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  • Get the Facts: Health insurance expected to rise if tax credits expire amid government shutdown

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    At the core of the government shutdown is a debate about the extension of health insurance subsidies under the Affordable Care Act, first implemented in 2021.The shutdown began at the start of the new fiscal year, Oct. 1. In budget negotiations, Democrats were aiming to extend the expanded subsidies, set to expire at the end of 2025, while Republicans have emphasized reopening the government before beginning health care talks.If these tax credits expire, it’s estimated that the more than 24 million people enrolled in marketplace plans will pay twice as much out of pocket, according to Jeanne Lambrew, director of health care reform at the Century Foundation. KFF estimated the average premium payment would increase 114% from $888 to $1,904 without expanded subsidies.Plus, the impacts could be felt even sooner as open enrollment is set to begin Nov. 1 for people to select health insurance coverage for 2026. The ACA, sometimes referred to as “Obamacare,” was designed to make health care affordable and accessible via marketplaces, Lambrew said, who also worked on drafting and implementing the ACA during the Obama administration.The goal of the marketplaces were to fill in the gaps, according to Lambrew. It is for people who make too much to qualify for Medicaid, but also for people who don’t have access to affordable insurance through their work.Enrollment in the ACA has increased since its passage in 2014, but really climbed in the last five years. From 2020 to 2025, enrollment more than doubled as a result of expanded tax credits passed in the American Rescue Plan Act in 2021, which increased the subsidies and lifted a cap that disqualified people making four times the poverty level or more from being eligible for the subsidies. Under 2025 guidelines for the 48 contiguous states and Washington, D.C., the federal poverty level is $15,650 for a one-person household. At 400%, it’s $62,600.Nearly all states saw an increase in enrollment under the ACA from 2020 to 2025, with 20 states more than doubling in enrollment.Six states more than tripled in the number of people enrolled under the ACA — Texas, Mississippi, West Virginia, Louisiana, Georgia and Tennessee.States that President Donald Trump won in the 2024 election have the majority of enrollees, according to an analysis from KFF.“We know that three out of four enrollees in the health insurance marketplace live in states that voted for President Trump in 2024,” Lambrew said. “So this is not a partisan issue, it’s a nationwide issue, and it affects people in different ways, but the overall effect is significant.”Who is impacted?The subsidies, also called tax credits, at the center of the shutdown are utilized by about 92% of people enrolled in marketplace plans under the ACA, according to data from the Centers for Medicare & Medicaid Services.These expanded credits allow households of different sizes and income levels to be capped with maximum out-of-pocket costs.Once the expanded tax credits expire at the end of this year, the out-of-pocket maximums will increase across the board, and people making above four times the poverty level will become ineligible for any tax credits.More than 6.7% of those who were enrolled in ACA plans earned more than 400% of the federal poverty level, accounting for 1.6 million people. Once the subsidies expire, these enrollees would no longer qualify for the subsidies under the ACA.Also heavily impacted are people approaching retirement age. The age group with the highest enrollment in marketplace plans is ages 55 to 64, data shows. KFF estimated in March that about half the enrollees who would lose the tax credit upon expiration are between 50 and 64.As people grow closer to retirement age, they may not rely as much on employer-provided insurance before turning 65 and qualifying for Medicaid, according to Lambrew.How much would premiums change?KFF has estimated the average premium will more than double next year if the expanded subsidies were to expire.In addition to the potential ending of the subsidies, insurance rates are projected to rise across marketplace plans and employer-provided insurance.”I looked at Medicare history, employer-sponsored insurance history, marketplace history. Without a doubt, this is the highest one-year increase in premiums for people in history,” Lambrew said.The Get the Facts Data Team analyzed maximum out-of-pocket rate changes for benchmark plans to find how rates may change.A one-person household with an annual income of $25,000 — a little more than 1.5 times the federal poverty level — is estimated to go from paying a maximum $100 out of pocket annually to $1,168. They would pay a maximum of less than $98 a month — 10 times more than the previous payment of less than $9 a month.Households with an income between 100% and 150% of the federal poverty level made up the largest share of enrollees at almost 45%. Under the expanded subsidies, they aren’t required to pay anything out of pocket for benchmark plans.If the tax credits expire, they will pay a maximum between 2.1% and 4.19% of their income annually. At 1.5 times the federal poverty level, a one-person household would be earning $23,475 annually and may have to pay nearly $984 a year.The interactive below shows how the maximum out-of-pocket rates for benchmark plans may change if expanded subsidies expire for one, two and four-person households at various incomes. Estimates were calculated using maximum out-of-pocket rates from KFF published by the IRS, along with 2025 federal poverty level data from the U.S. Department of Health and Human Services for the 48 contiguous states plus D.C. The tool is not intended to calculate an individual’s actual payments. Healthcare.gov and other state marketplaces are the best source for specific premium costs.PHNjcmlwdCB0eXBlPSJ0ZXh0L2phdmFzY3JpcHQiPiFmdW5jdGlvbigpeyJ1c2Ugc3RyaWN0Ijt3aW5kb3cuYWRkRXZlbnRMaXN0ZW5lcigibWVzc2FnZSIsKGZ1bmN0aW9uKGUpe2lmKHZvaWQgMCE9PWUuZGF0YVsiZGF0YXdyYXBwZXItaGVpZ2h0Il0pe3ZhciB0PWRvY3VtZW50LnF1ZXJ5U2VsZWN0b3JBbGwoImlmcmFtZSIpO2Zvcih2YXIgYSBpbiBlLmRhdGFbImRhdGF3cmFwcGVyLWhlaWdodCJdKWZvcih2YXIgcj0wO3I8dC5sZW5ndGg7cisrKXtpZih0W3JdLmNvbnRlbnRXaW5kb3c9PT1lLnNvdXJjZSl0W3JdLnN0eWxlLmhlaWdodD1lLmRhdGFbImRhdGF3cmFwcGVyLWhlaWdodCJdW2FdKyJweCJ9fX0pKX0oKTs8L3NjcmlwdD4=

    WASHINGTON —

    At the core of the government shutdown is a debate about the extension of health insurance subsidies under the Affordable Care Act, first implemented in 2021.

    The shutdown began at the start of the new fiscal year, Oct. 1. In budget negotiations, Democrats were aiming to extend the expanded subsidies, set to expire at the end of 2025, while Republicans have emphasized reopening the government before beginning health care talks.

    If these tax credits expire, it’s estimated that the more than 24 million people enrolled in marketplace plans will pay twice as much out of pocket, according to Jeanne Lambrew, director of health care reform at the Century Foundation. KFF estimated the average premium payment would increase 114% from $888 to $1,904 without expanded subsidies.

    Plus, the impacts could be felt even sooner as open enrollment is set to begin Nov. 1 for people to select health insurance coverage for 2026.

    The ACA, sometimes referred to as “Obamacare,” was designed to make health care affordable and accessible via marketplaces, Lambrew said, who also worked on drafting and implementing the ACA during the Obama administration.

    The goal of the marketplaces were to fill in the gaps, according to Lambrew. It is for people who make too much to qualify for Medicaid, but also for people who don’t have access to affordable insurance through their work.

    Enrollment in the ACA has increased since its passage in 2014, but really climbed in the last five years.

    From 2020 to 2025, enrollment more than doubled as a result of expanded tax credits passed in the American Rescue Plan Act in 2021, which increased the subsidies and lifted a cap that disqualified people making four times the poverty level or more from being eligible for the subsidies.

    Under 2025 guidelines for the 48 contiguous states and Washington, D.C., the federal poverty level is $15,650 for a one-person household. At 400%, it’s $62,600.

    Nearly all states saw an increase in enrollment under the ACA from 2020 to 2025, with 20 states more than doubling in enrollment.

    Six states more than tripled in the number of people enrolled under the ACA — Texas, Mississippi, West Virginia, Louisiana, Georgia and Tennessee.

    States that President Donald Trump won in the 2024 election have the majority of enrollees, according to an analysis from KFF.

