Delaware reported on Monday the state’s first case of measles in more than 10 years.
The case was identified in an unvaccinated man in Kent County in central Delaware, health officials said in a news release.
Officials said they were conducting contact tracing to determine whether anyone else had been exposed to the highly contagious disease, which can linger in the air for up to two hours and infect up to 90% of unvaccinated people who come into contact with it.
They encouraged Delawareans to ensure they are vaccinated against measles. People who have received two doses of the measles, mumps, and rubella (MMR)vaccine are considered protected from the virus, as well as those born before 1957, or who have a lab test confirming they are immune to measles.
People who do not know their vaccination status can check with their primary care doctor or visit the DelVAX Public Portal to check their vaccination records. Vaccines are typically available at primary care providers, pharmacies, and public health clinics, though health officials encouraged residents to call ahead to ensure a provider has the vaccine.
People with measles symptoms — a fever, cough, runny nose, or pink eye, followed by a rash — should call their primary care doctor. Those with severe symptoms should visit an emergency room; in serious cases, the virus can cause pneumonia, brain inflammation, and death. Patients should call providers before visiting to let them know they were exposed to measles.
Cases spread in Pennsylvania
The positive test comes as Pennsylvania grapples with its biggest measles outbreak in 30years, with 102 people sickened and 20 hospitalized since April.
On Monday, health officials reported that cases had spread to two new counties, with one case each confirmed in Indiana and Snyder Counties.
Indiana County is in Western Pennsylvania. Snyder County, in central Pennsylvania, borders Northumberland County, where six cases had already been reported.
It was unclear whether those cases were connected. The bulk of cases have been detected in Lancaster County, where 61 people have contracted measles since April.
In the Philadelphia region, six cases have been reported in Chester County.
Pennsylvania and New Jersey are among the 27 states seeing recalls of shredded lettuce products sourced to Taylor Farms, the produce company at the center of a food safety investigation into an outbreak of “explosive” diarrhea caused by the parasite Cyclospora cayetanensis.
Federal officials announced over the weekend that a sample of lettuce taken from a Taylor Farms shipment at the U.S.’s southern border with Mexico tested positive for Cyclospora.
The test involved lettuce that wasn’t affected by the California-based produce company’s recall.
The results turned out to be a false positive. As of Sunday, federal officials said, they had not found a positive test for Cyclospora in a produce sample.
Officials notified the public because it was “actionable public health information,” acting Deputy Commissioner for Food Donald Prater said in a press call Monday.
Thousands of people have been sickened in a cyclosporiasis outbreak, with cases reported across Indiana, Kentucky, Michigan, Ohio, and West Virginia.
Investigators at the Centers for Disease Control and Prevention found more than 1,600 people in those states became ill after they ate iceberg lettuce from Taco Bell, which sourced lettuce from Taylor Farms.
Taylor Farms did not immediately return a request for comment.
Cases in Pa. and N.J.
Cases of cyclosporiasis have been reported in 34 states, including Pennsylvania, though case counts here were low as of last week, affecting 28 people since the beginning of the year, including 14 in Southeastern Pennsylvania.
New Jersey health officials said the state had recorded 46 cases between May 1 and July 16. Cases typically rise in the late spring and summer months, and this year’s are in line with a typical year’s case count.
It’s unclear whether anyone in Pennsylvania or New Jersey was sickened after eating Taylor Farms products. The CDC said it was also investigating outbreaks and other cases that are not connected to the Michigan outbreak.
They should wash items and surfaces that might have touched the lettuce with hot, soapy water, and avoid recalled lettuce at Taco Bell or other restaurants. Customers should ask restaurants about the source of their lettuce before ordering it.
Cyclosporiasis is caused by a single-celled parasite that spreads through fecal material. It can infect a person’s gut after they consume food or water contaminated by feces. Common symptoms include watery diarrhea, a loss of appetite, cramping, nausea, and fatigue.
Jeans that fit perfectly. The ideal Netflix show for a Tuesday night. Your one and only soulmate. Modern life promises that with enough options, you will happily find the best of everything.
But behavioral scientists say the increasing flood of choices — whether it comes to shopping, social lives, or relationships — is doing the opposite.
The idea that more choice is better is baked into Western culture, but research shows that having more options can make people anxious, indecisive and, paradoxically, less happy with what they pick, said Barry Schwartz, an emeritus psychology professor at Swarthmore University and author of The Paradox of Choice.
“There have been hundreds of studies showing that there can be too much of a good thing,” Schwartz said.
To minimize the mental noise, he said, limit the number of choices you make, and your brain will thank you for it.
More is often more confusing
Schwartz offered several examples of cases where more options left people worse off.
In the case of Medicare Part D prescription drug plans, people in states with more choices were less likely to choose any of them, he said. The same goes for 401(k) investments. The more options a company had, the less likely employees were to sign up, even when the employer offered matching money.
Less consequential choices are no different. Schwartz pointed to one often-cited study that showed shoppers at a gourmet grocery store bought more jars of artisanal jam when they were presented with six flavors rather than with a wider array of 24. In a follow-up study, students were more likely to complete an extra-credit assignment when they were given six topics to choose from instead of 30.
