US Mental Health Failure 12-31-25

Yes, mental health providers in the U.S. may stop treating patients when insurance funding runs out, as they are generally not obligated by ethics codes to provide indefinite pro bono care. However, providers have ethical and legal obligations to ensure patients are not abandoned and to facilitate a smooth transition of care.  

Here are the key considerations in 2025:

Ethical Obligations: Professional ethics codes (such as the APA's) generally require the termination of therapy when the client is no longer benefiting from treatment, but they also require that the patient not be abandoned. This means providers must take steps to ensure continuity of care, such as discussing the change in financial status in advance, providing referrals to more affordable options (e.g., community mental health centers, sliding scale clinics, or group therapy), or offering a temporary payment plan.

Legal Protections (MHPAEA): The federal Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurers to provide coverage for mental health and substance use disorders on par with medical and surgical benefits.

New 2025 regulations strengthen this act by requiring insurers to document and prove that their non-quantitative treatment limitations (NQTLs), such as prior authorization or network adequacy standards, are not more restrictive than those for medical benefits.

If a patient is being released due to a limitation that violates parity (e.g., an arbitrary session limit not based on medical necessity and not applied to medical conditions), the insurer may be in violation of the law. Patients can file complaints with the Employee Benefits Security Administration or the No Surprises Help Desk.

Provider Discretion: While the law prohibits discriminatory limits by insurers, it does not mandate that providers treat patients for free once benefits are exhausted. Providers can generally terminate the professional relationship if a patient cannot pay, provided the termination is handled ethically and does not constitute abandonment.

Medicare and Medicaid Changes: Recent 2025 legislative changes and potential federal funding cuts could impact coverage. For example, Medicare telehealth flexibilities for mental health services (which currently allow for phone-only sessions and waive in-person visit requirements) are set to expire unless Congress acts. Providers must be aware of these changes and communicate them to patients using tools like an Advance Beneficiary Notice of Noncoverage (ABN) if a service is no longer covered. 

In essence, while providers can stop treatment for non-payment, the process must be ethical and prioritize the patient's well-being and continued access to care, even if it is through a different, more affordable channel. 

In 2025, U.S. mental health providers generally cannot immediately "release" or abandon patients solely because insurance funding has run out. Ethical guidelines and federal laws require providers to ensure a safe transition of care to prevent patient abandonment. 

Legal and Ethical Requirements

Prohibition of Abandonment: Mental health professionals are ethically and legally bound to avoid "patient abandonment." If insurance coverage ends, providers must typically provide a reasonable notice period and assist in finding alternative care or lower-cost options.

Mental Health Parity Laws: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurers to cover mental health services at the same level as physical health services. As of January 1, 2025, new federal regulations strengthened these protections, prohibiting insurers from applying more restrictive "nonquantitative treatment limitations" (such as arbitrary session limits) than those applied to medical care.

Transition of Care: In cases where a provider is no longer covered (e.g., they leave a network), many states and federal rules require a "transition of care" period (often 30–90 days) where the insurer must continue to pay for treatment at in-network rates to ensure stability for the patient. 

Key 2025 Regulatory Changes

Parity Enforcement: While new 2024 parity rules were set for 2025, some enforcement aspects faced legal challenges. However, the core 2008 parity law remains in effect, ensuring that mental health benefits cannot be more restrictive than medical benefits.

Telehealth Flexibilities: As of late 2025, many Medicare telehealth flexibilities for mental health were extended through January 2026, preventing a sudden loss of access for patients receiving remote care.

Inpatient Access: The Restoring Inpatient Mental Health Access Act of 2025 was introduced to lift Medicaid exclusions for certain inpatient facilities, potentially expanding funding for high-need patients who might otherwise have been discharged due to lack of coverage. 

What Happens if Funding Runs Out?

If your insurance stops paying in 2025, your provider should:

Provide Referrals: Offer a list of providers who accept your current insurance or operate on a sliding scale.

Ensure Stability: Continue treatment long enough to ensure you are not in a crisis during the transition.

Offer Self-Pay Options: Discuss "private pay" rates or payment plans if you wish to remain with that specific provider. 

If you believe your insurance has unfairly cut off funding, you can contact the Employee Benefits Security Administration at 1-866-444-3272 or use the CMS No Surprises Help Desk for assistance. 

https://www.google.com/search?q=do+us+mental+health+providers+release+patients+when+insurance+funding+runs+our+2025

Comments

Mental Health Providers should not admit Addicts until they have “hit bottom” and have decided to “get well”.

Norb Leahy, Dunwoody GA Tea Party Leader

Mental Health Funding 12-31-25

There's no precise annual count of mental health patients released due to lack of funding, but data shows millions can't access care because of costs, provider shortages, and underfunded systems, leading to unmet needs, delayed treatment, or premature discharge, with roughly 1 in 4 adults facing barriers, causing significant crises and worsening outcomes like suicide rates. The issue stems from systemic underinvestment, workforce deficits (only ~1 provider per 350 people), and insurance gaps, forcing many into crisis or lack of necessary follow-up care after hospitalization.  

Key Indicators of the Funding/Access Crisis:

Unmet Need: Around 25% (over 5 million) of U.S. adults with mental illness report an unmet need for treatment due to cost and access issues.

Hospital Discharge Gaps: Only about one-third of insured individuals discharged from hospitals after a mental health crisis receive timely follow-up care within a month, indicating failures in transition and funding.

Workforce Shortages: Over 152 million Americans live in areas with severe mental health workforce shortages, limiting access even with insurance.

Systemic Underinvestment: Despite some growth, mental health research and services remain significantly underfunded compared to overall health spending. 

Why it's Hard to Get a Specific Number:

Data often focuses on unmet needs or lack of access rather than specific releases from facilities.

"Funding gaps" manifest in many ways: canceled appointments, provider shortages, lack of beds, and insufficient post-discharge support, not just outright patient release. 

