KFF Health News senior correspondent Jordan Rau discussed the use of antipsychotic drugs in sedating dementia patients on Michigan Public’s Stateside on Oct. 6.
Céline Gounder, KFF Health News’ editor-at-large for public health, discussed the death of a lab researcher in Russia who was studying the plague on CBS News 24/7’s The Daily Report on Oct. 5.
KFF Health News Georgia correspondent Briah Lumpkins discussed how healthcare costs and other economic challenges are being received by rural voters on WUGA’s The Georgia Health Report on Oct. 2.
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.
From the commute to the dinner table to the last minutes before sleep, the scroll rarely stops. On World Mental Health Day, ETHealthworld explores the toll of screen addiction on young minds, the warning signs to watch for and the small changes that help.
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AiMeD said that while it has always backed trade margin rationalisation for medical devices, the design of any such cap will decide whether it works.
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CHATHAM COUNTY, N.C. — Despite being in one of the nation’s fastest-growing states, this rural county of roughly 85,000 people is still brimming with red foxes, coyotes, white-tailed deer, and wild turkeys.
But in recent months, Enbridge Gas North Carolina’s proposed plans for a natural gas pipeline have exposed how population growth, here and across the nation, is driving a divide between wealthy newcomers and longtime residents.
Chatham has grown into one of North Carolina’s most affluent counties, fueled by an influx of new residents in its northeastern corner. Yet the pipeline would run from Moncure to Siler City, two communities where the per capita income is roughly $25,000 a year, or about half the income typical for the region.
And it’s raising familiar concerns. A 2020 report from the Chatham County Public Health Department stated that “unjust, unfair, and uneven distribution of social and economic resources” in the county, including exposure to environmental hazards, limited people’s “ability to achieve optimal health.”
In September, the Chatham County Board of Commissioners unanimously voted to oppose the project, saying that “protecting public health, safety, environmental resources, and private property rights remains a priority.” The resolution states that the proposed pipeline could affect areas occupied by vulnerable, low-income residents. Under state law, Enbridge could still attempt to take land through eminent domain, and low-income communities affected would have fewer resources available to fight back.
The state Department of Environmental Quality typically would review applications for permits to build a natural gas pipeline. That department has not yet received a permit application for the pipeline, said Onotse Omoyeni, senior press secretary for the office of Gov. Josh Stein. The North Carolina Utilities Commission declined to comment.
Enbridge says the 12-inch-diameter pipeline is needed to meet growing energy demands in the area, including Chatham, where the population has soared 21% since 2016, as well as neighboring Lee County.
Yet the proposed pipeline has set off protests at public meetings and attracted hundreds of people to a Facebook group to express their opposition, many of them small farmers, retirees, or their relatives. They argue the pipeline would pose an environmental threat to wells used for drinking water and expose people in less affluent areas to toxic pollutants that could increase the risks of cancer, preterm births, and asthma — all for the benefit of people who live nowhere near the proposed route.
“Nobody wants to be next to a pipeline,” Dorasue Burns Christian, a retired dental hygienist, told KFF Health News. She said the proposed route cuts across the roughly 22-acre farm where she has lived for more than 50 years. “I’m stressed and I can’t sleep at night. I have been pushed as far as I can be pushed.”
Enbridge Gas North Carolina is a subsidiary of the Canadian energy company Enbridge. Residents point to other communities in which Enbridge has operated — such as Marshall, Michigan; Romeoville, Illinois; and Danville, Kentucky — where oil spills and a natural gas pipeline rupture led to evacuations, injuries, and at least one death.
Enbridge declined an interview request to answer questions about the location of the North Carolina pipeline and the company’s safety record. In a statement, spokesperson Persida Montanez said the pipeline is needed to accommodate population and business growth in Chatham and neighboring Lee County.
A company website says safety will be prioritized during construction and operation, including monitoring, maintenance, and compliance with regulatory rules.
