Three Democratic senators issued recommendations a year after launching an inquiry into companies — Deloitte, General Dynamics Information Technology, Gainwell Technologies, and Conduent — that are paid billions in taxpayer dollars to build or run eligibility systems for safety net health coverage. Those benefits, provided to the poorest Americans, can mean the difference between having medical care or going without.

A handful of states directly operate their Medicaid eligibility systems, but most rely on contractors to build and run them. ³Ô¹Ï²»´òìÈ found that Deloitte dominates this slice of government business. Deloitte-run systems have been plagued by errors that can result in eligible people losing their health coverage, previous ³Ô¹Ï²»´òìÈ investigations have shown. Malfunctions can cost millions of taxpayer dollars and take years to fix.

“Administrative errors in this line of work are not like errors in other fields,” the senators . “There are life-and-death consequences for sick Americans who seek care only to find that their Medicaid coverage has been terminated.”

President Donald Trump’s signature tax and domestic policy law has mandated Medicaid changes that are forcing states to adapt their computer systems on a compressed timeline. Medicaid policies under the One Big Beautiful Bill Act add red tape and restrictions that make it harder for people to stay enrolled.

Those include the first federally mandated work requirements in Medicaid’s history. Next year, to keep benefits, millions of adult Medicaid enrollees in more than 40 states must prove they’re working or doing a similar activity for at least 80 hours a month, unless they qualify for an exemption.

Democratic senators Ron Wyden of Oregon, Elizabeth Warren of Massachusetts, and Raphael Warnock of Georgia say the new restrictions — layered atop computer systems with histories of problems — will result in large numbers of people improperly losing health coverage.

State eligibility systems “have been built up, patched, and frankensteined for decades,” the senators said.

The senators sit on the powerful Senate Finance Committee, which oversees government health programs such as Medicare and Medicaid. Many of their recommendations target the Centers for Medicare & Medicaid Services. Their ideas face long odds at the moment. Republicans control executive branch agencies, and any potential legislation would need to advance in a Republican-controlled Congress.

That balance of power could shift if Democrats win a majority of Senate seats in November’s midterm elections. The three lawmakers called on CMS to establish mandatory standards in state contracts with companies so states can receive federal funds.

These companies sign contracts with state governments, but the federal government approves them and pays the bulk of the cost. The federal government covers 90% of state costs to develop and implement state Medicaid eligibility systems and 75% of ongoing maintenance and operations expenses, according to federal regulations.

The lawmakers also said CMS should publicize the contracts and contract amendments. Currently, those documents can be obtained from state governments, but accessibility varies significantly.

The senators also said CMS should publicly disclose companies’ performance data and change orders. Change orders are used to adjust computer systems, and states set aside millions of dollars for them. But systems may require fixes beyond the agreed-upon work.

“The millions of Medicaid enrollees who will be required to prove their eligibility every six months, to document every hour of work on a glitchy portal, to find a doctor willing to certify that their cancer or their chronic condition is bad enough to qualify for an exemption — deserve contractors who are accountable for what happens when the system fails them,” they wrote.

In October 2025, the three Democratic senators, as well as Sen. Bernie Sanders (I-Vt.), sent letters to several companies that CMS identified as eligibility system contractors. At the time, they wrote that it is each company’s responsibility to build functioning eligibility systems, “rather than to prioritize their bottom line.”

As of June, were enrolled in Medicaid, according to CMS.

The lawmakers had asked the companies about their contracts, lobbying expenditures, and protocols for making changes in light of system errors, among other issues. The companies provided the lawmakers with some details but often did not answer their questions.

The companies said states are responsible for making the final call on whether a person receives benefits. State workers approve or deny eligibility, Deloitte said in its response letter, “not a private contractor or an automated system acting alone.”

The companies did not provide the senators with specific details about documents or processes they use to help states make eligibility determinations.

The companies also denied they have any financial incentives to remove people from Medicaid. Conduent said it gets paid less if enrollment drops.

The companies did not say whether states are on the hook for paying to fix the companies’ errors.

Deloitte, Gainwell, GDIT, and Conduent said it’s common for states to require that they meet certain performance metrics.

Gainwell told lawmakers, “We take seriously the issues raised.”

GDIT said it would answer additional questions from lawmakers and told ³Ô¹Ï²»´òìÈ that it “has a strong track record” of supporting Medicaid programs. In New York, GDIT said it has a “limited role” in determining eligibility because it relies on rules provided by the state. GDIT operates New York’s online Affordable Care Act marketplace, where New Yorkers can enroll in various health plans, including Medicaid.

Deloitte said in its response to the lawmakers: “We are proud of our work serving individuals and families across the U.S.”

CMS did not respond to a request for comment.

CMS takes steps to check whether Medicaid eligibility systems are working properly. As part of the process for certifying states’ systems, federal officials . They include whether states are correctly calculating people’s incomes, whether individuals are given timely eligibility decisions, and whether eligibility categories are accurate. However, it is rare for the federal government to withdraw federal money from states for falling short.

In August, CMS announced it intends to for Medicaid systems. The ultimate goal is to improve enrollees’ access to care and their experiences with these systems, CMS said. The agency also has said the standards will hold companies accountable to deliver systems that are “continuously improving” and have a “stronger capacity to implement critical policy changes.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

But in January 2025, the city’s health systems had no good options for Debbie Doppelt, a 60-year-old jeweler with an unusual form of lung cancer that mostly afflicts nonsmokers like her. The Food and Drug Administration hadn’t yet approved sunvozertinib, a drug developed in China that targets the mutation driving Doppelt’s tumors. She had been through chemotherapy and surgery, but the cancer had now spread to her brain. And she didn’t qualify for the relevant clinical trials.

Then an option emerged, in an offhand remark.

“Too bad she’s not Chinese,” a doctor told her son Max Doppelt, who had organized his mother’s care since her 2023 diagnosis. “She could go to a pharmacy in China and buy it.”

Within hours, mother and son had reached out to friends and relatives, one of whom procured a small supply of sunvozertinib from a contact living in China. A few months later, Max flew to Shanghai to get a refill.

Other patients have followed. “No organization or doctor is guiding patients to China, but word gets out,” Max said. He said he knows of at least 30 Americans who’ve made the pilgrimage to obtain the drug, which the FDA licensed in July 2025 but wasn’t yet on the U.S. market as of mid-October of this year.

Sunvozertinib, made by Shanghai-based Dizal Pharmaceutical, isn’t the only treatment drawing patients to China. Americans, Europeans, and others are trekking there to enter clinical trials for CAR-T therapy, an area in which China is .

China, until recently known more as a supplier of drug precursor chemicals and generic medicines, has become a biotech powerhouse, accounting for of new drugs tested around the world in 2025. U.S. pharmaceutical companies are testing new therapies there and signing billion-dollar contracts with Chinese firms to develop and market their drugs.

China’s progress has alarmed some politicians, who warn of lost jobs and U.S. dependency on Chinese medicines. The Trump administration in June kicked off Operation TrialBlazer, aimed at speeding up some FDA regulatory processes to lure back more clinical trials.

China’s poor showing in vaccine and drug development during the covid pandemic prompted the country to overhaul its biotech sector, dramatically altering the global industry, said Sam Rasty, a veteran of small biotech companies who now leads one called FynderBio. Venture capital now flows heavily to early-stage clinical work in China and Australia, where regulatory systems enable key first-in-human studies much more quickly than in the United States.

Chinese companies are so much faster at this process that U.S. biotechs, which used to share early advances at conferences or funding meetings, now routinely conceal their progress out of fear that competitors will take their ideas and speed them to market, said Steve Potts, CEO of Breakthru Medicine, a small biotech.

At a meeting he attended in May, nearly all the 60 biotech CEOs in the room planned to run phase 1 trials in Australia, Europe, or China, Potts said. Five or 10 years ago, most of those trials would have been carried out in the U.S.

“Slow and prohibitive” FDA requirements are driving investment to more-nimble Chinese companies, President Donald Trump’s nominee to lead the agency, Heidi Overton, warned in her opening statement at her Sept. 24 confirmation hearing.

The movement of clinical trials overseas “should give pause to every American and those who serve on their behalf,” Overton said. “When we lose this advantage, we lose our health security. And when we lose our health security, we lose everything.”

Overton pledged to continue TrialBlazer, which mirrors Australian processes begun in 1991. It is aimed at accelerating clinical trials and approvals so patients do not feel compelled to seek treatment abroad, said Department of Health and Human Services spokesperson Emily Hilliard. It is sometimes legal to obtain medication abroad for personal use, but the FDA “cautions patients about potential safety and quality risks associated with treatments outside our regulatory system,” she added.

As the FDA moves to streamline drug development, members of Congress are trying to slow Chinese firms’ integration into U.S. biotech.

Rep. John Moolenaar (R-Mich.), who chairs the House Select Committee on the Chinese Communist Party, in June co-sponsored legislation with Rep. Debbie Dingell (D-Mich.) requiring all U.S. pharmaceutical deals with Chinese companies to be cleared by the Treasury Department.

Others see biotech protectionism as misguided. China’s focus on improved medicines can only help us, said Peter Kolchinsky, managing partner of RA Capital Management, which has Chinese investments in its biotech portfolio.

“We may be adversaries in many areas, but we’re not competing with them to cure cancer. We are collaborating with them to cure cancer,” he said. “There are things that are bigger enemies than any other nation on Earth.”

