Most Americans still tell pollsters immigration is good for their communities and reject cruel deportations, especially those that separate families, target people without criminal records, or penalize people who came here as young children.
byEmily Rodiguez OtherWords
In the 19 years my uncle has worked in the healthcare industry, he’s only missed one day — the day his mother, my grandmother, passed away. He would then help plan a funeral he couldn’t attend.
Photo provided
If you live in his small town in Utah, you know my uncle. He’s the big man you see on a bike riding all over town. He’s part of the kitchen staff at a care facility and a friend to the other workers and patients. He’s the man who has the bus schedule memorized and can get you anywhere.
He’s also the man who was forced to miss his mother’s funeral in his home country. His immigration status requires him to apply for travel authorization, which can take months and puts him at risk of being denied reentry. Unfortunately, it just wasn’t possible for him to make it.
While it’s characterized as temporary, over 200,000 TPS holders have lived here for more than two decades.
Stories like these are all too common. And they could soon get worse.
My uncle has what’s called Temporary Protected Status, or TPS. TPS was created by Congress in 1990 to provide work authorization and protection from deportation to individuals from designated countries enduring armed conflict or environmental disasters.
Over a million people rely on the program. While it’s characterized as temporary, over 200,000 TPS holders have lived here for more than two decades. They’ve established lives here, yet live with the fear that it could be taken away at any moment.
Unfortunately, that moment has arrived.
President Trump and Secretary of Homeland Security Kristi Noem have made it clear that they’re coming for TPS. The administration has carelessly terminated or rescinded the legal status of hundreds of thousands of TPS holders, needlessly uprooting their lives.
These deported TPS holders are now expected to navigate poverty, instability, violence, and other unsafe conditions in countries many haven’t lived in for decades. Many struggle to reintegrate after their return, and are often targeted by local criminal groups.
While the administration slanders TPS holders as criminals, an overwhelming amount of research shows that immigrants actually make our communities safer. They have a nearly 95 percent employment rate and generate over $1.3 billion in federal taxes, contributing to programs like Social Security and Medicare. With a high rate of entrepreneurship, they generate a spending power of more than $8 billion.
Their positive impact is undeniable. Yet instead of providing a pathway to citizenship, the Trump administration is systematically phasing out TPS and imposing significant financial hardship on TPS holders and their communities.
I urge you to defend the rights of your neighbors.
In addition to deeply slashing programs like SNAP to fund tax benefits for the wealthy, Trump and the GOP’s “Big Beautiful Bill” also adds exorbitant new fees for immigrants with TPS, asylum seekers, and migrants on humanitarian parole. The new law increases initial application fees for TPS holders from $50 to $500 and adds a non-waivable $550 fee for work authorization for first-time applicants — along with a new annual renewal fee of at least $275.
My uncle has already paid thousands of dollars in renewal fees during his 20 years as a TPS recipient, saving the money needed from his $16 an hour job to continue to work and provide for his family. Because my uncle loves this country, he’ll pay these predatory fees.
But he shouldn’t have to — and neither should anyone else on TPS. Our communities are better because TPS holders are here. Their livelihoods are in jeopardy unless Congress provides them a pathway to citizenship.
The American Dream and Promise Act would provide TPS holders — along with DACA recipients and other undocumented youth — a pathway to citizenship, along with the permanent relief and stability they and their families deserve.
As the niece of one of the one million-plus TPS holders, I urge you to defend the rights of your neighbors. Now is the time to protect what makes our communities so great.
Emily Rodiguez, a native of Utah, is a recent college graduate who’s pursuing a career in public policy. This op-ed was distributed by OtherWords.org.
For the first time, states will have to take on a significant share of funding SNAP. New work requirements for SNAP will have little effect on employment, but will cause more children to go hungry.
Photo: Use at your Ease/Pixabay
Hundreds of thousands of lawfully present immigrants, including children, will lose access to Medicaid
bySarah Anderson and Lindsay Koshgarian OtherWords
The GOP’s “One Big Beautiful Bill,” which narrowly passed Congress and was recently signed by President Trump, represents the largest transfer of wealth from the poor to the rich since chattel slavery.
