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At Trump’s FDA, Anti-Regulatory Approach and Cost-Cutting Put Food Safety System at Risk

The Trump administration’s anti-regulatory approach and cost-cutting moves risk unraveling a critical system of checks and balances that helps ensure the safety of the U.S. food supply, industry experts told KFF Health News.

An E. coli outbreak that occurred late last year — for which the investigation was concluded in February — signals how, with the FDA changes, more people could get sick with foodborne illnesses as companies and growers face less regulatory oversight and fewer consequences for selling tainted food products, according to interviews with consumer advocates, researchers, and former employees at the FDA and U.S. Department of Agriculture.

In addition, the administration withdrew a proposed regulation to reduce the presence of salmonella in raw poultry, a plan that could have saved more than $13 million annually by preventing roughly 3,000 illnesses. It is also disbanding a Department of Justice unit that pursues civil and criminal actions against companies that sell contaminated food and is reassigning its attorneys, according to a former FDA official, a publicly posted memo from the head of the department’s criminal division, and a white paper by the law firm Gibson Dunn.

“It’s all about destruction and not about efficiency,” said Siobhan DeLancey, who worked in the agency’s Office of Foods and Veterinary Medicine for more than 20 years before being laid off in April. “We’re going to see the effects for years. It will cost lives.”

Officials from the Department of Health and Human Services did not comment on the record for this article but have maintained that food safety is a priority.

Staffing cuts mean delays in publicizing deadly outbreaks, said Susan Mayne, an adjunct professor at the Yale School of Public Health who retired from the FDA in 2023. DeLancey said new requirements from the Trump administration for reviewing agency announcements became so arduous that it took weeks to get approval for alerts that should have been going out much sooner.

The November 2024 outbreak caused by E. coli bacteria in lettuce sickened nearly 90 people and killed one person. But after the investigation was completed under the Trump administration, the FDA redacted any information identifying the grower or processor. The FDA said in its February internal summary that the grower wasn’t named because no product remained on the market.

The information is still important because it can prevent further cases, pressure growers to improve sanitation, and identify repeat offenders, said Bill Marler, a Seattle lawyer who specializes in food-safety litigation.

“The whole ‘Make America Healthy Again,’ the focus on taking food color dyes out of cereal?” said Chris George, of Avon, Indiana, whose son was hospitalized in the outbreak. “How about we take E. coli out of our lettuce, so it doesn’t kill our kids?”

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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American Doctors Are Moving to Canada To Escape the Trump Administration

Earlier this year, as President Donald Trump was beginning to reshape the American government, Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out.

Michael now works in a small-town hospital in Canada. KFF Health News and NPR granted him anonymity because of fears he might face reprisal from the Trump administration if he returns to the U.S. He said he feels some guilt that he did not stay to resist the Trump agenda but is assured in his decision to leave. Too much of America has simply grown too comfortable with violence and cruelty, he said.

“Part of being a physician is being kind to people who are in their weakest place,” Michael said. “And I feel like our country is devolving to really step on people who are weak and vulnerable.”

Michael is among a new wave of doctors who are leaving the United States to escape the Trump administration. In the months since Trump was reelected and returned to the White House, American doctors have shown skyrocketing interest in becoming licensed in Canada, where dozens more than normal have already been cleared to practice, according to Canadian licensing officials and recruiting businesses.

The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on physiciansapply.ca, which is “typically the first step” to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615. Separately, medical licensing organizations in Canada’s most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump.

“The doctors that we are talking to are embarrassed to say they’re Americans,” said John Philpott, CEO of CanAm Physician Recruiting, which recruits doctors into Canada. “They state that right out of the gate: ‘I have to leave this country. It is not what it used to be.’”

Canada, which has universal publicly funded health care, has long been an option for U.S.-trained doctors seeking an alternative to the American health care system. While it was once more difficult for American doctors to practice in Canada due to discrepancies in medical education standards, Canadian provinces have relaxed some licensing regulations in recent years, and some are expediting licensing for U.S.-trained physicians.

In mere months, the Trump administration has jeopardized the economy with tariffs, ignored court orders and due process, and threatened the sovereignty of U.S. allies, including Canada. The administration has also taken steps that may unnerve doctors specifically, including appointing Robert F. Kennedy Jr. to lead federal health agencies, shifting money away from pandemic preparedness, discouraging gender-affirming care, demonizing fluoride, and supporting deep cuts to Medicaid.

The Trump administration did not provide any comment for this article. When asked to respond to doctors’ leaving the U.S. for Canada, White House spokesperson Kush Desai asked whether KFF Health News knew the precise number of doctors and their “citizenship status,” then provided no further comment. KFF Health News did not have or provide this information.

Philpott, who founded CanAm Physician Recruiting in the 1990s, said the cross-border movement of American and Canadian doctors has for decades ebbed and flowed in reaction to political and economic fluctuations, but that the pull toward Canada has never been as strong as now.

Philpott said CanAm had seen a 65% increase in American doctors looking for Canadian jobs from January to April, and that the company has been contacted by as many as 15 American doctors a day.

Rohini Patel, a CanAm recruiter and doctor, said some consider pay cuts to move quickly.

“They’re ready to move to Canada tomorrow,” she said. “They are not concerned about what their income is.”

The College of Physicians and Surgeons of Ontario, which handles licensing in Canada’s most populous province, said in a statement that it registered 116 U.S.-trained doctors in the first quarter of 2025 — an increase of at least 50% over the prior two quarters. Ontario also received license applications from about 260 U.S.-trained doctors in the first quarter of this year, the organization said.

British Columbia, another populous province, saw a surge of licensure applications from U.S.-trained doctors after Election Day, according to an email statement from the College of Physicians and Surgeons of British Columbia. The statement also said the organization licensed 28 such doctors in the fiscal year that ended in February — triple the total of the prior year.

Quebec’s College of Physicians said applications from U.S.-trained doctors have increased, along with the number of Canadian doctors returning from America to practice within the province, but it did not provide specifics. In a statement, the organization said some applicants were trying to get permitted to practice in Canada “specifically because of the actual presidential administration.”

Michael, the physician who moved to Canada this year, said he had long been wary of what he described as escalating right-ring political rhetoric and unchecked gun violence in the United States, the latter of which he witnessed firsthand during a decade working in American emergency rooms.

Michael said he began considering the move as Trump was running for reelection in 2020. His breaking point came on Jan. 6, 2021, when a violent mob of Trump supporters besieged the U.S. Capitol in an attempt to stop the certification of the election of Joe Biden as president.

“Civil discourse was falling apart,” he said. “I had a conversation with my family about how Biden was going to be a one-term president and we were still headed in a direction of being increasingly radicalized toward the right and an acceptance of vigilantism.”

It then took about a year for Michael to become licensed in Canada, then longer for him to finalize his job and move, he said. While the licensing process was “not difficult,” he said, it did require him to obtain certified documents from his medical school and residency program.

“The process wasn’t any harder than getting your first license in the United States, which is also very bureaucratic,” Michael said. “The difference is, I think most people practicing in the U.S. have got so much administrative fatigue that they don’t want to go through that process again.”

Michael said he now receives near-daily emails or texts from American doctors who are seeking advice about moving to Canada.

This desire to leave has also been striking to Hippocratic Adventures, a small business that helps American doctors practice medicine in other countries.

The company was co-founded by Ashwini Bapat, a Yale-educated doctor who moved to Portugal in 2020 in part because she was “terrified that Trump would win again.” For years, Hippocratic Adventures catered to physicians with wanderlust, guiding them through the bureaucracy of getting licensed in foreign nations or conducting telemedicine from afar, Bapat said.

But after Trump was reelected, customers were no longer seeking grand travels across the globe, Bapat said. Now they were searching for the nearest emergency exit, she said.

“Previously it had been about adventure,” Bapat said. “But the biggest spike that we saw, for sure, hands down, was when Trump won reelection in November. And then Inauguration Day. And basically every single day since then.”

At least one Canadian province is actively marketing itself to American doctors.

Doctors Manitoba, which represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S.

The campaign focuses on Florida and North and South Dakota and advertises “zero political interference in physician patient relationship” as a selling point.

Alison Carleton, a family medicine doctor who moved from Iowa to Manitoba in 2017, said she left to escape the daily grind of America’s for-profit health care system and because she was appalled that Trump was elected the first time.

Carleton said she now runs a small-town clinic with low stress, less paperwork, and no fear of burying her patients in medical debt.

She dropped her American citizenship last year.

“People I know have said, ‘You left just in time,’” Carleton said. “I tell people, ‘I know. When are you going to move?’”

