Home » Archive for Februari 2026

A Canadian Hospital Scoops Up Nurses Who No Longer Feel Safe in Trump’s America

Last year, as the California hospital where she worked was appeasing the Trump administration by erasing words like “equity” and “diversity” from its paperwork, Brandy Frye had seen enough.

Frye, an emergency room nurse with 25 years of experience, felt that ignoring inequality’s role in health and sickness was an affront to the compassionate soul of the nursing profession.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Now Frye has found a new place to belong. She is part of a surge of American nurses and other health care workers moving to Canada — specifically, British Columbia — to escape the policies of President Donald Trump. Frye settled in Nanaimo on Vancouver Island, where the local hospital has hired 20 American nurses in less than a year.

“There are so many like-minded people out there,” said Justin Miller, another American nurse who started at Nanaimo Regional General Hospital this month. “You aren’t trapped. You don’t have to stay. Health care workers are welcomed with open arms around the world.”

More than 1,000 U.S.-trained nurses have been approved to work in British Columbia since April, when the province streamlined its licensing process for Americans, then launched an advertising campaign to take advantage of the “chaos and uncertainty happening in the U.S.” Nursing associations in Ontario and Alberta said they too have seen increased interest from American nurses in the past year.

“Some of them were living in fear of the administration, and they shared a sense of relief when crossing the border,” said Angela Wignall, CEO of Nurses and Nurse Practitioners of British Columbia. “As a Canadian, it’s heartbreaking. And also a joy to welcome them.”

The Trump administration, for its part, doesn’t seem concerned. When asked to comment, the White House dismissed accounts of nurses moving to Canada as “anecdotes of individuals with severe cases of Trump derangement syndrome.”

This aligns with an article we reported last year that found American doctors were also relocating north to get away from the Trump administration. According to the Medical Council of Canada, more than 1,200 American doctors created accounts on physiciansapply.ca in 2025 — typically the first step to getting licensed in Canada — compared with only about 300 in 2024.

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.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

He Needs an Expensive Drug. A Copay Card Helped — Until It Didn’t.

Over the course of 2025, Jayant Mishra of Mission Viejo, California, progressively developed scaly, itchy red patches on his skin. Then came the pain and swelling in the joints of his hands, making it difficult to do his work at a bank.

His primary care doctor referred him to a rheumatologist, who diagnosed psoriatic arthritis. She advised Mishra that while there’s no cure, there were many new medicines that could keep the autoimmune disease in check, and she recommended one, Otezla.

At first, Mishra balked. He knew the medicines were expensive. He worried about side effects. He thought he could manage with over-the-counter drugs.

But by September he was in so much pain that he agreed to try a starter pack provided by Otezla’s manufacturer, Amgen. It worked: The skin lesions disappeared, and the joint pain that kept him up at night dissipated. He was sold.

His rheumatologist got approval for the drug from his insurer, UnitedHealthcare, and signed him up for Amgen’s copayment assistance program. Having enrolled other patients, she told Mishra the copay card, similar to a credit card, should last a year, he said, shielding him from the drug’s high list price: around $5,000 for a 30-day supply, according to GoodRx.

He said the doctor explained that, in her patients’ experience, insurers and their pharmacy benefit managers negotiated a deeply discounted price with Amgen — she estimated $1,400 to $2,200 a month. Patients paid a percentage of that amount, their “patient responsibility,” using the copay card.

Mishra said he was approved for a copay card covering $9,450 a year. “I was happy when I got the message,” he said.

He added that the doctor reassured him about the cost. “She said: ‘You shouldn’t have to pay anything out-of-pocket. Your copay card will cover this.’”

He started the medicine and, at first, paid nothing.

Then the bill came.

The Medical Service

Otezla, which comes in a pill, is approved to treat some autoimmune disorders, including psoriatic arthritis.

The Bill

$441.02, for the second month’s fill of the drug — before Mishra chose to ration rather than refill his prescription, because his copay card was empty.

The insurance statement from UnitedHealthcare’s pharmacy benefit manager, Optum Rx — another subsidiary of the same parent company, UnitedHealth Group — showed it did not provide a negotiated discount and covered just $308.34 of the full $5,253.85 charge for a 30-day supply. The charges for the second month depleted the copay card and left Mishra owing the balance.

The Billing Problem: Copay Card ‘Tug-of-War’

Copay assistance programs are part of a “tug-of-war between drug manufacturers and insurers,” said Aaron Kesselheim, a professor of medicine at Harvard Medical School who studies the pharmaceutical industry.

The value of drugmakers’ copay cards has become more unpredictable as insurers try to restrict their use. Many insurance plans, for instance, do not count the money from a copay program toward a patient’s deductible.

And patients who use a copay card can wind up paying full or nearly full price rather than the discounted rate negotiated by their insurer’s pharmacy benefit manager.

“When you purchased your medication a Manufacturer Coupon was used,” Mishra’s explanation of benefits statements read, in tiny letters. The amount the copay card covered “was not applied towards your Deductible and Out of Pocket Maximum.”

Caroline Landree, a spokesperson for UnitedHealthcare, said that “the copay card is an arrangement between the patient and the pharmacy. It is used outside of insurance.”

In an emailed statement, Elissa Snook, a spokesperson for Amgen, expressed a different view of who was responsible for Mishra’s dilemma: “Copay assistance programs are designed to help patients start and stay on prescribed therapy, but the value of that assistance can be exhausted more quickly when a health plan requires patients to pay the full list price of a medicine.”

Few patients can afford the list prices that pharmaceutical manufacturers charge in the United States for brand-name drugs.

Insurers insulate themselves and their customers from those higher prices through pharmacy benefit managers’ negotiated discounts. They might, for example, designate certain drugs as preferred medications for plan members in exchange for the manufacturer agreeing to a significant price reduction.

Manufacturers’ copay assistance programs offer another way for patients to avoid paying full price. The assistance is intended to encourage patients to choose an expensive, brand-name drug — not one that “treats the same condition that the insurer has gotten for a cheaper price,” said Fiona Scott Morton, an economist at the Yale School of Management who studies drug pricing.

The assistance also discourages patients from discussing with their doctor whether a cheaper, generic drug would do, drug industry researchers said.

While the Food and Drug Administration first approved a generic version of Otezla in 2021, Amgen has sued to block U.S. sales of its generic competitors, ensuring the brand-name drug has patent protection until 2028. Generic versions are available overseas and in Canada, where patients can purchase it in some cases for less than $100 a month.

Mishra said one of his children joked he could cover a trip to visit relatives in India simply by purchasing his medicine while he was there.

The Resolution

Mishra has a health plan with a $5,000 deductible and contributes to a tax-free health savings account.

In September, he paid for the first month’s supply of Otezla with the copay card. But paying for October’s supply emptied the card — which he originally expected to last a year — and he said he used his HSA to pay for the roughly $400 that remained.

But wary of what the drug would cost in November and December, Mishra said, he tried to spread out the pills he had left from the starter pack and the first two months’ supply. He skipped some days and took only half of the prescribed dose to stretch the supply for two more months, knowing he would get a new copay card with the new year. Many of his symptoms returned, he said.

In January, he got another copay card, good for $9,450, which again wasn’t sufficient to pay for two months’ supply. He again paid the remaining balance in February from his HSA to count toward his $5,000 annual deductible. This time he owed $550, he said.

Mishra said his symptoms have resolved. With no clue what he’d be charged for March’s supply, he called UnitedHealthcare in late February and was told he would need to pay $4,450 for the month to meet his out-of-pocket maximum, he said.

But he said he pressed the representative further, asking why UnitedHealthcare doesn’t have a negotiated price. It does, they told him. “Actual price is $6,995.36.”

The Takeaway

Copay cards and drugmaker programs that promise patients “you could pay $0” work in mysterious ways.

On the one hand, they encourage patients to use brand-name or expensive drugs that are off insurers’ formularies, or lists of preferred, covered drugs. On the other, many patients couldn’t afford prescribed medicines without them.

Patients with public insurance, such as Medicare and Medicaid, are not permitted to use the cards, because the government considers them an end run around its attempts to bring down drug spending.

Using a copay card has gotten trickier as insurers push back. First, patients need to understand whether there is an annual dollar or time limit on the card and how it works with their insurance. Otherwise, they risk ending up reliant on a drug they can’t afford.

Less expensive drugs often can suffice. For example, there are a number of medicines to treat psoriatic arthritis, some of which may be cheaper or have better coverage from a particular insurer. Patients should ask their doctors whether cheaper medicines will work.

