President-elect Donald J. Trump never revealed the “concepts” of the plan he said he had to replace the Affordable Care Act, the law that he tried unsuccessfully to kill during his first term.But the fact that Republicans have gained control of the Senate — and possibly the House — could give Mr. Trump an opening to try and transform the 2010 health law and remake the nation’s health care system.Key to that strategy, health policy experts said, is simple inaction. Major subsidies that lawmakers approved during President Biden’s term that have lowered the cost of plans are set to expire next year. Republicans could allow them to sunset, a move that could deprive roughly 20 million Americans of extra financial help for coverage on the Affordable Care Act’s marketplaces.The subsidies, which are estimated to cost more than $300 billion if extended for a decade, helped Obamacare enrollment almost double during President Biden’s term, shattering records. The Congressional Budget Office estimates that 3.4 million people will lose insurance if the subsidies expire and the cost of plans rises. Lower-income Americans would still receive some federal assistance, while higher-income people would lose it altogether.“Because premium payments would go up for so many people, you’re likely to see a lot of people dropping coverage,” said Cynthia Cox, an Obamacare expert at KFF, a nonprofit health policy research group. And since the marketplaces are a last resort for many Americans, she said, many of those with plans now would likely be uninsured.The future of the law has taken on new urgency, not just because of Mr. Trump’s record in office seeking to reverse it. Speaker Mike Johnson, who would likely continue in his role in a Republican majority, said last week at a campaign stop that his caucus would seek “massive reform” if Mr. Trump was elected again, with health care a top priority in the early months.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Federal officials have celebrated a striking drop in drug overdoses across the country. But state-level data shows that Black people are suffering significantly worse outcomes than white people.Overdose deaths across the country decreased by more than 12 percent between May 2023 and May 2024, according to new federal data, a major development in the nation’s efforts to combat the effects of fentanyl. The decrease continued a trend observed in recent months, and was the largest on record, the White House said last week.But a new analysis from Georgetown University researchers tells a more complicated story about a health crisis still claiming about 100,000 lives every year. In 22 states that track drug overdoses by race and ethnicity, the number of fatal overdoses among Black Americans typically increased between 2022 and 2023, while deadly overdoses among white Americans often decreased, the researchers found.The findings reveal a continuation of what federal and state health officials have described as a two-track epidemic, with white Americans experiencing better outcomes and Black Americans struggling to keep up. As overdose deaths rose to record levels in recent years, rates among Black and Native Americans were higher. But the more recent data goes further in showing how sharply the experiences of drug users have diverged by race.In Arizona, for instance, fatal drug overdoses among white people decreased by more than 2 percent, while overdoses among Black people increased by roughly a third. In Michigan, deadly drug overdoses among white people decreased by 12 percent, and increased among Black people by 6 percent. In Maine, fatal overdoses dropped by about 20 percent among white people but rose by over 40 percent among Black people.In states where decreases were found in both groups, they were typically smaller for Black Americans. In states where increases were found in both groups, they were often greater for Black people. And in places that tracked overdoses among Native and Hispanic Americans, similar disparities arose.Drug policy experts said that the new data underscored how public health strategies for drug addiction were still being applied unevenly, with deadly consequences. Naloxone, the overdose-reversing medication, has been harder to find for some Black Americans, as have addiction treatments.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The decrease across the country is a major breakthrough in efforts to reverse the effects of fentanyl. Researchers and health officials say there is no easy explanation for the trend.Drug overdose deaths are decreasing sharply across the country, according to recent state and federal data, a dramatic improvement in the nation’s efforts to reverse the consequences of fentanyl’s spread in the illicit drug supply.Between April 2023 and April 2024, overdose deaths declined by about 10 percent nationally to roughly 101,000, according to preliminary data published recently by the Centers for Disease Control and Prevention. That amounted to the largest decrease on record, according to the Biden administration. Nonfatal overdoses are also down more than 10 percent.The data suggests that some of the tools used to combat opioid overdoses, such as naloxone, the overdose-reversing medication, were having a significant impact. But researchers and federal and state health officials