Category: Health

  • How brokers gamed the ACA marketplace, roiling subsidy debate in Congress

    How brokers gamed the ACA marketplace, roiling subsidy debate in Congress

    The Florida insurance brokers offered an enticing deal to unemployed and homeless people: Enroll in a Healthcare.gov health plan they weren’t eligible for in exchange for gift cards, food, alcohol, or cash. They coached them to lie about their income to qualify for heavily subsidized coverage, according to court documents. Sometimes they enrolled people without their knowledge.

    A federal jury convicted Cory Lloyd and Steven Strong last month of collecting millions of dollars in commissions between 2018 and 2022 through a widespread plot to defraud the federal insurance marketplace. People earning at least the federal poverty level can get income-based subsidies to help them afford monthly premiums for plans sold through the Affordable Care Act. Under Lloyd and Strong’s scheme, the federal government paid at least $180 million in ineligible subsidies.

    Many more agents and brokers — likely thousands, according to two career staffers at the Centers for Medicare and Medicaid Services, who spoke on the condition of anonymity because they weren’t authorized to speak to press — are gaming the marketplace where 24 million Americans get health insurance.

    Corruption among Healthcare.gov agents and brokers had emerged as a sticking point in Washington as Congress failed to reach a deal to halt the year-end expiration of enhanced subsidies for insurance premiums, which will drive up the cost of plans for millions of Americans. Republicans invoked the fraud to argue against extending the subsidies while Democrats said the solution is better enforcement rather than withholding assistance from Americans who need it.

    Last year, the Biden administration temporarily suspended 850 insurance agents and brokers suspected of fraudulent or abusive conduct. CMS hasn’t terminated any agents or brokers this year — although spokesman Christopher Krepich said the agency has “initiated terminations” even as it sets up stricter enrollment rules for customers amid Administrator Mehmet Oz’s promises to root out fraud.

    Around 100,000 agents and brokers are authorized by Healthcare.gov. They facilitate more than three-quarters of enrollments. For each person enrolled, insurers pay them a small monthly commission, typically between $5 and $20. Florida, where Lloyd and Strong operated, offers the largest commissions in the country, averaging $28 per enrollee, according to the nonpartisan health policy organization KFF.

    A new government report underscored how easy it is to game the marketplace.

    When the Government Accountability Office, which evaluates federal programs and spending, submitted 20 fraudulent applications to Healthcare.gov for coverage this year, 19 were initially approved even though the agency didn’t submit documents requested to prove income, citizenship, and Social Security numbers. The marketplace terminated one enrollee for insufficient documentation. The government is still paying more than $10,000 a month in subsidies for 18 remaining enrollments.

    Investigators also discovered misuse of Society Security numbers — in one case, a single number was used for 125 policies in 2023 — and identified serious shortcomings in how CMS assesses marketplace fraud.

    Stopping marketplace fraud is “not a priority” for CMS, said Seto Bagdoyan, a director at GAO who worked on the report.

    Krepich said the agency has undertaken “a thorough investigation into improper agent and broker activity” and is committed to “ensuring consumers are never enrolled in coverage without their knowledge or consent.”

    Democrats complain the Trump administration is doing little to fix the problem despite its bluster about waste, fraud, and abuse in federal health programs.

    Rep. Lloyd Doggett (Texas), the top Democrat on a subcommittee overseeing CMS, wrote a letter to Oz last week requesting closer scrutiny of the reinstated agents and brokers. “The remedy is not to deny a mother access to care for her sick child,” Doggett said in a statement. “What we need is effective law enforcement.”

    Like brokers for Lloyd and Strong, who did not return requests for comment, many have enrolled people without their knowledge, switched their plan without their consent or created fake enrollments to maximize commissions.

    The GAO concluded that the enhanced subsidies worsened fraud in recent years as bad actors seized upon the beefier assistance to lure new customers. As enrollments on Healthcare.gov skyrocketed under the extra subsidies, fraudulent sign-ups grew too. The Congressional Budget Office estimated those misstating their incomes to get more subsidies nearly doubled from 1.3 million to 2.3 million between 2023 and 2025.

    “We believe that the expansion of the subsidies — which put more money in the pool — invigorated the financial incentive to sign up as many people as possible,” Bagdoyan said.

    The GAO’s findings were among the hurdles to Republicans in Congress agreeing to extend extra subsidies for a marketplace they’ve accused of failing to sufficiently police from bad actors.

    “These findings validate long-standing Republican warnings: Obamacare’s subsidy system lacks even the most basic guardrails and has created an environment where criminals, identity thieves, and unscrupulous brokers can exploit taxpayers with ease,” House Speaker Mike Johnson (R., La.) said in a statement last week.

    Democrats say the proper response isn’t to let the extra subsidies expire but to go after the brokers.

    “I’ve always said any fraud is too much,” said Sen. Ron Wyden (Oregon), the top Democrat on the Senate Finance Committee, which has oversight of healthcare issues.

    Wyden introduced a bill to create new civil penalties for brokers who commit fraud. He said Republicans haven’t signed onto his bill or offered similar measures.

    After receiving hundreds of thousands of complaints about fraud, the Biden administration started requiring customers to hold a three-way call with their broker and the marketplace call center in July 2024. But the new policy left plenty of loopholes, agents told GAO. The rule didn’t apply to new enrollees. And the marketplace took only “limited steps to verify the identity of the consumer on the three-way call,” the report says.

    Oz has been vowing to root out the abuse, slamming the prior administration for rules he said were too lenient and touting stricter enrollment rules CMS released in June. Those rules don’t include any direct, new restrictions on agents and brokers but could indirectly make fraud harder by ending year-round enrollment for people earning less than 150% of the federal poverty level, roughly $23,000 for an individual.

    “The past administration prioritized achieving big program enrollment numbers over protecting program integrity,” Oz said in a video posted recently to X.