Schwartz’s research expanded on those findings to learn the emotional responses to this phenomenon.
“Instead of being liberated by all this choice, you’re paralyzed,” he said. “You can do anything, and you can’t figure out which of those many things to do.”
People also often end up making worse decisions since more options suggest more potentially bad outcomes, he said. And once someone finally decides from all the possibilities, they may be less satisfied with even a good choice because they fear there was a better alternative.
Schwartz said the satisfaction problem is especially acute for people whose aim is to get the best, whom psychologists call maximizers.
“People who are maximizers especially suffer from the proliferation of options,” he said. “Only the best will do.”
The tendency isn’t true for all people in all situations, Schwartz noted. Car buffs will gladly dive into the details of nearly unlimited choice when buying a new one.
“But you don’t feel that way when it comes to buying jam,” he said.
The brain doesn’t like making decisions
Daniel Willingham, a psychology professor and neuroscience researcher at the University of Virginia, said the phenomenon occurs because the brain is designed to save people from having to think.
Problem-solving requires more energy than relying on memory, a fact that has roots in evolutionary survival mode, Willingham said. When faced with a goal, whether it be an immediate need like responding to a threat or something longer term like finding shelter, the mind first searches for what’s worked before. The problem-solving part of the brain only kicks in afterward.
“Another way to put it is that if you’re thinking, things are not going well,” he said.
That explains why sometimes people move through parts of their day on autopilot, he said. Throughout the day, people are confronted with hundreds of situations where they could do something different, but they almost always take the same route to work.
Schwartz said the proliferation of choices also has become tangled with identity in the social media age, where everyone can easily compare their choices to others.
“When all you’ve got to choose from is Lee’s and Levi’s, nobody expects the jeans they buy to fit perfectly,” he said. “When there are 2,000 options, well, now, dammit, you do expect your jeans to fit perfectly.”
Limit your choices and move on
David Epstein said that after researching his book, Inside the Box: How Constraints Make Us Better, he began to shift away from his maximalist tendencies. Now, he limits his opportunities for making choices, such as when he bought 10 of the same well-fitting T-shirts in different colors.
He was following the example of Herbert Simon, a psychologist and 1978 Nobel laureate in economics, who had three sets of clothes and ate nearly the same thing every day. Simon introduced the term “satisficing,” a combination of satisfying and sufficing that means setting good-enough criteria for decisions and moving on.
Epstein sets satisficing rules for himself when shopping online by first focusing on the purpose of the purchase.
“When I find one that does that, I’m buying it, instead of reading all the reviews and getting sucked into, ‘Well, this one has all these other features.’”
Willingham and Schwartz suggested farming out some decisions. If you’re looking for a new phone, find a friend who is happy with theirs and buy that one.
For larger decisions like financial planning, you’ll be happier if you rely on someone else’s professional expertise, Willingham said.
“If you’re thinking, ‘Well, I’m a clever guy, I can figure that out,’ I think 9 times out of 10, you’re fooling yourself,” he said.
Schwartz acknowledged that for people who have trouble making decisions, changing is difficult. But it’s worth it.
“What happens over time is you find it easier to make decisions, you end up more satisfied with the decisions you make, and all of a sudden, you’ve got an extra two hours in every day,” he said.
Q. How bad are flip-flops, really? Am I inflicting lasting damage on my feet every time I wear them?
A. Flip-flops must be the most vilified form of footwear. Each summer, the media are filled with stories about how bad they are for your feet. According to some experts, wearing flip-flops will cause acute injuries, such as sprains, or contribute to more insidious injuries, such as plantar fasciitis. Some even claim they can contribute to hammertoes and bunions.
While it is reasonable to be cautious about flip-flop use for those who may be vulnerable to lower-extremity conditions, are they really that bad for everyone? And should you never slip on a pair if you care about your foot health? The answer I give my patients might surprise you.
As a podiatrist in Minnesota, my clinic is slowest in late winter and becomes busier as we transition to spring and summer. Coincidently, some people also start to wear flip-flops around this time. It would be easy to assume a cause-and-effect relationship for the flip-flop wearers and their foot pain, but that is an incomplete picture.
A winter spent in more structured shoes combined with the tendency to be more sedentary can essentially decondition your feet, so when you start to become more active and wear less supportive shoes, your feet might hurt as they adjust to the greater demands you’re putting on them. This reduced capacity is often high on the list of potential causes of foot pain whether wearing flip-flops or not.
It is true that the risk of falling is higher in flip-flops, but this risk applies to all shoes that do not secure well to the foot such as high heels, mules, clogs, or even poorly fitting shoes.
Additionally, there is no evidence in the research that flip-flops increase the risk of heel pain or toe alignment changes in people with healthy feet any more than other types of footwear. Heel pain, hammertoes, and bunions are common in the general population, even in those who have never worn flip-flops. Many factors contribute to these foot concerns including genetics, lifestyle, and biomechanical imbalances.
