By TERRY TANG and OBED LAMY

INDIANAPOLIS (AP) — Cradling his newborn daughter in his lap in their Indianapolis home, JaKobi Burton’s love for the new lady in his life is evident with each caress.

The first-time dad’s commitment started months earlier. Burton attended every medical appointment and took classes with Dads to Doulas, a program created by the organization Dear Fathers that teaches Black fathers-to-be how to provide physical, mental and spiritual support up to and after childbirth.

He and his wife, Crystal Wilmot-Burton, understood that the pregnancy came with immense risk, not just because they were in their 40s but also because they are Black. Federal health data shows Black women are almost 3.5 times more likely than white women to die around the time of childbirth.

Health professionals and advocates hope that by giving Black fathers-to-be the tools to be more hands-on — through government-funded programs and nonprofit center resources — they can cut into those odds. Organizers say there has been a noticeable shift in the attitudes of some Black men who now openly discuss their pregnancy fears and insecurities.

“I want you to know that I was involved and that I was looking out for you from the very beginning, and I’m always going to be your biggest protector,” Burton tells his 1-month-old daughter. “That’s what I did from the beginning of this experience, trying to learn as much as I could.”

Paternal involvement is ‘directly correlated with better outcomes’

Health disparities, racism and equal access to prenatal care are among the contributing factors for the disparities in mortality rates among women of different races, according to the National Center for Health Statistics. Two recent viral cellphone videos — including one in Indiana — show hospital staff dismissing the concerns of Black women in labor.

The maternal mortality rate for Black women soars above that of other racial groups. They suffered 50.3 deaths per 100,000 live births in 2023, according to the Centers for Disease Control and Prevention. White women experienced 14.5. Hispanic and Asian women faced 12.4 and 10.7, respectively.

The National Healthy Start Association, which was created in 1998 to help improve infant and maternal mortality rates, has “fatherhood practitioners” at its 116 project sites. They, along with case managers, offer men assistance including webinars, a texting service and even cooking lessons.

Kenneth Scarborough, who has been the NHSA’s fatherhood and men’s health consultant for 10 years, has noticed a shift toward including male partners in the efforts to preserve the health of pregnant women.

“There’s more research that is being done to be able to change those narratives, without a shadow of a doubt,” Scarborough said. “The challenge with that is still getting these institutions to understand the value of making sure that Dad is there and he is at the table.”

Doctors still leave Black fathers “on the fringes of the conversation” while society often codifies them as “scary and rough,” said Dr. Ndidiamaka Amutah-Onukagha, founder and director of the Center of Black Maternal Health and Reproductive Justice at Tufts University.

She said she has heard countless anecdotes of fathers being ignored in the exam room, even though paternal involvement is “directly correlated with better outcomes.”

Mothers- and fathers-to-be face racism in medical institutions

Black patients are frequently advised to seek out an OB-GYN who looks like them, and Wilmot-Burton did just that.

“I thought maybe she would be more caring, be more willing to listen to my issues, which she was,” she said.

But Black doctors make up a tiny share of OB-GYNs nationwide. Of the estimated 43,700 practicing OB-GYNs, 7.5% are Black women, according to 2023 data from the American Medical Association and the Association of American Medical Colleges. Even fewer — 2.3% — are Black men.

Deborah Frazier, the CEO of National Healthy Start, said medical organizations must let go of any stigma about paternal involvement. Black and brown fathers still face stereotypes of absenteeism.

“We have data and interviews with fathers, and those fathers have told us that they wanted to be there with their partners, and they wanted be present for their births,” Frazier said.

Charles Johnson IV founded 4Kira4Moms in 2017 after his wife, Kira, bled to death during a cesarean section at Cedars-Sinai hospital in Los Angeles. Johnson sued the hospital in 2022, saying she died because of a culture of racism.

Fathers should be able to walk the line between assertive and aggressive while still being a “force in the room,” the group’s executive director Gabrielle Albert said.

“What if you happen to be 6-foot-5 and 200-something pounds? If you speak up, what’s gonna happen?” Albert said. “Let’s role-play conversations. How do you push back against the doctor?”

From dad to doula

In August — two months before Wilmot-Burton gave birth — Burton was one of a dozen prospective dads holding a Black baby doll at a Dads to Doulas workshop. Facilitator Kyra Betts Patton tells them studies show present fathers-to-be can lower the chances of premature births.

“The largest time frame for maternal mortality, you’re looking at 43 to 100 days after you’ve had a baby. No one’s there but the partner,” Patton said.

Burton said the classes gave him the courage to advocate throughout the pregnancy, and that he took a checklist of questions from the class to every appointment.

“I pushed hard prior to the delivery to make sure that our birth plan was followed, even though it wasn’t completely. But she (Phoenix) still turned out great and was delivered successfully,” said Burton. He also took classes with the Indiana Breastfeeding Coalition.

Wilmot-Burton gives her husband credit for taking these workshops while also working and attending grad school. His presence was vital, especially when she felt unwell or was nervous.

“I would encourage other Black women to make sure their partners are on board to attend some classes or read books,” she said, “and definitely go to as many appointments as they can.”

Tang reported from Phoenix.

By CHEYANNE MUMPHREY

Children living through the latest war in the Middle East or seeing images of the conflict may need help making sense of events that many adults find unnerving. Exposure to war, even if it is indirect, can affect how kids think, feel and behave, according to mental health experts.

Child psychologists and development specialists encourage parents to check in with their children, make time for age-appropriate conversations and to correct misinformation without going into excessive detail.

“Sometimes adults think if they don’t talk about something that is difficult, than it doesn’t exist. But we know that’s not the reality in children’s lives,” said Rebecca Smith, the global head of child protection at Save the Children, an international aid and advocacy organization. “Ignoring or avoiding the topic of conflict can lead to children feeling lost, alone and scared. … It is essential to have open and honest conversations with children to help them process what is happening.”

Below are suggestions for having conversations with children about war and its impacts.

Create a safe space, then listen and validate feelings

Experts recommend starting with what a child might know about what is happening in Ukraine, Gaza, Iran, Israel, Sudan or other parts of the world before attempting to address any feelings of fear, sadness, anger or anxiety.

Some children may not know that fighting has escalated between the United States and Israel on one side and Iran and its proxies on the other. Other kids may be more aware than their families realize and suppress their emotions. Children visiting or living in Middle Eastern countries directly impacted will have seen weapons light up the sky and may know people killed or have to leave their homes.

“For some children where missiles are now visible in the skies, this might be an entirely new and terrifying experience,” Smith said. “When events like this happen, they disrupt a child and family’s sense of safety. What once felt stable and secure may suddenly feel uncertain.”

To help children work through their emotions, the trusted adults in their lives also need to take care of themselves, according to experts. Guidance from the National Child Traumatic Stress Network says adults sharing their own feelings with children can be an opportunity to convey personal beliefs and values about how to treat others. The key is to not assume what children might be thinking or feeling.

If children do not want to talk or are not ready, experts suggest adults remain patient and tell children they are there for them.

“It is necessary to respect child’s ability to refuse communication, their ability not to talk or not to tell about something. Because they can have their own feelings, their own states, which they might not want to share,” child psychologist Nataliia Sosnovenko said, speaking in Ukrainian. Sosnovenko works with Voices of Children, a Ukrainian organization that provides psychological support and documents children’s experiences in the country during the yearslong war with Russia.

Some children might share what they have seen or heard, how they feel or ask questions when given an opportunity. Experts say this is when adults should validate their feelings and address what’s happening honestly while taking their ages and maturity levels into account.

Let their age guide the conversation

The American Psychological Association recommends giving kids basic, age-appropriate information about war and conflict, and addressing any upsetting images, headlines or conversations they were exposed to without going into details that might make them unnecessarily anxious. But ultimately, parents know their children best, experts say.

Families who have loved ones in the region may need to take the extra time to discuss the safety of their relatives and friends, and the difficulty of uncertainty. Families in the region themselves may need to have a plan in place for what to do if they become separated. Experts with Save the Children say to keep it simple and to practice the plan calmly.

Depending on how young, some children can understand the idea that two countries are fighting. But young children living abroad may not be able to distinguish between what they see on screens and what is happening nearby. For children in the U.S., the Iran war can seem much closer than it is if they are frequently seeing images on TV or social media, meaning they may need additional reassurance they are safe from danger.

Older children are likely to understand war and its consequences, which means they might be more concerned and have more questions, the American Psychological Association says. Adults may want to consider focusing on what is within their control and giving children some agency, such as supporting humanitarian efforts, staying informed and addressing misinformation.

UNICEF, the United Nations agency that provides humanitarian aid and long-term support to children worldwide, says it is OK to not have all the answers.

In Lebanon, some families have sought refuge since Saturday in a brick school building. Nora Ingdal, Save the Children’s Lebanon Country Director, says children there are asking several questions about the reason for conflict and when things might return to normal.

“This one daughter was clinging to her mother and looking up to her mom and asking, ‘Mom, why are they fighting? Why are they attacking us?’ The mother looks at me, but has no answer. Then she’s asking, ‘When are we gonna go home?’ Again, the mom looked at me,” Ingdal said. “I said to her, ‘It’s all right to say that you don’t know, you cannot guarantee anything, but I’m here with you.’”

Limit unnecessary exposure and use this as a teaching opportunity

While some global agencies say children should be aware of what is happening in the world, experts say adults still have a responsibility to keep youngsters safe and limit unnecessary exposure.

Parents are encouraged to pay attention to how exposed children are to the news. The younger the child, the less exposure they should have, according to the National Child Traumatic Stress Network.

Some agencies recommend switching off the news entirely or limiting conversations about distressing events with other adults if children can hear. Others recommend using the opportunity to educate children on the importance of news, understanding where to find accurate facts and how to identify when something is not true or deceiving.

Save the Children says caregivers can model responsible digital behavior, encourage kids not to spread harmful or graphic information and remind them to think twice before sharing content that is possibly inaccurate or emotionally triggering.

It is important for caregivers of children living in conflict zones to remember that some kids do not know a time before war and do not have the ability to disconnect from what is happening around them, Sosnovenko said. That’s where professional help might support conversations and education.

“During the war, the types of people who come to us have changed,” she said. “Thanks to the fact that the psychological culture of the population is improving, people began to understand that therapy is important. These days, help of a psychologist is needed by most people and children as well.”

AP journalist Illia Novikov in Kyiv, Ukraine, contributed to this story.

By Darius Tahir, Lauren Sausser, KFF Health News

It’s the rare policy question that unites Republican Gov. Ron DeSantis of Florida and the Democratic-led Maryland government against President Donald Trump and Gov. Gavin Newsom of California: How should health insurers use AI?

Regulating artificial intelligence, especially its use by health insurers, is becoming a politically divisive topic, and it’s scrambling traditional partisan lines.

Boosters, led by Trump, are not only pushing its integration into government, as in Medicare’s experiment using AI in prior authorization, but also trying to stop others from building curbs and guardrails. A December executive order seeks to preempt most state efforts to govern AI, describing “a race with adversaries for supremacy” in a new “technological revolution.”

“To win, United States AI companies must be free to innovate without cumbersome regulation,” Trump’s order said. “But excessive State regulation thwarts this imperative.”

Across the nation, states are in revolt. At least four — Arizona, Maryland, Nebraska, and Texas — enacted legislation last year reining in the use of AI in health insurance. Two others, Illinois and California, enacted bills the year before.

Legislators in Rhode Island plan to try again this year after a bill requiring regulators to collect data on technology use failed to clear both chambers last year. A bill in North Carolina requiring insurers not to use AI as the sole basis of a coverage decision attracted significant interest from Republican legislators last year.

DeSantis, a former GOP presidential candidate, has rolled out an “AI Bill of Rights,” whose provisions include restrictions on its use in processing insurance claims and a requirement allowing a state regulatory body to inspect algorithms.

“We have a responsibility to ensure that new technologies develop in ways that are moral and ethical, in ways that reinforce our American values, not in ways that erode them,” DeSantis said during his State of the State address in January.

Ripe for Regulation

Polling shows Americans are skeptical of AI. A December poll from Fox News found 63% of voters describe themselves as “very” or “extremely” concerned about artificial intelligence, including majorities across the political spectrum. Nearly two-thirds of Democrats and just over 3 in 5 Republicans said they had qualms about AI.

Health insurers’ tactics to hold down costs also trouble the public; a January poll from KFF found widespread discontent over issues like prior authorization. (KFF is a health information nonprofit that includes KFF Health News.) Reporting from ProPublica and other news outlets in recent years has highlighted the use of algorithms to rapidly deny insurance claims or prior authorization requests, apparently with little review by a doctor.

Last month, the House Ways and Means Committee hauled in executives from Cigna, UnitedHealth Group, and other major health insurers to address concerns about affordability. When pressed, the executives either denied or avoided talking about using the most advanced technology to reject authorization requests or toss out claims.

AI is “never used for a denial,” Cigna CEO David Cordani told lawmakers. Like others in the health insurance industry, the company is being sued for its methods of denying claims, as spotlighted by ProPublica. Cigna spokesperson Justine Sessions said the company’s claims-denial process “is not powered by AI.”

Indeed, companies are at pains to frame AI as a loyal servant. Optum, part of health giant UnitedHealth Group, announced Feb. 4 that it was rolling out tech-powered prior authorization, with plenty of mentions of speedier approvals.

“We’re transforming the prior authorization process to address the friction it causes,” John Kontor, a senior vice president at Optum, said in a press release.

Still, Alex Bores, a computer scientist and New York Assembly member prominent in the state’s legislative debate over AI, which culminated in a comprehensive bill governing the technology, said AI is a natural field to regulate.

