coverage

The Trump administration has unveiled a sweeping set of regulatory proposals that would substantially change health plan offerings on the Affordable Care Act marketplace next year, aiming, it says, to provide more choice and lower premiums.

But it also proposes sharply raising some annual out-of-pocket costs — to more than $27,600 for one type of coverage — and could cause up to 2 million people to drop insurance.

The changes come as affordability is a key concern for many Americans, some of whom are struggling to pay their ACA premiums since the Republican-led Congress allowed enhanced subsidies expired at the end of last year. Initial enrollment numbers for this year fell by more than 1 million.

Healthcare coverage and affordability have become politically potent issues in the run-up to November’s midterm elections.

The proposed changes are part of a 577-page rule that addresses a broad swath of standards, including benefit packages, out-of-pocket costs and healthcare provider networks. Insurers refer to these standards when setting premium rates for the coming year.

After a comment period, the rule will be finalized this spring.

It “puts patients, taxpayers, and states first by lowering costs and reinforcing accountability for taxpayer dollars,” Mehmet Oz, the Centers for Medicare & Medicaid Services administrator, said in a news release Monday.

One way it would do so focuses heavily on a type of coverage — catastrophic plans — that last year attracted about only 20,000 policyholders, according to the proposal, although other estimates put it closer to 54,000.

“This proposal reads like the administration has found their next big thing in the catastrophic plans,” said Katie Keith, director of the Health Policy and the Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center.

Such plans have very high annual out-of-pocket costs for the policyholder but often lower premiums than other ACA coverage options. Formerly restricted to those under age 30 or facing certain hardships, the Trump administration allowed older people who lost subsidy eligibility to enroll in them this year. It is not known how many people did so.

The payment rule cements this move by making anyone eligible if their income is below the poverty line ($15,650 for 2026) or if they’re earning more than 2½ times that amount but lost access to an ACA subsidy that lowered their out-of-pocket costs. It also notes that a person meeting these standards would be eligible in any state — an important point because this coverage is now available in only 36 states and the District of Columbia.

In addition, the proposal would require out-of-pocket maximums on such plans to hit $15,600 a year for an individual and $27,600 for a family, Keith wrote this week in Health Affairs. (The current out-of-pocket max for catastrophic plans is $10,600 for an individual plan and $21,200 for family coverage.) Not counting preventive care and three covered primary care doctor visits, that spending target must be met before a policy’s other coverage kicks in.

In the rule, the administration wrote that the proposed changes would help differentiate catastrophic from “bronze” plans, the next level up, and, possibly, spur more enrollment in the former. Currently, the proposal said, there may not be a significant difference if premiums are similar. Raising the out-of-pocket maximum for catastrophic plans to those levels would create that difference, the proposal said.

“When there is such a clear difference, the healthier consumers that are generally eligible and best suited to enroll in catastrophic plans are more motivated to select a catastrophic plan in lieu of a bronze plan,” the proposal noted.

However, ACA subsidies cannot be used toward catastrophic premiums, which could limit shoppers’ interest.

Enrollment in bronze plans, which have an average annual deductible of $7,500, has doubled since 2018 to about 5.4 million last year. This year, that number likely will be higher. Some states’ sign-up data indicate a shift toward bronze as consumers left higher-premium “silver,” “gold” or “platinum” plans following the expiration of more generous subsidies at the end of last year.

The proposal also would allow insurers to offer bronze plans with cost-sharing rates that exceed what the ACA law currently allows, but only if that insurer also sells other bronze plans with lower cost-sharing levels.

In what it calls a “novel” approach, the proposal would allow insurers to offer multiyear catastrophic plans, in which people could stay enrolled for up to 10 years, and their out-of-pocket maximums would vary over that time. Costs might be higher, for example, in the early years, then fall the longer the policy is in place. The proposal specifically asks for comments on how such a plan could be structured and what effect multiyear plans might have on the overall market.

“As we understand it thus far, insurers could offer the policy for one year or for consecutive years, up to 10 years,” said Zach Sherman, managing director for coverage policy and program design at Health Management Associates, a health policy consulting firm that does work for states and insurance plans. “But the details on how that would work, we are still unpacking.”

Matthew Fiedler, senior fellow with the Center on Health Policy at the Brookings Institution, said the proposed rule included a lot of provisions that could “expose enrollees to much higher out-of-pocket costs.”