    CMS is also preparing to implement stricter verification requirements laid out in Trump’s sweeping tax-and-spending law he signed this summer. That legislation bans the marketplaces from awarding subsidies before verifying a customer’s personal information, including their income and legal status, before awarding any subsidies, which could make it harder for bad actors to sign people up.

  • California biotech BioMarin will pay $4.8 billion for Amicus Therapeutics, a rare-disease company with a presence in Philadelphia

    California biotech BioMarin Pharmaceutical Inc. will pay $4.8 billion in cash for Amicus Therapeutics, a Princeton rare-disease company with a presence in Philadelphia, the two publicly traded companies announced Friday.

    The acquisition of Amicus, expected to be completed in the second quarter of next year, will give BioMarin treatments for rare genetic diseases that generated $599 million in revenue over the last 12 months, according to BioMarin, which is based in the San Francisco Bay Area.

    Amicus has a treatment for Fabry disease, which is caused by a genetic mutation that allows fatty waste to build up in the body, damaging tissues and organs, according the BioMarin. The second treatment is for late-onset Pompe disease, which is an inherited genetic condition that causes muscle weakness that worsens over time.

    BioMarin CEO Alexander Hardy said on a webcast about the deal that both of those treatments have the potential to reach $1 billion in global sales. BioMarin had $2.85 billion in revenue last year, compared to $528 million at Amicus.

    The Philadelphia tie

    In 2019, Amicus established its Global Research and Gene Therapy Center of Excellence at 3675 Market St. in University City, saying at the time that the facility would employ 200 people eventually. The company’s website now lists the location as its Research Center of Excellence.

    Amicus now has 12 people in its Philadelphia office, a spokesperson said Friday.

    The company laid off 35 people working in research and development in 2022 after terminating plans for a gene therapy spinoff, according to Fierce Biotech.

    The University of Pennsylvania’s Gene Therapy Center under researcher Jim Wilson drew Amicus to Philadelphia from central New Jersey, where the company was then based in Cranbury. Penn has since spun out Wilson’s center into two for-profit companies, Gemma Biotherapeutics and Franklin Biolabs.

    John Crowley, chief executive of Amicus at the time, liked to call Philadelphia the “Cradle of Cures,” a name that hasn’t stuck. Crowley is now president and CEO of the Biotechnology Innovation Organization (BIO), a biotech trade organization in Washington.

  • One year of inspections at Fox Chase Cancer Center: November 2024 – October 2025

    One year of inspections at Fox Chase Cancer Center: November 2024 – October 2025

    Fox Chase Cancer Center was not cited by the Pennsylvania Department of Health for any safety violations between November 2024 and October of this year.

    Here’s a look at the publicly available details:

    • Feb. 21, 2025: Inspectors came to investigate a complaint but found the hospital was in compliance. Complaint details are not made public when inspectors determine it was unfounded.
    • March 17: Inspectors came to investigate a complaint but found the hospital was in compliance.
    • April 15: The Joint Commission, a nonprofit hospital accreditation agency, renewed the hospital’s accreditation, effective January 2025, for 36 months.
  • CHOP faces threat as Trump administration proposes rules to stop gender-affirming care for minors

    CHOP faces threat as Trump administration proposes rules to stop gender-affirming care for minors

    President Donald Trump’s administration proposed a sweeping set of rules Thursday designed to prevent hospitals from providing gender-affirming care to minors, a move that could have consequential implications for Children’s Hospital of Philadelphia.

    CHOP runs one of the nation’s largest clinics providing medical care and mental health support for transgender and gender-nonbinary children and teens and their families. Each year, hundreds of new families seek care at CHOP’s Gender and Sexuality Development Program, created in 2014. The information of CHOP patients who have sought gender-affirming care had been the target of a recent unsuccessful lawsuit from the Trump administration.

    The proposals constitute the most significant moves the administration has taken to restrict the use of puberty blockers, hormone therapy, and surgical interventions for transgender people under the age of 18 — including cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children and prohibiting federal Medicaid dollars from being used to fund such procedures.

    “This is not medicine, it is malpractice,” Health Secretary Robert F. Kennedy Jr. said, referring to gender-affirming procedures, at a news conference Thursday. “Sex-rejecting procedures rob children of their futures.”

    CHOP, like most other hospitals in the country, participates in both Medicare and Medicaid.

    CHOP declined to comment Thursday.

    The renowned pediatric hospital treats children and teens with gender dysphoria — a medical condition in which a person’s body does not match their gender identity. Its doctors prescribe hormone therapy and puberty blockers.

    The American Academy of Pediatrics and other major medical associations, citing research, widely accept such medications as safe, effective, and medically necessary for the patients’ mental health.

    CHOP has said its doctors do not prescribe any medication before its patients undergo extensive medical and psychological evaluations.

    Gender-affirming care is legal in Pennsylvania, and states, not the federal government, regulate medicine and doctors.

    But Trump has sought to criminalize this care for minors, saying doctors are engaged in “chemical mutilation,” akin to child abuse, and he has called the research “junk science.”

    Just days into his second term in office, the president issued an executive order titled “Protecting Children from Chemical and Surgical Mutilation,” which contains inflammatory and misleading descriptions of largely medically approved transgender care. Kennedy has followed the president’s lead, signing a declaration Thursday rejecting these procedures.

    Other actions proposed Thursday include the U.S. Food and Drug Administration issuing warning letters to 12 manufacturers and retailers for what an HHS news release claims to be “illegal marketing of breast binders to children for the purposes of treating gender dysphoria.”

    The court battle over gender care for minors

    In June, the U.S. Department of Justice issued subpoenas to CHOP and at least 19 other hospitals that treat transgender youth as part of an investigation into possible healthcare fraud. The federal subpoenas demanded patient medical records, including their dates of birth, Social Security numbers, and addresses, as well as every communication by doctors — emails, voicemails, and encrypted text messages — dating back to January 2020.