“So many people already find the answers that they’re getting from their insurance companies to be inscrutable,” said Bores, a Democrat who is running for Congress. “Adding in a layer that cannot by its nature explain itself doesn’t seem like it’ll be helpful there.”

At least some people in medicine — doctors, for example — are cheering legislators and regulators on. The American Medical Association “supports state regulations seeking greater accountability and transparency from commercial health insurers that use AI and machine learning tools to review prior authorization requests,” said John Whyte, the organization’s CEO.

Whyte said insurers already use AI and “doctors still face delayed patient care, opaque insurer decisions, inconsistent authorization rules, and crushing administrative work.”

Insurers Push Back

With legislation approved or pending in at least nine states, it’s unclear how much of an effect the state laws will have, said University of Minnesota law professor Daniel Schwarcz. States can’t regulate “self-insured” plans, which are used by many employers; only the federal government has that power.

But there are deeper issues, Schwarcz said: Most of the state legislation he’s seen would require a human to sign off on any decision proposed by AI but doesn’t specify what that means.

The laws don’t offer a clear framework for understanding how much review is enough, and over time humans tend to become a little lazy and simply sign off on any suggestions by a computer, he said.

Still, insurers view the spate of bills as a problem. “Broadly speaking, regulatory burden is real,” said Dan Jones, senior vice president for federal affairs at the Alliance of Community Health Plans, a trade group for some nonprofit health insurers. If insurers spend more time working through a patchwork of state and federal laws, he continued, that means “less time that can be spent and invested into what we’re intended to be doing, which is focusing on making sure that patients are getting the right access to care.”

Linda Ujifusa, a Democratic state senator in Rhode Island, said insurers came out last year against the bill she sponsored to restrict AI use in coverage denials. It passed in one chamber, though not the other.

“There’s tremendous opposition” to anything that regulates tactics such as prior authorization, she said, and “tremendous opposition” to identifying intermediaries such as private insurers or pharmacy benefit managers “as a problem.”

In a letter criticizing the bill, AHIP, an insurer trade group, advocated for “balanced policies that promote innovation while protecting patients.”

“Health plans recognize that AI has the potential to drive better health care outcomes — enhancing patient experience, closing gaps in care, accelerating innovation, and reducing administrative burden and costs to improve the focus on patient care,” Chris Bond, an AHIP spokesperson, told KFF Health News. And, he continued, they need a “consistent, national approach anchored in a comprehensive federal AI policy framework.”

Seeking Balance

In California, Newsom has signed some laws regulating AI, including one requiring health insurers to ensure their algorithms are fairly and equitably applied. But the Democratic governor has vetoed others with a broader approach, such as a bill including more mandates about how the technology must work and requirements to disclose its use to regulators, clinicians, and patients upon request.

Chris Micheli, a Sacramento-based lobbyist, said the governor likely wants to ensure the state budget — consistently powered by outsize stock market gains, especially from tech companies — stays flush. That necessitates balance.

Newsom is trying to “ensure that financial spigot continues, and at the same time ensure that there are some protections for California consumers,” he said. He added insurers believe they’re subject to a welter of regulations already.

The Trump administration seems persuaded. The president’s recent executive order proposed to sue and restrict certain federal funding for any state that enacts what it characterized as “excessive” state regulation — with some exceptions, including for policies that protect children.

That order is possibly unconstitutional, said Carmel Shachar, a health policy scholar at Harvard Law School. The source of preemption authority is generally Congress, she said, and federal lawmakers twice took up, but ultimately declined to pass, a provision barring states from regulating AI.

“Based on our previous understanding of federalism and the balance of powers between Congress and the executive, a challenge here would be very likely to succeed,” Shachar said.

Some lawmakers view Trump’s order skeptically at best, noting the administration has been removing guardrails, and preventing others from erecting them, to an extreme degree.

“There isn’t really a question of, should it be federal or should it be state right now?” Bores said. “The question is, should it be state or not at all?”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Darius Tahir, KFF Health News

Republicans think patients should be shopping for better health care prices. The party has long pushed to give patients money and let consumers do the work of reducing costs. After some GOP lawmakers closed out 2025 advocating to fund health savings accounts, President Donald Trump introduced his Great Healthcare Plan, which calls for, among other policies, requiring providers and insurers to post their prices “in their place of business.”

The idea echoes a policy implemented during his first term, when Trump suggested that requiring hospitals to post their charges online could ease one of the most common gripes about the health care system — the lack of upfront prices. To anyone who’s gotten a bill three months after treatment only to find mysterious charges, the idea seemed intuitive.

“You’re able to go online and compare all of the hospitals and the doctors and the prices,” Trump said in 2019 at an event unveiling the price transparency policy.

But amid low compliance and other struggles in implementing the policy since it took effect in 2021, the available price data is sparse and often confusing. And instead of patients shopping for medical services, it’s mostly health systems and insurers using the little data there is, turning it into fodder for negotiations that determine what medical professionals and facilities get paid for what services.

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

Not all hospitals have fallen in line with the price transparency rules, and many were slow to do so. A study conducted in the policy’s first 10 months found only about a third of facilities had complied with the regulations. The federal Centers for Medicare & Medicaid Services notified 27 hospitals from June 2022 to May 2025 that they would be fined for lack of compliance with the rules.

The struggles to make health care prices available have prompted more federal action since Trump’s first effort. President Joe Biden took his own thwack at the dilemma, by requiring increased data standardization and toughening compliance criteria. And in early 2025, working to fulfill his promises to lower health costs, Trump tried again, signing a new executive order urging his administration to fine hospitals and doctors for failing to post their prices. CMS followed up with a regulation intended to up the fines and increase the level of detail required within the pricing data.

So far, “there’s no evidence that patients use this information,” said Zack Cooper, a health economist at Yale University.

In 2021, Cooper co-authored a paper based on data from a large commercial insurer. The researchers found that, on average, patients who need an MRI pass six lower-priced imaging providers on the way from their homes to an appointment for a scan. That’s because they follow their physician’s advice about where to receive care, the study showed.

Executives and researchers interviewed by KFF Health News also didn’t think opening the data would change prices in a big way. Research shows that transparency policies can have mixed effects on prices, with one 2024 study of a New York initiative finding a marginal increase in billed charges.

The policy results thus far seem to put a damper on long-held hopes, particularly from the GOP, that providing more price transparency would incentivize patients to find the best deal on their imaging or knee replacements.

These aspirations have been unfulfilled for a few reasons, researchers and industry insiders say. Some patients simply don’t compare services. But unlike with apples — a Honeycrisp and a Red Delicious are easy to line up side by side — medical services are hard to compare.

For one thing, it’s not as simple as one price for one medical stay. Two babies might be delivered by the same obstetrician, for example, but the mothers could be charged very different amounts. One patient might be given medications to speed up contractions; another might not. Or one might need an emergency cesarean section — one of many cases in medicine in which obtaining the service simply isn’t a choice.

And the data often is presented in a way that’s not useful for patients, sometimes buried in spreadsheets and requiring a deep knowledge of billing codes. In computing these costs, hospitals make “detailed assumptions about how to apply complex contracting terms and assess historic data to create a reasonable value for an expected allowed amount,” the American Hospital Association told the Trump administration in July 2025 amid efforts to boost transparency.

Costs vary because hospitals’ contracts with insurers vary, said Jamie Cleverley, president of Cleverley and Associates, which works with health care providers to help them understand the financial impacts of changing contract terms. The cost for a patient with one health plan may be very different than the cost for the next patient with another plan.

The fact that hospital prices might be confusing for patients is a consequence of the lack of standardization in contracts and presentation, Cleverley said. “They’re not being nefarious.”

“Until we kind of align as an industry, there’s going to continue to be this variation in terms of how people look at the data and the utility of it,” he said.

Instead of aiding shoppers, the federally mandated data has become the foundation for negotiations — or sometimes lawsuits — over the proper level of compensation.

The top use for the pricing data for health care providers and payers, such as insurers, is “to use that in their contract negotiations,” said Marcus Dorstel, an executive at price transparency startup Turquoise Health.

Turquoise Health assembles price data by grouping codes for services together using machine learning, a type of artificial intelligence. It is just one example in a cottage industry of startups offering insights into prices. And, online, the startups’ advertisements hawking their wares often focus on hospitals and their periodic jousts with insurers. Turquoise has payers and providers as clients, Dorstel said.

“I think nine times out of 10 you will hear them say that the price transparency data is a vital piece of the contract negotiation now,” he said.

Of course, prices aren’t the only variable that negotiations hinge on. Hoag said Blue Cross Blue Shield of Minnesota also considers quality of care, rates of unnecessary treatments, and other factors. And sometimes negotiators feel as if they have to keep up with their peers — claiming a need for more revenue to match competitors’ salaries, for example.

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

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

By KAITLYN HUAMANI and BARBARA ORTUTAY The Associated Press

LOS ANGELES (AP) — A young woman who is battling against social media giants took the stand Thursday to testify about her experience using the platforms as she was growing up, saying she was on social media “all day long” as a child.

The now 20-year-old, who has been identified in court documents as KGM, says her early use of social media addicted her to the technology and exacerbated depression and suicidal thoughts. Meta and YouTube are the two remaining defendants in the case, which TikTok and Snap have settled.

The case, along with two others, has been selected as a bellwether trial, meaning its outcome could impact how thousands of similar lawsuits against social media companies are likely to play out.

KGM, or Kaley, as her lawyers have called her during the trial, started using YouTube at age 6 and Instagram at age 9.

A turbulent home life

Kaley took the stand wearing a pink floral dress and a beige cardigan and said she was “very nervous” after her attorney, Mark Lanier, asked how she was doing Thursday morning.

Lanier displayed childhood photos of Kaley and her family and asked about positive memories from her upbringing in a quiet cul-de-sac in Chico, California. She spoke of themed birthday parties, trips to Six Flags and her mom’s consistent efforts to make her childhood special.

Still, Kaley’s relationship with her mother was challenging at times. Kaley said most of their arguments were over the use of her phone.

Both the defendants and the plaintiff have pointed to a turbulent home life for Kaley. Her attorneys say she was preyed upon as a vulnerable user, but attorneys representing Meta and Google-owned YouTube have argued Kaley turned to their platforms as a coping mechanism or a means of escaping her mental health struggles.

When asked about claims that her mother had hit her, abused her and neglected her, Kaley said “she wasn’t perfect, but she was trying her best,” and clarified that she doesn’t think she would label her mother’s past actions as abuse or neglect today.

But later Thursday, during her cross-examination, Kaley did agree that her mother was being physically and emotionally abusive during the time that she was self-harming around when she was in the 6th grade.

Kaley, who works as a personal shopper at Walmart, lives with her mother in the home she grew up in.

Notifications gave her a ‘rush’

As a child, Kaley set up multiple accounts on both Instagram and YouTube so she could like and comment on her posts. She said she would also “buy” likes through a platform where she could like other people’s photos and get a slew of likes in return. “It made me look popular,” she said.

Kaley was asked specifically about the features the plaintiffs argue are deliberately designed to be addictive, including notifications. Those notifications on both Instagram and YouTube gave her a “rush,” she said. She would receive them throughout the day and would go to the bathroom during school to check them — something she still does.

Kaley said while she uses YouTube less often now, she believes she was previously addicted to it. “Anytime I tried to set limits for myself, it wouldn’t work and I just couldn’t get off,” she said.

Filters on Instagram, specifically those that could change a person’s cosmetic appearance, have also loomed large in the case and were also a constant fixture of Kaley’s use. Lanier and his colleagues unfurled a nearly 35-foot-long canvas banner with photos Kaley has posted on Instagram. She said “almost all” of the photos had a filter on them.

The jury was also shown Instagram posts and YouTube videos Kaley posted as a child and young teen. One video showed her saying she was “crying tears of joy” after surpassing 100 YouTube subscribers — but then she quickly turned to her looks, apologizing for her “ugly appearance.”

“I look so fat in this shirt,” the young Kaley says in the video.

Kaley said she did not experience the negative feelings associated with her body dysmorphia diagnosis before she began using social media and filters.

Meta focuses on plaintiff’s home life, contradicting statements

Meta has argued that Kaley faced significant challenges before she ever used social media. The company’s lawyer, Paul Schmidt, said earlier this month that the core question in the case is whether the platforms were a substantial factor in Kayley’s mental health struggles.

Meta attorney Phyllis Jones took a polite, respectful tone in her cross-examination Thursday, acknowledging that it could be uncomfortable for her to speak about her private life in front of a room of strangers. Jones proceeded to zero in on Kaley’s home life and did not ask her any questions about social media addiction within the first hour and a half of the cross-examination.

Jones pulled up text exchanges and posts Kaley had made on Instagram about her mental health and her relationship with her mother and played videos Kaley took of her mother yelling at her.

On nearly 20 occasions during the Meta cross-examination, Jones asked Kaley to look at the transcript from her 2025 deposition, which contradicted some of the responses she gave during her testimony. Many of those questions were about how a specific action by her family members or a specific experience impacted her mental health, with Kaley saying on Thursday they either didn’t have an impact or didn’t significantly contribute to anxiety and depression. Her deposition from about a year ago often said the opposite.

“I tried to answer the questions to the best of my ability, but I may have misspoke at times,” Kaley said of her deposition.

This time, Kaley did agree that her mother was being physically and emotionally abusive during the time that she was self-harming around when she was in the 6th grade. She testified earlier in the day that she doesn’t think she would label her mother’s past actions as abuse or neglect today.

