A weekly roundup of public health news
Marketplace insurance costs expected to jump again
Another big price hike may be on its way for Americans who buy their coverage through the health insurance marketplace.
A new brief from KFF predicts a second year of double-digit price increases, with health insurers that offer plans through the marketplace proposing a median 14% increase in 2027.
The findings are based on an analysis of insurer proposals recently submitted to regulators in 16 states and the District of Columbia. Rising healthcare and labor costs, U.S. inflation and higher prescription drug costs were cited by insurers as some of the reasons for the increases.
While most Americans are covered by employer-based health plans and public insurance such as Medicaid and Medicare, about 10% of the U.S. population buys insurance through the marketplace, which was established under the Affordable Care Act to offer affordable, comprehensive insurance options.
Last year’s rate increase, which had been proposed at 18%, ended up at a median of 20%. While most people who signed up for a 2026 marketplace plan received some kind of subsidy on their premiums, the decision by Congress to let enhanced premium tax credits expire at the end of 2025 meant fewer people received subsidies this year.
Enrollment in marketplace plans dropped at least 13% from 2025 to 2026 following the changes. More people have moved to high-deductible “bronze level” health plans, with a 58% increase in premiums, and millions dropped out, according to KFF.
While the Trump administration alleged that a decrease in “improper, phantom or fraudulent” enrollments led to the dip in sign-ups, that claim was debunked by an July 7 analysis from Public Citizen. The organization said people who dropped out of the marketplace were primarily low-income Americans who would previously have qualified for tax subsidies and were pushed out by higher costs.
US flailing on work to address climate change, index says
When it comes to climate change and environmental health, the U.S. does not even break the top 10 among nations making progress around the world, new rankings show.
The 2026 Environmental Performance Index, released July 9 by researchers at Yale and Columbia universities, named Estonia, Luxembourg, the U.K., Finland and the Netherlands as the top five nations that are significantly moving forward on international environmental goals.
Out of 177 nations that were assessed, the U.S. ranked 27th, just above Iceland and Canada. The nation was cited for its poor showing on addressing climate change, reflected in its high per-capita greenhouse emissions and lagging transition to greener energy sources. The U.S. has backed off its climate change work under the Trump administration, allowing more emissions from coal plants and pulling the nation from international agreements, among other harmful measures.
India and China, which along with the U.S. are the world’s greatest emitters of greenhouse gases, were ranked 176th and 129th, respectively.
The index, which also looks at work to protect ecosystems, examined progress on issues such as air quality, toxic exposure, agricultural sustainability and reductions in greenhouse gases. Estonia earned top honors because of its 2019 closure of oil shale power generators, which dramatically lowered the country’s greenhouse gas emissions. European nations in general took top positions on the leaderboard.
While high-income countries tended to score better overall on the index, with low-income nations making up most of the bottom tier, wealth is not a guarantee of success, researchers noted. Zimbabwe, which is considered a lower-middle income nation, outperformed higher-income nations such as Saudi Arabia and Singapore, for example.
Hundreds of U.S. hospitals could be forced to close because of cuts
More than 600 U.S. hospitals could be pushed closer to closure because of federal cuts, new research from National Nurses United finds.
Released July 6, a policy brief from the organization estimates that cuts to Medicaid and tax subsidies could force hundreds of already-struggling hospitals to cut services or close their doors altogether.
Communities could lose access to emergency care, maternity services, surgery, cancer treatment and other essential healthcare if financially strained hospitals are forced to scale back or shut down, according to the policy brief. Hospitals also could shift more costs to patients, creating ripple effects for families, employers and local economies.
California has the largest number of financially vulnerable hospitals, with 67 at risk in that state alone, followed by New York, Texas and Oklahoma, the analysis found.
Nearly 61% of the vulnerable hospitals are in metropolitan areas, where many serve as safety nets for low-income communities, and 21% are in rural areas. About 130 hospitals are considered critical access facilities, which are often the only inpatient and emergency care providers for rural counties.
The projected losses stem from three main federal policy changes: a reduction in Medicare payments, the expiration of enhanced ACA marketplace subsidies and a cut in Medicaid funding under a 2025 federal budget bill —the latter of which is the largest driver of projected losses.
Other recent public health news of note includes:
• Breathing in air pollution over a long period of time can raise risks for Parkinson’s disease, new findings in Environment International show. Researchers reviewed more than 40 studies, concluding that long-term exposure to either fine-particle pollution or particle pollution — known as PM2.5 and PM10 — can increase Parkinson’s disease risk. PM2.5 is produced by sources such as vehicle emissions, power plants, industrial activity and wildfires, while PM10 also includes roadway and construction dust, pollen and mold spores. Researchers said air pollution may contribute to Parkinson’s disease by triggering inflammation and stress that damage brain cells involved in movement.
• Insurance denials for brand-name drugs made by a sole manufacturer are frequent, often resulting in delayed or missed treatments, according to a July 9 study in the Journal of the American Medical Association. Researchers analyzed more than 2 million attempts by patients to fill prescriptions for such drugs between 2018 and 2024. Overall, more than a third were rejected because a drug was not covered, prior authorization was needed or patients were required to try another drug first before insurance would pay. Marketplace exchange and Medicaid managed care plans had the highest rejection rates, which increased markedly over the study period.
• Industrial facilities that promise to recycle plastic using chemicals pose health risks to both workers and communities, a recent issue brief says. Rather than repurposing plastic materials, the facilities mainly incinerate them, according to the Natural Resources Defense Council. The sites also store and ship vast amounts of hazardous chemicals, risking spills and contamination, the brief said.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.