    The subpoenas touched off a wave of legal battles that continue to play out. Several hospitals around the country, including CHOP, filed motions asking federal judges to block the release of private patient information.

    So far, federal judges in Philadelphia, Boston, and Washington state have sided with the hospitals, ruling the subpoenas were politically motivated.

    In Philadelphia, U.S. District Judge Mark A. Kearney last month determined that the “privacy interests of children and their families substantially outweighs the department’s need to know” such confidential and sensitive information. The federal government has 60 days to appeal the Nov. 21 ruling.

    In September, patients and their parents joined the legal fight to limit the scope of the subpoenas issued to CHOP and UPMC Children’s Hospital of Pittsburgh. The Philadelphia-based Public Interest Law Center (PILC) filed separate but similar legal relief on behalf of families with children and teens who have received gender-affirming care at CHOP and in Pittsburgh.

    The federal judge presiding over the Pittsburgh hospital’s case has yet to issue a ruling. Earlier this week, however, DOJ lawyers said they are willing to accept redacted medical records. They argued that would solve the dispute over patient privacy rights.

    On Thursday, Mimi McKenzie, PILC’s legal director, said the center “strongly disagrees” and would fight the release of redacted medical records.

    “These records are so deeply personal and contain such highly sensitive information about these young patients,” McKenzie said. “There is no anonymization or redaction that can protect their privacy interests.”

    McKenzie said the proposed federal rule to ban all federal funding to hospitals that treat transgender youth would “face a myriad of legal challenges.” She described gender-affirming care as “lifesaving” for many children.

    “The notion that our federal government would tell hospitals to pick which children you want to save — the children who need gender-affirming care or all the other children — is despicable. The cruelty of this administration knows no bounds.”

    Other institutions have recoiled in the face of the Trump administration’s threats.

    Earlier this year, Penn Medicine and Penn State Health cut back gender-affirming care for youth. Nemours Children’s Hospital in Delaware and UPMC Children’s Hospital of Pittsburgh announced they will no longer provide gender-affirming care beyond behavioral health services to new patients.

    All cited fear of federal funding cuts.

  • Drexel University signed a lease to consolidate medical college research in University City

    Drexel University signed a lease to consolidate medical college research in University City

    Drexel University has signed a lease that will enable it to consolidate its College of Medicine research labs in University City, Drexel and the developers of a new building at 3201 Cuthbert St. said Thursday.

    Drexel’s space in the $500 million building, a joint project from Gattuso Development Partners and Vigilant Holdings, is slated for completion in 2027. Drexel researchers moving from sites in Center City and East Falls are expected to fill four floors of the structure.

    “By bringing our research spaces together in University City, we will create an environment that fosters greater interdisciplinary collaboration, accelerates innovation, and strengthens our collective capacity for discovery,” Drexel president Antonio Merlo said in a message to the school community.

    Drexel will occupy 150,741 square feet of the 11-story, 520,000-square-foot building. The developers’ goal is to fill the rest of the building with life sciences tenants, though that could be harder than it was in 2022, when the building was announced as a partnership between Drexel and Gattuso Development.

    The move of research labs to University City is part of a long-term plan to centralize the Drexel College of Medicine, which includes the combined operations of the former Hahnemann Medical College in Center City and the former Medical College of Pennsylvania in East Falls.

    In 2023, most of the medical school’s administrative and academic functions moved to Drexel’s Health Sciences Building at 60 N. 36th St.

  • Trump administration moves to cut off transgender care for children

    Trump administration moves to cut off transgender care for children

    WASHINGTON — The U.S. Department of Health and Human Services on Thursday unveiled a series of regulatory actions designed to effectively ban gender-affirming care for minors, building on broader Trump administration restrictions on transgender Americans.

    The sweeping proposals — the most significant moves this administration has taken so far to restrict the use of puberty blockers, hormone therapy, and surgical interventions for transgender children — include cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children and prohibiting federal Medicaid dollars from being used to fund such procedures.

    “This is not medicine, it is malpractice,” Health Secretary Robert F. Kennedy Jr. said of gender-affirming procedures on children in a news conference on Thursday. “Sex-rejecting procedures rob children of their futures.”

    Kennedy also announced Thursday that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the definition of a disability.

    In a related move, the Food and Drug Administration issued warning letters to a dozen companies that market chest-binding vests and other equipment used by people with gender dysphoria. Manufacturers include GenderBender LLC of Carson, Calif., and TomboyX of Seattle. The FDA letters state that chest binders can only be legally marketed for FDA-approved medical uses, such as recovery after mastectomy surgery.

    Proposed rules would threaten youth gender-affirming care in states where it remains legal

    Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have adopted laws restricting or banning the care. The Supreme Court’s recent decision upholding Tennessee’s ban means most other state laws are likely to remain in place.

    Thursday’s announcements would imperil access in nearly two dozen states where drug treatments and surgical procedures remain legal and funded by Medicaid, which includes federal and state dollars.

    The proposals announced by Kennedy and his deputies are not final or legally binding. The federal government must go through a lengthy rulemaking process, including periods of public comment and document rewrites, before the restrictions becoming permanent. They are also likely to face legal challenges.

    But the proposed rules will likely further intimidate healthcare providers from offering gender-affirming care to children and many hospitals have already ceased such care in anticipation of federal action.

    Children’s Hospital of Philadelphia recently went to court to prevent the Trump administration from obtaining the private medical records of youth who sought gender-affirming care.

    Nearly all U.S. hospitals participate in the Medicare and Medicaid programs, the federal government’s largest health plans that cover seniors, the disabled and low-income Americans. Losing access to those payments would imperil most U.S. hospitals and medical providers.

    The same funding restrictions would apply to a smaller health program when it comes to care for people under the age of 19, the State Children’s Health Insurance Program, according to a federal notice posted Thursday morning.