Therapist: Social media and sense of self ‘were closely related’

Victoria Burke, a former therapist Kaley worked with in 2019, testified on Wednesday, and Burke said her social media and her sense of self “were closely related,” adding that what was happening on the platforms could “make or break her mood.”

An attorney for Meta parsed through Burke’s notes from her sessions with Kaley extensively in a cross examination that lasted about three hours. He highlighted Kaley’s negative experiences with in-person bullying, other school-based sources of stress and anxiety and issues with her family. Mentions of social media in the notes were mostly limited to Kaley saying she didn’t feel she had a place at home, at school or among her peers, but did feel she had a place to be seen on social media.

Burke’s treatment of Kaley lasted about six months and that period took place seven years ago.

The case is expected to continue for several weeks, and the outcome the jury reaches could shape the outcome of a slew of similar lawsuits against social media companies. Meta is also facing a separate trial in New Mexico.

Matthew Nix had driven past the brewery in Sauganash for years, but — not much of a weekday drinker — had never stopped in.

When he finally decided to meet friends at the taproom on a recent Saturday to play some cards, he found bartenders dancing on countertops, dogs wearing sweaters and the last of the beer draining from the tap. It was the farewell party for Alarmist Brewing.

“This is my first time here, first and obviously last,” said Nix, 36, a high school teacher living in the Edgewater neighborhood, about the closure.

In Illinois and across the country, breweries have been struggling as consumers seek healthier drinking habits or have a wider range of options, such as THC-infused drinks, as business costs continue to rise. Many have closed their doors, while others have redefined its meaning as a social space that offers beverage variety and events.

In Chicago alone, a handful of breweries have closed or consolidated in recent years, including Metropolitan Brewing, Revolution Brewing Brewpub and Lo Rez Brewing and Taproom. 

The number of U.S breweries closing outpaced those that opened for the second year in a row in 2025 for a net loss of 179 last year, according to preliminary 2025 data from Brewers Association, a trade group for small American brewers.

It stands in stark contrast from a decade ago — a golden age — for craft brewers when the number of breweries opening was about 10 times higher than those closing, according to Matt Gacioch, staff economist at Brewers Association.

One industry challenge is that Americans are now drinking less. A 2025 Gallup poll showed that only 54% of U.S. adults said they consume alcohol — the lowest percentage in 90 years. 

Figures are even lower among young adults with only 50% reporting that they drink alcohol. These numbers fall in line with healthier drinking trends like “sober curious” and “Dry January,” which seek mindful and moderate drinking.

On top of drinking less, consumers are also seeking wider beverage options from nonalcoholic drinks to hard seltzers, which adds pressure for traditional craft breweries specializing in beer.

Sports and music arena United Center is expected to start selling THC-infused drinks Señorita and Rythm at its stands this month — apparently the largest U.S. arena to do so. 

“Bringing Señorita and Rythm to the United Center reflects a simple truth: Consumers want nonalcoholic options, and leading venues are responding,” Ben Kovler, Rythm, Inc. chairman and interim CEO, said in a statement last month.

Other music venues that sell cannabis-derived drinks are the Salt Shed, Riviera, Ramova Theatre and Thalia Hall, taking up coveted beverage shelf space.

“There’s just so much more competition in terms of consumer attention and physical retail space,” Gacioch said. “There’s this whole world of other options.” 

Rising business expenses and the cost of goods like aluminum have also contributed to the strain, particularly after the pandemic.

“You have the increased cost of just about everything,” said Andrew Heritage, chief economist at the Beer Institute, noting the increase in operating costs, rent and labor. 

Some Chicago breweries were unable to recover, with Lo Rez Brewing in the Pilsen neighborhood closing its doors in 2023 in what cofounder Dave Dahl called a “pandemic casualty.” Another staple in the craft industry, Metropolitan Brewing, one of Chicago’s oldest, closed in 2023 after filing for Chapter 11 bankruptcy.

Most recently, award-winning Alarmist Brewing closed on Feb. 1 after years of struggling with falling business after the pandemic.

“The bottom line is we’re just not selling,” said Alarmist owner Gary Gulley. “It just never recovered since COVID.”

Illinois lost over 30 breweries in two years after 2020, falling to 218 total breweries, according to data from the Beer Institute. By 2024, the number of Illinois breweries rebounded to 251.

Some breweries have adapted to create third spaces, a place to mingle and play trivia with friends — and pups.

“I like a place where you can bring your dog, you can bring a book,” Nix said, likening these breweries to social spaces where you can play card games. 

One brewery that has been bolstering events and activities is Maplewood Brewery and Distillery in the Logan Square neighborhood. The decade-old brewery holds events like its upcoming Pulaski Day Party to celebrate its Pulaski pilsner, trivia nights and beer festivals to cultivate brand loyalty.

“We have our core brand that we make, but we’re always coming out with something new and fun … that’s helped us out,” said Paul Megalis, co-owner and CFO of Maplewood Brewery.

Their expansive beverage options include ready-to-drink rum punch cocktails, in-house coffee liqueurs for espresso martini lovers and seasonal beer concoctions. 

“We’ve essentially been a beverage company since Day 1, and so we’ve always had a diversified portfolio. I mean, we just hustle,” Megalis said.

They plan to open a second location in Glen Ellyn slated for this spring.

Despite the changing tides in the craft beer business, experts believe craft breweries are evolving not disappearing.

“Craft beer industry is nothing if not creative,” Gacioch said.

By BARBARA ORTUTAY and KAITLYN HUAMANI, AP Technology Writers

Social media addiction has been compared to casinos, opioids and cigarettes.

While there’s some debate among experts about the line between overuse and addiction, and whether social media can cause the latter, there is no doubt that many people feel like they can’t escape the pull of Instagram, TikTok, Snapchat and other platforms.

The companies that designed your favorite apps have an incentive to keep you glued to them so they can serve up ads that make them billions of dollars in revenue. Resisting the pull of the endless scroll, the dopamine hits from short-form videos and the ego boost and validation that come from likes and positive interactions, can seem like an unfair fight. For some people, “rage-bait,” gloomy news and arguing with internet strangers also have an irresistible draw.

Much of the concern around social media addiction has focused on children. But adults are also susceptible to using social media so much that it starts affecting their day-to-day lives.

Recognizing signs of compulsive use

Dr. Anna Lembke, a psychiatrist and the medical director of addiction medicine at Stanford University’s School of Medicine, defines addiction as “the continued compulsive use of a substance or behavior despite harm to self or others.”

During her testimony at a landmark social media harms trial in Los Angeles, Lembke said that what makes social media platforms so addictive is the “24/7, really limitless, frictionless access” people have to them.

Some researchers question whether addiction is the appropriate term to describe heavy use of social media, arguing that a person must be experiencing identifiable symptoms. These include strong, sometimes uncontrollable urges and withdrawal to qualify as addiction.

Social media addiction is not recognized as an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, which is the standard reference psychiatrists and other mental health practitioners use to assess and treat patients. That’s partly because there is no widespread consensus on what constitutes social media addiction and whether underlying mental health issues contribute to problematic use.

But just because there is no official agreement on the issue doesn’t mean excessive social media use can’t be harmful, some experts say.

“For me, the biggest signpost is how does the person feel about the ‘amount,’ and how viewing it makes them feel,” said Dr. Laurel Williams, professor of psychiatry and behavioral sciences at Baylor College of Medicine. “If what they discover is they view it so much that they are missing out on other things they may enjoy or things that they need to attend to, this is problematic use. Additionally, if you leave feeling overwhelmed, drained, sad, anxious, angry regularly, this use is not good for you.”

In other words, is your use of social media affecting other parts of your life? Are you putting off chores, work, hobbies or time with friends and family? Have you tried to cut back your time but realized you were unable to? Do you feel bad about your social media use?

Ofir Turel, a professor of information systems management at the University of Melbourne who has studied social media use for years, said there was “no agreement” over the term social media addiction, and he doesn’t “expect agreement soon.”

“It’s obvious that we have an issue,” Turel said. “You don’t have to call it an addiction, but there is an issue and we need, as a society, to start thinking about it.”

Noninvasive tips to reduce social media use

Before setting limits on scrolling, it’s helpful to understand how social media feeds and advertising work to draw in users, Williams said.

“Think of social media as a company trying to get you to stay with them and buy something — have the mindset that this is information that I don’t need to act on and may not be true,” she added. “Get alternate sources of information. Always understand the more you see something, anyone can start to believe it is true.”

Ian A. Anderson, a postdoctoral scholar at California Institute of Technology, suggests making small, meaningful changes to stop you from opening your social media app of choice. Moving the app’s place on your phone or turning off notifications are “light touch interventions,” but more involved options, like not bringing your phone into the bedroom or other places where you tend to use it, could also help, Anderson said.

Tech tools can also help to cut back on tech overuse. Both iPhones and Android devices have onboard controls to help regulate screen time.

Apple’s Screen Time controls are found in the iPhone’s settings menu. Users can set overall Downtime, which shuts off all phone activity during a set period of their choice.

The controls also let users put a blanket restriction on certain categories of apps, such as social, games or entertainment or zero in on a specific app, by limiting the time that can be spent on it.

The downside is that the limits aren’t hard to get around. It’s more of a nudge than a red line that you can’t cross. If you try to open an app with a limit, you’ll get a screen menu offering one more minute, a reminder after 15 minutes, or to completely ignore it.

If a light touch doesn’t work

If a light touch isn’t working, more drastic steps might be necessary. Some users swear by turning their phones to gray-scale to make it less appealing to dopamine-seeking brains. On iPhones, adjust the color filter in your settings. For Android, turn on Bedtime Mode or tweak the color correction setting. Downgrading to a simpler phone, such as an old-school flip phone, could also help curb social media compulsions.

Some startups, figuring that people might prefer a tangible barrier, offer hardware solutions that introduce physical friction between you and an app. Unpluq, for instance, is a yellow tag that you have to hold up to your phone in order to access blocked apps. Brick and Blok are two different products that work along the same lines — they’re squarish pieces of plastic that you have to tap or scan with your phone to unlock an app.

If that’s not enough of an obstacle, you could stash away your phone entirely. There are various phone lockboxes and cases available, some of them designed so parents can lock up their teenagers’ phones when they’re supposed to be sleeping, but there’s no rule that says only teenagers can use them.

Yondr, which makes portable phone locking pouches used at concerts or in schools, also sells a home phone box.

Seeking outside help

If all else fails, it may be a good idea to look for deeper reasons for feeling addicted to social media. Maybe it’s a symptom of underlying problems like anxiety, stress, loneliness, depression or low self-esteem. If you think that’s the case, it could be worth exploring therapy that is becoming more widely available.

“For people struggling to stay away — see if you can get a friend group to collaborate with you on it. Make it a group effort. Just don’t post about it! The more spaces become phone free, the more we may see a lessened desire to be ‘on,’” Williams said.

By Claudia Boyd-Barrett, Oona Zenda, KFF Health News

Lydia Romero strained to hear her husband’s feeble voice through the phone.

A week earlier, immigration agents had grabbed Julio César Peña from his front yard in Glendale, California. Now, he was in a hospital after suffering a ministroke. He was shackled to the bed by his hand and foot, he told Romero, and agents were in the room, listening to the call. He was scared he would die and wanted his wife there.

“What hospital are you at?” Romero asked.

“I can’t tell you,” he replied.

Viridiana Chabolla, Peña’s attorney, couldn’t get an answer to that question, either. Peña’s deportation officer and the medical contractor at the Adelanto ICE Processing Center refused to tell her. Exasperated, she tried calling a nearby hospital, Providence St. Mary Medical Center.

“They said even if they had a person in ICE custody under their care, they wouldn’t be able to confirm whether he’s there or not, that only ICE can give me the information,” Chabolla said. The hospital confirmed this policy to KFF Health News.

Family members and attorneys for patients hospitalized after being detained by federal immigration officials said they are facing extreme difficulty trying to locate patients, get information about their well-being, and provide them emotional and legal support. They say many hospitals refuse to provide information or allow contact with these patients. Instead, hospitals allow immigration officers to call the shots on how much — if any — contact is allowed, which can deprive patients of their constitutional right to seek legal advice and leave them vulnerable to abuse, attorneys said.

Hospitals say they are trying to protect the safety and privacy of patients, staff, and law enforcement officials, even while hospital employees in Los Angeles, Minneapolis, and Portland, Oregon, cities where Immigration and Customs Enforcement has conducted immigration raids, say it’s made their jobs difficult. Hospitals have used what are sometimes called blackout procedures, which can include registering a patient under a pseudonym, removing their name from the hospital directory, or prohibiting staff from even confirming that a patient is in the hospital.

“We’ve heard incidences of this blackout process being used at multiple hospitals across the state, and it’s very concerning,” said Shiu-Ming Cheer, the deputy director of immigrant and racial justice at the California Immigrant Policy Center, an advocacy group.

Some Democratic-led states, including California, Colorado, and Maryland, have enacted legislation that seeks to protect patients from immigration enforcement in hospitals. However, those policies do not address protections for people already in ICE custody.

More detainees hospitalized

Peña is among more than 350,000 people arrested by federal immigration authorities since President Donald Trump returned to the White House. As arrests and detentions have climbed, so too have reports of people taken to hospitals by immigration agents because of illness or injury — due to preexisting conditions or problems stemming from their arrest or detention.

ICE has faced criticism for using aggressive and deadly tactics, as well as for reports of mistreatment and inadequate medical care at its facilities. Sen. Adam Schiff, D-Calif., told reporters at a Jan. 20 news conference outside a detention center he visited in California City that he spoke to a diabetic woman held there who had not received treatment in two months.

