The Nation’s Largest Food Aid Program Is About To See Cuts. Here’s What You Should Know.

The Trump administration’s overhaul of the nation’s largest food assistance program will cause millions of people to lose benefits, strain state budgets, and pressure the nation’s food supply chain, all while likely hindering the goals of the administration’s “Make America Healthy Again” platform, according to researchers and former federal officials.

Permanent changes to the Supplemental Nutrition Assistance Program are coming regardless of the outcome of at least two federal lawsuits that seek to prevent the government from cutting off November SNAP benefits. The lawsuits challenge the Trump administration’s refusal to release emergency funds to keep the program operating during the government shutdown.

A federal judge in Rhode Island ordered the government to use those funds to keep SNAP going. A Massachusetts judge in a separate lawsuit also said the government must use its food aid contingency funds to pay for SNAP, but gave the Trump administration until Nov. 3 to come up with a plan.

Amid that uncertainty, food banks across the U.S. braced for a surge in demand, with the possibility that millions of people will be cut off from the food program that helps them buy groceries.

On Oct. 28, a vanload of SpaghettiOs, tuna, and other groceries arrived at Gateway Food Pantry in Arnold, Missouri. It may be Gateway’s last shipment for a while. The food pantry south of St. Louis largely serves families with school-age children, but it has already exhausted its yearly food budget because of the surge in demand, said Executive Director Patrick McKelvey.

New Disabled South, a Georgia-based nonprofit that advocates for people with disabilities, announced that it was offering one-time payments of $100 to $250 to individuals and families who were expected to lose SNAP benefits in the 14 states it serves.

Less than 48 hours later, the nonprofit had received more than 16,000 requests totaling $3.6 million, largely from families, far more than the organization had funding for.

“It’s unreal,” co-founder Dom Kelly said.

The threat of a SNAP funding lapse is a preview of what’s to come when changes to the program that were included in the One Big Beautiful Bill Act that President Donald Trump signed in July take effect.

The domestic tax-and-spending law cuts $187 billion within the next decade from SNAP. That’s a nearly 20% decrease from current funding levels, according to the Congressional Budget Office.

The new rules shift many food and administrative costs to states, which may lead some to consider withdrawing from the program, which helped about 42 million people buy groceries last year. Separate from the new law, the administration is also pushing states to limit SNAP purchases by barring such things as candy and soda.

All that “puts us in uncharted territory for SNAP,” said Cindy Long, a former deputy undersecretary at the Department of Agriculture who is now a national adviser at the law firm Manatt, Phelps & Phillips.

The country’s first food stamps were issued at the end of the Great Depression, when the poverty-stricken population couldn’t afford farmers’ products. Today, instead of stamps, recipients use debit cards. But the program still buoys farmers and food retailers and prevents hunger during economic downturns.

The CBO estimates that about 3 million people will lose food assistance as a result of several provisions in the budget law, including applying work requirements to more people and shifting more costs to states. Trump administration leaders have backed the changes as a way to limit waste, to put more people to work, and to improve health.

This is the biggest cut to SNAP in its history, and it is coming against the backdrop of rising food prices and a fragile labor market.

The exact toll of the cuts will be difficult to measure, because the Trump administration ended an annual report that measures food insecurity.

Here are five big changes that are coming to SNAP and what they mean for Americans’ health:

1. Want food benefits? They will be harder to get.

Under the new law, people will have to file more paperwork to access SNAP benefits.

Many recipients are already required to work, volunteer, or participate in other eligible activities for 80 hours a month to get money on their benefit cards. The new law extends those requirements to previously exempted groups, including homeless people, veterans, and young people who were in foster care when they turned 18. The expanded work requirements also apply to parents with children 14 or older and adults ages 55 to 64.

Starting Nov. 1, if recipients fail to document each month that they meet the requirements, they will be limited to three months of SNAP benefits in a three-year period.

“That is draconian,” said Elaine Waxman, a senior fellow at the Urban Institute, a nonprofit research group. About 1 in 8 adults reported having lost SNAP benefits because they had problems filing their paperwork, according to a December Urban Institute survey.

Certain refugees, asylum-seekers, and other lawful immigrants are cut out of SNAP entirely under the new law.

2. States will have to chip in more money and resources.

The federal law drastically increases what each state will have to pay to keep the program.

Until now, states have needed to pay for only half the administrative costs and none of the food costs, with the rest covered by the federal government.

Under the new law, states are on the hook for 75% of the administrative costs and must cover a portion of the food costs. That amounts to an estimated median cost increase for states of more than 200%, according to a report by the Georgetown Center on Poverty and Inequality.

A KFF Health News analysis shows that a single funding shift related to the cost of food could put states on the hook for an additional $11 billion.

All states participate in the SNAP program, but they could opt out. In June, nearly two dozen Democratic governors wrote to congressional leaders warning that some states wouldn’t be able to come up with the money to continue the program.

“If states are forced to end their SNAP programs, hunger and poverty will increase, children and adults will get sicker, grocery stores in rural areas will struggle to stay open, people in agriculture and the food industry will lose jobs, and state and local economies will suffer,” the governors wrote.

3. Will the changes lead to more healthy eating?

The Trump administration, through its “Make America Healthy Again” platform, has made healthy eating a priority.

Health and Human Services Secretary Robert F. Kennedy Jr. has championed the restrictions on soda and candy purchases within the food aid program. To date, 12 states have received approval to limit what people can buy with SNAP dollars.

Federal officials previously blocked such restrictions, because they were difficult for states and stores to implement and they boost stigma around SNAP, according to a 2007 USDA report. In 2018, the first Trump administration rejected an effort from Maine to ban sugar-sweetened drinks and candy.

A store may decide that hassle isn’t worth participating in the program and drop out of it, leaving SNAP recipients fewer places to shop.

People who receive SNAP are no more likely to buy sweets or salty snacks than people who shop without the benefits, according to the USDA. Research shows that encouraging healthy food choices is more effective than regulating purchases.

When people have less money to spend on food, they often resort to cheaper, unhealthier alternatives that keep them sated longer rather than paying for more expensive food that is healthy and fresh but quick to perish.

4. How will SNAP cuts affect health?

Advocacy organizations working to end hunger in the nation say the cuts will have long-term health effects.

Research has found that kids in households with limited access to food are more likely to have a mental disorder. Similarly, food insecurity is linked to lower math and reading skills.

Working-age people with food insecurity are more likely to experience chronic disease. That long list includes high blood pressure, arthritis, diabetes, asthma, and chronic obstructive pulmonary disease.

Those health issues come with costs for individuals. Low-income adults who aren’t on SNAP spend on average $1,400 more a year on health care than those who are.

About 47 million people lived in households with limited or uncertain access to food in 2023.

5. What does this mean for the nation’s food supply chain?

SNAP spending directly boosts grocery stores, their suppliers, and the transportation and farming industries. Additionally, when low-income households have help accessing food, they’re more likely to spend money on other needs, such as prescriptions or car repairs. All that means that every dollar spent through SNAP generates at least $1.50 in economic activity, according to the USDA.

A report by associations representing convenience stores, grocers, and the food industry estimated it could cost grocers $1.6 billion to comply with the new SNAP restrictions.

Advocates warn stores may pass the costs on to shoppers, or they may close.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Better Treatments Buoy Multiple-Myeloma Patients, Bound by Research Cuts and Racial Disparities

For more than a year, Diane Hunter, now 72, had been experiencing vague symptoms — pain in her spine and hips, nausea, exhaustion, thirst, and frequent urination. Her primary care physician had ruled out diabetes before finally chalking up her ailments to getting older.

But months of intense back pain eventually landed her in the emergency room, where a doctor suggested that Hunter might have multiple myeloma. Hunter’s first question was, “What is that?”