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Recortes en servicios de idiomas generan temor a errores médicos, diagnósticos equivocados y muertes

SAN FRANCISCO, California — Organizaciones de salud sin fines de lucro e intérpretes médicos advierten que los recortes federales han eliminado docenas de puestos de trabajadores comunitarios en California, que ayudan a quienes no hablan inglés a obtener cobertura médica y a navegar el sistema de salud.

Al mismo tiempo, las personas con dominio limitado del inglés están pidiendo menos servicios lingüísticos, lo que los defensores de la atención de salud atribuyen en parte a la ofensiva migratoria del presidente Donald Trump y a su orden ejecutiva declarando al inglés como idioma nacional.

Estos cambios en las políticas y la financiación podrían dejar a algunas personas sin atención vital, especialmente a niños y adultos mayores.

“Las personas tendrán dificultades para acceder a beneficios a los que tienen derecho y que necesitan para vivir de forma independiente”, expresó Carol Wong, abogada senior de derechos humanos de Justice in Aging, un grupo nacional de defensa.

Cerca de 69 millones de personas en el país hablan un idioma que no es inglés, y 26 millones de ellas hablan inglés a un nivel por debajo de “muy bien”, según los datos más recientes disponibles de 2023 de la Oficina del Censo de Estados Unidos.

Una encuesta de KFF-Los Angeles Times de ese año reveló que los inmigrantes con un dominio limitado del inglés reportaron más obstáculos para acceder a la atención médica y peor salud que los que hablan mejor inglés.

Los defensores de salud temen que, sin el apoyo adecuado, millones de personas con un dominio limitado del inglés sean más propensas a sufrir errores médicos, diagnósticos equivocados, negligencia y otros resultados adversos.

Al inicio de la pandemia en 2020, ProPublica informó que una mujer con síntomas de coronavirus murió en Brooklyn luego de no recibir tratamiento oportuno porque el personal de emergencias no pudo comunicarse con ella en húngaro.

Y, en el punto álgido de la crisis, The Virginian-Pilot fue el primero en informar que una traducción al español en un sitio web estatal afirmaba erróneamente que la vacuna contra covid-19 no era necesaria.

En el año 2000, el presidente Bill Clinton firmó una orden ejecutiva destinada a mejorar el acceso a los servicios federales para las personas con inglés limitado. Investigaciones muestran que la asistencia lingüística se traduce en una mayor satisfacción del paciente, y también en una reducción de errores médicos, diagnósticos equivocados y consecuencias adversas para la salud.

Los servicios de interpretación de idiomas también ahorran dinero al sistema de salud al reducir las estadías en el hospital y los reingresos.

La orden de Trump derogó la directiva de Clinton y dejó en manos de cada agencia federal la decisión de mantener o adoptar una nueva política sobre lenguas. Algunas ya han reducido sus servicios: según se ha informado, el Departamento de Seguridad Nacional y la Administración del Seguro Social redujeron los servicios de idiomas, y el Departamento de Justicia afirma estar revisando las directrices. El enlace a su plan de lenguas no funciona.

No está claro qué pretende hacer el Departamento de Salud y Servicios Humanos (HHS). El HHS no respondió a las preguntas de KFF Health News.

Un plan del HHS implementado durante la presidencia de Joe Biden, que incluye directrices durante emergencias y desastres de salud pública, ha sido archivado, lo que significa que podría no reflejar las políticas actuales. Sin embargo, la Oficina de Derechos Civiles del HHS sigue informando a los pacientes sobre su derecho a recibir servicios de asistencia en sus idiomas nativos cuando recogen una receta médica, solicitan un seguro de salud o van al médico.

Además, en julio pasado, la oficina agregó protecciones que prohíben a los proveedores de salud utilizar personal no capacitado, familiares o niños para brindar interpretación durante las consultas médicas. También requiere que un traductor humano calificado revise traducciones de información confidencial realizadas con herramientas de inteligencia artificial (IA), para garantizar su precisión.

La administración Trump podría anular estas salvaguardas, afirmó Mara Youdelman, directora general del National Health Law Program, una organización nacional de defensa de políticas legales y de salud. “Hay un proceso que debe seguirse”, agregó, refiriéndose a la implementación de cambios con la participación del público.

“Les insto encarecidamente a que consideren las graves consecuencias cuando las personas no tienen una comunicación efectiva”, enfatizó.

Youdelman dijo que, incluso si el gobierno federal finalmente no ofrece servicios de idiomas al público, los hospitales y proveedores de salud están obligados a proporcionar esta asistencia a los pacientes de manera gratuita. El Título VI de la Ley de Derechos Civiles de 1964 prohíbe la discriminación por raza u origen nacional, y sus protecciones se extienden al idioma. Además, la Ley de Cuidado de Salud a Bajo Precio (ACA) de 2010, que amplió la cobertura médica para millones de estadounidenses y adoptó numerosas protecciones al consumidor, exige que los proveedores de salud que reciben fondos federales ofrezcan servicios de idiomas, incluyendo traducción e interpretación.

“El inglés puede ser el idioma oficial y las personas aún tienen derecho a obtener servicios de idiomas cuando acceden a la atención médica”, dijo Youdelman. “Nada en la orden ejecutiva cambió la ley vigente”.

Las aseguradoras aún deben incluir eslóganes multilingües en la correspondencia a sus miembros, explicando cómo pueden acceder a los servicios de idiomas.

Los centros de salud deben colocar avisos visibles que informen a los pacientes sobre los servicios de asistencia lingüística, y garantizar intérpretes certificados y calificados.

Los gobiernos estatales y locales podrían ampliar sus propios requisitos de acceso a idiomas. Algunos estados han tomado medidas similares en los últimos años, y los legisladores estatales de California están considerando un proyecto de ley que establecería un director de acceso lingüístico, exigiría la revisión humana de las traducciones de IA y mejoraría las encuestas que evalúan las necesidades lingüísticas.

“Con la creciente incertidumbre a nivel federal, las leyes y políticas de acceso estatales y locales son aún más importantes”, afirmó Jake Hofstetter, analista de políticas del Migration Policy Institute.

En California, el Departamento de Salud Pública de Los Ángeles y la Oficina de Participación Cívica y Asuntos de Inmigrantes de San Francisco afirmaron que sus servicios de idiomas no se han visto afectados por la orden ejecutiva de Trump ni por los recortes de fondos federales.

Sin embargo, la demanda ha disminuido. Aurora Pedro, de Comunidades Indígenas en Liderazgo, una de las pocas intérpretes médicas en Los Ángeles que habla akatek y qʼanjobʼal, lenguas mayas de Guatemala, dijo que recibe menos llamadas solicitando sus servicios desde que asumió Trump.

Y otras áreas de California han reducido los servicios lingüísticos por los recortes de fondos federales.

Hernán Treviño, vocero del Departamento de Salud Pública del condado de Fresno, dijo que el condado redujo el número de trabajadores de salud comunitarios a más de la mitad, de 49 a 20 puestos. Esto ha limitado la disponibilidad de guías locales que hablan español, hmong o lenguas indígenas de Latinoamérica, y que ayudan a los inmigrantes a inscribirse en planes de salud y programar exámenes de rutina.

Treviño indicó que, en las oficinas del condado, el personal sigue disponible para atender a los residentes en español, hmong, lao y panyabí. También hay una línea telefónica gratuita disponible para ayudar a acceder a servicios en el idioma preferido.

Mary Anne Foo, directora ejecutiva de la Asian and Pacific Islander Community Alliance del condado de Orange, informó que la Administración de Servicios de Abuso de Sustancias y Salud Mental congeló los $394.000 restantes de un contrato de dos años para mejorar los servicios de salud mental. Como resultado, la alianza planea despedir a 27 de sus 62 terapeutas, psiquiatras y administradores de casos bilingües. La alianza atiende a más de 80.000 pacientes que hablan más de 20 idiomas.

“Solo podemos mantenerlos hasta el 30 de junio”, dijo Foo. “Todavía estamos tratando de ver si podremos cubrir a las personas”.

Orozco Rodríguez reportó desde Elko, Nevada.

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Language Service Cutbacks Raise Fear of Medical Errors, Misdiagnoses, Deaths

SAN FRANCISCO — Health nonprofits and medical interpreters warn that federal cuts have eliminated dozens of positions in California for community workers who help non-English speakers sign up for insurance coverage and navigate the health care system.

At the same time, people with limited English proficiency have scaled back their requests for language services, which health care advocates attribute in part to President Donald Trump’s immigration crackdown and his executive order declaring English as the national language.

Such policy and funding changes could leave some without lifesaving care, particularly children and seniors. “People are going to have a hard time accessing benefits they’re entitled to and need to live independently,” said Carol Wong, a senior rights attorney for Justice in Aging, a national advocacy group.