As a general rule of thumb, I caution anyone with poor balance, osteoarthritis, rheumatoid arthritis, a history of lower-extremity surgery, diabetes, lower-extremity swelling, peripheral neuropathy, peripheral vascular disease, neurodegenerative conditions, or gait abnormalities to avoid not just flip-flops but any footwear that does not strap securely to the foot including at the heel. People with these conditions are more likely to fall or worsen existing issues when wearing unsupportive footwear.
Even if you don’t have any of the health concerns listed above, remember that flip-flops are really made for walking on flat, dry surfaces only. That’s because you are more likely to fall if you are on a wet surface and subsequently injure yourself if your footwear is not secured to your feet.
If you’re wondering what footwear is best for avoiding foot conditions, the answer is that there’s no one single type. Each of the shoes that we own uniquely alters how our feet function and affects how we move. Therefore, it’s best to have multiple types of comfortable footwear options with varying degrees of cushioning, support, and fit characteristics to allow your feet to maintain their strength, mobility, and adaptability.
Flip-flops place more demand on the muscles and joints of the feet than conventional shoes, and that can be a good thing. Having a capacity to wear footwear with little to no support is an important part of long-term foot health. If you don’t have any of the health issues that I previously mentioned, this capacity can be built by transitioning to flip-flops gradually at the beginning of the season, wearing them for short periods of time in the beginning to give your feet a chance to adjust. Doing targeted foot-strengthening exercises as part of a fitness routine can also help.
An often-overlooked benefit of flip-flops (and more broadly, sandals) is that they let our feet spread out more than shoes typically do. This is one of the reasons people find flip-flops comfortable. It is very common for people to develop foot pain due to poorly fitting shoes. In fact, a 2018 study showed that up to 72% of people wore shoes that did not fit properly and there was also an association with improper shoe fit and foot pain.
All shoes affect our lower extremities in ways that can be potentially beneficial or detrimental. Telling healthy people to avoid certain types of footwear is like telling people to avoid the sun. Sure, too much exposure to either can be bad, but some exposure is beneficial and even necessary for our overall health. Having a variety of comfortable footwear options is a good strategy to maintain foot health — and for many people, that strategy can include flip-flops.
Paul Langer is a sports medicine podiatrist practicing with Twin Cities Orthopedics in Minnesota and an adjunct clinical faculty at the University of Minnesota Medical School. He is also the author of “Great Feet for Life.”
Pennsylvania’s new budget has two significant changes for nursing homes.
In a long-sought victory for the nursing-home industry, lawmakers altered how the Medicaid long-term care budget is set, increasing the state’s share of nursing home funding by $162 million next year.
Lawmakers also amended the formula used to calculate whether nursing homes are complying with a 2022 law that required them to devote 70% of their expenses to resident care. The changes will make it easier to comply.
Change to 20-year-old Medicaid funding rule
For two decades, Pennsylvania Medicaid has paid nursing homes less than their audited costs, according to Michael Jacobs, CEO of the Pennsylvania Health Care Association, a trade group for nursing homes and other long-term care providers.
In 2005, when lawmakers decided they could only afford to pay nursing homes 95% of their costs, the measure was supposed to be temporary. But 20 years later, what was called the “budget adjustment factor” remains in place. The gap between funding and audited costs grew to 20% from 5%, Jacobs said.
This year, lawmakers agreed to raise the factor from 80% to 86% of costs and guarantee that it won’t drop below that level for two years.
“It’s a monumental victory for long-term care to get predictability and stability by putting in a floor,” Jacobs said.
That translates to a $162 million increase in state funding next year. (The change takes effect Jan. 1, because that’s when the fiscal years for Medicaid insurers begins.)
The floor on the budget adjustment factor “provides much-needed resources and stability to help nursing homes recruit and retain the experienced caregivers residents depend on,” Matt Yarnell, president of SEIU Healthcare Pennsylvania, said in an email.
“Now it’s critical that nursing home operators put these additional resources where they belong: into the quality of care for residents and into the frontline workforce,” said Yarnell, whose union represents thousands of nursing home workers.
Including a federal match of more than $200 million, nursing homes are expected to see a roughly $20 to $25 per day increase for residents with Medicaid, Jacobs said. He did not provide a percentage for the total state and federal increase.
Current minimum daily Medicaid rates range from $236.56 for Burgh Care Center in Pittsburgh to $573.92 for Fox Subacute in South Philadelphia, which specializes in caring for patients who need ventilators to breathe, according to state data.
A new formula for calculating 70% rule
In 2022, Pennsylvania became the fourth state to require nursing homes to devote a specific percentage of expenditures to resident care. Pennsylvania’s law set the threshold at 70%, with fines for nursing homes that didn’t comply.
When the state Department of Human Services began evaluating nursing homes under the new law, the analysis resulted in what the agency described last year as “distorted” penalties that it considered “inconsistent” with the intent of the law, known as Act 54 of 2022.
The agency found a lack of consistency in how nursing homes were reporting expenses. Some facilities, “mistakenly reported items that would be considered costs for resident care and services as administrative operating costs,” making it seem like they owed big fines, the agency said.
The original formula for overall costs also included things over which the nursing home operators had no control. Examples are property taxes, a nursing-home assessment, and depreciation. These items elevated total costs, making it harder for nursing homes to comply with the 70% rule.
