By Rae Ellen Bichell, KFF Health News

Stacey Knoll thought the court summons she received was a scam. She didn’t remember getting any medical bills from Montrose Regional Health, a nonprofit hospital, after a 2020 emergency room visit.

So she was shocked when, three years after the trip to the hospital, her employer received court orders requiring it to start funneling a chunk of her paychecks to a debt collector for an unpaid $881 medical bill — which had grown to $1,155.26 from interest and court fees.

The timing was terrible. After leaving a bad marriage and staying in a shelter, she had just gotten full custody of her three children, steady housing in Montrose, Colorado, and a job at a gas station.

“And that’s when I got that garnishment from the court,” she said. “It was really scary. I’d never been on my own or raised kids on my own.”

KFF Health News reviewed 1,200 Colorado cases in which judges, over a two-year period from Feb. 1, 2022, through Feb. 1, 2024, gave permission to garnish wages over unpaid bills. At least 30% of the cases stemmed from medical care — even when patients’ bills should have been covered by Medicaid, the public insurance program for those with low incomes or disabilities. That 30% is likely an underestimate since medical debt is often hidden behind other types of debt, such as from credit cards or payday loans. But even that minimum would translate to roughly 14,000 cases a year in Colorado in which courts approved taking people’s wages because of unpaid medical bills.

Among the other findings:

• Patients were pursued for medical bills ranging from under $30 to over $30,000, with most of the bills amounting to less than $2,400. As the cases rolled through the legal system, accumulating interest and court fees, the amount that patients owed often grew by 25%. In one case, it snowballed by more than 400%.
• Cases trailed people for up to 14 years after they received medical care, with debt collectors reviving their cases even as they moved from job to job.
• Medical providers of all stripes are behind these bills — big health care chains, small rural hospitals, physician groups, public ambulance services, and more. In several cases, hospitals won permission to take the pay of their own employees who had unpaid bills from treatment at the facilities.

Colorado has company. It is one of 45 states that allow wage garnishment for unpaid medical bills. Only Delaware, New York, North Carolina, Pennsylvania, and Texas have banned wage garnishment for medical debt.

As KFF Health News has reported, medical debt is devastating for millions of people across the country. And now the problem is likely to grow more pressing nationwide. Millions of Americans are expected to lose health insurance in the coming years due to Medicaid changes in President Donald Trump’s tax and spending law and if Congress allows some Affordable Care Act subsidies to expire. That means health crises for the newly uninsured could lead them, too, into a spiral of medical debt.

And the hurt will linger: Large unpaid medical bills are staying on credit reports in most states after a July decision from a federal judge reversed a new rule aimed at protecting consumers.

“If you can’t maintain your health, how are you going to work to pay back a debt?” said Adam Fox, deputy director of the Colorado Consumer Health Initiative, a nonprofit aimed at lowering health costs. “And if you fundamentally can’t pay the bill, wage garnishment isn’t going to help you do that. It’s going to put you in more financial distress.”

Flying blind on medical debt

When someone fails to pay a bill, the creditor that provided the service — whether for a garage door repair, a car loan, or medical care — can take the debtor to court. Creditors can also pass the debt to a debt collector or debt buyer, who can do the same.

“At any given point, about 1% of working adults are being garnished for some reason,” said Anthony DeFusco, an economist at the University of Wisconsin-Madison, who studied paycheck data from ADP, a payroll processor that distributes paychecks to about a fifth of private sector U.S. workers. “That’s a big chunk of the population.”

But specific research into the practice of garnishing wages over medical debt is scant. Studies in North Carolina, Virginia, and New York have found that nonprofit hospitals commonly garnish wages from indebted patients, with some studies finding those patients tend to work in low-wage occupations.

Marty Makary, who led research on medical debt wage garnishment in Virginia at Johns Hopkins University before joining Trump’s cabinet as Food and Drug Administration commissioner, has called the practice “aggressive.” He co-authored a study that found 36% of Virginia hospitals, mostly nonprofit and mostly in urban areas, were using garnishment to collect unpaid debts in 2017, affecting thousands of patients.

The Colorado findings from KFF Health News show that hospitals are far from the only medical providers going after patients’ paychecks, though.

Researchers and advocates say that, in addition to a dearth of court case data, another phenomenon tends to obscure how often this happens. “People find debt shameful,” said Lester Bird, a senior manager at the Pew Charitable Trusts who specializes in courts. “A lot of this exists in the shadows.”

Without data on how often this tactic is employed, lawmakers are flying blind — even as a 2024 Associated Press-NORC poll showed about 4 in 5 U.S. adults believe it’s important for the federal government to provide medical debt relief.

‘Blood from a turnip’

Colorado was among the first of 15 states to scratch medical debt from credit reports. Debt buyers in the state aren’t allowed to foreclose on a patient’s home. If qualified patients opt to pay in monthly installments, those payments shouldn’t exceed 6% of their household income — and the remaining debt gets wiped after about three years of paying.

But if they don’t agree to a payment plan, Coloradans can have up to 20% of their disposable earnings garnished. The National Consumer Law Center gave the state a “D” grade for state protections of family finances.

Consumer advocates said they aren’t sure how well even those Colorado requirements are being followed. And people wrote letters to the courts saying wage garnishment would exacerbate their already dire financial situations.

“I have begun to fall behind on my electricity, my gas, my water my credit cards,” wrote a man in western Colorado in a letter to a judge that KFF Health News obtained in the court filings. Court records show he was working in construction and at a rent-to-own store, with about $8,000 in medical debt. He wrote to the judge that he was paying close to $1,000 a month. “The way things are going now I will lose everything.”

The people being sued in KFF Health News’ Colorado review worked in a wide array of jobs. They worked in school districts, ranching, mining, construction, local government, even health care. Several worked at stores such as Walmart and Family Dollar, or at gas stations, restaurants, or grocery stores.

“You’re really kicking people when they’re down,” said Lois Lupica, a former attorney working with the Denver-based Community Economic Defense Project and the Debt Collection Lab at Princeton. “They’re basically suing the you-can’t-get-blood-from-a-turnip population.”

In 2022, court records show, Valley View health system based in Glenwood Springs was allowed to garnish the wages of one of its patients over a $400 medical bill. The patient was working at a local organization that the health system supported as part of the community benefits it provides to keep its tax-exempt status. Nonprofit hospitals like Valley View are required to provide community benefits, which can also include charity care that covers patients’ bills.

Stacey Gavrell, the health system’s chief community relations officer, said it offers options such as interest-free payment plans and care at reduced or no cost to families with incomes up to 500% of the federal poverty level.

“As our rural region’s largest healthcare provider, it is imperative to the health and well-being of our community that Valley View remains a financially viable organization,” she said. “Most of our patients work with us to develop a payment plan or pursue financial assistance.”

The collection agency that took the employee to court, A-1 Collection Agency, advertises itself on its website as empathetic: “We understand times are tough and money is tight.”

Pilar Mank, who oversees operations at A-1’s parent company, Healthcare Management, said it accepts payment plans as small as $50 a month and that most of the hospitals it works with allow it to offer a discount if patients pay all at once.

“Suing a patient is the absolute last resort,” she said. “We try everything we can to work with the patient.”

If you can’t maintain your health, how are you going to work to pay back a debt?

Hospitals sometimes also garnish wages from their own employees for care they provided them. In one case, a hospital employee worked her way up from housekeeper to registrar to quality analyst. She even participated in public events representing her employer and appeared on the hospital’s website as a featured employee — while the court issued writs of garnishment until her $10,000 in medical bills from the hospital was paid off.

“Hospital care costs money to deliver,” said Colorado Hospital Association spokesperson Julie Lonborg about hospitals’ garnishing their own employees’ wages. “In some ways, I think it’s funny to be asked the question. I would understand if someone said, ‘Why aren’t you garnishing their wages?’”