Nearly 69 million people in the U.S. speak a language other than English, and 26 million of them speak English less than “very well,” according to the most recent U.S. Census data available, from 2023. A KFF-Los Angeles Times survey from that year found that immigrants with limited English proficiency reported more barriers accessing health care and worse health than English-proficient immigrants.

Health advocates fear that, without adequate support, millions of people in the U.S. with limited English proficiency will be more likely to experience medical errors, misdiagnosis, neglect, and other adverse outcomes. During the start of the pandemic in 2020, ProPublica reported that a woman with coronavirus symptoms died in Brooklyn after missing out on timely treatment because emergency room staffers could not communicate with her in Hungarian. And, at the height of the crisis, The Virginian-Pilot first reported that a Spanish translation on a state website erroneously stated that the covid-19 vaccine was not necessary.

In 2000, President Bill Clinton signed an executive order aimed at improving access to federal services for people with limited English proficiency. Research shows language assistance results in higher patient satisfaction, as well as fewer medical errors, misdiagnoses, and adverse health outcomes. Language services also save the health care system money by reducing hospital stays and readmissions.

Trump’s order repealed Clinton’s directive and left it up to each federal agency to decide whether to maintain or adopt a new language policy. Some have already scaled back: The Department of Homeland Security and the Social Security Administration reportedly reduced language services, and the Justice Department says it is reviewing guidance materials. A link to its language plan is broken.

It’s unclear what the Department of Health and Human Services intends to do. HHS did not respond to questions from KFF Health News.

An HHS plan implemented under President Joe Biden, including guidance during public health emergencies and disasters, has been archived, meaning it may not reflect current policies. However, HHS’s Office for Civil Rights still informs patients of their right to language assistance services when they pick up a prescription, apply for a health insurance plan, or visit a doctor.

And the office added protections in July that prohibit health providers from using untrained staff, family members, or children to provide interpretation during medical visits. It also required that translation of sensitive information using artificial intelligence be reviewed by a qualified human translator for accuracy.

Those safeguards could be undone by the Trump administration, said Mara Youdelman, a managing director at the National Health Law Program, a national legal and health policy advocacy organization. “There’s a process that needs to be followed,” she said, about making changes with public input. “I would strongly urge them to consider the dire consequences when people don’t have effective communication.”

Even if the federal government ultimately doesn’t offer language services for the public, Youdelman said, hospitals and health providers are required to provide language assistance at no charge to patients.

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race or national origin, protections that extend to language. And the 2010 Affordable Care Act, which expanded health coverage for millions of Americans and adopted numerous consumer protections, requires health providers receiving federal funds to make language services, including translation and interpretation, available.

“English can be the official language and people still have a right to get language services when they go to access health care,” Youdelman said. “Nothing in the executive order changed the actual law.”

Insurers still need to include multi-language taglines in their correspondence to enrollees explaining how they can access language services. And health facilities must post visible notices informing patients about language assistance services and guarantee certified and qualified interpreters.

State and local governments could broaden their own language access requirements. A few states have taken such actions in recent years, and California state lawmakers are considering a bill that would establish a language access director, mandate human review of AI translations, and improve surveys assessing language needs.

“With increasing uncertainty at the federal level, state and local access laws and policies are even more consequential,” said Jake Hofstetter, policy analyst at the Migration Policy Institute.

The Los Angeles Department of Public Health and San Francisco’s Office of Civic Engagement and Immigrants Affairs said their language services have not been affected by Trump’s executive order or federal funding cuts.

Demand, however, has dropped. Aurora Pedro of Comunidades Indígenas en Liderazgo, one of the few medical interpreters in Los Angeles who speaks Akatek and Qʼanjobʼal, Mayan languages from Guatemala, said she has received fewer calls for her services since Trump took office.

And other pockets of California have reduced language services because of the federal funding cuts.

Hernán Treviño, a spokesperson for the Fresno County Department of Public Health, said the county cut the number of community health workers by more than half, from 49 to 20 positions. That reduced the availability of on-the-ground navigators who speak Spanish, Hmong, or Indigenous languages from Latin America and help immigrants enroll in health plans and schedule routine screenings.

Treviño said staffers are still available to support residents in Spanish, Hmong, Lao, and Punjabi at county offices. A free phone line is also available to help residents access services in their preferred language.

Mary Anne Foo, executive director of the Orange County Asian and Pacific Islander Community Alliance, said the federal Substance Abuse and Mental Health Services Administration froze $394,000 left in a two-year contract to improve mental health services. As a result, the alliance is planning to let go 27 of its 62 bilingual therapists, psychiatrists, and case managers. The organization serves more than 80,000 patients who speak over 20 languages.

“We can only keep them through June 30,” Foo said. “We’re still trying to figure it out — if we can cover people.”

Orozco Rodriguez reported from Elko, Nevada.

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Call Centers Replaced Many Doctors’ Receptionists. Now, AI Is Coming for Call Centers.

At one call center in the Philippines, workers help Americans with diabetes or neurological conditions troubleshoot devices that monitor their health. Sometimes they get pressing calls: elderly patients who are alone and experiencing a medical emergency.

“That’s not part of the job of our employees or our tech supports,” said Ruth Elio, an occupational nurse who supervised the center’s workers when she spoke with KFF Health News last year. “Still, they’re doing that because it is important.”

Elio also helped workers with their own health problems, most frequently headaches or back pains, borne of a life of sitting for hours on end.

In a different call center, Kevin Asuncion transcribed medical visits from half a world away, in the United States. You can get used to the hours, he said in an interview last year: 8 p.m. to 5 a.m. His breaks were mostly spent sleeping; not much is open then.

Health risks and night shifts aside, call center workers have a new concern: artificial intelligence.

Startups are marketing AI products with lifelike voices to schedule or cancel medical visits, refill prescriptions, and help triage patients. Soon, many patients might initiate contact with the health system not by speaking with a call center worker or receptionist, but with AI. Zocdoc, the appointment-booking company, has introduced an automated assistant it says can schedule visits without human intervention 70% of the time.

The medically focused call center workforce in the Philippines is a vast one: 200,000 at the end of 2024, estimates industry trade group leader Jack Madrid. That figure is more than the number of paramedics in the United States at the end of 2023, according to the Bureau of Labor Statistics. And some employers are opening outposts in other countries, like India, while using AI to reshape or replace their workforces.

Still, it’s unclear whether AI’s digital manipulations could match the proverbial human touch. For example, a recent study in Nature Medicine found that while some models can diagnose maladies when presented with a canned anecdote, as prospective doctors do in training, AI struggles to elicit information from simulated patients.

“The rapport, or the trust that we give, or the emotions that we have as humans cannot be replaced,” Elio said.

Sachin Jain, president and CEO of Scan Health Plan, an insurer, said humans have context that AI doesn’t have — at least for now. A receptionist at a small practice may know the patients well enough to pick up on subtle cues and communicate to the doctor that a particular caller is “somebody that you should see, talk to, that day, that minute, or that week.”

The turn toward call centers, while creating more distance between a caller and a health provider, preserved the human touch. Yet some agents at call centers and their advocates say the ways they are monitored on the job undermine care. At one Kaiser Permanente location, it’s a “very micromanaging environment,” said one nurse who asked not to provide her name for fear of reprisal.

“From the beginning of the shift to your end, you’re expected to take call after call after call from an open queue,” she said. Even when giving advice for complex cases, “there’s an unwritten rule on how long a nurse should take per call: 12 minutes.”

Meanwhile, the job is getting tougher, she said. “We’re the backup to the health care system. We’re open 24/7,” she said. “They’re calling about their incision sites, which are bleeding. Their child has asthma, and the instructions for the medications are not clear.”

One nurses union is protesting a potential AI management tool in the call centers.

“AI tools don’t make medical decisions,” Kaiser Permanente spokesperson Vincent Staupe told KFF Health News. “Our physicians and care teams are always at the center of decision-making with our patients and in all our care settings, including call centers.”

Kaiser Permanente is not affiliated with KFF, a health information nonprofit that includes KFF Health News.

Some firms cite 30% to 50% turnover rates — stats that some say make a case for turning over the job to AI.

Call centers “can’t keep people, because it’s just a really, really challenging job,” said Adnan Iqbal, co-founder and CEO of Luma Health, which creates AI products to automate some call center work. No wonder, “if you’re getting yelled at every 90 seconds by a patient, insurance company, a staff member, what have you.”

To hear business leaders tell it, their customers are frustrated: Instead of the human touch, patients get nothing at all, stymied by long wait times and harried, disempowered workers.

