Readers Scrutinize Federal Cuts and Medical Debt

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Trump Team’s Rhetoric Doesn’t Match Actions

The recent KFF Health News article “Beyond Ivy League, RFK Jr.’s NIH Slashed Science Funding Across States That Backed Trump” (April 17) struck a nerve. The rapid succession of suspended National Institutes of Health grants that swept the country shortly after President Donald Trump’s election have left us struggling to understand why such vital research — the bedrock of our ability to support the public’s health — would be treated as unnecessary or, worse, harmful.

People often think research, per se, doesn’t directly affect them. But research forms the basis for what we know will best work to treat, prevent, and manage illness, from chronic diseases such as diabetes, hypertension, and HIV, to mental health disorders. In addition to basic and applied research, NIH grants provide services directly to individuals and families, and they build community-based systems of care for its residents. We all benefit.

One area where federally funded research and programs have been especially impactful is in addressing the substance use crisis in America. With relatively modest investments, addiction science has led to enormous personal, societal, and economic benefits. Accomplishments include the treatments we use to break the cycle of addiction for millions of people, strategies for communities to support families with substance-related problems, prevention programs that divert youth away from substance use, and policies that reduce crime, suicide, overdose, and substance-related conditions like hepatitis and liver disease. Although we’re not done yet by any measure, these accomplishments have produced considerable returns on investment in personal and economic terms that are now at risk.

Out of a high level of concern, a group of career scientists formed the Addiction Science Defense Network to protect addiction research and evidence-based practice from actions by this administration. The number of researchers, practitioners, people with lived experience, and national organizations expressing their support for ASDN’s mission is growing into the hundreds. The Trump administration touts its commitment to reducing addiction, but its action don’t match the rhetoric. By curtailing research and funding for science-based solutions, we are practically assuring that the problem will continue to worsen over time. And, as underscored in Rae Ellen Bichell and Rachana Pradhan’s article, given that rates of drug overdose are highest in red states, predictions are that Trump supporters may suffer most of all.

— Diana Fishbein, Nova Institute for Health scholar, ASDN Coordinating Committee member, and University of North Carolina senior scientist, Chapel Hill, North Carolina

Staying Afloat Amid Federal Funding Cuts

Your article “Moms in Crisis, Jobs Lost: The Human Cost of Trump’s Addiction Funding Cuts” (April 25) mentioned that the Niyyah Recovery Initiative may be affected by losing federal funding. But it has been provided a state grant not associated with federal money in the sum of $200,000 a year through 2027. Presumptive speculation on how its services would be affected should have been disclosed.

— John Smythe, Fort Lauderdale, Florida

Count the Blessings of Direct Primary Care

While I am almost always a fan of the work that KFF Health News and NPR publish, particularly together, the article “In Rural Massachusetts, Patients and Physicians Weigh Trade-Offs of Concierge Medicine” (April 16) contained a mischaracterization that was pretty disappointing.

The author suggests, and a photo caption states, that “direct primary care is similar to concierge medicine but does not accept insurance.” While it’s true DPC patients and concierge patients both pay membership fees, they couldn’t be more different. The membership fee for concierge practices just gets you in the door — patients still pay copays/coinsurance or, in some cases, full out-of-network price, for every service. With direct primary care, your monthly cost — typically (I’ll hedge, though I haven’t seen any exceptions) — includes unlimited visits, in-house procedures and tests, and telemedicine appointments. Many even offer the ability to text-message your doctor when you need medical advice on a more urgent basis.

I’m not affiliated with the DPC industry in any way, I’m just a former patient. DPC changed my life. I felt for the first time as an adult (I am 33) as if I had actual, genuine health care. Not worrying about the drudgery of fee-for-service meant I didn’t hesitate to get, say, tested for flu and covid-19 when I had a respiratory illness, have skin issues looked at, or finally get care for long-standing issues. The fact that I had a high-deductible health plan only rarely mattered. For $100 a month, it was an absolute steal, and I was a cheerleader for everyone in my area who could afford it. At least a few folks who were uninsured or severely underinsured got health care thanks to that practice, which unfortunately is no longer serving primary care.

DPC has its thorns. Certainly, not everyone can afford a monthly fee. Access can be limited by capped patient loads. But, on the whole, DPC is a blessing for many people, and it’s simply unfair to paint it with the same brush as concierge medicine. I hope to see better from KFF Health News and its partners in the future.

