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Yahoo
7 hours ago
- Business
- Yahoo
American Doctors Are Moving to Canada To Escape the Trump Administration
Illustration credit: Oona Zenda/KFF Health News Earlier this year, as President Donald Trump was beginning to reshape the American government, Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out. Michael now works in a small-town hospital in Canada. KFF Health News and NPR granted him anonymity because of fears he might face reprisal from the Trump administration if he returns to the U.S. He said he feels some guilt that he did not stay to resist the Trump agenda but is assured in his decision to leave. Too much of America has simply grown too comfortable with violence and cruelty, he said. 'Part of being a physician is being kind to people who are in their weakest place,' Michael said. 'And I feel like our country is devolving to really step on people who are weak and vulnerable.' Michael is among a new wave of doctors who are leaving the United States to escape the Trump administration. In the months since Trump was reelected and returned to the White House, American doctors have shown skyrocketing interest in becoming licensed in Canada, where dozens more than normal have already been cleared to practice, according to Canadian licensing officials and recruiting businesses. The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on which is 'typically the first step' to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615. Separately, medical licensing organizations in Canada's most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump. 'The doctors that we are talking to are embarrassed to say they're Americans,' said John Philpott, CEO of CanAm Physician Recruiting, which recruits doctors into Canada. 'They state that right out of the gate: 'I have to leave this country. It is not what it used to be.'' Canada, which has universal publicly funded health care, has long been an option for U.S.-trained doctors seeking an alternative to the American health care system. While it was once more difficult for American doctors to practice in Canada due to discrepancies in medical education standards, Canadian provinces have relaxed some licensing regulations in recent years, and some are expediting licensing for U.S.-trained physicians. In mere months, the Trump administration has jeopardized the economy with tariffs, ignored court orders and due process, and threatened the sovereignty of U.S. allies, including Canada. The administration has also taken steps that may unnerve doctors specifically, including appointing Robert F. Kennedy Jr. to lead federal health agencies, shifting money away from pandemic preparedness, discouraging gender-affirming care, demonizing fluoride, and supporting deep cuts to Medicaid. The Trump administration did not provide any comment for this article. When asked to respond to doctors' leaving the U.S. for Canada, White House spokesperson Kush Desai asked whether KFF Health News knew the precise number of doctors and their 'citizenship status,' then provided no further comment. KFF Health News did not have or provide this information. Philpott, who founded CanAm Physician Recruiting in the 1990s, said the cross-border movement of American and Canadian doctors has for decades ebbed and flowed in reaction to political and economic fluctuations, but that the pull toward Canada has never been as strong as now. Philpott said CanAm had seen a 65% increase in American doctors looking for Canadian jobs from January to April, and that the company has been contacted by as many as 15 American doctors a day. Rohini Patel, a CanAm recruiter and doctor, said some consider pay cuts to move quickly. 'They're ready to move to Canada tomorrow,' she said. 'They are not concerned about what their income is.' The College of Physicians and Surgeons of Ontario, which handles licensing in Canada's most populous province, said in a statement that it registered 116 U.S.-trained doctors in the first quarter of 2025 — an increase of at least 50% over the prior two quarters. Ontario also received license applications from about 260 U.S.-trained doctors in the first quarter of this year, the organization said. British Columbia, another populous province, saw a surge of licensure applications from U.S.-trained doctors after Election Day, according to an email statement from the College of Physicians and Surgeons of British Columbia. The statement also said the organization licensed 28 such doctors in the fiscal year that ended in February — triple the total of the prior year. Quebec's College of Physicians said applications from U.S.-trained doctors have increased, along with the number of Canadian doctors returning from America to practice within the province, but it did not provide specifics. In a statement, the organization said some applicants were trying to get permitted to practice in Canada 'specifically because of the actual presidential administration.' Michael, the physician who moved to Canada this year, said he had long been wary of what he described as escalating right-ring political rhetoric and unchecked gun violence in the United States, the latter of which he witnessed firsthand during a decade working in American emergency rooms. Michael said he began considering the move as Trump was running for reelection in 2020. His breaking point came on Jan. 6, 2021, when a violent mob of Trump supporters besieged the U.S. Capitol in an attempt to stop the certification of the election of Joe Biden as president. 