Multiple myeloma is a cancer that develops in bone marrow plasma cells, crowding out healthy blood cells and damaging the bones. It is one of the most common blood cancers — and the most diagnosed among African Americans. The mortality rate from multiple myeloma also is higher among African American patients than white people, with a number of studies showing that, in addition to disease biology, societal factors such as socioeconomic status and lack of access to health insurance or medical services delay timely diagnoses.

A belated diagnosis is what happened to Hunter, a Black woman in Montgomery, Alabama. She said her primary care doctor dismissed a recommendation from her endocrinologist to refer her to a hematologist after finding high protein counts in her blood. Then, she said, he also refused to order a bone marrow biopsy after the ER doctor suggested she might have multiple myeloma. Fed up, she said, she found a new doctor, got tested, and learned she indeed had the disease.

Monique Hartley-Brown, a multiple myeloma researcher at the Dana-Farber Cancer Institute in Boston, said Hunter’s experience is fairly common, particularly among Black patients who live in underserved communities.

“On average, patients see their primary doctor three times before being accurately diagnosed,” Hartley-Brown said. “The delay from symptom onset to diagnosis is even longer for Black Americans. Meanwhile, the disease is wreaking havoc — causing fractures, severe anemia, fatigue, weight loss, kidney problems.”

Black and Hispanic patients are also less likely to receive the newest therapies, according to the Multiple Myeloma Research Foundation, and, when they do, they are more likely to do so later in the course of their disease than white patients. An analysis published in 2022 of racial and ethnic disparities in multiple myeloma drug approval trials submitted to the FDA concluded that Black patients made up only 4% of participants despite being roughly 20% of those living with the disease.

Now, even though significant progress has been made in understanding the biology of multiple myeloma and how to treat it, those racial gaps may grow larger amid federal cuts to cancer research and the backlash against diversity and inclusion efforts. While few multiple myeloma experts were willing to talk on the record about the impact of the funding cutbacks, Michael Andreini, president and CEO of the Multiple Myeloma Research Foundation, has written that cuts to the National Institutes of Health and its National Cancer Institute put future innovations at risk.

“Even before these potential cuts, funding for myeloma lagged behind,” he wrote before the cuts were finalized. “The myeloma specific budget has decreased significantly. Myeloma is almost 2% of all cancers, yet receives less than 1% of the NCI’s budget.”

The disease is already hard to diagnose. Because multiple myeloma is usually diagnosed when a patient is over 65 (African Americans tend to be diagnosed five years younger, on average), common symptoms such as lower back pain and fatigue are often chalked up to just getting older.

That’s what happened to Jim Washington of Charlotte, North Carolina. He was 61 when excruciating hip pain brought his regular tennis games to a sudden stop.

“I figured I’d done something to injure myself,” Washington said. “But I’d been playing tennis all my life, and this pain was different from anything I’d ever felt before.”

Washington was fortunate to have a concierge doctor and premium health insurance. In quick succession, he underwent X-rays that revealed a lesion on his spine and received a referral to an oncologist, who identified a cancerous tumor. A subsequent biopsy and blood tests confirmed he had multiple myeloma.

Washington had weeks of high-dose chemotherapy, followed by what is known as an autologous stem cell transplant, which used his own stem cells to regrow healthy blood cells in his body. It was a grueling process that ultimately left him with a clean bill of health. For the next several years, his doctors monitored him closely, including conducting an annual bone marrow biopsy.

Before treatment, he said, myeloma had infiltrated 60% of his blood cells. The stem cell transplant brought those levels down to zero. After about five years, however, his multiple myeloma level had crept back up to 10% and required more treatment.

But Washington had closely followed the latest research and believed he had reason to be optimistic. The FDA had approved the first CAR T-cell therapy for multiple myeloma in 2021.

Hartley-Brown said the lack of Black patients in multiple myeloma drug approval trials raises concerns about whether the trial results are equally applicable to the Black population and may help explain why treatment advances have been less effective in Black patients.

She cited multiple causes for the low trial participation rate, including historical distrust of the medical establishment and a lack of available clinical trials. “If you are living in an underserved or underrepresented area, the hospital or community doctor may not have clinical trials available, or that patient may have limitations getting to that location affiliated with the clinical trial,” she said.

Washington, a Black patient, appears to have avoided this trap, having benefited from the latest treatments both times. In January, he began six weeks of chemotherapy with a three-drug combination of Velcade, Darzalex, and dexamethasone before undergoing CAR T-cell therapy.

For that, doctors collected Washington’s T cells, a type of white blood cell, and genetically modified them to better recognize and destroy the cancer cells before reinfusing them into his body. He didn’t require hospitalization post-transplant and could do daily blood draws at home. His energy levels were much higher than during his first treatment.

“I’ve been in a very privileged position,” Washington said. “The prognosis is very positive, and I’m feeling good about where I am at this point.”

Hunter, too, considers herself lucky despite receiving a delayed diagnosis. After her diagnosis in January 2017, she underwent five months of immunotherapy with a three-drug combination (Revlimid, Velcade, and dexamethasone) followed by a successful stem cell transplant and two weeks in the hospital. She has been in remission since July 2017.

Hunter, now a support group co-leader and patient advocate, said that stories like Washington’s and her own provide hope despite the research cuts.

In the eight years since her treatment, she said, she’s seen the thinking around multiple myeloma — long described as a treatable but incurable disease — begin to shift as a growing subset of patients remain disease-free for many years. She said she has even met people living with the disease for 30 years.

“The word ‘cure’ is now being heard,” Hunter said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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What the Health? From KFF Health News: Happy Open Enrollment Eve!

The Host

Julie Rovner KFF Health News @jrovner @julierovner.bsky.social Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Open enrollment for 2026 Affordable Care Act insurance plans starts in most states Nov. 1, with no resolution in Congress about whether to continue more generous premium tax credits expanded under President Joe Biden or let them expire at the end of this year. It is unclear whether the backlash from millions of enrollees seeing skyrocketing premiums will move Democrats or Republicans to back away from entrenched positions that are keeping most of the federal government shut down.

Meanwhile, the Trump administration — having done away earlier this year with a Biden-era regulation that prevented medical debt from being included on consumers’ credit reports — is now telling states they cannot pass their own laws to bar the practice.

This week’s panelists are Julie Rovner of KFF Health News, Paige Winfield Cunningham of The Washington Post, Maya Goldman of Axios, and Alice Miranda Ollstein of Politico.

Panelists

Paige Winfield Cunningham The Washington Post @pw_cunningham Read Paige's stories. Maya Goldman Axios @mayagoldman_ @maya-goldman.bsky.social Read Maya's stories Alice Miranda Ollstein Politico @AliceOllstein @alicemiranda.bsky.social Read Alice's stories.

Among the takeaways from this week’s episode:

  • Tens of millions of Americans are bracing to lose government food aid on Nov. 1, after the Trump administration opted not to continue funding the Supplemental Nutrition Assistance Program during the shutdown. President Donald Trump and senior officials have made no secret of efforts to penalize government programs they see as Democratic priorities, to exert political pressure as the stalemate continues on Capitol Hill.
  • People beginning to shop for next year’s plans on the ACA marketplaces are experiencing sticker shock due to the expiration of more generous premium tax credits that were expanded during the covid pandemic. The federal government will also take a particular hit as it covers growing costs for lower-income customers who will continue to receive assistance regardless of a deal in Congress.
  • In state news, after killing a Biden-era rule to block medical debt from credit reports, the Trump administration is working to prevent states from passing their own protections. In Florida, doctors who support vaccine efforts are being muffled, and the state’s surgeon general says he did not model the outcomes of ending childhood vaccination mandates before pursuing the policy — a risky proposition as public health experts caution that recent measles outbreaks are a canary in the coal mine for vaccine-preventable illnesses.
  • And in Texas, the state’s attorney general, who is also running for the U.S. Senate as a Republican, is suing the maker of Tylenol, claiming the company tried to dodge liability for the medication’s unproven ties to autism. The lawsuit is the latest problem for Tylenol, with recent allegations undermining confidence in the common painkiller, the only one recommended for pregnant women to reduce potentially dangerous fevers and relieve pain.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: KFF Health News’ “Many Fear Federal Loan Caps Will Deter Aspiring Doctors and Worsen MD Shortage,” by Bernard J. Wolfson.