In essence, funding shortfalls create a pipeline where people can't get in, get the right care, or get help after a crisis, resulting in poorer health, not a specific tally of "released" patients. 

A specific annual figure for the number of mental illness patients released from facilities due to lack of funding is not tracked or publicly available in the United States. 

However, reports indicate that millions of Americans face significant financial barriers and a fragmented, costly system that prevents them from accessing necessary mental health care or results in inadequate treatment. 

Key Information on Access to Care

Unmet Need for Treatment: In 2021, roughly two-thirds of Americans with a diagnosed mental health condition were unable to access treatment even if they had insurance. In 2022 and 2023, 25% of adults with any mental illness reported an unmet need for treatment.

Cost as a Barrier: The high price of care and lack of insurance coverage are major obstacles to treatment. A study found that nearly 38% of those with an unmet need for services in 2016 cited cost as the primary reason.

Insurance Disparities: Insurance reimbursements for behavioral health visits are often lower than for medical/surgical visits, creating disincentives for providers to join insurance networks and forcing patients to seek expensive out-of-network care.

Systemic Issues: Systemic issues such as provider shortages, a lack of psychiatric beds, and funding cuts contribute to a crisis where individuals may end up in emergency departments, experience premature discharge, or get involved with the criminal justice system instead of receiving appropriate care. 

More information and resources are available from organizations like the National Alliance on Mental Illness (NAMI). You can also use the US Department of Health & Human Services website to find information on federal mental health policies. 

https://www.google.com/search?q=how+many+mental+illness+patients+are+released+because+of+lack+of+funding+in+the+us+each+year

Norb Leahy, Dunwoody GA Tea Party Leader

US Addiction Recidivism 12-31-25

There is no official "cure rate" for addiction as it is medically classified as a chronic disease, similar to hypertension or asthma, that requires ongoing management rather than a one-time cure. Instead of a "cure rate," success is measured by long-term recovery and reduced recidivism rates, which vary widely based on treatment duration and support systems.  

Addiction Recovery and Recidivism Statistics (2025 Data)

Long-Term Recovery: Research indicates that millions of people achieve successful, long-term recovery. Nearly 75% of people who experience addiction eventually go on to recover, with or without formal treatment.

Relapse Rates: Relapse is a common part of the recovery process, with rates for substance use disorders (40-60%) comparable to other chronic diseases.

Relapse risk drops significantly over time: while high in the first year (up to 85% within one year of treatment), it falls to less than 15% after five years of continuous sobriety.

Impact of Treatment on Recidivism: Treatment and rehabilitative programming are highly effective at reducing criminal activity.

People who receive and remain in treatment are more likely to stop misusing drugs and alcohol, and reduce their criminal activity.

Specific programs in correctional settings have shown significant reductions in recidivism. For example, a Massachusetts study from November 2025 found that men completing a substance use education program had a 7.1% recidivism rate compared to 14.9% for those who did not. Women completing certain programs had even lower rates.

Providing access to medication for opioid use disorder (OUD) during incarceration was associated with a 32% reduction in recidivism risk.

General Recidivism Rates: The overall three-year re-conviction rate for individuals released from the California Department of Corrections and Rehabilitation (CDCR) in FY 2019-20 was 39.1% (reported in an April 2025 study), but this rate was lower (35.8%) for those who participated in rehabilitative programming. Nationally, around 68% of individuals with drug involvement are rearrested within three years of release without treatment. 

In summary, while addiction cannot be "cured" in the traditional sense, successful, long-term management and recovery are highly achievable, and effective treatment significantly reduces the risk of both relapse and recidivism. 

In 2025, addiction is clinically classified as a chronic disease for which there is no permanent "cure," though long-term recovery is widely achievable with specialized treatment. Data indicates that while relapse is common early in the process, the risk of "recidivism" (returning to substance use) drops significantly as a person achieves longer periods of sobriety. 

Addiction Recovery and Recidivism Statistics (2025)

Long-Term Recovery Success: Up to 75% of individuals who experience addiction eventually achieve recovery.

Relapse/Recidivism Timelines:

Early Recovery (Years 1-2): Relapse rates are typically 40% to 60% during the first year, similar to other chronic illnesses like hypertension or asthma.

5-Year Milestone: For those who maintain continuous sobriety for five years, the risk of relapse drops to less than 15%, which is roughly equivalent to the general population.

Sobriety Persistence: In 2025, approximately 70% of patients in modern addiction programs maintain sobriety at the 9-month mark when programs combine personalized care with monitoring systems.

Medication-Assisted Treatment (MAT) Impact: The use of MAT (such as buprenorphine or methadone) reduces the risk of post-release fatal overdose by 81% and lowers overall recidivism rates by 32% compared to untreated populations. 

Criminal Recidivism and Substance Use (2025)

For individuals involved in the justice system, substance use remains a primary driver of reincarceration: 

Rearrest Rates: Approximately 68% of drug-involved individuals are rearrested within three years of release from prison.

Treatment Effectiveness: Completing a residential drug abuse treatment program (RDAP) makes

individuals 27% less likely to recidivate compared to eligible non-participants.

In-Jail Treatment: New 2025 data shows that 60.2% of individuals who receive medication for opioid use disorder (MOUD) in jail successfully initiate community treatment upon release, compared to only 17.6% of those who remain untreated. 

https://www.google.com/search?q=what+is+the+cure+rate+addiction+to+resist+recidivism+in+2025

Norb Leahy, Dunwoody GA Tea Party Leader

US Addiction Treatment Costs 12-31-25

While exact 2025 figures for addiction treatment as a percentage of total US health insurance costs aren't readily available, it's a significant driver within the much larger $3.7 trillion spent annually on chronic diseases and mental health (around 90% of total U.S. healthcare), with substance use disorders heavily influencing these massive figures, though separate direct addiction treatment costs are in the tens of billions, dwarfed by lost productivity.  