It also can help patients to consider their prescriptions when they select a health plan. Landree, of UnitedHealthcare, said Mishra could have selected a plan for 2026 that would have covered Otezla for a $100 copay each month, though that would have meant a higher premium.

“Personally I’m not in financial distress — I can afford it,” Mishra said. “But it was sticker shock, and it just doesn’t seem right.”

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!

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

Cientos de enfermeros estadounidenses dejan atrás el Estados Unidos de Trump y eligen trabajar en Canadá

El mes pasado, Justin y Amy Miller colmaron sus autos con tres niños, dos perros, un dragón barbudo y todas las pertenencias que pudieron, y condujeron 2.000 millas desde Wisconsin hasta British Columbia, en Canadá, para dejar atrás los Estados Unidos del presidente Donald Trump.

Los Miller se establecieron en Vancouver Island, su refugio rodeado de paisajes naturales y accesible solo por ferry o avión. Justin comenzó a trabajar en la sala de emergencias del Nanaimo Regional General Hospital, donde se convirtió en uno más de los 20 enfermeros formados en Estados Unidos contratados desde abril.

El temor a Trump, dijeron algunos de los enfermeros, fue la razón por la que se fueron.

“Somos muchos los que pensamos igual”, dijo Justin, quien ahora trabaja codo con codo con otros estadounidenses en Canadá. “No estás atrapado. No tienes que quedarte. A los trabajadores de salud los reciben con los brazos abiertos en todo el mundo”.

Los Miller forman parte de un nuevo y creciente número de enfermeros, doctores y otros trabajadores de salud estadounidenses que se mudan a Canadá, y en particular a British Columbia, donde más de 1.000 enfermeros y enfermeras formados en Estados Unidos han recibido autorización para trabajar desde abril pasado.

Mientras el gobierno de Trump implementa políticas de extrema derecha, cada vez más autoritarias, y reduce el financiamiento para la salud pública, los seguros y la investigación médica, muchos profesionales de enfermería se han sentido atraídos por la política progresista de Canadá, su reputación de país acogedor y su sistema de salud universal.

Además, algunos enfermeros se indignaron el año pasado cuando el gobierno de Trump dijo que reclasificaría la enfermería como un título no profesional, lo que impondría límites federales estrictos a los préstamos que los estudiantes de enfermería podrían recibir.

Canadá está listo para sacar partido de esta situación. Dos de sus provincias más pobladas, Ontario y British Columbia, han simplificado el proceso de obtención de licencias para enfermeros estadounidenses desde que Trump regresó a la Casa Blanca.

British Columbia también lanzó una campaña publicitaria de $5 millones —“aprovechando la oportunidad” creada por el “caos e incertidumbre que ocurren en Estados Unidos”— para contratar enfermeros de California, Oregon y Washington.

Temores hechos realidad

Amy Miller, enfermera practicante, dijo que ella y su esposo estaban decididos a sacar a sus hijos del país porque sentían que el segundo mandato de Trump inevitablemente derivaría en violencia.

Primero, los Miller obtuvieron licencias de enfermería en Nueva Zelanda, pero cuando la búsqueda de empleo tomó demasiado tiempo, cambiaron su plan hacia Canadá.

A Justin le ofrecieron un trabajo en cuestión de semanas.

Amy encontró uno en tres meses.

Así que se mudaron. Y solo unos días después, los Miller observaron con horror desde la distancia cómo sus temores se hacían realidad. Mientras fuerzas federales de inmigración se enfrentaban con manifestantes en Minneapolis el 24 de enero, agentes federales dispararon y mataron a un enfermero de cuidados intensivos, Alex Pretti, cuando filmaba un enfrentamiento y parecía intentar proteger a una mujer que había sido empujada al piso.

El video del asesinato mostró a los agentes fronterizos inmovilizando a Pretti en el suelo antes de confiscarle su pistola oculta, para la cual tenía licencia, y dispararle.

El gobierno de Trump calificó rápidamente a Pretti como un “terrorista doméstico”. Esa acusación fue cuestionada por videos de testigos que circularon en redes sociales y generaron indignación, incluso entre enfermeros y organizaciones de enfermería, algunos de los cuales mencionaron el deber de la profesión de cuidar a las personas vulnerables.

“No quiero decir que era algo esperado, pero por eso estamos aquí”, dijo Amy Miller. “Incluso nuestra hija mayor dijo: ‘Está bien, mamá, porque ya no estamos allá. Aquí estamos seguros’. Ella lo entiende y ni siquiera está en la escuela media”.

Tanto Estados Unidos como Canadá tienen una gran necesidad de enfermeros. Se proyecta que Estados Unidos tendrá un déficit de unos 270.000 enfermeros registrados, además de al menos 120.000 enfermeros practicantes con licencia, para 2028, según estimaciones recientes de la Administración de Recursos y Servicios de Salud (HRSA, por sus siglas en inglés).

En Canadá, las vacantes de empleo en enfermería se triplicaron entre 2018 y 2023, cuando alcanzaron casi 42.000, según un informe reciente del Montreal Economic Institute, un centro de análisis canadiense.

Consultada para comentar, la Casa Blanca señaló que datos del sector muestran que el número de enfermeros con licencia en Estados Unidos aumentó en 2025. Y desestimó los relatos de enfermeros que se mudan a Canadá como “anécdotas de personas con casos graves del síndrome de trastorno por Trump”.

“La fuerza laboral de salud estadounidense es la mejor del mundo y sigue creciendo bajo el presidente Trump”, dijo Blanca Kush Desai, vocera de la Casa. “Las oportunidades de empleo en el sistema de salud estadounidense siguen siendo sólidas, con posibilidades de avance profesional y salarios que superan ampliamente a los de otras naciones desarrolladas”.

“Una sensación de alivio”

No se sabe con precisión cuántos enfermeros estadounidenses se han mudado al norte desde que Trump regresó al cargo, porque algunas provincias canadienses no registran o no publican esas estadísticas.

Desde que el proceso simplificado entró en vigencia en abril de 2025 hasta enero, la provincia de British Columbia, que ha hecho más esfuerzos para contratar estadounidenses, había aprobado las solicitudes de licencia de 1.028 enfermeros formados en Estados Unidos, según el British Columbia College of Nurses and Midwives. En todo 2023 y 2024, solo se habían aprobado 112 y 127 solicitudes de estadounidenses, respectivamente, informó la agencia.

El aumento del interés de enfermeros estadounidenses también fue confirmado por asociaciones de enfermería en Ontario y Alberta, así como por la Canadian Nurses Association a nivel nacional.

Angela Wignall, CEO de Nurses and Nurse Practitioners of British Columbia, dijo que antes los enfermeros estadounidenses se mudaban al norte porque se habían enamorado de Canadá (o de un canadiense). Pero más recientemente, afirmó, ha conocido a enfermeros que temían que la Casa Blanca fomentara la violencia y la vigilancia, en particular contra familias que incluyen parejas del mismo sexo.

“Algunos vivían con miedo al gobierno y compartieron una sensación de alivio al cruzar la frontera”, dijo Wignall. “Como canadiense, es desgarrador. Y también es una alegría darles la bienvenida”.

Vancouver Island, que tiene una población de unas 860.000 personas, ha incorporado a 64 enfermeros formados en Estados Unidos desde abril, incluidos los del Nanaimo Regional, dijo Andrew Leyne, vocero de la autoridad de salud de la isla.

Una de las enfermeras fue Susan Fleishman, una canadiense que se mudó a Estados Unidos cuando era niña y luego trabajó durante 23 años en salas de emergencias antes de dejar el país en noviembre.

Fleishman dijo que la retórica de odio de Trump ha alimentado una división que ha permeado y deteriorado la vida en el país.

“No fue una mudanza fácil; eso es seguro. Pero creo que definitivamente vale la pena”, dijo, ya de regreso en Canadá. “Siento que aquí hay mucha más amabilidad. Y creo que eso hará que me quede”.

Brandy Frye, quien también trabajó durante décadas en salas de emergencias estadounidenses, contó que se mudó a Vancouver Island el año pasado tras esperar a ver si Mark Carney se convertiría en primer ministro de Canadá. El ascenso de Carney fue ampliamente visto como un rechazo al trumpismo.

Mientras tanto, dijo Frye, el hospital de California donde trabajaba había estado eliminando de sus documentos palabras asociadas con diversidad y equidad para complacer al gobierno de Trump. No pudo tolerarlo.

“Lo vi como un paso en contra de todo en lo que creo”, señaló Frye. “Y ya no me sentía parte de ese lugar”.

