A group of 15 states have reached a tentative new deal that would require them to set aside hundreds of millions of dollars from the settlement in a legal-defense fund for the family.
Seven months after the Supreme Court struck down a deal that would have resolved thousands of opioid cases against Purdue Pharma, the company’s owners, members of the Sackler family, have increased their cash offer to settle the litigation — but with a novel catch.
Under the framework for a new deal, the Sacklers would not receive immunity from future opioid lawsuits, a condition that they had long insisted upon but that the court ruled was impermissible.
Instead, they would pay up to $6.5 billion — $500 million more than the previous agreement — but with a new condition: Claimants, including states, municipalities and individuals, would have to set aside as much as $800 million in an account akin to a legal-defense fund for the billionaires to fight such cases, according to people familiar with the negotiations.
Some details of the framework — but not the legal-defense fund — were announced on Thursday by the New York attorney general, Letitia James. She said the overall settlement totaled $7.4 billion, which would include $897 million from Purdue.
New York could receive as much as $250 million, she said.
“The Sackler family relentlessly pursued profit at the expense of vulnerable patients and played a critical role in starting and fueling the opioid epidemic,” Ms. James said.
When the deal is finalized, she added, the Sacklers will “no longer have control of Purdue and will never be allowed to sell opioids in the United States again.”
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California is advising health care providers not to write down patients’ immigration status on bills and medical records and telling them they don’t have to assist federal agents in arrests. Some Massachusetts hospitals and clinics are posting privacy rights in emergency and waiting rooms in Spanish and other languages.
Meanwhile, Florida and Texas are requiring health care facilities to ask the immigration status of patients and tally the cost to taxpayers of providing care to immigrants living in the U.S. without authorization.
Donald Trump returned to the White House declaring a national emergency at the U.S.-Mexico border, suspending refugee admissions, and challenging birthright citizenship, or the policy of giving U.S. citizenship to anyone born in the U.S. As he begins carrying out the “largest deportation operation” in the nation’s history, states have offered starkly different guidelines to hospitals, community clinics, and other health facilities for immigrant patients.
Trump has also rescinded a long-standing policy not to arrest people without legal status at or near sensitive locations, including schools, churches, and hospitals. A proposal to formalize such protections died in Congress in 2023.
But no matter the guidelines that states issue, hospitals around the U.S. say patients won’t be turned away for care because of their immigration status. “None of this changes the care patients receive,” said Carrie Williams, a spokesperson for the Texas Hospital Association, which represents hospitals and health care systems in the state. “We don’t want people to avoid care and worsen because they are concerned about immigration questions.”
During Trump’s first term, immigration agents arrested people receiving emergency care in hospitals and a child during an ambulance transfer. Immigration officers in Texas arrested a woman awaiting brain surgery in a hospital in Fort Worth. In Portland, Oregon, officers arrested a young man leaving a hospital, and in San Bernardino, California, a woman drove herself to the hospital to give birth after her husband was arrested at a gas station.
An estimated 11 million immigrants live in the United States without authorization, with the largest numbers in California, Texas, Florida, New York, New Jersey, and Illinois, according to Pew Research Center.
Half of immigrant adults likely without authorization are uninsured, compared with fewer than 1 in 10 citizens, according to the 2023 KFF-Los Angeles Times Survey of Immigrants, the largest nongovernmental survey of immigrants in the U.S. to date. While some states are highlighting health care expenses incurred by immigrants, a KFF brief noted that immigrants contribute more to the system through health insurance premiums and taxes than they use. Immigrants also have lower health care costs than citizens.
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Some health care providers fear Immigration and Customs Enforcement agents will disrupt their work at health facilities and cause patients, particularly children, to skip medical care. On Trump’s first day, the Republican president issued an executive order aimed at ending birthright citizenship for children born to a parent without legal authorization or on a visa, which could leave them ineligible for federal health and social programs. The order was immediately challenged by states and a civil rights group.
“You are instilling fear into folks who may defer care, who may go without care, whose children may not get the vaccines they need, who may not be able to get treatment for an ear infection or surgery,” said Minal Giri, a pediatrician and the chair of the Refugee/Immigrant Child Health Initiative at the Illinois chapter of the American Academy of Pediatrics.
A recent survey conducted by the Im/migrant Well-Being Research Center at the University of South Florida found that 66% of noncitizens reported increased hesitation in seeking care after Florida Gov. Ron DeSantis signed a law in 2023 requiring hospitals that accept Medicaid to ask about a patient’s legal status. That’s compared with just 27% for citizens.
“That really was alarming to me to see how this law made people hesitant to go to the doctor, even in an emergency,” said Liz Ventura Molina, a co-author of the survey and report.
In signing the law, DeSantis touted it as “the most ambitious anti-illegal immigration” legislation in the nation. This month, the Republican governor called for a special session of the state legislature to help support Trump’s immigration agenda.
Jackson Health System, a public safety net provider in Miami, said in a statement that quarterly reports to the state don’t contain individual patient information. “We do adhere to all required cooperation with law enforcement agencies, including ICE, as part of any criminal investigations, understanding that privacy laws mandate we only release private patient information through a court-ordered warrant.”
In August, Texas Gov. Greg Abbott, a Republican, issued an executive order similar to Florida’s law to record health care costs incurred by immigrants without legal authorization. All hospitals that receive funding from Medicaid or the Children’s Health Insurance Program are expected to begin reporting the data to Texas Health and Human Services in March.
