PNHP

Area hospitals brace for Medicaid cuts as uninsured patients rise

Area hospitals brace for Medicaid cuts as uninsured patients rise

By Max Blaisdell
Hyde Park Herald, March 13, 2026

In January, a young man arrived at the University of Chicago Medical Center and received a cancer diagnosis expected to shorten his life to just a few years.

The patient was younger than the 27-year-old resident treating him, and he had no insurance. Instead of leaving with an oncologist and a treatment plan, he left with a referral to a safety-net hospital down the road.

“It’s devastating to have to say anything other than ‘Here’s how we can help,’” said Zachary Pellis, a third-year internal medicine resident at UChicago Medicine, who treated the young man.

The case wasn’t an anomaly. The same month, Pellis said he encountered a man who needed a liver transplant but could not resolve his insurance in time to remain eligible. His only option was to visit an emergency room every week for the lab work required to maintain his transplant candidacy. Pellis wrote him a handwritten list of lab tests to give whichever ER doctor he saw.

“That is entirely because of his insurance,” Pellis said. “We’re the richest country on Earth and that’s our plan.”

Doctors told the Herald that cases like these are becoming more common across area hospitals, even before the most significant provisions of last summer’s One Big Beautiful Bill Act take effect. The law, signed by President Trump in July, is projected to cut federal Medicaid and Supplemental Nutrition Assistance Program (SNAP) spending by $1 trillion over the next decade. Illinois alone could lose as much as $48 billion in federal health funding.

The biggest changes, including new work requirements for Medicaid recipients and tighter eligibility rules for Affordable Care Act (ACA) Medicaid expansion enrollees, are slated to kick in on January 1, 2027. More than 300,000 Illinoisans are expected to lose coverage as a result.

More than 70% of UChicago Medicine’s patients receiving inpatient care are insured by Medicaid or Medicare, making it one of the hospitals in Chicago serving the highest share of patients on government-funded health care.

When Pellis started his residency two and a half years ago, he recalls being struck by how nearly all the patients at UChicago Medicine had some form of coverage, even if only Medicaid.

But now, Pellis said, he sees about 10 uninsured patients per month — “way more frequently than I’m used to.”

Nick Pradhan, a fellow resident at UChicago Medicine, is also watching the situation closely, particularly for patients who currently rely on Medicaid expansion and whose eligibility could evaporate under the new rules. One patient Pradhan has seen for years in his primary care clinic, a young adult who recently enrolled in Medicaid and who had been receiving gender-affirming care, including hormones, that have transformed their life, may soon lose their coverage.

“I’ve seen them go from someone who was stressed, who had issues with mental health, to a young adult with a job and hopes and dreams for their career,” Pradhan said.

Under provisions in the bill, federal Medicaid dollars no longer cover gender-affirming care, including hormone therapy. (Last July, UChicago Medicine suspended gender-affirming care for minors under pressure from the federal government.)

Whether Pradhan’s patient will remain eligible for Medicaid at all after the tightening of income-based enrollment rules is something he doesn’t yet know, but fears.

Across the South Side, hospital administrators are bracing for similar ripple effects of the law, even as the full dimensions of the cuts remain uncertain. At La Rabida Children’s Hospital, 6501 S. Promontory Dr., where about 90% of the hospital’s roughly 9,000 patients rely on Medicaid, CEO Dr. Rolla Sweis said the hospital is expanding its walk-in clinic capacity to meet what she expects to be an uptick in patients entering the emergency departments of nearby children’s hospitals.

“When patients lose coverage, they tend to turn to the emergency departments for care,” she said. “We try to ensure that we are supporting not only the community but the children’s hospitals around us.”

Patients 19 and older with complex conditions who age out of typical pediatric care will be at heightened risk of losing Medicaid coverage, Sweis said. A recent study by U. of C. researchers found that roughly 38% of young adults with complex medical conditions lost coverage at some point in the three years after turning 19.

Parents of medically complex children, many of whom serve as around-the-clock caregivers for kids on ventilators or feeding tubes, could also lose their own health coverage, compromising their ability to provide that care. Hands-on training for those caregivers may also be curtailed.

La Rabida is also anticipating impacts beyond direct coverage losses. A temporary pause in SNAP benefits, the federal food assistance program, led to a 143% increase in use of the hospital’s food pantry in the last six months of 2025 compared with the same period in 2024, rising from 2,288 people served to more than 5,500. Hospital leaders said further SNAP cuts could push demand even higher.

“Food is medicine,” Sweis said, noting that many of the hospital’s diabetic patients depend on reliable access to nutritious food.

So far, state legislative relief has been limited. Safety-net hospitals received some additional line-item funding in last spring’s legislative session, but La Rabida was not among the recipients. While Illinois Governor J.B. Pritzker promised continued relief for Illinoisans with medical debt in his February state of the state address, he made no mention of sustaining access to health care for those at risk of losing it in what is expected to be a deeply uncertain budget year.

