Category Archives for Healthcare

Congress Must Confront the Financial Realities Facing Older Americans

Published in the Blackstone Valley Call & Times on June 30, 2026

Timing is everything. With the midterm elections looming – just 126 days away – the AARP Foundation is putting the spotlight on affordability – a key campaign issue closely tied to economic security that deeply concerns both older Democratic and Republican voters.  But for millions of older Americans living on limited incomes, the rising cost of food, housing, transportation, and health care isn’t simply a political issue to them—it’s a daily struggle

As a result, strategists in both major political parties are scrambling to tailor their policy messages to offer voters comprehensive solutions to address the high cost of living.

A new report released June 25 by the AARP Foundation highlights just how financially strained many older Americans have become. Rising housing, food, transportation, and health care costs are creating hardships long before many people become eligible for Social Security and Medicare benefits.

A Crisis in Plain Sight

“Today, 39 million Americans age 50-plus with low incomes are living one emergency away from financial hardship. That’s not a warning sign. It’s a crisis hiding in plain sight,” said Claire Casey, president of the AARP Foundation, in a statement announcing the release of the report.

The Foundation’s new Economic Security Monitor (ESM) is based on a nationally representative quarterly survey of more than 2,000 adults age 50 and older living at or below 250% of the federal poverty level.

ESM is conducted quarterly, with each quarter tracking the same respondents to capture changes in financial conditions among older adults with low incomes.  The Winter 2025-2026 data was collected December 24, 2025, through January 12, 2026, and the Spring 2026 data was collected March 30, through April 15, 2026.

According to Casey, the survey is the first tool designed to track, in near real time, how rising prices and economic conditions are affecting older adults with low incomes.

“The power of the Monitor is that it helps us see change and challenges as they unfold. By providing timely, actionable data, it gives decision makers the information they need to respond faster and target resources more effectively to address the growing economic pressures that older Americans face,” says Cassey.

One finding, notes Cassey, is especially alarming: adults ages 50 to 64 are among those facing the greatest challenges, often falling into a gap where they are too young for Social Security and Medicare but increasingly vulnerable to economic shocks.

Keeping Your Head Above Water Financially

The Foundation’s new ESM report also found that 56% worry about losing government or essential public benefits, underscoring how dependent many households are on programs that help them stay afloat.

The survey found that inflation remains the biggest financial concern. Nearly nine in 10 respondents (88%) cited rising prices as one of their top worries, ahead of retirement savings (80%) and medical costs and debt (72%).

Higher prices are forcing many households to make difficult choices. Three-quarters (75%) of those surveyed said their necessary household expenses increased during the previous three months, up from 64% in the prior quarter. More than one-third said they struggled to pay at least one bill.

Among those having difficulty making ends meet, food (75%) was the expense most often mentioned, followed by transportation (63%), housing (60%), unexpected expenses (59%), and health care (51%). Thirty-eight percent of these respondents also reported running out of food before they had enough money to buy more.

The survey findings indicated that adults aged 50 to 64 appear to be especially vulnerable. Many have not yet reached eligibility for Social Security or Medicare but are already coping with rising living expenses and limited financial resources.

The survey also found that nearly one-third of respondents in that age group could not cover an unexpected expense exceeding $100. More than half said they could continue paying their bills for only one month or less if their primary source of income disappeared.

Having a job has not insulated many from financial hardship. Nearly half of the low-income adults ages 50 to 64 are employed, yet 63% of those workers admit they are struggling financially.

When money becomes tight, respondents reported taking steps that may provide short-term relief but could create larger financial problems later. Many said they cut back on household spending (41%), paid only part of their bills (39%), relied on credit cards (32%), delayed payments (24%), or borrowed money from relatives and friends (21%).

The survey also highlights the importance of public assistance. Nearly half of those surveyed receive some form of government support, including food assistance, housing assistance, health coverage, or income support. More than half worry about losing those benefits, reflecting how important these programs have become for households already living close to the financial edge.

The ESC findings are especially relevant in Rhode Island, one of the nation’s oldest states. Communities across the Ocean State are seeing steady growth in their older populations, increasing the demand for affordable housing, transportation, health care, and supportive services. For many older Rhode Islanders living on fixed incomes, rising prices are making it increasingly difficult to remain financially independent.

The ESC report warns that for older, low-income adults, “public benefits are not a supplement, they are a lifeline.”  Nearly half of the survey respondents currently receive at least one form of public assistance. This includes food, housing, health coverage, or income support.

As Congress continues to debate the future of Social Security and Medicare and hammer out policies to ensure the programs’ financial viability, 56% of the low-income older respondents say losing public benefits is a financial concern to them.

A Final Note

With the midterm elections nearing, both political parties are expected to make affordability a central campaign issue. Older voters will be listening closely, but they are likely to judge candidates less by campaign promises than by whether elected officials take meaningful steps to address the financial pressures many Americans now face.

