A weekly roundup of public health news
Where you live determines your Medicare coverage
Medicare may be a federal program, but the care it supports is not level nationwide. A new analysis finds that for the nation’s 69 million beneficiaries, access to doctors, out-of-pocket costs and even health outcomes vary widely by state.
Differences in supplemental coverage, local health care infrastructure and other factors shape how easily Medicare users can afford care, see providers and avoid preventable hospital stays, according to The Commonwealth Fund’s State Scorecard on Medicare Performance.
Medicare beneficiaries fare best in Vermont, Utah and Minnesota, which lead the nation in access, affordability, quality and health outcomes, the report found. In contrast, Louisiana, Mississippi and Kentucky rank on the low end of the scorecard, with residents facing the weakest benefits and some of the nation’s worst health indicators.
In Vermont, for example, less than half of beneficiaries covered by traditional Medicare had three or more chronic conditions such as diabetes or high blood pressure, compared to 68% in Louisiana. In Mississippi, 5% of older adults went without care because of cost in 2024, versus less than 3% in Utah. And in Minnesota, only one-third of Medicare Advantage plans required prior authorization for specialist visits or preventive care in 2025, compared with more than half of plans in Kentucky.
Hospitalization rates for conditions that could have been avoided with better outpatient care — such as heart failure, asthma flare-ups or vaccine-preventable diseases — also differed sharply. In West Virginia, 35 per 1,000 Medicare users were hospitalized for preventable reasons, which was more than double the rate in Idaho, the top-ranked state for the measure.
Report authors urged policymakers to use the findings to strengthen Medicare in their states by improving support for low-income beneficiaries, increasing oversight of Medicare Advantage and drug plans, and investing in stronger health systems.
Health workers face rising hardship, job threats
Even as health workers care for others, new research shows many are struggling themselves, with rising financial insecurity and looming threats to jobs across the industry.
A new study in JAMA finds food insecurity has grown among some U.S. health care workers, especially those in lower-wage positions such as direct care and support roles. About a quarter of such workers reported at least one measure of food insecurity, along with 10% of health technologists and technicians. Researchers said the findings signal worsening financial hardship within the workforce since the onset of the COVID-19 pandemic in 2020.
Health workers in direct care and support roles often are employed by nursing homes, long-term care facilities or home health agencies that offer low wages and limited benefits, making it hard for workers to meet basic needs. Such employees also have the highest rates of poverty and housing instability among U.S. health workers, the study said.
At the same time, a separate analysis from The Commonwealth Fund projects that nearly 154,000 health care jobs could be lost in 2026 if Affordable Care Act premium tax credits are allowed to expire as planned this year. The loss of federal subsidies would make it harder for millions of Americans to afford coverage, leading to fewer patients seeking care and forcing providers to cut staff, the report said.
The projected job losses are estimated to hit hospitals and doctors’ offices hardest. Outpatient clinics and community health centers serving low- and middle-income populations also would face cuts, along with home health and nursing facilities, which are already struggling with staffing shortages. Administrative and support roles tied to billing and insurance processing are expected to shrink as well.
Another 185,000 U.S. jobs would be lost beyond the health care sector, impacting occupations such as retail, real estate and food services. Overall, the losses would hit hardest in states where more residents are enrolled in ACA marketplace plans, the analysis found. Texas would face the most overall job cuts, with 83,400 workers lost, followed by Florida, Georgia and California.
Climate change worsens extreme wildfires across the Americas
Climate change has supercharged wildfire seasons across the Americas, making burned areas up to 30 times larger than they would have been in a world without global warming, according to a new international report.
The assessment, published in Earth System Science Data, found that record heat, drought and shifting weather patterns have fueled massive blazes from California to the Amazon. January’s wildfires in Los Angeles were estimated to be 25 times larger in burned area than they would have been without recent global warming, for example. Those fires destroyed at least 11,500 homes and burned more than 40,000 acres.
The findings show how rising temperatures and drying landscapes are amplifying the scale and intensity of wildfires, turning what once were rare events into regular disasters. In addition to destroying communities, recent wildfires have released large volumes of carbon dioxide, adding to the warming cycle that drives future fires.
The Americas — which encompass North, Central and South America and the Caribbean — have become one of the world’s fastest-changing regions for fire risk, with increasingly long and severe dry seasons.
Without significant cuts in greenhouse gas emissions, extreme fire seasons could become routine, striking as often as every 15 years in some regions of the Americas instead of once in a generation. The researchers called for better land management, stronger early-warning systems and public campaigns to reduce unintentional fires, among other measures.
Other recent public health news of note:
• Weather-related power outages in hurricane-prone Gulf and Atlantic coastal states disproportionately harm Hispanic people, older adults and low-income communities, new findings in the Proceedings of the National Academy of Sciences show. Researchers warn that such events, which are already responsible for about 78% of major U.S. power outages, will worsen with growing climate change.
• Clothes dryers in U.S. homes release more than 3,500 metric tons of microfibers into the air each year, including microplastics from synthetic fabrics, a recent study finds. Published in Environmental Toxicology and Chemistry, the study said most U.S. dryer systems lack ways to trap clothing fibers beyond lint filters.
• U.S. doctors in non-metropolitan areas and regions with health worker shortages are more likely to leave the Medicare program, new research in the Journal of the American Medical Association says. Researchers say the trend could further restrict access to care in already underserved communities and worsen health.
• While most U.S. hospitals now offer online portals for patients to view records, see test results and communicate with their care team, many non-English speakers are being shut out of the systems, new research in JAMA Network Open finds. About one-third of hospital patient portals are available only in English, and roughly 60% also offer access in Spanish, the nation’s second-most-spoken language. An estimated 25 million Americans have limited proficiency in English.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.