Alice Miranda Ollstein: ProPublica’s “Citing Trump Order on ‘Biological Truth,’ VA Makes It Harder for Male Veterans With Breast Cancer To Get Coverage,” by Eric Umansky.

Paige Winfield Cunningham: The Washington Post’s “Study Finds mRNA Coronavirus Vaccines Prolonged Life of Cancer Patients,” by Mark Johnson.

Maya Goldman: KFF Health News’ “As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction,” by Karen Brown, New England Public Media.

Also mentioned in this week’s podcast:

Credits

Francis Ying Audio producer Emmarie Huetteman Editor

Click here to find all our podcasts.

And subscribe to “What the Health? From KFF Health News” on Apple Podcasts, Spotify, YouTube, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Doctor Tripped Up by $64K Bill for Ankle Surgery and Hospital Stay

Physician Lauren Hughes was heading to see patients at a clinic about 20 miles from her Denver home in February when another driver T-boned her Subaru, totaling it. She was taken by ambulance to the closest hospital, Platte Valley Hospital.

A shaken Hughes was examined in the emergency room, where she was diagnosed with bruising, a deep cut on her knee, and a broken ankle. Physicians recommended immediate surgical repair, she said.

“They said: ‘You have this fracture and a big gaping wound in your knee. We need to take you to the OR to wash it out and make sure there’s no infection,’” she said. “As a clinician, I thought, ‘Yes.’”

She was taken to the operating room in the early evening, then admitted to the hospital overnight.

A friend took her home the next day.

Then the bills came.

The Medical Procedure

Surgeons cleaned the cut on her right knee, which had hit her car’s dashboard, and realigned a broken bone in her right ankle, stabilizing it with metal screws. Surgery is typically recommended when a broken bone is deemed unlikely to heal properly with only a cast.

The Final Bill

$63,976.35, charged by the hospital — which was not in-network with the insurance plan she got through her job — for the surgery and overnight stay.

The Problem: Should I Stay or Should I Go?

Hughes’ insurer, Anthem, fully covered the nearly $2,400 ambulance ride and some smaller radiology charges from the ER but denied the surgery and overnight stay charges from the out-of-network hospital.

“Sixty-three thousand dollars for a broken ankle and a cut to the knee, with no head injury or internal damage,” Hughes said. “Just to stay there overnight. It’s crazy.”

Insurers have broad power to determine whether care is medically necessary — that is, what is needed for treatment, diagnosis, or relief. And that decision affects whether and how much they will pay for it.

Four days after her surgery, Anthem notified Hughes that after consulting clinical guidelines for her type of ankle repair, its reviewer determined it was not medically necessary for her to be fully admitted for an inpatient hospital stay.

If she had needed additional surgery or had other problems, such as vomiting or a fever, an inpatient stay might have been warranted, according to the letter. “The information we have does not show you have these or other severe problems,” it said.

To Hughes, the notion that she should have left the hospital was “ludicrous.” Her car was in a junkyard, she had no family nearby, and she was taking opioid painkillers for the first time.

When she asked for further details about medical necessity determinations, Hughes was directed deep inside her policy’s benefit booklet, which outlines that, for a hospital stay, documentation must show “safe and adequate care could not be obtained as an outpatient.”

It turns out the surgery charges were denied because of an insurance contract quirk. Under Anthem’s agreement with the hospital, all claims for services before and after a patient is admitted are approved or denied together, said Anthem spokesperson Emily Snooks.

A hospital stay is not generally required after ankle surgery, and the insurer found Hughes did not need the kind of “comprehensive, complex medical care” that would necessitate hospitalization, Snooks wrote in an email to KFF Health News.

“Anthem has consistently agreed that Ms. Hughes’ ankle surgery was medically necessary,” Snooks wrote. “However, because the ankle surgery was bundled with the inpatient admission, the entire claim was denied.”

Facing bills from an out-of-network hospital where she was taken by emergency responders, though, Hughes did not understand why she wasn’t shielded by the No Surprises Act, which took effect in 2022. The federal law requires insurers to cover out-of-network providers as though they are in-network when patients receive emergency care, among other protections.

“If they had determined it was medically necessary, then they would have to apply the No Surprises Act cost,” said Matthew Fiedler, a senior fellow with the Center on Health Policy at Brookings. “But the No Surprises Act is not going to override the normal medical necessity determination.”

There was one more oddity in her case. During one of many calls Hughes made trying to sort out her bill, an Anthem representative told her that things might have been different had the hospital billed for her hospitalization as an overnight “observation” stay.

Generally, that’s when patients are kept at a facility so staff can determine whether they need to be admitted. Rather than being tied to the stay’s duration, the designation mainly reflects the intensity of care. A patient with fewer needs is more likely to be billed for an observation stay.

Insurers pay hospitals less for an observation stay than admission, Fiedler said.

That distinction is a big issue for patients on Medicare. Most often, the government health program will not pay for any care needed in a nursing home if the patient was not first formally admitted to a hospital for at least three days.

“It’s a classic battle between providers and insurers as to what bucket a claim falls in,” Fiedler said.

The Resolution

As a physician and a director of a health policy center at the University of Colorado, Hughes is a savvier-than-usual policyholder. Yet even she was frustrated during the months spent going back and forth with her insurer and the hospital — and worried when it looked like her account would be sent to a collection agency.

In addition to appealing the denied claims, she sought the help of her employer’s human resources department, which contacted Anthem. She also reached out to KFF Health News, which contacted Anthem and the Platte Valley Hospital.

In late September, Hughes received calls from a hospital official, who told her they had “downgraded the level of care” the hospital billed her insurance for and resubmitted the claim to Anthem.

In a written statement to KFF Health News, Platte Valley Hospital spokesperson Sara Quale said that the facility “deeply regrets any anxiety this situation has caused her.” The hospital had “prematurely” and erroneously sent Hughes a bill before working out the balance with Anthem, she wrote.

“After a careful review of Ms. Hughes’ situation,” Quale continued, “we have now stopped all billing to her. Furthermore, we have informed Ms. Hughes that if her insurance company ultimately assigns the remaining balance to her, she will not be billed for it.”

Anthem spokesperson Stephanie DuBois said in an email that Platte Valley resubmitted Hughes’ bill to the insurer on Oct. 3, this time for “outpatient care services.”

An explanation of benefits that was sent to Hughes shows the hospital rebilled for around $61,000 — about $40,000 of which was knocked off the total by an Anthem discount. The insurer paid the hospital nearly $21,000.

In the end, Hughes owed only a $250 copayment.

The Takeaway

There are places where patients receiving emergency care at an out-of-network hospital may fall through the cracks of federal billing protections, in particular during a phase that may be nearly indistinguishable to the patient, known as “post-stabilization.”

Generally, that occurs when the medical provider determines the patient is stable enough to travel to an in-network facility using nonmedical transport, said Jack Hoadley, a research professor emeritus at the McCourt School of Public Policy at Georgetown University.

If the patient prefers to stay put for further treatment, the out-of-network provider must then ask the patient to sign a consent form, agreeing to waive billing protections and continue treatment at out-of-network rates, he said.

“It’s very important that if they give you some kind of letter to sign that you read that letter very carefully, because that letter might give them your permission to get some big bills,” Hoadley said.

If possible, patients should contact their insurer, in addition to asking the hospital’s billing department: Are you being fully admitted, or kept under observation status, and why? Has your care been determined to be medically necessary? Keep in mind that medical necessity determinations play a key role in whether coverage is approved or denied, even after services are provided.

That said, Hughes did not recall being told she was stable enough to leave with nonmedical transportation, nor being asked to sign a consent form.

