and Valerie Ganetsky contributed to the database featured in this article.

The has taken a leading role in providing guidance to state and local governments on the use of opioid settlement funds. Faculty from the school collaborated with other experts in the field to create , which have been endorsed by over 60 organizations.

is a national nonprofit that addresses substance use disorder through distinct initiatives, including advocating for state and federal policies, ending addiction stigma, and educating communities about the treatment system.

Shatterproof is partnering with some states on projects funded by opioid settlements. ºÚÁϳԹÏÍø News, the Johns Hopkins Bloomberg School of Public Health, and the Shatterproof team that worked on this report are not involved in those efforts.

ºÚÁϳԹÏÍø 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 .

USE OUR CONTENT

This story can be republished for free (details).

Author Barbara Kingsolver opened the facility in January with royalties from her Pulitzer Prize-winning novel, “,” whose plot revolves around Appalachia’s opioid crisis. The home offers a supportive place for people to stay while learning to live without drugs. Kingsolver had asked the women now living there to join her on stage.

Kingsolver, who grew up in Appalachia, suggested the women share with the audience what they were most proud of having gained from their first weeks at Higher Ground. But she learned they were more eager to brag on one another.

Supporters say provides stability and a reentry point after leaving jail, prison, or a treatment center. It offers a range of services and support in an area devastated by addiction to painkilling pills and other types of opioids. Most fundamentally, it’s a true home, with one- and two-person bedrooms, a communal kitchen, and a den. Residents say they have found affirmation from a cohort of women who understand how addiction can demoralize a person and estrange them from family and community.

Ronda Morgan, a resident, said her family has always been in her corner. But while she was serving a jail sentence for drug possession, she told herself, “I’m sick of them having to do time with me.” She was ready for recovery. Her daughter, who’s a nurse, told her about Higher Ground, the first facility of its kind in sprawling, rural Lee County. Morgan learned she could live there for up to two years to gain the footing that had eluded her in three-plus decades of addiction.

What she didn’t anticipate was the kinship she forged with her housemates — among them, Syara Parsell — and with Higher Ground’s staff.

Parsell, 35, one of Higher Ground’s first residents, said that in her time there she’s received help finding employment and enrolling in community college courses.

From the staff and Kingsolver, Parsell said, she has received judgment-free support. “Together,” she said, “we figure it out.”

Traditional treatment facilities typically operate under highly structured medical supervision. Recovery houses, like Higher Ground, offer a more relaxed environment, helping move a resident “toward being an independent, fully functional, self-reliant human being,” said Marvin Ventrell, CEO of the National Association of Addiction Treatment Providers.

“Recovery occurs in the community,” he said. But reentry must be approached delicately. “When addiction occurs with a human being, it also occurs within a family social structure.” If a person in early recovery returns to a family that’s unprepared, that person’s chances of success “are severely diminished.”

For Kingsolver, the opioid crisis became a focal point for what she hoped would be “the great Appalachian novel.” The epidemic “has changed so much of the texture of this place,” devastating families and communities.

Pharmaceutical companies targeted central Appalachia for sales of what they prescription opioids. Kingsolver wanted to “cast my net back over all of the extractive industries that have come to this place, taken out what was good, and left behind a mess.”

“The way I put it is, ‘They came to harvest our pain when there was nothing else left,’” she said.

In research for “Demon Copperhead,” she immersed herself in the stories of people who’ve navigated addiction and those who care and advocate for them.

The novel has been an enormous success, having sold more than 3 million copies and earning far more than her previous works. Kingsolver decided to dedicate hundreds of thousands of dollars to address the crisis that has overwhelmed the region where she was raised — and to which she returned full time in 2004.

Again, she set about listening. Drawing on a wide range of expertise, she determined that a women’s recovery home was the wisest investment.

Joie Cantrell works as a public health nurse in for the Virginia Department of Health, supporting policies and practices to curb the negative effects of drug use, and serves as Higher Ground’s board chair. She had long recognized the need for just such a home.

“That was the part that was missing,” Cantrell said. Too often, when someone would come out of a treatment facility or incarceration, “we lost them. They fell back into the same old patterns.” She said the region sorely needed a safe, stable environment where women could recalibrate.

By August, the home reached its capacity of seven women. It’s right in town, “which is so important,” Kingsolver said, “because in this part of the country we have no public transportation.”

