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Meet the researchers leaving the U.S. because of Trump's funding cuts and politicization of science
NEW YORK -- Halley Froehlich was sure she'd spend her scientific career in the United States. Her family has been in America since the 1700s.
What Trump shares with Truman after a midterm shellacking
Shortly after World War II, as the United States faced a rising Soviet Union, a devastated Europe, and the dawn of a Cold War, President Harry S. Truman got clobbered in midterm elections.
The CDC has recorded more than 5,000 measles cases this year
The number of measles cases reported in 2026 is the highest in 35 years, with cases reported in 45 states and D.C.
Salem artist, business owner keeps creativity local
Jessica Ramey, 48, of Salem, owns Art Department in downtown and uses art as a way to connect community members.
Salem artist, business owner keeps creativity local
Jessica Ramey, 48, of Salem, owns Art Department in downtown and uses art as a way to connect community members.
Texas has a long history of political upsets. Where does 2026 fit?
From "Pappy" O'Daniel to Ann Richards, Texas has seen surprising elections. Here's how the 2026 results fit that history.
Steelers' rookie set for special change in 2026
Pittsburgh Steelers rookie Eli Heidenreich will wear a United States Marine Corps helmet decal as part of the league's Salute to Service initiative.
Top 10 states where housing permits point to lower costs
We're not building enough new homes in the US to keep costs reasonable, a new report says. But some states are doing better than others: See the map.
Friday's Connecticut high school sports roundup: Brien McMahon boys soccer advances in states
A look at the Connecticut high school sports scene for Friday, November 6, 2026.
Louisiana has highest flu activity in U.S., health department data shows
Louisiana has the highest influenza activity in the United States, according to data from the Louisiana Department of Health.
Trump administration delays awards slated to improve rural America’s health
Federal leaders overseeing a $50 billion rural health fund missed a critical deadline to announce how much they’ll give states next year, alerting state leaders to the delay with a mass email.
Montana, Michigan and More U.S. States Vote to Kick Big Money Out of Politics
In Citizens United v. FEC, the U.S. Supreme Court decided that companies and other private groups have the First Amendment right to spend unlimited money in elections. In this year’s midterms, voters in four states decided whether to move on their own to limit the influence of corporations and wealthy megadonors on democracy.
Health Data Utilities Could Provide Needed Public Health Infrastructure
In states, clinical, public health and Medicaid administrative data are not integrated, which fragments clinical care and limits states’ ability to see
LSU reinstates law professor suspended for political comments
LSU has reinstated a law professor that it removed from the classroom for making political comments critical of Gov. Jeff Landry
U.S. sanctions relatives of Cuban military business leaders
The United States has imposed sanctions on relatives of current and former leaders of Cuba's military-run business conglomerate GAESA.
After a Wisconsin infant dies from measles, health officials urge people to get vaccinated
Measles is a highly contagious and deadly disease that the United States had all but eradicated, through vaccination. Now it’s back.
Democrats rode a blue wave. Can they ever keep up momentum in Missouri and Kansas?
Democrats made historic gains in states where they’ve struggled for years to gain a foothold. What’s next?
States tax sports betting heavily, but gamblers may barely feel it
Sports betting has grown explosively since 2018, when a U.S. Supreme Court ruling struck down a federal ban on it. Now, Americans wager more than $165 billion on sports annually, contributing to an industry ...
Scientists achieve record-breaking low temperature on China's space station, paving the way for new physics experiments
Matter starts to behave differently at extremely low temperatures, creating conditions ideal for studying quantum physics and new states of matter. Now, researchers from China have achieved a new low-temperature ...
Every Brand Selling Sports Cars in the U.S. in 2027
From Aston Martin to Toyota, this is every performance two-door car for sale in the United States.
Jay Rockefeller, former West Virginia governor and U.S. senator, dies at 89
Rockefeller came from one of the nation’s richest families to spend a half century in public service in one of the poorest states.