Even cities controlled by Democrats are walking a fine line. New York City Mayor Eric Adams met in December with Trump’s incoming “border czar,” Tom Homan, and pledged to remove immigrants who have been convicted of a major felony and lack legal status to remain in the country.
At the same time, Adams proposed an awareness campaign to let immigrants and asylum-seekers know they are safe to use the city’s hospital systems.
Some states are going further by advising health facilities to do all they can to protect immigrant patients.
In December, California Attorney General Rob Bonta released a 42-page document recommending providers avoid including patients’ immigration status in bills and medical records. The guidance also emphasized that while providers should not physically obstruct immigration agents, they are under no obligation to assist with an arrest.
According to the document, health care facilities should post information about patients’ right to remain silent and are encouraged to provide patients with contact information for legal-aid groups “in the event that a parent is taken into immigration custody.” If feasible, it says, the facility should designate an immigrant-affairs liaison to help train staff and provide nonlegal advice to families.
“We cannot let the Trump deportation machine create a culture of fear and mistrust that prevents immigrants from accessing vital public services,” said Bonta, a Democrat.
On Tuesday, the Trump administration directed the Department of Justice to investigate state and local officials who don’t cooperate with immigration enforcement. During Trump’s first term, California limited cooperation with federal authorities, citing public safety and community trust concerns. The department, then under Jeff Sessions, sued to block the law but the state won in federal court, arguing that states have the authority to decide whether local resources are used to enforce federal law. The Trump administration appealed, but the Supreme Court turned down the petition.
Under California law, state-run health care facilities are required to adopt policies to limit their participation in immigration enforcement, and private entities are encouraged to follow similar protocols. David Simon, a spokesperson for the California Hospital Association, which represents more than 400 hospitals, said members have incorporated such policies, ensuring patient privacy.
“Hospitals don’t call ICE about patients,” Simon said.
California is bracing for a new round of clashes with Trump. Gov. Gavin Newsom and fellow Democratic state leaders have agreed to set aside $50 million for litigation and grants to nonprofit immigrant groups.
Lawmakers in New Jersey are considering legislation to limit health care facilities from asking about a patient’s immigration status. The bill would also require the state attorney general to establish policies for hospitals and health care facilities for ensuring patient access.
In New York City, hospital administrators are directing staff to seek guidance from an “immigration liaison” if immigration authorities show up, and to take photos and videos of any enforcement actions if they can’t reach them first. They are also discouraging staff from actively helping a person hide from ICE. In Massachusetts, some clinics and hospitals are training staff on how to read ICE warrants and plan to require ICE agents to identify themselves and present a warrant if they want to enter a private area.
“You can’t be scrambling in the moment,” said Altaf Saadi, a neurologist who co-directs a clinic for asylum-seekers at the Massachusetts General Hospital. “We have to prepare for these worst-case scenarios, and we hope that they don’t happen, but we do need to be prepared.”
President Donald Trump’s early actions on health care signal his likely intention to wipe away some Biden-era programs to lower drug costs and expand coverage under public insurance programs.
The orders he issued soon after reentering the White House have policymakers, health care executives, and patient advocates trying to read the tea leaves to determine what’s to come. The directives, while less expansive than orders he issued at the beginning of his first term, provide a possible road map that health researchers say could increase the number of uninsured Americans and weaken safety net protections for low-income people.
However, Trump’s initial orders will have little immediate impact. His administration will have to take further regulatory steps to fully reverse Biden’s policies, and the actions left unclear the direction the new president aims to steer the U.S. health care system.
“Everyone is looking for signals on what Trump might do on a host of health issues. On the early EOs, Trump doesn’t show his cards,” said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling, and news organization that includes KFF Health News.
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A flurry of executive orders and other actions Trump issued on his first day back in office included rescinding directives by his predecessor, former President Joe Biden, that had promoted lowering drug costs and expanding coverage under the Affordable Care Act and Medicaid.
Executive orders “as a general matter are nothing more than gussied up internal memoranda saying, ‘Hey, agency, could you do something?’” said Nicholas Bagley, a law professor at the University of Michigan. “There may be reason to be concerned, but it’s down the line.”
That’s because making changes to established law like the ACA or programs like Medicaid generally requires new rulemaking or congressional action, either of which could take months. Trump has yet to win Senate confirmation for any of his picks to lead federal health agencies, including Robert F. Kennedy Jr., the anti-vaccine activist and former Democratic presidential candidate he has nominated the lead the Department of Health and Human Services. On Monday, he appointed Dorothy Fink, a physician who directs the HHS Office on Women’s Health, as acting secretary for the department.
During Biden’s term, his administration did implement changes consistent with his health orders, including lengthening the enrollment period for the ACA, increasing funding for groups that help people enroll, and supporting the Inflation Reduction Act, which boosted subsidies to help people buy coverage. After falling during the Trump administration, enrollment in ACA plans soared under Biden, hitting record highs each year. More than 24 million people are enrolled in ACA plans for 2025.
The drug order Trump rescinded called on the Centers for Medicare & Medicaid Services to test ways to lower drug costs, such as setting a flat $2 copay for some generic drugs in Medicare, the health program for people 65 and older, and having states try to get better prices by banding together to buy certain expensive cell and gene therapies.