In addition to the planned changes to bronze and catastrophic plans, he points to another provision that would allow plans to be sold on the ACA exchange that have no set healthcare provider networks. In other words, the insurer has not contracted with specific doctors and hospitals to accept their coverage. Instead, such plans would pay medical providers a set amount toward medical services, possibly a flat fee or a percentage of what Medicare pays, for example.

The rule says insurers would need to ensure “access to a range of providers” willing to accept such amounts as payment in full. Policyholders might be on the hook for unexpected expenses, however, if a clinician or facility doesn’t agree and charges the patient the difference.

Because the rule is so sweeping — with many other parts — it is expected to draw hundreds if not thousands of comments between now and early March.

Pennsylvania insurance broker Joshua Brooker said one change he would like to see is requiring insurers that sell the very high out-of-pocket catastrophic plans to offer other catastrophic plans with lower annual maximums.

Overall, though, a wider range of options might appeal to people on both ends of the income scale, he said.

Some wealthier enrollees, especially those who no longer qualify for any ACA premium subsidies, would prefer a lower premium like those expected in catastrophic plans, and could just pay the bills up to that max, he said.

“They’re more worried about the half-million-dollar heart attack,” Brooker said. It’s tougher for people below the poverty level, who don’t qualify for ACA subsidies and, in 10 states, often don’t qualify for Medicaid. So they’re likely to go uninsured. At least a catastrophic plan, he said, might let them get some preventive care coverage and cap their exposure if they end up in a hospital. From there, they might qualify for charity care at the hospital to cover out-of-pocket costs.

Overall, “putting more options on the market doesn’t hurt, as long as it is disclosed properly and the consumer understands it,” he said.

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

Jeffrey Epstein pressured a media tycoon he did business with to quash coverage of allegations of his sexual abuse of girls, according to documents released by the United States Department of Justice.

Epstein leveraged close personal and professional ties with the Canadian-American billionaire Mortimer Zuckerman to try to influence the New York Daily News’s coverage of allegations against him after his 2008 conviction for soliciting a minor for prostitution, the documents show.

After Epstein reached out to Zuckerman, the then-owner of the Daily News, the tabloid first delayed its coverage of the allegations and then omitted details that the late financier had specifically requested be left out, according to the documents.

In an email dated October 9, 2009, Epstein shared a “proposed answer” to questions from the newspaper with Zuckerman that disputed allegations made against him and his girlfriend Ghislaine Maxwell, who is currently serving a 20-year sentence for child sex trafficking.

The allegations, which had been put to Epstein and Maxwell by then-Daily News journalist George Rush, included accusations that the pair had subjected a minor known as “Jane Doe No 102” to routine sexual abuse and had engaged in threesomes with “various underage girls”.

The allegations also included claims that Maxwell kept a computer database of “hundreds of girls and oversaw the schedule of girls who came to Epstein’s homes”.

In the proposed response that he shared with Zuckerman, Epstein said “no sex occurred” with Jane Doe No 102 and she had admitted in a deposition to being an “escort, call girl, and a massage parlor worker since the age of 15”.

“All of the adult establishments in which she admitted working require proof of age. Rc the rest of the questions,” Epstein’s email to Zuckerman said.

“These are all malicious fabrications designed to get Mr Edwards clients more money than they normally receive though she did testify under oath that she made as much as 2000 per day,” the email said, referring to Bradley J Edwards, a Florida-based lawyer who has represented many of Epstein’s accusers.

Later that day, Zuckerman told Epstein in an email that the Daily News was “doing major editing over huge objections” and he would “c copy asap”.

“take ghislaine out. if possible,” Epstein responded in an email a few minutes later.

“the very first plaintiff, deposed admitted in a sworn videotaped statement that she lied and was an escort , call girl since age 15. SHE took the fifth. over 40 times.. its crazy.. thanks for you help.”

“Please call me asap,” Zuckerman wrote to Epstein several hours later, before asking Epstein to call him again later that night.

The Daily News ultimately published an article on December 19, 2009, that described Epstein reaching a settlement with his accuser for an undisclosed amount of money.

The article noted that Epstein was facing “more than a dozen” lawsuits from women who accused him of sexually abusing them but made no mention of Maxwell or the allegations against her.

Zuckerman, a staunch supporter of Israel who served as head of the America-Israel Friendship League and the Conference of Presidents of Major American Jewish Organizations, has never been accused of any involvement in Epstein’s crimes.