What many get wrong about Amish or Plain Anabaptist communities, measles, and health
The U.S. has reported three measles deaths this week in three different states. All the affected were unvaccinated, and some were too young to get vaccinated, relying on herd immunity. Many states haven’t seen a measles death in more than 30 years. Measles is highly contagious, but it mainly spreads among those without immunity. Social factors typically shape these unvaccinated pockets. Many states describe these deaths as occurring among “under-immunized, rural communities.” (In the future, it could be among other tight-knit groups.) Small signals in the news point to many outbreaks right now among the Plain Anabaptists (APA), which include communities like the Amish and Mennonite. Many know APA communities from a distance through their bakeries, furniture, and roadside buggies. But most of us don’t know enough about them, their traditions, or how those traditions actually interact with health and disease. Rumors, misconceptions, and frustration fill those voids. Tristan Sharratt, a family nurse practitioner and rural health researcher who grew up near and works with these communities in Central New York (and a YLE reader who reached out!), says misconceptions continue to create major problems. If the U.S. wants to stop a tsunami of measles coming down the pipeline, or even support health in those communities proactively beyond measles (which is ideal), we must understand how specific communities protect themselves, their values, and the role broader society plays. This starts with a conversation and some self-reflection. Here are the top five lessons I learned from my conversation with Tristan.
National Politics Will Never Be the Same: Juan González on How Latino Voters Remade the Political Map
The midterms saw a landslide of Latinos vote for Democrats. In Texas, California, Kansas and Colorado, Latinos who had voted for Republicans just two years ago voted for Democrats in large numbers, helping secure Democratic control of both the House and the Senate. Latino lawmakers will make up about a fifth of the Democratic majority in the House. And in an historic victory, the two most populous states in the country, California and Texas, will soon be led by Democratic Latino governors. “Texas has been suddenly transformed into a battleground state,” says Democracy Now! co-host Juan Gonzalez. “Texas has been the biggest and most important red state in the country for decades, and I’ve been predicting for years that it is the key link for achieving a realignment of national politics.”
The women behind the Democratic wave transforming US politics
A record 155 women are set to serve in Congress, while one-third of the states will be led by female governors
Did a nationwide ‘blue wave’ skip Idaho this election? Experts weigh in
One Idaho candidate said he instead saw a “red undertow”: a rebuke of Republicans and President Donald Trump.
Political Turmoil Needs More Than Political Solutions
Unrest in Europe and the United States calls out for moral and spiritual renewal.
Oregon sues Trump administration over Medicaid work requirements
Oregon has sued the Trump administration over changes to Medicaid that the Oregon Health Authority warned could impact around 600,000 Oregonians.
Georgia Southern military science professor to keynote Veterans Day public observance downtown
With the public encouraged to attend, the annual Veterans Day observance hosted by American Legion Dexter Allen Post 90 will be held Wednesday morning, Nov. 11, at the Emma Kelly Theater in downtown Statesboro.
Will Lawmakers Heed the Call for More Affordable Health Care by Expanding Medicaid in TX, GA, KS & WI?
Over the last year there hasn’t been much discussion around creating more affordable health coverage in the last ten states that haven’t expanded Medicaid. But yesterday’s election dramatically changed the political status quo in at least four of the non-expansion states: Georgia, Kansas, Texas, and Wisconsin. That makes Medicaid expansion more viable in those states […]
Health: How Can Congress Combat The Rising Cost Of Healthcare?
The cost of most necessities is rising right now. And healthcare is no exception.In 2026, the average employer-based family healthcare plan cost a little over $28,000. And employees contributed over $7,400 more to those plans than in 2025. That’s according to analysis from the health research group KFF.And the nearly 20 million Americans who rely on the Affordable Care Act for health insurance are facing a 13 percent premium increase next year.Two days out from the midterm elections, what can Congress do to keep healthcare affordable in the United States?Find more of our programs online. Listen to 1A sponsor-free by signing up for 1A+ at plus.npr.org/the1a.
Why California’s billionaire tax was a harder sell than expected
LOS ANGELES — Despite a nationwide blue wave in the midterm election, California’s much-debated billionaire tax didn’t get the support many expected in one of the country’s most liberal states.
How Democrats’ midterm wins reshape Farm Bill politics
Democrats’ sweeping gains in this week’s congressional midterms, driven in part by voter frustration in farm states, give the party new leverage in Farm Bill negotiations, according to farmers and farm advocates.
1115 Waiver Watch: A Look at Budget Neutrality Policy Changes
This brief discusses key Medicaid policy changes included in CMS budget neutrality guidance and identifies open questions about how the policy changes may be clarified and how they may affect states with existing 1115 waivers or states interested in applying for new ones.
US Department of Justice Intervenes in Health Insurance Whistleblower Lawsuit Brought by Lieff Cabraser Against Centene Corporation
The Lieff Cabraser law firm represents a former employee. NASHVILLE, Tenn.–(BUSINESS WIRE)–On October 27, 2026, the United States sued one of the nation’s largest health insurance companies, Centene Corporation, for fraud under the False Claims Act. Lieff Cabraser’s Nashville Office is proud to represent the relator, who brought this matter to the government after internal
Patrick’s Politics: Enjoy this moment of hope
There is good news in the United States today. After two years of one-party Republican rule, the people fought back.
Trump Administration Delays Awards Slated To Improve Rural America’s Health
State leaders who scrambled to win and begin spending their first-year shares of Republicans’ five-year, $50 billion fund are in the dark about how much they’ll receive in the Rural Health Transformation Program’s second year after a federal office notified states that more time is needed to make allocations.
Commentary: Shift the wildfire spending to damage prevention, not just reaction
While a fire may be burning two states away, the smoke still arrives, settling over neighborhoods and dimming skylines. School administrators move recess indoors, and outdoor work slows or stops.
Imaging Science Thesis Defense: A Step Towards Developing Digital Twins of Forest Environments with Terrestrial Laser Scanning | Events
Imaging Science MS Thesis Defense A Step Towards Developing Digital Twins of Forest Environments with Terrestrial Laser Scanning Zoom Link here Aisha Co Imaging Science MS Candidate Rochester Institute of Technology Abstract: Digital twins have become an increasingly relevant topic as we pursue accurate representations of the real world for planning, research, and even design purposes. This study focuses on the steps for creating digital twins of forest environments using sparse points from terrestrial light detection and ranging (LiDAR). Specifically, we developed geometric models of structural digital twins (SDTs) from leaf-off terrestrial laser scanning of real-world forests. Three algorithms were used to develop an approach to handle individual tree reconstructions for sparse point clouds, and they were tested and validated with a two-sample Kolmogorov-Smirnov statistic against an existing inventory of the RIT Nature Trail to evaluate the reconstruction’s fidelity. The key evaluation metrics included diameter at breast height (DBH) and height. The limited nature of available ground truth necessitated the use of an additional validation method using a PANGAEA open dataset, based on comparing DBH, height, and crown diameter against the dataset’s calculated measurements. Reconstructions were compared against per-tree reference values at two-point spacings for sixteen trees from the open BR07 dataset (PANGAEA); these specifications matched the collected RIT Nature Trail data and the scanner’s nominal spacing. On BR07, the proposed method had the lowest median DBH error among the methods that modeled every tree (1.28cm, 4.1%), and this error was nearly unchanged at the coarser spacing, while TreeQSM’s rose from 4.2% to 6.5% and AdTree overestimated DBH by 30% to 40%. Results show the proposed method understates the tree heights by 0.2m to 1.4m but contains the least error when estimating DBH. The proposed method was able to produce all 69 trees, while SimpleTree produced 49 and none at the 4.35 cm BR07 spacing. We concluded that the developed geometric model (digital) twins have significant potential to serve as both simulation and prediction tools. We recommend that future efforts focus on collecting per-tree ground truth measurements within the scanned plot and incorporating leaf-on scans. Leaf-on scans include representative foliage, which would add realism to the model and ecological function of the trees. Intended Audience: Beginners, undergraduates, graduates. Those with interest in the topic. To request an interpreter, please visit myaccess.rit.edu
Historic midterm leaves UMD political professor shocked at results
Across the nation on Election Day, democrats flipped several traditionally republican states. UMD Political Science Associate Professor Cindy Rugeley said voters made big waves this midterm.
Moderate Democrats Increase Their Numbers, and Their Clout
Victories by moderates in competitive or Republican-leaning states and districts paved the way for large new Democratic majorities likely to be shaped by their priorities.
Montana Remains Top 10 for Fiscal Health Under Gov. Gianforte’s Leadership
HELENA, Mont. – Governor Greg Gianforte today announced that Montana’s fiscal health remained in the top 10 states nationally under his leadership, rising from 22nd in 2021 to 7th in 2026. In 2025, Montana was ranked 8th for fiscal health.
Voters approved two sex-based school sports measures, defeated one measure on medical procedures for transgender minors; three remain uncalled
Voters in five states decided six ballot measures related to sex-based sports eligibility and medical procedures for transgender minors in 2026. Here are the results and what they mean. As of 2:15 PM EST on Nov. 4, of the four measures to establish sex-based requirements for school sports, two passed, and two were not called […]
Will Gina Hinojosa be pro-business? What the governor-elect's voting record says
Gov. Greg Abbott turned Texas into on of the most pro-business states in the country, but that could change after his stunning defeat by Democrat Gina Hinojosa.
'Hopefully things get done': Americans react to historic political shift
The BBC spoke to voters from different states for their reaction to Democrats taking control of both the Senate and the House of Representatives.
Trans sports bans get voter approval in 4 states
Voters in four states — Arizona, Colorado, Nebraska and Washington — are on track to pass or have passed measures to restrict transgender athletes’ participation in sports, a key policy focus of the Trump administration.
Political science expert breaks down Tuesday's election results
BOWLING GREEN, Ky. – Election Day, Tuesday, brought both a large and small scale blue wave, along with some very close local races here in south-central Kentucky. On a national scale, the republican lead house has lost at least 29 seats with 64 seats still yet to be officially confirmed. The United States Senate Democratic Party has gained seven seats, while...
Democrats win full control of more state governments and the Texas House
Democrats in Texas took control of the state House after historic wins for governor and U.S. Senate, part of a series of sweeping gains nationwide in Tuesday’s elections that shifted the balance of power across several battleground and Republican-leaning states.
How Science and the Environment Fared in the 2026 U.S. Midterms
Science was on the ballot across the United States in Tuesday’s midterm elections. On federal, state, and municipal levels, hundreds of people with backgrounds in science, technology, engineering, mathematics, and medicine ran for office. Americans also voted on measures related to conservation projects, pollutant abatement, healthcare access, and environmental reviews.
Fidel Estrada Jr., East Austin business owner and community elder, dies at 90
Fidel Estrada Jr. spent decades running Estrada's Cleaners and helping lead an East Austin community network.
How Trump and Republicans lost the 2026 midterm elections, according to AP Voter Poll
After more than a decade with Donald Trump at the epicenter of U.S. politics, most voters appear exhausted and exasperated by him, according to The AP Voter Poll, a survey of midterm voters in all 50 states.
ARCare triples nurse capacity by combining RPM and chronic care management
A redesigned nursing workflow connects home blood pressure readings with patient relationships – expanding remote monitoring across three states.
The Future of Democracy
The 2026 midterm elections didn’t just determine who controls Congress for the next two years—they also determined whether the United States, 250 years after its founding, remains a democracy, Anne Applebaum says. She explores what citizens and lawmakers can do next to strengthen the institutions and values that have been threatened in the Trump era.
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.
Major Changes to Hemp Regulation Are Taking Effect: Is Your Business Ready?
The hemp industry is preparing for significant federal restrictions that will change which hemp-derived products can legally remain on the market, with key provisions taking effect in November and December. At the same time, states continue to take different approaches to intoxicating hemp products, creating added complexity for manufacturers, retailers and consumer brands.
The political map is anyone's guess after a Democratic wave in the midterm elections
Voters have dramatically shifted the political landscape by electing Democrats in traditionally Republican states.
The political map is anyone's guess after a Democratic wave in the midterm elections
Voters have dramatically shifted the political landscape by electing Democrats in traditionally Republican states.
The political map is anyone's guess after a Democratic wave in the midterm elections
Voters have dramatically shifted the political landscape by electing Democrats in traditionally Republican states.
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.
Star Health's Arogya Seva Kendra clinics cross 1.8+ lakh beneficiary visits within a year of their inception, bringing free primary healthcare to communities across 9 states
Star Health and Allied Insurance Company Limited (NSE: STARHEALTH) (BSE: 543412), India's leading standalone health insurer, has been safeguarding the health and well-being of millions of Indians for over 20 years through a strong focus on customer-centricity, transparency, and innovation. Reflecting its commitment to creating lasting social impact, Star Health's CSR initiatives focus on improving health outcomes through accessible healthcare, preventive interventions, and community wellness pro
Washington voters backing initiative to keep transgender girls out of girls’ sports
Washington state voters backing initiative to ban transgender girls from girls' sports, election results show
Abdul El-Sayed Wins Michigan Senate Race, Making History as First Muslim Senator
El-Sayed has defeated former Rep. Mike Rogers in Michigan’s open Senate race, making him the first Muslim elected to the United States Senate.
Angry Voters Usher in Beginning of the End to the Trump Era
The electoral backlash extended even into deep red states and indicated that President Trump has lost his hold over the coalition that lifted him to the White House twice.
Democrats flip four governorships, extending the party’s inroads into red states
Republicans entered Tuesday’s midterms with a 26-24 advantage in governor’s offices across the country.
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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