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GOP Focuses on Fraud, Seeking To Redirect Voters’ Ire Over Healthcare Costs

Stephanie Armour — Mon, 19 Oct 2026 09:00:00 +0000

Heading into the midterm elections, high healthcare costs rank among voters’ biggest concerns. But lately, there’s a twist giving the issue new momentum on campaign agendas: a in government health programs.

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 �Թϲ��. 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 �Թϲ�� 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.”

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

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Next Governor To Face Thorny Choices After California’s Rapid Medicaid Expansion

Christine Mai-Duc — Fri, 16 Oct 2026 09:00:00 +0000

In March 2025, when California ran out of Medicaid funds to pay doctors and hospitals, the state borrowed $3.4 billion to keep the program afloat. It was, as a spokesperson for Gov. Gavin Newsom insisted, nothing new. Indeed, a handful of times over the years, the state had taken out internal, short-term loans to sustain its healthcare program for the poor and disabled.

The unprecedented move came a few months later, when Newsom and Democratic state lawmakers agreed to pay down the loan — which grew to $4.4 billion — instead of later in the year. California’s healthcare safety net, it seemed, was buckling.

Rising healthcare costs systemwide were partly to blame. But so were several state-led expansions that made California’s Medicaid program, known as Medi-Cal, one of the nation’s most generous.

Now, with congressional Republicans’ One Big Beautiful Bill Act expected to reduce federal Medicaid spending by more than $900 billion over 10 years, California and dozens of other states must contemplate the limits of their generosity. The problem is particularly acute in the nation’s most populous state, which spends more on Medicaid than combined.

“We know we can’t afford to serve everybody we want to serve in the model that we have today,” said Mark Ghaly, the former top Newsom health official who now co-chairs , a 29-person panel with the goal of modernizing and sustaining California’s Medicaid program for those who need it. “What can we do differently? What can we do smarter?”

The 2025 law that Newsom, a Democrat, has dubbed President Donald Trump’s is expected to leave millions more Americans without health insurance, mostly because of new . It also curbs the use of healthcare provider taxes and other strategies states have deployed to maximize federal funds. Some state lawmakers and consumer advocates have argued the federal cuts, along with rising costs, present an opportunity for the next governor to overhaul a program plagued by long appointment wait times, low reimbursement rates for healthcare providers, and volatile financing.

“If we continue to just give millions and millions into the same system and expect something different — I’m sick and tired of that,” said Caroline Menjivar, a Democratic state senator representing a Los Angeles-area district where roughly half of constituents rely on Medi-Cal.

Democratic lawmakers, who have often clashed with Newsom on Medi-Cal rollbacks, succeeded in getting him to delay a number of painful cuts until 2027 in hopes that a new governor might reverse them.

So far, neither of the candidates running in the November election to replace Newsom have offered substantive proposals for weathering the upheaval health policy experts say is on the horizon for a program that covers 1 in 3 Californians — roughly 13.6 million people.

Republican Steve Hilton, a former Fox News commentator, wants to pare back Medi-Cal eligibility and has promised to end coverage for immigrants without legal status, citing that benefit as an example of “wildly unsustainable” state spending. Democrat Xavier Becerra, who has spent decades trying to , has promised to protect Californians from the massive federal cuts.

Expanding Coverage

President Lyndon B. Johnson that established Medicaid and Medicare in 1965 to cover certain low-income groups, such as families with children, older people, and those with disabilities. Over the past six decades, states have substantially widened that pool, most notably under the Affordable Care Act’s Medicaid expansion to childless adults.

Starting in 2024, California offered healthcare coverage to all low-income residents, regardless of age or immigration status, although lawmakers scaled that back this year. At the same time, the state opted to cover a slew of non-mandated benefits such as physical therapy, hospice care, and housing assistance.

“California has always struggled with wanting to have as broad a program as possible but then having to figure out a way to pay,” said Jennifer Kent, who oversaw Medi-Cal under Gov. Jerry Brown, a Democrat. “There is no population that we have met that we don’t want to offer coverage to, and we’ve never met a benefit that we don’t like.”

Since 2010, California’s Medi-Cal enrollment has nearly doubled while spending has ballooned from $50 billion a year to . It now makes up more than 40% of overall state spending, according to the .

Conservatives argue the program is . They say the federal changes will force states to refocus resources on the neediest.

“The role of the safety net programs was just that — to be a safety net,” Hilton said in an interview. “I don’t think it’s a particularly positive boast to say 40% of Californians should be on a program that was designed for people living in poverty.”

Becerra declined an interview request.

Nelly, a 59-year-old from Los Angeles County, was one of millions who have benefited from the state’s Medi-Cal expansion, but she was initially reluctant to sign up.

For years after she left her corporate job to care for her ailing mother, Nelly said, she didn’t consider applying. She remained uninsured until three years ago, when she woke up and couldn’t see out of her left eye.

She enrolled in Medi-Cal in the emergency room. It now covers her appointments with specialists and transportation to and from. While her condition may exempt her from the new Medicaid work requirements, Nelly said, she’s still worried about losing coverage after experiencing numerous paperwork hiccups simply trying to renew.

Nelly, who asked that her full name not be used, because she hasn’t told her family about her condition, said she understands not everyone on the program may need it. But, she added, “it should be there for someone like me.”

Tough Choices Ahead

When Republican state lawmakers got wind of Newsom’s plan to stretch the debt repayment over a decade, they accused Democrats of trying to “paper over” the state’s structural deficit.

“This leaves future governors and legislatures to clean up the mess,” stated from GOP senators. The Legislative Analyst’s Office later called the maneuver “unusual.” That could leave Becerra, the favorite to succeed Newsom in the overwhelmingly liberal state, as the face of staggering changes to a program he spent his career defending.

More than 2 million Californians under age 65 could lose health coverage over the next four years as a result of the state and federal policy changes, according to by the University of California-Berkeley Labor Center and the UCLA Center for Health Policy Research. At least 730,000 residents have already disenrolled since June 2025.

State agencies are scrambling to implement new federal work requirement rules for adult Medicaid enrollees under 65, hoping to automate as much verification as possible to blunt coverage losses. And in 2028, states will be required to charge some enrollees fees for many services, making it harder for them to maintain coverage.

