San Diego, CA – Hackensack Meridian JFK Johnson Rehabilitation Institute, a nationally recognized leader in physical medicine and rehabilitation, is proud to announce its participation in the upcoming American Academy of Physical Medicine And Rehabilitation Annual Assembly (AAPMR) 2024 Annual Assembly, taking place November 6-10 in San Diego, CA.
Hackensack Meridian JFK Johnson Rehabilitation Institute physicians and researchers are available for interviews. They will be presenting numerous research and poster presentations, including:
Transforming Stroke Care with Cardiac Rehab
Dr. Sara Cuccurullo and Dr. Talya Fleming, renowned experts from JFK Johnson, will present “Transforming Stroke Care with Cardiac Rehab: Saving Lives, Optimizing Recovery, and Driving Change in Policy” on Thursday, November 7th. Their Stroke-HEART (TM) Trials have found that survivors of stroke could reduce mortality risk by 76 percent if they completed a modified cardiac rehabilitation program.
Engaging PM&R Trainees in Research
Dr. Kristen Harris, a dedicated educator and researcher at JFK Johnson, will deliver an oral presentation titled “How to Get Involved in Research: A Systemic Guide for the PM&R Trainee” on Friday, November 8th. This session provides a roadmap for trainees interested in research, outlining practical steps and resources available at JFK Johnson and beyond.
Exploring the Biphasic Effects of Cannabis and Cannabinoids
Dr. Alexander Shustorovich, a leading researcher at JFK Johnson, will present a poster titled “Biphasic effects of cannabis and cannabinoid therapy on pain severity, anxiety and sleep disturbance: A scoping review” on Saturday, November 9th. This research delves into the complex relationship between cannabis and cannabinoids and their impact on pain, anxiety, and sleep, offering valuable insights for patient care.
Investigating Subarachnoid Hemorrhage and its Impact
A team led by Dr. Ally Ferber, a renowned neurorehabilitation specialist at JFK Johnson, will present two posters on Friday, November 8th: “A Brain Bleed That Breaks the Heart: Subarachnoid Hemorrhage Induced Takotsubo Cardiomyopathy” and “No Gains No Pains: Weightlifting-Induced Subarachnoid Hemorrhage due to Venous Perimesencephalic Bleed.” These presentations explore the diverse and often unexpected consequences of subarachnoid hemorrhage, highlighting the institute’s expertise in managing complex neurological conditions.
Unveiling Statin-Induced Autoimmune Myopathy
Dr. Esha Patel and colleagues, experts in neuromuscular disorders at JFK Johnson, will present a poster titled “Statin’ the Obvious: Statin Necrotizing Autoimmune Myopathy” on Friday, November 8th. This research sheds light on a rare but serious side effect of statin medications, providing valuable insights for clinicians and patients alike.
A Rare Case of Takotsubo Cardiomyopathy after Brain Trauma
Dr. Aimee Abbott-Korumi and a team of researchers from JFK Johnson will present a poster titled “A Rare Case of Takotsubo Cardiomyopathy after Brain Trauma” on Saturday, November 9th. This case study explores the complex interplay between brain trauma and heart health, showcasing the institute’s commitment to advancing understanding and treatment of these conditions.
Sphenopalatine Ganglion Block for Central Pain
Dr. Abbott-Korumi will also present a poster titled “Sphenopalatine Ganglion Block for Central Pain after Thalmic Ischemic Stroke” online from November 6th to 10th. This research investigates a novel treatment approach for chronic pain following stroke, demonstrating JFK Johnson’s dedication to exploring innovative pain management strategies.
Dr. Cuccurullo serves as Co-Director of the Chair Program Summit and will participate in the AAPM&R Graduate Medical Education Academic Leaders Lunch. Dr. Fleming is a member of the Exercise As a Medicine Member Community Meeting and the Board of Governors Closing Meeting. Additionally, she co-chairs the Academy’s PM&R BOLD Steering Committee and the Rehabilitation Care Continuum (RCC) practice area. Dr. Bagay serves as Community Session Director for both the Cancer Rehabilitation Medicine Business Meeting and the Cancer Rehabilitation Medicine Meet-up, and will also participate in the AAPM&R GME Academic Leaders Lunch.
“Right To Try” experimental drug program saved “thousands and thousands of lives”
Former President Donald Trump on Aug. 30
Former President Donald Trump has boasted in recent months about “Right To Try,” a law he signed in 2018. It’s aimed at boosting terminally ill patients’ access to potentially lifesaving medications not yet approved by the Food and Drug Administration.
“We have things to fight off diseases that will not be approved for another five or six years that people that are very sick, terminally ill, should be able to use. But there was no mechanism for doing it,” Trump said Aug. 30, speaking in Washington, D.C., to supporters of the conservative parental rights advocacy group Moms for Liberty.
He also said that because of Right To Try, “we have saved thousands and thousands of lives.”
Trump similarly praised the program during an Aug. 17 rally in Pennsylvania, in a podcast interview with a conservative commentator, and during his Republican National Convention acceptance speech: “Right To Try is a big deal,” Trump said then.
Medical experts who’ve studied the experimental treatment program, however, say there’s no evidence to support Trump’s claims. These experts say Right To Try weakened regulations intended to protect patients.
What Is Right To Try?
The Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right To Try Act, aka Right To Try, passed Congress on a bipartisan basis and was signed into law in 2018. It sought to streamline the process for getting potentially lifesaving drugs that weren’t yet FDA-approved to terminally ill patients. The speed matters; industry groups say it takes 10 to 15 years on average for a new medicine to reach pharmacy shelves.
However, a similar FDA program, the expanded access pipeline, sometimes called “compassionate use,” has existed since the 1970s, and became law in 1987.
And that is the root of many criticisms of Right To Try.
“Right To Try is basically ‘expanded access light,’” said Alison Bateman-House, a medical ethicist who researches access to investigational medical products at New York University’s Grossman School of Medicine.
Right To Try caters to fewer patients than expanded access and offers them fewer treatments, Bateman-House said.
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Easing Access or Erasing Safeguards?
Patients must meet specific, but different, criteria to qualify for either experimental medication program.
To qualify for expanded use, patients must have a “serious or immediately life-threatening disease or condition” for which there is no “comparable or satisfactory alternative therapy available to diagnose, monitor, or treat the disease or condition,” according to government regulations. Clinical trials must be infeasible for the patients, and the use of these drugs must not interfere with any in-progress studies. Also, the potential benefits must justify the risks, according to the prescribing physicians.
Then, after identifying a treatment, the patient’s doctor must receive approval from its manufacturer, the FDA, and the institutional review board overseeing the medication’s clinical trials.
The FDA said these steps exist so the agency can “fairly weigh the risks and benefits” of the medication and protect the patient’s safety. The agency also collects data about the drugs’ clinical impact on the patient and any adverse effects to inform the wider approval process for the drug.
Right To Try sought to hasten this approval process. Under the new program, for instance, a doctor must merely identify an experimental medication and receive authorization to use it from the manufacturer. In most cases, the FDA has no authority to approve or deny the application, and there’s no review board process to navigate.
But, because of the Right To Try program’s definitions, fewer patients and fewer medicines qualify.
Under Right To Try, patients must have a “life-threatening” disease or condition, not just “serious,” as with expanded access. Experimental medications are available only after they’ve completed Phase 1 clinical trials; treatments accessed through the expanded access program can be administered during a Phase 1 study.
Right To Try, which includes liability protections for manufacturers and prescribing physicians, also weakens requirements that govern how doctors disclose experimental medications’ risks to patients, leaving informed consent undefined. And it prevents the FDA from using information about how patients tolerate the drugs to “delay or adversely affect the review or approval of such drug(s),” unless top officials justify the benefit to public health in writing.
Supporters say Right To Try is an example of successful deregulation and claim that its more efficient approval process saved lives. But critics see this as a key reason for concern, because it “opens up the opportunity of exploiting desperate patients,” said Holly Fernandez Lynch, a bioethicist who studies pharmaceutical policy at the University of Pennsylvania’s Perelman School of Medicine.
Government data shows regulatory agencies weren’t the main hurdle patients faced when seeking experimental drugs. The FDA almost always approved expanded access applications, and quickly by government standards.
According to a 2018 FDA report on the expanded access program, the FDA authorized 99% of the roughly 9,000 requests it received in the previous five years, approving emergency requests for experimental medications in less than one day on average. More recent data shows that approval trend has continued, even as the number of applications has grown each year.
In rare cases in which the FDA didn’t automatically approve requests, regulators often didn’t deny them, but recommended tweaks to the requested dosage to address safety and effectiveness concerns.
Right To Try by the Numbers
The FDA does not share detailed information about the number of doses provided or patients treated under Right To Try. Instead, it posts only an annual summary showing how many drugs have been approved under the program. The agency says that since Right To Try began in 2018 it has approved 16 treatments: 12 from 2018 to 2022 and four last year.
