Last winter, Amber Wingler started getting a series of increasingly urgent messages from the local hospital in Columbia, Missouri, letting her know her family’s health care might soon be upended.

MU Health Care, where most of her family’s doctors work, was mired in a contract dispute with Wingler’s health insurer, Anthem. The existing contract was set to expire.

Then, on March 31, Wingler received an email alerting her that the next day Anthem was dropping the hospital from its network. It left her reeling.

“I know that they go through contract negotiations all the time … but it just seemed like bureaucracy that wasn’t going to affect us. I’d never been pushed out-of-network like that before,” she said.  

The timing was awful.

The query: When a Missouri mom’s health insurance company couldn’t come to an agreement with her hospital, most of her doctors were suddenly out-of-network. She wondered how she would get her kids’ care covered or find new doctors. “For a family of five, … where do we even start?”

— Amber Wingler, 42, in Columbia, Missouri

Wingler’s 8-year-old daughter, Cora, had been having unexplained troubles with her gut. Waitlists to see various pediatric specialists to get a diagnosis, from gastroenterology to occupational therapy, were long — ranging from weeks to more than a year.

(In a statement, MU Health Care spokesperson Eric Maze said the health system works to make sure children with the most urgent needs are seen as quickly as possible.)

Suddenly, the specialist visits for Cora were out-of-network. At a few hundred bucks a piece, the out-of-pocket cost would have added up fast. The only other in-network pediatric specialists Wingler found were in St. Louis and Kansas City, both more than 120 miles away.

So Wingler delayed her daughter’s appointments for months while she tried to figure out what to do.

Nationwide, contract disputes are common, with more than 650 hospitals having public spats with an insurer since 2021. They could become even more common as hospitals brace for about $1 trillion in cuts to federal health care spending prescribed by President Donald Trump’s signature legislation signed into law in July.

Patients caught in a contract dispute have few good options. “There’s that old African proverb: that when two elephants fight, the grass gets trampled. And unfortunately, in these situations, oftentimes patients are grass,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation, a nonprofit that helps people who are having trouble accessing health care.

If you’re feeling trampled by a contract dispute between a hospital and your insurer, here is what you need to know to protect yourself financially:

1. “Out-of-network” means you’ll likely pay more.

Insurance companies negotiate contracts with hospitals and other medical providers to set the rates they will pay for various services. When they reach an agreement, the hospital and most of the providers who work there become part of the insurance company’s network.

Most patients prefer to see providers who are “in-network” because their insurance picks up some, most, or even all of the bill, which could be hundreds or thousands of dollars. If you see an out-of-network provider, you could be on the hook for the whole tab.

If you decide to stick with your familiar doctors even though they’re out-of-network, consider asking about getting a cash discount and about the hospital’s financial assistance program.

2. Rifts between hospitals and insurers often get repaired.

When Brown University health policy researcher Jason Buxbaum examined 3,714 nonfederal hospitals across the U.S., he said, he found that about 18% of them had a public dispute with an insurance company sometime from June 2021 to May 2025.

About half of those hospitals ultimately dropped out of the insurance company’s network, according to Buxbaum’s preliminary data. But most of those breakups ultimately get resolved within a month or two, he added. So your doctors very well could end up back in the network, even after a split.

3. You might qualify for an exception to keep costs lower.

Certain patients with serious or complex conditions might qualify for an extension of in-network coverage, called continuity of care. You can apply for that extension by contacting your insurer, but the process may prove lengthy. Some hospitals have set up resources to help patients apply for that extension.

Wingler ran that gantlet for her daughter, spending hours on the phone, filling out forms, and sending faxes. But she said she didn’t have the time or energy to do that for everyone in her family.

“My son was going through physical therapy,” she said. “But I’m sorry, dude, like, just do your exercises that you already have. I’m not fighting to get you coverage too, when I’m already fighting for your sister.”

Also worth noting, if you’re dealing with a medical emergency: For most emergency services, hospitals can’t charge patients more than their in-network rates.

4. Switching your insurance carrier may need to wait.

You might be thinking of switching to an insurer that covers your preferred doctors. But be aware: Many people who choose their insurance plans during an annual open enrollment period are locked into their plan for a year. Insurance contracts with hospitals are not necessarily on the same timeline as your “plan year.”

Certain life events, such as getting married, having a baby, or losing a job, can qualify you to change insurance outside of your annual open enrollment period, but your doctors’ dropping out of an insurance network is not a qualifying life event.

5. Doctor-shopping can be time-consuming.

If the split between your insurance company and hospital looks permanent, you might consider finding a new slate of doctors and other providers who are in-network with your plan. Where to start? Your insurance plan likely has an online tool to search for in-network providers near you. 

But know that making a switch could mean waiting to establish yourself as a patient with a new doctor and, in some cases, traveling a fair distance.

6. It’s worth holding on to your receipts.

Even if your insurance and hospital don’t strike a deal before their contract expires, there’s a decent chance they will still make a new agreement.

Some patients decide to put off appointments while they wait. Others keep their appointments and pay out-of-pocket. Hold on to your receipts if you do. When insurers and hospitals make up, the deals often are backdated, so the appointments you paid for out-of-pocket could be covered after all.

End of an Ordeal

Three months after the contract between Wingler’s insurance company and the hospital lapsed, the sides announced they had reached a new agreement. Wingler joined the throng of patients scheduling appointments they’d delayed during the ordeal.

In a statement, Jim Turner, a spokesperson for Anthem’s parent company, Elevance Health, wrote, “We approach negotiations with a focus on fairness, transparency, and respect for everyone impacted.”

Maze from MU Health Care said: “We understand how important timely access to pediatric specialty care is for families, and we’re truly sorry for the frustration some parents have experienced scheduling appointments following the resolution of our Anthem contract negotiations.”

Wingler was happy her family could see their providers again, but her relief was tempered by a resolve not to be caught in the same position again.

“I think we will be a little more studious when open enrollment comes around,” Wingler said. “We’d never really bothered to look at our out-of-pocket coverage before because we didn’t need it.”

Author: Bram Sable-Smith: brams@kff.org, @besables

Illustrations: Oona Zenda: ozenda@kff.org

The post So Your Insurance Dropped Your Doctor. Now What? appeared first on Medika Life.

TUSTIN, Calif. — Cynthia Williams is furious with U.S. House Republicans willing to slash Medicaid, the government-run insurance program for people with low incomes or disabilities.

The 61-year-old Anaheim resident cares for her adult daughter, who is blind, and for her sister, a military veteran with severe post-traumatic stress disorder and other mental health conditions. Medi-Cal, the state’s version of Medicaid, pays Williams to care for them, and she relies on that income, just as her sister and daughter depend on her.

“Let’s be real. We shouldn’t have to be here tonight,” Williams told a raucous standing-room crowd of over 200 people at a recent town hall. “We should be home, spending time with our loved ones and our families, but we’re here. And we’re here to fight, because when politicians try to take away our health care, we don’t have the option to sit back and let it happen.”

The House last week approved a Republican budget plan that could shrink Medicaid spending by $880 billion over 10 years, only partially paying for an extension of expiring tax cuts from President Donald Trump’s first term, plus some new ones he has promised, totaling as much as $4.5 trillion.

A spending cut of that magnitude would have a huge impact in California, with nearly 15 million people — more than a third of the population — on Medi-Cal. Over 60% of Medi-Cal’s $161 billion budget comes from Washington.

Williams was among about a dozen providers, patient advocates, disabled people, and family members who stood up one after the other to tell their stories. Rep. Young Kim, a Republican whose district includes this relatively affluent Orange County city, declined an invitation for her or a staff member to attend. But her constituents delivered their message loud and clear to her and the other Republicans in Congress: Hands off Medicaid.

Josephine Rios, a certified nursing assistant at a Kaiser Permanente surgical center in Irvine, said her 7-year-old grandson, Elijah, has received indispensable treatments through Medi-Cal, including a $5,000-a-month medication that controls his seizures, which can be life-threatening. Elijah, who has cerebral palsy, is among the more than 50% of California children covered by Medi-Cal.

“To cut Medicaid, Medi-Cal, that’s like saying he can’t live. He can’t thrive. He’s going to lie in bed and do nothing,” Rios said. “Who are they to judge who lives and who doesn’t?”

Two thirds of Californians across party lines oppose cuts to Medi-Cal, according to a new survey by the California Health Care Foundation and NORC at the University of Chicago.

