Category: Rehab News

It sounds like a joke: poppy seeds infused with opioids.

Indeed, it was a plotline on the sitcom Seinfeld. But for some it has been a tragedy.

People have died after drinking tea brewed from unwashed poppy seeds.

And after eating lemon poppy seed bread or an everything bagel, mothers reportedly have been separated from newborns because the women failed drug tests.

Poppy seeds come from the plant that produces opium and from which narcotics such as morphine and codeine are derived. During harvesting and processing, the seeds can become coated with the opium fluid.

Members of the House and Senate have proposed legislation “to prohibit the distribution and sale of contaminated poppy seeds in order to prevent harm, addiction, and further deaths from morphine-contaminated poppy seeds.” The bill was one of several on the agenda for a Sept. 10 House hearing.

The day before the hearing, The Marshall Project and Reveal reported on a woman who ate a salad with poppy seed dressing before giving birth, tested positive at the hospital for opiates, was reported to child welfare, and saw her baby taken into protective custody. Almost two weeks passed before she was allowed to bring her baby home, the story said.

“It’s not an urban legend: Eating poppy seeds can cause diners to test positive for codeine on a urinalysis,” the Defense Department warned military personnel in 2023.

The U.S. Anti-Doping Agency long ago issued a similar warning to athletes.

The Center for Science in the Public Interest, a watchdog group, petitioned the FDA in 2021 to limit the opiate content of poppy seeds. In May, after more than three years with no response, it sued the agency to force action.

“So far the FDA has been negligent in protecting consumers,” said Steve Hacala, whose son died after consuming poppy seed tea and who has joined forces with CSPI.

The lawsuit was put on hold in July, after the FDA said it would respond to the group’s petition by the end of February 2025.

The FDA did not answer questions for this article. The agency generally does not comment on litigation, spokesperson Courtney Rhodes said.

A 2021 study co-authored by CSPI personnel found more than 100 reports to poison control centers between 2000 and 2018 resulting from intentional abuse or misuse of poppy seeds, said CSPI scientist Eva Greenthal, one of the study’s authors.

Only rarely would baked goods or other food items containing washed poppy seeds trigger positive drug tests, doctors who have studied the issue said.

It’s “exquisitely doubtful” that the “relatively trivial” amount of morphine in an everything bagel or the like would cause anyone harm, said Irving Haber, a doctor who has written about poppy seeds, specializes in pain medicine, and signed the CSPI petition to the FDA.

On the other hand, tea made from large quantities of unwashed poppy seeds could lead to addiction and overdose, doctors said. The risks are heightened if the person drinking the brew is also consuming other opioids, such as prescription pain relievers.

Benjamin Lai, a physician who chairs a program on opioids at the Mayo Clinic in Rochester, Minnesota, said he has been treating a patient who developed long-term opioid addiction from consuming poppy seed tea. The patient, a man in his 30s, found it at a health food store and was under the impression it would help him relax and recover from gym workouts. After a few months, he tried to stop and experienced withdrawal symptoms, Lai said.

Another patient, an older woman, developed withdrawal symptoms under similar circumstances but responded well to treatment, Lai said.

Some websites tout poppy seed tea as offering health benefits. And some sellers “may use specific language such as ‘raw,’ ‘unprocessed,’ or ‘unwashed’ to signal that their products contain higher concentrations of opiates than properly processed seeds,” the CSPI lawsuit said.

Steve Hacala’s son, Stephen Hacala, a music teacher, had been experiencing anxiety and insomnia, for which poppy seed tea is promoted as a natural remedy, the lawsuit said. In 2016, at age 24, he ordered a bag of poppy seeds online, rinsed them with water, and consumed the rinse. He died of morphine poisoning.

The only source of morphine found in Stephen’s home, where he died, was commercially available poppy seeds, a medical examiner at the Arkansas State Crime Lab said in a letter to the father. The medical examiner wrote that poppy seeds “very likely” caused Stephen’s death.

