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<ul class="summary-list"><li>While many tech VCs are optimistic about Trump's second term, some healthcare investors feel stuck.</li><li>They're torn between the promise of long-awaited exits and potential threats to healthcare access.</li></ul>Some healthcare-focused VCs are torn about what Donald Trump's presidential win could mean for their portfolios.Six healthcare investors expressed mixed feelings about Trump's win — largely rooted in a tension they feel between the potential for big deals to come back and policies that fear could restrict healthcare access to many patients.Trump could make sweeping changes to healthcare policy in his return to the presidency. He's said he'll let Robert F. Kennedy Jr. "go wild" on health initiatives in the new administration, which could see the former presidential candidate making good on his desires to <a target="_blank" href="https://x.com/RobertKennedyJr/status/1852812012478398923">ban fluoride from public water systems</a>, "<a target="_blank" href="https://x.com/RobertKennedyJr/status/1852872924170010840">get toxins out of our food</a>," and <a target="_blank" href="https://www.forbes.com/sites/conormurray/2024/11/06/heres-what-an-rfk-jr-health-role-in-a-trump-administration-could-look-like-vaccine-skepticism-fluoride-ban/">inject vaccine skepticism into federal decisionmaking</a>, among other initiatives.While Trump is unlikely to <a target="_blank" href="https://www.cnn.com/2024/10/31/politics/aca-trump-repeal-affordable-care-act/index.html">try again</a> to repeal the Affordable Care Act, he may seek to boost Medicare Advantage plans, cut Medicaid spending, and <a target="_blank" href="https://spectrumnews1.com/wi/madison/news/2024/11/07/trump-rfk-fda-cdc-vaccines-fluoride">reorganize federal agencies,</a> from the Food and Drug Administration to the Centers for Disease Control and Prevention, according to an interview Kennedy Jr. gave from Trump's Florida estate shortly after the election.After a <a target="_blank" class="" href="https://www.businessinsider.com/more-healthcare-ipos-coming-what-startups-should-know-barclays-banker-2024-10">three-year IPO desert</a> for digital health startups, healthcare investors are desperate for the exit opportunities that a second Trump presidency could usher in. But some of Trump's proposed health policy moves are making investors nervous about their potential impacts on startups building in care areas like women's health and Medicaid, as well as on doctors and patients.Compared to Trump's first term, "I think you're going to see a more systemic overhaul of the infrastructure that administers our healthcare system, and that could happen relatively quickly," said Michael Greeley, cofounder and managing partner of Flare Capital Partners. "It's the unknown of those moves that makes it really hard to make a long-term investment decision."<div type="image" title="RFK Jr. speaks at a Trump rally as Trump watches." height="683" width="1024" msid="115114971" hostid="261" sizebytes="60192"></div><h2 id="cadda1d2-41e5-4dcc-8fbd-97541af9ac1a">Healthcare exits on the horizon</h2>In the three years since 2021's healthcare funding boom — during which <a target="_blank" class="" href="https://rockhealth.com/insights/2021-year-end-digital-health-funding-seismic-shifts-beneath-the-surface/#:~:text=And%20while%20some%20of%20the,peak%20of%20eight%20in%202020.">21</a> healthcare startups went public — <a target="_blank" href="https://www.businessinsider.com/exclusive-omada-health-confidentially-filed-s1-ipo-public-2024-10">only four</a> digital health startups have gone public in total, with mixed success.A number of healthtech startups have been waiting on the sidelines for their chance to IPO — and Trump's election should boost their odds, healthcare investors told BI.The lower corporate taxes and deregulation a second Trump term could promise are already amplifying public market optimism. A number of tech and finance giants, from Tesla to JP Morgan Chase, saw their stocks soar Wednesday morning. By midday Friday, the S&amp;P 500 index had risen 3.6% from Tuesday's close.Some startups, including physical therapy startup <a target="_blank" href="https://www.businessinsider.com/hinge-health-s-1-morgan-stanley-ipo-2024-9">Hinge Health </a>and diabetes startup <a target="_blank" href="https://www.businessinsider.com/exclusive-omada-health-confidentially-filed-s1-ipo-public-2024-10">Omada Health, have already signaled their intentions to IPO when the digital health markets reopen.