Tradeoffs

Tradeoffs

@tradeoffs.org

Journalism that explores the complicated, costly, and often counterintuitive world of health care. New podcast episodes every Thursday, hosted by Dan Gorenstein. Subscribe to our weekly newsletter: tradeoffs.org/subscribe

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Today at 2 p.m. ET/11 a.m. PT, @dgorenstein.bsky.social moderates a virtual event about presumptive eligibility with Melanie Evans, @kffhealthnews.org's Noam Levey, and policymakers and hospital leaders in Oregon and Los Angeles. Register: us02web.zoom.us/webinar/regi...

us02web.zoom.usWelcome! You are invited to join a webinar: “An Emerging Tool to Prevent Medical Debt”: A live event from Tradeoffs, in partnership with KFF. After registering, you will receive a confirmation email about joining the webinar.Most hospitals offer financial assistance to patients who struggle to afford their bills, often referred to as charity care. But many people are stymied by cumbersome aid applications. Others don’t even know help exists. Hospitals can proactively screen patients to see if they’re eligible for aid and, if so, automatically wipe out or reduce their bills — a process known as presumptive eligibility. A growing number of state policymakers and researchers believe requiring hospitals to use presumptive eligibility would protect low-income Americans from falling into medical debt, especially with federal funding cuts expected to increase the number of people without health insurance. Some hospital leaders resist new requirements, arguing in part that they put unfair responsibility on hospitals to address rising patient costs and a shrinking safety net. Oregon passed the most comprehensive presumptive eligibility law in 2023. A similar law in California — originally opposed by hospitals — is set to take effect in July 2027. Los Angeles County public health officials have been working with local hospitals to make the new rules easier for them to implement. In this live virtual event, KFF Health News senior correspondent Noam Levey and Tradeoffs reporter Melanie Evans will share their reporting about this emerging policy solution and the challenges that remain. They will be joined by policymakers and hospital officials from Oregon and Los Angeles, who will share their experiences, obstacles they faced and lessons learned. Panelists: - Melanie Evans, Reporter and Producer, Tradeoffs - Noam N. Levey, Senior Correspondent, KFF Health News - Lisa Reynolds, Pediatrician, Oregon State Senator - Vardan Shamamyan, Staff Analyst, Los Angeles County Department of Public Health - Adena Tessler, Regional Vice President, Los Angeles, Hospital Association of Southern California

The Trump administration has tried repeatedly to upend health care research in the U.S. But the quiet decimation of the Agency for Healthcare Research and Quality has many academics deeply concerned. Listen to today's episode of Tradeoffs:

tradeoffs.orgReimagining the Future of Health Research After Sweeping CutsThe Trump administration’s decimation of the Agency for Healthcare Research and Quality has many academics deeply concerned.

In the second episode of our special series on medical debt with @kffhealthnews.org, we explore lessons from Oregon’s aggressive legislation to push hospitals to prevent patients from falling into medical debt. Listen now:

tradeoffs.orgHidden Help: What Happened When Oregon Forced Hospitals to Boost Financial Aid?In the second episode of our special series on medical debt, we explore lessons from Oregon’s aggressive legislation to push hospitals to prevent patients from falling into medical debt.

Hospitals can automatically wipe out the cost of care for low-income patients. A Tradeoffs analysis finds that hospitals in Texas could be doing more to protect people from unaffordable bills. Part of our new Hidden Help series with @kffhealthnews.org.

tradeoffs.orgHidden Help: A New Push for Hospitals to Prevent Medical DebtHospitals can automatically wipe out the cost of care for low-income patients. A Tradeoffs analysis finds that hospitals in Texas could be doing more to protect people from unaffordable bills.

"Hidden Help" is a new investigative series from Tradeoffs and @kffhealthnews.org about how hospitals can protect their patients from the life-altering harms of medical debt. Read the first story to learn what presumptive eligibility is and how it works:

tradeoffs.orgHidden HelpAn investigative series from Tradeoffs and KFF Health News about how hospitals can protect their patients from the life-altering harms of medical debt.