    Moves contradict advice from medical organizations and transgender advocates

    Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, on Thursday called transgender treatments “a Band-Aid on a much deeper pathology,” and suggested children with gender dysphoria are “confused, lost, and need help.”

    Polling shows many Americans agree with the administration’s view of the issue. An Associated Press-NORC Center for Public Affairs Research survey conducted earlier this year found that about half of U.S. adults approved of how Trump was handling transgender issues.

    Chloe Cole, a conservative activist known for speaking about her gender-transition reversal, spoke at the news conference to express appreciation. She said cries for help from her and others in her situation, “have finally been heard.”

    But the approach contradicts the recommendations of most major U.S. medical organizations, including the American Medical Association, which has urged states not to restrict care for gender dysphoria.

    Advocates for transgender children strongly refuted the administration’s claims about gender-affirming care and said Thursday’s moves would put lives at risk.

    “In an effort to strongarm hospitals into participating in the administration’s anti-LGBTQ agenda, the Trump Administration is forcing health care systems to choose between providing lifesaving care for LGBTQ+ young people and accepting crucial federal funding,” Jamila Perritt, a Washington-based OB/GYN and president and CEO of Physicians for Reproductive Health, said in a statement. “This is a lose-lose situation where lives are inevitably on the line. “

    Rodrigo Heng-Lehtinen, senior vice president at The Trevor Project, a nonprofit suicide prevention organization for LBGTQ+ youth, called the changes a “one-size-fits-all mandate from the federal government” on a decision that should be between a doctor and patient.

    “The multitude of efforts we are seeing from federal legislators to strip transgender and nonbinary youth of the health care they need is deeply troubling,” he said.

    Actions build on a larger effort to restrict transgender rights

    The announcements build on a wave of actions President Donald Trump, his administration and Republicans in Congress have taken to target the rights of transgender people nationwide.

    On his first day in office, Trump signed an executive order that declared the federal government would recognize only two immutable sexes: male and female. He also has signed orders aimed at cutting off federal support for gender transitions for people under age 19 and barring transgender athletes from participating in girls’ and women’s sports.

    On Wednesday, a bill that would open transgender health care providers to prison time if they treat people under the age of 18 passed the U.S. House and heads to the Senate. Another bill under consideration in the House on Thursday aims to ban Medicaid coverage for gender-affirming care for children.

    Young people who persistently identify as a gender that differs from their sex assigned at birth are first evaluated by a team of professionals. Some may try a social transition, involving changing a hairstyle or pronouns. Some may later also receive hormone-blocking drugs that delay puberty, followed by testosterone or estrogen to bring about the desired physical changes in patients. Surgery is rare for minors.

  • ChristianaCare and Virtua Health have ended merger talks

    ChristianaCare and Virtua Health have ended merger talks

    ChristianaCare and Virtua Health have ended merger negotiations that would have created a healthcare system with more than $6 billion in annual revenue and business in four states, the two nonprofits announced Thursday.

    The nonprofits, the largest in South Jersey and the largest in Delaware, had disclosed a preliminary agreement to join forces in July. ChristianaCare and Virtua did not share specific reasons for dropping the idea.

    They issued identical statements: “After thoughtful evaluation, both organizations have determined that they can best fulfill their missions to serve their communities by continuing to operate independently.”

    It wasn’t obvious to industry insiders what advantages combining the two systems would have brought other than more revenue and the potential for some relatively small savings from greater scale.

    Both systems are financially solid. Virtua has a AA- credit rating from Standard & Poor’s. The S&P rating for ChristianaCare is two notches higher, at AA+.

    They have been expanding on their own.

    Virtua acquired Lourdes Health System in New Jersey in 2019, and is now spending hundreds of millions to renovate two of its hospitals.

    ChristianaCare explored an acquisition of Crozer Health in 2022, but decided not to go through with the deal. It won a May bankruptcy auction with a $50.3 million bid to assume Crozer leases at five outpatient locations in Delaware County. It has since opened 15 medical practices at those locations.

    ChristianaCare previously acquired the shuttered Jennersville Hospital in Chester County and turned it into a micro-hospital. It plans two more micro-hospitals for Delaware County.

    The five-hospital Virtua system had $3.24 billion in revenue last year. ChristianaCare, with three full-scale hospitals, had $3.3 billion in revenue in the year that ended June 30, 2025.

  • The nursing crisis has a cure — and it begins in the classroom | Expert Opinion

    The nursing crisis has a cure — and it begins in the classroom | Expert Opinion

    The nation’s nursing shortage is straining hospitals, clinics, and long-term care facilities. Yet as this well-known crisis reaches a critical point, a quieter one threatens to make it worse: the growing shortage of nursing faculty. Without enough educators to train the next generation of nurses, efforts to expand the nursing workforce will fall short.

    A survey by the American Association of Colleges of Nursing last year found nearly 1,700 faculty vacancies in 808 schools nationwide. As a result, thousands of capable and motivated future nurses are turned away each year — not for lack of talent or drive, but because nursing schools do not have enough faculty to educate them. In 2024, more than 65,000 qualified applicants were not accepted into entry-level undergraduate nursing programs nationally. Expanding the educator pipeline is a critical piece of the solution to issues such as understaffing at hospitals and burnout among nurses facing increasing workloads.

    But building up the nursing faculty ranks involves challenges unique to academia. Many nurses pursue the doctoral education needed to become professors later in their careers, after years of clinical work. Those who do pursue doctoral degrees often have to reduce work hours, resulting in less income, and they have limited access to financial support for their education or loan repayment programs.

    Then nurses who go into teaching typically earn significantly less. Practicing nurses can earn up to $40,000 to $50,000 more annually than those in academia. Given this pay gap, and heavy teaching loads and administrative duties for faculty at nursing schools, it is no surprise that many nurses choose the bedside over the classroom.

