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Continental is raising its full-year profit outlook after a strong quarter in its tire business
The tire maker expects an adjusted EBIT margin of around 13.4% to 14.0% this year, up from a prior range of 12.0% to 13.5%
Contract Brings Big Wins for Healthcare Professionals in New York - The United Food & Commercial Workers International Union
Contract Brings Big Wins for Healthcare Professionals in New York
CVS confirms it will split pharmacy business from insurance
The 2018 merger of insurance behemoth Aetna and a 9,000-store retail pharmacy chain had built a $117 billion empire.
New nurses find family and fulfillment in long-term care
The group found support in each other during nursing school and at Good Samaritan - Comforcare, where all four RNs work today.
This Week In Politics: G20 Foreign Ministers’ Meeting
Amid national divides over the upcoming midterm elections, international friction also surfaced at the Group of Twenty’s (G20) foreign ministers’ meeting in Atlanta, Georgia, on Friday, Oct. 30, and Saturday, Oct. 31. Top diplomats from the G20, an international forum comprising the world’s largest economies that convene to address global economic policy and development, gathered...
Voya Financial Expands its Multiple Employer Solutions as Business Nearly Doubles
WINDSOR, Conn., November 04, 2026--Voya Financial, Inc. (NYSE: VOYA) today announced new capabilities that will expand its Multiple Employer Solutions (MES) business, giving employers, workers and advisors more choice and a simpler experience. Voya’s MES business serves a wide range of organizations, including industry associations, faith-based groups, public sector entities, professional employer organizations and small-to-middle market businesses.
Opponent Breakdown: Georgia Tech Yellow Jackets Offense
Brent Key started last season 9-1 before losing three straight games to close out a strong season for a Georgia Tech program that hasn’t had a lot of 9-win seasons as of late. Key faced lofty expectations this season after such a good season, but things have gone about as poorly as possible for Tech. […]
CVS to split into two companies, in major breakup of its $117 billion healthcare empire
CVS Health said Wednesday it is splitting into two companies, marking one of the largest shakeups in the healthcare industry. It’s a major reversal of the mergers that brought together the nation’s largest drugstore retailer along with health insurance giant Aetna and pharmacy benefit manager Caremark.
CVS to split into two companies, in major breakup of its $117 billion healthcare empire
CVS Health said Wednesday it is splitting into two companies, marking one of the largest shakeups in the healthcare industry. It’s a major reversal of the mergers that brought together the nation’s largest drugstore retailer along with health insurance giant Aetna and pharmacy benefit manager Caremark.
Apple May Phase Out Non-Touch High-End MacBook Pros
Apple will likely consolidate its high-end MacBook Pro lineup around touchscreen models, according to Bloomberg's Mark Gurman. Writing in his latest "Power On" newsletter, Gurman questioned whether Apple would keep updating its high-end MacBook Pro models without touchscreens. The company has retained the mini-LED M5 Pro and M5 Max models alongside the new touchscreen versions, which cost $400 more.
Midterm Voters Give Democrats a Big Advantage to Handle Health Care
KFF's analysis of the 2026 Voter Poll by SSRS shows midterm voters gave Democrats a 19-percentage-point advantage on which party is better able to handle health care.
Business Beat : Thurston Woods offers financial incentives to fill multiple positions
STURGIS, MI (WTVB) - Thurston Woods Village, a faith-based retirement community in Sturgis, has launched a maj...
HOMETOWN HEALTH: Cannabis involved in most substance-related ER visits for teens, study finds
Cannabis-related emergency room visits also are rising among adults ages 19 to 24.
Mavs at Spurs Preview: Wemby Vs. 'Dangerous' Dallas Combo
Rookie sensation Cooper Flagg joins Kyrie Irving to challenge Victor Wembanyama’s surging Spurs, as Dallas seeks revenge and a statement win in this high-stakes, nationally televised rivalry.
Joe Morrissey returns to politics, unseats 16-year Petersburg City Council incumbent
Joe Morrissey (D), a former Virginia senator whose political career has been marked by controversy, defeated Howard W. Myers, the 16-year incumbent, for a seat on the Petersburg City Council.
