Main Street Independent

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ACA, Medicaid, and Healthcare Coverage Crisis

Expiration of enhanced ACA subsidies, Republican Medicaid work mandates, and millions at risk of losing health coverage

DOJ secures 6 healthcare fraud convictions in 3 weeks

Illustration accompanying article: DOJ secures 6 healthcare fraud convictions in 3 weeks
  • The Justice Department secured convictions of six people across five states between May 13 and June 1 for healthcare fraud totaling approximately $1.1 billion in fraudulent billing, according to a department press release.
  • The largest scheme, run by Brett Blackman and his company HealthSplash, generated more than $1 billion in false claims for medically unnecessary orthopedic braces; Medicare paid over $450 million.
  • Dr. Violetta Mailya billed Medicare $24 million for Botox injections she never administered, including $19 million while her clinic was closed.
  • Tony Brown-Arkah operated a Brooklyn substance abuse clinic that prescribed Suboxone and then repurchased the drug from patients, generating over $52 million in false Medicare and Medicaid claims.
  • Heather Marks, a nurse practitioner, prescribed nearly one million opioid pills to almost 1,000 pain clinic patients in Tennessee.
 3 MIN READ

Democratic-led states sue to block student loan caps for nursing, health degrees

Illustration accompanying article: Democratic-led states sue to block student loan caps for nursing, health
  • Twenty-four Democratic-led states and the District of Columbia sued the federal government to block new caps on federal student loans for graduate health professions degrees, arguing the limits will worsen a national nursing shortage.
  • The caps, set to take effect July 1, limit nursing and other non-physician graduate students to borrowing $20,500 per year with a $100,000 total, while professional medical students face a $50,000 annual and $200,000 total cap.
  • A study in Health Affairs Scholar found that more than a quarter of advanced practice nurses with loans already have balances exceeding the $100,000 limit.
  • Coby Rodriguez, a Johns Hopkins nursing graduate, said the caps will force him to delay his nurse anesthetist program by three to four years because he lacks a co-signer for private loans carrying interest rates up to 18%.
 4 MIN READ
Illustration accompanying article: ACA enrollment projected to drop by nearly 5 million as costs spike

Connecticut comptroller urges realistic Medicaid budgets as federal cuts loom

2026-01-06

Connecticut State Comptroller Sean Scanlon on Monday warned the state legislature it must adopt more realistic Medicaid budgets, saying surging program costs and looming federal funding cuts threaten health coverage for roughly 1 million state residents. Scanlon said 60% of the state's current overspending problem is concentrated in Medicaid, and called on state officials to stop authorizing amounts that ignore clear demand growth trends.

Connecticut comptroller urges legislature to budget more realistically for Medicaid

2026-01-05

Connecticut Comptroller Sean Scanlon urged state lawmakers on Monday to craft more realistic Medicaid budgets as surging costs and expiring federal aid threaten Connecticut’s finances. He warned that “60%” of the state’s overspending is tied to Medicaid and said officials should review all options to ensure about a million people can keep getting health care.

ACA health subsidies expire, leaving millions facing sharply higher premiums in 2026

2026-01-01

Enhanced tax credits that reduced health insurance costs for more than 20 million Affordable Care Act enrollees expired at midnight Wednesday, beginning 2026 with premium increases averaging 114% for subsidized participants, according to an analysis by the health care research nonprofit KFF. The expiration affects self-employed workers, small business owners, farmers, and others who purchase coverage on the individual market and do not qualify for Medicaid or Medicare.

Adult immigrants in Minnesota lose MinnesotaCare coverage starting Jan. 1

2026-01-01

Adult immigrants in Minnesota lost access to state-funded health care on Jan. 1, after the state ended MinnesotaCare benefits for most people who entered the country illegally. The change affects about 15,000 adults statewide, according to the Minnesota Department of Human Services.

Health insurance subsidies tied to Affordable Care Act expire for millions

2026-01-01

Millions of Americans who buy health plans through the Affordable Care Act are set to see higher premium costs in 2026 after enhanced tax credits expired overnight, the Associated Press reported. The change affects people who do not get coverage through an employer and do not qualify for Medicaid or Medicare, including many self-employed workers and small-business owners.

Vermont provides millions for nursing home bailouts as beds shrink

2025-12-31

Vermont has used “extraordinary financial relief” backed by Medicaid dollars to help nursing homes stay afloat as the state’s long-term care system shrank, according to state records obtained by VTDigger and reported by The Associated Press. The program has delivered about $38 million over the past five years, and lawmakers have asked for detailed reports and payment records. State health officials say without it, Vermont would have lost even more bed capacity for elderly residents.