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I was afraid of layoffs. So I started my own company.
Erika Sinner grew up in poverty in Missouri before starting as a receptionist and building a $13 million pharmaceutical marketing firm.
CVS Health CEO on splitting into two companies: ‘We’re doing it out of a position of strength’
CVS CEO David Joyner joins 'Squawk on the Street' to discuss the company splitting in two, Q3 earnings, and more.
CVS Health to split in two, separating pharmacy business from insurance
Health insurers have grappled with higher medical costs recently, while drugstores face mounting competition from Amazon and a declining foot-traffic.
CVS Health to split in two, separating pharmacy business from insurance
Health insurers have grappled with higher medical costs recently, while drugstores face mounting competition from Amazon and a declining foot-traffic.
Bean Life Science Museum hosted its annual free Halloween Family Night for students and families
The Bean Life Science Museum hosted its annual Halloween Family Night on Oct. 26, offering families a free evening of hands-on activities, crafts, and opportunities to explore the natural world.
Fans Furious as The Chicks Cancel L.A. Show Moments Before Doors Were Set to Open
Fans expressed their outrage after country music icons The Chicks canceled their show in Los Angeles just moments before doors were set to open. The band announced on Monday, November 2, that “due to ...
As Holidays Approach, No One Cares About Amazon’s Biggest Business
Amazon quietly became America's largest company by revenue, yet holiday shoppers and Wall Street investors seem far more focused on its AI ambitions than its massive e-commerce engine, and that split attention may be hiding a serious risk.
Madison Square Garden Entertainment Corp reports results for the quarter ended September 30
FORECAST CHANGESRECOMMENDATIONSThis summary was machine generated from LSEG data November 4 at 02:32 p.m. UTC. All figures in US dollars unless otherwise stated. (For questions concerning the data in this report, contact Estimates.Support@lseg.com. For any other questions or feedback, contact Refi…
3 players the Titans should try trading before the deadline
Identifying three players the Tennessee Titans should try trading before the NFL trade deadline (Nov. 10)
Giants Should Target Senzatela for More Bullpen Depth
Antonio Senzatela offers a versatile solution, bringing starter experience and proven relief stability to stabilize the San Francisco Giants’ taxed pitching staff.
Best Foods for Brain Health: Cocoa Powder, Sardines, More
New research shows diet is an essential way to boost brain health, but which foods are the most effective? TODAY nutrition and health expert Joy Bauer stops by Studio 1A to share the best foods to improve cognitive health, mental resilience and memory function — and some of them may surprise you.
Tennis legend Rafael Nadal joins Real Madrid board
Rafael Nadal won 22 grand slam titles in his tennis career before retiring in 2024
The Donald Trump Era in American Politics Is Ending
The takeaways from the midterms are clear: no amount of billionaire spending could overcome the fact that Donald Trump’s dominance is coming to a close, the Left has much more room to grow, and we have entered a period of new possibility in US politics.
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.
Skye chef pledges health before wealth at 'pay what you can' cafe
Araich has been set up in a former woollen mill in Portree and offers healthy food options.
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...
Breaking Down Penn State Offense Improvement
The Penn State offense has struggled since the beginning of Big Ten play at the end of September. The Nittany Lions didn't score more than 23 points in their last four games; that was until Saturday's 31-17 victory over Purdue. It was a refreshing showing from Taylor Mouser's group. The ground game looked competent, the …
Scientists develop novel model to forecast internal solitary waves from multiple sources in the Sulu Sea
A research team led by Professor Li Xiaofeng from the Institute of Oceanology of the Chinese Academy of Sciences (IOCAS) has developed a model to forecast internal solitary waves originating from multiple ...
Health Plan Unlocks More Than $10M in Savings in Six Months Using Cohere Health's AI-Powered Pre-Payment Review
Cohere Health®, the leading clinical intelligence and operations platform for health plans, today announced that a Medicare Advantage client identified more than $10 million in savings in six months by finding complex clinical and coding errors in high-cost drug and durable medical equipment claims before payment.