Studies show that hospital debt collection efforts through wage garnishment bring in only about 0.2% of hospital revenues, said April Kuehnhoff, a senior attorney with the National Consumer Law Center, which advocates for people with low incomes.

“We also know that there are states that don’t allow this at all,” she said. “Hospitals are continuing to provide medical care to consumers.”

Smooth sailing for collectors —but not for patients

Health care providers appeared as the plaintiffs in only 2% of the medical debt cases. Instead, cases were filed almost entirely by third-party debt collectors and buyers, with BC Services and Professional Finance Company behind more than half of the cases, followed by A-1 Collection Agency and Wakefield & Associates.

Debt buyers make money by buying debt from providers who’ve given up on getting paid then collecting what they can of the money owed, plus interest. Debt collectors get paid a percentage of what they recover. Some companies do a bit of both.

BC Services declined to comment, and Wakefield & Associates did not respond to questions.

Charlie Shoop, president of Professional Finance Company, said his company initiates wage garnishment on less than 1% of all accounts placed with it for collection.

Health care providers in Colorado can no longer hide behind debt collectors’ names when they sue people, according to a 2024 state law prompted by a 9News-Colorado Sun investigation in partnership with a Colorado News Collaborative-KFF Health News reporting project.

In many states, the path for filing a case against a debtor and garnishing their wages is relatively smooth — especially if the debtor doesn’t appear in court.

“It’s unbelievably easy,” said Dan Vedra, a lawyer in Colorado who often represents consumers in debt cases. “If you have a word processor and a spreadsheet, you can mass-produce thousands of lawsuits in a matter of hours or minutes.”

Within KFF Health News’ sample, nearly all the medical debt cases were default judgments, meaning the patient did not defend themselves in court or in writing. Missing a court date can happen for a variety of reasons, such as not receiving the notice in the mail, assuming it was a scam, knowingly ignoring it, or not having the time to take off from work.

Vedra and other debt law experts said a high rate of default judgments indicates a system that favors the pursuers over the pursued — and increases the chances someone will be harmed by an erroneous bill.

But in New Hampshire, creditors now have to keep going to court for each paycheck they want to garnish, because the state allows creditors to garnish only wages that have already been earned, said Maanasa Kona, an associate research professor at the Center on Health Insurance Reforms at Georgetown University.

“It might not look like much on paper,” she said. “It’s just not worth it if they have to keep going back to court.”

If you have a word processor and a spreadsheet, you can mass-produce thousands of lawsuits in a matter of hours or minutes.

Wrongly pursued for bills

The nation’s medical billing setup is already prone to errors due to its complexity, according to Barak Richman, a law professor at George Washington University and a senior scholar at Stanford Medicine who has studied medical debt collection practices in several states. “Bills are not only noncomprehensible, but often wrong,” Richman said.

Indeed, Colorado’s Health Care Policy & Financing Department, which runs Medicaid in the state, said it sent out nearly 11,000 letters in the past fiscal year to health providers and collectors that erroneously went after patients on Medicaid. Bills for Medicaid recipients are supposed to be sent to Medicaid, not the patients, who typically pay a nominal amount, if anything, for their care.

Shoop said his industry has pushed Colorado, without success, for access to a database that would allow them to confirm if patients had Medicaid coverage.

Colorado’s Medicaid program declined to comment.

Patricia DeHerrera in Rifle, Colorado, had to prove that she and her children had Medicaid when they received care at Grand River Health — but only after A-1 contacted her employer at the time, the gas station chain Kum & Go, with court-approved paperwork to take a portion of her paychecks.

She contacted the state, which sent letters to the hospital and the collector notifying them they were engaging in “illegal billing action” and telling the collector to stop. The companies did.

Theresa Wagenman, controller for Grand River Health, said if a patient can present a letter from a Medicaid caseworker saying they’re eligible, then their bills get removed from the collections pipeline. Wagenman also said patients get at least eight letters in the mail and several phone calls before Grand River gives the go-ahead for the collector to send them to court.

DeHerrera’s main advice to others in this situation: “Know your rights. Otherwise, they’re going to take advantage of you.”

Yet fighting back isn’t easy.

Nicole Silva, who lives in the 900-person town of Sanford in south-central Colorado, said she and her family were all on Medicaid when her daughter was in a car crash. Still, court records show, her wages were garnished for a $2,181.60 ambulance ride, which grew to more than $3,000 from court fees and interest.

She tried to prove the bill was wrong, contacting her county’s social services office, but Silva said it wasn’t helpful and she wasn’t able to reach the right person at a state office. The state Medicaid program confirmed to KFF Health News that her daughter was covered at the time of the wreck.

Fighting the bill felt like too much for Silva and her husband to handle while parenting a growing number of kids, one of them severely disabled, and working — she as a preschool teacher and he as a rancher.

Not receiving the roughly $500 a month that she said came out of her pay was enough to affect their ability to pay other bills. “It was deciding to buy groceries or pay the electric bill,” Silva said.

When their electricity got shut off, she said, they had to scramble to borrow money from colleagues and friends to get it turned back on — with an extra fee.

She said the saga makes her hesitant to call an ambulance in the future.

Fox, of the Colorado Consumer Health Initiative, said consumers often think they cannot do anything to stop their wages from being garnished, but they can contest it in court, for example by pointing out they should have qualified for discounted — or charity — care if the hospital that provided the treatment is a nonprofit.

DeFusco, the economist, believes filing for Chapter 7 bankruptcy is an underused option for debtors. It halts garnishment in its tracks, though not always permanently, and it comes with other consequences. But he understands it’s a Catch-22: It’s a complex process and typically necessitates hiring a lawyer.

“To get rid of your debt, you need money,” he said. “And the whole reason you’re in this situation is because you don’t have money.”

Methodology

We wanted to know how often Coloradans get their wages garnished due to medical debt. Courts don’t compile this information, and researchers and advocates haven’t tracked it systematically.

So we created our own database. We requested a list of all civil cases across the state in which judges gave permission for a person’s earnings to be garnished — known as writs of garnishment in court lingo — from Feb. 1, 2022, through Feb. 1, 2024. The Colorado Supreme Court Library provided a list from all courts except for Denver County Court, which provided its own records. The combined list comprised nearly 90,000 unique court cases. We split up the cases by county population — small (fewer than 10,000 people), medium (10,000 to 100,000 people), and large (more than 100,000 people) — then generated a random sample of 400 cases from each group to ensure we evaluated medical debt across counties of all sizes.

To identify medical debt cases, we looked at the original creditors named in court records, primarily the complaints or affidavits of indebtedness. Often, this information was available through a state website. When it wasn’t available online, we asked county courthouses to send us supporting documents. We counted dentists as medical providers. We excluded 14 cases in which the debt wasn’t exclusively medical.

We looked only at cases in which courts approved money to be garnished from someone’s paycheck, as opposed to from other sources such as their bank accounts. We did not review garnishment cases involving child support, taxes, or federal student loans.

KFF Health News intern Henry Larweh, data editor Holly K. Hacker, Mountain States editor Matt Volz, and web editor Lydia Zuraw contributed to this report.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

October is Domestic Violence Awareness Month, and one local non-profit is recruiting men to help end the abuse.

While men are typically the perpetrators of violence, 23% of men in Michigan experience intimate partner violence, rape or stalking. This places men in a very unique place in which they can discuss, amongst themselves, both the impacts of violence on victims and discuss how their experiences could lead to violence.

Haven, a non-profit in Oakland County, has been calling on men to raise their voices on this issue. The organization aims to eliminate domestic violence and sexual assault and provides resources to survivors in their time of need.

Haven is currently recruiting 100 men to lend their voices and support their communities in eliminating domestic violence. There’s a Men of Haven recruitment event coming up on Thursday, Oct. 23 from 6-8 p.m. at Haven’s headquarters in Pontiac.