One time, Marissa Moore — an investor at OMERS Ventures — got a taste of patients’ frustrations when trying to schedule a visit by phone at five doctors’ offices. “In every single one, I got a third party who had no intel on providers in the office, their availability, or anything.”

These types of gripes are increasingly common — and getting the attention of investors and businesses.

Customer complaints are hitting the bottom lines of businesses — like health insurers, which can be rewarded by the federal government’s Medicare Advantage policies for better customer service.

When Scan noticed a drop in patient ratings for some of the medical providers in its insurance network, it learned those providers had switched to using centralized call centers. Customer service suffered, and the lower ratings translated into lower payments from the federal government, Jain said.

“There’s a degree of dissatisfaction that’s bubbling up among our patients,” he said.

So, for some businesses, the notion of a computer receptionist seems a welcome solution to the problem of ineffectual call centers. AI voices, which can convincingly mimic human voices, are “beyond uncanny valley,” said Richie Cartwright, the founder of Fella, a weight loss startup that used one AI product to call pharmacies and ask if they had GLP-1s in stock.

Prices have dropped, too. Google AI’s per-use price has dropped by 97%, company CEO Sundar Pichai claimed in a 2024 speech.

Some boosters are excited to put the vision of AI assistants into action. Since the second Trump administration took office, policy initiatives by the quasi-agency known as the Department of Government Efficiency, led by Elon Musk, have reportedly explored using artificial intelligence bots for customer service at the Department of Education.

Most executives interviewed by KFF Health News — in the hospital, insurance, tech, and consultancy fields — were keen to emphasize that AI would complement humans, not replace them. Some resorted to jargon and claimed the technology might make call center nurses and employees more efficient and effective.

But some businesses are signaling that their AI models could replace human workers. Their websites hint at reducing reliance on staff. And they are developing pricing strategies based on reducing the need for labor, said Michael Yang, a venture capitalist at OMERS.

Yang described the prospect for businesses as a “we-share-in-the-upside kind of thing,” with startups pitching clients on paying them for the cost of 1½ hires and their AI doing the work of twice that number.

But providers are building narrow services at the moment. For example, the University of Arkansas for Medical Sciences started with a limited idea. The organization’s call center closes at 5 p.m. — meaning patients who try to cancel appointments after hours left a phone message, creating a backlog for workers to address the next morning that took time from other scheduling tasks and left canceled appointments unfilled. So they started by using an AI system provided by Luma Health to allow after-hours cancellations and have since expanded it to allow patients to cancel appointments all day.

Michelle Winfeld-Hanrahan, the health system’s chief clinical access officer, who oversees its deployment, said UAMS has plenty of ideas for more automation, including allowing patients to check on prior authorizations and leading them through post-discharge follow-up.

Many executives claim AI tools can complement, rather than replace, humans. One company says its product can measure “vocal biomarkers” — subtle changes in tone or inflection — that correlate with disease and supply that information to human employees interacting with the patient. Some firms are using large language models to summarize complex documents: pulling out obscure insurance policies, or needed information, for employees. Others are interested in AI guiding a human through a conversation.

Even if the technology isn’t replacing people, it is reshaping them. AI can be used to change humans’ behavior and presentation. Call center employees said in interviews that they knew of, or had heard omnipresent rumors of, or feared, a variety of AI tools.

At some Kaiser Permanente call centers, unionized employees protested — and successfully delayed — the implementation of an AI tool meant to measure “active listening,” a union flyer claimed.

And employees and executives associated with the call center workforce in the Philippines said they’d heard of other software tools, such as technology that changed Filipino accents to American ones. There’s “not a super huge need for that, given our relatively neutral accents, but we’ve seen that,” said Madrid, the trade group leader.

“Just because something can be automated doesn’t mean it should be,” he said.

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Trump Won’t Force Medicaid to Cover GLP-1s for Obesity. A Few States Are Doing It Anyway.

CHARLESTON, S.C. — When Page Campbell’s doctor recommended she try an injectable prescription drug called Wegovy to lose weight before scheduling bariatric surgery, she readily agreed.

“I’ve struggled with my weight for so long,” said Campbell, 40, a single mother of two. “I’m not opposed to trying anything.”

In early April, about four weeks after she’d started taking Wegovy, Campbell said she hadn’t experienced any side effects, such as nausea or bowel irritation. But she doesn’t use a scale at home, she said, so she didn’t know whether she’d lost any weight since her most recent medical appointment earlier this year, when she weighed 314 pounds. Still, she was confident about achieving weight loss.

“It’s going to work because I’m putting in the work. I’m changing my eating habits. I’m exercising,” said Campbell, a shipping manager at a Michaels store. “I’m not going to second-guess myself.”

Wegovy belongs to a pricey class of drugs called GLP-1s (short for glucagon-like peptide-1 agonists) that have upended the treatment of obesity in recent years, offering hope to patients who have tried and failed to lose weight in myriad other ways.

Campbell gained access to Wegovy through South Carolina Medicaid’s decision in late 2024 to cover these weight loss drugs. But the medications remain out of reach for millions of patients across the country who could benefit from them, because many public and private health insurers have deemed the drugs too expensive.

A report published in November by KFF, a health information nonprofit that includes KFF Health News, found only 13 states were covering GLP-1s for the treatment of obesity for Medicaid beneficiaries as of August. South Carolina became the 14th in November.

Liz Williams, one of the report’s authors and a senior policy manager for the Program on Medicaid and the Uninsured at KFF, said she was not aware of any other state Medicaid programs joining the list since then. Looking ahead, the remaining states may be reluctant to add a new, expensive drug benefit while they brace for potential federal cuts coming from Congress, she said.

“As the budget debate, federally, is developing, that may impact how states are thinking about this,” Williams said.

The federal government won’t be helping anytime soon, either. Medicare covers GLP-1s to treat diabetes and some other health conditions, including obstructive sleep apnea and cardiovascular disease, but not obesity. In early April, the Trump administration announced it will not finalize a rule proposed by the Biden administration that would have allowed an estimated 7.4 million people covered by Medicare and Medicaid to access GLP-1s for weight loss. Meanwhile, the FDA is poised to force less expensive, compounded versions of these drugs off the market.

And the barrier to entry remains high, even for Medicaid patients in those few states that have agreed to cover the drugs without a federal mandate.

Case in point: In South Carolina, where more than one-third of all adults, and nearly half of the African American population, qualify as obese, the state Medicaid agency estimates only 1,300 beneficiaries will meet the stringent prerequisites for GLP-1 coverage.

Under one of those requirements, Medicaid beneficiaries who wish to access these drugs to lose weight must attest to “increased exercise activity,” said Jeff Leieritz, a spokesperson for the South Carolina Department of Health and Human Services.

Campbell, who is insured by Medicaid, was granted coverage for Wegovy based on her body mass index. First, though, she was required to submit six months’ worth of documentation proving that she’d tried and failed to lose weight after receiving nutrition counseling and going on a 1,200-calorie-a day diet, said Kenneth Mitchell, one of Campbell’s doctors and the medical director for bariatric surgery and obesity medicine at Roper St. Francis Healthcare.

Campbell’s Wegovy prescription was approved for six months, Mitchell said. When that authorization expires, Campbell and her health care team will need to submit more documentation, including proof that she has lost at least 5% of her body weight and has kept up with nutrition counseling.

“It’s not just, ‘Send a prescription in and they cover it.’ It’s rather arduous,” Mitchell said. “Not a lot of folks are going to do this.”

Mitchell said South Carolina Medicaid’s decision to cover these drugs was met with excitement among those working in his medical specialty. But he wasn’t surprised that the state anticipates relatively few people will access this benefit annually, since the approval process is so rigorous and the cost high. “The problem is the medicines are so expensive,” Mitchell said.

Novo Nordisk, which manufactures Wegovy, announced in March that it was cutting the monthly price for the drug from $650 to $499 for cash-paying customers. The price that health insurance plans and beneficiaries pay for these drugs varies, but some GLP-1s cost more than $1,000 per patient per month, Mitchell said, and many people will need to take them for the rest of their lives to maintain weight loss.

“That is a tremendous price tag that someone has to foot the bill for,” Mitchell said.

That’s the reason California Gov. Gavin Newsom on May 14 proposed eliminating Medicaid coverage of GLP-1s for weight loss starting Jan. 1, to save an estimated $680 million a year by 2028.

And the North Carolina State Health Plan Board of Trustees voted last year to end coverage of GLP-1s for state employees, after then-North Carolina Treasurer Dale Folwell’s office estimated in 2023 that the drugs were projected to cost the State Health Plan $1 billion over the next six years. The decision came only a few months after a separate North Carolina agency announced it would start covering these drugs for Medicaid beneficiaries. North Carolina Medicaid has estimated it will spend $16 million a year on GLP-1s.