Key Context for 2025:

Chronic & Mental Health Dominance: Roughly 90% of U.S. healthcare spending goes to chronic diseases and mental health conditions, a category addiction falls under.

Substance Use Disorder (SUD) Costs: In one analysis from 2025, health insurance and uninsured costs related to SUD were $111 billion, but direct treatment costs were a smaller $12 billion portion, with lost productivity being a much larger societal burden.

High-Level Trends: Health insurance costs are rising, with a 7-10% medical trend expected for 2025, driven by prices and utilization. 

Why a Specific Percentage is Hard to Pinpoint:

Data Aggregation: Addiction treatment is often grouped with general mental health or substance use disorder services, not always isolated as a separate line item in national health expenditure reports.

Broader Economic Impact: The total economic cost of addiction (including lost work, criminal justice, etc.) is much higher (>$740 billion) than just insurance claims. 

In summary, addiction treatment is a substantial, growing part of the massive costs associated with chronic and mental health conditions, but a precise percentage of total insurance spending isn't clearly defined for 2025, though figures point to tens of billions in direct costs and much higher societal costs. 

In 2025, substance use disorder (SUD) treatment costs are projected to account for approximately 1.2% of total U.S. health spending. 

While addiction treatment represents a small fraction of overall expenditures, the broader behavioral health category—which includes mental health services—is a major driver of health insurance cost increases in 2025. 

Key Spending Data for 2025

Total National Health Expenditure: Projected to reach $5.6 trillion in 2025.

Substance Use Disorder (SUD) Share: SUD treatment typically accounts for about 1.2% of this total.

Mental Health Share: Combined with SUD as "behavioral health," mental health services account for an additional 6.4% of national spending.

Employer-Sponsored Insurance (ESI) Costs: SUD treatment specifically costs employer-sponsored plans over $35 billion annually. 

2025 Cost Trends and Drivers

Health insurance costs are rising by an estimated 7% to 9% in 2025. While addiction treatment is a steady component, it is part of a surging "behavioral health" trend: 

Utilization Growth: Claims for inpatient behavioral health services rose nearly 80% leading into 2025, while outpatient claims rose nearly 40%.

Payer Projections: One-third of health plan actuaries identify behavioral health as a top three cost inflator for 2025, expecting a trend increase of 10% to 20% for these services.

Top Conditions: For employers, alcohol-related disorders ($10.2 billion) and opioid-related disorders ($7.3 billion) remain the most expensive SUD categories. 

https://www.google.com/search?q=what+percent+of+total+us+health+insurance+costs+are+addiction+treatment+costs+2025

Comments

A large portion of US Healthcare Costs come from addiction treatment.

Norb Leahy, Dunwoody GA Tea Party Leader

US Marijuana Use EO 12-31-26

President Trump did issue an executive order (EO) on December 18, 2025, directing the Attorney General to expedite the process of moving marijuana from Schedule I to Schedule III of the Controlled Substances Act (CSA). However, the EO itself does not immediately change the legal status of marijuana; it initiates an administrative process that must be completed by the Department of Justice (DOJ) and the Drug Enforcement Administration (DEA).  

Current Status

Executive Order Signed: President Trump signed an executive order titled "Increasing Medical Marijuana and Cannabidiol Research".

Directive to DOJ: The order directs the DOJ to "take all necessary steps" to complete the rulemaking process for rescheduling marijuana "in the most expeditious manner".

Process Underway: This action builds on a process already initiated under the Biden administration, where the Department of Health and Human Services (HHS) and the FDA recommended rescheduling to Schedule III based on scientific evidence of accepted medical use.

Rulemaking Process: The DEA had already published a proposed rule in May 2024 and received public comments. The next step is a potential administrative law hearing, which had been postponed.

Not Yet Finalized: The rescheduling is not yet complete or in effect as of late December 2025. The final rule must be published and an effective date established, which could still face legal challenges. 

What Rescheduling Would Mean

If finalized, moving marijuana to Schedule III would have significant implications: 

Medical Use Acknowledged: It would officially acknowledge marijuana's accepted medical uses at the federal level.

Research Barriers Lowered: Researchers would face significantly fewer barriers to studying medical marijuana.

Tax Relief for Businesses: State-legal cannabis businesses could deduct ordinary business expenses under federal tax law (Internal Revenue Code Section 280E), which is currently prohibited for Schedule I and II substances.

Federal Legality Unchanged: It would not, however, make recreational marijuana legal under federal law; marijuana would remain a controlled substance, albeit in a less restrictive category. 

On December 18, 2025, President Donald Trump signed the "Increasing Medical Marijuana and Cannabidiol Research" Executive Order. The order directs the Attorney General to expedite the official reclassification of marijuana from Schedule I to Schedule III under the Controlled Substances Act. 

Key Directives of the Executive Order

Expedited Rulemaking: Directs Attorney General Pam Bondi and the Department of Justice (DOJ) to take all necessary steps to finalize the rescheduling process "in the most expeditious manner".

CBD Access and Hemp Policy: Instructs senior White House staff to work with Congress to update the definition of "final hemp-derived cannabinoid products" to ensure patient access to full-spectrum CBD while restricting unsafe products.

Medicare Pilot Program: Announces plans for the Centers for Medicare and Medicaid Services (CMS) to launch a pilot program to pay for treatments containing cannabidiol (CBD).

Medical Recognition: Formally acknowledges the medical value of marijuana at the federal level, citing FDA findings of support for treating chronic pain, anorexia, and chemotherapy-induced nausea. 

Important Legal and Regulatory Clarifications

Not Immediate Rescheduling: The order does not automatically or instantly move marijuana to Schedule III. It directs federal agencies to complete a formal rulemaking process, which includes administrative steps and legal review.

Federal Legal Status: Marijuana remains a Schedule I substance until the DOJ/DEA issues a final rule. Even as a Schedule III drug, marijuana would not be federally "legalized" for recreational use; it would remain a controlled substance subject to federal oversight.