Many residents believe the company is attempting to profit from a proposed data center, which many also oppose. The company website says that Enbridge does not intend to use the pipeline for that purpose and that serving a data center would require a pipeline at least twice the size of the one planned for Chatham.
The pipeline would connect to existing natural gas infrastructure in Siler City and near Moncure, the company said.
Still, pipeline opponents say they are fed up.
“They chose this route because they probably thought people would not fight back,” said Amanda Clark, a protest organizer who grew up in Chatham. Her family roots in the county date to the 1700s. “In rural communities, we are seen as disposable.”
Research shows natural gas pipeline leaks are concentrated in low-income and minority communities where people experience higher rates of poverty and physical disabilities and have fewer means to respond to crises.
Nationwide, there were nearly 2,600 pipeline incidents from 2010 to 2021 that were serious enough that they were required to be reported to the federal government, including fires and explosions that killed 122 people and injured more than 600.
In 2019, one person died and six were injured in Kentucky when an Enbridge natural gas pipeline ruptured, according to a federal government report.
Enbridge reached a $177 million settlement with the federal government after the 2010 oil spills in Michigan and Illinois. In the Michigan spill, a pipeline discharged 1 million gallons of oil into Talmadge Creek, in one of the largest inland oil spills in U.S. history.
“No Pipeline. No Compromise,” read the red T-shirts worn by some of the more than 300 people who attended a Chatham County Board of Commissioners meeting in Pittsboro, North Carolina, in early August. Outside the building, they displayed signs that said “People NOT Pipelines” and “Save Our Farms.”
More than 300 people attended a Chatham County Board of Commissioners meeting in Pittsboro, North Carolina, in early August, many wearing T-shirts to protest a proposed natural gas pipeline. Speakers said they feared the pipeline would pose an environmental threat to the community, including to farms, waterways, and wildlife. (Fred Clasen-Kelly/KFF Health News)
Under North Carolina law, private utilities and pipeline companies can obtain property easements, which give them the right of way to construct, operate, and maintain pipelines without outright taking ownership.
Enbridge will propose the final route for the pipeline based on field surveys, environmental studies, and engineering analysis, Montanez said. “The utility is also focused on delivering safe, reliable natural gas service that supports long-term economic vitality,” Montanez said.
Some residents, like Clark, argue that while the pipeline would power more housing and business development in wealthier parts of Chatham, it would create a public health risk in rural, poorer areas.
Clark, who works as the drug and injury prevention manager for the public health office in nearby Guilford County, said her great-grandparents were full-time farmers and passed down land near Siler City where her grandparents, dad, aunt, and cousin live.
Her grandfather retired from a hosiery mill and farmed part-time. He gave land to his children when they married, Clark said, because it was the only major asset he owned.
Clark said she is now in line to inherit land from her family and wants to protect the legacy of people who worked as farmers, mechanics, and schoolteachers from profit-taking by a company.
“We’re the collateral damage,” Clark said. “It makes people feel like they don’t have value.”
Enbridge Gas has promised to prioritize safety during the construction and operation of a proposed natural gas pipeline in Chatham County, North Carolina. But residents point to other communities in which Enbridge has operated — in Michigan, Illinois, and Kentucky — where government reports say oil spills and a natural gas pipeline rupture led to evacuations, injuries, and at least one death. (Fred Clasen-Kelly/KFF Health News)
A Class Divide
Northern Chatham — which is an easy drive from major universities and Research Triangle Park, home to more than 250 companies — has seen a rush of newcomers.
Many have settled into places like Fearrington Village, a community with boutique shops, gardens, and homes that can cost nearly $1 million. Another master-planned community nearby, Chatham Park, is expected to bring up to tens of thousands of new residents over the next 20 years.
Not far outside the county’s borders are Chapel Hill, home to the University of North Carolina; the state capital of Raleigh, home to North Carolina State University; and Durham, home to Duke University.
As those places have grown more crowded, Chatham has become a cheaper alternative.