Steve Hacala estimated that the quantity of poppy seeds found in a 1-liter plastic water bottle in his son’s home could have delivered more than 10 times a lethal dose.

Steve Hacala and his wife, Betty, have funded CSPI’s efforts to call attention to the issue. (David Rousseau, the publisher of KFF Health News, which publishes California Healthline, is on the CSPI board.)

The lawsuit also cited mothers who, like those in the investigation by The Marshall Project and Reveal, ran afoul of rules meant to protect newborns. For example, though Jamie Silakowski had not used opioids while pregnant, she was initially prevented from leaving the hospital with her baby, the suit said.

Silakowski recalled that, before going to the hospital, she had eaten lemon poppy seed bread at Tim Hortons, a fast-food chain, CSPI said in its petition. “No one in the hospital believed Ms. Silakowski or appeared to be aware that the test results could occur from poppy seeds.”

People from child protective services made unannounced visits to her home, interviewed her other children, and questioned teachers at their school, she said in an interview.

While on maternity leave, she had to undergo drug testing, Silakowski said. “Peeing in front of someone like I’m a criminal — it was just mortifying.”

Even family members were questioning her, and there was nothing she could do to dispel doubts, she said. “Relationships were torn apart,” she said.

The parent company of Tim Hortons, Restaurant Brands International, which also owns Burger King and Popeyes, did not respond to questions from KFF Health News.

In July, The Washington Post reported that Trader Joe’s Everything but the Bagel seasoning was banned and being confiscated in South Korea because it contains poppy seeds. Trader Joe’s did not respond to inquiries for this article. The seasoning is listed for sale on the company’s website.

The U.S. Drug Enforcement Agency says unwashed poppy seeds can kill when used alone or in combination with other drugs. While poppy seeds are exempt from drug control under the Controlled Substances Act, opium contaminants on the seeds are not, the agency says. The Justice Department has brought criminal prosecutions over the sale of unwashed poppy seeds.

Meanwhile, the legislation to control poppy seed contamination has not gained much traction.

The Senate bill, introduced by Sen. Tom Cotton (R-Ark.), has two co-sponsors.

The House bill, introduced by Rep. Steve Womack (R-Ark.), has none. Though it was on the agenda, it didn’t come up at the recent hearing.

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

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. 

SIKESTON, Mo. — In the summer of 2021, Sikeston residents organized the biggest Juneteenth party in the city’s history. Sikeston police officers came too, both to provide security for the event and to try to build bridges with the community. But after decades of mistrust, some residents questioned their motives. 

In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police. 

Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things. 

“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.” 

Host

In Conversation With …

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click here.

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. 

Estamos en esa época del año otra vez. En la mayoría de los estados, la temporada de inscripción abierta de la Ley de Cuidado de Salud a Bajo Precio (ACA) para los planes de salud comienza el 1 de noviembre y dura hasta el 15 de enero.

Los consumidores que no actualicen su información o seleccionen una alternativa serán automáticamente reinscriptos en su plan actual o, si ese plan ya no está disponible, en uno con cobertura similar.

El año pasado se registró un récord de inscripciones, con unas 21 millones de personas. Esta vez, los consumidores descubrirán que han cambiado algunas cosas.

No seas víctima de estafas publicitarias

Aunque algunos planes de salud ofrecen tarjetas de regalo de poco valor u otros incentivos para fomentar la participación en iniciativas de bienestar, nunca ofrecerían tarjetas en efectivo por valor de miles de dólares al mes para ayudar a pagar las compras, la gasolina o el alquiler. Aun así, las redes sociales y los sitios web están plagados de promesas de este tipo.

Según una demanda presentada en Florida, este tipo de anuncios es una de las vías supuestamente utilizadas por corredores sin escrúpulos que inscriben o cambian de plan sin el permiso expreso de los consumidores.

Además, hay que tener cuidado con los sitios de internet que utilizamos para buscar cobertura.

