In This Edition:
- KFF HEALTH NEWS ORIGINAL STORIES
- 1. Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
- SPENDING AND FISCAL BATTLES
- 2. Many Americans Get Reality Check As Several States Unveil ACA Price Hikes
- ADMINISTRATION NEWS
- 3. Seniors Paying More For Pills Now That Tariffs Put Foreign Deals Out Of Reach
- EDITORIALS AND OPINIONS
- 8. Viewpoints: Academic Medicine Changes Due To AI, Lack Of Funding; Some Turn To TikTok Diets For Cures
From KFF Health News:
KFF HEALTH NEWS ORIGINAL STORIES
1. Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
A federal probe of Medicare and Medicaid plans run by private insurance companies found that the plan operators often overstated how many mental health providers were available in their networks. In some cases, investigators found providers had never had contracts with plans they were listed on. (Tony Leys, 10/20)
Here’s today’s health policy haiku:
WHERE’S THE COMPASSION?
Medicaid’s deep cuts
affront those in need of help.
Health care is a right!
– Brian Rifkin
If you have a health policy haiku to share, please Contact Usand let us know if we can include your name. Haikus follow the format of 5-7-5 syllables. We give extra brownie points if you link back to an original story.
Opinions expressed in haikus and cartoons are solely the author’s and do not reflect the opinions of KFF Health News or KFF.
Summaries Of The News:
2. Many Americans Get Reality Check As Several States Unveil ACA Price Hikes
Annual premiums will rise sharply — in some cases by tens of thousands of dollars — unless Congress extends Obamacare subsidies. Some people also discovered they would have fewer choices because their insurers dropped out of some markets for 2026, The New York Times reported. Meanwhile, the 28 state exchanges run by the federal government have not yet unveiled their prices.
The New York Times: Higher Obamacare Prices Become Public In A Dozen States
Health insurance prices for next year under the Affordable Care Act are now available in about a dozen states, giving Americans their first look at the sharp increases many will pay for coverage if Congress does not extend subsidies that have made some plans more affordable. The annual enrollment period for Obamacare is expected to begin Nov. 1, but the costs for some Americans are becoming publicly available piecemeal through some state marketplaces. The federal website healthcare.gov, which includes 28 other state marketplaces, is slated to post prices before the end of October. (Abelson and Sanger-Katz, 10/17)
The Wall Street Journal: The Government Shutdown Fight Over ACA Subsidies Is Running Out Of Time
“Actually being able to write something that can be put in effect between now and Nov. 1? I don’t know how it gets done,” said Sen. Mike Rounds (R., S.D.). “There are fundamental differences between what Republicans want and what Democrats want on this issue.” (Wise, Mathews and Ferek, 10/19)
The Washington Post: Here’s Who Pays When Undocumented Immigrants Get Health Care In America
Republicans have attacked Democratic health care demands in shutdown debate as funding medical care for undocumented immigrants. The reality is more complicated. Immigrants living in the United States illegally are ineligible for federal health plans, including Medicaid and Medicare, as well as insurance sold through Affordable Care Act marketplaces. But federal money can indirectly help those immigrants by reimbursing hospitals that are required to provide emergency care to all patients and by supporting state Medicaid programs that use their own money to offer coverage to patients without legal status. (Ovalle, 10/20)
In related news —
Maryland Matters: State Cites Federal Rules In Postponing Access To Care Act
A plan to give undocumented immigrants access to Maryland’s state health insurance marketplace next year has been put off until 2028 by state officials, citing recent federal policies affecting immigrants as well as overall uncertainty in health care markets. (Brown, 10/18)
More on the federal shutdown —
Politico: Nearly 3 Weeks In, White House And GOP Remain Aligned On Shutdown
The White House feels as confident about the shutdown on day 19 as it was on day one– in part because congressional Republicans have, for the most part, remained largely in line. “There’s no discussions at all at the rank-and-file level, and what is there even for Republicans to be skittish about?” said a Senate GOP aide granted anonymity to discuss the dynamics between the White House and Congress. (Gangitano, 10/19)
Politico: California Democrat Ro Khanna: ‘I Agree With Marjorie Taylor Greene’ On Health Care
Rep. Ro Khanna surprised Fox News host Shannon Bream on Sunday when he said he agrees with Republican Rep. Marjorie Taylor Greene (Ga.) on health care. The California Democrat’s remarks came as the ongoing government shutdown appears to be without end as Democrats and Republicans blame each other. In their discussion on the shutdown during “Fox News Sunday,” Bream pointed out that Democrats are demanding an extension of Covid-era subsidies through the Affordable Care Act. When asked why Democrats are holding the line over a policy that was “always supposed to sunset,” Khanna replied: “I agree with Marjorie Taylor Greene. The health care system is broken.” (Daniels, 10/19)
Roll Call: WIC Becomes A Political Football In Shutdown