Como muchos de los enfermeros estadounidenses que se han mudado a Vancouver Island, Frye se sintió atraída por primera vez a la zona gracias a un video viral que estaba destinado al turismo, pero que terminó logrando mucho más.

Hace aproximadamente un año, Tod Maffin, creador de contenido en redes sociales y ex presentador de CBC Radio, invitó a estadounidenses a la ciudad portuaria de Nanaimo para un fin de semana de “infusión” diseñado para compensar el impacto de los aranceles de Trump en la economía local.

Maffin dijo que alrededor de 350 personas asistieron al evento en abril.

“Muchos eran trabajadores de salud que buscaban una ruta de escape”, dijo Maffin. “Estaban allí para apoyar nuestra economía, pero también para explorar Canadá”.

Maffin vio una oportunidad. Reutilizó el sitio web del evento como herramienta de reclutamiento y lanzó una sala de chat en Discord para ayudar a estadounidenses a mudarse.

Maffin dijo que cree que la campaña ayudó a unos 35 trabajadores de salud a mudarse a Vancouver Island. Voluntarios en más de 30 comunidades canadienses han replicado su sitio web para atraer a sus propios enfermeros y doctores estadounidenses.

“Hay comunidades en todo Canadá donde la sala de emergencias cierra por la noche porque falta un enfermero. Así de apretado está el personal”, dijo Maffin.

“Un nuevo enfermero en un pueblo pequeño, o en una ciudad mediana como Nanaimo hace la diferencia”, agregó.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

‘Kind of Morbid’: Health Premiums Threaten Their Nest Egg. A Terminal Diagnosis May Spare It.

COLUSA, Calif. — Early on, Jean Franklin got some career advice she followed religiously: “Pay yourself first.” So she did, socking away hundreds of thousands of dollars in retirement savings by the time she became a stay-at-home mom at age 41.

She and her husband, Charles, a former high school teacher who goes by Chaz, planned to retire comfortably in the three-bedroom house where they raised their kids about 60 miles northwest of Sacramento.

But early last year, the 63-year-old became unsteady on her feet. One morning in May, she woke up with slurred speech and landed in the hospital, then rapidly lost the ability to move the right side of her body.

In August, as doctors continued to puzzle over a possible diagnosis, the couple received a notice saying that on Jan. 1 their combined health care premium payments through the state insurance exchange would shoot up from $540 a month to $3,899 a month. The reason: Federal enhanced premium subsidies expiring at the end of last year would no longer offset their payment.

They immediately canceled a monthlong cruise they’d been planning with friends and looked through their retirement accounts.

“Now, instead of thinking about where we can go in our retirement, we’re asking the question, ‘Are we still going to be able to stay where we are because of the health care costs?’” said Chaz, who retired in 2021 at age 59.

Then they received more bad news. In October, at the age of 63, Jean was diagnosed with ALS, a debilitating disease that will eventually leave her unable to speak, swallow, or breathe on her own. But Jean’s condition allowed her to enroll in Medicare, the federal health insurance program that covers adults 65 and older and people with disabilities. The diagnosis saved them roughly $1,600 a month in premiums — little comfort as Jean lost her ability to walk, bathe, and dress herself.

“It’s kind of morbid that, because of my diagnosis, I got put on Medicare right away, so at least we don’t have to pay that out-of-pocket,” Jean said, sitting in a wheelchair in her living room, a quilt draped over her legs to guard against the intense chills she now often gets. “We’re not going to get buried under this.”

Yet the premiums for Chaz’s plan and her Medicare remain a significant strain on their finances. The $2,300 a month they now owe, which includes roughly $342 in premium payments for Jean’s Medicare supplemental insurance, is higher than their monthly mortgage and eats up more than a quarter of their budget.

The Franklins are among the 22 million people across the nation facing greater financial pressure after Congress chose not to extend 2021 enhanced federal subsidies. That assistance helped more than double enrollment in Obamacare plans to over 24 million.

The Congressional Budget Office estimated in 2024 that, without an extension of the tax credits, the number of uninsured Americans would climb by 2.2 million this year alone. As of January, nationwide enrollment in ACA plans was down about 1.2 million year over year, though experts say it could be months before the full effects of rising premiums are known, as people miss payments and lose coverage.

The groups hit hardest will be early retirees, middle-income earners, and people living in high-cost states, said Stacey Pogue, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University. The Franklins are all three.

“They fell off what we call a subsidy cliff,” Pogue said. “It’s very, very shocking, the amount that a person would have to absorb.”

That’s because the expanded tax credits made the biggest difference for people nearing retirement age who sat just above previous income eligibility thresholds, Pogue said. People such as the Franklins, who likely wouldn’t have qualified for financial help before expanded credits were implemented, are now losing that support at a time when insurers have responded to the uncertainty by dramatically raising rates.

Roughly half of people who were expected to lose eligibility for premium tax credits were ages 50 to 64, according to an analysis by KFF, a health information nonprofit that includes KFF Health News.

Republicans who opposed the extension have said the premium assistance went directly to insurance companies rather than consumers, incentivizing fraud and wasteful coverage. They also say the enhanced subsidies, which had no upper income limit for eligibility, were far too generous in capping premium payments at 8.5% of income, no matter how much an enrollee made.

“Most Americans would agree that taxpayers should not be subsidizing the health insurance of someone making $250,000,” U.S. Rep. Ken Calvert, a California Republican who voted against an extension in January, wrote in an Orange County Register op-ed. “I cannot accept the simple extension of a program that will line the pockets of insurers and is riddled with fraud at the expense of the American taxpayer.”

Patient advocates say the premium increases and expiration of subsidies have forced people into difficult choices. “The young people who are healthy are the first to say, I’m going to roll the dice” and forgo coverage, said Rebecca Kirch, executive vice president of policy and programs at the National Patient Advocate Foundation. “Those who are remaining in the system — because they have no choice — are holding off care, they’re holding off their meds, they’re going without necessary food.”

While the Franklins are getting by, they have relied on their sons to pay for a motorized recliner to assist with lifting Jean and a handicap van to transport her. Chaz, who broke a tooth a year ago, delayed fixing it because a crown would cost him $1,000.

This year, the couple will draw $36,000 more than they had anticipated from their retirement savings, most of it to cover Chaz’s insurance premiums.

“I have a nest egg,” Chaz said. “But there’s a lot of people around here who don’t.”

For a while, he was outraged.

“I wish Congress would get off their butts and solve this issue,” said Chaz, who is a registered Republican but blames both sides of the aisle. “You’re so busy bickering over stupid crap and it’s both parties pointing fingers and blaming. Where was this discussion two years ago?”

Now, Chaz said, he’s focused on making Jean, his wife of 27 years, as comfortable as possible.

Before she got sick, they did practically everything together — hiking, traveling, tai chi, amateur photography, and bug-hunting. One of her favorite specimens was the rain beetle, a fuzzy scarab-like insect that can’t feed as an adult, relying solely on fat stores from its larval stages.

In the mornings, Chaz and their sons, Charlie and Louis, take turns lifting Jean, dressing her, and helping her use the bathroom. It’ll be fodder for the counselor, she jokes to her sons, when they inevitably need therapy later in life.

Most days, Jean’s outdoor adventures rarely extend beyond being wheeled to her back patio, where she loves to watch their backyard chickens bobble around. Chaz’s stubbornness makes him a great patient advocate. Charlie always seems to know exactly when she needs a big hug, and Louis tells jokes that can still make her snort with laughter.

“I don’t know what I would do without my boys making me laugh,” she said.

In December, Chaz will turn 65, old enough to qualify for Medicare himself. “After this year — knock on wood — we should be OK,” Jean said, before pausing and shooting her husband a wry smile.

“Well, you’re gonna be OK.”

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact KFF Health News and share your story.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

Estados rojos y azules buscan limitar el uso de la inteligencia artificial en seguros de salud. Trump quiere lo opuesto

¿Cómo deben usar la inteligencia artificial (IA) las aseguradoras de salud? La respuesta a esta pregunta inusual de política pública, encuentra en un mismo bando al gobernador republicano Ron DeSantis, de Florida, y al gobierno demócrata de Maryland, los dos contra el presidente Donald Trump y el gobernador de California, Gavin Newsom.

La regulación de la inteligencia artificial, en especial su uso por parte de las aseguradoras de salud, se está convirtiendo en un tema que divide políticamente y altera las líneas partidarias tradicionales.

Quienes la impulsan, con Trump a la cabeza, no solo quieren insertar la IA de lleno en el gobierno, como en el experimento de Medicare que la utiliza en las autorizaciones previas (el proceso para autorizar ciertos tratamientos y medicamentos), sino que además buscan frenar a los estados que pretenden poner reglas y límites. Una orden ejecutiva firmada en diciembre busca invalidar la mayoría de los esfuerzos de los estados para regularla, al plantear que existe “una carrera con adversarios por la supremacía” en una nueva “revolución tecnológica”.

