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<ul class="summary-list"><li>Trump said he plans to change the Affordable Care Act, which provides healthcare for 45 million Americans.</li><li>His past actions include ACA opposition. He has flip-flopped on Medicaid and Medicare cuts.</li></ul>Donald Trump's return to the Oval Office could mean changes to Americans' healthcare coverage, based on his previous comments and actions while president.During his recent campaign, Trump promised to <a target="_blank" class="" href="https://www.businessinsider.com/what-us-economy-would-look-like-with-trump-biden-presidency-2024-5">make changes to the Affordable Care Act</a>, colloquially called Obamacare, but did not give specifics."If we can come up with a plan that's going to cost our people, our population less money and be better healthcare than Obamacare, then I would absolutely do it," Trump said at the presidential debate in September.As president, he will also have the power to influence America's healthcare landscape, including insurance coverage, drug price negotiations, government <a target="_blank" class="" href="https://www.businessinsider.com/fluoride-in-water-why-it-is-controversial-risks-benefits-2024-11">health and safety regulations</a>, and reproductive healthcare access.Trump has a <a target="_blank" class="" href="https://www.businessinsider.com/healthcare-investors-torn-on-trump-second-term-2024-11">mixed record</a> on supporting government health insurance policies like the ACA, which the Department of Health and Human Services estimated covers 45 million people in health plans like <a target="_blank" class="" href="https://www.businessinsider.com/medicare-changes-increase-costs-deductibles-prescription-drugs-premiums-copays-2024-10">Medicare</a> and Medicaid. Also in the hot seat: the enhanced federal ACA subsidies, which are <a target="_blank" class="" href="https://www.cbsnews.com/news/trump-aca-subsidies-health-insurance-affordable-care-act-congress/">set to expire</a> at the end of next year.If Trump doesn't extend the enhanced subsidies policy, which helps many low- and middle-income Americans pay for medical care, the Congressional Budget Office estimated that <a target="_blank" href="https://www.cbo.gov/system/files/2024-07/60523-2024-07-premium-tax-credit.pdf">nearly 4 million people </a>will lose their coverage in 2026 because they won't be able to afford it.Trump's transition team told Business Insider in a statement that he will "strongly protect" Medicare in his second term — although he has <a target="_blank" class="" href="https://www.businessinsider.com/trump-cutting-medicare-social-security-benefits-2024-3">previously suggested cuts</a>. Any changes to Medicaid and Medicare under Trump could also cause those with ACA insurance see a reduction in their care options.<h2 id="69e6831b-4c89-4dd9-8ec0-501ab8666185">Medicare, Medicaid, and preexisting conditions</h2>Trump has not provided specifics about his affordable healthcare policies, beyond saying he has "concepts of a plan" at the September debate.During his first term, Trump backed a rejected Supreme Court case to overturn the Affordable Care Act, which former President Barack Obama passed in 2010 and that expanded Medicaid coverage for low-income Americans and Medicare coverage for older Americans. ACA's other marquee change required insurance companies to cover care for individuals with preexisting conditions, like asthma, heart disease, and diabetes.Yunan Ji is an assistant professor and economist at Georgetown University with an expertise in healthcare policy. She told BI that reducing or repealing ACA coverage — which Trump proposed during his first-term — could be detrimental to Americans with preexisting conditions, who may lose their coverage or have to pay more for healthcare."We purchase insurance to protect against future risk," Ji said. "If we make people go into a different risk pool when they require care for some medical condition, that defeats the purpose of insurance."Trump has also voiced support for privatizing more of the healthcare sector. This could mean some Americans on ACA plans could face higher out-of-pocket costs and fewer in-network care options.President Joe Biden's <a target="_blank" class="" href="https://www.businessinsider.com/house-passes-inflation-reduction-act-sending-it-to-biden-2022-8">Inflation Reduction Act</a> also took steps to lower the cost of prescription drugs and cap out-of-pocket costs for Medicare beneficiaries. The legislation <a target="_blank" href="https://www.axios.com/2024/02/07/trump-medicare-price-negotiations-executive-power">requires</a> Trump to continue existing drug price negotiations through at least the end of 2025.<h2 id="1380ef19-42c4-43c1-841e-04dcb5227dd9">Reproductive and gender-affirming care</h2>Trump has said he would take steps to <a target="_blank" href="https://www.nbcnews.com/politics/2024-election/trump-vows-stop-gender-affirming-care-minors-re-elected-president-rcna68461">ban all gender-affirming healthcare and hormone therapies</a> for minors, which ACA plans cover in some states.<a target="_blank" href="https://www.businessinsider.com/what-is-project-2025-conservative-political-playbook-heritage-foundation-trump-2024-7">Project 2025</a>, a policy plan proposed by Trump allies, calls for significant national restrictions on abortion and birth control. Trump has expressed support for federal enforcement of the Hyde Amendment, a rule that prevents Medicaid from covering abortion pills and procedures. Among the <a target="_blank" class="" href="https://www.kff.org/womens-health-policy/dashboard/abortion-in-the-u-s-dashboard/">37 states and DC</a> that do not ban abortion, <a target="_blank" href="https://www.kff.org/medicaid/state-indicator/abortion-under-medicaid/?currentTimeframe=0&amp;sortModel=%7B%22colId%22:%22Follows%20Federal%20Standard,%20Funding%20Only%20Cases%20Involving%20Life%20Endangerment,%20Rape%20and%20Incest%22,%22sort%22:%22desc%22%7D">17 states and DC</a> currently follow the Hyde Amendment.Trump has called for federally-subsidized in-vitro fertilization — a proposal that is divisive among Republicans.<h2 id="f6dc24d6-1b01-41c0-99ba-9603db98ef3f">Insurance regulations and national health policy</h2>Ji said that Americans often focus on the sticker price of premiums in their healthcare plan — how much they are expected to pay out-of-pocket each month or year. But a Trump presidency would also shape rules and regulations for insurance companies. For example, companies are required to cover a wide range of providers, so someone with heart disease can find an in-network cardiologist in their area.Ji added that Trump's cabinet appointments will give insight into his second-term healthcare priorities. His leadership selections will determine federal investment in medical research, health and safety guidelines, insurance company regulations, and vaccines. Trump is expected to <a target="_blank" href="https://www.nbcnews.com/politics/2024-election/trump-banning-vaccines-president-rfk-fluoride-rcna178570">discourage vaccinations</a> and limit federal health and insurance regulations.Trump tapped <a target="_blank" class="" href="https://www.businessinsider.com/trump-robert-f-kennedy-jr-rfk-department-health-human-services-2024-11">Robert F. Kennedy Jr.</a> on November 14 to lead the Department of Health and Human Services, a decision that will require Senate approval. Kennedy has not outlined specific plans to increase healthcare affordability, but he would have some influence over the ACA in the role. The former presidential candidate is a vaccine-skeptic, who Trump hopes will "<a target="_blank" class="" href="https://www.businessinsider.com/how-rfk-jr-plans-to-make-america-healthy-again-2024-11">go wild</a>" on health, safety, and food protocols.Any major changes to healthcare policy and federal budgets would need to be approved by Congress. Trump will likely have the support of a Republican-led Senate and House."The American people re-elected President Trump by a resounding margin giving him a mandate to implement the promises he made on the campaign trail," Karoline Leavitt, a spokesperson for the Trump-Vance transition team, told BI in a statement. "He will deliver."Are you doing anything to prepare your finances or healthcare plan for Trump's second term? If so, please reach out to this reporter at <a target="_blank" class="" href="mailto:allisonkelly@businessinsider.com">allisonkelly@businessinsider.com</a>.