The town hall here was one of three organized late last month by “Fight for Our Health,” a coalition of health advocacy groups and unions, to target Republican House members whose California districts are considered politically competitive. The other two were in Bakersfield, part of which is represented by Rep. David Valadao, and Corona, home to Rep. Ken Calvert. Multiple other town halls and protests have sprung up across the country in recent weeks.

The coalition has reprised a campaign — part of a broader national movement — that fought against the GOP’s unsuccessful 2017 effort to repeal the Affordable Care Act.

The Republicans’ loss of House control in the 2018 midterm elections has been widely attributed to their stance on health care. Valadao was among the GOP members who lost their seats in 2018, though he took his back two years later.

Still, he voted for the House budget proposal last week, despite the fact that about two-thirds of the population in his district is on Medicaid — the highest in the state — and even though he is one of eight GOP House members who sent a letter to Speaker Mike Johnson warning about the “serious consequences” of deep cuts to Medicaid. Valadao’s office did not respond to requests for comment.

Calvert, who’s been in the House for 32 years and eked out reelection last November, also voted for the budget, as did Kim. All nine GOP members of California’s congressional delegation supported it, as did all House Republicans except one.

Critics of the budget plan say it helps the rich at the expense of society’s most vulnerable — an argument that was vigorously repeated at the Tustin town hall. But supporters of the plan say that extending the tax cuts, key provisions of which are set to expire at the end of this year, would avoid a large tax hike for average Americans and benefit low-income families the most.

“American families are facing a massive tax increase unless Congress acts by the end of the year,” Calvert said in a statement to KFF Health News before the vote. He vowed the GOP would not touch Social Security or Medicare. He did not offer similar assurances on Medicaid, but said, “We are not interested in cutting the social and healthcare safety net for children, disabled, and low-income Americans. We are focused on eliminating waste, fraud, and abuse.”

The document greenlit last Tuesday does not specify spending cut details, though it instructs the Energy and Commerce Committee, which oversees Medicaid and Medicare spending, to cut $880 billion — a large chunk of the up to $2 trillion in total cuts. The GOP’s razor-thin majority means Johnson will have a narrow path to get a more detailed budget passed. Republican support, whether from fiscal hawks who want deeper spending cuts or House members worried about slashing Medicaid, could ebb and flow as the details are hashed out.

Moreover, the House must reach a compromise with the Senate, which has passed a much narrower budget resolution that leaves the big tax cuts out for now.

Like Kim, Valadao and Calvert declined invitations to attend or send staffers to the town hall meetings in their regions. At the Tustin meeting, multiple speakers chided Kim for her absence. At one point, the large screen behind the podium flashed a picture of an empty chair with the words, in large block letters, “Congresswoman Kim, we saved you a seat.”

Kim spokesperson Callie Strock said in an email that Kim and her local staff had preexisting commitments that night. She added that Kim is “committed to protecting and strengthening our health care system.”

But those in attendance were clearly worried.

“It’s a moral obligation for all of us to look at the most disadvantaged people in our country and take good care of them,” said Beth Martinko, whose 33-year-old son, Josh, has autism and relies on Medi-Cal for his care. “This has no place in politics.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Bernard J. Wolfson: bwolfson@kff.org, @bjwolfson

The post To Patients, Parents, and Caregivers, Proposed Medicaid Cuts Are a Personal Affront appeared first on Medika Life.

Like an endangered species, preventive medicine and chronic disease management—the US primary care system—face extinction. With nearly 30% of American adults lacking a source of care and 28 percent reporting delaying or not getting care due to cost, the consequences are far-reaching.  The focus on chronic disease prevention and addressing its root causes demands greater attention, as the health of the system—and the people it serves—depends on it. If we are frustrated about something, this is worth the outrage.

It has been almost impossible for elected officials, who too often look for singular villains, to grasp the extent of this system-wide dysfunction. This crisis extends beyond consumer comfort with technology or the cost of medicines. Primary care medicine—the basis for health delivery—is marginalized as an honored medical discipline. Somehow, we opt for a national health system prioritizing sick care over healthcare.

Primary care providers are grappling with burnout and inadequate compensation compared to their specialist counterparts, and the system often prioritizes paperwork over quality of care. Economics drives health delivery and access, and it’s simply not working to the advantage of consumers and primary care physicians.  

Finger-pointing and Senate HELP Committee photo ops cannot solve this nation’s care crisis. What’s needed is a fundamental shift in our approach to illness, prevention, and access—one that addresses the root causes of our failing primary care system and ensures that quality healthcare is accessible to all Americans, regardless of zip code or digital literacy. That will reduce our total health costs.

Obesity and Heart Disease: A Multigenerational Threat

America’s waistline is changing—we are adding notches to the nation’s belts. Obesity rates among younger Americans are climbing, creating an abundance of chronic diseases that once seemed confined to older generations. Alarmingly, heart disease, which had been in decline for decades, is creeping back up.

The invention of new weight-loss drugs like GLP-1 receptor agonists helps many struggling with chronic weight issues and mitigates some health risks. Yet, these drugs are not a complete answer to the challenge. They do not adequately address the underlying risks—heart disease, diabetes, and other chronic conditions—that require ongoing, consistent engagement with health professionals. Without this, even those who benefit from these medications – looking trim – may still end up battling old health challenges.

The persistent challenge of obesity across various age groups in the US, which hovers at +/- 40 percent, reinforces worrisome trends that impact people by age, race and region. A rate stable at 40 percent is not something to celebrate – it requires action. It’s a tipping point for illness.

Prediabetes: A Perfect Public Health Storm

Prediabetes is the nation’s silent epidemic. Close to 90 million adults—more than 1 in 3 Americans—have it, and 90% don’t know they do. Left unchecked, some 20 percent of these people “graduate” to Type 2 diabetes and other complications annually. The rise in obesity among younger populations only exacerbates this issue, setting the stage for an earlier onset of chronic diseases that worsen over time.

Prediabetes demands a dedicated behavior-focused treatment plan. Without significant lifestyle changes, individuals are on a fast track to diabetes and its life-altering complications. And yet, the primary care system—our first line of defense—is buckling under pressure, unable to provide the consistent support patients need. It’s not just the use of medications – it’s understanding that obesity is a multi-system condition and a unique disease that transcends more belt notches.

The Limitations of GLP-1 Drugs:

GLP-1 drugs do reduce weight and lower the risk of diabetes and heart disease. But they are not a substitute for comprehensive care. The underlying dangers—poor cardiovascular health, insulin resistance, and other metabolic issues—don’t disappear with weight loss alone. Without engagement with allied health professionals trained to address the complexities of obesity to monitor and address these risks, consumers will face new challenges despite these drugs’ initial success in losing pounds.

We live in what Katherine Saunders, MD, DABOM, a Weill Cornell Medicine’s Comprehensive Weight Control Center and co-founder of FlyteHealth, calls the “Obese-a-genetic” era.  Her efforts at FlyteHealth leverage the latest in science, technology, patient support, and a range of medications to individually tailor weight treatment based on a person’s unique biology alongside the complexity of obesity treatment:

“Overweight and obesity are misunderstood medical conditions that are more complex than calories in and calories out. The advice many patients receive—to eat less and exercise more—often fails to address the problem.”

Saunders and her colleagues are at the cutting edge of results-oriented care, but she is among the handful who have dedicated their careers to this pressing clinical discipline.

Walk-In Clinics are about Convenience

Convenience of care is essential to people’s well-being. Entrepreneurial internists have recognized this, creating “pop-up” vaccination and care centers to bring services closer to those in need and better work/life balance. But convenience alone isn’t enough. Urgent care clinics underscore one of the nation’s most pressing public health threats—the erosion of primary care—has reached a retail-like inflection point.

Walk-in clinics and telehealth check-ins are helpful but do not offer dedicated follow-up. They are geared to address the consumer’s immediate need and are not structured for the longitudinal engagement for the hard-to-tackle considerations that call for comprehensive support.

We are stuck between a system that focuses on its self-preservation and what is in our and national long-term interests – protecting our most important asset – our health.

The Rise of the Make American Health Again Movement

Primary care physicians, the cornerstone of preventive health, are becoming extinct as a medical profession species. The reasons are many: medical school debt driving doctors to higher-paying specialties, they are paid by the number of patients seen daily burnout, and the rise of retail clinics offering quick, transactional care.

