The head of the Food and Drug Administration on Thursday praised a plan announced by the White House earlier this week that President Trump said is designed to lower the cost of prescription drugs, calling it a “major step” toward making medication more affordable for Americans.
On Tuesday, the president announced that drug giant Pfizer had agreed to be part of a new direct-to-consumer government purchasing platform known as TrumpRx, that, according to Pfizer, will allow “American patients to purchase medicines from Pfizer at a significant discount.”
The president said that Pfizer had “agreed to offer countless prescription medications at major discounts in the United States.”
Pfizer is the first of many drug makers the president claimed has agreed to offer steep drug discounts to all Americans through TrumpRx, in line with the lowest prices paid by Europeans.
“We’ve seen this disparity for a long time, and we know it has not been sustainable,” FDA Commissioner Dr. Marty Makary told CBS News in an interview Thursday.
The president also said that Pfizer had agreed to lower the cost of the prescription medications that it provides to Medicaid recipients.
“Pfizer is committing to offer all of their prescription medications to Medicaid, and it will be at the most-favored nations prices,” Mr. Trump said.
Makary argues the Trump administration’s agreement with Pfizer will help in addressing health care costs across the board.
“By reigning in egregious drug prices, we’re actually addressing the larger issue of healthcare costs in the United States, which is something no one has really be able to get a handle on until now,” Makary said.
According to Pfizer, TrumpRx will provide savings up to 85% for certain medications, such as Duavee, a drug that treats menopause symptoms.
Duavee’s sticker price is $203 per month, but according to Pfizer, on TrumpRx, it will cost $30 per month. Xeljanz, a Pfizer medication for arthritis, currently costs $6,000 out-of-pocket per month, but on TrumpRx, it will cost about $3,600.
“This is a major, major step, and we have to do it,” Makary told CBS News when asked if, even with the discounts, the drugs will still be unaffordable for many Americans.
The Trump administration said the TrumpRx website will launch next year, but Makarty did not have specific timing.
Makary believes that patients with health insurance who are still unable to afford certain medications will still be helped by TrumpRx.
“I think it’s going to help them significantly,” Makary said. “You’re going to see a series of announcements by different pharmaceutical companies. This has been the No. 1 health priority in this administration.”
Sarah Wisniewski, a Maryland resident in her mid-40s, has been living with multiple sclerosis since 2018. Although she she says she has good insurance, it has repeatedly failed to cover the specialty medication her doctor prescribed to slow the progression of her disease. In 2024, when her physician recommended a treatment that could help, she says her insurance company denied coverage three times. She was only approved after the Maryland attorney general intervened.
When CBS News asked Makarty about Wisniewski, he explained, “I’ve seen that story throughout my career as a cancer surgeon, and it’s tragic, and we’ve seen nothing on drug prices for the last 50 years.”
More than 90% of Americans have some form of health insurance, yet many still struggle to afford critical medications. Wisniewski told CBS News she is skeptical about the new TrumpRx program.
“If big pharma isn’t required to put their drugs on this market, and if they’re not forced to lower prices, then this feels like a toothless, symbolic statement, as opposed to having any real, long-term impact on the lives of the clinically ill,” she said.
She also questioned how the administration plans to pressure pharmaceutical companies to list the most urgently needed medications on the platform. Even at 50% to 80% cheaper, she said, some of these drugs remain unaffordable.
Makary told CBS News that this is just the beginning of the solution:
“Each year, we throw good money after bad into a broken system where we pay more and more for drugs,” Makary said. “This is the first time we’re seeing a major reset — cutting the price of some drugs, not all, but some, by 50% to 80%.”
Stacie Dusetzina, a prescription medication industry expert and a health policy professor at the Vanderbilt University Medical Center, says the president’s plan will not lower most Americans’ out-of-pocket costs for medications. “The reality of who can actually benefit by paying cash for these drugs through this website, it’s probably going to be a smaller number of people than what is being promoted,” Dusetzina said.
Sean Sullivan, a health economist at the University of Washington, also previously expressed doubts to CBS News about how much the program would help Americans save.
“Most patients have drug coverage…Very few are going to buy medications with cash, unless the drug is not a covered benefit, like weight loss or erectile dysfunction drugs,” he said.
Nikki Battiste is a CBS News national correspondent based in New York. She is an Emmy and Peabody-award winning journalist, and her reporting appears across all CBS News broadcasts and platforms.
As the U.S. headed for a government shutdown, Republicans repeatedly accused Democrats of forcing the closure because they want to give health care access to immigrants in the U.S. illegally.
“Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of healthcare benefits to illegal aliens,” Vice President JD Vance said Sept. 28 on “Fox News Sunday.”
President Donald Trump, House Speaker Mike Johnson and Republican members of Congress have repeated this line.
It’s wrong.
Democrats have refused to vote for Republicans’ resolution to extend the federal spending deadline, and their position does, in part, hinge on health care spending. Democrats want to extend pandemic-era Affordable Care Act subsidies that are set to expire at the end of the year and roll back Medicaid cuts in the tax and spending bill that Trump signed into law this summer.
Sign up for PolitiFact texts
The Democrats’ proposal wouldn’t give health care to immigrants illegally in the U.S. — they are already largely ineligible for federally funded health care. Instead, the proposal would restore access to certain health care programs for legal immigrants who will lose access under the Republican law.
The White House did not respond to PolitiFact’s request for comment for this fact-check. Vance addressed criticism of his talking point in another interview by saying it was included in the Democrats’ spending proposal; it’s not.
A White House X account followed up with screenshots of the Democratic proposal repealing a section of the Republican law labeled “alien Medicaid eligibility.” It’s important to know that these changes would not give Medicaid access to immigrants illegally in the U.S.
IMAGE 1: Straight from Democrat proposal
IMAGE 2: OBBB Table of Contents (Title VII, Subsection B repealed in Democrat proposal)
Vance defended his statement again in an Oct. 1 White House press conference, saying former President Joe Biden “waived away illegal immigration status” that helped migrants access federal assistance. It’s important to note that many people granted lawful status through humanitarian parole or Temporary Protected Status programs don’t automatically qualify for Medicaid; TPS recipients aren’t eligible, and many people who entered the U.S. on humanitarian parole are required to wait five years before accessing it.
The Trump administration has ended humanitarian parole and Temporary Protected Status for many people, rendering them ineligible for Medicaid and the Affordable Care Act marketplace.
We did not find evidence that Democrats want to spend “hundreds of billions” in costs for insuring migrants with unlawful presence.
Immigrants in the U.S. illegally are ineligible for federally funded health care
The vast majority of federal health care dollars cannot be spent on health care for people in the U.S. illegally. They cannot enroll in Medicaid or Medicare, and they are ineligible to purchase health care coverage through the Affordable Care Act marketplace. A small Medicaid program reimburses hospitals for uninsured emergency care, which can include immigrants in the country illegally but is not exclusive to them.
Some states including California and Illinois expanded Medicaid coverage for people regardless of their immigration status, and the states pay for that. Federal law already banned states from using federal money for these programs. An earlier version of the Republican spending law would have penalized such states by withholding funding, but that provision didn’t last.
People in the country illegally might receive some federally funded health care in emergency cases; in those situations, hospitals must provide care even if a person is uninsured or in the country illegally. Emergency Medicaid covers hospital care for immigrants who would be eligible for Medicaid if not for their immigration status. The Republican tax and spending law reduced the amount hospitals can receive for emergency immigrant care.
Most of the Emergency Medicaid spending is used on childbirth. In all, it represented less than 1% of total Medicaid spending in fiscal year 2023, according to KFF, a health think tank.
Republican law limited health care access for immigrants with legal status
The Republican tax and spending law made several changes to health care eligibility for immigrants in the country with legal permission. An estimated 1.4 million legal immigrants are expected to lose their health insurance, according to KFF’s analysis of Congressional Budget Office projections.
Starting October 2026, the law will restrict eligibility for Medicaid and the Children’s Health Insurance Program to lawfully permanent residents, people from the Marshall Islands, Micronesia or Palau who lawfully reside in the U.S. under an international agreement, and certain Cubans and Haitians.
Previously, a broad group described as “qualified noncitizens” were eligible for Medicaid and CHIP, including refugees and people granted asylum.
Some immigrants who are eligible for Medicaid and CHIP, such as lawful permanent residents, are required to wait five years before accessing the benefits.
The law also limited Affordable Care Act marketplace eligibility to the same group eligible for Medicaid and CHIP beginning Jan. 1, 2027. Previously, people who were described as “lawfully present” were eligible. That group included the “qualified noncitizens” eligible for Medicaid and people with short-term statuses, such as Temporary Protected Status or international students.
Beneficiaries of the Deferred Action for Childhood Arrivals program, known as DACA, for immigrants who entered the U.S. illegally as children were previously eligible for Affordable Care Act coverage and its subsidies. They are ineligible after an August Trump administration rule.
Democrats’ proposal would restore legal immigrants’ access to federally funded health care
The Democrats’ Sept. 17 budget proposal would, in part, permanently extend the Affordable Care Act subsidies and roll back billions in Republican cuts to Medicaid and other health programs.
The change would make Medicaid, CHIP and Affordable Care Act coverage available to all legal immigrants who were previously eligible for it, such as refugees and people granted asylum.
The Democratic proposal would not broaden eligibility to federally funded health care programs to immigrants who are in the U.S. illegally.
Vance said the Democratic policies would “give hundreds of billions of dollars of health care benefits to illegal aliens,” and the White House did not offer its source for that figure. When Johnson was pressed to support a similar talking point, he referenced the Congressional Budget Office. An August KFF analysis of CBO estimates found that the Republican law’s provisions related to legal immigrants would reduce federal spending by $131 billion; this projection did not include an estimate for people without legal status.
Our ruling
Vance said, “Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of health care benefits to illegal aliens.”
Immigrants in the U.S. illegally are largely ineligible for federally funded health care programs Medicare and Medicaid, and they cannot seek coverage in the Affordable Care Act marketplace or apply for subsidies.
The Democrats’ budget proposal would not change that.
The Democrats want to restore access to certain health care programs to legal immigrants who will lose access under the Republican tax and spending law — among other measures aimed at making Medicaid and Affordable Care Act insurance plans easier to keep.