Rush, who left the Daily News in 2010, confirmed that Epstein had tried to “cajole” Zuckerman, the current owner of US News & World Report, into burying or shaping the story to Epstein’s liking.

Rush said the Daily News decided to delay publication after Epstein offered the newspaper an interview.

“Unfortunately, Epstein immediately insisted that the interview be off the record. He also used the conversation to make remorseless claims that he was a victim of overzealous prosecutors and shyster lawyers,” Rush told Al Jazeera.

Rush said Zuckerman, who sold the Daily News in 2017, never suggested that the newspaper cancel the story altogether or publish coverage that was favourable to Epstein.

“I do recall being advised to leave Ghislaine Maxwell out of the story,” Rush said.

“At the time, the paper’s lawyers had libel concerns, and I saw it as a necessary compromise.”

Rush said he had objected to the efforts to interfere in his story but the episode did not cause a “newsroom furore”.

“Most people hadn’t heard of Epstein at that point. I didn’t like Epstein and Maxwell trying to appeal to the owner,” he said.

“But I was relieved that the story wasn’t killed, just delayed, and hopeful that Epstein might say something quotable in the interview. It speaks to Epstein’s arrogance that he thought he had the power to get Mort to do his bidding.”

Zuckerman’s personal assistant and the Zuckerman STEM Leadership Program, an initiative founded by the billionaire to fund scientific collaboration between the US and Israel, did not reply to requests for comment from Al Jazeera.

Ties for two decades

Zuckerman’s ties to Epstein stretch back more than 20 years.

In 2005, Zuckerman, who also owned The Atlantic magazine from 1984 to 1999, worked with Epstein on the short-lived relaunch of the gossip-and-entertainment magazine Radar.

After a US congressional panel in September released a scrapbook prepared for Epstein’s 50th birthday in 2003, Zuckerman was among a slew of high-profile names revealed to have sent the financier their well-wishes.

But the latest tranche of files from the 2019 prosecution of Epstein, released last week by US authorities, show that Zuckerman’s relationship with the sex offender was much closer than previously believed.

In 2008, Zuckerman sought Epstein’s advice on his plans for passing on his estate, sharing sensitive details about his financial affairs in the process, including a copy of his will and an evaluation of his assets that put his net worth at $1.9bn.

In 2013, Epstein drafted several agreements to provide Zuckerman with “analysing, evaluating, planning and other services” related to the billionaire’s plans for passing on his wealth.

Epstein proposed a fee of $30m in a proposal drafted in June 2013 before offering his services for $21m in a revised proposal that December, according to the documents.

In correspondence around this period, Zuckerman appeared to hold Epstein’s claimed expertise in high regard.

“Your questions have been critical to my growing understanding of how much lies ahead before my finances are properly organized,” Zuckerman wrote to Epstein in an email dated October 12, 2013, after the financier had earlier claimed to have identified “wild errors” in Zuckerman’s accounting of his finances.

“You have been an invaluable friend and In the most constructive way a provocateur I am completely grateful and am now beginning to focus, in on the issues you have raised. With appreciation from a hesitant amateur   Mort.”

It is not clear whether Zuckerman ultimately signed the agreement proposed by Epstein.

Zuckerman and Epstein communicated regularly, and the two men arranged numerous dinners and other meetings over the years, according to the documents, including at the financier’s Manhattan home.

“Mort is now booked for tonight at 8:30…i am being asked if you could see him this weekend…please advise,” Lesley Groff, Epstein’s personal assistant, wrote on May 5, 2015, in one of many emails detailing appointments.

While Zuckerman turned to Epstein for financial advice, he also appeared to regard him as a friend.

“Hi there. You are very special. And a great friend. Mort,” Zuckerman wrote to Epstein in an email dated August 24, 2014.

For Mikayla Tencer, being self-employed already meant juggling higher taxes, irregular income and the constant pressure of finding her own health insurance. This year, it also meant rethinking how often she could afford to see a doctor.

The 29-year-old content creator in San Francisco paid $168 a month last year for a Blue Shield health plan through Covered California. This year — without enhanced federal subsidies that expired at the end of December — that same plan would have cost $299 a month, with higher copays.

“People assume that because I’m young, I can just pick the cheapest plan and not worry about it,” Tencer said. “But I do need regular care, especially for mental health.”

Tencer is among tens of thousands of middle-class Californians facing steep increases in health insurance costs after Congress allowed enhanced federal subsidies for Affordable Care Act plans to expire Dec. 31.