“Para ganar, las empresas estadounidenses de IA deben tener la libertad de innovar sin regulaciones engorrosas”, dice la orden de Trump. “Pero la regulación estatal excesiva frustra este imperativo”.

En todo el país, los estados se están rebelando. Al menos cuatro —Arizona, Maryland, Nebraska y Texas— aprobaron el año pasado leyes que limitan el uso de la IA en los seguros de salud. Otros dos, Illinois y California, habían aprobado leyes similares el año anterior.

Los legisladores de Rhode Island se proponen intentarlo de nuevo este año, después de que durante 2025 no lograran sancionar un proyecto que exigía a los organismos reguladores que recopilaran datos sobre el uso de las tecnologías. El año pasado, en Carolina del Norte, una iniciativa que exige que las aseguradoras no utilicen la IA como única base para decidir la cobertura generó interés entre legisladores republicanos.

DeSantis, ex candidato presidencial del Partido Republicano, ha presentado una “Carta de Derechos de la IA”, cuyas disposiciones incluyen restricciones a su uso en la tramitación de reclamos de seguros y el requisito de que un organismo regulador estatal inspeccione los algoritmos.

“Tenemos la responsabilidad de garantizar que las nuevas tecnologías se desarrollen de forma moral y ética, de modo que refuercen nuestros valores estadounidenses, no que los erosionen”, dijo DeSantis durante su discurso anual sobre la situación de su estado en enero.

Lista para regular

Las encuestas muestran que los estadounidenses desconfían de la IA. En diciembre, un relevamiento de Fox News encontró que el 63% de los votantes se describen como “muy” o “extremadamente” preocupados por la inteligencia artificial. La preocupación es mayoritaria en todo el espectro político. Casi dos tercios de los demócratas y poco más de 3 de cada 5 republicanos dijeron tener reparos sobre la IA.

Las tácticas de las aseguradoras de salud para reducir costos también preocupan a la población. Una encuesta de enero de KFF mostró un descontento generalizado en temas como la autorización previa.

En los últimos años, informes de ProPublica y otros medios han destacado el uso de algoritmos para rechazar rápidamente reclamos de seguros o solicitudes de autorización previa, al parecer con muy poca revisión por parte de un profesional de salud.

En enero, el Comité de Medios y Arbitrios de la Cámara de Representantes convocó a ejecutivos de Cigna, UnitedHealth Group y otras grandes aseguradoras para discutir preocupaciones sobre los altos costos de la atención médica.

Cuando se les preguntó directamente, los ejecutivos negaron o evitaron referirse al uso de la tecnología más avanzada para rechazar solicitudes de autorización o descartar reclamos.

La IA “nunca se utiliza para una denegación”, aseguró a los legisladores David Cordani, director ejecutivo de Cigna. Al igual que otras empresas del sector de seguros de salud, la compañía enfrenta demandas por sus métodos para rechazar reclamos, como destacó ProPublica. Justine Sessions, vocera de Cigna, dijo que el proceso de rechazo de reclamos de la empresa “no está impulsado por la IA”.

De hecho, las compañías insisten en presentar la IA como una herramienta de apoyo que no decide sola. Optum, parte del gigante de la salud UnitedHealth Group, anunció el 4 de febrero que implementaría autorización previa impulsada por tecnología, destacando que permitirá aprobaciones más rápidas.

“Estamos transformando el proceso de autorización previa para abordar los puntos de conflicto que genera”, dijo John Kontor, vicepresidente sénior de Optum, en un comunicado de prensa.

Aun así, Alex Bores, científico informático y miembro de la Asamblea de Nueva York, una figura clave en el debate legislativo del estado sobre la IA—que terminó en una ley integral para regular esta tecnología—, aseguró que la IA es un campo que, naturalmente, requiere regulación.

“Muchas personas consideran que las respuestas que reciben de sus aseguradoras son difíciles de entender”, dijo Bores, demócrata que compite por un escaño en el Congreso. “Agregar una tecnología que no puede explicar sus propias decisiones no ayudará a hacer las cosas más claras”.

Al menos una parte del ámbito de la salud —por ejemplo, muchos médicos— respalda a los legisladores y a quienes defienden las regulaciones.

La Asociación Médica Americana (AMA, por sus siglas en inglés) “apoya las regulaciones estatales que buscan más responsabilidad y transparencia de las aseguradoras comerciales que usan herramientas de IA y aprendizaje automático para revisar solicitudes de autorización previa”, dijo John Whyte, su director ejecutivo.

Whyte señaló que las aseguradoras ya utilizan IA y que “los médicos siguen enfrentando retrasos en la atención de los pacientes, decisiones poco claras de las aseguradoras, reglas de autorización inconsistentes y una carga administrativa abrumadora”.

Las aseguradoras responden

Con legislación aprobada o pendiente de aprobación en por lo menos nueve estados, aún no está claro el impacto real que tendrán esas leyes estatales, dijo Daniel Schwarcz, profesor de Derecho en la Universidad de Minnesota. Los estados no pueden regular los planes “autoasegurados”, que utilizan muchos empleadores; solo el gobierno federal tiene esa facultad.

Pero hay problemas más profundos, dijo Schwarcz: la mayoría de las leyes estatales que ha visto exigirían que un ser humano apruebe cualquier decisión propuesta por la IA, pero no especifican qué significa eso en la práctica.

Las leyes no ofrecen un marco claro para entender cuánta revisión es suficiente y, con el tiempo, los humanos tienden a volverse un poco descuidados y simplemente dan el visto bueno a cualquier sugerencia de una computadora, dijo.

Aun así, las aseguradoras ven esta ola de proyectos de ley como un problema.

“En términos generales, la carga regulatoria es real”, dijo Dan Jones, vicepresidente sénior de asuntos federales de la Alliance of Community Health Plans, un grupo comercial que representa a algunas aseguradoras de salud sin fines de lucro. Si las aseguradoras pasan mucho tiempo lidiando con un mosaico de leyes estatales y federales, agregó, eso significa que se dispondrá de “menos tiempo y recursos para enfocarnos en lo que se supone que debemos hacer: asegurarnos de que los pacientes tengan el acceso adecuado a la atención médica”.

Linda Ujifusa, senadora estatal demócrata en Rhode Island, dijo que las aseguradoras se opusieron el año pasado a un proyecto que presentó para restringir el uso de la IA en las denegaciones de cobertura. Fue aprobado en una cámara, pero en la otra no avanzó.

“Hay una oposición enorme” a cualquier intento de regular prácticas como la autorización previa, dijo, y también “una oposición enorme” a señalar a intermediarios —como las aseguradoras privadas o los administradores de beneficios farmacéuticos— “como parte del problema”.

En una carta en la que criticó el proyecto, AHIP, el principal grupo que representa a las aseguradoras, pidió “políticas equilibradas que promuevan la innovación y, al mismo tiempo, protejan a los pacientes”.

“Los planes de salud reconocen que la IA tiene el potencial de impulsar mejores resultados en la atención médica mejorando la experiencia del paciente, cerrando brechas en la atención, acelerando la innovación y reduciendo la carga administrativa y los costos para mejorar el enfoque en la atención al paciente”, dijo Chris Bond, portavoz de AHIP, a KFF Health News.

Y agregó que el sector necesita “un enfoque nacional coherente basado en un marco federal integral de políticas de IA”.

En busca de equilibrio

En California, Newsom ha promulgado algunas leyes que regulan la IA, incluida una que exige que las aseguradoras de salud garanticen que sus algoritmos se apliquen de manera justa y equitativa. Pero el gobernador demócrata ha vetado otras iniciativas con un enfoque más amplio, como un proyecto que imponía más requisitos sobre cómo debe funcionar la tecnología y que exigía revelar su uso a reguladores, médicos y pacientes cuando lo pidieran.

Según Chris Micheli, lobista de Sacramento, es probable que el gobernador quiera asegurarse de que el presupuesto estatal —que se mantiene fuerte gracias a las grandes ganancias de la Bolsa, especialmente de las empresas tecnológicas— no se resienta. Y para eso, dijo, hace falta equilibrio.

Newsom está tratando de “garantizar que ese flujo de dinero continúe y, al mismo tiempo, que haya algunas protecciones para los consumidores de California”, afirmó. Añadió que las aseguradoras consideran que ya están sujetas a una gran cantidad de regulaciones.