That might indicate Trump expects to do less on drug pricing this term or even roll back drug price negotiation in Medicare.
The White House did not respond to a request for comment.
Biden’s experiments in lowering drug prices didn’t fully get off the ground, said Joseph Antos of the American Enterprise Institute, a right-leaning research group. Antos said he’s a bit puzzled by Trump’s executive order ending the pilot programs, given that he has backed the idea of tying drug costs in the U.S. to lower prices paid by other nations.
“As you know, Trump is a big fan of that,” Antos said. “Lowering drug prices is an easy thing for people to identify with.”
In other moves, Trump also rescinded Biden orders on racial and gender equity and issued an order asserting that there are only two sexes, male and female. HHS under the Biden administration supported gender-affirming health care for transgender people and provided guidance on civil rights protections for transgender youths. Trump’s missive on gender has intensified concerns within the LGBTQ+ community that he will seek to restrict such care.
“The administration has forecast that it will fail to protect and will seek to discriminate against transgender people and anyone else it considers an ‘other,’” said Omar Gonzalez-Pagan, senior counsel and health care strategist at Lambda Legal, a civil rights advocacy group. “We stand ready to respond to the administration’s discriminatory acts, as we have previously done to much success, and to defend the ability of transgender people to access the care that they need, including through Medicaid and Medicare.”
Trump also halted new regulations that were under development until they are reviewed by the new administration. He could abandon some proposals that were yet to be finalized by the Biden administration, including expanded coverage of anti-obesity medications through Medicare and Medicaid and a rule that would limit nicotine levels in tobacco products, Katie Keith, a Georgetown University professor who was deputy director of the White House Gender Policy Council under Biden, wrote in an article for Health Affairs Forefront.
“Interestingly, he did not disturb President Biden’s three executive orders and a presidential memorandum on reproductive health care,” she wrote.
However, Trump instructed top brass in his administration to look for additional orders or memorandums to rescind. (He revoked the Biden order that created the Gender Policy Council.)
Democrats criticized Trump’s health actions. A spokesman for the Democratic National Committee, Alex Floyd, said in a statement that “Trump is again proving that he lied to the American people and doesn’t care about lowering costs — only what’s best for himself and his ultra-rich friends.”
Trump’s decision to end a Biden-era executive order aimed at improving the ACA and Medicaid probably portends coming cuts and changes to both programs, some policy experts say. His administration previously opened the door to work requirements in Medicaid — the federal-state program for low-income adults, children, and the disabled — and previously issued guidance enabling states to cap federal Medicaid funding. Medicaid and the related Children’s Health Insurance Program cover more than 79 million people.
“Medicaid will be a focus because it’s become so sprawling,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It’s grown after the pandemic. Provisions have expanded, such as using social determinants of health.”
The administration may reevaluate steps taken by the Biden administration to allow Medicaid to pay for everyday expenses some states have argued affect its beneficiaries’ health, including air conditioners, meals, and housing.
One of Trump’s directives orders agencies to deliver emergency price relief and “eliminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.” (Rent-seeking is an economic concept describing efforts to exploit the political system for financial gain without creating other benefits for society.)
“It is not clear what this refers to, and it will be interesting to see how agencies respond,” Keith wrote in her Health Affairs article.
Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans are working on budget proposals that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.
Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed to Congress: “On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes. But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid.”
This article was produced by KFF Health News, 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.
Newswise — The prevalence of diagnosed disorders from recurrent use of sedative, hypnotic and antianxiety medications in adolescents and young adults has increased sharply since 2001, according to Rutgers Health researchers.
Their study, published in Addiction, examined diagnoses of these disorders in adolescents and young adults between 2001 to 2019.
Sedative, hypnotic and antianxiety medications are used to treat a variety of conditions, including sleep and anxiety disorders. According to Harvard Health, consistent use of these drugs can lead to a higher tolerance for their effects, meaning patients require higher doses to achieve the intended effects.
For some, a problematic pattern of use of these medications can lead to significant impairment and distress. When this happens, patients may be diagnosed with sedative, hypnotic or anxiolytic use disorders, which are estimated to impact 2.2 million Americans, according to data from the National Survey on Drug Use and Health.
Using national Medicaid data from nearly 7 million adolescents and young adults in 2001 and 13 million adolescents and young adults in 2019, Rutgers Health researchers looked at trends in sedative, hypnotic or anxiolytic use disorder diagnoses. The prevalence increased threefold in adolescents and increased fivefold in young adults from 2001 to 2019.
“The increase in diagnoses of these disorders may be due to changes in the availability, use and misuse of sedatives, hypnotics and anxiolytics, as well as an increase in detection, awareness and diagnosing of these disorders,” said Greta Bushnell, an assistant professor at the Rutgers Center for Pharmacoepidemiology and Treatment Science (PETS) and lead author of the study.
Sedative, hypnotic and anti-anxiety medications are accessed in number of ways, including through medical prescriptions as well as through nonmedical sources such as a friend or in a medicine cabinet. Researchers found the prevalence of a sedative, hypnotic, or anxiolytic use disorders to be elevated in youths with prescriptions. However, the majority of adolescents and young adults diagnosed with a sedative, hypnotic or anxiolytic use disorder didn’t have a prescription for one of those medications.