Their proposal would not grant federally supported health care benefits to people in the U.S. illegally, because they did not have access to them in the first place. The small amount of funding designated for Emergency Medicaid reimburses hospitals that provide emergency care to immigrants who would be eligible for Medicaid if not for their immigration status. Finally, we did not find evidence for Vance’s assertion that Democrats want “hundreds of billions” in health benefits for migrants in the country illegally.
Plunged into a government shutdown, the U.S. is confronting a fresh cycle of uncertainty after President Donald Trump and Congress failed to strike an agreement to keep government programs and services running by Wednesday’s deadline.What we know: The Senate voted down two short-term spending bills on Tuesday: one Democratic proposal and one Republican proposal that passed in the House.The Senate has adjourned until Wednesday morning. The House is not in session this week.Senate Democrats are demanding that health care subsidies and Medicaid cuts be addressed before passing a funding bill.Thousands of federal workers are facing furloughs or layoffs.This is the first government shutdown in nearly seven years. Roughly 750,000 federal workers are expected to be furloughed, some potentially fired by the Trump administration. Many offices will be shuttered, perhaps permanently, as Trump vows to “do things that are irreversible, that are bad” as retribution. His deportation agenda is expected to run full speed ahead, while education, environmental and other services sputter. The economic fallout is expected to ripple nationwide.”We don’t want it to shut down,” Trump said at the White House before the midnight deadline.But the president, who met privately with congressional leadership this week, appeared unable to negotiate any deal between Democrats and Republicans to prevent that outcome.This is the third time Trump has presided over a federal funding lapse, the first since his return to the White House this year, in a remarkable record that underscores the polarizing divide over budget priorities and a political climate that rewards hardline positions rather than more traditional compromises.Plenty of blame being thrown aroundThe Democrats picked this fight, which was unusual for the party that prefers to keep government running, but their voters are eager to challenge the president’s second-term agenda. Democrats are demanding funding for health care subsidies that are expiring for millions of people under the Affordable Care Act, spiking the costs of insurance premiums nationwide.Republicans have refused to negotiate for now and have encouraged Trump to steer clear of any talks. After the White House meeting, the president posted a cartoonish fake video mocking the Democratic leadership that was widely viewed as unserious and racist.What neither side has devised is an easy offramp to prevent what could become a protracted closure. The ramifications are certain to spread beyond the political arena, upending the lives of Americans who rely on the government for benefit payments, work contracts and the various services being thrown into turmoil.”What the government spends money on is a demonstration of our country’s priorities,” said Rachel Snyderman, a former White House budget official who is the managing director of economic policy at the Bipartisan Policy Center, a think tank in Washington.Shutdowns, she said, “only inflict economic cost, fear and confusion across the country.” Economic fallout expected to ripple nationwideAn economic jolt could be felt in a matter of days. The government is expected Friday to produce its monthly jobs report, which may or may not be delivered.While the financial markets have generally “shrugged” during past shutdowns, according to a Goldman Sachs analysis, this one could be different partly because there are no signs of broader negotiations.”There are also few good analogies to this week’s potential shutdown,” the analysis said.Across the government, preparations have been underway. Trump’s Office of Management and Budget, headed by Russ Vought, directed agencies to execute plans for not just furloughs, as are typical during a federal funding lapse, but mass firings of federal workers. It’s part of the Trump administration’s mission, including its Department of Government Efficiency, to shrink the federal government.What’s staying open and shutting downThe Medicare and Medicaid health care programs are expected to continue, though staffing shortages could mean delays for some services. The Pentagon would still function. And most employees will stay on the job at the Department of Homeland Security.But Trump has warned that the administration could focus on programs that are important to Democrats, “cutting vast numbers of people out, cutting things that they like, cutting programs that they like.”As agencies sort out which workers are essential, or not, Smithsonian museums are expected to stay open at least until Monday. A group of former national park superintendents urged the Trump administration to close the parks to visitors, arguing that poorly staffed parks in a shutdown are a danger to the public and put park resources at risk.Video below: House Speaker rejects Democrats’ calls for health care negotiations as government shuts downNo easy exit as health care costs soarAhead of Wednesday’s start of the fiscal year, House Republicans had approved a temporary funding bill, over opposition from Democrats, to keep government running into mid-November while broader negotiations continue.But that bill has failed repeatedly in the Senate, including late Tuesday. It takes a 60-vote threshold for approval, which requires cooperation between the two parties. A Democratic bill also failed. With a 53-47 GOP majority, Democrats are leveraging their votes to demand negotiation.Senate Majority Leader John Thune has said Republicans are happy to discuss the health care issue with Democrats — but not as part of talks to keep the government open. More votes are expected Wednesday.The standoff is a political test for Senate Democratic leader Chuck Schumer, who has drawn scorn from a restive base of left-flank voters pushing the party to hold firm in its demands for health care funding.”Americans are hurting with higher costs,” Schumer said after the failed vote Tuesday.House Speaker Mike Johnson sent lawmakers home nearly two weeks ago after having passed the GOP bill, blaming Democrats for the shutdown.”They want to fight Trump,” Johnson said Tuesday on CNBC. “A lot of good people are going to be hurt because of this.”Trump, during his meeting with the congressional leaders, expressed surprise at the scope of the rising costs of health care, but Democrats left with no path toward talks.During Trump’s first term, the nation endured its longest-ever shutdown, 35 days, over his demands for funds Congress refused to provide to build his promised U.S.-Mexico border wall.In 2013, the government shut down for 16 days during the Obama presidency over GOP demands to repeal and replace the Affordable Care Act, also known as Obamacare. Other closures date back decades. ___Associated Press writers Matt Brown, Joey Cappelletti, Will Weissert, Fatima Hussein and other AP reporters nationwide contributed to this report.
Plunged into a government shutdown, the U.S. is confronting a fresh cycle of uncertainty after President Donald Trump and Congress failed to strike an agreement to keep government programs and services running by Wednesday’s deadline.
What we know:
The Senate voted down two short-term spending bills on Tuesday: one Democratic proposal and one Republican proposal that passed in the House.
The Senate has adjourned until Wednesday morning. The House is not in session this week.
Senate Democrats are demanding that health care subsidies and Medicaid cuts be addressed before passing a funding bill.
Thousands of federal workers are facing furloughs or layoffs.
This is the first government shutdown in nearly seven years.
Roughly 750,000 federal workers are expected to be furloughed, some potentially fired by the Trump administration. Many offices will be shuttered, perhaps permanently, as Trump vows to “do things that are irreversible, that are bad” as retribution. His deportation agenda is expected to run full speed ahead, while education, environmental and other services sputter. The economic fallout is expected to ripple nationwide.
“We don’t want it to shut down,” Trump said at the White House before the midnight deadline.
But the president, who met privately with congressional leadership this week, appeared unable to negotiate any deal between Democrats and Republicans to prevent that outcome.
This is the third time Trump has presided over a federal funding lapse, the first since his return to the White House this year, in a remarkable record that underscores the polarizing divide over budget priorities and a political climate that rewards hardline positions rather than more traditional compromises.
Plenty of blame being thrown around
The Democrats picked this fight, which was unusual for the party that prefers to keep government running, but their voters are eager to challenge the president’s second-term agenda. Democrats are demanding funding for health care subsidies that are expiring for millions of people under the Affordable Care Act, spiking the costs of insurance premiums nationwide.
Republicans have refused to negotiate for now and have encouraged Trump to steer clear of any talks. After the White House meeting, the president posted a cartoonish fake video mocking the Democratic leadership that was widely viewed as unserious and racist.
What neither side has devised is an easy offramp to prevent what could become a protracted closure. The ramifications are certain to spread beyond the political arena, upending the lives of Americans who rely on the government for benefit payments, work contracts and the various services being thrown into turmoil.
“What the government spends money on is a demonstration of our country’s priorities,” said Rachel Snyderman, a former White House budget official who is the managing director of economic policy at the Bipartisan Policy Center, a think tank in Washington.
Shutdowns, she said, “only inflict economic cost, fear and confusion across the country.”
Economic fallout expected to ripple nationwide
An economic jolt could be felt in a matter of days. The government is expected Friday to produce its monthly jobs report, which may or may not be delivered.
While the financial markets have generally “shrugged” during past shutdowns, according to a Goldman Sachs analysis, this one could be different partly because there are no signs of broader negotiations.
“There are also few good analogies to this week’s potential shutdown,” the analysis said.
Across the government, preparations have been underway. Trump’s Office of Management and Budget, headed by Russ Vought, directed agencies to execute plans for not just furloughs, as are typical during a federal funding lapse, but mass firings of federal workers. It’s part of the Trump administration’s mission, including its Department of Government Efficiency, to shrink the federal government.
What’s staying open and shutting down
The Medicare and Medicaid health care programs are expected to continue, though staffing shortages could mean delays for some services. The Pentagon would still function. And most employees will stay on the job at the Department of Homeland Security.
But Trump has warned that the administration could focus on programs that are important to Democrats, “cutting vast numbers of people out, cutting things that they like, cutting programs that they like.”
As agencies sort out which workers are essential, or not, Smithsonian museums are expected to stay open at least until Monday. A group of former national park superintendents urged the Trump administration to close the parks to visitors, arguing that poorly staffed parks in a shutdown are a danger to the public and put park resources at risk.
Video below: House Speaker rejects Democrats’ calls for health care negotiations as government shuts down
No easy exit as health care costs soar
Ahead of Wednesday’s start of the fiscal year, House Republicans had approved a temporary funding bill, over opposition from Democrats, to keep government running into mid-November while broader negotiations continue.
But that bill has failed repeatedly in the Senate, including late Tuesday. It takes a 60-vote threshold for approval, which requires cooperation between the two parties. A Democratic bill also failed. With a 53-47 GOP majority, Democrats are leveraging their votes to demand negotiation.
Senate Majority Leader John Thune has said Republicans are happy to discuss the health care issue with Democrats — but not as part of talks to keep the government open. More votes are expected Wednesday.
The standoff is a political test for Senate Democratic leader Chuck Schumer, who has drawn scorn from a restive base of left-flank voters pushing the party to hold firm in its demands for health care funding.
“Americans are hurting with higher costs,” Schumer said after the failed vote Tuesday.
House Speaker Mike Johnson sent lawmakers home nearly two weeks ago after having passed the GOP bill, blaming Democrats for the shutdown.
“They want to fight Trump,” Johnson said Tuesday on CNBC. “A lot of good people are going to be hurt because of this.”