One expense — excess administrative costs — was added to the new formula. That figure frequently topped $1 million per nursing home last year, according the cost report data.
Jacobs welcomed the formula changes, saying the industry was particularly interested in removing nursing home assessments and property taxes from total costs.
“We’re happy to be held accountable for the dollars that are being paid to the facilities and making sure they go where they need to be,” he said.
One year after the Trump administration announced that dozens of health insurers had signed a six-part pledge promising to reduce barriers to doctor-recommended care, some insurers now say they won’t implement all the promised initiatives.
Meanwhile, patients, their advocates, and clinicians say little has improved.
“It has never been this bad for patients,” said U.S. Rep. Greg Murphy (R., N.C.), a physician who co-chairs the GOP Doctors Caucus.
The overarching intent of the June 2025 pledge was to improve a controversial process called prior authorization, which regularly requires patients or someone on their medical team to seek approval from insurers before proceeding with treatment.
According to AHIP, the health insurance industry trade group, health plans have eliminated 6.5 million prior authorizations for patients — equal to an 11% reduction — since the announcement.
But critics remain skeptical. Sally Nix, a patient advocate who has a chronic disease, described the voluntary pledge as “performative.” And Murphy, who participated in the news conference with Health and Human Services Secretary Robert F. Kennedy Jr. announcing the pledge last year, said it has “no teeth.”
Voluntary insurer pledges rarely make things better for patients, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.
“In the absence of clear rules, policies, standards, and mandates,” she said, insurance companies are “going to do what makes sense for them to do financially.”
The Department of Health and Human Services did not respond to questions for this report. It isn’t clear how, or whether, the Trump administration is holding insurers accountable.
‘Zero faith’
Prior authorization — sometimes called preauthorization or precertification — has been around for decades. The insurance industry has long argued that the practice, which varies by company, helps control costs, reduces waste and fraud, and prevents potential harm to patients. It’s regularly invoked for a huge swath of services, ranging from low-cost urgent care to expensive cancer treatment.
“Prior authorization is a vital patient safeguard,” said Chris Bond, a spokesperson for AHIP.
The 2024 killing of UnitedHealthcare CEO Brian Thompson sparked a national groundswell of anger about insurance denials, with patients and doctors becoming increasingly vocal about the tactics they say insurance companies use to boost profits at the expense of care.
Prior authorization reform is one of the rare healthcare issues Democrats and Republicans tend to agree on. On July 15, the House Ways and Means Committee unanimously advanced a bill that would force Medicare Advantage plans to provide to the federal government a list of all items and services that are subject to prior authorization, and to report data about denials and grievances, among other requirements.
Last year’s industry pledge was organized as a direct response to public anger, Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, said when it was announced. “There’s violence in the streets over these issues,” he said.
“Americans are upset about it,” Oz said, later adding, “I’m looking forward to seeing the results.”
Mike Gartner, founder of Health Access Innovation, an organization that helps patients overturn insurance denials, said he doubts that insurance companies are changing their policies in meaningful ways. The 11% reduction in prior authorization cited by AHIP “hides a lot of nuance,” Gartner said.
Patients who need the costliest services, such as cancer treatment, are still being disproportionately denied access to doctor-recommended care, he said.
AHIP said its data included reductions in prior authorization for medical services, not prescription medicines. The trade group didn’t provide details explaining which services have been dropped from prior authorization or how those reductions differ across individual insurers.
Last year, Oz said the federal government would be “evaluating progress” toward the pledge and “driving accountability,” and he foreshadowed “public dashboards.” But no such dashboards exist, and federal officials did not respond to questions about how they’re holding companies accountable.
Murphy, the North Carolina congressman, said he has “zero faith” in the industry policing itself.
He didn’t believe insurance companies then, he said, “and I don’t believe them now.”
Shortly after Betsy Adler’s daughter Coco was born with a serious heart defect, she started receiving estimates showing her family could owe thousands of dollars in out-of-network costs.Justin Young
‘At war’ with an insurer
In February, days after Betsy Adler and Justin Young’s daughter Coco was born with a serious heart defect, the Stillwater, Minn., family received paperwork showing they were racking up out-of-network costs.
During Adler’s pregnancy, the family had switched insurers, moving to Medica, which is based in Minnetonka, Minn., and one of many insurers that initially signed the industry pledge. Adler said she’d checked with her employer’s human resources department and on Medica’s website to make sure her maternal-fetal specialists and hospital were in-network before their new health plan went into effect earlier this year.
But then, the insurance company started processing some claims as out-of-network. By mid-March, the family had accrued more than $4,000 in out-of-network charges, on top of more than $3,000 for in-network bills. And the bills kept coming.
When Adler, a psychotherapist, called to figure out what was going on, she said, an insurance company representative said she hadn’t submitted a referral from her primary care provider beforehand. Attempts to fix the problem went nowhere. At one point, Adler said, Medica required her to visit a clinic she’d never been to before to obtain a referral. But she said a Medica representative told her the referral was never received, because the insurer’s fax machine was down.
“I have a critically ill child,” Adler remembered thinking shortly after Coco was discharged from the cardiovascular intensive care unit. “I can either spend my emotional energy at war with Medica, or I can let it go and just enjoy my time with my daughter.”