Her advice is to quickly and aggressively question insurance denials once they are received, including by asking for your case to be escalated to the insurer’s and hospital’s leadership. She said expecting patients to navigate complicated billing questions while in the hospital after a serious injury isn’t realistic.

“I was calling family,” Hughes said, “alerting my work colleagues about what happened, processing the extent of my injuries and what needed to be done clinically, arranging care for my pet, getting labs and imaging done — coming to grips with what just happened.”

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Trump Team Takes Aim at State Laws Shielding Consumers’ Credit Scores From Medical Debt

The Trump administration took another step Tuesday to weaken protections for Americans with medical debt, issuing new guidance that threatens ongoing state efforts to keep that debt off consumers’ credit reports.

More than a dozen states, including Washington, Oregon, California, Colorado, Minnesota, Maryland, New York, and most of New England, have enacted laws in recent years to keep medical debt from affecting consumers’ credit.

And more states — including several in conservative regions of the Midwest and Mountain West — have been considering similar protections, spurred by bipartisan concerns that medical debt on a credit report can make it harder for people to get a home, a car, or a job.

Nationwide, about 100 million people have some form of health care debt, with millions burdened by $10,000 or more in unpaid bills.

But in the new guidance, the Consumer Financial Protection Bureau asserts that federal law bars states from restricting medical debts from credit reports, arguing that only the federal government has this authority.

“Congress meant to occupy the field of consumer reporting and displace state laws,” the bureau concluded in an “interpretive rule” signed by Russell Vought, the White House budget director and acting head of the CFPB.

The guidance, which offers a new interpretation of the Fair Credit Reporting Act, reverses policies advanced under former President Joe Biden that sought to empower states to expand protections for people with medical debt.

The Trump administration’s latest move will not immediately roll back existing state protections.

But advocates for patients and consumers warn that the new guidance may stall progress elsewhere, just as millions of Americans are poised to lose federal aid that helps them buy health insurance through the Affordable Care Act. The aid is tied up in the current budget showdown between congressional Republicans and Democrats.

“You’d be hard-pressed to find a crueler regulatory interpretation,” said Elisabeth Benjamin, a vice president for the Community Service Society of New York. The nonprofit has pushed for medical debt protections in that state.

Lucy Culp, who oversees state lobbying efforts by Blood Cancer United, formerly known as the Leukemia & Lymphoma Society, warned that the Trump administration’s guidance could reverberate across the country. “This rule will have a chilling effect on states’ willingness to pass these critical patient protections,” she said.

The CFPB did not respond to a request for comment.

The new CFPB guidance might spur more litigation challenging state restrictions on medical debt credit reporting.

Trade groups representing credit reporting agencies and debt collectors went to court early this year challenging regulations issued by the Biden administration that would have removed medical debt from credit reports nationwide. They argued that the administration exceeded its authority in issuing the credit reporting restrictions.

The federal restrictions would have helped an estimated 15 million people. But the Trump administration chose not to defend the new regulations, and a federal judge in Texas appointed by Trump ruled that the regulations should be scrapped. They never went into effect.

The Consumer Data Industry Association, which represents credit bureaus, did not respond to a request for comment about the new CFPB rule, but the industry group has argued that regulating medical debt should be left to the federal government.

“Only national, uniform standards can achieve the dual goals of protecting consumers and maintaining accurate credit reports,” Zachary Taylor, the group’s government relations director, warned lawmakers in Maine this year before that state barred medical debts from credit reports there.

Broader health insurance protections could prevent more Americans from sinking into debt and depressing their credit scores.

But millions of Americans are expected to lose health coverage in the coming years as a result of the tax and spending bill signed by the president in July.

“Millions of Americans are avoiding medical care, putting off needed surgeries, skipping essential treatments,” said Allison Sesso, president and chief executive of Undue Medical Debt, a nonprofit that buys up and retires patients’ debts and advocates for broader patient protections.

“This isn’t just a health care issue,” Sesso added. “It’s an economic crisis that’s keeping families from building wealth and fully participating in the economy. When credit scores are dinged by medical bills, everyone loses.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Frente al auge de las apuestas deportivas, estados buscan frenar la adicción al juego

No es fácil promover la moderación y la disciplina financiera desde las entrañas de un casino.

Pero eso es lo que los empleados estatales de Massachusetts intentan hacer a diario, entre los sonidos y las luces intermitentes de las máquinas tragamonedas.

En el MGM Springfield, al oeste del estado, empleados con remeras verdes se encuentran frente a su pequeña oficina, justo al lado del casino.

Sobre ellos, un cartel dice GameSense, el programa insignia del estado para combatir la ludopatía (adicción al juego). Una pantalla muestra mensajes como “Mantén las apuestas deportivas divertidas. Establece un presupuesto y cúmplelo”.

Los empleados reparten etiquetas para maletas y pañuelos desechables gratuitos para animar a la gente a charlar. Si lo consiguen, entregan a los clientes folletos con el número de teléfono estatal de ayuda para jugadores y su sitio web. Incluso pueden inscribirlos en un programa llamado PlayMyWay, que permite a las personas establecer un presupuesto fijo mensual para sus apuestas.

Fuera de los casinos, GameSense se promociona en redes sociales, aplicaciones y sitios web de apuestas deportivas. Mientras tanto, el Departamento de Salud Pública del estado coloca sus propios mensajes sobre moderación en autobuses y vallas publicitarias.

“Es un gran movimiento de 12 años”, dijo Mark Vander Linden, quien supervisa el programa GameSense en Massachusetts.

El primer casino de Massachusetts abrió sus puertas en 2015 y, a medida que la industria del juego crecía, el estado desarrolló lo que denomina un programa de “juego responsable”, financiado con un impuesto adicional sobre las ganancias de la industria.

Al principio, los reguladores estatales probaron diversas estrategias para educar a los clientes sobre la naturaleza adictiva del juego y sobre sus riesgos financieros.

“Se trataba más bien de asegurar la disponibilidad de folletos que explicaran las probabilidades de cualquier juego”, explicó Vander Linden.

Desde entonces, Massachusetts ha implementado regulaciones adicionales para una industria en auge que ahora incluye las apuestas deportivas generalizadas.

Por ejemplo, no se pueden apostar sobre equipos universitarios de Massachusetts ni jugar con tarjeta de crédito. Todas las empresas de juegos de azar deben permitir a los clientes establecer límites voluntarios e inscribirse en una “lista de autoexclusión voluntaria” que les prohíbe el acceso a casinos o apuestas deportivas durante determinados intervalos de tiempo.

Un mosaico de normas estatales

Algunos estados han establecido límites similares para frenar la ludopatía, pero otros tienen muy pocos. A falta de una política nacional o de una comisión nacional del juego que supervise la industria, cada estado elabora su propio plan.

Un número creciente de investigadores y legisladores en materia de adicciones afirman que es hora de tomar medidas más audaces y unificadas para combatir los trastornos del juego.

Resaltan el auge de la industria del juego desde 2018, cuando la Corte Suprema de Estados Unidos abrió la puerta a que los estados legalizaran las apuestas deportivas y desató una industria agresiva, ahora legal en 39 estados. (Cuarenta y ocho estados han legalizado al menos alguna forma de juego, incluyendo las loterías).

Otros países han avanzado mucho más en la regulación de la industria del juego, y algunos expertos estadounidenses los consideran modelos potenciales.

Por ejemplo, el gobierno de Noruega tiene el monopolio de todas las máquinas tragamonedas, lo que le permite controlar los tipos de juegos que se ofrecen, y cada jugador del país tiene un límite de pérdida de 20.000 coronas (unos $2.000) al mes.

En el Reino Unido, la mayoría de los adultos tienen un límite de apuesta de 5 libras (unos $7) por cada giro en una máquina tragamonedas, y las empresas de juegos de azar están sujetas a un impuesto del 1% que se destina a un fondo para el tratamiento y la prevención de los trastornos del juego.

