As states continue to curb health insurers’ use of artificial intelligence, patients and doctors are arming themselves with AI tools to fight claims denials, prior authorizations and soaring medical bills. (Photo by Anna Claire Vollers/Stateline)

As states strive to curb health insurers’ use of artificial intelligence, patients and doctors are arming themselves with AI tools to fight claims denials, prior authorizations and soaring medical bills.

Several businesses and nonprofits have launched AI-powered tools to help patients get their insurance claims paid and navigate byzantine medical bills, creating a robotic tug-of-war over who gets care and who foots the bill for it.

Sheer Health, a three-year-old company that helps patients and providers navigate health insurance and billing, now has an app that allows consumers to connect their health insurance account, upload medical bills and claims, and ask questions about deductibles, copays and covered benefits.

“You would think there would be some sort of technology that could explain in real English why I’m getting a bill for $1,500,” said cofounder Jeff Witten. The program uses both AI and humans to provide the answers for free, he said. Patients who want extra support in challenging a denied claim or dealing with out-of-network reimbursements can pay Sheer Health to handle those for them.

In North Carolina, the nonprofit Counterforce Health designed an AI assistant to help patients appeal their denied health insurance claims and fight large medical bills. The free service uses AI models to analyze a patient’s denial letter, then look through the patient’s policy and outside medical research to draft a customized appeal letter.

Other consumer-focused services use AI to catch billing errors or parse medical jargon. Some patients are even turning to AI chatbots like Grok for help.

A quarter of adults under age 30 said they used an AI chatbot at least once a month for health information or advice, according to a poll the health care research nonprofit KFF published in August 2024. But most adults said they were not confident that the health information is accurate.

State legislators on both sides of the aisle, meanwhile, are scrambling to keep pace, passing new regulations that govern how insurers, physicians and others use AI in health care. Already this year, more than a dozen states have passed laws regulating AI in health care, according to Manatt, a consulting firm.

“It doesn’t feel like a satisfying outcome to just have two robots argue back and forth over whether a patient should access a particular type of care,” said Carmel Shachar, assistant clinical professor of law and the faculty director of the Health Law and Policy Clinic at Harvard Law School.

“We don’t want to get on an AI-enabled treadmill that just speeds up.”

A black box

Health care can feel like a black box. If your doctor says you need surgery, for example, the cost depends on a dizzying number of factors, including your health insurance provider, your specific health plan, its copayment requirements, your deductible, where you live, the facility where the surgery will be performed, whether that facility and your doctor are in-network and your specific diagnosis.

Some insurers may require prior authorization before a surgery is approved. That can entail extensive medical documentation. After a surgery, the resulting bill can be difficult to parse.

Witten, of Sheer Health, said his company has seen thousands of instances of patients whose doctors recommend a certain procedure, like surgery, and then a few days before the surgery the patient learns insurance didn’t approve it.

In recent years, as more health insurance companies have turned to AI to automate claims processing and prior authorizations, the share of denied claims has risen. This year, 41% of physicians and other providers said their claims are denied more than 10% of the time, up from 30% of providers who said that three years ago, according to a September report from credit reporting company Experian.

Insurers on Affordable Care Act marketplaces denied nearly 1 in 5 in-network claims in 2023, up from 17% in 2021, and more than a third of out-of-network claims, according to the most recently available data from KFF.

Insurance giant UnitedHealth Group has come under fire in the media and from federal lawmakers for using algorithms to systematically deny care to seniors, while Humana and other insurers face lawsuits and regulatory investigations that allege they’ve used sophisticated algorithms to block or deny coverage for medical procedures.

Insurers say AI tools can improve efficiency and reduce costs by automating tasks that can involve analyzing vast amounts of data. And companies say they’re monitoring their AI to identify potential problems. A UnitedHealth representative pointed Stateline to the company’s AI Review Board, a team of clinicians, scientists and other experts that reviews its AI models for accuracy and fairness.

“Health plans are committed to responsibly using artificial intelligence to create a more seamless, real-time customer experience and to make claims management faster and more effective for patients and providers,” a spokesperson for America’s Health Insurance Plans, the national trade group representing health insurers, told Stateline.

But states are stepping up oversight.

Arizona, Maryland, Nebraska and Texas, for example, have banned insurance companies from using AI as the sole decisionmaker in prior authorization or medical necessity denials.

Dr. Arvind Venkat is an emergency room physician in the Pittsburgh area. He’s also a Democratic Pennsylvania state representative and the lead sponsor of a bipartisan bill to regulate the use of AI in health care.

He’s seen new technologies reshape health care during his 25 years in medicine, but AI feels wholly different, he said. It’s an “active player” in people’s care in a way that other technologies haven’t been.

“If we’re able to harness this technology to improve the delivery and efficiency of clinical care, that is a huge win,” said Venkat. But he’s worried about AI use without guardrails.

His legislation would force insurers and health care providers in Pennsylvania to be more transparent about how they use AI; require a human to make the final decision any time AI is used; and mandate that they show evidence of minimizing bias in their use of AI.

“In health care, where it’s so personal and the stakes are so high, we need to make sure we’re mandating in every patient’s case that we’re applying artificial intelligence in a way that looks at the individual patient,” Venkat said.

Patient supervision

Historically, consumers rarely challenge denied claims: A KFF analysis found fewer than 1% of health coverage denials are appealed. And even when they are, patients lose more than half of those appeals.

New consumer-focused AI tools could shift that dynamic by making appeals easier to file and the process easier to understand. But there are limits; without human oversight, experts say, the AI is vulnerable to mistakes.

“It can be difficult for a layperson to understand when AI is doing good work and when it is hallucinating or giving something that isn’t quite accurate,” said Shachar, of Harvard Law School.

For example, an AI tool might draft an appeals letter that a patient thinks looks impressive. But because most patients aren’t medical experts, they may not recognize if the AI misstates medical information, derailing an appeal, she said.

“The challenge is, if the patient is the one driving the process, are they going to be able to properly supervise the AI?” she said.

Earlier this year, Mathew Evins learned just 48 hours before his scheduled back surgery that his insurer wouldn’t cover it. Evins, a 68-year-old public relations executive who lives in Florida, worked with his physician to appeal, but got nowhere. He used an AI chatbot to draft a letter to his insurer, but that failed, too.

On his son’s recommendation, Evins turned to Sheer Health. He said Sheer identified a coding error in his medical records and handled communications with his insurer. The surgery was approved about three weeks later.

“It’s unfortunate that the public health system is so broken that it needs a third party to intervene on the patient’s behalf,” Evins told Stateline. But he’s grateful the technology made it possible to get life-changing surgery.

“AI in and of itself isn’t an answer,” he said. “AI, when used by a professional that understands the issues and ramifications of a particular problem, that’s a different story. Then you’ve got an effective tool.”

Most experts and lawmakers agree a human is needed to keep the robots in check.

AI has made it possible for insurance companies to rapidly assess cases and make decisions about whether to authorize surgeries or cover certain medical care. But that ability to make lightning-fast determinations should be tempered with a human, Venkat said.

“It’s why we need government regulation and why we need to make sure we mandate an individualized assessment with a human decisionmaker.”

Witten said there are situations in which AI works well, such as when it sifts through an insurance policy — which is essentially a contract between the company and the consumer — and connects the dots between the policy’s coverage and a corresponding insurance claim.

But, he said, “there are complicated cases out there AI just can’t resolve.” That’s when a human is needed to review.

“I think there’s a huge opportunity for AI to improve the patient experience and overall provider experience,” Witten said. “Where I worry is when you have insurance companies or other players using AI to completely replace customer support and human interaction.”

Furthermore, a growing body of research has found AI can reinforce bias that’s found elsewhere in medicine, discriminating against women, ethnic and racial minorities, and those with public insurance.

“The conclusions from artificial intelligence can reinforce discriminatory patterns and violate privacy in ways that we have already legislated against,” Venkat said.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

Group Health Cooperative of South Central Wisconsin's East Side Madison clinic. (Photo by Erik Gunn/Wisconsin Examiner)

Directors of a Madison health care system will consider Thursday whether to change course in the organization’s response to a union organizing campaign.

Supporters of the union campaign at Group Health Cooperative of South Central Wisconsin put five motions before the board of directors at an in-person meeting in October — including one to voluntarily recognize the union, SEIU Wisconsin.

A statement from the co-op management Wednesday did not address whether the board will directly act on any of the motions when it meets.

“The motions are advisory to the Board of Directors concerning its instructions to management about the unionization efforts of our direct care employees,” Group Health stated. “All the Motions will be considered by the Board at the November 20th meeting. The results of those discussions will be communicated to our membership in a future statement.”

Group Health’s response to the union drive, which became public about a year ago, has produced a rift between the co-op’s management and some of its members, who have criticized the organization’s response as a betrayal of its progressive heritage.

“To me it was horrifying to learn that we had people leaving because the conditions were not tolerable,” said Ruth Brill, a Group Health member since 1979 who has supported the union organizing campaign.

According to union supporters, the five motions offered at an Oct. 11 in-person mass meeting to discuss the union organizing campaign passed unanimously. About 170 Group Health members attended that meeting, and union allies said it was the largest turnout in memory for an in-person meeting of co-op members.

Three of the five motions call on the board, the co-op management, or both:

• To report to members how much money Group Health has spent in 2024 and 2025 to pay the law firm Husch Blackwell, which has represented the co-op in connection with the union campaign.
• To voluntarily recognize SEIU Wisconsin as the representative for the professions and departments that the union first sought to represent when workers petitioned the National Labor Relations Board for a union election on Dec. 12, 2024. That motion also demands that Group Health “observe strict neutrality regarding the unionization of any of its workers.”
• To compile a report “of all meeting minutes, emails, and other communications involving Board members, administrators, and/or supervisory employees regarding union activity, from January 2024 to the present.”

The third motion also demands a report on all legal or consulting fees that Group Health has spent related to the union drive, including itemized details.

The fourth motion demands that the board and administration “faithfully follow the democratically expressed will” of the co-op members, charging that the membership has “been denied an opportunity to duly and fully exercise its role” in leading the co-op.

The fifth motion calls for a meeting by mid-January “on the democratization of GHC governance.”

“GHC says members are the most important part of our cooperative and yet the board is not listening to what the members have very clearly stated what they would like to happen,” said Dr. Nisha Rajagopalan, a family practice physician and among the union campaign’s leaders.

“If we are a cooperative that is for our members and our patients, those people showed up in the room and they voted and said exactly what they wanted, and we would like to hear the board uphold that,” said Katie Cloud, a certified medical assistant who has also been active in the union campaign.

Paul Terranova, a Group Health member for 25 years, organized a presentation to the co-op board earlier this year to make the case for unionization in the context of a nonprofit co-op. He later helped organize a slate of candidates for the board in opposition to four incumbent board members. All four of the rival candidates were elected in June.

Terranova said that board members have not communicated directly with Group Health members about the union campaign. Board discussions about the matter have been conducted in closed sessions.

The board’s consideration of the motions is “a really pivotal moment for GHC,” Terranova said, “and how they handle this is going to say a lot about whether this is still a cooperative or if it’s become just a corporate board with cooperative window dressing.”

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The U.S. Capitol building in Washington, D.C., amid fog on Tuesday, Dec. 10, 2024. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. senators began debating how to reduce health care costs for Americans during a hearing Wednesday, where experts’ varied recommendations and comments from lawmakers previewed the rocky and potentially long path ahead. 

Republicans on the Finance Committee argued the Affordable Care Act, or Obamacare, has led to a spike in health insurance costs for individuals  that shouldn’t be offset by tax credits any longer. 

Democrats urged their colleagues to extend the enhanced subsidies for at least another year to give Congress more time to address larger, more complex issues within the country’s health insurance and health care systems. 