Disability rights activists say new asset limits will prevent Californians from getting needed home care, which they say is more cost-effective and humane than nursing homes. Counties, deemed by state law to be healthcare providers of last resort, say they need immediate funding for the millions of uninsured patients they anticipate in the new year.

Hospital administrators have urged policymakers to help them keep their facilities stable, and the state’s most recent budget included some $390 million to assist public and .

Martin Luther King Jr. Community Hospital in Los Angeles treats five times the patients it was designed to serve, and 80% of patients are uninsured or on Medi-Cal. Demand is so high in the chronically underserved area, MLK Community Healthcare CEO Elaine Batchlor said, that the hospital has erected tents in the parking lot. Most emergency room patients are now treated there.

“We already have an extremely overcrowded, overburdened emergency department,” Batchlor said. “Insured care will turn into uncompensated care, and the financial burden for that will fall on providers.”

Becerra has said he opposes the state’s recent freeze on enrollment for adult immigrants without legal status, as well as new monthly premiums set to take effect next year, saying such moves will only saddle taxpayers with higher bills for ER care.

If elected, Becerra will probably need to wade into the politically toxic debate over whether to raise more revenue, , or do both.

Aside from promising to find and eliminate billions in administrative waste from the industry, the nation’s former top health official has not explained how he would cobble together the tens of billions of dollars the state is likely to need just to maintain status quo.

The next governor must tread carefully, Kent warned. “When people come and say, ‘Well, you should just do this because it’s the right thing,’” she said, “all of those right things have fiscal consequences.”

This article first appeared on �Թϲ�� and is republished here under a .

Early Voting Begins

Thu, 15 Oct 2026 19:51:00 +0000

Host

Mary Agnes Carey �Թϲ�� Mary Agnes Carey is managing editor of �Թϲ��. She previously served as the director of news partnerships, overseeing placement of �Թϲ�� content in publications nationwide. As a senior correspondent, Mary Agnes covered health reform and federal health policy.

This week, Trump administration officials announced their latest efforts to trim what they identified as duplicative and ineligible enrollees from government health programs. They tied the efforts to the administration’s broader crackdown on waste, fraud, and abuse — just as some states are opening polling stations for early voting.

The outcome of the midterm elections is expected to affect how and whether Congress addresses several healthcare issues during the lame-duck session, not the least of which is government spending. Plus, Health and Human Services Secretary Robert F. Kennedy Jr. unveiled a new initiative to identify vaccine injuries, complete with a ribbon-cutting ceremony at the National Institutes of Health.

This week’s panelists are Mary Agnes Carey of �Թϲ��, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health, Sandhya Raman of Bloomberg Law, and Paige Winfield Cunningham of The Washington Sun.

Panelists

Joanne Kenen Johns Hopkins University

Sandhya Raman Bloomberg Law

Paige Winfield Cunningham The Washington Sun

Among the takeaways from this week’s episode:

Federal health officials this week pointed to their efforts to cut Affordable Care Act plan subsidies from people who were dead or found to have duplicate coverage under government health programs. While they were careful to say that these cases were not fraud, they tied their housekeeping activities to the Trump administration’s broader crackdown on waste, fraud, and abuse — and made that point just as some states are beginning early voting.
The outcome of the midterm elections is expected to shape how Congress spends its time during the coming lame-duck session, with benefits or repercussions for health policy. Should the Democrats win control of one or both chambers, for instance, the party’s leaders could push to hold off on tackling government spending until they have more clout next year. Among the issues on the table are changes to the No Surprises Act, which has shielded patients from many bills but also has come under criticism for problems with the arbitration system it created.
And Kennedy is pursuing a new initiative on vaccine injuries, opening a designated clinic at the NIH. The federal health department has also proposed reimbursing medical professionals for reporting vaccine-related injuries.

Also this week, �Թϲ��’ Julie Rovner talks with Dan Weissmann, host of the healthcare podcast An Arm and a Leg, about the new and even more confusing landscape for Medicare enrollees as open enrollment begins.

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

Mary Agnes Carey: �Թϲ��’ “People Say These Peptides Hurt Them. Their Stories Are Muffled in MAHA’s Push for Medical Freedom,” by Amy Maxmen.

Sandhya Raman: Stat’s “,” by Andrew Joseph.

Paige Winfield Cunningham: �Թϲ��’ “AI, Tech Leaders Are Lobbying Trump Health Officials in a Government-Run Chat Room,” by Amanda Seitz, Maia Rosenfeld, and Darius Tahir.

Joanne Kenen: On CBS News’ Face the Nation, host Margaret Brennan’s interview with Shyam Sankar, chief technology officer at Palantir. ()

Also mentioned in this week’s podcast:

Reuters’ “,” by Andy Sullivan, Helen Coster, Ahmed Aboulenein, and Tim McLaughlin.

click to open the transcript Transcript: Early Voting Begins

California’s Billionaire Tax Promises Healthcare Relief. The Fine Print Is Murkier.

Jackie Fortiér — Wed, 14 Oct 2026 09:00:00 +0000

The pitch behind California’s is simple: Tax the richest residents in the nation’s wealthiest state to offset steep federal cuts to healthcare, food assistance, and education.

But if approved by voters in November, it’s unclear how much money the ballot initiative would raise, how quickly the funding would become available, and how lawmakers would spend it.

The measure would steer proceeds from a first-in-the-nation wealth tax to a state healthcare fund, giving the governor and lawmakers the power to decide how to spend what California’s nonpartisan legislative analyst “tens of billions of dollars.” Backers say it could raise up to $100 billion over five years to keep hospitals and emergency rooms open and preserve insurance coverage for millions of Californians. Yet, community health centers, doctors, and other healthcare entities that might benefit from such a cash infusion argue that the union spearheading the measure has readied a blank check for politicians.

“I’m not sure that you can say, with full security, that this will stop clinics from being closed or healthcare workers from being laid off, or people from losing their healthcare,” said Chris Hoene, executive director of the California Budget & Policy Center, a left-leaning nonprofit.

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Can’t see the audio player? Visit kffhealthnews.org to listen.