Those extra subsidies were enacted in 2021 as part of temporary, pandemic-era relief, boosting financial help for people buying coverage on state-run insurance marketplaces such as Covered California. The law also expanded eligibility to people earning more than 400% of the federal poverty level, about $62,600 for a single person and $128,600 for a family of four.

Mikayla Tencer records a TikTok video featuring eyeliners. Her blog showcases Bay Area attractions and local businesses.

(Paul Kuroda/For The Times)

With the expiration of the enhanced subsidies, people above that income threshold no longer receive federal assistance, and many who still qualify are seeing sharply higher premiums and out-of-pocket costs. On top of the loss of the extra federal benefits, the average Covered California premium this year rose by 10.3% because of fast-rising medical costs.

To lower her monthly bill, Tencer switched to the cheapest Covered California option, bringing her premium down to about $161 a month. But the savings came with new costs. Primary care and mental health visits now carry $60 copays, up from $35.

When she showed up for a psychiatric appointment to manage her ADHD and generalized anxiety disorder, she said, she learned her doctor was out of network.

“That visit would have been $35 before,” she said. “Now it’s $180 out of pocket.”

Because of the higher costs, Tencer said she has cut therapy from weekly to biweekly sessions.

“The subsidies made it possible for me to be self-employed in the first place,” Tencer said. “Without them, I’m seriously thinking about applying for full-time jobs, even though the market is terrible.”

For another self-employed Californian, the increase was even more dramatic.

Krista, a 42-year-old photographer and videographer in Santa Cruz County, relies on costly monthly intravenous treatments for a rare blood disorder. She asked that her full name not be used but shared her insurance and medical documents with The Times.

Last year, she paid about $285 a month for a Covered California plan. In late December, she received a notice showing her premium would rise to more than $1,200 a month. The rise was due to her loss of federal subsidies, as well as a 23% increase in the premium charged by Blue Shield.

“It terrified me. I thought, how am I ever going to retire?” she asked. “What’s the point?”

Krista ultimately enrolled in a plan costing about $522 a month, still nearly double what she had been paying, with a $5,000 deductible. She said she cannot downgrade to a cheaper plan because her clinic bills her treatment to insurance at roughly $30,000 a month, according to medical statements.

To cut costs and preserve the ability to save for retirement and eventually afford a place of her own, Krista decided to move into an RV on private land. The decision came the same week she received notices showing a rent increase and a steep jump in her health insurance premiums.

Mikayla Tencer, a marketing influencer, with her elder dog, “Lucky” at Alamo Square Park.

(Paul Kuroda/For The Times)

Krista said she had been planning for more than a year to find a long-term living situation that would enable her to live independently, rather than continue paying more for an apartment.

“Nobody asks to be sick,” Krista said. “No one should have their life ruined because they get diagnosed with a disease or break a leg.”

Jessica Altman, executive director of Covered California, said that about 160,000 Californians lost their subsidies when the enhanced federal assistance expired because their incomes were higher than 400% of the federal poverty level.

Although overall enrollment in Covered California this year has held steady, Altman said, she worries that more people will drop coverage as bills with the higher premiums arrive in the mail.

Those fears are already playing out.

Jayme Wernicke, a 34-year-old receptionist and single mother in Chico who earns about $49,000 a year, said she was transferred from Medi-Cal to a Covered California Anthem Blue Cross plan at the end of 2023. Her premium rose from about $30 a month to $60, then jumped to roughly $230 after the subsidies expired.

“For them to raise my health insurance almost 400% is just insane to me,” Wernicke said.

Her employer, a small family-owned business, does not offer health insurance. Her plan does not include dental or vision care and, she said, barely covers medical costs.

“At a certain point, it just feels completely counterintuitive,” she said. “Either way, I’m losing.”

Wernicke dropped her own coverage and plans to pay for care with cash, calculating that the state tax penalty is less than the cost of premiums. Her daughter remains insured.

Two other Californian residents told The Times that they also decided to go without coverage because they could no longer afford it. They declined to provide their full names, citing concerns about financial and professional consequences.

Under California law, residents without coverage face an annual penalty of at least $900 per adult and $450 per child.

One, a 29-year-old self-employed publicist in Los Angeles requires medication for epilepsy. Last year, she paid about $535 a month for a silver plan through Covered California. This year, the same plan would have cost $823.

After earning about $55,000 last year, she calculated that paying for care out of pocket would cost far less. Her epilepsy medication costs about $175 every three months without insurance, and her annual doctor visits total roughly $250.