At Cook County Health, which operates Provident Hospital, 500 E. 51st St., in Bronzeville and serves one of the largest concentrations of Medicaid patients in the region, Chief Hospital Executive Donnica Austin-Cathey drew a comparison between the current moment and the era before the ACA. Before Medicaid expansion took full effect in 2014, she said, nearly half of all patients at Cook County facilities were uninsured. After expansion, that figure dropped by roughly half.

“We’re continuing to watch what’s happening, bracing for what the impact would be,” Austin-Cathey said. “There could be longer waits for care, higher costs, sicker communities.”

More than 40% of Provident’s patients are insured by Medicaid, according to its state hospital report card.

In light of those potential strains, Austin-Cathey said Cook County Health is focused on scenario planning, monitoring emergency department capacity and working to keep patients visiting their primary care physicians rather than waiting until a crisis forces a hospital visit.

“We certainly don’t want to see people managing care through the emergency department,” she said. “We know it’s an expensive way to manage care.”

Meanwhile, some physicians are channeling their anger over the Medicaid cuts into legislative advocacy. Both Pellis and Pradhan are members of Physicians for a National Health Program, an advocacy organization pushing for a single-payer health care system, similar to those in Canada and the United Kingdom.

Pellis is helping lead a state-level effort to explore “deprivatizing” Medicaid in Illinois — removing the private managed care organizations that currently act as middlemen between the state and Medicaid recipients, and having the state administer coverage directly. Connecticut pursued a similar approach and saved more than $4 billion over 13 years since the change took effect, according to the Connecticut Health Policy Project. A 2025 report from Physicians for a National Health Program estimated that a state as large as Illinois could save billions annually through such a move.

“Even Republicans who don’t want to raise taxes might find this appealing, because the money’s just sitting there,” Pellis said. “Nobody wants to balance the budget on the backs of sick people. If there are billions of dollars to be saved, I think the political appetite is there.”

For now, physicians like Pellis and Pradhan are devising workarounds, such as handwritten lab lists, emergency room contingency plans and calls to social workers, but they say those measures are not a long-term solution or a substitute for insurance coverage.

“The system is designed to make it so much harder to do the right thing,” Pellis said. “And there are not enough doctors to go above and beyond for everyone.”

https://hpherald.com…

One-Third of Americans Cut Back to Cover Healthcare Expenses

Cost of healthcare also causing many to delay pursuing milestones and life-enhancing goals

By Ellyn Maese
Gallup, Wellbeing, March 12, 2026

Amid a landscape of elevated prices and a rising cost of living, Americans are feeling financial strain from both a range of daily expenses, such as groceries and utilities, and healthcare expenses.

The West Health-Gallup Affordability Index indicates that Americans’ ability to afford healthcare has deteriorated in recent years. In 2026, millions are expected to face higher insurance premiums and rising out-of-pocket costs as the expiration of some Affordable Care Act subsidies and upcoming cuts to Medicaid enrollment threaten coverage. Collectively, these shifts could leave millions of Americans without health insurance at a time when financial stress is already running high.

New findings from the West Health-Gallup Center on Healthcare in America reveal that some Americans are cutting back on a wide range of other expenses, including utilities, driving less to save gas money to pay for healthcare, and stretching out doses of prescription drugs or borrowing money.

Americans also report that healthcare expenses are influencing long-term planning and major life decisions. Even middle-income households are feeling the strain.

Healthcare Costs Impact Daily Life

In a nationally and state-representative survey of nearly 20,000 U.S. adults conducted from June through August 2025, roughly one-third of respondents — the equivalent of more than 82 million Americans — said they have made at least one trade-off with daily living expenses to afford healthcare.

These financial trade-offs are far more common among Americans who do not have health insurance, with 62% saying they have made at least one sacrifice to pay for healthcare, including 32% who have borrowed money and 24% who have prolonged medication. But even among those with insurance, close to three in 10 have made at least one sacrifice.

full survey results: https://news.gallup.com…

Chicago City Council testimony in support of Medicare for All

By Claudia Fegan, M.D.
Chicago City Council, Committee on Health and Human Relations, March 10, 2026

My name is Dr. Claudia Fegan, I retired in December of 2024 after 12 years as the Chief Medical Officer of Cook County Health, and 24 years with the system. I am the National Coordinator of Physicians for a National Health Program, a national organization with over 25,000 members, based here in Chicago. I am grateful to all the members of this committee who have already signed on to Alder Cruz’s Resolution Supporting Medicare for All. While many people think access to health care is a national issue to be addressed by congress, this is a crucial issue for Chicago, and I’m thankful for the opportunity to address you today and explain why it is so important to address now, prior to the midterm elections.

As the resolution points out, the city of Chicago spends over $600,000,000 annually to provide health insurance to city employees. Think for a moment what the city could do with those funds if we had universal health care, if employers were no longer expected to pay for their employees to have access to health care. Employers are not expected to be responsible for the education of the children of their employees or guarantee their access to police or fire protection. What could Chicago do with an extra $600,000,000?