Taxing the Ultrarich

Put on the ballot by one of California’s largest healthcare unions, Proposition 40 would impose a one-time 5% tax on with a net worth of at least $1 billion, including most of their stock holdings, yachts, and artwork. It would apply to those who were residents of California on Jan. 1, 2026. Real estate, pensions, and retirement accounts would generally be exempt.

The revenue raised is intended to offset the roughly in anticipated losses to the Golden State from congressional Republicans’ One Big Beautiful Bill Act. Over the next four years, state and federal funding cuts are projected to nearly double California’s uninsured population, which stands at , according to the University of California-Berkeley Labor Center.

Securing additional tax revenue is essential because state lawmakers have yet to come up with a way to pay for healthcare services that will be affected by the cuts, said Dave Regan, president of Service Employees International Union-United Healthcare Workers West, which represents hospital workers and got the wealth tax on the ballot. It would earmark 90% of the tax revenue for healthcare, while the remaining 10% would be split between food assistance and education at lawmakers’ discretion. Regan said such broad categories would give politicians flexibility to be more responsive to the looming cuts.

“Figuring out or predicting exactly what the fallout will be, of where reductions and cuts get made, in a complicated healthcare system, it’s just too difficult to predict,” Regan said.

Among the choices the next governor and lawmakers will face are whether to provide healthcare to people cut off by the new federal Medicaid work requirements, reverse state rollbacks limiting coverage for immigrants with legal status, or raise the low physician reimbursement rates that make some providers reluctant to accept patients enrolled in Medi-Cal, the state’s version of Medicaid.

Lawmakers could also shore up subsidies on Covered California, the state’s health insurance marketplace, whose enrollees have seen their premiums skyrocket after losing millions in federal assistance after Congress last year let enhanced subsides expire.

Most of the money must be spent on health, but healthcare experts said the measure’s ambiguous language could allow lawmakers to use the new billionaire health fund to replace existing state dollars, contrary to the text of the proposition.

“A lot of times these propositions are written in a way to get attention and get support,” said Glenn Melnick, a healthcare economist at the University of Southern California. “But in fact, they can be used for other things later.”

Instead, the healthcare industry is pushing for a long-term funding plan. René Bravo, a pediatrician in San Luis Obispo County and the president of the California Medical Association, worries that a one-time infusion of tax dollars “is going to run out.”

“We need to work on a more sustainable, durable funding mechanism for the Medi-Cal system,” he said.

At the same time, doctors are asking him what will happen when the biggest Medi-Cal eligibility cuts begin to take effect next year. Even if voters approve the ballot measure, the money wouldn’t be available for at least a few months while the state collects the tax. And billionaires could spread their payments over five years.

Californians Divided

Pasadena resident Lynne Wines, a 72-year-old retired banker, knows the state needs the money. But she worries that wealthy investors will see the measure as a precedent and flee the state. Even though the ballot measure is clear that it’s a one-time tax, Wines said it’s a slippery slope.

“Taxes have a way of being needed over and over, and politicians have a way of finding those needs,” Wines said. “So, I don’t really feel secure that this is just a one-time thing.”

She noted that Google co-founder and billionaire Sergey Brin bought a home in Nevada and moved some of his businesses to the Silver State late last year. He is backing ad campaigns opposing the measure. Brin has given more than $100 million to a nonprofit promoting two competing measures, Propositions 41 and 42, designed to blunt or block it, according to contributions filed with the secretary of state’s office. One would count some new state taxes toward California’s overall spending limit and require the state auditor to review new state tax proposals before voters weigh in. The other would prohibit new state taxes on personal property, intellectual property, retirement accounts, and other assets.

GOP gubernatorial candidate Steve Hilton, who has been endorsed by President Donald Trump, warned on CNN in June that just the threat of the tax “has sent trillions of dollars, by some estimates, of wealth leaving the state.” A March study by the conservative Hoover Institution at Stanford University projected that the billionaire tax would , citing, in part, the lost revenue from billionaires who have already left the state.

California voters appear torn over departing billionaires. Two independent September polls suggested voter support for Proposition 40 varied from a to a .

Pasadena resident Steve Erler, 74, works full-time as a building manager because he can’t afford to retire. He worries that federal cuts will hurt children and seniors.

Steve Erler of Pasadena, California, works full-time as a building manager because he can’t afford to retire. He worries that federal cuts will hurt children and seniors, and he supports a California ballot measure that would tax billionaires. (Jackie Fortiér/�Թϲ��)

“These people who are making all this money, they can never spend it all. What are they going to do, buy another house in the Hamptons, buy another jet? They don’t need that,” Erler said while out walking his dog in August. “They need to be able to say when they go to bed at night, ‘I helped a child with healthcare. I helped a senior get fed.’ That’s what’s important,” he said.

Democrats are divided — one of many ideological fights playing out nationwide this election cycle as progressives take on more centrist candidates. U.S. Sen. (I-Vt.) and the have endorsed Proposition 40, while Gov. Gavin Newsom, who is exploring a presidential bid, and Democratic gubernatorial nominee Xavier Becerra oppose it while saying that ultrawealthy or high-earning people should pay more. “It’s time for an economic reset, a true minimum tax on billionaires that, well, ensures the people at the very top pay at least the tax rate their own workers pay,” said Newsom, who supports a , although legislation for a federal has stalled.

If voters approve the ballot measure, political analysts said, it could show other states that taxing the wealthy may help close budget gaps and pay for essential services. Already several Democratic states, including , , , and , have approved millionaire taxes, but those have been limited to income, not overall wealth. Voters in Washington state will decide this fall whether to .

“I do think this is just the beginning of these proposals nationwide,” said Melnick, the USC healthcare economist.

This article first appeared on �Թϲ�� and is republished here under a .

Fears About Kids’ Online Safety Unite Democrats and Republicans

Darius Tahir — Tue, 13 Oct 2026 09:00:00 +0000

The U.S. Senate candidates in Texas could hardly be more different: James Talarico, a former seminarian turned Democratic state lawmaker who speaks in calm cadences about love and empathy, and Ken Paxton, the pugnacious Republican state attorney general who speaks about a refusal to compromise.