While there are no publicly available statistics on the number of people sick or injured in ICE detention, the agency’s news releases point to 32 people who died in immigration custody in 2025. Six more have died this year.

The Department of Homeland Security, which oversees ICE, did not respond to a request for information about its policies or Peña’s case.

According to ICE’s guidelines, people in custody should be given access to a telephone, visits from family and friends, and private consultation with legal counsel. The agency can make administrative decisions, including about visitation, when a patient is in the hospital, but should defer to hospital policies on contacting next of kin when a patient is seriously ill, the guidelines state.

Asked in detail about hospital practices related to patients in immigration custody and whether there are best practices that hospitals should follow, Ben Teicher, a spokesperson for the American Hospital Association, declined to comment.

David Simon, a spokesperson for the California Hospital Association, said that “there are times when hospitals will — at the request of law enforcement — maintain confidentiality of patients’ names and other identifying characteristics.”

Although policies vary, members of the public can typically call a hospital and ask for a patient by name to find out whether they’re there, and often be transferred to the patient’s room, said William Weber, an emergency physician in Minneapolis and medical director for the Medical Justice Alliance, which advocates for the medical needs of people in law enforcement custody. Family members and others authorized by the patient can visit. And medical staff routinely call relatives to let them know a loved one is in the hospital, or to ask for information that could help with their care.

But when a patient is in law enforcement custody, hospitals frequently agree to restrict this kind of information sharing and access, Weber said. The rationale is that these measures prevent unauthorized outsiders from threatening the patient or law enforcement personnel, given that hospitals lack the security infrastructure of a prison or detention center. High-profile patients such as celebrities sometimes also request this type of protection.

Several attorneys and health care providers questioned the need for such restrictions. Immigration detention is civil, not criminal, detention. The Trump administration says it’s focused on arresting and deporting criminals, yet most of those arrested have no criminal conviction, according to data compiled by the Transactional Records Access Clearinghouse and several news outlets.

Taken outside his home

According to Peña’s wife, Romero, he has no criminal record. Peña came to the United States from Mexico in sixth grade and has an adult son in the U.S. military. The 43-year-old has terminal kidney disease and survived a heart attack in November. He has trouble walking and is partially blind, his wife said. He was detained Dec. 8 while resting outside after coming home from dialysis treatment.

Initially, Romero was able to find her husband through the ICE Online Detainee Locator System. She visited him at a temporary holding facility in downtown Los Angeles, bringing him his medicines and a sweater. She then saw he’d been moved to the Adelanto detention center. But the locator did not show where he was after he was hospitalized.

When she and other relatives drove to the detention facility to find him, they were turned away, she said. Romero received occasional calls from her husband in the hospital but said they were less than 10 minutes long and took place under ICE surveillance. She wanted to know where he was so she could be at the hospital to hold his hand, make sure he was well cared for, and encourage him to stay strong, she said.

Shackling him and preventing him from seeing his family was unfair and unnecessary, she said.

“He’s weak,” Romero said. “It’s not like he’s going to run away.”

ICE guidelines say contact and visits from family and friends should be allowed “within security and operational constraints.” Detainees have a constitutional right to speak confidentially with an attorney. Weber said immigration authorities should tell attorneys where their clients are and allow them to talk in person or use an unmonitored phone line.

Hospitals, though, fall into a gray area on enforcing these rights, since they are primarily focused on treating medical needs, Weber said. Still, he added, hospitals should ensure their policies align with the law.

Family denied access

Numerous immigration attorneys have spent weeks trying to locate clients detained by ICE, with their efforts sometimes thwarted by hospitals.

Nicolas Thompson-Lleras, a Los Angeles attorney who counsels immigrants facing deportation, said two of his clients were registered under aliases at different hospitals in Los Angeles County last year. Initially, the hospitals denied the clients were there and refused to let Thompson-Lleras meet with them, he said. Family members were also denied access, he said.

One of his clients was Bayron Rovidio Marin, a car wash worker injured during a raid in August. Immigration agents surveilled him for over a month at Harbor-UCLA Medical Center, a county-run facility, without charging him.

In November, the Los Angeles County Board of Supervisors voted to curb the use of blackout policies for patients under civil immigration custody at county-run hospitals. In a statement, Arun Patel, the chief patient safety and clinical risk management officer for the Los Angeles County Department of Health Services, said the policies are designed to reduce safety risks for patients, doctors, nurses, and custody officers.

“In some situations, there may be concerns about threats to the patient, attempts to interfere with medical care, unauthorized visitors, or the introduction of contraband,” Patel said. “Our goal is not to restrict care but to allow care to happen safely and without disruption.”

Leaving patients vulnerable

Thompson-Lleras said he’s concerned that hospitals are cooperating with federal immigration authorities at the expense of patients and their families and leaving patients vulnerable to abuse.

“It allows people to be treated suboptimally,” Thompson-Lleras said. “It allows people to be treated on abbreviated timelines, without supervision, without family intervention or advocacy. These people are alone, disoriented, being interrogated, at least in Bayron’s case, under pain and influence of medication.”

Such incidents are alarming to hospital workers. In Los Angeles, two health care professionals who asked not to be identified by KFF Health News, out of concern for their livelihoods, said that ICE and hospital administrators, at public and private hospitals, frequently block staff from contacting family members for people in custody, even to find out about their health conditions or what medications they’re on. That violates medical ethics, they said.

Blackout procedures are another concern.

“They help facilitate, whether intentionally or not, the disappearance of patients,” said one worker, a physician for the county’s Department of Health Services and part of a coalition of concerned health workers from across the region.

At Legacy Emanuel Medical Center in Portland, nurses publicly expressed outrage over what they saw as hospital cooperation with ICE and the flouting of patient rights. Legacy Health has sent a cease and desist letter to the nurses’ union, accusing it of making “false or misleading statements.”

“I was really disgusted,” said Blaire Glennon, a nurse who quit her job at the hospital in December. She said numerous patients were brought to the hospital by ICE with serious injuries they sustained while being detained. “I felt like Legacy was doing massive human rights violations.”

Handcuffed while unconscious

Two days before Christmas, Chabolla, Peña’s attorney, received a call from ICE with the answer she and Romero had been waiting for. Peña was at Victor Valley Global Medical Center, about 10 miles from Adelanto, and about to be released.

Excited, Romero and her family made the two-hour-plus drive from Glendale to the hospital to take him home.

When they got there, they found Peña intubated and unconscious, his arm and leg still handcuffed to the hospital bed. He’d had a severe seizure on Dec. 20, but no one had told his family or legal team, his attorney said.

Tim Lineberger, a spokesperson for Victor Valley Global Medical Center’s parent company, KPC Health, said he could not comment on specific patient cases, because of privacy protections. He said the hospital’s policies on patient information disclosure comply with state and federal law.

Peña was finally cleared to go home on Jan. 5. No court date has been set, and his family is filing a petition to adjust his legal status based on his son’s military service. For now, he still faces deportation proceedings.

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Susan Jaffe, KFF Health News

Ever since Larry Wilkewitz retired more than 20 years ago from a wood products company, he’s had a commercial Medicare Advantage plan from the insurer Humana.

But two years ago, he heard about Peak Health, a new Advantage plan started by the West Virginia University Health System, where his doctors practice. It was cheaper and offered more personal attention, plus extras such as an allowance for over-the-counter pharmacy items. Those benefits are more important than ever, he said, as he’s treated for cancer.

“I decided to give it a shot,” said Wilkewitz, 79. “If I didn’t like it, I could go back to Humana or whatever after a year.”

He’s sticking with Peak Health. Members of Medicare Advantage plans, a privately run alternative to the government’s Medicare program, can change plans through the end of March.

Now entering its third year, Peak Health has tripled its enrollment since last year, to “north of 10,000,” said Amos Ross, its president. It expanded from 20 counties to 49, he said, and moved into parts of western Pennsylvania for the first time.

Although hospital-owned plans are only a sliver of the Medicare Advantage market, their enrollment continues to grow, reflecting the overall increase in Advantage members. Of the 62.8 million Medicare beneficiaries eligible to join Advantage plans, 54% signed up last year, according to KFF, the health information nonprofit that includes KFF Health News. While the number of Advantage plans owned by hospital systems is relatively stable, Mass General Brigham in Boston and others are expanding their service areas and types of plan offerings.

Health systems have dabbled in the insurance business for years, but it’s not for everyone. MedStar Health, serving the greater Washington, D.C., area, said it closed its Medicare Advantage plan at the end of 2018, citing financial losses.

“It’s a ton of work,” said Ross, who spent more than a decade in the commercial health insurance industry.

Like any other health insurer, hospitals entering the business need a back-office infrastructure to enroll patients, sign up providers, fill prescriptions, process claims, hire staff, and — most importantly — assure state regulators they have a reserve of money to pay claims. Once they get a state insurance license, they need approval from the federal Centers for Medicare & Medicaid Services to sell Medicare Advantage policies. Some systems affiliate with or create an insurance subsidiary, and others do most of the job themselves.

Kaiser Permanente, the nation’s largest nonprofit health system by revenue, started an experimental Medicare plan in 1981 and now has nearly 2 million people enrolled in dozens of Advantage plans in eight states and the District of Columbia. The Justice Department announced Jan. 14 that KP had agreed to pay $556 million to settle accusations that its Advantage plans fraudulently billed the government for about $1 billion over a nine-year period.

Last year, UCLA Health introduced two Medicare Advantage plans in Los Angeles County, the most populous county in the United States. Other new hospital-owned plans have cropped up in less profitable rural areas.

“These are communities that have been very hard for insurers to move into,” said Molly Smith, group vice president for public policy at the American Hospital Association.

But Advantage plans offered by hospitals have a familiar, trusted name. They don’t have to move into town, because their owners — the hospitals — never left.

Bad Breakups

Medicare Advantage plans usually restrict their members to a network of doctors, hospitals, and other clinicians that have contracts with the plans to serve them. But if hospitals and plans can’t agree to renew those contracts, or when disputes flare up — often spurred by payment delays, denials, or burdensome prior authorization rules — the health care providers can drop out.

These breakups, plus planned terminations and service area cuts, forced more than 3.7 million Medicare Advantage enrollees to make a tough choice last year: find new insurance for 2026 that their doctors accept or, if possible, keep their plan but find new doctors.

About 1 million of these stranded patients had coverage from UnitedHealthcare, the country’s largest health insurer. In a July earnings update for financial analysts, chief financial officer John Rex blamed the company’s retreat on hospitals, where “most encounters are intensifying in services and costing more.”

The turbulence in the commercial insurance market has upset patients as well as their providers. Sometimes contract disputes have been fought out in the open, with anxious patients in the middle receiving warnings from each side blaming the other for the imminent end to coverage.

When Fred Neary, 88, learned his doctors in the Baylor Scott & White Health system in central and northern Texas would be leaving his Medicare Advantage plan, he was afraid the same thing could happen again if he joined a plan from another commercial insurer. Then he discovered that the 53-hospital system had its own Medicare Advantage plan. He enrolled in 2025 and is keeping the plan this year.

“It was very important to me that I would never have to worry about switching over to another plan because they would not accept my Baylor Scott & White doctors,” he said.

Eugene Rich, a senior fellow at Mathematica, a health policy research group, said hospital systems’ Medicare Advantage plans offer “a lot of stability for patients.”

“You’re not suddenly going to discover that your primary care physician or your cardiologist are no longer in the plan,” he said.

A Health Affairs study that Rich co-authored in July found that enrollment in Advantage plans owned by hospital systems grew faster than traditional Medicare enrollment for the first time in 2023, though not as rapidly as the overall rise in sign-ups for all Advantage plans.

The massive UCLA Health system introduced its two Medicare Advantage plans in Los Angeles County in January 2025, even though patients already had a list of more than 70 Advantage plans to choose from. Before rolling out the plan, the University of California Board of Regents discussed its merits at a November 2024 meeting. The meeting minutes offer rare insight into a conversation that private hospital systems would usually hold behind closed doors.

“As increasing numbers of Medicare-enrolled patients turn to new Medicare Advantage plans, UC Health’s experience with these new plans has not been good, either for patients or providers,” the minutes read, summarizing comments by David Rubin, executive vice president of UC Health.

The minutes also describe comments from Jonathon Arrington, CFO of UCLA Health. “Over the years, in order to care for Medicare Advantage patients, UCLA has entered numerous contracts with other payers, and these contracts have generally not worked out well,” the minutes read. “Every two or three years, UCLA has found itself terminating a contract and signing a new one. Patients have remained loyal to UCLA, some going through three iterations of cancelled contracts in order to remain with UCLA Health.”

Costs to Taxpayers

CMS pays Advantage plans a monthly fixed amount to care for each enrollee based on the member’s health condition and location. In 2024, the federal government paid Advantage plans an estimated $494 billion to care for patients, according to the Medicare Payment Advisory Commission, which monitors the program for Congress.

The commission said this month that it projects insurers in 2026 will be paid 14%, or about $76 billion, more than it would have cost government-run Medicare to care for similar patients.

Many Democratic lawmakers have criticized overpayments to Medicare Advantage insurers, though the program has bipartisan congressional support because of its increasing popularity with Medicare beneficiaries, who are often attracted by dental care and other coverage unavailable through traditional Medicare.

Whenever Congress threatens cuts, insurers claim these generous federal payments are essential to keep Medicare Advantage plans afloat. UCLA Health’s Advantage plans will need at least 15,000 members to be financially sustainable, according to the meeting minutes. CMS data indicates that 7,337 patients signed up in 2025.