A poll of voters from November 2025 showed 90% of Democrats and the majority of independent voters support Medicare for All. Voters want to regain control of their health care and lower costs. We are the only industrialized country that does not guarantee access to health care for everyone living within our borders. Not just every citizen, everyone living here. We already spend enough on health care; we spend more money per person than any other country in the world. We allow patients to be denied access to care they need to maximize the profits of the insurance industry.

There has been a lot written about burnout among people in health care. This past year PNHP partnered with the Robert Wood Johnson Foundation to assess that burnout. Surveying over 1100 practicing physicians, we found what has been labeled as physician burnout is often moral injury inflicted by the financialization of the practice of medicine in this country. We found it has harmed the morale of the entire health care workforce, leading to increased shortages and decreased access to care as professionals retire early, cut back on their hours or leave the practice of clinical medicine altogether. Tragically, there are increasing totals of suicides among physicians. More and more, physicians are frustrated by their inability to offer patients the most appropriate care. They are stymied by required prior authorizations that issue inappropriate denials of care, make treatment recommendations their patients cannot pursue and create conflicts between health goals for their patients and the financial goals of the institutions that employ them.

It would be life-changing for Chicago to take the lead here and make a statement by supporting Medicare for All. If the city that sent the first Black woman to the Senate, that first sent Barack Obama to the Senate and then to the White House could send the message that health care is important for everyone, it would have a tremendous impact and continue our local tradition of initiating progress.

The tide is going to turn in this country. We need to build our power and be prepared to take what we need when the opportunity presents itself. We must be represented by people who have the courage to support our agenda. Medicare for All is something representatives have to be willing to fight for. We have a Congress that has acquiesced its power to a president who doesn’t believe in checks and balances. We will not get universal health care while Donald Trump is in the White House. We must be prepared for when Trump is gone. In 3 years, we must be prepared to seize the opportunity when it presents itself.

Last year, one-third of Americans delayed getting care they needed or skipped care entirely. That is the highest number since Gallup started asking questions about this 30 years ago.

I am reminded of a woman I admitted to the hospital one night a few years ago. Both of her breasts were rock hard. They were infiltrated with cancer with palpable lymph nodes in her axilla. She worked as a hairdresser, owned her own shop but had no health insurance. She was sitting at home waiting to die. She believed she had no other choice. She knew she could not afford her care. Her daughter made her come in. Remarkably we were able to get a dramatic response with treatment. No one should ever have to sit at home waiting to die in this country, when we have treatments that can be lifesaving.

Families are desperate for solutions to their everyday health care problems, skyrocketing drug prices, rising copayments and deductibles, surprise medical bills; and are tired of having to switch doctors because of the revolving door of job-based health insurance.

The United States has struggled with the effects of ‘For Profit” Health Care for decades. The country has never embraced access to health care as a basic human right.

In the United States, we know some 28 million people or 8% of the population are uninsured and that 45,000 people die each year as a direct result of not having insurance.

If there is a lesson for the rest of the world to learn from the United States, it is the lesson of the private insurance industry. The insurance companies have a fiduciary responsibility to make as much money as possible for their shareholders. They also determine which patients have access to which care. There is an inherent conflict of interest here. By eliminating the waste and greed of private insurance, we can afford to cover everyone in our country for all necessary care, and end the scourges of surprise bills, skipped medications, and medical bankruptcy. Medical illness or medical debt is the number one cause of bankruptcy in this country, even though the majority of people who declared bankruptcy had insurance at the time of their precipitating illness.

There will always be limitations on how much money is available to spend on health care. Those decisions need to be based on societal need, cost effectiveness and population health, not profits and financial yields.

We already spend enough money on health care in this country; we just allow too many people who do none of the work of delivering health care to take profit from it. I am asking the Chicago City Council to have the political courage to lead the way and to tell our nation that health care needs to be a right for everyone. Thank you so much.

Read the full Chicago City Council resolution HERE.

Sky High ACA Deductible Highlights Need for Universal Insurance

The Trump administration is dismantling financial protections offered by the Affordable Care Act, proposing a $31,000 family deductible. This attack on the economic integrity of families is registering, boosting support for single payer.

New A.C.A. Plans Could Increase Family Deductibles to $31,000, The New York Times, Feb. 26, 2026, by Reed Abelson

The Trump administration’s proposed new rules for Obamacare plans next year would shift more health care costs to Americans, with much higher deductibles that could lead to greater medical bills.

Under the proposal, people who rely on the Affordable Care Act for their health insurance coverage could choose plans with much lower monthly premiums. But that could leave them exposed to medical expenses totaling thousands of dollars more than A.C.A. plans do now before their insurance would kick in.

Dr. Mehmet Oz’s new proposal would allow one kind of health plan to raise the annual deductible to more than $15,000 for an individual and $31,000 for a family.

The proposal involves a type of plan known as a catastrophic or skinny policies. Amitabh Chandra, a Harvard health economist who has studied high-deductible plans, said, “It’s going to be a really cheap product that nobody wants.”