    “We know that three out of four enrollees in the health insurance marketplace live in states that voted for President Trump in 2024,” Lambrew said. “So this is not a partisan issue, it’s a nationwide issue, and it affects people in different ways, but the overall effect is significant.”

    Who is impacted?

    The subsidies, also called tax credits, at the center of the shutdown are utilized by about 92% of people enrolled in marketplace plans under the ACA, according to data from the Centers for Medicare & Medicaid Services.

    These expanded credits allow households of different sizes and income levels to be capped with maximum out-of-pocket costs.

    Once the expanded tax credits expire at the end of this year, the out-of-pocket maximums will increase across the board, and people making above four times the poverty level will become ineligible for any tax credits.

    More than 6.7% of those who were enrolled in ACA plans earned more than 400% of the federal poverty level, accounting for 1.6 million people. Once the subsidies expire, these enrollees would no longer qualify for the subsidies under the ACA.

    Also heavily impacted are people approaching retirement age. The age group with the highest enrollment in marketplace plans is ages 55 to 64, data shows.

    KFF estimated in March that about half the enrollees who would lose the tax credit upon expiration are between 50 and 64.

    As people grow closer to retirement age, they may not rely as much on employer-provided insurance before turning 65 and qualifying for Medicaid, according to Lambrew.

    How much would premiums change?

    KFF has estimated the average premium will more than double next year if the expanded subsidies were to expire.

    In addition to the potential ending of the subsidies, insurance rates are projected to rise across marketplace plans and employer-provided insurance.

    “I looked at Medicare history, employer-sponsored insurance history, marketplace history. Without a doubt, this is the highest one-year increase in premiums for people in history,” Lambrew said.

    The Get the Facts Data Team analyzed maximum out-of-pocket rate changes for benchmark plans to find how rates may change.

    A one-person household with an annual income of $25,000 — a little more than 1.5 times the federal poverty level — is estimated to go from paying a maximum $100 out of pocket annually to $1,168.

    They would pay a maximum of less than $98 a month — 10 times more than the previous payment of less than $9 a month.

    Households with an income between 100% and 150% of the federal poverty level made up the largest share of enrollees at almost 45%. Under the expanded subsidies, they aren’t required to pay anything out of pocket for benchmark plans.

    If the tax credits expire, they will pay a maximum between 2.1% and 4.19% of their income annually. At 1.5 times the federal poverty level, a one-person household would be earning $23,475 annually and may have to pay nearly $984 a year.

    The interactive below shows how the maximum out-of-pocket rates for benchmark plans may change if expanded subsidies expire for one, two and four-person households at various incomes. Estimates were calculated using maximum out-of-pocket rates from KFF published by the IRS, along with 2025 federal poverty level data from the U.S. Department of Health and Human Services for the 48 contiguous states plus D.C.

    The tool is not intended to calculate an individual’s actual payments. Healthcare.gov and other state marketplaces are the best source for specific premium costs.

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  • Video: What Happens if Obamacare Subsidies Expire?

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    new video loaded: What Happens if Obamacare Subsidies Expire?

    Consumers are facing greater costs for their 2026 A.C.A. health coverage as Congress continues to debate whether to extend subsidies that help people afford their premiums. Margot Sanger-Katz, a health care policy reporter for The New York Times, explains why.

    By Margot Sanger-Katz, Laura Bult, Claire Hogan, Zach Wood and Stephanie Swart

    October 22, 2025

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    Margot Sanger-Katz, Laura Bult, Claire Hogan, Zach Wood and Stephanie Swart

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  • Most Americans fear rising health care costs, poll finds | Long Island Business News

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    Most U.S. adults are worried about care becoming more expensive, according to a new , as they make decisions about next year’s health coverage and a keeps future health costs in limbo for millions.

    About 6 in 10 Americans are “extremely” or “very” concerned about their health costs going up in the next year, the survey from The Associated Press-NORC Center for Public Affairs Research finds — a worry that extends across age groups and includes people with and without .

    Many Americans have other health care anxieties, too. The poll found that about 4 in 10 Americans are “extremely” or “very” concerned about not being able to pay for health care or medications they need, not being able to access health care when they need it, or losing or not having health insurance.

    beneficiaries are already shopping for next year’s coverage, and open enrollment periods for many other health plans are approaching quickly in November. Federal policies have left millions of people at risk of skyrocketing health insurance premiums or of losing their health insurance altogether. The findings show that many Americans are feeling vulnerable to spiking , with some expressing concerns about whether they’ll have coverage at all.

    Latoya Wilson, an independent nurse consultant in Lafayette, Louisiana, currently uses a health insurance plan from the marketplace. But in the past two weeks, the 46-year-old has applied for more jobs than she had previously in her life, largely because she’s concerned about her premiums going up and wants the stability of employer-sponsored insurance.

    “Even before these health care cuts came into play, I was already having a significant issue getting the care that I needed this year,” she said. “Anything worse than what I already have is pretty scary.”
    Health care remains important to Americans when it’s center stage in Washington

    About 8 in 10 U.S. adults say the issue of health care is “extremely” or “very” important to them personally. That includes about 9 in 10 Democrats and three-quarters of Republicans, and it puts health care next to the economy among Americans’ top issue priorities.

    That significant attention on the issue raises the political stakes in what’s already been a crucial moment for federal health policy in the nation’s capital.

    President Donald Trump’s mega-bill passed this summer cuts more than $1 trillion from federal health care and food assistance over a decade, largely by imposing work requirements on those receiving aid and by shifting certain federal costs onto the states. Republicans say the cuts will prevent people who don’t need aid from gaming the system, but the cuts will ultimately result in millions of people losing health insurance coverage, according to projections from the nonpartisan Congressional Budget Office.

    More urgently, a congressional deadlock over Affordable Care Act subsidies that expire this year has thrown the federal government into a shutdown that’s dragged into a fourth straight week with no end in sight. Democratic lawmakers want any funding bill they sign to extend the subsidies, which have made ACA premiums less expensive for millions of people. Republicans in Congress have expressed willingness to negotiate on the issue, but only after the government is reopened.

    In interviews, some Americans said they doubted government leaders would take the necessary action to address their concerns on health care.

    “It is the federal government’s job to provide a better way of life for its people,” said Caleb Richter, a 30-year-old certified nursing assistant in Belleville, Wisconsin, who identifies as an independent. ”Right now, it just feels like they’re not trying.”

    But the poll reveals a deep ideological divide over what the government’s role should be, with Democrats far more likely than Republicans to say it’s the federal government’s job to make sure all Americans have health coverage. About 8 in 10 Democrats say this, compared with about one-third of Republicans.
    Most US adults disapprove of Trump’s handling of health care, the poll finds

    Health care continues to be a weakness for Trump. Only about 3 in 10 U.S. adults approve of the Republican president’s handling of health care, which hasn’t changed meaningfully since September. Almost all Democrats disapprove of his approach, but so do about 8 in 10 independents and about one-third of Republicans.

    Wilson, a Democrat, said she thinks Trump should be “doing things that affect the good of the group” when it comes to health care, including catering more to working-class Americans.

    But Michelle Truszkowski, a disabled veteran in Sterling Heights, Michigan, who is politically conservative, said she appreciates how Trump is focused on cutting and abuse in the health care system.

    “I like that people who shouldn’t be getting benefits from the government are getting kicked off of them,” the 48-year-old said. “Health care is not a right. It’s a privilege.”
    Democrats trusted more than Republicans on health care, but many trust neither

    About 4 in 10 U.S. adults say they trust the Democrats to do a better job handling health care, compared with about one-quarter who trust the Republicans more. About one-quarter trust neither party, and about 1 in 10 trust both equally.

    Americans are more likely to trust their own party on health care, generally speaking, but 76% of Democrats trust their party more on health care, while only 57% of Republicans have more trust in theirs.

    Independents are especially likely to trust neither party on health care — about half of independents say this. But the remaining independents are more likely to trust the Democrats.