A study published in JAMA Surgery in August compared patients in commercial Medicare Advantage who had major surgery with those covered by Medicare Advantage plans owned by their hospital. The latter group had fewer complications, said co-author Thomas Tsai, an associate professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.

Smith, of the American Hospital Association, isn’t surprised. When insurers and hospitals are not on opposite sides, she said, care delivery can be smoother. “There’s more flexibility to manage premium dollars to cover services that maybe wouldn’t otherwise be covered,” Smith said.

But Tsai warns seniors that hospital-owned Medicare Advantage plans operate under the same rules as those run by commercial health insurance companies. He said patients should consider whether the extra benefits of Advantage plans “are worth the trade-off of potentially narrow provider networks and more utilization management than they would get from traditional Medicare.”

In Texas, Neary hopes the closer relationship between his doctors and his insurance plan means there’s less of a chance that bills for his medical care will be kicked back.

“I don’t think I would run into a situation where they would not provide coverage if one of their own doctors recommended something,” he said.

©2026 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC. ©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

James Russ and Joseph Parker, the former and current presidents of the Round Valley Indian Tribes in northern California, are seeking to make their reservation healthy again.

That means helping their people, they say, and specifically tackling high rates of diabetes and obesity that affect their tribal nation and many other Indigenous communities.

It also means restoring their land and the river that has been intrinsically linked with their people for millennia.

“We are Native people tied to the resources and rhythms of the Eel River,” Parker said. “Our health is connected to the river.”

Now, the tribal nation is confronting the Trump administration over the river’s future and fighting some of its regional allies to reclaim water rights that have been overlooked for a century.

The struggle is taking place as the entity with a dominant stake in the river for generations, Pacific Gas & Electric Co., seeks to give up in Lake and Mendocino counties its network of Eel River dams and a linked hydropower plant. The move has triggered a federal review that has pitted the tribes, together with environmental groups in favor of dam removal, against farming interests, reservoir supporters and the Trump administration, which has taken a dim view of dam demolition.

The tribes never had much of a say when those dams went up starting 118 years ago, but they have been heavily involved in talks in recent years geared to planning for the future of the Eel River. Due to a century-old diversion that links the Eel River to the Russian River in the south — and to farms and about 100,000 residents who rely on the upper Russian for drinking and irrigation supplies — those talks have drawn in a host of sometimes competing interests, including counties and farm and fishery groups with a wider scope of interest across the North Coast.

Our “water rights were completely ignored,” Parker said of his ancestors. “The Round Valley Indian Tribes were very much in survival mode when the dams were built and the diversions began.

“It started in 1905 when W.W. Van Arsdale posted a note along a tree saying he had a right to appropriate more than 100,000 acre-feet of Eel River water to put into the Russian River basin,” Parker said. “That’s how it all started.”

PG&E has informed federal officials it wants to decommission Scott and Cape Horn dams and give up the aging, associated hydropower plant, offline since 2021, that has helped get Eel River water through Mendocino County’s Potter Valley into the Russian River basin.

In 2022, the power company applied to surrender its operating license to the Federal Energy Regulation Commission, which oversees the nation’s hydropower projects. The utility giant followed through with formal plans to FERC in June 2025.

Historically, FERC has had the final say and has not stood in the way of dam removal, though Congress and the White House have.

Years from now, the tribes and their allies hope their efforts will lead to the nation’s next big dam removal project, freeing the headwaters of California’s third longest river to revive its beleaguered salmon and steelhead trout runs — and the culture and economy of the Round Valley Indian Tribes, said John Bezdek, an attorney for the seven-tribe nation.

“The fishery declined with the significant diversions of water into the watershed,” Bezdek said. “It was a source of subsistence and culture. This is a fishing tribe. That was taken away from them.”

Farming interests and others in the region, however, are against dam removal, pointing to downstream ripples for irrigators and drinking water customers, the loss of reservoir water for aerial fire suppression and the blow to the hundreds of Lake County residents and visitors around the largest of those reservoirs, Lake Pillsbury, a destination for boaters and hunters.

They secured a powerful ally late last year in the Trump administration, which raised its objections to dam regulators in a Dec. 19 letter from Agriculture Secretary Brooke Rollins. She warned that “if this plan goes through as proposed, it will devastate hundreds of family farms and wipe out more than a century of agricultural tradition in Potter Valley. Without it, crops fail, businesses close and rural communities crumble.”

Rollins also said that her department would work with the Department of the Interior to bring “real solutions” for water security to the North Coast.

The Round Valley tribes responded Jan. 14 in a letter to those two agencies, spotlighting a familiar slight: Rollins’ failure to acknowledge or even mention the tribes’ “senior water and fishing rights, much less our culture, our economy and our way of life.”

“We are reminding the departments … that the discussions going back to DC have been one sided and that we have been left out of the conversation,” Parker said in an interview with The Press Democrat.

Tribes to DC: Respect local solution

Just as dam removal opponents, including Lake County itself, are lobbying the administration to intervene and block federal sign-off on PG&E’s plans, the tribes and their allies are asking Washington, D.C., to allow a locally brokered water pact to proceed.

Known as the two-basin solution, it solidified a 30-year framework under which diversions from the Eel River to the Russian River would continue after dam removal, at least in periods of high flows, and only if there’s enough water in the Eel to support its salmon and steelhead runs. The pact supporters, including many local governments and water providers, agreed to construct a new diversion facility to support those operations, and to return water rights to Round Valley Indian Tribes who, as the first people in the area, have seniority rights to Eel River flows.

Hailed by supporters as historic when it was finalized in early 2025, the deal sought to rectify wrongs that disadvantaged tribes and harmed Eel River fisheries, signatories said.

“Our tribal members work and live in the broader regional community and despite the historic injustice to our tribal community, an ‘all or nothing approach’ is simply not realistic,” Parker wrote to the secretaries.

Parker and Russ said it was better to come together with partners and collaborate on a solution.

“We decided at the time we could spend the next 20 years arguing about what’s right and what’s wrong,” Russ said. “We decided collectively to focus on our commonalities so that maybe our kids and grandkids wouldn’t be fighting this war. We started to figure out what would be beneficial for everyone.”

But the deal has many staunch opponents, and few more visible these days than Cloverdale Vice Mayor Todd Lands, who has made his opposition to the pact and to dam removal a central part of his campaign for a seat on the Sonoma County Board of Supervisors. In January, he accompanied Secretary Rollins at an American Farm Bureau Federation conference in Anaheim, speaking out against the two-basin solution and appealing to the Trump administration to intervene.

“The two-basin solution does not guarantee water,” Lands told The Press Democrat. He fears the change from year-round to seasonal diversions will not be enough to fill Lake Mendocino, which helps sustain dry-season flows in the upper Russian River, the main source of drinking water for communities stretching from Ukiah to Healdsburg.

“This will cause drought conditions, not allow cities to replenish their water systems for fire and public use, and cause disease in the (Russian) river basin,” Lands said. “People will have to decide between showers and laundry and will not be able to have their own gardens as a food source.”

He also echoed shared concerns among dam removal opponents that the Round Valley Indian Tribes would cease all diversions “if the goals of the water supply and fish in the Eel River are not met.”

Those fears were inflamed in December when a California-based attorney for the Round Valley Indian Tribes told a group of Potter Valley farmers that diversions would one day end — comments that were caught on video and circulated widely.

In an interview with The Press Democrat, Bezdek, the tribal attorney based in Washington, D.C., sought to clarify that statement.

“Obviously if the fishery doesn’t recover, that will be a problem for us,” he said. “But we believe the best science is available and it says that we can do this.”

Parker and Russ elaborated.

“We believe everything is integrated,” Russ said. “The other side is saying we are putting fish before people. But we need healthy fish for a healthy balance for people. We are trying to create a healthy ecosystem for healthy people.”

Critical resource over millennia

The Round Valley coalition, made up of the Yuki, Pit River, Little Lake, Pomo, Nomlacki, Concow and Wailacki tribes, trace their ancestry in the area to “the beginning of time,” Bezdek said.

The Eel River and its tributaries served as the center of Indigenous culture, religion and trade.

“Our elders used to tell us stories about seeing so many fish that you could walk on their backs,” Bezek said. “Now, when we fish, we barely see a fish. Our ecosystem has just been decimated.”

As they told Rollins and Interior Secretary Doug Burgum in their Jan. 14 letter, the tribal nation seeks to bring back the health of the river and their community.

“If the river is not healthy, the community is not healthy,” Russ said.

Sonoma County Supervisor David Rabbitt, who has close ties to the region’s farming industry, has heard the concerns of those opposed to dam removal, including their fears the tribe will end all diversions.

He isn’t buying that claim.

“There’s no automatic termination and no single entity can end diversions,” Rabbitt said. “The whole thing is a collaborative effort.”

Rabbitt, who read the Round Valley Indian Tribes’ letter, said he supported their effort “to set the record straight” and “establish a position within all the noise that’s going on. That’s vitally important.”

At the same time, he understood people’s fears and reservations.

“I will admit, I’m not a huge fan of taking down dams, but ultimately it isn’t my decision,” he said. “But then it’s ‘OK, what happens if you’re on your soapbox in the corner, it comes down and there’s no agreement for diversion? Then what?’

“We have to move forward.”

Rabbit is board president of the entity created by the pact outlining a post-dam future, the Eel-Russian Project Authority. Its aim for fish, he said, is “making sure both runs” — the Eel’s and the Russian’s — “are healthy. Our goal is to keep the diversion active and to do it in a responsible, collaborative way.”

Parker said collaboration is key and he shared his hope the Trump administration will work with the tribes and Eel-Russian Project Authority.

A spokesperson for the Department of Agriculture said it had received the tribes’ letter and “looks forward to formally responding to President Parker on this important topic.” The Department of the Interior declined to comment.

Bezdek said both secretaries have reached back out to him and are trying to coordinate dates to discuss a way forward.

“We were here before Sonoma County and Mendocino County and we will be here after they are gone,” Parker said. “PG&E’s decision to decommission the project is a once-in-a-lifetime opportunity to bring fairness. We know we won’t be adequately compensated, but the two-basin solution is the first step to heal those wounds and remedy this historical wrong.”

Boston University researchers in a groundbreaking study found that those with CTE have a much higher chance of being diagnosed with dementia.

The largest study of its kind from the Boston University CTE Center reveals that the progressive brain disease chronic traumatic encephalopathy should be recognized as a new cause of dementia.

The BU researchers discovered that those with advanced CTE — who had been exposed to repetitive head impacts — had four times higher odds of having dementia.

“This study provides evidence of a robust association between CTE and dementia as well as cognitive symptoms, supporting our suspicions of CTE being a possible cause of dementia,” said Michael Alosco, associate professor of neurology at Boston University Chobanian and Avedisian School of Medicine.

“Establishing that cognitive symptoms and dementia are outcomes of CTE moves us closer to being able to accurately detect and diagnose CTE during life, which is urgently needed,” added Alosco, who’s the co-director of clinical research at the BU CTE Center.

The researchers studied 614 brain donors who had been exposed to repetitive head impacts, primarily contact sport athletes.

By isolating 366 brain donors who had CTE alone, compared to 248 donors without CTE, researchers found that those with the most advanced form of CTE had four times increased odds of having dementia.

The four times odds are similar to the strength of the relationship between dementia and advanced Alzheimer’s disease pathology, which is the leading cause of dementia.

Dementia is a clinical syndrome that refers to impairments in thinking and memory, in addition to trouble with performing tasks of daily living like driving and managing finances. Alzheimer’s disease is the leading cause, but there are several other progressive brain diseases listed as causes of dementia that are collectively referred to as Alzheimer’s disease related dementias (ADRD).

With this new study, the authors argue that CTE should now also be formally considered an ADRD.

The study also reveals that dementia due to CTE is often misdiagnosed during life as Alzheimer’s disease, or not diagnosed at all. Among those who received a dementia diagnosis during life, 40% were told they had Alzheimer’s disease despite showing no evidence of Alzheimer’s disease at autopsy. An additional 38% were told the causes of their loved one’s dementia was “unknown” or could not be specified.

In addition, this study addressed the controversial viewpoint expressed by some clinicians and researchers that CTE has no clinical symptoms. As recently as 2022, clinicians and researchers affiliated with the Concussion in Sport Group meeting, which was underwritten by international professional sports organizations, claimed, “It is not known whether CTE causes specific neurological or psychiatric problems.”

Alosco said, “There is a viewpoint out there that CTE is a benign brain disease; this is the opposite of the experience of most patients and families. Evidence from this study shows CTE has a significant impact on people’s lives, and now we need to accelerate efforts to distinguish CTE from Alzheimer’s disease and other causes of dementia during life.”

As expected, the study did not find associations with dementia or cognition for low-stage CTE.

The BU CTE Center is an independent academic research center at the Boston University Avedisian and Chobanian School of Medicine. It conducts pathological, clinical and molecular research on CTE and other long-term consequences of repetitive brain trauma in athletes and military personnel.

By Max Bryan, mbryan@detroitnews

Oakland County’s community mental health agency and a nonprofit that provides mental health services in the county are accusing each other of acting in bad faith as the county absorbed part of the nonprofit’s services Thursday.

Crisis care nonprofit Common Ground announced in a statement Thursday afternoon that it was ending its adult crisis services at its Pontiac location because the Oakland Community Health Network “failed to issue multiple monthly payments” to the nonprofit.

Adult services at Common Ground include a crisis helpline, walk-in assessments and a sober support unit for adults experiencing mental health crisis or substance abuse. Common Ground CEO Heather Rae said 8,000-9,000 people use the nonprofit’s adult crisis services annually.