Christine Kinal is the CEO of Haven. She joined the show to discuss men’s roles in addressing this very important issue.

Listen to The Metro weekdays from 10 a.m. to noon ET on 101.9 FM and streaming on demand.

Subscribe to The Metro on Apple Podcasts, Spotify, NPR.org or wherever you get your podcasts.

Trusted, accurate, up-to-date.

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A few years out of the pandemic, overdose deaths continue to drop. 

A new report found that overdose deaths declined by 37 percent from 2023 to 2024. Local EMS calls related to drug overdoses dropped as well.

What are Southeast Michigan government officials doing to try to continue lowering addiction and overdose rates since the numbers hit all-time highs?

Narcan availability is a big reason for this drop. But local governments are making more investments in physical and mental health care too. Oakland County just opened its 360 Care Center, which offers same-day services for non-emergency medical needs. 

Why is addiction a big problem for so many people in the first place? And what can health professionals and everyday folks do to try to stop it from ruining peoples’ lives? Producer Sam Corey spoke with Deputy County Executive for Oakland County Madiha Tariq to learn more.

Listen to The Metro weekdays from 10 a.m. to noon ET on 101.9 FM and streaming on-demand.

Subscribe to The Metro on Apple Podcasts, Spotify, YouTube, or NPR or wherever you get your podcasts.

 

Trusted, accurate, up-to-date.

WDET strives to make our journalism accessible to everyone. As a public media institution, we maintain our journalistic integrity through independent support from readers like you. If you value WDET as your source of news, music and conversation, please make a gift today.

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By ALI SWENSON and MARY CLARE JALONICK

WASHINGTON (AP) — The U.S. government shut down Wednesday, with Democratic lawmakers insisting that any deal address their health care demands and Republicans saying those negotiations can happen after the government is funded.

At issue are tax credits that have made health insurance more affordable for millions of people since the COVID-19 pandemic. The subsidies, which go to low- and middle-income people who purchase health insurance through the Affordable Care Act, are slated to expire at the end of the year if Congress doesn’t extend them. Their expiration would more than double what subsidized enrollees currently pay for premiums next year, according to an analysis by KFF, a nonprofit that researches health care issues.

Democrats have demanded that the subsidies, first put in place in 2021 and extended a year later, be extended again. They also want any government funding bill to reverse the Medicaid cuts in President Donald Trump’smega-bill passed this summer, which don’t go into effect immediately but are already driving some states to cut Medicaid payments to health providers.

Some Republicans have expressed an openness to extending the tax credits, acknowledging many of their constituents will see steep hikes in insurance premiums. But the party’s lawmakers in Congress argue negotiations over health care will take time, and a stopgap measure to get the government funded is a more urgent priority.

Health insurance rates will skyrocket for millions without congressional action

A record 24 million people have signed up for insurance coverage through the ACA, in large part because billions of dollars in subsidies have made the plans more affordable for many people.

With the expanded subsidies in place, some lower-income enrollees can get health care with no premiums, and high earners pay no more than 8.5% of their income. Eligibility for middle-class earners is also expanded.

When the tax credits expire at the end of 2025, enrollees across the income spectrum will see costs spike. Annual out-of-pocket premiums are estimated to increase by 114% — an average of $1,016 — next year, according to the KFF analysis.

Millions expected to lose Medicaid coverage without changes to Trump’s big bill

Republicans’ tax and spending bill passed this summer includes more than $1 trillion in cuts to Medicaid and food assistance over the next decade, largely by imposing new work requirements on those receiving aid and by shifting certain federal costs onto the states.

Medicaid’s programs, which serve low-income Americans, enroll roughly 78 million adults and children. The nonpartisan Congressional Budget Office projects 10 million additional Americans will become uninsured in the next decade as a result of Republicans’ law, between Medicaid and other federal health care programs.

Democrats want to roll back the Medicaid cuts in any government funding measure, while Republicans have argued that cuts are needed to reduce federal deficits and eliminate what they say is waste and fraud in the system.

Democrats say health care can’t wait

Democrats have insisted an extension of the health subsidies needs to be negotiated immediately as people are beginning to receive notices of premium increases for next year.

“In just a few days, notices will go out to tens of millions of Americans because of the Republican refusal to extend the Affordable Care Act tax credits,” House Democratic Leader Hakeem Jeffries said Tuesday on the steps of the U.S. Capitol.

He added the higher health care costs millions of Americans are facing are coming “in an environment where the cost of living is already too high.”

At the White House on Monday, congressional Democratic leaders shared their health care concerns with Trump. Senate Democratic Leader Chuck Schumer said after the meeting that Trump “was not aware” that so many Americans would see increases to their health care costs.

Republicans call for stopgap funding first, and a negotiation later

Republican leaders say they handed Democrats a noncontroversial stopgap funding measure and argue that Democrats are instead choosing to shut the government down.

“We didn’t ask Democrats to swallow any new Republican policies,” Senate Majority Leader John Thune said after Tuesday’s failed vote. “We didn’t add partisan riders. We simply asked Democrats to extend the existing funding levels, to allow the Senate to continue the bipartisan appropriations work that we started. And the Senate Democrats said no.”

Republican leaders have offered to negotiate with Democrats on ACA health insurance subsidies — but only once they vote to keep the government open until Nov. 21.

“I will go to the Capitol right now to talk to Chuck Schumer and Senate Democrats about premium support for the Affordable Care Act, but only after they’ve reopened the government,” Vice President JD Vance said Wednesday on Fox News.

That might be easier said than done, with many Republicans in Congress still strongly opposed to extending the enhanced tax credits.

Swenson reported from New York.

By NICOLE WINFIELD, Associated Press

ROME (AP) — Pope Leo XIV has intervened for the first time in an abortion dispute roiling the U.S. Catholic Church by raising the seeming contradiction over what it really means to be “pro-life.”

Leo, a Chicago native, was asked late Tuesday about plans by Chicago Cardinal Blase Cupich to give a lifetime achievement award to Illinois Senator Dick Durbin for his work helping immigrants. The plans drew objection from some conservative U.S. bishops given the powerful Democratic senator’s support for abortion rights.

Leo called first of all for respect for both sides, but he also pointed out the seeming contradiction in such debates.

“Someone who says ‘I’m against abortion but says I am in favor of the death penalty’ is not really pro-life,” Leo said. “Someone who says that ‘I’m against abortion, but I’m in agreement with the inhuman treatment of immigrants in the United States,’ I don’t know if that’s pro-life.”

Leo spoke hours before Cupich announced that Durbin had declined the award.

Church teaching forbids abortion but it also opposes capital punishment as “inadmissible” under all circumstances. U.S. bishops and the Vatican have strongly called for humane treatment of migrants, citing the Biblical command to “welcome the stranger.”

Pope Leo says mutual respect is needed

Leo said he wasn’t familiar with the details of the dispute over the Durbin award, but said it was nevertheless important to look at the senator’s overall record and noted Durbin’s four-decade tenure. Responding to a question in English from the U.S. Catholic broadcaster EWTN News, he said there were many ethical issues that constitute the teaching of the Catholic Church.

“I don’t know if anyone has all the truth on them but I would ask first and foremost that there be greater respect for one another and that we search together both as human beings, in that case as American citizens or citizens of the state of Illinois, as well as Catholics to say we need to you know really look closely at all of these ethical issues and to find the way forward in this church. Church teaching on each one of those issues is very clear,” he said.

Cupich was a close adviser to Pope Francis, who strongly upheld church teaching opposing abortion but also criticized the politicizing of the abortion debate by U.S. bishops. Some bishops had called for denying Communion to Catholic politicians who supported abortion rights, including former President Joe Biden.

Biden met on several occasions with Francis and told reporters in 2021 that Francis had told him to continue receiving Communion. During a visit to Rome that year he received the sacrament during Mass at a church in Francis’ diocese.