Si escribes “Obamacare” o “seguro médico barato” en un buscador, a menudo, lo que aparece en primer lugar son sitios web patrocinados por el sector privado no afiliados a los mercados federales o estatales oficiales para la cobertura de ACA.

Aunque intenten parecer oficiales, no lo son. Muchos de estos sitios ofrecen varias opciones, incluida cobertura que no es de ACA con beneficios limitados, según descubrió en 2023 un studio de “comprador secreto”. Con estas coberturas no se pueden obtener subsidios federales para ayudar a los consumidores a pagar las primas.

La letra chica de algunos sitios web dice que los consumidores que facilitan información personal consienten automáticamente que agentes de ventas se pongan en contacto con ellos a través de llamadas telefónicas, correos electrónicos, mensajes de texto o sistemas automatizados con mensajes pregrabados.

Cuando busques un plan, empieza siempre por el sitio web oficial del mercado federal, cuidadodesalud.gov (healthcare.gov).

Incluso si no vives en uno de los 29 estados en los que funciona el mercado federal, el sitio web proporciona el enlace a tu sitio oficial de inscripción cuando seleccionas tu estado, o el Distrito de Columbia, en una lista desplegable.

Los mercados estatales y el federal también tienen centros de llamadas y otras formas de obtener ayuda para la inscripción. Por ejemplo, el enlace “encuentre ayuda local” en cuidadodesaludgov, ofrece a los consumidores la posibilidad de encontrar asistentes o agentes de ventas cerca de sus domicilios.

¿Es un seguro real?

Otra preocupación: los reguladores han observado un aumento en las quejas de los consumidores sobre ofertas de coberturas de salud en las que se les exige que se afilien a una corporación de responsabilidad limitada o que den fe de que trabajan para una empresa concreta.

De hecho, al menos dos estados —Maryland y Maine—- han emitido advertencias, señalando que en lugar de una cobertura completa de ACA, a menudo se trata de productos que no pertenecen a ACA, y que equivalen a cosas como una mezcla de tarjetas de descuento o planes de indemnización limitada.

Este tipo de plan paga una cantidad fija —por ejemplo, $50 por una visita al médico o $1,000 por una hospitalización— y está pensado para reforzar una cobertura más completa, no para sustituirla.

“A diferencia de los planes medicos grandes, algunos de estos planes autofinanciados sólo cubren servicios preventivos, como un chequeo o un examen médico anual”, advierte la Oficina de Seguros de Maine.

Las primas podrían ser más altas… y otras novedades

Algunas aseguradoras reducirán las primas para 2025, pero muchas otras las aumentarán.

Aunque todavía no hay cifras oficiales, los expertos estiman un aumento promedio del 7% para las primas, según un análisis de KFF. La mayoría de las personas que compran cobertura médica en los mercados de seguros de ACA son elegibles para recibir subsidios para ayudar con las primas, lo que probablemente compensará gran parte del aumento, aunque el mayor costo significa que el gobierno pagará más por esos subsidios.

El aumento de los costos de salud —incluida la atención hospitalaria y la nueva clase de medicamentos para adelgazar— contribuye a este incremento.

Otros cambios en esta temporada:

—Las personas a menudo conocidas como “Dreamers” porque calificaron para la Acción Diferida para los Llegados en la Infancia (DACA) —un programa federal que ofrece cierta protección a los traídos al país cuando eran niños sin documentación migratoria adecuada— ahora pueden inscribirse en la cobertura de ACA y son elegibles para los subsidios.