The FDA declined to provide additional information about the number of Right To Try requests or approvals.
Although the 16 medications approved through Right To Try were possibly provided to more than one patient each, experts said it’s extremely unlikely thousands of patients were involved, as Trump said.
Trump’s claim represents an “egregious overestimate of the number of people who are using Right To Try,” said Fernandez Lynch, noting she believes the real numbers are “very, very low.”
The Trump campaign did not respond to multiple inquiries about the source of the former president’s statistics. Karoline Leavitt, the campaign’s national press secretary, told KFF Health News that in a second term “President Trump will of course remain open to other pathways to expand ‘Right to Try’ to save more American lives.”
It remains unclear how Trump might expand the program, though the conservative Goldwater Institute is advocating for “Right To Try 2.0,” which it claims will let patients receive individualized therapeutics.
Experts noted such drugs are already accessible through the expanded access program.
Meanwhile, evidence shows that the high price of experimental treatments, which are sometimes available through certain drug company programs but not typically covered by insurance, is a greater hurdle to patients than regulatory guardrails are.
“I don’t think that people are having a problem with the FDA blocking access to individualized therapeutics,” Bateman-House said. “I think the problem is that individualized therapeutics are incredibly expensive, and there’s only a very small number of researchers in the country who know how to make them.”
Our Ruling
Trump has claimed throughout the campaign that his Right To Try program is novel and has saved thousands of lives. But a similar program has existed for decades, and there is no evidence Right To Try has had anywhere close to the impact Trump said it has had.
Neither the Trump campaign nor Right To Try advocates provided evidence to back claims of widespread benefit. And government data shows only 16 medications have been approved under the program in its first six years, with no accounting of how many patients used those medications or their clinical outcomes.
Moreover, public health experts have said Right To Try weakens patient protections and fails to address the true barriers to experimental medications.
We rate Trump’s claim False.
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.
Phone interview with Alison Bateman-House, assistant professor at New York University’s Grossman School of Medicine, Sept. 24, 2024
Phone interview with Holly Fernandez Lynch, associate professor of medical ethics and law at the University of Pennsylvania Perelman School of Medicine, Sept. 17, 2024
On the campaign trail, both former President Donald Trump and Vice President Kamala Harris are eager to portray themselves as guardians of Medicare. Each presidential candidate accuses the other of backing spending cuts and other policies that would damage the health insurance program for older Americans.
But the election’s outcome could alter the very nature of the nearly 60-year-old federal program. More than half of Medicare beneficiaries are already enrolled in plans, called Medicare Advantage, run by commercial insurers, and if Trump wins, that proportion is expected to grow — perhaps dramatically.
Trump and many congressional Republicans have already taken steps to aggressively promote Medicare Advantage. And Project 2025, a political wish list produced by the conservative Heritage Foundation for the next presidency, calls for making insurer-run plans the default enrollment option for Medicare.
Such a change would effectively privatize the program, because people tend to stick with the plans they’re initially enrolled in, health analysts say. Trump has repeatedly tried to distance himself from Project 2025, though the document’s authors include numerous people who worked in his first administration.
Conservatives say Medicare beneficiaries are better off in the popular Advantage plans, which offer more benefits than the traditional, government-run program. Critics say increasing insurers’ control of the program would trap consumers in health plans that are costlier to taxpayers and that can restrict their care, including by imposing onerous prior authorization requirements for some procedures.
“Traditional Medicare will wither on the vine,” said Robert Berenson, a former official in the Jimmy Carter and Bill Clinton administrations who’s now a senior fellow at the Urban Institute, a left-leaning research group.
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While the fate of Medicare has gotten scant attention so far in the campaign, the different visions under Trump versus Harris indicate the high stakes.
A candidate’s position on protecting Medicare and Social Security is the most important health care issue, or among the most important, in determining 63% of Americans’ vote in the presidential election, according to a September poll by Gallup and West Health, a family of nonprofit and nonpartisan organizations focused on health care and aging.
Medicare, which covers about 66 million people, is funded largely by payroll taxes. At age 65, most Americans are automatically enrolled in Medicare coverage for hospitalization and doctor visits, known as Part A and Part B, though others must sign up. Consumers must also sign up for other aspects of Medicare, specifically drug coverage (Part D) and supplemental plans from insurers that pay for costs that aren’t covered by traditional Medicare, such as extended stays in skilled nursing facilities and cost sharing.
People on Medicare pay premiums plus as much as 20% of the cost of their care.
Medicare Advantage plans typically combine coverage for hospital and outpatient care and prescriptions, while eliminating the 20% coinsurance requirement and capping customers’ annual out-of-pocket costs. Many of the plans don’t charge an extra monthly premium, though some carry a deductible — an amount patients must pay each year before coverage kicks in.
Sometimes the plans throw in extras like coverage for eye exams and glasses or gym memberships.
However, they control costs by limiting patients to networks of approved doctors and hospitals, with whom the plans negotiate payment rates. Some hospitals and doctors refuse to do business with some or all Medicare Advantage plans, making those networks narrow or limited. Traditional Medicare, in comparison, is accepted by nearly every hospital and doctor.
Medicare’s popularity is one reason both candidates are pledging to enhance it. Last month, Harris released a plan that would add benefits including care for hearing and vision, and long-term in-home health care. The costs would be covered by savings from expanding Medicare’s negotiations with drugmakers, reducing fraud, and increasing discounts drugmakers pay for certain brand-name drugs in the program, according to Harris’ campaign.
Trump’s campaign said he would prioritize home care benefits and support unpaid family caregivers through tax credits and reduced red tape.
The Trump campaign also noted enhancements to Medicare Advantage plans during his tenure as president, such as increasing access to telehealth and expanding supplemental benefits for seniors with chronic diseases.
But far less attention has been paid to whether to give even more control of Medicare to private insurers. Joe Albanese, a senior policy analyst at Paragon Health Institute, a right-leaning research group, said “a Trump administration and GOP Congress would be more friendly” to the idea.
The concept of letting private insurers run Medicare isn’t new. Former House Speaker Newt Gingrich, a Republican, asserted in 1995 that traditional Medicare would fade away if its beneficiaries could pick between the original program and private plans.
The shift to Medicare Advantage was accelerated by legislation in 2003 that created Medicare’s drug benefit and gave private health plans a far greater role in the program.
Lawmakers thought private insurers could better contain costs. Instead, the plans have cost more. In 2023, Medicare Advantage plans cost the government and taxpayers about 6% — or $27 million — more than original Medicare, though some research shows they provide better care.
The Trump administration promoted Medicare Advantage in emails during the program’s open enrollment period each year, but support for the privately run plans has become bipartisan as they have grown.
“It helps inject needed competition into a government-run program and has proven to be more popular with those who switch,” said Roger Severino, lead architect of Project 2025’s section on the Department of Health and Human Services. He served as director of HHS’ civil rights office during the Trump administration.
But enrollees who want to switch back to traditional Medicare may not be able to. If they try to buy supplemental coverage for the 20% of costs Medicare doesn’t cover, they may find they have to pay an unaffordable premium. Unless they enroll in the plans close to the time they first become eligible for Medicare, usually at age 65, insurers selling those supplemental plans can deny coverage or charge higher premiums because of preexisting conditions.
“More members of Congress are hearing from constituents who are horrified and realize they are trapped in these plans,” said Andrea Ducas, vice president of health policy at the Center for American Progress, a liberal public policy organization.
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.
California this year took the final step in opening Medi-Cal, its Medicaid program, to every eligible resident regardless of immigration status. It’s a significant expansion for an already massive safety net program.
Medi-Cal’s annual spending now stands at $157 billion, serving about 15 million low-income residents, more than a third of Californians. Of those, about 1.5 million are immigrants living in the U.S. without authorization, costing an estimated $6.4 billion, according to the Department of Health Care Services. They have been gradually added to the program as the state lifted legal residency as an eligibility requirement for children in 2016, young adults ages 19-25 in 2020, people 50 and older in 2022, and all remaining adults in January.
As California’s public insurance roll swells, advocates for immigrants praise the Golden State for an expansion that has helped reduce the uninsured rate to a record low 6.4%. Providers and hospitals, however, caution that the state hasn’t expanded its workforce adequately or increased Medi-Cal payments sufficiently, leaving some enrollees unable to find providers to see them in a timely manner — if at all.
“Coverage does not necessarily mean access,” said Isabel Becerra, CEO and president of the Coalition of Orange County Community Health Centers, during an Oct. 2 health policy summit in Los Angeles. “There’s a workforce shortage. We’re all fighting for those doctors. We’re fighting with each other for those doctors.”
Though the state has raised Medi-Cal payments for primary care, maternity care, and mental health services to 87.5% of what Medicare pays, private insurance still tends to pay more, according to the California Legislative Analyst’s Office.
A ballot initiative this month could guarantee revenue from a tax on managed-care plans goes toward raising the pay of health care providers who serve Medi-Cal patients.