Cancer Knows No Boundaries

A minor but persistent cough led to the diagnosis of Debbie Doppelt’s cancer in late 2023. Chemo, immunotherapy, and surgery kept it at bay for months, but in December 2024, scans showed the cancer had spread to her brain, with 10 tiny tumors.

The FDA earlier that year had approved amivantamab, a drug that targeted the mutation driving Doppelt’s tumor, but Max was concerned about its toxicity. Also, several doctors he consulted told him that amivantamab might not penetrate brain tissue to fight cancer there.

Doppelt tried to enter a clinical trial at Memorial Sloan Kettering Cancer Center, where she was a patient, for zipalertinib, another drug that targeted her mutation. But in January 2025, the Doppelts learned that a slight scarring on her lungs had rendered her ineligible for the study.

That left sunvozertinib, which gained approval in China in 2023. It was also being tested in the U.S., but only in late-stage trials in which half the subjects received chemotherapy only. That risk was a nonstarter for Doppelt, whose cancer had already outsmarted chemo.

So Max flew to Shanghai, returning with 26 boxes of sunvozertinib in his luggage. The drugs cost about $10,000, he said.

“Getting on the plane and bringing the medicine home felt like my life’s purpose,” Max said. “The data was so clear that this drug had significant efficacy in the brain. Anything else she might do, she might not last a year.”

On Sept. 1 of this year, AstraZeneca signed an agreement with Dizal to distribute the drug worldwide, and it plans to make it available in the U.S. by the start of 2027, spokesperson Tara Parsell said.

Doppelt, who runs a diamond business with her husband, has tried to stay positive and healthy, scarcely missing a day of work since her 2023 diagnosis. She said she’s grateful she has a loving community and the means to afford the best available therapies.

“I think I’ve been pretty successful at having, actually, an amazing three years,” she said. “In some ways a better three years, with all of it, than the three years before, because you’re so appreciative of everything.”

Doppelt’s parents were Holocaust survivors. “They were always saying: ‘This piece of bread tastes so good! Do you know what it is to be hungry?’”

³Ô¹Ï²»´òìÈing for help for his mother gave Max, a 30-year-old computer engineer, an idea for helping patients find the right treatment — which, in cases of advanced cancers, may be a clinical trial.

A year ago, he quit his tech job and that uses artificial intelligence to combine data from research and drug company sites with a patient’s health records to help them find the right study.

Similar apps are being used to help drug companies and hospital systems increase the percentage of U.S. cancer patients who enter clinical treatment trials, currently . This will also strengthen the U.S. drug industry, said CEO Kent Thoelke, whose company offers an AI program designed to help hospitals and clinics enroll trial subjects.

About 300 patients have used Max’s app. So far his clients, whom he doesn’t charge, have all been lung cancer patients like his mom. Sunvozertinib seems to help about half those who take it, he said.

A 70-year-old woman whom Max had assisted got a six-month supply of the drug earlier this year from China, only to learn after three months that it wasn’t working. “My cancer had spread,” said the woman, whom ³Ô¹Ï²»´òìÈ agreed not to name, to protect sensitive health information.

‘I’ll Do Everything in Our Power’

Doppelt has done well on the drug. Some 19 months after starting on it, her cancer was still mostly kept at bay, with the help of a few radiation treatments and dose adjustments.

AstraZeneca’s plans to widely distribute sunvozertinib would mean no more trips to China. But Max had few illusions that the drug would work for his mom forever.

“She has a metastasizing cancer that will learn to bypass the drug,” he said. “At that point we’ll be dependent on the latest and greatest therapies. If they happen to be in China, I’ll do everything in our power to go there.”

At his Upper East Side apartment one recent afternoon, Max examined the current clinical trial outlook for his mother. He pulled up her profile on the app and scrolled down a list scoring available trial sites according to their fit and proximity.

“This one looks good,” he said, pointing to a clinical trial for firmonertinib, a drug China approved in 2021 that’s under study in the U.S. and elsewhere.

CAR-T therapy is another possibility, particularly a variety that the University of Colorado has developed to boost patients’ immunological attack on mutations like the ones driving Doppelt’s cancer.

But Kyle Concannon, a leader of the Colorado research team, said regulatory uncertainty has slowed his progress. As new tools enable sophisticated measures of things like toxicity and tissue distribution, they add time, cost, and risk to the therapy’s development. These technologies may be better at detecting possible harms, “which is good,” Concannon said, “but the alternative to a new medicine, with a natural disease like lung cancer, is the individuals will die from their disease.”

Max Doppelt and other patient advocates, while pushing for faster FDA processes, don’t want to rule out more Chinese medicine runs.

“When drugs are approved in China but not in the U.S., of course we will deploy the China option where necessary,” said Marcia Horn, CEO of the nonprofit International Cancer Advocacy Network. “Lives depend on it.”

Max would prefer to see the drugs his mother needs developed in the United States. But he, too, opposes any effort to freeze out the Chinese biotech industry.

The discovery of new life-preserving drugs “really brings us together,” he said. “We’re all humans at the end of the day.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

The administration of President Donald Trump has used claims of widespread wrongdoing to justify investigations, suspensions of billions of dollars in payments to states, and the cancellation of Affordable Care Act health coverage for hundreds of thousands of people.

has opened a broader political fight over the extent of fraud and the administration’s response to it. Republicans say they’re safeguarding taxpayer dollars by going after bad actors. Democrats contend the administration has relied on insufficient evidence to target blue states and cut programs Republicans have long tried to shrink. Meanwhile, Trump’s pardons of executives convicted of healthcare fraud, administration moves to weaken some protections against abuses, and a high-profile error by Trump regulators stand in contrast with the administration’s proclaimed fraud-fighting goals.

The dispute is becoming a talking point for both parties leading up to the November election.

Republican candidates are trying to win voters’ confidence by emphasizing their efforts to halt what they say is the misuse of taxpayer dollars in federal health programs.

“Going after fraud gives Republicans a healthcare message when they would otherwise just be defending cuts to Medicaid and the Affordable Care Act,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes ³Ô¹Ï²»´òìÈ. The approach, he said, helps “blunt” those attacks.

Democrats, however, traditionally have an advantage on healthcare in general, with are with such issues. Now Democrats are portraying Republicans’ fraud crackdown as a cover for the GOP’s weakening of safety net programs. But the GOP messaging could resonate at the ballot box.

About 44% of voters — and 54% of Republican voters — say fraud in government programs is “extremely important” for candidates to talk about, conducted in mid-September, suggesting the fraud focus might be connecting with the GOP base. Such fraud is also the top issue rural Republican voters want candidates to talk about, based on a by KFF and the Associated Press.

It’s an issue that is hardly new, and government watchdogs have repeatedly documented fraud by health providers and brokers, as well as improper enrollment in government health programs. A report by the in March warned that the “sheer amount of payments in the Medicare program creates significant fraud risks.” And in a , GAO investigators were able to get subsidized insurance for fake ACA enrollees.

What has changed is the prominence the issue now occupies in national politics.

Administration’s Fraud Targets

Trump administration authorities have this year charged hundreds of people, , in alleged billing schemes. It has announced and increased scrutiny of enrollment in federal programs, withholding in federal Medicaid payments over claims of lax oversight — with what Democrats say is a laser focus on blue states despite a lack of evidence.

The administration’s more expansive claims about fraud — and the actions it has taken in response — have generated fierce political clashes.

Most recently, the Centers for Medicare & Medicaid Services canceled ACA enrollments covering 760,000 people. While Democrats have questioned the methods that found them to be fraudulent, federal officials said they included nonexistent consumers whose applications were submitted by brokers or agents who can earn commissions from insurers.

CMS Administrator Mehmet Oz that the cancellations included people who had coverage through the ACA but hadn’t used it. He also said some had no Social Security numbers, calling that evidence of problems.

“About 35% of current people on the Obamacare system — 35%, more than a third — had never used the program. They haven’t bought a prescription medication. They haven’t seen a doctor. That just is not possible,” Oz said. “So we know there is fraud.”

Democrats and some health policy analysts challenge that conclusion. They say that younger and healthier people are much less likely to use their insurance and that not using their coverage doesn’t mean they were improperly enrolled. Critics also say the absence of Social Security numbers doesn’t necessarily establish fraud; for example, newborns can be added to their parents’ plans before receiving a number.

“This is yet another attempt by the Trump administration to kick hundreds of thousands of vulnerable Americans off their healthcare,” on the social media site X. “Millions are already struggling to access healthcare—and this is their plan?”

There are political risks for the GOP as well. The disenrollment of alleged phantom accounts is likely to ensnare legitimate consumers, say health analysts and ACA advocates, leading to a potential backlash against Republicans if scores of people lose coverage just before the midterm elections.

States that tend to deliver for GOP candidates will be hit especially hard, they say, because ACA enrollees are concentrated in those states. The 4.5 million people in Florida and 4.1 million in Texas who have marketplace coverage account for nearly 40% of the country’s ACA enrollment, according to .

Conservative health policy advisers say the administration took multiple steps to avoid canceling legitimate coverage, including attempts to contact consumers and requirements that additional criteria be met before coverage was terminated.

“Those criticizing the action either don’t understand it or see some political advantage in mischaracterizing it,” said Brian Blase, president of Paragon Health Institute and a former Trump health policy adviser.