While these clinics improve access, their focus is not on a long-term patient-physician relationship. This shift leaves a dangerous gap in the medical safety net, particularly for chronic conditions like obesity, prediabetes, and heart disease. Without a trusted health provider to guide them, patients are left to navigate their health journeys solo—often with devastating consequences.

Many are aghast at Robert F. Kennedy Jr.’s nomination to the Department of Health and Human Services as Secretary of the nation’s key organization setting national health policy. This justified anxiety centers on his stated positions on vaccines and his off-hand comments dismissing the importance of medicines in preventing more serious illnesses. However, his thoughts about America’s poor health report card grades deserve attention regardless of the outcome of the Senate confirmation hearings.

His Make America Healthy Again movement has an approach that deserves consideration: the need to tackle the chronic disease epidemic, which has become the leading cause of death in the US and, later, drives massive costs in hospitalization.

“There are some things that RFK Jr. gets right,” says Resolve to Save Lives CEO Dr. Tom Frieden, who was appointed Director of the Centers for Disease Control and Prevention during the Obama Administration. “We do have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science.” Frieden made his comments in an NPR interview on the RFK Jr. nomination.

We need (much) more than medications and pop-up clinics to address America’s growing health crises. The health ecosystem must be reimagined to center around people’s health outcomes – not a one-size-fits-all approach to keeping them well. We must foster long-term patient-provider relationships, ensure easy access to understandable health data, emphasize nutrition and physical education in schools, and make care accessible to people across racial and generational lines.

As the ticking time bombs of obesity, prediabetes, and heart disease continue to warn, the urgency for change cannot be overstated. The frustration over the current complexity of access underscores what happens when we prioritize the system over prevention. Access to care isn’t just a convenience—it’s a matter of survival. To prevent the collapse of this fragile house of cards, we must act decisively and collaboratively to build a health system that sustains us all.

The post Conceptually, the “Make America Healthy Again Movement” Needs a Nod appeared first on Medika Life.

This move benefits Indian patients and has the potential to reshape the global pharmaceutical landscape. With India’s new policy, many multinational biopharmaceutical companies will need to reflect on how India evolves into a priority market.  

Speaking on the decision, Dr. V.G. Somani, Drugs Controller General of India (DCGI), Central Drugs Standard Control Organization, stated, “This policy shift is designed to bring the best of global medical innovation to India more swiftly. By relying on the robust data from international trials, we can ensure that Indian patients benefit from these advancements without unnecessary delays.”

This is more than just a regulatory update for multinational biopharmaceutical companies—it’s a strategic inflection point. India has long been considered a market of interest due to its significant population, favorable policy environment, and emerging middle class. Now, it has signaled its readiness to engage with the global pharmaceutical ecosystem on a new level.

The shift opens up a new market for these pharma companies. It presents an opportunity, but more importantly, a responsibility to extend their voice in India, increasing corporate brand reputation, science communication, and patient advocacy. It’s a turning point that could redefine the global pharmaceutical landscape, underscoring the weight of their role in shaping the future of healthcare.

S. Rajan, Chief Communications, Corporate Affairs and CSR officer at Roche, is among the industry leaders who applauded the GoI news: “This circular is a welcome and much-needed move. The calling out of specific drug categories will help drive a uniform and consistent understanding and avoid any delays. It is important that this is implemented well. We are hopeful that access to the latest innovations will be expedited, addressing unmet healthcare needs and benefitting Indian patients.”

Eliminating the cost barrier of conducting local clinical trials indicates that the GoI is seeking to address a public health need.  One obstacle has been removed, though others remain. Global biopharma companies still face significant challenges operating in India, primarily due to price controls impacting innovative therapies. At this time, India’s government enforces price caps that too often make it financially unviable for multinational companies to launch new, innovative drugs in this market. But it’s not impossible!

This is a favorable move to bring innovative cancer therapies and treatments for rare diseases to people in India. This remains a market of incredible potential, and biopharma companies will need to continue advancing innovative therapies and supporting them with economic solutions to make the best medicines available to more people worldwide. In the meantime, an expansion strategy to India is a medical and communication priority.

Investing in Corporate Brand Reputation

With India becoming a priority market, global pharmaceutical companies must assess how to build relationships with India’s medical and patient advocacy communities.  This is more than relying on marketing muscle. It’s about establishing a reputation as a trusted partner in health innovation and delivery in fast-emerging nations. This could involve initiatives such as collaborating with local healthcare providers, supporting patient education programs, and participating in policy discussions on health innovation and delivery in India.

Even before the GoI decision, the Indian pharmaceutical market was expected to grow to US$130 billion by 2030, up from US$42 billion in 2021, making it one of the fastest-growing health markets in the world.  The decision to embrace other nations’ regulatory moves will likely dramatically accelerate that growth.

Patrizia Cavazzoni, MD, Center for Drug Evaluation and Research, at FDA, has long tracked GoI decisions: “India’s decision to align its drug approval processes with global standards is a significant step that will foster greater collaboration. It also highlights the need for pharmaceutical companies to engage more deeply with Indian stakeholders, ensuring their corporate presence is synonymous with trust and transparency.”

Like audiences everywhere, the Indian public is increasingly discerning the corporate behaviors of those they entrust with their health.  People with urgent health concerns are excited about this decision, which will speed up access to therapies.  Companies must recognize that investing in world-class science may not be enough in the post-COVID era to secure physician support and consumer confidence.  To facilitate market entry in India requires establishing corporate identities people can trust.

The Imperative for Science-Based Communication

Effective science communication will be paramount as these companies introduce their health innovations into India. The complexities of advanced medical treatments, particularly newly approved ones, require careful explanation to health providers and the public.

Transparent, accessible communication will help demystify these innovations, fostering greater acceptance and understanding.  This also calls on major hospital provider systems that served as drug trial sites for these regulatory-approved medicines to step forward and share clinical backgrounds and best practices in patient care.

According to published studies, 87% of Indian physicians are highly engaged in continuing medical education (CMEs) and are keen to stay updated with the latest advancements in treatments and drug safety protocols, highlighting a receptive audience for apparent, data-driven communication efforts. Companies have an opportunity to lead by example, demonstrating that they are bringing innovative products to market by showing commitment to educating and empowering Indian patients and health professionals.

Dr. V.G. Somani, DCGI, emphasized the importance of clear communication in this new regulatory landscape: “Pharmaceutical companies must now rise to the challenge of effectively communicating the science behind these treatments to healthcare providers and patients. This will be crucial in ensuring that the benefits of these new therapies are fully realized.”

Patient Advocacy as a Pillar of Reputation

Most crucially, multinational pharmaceutical companies must prioritize patient advocacy in India. The recent regulatory change will undoubtedly bring some innovative treatments to the market. The policy change is a catalyst toward ensuring treatments are accessible, affordable, and aligned with patients’ needs.  However, it remains a complex challenge.  India has 1.4 billion people – as many as 400 million classified as middle class – and a diverse and complex healthcare insurance system that includes government, private, and, in some cases, a heavy reliance on consumer out-of-pocket payments.

Companies must engage with patient communities, understand their unique challenges, and advocate for solutions that address them. Organizations such as the Organization for Rare Diseases India (ORDI) and the Lysosomal Storage Disorders Support Society (LSDSS) are among the advocacy groups advocating for patients with rare diseases in India. ORDI ensures early diagnosis, treatment, and support for individuals with rare diseases, while LSDSS focuses on increasing awareness and providing access to therapies for lysosomal storage disorders.

Dr. Manjit Singh, LSDSS Executive Committee President, commented on the significance of this regulatory change: “This policy decision is a critical step forward for patients with rare diseases in India. It will help bring much-needed therapies to the market faster. Still, it also places the onus on pharmaceutical companies to ensure these treatments are accessible and affordable for all patients.”

By engaging with these patient advocacy groups, pharmaceutical companies can help amplify patients’ voices, ensuring their needs are central in developing and distributing new treatments. Over time, this will include ensuring peer-reviewed science is shared with India-based media covering health and science, prioritizing pricing strategies to ensure accessibility to patient support programs, and investing in awareness efforts so that people with these conditions understand the importance of medication adherence.