El año pasado, un informe publicado en la revista médica The Lancet instó a los líderes de salud internacionales a actuar con rapidez en las regulaciones antes de que los trastornos del juego se generalicen y se vuelvan comunes, y mucho más difíciles de detener.

Sin embargo, los líderes políticos señalan que Estados Unidos tiene menos interés en la regulación corporativa que muchos otros países, especialmente bajo la administración Trump. Al mismo tiempo, advierten que no hacer nada podría representar una grave amenaza para la salud pública, en especial ahora que las aplicaciones de apuestas deportivas permiten a las personas apostar en cualquier lugar y en cualquier momento.

El temor: más apuestas, más adicción

Incluso antes del “matrimonio” entre los juegos en línea y los teléfonos celulares, los investigadores estimaban que entre el 1% y el 2% de los estadounidenses ya padecían un trastorno del juego, y que un 8% adicional corría el riesgo de desarrollarlo.

Algunos políticos estadounidenses temen que el problema solo empeore.

“La sofisticación y complejidad de las apuestas se han vuelto abrumadoras”, declaró el senador Richard Blumenthal (demócrata de Connecticut). “Y por eso necesitamos protecciones que permitan a las personas decir que no”.

Blumenthal ha copatrocinado el Safe Bet Act (la Ley de Apuestas Seguras), una legislación que impondría normas federales a las empresas de apuestas deportivas.

El proyecto de ley propone la prohibición de la publicidad de juegos de azar durante eventos deportivos en vivo, controles obligatorios de asequibilidad para clientes con grandes gastos, límites a los programas de membresía VIP, la prohibición del uso de la inteligencia artificial para marketing y la creación de una base de datos nacional de “autoexclusión”, entre otras normas.

“Los estados no pueden proteger a sus consumidores de las ofertas excesivas y abusivas, y a veces de los anuncios engañosos”, declaró Blumenthal. “Simplemente no tienen los recursos ni la jurisdicción”.

La industria del juego se opone firmemente a esta ley. Las normas federales serían una bofetada para los reguladores estatales, afirmó Joe Maloney, vocero de la American Gaming Association.

“Tienen el potencial de, primero, usurpar drásticamente la autoridad de los estados y, segundo, congelar la industria”, afirmó.

El juego responsable y la salud pública

Las nuevas regulaciones también son innecesarias, afirmó Maloney. La industria reconoce que el juego es adictivo para algunas personas, explicó, por lo que desarrolló una iniciativa de divulgación y concientización conocida como “juego responsable”.

Esto incluye mensajes en autobuses y carteles que advierten a la gente que deje de jugar cuando ya no sea divertido y les recuerdan que las probabilidades de ganar son muy bajas.

“Hay mensajes muy directos, como: ‘Aquí perderás dinero’”, dijo Maloney.

Agregó que su grupo industrial no recopila datos sobre si tales medidas reducen las tasas de adicción. Sin embargo, afirmó que las restricciones al juego no son la solución.

“Si de repente se empieza a elegir entre lo legal y lo prohibido, se está alejando a los apostadores del mercado legal y llevándolos al ilegal”, afirmó Maloney.

Los líderes de salud pública argumentan que el modelo de “juego responsable” de la industria no funciona.

“Se necesita regulación cuando la industria ha demostrado incapacidad y falta de voluntad para autocontrolarse”, afirmó Harry Levant, director de políticas de juego del Instituto de Defensa de la Salud Pública de la Facultad de Derecho de la Universidad de Northeastern en Boston.

Una de las razones por las que el enfoque de la industria es “ética y científicamente defectuoso” es que atribuye toda la culpa y la responsabilidad a las personas con un trastorno del juego, afirmó Levant. “No se puede decir a una persona que lucha contra la adicción: ‘Bueno, simplemente deja de hacerlo’”.

Levant aborda el tema desde su experiencia personal. Se está recuperando de una adicción al juego. Ex abogado, fue condenado en 2015 por robar dinero de sus clientes para financiar su adicción al juego. Desde entonces, no solo se ha convertido en un defensor de regulaciones más estrictas, sino que también es un terapeuta especializado en adicciones.

La American Gambling Association (AGA) afirmó apoyar el tratamiento de los trastornos del juego y ayudar a financiar algunos servicios de derivación y tratamiento a través de impuestos estatales. Sin embargo, Levant calificó esto como “el equivalente moral de que las grandes tabacaleras digan: ‘Hagamos lo que queramos con nuestros cigarrillos, siempre y cuando paguemos la quimioterapia y los cuidados paliativos'”.

En cambio, Levant aboga por un enfoque de salud pública que ayude a prevenir la adicción de raíz. Esto significa limitar la publicidad, y los tipos y la frecuencia de las apuestas, para todos, no solo para quienes ya tienen problemas.

Para defender su postura, Levant abre su computadora y muestra un anuncio corporativo producido por Simplebet, filial de DraftKings.

En el video, la compañía presume de conseguir que más gente apueste en deportes mediante las llamadas microapuestas durante los partidos en directo. “Impulsamos la participación de los aficionados convirtiendo cada momento de cada partido en una oportunidad para apostar. Automático, algorítmico, impulsado por el aprendizaje automático y la IA”, dice la voz en off.

Ese es el tipo de participación constante que fomenta la adicción, afirmó Levant. (Contactados por KFF Health News y NPR, DraftKings declinó hacer comentarios y, en su lugar, envió un enlace a su programa de “juego responsable”).

Legisladores quieren actuar ya

Algunos de estos mecanismos de juego se verían limitados por la Ley de Apuestas Seguras, que Levant y sus colegas del Instituto de Defensa de la Salud Pública ayudaron a redactar.

Pero si la legislación no se aprueba en el actual Congreso, reacio a las regulaciones, los estados deberán tomar medidas contundentes por su cuenta, afirmó Levant.

La Legislatura de Massachusetts está considerando actualmente la “Ley de Salud del Apostador” (Bettor Health Act), que impondría normas adicionales a las empresas de apuestas deportivas.

“El objetivo no es eliminar por completo las apuestas”, dijo

La representante estatal de Massachusetts, la demócrata Lindsay Sabadosa, copatrocinadora del proyecto de ley, dijo: “Es para detener los peores excesos de las apuestas deportivas en línea”.

El proyecto de ley de Massachusetts incluye componentes de la legislación federal, como los controles de asequibilidad obligatorios. Estos limitarían la cantidad de dinero que algunos jugadores pueden perder. Los controles de asequibilidad se basan en un programa piloto del Reino Unido.

“Si solo te permiten tomar dos copas, sabemos que no te vas a emborrachar, ¿verdad?”, dijo Sabadosa. “Si solo te permiten apostar $100 al día porque es una cantidad asequible, no te arruinarás. Podrás pagar el alquiler”.

La Ley de Salud del Apostador también prohibiría las apuestas “prop”, que son apuestas realizadas durante un partido en vivo, como quién marca el primer tiro en baloncesto o quién conecta el primer jonrón en béisbol.

Sin embargo, los ingresos fiscales estatales provenientes de las apuestas deportivas ascendieron a $2.800 millones en 2024, una fuente de financiación muy útil para los presupuestos estatales con dificultades. Debido a este posible impulso, Levant teme que los gobiernos estatales eviten una mayor regulación.

Los estados podrían incluso verse tentados por la promesa de ingresos adicionales provenientes de nuevos tipos de juegos de azar, como el “iGaming”. Se refiere a las versiones en línea de la ruleta, el blackjack y otros juegos de casino, disponibles a cualquier hora, desde la comodidad del hogar.

Actualmente, el iGaming es legal en siete estados, pero la legislación pendiente en otros estados, incluido Massachusetts, podría expandir sus mercados.

“Comprendemos lo difícil que es para los estados equilibrar sus presupuestos en el actual entorno político”, declaró Levant, “pero están empezando a reconocer que la solución a ese problema no es seguir impulsando un producto conocido por ser adictivo”.