“Efforts to target nonmedical use of these drugs is important as a means to reduce this disorder,” said Bushnell, who also is an assistant professor of epidemiology at Rutgers School of Public Health, “as is cautious prescribing in this young population.”
Researchers also found that most adolescents and young adults with sedative, hypnotic or anxiolytic use disorders had another comorbid substance use disorder diagnosis; in adolescents, cannabis use disorder was the most common and opioid use disorder in young adults.
“While sedative, hypnotic and anxiolytic use disorders are less common than other substance use disorders, it warrants attention from clinicians and researchers given treatment difficulties and the association with other substance use issues,” Bushnell said.
Examining trends in youth diagnosed with this disorder can lead to a better understanding of the population and improve support through care and resources, say researchers.
Coauthors of the study include Kristen Lloyd and Tobias Gerhard of PETS and Rutgers Institute for Health, Health Care Policy and Aging Research; Katherine Keyes, Mark Olfson and Deborah Hasin of Columbia University; and Magdalena Cerdá of New York University.
From rolling back drug pricing policies to limiting gender-affirming care, President Donald Trump signed several health-related executive orders in the first hours of his second presidency. Here’s a roundup of the changes and what they mean.
This slide presentation first appeared on KFF Health News’ Instagram account. If you enjoyed this story from the KFF Health News social team, follow us on Instagram @kffhealthnews.
Erica Hayes, 40, has not felt healthy since November 2020 when she first fell ill with covid.
Hayes is too sick to work, so she has spent much of the last four years sitting on her beige couch, often curled up under an electric blanket.
“My blood flow now sucks, so my hands and my feet are freezing. Even if I’m sweating, my toes are cold,” said said Hayes, who lives in Western Pennsylvania. She misses feeling well enough to play with her 9-year-old son or attend her 17-year-old son’s baseball games.
Along with claiming the lives of 1.2 million Americans, the covid-19 pandemic has been described as a mass disabling event. Hayes is one of millions of Americans who suffer from long covid. Depending on the patient, the condition can rob someone of energy, scramble the autonomic nervous system, or fog their memory, among many other symptoms.
In addition to the brain fog and chronic fatigue, Hayes’ constellation of symptoms includes frequent hives and migraines. Also, her tongue is constantly swollen and dry.
“I’ve had multiple doctors look at it and tell me they don’t know what’s going on,” Hayes said about her tongue.
Estimates of prevalence range considerably, depending on how researchers define long covid in a given study, but the Centers for Disease Control and Prevention puts it at 17 million adults.
Despite long covid’s vast reach, the federal government’s investment in researching the disease — to the tune of $1.15 billion as of December — has so far failed to bring any new treatments to market.
This disappoints and angers the patient community, who say the National Institutes of Health should focus on ways to stop their suffering instead of simply trying to understand why they’re suffering.
“It’s unconscionable that more than four years since this began, we still don’t have one FDA-approved drug,” said Meighan Stone, executive director of the Long COVID Campaign, a patient-led advocacy organization. Stone was among several people with long covid who spoke at a workshop hosted by the NIH in September where patients, clinicians, and researchers discussed their priorities and frustrations around the agency’s approach to long-covid research.
Some doctors and researchers are also critical of the agency’s research initiative, called RECOVER, or Researching COVID to Enhance Recovery. Without clinical trials, physicians specializing in treating long covid must rely on hunches to guide their clinical decisions, said Ziyad Al-Aly, chief of research and development with the VA St Louis Healthcare System.
“What [RECOVER] lacks, really, is clarity of vision and clarity of purpose,” said Al-Aly, saying he agrees that the NIH has had enough time and money to produce more meaningful progress.
Now the NIH is starting to determine how to allocate an additional $662 million of funding for long-covid research, $300 million of which is earmarked for clinical trials. These funds will be allocated over the next four years.
At the end of October, RECOVER issued a request for clinical trial ideas that look at potential therapies, including medications, saying its goal is “to work rapidly, collaboratively, and transparently to advance treatments for Long COVID.”
This turn suggests the NIH has begun to respond to patients. This has stirred cautious optimism among those who say that the agency’s approach to long covid has lacked urgency in the search for effective treatments.
Stone calls this $300 million a down payment. She warns it’s going to take a lot more money to help people like Hayes regain some degree of health.
“There really is a burden to make up this lost time now,” Stone said.
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The NIH told KFF Health News and NPR via email that it recognizes the urgency in finding treatments. But to do that, there needs to be an understanding of the biological mechanisms that are making people sick, which is difficult to do with post-infectious conditions.
That’s why it has funded research into how long covid affects lung function, or trying to understand why only some people are afflicted with the condition.
Then-NIH Director Francis Collins explained that RECOVER’s goal was to better understand long covid as a disease and that clinical trials of potential treatments would come later.
According to RECOVER’s website, it has funded eight clinical trials to test the safety and effectiveness of an experimental treatment or intervention. Just one of those trials has published results.
On the other hand, RECOVER has supported more than 200 observational studies, such as research on how long covid affects pulmonary function and on which symptoms are most common. And the initiative has funded more than 40 pathobiology studies, which focus on the basic cellular and molecular mechanisms of long covid.
RECOVER’s website says this research has led to crucial insights on the risk factors for developing long covid and on understanding how the disease interacts with preexisting conditions.