But prosperity is fleeting in many parts of the county. A quarter of residents are considered low-income, and on average there are 24 candidates for every job opening, according to a report released this year by the NC Budget and Tax Center.
Christian, an 85-year-old widow who lives a few miles south of Pittsboro, spends her days on her farm, raising hay and caring for chickens, birds, dogs, and cats. She has received letters from Enbridge saying the company wants to survey her property, where she lives with her 66-year-old son, who has a disability.
Christian said she needs money to care for her son and worries that she may one day need to move to a nursing home because of declining health. She said she has been diagnosed with macular degeneration, an eye disease that blurs straight-ahead vision, making it difficult to recognize faces or read.
She had planned to make ends meet by selling multiple parcels of land, but she said potential buyers backed out once they heard about the pipeline. At the Board of Commissioners meeting in August, she pleaded for local officials to try to stop Enbridge.
“They should be ashamed of themselves,” she told KFF Health News. “It’s disheartening. They are stealing from poor 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—an independent source of health policy research, polling, and journalism. Learn more about KFF.
The research paper, titled "Green-light-activated Os(II) metallophotoantibiotics for antibacterial therapy and infected wound healing," presents a promising scientific approach to addressing some of the major challenges in modern healthcare, including antimicrobial resistance, persistent bacterial infections and infected wound healing.
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The Food Safety and Standards Authority of India (FSSAI) said the product was advertised as providing high-protein support for preserving lean muscle during GLP-1/GIP therapies, commonly used in weight-loss treatment.
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LOS ANGELES — Every Tuesday, Naman Shah sees tuberculosis patients at a small public clinic in Los Angeles’ San Fernando Valley. Shah, a physician and epidemiologist at the Los Angeles County Department of Public Health, pores over images of battered lungs, listens to labored breathing, and checks medications.
It’s part of an initiative dating to the early 20th century to control infections so tuberculosis doesn’t spread. “We like doing things upstream,” Shah said, “meaning before they happen, not after the damage is done.”
Today, Shah and his colleagues are applying the same principle to medical debt. A key part of that effort is a new system to allow every hospital in Los Angeles County to easily screen patients for financial aid. The goal: to stop low-income families from getting a bill that buries them in debt.
Shah estimates this system could prevent several hundred million dollars of medical debt every year.
Vicious Cycle
Nationwide, an estimated 100 million adults have some form of healthcare debt. In Los Angeles County, the nation’s most populous, public health officials calculate that about 800,000 residents have medical bills they can’t pay.
“The impacts of medical debt were staggering,” said Shah, who used to staff a rural health clinic in India and, since 2023, has led a county initiative in Los Angeles to tackle the debt problem.
“People end up with credit card debt and then a vicious cycle of high interest rates and poverty,” he said. “People forgo their prescriptions. People forgo appointments. And then you get into worse health.”
Hospitals typically offer financial aid to patients with low incomes. But information about assistance is often hard for patients to get. Applying can be cumbersome. And many eligible patients never seek aid, research shows.
“Most people walk into the hospital and walk out without any knowledge of financial assistance,” said Jared Walker, founder of Dollar For, a nonprofit that helps patients nationwide apply for aid, often called charity care.
That’s fueling debt. It’s also driving costly collection efforts that even hospital officials acknowledge pointlessly target low-income patients who are unlikely to be able to pay.
“They’re turning their wheels trying to collect on debt that isn’t collectable,” said Adena Tessler, regional vice president for the Hospital Association of Southern California.
Naman Shah examines a patient at Monrovia Health Center, a Los Angeles County public health clinic in Monrovia, California. Shah says reducing medical debt in the community will depend on effective prevention strategies, just as stopping the spread of infectious disease does. (Lauren Justice for KFF Health News and Tradeoffs)
(Lauren Justice for KFF Health News and Tradeoffs)
(Lauren Justice for KFF Health News and Tradeoffs)
Presumptive Eligibility
One potential solution is a system that automatically screens and qualifies low-income patients for financial aid without requiring an application. This is called presumptive eligibility.