The Government of India’s decision to waive local clinical trial requirements for drugs approved by gold-standard regulatory bodies is forward-thinking and aligns with the country’s demonstrated efforts to improve health delivery for serious illnesses. Multinational biopharmaceutical companies should get the signal that India is a welcoming market ready to be at the forefront of their phyician education and patient advocacy efforts. By investing in corporate brand awareness, scientific communication, and patient advocacy, these companies can contribute meaningfully to the health and well-being of India and other emerging nations. 

One barrier to access has been lowered for innovative cancer and rare disease therapies.  In reality, others remain.  One of the biggest is that the Indian National Pharmaceutical Pricing Authority sets ceiling prices – caps – that include certain patented and innovative drugs. The pricing formula often uses a cost-plus approach, a non-starter for significant biopharma companies championing breakthrough therapies in a price-referring policy environment.  But the door to possibilities has opened wider.

In responding to the GoI welcoming decision with action, the biopharmaceutical industry can reinforce its commitment to good business, science, and patient care—a true win-win-win for all involved and a global health impact. The message is clear: Pharma companies consider the possibilities and  “Go to India!”

The post India’s Pivotal Regulatory Shift: A Possible Game-Changer in Expediting Medicines to Millions in Dire Need appeared first on Medika Life.

I’ve had a physician tell me, in strictest confidence, that the hospital replaces physicians who leave with any available MD, regardless of their expertise. “They see an MD as an MD, and that’s it.” We have to wonder what effect this has on patient care.

In an ideal practice setting, medicine and surgery are used in a two-way connection between a doctor and a patient, with support from leadership, staff, and the care team. The clinician has all the tools they need to heal. The goal should be to do what is best for the patient at all times.

But there is ample proof that the health system is becoming increasingly corporate. In 2023, 65 hospitals or health systems revealed deals to merge or buy other hospitals, bringing in more than $38 billion. The business of medicine is a big part of the economy, especially since the US spends almost $5 trillion a year on healthcare. And the system is underperforming.

Private equity investors have a big stake in the US healthcare system; they own more than 30% of hospitals in some markets and almost 400 hospitals. Little is left for the smaller hospitals or, indeed, the single practitioner who wishes to work independently. Little by little, they are being forced into a market that seems to smack of monopolistic practices.

In America’s profit-driven healthcare system, physicians believe they are hurt when managers, hospital executives, and insurers make them break the rules of ethics that were supposed to guide their profession. It is hard for many physicians to balance their Hippocratic oath with the reality of making money off of sick and vulnerable people. Some say this promotes a very high rate of physician suicide and burnout.

The 2024 physician burnout and depression study from Medscape says that almost half of physicians feel burned out. The number of physicians who are burned out has gone down since last year, when 53% said they were burned out. But many are considering leaving the field. Due to employees quitting, the resource gap in available care will widen. Nurses, too, are leaving the field because of overload, lack of support, and wages.

A physician I spoke to told me that he resisted being bought by a hospital chain and, as a result, will not be permitted to admit patients there or receive referrals; they are squeezing him out of existence. He now plans to leave medicine in about two years. The daily stress of dealing with insurance companies is exhausting for his staff.

The concerns regarding patient care are real, and the US government realizes them. The Office of Civil Rights in the U.S. Department of Health and Human Services released a rule about the nondiscrimination section in Section 1557 of the Affordable Care Act (PDF). This rule could punish doctors if they use algorithm-based tools that cause discriminatory harm.

The Federation of State Medical Boards also put out a set of rules saying that doctors are responsible for harm caused by tools that use algorithms. But what if the physicians or staff have little say over how algorithms are used and who uses them? Can we hold them responsible for management’s actions? And, if management is a private equity company, where does the buck stop? Harry Truman knew.

A new report from the World Health Organization (WHO) discusses five fundamental ways AI LLMs could be used in medicine and public health: diagnosis, patient care, administrative chores, medical education, and research. However, the study also warns that AI comes with big risks of bias, unfairness, privacy breaches, and problems with openness.

Experts and civil society groups share these worries. Depending on algorithms that are devoid of emotion and only deal with data is taking a road too far and giving too much power to a math formula over medical staff and patient input. In fact, there is NO patient input, only data.

One patient I knew who found a major error in the EHR attempted to have it remediated to the correct information—it took seven years, and the patient was told the hospital could do nothing about the EPIC software errors. How is it possible that a program has no fail-safe corrections for inaccurate diagnoses, treatments, or medications and on which major health decisions are made?

One thing about making professional decisions is that the situation is often much tougher and more complicated than people think. The assumption is that it is not hard to make a medically complicated decision. You need to gather a few facts and think about them like a medical professional (i.e., a doctor), and you can figure out exactly what the patient is sick with and how to treat it. That’s how AI would act, and it would be done within minutes if not seconds.

But medical staff need to consider more variables than the AI may have been trained on and therein may lie a bed of thorns. Who is truly conversant with the limits of AI training and the bias inherent within its vast network? Certainly, hospital staff aren’t equipped to do much. What are the potential harmful effects?

The AI tools and machine learning (ML) methods that make them up are not perfect, and it is not likely that they will ever be. So, adding AI will bring benefits and the common problem of AI tools making mistakes. According to a study from the European Parliamentary Research Service, one of the biggest risks of putting AI into healthcare is that it could hurt patients through mistakes.

Are hospital administrators or private equity managers up to the task of monitoring instead of zeroing in on the bottom-line savings of AI? Instead of becoming a major moneymaker for them, it could become a swamp of lawsuits that will push some of them into bankruptcy from major decisions against them.

Caution seems to have been thrown to the wind in the heady giddiness that may be exhibited by people who should know better. Yes, I realize I am being caustic, but people’s lives, livelihoods, and professions are on the line. We are not talking about trading stocks but working with lives.

The post Hospital Managers, Medical Decisions, and Patients’ Need to Know appeared first on Medika Life.

Bill Thompson’s wife had never seen him smile with confidence. For the first 20 years of their relationship, an infection in his mouth robbed him of teeth, one by one.

“I didn’t have any teeth to smile with,” the 53-year-old of Independence, Missouri, said.

Thompson said he dealt with throbbing toothaches and painful swelling in his face from abscesses for years working as a cook at Burger King. He desperately needed to see a dentist but said he couldn’t afford to take time off without pay. Missouri is one of many states that do not require employers to provide paid sick leave.

So, Thompson would swallow Tylenol and push through the pain as he worked over the hot grill.

“Either we go to work, have a paycheck,” Thompson said. “Or we take care of ourselves. We can’t take care of ourselves because, well, this vicious circle that we’re stuck in.”

In a nation that was sharply divided about government health mandates during the COVID-19 pandemic, the public has been warming to the idea of government rules providing for paid sick leave.

Before the pandemic, 10 states and the District of Columbia had laws requiring employers to provide paid sick leave. Since then, Colorado, New York, New Mexico, Illinois, and Minnesota have passed laws offering some kind of paid time off for illness. Oregon and California expanded previous paid leave laws. In Missouri, Alaska, and Nebraska, advocates are pushing to put the issue on the ballot this fall.

The U.S. is one of nine countries that do not guarantee paid sick leave, according to data compiled by the World Policy Analysis Center.

In response to the pandemic, Congress passed the Emergency Paid Sick Leave and Emergency Family and Medical Leave Expansion acts. These temporary measures allowed employees to take up to two weeks of paid sick leave for covid-related illness and caregiving. But the provisions expired in 2021.

“When the pandemic hit, we finally saw some real political will to solve the problem of not having federal paid sick leave,” said economist Hilary Wething.

Wething co-authored a recent Economic Policy Institute report on the state of sick leave in the United States. It found that more than half, 61%, of the lowest-paid workers can’t get time off for an illness.

“I was really surprised by how quickly losing pay — because you’re sick — can translate into immediate and devastating cuts to a family’s household budget,” she said.

Wething noted that the lost wages of even a day or two can be equivalent to a month’s worth of gasoline a worker would need to get to their job, or the choice between paying an electric bill or buying food. Wething said showing up to work sick poses a risk to co-workers and customers alike. Low-paying jobs that often lack paid sick leave — like cashiers, nail technicians, home health aides, and fast-food workers — involve lots of face-to-face interactions.

“So paid sick leave is about both protecting the public health of a community and providing the workers the economic security that they desperately need when they need to take time away from work,” she said.

The National Federation of Independent Business has opposed mandatory sick leave rules at the state level, arguing that workplaces should have the flexibility to work something out with their employees when they get sick. The group said the cost of paying workers for time off, extra paperwork, and lost productivity burdens small employers.