—Los planes de corto plazo, que técnicamente no son parte de la cobertura de ACA y no están sujetos a sus normas de beneficios y protecciones de beneficios preexistentes, pueden ser emitidos por sólo cuatro meses de cobertura, como máximo, según lo dispuesto por la administración Biden, que entró en vigencia  con planes que empezaron el 1 de septiembre.  Esto ha revocado una norma de la administración Trump que flexibilizaba los requisitos para permitir a las aseguradoras ofrecer una cobertura de hasta 364 días, con la opción de renovar las pólizas hasta por dos años más. Los planes existentes y los emitidos antes del 1 de septiembre no caen bajo las nuevas reglas. Pero los consumidores que contaban con períodos más largos deben comprobar los detalles de sus planes y considerar la posibilidad de cambiar a un plan de ACA para evitar una situación en la que su plan a corto plazo expire antes de tiempo o a mediados de año, arriesgándose así a no poder obtener otra cobertura por el resto del año.

El proceso de inscripción también podría alargarse

Este año, los reguladores federales han tenido que hacer frente a un número creciente de quejas —200,000 sólo en los primeros seis meses— de consumidores que estaban siendo inscritos o transferidos a otros planes de ACA sin su permiso por agentes que pretendían obtener comisiones.

Para evitarlo, se han establecido nuevas normas.

¿Qué significa esto para la mayoría de los consumidores? Si trabajas con un nuevo agente —uno que no estaba ya en la lista en tu plan de ACA— es probable que tengas que ser parte de una llamada con dos representantes del mercado federal para confirmar que autorizas a ese agente para hacer cambios en tu plan para el próximo año. Esto te llevará más tiempo. Nadie sabe lo ocupadas que estarán las líneas telefónicas durante la inscripción abierta.

No es necesario recurrir a un intermediario para inscribirse. Pero la búsqueda entre las docenas de opciones del mercado es un reto, por lo que la mayoría de las personas busca ayuda. Los consumidores deben sopesar no sólo el costo mensual de la prima, sino también las variaciones en deducibles y copagos por cosas como visitas al médico, hospitalización y medicamentos.

Compara precios

Los expertos señalan que otra consideración a tener en cuenta al elegir un plan es comprobar si tu red incluye los médicos y hospitales a los que sueles acudir, y si se cubren tus medicamentos recetados y cuánto cobran por ellos.

Para facilitar las comparaciones, hace dos años entraron en vigencia unas normas que obligan a las aseguradoras a incluir como opciones algunos “planes estandarizados”, que deben tener los mismos deducibles y costos por conceptos como visitas al médico, atención en urgencias y otros gastos compartidos por el consumidor.

Aun así, muchas personas disponen de docenas de opciones, lo que puede resultar desalentador.

Pero hay un consejo que no cambia: tanto si te inscribes por primera vez, como si ya tienes un plan, vale la pena comparar precios. Aunque no cambies de plan, puedes asegurarte de que el que tienes sigue siendo tu mejor opción.

En la mayoría de los estados, los consumidores deben inscribirse antes del 15 de diciembre para obtener cobertura a partir del 1 de enero. Atención a Idaho, donde la inscripción abierta empieza antes, el 15 de octubre, pero también termina antes, el 15 de diciembre. En California, Nueva Jersey, Nueva York, Rhode Island y el Distrito de Columbia, los residentes pueden inscribirse hasta el 31 de enero.

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. 

DURHAM, N.C. — It’s been 35 years since John Parker died after a pickup collided with the bike he was riding on Cheek Road in east Durham before school. He was 6.

His mother, Deborah Melvin-Muse, doesn’t display photos of him, the second-youngest of six children. His brother’s birthday was the day after the crash — and he hasn’t celebrated it since. An older brother carries a deep sense of guilt because he was looking after John that morning.

And Cheek Road, in a predominantly Black neighborhood, still lacks sidewalks for children to safely make their way to the local elementary school.

This, despite the years community activists and academic researchers have spent pleading with city leaders for safety improvements along the busy thoroughfare with sloping shoulders where John died. Drivers zoom along Cheek Road in the Merrick-Moore neighborhood, which connects downtown Durham to industrial sites and newer suburban developments.

Melvin-Muse moved her family out of the neighborhood after John’s death. “Now when I go down there, I look and see, you know, nothing really changed,” she said. “It still looks the same.”