Here are just 10 of the worst things about it.
1. It’s going to kill people.
Cuts to Medicaid and the Affordable Care Act, combined with new administrative hurdles, could result in an estimated 51,000 preventable deaths per year. The new law and other actions by the Trump administration will strip health insurance from 17 million people.
2. It will be an apocalypse for rural hospitals.
The budget restricts the provider taxes that many states use to fund Medicaid. The threat is particularly severe for rural hospitals, which rely heavily on Medicaid revenue. More than 700 rural hospitals are already at risk of closure — and at least 338 are at increased risk due to changes in this budget.
3. It takes food from the mouths of hungry people.
New work requirements for SNAP benefits will take food assistance from millions, including children and veterans. As with Medicaid, new work requirements for SNAP will have little effect on employment, but will cause more children to go hungry.
4. It squeezes states on SNAP.
For the first time, states will have to take on a significant share of funding SNAP. This unprecedented shift will likely lead many states to cut enrollees or even terminate food aid altogether.
5. It bars lawfully present immigrants from aid.
Hundreds of thousands of lawfully present immigrants, including children, will lose access to Medicaid, the Children’ s Health Insurance Program, Medicare, ACA tax credits, and SNAP benefits. And 2.6 million U.S. citizen children who live with only an undocumented adult are expected to lose their Child Tax Credit.
6. It terrorizes immigrant families.
The GOP budget provides $170 billion to arrest, detain, deport, and wall off migrants. That includes $45 billion for new immigration detention centers, including family detention facilities — a vast increase that will primarily benefit private companies contracted to build and run them.
7. It takes from the poor to give to the rich.
The bill’s tax policies will overwhelmingly benefit the wealthiest households. A Yale analysis of the bill’s combined tax and spending policies finds that the poorest 20 percent of households will suffer a net income loss of $700 per year on average, while the top 1 percent will get a $30,000 increase.
8. Corporations will take the spoils for themselves.
The budget keeps the corporate tax rate at 21 percent, a drastic reduction from the 35 percent rate from before the first Trump tax cuts in 2018 — despite the fact that ordinary workers have not benefited from this rate reduction.
9. It rewards polluters while raising energy costs.
The budget also includes more than $1 billion in new tax breaks and subsidies for the fossil fuel industry, accelerating climate change while costing taxpayers. It also allows oil and gas companies to avoid paying fees for polluting methane leaks, a major cause of climate change.
Meanwhile, cuts to clean energy subsidies could raise household energy bills by $415 a year over the next decade.
Photo: Dariusz Sankowski/Pixabay
The Big Beautiful Bill gives the Pentagon billions of dollars to spend with private contractors.
10. It funds war and enriches war profiteers.
The bill gives the Pentagon a $150 billion boost, bringing overall Pentagon spending to over $1 trillion — a record high. That includes $25 billion for the “Golden Dome,” a missile defense system that’s economically and physically impossible but would enrich wealthy Pentagon contractors like Elon Musk.
Instead, Congress should harness America’s abundant wealth to create a moral economy that works for all of us. By fairly taxing the wealthy and big corporations, reducing our bloated military budget, and de-militarizing immigration policy, we could free up more than enough public funds to ensure we can all survive and thrive.
We have no excuse for not investing our national resources in ways that reflect our Constitutional values: to establish justice, domestic tranquility, real security, and the general welfare for all.
Sarah Anderson directs the Global Economy Project at the Institute for Policy Studies. Lindsay Koshgarian directs the IPS National Priorities Project. They produced a longer version of this analysis for Repairers of the Breach. This version was distributed by OtherWords.org.
The Illinois Department of Public Health said nine rural hospitals in Illinois would face closure or severe service reductions due to the cuts.
Photo: Capitol News Illinois/Andrew Adams
President Donald Trump raises his fist at the Republican National Convention in Milwaukee last year alongside U.S. Rep. Steve Scalise (left) and then-running mate J.D. Vance (right). His largest domestic policy bill, which makes drastic cuts to Medicaid, appeared poised to become law last week.
by Peter Hancock
Capitol News Illinois
SPRINGFIELD - The U.S. House gave final passage Thursday to a budget bill that will cut federal Medicaid spending by an estimated $1 trillion over 10 years.