“There’s no doubt that we have an affordability crisis. As we move forward to shifting more of the burden to patients, there’s a chance to really exacerbate the crises,” said Dr. Joseph R. Betancourt, the president of the Commonwealth Fund.

The proposal could also erode other consumer protections. Overall, the rules could result in up to two million people dropping coverage in 2027, according to the administration’s own estimates.

Selected quotes from the NYT reader comments:

  • “This won’t work without price controls for health care, which is best achieved by a universal health care system run by the government.”
  • “…it is time for universal health care.”
  • “Grow up USA – figure out how to do a nationalized health care.”
  • “Medicare for All please.”
  • “— we need UNIVERSAL HEALTH CARE.”
  • “America desperately needs universal health care.”
  • “Can’t we just provide single payer health care…”
  • “There’s no winning the health insurance battle until we get universal health care.”
  • “Why not look at other countries that have universal health care and build our own similar system?”
  • “Medicare for All, now.”
  • “I’m a 75 year old retired Canadian who hasn’t paid out of pocket for any of my medical care and several surgeries over the years. Health care in my opinion is a human right.”

Comment:

By Don McCanne, M.D.

What is the leading health care concern in the United States? It is high costs + high deductibles + copays, which translates to … unaffordability and family economic risk.

Those least worried are the wealthy who comfortably pay for quality health plans and out-of-pocket costs. Also, those of us who remain healthy and don’t require much care are generally protected from growing personal expenses, though we all still pay taxes for public programs, such as Medicare, Medicaid, and the VA. Plus there is no guarantee that the healthy won’t eventually face truly expensive medical problems. In fact, that’s a likelihood.

The very poor may be eligible for public programs such as Medicaid. However, this is no longer assured, with recent federal cuts to coverage for the near-poor. Also: some states have declined federal funds for state Medicaid programs, and some areas lack providers who are willing to accept Medicaid. On top of this, Medicaid often underfunds essential health care services, shifting costs to the rest of us.

Moderate-income individuals and families may have employer-sponsored plans, but these costs are paid for by reductions in salaries. The costs of premiums, deductibles, and copays continue to increase. As workplace plans became less affordable, many were able to obtain plans through the Affordable Care Act. Government subsidies, especially during the Covid pandemic, made these plans more affordable. However, recently Congress split in continued support of the subsidies, and they were allowed to expire. Millions are losing ACA insurance simply because they can’t afford the premiums and cost-sharing. Thus we have an increasing crisis in the funding of health care.

Since it was primarily the Republicans who ended the COVID ACA subsidies, we should ask about their proposals to address this funding problem. However, they have been quite vague on what they do propose. President Trump mentioned very modest cash distributions to citizens so that they can place their funds in health savings accounts and use them to purchase their own insurance plans or pay for care directly. Any reasonable analysis of this proposal shows that it would be grossly inadequate to pay for the health care of anyone with significant needs. Thus, it would defeat the concept of health insurance – pooling funds to make essential, expensive health care accessible to those who need it.

This latest ACA scheme, from Dr. Oz and colleagues, would greatly increase the deductible before care is paid for. This would force funding of most routine care to come out of the pockets of most Americans – mainly individuals with low and moderate incomes. The proposed amount for the deductible for a family would be $31,000. With all other essential costs rising, how would $31,000 be handled by a family with an income of, say, $60,000? We already have the tragic answer to that: severe financial hardship and bankruptcy.

Keep in mind that a universal health care system funded with equitable, progressive taxes does not produce financial hardship for anyone.

People increasingly understand the need for broad reform. Many readers responding to the NYT article advocate for universal health care. Recent polls indicate that a clear majority support Medicare for All, especially among Democrats, but also increasingly among Independents and even Republicans. Truly, what Republican wants to see a child in bankruptcy court because a beloved grandchild was unfortunate enough to develop a serious and expensive disorder? Even $31,000 for a young family that is launching its blissful voyage through life can be a profound hardship. Surely we can agree on a program that will take care of all of us!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Greenland hospital ship intent

By Marvin Malek, M.D., M.P.H.
The Barre-Montpelier (Vt.) Times Argus, March 5, 2026

On Feb. 22, President Trump announced plans to send a U.S. hospital ship to Greenland to address unmet health needs.

If the goal were to showcase American medicine in full, one ship would not be enough. We would need additional vessels carrying insurance administrators to process prior authorizations, review claims, issue denials, and manage billing disputes. It would hardly be an authentic demonstration of U.S. health care without the paperwork and surprise bills.

Perhaps, however, Trump’s intention was likely to create a mini-single-payer system: U.S. taxpayers would fund the care and there would be no deductibles, copays, network restrictions or other insurance-related hassles that impede care and add expense. Under such a system, the ship could sail alone.

If the U.S. had a single-payer system, our nation’s taxpayers would all contribute — just as in Trump’s Greenland offer — but instead of our taxpayers funding care for citizens of another country, we would be taking care of our own people here in the U.S. and eliminate all the cost, stress and aggravation of dealing with multiple insurers.