Some believe the next chapter for covering immigrants will require more than Medi-Cal.
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Democratic state Assembly member Joaquin Arambula in 2022 proposed legislation to allow the approximately 520,000 uninsured unauthorized residents who earn more than 138% of the federal poverty level to apply for state-subsidized health coverage through Covered California, the state’s health exchange. The bill, however, died in committee this year.
The final installment of the “Faces of Medi-Cal” series looks at how Medi-Cal has affected its newest enrollees. They include Vanessa López Zamora, who is finally getting treated for hepatitis and cirrhosis but has trouble seeing a gastroenterologist close to home; Douglas Lopez, an entertainment park worker who credits dental coverage for boosting his well-being; and Daniel Garcia, who suffers from gout but has given up his search for a primary care provider. All spoke to KFF Health News in Spanish after recently becoming eligible for Medi-Cal.
‘Started Feeling Sick a Long Time Ago’
In March, Vanessa López Zamora’s stomach had swollen so much it looked like she was pregnant. She had been vomiting and in pain for days.
She went to her local emergency room, at Kaweah Health Medical Center, but it didn’t have a specialist available, she said. So, the 31-year-old was transferred by ambulance to Adventist Health Bakersfield, about 80 miles from her home in Visalia.
Doctors diagnosed Vanessa López Zamora with hepatitis A and C and cirrhosis. After four days in the hospital, López Zamora got referred for further treatment to a gastroenterologist, whom she is able to see as a new Medi-Cal enrollee.(Craig Kohlruss for KFF Health News)
Doctors diagnosed her with hepatitis A and C and cirrhosis, which had caused internal injuries to her liver and esophagus, she said. She spent four days in the hospital and for further treatment got a referral to a gastroenterologist, whom she can see as a new Medi-Cal enrollee — an option she couldn’t afford in the past when she had stomach pains and nausea.
“It’s been a very long process because I started feeling sick a long time ago.” said López Zamora, an accountant at a local radio station in Visalia in the San Joaquin Valley. “My girls are very little, and if I can’t get the necessary treatment, I won’t know how much time I have left.”
López Zamora, who came to California from Mexico City when she was 8 years old, is grateful for the care she initially received.
But she’s also frustrated.
The gastroenterologist the hospital referred her to is in Bakersfield — a tough journey for López Zamora, who doesn’t drive and can’t afford to travel to another city.
Limited access to specialists — from gastroenterologists to cardiologists — has been a long-standing challenge for many Medi-Cal patients, especially those in rural areas or regions facing staff shortages. The San Joaquin Valley, where López Zamora lives, has the lowest supply of specialists in the state, according to the California Health Care Foundation.
Michael Bowman, a spokesperson for Anthem Blue Cross, her Medi-Cal plan, said in an email that Anthem has a broad network of specialists that serve Medi-Cal beneficiaries, including more than 100 gastroenterologists within 20 miles of Visalia.
She is treating her cirrhosis with medication and diet, but in August her gastroenterologist in Bakerfield discovered signs of a precancerous condition in the stomach.
López Zamora said she is searching for a specialist closer to home. For now, she relies on her mother, who must take the day off work, to get to appointments or she takes the bus. She tried using transportation provided by Medi-Cal but was left stranded at the hospital. And she has rescheduled her appointments twice.
“They drove me up but didn’t take me back because they couldn’t find an Uber,” she said.
‘A Very Simple Process’
Medi-Cal gave Douglas Lopez the dental treatment he couldn’t afford.
Medi-Cal gave Douglas Lopez dental treatment he couldn’t previously afford. In January, Orange County automatically enrolled Lopez in Molina Healthcare’s Medi-Cal plan when the state expanded insurance eligibility for unauthorized residents ages 26-49. The coverage has boosted his care, he says.(Arlene Mejorado for KFF Health News)
The 33-year-old earned minimum wage as a cleaner in an entertainment park in 2022, and the emergency Medi-Cal plan he signed up for covered only emergency extractions.
That year, Lopez experienced a sharp pain in his back teeth when he ate his beloved coconut-and-tamarind candy balls from his native Guatemala.
A dentist told him that he needed several filings and three root canals. He began treatment, but the bills became more expensive: $150 the first session, then $200, then $300.
“I couldn’t afford it,” recalled Lopez, who lives in Fullerton. “I had to pay rent and food.”
Worried he would lose teeth, he stopped eating anything that would cause him pain.
In January, Orange County automatically enrolled Lopez in Molina Healthcare’s Medi-Cal plan when the state expanded insurance eligibility for unauthorized residents ages 26-49. The coverage has transformed his care, he said.
So far, Lopez has seen a dentist six times, for a cleaning, three root canals, two filings, and X-rays. And Medi-Cal has footed the bill.
Lopez’s experience contrasts with that of many other Medi-Cal enrollees, who struggle to get the care they need. The UCLA Center for Health Policy Research found that 21% of California dentists saw Medi-Cal patients of all ages, according to data from 2019 to 2021. Often those dentists limit the number of Medi-Cal patients they will see; only 15% of adult enrollees might get dental care in a given year.
Lopez said Medi-Cal has come through for him.
“It was a very simple process. I was so excited to search for a dentist,” Lopez said. “The fear of losing my teeth because I wasn’t getting treatment disappeared.”
‘Something That You Can’t Even Use’
Last year, the stabbing pain in Daniel Garcia’s arm and foot got so bad that the 39-year-old went to the ER.
Garcia has gout, a type of inflammatory arthritis that can cause intense pain and swelling in his joints. When he became eligible for Medi-Cal coverage this year, he thought he could finally see a doctor for treatment.
But the Los Angeles County resident said he hasn’t been able to find a primary care provider willing to take his Molina Healthcare insurance.
“It’s frustrating because you have something that you can’t even use,” said Garcia, who has been unable to get an annual physical. “I’ve called, and they say they don’t take my insurance.”
Daniel Garcia (left) and Yaneth Cardona (right) at their home in Los Angeles. Garcia gained Medi-Cal coverage this year but has not yet found a primary care provider. Cardona qualified for Medi-Cal in 2022. (Arlene Mejorado for KFF Health News)
Molina declined to comment on Garcia’s case and didn’t respond to questions about its primary care network.
Nearly 6 million people in California live in a total of 611 primary care shortage areas, according to a KFF analysis, which found the state would need to add 881 practitioners to close this gap.
Garcia, a construction worker, said he read that he could manage his arthritis by changing his eating habits. He now eats healthier and has cut back on sugar and Coke. As for the pain, he eases it with ibuprofen. He has given up looking for a provider.
Keeping patients out of the ER, which can be 12 times as expensive as primary care, is one of the arguments for expanding Medi-Cal. Studies have shown that not only does expanding health coverage lead to lower rates of ER visits, but expanding coverage also leads to patients using preventive care more, said Drishti Pillai, immigrant health policy director at KFF, a health information nonprofit that includes KFF Health News, the publisher of California Healthline.
“It can help save health care costs because conditions are no longer going untreated for a long time, in which case they may become more complex and expensive to treat,” Pillai said.
This article is part of “Faces of Medi-Cal,” a series exploring the impact of the state’s safety net health program on enrollees.
In the final days of the campaign, stark disagreements between Vice President Kamala Harris and former President Donald Trump over the future of American health care are on display — in particular, in sober warnings about abortion access, the specter of future cuts to the Affordable Care Act, and bold pronouncements about empowering activists eager to change course and clean house.
Trump and his campaign have been vague about plans on health care policies, though current and former Trump aides have published blueprints that go well beyond reversing programs in force under the Biden administration, to overhauling public health agencies and enabling Trump to quickly fire officials who disagree.
Here are some of the most consequential changes in health policies that could hinge on who wins the White House.
ACA Premiums
The election is likely to affect the cost of health insurance for millions who buy coverage on the Affordable Care Act marketplaces.
That’s because extra, pandemic-era subsidies that lower the cost of premiums will expire at the end of 2025 — unless Congress and the next president act.
Harris has pledged to make the enhanced subsidies permanent, while Trump has made no such commitment.
Letting them expire “would reduce fraud and waste,” said Brian Blase, a former Trump adviser who is president of the Paragon Health Institute, a conservative policy research firm.
About 19.7 million people with ACA coverage benefit from a subsidy — 92% of all enrollees. The expanded subsidies, started in 2021, helped increase ACA enrollment to a record high and reduce the uninsured rate to a record low.
They have also cut premium payments by an estimated 44%. Many pay no premiums at all.
Without congressional action, almost all ACA enrollees will experience steep increases in premium payments in 2026, according to KFF. The Urban Institute estimates 4 million people could wind up uninsured.
Letting the subsidies lapse could cause blowback for Republicans in 2026, said Jonathan Oberlander, a health policy expert at the University of North Carolina’s School of Medicine: “Is it worth the pain politically?”
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Abortion
When he was president, Trump promised — and delivered — Supreme Court justices who would vote to overturn the constitutional right to an abortion. In the event of a second term, he has promised to leave abortion policy to the states — though he would have significant leeway to reduce access nationwide.