Trump's plans to change healthcare could slash insurance for some low-income Americans and retirees

No expert committee has been set up for extending <keyword id="19923745" type="General" weightage="20" keywordseo="health-benefits" source="keywords">health benefits</keyword> to cover citizens aged 70 and above under <keyword id="19913233" type="General" weightage="100" keywordseo="Ayushman-Bharat" source="keywords">Ayushman Bharat</keyword>, <keyword id="22556022" type="General" weightage="20" keywordseo="Union-Minister-of-State-for-Health" source="keywords">Union Minister of State for Health</keyword> Prataprao Jadhav told the Lok Sabha on Friday. He was responding to a question on whether the government proposed to cover citizens aged 70 and above by expanding Ayushman Bharat through the launch of a <keyword id="21782708" type="General" weightage="20" keywordseo="National-Health-Claims-Exchange" source="keywords">national health claims exchange</keyword> and if an expert panel had been set up to strengthen the format of the scheme for the planned expansion. Jadhav, in a written reply, said all members of eligible families, irrespective of age, were covered under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana. The scheme provides <keyword id="19894985" type="General" weightage="20" keywordseo="health-insurance" source="keywords">health insurance</keyword> cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to 55 crore individuals, corresponding to 12.34 crore families, he said. "No expert committee has been set up for extending the health benefits to cover <keyword id="19894991" type="General" weightage="20" keywordseo="senior-citizens" source="keywords">senior citizens</keyword> aged 70 and above," he stated. Responding to another question, Jadhav said 34 insurers and third-party administrators were live and approximately 300 hospitals ramping up to start sending their claims on the National Health Claims Exchange (NHCX), which aims to streamline and fasten health <keyword id="35450" type="General" weightage="20" keywordseo="Insurance" source="Orion">insurance</keyword> claim processing, as on July 21. Jadhav said the government built the NHCX gateway under the Ayushman Bharat Digital Mission. It aims to streamline and standardise health insurance claim processing, enhance efficiency in the insurance industry and improve patient experience. It serves as a gateway for exchanging health claim information among insurers, third party audit, healthcare providers, beneficiaries and other relevant entities and ensures interoperability, machine-readability, auditability and verifiability, making the information exchange accurate and trustworthy, the minister said. This system will enhance efficiency and transparency in the insurance industry, benefiting policyholders and patients, he added. Supported by the Insurance Regulatory and Development Authority of India and the General Insurance Council, the NHCX will enable standardised and faster health insurance claim processing, Jadhav said.

No panel formed for extending benefits to cover citizens above 70 under Ayushman Bharat, says govt

<ul class="summary-list"><li>Shanna Nasiri, 34, decided to leave her tech job when she no longer felt aligned with the work.</li><li>Earlier this year, she opened a natural wine bar in Williamsburg called With Others.</li></ul>This as-told-to essay is based on a conversation with Shanna Nasiri, the 34-year-old owner of <a target="_blank" class="" href="https://www.withothersbrooklyn.com/?fbclid=PAZXh0bgNhZW0CMTEAAaYikrw0VpjpCpAQ0ZvjvLvpFSaoADEXEYZSPsfVYegg3r5FJj2KHjPZ-Cs_aem_1Utqp3zKNtwMvha7MZMTkA">With Others</a>, a natural wine bar in Brooklyn, New York. It has been edited for length and clarity. Business Insider has verified Nasiri's salary.I grew up in the <a target="_blank" class="" href="https://www.businessinsider.com/moved-san-francisco-worth-it-cost-of-living-negativity-2024-2">Bay Area</a> near Silicon Valley, and everyone I knew was in some variation of tech. I continued on that trajectory.My first job was working for the corporate ventures team at Qualcomm. After that, I worked in semiconductors for a few years. Then, I went back to business school and got a job in product marketing for a regulatory technology startup.I liked aspects of what I was doing. The <a target="_blank" class="" href="https://www.businessinsider.com/big-tech-workers-pushed-limits-of-perks-benefits-pampering-over-2024-10">perks</a> were nice. I had full benefits. And there <a target="_blank" class="" href="https://www.businessinsider.com/left-big-tech-job-uber-entrepreneur-2024-10">was the salary</a>. I was making around $200,000 at the time I left, plus a bonus. I also got a lot of stock options.I was working for <a target="_blank" class="" href="https://www.businessinsider.com/startups-to-bet-your-career-on-in-2024-2024-2">startup companies</a>, so I had the chance to be at the ground level, build teams, and craft messaging. I felt like I had an impact.But I wasn't creatively fulfilled. I didn't like what I was doing. It didn't resonate with who I am. I was kind of embarrassed to tell people I did product marketing for regulatory technology startups. I felt like I was speaking a different language.At the time, I compartmentalized. This is who I am at work, and this is who I am in my personal life. I just accepted my life for what it was and figured you could <a target="_blank" class="" href="https://www.businessinsider.com/happiness-at-work-employee-engagement-fulfillment-flexibility-four-days-2023-12">never be fully happy at work.</a><h2 id="ddbf58b0-8e32-403f-9d1f-46fdacdaa027">That started to change when I turned 30</h2>Around my 30th birthday, I started having these existential questions and ideas. I had recently moved from San Francisco to New York City. That was also right at the start of COVID, so I had a lot of <a target="_blank" class="" href="https://www.businessinsider.com/how-the-pandemic-changed-my-career-2-years-stories-2022-3">alone time to reflect.</a>I was seeing this whole new world in <a target="_blank" class="" href="https://www.businessinsider.com/san-francisco-new-york-london-tech-where-to-live-2024-8">New York City</a>, with so many diverse careers. In San Francisco, I knew a lot of tech founders. But when I moved to New York, I started to see that entrepreneurship could have a greater meaning beyond tech.<div type="image" title="A photo of Shanna Nasiri holding a bottle of wine next to a photo of Williamsburg" height="1500" width="3000" msid="115114938" hostid="261" sizebytes="438074"></div>I had always fantasized about opening a space, but it wasn't something I thought I would actually do.I moved to <a target="_blank" class="" href="https://www.businessinsider.com/photos-show-what-its-like-to-live-in-williamsburg-brooklyn-2021-5">Williamsburg in 2021</a>. It was still pretty desolate at the time. There were lots of empty storefronts. I would go on these long walks and start fantasizing about what I would do with the space.I've always been passionate about hosting. I love to curate an environment. I'm obsessed with the little details like glassware, music, lighting, and sparkling water choice. I grew up in a family where my mom and grandma would host huge parties all the time and I was the mini host. I'm Middle Eastern and I think there is a sense of Middle Eastern hospitality that's embedded within me.My <a target="_blank" class="" href="https://www.businessinsider.com/guides/kitchen/types-of-wine">wine journey</a> started young. My stepdad collected limited-production Pinot Noirs. He introduced me to wine and taught me how to taste and the artisanship that goes into production.When I think about it now, it was pretty brazen to start a wine bar. But it was COVID, and <a target="_blank" class="" href="https://www.businessinsider.com/how-people-changed-careers-jobs-during-pandemic-2022-3">life felt so short and precious</a>. I wanted to prove to myself I could do itIt was either get stuck in this unfulfilling career trajectory and <a target="_blank" class="" href="https://www.businessinsider.com/careerist-corporate-ladder-decline-promotions-work-ethic-american-dream-2024-10">climb the corporate ladder</a>, or try to be an entrepreneur. It was a huge leap of faith and required me to believe in myself 100%So, in the summer of 2022, I got a job at a wine bar in Brooklyn to see what it was like. I was so passionate about it.After that, I started pursuing my wine education and got my Wine and Spirit Education Trust certification, which is a globally recognized qualification. I got a job at a wine shop. And I fully committed to opening my own bar.<h2 id="49faa484-70c2-47b4-9558-670c2708ed17">My tech experience came in handy</h2>A lot of my past work was helpful as I was building the bar. I knew how to manage teams. I had always worked at the ground level, so I had experience juggling a lot of responsibilities and working with limited resources.I started asking everyone to introduce me to other entrepreneurs and asking about their contractors, their agents, and their plumbers.<div type="image" title="A photo of Shanna Nasiri posing at her wine bar next to a photo of Williamsburg" height="1500" width="3000" msid="115114935" hostid="261" sizebytes="153358"></div>I used my own money and opened the bar on a very small budget.It took me a year to find the space because I was only looking for places within a few blocks of my home. I wanted it to be really integrated with the community. I found the space in June 2023 and started construction in October 2023.We opened in March of this year. It's been incredible. It's beyond anything I could have ever imagined.It has quickly become the neighborhood spot. We have regulars that come in twice a week. And the coolest thing has started happening recently, where I have probably met 11 or 12 parents of our regulars.I've continually reinvested in the bar. For example, the backyard buildout happened three months after we opened. After that, I built out the basement and cellar. Then I invested in hiring a general manager and growing out the wine list.<h2 id="ac1863d1-953a-4300-b4ce-24a04c6e730e">It's been a major lifestyle change from tech</h2>I don't have health insurance. I'm working probably 12-hour days. There's just so much stuff to do in terms of maintenance. And I work service every single night.In tech, I could work from anywhere. I traveled a lot and <a target="_blank" class="" href="https://www.businessinsider.com/working-remotely-feel-isolated-from-coworkers-quit-2024-7">worked remotely</a>. Now, I have a physical space. I haven't left a 20-mile radius since Christmas and have no plans to.But I feel so aligned with what I'm doing. It feels like what I was always meant to be doing. I work way more hours than I did in tech, but it doesn't feel as hard.I'm in such awe of what we've been able to create in such a short amount of time.