Greenland’s prime minister, Jens-Frederik Nielsen, declined the offer. Greenland already has a single-payer system that covers its entire population. Residents receive care without deductibles or copays. Universal access is not debated; it is assumed.

The contrast with the United States is sobering. In 2024, 28 million Americans lacked health insurance. Millions more carry high deductibles that discourage them from seeking routine care. Onerous medical debt is widespread. The United States spends more per capita on health care than any other developed nation, yet leaves millions uninsured and burdens providers with mind-boggling administrative complexity. Hospitals employ large billing staffs simply to navigate multiple insurers and payment rules.

But Greenland goes beyond simplifying and streamlining its financing and payment systems. It carefully evaluates the health needs of its population, and works to meet them as efficiently as possible. Consider air ambulances, a necessity given Greenland’s dispersed population and the near absence of a highway system for ground transport. Air ambulance transports are essential. In the United States, the median charge for air ambulance transports exceeds $35,000, a figure that has risen sharply after we allowed predatory, private-equity capital firms to acquire much of the industry. In Greenland, where the government treats air transport as an essential public service, the median cost is about $4,850 — despite harsher geography and turbulent weather.

Sending a hospital ship abroad may generate goodwill. But it also underscores a deeper question: If we can imagine providing streamlined, publicly financed care overseas, why not at home?

Dr. Marvin Malek is an internist and former president of the Vermont chapter of Physicians for a National Health Program.

https://timesargus.com…

New report: Financialization of U.S. health care causes widespread moral injury among physicians

“Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System” draws on physician focus groups, a national survey of over 1,200 physicians, individual physician interviews, and patient focus groups

FOR IMMEDIATE RELEASE: March 5, 2026

Media Contact: Anika Thota, PNHP Policy & Communications Specialist, anika@pnhp.org

A groundbreaking new report released by Physicians for a National Health Program (PNHP) finds that the growing financialization of U.S. health care is causing widespread moral injury among physicians – with dire consequences for doctors, patients, and the U.S. health care system as a whole.

The report, “Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System” draws on physician focus groups, a national survey of over 1,200 physicians, individual physician interviews, and patient focus groups to examine how financialized health care structures shape the daily realities of patient care.

Physicians described experiences that go well beyond the common misdiagnosis of “burnout” and reveal how they are routinely prevented from delivering quality care. As one interviewed physician said, “We are not happy with the fact that [we] can’t get you the medicine that you need or that it is too expensive.” Who is to blame for moral injury? Insurers and corporate investors, who demand profits and hold strong influence over how physicians provide treatment, often resulting in subpar care.

“Our research shows that physicians are not failing the system, but rather, the system is failing both physicians and patients,” said Dr. Diljeet K. Singh, president of PNHP. “Doctors enter medicine to care for people, yet they are increasingly forced to navigate corporate agendas and insurance barriers that delay or deny treatment. When clinical judgment is overridden by financial priorities, patient care is no longer prioritized.”

The report indicates that 35% of surveyed physicians felt as if they had to care for more patients than they could safely manage, while 44% said insurance approval barriers or lack of service availability often prevented medically necessary treatment. The research also highlights how financialized health care structures deepen racial inequities. Among surveyed physicians, 41% reported often feeling complicit in structural racism perpetuated by their health care systems.The report concludes that commonly proposed solutions, such as wellness programs or resilience training, fail to address the root causes of physician distress. Physicians consistently emphasized that moral injury arises from structural forces within the health care system, particularly the prioritization of revenue generation and cost containment over patient care.

“If we want to restore trust in medicine and allow physicians to practice ethically, we must address the structural incentives that place profits ahead of patients,” Dr. Singh said.

The full report is available at pnhp.org/MoralInjuryReport 

Physicians for a National Health Program (pnhp.org) is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform. Support for this program is provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Robert Wood Johnson Foundation.

Insured But Still Can’t Afford Care? The Underinsured Crisis

By Brenda Gazzar
Code Wack Podcast, March 2, 2026

Millions of Americans have health insurance, but still can’t afford to use it. So what happens when high deductibles and corporate profit pressures shape the care patients receive?

To break it down, we spoke with Dr. Adam Gaffney, a pulmonary and critical care physician, public health researcher, and Assistant Professor of Medicine at Harvard Medical School. He’s also a former president of Physicians for a National Health Program, and his work focuses on health care financing and national reform.

This is the second episode in a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

Protecting essential services by eliminating waste in Missouri Medicaid

By Priya Pal, M.D., Ph.D.
Missouri Independent, Feb. 28, 2026

If you polled Missourians, you would be hard-pressed to find someone who enjoys paying taxes, regardless of political affiliation. Yet most Missourians recognize that some services are essential — things like roads, schools, and programs that support independence, self-sufficiency and community health.

These services provide stability not just for individuals, but for entire communities. The expectation is simple: if tax dollars must be spent, they should be spent wisely.