It notes that observational studies are important in helping scientists to design and launch evidence-based clinical trials.
Long-covid activists attend a Senate Appropriations subcommittee hearing on National Institutes of Health funding in May.(Tom Williams/CQ Roll Call via Getty Images)
Good science takes time, said Leora Horwitz, the co-principal investigator for the RECOVER-Adult Observational Cohort at New York University. And long covid is an “exceedingly complicated” illness that appears to affect nearly every organ system, she said.
This makes it more difficult to study than many other diseases. Because long covid harms the body in so many ways, with widely variable symptoms, it’s harder to identify precise targets for treatment.
“I also will remind you that we’re only three, four years into this pandemic for most people,” Horwitz said. “We’ve been spending much more money than this, yearly, for 30, 40 years on other conditions.”
NYU received nearly $470 million of RECOVER funds in 2021, which the institution is using to spearhead the collection of data and biospecimens from up to 40,000 patients. Horwitz said nearly 30,000 are enrolled so far.
This vast repository, Horwitz said, supports ongoing observational research, allowing scientists to understand what is happening biologically to people who don’t recover after an initial infection — and that will help determine which clinical trials for treatments are worth undertaking.
“Simply trying treatments because they are available without any evidence about whether or why they may be effective reduces the likelihood of successful trials and may put patients at risk of harm,” she said.
Delayed Hopes or Incremental Progress?
The NIH told KFF Health News and NPR that patients and caregivers have been central to RECOVER from the beginning, “playing critical roles in designing studies and clinical trials, responding to surveys, serving on governance and publication groups, and guiding the initiative.”
But the consensus from patient advocacy groups is that RECOVER should have done more to prioritize clinical trials from the outset. Patients also say RECOVER leadership ignored their priorities and experiences when determining which studies to fund.
RECOVER has scored some gains, said JD Davids, co-director of Long COVID Justice. This includes findings on differences in long covid between adults and kids.
But Davids said the NIH shouldn’t have named the initiative “RECOVER,” since it wasn’t designed as a streamlined effort to develop treatments.
“The name’s a little cruel and misleading,” he said.
The patient advocacy groups #MEAction and Body Politic organized an installation of hundreds of cots on the National Mall in Washington in May 2023 to represent the millions of people “missing” from daily life because of long covid and myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS.(Sarah Silbiger/Bloomberg via Getty Images)
RECOVER’s initial allocation of $1.15 billion probably wasn’t enough to develop a new medication to treat long covid, said Ezekiel J. Emanuel, co-director of the University of Pennsylvania’s Healthcare Transformation Institute.
But, he said, the results of preliminary clinical trials could have spurred pharmaceutical companies to fund more studies on drug development and test how existing drugs influence a patient’s immune response.
Emanuel is one of the authors of a March 2022 covid roadmap report. He notes that RECOVER’s lack of focus on new treatments was a problem. “Only 15% of the budget is for clinical studies. That is a failure in itself — a failure of having the right priorities,” he told KFF Health News and NPR via email.
And though the NYU biobank has been impactful, Emanuel said there needs to be more focus on how existing drugs influence immune response.
He said some clinical trials that RECOVER has funded are “ridiculous,” because they’ve focused on symptom amelioration, for example to study the benefits of over-the-counter medication to improve sleep. Other studies looked at non-pharmacological interventions, such as exercise and “brain training” to help with cognitive fog.
People with long covid say this type of clinical research contributes to what many describe as the “gaslighting” they experience from doctors, who sometimes blame a patient’s symptoms on anxiety or depression, rather than acknowledging long covid as a real illness with a physiological basis.
“I’m just disgusted,” said long-covid patient Hayes. “You wouldn’t tell somebody with diabetes to breathe through it.”
Chimére L. Sweeney, director and founder of the Black Long Covid Experience, said she’s even taken breaks from seeking treatment after getting fed up with being told that her symptoms were due to her diet or mental health.
“You’re at the whim of somebody who may not even understand the spectrum of long covid,” Sweeney said.
After developing long covid in late 2020, Erica Hayes has struggled with chronic fatigue and brain fog. When she’s feeling well enough, she enjoys spending time with her flock of 10 chickens.(Sarah Boden for KFF Health News)
Insurance Battles Over Experimental Treatments
Since there are still no long-covid treatments approved by the Food and Drug Administration, anything a physician prescribes is classified as either experimental — for unproven treatments — or an off-label use of a drug approved for other conditions. This means patients can struggle to get insurance to cover prescriptions.
For example, intravenous immunoglobulin therapy, low-dose naltrexone, and hyperbaric oxygen therapy are all promising treatments, he said.
For hyperbaric oxygen, two small, randomized controlled studies show improvements for the chronic fatigue and brain fog that often plague long-covid patients. The theory is that higher oxygen concentration and increased air pressure can help heal tissues that were damaged during a covid infection.
However, the out-of-pocket cost for a series of sessions in a hyperbaric chamber can run as much as $8,000, Brode said.
“Am I going to look a patient in the eye and say, ‘You need to spend that money for an unproven treatment’?” he said. “I don’t want to hype up a treatment that is still experimental. But I also don’t want to hide it.”
There’s a host of pharmaceuticals that have promising off-label uses for long covid, said microbiologist Amy Proal, president and chief scientific officer at the Massachusetts-based PolyBio Research Foundation. For instance, she’s collaborating on a clinical study that repurposes two HIV drugs to treat long covid.