— James Joyce, Opelika, Alabama

— Ian Carter, Hillsboro, Oregon

Some Medical Debt Is Clearly Fraud

Be aware that false unpaid medical bills are sold to collection companies in bulk along with legitimate paid charges (“Diagnosis: Debt: Blockbuster Deal Will Wipe Out $30 Billion in Medical Debt. Even Backers Say It’s Not Enough,” April 7).

I went through cancer treatment in 2023. I paid all my legitimate charges after my Medicare Advantage plan paid. I paid regularly and on time. But I made sure I received my explanation of benefits (EOB) from my insurance company before I paid any additional fees. Those EOB statements list legal charges and billing.

In February 2024, I received new statements from SSM Healthcare for the infusion center, doctors, and hospital. These statements were for charges that were a year old and listed as paid in full in 2023. The SSM system sold some of that fake debt to a collection agency. I sent that collection company proof of payment and the paid-in-full statements that were still in the MyChart billing system.

Patients who go through chemotherapy, surgeries, and treatments for severe disabling conditions often also have cognitive deficits afterward. These cognitive problems may be short-term, but they can be extreme. False medical billing and fraudulent charges are often purposely used in these situations to take advantage of patients’ cognitive deficits. The medical systems utilize the false debt scam to sell it to collection companies to make a profit on essentially nonexistent debt. This system defrauds patients and the debt collection industry.

The elderly and disabled patients end up paying the legitimate debt and the fraudulent debt. The “unpaid” medical debt is bundled in such a way as to be impossible to identify as fraudulent or legitimate. Disadvantaged individuals aren’t capable of managing the documentation to prove their debt was paid, and the collection companies frighten and bully those individuals.

How much of the debt written off by Undue Medical Debt was legitimate? No one will ever know. But there’s a much larger issue than the simple belief that people don’t pay medical bills. Organizational fraud is likely responsible for a large percentage of the debt that companies like Undue purchase and utilize for profit.

— Diana Rickles, Ballwin, Missouri

— Ellen Andrews, Hamden, Connecticut

Don’t Hesitate To Sound the Alarm

I am a regular watcher of “CBS Mornings” and always appreciated Dr. Céline Gounder’s reports during the covid-19 pandemic. But I found her report March 28 on CBS much too meek in the face of a devastating effort on the part of Robert F. Kennedy Jr. to slash the Department of Health and Human Services workforce by 25%.

This is catastrophic for disease prevention and future medical science — as well as the flight of talent from the U.S. to other countries. Dr. Gounder mentioned people from Yale leaving for Toronto. But Dr. Gounder should have been more assertive and sounded a greater alarm than just saying the impact of these cuts “remains to be seen.” For heaven’s sake! These cuts are catastrophic — not only for America’s health, but for the 20,000 talented people who have been shown the door. Dr. Gounder: You need to be more assertive and alert Americans that this is a tragedy.

— Uldis Kruze, El Cerrito, California

— Lawson Mansell, Washington, D.C.

We Must Prioritize Children’s Mental Health

As a concerned member of our mental health support community, I write to highlight an urgent issue that too often goes unnoticed: the mental health of our children (“More Psych Hospital Beds Are Needed for Kids, but Neighbors Say Not Here,” April 11). With rising rates of anxiety, depression, suicide, and behavioral challenges among youth, it is imperative that we take collective action to prioritize mental well-being just as seriously as we do physical health.

Children today face a unique set of stressors — from academic pressure and social media to family instability and global uncertainty. These factors can significantly affect their emotional development and overall well-being. Yet, despite the growing need, access to qualified mental health professionals, school counselors, and community support services remains limited or unaffordable for many families. Not all hospitals are equipped for mental health cases, and the number of psychiatric beds available is often little to none. A child in mental health crisis should not have to wait days or weeks to find treatments. Parents shouldn’t have to watch their child struggle and not have their concerns taken seriously. If a child goes into a hospital with a broken bone, it is immediately treated; the parents aren’t given numbers for places to call in hopes that they can be seen in a few days.

We must advocate for policies that ensure mental health screenings in schools, expand funding for youth-focused services, and promote training for educators to identify early signs of distress. Hospitals and mental health facilities need to be prepared and equipped to take in patients, not turn them away. Children should never be unable to receive treatment because of a lack of a bed. Our children should be our priority, not an afterthought of what a care facility will do to the neighborhood. No child should suffer in silence due to a lack of resources or awareness.

Investing in children’s mental health is not just compassionate — it’s smart. Healthy, supported children are more likely to succeed academically and socially and, ultimately, become well-adjusted adults. Let’s ensure that every child has access to the help they need.

— Jennifer Groseclose, Leeton, Missouri