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.

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That creamy Reese’s peanut butter cup dissolving on your tongue. The next crunchy Dorito you’re reaching for before you’ve swallowed the last one. The first sip of an ice-cold Coke, with a mix of syrup and carbonation; it hits like relief.

Your brain’s reward center is supposed to keep you alive, but a major new study from the University of Michigan, Harvard, and Duke says the food industry learned how to use it against you — engineering products with the same science as cigarettes.

The playbook is this: optimize the craving, accelerate the reward, and make it nearly impossible to stop.

Ultraprocessed foods now make up roughly 60% of what Americans eat. San Francisco has sued 10 major food manufacturers over the harm.

Health Secretary Robert F. Kennedy Jr. has said these foods are poisoning Americans, but he has stopped short of regulating them.

In Detroit, 69% of households face food insecurity and researchers describe the city as a food swamp, where drive-throughs, party stores and gas-station snack aisles vastly outnumber places to buy fresh produce.

Detroit’s numbers make the question sharper: What happens when engineered food is all that’s there?

Ashley Gearhardt, clinical psychologist, addiction scientist at the University of Michigan, creator of the Yale Food Addiction Scale and lead author of the study, joined Robyn Vincent on The Metro to discuss this and more.

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

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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.

Young people’s brains are changing.

Research shows social media activates the same dopamine-driven reward pathways in the brain as addictive substances. The scroll, the like, the notification — each one is a quick hit of pleasure that keeps you coming back.

The U.S. Surgeon General has warned that teens who use social media for more than three hours a day face double the risk of depression and anxiety, and the vast majority of American teenagers use social media. More than a third say they use it “almost constantly.” 

The platforms keep us sucked in so long that we now have new terms for our interactions with these devices, like “doomscrolling” and “brain rot.”

Now, the courts are getting involved. In Los Angeles, a jury is hearing claims that Meta and YouTube deliberately designed their platforms to get children addicted. In New Mexico, the state attorney general is suing Meta for allegedly failing to protect minors from sexual exploitation. 

In Michigan, legislators are cracking down on phones in schools. This month, Michigan banned smartphones in the classroom, affecting students in the fall. 

State Representative Mark Tisdel, a Republican representing Rochester Hills, sponsored the cell phone ban. He joined Robyn Vincent on The Metro to discuss how he believes lawmakers should stand up to Big Tech.

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

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

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On Wednesday, the Great Lakes Water Authority will vote on a nearly 7% water rate increase and a 6% sewer increase.

Last year, GLWA proposed an even bigger hike — close to 8% for water — but public testimony at the hearing pushed the board to lower it. Wednesday’s hearing is another chance for residents to weigh in. What’s driving these increases — and why does water keep getting more expensive?

Suzanne Coffey is CEO of the Great Lakes Water Authority or GLWA. She spoke with The Metro‘s Robyn Vincent.

On The Metro, we also spoke about GLWA rate hikes — and why utility costs are rising — with Nick Schroek, dean of the University of Detroit Mercy School of Law. You can listen to that conversation here.

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

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

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Wayne State University researchers are looking for ways to help people with multiple sclerosis move better.

MS is a degenerative neurological disease that makes it hard for some patients to walk and keep their balance. 

Scientists wanted to know whether a physical therapy regimen that includes walking backward could improve mobility and balance. Their new study suggests it can.

They started small

Dr. Nora Fritz led the research team. She’s the director of research for WSU’s Department of Health Sciences. She’s also a physical therapy professor.

She says they’ve been looking at this in the lab for some time.

“We noticed that some individuals tend to fall backward more frequently than forward,” Fritz says. “We also noticed that individuals tend to have more trouble walking backward than they do walking forward.”

Researchers asked eight MS patients to take part in an eight-week case study. They came to the lab once a week to do backward walking training with a neurologic physical therapist. Subjects walked on a treadmill and on the ground. They also did back-stepping exercises in the lab and at home.

Fritz says the results were encouraging.

“It seems that everyone who’s participating is experiencing some level of improvement,” she says. “They really like it and they’re finding it useful.”

The team also conducted MRI screenings before and after the eight-week program.

“We looked at how the brain changed during this period,” Fritz says. “We saw evidence that there was actually some changes in structures of the brain related to balance in just a short time.”

Results could lead to new treatment

Fritz says it’s too early to reach any conclusions from the study, but the results were good enough to begin a larger, randomized control study with 90 MS patients. That lasted six months.

“Everyone has completed the training, and we’re just in the monitoring period now,” Fritz says. “We anticipate the first papers from that study to come out within the next several months.”

The findings of the eight-week trial appear in the Journal of Neurologic Physical Therapy.

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When a government agency decides whether a chemical in your food is safe, where does the science come from? Most of us assume it’s independent. In the case of Roundup — the world’s most widely used weedkiller — the manufacturer wrote the research, and it went unchallenged for 25 years.

In 2000, a study published in the journal Regulatory Toxicology and Pharmacology concluded Roundup posed no health risk to humans. But internal Monsanto emails released in 2017 litigation revealed company employees had ghostwritten the paper. Despite that, it remained in the scientific record, cited without caveat in hundreds of academic papers and dozens of government documents worldwide.

Harvard historian of science Naomi Oreskes and researcher Alexander Kaurov changed that. Their 2025 analysis found the ghostwritten paper ranked in the top 0.1% of all cited glyphosate literature. They requested the journal retract it. In November 2025, it did, citing “serious ethical concerns.” Oreskes and Kaurov also wrote about their findings in Undark.

The retraction comes as Bayer, which acquired Monsanto in 2018, faces roughly 65,000 Roundup cancer lawsuits. On February 17, the company proposed a $7.25 billion class settlement. The U.S. Supreme Court has agreed to hear a related case this term. Bayer maintains glyphosate is safe.

Oreskes, author of “Merchants of Doubt,” joined Robyn Vincent on The Metro to discuss how one ghostwritten paper shaped pesticide policy for a generation, and what it means now that it’s been thrown out.

Hear the full conversation using the media player above.

 

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

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

Trusted, accurate, up-to-date.

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In 2023, Governor Gretchen Whitmer signed one of the most aggressive clean energy laws in the country — requiring Michigan utilities to hit 50% renewable energy by 2030 and 100% clean electricity by 2040. That plan assumed federal policy would be moving in the same direction. Things like federal tax credits, Environmental Protection Agency regulations, and infrastructure money for electric vehicles were anticipated to follow.

But that’s not what’s happening now. Last week, the Trump administration revoked the EPA’s ability to regulate pollution.

What does that decision mean for Michigan? What does it mean for DTE and Consumers Energy, which are both tasked with transitioning to clean energy sources instead of relying on things like natural gas?

Liesl Clark is the director of climate action engagement for the University of Michigan’s School for Environment and Sustainability. She also used to run the Michigan Department of Environment, Great Lakes, and Energy. 

The Metro‘s Sam Corey spoke with the director about the president’s actions and what she would recommend the state do now.

 

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

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

Trusted, accurate, up-to-date.

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

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By 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.”

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