Durbin was barred from receiving Communion in his home diocese of Springfield in 2004. Springfield Bishop Thomas Paprocki has continued the prohibition and was one of the U.S. bishops who strongly objected to Cupich’s decision to honor the senator. Cupich claims Durbin as a member of the Chicago Archdiocese, where Durbin also has a home.

Senator Durbin declines his award

In his statement announcing that Durbin would decline the award, Cupich lamented that the polarization in the U.S. has created a situation where U.S. Catholics “find themselves politically homeless” since neither the Republican nor the Democratic party fully encapsulates the breadth of Catholic teaching.

He defended honoring Durbin for his pro-immigration stance, and said the planned Nov. 3 award ceremony could have been an occasion to engage him and other political leaders with the hope of pressing the church’s view on other issues, including abortion.

“It could be an invitation to Catholics who tirelessly promote the dignity of the unborn, the elderly, and the sick to extend the circle of protection to immigrants facing in this present moment an existential threat to their lives and the lives of their families,” Cupich wrote.

Paprocki, for his part, thanked Durbin for declining the award. “I ask that all Catholics continue to pray for our church, our country, and for the human dignity of all people to be respected in all stages of life including the unborn and immigrants,” Paprocki said in a Facebook post.

The dispute came as President Donald Trump’s administration maintains a surge of immigration enforcement in the Chicago area.

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

On Sunday, a place of worship was turned into a scene of violence. 

In Grand Blanc, a former Marine and Iraq war veteran shot and killed at least four people at a Mormon church and allegedly set the building on fire. Officials say it was an act of targeted violence, though the motive remains unclear. Some victims are being treated at a local hospital. 

It’s no secret that gun violence is a big part of our culture here in the U.S. Gun deaths have increased over the last decade by 33 percent.

The United States is the rare wealthy nation with more guns than people.

Less than 14 hours before the attack in Michigan, another former Marine, Iraq war veteran and Purple Heart recipient killed three people and wounded five others in North Carolina. 

These stories are about guns and access, but they’re also about veterans reentering civilian life, about isolation, grievance, trauma, and how people respond—or don’t—to warning signs. 

Erin Comartin is a social work professor at Wayne State University. She spoke with Robyn Vincent about the roots of gun violence and how people can try to help prevent the next possible shooting.

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In Southwest Detroit, 18-wheeled vehicles frequently rumble through streets that aren’t made for them. Heavy truck traffic has been more than just an inconvenience here. 

For years, it’s meant noise, pollution, and danger for neighbors. And the problem is significant. 

Detroit is one of the country’s busiest freight hubs. Per Outlier Media reporting, about 128,000 loaded containers entered the city in July alone. 

To improve the situation, the city of Detroit is creating new truck restrictions on certain streets. Samuel Krassenstein is the Chief of Infrastructure and the Deputy Director for Public Works for the City of Detroit. He tells The Metro that next week the city plans to make some of the biggest series of truck route restrictions yet.

Krassenstein spoke with Robyn Vincent about truck traffic in Detroit, the problems it causes, and how the city is working to alleviate the problem for residents who live near it.

 

Listen to The Metro weekdays from 10 a.m. to noon ET on 101.9 FM and streaming on-demand.

Subscribe to The Metro on Apple Podcasts, Spotify, YouTube, or NPR or wherever you get your podcasts.

 

Support local journalism.

WDET strives to cover what’s happening in your community. As a public media institution, we maintain our ability to explore the music and culture of our region through independent support from readers like you. If you value WDET as your source of news, music and conversation, please make a gift today.

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By TOM MURPHY

Drugstores are ready to deliver updated COVID-19 vaccines this fall and insurers plan to pay for them, even though the shots no longer come recommended by an important government committee.

On Friday, vaccine advisers picked by Health Secretary Robert F. Kennedy Jr. declined to specifically recommend the shots but said people could make individual decisions on whether to get them.

The recommendations from the advisers to the Centers for Disease Control and Prevention require sign-off by the agency’s director, but they are almost always adopted.

Those recommendations normally trigger several layers of insurance coverage and allow drugstores in many states to deliver the shots. But insurers and government officials have said coverage will continue, and several states have allowed for vaccine access through pharmacies, the most common place to get shots.

Many people start seeking vaccinations in the late summer or early fall to get protection against any winter surges in cases.

Here’s a closer look at the issue.

Will insurers cover these shots?

Many are expected to do so, but you still may want to check with yours.

The Department of Health and Human Services said Friday that the committee vote “provides for immunization coverage through all payment mechanisms.” An HHS spokesperson said that includes Medicaid, the Children’s Health Insurance Program, commercial coverage sold through health insurance marketplaces and the federal Vaccines for Children program, which pays for roughly half of childhood vaccinations in the U.S. each year.

The VFC program normally automatically covers any vaccines recommended by the CDC committee.

The trade group America’s Health Insurance Plans said earlier this week that its members will continue to cover the shots at no cost to patients through 2026.

That group includes every major insurer except UnitedHealthcare. And that insurer has said it will continue covering the vaccine at no cost for its standard commercial coverage, which includes plans offered for individuals and through small businesses.

One caveat: Large employers that offer coverage will make their own decisions on the vaccines.

They may be motivated to continue coverage: The vaccines can help ward off expensive hospital bills from people who develop a bad case of COVID-19.

Where people can get vaccinations

About two-thirds of adults get COVID-19 shots at pharmacies, and around 30% receive them at doctors’ offices, according to CDC data.

Access to the shots has grown after a clunky start to vaccine season that saw some people travel to nearby states when they couldn’t make appointments at pharmacies closer to home.

Drugstore chains like CVS say their locations are stocked with the latest vaccines, and they now are able to deliver vaccinations in all 50 states and Washington, D.C. Prescriptions are required in D.C. and a handful of states, including Florida and Georgia, CVS Health spokeswoman Amy Thibault said.

Walgreens also requires prescriptions in a few states, a company spokesperson said.

Who can get the shot

Until now, the U.S. has recommended yearly COVID-19 shots for everyone age 6 months and older.

The U.S. Food and Drug Administration recently approved the shots for all people age 65 and older, and for younger adults and children with conditions that put them at high risk for catching a bad case of COVID-19.

The CDC maintains a long list of conditions that would put someone at high risk, including asthma, cancer, heart or lung problems, obesity, depression and a history of smoking. It also includes those who are physically inactive, and the agency notes that this list is not conclusive.

Patients can consult with their doctor or care provider to decide whether they are high risk if they don’t have a condition on that list.

Both CVS and Walgreens representatives say their companies will ask patients under age 65 if they have any of these factors. They won’t require proof.

“In simplest terms, if a patient says they’re eligible, they will get the vaccine,” said Thibault, the CVS Health spokeswoman.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

By LAURAN NEERGAARD, Associated Press

WASHINGTON (AP) — The Trump administration moved Thursday to shut down a Miami organ donation group, calling it “failing” because of underperformance, unsafe practices and paperwork errors.

The Life Alliance Organ Recovery Agency is one of 55 organ procurement organizations, or OPOs, nonprofit agencies around the country that coordinate the recovery of organs from deceased donors and help match them to patients on the nation’s transplant waiting list.

The administration cited an investigation that found a 2024 case where an unspecified mistake led a surgeon to decline a donated heart for a patient awaiting surgery.

In a news briefing, Dr. Mehmet Oz, who heads the Centers for Medicare and Medicaid Services, said problems included would-be donations that went unrecovered, sending some donated organs to the wrong place and a lack of staff.

Life Alliance, a division of the University of Miami Health System, can appeal the decision. If it is shut down, it would mark the first time the federal government has decertified an OPO.

Life Alliance didn’t immediately respond to a request for comment.

More than 100,000 Americans are on the transplant list and thousands die waiting because there aren’t enough donations to go around. Last year there were more than 48,000 transplants, a record, the vast majority from deceased donors.