    Richter, in Wisconsin, said he wishes Congress would put more faith and funding into hospital staffers who know how to help patients. He said he’d be fine with paying higher taxes if it meant ensuring health care for people who need it.

    But instead of working toward solutions, he said, federal lawmakers are acting “like a bunch of high school arguing.”

    “My faith that something will get done is very, very low at this point,” Richter said. “It just feels like they don’t really care.”


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  • Florida is one of ‘hardest hit’ states if ACA credits expire

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    As the government shutdown entered its third week, Democrats continued to withhold their support for a government funding bill unless Republicans agree to extend expiring Affordable Care Act marketplace subsidies. 

    A Democratic lawmaker said Florida will be affected by the expiring subsidies more than any other state after the Nov. 1 ACA enrollment start.

    “FL will be HARDEST HIT by Obamacare cuts in the nation on Nov 1st,” U.S. Rep. Darren Soto, D-Fla., wrote Oct. 13 on X. “4.6 Million Floridians will see HUGE healthcare hikes of 75% or more unless Congress fixes it. The clock is ticking!” 

    Soto, who represents Florida’s 9th Congressional District, which includes eastern Orlando and the cities of Kissimmee and St. Cloud, expanded on his point in an Oct. 12 Orlando Sentinel opinion editorial. “The top 10 Obamacare congressional districts are all in the state,” Soto wrote. “Our district has the second-most enrollment in the nation, with 271,000 people receiving the Premium Tax Credits.”

    Without congressional action, the pandemic-era enhanced ACA credits will expire Dec. 31, and researchers estimate premiums around the U.S. will rise by more than 114% on average for enrollees who use the credits, leading to an estimated 3.8 million more people becoming uninsured over the next decade.

    Health care experts said Soto’s Florida warning is on point.

    “Florida might be tied with Texas in the percentage of enrollment increase since the credits have been in place, but it has always had a lot of people signing up for the ACA,” said Cynthia Cox, vice president of the ACA program at KFF, a health care research think tank. “This might be due to demographics and the kinds of jobs residents have, but Florida would definitely be the top, or tied as the top state affected by these cuts.”

    Soto’s office pointed PolitiFact to Congressional Budget Office and KFF estimates for coverage loss and premium increases if the credits expire.

    Sign up for PolitiFact texts

    What will happen in Florida if the enhanced ACA tax credits expire?

    Florida has more people enrolled in Affordable Care Act plans than any state — around 4.7 million in 2025. About 97% of enrollees receive a discount that makes their plans cheaper.

    In 2021, then-President Joe Biden signed legislation that made ACA subsidies more generous, by reducing the maximum amount enrollees would have to pay for coverage and enabling households whose incomes were higher than 400% of the federal poverty level to receive the subsidies. Congress renewed these enhanced subsidies in 2022 through the end of 2025, so they are now poised to expire.

    Determining whether Florida would be the “hardest-hit” state if the enhanced credits expire depends on how that is measured. Data shows Florida as one of the top states, if not the top, for the number of people affected.

    “There are different ways to measure the effects,” Cox said. “For instance, if it’s the steepest premium increases for a smaller number of people, that might be West Virginia or Wyoming.”

    An Oct. 14 Washington Post analysis found that Florida has the highest number of people receiving the enhanced credits, which could result in the state bearing the biggest blow, relative to its population, of residents becoming uninsured or experiencing steep premium increases. The analysis puts Texas second. 

    About 8% of ACA enrollees under 65 nationwide use the enhanced credit; but in Florida, the same share is 24% — the highest in the country, The Washington Post found. 

    That disparity is largely because Florida did not expand Medicaid eligibility, making the ACA the main pathway for people with lower incomes to obtain affordable coverage. Many people with ACA coverage are self-employed or work for a small business.

    About 2.4 million Floridians with ACA Marketplace plans in 2025 earn under 138% of the federal poverty limit. 

    “When states expand Medicaid, anyone who makes below 138% of the federal poverty level is eligible for the program, so they’re not on the ACA marketplaces,” Cox said. “In states that didn’t expand Medicaid, like Florida, Texas and Georgia, residents can get ACA coverage and qualify for the enhanced credits.”

    Another study, by the nonpartisan Urban Institute think tank and the Commonwealth Fund health care research organization, put Texas ahead of Florida for the overall number of people who will not enroll in ACA plans in 2026.

    “In terms of absolute numbers of people becoming uninsured, our tables show Texas being hit harder,” said Jessica Banthin, a senior fellow at the Urban Institute’s health policy division and one of the report’s authors. “But in terms of population share, it’s very likely the case that Florida is being hit harder.”

    A KFF analysis found that, in every Florida congressional district, enrollees over age 60 who make just over 400% of the federal poverty level — about $84,600 for two people — will face premiums in 2026 quadruple what they pay now, on average.

    Overall, lower- and middle-income Floridians will feel the brunt of expired subsidies.

    “Especially an older couple who are early retirees who may still have a moderate income,” Cox said. “They won’t have any other option and may see a premium increase of $20,000 because they aren’t eligible for Medicare yet.”

    Floridians with private employer-based insurance may also see indirect effects.

    “If many more people in Florida become uninsured, then hospitals and other providers will face an increase in patients who can no longer pay their medical bills,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. “These costs are projected to result in service cutbacks, hospital closures and mergers, particularly in rural areas, which affect everyone.”

    Our ruling

    Soto said Florida will be the “hardest hit” state if ACA enhanced subsidies expire.

    Florida has 4.7 million people enrolled in ACA plans in 2025, more than in any other state. One analysis found that 24% of Florida’s enrollees under age 65 use enhanced subsidies, the highest in the country, compared with 8% of enrollees nationally.

    “Hardest hit” can mean many things. In terms of the share of enrollees relative to a state’s population, Florida is safely one of the most affected states, if not the most affected for people who will see premium increases or become uninsured as a result of higher prices. By raw numbers in another analysis, Texas might be first, because it has a bigger population.

    Experts said other states such as West Virginia may face steeper premium hikes, but for a smaller number of people. 

    Soto’s statement is accurate but needs additional information. We rate it Mostly True.

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  • The use of AI in health care is evolving in ways that require regulations, Pa. lawmakers say

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    Pennsylvania lawmakers want to make sure humans are still involved in health care decisions that rely on artificial intelligence. 

    Bipartisan legislation introduced this month in the House of Representatives would require health care providers and insurers to be transparent about how they use artificial intelligence and ensure that humans review all assessments made by AI. Providers and insurers also would be mandated to provide evidence that their uses of AI minimize bias and discrimination prohibited by law. 

    MORE: No matter your age, it’s never too late to reap the benefits of a healthy lifestyle

    AI has a range of applications in health care — from AI chatbots that offer simple care or answer questions about insurance coverage to algorithms that interpret medical images to the filing of visitation notes into patient files.

    But because AI technologies are trained on existing medical records and treatment data, they can perpetuate the biases within them. For instance, an AI program used by several health systems prioritized healthier white patients over sicker Black patients to receive additional care management, Harvard Medical School notes. Rather than training the program on the patients’ care needs, it was trained on cost data. 

    A Rutgers University study also found that AI algorithms can perpetuate false assumptions because they rely on data that can lead to generalizations about people of color. Algorithms struggle to account for social determinants of health, like access to transportation, healthy food costs and work schedules. This may make it harder for patients to follow treatment plans that require frequent doctors visits, exercise and other measures. 

    Rep. Tarik Khan, a nurse practitioner who co-sponsored the bill, said the idea isn’t to remove AI from health care, but to put some guardrails in place. 

    “Something as rich and as dynamic as AI, we have to make sure we’re very deliberate, especially when we’re getting into science, we have to make sure that the computer doesn’t take over,” said Khan, a Democrat from Philadelphia. “We have to make sure that people are weighing in, clinicians are making medical decisions, not the computer.”