    The Bureau of Labor Statistics predicts a steady 6% annual growth in nursing jobs through 2033 — meaning nearly 200,000 new nurses will be needed each year. We simply can’t graduate enough new nurses if there aren’t enough qualified faculty to educate them.

    Another growing challenge is the shortage of clinical placements — essential hands-on experiences through which nursing students train. Today, healthcare systems are accepting fewer nursing students for clinical training than they did a decade ago, when educating the next generation was seen as an institutional responsibility. One reason is that healthcare organizations now employ many nurses who are new to practice themselves and may not feel prepared to precept students. There’s also more pressure on healthcare organizations to focus on financial efficiency, with providers caring for more patients to generate more revenue.

    This has left hospital nurses and physicians increasingly reluctant to serve as preceptors — mentors who guide nursing students during clinical rotations. Facing intense pressure to meet productivity targets, they worry that mentoring students will slow down patient care, impacting them financially. This shortage of preceptors makes it challenging for students to complete the clinical hours required to graduate.

    To address this concern, several Philadelphia-area nursing deans, including myself, are advocating for policy changes that could attract more physicians and nurses to serve as clinical preceptors. We’re meeting with Pennsylvania state leaders in Harrisburg to lobby for tax incentives adopted successfully in several states, such as to provide $2,000 to $3,000 in annual tax relief directly to the nurses, and sometimes the institution, as an incentive to address preceptor shortages.

    Simulation learning centers offer another promising strategy to give nursing students hands-on experience without always needing bedside placements. But to truly move the needle on the nursing shortage, universities must also support and invest in educators. At Villanova University, we’re trying to innovate with programs such as the Conway Scholars Program — an accelerated PHD program in which scholars are prepared for and commit to nursing education positions upon completion. This program is unique because students are supported financially to complete the training within three years, in contrast with the typical four-to six-year trajectory.

    To patients, the nursing shortage may mean longer time spent in the waiting room and slower care at the bedside. But for those of us in healthcare education, it signals a looming crisis that threatens patient outcomes. We must act now.

    Donna S. Havens, PhD, RN, FAAN is the Connelly Endowed Dean and Professor at Villanova University’s M. Louise Fitzpatrick College of Nursing. She is a registered nurse and health services researcher focusing on nurse workforce issues.

  • What happened when Dr. Oz took charge of a wonky health agency

    What happened when Dr. Oz took charge of a wonky health agency

    BALTIMORE — Dr. Oz, mouth full of quinoa, paused midbite.

    He motioned a nearby videographer to a spot behind the tent where he and celebrity chef Geoffrey Zakarian sat tasting entries in a staff cooking competition. It was a better angle to capture dozens of employees watching them in the Centers for Medicare and Medicaid Services headquarters parking lot that August day.

    The famous television doctor Mehmet Oz hasn’t left the stage. He has found a new one as he runs the federal agency that spends $1.5 trillion a year and oversees health insurance for almost half of all Americans. Instead of a New York City studio, Oz spends his time in drab government buildings. But Oz says his ability to reach people is why President Donald Trump wanted him for the job.

    “He’ll say, ‘Oz, he was good on TV. It’s a good sign if you’re on TV because it means people can listen to you and you’re making sense to them,’” he said in his first wide-ranging interview as CMS administrator.

    Oz’s ability to reach an audience is undisputed. But he now faces a test of whether showmanship and affability can win over public support as he guides major Medicaid changes, oversees soaring costs of Affordable Care Act plans, and contends with the nation’s chronic malady: paying exorbitant prices for mediocre results.

    The issues Oz confronts are among the wonkiest in the federal government, with the lives of millions of Americans at stake. His ability to communicate and charm has earned him praise, even from critics skeptical of a man once summoned before senators for hawking “magic” weight loss from a coffee bean extract. Some of his predecessors under Democratic presidents, with whom he regularly consults, and many at the CMS and in the health industry say he has displayed policy expertise and been effective at boosting morale at his agency.

    “I’ve been impressed,” said Andy Slavitt, who was CMS acting administrator under President Barack Obama. “He’s taken it very seriously.”

    Oz’s name still provokes eye rolls among some health advocates and Democrats. “Nobody who’s serious in this country takes Dr. Oz seriously,” House Minority Leader Hakeem Jeffries (D-N.Y.) recently said.

    Critics also say Oz brings with him concerns about his investments into companies that could be regulated by the agency he leads, such as those offering drug discounts, supplements, and AI health technology.

    The renowned heart surgeon is better known for his pageantry during 13 seasons of “The Dr. Oz Show,” where he told viewers how to eat more protein or handle menopause. He’s the only administrator since CMS was established in 1977 with no experience in health policy or economics. His only foray into politics was a failed Pennsylvania Senate bid in 2022.

    Oz acknowledges that his ascent from television star to the head of a highly technical government agency is surprising. “Of all people, what?” Oz said.

    Oz’s central role in implementing cuts to public insurance programs and defending his polarizing boss, Health Secretary Robert F. Kennedy Jr., has drawn sharp criticism.

    “Maybe he makes funny jokes and he’s a good hang,” said Sen. Chris Murphy (D-Conn.), a longtime member of the Senate Health, Education, Labor, and Pensions Committee. “That doesn’t mean that what he’s doing isn’t pure evil.”

    Yet some policy experts said that compared to the tumultuous layoffs, leadership turmoil, and infighting at the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health, Oz’s agency appears less chaotic — at least so far.

    “Out of all of those agency leaders, I think Oz is probably doing the best,” said a former Biden administration health official, who spoke on the condition of anonymity to speak candidly.

    From surgeon to celebrity to CMS

    Oz is used to career makeovers.

    The pioneering cardiac surgeon launched his eponymous show in 2009. On it, he sometimes leaned into the sensational, undergoing a colonoscopy on-screen and entertaining unproven ideas, including that cellphones cause cancer and zodiac signs influence health traits.

