healthcare

Dec. 29 (UPI) — The Trump administration on Monday announced it will distribute $50 billion dollars to expand access to rural healthcare across all 50 states with investments in growing the workforce, modernizing facilities and introducing new models of care delivery.

States are set to receive first-year awards next year of roughly $200 million under the Rural Health Transformation Program, which Congress authorized earlier this year as part of the Working Families Tax Cuts bill, the Centers for Medicare and Medicaid Services said in a press release.

“More than 60 million Americans living in rural areas have the right to equal access to quality care,” said Robert F. Kennedy, Jr., secretary of the Department of Health and Human Services.

“This historic investment puts local hospitals, clinics and health workers in control of their communities’ health care,” Kennedy said.

The CMS is set to distribute the $50 billion dollars over the next five years, from 2026 through 2030, as part of the program established by the bill, which is more commonly known as the One Big Beautiful Bill Act.

Each year, $5 billion will be distributed equally to each of the 50 states, while another $5 billion will be allocated based on the proportion of rural health facilities, situations at specific facilities in the state and other factors, the agency said on the program website.

The CMS announced each state’s 2026 allocation — Washington, D.C., and U.S. territories are not eligible for the funds — in the release, with the awards ranging from New Jersey’s $147 million to Texas’ $281 million.

The funds are meant to accomplish a range of goals to “make rural America healthy again,” including:

• expanding access to preventive, primary, maternal and behavioral health services;
• strengthening, growing and sustaining the clinical work force in rural areas;
• modernizing health infrastructure and technology;
• driving structural efficiency through streamlining operations and working to make more services available locally;
• and testing new primary care and value-based care models of delivery and payment.

The announcement comes after the American Hospital Association estimated earlier this year that rural hospitals could lose $50.4 billion in revenue from federal Medicaid funds over the next 10 years.

The reason is based on a Congressional Budget Office estimate earlier this year that the $1 trillion that was cut from Medicaid in the One Big Beautiful Bill Act could result in more than 7.8 million more people across the country becoming uninsured.

This loss of Medicaid coverage for patients affects revenue for healthcare providers, and the effects will be felt most acutely in rural areas.

These areas of the country currently include an estimated 16.1 million people with Medicaid coverage. Sparsely populated states such as Montana, Wyoming and Alaska have more than 50% of Medicaid recipients living in rural areas, the American Hospital Association says.

For many rural health facilities, a mixture of Medicare and Medicaid patients help them stay open, Sarah Hohman, director of government affairs for the National Association of Rural Health Clinics, told UPI in July.

“If the coverage losses pan out as they are estimated, that would mean that they are treating fewer patients that are covered by insurance,” Hohman said. “The more you have uncompensated care and individuals not able to pay, your balance gets concerning pretty quickly. That really threatens the financial viability in these areas.”

The Trump administration made work requirements for low-income people receiving government assistance a priority in 2025.

The departments of Health and Human Services, Agriculture and Housing and Urban Development have worked to usher in stricter employment conditions to receive healthcare, food aid and rental assistance benefits funded by the federal government.

The idea is that public assistance discourages optimal participation in the labor market and that imposing work requirements not only leads to self-sufficiency, but also benefits the broader economy.

“It strengthens families and communities as it gives new life to start-ups and growing businesses,” the Cabinet secretaries wrote in a New York Times essay in May about work requirements.

Yet many economists say there is no clear evidence such mandates have that effect. There’s concern these new policies that make benefits contingent on work could ultimately come at a cost in other ways, from hindering existing employment to heavy administrative burdens or simply proving unpopular politically.

Here is a look at how work requirements could affect the millions of people who rely on the Supplemental Nutrition Assistance Program (SNAP), Medicaid and HUD-subsidized housing:

SNAP

What President Trumprefers to as his “Big Beautiful Bill” in July expanded the USDA’s work requirements policy for SNAP recipients who are able-bodied adults without dependents.

Previously, adults older than 54, as well as parents with children under age 18, at home were exempted from SNAP’s 80-hours monthly work requirement. Now, adults up to age 64 and parents of children between the age of 14 and 17 have to prove they’re working, volunteering or job training if they are on SNAP for more than three months.