Este artículo forma parte de una colaboración entre NPR y New England Public Media.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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¿Un auto nuevo o un seguro médico? La cobertura familiar a través del empleo cuesta a los trabajadores hasta $27.000

El cierre del gobierno federal continúa, trabado por el desacuerdo en el Congreso sobre el costo del seguro médico de 22 millones de personas que tienen planes adquiridos en los mercados establecidos por la Ley de Cuidado de Salud a Bajo Precio (ACA).

Mientras tanto, un nuevo informe muestra que más de 154 millones de personas con cobertura médica a través de sus empleos enfrentan fuertes aumentos de precios. Y, concluye la investigación, la situación podría empeorar.

Según una encuesta anual de empleadores publicada el 22 de octubre por KFF, las primas de los seguros médicos que ofrecen los empleadores aumentaron 6% en 2025, alcanzando un promedio de $26.993 al año para una cobertura familiar.

Es la primera vez en dos décadas que el costo de asegurar a una familia de cuatro personas aumenta 6% o más durante tres años consecutivos, según los datos de KFF.

En los últimos cinco años, la prima promedio por cobertura familiar ha aumentado un 26%, en comparación con un alza del 29% en los salarios de los trabajadores y casi un 24% en la inflación. Hoy, el seguro médico para una familia cuesta más o menos lo mismo que comprar un Toyota Corolla híbrido nuevo.

La prima promedio anual para un plan individual proporcionado por los empleadores subió un 5%, alcanzando los $9.325, casi $3.000 más que en 2016, según la encuesta.

“Nos preocupa que los costos de salud sigan subiendo”, dijo Eric Trump, encargado del área contable de Steve Reiff Inc., una pequeña empresa en South Whitley, Indiana, especializada en el arenado y la pintura de maquinaria pesada.

Trump, quien no tiene relación con el presidente Donald Trump, comentó que los costos de los planes médicos que ofrece la empresa subieron un 8% para el año fiscal 2026, más o menos lo mismo que en los últimos años.

Los trabajadores de Reiff pagan aproximadamente el 50% del costo de su cobertura médica. Cerca de la mitad de los 20 empleados rechazaron el seguro porque obtienen la cobertura a través de un familiar o prefieren no tener cobertura, explicó. “No podemos hacer mucho; no tenemos suficientes empleados para distribuir el costo”.

La mayoría de las personas que acceden al seguro médico a través del trabajo contribuyen al pago de sus primas. Este año, el trabajador promedio aportó $1.440 por cobertura individual y $6.850 por cobertura familiar.

Con el tiempo, muchos trabajadores han tenido que asumir deducibles más altos —el monto que deben pagar de su bolsillo por servicios médicos antes de que su seguro comience a cubrir los costos—. Más de un tercio de los trabajadores asegurados están inscritos en planes con un deducible de $2.000 o más por persona. Según el informe, la proporción de trabajadores con un plan de este tipo ha aumentado un 32% en los últimos cinco años y un 77% en la última década.

Los crecientes costos de los medicamentos y las hospitalizaciones suelen destacarse como las principales causas del incremento en el precio de los seguros médicos, y ninguno de estos factores muestra señales de disminuir.

“Los primeros informes indican que los costos seguirán en alza en 2026, lo que podría provocar aumentos aún más elevados en las primas, a menos que los empleadores y las aseguradoras encuentren formas de compensar estos costos mediante cambios en los beneficios, el reparto de gastos o el diseño de los planes”, señala la encuesta de KFF.

Una de las cuestiones que más preocupa a los empleadores es el alto precio de los medicamentos GLP-1 para bajar de peso, que cada vez más empresas cubren. Los precios elevados, junto con la alta demanda, han llevado a algunas compañías a restringir o eliminar la cobertura de estos medicamentos.

“Las grandes empresas saben que estos nuevos medicamentos para bajar de peso, muy costosos, son un beneficio importante para sus trabajadores, pero su precio a menudo supera las previsiones”, afirmó en un comunicado de prensa Gary Claxton, autor del estudio y vicepresidente senior de KFF.

“No es una sorpresa que algunas compañías estén reconsiderando el acceso a los medicamentos para bajar de peso”, agregó.

Los empleadores suelen responder al aumento de los costos de salud trasladando parte de esos gastos a sus trabajadores, pero no está claro cuánto más ellos pueden resistir económicamente. La encuesta mostró que casi la mitad de las grandes empresas dijeron que sus empleados están “bastante” o “muy” preocupados por cuánto les toca pagar de su propio bolsillo.

Aunque el aumento en el precio de los seguros pagados por las empresas ha superado la inflación general, la cuestión ha recibido poca atención en el Congreso en los últimos meses.

Para ayudar a financiar la ampliación de los recortes fiscales, la ley tributaria y de gasto público del presidente Trump reduce en miles de millones de dólares el monto que el gobierno destina a Medicaid, el programa de seguro de salud federal y estatal que cubre a 70 millones de personas de bajos ingresos y con discapacidades. Los analistas presupuestarios del Congreso pronostican que estos recortes harán que millones de personas pierdan su cobertura médica a lo largo de la próxima década.

El gobierno federal está cerrado desde el 1 de octubre, ya que los demócratas se niegan a aprobar un nuevo presupuesto federal a menos que los republicanos acepten prorrogar los subsidios que ayudan a unas 22 millones de personas a adquirir cobertura de salud a través de los mercados de ACA.

Sin la intervención del Congreso, estos subsidios (también llamados créditos fiscales) expirarán y las primas se duplicarán para muchos consumidores a partir de enero.

El informe de KFF se basa en una encuesta realizada este año a 1.862 empleadores públicos no federales y privados, seleccionados al azar, con 10 o más trabajadores.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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A Ticking Clock: How States Are Preparing for a Last-Minute Obamacare Deal

One family in Virginia Beach, Virginia, just found out their health plan’s deductible will jump from $800 to $20,000 next year. About 200 miles north, in Maryland, another household learned they’ll pay $500 more monthly to insure their brood in 2026. And thousands of people in Idaho were greeted with insurance rates that’ll cost, on average, $100 more every month.

As shopping season opens for Affordable Care Act plans in some states, customers are confronting staggering costs for their health insurance next year. The extra federal subsidies put in place in 2021 that made coverage more affordable for millions of people will expire at the end of this year unless a gridlocked and idle Congress acts.

With Democratic and Republican lawmakers at an impasse, the federal government shut down on Oct. 1, spurred by the need for an estimated $353 billion over a decade to continue providing enhanced ACA subsidies for roughly 24 million people. Both sides have dug in, with Republicans saying Senate Democrats must vote to reopen the government before they’re willing to negotiate on the ACA’s costs.

If Congress does manage to strike a deal in the coming days or weeks to extend some subsidies, the prices and types of plans available on the online marketplaces could change dramatically, bringing unprecedented uncertainty and upheaval to this year’s open enrollment, which begins in most states on Nov. 1.

Michele Eberle, executive director of the Maryland Health Benefit Exchange, the state-run marketplace, is gaming out strategies should that happen, including the possibility of pausing enrollment so her 200-person team can update the plans to reflect any changes, should Congress pass a new bill on ACA subsidies.

“We will do whatever it takes to make sure we can provide Marylanders with the most affordable health coverage,” Eberle said. “The mechanics of how that gets done, we don’t really know until we figure out what Congress might do.”

“I think everyone realizes that, depending on what happens, we just can’t flip a switch overnight,” she added.

Exchange customers in Maryland can expect to pay, on average, about 35% more next year, even with help from the state, which agreed to offer backup subsidies should the federal government’s discounts expire at the end of this year. Eberle said notices of premium hikes — which assumed the federal subsidies would expire — already were sent to mailboxes and inboxes. One middle-income family of four in the state, for example, will see their monthly premiums go from $916 to $1,427.

People living in most states still use healthcare.gov, the federal marketplace, to enroll in coverage. The Centers for Medicare & Medicaid Services, which oversees the federal exchange, declined to answer questions about how quickly the agency could pivot on any changes Congress may make after sign-ups start.