Tradeoffs and @pennldi.bsky.social co-hosted a conversation with three state Medicaid officials to push past the political talking points and understand the state perspective on all the anti-fraud energy coming out of Washington. Listen to the special live episode:

tradeoffs.orgStates Weigh In on Medicaid FraudA live conversation with a bipartisan group of state Medicaid leaders on the impact of the Trump administration’s aggressive anti-fraud push.

911 calls related to mental health are most likely to involve police use of force. A new book by Rebecca Neusteter offers a blueprint for a 911 redesign. We spoke with her and a Texas sheriff who describes how he’s seen 911 fail his community. Listen:

tradeoffs.org911 Fails People in Mental Health Crises. Here's a Plan to Fix It.911 calls related to mental health are the most likely to involve police use of force. A new book offers a blueprint for a 911 redesign that could save lives.

Join us and @pennldi.bsky.social today from 12:30-1:30 p.m. ET as a bipartisan panel of state Medicaid leaders share their perspectives on how they handle fraud, and the opportunities and challenges of the Trump administration’s aggressive anti-fraud push. Register:

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The Trump administration says states aren’t doing enough to combat Medicaid fraud. States face demands for more data, frozen Medicaid payments and cuts to anti-fraud funding. What are the opportunities, challenges and tradeoffs? Join us + @pennldi.bsky.social on 9/17: tradeoffs.org/event/decodi...

tradeoffs.orgDecoding the Moment: States Weigh in on Medicaid FraudHow much fraud is there and how do states try to prevent and prosecute it? In the next virtual event in the “Decoding the Moment” series, our panel of state Medicaid leaders will share their perspecti...

Cash-strapped states and struggling families are wrestling with the consequences of major reforms to the SNAP program passed as part of Republicans’ Big Beautiful Bill. Listen to today's episode of Tradeoffs to meet one man living with the consequences. tradeoffs.org/2026/09/10/a...

tradeoffs.orgAs SNAP Shrinks, What's the Future of Food Aid in America?Cash-strapped states and struggling families are wrestling with the consequences of major reforms to the SNAP program passed as part of President Trump’s Big Beautiful Bill.

In a live conversation recorded at Aspen Ideas: Health, executives from a hospital, insurer and pharmacy join a top Trump administration official and leading health economist to discuss how to collectively bring down health care costs. Listen to the Tradeoffs episode: tradeoffs.org/2026/09/03/b...

tradeoffs.orgBeyond Finger Pointing: The Fight to Lower Health Care CostsIn a live conversation recorded at Aspen Ideas: Health, executives from a hospital, insurer and pharmacy join a top Trump administration official and leading health economist to discuss how to collect...

Listen to a candid conversation between a professor and a Ph.D. candidate about potential funding cuts from the National Institutes of Health and their impact on the future of medical research.

tradeoffs.orgThe Cost of Cutting NIH Research: Voices from the FrontlinesA candid conversation between a professor and a Ph.D. candidate about potential NIH funding cuts and their impact on the future of medical research.

Trump has nominated former health care executive Chris Klomp to help RFK Jr. get his health agenda back on track. With senators set to consider the nomination, we're bringing back our conversation with @ddiamond.bsky.social, who profiled Klomp in March. Listen:

tradeoffs.orgTrump's Pick to Quiet the Chaos at HHSThe administration is looking to former health care executive Chris Klomp to help RFK Jr. get Trump’s health agenda back on track.

Under new federal rules signed into law last year, ~20M people in 44 states will need to work, volunteer or attend school 80 hours per month to keep their Medicaid benefits. In Nebraska, these changes have already launched. We spoke to @marketplace.org about what these updates mean: bit.ly/45xNyik

marketplace.orgRoughly 200 people in Nebraska lost Medicaid on Aug. 1It’s the first wave of terminations under new federal work requirements. And it may portend what’s to come for the rest of the country.