Harris has promised to restore the protections of Roe v. Wade, though doing so would require Congress’ help. At the very least, a Harris presidency would mostly preserve existing protections and prevent new federal restrictions.
Trump’s first actions would likely mirror those of many Republican presidents since the 1980s: defunding Planned Parenthood and the United Nations’ family planning agency, and, more recently, allowing employers with religious or moral objections to contraception to decline coverage through job-sponsored health plans.
But Trump could go considerably further, effectively banning abortion even in states where it is legal. For instance, the FDA could reduce availability of the abortion pill mifepristone or cancel its approval. This has been the subject of numerous lawsuits, including one before the Supreme Court that was recently revived.
Trump could also order the Justice Department to enforce the Comstock Act, an 1873 law that bans mailing “every article or thing designed, adapted, or intended for producing abortion, or for any indecent or immoral use.” That could apply not just to abortion pills, but also to supplies for abortion procedures.
— Julie Rovner
Drug Prices
Both campaigns say they are committed to lowering drug prices. Trump has offered few specifics, though the America First Policy Institute, a think tank led by close Trump allies, has put forward policies that are considerably less aggressive than Harris’ proposals.
Harris has said she would expand drug pricing negotiations and out-of-pocket drug spending caps enabled by the Inflation Reduction Act. She has also called for more transparency requirements for pharmacy benefit managers, or PBMs, the powerful drug-industry middlemen.
America First’s plan would cut costs by lowering reimbursements to doctors for some expensive infused drugs, using trade policy to force other developed countries to increase what they pay for drugs, and making more prescription medications available over the counter.
The plan makes no mention of bipartisan legislation under consideration in both chambers of Congress that seeks to achieve lower drug prices through new transparency requirements for PBMs.
— Arthur Allen
Trans People’s Health
The presidential election could determine whether transgender Americans hold on to broad protections ensuring access to gender-affirming medical care. Trump has said he would seek to ban hormone replacement therapy, gender reassignment surgery, and other treatments for minors — and make the services more difficult for adults to receive.
In the closing days of the campaign, Trump and his political action committees have leaned into divisive ads attacking Harris for past comments supporting access to care for transgender people who are incarcerated.
Backed by Republicans eager to stoke culture-war social issues, Trump has pledged to repeal Biden policies affecting transgender health care, including rules prohibiting federally funded providers and insurers from discriminating based on gender identity.
As some states passed legislation that opposed transgender rights, the Biden administration expanded coverage for gender-affirming care and increased research funding for the National Institutes of Health.
In a video on his campaign site, Trump vowed to order federal agencies to “cease all programs that promote the concept of sex and gender transition at any age” and bar government programs such as Medicare and Medicaid from paying for gender-affirming care.
Trump also said he would strip federal funding from hospitals that provide such care, create a right to sue doctors who perform gender-affirming procedures on children, and investigate whether the pharmaceutical industry and hospitals have “deliberately covered up horrific long-term side effects” of transition treatments.
Harris has been largely silent on the Trump campaign’s rhetoric targeting trans people. But she has said she would “follow the law” in providing transgender Americans the same right as others to access medically necessary care.
— Daniel Chang
Medicaid
Though the word “Medicaid” was barely uttered on the campaign trail this year, the election will determine future benefits for its 80 million primarily low-income and disabled enrollees.
“The stakes are very high,” said UNC’s Oberlander.
While Harris has described Medicaid as a key program to improve health, Trump has framed it as a broken welfare program in need of cuts.
Nearly half of Medicaid enrollees are children, and the program pays for about 40% of births nationwide.
The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, or $20,783 this year. All but 10 states, which are GOP-led, have opted to expand their program.
The Biden administration has largely focused on efforts to protect and expand Medicaid to reduce the number of uninsured people.
The Trump administration, and GOP proposals since then, sought to reduce Medicaid spending by stiffening eligibility standards, such as adding work requirements, and by changing federal financing to a block grant, which would put more burden on states.
— Phil Galewitz
Shaking Up Biomedical Agencies
Trump said at an Oct. 27 rally in New York City that he would give anti-vaccine activist Robert F. Kennedy Jr. free rein to “go wild” on health and food policy in a second term.
Even a Republican-controlled Senate would be unlikely to confirm Kennedy for any top government position. Regardless of whether he had a specific role, RFK Jr.’s influence could be powerful, said Georges Benjamin, executive director of the American Public Health Association.
Kennedy said Trump promised to give him “control” of public health, including naming leaders of the NIH, FDA, and the Centers for Disease Control and Prevention. He has advocated for a doctor who made a name for herself as a right-wing health guru, Casey Means, to head the FDA. This week, in a discussion on CNN during which he put forward the debunked theory that vaccines cause autism, Trump transition team co-chair Howard Lutnick said Kennedy wanted data on vaccines “so he can say these things are unsafe,” at which point “the companies will yank the vaccines right off … the market.”
Numerous Trump allies have urged disempowering public health agencies — stripping the CDC of much of its research and promotional authority while streamlining NIH and adding congressional oversight over its grant-making.
Project 2025, the Heritage Foundation blueprint disavowed by Trump but whose authors include many former Trump officials, says the drug industry and other corporations have “captured” regulatory agencies: “We must shut and lock the revolving door” between agencies like the NIH, CDC, and FDA, and the industries they regulate, it states.
Kennedy recently posted on the social platform X that “FDA’s war on public health” — by which he meant restrictions on disproven therapies and cure-alls like raw milk and ivermectin — “was about to end.”
He warned FDA employees who are “part of the corrupt system” that they should “1. Preserve your records, and 2. Pack your bags.”
— Arthur Allen
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.
Becky Carroll was missing a few teeth, and others were stained or crooked. Ashamed, she smiled with lips pressed closed. Her dentist offered to fix most of her teeth with root canals and crowns, Carroll said, but she was wary of traveling a long road of dental work.
Then Carroll saw a TV commercial for another path: ClearChoice Dental Implant Centers. The company advertises that it can give patients “a new smile in as little as one day” by surgically replacing teeth instead of fixing them.
So Carroll saved and borrowed for the surgery, she said. In an interview and a lawsuit, Carroll said that at a ClearChoice clinic in New Jersey in 2021, she agreed to pay $31,000 to replace all her natural upper teeth with pearly-white prosthetic ones. What came next, Carroll said, was “like a horror movie.”
Carroll alleged that her anesthesia wore off during implant surgery, so she became conscious as her teeth were removed and titanium screws were twisted into her jawbone. Afterward, Carroll’s prosthetic teeth were so misaligned that she was largely unable to chew for more than two years until she could afford corrective surgery at another clinic, according to a sworn deposition from her lawsuit.
ClearChoice has denied Carroll’s claims of malpractice and negligence in court filings and did not respond to requests for comment on the ongoing case.
“I thought implants would be easier, and all at once, so you didn’t have to keep going back to the dentist,” Carroll, 52, said in an interview. “But I should have asked more questions … like, Can they save these teeth?”
Becky Carroll of New Jersey has alleged in a lawsuit that she suffered a botched dental implant surgery in 2021, leaving her unable to chew for more than two years. ClearChoice Dental Implant Centers has denied all wrongdoing in the ongoing suit.(Nicole Keller/CBS News)
Dental implants have been used for more than half a century to surgically replace missing or damaged teeth with artificial duplicates, often with picture-perfect results. While implant dentistry was once the domain of a small group of highly trained dentists and specialists, tens of thousands of dental providers now offer the surgery and place millions of implants each year in the U.S.
Amid this booming industry, some implant experts worry that many dentists are losing sight of dentistry’s fundamental goal of preserving natural teeth and have become too willing to remove teeth to make room for expensive implants, according to a months-long investigation by KFF Health News and CBS News. In interviews, 10 experts said they had each given second opinions to multiple patients who had been recommended for mouths full of implants that the experts ultimately determined were not necessary. Separately, lawsuits filed across the country have alleged that implant patients like Carroll have experienced painful complications that have required corrective surgery, while other lawsuits alleged dentists at some implant clinics have persuaded, pressured, or forced patients to remove teeth unnecessarily.
The experts warn that implants, for a single tooth or an entire mouth, expose patients to costs and surgery complications, plus a new risk of future dental problems with fewer treatment options because their natural teeth are forever gone.
“There are many cases where teeth, they’re perfectly fine, and they’re being removed unnecessarily,” said William Giannobile, dean of the Harvard School of Dental Medicine. “I really hate to say it, but many of them are doing it because these procedures, from a monetary standpoint, they’re much more beneficial to the practitioner.”
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Giannobile and nine other experts say they are combating a false public perception that implants are more durable and longer-lasting than natural teeth, which some believe stems in part from advertising on TV and social media. Implants require upkeep, and although they can’t get cavities, studies have shown that patients can be susceptible to infections in the gums and bone around their implants.