Committee Chairman Mike Crapo, R-Idaho, said the hearing marked “the first step in building the foundation for” health care reform.

“We need both short-term and long-term solutions,” Crapo said. “In the short term, we cannot simply throw good money after bad policy. If we keep advancing a system that drives up premiums, we will make this problem even harder to solve.”

“Instead, we should set the groundwork for giving Americans more control over their health care choices,” Crapo added. “Rather than accepting the current system of giving billions of taxpayer dollars to insurers, we should consider providing financial assistance directly to consumers through health savings accounts, which are now available on the Obamacare exchanges through a provision in the One Big Beautiful Bill.”

Such tax-advantaged accounts are used to save money to pay for medical expenses and generally are used in conjunction with a high-deductible insurance plan, but an HSA “is a trust/custodial account and is not health insurance,” according to the Congressional Research Service.

The ACA, signed into law by President Barack Obama in 2010, overhauled the U.S. health care system with the intent of reducing high rates of uninsured people and ending insurance industry practices such as exclusions based on pre-existing conditions and the sale of policies with high costs and skimpy coverage. The law also expanded Medicaid and, for individual coverage, introduced the health insurance exchanges, or marketplaces, that now are at issue.

According to the health organization KFF, the number of uninsured Americans fell from about 14% to 16% in the years preceding passage of the law to a record low of 7.7% in 2023.

Pessimism about health care action

Oregon Sen. Ron Wyden, the top Democrat on the panel, rebuked Republicans for focusing on other policy areas throughout the year instead of making improvements to health care.

“Sitting on your hands has consequences,” he said. 

Wyden doesn’t see a way for Congress to extend the enhanced tax credits set to expire at the end of the year for people who get their health insurance from the ACA marketplace, despite Democrats pressing for that during the 43-day government shutdown that ended in mid-November. 

Wyden expressed support for working with Republican senators to address health insurance companies’ structure, though he said he is “skeptical” his GOP colleagues will actually approve legislation on that particular issue in the months ahead. 

“Now if they are serious about taking on the crooks that dominate big insurance, like UnitedHealthcare, I’m all in,” Wyden said. “In my view that starts with a laser focus on lower costs for consumers, going after fraud where it truly exists, and cracking down on middlemen.”

‘Very little that this Congress can do’

Douglas Holtz-Eakin, president at the center-right American Action Forum and former chief economist at the Council for Economic Advisers during the President George W. Bush administration, told the committee the structure of the Affordable Care Act poses problems. 

“As a piece of health policy, economic policy and budget policy, the ACA has always been a troubling construct,” Holtz-Eakin said, later adding there is “very little that this Congress can do to change the outlook” for 2026. 

Holtz-Eakin testified that Congress is long “overdue for a real rethinking of health care policy at the federal level” that he believes should focus on two primary areas. 

The first is to “rationalize the insurance subsidies” and the second is to address what he referred to as “high-value care,” which he said should include Medicare, the health program that covers 69 million Americans over 65 and some people with disabilities. 

“Medicare is a great budgetary threat, and so I encourage the committee and the Congress as a whole to take a hard look at that and make some progress toward better health care outcomes and better budgetary outcomes,” Holtz-Eakin said.  

Jason Levitis, senior fellow of the Health Policy Division at the left-leaning Urban Institute and a Treasury employee who led the ACA implementation at the department during the Obama administration, urged lawmakers to address the “too complicated and segmented” health insurance marketplace. 

Levitis said the best short-term option for Congress would be to extend the enhanced tax credits for ACA enrollees during 2026, despite the time crunch. 

“At this point the only feasible option is a clean extension of the existing enhancements,” Levitis said. “The marketplaces have already built that option and have been preparing for months for the possibility of an extension.” 

Former Trump adviser says ACA ‘failed’

Brian Blase, president of the Paragon Health Institute and a former special assistant to President Donald Trump at the White House National Economic Council, said bluntly that the Affordable Care Act has “failed.”

“The law entrenched an inefficient insurance-dominated health sector with massive subsidies flowing straight from the Treasury to health companies,” Blase said. 

The subsidies for ACA marketplace plans, he said, were “ill-designed and inflationary,” urging lawmakers not to extend them for another year.  

“The enrollee share of the premium is capped regardless of the total premium. When enrollees pay only a small slice of the premium or no premium at all, insurers face almost no price discipline,” Blase said. “Insurers can raise premiums knowing the taxpayers will absorb almost all of the increase.”

Blase said he believes the ACA’s regulations on health insurance companies are one of the reasons costs have spiked. 

“For example, under the medical loss ratio, insurers must spend a minimum share of premium revenue on medical claims. In other words, to increase profits, insurers must increase premiums,” Blase said. “The ACA’s essential health benefits require plans to cover the same set of services regardless of what people want or need. These rules increase premiums and wasteful spending.”

The medical loss ratio was included in the ACA in response to insurers who spent “a substantial portion” of premiums on administrative costs and profits, including executive salaries, overhead and marketing, according to the Centers for Medicare and Medicaid Services.

‘We all believe we need to reform’

Senate Majority Leader John Thune, R-S.D., told reporters separately from the hearing the debate over how to restructure health insurance to bring down costs has highlighted the “differences of opinion” among GOP lawmakers. 

“We’ve got a lot of people who have strong views, but the one thing that unites us is we all believe we need to reform, and we’ve got to do something to drive health care costs down,” Thune said. 

GOP leaders, he added, are “looking for solutions that will lower health care premiums, not increase them. And what we see today is just constant inflationary impacts from some of these policies of the past.”

Trump, who would need to support any health care overhaul bill for it to move through Congress, wrote in a social media post Tuesday that he wants lawmakers to send money straight to Americans, without detail on how that would work. 

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH,” Trump wrote. “THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE. POWER TO THE PEOPLE! Congress, do not waste your time and energy on anything else. This is the only way to have great Healthcare in America!!! GET IT DONE, NOW. President DJT”

Photo by Getty Images

In an ever-changing world, it’s nice to know that some things stay the same – my annual health insurance premium increase just came through for the 20th year in a row! For 2026, my company’s small-group policy will rise roughly 10%. And believe it or not, in the world of American health care, that’s considered a modest increase.

For my own family — myself, my wife, and our four kids — our health insurance plan costs about $1,800 per month with a $12,000 annual deductible. That is about $34,000 per year. 

If your household earns around $110,000 a year, you’re actually doing extremely well: that puts you in the top 15% of earners in states like Wisconsin.

But even at that income, a $34,000 annual healthcare bill eats up 40% of your post-tax income.

Let’s put that in perspective:

• That $34,000 is almost six times what that same family pays in Medicare taxes — taxes that help cover the oldest, sickest people in the country.
• That $34,000 is more than my family spends on food, mortgage, property taxes, and utilities combined.
• And the gap between what we pay and what we use has become downright comical: I’m at Hy-Vee four times a week, but I haven’t been to a doctor in over three years.

But here’s the bigger problem: When premiums go up 7% per year — again, considered “moderate” — the magic of compound interest turns that into a doubling of price in just a decade.

At only 7% increases, by 2037, a family earning $110,000 will be paying a $45,000 annual premium for a small-group plan. Add a $15,000 deductible, and private insurance would consume 80% of their after-tax take-home pay.

No household, no matter how responsible or hard-working, can withstand that. 

We’ve been promised reform for nearly a decade. Donald Trump began talking about fixing healthcare back in 2016. By 2024, the country still had nothing more than “concepts of a plan.” And temporary patches — tweaked subsidies, tinkering with tax credits, or tossing out $2,000 checks — are not even in the neighborhood of a real solution. 

At the very least, Congress should make sure those price spikes don’t devastate families on Jan. 1, but the fact that those tax credits are needed speaks to out of control costs within the health care system. 

We are out of time for small fixes. The system doesn’t need polishing — it needs structural change. 

What we need is bold leadership and big ideas. And in my view, the fastest, most practical path forward is a public option — Medicare-for-all-who-want-it. Let individuals and small businesses buy into Medicare. If my family could get coverage for anything less than $34,000 a year, that’s an immediate savings! And we’re far from alone. That’s why I’m advocating with other small business owners, including those at the Main Street Alliance, to get it done. 

You can’t solve an economic problem with partisan politics. That’s why Rep. Derrick Van Orden must come to the table to negotiate on health care. He said he would protect rural health care earlier this year, then turned his back on folks on Western Wisconsin and voted for the ‘Big Ugly Law’. The system is broken and we need serious people to address health care in a serious way. The math has already made the case. Now we need you to have the courage to follow it. 

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Health insurance claim form. (krisanapong detraphiphat/Getty Images)

WASHINGTON — Two leading Democrats on a U.S. House panel called on the head of an agency within the U.S. Department of Labor responsible for protecting workers’ benefits to take action to address improper health insurance claim denials, in a Tuesday letter provided exclusively to States Newsroom.  

Reps. Bobby Scott of Virginia and Mark DeSaulnier of California — the respective ranking members of the House Committee on Education and Workforce and its Subcommittee on Health, Employment, Labor, and Pensions — offered three recommendations to Daniel Aronowitz. He is the assistant secretary of the DOL’s Employee Benefits Security Administration, or EBSA. 

“Improper claim denials impose substantial health and financial hardships on individuals, leading to delays in necessary treatments, worsened health outcomes, and high out-of-pocket costs,” Scott and DeSaulnier wrote.

“In far too many tragic cases, denials lead to the unnecessary deaths of people who have earned benefits through their plan, but are nonetheless denied the care that could have saved their lives,” they added. 

Improvements called for in collecting data on denials

As head of EBSA, Aronowitz is responsible for administering, regulating and enforcing Title I of the Employee Retirement Income Security Act, or ERISA, which is intended to protect participants’ and their beneficiaries’ interests when it comes to benefit plans under their employers. 

DOL estimated roughly 136 million participants and beneficiaries were covered by approximately 2.6 million ERISA-covered group health plans in 2022.  

As part of their recommendations, Scott and DeSaulnier called on Aronowitz to “implement long-delayed transparency requirements to collect data on health claim denials by insurance companies and group health plans.”

The two suggested building upon Form 5500, ERISA’s annual reporting requirement, to “improve data collection from group health plans.” 

Staffing at agency, Trump budget cuts cited

Scott and DeSaulnier also urged Aronowitz to “commit to fully enforcing the law and to ensuring that EBSA is adequately staffed to fulfill its mission,” pointing to a decline in more than a fifth of the agency’s staff under President Donald Trump’s administration. 

Trump’s fiscal 2026 budget request for DOL also called for $181 million in funding for EBSA, a $10 million proposed cut from the prior fiscal year. 

The Senate Appropriations Committee passed its annual bill to fund DOL, including EBSA, back in July and maintained funding for the program in fiscal 2026 at $191 million. 

The corresponding panel in the House also approved its bill to fund DOL in September, aligning with the administration’s request of cutting funding for EBSA by $10 million in fiscal 2026. 

The Democrats also recommended Aronowitz take steps to “improve consumers’ ability to appeal wrongfully denied health benefits.” 

They encouraged the assistant secretary to consult the Advisory Council on Employee Welfare and Pension Benefit Plans and to “reverse” DOL’s current posture regarding the council. 

Scott and DeSaulnier noted that DOL took several steps to “undermine” the council, including “delaying public release of its report, purging documents such as testimonies from consumer advocates from the Department’s website, and, to date, failing to convene the Council for any of the four statutorily-mandated meetings.” 

The department did not immediately respond to a request for comment Tuesday. 

Lt. Gov. Sara Rodriguez speaks during a Wisconsin Technology Council forum featuring Democratic and Republican hopefuls in the 2026 governor's race Nov. 6, 2025. (Photo by Baylor Spears/Wisconsin Examiner)

The longest ever federal government shutdown that ended last week revolved around a top issue for Lt. Gov. Sara Rodriguez as she campaigns to be Wisconsin’s next governor: health and health care.