I left my $195,000 tech job to open a wine bar. I work 12-hour days and don't have health insurance, but I've never been happier.

<ul class="summary-list"><li>"Beverly Hills, 90210" star Shannen Doherty died Saturday at age 53.</li><li>Her publicist told BI she "lost her battle" with cancer after 9 years, including some in remission.</li></ul>"Beverly Hills, <a target="_blank" class="" href="https://www.businessinsider.com/shannen-doherty-dead-90210-star">90210" star Shannen Doherty</a> had, in recent years, become an outspoken voice for cancer awareness and treatment, speaking openly about her diagnosis and plans for after her death.As recently as April, she said on her podcast that she felt hopeful about possible medical treatments that could "prolong" her life.But she also said she'd taken some time in recent months to "take stock of my life and shift my priorities" by <a target="_blank" class="" href="https://www.businessinsider.com/shannen-doherty-90210-declutter-downsize-breast-cancer-mom-2024-4">downsizing</a>, decluttering, and spending more time with her mom, "just in case."On Saturday, Doherty died "surrounded by her loved ones," according to her publicist."It is with a heavy heart that I confirm the passing of actress Shannen Doherty. On Saturday, July 13, she lost her battle with cancer after many years of fighting the disease," Leslie Sloane said in a statement to Business Insider.Doherty was first diagnosed with an invasive form of breast cancer in 2015. She went into remission in 2017, but in 2019, she was rediagnosed with metastatic stage 4 breast cancer, the most advanced form of the disease.By 2023, Doherty shared on her podcast that her cancer had spread into her bones, but she said she was "not done living yet."And Doherty always wondered what might've happened if her cancer had initially been diagnosed a little bit earlier.<h2 id="3758acf3-8bed-4a88-a8a4-cd6693512ae6">Doherty said she didn't go to the doctor for a year before her diagnosis</h2><div type="image" title="Shannen Doherty posing with her dog Bowie." height="2202" width="3303" msid="111763633" hostid="261"></div>In 2015, <a target="_blank" class="" href="https://affiliate.insider.com?h=db75c9bfbd28aca6a67ba25a749f0695edf6034c37fbacde3e790f9469c61c97&amp;postID=66954dbc20eaab25bc14dec9&amp;postSlug=shannen-doherty-cancer-lawsuit-management-firm-health-insurance-2024-7&amp;site=bi&amp;u=https%3A%2F%2Fwww.scribd.com%2Fdocument%2F275197945%2FDoherty-v-Tanner">Doherty sued</a> her former accounting firm, Tanner Mainstain Glynn and Johnson, alleging that it didn't pay her health insurance premium to the Screen Actors Guild in late 2013, and her health coverage in 2014 lapsed as a result.(The company denied Doherty's allegation, <a target="_blank" class="" href="https://abcnews.go.com/Entertainment/inside-shannen-doherty-breast-cancer-lawsuit/story?id=33202707">telling</a> ABC News at the time that "the claim that Tanner Mainstain caused her to be uninsured, prevented her from seeking medical care, or somehow contributed to her cancer is patently false.")By the time Doherty received her cancer diagnosis in early 2015, she had "invasive breast cancer metastatic to at least one lymph node," according to her lawsuit. "Had she been insured and able to visit her doctor, the cancer could potentially have been stopped, thus obviating the need for the future treatment (including mastectomy and chemotherapy)."The matter was never settled in court though, because Doherty reached a confidential settlement with the now-acquired accounting firm in 2016, <a target="_blank" class="" href="https://www.usmagazine.com/celebrity-news/news/shannen-doherty-settles-lawsuit-against-ex-manager-w435709/">according to</a> US Weekly.<h2 id="b265a840-8808-4360-bede-c7cae06a7e02">Would an earlier mammogram have helped?</h2>Many women with breast cancer display no symptoms until later stages of the disease, which is why the American Cancer Society recommends yearly mammograms to every <a target="_blank" class="" href="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html">woman over age 40</a> and even earlier screenings for patients at high risk, like those with a family history of breast cancer, or certain genetic mutations.Given that Doherty turned 44 in 2015, it's likely that her doctor would have recommended some kind of breast cancer screening that year, but it's impossible to know exactly how Doherty's diagnosis might've played out if she had visited the doctor earlier.When breast cancer is detected early, the <a target="_blank" class="" href="https://www.nationalbreastcancer.org/early-detection-of-breast-cancer/">survival rate is near 100%</a>, but no statistic can ever perfectly predict what will happen to an individual patient.Doherty recently told her best friend that when she died, <a target="_blank" class="" href="https://www.businessinsider.com/shannen-doherty-funeral-cremation-death-arrangements-ashes-mixed-dog-dad-2024-7">she wanted to be cremated</a> and have her ashes mixed with her dog and her dad.

Shannen Doherty once said in a lawsuit that her cancer could have been stopped if she'd had health insurance