Cheek Road has been “identified as needing improvements” by a local metropolitan planning board, said Erin Convery, Durham’s transportation planning manager, in an email.

“The infrastructure that exists is not well implemented,” concluded a May preliminary report produced by University of North Carolina-Chapel Hill students who collected data on speeding, noise, and air quality along Cheek Road. “Poorly marked crosswalks and inadequately positioned bus stops show a need for safety and accessibility improvements,” the report said.

Data was difficult to collect because “there were areas we didn’t want to get out of our cars because of the dangerous conditions,” said Ari Schwartz, one of the researchers.

In the 1940s, Black military veterans returning from World War II helped establish the Merrick-Moore neighborhood. Since then, residents say they have endured everything from noisy industrial trucks and speeding cars to illegal tire dumping and air pollution that threaten their health and safety.

Pedestrian deaths are highest in formerly redlined areas, neighborhoods where Black people lived because of discriminatory federal mortgage lending practices, research shows. The lack of sidewalks, damaged walkways, and roads with high speed limits are concentrated in these neighborhoods, studies show, creating a little-recognized public health crisis.

Governments invest in roads for people driving through such neighborhoods, but not in safety measures — like sidewalks, crosswalks, traffic circles, and speed bumps — that protect people living in them, researchers and advocates say.

“People will talk about vulnerable communities as if there is a problem with these communities, when in fact it is our systems and policies that have created these failings,” said Darya Minovi, a senior analyst at the Union of Concerned Scientists who studies environmental health and justice.

While the share of Black residents in Merrick-Moore has dropped in recent decades, data shows the neighborhood remains more than 80% Black or Hispanic and households there are typically less well-off than in other parts of the city.

“Local government takes money from the neighborhood but does not invest in it,” said Bonita Green, head of the Merrick-Moore Community Development Corporation and a former City Council candidate.

Green said the community group had documented more than 100 auto crashes along Cheek Road during a recent four-year span and at least three pedestrian deaths before 2020. In this fast-growing city of roughly 300,000, students at Merrick-Moore Elementary and others at a nearby high school sometimes walk along the road — where traffic is heavy, drivers are known to disregard the 25-mph speed limit, and the shoulders slope steeply.

When longtime residents like Ponsella Brown see kids walking there or hear about another accident, they remember the death of John Parker, who was in first grade.

“I just cringe,” said Brown, who worked as an administrative assistant at Merrick-Moore Elementary when John died. “Every time it comes up, it’s like really vivid in my mind.”

On the day John died, someone rushed into the office and said a child had been hit by a car on Cheek Road, recalled Brown, who said she ran to the scene.

“I remember the way his head was turned. I remember the spot of blood on his face. Like one speck of blood,” said Brown, who also works for the Merrick-Moore Community Development Corporation and is now a counselor at another school.

Traffic on Cheek Road is expected to increase as the population grows in Durham and surrounding areas, according to a separate April report from UNC graduate students. It noted that during the morning school drop-off time, many cars driving on Cheek Road don’t observe the posted speed limits.

Under an equity program meant to reverse the harm done to communities of color, Convery said, Durham officials are considering traffic-calming measures, including traffic circles, speed cushions, and high-visibility crosswalks.

“We’re open to future conversations that will help us achieve zero traffic deaths and injuries,” Convery said.

Yet a 2017 plan that prioritized more than 600 sidewalk projects based on safety, equity, and demand did not include Merrick-Moore Elementary School on Cheek Road, she said.

A strike by Durham school bus drivers this year only heightened concerns about the lack of safe walking routes for the 650 students who attend the elementary school, according to the April report.

Melvin-Muse, now 67, was at work when she got a call that John had been struck by a truck in front of their house. Before she left home that late May morning in 1989, she put her older kids in charge of the younger ones. They passed the time before school riding bicycles near their house, a few blocks from Merrick-Moore Elementary School, when the accident occurred.