</a>Several other late-stage startups are moving towards the exits, too. <a target="_blank" href="https://www.businessinsider.com/mavens-cfo-out-as-womens-health-startup-gets-fresh-funding-2024-10">Maven replaced its chief financial officer</a> in October with an executive with public market experience, BI reported. Sword Health has said it's planning to IPO <a target="_blank" href="https://www.axios.com/pro/health-tech-deals/2024/06/04/sword-healths-road-to-ipo">as soon as the second half of 2025</a>.<div type="image" title="Sean Duffy Omada" height="1880" width="2507" msid="115114964" hostid="261" sizebytes="278880"></div>The healthcare M&amp;A market looks ripe for more activity. Big deals could be on the horizon, including the proposed mega-merger of health insurance rivals Cigna and Humana. Bloomberg reported in October that the insurers had <a target="_blank" href="https://www.bloomberg.com/news/articles/2024-10-18/cigna-resumes-merger-discussions-with-humana-after-talks-ended-last-year">resumed talks of combining</a> after previously shelving the deal last December.The Cigna-Humana merger was expected to face significant antitrust scrutiny from the Federal Trade Commission, <a target="_blank" class="" href="https://www.businessinsider.com/openness-in-ai-is-necessary-ftc-lina-khan-2024-7">led by Lina Khan</a> since 2021. She could be removed as the FTC's head early in Trump's second term — and with relaxed M&amp;A regulations, "anything is possible," said What If Ventures founder Stephen Hays.Investors said they also expect to see <a target="_blank" href="https://www.businessinsider.com/big-deals-coming-healthcare-startups-take-privates-private-equity-2024">increased private equity involvement in healthcare</a> through more investments and acquisitions. Healthcare VC has been calling for consolidation in overcrowded areas of healthcare <a target="_blank" href="https://www.businessinsider.com/13-mental-health-startups-ipo-acquisition-merge-buyout-2024-5">like behavioral health</a> for years. Additional interest rate cuts could help facilitate PE-backed mergers, or even rollups of multiple solutions, in the many fragmented areas of digital health and healthcare services, said a Boston-based healthcare investor.<div type="image" title="Cigna insurance" height="2672" width="3563" msid="115114973" hostid="261" sizebytes="1378900"></div><h2 id="8fd35f3b-b1b9-4ac8-ab08-0143afe9541f">Reverberations in women's health and Medicaid</h2>While healthcare investors remain optimistic about what a second Trump term could mean for late-stage startups, VCs said his win could have consequences for key areas of the industry.Reproductive rights remained a top concern throughout the election cycle. Founders of women's health companies and their investors previously expressed concerns to Business Insider about <a target="_blank" href="https://www.businessinsider.com/womens-health-startups-risk-trump-wins-election-2024-10">what a second Trump term could mean for their businesses</a>.While Trump has said he wouldn't sign off on a national abortion ban, experts have <a target="_blank" href="https://www.cnbc.com/2024/11/07/how-trumps-victory-could-change-abortion-rights-in-america.html">raised worries</a> that the president-elect could impose more restrictions on birth control access and abortion pills delivered by mail. Demand for abortion pills, emergency contraception, and related treatments <a target="_blank" href="https://www.theguardian.com/us-news/2024/nov/07/abortion-pills-hormones-trump">exploded on Wednesday</a> as patients rushed to stockpile the drugs in fear of potential restrictions.In the wake of the election, women's health investors are dismayed but hopeful that the sector will largely remain untouched by federal policy changes and that VCs will be able to use their capital to push care forward even in the face of policy threats."In our conversations with others, there is a shared resoluteness to continue to pledge investment and develop innovation in historically underfunded categories (e.g. contraception &amp; abortion access, menstruation &amp; hormonal health, maternal health &amp; fertility, menopause &amp; aging)," said Carli Sapir, the founding partner of Amboy Street Ventures, in an email to Business Insider. "Every dollar and ounce of effort toward these areas now speaks volumes for future impact."