In its own statement following Common Ground’s, OCHN announced it was immediately assuming responsibility for the services. OCHN is contracted through the Michigan Department of Health and Human Services to lead the county’s provider service network.

“That the attempts to cause panic among the Oakland County residents and the citizens of the county are very shocking and disappointing, because you’re talking about people whose lives have been put at risk when they believe help is no longer available for them at their most vulnerable,” said OCHN CEO Dana Lasenby.

Common Ground members have attended county meetings since November opposing OCHN absorbing its services.

“Transition meetings between the organizations were initially productive and focused on program continuity and collaboration. However, discussions ultimately stalled as Common Ground shifted its focus toward financial demands rather than operational coordination for the people served,” OCHN’s statement reads.

Rae contends OCHN hasn’t paid the nonprofit since November for its crisis residential unit or sober support unit and hasn’t paid for its main contract since December. In its statement, Common Ground claims OCHN told them Tuesday they didn’t plan to make these payments, citing “outstanding cost settlement reviews.”

Rae said the cost settlement — more than $1 million — is usually worked out in late spring or summer. OCHN claims those funds that Common Ground owes the network were an overpayment.

“It is premature for them to have a number because it is not as simple as that. We go through an audited process, an in-depth review of payments made, expenditures, and we arrive together at a number, and we work that for as long as it takes,” Rae told The Detroit News on Thursday. “Usually, it takes a month or two to arrive at what is the reality of who owes who and how much.”

Rae also claimed Common Ground’s amount would be much smaller if the amounts OCHN hasn’t paid them were factored in.

Lasenby called Rae’s claims about the $1 million and monthly payments “inaccurate.” She said they have tried to work out the overpayment amount with Common Ground “for quite a bit of time now.”

Lasenby also said the last payment they made to Common Ground was in December.

“January payment was not made because of a contractual breach of the provider,” Lasenby said.

In addition to the money claims, Rae said Common Ground issued 155 layoff notices in December for Feb. 13, when OCHN was originally supposed to absorb the services. OCHN claimed in its statement that it has transitioned more than 55 employees from Common Ground “to support the continuation of crisis services” and expects that number to grow as employees transition from the nonprofit.

By Paula Span, KFF Health News

You’re ready to leave the hospital, but you don’t feel able to care for yourself at home yet.

Or, you’ve completed a couple of weeks in rehab. Can you handle your complicated medication regimen, along with shopping and cooking?

Perhaps you fell in the shower, and now your family wants you to arrange help with bathing and getting dressed.

There are facilities that provide such help, of course, but most older people don’t want to go there. They want to stay at home; that’s the problem.

When older people struggle with daily activities because they have grown frail, because their chronic illnesses have mounted, or because they have lost a spouse or companion, most don’t want to move. For decades, surveys have shown that they prefer to remain in their homes for as long as possible.

That means they need home care, either from family and friends, paid caregivers, or both. But paid home care represents an especially strained sector of the long-term care system, which is experiencing an intensifying labor shortage even as an aging population creates surging demand.

“It’s a crisis,” said Madeline Sterling, a primary care doctor at Weill Cornell Medicine and the director of Cornell University’s Initiative on Home Care Work. “It’s not really working for the people involved,” whether they are patients (who can also be younger people with disabilities), family members, or home care workers.

“This is not about what’s going to happen a decade from now,” said Steven Landers, chief executive of the National Alliance for Care at Home, an industry organization. “Do an Indeed.com search in Anytown, USA, for home care aides, and you’ll see so many listings for aides that your eyes will pop out.”

Against this grim backdrop, however, some alternatives show promise in upgrading home care jobs and in improving patient care. And they’re growing.

Some background: Researchers and elder care administrators have warned about this approaching calamity for years. Home care is already among the nation’s fastest-growing occupations, with 3.2 million home health aides and personal care aides on the job in 2024, up from 1.4 million a decade earlier, according to PHI, a research and advocacy group.

But the nation will need about 740,000 additional home care workers over the next decade, according to the Bureau of Labor Statistics, and recruiting them won’t be easy. Costs to consumers are high — the median hourly rate for a home health aide in 2024 was $34, the annual Genworth/CareScout survey shows, with big geographic variations. But an aide’s median hourly wage was less than $17.

These remain unstable, low-paying jobs. Of the largely female workforce, about a third of whom are immigrants, 40% live in low-income households and most receive some sort of public assistance.

Even if the agencies that employ them offer health insurance and they work enough hours to qualify, many cannot afford their premium payments.

Unsurprisingly, the turnover rate approaches 80% annually, according to a survey by the ICA Group, a nonprofit organization that promotes co-ops.

But not everywhere. One innovation, still small but expanding: home care cooperatives owned by the workers themselves. The first and largest, Cooperative Home Care Associates in the Bronx borough of New York City, began in 1985 and now employs about 1,600 home care aides. The ICA Group now counts 26 such worker-owned home care businesses nationwide.

“These co-ops are getting exceptional results,” said Geoffrey Gusoff, a family medicine doctor and health services researcher at UCLA. “They have half the turnover of traditional agencies, they hold onto clients twice as long, and they’re paying $2 more an hour” to their owner-employees.

When Gusoff and his co-authors interviewed co-op members for a qualitative study in JAMA Network Open, “we were expecting to hear more about compensation,” he said. “But the biggest single response was, ‘I have more say’” over working conditions, patient care, and the administration of the co-op itself.

“Workers say they feel more respected,” Gusoff said.

Through an initiative to provide financing, business coaching, and technical assistance, the ICA Group intends to boost the national total to 50 co-ops within five years and to 100 by 2040.

Another approach gaining ground: registries that allow home care workers and clients who need care to connect directly, often without involving agencies that provide supervision and background checks but also absorb roughly half the fee consumers pay.

One of the largest registries, Carina, serves workers and clients in Oregon and Washington. Established through agreements with the Service Employees International Union, the nation’s largest health care union, it serves 40,000 providers and 25,000 clients. (About 10% of home care workers are unionized, according to PHI’s analysis.)

Carina functions as a free, “digital hiring hall,” said Nidhi Mirani, its chief executive. Except in the Seattle area, it serves only clients who receive care through Medicaid, the largest funder of care at home. State agencies handle the paperwork and oversee background checks.

Hourly rates paid to independent providers found on Carina, which are set by union contracts, are usually lower than what agencies charge, while workers’ wages start at $20, and they receive health insurance, paid time off, and, in some cases, retirement benefits.

Other registries may be operated by states, as in Massachusetts and Wisconsin, or by platforms like Direct Care Careers, available in four states. “People are seeking a fit in who’s coming into their homes,” Mirani said. “And individual providers can choose their clients. It’s a two-way street.”

Finally, recent studies indicate ways that additional training for home care workers can pay off.

“These patients have complex conditions,” Sterling said of the aides. Home care workers, who take blood pressure readings, prepare meals, and help clients stay mobile, can spot troubling symptoms as they emerge.

Her team’s recent clinical trial of home health aides caring for patients with heart failure— “the No. 1 cause of hospitalization among Medicare beneficiaries,” Sterling pointed out — measured the effects of a 90-minute virtual training module about its symptoms and management.

“Leg swelling. Shortness of breath. They’re the first signs that the disease is not being controlled,” Sterling said.

In the study, involving 102 aides working for VNS Health, a large nonprofit agency in New York, the training was shown to enhance their knowledge and confidence in caring for clients with heart failure.

Moreover, when aides were given a mobile health app that allowed them to message their supervisors, they made fewer 911 calls and their patients made fewer emergency room visits.

Small-scale efforts like registries, co-ops, and training programs do not directly address home care’s most central problem: cost.

Medicaid underwrites home care for low-income older adults who have few assets, though the Trump administration’s new budget will slash Medicaid by more than $900 billion over the next decade. The well-off theoretically can pay out-of-pocket.

But “middle-class retired families either spend all their resources and essentially bankrupt themselves to become eligible for Medicaid, or they go without,” Landers said. Options like assisted living and nursing homes are even more expensive.

The United States has never committed to paying for long-term care for the middle class, and it seems unlikely to do so under this administration. Still, savings from innovations like these can reduce costs and might help expand home care through federal or state programs. Several tests and pilots are underway.

Home care workers “have a lot of insight into patients’ conditions,” Sterling said. “Training them and giving them technological tools shows that if we’re trying to keep patients at home, here’s a way to do that with the workforce that’s already there.”

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

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Jolie Kerr

Special to The Washington Post

January is a great time of year to pick off decluttering projects, big and small. The new year, new you vibe can transform a task you’ve been putting off into one you cannot wait to cross off your to-do list.

And for many people, that overcrowded, overstuffed feeling the home can take on gives way to a burst of energy to get rid of it all.

Parting with your things, however, can be hard even when you’re excited at the prospect of a fresh start. Picking some easy(ish) decluttering projects is a great way to build momentum.

Here are 20 pretty easy things to consider removing from your home, your car or your life, in service of a less-cluttered 2026:

Holiday decorations

Start with the most obvious: As you take down holiday decor, weed out and throw away broken light sets and ornaments. (Will you need replacements? Order them now when you’re thinking of it, and they’re on sale.) Include holiday cards in the purge; keep the ones you want and throw away the rest.

Unwanted gifts

This one pushes the boundaries of “easy.” It can be hard to get rid of a gift that someone put thought and effort into. But if you got a gift you will truly never use, get rid of it. Return it, regift it, donate it, whatever the right move is, make it now. It won’t be easier in July.

Holiday food

It’s time to break up with that tin of peppermint bark, the container of homemade cranberry sauce or the turkey carcass that hasn’t and will never be turned into stock. Use it up now or throw it out.

Ingredients from 2025 that are languishing

If you bought an ingredient for a dish you made once and will never make again, or that you simply ended up not liking, this is the time to remove it from your life.

That one serving platter that exists to cause you trouble

Not everyone will have one of these, but those of you who do know the exact platter in question: It’s too heavy, too wide or too weirdly shaped, and it never quite works for anything other than getting in your way. Make 2025 the last year you deal with this diva! Donate or sell it if you can, and if it’s an heirloom or similarly significant, pass it along to a family member.

Reusable bags

These things proliferate in the night, and we all have too many of them. If you’ve still got a stack of Trader Joe’s bags with receipts from 2024 in them, a stash of plastic bags spilling out of other plastic bags or shopping bags from stores you haven’t shopped at in years, it’s a sign that you do not actually reuse those reusable bags you keep hanging on to.

Automotive detritus

Does your car need to be cleaned out? Grab a trash bag and spend five minutes purging. It will have an almost-immediate positive effect on your life.

Broken, duplicate or unused cooking utensils and small appliances

This one is especially well-suited to people who plan to make changes to their diets or undertake new cooking or baking endeavors in the new year. Donating or selling utensils and small appliances in January is ideal because for every person who vowed to eat less ice cream in the new year, there’s also a person who is making 2026 their year of ice cream artistry.

Anything you don’t like the smell of

Whether it’s a candle, a body wash, a countertop spray or a perfume, the experience of feeling stuck with a scented item that you hate the smell of is so relatable. Free yourself from those stinking shackles! Admit it was a mistake, and cast it off.

Promotional items and/or freebies you got in 2025

Water bottles, koozies, T-shirts, key chains, notepads — promotional items take many forms, and they’re free, which makes it easy to say, “Eh, it was free. Might as well keep it.” But if you didn’t pay for it and you don’t use it, you owe it nothing and it owes nothing to you. Toss, recycle or donate.

Cleaning products you don’t use

A small collection of cleaning agents are all you need to keep a clean home. Stocking a huge array of cleaning products is counterproductive. They’ll get in your way and make it harder for you to keep your home clean! Unwanted cleaning products, including ones that have been opened, are also super donate-able.

Old slippers

Alas, old slippers are not super donate-able, which can make them oddly hard to part with. But when you replace old slippers with new ones, it is time to say goodbye to your old friends. Beware of the role reassignment trap, here: Are those house slippers you bought in 2019 really going to serve as your new outdoor shoe?

Old dog leashes and collars

Leashes and collars are to our dogs as slippers are to us, which is funny to think about! Hopefully, bringing a bit of humor to the purge party will make it easier to admit that those old leashes and collars will not be used again.

Broken luggage

If you returned from holiday travels with broken luggage, repair it or toss it. Deal with it now; it won’t become less broken in the future.

Hair accessories, products or tools from two hair styles ago

Maybe it’s a bottle of purple conditioner from your short-lived platinum blond era or the round brush you bought when you decided to cut bangs or those clips you bought when you admitted the bangs were a mistake and set about growing them out. If it’s intended for a hairstyle you no longer have, it’s clutter that’s taking up valuable bathroom storage space.

Too many hangers

A common reason people struggle to keep their clothes organized is that their closets are simply too jammed up to be functional. Free up some space by paring down your spare hanger collection.

Rags, used sponges and old toothbrushes

All the stuff you reassigned as cleaning tools, if you’re not actually using them, then you’re just storing old, gross trash with your cleaning supplies.

Clothes you didn’t mend in 2025

This can feel like a bummer, because it requires admitting that you meant to do something, and didn’t, and that you’re unlikely to do it in the future. Use January’s “fresh start” energy to make a clean break from those unmended clothes, instead of clinging to a past you’ve grown out of.

Broken electronics you didn’t fix in 2025

Ditto broken electronics.

Empty boxes

Empty boxes — shipping boxes, product boxes, even unused storage containers — take up space and get in the way. Remove them from your orbit! Put the broken electronics and unmended clothes and gross old toothbrushes in them and get rid of all of it at once!