Trump, during his meeting with the congressional leaders, expressed surprise at the scope of the rising costs of health care, but Democrats left with no path toward talks.
During Trump’s first term, the nation endured its longest-ever shutdown, 35 days, over his demands for funds Congress refused to provide to build his promised U.S.-Mexico border wall.
In 2013, the government shut down for 16 days during the Obama presidency over GOP demands to repeal and replace the Affordable Care Act, also known as Obamacare. Other closures date back decades.
___
Associated Press writers Matt Brown, Joey Cappelletti, Will Weissert, Fatima Hussein and other AP reporters nationwide contributed to this report.
Senate Democrats have voted down a Republican bill to keep funding the government, putting it on a near-certain path to a shutdown after midnight Wednesday for the first time in nearly seven years.What we know: The Senate voted down two short-term spending bills — one Democratic proposal and one Republican proposal.The Senate has adjourned until tomorrow morning, all but guaranteeing the government will shut down.Senate Democrats are demanding that health care subsidies and Medicaid cuts be addressed before passing a funding bill.Thousands of federal workers face furloughs or layoffs if the government shuts down at midnight Wednesday.There are fewer than 2 hours before the government shuts down for the first time in nearly seven years. The Senate rejected the legislation as Democrats are making good on their threat to close the government if President Donald Trump and Republicans won’t accede to their health care demands. The 55-45 vote on a bill to extend federal funding for seven weeks fell short of the 60 needed to end a filibuster and pass the legislation.Senate Democratic Leader Chuck Schumer, D-N.Y., said Republicans are trying to “bully” Democrats by refusing to negotiate on an extension of expanded Affordable Care Act tax credits that expire at the end of the year.”We hope they sit down with us and talk,” Schumer said after the vote. “Otherwise, it’s the Republicans will be driving us straight towards a shutdown tonight at midnight. The American people will blame them for bringing the federal government to a halt.”The failure of Congress to keep the government open means that hundreds of thousands of federal workers could be furloughed or laid off. After the vote, the White House’s Office of Management and Budget issued a memo saying “affected agencies should now execute their plans for an orderly shutdown.”Threatening retribution to Democrats, Trump said Tuesday that a shutdown could include “cutting vast numbers of people out, cutting things that they like, cutting programs that they like.”Trump and his fellow Republicans said they won’t entertain any changes to the legislation, arguing that it’s a stripped-down, “clean” bill that should be noncontroversial. Senate Majority Leader John Thune said “we can reopen it tomorrow” if enough Democrats break party lines.The last shutdown was in Trump’s first term, from December 2018 to January 2019, when he demanded that Congress give him money for his U.S.-Mexico border wall. Trump retreated after 35 days — the longest shutdown ever — amid intensifying airport delays and missed paydays for federal workers. Democrats take a stand against Trump, with exceptionsWhile partisan stalemates over government spending are a frequent occurrence in Washington, the current impasse comes as Democrats see a rare opportunity to use their leverage to achieve policy goals and as their base voters are spoiling for a fight with Trump. Republicans who hold a 53-47 majority in the Senate needed at least eight votes from Democrats after Republican Sen. Rand Paul of Kentucky opposed the bill.Democratic Sens. John Fetterman of Pennsylvania and Catherine Cortez Masto of Nevada and Independent Sen. Angus King of Maine voted with Republicans to keep the government open — giving Republicans hope that there might be five more who will eventually come around and help end a shutdown.After the vote, King warned against “permanent damage” as Trump and his administration have threatened mass layoffs.”Instead of fighting Trump we’re actually empowering him, which is what finally drove my decision,” King said.Thune predicted Democratic support for the GOP bill will increase “when they realize that this is playing a losing hand.”Shutdown preparations beginThe stakes are huge for federal workers across the country as the White House told agencies last week that they should consider “a reduction in force” for many federal programs if the government shuts down. That means that workers who are not deemed essential could be fired instead of just furloughed.Either way, most would not get paid. The nonpartisan Congressional Budget Office estimated in a letter to Iowa Sen. Joni Ernst on Tuesday that around 750,000 federal workers could be furloughed each day once a shutdown begins.Federal agencies were already preparing. On the home page of the Department of Housing and Urban Development, a large pop up ad reads, “The Radical Left are going to shut down the government and inflict massive pain on the American people.”Democrats’ health care asksDemocrats want to negotiate an extension of the health subsidies immediately as people are beginning to receive notices of premium increases for the next year. Millions of people who purchase health insurance through the Affordable Care Act could face higher costs as expanded subsidies first put in place during the COVID-19 pandemic expire.Democrats have also demanded that Republicans reverse the Medicaid cuts that were enacted as a part of Trump’s “big, beautiful bill” this summer and for the White House to promise it will not move to rescind spending passed by Congress.”We are not going to support a partisan Republican spending bill that continues to gut the health care of everyday Americans,” House Democratic Leader Hakeem Jeffries said.Thune pressed Democrats to vote for the funding bill and take up the debate on tax credits later. Some Republicans are open to extending the tax credits, but many are strongly opposed to it.In rare, pointed back-and-forth with Schumer on the Senate floor Tuesday morning, Thune said Republicans “are happy to fix the ACA issue” and have offered to negotiate with Democrats — if they will vote to keep the government open until Nov. 21.A critical, and unusual, vote for DemocratsDemocrats are in an uncomfortable position for a party that has long denounced shutdowns as pointless and destructive, and it’s unclear how or when a shutdown will end. But party activists and lawmakers have argued that Democrats need to do something to stand up to Trump.”The level of appeasement that Trump demands never ends,” said Sen. Peter Welch, D-Vt. “We’ve seen that with universities, with law firms, with prosecutors. So is there a point where you just have to stand up to him? I think there is.”Some groups called for Schumer’s resignation in March after he and nine other Democrats voted to break a filibuster and allow a Republican-led funding bill to advance to a final vote.Schumer said then that he voted to keep the government open because a shutdown would have made things worse as Trump’s administration was slashing government jobs. He says things have now changed, including the passage this summer of the massive GOP tax cut bill that reduced Medicaid.Trump’s role in negotiationsA bipartisan meeting at the White House on Monday was Trump’s first with all four leaders in Congress since retaking the White House for his second term. Schumer said the group “had candid, frank discussions” about health care.But Trump did not appear to be ready for serious talks. Hours later, he posted a fake video of Schumer and House Democratic Leader Hakeem Jeffries taken from footage of their real press conference outside of the White House after the meeting. In the altered video, a voiceover that sounds like Schumer’s voice makes fun of Democrats and Jeffries stands beside him with a cartoon sombrero and mustache. Mexican music plays in the background.At a news conference on the Capitol steps Tuesday morning, Jeffries said it was a “racist and fake AI video.”Schumer said that less than a day before a shutdown, Trump was trolling on the internet “like a 10-year-old.””It’s only the president who can do this,” Schumer said. “We know he runs the show here.”___Associated Press writers Seung Min Kim, Kevin Freking, Matthew Brown, Darlene Superville and Joey Cappelletti in Washington contributed to this report.
Senate Democrats have voted down a Republican bill to keep funding the government, putting it on a near-certain path to a shutdown after midnight Wednesday for the first time in nearly seven years.
What we know:
The Senate voted down two short-term spending bills — one Democratic proposal and one Republican proposal.
The Senate has adjourned until tomorrow morning, all but guaranteeing the government will shut down.
Senate Democrats are demanding that health care subsidies and Medicaid cuts be addressed before passing a funding bill.
Thousands of federal workers face furloughs or layoffs if the government shuts down at midnight Wednesday.
There are fewer than 2 hours before the government shuts down for the first time in nearly seven years.
The Senate rejected the legislation as Democrats are making good on their threat to close the government if President Donald Trump and Republicans won’t accede to their health care demands. The 55-45 vote on a bill to extend federal funding for seven weeks fell short of the 60 needed to end a filibuster and pass the legislation.
Senate Democratic Leader Chuck Schumer, D-N.Y., said Republicans are trying to “bully” Democrats by refusing to negotiate on an extension of expanded Affordable Care Act tax credits that expire at the end of the year.
“We hope they sit down with us and talk,” Schumer said after the vote. “Otherwise, it’s the Republicans will be driving us straight towards a shutdown tonight at midnight. The American people will blame them for bringing the federal government to a halt.”
The failure of Congress to keep the government open means that hundreds of thousands of federal workers could be furloughed or laid off. After the vote, the White House’s Office of Management and Budget issued a memo saying “affected agencies should now execute their plans for an orderly shutdown.”
Threatening retribution to Democrats, Trump said Tuesday that a shutdown could include “cutting vast numbers of people out, cutting things that they like, cutting programs that they like.”
Trump and his fellow Republicans said they won’t entertain any changes to the legislation, arguing that it’s a stripped-down, “clean” bill that should be noncontroversial. Senate Majority Leader John Thune said “we can reopen it tomorrow” if enough Democrats break party lines.
The last shutdown was in Trump’s first term, from December 2018 to January 2019, when he demanded that Congress give him money for his U.S.-Mexico border wall. Trump retreated after 35 days — the longest shutdown ever — amid intensifying airport delays and missed paydays for federal workers.
Democrats take a stand against Trump, with exceptions
While partisan stalemates over government spending are a frequent occurrence in Washington, the current impasse comes as Democrats see a rare opportunity to use their leverage to achieve policy goals and as their base voters are spoiling for a fight with Trump. Republicans who hold a 53-47 majority in the Senate needed at least eight votes from Democrats after Republican Sen. Rand Paul of Kentucky opposed the bill.
Democratic Sens. John Fetterman of Pennsylvania and Catherine Cortez Masto of Nevada and Independent Sen. Angus King of Maine voted with Republicans to keep the government open — giving Republicans hope that there might be five more who will eventually come around and help end a shutdown.
After the vote, King warned against “permanent damage” as Trump and his administration have threatened mass layoffs.
“Instead of fighting Trump we’re actually empowering him, which is what finally drove my decision,” King said.
Thune predicted Democratic support for the GOP bill will increase “when they realize that this is playing a losing hand.”
Shutdown preparations begin
The stakes are huge for federal workers across the country as the White House told agencies last week that they should consider “a reduction in force” for many federal programs if the government shuts down. That means that workers who are not deemed essential could be fired instead of just furloughed.