Medica spokesperson Greg Bury said he wouldn’t discuss the case, citing patient privacy rules. In an emailed statement, he wrote the company is “committed to working with her to ensure she understands what is covered under her benefits and our responsibilities.”
One of six specific promises all insurers made when they signed the pledge was to honor a 90-day grace period when patients switch insurance plans, starting Jan. 1 of this year. Often called “continuity of care,” this grace period allows patients to temporarily continue receiving services and medications that were authorized under a previous insurer.
But that applies only in some circumstances, Georgetown’s Corlette said. The wording of the pledge suggests that insurance companies aren’t obligated to honor another company’s network parameters. When Adler and Young switched insurers, for example, Medica was not obligated to cover the cost of out-of-network providers as if they were in-network, even though they were in-network under the family’s old plan.
Adler and Young switched insurance companies again when Coco was a month old, to avoid accruing more out-of-network costs.
Sally Nix with her service dog, Jon Snow, at home in Statesville, N.C. Nix, a patient advocate, recently had her health insurer process, then later deny, a claim for injections to relieve her chronic nerve pain. She’s skeptical about industry promises to reform the health insurance denial process.Logan Cyrus / For KFF Health News
Denial after approval
The percentages cited by AHIP don’t tell the whole story, said Nix, the patient advocate. Insurers are “not including the data for the loopholes they create,” she said.
For example, nothing in the pledge prevents insurance companies from retroactively denying payment, even when care is preapproved. “Patients are going to see a lot more retroactive denials,” said Nix, who recently had her insurer process, then later deny, a claim for injections to relieve her nerve pain.
Something similar recently happened to Jocelyn Austin, 49, of Amherst, N.Y. Over the course of nearly 20 years, she developed an addiction to sleeping and anxiety pills prescribed to her by a doctor. Last year, she spent weeks at an inpatient treatment center for substance abuse. Her insurer, Independent Health, had approved the admission. Austin said she has been substance-free since her discharge.
But the facility sent her a bill for more than $12,000 in December showing her insurer had not paid for the treatment she received, according to documents Austin shared with KFF Health News. This was in addition to the $10,000 she paid at the beginning of her treatment to satisfy her out-of-network deductible. The approval letters from Independent Health had specified that “authorization is not a guarantee of claim payment.”
Frank Sava, a spokesperson for Independent Health, said a denial was issued and upheld in this case because the services provided “were inconsistent with the care that was authorized” and “the medical record did not sufficiently support what was billed.” He said those findings were reviewed and confirmed by an outside consultant.
An explanation of benefits issued by the insurer last summer indicated the “provider,” not the patient, was responsible for the cost of her treatment. And yet the treatment facility has continued to pressure her for payment, she said.
Austin, who has not paid her outstanding bill, said insurance companies “should be held accountable.”
‘Significant work ahead’
Another one of the six commitments insurers made last year was to adopt new technology that would standardize the electronic submission of prior authorization requests. During the news conference announcing the pledge last summer, Chris Klomp, the director of Medicare and a deputy CMS administrator, said more than 50% of prior authorizations are still paper-based and processed by phone or fax machine.
In April, AHIP released an update related to that technology initiative, explaining that participating insurers would adopt the new standards on a rolling basis. Health insurers agreed to implement the pledge’s various commitments by predetermined deadlines, and this initiative is scheduled to be operational by Jan. 1, 2027. But eight insurers that initially signed the pledge last year didn’t sign the technology update when it was announced in April, AHIP told KFF Health News.
Those insurers are Alignment Health Plan, EmblemHealth, HealthFirst, Independent Health, Medica, MVP Health Care, Point32Health, and SummaCare. Their beneficiaries span the country, from California to New York. None of those eight insurers agreed to interviews for this report, but most sent KFF Health News emailed statements indicating that they remain committed to prior authorization reform.
AHIP’s approach to continuity of care “would have required the transfer of confidential member health information through a non-standardized process involving third-party participation,” wrote Jerry Slowey, a spokesperson for Alignment Health, which offers Medicare Advantage policies in Arizona, California, Nevada, North Carolina, and Texas. “We do not believe that level of data sharing was contemplated in the original commitment.”
Bury, the spokesperson for Medica, which covers beneficiaries in Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, and Wisconsin, said the company “supports the goal of these standardization efforts.” But the April update “raised a significant technical and operational hurdle that we are not able to commit to at this time,” he said.
Alex Gomez, a spokesperson for EmblemHealth, said in late June the company “will sign onto the commitment” after KFF Health News posed questions about why it had not endorsed the April update.
“We anticipate more plans will be added over the coming months,” said Bond, the AHIP spokesperson. Health plans are “working continuously to implement their commitments to simplify and improve the experience.” He acknowledged that “there is still significant work ahead.”
The original pledge also included a promise that insurance companies would enhance transparency and use “clear, easy-to-understand explanations” when communicating to patients — something they were already supposed to be doing under the Affordable Care Act.