Nebraska Medicaid Director Drew Gonshorowski says the state’s data capabilities put it in a strong position to quickly implement the historic changes. Advocates and researchers warn that eligible people may still fall through the cracks. tradeoffs.org/2026/07/30/m...

tradeoffs.orgMeet the Man Launching Trump's Medicaid Work Requirements Months EarlyNebraska Medicaid Director Drew Gonshorowski says the state’s data capabilities put it in a strong position to quickly implement the historic changes. Advocates and researchers warn that eligible peop...

Meet Giovannina Anthony—she's spent the last four years juggling her work as an gynecologist and abortion provider in Wyoming with the new task of suing state lawmakers to keep abortion legal.

tradeoffs.orgA Wyoming Doctor’s Fight to Keep Abortion Legal in Her Deep Red StateGiovannina Anthony has spent the last four years juggling her work as an gynecologist and abortion provider in Wyoming with the new task of suing state lawmakers to keep abortion legal.

Today, listen to a deep dive on the unique mental health challenges faced by immigrants in America, produced by Call to Mind from American Public Media.

tradeoffs.orgCall to Mind: Immigration and the Challenge to BelongA deep dive on the unique mental health challenges faced by immigrants in America, produced by Call to Mind from American Public Media.

Tradeoffs reposted

@lizzylawrence.bsky.social

Thank you @dgorenstein.bsky.social and @lesliemwalker.bsky.social for featuring my FDA reporting on @tradeoffs.org! It was a great conversation. Listen to the podcast episode here: tradeoffs.org/2026/07/09/a...

tradeoffs.orgAs Drama at Trump's FDA Subsides, Doubts and Damage LingerWe talk with STAT News reporter Lizzy Lawrence about the agency’s recent turmoil and its hunt for a new leader.

From approving controversial products to losing thousands of staff, President Trump's Food and Drug Administration has been mired in controversy. Tradeoffs sat down with @statnews.com journalist @lizzylawrence.bsky.social_ who’s had a front row seat to that chaos. Listen to today's episode:

tradeoffs.orgAs Drama at Trump's FDA Subsides, Doubts and Damage LingerWe talk with STAT News reporter Lizzy Lawrence about the agency’s recent turmoil and its hunt for a new leader.

Americans have nearly $200 billion in unpaid medical bills in collections. “If a debt collector is calling you up or is knocking on your door, more than half of the time, it’s for medical debt,” said economist @nealemahoney.bsky.social.

tradeoffs.orgWith Millions Expected to Lose Coverage, States Look for New Ways to Prevent Medical DebtEconomist Neale Mahoney explains the latest research on solutions to medical debt and evaluates policy fixes designed to protect consumers.

How do you make good health care decisions when the science isn’t clear? @dgorenstein.bsky.social explored this question in a live conversation at @aspenideas.bsky.social: Health. Listen now: tradeoffs.org/2026/07/02/m...

tradeoffs.orgMaking Medical Decisions with Uncertain ScienceTwo physicians and an ethicist discuss how to make the best decisions in areas like artificial intelligence and gender-affirming care when there is limited evidence in a live conversation recorded at ...

In the today's Tradeoffs episode, two physicians and an ethicist discuss how to make the best decisions in areas like artificial intelligence and gender-affirming care when there is limited evidence in a live conversation recorded at Aspen Ideas: Health @aspenideas.bsky.social.

tradeoffs.orgMaking Medical Decisions with Uncertain ScienceTwo physicians and an ethicist discuss how to make the best decisions in areas like artificial intelligence and gender-affirming care when there is limited evidence in a live conversation recorded at Aspen Ideas: Health.

Economist @nealemahoney.bsky.social explains the research into strategies for relief from high healthcare costs and evaluates policy fixes to protect consumers. Listen to the episode: tradeoffs.org/2026/06/25/w...

tradeoffs.orgWith Millions Expected to Lose Coverage, States Look for New Ways to Prevent Medical DebtEconomist Neale Mahoney explains the research into strategies for relief from high healthcare costs and evaluates policy fixes to protect consumers.