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 �Թϲ��.

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 �Թϲ��, 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 �Թϲ�� 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 �Թϲ��. 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 �Թϲ�� and is republished here under a .

Midterm Madness

Thu, 08 Oct 2026 19:05:00 +0000

The Host

Julie Rovner �Թϲ�� Read Julie's stories. Julie Rovner is chief Washington correspondent and host of �Թϲ��’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

The midterm elections are less than a month away, and a new poll from KFF shows voters are very concerned about rising health costs and trust Democrats more than Republicans to address the issue. In an apparent attempt to close the gap, President Donald Trump is sending checks, some dubbed as “refunds,” to some Medicare and Affordable Care Act enrollees, but those checks are for far less than most patients’ costs have risen in 2026.

Meanwhile, Republicans had planned for the healthcare cuts included in their signature 2025 budget law to take effect after the midterms. But many states and healthcare providers have jumped the gun, cutting funding and services now in anticipation of fewer federal funds in 2027.

This week’s panelists are Julie Rovner of �Թϲ��, Anna Edney of Bloomberg News, Alice Miranda Ollstein of Politico, and Paige Winfield Cunningham of The Washington Sun.

Panelists

Anna Edney Bloomberg News

Alice Miranda Ollstein Politico

Paige Winfield Cunningham The Washington Sun

Among the takeaways from this week’s episode:

Healthcare affordability is a top issue for voters heading into the midterms, a political reality prompting Trump to talk up his deals with drug companies and promise checks to Americans affected by government healthcare policies. Meanwhile, a new poll shows “Medicare for All” is at its highest popularity in at least a decade, suggesting some Americans are so squeezed by medical bills that they’re willing to support a major healthcare overhaul.
While Republican lawmakers wrote the One Big Beautiful Bill Act so that most changes to the Medicaid program would take effect after the midterms, people are starting to feel the bite. Clinics, hospitals, and state governments are already making cuts in anticipation of the drop in federal funding. Plus, Nebraska’s early implementation of the law’s Medicaid work requirement is showing that most of those losing coverage are being dropped for procedural reasons.
In infectious disease news, the measles outbreak in Pennsylvania has topped 1,000 cases. Those who contract the disease are likely to experience long-term effects, because it can have serious repercussions for the body’s immune system. And the death of a lab worker in Siberia from an unknown pneumonia has raised plague concerns and is making headlines as Russia shares little with the international community about the case.
Plus, the Trump administration disclosed in court filings this week that the findings of its safety study of the abortion pill mifepristone will be released next year. And the practice of lethal injection is under scrutiny after the botched execution of a Tennessee woman. Many pharmaceutical companies refuse to even supply the drugs needed for lethal injections to correctional facilities, raising questions about the source and handling of the drugs used.

Also this week, Rovner interviews Michelle Andrews, who reported and wrote the latest �Թϲ�� “Bill of the Month,” about a patient who got a bill from a hospital emergency department though she never got out of the waiting room. If you have a medical bill that’s baffling, outrageous, or inscrutable, you can submit it to us here.

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

Julie Rovner: The Atlantic’s “,” by Sarah Zhang.

Alice Miranda Ollstein: Politico’s “,” by Carmen Paun.

Paige Winfield Cunningham: The New York Times’ “,” by Reed Abelson and Teddy Rosenbluth.

Anna Edney: ProPublica’s “,” by Annie Waldman.

Also mentioned in this week’s podcast:

KFF’s “,” by Shannon Schumacher, Isabelle Valdes, Mardet Mulugeta, Audrey Kearney, Ashley Kirzinger, and Liz Hamel.
KFF’s “,” by Drew Altman.
�Թϲ��’ “Confusion and Angst Follow State’s Early Rollout of Medicaid Work Rules,” by Aaron Bolton, MTPR.
Politico’s “,” by Alice Miranda Ollstein.
The Center for Infectious Disease Research and Policy’s “,” by Liz Szabo.
The New York Times’ “,” by Christina Jewett.
�Թϲ��’ “Witnessing the Failed Execution of Christa Pike: ‘We Could All Hear Her Breathing,’” by Catherine Sweeney, WPLN.

click to open the transcript Transcript: Transcript: Midterm Madness

‘Medicare for All’ Message Attracts Voters Buckling Under Medical Bills

Kate Wells — Wed, 07 Oct 2026 09:00:00 +0000

LANSING, Mich. — Christina Starks-Clay doesn’t know how “Medicare for All” would work exactly, but she’s willing to bet it’d be better than what she has now.

Standing in line for U.S. Senate candidate Abdul El-Sayed’s town hall in the state’s capital in September, she whipped out her phone to pull up a screenshot. It was of the $1,000 cashier’s check she’d picked up at the bank that day to pay down a chunk of her son’s dental bills. An early childhood special education paraprofessional, she still owed $389, even with good dental insurance. Her own cleaning a few weeks before cost $600.

She tried to talk herself down at the bank, to focus on being grateful for what she could afford.

“I’m like, ‘Tina, OK, you were in a position for this moment to do this,’” she said. “A lot of people couldn’t do what I had to do today. I couldn’t do it. But I did it. So I need to hear, how are you going to make this better for everyone?”

Many who waited in the hot sun that afternoon in a line stretching blocks through downtown Lansing shared similar anxieties. A man ahead of Starks-Clay talked about watching his brother rack up thousands of dollars in medical debt. A professor emeritus at nearby Michigan State University worried aloud about his grandkids’ medical care, because his adult kids were struggling to meet a $9,000 insurance deductible. Healthcare workers who’d turned up for the event described patients choosing between affording medication or food, or how they themselves had been financially devastated by a medical crisis.

They all knew Michigan Democrat El-Sayed’s rallying cry by heart, chanting it when the candidate took the stage: “Money out of politics! Money in your pocket! Medicare for All!”

Abdul El-Sayed (D-Mich.) speaks at a rally in Detroit on Aug. 7. (Emily Elconin/Bloomberg via Getty Images)

Support for Medicare for All is at its highest in at least a decade, according to a . The survey found two-thirds of Americans now favor expanding the government health program that largely covers seniors (about are enrolled in private plans through Medicare Advantage).