    But Khan said a particular concern is insurers’ use of AI in prior authorization — when patients must receive approval from their insurers before undergoing medical procedures. A report from the American Medical Association noted that, in some cases, AI denied prior authorizations at a rate 16 times higher than typical. A 2024 AMA found that 61% of doctors worried that AI use is increasing prior-authorization denials.

    For patients, a denial can mean going into medical debt to get the treatment or deciding not to have it, which Khan said can be life-threatening. Another AMA survey found that 93% of doctors said prior-authorization issues have delayed what they considered to be necessary care, and 29% said those delays caused a serious adverse event resulting in hospitalization, permanent injury or death. 

    “The concern is that insurance companies are having AI do these denials without a human ever reviewing the case and weighing in,” Khan said. “There is a lack of transparency of when it’s happening, how often it’s happening, who’s using it, who’s not using it, and we think that the public has a right to know, especially with something as sensitive as health care, which is very personal for people.”

    Khan said AI can be useful in health care, particularly in analyzing data that allows providers to draw medical conclusions. But he said AI needs human review and patients need to be aware that it is being used, even if it’s just used by insurers to craft letters to patients. To Kahn, it’s important that final decisions are made by someone with medical training, which AI cannot offer.

    Khan said the bill’s regulations will impact the current uses of AI, but he also wants them in place to protect patients as the technology continues to evolve.

    Pennsylvania is one of many states considering legislation that regulates AI. States including Arizona, Maryland and Texas have blocked AI from being the sole decision-maker in prior authorizations. Other states have said AI can’t present itself as a health care provider or added guidance for AI chat bots in mental health treatment.

    “The technology is evolving so rapidly that we have to make sure that we’re thinking of or being on top of scenarios that are changing,” Khan said. “We have to make sure that there are appropriate guardrails.”

    The Pennsylvania bill was introduced by a bipartisan group of state representatives, including Joe Hogan (R-Bucks County) and Greg Scott (D-Montgomery County). The legislation has been referred to the House Communications and Technology Committee, where is will get further review. 

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  • Colorado becomes first state to cap prescription drug prices, starting with Enbrel

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    DENVER — Colorado has become the first state in the nation to implement a prescription drug price cap, targeting Enbrel, an expensive injectable medication used to treat several autoimmune conditions.

    On Friday, the Colorado’s Prescription Drug Affordability Review Board (PDAB) set the cap at $600 for a 50-milligram dose of Enbrel, which adults typically take weekly. Over the course of a year, this amounts to $31,200 — significantly less than what insurance companies and patients have been paying.

    According to 2023 data from the Board, insurance companies paid approximately $53,000 annually for each customer using Enbrel, while patients paid about $4,600 out of pocket each year.

    Since the drug was introduced in 1998, its wholesale price has increased more than 1,500%.

    Denver7

    The cap comes after PDAB deemed the drug Enbrel “unaffordable” in February 2024.

    PDAB was established by the state in 2021 to review prescription drug prices and determine whether certain drugs are unaffordable for Colorado consumers.

    “This is groundbreaking,” said Priya Telang, communications manager at the Colorado Consumer Health Initiative.

    Telang emphasized the bipartisan nature of healthcare affordability concerns.

    “It’s a bipartisan issue,” she told Denver7. “Everyone has issues accessing and affording health care in general, but particularly for prescription drugs. This is just the start of so many consumer savings.”

    However, the price cap has raised concerns among local pharmacies about potential financial impacts.

    Ali DiLorenzo, lead technician at Wheat Ridge Professional Pharmacy, explained the financial burden these expensive medications place on pharmacies.

    “It is a very expensive med. It’s over $7,000,” DiLorenzo said, referring to the monthly cost. “Insurance companies don’t really reimburse you.”

    ALI PHARMACIST.png

    Denver7

    Lead Pharmacy Technician at Wheat Ridge Professional Pharmacy Ali DiLorenzo speaking with Denver7’s Claire Lavezzorio.

    DiLorenzo expressed concern about how the price cap might affect independent pharmacies that are already operating on thin margins.

    “Taking a loss on a quarter of your scripts is not a business,” DiLorenzo said.

    After PDAB deemed the drug Enbrel “unaffordable,” the pharmaceutical company, Amgen, which makes the drug, filed a federal lawsuit to stop the board from pursuing a price cap.

    A federal judge dismissed the case in March 2024, saying Amgen did not have enough to prove this would cause the company harm. Amgen is appealing.

    Now that the price cap has been officially set, more litigation is anticipated.

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  • Trump is freezing billions in funding for a Chicago train project because of ‘race-based contracting’ | Fortune

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    President Donald Trump’s administration will withhold $2.1 billion for Chicago infrastructure projects, the White House budget director said Friday, expanding funding fights that have targeted Democratic areas during the government shutdown.

    The pause affects a long-awaited plan to extend the city’s Red Line train. The money was “put on hold to ensure funding is not flowing via race-based contracting,” budget director Russ Vought wrote on social media.

    Vought made a similar announcement earlier this week involving New York, where he said $18 billion for infrastructure would be paused, including funding for a new rail tunnel under the Hudson River.

    Trump, a Republican, has embraced Vought’s tactics. On Thursday night, he posted a video depicting him as the reaper, wearing a hood and holding a scythe.

    Losing the money would be a significant setback for Chicago’s transportation plans. The Red Line extension is slated to add four train stops on the city’s South Side, improving access for disadvantaged communities.

    In addition, a broader modernization project for the Red and Purple lines, which Vought said was also being targeted, is intended to upgrade stations and remove a bottleneck where different lines intersect.

    In New York’s case, Trump’s Transportation Department said it had been reviewing whether any “unconstitutional practices” were occurring in the two massive infrastructure projects but that the government shutdown, which began Wednesday, had forced it to furlough the staffers conducting the review.

    The suspension of funds for the Hudson River tunnel project and a Second Avenue subway line extension is likely meant to target Senate Democratic leader Chuck Schumer, whom the White House is blaming for the impasse. The New York senator said the funding freeze would harm commuters.

    “Obstructing these projects is stupid and counterproductive because they create tens of thousands of great jobs and are essential for a strong regional and national economy,” Schumer said on X.

    ___

    This story has been corrected to show $18 billion, not $18 million, was held in New York.

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  • Would rural areas be hit twice as hard if subsidies lapse?

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    As Republicans and Democrats careened toward an Oct. 1 government shutdown, the parties clashed over whether to pass a clean extension of federal funding, as Republicans sought, or to extend expiring Affordable Care Act subsidies, as Democrats wanted.

    In an interview on CBS’ “Face the Nation” — aired Sept. 28, three days before government funding was set to run out — Sen. Amy Klobuchar, D-Minn., said that if Republicans failed to extend the expiring subsidies, many Americans would see a big hit in their out-of-pocket health insurance costs. 

    Klobuchar said rural Americans, including farmers, would be hit disproportionately.

    “Republicans have created a health care crisis,” Klobuchar said. “My constituents, Americans, are standing on a cliff right now with these insurance premium increases that are upon them. So, Democrats are united in pushing on this and saying, look, let us do something about this crisis before it is too late — a 75% increase in premiums starting Nov. 1 on people who are small business owners, people who are farmers out there, twice as much in the rural areas.”

    We previously rated the 75% talking point Mostly True. (The group that made that estimate subsequently upped it to 114%.)

    Sign up for PolitiFact texts

    Klobuchar’s “twice as much” comparison can be interpreted in more than one way. By one of those readings — the one her office said she intended, that rural enrollees would see their out-of-pocket costs double — Klobuchar is correct.

    What are enhanced Affordable Care Act subsidies?

    People who use the Affordable Care Act’s marketplaces can buy health insurance from providers at various levels of coverage and varying premium costs. Most purchasers obtain subsidies, as long as they meet the income guidelines. 