    But Oz centered the show on the notion that people should control their health through diet and exercise — a precursor to Kennedy’s Make America Healthy Again movement. He explored how poor gut health and chronic inflammation could cause disease, an idea affirmed in peer-reviewed studies. He urged viewers to stop eating processed foods and promoted bone broth and Greek yogurt.

    “The MAHA movement was that on steroids,” he said.

    In 2016, Trump went on Oz’s show during his presidential campaign to release a letter from his doctor attesting to his health. Six years later, Trump’s endorsement helped Oz win the Republican nomination to run for an open Senate seat in Pennsylvania, though he lost to Democrat John Fetterman.

    Oz’s connection to Kennedy goes back even further to a 2010 clean water event in Utah where they skied together. He interviewed Kennedy in 2014 on his show about potential dangers from the vaccine preservative thimerosal, which scientists have deemed safe. During the segment, Oz told pregnant women to take a thimerosal-free nasal flu shot instead.

    After Kennedy ended his independent presidential bid to endorse Trump last year, he and Oz threw Trump a fundraiser at Oz’s Pennsylvania home. Oz regularly hosted Kennedy at his Palm Beach, Fla., home as they awaited Senate confirmation.

    As Oz tells it, health insurance is “a bit of an away game” for Kennedy. Shortly after the November election, Oz recalls Kennedy saying he was really excited about every part of running HHS — except for the highly technical health insurance programs under CMS’s purview.

    ‘That crazy guy from TV’

    After Oz took the helm of CMS, some questioned whether he would be up for learning its soporific machinery — a job that requires drilling into such doze-inducing terminology as medical loss ratio and bundled payments.

    “There was a fair amount of skepticism among people in the beginning, like, Dr. Oz, he’s that crazy guy from TV,” said CMS deputy administrator Kim Brandt, a Trump appointee who worked at the agency during his first term.

    Oz, who has medical and business degrees from the University of Pennsylvania, said he has “always been a bit of a wonk” on health policy and enjoys thinking about how the health system works as a whole.

    “He’ll sit and talk to you about something like surety bonds for 30 minutes,” said Brandt, whom Oz has dubbed “Kimba.”

    He said he started compiling a health policy “bible” for himself as soon as he learned he would be nominated, calling past CMS leaders to learn how the agency works. He has talked many times to Slavitt and Chiquita Brooks-LaSure, who was CMS administrator under President Joe Biden.

    And he surrounded himself with deeply experienced senior staff and worked to prevent infighting.

    “Don’t waste time on battles that drain you of chi,” he said.

    He has been steering the agency in its own wonky way toward Kennedy’s goals of reducing chronic illness, finalizing a Medicare payment rule in October aimed at nudging doctors away from surgeries and toward prevention.

    Rep. Richard E. Neal (Massachusetts), the Democratic leader on a committee overseeing health agencies, said he viewed Oz as a moderating force after lawmakers on his panel met with the administrator over the summer.

    “He didn’t come across as being radical,” Neal said. “Largely because he’s a real scientist, a real doctor.”

    Oz is also by far the richest person in recent history to run CMS, with a net worth between $100 million and $300 million, according to a review of his financial disclosures and previous administrators’ backgrounds. His past financial ties — and the millions he has invested in health insurers, pharmaceutical companies, and other health firms — raise questions about how deeply he has profited from industries he now regulates.

    He previously advised Eko Health, a company whose AI-enabled heart monitoring device CMS recently approved for funding amid a broader embrace of AI health technology. A CMS spokesperson didn’t explicitly answer whether Oz recused himself from the decision but said he “abided by all of his recusal obligations.”

    Last year he co-founded ZorroRX with his son, Oliver, which aims to profit from a drug discount program overseen by a separate branch of HHS — but which could move to CMS under a pending restructuring plan.

    Oz said he has divested all of his holdings in healthcare. “There’s not a single thing left in my portfolio which I have any involvement in,” he said.

    But Oz also said he transferred his holdings in ZorroRX to a trust managed by Oliver, who is still involved in the company.

    Oz also held millions of dollars of stock in iHerb, a wellness company that sells direct-to-consumer folinic acid supplements and other products. At a news conference on autism in September, Oz, along with Trump and Kennedy, praised leucovorin, a highly concentrated folinic acid medication requiring a prescription, as an effective treatment. HHS stressed in an X post that they are different products, after critics questioned on social media whether Oz stood to profit.

    CMS spokesman Christopher Krepich said Oz complied with government ethics rules in divesting his ZorroRX and iHerb holdings, but Krepich did not answer whether he transferred his iHerb stock to his son or another relative.

    Selling GOP policies

    Establishing new Medicaid rules under Trump’s sweeping domestic policy law and selling them to the public poses one of Oz’s steepest challenges. The law, estimated to cut Medicaid spending by $911 billion over a decade, has alarmed Democrats and healthcare advocates, who say millions will be harmed by its work requirements, cuts to states’ funding. and new barriers to enrolling.

    Oz emerged as one of the Trump administration’s top advocates for the changes, repeatedly dismissing projections by the nonpartisan Congressional Budget Office that 10 million more people will be uninsured under it.

    He has been assuring states that tapping into better health technology will help limit coverage losses, touting plans for a CMS app for Medicaid beneficiaries to quickly report to states how many hours they worked, volunteered, or attended school in a given week to qualify for the insurance.

    Oz rarely gives a speech without championing health technology, painting a picture of how it can improve care. He revealed in July that CMS would partner with Google and other tech companies in a “digital health ecosystem” to ease sharing of health information.

    Slavitt, the CMS administrator under Obama, said in their conversations Oz tells him about leveling the playing field for “insurgent” smaller tech innovators to compete with “incumbent” healthcare giants such as Epic or UnitedHealthcare.

    Oz has also played defense on another hot-button issue vexing Democrats: the expiration of pandemic-era enhanced subsidies for insurance plans sold through the Affordable Care Act, which sparked the longest government shutdown in history. Millions of Americans will have to pay hundreds or thousands more for monthly premiums after the extra subsidies expire Dec. 31.