By Anne Snabes, asnabes@detroitnews.com

When he was to gather with family at his grandparents’ house for Christmas dinner this year, Edward Constantineau of Sterling Heights planned to be surrounded by the people who pushed him to fight to recover from the hardest thing he’s ever faced in his young life, a hurdle he’s still working to overcome.

Constantineau was just 19, working out at his local gym in March of this year, when he suffered the unimaginable for a teenager: a stroke. He underwent immediate surgery on a bleed in his brain and later went through six weeks of inpatient rehab at a facility in Detroit, learning how to move again, talk and regain fine motor skills.

But through it all, Constantineau said his biggest motivator as he’s gone through rehab and fought to recover has been “my family and friends.”

“My family was always there,” said Constantineau, now 20. “I mean, my mom never left my side.”

Henry Ford Health officials say Constantineau’s story highlights the importance of early detection and rapid treatment of strokes, only about 10-15% of which occur in people younger than 50. Constantineau’s stroke was caused by a rare condition called arteriovenous malformation, in which arteries and veins mesh together without capillaries connecting them, said his neurologist, Dr. Mohammed Rehman.

Constantineau didn’t know he had the malformation at the time, but it ruptured.

Rehman said that in Edward’s case, the gym receptionist called 911 “right away.”

“If you ever have a neurological deficit … or you think something is going on and something is off, don’t hesitate” to call 911, Rehman said.

Looking back on her son’s ordeal and how it started, Stephanie Constantineau, Edward’s mom, thinks he “saved his own life” by asking for help when he was in the gym and felt his arm weaken. He was the one who asked the receptionist to call 911.

“I definitely believe there was a stronger force with him, watching over him,” she said. “I don’t know, a guardian angel, if you will.”

And Rehman believes Constantineau’s steadfast support system and drive to get better have played a role in his “remarkable” recovery.

“That’s a very rare thing I see, because at his age, when you face something like this, it’s very tough to cope with a lot of things,” Rehman said. “And I could tell, Eddie was driven.”

The stroke

Constantineau, a 2023 graduate of Henry Ford II High School, where he played varsity baseball, said he doesn’t have any memory of the stroke, but he has been told that it started soon after he got to his gym, The Edge Fitness Clubs, on March 14.

As he was doing lat pulldowns, an exercise that involves pulling down a weighted bar attached to a gym machine while seated, he felt his left arm go weak. He asked the gym’s receptionist to call 911; she also called his parents.

Paramedics brought Constantineau to Henry Ford Macomb Hospital in Clinton Township, where they quickly performed surgery.

The next couple of days were “kind of a blur,” Stephanie Constantineau recalled. She describes them as “emotional” and “hard.” She felt helpless as a parent.

“I think the first 48 to 72 hours were really touch and go with him, like it was just like getting him through those first three days to see how, if he was going to recover from the surgeries,” she said.

A rare medical condition

Rehman, a neuroendovascular physician at Henry Ford Health, said most strokes are caused by a blockage of a blood vessel, while others are caused by a bleed in the brain. He said one of the rare causes of a bleed in the brain is an arteriovenous malformation.

Capillaries connect arteries to veins in the body. An arteriovenous malformation (AVM) is a jumble of arteries and veins with no capillaries between them, according to the Cleveland Clinic. The incidence of the condition is around 1 in 100,000 people. The malformations typically occur in the brain, and they’re usually present from birth, according to Henry Ford Health.

Rehman said AVMs often present in young people, and bleeding most commonly occurs between the ages of 10 and 40. He said the Henry Ford Health system sees three to five ruptured arteriovenous malformations a year, and it also sees around 40 to 50 people a year whose malformations haven’t ruptured. AVMs cause symptoms such as severe headaches, seizures or weakness as damage builds, he said.

Dr. Mark Goldberger, a neurosurgeon, did the initial surgery on Constantineau, removing a significant amount of blood from the brain. In the following weeks, his doctors did a few angiograms, or blood vessel tests. In the second angiogram, they discovered the AVM, Stephanie Constantineau said.

Rehman said it took Constantineau at least five to seven days to wake up from the initial surgery ― he was in a coma. Overall, he spent 27 days in the intensive care unit.

“It’s heartbreaking to see your son go through something like this and not know how it’s gonna end up,” Stephanie Constantineau said, tearfully. “Like I say, ‘You just put all your faith in God and the doctors, and just trust that everything’s going to be OK.’ But it’s hard, because we have two other kids.”

She said she never left her son’s side. She spent every night at the hospital and would return home briefly to shower.

The therapy process

After leaving the hospital, Constantineau spent 43 days in inpatient rehabilitation. He said the beginning of the recovery process was “the toughest.”

“I was at a stage where I couldn’t even sit up straight,” he said, referring to when he was in the hospital and the early days of rehab. “I had lost all my muscle and was just sitting in a wheelchair, which was tough every single day. I just felt like stuck in a place where I couldn’t even move.”

He said therapy was “intense” and “very constant,” occurring five or more days a week. He underwent occupational, physical and speech therapy, the latter of which was necessary because he had “no voice after coming off of intubation,” he said.

Constantineau said fine motor skills were “the most frustrating” part of therapy, and he’s still working on it.

“He still doesn’t have, like, mobility of his left hand, like the wrist and fingers, yet,” said Stephanie Constantineau, adding that the recovery takes “a good 18 months.”

“I mean, we haven’t lost hope,” she said. “He works hard every single day.”

At home, Constantineau continues to do therapy each day, he said. In his family’s basement, he does exercises his therapist has recommended and rides on a stationary bike.

“I’ve been trying to adjust to getting back into my regular life by hanging out with friends” and taking an online class at Macomb Community College this fall, he said.

The signs of stroke

Rehman said in an email that strokes can affect anyone at any age, though the likelihood of it increases with age. He said about 10-15% of strokes occur in people under 50. He urged everyone, including young people, to be aware of the signs of a stroke and shared the acronym F.A.S.T. It stands for “Facial drooping, Arm weakness, Slurred speech, Time to call 911.”

He said that if you or anyone around you experiences these symptoms, you should seek medical attention immediately.

“The fact that Eddie sought help immediately when he began experiencing symptoms is incredibly important,” he said. “That allowed 911 to be called and emergency care to be administered quickly. When a stroke occurs, every second counts. The faster a person seeks treatment, the better their outcome.”

His plans for the future

In January, Constantineau will resume in-person classes at MCC, where he is studying exercise science. He plans to re-do the classes he was taking when the stroke occurred earlier this year.

After finishing his associate’s degree, he plans to transfer to Oakland University and is planning to go into health care, either as a nurse or a physician assistant. Constantineau said he originally wanted to go into health care because of his interest in sports, but after everything he’s experienced since his stroke, it has reinforced his decision to go into the field.

Looking back on his experience, Constantineau said the early days of his recovery were “rough” — “I think I was stuck in that ‘why me?’ mentality” — but is now “very confident” with the progress he has made. But he also knows that recovery takes time.

“I think that’s the tough part … just waiting all that time, but … I’m definitely optimistic for the future,” he said.

By DEVI SHASTRI, Associated Press

The new year is a time when many try to start new good habits and commit to improving health and wellness.

But resolutions, lofty as they may be, can turn daunting quickly with all the advice and sometimes contradicting information coming at you from news reports, advertisers, influencers, friends and even politicians.

But they don’t have to be.

This year, The Associated Press got the downlow on all manner of health and wellness claims and fads. The good news is that the experts mostly say to keep it simple.

As 2026 arrives, here’s what you can skip, what you should pay attention to and how to get credible information when you are inevitably faced with more confusing claims next year.

Protein and fiber are important, but you probably don’t need to pay more

When it comes to your diet, experts say most people can skip the upcharge. If you’re eating enough, you’re probably getting enough protein and don’t need products that promise some big boost.

And it’s true that most people could use more fiber in their diets. But, please, ditch the “fiber-maxxing” trend. Instead, eat whole foods such as fruits, vegetables, beans and whole grains.

A good skin care routine is not expensive or complicated

That 20-step skin care routine and $200 serum some TikToker sold you on? Dermatologists say you really don’t need it. Stay away from the beef tallow and slather on a good sunscreen instead (yes, even if you have darker skin ), they say.

And the same rule for simplicity applies to that hourlong “everything shower.” The best showers are simple and short, dermatologists say, no “double cleansing” required.

There are many simple ways to get that workout in

If the gym and all its equipment feel intimidating, you can drop the illusion that a good workout requires either. This year, the comeback of calisthenics put the focus back on no frills, bodyweight workouts you can do in the comfort of home. Research shows calisthenics helps with muscle strength and aerobic conditioning. You may eventually need weightlifting or other equipment, but it is a great place to start to build consistency and confidence.

Be wary of wellness fads and treatments — they are often too good to be true

Even if you imbibe too much this New Year’s Eve, doctors say you can do without “IV therapy” which have vitamins you can get more easily and cheaper in pill form — if you even need more, which is unlikely if you have a balanced diet. You’re pretty much just paying for “expensive urine,” one doctor said.

Same for “wellness” focused products like microbiome testing kits that generate information that doctors can’t actually act on. And if you don’t have diabetes, there’s scant evidence that you need a continuous glucose monitor.

To improve your health, go back to the basics

The idea of a panacea pill, product or routine can be enticing. But science already knows a lot about how to improve mental and physical health, and they are tried and true:

1. Whether you’re in the city or the country — walk more. Research shows walking is great for physical and mental health. It’s so good for you, doctors are literally prescribing time in the outdoors to their patients.

2. Take steps to get certain health metrics under control, like high blood pressure, which often goes undiagnosed and is known to cause a range of health problems down the road. Prioritize getting enough sleep, and make sure your family does too. Don’t just eat right — eat slower.

3. Give your mind some care too. Set better boundaries with your technology and regain and retrain your attention span. Build out your social networks and invest in all forms of love for the people around you.

These lifestyle changes don’t just make you feel better in the moment. Research shows they impact your life for years to come, by lowering the risk of dementia and many other health issues.

Don’t know who to trust? Start with your doctor

It can be tough to know who to listen to about your health, faced with compelling personal stories on social media from people who swear something worked from them, or clever marketing and advertising from companies that scare you or promise an easy fix.

Doubts have been raised this year about established medicine, including the safety of food dyes, fluoride dental treatments,hepatitis B shot for newborns, and hormone therapies for menopause.

While the medical system is not perfect, your doctor remains the best person to talk to about prevention, health concerns and potential treatments.

If you can’t get to a human doctor and turn to Dr. Google instead, be sure to follow these tips and never use it to diagnose yourself. When you do get that doctor’s appointment, you can make the most of it by bringing a list of written questions — and don’t hesitate to ask for any clarification you need.

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 ALI SWENSON The Associated Press

NEW YORK (AP) — Enhanced tax credits that have helped reduce the cost of health insurance for the vast majority of Affordable Care Act enrollees expired overnight, cementing higher health costs for millions of Americans at the start of the new year.

Democrats forced a 43-day government shutdown over the issue. Moderate Republicans called for a solution to save their 2026 political aspirations. President Donald Trump floated a way out, only to back off after conservative backlash.

In the end, no one’s efforts were enough to save the subsidies before their expiration date. A House vote expected in January could offer another chance, but success is far from guaranteed.

The change affects a diverse cross-section of Americans who don’t get their health insurance from an employer and don’t qualify for Medicaid or Medicare — a group that includes many self-employed workers, small business owners, farmers and ranchers.

It comes at the start of a high-stakes midterm election year, with affordability — including the cost of health care — topping the list of voters’ concerns.

“It really bothers me that the middle class has moved from a squeeze to a full suffocation, and they continue to just pile on and leave it up to us,” said 37-year-old single mom Katelin Provost, whose health care costs are set to jump. “I’m incredibly disappointed that there hasn’t been more action.”

Some families grapple with insurance costs that are doubling, tripling or more

The expired subsidies were first given to Affordable Care Act enrollees in 2021 as a temporary measure to help Americans get through the COVID-19 pandemic. Democrats in power at the time extended them, moving the expiration date to the start of 2026.

With the expanded subsidies, some lower-income enrollees received health care with no premiums, and high earners paid no more than 8.5% of their income. Eligibility for middle-class earners was also expanded.

On average, the more than 20 million subsidized enrollees in the Affordable Care Act program are seeing their premium costs rise by 114% in 2026, according to an analysis by the health care research nonprofit KFF.

Those surging prices come alongside an overall increase in health costs in the U.S., which are further driving up out-of-pocket costs in many plans.

Some enrollees, like Salt Lake City freelance filmmaker and adjunct professor Stan Clawson, have absorbed the extra expense. Clawson said he was paying just under $350 a month for his premiums last year, a number that will jump to nearly $500 a month this year. It’s a strain for the 49-year-old but one he’s willing to take on because he needs health insurance as someone who lives with paralysis from a spinal cord injury.

Others, like Provost, are dealing with steeper hikes. The social worker’s monthly premium payment is increasing from $85 a month to nearly $750.

Effects on enrollment remain to be seen

Health analysts have predicted the expiration of the subsidies will drive many of the 24 million total Affordable Care Act enrollees — especially younger and healthier Americans — to forgo health insurance coverage altogether.

Over time, that could make the program more expensive for the older, sicker population that remains.

An analysis conducted last September by the Urban Institute and Commonwealth Fund projected the higher premiums from expiring subsidies would prompt some 4.8 million Americans to drop coverage in 2026.

But with the window to select and change plans still ongoing until Jan. 15 in most states, the final effect on enrollment is yet to be determined.