John died two months shy of his 7th birthday from “massive head injuries,” according to The (Raleigh) News & Observer, which wrote about his death on Cheek Road at the time. John was buried in Markham Memorial Gardens, according to his obituary in The (Durham) Herald-Sun.

Melvin-Muse said his death sent the family into a tailspin of grief, anger, and regret.

“It caused a big rip in the family,” Melvin-Muse said.

Melvin-Muse and John’s father later divorced. She said she paid for therapy for her other kids, but they still got in trouble at school and two of her children ended up living in a home for kids with behavioral health issues. “It was just a bad time,” she said.

Years after the accident, Melvin-Muse said, she worked up the courage to call the driver who had hit her son. When he answered, he didn’t recognize her name, or John’s, fueling her rage, she recalled.

“I wanted revenge. An eye-for-an-eye kind of thing,” she said. “And I plotted to take him out the same way my son was taken out.”

She went so far as to get a job where he worked, the Durham County tax department, only to find he had left a week before she started.

“God knows what was in my heart and what I planned on doing,” Melvin-Muse said. “God moved him out of that place before I got there.”

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

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. 

It’s that time of year again: In most states, the Affordable Care Act’s annual open enrollment season for health plans begins Nov. 1 and lasts through Jan. 15.

Current enrollees who do not update their information or select an alternative will be automatically reenrolled in their current plan or, if that plan is no longer available, into a plan with similar coverage.

Last year marked a record enrollment of about 21 million people. This time around, consumers will find a few things have changed.

Don’t Fall for Advertising Scams

While some health plans offer small-dollar gift cards or other incentives to encourage participation in wellness efforts, they would not offer cash cards worth thousands of dollars a month to help with groceries, gas, or rent. Even so, social media and online sites are rife with such promises.

Such ads are among the avenues allegedly used by unscrupulous brokers who enroll or switch plans without the express permission of consumers, according to a lawsuit filed in Florida.

Also, be cautious about the websites you use to search for coverage.

Type “Obamacare” or “cheap health insurance” into a search engine and often what pops up first are sponsored private sector websites unaffiliated with the official state or federal government marketplaces for ACA coverage.

While they may try to look official, they are not. Many such sites offer various options, including non-ACA coverage with limited benefits, a “secret shopper” study found in 2023. Such non-ACA coverage would not qualify for federal subsidies to help consumers pay premiums.

The fine print on some websites says that consumers who provide personal information automatically consent to be contacted by sales agents via phone calls, emails, text messages, or automated systems with prerecorded messages.

When exploring plans, always start with the official federal marketplace’s website, healthcare.gov.

Even if you don’t live in one of the 29 states served by the federal marketplace, its website provides the link to your official enrollment site when you select your state, or the District of Columbia, from a drop-down list. The federal and state marketplaces also have call centers and other ways to get enrollment assistance. The “find local help” link on healthcare.gov, for example, gives consumers a choice of finding assisters or sales agents near them.

Is It Real Insurance?

Another concern: Regulators are seeing an increase in complaints from consumers about offers of health coverage requiring consumers to join a limited liability corporation, or otherwise attest they are working for a specific company. Indeed, at least two states — Maryland and Maine — have issued warnings, saying that instead of comprehensive ACA coverage, these are often non-ACA products, amounting to a hodgepodge of discount cards, for example, or limited-indemnity plans. This type of plan pays a flat-dollar amount — say, $50 for a doctor visit or $1,000 for a hospital stay — and is meant to buttress more comprehensive coverage, not replace it.

“Unlike major medical plans, some of these self-funded plans only cover preventive services such as a yearly check-up or annual health screening,” the warning from the Maine Bureau of Insurance says.

Premiums Might Be Higher … and Other New Things

Some insurers will lower premium rates for 2025, but many others are increasing them.