'Civil discourse was falling apart,' he said. 'I had a conversation with my family about how Biden was going to be a one-term president and we were still headed in a direction of being increasingly radicalized toward the right and an acceptance of vigilantism.' It then took about a year for Michael to become licensed in Canada, then longer for him to finalize his job and move, he said. While the licensing process was 'not difficult,' he said, it did require him to obtain certified documents from his medical school and residency program. 'The process wasn't any harder than getting your first license in the United States, which is also very bureaucratic,' Michael said. 'The difference is, I think most people practicing in the U.S. have got so much administrative fatigue that they don't want to go through that process again.' Michael said he now receives near-daily emails or texts from American doctors who are seeking advice about moving to Canada. This desire to leave has also been striking to Hippocratic Adventures, a small business that helps American doctors practice medicine in other countries. The company was co-founded by Ashwini Bapat, a Yale-educated doctor who moved to Portugal in 2020 in part because she was 'terrified that Trump would win again.' For years, Hippocratic Adventures catered to physicians with wanderlust, guiding them through the bureaucracy of getting licensed in foreign nations or conducting telemedicine from afar, Bapat said. But after Trump was reelected, customers were no longer seeking grand travels across the globe, Bapat said. Now they were searching for the nearest emergency exit, she said. 'Previously it had been about adventure,' Bapat said. 'But the biggest spike that we saw, for sure, hands down, was when Trump won reelection in November. And then Inauguration Day. And basically every single day since then.' At least one Canadian province is actively marketing itself to American doctors. Doctors Manitoba, which represents physicians in the rural province that struggles with one of Canada's worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S. The campaign focuses on Florida and North and South Dakota and advertises 'zero political interference in physician patient relationship' as a selling point. Alison Carleton, a family medicine doctor who moved from Iowa to Manitoba in 2017, said she left to escape the daily grind of America's for-profit health care system and because she was appalled that Trump was elected the first time. Carleton said she now runs a small-town clinic with low stress, less paperwork, and no fear of burying her patients in medical debt. She dropped her American citizenship last year. 'People I know have said, 'You left just in time,'' Carleton said. 'I tell people, 'I know. When are you going to move?'' 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—an independent source of health policy research, polling, and journalism. Learn more about KFF. Subscribe to KFF Health News' free Morning Briefing. This article first appeared on KFF Health News and is republished here under a Creative Commons license.
Yahoo
a day ago
- Business
- Yahoo
Native Americans Hurt by Federal Health Cuts, Despite RFK Jr.'s Promises of Protection
Navajo Nation leaders took turns hiking alongside Health and Human Services Secretary Robert F. Kennedy Jr. in April to detail the tribal nation's priorities to improve access to health care and clean water. They also advocated for the preservation and reestablishment of U.S. government programs that have far-reaching impacts for their nation. (Katheryn Houghton/KFF Health News) WINDOW ROCK, Ariz. — Navajo Nation leaders took turns talking with the U.S. government's top health official as they hiked along a sandstone ridge overlooking their rural, high-desert town before the morning sun grew too hot. Buu Nygren, president of the Navajo Nation, paused at the edge with Health and Human Services Secretary Robert F. Kennedy Jr. Below them, tribal government buildings, homes, and juniper trees dotted the tan and deep-red landscape. Nygren said he wanted Kennedy to look at the capital for the nation of about 400,000 enrolled members. The tribal president pointed toward an antiquated health center that he hoped federal funding would help replace and described life for the thousands of locals without running water due to delayed government projects. Nygren said Kennedy had already done a lot, primarily saving the Indian Health Service from a round of staffing cuts rippling through the federal government. 'When we started hearing about the layoffs and the freezes, you were the first one to stand up for Indian Country,' he told Kennedy, of his move to spare the federal agency charged with providing health care to Native Americans and Alaska Natives. But Nygren and other Navajo leaders said cuts to federal health programs outside the Indian Health Service are hurting Native Americans. 