Impact on Business: Once finalized, moving to Schedule III would allow state-legal cannabis businesses to access standard federal tax deductions (previously barred by IRS Code Section 280E) and ease barriers for medical research. 

https://www.google.com/search?q=trump+eo+to+move+marijuana+from+schedule+1+to+schedula+3+2025

Norb Leahy, Dunwoody GA Tea Party Leader

GOP Plan for Health Insurance 12-30-25

Premiums for All Americans Act," a bill passed by the House of Representatives in December 2025. This plan focuses on market-based solutions and regulatory changes, while notably allowing the enhanced Affordable Care Act (ACA) premium subsidies to expire at the end of 2025.  

Key Components of the House GOP Plan

No Extension of Enhanced ACA Subsidies: The plan does not extend the expanded premium tax credits put in place during the COVID-19 pandemic, which are set to expire on December 31, 2025. This expiration will likely result in significantly higher premiums for millions of Americans who buy insurance through the ACA marketplaces starting in 2026.

Expansion of Association Health Plans (AHPs): The legislation expands access to AHPs, allowing small businesses and self-employed individuals to pool together to purchase coverage as a large group. Proponents argue this will provide cheaper options, while critics note these plans may offer less comprehensive coverage and could draw healthier individuals away from the ACA marketplaces, potentially raising costs for those remaining in ACA-regulated plans.

Funding for Cost-Sharing Reduction (CSR) Payments (Starting in 2027): The bill appropriates federal funds to directly pay insurers for CSRs, which help lower-income enrollees with deductibles and out-of-pocket costs. This measure is intended to stabilize the individual market and reduce silver plan premiums, though it may effectively lower the total federal assistance many enrollees receive when combined with the lapse of enhanced premium tax credits.

Pharmacy Benefit Manager (PBM) Transparency: The plan requires PBMs, the middlemen in drug pricing, to provide more detailed data to employers about prescription drug spending, rebates, and pricing, aiming to lower overall drug costs through increased transparency.

Individual Coverage Health Reimbursement Arrangements (ICHRAs): The legislation codifies rules that allow employers to offer workers tax-advantaged funds (rebranded as "CHOICE arrangements") to purchase individual health insurance, in lieu of a traditional group plan. 

Other Related Republican Proposals

Beyond the House bill, other proposals have been discussed, often within the framework of the conservative Project 2025 blueprint: 

Health Savings Accounts (HSAs): A Senate GOP proposal, which did not pass, advocated for replacing enhanced ACA tax credits with direct contributions to HSAs for individuals in high-deductible plans. President Donald Trump has also repeatedly advocated for a system that sends money directly to people, rather than insurance companies, to help them buy healthcare, often linking this to HSAs.

Medicaid Restructuring: Broader conservative proposals, such as those from the Republican Study Committee (RSC) and the House Budget Committee (HBC), include plans for significant cuts to Medicaid and converting its funding structure to block grants for states, potentially adding work requirements and lifetime limits on coverage.

Rolling Back Protections: Proposals from Project 2025 and the RSC suggest rolling back certain federal insurance protections, which could weaken pre-existing condition protections and allow insurers to charge older people more compared to younger people. 

Current Status

The House-passed bill faces an uncertain future in the Senate, where it would likely require bipartisan support to pass. Moderate Republicans in the House have also pursued separate efforts to force a vote on a temporary extension of the expiring ACA subsidies through a discharge petition, highlighting internal party divisions on the strategy and timing of healthcare policy. 

In late 2025, Republicans in the U.S. House of Representatives passed a major healthcare package titled the Lower Health Care Premiums for All Americans Act. The plan focuses on reducing federal spending, expanding alternative insurance models, and increasing transparency, while notably allowing certain pandemic-era subsidies to expire. 

Key Components of the 2025 Republican Plan

Expiration of Enhanced ACA Subsidies: The bill does not renew the enhanced Affordable Care Act (ACA) premium tax credits, which are set to expire on December 31, 2025. This is expected to lead to significant premium increases for millions of enrollees starting in 2026.

Expansion of Association Health Plans (AHPs): The plan allows small businesses and self-employed individuals to band together to purchase group health insurance across state lines. While these plans may offer lower premiums, they are often exempt from some ACA requirements, such as covering a full set of "essential health benefits".

Cost-Sharing Reduction (CSR) Funding: The bill proposes directly appropriating federal funds for CSR payments starting in 2027. Republicans argue this will stabilize the market and lower gross premiums for silver-level plans.

Pharmacy Benefit Manager (PBM) Transparency: The legislation requires PBMs to disclose more detailed data regarding drug spending, rebates, and pricing to employers and group health plans to help lower prescription drug costs.

CHOICE Arrangements: The plan codifies "Individual Coverage Health Reimbursement Arrangements" (ICHRAs), which allow employers to provide employees with tax-free funds to purchase their own insurance on the individual market rather than offering a traditional group plan.

Health Savings Account (HSA) Enhancements: Senate proposals have explored allowing HSA funds to be used for insurance premiums and increasing federal contributions to these accounts for those with high-deductible plans. 

Anticipated Impact

Uninsured Rates: The Congressional Budget Office (CBO) estimates that the House-passed bill would decrease the number of insured Americans by an average of 100,000 per year through 2035.

Cost Shifts: While the CBO expects the bill to lower gross benchmark premiums by roughly 11% through 2035, the loss of tax credits means many individuals' net out-of-pocket costs will rise.

Legislative Status: As of late December 2025, the bill faces an uncertain future in the Senate, where it requires bipartisan support to overcome potential procedural hurdles. 

https://www.google.com/search?q=what+is+the+republican+plan+for+healthcare+2025

Norb Leahy, Dunwoody GA Tea Party Leader

Pharma Cost Reductions 12-30-25

Trump's Most US Favored Nation (MFN) drug pricing initiatives begin to take effect in early 2026 through voluntary agreements with pharmaceutical companies.  