A registered nurse by training and former official at the Centers for Disease Control and Prevention, Rodriguez has been deeply involved in health care policy, first in her single term as a member of the Wisconsin Assembly and then, since 2023, as the No. 2 official in the state’s executive branch.

And, she says, it motivated her to declare her intention to succeed Gov. Tony Evers after Evers decided to stand down from the 2026 election.

“One of the reasons why I wanted to run is to make sure that we have somebody in a leadership position that, No. 1, understands health care, and No. 2, really gets how unaffordable and broken it is,” Rodriguez told the Wisconsin Examiner in an interview Monday.

She also sees a shift in the federal government away from established public health principles, forcing states to take the lead on setting public health standards. In the governor’s office, she said, her professional background would equip her to tackle  those issues.

As  a state representative, Rodriguez proposed a bill in the 2021-22 legislative term to accept the expansion of Medicaid — BadgerCare in Wisconsin — through the Affordable Care Act. Expansion would allow the state to enroll people with incomes between 100% and 138% of the federal poverty guidelines in Medicaid, with the federal government paying 90% of the additional cost.

When the ACA took effect, Gov. Scott Walker was in office and refused throughout his two terms as governor to accept the federal support and expand the program.

Evers defeated Walker in 2018 and promised to accept the federal expansion, but in the lame-duck session before he was sworn in, the Republican majority in the Legislature passed a bill that Walker signed, requiring the Legislature’s approval for expansion.

Since then, repeated attempts by Democrats to expand Medicaid, including the bill Rodriguez authored four years ago, have failed with Republican majorities in both houses of the Legislature.

Another form of Medicaid expansion — covering mothers for a year after they give birth — has the support of bipartisan majorities in the Senate and the Assembly, but Assembly Speaker Robin Vos (R-Rochester) has opposed bringing it to the floor. 

“We are one of two states that have not done that — us and Arkansas,” Rodriguez said. “And I think Arkansas may be working on it. So we may be the only one left at the end of the day.”

Rodriguez’s political career started with her Assembly race in 2020, flipping a Republican seat in the Milwaukee suburbs. She followed that with her race for lieutenant governor in 2022 and now her  campaign for the Democratic nomination to run for governor in 2026.

Throughout her political life, she said, she has been supported by 314 Action, a political organizing group seeking to elect more scientists and people in science-related professions, including health care.

During the recent federal government shutdown, Democrats in the U.S. Senate insisted that any resolution to fund the government also extend federal subsidies for health insurance under the ACA. The expiration of those subsidies at the end of this year will cause health insurance premiums to double, on average, participants in the ACA marketplace. 

Ultimately, a handful of Democratic senators voted with the Republicans to advance a GOP-authored spending bill that ended the shutdown without addressing the looming health insurance cost spike.

But the issue won’t go away, Rodriguez said.

“We’re looking at a doubling of premiums,” she said. “A 60-year-old couple are looking $1,500 to $2,000 more a month to be able to pay for their health insurance. That is absolutely unaffordable for most Wisconsinites.”

The problem extends beyond just people who buy their insurance through the federal marketplace, she warned.

“The larger amount of people who are uninsured in the state, the higher our health care costs are going to get, because they’re going to wait, they’re going to delay care, they’re going to be sicker when they get into care, and it’s going to cost hospital systems more in terms of uncompensated care,” Rodriguez said.

“If people will go uninsured, it’s going to raise costs,” she added. “And continuing to talk about it, continuing to let people know how that works, is something that I’m uniquely equipped to do as a nurse, as somebody who’s worked within the health care system. And it’s one of the reasons why I’m running for governor.”

Rodriguez said she has seen the benefits that the ACA has brought in the last decade and a half.

Before it was in place, “people delayed care,” she said. “They came in sicker to my emergency department and it cost a whole lot more dollars to be able to treat them and they were out of work because they had to be treated within a hospital system as opposed to going to their regular doctor and being able to get the care that they needed and be able to take care of their diabetes, to take care of their hypertension. Those are the kind of things that the Affordable Care Act has allowed us to do.”

She said she’s heard from small business owners who were able to start a business because they could get health insurance thanks to the ACA.

“Do we need to fix it? Absolutely. Do we need to get it better? Absolutely,” Rodriguez said. “But to get rid of it is going to have devastating effects on health care in Wisconsin.”

Rodriguez said she also brings the perspective of health and health care to other policy topics.

“The medicine we give you, the procedures that we do — it’s such a tiny fraction of how healthy we are,” she said.

Food, housing and “a good-paying job to put a roof over our heads and to pay for the food we eat and to pay for the medications we’re prescribed” are health issues, too, Rodriguez said. That’s why housing affordability, for example, is part of her platform, she said. 

“Tom Tiffany in the governor’s seat [is] not going to put a priority on lowering costs for Wisconsinites,” she said.

She also predicted that, if elected, Tiffany would sign laws restricting abortion in Wisconsin — “and that is going to be extraordinarily dangerous for people.”

Rodriguez views her science background as a strong selling point. “I think we want somebody who’s going to use data and science to make decisions,” she said.

Robert F. Kennedy Jr., President Donald Trump’s secretary of the federal Department of Health and Human Services, has been “using conspiracy theories as his underlying belief system, and that hurts real people,” Rodriguez said.

She cited surging measles cases in Wisconsin and nationally and the deaths of children in some states after the federal government weakened its support for vaccination.

“That hasn’t happened in a decade, and they’re continuing to feed this anti-science rhetoric that is going to harm our kids here in Wisconsin,” Rodriguez said. “I’ve been clear, I think RFK Jr. should resign. I don’t think he’s qualified for the job that he has and he’s actually a danger to public health across the country.”

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A farmhouse sits along a gravel road near Elgin, Iowa. For at least the next dozen years, rural areas will continue to have only about two-thirds of the primary care physicians they need, according to a new report. (Photo by Scott Olson/Getty Images)

For at least the next dozen years, rural areas will continue to have only about two-thirds of the primary care physicians they need, according to a report released Monday.

The nonprofit Commonwealth Fund based its analysis on federal health workforce data. Its report comes just days after states applied for portions of a $50 billion rural health fund included in the broad tax and spending law President Donald Trump signed in July. Some states want to use the federal money to expand their rural residency programs, as physicians who complete their residencies in rural areas are more likely to practice in one.

About 43 million people live in rural areas without enough primary care physicians, according to the report. Across the country, nearly all — 92% — of rural counties are considered primary care professional shortage areas, compared to 83% of nonrural counties. Forty-five percent of rural counties had five or fewer primary care doctors in 2023. Roughly 200 rural counties lacked one altogether.

Nationally, the report found there was an average of one physician per 2,881 rural residents. States in the South had 3,411 patients per physician, whereas states in the Northeast had 1,979 residents per physician.

Rural residents are less likely to use telehealth for primary care, largely because of limited broadband internet access. About 19% of rural respondents said they received health care from a primary care physician via telehealth over the past year, compared with the national average of 29%.

The report also took the pulse of states’ participation in national programs for rural areas, such as a federal loan repayment and scholarship program for physicians working in areas with a shortage of health care providers. In 2023, 40% of rural counties had at least one primary care clinician participating in the program — compared to 60% of nonrural counties.

While the demand for primary care physicians will surpass the supply, the study estimates that the supply of rural nurse practitioners will exceed demand over time, as nurse practitioners are the fastest-growing type of clinician in the U.S., regardless of geography, the authors wrote.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

 

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Two of the biggest political issues of the year are immigration and health care.

In the latest Marquette Law School Poll, 75% of Republicans said they were very concerned about illegal immigration and border security while 83% of Democrats said they were very concerned about health insurance. Those were the top issues among those groups. (Among independents, 79% said they were very concerned about inflation and the cost of living, making it their top issue.)

Here’s a look at some recent fact checks of claims related to health care and immigration. 

Health care

No, Obamacare premiums aren’t doubling for 20 million Americans in 2026, but 2 to 3 million Americans would lose all enhanced subsidies and about half of them could see their premium payments double or triple.

Yes, Obamacare premiums increased three times the rate of inflation since the program started in 2014. They’re making headlines now for going up even more.

No, 6 million people have not received Obamacare health insurance without knowing it. There wasn’t evidence to back a claim by U.S. Sen. Ron Johnson, R-Wis., about the level of fraud in the program.

No, Wisconsin does not have a law on minors getting birth control without parental consent. But residents under age 18 can get birth control on their own.

Immigration

Yes, unauthorized immigrants have constitutional rights that apply to all people in the U.S. That includes a right to due process, to defend oneself in a hearing, such as in court, though not other rights, such as voting.

No, standard driver’s licenses do not prove U.S. citizenship. There’s a court battle in Wisconsin over whether voters must prove citizenship to cast a ballot.

Yes, U.S. Immigration and Customs Enforcement (ICE) is offering police departments $100,000 to cooperate in finding unauthorized immigrants. It’s for vehicle purchases.

No, tens of millions of unauthorized immigrants do not receive federal health benefits. 

Here are 8 claims related to health care and immigration … and the facts is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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The amount some pay for Affordable Care Act health insurance will double when enhanced subsidies expire, but there isn’t evidence the number is 20 million.

KFF, a health policy nonprofit, estimates monthly payments for Obamacare recipients will increase, on average, $1,016 – more than doubling, from $888 in 2025 to $1,904 in 2026.

That counts increases to premiums and lost subsidies.

U.S. Sen. Bernie Sanders, I-Vermont, citing KFF, made the 20 million claim. U.S. Sen. Ron Johnson, R-Wis., said Sanders was wrong.

KFF doesn’t say how many of the 24 million Obamacare enrollees will see premiums double.

But 2 to 3 million people on the high end of income eligibility would lose all enhanced subsidies. About half could see premium payments double or triple. 

Enhanced subsidies, created in 2021, expire Dec. 31. Some Obamacare enrollees will receive lower enhanced subsidies or none. Standard subsidies remain.

This fact brief is responsive to conversations such as this one.

Sources

• KFF: ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire
• U.S. Sen. Bernie Sanders: Email
• KFF: Email
• Centers for Medicare & Medicaid Services: Health Insurance Exchanges 2025 Open Enrollment Report
• The Journalist's Resource: The battle over Affordable Care Act insurance subsidies: What to know as open enrollment looms
• NBC News: What the government shutdown's end means for Obamacare subsidies
• PolitiFact: Fact-checking Democrats’ talking points about Affordable Care Act subsidies

Will 2026 Obamacare premiums double for 20 million Americans? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Senate Minority Leader Chuck Schumer, D-N.Y., left, accompanied by Sen. Cory Booker, D-N.J., points to a poster depicting rising medical costs if Congress allows the Affordable Care Act tax credits to expire in December as he speaks to reporters following a Democratic policy luncheon at the U.S. Capitol on Oct. 15, 2025 in Washington, D.C. (Photo by Andrew Harnik/Getty Images)

WASHINGTON — Congress has roughly two months to find bipartisan agreement to curb rising health insurance costs if lawmakers want to avoid another government shutdown.

That herculean task would be difficult in the best circumstances, but is much more challenging after lawmakers spent the last 43 days criticizing each other instead of building the types of trust that are usually needed for large deals. Democrats maintained they wanted to address skyrocketing premiums for individual health care plans, while Republicans insisted those talks had to occur when the government was open.

At the same time, congressional leaders will try to wrap up work on the nine full-year government funding bills that were supposed to become law before Oct. 1 and weren’t included in the package that reopened the government. 

Congress must pass all of those bills or another stopgap measure before the new Jan. 30 deadline, regardless of how well or disastrous talks on a health care bill turn out. 

The two-track negotiations will push party leaders to compromise on issues they’d rather not, especially as next year’s November midterm elections inch closer. 