Proal said research on treatments can move forward based on what’s already understood about the disease. For instance, she said that scientists have evidence — partly due to RECOVER research — that some patients continue to harbor small amounts of viral material after a covid infection. She has not received RECOVER funds but is researching antivirals.
But to vet a range of possible treatments for the millions suffering now — and to develop new drugs specifically targeting long covid — clinical trials are needed. And that requires money.
Hayes said she would definitely volunteer for an experimental drug trial. For now, though, “in order to not be absolutely miserable,” she said she focuses on what she can do, like having dinner with her family.
At the same time, Hayes doesn’t want to spend the rest of her life on a beige couch.
RECOVER’s deadline to submit research proposals for potential long-covid treatments is Feb. 1.
This article is from a partnership that includes NPR and KFF Health News.
Covered California, the state’s health insurance marketplace, has hit a record 1.8 million enrollees and the number could climb higher ahead of a Jan. 31 open enrollment deadline, due in large part to enhanced subsidies that have made plans more affordable.
But the state’s progress in extending health coverage to all residents could come to an abrupt halt as the second Trump administration takes power alongside a Republican Congress whose leadership has long been hostile to the Affordable Care Act, the 2010 federal law also known as Obamacare.
Top of mind for Covered California officials is the looming expiration of the additional federal subsidies for health insurance approved by Congress in 2021 as part of a covid pandemic relief package. That resulted in lower premiums for people around the country — especially middle-class households — who buy health insurance through the exchanges established by the Affordable Care Act.
“Whether there will be action to extend the enhanced subsidies — that’s a big impact that we are closely tracking,” said Covered California Executive Director Jessica Altman, who noted the program had about 1.5 million enrollees prior to enhanced subsidies.
Republicans have criticized the cost of the subsidies, and it’s not clear they’ll renew them.
Without an extension, researchers at the University of California-Berkeley Labor Center estimate, Covered California premiums for subsidized enrollees would soar by an average of $967 a year beginning in 2026, and an estimated 69,000 Californians would lose their insurance.
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California took its own steps last year to make coverage more affordable, eliminating deductibles and reducing other out-of-pocket costs on all mid-tier policies known as “silver” plans.
However, the state’s health care spending is likely to face fresh pressure if Republicans in Washington follow through on long-standing designs to cut funding for Medicaid, the health insurance program for low-income Americans, known in California as Medi-Cal. In addition to bolstering Covered California, the state has also aggressively pushed to expand Medi-Cal, including to immigrants living in the U.S. without authorization, and now spends $161 billion a year on that program, about half paid by the federal government.
About 144,000 of Covered California’s 1.8 million enrollees as of Dec. 14 are first-time buyers, and nearly 90% of all enrollees qualify for financial help. Covered California has extended the enrollment period to March 8 for residents in Los Angeles and Ventura counties due to wildfires, and has also issued extensions related to the bird flu and an earthquake in Northern California.
Low-income residents pay little or nothing for monthly premiums, while for those earning more, premiums are capped at a percentage of household income. With the enhanced federal subsidies, no one is required to spend more than 8.5% of their income on premiums, provided they stick to a silver plan. Such plans, however, can have smaller provider networks and significant out-of-pocket costs.
According to Covered California, the average monthly premium is $136 for those who receive subsidies, two-thirds of whom pay $10 or less a month. But people with higher incomes can end up paying significantly more. For example, a family of four making $200,000 in the Los Angeles area would pay well over $1,000 a month for a silver plan, according to a calculator for estimating costs.
While federal and state subsidies have significantly boosted the amount of assistance available, the underlying cost of insurance has continued to go up. Covered California premiums are up by 7.9% on average for 2025, but the extra subsidies shield most enrollees from the increase.
“You end up with people’s out-of-pocket spending probably being lower than we’ve seen,” said Dylan Roby, a professor of health, society, and behavior at the University of California-Irvine. “That doesn’t necessarily mean that premiums are going down. It just means that the state or federal government is paying a larger share of premiums on behalf of enrollees than before.”
Neither Trump nor incoming congressional leaders have given clear signals about how they view the future of the subsidies, but both have a history of seeking to repeal and weaken the Affordable Care Act. House Speaker Mike Johnson has vowed “massive reform” of the health care law, though without offering specifics.
Experts including Roby say Republicans could extend the subsidies to avoid an outcry from consumers, health insurers, hospitals, and others who have benefited from them. Enrollment in marketplace plans is especially high in Republican-controlled states that have not expanded Medicaid, because it offers low-income people a way to access affordable health insurance.
“I don’t think Republican House members are that inclined to make all of their constituents’ health insurance premiums go up,” Roby said. “I’m kind of optimistic that [the subsidies] will be renewed.”
But uncertainty over the future of the subsidies, even if they eventually get renewed, could affect the cost of marketplace plans, said Rachel Linn Gish, communications director for Health Access California, a consumer advocacy coalition. That’s because insurers are already starting to plan their rates for next year and will likely price in the risk of nonrenewal, she said.
“We are going to be fighting for the next year to try to save those enhanced subsidies and subsequently all of the other frameworks and financing of the Affordable Care Act,” Linn Gish said. “Because if any of that gets rolled back, people will lose health care coverage.”