“Just because somebody can afford implants doesn’t necessarily mean that they’re a good candidate,” said George Mandelaris, a Chicago-area periodontist and member of the American Academy of Periodontology Board of Trustees. “When an implant has infection, or when an implant has bone loss, an implant dies a much quicker death than do teeth.”
In its simplest form, implant surgery involves extracting a single tooth and replacing it with a metal post that is screwed into the jaw and then affixed with a prosthetic tooth commonly made of porcelain, also known as a crown. Patients can also use “full-arch” or “All-on-4” implants to replace all their upper or lower teeth — or all their teeth.
Dental implants have been used to replace damaged or missing teeth for decades. They generally consist of a metal anchor screwed into the bone, then capped with a prosthetic tooth, commonly made of porcelain.(Moment/Getty Images)
For this story, KFF Health News and CBS News sought interviews with large dental chains whose clinics offer implant surgery — ClearChoice, Aspen Dental, Affordable Care, and Dental Care Alliance — each of which declined to be interviewed or did not respond to multiple requests for comment. The Association of Dental Support Organizations, which represents these companies and others like them, also declined an interview request.
ClearChoice, which specializes in full-arch implants, did not answer more than two dozen questions submitted in writing. In an emailed statement, the company said full-arch implants “have become a well-accepted standard of care for patients with severe tooth loss and teeth with poor prognosis.”
“The use of full-arch restorations reflects the evolution of modern dentistry, offering patients a solution that restores their ability to eat, speak, and live comfortably — far beyond what traditional dentures can provide,” the company said.
Carroll said she regrets not letting her dentist try to fix her teeth and rushing to ClearChoice for implants.
“Because it was a nightmare,” she said.
Carroll displays the dental implants she got in her upper jaw in 2021. She has alleged in a lawsuit against ClearChoice that her implants were misaligned with her bottom teeth, leaving her unable to eat solid food. ClearChoice has denied all wrongdoing in the lawsuit.(Rebecca Carroll)
‘They Are Not Teeth’
Dental implant surgery can be a godsend for patients with unsalvageable teeth. Several experts said implants can be so transformative that their invention should have contended for a Nobel Prize. And yet, these experts still worry that implants are overused, because it is generally better for patients to have their natural teeth.
Paul Rosen, a Pennsylvania periodontist who said he has worked with implants for more than three decades, said many patients believe a “fallacy” that implants are “bulletproof.”
“You can’t just have an implant placed and go off riding into the sunset,” Rosen said. “In many instances, they need more care than teeth because they are not teeth.”
Generally, a single implant costs a few thousand dollars while full-arch implants cost tens of thousands. Neither procedure is well covered by dental insurance, so many clinics partner with credit companies that offer loans for implant surgeries. At ClearChoice, for example, loans can be as large as $65,000 paid off over 10 years, according to the company’s website.
Despite the price, implants are more popular than ever. Sales increased by more than 6% on average each year since 2010, culminating in more than 3.7 million implants sold in the U.S. in 2022, according to a 2023 report produced by iData Research, a health care market research firm.
Dental implant surgery often involves extracting a patient’s natural tooth so it can be swapped for a prosthetic replacement. Patients can use “full-arch” or “All-on-4” dental implants to replace all their upper or lower teeth — or all their teeth.(Giovanni Mereghetti/UCG/Universal Images Group via Getty Images)
Some worry implant dentistry has gone too far. In 10 interviews, dentists and dental specialists with expertise in implants said they had witnessed the overuse of implants firsthand. Each expert said they’d examined multiple patients in recent years who were recommended for full-arch implants by other dentists despite their teeth being treatable with conventional dentistry.
Giannobile, the Harvard dean, said he had given second opinions to “dozens” of patients who were recommended for implants they did not need.
“I see many of these patients now that are coming in and saying, ‘I’ve been seen, and they are telling me to get my entire dentition — all of my teeth — extracted.’ And then I’ll take a look at them and say that we can preserve most of your teeth,” Giannobile said.
Tim Kosinski, who is a representative of the Academy of General Dentistry and said he has placed more than 19,000 implants, said he examines as many as five patients a month who have been recommended for full-arch implants that he deems unnecessary.
“There is a push in the profession to remove teeth that could be saved,” Kosinski said. “But the public isn’t aware.”
Luiz Gonzaga, a periodontist and prosthodontist at the University of Florida, said he, too, had turned away patients who wanted most or all their teeth extracted. Gonzaga said some had received implant recommendations that he considered “an atrocity.”
Dental implants are used to permanently replace damaged or missing teeth. They can restore a patient’s appearance and chewing ability. Implants are placed surgically and can’t be removed like most dentures.(Moment/Getty Images)
“You don’t go to the hospital and tell them ‘I broke my finger a couple of times. This is bothering me. Can you please cut my finger off?’ No one will do that,” Gonzaga said. “Why would I extract your tooth because you need a root canal?”
Jaime Lozada, director of an elite dental implant residency program at Loma Linda University, said he’d not only witnessed an increase in dentists extracting “perfectly healthy teeth” but also treated a rash of patients with mouths full of ill-fitting implants that had to be surgically replaced.
Lozada said in August that he’d treated seven such patients in just three months.
“When individuals just make a decision of extracting teeth to make it simple and make money quick, so to speak, that’s where I have a problem,” Lozada said. “And it happens quite often.”
When full-arch implants fail, patients sometimes don’t have enough jawbone left to anchor another set. These patients have little choice but to get implants that reach into cheekbones, said Sohail Saghezchi, an oral and maxillofacial surgeon at the University of California-San Francisco.
“It’s kind of like a last resort,” Saghezchi said. “If those fail, you don’t have anywhere else to go.”
‘It Was Horrendous Dentistry’
Most of the experts interviewed for this article said their rising alarm corresponded with big changes in the availability of dental implants. Implants are now offered by more than 70,000 dental providers nationwide, two-thirds of whom are general dentists, according to the iData Research report.
Dentists are not required to learn how to place implants in dental school, nor are they required to complete implant training before performing the surgery in nearly all states. This year, Oregon started requiring dentists to complete 56 hours of hands-on training before placing any implants. Stephen Prisby, executive director of the Oregon Board of Dentistry, said the requirement — the first and only of its kind in the U.S. — was a response to dozens of investigations in the state into botched surgeries and other implant failures, split evenly between general dentists and specialists.
“I was frankly stunned at how bad some of these dentists were practicing,” Prisby said. “It was horrendous dentistry.”
Private equity firms have spent about $5 billion in recent years to buy large dental chains that offer implants at hundreds of clinics owned by individual dentists and dental specialists. ClearChoice was bought for an estimated $1.1 billion in 2020 by Aspen Dental, which is owned by three private equity firms, according to PitchBook, a research firm focused on the private equity industry. Private equity firms also bought Affordable Care, whose largest clinic brand is Affordable Dentures & Implants, for an estimated $2.7 billion in 2021, according to PitchBook. And the private equity wing of the Abu Dhabi government bought Dental Care Alliance, which offers implants at many of its affiliated clinics, for an estimated $1 billion in 2022, according to PitchBook.
ClearChoice and Aspen Dental each said in email statements that the companies’ private equity owners “do not have influence or control over treatment recommendations.” Both companies said dentists or dental specialists make all clinical decisions.
Private equity deals involving dental practices increased ninefold from 2011 to 2021, according to an American Dental Association study published in August. The study also said investors showed an interest in oral surgery, possibly because of the “high prices” of implants.
“Some argue this is a negative thing,” said Marko Vujicic, vice president of the association’s Health Policy Institute, who co-authored the study. “On the other hand, some would argue that involvement of private equity and outside capital brings economies of scale, it brings efficiency.”
Edwin Zinman, a San Francisco dental malpractice attorney and former periodontist who has filed hundreds of dental lawsuits over four decades, said he believed many of the worst fears about private equity owners had already come true in implant dentistry.
“They’ve sold a lot of [implants], and some of it unnecessarily, and too often done negligently, without having the dentists who are doing it have the necessary training and experience,” Zinman said. “It’s for five simple letters: M-O-N-E-Y.”
Hundreds of Implant Clinics With No Specialists
For this article, journalists from KFF Health News and CBS News analyzed the webpages for more than 1,000 clinics in the nation’s largest private equity-owned dental chains, all of which offer some implants. The analysis found that more than 70% of those clinics listed only general dentists on their websites and did not appear to employ the specialists — oral surgeons, periodontists, or prosthodontists — who traditionally have more training with implants.
Affordable Dentures & Implants listed specialists at fewer than 5% of its more than 400 clinics, according to the analysis. The rest were staffed by general dentists, most of whom did not list credentialing from implant training organizations, according to the analysis.
An Affordable Dentures & Implants location in the suburbs of Nashville, Tennessee. Affordable Dentures & Implants is part of Affordable Care, which was purchased by private equity firms for an estimated $2.7 billion in 2021.(Brett Kelman/KFF Health News)
ClearChoice, on the other hand, employs at least one oral surgeon or prosthodontist at each of its more than 100 centers, according to the analysis. But its new parent company, Aspen Dental, which offers implants in many of its more than 1,100 clinics, does not list any specialists at many of those locations.