“CMS does not speculate on potential Congressional action,” Health and Human Services spokesperson Emily Hilliard said in an email.

Like other states that run their own ACA exchanges, California has sent letters to policyholders with information about their 2026 coverage, with costs calculated under the assumption that the subsidies would expire.

But the California exchange team, too, devised backup plans to contact policyholders and revamp its online marketplace if Congress acts before year’s end.

“At no point is it too late,” said Jessica Altman, executive director of Covered California, the state’s exchange. “We are ready to move any mountain we can possibly move to make any changes as quickly as we possibly can.”

It could take about a week to reprogram the site to reflect prices that factor in more generous subsidies, if Congress were to approve them exactly as they currently are, Altman said.

States may also have to update premiums themselves to reflect new rates. Most insurers submitted two sets of premium rates to states this year in case Congress agreed to extend the subsidies.

Right now, many shoppers are seeing the set of higher rates that insurers plan to charge if the subsidies expire.

Insurers say it is necessary to raise premiums without the subsidies because they anticipate healthier, younger people will drop coverage rather than pay more. That would leave insurers with a sicker, older pool of people to cover.

If a subsidy deal is reached, insurers could lower the premiums.

The complications don’t end there.

If Congress passes a subsidy deal after customers have started picking plans, people might see the new prices and want to reconsider the type of coverage for which they already signed up. Enrollees may change plans as long as enrollment is open, through Jan. 15 in most states.

Dozens of insurers offer ACA plans across the country. Those plans range widely in the doctors or medications they cover, as well as how much customers contribute in copays, the fees owed for medical services, and deductibles, the out-of-pocket amount paid before insurers pitch in.

Some people might be willing to pay a higher monthly premium in exchange for a lower deductible. Others, especially those who don’t expect to incur major medical bills, might risk a higher deductible to keep monthly premium payments lower.

In Virginia, some customers are being presented with strikingly high deductibles for next year, said Deepak Madala, the director of Enroll Virginia, which assists people with enrolling in coverage.

He said he’s helping one family in Virginia Beach facing a jump in premium costs from $70 to about $280 a month.

To buy a plan at a similar price, the family, with a household income of about $60,000, would need to look at coverage that carries a deductible of $20,000 or more, he said. Right now, their deductible is $800.

With premiums and deductibles that high, some customers might rethink coverage entirely, he said.

They’re deciding whether “to go without or switch to a plan with a very high deductible,” Madala said of ACA customers’ options.

Pennsylvania’s state-based exchange, which last week started sending out notices detailing 2026 rates, estimates a 102% increase in premiums for its roughly 500,000 customers. About a third of customers are expected to drop coverage, said Devon Trolley, executive director of the Pennsylvania Health Insurance Exchange Authority.

The timing of any subsidy deal reached by Congress is most precarious, though, for the roughly 135,000 Idahoans enrolled in ACA coverage.

That’s because their state opened enrollment on Oct. 15, weeks before the rest of the country — and it will end earlier, on Dec. 15.

With ACA enrollees facing average increases of 75% for coverage costs, about 20% are expected to drop out of the marketplace, said Pat Kelly, executive director of Your Health Idaho, the state exchange.

Idaho is prepared to revamp its website if anything changes on the subsidies — a process that could take days — and has “notices ready to go” to inform policyholders of additional savings, Kelly said.

“We would work to do it as quickly as possible, and make sure it is done right,” he said, adding that factors such as the day of the week or proximity to the Thanksgiving holiday could add time.

If Congress waited to act until the federal subsidies expire on Dec. 31 — the date Republican House Speaker Mike Johnson has repeatedly raised as the deadline for a deal — it would be too late for people in Idaho.

“We would run out of open enrollment, and there would not be enough time to make changes,” Kelly said of any congressional deals reached after mid-December.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction

It isn’t easy to promote moderation and financial discipline from the bowels of a casino.

But that’s what Massachusetts state workers try to do every day, amid the clanging bells and flashing lights of the slot machines.

At the MGM Springfield in western Massachusetts, workers wearing green polos stand outside their small office, right off the casino floor.

Above them, a sign reads “GameSense,” the state’s signature program to curb problem gambling. A mounted screen cycles through messages such as “Keep sports betting fun. Set a budget and stick to it.”

The workers hand out free luggage tags and travel-size tissues to encourage people to stop and chat. If they succeed, they give customers brochures displaying the state’s gambling helpline number and website. They can even enroll them in a program called “PlayMyWay,” which allows customers to set monthly spending limits on how much they gamble.

Outside the casinos, GameSense is marketed on social media and on sports betting apps and websites. Meanwhile, the state’s Department of Public Health puts its own moderation messages on buses and billboards.

“That’s a big movement in 12 years,” said Mark Vander Linden, who oversees the GameSense program in Massachusetts.

Massachusetts’ first casino opened in 2015, and as the gaming industry grew, the state developed what it calls a “responsible gaming” program, funded by a surtax on gambling industry profits.

At first, state regulators tried various strategies to educate customers about the addictive nature of gambling, as well as the financial risks.

“It was much more about making sure that there are brochures that are available that explained the odds of whatever game it was,” Vander Linden said.

Since then, Massachusetts has put in place additional regulations on a booming industry that now includes widespread sports betting. For example, there’s no betting on Massachusetts college teams, and no gambling by credit card. All gambling companies must allow customers to set voluntary limits and sign up for a “voluntary self-exclusion list” that bans them from casinos or sports betting over various time intervals.

A Patchwork of State Policies

Some states have set similar limits to curb problem gambling, but others have very few. In the absence of a nationwide policy, or a national gambling commission to oversee the industry, each state is on its own. 

A growing number of addiction researchers and policymakers say it’s time to take bolder — and more unified — steps to combat gambling disorders. They point to the explosion of the gaming industry since 2018, when the U.S. Supreme Court opened the door for states to legalize sports betting and unleashed an aggressive industry, now legal in 39 states. (Forty-eight states have legalized at least some form of gambling, including lotteries.)

Compared with the U.S., several other countries have gone much further in regulating the gambling industry, and some experts in the U.S. are looking to them as potential models.

For example, Norway’s government has a monopoly on all slot machines so it can control the types of games offered, and every gambler in the country is limited to losing 20,000 kroner (about $2,000) a month.

In the United Kingdom, most adults are limited to betting 5 pounds (about $7) on every spin on a slot machine, and gambling companies are subject to a 1% levy that goes into a fund for treatment and prevention of gambling disorders.

Last year, a report published in the medical journal The Lancet called on international health leaders to act quickly on regulations before gambling disorders become widespread and common — and that much harder to stop.

But policy leaders point out that the U.S. has less appetite for corporate regulation than many other countries, especially under the Trump administration. At the same time, they warn that doing nothing could pose a serious public health threat, especially now that sports betting apps allow people to gamble anywhere and anytime.

Fears That More Gambling Means More Addiction

Even before the marriage of online gaming and cellphones, researchers had estimated 1% to 2% of Americans already had a gambling disorder, and an additional 8% of people were at risk of developing one.

Some U.S. politicians fear the problem will only get worse.

“The sophistication and complexity of betting has become staggering,” said Democratic U.S. Sen. Richard Blumenthal of Connecticut. “And that’s why we need protections that will enable an individual to say no.”

Blumenthal has cosponsored the SAFE Bet Act, legislation that would impose federal standards on sports betting companies.

The bill proposes a ban on gambling ads during live sporting events, mandatory “affordability checks” for high-spending customers, limits on VIP membership schemes, a ban on artificial intelligence tracking for marketing, and the creation of a national “self-exclusion” database, among other rules.

“States are unable to protect their consumers from the excessive and abusive offers, and sometimes misleading pitches,” Blumenthal said. “They simply don’t have the resources or the jurisdiction.”

The gambling industry is strongly opposed to the SAFE Bet Act. Federal standards would be a “slap in the face” to state regulators, said Joe Maloney, a spokesperson for the American Gaming Association.