When Josef Woodman's shoulder gave out in 2012 — strained from chopping firewood on his farm outside Chapel Hill, North Carolina — he said he was quoted between $2,400 and $3,200 for an MRI at Duke University Hospital.He didn't want to shell out the cost of a nice vacation just to find out he didn't need surgery, so he decided to wait, even as his mobility decreased to the point where he had to severely limit his farm work and could hold only one-third of the weight he normally could. Two years later, his patience was rewarded: While on a work trip to Bangkok, he got an MRI for just $460, landing an appointment two days after his consultation at a hospital."The results came back and they said, 'You don't need surgery. You've got a separated rotator cuff,'" Woodman said. The surgeon prescribed physical therapy, which he completed in the US. "The shoulder got way better," he told me. He was glad he waited.Like Woodman, millions of Americans travel abroad for medical procedures each year, saving anywhere from 40% to 90% on the services they receive. Many <a target="_blank" href="https://www.amjmed.com/article/S0002-9343(18)30620-X/fulltext">don't have health insurance</a> or don't get coverage for the procedures they seek out — dental work and cosmetic procedures like breast implants and liposuction are by far the most popular. There's also a small but growing market for people seeking thorough checkups and testing abroad. An ascendant medical-tourism industry is offering these types of screenings, including MRIs and electrocardiograms, in beautiful locations around the world and packaging them with transportation, accommodations, food, shopping, and sightseeing. And with an increasing obsession with "wellness" and celebrities like Kim Kardashian promoting full-body imaging, it's easy to see why more and more Americans are looking to pair cabanas with CAT scans."If you've got some kind of joint pain, or if you have some kind of condition that isn't progressing, incorporate that into your normal travel plans," Woodman, now 72, said. In 2007, he founded Patients Beyond Borders, a healthcare-consulting company that helps Americans plan medical vacations, after growing up taking trips to Mexico for dental work with his dad. "In any kind of industrialized nation, you'd be able to get access to good-quality screening and people who can interpret the results," he said.Medical tourism comes with risks; the American Medical Association recommends going only to medical facilities recognized by international accrediting bodies and following up testing with care at home. But a growing number of Americans are willing to take those risks, as suites of tests abroad are often cheaper and faster than just a single test in the US."We just don't have a preventative-oriented society here in the United States," Woodman said. "Our approach is reactive."In a July <a target="_blank" href="https://www.tiktok.com/@bryn.elise/video/7386406512593325355?lang=en">TikTok</a> that's amassed over 17 million views, Bryn Elise documented her experience at a Turkish hospital where she received over 30 scans and tests, including an EKG, chest X-ray, and abdominal and thyroid ultrasounds, in a single day. The bill? $830. Without insurance, the cost of an EKG alone in the US <a target="_blank" href="https://enhancehealth.com/blog/how-much-does-an-ekg-cost-at-urgent-care-without-insurance/#:~:text=The%20total%20cost%20of%20an,where%20you%20get%20the%20service.">can vary from $100 to $5,000</a>."Personally, I'd rather spend $700 on a flight to Turkey, get dozens of tests there, and take a whole vacation than spend the thousands that this would have cost in the United States," Elise said in the video, which also featured clips of her on a beach, poolside, and eating a spread of delicious-looking Turkish veggie bowls. The 29-year-old health- and beauty-tourism influencer said she booked the trip because she wanted to investigate some "mysterious ailments," including brain fog, vision problems, and heart palpitations, without paying America's sky-high healthcare costs. She told her followers she had struggled with an eating disorder for 10 years and that "since our US checkups are only a tap on the knee and a blood-pressure check, I've been low-key terrified that I've caused permanent damage to my body but would never find out until it's too late."Her tests unearthed an astigmatism, early signs of osteoporosis, and "critically low" levels of vitamin B12. "The feeling of impending doom I've had due to health concerns is gone," Elise said.She chose a hospital that had been accredited by the Joint Commission International, an Illinois-based organization that has accredited over 1,000 health facilities in more than 70 countries. Dr. Paulo Neno, an international-accreditation surveyor at the commission, told Business Insider the accreditation process takes up to two years to complete and is renewed every three years. It includes a 12-part evaluation, during which a team of doctors and nurses visit the medical facility and assess everything from its operating theaters and intensive-care units to its power and water systems."We are focused on understanding how they are providing safe care for high-risk patients," Neno said.It's unclear, though, how many medical tourists visit accredited facilities, and there's still the question of whether all these tests are useful for someone who is seemingly in good health. Woodman knew he had an issue that needed to be examined, but Elise was more interested in a holistic screening regimen. One person commented on Elise's TikTok, "The hypochondriac in me thinks this is the perfect vacation. I'd go every year."Since COVID-19 came into the picture, health screenings and extensive physicals have received some buzz. Last year, Kardashian got a full-body MRI done by Prenuvo, a US chain of diagnostic clinics that offers the service for $2,500. In an Instagram post promoting it, Kardashian described it as a "life saving machine" that could detect cancer or conditions like aneurysms in their earliest stages. Especially given the <a target="_blank" href="https://www.businessinsider.com/colon-cancer-cases-doubled-young-people-2024-5">rise in colon cancer</a> among young people — a disease that can spread with no or minimal symptoms — <a target="_blank" href="https://www.businessinsider.com/get-colonoscopy-colon-cancer-symptoms-colorectal-oncologist-2024-4">early screenings</a> are on more people's minds.But Arturo Vargas Bustamante, an associate professor of health policy and management at the University of California, Los Angeles, said these kinds of rigorous tests can often do more harm than good."You may get a lot of things that you may not need based on your age profile, or you may get screenings that ultimately would find something that could lead to treatment that may harm you," he said. US guidelines on which demographics should get tested are based on scientific evidence, he added, while clinics abroad may be more motivated by profit.If a test finds cancer at a very early stage when it's very slow-moving, Vargas Bustamante said, the patient may feel compelled to treat it immediately, subjecting themself to chemotherapy and radiation. But in reality, it's possible they could have gone years without needing to start treatment. "Sometimes knowing too much may not be that good for you," he