Democrats, meanwhile, highlight inconsistencies in the administration’s broader anti-fraud campaign.

They note that the Department of Health and Human Services last year of insurance brokers and agents who had been suspended in 2024 by the Biden administration for suspected fraud or abuse. The Trump administration also laid off from involved in regional oversight of the ACA marketplace.

On Oct. 3, to pass legislation with mandatory prison terms for defrauding Medicare and Medicaid, eliminating probation as an option.

But Trump has also pardoned health industry executives convicted of major fraud schemes, including people who are connected to his political allies or who spent heavily on lobbying on their behalf. The pardons included a sentenced to three years in prison for a nearly $40 million tax scheme and, in Trump’s first term, convicted for Medicaid fraud.

Trump’s pardons in 2021 of executives who profited from massive public healthcare fraud spurred criticism from the National Health Care Anti-Fraud Association. Critics now say the administration is portraying cuts to Medicare and Medicaid as necessary for weeding out waste, fraud, and abuse while exonerating criminals who have engaged in some of the biggest schemes in federal health programs.

Blue State Allegations

HHS has raised concerns about Medicaid fraud and program integrity in several states, and the administration has deferred or threatened to cut federal Medicaid funding while disputes are investigated.

Democrats say the administration is itself engaging in fraud by using unsubstantiated allegations of abuse to politically target blue states.

One of the most striking clashes occurred in New York.

Federal officials launched an investigation of the state’s Medicaid program after claiming that personal care services — including help with bathing, dressing, and meal preparation — had been provided to more than 5 million people, which would have amounted to roughly three-quarters of the state’s Medicaid population — an almost impossibly large proportion.

“It is time for New York to come clean about its Medicaid program,” CMS’ Oz .

CMS its calculations were wrong. The agency said that it had misunderstood the state’s billing codes and that the actual number of beneficiaries who received the services was closer to 450,000. The administration continued its scrutiny of the New York program, however, and later suspended millions of dollars in federal funding for the state’s Medicaid fraud unit, wasn’t producing enough indictments.

The administration also withheld about from California, citing concerns about program integrity and oversight of some home medical services. State officials deny the allegations, saying has grown because of factors such as higher wages for home health aides and an increase the number of older people receiving care.

The White House announced plans to in federal funds from Minnesota, claiming the state had failed to protect its Medicaid program from abuse. State officials have and gone to court to challenge the decision.

Vice President JD Vance, who chairs Trump’s Task Force to Eliminate Fraud, and other administration officials announced the state deferrals at the White House, giving what traditionally would have been technical disputes between state and federal health officials a much higher political profile. Vance’s office did not respond to ³Ô¹Ï²»´òìÈ questions about the administration’s anti-fraud activities related to healthcare.

“I’ve never seen anything like this,” said , a Georgetown University research professor and a senior adviser at CMS during the Obama administration. “It’s a deferral, not a finding of fraud. This is being elevated by political decision-makers.”

Republican candidates have pounced on the investigations and allegations. In Minnesota, Republican gubernatorial candidate , who is speaker of the Minnesota House, released claiming that her Democratic opponent, U.S. Sen. Amy Klobuchar, “has never done anything to stop the fraud here in Minnesota.” Klobuchar has said that as governor she would “launch a top-to-bottom audit of state government to root out fraud.”

In New York, , a Democrat whose office runs the Medicaid fraud unit, criticized the decision to withhold funds and said weakening the operation would benefit criminals. Her Republican challenger in the November election, , has cited the Trump administration’s claims , telling Fox News Digital that James is “totally failing to prosecute Medicaid fraud.”

The administration says its actions are necessary because fraud diverts taxpayer money from people who legitimately qualify for government programs.

“The fraud doesn’t just steal money — it steals our trust,” Oz said in August on .

Democrats and healthcare advocates say the White House’s anti-fraud crusade is being used by Republicans to distract from criticisms over its to Medicaid, the ACA, and other federal health programs.

Republican-backed legislation enacted last year is projected to reduce federal Medicaid spending by hundreds of billions of dollars over a decade.

Congressional Republicans also declined to extend enhanced ACA premium subsidies that expired , increasing premium costs for many people who buy insurance through the marketplaces. Enrollment has since declined by millions.

Overall, the combined effect of GOP-led changes will result in more uninsured people by 2034, according to an analysis by the Congressional Budget Office.

Those changes have given Democrats an opening to campaign on protecting healthcare coverage and affordability while Republicans seek to shift some of the debate toward fraud and government spending.

“It’s really a way to distract and reframe the cuts in a different way, to say it’s part of an anti-fraud effort,” said Anthony Wright, executive director of Families USA, an advocacy group focused on expanding health coverage. “Fighting fraud shouldn’t result in people losing coverage.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

They share an enemy, though. They dislike social media’s effects on children’s mental health. Talarico, who did not respond to a request for comment, has for kids under 16, while denouncing “predatory algorithms that divide us on an hourly, daily basis.” As a legislator, he targeting explicit deepfakes — digital imitations of individuals that are often made or manipulated by artificial intelligence and used for harassment on social media.

Paxton has been suing Big Tech, alleging the companies on their apps or from being viewed by kids. “When elected to the U.S. Senate, he will continue his proven record of advancing policies that protect children online, strengthen parental rights, and hold Big Tech accountable when it breaks the law,” Paxton campaign spokesperson Madison Cercy said in a statement to ³Ô¹Ï²»´òìÈ.

Youth mental health is in decline. Even as researchers explore what’s causing the problem, momentum is gathering among policymakers from both parties to crack down on social media companies. Several major companies are being sued, investigated, and, soon, potentially regulated. That they may be harming kids’ mental health is a key reason.

Companies are starting to feel the bite. In late August, the social media conglomerate Meta with a coalition of 48 states, the District of Columbia, and three territories and promised to change its policies and settings to protect children. Meta immediately took out advertisements in major newspapers, pressuring its competitors to adopt similar guardrails. Children’s health advocates want to go further, with federal legislation.

Indeed, at least 35 nominees for the U.S. Senate this year have sponsored bills to curb social media, initiated investigations, or publicly lambasted Big Tech companies that, in their telling, have exploited teens and kids.

“We’re protecting our children, not those profiting off their online presence,” Juliana Stratton, the Democratic lieutenant governor and Senate candidate in Illinois, , trumpeting state legislation.

Congress is edging closer to passing the Kids Online Safety Act, the vanguard social media regulation bill. The bill would require social media companies to implement various safeguards, such as limiting users’ ability to communicate with minors. to pass a version of the bill earned 91 yes votes in the Senate. Donald Trump Jr., the president’s son, that the bill needed to be passed “ASAP.”

Amid the momentum toward new federal regulations, Big Tech companies are lobbying for their preferred policy. Apple supports the bill, a spokesperson told ³Ô¹Ï²»´òìÈ, while Meta, which owns Facebook and Instagram, has spent $10 million on television advertising touting its teen accounts.

“Any youth safety legislation must put parents in the driver’s seat — blanket social media bans do not do that,” said Meta spokesperson Ed Patterson, who argued blanket bans push youths onto less safe platforms. “We support legislation that empowers parents — not the government — to approve the apps their teens can download from the App Store.”

Meta and other industry groups are scrambling to shape regulations for social media, and tech in general. Meta also gave some $10 million to a President Donald Trump-aligned campaign nonprofit, Securing American Greatness. Based on a ³Ô¹Ï²»´òìÈ search of the Senate’s lobbying database, about 70 corporations, trade groups, nonprofits, and other groups have been lobbying senators about the bill.

According to The Washington Post, the Trump administration has the online safety bill to other parts of its AI agenda, which includes legislation that would make it harder to regulate the technology at the state level. The White House did not respond to requests for comment.

The public’s views of major tech companies are souring. In 2024, the 78% of Americans said tech companies had too much influence in politics, while 64% said social media had a mostly negative effect on the country.

A widespread movement encompassing much of the public health establishment, parents’ groups, attorneys general, and whistleblowers is calling for greater regulation, as parts of the tech industry fight back by spending big on lobbying and marketing.

“You have the whole industry and all their lobbying dollars,” said Allison Ivie, chief policy officer at the Eating Disorders Coalition. that social media, by showing kids images of unrealistically thin peers and by amplifying content encouraging extreme diets, helps fuel eating disorders. “It’s not a balanced fight by any means,” Ivie said of the lobbying muscle. “How do you compete against that on any given day?”

Growing Up Online, Breaking Down Offline

from the Centers for Disease Control and Prevention, a third of youth have persistent feelings of sadness or hopelessness — about 10% more than a decade earlier. But many researchers question whether social media is causing the trouble. (Other metrics tracked by the agency show improvement.)

“The science is crude and messy,” said Sandro Galea, dean of public health at Washington University in St. Louis, who previously chaired a on the effects of social media on kids’ mental health. and have proposed a wide variety of causes for the crisis, like changes in the economy, decreasing social connections, access to firearms, and the pandemic.

Despite the uncertainty, much of the public health establishment is massing against social media. In early September, the Department of Health and Human Services advising parents and children to live life off-screen. It’s only the latest in a series of warnings from the U.S. surgeon general’s office — under both the Biden and Trump administrations — about these technologies.