Changes to the transplant system have been underway for years to increase donations, reduce waste of potentially usable organs and address other concerns. They include some new safeguards after complaints last year that a different OPO didn’t stop donation preparations quickly enough when some patients showed signs of life, prompting some people to opt out of donor registries. Organ donation can proceed only after a hospital has declared someone dead — and by law, OPOs cannot be involved in that decision.

On Thursday, Oz sought to reassure would-be donors.

“Congress has thoughtfully and aggressively pursued some horrifying stories that have chilled some Americans’ enthusiasm for donating organs. We are here today to tell you this system is safe. It’s rigorously being addressed,” he said, adding later, “I want to applaud the OPOs that are doing a great job because most are.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By Jackie Fortiér, KFF Health News

A key federal vaccine advisory panel whose members were recently replaced by Health and Human Services Secretary Robert F. Kennedy Jr. is expected to vote to recommend delaying until age 4 the hepatitis B vaccine that’s currently given to newborns, according to two former senior Centers for Disease Control and Prevention officials.

“There is going to likely be a discussion about hepatitis B vaccine, very specifically trying to dislodge the birth dose of hepatitis B vaccine and to push it later in life,” said Demetre Daskalakis, former director of the National Center for Immunization and Respiratory Diseases. “Apparently this is a priority of the secretary’s.”

The vote is expected to take place during the next meeting of the CDC’s Advisory Committee on Immunization Practices, scheduled for Sept. 18-19.

For more than 30 years, the first of three shots of hepatitis B vaccine has been recommended for infants shortly after birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Pediatricians warn that waiting four years for the vaccine opens the door to more children contracting the virus.

“Age 4 makes zero sense,” pediatrician Eric Ball said. “We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis. It’s really the best way to keep our entire population healthy.”

In addition to the hepatitis B vaccine, the panel will also discuss and vote on recommendations for the combined measles, mumps, rubella, and varicella vaccine and covid-19 vaccines. Pediatricians worry changes to the schedules of these vaccines will limit access for many families, leaving them vulnerable to vaccine-preventable diseases.

Typically, ACIP would undertake an analysis of the data before recommending a change to vaccine guidelines. As of the end of August, this process had not begun for the hepatitis B vaccines, Daskalakis and another former official said.

“This is an atypical situation. There’s been no work group to discuss it,” Daskalakis said.

The second former senior official spoke to NPR and KFF Health News on the condition of anonymity.

In response to questions from KFF Health News, HHS spokesperson Andrew Nixon wrote, “ACIP exists to ensure that vaccine policy is guided by the best available evidence and open scientific deliberation. Any updates to recommendations will be made transparently with gold standard science.”

The draft agenda for the upcoming ACIP meeting was released to the public less than a week before it is scheduled to begin.

At the last ACIP meeting, in June, Martin Kulldorff, the chair and one of seven new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread. Kulldorff is a former Harvard Medical School professor who became known for opposing some public health measures during the pandemic.

“Unless the mother is hepatitis B positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use,” he said.

The virus spreads via direct exposure to an infected bodily fluid like blood or semen. The disease has no cure and can lead to serious conditions like cirrhosis and liver cancer later in life. The CDC advisory panel may maintain the recommendation to inoculate newborns whose mothers have hepatitis B or are considered at high risk of the disease, the former officials said.

Protection from birth

In 1991, federal health officials determined it was advisable for newborns to receive their first dose of the hepatitis B vaccine within 24 hours of birth, which blocks the virus from taking hold if transmitted during delivery. While parents may opt out of the shots, many day care centers and school districts require proof of hepatitis B vaccination for enrollment.

The prospect of ACIP’s altering the recommendation has left some people living with the virus deeply unsettled.

“I am goddamn frustrated,” said Wendy Lo, who has lived with the liver disease, likely since birth. Years of navigating the psychological, monetary, medical, and social aspects of chronic hepatitis B has touched almost every aspect of her life.

“I would not want anyone to have to experience that if it can be prevented,” she said. Lo learned she had the disease due to a routine screening to study abroad in college.

Lo credits the vaccines with protecting her close family members from infection.

“I shared with my partner, ‘If you get vaccinated, we can be together,’” she said. He got the vaccine, which protects him from infection, “so I’m grateful for that,” she said.

The CDC estimates half of people with hepatitis B do not know they are infected. It can range from an acute, mild infection to a chronic infection, often with few to no symptoms. Most people with chronic hepatitis B were born outside of the U.S., and Asians and Pacific Islanders followed by Black people have the highest rates of newly reported chronic infections.

When her children were born, Lo was adamant that they receive the newborn dose, a decision she says prevented them from contracting the virus.

The earlier an infection occurs, the worse the consequences, according to the CDC. When contracted in infancy or early childhood, hepatitis B is far more likely to become a chronic infection, silently damaging the liver over decades.

Those who become chronic carriers can also unknowingly spread the virus to others and face an increased risk of long-term complications including cirrhosis and liver cancer, which may not become evident until much later in life.

“Now I’m in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it’s lifesaving, and it protects you against cancer. How many vaccines do that?” Lo said.

Thirty years of universal vaccination

Treatments like the antivirals Lo now takes weren’t available until the 1990s. Decades of the virus’s replicating unchecked damaged her liver. Every six months she gets scared of what her blood tests may reveal.

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on people thought to be at highest risk of infection.

“I, and every other doctor, had been trained in medical school to think of hepatitis B as an infection you acquired as an adult. It was the pimps, the prostitutes, the prisoners, and the health care practitioners who got hepatitis B infection. But we’ve learned so much more,” said William Schaffner, a professor of infectious diseases at the Vanderbilt University School of Medicine and a former voting member of ACIP.

As hepatitis B rates remained stubbornly high in the 1980s, scientists realized an entire vulnerable group was missing from the vaccination regime — newborns. The virus is often transmitted from an infected mother to baby in late pregnancy or during birth.

“We may soon hear, ‘Let’s just do a blood test on all pregnant women.’ We tried that. That doesn’t work perfectly either,” Schaffner said.

Some doctors didn’t test, he said, and some pregnant women falsely tested negative while others acquired hepatitis B after they had been tested earlier in their pregnancies.

In 1991, Schaffner was a liaison representative to ACIP when it voted to advise universal vaccination for hepatitis B before an infant leaves the hospital.

“We want no babies infected. Therefore, we’ll just vaccinate every mom and every baby at birth. Problem solved. It has been brilliantly successful in virtually eliminating hepatitis B in children,” he said.

In 1990, there were 3.03 cases of hepatitis B per 100,000 people 19 years old or under in the U.S., according to the CDC.

Since the federal recommendation to vaccinate all infants, cases have dramatically decreased. CDC data shows that in 2022 the rate among those 19 or under was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, health experts note that it is possible for the virus to be transmitted in ordinary situations too, including among young children.

The virus can survive for up to seven days outside the body. During that time, even microscopic traces of infected blood on a school desk or playground equipment can pose a risk. If the virus comes into contact with an open wound or the mucous membranes of the eyes, an infection can occur. This means that unvaccinated children not considered at high risk can still be exposed in everyday environments.

Future access uncertain

If the CDC significantly alters its recommendation, health insurers would no longer be required to cover the cost of the shots. That could leave parents to pay out-of-pocket for a vaccine that has long been provided at no charge. Children who get immunizations through the federal Vaccines for Children program would lose free access to the shot as soon as any new ACIP recommendations get approved by the acting CDC director.

The two former CDC officials said that plans were underway to push back the official recommendation for the vaccine as of August, when they both left the agency, but may have changed.

Schaffner is still an alternate liaison member of ACIP, and hopes to express his support for universal newborn vaccination at the next meeting.

“The liaisons have now been excluded from the vaccine work groups. They are still permitted to attend the full meetings,” he said.