Although final numbers are still being crunched, experts estimate a median increase of 7% for premiums, according to an analysis by KFF, a health information nonprofit that includes KFF Health News, the publisher of California Healthline. Most people who buy ACA coverage are eligible for a subsidy to help with the premiums, which is likely to offset much of the increase, although the higher cost means the government will be paying out more for those subsidies.

Rising health costs — including for hospital care and the new class of weight loss drugs — are contributing to the increase.

Some other changes this open season:

• People often referred to as “Dreamers” because they qualified for the Deferred Action for Childhood Arrivals — a federal program offering some protection to those brought to the country as children without proper immigration documentation — can now enroll in ACA coverage and are eligible for subsidies.
• Short-term plans, which are technically not ACA coverage and not subject to its benefit rules and preexisting benefit protections, can be issued for, at most, only four months of coverage, based on a Biden administration action that took effect with plans starting Sept. 1. It walks back a Trump administration rule that loosened requirements to allow insurers to offer coverage that ranged up to 364 days, and allowed insurers the option of renewing the policies for up to two additional years. Existing plans and those issued before Sept. 1 don’t fall under the new rules. But consumers who relied on the longer periods need to check their plans’ details and consider enrolling in an ACA plan instead to avoid a situation in which their short-term plan expires early or midyear, potentially leaving them unable to get coverage elsewhere for the remainder of the year.

The Sign-Up Process Might Take Longer, Too

Federal regulators this year wrestled with a growing number of complaints — 200,000 in the first six months alone — from consumers who were being enrolled into or switched from ACA plans without their express permission by agents seeking to gain commissions.

To thwart such efforts, they put new rules in place.

What does that mean for most consumers? If you are working with a new agent — one who wasn’t already listed on your ACA plan — you will likely need to get on a three-way call with the federal marketplace to confirm that you are, indeed, authorizing that agent to make changes to your policy for the coming year. Plan on this taking additional time. No one knows how busy the call lines will get during open enrollment.

You don’t need to use a broker to enroll. But sorting through the dozens of options on the marketplace is challenging, so most people do seek assistance. Consumers need to weigh not only the monthly premium cost, but also variations in deductibles and copayments for such things as doctor visits, hospitalization, and drugs.

Shop Around

Experts say another consideration when choosing a plan is to check whether its network includes the doctors and hospitals you typically see, as well as whether its formulary covers your prescription medications, and how much it charges for them.

To help with making comparisons, rules kicked in two years ago requiring insurers to include some “standardized plans” as options, which must all have the same deductibles, and costs for such things as doctor visits, emergency room care, and other consumer cost sharing.

Even so, many people have dozens of options available, which can be daunting.

But one piece of advice remains constant: Whether you are enrolling for the first time or have an existing plan, it’s always worth it to shop around. Even if you don’t change plans, you can make sure the one you have is still your best option.

In most states, consumers must enroll by Dec. 15 to get coverage that begins Jan. 1. Heads up in Idaho, where open enrollment starts earlier — Oct. 15 — but also ends sooner, closing on Dec. 15. In California, New Jersey, New York, Rhode Island, and the District of Columbia, residents can enroll through Jan. 31.

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. 

While hot-button health care issues such as abortion and the Affordable Care Act roil the presidential race, Democrats and Republicans in statehouses around the country have been quietly working together to tackle the nation’s medical debt crisis.

New laws to curb aggressive hospital billing, to expand charity care for lower-income patients, and to rein in debt collectors have been enacted in more than 20 states since 2021.

Democrats championed most measures. But the legislative efforts often passed with Republican support. In a few states, GOP lawmakers led the push to expand patient protections.

“Regardless of their party, regardless of their background … any significant medical procedure can place people into bankruptcy,” Florida House Speaker Paul Renner, a conservative Republican, said in an interview. “This is a real issue.”

Renner, who has shepherded controversial measures to curb abortion rights and expand the death penalty in Florida, this year also led an effort to limit when hospitals could send patients to collections. It garnered unanimous support in the Florida Legislature.