As physicians, our mission is to help people live healthier lives. But even the best medical knowledge or the newest treatments do little if our patients can’t access care or afford the medicines they need. Medicaid has long helped bridge that gap, ensuring Missourians can get timely care before small problems become serious ones. Medicaid helps keep families healthy, communities stable, and local economies strong- making it a highly effective use of taxpayer dollars.

Missouri legislators carry the responsibility of stewarding hard-earned tax dollars wisely. In times of fiscal uncertainty, that responsibility becomes even more challenging — and even more important.

The budget unveiled by Governor Mike Kehoe includes a reduction of ~$600 million across state funds. These constraints follow last year’s elimination of the capital gains tax, which reduced general revenue by an estimated $360–600 million annually, and ongoing discussions about eliminating the state income tax — which currently comprises ~65% of Missouri’s general revenue. More recently, conversations have expanded to reduction or elimination of property taxes, which would place additional strain on public services, including Missouri schools.

In this fiscal climate, Missouri lawmakers will need to make difficult decisions on how to allocate limited resources.

As the federal reconciliation bill began moving forward in 2025, a group of Missouri physicians began discussing how the state might preserve Medicaid access despite growing budget pressures. One potential opportunity emerged: reducing administrative costs by transitioning Missouri’s Medicaid program away from managed care organizations and toward direct state administration. Preliminary estimates suggest this approach could not only save hundreds of millions of dollars annually but improve healthcare outcomes.

Since the legislative session began, Missourians have heard repeated warnings about possible cuts to essential programs. Proposed reductions include services that help Missourians remain healthy, and those with disabilities live safely in their homes, or engage more fully in their communities.

Legislators from both parties have expressed a clear commitment to identifying and eliminating wasteful spending beforecutting essential services.

Representative Darin Chappell pledged to eliminate unnecessary spending before reducing vital programs, stating his intention to “wring every last penny” of waste before making cuts that could harm vulnerable Missourians.

These are reasonable goals. Transitioning to direct state administration for Medicaid offers a viable option to retain essential services and achieve meaningful savings without reducing benefits or eligibility.

Medicaid is one of the largest components of Missouri’s budget and one of its most important services. The program provides healthcare coverage to more than 1.2 million Missourians, nearly one in five Missourians. The program covers 40%of births, half of Missouri’s children, and ~66% of nursing home residents.

Medicaid is particularly important in rural communities, where hospitals often operate on thin margins. Since 2004, at least 12 rural hospitals in Missouri have closed; many others remain financially vulnerable. Medicaid funds keep these facilities open,  ensuring access to care.

In Missouri, the federal government currently funds approximately 78%of the Medicaid program — roughly $12.5 billion annually.

Missouri lawmakers are right to look for ways to control costs before reducing access to care. One potential solution could help address both at once.

Missouri currently contracts with managed care organizations (MCOs) to administer much of its Medicaid program. These organizations manage benefits and process claims for Medicaid enrollees. While managed care was intended to improve efficiency, it has come at a substantial administrative cost.

Missouri already directly administers the most medically complex portion of Medicaid, with administrative overhead estimated at approximately 1-3%. By comparison, managed care organizations operating in Missouri are estimated to have administrative overhead costs closer to 12%.

This difference represents a significant opportunity for savings.

Estimates suggest that transitioning to direct state administration and direct payment to providers could reduce Medicaid spending by up to $150 million in general revenue annually, primarily through lower administrative costs. There would also be one-time savings between $230-420 million from the claims lag on the outgoing managed care program after MCOs were paid their last fee.

At a time when lawmakers are considering cuts to disability services, and prevention programs, savings of this magnitude deserve serious consideration.

Another example of hidden administrative costs include legislation like HJR154 and SJR108 which would make Medicaid work reporting requirements a permanent part of Missouri’s Constitution. While work requirements are often intended to encourage employment and reduce spending, evidence from other states underscores that they increase administrative costs and cause eligible individuals to lose coverage due to paperwork and reporting requirements rather employment status while having no impact on employment numbers.

For Missouri, implementation costs are projected to reach approximately $131 million in the first year alone.

Missouri’s administrative capacity further heightens these concerns. The state has consistently struggled to meet federal Medicaid processing timelines, with periods where 50–72% of applications exceeded the 45-day federal requirement. Missouri has also been sued for failure to properly administer SNAP benefits, reflecting broader capacity challenges within the DSS. Under federal HR1, failure to maintain an error rate <3% could jeopardize $1.2 Billion in Medicaid funding.

If the goal is to eliminate wasteful spending, administrative inefficiencies deserve as much scrutiny as direct program costs.

Transitioning Missouri’s Medicaid program away from managed care organizations and toward direct administration would not solve every budget challenge. But it represents a practical opportunity to reduce waste while protecting services that Missourians rely on.

Dr. Priya Pal is an assistant professor of medicine in the division of infectious disease at Washington University in St Louis. She conducts HIV basic and translational research and treats patients with a variety of infections.

https://missouriindependent.com…

It’s the Prices and More

A blog post in Health Affairs highlights high US prices as the cause of massive healthcare costs. There is truth in this view. However, the problems plaguing US health care are far beyond prices. And, the price problem itself would be mitigated with single payer.