These price decreases are being implemented through the following mechanisms:

TrumpRx.gov portal: A new direct-to-consumer (DTC) platform, expected to launch in early 2026, where participating manufacturers (including Merck, Amgen, AstraZeneca, Eli Lilly, and Novo Nordisk) will offer MFN-aligned discounted prices directly to consumers.

Medicare and Medicaid discounts: The agreements will also provide MFN-level pricing to all state Medicaid programs and expand coverage under Medicare for certain drugs, such as GLP-1 medications for weight loss and diabetes, with some Medicare beneficiaries expecting copays around $50 per month. 

Separately, the first round of drug prices negotiated under the Inflation Reduction Act (IRA) of 2022 (a different policy from the Trump MFN initiative) will take effect for Medicare beneficiaries on January 1, 2026. These negotiated prices apply to ten high-cost drugs, including Eliquis, Xarelto, and Jardiance, and are expected to result in significant out-of-pocket savings for Medicare enrollees. 

In 2026, President Trump’s "Most-Favored-Nation" (MFN) drug pricing initiatives will begin through several distinct platforms and regulatory models: 

TrumpRx.gov Launch (January 2026): This new direct-to-consumer (DTC) platform is expected to go live in early 2026, with some reports specifically citing January 1, 2026. It allows patients to purchase brand-name drugs directly from manufacturers at discounted "cash" prices, bypassing insurance companies.

GENEROUS Model (January 1, 2026): A voluntary five-year model for Medicaid programs is scheduled to begin on January 1, 2026. Under this model, participating manufacturers agree to provide state Medicaid agencies with prices pegged to international benchmarks from eight peer countries (e.g., U.K., Canada, and Japan).

GLOBE Model (October 1, 2026): The Global Benchmark for Efficient Drug Pricing (GLOBE) model, which targets physician-administered drugs under Medicare Part B, is scheduled to begin on October 1, 2026. This model aligns U.S. payments with prices paid in 19 other OECD nations. 

Key Drug Price Examples (Effective 2026)

Several major pharmaceutical companies, including Pfizer, AstraZeneca, Eli Lilly, and Novo Nordisk, have reached MFN agreements to lower specific drug costs on the TrumpRx platform starting in 2026: 

Medication  Condition             Est TrumpRx Price  Current List Price

Ozempic     Diabetes/Obesity $350/mo                   $1,000-$1,350

Januvia       Diabetes              $100/mo                   $330

Repatha      Cholesterol          $239/mo                   $573

Zepbound    Obesity                $346/mo                   $1,059

Trulicity        Diabetes              $389/mo                   $900

Future Implementations

GUARD Model: The Guarding U.S. Medicare Against Rising Drug Costs (GUARD) model for Medicare

Part D retail drugs is not scheduled to begin until January 1, 2027.

Medicare Price Negotiations: Separate from MFN but coinciding in 2026, the first round of 10 Medicare-negotiated drug prices (originally initiated by the Inflation Reduction Act) also takes effect on January 1, 2026. 

https://www.google.com/search?q=when+do+trump%27s+most+favored+nation+pharma+cost+decreases+begin+in+2026

Norb Leahy, Dunwoody GA Tea Party Leader

Modifying Obamacare 12-30-25

As of late December 2025, the core Republican plan for passing cost-reducing modifications to the Affordable Care Act (ACA) for 2026 is centered on a House-passed bill, the "Lower Health Care Premiums for All Americans Act". This bill promotes competition through alternative insurance options and aims for general market changes rather than extending the current enhanced premium tax credits that are set to expire.  

Key components of the Republican approach include:

Expanded Access to Association Health Plans (AHPs): The plan would allow small businesses and self-employed individuals to band together across state lines to purchase coverage, which Republicans argue would offer cheaper insurance options by avoiding some ACA regulations and risk-pooling requirements.

Funding for Cost-Sharing Reductions (CSRs): The bill would restore federal funding for CSR payments to insurers (beginning in 2027), which would directly lower out-of-pocket costs for low-income enrollees in silver-level plans. The Congressional Budget Office (CBO) estimated this would lower gross benchmark premiums by 11% on average, but would also reduce overall federal subsidies and potentially decrease the number of insured people due to the loss of enhanced tax credits.

Health Savings Account (HSA) Alternatives: Senate Republicans have coalesced around a separate proposal that would end the expiring enhanced tax credits and instead put money into HSAs for individuals who enroll in bronze or catastrophic plans. This approach aims to help Americans cover out-of-pocket expenses for high-deductible plans.

Pharmacy Benefit Manager (PBM) Reforms: The legislation includes bipartisan reforms designed to increase transparency and oversight of PBMs (drug middlemen), which is projected to reduce government spending and potentially lower drug costs.

No Extension of Enhanced Premium Tax Credits: The central point of contention is the Republican refusal to extend the pandemic-era enhanced ACA tax credits, which, if allowed to expire at the end of 2025, would lead to significant premium spikes for millions of Americans in 2026. 

Legislative Status:
The House has passed the "Lower Health Care Premiums for All Americans Act," but it faces an uncertain future in the Democratic-controlled Senate, where it would likely require bipartisan support that is not currently guaranteed. Meanwhile, a separate Democratic-led effort to force a House vote on a three-year extension of the enhanced premium tax credits is expected in January 2026. The various proposals indicate a divided Congress, with significant legislative battles over healthcare costs expected to continue into the new year. 

In late 2025, Republicans proposed several modifications to the Affordable Care Act (ACA) aimed at reducing costs through alternative market structures rather than extending expiring pandemic-era subsidies. 

The primary Republican plan for 2026, the Lower Health Care Premiums for All Americans Act, passed the House in mid-December 2025 but remains a subject of negotiation heading into 2026. 