WSU Regent Howard Wright honored for longstanding commitment to improving public health in Guatemala
Later this month, the vice-chair of the WSU Board of Regents will receive an honorary doctorate from the Universidad del Valle de Guatemala and deliver its commencement address to graduating students.
PAVS Subsidiary 2Lab3 Launches AniMano+, an AI-Native Digital Entertainment Streaming Platform, on the Apple App Store
NEW YORK, NY / ACCESS Newswire / November 4, 2026 / Paranovus Entertainment Technology Ltd. NASDAQ:PAVS ("PAVS" or the "Company") today announced that its subsidiary, 2Lab3, launched AniMano+, an AI-native, vertical-first short-form dramas and animation streaming app, on the Apple App Store on Octo…
PAVS Subsidiary 2Lab3 Launches AniMano+, an AI-Native Digital Entertainment Streaming Platform, on the Apple App Store
NEW YORK, NY / ACCESS Newswire / November 4, 2026 / (NASDAQ:PAVS) ("PAVS" or the "Company") today announced that its subsidiary, 2Lab3, launched AniMano+, an AI-native, vertical-first short-form dramas and animation streaming app, on the Apple App Store on October 23, 2026.AniMano+ combines storytelling and creative expertise with AI-enabled content production capabilities to develop entertainment for global audiences.
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.
Mets Morning News: More salary cap nonsense
Your Wednesday morning dose of Mets and Major League Baseball news, notes, and links.
Braves News: Salary cap proposal, Rolddy Muñoz review, and more
Atlanta Braves news and notes from Tuesday.
Analysis-AI shopping agents could threaten Amazon and Walmart’s ad business
By Juveria Tabassum, Nicholas P. Brown and Arriana McLymore Nov 4 (Reuters) - The rise of AI-led shopping is posing a conundrum for retailers like Walmart and Amazon: how to enable AI agents to shop on their websites, without threatening their lucrativ...
Analysis-AI shopping agents could threaten Amazon and Walmart’s ad business
By Juveria Tabassum, Nicholas P. Brown and Arriana McLymore Nov 4 (Reuters) - The rise of AI-led shopping is posing a conundrum for retailers like Walmart and Amazon: how to enable AI agents to shop on their websites, without threatening their lucrativ...
Dodgers notes: Tarik Skubal, Shohei Ohtani
Free agency has officially begun, and the Dodgers are now on the clock to try to fortify their roster before the impending lockout. Left-hander Tarik Skubal is atop the list of the most highly coveted free agents this offseason, and the Dodgers are not the only bidder for his services. Jeff Passan at ESPN reports […]
Buckeyes Roll into Saturday's Game as Massive Favorites Against Oregon
Ohio State opens as massive favorites on Saturday against the Oregon Ducks.
TCA Health Nutrition and Wellness Center celebrates ribbon cutting
TCA Health was recently joined by DPD Commissioner Boatright and 10th Ward Alderman Chico to celebrate the ribbon cutting for the TCA Health Nutrition and Wellness Center at 1029 E. 130th. Located in Altgeld Gardens, the center is planned by TCA Health to help address the longstanding food desert that was created when the area lost its only full-service grocery store in 2018.
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.
Video: McKennie joins Juventus group training before AZ Alkmaar clash
Juventus midfielder Weston McKennie trained with his teammates at Continassa this morning, on the eve of a Europa League game against AZ Alkmaar.Juventus are preparing for Thursday’s away Europa Lea...
Flutter Entertainment (NYSE:FLUT) reports sales below analyst estimates in Q3 2026 earnings
Global online betting company Flutter Entertainment (NASDAQ:FLUT) fell short of the market’s revenue expectations in Q3 2026 as revenue rose 2.1% year on year to $3.87 billion. Its non-GAAP loss of $0.18 per share was significantly below analysts’ consensus estimates.For more on Flutter Entertainme…
Askeland upsets Ladyman in House race
In a surprise state house race, Democrat Erika Askeland defeated her incumbent opponent Jack Ladyman R-Jonesboro on election night (Nov. 3). With more than 100% of the votes counted, she...