The No Suprises Act has stopped patients from receiving unexpected charges from doctors who were not covered by a patient’s insurance, even though they worked at covered hospitals. There were unexpected impacts—we discussed them with national experts. tradeoffs.org/2026/06/11/w...

tradeoffs.orgWhere Did the No Surprises Act Go Wrong? And Can It Be Fixed?A live conversation with national experts about the unexpected impacts of the consumer protection law, what could be done to change things, and what lessons can be learned about crafting complicated h...

States are enrolling people leaving prison and jail in Medicaid, the health insurance program for low-income and disabled Americans. But funding cuts and program changes required by H.R. 1 are likely to shape the future of this bipartisan experiment.

tradeoffs.orgMedicaid Overhaul Complicates States’ Plans to Bring Care Into Jails and PrisonsFunding cuts and program changes required by H.R. 1 are forcing states to make hard choices about the future of this bipartisan experiment.

Tradeoffs and @pennldi.bsky.social talked to Zack Cooper, @benchartock.bsky.social & Lindsey Murtagh about the unexpected impacts of the consumer protection law, what could be changed, and what lessons can be learned. Listen to today's special live episode:

tradeoffs.orgWhere Did the No Surprises Act Go Wrong? And Can It Be Fixed?A live conversation with national experts about the unexpected impacts of the consumer protection law, what could be done to change things, and what lessons can be learned about crafting complicated health policy.

Mental health courts offer treatment as an alternative to incarceration. But critics say they have outpaced research on their effectiveness. tradeoffs.org/2026/06/04/m...

tradeoffs.orgMental Health Courts Offer People Facing Prison an Imperfect AlternativeHundreds of U.S. courts offer treatment over prison for some defendants with mental illness. But critics say mental health courts have outpaced research on their effectiveness.

For more than a half century, health care spending in the U.S. has steadily gone up. But, over roughly the last 15 years, something unprecedented has happened—our health care spending slowed down. tradeoffs.org/2026/05/14/t...

tradeoffs.orgThe U.S. Saved $1 Trillion on Health Care. Why Doesn't It Feel Like It?New research from leading health economist David Cutler explores what’s behind a historic slowdown in health spending, even as millions of Americans struggle to afford their care.

Hundreds of U.S. courts offer treatment over prison for some defendants with mental illness. @gracehauck.bsky.social and Josh McGhee investigated mental health courts in Illinois for @mindsitenews.bsky.social and the @illinoisanswers.bsky.social. Listen to our conversation with Hauck:

tradeoffs.orgMental Health Courts Offer People Facing Prison an Imperfect AlternativeHundreds of U.S. courts offer treatment over prison for some defendants with mental illness. But critics say mental health courts have outpaced research on their effectiveness.

Tradeoffs reposted

@gracehauck.bsky.social

Today's @tradeoffs.org podcast episode features our @illinoisanswers.bsky.social @mindsitenews.bsky.social reporting on mental health courts, with context from Dr. Debra Pinals, a forensic psychiatrist who has spent 20 years studying + working in mental health courts. tradeoffs.org/2026/06/04/m...

tradeoffs.orgMental Health Courts Offer People Facing Prison an Imperfect AlternativeHundreds of U.S. courts offer treatment over prison for some defendants with mental illness. But critics say mental health courts have outpaced research on their effectiveness.

Health policy changed quickly in 2025. From Medicaid and Affordable Care Act subsidies to vaccine policy and health care affordability, Tradeoffs helped audiences understand what was changing, why it mattered and what might work better. Explore the 2025 Impact Report: tradeoffs.org/2025-impact-...

tradeoffs.org2025 Impact ReportExplore the stories, people and partnerships that shaped Tradeoffs’ work during a year of extraordinary change.

High health care costs remain top of mind for many Americans. And yet, one of the best tools we have to rein in those costs is also the most hated: prior authorization. We took a closer look at the pros and the cons of this polarizing policy. Listen:

tradeoffs.orgA Closer Look at a Widely Despised Health Insurance PolicyEvery year, millions of people’s medical care runs into the roadblock known as prior authorization, which requires a patient’s health insurer to sign off before chemotherapy, surgery or countless other services can proceed. Who does this often onerous process help, who does it hurt and how could it work better for everyone?