Key Components of the Republican Plan

Expansion of Health Savings Accounts (HSAs): A central GOP proposal involves redirecting funds from enhanced tax credits into HSAs for enrollees who choose bronze or "catastrophic" plans. Eligible individuals earning less than 700% of the federal poverty level would receive $1,000 to $1,500 in HSA funding to cover out-of-pocket costs.

Association Health Plans (AHPs): The plan would allow small businesses and self-employed workers to band together to purchase coverage, which Republicans argue would lower costs through greater scale and fewer regulatory mandates.

Cost-Sharing Reduction (CSR) Payments: The House-passed bill would restore CSR payments starting in 2027 to lower premiums specifically for low-income enrollees in silver-level plans. The CBO estimates this would lower gross premiums for benchmark silver plans by 11% on average.

Drug Pricing Reform: The legislation includes bipartisan reforms aimed at pharmacy benefit managers (PBMs) to increase transparency and lower drug costs.

Hardship Exemptions for Catastrophic Plans: Beginning in 2026, new rules will expand eligibility for lower-premium "catastrophic" plans to anyone ineligible for other marketplace savings due to their income. 

Ongoing 2026 Negotiations

As of late December 2025, several alternative proposals and bipartisan negotiations are active: 

Bipartisan CARE Act: Senators Bernie Moreno (R-OH) and Susan Collins (R-ME) have proposed a two-year extension of enhanced subsidies with new restrictions, such as an income cap of $200,000 and a minimum $25 monthly premium to prevent fraud.

Subsidy Extension Vote: Four moderate House Republicans joined a Democratic-led discharge petition to force a floor vote in January 2026 on a three-year extension of the current enhanced tax credits.

Retroactive Credits: If an agreement is reached in early 2026, lawmakers may apply tax credits retroactively to the beginning of the year to mitigate the price hikes enrollees are facing during the current enrollment cycle. 

https://www.google.com/search?q=what+is+the+republican+plan+for+passing+cost+reducing+modifications+to+obamacare+2026

Norb Leahy, Dunwoody GA Tea Party Leader

Avoiding 2026 Govt Shutdown 12-30-25

To stop a government shutdown, Republicans must pass appropriations bills that can be signed into law by the President. Because most spending bills require a 60-vote threshold to advance in the Senate, this currently necessitates bipartisan negotiation and a deal with Democrats.  

Republicans have several options to achieve the necessary votes or change the process:

Negotiate a Bipartisan Deal: The most common way to end a shutdown is through compromise. Republicans can negotiate with Democrats to create a funding bill that addresses key Democratic priorities (such as the extension of Affordable Care Act subsidies) in exchange for their votes.

Secure Democratic Support: Republicans can attempt to convince enough moderate Democrats (at least seven in recent scenarios, as Republicans hold 53 seats) to cross the aisle and vote for a "clean" short-term funding bill or other Republican-led proposals, thereby breaking the Democratic filibuster.

Change Senate Rules (The "Nuclear Option"): President Trump has previously urged Republicans to eliminate the legislative filibuster, which would allow spending bills to pass with a simple 50-plus-one majority vote. However, key Republican leaders have consistently rejected this idea, citing the importance of the filibuster as a safeguard for the minority party.

Utilize Existing Senate Rules: Some procedural tactics exist, such as strictly enforcing Senate Rule XIX (the "two-speech rule"), which limits how many times a senator can speak on a single legislative day. This could theoretically allow Republicans to force a vote without eliminating the filibuster, but it requires significant effort and continuous session time.

Ultimately, the most practical and historically common methods involve reaching a legislative compromise that secures sufficient bipartisan support to overcome the 60-vote threshold in the Senate and avoid the political fallout of a prolonged closure. 

In 2025, Republicans ended the record-breaking 43-day government shutdown by negotiating a bipartisan deal in the Senate that successfully bypassed a Democratic filibuster. 

The shutdown, which began on October 1, 2025, was resolved through the following actions taken by Republican leadership: 

1. Bipartisan Senate Negotiation

To overcome the 60-vote threshold in the Senate, Majority Leader John Thune (R-SD) and Senate

Appropriations Chair Susan Collins (R-ME) negotiated a package that secured the support of eight moderate Democrats. The deal, passed on November 10, 2025, included: 

A "Clean" Funding Extension: Temporary funding through the end of January 2025.

Concessions on Federal Workers: Reversing some mass layoffs/firings of government workers initiated by the White House.

Food Assistance Safeguards: Long-term funding for SNAP (Supplemental Nutrition Assistance Program) benefits. 

2. Rejecting the "Nuclear Option"

President Trump repeatedly urged Senate Republicans to use the "nuclear option" to eliminate the filibuster and reopen the government with a simple 51-vote majority. However, Republican leaders, including Senator Thune and House Speaker Mike Johnson, rejected this move to protect the long-term institutional rules of the Senate. 

3. House Passage and Final Signing

Following the Senate's lead, the House passed the bipartisan bill on November 12, 2025. President Trump signed the legislation shortly after, officially ending the shutdown and reopening federal agencies. 

Summary of Legislative Strategies

Strategy  Action Taken

Negotiation  Republicans dropped their refusal to negotiate and accepted terms regarding federal worker protection and SNAP funding.

Rule Enforcing  Senate Republicans considered using Rule XIX (the two-speech rule”) to exhaust filibustering Democrats before ultimately reaching a bipartisan deal.

Midterm Pressure   Moderate Republicans pressured leadership to settle due to fears of voter backlash in the 2026 midterms over rising healthcare costs.

https://www.google.com/search?q=how+can+the+republicans+stop+the+shutdown

Norb Leahy, Dunwoody GA Tea Party Leader

Fraud Reports 12-29-25

Fraud attempts are extremely common, with millions reported annually in the U.S.; the Federal Trade Commission (FTC) received around 2.6 million fraud reports in 2024, with losses exceeding $12.7 billion, mostly from imposter scams and investment scams, while the FBI's IC3 reported over 1.1 million complaints for 2024 in areas like phishing, ransomware, and identity theft. Specific numbers vary by source and year, but trends show high volumes, particularly with mobile-based fraud and identity theft.  