“All of that combined is still far less than paying hundreds of dollars every month,” she said.

Another, April, a 58-year-old small-business owner in San Francisco, canceled her insurance in December after her quoted premium rose to $1,151 a month for a bronze plan and $1,723 for a silver plan, just for herself. Last year, April said she paid $566 for both her and her daughter. This year, her daughter’s premium alone jumped from $155 to $424.

The bronze plan also carried a $3,500 deductible for lab work and specialist visits, meaning she would have had to pay thousands of dollars out of pocket before coverage kicked in, on top of the higher monthly premium.

“The subsidies were absolutely what allowed me to sustain my business,” April said. “They were helping me sustain my financial world and have affordable care.”

She rushed to complete medical tests before dropping coverage and hopes to go a year uninsured.

“The scariest part is not having catastrophic coverage,” she said. “If something happens, it can be millions of dollars.”

Tencer, the content creator in San Francisco, believes that in order to make the nation healthier, affordable healthcare should be universal.

“Our government should be providing it.” she said. “People can’t go to the doctor for routine checkups, they can’t get things checked out early, and they can’t access the resources they need.”

California Gov. Gavin Newsom, who has acknowledged he is eyeing a presidential bid, has incensed both Democrats and Republicans over immigrant healthcare, underscoring the delicate political path ahead.

For a second straight year, the Democrat has asked state lawmakers to roll back coverage for some immigrants in the face of federal Medicaid spending cuts and a roughly $3-billion budget deficit that analysts warn could worsen if the AI bubble bursts. Newsom has proposed that the state not step in when, starting in October, the federal government stops providing health coverage to an estimated 200,000 legal residents — comprising asylees, refugees and others.

Progressive legislators and activists said the cost-saving measures are a departure from Newsom’s “health for all” pledge, and Republicans continue to skewer Newsom for using public funds to cover any noncitizens.

Newsom’s latest move would save an estimated $786 million this fiscal year and $1.1 billion annually in future years in a proposed budget of $349 billion, according to the Department of Finance.

State Sen. Caroline Menjivar, one of two Senate Democrats who voted against Newsom’s immigrant health cuts last year, said she worried the governor’s political ambition could be getting in the way of doing what’s best for Californians.

“You’re clouded by what Arkansas is going to think, or Tennessee is going to think, when what California thinks is something completely different,” said Menjivar, who said previous criticism got her temporarily removed from a key budget subcommittee. “That’s my perspective on what’s happening here.”

Meanwhile, Republican state Sen. Tony Strickland criticized Newsom for glossing over the state’s structural deficit, which state officials say could balloon to $27 billion the following year. And he slammed Newsom for continuing to cover California residents in the U.S. without authorization. “He just wants to reinvent himself,” Strickland said.

It’s a political tightrope that will continue to grow thinner as federal support shrinks amid ever-rising healthcare expenses, said Guian McKee, a co-chair of the Health Care Policy Project at the University of Virginia’s Miller Center of Public Affairs.

“It’s not just threading one needle but threading three or four of them right in a row,” McKee said. Should Newsom run for president, McKee added, the priorities of Democratic primary voters — who largely mirror blue states like California — look very different from those in a far more divided general electorate.

Americans are deeply divided on whether the government should provide health coverage to immigrants without legal status. In a KFF poll last year, a slim majority — 54% — were against a provision that would have penalized states that use their own funds to pay for immigrant healthcare, with wide variation by party. The provision was left out of the final version of the bill passed by Congress and signed by President Trump.

Even in California, support for the idea has waned amid ongoing budget problems. In a May survey by the Public Policy Institute of California, 41% of adults in the state said they supported providing health coverage to immigrants without authorization, a sharp drop from the 55% who supported it in 2023.

Trump, Vice President JD Vance, other administration officials, and congressional Republicans have repeatedly accused California and other Democrat-led states of using taxpayer funds on immigrant healthcare, a red-meat issue for their GOP base. Centers for Medicare & Medicaid Services Administrator Mehmet Oz has accused California of “gaming the system” to receive more federal funds, freeing up state coffers for its Medicaid program, known as Medi-Cal, which has enrolled roughly 1.6 million immigrants without legal status.

“If you are a taxpayer in Texas or Florida, your tax dollars could’ve been used to fund the care of illegal immigrants in California,” he said in October.