All three Republican members of the Illinois congressional delegation voted in favor of the bill, despite a last-minute plea from Democratic Gov. JB Pritzker who warned the bill will result more than 330,000 Illinoisans losing Medicaid coverage and have a devastating effect on some rural hospitals.
“As those who are entrusted with protecting the health of all your constituents, I urge you to oppose these harmful Medicaid provisions and work to protect healthcare access for rural Illinois families, workers, and veterans,” Pritzker wrote in the letter addressed to GOP Reps. Mike Bost, Darin LaHood and Mary Miller.
The cuts would translate to about $48 billion in Illinois over that period, or about 20% of what the state would otherwise receive, according to an analysis by KFF, a nonpartisan health policy research organization.
That would be one of the largest percentage reductions in any state in the nation, according to KFF, a nonpartisan health policy research organization formerly known as the Kaiser Family Foundation. Louisiana and Virginia would each see cuts of about 21%, KFF said.
The state-level analysis is based largely on Congressional Budget Office estimates showing the bill would reduce federal Medicaid spending by $1 trillion nationwide over the next decade.
The KFF analysis does not include estimates of the number of people who would lose Medicaid coverage under the bill, noting how that will depend on how individual states respond to the policy changes contained in the bill. But overall, it estimates the number of uninsured Americans will grow by 11.8 million.
The bill, which includes many of President Donald Trump’s domestic policy priorities – including tax cuts and increased spending on border security – passed the Senate on Tuesday by a vote of 51-50, with Vice President J.D. Vance casting the tie-breaking vote. Both senators from Illinois, Democrats Dick Durbin and Tammy Duckworth, voted no.
The final vote in the House was 218-214.
“The One Big, Beautiful Bill is a once-in-a-generation victory for the American people,” Miller said in a statement after the House vote. “It delivers on President Trump’s America First agenda with bold, decisive, and immediate action. This is the most pro-worker, pro-family, pro-America legislation I have voted for during my time in Congress, and I was proud to help get it across the finish line for the hardworking Americans across my district.”
Medicaid and the health care marketplace
Medicaid, which is jointly funded by states and the federal government, provides health coverage for lower-income individuals and families. It was established in 1965 alongside Medicare, the federally funded health coverage program for people over 65.
Today, according to the Illinois Department of Healthcare and Family Services, the program covers about 3.4 million people in Illinois, or a fourth of the state’s population. At a total cost of $33.7 billion a year, it is one of the largest single categories of expenditures in the state’s budget. It pays for about 40% of all childbirths in the state, according to KFF, as well as 69% of all nursing home care.
But questions about its future loomed over the Illinois General Assembly during the just-completed legislative session as both Congress and the General Assembly were crafting their respective budgets for their upcoming fiscal years.
“This was a difficult year because of the unprecedented changes and cuts that are looming on the horizon in Washington,” state Rep. Anna Moeller, D-Elgin, said on the floor of the Illinois House during debate over a Medicaid bill on the final day of the session.
Speaking with reporters at an unrelated event Tuesday, Pritzker predicted “hundreds of thousands” of people in Illinois will lose Medicaid coverage if the Senate bill is signed into law.
“This is shameful, if you ask me, and it’s going to be very hard to recover,” Pritzker said. “The state of Illinois can’t cover the cost – no state in the country can cover the cost of reinstating that health insurance that is today paid for mostly by the federal government, partly by state government.”
Policy changes under the bill
According to KFF, most of the reductions in Medicaid spending would result from just a few policy changes contained in the bill
Those include imposing a work requirement on adults enrolled in Medicaid through the Affordable Care Act, also known as “Obamacare.” That law expanded eligibility for Medicaid to working-age adults with incomes up to 138% of the federal poverty level. About 772,000 people in Illinois are enrolled under that program.
The bill also calls for requiring people enrolled through the ACA expansion to verify their continued eligibility for Medicaid twice a year instead of annually. That is expected to filter out enrollees whose incomes rise above the eligibility limit as well as those who simply fail to complete the verification process.