    In 2021, then-President Joe Biden signed legislation that made Affordable Care Act subsidies more generous. The law reduced the maximum amount purchasers would have to pay for coverage and enabled subsidies for households with incomes higher than 400% of the federal poverty level. Previously, the subsidies were capped at 400% of the poverty limit for a household. In 2024, that amounted to $60,240 for a one-person household. That figure increases depending on the number of people in the household.

    Congress renewed these enhanced subsidies in 2022 through the end of 2025, so they are now poised to expire.

    The subsidies proved popular. The number of people receiving them increased from 12 million in 2021 to 21.4 million in 2024, according to an analysis of federal data by KFF, a health care think tank.

    Where does the 75% figure come from?

    Using 2024 federal data, KFF calculated the average annual premium for enrollees who received enhanced subsidies. The government paid $5,727 of the total premium under the original Affordable Care Act subsidy rules. Another $888 came out of the beneficiary’s pocket.

    The enhanced subsidy provision covered the final portion, $705. If the enhanced subsidy disappeared and the enrollee had to pay both the $888 and the $705 amounts, that would total $1,593. That’s about 79% more than the same person was paying with the enhanced subsidies in place — close to Klobuchar’s 75% figure.

    On Sept. 30, two days after Klobuchar’s remarks, KFF released a new estimate that showed an even higher out-of-pocket increase of 114%, superseding the group’s previous 79% figure.

    Will the out-of-pocket hit be “twice as much in the rural areas”?

    There are at least two ways to interpret Klobuchar’s statement: that she was comparing rural enrollees’ costs with people living elsewhere, or comparing their costs with what they paid before.

    Klobuchar’s office told PolitiFact that the senator referred to rural enrollees’ out-of-pocket costs doubling compared with what they would pay with a continuation of enhanced subsidies. (That aligns with what Klobuchar has said in other settings.) 

    This is accurate, according to an analysis by the Century Foundation, which describes itself as a “progressive, independent think tank” and which Klobuchar’s office told PolitiFact is the source of her talking point about rural impact,

    The Century Foundation analysis concluded that out-of-pocket insurance costs in rural counties would increase on average from $713 to $1,473 — a 107% increase, or slightly more than a doubling. 

    By contrast, the increase for people in urban counties was 89%.

    But there’s less evidence to support the interpretation some might have drawn from Klobuchar’s statement: that rural enrollees would experience a hit twice as big as enrollees elsewhere. The Century Foundation analysis found that’s not the case.

    In its August analysis, the Century Foundation separated out the impacts of expiring subsidies by several demographic factors, including whether a county is predominantly rural.

    The group found that enrollees in rural counties would, on average, see out-of-pocket increases of $760 from expiring enhanced subsidies, compared with $624 for all counties and $593 for urban counties. That means the rural increase would be 22% larger than the increase for enrollees overall, and 28% larger than the increase for urban enrollees. 

    That amounts to a disproportionately large increase for rural areas, but not twice as much.

    Our ruling

    Klobuchar said people with Affordable Care Act insurance will see a “75% increase in premiums starting Nov. 1,” if enhanced subsidies are not extended, including “people who are farmers out there — twice as much in the rural areas.”

    A KFF analysis found that the disappearance of enhanced subsidies would increase out-of-pocket health care costs by an average of 79%, which is close to 75%. (KFF subsequently raised its estimate to 114%.)

    A Century Foundation analysis found that the increase in out-of-pocket costs for Affordable Care Act insurance wouldn’t be twice as big for rural enrollees, which is one way to interpret Klobuchar’s comment. The rural cost increase would be 22% bigger than for enrollees overall and 28% bigger than for urban enrollees.

    However, the way Klobuchar’s office said she intended the statement — that rural enrollees would pay twice as much out of pocket for their coverage than they did before an expiration of the enhanced subsidies — is accurate, because the study found that costs in rural counties would increase by 107%.

    The statement is accurate but needs additional information, so we rate it Mostly True.

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  • One-third of Gov. Jared Polis’ budget cuts involve Medicaid

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    Almost one-third of the budget cuts and sweeps of unused money that Gov. Jared Polis used to close a $249 million budget hole will come from Medicaid, and providers are trying to figure out how much disruption that will cause for them and their patients.

    H.R. 1, known as the “Big Beautiful Bill,” blew a roughly $783 million hole in the state budget in July, because Colorado’s tax laws automatically adjust to stay in harmony with the federal government’s. The legislature opted to undo some of those changes during a special session in August and gave Polis the authority to fill the rest of the gap.

    About $79.2 million of the $252 million in cuts came from the Colorado Department of Health Care Policy and Financing, which runs Medicaid in the state. The list includes a mix of reductions in the rates paid to people who provide care, unused funds swept from specific programs and plans to review some care types more strictly before paying.

    The largest cut, worth roughly $38.3 million, would roll back most of a 1.6% increase that most providers expected to get this year. Since providers received slightly higher rates in the first months of the fiscal year, it will work out to about a 0.4% increase, which is in line with recent years, the department said.

    Denver Health estimated the rollback would cost the city’s safety-net hospital about $5 million. The health system isn’t planning any layoffs or service reductions, but could cut back on nonessential maintenance and technology updates, CEO Donna Lynne said. As it was, the increase only partially offset growth in costs in recent years, she said.

    “We were already trying to absorb the difference between medical inflation and the 1.6%,” she said. The American Hospital Association estimated hospital costs rose about 5.1% in 2024.

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    Meg Wingerter

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  • Amazon to invest over $1 billion in fulfillment and transportation workers to boost pay, cut health care costs | Fortune

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    Amazon says it’s investing more than a $1 billion to raise wages and lower the cost of health care plans for its U.S. fulfillment and transportation workers.

    The Seattle-based company said Wednesday the average pay is increasing to more than $23 per hour. Some of its most tenured employees will see an increase between $1.10 and $1.90 per hour. Full-time employees, on average, will see their pay increase by $1,600 per year.

    Amazon also said it will lower the cost of its entry health care plan to $5 per week and $5 for co-pays, starting next year. Amazon said that will reduce weekly contributions by 34% and co-pays by 87% for primary care, mental health and most non-specialist visits for employees using the basic plan.

    Amazon has a global workforce of 1.5 million workers.

    Last December, seven Amazon facilities went on strike, an effort by the Teamsters union to pressure the e-commerce company for a labor agreement during a key shopping period.

    That same month, Amazon reached a settlement with the Occupational Safety and Health Administration that requires the online behemoth to adopt corporatewide ergonomic measures at facilities across the country. The agency claimed hazardous working conditions led to serious lower back and other musculoskeletal disorders at Amazon facilities.

    In January 2024, Walmart, the nation’s largest private employer, said that average wages for hourly workers would exceed $18, up from $17.50. The increase was due to Walmart introducing some higher-paying hourly roles in its Auto Care Centers last year, among other changes, the company said.

    Walmart, based in Bentonville, Arkansas, had announced in January 2023 that U.S. workers would get pay raises the following month, increasing starting wages to between $14 and $19 an hour. Starting wages had previously ranged between $12 and $18 an hour, depending on location.

    At Minneapolis-based Target, the starting hourly wage ranges from $15 to $24 for workers employed at stores and distribution centers, depending on the location, company spokesman Brian Harper-Tibaldo said.

    The average hourly wage for a Target store worker is more than $18, he said.

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    Anne D’Innocenzio, The Associated Press

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  • New Yorkers question U.S. readiness for health crises | Long Island Business News

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    THE BLUEPRINT:

    • 44% of New Yorkers say the U.S. is unprepared for future crises.

    • 77% are concerned about such as , while 75% worry about .

    • 67% worry about affording healthcare for themselves and their families.

    • 61% trust government vaccine decisions; fewer trust chronic disease guidance.

    New Yorkers worry about the next crisis, with 44 percent saying they don’t believe the U.S. is prepared. That’s according to the latest Mount Sinai South Nassau “Truth in Medicine” public health poll, which was released Tuesday.

    Among those surveyed, 40 percent said the nation is prepared.

    Still, a large majority worry about infectious diseases, with 77 percent citing measles, 75 percent bird flu and 65 percent the new .