Parsell has long suffered from social anxieties; drugs were her escape. Here, her housemates embraced her. They’ve offered the support she’d never experienced.

“Every two seconds, someone’s like, ‘Syara’s here!’” she said. “I’m very grateful for it.” If there’s an issue in the house, “one of the seven of us has the solution.”

Four residents are employed outside the home, one is enrolled in community college classes, one is completing her GED with plans to continue her education, and everyone volunteers in the community. Crafting classes are offered. Family members visit.

“They’re living life,” said Subrenda Huff, who was filling in while director Liz Brooks took maternity leave.

Morgan said she accomplished more in a month at Higher Ground than she had in years. That includes applying for identification documents, taking budgeting classes, and seeking permanent housing. It includes sharing upkeep duties in the house.

Such was Kingsolver’s vision. But, she said, “here’s what I didn’t expect: The community embraced this with loving arms. I thought maybe people would say, ‘I don’t want this in my backyard.’”

Most of the furniture was donated. Kingsolver’s quarter-million or so social media followers have been instrumental in that. “But it’s not just book clubs in Switzerland or in California; it’s people in Pennington Gap,” she said. Church groups have donated “quilts, bedside lamps, things to hang on the walls just to make it homey.”

Before the facility opened, local folks volunteered to pull weeds, take down an old fence, and put up a new one. Kingsolver said the well of support “has been just endless. It’s been deep, and loving, and a wonder to see.”

Higher Ground, with only one paid staff member, has estimated yearly operating costs of $120,000, Cantrell said. Residents are charged $50 a week. Ventrell said that fees at other recovery houses vary widely but that $2,500 a month is an approximate average.

“We want them to focus on saving money and paying any restitution or fines they may have from past charges,” Cantrell said. “Some may be focused on repaying child support they may owe.”

Higher Ground receives no federal or state funding. Donations continue to pour in. And Kingsolver recently bought the building next door with plans to open a thrift shop, which would be a source of additional income for the home and offer retail work experience for its residents.

Supporters aspire to open more Higher Ground homes elsewhere in the region.

What these women are gaining, Kingsolver said, “is not just sobriety, but belief in themselves.”

ºÚÁϳԹÏÍø 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 .

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Pharmacy benefit managers, often called PBMs, that negotiate prescription drug prices between drug companies, insurance plans, and pharmacies. Some lawyers and advocates say PBMs helped fuel the overdose crisis by of opioid prescriptions.

As governments begin exploring potential lawsuits against PBMs — a step that could represent the next wave in opioid-related litigation — Optum Rx is attempting to shut down those efforts, in some cases before they even fully take shape.

In June, Optum Rx sued Anderson, Boyd, Christian, Nicholas, and Oldham counties in Kentucky for allegedly making decisions about participating in the new wave of national opioid lawsuits behind closed doors, violating Kentucky’s open meetings law. Optum Rx is asking courts to effectively force those counties to make their decisions again, this time in open meetings, potentially with the hope that some won’t bother because of the administrative burden. The result could be fewer claims against the company and possibly less money for it to pay in a future settlement.

But legal experts call Optum’s case “hypertechnical” and “frivolous,” and addiction recovery advocates say it could set a dangerous precedent for companies to evade accountability for their role in fueling the overdose crisis.

, an attorney, a national expert on opioid litigation, and founder of , said Optum’s suit reminded her of an adage among lawyers: “If the facts are on your side, pound the facts. If the law is on your side, pound the law. If neither is on your side, pound the table.”

“Right now, what we’re seeing is it pounding the table,” Minhee said of Optum Rx. The company is “desperately” trying “to find some kind of foothold” to get cases against it thrown out.

Minhee said these suits fit a pattern of Optum Rx using thin arguments to try to delay or evade opioid litigation nationwide.

Last year, Optum Rx, along with another PBM, to throw out an opioid lawsuit filed by Los Angeles County, claiming during a December hearing that the county hadn’t shown harm. The judge and ultimately rejected the companies’ request.

In April, the same companies a federal judge overseeing national opioid litigation, claiming he was biased. was based partly on a Florida lawyer’s having said the judge was “plaintiff-oriented.” Their attempt failed.