have puzzled over the exact reasons for the decrease, including why overdoses have fallen so much in recent months.The pace of the decline “is such an anomaly in the last 20 years,” said Nabarun Dasgupta, a leading drug policy expert at the University of North Carolina at Chapel Hill who published an analysis this week of the state and federal data.Some states have reported even greater decreases than the national rate. In Kentucky, overdose deaths dropped by more than a third between April 2023 and March 2024. Arizona, Maine and Vermont all recorded recent decreases of around 15 percent.North Carolina’s fentanyl overdose rate fell by more than 30 percent from May 2023 to May 2024, Dr. Dasgupta said, a figure that prompted him to call the state’s health department to confirm that the number was real.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A fierce battle with Georgia over a Medicaid experiment with stricter enrollment underscores the vast divide between parties over how to cover lower-income Americans.The Affordable Care Act was once a potent electoral issue that could swing campaigns with its more familiar moniker, Obamacare. But the 2010 health law, a core piece of President Biden’s re-election campaign, did not factor into last week’s Republican National Convention.The Republican National Committee’s platform made only vague reference to a Trump health plan, saying that the party will “increase transparency, promote choice and competition, and expand access to new affordable health care.” Former President Donald J. Trump, who said last year he was “seriously looking at alternatives” to Obamacare, made little reference to health policy in his speech on Thursday accepting the Republican nomination.The fight over Obamacare has instead shifted more to state capitals, in part because a provision of the law allows states — which jointly finance Medicaid with the federal government — to expand their programs to cover more adults.No state represents the continuing divisions over the Affordable Care Act’s place in the safety net more than Georgia, one of the last 10 holdouts that have refused to take up Medicaid expansion.Last July, Georgia officials implemented a stricter alternative to Medicaid expansion, known as Georgia Pathways to Coverage. The new program required participants to show that they were working, enrolled in college or doing community service for at least 80 hours each month — activities that Republican state lawmakers said would encourage a spirit of accountability among recipients of publicly subsidized health benefits.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Mental health experts have said that the 988 hotline for mental health emergencies is still a work in progress, in need of more funding, coordination and awareness.More than 10 million calls, texts and chat messages have been answered by counselors working for the National Suicide Prevention Lifeline’s three-digit hotline in the two years since it debuted, federal officials said on Tuesday.The three-digit number, 988, was introduced in 2022 as a way to simplify emergency calls and help a metastasizing mental health crisis in the United States, accelerated by the Covid-19 pandemic and the social environments of younger Americans. The hotline previously used a traditional 10-digit number.“People who felt like they didn’t have any other options got what they needed,” Andrea Palm, the deputy secretary of the Health and Human Services Department, said at a news briefing on Tuesday. The 988 line, Ms. Palm said, had resulted in “countless stories of real people whose lives have been changed forever.”The 988 network has been a rare instance of bipartisanship in federal health policy. President Donald J. Trump in 2020 signed the law establishing the new number, and the Biden administration has implemented and expanded the network of more than 200 call centers, which typically operate around the clock.A growing number of adults in the United States have reported feeling more anxious. Federal officials on Tuesday cited a 2022 national survey that found that more than 12 million adults and nearly 3.5 million adolescents had seriously considered suicide in the previous year. Roughly one in five adolescents reported symptoms of depression or anxiety in a federal survey of teen health from 2021 to 2022.The condensed phone number was meant to function as a more memorable option for emergency calls, similar to 911. Yet only around a quarter of Americans are at least somewhat familiar with 988, according to a poll released this week by Ipsos and the National Alliance on Mental Illness.