The new law also cuts exemptions for people who are homeless, veterans and young people who have aged out of foster care. There are also significant restrictions on waivers for states and regions based on how high the local unemployment rates are.

The Pew Research Center, citing the most recent census survey data from 2023, notes 61% of adult SNAP recipients had not been employed that year, and that the national average benefit as of May was $188.45 per person or $350.89 per household.

Ismael Cid Martinez, an economist at the Economic Policy Institute, said the people who qualify for SNAP are likely working low-wage jobs that tend to be less stable because they are more tied to the nation’s macroeconomics. That means when the economy weakens, it’s the low-wage workers whose hours are cut and jobs are eliminated, which in turn heightens their need for government support. Restricting such benefits could threaten their ability to get back to work altogether, Martinez said.

“These are some of the matters that tie in together to explain the economy and [how] the labor market is connected to these benefits,” Martinez said. “None of us really show up into an economy on our own.”

Angela Rachidi, a researcher at the conservative think tank American Enterprise Institute, said she expects the poverty rate to decline as a result of the work requirements but even that wouldn’t ultimately affect the labor force.

“[E]ven if every nonworking SNAP adult subject to a work requirement started working, it would not impact the labor market much,” Rachidi said by email.

Medicaid

Trump’s big bill over the summer also created new requirements, starting in 2027, for low-income 19- to 64-year-olds enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion or through a waiver program to complete 80 hours of work, job training, education or volunteering per month. There are several exemptions, including for those who are caregivers, have disabilities, have recently left prison or jail or are pregnant or postpartum.

The nonpartisan Congressional Budget Office has predicted that millions of people will lose healthcare because of the requirements.

Nationally, most people on Medicaid already work. The majority of experts on a Cornell Health Policy Center panel said that new national requirements won’t lead to large increases in employment rates among working adults on Medicaid, and that many working people would lose healthcare because of administrative difficulties proving they work.

Georgia is currently the only state with a Medicaid program that imposes work requirements, which Gov. Brian Kemp created instead of expanding Medicaid. The program, called Georgia Pathways, has come under fire for enrolling far fewer people than expected and creating large administrative costs.

Critics say many working people struggle to enroll and log their hours online, with some getting kicked out of coverage at times because of administrative errors.

And research released recently from the United Kingdom-based research group BMJ comparing Georgia with other states that did not expand Medicaid found Georgia Pathways did not increase employment during the first 15 months, nor did it improve access to Medicaid.

Kemp’s office blames high administrative costs and startup challenges on delays because of legal battles with former President Biden’s administration. A spokesperson said 19,383 Georgians have received coverage since the program began.

HUD

HUD in July also proposed a rule change that would allow public housing authorities across the country to institute work requirements, as well as time limits.

In a leaked draft of that rule change, HUD spells out how housing authorities can choose to opt in and voluntarily implement work requirements of up to 40 hours a week for people getting rental assistance, including adult tenants in public housing and Section 8 voucher-holders.

HUD also identified two states — Arkansas and Wisconsin — where it could trigger implementation based on existing state laws if and when the HUD rule change is approved. The proposal remains in regulatory review and would be subject to a public comment period.

HUD spokesman Matthew Maley declined to comment on the leaked documents, which broadly define the age of work-eligible people being up to age 61, with exemptions for people with disabilities and those who are in school or are pregnant. Primary caregivers of disabled people and children under 6 years old are also exempted.

HUD’s proposed rule change also notes that it is only defining the upper limits of the policy, allowing flexibility for local agencies to further define their individual programs with additional exemptions.

In a review of how housing authorities have tested work requirements over time, researchers at New York University found few successful examples, noting only one case where there were modest increases in employment — in Charlotte, N.C. — as compared to seven other regions where work requirements were changed or discontinued “because they were deemed punitive or hard to administer.”

Ho and Kramon write for the Associated Press.