No. 15 Texas Tech Faces Must-Win Test Against West Virginia
No. 15 Texas Tech hosts West Virginia Saturday with its College Football Playoff hopes on the line. Injuries and quarterback questions add to the pressure.
Commentary: Rural and religious Americans lost faith in science. We can win them back
In July 2014, a man sick with Ebola flew from Liberia into Lagos, Nigeria, one of Africa’s largest and busiest cities. One imported case in a place like that could
Small Business Saturday campaign to begin at Mohawk Harvest After Hours
Small Business Saturday was created in 2010 to support independent merchants and redirect holiday spending locally.
Regional business leaders share their perspectives on giving back
This month we asked: In what ways does your organization give back to the community?
Flutter Entertainment (NYSE:FLUT) reports sales below analyst estimates in Q3 2026 earnings
Flutter Entertainment (NYSE:FLUT) reports sales below analyst estimates in Q3 2026 earnings
Democrats win governorships in Texas and other GOP-controlled states in rebuke to Republicans
The wins delivered a majority of governorships to Democrats for the first time in two decades, allowing them to put up a stronger defense against Trump's second-term agenda.
Police investigating 6 business burglaries on same street in Rogers Park
Cook County Public Health: Vaccinate Now Before the Holidays - Cook County Department of Public Health
As families make plans for holiday gatherings, health officials say now is a good time to get vaccinated against flu, COVID-19 and RSV. "It takes two to three weeks for respiratory vaccinations to provide maximum protection in vaccinated individuals. So, this is a perfect time to get vaccinated before gathering with family and friends for Thanksgiving," said Dr. Kiran Joshi, chief operating officer of Cook County Department of Public Health.
CVS announces plan to split into 2 companies, separating pharmacy from insurance
CVS announced plans to separate into two independent, publicly traded companies on Wednesday, reshaping one of the largest healthcare companies in the US.
Michigan votes in favor of Proposal 2 to get ‘Money Out of Politics,’ AP projects
Michigan voters have voted in favor of Proposal 2, which aims to “get money out of politics.”
‘A mandate for change’: Democrats remake Texas politics in election rout
By Brad Brooks Nov 4 (Reuters) - Texas Democrats, shut out of every statewide office for more than three decades, have toppled Republicans from the top of the ballot to the bottom, remaking the political landscape of the nation’s largest conservative s...
'A Mandate for Change': Democrats Remake Texas Politics in Election Rout
By Brad Brooks Nov 4 (Reuters) - Texas Democrats, shut out of every statewide office for more than three decades, have toppled Republicans from the top of the ballot to the bottom, remaking the political landscape of the nation’s largest conservative state in a single earth-shattering night.
Bills trade deadline candidate: Colts receiver Josh Downs
The ninth installment in the series examining possible Bills trade targets before the deadline
Manchester City Faces 114 Charges Amid Champions League Speculation
A shocking twist: Manchester City's massive financial cheating scandal might actually increase their chances of winning the Champions League. Here is why.
Geron Corporation Reports Third Quarter 2026 Financial Results and Recent Business Highlights
Achieved $60.1 million in RYTELO® (imetelstat) net product revenue in Q3 2026, an increase of 5% compared to Q2 2026 Reiterated 2026 RYTELO net product revenue at the mid-to-high end of the $220 million to $240 million range; lowered 2026 total operating expenses range to $220 million to $230 million Initiated gated commercial launch to expand RYTELO access to eligible LR-MDS patients in targeted European markets, with availability expected in Germany by end of year Ended Q3 2026 with cash, cash
Hidden planet emerges from the glare
Stars are so bright that their glare overwhelms faint nearby planets. Scientists combined detailed physics from telescope observations with modern computational techniques to precisely remove this glare. After applying the tool to existing JWST images, they found a previously hidden giant exoplanet. Technique could improve planet-detection sensitivity without requiring changes to telescope hardware.
How space weather shapes young planets
Scientists suspect powerful solar flares helped strip away the atmospheres of planets like Mars. A Michigan State University researcher is now searching for evidence of how those same forces shape planets beyond our solar system. Adina Feinstein, assistant professor of physics and astronomy, believes exoplanets are the key to understanding the early days of our solar system. This week, she received a Schmidt Sciences FirstLight grant to investigate how space weather influences young planets.
Earth’s geological record is missing hundreds of millions of years. UOW scientists think they know why
Research led by a University of Wollongong (UOW) PhD candidate may have solved one of Earth’s most perplexing geological mysteries – what caused the Great Unconformity?
Food contains thousands of overlooked chemicals. This physicist is mapping them
Giulia Menichetti is exploring how food’s vast chemical complexity may shape the microbiome and human health.
MIT scientists break a 20-year rule and unlock never-before-seen crystal structures
MIT scientists have challenged two decades of conventional thinking by discovering that flexible molecular connections, rather than rigid ones, can unlock entirely new ways to arrange nanoparticles. The breakthrough could lead to a new generation of designer materials with unusual properties and applications in electronics, medicine, and energy.
A tiny squeeze dramatically changes the magnetism of exotic materials
Scientists have discovered that a simple mechanical squeeze can dramatically alter the magnetic properties and electrical behavior of exotic materials called altermagnets. The surprising breakthrough could open the door to faster, more energy-efficient electronics and new technologies for quantum computing.
Bridge near Business 85/I-26 interchange to close Nov. 9
Repairs to the bridge over Fairforest Creek on Zimmerman Road/College Drive are expected to be complete by the end of the year.
Democrats seize Congress in sweeping midterm repudiation of Trump
Democrats seized control of both the Senate and House of Representatives on Tuesday, scoring sweeping victories in Republican strongholds for the first time in generations.
State employees to see small jump in health premiums under new PEIA proposal
During a hearing Thursday, Oct. 29, 2026, the PEIA Finance Board released a plan that raised health insurance premiums 2% next year. This affects West Virginia state government employees.
Police investigating 6 business burglaries on same street in Rogers Park
At least six businesses were broken into on the same street in Rogers Park overnight.
Fit Tips: The science of recalling your forgotten glutes
To fix gluteal amnesia (or “dead butt syndrome”), you need to stretch tight hip flexors and retrain your brain to fire your glute muscles using targeted activation exercises. Movement is how you remind your glutes what they’re capable of doing.
Cutting Away More Healthy Tissue Might Not Meaningfully Reduce Future Cancer Risk
By Dennis Thompson HealthDay ReporterWEDNESDAY, Nov. 4, 2026 (HealthDay News) — Doctors removing cancers surgically might not need to cut away lots of healthy tissue to make sure they’ve gotten all the tumor, a new study says. For one form of childhood cancer, the chances it might come back can be ...
A blue tsunami wipes out Republicans
Jonathan Freedland and Shrai Popat run through the results of the US midterms, on a historic night for Democrats and a night to forget for Republicans
Xeris adds longtime biotech exec to its board
The move to bring Menassie Taddese on comes amid reports that the Chicago-based rare disease and endocrinology drug company is being considered for acquisition.
'Full-time job to keep up with it': Drug pricing program changes worry WV clinic
Beginning in 2027, Trump administration changes to the federal 340B drug pricing program will increase the purchasing and administrative costs for eligible clinics, including in West Virginia, which will have to pay up front for the drugs and seek rebates from drug manufacturers.
Scientists find evidence of rarest particle decay after 42-years | Science and Technology Facilities Council
UK physicists have found the first evidence of an extremely rare particle decay at CERN's Large Hadron Collider (LHC), after a 42-year hunt.
Why big mergers aren’t in Inova’s playbook
Inova President and CEO Dr. J. Stephen Jones outlined the system's growth plans and capital project strategy.
Commentary: West Virginia’s doctors and federal workers fear the paper trail
Along Interstate 79 in North Central West Virginia, two kinds of workers carry a quiet fear about their own mental health.
Apple HomePod Mini 2 Review: Still Small, But With Much Larger SoundApple’s HomePod Mini 2 Is Just as Tiny, but My Tests Found Powerful Upgrades
What’s inside the 2026 HomePod, especially its audio, helps it stand apart from the old HomePod Mini, but Siri AI remains an open question.
UGA celebrates Science and Ag Hill modernization
The University of Georgia completed the second phase of its Science and Ag Hill modernization initiative and celebrated with a ribbon-cutting and tour of the renovated facility on Oct. 28,
Pens Points: Penguins blow another one with late-game collapse
Here are your Pens Points for this Wednesday morning… The Pittsburgh Penguins fell 3-2 to the Vegas Golden Knights on Tuesday night after special-teams struggles cost them another game, as they failed to capitalize on key power-play opportunities, including a lengthy two-man advantage in the third period. [Recap] NHL Commissioner Gary Bettman said he is […]
Mustafa Foundation unveils programs for International Week of Science and Peace
TEHRAN – The Mustafa Science and Technology Foundation has organized a series of programs and educational and media productions to mark the International Week of Science and Peace (November 9–15) and World Science Day for Peace and Development (November 10).
Historic election reshapes Georgia's political future: Here's what happened
Georgia voters made history Tuesday, electing Keisha Lance Bottoms as the state's first female governor, returning Sen. Jon Ossoff to Washington and flipping several statewide offices to Democrats.
Election 2026 live updates: Democrats take Congress as Trump distances himself from historic losses
Democrats have taken control of the House and Senate and are poised to launch a wave of investigations into President Donald Trump's administration.
ASUS announces ROG XG Station 3 with Thunderbolt 5 and RTX 5090 BTF support
ASUS ROG XG Station 3 supports up to 80 Gbps Thunderbolt 5 bandwidth and 140W laptop charging. The external GPU dock requires a separate SFX or SFX-L power supply.
Berks Nature to Launch New Mental Health Effort
During the 18th annual State of the Environment Breakfast, Berks Nature will introduce the first tool in what the nonprofit envisions as a multidisciplinary community partnership to help local youth find peace, healing, and connection in nature: a map of Reading’s 50+ parks, playgrounds, and green spaces.
Expecting a new grandchild? Here’s why you may need to see your doctor first
When a baby is on the way, doctors often recommend that the mother get certain vaccinations to protect her newborn – and it turns out that other family members who may visit the infant, especially grandparents, are urged to be up to date on certain shots, too.
IVF Patients, Doctors Navigate Fetal Personhood Laws’ Unknowns
People trying to start families and clinics trying to help them have been left confused and worried since the Supreme Court overturned Roe v. Wade, triggering fetal personhood laws in several states.
International Politicians React to Democrats Winning US Midterms
Nov 4 (Reuters) - Governments and politicians around the world reacted to the Democrats winning the US midterm elections, a result that could have major implications for global trade, security and energy prices. Here is a selection of the reaction: SPAIN PRIME MINISTER PEDRO SANCHEZ ON X
Political consultant Mike Madrid discusses the Latino vote
NPR's Steve Inskeep speaks to political consultant Mike Madrid about Latino voters.
Brenda Lucas: Community news for Wednesday, Nov. 4
Click for community news in the Huntington, West Virginia, and Tri-State area.
Hackers use n-day exploits in zero-click attacks on iOS, Android devices
A large-scale watering hole attack associated with Russian hackers has been targeting iOS and Android users visiting compromised sites or fake ones impersonating legitimate portals.
West Ham: Scott Parker returns to east London after 15 years to succeed Nuno Espirito Santo as Hammers head coach
Parker replaces Nuno Espirito Santo, who was sacked on November 3 after just over 13 months in charge; the 46-year-old returns to east London 15 years after leaving as a player; he has won promotion from the Sky Bet Championship on three occasions
Scaled-back version of NC's rural health pilot will return in January
After an 18-month pause, the Medicaid initiative will resume with stricter eligibility requirements and a narrower focus on food assistance.
Europa League lights in Brussels await!
Preview of RSC Anderlecht clashWith four points already on the board and plenty of momentum behind them, our Red Bulls head into a crucial phase of the UEFA Europa League this Thursday at 18:45 CET. I...
BP Appoints Former Shell Executive Emma Lewis to Lead Downstream Business
BP names an experienced energy industry executive to lead its global downstream operations as it advances its corporate restructuring.
G5 Entertainment: Established-game declines weighed on revenue as G5 Store growth lifted margins
Revenue fell 20% YoY as established games weakened, while gross margin hit 74.1% and adjusted EBIT rose YoY. G5 Store distribution, cost savings and a soft-launched new game are key growth levers, with new-game scalability still uncertain.Based on G5 Entertainment AB [G5EN] Q3 2026 Audio Transcript…
Democrats seize power in Texas, ending decades of GOP dominance
Texas’ governor, lieutenant governor, attorney general and every other statewide candidate fell, upending the state’s political power structure in one night.
G5 Entertainment Q3 2026 slides: record margins offset revenue decline
G5 Entertainment Q3 2026 slides: record margins offset revenue decline
AI boosts operational efficiency but not systemic climate action, global study finds
Artificial intelligence (AI) is widely promoted as a tool for sustainable development, but whether its operational gains translate into deeper ecological transformation remains uncertain. A new global assessment examines how AI diffusion relates to seven core United Nations Sustainable Development Goals (SDGs), covering health, education, clean energy, industry and infrastructure, sustainable cities, responsible consumption and production, and climate action. It also explores the channels behind
🗞️ Jesús de Miguel remembered, Champions League Wednesday's front pages
Football is in shock. The death of Jesús de Miguel has stunned the entire sporting world on a Tuesday to forget.On days like this, there is little point in talking about the Champions League or the s...
“Sad To Hear What Jorge Posada Had To Say” – Alexandria Ocasio-Cortez Takes Shots at Aaron Boone and Yankees Management
U. S. Representative Alexandria Ocasio-Cortez has questioned the New York Yankees’ decision to retain manager Aaron Boone, calling for changes within the organization after another disappointing season.
Nebraska voters appear to say 'no' to legalizing online sports betting
Though margins were still slim late Tuesday night, Nebraska voters were on track to reject a pair of ballot measures looking to legalize and regulate online sports betting, according to unofficial results. Initiative Measures 440 and 441 would together amend the Nebraska Constitution and state law, respectively, to legalize and regulate online sports wagers. Initiative […]
WATCH: Sen. Chuck Schumer speaks after Democrats win control of Senate
The longtime Democratic leader told reporters in Washington that “Americans voted for change” and that there had been a “generational remake of the Senate map.”
WATCH: New York Gov. Kathy Hochul speaks after winning reelection
This is Hochul's second time being elected governor. She was serving as lieutenant governor when Andrew Cuomo resigned in 2021, and she ascended to take his place.
Letters: Credit card change could hurt small businesses
I recently read an op-ed in this newspaper arguing that the Durbin-Marshall credit card mandates would ease pressure on Louisiana businesses and keep our economy growing. As an entrepreneur, I
Business-friendly Texas flips: Democrats end nearly 40-year drought, winning Senate seat and governor’s mansion
James Talarico and Gina Hinojosa turned Elon Musk’s $190 million campaign blitz into their closing arguments.
Here are the results from the sports wagering ballot measures
Two ballot measures are seeking a constitutional amendment to legalize online sports betting in the state and to create the regulatory framework to tax the wagers.
Democrat Denise Powell wins election to U.S. House in Nebraska's 2nd Congressional District
Powell flipped a district that Democrats have been targeting for several election cycles.
Jake Ferguson gets good prognosis on ankle injury
Dallas Cowboys tight end Jake Ferguson suffered an ankle injury in Week 8, but head coach Brian Schottenheimer said the initial feedback was good.
The Midterm Election Was About Health Care
In the face of Trump’s destruction of public health and modern science, voters are putting candidates who support Medicare for All, doctors, and nurses into positions of power.
The dangerous myth of the well-meaning health guru
In healthcare, a warm heart is no substitute for a trained mind. Banned Australian naturopath Barbara O’Neill built a global empire on the defense that she "just wants to help," but good intentions mean nothing when uncredentialed health advice causes real-world harm.
Event to celebrate anniversary of ‘Gone With the Wind’
Ninety years after Margaret Mitchell introduced readers to a world that would become one of the most recognizable stories in American literary and cinematic history, the story is coming home.
AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.
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