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The NewsThe rate of emergency room visits caused by heat illness increased significantly last year in large swaths of the country compared with the previous five years, according to a study published on Thursday by the Centers for Disease Control and Prevention.The research, which analyzed visits during the warmer months of the year, offers new insight into the medical consequences of the record-breaking heat recorded across the country in 2023 as sweltering temperatures stretched late into the year.The sun setting in July over Phoenix. Last year was the warmest on Earth in a century and a half, with the hottest summer on record.Matt York/Associated PressWhat the Numbers Say: People in the South were especially affected by serious heat illness.The researchers used data on emergency room visits from an electronic surveillance program used by states and the federal government to detect the spread of diseases. They compiled the number of heat-related emergency room visits in different regions of the country and compared them to data from the previous five years.Nearly 120,000 heat-related emergency room visits were recorded in the surveillance program last year, with more than 90 percent of them occurring between May and September, the researchers found.The highest rate of visits occurred in a region encompassing Arkansas, Louisiana, New Mexico, Oklahoma and Texas. Overall, the study also found that men and people between the ages of 18 and 64 had higher rates of visits.How It Happens: Heat can be a silent killer, experts and health providers say.Last year was the warmest on Earth in a century and a half, with the hottest summer on record. Climate scientists have attributed the trend in part to greenhouse gas emissions and their effects on global warming, and they have warned that the timing of a shift in tropical weather patterns last year could foreshadow an even hotter 2024.Heat illness often occurs gradually over the course of hours, and it can cause major damage to the body’s organs. Early symptoms of heat illness can include fatigue, dehydration, nausea, headache, increased heart rate and muscle spasms.Trying to cool off on a day of heat above 110 degrees in Phoenix last summer.Ross D. Franklin/Associated PressWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

In the year after a pandemic-era policy preserving Medicaid coverage lapsed, more than 20 million people were dropped from the program at some point.Lindsey McNeil and her 7-year-old daughter, Noelle, who suffers from cerebral palsy and epilepsy, were jolted by an alert they received from Florida’s Department of Children and Families late last month that Noelle would be losing her Medicaid coverage 10 days later.Their lives have since begun to unravel, Ms. McNeil said. Noelle has stopped seeing the four therapists she visits each week and is running low on medications she needs to prevent her seizures from flaring up. Monday brought a measure of relief: Ms. McNeil learned that Noelle’s coverage had been temporarily reinstated as they wait for a resolution to an appeal filed with the state.“We’ve worked really hard to grow our family and our life and a home for this child,” Ms. McNeil said. “It’s a little daunting to think about what she may lose, and what we may not be able to provide for her.”Noelle was one of the most recent casualties of the unwinding of a pandemic-era federal policy that required states to keep people on Medicaid, the health insurance program that covers low-income Americans, in exchange for more federal funding. While the policy was in place, enrollees were spared regular eligibility checks. Enrollment in Medicaid and the Children’s Health Insurance Program swelled to a record of more than 90 million, and the nation’s uninsured rate dropped to record lows.But the policy lapsed at the start of April last year, allowing states to resume trimming their rolls, and the so-called unwinding process that ensued has had far-reaching effects. More than 20 million Americans lost Medicaid at some point in the past year, according to KFF, a nonprofit health policy research group — an unprecedented event in the joint federal-state program’s nearly 60-year history.Noelle was one of the most recent casualties of the unwinding of a pandemic-era federal policy that required states to keep people on Medicaid in exchange for more federal funding.Thomas Simonetti for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

As Southern states reconsider Medicaid expansion, Gov. Laura Kelly of Kansas is pushing her own plan meant to appeal to conservatives. So far, success has been elusive.As lawmakers in a nearby hearing room debated last month whether to support her legislation to expand Medicaid, Gov. Laura Kelly of Kansas dared the state’s Republican House speaker to hold a vote.“If he thinks he can kill it, bring it,” Ms. Kelly, a soft-spoken moderate Democrat, said in an interview in her sprawling office suite at the State Capitol in Topeka.The next morning, in his own office off the House floor, Speaker Dan Hawkins showed no sign of yielding. He described Medicaid expansion as “almost like the greatest Ponzi scheme ever devised.” The same day, a House committee voted against sending Ms. Kelly’s bill to the floor, derailing the proposal — at least for now.The standoff between Ms. Kelly and Mr. Hawkins represented one fight in a fierce political battle playing out in several state capitals over the future of Medicaid, the health insurance program for the poor. In Kansas and in a handful of Republican-controlled states in the South, supporters of expanding the program under the Affordable Care Act have renewed their efforts to overcome longstanding Republican opposition, generating a sense of headway.Yet neither Ms. Kelly nor backers of Medicaid expansion elsewhere have managed to advance legislation far enough to become law, a reflection of the continuing political power of conservative ideas about the nature of government-subsidized coverage and the people deserving of it.