California state officials have denied the charges, noting that only state funds are used to pay for general health services to those without legal status because the law prohibits using federal funds. Instead, Newsom has made it a “point of pride” that California has opened up coverage to immigrants, which his administration has noted keeps people healthier and helps them avoid costly emergency room care often covered at taxpayer expense.

“No administration has done more to expand full coverage under Medicaid than this administration for our diverse communities, documented and undocumented,” Newsom told reporters in January. “People have built careers out of criticizing my advocacy.”

Newsom warns the federal government’s “carnival of chaos” passed Trump’s One Big Beautiful Bill Act, which he said puts 1.8 million Californians at risk of losing their health coverage with the implementation of work requirements, other eligibility rules, and limits to federal funding to states.

Nationally, 10 million people could lose coverage by 2034, according to the Congressional Budget Office. Health economists have said higher numbers of uninsured patients — particularly those who are relatively healthy — could concentrate coverage among sicker patients, potentially increasing premium costs and hospital prices overall.

Immigrant advocates say it’s especially callous to leave residents who may have fled violence or survived trafficking or abuse without access to healthcare. Federal rules currently require state Medicaid programs to cover “qualified noncitizens” including asylees and refugees, according to Tanya Broder with the National Immigration Law Center. But the Republican tax-and-spending law ends the coverage, affecting an estimated 1.4 million legal immigrants nationwide.

With many state governors yet to release budget proposals, it’s unclear how they might handle the funding gaps, Broder said.

For instance, Colorado state officials estimate roughly 7,000 legal immigrants could lose coverage due to the law’s changes. And Washington state officials estimate 3,000 refugees, asylees, and other lawfully present immigrants will lose Medicaid.

Both states, like California, expanded full coverage to all income-eligible residents regardless of immigration status. Their elected officials are now in the awkward position of explaining why some legal immigrants may lose their healthcare coverage while those without legal status could keep theirs.

Last year, spiraling healthcare costs and state budget constraints prompted the Democratic governors of Illinois and Minnesota, potential presidential contenders JB Pritzker and Tim Walz, to pause or end coverage of immigrants without legal status.

California lawmakers last year voted to eliminate dental coverage and freeze new enrollment for immigrants without legal status and, starting next year, will charge monthly premiums to those who remain. Even so, the state is slated to spend $13.8 billion from its general fund on immigrants not covered by the federal government, according to Department of Finance spokesperson H.D. Palmer.

At a news conference in San Francisco in January, Newsom defended those moves, saying they were necessary for “fiscal prudence.” He sidestepped questions about coverage for asylees and refugees and downplayed the significance of his proposal, saying he could revise it when he gets a chance to update his budget in May.

Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, pointed out that California passed a law in the 1990s requiring the state to cover Medi-Cal for legal immigrants when federal Medicaid dollars won’t. This includes green-card holders who haven’t yet met the five-year waiting period for enrolling in Medicaid.

Calling the governor’s proposal “arbitrary and cruel,” Savage-Sangwan criticized his choice to prioritize rainy-day fund deposits over maintaining coverage and said blaming the federal government was misleading.

It’s also a major departure from what she had hoped California could achieve on Newsom’s first day in office seven years ago, when he declared his support for single-payer healthcare and proposed extending health insurance subsidies to middle-class Californians.

“I absolutely did have hope, and we celebrated advances that the governor led,” Savage-Sangwan said. “Which makes me all the more disappointed.”

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

“Today” co-anchor Savannah Guthrie will not head to Milan for NBC’s 2026 Winter Olympics coverage as she deals with the ongoing police investigation into the suspected abduction of her mother.

“Savannah will not be joining us at the Olympics as she focuses on being with her family during this difficult time,” an NBC News representative said Tuesday in a statement. “Our hearts are with her and the entire Guthrie family as the search continues for their mother.”

Guthrie was scheduled to co-host NBC’s telecast of the Friday opening ceremonies for the Milan Cortina Games alongside Terry Gannon of NBC Sports. The network representative said alternative plans will be announced shortly.

June 2023 photo of Savannah Guthrie and mother Nancy Guthrie. (Photo by: Nathan Congleton/NBC via Getty Images)

(Nathan Congleton/NBC via Getty Images)

Law enforcement officials believe Nancy Guthrie, 84, was last seen at her home outside of Tuscon, Ariz. on Saturday night. Police were called after relatives were told she missed the Sunday church service she regularly attends and did not find her at home.