“The evidence keeps building on the real and potential dangers of unregulated access for children,” Jerome Adams, Trump’s first surgeon general, told ³Ô¹Ï²»´òìÈ. These include, he said, “serious risks like higher rates of anxiety, depression, sleep problems, and developmental concerns. Kids spending too much time on these platforms face real challenges during key stages of growth.”

The policy backlash against social media has extended worldwide. The United Kingdom and Australia recently banned social media for kids under 16. The European Union has with a potential fine, up to 6% of revenue, for pushing “addictive designs” in a breach of the confederation’s regulations.

Besides the $17 billion settlement with Meta, other lawsuits in the United States have targeted Snapchat, owned by Snap, and TikTok, a short-video app owned by a consortium of American and Chinese companies. A won a $27 million settlement from social media companies; , including in Los Angeles, have , citing alleged addictive effects on youth, among other harms.

Coalitions of state attorneys general, including Paxton, have sued Big Tech companies, in some cases winning settlements related to allegations of mental health harm and addiction. In early August, to pay nearly $950 million after a New Mexico state court found it to be a “significant contributing factor to the current mental health crisis.” This preceded the multibillion-dollar settlement.

And a broad base of companies are feeling effects from the government and civil suits. The online gaming company Roblox in legal settlements, including expenses targeting “youth-related consumer protection and digital safety matters,” in the first half of 2026. YouTube, the video hosting website, multiple youth-related cases this year.

Taking Big Tech to Task

Yet the push in Congress has garnered much of the attention. Congressional committees on occasion have summoned tech company executives — sometimes with a friendly ear, but more often to berate them.

Accompanying the push for legislation are ongoing investigations, many of which collect testimony from whistleblowers. In 2025, Sarah Wynn-Williams — a former United Nations diplomat who later joined Meta — testified before the Senate about the company’s record.

Asked about allegations the company covered up or denied its knowledge of harms, : “Facebook was targeting 13- to 17-year-olds. It could identify when they were feeling worthless or helpless or like a failure, and they would take that information and share it with advertisers.”

For example, Wynn-Williams told lawmakers, “if a 13-year-old girl would delete a selfie, that’s a really good time to try and sell her a beauty product.”

Meta has been dogged by claims it has attempted to hide relevant internal research, including from the government. In a series of rulings in 2025 and 2026, a judge in Washington, D.C., found the company’s lawyers directed employees to “remove portions of research showing Meta’s knowledge of teen users’ developmental vulnerability because the research could be used by government enforcers investigating Meta.” But it has approved three dozen studies on social issues related to young people, and that they have “made real changes to protect teens online,” like creating teen accounts, whose settings parents can control.

Complicating any regulatory push, though, are protections for speech and privacy. For the legislation to work, said Jenna Leventoff, senior policy counsel with the American Civil Liberties Union, “the platforms are going to want to know who is a kid and who isn’t.” Simply asking users will not be enough, she said. “I know when I was a kid, I always said I was older than I was to try to create accounts.”

But the momentum for constraints continues. Over time, Ivie said, “we get all this damning evidence. It shifts perspectives.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Nationally, an estimated were enrolled in the Supplemental Nutrition Assistance Program, also known as SNAP or food stamps, this June than in July 2025, when the law was enacted. Louisiana saw one of the most precipitous declines, dropping about 170,000 people, or 21% of state enrollees, according to federal data.

“We haven’t seen a decline of this magnitude in about three decades,” said , senior director of research on food assistance at the left-leaning Center on Budget and Policy Priorities, which did the analysis.

Meanwhile, food prices from August 2025 to this August, according to the U.S. Department of Agriculture.

Elected officials, policy analysts, and anti-hunger advocates are pressing Congress to delay provisions in the law that will cut federal funding for food benefits and steeply increase the cost for states. They want to insert the delay in the Farm Bill, which is pending in the Senate.

The provisions required states to start paying for 75% of the cost to operate SNAP on Oct. 1. Previously, the USDA and states split SNAP’s administration cost 50-50.

Beginning in October 2027, some states may also have to cover part of the cost of SNAP benefits that had been paid fully by the federal government. The amount that a state pays toward benefits will depend on its , or how often it underpays or overpays enrollees. The higher the error rate, the higher the state’s share of SNAP benefit costs.

In Louisiana, the state may have to cover up to $199 million of the cost for benefits, according to an analysis by the . Its error rate increased from 6.62% in fiscal year 2024 to 8.14% in FY 2025, the most recent data available.

Many states, including Louisiana, have placed pressure on applicants to submit more information more often to verify their eligibility to reduce the state’s payment error rate and limit how much the cost of benefits shifts to the state.

“It’s been a race to drive down those error rates,” Llobrera said.

He said the challenge of implementing new program restrictions and requiring more documentation has increased the burden on applicants and state agencies. The agencies have to process more paperwork on a tight timeline without enough staff. This can increase the likelihood of errors when processing applications, potentially leading to rejection of benefits for more people. It’s also harder for applicants to meet additional verification requirements.

The One Big Beautiful Bill Act expanded work requirements for SNAP, made it harder for states to waive the work requirements, and revoked access for many noncitizens with legal status.

The Louisiana Department of Health did not respond to requests for comment.

Tia Fields, the safety net policy analyst for the nonpartisan Invest in Louisiana think tank, said the cost increase to the state has contributed to two crises: a projected shortfall in the state budget and eligible families’ losing access to help.

In Louisiana, state data shows that 75% of people who lost SNAP from July 2025 to June 2026 did so for . When the program’s strict deadlines for documentation and verification aren’t met, applications and renewals are closed.

Fields said applicants may miss forms and interviews or fail to recertify or report changes in their status. Other times, the problem is on the state’s side. Agency notices may reach applicants past the deadline due to mail delays, they may be sent to the wrong address, or caseworkers may have backlogs in processing paperwork.

“Families are still hungry, and they’re actually eligible for the program,” Fields said. “This is a tax bill that we really cannot afford.”

The additional administrative burden and the financial penalties tied to having a high payment error rate give states an incentive to deny more applications, Llobrera said.

“The pressure that states feel now to really get their error rates down is pushing states to just ask for a lot more verification and more frequently,” Llobrera said.

Anti-hunger advocates say the need for food assistance has increased as barriers to SNAP have grown.

A Steadily Increasing Need

Aaranika Macon and her son received SNAP benefits for more than three years, continuing when she began nursing school last year. But she no longer qualified when she took a job in healthcare. After three months of trying to juggle work and school, her grades started to slip and she quit the job to focus on school.

So she reapplied to SNAP in February but did not receive benefits until April.

“I’m waiting, like, two months with nothing, because I stopped working,” Macon said. “Usually when you fill out, they’ll get back with you in, like, two weeks.”

According to the Food and Nutrition Act of 2008, SNAP-eligible households are required to receive benefits within 30 days of application.

When Macon’s SNAP application was finally processed, she received less assistance than she previously did. She was deemed ineligible as a student, though she’s taking the same number of classes as she did last year when she was considered eligible. In Louisiana, higher education students are eligible for SNAP if they attend school at least half-time and meet other requirements.

Only her 11-year-old son was approved for benefits. Instead of the roughly $500 a month for two people that she received previously, she said, the $298 for her son feeds them both.

She said she had to stretch a $5 balance in her SNAP account over six days at one point this summer.

“I’m in the same position as before the job. So, why is it cut?” Macon said. “You’ve got to fight to communicate with them.”

Lindsay Hendrix, chief impact officer for in southern Louisiana, said the organization has seen the need for food increase steadily for several years. Even before the passage of the SNAP changes last year, anti-hunger advocacy group Feeding America in food insecurity in Louisiana from 2022 to 2024.

“What we’re seeing is actually that more of our neighbors are coming to the food pantries longer than they used to before,” Hendrix said, and “the frequency of their visits have increased.”

Hendrix said last year’s government shutdown — which halted federal SNAP distributions and left states scrambling to fill the gap — illustrated the necessity of the food assistance program.

“Every politician was like, ‘Oh, just go to your food bank,’” Hendrix said. “And all of us working in food banks just around the country were like, ‘We will run out of food.’”

Instead, some states, including Louisiana, ensured SNAP benefits weren’t disrupted by distributing the benefits themselves until the federal government reopened and the agencies could be reimbursed. Hendrix said food banks complement SNAP and can’t compare with the scale of the program.

“We could not absorb that level of need without that program operating at its best, most effective level,” Hendrix said.

Cushion Against Higher Costs for States

Policy advocates and anti-hunger groups have been pressuring legislators in Congress to amend the latest Farm Bill or appropriations bill to delay any new costs to the states for SNAP by two years.

“We’re asking for every state to be able to have that cushion to try to get their systems in order, lower their error rate, and then give us time to reset, so that we’re not penalized for not yet having a strong enough system in place,” Fields said.

In September, the Senate Committee on Agriculture, Nutrition, and Forestry sent a to the full Senate that would give states another year before they may have to help pay for SNAP benefits. The cost would shift to — and penalties would be set in — 2028 instead of 2027. The legislation would still require states to start paying more for the cost of administering the program this year starting in October.

Sen. (D-Minn.) and other Democrats on the committee for a two-year delay.

The committee chair, Republican Sen. of Arkansas, told an in September that he expects negotiations on the bill to continue in October, with the goal of having legislation that can pass the House and Senate by the end of the year.