Early signs were not good.

House Speaker Mike Johnson said during a Wednesday night press conference the enhanced Affordable Care Act tax credits set to expire at the end of the year are a “boondoggle” and that “Republicans would demand a lot of reforms” before agreeing to extend those in any way. 

“We currently have 433 members of the House of Representatives. There’s a lot of opinions in this building. And on our side, certainly, a lot of opinions on how to fix health care and make it more affordable. I have to allow that process to play out,” Johnson, R-La., said. 

While Senate Majority Leader John Thune, R-S.D., made a commitment to hold a vote on a health care bill before the end of December to conclude the shutdown, Johnson has avoided giving a timeline for when he would bring any similar legislation to the floor. 

President Donald Trump, aside from throwing insults at Democrats, largely stayed on the sidelines of the shutdown fight, though he suggested the funds used for the tax credits should in some way go directly to individuals instead of large insurance companies.

Pessimism over progress

The shutdown highlighted the stark differences Republicans and Democrats hold on health care as prices for insurance continue to spike, forcing millions of Americans to choose between taking care of themselves and breaking their budgets, States Newsroom found in interviews with members of Congress. 

GOP leaders held together throughout the funding lapse and didn’t negotiate on the expiring ACA marketplace tax credits, or anything else. 

Now that it’s over, Republicans will need to put something forward.

Connecticut Rep. Rosa DeLauro, the top Democrat on the House Appropriations Committee, said her sense is that Congress will “probably be in the same place on January 30th that we are now.”

“We have two parties here, two sides,” DeLauro said. “In the past … we’ve had serious negotiation back and forth, and that’s what we need to do, and that’s not happening.”

While Republicans have unified control of government, major legislation needs the support of at least 60 senators to advance in that chamber. Republicans hold 53 seats at the moment, meaning at least some Democrats must support a bill for it to pass. 

DeLauro did not rule out another shutdown, saying Democrats plan to take the next few months “one day at a time,” while closely watching what Republicans are willing to do on the nine full-year appropriations bills and health care costs. 

Maryland Democratic Rep. Steny Hoyer, former House majority leader and a senior member of the Appropriations Committee, said Republican leaders keeping that chamber in recess for nearly two months leading up to and during the shutdown significantly delayed work on the full-year government funding bills. 

Hoyer said that scheduling decision was a clear “indication they’re not interested in solving the problem.”

“If they were, they would have had members here working on appropriation bills,” Hoyer said. “And the only way you’re going to ultimately solve this problem is to pass appropriation bills.”

Hoyer said the real question facing Congress now isn’t whether there is time to work out agreement on the remaining nine government spending bills, but whether there’s a will to make the types of compromises needed. 

Untangling spending bills

The spending package that reopened the government included three of the dozen full-year bills, funding the Agriculture Department, Food and Drug Administration, Legislative Branch, military construction projects and Department of Veterans Affairs.

The remaining appropriations bills will be considerably tougher to resolve, especially because the House and Senate have yet to agree on how much they want to spend across the thousands of programs. Trump proposed major cutbacks in multiple programs in his budget request earlier this year that Democrats have strongly resisted.

The Defense, Homeland Security, Labor-HHS-Education and State-Foreign Operations bills will be some of the more difficult to settle. 

Congress could always lean on another stopgap spending bill to keep funding relatively flat for the departments and agencies not covered by a full-year bill before Jan. 30. But lawmakers will need bipartisan support to advance in the Senate.

Washington Democratic Rep. Pramila Jayapal, former chair of the Congressional Progressive Caucus, said Republicans don’t seem to grasp how much Americans are struggling with the cost of living, including for health insurance and health care. 

“My constituents are already telling me that they’re making that choice between having health insurance or having a house to live in, and they’re going to choose the house,” Jayapal said. 

Whether or not a partial government shutdown begins in early 2026 will likely depend on whether Republican lawmakers from swing districts force bipartisanship on a health care bill. 

“I really don’t know,” Jayapal said. “I think it depends on these vulnerable House Republicans, who are not going to be able to go back to their constituents without telling them that they’ve done something on health care.”

Political juice and a backbone

Democratic Rep. Melanie Stansbury of New Mexico said she wouldn’t be surprised if Congress is unable to strike a deal on government funding and winds up in a partial shutdown by February. 

“Do I think that the Republicans have the political juice to get … the rest of their appropriation bills across the finish line and a health care deal? No,” Stansbury said. 

She added that she hopes a handful of Republicans decide to join Democrats on the discharge petition bill that would force a floor vote on a bill to extend the ACA marketplace subsidies for three years. 

“We gotta find a few brave Republicans who still have a backbone and some guts to stand up to this administration and actually care for their constituents,” Stansbury said. 

But any bipartisan deal to extend those health care tax credits seems fraught, as House Minority Leader Hakeem Jeffries slammed Republicans as having “zero credibility on this issue.”

He pointed to Republicans trying several times to repeal the Affordable Care Act, including their last attempt in 2017, when GOP Sens. Lisa Murkowski of Alaska, Susan Collins of Maine and the late John McCain of Arizona crossed party lines to vote against repealing the 2010 law.

“There’s no evidence that they’re serious about extending the Affordable Care Act tax credits,” Jeffries, of New York, said. “Republicans have zero interest in fixing the health care crisis that they’ve created.”

‘No point in taking 41 days to cave’

When Democrats controlled both chambers, temporary health care subsidies were originally passed as part of the COVID-19-era American Rescue Plan in 2021 for two years. 

With Democrats still controlling both chambers, lawmakers approved the Inflation Reduction Act, the 2022 signature climate policy bill from the Biden administration, that extended those health care subsidies for three years, expiring at the end of December 2025.

The outcome of the just concluded shutdown is shaping some House Democrats’ views.

Virginia Democratic Rep. Bobby Scott said if there is a new shutdown come February, Senate Democrats will have to decide whether they’re going to “cave again, or at least engage in negotiations.” 

“When the (Senate) Democrats say: ‘Our strategy wasn’t working,’ it wasn’t working because they assume you’re going to cave, which you just proved,” Scott told States Newsroom. “Their strategy worked — trying to get them to negotiate and talk to you doesn’t because they know you’re going to cave.”

Scott said “there’s no point in taking 41 days to cave,” pointing to the eight members of the Senate Democratic Caucus who broke ranks to advance and later approve the package to reopen the government. 

“Why don’t you just cave right at the beginning, on February 2nd?” he said. “If the Republican strategy is: ‘We’re not going to negotiate at all because you’re going to cave,’ you have to show them that you’re not going to cave, then you can have a discussion.”

Scott said the same health care issues will still exist if nothing happens between now and the package’s Jan. 30 government funding deadline.  

“By then, we’ll know that several million people don’t have health insurance, we’ll know that rural hospitals are beginning to suffer,” Scott said. 

Delaware Democratic Rep. Sarah McBride said that “from today through November (2026) and after, we will continue to be talking about health care, to be fighting for health care.”

“I think what you’ve seen over the last several months, you will continue to see from us through November and then, God willing, once we’re in a majority, we’ll do all that we can to reverse these cuts and restore care and expand access to it,” she said. 

Sen. Tammy Baldwin (D-Wisconsin) speaks Wednesday about the effort to extend enhanced Affordable Care Act insurance premium tax credits that will expire at the end of 2025. Nancy Peske, left, and Julia Harris-Robinson, center also joined the press conference. (Photo by Erik Gunn/Wisconsin Examiner)

With the loss of enhanced subsidies for the health insurance she has bought on the federal marketplace HealthCare.gov, Nancy Peske’s health plan will cost $1,163.50 a month in 2026.

That’s more than three times what she paid this year — $372 a month, Peske said Wednesday.

But if there’s one thing she wants everyone to know, it’s this: The higher prices for health insurance aren’t just something that she and other people who buy their coverage on the federal marketplace are facing.

Long before the ACA, Peske learned about “the premium death spiral,” she said.

“The more you raise the price, the more people drop out of the pool. This means you have to raise the price, which means more people drop out of the pool. And it goes on and on and on,” Peske said.

“It’s not just my health insurance that’s going to go up. It’s everybody’s — right?” she said. “We’re all in this together.”

Peske was one of two people who have relied on HealthCare.gov, created as part of the Affordable Care Act, who spoke Wednesday at a press conference in Milwaukee with Sen. Tammy Baldwin (D-Wisconsin).

Baldwin called the press conference  to draw attention anew to the skyrocketing cost of health insurance — and to the failure of Congress to address it in the stopgap spending bill that passed the U.S. Senate Monday, the U.S. House Wednesday evening and was signed by President Donald Trump.

“This is a health and wellness issue,” Baldwin said. “This is an affordability and cost-of-living issue, and this is a quality of life and dignity issue. And it touches every single one of us right now.”

A success amid ‘a broken system’

Health care in the U.S. is “a broken system that prioritizes profits over patients,” Baldwin said. Despite that, she said, the 2010 Affordable Care Act was an important advance for expanding health care access.

She said that was improved by enhanced federal subsidies enacted in 2021 to offset the cost of health insurance for people who must buy their own policies on the federal HealthCare.gov marketplace that was created by the ACA — making insurance more affordable and drawing record numbers of people to the marketplace to get health coverage.

The enhanced subsidies expire at the end of 2025, however, and until this week a Republican stopgap spending bill that passed the U.S. House in September stalled in the U.S. Senate as Democrats pushed unsuccessfully to extend the subsidies.  

“That is what is at the center of the government shutdown and debate in Washington, D.C.,” Baldwin said. “We know the impact of taking away these tax breaks. For 275,000 Wisconsinites, their health care [insurance] costs will double, triple or even more. For 30,000 Wisconsinites, they predict the price will be too high, and that those Wisconsinites will go without insurance altogether.”

A handful of Democratic Senators changed their votes Monday to advance the spending bill in return for a promise of a future vote on the subsidies, with the House taking up the revised bill Wednesday. Baldwin didn’t join them.

“I said the entire time that a handshake deal with my Republican colleagues to reopen the government and no real action to lower health care costs was simply not good enough,” said Baldwin of her vote against the bill.

She also forced an amendment to extend the tax credits for a year — a compromise, she said, because she wants them extended permanently, but one she offered “to avoid catastrophe for families across Wisconsin and give folks breathing room while we negotiate longer-term solutions.”

The amendment failed on a party-line vote.

“Every single Republican voted no on my amendment,” Baldwin said. “They chose to send a clear, unmistakable message that they are OK with jacking up health care costs on 22 million Americans.”

Early retirement, then sticker shock

HealthCare.gov user Erica Topps also joined Baldwin’s news conference. Topps took early retirement in April and bought a health insurance policy through the federal marketplace for herself and her college-age daughter that started in June.

At the marketplace open enrollment for 2026 that started Nov. 1, that plan’s premium increased by $1,200 a month and the deductible went from $6,700 per person to $10,600 per person, Topps told reporters She found another plan via the marketplace and is enrolling, but she’s concerned about the future beyond that.

“Part of my plan is to go back to work” so she can get health insurance, Topps told the Wisconsin Examiner, because it will be 10 years before she can qualify for Medicare.

Before taking early retirement, “I did my due diligence,” she said. “I feel like the rug was pulled out from under me.”

Peske is a freelance writer, editor and consultant. She is also a cancer survivor, whose diagnosis two years ago was covered thanks to her HealthCare.gov policy. Going without health insurance is unthinkable, but at the age of 63, she must wait another two years before she can go on Medicare, she said.

Peske told the Wisconsin Examiner that she will scrape together the money to afford her new premium. “I’ll not put a dime into my underfunded retirement account,” she said. She expects to “tighten the belt” on household expenses, “and I will probably cut into my savings.”

Freelancers and small businesses account for 40% of the U.S. economy, Peske told reporters.