South Carolina Medicaid, which insures fewer than half the number of people enrolled in North Carolina Medicaid, anticipates spending less. Leieritz estimated GLP-1s and nutrition counseling offered to Medicaid beneficiaries in South Carolina will cost $10 million a year. State funding will cover $3.3 million of the expense; the remainder will be paid for by matching Medicaid funds from the federal government.

In a recent interview, Health and Human Services Secretary Robert F. Kennedy Jr. didn’t rule out the possibility that Medicare and Medicaid might cover GLP-1s for obesity treatment in the future as costs come down.

They’re “extraordinary drugs” and “we’re going to reduce the cost,” Kennedy told CBS News in early April. He said he would like GLP-1s to eventually be made available to Medicare and Medicaid patients who are seeking obesity treatment after they have tried other ways to lose weight. “That is the framework that we’re now debating.”

Meanwhile, public health experts have applauded South Carolina Medicaid’s decision to cover GLP-1s. Yet the new benefit won’t help the vast majority of the 1.5 million adults in South Carolina who are classified as obese, according to data published by the South Carolina Department of Public Health.

“We still have some work to do,” acknowledged Brannon Traxler, the public health department’s chief medical officer.

But the state’s new “Action Plan for Healthy Eating and Active Living,” written by a coalition of groups in South Carolina, including the Department of Public Health, makes no mention of GLP-1s or the role they might play in lowering obesity rates in the state.

The action plan, underwritten by a $1.5 million federal grant, isn’t meant to lay out an overarching approach for lowering obesity in South Carolina, Traxler said. Instead, it promotes physical activity in schools, nutrition, and the expansion of outdoor walking trails, among other strategies. A more comprehensive obesity plan might address the benefits of surgical intervention and GLP-1s, but those also carry risk, expense, and side effects, Traxler said.

“Certainly, I think, there is a need to bring it all together,” she said.

Campbell, for one, is taking the comprehensive approach. On top of injecting Wegovy once weekly, she said, she is prioritizing protein intake and moving her body. She also underwent weight loss surgery in late April.

“Weight loss is my biggest goal,” said Campbell, who expressed appreciation for Medicaid’s coverage of Wegovy. “It’s one more thing that’s going to help me get to my goal.”

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How the Trump Administration Aims To Slash Health Care Spending

Health care has proved a vulnerable target for the firehose of cuts and policy changes President Donald Trump ordered in the name of reducing waste and improving efficiency. But most of the impact isn’t as tangible as, say, higher egg prices at the grocery store.

One thing experts from a wide range of fields, from basic science to public health, agree on: The damage will be varied and immense. “It’s exceedingly foolish to cut funding in this way,” said Harold Varmus, a Nobel Prize-winning scientist and former director of both the National Institutes of Health and the National Cancer Institute.

The blaze of cuts have yielded nonsensical and perhaps unintended consequences. Consider instances in which grant funding gets canceled after two years of a three-year project. That means, for example, that $2 million has already been spent but there will be no return on that investment.

Some of the targeted areas are not administration priorities. That includes the abrupt termination of studies on long covid, which afflicts more than 100,000 Americans, and the interruption of work on mRNA vaccines, which hold promise not just in infectious disease but also in treating cancer.

While charitable dollars have flowed in to plug some gaps, “philanthropy cannot replace federal funding,” said Dustin Sposato, communications manager for the Science Philanthropy Alliance, a group that works to boost support from charities for basic science research.

Here are critical ways in which Trump administration cuts — proposed and actual — could affect American health care and, more important, the health of American patients.

Cuts to the National Institutes of Health: The Trump administration has cut $2.3 billion in new grant funding since its term began, as well as terminated existing grants on a wide range of topics — vaccine hesitancy, HIV/AIDS, and covid-19 — that do not align with its priorities. National Institutes of Health grants do have yearly renewal clauses, but it is rare for them to be terminated, experts say. The administration has also cut “training grants” for young scientists to join the NIH.

Why It Matters: The NIH has long been a crucible of basic science research — the kind of work that industry generally does not do. Most pharmaceutical patents have their roots in work done or supported by the NIH, and many scientists at pharmaceutical manufacturers learned their craft at institutions supported by the NIH or at the NIH itself. The termination of some grants will directly affect patients since they involved ongoing clinical studies on a range of conditions, including pediatric cancer, diabetes, and long covid. And, more broadly, cuts in public funding for research could be costly in the longer term as a paucity of new discoveries will mean fewer new products: A 25% cut to public research and development spending would reduce the nation’s economic output by an amount comparable to the decline in gross domestic product during the Great Recession, a new study found.

Cuts to Universities: The Trump administration also tried to deal a harrowing blow — currently blocked by the courts — to scientific research at universities by slashing extra money that accompanies research grants for “indirect costs,” like libraries, lab animal care, support staff, and computer systems.

Why It Matters: Wealthier universities may find the funds to make up for draconian indirect cost cuts. But poorer ones — and many state schools, many of them in red states — will simply stop doing research. A good number of crucial discoveries emerge from these labs. “Medical research is a money-losing proposition,” said one state school dean with former ties to the Ivies. (The dean requested anonymity because his current employer told him he could not speak on the record.) “If you want to shut down research, this will do it, and it will go first at places like the University of Tennessee and the University of Arkansas.” That also means fewer opportunities for students at state universities to become scientists.

Cuts to Public Health: These hits came in many forms. The administration has cut or threatened to cut long-standing block grants from the Centers for Disease Control and Prevention; covid-related grants; and grants related to diversity, equity, and inclusion activities — which often translated into grants to improve health care for the underserved. Though the covid pandemic has faded, those grants were being used by states to enhance lab capacity to improve detection and surveillance. And they were used to formally train the nation’s public health workforce, many of whom learn on the job.

Why It Matters: Public health officials and researchers were working hard to facilitate a quicker, more thoughtful response to future pandemics, of particular concern as bird flu looms and measles is having a resurgence. Mati Hlatshwayo Davis, the St. Louis health director, had four grants canceled, three in one day. One grant that fell under the covid rubric included programs to help community members make lifestyle changes to reduce the risk of hypertension and diabetes — the kind of chronic diseases that Health and Human Services Secretary Robert F. Kennedy Jr. has said he will focus on fighting. Others paid the salaries of support staff for a wide variety of public health initiatives. “What has been disappointing is that decisions have been made without due diligence,” she said.

Health-Related Impact of Tariffs: Though Trump has exempted prescription drugs from his sweeping tariffs on most imports thus far, he has not ruled out the possibility of imposing such tariffs. “It’s a moving target,” said Michael Strain, an economist at the American Enterprise Institute, noting that since high drug prices are already a burden, adding any tax to them is problematic.

Why It Matters: That supposed exemption doesn’t fully insulate American patients from higher costs. About two-thirds of prescription drugs are already manufactured in the U.S. But their raw materials are often imported from China — and those enjoy no tariff exemption. Many basic supplies used in hospitals and doctors’ offices — syringes, surgical drapes, and personal protective equipment — are imported, too. Finally, even if the tariffs somehow don’t themselves magnify the price to purchase ingredients and medical supplies, Americans may suffer: Across-the-board tariffs on such a wide range of products, from steel to clothing, means fewer ships will be crossing the Pacific to make deliveries — and that means delays. “I think there’s an uncomfortably high probability that something breaks in the supply chain and we end up with shortages,” Strain said.

Changes to Medicaid: Trump has vowed to protect Medicaid, the state-federal health insurance program for Americans with low incomes and disabilities. But House Republicans have eyed the program as a possible source of offsets to help pay for what Trump calls “the big, beautiful bill” — a sweeping piece of budget legislation to extend his 2017 tax cuts. The amount of money GOP leaders have indicated they could squeeze from Medicaid, which now covers about 20% of Americans, has been in the hundreds of billions of dollars. But deep cuts are politically fraught.

To generate some savings, administration officials have at times indicated they are open to at least some tweaks to Medicaid. One idea on the table — work requirements — would require adults on Medicaid to be working or in some kind of job training. (Nearly two-thirds of Medicaid recipients ages 19-64 already work.)

Why It Matters: In 2024 the uninsured rate was 8.2%, near the all-time low, in large part because of the Medicaid expansion under the 2010 Affordable Care Act. Critics say work requirements are a backhanded way to slim down the Medicaid rolls, since the paperwork requirements of such programs have proved so onerous that eligible people drop out, causing the uninsured rate to rise. A Congressional Budget Office report estimates that the proposed change would reduce coverage by at least 7.7 million in a decade. This leads to higher rates of uncompensated care, putting vulnerable health care facilities — think rural hospitals — at risk.