Key Figures (2024/2025 Data):

FTC Reports: About 2.6 million fraud reports received in 2024, with $12.7 billion in reported losses.

FTC Identity Theft: Over 1.1 million identity theft reports in 2024.

FBI IC3: Received 1,135,291 complaints in 2024, with phishing and investment scams being major categories. 

Common Types of Fraud:

Imposter Scams: Scammers pretending to be from a government agency, known company, or family member.

Investment Scams: Including cryptocurrency and other fake opportunities, causing significant losses.

Phishing/Spoofing: Emails, texts, or calls designed to trick you into giving up personal info.

Identity Theft: Using your personal details for financial gain. 

Where to Find More Data:

Federal Trade Commission (FTC) for consumer fraud and identity theft reports.

Federal Trade Commission (.gov) for deeper analysis.

Internet Crime Complaint Center (IC3) (.gov) for internet-specific crimes. 

In 2024, the U.S. Federal Trade Commission (FTC) received approximately 2.6 million consumer fraud reports. This total remained nearly stable compared to 2023, though financial losses from these reports increased by 23% to a record $12.7 billion. 

Reported Fraud Attempts (2024–2025)

Total Consumer Fraud (2024): 2,626,600 complaints were logged by the FTC and affiliate agencies, a 0.1% increase from the previous year.

Identity Theft (2024): More than 1.1 million reports were filed, an increase of approximately 9.5% from 2023.

Identity Theft (2025 H1): In the first half of 2025, the FTC received 748,555 reports of identity theft, putting the year on pace to break records.

United Kingdom (2025 H1): Over 2 million fraud cases were reported in the first half of 2025 alone, a 17% increase year-over-year. 

Most Commonly Reported Categories (2024)

According to the FTC's Consumer Sentinel Network, the most frequent categories of reported fraud were:

Imposter Scams: 847,000+ reports.

Online Shopping: 386,000+ reports.

Credit Card Identity Theft: 449,000+ reports.

Job and Employment Agency Scams: Reports in this category tripled between 2020 and 2024. 

Digital and AI Trends

AI-Driven Attempts: AI now accounts for an estimated 42.5% of all detected fraud attempts in the financial and payments sector as of late 2024.

Global Digital Fraud: Suspected digital fraud attempts originating from the U.S. rose 122% between 2019 and 2022, though the rate of attempts relative to total transactions can fluctuate by industry.

Success Rates: While millions of attempts are reported, many more likely go unrecorded; studies suggest only about 14% of fraud cases in some regions are ever reported to authorities. 

https://www.google.com/search?q=how+many+fraud+attempts+were+reported

Norb Leahy, Dunwoody GA Tea Party Leader

Telemarketer Scams 12-29-25

Telemarketer scammers use a variety of deceptive tactics to trick individuals into revealing their bank account and routing numbers, which they then use to withdraw money without authorization.  

Common Scams Used to Obtain Bank Account Numbers

Automatic Debit Scams: Scammers call and say you have won a prize or pre-qualified for a major credit card, but need your checking account information (account and routing numbers) for "identification," "verification," or to "deposit" the prize money. Once they have the numbers, they create an unsigned "demand draft" to withdraw money from your account.

Imposter Scams: Posing as representatives from your bank, a government agency (like the IRS or FBI), or law enforcement, the scammer claims there is a problem with your account (e.g., fraud activity or a security issue). They use high-pressure tactics to convince you that you must provide your account information immediately to "safeguard" your funds or assist with an "investigation".

Guaranteed Grants/Loans: A caller might claim you qualify for a free government grant or a low-interest loan but needs your bank account details to deposit the funds or process an upfront fee. Legitimate grants or loans do not require advance payment or your bank account number for verification over the phone.

"Free" Offers with Hidden Fees: Scammers offer a free gift, vacation, or product but require you to pay a small fee for shipping, handling, or taxes. They ask for your bank account information to process this minor payment, which then allows them to make larger, unauthorized withdrawals. 

How to Protect Yourself

Never Give Out Account Information: Do not provide your bank account number, Social Security number, or other sensitive financial information over the phone to anyone who calls you, regardless of who they claim to be. Legitimate banks and government agencies will not ask for this information during an unsolicited call.

Initiate the Call: If you are concerned about an alert or offer, hang up and call the institution directly using a trusted phone number from your bank statement, the back of your debit card, or the official website. Do not use a number provided by the caller.

Beware of Pressure Tactics: Scammers use a sense of urgency or high-pressure tactics to force a quick decision. Legitimate businesses give you time to consider offers and provide information in writing.

Monitor Your Statements: Regularly check your bank statements for any unauthorized debits or transactions and report them to your bank immediately.

Register for the Do Not Call List: While this won't stop scammers, it will reduce legitimate telemarketing calls, making scam calls easier to spot. You can register your number on the National Do Not Call Registry. 

What to Do If You Are a Victim

If you believe you have been a victim of a telemarketing scam, take these steps immediately:

Contact your bank to report the fraud and prevent further unauthorized transactions.

File a complaint with the Federal Trade Commission (FTC) and your state's Attorney General's office.

File a report with the FBI's Internet Crime Complaint Center (IC3). 

Telemarketer scammers use high-pressure tactics and various impersonation schemes to trick individuals into revealing their bank account numbers, often through automatic debit scams or by pretending to be from a trusted institution like a bank or a government agency. 

Common Scams

Bank Imposter Scams Scammers pose as employees from your bank, claiming there is a fraud alert or an issue with your account. They may use caller ID spoofing to make the call look legitimate. They then pressure you to "verify" your personal information, including your account number, PIN, or a one-time verification code, in order to "secure" your account. Instead, they use this information to access your funds or transfer them to a "safe account" that they control.