said.Others, however, think that America's lack of access to robust preventive screening is a critical failure.Dr. Misael Uribe Ramos is the director of international medicine at Médica Sur in Mexico City, a Joint Commission International-accredited hospital that offers checkups with eight different specialists for $1,600. Uribe Ramos has seen interest in rigorous physicals boom since the outbreak of the COVID-19 pandemic — and he thinks it's a good thing.Often when you go to the doctor, it's to treat a specific issue or disease, he said. "But why is that? Because you don't have prevention," he said. "Prevention is the best way to be healthy."In America, chronic illnesses such as heart disease, diabetes, and cancer are leading causes of death and disability, driving the majority of the US's $4.5 trillion in yearly healthcare expenses, <a target="_blank" href="https://www.cdc.gov/chronic-disease/about/index.html">according to</a> the Centers for Disease Control and Prevention. These illnesses are largely preventable. The CDC also says that between 30% and 50% of cancers diagnosed today could be prevented by reducing risk factors (like not smoking and maintaining a healthy body weight) and getting recommended screenings and vaccinations. However, according to the <a target="_blank" href="https://health.gov/news/202401/prevention-still-best-medicine">US Office of Disease Prevention and Health Promotion</a>, only 5.3% of Americans 35 and older received all recommended clinical prevention services in 2020 — a number that dropped from 8.5% in 2015. Why? Simply put, many Americans aren't regular healthcare users. They often don't have a family doctor, they live too far from one, they don't have a way to get there, or they simply can't afford it, the Office of Disease Prevention and Health Promotion says. Meanwhile, preventive-care services aren't prioritized because healthcare providers are paid to treat diseases — not to prevent them by keeping people healthy. A 2020 study said the National Academy of Medicine <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309216/">estimated</a> that missed prevention opportunities cost the US $55 billion annually.Other countries take a different approach. In Japan, for instance, the most basic annual checkups include EKGs, chest X-rays, blood tests, eye and hearing tests, and stool and urine tests. And some residents require a more comprehensive version that includes cancer screening. Japanese employers are required to provide them for all of their employees. In 2019, about 74% of men and 66% of women in Japan completed some type of medical checkup, according to the country's Ministry of Health, Labour and Welfare.South Korea's regimen is similar to Japan's. On a work trip there in 2010, Woodman had extensive testing done, including an MRI and CT scan, as part of a "wellness preventative program" he tried out for work, he said. He was offered an endoscopy and colonoscopy as part of the package but declined."Testing in the United States is really kind of pathetic," Woodman said. "They weigh you. They take your blood test. 'How tall are you?' And that's pretty much it."Americans seeking better preventive screening tend to visit South Korea, Thailand, and the United Arab Emirates, while Mexico, Barbados, and Thailand are popular for genetic and fertility testing, as well as testing related to gender-affirming care, medical-tourism advocates told BI.Many of these countries have hospitals that cater to foreigners. In Mexico, Médica Sur's checkups take about five hours, with screenings across disciplines such as internal medicine, cardiology, gynecology, and ophthalmology. (In the US, a typical physical takes less than an hour.) Packages include breakfast, transportation, accommodation, menus catering to dietary restrictions, discounted sightseeing for an extra cost, and concierge staff who help patients coordinate their stay and remain by their side for the duration. The hospital is also connected to a Holiday Inn if visitors want to stay on-site.Results are available within two weeks, at which point the patient can discuss the findings with a doctor in person or remotely; a checkup three months later is also included in the price. If, for example, the screenings indicate a malignant tumor, Uribe Ramos said, doctors will explain to a patient which follow-up tests they need, either in their home country or at Médica Sur. He recommends getting a thorough exam once a year.Since opening its international-medicine wing in 2019, the hospital has seen 5,000 foreign patients, most of them American and Canadian, Uribe Ramos said.Imani Bashir was living in Cancún three years ago when she felt what she thought was a lump in her breast. At the time she was 34 — <a target="_blank" href="https://www.cancer.org/cancer/screening/screening-recommendations-by-age.html#:~:text=Women%20ages%2040%20to%2044,should%20get%20mammograms%20every%20year.">young</a> to be receiving a mammogram — but her family had a history of the disease, so she booked an appointment anyway. In the US, the median <a target="_blank" href="https://ascopubs.org/doi/10.1200/JCO.2023.41.16_suppl.e18917">cost</a> of a mammogram ranges from $140 to $360 for women who aren't insured. In Mexico, it was under $50. As a Black woman who grew up in the US without health insurance, the 37-year-old communications director found the experience especially validating."When we go to the doctor and say that we're in pain, it's kind of just shooed away, like it's not a big deal," Bashir said. In Mexico, the medical center didn't question her. Now that she's living in Washington, DC, she continues to travel to Mexico for both her and her son's dental appointments and other medical issues because it's cheaper and easier to get appointments. "It always feels good when you feel like you can take care of yourself, and financially, it's not going to be a detriment to your life and your health," she says.Given how many people experience difficulty navigating the American healthcare system, it's no surprise that the medical-tourism market is growing rapidly. Patients Beyond Borders estimates the industry is growing between 15% and 25% each year. And 2022 <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9104082/#:~:text=The%20increase%20in%20medical%20tourism,other%20time%20in%20the%20past.">research</a> found that the increase in international tourism had helped fuel the trend. As <a target="_blank" href="https://www.businessinsider.com/travel-agents-back-gen-z-millennials-vacation-planning-overseas-resorts-2024-6">more people spend time abroad</a>, it becomes easier to tack a few small medical tests onto your trip.Vargas Bustamante thinks traveling internationally for rigorous testing probably most benefits healthy people who just want "peace of mind." Despite the risk factors, the industry's growing appeal illustrates the limitations of American healthcare."Why would someone have to buy a plane ticket to go all the way on the other side of the world just for an adequate amount of healthcare? It's nuts," Bashir said. "But if people have the privilege, if people have the money to be able to do so, then I say, yeah."<a target="_blank" class="" href="https://www.businessinsider.com/author/manisha-krishnan">Manisha Krishnan</a> is an Emmy award-winning journalist who covers healthcare. She is based in Brooklyn.