La administración Trump parece estar de acuerdo. La reciente orden ejecutiva del presidente propone demandar ante la Justicia y restringir ciertos fondos federales a cualquier estado que apruebe lo que caracteriza como una regulación estatal “excesiva”, con algunas excepciones, como las políticas destinadas a proteger a los niños.

Esa orden posiblemente sea inconstitucional, dijo Carmel Shachar, experta en políticas de salud de la Facultad de Derecho de Harvard. La autoridad para invalidar leyes estatales generalmente recae en el Congreso, explicó, y los legisladores federales consideraron en dos ocasiones, pero finalmente rechazaron, una disposición que prohibía a los estados regular la IA.

“Según nuestro conocimiento previo del federalismo y del equilibrio de poderes entre el Congreso y el Poder Ejecutivo, es muy probable que una impugnación tenga éxito”, dijo Shachar.

Algunos legisladores ven la orden de Trump con mucho escepticismo, y señalan que la administración ha eliminado controles y ha impedido que otros los establezcan, en un grado extremo.

“En este momento, no se trata de decidir si la regulación debe ser federal o estatal”, dijo Alex Bores. “La pregunta es si va a haber regulación a nivel estatal o directamente no va a haber ninguna”.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

Más personas toman medicamentos para tratar la ansiedad, aunque el gobierno se burla de ellos

Después de un año agotador de quimioterapia, cirugía y radiación para tratar un cáncer de mama, Sadia Zapp se sentía ansiosa. No era la inquietud manejable que había sido parte de su vida durante años, sino algo más profundo y difícil de ignorar.

Dijo que “cada pequeña molestia, como un dolor de rodilla, le hacía pensar: este es el final del camino para mí”.

Así que Zapp, de 40 años, directora de comunicaciones en Nueva York, se convirtió en una de los millones de estadounidenses que comenzaron a tomar medicamentos para la ansiedad (ansiolíticos) en los últimos años. En su caso, fue Lexapro, un fármaco que aumenta la producción de serotonina.

“Me encanta. Ha sido excelente”, dijo. “Realmente me ha ayudado a manejarla”.

La proporción de adultos en el país que tomaron medicamentos para la ansiedad aumentó de 11,7% en 2019 a 14,3% en 2024, y la mayor parte del incremento se registró durante la pandemia de covid, según datos de encuestas de los Centros para el Control y la Prevención de Enfermedades (CDC).

Eso representa 8 millones de personas más, un total aproximado de 38 millones, con aumentos marcados entre adultos jóvenes, personas con título universitario y adultos que se identifican como LGBTQ+.

Aunque los medicamentos psiquiátricos han ganado aceptación pública y son más fáciles de conseguir mediante citas de telemedicina, el aumento en el uso de una clase de antidepresivos llamados inhibidores selectivos de la recaptación de serotonina, conocidos como ISRS, ha generado críticas de partidarios del movimiento “Make America Healthy Again” (MAHA), quienes sostienen que son perjudiciales.

Médicos e investigadores dicen que medicamentos como Prozac, Zoloft y Lexapro son tratamientos de primera línea para muchos trastornos de ansiedad, incluidos el trastorno por ansiedad generalizada y el trastorno de pánico, y que han sido presentados de forma incorrecta como adictivos y dañinos en general, a pesar de que se ha demostrado que son seguros para uso prolongado.

Robert F. Kennedy Jr., secretario del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), ha criticado el uso creciente de los ISRS. Durante su audiencia de confirmación el 29 de enero, dijo que conoce personas, incluidos familiares, a quienes les resultó más difícil dejar los ISRS que dejar la heroína. Más recientemente, afirmó que su agencia estudia un posible vínculo entre el uso de ISRS y otros medicamentos psiquiátricos y comportamientos violentos como tiroteos escolares.

Marty Makary, comisionado de la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés), también ha sugerido que el uso de los ISRS en mujeres embarazadas podría provocar malos resultados en el nacimiento.

Los efectos secundarios comunes de los ISRS incluyen malestar estomacal, dificultad para concentrarse y fatiga. Algunos también pueden reducir la libido y causar otros efectos sexuales secundarios.

Para muchas personas, sin embargo, los efectos secundarios son leves y tolerables, y los beneficios de tratar la ansiedad crónica lo compensan, señaló Patrick Kelly, presidente de la Sociedad Psiquiátrica del Sur de California. “Las declaraciones sobre los ISRS simplemente no estaban basadas en ningún tipo de evidencia o hecho”, dijo Kelly sobre los comentarios de Kennedy.

Un estudio reciente mostró que más de la mitad de las personas con trastorno por ansiedad generalizada que tomaban un ISRS vieron reducidos sus síntomas de ansiedad al menos en un 50%. Los efectos secundarios llevaron a aproximadamente 1 de cada 12 personas a dejar de usar el medicamento.

“Cuando se hace de manera adecuada y también se utilizan técnicas de terapia apropiadas, los ISRS pueden ser realmente muy útiles”, dijo Emily Wood, psiquiatra que ejerce en Los Ángeles.

MAHA atribuye la ansiedad a una mala alimentación y a la falta de ejercicio

Los partidarios de MAHA han atribuido en parte el aumento de varios problemas de salud, incluidos la ansiedad, la depresión y otros trastornos de salud mental, a malas decisiones alimentarias y a un estilo de vida sedentario. Como solución, han propuesto medidas como reducir el consumo de alimentos ultraprocesados, que estudios recientes han vinculado con la depresión y la ansiedad, y disminuir el tiempo frente a pantallas a favor del ejercicio.

Los psiquiatras suelen recomendar una alimentación saludable y ejercicio como terapia complementaria para la ansiedad y la depresión. Wood dijo que los que pueden manejar la ansiedad sin medicamentos también deberían considerar la terapia de conversación. La proporción de adultos en Estados Unidos que utilizan consejería en salud mental aumentó entre 2019 y 2024 a medida que la teleterapia ganó popularidad, según datos federales. “Los trastornos de ansiedad están entre los trastornos psiquiátricos que mejor responden a la terapia cognitivo-conductual”, dijo.

Pero los medicamentos pueden ayudar.

Estudios muestran que los riesgos de tomar ISRS durante el embarazo son bajos para la madre y el bebé. En contraste, “la depresión aumenta el riesgo de casi todas las complicaciones para la madre y el bebé”, expresó Wood, y agregó que declaraciones recientes de funcionarios del gobierno sobre el uso de ISRS durante el embarazo “podrían estar causando un daño real a estas mujeres”.

Algunas personas que dejan de tomar antidepresivos experimentan náuseas, insomnio u otros síntomas, especialmente si los suspenden de forma repentina. Pero “el concepto de adicción simplemente no se aplica a estos medicamentos”, dijo Kelly, una afirmación respaldada por estudios.

La adicción sí es posible con benzodiacepinas como Xanax, que a menudo son un tratamiento de segunda línea para la ansiedad. Estas sustancias controladas también pueden aumentar el riesgo de sobredosis de opioides en pacientes que toman ambos tipos de medicamentos. Durante audiencias en el Congreso el año pasado, Kennedy también criticó el uso excesivo de benzodiacepinas como un problema.

Aunque las benzodiacepinas son efectivas a corto plazo, requieren supervisión y cuidado, dijo Wood.

“Son medicamentos muy útiles para la ansiedad aguda y no son adecuados como tratamiento a largo plazo, porque pueden generar dependencia con el tiempo”, explicó Wood. “Si se toman a diario, se necesita cada vez más para lograr el mismo efecto y luego hay que reducir la dosis de manera gradual”.

Un número creciente de personas también toma ocasionalmente betabloqueantes como el propranolol para la ansiedad. Algunas las usan para prevenir el ritmo cardíaco acelerado antes de un discurso público u otros momentos importantes, aunque no están aprobadas por la FDA para tratar la ansiedad y se usan por fuera de lo que indica la receta.

Los betabloqueantes pueden causar mareos y fatiga, pero “no generan adicción, son útiles para reducir la activación del sistema nervioso autónomo, pasar de la respuesta de lucha o huida a un estado más neutral y son seguros”, dijo Wood.

Cambios sociales impulsan el aumento en el uso de estos medicamentos

Un número de teorías podrían explicar por qué muchas más personas están tomando medicamentos para la ansiedad, entre ellas un mayor uso de redes sociales, más aislamiento y mayor incertidumbre económica, según médicos e investigadores.

Además, los medicamentos son relativamente fáciles de obtener. Muchas personas reciben recetas de ISRS y benzodiacepinas de su médico de atención primaria. Otras, después de una breve cita de teleterapia.