The AARP Foundation’s survey provides a timely reminder that economic insecurity is not an abstract policy issue. For millions of older Americans—including many here in Rhode Island—it influences their everyday decisions about which bills to pay, how to buy groceries, and how to obtain needed health care. Those realities should remain part of the national debate on affordability long after the campaign season is over.

For a copy of the ESC report, go to AARP Foundation Economic Security Monitor Detailed Findings.

National Primary Care Coalition Takes on America’s Broken Healthcare System

Published in RINewsToday on May 4, 2026

In 2023, Primary Care for All Americans (PC4AA) was launched as a national initiative to raise primary care as a public policy priority and advocate for payment reform to promote universal access to high-quality primary care. Primary care physician and former Rhode Island Health Director Dr. Michael Fine is the driving force and co-founder of PC4AA. He is also the author of several books, including “Healthcare Revolt” and “On Medicine as Colonialism.”

When asked why PC4AA was needed, Dr. Fine responded:  “ We wondered about that ourselves.  Physician groups tend to focus on pocketbook issues.  Public health folks focus on health outcomes.  But no one was putting it all together.  And no one was specifically involving communities or showing them how they could provide primary care to everyone, in part because primary care is so affordable,” he said.

Dr. Fine explains the organization’s focus, stating: “Our mission is very clear. We exist to help communities figure out how to provide primary care to everyone, learning from the experience we gained in Scituate, Rhode Island.” In Scituate, the community locally funded a voucher program that successfully provided primary care to all uninsured residents for over two decades. “It’s the only place that we know of that assures everyone has access to primary medical and dental care,” he says, highlighting a replicable model.

Dr. Fine maintains that comprehensive primary care is a surprisingly affordable essential service, with its per-person cost comparable to municipal services such as police, fire, and road maintenance.

PC4AA’s influence and policy impact derive from the scale of its collaboration rather than from formal enrollment numbers alone. By uniting primary care physicians, health policy experts, patient advocates, academic leaders, and public health professionals, the coalition helps build nationwide consensus for health care reform—especially in making primary care accessible to all Americans, says Dr. Fine.

The coalition’s community-building efforts are apparent in its active workgroups. “We have over a thousand people in local or state workgroups who clicked ‘Join Us’ on our website, and they participate in some way,” says Dr. Fine. He further stresses that their growth is tracked by the number of these workgroups joining monthly online meetings and through the passage of primary care legislation at the state level.

Dr. Fine notes that the difficulty of accessing primary care inspired the creation of PC4AA. He notes that primary care uniquely improves public health while reducing costs, and that an adequate number of primary care doctors is essential to making healthcare affordable.

According to Dr. Fine, less than 43 percent of Americans have meaningful primary care relationships, a figure that is falling as fewer medical students choose primary care. Internationally, effective, affordable health care systems have at least 50 percent of physicians in primary care, he says.

Responding to these primary care workforce trends, PC4AA’s top priority is to expand access to primary care nationwide. “We need  thousands of new primary care clinicians,” says Dr. Fine, explaining that this can be accomplished by establishing new medical and physician assistant schools and by increasing residency programs.

PC4AA also advocates for reducing primary care doctors’ workloads, eliminating preauthorization and cutting administrative duties, and improving reimbursement. Although accounting for less than 4 percent of health spending, primary care accounts for half of all patient visits, costing about $575 per person annually, out of an average total of $15,000.

Having operated for over three years Dr. Fine acknowledges a major challenge the group faces: a “feeling of impotence.” Although healthcare may seem “too big and scary for some” and many believe that “only the big guys can fix it,” Dr. Fine insists that the power to make systemic changes actually lies with communities. He points out, “Look at how Newport fought successfully to keep their birthing center open, or what Scituate did.”

While these may be viewed like temporary strategic challenges, Dr. Fine reframes these obstacles as chances for growth and community empowerment.

Fine argues that fixing the healthcare system requires a broad-based social movement, similar to past movements for abolition and suffrage, to restore community agency and build a system that serves people ahead of profit.

Communities can take forward-thinking actions to solve their own healthcare problems, says Dr. Fine, by creating local primary care reports, passing city council resolutions, and building scholarship programs to grow their own healthcare workforce.

“Get started, have a conversation, understand that you can do this because you can,” states Fine. He challenges readers to actively join the movement—by connecting with local efforts, attending on-line meetings, and spreading the message in their communities. “Take concrete steps, unite others, and turn awareness into real progress. Together, we can build the future of primary care from the ground up.”

PC4AA Welcomes First Executive Director

According to its March 31 newsletter, PC4AA announced the hiring of Neda Ashtari, MD, MPP, as its first Executive Director.  This appointment arrives at a time when the nation is fiercely debating how to expand access to health care and reduce spiraling costs.