According to a report by the National Bureau of Economic Research, once these mandates go into effect, employees take, on average, two more sick days a year than before a law took effect.

Illinois’ paid time off rules went into effect this year. Lauren Pattan is co-owner of the Old Bakery Beer Co. there. Before this year, the craft brewery did not offer paid time off for its hourly employees. Pattan said she supports Illinois’ new law but she has to figure out how to pay for it.

“We really try to be respectful of our employees and be a good place to work, and at the same time we get worried about not being able to afford things,” she said.

That could mean customers have to pay more to cover the cost, Pattan said.

As for Bill Thompson, he wrote an op-ed for the Kansas City Star newspaper about his dental struggles.

“Despite working nearly 40 hours a week, many of my co-workers are homeless,” he wrote. “Without health care, none of us can afford a doctor or a dentist.”

That op-ed generated attention locally and, in 2018, a dentist in his community donated his time and labor to remove Thompson’s remaining teeth and replace them with dentures. This allowed his mouth to recover from the infections he’d been dealing with for years. Today, Thompson has a new smile and a job — with paid sick leave — working in food service at a hotel.

In his free time, he’s been collecting signatures to put an initiative on the November ballot that would guarantee at least five days of earned paid sick leave a year for Missouri workers. Organizers behind the petition said they have enough signatures to take it before the voters.

By Zach Dyer: zdyer@kff.org

The post Paid Sick Leave Sticks After Many Pandemic Protections Vanish appeared first on Medika Life.

The Pressing Challenge: Dual Health Threats in HTCs

HTCs face a dual healthcare challenge: the persistent threat of infectious diseases and the rising incidence of non-communicable diseases (NCDs). The countries featured in this report, such as South Africa and India, confront unique healthcare challenges, with marginalised communities experiencing greater health disparities and limited access to essential services (Health Equity & Inclusion in Action, p. 10).

The Vision of Health Equity and Inclusion

The report emphasises the overarching vision of a healthcare system that is universally accessible and holistically integrated. It ensures that every individual, irrespective of socioeconomic or cultural background, benefits equally from affordable access to quality healthcare. The report examines various health initiatives across HTCs that pave the way towards a more equitable and inclusive healthcare framework (Health Equity & Inclusion in Action, p. 10).

Bright Spots: Proven Strategies in Resource-Limited Settings

Amidst the challenges faced by HTCs, the report highlights innovative strategies emerging as beacons of hope. These include task shifting, ensuring the quality of health services and medications, and developing novel healthcare delivery models. The pivotal role of community health workers and the transformative impact of quality generic medicines are particularly noteworthy. These strategies are not only improving healthcare accessibility but also making healthcare more affordable (Health Equity & Inclusion in Action, p. 10).

Digital Leap: Technology’s Potential as the Great Equalizer

The report underscores the potential of technology to offer solutions in healthcare that transcend traditional access barriers. Although fundamental challenges such as the digital divide persist, technology is emerging as a crucial tool to democratise health access. The report spotlights initiatives harnessing mobile health applications, decentralised diagnostic technologies, digital health records, and a broader digital health ecosystem. These initiatives have immense potential to elevate care quality, expand reach, and bridge the healthcare divide (Health Equity & Inclusion in Action, p. 10).

Recommendations for a Healthier Tomorrow

The report offers several recommendations to generate progress towards health equity and inclusion:

1. Leverage scarce health system resources: Implement task shifting and digitisation programs to enhance efficiency. Prioritise clear delineation of roles and stringent quality control to ensure effective, context-specific healthcare delivery. Champion the adoption of effective pharmacovigilance programs and address the issue of low-quality or counterfeit medicines (Health Equity & Inclusion in Action, p. 10).

2. Improve access and increase affordability: Amplify funding for initiatives prioritising marginalised and underserved communities, fostering a more equitable and efficient health system (Health Equity & Inclusion in Action, p. 10).

3. Ensure smart use of technology and data to leapfrog constraints: Enhance healthcare with contextually relevant tech, predictive artificial intelligence, and Big Data, emphasising scalable solutions like mHealth to improve efficiency and decision-making. Ensure these technologies are accessible in urban and rural areas, supporting comprehensive care delivery (Health Equity & Inclusion in Action, p. 10).

4. Increase community leadership and inclusion: Actively engage individuals and communities in healthcare decisions, recognising that achieving health equity requires tailored approaches contingent upon generational, cultural, and country-specific contexts. Ensure adequate training and programs are in place to accommodate cultural and linguistic diversity in healthcare settings, preventing misunderstandings and misdiagnoses (Health Equity & Inclusion in Action, p. 10).

Case Studies: Illuminating the Path to Health Equity

The report features 12 case studies from six countries: Bangladesh, India, Morocco, Rwanda, South Africa, and Vietnam. These case studies demonstrate innovation, technology use, financial sustainability, scalability, and health impact (Health Equity & Inclusion in Action, p. 44).

Leveraging Scarce Health System Resources

The case studies in this category showcase strategies such as task shifting, improving the quality of medicines, and innovative healthcare service delivery routes. For example, the Jeeon Foundation in Bangladesh has created the largest digital network of over 35,000 pharmacies and drug shops, aiming to improve the quality of healthcare by connecting informal health practitioners with quality training, health information, and authentic medicines (Health Equity & Inclusion in Action, p. 45). In South Africa, the Central Chronic Medication Dispensing and Distribution (CCMDD/Dablapmeds) program has significantly improved access to chronic medication for stable patients by allowing them to collect their medication from external contracted pick-up points or fast lanes at public facilities (Health Equity & Inclusion in Action, p. 47).

Improving Access and Increasing Affordability for All

The case studies in this category highlight initiatives that aim to improve access to healthcare services and make them more affordable. HEALTHx in Bangladesh is a data-driven digital healthcare venture that offers one-stop essential health services, affordable health plans for patients, and cloud-based service solutions for physicians, clinics, and pharmacies (Health Equity & Inclusion in Action, p. 50). In India, iKure Techsoft has implemented a primary healthcare model that trains local community members to become frontline health workers, addressing the shortage of qualified medical staff and inadequate public health expenditure (Health Equity & Inclusion in Action, p. 51).

Smart Use of Technology and Data to Leapfrog Constraints

The case studies in this category demonstrate how technology and data can help address the constraints that impede healthcare systems’ ability to provide quality healthcare to their populations. DabaDoc in Morocco is an online platform for doctor appointment booking and video medical consultations, helping democratise healthcare access (Health Equity & Inclusion in Action, p. 54). In Vietnam, the Electronic Health Book application, launched by the Ministry of Health, helps manage health information on smart mobile devices, enabling medical staff to easily access patients’ health information and diagnose and treat them more effectively (Health Equity & Inclusion in Action, p. 57).

Conclusion

The Health Equity and Inclusion in Action report serves as a clarion call for stakeholders in the global health community to prioritise and champion the cause of health equity and inclusion. By highlighting innovative initiatives across HTCs that are working to bridge equity and inclusion gaps in access to health, the report aims to inspire collaboration, innovation, and sustained investment in strengthening health systems.

The case studies presented in the report demonstrate the potential of leveraging scarce health system resources, improving access and affordability, and harnessing technology and data to leapfrog constraints. They also underscore the importance of community engagement, cultural sensitivity, and tailoring approaches to local contexts in achieving health equity.

However, the report also acknowledges the challenges that persist, including the financial sustainability of initiatives, quality assurance as programs scale up, the digital divide limiting the reach of tech solutions, and difficulty integrating new programs with existing health systems. Addressing these challenges will require political will, sustainable financing, and a commitment to building equitable and resilient health systems.

As the global health community works towards achieving universal health coverage by 2030, the insights and recommendations provided in this report offer valuable guidance for policymakers, healthcare planners, and advocates. By learning from the successes and challenges of the initiatives highlighted in the report, stakeholders can develop effective strategies to promote health equity and inclusion and lay the foundations for a fairer, healthier future for all.