“Do you want everyone to go out of business?” she asked. “Should I just do what so many people do and get a much lower paying job at a company? Because I’m desperate for health care. I don’t think that’s the solution. I think you want to keep people like me in business, generating money, adding to the economy, and being able to live, to not die of cancer.”

Seeking inroads with GOP lawmakers

Baldwin said she has been talking with Republicans about finding common ground in increased transparency in the health care system, from insurance companies, pharmacy benefit managers and providers.

In addition, she told the Wisconsin Examiner after the press conference, she continues to have conversations with GOP Senate colleagues who have expressed interest in continuing the subsidies to avert the sharp hike in premiums.

None of them were willing to break ranks and vote for her amendment this week, however.

“Those discussions were happening informally, in quiet, not in the public spotlight,” Baldwin said. “But they were afraid to vote on something that they, probably, some of them want, because Donald Trump said you can’t talk about this before the government reopens.”

Baldwin said that the next step will be for the Democrats to settle on the bill that Republican Senate Majority Leader John Thune has promised they could bring to the upper chamber for a vote.

As much as she favors a permanent extension of the enhanced credits, if the Democrats go that route, “we know it will go down, and it will be on a pretty much a partisan vote,” Baldwin said.

“I want results, so that probably dictates towards supporting something that conceivably does respond to some of the concerns Republicans have raised,” she said. “I’d like to pick the path most reasonably likely to succeed on behalf of the people who sent me to Washington to fight for them.”

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Blister packs of hormone replacement therapy medication. (Getty photos)

WASHINGTON — The U.S. Food and Drug Administration announced Monday it plans to remove warnings from hormone replacement therapy drugs that can be used to address symptoms of menopause, saying the statements are no longer needed. 

The black box warning, the strongest caution possible from the FDA, was added in the early 2000s after a study from the Women’s Health Initiative showed an uptick in rates of blood clots, breast cancer, heart attacks and strokes for women who used certain types of hormone replacement therapy. 

FDA Commissioner Marty Makary said during a press conference the change for estrogen-related products “is based on a robust review of the latest scientific evidence.”

Makary rebuked the medical establishment for not putting enough effort into researching women’s health conditions, including menopause. 

“A male-dominated medical profession, let’s be honest, has minimized the symptoms of menopause, and as a result, women’s health issues have not received the attention that they deserve. More than 80% of women have notable severe symptoms lasting up to eight years. How could the medical establishment get it so wrong for so long?” Makary said. “Women deserve the same rigorous sciences as is used for men.”

Study criticized

Department of Health and Human Services Advanced Research Projects Agency for Health Director Alicia Jackson said the black box warning on estrogen was based on “the flawed, overgeneralized and misinterpreted WHI study.” 

Jackson said menopause leads to a series of complicated and often painful experiences for women, including “sleepless nights, derailed careers, painful sex, broken bones and a loss of wellbeing.”

Jackson explained that when the level of estrogen drops throughout and after menopause, “a cascade of disease and aging begins.”

“A preponderance of data now shows that estrogen, when started early, acts as a protective shield for the brain, lowering risks of memory loss, mental health decline and neurodegenerative disease, even Alzheimer’s,” Jackson said.  

Makary said women should talk with their doctors and can request their estrogen levels be monitored as they approach the age where menopause typically begins and throughout that years-long process. 

He said that sometimes doctors can prescribe microdosing for hormone replacement therapy, followed by a half-dose and eventually a full dose as a woman’s estrogen levels decrease over time. 

Makary didn’t say how many of the companies that produce hormone replacement therapies plan to remove the black box warning but said he expects nearly all will do so. 

“Companies are, generally speaking, very excited when the FDA tells them they can remove a scary warning on your product,” he said. 

Review by panel

The FDA’s process for removing the black box warning requirement, Makary said, began with an expert panel earlier this year. The FDA’s subject-matter experts then conducted a “comprehensive review of the literature” and recommended the agency remove the requirement, which Makary accepted. 

The scientists who were part of the expert panel, he said, have written an article that will be published in the Journal of the American Medical Association.

President of the American College of Obstetricians & Gynecologists Steven J. Fleischman wrote in a statement that he “commends the HHS leadership for improving the lives of perimenopausal women by making the estrogen products they need more accessible to them.”

“The modifications to certain warning labels for estrogen products are years in the making, reflecting the dedicated advocacy of physicians and patients across the country,” Fleischman wrote. “The updated labels will better allow patients and clinicians to engage in a shared decision-making process, without an unnecessary barrier, when it comes to treatment of menopausal symptoms. ACOG has long advised clinicians to counsel patients based on an individual’s unique risk factors and treatment goals; this announcement does not change ACOG’s guidance on estrogen therapy.”

Deysi Camacho shops at the Feeding South Florida food pantry on Oct. 27, 2025 in Pembroke Park, Florida. Feeding South Florida was preparing for a possible surge in demand as SNAP benefits were delayed and reduced due to the government shutdown. (Photo by Joe Raedle/Getty Images)

WASHINGTON —  Senate Democrats left their Thursday caucus lunch tight-lipped as an agreement to end the government shutdown, now the longest in U.S. history at 37 days, remained elusive.

Republicans have floated a deal that includes the reinstatement of federal workers laid off by President Donald Trump, but no votes were scheduled on a spending bill as of late Thursday afternoon. There was some speculation senators could work through the weekend.

The chair of the Senate Appropriations Committee, GOP Sen. Susan Collins of Maine, said negotiations are still underway. But she said as part of a deal, she supported the rehiring of the thousands of federal workers the Trump administration fired in its Reductions in Force, or RIFs, during the government shutdown that began Oct. 1.

“Those who were RIF’d during the shutdown should be recalled,” she said. “We’re still negotiating that language.”

Emboldened by this week’s Election Day victories, where Democrats swept major local and state races, Senate Democrats are seeking to use that momentum as leverage to get Republicans to also agree to a health care deal to end the government shutdown.

While Democrats have pushed to extend tax credits for health care, Senate Majority Leader John Thune told reporters Thursday that the best he can offer is a vote on extending those subsidies, which expire this year. 

The coming expiration has resulted in millions of people who buy their health insurance through the Affordable Care Act Marketplace receiving notices of a drastic spike in premium costs.

“I can’t speak for the House, and obviously I can’t guarantee an outcome here, and they know that,” Thune, a South Dakota Republican, said. “I think the clear path forward here, with regard to the ACA issue, is they get a vote, and we open up the government, and we head down to the White House and sit down with the president and talk about it.”

Democrats that represent states with a high population of federal employees, such as Sen. Tim Kaine of Virginia, are also seeking to strike a deal on RIFs. A federal judge blocked those Reductions in Force last month.

Kaine told reporters Wednesday that those negotiations are occurring with the White House.

“It is an item that is being discussed with the president, with the White House,” Kaine said.

The progressive wing of the Democratic Party has stressed that unless there is a commitment from House Speaker Mike Johnson and President Donald Trump to extend health care tax credits, Democrats should not agree to pass a stopgap spending bill to reopen the government. 

In session next week?

Senators are still scheduled to leave Capitol Hill late Thursday and be out next week on recess for the Veterans Day holiday.

But a couple Senate Republicans said late Thursday afternoon that lawmakers might stay in Washington, D.C. into Friday or later.

“I think they’re trying to work towards a vote tomorrow, maybe through the weekend. I’m pro-through the weekend,” Sen. Thom Tillis, R-N.C., said in an interview following a GOP lunch meeting.

Sen. John Kennedy, R-La., likened the situation to a “goat rodeo,” which is a hyperbolic phrase to refer to a disaster.

“We’re probably going to have a vote tomorrow, and then we will get on, and then we will know where we are, and we’ll know whether the Democrats are serious or not,” Kennedy said, adding that he was unsure exactly what they were voting on.

Democrats quiet about any deal

Following their Thursday caucus lunch, Democrats did not seem closer to an internal agreement on how to move forward with resolving the government shutdown as they left their huddle. 

Senate Minority Leader Chuck Schumer said Democrats had a “very good, productive meeting.”

One of the top negotiators for Democrats on finding a deal, New Hampshire Sen. Jeanne Shaheen, declined to comment.

Pennsylvania Democratic Sen. John Fetterman threw his hands up as he left the room.

“I don’t know how productive it was,” Fetterman, who has voted with Republicans to move legislation to reopen the government, said. 

Some Democrats said they were unified, such as New Jersey Sen. Andy Kim, Michigan’s Gary Peters and Connecticut’s Chris Murphy, a top appropriator. 

Peters did not specify what issue Democrats were unified on. 

“I don’t want to get into that, but it was an encouraging caucus (meeting) because there’s a great deal of unity as we came out,” he said.

Revised stopgap?

Additionally, a new continuing resolution, or CR, is needed, as the stopgap funding measure would have funded the government until Nov. 21, now just two weeks away. 

The House, which Johnson has kept in recess since September, would also need to be called back to pass a new version of a CR.

As the government shutdown continues, Transportation Secretary Sean Duffy warned this week that if funding is not restored, flights will need to be reduced by 10% in some air spaces due to a shortage of air traffic controllers, who have worked without pay for weeks.

The government shutdown has led to millions of federal workers furloughed or required to work without pay and has created uncertainty for vulnerable people who rely on food assistance and  heating services, as well as stoppages in vital child development and nutrition programs. 

In an effort to force Democrats to vote to reopen the government, the Trump administration has tried to withhold Supplemental Nutrition Assistance Program, or SNAP, benefits for 42 million people, until a court ordered the U.S. Department of Agriculture to release those benefits. 

Frustrated with the government shutdown, Trump has also tried to pressure Republicans into doing away with the Senate’s filibuster, which requires a 60-vote threshold, but Thune has resisted those calls. 

Progressives: ‘Do not cave’

Johnson, a Louisiana Republican, said during a Thursday press conference that he’s “not promising anyone anything” when it comes to a House vote on extending health care tax subsidies.  

Johnson criticized Senate Democrats for wanting a guarantee that the House would also take a vote on extending the ACA taxes.

“That’s ridiculous,” he said. 

House progressives said they have one message for Senate Democrats: “Do not cave,” as Rep. Pramila Jayapal put it during a Thursday morning press conference outside the U.S. House.

“Any deal must secure the extension of the ACA tax credits and ensure health care for the American people with agreement from the House, the Senate and the White House, full stop. We have the momentum,” the Washington state Democrat said.

Rep. Chrissy Houlahan, D-Pa., who publicly confronted Johnson during a press conference Wednesday, said, “We require a deal that actually addresses the health care crisis, not that promises to think about addressing it down the road in two weeks, with concepts of a plan.”

“Sadly, at this point in time, even I say it’s impossible to trust our Republican colleagues to honor their promises and their obligations,” Houlahan said.

April Verette, president of the labor union SEIU, which represents roughly 2 million members, spoke alongside Jayapal and Houlahan and praised Democrats as “courageous.”

“We are determined to say ‘Stick with this fight’ because righteousness, morality is on our side,” Verette said.

Patients have their blood pressure checked and other vitals taken at an intake triage at a Remote Area Medical mobile dental and medical clinic on Oct. 07, 2023 in Grundy, Virginia. (Photo by Spencer Platt/Getty Images)

WASHINGTON — All 50 states have applied for the $50 billion Rural Health Transformation Program in Republicans’ “big, beautiful” law, the Centers for Medicare and Medicaid Services said Thursday.

States had from Sept. 15 through Wednesday to apply for the program, which was authorized under the mega tax and spending cut package passed by Republicans and signed into law by President Donald Trump. The fund is intended to offset the budget impacts on rural areas due to sweeping Medicaid cuts. 

However, the temporary fund could only offset a little more than one-third of the package’s estimated $137 billion cut to federal Medicaid spending in rural areas over the next decade, according to the nonpartisan health research organization KFF.