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Los hospitales que atienden partos en zonas rurales están cada vez más lejos de las embarazadas

WINNER, Dakota del Sur — Sophie Hofeldt tenía previsto hacerse los controles de embarazo y dar a luz en el hospital local, a 10 minutos de su casa. En cambio, ahora, para ir a la consulta médica, tiene que conducir más de tres horas entre ida y vuelta.

Es que el hospital donde se atendía, Winner Regional Health, se ha sumado recientemente al cada vez mayor número de centros de salud rurales que cierran sus unidades de maternidad.

“Ahora va a ser mucho más estresante y complicado para las mujeres recibir la atención médica que necesitan, porque tienen que ir mucho más lejos”, dijo Hofeldt, que tiene fecha de parto de su primer hijo el 10 de junio.

Hofeldt agregó que los viajes más largos suponen más gasto en gasolina y un mayor riesgo de no llegar a tiempo al hospital. “Mi principal preocupación es tener que parir en un auto”, afirma.

Más de un centenar de hospitales rurales han dejado de atender partos desde 2021, según el Center for Healthcare Quality and Payment Reform, una organización sin fines de lucro. El cierre de los servicios de obstetricia se suele achacar a la falta de personal y la falta de presupuesto.

En la actualidad, alrededor del 58% de los condados de Dakota del Sur no cuentan con salas de parto. Es la segunda tasa más alta del país, después de Dakota del Norte, según March of Dimes, una organización que asiste a las madres y sus bebés.

Además, el Departamento de Salud de Dakota del Sur informó que las mujeres embarazadas y los bebés del estado — especialmente las afroamericanas y las nativas americanas— presentan tasas más altas de complicaciones y mortalidad.

Winner Regional Health atiende a comunidades rurales en Dakota del Sur y Nebraska, incluyendo parte de la reserva indígena Rosebud Sioux. El año pasado nacieron allí 107 bebés, una baja considerable respecto de los 158 que nacieron en 2021, contó su director ejecutivo, Brian Williams.

Los hospitales más cercanos con servicios de maternidad se encuentran en pueblos rurales a una hora de distancia, o más, de Winner.

Sin embargo, varias mujeres afirmaron que el trayecto en coche hasta esos centros las llevaría por zonas donde no hay señal de celular confiable, lo que podría suponer un problema si tuvieran una emergencia en el camino.

KFF Health News habló con cinco pacientes de la zona de Winner que tenían previsto que su parto fuera en el Avera St. Mary’s Hospital de Pierre, a unas 90 millas de Winner, o en uno de los grandes centros médicos de Sioux Falls, a 170 millas de distancia.

Hofeldt y su novio conducen cada tres semanas para ir a las citas prenatales en el hospital de Pierre, que brinda servicios a la pequeña capital y a la vasta zona rural circundante.

A medida que se acerque la fecha del parto, las citas de control y, por lo tanto los viajes, tendrán que ser semanales. Ninguno de los dos tiene un empleo que le brinde permiso con goce de sueldo para ese tipo de consulta médica.

“Cuando necesitamos ir a Pierre, tenemos que tomarnos casi todo el día libre”, explicó Hofeldt, que nació en el hospital de Winner.

Eso significa perder una parte del salario y gastar dinero extra en el viaje. Además, no todo el mundo tiene auto ni dinero para la gasolina, y los servicios de autobús son escasos en las zonas rurales del país.

Algunas mujeres también tienen que pagar el cuidado de sus otros hijos para poder ir al médico cuando el hospital está lejos. Y, cuando nace el bebé, tal vez tengan que asumir el costo de un hotel para los familiares.

Amy Lueking, la médica que atiende a Hofeldt en Pierre, dijo que cuando las pacientes no pueden superar estas barreras, los obstetras tienen la opción de darles dispositivos para monitorear el embarazo en el hogar y ofrecerles consulta por teléfono o videoconferencia.

Las pacientes también pueden hacerse los controles prenatales en un hospital o una clínica local y, más tarde, ponerse en contacto con un profesional de un hospital donde se practiquen partos, dijo Lueking.

Sin embargo, algunas zonas rurales no tienen acceso a la telesalud. Y algunas pacientes, como Hofeldt, no quieren dividir su atención, establecer relaciones con dos médicos y ocuparse de cuestiones logísticas como transferir historias clínicas.

Durante una cita reciente, Lueking deslizó un dispositivo de ultrasonido sobre el útero de Hofeldt. El ritmo de los latidos del corazón del feto resonó en el monitor.

“Creo que es el mejor sonido del mundo”, expresó Lueking.

Hofeldt le comentó que quería un parto lo más natural posible.

Pero lograr que el parto se desarrolle según lo planeado suele ser complicado para quienes viven en zonas rurales, lejos del hospital. Para estar seguras de que llegarán a tiempo, algunas mujeres optan por programar una inducción, un procedimiento en el que los médicos utilizan medicamentos u otras técnicas para provocar el trabajo de parto.

Katie Larson vive en un rancho cerca de Winner, en la localidad de Hamill, que tiene 14 habitantes. Esperaba evitar que le indujeran el parto.

Larson quería esperar a que las contracciones comenzaran de forma natural y luego conducir hasta el Avera St. Mary’s, en Pierre.

Pero terminó programando una inducción para el 13 de abril, su fecha probable de parto. Más tarde, la adelantó al 8 de abril para no perderse una venta de ganado muy importante, que ella y su esposo estaban preparando.

“La gente se verá obligada a elegir una fecha de inducción aunque no sea lo que en un principio hubiera elegido. Si no, correrá el riesgo de tener al bebé en la carretera”, afirmó.

Lueking aseguró que no es frecuente que las embarazadas den a luz mientras se dirigen al hospital en automóvil o en ambulancia. Pero también recordó que el año anterior cinco mujeres que tenían previsto tener a sus hijos en Pierre acabaron haciéndolo en las salas de emergencias de otros hospitales, porque el parto avanzó muy rápido o porque las condiciones del clima hicieron demasiado peligroso conducir largas distancias.

Nanette Eagle Star tenía previsto que su bebé naciera en el hospital de Winner, a cinco minutos de su casa, hasta que el hospital anunció que cerraría su unidad de maternidad. Entonces decidió dar a luz en Sioux Falls, porque su familia podía quedarse con unos familiares que vivían allí y así ahorrar dinero.

El plan de Eagle Star volvió a cambiar cuando comenzó el trabajo de parto prematuramente y el clima se puso demasiado peligroso para manejar o para tomar un helicóptero médico a Sioux Falls.

“Todo ocurrió muy rápido, en medio de una tormenta de nieve”, contó.

Finalmente, Eagle Star tuvo a su bebé en el hospital de Winner, pero en la sala de emergencias, sin epidural, ya que en ese momento no había ningún anestesista disponible. Esto ocurrió solo tres días después del cierre de la unidad de maternidad.

El fin de los servicios de parto y maternidad en el Winner Regional Health no es solo un problema de salud, según las mujeres de la localidad. También tiene repercusiones emocionales y económicas en la comunidad.

Eagle Star recuerda con cariño cuando era niña e iba con sus hermanas a las citas médicas. Apenas llegaban, iban a un pasillo que tenía fotos de bebés pegadas en la pared y comenzaban una “búsqueda del tesoro” para encontrar polaroids de ellas mismas y de sus familiares.

“A ambos lados del pasillo estaba lleno de fotos de bebés”, contó Eagle Star. Recuerda pensar: “Mira todos estos bebés tan lindos que han nacido aquí, en Winner”.

Hofeldt contó que muchos lugareños están tristes porque sus bebés no nacerán en el mismo hospital que ellos.

Anora Henderson, médica de familia, señaló que la falta de una correcta atención a las mujeres embarazadas puede tener consecuencias negativas para sus hijos. Esos bebés pueden desarrollar problemas de salud que requerirán cuidados de por vida, a menudo costosos, y otras ayudas públicas.

“Hay un efecto negativo en la comunidad”, dijo. “Simplemente no es tan visible y se notará bastante más adelante”.

Henderson renunció en mayo a su puesto en el Winner Regional Health, donde asistía partos vaginales y ayudaba en las cesáreas. El último bebé al que recibió fue el de Eagle Star.

Para que un centro de salud sea designado como hospital con servicio de maternidad, debe contar con instalaciones donde se pueden efectuar cesáreas y proporcionar anestesia las 24 horas del día, los 7 días de la semana, explicó Henderson.