Another provision would limit the ability of states to finance their share of the cost of Medicaid by levying taxes on health care providers. Illinois imposes such taxes on hospitals, nursing facilities and managed care organizations that administer the program. Revenue from those taxes is used to draw down federal matching funds that are then used to fund higher reimbursement rates to health care providers.
The final version of the bill does not, however, include a provision penalizing states like Illinois that also provide state-funded health care to noncitizens who do not have lawful status to be in the United States. That provision, which was included in the earlier House version, was not included in the Senate bill, according to KFF.
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
One in 31 children in the U.S. is diagnosed as being on the autism spectrum.
by Judith Ruiz-Branch Illinois News Connection
CHICAGO - Illinois is the first state to block the federal government from accessing state data on autism.
The order, signed by Gov. JB Pritzker last week, is in response to federal efforts to create a mass data collection on autism.
Health and Human Services Secretary Robert F. Kennedy Jr. plans to use Medicare and Medicaid data to create an autism registry with the goal of finding the cause of what he called an "autism epidemic." Pritzker's order prohibits the collection in Illinois without consent from an individual or guardian.
Federal agencies said they would protect sensitive health information.
Jeff Chan, associate professor of special education at Northern Illinois University, said along with concerns about accidental disclosure of protected health information, right now there is no single cause or cure for autism and he is skeptical a database could change it
"I don't even know if we will ever find that one, single cause," Chan acknowledged. "There's a variety of factors in play on the genetic side and the environmental side that are all affecting parents and mothers and children, which eventually lead to the expression of those symptoms."
Federal agencies said they would protect sensitive health information. More than a dozen autism organizations and advocates are pushing back against the planned database and any rhetoric claiming autism is "curable" or is caused by vaccines.
One in 31 children in the U.S. is diagnosed as being on the autism spectrum. Chan noted in Illinois the rate increased from one in 333 children in 2002 to one in 51 children in 2023. He added while cases are rising, the numbers are also influenced by earlier diagnosis and improved data collection.
Chan emphasized the importance of oversight of data and interpretation and cautioned about the potential for drawing conclusions from incomplete information or cherry-picking evidence.
"Anyone could collect data and they can interpret it differently, and they can spin it differently," Chan stressed. "That happens all the time. And that's happened in the past, especially about the causes of autism."
Chan advised caution regarding individuals with extreme theories. He acknowledged the difficulty parents and caregivers face in evaluating information and the importance of institutions to help navigate the evidence.
"There's people out there that, for whatever reason, are true believers about a particular narrative about autism," Chan explained. "You have to be a very careful consumer about what you take in and what evidence you choose to believe."
It’s clear that this nation’s safety net has to be stronger so that people like me don’t fall through the cracks.
byMarisa Pesce
OtherWords
Tens of millions of Americans rely on the public assistance programs — like Medicaid, SNAP, housing aid, and more — that Republican leaders are now threatening to gut.
I’m one of them.
My dream is to regain the financial independence I once enjoyed before life and systemic obstacles got in the way. I come from a family with a history of mental illness and domestic abuse, and I’ve suffered through mental health challenges myself.
I’ve always worked hard. After high school, I earned a college degree and found the calling of being a teacher. I earned and paid for my Master’s degree while teaching full time as a high school math teacher. I still struggled with challenges, but life was good. The system had worked. I had a home and was financially independent.
I’ve had to rely on someone who participated in the domestic violence against me to help with rent.
Then, I was the victim of a major, life changing domestic violence event, and my life started to unwind. I had to relocate to another state where I didn’t have a place to call home, my benefits were less, and my mental illness was exacerbated by the isolation and trauma.
Despite the challenges I faced, I was able to find some needed assistance for food and mental health care as I got on my feet.
Also known as “food stamps,” the Supplemental Nutrition Assistance Program (SNAP) was a godsend for helping me put food on the table. Throughout my life both Medicaid and Medicare have helped with mental health treatment, and the Supplemental Security Disability Income (SSDI) program helped keep me out of poverty.