Schaffner is worried about the next generation of babies and the doctors who care for them.

“We’ll see cases of hepatitis B once again occur. We’ll see transmission into the next generation,” he said, “and the next generation of people who wear white coats will have to deal with hepatitis B, when we could have cut it off at the pass.”

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

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

September is Suicide Prevention Month, a time to bring attention to a crisis that touches far too many families.

This month is a reminder that life can feel overwhelming as we juggle family, work, friends, and everything in between. Too often, what gets left behind is our own well-being. And when mental health goes unaddressed, the consequences can be devastating.

Suicide rates in the U.S. climbed between 2000 and 2018, dipped briefly, and remain elevated today. On average, one person dies by suicide every 11 minutes. Behind those numbers are real people—neighbors, loved ones, friends—whose struggles too often remain invisible until it’s too late.

Lori Edelson, a psychotherapist and the owner of Birmingham Maple Clinic, joined the show to raise awareness and share how we can spot the warning signs.
 

Listen to The Metro weekdays from 10 a.m. to noon ET on 101.9 FM and streaming on demand.

Subscribe to The Metro on Apple Podcasts, Spotify, NPR.org or wherever you get your podcasts.

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WDET strives to make our journalism accessible to everyone. As a public media institution, we maintain our journalistic integrity through independent support from readers like you. If you value WDET as your source of news, music and conversation, please make a gift today.

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By Jamie Ducharme, KFF Health News

After losing 50 pounds on the injectable weight loss medication Zepbound, Kyra Wensley received a surprising letter from her pharmacy benefit manager in April.

Her request for coverage had been denied, the letter said, because she’d had a body mass index of less than 35 when she started Zepbound. The 25-year-old who lives in New York had been taking Zepbound without incident for months, so she was confused: Why was her BMI, which had been around 32 when she started, becoming an issue only now?

Wensley had no interest in quitting an effective drug. “Going right off like that, it’s easier said than done,” she said.

Her doctor fought to keep her on the GLP-1 agonist, the category that includes weight loss and Type 2 diabetes drugs Ozempic, Wegovy, Mounjaro, and Zepbound. But Wensley ultimately had to switch from Zepbound to Wegovy to meet her plan’s requirements. She said she doesn’t like Wegovy as much as her old medication, but she now feels lucky to be on any GLP-1.

Lots of research suggests such medications must be used indefinitely to maintain weight loss and related health benefits. But with list prices of roughly $1,000 a month, public and private payers are struggling to keep up with ballooning demand for GLP-1 weight loss drugs and in some cases are eliminating or restricting their coverage as a result.

North Carolina Medicaid plans to end GLP-1 coverage for weight loss on Oct. 1, just over a year after starting the coverage. Pennsylvania is planning to limit Medicaid coverage to beneficiaries at the highest risk of complications from obesity. And despite recent reports of a potential federal pilot program to extend coverage of GLP-1 obesity drugs under Medicaid and Medicare, all state Medicaid programs are likely to be under pressure due to steep spending cuts in the budget reconciliation package recently signed into law by President Donald Trump.

Already, many GLP-1 users quit within a year, studies suggest — often due to side effects, high costs, or insurance issues. Now a growing number of researchers, payers, and providers are exploring deliberate “deprescription,” which aims to taper some patients off their medication after they have taken it for a certain amount of time or lost a certain amount of weight.

The U.K.’s National Institute for Health and Care Excellence, which creates guidance for the National Health Service, recommends two-year limits on the use of some weight loss medications, such as Wegovy. And the concept was raised in a recent Institute for Clinical and Economic Review report on affordable access to obesity drugs.

A. Mark Fendrick, who directs the Center for Value-Based Insurance Design at the University of Michigan, has argued that if some people using GLP-1s to lose weight were eventually transitioned off, more people could take advantage of them.

“If you’re going to spend $1 billion or $100 billion, you could either spend it on fewer people for a long period of time, or you can spend it on a lot more people for a shorter period of time,” he said.

Fendrick’s employer, the University of Michigan, indeed does that. Its prescription drug plan caps coverage of GLP-1 drugs at two years if they’re used solely for weight loss.

Jamie Bennett, a spokesperson for Wegovy and Ozempic maker Novo Nordisk, declined to comment on the concept of deprescription, noting that its drugs are intended for chronic conditions. Rachel Sorvig, a spokesperson for Zepbound and Mounjaro manufacturer Eli Lilly, said in a statement that users should “talk to their health care provider about dosage and duration needs.”

Studies have shown that people typically regain a substantial amount of weight within a year of stopping GLP-1 medications, and that many people who quit ultimately go back on the drugs.

“There’s no standard of care or gold standard on how to wean right now,” said Allison Adams, an obesity and internal medicine doctor with UK HealthCare in Kentucky.

But the math shows why time-limited coverage is appealing to payers that struggle to pay for beneficiaries’ GLP-1 prescriptions, said Michelle Gourdine, chief medical officer for the pharmacy benefit manager CVS Caremark.

And states are “between a rock and a hard place,” said Kody Kinsley, who until January led North Carolina’s Health and Human Services Department. “They’re going to have to look at every single thing and trim dollars everywhere they can.”

Pennsylvania was looking for cost-saving strategies even before the new federal tax-and-spending law, according to Brandon Cwalina, press secretary for the state’s Department of Human Services. Pennsylvania projects it will spend $1.3 billion on GLP-1 drugs this year.

Plans could see real savings, Fendrick said, if they covered GLP-1s for initial weight loss then moved people to cheaper options — such as more affordable drugs or behavioral health programs — to maintain it.

Plenty of companies are eager to sell insurers, employers, and individuals on behavioral alternatives. One is Virta Health, which advertises its nutrition-focused weight management program as “a proven approach for deprescribing GLP-1s when clinically appropriate.” A Virta-funded study assessed 154 people with Type 2 diabetes who stopped using GLP-1 medications but continued following Virta’s program, concluding that their weight did not significantly increase after a year.

Researchers affiliated with a European weight management company also recently reported that slowly tapering off the medications may help maintain weight loss.

For employers and insurers, the “initial question” was whether to cover GLP-1s for obesity, said Virta CEO Sami Inkinen. “Now, basically, everyone’s coming to the middle and asking, ‘How do we responsibly cover these drugs?’”

Part of responsible coverage, Inkinen said, is providing other forms of support to patients who stop using GLP-1 medications, by choice or otherwise.

For some people, however, maintaining weight loss without a GLP-1 remains a challenge, even with other options available.

Lily, who lives in Michigan, lost almost 80 pounds in roughly 18 months on Wegovy. But she had to quit the drug when she turned 26 and left her parents’ insurance plan this year. The plan her employer offers stopped covering GLP-1s for weight loss right around the time she joined.

Lily, who asked to be identified by only her first name because she is not out to her family as transgender, has tried other medications since then, and previously tried lifestyle programs to control her weight. But she said nothing works as well for her as Wegovy.

She has regained 20 pounds since going off the drug at the beginning of the year and worries that number will continue to rise, potentially contributing to future health problems.

“Just give people the drugs,” she said. “It seems cheaper and safer in the long run.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By GEOFF MULVIHILL, Associated Press

The governors of Arizona and Maine on Friday joined the growing list of Democratic officials who have signed orders intended to ensure most residents can receive COVID-19 vaccines at pharmacies without individual prescriptions.

Unlike past years, access to COVID-19 vaccines has become complicated in 2025, largely because federal guidance does not recommend them for nearly everyone this year as it had in the past.

Here’s a look at where things stand.

Pharmacy chain says the shots are available in most states without individual prescriptions

CVS Health, the biggest pharmacy chain in the U.S., says its stores are offering the shots without an individual prescription in 41 states as of midday Friday.

But the remaining states — Arizona, Florida, Georgia, Louisiana, Maine, North Carolina, Oregon, Utah and West Virginia, plus the District of Columbia — require individual prescriptions under the company’s interpretation of state policies.