    “It’s not surprising that confidence in whether we are prepared for the next public health crisis has eroded,” Dr. Aaron Glatt, chair of the Department of Medicine and Chief of Infectious Diseases at Mount Sinai South Nassau, said in a news release about the poll’s findings.

    “Science has become politicized and the divisions we see across the country have an impact,” Glatt added. “However, healthcare providers and researchers remain committed to evidence-based study and reporting.”

    The poll surveyed 600 adults on Long Island and New York City. Sponsored by FourLeaf Federal Credit Union, the poll was conducted from July 13-20 over landlines and cell phones.

    Vaccine safety, accessible mental health services and care, addressing childhood obesity, treatment for substance abuse, and reducing reliance on processed foods all play key roles in improving the population’s overall health and wellness, respondents said. The poll also looked at access to and affording coverage.

    Vaccine safety

    “Immunization is key to primary health care and paramount to the prevention and control of infectious disease outbreaks,” Glatt said.

    “ have proven that they are worth the investment to make them and the health insurance costs to cover them, as they are the safest, most effective way to protect the public from many preventable life-threatening diseases,” Glatt added. “I strongly encourage everyone to follow up with their physicians to get the recommended vaccines at the recommended times.”

    Meanwhile, 61 percent said they trust government agencies to make important decisions about vaccines, and 45 percent said they trust government to make important decisions about medical research. Just 38 percent said they trust government recommendations to prevent chronic diseases.

    According to the World Health Organization, vaccines can prevent more than 30 life-threatening diseases and infections, and 3.5 million to 5 million deaths every year, from diseases like diphtheria, tetanus, pertussis (whooping cough), influenza and measles.

    Health insurance

    The poll also looked at access to health insurance.

    The findings come at a time when New York is preparing major changes to its Essential Plan due to $7.5 billion in federal cuts. To preserve coverage for 1.3 million residents, the state said it will overhaul the plan and tighten income eligibility, removing about 450,000 people. The changes are expected to take effect in mid-2026.

    In the poll, 67 percent expressed concern about affording health care for themselves and their family. And 65 percent said they believe government should play a role in ensuring that everyone has access to affordable healthcare.

    Affordable, accessible health insurance is vital to primary care and crisis preparedness, experts say. The American Hospital Association links insurance to lower death rates, better outcomes and higher productivity.

    Just 8 percent of poll respondents were uninsured. Meanwhile, 36 percent had private coverage, 17 percent were insured through the Affordable Care Act and 25 percent had Medicare, Medicaid or both.

    Overall satisfaction is high among insured respondents, with 80 percent satisfied with their coverage and 76 percent satisfied with prescription drug costs.

    Among those without health insurance, 49 percent said it is too expensive, 26 percent said their employer does not offer it, 15 percent said they don’t need it, and 6 percent didn’t know how to get it.

    Affordability of health insurance concerns 67 percent of respondents, many of whom worry about covering healthcare costs for themselves and their families. As a result, 65 percent support government involvement to ensure access to affordable health insurance.

    “No one is immune to injuries or illnesses,” Dr. Adhi Sharma, president of Mount Sinai South Nassau, said in the news release. “Health insurance provides security and peace of mind in the event of a serious illness. It also plays an important role in preventive care.”

    Those needing help with health coverage are encouraged to contact the New York State Department of Health.

     

     


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    Adina Genn

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  • Coloradans can get updated COVID vaccines, but insurance might not cover the shots

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    Anyone 6 months and older who wants a COVID-19 shot in Colorado can now get one, but the vaccine will only be free for those with the right insurance — at least for now.

    Initially, pharmacies couldn’t administer the updated shots in Colorado unless a patient had a prescription. The state allows pharmacists to administer vaccines recommended by the Centers for Disease Control and Prevention’s advisory committee, but not other shots.

    Dr. Ned Calonge, chief medical officer for the state health department, responded by issuing a standing order — essentially, a prescription for every resident – allowing them to get vaccinated at retail pharmacies.

    But that order doesn’t guarantee insurance will cover the shots or that pharmacies will choose to stock them. Last year, fewer than half of people over 65 nationwide received an updated COVID-19 shot, with uptake dropping further in younger age groups, raising questions about whether health care providers will believe demand is high enough to justify buying the vaccine.

    “The standing order provides accessibility. It doesn’t necessarily provide availability,” Calonge said Tuesday.

    The Colorado Division of Insurance issued a draft rule last week that would require state-regulated plans to cover COVID-19 vaccines without out-of-pocket costs for people of any age, assuming the division passes it as written. Insurance cards from state-regulated plans typically have CO-DOI printed in the lower left corner.

    The state’s rule doesn’t apply to federally regulated plans, which account for about 30% of employer-sponsored insurance plans in Colorado, Calonge said. Typically, however, those plans try to offer competitive benefits, since they mostly serve large employers, he said.

    “My hope would be they would want to keep up with other insurers,” he said.

    This isn’t the first time that people on state-regulated plans have had benefits not guaranteed for people with federally regulated insurance.

    Colorado capped the cost of insulin and epinephrine shots to treat severe allergic reactions in state plans, but couldn’t require the same for plans the state doesn’t oversee. In those cases, it offered an “affordability program” requiring manufacturers to supply the medication at a lower cost for people who aren’t covered by the state caps, Medicare or Medicaid.

    At least two Colorado insurers surveyed by The Denver Post said all of their plans will cover COVID-19 vaccines, while others hedged.

    Select Health, which sells Medicare and individual marketplace plans in Colorado, said its plans currently cover COVID-19 vaccines without out-of-pocket costs for everyone. Kaiser Permanente Colorado said in a message to members that it will pay for the shot for anyone 6 months or older.

    Donna Lynne, CEO of Denver Health, said the health system’s insurance arm is waiting on clarification about when it should cover the vaccines. Denver Health Medical Plan offers multiple plan types, some state-regulated and some under federal rules, she said.

    “It’s less of a decision on our part than understanding what the health department and the insurance department are saying,” she said. “You can’t have one insurance company saying they are doing it and one saying they aren’t doing it.”

    Anthem said it considers immunizations “medically necessary” if the American Academy of Pediatrics, American Academy of Family Physicians or the CDC’s vaccine advisory committee has recommended them, but didn’t specify whether it would charge out-of-pocket costs for medically necessary vaccines.

    If those bodies stated that certain people could get a particular vaccine — but not that they should — Anthem would decide about coverage “on an individual basis,” its website said. The other groups have recommended the shots for people over 18 or under 2, with the option for healthy children in between to get a booster if their parents wish.

    The state’s Medicaid program is still waiting for guidance from federal authorities about whose vaccines it can cover, according to the Colorado Department of Health Care Policy and Financing, and Medicare isn’t yet paying for the shots.

    For most of the COVID-19 vaccines’ relatively brief existence, they were free and recommended for everyone 6 months and older. In 2024, the federal government stopped paying for them, which meant uninsured people no longer could be sure they could get the shot without paying.

    Almost all insurance plans still were required to pay for the shots, though, because the CDC’s Advisory Committee on Immunization Practices recommended them.

    In previous years, the committee recommended updated shots within days of the U.S. Food and Drug Administration approving them. In late August, the FDA approved the updated vaccines for people over 65 and those with one of about 30 conditions increasing their risk of severe disease, including asthma, obesity and diabetes.

    Doctors still could prescribe the vaccine “off-label” to healthy people, in the same way that they prescribe adult medications for children when an alternative specifically approved for kids isn’t available.

    This year, however, the committee won’t meet until Thursday, and may not recommend the shots when it does. Secretary of Health and Human Services Robert F. Kennedy Jr. dismissed all of the committee’s members earlier this year and replaced them with new appointees, most of whom oppose COVID-19 vaccines.

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    Meg Wingerter

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  • Health coverage expanding for Americans from November 1

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    The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) have revealed that access to catastrophic health coverage will be expanded from November 1 this year.