But many people don’t actually know how to define Medicare for All. Traditionally, the idea has been to establish a single health insurance program, run by the federal government, that would guarantee coverage for Americans and minimize or even eliminate private insurance. How much people like the idea depends on what they’re told about it, pollsters have found.

Still, at a time when of Americans say they can afford their healthcare, Medicare for All has become a progressive shorthand for radical, systemic change.

“Too many people don’t have health insurance, too many people who do have insurance can’t afford medical care, and many people are terrified about the costs of being sick,” said Jonathan Oberlander, a professor at the University of North Carolina-Chapel Hill who specializes in the politics of healthcare reform.

“And in an electorate that wants change, that is disenchanted with the status quo, Medicare for All is an important symbol,” he said.

That’s why Democrats running for Senate seats in the midterm elections in such states as Maine, Minnesota, and Florida tout their support for scrapping the current health insurance system in favor of broad Medicare coverage. But nowhere is the issue as central to a race as in Michigan, where Medicare for All has become synonymous with El-Sayed.

El-Sayed, who trained as a doctor and served as Detroit’s top public health official, has campaigned on Medicare for All since his unsuccessful bid for governor in 2018. To Starks-Clay, that means he has a plan and will “stick to it,” she said.

That’s appealing to voters right now, said Ashley Kirzinger, director of survey methodology at KFF, a health information nonprofit that includes �Թϲ��. “When we ask people what do they want to hear from candidates in regards to healthcare, it’s a plan to bring down healthcare costs.”

American Dream or Pipe Dream?

Medicare for All has been the shiny object of progressive politics in previous campaigns, including Vermont Sen. Bernie Sanders’ 2016 presidential bid and the 2020 Democratic presidential primary. Its popularity rises and falls in cycles, Oberlander said. And today people are painfully aware their care is getting more expensive and harder to access.

In the first decade or so after the passage of the Affordable Care Act in 2010, the nation’s uninsured rate was cut . Insurance companies could no longer deny people coverage based on preexisting conditions. Since then, to cover more people, 40 states plus Washington, D.C., have expanded Medicaid, the government health program for those with low incomes or disabilities.

Now it feels as if we’re moving backward, Oberlander said. “We are now, in the past two years, in an era where the Trump administration and congressional Republicans have reversed that progress.”

Michigan, a battleground state that President Donald Trump won in 2024, saw some of the after the GOP-controlled Congress allowed enhanced tax subsidies, which helped people afford their premiums, to expire at the end of last year. Insurance companies in Michigan hiked individual marketplace rates by an average of 20%. And up to 355,000 Michiganders are expected to lose their Medicaid coverage in 2028 because of cuts included in Trump’s signature law, the One Big Beautiful Bill Act, according to estimates from the , a left-leaning think tank.

At El-Sayed’s town hall in Lansing, Darleana Ash said patients at the medical diagnostics lab where she works are increasingly skipping tests because they can’t afford them. Others drive hours from rural areas because their local labs have closed or are no longer in their insurance networks. She worries about the patients who must choose between their medications and groceries some months.

“If you got somebody that’s 75, 80 years old, guess what? They’re going to go without the medication, because they got to eat,” she said.

Packed in near the front of the crowded town hall was Cindy Lou Coolich, a boisterous retiree wearing a campaign T-shirt and cowboy hat. She spent years working for a company that helped uninsured people enroll in coverage, until she got sick herself. A bout of sepsis nearly killed her and left her disabled. Suddenly, she was the one enrolling in Medicaid and living on $900 a month from Social Security.

She lost the 15-acre horse farm she’d owned, and then everything else, she said. “Except my car.” The saving grace, oddly, was the death of her ex-husband. Because they’d been married for more than 10 years, she could benefit from his Social Security benefits. “So now I’m doing quite well!” she laughed. But to her, it hardly seemed like the mark of a functioning healthcare system that someone had to die for things to get better.

A Universal Response

Democrats aren’t the only ones responding to voters’ healthcare discontent. Republican Mike Rogers, a former Michigan congressman and El-Sayed’s opponent, recently .

“I just can’t think of a more important issue to the people of Michigan than healthcare and costs, the rising costs,” he said. At a announcing his health platform, he broadly attacked El-Sayed and Medicare for All.

“[If] the government’s going to give you something, they have to take it away from someone else,” Rogers said.

Mike Rogers (R-Mich.) at a rally in Sterling Heights, Michigan, on Aug. 31. (Sarah Rice/Bloomberg via Getty Images)

Under Medicare for All, millions of Michiganders with private health insurance would lose that coverage, he said. Pointing to estimates that Medicare for All would cost some $4 trillion per year, he said, “Guess what? People pay for that.” (A recent researchers found that the cost of implementing Medicare for All, estimated at $4.2 trillion, would save about $1 trillion in healthcare spending.) Rogers’ campaign declined an interview request from �Թϲ��.

Concerns about increased taxation, disruption to the current system, and reduced access to services can make Medicare for All a political liability in a close election, Oberlander said. “It doesn’t matter if the fears that they’re spreading are actually accurate,” he said. “Politically, what matters is if they can scare people.”

But even if El-Sayed wins in November, the chances of Medicare for All replacing the current system “remain very remote in the short to medium term,” Oberlander said.

Given the staunch opposition from Republicans and many moderate Democrats, not to mention the lobbying power of the healthcare industry, massively overhauling the U.S. health system won’t suddenly be achievable because of a single Senate candidate.

Thomas “Jermaine” Carey knows this. A self-described activist, he attended a recent El-Sayed town hall in Detroit feeling “kind of sold out” by what he calls the “straight-ticket” Democratic Party. Medicare for All sounds good, he said. “Do I believe it?” He shrugged.

“It’s still America,” he said. “You still have super PACs, the lobbyists that control everything.”

This article first appeared on �Թϲ�� and is republished here under a .

Trump’s Immigration Crackdown Divides Rural Voters, KFF-AP Poll Finds

Mon, 05 Oct 2026 10:01:00 +0000

More than a year into President Donald Trump’s sweeping immigration crackdown, a poll finds that voters in rural parts of the country are divided on whether those immigration policies have benefited or harmed their communities.