Williams, el director ejecutivo del hospital, dijo que el Winner Regional Health no ha podido contratar suficientes profesionales médicos con formación en esas especializaciones.

En los últimos años, el hospital solo había podido ofrecer servicios de maternidad cubriendo aproximadamente $1,2 millones anuales en salarios de médicos contratados de forma temporal, señaló. Pero el hospital ya no podía seguir asumiendo ese gasto.

Otro reto financiero está dado porque muchos partos en los hospitales rurales están cubiertos por Medicaid, el programa federal y estatal que ofrece atención a personas con bajos ingresos o discapacidades.

El programa suele pagar aproximadamente la mitad de lo que pagan las aseguradoras privadas por los servicios de parto, según un informe de 2022 de la U.S. Government Accountability Office (GAO).

Williams contó que alrededor del 80% de los partos en Winner Regional Health estaban cubiertos por Medicaid.

Las unidades obstétricas suelen constituir el mayor gasto financiero de los hospitales rurales y, por lo tanto, son las primeras que se cierran cuando un centro de salud atraviesa dificultades económicas, explica el informe de la GAO.

Williams dijo que el hospital sigue prestando atención prenatal y que le encantaría reanudar los partos si pudiera contratar suficiente personal.

Henderson, la médica que dimitió del hospital de Winner, ha sido testigo del declive de la atención materna en las zonas rurales durante décadas.

Recuerda que, antes de que naciera su hermana, acompañaba a su madre a las citas médicas. En cada viaje, su madre recorría unas 100 millas después de que el hospital de la ciudad de Kadoka cerrara en 1979.

Henderson trabajó durante casi 22 años en el Winner Regional Health, lo que permitió que muchas mujeres no tuvieran que desplazarse para dar a luz, como le ocurrió a su madre.

A lo largo de los años, atendió a nuevas pacientes cuando cerraron las unidades de maternidad de un hospital rural cercano y luego las de un centro del Servicio de Salud Indígena. Finalmente, el propio hospital de Henderson dejó de atender partos.

“Lo que ahora realmente me frustra es que pensaba que iba a dedicarme a la medicina familiar y trabajar en una zona rural, y que así íbamos a solucionar estos problemas, para que las personas no tuvieran que conducir 100 millas para tener un bebé”, se lamentó.

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Rural Patients Face Tough Choices When Their Hospitals Stop Delivering Babies

WINNER, S.D. — Sophie Hofeldt planned to receive prenatal care and give birth at her local hospital, 10 minutes from her house. Instead, she’s driving more than three hours round trip for her appointments.

The hospital, Winner Regional Health, recently joined the increasing number of rural hospitals shuttering their birthing units.

“It’s going to be a lot more of a stress and a hassle for women to get the health care that they need because they have to go so much further,” said Hofeldt, who has a June 10 due date for her first child.

Hofeldt said longer drives mean spending more on gas — and a higher risk of not making it to the hospital in time. “My main concern is having to give birth in a car,” she said.

More than a hundred rural hospitals have stopped delivering babies since 2021, according to the Center for Healthcare Quality and Payment Reform, a nonprofit organization. Such closures are often blamed on shortages of staff and money.

About 58% of South Dakota counties have no birthing facilities, the second-highest rate among states, after North Dakota, according to March of Dimes. And the South Dakota health department says pregnant women and infants in the state, especially those who are Black or Native American, experience high rates of complications and death.

Winner Regional Health serves rural communities, including parts of the Rosebud Sioux Indian Reservation, in South Dakota and Nebraska. It delivered 107 babies last year, down from 158 in 2021, said CEO Brian Williams.

The nearest birthing hospitals are in rural towns an hour or more from Winner. But several women said driving to those facilities would take them through areas without reliable cellphone service, which could be a problem if they have an emergency along the way.

KFF Health News spoke with five patients from the Winner area who planned to deliver at Avera St. Mary’s Hospital in Pierre, about 90 miles from Winner, or at one of the large medical centers in Sioux Falls, 170 miles away.

Hofeldt and her boyfriend drive every three weeks to her prenatal appointments at the Pierre hospital, which serves the small capital city and vast surrounding rural area. She’ll have to make weekly trips closer to her due date. Neither of their jobs provides paid time off for such appointments.

“When you have to go to Pierre, you have to take almost the whole day off,” said Hofeldt, who was born at the Winner hospital.

That means forfeiting pay while spending extra money on travel. Not everyone has gas money, let alone access to a car, and bus services are scarce in rural America. Some women also need to pay for child care during their appointments. And when the baby comes, family members may need to pay for a hotel.

Amy Lueking, Hofeldt’s doctor in Pierre, said when patients can’t overcome these barriers, obstetricians can give them home monitoring devices and offer phone- or video-based care. Patients can also receive prenatal care at a local hospital or clinic before connecting with a doctor at a birthing hospital, Lueking said.

However, some rural areas don’t have access to telehealth. And some patients, such as Hofeldt, don’t want to split up their care, form relationships with two doctors, and deal with logistics like transferring medical records.

During a recent appointment, Lueking glided an ultrasound device over Hofeldt’s uterus. The “woosh-woosh” rhythm of the fetal heartbeat thumped over the monitor.

“I think it’s the best sound in the whole wide world,” Lueking said.

Hofeldt told Lueking she wanted her first delivery to be “as natural as possible.”

But ensuring a birth goes according to plan can be difficult for rural patients. To guarantee they make it to the hospital on time, some schedule an induction, in which doctors use medicine or procedures to stimulate labor.

Katie Larson lives on a ranch near Winner in the town of Hamill, population 14. She had hoped to avoid having her labor induced.

Larson wanted to wait until her contractions began naturally, then drive to Avera St. Mary’s in Pierre. But she scheduled an induction in case she didn’t go into labor by April 13, her due date.

Larson ended up having to reschedule for April 8 to avoid a conflict with an important cattle sale she and her husband were preparing for.

“People are going to be either forced to pick an induction date when it wasn’t going to be their first choice or they’re going to run the risk of having a baby on the side of the road,” she said.

Lueking said it’s very rare for people to give birth while heading to the hospital in a car or ambulance. But last year, she said, five women who planned to deliver in Pierre ended up delivering in other hospitals’ emergency rooms after rapidly progressing labor or weather made it too risky to drive long distances.

Nanette Eagle Star’s plan was to deliver at the Winner hospital, five minutes from home, until the hospital announced it would be closing its labor and delivery unit. She then decided to give birth in Sioux Falls, because her family could save money by staying with relatives there.

Eagle Star’s plan changed again when she went into early labor and the weather was too dangerous to drive or take a medical helicopter to Sioux Falls.

“It happened so fast, in the middle of a snowstorm,” she said.

Eagle Star delivered at the Winner hospital after all, but in the ER, without an epidural pain blocker since no anesthesiologist was available. It was just three days after the birthing unit closed.

The end of labor and delivery services at Winner Regional Health isn’t just a health issue, local women said. It also has emotional and financial impacts on the community.

Eagle Star fondly recalls going to doctor appointments with her sisters when she was a child. As soon as they arrived, they’d head to a hallway with baby photos taped to the wall and begin “a scavenger hunt” for Polaroids of themselves and their relatives.

“On both sides it was just filled with babies’ pictures,” Eagle Star said. She remembers thinking, “look at all these cute babies that were born here in Winner.”

Hofeldt said many locals are sad their babies won’t be born in the same hospital they were.

Anora Henderson, a family physician, said a lack of maternity care can lead to poor outcomes for infants. Those babies may develop health problems that will require lifelong, often expensive care and other public support.

“There is a community effect,” she said. “It’s just not as visible and it’s farther down the road.”

Henderson resigned in May from Winner Regional Health, where she delivered vaginal births and assisted on cesarean sections. The last baby she delivered was Eagle Star’s.

To be designated a birthing hospital, facilities must be able to conduct C-sections and provide anesthesia 24/7, Henderson explained.

Williams, the hospital’s CEO, said Winner Regional Health hasn’t been able to recruit enough medical professionals trained in those skills.

For the last several years, the hospital was only able to offer birthing services by spending about $1.2 million a year on temporary physicians, he said, and it could no longer afford to do that.

Another financial challenge is that many births at rural hospitals are covered by Medicaid, the federal and state program serving people with low incomes or disabilities. The program typically pays about half of what private insurers do for childbirth services, according to a 2022 report by the U.S. Government Accountability Office.

Williams said about 80% of deliveries at Winner Regional Health were covered by Medicaid.

Obstetric units are often the biggest financial drain on rural hospitals, and therefore they’re frequently the first to close when a hospital is struggling, the GAO report said.