'You're disrupting real lives,' Cherilyn Yazzie, a Navajo council delegate, told KFF Health News as she described recent changes. Kennedy has repeatedly promised to prioritize Native Americans' health care. But Native Americans and health officials across tribal nations say those overtures are overshadowed by the collateral harm from massive cuts to federal health programs. The sweeping reductions have resulted in cuts to funding directed toward or disproportionately relied on by Native Americans. Staffing cuts, tribal health leaders say, have led to missing data and poor communication. The Indian Health Service provides free health care at its hospitals and clinics to Native Americans, who, as a group, face higher rates of chronic diseases and die younger than other populations. Those inequities are attributable to centuries of systemic discrimination. But many tribal members don't live near an agency clinic or hospital. And those who do may face limited services, chronic underfunding, and staffing shortages. To work around those gaps, health organizations lean on other federally funded programs. 'There may be a misconception among some of the administration that Indian Country is only impacted by changes to the Indian Health Service,' said Liz Malerba, a tribal policy expert and citizen of the Mohegan Tribe. 'That's simply not true.' Tribes have lost more than $6 million in grants from other HHS agencies, the National Indian Health Board wrote in a May letter to Kennedy. Janet Alkire, chairperson of the Standing Rock Sioux Tribe in the Dakotas, said at a May 14 Senate committee hearing that those grants paid for community health workers, vaccinations, data modernization, and other public health efforts. The government also canceled funding for programs it said violated President Donald Trump's ban on 'diversity, equity, and inclusion,' including one aimed at Native American youth interested in science and medicine and another that helps several tribes increase access to healthy food — something Kennedy has said he wants to prioritize. Tribal health officials say slashed federal staffing has made it harder to get technical support and money for federally funded health projects they run. The firings have cut or eliminated staff at programs related to preventing overdoses in tribal communities, using traditional food and medicine to fight chronic disease, and helping low-income people afford to heat and cool their homes through the Low Income Home Energy Program. The Oglala Sioux Tribe is in South Dakota, where Native Americans who struggle to heat their homes have died of hypothermia. Through mid-May the tribe hadn't been able to access its latest funding installment from the energy program, said John Long, the tribe's chief of staff. Abigail Echo-Hawk, director of the Urban Indian Health Institute at the Seattle Indian Health Board, said the government has sent her organization incomplete health data. That includes statistics about Native Americans at risk for suicide and substance use disorders, which the center uses to shape public health policy and programs. 'People are going to die because we don't have access to the data,' Echo-Hawk said. Her organization is also having trouble administering a $2.2 million federal grant, she said, because the agency handling the money fired staffers she worked with. The grant pays for public health initiatives such as smoking cessation and vaccinations. 'It is very confusing to say chronic disease prevention is the No. 1 priority and then to eradicate the support needed to address chronic disease prevention in Indian Country,' Echo-Hawk said. HHS spokesperson Emily Hilliard said Kennedy aims to combat chronic diseases and improve well-being among Native Americans 'through culturally relevant, community-driven solutions.' Hilliard did not respond to questions about Kennedy's specific plans for Native American health or concerns about existing and proposed funding and staffing changes. As Kennedy hiked alongside Navajo Nation leaders, KFF Health News asked how he would improve and protect access to care for tribal communities amid rollbacks within his department. 'That's exactly what I'm doing,' Kennedy responded. 'Making sure that all the cuts do not affect these communities.' Kennedy has said his focus on Native American health stems from personal and family experience, something he repeated to Navajo leadership. As an attorney, he worked with tribes on environmental health lawsuits. He also served as an editor at ICT, a major Native American news outlet. The secretary said he was also influenced by his uncle, President John F. Kennedy, and his father, U.S. Attorney General Robert F. Kennedy, who were both assassinated when Robert F. Kennedy Jr. was a child. 'They thought that America would never live up to its moral authority and its role as an exemplary nation around the world if we didn't first look back and remediate or mitigate the original sin of the American experience — the genocide of the Native people,' Kennedy said during his visit. Some tribal leaders say the recent cuts, and the way the administration made them, violate treaties in which the U.S. promised to provide for the health and welfare of tribes in return for taking their land. 'We have not been consulted with meaningfully on any of these actions,' said Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, which advocates for tribes from Texas to Maine. Alkire said at the congressional hearing that many Native American health organizations sent letters to the health department asking for consultations but none has received a response. Tribal consultation is legally required when federal agencies pursue changes that would have a significant impact on tribal nations. 'This is not just a moral question of what we owe Native people,' Sen. Brian Schatz (D-Hawaii) said at the hearing. 'It is also a question of the law.' Tribal leaders are worried about additional proposed changes, including funding cuts to the Indian Health Service and a reorganization of the federal health department. Esther Lucero, president and CEO of the Seattle Indian Health Board, said the maneuvers remind her of the level of daily uncertainty she felt working through the covid-19 pandemic — only with fewer resources. 'Our ability to serve those who are desperately in need feels at risk,' Lucero said. Among the most pressing concerns are congressional Republicans' proposed cuts to Medicaid, the primary government health insurance program for people with low incomes or disabilities. About 30% of Native American and Alaska Native people younger than 65 are enrolled in Medicaid, and the program helps keep Indian Health Service and other tribal health facilities afloat. Native American adults would be exempt from Medicaid work requirements approved by House Republicans last month. After Kennedy summited Window Rock with Navajo Nation leaders, the tribe held a prayer ceremony in which they blessed him in Diné Bizaad, the Navajo language. President Nygren stressed how meaningful it was for the country's health secretary to walk alongside them. He also reminded Kennedy of the list of priorities they'd discussed. That included maintaining the federal low-income energy assistance program. 'We look forward to reestablishing and protecting some of the services that your department provides,' Nygren said. As of mid-May, the Trump administration had proposed eliminating the energy program, which remains unstaffed. 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—an independent source of health policy research, polling, and journalism. Learn more about KFF. Subscribe to KFF Health News' free Morning Briefing. This article first appeared on KFF Health News and is republished here under a Creative Commons license.
Miami Herald
2 days ago
- Business
- Miami Herald
American doctors are moving to Canada to escape the Trump administration
Earlier this year, as President Donald Trump was beginning to reshape the American government, Michael, an emergency room doctor who was born, raised and trained in the United States, packed up his family and got out. Michael now works in a small-town hospital in Canada. KFF Health News and NPR granted him anonymity because of fears he might face reprisal from the Trump administration if he returns to the U.S. He said he feels some guilt that he did not stay to resist the Trump agenda but is assured in his decision to leave. Too much of America has simply grown too comfortable with violence and cruelty, he said. "Part of being a physician is being kind to people who are in their weakest place," Michael said. "And I feel like our country is devolving to really step on people who are weak and vulnerable." Michael is among a new wave of doctors who are leaving the United States to escape the Trump administration. In the months since Trump was reelected and returned to the White House, American doctors have shown skyrocketing interest in becoming licensed in Canada, where dozens more than normal have already been cleared to practice, according to Canadian licensing officials and recruiting businesses. The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on which is "typically the first step" to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year - from 71 applicants to 615. Separately, medical licensing organizations in Canada's most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump. "The doctors that we are talking to are embarrassed to say they're Americans," said John Philpott, CEO of CanAm Physician Recruiting, which recruits doctors into Canada. "They state that right out of the gate: 'I have to leave this country. It is not what it used to be.'" Canada, which has universal publicly funded health care, has long been an option for U.S.-trained doctors seeking an alternative to the American health care system. While it was once more difficult for American doctors to practice in Canada due to discrepancies in medical education standards, Canadian provinces have relaxed some licensing regulations in recent years, and some are expediting licensing for U.S.-trained physicians. In mere months, the Trump administration has jeopardized the economy with tariffs, ignored court orders and due process, and threatened the sovereignty of U.S. allies, including Canada. The administration has also taken steps that may unnerve doctors specifically, including appointing Robert F. Kennedy Jr. to lead federal health agencies, shifting money away from pandemic preparedness, discouraging gender-affirming care, demonizing fluoride, and supporting deep cuts to Medicaid. The Trump administration did not provide any comment for this article. When asked to respond to doctors' leaving the U.S. for Canada, White House spokesperson Kush Desai asked whether KFF Health News knew the precise number of doctors and their "citizenship status," then provided no further comment. KFF Health News did not have or provide this information. Philpott, who founded CanAm Physician Recruiting in the 1990s, said the cross-border movement of American and Canadian doctors has for decades ebbed and flowed in reaction to political and economic fluctuations, but that the pull toward Canada has never been as strong as now. Philpott said CanAm had seen a 65% increase in American doctors looking for Canadian jobs from January to April, and that the company has been contacted by as many as 15 American doctors a day. Rohini Patel, a CanAm recruiter and doctor, said some consider pay cuts to move quickly. "They're ready to move to Canada tomorrow," she said. "They are not concerned about what their income is." The College of Physicians and Surgeons of Ontario, which handles licensing in Canada's most populous province, said in a statement that it registered 116 U.S.-trained doctors in the first quarter of 2025 - an increase of at least 50% over the prior two quarters. Ontario also received license applications from about 260 U.S.-trained doctors in the first quarter of this year, the organization said. British Columbia, another populous province, saw a surge of licensure applications from U.S.-trained doctors after Election Day, according to an email statement from the College of Physicians and Surgeons of British Columbia. The statement also said the organization licensed 28 such doctors in the fiscal year that ended in February - triple the total of the prior year. Quebec's College of Physicians said applications from U.S.-trained doctors have increased, along with the number of Canadian doctors returning from America to practice within the province, but it did not provide specifics. In a statement, the organization said some applicants were trying to get permitted to practice in Canada "specifically because of the actual presidential administration." Michael, the physician who moved to Canada this year, said he had long been wary of what he described as escalating right-ring political rhetoric and unchecked gun violence in the United States, the latter of which he witnessed firsthand during a decade working in American emergency rooms. Michael said he began considering the move as Trump was running for reelection in 2020. His breaking point came on Jan. 6, 2021, when a violent mob of Trump supporters besieged the U.S. Capitol in an attempt to stop the certification of the election of Joe Biden as president. "Civil discourse was falling apart," he said. "I had a conversation with my family about how Biden was going to be a one-term president and we were still headed in a direction of being increasingly radicalized toward the right and an acceptance of vigilantism." It then took about a year for Michael to become licensed in Canada, then longer for him to finalize his job and move, he said. While the licensing process was "not difficult," he said, it did require him to obtain certified documents from his medical school and residency program. "The process wasn't any harder than getting your first license in the United States, which is also very bureaucratic," Michael said. "The difference is, I think most people practicing in the U.S. have got so much administrative fatigue that they don't want to go through that process again." Michael said he now receives near-daily emails or texts from American doctors who are seeking advice about moving to Canada. This desire to leave has also been striking to Hippocratic Adventures, a small business that helps American doctors practice medicine in other countries. The company was co-founded by Ashwini Bapat, a Yale-educated doctor who moved to Portugal in 2020 in part because she was "terrified that Trump would win again." For years, Hippocratic Adventures catered to physicians with wanderlust, guiding them through the bureaucracy of getting licensed in foreign nations or conducting telemedicine from afar, Bapat said. But after Trump was reelected, customers were no longer seeking grand travels across the globe, Bapat said. Now they were searching for the nearest emergency exit, she said. "Previously it had been about adventure," Bapat said. "But the biggest spike that we saw, for sure, hands down, was when Trump won reelection in November. And then Inauguration Day. And basically every single day since then." At least one Canadian province is actively marketing itself to American doctors. Doctors Manitoba, which represents physicians in the rural province that struggles with one of Canada's worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S. The campaign focuses on Florida and North and South Dakota and advertises "zero political interference in physician patient relationship" as a selling point. Alison Carleton, a family medicine doctor who moved from Iowa to Manitoba in 2017, said she left to escape the daily grind of America's for-profit health care system and because she was appalled that Trump was elected the first time. Carleton said she now runs a small-town clinic with low stress, less paperwork, and no fear of burying her patients in medical debt. She dropped her American citizenship last year. "People I know have said, 'You left just in time,'" Carleton said. "I tell people, 'I know. When are you going to move?'" Copyright (C) 2025, Tribune Content Agency, LLC. Portions copyrighted by the respective providers.
Yahoo
2 days ago
- Business
- Yahoo
A Medicaid Patient Had a Heart Attack While Traveling — He Owed Almost $78,000
On Christmas Day at the WaTiki indoor water park, Hans Wirt was getting winded from following his son up the stairs to the waterslides. Wirt's breathing became more labored once they returned to the nearby hotel where they and Wirt's girlfriend were staying while visiting family in Rapid City, South Dakota. Then he grew nauseated and went pale. Wirt thought the cause might have been the altitude change between his home in Deltona, Florida — 33 feet above sea level — and Rapid City, at the edge of the Black Hills. But his 12-year-old son was worried and called for an ambulance. 'I could tell by the look in his eyes that there was something a little more to this,' Wirt said. 'So I can kind of thank my son for saving my life.' It turned out the 62-year-old was having a heart attack. A 'lousy Christmas present,' Wirt said. Medics stabilized Wirt before taking him to Monument Health — the only hospital in Rapid City with an emergency room — where he was treated over two days. Then the bill came. Paramedics used a defibrillator to restore a normal heart rhythm. Doctors at the hospital gave Wirt various medications, used an electrocardiograph and other diagnostic and monitoring devices, and inserted stents into his arteries to improve blood flow to his heart. $95,523.73, including $32,998.90 for medical supplies, mostly related to the stents, and $28,879 for treatment in a cardiac catheterization lab. After unspecified hospital adjustments to the bill, Wirt owed $77,574.44. Wirt is covered by Florida's Medicaid program through Sunshine Health, a managed-care plan. But the South Dakota hospital refused to submit the bill to his out-of-state Medicaid plan, instead sending it to Wirt and eventually threatening to send the debt to a collection agency. Medicaid, the government health insurance program primarily for low-income people and those with disabilities, is jointly funded by the federal government and states. States are responsible for administering Medicaid, and most contract with private insurance companies like Sunshine Health. Federal law says state Medicaid programs must reimburse out-of-state hospitals for beneficiaries' care in an emergency. Many hospitals bill out-of-state Medicaid plans in such situations. If they don't, they risk not being reimbursed at all, since Medicaid recipients probably won't be able to afford large bills, said Katy DeBriere, who was legal director for the Florida Health Justice Project when she spoke with KFF Health News in April. But there's no federal law that requires them to do so, she said. Federal court opinions have noted that hospitals are not required to bill Medicaid for every individual beneficiary they treat, even if they generally accept Medicaid. Monument Health didn't bill Wirt's insurance because the hospital isn't enrolled as a health care provider with Florida Medicaid, said hospital spokesperson Stephany Chalberg. She told KFF Health News that Monument bills Medicaid plans only in South Dakota and four bordering states: Wyoming, Montana, Nebraska, and Minnesota. The hospital's website says Medicaid patients who are not enrolled in one of those states 'are responsible for any charges.' 'Due to the significant credentialing requirements of our multiple hospitals and hundreds of physicians we do not participate with all states,' a hospital representative wrote in a message to Wirt. According to Florida's Medicaid website, out-of-state providers who have treated one of its enrollees must submit five documents to bill the program, including a six-page application, a copy of the provider's license, and a claim form. The process is different in each state, and many Medicaid programs reimburse out-of-state providers at lower rates than those that are in-state, according to the Medicaid and CHIP Payment and Access Commission, a federal agency that advises Congress. Provider enrollment barriers leave 'beneficiaries in an untenable situation, preventing them from accessing the coverage to which they are legally entitled,' Chalberg said. Wirt decided to submit his bill to his Medicaid plan on his own. But he said Sunshine Health told him it can only process bills received directly from providers. Elizabeth Boyd, a spokesperson for Sunshine Health, told KFF Health News that its staff contacted the hospital on Wirt's behalf. She did not respond when asked why the plan can't process bills submitted by patients or what more it could have done to help Wirt. A few days after KFF Health News emailed officials at Monument Health for this story, Wirt noticed his balance due fell from more than $77,000 to $0. Chalberg told KFF Health News that Monument Health covered Wirt's bill through its charity care program. She said that 'appropriate patients' are told about the program and that 'before any bill is sent to collections, it is evaluated to determine whether the patient may qualify for our financial assistance policy.' To retain tax-exempt status, nonprofit hospitals must have programs that provide free or discounted care to patients who can't afford their bills. But Wirt said that when he first contacted Monument Health after receiving his bill and said he couldn't afford to pay it, officials didn't mention the program. He said they didn't share any resources when he asked whether there were outside groups that could help him pay the bill. Wirt said hospital officials just recommended setting up a payment plan, but the monthly bills were still too high for him to afford. 'There's a reason why I'm on Medicaid,' Wirt said. 'It's just beyond me how they can expect somebody who had Medicaid to come up with that kind of money. It's unrealistic.' Sarah Somers, legal director at the National Health Law Program, said the various 'cogs in the Medicaid system' didn't operate correctly in Wirt's situation. 'Nobody's exerting themselves enough to just smooth the way for this person.' States are responsible for managing Medicaid and are therefore the main 'cog,' Somers said. She said Medicaid managed-care companies are also supposed to intervene. Somers and DeBriere said Medicaid recipients who receive bills they don't think they owe should file a complaint with their state's Medicaid program and, if they have one, their managed-care plan. They can also ask whether there is a Medicaid or managed-care caseworker who can advocate on their behalf. The attorneys said patients should also contact a legal aid clinic or a consumer protection firm that specializes in medical debt. DeBriere said those organizations can help file complaints and communicate with the hospital. DeBriere said that, had she assisted Wirt, she would have immediately sent a letter to Monument Health ordering it to stop billing him and to either register with Florida Medicaid to submit his bill or offer him charity care. Wirt said the doctors who treated him and the medical care he received at Monument Health were excellent. He said he spoke out about the hospital's billing practices because he doesn't want others to endure the same experience. 'If I get sick and have a heart attack, I have to be sure that I do that here in Florida now instead of some other state,' he joked. The Patient Expected a Free Checkup. The Bill Was $1,430. Apr 30, 2025He Had Short-Term Health Insurance. His Colonoscopy Bill: $7,000. Mar 28, 2025A Runner Was Hit by a Car, Then by a Surprise Ambulance Bill Feb 28, 2025 More from Bill of the Month Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post's Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it! 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—an independent source of health policy research, polling, and journalism. Learn more about KFF. Subscribe to KFF Health News' free Morning Briefing. This article first appeared on KFF Health News and is republished here under a Creative Commons license. The post A Medicaid Patient Had a Heart Attack While Traveling — He Owed Almost $78,000 appeared first on Katie Couric Media.
Yahoo
5 days ago
- Business
- Yahoo
Ballad Health's Hospital Monopoly Underperformed. Then Tennessee Lowered the Bar.
The Holston Valley Medical Center in Kingsport, Tennessee, is part of the Ballad Health hospital system. (Brett Kelman/KFF Health News) Despite years of patient complaints and quality-of-care concerns, Ballad Health — the nation's largest state-sanctioned hospital monopoly — will now be held to a lower standard by the Tennessee government, and state data that holds the monopoly accountable will be kept from the public for two years. Ballad is the only option for hospital care for most of the approximately 1.1 million people in a 29-county swath of Appalachia. Such a monopoly would normally be prohibited by federal law. But under deals negotiated with Tennessee and Virginia years ago, the monopoly is permitted if both states affirm each year that it is an overall benefit to the public. However, according to a newly renegotiated agreement between Ballad and Tennessee, the monopoly can now be considered a 'clear and convincing' benefit to the public with performance that would earn a 'D' on most A-to-F grading scales. And the monopoly can be allowed to continue even with a score that most would consider an 'F.' Six years into an Appalachia hospital monopoly, patients are fearful and furious 'It's an extreme disservice to the people of northeast Tennessee and southwest Virginia,' said Dani Cook, who has organized protests against Ballad's monopoly for years. 