Bipartisan measures in other states have gone further, barring unpaid medical bills from consumer credit reports and restricting medical providers from placing liens on patients’ homes.

About 100 million people in the U.S. are burdened by some form of health care debt, forcing millions to drain savings, take out second mortgages, or cut back on food and other essentials, KFF Health News has found. A quarter of those with debt owed more than $5,000 in 2022.

“Republicans in the legislature seem more open to protecting people from medical debt than from other kinds of debt,” said Marceline White, executive director of Economic Action Maryland, which helped lead efforts in that state to stop medical providers from garnishing the wages of low-income patients. That bill drew unanimous support from Democrats and Republicans

“There seems to be broad agreement that you shouldn’t lose your home or your life savings because you got ill,” White said. “That’s just a basic level of fairness.”

Medical debt remains a more polarizing issue in Washington, where the Biden administration has pushed several efforts to tackle the issue, including a proposed rule by the Consumer Financial Protection Bureau, or CFPB, to bar all medical debt from consumer credit reports.

Vice President Kamala Harris, who is spearheading the administration’s medical debt campaign, has touted the work on the presidential campaign trail while calling for new efforts to retire health care debt for millions of Americans.

Former President Donald Trump doesn’t typically talk about medical debt while stumping. But congressional Republicans have blasted the CFPB proposal, which House Financial Services Committee Chairman Patrick McHenry (R-N.C.) called “regulatory overreach.”

Nevertheless, pollster Michael Perry, who has surveyed Americans extensively about health care, said that conservative voters typically wary of government seem to view medical debt through another lens. “I think they feel it’s so stacked against them that they, as patients, don’t really have a voice,” he said. “The partisan divides we normally see just aren’t there.”

When Arizona consumer advocates put a measure on the ballot in 2022 to cap interest rates on medical debt, 72% of voters backed the initiative.

Similarly, nationwide polls have found more than 80% of Republicans and Democrats back limits on medical debt collections and stronger requirements that hospitals provide financial aid to patients.

Perry surfaced something else that may be driving bipartisan interest in medical debt: growing mistrust as health systems get bigger and act more like major corporations. “Hospitals aren’t what they used to be,” he said. “That is making it clear that profit and greed are driving lots of the decision-making.”

Not every state effort to address medical debt has garnered broad bipartisan support.

When Colorado last year became the first state to bar medical debt from residents’ credit reports, just one Republican lawmaker backed the measure. A Minnesota bill that did the same thing this year passed without a single GOP vote.

But elsewhere, similarly tough measures have sailed through.

A 2024 Illinois bill to bar credit reporting for medical debt passed unanimously in the state Senate and cleared the House of Representatives 109-2. In Rhode Island, not a single GOP lawmaker opposed a credit reporting ban.

And when the California Legislature took up a 2021 bill to require hospitals in the state to provide more financial assistance to patients, it passed 72-0 in the state Assembly and 39-0 in the Senate.

Even some conservative states, such as Oklahoma, have taken steps, albeit more modest. A new law there bars medical providers from pursuing patients for debts if the provider has not publicly posted its prices. The measure, signed by the state’s Republican governor, passed unanimously.

New Mexico state Sen. Steve Neville, a Republican who backed legislation to restrict aggressive collections against low-income patients in that state, said he was simply being pragmatic.

“There was not much advantage to spending a lot of time trying to do collections on indigent patients,” Neville said. “If they don’t have the money, they don’t have the money.” Three of 12 GOP senators supported the measure.

North Carolina state Treasurer Dale Folwell, a Republican who as a state legislator spearheaded a 2012 effort to ban same-sex marriage, said all elected officials, no matter their party, should care about what medical debt is doing to patients.

“It doesn’t matter if, as a conservative, I’m saying these things, or if Bernie Sanders is saying these things,” Folwell said, referencing Vermont’s liberal U.S. senator. “At the end of the day, it should be all our jobs to advocate for the invisible.”

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.