Either way, most would not get paid. The nonpartisan Congressional Budget Office estimated in a letter to Iowa Sen. Joni Ernst on Tuesday that around 750,000 federal workers could be furloughed each day once a shutdown begins.
Federal agencies were already preparing. On the home page of the Department of Housing and Urban Development, a large pop up ad reads, “The Radical Left are going to shut down the government and inflict massive pain on the American people.”
Democrats’ health care asks
Democrats want to negotiate an extension of the health subsidies immediately as people are beginning to receive notices of premium increases for the next year. Millions of people who purchase health insurance through the Affordable Care Act could face higher costs as expanded subsidies first put in place during the COVID-19 pandemic expire.
Democrats have also demanded that Republicans reverse the Medicaid cuts that were enacted as a part of Trump’s “big, beautiful bill” this summer and for the White House to promise it will not move to rescind spending passed by Congress.
“We are not going to support a partisan Republican spending bill that continues to gut the health care of everyday Americans,” House Democratic Leader Hakeem Jeffries said.
Thune pressed Democrats to vote for the funding bill and take up the debate on tax credits later. Some Republicans are open to extending the tax credits, but many are strongly opposed to it.
In rare, pointed back-and-forth with Schumer on the Senate floor Tuesday morning, Thune said Republicans “are happy to fix the ACA issue” and have offered to negotiate with Democrats — if they will vote to keep the government open until Nov. 21.
A critical, and unusual, vote for Democrats
Democrats are in an uncomfortable position for a party that has long denounced shutdowns as pointless and destructive, and it’s unclear how or when a shutdown will end. But party activists and lawmakers have argued that Democrats need to do something to stand up to Trump.
“The level of appeasement that Trump demands never ends,” said Sen. Peter Welch, D-Vt. “We’ve seen that with universities, with law firms, with prosecutors. So is there a point where you just have to stand up to him? I think there is.”
Some groups called for Schumer’s resignation in March after he and nine other Democrats voted to break a filibuster and allow a Republican-led funding bill to advance to a final vote.
Schumer said then that he voted to keep the government open because a shutdown would have made things worse as Trump’s administration was slashing government jobs. He says things have now changed, including the passage this summer of the massive GOP tax cut bill that reduced Medicaid.
Trump’s role in negotiations
A bipartisan meeting at the White House on Monday was Trump’s first with all four leaders in Congress since retaking the White House for his second term. Schumer said the group “had candid, frank discussions” about health care.
But Trump did not appear to be ready for serious talks. Hours later, he posted a fake video of Schumer and House Democratic Leader Hakeem Jeffries taken from footage of their real press conference outside of the White House after the meeting. In the altered video, a voiceover that sounds like Schumer’s voice makes fun of Democrats and Jeffries stands beside him with a cartoon sombrero and mustache. Mexican music plays in the background.
At a news conference on the Capitol steps Tuesday morning, Jeffries said it was a “racist and fake AI video.”
Schumer said that less than a day before a shutdown, Trump was trolling on the internet “like a 10-year-old.”
“It’s only the president who can do this,” Schumer said. “We know he runs the show here.”
___
Associated Press writers Seung Min Kim, Kevin Freking, Matthew Brown, Darlene Superville and Joey Cappelletti in Washington contributed to this report.
On the other side of the aisle, Democrat Angie Craig blamed the GOP.
“People are not going to be able to afford their health care,” said Craig.
The battle is focused on roughly $1 trillion in Medicaid and Affordable Care Act (ACA) — aka “Obamacare” — cuts in President Trump’s so-called “Big Beautiful Bill.” It would have a major impact on health care premiums and even determine who qualifies for ACA subsidies.
ACA tax credits that were passed in 2021 expanded access to Medicaid funding from 11 million people to 24 million people. Those tax credits expire at the end of 2025.
The Kaiser Family Foundation estimates that for a Minnesota family with a household income of $100,000, premiums on the exchange would go from $523 a month to $830 a month starting Jan. 1, 2026.
“I mean, they say that they’re going to terminate folks that end up getting furloughed as part of a shutdown,” said federation vice president Ruark Hotopp. “That’s going to be, you know, thousands of employees without paychecks, and that’ll hurt them directly, but then that’s going to have an impact on the economy and the jobs market as well.”
For both sides, there is frustration that this entire debate, and the entire possible government shutdown, is over a funding bill that would fund the government for only six weeks, until Nov. 21. Then it’s likely they will have to do it all over again.
Esme Murphy, a reporter and Sunday morning anchor for WCCO-TV, has been a member of the WCCO-TV staff since December 1990. She is also a weekend talk show host on WCCO Radio. Born and raised in New York City, Esme ventured into reporting after graduating from Harvard University.
With a government shutdown just hours away, one of the sticking points between Republicans and Democrats involves health care, specifically whether to extend premium subsidies under the Affordable Care Act.
With a government shutdown just hours away, one of the key sticking points between Republicans and Democrats involves health care, specifically whether to extend premium subsidies under the Affordable Care Act.
The debate centers on enhanced tax credits that help millions of Americans afford insurance through ACA marketplaces. These subsidies are currently scheduled to expire at the end of 2025, but Democrats are pushing for action now to avoid disruptions during the upcoming open enrollment period.
“Twenty-two million people across the country get their coverage through the Affordable Care Act marketplaces,” said Anne Reid, policy director of the Funders Forum on Accountable Health at the Milken Institute School of Public Health at George Washington University.
“The vast majority of those folks have some level of subsidization of their coverage, which is tied to their income.”
Reid warns that without an extension, millions could lose coverage or face unaffordable premiums.
The credits were expanded in recent years to raise income thresholds, allowing more Americans to qualify for help.
“The credits were enhanced in the sense that a higher minimum income was set so more people could qualify to receive some relief toward these premiums,” Reid said.
Reid previously served as a senior congressional staffer, where she contributed to health workforce policy during the development of the Affordable Care Act.
Democrats want the extension included in the continuing resolution needed to keep the government open. Reid said they view it as a must-pass provision.
“Democrats are arguing that we need to handle this in must-pass legislation, which at the moment is the appropriations bill.”
They also want to reverse earlier Medicaid cuts that could result in more than 10 million people losing coverage.
But Republicans argue the funding bill should be a “clean” continuing resolution, focused solely on keeping the government running.
“Let’s just keep the government going on current fiscal year levels through the middle of November, to give us some time to work things out and negotiate a longer-term package,” Reid said, summarizing the GOP position.
University of Maryland finance professor David Kass said Democrats are pushing to extend the expanded benefits into 2026, but Republicans want to debate the issue separately from the stopgap funding measure.
“Fewer Americans would be able to purchase health insurance” if the premium help isn’t available as open enrollment begins, Kass said.
Reid said the timing is critical, not just for consumers, but for insurers who need clarity to set rates.
“Days and weeks matter in terms of being able to rightsize the premium levels.”
The potential shutdown could also hit the D.C. region particularly hard, given its large federal workforce.
“Job security and financial security would very acutely be felt in the D.C. region, given our demographics and who all comprises the federal workforce,” Reid said.
With open enrollment approaching and budget negotiations stalled, Reid said the lack of clarity could leave consumers in limbo and millions of Americans at risk of losing affordable health coverage.
Get breaking news and daily headlines delivered to your email inbox by signing up here.
Millions of Medicaid enrollees may have a way out of the new federal work requirement — if they live in a county with high unemployment.
By January 2027, President Trump’s far-reaching domestic policy law will require many adult, nondisabled Medicaid enrollees in 42 states and Washington, D.C., to work or volunteer 80 hours a month or go to school.
But under the law, Medicaid enrollees in counties where unemployment is at least 8% or 1.5 times the national unemployment rate could be shielded from the work requirement, if their state applies for an exemption.
A new analysis by KFF shows that exemption in the GOP’s work requirement could offer a reprieve to potentially millions of Americans caught in a tough spot — needing to work to secure health insurance but having trouble finding a job.
The Congressional Budget Office projected the work requirement would apply to 18.5 million Medicaid enrollees, causing about 5.3 million to lose their government health coverage by 2034. CBO spokesperson Caitlin Emma confirmed to KFF Health News that analysts factored the unemployment rate exemption into their projections. Only states that expanded Medicaid under the 2010 Affordable Care Act or a special waiver must enact a work requirement, under the federal law.
But how many people could be exempt depends on how the Trump administration interprets the law, in addition to whether their states’ officials apply.
For example, if Trump officials exempt people in counties where the unemployment rate has been above the law’s thresholds for any month over a 12-month period, about 4.6 million Medicaid enrollees in 386 counties could qualify for an exemption today based on the latest unemployment data, according to KFF, a health information nonprofit that includes KFF Health News.
That amounts to just under a quarter of all Medicaid enrollees subject to the work requirement.
Under that one-month threshold, “the impact could be fairly significant,” said Jennifer Tolbert, a co-author of the analysis and the deputy director of KFF’s Program on Medicaid and the Uninsured.
But, she said, the Trump administration is more likely to adopt a stricter threshold based on average unemployment over a 12-month period. That would align with work requirements under the federal Supplemental Nutrition Assistance Program, the food assistance commonly known as food stamps.
Only about 1.4 million Medicaid enrollees living in 158 counties could be exempted under that standard, or about 7% of the total subject to work requirements, KFF found. That’s about 7% of enrollees who live in expansion states who would otherwise need to meet the new requirement.
Based on the 12-month criteria, about 90% of Medicaid enrollees who could be exempted based on high unemployment reside in five states, according to KFF: California, New York, Michigan, Kentucky, and Ohio. California alone accounts for over half of those who could be exempted.
The unemployment rate exemption is one of several carve-outs from the Medicaid work requirement in the GOP’s law. The law also exempts parents with children under 14, people who are disabled or frail, and those who are pregnant, incarcerated, or in a substance use disorder program, among others. The high unemployment provision is different than most because it exempts people living in entire counties.
Two top Republicans key to the bill’s passage — House Speaker Mike Johnson and Sen. Mike Crapo, chair of the Senate Finance Committee — did not respond to requests for comment.
To qualify for the Medicaid exemption, states would have to apply to the federal government on behalf of individuals in eligible counties. And if a county earned an exemption, the government would determine how long it applies.
Even if the federal government grants exemptions broadly, health advocates fear some Republican-led states could balk at applying for exemptions in order to keep enrollment down, as they say has been the case with SNAP exemptions. As of 2023, 18 states did not have an exemption under the SNAP program, even though some of their residents might be eligible.