Provost, the single mother, said she is holding out hope that Congress finds a way to revive the subsidies early in the year — but if not, she’ll drop herself off the insurance and keep it only for her four-year-old daughter. She can’t afford to pay for both of their coverage at the current price.

Months of discussion, but no relief yet

Last year, after Republicans cut more than $1 trillion in federal health care and food assistance with Trump’s big tax and spending cuts bill, Democrats repeatedly called for the subsidies to be extended. But while some Republicans in power acknowledged the issue needed to be addressed, they refused to put it to a vote until late in the year.

In December, the Senate rejected two partisan health care bills — a Democratic pitch to extend the subsidies for three more years and a Republican alternative that would instead provide Americans with health savings accounts.

In the House, four centrist Republicans broke with GOP leadership and joined forces with Democrats to force a vote that could come as soon as January on a three-year extension of the tax credits. But with the Senate already having rejected such a plan, it’s unclear whether it could get enough momentum to pass.

Meanwhile, Americans whose premiums are skyrocketing say lawmakers don’t understand what it’s really like to struggle to get by as health costs ratchet up with no relief.

Many say they want the subsidies restored alongside broader reforms to make health care more affordable for all Americans.

“Both Republicans and Democrats have been saying for years, oh, we need to fix it. Then do it,” said Chad Bruns, a 58-year-old Affordable Care Act enrollee in Wisconsin. “They need to get to the root cause, and no political party ever does that.”

By Peter WhoriskeyThe Washington Post

JACKSON HOLE, Wyo. – Like millions of other Americans, Stacy Newton turns to Healthcare.gov to shop for health insurance for her family. The Affordable Care Act website, according to the government, is where consumers are supposed to find “a menu of health insurance plans.”

But for the Newtons and many others in the country, next year’s menu is severely limited: There is only one company offering ACA plans here – and costs have risen steeply.

To continue health coverage for themselves and their two teenage children, the Newtons would have to pay an annual premium of $43,000 – about a third of their gross income. It is the price of the cheapest plan available to the family from Blue Cross Blue Shield of Wyoming, the only ACA insurer left in Teton County.

This year, millions of American families that have relied on ACA, popularly known as Obamacare, are being squeezed on multiple sides: Premiums are rising, the covid-era subsidies that helped pay for those policies are shrinking, and there are fewer choices with insurers pulling out of some markets.

The squeeze here is a symptom of broader trouble in American health care. In western Wyoming and other regions, the expected rollback of enhanced subsidies has destabilized the economics of Obamacare, pushing some insurers to retreat from the government-supported market because it won’t be profitable.

That is leaving consumers such as the Newtons with little choice but to buy a pricey, unsubsidized policy from a local monopoly.

Next year, the number of counties with only one company providing Obamacare will jump from 72 to 146, according the Robert Wood Johnson Foundation. That number is expected to rise further if, as appears likely, Congress fails to renew the enhanced subsidies.

Newton and her husband, Derek, each run a small business – she is an independent sales representative, and he outfits vans – and like many entrepreneurs, they have relied on the ACA for health insurance. But this year, the price of their policy rose 34 percent, and the federal subsidy that helped them pay for it is due to go away. At the same time, they know they will need medical care: Last year, Newton, 51, was diagnosed with chronic leukemia.

“It’s terrifying,” she said. “We’re not rich, we’re not poor. We’re a standard, middle-class family, and somehow now I can’t afford health insurance.”

This year, the enhanced subsidies that helped middle-income people afford Obamacare plans have been stuck in partisan congressional deadlock. The subsidies expire Dec. 31, and Republicans, who hold the majority, have opposed extending them.

Anticipating that sticker shock will induce healthy people to drop out of insurance and saddle health plans with a higher proportion of the sickest, costliest patients, insurers say they must dramatically raise ACA prices or pull out of Obamacare marketplaces altogether.

Without the enhanced subsidies, “I would expect more insurers to retreat, to exit,” said Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation. “People will see less choice and higher prices.”

According to economic studies conducted in 2017 and 2018, another turbulent period when Obamacare insurers faced losses and political uncertainty, prices rose between 30 and 50 percent when an area was reduced to only one ACA insurer.

The problem here in Teton County began in August when the only other insurer providing ACA coverage, Mountain Health Co-op, announced it was pulling out, citing the looming expiration of the enhanced subsidies. Of the roughly 46,000 people on Obamacare in Wyoming, about 11,000 are expected to drop coverage, according to insurers.

“The basic problem with reducing the subsidies is that healthier people say ‘we can’t afford insurance’ and drop out, while the sicker population are, like, ‘Oh, my God, I still need it,’” said Alexander Muromcew, a board member of the Mountain Health Co-op. “As an insurer, you end up with a smaller and higher-risk membership, which is not sustainable.”

Muromcew said competition had been good for consumers, noting that when Mountain Health entered the market here a few years ago, Blue Cross Blue Shield dropped its prices. Now, as a monopoly, he said, Blue Cross Blue Shield has more power to dictate prices.

“Without competition, I worry that it’ll be easier for Blue Cross Blue Shield to raise rates even further,” Muromcew said.

Diane Gore, president and chief executive of Blue Cross Blue Shield of Wyoming, said she understands the frustration of people getting hit with rising premiums and lowered subsidies.

“I get it, I completely get it,” Gore said.

The company says its prices are the same across most of Wyoming, regardless of whether there is a competitor. Gore attributed this year’s price hikes, which she said were 25 percent on average, to the expectation that the remaining Obamacare customers will be sicker, and to the rising cost of medical care in rural areas, where health care providers are scarce and competition is often limited. Of every premium dollar the company collected last year, she said, 95 cents went to direct medical care.

Insurance companies don’t always find Obamacare markets profitable. Aetna, one of the largest insurance companies, announced earlier this year that it was dropping ACA coverage in 11 of 15 states. The move affected about a million Obamacare customers.

“I understand that there is rhetoric from the Beltway that the insurance companies are getting rich off of Obamacare,” Gore said. “But that’s not this insurer in Wyoming.”

‘Clearly, the system is broken’

Many people in this resort town are seasonal workers, self-employed or small-business entrepreneurs. Lacking employer insurance plans, they have come to rely on Obamacare. Among them, the anxiety is widespread.

“Clearly, the system is broken,” said Heather Huhn, an insurance broker in Jackson.

On her desk, she has a stack of files with the applications for about 30 families that she calls the “Hold Tight” pile. They are mainly people who have ongoing medical needs, such as chronic conditions or expensive prescriptions, and can’t afford to pay for health insurance at the current costs. For weeks, she said, they have been desperately waiting to see whether the government will extend the enhanced subsidies that began during the pandemic.

“They sit across from my desk and say, ‘I just don’t know what to do,’” Huhn said. “I tell them not to have a mental breakdown just yet. People are having to suffer because the government can’t figure out how to fix it.”

Sophia Schwartz, a professional skier and health care administrator here, senses similar apprehension. For years, she has been inviting groups of “ski friends,” many of whom have irregular jobs, over for dinner to counsel them on how to get health insurance.

“This was the scariest year I’ve ever done it,” said Schwartz, a former member of the U.S. ski team and now a big-mountain skier. “People came to me in pure panic.”

Considering ‘BearCare’ and other options

In desperation, many are turning to stopgap measures.

Some, especially skiers, were looking at policies at a company called Spot Insurance that cover reimbursement of medical bills incurred after accidents on the slopes. Others were looking at “healthshare” groups in which members contribute monthly to cover each other’s eligible medical bills; among the drawbacks of these programs is that elective surgeries and nonemergency treatments might not be covered.

And some were considering “short-term” insurance policies. Those are closer to conventional health insurance, but those insurers might reject applicants with medical conditions such as diabetes, heart disease or cancer.

With so many in Wyoming searching for answers, even the state is jumping in. State officials have proposed “a major medical plan” they have called “BearCare.” The policies would, at “a significantly lower price,” cover emergency situations such as “being attacked by a bear” and other more common medical catastrophes. It would not cover ongoing or chronic medical needs.

Some of those looking for conventional health insurance say the state proposal is woefully inadequate.

“I don’t worry about being bitten by a bear, I worry about getting cancer,” said Margie Lynch, 58, an energy efficiency consultant based here. For the cheapest Obamacare plan, she would have to pay $1,585 a month. Its benefits would not kick in until she paid a deductible of $10,600.

“The cost of the premium is almost as much as my mortgage,” Lynch said. “I’m lucky enough to be able to pay for it if I have to. But there are so many people out there who won’t be able to.”

Newton, Lynch and others here have shared their concerns with Wyoming’s representatives in Congress: Sen. John Barrasso, Sen. Cynthia Lummis and Rep. Harriet Hageman. All three Republican lawmakers have opposed Obamacare and criticized Democrats, who have pushed to extend the enhanced subsidies.

“Stacy’s story and experience is one of the many heartbreaking examples of how Obamacare has failed families across Wyoming,” a statement from Barrasso said. “Instead of working with Republicans to make health care more affordable for all Americans, Democrats would rather use more taxpayer dollars to bail out Obamacare and hide its failures.”

A spokesman for Lummis said, “The health care problem Americans are facing is a direct result of the Democrats’ failed Affordable Care Act – Sen. Lummis had the foresight to oppose this misguided legislation from day one.”

A spokesperson for Hageman said in a statement that “Rep. Hageman knows there are many people struggling with the weight of medical expenses, and the catastrophic failure of Obamacare is making it far worse.”

The squeeze

For years, Obamacare had worked well for the Newtons.

In 2017, when the couple were starting their businesses, their income was low – about $56,000. The price of their policy was $1,585 a month, but the standard ACA subsidy covered most of that, and the couple had to come up with only $332 monthly.

Since then, however, the prices of the premiums have risen steadily, and now, because of the expected subsidy reductions, they would no longer qualify for government help. They would have to pay full price – $3,573 monthly for the cheapest option. Even at $43,000 a year, the plan carries a $21,200 deductible, according to the paperwork Stacy Newton showed The Washington Post.

This month, the couple struggled with whether to pay that to Blue Cross Blue Shield of Wyoming, go without health insurance or find some other stopgap option. Newton was getting notices that said, in bold red lettering: “Important – You’re about to end (terminate) this coverage. If any of the people above get health care services or supplies after 12/31/2025, they’ll have to pay full cost.”

Eventually, Newton knows, she will need leukemia treatment. She’s just not sure when.

“If my leukemia acts up, I’m up a creek,” she said this month. “I just don’t have a solution yet.”

On Monday, she sent a text.

“I just officially canceled my ACA marketplace insurance for 2026,” she wrote. “How on Earth is this going to unfold for millions of people in America?

By Maria Salette Ontiveros, The Dallas Morning News

DALLAS — A new version of the common flu is spreading globally, and health officials are monitoring this evolving strain of influenza A(H3N3) Subclade K, which has been increasingly detected worldwide.

Seasonal influenza activity has increased globally in recent months, with influenza A viruses accounting for the majority of detections, according to the World Health Organization.

Health officials are closely monitoring a growing subgroup of influenza A(H3N2) viruses known as J.2.4.1, also referred to as Subclade K.

The WHO says detections of this subclade have risen rapidly since August 2025 based on genetic sequence data shared through the global GISAID database.

Current epidemiological data do not indicate increased disease severity associated with subclade K, the WHO says, though its spread reflects the continued evolution of seasonal influenza viruses.

What is subclade K?

Subclade K is a genetically distinct subgroup of influenza A(H3N2) viruses, according to the WHO.

These viruses have drifted genetically from related J.2.4 viruses and carry several amino acid changes in the haemagglutinin protein, which plays a key role in the virus’s attachment to human cells.

Influenza viruses commonly undergo such changes over time. Global surveillance tracks these shifts to assess potential impacts on transmission, severity, and vaccine effectiveness.

Where is subclade K circulating?

The WHO reports that subclade K viruses were first detected at increased levels beginning in August 2025, particularly in Australia and New Zealand.

Since then, the viruses have been identified in more than 34 countries over the past six months, including the U.S.

Detections are increasing in many regions of the world, except so far in South America, according to the WHO.

What is happening in America?

Data from the U.S. Centers for Disease Control and Prevention show that influenza activity in North America remains relatively low but is increasing, driven mainly by detections of influenza A viruses.

During the 2025 southern hemisphere influenza season in the Americas, transmission exceeded the seasonal threshold in mid-March and mainly remained at low to moderate levels, the CDC says.

The CDC reports a predominance of influenza A(H3N2) in both the United States and Canada, with growing detections of the A(H3N2) subclade K.

Are symptoms different?

The WHO says there is no evidence that infections caused by subclade K produce symptoms that differ from or are more severe than those caused by other seasonal influenza A(H3N2) viruses.

Seasonal influenza symptoms typically include fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headache and fatigue. Severity can vary based on age, underlying health conditions and immune status.

Do vaccines still protect?

Early estimates cited by the WHO suggest that seasonal influenza vaccines continue to protect against severe illness and hospitalization in both children and adults.

While effectiveness against symptomatic infection may vary from season to season, health officials say vaccination remains one of the most effective public health measures, particularly for people at higher risk of influenza complications and their caregivers.

Even when circulating viruses differ genetically from vaccine strains, vaccines may still reduce the risk of severe outcomes, the WHO says.

What happens next?

The WHO says it continues to monitor global influenza activity and viral evolution, while supporting countries in surveillance efforts and updating guidance as new data emerge.

Health officials note that changes in circulating influenza viruses are expected each season and are routinely assessed through international monitoring systems.

©2025 The Dallas Morning News. Distributed by Tribune Content Agency, LLC.