Unlike some mandatory spending programs like Social Security, which continues to pay beneficiaries during a shutdown, the WIC program is run using discretionary federal funds appropriated by Congress and allocated to state and tribal agencies by the USDA. WIC cost the federal government about $7.3 billion in fiscal year 2024, and Congress approved another $7.6 billion for fiscal year 2025, which ended Sept. 30. Without more federal financing, state governments, if they have money to spare, would have to decide whether to use state resources to finance the program in their areas and then request federal reimbursement when the government reopens. (Gore, 10/17)
MedPage Today: Osteopathic Medical Schools Warn Of Fallout From Federal Shutdown
A group representing the nation’s osteopathic medical schools urged Congress to end the federal government shutdown before its deeper effects take hold. Outlining current and anticipated impacts from the first 2 weeks of the shutdown, officials with the American Association of Colleges of Osteopathic Medicine (AACOM) voiced support for two bills that address key challenges faced by its member institutions. … The budget-driven shutdown leaves the nation’s 44 osteopathic schools disproportionately exposed because of their mission focus and funding structure. More than half of schools are located in health professional shortage areas, and they depend heavily on federal programs for medical education, clinical training, and research funding. (McCreary, 10/17)
3. Seniors Paying More For Pills Now That Tariffs Put Foreign Deals Out Of Reach
Prices for imported medicines have surged under President Trump’s trade policies, and some countries have stalled shipments to the U.S., leaving senior citizens and uninsured Americans without an affordable option for their needs. Plus, the buzz about cheap weight loss drugs.
The Washington Post: Many Seniors Get Cheaper Medicine From Canada. That Might Become Harder.
Linda Klonsky usually orders her prescription eye drops from a Canadian pharmacy that charges $250 for a three-month supply. But that came to an abrupt halt late this summer when it came time for her to reorder, as the Trump administration’s latest trade edict prompted dozens of international postal services to suspend shipments to the United States. With little choice, the 75-year-old turned to a CVS near her home in Silver Spring, Maryland, and bought 30 days’ worth of similar drops for $740 — nearly nine times what she usually pays. (Najmabadi, 10/18)
CNN: Trump’s $150 Ozempic? Oz Cautions It’s Not A Done Deal, But Patients And Doctors Say It Could Be A Gamechanger
Janet McCaskill was on vacation in Arizona with her husband and best friend when she heard that President Donald Trump had suggested he might be able to bring the cost of popular weight-loss drugs down to $150 a month. “The thought of it going to $150 a month is dramatic,” said McCaskill, a grandmother from North Carolina who’s lost 100 pounds with the help of GLP-1 medicines, a class best known for the diabetes drug Ozempic. “That is most fantastic – if it comes to pass.” (Tirrell, 10/17)
Politico: Trump Struggles To Crack Tariff Piggy Bank
President Donald Trump and his top officials have repeatedly promised to tap the billions of dollars collected from their historic tariff hikes for key priorities like troop pay, nutrition assistance and farmer bailouts. That’s not how it works. The administration has brought in about $200 billion in tariff revenue so far this year, cash the president and members of his Cabinet have boasted is a sign their tariff hikes are succeeding — and have suggested they can now use at their discretion. … The reality, however, is that the White House has extremely limited power to direct those funds without congressional direction, since revenue generated by the federal government flows into the Treasury and Congress decides how that money gets doled out. (Desrochers and Scholtes, 10/19)
Modern Healthcare: Cuban Praises TrumpRx, Hits Both Sides On Government Shutdown
In his keynote address at the HLTH 2025 event in Las Vegas on Sunday evening, Cost Plus Drugs co-founder and entrepreneur Mark Cuban complimented TrumpRx, President Trump’s website for drug discounts. Cuban said he is a fan of the concept, which will help Americans purchase certain prescription drugs directly from participating manufacturers. (Perna and Kacik, 10/19)
How philanthropists are coping with the tariffs —
Modern Healthcare: Hospital Donors Offer Cryptocurrency, Stock Instead Of Checks
Health systems are embracing cryptocurrency, real estate and and stock gifts as donors who once wrote checks navigate economic volatility. Tariffs, inflation and the government shutdown have squeezed some philanthropists’ cash reserves, prompting nonprofit health systems’ foundations to get more creative in their funding requests. Many of those requests are seeking support for mental healthcare efforts, patient financial assistance funds, community health initiatives, workforce training, new technology, cancer care and cardiovascular programs, foundation directors said. (Kacik, 10/17)
In other news about the Trump administration —
ABC News: Luigi Mangione’s Attorneys: White House Making Him ‘Pawn To Further Its Political Agenda’