    The announcement comes ahead of the projected soar in health insurance premiums for the 2026 plan year, as enhanced tax credits for Affordable Care Act (ACA)-compliant plans are set to expire.

    Newsweek has contacted HHS and CMS via email for comment.

    Why It Matters

    Catastrophic health coverage plans are designed to protect consumers from very high medical costs in the event of serious illness or injury while having lower monthly premiums.

    File photo: a doctor fills out a patient’s medical notes.

    demaerre/Getty Images

    What To Know

    Those who qualify for catastrophic health coverage are those facing “hardship,” such as when “an individual becomes ineligible for taxpayer-subsidized low premiums due to the expiration of these subsidies at the end of this year,” Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, Maryland, told Newsweek.

    Hardships are usually evaluated based on an individual’s projected annual household income, Bai added.

    These hardship exemptions may also recognize circumstances like “homelessness, eviction or foreclosure, natural disasters, bankruptcy, medical debt, or job-based coverage being unaffordable,” Kosali Simon, a professor and associate vice provost for health sciences at Indiana University Bloomington, told Newsweek.

    Previously, those under 30 were eligible for these catastrophe plans, but now those who are no longer eligible for advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSRs) due to their projected annual income being either below 100 percent or above 400 percent of the federal poverty level will be eligible for a hardship exemption and can enroll in catastrophic coverage.

    In a press release, CMS said it also “plans to begin streamlining this process for consumers ineligible for APTC due to income and expand to consumers who are over 250 percent of the [federal poverty level] and are only ineligible for CSRs.”

    The policy likely means it “will become easier as a process and the what qualifies you for an exemption will be broadened,” Simon added.

    The new guidance applies to consumers in Federally-facilitated Exchange (FFE) states and those participating State-based Exchanges (SBEs). States participating in SBEs include: California, Colorado, Connecticut, Georgia, Idaho, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Virginia and Washington. States participating in SBE’s on the Federal platform include: Arkansas, Illinois and Oregon.

    In terms of how effective the policy will be, Mark Pauly, a professor of health care management at Wharton School of the University of Pennsylvania, told Newsweek that “it depends on how strictly the rules are enforced.”

    He said this is “really a string and tape solution to covering people who fall below the income threshold for exchange subsidies.”

    Catastrophic coverage only begins after a very large deductible, meaning it is “really designed for someone who has access to a large amount of financial assets or credit, and could cover about $9,000 in healthcare spending as an individual or $18,000 as a family,” Keith Ericson, professor and department chair of markets, public policy and law at Boston University Questrom School of Business, told Newsweek.

    “This is not an effective strategy for getting low-income Americans access to healthcare because low-income families will have a lot of trouble coming up with an $18,000 deductible,” he added.

    What People Are Saying

    Secretary of HHS Robert F. Kennedy, Jr. said in a statement: “Catastrophic coverage offers affordable health insurance for younger Americans and those facing hardship to have security when they need it most. Expanding access to catastrophic coverage is another step in making health insurance more affordable, building on the progress made since the passage of President Trump’s One Big Beautiful Bill.”

    CMS Administrator Dr. Mehmet Oz said in a statement: “President Trump promised to give Americans real choices in health care, and today we are delivering on that promise. By expanding access to catastrophic plans, we are making sure hardworking people who face unexpected hardships can get affordable coverage that protects them from devastating medical costs. This change reflects our commitment to lowering costs, strengthening program integrity, and ensuring every American has a pathway to coverage that fits their needs without burdening taxpayers.”

    Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, told Newsweek: “This policy expands access to affordable insurance coverage for low-income Americans and represents a paradigm shift in federal insurance regulation, that is, allowing a variety of plans to meet diversified patient needs. Since most non-senior Americans use relatively little healthcare each year, many will find these plans suitable: low monthly premiums combined with the ability to save directly on out-of-pocket costs by choosing low-cost care options and engaging in health-enhancing activities.”

    Kosali Simon, a professor and associate vice provost for health sciences at Indiana University Bloomington, told Newsweek: “This expansion may increase access and reduce the number of completely uninsured people, since catastrophic plans offer lower premiums and protect against worst-case medical bills. However, catastrophic plans do not qualify for subsidies or cost-sharing reductions, and premiums are still going to seem affordable to many. This means they are better suited to protecting against catastrophic costs than meeting the ongoing health needs of middle-income individuals.”

    Keith Ericson, professor and department chair of markets, public policy and law at Boston University Questrom School of Business, also told Newsweek: “This policy might contribute to the destabilization of the health insurance exchange market. Risk adjustment is an important stabilizer for the insurance market. Catastrophic health plans, however, don’t contribute to the standard risk adjustment pool. As a result, if healthier people move into catastrophic plans, leaving the sicker people behind, premiums could rise in the rest of the market. In this case, the policy would harm affordability for the metal tier plans purchased by the typical individual.”

    Coleman Drake, a professor in the Department of Health Policy and Management at the University of Pittsburgh, told Newsweek: “Those that do switch to catastrophic plans will do so because those plans have lower premiums and, in that sense, they will have access to more affordable coverage, though not more protection from healthcare costs nor affordable access to healthcare. Aside from their annual check-ups, enrollees in catastrophic plans have to pay for all of their healthcare until they hit their deductibles. Prior research has shown that when people are faced with large out-of-pocket costs, they broadly cut back on all forms of healthcare, regardless of how important it is for their health. In that sense, I worry that transitioning people to catastrophic coverage will worsen their health.”

    What Happens Next

    Starting from November 1, Americans in FFE states, or those participating in SBEs, can apply for health coverage with financial assistance through HealthCare.gov.

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  • Hochul expands COVID vaccine access at NY pharmacies | Long Island Business News

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    In Port Washington on Friday, State Gov. signed an executive order to allow people to get the at pharmacies without a prescription across the state.

    New Yorkers can “go into a pharmacy, as they’re accustomed to doing, and the pharmacist will now, as a result of this signing, be authorized to administer COVID shots to those who choose to have them,” Hochul told reporters during a visit to Manorhaven Elementary School in Port Washington.

    The executive order was developed to get around newly imposed federal restrictions on vaccine access introduced last week that limited eligibility to those 65 and older, or younger with underlying conditions.

    On Friday, Hochul said that “we’re going to make sure that everyone who has has coverage” to get the COVID vaccine, and added that covers it.

    “Many of the large insurers have said they’ll cover it anyhow, because if you can prevent an illness, isn’t that a lot less expensive to treat in the long run?” Hochul said. “The insurance companies understand how important these are, but we’re going to work through some of the details.”

    Many of those details “can be settled when we come back with more comprehensive legislation in January,” Hochul said. But, she added, “I can’t wait that long. We are in peak COVID season. It’s starting up now. The cases are going up. People need to be aware of this, and this is the time when people should be thinking about getting their shots for themselves and their families if they choose.”

    She said that people have been “conditioned to be able to walk into a pharmacy, and I want to keep the status quo,” and added that she did not think people would take the time to get to a doctor’s office to get a prescription. “I don’t want there to be barriers to their or their family’s health because of an artificial roadblock.”

    Hochul said she and her team are “working around the clock to ensure that whatever Washington does, that we’re prepared to respond, so there’s no gap in coverage for New Yorkers.”


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    Adina Genn

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  • Health insurers to provide $75.6M in rebates

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    BOSTON — More than 350,000 Massachusetts health care consumers will be receiving rebates from several major private health insurers under a state law requiring them to spend a majority of premiums on medical services.

    That’s according to the Healey administration, which recently announced that a review by the state Division of Insurance determined that five of the state’s health insurance carriers had medical loss ratios lower than the required threshold and must return $75.6 million to ratepayers.


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    By Christian M. Wade | Statehouse Reporter

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  • CVS, Walgreens now require prescriptions for COVID vaccines in Colorado

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    People who want to get an updated COVID-19 vaccine at CVS or Walgreens pharmacies in Colorado this fall will need to present a prescription.