Arizona and Maine are likely to come off that list as the new orders take effect there.

“I will not stand idly by while the Trump Administration makes it harder for Maine people to get a vaccine that protects their health and could very well save their life,” Maine Gov. Janet Mills said in the statement. “Through this standing order, we are stepping up to knock down the barriers the Trump Administration is putting in the way of the health and welfare of Maine people.”

Democratic governors have been taking action

At least 14 states — 12 with Democratic governors, plus Virginia, where Republican Glenn Youngkin is governor — have announced policies this month to ease access.

In some of the states that have expanded access — including Delaware and New Jersey this week — at least some pharmacies were already providing the shots broadly.

But in Arizona and Maine, Friday’s orders are expected to change the policy.

While most Republican-controlled states have not changed vaccine policy this month, the inoculations are still available there under existing policies.

In addition to the round of orders from governors, boards of pharmacy and other officials, four states — California, Hawaii, Oregon and Washington — have announced an alliance to make their own vaccine recommendations. Of those, only Oregon doesn’t currently allow the shots in pharmacies without individual prescriptions.

Vaccines have become politically contentious

In past years, the federal government has recommended the vaccines to all Americans above the age of 6 months.

This year, the U.S. Food and Drug Administration approved them for people age 65 and over but said they should be used only for children and younger adults who have a risk factor such as asthma or obesity.

That change came as U.S. Health Secretary Robert F. Kennedy fired the entire Advisory Committee on Immunization Practices in June, accusing of them of being too closely aligned with the companies that make the vaccines. The replacements include vaccine skeptics.

Arizona Gov. Katie Hobbs, a Democrat, framed her order Friday as “protecting the health care freedom” of people in the state.

One state has taken another stance on vaccines

Florida’s surgeon general, Dr. Joseph Ladapo, announced this month that the state could become the first to eliminate requirements that children have a list of vaccinations.

Since then, though, the state health department said that the change likely wouldn’t take effect until December and that without legislative action, only some vaccines — including for chickenpox — would become optional. The measles and polio shots would remain mandatory.

Associated Press writer Patrick Whittle in Maine contributed to this report.

By Lena H. Sun, Rachel Roubein, Dan Diamond
The Washington Post

Trump health officials plan to link coronavirus vaccines to the deaths of 25 children as they consider limiting which Americans should get the shots, according to four people familiar with the situation who spoke on the condition of anonymity to describe confidential information.

The findings appear to be based on information submitted to the federal Vaccine Adverse Event Reporting System, which contains unverified reports of side effects or bad experiences with vaccines submitted by anyone, including patients, doctors, pharmacists or even someone who sees a report on social media. The Centers for Disease Control and Prevention emphasizes that the database is not designed to assess whether a shot caused a death, a conclusion that requires thorough investigations by scientists and public health professionals.

Trump health officials plan to include the pediatric deaths claim in a presentation next week to an influential panel of advisers to the CDC that is considering new coronavirus vaccine recommendations, which affect access to the shots and whether they’re free.

The plan has alarmed some career scientists who say coronavirus vaccines have been extensively studied, including in children, and that dangers of the virus itself are being underplayed. CDC staff in June presented data to the same vaccine committee showing that at least 25 children died who had covid-associated hospitalizations since July 2023 and that number was likely an undercount. Of the 16 old enough for vaccination, none was up-to-date on vaccines.

Food and Drug Administration Commissioner Marty Makary confirmed on CNN last week that officials were investigating reports of possible child deaths from the vaccine, including reviewing autopsy reports and interviewing families. Such a review could take months, according to health officials, and it is unclear when those investigations began.

The pediatric deaths presentation to the CDC’s Advisory Committee on Immunization Practices (ACIP) is not final, according to one person familiar with the matter, who spoke on the condition of anonymity to describe ongoing policy discussions. The full methodology for the analysis was not immediately clear.

“FDA and CDC staff routinely analyze VAERS and other safety monitoring data, and those reviews are being shared publicly through the established ACIP process,” HHS spokesperson Andrew Nixon said in an email. “Any recommendations on updated COVID-19 vaccines will be based on gold standard science and deliberated transparently at ACIP next week.”

The FDA in August approved the latest coronavirus vaccines for people ages 65 and older or who have risk factors for severe disease, but the CDC vaccine panel can recommend the shots more narrowly or broadly. The committee is weighing a plan to recommend the shot for those 75 and older but instruct people who are younger to speak to a physician before they get the vaccine, according to two people familiar with the matter who spoke on the condition of anonymity to share policy discussions. Another option would not recommend the vaccine to people under the age of 75 without preexisting conditions, the people said.

But limiting access for people ages 65 to 74 has raised concerns about a political backlash, said one federal health official who spoke on the condition of anonymity to share private conversations. According to CDC estimates, nearly 43 percent of people in that age group received the 2024-2025 version of the coronavirus vaccine.

Many countries do not recommend annual coronavirus vaccination for healthy children because they rarely die from covid and most experience mild symptoms. U.S. officials have justified yearly shots based on data showing infants and toddlers faced elevated risk of hospitalization and that significant shares of those who were hospitalized had no underlying conditions. They have also said vaccines offer children protection against long covid.

Health and Human Services Secretary Robert F. Kennedy Jr., a longtime critic of coronavirus vaccines, in May directed health officials to stop recommending the shots for otherwise healthy children. The CDC later instructed parents to consult a doctor before getting their children coronavirus vaccines. The American Academy of Pediatrics recommends annual coronavirus vaccines for all children ages 6 to 23 months and for older children if their parents want them to have protection.

Next week’s vaccine advisory panel’s meeting is critical because the recommendations determine whether insurers must pay for the immunizations, pharmacies can administer them and doctors are willing to offer them. Kennedy purged the membership of the panel earlier this year and appointed his own picks, most of whom have criticized coronavirus vaccination policy. He is considering adding additional critics of covid shots to the committee.

The previous vaccine panel was already considering a more targeted approach to coronavirus vaccination, recommending the shot for high-risk groups, but allowing others, including children, to get the vaccine if they wanted.

Tracy Beth Hoeg, one of Makary’s top deputies who was a critic of broad childhood coronavirus vaccination before joining the FDA, has been one of the officials looking into vaccine safety data, according to five people familiar with the matter who spoke on the condition of anonymity to describe private information.

The planned pediatric death presentation included attempts to interview some families, but it’s not clear what other information was used. Some of those same families had been previously interviewed by the CDC officials as part of vaccine safety tracking, according to one person familiar with the matter.

Harleen Marwah, a pediatrician at Mass General Brigham for Children who recently reviewed data on the coronavirus vaccine and its safety and efficacy in children, said new studies since June identified “no new safety concerns.” Marwah conducted the research on behalf of the Vaccine Integrity Project, a new initiative based at the University of Minnesota to provide scientific evidence to inform vaccine recommendations.

The CDC has been monitoring coronavirus vaccine safety data since the first shots rolled out in the United States. Much stricter requirements were put in place for reporting adverse events than for other vaccines because the vaccines were initially fast-tracked under the FDA’s emergency response authority.

Death rates among all ages after mRNA coronavirus vaccination were below those for the general population, according to data presented to the CDC vaccine committee in June.

Noel Brewer, a public health professor at the University of North Carolina and one of the vaccine advisers terminated by Kennedy, said the focus on vaccine harms ignores the harms of coronavirus.

“They are leveraging this platform to share untruths about vaccines to scare people,” Brewer said. “The U.S. government is now in the business of vaccine misinformation.”

By Nada Hassanein, Stateline.org

Pharmacies in Black and Latino neighborhoods are less likely to dispense buprenorphine — one of the main treatments for opioid use disorder — even though people of color are more likely to die from opioid overdoses.

The drug helps reduce cravings for opioids and the likelihood of a fatal overdose.