Dec. 22 (UPI) — The former CEO of a healthcare software company in Arizona was sentenced to 15 years in prison and ordered to pay more than $452 million in restitution for conspiring to defraud Medicare for $1 billion, the U.S. Department of Justice said Monday.

Gary Cox, 79, of Maricopa County, was found guilty in June of healthcare fraud in which he generated false doctors’ orders to support fraudulent claims for various medical items.

He was sentenced Friday in the Southern District of Florida.

“This just sentence is the result of one of the largest telemarketing Medicare fraud cases ever tried to verdict,” Acting Assistant Attorney General Matthew R. Galeotti of the Justice Department’s Criminal Division said in a statement. “Telemedicine scammers who use junk mailers, spam calls and the internet to target senior citizens steal taxpayer money and harm vulnerable populations. The Criminal Division will continue dedicating substantial resources to the fight against telemedicine and medical equipment frauds that drain our health care benefit programs.”

Cox was convicted of conspiracy to commit healthcare fraud and wire fraud, three counts of healthcare fraud, conspiracy to pay and receive healthcare kickbacks, and conspiracy to defraud the United States and make false statements in connection with healthcare matters.

Cox was the CEO of Power Mobility Doctor Rx, LLC.

Prosecutors say Cox and his co-conspirators targeted several hundred thousand Medicare beneficiaries who provided personally identifiable information and agreed to accept medically unnecessary orthotic braces, pain creams and other items through misleading mailers, television advertisements and calls from offshore call centers, the Justice Department said.

Cox connected pharmacies, durable medical equipment suppliers and marketers with telemedicine companies to accept illegal kickbacks and bribes in exchange for signed doctors’ orders transmitted using the DMERx platform.

Prosecutors said DMERx falsely said that a doctor had examined and treated the Medicare beneficiaries when, in fact, purported telemedicine companies paid doctors to sign the orders without regard to medical necessity. It was based on a brief telephone call with the beneficiary or no interaction with the beneficiary, the Justice Department said.

These doctors’ orders billed Medicare and other insurers more than $1 billion with Medicare and the insurers paying more than $360 million based on these claims.

The scheme was concealed through sham contracts and elimination from doctors’ orders in which one co-conspirator described as “dangerous words” that might cause Medicare to audit the scheme’s DME suppliers.

“This sentence sends a clear message: Those who exploit telemedicine to prey on seniors and steal from taxpayer-funded health care programs will be held accountable,” said Christian J. Schrank, deputy inspector general for investigations of the U.S. Department of Health and Human Services.

“This scheme was a massive betrayal of trust, built on deception and greed. Our investigators, working with law enforcement partners, dismantled this billion-dollar fraud operation that targeted vulnerable patients and undermined the integrity of Medicare. We will not relent in our mission to protect the public and safeguard Medicare and other federal health care programs from fraud, waste, and abuse.”

Before his sentencing, friends of the defendant submitted letters to the judge vouching for Cox’s good character.

“It is my belief, based on all my life experiences both good and bad that Gary is not a person that would take advantage of or cheat another,” one letter said.

Since March 2007, the Justice Department’s Fraud Section, operating nine strike forces in 27 federal districts, has charged more than 5,800 defendants, who collectively have billed federal healthcare programs and private insurers more than $30 billion.

“Together with our partners, the FBI will aggressively pursue those who defraud taxpayer-funded health care programs,” Rebecca Day, acting assistant director of the FBI’s Criminal Investigative Division, said. “Programs like Medicare are intended to help the most vulnerable among us, and fraud schemes like the one orchestrated by the defendant can jeopardize the delivery of critical care to those who need it the most.”

Approximately 69.4 million Americans are enrolled in the federal health insurance, which is primarily for people aged 65 and older. It also covers younger people with long-term disability, end-stage renal disease or ALS.

Medicare fraud, mistakes and abuse cost the program an estimated $60 billion annually.

“Medicare numbers are more valuable than Social Security numbers because if they have all the right documentation, the Medicare claim has to go through, there are rules and regulations around that,” Nancy Moore, director of Indiana Senior Medicare Patrol, told WRTV-TV in June.