Appendix: Case Studies

The report includes 12 case studies from six countries: Bangladesh, India, Morocco, Rwanda, South Africa, and Vietnam. These case studies demonstrate innovation, use of technology, financial sustainability, and scalability, and all aim to show health impact. The case studies are categorised by the main health system challenge they seek to address:

Leveraging scarce health system resources

• Bangladesh: Jeeon Foundation
• Rwanda: https://www.babyl.rw/
• Rwanda: https://mizerocare.com/
• South Africa: Central Chronic Medication Dispensing and Distribution (CCMDD/Dablapmeds)
• South Africa: Unjani Clinic

Improving access and increasing affordability for all

• Bangladesh: HEALTHx
• India: iKure Techsoft
• India: YRGCARE

Smart use of technology and data to leapfrog constraints

• Morocco: DabaDoc
• Morocco: National Programme of Telemedicine
• Vietnam: IVIE by ISOFH
• Vietnam: The Electronic Health Book application

The post Health Equity & Inclusion in Action: Laying the Foundations for a Fairer, Healthier Future appeared first on Medika Life.

It was a move that supercharged my mission to make a difference in the world. It sparked a passion for providing people with a better shot at prosperity by improving access to health services, often by working in some of the world’s most challenging places.

My public health journey has had a lot of high points and reached another milestone this week with the launch of the FINN Partners Global Health Impact Group dedicated to harnessing the potential for health to catalyze economic growth in emerging markets and underserved communities around the world.

Looking back, I could not have wished for a better time to shift to public health. I started my career working in the consumer goods sector in Southeast Asia when countries there were the hottest economies around. This background and my corporate experience in the U.S. prepared me to blend traditional marketing and communications practices with the real-world challenges that confronted me in DR Congo and many other African and Asian countries where I would later work.

In the years since I moved to Kinshasa, a historic shift in the balance of power has gained momentum as traditionally poor and middle-income countries – nations whose citizens make roughly between $1,100 and $13,000 per year – gain prominence on the global economic stage.

“The rise of the rest,” as author and CNN Commentator Fareed once called this phenomenon, captures the growth of the group of low- and middle-income countries that now contribute almost 34 trillion dollars to the global economy, nearly one-third of total worldwide output, according to the World Bank.  To highlight the tremendous pace that developing countries have set over the past two decades, consider:  Real Gross Domestic Product (GDP), as reported by the International Monetary Fund, increased at an average rate of 4 percent among developing economies, compared with an average just under 2 percent growth for advanced countries.

While the astounding population growth of young African consumers has not yet translated to an economic boom, as global health communication advocate Mark Chataway notes, I remain optimistic that the dynamic growth we need to drive the global economy will come from the future markets of Africa and Asia.

The emergence of lower-income consumers as a major market force in these two regions offers tremendous opportunities for companies that can re-tool their marketing mix from a model that has traditionally targeted the most affluent one billion people on the planet to one that efficiently reaches the following several billion people.

While this idea isn’t new, it warrants renewed interest and investment in a post-pandemic, highly fractured world flirting with a rejection of globalism in favor of economically ruinous national isolationism.

Here’s why U.S. companies need to deepen their engagement with emerging markets: As incomes continue to rise in more than 100 countries throughout Africa, Asia and Latin America, so too will the demand for better healthcare, convenience products, electronics, and household staples, to name a few categories. 

How can organizations most effectively and sustainably succeed in this environment? In evaluating strategies for entry and sustainable management in many emerging markets, companies should consider establishing alliances with an unlikely resource: leading Non-Governmental Organizations (NGOs) operating locally. 

Building public-private partnerships between corporate and non-profit organizations can benefit both groups working in nascent and emerging markets. NGOs can often provide sharp insight into consumer habits and preferences, access to government influencers, and opportunities to build significant goodwill, brand recognition, and loyalty among local communities through the effective sponsorship of corporate social responsibility projects.

A strategic alliance between non-profits and companies also offers a less threatening means for global firms to operate in a new country than through the development of a venture with a local company in the same industry, a potential competitor that could receive protection from a host government down the road.

International and locally based NGOs have operated in developing countries for decades and have learned through tough lessons what works and what will often lead to failure.  Working with lean budgets and staff, many of these organizations have succeeded in grassroots outreach, communications, mobilization, and behavior change within population segments, often well outside of conventional marketing channels.  Those segments define the middle and bottom-of-the-pyramid consumers now sought after by multinational firms trying to build their brands and sustain competitive advantage in emerging markets.

At the same time, many non-profit organizations now view partnerships with the private sector as essential to their long-term ability to fulfill their mission of serving local populations.  Highly effective corporate responsibility programs have become mainstream in emerging markets as companies work with NGOs to contribute goodwill to needy populations while also meeting operational interests, such as improving employee and community health or safeguarding valuable natural resources that drive local economies.

The power of partnerships can offer three areas of strategic advantage to firms entering developing markets, particularly in Africa and South Asia:

• 360^o Market Data: Rather than relying solely on outside research firms, companies can work with NGO partners to round out their understanding of the consumer landscape in a new country, mainly when vital economic and cultural elements are in play. By operating in poorer communities and managing customer research and outreach operations over several years, NGOs often have a ready-built network of communities for private companies to engage as part of their market shaping.  These communities may deliver a more representative study sample, and the methodology for any consumer research efforts will be more informed through the input that NGOs and local community representatives can offer. At the same time, NGOs need more sophisticated marketing and outreach tools, particularly in segmenting populations, to deliver more relevant messaging.  These are areas of technical expertise that private sector partners can share.

• Access to Government Decision Makers: The emergence of mainstream consumerism in developing countries alters how some governments can support private sector development and direct foreign investment. Local and international NGOs have valuable insights regarding which government contacts are most appropriate to engage and how best to work with them. Money may talk in emerging markets, but transparent relationships with key government decision-makers are paramount for long-term operational success and competitive advantage. NGOs are an integral resource for helping companies to forge these government relationships. Correspondingly, the changing world of international aid requires NGOs to develop multilateral funding streams. Public-private partnerships offer a means for NGOs to build greater credibility and differentiation by demonstrating that they have the project scope and capacity to appeal to a broad base of donors.

• Brand Equity Development: Corporate responsibility programs offer a platform for companies to create brand awareness and loyalty in new markets while building goodwill in under-resourced populations. A partnership with an NGO operating in a developing country provides the opportunity to identify projects that meet a community’s social needs and the sponsoring company’s interests. NGOs undertaking projects may also gain positive recognition through such partnerships, particularly in countries where the reputations of development organizations have suffered from aid fatigue.

The risks are significant for firms venturing into low- and middle-income markets.  Market data, local relationships, and flexible operating models are indispensable resources, as are the right alliances.  Before relying on traditional approaches for assessing new market opportunities, consider how successful engagement and communication with NGO partners may offer the insights and understanding required for companies to reach efficiently and sustainably some of the most promising but untapped segments of the world’s population.

The post Why Engagement with Emerging Markets Matters More than Ever appeared first on Medika Life.

More than a year after the federal government first cut off her disability benefits, Denise Woods drives nightly to strip malls, truck stops, and parking lots around Savannah, Georgia, looking for a safe place to sleep in her Chevy.

Overpayment Outrage

Social Security has been overpaying billions of dollars to people, many on disability — then demanding the money back, even if the government made mistakes, an investigation by KFF Health News and Cox Media Group revealed. The reporting has triggered harsh criticism in Congress and led to an investigation by the agency. READ MORE

Woods, 51, said she had rented a three-bedroom house she shared with her adult son and grandson until March 2022, when the government terminated her disability payments without notice.

According to letters sent by the Social Security Administration, the agency determined it had been overpaying Woods and demanded she send back nearly $58,000.

Woods couldn’t come up with the money. So, until February 2026, the agency is withholding the $2,048 in disability she would have received each month.

“I still don’t know how it happened,” said Woods, who has requested a waiver and is seeking a hearing. “No one will give me answers. It takes weeks or months to get a caseworker on the phone. They have made my life unbearable.”

Kilolo Kijakazi, acting commissioner of the Social Security Administration, told a congressional subcommittee in October that her agency notifies recipients when they have received overpayments and works to “help those who want to establish repayment plans or who seek waiver of the debt.”

But relief from overpayments goes to only a relatively small number of people. And many others face dire consequences: Some become homeless, are evicted from rental housing, or see their mortgages fall into foreclosure.

The SSA has a painful legacy of excluding Black people from benefits. Today the agency’s own published research shows its overpayments most often hit Black and Hispanic people, the poorest of the poor, those with the least education, and those whose medical conditions are unlikely to improve.

Woods is one of millions who have been targeted in the Social Security Administration’s attempt to claw back billions of dollars it says was wrongly sent to beneficiaries. Years can pass before the agency catches a mistake, and even the little bit extra it might send each month can add up.