    Oz has stressed the subsidies were always meant to be temporary and noted they prompted more fraud in the marketplaces.

    “It’s hard to disentangle Oz with the actions of the Trump administration broadly,” said Anthony Wright, executive director of Families USA, a consumer healthcare advocacy organization. “He is a main point person for many of the policy changes to make it harder to get on and stay on coverage.”

    Oz has walked a fine line, supporting Trump and Kennedy but sometimes smoothing over controversial things they say.

    Oz said it’s unfair to call Kennedy, the founder of an anti-vaccine group, “anti-vax” because he questions vaccine safety. He shares Kennedy’s view that the medical establishment has been too reticent to adjust to new evidence.

    “That’s one of the hardest things to do in medicine: change your mind,” he said.

    But as Kennedy built a career around vaccine skepticism, Oz hewed more closely to the experts. As Kennedy slammed the coronavirus shots, Oz told his viewers to get them. Unlike its sister agencies, CMS hasn’t pulled back on vaccines other than lifting a requirement that hospitals report COVID vaccinations among staff.

    When Trump claimed an unproven link between Tylenol and autism, Oz adopted a more measured tone.

    After the president repeatedly told pregnant women to avoid Tylenol, Oz told Newsmax that “of course” pregnant women should take Tylenol for a high fever if a doctor tells them to. On “TMZ Live,” he said Tylenol may be the “best option” for fighting lower-grade fevers during pregnancy.

    Charming his audience

    But Oz has a more basic goal than playing defense for his bosses. He said his chief aim is to improve outreach to people enrolled in Medicare and Medicaid.

    “The most important accomplishment at CMS — if I can pull it off — is to talk to our customers,” Oz said.

    He finds the Medicare enrollment booklets “dense” and wants to reach more seniors with an email newsletter instead. He made videos with Martha Stewart and Tony Robbins discussing aging. He pretended to call the Medicare hotline to enroll the day after his 65th birthday.

    A team of photographers and videographers often tails him, ready if he has a spontaneous idea for a social media post.

    Several hours after the cooking competition, Oz trekked to a roomy basement studio on the CMS campus to record videos promoting Medicare and marketplace enrollment.

    Standing in front of a green screen, he launched into the first line as though introducing his show: “Medicare open enrollment is coming in hot.”

    For a final video, he removed his jacket to demonstrate yoga moves for seniors.

    Oz wants his staff to embrace this camera-ready strategy too. Medicare director Chris Klomp recounted running late at night when Oz called him to coach him on a media appearance.

    “He believes in the ‘Fox & Friends’ model,” Klomp said, referring to the morning TV show that regularly features three hosts. “It shouldn’t just be the Oz show.”

    Four CMS career staffers said he has been good for morale and more visible than past administrators, although some of them have misgivings about Kennedy and Trump.

    He attended an employee Zumba class. Last spring, he was “mobbed” by staff during a lunchtime walk around the Baltimore campus, according to Dora Hughes, a career staffer who directs the CMS Center for Clinical Standards & Quality. Oz held a competition over the summer to see who could clock the most steps. He offered tips for “crushing cubicle cravings” during the holiday season as part of a regular agency update e-mailed to staff. “You don’t have to try every cookie on the cookie table,” he wrote.

    As he browsed a farmers market in the CMS parking lot in August, a woman giggled as he donned her bright red glasses and posed with her for a photo. Born to Turkish immigrants, he spoke to another woman in Turkish.

    Oz is “hard not to like,” said one CMS career employee who spoke on the condition of anonymity because they were not authorized to speak to reporters.

    “Part of me thinks it’s a facade,” the employee said. “And part of me thinks it’s a little reassuring.”

    Rebecca Adams contributed to this report.

  • FDA panelists questioned antidepressants in pregnancy. But doctors call them a lifeline.

    FDA panelists questioned antidepressants in pregnancy. But doctors call them a lifeline.

    If you are pregnant or a new mother who is struggling with depression or anxiety, you can call or text the National Maternal Mental Health Hotline, 24/7: 833-TLC-MAMA (833-852-6262). Postpartum Support International can help connect you with a local mental health provider at 800-944-4773 or psidirectory.com.

    Before giving birth to her second child, Heidi DiLorenzo was anxious. She worried about her blood pressure, and the preeclampsia that prompted her to be hospitalized twice during the pregnancy. She worried that some terrible, unnamed harm would come to her 3-year-old daughter. She worried about her ability to love another baby as much as she loved her first.

    But DiLorenzo, an attorney in Birmingham, Ala., did not worry about taking Zoloft. She had used the medication to treat anxiety before she had her first child, and she continued it throughout that pregnancy and this latest one.

    And since having her second daughter, in September, she credits an increased dosage with pulling her out of the “dark hole” of sadness she felt postpartum. “I wouldn’t be as good of a mom to my girls if I didn’t take it,” DiLorenzo said. “I wouldn’t have the energy.”

    She is among the estimated 20% of women in the U.S. who have depression or anxiety during or after pregnancy. Yet only half of those mothers receive adequate treatment, according to Kay Roussos-Ross, who runs the perinatal mood disorders program at the University of Florida. And just 5% take a selective serotonin reuptake inhibitor, a class of medications commonly used to treat both conditions.

    Now medical experts are concerned that a July panel discussion convened by the Food and Drug Administration could lead to more cases of untreated depression. Many of the 10 members of the panel expressed concern about the use of SSRIs, such as Zoloft, during pregnancy. They included Josef Witt-Doerring, a psychiatrist who owns clinics aimed at helping people wean themselves off antidepressants, and Adam Urato, an OB-GYN who recently petitioned the FDA to put stronger warnings on SSRIs.