In the Associated Press-KFF survey of more than 2,000 rural voters in August, about a third said the Trump administration’s immigration enforcement had been positive for their community and about a third said it had been negative. The remaining 3 in 10, roughly, said it had no impact.

Trump promised tough enforcement on the campaign trail in 2024, and the survey highlights how a cornerstone of his base, rural supporters of his Make America Great Again movement, are especially likely to say they see a benefit where they live from the Republican president’s stringent immigration policies.

Yet many rural voters also say immigrants are a key part of their local economies, and some believe Trump’s immigration actions have gone too far.

Laura Leigh Taylor, a 37-year-old farmer who voted for Trump in 2024, said she disapproves of the wide-ranging scope of Trump’s immigration crackdown, which resulted in a friend’s hardworking father being deported.

“I understand getting rid of the rapists and the murderers,” she said. “But all the people that fell in between, that really weren’t doing nothing but taking care of their family, … they got torn from their families.”

Taylor now regrets her vote for Trump. As a resident of Smithville, Georgia, a town of about 600, Taylor thinks she will vote for Democratic Sen. Jon Ossoff in November because, she said, the Democrats have been the ones talking about families being uprooted by Trump’s immigration enforcement.

“Just because of that simple fact, I’m going to go with him,” Taylor said.

Taylor regrets voting for Trump in 2024. (Matt Odom for �Թϲ��)

Most Rural Voters Want Politicians To Talk About Immigration

Roughly three-quarters of rural voters say it’s “extremely” or “very” important for midterm candidates to talk about immigration, though that’s lower than the share who want them to address the cost of living, fraud in government programs, or healthcare costs.

Rural voters don’t overwhelmingly think Trump’s immigration policies have helped their communities, but they are also less likely than the general public to say that Trump has overstepped in his efforts, which have involved mass deportations and rapid deportations of immigrants to countries where they have no ties.

Only about 4 in 10 rural voters say Trump has “gone too far” in restricting legal immigration or deporting immigrants living in the U.S. without authorization, below the 55% of U.S. adults overall who said the same in a September AP-NORC poll.

John Thomas, a 55-year-old from Liberty, Kentucky, supports Trump’s efforts to deport people without legal status. Thomas, who has just been approved for disability benefits after injuring his back in 2008, believes they put too much of a burden on the healthcare system. Regulating immigration, he said, is a means of providing better healthcare to Americans.

“They’ve been taking from everybody,” Thomas said of immigrants. “People that really need this stuff can’t get it because of them.”

David Grabowski, a professor of healthcare policy at Harvard Medical School, said that research suggests immigrants use less healthcare than native-born Americans. “It is hard to argue that they are placing an undue burden on the system,” he said, because many immigrants work in healthcare and pay taxes.

Most Rural Voters See Immigrants’ Economic Importance

Immigrants often play key roles in sustaining local industries, including by filling jobs in manufacturing, healthcare, and agriculture. The survey suggests the vast majority of rural voters see immigrants in the country legally as an important part of their local economies.

Shannon Monnat, director of the Center for Policy Research at Syracuse University and president of the Rural Sociological Society, said immigration has been a demographic lifeline for much of rural America. Rural areas have been losing young adults for years, she said.

“For a lot of small towns, immigrants are the reason the school and hospital stayed open and the county didn’t shrink,” Monnat said.

About 7 in 10 rural voters see immigrants who are in the country legally as “very” or “somewhat” important to their local economies, and a similar share say the same about temporary or seasonal agriculture workers. Hundreds of thousands of immigrants take seasonal jobs on U.S. farms each year, with most of them coming from Mexico, on H-2A visas.

Rural voters with a connection to agriculture and farming are more likely than those without one to say that temporary or seasonal workers are “very important” to their local economies, the poll found.

Jeff Miller, a 56-year-old Republican hydro blaster and vacuum technician, has mostly been pleased with Trump’s agenda, and he believes things are “heading in the right direction.” The one thing Miller has struggled with is Trump’s aggressive immigration policy, which he blames for the deportation of a “really good worker” and friend, who was removed from the U.S. when his work permit expired.

Miller, from Racine, Ohio, said he would support exceptions for hard workers, or just a less aggressive approach.

“There’s kind of an up-and-down thing because I lost a really good friend over that,” Miller said.

Rural voters are much less likely to say immigrants who are in the country illegally are beneficial, but 45% say they are at least “somewhat” important to local economies.

Albert Martinez, a 70-year-old Democrat from San Diego, Texas, voted for Trump in 2016, but he now believes the Trump administration has “gone amok.” The Army veteran said he is a proponent of getting criminals out of the country, but that is not what he is seeing happening with current immigration enforcement.

“They started doing everybody across the board,” Martinez said. “Innocent kids and women, people who work in restaurants, people who work in hotels, people who are building homes, people who are doing masonry work, and innocent, good, taxpaying people. Taxpayers. It’s insane.”

Rural MAGA Voters Support Trump’s Immigration Policies

Some of Trump’s most loyal supporters — rural Republicans who consider themselves MAGA supporters — are about twice as likely as rural, non-MAGA Republicans to see a benefit to Trump’s immigration policies where they live.

Roughly 4 in 10 rural voters identify as MAGA Republicans, while about 1 in 10 are Republicans but not MAGA supporters.

About two-thirds of rural MAGA Republicans say Trump’s immigration policies have had a positive impact where they live. Roughly half say the Trump administration has “not gone far enough” on deporting immigrants in the country illegally, while about half say his actions have been “about right.”

Katherine Reed, a 27-year-old Republican who supports the MAGA movement, has been pleased to see the Trump administration’s deportation policies play out. The resident of Mount Pleasant, Texas, believes her community has always been safe but that the administration’s policies have had a positive impact by reducing violent crime nationwide, saying, “It’s made life for people a lot safer.”

She believes if someone comes to America, they should “respect the law of the land” and “do it legally.”

“I want really amazing people to become Americans,” Reed said. “That’s the whole point of America.”