Anti-hunger advocates say a one-year delay isn’t enough. Jordan Baker, a spokesperson for the , said the financial strain of the impending administrative costs could eventually cause some states to opt out of SNAP altogether. Four states said they might withdraw from or pause the program if they have to start paying for benefits, according to a by the American Public Human Services Association.

Fields and Hendrix said it’s unlikely that Louisiana would completely drop SNAP. Hendrix said Louisiana’s SNAP program has been understaffed for a long time, straining the state’s ability to administer the program and do community outreach. That’s why Second Harvest’s food banks also help people with their SNAP applications. Fields said she also believes the state Department of Health is doing the best it can under a tight deadline.

“We just have to work out the kinks again,” Fields said. “That’s why we’re asking for that cost shift delay, so that the agency can have the opportunity to get it right and to keep the families fed here in Louisiana.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

The poll of more than 2,000 rural registered voters by The Associated Press in partnership with KFF found broadly negative views on the national and local economies, including from many Republicans. The costs of groceries, gas, and healthcare rank as top pain points for the rural voters, who were surveyed over two weeks starting in mid-August. And a larger share than among voters overall say they are worried about being able to afford groceries or gas.

At the same time, about half of rural voters approve of Trump’s job performance, more than among U.S. adults overall in separate AP-NORC polling.

The findings suggest that many rural voters haven’t turned on Trump but that they also largely don’t think he has delivered the economic renaissance he promised on the campaign trail.

Ed Westrick, a registered Republican and veteran, rates Trump’s job performance as “mediocre, middle-of-the-road.” Westrick, who lives in rural Texas, isn’t sure he will cast a midterm ballot, a troubling sign for Republicans in a key state in their fight to keep control of Congress.

Rural Americans skew Republican and historically have been an instrumental group of voters for Trump. The survey reveals that while rural voters seem unlikely to support Democrats on a large scale, Trump and the Republican Party could face challenges with them in November.

Deep Unhappiness About the Economy

As the election approaches, only about 4 in 10 rural voters approve of Trump’s performance on the economy. They rate him similarly on his handling of the Iran war, an entanglement that has proved expensive for the U.S. and increased oil and gas prices. And rural voters rank pocketbook concerns and fraud in government programs higher among the things they want to hear about from politicians than other perennial issues, such as gun policy and abortion.

Westrick, 59, is a technical trainer in the electronics industry and has seen an increase in business in part because he works with defense contractors, but he said he’s concerned about the cost of living.

“I hear the politicians talk about making groceries more affordable and making healthcare more affordable but yet none of them are addressing the issues,” Westrick said.

In the poll, about three-quarters of rural voters rated the cost of living in their communities as “only fair” or “poor” — up from about half in a KFF-Washington Post survey in 2017. Rural Americans, who have consistently lower wages than those who live in suburban and metro areas, have been hurting economically for decades, according to Tim Slack, a professor of sociology at Louisiana State University and co-author of the book Rural and Small-Town America.

“Many folks are connecting the cost-of-living crisis to many of the Trump administration’s policy choices: the war in Iran, tariffs, trade wars,” Slack said. “None of those things are going to bring down prices at the pump or the local Walmart.”

“Trump promised to lower prices on Day 1, and instead the cost of living’s continued to climb. And that’s especially painful in rural America,” Slack said, adding that he expects many working-class Republicans to skip voting in November.

Rural Republicans do have a brighter economic perspective than rural Democrats or independents, particularly about the U.S. as a whole, according to the survey. About 6 in 10 rural Republican voters say Trump has improved the national economy, compared with only about 2 in 10 independents and fewer than 1 in 10 Democrats.

But only 45% of rural Republican voters say Trump has made their local economies better off. About 1 in 4 said there are fewer good-paying jobs where they live than five years ago.

In Michigan, 37-year-old independent voter Brittainy Sosebee said she isn’t sure if she will vote in the state’s midterm election, which includes a tight Senate race seen as crucial to the Democratic Party’s push to win back a majority. Sosebee voted for Trump in 2016 and Democratic candidate Joe Biden in 2020; she didn’t vote in 2024.

Sosebee, who lives in St. Johns, a small town just north of Lansing, said she used to have extra money to take a vacation or buy a new pair of jeans without worrying. Now, she scrutinizes every expense, cringing at the rising cost of fresh produce when she shops for her three children.

“We hunt, so we have a lot of venison and things like that, so we don’t have to buy meat from the grocery store, but it’s still crippling,” she said.

Healthcare Policies Go Unnoticed

The KFF-AP poll found that rural voters overall don’t perceive much positive impact from the Trump administration’s healthcare policies even as they have been a top priority for Republican leaders, who have promoted efforts to lower drug costs and touted a $50 billion rural health program.

Only 17% of the voters said the Trump administration’s healthcare policies have had a “positive impact” on their healthcare costs, while 41% said they’ve had “no impact” and another 41% said they’ve had a “negative impact.”

Sitting on her front porch in Woolwich, Maine, 71-year-old Democrat Kathleen Hanning sipped a chai tea latte in the sun and recalled how she stopped voting for Republican Sen. Susan Collins in 2020.

Collins and Trump are “intertwined,” Hanning said. “She is not independently voting on what’s best for Maine.”

Hanning, a retired federal worker, said she hadn’t paid much attention to the health policies in Trump’s signature tax-break-and-spending-cut bill passed last year. The law reduces federal Medicaid spending by roughly $900 billion over a decade but also includes the billions of dollars for the Rural Health Transformation Program, which it created.

A year after the law’s passage, more than 8 in 10 rural voters said they’d heard either “a little” or “nothing at all” about the health fund. About 60% said they had heard nothing, according to the survey.

Rather than transforming, Hanning said, “hospitals up here in Maine are consolidating.” She travels an hour to see a specialist and noted that mothers will now have to drive farther for care because the hospital in nearby Damariscotta announced it would soon close its labor and delivery center.

Nine in 10 rural voters said it was “extremely” or “very” important for candidates to talk about healthcare costs, with more than half saying it’s “extremely important.” Mirroring the general population, rural voters ranked healthcare costs and gas prices as top economic worries.

Rural Republican Voters Still Trust GOP More

When asked which political party they trusted to do a better job handling issues such as the cost of healthcare or the cost of living, rural voters tended to side with their own party. The finding signals that Democratic candidates are more likely to benefit from rural Republicans’ staying home this November than from their voting across party lines in large numbers.

Republicans are more ambivalent about their party’s ability to handle key healthcare issues, compared with Democrats. About 8 in 10 Democratic voters say they trust the Democrats to address healthcare costs, while closer to 6 in 10 Republican voters say the same of the Republicans.

In Manassas, Georgia, a tiny town about an hour’s drive inland from Savannah, Republican voter Wanda Rogers feels the Trump administration is doing the best it can to clean up what she sees as an economic mess that Democrats left behind when they lost power.

“I kind of think people think like I do, that he knows what needs to be done,” she said. “It’s just taking them a while to get it there.”

Still, the 66-year-old said, “gas prices, they’re eating me alive right now.” She said she has stopped traveling to the beach because it has become too expensive.

Pamela Shaw, an independent voter who lives in a rural area near Asheville, North Carolina, said she sees the impact of rising costs in her community.

“When hamburger is over $7 a pound and steak is $15 or more a pound, a lot of people are not able to buy some of the things that they are used to buying,” the 59-year-old said in an interview.

Trump’s Rural Standing Has Slipped

Trump remains relatively popular among rural voters in the KFF-AP poll, with 48% approval — substantially higher than in a July AP-NORC poll of U.S. adults overall, in which only a third approved of his performance. But he’s also down slightly, from 56% approval, among rural voters, based on a similar question asked in the earlier KFF-Washington Post survey.

Asunta Washington, 38, is a truck driver who lives in South Texas. He said he is not against voting for Republican candidates if he wholeheartedly agrees with what they stand for, but he has not seen that. Instead, he has seen a lot of flip-flopping, he said.

“Like, a lot of people that are giving us promises and the moment they get elected, all that’s out the window,” Washington said.

This year’s competitive elections feature key Senate races in states including Ohio, Michigan, and Maine, all of which have large rural populations. In close races, Democrats may have a chance to “show up and give a message that rural people might find appealing,” said Nicholas Jacobs, a political scientist at Colby College and co-author of the book The Rural Voter.

“But it’s nothing more and it’s nothing less than that — an opportunity,” Jacobs said. “And time and time again, Democrats have shown a certain proclivity for not seizing that opportunity.”

Many rural voters don’t think the major parties or the president respect people like them. About half, 48%, of rural voters say the GOP respects people like them “a lot” or “some,” while 45% of rural voters say this about Trump and 37% say this about the Democratic Party.

On a recent Thursday, registered Republican Nate Lawrence answered his phone after paying $57 to fill up his Chevy Equinox in New Concord, Ohio, a village of fewer than 3,000 people about an hour’s drive east of Columbus.

Lawrence, a middle school English teacher, said the candidates should be talking about spending power: “I need to be able to go to the store and feed my family on what I make as a teacher,” Lawrence said. “I should be able to pay for a house on a teacher’s salary.”

Lawrence has voted for Trump in the past but didn’t in 2024. For Ohio’s Senate race, Lawrence said he is torn and not sure whether to pick Democrat Sherrod Brown or Republican Jon Husted.