The life expectancy among Native Americans in the western United States has dropped below 64 years, close to life expectancies in the Democratic Republic of the Congo and Haiti. For many Asian Americans, it’s around 84 — on par with life expectancies in Japan and Switzerland.
Americans’ health has long been unequal, but a new study shows that the disparity between the life expectancies of different populations has nearly doubled since 2000. “This is like comparing very different countries,” said Tom Bollyky, director of the global health program at the Council on Foreign Relations and an author of the study.
Called “Ten Americas,” the analysis published late last year in The Lancet found that “one’s life expectancy varies dramatically depending on where one lives, the economic conditions in that location, and one’s racial and ethnic identity.” The worsening health of specific populations is a key reason the country’s overall life expectancy — at 75 years for men and 80 for women — is the shortest among wealthy nations.
To deliver on pledges from the new Trump administration to make America healthy again, policymakers will need to fix problems undermining life expectancy across all populations.
“As long as we have these really severe disparities, we’re going to have this very low life expectancy,” said Kathleen Harris, a sociologist at the University of North Carolina. “It should not be that way for a country as rich as the U.S.”
Since 2000, the average life expectancy of many American Indians and Alaska Natives has been steadily shrinking. The same has been true since 2014 for Black people in low-income counties in the southeastern U.S.
“Some groups in the United States are facing a health crisis,” Bollyky said, “and we need to respond to that because it’s worsening.”
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Heart disease, car fatalities, diabetes, covid-19, and other common causes of death are directly to blame. But research shows that the conditions of people’s lives, their behaviors, and their environments heavily influence why some populations are at higher risk than others.
Native Americans in the West — defined in the “Ten Americas” study as more than a dozen states excluding California, Washington, and Oregon — were among the poorest in the analysis, living in counties where a person’s annual income averages below about $20,000. Economists have shown that people with low incomes generally live shorter lives.
About 1 in 5 Native Americans in the Southwest don’t have health insurance, according to a KFF report. Although the Indian Health Service provides coverage, the report says the program is weak due to chronic underfunding. This means people may delay or skip treatments for chronic illnesses. Postponed medical care contributed to the outsize toll of covid among Native Americans: About 1 of every 188 Navajo people died of the disease at the peak of the pandemic.
“The combination of limited access to health care and higher health risks has been devastating,” Bollyky said.
At the other end of the spectrum, the study’s category of Asian Americans maintained the longest life expectancies since 2000. As of 2021, it was 84 years.
Education may partly underlie the reasons certain groups live longer. “People with more education are more likely to seek out and adhere to health advice,” said Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington, and an author of the paper. Education also offers more opportunities for full-time jobs with health benefits. “Money allows you to take steps to take care of yourself,” Mokdad said.
The group with the highest incomes in most years of the analysis was predominantly composed of white people, followed by the mainly Asian group. The latter, however, maintained the highest rates of college graduation, by far. About half finished college, compared with fewer than a third of other populations.
The study suggests that education partly accounts for differences among white people living in low-income counties, where the individual income averaged less than $32,363. Since 2000, white people in low-income counties in southeastern states — defined as those in Appalachia and the Lower Mississippi Valley — had far lower life expectancies than those in upper midwestern states including Montana, Nebraska, and Iowa. (The authors provide details on how the groups were defined and delineated in their report.)
Opioid use and HIV rates didn’t account for the disparity between these white, low-income groups, Bollyky said. But since 2010, more than 90% of white people in the northern group were high school graduates, compared with around 80% in the southeastern U.S.
The education effect didn’t hold true for Latino groups compared with others. Latinos saw lower rates of high school graduation than white people but lived longer on average. This long-standing trend recently changed among Latinos in the Southwest because of covid. Hispanic or Latino and Black people were nearly twice as likely to die from the disease.
On average, Black people in the U.S. have long experienced worse health than other races and ethnicities in the United States, except for Native Americans. But this analysis reveals a steady improvement in Black people’s life expectancy from 2000 to about 2012. During this period, the gap between Black and white life expectancies shrank.
This is true for all three groups of Black people in the analysis: Those in low-income counties in southeastern states like Mississippi, Louisiana, and Alabama; those in highly segregated and metropolitan counties, such as Queens, New York, and Wayne, Michigan, where many neighborhoods are almost entirely Black or entirely white; and Black people everywhere else.
Better drugs to treat high blood pressure and HIV help account for the improvements for many Americans between 2000 to 2010. And Black people, in particular, saw steep rises in high school graduation and gains in college education in that period.
However, progress stagnated for Black populations by 2016. Disparities in wealth grew. By 2021, Asian and many white Americans had the highest incomes in the study, living in counties with per capita incomes around $50,000. All three groups of Black people in the analysis remained below $30,000.
A wealth gap between Black and white people has historical roots, stretching back to the days of slavery, Jim Crow laws, and policies that prevented Black people from owning property in neighborhoods that are better served by public schools and other services. For Native Americans, a historical wealth gap can be traced to a near annihilation of the population and mass displacement in the 19th and 20th centuries.
Inequality has continued to rise for several reasons, such as a widening pay gap between predominantly white corporate leaders and low-wage workers, who are disproportionately people of color. And reporting from KFF Health News shows that decisions not to expand Medicaid have jeopardized the health of hundreds of thousands of people living in poverty.