Administrator of the Centers for Medicare and Medicaid Services Dr. Mehmet Oz said the program “moves us from a system that has too often failed rural America to one built on dignity, prevention, and sustainability” in a Thursday statement alongside the announcement. 

Oz said “every state with an approved application will receive funding so it can design what works best for its communities — and CMS will be there providing support every step of the way.”

Each state was asked to “design a plan for transforming its rural health care system” and outline in proposals how they “intend to expand access, enhance quality, and improve outcomes for patients through sustainable, state-driven innovation.” 

The program allocates $25 billion equally to approved states between fiscal years 2026 and 2030. CMS said states meeting the baseline criteria will then “undergo a rigorous, data-driven merit review” for the remaining half of the funds. 

In September, when announcing the application opening, CMS said the remaining half of funds would be administered to approved states based on “individual state metrics and applications that reflect the greatest potential for and scale of impact on the health of rural communities.” 

CMS said approved awardees will be notified by Dec. 31. 

Senate Minority Leader Chuck Schumer, D-N.Y., speaks to reporters during a news conference on Nov. 5, 2025 on Capitol Hill in Washington, D.C. (Photo by Tom Brenner/Getty Images)

WASHINGTON — Following major Democratic wins in local and state elections across the country on Election Day, top Democratic congressional leaders pushed for a meeting with the president to end the federal government shutdown, which on Wednesday became the longest in U.S. history at day 36.

“The election results ought to send a much-needed bolt of lightning to Donald Trump that he should meet with us to end this crisis, his shutdown,” Senate Minority Leader Chuck Schumer said on the Senate floor Wednesday. “It’s time to hold a bipartisan meeting. The takeaway from last night was simply unmistakable.” 

Schumer and House Minority Leader Hakeem Jeffries, both New York Democrats, sent a Wednesday letter to President Donald Trump, calling for a bipartisan meeting at the White House to end the government shutdown and to address the spike in individual health care premiums.

“Last night, Republicans felt political repercussions,” Schumer said after Tuesday’s Election Day wins for Democrats. They included passage of a redistricting measure in California to offset partisan gerrymandering by GOP states, governorships in New Jersey and Virginia and local races across the country.

For more than a month, Democrats have voted against approving the House-passed GOP stopgap spending measure over concerns that health care tax subsidies will expire at the end of the year. As open enrollment begins, people who buy their health insurance through the Affordable Care Act Marketplace are seeing a drastic increase in premium costs. 

Sanders pushes back on dealmaking

Schumer did not detail what kind of deal Democrats would accept, but said any negotiation “must address the health care needs of the American people.”

However, independent Sen. Bernie Sanders of Vermont said that Democrats should not accept any agreement with the GOP unless there is a commitment from House Speaker Mike Johnson and the president to pass legislation to extend those tax credits.

“Bottom line is, we need to be successful in protecting the health care of the American people, and if it’s just a piece of legislation that passes the Senate … so what? Where does it go? Then it becomes just a meaningless gesture,” Sanders said. 

Republicans have maintained that they will only have a discussion on health care after Democrats agree to resume government funding. 

This week, the Senate failed for the 14th time to pass a stopgap spending measure that would fund the government until Nov. 21. 

Lawmakers have acknowledged that a new stopgap spending bill will need to be extended past the Nov. 21 deadline, but have not come to an agreement on a new deadline.

Thune plays down Democratic victories

Senate Majority Leader John Thune told reporters Wednesday that he was skeptical the government shutdown played into major wins for Democrats across the country. 

“The shutdown doesn’t benefit anyone,” he said.

The South Dakota Republican noted the shutdown may have played a role in suburban Virginia, where a large share of federal workers live and are furloughed due to the government shutdown.

“In Northern Virginia, that has a lot of federal workers, so it certainly could have been a factor in the elections,” Thune said. “But I think it’s hard to draw conclusions.”

But Thune said he’s focused on ending the government shutdown, and hopes progress can continue to be made before senators are scheduled to be out next week for recess due to the Veterans Day holiday. 

Transportation Secretary Sean Duffy this week warned that if the shutdown continues into next week, it could lead to certain airspace needing to be closed due to a shortage of air traffic controllers who have continued to work amid the shutdown.

Trump, in a social media post, blamed two factors for Republicans not performing well on Tuesday: his absence from the ballot, and the government shutdown.

“I think if you read the pollsters, the shutdown was a big factor, negative for the Republicans, and that was a big factor, and they say that I wasn’t on the ballot was the biggest factor,” Trump said during a Wednesday press conference.

Withholding SNAP benefits

As the government shutdown has continued, the Trump administration has tried to get Senate Democrats to agree to the stopgap spending measure by directing the U.S. Department of Agriculture to not tap into its contingency fund to provide food assistance to 42 million people.

Two federal courts found that the Trump administration acted unlawfully in holding back those Supplemental Nutrition Assistance Program, or SNAP, benefits, and USDA agreed that it would partially release SNAP benefits. 

Trump earlier this week wrote on his social media platform that SNAP benefits would only be released when Democrats vote to reopen the government, a move that would likely violate the two court orders.

“SNAP BENEFITS, which increased by Billions and Billions of Dollars (MANY FOLD!) during Crooked Joe Biden’s disastrous term in office (Due to the fact that they were haphazardly ‘handed’ to anyone for the asking, as opposed to just those in need, which is the purpose of SNAP!), will be given only when the Radical Left Democrats open up government, which they can easily do, and not before!,” he wrote.

However, White House press secretary Karoline Leavitt seemed to walk back that statement on Tuesday, arguing that the president’s social media post did not refer to the court order, but to future SNAP payments.

“The president doesn’t want to tap into this (contingency) fund in the future and that’s what he was referring to,” Leavitt said.

Volunteers with the Capital Area Food Bank distribute items to furloughed federal workers in partnership with No Limits Outreach Ministries in Hyattsville, Maryland, on Oct. 28, 2025. (Photo by Ashley Murray/States Newsroom)

This report has been updated.

WASHINGTON — The U.S. Senate Tuesday failed for the 14th time to advance a stopgap spending bill to fund the government, as the ongoing shutdown hit 35 days and is now tied with the shutdown of 2018-2019 as the longest ever.

The 54-44 vote was nearly identical to the previous 13 votes, as Republicans and Democrats remained unwilling to change positions. The legislation extending funding to Nov. 21 needed at least 60 votes to advance, per the Senate’s legislative filibuster. 

Even though the upper chamber has been unable to pass a stopgap spending measure for more than a month, Senate Majority Leader John Thune, R-S.D., told reporters Tuesday that he believes senators are “making progress.” 

He floated keeping the Senate in session next week. The chamber is scheduled to be in recess for the Veterans Day holiday. 

“We’ll think through that as the week progresses, but I guess my hope would be we’ll make some progress,” he said.

Thune added that any stopgap spending bill will need to be extended past Nov. 21, “because we’re almost up against the November deadline right now.”

Duffy warns of flight ‘chaos’ due to staff shortages

Transportation Secretary Sean Duffy warned during a Tuesday press conference at the Department of Transportation that if the government shutdown continues into next week, it would lead to “chaos” and certain airspace would need to be closed due to a shortage of air traffic controllers who have continued to work amid the shutdown.

House Speaker Mike Johnson, R-La., said at a separate press conference at the Capitol that he would bring the House back to vote on a stopgap spending measure if the Senate extends the funding date.

“If the Senate passes something, of course we’ll come back,” Johnson said. “We’re running out of (the) clock.”

Johnson said he is “not a fan” of extending the bill to December and would prefer a January deadline. 

He said extending a stopgap funding bill “into January makes sense, but we got to, obviously, build consensus around that.” 

Senators at odds

On Tuesday’s Senate vote, Nevada Sen. Catherine Cortez Masto and Pennsylvania Sen. John Fetterman, both Democrats, and Maine independent Sen. Angus King voted with Republicans to advance the legislation. Kentucky GOP Sen. Rand Paul voted no.

Senate Democrats have refused to support the House-passed GOP measure over concerns about the expiration of health care tax subsidies. As open enrollment begins, people who buy their health insurance through the Affordable Care Act Marketplace are seeing a drastic spike in premium costs. 

Republicans have maintained that any negotiations on health care must occur after Democrats agree to fund the government. 

The Trump administration has also tried to pressure Democrats to accept the House stopgap spending measure by instructing the U.S. Department of Agriculture to not tap into its contingency fund to provide critical food assistance to 42 million Americans. 

SNAP fight

Two federal courts have found the Trump administration acted unlawfully in holding back those benefits, and on Monday USDA announced it would partially release Supplemental Nutrition Assistance Program, or SNAP, benefits. 

However, President Donald Trump Tuesday morning wrote on his social media platform that SNAP benefits would only be released when Democrats vote to reopen the government, a move that would likely violate the two court orders.

“SNAP BENEFITS, which increased by Billions and Billions of Dollars (MANY FOLD!) during Crooked Joe Biden’s disastrous term in office (Due to the fact that they were haphazardly ‘handed’ to anyone for the asking, as opposed to just those in need, which is the purpose of SNAP!), will be given only when the Radical Left Democrats open up government, which they can easily do, and not before!,” he wrote.

White House press secretary Karoline Leavitt said during a Tuesday briefing that the president’s social media post did not refer to the court order, but was referring to future SNAP payments.

“The president doesn’t want to tap into this (contingency) fund in the future and that’s what he was referring to,” she said.

‘Republican health care crisis’ 

House Minority Leader Hakeem Jeffries of New York stood firm in his party’s demands over extending health care tax credits in order to back a stopgap spending bill during a Tuesday press conference at the Capitol.

“We want to reopen the government — we want to find a bipartisan path forward toward enacting a spending agreement that actually makes life better for the American people, that lowers costs for the American people, as opposed to the Trump economy where things are getting more expensive by the day,” Jeffries said. 

“And, of course, we have to decisively address the Republican health care crisis that is crushing the American people all across the land.” 

He noted that Republicans’ refusal to extend the enhanced Affordable Care Act tax credits would result in “tens of millions of Americans experiencing dramatically increased premiums, co-pays and deductibles.” 

An analysis by KFF shows that those enrollees in the Affordable Care Act marketplace who currently receive a tax credit are likely to see their monthly premium payments more than double by about 114% on average.

Senate Minority Leader Chuck Schumer said the spike in health care premiums will cause some people to choose to forgo health care insurance.

“It’s a five-alarm health care emergency,” Schumer said. 

Johnson’s January CR rationale 

Meanwhile, Johnson said at his press conference that “a lot of people around here have PTSD about Christmas omnibus spending bills,” when speaking out against a December extension of the stopgap spending bill. 

GOP leaders have sought to do away with the practice of bundling at the end of the year the final versions of the dozen annual government funding bills into what’s known as an omnibus package. 

“We don’t want to do that. It gets too close, and we don’t want to have that risk,” Johnson said. “We’re not doing that.” 

However, it’s unclear how long the new stopgap spending bill will extend. Thune, during a Tuesday press conference, said a year-long continuing resolution, or CR, was not on the table. 

“There’s a conversation around what that next deadline would be,” Thune said, adding that there is not an agreement yet.

The Trump Administration yanked more than $65 million in Title X funding from clinics nationwide in April, and some of that funding is still frozen, leaving clinics struggling to offer free or low-cost contraception and other family planning services. Some states are suing to get the funding back, but Idaho officials chose to forego it due to a conflict with state law. (Getty Images)

The Idaho Department of Health and Welfare quietly declined the entirety of its annual $1.5 million federal Title X funding, leaving patients statewide without free and low-cost contraception and reproductive health care services from a key family planning program. 