Still, even if the politicians say they will lower prices, Lawrence said, he won’t believe them.

“Trump said that, and it didn’t happen,” he said.

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She and her husband have not had health coverage for the past two years, Bates said, because their employment is unsteady and they earn too much to qualify for Medicaid, the public health insurance for those with disabilities or low incomes.

When the GOP-led Congress allowed enhanced Affordable Care Act subsidies — which helped lower the cost of plans sold on the marketplace — to expire at the end of last year, Bates’ mother-in-law dropped her plan, too.

Bates and her husband have a 2-year-old son. The mother-in-law also cares for a son who has autism. They all live together in a trailer home, spending about a third of their family income on prescription medications and opting for trips to the emergency room — often their main destination for medical care, since they aren’t billed up front.

It’s stressful, Bates said. Yet despite their situation, she said she remains “all in” for President Donald Trump. But she also said she’s recognizing flaws in his leadership.

“He’s trying,” Bates said. “It’s just a lot more other things have his attention.”

Georgia’s 14th District is the . It’s the district Marjorie Taylor Greene, who rose to prominence as one of Trump’s most vocal and loyal supporters, represented from 2021 to January 2026.

Greene made a notable pivot from the president last year when she publicly bashed Republicans’ handling of the enhanced ACA subsidies, which helped — along with her own adult children, she said — afford healthcare.

The following month, after Greene Trump of focusing too much on “foreign wars” and ignoring Americans’ economic struggles, the president attacked Greene and said he would no longer support her. Soon after, she announced that from Congress.

Still, many others in this semirural, exurban district, like Bates, remain loyal to Trump, even as more people go uninsured and face rising costs as a result.

Bates isn’t alone in feeling the pinch of healthcare costs this year. Nationally, 37% of Republican voters surveyed in June for said healthcare costs were “extremely important.” More than half of Republicans and Republican-leaning independents who support the Make America Great Again movement said that Congress did the wrong thing by letting the enhanced subsidies expire, according to released in March. And 62% of ACA marketplace enrollees put the most blame for the expiration on Republicans (30%) or Trump (32%).

But, as the November midterm elections approach, policy experts don’t anticipate the issue of healthcare costs will lead to a major shift in how people vote in deeply conservative areas like Georgia’s 14th District, even as policies that once benefited them are rolled back.

“They’re willing to stick with the party line,” said , a professor of political science at the University of Georgia. “As long as Donald Trump and other Republicans are saying Obamacare is bad, they’re going to continue to buy into that idea,” Bullock said, “even when it’s against their economic self-interest.”

Obamacare Still a ‘Dirty Word’

When the ACA was passed in 2010, voted for it. Now, 16 years later, Obamacare is still a “dirty word” for many conservatives, said , a professor of social medicine at the University of North Carolina-Chapel Hill.

While previously the GOP’s goal was to “repeal and replace” the ACA, the current political strategy is “effectively rolling back some of the coverage gains,” he said.

According to a dashboard from NYU Langone Health’s Department of Population Health, of people younger than 65 living in Georgia’s 14th District were uninsured in 2024, which is higher than the . And in 2023, relied on Medicaid or the Children’s Health Insurance Program, known as CHIP, according to Georgetown University’s Center for Children and Families.

Last summer, Congress passed the One Big Beautiful Bill Act, which restricted ACA enrollment periods, added monthly fees, and imposed new documentation requirements for enrollees. The Congressional Budget Office estimated that the number of uninsured people in the U.S. would increase by about 15 million people over 10 years as a result of the new law, the expiration of the ACA subsidies, and other ACA changes. With the enhanced subsidies expiring at the end of 2025, ACA enrollment fell by this year. In Georgia, enrollment dropped by .

Greene’s not a fan of the ACA. She said her family’s health insurance premiums skyrocketed after it became law in 2010. But last year she surprised those on both sides of the aisle when she openly criticized her Republican colleagues over the subsidies.

“I’m going to go against everyone on this issue,” she wrote in an , “because when the tax credits expire this year my own adult children’s insurance premiums for 2026 are going to DOUBLE, along with all the wonderful families and hard-working people in my district.”

In a June interview with ³Ô¹Ï²»´òìÈ in Cumming, Georgia, Greene described the end of the subsidies as “catastrophic.”

“All over the country, people are constantly outraged over the cost of health insurance,” she said.

Like Greene, Bates has also wavered in her support for Trump. In addition to her frustration about the ACA subsidies expiring, she said the Iran war and inflation have also hit her wallet.

“I just don’t feel like he’s doing the best he could,” she said. “He did great his first term. But this term, it’s just not OK.”

While Republicans’ policies have made it more difficult for people to qualify for Medicaid and led to the end of the subsidies that made ACA marketplace plans more affordable, a clear plan to improve the U.S. healthcare system hasn’t emerged, Greene and policy experts say.

In December, House Speaker the Lower Health Care Premiums for All Americans Act. Touted as an alternative to extending ACA subsidies, was intended to lower premiums and increase healthcare access.

But the Congressional Budget Office found the bill would people by 100,000 a year from 2027 to 2035. While the House passed the measure in December, nearly nine months later the Senate hasn’t voted on it.

“It’s a Republican-controlled House, Republican-controlled Senate, Republican-controlled White House,” Greene said. “If Republicans had a plan, this was the perfect scenario to get it passed. You should have all the votes — get it done. And they’re not doing anything.”

Sticking to the Party Line

Despite such criticisms of Republicans for lacking a healthcare plan, voters in deeply conservative areas such as Georgia’s 14th District are sticking with Trump and his allies.

In April, the district elected Trump-backed Clay Fuller to replace Greene, though he won with than she had. He’s up for election again in November for a full congressional term. The University of Georgia’s Bullock said flipping the district from red to blue is unlikely.

Fuller’s office did not respond to interview requests for this report. But in a Q&A with the ahead of his April runoff with Democrat Shawn Harris, Fuller said that the expanded ACA subsidies, introduced under the Biden administration during the covid pandemic, were not a “a long-term solution.” Lowering healthcare costs would come from increasing competition and reducing federal overreach, he said.

Harris, who’s facing off with Fuller again in November, told ³Ô¹Ï²»´òìÈ that the GOP strategy for the midterms is to continue to play off Republicans’ long-standing negative perceptions about Obamacare.

When people in the community are asked whether they support Obamacare, “they’re probably going to say no,” Harris said. But when asked about the Affordable Care Act, people tend to say, “‘Oh, yes, I need to have that,’” he said.

“They don’t realize it’s one in the same,” Harris said, adding that Republicans “sold everybody a bill of goods.”

As candidates campaign, they need to be in tune with their constituents, Greene said.

“That’s where I think they’re completely missing the mark,” she said. “They’re totally tone deaf to what Americans’ needs really are. And we need a serious solution.”

Bates considers healthcare among her top concerns. She said she doesn’t think anybody, including Trump, can make healthcare more affordable. But she hopes politicians will talk with people like her to better understand the burdens that consumers face.

“I honestly wish Congress would actually spend time in the life that we live,” she said. “They just sit behind their desks, and they don’t know what’s really going on in life, because they make so much money.”

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact ³Ô¹Ï²»´òìÈ and share your story.

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Imbalance of Power — And Healthcare

Why can members of Congress remain on full taxpayer-funded salaries during prolonged medical absences while millions of working Americans cannot afford to get sick? (Kennedy, Oz Contend Fraud Crackdown, Not Skyrocketing Prices, Led Millions To Leave Obamacare, Aug. 3.) Sen. Mitch McConnell’s current extended medical absence brings that disparity into sharp focus. He has missed dozens of Senate votes while continuing to receive his $174,000 taxpayer-funded salary.

Meanwhile, I have a friend who works two jobs and still cannot afford her mortgage and utilities without a roommate. She does not even have basic medical insurance. She earns too much to qualify for government assistance but not enough to comfortably afford insurance along with the basic cost of living. What happens if she gets seriously ill?

She doesn’t have the luxury of taking months off to recover while her income continues. She could lose her income, her home, and everything she has worked for simply because she got sick. Yet she is one of the taxpayers providing that financial security to members of Congress.

McConnell’s situation is particularly striking because of his long legislative history of opposing or limiting federal family and medical leave protections.

If continuing someone’s income while they recover from a serious illness is reasonable and humane when that person is a member of Congress, why isn’t it reasonable and humane for the Americans paying their salaries?

Americans should not face financial ruin because they get sick while their elected representatives enjoy protections unavailable to the people they serve.

— Ruth Bower; Salem, Oregon

Hospice Saga Hits Home

I could really have used the information in the article “My Husband Was Kicked Out of Hospice for Dying Too Slowly” (Aug. 14) before it happened to me. I was notified on a Monday morning by my husband’s residential hospice agency that I needed to find a new place for him ASAP, and “here’s a list of places.” I asked what it would cost for him to stay a day or two — saying I would pay it myself, just tell me how much. They didn’t. So I got on the phone, and it was a hectic and horrifying day calling around for a new place.

My husband had been home twice between hospital stays, had fallen both times, requiring me to call 911, and then he was rehospitalized. I’m 64, and there was no way I could lift my 300-pound husband if he fell again. Even a half-dozen firefighters had trouble.

I spent most of his final day calling hospice agencies, and a representative from one even showed up to visit (uninvited and unexpected). It was scary how little oversight or medical professionalism there was. His life ended about 7 p.m. that evening. We had already stopped his pacemaker a few days before.