Researchers have studied the potential health benefits of reparation payments to address historical injustices that led to racial wealth gaps. One new study estimates that such payments could reduce premature death among Black Americans by 29%.
Less controversial are interventions tailored to communities. Obesity often begins in childhood, for example, so policymakers could invest in after-school programs that give children a place to socialize, be active, and eat healthy food, Harris said. Such programs would need to be free for children whose parents can’t afford them and provide transportation.
But without policy changes that boost low wages, decrease medical costs, put safe housing and strong public education within reach, and ensure access to reproductive health care including abortion, Harris said, the country’s overall life expectancy may grow worse.
“If the federal government is really interested in America’s health,” she said, “they could grade states on their health metrics and give them incentives to improve.”
This article was produced by KFF Health News, 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.
A couple of years ago, Robert Wolfe was experimenting with an artificial intelligence system. He wanted it to complete the sentence, “The teenager ____ at school.” Wolfe, a University of Washington doctoral student in the Information School, had expected something mundane, something that most teenagers do regularly — perhaps “studied.” But the model plugged in “died.”
This shocking response led Wolfe and a UW team to study how AI systems portray teens. The researchers looked at two common, open-source AI systems trained in English and one trained in Nepali. They wanted to compare models trained on data from different cultures, and co-lead author Aayushi Dangol, a UW doctoral student in human centered design and engineering, grew up in Nepal and is a native Nepali speaker.
In the English-language systems, around 30% of the responses referenced societal problems such as violence, drug use and mental illness. The Nepali system produced fewer negative associations in responses, closer to 10% of all answers. Finally, the researchers held workshops with groups of teens from the U.S. and Nepal, and found that neither group felt that an AI system trained on media data containing stereotypes about teens would accurately represent teens in their cultures.
The team presented its research Oct. 22 at the AAAI/ACM Conference on AI, Ethics and Society in San Jose.
“We found that the way teens viewed themselves and the ways the systems often portrayed them were completely uncorrelated,” said co-lead author Wolfe. “For instance, the way teens continued the prompts we gave AI models were incredibly mundane. They talked about video games and being with their friends, whereas the models brought up things like committing crimes and bullying.”
The team studied OpenAI’s GPT-2, the last open-source version of the system that underlies ChatGPT; Meta’s LLaMA-2, another popular open-source system; and DistilGPT2 Nepali, a version of GPT-2 trained on Nepali text. Researchers prompted the systems to complete sentences such as “At the party, the teenager _____” and “The teenager worked because they wanted_____.”
The researchers also looked at static word embeddings — a method of representing a word as a series of numbers and calculating the likelihood of it occurring with certain other words in large text datasets — to find what terms were most associated with “teenager” and its synonyms. Out of 1,000 words from one model, 50% were negative.
The researchers concluded that the systems’ skewed portrayal of teenagers came in part from the abundance of negative media coverage about teens; in some cases, the models studied cited media as the source of their outputs. News stories are seen as “high-quality” training data, because they’re often factual, but they frequently focus on negative stories, not the quotidian parts of most teens’ lives.
“There’s a deep need for big changes in how these models are trained,” said senior author Alexis Hiniker, a UW associate professor in the Information School. “I would love to see some sort of community-driven training that comes from a lot of different people, so that teens’ perspectives and their everyday experiences are the initial source for training these systems, rather than the lurid topics that make news headlines.”
To compare the AI outputs to the lives of actual teens, researchers recruited 13 American and 18 Nepalese teens for workshops. They asked the participants to write words that came to mind about teenagers, to rate 20 words on how well they describe teens and to complete the prompts given to the AI models. The similarities between the AI systems’ responses and the teens’ were limited. The two groups of teens differed, however, in how they wanted to see fairer representations of teens in AI systems.
“Reliable AI needs to be culturally responsive,” Wolfe said. “Within our two groups, the U.S. teens were more concerned with diversity — they didn’t want to be presented as one unit. The Nepalese teens suggested that AI should try to present them more positively.”
The authors note that, because they were studying open-source systems, the models studied aren’t the most current versions — GPT-2 dates to 2019, while the LLAMA model is from 2023. Chatbots, such as ChatGPT, built on later versions of these systems typically undergo further training and have guardrails in place to protect against such overt bias.
“Some of the more recent models have fixed some of the explicit toxicity,” Wolfe said. “The danger, though, is that those upstream biases we found here can persist implicitly and affect the outputs as these systems become more integrated into peoples’ lives, as they get used in schools or as people ask what birthday present to get for their 14-year-old nephew. Those responses are influenced by how the model was initially trained, regardless of the safeguards we later install.”
Jan. 9, 2025 – After sleeping in the jungle for 26 days, Carolyn Wiger, 37, is more than ready to take on The Traitors. “I do think I need to calm down a little bit, but I really don’t want to—I’m just too excited!” The Minnesota native has dealt with addiction in the past, which helped inspire her career path—and prepared her well to play these types of strategic games.
“Active addiction is mental and emotional torture,” she told Parade in 2023 ahead of her Survivor debut. “It took me years to realize my mistakes don’t define me. I’ve worked hard to become this person I am proud of. I know this game will break me down but I am strong, resilient, and most importantly I believe in myself!”
Here’s what Carolyn has shared about her struggles—and how she’s helping others now.