“One of the best ways to look out for fraud is to read your summary notices, your EOB if you’re on Medicare Advantage, or your Medicare summary notice. If you notice a charge for something you never received or didn’t need. That’s when you should call us to report it.”

Consumers can also report suspected medical identity theft to the Health & Human Services fraud hotline at 800-447-8477 (800-HHS-TIPS) or the National Insurance Crime Bureau at 800-835-6422.

Folks, who was supposed to be watching grandpa last night? Because he got out, got on TV and … It. Was. Not. Good.

For 18 long minutes Wednesday evening, we were subjected to a rant by President Trump that predictably careened from immigrants (bad) to jobs (good), rarely slowing down for reality. But jumbled between the vitriol and venom was a vision of American healthcare that would have horror villainess M3GAN shaking in her Mary Janes — a vision that we all should be afraid of because it would take us back to a dark era when insurance couldn’t be counted on.

Trump’s remarks offered only a sketchy outline, per usual, in which the costs of health insurance premiums may be lower — but it will be because the coverage is terrible. Yes, you’ll save money. But so what? A cheap car without wheels is not a deal.

“The money should go to the people,” Trump said of his sort-of plan.

The money he vaguely was alluding to is the government subsidies that make insurance under the Affordable Care Act affordable. After antics and a mini-rebellion by four Republicans also on Wednesday, Congress basically failed to do anything meaningful on healthcare — pretty much ensuring those subsidies will disappear with the New Year.

Starting in January, premiums for too many people are going to leap skyward without the subsidies, jumping by an average of $1,016 according to the health policy research group KFF.

That’s bad enough. But Trump would like to make it worse.

The Affordable Care Act is about much more than those subsidies. Before it took effect in 2014, insurance companies in many states could deny coverage for preexisting conditions. This didn’t have to be big-ticket stuff like cancer. A kid with asthma? A mom with colitis? Those were the kind of routine but chronic problems that prevented millions from obtaining insurance — and therefore care.

Obamacare required that policies sold on its exchange did not discriminate. In addition, the ACA required plans to limit out-of-pocket costs and end lifetime dollar caps, and provide a baseline of coverage that included essentials such as maternity care. Those standards put pressure on all plans to include more, even those offered through large employers.

Trump would like to undo much of that. He instead wants to fall back on the stunt he loves the most — send a check!

What he is suggesting by sending subsidy money directly to consumers also most likely would open the market to plans without the regulation of the ACA. So yes, small businesses or even groups of individuals might be able to band together to buy insurance, but there likely would be fewer rules about what — or whom — it has to cover.

Most people aren’t savvy or careful enough to understand the limitations of their insurance before it matters. So it has a $2-million lifetime cap? That sounds like a lot until your kid needs a treatment that eats through that in a couple of months. Then what?

Trump suggested people pay for it themselves, out of health savings accounts funded by that subsidy check sent directly to taxpayers. Because that definitely will work, and people won’t spend the money on groceries or rent, and what they do save certainly will cover any medical expenses.

“You’ll get much better healthcare at a much lower price,” Trump claimed Wednesday. “The only losers will be insurance companies that have gotten rich, and the Democrat Party, which is totally controlled by those same insurance companies. They will not be happy, but that’s OK with me because you, the people, are finally going to be getting great healthcare at a lower cost.”

He then bizarrely tried to blame the expiring subsidies on Democrats.

Democrats “are demanding those increases and it’s their fault,” he said. “It is not the Republicans’ fault. It’s the Democrats’ fault. It’s the Unaffordable Care Act, and everybody knew it.”

It seems like Trump just wants to lower costs at the expense of quality. Here’s where I take issue with the Democrats. I am not here to defend insurance companies or our healthcare system. Both clearly need reform.

But why are the Democrats failing to explain what “The money should go to the people” will mean?

I get that affordability is the message, and as someone who bought both a steak and a carton of milk this week, I understand just how powerful that issue is.