“It’s not a guarantee that people can rely on,” said Emily Beauregard, executive director of Kentucky Voices for Health, an advocacy group that intends to push for the broadest possible exemptions to help people maintain their coverage. Eastern Kentucky has several counties with perennially high unemployment.
But as Georgia’s and Arkansas’ experiences have shown, Medicaid work requirements can be costly for states to run and frustrating for enrollees to navigate. About 18,000 people in Arkansas, or nearly a quarter of the state’s adults who gained Medicaid coverage through the ACA expansion, lost coverage when the state had a work requirement in 2018 and 2019. A court ended the state’s work requirement program.
Critics point out that most Medicaid enrollees already work or have a disability or caregiving responsibilities, and they argue the reporting requirements merely serve as a bureaucratic hurdle to obtaining and keeping coverage. Under the GOP law, enrollees’ work status needs to be verified at least twice a year.
Most of the coverage losses due to work requirements occur among people who work or should qualify for an exemption but nevertheless lose coverage due to red tape, research shows.
Not every state must implement a work requirement under Mr. Trump’s law, only those that chose to expand Medicaid coverage to more low-income people through the ACA or a federal waiver. The ACA has provided hundreds of billions in federal dollars to help states cover everyone making up to 138% of the federal poverty level — $21,597 for an individual in 2025.
Forty states and Washington, D.C., took up the expansion. Georgia and Wisconsin partly expanded their Medicaid eligibility by getting a federal waiver, adding them to the list of states subject to the work requirement. These two states were not included in the KFF analysis because of a lack of county-level enrollment data.
Jennifer Wagner, director of Medicaid eligibility and enrollment at the left-leaning Center on Budget and Policy Priorities, said she is pleased the law makes some exceptions for places where jobs are scarce. It could limit how many people lose coverage because of the work requirement, she said.
Wagner said SNAP’s unemployment rate exemption has helped millions of people avoid losing their food assistance, but its impact also depends on whether a state seeks the waiver.
She is concerned the Trump administration may make it difficult for counties to get exempted under the Medicaid law.
“I’m glad it’s in there as it will certainly help people, but it’s still a terrible bill,” she said. “This will not really blunt the harm of the bill.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Smart Therapy Center is an autism center housed in side this building on Nicollet Avenue in Minneapolis. Photo by Max Nesterak/Minnesota Reformer.
A 28-year-old woman was charged with wire fraud Wednesday for what federal prosecutors allege is her role in a $14 million scheme to defraud Minnesota’s Medicaid autism treatment program — the first person charged as part of what is believed to be a wide-ranging investigation.
The U.S. Attorney’s Office for Minnesota charged Asha Farhan Hassan for what they say is her role in the theft from the state’s Early Intensive Developmental Behavioral Intervention services program, which is supposed to assist people under 21 with autism spectrum disorder. The Reformerfirst reported the autism Medicaid fraud investigation last year.
Prosecutors also said Hassan used her business to defraud the Federal Child Nutrition Program that was at the center of the massive pandemic-era food aid scandal known as Feeding Our Future, according to court documents.
The Reformer left a message with Hassan’s attorney, Ryan Pacyga, who didn’t immediately respond.
In 2019, Hassan began Smart Therapy with several partners to purportedly provide one-on-one therapy to children with autism. To be reimbursed by the state, Smart Therapy needed to enroll children with autism, and Hassan and her partners approached parents in the Somali community to recruit and enroll children, according to court documents. Some of the children were not diagnosed with autism.
Hassan and Smart Therapy paid monthly kickbacks ranging from $300 to $1,500 each month to the parents who enrolled their children with Smart Therapy, according to court documents.
Smart Therapy quickly became one of the state’s biggest autism treatment providers.
Smart Therapy also employed 18- or 19-year-old relatives with no experience related to the treatment of autism and had no formal education beyond high school, according to court documents.
Smart Therapy obtained over $14 million from 2019 to 2024 from Medicaid through the Minnesota Department of Human Services and U Care, according to the U.S. Attorney’s Office.
The Reformerreported in 2024 that a former supervisor at Smart Therapy made repeated attempts to report what she said were negligence and fraud to state officials.
Growth of spending on the Minnesota autism program has exploded in recent years. The number of providers — who are supposed to diagnose and treat people with autism spectrum disorder — has increased 700% in five years, climbing from 41 providers in 2018 to 328 in 2023.
While allegedly defrauding the autism program, Hassan also used Smart Therapy to submit fraudulent claims to Feeding Our Future, according to court documents. Between 2020 and 2021, Hassan claimed to serve nearly 200,000 meals to children in Smart Therapy, for which she received about $465,000, the documents said.
Hassan shared the fraudulent dollars with her partners, sent hundreds of thousands abroad and used some of the money to purchase real estate in Kenya, according to court documents.
Wednesday’s charge is another instance of the alleged defrauding of a Minnesota public program.
“Today’s charges mark the first in the ongoing investigation into fraud in the EIDBI Autism Program,” said Acting U.S. Attorney Joe Thompson. “To be clear, this is not an isolated scheme. From Feeding Our Future to Housing Stabilization Services and now Autism Services, these massive fraud schemes form a web that has stolen billions of dollars in taxpayer money. Each case we bring exposes another strand of this network.”
Hassan is at least the 76th person charged in the Feeding Our Future investigation.
Last week, Thompson announced charges against eight in another Medicaid fraud scheme through the state’s Housing Stabilization Services program.
The latest charges are likely to be more fodder for opponents of DFL Gov. Tim Walz — who announced last week he’s running for a third term — who say his administration was asleep on the watchtower as fraudsters looted state programs.
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.
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.
The Colorado Hospital Association said its members were “disappointed” with the rollback, especially since they expect to lose Medicaid funding under provisions of H.R. 1 in 2027 and beyond. An unknown number of patients will lose Medicaid coverage due to new work requirements, and states won’t be able to draw down as much federal funding for hospitals because of limits on provider taxes.
“We recognize the tough choices required in this budget process, but reductions to provider rates — particularly alongside other health care cuts stemming from H.R. 1 — add to the challenges ahead,” the association said in a statement. “CHA and our members remain committed to working with the governor and legislators to identify solutions that protect health care funding and sustain access to care across Colorado.”
Dentists also will receive less for treating Medicaid patients than they anticipated, with about $2.5 million in reductions to planned increases. The Colorado Dental Association said it was waiting for details about which services would take cuts, and how deep they would go.
Other Medicaid cuts include:
$7 million from reviewing applied behavior analysis claims for improper billing. The therapy attempts to teach daily living skills to people with severe autism.
$6.1 million from requiring prior authorization for more than 24 psychotherapy visits in one year
$5.6 million that Colorado was going to spend to keep children covered by Medicaid until age 3. The Centers for Medicare and Medicaid Services revoked permission for the state to do that.
$4.4 million from a fund to raise pay in nursing homes above $15 per hour. The state’s minimum wage will be over $15 next year, making the fund largely irrelevant.
$3 million from reducing the “community connector” benefit to bring kids with disabilities into integrated settings
$3 million from reducing incentives for behavioral health care improvements
$2.7 million from benchmarking the state’s rate for applied behavior analysis for autism to 95% of the rate in comparable states
$1.7 million from requiring prior authorization to administer 17 or more drug tests to the same person in one year
$1.5 million from starting payments to small, rural and pediatric providers in January 2026 instead of July 2025
$1.5 million from reducing the rate paid to family caregivers for people with disabilities
$750,000 from reducing incentives to coordinate primary care
$500,000 in unused funding appropriated for family planning services to undocumented people
$500,000 from training for providers about screening patients for substance misuse and referring them to treatment
$131,000 in funding to advertise Cover All Coloradans, which offers Medicaid-like coverage to undocumented people
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.
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.
The committee’s decision also will determine whether the Vaccines for Children program can supply the shots for children who are uninsured, covered by Medicaid or are members of American Indian tribes, Calonge said. If the committee decides not to recommend the vaccines, those children likely won’t have another option to get the shots, he said.
When states and the federal government passed laws linking coverage to the committee’s recommendations, they did so expecting that it would also remain an apolitical arbiter of the evidence for vaccinating the population or specific subgroups, said Cathy Bradley, dean of the Colorado School of Public Health.
Now, that premise is in doubt, and states are looking for other ways to ensure access, she said.
Allowing anyone who wants a COVID-19 vaccine to get one from the provider of their choice is an important first step for Colorado, because the vaccines remain effective in preventing severe illness, Bradley said. As the situation develops, the state will likely need to come up with other partial solutions to preserve access, she said.
“It’s a different path for everyone, depending on what your coverage is,” she said.
In Port Washington on Friday, New York State Gov. Kathy Hochul signed an executive order to allow people to get the COVID-19 vaccine 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 health conditions.
On Friday, Hochul said that “we’re going to make sure that everyone who has health insurance has coverage” to get the COVID vaccine, and added that Medicaid 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.”
More than $250 million down, another $530 million to go.
That’s how much of a projected $783 million state budget hole the Colorado legislature filled by the time a special session called to address the impact of the federal tax bill ended Tuesday afternoon — and the larger amount that still remains. Erasing the rest of the red ink will fall to Gov. Jared Polis, who plans to rebalance this year’s budget in the coming days through a mix of cuts to state funding and a big dip into the rainy-day fund.
Over six days, the legislature’s majority Democrats fulfilled their part of a plan worked out with the governor’s office: to pass legislation that is expected to generate enough revenue to close about a third of the shortfall projected for the state’s budget in the current fiscal year, which began July 1. They ended tax breaks and found other ways to offset declining state income tax revenue, while leaving spending cuts largely for Polis to decide.
“What we did here in this special session is soften the blow,” said Sen. Jeff Bridges, a Greenwood Village Democrat who chairs the legislature’s budget committee. “But when the federal government cuts $1.2 billion in revenue from the state with a stroke of a pen, after we’ve already cut $1.2 billion (from the budget) in the regular session, that’s a tough deficit to come back from in a way that doesn’t impact the people of Colorado.”
The special session ended with 11 bills going to Polis for final approval. Five sought to fill the budget gap, largely by ending tax incentives for businesses and high-income earners.
The single largest revenue-raising measure, House Bill 1004, will auction off tax credits that can be claimed in future tax years for a discount. Backers expected that bill to bring in an additional $100 million to state coffers this year, at the expense of about $125 million in future years.