I will never forget or forgive that I wasted my last day with him because he was not dying quickly enough for the hospice. He never saw a doctor once he enrolled in hospice. There are great nurses in hospice — I’ve met a few — but there are a lot of places for which this is just an easy revenue stream, and they seem to be in it just for the money.

— Debbie Bond; Corpus Christi, Texas

On Improving the Hospice Experience

Thank you for publishing the article on hospice. As a hospice clinician and leader who has been providing hospice education for over 20 years, I, too, continue to see the need for increased awareness around hospice in our communities. This story is similar to many I have recently collected from families who are searching online, using AI tools that fall short of accuracy, and expressing they are overwhelmed.

As the article states, they were given a list of hospices to pick from; that is common and can be a major cause of panic for families. The article provides nice tips on choosing a hospice, but there is so much more to it. Picking a hospice that aligns with your values is a good first step, but we cannot overlook the idea that people and families need help walking this journey, help with exploring their care goals and wishes.

I recently took on a mission to enhance and make hospice education more accessible. In doing so, I launched an app, , focused on helping people and families learn about hospice before they need it; what hospice is and how it works, when they are ready; and what to understand and expect, all the way to the end. Two important articles were posted this year: a recent one entitled “,” by Kurt Merkelz, and a about how the Centers for Medicare & Medicaid Services could save $1.5 billion annually if hospice were elected just five days sooner.

The data supports that people and families are looking for reliable sources of education. However, the hospice industry as a whole has focused on providing that information once someone is admitted, which is too late.

Educational leaders in our communities need to work together to enhance end-of-life knowledge. Our mission is to give them a tool to make a meaningful impact.

— Jason Kimbrel; Columbus, Ohio

Common Ground: The Height of Folly?

Whoever is investigating common ground between the major political parties (³Ô¹Ï²»´òìÈ’ series “Common Ground”) clearly isn’t interviewing or polling Republican members of Congress — although there are probably a few Democrats in Congress who’ve gone along with making cuts to Medicaid and the Supplemental Nutrition Assistance Program, who don’t want to tax the rich more to keep the Social Security trust funds solvent, and who would never, ever vote for national healthcare systems similar to any of those in Western Europe or the Scandinavian nations.

I’ve yet to read that any members of Congress have seriously analyzed how nations with “universal” healthcare coverage manage such a system, and how much it would cost to implement in the United States. That demonstrates that neither party is truly committed to finding a better way to provide healthcare for all of us.

Too many GOP members of Congress have, for many years, tried to privatize Medicare (with some success), cater to healthcare insurers, and in every way demonstrate that they do not share what’s supposedly a general concern: improving the healthcare system in the U.S. and improving access for anyone not superwealthy to good quality healthcare. They should not only be making it more affordable, but making pre-med training and obtaining a doctor or nurse practitioner degree far, far, far more affordable than good programs for obtaining those degrees currently are.

We also need to pay registered nurses better than what they are being paid now, and support the National Science Foundation, the Centers for Disease Control and Prevention, the National Institutes of Health, et al., so that the U.S. continues to conduct medical research and fund the FDA so it can actually regulate the drug industry. We need an affordable drug system, too. Again, too many people in the U.S. can’t afford drugs that are affordable in other nations.

There’s no way the GOP in Congress will fix this. Republican presidents, from Ronald Reagan to the present, could’ve done so and did not. That the GOP has managed to propagandize so many people on vaccines, and toleration of increasingly expensive and poor-quality healthcare (and less access), just goes to show how many in the U.S. seem willing to effectively sabotage their lives — and the lives of their children.

— Susan Hogg; Newport, Oregon

Monopolies Hurt Healthcare Providers, Too

I am a recently retired health executive. I just read the article “Same Knee Surgery, Twice the Price: Hospital Monopolies Push Up Healthcare Costs” (Aug. 10). I loved the article. Very well written. Based on my experience, it is completely accurate. Well done.

However, you omitted a critical factor. During my approximately 40-year healthcare career, I saw the competitive landscape among health insurance companies shrink incredibly. One cannot discuss “merger mania” among hospitals and other medical institutions without acknowledging the negative impact that consolidation of health insurance carriers has had on the industry.

While the article made great points, it failed to articulate the effect insurance carrier consolidation has on healthcare providers’ bottom lines and their ability to negotiate reasonable fees. Your readers deserve to hear a balanced story.

— Quinten Davis; Randallstown, Maryland

Healthcare Students Clutching at Straws

Benjamin Pinckney’s story about the new federal student loan caps upending his dream of becoming a physician assistant is one that many students and prospective students unfortunately know all too well (“He Dreamed of Becoming a Physician Assistant. New Loan Rules May Thwart Him,” June 30). I’m a nurse practitioner and educator myself, and federal student loans were instrumental in my own educational journey. I might not be where I am today without them.

There are many bright, aspiring individuals seeking to become nurses to serve our nation’s growing patient needs. Yet the new federal loan caps have the healthcare workforce clutching at straws, as many students question their ability to pursue higher education. While the goal of lowering the cost of education is worthwhile, the rule risks forcing nursing students to choose between drowning in private, high-interest loans and abandoning their educational goals entirely. Either way, it will weaken our healthcare workforce at a time when the United States is expected to face worsening shortages of advanced practice providers and nursing faculty.

Just consider a few key data points: Demand for advanced practice nurses is much faster than the 3% average growth for all occupations. by 2030, far outpacing the projected number of new nurse graduates. And across the nation currently sit vacant, with about 81% of open positions requiring advanced degrees.

Fewer students can afford nursing education. Combined with fewer opportunities for clinical educators to pursue the advanced training needed to prepare future professionals, that equals a reduced ability of the nation’s healthcare system to meet Americans’ demand for high-quality care.

For now, the healthcare workforce is relieved that the rule has been paused in the courts. Looking ahead, we must actively work not only to control graduate education costs but also expand educational opportunities by championing legislation that designates advanced nursing degrees as professional degrees. Students who wish to become nurse educators and advanced practice registered nurses should be able to secure the federal financial aid they need, which is why legislation like the , the , and the are all so important.

I urge Congress to listen to stories like Pinckney’s and to the countless aspiring nurses across the nation who want to pursue careers that will strengthen our healthcare system but are being held back by loan policies that stand between qualified students and the workforce our country urgently needs.

— Lorie Hacker; Bargersville, Indiana

Rural Healthcare Needs AI That Earns Its Place

Rural patients’ skepticism of artificial intelligence raises an important point (“Patients Wary of Governments, Companies Pushing AI as a Rural Healthcare Solution,” Aug. 11). At this point, there’s not a “should” around AI adoption. It’s more about whether the technology can demonstrate enough value to earn the trust of patients and clinicians.

AI can and will help rural health systems facing staffing shortages, financial pressure, and limited technology resources. But the most meaningful opportunities may initially be behind the scenes. Reducing documentation burden, streamlining referrals, improving scheduling, and automating repetitive administrative work can give clinicians something rural communities urgently need: more time to care for patients.

That’s very different from asking patients to replace a trusted relationship with an AI avatar or chatbot.

Healthcare leaders should resist measuring success by how many AI tools they deploy or how many people use them. Rural AI investments should be judged by outcomes. Did clinicians save time? Did patients get appointments sooner? Did the technology reduce costs, improve efficiency, improve access, or produce better clinical results?

Because many AI tools have been developed using data and infrastructure from large health systems, rural organizations also need rigorous evaluation, strong governance, and reliable data before scaling them.

Patient skepticism is not an obstacle to innovation. It reminds us that technology earns trust through results. If AI gives rural clinicians more capacity to deliver human care — and health systems can prove it does — it can become part of the solution without pretending to be the solution itself.

— Jason Griffin; Missouri City, Texas

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

But U.S. District Judge John D. Bates, in a , also agreed with the administration that it was unconstitutional for the government to use race or ethnicity as the basis to award money under a program created to expand internet skills and access.

“It was definitely disappointing,” said Angela Siefer, executive director of the National Digital Inclusion Alliance, a nonprofit that filed suit last year after not receiving a award meant to bolster digital and internet skills nationwide. “With this administration it’s really worrisome.”

Congress passed the $2.75 billion Digital Equity Act in 2021 as the skill development component of a multilayered “” initiative under President Joe Biden’s signature infrastructure law, which included a bigger pot of money for expanding internet infrastructure.

A few months into his second term, Trump directly attacked the Digital Equity Act on social media, pledging “” and calling the program “illegal.” The language echoed two Trump executive orders characterizing diversity, equity, and inclusion programs .

The National Telecommunications and Information Administration, which oversees implementation of the law, responded by Digital Equity Act grant programs, leaving states and organizations like the National Digital Inclusion Alliance in limbo.

In response to Bates’ decision, federal attorneys said the government would reinstate the NDIA-related competitive grant program without racial classification. The government aims to release a new grant application in December, according to a filed in the case.

The NDIA now must reapply for the grant award, which was slated to be disbursed among more than a dozen organizations and tribes, including the Cherokee Nation in Oklahoma, El Centro Hispano in Arkansas, Portland Community College in Oregon, and Community Service Programs of West Alabama. The grants are meant to go toward digital navigator programs, in which community workers teach technology and internet skills, according to the NDIA.