While the nation as a whole has seen decreases in opioid overdose deaths in recent years, overdose deaths among Black, Latino and Indigenous people have continued to increase.

Many medical and health policy experts fear the broad domestic policy law President Donald Trump signed in July will worsen the problem by increasing the number of people without health insurance. As a result of the law, the number of people without coverage will increase by about 10 million by 2034, according to the Congressional Budget Office.

About 7.5 million of the people who will lose coverage under the new law are covered by Medicaid. Shortly before Trump signed the bill into law, researchers from the University of Pennsylvania and Boston University estimated that roughly 156,000 Medicaid recipients will lose access to medications for opioid addiction because of the cuts, resulting in approximately 1,000 more overdose deaths annually.

Because Black and Hispanic people are overrepresented on the rolls, the Medicaid cuts will have a disproportionate effect on communities that already face higher barriers to getting medications to treat addiction.

From 2017 to 2023, the percentage of U.S. retail pharmacies regularly dispensing buprenorphine increased from 33% to 39%, according to a study published last week in Health Affairs.

But researchers found the drug was much less likely to be available in pharmacies in mostly Black (18% of pharmacies) and Hispanic neighborhoods (17%), compared with mostly white ones (46%).

In some states, the disparity was even worse. In California, for example, only about 9% of pharmacies in Black neighborhoods dispensed buprenorphine, compared with 52% in white neighborhoods.

The researchers found buprenorphine was least available in Black and Latino neighborhoods across nearly all states.

Barriers to treatment

Dr. Rebecca Trotzky-Sirr, a family physician who specializes in addiction medicine, said many communities of color are “pharmacy deserts.” Even the pharmacies that do exist in those neighborhoods tend to “have additional barriers to obtain buprenorphine and other controlled substances out of a concern for historic overuse of some treatments,” said Trotzky-Sirr, who wasn’t involved in the study.

In addition to its federal classification as a controlled substance, buprenorphine is also subject to state regulations to prevent illegal use. Pharmacies that carry it know that wholesalers and distributors audit their orders, which dissuades some from stocking or dispensing it.

Dima Qato, associate professor of clinical pharmacy at the University of Southern California and an author of the Health Affairs study, said that without changes in policy, Black and Hispanic people will continue to have an especially hard time getting buprenorphine.

“If you don’t address these dispensing regulations, or regulate buprenorphine from the aspect of pharmacy regulations, people are still going to encounter barriers accessing it,” she said.

In neighborhoods where at least a fifth of the population is on Medicaid, just 35% of pharmacies dispensed buprenorphine, Qato and her team found. But in neighborhoods with fewer residents on Medicaid, about 42% of pharmacies carried the drug.

Medicaid covers nearly half— 47% — of nonelderly adults who suffer from opioid use disorder. In states that expanded Medicaid under the Affordable Care Act, another recent study found an increase in people getting prescriptions for buprenorphine.

“Medicaid is the backbone of care for people struggling with opioid use disorder,” said Cherlette McCullough, a Florida-based mental health therapist. “We’re going to see people in relapse. We’re going to see more overdoses. We’re going to see more people in the ER.”

Qato said the shortage of pharmacies in minority communities is likely to get worse, as many independent pharmacists are already struggling to stay open.

“We know they’re more likely to close in neighborhoods of color, so there’s going to be even fewer pharmacies that carry it in the neighborhoods that really need it,” she said.

‘There needs to be urgency’

Qato and her colleagues say states and local governments should mandate that pharmacies carry a minimum stock of buprenorphine and dispense it to anyone coming in with a legitimate prescription. As examples, they point to a Philadelphia ordinance mandating that pharmacies carry the opioid overdose-reversal drug naloxone and similar emergency contraception requirements in Massachusetts.

“We need to create expectations. We need to encourage our pharmacies to carry this to make it accessible, same day, and there needs to be urgency,” said Arianna Campbell, a physician assistant and co-founder of the Bridge Center, a California-based organization that aims to help increase addiction treatment in emergency rooms.

“In many of the conversations I have with pharmacies, when I’m getting some pushback, I have to say: ‘Hey, this person’s at the highest risk of dying right now. They need this medication right now.’”

She said patients frequently become discouraged due to barriers they face in getting prescriptions filled. The Bridge Center has been expanding its patient navigator program across the state, and helping other states start their own. The program helps patients identify pharmacies where they can fill their prescription fastest.

“There’s a medication that can help you, but at every turn it’s really hard to get it,” she said, calling the disparities in access to medication treatment “unacceptable.”

Trotzky-Sirr, the California doctor, fears the looming Medicaid cuts will cause many of her patients to discontinue treatment and relapse. Many of her patients are covered by Medi-Cal, the state’s Medicaid program.

“A lot of our patients are able to obtain medications for treatment of addiction like buprenorphine, because of the state covering the cost of the medication,” said Trotzky-Sirr, who also is a regional coordinator at the Bridge Center.

“They don’t have the resources to pay for it, cash, out of pocket.”

Some low-income patients switch between multiple providers or clinics as they try to find care and coverage, she added. These could be interpreted as red flags to a pharmacy.

Trotzky-Sirr argued buprenorphine does not need to be monitored as carefully as opioids and other drugs that are easier to misuse or overuse.

“Buprenorphine does not have those features and really needs to be in a class by itself,” she said. “Unfortunately, it’s hard to explain that to a pharmacist in 30 seconds over the phone.”

More is known about the medication now than when it was placed on the controlled substances list about two decades ago, said Brendan Saloner, a Bloomberg Professor of American Health in Addiction and Overdose at Johns Hopkins University.

Pharmacies are fearful of regulatory scrutiny and don’t have “countervailing pressure” to ensure patients get the treatments, he said.

On top of that fear, Medicaid managed care plans’ prior authorization processes may also be adding to the pharmacy bottleneck, he said.

“Black and Latino communities have higher rates of Medicaid enrollment, so to the extent that Medicaid prior authorization techniques are a hassle to pharmacies, that may also kind of discourage them [pharmacies] from stocking buprenorphine,” he said.

In some states, buprenorphine is much more readily available. In Maine, New Hampshire, Oregon, Rhode Island, Utah and Vermont, more than 70% of pharmacies carried the drug, according to the study. Buprenorphine availability was highest in states such as Oregon that have the least restrictive regulations for dispensing it.

In contrast, less than a quarter of pharmacies in Iowa, North Dakota, Texas, Virginia and Washington, D.C., carried the medication.

“We’re going to see more people becoming unhoused, because without treatment, they’re going to go back to those old habits,” McCullough, the Florida therapist, said. “When we talk about marginalized communities, these are the populations that are going to suffer the most because they already have challenges with access to care.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

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The University of Michigan is ending gender-affirming care for minors, leaving an untold number of families with fewer options and greater uncertainty.

Gender-affirming care for minors is legal in Michigan, and major medical and mental-health associations recognize it as best practice. Research links it to lower depression and suicide risk. 

But a Michigan Medicine spokesperson said in a prepared statement that the risks of offering this care are now too high. This comes after it received a federal subpoena as part of a criminal and civil investigation into gender-affirming care for minors.

“We recognize the gravity and impact of this decision for our patients and our community. We are working closely with all those impacted,” the statement reads.

The announcement represents a profound loss for families. For some young people, it means a place they felt safe and could trust is closing its doors. And the consequences are real: more anxiety, more depression, greater risk of suicide.

Equality Michigan’s Emme Zanotti joined Robyn Vincent to discuss the impacts on Michigan families. Zanotti, a trans woman, also took off her advocate hat to reflect on the personal reverberations she feels at this moment.

Michigan Medicine did not respond to an email request about the number of patients who will be affected and how the hospital plans to assist patients during this transition. 

Editor’s Note: After this conversation aired, Corewell Health, a major healthcare provider in Michigan, also announced the end of its gender-affirming care. 

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