Police found Nancy Guthrie’s cell phone, wallet, car and medication were left behind, indicating she did not leave voluntarily. She has no cognitive issues, but has limited physical mobility and could not walk far on her own, family members have told police.

On Tuesday, Lima County Sheriff Chris Nanos said at press briefing that authorities believe Nancy Guthrie was taken against her will. He also said the department is aware of “reports circulating about possible ransom note(s)” in the case. TMZ reported on the existence of an alleged ransom note Tuesday, but Nanos did not verify the account,

According to law enforcement sources not authorized to speak about the case publicly, there was blood at the scene and someone appeared to have forced their way inside.

Guthrie, a “Today” co-host since 2012, has been off the program since Monday. She was scheduled to head to Milan early this week.

Guthrie’s mother, who lived on her own, has been an occasional on-air guest at “Today.” Her appearances made her a favorite of Guthrie’s co-workers and staff at the program.

SACRAMENTO — As massive federal cuts are upending the healthcare system in California, analysts and healthcare professionals are urging state lawmakers to soften the blow by creating new revenue streams and helping residents navigate through the newly-imposed red tape.

“It impacts not only uninsured but also Medicare and commercially insured patients who rely on the same system,” said Dolly Goel, a physician and chief officer for the Santa Clara Valley Healthcare Administration. “People will die.”

Goel was among more than a dozen speakers this week at a state Assembly Health Committee hearing held to collect input on how to address cuts enacted by a Republican-backed tax and spending bill signed last year by President Trump. The committee’s Republican members — Assemblymembers Phillip Chen of Yorba Linda, Natasha Johnson of Lake Elsinore, Joe Patterson of Rockin, and Kate Sanchez of Trabuco Canyon — did not attend.

The so-called “Big, Beautiful Bill” passed by Republicans shifts federal funding away from safety-net programs and toward tax cuts and immigration enforcement. A recent report from the Legislative Analyst’s Office, which advises the state Legislature on budgetary issues, estimated this will reduce funding for healthcare by “tens of billions of dollars” in California and warned about 1.2 million people could lose coverage through Medi-Cal, the state’s version of the federal Medicaid program providing healthcare coverage to low-income Americans.

Congress allowed enhanced Affordable Care Act subsidies to expire, which is dramatically increasing the cost of privately-purchased health insurance. Covered California, the state’s Affordable Care Act health insurance marketplace, estimates hundreds of thousands of Californians will either be stripped of coverage or drop out due to increased cost.

Sandra Hernández, president of the California Health Care Foundation, said the federal legislation creates administrative hurdles, requiring Medicaid beneficiaries to meet new work or income requirements and to undergo the eligibility re-determination process every six months instead of annually.

“We are looking at a scenario where otherwise eligible working parents lose their coverage simply because they aren’t able to navigate a complex verification process in a timely way,” she said.

California should move aggressively to automate verification instead of putting the burden of proof on beneficiaries, Hernández said. She advised legislators to center new healthcare strategies around technology, like artificial intelligence and telehealth services, to improve efficiency and keep costs down.

“While the federal landscape has shifted, California has enormous power to mitigate the damage,” said Hernández. “California has had a long tradition of taking care of its own.”

Hannah Orbach-Mandel, an analyst with the California Budget and Policy Center, said legislators should establish new revenue sources.

“A common sense place to start is by eliminating corporate tax loopholes and ensuring that highly profitable corporations pay their fair share in state taxes,” she said, adding that California loses out on billions annually because of the “water’s edge” tax provision, which allows multinational corporations to exclude the income of their foreign subsidiaries from state taxation.

One proposal to raise money for state healthcare benefits already is raising controversy. Under the Billionaire Tax Act, Californians worth more than $1 billion would pay a one-time 5% tax on their total wealth. The Service Employees International Union-United Healthcare Workers West, the union behind the act, said the measure would raise much-needed money for healthcare, education and food assistance programs. It is opposed by Gov. Gavin Newsom, among others.

During last week’s legislative hearing in Sacramento, other speakers stressed the importance of communicating clearly with the public, collaborating with nonprofits and county governments and bracing for an influx of hospital patients.

Those who lose health insurance will skip medications and primary care and subsequently get sicker and end up in the emergency room, explained Goel. She said this will strain hospital staff and lead to longer wait times and delayed care for all patients.

The federal cuts come at a time when California is struggling with its own budgetary woes. The Legislative Analyst’s Office estimates the state will have an $18-billion budget shortfall in the upcoming fiscal year.