Some hospitals already use such systems, which rely on software that checks patient eligibility based on publicly available information such as credit history.
The strategy can be very effective. Shah said hospitals that have deployed presumptive eligibility systems have reported as much as a 50% increase in the amount of financial aid they give patients.
Under a state law passed last year, all California hospitals will have to start doing presumptive eligibility screening by next July.
But the systems can be expensive and difficult for smaller hospitals to implement. Only about 1 in 5 hospitals in Los Angeles County currently use them, Shah said.
Public health officials wondered if they could help more hospitals set them up.
The county, which, like many local governments, faces major fiscal challenges, couldn’t pay for this, Shah said. But the public health department could bring together healthcare and hospital officials in the county to figure out another solution.
“The beauty of government is not when it always has to do the work,” Shah said. “We have the ability to make sure that people cooperate.”
The Hospital Association of Southern California, initially wary of the county initiative, came to see improving hospital financial aid programs as beneficial to hospitals, many of which were wasting money on collections. “The billing process is cumbersome and costly,” said Paul Young, a senior vice president with the association.
The association agreed to procure a presumptive eligibility system and make it available to its members. This bulk-purchasing approach, which Young compared to “a Costco model,” would lower the cost for individual hospitals, he said.
At the same time, L.A. Care, a nonprofit health plan that administers Medicaid coverage for more than 2.5 million low-income county residents, committed $2 million to set up the system.
The investment reflected the safety net insurer’s mission to make medical care accessible to more people, said Melanie Fontes Rainer, who leads strategic planning for L.A. Care. “It’s going to make Los Angeles County better,” she said.
Making It Work
Getting the new system up and running by January, as the partners hope, faces challenges.
Hospital officials are figuring out how the system will be funded in the long term. And it’s unclear how many of the county’s 88 acute care hospitals will ultimately use it, even if it’s cheaper and easier to access.
The partners are also working to improve data that the system relies on to screen patients. One goal is to link the system to tax records maintained by the state of California. This would provide hospitals with more accurate information on patients’ income than current systems, which often rely on estimated income.
Walker, the patient advocate at Dollar For, said he’s heartened by the county’s effort. “I’m optimistic that we can make a better charity care system,” he said. “And the fact that hospitals in Los Angeles County are willing to be innovative and creative about ways we can do that is super encouraging.”
For his part, Shah said county public health officials recognize that a better screening system at hospitals won’t by itself eliminate medical debt. But he said the public health department couldn’t ignore a problem that affects more county residents than asthma or tobacco use.
“Prevention is our bread and butter,” he said.
“The impacts of medical debt were staggering,” says Naman Shah, who since 2023 has led a Los Angeles County initiative to tackle the debt problem. (Lauren Justice for KFF Health News and Tradeoffs)
This article is part of “Hidden Help,” an investigative series from Tradeoffs and KFF Health News about how hospitals can protect their patients from the life-altering harms of medical debt.
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.
Russia's health watchdog said on Tuesday that no cases of plague had been detected among anyone who had come into contact with the deceased worker, Darya Shipilova, and a local official said that 60% of those placed in quarantine had been released.
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After President Donald Trump signed the One Big Beautiful Bill Act more than a year ago, enrollment in the federal food assistance program dropped rapidly across the nation as states enforced new restrictions and prepared to take on more of the costs.
Nationally, an estimated 5 million, or 13%, fewer people were enrolled in the Supplemental Nutrition Assistance Program, also known as SNAP or food stamps, this June than in July 2025, when the law was enacted. Louisiana saw one of the most precipitous declines, dropping about 170,000 people, or 21% of state enrollees, according to federal data.
“We haven’t seen a decline of this magnitude in about three decades,” said Joseph Llobrera, senior director of research on food assistance at the left-leaning Center on Budget and Policy Priorities, which did the analysis.
Meanwhile, food prices rose nearly 3% from August 2025 to this August, according to the U.S. Department of Agriculture.