Not everyone is worried about private equity in implant dentistry. In interviews arranged by the American Academy of Implant Dentistry, which trains dentists to use implants, two other implant experts did not express concerns about private equity firms.
Brian Jackson, a former academy president and implant specialist in New York, said he believed dentists are too ethical and patients are too smart to be pressured by private equity owners “who will never see a patient.”
Jumoke Adedoyin, a chief clinical officer for Affordable Care, who has placed implants at an Affordable Dentures & Implants clinic in the Atlanta suburbs for 15 years, said she had never felt pressure from above to sell implants.
“I’ve actually felt more pressure sometimes from patients who have gone around and been told they need to take their teeth out,” she said. “They come in and, honestly, taking a look at them, maybe they don’t need to take all their teeth out.”
Still, lawsuits filed across the country have alleged that dentists at implant clinics have extracted patients’ teeth unnecessarily.
For example, in Texas, a patient alleged in a 2020 lawsuit that an Affordable Care dentist removed “every single tooth from her mouth when such was not necessary,” then stuffed her mouth with gauze and left her waiting in the lobby as he and his staff left for lunch. In Maryland, a patient alleged in a 2021 lawsuit that ClearChoice “convinced” her to extract “eight healthy upper teeth,” by “greatly downplay[ing] the risks.” In Florida, a patient alleged in a 2023 lawsuit that ClearChoice provided her with no other treatment options before extracting all her teeth, “which was totally unnecessary.”
After Aspen Dental bought ClearChoice for an estimated $1.1 billion in 2020, the companies began opening “co-location” clinics, like this one in Charlotte, North Carolina.(Fred Clasen-Kelly/KFF Health News)
ClearChoice and Affordable Care denied wrongdoing in their respective lawsuits, then privately settled out of court with each patient. ClearChoice and Affordable Care did not respond to requests for comment submitted to the companies or attorneys. Lawyers for all three plaintiffs declined to comment on these lawsuits or did not respond to requests for comment.
Fred Goldberg, a Maryland dental malpractice attorney who said he has represented at least six clients who sued ClearChoice, said each of his clients agreed to get implants after meeting with a salesperson — not a dentist.
“Every client I’ve had who has gone to ClearChoice has started off meeting a salesperson and actually signing up to get their financing through ClearChoice before they ever meet with a dentist,” Goldberg said. “You meet with a salesperson who sells you on what they like to present as the best choice, which is almost always that they’re going to take out all your natural teeth.”
Becky Carroll, the ClearChoice patient from New Jersey, told a similar story.
Carroll said in her lawsuit that she met first with a ClearChoice salesperson referred to as a “patient education consultant.” In an interview, Carroll said the salesperson encouraged her to borrow money from family members for the surgery and it was not until after she agreed to a loan and passed a credit check that a ClearChoice dentist peered into her mouth.
“It seems way backwards,” Carroll said. “They just want to know you’re approved before you get to talk to a dentist.”
CBS News producer Nicole Keller contributed to this report.
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.
Maria Sanchez immigrated to the Chicago area from Mexico about 30 years ago. Now 87, she’s still living in the U.S. without authorization. Like many longtime immigrants, she has worked — and paid taxes, including Medicare taxes — all that time.
But Sanchez never had health insurance, and when she turned 65, she couldn’t enroll in Medicare. She has never had preventive care or screenings. No physicals. No cholesterol checks. No mammograms.
“Nada, nada, nada,” she said in an interview conducted in Spanish. Nothing, nothing, nothing.
When she did get sick, she delayed seeking care until she was so ill that she was twice hospitalized with pneumonia. She finally got covered last year under a landmark Illinois program for older people without legal residency that took effect in December 2020.
Democratic-led states such as Illinois are increasingly opening public insurance programs to immigrants lacking permanent legal status. A dozen had already covered children; even more provided prenatal coverage. But now more states are covering adults living in the country without authorization — and some are phasing in coverage for seniors, who are more expensive and a harder political sell than kids.
The expansions recognize the costs that patients living here illegally can otherwise impose on hospitals. But the policies are under harsh attack from former President Donald Trump and other Republicans who seek to make his opponent, Vice President Kamala Harris, the face of reckless immigration policies.
Republicans point to Harris’ home state of California’s expansion of Medi-Cal coverage to immigrants of all ages regardless of legal status, saying it comes at the expense of American citizens.
It’s a regular complaint for Trump. “She’ll go around saying, ‘Oh, Trump is going to do bad things to Social Security,’” he said of Harris at a Sept. 13 news conference. “No, she’s going to do it because she’s putting these illegal immigrants onto Social Security, onto Medicare, and she’s going to destroy those programs, and the people are going to have to pay.”
Harris’ choice of Minnesota Gov. Tim Walz as her running mate has added fuel to Republican attacks at the intersection of immigration and health policy.
Under a law Walz signed, immigrants living without authorization in Minnesota will be able to gain health coverage starting next year through the state’s MinnesotaCare program for people with low incomes who aren’t eligible for Medicaid.
The issue is top of mind for some Americans. At an Oct. 10 town hall in Las Vegas, an audience member event host Univision identified as Ivett Castillo asked Harris what her administration would do about health care for people like her mother, who had immigrated from Mexico without authorization many years ago, worked her whole life, and died this year without ever receiving “the type of care and service that she needed or deserved.”
“What are your plans, or do you have plans, to support that subgroup of immigrants who have been here their whole lives, or most of them, and have to live and die in the shadows?” Castillo asked.
Harris noted her past support for a path to citizenship for unauthorized residents — and for a bipartisan border security bill that Senate Republicans killed earlier this year at the behest of Trump.
“This is one example of the fact that there are real people who are suffering because of an inability to put solutions in front of politics,” Harris said.
Even without such policies, immigrants can get free or inexpensive primary care at community clinics throughout the country — assuming they know it’s an option and feel safe at the facilities. But primary care can’t take care of all medical needs, particularly as people age and develop more complex health problems and chronic illnesses. So immigrants often rely on charity care, go into debt, or, like Sanchez, skimp. Some even return to their home countries for care.
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Illinois, where Sanchez got covered, was a pioneer in extending insurance coverage to unauthorized migrants. Now, six states and the District of Columbia — all led by Democrats — cover at least some low-income older immigrants under Medicaid or Affordable Care Act waivers. Minnesota next year will become the seventh. State funds must be used for the expansions, as federal dollars generally can’t cover people lacking legal status.
Whether or how quickly more states follow remains to be seen, and if Trump wins the White House, his administration would likely try to thwart the trend, given that he has pledged mass deportations. Coverage for all immigrants is still a tough sell economically and politically — and the noncitizen population can’t vote its gratitude at the ballot box. Immigrant health initiatives in several other states have fizzled or been scaled back.
Maryland, for example, settled on opening its Obamacare exchange to people living in the state without authorization, starting in 2026 — but without taxpayer subsidies for their premiums.
Still, there’s enough activity in states to make advocates for immigrant health believe something has shifted. The pandemic’s severity and its uneven toll helped build support for covering older immigrants, said Lee Che Leong, the senior policy advocate at Northwest Health Law Advocates in Washington state.
“People are looking around and realizing that our health is interconnected, both globally and locally,” Leong said. “The pandemic really brought that home, that when you look at the disparities in who got covid, who was exposed to covid, and who died from covid.”
Access to U.S. health care has long been an obstacle for immigrants, even those in the country legally. People with green cards must wait five years for coverage under Medicaid or other government health programs. Some older green-card holders have to pay extra premiums for Medicare Part A — the portion that covers hospital care — if they haven’t been employed for at least 10 years in the U.S.
The new state health programs close those gaps, said Shelby Gonzales, vice president for immigration policy at the Center on Budget and Policy Priorities.
In July, Washington state started covering low-income immigrants in a Medicaid-like program called Apple Health Expansion, using a federal waiver. Enrollment is capped and the program filled quickly, but some slots were reserved for people 65 and older, Leong said. Earlier this year, the state opened its Obamacare exchange to immigrants living in the U.S. without authorization.
Oregon and Colorado now also offer some coverage to people in their states who lack legal status, though the Colorado program didn’t attract many older immigrants, according to data recently presented to the state Affordable Care Act exchange oversight committee.
New York has covered child immigrants lacking legal residency for years, and the state’s Medicaid program was opened in January to all adult immigrants regardless of status. About 25,000 people signed up in the first four months, according to New York Medicaid Director Amir Bassiri.
Back in Illinois, Maria Sanchez said her new coverage has been life-changing — and possibly lifesaving. Her bouts of pneumonia were severe, partly because she had delayed care. After her second hospitalization, she needed follow-up cardiac care. The hospital didn’t charge her for her stay.