Now, Optum Rx is working to keep five Kentucky counties out of that same sweeping opioid litigation.

That national legal undertaking began more than seven years ago, as jurisdictions saw overdose deaths climb. Many people who had become addicted to prescription painkillers were cut off by their doctors, and some transitioned to using deadlier heroin or fentanyl. Health care and public safety costs skyrocketed. Thousands of cities, counties, and states began suing health care companies for allegedly creating a public nuisance by aggressively marketing prescription painkillers and negligently distributing them.

Those cases were lassoed together , which has resulted in . The first few waves of settlements involved opioid manufacturers, distributors, and retail pharmacies, with companies such as Johnson & Johnson, CVS, and Walgreens agreeing to pay state and local governments billions of dollars. The money is meant to be used for addiction treatment and prevention services — though its rollout has been controversial.

To add a new round of companies as defendants, jurisdictions must undertake a multistep process, said , a Florida-based attorney who represents many local governments in the massive national litigation. The five Kentucky counties in question were in the early stages of that process, only having asked the judge to amend their complaint, he said. They hadn’t added Optum Rx yet.

If Optum Rx’s suits are successful, those counties would have the option of redoing the initial steps of the process in a public meeting, then continuing to add Optum Rx as a defendant, Mougey explained. The company may hope that some counties won’t undertake the extra administrative effort.

Optum Rx’s “goal is clearly just to wear down and tire out these small counties,” Mougey said. “They’re trying to have a chilling effect on the litigation.”

It’s not clear why Optum Rx targeted those five counties out of the many localities undertaking the process to add the company as a defendant. The Kentucky counties range from having (Nicholas) to (Christian). One is among (Oldham), while others are poorer. Boyd County, , is one of the hardest hit, with a recent overdose rate .

Optum Rx, in its , which was similar to claims against the other counties, said local authorities had taken official legal action by asking the judge to make a change in its case. The suit said such action must be done in a public meeting and that the county did not hold one.

Optum spokesperson Isaac Sorensen told ºÚÁϳԹÏÍø News that the company’s argument is not about “a technicality.”

It is “an important legal requirement designed to ensure accountability and transparency before a county takes legal action,” said the statement Sorensen provided. “We have found many counties ignored this requirement, alongside their duty to preserve relevant evidence, and Optum Rx will defend against these improper legal actions.”

The five Kentucky counties disagree with these assertions, according to court records. As of late July, all five had filed motions to dismiss Optum Rx’s claim.

Boyd County, like the others, argued in that asking a judge to amend its complaint was a routine, procedural step that did not require a public meeting. Optum Rx jumped the gun, the county argued, filing a case before any final action had been taken.

“No amended complaint has been filed. No new defendant, OptumRx included, has been added. No new lawsuit has been initiated,” Boyd County’s response said.

The county also pointed out that it held an open meeting in 2017 that kicked off its involvement in the national litigation and authorized future amendments to that litigation.

Hearings on the counties’ motions to dismiss Optum Rx’s suits are set for late August and early September, according to court records.

These cases are shaping up to be a Goliath-versus-David legal action. Although Oldham County is the wealthiest of the Kentucky counties that Optum Rx sued, is less than 0.1% of Optum Rx’s annual revenue, which the company reported as in 2024.

Oldham County Attorney told ºÚÁϳԹÏÍø News he’d seen the impact of the opioid epidemic as a prosecutor working on a growing number of drug-related cases over the years. Now, as settlement money is arriving from other companies, it has funded increased addiction treatment in local jails. More settlement money from additional companies could expand such services, Baxter said.

If Optum Rx succeeds in kicking Kentucky counties out of the national litigation, it would set “a really horrific precedent” for other PBMs and health care companies to do something similar, said , CEO of the statewide nonprofit People Advocating Recovery.

Hyde said she’s been in recovery for more than a decade from an addiction that began with prescription painkillers for a broken leg. She wants to see PBMs and other companies held accountable and made to change their processes to prevent future crises.

Despite a recent , Hyde said people in her state, their families, and the economy are still hurting.

“Recovery doesn’t just happen overnight,” she said. “Without these dollars that have been a direct result of people being misled, mistreated, and taken advantage of, we will still be detrimentally impacted.”

ºÚÁϳԹÏÍø 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 .

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This story can be republished for free (details).