Prize or Free Gift Scams You are told you have won a major prize, vacation, or grant but must pay an upfront "fee" for taxes, shipping, or processing. To process the payment or deposit the "prize money," they ask for your bank account details. Legitimate prize promotions never require a payment to win.

Automatic Debit Scams Scammers may call with an offer for a credit card or other service and ask for your checking account number and routing number to "verify" your identity or process the offer. This information is then used to create an unauthorized "demand draft" to withdraw money from your account without your signature.

Government Impersonators Scammers pretend to be from government agencies like the IRS or a grant organization, claiming you owe money or qualify for a free grant. They demand your bank information to either collect payment or deposit the grant funds, but instead, they steal your money. 

How to Protect Yourself

Never share sensitive information Do not give out your bank account number, credit card number, Social Security number, or PIN over the phone to someone who calls you unexpectedly. Your bank or a government agency will never call you and ask for this information unsolicited.

Verify the caller's identity If you receive a suspicious call, hang up immediately. Call the institution back using a trusted, verified phone number, such as the one on the back of your bank card, a recent statement, or their official website.

Beware of high pressure tactics Scammers create a sense of urgency to force you into making a quick decision without thinking. Legitimate companies will give you time to consider their offer.

Monitor your accounts Regularly check your bank statements for any unauthorized transactions and report them to your bank immediately.

Register for the Do Not Call list Sign up your phone number on the official National Do Not Call Registry to reduce the number of legitimate telemarketing calls, making scam calls easier to spot. 

If you believe you are a victim of fraud, contact your bank immediately and consider filing a complaint with the Federal Trade Commission (FTC). 

https://www.google.com/search?q=telemarketer+scams+used+to+get+your+bank+account+number

Norb Leahy, Dunwoody GA Tea Party Leader

Telemarketer Fraud 12-29-25

Telemarketing frauds trick victims with fake prizes (lotteries, vacations), urgent threats (utility shut-off, bank fraud), phony government grants, or bogus investments, using high-pressure tactics, requests for upfront fees/personal info, and promises of huge returns to steal money or data, often disguised as legitimate companies or agencies. Common examples include the Foreign Lottery Scam, Auto Warranty Scam, Government Grant Scam, Tech Support Scam, and Charity Scams, all designed to get you to send money or share sensitive details.  

Common Telemarketing Fraud Examples:

Prize/Lottery Scams: You "won" a foreign lottery or free trip but must pay taxes, fees, or processing charges first to claim it.

Government Grant Scams: You qualify for a "free" government grant, but need to pay an "application fee" or "processing fee" to get the funds.

Utility Shut-Off Scams: A caller claims your gas, electric, or water bill is overdue and you must pay immediately via gift card or wire transfer to avoid disconnection.

Auto Warranty/Insurance Scams: Posing as your car's manufacturer or insurer, they claim your warranty is expiring and pressure you to buy an expensive new plan.

Tech Support Scams: A caller claims your computer has a virus or security issue and needs remote access or payment for fake repairs.

Charity Scams: Faking affiliation with a charity to solicit donations, often with little money actually reaching the cause.

Investment Scams: Pitching "risk-free" investments or work-from-home opportunities promising high returns with little effort.

Bank/Account Fraud: Claiming your bank account is compromised and needing your personal details or money moved for "safekeeping". 

Red Flags to Watch For:

High Pressure: Demanding an immediate decision or payment.

Upfront Fees: Asking for money (gift cards, wire, crypto) to receive a prize, grant, or refund.

Too Good to Be True: Unbelievable offers or guaranteed returns.

Unsolicited Offers: Calls about things you didn't sign up for.

No Written Info: Refusal to send details in writing or provide references.

Unknown Caller ID: Spoofed or blocked numbers. 

Telemarketing fraud often involves high-pressure tactics or enticing offers designed to extract money or sensitive personal information. In 2025, scammers frequently use technology like AI-generated robocalls and caller ID spoofing to appear legitimate. 

Common examples of telemarketing fraud include:

Prize and Lottery Scams: Callers claim you have won a major prize or a foreign lottery but insist you must first pay "taxes," "insurance," or "processing fees" to release the funds.

Government Impersonator Scams: Fraudsters pose as officials from agencies like the IRS, Social

Security Administration, or the FBI, threatening arrest or legal action if you do not immediately pay a supposed debt or "verify" your Social Security number.

Grandparent/Emergency Scams: A scammer calls an older adult pretending to be a grandchild in urgent trouble (e.g., arrested or hospitalized in a foreign country) and begs for money to be wired immediately.

Tech Support Scams: Scammers claim to be from a well-known company like Microsoft and warn that your computer has a virus. They then ask for remote access to "fix" the issue and charge for unnecessary software or services.

Utility Cut-off Scams: A phony utility worker calls claiming your gas, water, or electric bill is past due and service will be disconnected within hours unless an immediate payment is made over the phone.

Credit Card and Debt Relief Scams: Callers promise to lower your credit card interest rates, repair your credit, or forgive student loans for an upfront fee.

Charity Fraud: Scammers exploit recent natural disasters or appeal to generic causes (e.g., veterans' support) using names that sound similar to legitimate charities to solicit donations.

Auto Warranty Scams: Callers posing as representatives from your car dealership or manufacturer urge you to buy an "extended warranty" to prevent service lapses.

Business Opportunity/Work-at-Home Scams: Scammers lure victims with promises of high earnings for minimal effort, such as medical billing or stuffing envelopes, provided the victim pays an upfront fee for a "start-up kit". 

Reporting and Prevention

National Do Not Call Registry: Add your number at DoNotCall.gov to reduce legitimate sales calls; if you still receive calls, they are likely fraudulent.

Report Fraud: File a complaint with the FTC at ReportFraud.ftc.gov if you have been targeted.

Identity Theft: If you have shared personal information, visit IdentityTheft.gov to set up a recovery plan. 

https://www.google.com/search?q=telemarketing+frauds+examples

Norb Leahy, Dunwoody GA Tea Party Leader