Mojitos and an MRI: Meet the Americans who are getting health screenings on vacation 

<ul class="summary-list"><li>The giant health insurers Cigna and Humana are reportedly considering a merger.</li><li>While they offer different kinds of health insurance, the deal is likely to face antitrust scrutiny.</li></ul>Cigna and Humana, two of the biggest, richest health insurers, are considering merging in a monster deal that would have seismic implications for US healthcare, Reuters, Bloomberg and The Wall Street Journal reported this week.But antitrust experts say such a merger would have a hard time standing up to the scrutiny of a Department of Justice that's arguably stronger than the one that <a target="_blank" href="https://money.cnn.com/2017/02/14/investing/aetna-humana/index.html">blocked</a> previous proposed insurance megamergers six years ago.A deal between Cigna and Humana would create a healthcare conglomerate worth about $140 billion, based on their combined market caps, and help it compete with the nation's largest healthcare company UnitedHealth Group, which has a market value of about $500 billion.Cigna, which boasted revenue north of $180 billion in 2022, primarily administers health plans for large employers. Combining with Humana, with annual revenue of about $93 billion, would give Cigna a powerful presence in Medicare Advantage, the lucrative, private health-plan market for people 65 and older.Combined, they serve about 37 million people in health-insurance plans. Both companies also own large pharmacy-benefit managers that administer prescription-drug plans.Equity analysts at BofA wrote in research notes that Cigna and Humana have little business overlap in insurance, and where they do, they may be able to divest some assets to alleviate antitrust concerns. Still, analysts at several investment firms warned the merger would throw together two large PBMs, which is bound to invite significant scrutiny.Antitrust experts said that even with divestitures the insurers would face an uphill battle convincing skeptical antitrust enforcers that their combination won't harm competition and consumers."The parties have an incredibly daunting task ahead of them. The agencies are much stronger enforcers than they were back in 2016. They are much more skeptical about some of the arguments that will be crucial to the merging parties, such as the role of efficiencies," said David Balto, a consumer advocate and the former policy director of the Federal Trade Commission.<h2>Giant insurers' past attempts to combine failed</h2>Reports that Cigna and Humana want to pursue a merger are somewhat surprising given previous attempts between giant health insurers went up in flames, leading in one case to a prolonged, expensive legal battle. Still, Cigna and Humana did <a target="_blank" href="https://www.modernhealthcare.com/article/20150811/NEWS/150819988/how-humana-hitched-with-aetna-and-drove-cigna-to-anthem">toy with a deal</a> way back in 2014 before they pursued deals with other partners.In mid-2015, Cigna and Anthem said they would pair up in a $54 billion deal, while Aetna and Humana sought a $37-billion tie-up. But federal judges blocked both proposed mergers in 2017 after they were challenged by the Justice Department for threatening to harm competition in various insurance markets.Cigna and Anthem sued each other for billions, each arguing that the other had sabotaged the deal. Years later, in 2020, a Delaware court <a target="_blank" href="https://www.modernhealthcare.com/insurance/anthem-cigna-cant-collect-billions-damages-over-failed-merger">ruled</a> that neither of the companies could recover any damages.Later, to sidestep antitrust scrutiny, health insurers eyed mergers with other pieces of the healthcare system outside of insurance. In 2018, Cigna combined with the pharmacy-benefit manager Express Scripts and pharmacy chain CVS Health bought Aetna.Humana, meanwhile, pushed deeper into providing care directly to patients by acquiring home-health company Kindred and building primary-care clinics for seniors.<h2>Cigna and Humana would face a more skeptical Justice Department</h2>Any deal between health insurers the size of Cigna and Humana would have to get past the Justice Department's antitrust enforcers. That's not going to be easy.Not only are health-insurance markets already heavily consolidated, but antitrust enforcers under the Biden Administration have <a target="_blank" href="https://www.statnews.com/2023/07/19/antitrust-scrutiny-health-care/">adopted a more aggressive stance</a> toward all types of healthcare mergers in the past year. The FTC has also dialed up scrutiny of PBMs, and though the Justice Department likely would review an insurance merger, the two agencies often work together.Balto said the Justice Department is "vastly more sensitive" to whether mergers will harm consumers and healthcare providers, whereas in the past it focused on a merger's impact on businesses such as employers.<a target="_blank" href="https://healthpolicy.duke.edu/people/barak-richman-phd">Barak Richman</a>, law professor at Duke University, said that traditionally, antitrust enforcers took a narrow view of harm, scrutinizing overlap between businesses in specific geographic markets. But he said there's now a greater appetite to challenge mergers based on "more expansive theories of harm.""These are two large health-insurance companies. They offer insurance products all over the country. They engage with providers all over the country. They both have PBMs and provide pharmaceutical benefits all over the country. The analysis has to have a more wide-angle lens."<a target="_blank" href="https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2015_nov_1845_dafny_impact_hlt_ins_industry_consolidation_ib.pdf">Research</a> has shown that when insurers merge, health-plan premiums increase.The insurers may argue that they have little overlap between their businesses. Already, Cigna is considering selling its small Medicare Advantage business, Reuters <a target="_blank" href="https://www.reuters.com/markets/deals/cigna-explores-shedding-medicare-advantage-business-sources-2023-11-06/#:~:text=NEW%20YORK%2C%20Nov%206%20(Reuters,people%20familiar%20with%20the%20matter.">reported</a> earlier this month. And Humana in February <a target="_blank" href="https://press.humana.com/news/news-details/2023/Humana-to-Exit-Employer-Group-Commercial-Medical-Products-Business/default.aspx#gsc.tab=0">said</a> it was getting out of the commercial-insurance business over the next 18 to 24 months.But Matthew Cantor, an antitrust expert and partner at the law firm Constantine Cannon, said divestitures aren't always a sure fix. He pointed to the failed merger attempt between Aetna and Humana, in which the court <a target="_blank" href="https://www.healthaffairs.org/content/forefront/court-blocks-aetna-humana-deal-mega-mergers-meet-trump-administration-next">determined</a> that Aetna's plan to sell Medicare Advantage plans to Molina wouldn't help replace competition."All of this comes down to not only are they going to divest, but who's going to buy it?" Cantor said. "Are they a vibrant competitor? Or is it going to be that someone's going to buy this and not know how to run it and it's going to be run to the ground, and at the end of the day you're going to be left with a more powerful Cigna. That's going to be the question."