The Trump administration is making Luigi Mangione “a pawn to further its political agenda” and uttering or posting statements about him that are prejudicing the accused killer’s prospects at a fair trial, his attorneys argued Friday in a new court filing that asked a federal judge to either dismiss the indictment or take the death penalty off the table. Federal prosecutors said President Donald Trump’s social media posts calling Mangione “a pure assassin,” and subsequent reposts by Justice Department officials, did not prejudice Mangione “because the statements were made by persons not associated with this matter.” The defense said the government can’t make that claim because of Trump’s unprecedented intervention in Justice Department matters. (Katersky and Hemingway, 10/17)
The 19th: Trump’s Attempt To Gut Special Education Office Has Some Conservative Parents On Edge
The Trump administration’s decision to lay off most employees within the U.S. Department of Education’s special education office was described by the president this week as part of cuts to “Democrat programs that we were opposed to.” This was news to many conservative parents of disabled children, as well as disability policy experts. … “Education for people with disabilities goes hand in hand with conservative ideals,” wrote disabled journalist Eric Garcia in a recent MSNBC column. “While that may seem counterintuitive, having people with disabilities integrated into larger society is a way to reduce the chance that they have to depend on the government.”. (Luterman, 10/17)
4. Study: Some Cancer Patients Who Got mRNA Covid Vax Lived Much Longer
Researchers found that patients with advanced lung cancer and melanoma who received an mRNA shot within 100 days before receiving immunotherapy had “nearly double overall survival.”
Stat: MRNA Covid Shots May Boost Effects Of Cancer Immunotherapy
The study found that advanced cancer patients who received a Covid vaccine within 100 days before taking an immunotherapy drug during the pandemic lived longer than patients who did not, in a retrospective analysis. Researchers from MD Anderson Cancer Center presented the study at the European Society for Medical Oncology conference in Berlin on Sunday. The results are intriguing cancer immunologists and oncologists, who reacted with both excitement and caution. (Chen, 10/19)
Stat: Moderna Founder Says Attack On Science Won’t Stop At MRNA Vaccines
Over the last year, venture capitalist Noubar Afeyan has watched his signature creation, Moderna Therapeutics, go from perhaps the world’s most celebrated company, hailed for helping ease a once-in-a-century pandemic, to a target of government officials promoting falsehoods about mRNA technology. Those attacks, Afeyan warned Thursday, would not end with Moderna or mRNA vaccines. They are a canary in the coal mine for a larger assault on science and expertise, he said. (Mast, 10/20)
CNN: First On CNN: City Health Officials Urge Vaccination, Criticize Federal Government Messaging
The Big Cities Health Coalition is the latest group to take a strong public stand in support of vaccination as a direct response to concerns that the federal government is limiting access and raising doubts. “We are united behind a simple message: get vaccinated,” the group wrote in a statement that was published Monday. It was signed by two dozen public health leaders from some of the nation’s largest cities, in both Democrat- and Republican-led states. (McPhillips, 10/19)
The Washington Post: Two Infectious-Disease Experts Say This Is When You Should Get Covid, Flu Shots
The Washington Post spoke to two infectious-disease experts about how they make their own decisions and how they talk about these issues with friends and family. Caitlin Rivers, an infectious-disease epidemiologist and senior scholar at the Johns Hopkins Center for Health Security, is a 35-year-old mother of an 11-year-old and 6-year-old twins. She also writes a weekly newsletter that tracks covid, influenza, RSV and food recalls. Andrew Pavia is a 69-year-old pediatrics infectious-disease physician at the University of Utah. (Sun, 10/19)
CIDRAP: Protection From Flu Vaccine Around 50% For Southern Hemisphere, Data Reveal
In a precursor to what we might expect in the coming flu season in the United States and across the Northern Hemisphere, a new study shows flu vaccine effectiveness to be around 50% for both clinic visits and hospital stays for influenza during the 2025 Southern Hemisphere flu season. (Wappes, 10/17)
The Washington Post: Want To Get Vaccinated For A Trip? What To Know About Travel Clinics.
During Courtney Gardner’s first visit to a travel clinic, she learned about all the diseases she could catch on an upcoming trip to India: typhoid, Japanese encephalitis, hepatitis A, chikungunya, cholera, malaria. The litany of health risks wasn’t the biggest surprise; it was the $2,751 bill for the consultation and immunizations. “It was sticker shock,” said Gardner, 56, who lives in Maryland. “I’m grateful for the service, and I get that there’s a cost, but it had never occurred to me that it would be so much.” (Sachs, 10/15)
5. Large Health Systems Vie To Be Lifeline For Struggling Rural Hospital In Florida
The three contenders — Tampa General Hospital, AdventHealth, and NorthStar Hospitals Inc. — each would keep DeSoto Memorial Hospital operating in DeSoto County. Additional health industry news is about mobile health clinics, the Kaiser Permanente strike, Medicare, Medicaid, and more.