Tradeoffs reposted

@pennldi.bsky.social

🎧LISTEN: LDI Fellow @aschwartz.bsky.social discusses the benefits and challenges of prior authorization in this episode of the @tradeoffs.org podcast.

Tradeoffs@tradeoffs.org

Every year, millions of people’s medical care runs into the roadblock known as prior authorization. Who does this often onerous process help, who does it hurt and how could it work better for everyone?

tradeoffs.orgA Closer Look at a Widely Despised Health Insurance PolicyEvery year, millions of people’s medical care runs into the roadblock known as prior authorization, which requires a patient’s health insurer to sign off before chemotherapy, surgery or countless other services can proceed. Who does this often onerous process help, who does it hurt and how could it work better for everyone?

Every year, millions of people’s medical care runs into the roadblock known as prior authorization. Who does this often onerous process help, who does it hurt and how could it work better for everyone?

tradeoffs.orgA Closer Look at a Widely Despised Health Insurance PolicyEvery year, millions of people’s medical care runs into the roadblock known as prior authorization, which requires a patient’s health insurer to sign off before chemotherapy, surgery or countless other services can proceed. Who does this often onerous process help, who does it hurt and how could it work better for everyone?

With Republicans in control of Washington and health costs on the rise, there’s new momentum behind an old conservative policy: Put more cash in patients’ hands and let them buy their own health care.

tradeoffs.orgRepublicans Want to Change How You Buy Health CarePresident Trump and other leading conservatives are pushing policies they hope will empower patients to shop more wisely for the health care they need.

⏰ Last chance to register Join us and @pennldi.bsky.social today for a discussion about why the No Surprises Act has failed to deliver on its cost-cutting promise, what could be done to change things, and whether there are larger lessons for future policy change.

ldi.upenn.eduDecoding the Moment: Can the No Surprises Act Be Fixed?National experts will discuss why the No Surprises Act has failed to deliver on its cost-cutting promise, what could be done to change things, and whether there are larger lessons for future policy change.

Economist David Cutler has advised multiple presidents on health policy and was a key voice in crafting Obamacare. When he published a splashy new paper suggesting that America has actually saved money on health care, Tradeoffs had to give him a call.

tradeoffs.orgThe U.S. Saved $1 Trillion on Health Care. Why Doesn't It Feel Like It?New research from leading health economist David Cutler explores what’s behind a historic slowdown in health spending, even as millions of Americans struggle to afford their care.

President Trump and other leading conservatives are pushing policies they hope will empower patients to shop more wisely for the health care they need. In today's episode, we break down the pros, the cons and the evidence behind these policies. Listen:

tradeoffs.orgRepublicans Want to Change How You Buy Health CarePresident Trump and other leading conservatives are pushing policies they hope will empower patients to shop more wisely for the health care they need.

Tradeoffs reposted

@pennldi.bsky.social

Can the No Surprises Act be fixed? Join us and @tradeoffs.org on May 26 for a virtual conversation on why the law succeeded in protecting patients from surprise bills, but may be falling short on lowering costs. https://ldi.upenn.edu/events/decoding-the-moment-can-the-no-surprises-act-be-fixed/

ldi.upenn.eduDecoding the Moment: Can the No Surprises Act Be Fixed?National experts will discuss why the No Surprises Act has failed to deliver on its cost-cutting promise, what could be done to change things, and whether there are larger lessons for future policy ch...