Why a giant health insurer merger is probably destined to fail

<ul class="summary-list"><li>Donald Trump proposed mass deportation to lower housing costs and boost job opportunities.</li><li>Democrats argue deportations harm businesses, separate families, and displace millions.</li></ul>The <a target="_blank" class="" href="https://www.businessinsider.com/trump-deportation-immigration-policy-election-housing-home-prices-construction-costs-2024-10">mass deportation</a> of people living in the US illegally has been one of the cornerstones of the Republican presidential ticket leading up to the November election.In speeches, former president <a target="_blank" class="" href="https://www.businessinsider.com/housing-affordability-supply-impact-presidential-election-scenarios-homebuyers-harris-trump-2024-10">Donald Trump</a> has suggested that deportations could lower housing prices and give legal residents, especially Black and Hispanic Americans, more job opportunities. His supporters say allowing migrants to enter the country and live and work illegally places a long-term burden on the economy."We're going to have the largest deportation in the history of our country," Trump <a target="_blank" href="https://abcnews.go.com/Politics/trump-vows-mass-deportation-migrants-springfield-dismisses-threats/story?id=113661663">said in September</a> while taking reporter questions in Los Angeles. "And we're going to start with <a target="_blank" href="https://www.businessinsider.com/springfield-ohio-town-center-baseless-trump-pet-eating-claims-tensions-2024-9">Springfield</a> and <a target="_blank" href="https://www.denverpost.com/2024/09/13/aurora-tren-de-aragua-donald-trump-venezuela-immigration/">Aurora</a>," he added, referring to the Ohio and Colorado cities where debates around immigration have been particularly tense.Many Democrats say <a target="_blank" class="" href="https://www.businessinsider.com/trump-mass-deportation-immigraiton-plan-federal-reserve-inflation-2024-9">mass deportations</a> would hurt businesses and employment opportunities for all Americans, in addition to separating families and displacing millions of people. It's especially salient in the crucial southern border swing state of Arizona."We all remember what they did to tear families apart, and now they have pledged to carry out the largest deportation — a mass deportation — in American history," Vice President Kamala Harris said at a <a target="_blank" href="https://www.youtube.com/watch?v=AFCjE-73yUw">September conference</a>. "Imagine what that would look like and what that would be. How is that going to happen? Massive raids? Massive detention camps?"Current <a target="_blank" class="" href="https://www.businessinsider.com/texas-latinos-shifting-right-trump-harris-gop-democrats-starr-county-2024-10">immigration</a> policy already supports deporting large numbers of unauthorized residents. The Biden administration has deported over <a target="_blank" href="https://www.migrationpolicy.org/article/biden-deportation-record">1.1 million</a> people from 2021 to February 2024, and Vice President Kamala Harris has supported <a target="_blank" href="https://www.piie.com/blogs/realtime-economics/2024/trump-vs-harris-immigration-future-policy-proposals">higher standards</a> for asylum eligibility.Deportations would likely continue under Harris' administration, but Trump's proposals would be an order of magnitude greater and perhaps the most consequential outcome of his second term.A September <a target="_blank" href="https://www.pewresearch.org/politics/2024/09/09/issues-and-the-2024-election/">Pew Research Center poll</a> found that immigration is a key issue for more than half of Americans as they cast their ballots. To untangle the data and campaign rhetoric and understand the effects of mass deportation on the economy, Business Insider reviewed research and spoke with over a dozen experts, politicians, local advocacy organizations, and immigrants.<h2 id="460770c2-debc-4bb0-921f-c9c4040c1f7b">2 cities in Arizona show the crux of the economic debate</h2>Immigrants, both authorized and unauthorized, make up nearly 13% of Arizona's population, one of the highest in the country, the nonpartisan think tank <a target="_blank" href="https://www.migrationpolicy.org/data/state-profiles/state/demographics/AZ">Migration Policy Institute</a> estimates. Pew Research Center estimates <a target="_blank" class="" href="https://www.kjzz.org/kjzz-news/2024-07-30/report-undocumented-migrants-make-up-3-5-of-arizonas-population">as many as 250,000</a> Arizona residents could be deported under Trump's plan.Some of those deportees could be from Yuma, Arizona, a city near the <a target="_blank" class="" href="https://www.businessinsider.com/kamala-harris-arizona-mexico-border-security-immigration-trump-election-2024-9">US-Mexico border</a>. Its mayor, Douglas Nicholls, told BI that upticks in illegal immigration have strained the city's resources and infrastructure.Nicholls, a Republican, plans to vote for Trump and wants the next president to focus on more funding and staffing for the Immigration and Customs Enforcement agency. He said the US needs to prioritize immediate processing for those seeking asylum, improve technology along the border, and expedite removal processes."We're not equipped as a community to handle large amounts of people coming through without resources," Nicholls said. "We don't have a homeless shelter focused on migrants. Our homeless shelter is focused on pretty much residents, and it's pretty busy at that already."When it comes to mass deportations, he said the town's main industry, agriculture, wouldn't suffer too much because employers use legal paths to work authorization, like H-2A or green-card programs, to recruit labor. He said that migrants tend to pass through Yuma before moving on.Tucson's mayor, Regina Romero, said the story is different in Arizona's second-most populous city. She told BI that a mass deportation would devastate the agriculture, construction, and hospitality industries.Romero, a Democrat who endorsed Vice President Kamala Harris, said immigrants living in the country illegally "pay <a target="_blank" class="" href="https://www.businessinsider.com/rich-life-insurance-estate-taxes-ilit-2024-9">taxes</a> and have billions of dollars worth of spending power."Instead of deportation, Romero said she wants the federal government to add more judges and staff to shorten asylum-application wait times and invest more in infrastructure at ports of entry."For many decades, Tucson has known how to help immigrant refugee and asylum-seeking populations connect to whomever they need to connect to," Romero said. "We know how to do it."<h2 id="797f992d-38a7-4c54-a0ef-9b344070016b">The national economic impact of mass deportations</h2>Removing the <a target="_blank" href="https://cmsny.org/us-undocumented-population-increased-in-july-2023-warren-090624/#:~:text=The%20total%20undocumented%20population%20increased,to%2010%20million%20in%202020.">estimated</a> 11.7 million unauthorized immigrants from the US would reshape the labor market, cost an enormous amount, strain government services, and affect economic growth and inflation for a decade or more.<h3 id="91aa708f-8270-476a-97e4-7e553eda3734">Employment and the labor market</h3>The Trump campaign and its allies have argued that deportations could open more employment opportunities for Americans.Immigrants are "going to be attacking — and they already are — Black population jobs, the Hispanic population jobs, and they're attacking union jobs, too," Trump said at an October rally in Reading, Pennsylvania.Immigrants account for a third of workers in jobs paying under $30,000 a year, the conservative think tank American Compass <a target="_blank" href="https://americancompass.org/a-guide-to-labor-supply/">said</a>. Duncan Braid, its coalition director, told BI that competition from those immigrants hurts lower-income Americans. He said while mass deportations may cost the government a lot of money, its role is to protect the Constitution and its citizens."We currently have a situation where there is sort of an unlimited number of lower-skilled people coming into this country, and them competing directly with other low-skilled Americans already here would necessarily, just based on very basic theory, suppress their wages," Braid said.Recent research suggests the opposite. A <a target="_blank" href="https://www.nber.org/papers/w32389">working paper by economists</a> at the University of California, Davis, found that increases in immigration can boost native employment."We really don't see much evidence of substitution between unauthorized immigrants and US-born people at all," <a target="_blank" href="https://www.brookings.edu/people/chloe-east/">Chloe East</a>, a fellow at the Brookings Institution, said. "That's partly because the jobs that unauthorized immigrants are willing to take are lower-paying, are more dangerous, and are less desirable for other reasons."<h3 id="dd881018-1654-4a0f-89bc-4814c3eb733e">How much a mass deportation would cost the government</h3>The Trump campaign has talked little about how mass deportations could be implemented and on what scale. While in the White House, Trump carried out about <a target="_blank" class="" href="https://www.migrationpolicy.org/article/biden-deportation-record">1.5 million</a> deportations and made similar promises about mass deportation but was met with various legal challenges. At a campaign rally on October 11 in Aurora, Colorado, Trump pledged to use a 1798 law to deport suspected members of cartels and gangs.To carry out what he called "the largest domestic deportation operation in American history," Trump plans to bolster ICE raids by reassigning federal agents and recruiting from local police forces and says he'll order the construction of new detention camps for people waiting for their cases to be processed, <a target="_blank" href="https://www.nytimes.com/2023/11/11/us/politics/trump-2025-immigration-agenda.html">The New York Times reported</a>.That would be an expensive undertaking. Using Census Bureau data, the <a target="_blank" href="https://www.americanimmigrationcouncil.org/research/mass-deportation">American Immigration Council</a> estimated it would cost the federal government over $315 billion, including hiring up to 409,000 new government employees.In addition to labor market disruptions, economists also say the country would lose tax revenue. Unauthorized immigrants paid $96.7 billion in federal, state, and local taxes — about $8,889 per person — in 2022, the <a target="_blank" href="https://itep.org/undocumented-immigrants-taxes-2024/">Institute on Taxation and Economic Policy</a> said. In 2022, unauthorized immigrants paid about $704 million in state and local taxes in Arizona alone.Supporters of deportation argue that the loss of tax revenue would be offset by savings on reduced services for immigrants. A study from the conservative <a target="_blank" href="https://manhattan.institute/article/the-lifetime-fiscal-impact-of-immigrants">Manhattan Institute</a> estimated that while older and less-educated immigrants, on average, receive more in federal benefits than they pay in taxes, higher-educated young immigrants are taxed more than they get back over their lifetime.The Trump campaign has made a similar argument, saying that welfare programs, taxpayer-subsidized health insurance, transportation costs through FEMA, and education expenses for immigrants ultimately cost taxpayers billions of dollars."The real economic crisis is the $182 billion American tax dollars spent each year to cover the costs of 20 million illegal immigrants that have flooded our communities thanks to Kamala Harris' wide-open border policies," Taylor Rogers, an RNC spokesperson, said in a statement to Business Insider."President Trump's mass deportation of illegal immigrants will not only make our communities safer but will save Americans from footing the bill for years to come," Rogers added.<h3 id="636206ff-627e-4eb3-9f7e-3ba104a3e936">Economic growth and inflation</h3>Mass deportations could have consequences for economic growth as a whole. The Trump campaign hasn't addressed overall growth and inflation concerns but has said deportations would help reduce demand in the housing market.On a more macro scale, the <a target="_blank" href="https://www.piie.com/blogs/realtime-economics/2024/mass-deportations-would-harm-us-economy">Peterson Institute</a> for International Economics said gross domestic product could fall 1.2% below baseline by 2028 if 1.3 million people are deported, while inflation could climb 0.5 percentage points above current estimates by 2026. In a more extreme scenario where 8.4 million people are deported, GDP could fall by 7.4% and inflation could climb 3.5 percentage points above baseline by the end of the decade.The American Immigration Council has a similarly negative view of the economic impact. It estimated that the US could lose between 4.2% and 6.8% in GDP if about 11 million people are deported."It would be very easy for an average American to see the impact of this policy in their daily life," Marcus Noland, the executive vice president and director of studies at the Peterson Institute, said.