In western Ohio, Jamie Huber said her organization was a subrecipient of the NDIA grant funds. Huber, director of community services at the Northwestern Ohio Community Action Commission, said that without the funding, she is left searching for money to continue navigator programs such as one she runs for people who are unemployed, homeless, or both.

“How do you find a home? Well, you got to look online. And how do you find a job? You have to look online,” Huber said.

Huber’s digital navigators also teach internet skills at 10 senior centers in rural counties stretching along the corner of Ohio bordering Michigan and Indiana. They help active older adults learn how to go online to pay bills and get healthcare, so they “continue having agency over their own life,” Huber said.

Rural residents live sicker and die younger on average than people in the rest of the country when they live in counties lacking high-speed internet access and healthcare, an analysis by ³Ô¹Ï²»´òìÈ found.

At Computer Reach in western Pennsylvania, Executive Director Dave Sevick said his organization has cut staff and programs. He said the nonprofit, which started in 2001, has refurbished more than 24,000 computers, giving them away to families it finds through schools and churches.

“We’re aware that affordability is the biggest issue around, and this doesn’t make it any better for folks,” Sevick said. “We’re helping a little bit by getting a free computer out to people.”

The Digital Equity Act the money should benefit, including low-income households, older people, some incarcerated people, rural Americans, veterans, and members of racial or ethnic minority groups.

According to by the Pew Research Center, people in rural communities were less likely to have internet subscriptions compared with their urban and suburban counterparts.

The Pew Research polling that home broadband use among Black and Hispanic adults lagged that of white and Asian adults. While 81% of white adults surveyed said they subscribed to broadband at home, only 71% of Black adults and 68% of Hispanic adults said the same.

In court, lead federal attorney Patrick Butler argued that Congress failed to prove a compelling government interest when including the racial or ethnic criteria. Congress did not “identify anything close to” a specific instance of discrimination in the broadband industry, Butler said, .

Butler then surprised the court, if the racial or ethnic status could be severed from the law, “we would obviously apply the grant program without considering race.”

In his opinion severing the race factor, Bates that “the President lacks the power to cancel laws passed by Congress based on his bald disagreement with Congress’s policy determinations.”

Sen. Patty Murray (D-Wash.), a primary , said she will be “watching very carefully to ensure this administration does what Congress intended.”

“It is indisputable that these challenges are particularly pronounced in low income, rural, and Tribal communities — and there’s a reason Democrats and Republicans across the country support this program so strongly,” Murray said in a statement to ³Ô¹Ï²»´òìÈ. 

Sen. Ted Cruz (R-Texas) Biden’s infrastructure bill in 2021 and to the National Telecommunications and Information Administration in late 2024 asking the agency to pause the $1.25 billion competitive grants program, arguing the use of racial classifications “does not serve a compelling governmental interest.” Cruz did not respond to requests for comment.

Arielle Roth, administrator of the agency, previously worked as the telecommunications policy director for the Senate Commerce, Science, and Transportation Committee’s majority staff under Cruz. She was to lead the agency.

In June, during a House committee hearing, Roth had tense exchanges with Democrats who took issue with changes to the Biden-era infrastructure law’s internet deployment program, which now allows more satellite services rather than prioritizing fiber-optic cable lines.

Lawmakers also asked about the Digital Equity Act’s grant programs.

“Communities across the country deserve a clear answer and a path forward,” Rep. Nanette Barragán (D-Calif.) said during the hearing. While the National Digital Inclusion Alliance’s lawsuit does not include the state grants, Barragán asked how those grants would be rolled out, considering the federal judge’s decision on race.

California was awarded a $70 million state capacity grant. Early this year, the Justice Department to Congress asserting that the state grant and the competitive grant program both are illegally based on race, citing the Supreme Court’s decision invalidating affirmative action in higher education admissions. Roth declined to answer Barragán’s question, noting there is active litigation.

Barragán said she was “extremely” frustrated by “some of the responses or nonresponses.”

Stephen Yusko, a spokesperson with the National Telecommunications and Information Administration, declined to comment or respond to questions for this article.

The government and the National Digital Inclusion Alliance agreed to pause court proceedings to give the agency time to reinstate the competitive grant program. The NDIA has also proposed that the agency provide status reports every 30 days during the court pause “to ensure prompt attention to reinstatement,” according to the most recent .

“We need to make sure it’s all moving forward,” Siefer said.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

MILLVILLE, Pa. — In an open field, arrows whizzed through the humid June air and struck their targets. Campers and counselors cheered.

It was archery hour at . Operations director Drew Meyer watched, a few tears escaping from behind his dark sunglasses.

“They will surprise you, like, flat out,” he said of the campers, who have all survived brain injuries. “They’ll come out here, and they’ll shoot for three hours and start hitting the target.”

Campers, ranging in age from 10 to 21, have been coming to Camp Cranium in Pennsylvania’s rural Columbia County since 2008. Some of their brain injuries are so severe that they have to relearn basics, from talking to tying their shoelaces. Some use wheelchairs or crutches. But during a week at camp, they climb rock walls, swim, and whiz down a zip line through the lush forest.

The existence of Camp Cranium, and a handful of others like it, is a response to a decades-long national trend: More people, including children, now survive crises resulting in brain injury than did in the 1980s. The improvements in survival are largely due to seat belt laws and and trauma centers that can treat injuries quickly.

But recently, efforts to track and prevent one type of brain injury, traumatic ones, are in flux after Congress didn’t renew a and prevention of traumatic brain injuries, and the Trump administration fired hundreds of employees at the Centers for Disease Control and Prevention, including the team tracking traumatic brain injuries, or TBIs.

“Brain injury can happen to anybody,” said , executive director of the . “This community deserves more.”

Tracking Brain Injuries

Lucas Hardy, 14, smiled at the encouraging crowd below. In a shady clearing in the woods, he climbed the 30-foot rock wall, aided by a hoist that pulled him out of his wheelchair and helped support his moves. Hardy suffered a traumatic brain injury at age 3, when a tree branch fell on him at a birthday party.

Annually, an estimated 2.8 million Americans experience a TBI — including about 475,000 children, according to the .

Recent data suggests those are undercounts. In 2018, a CDC team piloted a household survey asking about TBIs in a sample of U.S. children and adults. The results concluding that such injuries, which are often considered “hidden” because the damage is internal and unseen, are more widespread than hospitalization numbers suggest.

The mass firings at the CDC in early 2025 studying TBI, right before they were expected to launch a . A spokesperson for the Department of Health and Human Services, Emily Hilliard, did not respond to questions about the number of employees terminated, or if they were reinstated or replaced.

In a statement, she said: “The Trump Administration remains committed to supporting efforts to prevent traumatic brain injuries, improve surveillance, and ensure Americans have access to practical, evidence-based information that can help protect their health and safety.”

She said the agency’s TBI work is now handled by other staff members at the National Center for Injury Prevention and Control.

Hilliard said the CDC is deciding how to establish a cost-effective national concussion surveillance system within the bounds of current funding, and said the agency in 2026 dedicated funds to support, among other things, an about concussions, an , and concussion surveillance.

But Wolfkiel still worries about how the CDC firings and the impasse over federal funding will affect brain injury research and prevention efforts in the long term.

“The lack of resources and programs and information that’s out there is really just sort of appalling,” Wolfkiel said.

Federal Funding Uncertainty

Tony Sadowski, the camp’s , remembers when his son, Bryan, suffered a brain bleed that caused a hemorrhagic stroke at age 6. “You’re in the emergency room,” he recalled, “not knowing what version of your son’s going to wake up.”

Now 18, Bryan Sadowski has attended the camp for years.

“We’re very lucky to be able to be here,” the elder Sadowski said.

In 1996, before Bryan was born, Congress passed the Traumatic Brain Injury Act, which has provided many states with grants for TBI research, advocacy, and services. Since then, Congress reauthorized the act four times, largely with bipartisan support, until 2024.

It has remained lapsed since then. Trump’s secretary of the Department of Homeland Security, , supported when he was a senator. Congress is whether to reauthorize funding through 2030.

Despite the lapse in funding, money is still flowing to TBI programs at the CDC and in states, according to , president and CEO of the Brain Injury Association of America.

Congress did appropriate $8.25 million for TBI program activities through the . That’s far less than the $23 million Congress provided for each fiscal year, from 2020 through 2024, the last time it .

“The TBI Act is the only piece of federal funding for traumatic brain injury at the federal level,” Willis said. “We’re aiming to preserve what we have.”

The funding uncertainty has not affected the handful of brain injury camps, including Camp Cranium and in Alabama, because they are nonprofits that mostly rely on private donations.

Back at Camp Cranium, bursts of laughter, whoops of delight, and distant chatter punctuated the humid summer air.

While her fellow campers did archery or art, Brianna Engleman moved between groups, collecting song requests for a dance that evening. When she was 5, doctors performed a to relieve her of debilitating seizures. But the surgery itself can injure other parts of the brain.

She lives in Northern Virginia and first attended Camp Cranium as a teen in 2018. It was her first time being around so many people like her, said Engleman, now 21.

“I’ve gotten more confident,” Engleman said. “It made me think, well, there’s actually good people out there.”

Next time she returns to camp, she said, she plans to do so as a counselor.

This article is from a partnership that includes , , and ³Ô¹Ï²»´òìÈ.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .