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Rising Healthcare Costs Have Hit Georgia’s Most Conservative District. But Its Politics Are Unlikely To Change.
Amber Bates of Cohutta, Georgia, is one of thousands of people without health insurance in the 14th Congressional District, home to about 765,000 people in the northwestern corner of the state.
She and her husband have not had health coverage for the past two years, Bates said, because their employment is unsteady and they earn too much to qualify for Medicaid, the public health insurance for those with disabilities or low incomes.
When the GOP-led Congress allowed enhanced Affordable Care Act subsidies — which helped lower the cost of plans sold on the marketplace — to expire at the end of last year, Bates’ mother-in-law dropped her plan, too.
Bates and her husband have a 2-year-old son. The mother-in-law also cares for a son who has autism. They all live together in a trailer home, spending about a third of their family income on prescription medications and opting for trips to the emergency room — often their main destination for medical care, since they aren’t billed up front.
It’s stressful, Bates said. Yet despite their situation, she said she remains “all in” for President Donald Trump. But she also said she’s recognizing flaws in his leadership.
“He’s trying,” Bates said. “It’s just a lot more other things have his attention.”
Georgia’s 14th District is the most conservative in the state. It’s the district Marjorie Taylor Greene, who rose to prominence as one of Trump’s most vocal and loyal supporters, represented from 2021 to January 2026.
Greene made a notable pivot from the president last year when she publicly bashed Republicans’ handling of the enhanced ACA subsidies, which helped 74,000 people in her district — along with her own adult children, she said — afford healthcare.
The following month, after Greene publicly accused Trump of focusing too much on “foreign wars” and ignoring Americans’ economic struggles, the president attacked Greene on social media and said he would no longer support her. Soon after, she announced that she would be resigning from Congress.
Still, many others in this semirural, exurban district, like Bates, remain loyal to Trump, even as more people go uninsured and face rising costs as a result.
Bates isn’t alone in feeling the pinch of healthcare costs this year. Nationally, 37% of Republican voters surveyed in June for a KFF health opinion poll said healthcare costs were “extremely important.” More than half of Republicans and Republican-leaning independents who support the Make America Great Again movement said that Congress did the wrong thing by letting the enhanced subsidies expire, according to KFF poll data released in March. And 62% of ACA marketplace enrollees put the most blame for the expiration on Republicans (30%) or Trump (32%).
But, as the November midterm elections approach, policy experts don’t anticipate the issue of healthcare costs will lead to a major shift in how people vote in deeply conservative areas like Georgia’s 14th District, even as policies that once benefited them are rolled back.
“They’re willing to stick with the party line,” said Charles Bullock, a professor of political science at the University of Georgia. “As long as Donald Trump and other Republicans are saying Obamacare is bad, they’re going to continue to buy into that idea,” Bullock said, “even when it’s against their economic self-interest.”

Obamacare Still a ‘Dirty Word’
When the ACA was passed in 2010, not a single Republican voted for it. Now, 16 years later, Obamacare is still a “dirty word” for many conservatives, said Jonathan Oberlander, a professor of social medicine at the University of North Carolina-Chapel Hill.
While previously the GOP’s goal was to “repeal and replace” the ACA, the current political strategy is “effectively rolling back some of the coverage gains,” he said.
According to a dashboard from NYU Langone Health’s Department of Population Health, nearly 14% of people younger than 65 living in Georgia’s 14th District were uninsured in 2024, which is higher than the national average. And in 2023, over 16% relied on Medicaid or the Children’s Health Insurance Program, known as CHIP, according to Georgetown University’s Center for Children and Families.
Last summer, Congress passed the One Big Beautiful Bill Act, which restricted ACA enrollment periods, added monthly fees, and imposed new documentation requirements for enrollees. The Congressional Budget Office estimated that the number of uninsured people in the U.S. would increase by about 15 million people over 10 years as a result of the new law, the expiration of the ACA subsidies, and other ACA changes. With the enhanced subsidies expiring at the end of 2025, ACA enrollment fell by nearly 3 million this year. In Georgia, enrollment dropped by more than half a million.
Greene’s not a fan of the ACA. She said her family’s health insurance premiums skyrocketed after it became law in 2010. But last year she surprised those on both sides of the aisle when she openly criticized her Republican colleagues over the subsidies.
“I’m going to go against everyone on this issue,” she wrote in an October post on X, “because when the tax credits expire this year my own adult children’s insurance premiums for 2026 are going to DOUBLE, along with all the wonderful families and hard-working people in my district.”
In a June interview with KFF Health News in Cumming, Georgia, Greene described the end of the subsidies as “catastrophic.”
“All over the country, people are constantly outraged over the cost of health insurance,” she said.
Like Greene, Bates has also wavered in her support for Trump. In addition to her frustration about the ACA subsidies expiring, she said the Iran war and inflation have also hit her wallet.
“I just don’t feel like he’s doing the best he could,” she said. “He did great his first term. But this term, it’s just not OK.”
While Republicans’ policies have made it more difficult for people to qualify for Medicaid and led to the end of the subsidies that made ACA marketplace plans more affordable, a clear plan to improve the U.S. healthcare system hasn’t emerged, Greene and policy experts say.
In December, House Speaker Mike Johnson championed the Lower Health Care Premiums for All Americans Act. Touted as an alternative to extending ACA subsidies, the bill was intended to lower premiums and increase healthcare access.
But the Congressional Budget Office found the bill would increase the number of uninsured people by 100,000 a year from 2027 to 2035. While the House passed the measure in December, nearly nine months later the Senate hasn’t voted on it.
“It’s a Republican-controlled House, Republican-controlled Senate, Republican-controlled White House,” Greene said. “If Republicans had a plan, this was the perfect scenario to get it passed. You should have all the votes — get it done. And they’re not doing anything.”

Sticking to the Party Line
Despite such criticisms of Republicans for lacking a healthcare plan, voters in deeply conservative areas such as Georgia’s 14th District are sticking with Trump and his allies.
In April, the district elected Trump-backed Clay Fuller to replace Greene, though he won with smaller margins than she had. He’s up for election again in November for a full congressional term. The University of Georgia’s Bullock said flipping the district from red to blue is unlikely.
Fuller’s office did not respond to interview requests for this report. But in a Q&A with the Chattanooga Times Free Press ahead of his April runoff with Democrat Shawn Harris, Fuller said that the expanded ACA subsidies, introduced under the Biden administration during the covid pandemic, were not a “a long-term solution.” Lowering healthcare costs would come from increasing competition and reducing federal overreach, he said.
Harris, who’s facing off with Fuller again in November, told KFF Health News that the GOP strategy for the midterms is to continue to play off Republicans’ long-standing negative perceptions about Obamacare.
When people in the community are asked whether they support Obamacare, “they’re probably going to say no,” Harris said. But when asked about the Affordable Care Act, people tend to say, “‘Oh, yes, I need to have that,’” he said.
“They don’t realize it’s one in the same,” Harris said, adding that Republicans “sold everybody a bill of goods.”
As candidates campaign, they need to be in tune with their constituents, Greene said.
“That’s where I think they’re completely missing the mark,” she said. “They’re totally tone deaf to what Americans’ needs really are. And we need a serious solution.”
Bates considers healthcare among her top concerns. She said she doesn’t think anybody, including Trump, can make healthcare more affordable. But she hopes politicians will talk with people like her to better understand the burdens that consumers face.
“I honestly wish Congress would actually spend time in the life that we live,” she said. “They just sit behind their desks, and they don’t know what’s really going on in life, because they make so much money.”
Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact KFF Health News and share your story.
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.This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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A Cancer Survivor Hoped To Work — Then She Lost Her Medicaid Disability Coverage
Taya Hailstone has been in remission from childhood Hodgkin lymphoma for five years. But the cancer’s lasting damage to her organs and nerves can make basic tasks, like loading a dishwasher, hard.
Still, Montana’s health department decided last year that Hailstone is no longer eligible for low-cost disability health coverage through Medicaid. The department switched her coverage to the state’s Children’s Health Insurance Program, another Medicaid program — three months before she aged out.
Before making the decision, the state didn’t seek records from the medical team treating Hailstone, according to letters from those doctors reviewed by KFF Health News. Rather, the administrative ruling came after state officials learned the now-19-year-old had stopped receiving Social Security disability payments. She said she did that because she hoped to get healthy enough to work and save some money — beyond what’s allowed under the strict income caps tethered to those payments. But her health changes day to day, and she said for now she’s still too sick to consistently work.
Hailstone, who lives with her mom, has been able to keep Medicaid coverage while they appeal the case. She said that without Medicaid she can’t afford the treatment to manage the aftermath of her cancer.
“It feels like this process was made to make you give up,” Hailstone said.
Patients with disabilities have long struggled with administrative hoops, blunders, and confusion when trying to qualify for federally subsidized health coverage because of their illness. Now, new federal Medicaid work requirements mean states face the additional task of deciding who qualifies for a medical exemption. That means reviewing medical cases for an even larger swath of Medicaid enrollees.
Attorneys, researchers, and advocates who specialize in public aid said disability cases like Hailstone’s — though separate from the incoming work requirements — are an indication that states aren’t ready. As a result, they said, more people will be denied coverage in an opaque process.
“This will be the story of millions of people,” said Anthony Wright, who heads Families USA, a national nonprofit that advocates for ways to make healthcare more accessible.
Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, said the state doesn’t comment on individual Medicaid cases.
An estimated 18.5 million people will have to meet the new rules requiring them to prove they’re working, going to school, or volunteering to keep their Medicaid coverage, according to the Congressional Budget Office. More than 40% of those enrollees live with a chronic health condition, according to KFF. Some will be excused from those rules if they can prove they’re too sick to work.
More than 5 million people are expected to lose Medicaid coverage by 2034 because of the work requirements, according to the CBO.
Work Requirements Become Law
Many Republican policymakers and the Trump administration have touted Medicaid work requirements to preserve coverage for the neediest. Congress made that national policy through last year’s One Big Beautiful Bill Act and gave states until January 2027 to implement work-for-coverage rules.
Some states are starting those checks early. Montana began in July. Nebraska initiated work requirements in May.
In the federal law creating the work requirements, Congress allowed states to exempt people who have an illness that qualifies them as “medically frail.” Many states created plans for those judgment calls, only to be surprised when federal officials released rules for the requirements that went beyond what Congress outlined, by also requiring enrollees to prove their illness makes it too hard to work.
Families USA and other organizations have argued the new rules force states to set up a patchwork of systems that, together, would be larger and more complicated than the Social Security Administration’s own disability review system. Last year, that federal program cost more than $5 billion to administer to roughly 7 million people nationally. For comparison, Wright said, the federal law provided $200 million for states to share as they implement the work requirements. States are paying contractors millions of dollars to prepare often already flawed public aid systems to meet the new standards.
In June, 25 states sued the Trump administration over the medical frailty rules, arguing they’re too hard for patients to meet and for states to assess. That case is ongoing.
Hailstone was diagnosed with blood cancer at age 10. Her intestines tore, which led to their partial removal. As a result, her body struggles to process food and she can face severe dehydration. She said lingering side effects from her cancer treatment can leave her mind foggy and cause her hands and feet to swell enough that it’s hard to grip a fork or walk across a room.
Cancer dominated nearly half her life. It left mental scars, too.
“Some days you feel fine and then you suddenly crash,” Hailstone said.

Hailstone and her mom live in Roundup, a central Montana town of roughly 2,000 people. They regularly make the nearly two-hour round-trip drive to Billings for specialized care. She typically has three medical appointments a week to see her physical and occupational therapists and a mental health counselor.
Hailstone said she’s lucky she has her mother’s help navigating Medicaid. Her mom, Kyla Hailstone, said that the state hasn’t clearly defined how it determined her daughter’s disability status and that its appeal process has been slow and dysfunctional.
Taya Hailstone would qualify for Medicaid based on her income if she can’t prove her eligibility for disability coverage. But that would mean proving she’s too sick to meet the work requirement — putting her in the same position of having to rely on a state review of her illness.
“If I lose this, this is life-changing,” Hailstone said.
‘Things Fall Through the Cracks’
Hailstone qualified as disabled through the federal government as recently as 2024, about a year before the state said it was dropping her coverage. State officials can do their own medical review to determine whether someone meets the federal definition of a disability to access Medicaid.
“Whether that happens is always a bit of a crapshoot just based on state capacity,” said Megan Dishong, deputy director of the Montana Legal Services Association, which helps low-income people navigate public programs. “Things fall through the cracks.”
Ebelt said the state health department accepts disability decisions from the Social Security Administration. The state agency can conduct an internal disability determination if a person doesn’t have one from the SSA, but Ebelt said it doesn’t have to if a person qualifies for coverage another way.
“We are committed to treating every client with respect and helping those who are eligible receive appropriate Medicaid coverage,” Ebelt said.
Montana instituted a three-month grace period for the work requirements. State officials won’t begin disenrolling people for noncompliance until October.
Pamela Herd, a University of Michigan social policy professor who has studied bureaucratic obstacles to public benefits, said convoluted disability cases are common enough for attorneys to specialize in accessing aid.
“When we’ve designed public programs in ways that people can’t figure out whether they’re eligible without consulting lawyers, we’ve done something wrong,” Herd said. “That has huge, huge implications for what’s to come.”
Montana officials have said they’ll automatically review medical records that could help patients qualify for an exemption. Even so, the federal guidelines released in June mean patients will probably still face additional steps to guarantee an exemption.
Meanwhile, already overstretched doctors worry they’ll face the burden of judging whether someone’s illness qualifies them for a work exemption.
Dishong said that between now and October, Montana officials could offer more clarity on how the process will work. She said she’s worried the state will end up “with a slow-roll mess” instead.
“This is a problem that’s just starting,” Dishong said.
As for Hailstone, she’s now reapplying for Social Security disability payments. That aid would limit how much she can work. But it would also guarantee access to Medicaid.
Have you tried to prove your eligibility for Medicaid under new rules that require people to show they are working, going to school, or participating in another qualifying activity? Click here to contact KFF Health News.
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.This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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A Generation of Kids Suffer as Trump Destabilizes Immigrant Families
The little girl stared up at Norma Gómez from the doorway of her neighbor’s apartment, her sad, brown eyes suddenly flashing with hope.
“Are you the person who’s going to bring my mom back?” she asked.
Gómez struggled to find an answer. It was a December morning, and she’d brought food, diapers, baby wipes, and clothes — items she hoped would help the 6-year-old girl, her baby brother, and the neighbor who had stepped in to care for them. The children were left alone after federal immigration agents arrested their parents outside their apartment in Oxnard, a mostly Latino agricultural community on the Southern California coast. But Gómez had no power to bring the parents back.
“We’re working on that,” Gómez recalled telling the girl. In reality, she was at a loss for how to answer truthfully without upsetting her.
As a project manager for a nonprofit that provides food assistance to immigrant families affected by Immigration and Customs Enforcement raids, Gómez has witnessed the tumult and pain that have roiled the lives of millions of immigrant families since President Donald Trump returned to office, with devastating consequences for children’s health. They include an estimated 205,000 children with at least one parent detained by immigration authorities through April, a number that has undoubtedly climbed since. Separation from parents harms children psychologically. It destabilizes families, often leaving the remaining parent or caregiver scrambling to stay housed, buy food, and fulfill kids’ medical needs. Some kids are left alone to care for themselves.

Many kids whose parents aren’t detained are experiencing threats to their health and well-being too. Two children in the South died by suicide in February 2025 after reportedly being bullied over their family’s alleged immigration status.
Millions of children live in families losing access to medical care, food, tax credits, and other supports as federal and state governments roll back eligibility for immigrants with and without legal status. Fear of federal enforcement has pushed parents to avoid taking kids to school, going to the doctor, and engaging in social activities. Some have disenrolled from or avoided signing kids up for health and nutrition programs.
Children from immigrant backgrounds are also living in fear. They’re experiencing more emotional distress, increased bullying in school, and anxiety about racial profiling by ICE, even when they or their family members are citizens or legal residents.
Most of these children are American citizens. About 1 in 4 U.S.-born kids have an immigrant parent, including around 4.6 million with a parent who lacks legal status.
“I’m really concerned about how long it’s going to take for us as a country to address all of the harm that’s happening to this generation of kids,” said Wendy Cervantes, director of immigration and immigrant families at the Center for Law and Social Policy. “This type of stress can have long-term developmental harm and can really inhibit their ability to do well in school, to have good health outcomes, and to grow into thriving, stable adults.”
Curbing Public Benefits
Trump has made cracking down on immigrants — including the children of immigrants — a priority since his second term began last year. On Inauguration Day, he issued an executive order purporting to end birthright citizenship for kids born to parents without legal status or in the country on temporary visas, an attempt ultimately blocked by the Supreme Court.
His administration, with the approval of Republicans in Congress, has poured billions of dollars into immigration enforcement, detaining the parents of an estimated 145,000 U.S. citizen children as of April, and, according to an analysis by nonprofit newsroom The Marshall Project, over 6,200 children. It’s sought to rescind temporary protected status, or TPS, for over 1 million immigrants, tens of thousands of whom have U.S. citizen children, and stalled renewals in the Deferred Action for Childhood Arrivals program, which includes the parents of about 300,000 citizen children.
White House officials say the immigration crackdown benefits American citizens by freeing up resources such as jobs and housing, reducing pressure on public coffers, expelling criminals, and restoring integrity to the immigration system. (Studies have shown that mass deportations harm U.S. workers.) Trump and other Republican leaders have argued that birthright citizenship encourages unauthorized immigration and “birth tourism,” and that TPS has allowed immigrants from “dangerous, third-world countries” to remain in the United States indefinitely under what is supposed to be a temporary program.
In a statement, White House spokesperson Lauren Bis did not directly address whether the administration is concerned about long-term harm to children and increased healthcare costs because of its immigration policies. Instead, she repeated past White House criticisms that President Joe Biden’s immigration policies allowed children to be trafficked across the U.S. border.
“The real story is the psychiatric impact on the tens of thousands of children who were smuggled across the border — many by human and sex traffickers,” she wrote in an email.

Only 39% of Americans approve of Trump’s handling of immigration, according to a recent Associated Press-NORC Center for Public Affairs Research poll.
Stephen Miller, the chief architect of Trump’s immigration policies, has accused the children of immigrants of draining public resources and perpetuating problems from their parents’ home countries. Research, however, shows that immigrants earn more and do better the longer they live in the United States and that they and their children assimilate rapidly. Data also shows they rely less on welfare than native-born Americans.
“This is the great lie of mass migration,” Miller wrote on the social platform X in November. “You are not just importing individuals. You are importing societies. No magic transformation occurs when failed states cross borders. At scale, migrants and their descendants recreate the conditions, and terrors, of their broken homelands.”
The Republican tax-and-spending law enacted last summer curbs immigrant eligibility for health and food assistance programs. And this July, the administration issued new “public charge” rules that give immigration officers broad discretion to deny green cards to lawfully present immigrants if they or family members have used public benefit programs, a move that could result in over a million U.S. citizen children disenrolling from safety net healthcare programs.
Together but Afraid
Separation from parents is traumatic for children and can lead to lifelong health problems, including anxiety, depression, cardiovascular disease, and learning difficulties. Children separated from their parents at the border during the first Trump administration were found to exhibit lasting trauma. Researchers have also tied deportations and detentions of immigrant parents — as well as the threat of them — to widespread emotional trauma, higher school dropout rates, housing instability, and hunger among both immigrant and U.S.-born children.
It’s also costly to society. A 2024 study by federal researchers estimated that health conditions related to childhood trauma accounted for $292 billion in healthcare spending in 2021 alone, including by taxpayer-funded programs such as Medicaid and Medicare.
Emmanuel, a 13-year-old in Oxnard, gets anxious every time his dad goes to work as a farm laborer, his mother, Ana, said. He asks her for reassurance that his father will return, and about what would happen to him if his parents got detained. He tries to hurry Ana up when they’re out in public, worried that ICE could suddenly appear. KFF Health News is not using their full names because they fear deportation.
Doctors and therapists interviewed by KFF Health News said they have observed a notable increase in mental health problems, especially anxiety, in children from immigrant families. Kimberly McNally, a pediatrician at Venice Family Clinic’s Inglewood South La Brea Health Center, said she’s regularly referring children of all ages for mental health services related to fears that their parents will be taken away. At daycares, kids have been showing up with an extra bag in case their parents don’t pick them up, said Liza Davis, advocacy director for Children in Immigrant Families at The Children’s Partnership, which works with a coalition of early childhood educators.
Sometimes, the distress leads young people to take extreme actions. In June, 19-year-old Eliel José took his own life after his father was deported from the Atlanta area to Mexico, according to Univision.
Rosie Harrison, executive director of Grow Initiative GA, a community organization that serves low-income families, said she’s received calls over the past year from immigrant parents seeking help for suicidal and depressed kids. Their situations are often made worse because many lack health insurance and can’t afford to pay for therapy. That’s often because parents have lost jobs that came with health insurance due to worksite raids or because of eligibility changes imposed by the Trump administration.
“I’m concerned about the families that are going to be burying their child,” Harrison said. “I’m concerned that we are going to miss out on having an amazing person do amazing things for our community, for our country, because they took their life.”
Strength Under Pressure
Many children are showing resilience, though.
In a role reversal, some children have become their parents’ protectors. They go grocery shopping and take their younger siblings to school so that their parents don’t have to leave the house.

Giselle Gonzalez, a university student and volunteer with the immigrant protection network VC Defensa in Ventura County, California, said she’ll never forget the morning last summer when she woke up to the sound of kids on bicycles pedaling through her immigrant-heavy neighborhood in Thousand Oaks, yelling “La migra! La migra! Don’t come out!” They’d spotted ICE agents grabbing factory workers and gardeners on their way to work, she said.
Neighbors, community groups, health providers, and others have also stepped up in a variety of ways to support children and families affected by immigration enforcement. They deliver groceries, provide free therapy, walk kids to school, and help parents create emergency childcare plans in case they get detained or deported.
Ultimately, more humane immigration policies and enforcement tactics will be required to end the harm being done to children, academic experts and advocates said.
Researchers at Arizona State University point to a pilot called the Family Case Management Program as a model for keeping families together while also enforcing immigration laws. Launched in January 2016 under President Barack Obama, the program allowed families seeking asylum to remain in the community while awaiting resolution of their cases. Through a case manager, they received support in meeting the obligations of their immigration cases and preparing for deportation if needed. The program, which proved successful and cost-effective, was terminated by the first Trump administration.
At Venice Family Clinic in Los Angeles, case manager Mabel Alavez sees the pressures facing families who are still together but worried they could be separated. Many of the people are parents or grandparents who have been in the U.S. for decades. Some are afraid to take their children to school, the park, or the beach. They ask whether it’s safe to enroll their U.S.-born kids in Medicaid. She helps families who are facing eviction because they’re afraid to go to work and can no longer afford rent. She often helps them create plans for who will look after their children if they get detained.
Raised in an immigrant family herself, Alavez knows how challenging it can be for kids who are first-generation Americans to navigate growing up, going to school, and finding a sense of belonging in a country their parents aren’t from.
“It’s hard for me to imagine how they could possibly do that in addition to what’s going on now,” she said. “I do feel like there will be a big impact on them. What that might look like, I’m not exactly sure.”
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.This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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