Arizona is the epicenter of the debate over how Trump's mass deportation plan would hit the economy

Gina Papini honestly isn't sure whether she got taken for a ride on <a target="_blank" href="https://www.businessinsider.com/personal-finance/should-i-get-pet-insurance">pet insurance</a>, but it's pretty clear she didn't get much bang for her buck.Papini and her husband decided to add coverage for their two dogs and their cat when it was offered in 2021 as a bundle with their home-insurance plan. It seemed like a simple way to protect their pets' health. But the whole endeavor wound up being a headache. The pets' <a target="_blank" href="https://www.businessinsider.com/personal-finance/what-is-an-insurance-premium-definition-cost">combined premiums</a> cost hundreds of dollars a month, she says, and the coverage proved far less comprehensive than they anticipated. The couple never really needed to use the insurance for their two younger animals, and for their older dog, Kato, the process was a mess. Whenever Kato wound up at the vet, usually with stomach issues, they'd pay the bill and then submit it to the insurance company, which would then balk at reimbursing them."We thought it would save us money in the long run if we got it, but then they would refute claims and say, 'Well, this could have been a preexisting condition,' and preexisting conditions aren't covered," Papini said. "You need extra vet paperwork to back up that it wasn't. And so then you just get to a point where you're jumping through so many hoops."Papini and her husband got tired of dealing with all the rigamarole and axed their insurance plan after a year. Despite paying thousands of dollars in premiums, they never saw a single reimbursement.<a target="_blank" href="https://www.businessinsider.com/half-owners-say-pets-equal-human-family-member-survey-2023-7">People love their pets</a>, and they're willing to do a lot for them, <a target="_blank" href="https://www.businessinsider.com/protect-finances-pets-likely-recession-2022-11">financially</a> and otherwise. The American Pet Products Association has estimated that Americans spent $147 billion on their animals in 2023, including $38 billion on their healthcare. This level of attachment has helped turn the pet insurance industry into a lucrative and rapidly expanding market. The North American Pet Health Insurance Association found that pet owners in the US paid $3.9 billion in premiums in 2023, a 22% increase from the year before. Some 6.25 million pets in the US were insured as of the end of 2023, per NAPHIA. That's still a small fraction of all the pets in the country, given that there are over 80 million pet dogs and 60 million pet cats, according to the American Veterinary Medical Association. But it's growing.As pet insurance becomes more prevalent, so too do the questions about it. While some people swear by it, others think it's a scam. One thing is for sure: As the industry grows, pet insurance is becoming as <a target="_blank" href="https://www.businessinsider.com/insurance-companies-get-you-to-pay-more-deny-claims-2023-10">confusing and messy</a> as health insurance is for humans. It's barely regulated, and deciphering what it does and doesn't encompass can be super confusing. Just like <a target="_blank" href="https://www.businessinsider.com/how-to-fight-rejected-insurance-claims-2013-11">regular health insurance</a>, coverage for pets often winds up being riddled with loopholes and fine print that allows insurers to deny claims, declining to pay for the very care that motivated consumers to buy the policy in the first place. Because consumers pay up front, they often don't realize they won't be reimbursed until it's too late. Pet insurance gets pricier over time, meaning many people can no longer afford to keep their coverage just when they might start to need it.In short, pet insurance isn't a grift — some people do end up using their benefits. But for many people, insuring their furry friends ends up being a money suck.Pet insurance isn't technically even health insurance; it falls in the property-and-casualty category. It's generally regulated pretty lightly by states. There are no broad federal regulations around it, and only a handful of states have laws and standards around it specifically. How it usually works is people pay a monthly premium, and after they've paid a vet bill, they submit it to the insurer to try to get their money back. Just as with human health insurance, there are also deductibles and copays and annual limits on how much the policy will pay out. There are three categories of pet insurance: accident only; accident and illness; and accident, illness, and wellness. Adding more coverage makes the policy more expensive. Accident and accident-illness policies cover costs only if something goes awry — Rover gets into a rough fight at the dog park or develops arthritis. Fancier, more-comprehensive policies also cover wellness visits and preventive care, like dental care and vaccines. No matter the policy you choose, insurance <a target="_blank" href="https://www.businessinsider.com/personal-finance/average-cost-pet-insurance">can get expensive fast</a>. Premiums generally go up each year as a pet gets older. And <a target="_blank" href="https://www.businessinsider.com/soaring-home-car-insurance-rates-hurting-americans-finances-us-economy-2023-11">as with many insurance products</a>, pet-insurance premiums across the board are on the rise because of inflation and the increasing cost of care."The big problem with pet insurance is it's just an expensive product," said Kevin Brasler, the executive editor of Consumers' Checkbook, a consumer watchdog group. "If you're going to be one of these plans, buy it when your pet's young, but just know your costs are likely going to skyrocket as time goes on."Even if a pet owner can find an affordable policy, they may have trouble deciphering what's covered. <a target="_blank" href="https://www.businessinsider.com/personal-finance/preexisting-conditions-in-dogs">Pet insurance almost never covers preexisting conditions</a>, and what <a target="_blank" href="https://www.businessinsider.com/what-counts-pre-existing-condition-bcra-trump-obamacare-2017-7">qualifies as preexisting</a> can be quite broad and hard to parse. (It's wild that <a target="_blank" href="https://www.businessinsider.com/obama-jimmy-kimmel-healthcare-preexisting-conditions-2017-5">we used to do this for people</a>, by the way.) If you get a policy for your puppy before it has a chance to develop any problems, it might be a good deal. But if you have a 10-year-old dog with diabetes, that's a different story. I got some quotes from the website Pawlicy Advisor for my fictional dog, a mixed breed named Dan. When I changed the inputs to make Dan a six-month-old in optimal health, the platform recommended a policy starting at $28 a month. When Dan was 10 and had some issues, the first policy it suggested was $125, and some plans were about $350.Michael San Filippo, a spokesperson for the American Veterinary Medical Association, said in an email that the group endorsed the "concept" of pet health insurance, which can help keep vet costs down and save animals' lives, but he acknowledged that when the rubber hits the road, it can get hard to figure out."It's important that pet owners understand the scope of what their pet insurance does and does not cover, so they're not caught off guard by unexpected payments," he said.Even getting good advice on which pet-insurance policy is right for you can be a challenge. There are endless listicles recommending various policies, as well as websites dedicated to comparing insurers. The sheer volume of information can be hard to parse. It's also difficult to differentiate what is genuine advice and what's paid for. Many comparison tools get <a target="_blank" href="https://www.businessinsider.com/how-to-earn-six-figures-with-affiliate-marketing-websites-2023-5">commissions for sales</a> made through their platforms, so what they're recommending may not actually be the best option — it's just the one <a target="_blank" href="https://www.businessinsider.com/youtube-creators-discuss-new-affiliate-program-rates-features-2024-3">they'll make money off of</a>. (This is <a target="_blank" href="https://www.businessinsider.com/the-affiliate-marketing-report-how-mainstream-publishers-are-turning-performance-based-marketing-into-a-fine-art-2015-11">true for all sorts of platforms</a> that compare and recommend financial products, from credit cards to travel insurance.) The spread of these lists also points to another problem with the industry: the corporatization of pet insurance. Doug Kenney, a retired veterinarian who writes about the pet-insurance industry, said in an email that a decade ago, most pet-insurance companies were considered small businesses and were led by a founder/CEO with a vision for the company. Over time, these companies took on larger corporate structures, and some founders were pushed out by their boards. Nowadays, there are many large pet-insurance companies, some of which specialize only in pets, others of which are larger insurers that offer pet insurance, and many of which are publicly traded, meaning they ultimately answer to shareholders."This new structure has been a detriment to the industry with profit as the primary motive versus what is in the best interest of the consumer," Kenney said. "I used to say that pet insurance was a win, win, win proposition with the insurance company, veterinarians, and the policyholders and their pets all benefiting. I don't think that's the case anymore."Reporting this story, I fully expected to come down on one side or the other on whether pet insurance is good or bad. But I really didn't come up with an answer. I heard about a wide array of experiences with pet insurance, from awesome to mediocre to awful. One woman saved $4,000 on vet bills thanks to her insurance after her cat ate a pom-pom toy and the doctor had to fish it out. One man looked into getting coverage for his two cats after learning that both had extra teeth, but the minute they were documented, those overcrowded mouths became a preexisting condition. Another woman adopted a dog from Mexico with a "pretty wonky leg" that's "very noticeable." At her first vet appointment with the animal, the doctor told her to apply for pet insurance. She said she wouldn't note the leg on the dog's chart so the application would be approved — everyone agreeing to do a <a target="_blank" href="https://www.businessinsider.com/insurance-fraud-artificial-intelligence-detection-2023-10">light amount of insurance fraud</a>. In a purely financial or economic sense, pet insurance seems pretty worthless for many consumers. There are too many exceptions, too many hoops to jump through, and little regulatory recourse if you think you got taken for a ride. Unless something goes really awry, people pay more into their policies than they get out of them. Brasler was pretty blunt in his assessment of the overall product."You really need to think carefully about 'What kind of pet owner am I?' No judgments," he said. "This is a really expensive product. It's not likely to save you money down the road, and if it does, you're an outlier."Ultimately, a lot of the value of this sort of insurance is emotional. It's possible to do some back-of-the-envelope calculations to figure out the lifetime cost of a policy, but the personal side of the equation is considering how much you're willing to spend on your furry friend. Maybe you feel like spending $10,000 over the course of your pet's life on insurance is worth it for the peace of mind. Or maybe you forgo insurance, figuring that if your companion has a serious health problem, you'll make the decision then to spend the money on them — or not. (Again, no judgments!)As for Papini, she's not getting back on the pet-insurance train. It was just too hard to deal with, and her husband is still cranky about the ordeal. She knows they're fortunate to be able to pay out of pocket for their animals' needs, which remain expensive. Kato now has cancer, and the treatments cost thousands of dollars. Would the insurance be worth it now? It's hard to know."Who's to say they wouldn't have been like, 'Well, he had diarrhea in 2017, so therefore it's a preexisting condition,'" she said. "Then we would've spent thousands of dollars for the insurance, never been able to use it, and still had to pay out of pocket on top of it."<a target="_blank" href="https://www.businessinsider.com/author/emily-stewart">Emily Stewart</a> is a senior correspondent at Business Insider, writing about business and the economy.

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