About the Poll

The KFF-AP Rural Voters Survey was conducted online and by telephone Aug. 12-24, 2026, among 2,241 registered voters living in rural areas, defined as census tracts that fall within codes 5-10 of the U.S. Department of Agriculture’s 2020 Rural-Urban Commuting Area codes. Voters were reached through a combination of the probability-based SSRS Opinion Panel and a registration-based sample from the L2 voter file. Overall results have a margin of sampling error of plus or minus 3 percentage points, including design effects due to weighting. Error margins are larger for subgroups. In collaboration with the AP, KFF researchers worked to design the survey sample and questionnaire and analyze and report findings.

This report is from a collaboration between �Թϲ�� and The Associated Press.

This article first appeared on �Թϲ�� and is republished here under a .

Midterms Have Revived Universal Healthcare Debate. These States Are Ahead of Everyone.

Markian Hawryluk — Fri, 02 Oct 2026 09:00:00 +0000

Democratic congressional members and candidates are already planning to use any midterm election gains to , including boosting Affordable Care Act subsidies, reversing Medicaid cuts, and lowering the Medicare eligibility age.

But Democratic strongholds across the country — including Oregon, California, , and — have more ambitious goals: single-payer, universal healthcare systems.

No state is closer to that goal than Oregon. A panel created by the state legislature in 2023 is slated to send lawmakers its proposal for a universal health plan by Dec. 1. The nine-person seeks to establish, starting in 2032, medical, vision, dental, and mental health benefits for every state resident from cradle to grave — with no premiums, deductibles, or copayments. Lawmakers could vote on a plan during the 2027 legislative session or refer it to voters as a ballot measure in 2028.

If approved, the state would be the first in the U.S. to implement what’s called a single-payer health coverage system. It could serve as a model for other states — and potentially the nation.

Proponents of the proposal argue that the public supports universal healthcare more than ever as healthcare spending and complexity grow. patients often delay care due to out-of-pocket costs. And medical debt remains a in the nation.

States have often served as laboratories to test health policies later implemented nationally. The Affordable Care Act was modeled after Massachusetts’ attempt to achieve universal health insurance coverage, once single-payer efforts there stalled. And Canada’s universal healthcare system began with a provincial plan in Saskatchewan.

“In the short to medium term, there is no chance that ‘Medicare for All’ can be passed at the national level,” said , a University of North Carolina health policy professor. “That’s where the states come in. A state like Oregon provides a more hospitable political environment and a more realistic path to single-payer reform.”

But advocates of the plan expect a significant fight from healthcare behemoths, including large hospital systems, seeking to sour public opinion on making such widespread changes. are health insurers. The industry’s deep pockets have helped derail myriad universal healthcare efforts at the federal and state levels.

In 2011, the Vermont Legislature voted to implement a universal healthcare plan but, three years later, Democratic Gov. Peter Shumlin, who had campaigned on the promise of single-payer, pulled the plug, citing “potential economic disruption.”

States that took the issue directly to voters have fared no better. Ballot measures in in 2016, in 2002, and in 1994 all failed by large margins.

“The aspirations of progressive reformers usually run smack into sobering political realities,” Oberlander said. “Translating a slogan into a legislative and political reality is a daunting task.”

Valdez Bravo, president of Health Care for All Oregon, speaks at the nonprofit’s annual garden party in Portland on Sept. 12. The state will soon consider a plan for universal health coverage that the state legislature ordered in 2023. (Christena Dowsett for �Թϲ��)

Redirected Healthcare Dollars

Oregon’s proposal seeks to maintain the current level of spending on healthcare by government, business, and consumers with new corporate and personal taxes to replace insurance premiums and other out-of-pocket costs. Those would be combined with federal and state spending to create a single fund from which all hospitals, doctors, and other practitioners would be paid.

Board members said savings from cutting red tape, reducing fraud, and negotiating drug costs should allow the state to provide better benefits to more people.

In , the board estimated that a 30-year-old making $55,000 and purchasing a benchmark silver-level plan through the Affordable Care Act now pays $5,478 a year for insurance premiums in Oregon, but instead could pay $2,331 in taxes under the proposed plan.

Someone making $55,000 a year with coverage through their employer now pays $3,063 in premiums and out-of-pocket costs. Under the draft plan, that person could pay nothing for health services and could see any doctor in the state.

Currently, many employers pay much of the health insurance costs for their workers. The plan seeks to maintain those contributions by establishing a corporate payroll tax for companies whose payrolls exceed $500,000. Their employees could receive a partial tax credit for the taxes their employers pay. As a result, 31% to 60% of Oregonians wouldn’t pay anything for health benefits.

More affluent people, however, could end up paying more than they do now. The exact numbers would depend on how lawmakers set tax rates and payment thresholds.

“What we are proposing is something very different,” said , executive director of the Oregon board. “Everyone contributes based on the amount that they are able to contribute and not based on utilization.”

A work group created by the state legislature in 2023 is slated to send lawmakers its proposal for a universal health plan by Dec. 1. Lawmakers could vote on the plan as soon as the next legislative session or refer it to a ballot measure in 2028. The nonprofit Health Care for All Oregon hosted a garden party on Sept. 12 ahead of the reveal. (Christena Dowsett for �Թϲ��)

Backers of the universal healthcare coverage plan will try to convince hospitals and health systems that they would benefit from reducing red tape and eliminating unpaid bills. (Christena Dowsett for �Թϲ��)

Messaging Challenge Lies Ahead

The plan’s backers will try to convince hospitals and health systems that they would benefit from reducing red tape and eliminating unpaid bills. Currently, hospitals to bill dozens of public and private health plans, each with its own coverage and billing rules. A single plan covering everyone in the state could streamline the process, saving billions.

Rural hospitals could gain financial stability. They now often struggle to stay afloat because they typically have higher rates of patients who are uninsured or on Medicaid, with its often low reimbursement rates.

Hospitals aren’t so sure.

“The universal health plan proposal preserves much of the broken, fragmented status quo and adds new taxes and complexity that Oregonians can’t afford,” said Becky Hultberg, president and CEO of the . “With federal policy changes looming, we are entering a period of tremendous upheaval. This proposal could destabilize a system that is already struggling.”