Muchos influencers en redes sociales hablan sobre sus problemas de salud mental, lo que ha reducido el estigma entre los jóvenes y los anima a buscar ayuda. Aproximadamente un tercio de los adolescentes en un estudio reciente dijo que busca información sobre salud mental a través de redes sociales.

Aun así, el mayor acceso a medicamentos para la ansiedad puede ser problemático cuando se combina con una tendencia a autodiagnosticarse basada en información en redes sociales. Una búsqueda en Google de “buy Xanax online” muestra promesas patrocinadas de tratamiento el mismo día, aunque la letra pequeña aclara que no se garantiza una receta.

“Creo que un mayor acceso es algo positivo, pero no es lo mismo que, por ejemplo, pedir Xanax por internet”, dijo Kelly.

Los adultos jóvenes impulsan en gran medida el aumento en el uso de medicamentos para la ansiedad. La proporción de estadounidenses de 18 a 34 años que los toman aumentó de 8,8% en 2019 —el primer año en que estos datos estuvieron disponibles— a 14,6% en 2024. En contraste, la tasa cambió poco entre los adultos de 65 años o más, según datos de los CDC.

La pandemia y los confinamientos por covid aumentaron de forma importante el estrés entre muchos adultos, en especial los jóvenes.

Los datos también muestran que más mujeres que hombres toman medicamentos para la ansiedad.

Jason Schnittker, jefe de departamento y profesor de Sociología en la Universidad de Pennsylvania, dijo que esto se debe a que es más probable que los necesiten. También es más probable que las mujeres digan cuando se sienten ansiosas, y los médicos “tienden a identificar la ansiedad con mayor facilidad en sus pacientes mujeres que en sus pacientes hombres”, añadió Schnittker.

También podrían influir tendencias más amplias. Schnittker señaló que estudios han mostrado que la ansiedad se ha vuelto más común entre generaciones sucesivas durante gran parte del siglo XX y el siglo XXI. Autor de Unnerved: Anxiety, Social Change, and the Transformation of Modern Mental Health, dijo que el aumento de la desigualdad de ingresos podría ser un factor, ya que las personas sienten presión por mejorar su situación económica. Las actividades sociales y religiosas han sido reemplazadas por un mayor aislamiento. Y las personas se han vuelto más desconfiadas de los demás, lo que crea una sensación de inquietud frente a extraños.

Para Zapp, sobreviviente de cáncer, pasaron algunos meses tomando Lexapro antes de notar resultados claros. Cuando ocurrió, dijo, sintió que su mente estaba menos saturada, lo que le facilitó concentrarse. También recibió terapia, pero ahora su ansiedad crónica está estabilizada solo con el medicamento.

“Definitivamente me ayudó a volver a mi rutina diaria de una manera productiva y no simplemente llena de ansiedad durante todo el día”, dijo.

Holly Hacker, Maia Rosenfeld y Lydia Zuraw, de KFF Health News, contribuyeron con este artículo.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

As More Americans Embrace Anxiety Treatment, MAHA Derides Medications

After a grueling year of chemotherapy, surgery, and radiation to treat breast cancer, Sadia Zapp was anxious — not the manageable hum that had long been part of her life, but something deeper, more distracting.

“Every little ache, like my knee hurts,” she said, made her worry that “this is the end of the road for me.”

So Zapp, a 40-year-old communications director in New York, became one of millions of Americans to start taking an anxiety medication in recent years. For her, it was the serotonin-boosting drug Lexapro.

“I love it. It’s been great,” she said. “It’s really helped me manage.”

The proportion of American adults who took anxiety medications jumped from 11.7% in 2019 to 14.3% in 2024, with most of the increase occurring during the covid pandemic, according to survey data from the Centers for Disease Control and Prevention. That’s 8 million more people, bringing the total to roughly 38 million, with sharp increases among young adults, people with a college degree, and adults who identify as LGBTQ+.

Even as psychiatric medications gain public acceptance and become easier to access through telehealth appointments, the rise of a class of antidepressants called selective serotonin reuptake inhibitors, known as SSRIs, has triggered a backlash from supporters of the “Make America Healthy Again” movement who argue they are harmful. Doctors and researchers say medications such as Prozac, Zoloft, and Lexapro are front-line treatments for many anxiety disorders, including generalized anxiety disorder and panic disorder, and are being misrepresented as addictive and broadly harmful even though they’ve been proved safe for extended use.

Health and Human Services Secretary Robert F. Kennedy Jr. has decried broadening SSRI use. During his Jan. 29 confirmation hearing, he said he knows people, including family members, who had a tougher time quitting SSRIs than people have quitting heroin. More recently, he said his agency is studying a possible link between the use of SSRIs and other psychiatric medications and violent behavior like school shootings.

Food and Drug Administration Commissioner Marty Makary has also suggested that SSRI use among pregnant women could lead to poor birth outcomes.

SSRIs’ common side effects include upset stomach, brain fog, and fatigue. Some SSRIs also can reduce libido and cause other sexual side effects.

For many people, however, the side effects are mild and tolerable and the benefits of treating chronic anxiety are worth it, said Patrick Kelly, president of the Southern California Psychiatric Society. “The statements about SSRIs were just not grounded in any sort of evidence or fact,” Kelly said of Kennedy’s comments.

A recent comprehensive study showed that over half of people with generalized anxiety disorder taking an SSRI saw their anxiety symptoms reduced by at least 50%. Side effects prompted about 1 in 12 to stop taking an SSRI.

“When it’s being done right and when you’re also using appropriate therapy techniques, SSRIs can be really, really helpful,” said Emily Wood, a psychiatrist who practices in Los Angeles.

MAHA Blames Anxiety on Poor Diet, Lack of Exercise

Supporters of MAHA have partly blamed poor dietary choices and the increase of a sedentary lifestyle for the rise of a number of health problems, including anxiety, depression, and other mental health disorders. As a remedy, they have called for measures such as reducing consumption of ultraprocessed foods, which studies in recent years have connected to depression and anxiety, and cutting back on screen time in favor of exercise.

Psychiatrists often encourage a healthy diet and exercise as an adjunctive therapy for anxiety and depression. Wood said those who can manage anxiety without medication should also consider talk therapy. The proportion of American adults using mental health counseling boomed from 2019 to 2024 as teletherapy grew in popularity, federal data shows. “Anxiety disorders are amongst our psychiatric disorders that really respond well to cognitive behavioral therapy,” she said.

But medication can help.

Studies show the risks of taking SSRIs during pregnancy are low for mother and child. By contrast, “depression increases your risk for every complication for a mother and a baby,” Wood said, adding that recent statements by government officials about SSRI use during pregnancy are “potentially leading to real harm for these women.”

Some people who stop taking antidepressant medication will experience nausea, insomnia, or other symptoms, especially if they quit suddenly. But “the concept of addiction simply does not apply to these chemicals,” Kelly said, a statement backed up by studies.

Addiction, though, is a possibility with benzodiazepines such as Xanax that are often a second line of treatment for anxiety. These controlled substances can also increase the risk of opioid overdose in patients taking both types of drugs. During congressional hearings last year, Kennedy also decried benzodiazepine overuse as a problem.

While benzodiazepines are effective for short-term use, they require monitoring and care, Wood said.

“Those are really great meds for acute anxiety and not great as long-term anxiety medications, because they are habit-forming over time,” Wood said. “If you’re taking them on a daily basis, you’ll need more and more to get the same effect, and then you have to come down from them in a tapered way.”

And an increasing number of people are also occasionally taking beta-blockers such as propranolol for anxiety. Some people use beta-blockers to prevent a racing heart before a public speech or other big moments, even though they are not FDA-approved for treating anxiety and are prescribed “off-label.”

Beta-blockers can cause dizziness and fatigue, but they are “nonaddictive, really helpful for bringing down the autonomic nervous system, going from fight or flight to something more neutral, and really safe,” Wood said.

Social Shifts Drive Increased Use of Anxiety Meds

A number of leading theories could explain why so many more people are taking anxiety medication, including increased social media use, more isolation, and heightened economic uncertainty, physicians and researchers say.

Plus, the medicines are relatively easy to get. Many people obtain SSRI and benzodiazepine prescriptions from their primary care physician. Others obtain the medications after a brief teletherapy appointment.

Many social media influencers talk about their mental health struggles, easing some stigma among young people and encouraging them to get help. About a third of teens in a recent study said they get mental health information via social media.

Still, increased access to anxiety medication can be a problem when combined with a trend of self-diagnosis based on social media trends. A Google search for “buy Xanax online” leads to sponsored promises of same-day treatment, though fine-print disclaimers clarify that a prescription is not guaranteed.