Elected officials, policy analysts, and anti-hunger advocates are pressing Congress to delay provisions in the law that will cut federal funding for food benefits and steeply increase the cost for states. They want to insert the delay in the Farm Bill, which is pending in the Senate.
The provisions required states to start paying for 75% of the cost to operate SNAP on Oct. 1. Previously, the USDA and states split SNAP’s administration cost 50-50.
Beginning in October 2027, some states may also have to cover part of the cost of SNAP benefits that had been paid fully by the federal government. The amount that a state pays toward benefits will depend on its payment error rate, or how often it underpays or overpays enrollees. The higher the error rate, the higher the state’s share of SNAP benefit costs.
In Louisiana, the state may have to cover up to $199 million of the cost for benefits, according to an analysis by the Food Research & Action Center. Its error rate increased from 6.62% in fiscal year 2024 to 8.14% in FY 2025, the most recent data available.
Many states, including Louisiana, have placed pressure on applicants to submit more information more often to verify their eligibility to reduce the state’s payment error rate and limit how much the cost of benefits shifts to the state.
“It’s been a race to drive down those error rates,” Llobrera said.
He said the challenge of implementing new program restrictions and requiring more documentation has increased the burden on applicants and state agencies. The agencies have to process more paperwork on a tight timeline without enough staff. This can increase the likelihood of errors when processing applications, potentially leading to rejection of benefits for more people. It’s also harder for applicants to meet additional verification requirements.
The One Big Beautiful Bill Act expanded work requirements for SNAP, made it harder for states to waive the work requirements, and revoked access for many noncitizens with legal status.
The Louisiana Department of Health did not respond to requests for comment.
Tia Fields, the safety net policy analyst for the nonpartisan Invest in Louisiana think tank, said the cost increase to the state has contributed to two crises: a projected shortfall in the state budget and eligible families’ losing access to help.
In Louisiana, state data shows that 75% of people who lost SNAP from July 2025 to June 2026 did so for procedural reasons. When the program’s strict deadlines for documentation and verification aren’t met, applications and renewals are closed.
Tia Fields, a policy analyst for the nonpartisan Invest in Louisiana think tank, says covering federal cuts to the Supplemental Nutrition Assistance Program will contribute to a shortfall in Louisiana’s state budget. One Big Beautiful Bill Act restrictions on the program could also lead eligible families to lose access to food aid. (Christiana Botic/Verite News and CatchLight Local/Report for America)
Fields said applicants may miss forms and interviews or fail to recertify or report changes in their status. Other times, the problem is on the state’s side. Agency notices may reach applicants past the deadline due to mail delays, they may be sent to the wrong address, or caseworkers may have backlogs in processing paperwork.
“Families are still hungry, and they’re actually eligible for the program,” Fields said. “This is a tax bill that we really cannot afford.”
The additional administrative burden and the financial penalties tied to having a high payment error rate give states an incentive to deny more applications, Llobrera said.
“The pressure that states feel now to really get their error rates down is pushing states to just ask for a lot more verification and more frequently,” Llobrera said.
Anti-hunger advocates say the need for food assistance has increased as barriers to SNAP have grown.
A Steadily Increasing Need
Aaranika Macon and her son received SNAP benefits for more than three years, continuing when she began nursing school last year. But she no longer qualified when she took a job in healthcare. After three months of trying to juggle work and school, her grades started to slip and she quit the job to focus on school.
So she reapplied to SNAP in February but did not receive benefits until April.
“I’m waiting, like, two months with nothing, because I stopped working,” Macon said. “Usually when you fill out, they’ll get back with you in, like, two weeks.”
According to the Food and Nutrition Act of 2008, SNAP-eligible households are required to receive benefits within 30 days of application.