These are precisely the circumstances for which temporary assistance for basic needs like food, housing, and health care exists. But affordable housing was unavailable in my new home state, and SNAP benefits were much lower — even as my food needs stayed the same.
So my debts increased, and I’ve had to rely on someone who participated in the domestic violence against me to help with rent. I have a little income from SSDI, and I volunteer to stay engaged in my calling to teach and help others while I fight to recover from losing my home and my ability to keep up financially.
It’s clear that this nation’s safety net has to be stronger so that people like me don’t fall through the cracks. But House Republicans are currently trying to cut food assistance and other benefits, not strengthen them.
I just want to eat, get better, and afford safe housing so I can get back on my feet, back to financial independence, and back to doing all I can to help my community.
I need more help putting food on the table. But they’re proposing cuts to drastically reduce federal funding for SNAP, expand already harsh working requirements, and change how our need for healthy food is calculated, which is likely to slash benefits. And they’re doing it all to finance $4.5 trillion in tax breaks for corporations and the wealthiest.
I just want to eat, get better, and afford safe housing so I can get back on my feet, back to financial independence, and back to doing all I can to help my community. Yet I and millions like me are nothing but pawns in a political game that aims to hurt us and help those who already have wealth.
When I was teaching, I taught my students about fairness and equality — about what it means to live in a society where we look out for each other, where no one is left to be ill, unhoused, and hungry. I think some politicians need to go back to school, because they seem to have forgotten lessons like these.
So it’s our job to school them. We must let them know that basic human needs are not fair game for getting money for tax cuts for billionaires. Instead, our priorities should be healthy and safe communities for all.
About the author:
Marisa Pesce is a teacher, human rights consultant, anti-poverty advocate, and volunteer with RESULTS from Providence, Rhode Island. This op-ed was distributed by OtherWords.org.
by Glenn Mollette, Guest Commentator
America has given Ukraine a lot of money. Does anyone really know how much?
President Trump recently said $350 billion while other sources say we have spent less than $200 billion. A billion dollars is a billion dollars. Hundreds of billions of dollars mean Americans across our country are being taxed hard earned dollars to send to another country for the purpose of financially underwriting their war.
The Beatles sang, “Can’t Buy Me Love,” but apparently you can buy some fake friends for a while. When the money ceases then the love and friendship you bought speedily goes away.
If we don’t write big checks to countries like Ukraine then they get mad really quick and for some reason, we become the bad guys. What happens when we totally run out of money? Our national debt is $36 trillion dollars. Who will rescue us when we go bankrupt and there is no Social Security, Medicare or Medicaid? No one will come to save us.
Approximately 58,220 Americans were killed in the Vietnam war. This number includes battle and non-battle related deaths. The Vietnam war cost around $111 billion in 1968 dollars, equivalent to approximately $800 billion in today’s dollars. The war lasted about 15 years. What does our country have to show for $800 billion and almost 60,000 lives? A lot of graves and a lot of Veterans with PTSD.
The war in Afghanistan cost America approximately $2,313 trillion dollars from 2001 to 2022. This includes money we spent in Afghanistan and Pakistan but does not account for the cost of lifetime care for veterans. Some estimates suggest the total cost could be higher ranging from $4 to $6 trillion when including long-term medical care and disability compensation. Plus, we spent over $68 million on a second runway at Bagram airfield in 2006 making it the best and strongest runway in that part of the world.
In the 1960s, we built the Kandahar International Airport which cost us over $15 million dollars. Who are the people using these airports today? A lot of Americans have suffered to pay big taxes bills while our government plays Santa Claus.
It’s a great idea to ask Ukraine to pay back the billions we have given to them. The idea of America having access to their land and vast resource of minerals sounds appealing.
Financially, it sounds like it would be worth mega billions and would supply us with badly needed resources. However, how many roads and bridges will we have to build?
How big will our military presence have to become to protect American citizens who will go to work the land? A military presence in Afghanistan could only mean the possibility of altercations with Russia’s army which would escalate into America becoming head and shoulders into a full scale war with Russia.