The US Health Spending Problem Is Still About Prices, Health Affairs Forefront, Feb. 18, 2026, by Irene Papanicolas, Jonathan Cylus, and Luca Lorenzoni

For more than two decades, debates about why US health care spending is so high have been shaped by the insight articulated by Gerard Anderson, Uwe Reinhardt and Peter Hussey: that the United States does not use more health care than other high-income countries but pays much higher prices for it. The original “It’s the Prices, Stupid” argument was fundamentally about price levels, not price growth. That central insight remains as true today as when it was first articulated: across services, drugs, and inputs, the United States consistently pays substantially higher prices than its peers for comparable services, drugs, and inputs.

Recent estimates of US national health expenditures, produced by the national health expenditures (NHE) team at the Centers for Medicare and Medicaid Services, have reignited debate about what is driving spending growth, which is a related but distinct question. In his recent Health Affairs Forefront piece, “It’s Not the Prices, Stupid,” Michael Chernew argues that utilization and intensity, rather than prices, are the primary explanation for recent expenditure growth.

While we agree that understanding what drives expenditure growth is essential for sound policy, we worry that this framing risks conflating growth dynamics with the underlying reason the United States spends so much on health care in the first place: price levels that are far higher than those paid in other high-income countries.

Health care spending reflects the interaction of prices and volume. In practice, when researchers decompose spending growth, volume typically encompasses both the use and the intensity of care delivered, with intensity referring to changes in the mix or complexity of services per episode.

Although it is lumped together with use, changes attributed to intensity may reflect shifts in service mix, coding practices, payment design, or the adoption of new technologies—many of which operate through higher prices per episode rather than greater quantities of care.

While the NHE estimates do account separately for the administrative spending incurred by payers and insurance, they are not able to do the same for provider-facing administrative costs, such as billing, coding, and prior authorization compliance; instead, these administrative costs are embedded in estimates of provider spending.

There are real consequences of erroneously focusing policy attention on the use and intensity of care as the driver of exorbitant expenditure growth. By suggesting the use and intensity of care as the culprit, decisionmakers may perceive coverage reductions and higher co-payments as the solution to reduce demand. This will result in less access to care and worsen health outcomes, when the real cause of high spending growth is that the prices paid for care exceed the value they provide.

Health Affairs Online Comment:

By Don McCanne, M.D.

Of course, prices, utilization and intensity all play some role in the cost of health care. But limiting attention to such factors, as we now do to some extent, has resulted in the most expensive health care system in the world with performance of the system ranking near the bottom of industrialized nations. What we really need is structural reform. A single payer financing system can control costs while maintaining high performance through much lower administrative costs, stronger negotiating power, limiting profit from basic coverage while covering costs, universal risk pooling, and emphasis on primary and preventive care. It’s astonishing that we are not supporting reform that would work well for everyone and instead we support reform that enables enrichment of superfluous passive investors and private equity through diversion of our health care dollars. Isn’t it time for Health Affairs to expand its coverage to such patient-friendly models that would greatly improve efficiency and value for our health care spending?

https://disqus.com…

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

The renewed emphasis on prices in medical care brings back thoughts of free markets in health care as preached by Milton Friedman. But in a previous HJM post we highlighted that a universal, publicly financed and publicly administered program, as advocated by Kenneth Arrow, will bring us universal coverage, low administrative waste, removal of excess profits, and protected health care access as a social good – features not found in a free-market based system.

The Arrow model relieves us of the need to be concerned about prices because the legitimate costs are already built into the health care delivery system. Thus price shopping is an unnecessary feature that can be omitted from consideration when accessing health care. Rather than being concerned about prices in the marketplace, the patient’s concern is only about access since the payment has already been made through progressive taxes based on the ability to pay. Thus health care is always readily available to everyone without having to face the potential hardship of market prices since they will have been addressed by our public negotiators, as the growth in utilization and intensity will have been similarly addressed on our behalf. After all, negotiators representing all of us should certainly have a greater impact than any of us negotiating on our own. And for those worried about government negotiated expenses, remember that the savings come from reducing waste that is currently going to the investors, private equity and superfluous administration.

P.S. from Jim: The article states “NHE estimates … are not able to [quantify] provider-facing administrative costs, such as billing, coding, and prior authorization compliance …”. Hence costs attributable to administrative bloat imposed by complicated insurance are not highlighted. However, provider billing and insurance-related (BIR) administrative costs have been quantified. I’ve done much of that work with colleagues. The excess (and hence avoidable) provider BIR burden is ~10% of all spending. E.g., see a 2014 review here. It seems to me that if we need to discuss prices (and we do), we must highlight the wasteful BIR portion, which of course disappears with single payer.

https://healthjusticemonitor.org…

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The Deadly Design of U.S. Health Care

By Brenda Gazzar
Code Wack Podcast, Feb. 23, 2026

Why do Americans live about four years less, on average, than people in similar European countries, despite spending far more on health care? And why are so many dying from illnesses we already know how to prevent or treat?