“I think increased access is good, but that’s not the same thing as, you know, ordering Xanax online,” Kelly said.

Young adults are largely driving an increase in anxiety medication use. The proportion of Americans ages 18 to 34 taking anxiety medication rose from 8.8% in 2019 — the first year such survey data became available — to 14.6% in 2024. By contrast, the rate didn’t change much among adults 65 and older, CDC data shows.

The pandemic and covid lockdowns greatly increased stress among many American adults, particularly young adults.

And data shows more women than men take anxiety medication. Jason Schnittker, a department chair and professor of sociology at the University of Pennsylvania, said that’s because they’re more likely to need them. They are also likelier than men to report when they feel anxious, and doctors are “inclined or see anxiety more readily in their female patients than their male patients,” Schnittker added.

Broader trends could also be at work. Schnittker said studies have shown anxiety growing more prevalent among ensuing generations for much of the 20th and 21st centuries. Schnittker, author of Unnerved: Anxiety, Social Change, and the Transformation of Modern Mental Health, said growing income inequality could be partly to blame, with people feeling stress over improving their economic status. Social and religious activities have been replaced by more isolation. And people have become more suspicious of others, creating a sense of unease around strangers.

For Zapp, the cancer survivor, it took a few months on Lexapro before she started seeing clear results. When she did, she said, it felt like her mind was less noisy, making it easier to focus. She also underwent talk therapy, but now her chronic anxiety is stabilized on medication alone.

“It definitely helped me get back to my day-to-day in a way that was productive and not just riddled with my anxieties throughout the day,” she said.

KFF Health News’ Holly Hacker, Maia Rosenfeld, and Lydia Zuraw contributed to this report.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

Trump’s Transparent Hospital Pricing Pays Off for Industry — But Not So Much for Patients

“We’re going to post that, all the prices for everything,” Health and Human Services Secretary Robert F. Kennedy Jr. declared at a recent event held by the conservative Heritage Foundation in Washington.

It’s a bold-sounding promise, and a familiar one; politicians from both parties have been repeating it for years now. Both Trump administrations — and the Biden administration in between — have taken whacks at making medical prices more accessible, with the goal of empowering patients to shop for better deals.

The idea makes intuitive sense. Why shouldn’t you be able to compare the prices of MRI scans, for instance?

The feds have made some strides. Prices are available, albeit in confusing or fragmentary form. But there’s one big problem: “There’s no evidence that patients use this information,” said Zack Cooper, a health economist at Yale University.

Health care is an inherently complicated marketplace. For one thing, it’s not as simple as one price for one medical stay. Two babies might be delivered by the same obstetrician, for example, but the mothers could be charged very different amounts. One patient might be given medications to speed up contractions; another might not. Or one might need an emergency cesarean section — one of many cases in medicine in which obtaining the service simply isn’t a choice. Plus, the same hospital typically has different contract terms with each insurer, making comparing prices even more difficult for patients.

Instead of helping consumers sort things out, this federally mandated price data largely has become a tool for providers and insurers, looking for intel about their competitors — so they can use it at the negotiating table in a quest for more advantageous rates.

“We use the transparency data,” said Eric Hoag, an executive at Blue Cross Blue Shield of Minnesota, noting that the insurer wants to make sure health care providers aren’t being paid substantially different rates. It’s “to make sure that we are competitive, or, you know, more than competitive against other health plans.”

For all those tugs-of-war, it’s not clear these policies have had much of an effect overall. Research shows that transparency policies can have mixed effects on prices, with one 2024 study of a New York initiative finding a marginal increase in billed charges.

Price isn’t the only piece of information negotiations hinge on. Hoag said Blue Cross Blue Shield of Minnesota also considers quality of care, rates of unnecessary treatments, and other factors. And sometimes negotiators feel they keep up with their peers — claiming a need for more revenue to match competitors’ salaries, for example.

Hoag said doctors and other care providers often look at the data from comparable health systems and say, “‘I need to be paid more.’”

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

Should Drug Companies Be Advertising to Consumers?

Tamar Abrams had a lousy couple of years in 2022 and ’23. Both her parents died; a relationship ended; she retired from communications consulting. She moved from Arlington, Virginia, to Warren, Rhode Island, where she knew all of two people.

“I was kind of a mess,” recalled Abrams, 69. Trying to cope, “I was eating myself into oblivion.” As her weight hit 270 pounds and her blood pressure, cholesterol, and blood glucose levels climbed, “I knew I was in trouble health-wise.”

What came to mind? “Oh, oh, oh, Ozempic!” — the tuneful ditty from television commercials that promoted the GLP-1 medication for diabetes. The ads also pointed out that patients who took it lost weight.

Abrams remembered the commercials as “joyful” and sometimes found herself humming the jingle. They depicted Ozempic-takers cooking omelets, repairing bikes, playing pickleball — “doing everyday activities, but with verve,” she said. “These people were enjoying the hell out of life.”

So, just as such ads often urge, even though she had never been diagnosed with diabetes, she asked her doctor if Ozempic was right for her.

Small wonder Abrams recalled those ads. Novo Nordisk, which manufactures Ozempic, spent an estimated $180 million in direct-to-consumer advertising in 2022 and $189 million in 2023, according to MediaRadar, which monitors advertising.

By last year, the sum — including radio and TV commercials, billboards, and print and digital ads — had reached an estimated $201 million, and total spending on direct-to-consumer advertising of prescription drugs topped $9 billion, by MediaRadar’s calculations.

Novo Nordisk declined to address those numbers.

Should it be legal to market drugs directly to potential patients? This controversy, which has simmered for decades, has begun receiving renewed attention from both the Trump administration and legislators.

The question has particular relevance for older adults, who contend with more medical problems than younger people and are more apt to take prescription drugs. “Part of aging is developing health conditions and becoming a target of drug advertising,” said Steven Woloshin, who studies health communication and decision-making at the Dartmouth Institute.

The debate over direct-to-consumer ads dates to 1997, when the FDA loosened restrictions and allowed prescription drug ads on television as long as they included a rapid-fire summary of major risks and provided a source for further information.

“That really opened the door,” said Abby Alpert, a health economist at the Wharton School of the University of Pennsylvania.

The introduction of Medicare Part D, in 2006, brought “a huge expansion in prescription drug coverage and, as a result, a big increase in pharmaceutical advertising,” Alpert added. A study she co-wrote in 2023 found that pharmaceutical ads were much more prevalent in areas with a high proportion of residents 65 and older.

Industry and academic research have shown that ads influence prescription rates. Patients are more apt to make appointments and request drugs, either by brand name or by category, and doctors often comply. Multiple follow-up visits may ensue.

But does that benefit consumers? Most developed countries take a hard pass. Only New Zealand and, despite the decadelong opposition of the American Medical Association, the United States allow direct-to-consumer prescription drug advertising.

Public health advocates argue that such ads encourage the use and overuse of expensive new medications, even when existing, cheaper drugs work as effectively. (Drug companies don’t bother advertising once patents expire and generic drugs become available.)

In a 2023 study in JAMA Network Open, for instance, researchers analyzed the “therapeutic value” of the drugs most advertised on television, based on the assessments of independent European and Canadian organizations that negotiate prices for approved drugs.

Nearly three-quarters of the top-advertised medications didn’t perform markedly better than older ones, the analysis found.

“Often, really good drugs sell themselves,” said Aaron Kesselheim, senior author of the study and director of the Program on Regulation, Therapeutics, and Law at Harvard University.

“Drugs without added therapeutic value need to be pushed, and that’s what direct-to-consumer advertising does,” he said.

Opponents of a ban on such advertising say it benefits consumers. “It provides information and education to patients, makes them aware of available treatments and leads them to seek care,” Alpert said. That is “especially important for underdiagnosed conditions,” like depression.

Moreover, she wrote in a recent JAMA Health Forum commentary, direct-to-consumer ads lead to increased use not only of brand-name drugs but also of non-advertised substitutes, including generics.

The Trump administration entered this debate last September, with a presidential memorandum calling for a return to the pre-1997 policy severely restricting direct-to-consumer drug advertising.

That position has repeatedly been urged by Health and Human Services Secretary Robert F. Kennedy Jr., who has charged that “pharmaceutical ads hooked this country on prescription drugs.”

At the same time, the FDA said it was issuing 100 cease-and-desist orders about deceptive drug ads and sending “thousands” of warnings to pharmaceutical companies to remove misleading ads. Marty Makary, the FDA commissioner, blasted drug ads in an essay in The New York Times.