Putin can’t be trusted as far as you can throw the car sitting in your driveway. A growing presence in Ukraine by America will eventually mean fighting to protect our interests in that country. Such a land deal with Ukraine sounds like a good deal but has the potential of becoming a very bad deal.
Unfortunately, after last week’s oval office disaster between Zelenskyy, President Trump and Vice-President Vance there may never be a deal.
If Russia eventually topples Ukraine, Putin won’t be making any deals, paying anyone anything back and we may be buying our bread from him.
About the author ~
Glen Mollett is the author of 13 books including Uncommom Sense, the Spiritual Chocolate series, Grandpa's Store, Minister's Guidebook insights from a fellow minister. His column is published weekly in over 600 publications in all 50 states.
The views expressed are those of the author and are not necessarily representative of any other group or organization. We welcome comments and views from our readers. Submit your letters to the editor or commentary on a current event 24/7 to editor@oursentinel.com.
During his recent budget address, Gov. JB Pritzker pretentiously proclaimed, "We don’t have kings in America – and I don’t intend to bend the knee to one," referring to President Trump.
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Ironic when you consider it was Pritzker who issued at least 41 consecutive disaster proclamations related to COVID-19 between 2020 and 2023, and over 100 specific executive orders tied to the pandemic. These orders included stay-at-home mandates, school and business closures, mask requirements, and vaccination mandates for certain workers.
Pritzker’s unilateral rule in Illinois disqualifies him from making public complaints about kings, fascists, and tyrants in America.
Moreover, his repeated attempts to redefine and paint political opponents as “Nazis” is getting very old.
Pritzker and his allies want the public to believe that “Nazis” are on the right side of the political spectrum. They are being deceitful. The National Socialist German Worker’s Party (Nazi) was organized to advance socialism. They advocated big government policies, putting them on the left side of the political spectrum. Think "Medicare for all," "universal Pre-K," and "universal free college," among others. Sound familiar?
The governor doth protest too much, methinks.
David E. Smith, Executive Director
Illinois Family Institute
Got something you want to get off your chest? Send us your letter to the editor today. Here is how: Read this.
One example: The price of oranges and the price of orange juice have both steadily increased in recent years due to declining production in Florida caused by large hurricanes.
CHICAGO - Consumers are unhappy with increasing food prices and blame inflation. In reality, natural disasters have a direct link to grocery costs, with no end in sight.
Climate change affects Illinois farms, especially drought. The weather extremes lower their livestock's productivity, raising the price of dairy and meat products.
Michael Stromberg, spokesperson for Trace One, a food and beverage regulatory compliance company, said the effects of floods, hurricanes, drought and extreme heat have a nationwide and global impact.
Photo: Hans/Pixabay
"The price of oranges and the price of orange juice have both steadily increased in recent years due to declining production in Florida caused by large hurricanes," Stromberg outlined. "Grain prices are through the roof in critical agriculture regions like the Midwest. It starts with drought. It affects a huge portion of agriculture in that region that has an aftereffect at the grocery store in terms of your grocery prices."
Illinois ranked 10th in the Trace One study of all 50 states where natural disasters have the biggest impact on the nation's food supply. Losses were mostly due to drought in Henry, Sangamon, Lee, Logan, Bureau and Mason counties.
Stromberg argued innovation is needed to solve these dilemmas. One solution is to develop and
distribute climate-resilient crops capable of withstanding extreme droughts and floods. Other strategies are to implement effective water resource management systems and invest in flood control measures alongside restoring natural buffers. Wetlands and watersheds will act as sponges to help mitigate the dangers of excessive rainfall. He added more answers can take on a scientific tone.
"Farmers can use newer precision agriculture technologies like IOT sensors, drones, advanced analytics that can allow farmers to better monitor weather patterns, things like soil health and their water usage, which can optimize resources better," Stromberg explained.
He urged the public to vote for policies prioritizing renewable energy, water conservation and sustainable agriculture to drive "incremental improvement," and for the public to reduce their food waste. Another Trace One study found Illinoisans lost slightly more than $1,900 per household, or $766 per person from food waste last year.