Can GLP-1s save employers money in the long run? Tradeoffs Reporter and Producer Julie Wernau joined The Indicator podcast from @npr.org @planetmoney.bsky.social to discuss her reporting on GLP-1s. Listen now:

open.spotify.comWhy GLP-1s aren't lowering employers' costsThe Indicator from Planet Money · Episode

Tradeoffs reposted

@jessicabari.bsky.social

Has been thrilling to share Call to Mind w @mprnews.org listeners all week. This morning we end w a jewel. In Call to Mind: The Fifth Branch, @tradeoffs.org takes us to a city that's reimagined their crisis-response system. Incredible reporting. 9AM on MPR NEWS. 📻 = 91.1 🎧 = www.mprnews.org/listen

New research from leading health economist David Cutler explores what’s behind a historic slowdown in health spending, even as millions of Americans struggle to afford their care. Listen: tradeoffs.org/2026/05/14/t...

tradeoffs.orgThe U.S. Saved $1 Trillion on Health Care. Why Doesn't It Feel Like It?New research from leading health economist David Cutler explores what’s behind a historic slowdown in health spending, even as millions of Americans struggle to afford their care.

The latest episode of Tradeoffs is a collaboration with American Public Media’s Call to Mind, highlighting how Durham, North Carolina, has reimagined its mental health crisis response system — and what it has learned. Listen now or read the transcript: tradeoffs.org/2026/05/07/c...

tradeoffs.orgCall to Mind: The Fifth BranchA collaboration with American Public Media’s Call to Mind highlighting how Durham, North Carolina, has reimagined its mental health crisis response system — and what it has learned.

Many people cheered in 2020 when Congress passed a wildly popular bill to protect patients from big, out of the blue health care bills. But new reporting by @nytimes.com finds some doctors keep sending big bills, and keep getting paid. tradeoffs.org/2026/04/30/d...

tradeoffs.orgDoctors Hated the No Surprises Act. Now Some Are Getting Rich Off of It.Doctors are winning big paydays from insurers under a law intended to protect patients and rein in high prices.

Tradeoffs reposted

@jessicabari.bsky.social

Happy #mentalhealthawarenessmonth! I’m celebrating with FIVE new public radio specials from Call to Mind 💚. Listen for them on your public radio station or subscribe to our new podcast channel! New episodes drop each Wednesday! www.calltomindnow.org/mental-healt... www.calltomindnow.org/podcast

Doctors are winning big paydays from insurers under a law intended to protect patients and rein in high prices. @nytimes.com reporter Margot Sanger-Katz @sangerkatz.bsky.social talked with Tradeoffs about how this is fueling higher premiums. Listen to the episode: tradeoffs.org/2026/04/30/d...

tradeoffs.orgDoctors Hated the No Surprises Act. Now Some Are Getting Rich Off of It.Doctors are winning big paydays from insurers under a law intended to protect patients and rein in high prices.

New York’s Medicaid chief Amir Bassiri is navigating the new challenge of work requirements, "Our mission is to provide widespread coverage and access to low-income New Yorkers," he said. "...We’re not going to let them tear down what we’ve built."

tradeoffs.orgNew York Braces for Trump's Big Medicaid ShakeupThe state’s Medicaid director Amir Bassiri shares his plans for blunting the effects of Republican health reforms — starting with work requirements.

New York is bracing for Trump's big Medicaid shakeup. The state's Medicaid director Amir Bassiri shares his plans for blunting the effects of Republican health reforms — starting with work requirements.

tradeoffs.orgNew York Braces for Trump's Big Medicaid ShakeupThe state’s Medicaid director Amir Bassiri shares his plans for blunting the effects of Republican health reforms — starting with work requirements.

From obesity management programs to rebates and apps, employers are experimenting with new approaches to make GLP-1 costs more sustainable. tradeoffs.org/2026/04/16/g...

tradeoffs.orgGLP-1s Are Busting Employer Budgets. Some Are Getting Creative to Lower Costs.From obesity management programs to rebates and apps, employers are experimenting with new approaches to make GLP-1 costs more sustainable.

As demand for new weight loss drugs soars, some employers are making workers track their diet and exercise in hopes of limiting use and keeping costs down. What's it’s like for employees who must prove they deserve obesity drugs?

tradeoffs.orgShould People Who Want GLP-1s Have to Work for Them?As demand for new weight loss drugs soars, some employers are making workers track their diet and exercise in hopes of limiting use and keeping costs down.