Under the proposal, doctors and other practitioners would be paid somewhere between what Medicare pays on the low end and what private insurance pays on the high end. Although total payments to doctors would remain unchanged, rates would be negotiated with physician groups to shift more money into primary care and less into specialty services.

But it is unclear whether doctors would agree that more patient time, fewer administrative hurdles, and no more unpaid bills would be worth a payment structure that could cause specialists to lose out.

Rebecca Schoon, an associate professor at Pacific University who attended last month’s Health Care for All Oregon garden party, says that communicating what universal healthcare is will be one of the biggest challenges ahead for Oregon’s proposed plan. (Christena Dowsett for �Թϲ��)

“There’s always winners and losers in designing something like this, and so how to distribute those is the hardest part,” said , an associate health policy professor at Pacific University who is slated to join the Oregon board in January. “But the second-hardest part is, I think, messaging this.”

Courtni Dresser, vice president of government relations for the , said her physicians group shares many of the board’s goals in improving access to care and reducing administrative burdens. But the group has yet to declare its support or opposition to the effort.

Health insurers haven’t formally weighed in on Oregon’s proposal either, but a single-payer system would, in essence, close off Oregon to any private healthcare plans.

“We expect insurance companies to put every ounce of money they can against this idea because our system is broken and they profit from it,” said Collin Stackhouse, communications coordinator for , a consumer group advocating for universal healthcare.

, a former insurance company executive who now works to expose industry influence, said he expects health plans to hammer the Oregon proposal with claims of high taxes, loss of choice, and the specter of “socialized medicine.”

“Most people go year to year without testing the limits of their health insurance policy,” Potter said. “And so, they’re easily scared into thinking that something valuable will be taken away from them, and that they will have something that’s inferior in its place.”

Health insurers argue their health plans help shield consumers from the full impact of rising healthcare costs.

“Americans consistently report strong satisfaction with their health coverage, including more than 180 million covered through work and 36 million who choose Medicare Advantage,” said Chris Bond, a spokesperson for the health insurance . “Policy solutions are needed to rein in the ever-higher prices charged by hospitals and drugmakers and make care more affordable for everyone.”

Volunteers converse at the Sept. 12 garden party in Portland. Oregon’s legislature created a work group in 2023 to draw up a plan to create universal healthcare in the state. The proposal is due Dec. 1. (Christena Dowsett for �Թϲ��)

Federal Approval Needed

It’s unclear whether Oregon could secure federal approval to redirect Medicare and Medicaid dollars into its universal plan. Backers of the proposal do not expect the Trump administration to be receptive but say it will be years before approval is needed and hope the 2028 presidential election ushers in a more supportive administration. If federal waivers are not secured, Oregon could proceed in stages, starting with the non-Medicare population.

In California, Democratic candidates for governor are not debating whether to implement single-payer but how. New York lawmakers are debating a single-payer bill called the . And in Washington, state legislators have created a commission to design a universal healthcare plan.

The Oregon board has had regular contact with teams working on single-payer proposals in California and Washington, sharing approaches and looking for ways to collaborate, McDonell said.

, an Oregon family physician and a member of Physicians for a National Health Program, said he could envision the other West Coast states joining Oregon in implementing single-payer, much as California, Washington, and �Ჹ�ɲ��‘i have in to counter changes in federal vaccine recommendations.

“If our four states could do it,” he said, “that would be the momentum we would need to get it nationally.”

This article first appeared on �Թϲ�� and is republished here under a .

The MAHA Metamorphosis

Thu, 01 Oct 2026 18:50:00 +0000

The Host

The big “Make America Healthy Again” summit at a glitzy Washington, D.C., hotel this week highlighted a split in the movement between moms who want pesticides and artificial ingredients out of their kids’ food and wellness entrepreneurs who want to promote their products to government regulators.

Meanwhile, as the new fiscal year begins, the Trump administration is refusing for the second year in a row to spend hundreds of millions of dollars Congress approved for the Department of Health and Human Services — and daring lawmakers or the courts to try to do something about it.

This week’s panelists are Julie Rovner of �Թϲ��, Shefali Luthra of The 19th, Rachana Pradhan of �Թϲ��, and Rachel Roubein of The Washington Post.

Panelists

Shefali Luthra The 19th

Rachana Pradhan �Թϲ�� Read Rachana's stories.

Rachel Roubein The Washington Post

Among the takeaways from this week’s episode:

The transformation of the Make America Healthy Again movement was on display at a MAHA Institute meeting in Washington this week. The gathering featured wellness companies hawking their wares and largely steered clear of the movement’s core issues, such as vaccines and pesticides. Many MAHA adherents have expressed disillusionment with the Trump administration, seeing it as favoring corporate interests over their priorities, and some progressives are starting to make a play for the support of these disaffected activists.
The Trump administration is again attempting to cancel some congressionally appropriated health funding via a controversial strategy known as a pocket rescission. The 2026 fiscal year concluded this week, effectively running out the clock for Congress to force the Trump administration to distribute that money — and with the House already recessed until after the midterm elections.
And the Hyde Amendment turned 50 this week. The legislative measure prohibits federal funding from being used to pay for abortions, effectively banning Medicaid funding of pregnancy termination unless states opt to spend their own money to offer that benefit for those who are low-income or disabled.

Also this week, Rovner interviews Aaron Carroll, president and CEO of AcademyHealth, to discuss the Trump administration’s dismantling of the federal Agency for Healthcare Research and Quality.

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

Julie Rovner: The New York Times’ “,” by Madaleine Rubin.

Shefali Luthra: The Atlantic’s “,” by Caitlin Dickerson.

Rachana Pradhan: �Թϲ��’ “US Poised To Boot Legal Immigrants From Medicaid, Including Refugees and Sex-Trafficking Victims,” by Phil Galewitz, Andrew Jones, and Claudia Boyd-Barrett.

Rachel Roubein: Stat’s “” by Elaine Chen.

Also mentioned in this week’s podcast:

The Washington Post’s “,” by Rachel Roubein.
The Washington Post’s “,” by Rachel Roubein.
The New York Times’ “,” by Apoorva Mandavilli.

Click to open the transcript Transcript: The MAHA Metamorphosis

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