KHN - When Michael Adams was researching health insurance options in 2023, he had one very specific requirement: coverage for prosthetic limbs.
Adams, 51, lost his right leg to cancer 40 years ago, and he has worn out more legs than he can count. He picked a gold plan on the Colorado health insurance marketplace that covered prosthetics, including microprocessor-controlled knees like the one he has used for many years. That function adds stability and helps prevent falls.
Prosthetic coverage by private health plans varies tremendously. Even though coverage for basic prostheses may be included in a plan, many insurance companies will cap payouts for devices and impose restrictions on the types of devices approved.
Photo: ThisisEngineering/Unsplash
But when his leg needed replacing last January after about five years of everyday use, his new marketplace health plan wouldn’t authorize it. The roughly $50,000 leg with the electronically controlled knee wasn’t medically necessary, the insurer said, even though Colorado law leaves that determination up to the patient’s doctor, and his has prescribed a version of that leg for many years, starting when he had employer-sponsored coverage.
“The electronic prosthetic knee is life-changing,” said Adams, who lives in Lafayette, Colorado, with his wife and two kids. Without it, “it would be like going back to having a wooden leg like I did when I was a kid.” The microprocessor in the knee responds to different surfaces and inclines, stiffening up if it detects movement that indicates its user is falling.
People who need surgery to replace a joint typically don’t encounter similar coverage roadblocks. In 2021, 1.5 million knee or hip joint replacements were performed in United States hospitals and hospital-owned ambulatory facilities, according to the federal Agency for Healthcare Research and Quality, or AHRQ. The median price for a total hip or knee replacement without complications at top orthopedic hospitals was just over $68,000 in 2020, according to one analysis, though health plans often negotiate lower rates.
To people in the amputee community, the coverage disparity amounts to discrimination.
Fewer than half of people with limb loss have been prescribed a prosthesis
“Insurance covers a knee replacement if it’s covered with skin, but if it’s covered with plastic, it’s not going to cover it,” said Jeffrey Cain, a family physician and former chair of the board of the Amputee Coalition, an advocacy group. Cain wears two prosthetic legs, having lost his after an airplane accident nearly 30 years ago.
AHIP, a trade group for health plans, said health plans generally provide coverage when the prosthetic is determined to be medically necessary, such as to replace a body part or function for walking and day-to-day activity. In practice, though, prosthetic coverage by private health plans varies tremendously, said Ashlie White, chief strategy and programs officer at the Amputee Coalition. Even though coverage for basic prostheses may be included in a plan, “often insurance companies will put caps on the devices and restrictions on the types of devices approved,” White said.
An estimated 2.3 million people are living with limb loss in the U.S., according to an analysis by Avalere, a health care consulting company. That number is expected to as much as double in coming years as people age and a growing number lose limbs to diabetes, trauma, and other medical problems.
Fewer than half of people with limb loss have been prescribed a prosthesis, according to a report by the AHRQ. Plans may deny coverage for prosthetic limbs by claiming they aren’t medically necessary or are experimental devices, even though microprocessor-controlled knees like Adams’ have been in use for decades.
Cain was instrumental in getting passed a 2000 Colorado law that requires insurers to cover prosthetic arms and legs at parity with Medicare, which requires coverage with a 20% coinsurance payment. Since that measure was enacted, about half of states have passed “insurance fairness” laws that require prosthetic coverage on par with other covered medical services in a plan or laws that require coverage of prostheses that enable people to do sports. But these laws apply only to plans regulated by the state. Over half of people with private coverage are in plans not governed by state law.
The Medicare program’s 80% coverage of prosthetic limbs mirrors its coverage for other services. Still, an October report by the Government Accountability Office found that only 30% of beneficiaries who lost a limb in 2016 received a prosthesis in the following three years.
Cost is a factor for many people.
“No matter your coverage, most people have to pay something on that device,” White said. As a result, “many people will be on a payment plan for their device,” she said. Some may take out loans.
Working with her doctor, she has appealed the decision to her insurer and been denied three times.
The federal Consumer Financial Protection Bureau has proposed a rule that would prohibit lenders from repossessing medical devices such as wheelchairs and prosthetic limbs if people can’t repay their loans.