In reclaiming it, the government is imposing debts that can reach tens of thousands of dollars against those least able to pay.

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(WHIO, Dayton)

‘Wreaking Havoc in People’s Lives’

KFF Health News and Cox Media Group reporters interviewed people who have received overpayment notices and nonprofit attorneys who advocate for them and reviewed SSA publications, policy papers, and congressional testimony.

A 64-year-old Florida man said he could no longer afford rent after his Social Security retirement payments were garnished last year because he allegedly had been overpaid $35,176 in disability benefits. He said he now lives in a tent in the woods. A 24-year-old Pennsylvania woman living with her mother and younger siblings in public housing lost the chance to buy her own home because of an alleged $6,063 overpayment that accrued when she was a child.

“Social Security overpayments are wreaking havoc in people’s lives,” said Jen Burdick, an attorney with Community Legal Services of Philadelphia, which represents clients who have received overpayment notices. “They are asking the poorest among us to account for every dollar they get. Under their rules, some people can save up money for a funeral burial but not enough to get housing.”

Woods has lupus and congestive heart failure and struggles to walk, but she started working part-time after her benefits were rescinded. She said she makes $14 an hour transporting railroad crew members in her 2015 Chevy Equinox between Savannah and Jacksonville, Florida, when she can get assignments and her health allows it.

The SUV costs $386 a month — a large portion of her income — but without it, Woods said, she would not have a job or a place to sleep.

“My life is just survival now,” Woods said. “Sometimes I feel like I am just waiting to die.”

The Social Security Administration has said it is required by law to attempt to recover overpayments. Notices ask beneficiaries to repay the money directly. Authorities can also recoup money by reducing or halting monthly benefits and garnishing wages and federal tax refunds.

Agency officials describe an orderly process in which they explain to beneficiaries the reason for the overpayment and offer the chance to appeal the decision and have the charges waived if they cannot afford it. One way to qualify for a waiver is if “paying us back would mean you could not pay your bills for food, clothing, housing, medical care or other necessary expenses,” according to a letter sent to one recipient.

Those most impacted by Social Security’s decisions, including people with disabilities and widows receiving survivors’ benefits, paint a different picture. They talk about having their benefits terminated without explanation or warning, an appeals process that can drag on for years, and an inability to get answers from the SSA to even basic questions.

Nancy Altman, president of Social Security Works, a group that pushes for the protection and expansion of the program, recalled how stressful it was when a colleague’s mother received an overpayment notice.

“After weeks of nonstop phone calls, he was able to get the matter resolved, but not before it put his mother in the hospital,” Altman said. “One can just imagine how much worse it would be for someone for whom English is not their native language, who lacks a high school education, and who is unassisted by such a knowledgeable and caring advocate.”

Problems surrounding the Social Security Administration are aggravated by congressional actions, including funding shortages that brought agency staffing to a 25-year low by the end of fiscal year 2022. Even so, advocates for people with disabilities say the agency does far less than it could to help people who have been overpaid, often through no fault of their own.

They said challenges faced by beneficiaries underscore how overpayments disproportionately impact Black people and other minority groups even as President Joe Biden and Social Security leaders promise to fix racial inequity in government programs.

Most overpayments are linked to the Supplemental Security Income program, which gives money to people with little or no income who are disabled, blind, or at least 65. The majority of SSI recipients are Black, Hispanic, or Asian people.

“Congress has turned a blind eye to this,” said David Weaver, a former associate commissioner for research, demonstration, and employment support at the SSA. Politicians “just want to save money. It is misplaced priorities. It is completely inexcusable.”

The Social Security Administration did not make its leaders available for an interview. Spokesperson Nicole Tiggemann declined to answer questions about the cases of Woods and other beneficiaries, citing privacy laws.

In a written statement, Tiggemann acknowledged that receiving an overpayment notice can be “unsettling,” but said the agency helps beneficiaries navigate the process and informs them of their rights if they believe they were not at fault or cannot repay the debt.

“Even if they do not want to appeal or request a waiver, the notice says to contact us if the planned withholding would cause hardship,” Tiggemann said. “We have flexible repayment options — including repayment of as low as $10 per month. Each person’s situation is unique, and we handle overpayments on a case-by-case basis.”

Critics say fighting an overpayment notice is not that simple.

Beneficiaries — many challenged by physical, mental, or intellectual disabilities — often are overwhelmed by complex paperwork or unable to find financial documents that may be years old.

The Social Security Administration has the authority to waive overpayments if officials determine recovering them would violate “equity and good conscience,” or the disputed amount falls below certain thresholds. The agency’s guidance also says collecting an overpayment “defeats the purpose” when the “individual needs substantially all of their current income to meet their current ordinary and necessary living expenses.”

Advocates for people with disabilities contend most overpayments arise from delays in processing paperwork and errors by the Social Security Administration or recipients making innocent mistakes. The agency can waive overpayments when the beneficiary is found not at fault.

But in fiscal year 2023, the Social Security Administration collected about $4.9 billion in overpayments with an additional $23 billion yet uncollected, according to an agency report. Just $267 million was waived, the report said.

David Camp, the interim chief executive officer of the National Organization of Social Security Claimants’ Representatives, which advocates for improvements in federal disability programs, said the Social Security Administration is a “broken structure.”

The agency sometimes tries to claw back overpayments from people falsely accused of failing to provide required documents, Camp said.

“Dropping off forms at their field offices is not a guarantee” paperwork will be processed, he said. “Mail is slow, or it doesn’t get opened. We see it so many times you are left with the idea that has to do with the structure.”

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(WFXT, Boston)

Left Destitute

Advocacy groups and others said they don’t know how many people become homeless after their benefits are terminated, but they say anecdotal accounts are common.

A study found that more than 800,000 disability applicants from 2007 to 2017 experienced homelessness. Advocates say it only makes sense that overpayments could lead more people to become homeless, since nearly 40% of people receiving disability benefits experience food insecurity and cannot keep up with their rent and utility bills, according to research.

Ronald Harrell sleeps in the woods near Wildwood, Florida, about 50 miles northwest of Orlando. He said he shelters in a tent, cooks his meals on a small grill, and showers at a friend’s house.

Harrell, 64, said he rented a room in a house for $125 a week until last year, when the Social Security Administration cut off his retirement benefits.

A letter the SSA sent him, dated Feb. 6, 2023, says his benefits are being withheld because of overpayment of $35,176 that accrued when Harrell received disability payments. The letter acknowledges he has asked the agency to lower his payments.

“I don’t know how they are doing this to me,” Harrell said. “I did everything by the law.”

Harrell said he once worked as an HVAC technician, but nerve damage left him unable to work sometime around 2002.

He said he collected disability benefits until about 2009, when rehabilitation allowed him to return to the workforce, and he said he reported the information to the federal government. Harrell said he applied for early Social Security retirement benefits last year when his health again declined.

“I started working when I was 16,” Harrell said. “I never thought my life would be like this.”

Kijakazi, the acting Social Security commissioner, and others have said overpayments stem at least partly from low staffing and budget cuts.

From 2010 to 2023, the agency’s customer service budget dropped by 17%, after inflation, according to a report by the Center on Budget and Policy Priorities, a think tank that conducts research on government programs.

At the same time, the report says, the number of Social Security beneficiaries grew by nearly 12 million people, or 22%.

Jonathan Stein, a former attorney with Community Legal Services of Philadelphia who has participated in workgroups and meetings with federal officials about access to Social Security payments for vulnerable populations, said budget cuts cannot fully account for the agency’s penchant for denying applications and terminating benefits.

Officials suspended Supplemental Security Income benefits for about 136,540 people in 2019 for “failure to furnish report,” which means they did not meet deadlines or paperwork requirements, Stein said, despite knowing many of those people were unable to contact the agency because they are homeless or have been evicted and lost access to phones and computers.

That’s more than double the number in 2010, he said.

“They have an implicit bias for denying benefits,” Stein said. “It is a very skewed view of integrity. It reinforces a culture of suspicion and prosecution of applicants.”

The 24-year-old Pennsylvania woman who received Supplemental Security Income as a child because of a learning disability described her ordeal on the condition that her name not be published. A letter from the Social Security Administration says she received an overpayment notice for more than $6,000.

“It was frustrating,” the woman said. “You are dealing with nasty people on the phone. I couldn’t get any answers.”