<div type="image" title="an abortion rights protest sign reading &quot;stars, stripes and reproductive rights&quot;" height="683" width="911" msid="115114963" hostid="261" sizebytes="45906"></div>Medicaid could also be targeted in Trump's second term. Experts think Trump could <a target="_blank" href="https://www.nbcnews.com/health/health-news/millions-risk-losing-health-insurance-trumps-victory-rcna179146">cut Medicaid funding</a> and enable states to refuse to expand their Medicaid coverage. Those changes could impact dozens of <a target="_blank" href="https://rockhealth.com/insights/unwinding-the-opportunity-medicaids-digital-health-moment/">startups innovating in Medicaid</a>, as well as the millions of patients covered under Medicaid plans, said Jordan Nof, a cofounder and managing partner at Tusk Venture Partners.And if the House of Representatives goes red along with the Senate, experts expect the subsidies that help people pay for health insurance under the Affordable Care Act <a target="_blank" href="https://www.nbcnews.com/health/health-news/millions-risk-losing-health-insurance-trumps-victory-rcna179146">to disappear after they expire at the end of 2025</a>. Without those subsidies, tens of millions of people will see their premiums significantly increase, potentially making coverage prohibitively expensive for many.If fewer patients can afford to be insured, the healthcare system is certain to see <a target="_blank" href="https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/#:~:text=Because%20people%20without%20health%20coverage,declines%20in%20their%20overall%20health.">rising spend</a> associated with increased hospitalizations from otherwise avoidable health problems — a consequence with far-reaching implications across healthcare and the companies building in the sector.<h2 id="f1af4c00-342b-4f1b-b392-ccfc3d9c72fa">A boon for healthcare AI and Medicare Advantage</h2>Trump's victory could have a positive impact on several big areas of healthcare investment.For one, Trump is expected to restrict the government's involvement in AI regulation. That means AI companies, <a target="_blank" href="https://www.businessinsider.com/22-most-promising-healthcare-ai-startups-2024-8">including healthcare AI companies, will keep soaring</a> with fewer guardrails.Without federal AI safety efforts, the healthcare industry will likely move to self-regulate new technologies, especially in more contentious areas like clinical decision support, Flare Capital Partners' Greeley said. Some of those efforts are already underway, including by groups like the <a target="_blank" href="https://www.politico.com/newsletters/future-pulse/2024/10/18/ai-self-regulation-comes-into-view-00184268">Coalition for Health AI</a>, which includes top academic medical centers like Mayo Clinic and Johns Hopkins Speaker alongside tech companies like Microsoft.Still, "there'll be temptations around the margins to more rapidly deploy technologies that aren't yet determined to be safe," Greeley said.<div type="image" title="Dr. Shiv Rao, CEO of Abridge" height="2268" width="3024" msid="115114962" hostid="261" sizebytes="233874"></div>Medicare Advantage plans are also expected to be boosted by a returning Trump administration that's likely to move to further incentivize commercial health insurance. That could be good for the few <a target="_blank" href="https://www.businessinsider.com/alignment-healthcare-devoted-health-startups-medicare-advantage-membership-market-2024-2">young insurers clamoring for market share in Medicare Advantage</a>, like Devoted Health and Alignment Healthcare, and the many startups working to <a target="_blank" href="https://www.businessinsider.com/exclusive-ai-cohere-health-raises-50-million-series-b-extension-2024-1">improve payment processes</a> between insurers and providers. (An increased share of Medicare Advantage plans in the Medicare market might not be good for patients, however, since Medicare Advantage plans <a target="_blank" href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815743">deny claims more frequently</a> than traditional Medicare.)And while Robert F. Kennedy Jr's potential appointment to a key health role in the Trump administration <a target="_blank" href="https://www.pbs.org/newshour/show/health-officials-concerned-about-rfk-jr-s-influence-in-trump-administration">worries some healthcare experts</a>, his focus on "food as medicine" could yield some interesting federal projects and perhaps add momentum to the <a target="_blank" href="https://rockhealth.com/insights/an-apple-a-day-but-keep-the-doctor-in-play-a-primer-on-food-as-medicine-trends-solutions-and-business-models/">nutrition startups gaining traction</a>, said Chrissy Farr, a managing director at Manatt, Phelps and Phillips, and a general partner at Scrub Capital."He's been given carte blanche, apparently, to take this on. Coupled with GLP-1s, I could see America really doing something interesting around food in the next couple of years," Farr said.