Though thousands of Idahoans relied on the health care provided through Title X for over 50 years, the state made no public announcements as the decision took effect in April, leading to the closure of 28 out of 43 — about 65% — Title X-funded family planning clinics in public health districts throughout the state, according to the Idaho Department of Health and Welfare. 

After turning down the Title X money entirely, Health and Welfare said there are no plans for the state to make up the difference by increasing the family planning budget. 

In one district, Eastern Idaho Public Health, spokesperson Brenna Christofferson said contraception services are no longer available at all, which has only been communicated to existing Title X patients. Sexually transmitted infection testing and treatment, and breast and cervical cancer screenings are still provided using different funding sources.

Many of the clinics closed in eastern Idaho, including more populated cities such as Twin Falls and Idaho Falls, and more rural areas such as Salmon, Rexburg and Rigby. Title X services also ended at clinics like Terry Reilly Health Services in one of southwestern Idaho’s most populous areas of Nampa and Caldwell. 

The decision to forego the funds came at the same time the Trump administration yanked more than $65 million in Title X funding from Planned Parenthood clinics and some independent reproductive health clinics across the country, much of which is still frozen, including for Idaho’s last remaining Planned Parenthood in Meridian. Spokesperson Nicole Erwin said Planned Parenthood continues to fundraise to help offset costs and keep family planning services affordable on a sliding scale.

Although Idaho’s move came at the same time national attention was focused on the frozen funds, it was a separate decision, according to Health and Welfare.

“The discontinuation of Title X funding … was not related to the federal administration’s Title X policy changes earlier this year,” said AJ McWhorter, spokesperson for the Health and Welfare Department. “The department made the decision to decline the funding to remain compliant with current Idaho laws concerning parental rights and counseling on pregnancy options.”

Nationally, seven out of 16 grantees have had their funding restored, while others have been waiting nearly seven months for resolution, said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association.

“For Idaho to walk away from the money doesn’t just disadvantage and imperil young people, it imperils all the people in the state,” she said. “It hurts women, it hurts men, and it hurts young people.”

Coleman’s organization sued the U.S. Department of Health and Human Services over the frozen funds, and the case is still pending. A coalition of 20 Democratic-led states sued federal government agencies in July to halt its actions related to several social safety net programs, including Title X. That case is paused while the government is shut down.

In 2023, U.S. Health and Human Services reported Title X provided care to nearly 3 million people nationwide, a 7% increase from the prior year. Under the program guidelines, people with family income levels at or below 100% of the federal poverty level can receive services free of charge, while those making up to 250% of the federal poverty level pay a discounted rate on a sliding scale.  

The program, established by Congress and signed by former Republican President Richard Nixon in 1970, is intended to prioritize low-income or uninsured people, including those who make too much to qualify for Medicaid, who may not otherwise have access to family planning and reproductive health services. Abortion services cannot be covered by Title X dollars.

Pregnancy options and parental consent 

The federal statute guiding the administration of Title X funds includes a section on adolescent services that says grantees cannot require the consent of parents or guardians before or after the minor has requested or received family planning services. Another section directs grantees to allow pregnant patients the opportunity to receive information and counseling regarding prenatal care and delivery, infant care, foster care, adoption and pregnancy termination. Idaho has a near-total abortion ban with few exceptions.

Idaho’s Legislature passed Senate Bill 1329 in 2024, requiring parental consent for “the furnishing of health care services” to a child, with the exception of lifesaving care. Idaho Capital Sun reported the law has also created difficulties for the state’s suicide hotline, because some minors need permission from a parent to receive certain services.

Coleman said the adolescent and pregnancy options requirements have long been part of Title X guidance, and it has not conflicted with state law because federal law should take precedence under the U.S. Constitution.

Idaho is one of at least two states that currently has no Title X funding, Coleman said, after Utah lost all of its Title X money when the Trump administration withheld funding from Planned Parenthood clinics, which were the only places offering those low-cost or free services. Planned Parenthood of Utah closed two of its centers — in Logan and St. George — in the wake of the decision to freeze funding. Logan is less than an hour away from eastern Idaho’s border.

Some states were temporarily left without Title X providers after the Trump administration’s actions in April, but the funding was restored at later dates for certain states, including Missouri and Mississippi. The federal health agency also restored funds in May for two states with abortion bans, Tennessee and Oklahoma, whose grants were revoked under Democratic President Joe Biden’s administration because of their refusal to include abortion among the options during pregnancy counseling. 

In a letter from HHS to Tennessee state officials providing notice of the award, the acting chief grants management officer wrote, “Tennessee is one of only two states to have lost funding for failure to comply with the Title X 2021 regulations requiring counseling and referral for abortion. The department is declining to enforce this provision against the state, and you may rely on this letter to that effect.” 

A total of 7,528 Title X clients were served across Idaho in 2024, McWhorter said. The 15 remaining family planning clinics are supported by other funds, and additional service sites may be added as funding becomes available. Those clinics are in two out of the state’s seven public health districts, which served about 1,400 people combined in 2024. 

The closures add another challenge in an already difficult landscape for sexual and reproductive health care in Idaho. A recent study found that 94 of 268 practicing OB-GYNs left Idaho between August 2022 and December 2024, and care is becoming harder to obtain, according to residents, who say wait times are longer and certain treatment is unavailable locally. 

Coleman said under Biden’s administration, when an entity lost Title X dollars for noncompliance or other reasons, there was an effort to reallocate the funding to another willing participant. Without that action, it would revert back to the U.S. Treasury, and the next opportunity for another Idaho entity to apply for Title X funding will be late 2026. 

Preventing unplanned pregnancies 

Amy Klingler, a clinician in rural eastern Idaho, told States Newsroom she was devastated by the closure of Eastern Idaho Public Health’s family planning clinic. She worked there in addition to another clinical job since 2006 and said there aren’t many other options for family planning care in that area of the state.

“Idahoans don’t trust doctors, but they trust their doctor,” Klingler said. “So when we see rural health care being eroded and doctors leaving Idaho or not coming to Idaho, I think that is really going to impact the health of people in our communities.”

The additional cuts to Planned Parenthood through Medicaid, along with overall Medicaid cuts that may force the closure of more rural hospitals and clinics, will force people to delay care until they are sicker and require more expensive medical care, Klingler said.

The minor consent for treatment bill had good intentions, she said, and in an ideal world, every child would feel comfortable talking to their family members about birth control. But she said she is confident there are young women who don’t get birth control because they don’t want to have that conversation with their parents. 

And with Idaho’s abortion ban, unplanned pregnancies either have to be carried to term or the person must go to another state where abortion is legal. It’s also a felony in Idaho for someone to take a minor to another state for an abortion without parental permission.

“Providing free birth control is really powerful if you’re trying to prevent unplanned pregnancies,” Klingler said.

On her last day at the family planning clinic in June, Klingler said the staffers cried together.

“We often ended the day by saying, ‘We did some really good work today,’” she said. “And to not be able to do that good work kind of hurts the heart.”

Sarah Donald of Pearl, Miss., left, who has been in recovery for nine years, receives naloxone nasal spray from an organizer at the state’s Save a Life Day in September. Overdose awareness is continuing to save lives, but overdoses and deaths have spiked in some areas this year. (Photo by Vickie D. King/Mississippi Today)

Illicit drug overdoses and the deaths they cause are trending down this year, despite spikes in a handful of states, according to a Stateline analysis of data from the federal Centers for Disease Control and Prevention.

A handful of places with rising overdoses are responding to the problem with cooperation, they say, by sharing information about overdose surges and distributing emergency medication.

“The national conversation is just about warships in the Caribbean and drones and borders,” said Nabarun Dasgupta, who studies overdose trends at the University of North Carolina. “It discounts this huge groundswell of Americans taking care of Americans. There’s a huge amount of caregiving and tending to the needs of local communities that is being done in a non-flashy way because this is hard, slow work.”

Overdose deaths have been dropping steadily since 2023. As of April, the latest date available, deaths were at 76,500 for the previous 12 months — their lowest level since March 2020. A pandemic spike in overdose deaths drove the number as high as almost 113,000 in the summer of 2023, according to federal statistics.

President Donald Trump has ordered more than a dozen military strikes against boats in the open waters of the Caribbean and the Pacific Ocean since Sept. 2, claiming without publicized evidence that their occupants were drug runners bringing narcotics to the United States. Nearly 60 people have been killed.

The bulk of deadly fentanyl is smuggled over the border with Mexico in passenger cars, according to a September report by the federal Government Accountability Office. Chemicals and equipment, mostly from China, are smuggled in via cargo trucks, commercial ships, airplanes and the mail, according to the report.

A more timely indicator of overdoses — nonfatal suspected overdose patients in hospital emergency departments — was down 7% this year through August compared with 2024, according to Stateline’s analysis of CDC statistics.

The nonfatal overdoses were up for the year in only a few states and the District of Columbia. The largest spikes were 17% in the district, 16% in Rhode Island, 15% in Delaware, 11% in Connecticut and 10% in New Mexico, with smaller increases in Colorado, Pennsylvania, Wyoming, South Dakota, Utah, New Jersey and Minnesota.

Other states saw drops in nonfatal overdoses: Maryland had the largest decrease through August, about 17%.

But Baltimore had an attention-grabbing cluster of 42 overdoses between July and October, all within the same neighborhood. No fatalities were reported. The cluster led the city to set aside $2 million in October for more mobile services, harm reduction and social supports to fight overdoses.

New Mexico is seeing more overdoses and more deaths than the previous year in three counties on the Colorado border. In response, New Mexico is distributing both warnings and naloxone, an opioid-overdose antidote.

Officials are giving naloxone to storekeepers near overdose sites and alerting those seeking services about the deadly threat in the local supply.

“We started planning naloxone saturation and different types of outreaches so we can hopefully stem this from getting even worse,” said David Daniels, harm reduction section manager in the New Mexico health department.

“Putting messaging directly into clients’ hands is extremely valuable. That might be, ‘If you’re choosing to use, don’t use the regular amount. Maybe you should use a quarter of it. Test it out first,’” Daniels said.

The three counties in New Mexico — which include the capital city Santa Fe, ski resort Taos and Española, the setting of the 2023 TV black comedy series “The Curse” — saw about 438 more deaths from July through September than they did during the third quarter of 2024, according to Stateline calculations. That’s more than double the 383 overdose deaths for the area during the same time period last year.

Roger Montoya, a former Democratic state representative who runs an arts nonprofit in Rio Arriba County, said most of the deaths there have been among homeless substance users.

A local hospital has responded with programs to get treatment for more people, and his own Moving Arts Española group concentrates on helping children and young people break a cycle of economic despair that often leads to addiction and homelessness, he said.

“We try to redirect and strengthen the resiliency of young people who largely are being raised by grandparents and kin because mom and dad are either dead, on the street or incarcerated,” Montoya said.

But most states with overdose increases are still showing fewer deaths, mostly because the drug supply in the eastern United States is more likely to be cut with sedatives that don’t have the same deadly effect as fentanyl, though they can cause overdose.

The drugs linked to Baltimore’s mass overdoses were cut with an unusual, powerful sedative, according to federal testing. The sedative can cause people to lose consciousness but can’t itself be treated with reversal medication such as naloxone.

By contrast New Mexico’s tests on this year’s clusters generally found more deadly fentanyl than usual in the local supply, said Phillip Fiuty, a technical adviser on adulterant testing in the state health department.

“We’re not seeing the type of adulteration they’re experiencing on the East Coast. Once something is in New Mexico, there’s little to no adulteration,” Fiuty said.

Some East Coast states are seeing more overdoses but fewer deaths. Rhode Island warned of spikes in nonfatal overdose in August and September, but deaths through September were still lower than during the same period last year, according to state figures.

That’s not always the case. Connecticut reported a surge of both fatal and nonfatal overdoses near interstate highways in May and June.