    State law allows pharmacists to administer vaccines recommended by the Advisory Committee on Immunization Practices, a group that counsels the director of the Centers for Disease Control and Prevention about who will benefit from which shots.

    In previous years, the committee recommended updated COVID-19 vaccines within days of the U.S. Food and Drug Administration approving them. This year, the committee doesn’t have any meetings scheduled until late September, and may not recommend the shot when it does meet, since Secretary of Health and Human Services Robert F. Kennedy Jr. appointed multiple members with anti-vaccine views after removing all prior appointees in June.

    The lack of a recommendation also means that insurance companies aren’t legally required to pay for the COVID-19 vaccine without out-of-pocket costs. Most private insurers will cover the updated shots this year, though that could change in 2026, according to Reuters.

    Initially, CVS said it couldn’t give the COVID-19 vaccine to anyone in Colorado or 15 other states, because of their ACIP-approval requirement. As of Friday morning, its pharmacies can offer the shots to eligible people who have a prescription, spokeswoman Amy Thibault said.

    As of about 10 a.m. Friday, CVS’s website wouldn’t allow visitors to schedule COVID-19 shots in Colorado.

    Walgreens didn’t respond to questions about its COVID-19 vaccine policy, but its website said patients need a prescription in Colorado. A New York Times reporter found the same in 15 other states.

    The FDA this week recommended the updated shots only for people who are over 65 or have a health condition that puts them at risk for severe disease.

    The listed conditions include:

    • Asthma and other lung diseases
    • Cancer
    • History of stroke or disease in the brain’s blood vessels
    • Chronic kidney disease
    • Liver disease
    • Cystic fibrosis
    • Diabetes (all types)
    • Developmental disabilities, such as Down syndrome
    • Heart problems
    • Mental health conditions, including depression and schizophrenia
    • Dementia
    • Parkinson’s disease
    • Obesity
    • Physical inactivity
    • Current or recent pregnancy
    • Diseases or medications that impair the immune system
    • Smoking

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    Meg Wingerter

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  • Peabody students, residents, can now access free mental health app

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    PEABODY — The city is partnering with a mental health app to support all residents and their families, especially students of Peabody Public Schools.

    Bloom is a mental health and wellness platform that can be accessed on desktop computers and as a mobile app on a smartphone. Developed by Gloucester-based Bloom-Ed Inc., the app provides local resources on topics ranging from mental health, parenting, financial wellness, end of life care and in a special section for teens, support for kids experiencing bullying.


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    By Caroline Enos | Staff Writer

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  • Still no new negotiation sessions planned in trash strike

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    There are still no new negotiation sessions planned as the Teamsters Local 25 strike moves into its 25th day.

    Officials in Peabody, Gloucester, Danvers, Beverly, Canton and Malden also still awaited a decision in their lawsuit against Republic on Thursday afternoon, after filing a joint request for a preliminary injunction last week that would force Republic to carry out all contracted services, if accepted. They appeared in court over the matter Tuesday afternoon.


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    By Caroline Enos | Staff Writer

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  • Legalization Associated With Declines in Prescription Drug Expenditures

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    State-level marijuana legalization is associated with declines in prescription drug spending, according to data published last week in the journal Health Economics.

    Researchers affiliated with Bowling Green State University in Ohio and Illinois State University assessed the impact of marijuana legalization laws on prescription drug expenditures among privately insured working-age adults.

    They identified pronounced declines in prescription drug expenditures among enrollees of small group insurance plans (plans typically sold to employers with fewer than 50 employees).

    “We find that net prescription drug claims in small group insurance markets are reduced by approximately six percent following recreational cannabis legalization,” they determined. “The reduction in claims in the small group market grows stronger in magnitude over time and gains statistical significance during the second full year of legalized cannabis.”

    Investigators did not identify a similar reduction among enrollees in large group insurance plans. Researchers speculated that this null result could be because larger companies typically impose mandatory marijuana testing among their employees.

    “Recreational cannabis laws result in significant relative declines in prescription drug claims that are concentrated in small group insurance markets,” the study’s authors concluded. “The legalization of cannabis offers a potential substitute to traditional prescription drugs and alternative methods for health maintenance.”

    The study’s findings are consistent with those of others concluding that marijuana legalization is associated with lower health care premiums and reduced Medicaid spending.

    Commenting on the data, NORML’s Deputy Director Paul Armentano said: “Cannabis has established efficacy in the treatment of multiple conditions, including chronic pain, and it possesses a safety profile that is either comparable or superior to many prescription medicines, like opioids. As legal access continues to expand, one would expect more patients to integrate cannabis products into their wellness strategies in a manner that reduces their overall disease burden as well as their reliance on traditional prescription medications.”

    The full text of the study, “The effects of medical and recreational cannabis laws on prescription drug claims in commercial group insurance markets,” appears in Health Economics. Additional information on prescription drug substitution is available from the NORML Fact Sheet, ‘Relationship Between Marijuana and Opioids.’

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  • AmeriLife’s Scott Perry Named 2025 Honoree by the Chinese American Insurance Association

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    Recognition celebrates the company’s expanding support of communities and agents that reflect America’s evolving demographics


    CLEARWATER, Fla., April 7, 2025 (Newswire.com)
    –
    AmeriLife Group, LLC (“AmeriLife”), a national organization that develops, markets, and distributes life and health insurance, annuities, and retirement planning solutions, proudly announced today that its Chairman and CEO, Scott R. Perry, was honored by the Chinese American Insurance Association (CAIA) during its annual Lunar New Year Banquet on April 3 in New York City. The event celebrates the achievements and contributions of individuals and organizations that have significantly impacted the insurance industry and its ability to serve the fast-growing Asian American community.

    “On behalf of AmeriLife and our incredible team across the country, I’m honored to be recognized by the CAIA for our efforts to advance the very best that the insurance industry has to offer and better serve consumers and the agents that support them,” said Perry. “We are committed to providing innovative solutions and education that empower consumers to make informed decisions about their health and financial futures. This recognition is a testament to our team’s continued hard work and dedication.”

    “We are thrilled to honor Scott and AmeriLife for their significant contributions to the insurance industry and their dedication to serving the Asian American community,” said CAIA President Vince Vitiello. “Their industry leadership and innovation have set a high standard for excellence, and we look forward to continuing our partnership to advance the goals of our organization.”

    The CAIA was founded to educate Asian American consumers on the importance of insurance and promote professionalism within the agent communities through continuing education credit opportunities while also acting as a bridge between China and the U.S. on best practices in the insurance space.

    AmeriLife is similarly dedicated to serving increasingly diverse agent and client communities nationwide through its robust distribution network. Since 2020, AmeriLife has expanded its network with more than 90 new partners in cities and regions that reflect America’s evolving demographics, such as Philadelphia-based CAIA member Happy Insurance, which works alongside AmeriLife’s The Senior Resource Group (SRG).

    “It’s a privilege to join our colleagues from Happy at this year’s CAIA event to celebrate the important work this industry group is doing to empower the next generation of agents and agencies,” said Shane Sounders, co-founder and principal of The Senior Resource Group. “We believe that it is critically important to continue reaching out to the Chinese American communities, and we take pride in how our partnership with AmeriLife – under Scott’s leadership – has enabled us to stay ahead of the game and deliver on the growing needs of demographic change.”

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    About AmeriLife

    AmeriLife’s strength is its mission: to provide insurance and retirement solutions to help people live longer, healthier lives. In doing so, AmeriLife has become recognized as a leader in developing, marketing, and distributing life and health insurance, annuities, and retirement planning solutions to enhance the lives of pre-retirees and retirees across the United States. For over 50 years, AmeriLife has partnered with top insurance carriers to provide value and quality to customers through a distribution network of over 300,000 insurance agents, financial professionals, and over 160 marketing organizations and insurance agency locations nationwide. For more information, visit AmeriLife.com and follow AmeriLife on Facebook and LinkedIn.

    Source: AmeriLife

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