Healthcare investors are torn on Trump's second term

Artificial intelligence has its hands in nearly every industry, from chatbots to healthcare, and one of the AI world's favorite new tools is <keyword id="20280828" type="General" weightage="20" keywordseo="whisper" source="keywords">Whisper</keyword>, a transcription program developed by <keyword id="19918823" type="General" weightage="20" keywordseo="OpenAI" source="keywords" meta.keywordsubtype="org" meta.entityname="OpenAI" meta.hostid="261" meta.entityid="OpenAI">OpenAI</keyword>. Whisper’s main selling point is that it supposedly delivers near “human-level robustness and accuracy,” as the company claims. But there’s a major catch — Whisper has a habit of “hallucinating.” If you’re picturing an AI tool hallucinating psychedelic visuals, it’s not quite like that. Hallucinations in AI transcriptions mean the tool has a tendency to make up words, phrases, and even entire sentences. Whisper has been known to slip in racial commentary, violent ideas, or medical jargon that no one actually said. And when used in sensitive settings like hospitals, these “creative” additions can be more than an oddity — they could be downright dangerous. <h2>The hospital risk factor</h2>Several developers and researchers have found these hallucinations are worryingly frequent. In hospitals, transcription software like Whisper is being trialed to record patient-doctor conversations. It seems like a great idea — automated transcriptions could give healthcare professionals more time to focus on patients instead of endless paperwork. But as Allison Koenecke, a professor at Cornell, points out, nearly 40% of these hallucinations could lead to misinterpretations. And, as Alondra Nelson, former director at the White House Office of Science and Technology Policy, said, “Nobody wants a misdiagnosis. There should be a higher bar.” In <keyword id="23715899" type="General" weightage="20" keywordseo="medical-transcriptions" source="keywords">medical transcriptions</keyword>, even one mistaken word can be serious. One version of Whisper, for example, took the phrase, “He, the boy, was going to, I’m not sure exactly, take the umbrella,” and turned it into something alarming: “He took a big piece of a cross, a teeny, small piece… I’m sure he didn’t have a terror knife so he killed a number of people.” Disturbing additions like these could leave hospital staff baffled or, worse, could result in patient notes that entirely misrepresent a consultation. <div type="Article" hostid="261" msid="111165894" title="Scientists find speech-to-text AI randomly adding violent language such as &amp;quot;terror,&amp;quot; &amp;quot;knife&amp;quot; and &amp;quot;killed&amp;quot; to audio transcription" mstype="2" mssubtype="0"></div>Researchers have analysed thousands of audio samples and found that hallucinations often appear in well-recorded clips, not just in low-quality recordings or when there’s lots of background noise. For instance, when someone said, “After she got the telephone, he began to pray,” Whisper turned it into “I feel like I’m going to fall, I feel like I’m going to fall…” In other cases, it has fabricated nonexistent medications, like “hyperactivated antibiotics,” or injected racial commentary where none existed. Hospitals aren’t the only ones using Whisper — its transcriptions are popping up in call centers, video captions, and consumer voice assistants. In each case, hallucinations could lead to confusion and miscommunication, particularly for those who rely on accuracy, such as the Deaf and hard of hearing community. Whisper can bury made-up text in long transcriptions, meaning someone reviewing the text may struggle to spot which parts are hallucinated, experts warn. <h2>Legal and ethical backlash</h2>With hospitals and health centers pushing forward with Whisper tools, former OpenAI engineer William Saunders believes OpenAI should address this flaw urgently. He points out, “It’s problematic if you put this out there and people are overconfident about what it can do and integrate it into all these other systems.” As usage grows, so do privacy concerns. California State Assembly member Rebecca Bauer-Kahan, who recently refused to allow a health provider to share her child’s medical recordings with OpenAI’s biggest investor, Microsoft Azure, expressed frustration about tech companies handling sensitive data. "The release was very specific that for-profit companies would have the right to have this,” Bauer-Kahan said. “I was like, ‘absolutely not.’” <div type="Article" hostid="261" msid="114683256" title="&amp;quot;Jarvis, you there?&amp;quot;: Google&amp;#39;s new AI agent might take over your web browser and carry out tasks on your behalf" mstype="2" mssubtype="0"></div>Despite the troubling feedback, OpenAI has been receptive to researchers’ findings. The company is working to address the hallucination issue, but they’ve also issued a warning: Whisper should not be used in “high-risk domains.” Yet, companies like Nabla, which offers Whisper-based tools to transcribe medical appointments, continue to integrate it. Nabla’s approach erases the original audio for “data safety reasons,” meaning hospitals may have no way to verify transcripts. Whisper’s hallucinations are a stark reminder that <keyword id="21222445" type="General" weightage="20" keywordseo="AI-in-healthcare" source="keywords">AI in healthcare</keyword> isn’t foolproof. The conversation about AI transcription flaws is picking up steam, with experts pushing for regulations and OpenAI encouraged to prioritise fixes. While AI is undeniably changing industries, sometimes its creative input needs a reality check — especially in life-and-death fields like medicine.