Williams said the hospital still provides prenatal care and that he’d love to restart deliveries if he could hire enough staff.

Henderson, the physician who resigned from the Winner hospital, has witnessed the decline in rural maternity care over decades.

She remembers tagging along with her mother for appointments before her sister was born. Her mother traveled about 100 miles each way after the hospital in the town of Kadoka shuttered in 1979.

Henderson practiced for nearly 22 years at Winner Regional Health, sparing women from having to travel to give birth like her mother did.

Over the years, she took in new patients as a nearby rural hospital and then an Indian Health Service facility closed their birthing units. Then, Henderson’s own hospital stopped deliveries.

“What’s really frustrating me now is I thought I was going to go into family medicine and work in a rural area and that’s how we were going to fix this, so people didn’t have to drive 100 miles to have a baby,” she said.

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Pharmacists Stockpile Most Common Drugs on Chance of Targeted Trump Tariffs

In the dim basement of a Salt Lake City pharmacy, hundreds of amber-colored plastic pill bottles sit stacked in rows, one man’s defensive wall in a tariff war.

Independent pharmacist Benjamin Jolley and his colleagues worry that the tariffs, aimed at bringing drug production to the United States, could instead drive companies out of business while raising prices and creating more of the drug shortages that have plagued American patients for several years.

Jolley bought six months’ worth of the most expensive large bottles, hoping to shield his business from the 10% across-the-board tariffs on imported goods that President Donald Trump announced April 2. Now with threats of additional tariffs targeting pharmaceuticals, Jolley worries that costs will soar for the medications that will fill those bottles.

In principle, Jolley said, using tariffs to push manufacturing from China and India to the U.S. makes sense. In the event of war, China could quickly stop all exports to the United States.

“I understand the rationale for tariffs. I’m not sure that we’re gonna do it the right way,” Jolley said. “And I am definitely sure that it’s going to raise the price that I pay my suppliers.”

Squeezed by insurers and middlemen, independent pharmacists such as Jolley find themselves on the front lines of a tariff storm. Nearly everyone down the line — drugmakers, pharmacies, wholesalers, and middlemen — opposes most tariffs.

Slashing drug imports could trigger widespread shortages, experts said, because of America’s dependence on Chinese- and Indian-made chemical ingredients, which form the critical building blocks of many medicines. Industry officials caution that steep tariffs on raw materials and finished pharmaceuticals could make drugs more expensive.

“Big ships don’t change course overnight,” said Robin Feldman, a UC Law San Francisco professor who writes about prescription drug issues. “Even if companies pledge to bring manufacturing home, it will take time to get them up and running. The key will be to avoid damage to industry and pain to consumers in the process.”

Trump on April 8 said he would soon announce “a major tariff on pharmaceuticals,” which have been largely tariff-free in the U.S. for 30 years.

“When they hear that, they will leave China,” he said. The U.S. imported $213 billion worth of medicines in 2024 — from China but also India, Europe, and other areas.

Trump’s statement sent drugmakers scrambling to figure out whether he was serious, and whether some tariffs would be levied more narrowly, since many parts of the U.S. drug supply chain are fragile, drug shortages are common, and upheaval at the FDA leaves questions about whether its staffing is adequate to inspect factories, where quality problems can lead to supply chain crises.

On May 12, Trump signed an executive order asking drugmakers to bring down the prices Americans pay for prescriptions, to put them in line with prices in other countries.

Meanwhile, pharmacists predict even the 10% tariffs Trump has demanded will hurt: Jolley said a potential increase of up to 30 cents a vial is not a king’s ransom, but it adds up when you’re a small pharmacy that fills 50,000 prescriptions a year.

“The one word that I would say right now to describe tariffs is ‘uncertainty,’” said Scott Pace, a pharmacist and owner of Kavanaugh Pharmacy in Little Rock, Arkansas.

To weather price fluctuations, Pace stocked up on the drugs his pharmacy dispenses most.

“I’ve identified the top 200 generics in my store, and I have basically put 90 days’ worth of those on the shelf just as a starting point,” he said. “Those are the diabetes drugs, the blood pressure medicines, the antibiotics — those things that I know folks will be sicker without.”

Pace said tariffs could be the death knell for the many independent pharmacies that exist on “razor-thin margins” — unless reimbursements rise to keep up with higher costs.

Unlike other retailers, pharmacies can’t pass along such costs to patients. Their payments are set by health insurers and pharmacy benefit managers largely owned by insurance conglomerates, who act as middlemen between drug manufacturers and purchasers.

Neal Smoller, who employs 15 people at his Village Apothecary in Woodstock, New York, is not optimistic.

“It’s not like they’re gonna go back and say, well, here’s your 10% bump because of the 10% tariff,” he said. “Costs are gonna go up and then the sluggish responses from the PBMs — they’re going to lead us to lose more money at a faster rate than we already are.”

Smoller, who said he has built a niche selling vitamins and supplements, fears that FDA firings will mean fewer federal inspections and safety checks.

“I worry that our pharmaceutical industry becomes like our supplement industry, where it’s the wild West,” he said.

Narrowly focused tariffs might work in some cases, said Marta Wosińska, a senior fellow at the Brookings Institution’s Center on Health Policy. For example, while drug manufacturing plants can cost $1 billion and take three to five years to set up, it would be relatively cheap to build a syringe factory — a business American manufacturers abandoned during the covid-19 pandemic because China was dumping its products here, Wosińska said.

It’s not surprising that giants such as Novartis and Eli Lilly have promised Trump they’ll invest billions in U.S. plants, she said, since much of their final drug product is made here or in Europe, where governments negotiate drug prices. The industry is using Trump’s tariff saber-rattling as leverage; in an April 11 letter, 32 drug companies demanded European governments pay them more or face an exodus to the United States.

Brandon Daniels, CEO of supply chain company Exiger, is bullish on tariffs. He thinks they could help bring some chemical manufacturing back to the U.S., which, when coupled with increased use of automation, would reduce the labor advantages of China and India.

“You’ve got real estate in North Texas that’s cheaper than real estate in Shenzhen,” he said at an economic conference April 25 in Washington, referring to a major Chinese chemical manufacturing center.

But Wosińska said no amount of tariffs will compel makers of generic drugs, responsible for 90% of U.S. prescriptions, to build new factories in the U.S. Payment structures and competition would make it economic suicide, she said.

Several U.S. generics firms have declared bankruptcy or closed U.S. factories over the past decade, said John Murphy, CEO of the Association for Accessible Medicines, the generics trade group. Reversing that trend won’t be easy and tariffs won’t do it, he said.

“There’s not a magic level of tariffs that magically incentivizes them to come into the U.S.,” he said. “There is no room to make a billion-dollar investment in a domestic facility if you’re going to lose money on every dose you sell in the U.S. market.”

His group has tried to explain these complexities to Trump officials, and hopes word is getting through. “We’re not PhRMA,” Murphy said, referring to the powerful trade group primarily representing makers of brand-name drugs. “I don’t have the resources to go to Mar-a-Lago to talk to the president myself.”

Many of the active ingredients in American drugs are imported. Fresenius Kabi, a German company with facilities in eight U.S. states to produce or distribute sterile injectables — vital hospital drugs for cancer and other conditions — complained in a letter to U.S. Trade Representative Jamieson Greer that tariffs on these raw materials could paradoxically lead some companies to move finished product manufacturing overseas.

Fresenius Kabi also makes biosimilars, the generic forms of expensive biologic drugs such as Humira and Stelara. The United States is typically the last developed country where biosimilars appear on the market because of patent laws.

Tariffs on biosimilars coming from overseas — where Fresenius makes such drugs — would further incentivize U.S. use of more expensive brand-name biologics, the March 11 letter said. Biosimilars, which can cost a tenth of the original drug’s price, launch on average 3-4 years later in the U.S. than in Canada or Europe.

In addition to getting cheaper knockoff drugs faster, European countries also pay far less than the United States for brand-name products. Paradoxically, Murphy said, those same countries pay more for generics.

European governments tend to establish more stable contracts with makers of generics, while in the United States, “rabid competition” drives down prices to the point at which a manufacturer “maybe scrimps on product quality,” said John Barkett, a White House Domestic Policy Council member in the Biden administration.

As a result, Wosińska said, “without exemptions or other measures put in place, I really worry about tariffs causing drug shortages.”

Smoller, the New York pharmacist, doesn’t see any upside to tariffs.

“How do I solve the problem of caring for my community,” he said, “but not being subject to the emotional roller coaster that is dispensing hundreds of prescriptions a day and watching every single one of them be a loss or 12 cents profit?”

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from Health Industry Archives - KFF Health News

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