Askeland upsets Ladyman in House race
In a surprise state house race, Democrat Erika Askeland defeated her incumbent opponent Jack Ladyman R-Jonesboro on election night (Nov. 3). With more than 100% of the votes counted, she...
Sanford Health Column: Keeping human connection at the heart of healthcare
When used appropriately, AI documentation can make a visit feel more personal, not less. Instead of dividing attention between a patient and a computer screen, a clinician may be able to focus more fully on the conversation.
Good sleep protects brain health in people with cardiometabolic disease
People with type 2 diabetes, heart disease or stroke who sleep well have better cognitive function and greater brain volume than people with the same conditions who sleep poorly, according to a new study from Karolinska Institutet.
NBA sits out Election Day yet again while other sports leagues go about business as usual
The NBA's "Get In The Game. VOTE." campaign saw all 30 teams sit out Tuesday's midterm election as players wore vote shirts at Monday's games.
VSU Science Café to Explore Infectious Disease Threats
VALDOSTA — A VSU biology professor will discuss infectious diseases, mosquitoes, ticks, and evolving health threats on Nov. 12.
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.
Seahawks Hit Unwanted Milestone After Lopsided Loss to Bears
The Seattle Seahawks have suffered yet another setback in the 2026 NFL season. The team has suffered an embarrassing defeat to the Chicago Bears with a score of 17-34. The reigning Super Bowl champions now have a current record of four wins and four losses. The franchise had a dominant season in 2025, which led […] The post Seahawks Hit Unwanted Milestone After Lopsided Loss to Bears appeared first on Gridiron Heroics.
Should the Broncos trade Marvin Mims before NFL's deadline?
Marvin Mims is scheduled to become a free agent in 2027. Should the Broncos consider trading him now?
‘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.
Data center memes flood X after Democrats' 2026 midterm wins
Democratic wins sparked data center memes on X, including a post from Elon Musk, as voters push for more limits on the AI infrastructure boom.
Walking more shows sharper links to lower health care costs as adults age
More than 60 years after "I look up as I walk," known worldwide as "Sukiyaki," became Japan's most famous song about walking, a new study finds that as walkers look up, their predicted health care costs ...
Bills trade deadline candidate: Colts receiver Josh Downs
The ninth installment in the series examining possible Bills trade targets before the deadline
More Segunda matches postponed: Andorra-Mallorca also called off ❌
This weekend’s match between FC Andorra and RCD Mallorca has been officially postponed. The sporting authorities and both clubs have agreed to call off the fixture amid the shock gripping Spanish fo...
China’s Photonic Quantum Computer Among WIC Award Winners
China’s Jiuzhang 4.0 photonic quantum computer was among 20 projects honored with the 2026 World Internet Conference.
Scientists may have finally explained why our brains and bodies are cross-wired
Scientists propose that the brain’s mysterious cross-wiring, which connects each hemisphere to the opposite side of the body, may have originated more than 500 million years ago in the visual systems of ancient fish. Rather than evolving for a specific advantage, this unusual arrangement may simply be a legacy of evolution building new brain circuits on an ancient foundation.
Lobo football to health care leadership, Brad Cook finds purpose in building better systems
For Brad Cook, leadership began long before he entered the healthcare industry. As a student at The University of New Mexico, Cook received a full ride scholarship to serve as the head equipment manager for the Lobo football team. This experience gave...
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.
‘Arrested Development’ alum David Cross coming to Iowa City
Comedian David Cross, known for his work on “Mr. Show” and “Arrested Development,” talked with The Gazette about fatherhood, his career and more ahead of his appearance Nov. 10 at
CVS to split off drugstore business in major breakup of healthcare giant
The move would reverse the company's $78 billion acquisition of Aetna, and dismantle the vertically integrated healthcare conglomerate it created in 2018.
CVS to split off drugstore business in major breakup of healthcare giant
The move would reverse the company's $78 billion acquisition of Aetna, and dismantle the vertically integrated healthcare conglomerate it created in 2018.
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 ...
Column: Remembering Election Central As Who’s Who of Fayetteville Politics
Before election results went virtual, candidates and residents gathered at the former Holiday Inn Bordeaux to await voting returns.
'Richard Avedon: Hollywood' is now on view at Gagosian in L.A.
A new exhibit at Gagosian, 'Richard Avedon: Hollywood,' features more than 120 images, spanning from 1947 to the year Avedon died in 2004.
Bears-Seahawks Monday Night Football: Overreaction Or Not?
The Monday Night Football game between the Seattle Seahawks and Chicago Bears produced some shocking results. Ben Johnson and Caleb Williams moved the ball at will on that vaunted Seahawks defense and scored 34 points. It was the most points Seattle had surrendered all season. I have three takeaways from the game, and I’ll decide […] The post Bears-Seahawks Monday Night Football: Overreaction Or Not? appeared first on Stadium Rant.
Trump’s Whole Theory of Power is in Ruins
More than any American president, Trump has used fear as a central tool of policymaking. He doesn’t look so fearsome today.
Quinn to exhibit photography at Blackstone River Theatre
CUMBERLAND – Blackstone River Theatre’s Art Gallery will host an exhibit and sale of concert photography by Kerry Quinn on display through Dec. 20, viewable two hours before and during
Reports: CVS Health plans breakup that would separate Hartford-based Aetna from drugstore chain
The CVS Health Aetna breakup would separate its drugstore chain from Hartford-based Aetna and Caremark, creating two public companies by early 2028.
See Brevard County's high school football live scoreboard, Week 12
Five games comprise the Nov. 4-6 slate as three FHSAA teams make up games with three SSAA teams looking to advance in state playoffs.
Three Trade Partners for the Detroit Tigers This Winter
With the team needing relief pitching and several teams needing outfield help, the Detroit Tigers have several potential trade partners. The Motown team allowed 11 walk-off hits in 2026 and blew 32 saves, both the most by an American League team. Although their offensive core and deep starting rotation will be back for next season, …
Juventus to Get More Cash from Owner, Outline Priority
Juventus have announced yet another capital increase of up to €250M, to be activated in due course. They were in the red by €66M in the last session. The stakeholders will have to pour more money ...
Bryant visits Quinnipiac following Harvey's 20-point game
Bryant Bulldogs (1-0) at Quinnipiac Bobcats (0-1)Hamden, Connecticut; Thursday, 7 p. ESTBOTTOM LINE: Bryant takes on Quinnipiac after Keegan Harvey scored 20 points in Bryant's 80-75 win over the Siena Saints.
Emperor Entertainment Hotel Expects Profit Attributable Of Not More Than HK$35 Million For HY
Emperor Entertainment Hotel Limited HKEX:296:
DAZN Pulse: Miami wins college football's bizarre Midterm Elections
Miami Hurricanes take center stage in college football’s bizarre midterm elections, with the latest headlines, analysis and reaction. Read more at DAZN News.
Today’s Papers
La Gazzetta dello SportReal InterThe Nerazzurri restart in style: Feyenoord crushedBisseck opens the account, then Pio and Zielinski score. Chivu keeps climbing the table: ‘Our best version.’Roma ...
Watch Live Sports Online & Stream FOX Sports
Watch live sports online with FOX One. Stream NFL, college football, MLB, NASCAR, INDYCAR and more, plus FOX Sports shows. Start your 3-day free trial.
Jets Make NHL History With Stunning Comeback Win Against Habs
The Winnipeg Jets appeared destined for what would have been a 10th straight loss, finding themselves trailing by a 4-0 score against the Montreal Canadiens at Bell Centre on Tuesday night.But then, suddenly, everything clicked and resulted in a stunning and historic turnaround, not only ending their miserable losing skid but also setting a new […] The post Jets Make NHL History With Stunning Comeback Win Against Habs appeared first on HEAVY.
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…
Declining influenza vaccinations continue among health care workers
Despite often caring for patients at higher risk of severe outcomes from respiratory virus infection, health care workers in Oregon continue to lag in rates of vaccination against the potentially
Titans’ biggest problem to fix during 2026 bye week
The Tennessee Titans are approaching their 2026 bye week with more questions than answers. Sure, Cam Ward’s development remains central to the franchise’s long-term ambitions. However, Tennessee’s struggles extend well beyond the quarterback position. The offense has shown occasional flashes of explosiveness. The defense, though, has repeatedly […] The post Titans’ biggest problem to fix during 2026 bye week appeared first on ClutchPoints.
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
Pacific Scientists Build a Regional Picture of a Changing Ocean
Understanding how ocean acidification is unfolding across the Pacific requires more than individual research projects or monitoring stations.
Girls' flag football: Tuesday's City Section playoffs scores
Check out Tuesday's girls' flag football scores.
Democrats secure historic majorities in the midterms — and are poised to win even more seats
The party is poised to have strong majorities in Congress for the final two years of President Trump’s term. Follow for live updates.
CVS Health To Split Into Two Companies As Pressure Mounts On Vertical Integration
CVS Health will split into two companies, putting the more than 9,000 drugstores under one business and its Aetna health insurance and pharmacy benefit operations into another.
“I Don’t Know If I’m Willing to Do It Just to Fight” – UFC Fans May Have Seen the Last of Beneil Dariush Inside the Octagon
Fans may have already seen the last of Beneil Dariush inside the Octagon. The veteran lightweight has endured a difficult stretch lately, losing four of his last five UFC fights, with all four defeats coming by knockout. Most recently, Dariush was stopped by Quillan Salkilld at UFC Perth in May 2026. Before that, he suffered …
Tight race between LA Mayor Karen Bass and democratic socialist Nithya Raman
The first returns were a tally of mail ballots received before Election Day. Others, including results from in-person voting, were to follow.
Tight race between LA Mayor Karen Bass and democratic socialist Nithya Raman
The first returns were a tally of mail ballots received before Election Day. Others, including results from in-person voting, were to follow.
How a Ms. Frizzle-esque librarian helped Flagship’s Louisa Helms find biotech
BioSpace 40 Under 40 honoree Louisa Helms is a lot of things—athlete, scientist, entrepreneur and likely future biotech executive. Just don’t ask her to pick up any pipettes.
Political analysts discuss Wisconsin governor's race results
Democrat David Crowley defeated a Republican with close ties to President Donald Trump on Tuesday, rising from a childhood in one of the nation’s poorest neighborhoods to become the first Black person to lead the battleground state.
Declining influenza vaccinations continue among health care workers
Despite often caring for patients at higher risk of severe outcomes from respiratory virus infection, health care workers in Oregon continue to lag in rates of vaccination against the potentially
Circadian depression: Body clock disruptions take mental health toll
About one in four depression cases follow disruptions to the sleep-wake cycle in what scientists say is a circadian subtype of the condition. After assessing data for more than 10,000 patients, resear...
Iconic country music act cancels LA show just hours before showtime: 'Flew in from Oklahoma for this!'
Before the Dawn in America’s Heartland
With hardly a cloud in sight, astronauts had a sweeping view of nighttime lights in the U.S. Midwest.
Connections: Sports Edition today: Hints and answers for Nov. 4, 2026, puzzle No. 772
Welcome to Connections: Sports Edition Coach — a spot to gather clues and discuss (and share) scores.
US stock futures mixed as Democrats score key midterm election wins
Wall Street faces fresh uncertainty over what Democratic control of Congress could mean for taxes, government spending and regulation.
US stock futures tumble as Democrats score key midterm election wins
Wall Street faces fresh uncertainty over what Democratic control of Congress could mean for taxes, government spending and regulation.
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.
U.S. Congressman Tim Moore, a longtime fixture of NC politics, defeated in reelection bid
Before moving to Congress, Moore was the longest-sitting Speaker of the N.C. House of Representatives.