But now, with her “tarjeta medica” — her medical card — she can see a doctor. Her heart condition is under control. She has seen a dentist. She’s getting her cataracts removed.
“With my medical card, I have peace of mind,” Sanchez said.
Illinois has gradually added coverage for other age groups; in summer 2022, it lowered eligibility to age 42. That means immigrants like Gaby Piceno, 45, can age more healthily.
“I don’t have to worry anymore,” she said, referring not just to herself but to her family.
But the coverage expansion has cost more than Illinois projected. People like Sanchez and Piceno, already on the rolls, remain covered, but new enrollment was paused this year. More people signed up than expected, and many continued seeking care in more costly hospital emergency departments rather than at doctors’ offices, said the state’s acting insurance commissioner, Ann Gillespie, who was an Illinois state senator when the program was established.
The state is now shifting covered immigrants into Medicaid managed-care plans, hoping to bring down the cost over time.
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.
María Sánchez emigró al área de Chicago desde México hace unos 30 años. Ahora, a sus 87, sigue viviendo en Estados Unidos sin papeles. Como muchos inmigrantes de larga data, ha trabajado —y pagado impuestos, incluyendo para Medicare— durante todo ese tiempo.
Pero Sánchez nunca tuvo seguro médico, y cuando cumplió 65, no pudo inscribirse en Medicare. Nunca ha tenido atención preventiva ni exámenes. No ha tenido chequeos físicos, ni mediciones de colesterol, ni mamografías.
“Nada, nada, nada”, dijo.
Cuando enfermaba, tardaba en buscar atención médica hasta que estaba tan mal que fue hospitalizada dos veces por neumonía. Finalmente, el año pasado obtuvo cobertura a través de un programa pionero en Illinois para personas mayores indocumentadas que entró en vigencia en diciembre de 2020.
Estados liderados por demócratas, como Illinois, están abriendo cada vez más programas de seguros públicos a inmigrantes sin papeles. Una docena ya cubría a niños; aún más proporcionaban cobertura prenatal. Pero ahora, están cubriendo a adultos que viven en el país sin autorización, y algunos están ampliando la cobertura para personas mayores, que son más costosos y representan un desafío político mayor que los niños.
Estas expansiones reconocen los costos que estos pacientes pueden imponer sobre los hospitales. Pero estas políticas están bajo dura crítica del ex presidente Donald Trump y otros republicanos, quienes buscan presentar a su oponente, la vicepresidenta Kamala Harris, como la cara de políticas de inmigración irresponsables.
Los republicanos señalan la expansión de la cobertura de Medi-Cal en el estado natal de Harris, California, a inmigrantes de todas las edades independientemente de su estatus legal, argumentando que esto afecta a los ciudadanos estadounidenses.
Es una queja frecuente de Trump. “Ella va por ahí diciendo, ‘Oh, Trump va a hacer cosas malas con la Seguridad Social’”, dijo sobre Harris en una conferencia de prensa el 13 de septiembre. “No, ella va a hacerlo porque está poniendo a estos inmigrantes ilegales en la Seguridad Social, en Medicare, y va a destruir esos programas, y la gente tendrá que pagar”.
La elección de Harris del gobernador de Minnesota, Tim Walz, como compañero de fórmula ha añadido combustible a los ataques republicanos en la intersección de la inmigración y la política de salud.
Con la esperanza de presentar a la candidata demócrata presidencial Kamala Harris como extrema en inmigración, el ex presidente Trump y sus partidarios han dicho que ella quería otorgar beneficios de salud gratuitos, pagados por los contribuyentes, a inmigrantes en el país sin permiso legal. Pero esta declaración omite detalles clave.
Bajo una ley firmada por Walz, los inmigrantes que viven sin documentos en Minnesota podrán obtener cobertura de salud a partir del próximo año a través del programa MinnesotaCare del estado para personas de bajos ingresos que no son elegibles para Medicaid.
El tema es de gran interés para algunos estadounidenses. En un foro en Las Vegas el 10 de octubre, una integrante del público identificada por Univision como Ivett Castillo le preguntó a Harris qué haría su administración respecto a la atención médica para personas como su madre, quien había emigrado de México sin autorización muchos años atrás, trabajado toda su vida ahasta su muerte este año sin haber recibido “el tipo de atención y servicio que necesitaba o merecía”.
“¿Cuáles son sus planes, o tienen planes, para apoyar a ese subgrupo de inmigrantes que han estado aquí toda su vida, o la mayoría de ellos, y tienen que vivir y morir en las sombras?”, preguntó Castillo.
Harris mencionó su apoyo anterior a un camino a la ciudadanía para residentes sin papeles, y a un proyecto de ley bipartidista de seguridad fronteriza que los republicanos del Senado bloquearon a principios de este año por insistencia de Trump.
“Este es un ejemplo de que hay personas reales que sufren debido a la incapacidad de anteponer soluciones a la política”, dijo Harris.
Incluso sin estas políticas, los inmigrantes pueden recibir atención primaria gratuita o económica en clínicas comunitarias en todo el país, asumiendo que saben que es una opción y se sienten seguros en las instalaciones.
Pero la atención primaria no puede cubrir todas las necesidades médicas, especialmente a medida que las personas envejecen y desarrollan problemas de salud y enfermedades crónicas más complejas. Así que los inmigrantes suelen depender de la atención caritativa, endeudarse o, como Sánchez, evadir al doctor. Algunos incluso regresan a sus países de origen para recibir atención.
Illinois, donde Sánchez obtuvo cobertura, fue pionero en la extensión de cobertura de seguros a migrantes no autorizados. Ahora, seis estados y el Distrito de Columbia —todos liderados por demócratas— cubren al menos a algunos inmigrantes mayores de bajos ingresos bajo Medicaid o exenciones de la Ley de Cuidado de Salud a Bajo Precio (ACA).
Minnesota se convertirá en el séptimo el próximo año. Para estas expansiones se utilizan fondos estatales, ya que los fondos federales generalmente no pueden cubrir a personas sin estatus legal.
Queda por ver si más estados seguirán esta tendencia y cuán rápido, y si Trump gana la Casa Blanca, es probable que su administración intente frenar esta tendencia, dado que ha prometido deportaciones masivas.
La cobertura para todos los inmigrantes sigue siendo una propuesta difícil tanto económica como políticamente, y la población no ciudadana no puede agradecer votando. Las iniciativas de salud para inmigrantes en varios otros estados han fracasado o se han reducido.
Maryland, por ejemplo, decidió abrir su mercado del Obamacare a personas que viven en el estado sin autorización a partir de 2026, pero sin subsidios de los contribuyentes para sus primas.
Aun así, hay suficiente actividad en los estados para que defensores de la salud de los inmigrantes crean que algo ha cambiado. La gravedad de la pandemia y su impacto desigual ayudaron a generar el apoyo para cubrir a inmigrantes mayores, dijo Lee Che Leong, defensora principal de políticas en Northwest Health Law Advocates en el estado de Washington.
“La gente está mirando a su alrededor y se da cuenta de que nuestra salud está interconectada, tanto global como localmente”, dijo Leong. “La pandemia realmente mostró eso, cuando miras las disparidades en quién se contagió de covid, quién estuvo expuesto a covid y quién murió por covid”.
Durante mucho tiempo, el acceso a la atención médica en el país ha sido un obstáculo para los inmigrantes, incluso aquellos que tienen papeles. Las personas con tarjetas de residencia deben esperar cinco años para obtener cobertura bajo Medicaid u otros programas de salud del gobierno. Algunos personas mayores con residencia tienen que pagar primas adicionales para Medicare Parte A —la parte que cubre la atención hospitalaria— si no han trabajado al menos 10 años en Estados Unidos.
Los nuevos programas de salud estatales cierran estas brechas, dijo Shelby Gonzales, vicepresidenta de política de inmigración en el Center on Budget and Policy Priorities.
En julio, el estado de Washington comenzó a cubrir a inmigrantes de bajos ingresos en un programa similar a Medicaid llamado Apple Health Expansion, utilizando una exención federal.
La inscripción es limitada y el programa se llenó rápidamente, pero se reservaron algunos lugares para personas de 65 años o más, dijo Leong. A principios de este año, el estado abrió su mercado de Obamacare a inmigrantes que viven en los EE. UU. sin autorización.
Oregon y Colorado ahora también ofrecen alguna cobertura a personas en sus estados que carecen de estatus legal, aunque el programa de Colorado no atrajo a muchos inmigrantes mayores, según datos presentados hace poco al comité de supervisión del mercado de ACA.
Nueva York ha cubierto a niños inmigrantes sin documentos durante años, y el programa de Medicaid del estado se abrió en enero para todos los inmigrantes adultos independientemente de su estatus. Aproximadamente 25,000 personas se inscribieron en los primeros cuatro meses, según el director de Medicaid de Nueva York, Amir Bassiri.