Suncoast Searchlight: DeSoto Memorial Weighs Offers From Major Health Systems As Rural Challenges Mount
Facing with an uncertain financial landscape for rural hospitals, the hospital board voted to hear competing presentations from Tampa General Hospital, AdventHealth and NorthStar. (Newhouse, 10/17)
The Daily Yonder: Study: Mobile Health Clinics Offer Alternative Access To Care
A new report found that mobile health clinics can provide rural communities with access to healthcare in areas where healthcare facilities and healthcare workers may be scarce. (Carey, 10/18)
More health industry updates —
Los Angeles Times: Kaiser Healthcare Worker Strike Ends After Five Days. Bargaining Resumes This Week
A five-day strike that affected hundreds of Kaiser Permanente clinics and hospitals in California and Hawaii came to an end after the union representing workers said it had “new momentum” to head back to the bargaining table, but no apparent agreement has been reached. (Hernandez, 10/19)
The Baltimore Sun: Rehabilitation And Wellness Center FutureCare Opens In Annapolis
FutureCare, a company that operates rehabilitation and wellness centers across the region, has opened in Annapolis, the company’s 16th facility. (Rothstein, 10/17)
Asheville Watchdog: HCA Arrived With Plans To Cut 800 Staff As Soon As It Bought Mission, New Court Filings In Antitrust Case Show
Mission Hospital administrators were aware, before the sale, that HCA Healthcare intended to cut hundreds of staff positions once it acquired Asheville’s flagship hospital, including deep reductions to the nursing staff that caused Mission’s then-president to have “significant concerns,” according to depositions filed recently in a long-running antitrust lawsuit against HCA. Jill Hoggard Green, a registered nurse who was Mission’s president and chief operating officer from 2011 until the sale of nonprofit Mission to HCA in February 2019, testified in a deposition earlier this year that she was “very, very concerned” when she learned that HCA was “working on building models related to reducing nursing.” (Lewis, 10/17)
Asheville Watchdog: Mission Hospital Faces New Immediate Jeopardy Recommendation As State Agency Flags Major Safety Risks
Mission Hospital should again be put in immediate jeopardy, the worst sanction a hospital can face, the North Carolina Department of Health and Human Services has recommended. The finding, made by NCDHHS and reported to the U.S. Centers for Medicare & Medicaid Services (CMS), is a devastating blow to the largest healthcare provider in western North Carolina: For the second time in two years, and the third since for-profit HCA Healthcare bought the nonprofit Mission Health system in 2019, the hospital risks losing Medicare and Medicaid funding because of deficiencies in care so severe that state inspectors believe they pose imminent risk of serious injuries or death to patients. (Evans and Jones, 10/17)
Asheville Watchdog: Mission Hospital Had Earlier, Unreported Immediate Jeopardy Citation After Patient’s Death In 2021, Court Documents Reveal
A patient found dying on the floor of her room at Mission Hospital led to a previously unreported citation of “immediate jeopardy” in 2021, two years after Asheville’s flagship hospital was acquired by HCA Healthcare, court documents show. The 2021 sanction, for violating federal hospital safety regulations so severely that patients are in imminent danger of serious injury or death, was not disclosed by HCA. It was followed in 2024 by a second, widely publicized immediate jeopardy citation against HCA and Mission, for violations that contributed to the deaths of four patients. (Lewis, 10/17)
On Medicare and Medicaid —
Modern Healthcare: Mayo Clinic To Leave Major Medicare Advantage Networks
Mayo Clinic will be out of network next year for most UnitedHealthcare and Humana Medicare Advantage plans. Starting Jan. 1, Mayo facilities in Minnesota, Wisconsin and Iowa will not be in network for UnitedHealthcare members enrolled in Medicare Advantage individual plans and Dual Eligible Special Needs Plans. In-network coverage will continue for group Medicare Advantage plans, which offer employers flat monthly fees. (Kacik, 10/17)
Axios: Medicare Advantage Plans Embrace Riskier Patients
Some health plans are finding new business opportunities customizing coverage for the sickest Americans. (Goldman, 10/20)
KFF Health News: Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as being available to treat the plans’ members, a new federal watchdog report says. The investigators allege that some insurers effectively set up “ghost networks” of psychologists, psychiatrists, and other mental health professionals who purportedly have agreed to treat patients covered by the publicly financed Medicare and Medicaid plans. In fact, many of those professionals do not have contracts with the plans, do not work at the locations listed, or are retired, the investigators said. (Leys, 10/20)