'We shouldn't have lowered the bar. We should be raising the bar.' The Ballad monopoly, which encompasses 20 hospitals and straddles the border of Tennessee and Virginia, was created in 2018 after lawmakers in both states, in an effort to prevent hospital closures, waived federal antitrust laws so two rival health systems could merge. Although Ballad has largely succeeded at keeping its hospitals open, staffing shortages and patient complaints have left some residents wary, afraid, or unwilling to seek care at Ballad hospitals, according to an investigation by KFF Health News published last year. In Tennessee, the Ballad monopoly is regulated through a 10-year Certificate of Public Advantage agreement, or COPA — now in its seventh year — that establishes the state's goals and a scoring rubric for hospital performance. Tennessee Department of Health documents show Ballad has fallen short of about three-fourths of the state's quality-of-care goals over the past four fiscal years. But the monopoly has been allowed to continue, at least in part, because the scoring rubric doesn't prioritize quality of care, according to the documents. Angie Odom, a county commissioner in Tennessee's Carter County, where leaders have clashed with Ballad, said she has driven her 12-year-old daughter more than 100 miles to Knoxville to avoid surgery at a Ballad hospital. After years of disappointment in Tennessee's oversight of the monopoly, Odom said she was 'not surprised' by Ballad's new grading scale. 'They've made a way that they can fail and still pass,' she said. Virginia regulates Ballad with a different agreement and scoring method, and its reviews generally track about one or two years behind Tennessee's. Both states have found Ballad to be an overall benefit in every year they've released a decision. Neither Ballad Health nor the Tennessee Department of Health, which has the most direct oversight of the monopoly, answered questions submitted in writing about the renegotiated agreement. In an emailed statement, Molly Luton, a Ballad spokesperson, said the company's quality of care has steadily improved in recent years, and she raised repeated complaints from the hospital system about KFF Health News' reporting. The news organization has reviewed every complaint from Ballad and has never found a correction or clarification to be warranted in the coverage. Tennessee Health Commissioner Ralph Alvarado, who has more than once described the regulation of Ballad Health as a matter of national importance, has declined or not responded to more than a dozen interview requests from KFF Health News to discuss the monopoly. 'Our effort and progress serve as a model for health care in Tennessee, the Appalachia Region, and the entire nation,' Alvarado said in a May news release about the monopoly, adding, 'We do not take our role lightly as we remain committed to transparency in our COPA oversight.' Tennessee's revised agreement was negotiated behind closed doors for more than a year and announced to the public in early May. As part of that announcement, Tennessee said it wouldn't score Ballad next year, to give the company time to adjust to the new scoring process. Under that process, the minimum score Ballad needs to meet to show a 'clear and convincing' public benefit has been lowered from 85 out of 100 to 70 out of 100. The new agreement also awards Ballad up to 20 points for providing Tennessee with data and records — for example, a report on patient satisfaction — regardless of the level of performance documented. The state can also raise or lower Ballad's overall score by up to 5 points in light of 'reputable information' that is not spelled out in the scoring rubric. Therefore, Ballad can score as low as 65 out of 100, with nearly a third of that score awarded for merely giving information to the state, and still be found to be a 'clear and convincing' benefit to the public, which is the highest finding Tennessee can bestow, according to the agreement. And Ballad could score as low as 55 out of 100 without the monopoly facing a risk of being broken up, according to the new agreement. The agreement also increases how much of Ballad's annual score is directly attributed to the quality of care provided in its hospitals, from 5% to 32%. But the agreement obscures how this will be measured. Tennessee sets 'baseline' goals for Ballad across dozens of quality-of-care issues — like infection rates and speed of emergency room care — and then tracks whether Ballad meets the goals. The new agreement resets these baselines to values that were not made public, leaving it unclear how much the goals for Ballad have changed. Health department spokesperson Dean Flener said the new baselines would not be disclosed until 2027. Cook, the longtime leader of protests against Ballad, said she believes Tennessee is attempting to silence data-supported criticism until the final year of the 10-year COPA agreement, which ends in 2028. By then, any outrage would be largely moot, she said. 'If you are going to wait until the last year to tell us the new measurements, why bother?' Cook said. 'It is clear, without a shadow of a doubt, that the Tennessee Department of Health is putting the needs and concerns of a corporation above the health and well-being of people.' 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.