OpenAI's tools are making up stuff in hospital transcriptions; can be dangerous for patients, experts warn

<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

<ul class="summary-list"><li>I've lived in Canada for over a decade, and though it's not perfect, I prefer it to the US.</li><li>I've had major surgery and dealt with long COVID for years and haven't paid a cent for healthcare.</li></ul>When my partner was offered a job in <a target="_blank" class="" href="https://www.businessinsider.com/why-toronto-best-city-quick-trip-things-to-do-skip-2024-10">Toronto</a> 13 years ago, we felt like we'd won the lottery.We were living in the Midwest, where people stared at us as if they'd never seen a multiracial couple before and <a target="_blank" href="https://www.businessinsider.com/cosmopolitan-jessica-pels-career-advice-how-to-get-dream-job-2020-4">Cosmopolitan magazine</a> was covered with black plastic in the supermarket because it was too racy.We'd long wanted to live somewhere more diverse and walkable, with less violence. Settling in downtown Toronto — where we could walk or take <a target="_blank" class="" href="https://www.businessinsider.com/canada-via-rail-vs-amtrak-business-class-review-photos-2022-8">public transportation</a> and over half of the population was born outside Canada — was like being in a smaller, cleaner version of New York City.Add on the promise of Canadian healthcare, and we were close to nirvana.After living for more than a decade in Canada, we've come to realize that the <a target="_blank" class="" href="https://www.businessinsider.com/moving-to-canada-from-us-pros-cons-heathcare-home-prices">country is far from perfect</a>. But there are many factors that make it unimaginable for me to live in the US again.<h2 id="a284571f-bca4-4fba-a6f4-d7f8b2efefe7">Canada's healthcare system isn't perfect, but I prefer it to the US's</h2>Canadian healthcare has its downsides.While the majority of care is free, people typically have to pay out of pocket for prescriptions, <a target="_blank" class="" href="https://www.businessinsider.com/why-americans-dont-exercise-mental-health-crisis-depression-anxiety-fitness-2024-6">mental-health</a> care, and dental and vision care, which can make these services inaccessible to many.Despite that, I can't envision living without <a target="_blank" class="" href="https://www.businessinsider.com/dr-adam-kay-americas-been-gaslit-about-socialized-medicine-2019-12">socialized medicine</a> again. I had a complicated pregnancy and an emergency C-section and I developed long COVID four years ago, but I've never paid a cent for healthcare here.When I lived in the US, I worked in public health in California, helping uninsured families access care. I saw firsthand <a target="_blank" class="" href="https://www.businessinsider.com/how-get-medical-bills-reduced-negotiate-challenge-payment-plan-2024-9">how medical debt could ruin people</a>.There was also a brief time when I was in my 20s, before the Affordable Care Act, when I <a target="_blank" class="" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">lived without health insurance</a> in California and was terrified of getting injured and ending up with a huge hospital bill.<h2 id="82b9efcc-e263-4015-b997-fc1d979a471a">Traveling in Canada can be more expensive, but we've found ways to manage</h2><div type="image" title="landscape of Canada's Laurentian Mountains" height="3840" width="5760" msid="115259769" hostid="261" sizebytes="1759662"></div>Because of <a target="_blank" href="https://nationalpost.com/news/canada/airlines-fees-canada">federal regulations</a>, domestic flights in Canada are often more expensive than flights to the US. However, we've found ways to manage by coordinating work trips and visiting friends.<a target="_blank" class="" href="https://www.businessinsider.com/beautiful-natural-wonders-2018-7">Canada's nature</a> is one of our favorite aspects of living here. We've vacationed across the country, but we have a special fondness for Québec's Laurentian Mountains and the forests of Ontario.We also spent months in the Yukon subarctic, where we glimpsed a grizzly bear, lynx, moose, scores of ravens, and wilderness more pristine than I thought possible.<h2 id="001263da-7c4c-4498-aabe-c1e9c7dbf46c">We love the diversity in Toronto, but we have experienced racism</h2>My husband and I found friends through community groups and parent-and-baby classes with other immigrant parents. Our friends are from all over, including Nigeria, Russia, Pakistan, Mexico, China, and Peru.Living in such a global environment is simply second nature for our Canadian-born child, who became trilingual in kindergarten in a public French school.However, immigrants and people of color aren't always treated kindly, despite Canada having had an official <a target="_blank" href="http://pier21.ca/research/immigration-history/canadian-multiculturalism-policy-1971">multiculturalism policy</a> since 1971.My Afro-Latino partner often