Together, those measures add up to $253 million in revenue to reduce the projected deficit — money that Democrats say represents averted cuts to Medicaid, schools and hospitals.
“Colorado legislators stepped up and helped protect children’s food access and minimized the devastating cost increases to health insurance premiums across the state, to the best of our ability,” Polis, who signed two of the new bills earlier Tuesday, said in a statement.
The legislature’s Joint Budget Committee expects to meet Thursday to hear Polis’ plan to address the remaining $500 million or so, including mid-year spending cuts.
As part of his call for a special session on Aug. 6, Polis announced a statewide hiring freeze. He said in an interview before the session started that he hoped to avoid cuts to K-12 education, but he has left all other options on the table, including Medicaid program spending.
The plan also factors in a significant use of reserves to offset some of the remaining gap.
Partisan debates
Over the past week, Republicans fought the Democrats’ bills, but strong Democratic majorities in both legislative chambers all but preordained the outcome.
“Not only did we increase taxes, we’re balancing the budget on the back of small businesses,” said Sen. Barbara Kirkmeyer, a Brighton Republican on the budget committee.
One of the bills heading to Polis would erase a fee paid by the state to businesses for collecting sales taxes — an outdated subsidy, according to Democrats, and an unnecessary new burden now put on businesses, according to Republicans.
Republicans said before the session that they’d likely challenge several bills in court over allegations that they violate provisions in the Taxpayer’s Bill of Rights that require voter approval for tax increases. Kirkmeyer and Rep. Rick Taggart, a Grand Junction Republican who’s also on the budget committee, said bills going to the governor that would eliminate some tax credits and allow the sale of tax credits against future collections seemed particularly vulnerable to a challenge under TABOR.
Debate throughout the special session took a distinctly partisan edge. Democrats laid the cuts on congressional Republicans and President Donald Trump and called the federal tax bill a de facto theft of benefits from the poorest Coloradans to benefit the wealthiest.
Republicans countered that the federal bill delivered much-needed tax cuts, and they said Democrats sought to yank those away instead of cutting partisan priorities.
Legislators begin to gather in the Senate Chambers before the start of another day of the special legislative session at the Colorado State Capitol in Denver on Aug. 26, 2025. (Photo by RJ Sangosti/The Denver Post)
Bills on wolves, artificial intelligence
Other bills passed sought to respond to different aspects of the federal bill, formerly known as the “One Big Beautiful Bill Act,” as well as other priorities.
Lawmakers stripped general fund money away from the voter-approved program to reintroduce wolves in the state, though releases are expected to continue this winter. They tweaked ballot language for a measure about taxes for universal school meals to allow that money to go to general food assistance, as well, if voters approve it in November.
The legislature also approved a bill allowing state Medicaid program to pay Planned Parenthood for services provided, after the federal government specifically barred federal money from going to the organization.
Polis included in his call of the session that lawmakers address concerns swirling around the state’s first-in-the-nation regulations of artificial intelligence after a similar effort in the spring blew up. The rules now in law go into effect in February.
After days of bruising negotiations, lawmakers punted on any new changes and delayed the existing rules from going into effect until the end of June — giving them time to resume the debate during the next regular legislative session in January.
Colorado won’t have to claw back nearly $60 million it paid to public hospitals, including Denver Health and more than two dozen rural facilities, under a deal announced Tuesday to end the state’s court battles with UCHealth.
“We thank UCHealth for working with us to resolve this issue in a manner that protects all Colorado hospitals,” Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing, said in a news release.
UCHealth sued the department, alleging it had incorrectly labeled two of its hospitals as public, rather than private nonprofits. A Denver District Court judge agreed, and ordered the state to reclassify Memorial Hospital in Colorado Springs and Poudre Valley Hospital in Fort Collins. The department filed an appeal in July.
Their classification matters because of the state’s provider tax.
Hospitals pay about $1.3 billion each year, gaining about $500 million in federal matching funds. Most come out ahead, though those with relatively few patients covered by Medicaid lose out. In future years, the state will have to reduce its tax rate under provisions of H.R. 1, colloquially known as President Donald Trump’s “big beautiful bill.”
The state pools the money by hospital type, and distributes it based on how each facility’s Medicaid share compares to the others in their group.
Moving Memorial and Poudre Valley from the public to the private bucket means that less money remains for all public hospitals to divide up, and that Memorial and Poudre Valley likely will get more back from the provider tax, because they’re being compared against hospitals that generally see fewer Medicaid patients.
The state said that to retrospectively reclassify the UCHealth hospitals and distribute the funds accordingly, it would have to take back $59.7 million paid last year to 29 publicly owned hospitals.
Denver Health didn’t comment on the possibility, but a group representing 13 Eastern Plains hospitals said some wouldn’t be able to hand over a significant chunk of cash, because they already used their share of the provider tax to pay employees and cover other expenses.
Under the agreement, the Department of Health Care Policy and Financing will drop its appeal, and UCHealth won’t demand redistribution of provider taxes it paid in previous years.
UCHealth president and CEO Elizabeth Concordia said the system supports the provider tax program, and thanked the state for working together on a solution.
“The greatest successes for patients and our state happen when hospitals, HCPF and the administration work together collaboratively,” she said in a news release.
The hospital system also agreed to donate $5.7 million to compensate public hospitals that may lose out with less money coming into their bucket. The Colorado Hospital Association will help determine how to divide up the donation.
“Instability or uncertainty in the fee could have pushed vulnerable hospitals past the breaking point,” Jeff Tieman, president and CEO of the Colorado Hospital Association, said in a news release. “UCHealth’s approach to waive changes for last year and invest millions this year demonstrates a real commitment to protecting access to care in rural Colorado. We are deeply grateful for their partnership.”
DENVER — Democrats in the Colorado House of Representatives on Sunday passed Senate Bill 25B-2, which would restore Medicaid funding using state money for reproductive health care providers, namely Planned Parenthood.
The 43-19 party-line vote comes after Republicans in Congress passed what is dubbed the One Big Beautiful Bill Act, which excluded Planned Parenthood from federal Medicaid reimbursement for reproductive health care services.
Existing federal law prohibits the use of Medicaid funds for most abortion-related services.
SB 25B-2 aims to preserve access to services like cancer screenings, STI testing, and birth control consultations for Medicaid recipients across Colorado, according to a news release from Colorado House Democrats.
“All Coloradans, whether or not they are a Medicaid recipient, deserve access to reproductive health care,” Jennifer Bacon, D-Denver, said in a statement.
Republicans opposed the bill, arguing that Colorado can’t afford it amid a $1.2 billion budget shortfall the state is facing.
The legislation, which was approved during the ongoing special legislative session, now heads to the governor’s desk.
Coloradans making a difference | Denver7 featured videos
Denver7 is committed to making a difference in our community by standing up for what’s right, listening, lending a helping hand and following through on promises. See that work in action, in the videos above.
BOSTON — Massachusetts taxpayers will receive a big break next year under President Donald Trump’s recently enacted spending package, according to a new report.
The Tax Foundation, a nonpartisan Washington-based think tank, estimates that Bay Staters will see their taxes cut by an average of $5,139 in 2026 under Trump’s so-called One Big Beautiful Bill – the third-largest reduction in the nation following Wyoming and Washington state.
This page requires Javascript.
Javascript is required for you to be able to read premium content. Please enable it in your browser settings.
Jonnell Wieder earned too much money at her job to keep her Medicaid coverage when the COVID-19 public health emergency ended in 2023 and states resumed checking whether people were eligible for the program. But she was reassured by the knowledge that Medicaid would provide postpartum coverage for her and her daughter, Oakleigh McDonald, who was born in July of that year.
Wieder is a member of the Confederated Salish and Kootenai Tribes in Montana and can access some health services for free through her tribe’s health clinics. But funding is limited, so, like a lot of Native American people, she relied on Medicaid for herself and Oakleigh.
Months before Oakleigh’s first birthday, the date when Wieder’s postpartum coverage would come to an end, Wieder completed and returned paperwork to enroll her daughter in Healthy Montana Kids, the state’s version of the Children’s Health Insurance Program. But her paperwork, caught up in the lengthy delays and processing times for applications, did not go through.
“As soon as she turned 1, they cut her off completely,” Wieder said.
It took six months for Wieder to get Oakleigh covered again through Healthy Montana Kids. Before health workers in her tribe stepped in to help her resubmit her application, Wieder repeatedly called the state’s health department. She said she would dial the call center when she arrived at her job in the morning and go about her work while waiting on hold, only for the call to be dropped by the end of the day.
“Never did I talk to anybody,” she said.
Oakleigh McDonald, Jonnell Wieder’s daughter, went without health coverage for six months when her paperwork was caught up in the 2023 process known as Medicaid “unwinding.”
Tommy Martino for KFF Health News
Wieder and Oakleigh’s experience is an example of the chaos for eligible Medicaid beneficiaries caused by the process known as the “unwinding,” which led to millions of people in the U.S. losing coverage due to paperwork or other procedural issues. Now, tribal health leaders fear their communities will experience more health coverage disruptions when new federal Medicaid work and eligibility requirements are implemented by the start of 2027.
The tax-and-spending law that President Trump signed this summer exempts Native Americans from the new requirement that some people work or do another qualifying activity a minimum number of hours each month to be eligible for Medicaid, as well as from more frequent eligibility checks. But as Wieder and her daughter’s experience shows, they are not exempt from getting caught up in procedural disenrollments that could reemerge as states implement the new rules.
“We also know from the unwinding that that just doesn’t always play out necessarily correctly in practice,” said Joan Alker, who leads Georgetown University’s Center for Children and Families. “There’s a lot to worry about.”
The new law is projected to increase the number of people who are uninsured by 10 million.
The lessons of the unwinding suggest that “deep trouble” lies ahead for Native Americans who rely on Medicaid, according to Alker.
Changes to Medicaid
Mr. Trump’s new law changes Medicaid rules to require some recipients ages 19 to 64 to log 80 hours of work or other qualifying activities per month. It also requires states to recheck those recipients’ eligibility every six months, instead of annually. Both of these changes will be effective by the end of next year.
Wieder said she was lucky that the tribe covered costs and her daughter’s care wasn’t interrupted in the six months she didn’t have health insurance. Citizens of federally recognized tribes in the U.S. can access some free health services through the Indian Health Service, the federal agency responsible for providing health care to Native Americans and Alaska Natives.