“It’s really the fundamental moral question of where the safety net should be,” said Ty Masterson, the Republican president of the Kansas Senate and a longtime opponent of expansion. “And the safety net should be on the frail and elderly and on the disabled and all the low-income mothers and children.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The new regulation reverses a Trump-era policy that expanded access to health plans with fewer benefits than those sold on the Affordable Care Act’s marketplaces.The Biden administration announced on Thursday that it had finalized a new regulation that curbs the use of short-term health insurance plans that do not comply with the Affordable Care Act, reversing a move by the Trump administration to give consumers more access to cheaper but skimpier plans.Under the new rule, the short-term plans will be able to last for only 90 days, with an option for consumers to make a one-month extension.In 2018, the Trump administration issued a rule allowing the plans to last for just under a year, with the option of renewing them for a total duration of up to three years. Previously, under an Obama-era policy, the plans could last no longer than three months.The plans, often with lower premiums than those found on the Affordable Care Act’s marketplaces, do not have to cover people with pre-existing conditions. They are also free from the health law’s requirement that plans offer a minimum set of benefits, like prescription drug coverage and maternity care.Democrats deride the so-called short-term, limited-duration plans as “junk” insurance, and the Obama-era policy was meant to ensure that healthy consumers could not use that option to sidestep the Affordable Care Act’s marketplaces, leaving a sicker pool of customers enrolling in the comprehensive plans offered under the health law.The White House cast the new rule as a way to fortify the marketplaces. In a briefing with reporters on Wednesday, Neera Tanden, President Biden’s domestic policy adviser, said that 45 million Americans were now covered through the marketplaces or the expansion of Medicaid under the Affordable Care Act. More than 20 million people signed up for plans on the marketplaces during the most recent open enrollment period.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The NewsThe Biden administration announced on Thursday that it was sending initial offers to the makers of the first 10 prescription drugs that have been selected for price negotiations with Medicare under a landmark federal program intended to reduce drug spending.The Biden administration has selected 10 medicines for price negotiations, including Farxiga, a drug from AstraZeneca for diabetes, heart failure and chronic kidney disease.George Frey/ReutersWhy It Matters: The price offers kick off negotiations.The medicines selected for negotiations are taken by millions of Americans to treat conditions like diabetes, cancer and heart disease. The administration identified them in August, beginning a lengthy process intended to result in an agreed-upon price that would take effect in 2026, assuming the negotiation program survives legal challenges.The initial round of price offers is a key step in the negotiation process. Each drugmaker has until early March to accept the offer or propose a counteroffer to the government. A series of negotiation sessions could follow, with the process set to conclude by August.Health policy experts said the announcement of the initial round of offers amounted to a kind of starting gun, giving the Biden administration the chance to take an aggressive posture and test the willingness of drugmakers to acquiesce.The proposals help in “setting the tone for the rest of this back and forth,” said Andrew W. Mulcahy, a health economist at the RAND Corporation who has advised the Biden administration on the implementation of the drug price negotiations.The administration did not publicly reveal how much it was offering for each drug.What Happens Next: The courts still have to weigh in.The price negotiation program was created by the Inflation Reduction Act, the climate, tax and health care package that President Biden signed into law in 2022. Additional medications will be chosen for price negotiations in the coming years. The program is expected to save the federal government nearly $100 billion over a decade.The price negotiation program is a key component of the White House’s efforts to lower everyday costs for Americans, and it is a policy that Mr. Biden can point to as he campaigns for re-election.“Medicare is no longer taking whatever prices for these drugs that the pharmaceutical companies demand,” Mr. Biden said in a statement on Thursday.But the pharmaceutical industry is hoping that the courts will step in to shut down the program, which drugmakers say is unconstitutional. The industry has long argued that allowing the government to negotiate prices will curtail private innovation and discourage companies from developing new drugs.Lawsuits filed by drugmakers, the industry’s main trade group and the U.S. Chamber of Commerce remain ongoing in courts around the country. A federal judge in Delaware heard arguments on Wednesday in a case brought by AstraZeneca, the maker of a diabetes drug that was selected for price negotiations.