laments the racism he's experienced in Canada, which has been more directly harmful to him than the racism he experienced in the United States.For example, he sold his bike after nearly being hit by drivers so many times, including one who told him to get off the road before calling him the N-word.When he does porch drop-offs of kids' items I've sold on Marketplace, he gets followed and questioned by people who act like he's a thief.And when we renewed his employer-sponsored work permit at the border a decade ago, an immigration official grilled him and said, "Couldn't they find a Canadian for the job?"In part because of those experiences, my husband has felt compelled to connect even more with different BIPOC communities in Canada.After we moved here, he found out about his Indigenous Caribbean ancestry through genetic testing, and it has become an extremely important part of our experience as a family to educate ourselves about Indigenous people's histories, lives, and teachings. We see it as one of our responsibilities as settlers.<h2 id="859b0674-9e41-4b48-abbc-f3eccee0cca8">I prefer living in Canada to the United States</h2><div type="image" title="Canadian flag with Toronto skyline in the background" height="3744" width="5616" msid="115259767" hostid="261" sizebytes="940328"></div>The longer I live here, the less I feel like I belong when I travel back to the US.My family inhabits multiple marginalized identities — queer, <a target="_blank" href="https://economichardship.org/2023/04/the-disabled-tax-means-i-pay-extra-for-necessities-constantly/">disabled</a>, immigrant, and BIPOC — that are under attack in the US. The ability to live and thrive outside the US, with free healthcare to boot, has long made me feel survivor's guilt for enjoying that stability.There are trade-offs to Canadian life: <a target="_blank" class="" href="https://www.businessinsider.com/canada-housing-crisis-bubble-imploding-real-estate-prices-rent-decline-2023-11">Astronomical housing costs</a> caused by foreign investment and government policy make me worry that when my child is an adult, they won't be able to afford rent, much less buy a home.I'm also disabled and cannot work full time. If I'm ever without my partner's financial support, I wouldn't qualify for or be able to live on my province's <a target="_blank" href="https://www.tvo.org/article/people-cant-live-on-dirt-disabled-ontarians-push-for-odsp-reform">paltry disability benefits</a>.In the end, it's a balancing act.I will forever follow events in American society and politics, even when I someday become a Canadian citizen. But for my family's safety and health, there's no going back.

My husband and I moved from the US to Canada 13 years ago. We love the free healthcare here and the great friends we made.

<ul class="summary-list"><li>A new report shows what jobs are typically held by asset-limited, income-constrained, but employed Americans.</li><li>Nearly a quarter of US nonprofit workers live just above the federal poverty line.</li></ul>Many of America's <a target="_blank" href="https://www.businessinsider.com/tiktok-calling-out-non-profit-low-pay-exploitation-2022-8">nonprofit employees</a> fill gaps in the <a target="_blank" href="https://www.businessinsider.com/gen-z-capitalism-socialism-economy-jobs-social-security-unemployment-2024-2">social safety net</a>, helping people <a target="_blank" href="https://www.businessinsider.com/half-of-nyc-residents-cant-afford-housing-food-healthcare-report-2023-4">access housing</a>, food, and <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">healthcare</a> where government programs fail.But a chunk of these workers are <a target="_blank" href="https://www.businessinsider.com/middle-class-americans-earning-above-poverty-live-paycheck-to-paycheck-2024-4">barely getting by themselves</a>. A report published in September by the policy and research firm United for ALICE found that 3 million US nonprofit employees — nearly a quarter of the total nonprofit workforce — are living just above the federal poverty line. The report examined Americans who have identified as nonprofit workers on the Census' American Community Survey, including many employees in healthcare, educational services, and social assistance.The <a target="_blank" href="https://www.businessinsider.com/meet-the-typical-alice-middle-class-poverty-housing-food-benefits-2024-4">ALICE demographic</a> is people who are asset-limited, income-constrained, and employed. The ALICE threshold varies based on local cost of living and household size. If an individual lives above the federal poverty line but can't afford survival necessities — like housing, food, and healthcare — where they live, they are considered ALICE. This might be $702 a month for a parent and school-age child in El Paso, Texas, or $2,158 a month for a parent and school-age child in Alexandria, Virginia.The cohort's financial experience is <a