    While the discussion did not represent any official FDA guidance, the panelists — in claims the American College of Obstetricians and Gynecologists called “outlandish and unfounded” — linked the drugs to increased risks of miscarriage, birth defects, and autism in children exposed to them in utero. The Society for Maternal-Fetal Medicine said its members were “alarmed by the unsubstantiated and inaccurate claims made by FDA panelists.”

    Antidepressants are a safe, “lifesaving” tool, given that mental health issues such as suicide and overdoses are the leading cause of maternal death in the country, ACOG President Steven Fleischman said in a statement on the group’s website.

    Christena Raines, a nurse-practitioner who in 2011 helped found the nation’s first inpatient perinatal psychiatric unit, in North Carolina, said SSRIs are “probably the most well-studied medicine in pregnancy.” In long-term studies of children exposed to the drugs in utero, she said, researchers haven’t seen problems.

    It’s too soon to know whether the panel discussion has affected prescribing rates — or whether those who are pregnant are avoiding the drugs more. But Raines, who teaches at the University of North Carolina-Chapel Hill School of Medicine, said she’s already fielding questions from patients. She said the misinformation the panelists spread — along with President Donald Trump’s distorted claims about taking Tylenol during pregnancy — is making her job harder.

    Dorothy DeGuzman is a family medicine physician who treats high-risk pregnancies in California. “There’s already so much stigma around taking antidepressants in pregnancy,” she said. “This will just add to the fear.”

    The panel

    The July panel discussion was one of four the FDA has convened since May. In the past, the agency vetted members of advisory committees to avoid conflicts of interest. Yet these panels were chosen in private and the events were held with scant public notice. In a July investigative report by MedPage Today, researchers and consultants raised questions about the events’ ethics and legality.

    Department of Health and Human Services spokesperson Emily Hilliard did not directly answer when asked about the panelist selection process. She called the panel events “roundtable discussions” in which experts review the latest scientific evidence, evaluate potential health risks, and “explore safer alternatives.”

    The July panel appeared to be following an executive order Trump issued in February establishing the Make America Healthy Again Commission and directing it to “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors” and other medications.

    Health and Human Services Secretary Robert F. Kennedy Jr., who oversees the FDA, is a frequent critic of such drugs. He has claimed, without evidence, that they might be contributing to school shootings.

    In opening remarks at the July panel discussion, FDA Commissioner Marty Makary also voiced concerns about the medications. “From a national standpoint, the more antidepressants we prescribe, the more depression there is,” he said.

    ‘Not a luxury’

    The sole member of the panel who was both a board-certified psychiatrist and an OB-GYN — the University of Florida’s Roussos-Ross — raised a different concern. “Research shows that in women who stop their medications in pregnancy, they are five times more likely to experience a relapse,” she said.

    Mothers with moderate to severe depression and anxiety during pregnancy are more likely to give birth early and have low-birth-weight infants, she added. If they don’t receive treatment, she said, they are more likely to misuse drugs or alcohol and are at risk of suicide. They can have trouble bonding with their babies, Roussos-Ross said, and those children are at higher risk for problems such as attention-deficit/hyperactivity disorder, depression, or anxiety — due to their mother’s mental health challenges, not the SSRIs.

    “I want to stress that treating mental illness in pregnancy is not a luxury,” she told the panel. “It’s a necessity.”

    Overall, about 19% of U.S. women in their 20s and 30s experience depression, according to the latest data from the Centers for Disease Control and Prevention, and roughly 10% take SSRIs. But studies show that half of women decide to stop taking antidepressants before or during their pregnancies.

    One reason so few expectant mothers receive depression treatment, doctors say, is that they are already afraid to take any medications during pregnancy. The majority of DeGuzman’s patients rely on Medicaid, the government health coverage for those with low incomes or disabilities. Half are Latina. She often prescribes SSRIs, she said, but her patients rarely take them.

    The issue is especially urgent for Black and Latina mothers, who experience higher rates of depression and anxiety than white, non-Latina mothers but are less likely to receive adequate treatment. Many factors contribute to this disparity, including systemic racism, exposure to violence, misdiagnosis, and a lack of access to care.

    Shanna Williams, a perinatal mental health therapist who treats African American mothers in Philadelphia, said many of her clients were already more likely to trust friends and family over their doctors when it comes to whether antidepressants are safe to take while pregnant or breastfeeding. The FDA panel is “one other voice that’s saying you shouldn’t do this,” Williams said. “And that does not help.”

    Judite Blanc, who studies perinatal mental health in women of color, said universal childcare and paid parental leave would help. “My research showed that the most important thing we can offer is social support,” said Blanc, an assistant professor of psychiatry at the University of Miami Miller School of Medicine. “We need the village to step up.”

    Kellyn Haight and her daughter at their home in Brevard, N.C. Kellyn experienced debilitating depression when her daughter was younger. Now she’s trying to have another child — and plans to keep taking Zoloft throughout the pregnancy. “I’m OK with assuming the risk, because I know what the alternative looks like, and I’m not going there,” she says. (Katie Shaw for KFF Health News)

    Kellyn Haight experienced debilitating depression after she moved to the mountain town of Brevard, N.C. The former labor and delivery nurse had no childcare for her then-2-year-old daughter and no family or friends nearby as her husband was traveling for work.

    Her doctor prescribed Prozac — it didn’t help. She called her husband to return home, but her insomnia just got worse. One morning, she begged him to end her suffering. He took her to the emergency room, and staffers sent her to the psychiatric unit of a local hospital. She said she was stripped of her clothing and put in a locked room. “I felt like a creature, like an animal,” said Haight, now 37. “One of my biggest fears is that happening again.”

    After she was released, Haight found a psychiatrist and started taking Zoloft. She built a community of friends and began to feel stable.

    Now that her daughter is 5, she’s trying to have another child — and plans to keep taking Zoloft throughout the pregnancy. “I would rather be safe and present for my child,” she said. “I’m OK with assuming the risk, because I know what the alternative looks like, and I’m not going there.”

    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.