Still, everyone, Democrat or Republican, wants decent healthcare they can afford, and the peace of mind of knowing if something terrible happens, they will have access to help. There is no American who gladly would pay for insurance each month, no matter how low the premium, that is going to leave them without care when they or their loved ones need it most.

Grandpa Trump doesn’t have this worry, since he has the best healthcare our tax dollars can buy.

But when he promises to send a check instead of providing governance and regulation of one of the most critical purchases in our lives, the message is sickening: My victory in exchange for your well-being.

An expanded federal healthcare subsidy that grew out of the pandemic looks all but certain to expire on December 31, as Republican leaders in the United States faced a rebellion from within their own ranks.

On Wednesday, four centrist Republicans in the House of Representatives broke with their party’s leadership to support a Democratic-backed extension for the healthcare subsidies under the Affordable Care Act (ACA), sometimes called “Obamacare”.

By a vote of 204 to 203, the House voted to stop the last-minute move by Democrats, aided by four Republicans, to force quick votes on a three-year extension of the Affordable Care Act subsidy.

Democrats loudly protested, accusing Republican leadership of gavelling an end to the vote prematurely while some members were still trying to vote.

“That’s outrageous,” Democratic Representative Jim McGovern of Massachusetts yelled at Republican leadership.

Some of the 24 million Americans who buy their health insurance through the ACA programme could face sharply higher costs beginning on January 1 without action by Congress.

Twenty-six House members had not yet voted – and some were actively trying to do so – when the House Republican leadership gavelled the vote closed on Wednesday. It is rare but not unprecedented for House leadership to cut a contested vote short.

Democratic Representative Rosa DeLauro of Connecticut said the decision prevented some Democrats from voting.

“Listen, it’s playing games when people’s lives are at stake,” DeLauro said. “They jettisoned it.”

It was the latest episode of congressional discord over the subsidies, which are slated to expire at the end of the year.

The vote also offered another key test to the Republican leadership of House Speaker Mike Johnson. Normally, Johnson determines which bills to bring to a House vote, but recently, his power has been circumvented by a series of “discharge petitions”, wherein a majority of representatives sign a petition to force a vote.

In a series of quickfire manoeuvres on Wednesday, Democrats resorted to one such discharge petition to force a vote on the healthcare subsidies in the new year.

They were joined by the four centrist Republicans: Mike Lawler of New York and Brian Fitzpatrick, Robert Bresnahan and Ryan MacKenzie of Pennsylvania.

The Democratic proposal would see the subsidies extended for three years.

But Republicans have largely rallied around their own proposal, a bill called the Lower Health Care Premiums for All Americans Act. It would reduce some insurance premiums, though critics argue it would raise others, and it would also reduce healthcare subsidies overall.

The nonpartisan Congressional Budget Office (CBO) on Tuesday said the legislation would decrease the number of people with health insurance by an average of 100,000 per year through 2035.

Its money-saving provisions would reduce federal deficits by $35.6bn, the CBO said.

Republicans have a narrow 220-seat majority in the 435-seat House of Representatives, and Democrats are hoping to flip the chamber to their control in the 2026 midterm elections.

Three of the four Republicans who sided with the Democrats over the discharge petition are from the swing state of Pennsylvania, where voters could lean right or left.

Affordability has emerged as a central question ahead of the 2026 midterms.

Even if the Republican-controlled House manages to pass a healthcare bill this week, it is unlikely to be taken up by the Senate before Congress begins a looming end-of-year recess that would stop legislative action until January 5.

By then, millions of Americans will be looking at significantly more expensive health insurance premiums that could prompt some to go without coverage.

Wednesday’s House floor battle could embolden Democrats and some Republicans to revisit the issue in January, even though higher premiums will already be in the pipeline.

Referring to the House debate, moderate Republican Senator Lisa Murkowski told reporters: “I think that that will help prompt a response here in the Senate after the first of the new year, and I’m looking forward to that.”

The ACA subsidies were a major point of friction earlier this year as well, during the historic 43-day government shutdown.

Democrats had hoped to extend the subsidies during the debate over government spending, but Republican leaders refused to take up the issue until a continuing budget resolution was passed first.