Macon at her home in LaPlace, Louisiana. (Halle Parker/Verite News)
When Macon’s SNAP application was finally processed, she received less assistance than she previously did. She was deemed ineligible as a student, though she’s taking the same number of classes as she did last year when she was considered eligible. In Louisiana, higher education students are eligible for SNAP if they attend school at least half-time and meet other requirements.
Only her 11-year-old son was approved for benefits. Instead of the roughly $500 a month for two people that she received previously, she said, the $298 for her son feeds them both.
She said she had to stretch a $5 balance in her SNAP account over six days at one point this summer.
“I’m in the same position as before the job. So, why is it cut?” Macon said. “You’ve got to fight to communicate with them.”
Lindsay Hendrix, chief impact officer for Second Harvest Food Bank in southern Louisiana, said the organization has seen the need for food increase steadily for several years. Even before the passage of the SNAP changes last year, anti-hunger advocacy group Feeding America documented a 14% increase in food insecurity in Louisiana from 2022 to 2024.
“What we’re seeing is actually that more of our neighbors are coming to the food pantries longer than they used to before,” Hendrix said, and “the frequency of their visits have increased.”
Hendrix said last year’s government shutdown — which halted federal SNAP distributions and left states scrambling to fill the gap — illustrated the necessity of the food assistance program.
“Every politician was like, ‘Oh, just go to your food bank,’” Hendrix said. “And all of us working in food banks just around the country were like, ‘We will run out of food.’”
Instead, some states, including Louisiana, ensured SNAP benefits weren’t disrupted by distributing the benefits themselves until the federal government reopened and the agencies could be reimbursed. Hendrix said food banks complement SNAP and can’t compare with the scale of the program.
“We could not absorb that level of need without that program operating at its best, most effective level,” Hendrix said.
Lindsay Hendrix, chief impact officer for Second Harvest Food Bank in southern Louisiana, says food insecurity in the area has increased and that the organization has seen people visit more frequently than in past years. (Halle Parker/Verite News)
Cushion Against Higher Costs for States
Policy advocates and anti-hunger groups have been pressuring legislators in Congress to amend the latest Farm Bill or appropriations bill to delay any new costs to the states for SNAP by two years.
“We’re asking for every state to be able to have that cushion to try to get their systems in order, lower their error rate, and then give us time to reset, so that we’re not penalized for not yet having a strong enough system in place,” Fields said.
In September, the Senate Committee on Agriculture, Nutrition, and Forestry sent a new Farm Bill to the full Senate that would give states another year before they may have to help pay for SNAP benefits. The cost would shift to — and penalties would be set in — 2028 instead of 2027. The legislation would still require states to start paying more for the cost of administering the program this year starting in October.
Sen. Amy Klobuchar (D-Minn.) and other Democrats on the committee have pushed for a two-year delay.
The committee chair, Republican Sen. John Boozman of Arkansas, told an Arkansas Farm Bureaupodcast in September that he expects negotiations on the bill to continue in October, with the goal of having legislation that can pass the House and Senate by the end of the year.
Anti-hunger advocates say a one-year delay isn’t enough. Jordan Baker, a spokesperson for the Food Research & Action Center, said the financial strain of the impending administrative costs could eventually cause some states to opt out of SNAP altogether. Four states said they might withdraw from or pause the program if they have to start paying for benefits, according to a spring survey by the American Public Human Services Association.
Fields and Hendrix said it’s unlikely that Louisiana would completely drop SNAP. Hendrix said Louisiana’s SNAP program has been understaffed for a long time, straining the state’s ability to administer the program and do community outreach. That’s why Second Harvest’s food banks also help people with their SNAP applications. Fields said she also believes the state Department of Health is doing the best it can under a tight deadline.
“We just have to work out the kinks again,” Fields said. “That’s why we’re asking for that cost shift delay, so that the agency can have the opportunity to get it right and to keep the families fed here in Louisiana.”
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.
The regulator in June ordered makers of high-caffeine beverages sold as "energy drinks" to stop using the description, rejecting the industry's efforts to stall the move in a market expected to be worth $1.6 billion by 2028.
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