Yet companies still regularly neglect to explain why care has been denied, and their communications often contain “inconsistent and contradictory information,” said Gartner, of Health Access Innovation. He and Murphy also said they suspect insurance companies are increasingly using artificial intelligence to generate denials.
“They craft the pathways to basically deny things immediately with the hope that people will give up,” Murphy said.
The congressman said he wishes President Donald Trump would sign executive orders addressing some of these issues. “The problem is the insurance industry is the strongest lobby in this town.”
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Imagine a 15-year-old scrolling through TikTok videos late at night and encountering a video titled: “Five signs you have ADHD that NO ONE talks about!” By morning, she’s watched 20 more. By the weekend, she’s certain she has ADHD — without ever having seen a professional.
Social media and increasingly, AI chatbots have become go-to mental health resources for teens. I understand the appeal of a seemingly quick and convenient way to get answers. We’ve all been Googling symptoms and searching WebMD for years.
But social media is now inundated with false information, and AI companions can amplify those mistruths. Teens who forget an assignment or daydream in class can become wrongly convinced that their common experiences point to a condition like ADHD. It’s critical that they learn to never take an online diagnosis at face value and to consult a professional.
The adolescent mental health crisis
Less than half of children and youth are receiving appropriate care for their mental health needs. That includes the 40% of high school students who report persistent sadness or hopelessness, an increase of roughly 10% from a decade ago. Nearly 20% of these youth have seriously considered suicide.
Many teens without access to expert care will fill that void digitally: In one survey, roughly 29% of respondents reported self-diagnosing via social media; among Gen Z, that figure was significantly higher.
AI is accelerating this trend. A Common Sense Media study found last year that 72% of teens had used AI companions at least once, and 52% did so regularly. In another nationally representative survey, about 20% of adolescents and young adults reported having used AI chatbots for mental health advice, an increase of nearly 50% in just one year. Notably, 63% never told anyone about it.
Platforms like Replika and Character. AI allow teens to build highly customized AI “companions” that remember your history, adapt to your language, and are available at 2 a.m. when no one else is.
The adolescent brain is very sensitive to social validation and identity cues — traits that social media platforms are engineered to exploit. A central question of adolescence is: Who am I? Diagnostic labels feel like answers.
And the social media algorithm makes it all very convincing. Once a teen engages with one mental health video, the platform serves up more — not because the content is accurate, but because engagement drives engagement.
Richard J. Chung is a physician and the senior medical director for Enterprise Adolescent Medicine at Children’s Hospital of Philadelphia.Courtesy of CHOP
Why the content can’t be trusted
A recent analysis of the top 100 TikTok videos tagged #teenmentalhealth found they collectively were viewed over 140 million times, yet only one video incorporated scientifically supported content.
Most content creators are not licensed clinicians; they speak from lived experience and often with a financial interest in selling products and coaching services. They are rewarded for content that is emotionally compelling and shareable, not clinically careful.
A video that says “here are five signs you’ve experienced trauma” can spread faster and wider than one explaining the differential diagnosis of mood symptoms.
AI makes it personal and more dangerous
A TikTok video is static, but a chatbot adapts to your phrasing, mirrors your concerns, and rarely pushes back. Because AI systems are optimized to keep you engaged, they default to agreement and validation, even when pushback is appropriate.
In some cases, the consequences can be catastrophic. Published case reports and wrongful-death lawsuits have documented adolescents disclosing suicidal thoughts to AI chatbots that sometimes offer back information on suicide methods and discourage users from seeking human support.
Chatbots cannot do what a trained clinician does: assess for risk, challenge harmful thinking, and ensure a young person stays connected to care.
All of this also makes it harder for teens who need the most help to get it. I know of one patient who struggled silently with a debilitating anxiety disorder for months because all her friends said they had it as well. They weren’t getting treatment, so why should she?
What you can do
For parents: Engage before you judge. Download TikTok. Search #mentalhealth, #anxiety, #ADHD — understand what your child is actually watching.
Teach a simple credential check: does this creator have LCSW, Ph.D., MD, or DO in their bio?
Watch for red flags: brief checklists presented as clinical diagnoses, product marketing, sweeping generalizations, absolute claims, and a few too many exclamation points. The goal is not to ban the conversation. It’s to be part of it.
For teens: Let social media be a starting point, not a conclusion. If content resonates, write it down and bring it to a counselor or a doctor. Your curiosity is valuable and deserves to be met with high-quality guidance and support.
Start with your pediatrician — they can screen for mental health conditions and coordinate referrals without you navigating the system alone. And always remember, you can call or text 988 for crisis support.
Lastly, we need your help! Pediatric Health Chat at CHOP wants to hear from you about what you’re seeing and hearing on the internet so that we can work together to improve the quality of information out there.
Building the system teens deserve
With real help too often out of reach, teens are turning to TikTok in search of answers.
The response from parents, clinicians, and policymakers should not be limited to policing social media or AI. Investing in services, removing barriers to care, and creating policies shaped by youth, will help ensure real help is as readily available offline. We must build the system of care that teens actually need, IRL.
The views expressed in this article are those of the authors and not necessarily those of CHOP. This information is not intended to provide medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional regarding any health or medical concerns.
Richard J. Chung is a physician and the senior medical director for Enterprise Adolescent Medicine at Children’s Hospital of Philadelphia.
In medical school, I was taught to choose medications based on how well a medication works and its risk or side effects. Cost was rarely mentioned, as if safety and efficacy were the only factors in the equation.
But to patients, cost is not negligible. Money spent on medications or healthcare will not be there for something else — whether putting food on the table, childcare, or other needs.
In my dermatology clinic, I see cost as an important “side effect” to pay attention to, and often the biggest reason for patients not filling their prescriptions.
Consider a couple examples of how the exact same hair loss treatment can cost more in one form compared to another:
The most common and effective over-the-counter hair loss treatment is topical minoxidil, best known under the brand name Rogaine. Forms of topical minoxidil marketed for women can cost 40% more than the exact same medication labeled for men — my colleagues and I published a study to prove it.
Another medication, finasteride, is commonly prescribed in 1-milligram tablets to treat hair loss in men, and in 5-mg tablets to treat enlarged prostates. According to GoodRx, 30 tablets of finasteride 1 mg cost about $30 for a one-month supply, and 30 tablets of finasteride 5 mg also cost $30.
I’m always looking for ways to save my patients money. So like many other doctors, I have prescribed the finasteride 5-mg tablets and directed patients to cut them in fourths with a pill splitter.
I often advise women to use the minoxidil marketed for men, because it’s cheaper for the same medicine. Why should women pay more for the same thing — a pink tax?
Here are some tips to help you navigate a system rife with irrational and unfair pharmaceutical pricing:
Co-pays can be based on the number of pills, or number of fills. Ask your doctor if you can save money by splitting pills (note: not all pills can be split), or by getting longer-term medications prescribed as a 90-day supply.
Many pharmacies offer a $4 (or other discount) formulary price for a 30-day supply. For instance, without insurance or any other program, you can usually get common prescription steroid creams for $10 for a 90-day supply. A full month of terbinafine, the common medication for toenail fungus, can cost around $10-15 without insurance. Strangely, sometimes certain medications may cost more out of pocket with insurance — it never hurts to ask.
Some over-the-counter prescriptions can be just as effective as more expensive prescription options. For acne, topical adapalene is similar to topical tretinoin, and an excellent option if you don’t have insurance.
Discount programs may offer coupons, and some pharmacies may offer discounts, e.g., GoodRx discounts and Mark Cuban’s Cost Plus Drugs pharmacy.
The pharmacies we use matter — for instance, if you use a telemedicine app like Hims or Keeps, it will likely cost you $90 every three months to get minoxidil or finasteride. My latest hot tip: In most states, Costco does not require membership to let anyone use their pharmacy, and instead of perhaps $360/year from Hims or Keeps or even regular pharmacies, for a full year supply of finasteride, it may only cost you $50-60.
The same prescription can carry dramatically different costs, depending on the pharmacy, the formulation, or a discount program. Before deciding you can’t afford a medication, ask your doctor or pharmacist if they know of a less expensive way to get the same treatment. My tips can save you hundreds of dollars a year.
Editor’s note: This story has been updated to clarify the cost of terbinafine without insurance.
Jules Lipoff practices as a board-certified dermatologist and Pennsylvania medical director for The Dermatology Specialists and serves as a clinical associate professor (adjunct) in the Department of Dermatology, Lewis Katz School of Medicine.
Under a five-year agreement signed last month between Children’s Hospital and the Department of Health – Abu Dhabi, CHOP will train scientists from the UAE on all aspects of gene therapy development.
The collaboration will focus on building local expertise in base-editing therapies for liver metabolic disorders, genetic clotting disorders, urea cycle disorders, and central nervous system conditions.
This latest partnership builds on CHOP’s longstanding relationship with Abu Dhabi, which in recent years has included a partnership to advance research in pediatric oncology.
Since founding its Global Health Center in 2007, CHOP has also collaborated with Brazil to build a CAR-T cell production center and with Botswana to advance clinical care and research.
CHOP declined to comment on the finances of the new partnership.
Five CHOP labs will host the UAE trainees, who will each spend 18 months to two years in West Philadelphia. Their training will span the bench to bedside — including learning how to design and manufacture the therapies, test their efficacy, and meet regulatory guidelines.
The first cohort is expected to start in early 2027.
“It’s hard to convey 25 years of knowledge in a few years of training,” Beverly Davidson, CHOP’s chief scientific strategy officer said.“But by bringing multiple individuals with different areas of focus together at the same time, we can help accelerate that.”
She learned of UAE leaders’ interest in expanding their personalized medicine efforts at the Abu Dhabi Future Health Summit in April 2025. That discussion inspired her and CHOP scientist Lindsey George, who was also in attendance, to devise the training program.
“Our ambition is to ensure these innovations are developed responsibly and become more accessible to patients in Abu Dhabi, the region and beyond,” Noura Khamis Al Ghaithi, undersecretary of the Department of Health – Abu Dhabi, said in a statement.
Prioritizing key disorders
Part of the agreement involves working with Abu Dhabi scientists to identify and prioritize key disorders, Davidson said.
The Emirati Genome Program has sequenced nearly one million genomes — making it one of the world’s largest DNA databases —in hopes of capturing the genetic diversity of UAE citizens.
Starting in January 2025, the UAE now requires couples to undergo genetic screening prior to marriage.
“Both the Department of Health and the Children’s Hospital of Philadelphia believe this to be a long-term commitment to providing improved healthcare for UAE citizens,” Davidson said.
Editor’s note: This story has been updated with the correct title for Beverly Davidson, CHOP’s chief scientific strategy officer.
Impacts from Canadian wildfire smoke increased throughout the Philadelphia region Friday, degrading air quality enough to prompt a code purple alert, and force the closure or suspension of some city amenities and services.
It was the latest bad weather event in Philadelphia’s run of tough luck in July, which has so far resulted in record-setting heat and destructive storms that have marred back-to-back weekends. Smoky conditions arrived Thursday, and were bad enough Friday to prompt the closure of city pools and spraygrounds, and temporarily stop trash pickup.
“Our worsening air quality is a dangerous development,” Palak Raval-Nelson, commissioner of the city Department of Public Health, said in a statement. “I strongly encourage all residents to take action to protect themselves by staying indoors, unless they need to be outdoors.”
Likewise, the Philadelphia Zoo remained closed Friday, saying in a statement that its animals were being “closely monitored.” The city, however, stopped short of recommending the cancellation of outdoor events, and large productions like comedian Shane Gillis’ performance at Lincoln Financial Field and a Death Cab for Cutie performance at the Highmark Mann Center for the Performing Arts were still set to go on as of late afternoon.
Officials said that venue owners had been advised of the conditions, and were able to make their own decisions as to whether those events would happen.
Trash collection in the city was expected to cautiously resume Saturday, officials said. Resumption of services was contingent upon improvement in air quality conditions, which vacillated between code purple and the comparatively less severe code red Friday.
“We will make judgment decisions as to when we will resume collections in terms of a start time tomorrow,” said Carlton Williams, director of the Philadelphia Office of Clean and Green Initiatives. “But we do plan on working all day Saturday and Sunday to ensure that last week’s trash and recycling is collected in time for our services to be on a regular schedule starting Monday.”
Pools would reopen Saturday if air conditions were code red or below, said Susan Slawson, commissioner for Philadelphia Parks and Recreation.
The Pennsylvania Department of Environmental Protection said the Philadelphia region would be under a code orange air quality alert Saturday, marking a decrease in smoke pollution. That alert level, described as “unhealthy for sensitive groups,” is the lowest it has been since the wildfire smoke arrived this week.
Air quality conditions in the area were poor Friday morning. The city’s air quality index stood at about 267 as of 7 a.m. Friday — a figure that put it solidly in the “very unhealthy” range, meaning the general public was at risk for serious health effects. It later moved into the code red — or “unhealthy” — range, but stood to potentially again become more severe as the day wore on, Raval-Nelson said.
The city of Chester, however, recorded an air quality index of 312 early Friday, putting it in the “hazardous” range — the highest on the U.S. Environmental Protection Agency’s scale. It later dipped into the “very unhealthy” range.
The region’s smoky conditions were expected to last at least until Saturday afternoon, the National Weather Service office in Mount Holly said. The sky’s hazy appearance, according to meteorologists, came from northwest winds that blanketed the region with particulate-filled air that was expected to stick around through the start of the weekend.
However, by Saturday, an anticipated storm system should clear the smoke out — though that development would likely come with its own risks. That system, said weather service meteorologist Joe DeSilva, could also bring “multiple rounds” of showers and thunderstorms, as well as the potential for flash flooding and possibly damaging winds — as well as a potential tornado.
“It definitely looks like damaging winds will be the primary hazard type,” he said.
City officials warned residents to prepare for potential flooding due to heavy rainfall Saturday. A flood watch will be in effect from 10 a.m. Saturday through 2 a.m. Sunday, the city’s Office of Emergency Management said, as storms could produce up to 2 or 3 inches of rain per hour.
Philadelphia is not the only area at risk this weekend. Berks, Carbon, Delaware, Chester, Montgomery, Lehigh, Bucks, Monroe, and Northampton Counties also face dangers from the storm, as do portions of northern Delaware and parts of New Jersey including Camden and Gloucester Counties.
“Excessive runoff may result in flooding of rivers, creeks, streams, and other low-lying and flood-prone locations,” the city said. “Creeks and streams may rise out of their banks. Flooding may occur in poor drainage and urban areas.”
The risk of storm damage Saturday comes a week after high winds and four “microburst” storms downed nearly 300 trees in the city, and left tens of thousands of residents without electricity. As a result of that storm, Philadelphia still remains under a disaster emergency declaration amid its ongoing recovery.
On Friday, officials encouraged city residents to “do what you have been doing since last week’s storm” in the face of renewed threats.
“As Mayor Parker constantly reminds us, we are one Philly,” said Adam Thiel, managing director of the city of Philadelphia. “We are a united city, as our entire city workforce, along with our residents, our neighbors, our communities, continue to move us forward through this unprecedented year.”
Staff writers Rob Tornoe and Emily Bloch contributed to this article.