To help us unpack this, we spoke with Dr. Adam Gaffney — a pulmonary and critical care physician, public health researcher, and Assistant Professor of Medicine at Harvard Medical School. He’s a former president of Physicians for a National Health Program, and his research and advocacy focus on health care financing and national reform. He’s also the author of To Heal Humankind: The Right to Health in History.

This is part one of a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

When Oh When Real Reform?

Health insurance reform has taken a decades-long, winding, and pot-holed road. Most recently, Obama’s Affordable Care Act grew private insurance & Medicaid, yet affordability worries are worse than ever. 2025 saw cuts to these modest gains. Are conditions coalescing for real reform?

How Much Longer Will Americans Wait for Real Health Reform?, Health Care un-Covered, Feb. 20, 2026, by Trudy Lieberman

Kudos to Merrill Goozner, former editor of Modern Healthcare, for spotlighting a grim but important story on his Substack column GoozNews. “A year spent degrading health” is a damning picture of the U.S. health care system …

Below is an excerpt:

  • Two snapshots of a health care system in precipitous decline: First, the latest Kaiser Family Foundation tracking poll shows Americans’ number one pocketbook concern is now the cost of health insurance and out-of-pocket health care expenses. Fully two-thirds of the public are more worried today about health care costs than food, housing, utilities or gasoline.
  • Second, the Centers for Medicare and Medicaid Services reports that 1.2 million households dropped health insurance coverage during the 2026 sign-up season, a direct result of the Republican Congress ending the enhanced premium subsidies for Obamacare plan purchasers. The missing 1.2 million came from just 30 states that use the federal exchange.

… Now Medicaid, which was passed in the mid-1960s along with Medicare for the elderly, is in jeopardy because of provisions in President Trump’s One Big Beautiful Bill Act that reduced funding for the program.

… Will Americans pay medical bills for the rest of their lives while the profit concerns of big companies continue to overshadow the needs of ordinary Americans who just want a health system that takes care of their medical needs?

Comment:

By Jim Kahn, M.D., M.P.H.

This is, as a colleague aptly characterized it, a “cri de coeur” – a painful and plaintiff cry from the heart, lamenting our dire situation. Who could have foreseen that Obama’s reforms and expansions to public and private insurance would leave hundreds of millions so deeply worried about health care costs? Many single payer advocates (myself included) said that the ACA tweaks were insufficient, costly and complex. But we (or at least I) failed to anticipate the worsening of health care financial woes.

As we’ve often written in HJM, other wealthy nations (in the OECD) use a well-proven and clear strategy: a standardized comprehensive benefit package, with affordable cost-sharing, overseen by a public payer or a network of private insurers acting under not-for-profit rules. That’s the formula. It works.

Why don’t we follow that model? As Trudy Lieberman writes, because of the interests of large corporations. They make tens of billions in profits, and impose many times that in administrative complexity. Hence decades of insurance tweaks at the margins. And with the new administration, retrenchments. More people are uninsured, and many more are under-insured, with sky-high deductibles and cost-sharing.

Yet, I’m optimistic. The pain so many of us feel with high health care costs and worsening insurance is registering widely as evidence of the abject failure of our current system. The collaborative response to the current administration’s excesses is building coalitions and empowerment. Progressive political candidates are surging. Several states are designing universal health plans.

This isn’t a post about technical insurance details (always time for that later). Instead, it’s about staying the course, seeking and creating action openings. Health care reform bringing affordable universal coverage is in our future. It is for us to manifest through values and determination. And change strategy – another technical topic, coming soon.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Censored Medical Research Restored to Federal Website

By Kathryn Palmer
Inside Higher Ed, Feb. 19, 2026

Nearly one year after researchers sued the federal government for removing articles from its patient safety website for allegedly promoting “gender ideology,” the government agreed Wednesday to permanently restore the papers and not remove any more titles for the same reasons.

As soon as President Donald Trump took office last January, he issued an executive order instructing federal agencies to “remove all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology.”

The editors of the government-operated Patient Safety Net, a website that hosts case reports and other medical information, identified multiple articles they believed violated the order. Two articles were subsequently removed after the authors declined to change their work.

According to court filings and a news release from the American Civil Liberties Union, which argued the case against the federal government, the articles in question included:

In March, Royce and Schiff filed a lawsuit against the Department of Health and Human Services, the Agency for Healthcare Research and Quality, and the Office of Personnel Management, arguing that the government’s removal of the research violated both the First Amendment and the Administrative Procedure Act.

In May, a federal district court issued a temporary injunction restoring the files. The settlement Wednesday makes that decision final.

“This agreement is a win for the First Amendment and for public health,” Scarlet Kim, senior staff attorney with the ACLU, said in a news release. “The government cannot censor medical research because it acknowledges the existence of transgender people. Research free from ideological interference by the government promotes rigor, objectivity, and scientific value, which benefits everyone.”

https://insidehighered.com…