But free care is limited because Congress has historically failed to fully fund the Indian Health Service. Tribal health systems rely heavily on Medicaid to fill that gap. Native Americans are enrolled in Medicaid at higher rates than the White population and have higher rates of chronic illnesses, die more from preventable diseases, and have less access to care.
Medicaid is the largest third-party payer to the Indian Health Service and other tribal health facilities and organizations. Accounting for about two-thirds of the outside revenue the Indian Health Service collects, it helps tribal health organizations pay their staff, maintain or expand services, and build infrastructure. Tribal leaders say protecting Medicaid for Indian Country is a responsibility Congress and the federal government must fulfill as part of their trust and treaty obligations to tribes.
Lessons learned during the unwinding
The Trump administration prevented states from disenrolling most Medicaid recipients for the duration of the public health emergency starting in 2020. After those eligibility checks resumed in 2023, nearly 27 million people nationwide were disenrolled from Medicaid during the unwinding, according to an analysis by the Government Accountability Office published in June. The majority of disenrollments — about 70% — occurred for procedural reasons, according to the federal Centers for Medicare & Medicaid Services.
CMS did not require state agencies to collect race and ethnicity data for their reporting during the unwinding, making it difficult to determine how many Native American and Alaska Native enrollees lost coverage.
The lack of data to show how the unwinding affected the population makes it difficult to identify disparities and create policies to address them, said Latoya Hill, senior policy manager with KFF’s Racial Equity and Health Policy program. KFF is a health information nonprofit that includes KFF Health News.
The National Council of Urban Indian Health, which advocates on public health issues for Native Americans living in urban parts of the nation, analyzed the Census Bureau’s 2022 American Community Survey and KFF data in an effort to understand how disenrollment affected tribes. The council estimated more than 850,000 Native Americans had lost coverage as of May 2024. About 2.7 million Native Americans and Alaska Natives were enrolled in Medicaid in 2022, according to the council.
The National Indian Health Board, a nonprofit that represents and advocates for federally recognized tribes, has been working with federal Medicaid officials to ensure that state agencies are prepared to implement the exemptions.
“We learned a lot of lessons about state capacity during the unwinding,” said Winn Davis, congressional relations director for the National Indian Health Board.
Nevada health officials say they plan to apply lessons learned during the unwinding and launch a public education campaign on the Medicaid changes in the new federal law. “A lot of this will depend on anticipated federal guidance regarding the implementation of those new rules,” said Stacie Weeks, director of the Nevada Health Authority.
Staff at the Fallon Tribal Health Center in Nevada have become authorized representatives for some of their patients. This means that tribal citizens’ Medicaid paperwork is sent to the health center, allowing staff to notify individuals and help them fill it out.
Davis said the unwinding process showed that Native American enrollees are uniquely vulnerable to procedural disenrollment. The new law’s exemption of Native Americans from work requirements and more frequent eligibility checks is the “bare minimum” to ensure unnecessary disenrollments are avoided as part of trust and treaty obligations, Davis said.
Eligibility checks are “complex” and “vulnerable to error”
The GAO said the process of determining whether individuals are eligible for Medicaid is “complex” and “vulnerable to error” in a 2024 report on the unwinding.
“The resumption of Medicaid eligibility redeterminations on such a large scale further compounded this complexity,” the report said.
It highlighted weaknesses across state systems. By April 2024, federal Medicaid officials had found nearly all states were out of compliance with redetermination requirements, according to the GAO. Eligible people lost their coverage, the accountability office said, highlighting the need to improve federal oversight.
In Texas, for example, federal Medicaid officials found that 100,000 eligible people had been disenrolled due to, for example, the state system’s failure to process their completed renewal forms or miscalculation of the length of women’s postpartum coverage.
Some states were not conducting ex parte renewals, in which a person’s Medicaid coverage is automatically renewed based on existing information available to the state. That reduces the chance that paperwork is sent to the wrong address, because the recipient doesn’t need to complete or return renewal forms.
But poorly conducted ex parte renewals can lead to procedural disenrollments, too. More than 100,000 people in Nevada were disenrolled by September 2023 through the ex parte process. The state had been conducting the ex parte renewals at the household level, rather than by individual beneficiary, resulting in the disenrollment of still-eligible children because their parents were no longer eligible. Ninety-three percent of disenrollments in the state were for procedural reasons — the highest in the nation, according to KFF.
Another issue the federal agency identified was that some state agencies were not giving enrollees the opportunity to submit their renewal paperwork through all means available, including mail, phone, online, and in person.
State agencies also identified challenges they faced during the unwinding, including an unprecedented volume of eligibility redeterminations, insufficient staffing and training, and a lack of response from enrollees who may not have been aware of the unwinding.
Native Americans and Alaska Natives have unique challenges in maintaining their coverage.
Communities in rural parts of the nation experience issues with receiving and sending mail. Some Native Americans on reservations may not have street addresses. Others may not have permanent housing or change addresses frequently. In Alaska, mail service is often disrupted by severe weather. Another issue is the lack of reliable internet service on remote reservations.
Tribal health leaders and patient benefit coordinators said some tribal citizens did not receive their redetermination paperwork or struggled to fill it out and send it back to their state Medicaid agency.
The aftermath
Although the unwinding is over, many challenges persist.
Tribal health workers in Montana, Oklahoma, and South Dakota said some eligible patients who lost Medicaid during the unwinding had still not been reenrolled as of this spring.
“Even today, we’re still in the trenches of getting individuals that had been disenrolled back onto Medicaid,” said Rachel Arthur, executive director of the Indian Family Health Clinic in Great Falls, Montana, in May.
Arthur said staff at the clinic realized early in the unwinding that their patients were not receiving their redetermination notices in the mail. The clinic is identifying people who fell off Medicaid during the unwinding and helping them fill out applications.
Marlena Farnes, who was a patient benefit coordinator at the Indian Family Health Clinic during the Medicaid unwinding, said she tried for months to help an older patient with a chronic health condition get back on Medicaid. He had completed and returned his paperwork but still received a notice that his coverage had lapsed. After many calls to the state Medicaid office, Farnes said, state officials told her the patient’s application had been lost.
Another patient went to the emergency room multiple times while uninsured, Arthur said.
“I felt like if our patients weren’t helped with follow-up, and that advocacy piece, their applications were not being seen,” Farnes said. She is now the behavioral health director at the clinic.
Montana was one of five states where more than 50% of enrollees lost coverage during the unwinding, according to the GAO. The other states are Idaho, Oklahoma, Texas, and Utah. About 68% of Montanans who lost coverage were disenrolled for procedural reasons.
In Oklahoma, eligibility redeterminations remain challenging to process, said Yvonne Myers, a Medicaid and Affordable Care Act consultant for Citizen Potawatomi Nation Health Services. That’s causing more frequent coverage lapses, she said.
Myers said she thinks Republican claims of “waste, fraud, and abuse” are overstated.
“I challenge some of them to try to go through an eligibility process,” Myers said. “The way they’re going about it is making it for more hoops to jump through, which ultimately will cause people to fall off.”
The unwinding showed that state systems can struggle to respond quickly to changes in Medicaid, leading to preventable erroneous disenrollments. Individuals were often in the dark about their applications and struggled to reach state offices for answers. Tribal leaders and health experts are raising concerns that those issues will continue and worsen as states implement the requirements of the new law.
Georgia, the only state with an active Medicaid work requirement program, has shown that the changes can be difficult for individuals to navigate and costly for a state to implement. More than 100,000 people have applied for Georgia’s Pathways program, but only about 8,600 were enrolled as of the end of July.
Alker, of Georgetown, said Congress took the wrong lesson from the unwinding in adding more restrictions and red tape.
“It will make unwinding pale in comparison in terms of the number of folks that are going to lose coverage,” Alker said.
This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
As an emergency room nurse in a rural community, and a mom whose daughter has multiple disabilities, I am appalled by Congress’ passage of President Trump’s cruelly named “Big Beautiful Bill,” which will result in millions of people losing their Medicaid coverage. But we still have our voices — and our votes — and advocates around the country are working to reverse these cuts. There’s a role for everyone to play, especially during Congress’ August recess.
Despite a glimmer of hope, I remain disgusted that the majority of Republicans who voted in favor of this inhuman legislation showed their complete disregard for the most vulnerable people in our state and nation who rely on this vital program: low-income moms and their children, people with disabilities, seniors, and rural residents. While 1 in 5 people nationwide have Medicaid coverage, in Michigan 1 in 4 people stand to lose their insurance, which includes both health and dental care.
Particularly despicable is that the majority of Republicans who voted in favor of cutting Medicaid funding by $1 trillion did it so they could give massive tax breaks to billionaires. As if this was not horrible enough, many people don’t even realize yet that these cuts will impact them: The changes to Medicaid won’t kick in until after the 2026 midterm election. That’s when the funding cuts, along with new rules that will require some people to work to keep their Medicaid coverage, go into effect — while the super-rich can take advantage of the tax breaks immediately.
What the politicians didn’t account for is the pain and suffering people are feeling now, the uncertainty of not knowing what their future holds — will they, their children, and loved ones lose their Medicaid coverage? Will hospitals close because they can’t sustain the flood of people who will turn to them for care as we expect, particularly in rural communities? Will people who work at those hospitals lose their jobs? We can only hope people will make the emotional turmoil they are now feeling known at the ballot box in 2026.
Overburdening rural hospitals, delaying care
For 10 years, I have worked at Beacon Three Rivers Health in Three Rivers, a rural area about 45 minutes south of Kalamazoo. We’re a very low-income community, which means we already see lots of patients in the ER because they can’t afford to get care anywhere else. Legally, the ER can’t turn them away. With the Medicaid cuts and new work requirements — which will take away Medicaid coverage from between 200,000 and 300,000 Michiganders starting in 2027 – we’ll see more patients turning to the ER because they don’t have any other choice.
Our hospital will also see a sicker population overall. Not only will people delay care. They won’t be able to afford medication and preventive care such as annual physical exams and routine screenings for health issues that can be treated with early detection, all of which is currently covered by Medicaid.
This will further stretch resources and burden already overworked nurses, who are forced to work longer hours and see more patients than we think is safe. We want to give every single patient safe, quality care, and Medicaid cuts will mean we have to work even harder to do so.