In November 2022, she contacted a nonprofit law firm, which helped her file an appeal. One year later, she received another letter from Social Security saying the overpayment had been waived because it was not her fault. The letter also said officials would not seek repayment because she could not afford basic needs such as food and housing without the monthly benefits.

The woman had already paid a price.

She lived in public housing and the Philadelphia Housing Authority had offered her a chance to fulfill a long-held goal of owning a house. But when the overpayment appeared on her credit report, she said, she could not obtain a mortgage.

“I was excited about getting my own home,” she said. “That’s what everybody wants. Losing it is not a good feeling.”

David Hilzenrath of KFF Health News, Jodie Fleischer of Cox Media Group, and Ben Becker of ActionNewsJax in Jacksonville, Florida, contributed to this report.

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While American balladeer Woody Guthrie called out, “The Land Was Made for You and Me,” Rural Americans increasingly find themselves left out of possibilities for future prosperity. While more than 46 million Americans live in rural communities, rural locales lag behind non-rural communities in almost every measure of prosperity, from poverty rates to employment opportunities.

Though Guthrie’s famed lyrics, amber grain and spacious skies suggested unlimited possibilities, rural Americans often live hours away from primary medical care, emergency services, and specialist care providers. Their well-being — indeed, their survival — often relies on a tenuous broadband connection. What’s more, the systems put in place that are intended to address their needs are usually based on urban and suburban expectations.

Recently, more than 20 top leaders from academia, associations, corporations, and government met in Washington, DC, in a candid conversation to discuss these challenges — but more importantly — the solutions they both believe and know firsthand can make a difference in the lives of rural Americans. What made these conversations compelling was that they sat around the table — without slides or prepared statements — and talked about what they were doing and what was working. They united around a shared commitment to champion solutions. [Read the eBook Heartbreak in the Heartland here.]

According to one of the gathering’s moderators, Sarah Dash, CEO of the Alliance for Health Policy: “We must continue to change the narrative about how rural America is viewed and overcome the stereotypes that continue to perpetuate. Rural communities are far more diverse, innovative, and vibrant than they’re given credit for. We must educate ourselves about the people we seek to serve and work with them to create the kind of programs that will move the needle in a meaningful way.”

Expanding Broadband to Connect the Nation

One of rural communities’ more significant challenges is high-speed internet access. The digital divide hinders education, economic growth, and access to vital health services. To address this issue, initiatives like the Federal Communications Commission’s (FCC) Rural Digital Opportunity Fund have been launched to provide funds for broadband infrastructure in underserved areas. Public-private partnerships are also crucial in expanding broadband access, with companies collaborating to build networks in rural regions.

“Poverty rates in rural communities are higher than those in urban areas, and the FCC’s Affordable Connectivity Program (ACP) helps ensure rural residents can afford the broadband they need for work, education, and healthcare,” shared Gary Lynch, a Global Practice Leader at Verizon. “At Verizon, we have health equity programs on top of the ACP that help those individuals get devices to manage their health. What will happen to the 20 million Americans using the program when federal funding runs out in mid-2024?”

Virtual Learning as a Path to Progress

Rural students often need equal access to quality education. The COVID-19 pandemic accelerated the shift toward online learning, highlighting the need for virtual education solutions. Schools and organizations have invested in virtual learning platforms and distance education programs to address this challenge. Mobile learning centers and Wi-Fi-equipped school buses have also been deployed to ensure that students in remote areas can access educational resources, but more investment is needed.

Agricultural Innovation Tapping the Great Potential of the Heartland

Farming communities are the heart of rural America. They face unique challenges, including fluctuating markets and climate change. To support rural farmers, varied solutions are underway, including training in sustainable farming practices, affordable loans and grants and promoting local food markets. Government agencies, nonprofit organizations, and agricultural extension services are working to support farmers in a changing world. But now all regions and farms are the same.

“The narrative around how rural areas are stereotyped as older, poorer, sicker, uneducated, and white must change, says Amy Elizondo, Chief Strategy Officer of the National Rural Health Association. ”If you look at one rural community, you have seen one rural community — it’s not representative of the entire spectrum of rural America. Rural communities possess a vast depth of innovation, as they often must use what little resources they have for the incredibly diverse communities they serve.”

Native American Empowerment

Native American communities face disparities across the board — in health, education, and economic opportunities. Solutions must be rooted in respecting tribal sovereignty and self-determination. Collaboration between tribal governments, Federal agencies, and nonprofits is critical to addressing these inequities. Initiatives that support tribal entrepreneurship, cultural preservation, and access to quality health are making a difference. Expanding educational opportunities for Native American youth, including scholarships and culturally sensitive curricula, is also a focus.

The Washington, D.C., gathering included one of the nation’s leading public health advocates for Native Americans — Rear Admiral (ret.) James Galloway, MD, formerly part of the Surgeon General’s leadership team and now chief medical and partnership officer at Arc Health, has dedicated most of his career as a physician and public health expert to rallying this community. According to Rear Admiral (ret.) Dr. Galloway:

“Particularly in light of the health care provider shortages, as well as for the overall improvement of patient care, the proposed and highly supported concept of the team approach to health care to include Community Health Representatives as an approach to rural health is an essential component of quality health care, especially in rural communities.”

Telehealth Brings Access to Care Closer to Home

Access to health services in rural areas has long been a concern. Telemedicine is a game-changer, enabling health professionals to diagnose and treat patients remotely. Expanding telehealth services has made it easier for rural Americans to access medical care, especially during emergencies and throughout the COVID-19 pandemic. Again, broadband technology has been vital to accessing this life-sustaining need and policies and companies are working to meet the challenge.

Rural healthcare professionals are using telehealth and tapping into electronic medical records to improve quality care delivery. At the same time, there is ample support for remote patient monitoring and digital health technologies as tools to bring physicians’ offices closer to peoples’ homes. The biggest concern among physicians on the frontlines of addressing patient needs is clinical training and financial assistance to keep community hospitals operating.

Rural Infrastructure and Remote Care

To boost economic opportunities in rural America, infrastructure investments are crucial. Initiatives like the Infrastructure Investment and Jobs Act allocate significant funding to improve roads, bridges, and public transportation in rural areas. These improvements enhance connectivity, create jobs, and stimulate economic growth.

The rise of remote work has opened up new possibilities for rural Americans. Rural communities can retain residents and attract talent while diversifying their economies by encouraging employers to offer remote work options and training programs to develop remote-friendly skills.

John Whyte, MD, chief medical officer of WebMD, has been partnering with companies like Walmart to improve quality care and make rural life sustainable: “We conducted a research survey with Walmart last year, and we surveyed actual rural physicians and compared their assessments of the quality of care for their rural patients versus urban physicians… We saw that physicians in rural communities rated the quality of care they provide lower quality than in urban communities. That really should be a wake-up call.”

Conversation and Collaboration Are Key to Making Progress

Companies like Arc Health, Exact Sciences, FINN Partners, GSK, Huma, LifePoint Health, Molecular Biologicals & PS Fertility, OffScrip Health, Verizon, Walgreens, Walmart, WebMD; and leaders from associations like AARP, Alliance for Health Policy, Asthma and Allergy Foundation of America, Biotechnology Innovation Organization (BIO), CPSI; government agencies such as Health and Human Services and National Health Institute, and Academic institutions including Ohio State University and West Virginia University, have essential roles at the table. All are in conversation and addressing rural America’s challenges. They are doing everything from expanding broadband infrastructure, investing in rural job creation, supporting local farmers, and providing affordable goods and services to underserved areas.

“Rural America knows what is best for rural America. We need to build programs and initiatives that empower individuals and their families. That leads to a sense of purpose in the community, which can stem the tide of many adverse health and social implications. Marrying purpose with economic empowerment is the real game-changer,” reflects Pritesh Gandhi, MD, Chief Community Health Officer at Walmart.

Walgreens has improved health access by expanding telemedicine, providing pharmacy services in rural communities, and working shoulder-to-shoulder with local health providers. WebMD has moved to upskill physicians and ensure they have access to breaking medical information. The private sector has the skill and scale to advance rural America’s technology, economic, and health challenges, contributing to the overall well-being of these communities.

In sharing ideas and possibilities, attendees show how to bridge the divide and ensure that rural Americans have the tools and resources to thrive. These practical solutions address problems and build a brighter future for rural America, where opportunities are abundant and quality of life is improved for all.

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