“There’s a lot of chatter,” Woloshin said of those actions. “I don’t know that we’ll see anything concrete.”

This month, however, the FDA notified Novo Nordisk that the agency had found its TV spot for a new oral version of Wegovy false and misleading. Novo Nordisk said in an email that it was “in the process of responding to the FDA” to address the concerns.

Meanwhile, Democratic and independent senators who rarely align with the Trump administration also have introduced legislation to ban or limit direct-to-consumer pharmaceutical ads.

Last February, independent Sen. Angus King of Maine and two other sponsors introduced a bill prohibiting direct-to-consumer ads for the first three years after a drug gains FDA approval.

King said in an email that the act would better inform consumers “by making sure newly approved drugs aren’t allowed to immediately flood the market with ads before we fully understand their impact on the general public.”

Then, in June, he and independent Sen. Bernie Sanders of Vermont proposed legislation to ban such ads entirely. That might prove difficult, Woloshin said, given the Supreme Court’s Citizens United ruling protecting corporate speech.

Moreover, direct-to-consumer ads represent only part of the industry’s promotional efforts. Pharmaceutical firms actually spend more money advertising to doctors than to consumers.

Although television still accounts for most consumer spending, because it’s expensive, Kesselheim pointed to “the mostly unregulated expansion of direct-to-consumer ads onto the web” as a particular concern. Drug sales themselves are bypassing doctors’ practices by moving online.

Woloshin said that “disease awareness campaigns” — for everything from shingles to restless legs — don’t mention any particular drug but are “often marketing dressed up as education.”

He advocates more effective educational campaigns, he said, “to help consumers become more savvy and skeptical and able to recognize reliable versus unreliable information.”

For example, Woloshin and Lisa Schwartz, a late colleague, designed and tested a simple “drug facts box,” similar to the nutritional labeling on packaged foods, that summarizes and quantifies the benefits and harms of medications.

For now, consumers have to try to educate themselves about the drugs they see ballyhooed on TV.

Abrams read a lot about Ozempic. Her doctor agreed that trying it made sense.

Abrams was referred to an endocrinologist, who decided that her blood glucose was high enough to warrant treatment. Three years later and 90 pounds lighter, she feels able to scramble after her 2-year-old grandson, enjoys Zumba classes, and no longer needs blood pressure or cholesterol drugs.

So Abrams is unsure, she said, how to feel about a possible ban on direct-to-consumer drug ads.

“If I hadn’t asked my new doctor about it, would she have suggested Ozempic?” Abrams wondered. “Or would I still weigh 270 pounds?”

The New Old Age is produced through a partnership with The New York Times.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

Nevada Debuts Public Option Amid Tumultuous Federal Changes to Health Care

More than 10,000 people have enrolled in Nevada’s new public option health plans, which debuted last fall with the expectation that they would bring lower prices to the health insurance market.

Those preliminary numbers from the open enrollment period that ended in January are less than a third of what state officials had projected. Nevada is the third state so far to launch a public option plan, along with Colorado and Washington state. The idea is to offer lower-cost plans to consumers to expand health care access.

But researchers said plans like these are unlikely to fill the gaps left by sweeping federal changes, including the expiration of enhanced subsidies for plans bought on Affordable Care Act marketplaces.

The public option gained attention in the late 2000s when Congress considered but ultimately rejected creating a health plan funded and run by the government that would compete with private carriers in the market. The programs in Washington state, Colorado, and Nevada don’t go that far — they aren’t government-run but are private-public partnerships that compete with private insurance.

In recent years, states have considered creating public option plans to make health coverage more affordable and to reduce the number of uninsured people. Washington was the first state to launch a program, in 2021, and Colorado followed in 2023.

Washington and Colorado’s programs have run into challenges, including a lack of participation from clinicians, hospitals, and other care providers, as well as insurers’ inability to meet rate reduction benchmarks or lower premiums compared with other plans offered on the market.

Nevada law requires that the carriers of the public option plans — Battle Born State Plans, named after a state motto — lower premium costs compared with a benchmark “silver” plan in the marketplace by 15% over the next four years.

But that amount might not make much difference to consumers with rising premium payments from the loss of the ACA’s enhanced tax credits, said Keith Mueller, director of the Rural Policy Research Institute.

“That’s not a lot of money,” Mueller said.

Three of the eight insurers on the state’s exchange, Nevada Health Link, offered the state plans during the open enrollment period.

Insurance companies plan to meet the lower premium cost requirement in Nevada by cutting broker fees and commissions, which prompted opposition from insurance brokers in the state. In response, Nevada marketplace officials told state lawmakers in January that they will give a flat-fee reimbursement to brokers.

The public option has faced opposition among state leaders. In 2024, a state judge dismissed a lawsuit, brought by a Nevada state senator and a group that advocates for lower taxes, that challenged the public option law as unconstitutional. They have appealed to the state Supreme Court.

Federal Policy Impacts

Recent federal changes create more obstacles.

Nevada is consistently among the states with the largest populations of people who do not have health insurance coverage. Last year, nearly 95,000 people in the state received the enhanced ACA tax credits, averaging $465 in savings per month, according to KFF, a health information nonprofit that includes KFF Health News.

But the enhanced tax credits expired at the end of the year, and it appears unlikely that lawmakers will bring them back. Nationwide ACA enrollment has decreased by more than 1 million people so far this year, down from record-high enrollment of 24 million last year.

About 4 million people are expected to lose health coverage from the expiration of the tax credits, according to the Congressional Budget Office. An additional 3 million are projected to lose coverage because of other policy changes affecting the marketplace.

Justin Giovannelli, an associate research professor at the Center on Health Insurance Reforms at Georgetown University, said the changes to the ACA in the Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will make it more difficult for people to keep their coverage. These changes include more frequent enrollment paperwork to verify income and other personal information, a shortened enrollment window, and an end to automatic reenrollment.

In Nevada, the changes would amount to an estimated 100,000 people losing coverage, according to KFF.

“All of that makes getting coverage on Nevada Health Link harder and more expensive than it would be otherwise,” Giovannelli said.

State officials projected ahead of open enrollment that about 35,000 people would purchase the public option plans. Of the 104,000 people who had purchased a plan on the state marketplace as of mid-January, 10,762 had enrolled in one of the public option plans, according to Nevada Health Link.

Katie Charleson, communications officer for the state health exchange, said the original enrollment estimate was based on market conditions before the recent increases in customers’ premium costs. She said that the public option plans gave people facing higher costs more choices.

“We expect enrollment in Battle Born State Plans to grow over time as awareness increases and as Nevadans continue seeking quality coverage options that help reduce costs,” Charleson said.

According to KFF, nationally the enhanced subsidies saved enrollees an average of $705 annually in 2024, and enrollees would save an estimated $1,016 in premium payments on average in 2026 if the subsidies were still in place. Without the subsidies, people enrolled in the ACA marketplace could be seeing their premium costs more than double.

Insights From Washington and Colorado

Washington and Colorado are not planning to alter their programs due to the expiration of the tax credits, according to government officials in those states.

Other states that had recently considered creating public options have backtracked. Minnesota officials put off approving a public option in 2024, citing funding concerns. Proposals to create public options in Maine and New Mexico also sputtered.

Washington initially saw meager enrollment in its Cascade Select public option plans; only 1% of state marketplace enrollees chose a public option plan in 2021. But that changed after lawmakers required hospitals to contract with at least one public option plan by 2023. Last year the state reported that 94,000 customers enrolled, accounting for 30% of all customers on the state marketplace. The public option plans were the lowest-premium silver plans in 31 of Washington’s 39 counties in 2024.

A 2025 study found that since Colorado implemented its public option, called the Colorado Option, coverage through the ACA marketplace has become more affordable for enrollees who received subsidies but more expensive for enrollees who did not.

Colorado requires all insurers offering coverage through its marketplace to include a public option that follows state guidelines. The state set premium reduction targets of 5% a year for three years beginning in 2023. Starting this year, premium costs are not allowed to outpace medical inflation.

Though the insurers offering the public option did not meet the premium reduction targets, enrollment in the Colorado Option has increased every year it has been available. Last year, the state saw record enrollment in its marketplace, with 47% of customers purchasing a public option plan.

Giovannelli said states are continuing to try to make health insurance more affordable and accessible, even if federal changes reduce the impact of those efforts.

“States are reacting and trying to continue to do right by their residents,” Giovannelli said, “but you can’t plug all those gaps.”

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact KFF Health News and share your story.

USE OUR CONTENT

This story can be republished for free (details).

from Health Industry Archives - KFF Health News

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts:

USE OUR CONTENT

Related Posts: