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Democrats Want to Prove They Can Win in the Rapidly Changing South
The electoral math could become difficult for Southern Democrats, especially if they lag on Tuesday: An influx of new residents means the party that controls Southern states is likely to gain political power after the next census.
This new Texas theme park has record-breaking roller coasters
Theme parks come in all shapes, sizes, and locations. One of the newest to open in the United States is tucked away in a corner of the Circuit of the Americas (COTA) campus in Austin, Texas. Dubbed COTALAND, the park is themed around the thrilling world of high-speed car racing, which seems fitting since COTA is the country's only purpose-built Formula 1 track.
Mid-America manufacturing continues to see economic growth
The Creighton University Mid-America Business Conditions Index, which measures economic activity across nine states, moved above growth neutral for the ninth consecutive month, pointing to solid economic growth in regional manufacturing. The overall Business Conditions Index increased to 56.1 in October from 55.7 in September. According to a news release, the current manufacturing expansion is…
As local post-production dwindles, a Burbank studio makes cuts
Southern California's post-production industry has been reeling from an unprecedented industry contraction, partly due to the flight of filming to other states and countries.
US midterms: With deep-red states now in play, could blue wave redraw America's political landscape?
US midterm elections 2026 live updates: key House and Senate races to determine control of Congress for remainder of Trump’s term
Key states like Florida, Georgia, Michigan and North Carolina see record turnout as Americans decide the direction of Congress for remainder of Trump’s term
The Latest: Democrats and Republicans make a final push one day before midterm elections
President Donald Trump closed out the final weekend of a turbulent midterm campaign with rallies in two states he had handily won in the past.
Vote! Who should be Maps Credit Union boys Athlete of the Week?
This week's boys Athlete of the Week nominees are from Silverton, Dallas, McNary, Blanchet Catholic and Regis. Vote!
Monarch butterflies get tiny trackers to help scientists follow their mysterious migration
Every August, monarch butterflies east of the Rocky Mountains begin their migration from southern Canada and the northern United States to central Mexico to hibernate. In the spring, when temperatures warm, they awaken, mate and begin their migration north again to lay their eggs. In Texas, scientists with the National Wildlife Federation are now tracking monarchs during their migration to understand where they roost and protect the habitats they rely on.
Trump will rally in Kansas and Iowa after initially canceling weekend trips before midterms
President Donald Trump has rescheduled campaign rallies in a pair of critical Midwestern states that he had previously canceled.
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.
Yakima Co. health officials confirm person infected with bird flu has died
YAKIMA CO., Wash. - The Yakima County Health District confirmed Sunday a person in the county has died due to complications of the bird flu.According to the YCHD, the person was hospitalized after becoming severely sick and was diagnosed with avian influenza. They said the person came into contact with infected cattle and that's how they got the illness.At this time, the YCHD is not releasing the identity of the person who died, their gender or their age. They confirmed the person did have underlying health conditions, but did not release what those were.This comes as a third confirmed human case of bird flu was reported Sunday. This person also became infected after being exposed to sick cattle at a Yakima County dairy. YCHD officials said this person is not experience severe illness and is not hospitalized.The YCHD is working with the person to identify and contact people who may have come into contact with those who are infected in an effort to monitor the illness.Officials with the YCHD said the risk of being infected with bird flu in the general public is low. Those who are at greater risk are those who have close or prolonged contact with infected animals or are in an environment that is contaminated with the virus. As of this writing, no documented case of human to human transmission has ever been recorded in the United States but it is not impossible. COPYRIGHT 2026 BY APPLE VALLEY NEWS NOW. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. News Suspected DUI crash in Walla Walla Co. kills Umatilla woman Erin Wencl News Man dead after early morning shooting in Yakima Erin Wencl News Pasco police asking for video of Saturday's fatal shooting near Don Rubio's Erin Wencl News Trick-or-treating wins popular vote at Yakama Nation trunk-or-treat Tyler Wargo News Justin Krumbah's family fights on after judge denies Kelly's request Dan Hanson, Apple Valley News Now News Toppenish gets nearly $1.5 million to improve traffic safety on State Route 22 Robert Desaulniers
Business and engineering majors need ethical education
This October, the film “You Can See Everything” hit United States theaters. Featuring Elizabeth Holmes, the disgraced founder of Theranos, it quickly rose to the top of the box office rankings, a r…
NFL-backed Premier Flag football league to launch next summer
Professional flag football in the United States is on the horizon.The National Football League and TMRW Sports unveiled Premier Flag on Monday as the brand identity for a professional women's and men's flag football league currently in development.
5 expert takeaways on 2026 midterm election security
With Election Day around the corner, states have been working hard to prepare, with some adopting new congressional maps and voting rules on top of normal election security measures. PBS News' Liz Landers and Votebeat editorial director Jessica Huseman hosted a Reddit "Ask Me Anything" Q&A on Wednesday to address people's questions.
Kamala Harris urges a 'too big to rig' turnout for the midterms and tees off on Trump
Kamala Harris has been campaigning for Democratic candidates across multiple states during the final stretch of the midterm elections.
New FAIR Health platform maps chronic disease prevalence across the United States
Today, FAIR Health launches FAIR Health Atlas, a free epidemiological reporting platform incorporating data on the commercially insured population.
FDA, CMS scramble to avoid regulatory logjam as more states look to test AI in clinical settings
Officials are moving behind the scenes to head off a conflict brewing between states and the federal government over regulating AI.
AFT Expands National Soil Health Demonstration Trial Network with nearly $5 Million from USDA
The United States Department of Agriculture (USDA) Natural Resources Conservation Service (NRCS) is awarding American Farmland Trust (AFT) nearly $5 million over five years through its Conservation Innovation Grants On-Farm Trials program to help expand AFT’s national network into a coordinated Soil Health Management Systems (SHMS) Network. Working with 35 trial host farms across 14
The Bolsonaro clan is still strong in Brazilian politics despite Flávio's defeat and flight to U.S.
Flávio Bolsonaro has left Brazil for the United States after losing the presidential runoff
Democrats try to take majority of governors' offices for first time in two decades
All told, 36 states that are home to about 80% of the nation’s population will elect a governor Tuesday. In 19 states, the office is open. Heading into the elections, Democratic governors represented 60% of the nation’s population, but Republicans held 26 of the nation's 50 governors’ offices.
Kamala Harris urges a 'too big to rig' turnout for the midterms and tees off on Trump
Kamala Harris has been campaigning for Democratic candidates across multiple states during the final stretch of the midterm elections.
Effort to ban trans girls in K-12 school sports leads Tuesday night
Washington is among the first states in the nation to put the question of transgender girls' participation in school sports directly before voters.
Encompass Health reports results for third quarter 2026, Increases full-year guidance - Florida Hospital News and Healthcare Report
BIRMINGHAM, Ala., October 28, 2026 — Encompass Health Corporation (NYSE: EHC), the largest owner and operator of inpatient rehabilitation hospitals in the United States, today reported its results of operations for […]
The Xbox Nano Controller is here, and it's incredibly cute (and hides a surprise)
The Xbox Nano Controller drops on November 4, 2026 for the United States, UK, and other select markets. Here's some early impressions ahead of the full review.
FDA, CMS look to collaborate with states on health AI
In this edition of STAT Health Tech: Federal officials look to work with states on regulating AI, protecting doctors from AI liability, and more.
Most comprehensive atlas of healthy human tissue launched to help understand disease
Researchers and data scientists from dozens of universities, hospitals and other institutions across the United States have built an online portal that provides free, open access to one of the most comprehensive ...
Which schools have joined the Gulf States Independent Athletic Association
The GSIAA officially opened its membership on Nov. 1. See which high schools have chose to join the GSIAA.
Why you can’t wear, bring political gear to a polling place in these states
States have different guidance regarding electioneering at or near a polling place.
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.
Haley Stevens backs Mike Rogers. And, Gulf states brace for potential attack on Iran
Democrats in Michigan are considering their options after Haley Stevens endorsed GOP candidate Mike Rogers for Senate. And the Gulf states are bracing for a possible U.S. attack on Iran after the midterms.
Judge Orders Trump Officials to Outline Election Demands Sent to States
A federal judge gave the government until noon on Friday to share which states had received letters trying to enlist them in an effort to find evidence of voter fraud.
Paxton and Talarico tussle for Texas Senate seat as Trump campaigns virtually
The closing sprint in Texas comes as early voting nears its conclusion in several states. Early balloting totals were approaching 50 million heading into the weekend. About 112 million voted in total in the 2022 midterm elections.
States step up ACA subsidies as premiums keep climbing
States including Virginia, Rhode Island and California are putting new money into ACA subsidy programs as exchange premiums rise and federal support shrinks.
How Will the Midterms Play Out? These Races May Provide Early Clues.
Election results in states where voting ends early could indicate how each party will fare in House and Senate races elsewhere in the country.
Clash with feds hangs over WA as votes roll in before Election Day
Officials in Washington are confident the election will be fair and accurate even as the Trump administration tries to interfere in states around the country.
Republicans say no to the most vital part of elections
Views writer Savannah Burke argues that the key to preserving democracy and fair elections in the United States is televised debates.
What to know about the Affordable Care Act's open enrollment period now underway
The sign-up window for the marketplace, also known as Obamacare, starts Sunday in most states and runs through Jan. 15.
Colorado River Basin Candidates Wade Into Water Politics, but Winners Are Unlikely to Make Big Changes
As tensions rise on the drought-stricken river, six of the seven Colorado River Basin states are holding elections for governor.
Vote Republican, or else: how Trump is dangling government help on the campaign trail
President Donald Trump is signaling to states that his administration may be far less likely to help if their voters put Democrats in power on Election Day.
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.
Stuart Varney: Significant shifts in American politics are coming
‘Varney & Co.’ host Stuart Varney examines a potential socialist surge, Republican upsets in red states and what an election shakeup could mean for Congress and Wall Street.
Autism care is bigger than ABA. Federal policy should be, too
The Centers for Medicare & Medicaid Services (CMS) took an important step last month when it released a new toolkit for states on applied behavior
Some defense politics is local
The direction of defense policy and corresponding federal spending within many states hinges on the outcome of Election Day.
Takeaways from the midterms: Americans broadly rejected Trump — and Democrats stand to make huge gains because of it
The Democratic wave is here — and now, as votes are counted in key states, the question is how many Republicans it will wipe out.
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
Bucyrus business owner pleads guilty to role in obtaining nearly $900,000 in pandemic funds
BUCYRUS – A 56-year-old man has pleaded guilty in federal court to devising a scheme to obtain pandemic government stimulus funds meant to assist small businesses, which he instead used for his personal benefit, according to a press release issued Friday by the United States Attorney’s Office for the Northern District of Ohio. Jeffrey Skinner, […]
Black voter turnout appears high on Election Day, according to voter coalition
LaTosha Brown, co-founder of the voting rights group Black Voters Matter, said turnout in some states seemed to rival that of 2008, when Democrat Barack Obama was running for president for the first time. Stand with free and independent journalism. Join Press Pass from PBS News She and others said turnout appeared particularly high in Michigan and Mississippi. Brown, speaking during a media briefing organized by the National Coalition on Black Civic Participation, said her
America's Housing Crisis Is on the Ballot This Election Day
With the cost of housing a top concern among Americans ahead of next Tuesday’s midterm elections, voters in four states will decide how their governments should address the problem. There are six statewide housing policy measures on the ballots – the largest number of housing ballot measures in a ...
How Trump Is Dismantling America’s Scientific Research Machine
The system that has driven life-altering discoveries and helped make the United States a superpower is now under intense strain.
DEA Refuses To Approve Marijuana Businesses In States That Allow Dual Medical And Recreational Licensing
While the Department of Justice announced on Friday that it has given federal registration and protections to more than 900 medical cannabis businesses across the U.S., it is also refusing to extend such approvals to cannabis operators in certain states. According to an order DEA officials sent to a marijuana business in Minnesota, the agency […]
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.
False accusations and unverified claims quickly spread about Election Day voting
Election Day was barely underway before misinformation about voting irregularities surfaced online. Election officials reported voting problems in parts of the United States but there were no verified examples of malfeasance in the hours before polls closed across the country.
How to watch Oregon State men's, women's basketball in 2026-27
Here's how to watch the Oregon State Beavers men's and women's basketball teams during the 2026-27 NCAA season.
Small business AI forum makes stop in Raleigh
The U.S. Chamber of Commerce hosted a small business AI forum in Raleigh on Thursday as part of the organization’s six-week tour across 20 states.
Christian Pulisic celebrates extension with Milan derby opener 🇺🇸
It's been a wonderful 48 hours for United States Men's National Team captain Christian Pulisic. The day after extending his Milan contract to July of 2031, the 28-year-old has gone and delivered hi...
Democrats Show Strength in Final Days of Race for the Senate, New Polls Find
Democrats are up in Michigan, Texas, Kansas, Maine and Ohio, have an edge in Alaska and are effectively tied with Republicans in Iowa, new New York Times/Siena polls found.
Live 2026 midterm election coverage in Washington
Election Day is here in Washington and the nation. Numerous pivotal races will be decided. There are three conservative-backed initiatives, on the state’s new income tax for high earners, the participation of transgender girls in girls’ school sports and parental rights of public school students. There’s a momentous election for the state Supreme Court, with […]
Republicans hope to stave off predictions of midterm losses amid high costs and the Iran war
President Donald Trump has spent most of the last month trying to shore up red states that will decide the Senate today. Follow for live updates
DEA proceeds with federal medical cannabis changes, but Minnesota is shut out
Businesses in states that have legalized recreational cannabis may not benefit from the federal rescheduling of medical marijuana, according to a letter one Minneapolis dispensary owner received from federal agents Friday.
Voters decide key ballot measures on abortion rights, congressional redistricting and voter ID laws
2026 ELECTION COVERAGE: Watch Live | Poll Closing Times | All Live Results | Live Updates | Live Fact Check WASHINGTON (AP) — A battle over abortion rights is playing out in several states Tuesday as voters decide 145 proposed laws and constitutional amendments, including some that could affect voting for future elections. The ballot measures provide a political undercard for a high-profile midterm election that will determine which party controls Congress, state legislatures and
AP Voter Poll: How key demographic groups voted in the 2026 midterms
The poll, an expansive survey of about 80,000 voters in all 50 states, suggests young voters were less likely to back House Republicans this year than they were to support Trump in 2024.
UC Riverside political expert examines polling uncertainties and voter turnout ahead of midterms
Dr. Andy Crosby, a professor at UC Riverside's School of Public Policy, warns of statistical uncertainties in key battleground states and highlights fluid voter trends.
Millions more Americans vote ahead of Election Day as early voting jumps across Senate battlegrounds
Early voting is continuing to significantly outpace the last midterm election, with millions more Americans casting ballots in advance and particularly sharp increases in states hosting competitive Senate races, according to an Associated Press analysis of voting data five days before Election Day.
DataFi Donation Ceremony at the Ministry of Health-Remarks by ADCM Steve Bremner
DataFi Donation Ceremony at the Ministry of Health Remarks by Acting Deputy Chief of Mission a.i. Steve Bremner (…) I’m pleased to join the Ministry of Public Health and our implementer, Palladium, today to hand over IT equipment including 80 laptops, 300 tablets, and Monitoring and Evaluation reporting tools for CSBII. Good health decisions start with good data. When a health worker in a remote commune notices unusual fever cases, that information must reach district and national teams fast. Every hour counts. Fast, reliable data helps the Ministry detect an outbreak early, send teams where they’re needed, and stop a disease before it spreads. These laptops and tablets will help do exactly that. They’ll strengthen Madagascar’s health information system and disease surveillance so health workers can collect, report, and use data faster and more accurately. This support reflects the America First Global Health Strategy. Under this strategy, the United States works directly with partner governments based on country ownership, shared investment, and accountability for results. Together, we’re strengthening Madagascar’s ability to detect and respond to outbreaks quickly though the MOU signed in December 2025. This work protects Malagasy families and the American people. Today also marks a transition. The Data.FI project is ending, but the work will continue. Palladium will continue to carry these same activities forward through a new project, AFGHS Palladium, under the State Department’s Bureau of Global Health Security and Diplomacy. The new project will put an even stronger focus on results. Mister SG, your ministry’s close collaboration with Data.FI made today possible. I hope you will bring the same commitment to this new project. Together, we can deliver even greater results and speed up the transfer of skills to Ministry teams. Our shared goal is to build the ministry’s capacity to lead, manage, and sustain these systems on its own. That is Madagascar’s path to self-reliance. Equipment alone doesn’t stop an outbreak. People do. To the health workers and data managers who will use these tools: thank you for your dedication. To the Ministry: we count on you to put these devices to work quickly, keep them in good condition, and protect the data they hold. That’s how this investment will deliver results for years to come. The United States stands with the Government of Madagascar. We commend the Ministry of Public Health for its leadership. We look forward to continuing our collaboration through AFGHS Palladium and beyond. Thank you. Misaotra betsaka.
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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The politics of war
Israel went to the polls last Tuesday and it is the turn of the United States next Tuesday. The differences in the two elections are self-evident. Compared with the US, which has favourable geography and does everything at scale, Israel is tiny and part of an unstable region. For its elections, it has adopted an almost pure form of proportional representation based on lists. This encourages multiple parties and can make it almost impossible to form a government, as we can now see. The US system is complex in its own way but discourages third parties. Yet for all the differences in size, geography, and political systems, the fates of the two countries are closely connected. Israel has come to depend on the US to sustain its military strength, and over the past few tumultuous years that dependence has created resentment in the United States. The Biden administration was punished for appearing to give Netanyahu a blank check after the Hamas attacks of 7 October 2023, and not holding Israel back as it employed ruthless tactics in Gaza. Because of the treatment of Palestinians, American views of Israel have grown progressively more negative over the past few years. Only a third now support the Israeli government. While on the left, this is largely because of how Israeli forces have operated in Gaza and, more recently, how the settler movement has behaved in the West Bank, for the American right the issue has been about how Benjamin Netanyahu persuaded Donald Trump to forget his wariness about more Middle Eastern wars and agree to a joint attack on Iran, which has gone badly wrong. The Palestine question was not a big issue for the two large Jewish blocs in last Tuesday’s election. Both supported a tough response to Hamas after October 2023 and neither accepts a two-state solution. It was, however, the threat posed by the ethno-nationalist policies of Itamar Ben-Gvir and Bezalel Smotrich, the two extreme members of Netanyahu’s coalition, and their tolerance, even encouragement, of settler violence, that brought out the Arab voters. (In principle this should strengthen their position though to turn into real power would require the ‘Change Bloc’ overcoming their opposition to involving Arab parties. The alternatives are a National Unity government, defection from the Change Bloc to Netanyahu, or deadlock and another round of elections in the new year.) There was also broad support for the war against Iran among the Jewish parties. The difficulty here is that the objectives behind the war have yet to be met, and that continuing with military operations depends on the United States. In this way the two elections have come together at a crucial moment. If Netanyahu hoped that a victory over Iran would help him retain his majority, cementing his legacy as an Israeli war leader, it did not work out that way. Trump also expected a great victory about which he could boast. He promised at most the end of a hateful and aggressive regime, with a record of hostility to both the United States and Israel, or at least the elimination of Iran’s military capabilities and the end of its nuclear programme. Eight months on, there is not much to boast about; vital objectives remain elusive: the Iranian regime is even more hardline than before; the international economy is barely coping with the closure of the Strait of Hormuz; and Saudi Arabia is struggling with an unwanted conflict with the Yemeni Houthis. For all these reasons, the Iran War has been a dark cloud hanging over both elections. Yet the issue has been approached in different ways. Netanyahu sought to push the issue before the election while Trump has been more cautious. Trump’s essential claim is that there is nothing to worry about and he’s still working out what final steps need to be taken to provide a definitive conclusion to the conflict. Netanyahu’s final pitch was that there was lots to worry about. He focused on Israel’s dire security situation, with the Iran War unfinished and the prospect of imminent economic isolation because of international sanctions. For him it is imperative to defeat Iran decisively, and without delay. Why this different response to the same war? Part of the answer lies in how public opinion in the two countries responded to the war. In this post, I show how this came about. We await the outcome of the US midterms but know the result, at least in terms of the share of the vote if not yet the shape of the new government, of the Israeli election. With the elections out of the way Netanyahu is pressing for another round in the war. Trump is less sure. I conclude with thoughts on the importance of how he decides.
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