At the start of the hearing, Assemblymember Mia Bonta (D-Alameda) criticized the federal government for leaving states in the lurch and prioritizing immigration enforcement over healthcare.

The Republican-led Congress and the president provided a staggering funding increase to Immigration and Customs Enforcement, known as ICE. The agency’s annual budget has ballooned to $85 billion.

“The federal dollars which once supported healthcare for working families are now being funneled into mass deportation operations,” said Bonta, who chairs the committee. “Operations that resulted in tragic murders — this is where our healthcare funding is going.”

Thousands of middle-class Californians who depend on the state-run health insurance marketplace face premiums that are thousands of dollars higher than last year because enhanced federal subsidies that began during the COVID-19 pandemic have expired.

Despite fears that more people would go without coverage with the end of the extra benefits, the number enrolling in Covered California has held steady so far, according to state data.

But that may change.

Jessica Altman, executive director of Covered California, said that she believes the number of people dropping their coverage could increase as they receive bills with their new higher premiums in the mail this month. She said better data on enrollment will be available in the spring.

Altman said that even though the extra benefits ended Dec. 31, 92% of enrollees continue to receive government subsidies to help pay for their health insurance. Nearly half qualify for health insurance that costs $10 or less per month. And 17% of Californians renewing their Covered California policies will pay nothing for premiums if they keep their current plan.

The deadline to sign up for 2026 benefits is Saturday.

Here’s help in sorting out what the expiration of the enhanced subsidies for insurance provided under the Affordable Care Act, often called Obamacare, means in the Golden State.

What expired?

In 2021, Congress voted to temporarily to boost the amount of subsidies Americans could receive for an ACA plan. The law also expanded the program to families who had more money. Before the vote, only Americans with incomes below 400% of the federal poverty level — currently $62,600 a year for a single person or $128,600 for a family of four — were eligible for ACA subsidies. The 2021 vote eliminated the income cap and limited the cost of premiums for those higher-earning families to no more than 8.5% of their income.

How could costs change this year for those enrolled in Covered California?

Anyone with income above 400% of the federal poverty level no longer receives subsidies. And many below that level won’t receive as much assistance as they had been receiving since 2021. At the same time, fast-rising health costs boosted the average Covered California premium this year by more than 10.3%, deepening the burden on families.

How much would the net monthly premium for a Los Angeles couple with two children and a household income of $90,000 rise?

The family’s net premium for the benchmark Silver plan would jump to $699 a month this year from $414 a month last year, according to Covered California. That’s an increase of 69%, costing the family an additional $3,420 this year.

Who else could face substantially higher health bills?

People who retired before the Medicare-qualifying age of 65, believing that the enhanced subsidies were permanent, will be especially hit hard. Those with incomes above 400% of the federal poverty level could now be facing thousands of dollars in additional health insurance costs.

How did enrollment in Covered California change after the enhanced subsidies expired on Dec. 31?

As of Jan. 17, 1,906,033 Californians had enrolled for 2026 insurance. That’s less than 1% lower than the 1,921,840 who had enrolled by this time last year.

Who depends on Covered California?

Enrollees are mostly those who don’t have access to an employer’s health insurance plan and don’t qualify for Medi-Cal, the government-paid insurance for lower-income people and those who are disabled.

An analysis by KFF, a nonprofit that provides health policy information, found that nearly half the adults enrolled in an ACA plan are small-business owners or their employees, or are self-employed. Occupations using the health insurance exchanges where they can buy an ACA plan include realtors, farmers, chiropractors and musicians, the analysis found.

What is the underlying problem?

Healthcare spending has been increasing faster than overall inflation for years. The nation now spends more than $15,000 per person on healthcare each year. Medical spending today represents about 18% of the U.S. economy, which means that almost one out of every five dollars spent in the U.S. goes toward healthcare. In 1960, health spending was just 5% of the economy.

What has California done to help people who are paying more?

The state government allocated $190 million this year to provide subsidies for those earning up to 165% of the federal poverty level. This money will help keep monthly premiums consistent with 2025 levels for those with an annual income of up to $23,475 for an individual or $48,225 for a family of four, according to Covered California.

Where can I sign up?

People can find out whether they qualify for financial help and see their coverage options at the website CoveredCA.com.

What if I decide to go without health insurance?

People without insurance could face medical bills of tens of thousands of dollars if they become sick or get injured. And under California state law, those without coverage face an annual penalty of at least $900 for each adult and $450 for each child.

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