“One of the factors is change in the illicit drug supply or bad batches. I think that’s what’s playing out now. The drug supply is increasingly unpredictable,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.

The association has a suggested framework for community response to spikes, but cities and counties may be hampered by a new aggressiveness on enforcement and more hostility to local efforts to stop deaths, she said.

The current Trump administration has shown some reluctance to support community harm reduction techniques, she said. That includes the temporary suspension of $140 million in funds for a program called Overdose Data to Action, known as OD2A, that the first Trump administration started to sound the alarm when spikes happen.

“Given recent cuts to health care and substance use and overdose prevention services that we’re seeing, that is impacting some of the work on the ground,” Freeman said. “It’s pushing people away from being able to make the changes they need to make to change their lives. It has the potential to create more of an overdose problem.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Volunteers from No Limits Outreach Ministries in Hyattsville, Maryland, and the Capital Area Food Bank prepare for distribution on Oct. 28, 2025 to furloughed federal workers affected by the government shutdown. People with government employment ID began lining up hours ahead of time. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — By Saturday, millions of Americans are expected to face a drastic spike in health care premium costs during open enrollment, though a hunger crisis may have been temporarily averted, both tied to the ongoing government shutdown.

A federal judge in Massachusetts Friday afternoon found that the U.S. Department of Agriculture acted unlawfully in deciding to withhold billions in emergency funding for 42 million people who rely on the Supplemental Nutrition Assistance Program, or SNAP, amid a government shutdown.

But while the ruling does not order USDA to immediately tap into its roughly $6 billion contingency fund, a separate ruling from a federal judge in Rhode Island ordered the agency to continue the payments after a coalition of religious and advocacy groups sued.

Prior to both rulings, Agriculture Secretary Brooke Rollins defended USDA’s decision to not use the contingency fund during a Friday press conference at the U.S. Capitol with House Speaker Mike Johnson on day 31 of the government shutdown. 

“We are here today because SNAP benefits run dry tomorrow, so the truth has finally revealed itself, hasn’t it?” Rollins said. “Democrats’ support for programs like SNAP is now reduced to cynical control over people’s lives.”

It was not yet clear midday Friday how the two court rulings would be carried out by the administration.

The move to cut off SNAP would leave millions hungry, nearly 40% of them children, and is an effort by the Trump administration to put pressure on Senate Democrats to accept the House-passed GOP stopgap spending bill to fund the government until Nov. 21. 

Senate Democrats have held out demanding action on tax credits that will expire at the end of the year for people who buy their health insurance through the Affordable Care Act marketplace, hugely driving up costs. 

They have tried to spark negotiations, but Republicans have maintained that talks on health care subsidies will only begin after the government is funded. 

Flight delays, filibuster fate 

As the government shutdown continues, millions of federal workers are furloughed, or have continued to work without pay, including air traffic controllers. 

Flight delays and cancellations are starting to mount, with 3,739 delays within, into or out of the United States and 364 cancellations within the United States by midday Friday, according to the FlightAware delays tracker.

Another shutdown complication emerged when President Donald Trump, who has spent most of the week abroad in Asia meeting with foreign leaders over trade and tariff talks, Thursday night urged Republicans to eliminate the Senate filibuster, which requires a 60-vote threshold. 

“Get rid of the Filibuster, and get rid of it, NOW!” Trump wrote on his social media platform. Senate Republicans have been lukewarm on the idea, since Democrats then could do the same if they regain control of the chamber now held by the GOP with 53 seats.

Lacking 60 votes, the Senate has failed 13 times to pass the House-passed stopgap spending measure and left Capitol Hill Thursday night. Democrat Sen. Jacky Rosen from Nevada tried to keep the Senate in session, but was overruled by Republicans. 

Another critical deadline approaching Friday was pay for active duty military members. Vice President JD Vance said the Trump administration would shuffle funds to ensure pay, but did not detail those plans. According to Axios, the Defense Department pulled billions from several accounts to ensure the troops could be paid. 

Rollins defends USDA refusal to pay benefits

Congress failed to fund SNAP and nearly every other discretionary federal program for the 2026 fiscal year that began Oct. 1.

In order to receive SNAP benefits, a household’s gross monthly income must be at or below 130% of the federal poverty guidelines. A family of four would receive a SNAP maximum monthly allotment of $994, according to USDA.

Rollins sought to justify her agency’s refusal to shuffle the contingency funds to pay for SNAP, saying that money “is only allowed to flow if the underlying program is funded,” and “by law, a contingency fund can only flow when the underlying fund is flowing.” 

The Agriculture secretary said that “even if it could flow, it doesn’t even cover half of the month of November.” 

USDA said in a memo earlier in October that it would not tap into the contingency fund to keep the program afloat in November, despite its since-deleted Sept. 30 shutdown plan saying it would tap into this reserve. 

The memo said the contingency fund “is a source of funds for contingencies, such as the Disaster SNAP program, which provides food purchasing benefits for individuals in disaster areas, including natural disasters like hurricanes, tornadoes, and floods, that can come on quickly and without notice.” 

Democrats have objected. Friday’s decision from a federal judge in Boston stems from a lawsuit brought by 25 states and the District of Columbia against the Trump administration to force USDA to use the contingency fund. 

USDA secretary recounts conversation with waiter

At the Capitol press conference, Rollins also recalled a recent encounter she had at a Louisiana restaurant with a “wonderful” waiter named Joe, who she said took on that job after being furloughed as a federal government employee due to the shutdown. 

“He didn’t know who I was. And I said, ‘Well, Joe, I can appreciate that. You know, I’m sort of in that world as well.’ And I said, ‘Where do you work?’ And he said, ‘Well, I work for the U.S. Department of Agriculture in their New Orleans office as part of the financial team.'”

Rollins said that encounter “just really brought home for me … to echo what Mike (Johnson) said, just thanking so many thousands of federal workers who are showing up, who are still doing their job, who aren’t getting paid, those that are now concerned about putting food on the table and making their mortgages and paying their rent.” 

Rollins, along with the rest of the president’s Cabinet, is still getting paid.

Health premiums skyrocket

As open enrollment begins Saturday, those enrollees in the Affordable Care Act marketplace who currently receive a tax credit are likely to see their monthly premium payments more than double to about 114% on average, according to an analysis by KFF. 

For the last month, Democrats have warned of this, as the tax credits that help pay for individual health insurance are set to expire at the end of the year. 

The top Democrat on the House Energy and Commerce Committee, Rep. Frank Pallone of New Jersey, said in a statement that many families will see an increase in their premiums on Nov. 1.

“The sticker shock many families will face when they shop for health coverage is unacceptable, and it’s why Congress must act,” Pallone said.

The nonpartisan Congressional Budget Office estimated that if Congress does not extend the tax credits, insurers expect healthy, younger people to drop their marketplace coverage plans, which will lead to increased premium costs. 

Anxiety over WIC program

Meanwhile, USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, a program separate from SNAP, got a $300 million infusion from the agency, using tariff revenue, to keep the program running through October. 

The program provides nearly 7 million women, infants and children with healthy foods, breastfeeding support, nutrition education and other resources. 

Advocates are calling on the administration to supply additional emergency funds for WIC. 

Led by the National WIC Association, more than three dozen national organizations signed on to an Oct. 24 letter to the White House urging the administration to provide an additional $300 million in emergency funding. 

Head Start affected

The consequences of the shutdown are also hitting Head Start — a federal program that provides early childhood education, nutritious meals, health screenings and other support services to low-income families and served more than 790,000 children in the 2023-2024 program year. 

The National Head Start Association estimates that 140 programs across 41 states and Puerto Rico serving more than 65,000 children will not receive their operational funding if the shutdown continues past Nov. 1 — a reality that appears certain.

Six of those programs serving more than 6,500 children did not receive this funding on Oct. 1 and have had to look to outside resources and local funds to keep their programs afloat. 

SNAP, WIC and Native communities 

American Indian and Alaska Native communities are also scrambling to fill the anticipated gaps in food security and assistance due to funding uncertainties for SNAP and WIC. 

Advocates and U.S. senators across the aisle say these funding uncertainties for the key federal nutrition programs are putting particular pressure on Native communities. 

At an Oct. 29 Senate Indian Affairs Committee hearing on the shutdown’s impacts on tribal communities, Minnesota Democratic Sen. Tina Smith said she is hearing from tribal nations in her state about people switching from SNAP to the Food Distribution Program on Indian Reservations, or FDPIR, a separate USDA initiative.

FDPIR is an alternative to SNAP and, per USDA, provides foods “to income-eligible households living on Indian reservations, and to American Indian households residing in approved areas near reservations and in Oklahoma.” 

American Family Children's Hospital in Madison. An annual report from the Wisconsin Hospital Association says hospitals in the state are doing better financially, but face uncertainty. (Photo by Erik Gunn/Wisconsin Examiner)

Uncompensated health care at Wisconsin hospitals rose more then 30% in 2024 from the year before, according to a new report from the Wisconsin Hospital Association.

People without health insurance or regular health providers are using emergency rooms more, the report also finds.

The association annually assesses the state of Wisconsin hospitals, including their finances, utilization and staffing. The 2024 report was released Thursday.

“We are seeing a modest improvement in hospital financials across the state,” said Kyle O’Brien, president of the Wisconsin Hospital Association, in an interview. Nevertheless, he added, “there’s a lot of uncertainty in the health care market right now.”

While the state’s hospitals were doing better in 2024 than in the previous two years, 40 hospitals had a negative operating margin, O’Brien said, and many hospitals across the state where margins were positive, but narrow.

Uncompensated care includes charity care — provided by the hospital with the full knowledge that the cost won’t be covered — as well as bad debt: care for which the hospital expected to be paid but wasn’t.

In 2024, uncompensated care in both categories added up to $1.77 billion — a 30.5% increase over the 1.36 billion in uncompensated care in 2023.

O’Brien said several factors are responsible for that increase. One of those is generally higher deductibles on health insurance plans, requiring patients to spend more out of pocket before their insurance coverage kicks in.

“If that patient can’t pay for that higher out-of-pocket [expense], hospitals are the ones that either have to try to collect those dollars, or they are the ones that provide relief through charity care, bad debt policies, or things like that,” O’Brien said.

For hospitals, another top concern is how much Medicaid pays to cover the cost of care.

State budgets over the last decade have been increasing Medicaid hospital payments, O’Brien said, with the 2025-27 budget having the largest increases to date. Even so, he said, hospital Medicaid reimbursements fall short of fully covering the cost of the care that Medicaid is supposed to cover.

Decisions by health insurance to deny coverage are a source of “general consternation” for hospitals, O’Brien said — both with group health insurance policies but also for Medicare Advantage policies. Medicare Advantage policies are sold to people eligible for the federal Medicare program but are instead provided by private insurance companies.

O’Brien said the hospital association is also concerned about projected increases in people without health insurance as a result of higher premiums paid by people who buy their own insurance at the federal marketplace, HealthCare.gov, created under the Affordable Care Act.

Enhanced subsidies for HealthCare.gov policies enacted in 2021 will expire at the end of this year unless they are renewed. The subsidies are provided in the form of federal income tax credits for consumers who purchase insurance through HealthCare.gov

This week the state Office of the Commissioner of Insurance released projected rates for 2026 that reflected the loss of those enhanced subsidies.

Those higher costs have prompted widespread predictions that, after years in which enrollment in the marketplace plans has set new records, enrollment will drop off and more people with go without health insurance instead.

“We are certainly concerned anytime there’s a potential that somebody might lose coverage,” O’Brien said. Federal law requires hospitals to treat patients whether or not they are able to pay.

“We have been advocating with the congressional delegation to reauthorize those enhanced premium tax credits,” O’Brien said. He said members of Congress have been focused on “issues that are playing out right now [that] may be even bigger than hospital-related issues, but I think that they understand our concerns.”

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