De vuelta en Illinois, María Sánchez dijo que su nueva cobertura ha cambiado su vida, y posiblemente le ha salvado la vida. Sus episodios de neumonía fueron graves, en parte porque retrasó la atención. Después de su segunda hospitalización, necesitó atención cardíaca de seguimiento. El hospital no le cobró por su estadía.
Pero ahora, con su “tarjeta médica”, puede ver a un médico. Su condición cardíaca está bajo control. Ha visto a un dentista. Va a tener una operación de cataratas. “Con mi tarjeta médica, tengo paz mental”, dijo Sánchez.
llinois ha agregado gradualmente cobertura para otros grupos de edad; en el verano de 2022, redujo la elegibilidad a los 42 años. Eso significa que inmigrantes como Gaby Piceno, de 45, pueden envejecer de manera más saludable.
“Ya no tengo que preocuparme”, dijo, refiriéndose no solo a sí misma, sino a su familia.
Pero la expansión de la cobertura ha costado más de lo proyectado en Illinois. Personas como Sánchez y Piceno, ya inscritas, siguen cubiertas, pero este año se frenó la nueva inscripción. Se inscribieron más personas de lo esperado, y muchas continuaron buscando atención en salas de emergencia de hospitales más costosos en lugar de en consultorios médicos, dijo la comisionada interina de seguros del estado, Ann Gillespie, quien era senadora estatal en Illinois cuando se estableció el programa.
El estado ahora está transfiriendo a los inmigrantes cubiertos a planes de atención administrada de Medicaid, con la esperanza de reducir el costo con el tiempo.
Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo.
With the 2024 election campaign in its final days, House Speaker Mike Johnson this week floated “massive” health care reform if former President Donald Trump wins — changes that are also dependent, of course, on whether Republicans control Congress next year.
Meanwhile, new reporting uncovers more maternal deaths under state abortion bans, plus at least one case in which a woman was jailed after a miscarriage. Plus, other investigations are shining a light on a reality of American health care, regardless of who wins on Tuesday: the consequences of health industry profiteering.
This week’s panelists are Emmarie Huetteman of KFF Health News, Lauren Weber of The Washington Post, Shefali Luthra of The 19th, and Jessie Hellmann of CQ Roll Call.
Among the takeaways from this week’s episode:
Trump has called for reopening the fight over the Affordable Care Act, and given enough votes in Congress, Johnson suggested this week that he’s ready to back the former president’s play. To be sure, the expiration next year of enhanced ACA premium subsidies will put the health law back on the agenda — though given the law’s popularity, changes may be a hard sell even to some Republicans.
Trump also unveiled his own proposal to address the long-term care crisis: a tax credit for family caregivers. His plan follows Vice President Kamala Harris’ proposal weeks ago to create a new Medicare benefit that pays for home health care.
New reporting is out this week on women suffering miscarriages being denied reproductive health care — or even being charged with manslaughter and incarcerated. While many abortion opponents say they have no intention of harming or punishing women, the consequences of overturning Roe v. Wade are coming into clearer focus.
Also this week, KFF Health News’ Julie Rovner interviews Irving Washington, a senior vice president at KFF and the executive director of its Health Misinformation and Trust Initiative.
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.
Conservative groups are working to undermine support for Montana’s Medicaid expansion in hopes the state will abandon the program. The rollback would be the first in the decade since the Affordable Care Act began allowing states to cover more people with low incomes.
Montana’s expansion, which insures roughly 78,800 people, is set to expire next year unless the legislature and governor opt to renew it. Opponents see a rare opportunity to eliminate Medicaid expansion in one of the 40 states that have approved it.
The Foundation for Government Accountability and Paragon Health Institute, think tanks funded by conservative groups, told Montana lawmakers in September that the program’s enrollment and costs are bloated and that the overloaded system harms access to care for the most vulnerable.
Manatt, a consulting firm that has studied Montana’s Medicaid program for years, then presented legislators with the opposite take, stating that more people have access to critical treatment because of Medicaid expansion. Those who support the program say the conservative groups’ arguments are flawed.
State Rep. Bob Keenan, a Republican who chairs the Health and Human Services Interim Budget Committee, which heard the dueling arguments, said the decision to kill or continue Medicaid expansion “comes down to who believes what.”
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The expansion program extends Medicaid coverage to adults with incomes up to 138% of the federal poverty level, or nearly $21,000 a year for a single person. Before, the program was largely reserved for children, people with disabilities, and pregnant women. The federal government covers 90% of the expansion cost while states pick up the rest.
National Medicaid researchers have said Montana is the only state considering shelving its expansion in 2025. Others could follow.
New Hampshire legislators in 2023 extended the state’s expansion for seven years and this year blocked legislation to make it permanent. Utah has provisions to scale back or end its Medicaid expansion program if federal contributions drop.
FGA and Paragon have long argued against Medicaid expansion. Tax records show their funders include some large organizations pushing conservative agendas. That includes the 85 Fund, which is backed by Leonard Leo, a conservative activist best known for his efforts to fill the courts with conservative judges.
The president of Paragon Health Institute is Brian Blase, who served as a special assistant to former President Donald Trump and is a visiting fellow at FGA, which quotes him as praising the organization for its “conservative policy wins” across states. He was also announced in 2019 as a visiting fellow at the Heritage Foundation, which was behind the Project 2025 presidential blueprint, which proposes restricting Medicaid eligibility and benefits.
Paragon spokesperson Anthony Wojtkowiak said its work isn’t directed by any political party or donor. He said Paragon is a nonpartisan nonprofit and responds to policymakers interested in learning more about its analyses.
“In the instance of Montana, Paragon does not have a role in the debate around Medicaid expansion, other than the testimony,” he said.
FGA declined an interview request. As early as last year, the organization began calling on Montana lawmakers to reject reauthorizing the program. It also released a video this year of Montana Republican Rep. Jane Gillette saying the state should allow its expansion to expire.
Gillette requested the FGA and Paragon presentations to state lawmakers, according to Keenan. He said Democratic lawmakers responded by requesting the Manatt presentation.
Manatt’s research was contracted by the Montana Healthcare Foundation, whose mission is to improve the health of Montanans. Its latest report also received support from the state’s hospital association.
The Montana Healthcare Foundation is a funder of KFF Health News, an independent national newsroom that is part of the health information nonprofit KFF.
Bryce Ward, a Montana health economist who studies Medicaid expansion, said some of the antiexpansion arguments don’t add up.
For example, Hayden Dublois, FGA’s data and analytics director, told Montana lawmakers that in 2022 72% of able-bodied adults on Montana’s Medicaid program weren’t working. If that data refers to adults without disabilities, that would come to 97,000 jobless Medicaid enrollees, Ward said. He said that’s just shy of the state’s total population who reported no income at the time, most of whom didn’t qualify for Medicaid.
“It’s simply not plausible,” Ward said.
A Manatt report, citing federal survey data, showed 66% of Montana adults on Medicaid have jobs and an additional 11% attend school.
FGA didn’t respond to a request for its data, which Dublois said in the committee hearing came through a state records request.
Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, also declined to comment. As of late October, a KFF Health News records request for the data the state provided FGA was pending.
In his presentation before Montana lawmakers, Blase said the most vulnerable people on Medicaid are worse off due to expansion as resources pool toward new enrollees.
“Some people got more medical care; some people got less medical care,” Blase said.
Drew Gonshorowski, a researcher with Paragon, cited data from a federal Medicaid commission that shows that, overall, states spend more on adults who qualified through the expansion programs than they do on others on Medicaid. That data also shows states spend more on seniors and people with disabilities than on the broader adult population insured by Medicaid, which is also true in Montana.
Nationally, states with expansions spend more money on people enrolled in Medicaid across eligibility groups compared with nonexpansion states, according to a KFF report.
Zoe Barnard, a senior adviser for Manatt who worked for Montana’s health department for nearly 10 years, said not only has the state’s uninsured rate dropped by 30% since it expanded Medicaid, but also some specialty services have grown as more people access care.
FGA has long lobbied nonexpansion states, including Texas, Kansas, and Mississippi, to leave Medicaid expansion alone. In February, an FGA representative testified in support of an Idaho bill that included an expansion repeal trigger if the state couldn’t meet a set of rules, including instituting work requirements and capping enrollment. The bill failed.
On the federal level, Paragon recently proposed a Medicaid overhaul plan to phase out the federal 90% matching rate for expansion enrollees, among other changes to cut spending. The left-leaning Center on Budget and Policy Priorities has countered that such ideas would leave more people without care.
In Montana, Republicans are defending a supermajority they didn’t have when a bipartisan group passed the expansion in 2015 and renewed it in 2019. Also unlike before, there’s now a Republican in the governor’s office. Gov. Greg Gianforte is up for reelection and has said the safety net is important but shouldn’t get too big.
Keenan, the Republican lawmaker, predicted the expansion debate won’t be clear-cut when legislators convene in January.
“Medicaid expansion is not a yes or no. It’s going to be a negotiated decision,” he said.
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.