target="_blank" href="https://www.businessinsider.com/alice-living-paycheck-to-paycheck-without-government-assistance-snap-medicaid-2024-5">marked by a catch-22</a> — their household income is often too high to get help but too low to comfortably afford daily life.Lisa Kelley, for example, lives paycheck to paycheck in Cincinnati. Often, the 47-year-old feels like she's "doing everything right" and is still <a target="_blank" class="" href="https://www.businessinsider.com/government-assistance-food-stamps-snap-doesnt-help-low-income-dinks-2024-5">unable to access</a> the assistance she needs."There's no help," she <a target="_blank" class="" href="https://www.businessinsider.com/rent-healthcare-plasma-gen-x-government-assistance-2024-5">previously told BI</a>. "If you make too much, there's no help; if you are healthy, there's no help; if you don't have kids, there's no help."<h2 id="1051b53b-ec29-4b34-a6e5-059d162766d3">Nonprofit workers provide help, but they're also struggling</h2>About 13% of Americans live at or below the federal poverty threshold, meaning their annual household income is below $15,060 for one person or $31,200 for a family of four. Access to many assistance programs, like SNAP, Medicaid, and housing vouchers, is based on this measure, which <a target="_blank" href="https://www.businessinsider.com/poverty-line-leaves-behind-low-income-americans-snap-medicare-wic-2024-6">largely hasn't been updated</a> since the 1960s. This measure was calculated when Americans spent about a third of their paycheck on food, whereas Americans now spend only 13% of their income on groceries.<a target="_blank" href="https://www.businessinsider.com/alice-living-paycheck-to-paycheck-without-government-assistance-snap-medicaid-2024-5">ALICEs</a>, however, make up another 29% of Americans who <a target="_blank" href="https://www.businessinsider.com/retirement-savings-social-security-baby-boomers-without-savings-401k-poverty-2024-8">feel like they are living in poverty</a> but are out of reach of these resources because their paychecks are slightly too high. This leaves some choosing between putting food on the table, paying bills, or going to necessary doctor's visits. It's led some to take extra part-time jobs or rely on gig work — especially if they live in a <a target="_blank" href="https://www.businessinsider.com/how-much-food-healthcare-housing-cost-most-expensive-us-cities-2024-2">high-cost-of-living area</a>."We need help, especially those of us that are trying to go to work every day," Cherie Tobias, a 48-year-old Applebees server in Michigan who lives on $25,000 a year, <a target="_blank" href="https://www.businessinsider.com/middle-class-americans-earning-above-poverty-struggles-afford-food-medicine-2024-4">previously told BI</a>. "No matter how we feel, no matter how much pain we're in, we're going to try to push through to provide — but we go home defeated."Younger nonprofit workers are particularly struggling. According to the report, 37% of nonprofit workers under the age of 25 fall into the ALICE category. This follows larger ALICE trends, which show that workers under 25 are one of the main cohorts living out of reach of most assistance programs. Similarly, 23% of nonprofit workers ages 25 to 44 are considered ALICEs.<a target="_blank" href="https://www.businessinsider.com/alabama-basic-income-single-mothers-afford-childcare-bills-birmingham-2024-8">Single parents</a> working for nonprofits are also facing grim prospects: According to the report, over half are living below the ALICE threshold. And, while 16% of white nonprofit workers were below the ALICE threshold, 35% of Black workers in the sector were struggling to make ends meet.It's an irony that addresses some of the larger struggles ALICE workers face in the US: Many of the larger support structures do not see them as in need, which exacerbates the need further. Without adequate income or access to resources, these Americans are stuck in the middle."I'm not homeless enough to get certain help because I have a roof over my head," Melissa Hedden, 41, <a target="_blank" href="https://www.businessinsider.com/not-poor-enough-low-income-millennial-cant-afford-rent-homeless-2024-5">previously told BI</a>. "But I'm too homeless to get a job because I don't know where I'm going to live in three weeks. What do you do?"Are you an ALICE or nonprofit employee struggling to afford daily life? Are you open to sharing your story? If so, reach out to <a target="_blank" href="mailto:allisonkelly@businessinsider.com">allisonkelly@businessinsider.com</a>, <a target="_blank" href="mailto:nsheidlower@businessinsider.com">nsheidlower@businessinsider.com</a>, and <a target="_blank" href="mailto:jkaplan@businessinsider.com">jkaplan@businessinsider.com</a>.

You Searched For "healthcare safety" and got 5 results

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My husband and I moved from the US to Canada 13 years ago. We love the free healthcare here and the great friends we made.

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