“You have the potential to just dramatically, one, usurp the states’ authority and then, two, freeze the industry in place,” he said.

‘Responsible Gaming’ Versus the Public Health Approach

New regulations are also unnecessary, Maloney said. The industry acknowledges that gambling is addictive for some people, he said, which is why it developed an outreach/awareness initiative known as “responsible gaming.”

That includes messages on buses and billboards warning people to stop playing when it’s no longer fun and reminding them the odds of winning are very low.

“There’s very direct messages, such as, ‘You will lose money here,’” Maloney said.

He said his industry group does not collect data on whether such measures reduce addiction rates. But he said gambling restrictions are not the answer.

“If you suddenly start to pick and choose what can be legal or banned, you’re driving bettors out of the legal market and into the illegal market,” Maloney said.

Public health leaders argue that the industry’s “responsible gaming” model doesn’t work.

“You need regulation when the industry has shown an inability and unwillingness to police itself,” said Harry Levant, director of gambling policy for the Public Health Advocacy Institute at the Northeastern University School of Law in Boston.

One reason the industry’s approach is “ethically and scientifically flawed” is that it puts all the blame and responsibility on individuals with a gambling disorder, Levant said. “You can’t say to a person who is struggling with addiction, ‘Well, just don’t do that anymore.’”

Levant comes to the issue from personal experience. He is in recovery from a gambling addiction. A former lawyer, Levant was convicted in 2015 for stealing clients’ money to fund his betting habit. Since then, he not only has become an advocate for stronger regulations but also is a trained addiction therapist.

The American Gaming Association said it supports treatment for gambling disorders and helps pay for some referral and treatment services through state taxes. But Levant called that “the moral equivalent of Big Tobacco saying, ‘Let us do whatever we want for our cigarettes, as long as we pay for chemotherapy and hospice.’”

Instead, Levant advocates for a public health approach that would help prevent addiction from the get-go. That means putting limits on marketing and on the types, and frequency, of gambling — for everyone, not just those already in trouble.

To make his case, Levant opens his laptop and pulls up a corporate infomercial produced by Simplebet, a DraftKings subsidiary.

In the video, the company boasts about getting more people to gamble on sports through what’s called microbetting during live games. “We drive fan engagement by making every moment of every game a betting opportunity. Automatic, algorithmic, powered by machine learning and AI,” the voiceover said.

That’s the kind of constant engagement that promotes addiction, Levant said. (Contacted by KFF Health News and NPR, DraftKings declined to comment, instead sending a link to its “responsible gaming” program.)

Lawmakers Want To ‘Stop the Worst Excesses’ Before the Next Gambling Trend

Some of those gambling mechanisms would be limited by the SAFE Bet Act, which Levant and his colleagues at the Public Health Advocacy Institute helped write.

But if the legislation doesn’t get through the current regulation-averse Congress, then states need to take strong action on their own, Levant said.

The Massachusetts Legislature is currently considering the “Bettor Health Act,” which would impose additional rules on sports betting companies.

“The goal is not to stop gambling entirely,” said Massachusetts state Rep. Lindsay Sabadosa, a cosponsor of the bill. “It’s to stop the worst excesses of online sports betting.”

The Massachusetts bill includes components of the federal legislation, such as mandatory “affordability checks.” Those would cap how much money some gamblers can lose. Affordability checks are modeled on a pilot program in the United Kingdom.

“If you’re only allowed to have two drinks, we know that you’re not going to get drunk, right?” Sabadosa said. “If you’re only allowed to gamble $100 a day because that’s an affordable amount, you’re not going to go broke. You’re still going to be able to pay the rent.”

The Bettor Health Act would also ban “prop” bets, which are wagers placed during a live game, such as who makes the first shot in basketball, or who hits the first home run in baseball.

But state tax revenue from sports betting rose to $2.8 billion in 2024 — a welcome source of funding for struggling state budgets. Because of that potential boost, Levant fears that state legislatures will shy away from further regulation.

States may even be tempted by the promise of additional revenue from new types of gambling, such as “iGaming.” That refers to online versions of roulette, blackjack, and other casino-style games, playable at any hour, from the comfort of home.

IGaming is currently legal in seven states, but pending legislation in other states, including Massachusetts, could expand its markets.

“We have empathy for how hard it is for states to balance their budgets in this current political environment,” Levant said, “but states are starting to recognize that the answer to that problem is not to further push a known addictive product.”

This article is part of a partnership with NPR and New England Public Media.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Listen: Amid Shutdown Stalemate, Families Brace for SNAP Cuts and Paycheck Limbo

Listen: Health care has been at the heart of the federal government’s shutdown. KFF Health News chief Washington correspondent Julie Rovner appeared on WAMU’s Oct. 22 “Health Hub” to explain the health care compromises some lawmakers want before they will agree to reopen the government.

Affordable Care Act tax credits are at the heart of one of the longest government shutdowns in U.S. history. The impact is starting to be felt by families and federal employees. Food assistance programs could run out of money at the end of the month. And federal health agencies such as the Centers for Disease Control and Prevention have faced layoffs.

KFF Health News chief Washington correspondent Julie Rovner appeared on WAMU’s Oct. 22 “Health Hub” to discuss the possible compromises that could reopen the government.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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KFF Health News' 'What the Health?': Nutrition Programs Face Their Own Shutdown

The Host

Julie Rovner KFF Health News @jrovner @julierovner.bsky.social Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Health programs are feeling the pinch of the ongoing government shutdown. Funding for the Supplemental Nutrition Assistance Program, or SNAP, and the food program for women, infants, and children, WIC, is likely to run out in November, and cuts at the Centers for Disease Control and Prevention are keeping the agency from carrying out some of its primary public health functions.

Meanwhile, the Trump administration’s immigration crackdown is also leading to health consequences, and the Department of Homeland Security is trying to bolster its medical staff to cope with the large number of people in its custody.

This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post.

Panelists

Shefali Luthra The 19th @shefali.bsky.social Read Shefali's stories. Alice Miranda Ollstein Politico @AliceOllstein @alicemiranda.bsky.social Read Alice's stories. Rachel Roubein The Washington Post @rachel_roubein Read Rachel's stories.

Among the takeaways from this week’s episode:

  • As the federal shutdown continues, some are facing the startling possibility that their SNAP and WIC benefits soon will be cut off. Lawmakers remain in a stalemate over renewing the enhanced Affordable Care Act subsidies that are set to expire, and the roughly 24 million people with such plans — about 90% of whom benefit from the subsidies — are starting to learn what they will owe next year without them.
  • With a key weekly government report on morbidity and mortality halted amid the shutdown, the New England Journal of Medicine and the Center for Infectious Disease Research and Policy announced they will team up to publish public health alerts. While others are stepping in to fill the gap left by the Trump administration’s pullback from public health, the federal government’s data and ability to access information are not easily replaced.
  • It’s unclear whether the Trump administration’s plan to make in vitro fertilization more accessible will yield a substantial improvement in access to fertility treatments. Some employers already offer supplemental IVF benefits, and so far there are few details, such as how generous the Trump proposal would require coverage to be.

Also this week, Rovner interviews KFF Health News’ Katheryn Houghton, who wrote the latest “Bill of the Month” feature, about a broken elbow and a nearly six-figure bill.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: ProPublica’s “The Shadow President,” by Andy Kroll.

Shefali Luthra: The 19th’s “More People Are Freezing Their Eggs — But Most Will Never Use Them,” by Shalini Kathuria Narang, Rewire News Group.

Alice Miranda Ollstein: Brown University’s “New Study: AI Chatbots Systematically Violate Mental Health Ethics Standards.”

Rachel Roubein: The Washington Post’s “Errors in New Medicare Plan Portal Mislead Seniors on Coverage,” by Dan Diamond and Akilah Johnson.

Also mentioned in this week’s podcast:

Credits

Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).



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