According to the Michigan Department of Health & Human Services, nearly 40% of small-town and rural Michiganders are covered by Medicaid. When these people lose their coverage, that means fewer payments to hospitals. The loss of those funds could force hospitals to cut essential services to stay open — or even close altogether. For many rural areas, the hospital is the largest employer. The Medicaid cuts will endanger people’s health and possibly our local economy.
Work requirements will create barriers to coverage
The work requirements also don’t take into account real-life challenges. To qualify for Medicaid, people will have to prove at least twice a year that they can’t work or show that they did work, were in school, and/or volunteered a total of 80 hours a month, according to a Kaiser Family Foundation (KFF) report. Consider my 26-year-old daughter, who has cerebral palsy, mild developmental delays, and profound hearing loss. Despite all of her challenges, she works in a Walmart stockroom 36 hours a week and fortunately qualifies for the company’s health insurance. But it took a year to find a job that worked for her abilities. She also had to make sure the bus line reached her new job because she can’t drive.
The same report from KFF makes it clear just how burdensome these work requirements are. In just one example: Each state can set its own requirements for how far back it can track someone’s work record. It could be one or two months — or possibly more. If someone has a gap in their past work history, they could lose their Medicaid coverage. Although it remains unclear just how many Michiganders will be impacted by these work requirements, KFF points out that when work requirements were enacted in Arkansas, 18,000 people lost coverage, but work participation did not increase. Plus, KFF analysis shows most adult Medicaid recipients under age 65 are already working, and many don’t receive insurance from work.
When crafting this legislation, I am certain our elected officials didn’t think about how challenging it is for some people, especially people with disabilities, to get a job and find a way to get there. My daughter, who can get a ride from my husband or me if the bus isn’t running, is one of the lucky ones, but what about the millions more who can’t work? The work requirements will likely tie them up in red tape that could take months to sort out before they can qualify for coverage.
Families earning low incomes who also stand to lose coverage will have to make very hard choices about whether to seek treatment at all — and then how to pay for their medication and follow-up visits to stay healthy, even if they visit our ER. They will have to choose between getting care or buying groceries or putting gas in their car.
The political maneuvering to delay the Medicaid cuts from taking effect until after the 2026 midterms is an unspoken admission of guilt by our elected leaders for the pain and suffering they know their constituents will endure with the loss of this coverage. They fear they will pay the price for their actions at the ballot box — as they should.
But we can take action now, during the August recess. Some legislators are talking about voting “no” on the September budget bill if these cuts aren’t reversed, which is a start. Even if all funding isn’t fully restored, minimizing this big, terrible bill’s harmful impact on the health of our country is a step in the right direction.
Tell your members of Congress to vote “no” on any budget bill that doesn’t restore the cuts to Medicaid. Even if President Trump vetoes a budget with Medicaid funding restored, those who vote to protect billionaires’ tax cuts over the health of our country’s most vulnerable will be on record — again — as voting against their constituents’ best interests. And we won’t forget when it’s time to vote in the 2026 midterms.
PEABODY — The One Big Beautiful Bill Act signed by President Donald Trump last month is causing concern among residents and caregivers at a local nursing home who rely on Medicaid.
Medicaid provides health care coverage to low-income individuals and families, and about every six in 10 nursing home residents in America rely on the program to pay for such care, according to KFF, a national non-partisan policy research center.
This page requires Javascript.
Javascript is required for you to be able to read premium content. Please enable it in your browser settings.
Senate’s rural hospital protections leave urban safety-net providers facing financial fallout and potential care cutbacks, new poll results reveal.
WASHINGTON, June 29, 2025 (Newswire.com)
– As the Senate advances the amended “One Big Beautiful Bill,” granting critical Medicaid relief exclusively to rural hospitals, urban safety-net hospitals are left facing significant financial peril, according to a flash poll by independent research firm Black Book Research. The survey, conducted June 25-28, 2025, gathered urgent perspectives from twelve senior executives at major urban hospitals averaging 440 beds and a Medicaid payer mix of 67%. Respondents included leaders in finance, clinical operations, and health IT.
Key findings signal unanimous concern among urban safety-net executives:
All respondents anticipate serious financial harm from pending Medicaid funding cuts. Additonally, every executive reported that their state has no viable contingency plan to address the shortfall from reduced federal Medicaid matching funds.
Seven of twelve foresee major operational consequences: significant reductions in healthcare services, layoffs, or deferral of essential investments in cybersecurity and technology infrastructure. The average projected uncompensated care expenses exceed $10 million per facility annually.
Two executives warn of even more severe outcomes: the potential for closure or bankruptcy of their health systems within three years without legislative intervention.
Independent assessments echo these concerns, finding that the current bill could impose severe financial burdens on urban hospitals due to Medicaid provider tax reductions. Leaders caution that the lack of urban protections may undermine care for millions of vulnerable urban residents and destabilize existing safety nets.
“While rural hospitals rightly received critical protections, urban safety-net hospitals have clearly been overlooked. Without comparable safeguards, vital healthcare services for millions of Medicaid-dependent urban residents are at risk, ” commented Doug Brown, Founder of Black Book Research. “Our flash poll highlights the urgent need for equity in the final bill negotiations. Congressional leaders must recognize the indispensable role urban safety-net hospitals play in delivering care to the nation’s most underserved populations.”
Urban hospital administrators urge lawmakers to ensure balanced, equitable emergency protections in ongoing legislative negotiations, calling for relief that supports the essential needs of both rural and urban hospitals.
How to Advocate: Hospital administrators and stakeholders are encouraged to contact their senators and representatives directly via www.congress.gov/members.
About Black Book Research
Black Book Research is an independent research firm specializing in healthcare market trends, vendor rankings, and provider insights. Employing impartial, data-driven methodologies and comprehensive surveys, Black Book tracks healthcare technology adoption and policy impacts while amplifying provider perspectives and identifying industry gaps.
Black Book’s rapid flash polling utilizes expert panels from both in-house and outsourced partners, ensuring timely, actionable intelligence on market and policy shifts. Access complimentary industry reports at www.blackbookmarketresearch.com or contact research@blackbookmarketresearch.com.
“There are so many people in our country who are right in the middle. They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work,” Harris said on ABC’s “The View,” part of a media blitz this week that’s putting her in front of friendlier interviewers with more targeted audiences.
Harris, who has promised on the campaign trail to improve long-term care, said the proposal will allow aging Americans to keep their dignity and help families with the emotional, financial and physical burdens of caring for their elders.
Nearly one-quarter of American adults are in the “sandwich generation,” which contains many remaining undecided voters, according to Harris campaign data. More than 105 million Americans are acting as caregivers, according to the campaign.
“We’re finding that so many are then having to leave their job, which means losing a source of income, not to mention the emotional stress,” Harris said Tuesday.
The plan calls for Medicare enrollees to be independently evaluated to determine whether they cannot handle activities of daily living, such as bathing, eating or going to the bathroom, according to a fact sheet issued by the campaign. The vast majority of seniors could continue living at home with an average of 20 hours or less a week of care provided by an aide, the fact sheet said.
Medicare would provide coverage for those with modest incomes, while seniors with higher incomes would share in the cost, according to the campaign.
Covering home health care, however, could be very expensive. One recent estimate from the Brookings Institution for a “very-conservatively designed” program, which would cover those unable to perform two activities of daily living and would require enrollees to share part of the cost, would have a price tag of about $40 billion a year.
The Harris campaign cited the Brookings research as a building block for the vice president’s proposal.
To cover the cost, Harris said she would expand Medicare drug price negotiations. Increasing drug discounts from manufacturers, implementing international tax reform and other measures would also help pay for the program.
In addition, Harris is proposing that Medicare cover hearing aids and exams, eye exams, and new glasses and lenses. She also wants to stop states from seizing seniors’ homes to recover Medicaid funds spent on long-term care services.
Costly long-term care
The proposal aims to address the long-term care needs of senior citizens and people with disabilities, helping them stay at home instead of moving to a nursing home, which can cost thousands of dollars a month. Medicare does not cover home health care except in very narrow circumstances. So most senior citizens have to pay for the services out of pocket or through Medicaid, if they are eligible.
On average, an American turning 65 in 2022 would incur an estimated $120,900 in future long-term services and supports, with families footing one-third of the bill themselves, according to the Department of Health and Human Services.
A home health aide costs nearly $69,000 a year for 40 hours of weekly care and more than $288,000 for round-the-clock services, while nursing home stays can total between $104,000 and nearly $117,000 a year, according to KFF, a nonpartisan health policy research organization. The typical Medicare beneficiary’s income is $36,000 a year.
In her caregiving push to voters, Harris has previously leaned into her experience of taking care of her late mother, Shyamala Gopalan, who died of colon cancer in 2009. She mentioned it again Tuesday, relaying the stress of taking care of a sick parent.
“That means trying to cook what they want to eat, what they can eat,” she said. “It means picking out clothes for them that [are] soft enough that it doesn’t irritate their skin, right? It means trying to think of something funny to make them laugh or smile.”
Some two-thirds of caregivers reporting having difficulty balancing their career and care responsibilities, according to a survey conducted in 2023 by AARP and S&P Global.
Just over a quarter of working caregivers have had to shift from full-time to part-time positions or have reduced hours, the survey found. About 1 in 6 stopped working for a period of time.
“Family caregivers are the backbone of a broken long-term care system, providing $600 billion in unpaid labor each year and saving taxpayers billions,” Nancy LeaMond, AARP’s chief public policy and engagement officer, said in a statement. “It is long past time for lawmakers to enact commonsense solutions that support family caregivers and help older Americans live independently in their homes, where they want to be.”
On the heels of Harris’ announcement, Care in Action PAC — the political arm of an organization advocating for care workers and care givers — announced a multimillion-dollar additional investment across battleground states and praised Harris’ longtime commitment to working adults who care for both their aging parents and their children.
“This is the financial relief that families are screaming for,” said the group’s executive director Hillary Holley. The money will in part support a new digital ad featuring a woman talking about her mother brushing her hair as a child and how she now has the responsibility of doing the same for her mother and daughter.
Harris’ appearance on “The View” comes as both she and her running mate, Minnesota Gov. Tim Walz, are appearing in a handful of interviews with traditional and new media figures after Republicans have criticized the pair for weeks for avoiding taking questions from the media.