“It is a replacement limb,” said White, whose organization has heard of several cases in which lenders have repossessed wheelchairs or prostheses. Repossession is “literally a punishment to the individual.”
Adams ultimately owed a coinsurance payment of about $4,000 for his new leg, which reflected his portion of the insurer’s negotiated rate for the knee and foot portion of the leg but did not include the costly part that fits around his stump, which didn’t need replacing. The insurer approved the prosthetic leg on appeal, claiming it had made an administrative error, Adams said.
“We’re fortunate that we’re able to afford that 20%,” said Adams, who is a self-employed leadership consultant.
Leah Kaplan doesn’t have that financial flexibility. Born without a left hand, she did not have a prosthetic limb until a few years ago.
Growing up, “I didn’t want more reasons to be stared at,” said Kaplan, 32, of her decision not to use a prosthesis. A few years ago, the cycling enthusiast got a prosthetic hand specially designed for use with her bike. That device was covered under the health plan she has through her county government job in Spokane, Washington, helping developmentally disabled people transition from school to work.
But when she tried to get approval for a prosthetic hand to use for everyday activities, her health plan turned her down. The myoelectric hand she requested would respond to electrical impulses in her arm that would move the hand to perform certain actions. Without insurance coverage, the hand would cost her just over $46,000, which she said she can’t afford.
Working with her doctor, she has appealed the decision to her insurer and been denied three times. Kaplan said she’s still not sure exactly what the rationale is, except that the insurer has questioned the medical necessity of the prosthetic hand. The next step is to file an appeal with an independent review organization certified by the state insurance commissioner’s office.
A prosthetic hand is not a luxury device, Kaplan said. The prosthetic clinic has ordered the hand and made the customized socket that will fit around the end of her arm. But until insurance coverage is sorted out, she can’t use it.
At this point she feels defeated. “I’ve been waiting for this for so long,” Kaplan said.
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.
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This article first appeared on KFF Health News and is republished here under a Creative Commons license.
CHICAGO - The federal government is launching a new program to help hospitals struggling to stay afloat in rural Illinois.
Severe financial problems have put 360 rural hospitals nationwide at immediate risk of closing. Fifteen rural Illinois hospitals have closed since 2015, according to a Center for Healthcare Quality and Payment Reform report.
Rural hospital closures can negatively affect the nation's food supply and energy production
The National Rural Health Resource Center is launching the federal Rural Hospital Stabilization pilot program to prevent further closings.
Alyssa Meller, chief operating officer of the pilot program, outlined its objectives.
"It is a program that's aiming to improve the health care in rural communities by really helping keep health care services available locally to increase patient volume and improve revenue," Meller explained.
The report showed rural hospital closures can negatively affect the nation's food supply and energy production. Farms and solar energy facilities are located mostly in rural areas. Those without health care facilities have a hard time attracting and retaining workers.
Meller noted several things contribute to hospitals' financial woes, including people bypassing local services and going elsewhere, fixed costs exceeding reimbursement rates from Medicare and Medicaid, and a lack of services tailored to meet community needs.
"This program then will help stabilize their current service line but also will help them dive into what is needed at that local level and provide technical assistance and support," Meller added.
The report indicated of Illinois's 74 rural hospitals, 10 are at risk of closing, and six are at immediate risk of closing. Meller said the program will also help engage the hospitals' communities to promote services. The application period ends Jan. 15.
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The combination of soaring heat and smothering fine particulate pollution may double the risk of heart attack death, according to a new study of more than 202,000 heart attack deaths in China. The study published today in the American Heart Association’s flagship journal Circulation.
ST. JOSEPH - St. Joseph-Ogden's Tyler Hess is congratulated by teammates after scoring a goal in the first half. The junior led the team to a 5-3 win over University High on Wednesday at Dick Duval Field. Hess, who is the top finisher in the area with a hat trick in the team's first three matches this season, will try to make it four in a row in the undefeated Spartans' road game against the Vermilion Valley Conference's Hoopeston Area Cornjerkers on Friday. More photos and a game recap coming soon.