 In the newsletter, PC4AA writes: “Dr. Ashtari brings to PC4AA something rare and deeply needed—a combination of lived experience, clinical insight, policy expertise, and movement-building leadership. As a physician serving in the safety net in Los Angeles during residency, she cared for patients managing a broken system where access too often depended on income and coverage status. She watched as patients were lost in the system due to insurance gaps or delayed medical care because of costs. These were not abstract policies; they were daily realities.”

 The newsletter also highlights Dr. Ashtari’s own perspective: “I keep coming back to a simple conclusion,” she writes. “Lasting reform starts with universal access to primary care.” It notes that this conviction has guided her work for more than a decade across organizing, policy, and clinical care.

PC4AA further points out in the newsletter that Dr. Ashtari has led national advocacy campaigns, including the American Medical Student Association’s Lower Drug Prices Now initiative, coordinating organizing efforts across more than 30 chapters nationwide. Through her leadership with Universities Allied for Essential Medicines, she helped build coalitions that expanded access to lifesaving medications globally—work recognized in the documentary White Coat Rebels.

The newsletter emphasizes that she co-founded Protect US, a public health nonprofit focused on expanding access, strengthening public health infrastructure, and combating misinformation. After serving as Associate Director of Health Policy at the Center for American Progress, Dr. Ashtari recently assumed a new role as Director of Federal Affairs at the American Medical Association, where she advocates on behalf of clinicians and patients on Medicare Advantage policy.

Looking forward, Dr. Ashtari outlines her vision for the role in the newsletter: “As PC4AA’s Executive Director, I will work to translate the organization’s grassroots energy into a durable national movement—one capable of changing how primary care is valued, funded, and delivered across the country.”

The newsletter closes by emphasizing a consistent theme across her work: Dr. Ashtari is “not only a thinker, but a builder,” noting that she understands policy alone is not enough—lasting change requires organizing and translating values into durable systems that people can rely on.

 Mark Your Calendar

The organization is convening the “Health Care Renaissance Summit,” its inaugural gathering to build a coordinated national movement for primary care reform.  The summit, scheduled for May 20, 2026, at the Le Méridien Hotel in Cambridge, MA, brings together an eclectic group of stakeholders—including clinicians, community organizers, medical students, policymakers, and advocates—reflecting PC4AA’s strategy of linking grassroots organizing with policy change.

“According to PC4AA, this one-day national summit is designed to be interactive and results-driven. The event features keynote speaker Dr. Jonathan Fitzsimons—a family physician and Medical Lead of the Renfrew County Virtual Triage and Assessment Centre—along with talks from national leaders, skill-building workshops, and “table talks.” These joint sessions allow participants to share strategies and unique experiences. Core discussions focus on practical approaches, such as advancing local policy resolutions, launching student-driven initiatives, and strengthening state- and community-based coalitions.”

Organizers hope attendees leave the summit with practical tools for local organizing and real-world examples to bring home to their communities. The event connects people to a national support network and advances PC4AA’s mission to expand primary care access through community-led work that creates lasting change.

Ticket Pricing is $50 for students and $250 for general admission. Register now at https://pc4aasummit.netlify.app/# to be part of this movement for healthcare reform and help drive change in primary care in your community.

Summit sponsors include: New Bedford Community Health (New Bedford, Massachusetts); City of Pawtucket (Pawtucket, Rhode Island); Tufts University School of Medicine, Department of Family Medicine; The Meyers-Keller Fund for Good Works (Denver, Colorado); Elation Health (San Francisco, California); and Michael Kaplan, MD(Lenox, Massachusetts).

To visit PC4AA’s website, go to https://primarycareforallamericans.org/

Listen to Dave Chase’s Relocalizing Health podcast interview with Dr. Michael Fine, “How Primary Care and Community Agency Can Transform Healthcare from Extraction to Empowerment,” at: https://relocalizinghealth.com/episode/how-primary-care-and-community-agency-can-transform-healthcare-from-extraction-to-empowerment

Home Foot Care Legislation Gains Momentum Toward Passage in RI

Published in RINewsToday on April 13, 2026

Through the efforts of aging advocates and older Rhode Islanders, the House last week followed the Senate’s lead in passing legislation that would allow certified foot care nurses to provide routine foot care to homebound patients. Under the legislative proposal, nurses must receive proper training and certification and demonstrate clinical competency.

At press time, the two chambers must still reconcile and pass identical versions of the bill before the legislation can be sent to the governor for signature.

On April 7, the Senate unanimously passed S. 2116A, introduced by Sen. Lori Urso, to expand access to routine foot care for homebound patients. Two days later, the House followed suit, passing Rep. Jennifer Boylan’s H 7029A by a vote of 65–0.

The sponsors—Rep. Boylan (D-Dist. 66, Barrington and Riverside) and Sen. Urso (D-Dist. 8, Pawtucket) —say the legislation addresses a critical need for basic, preventive foot care in the home. Many elderly and disabled patients require assistance with services such as toenail care and treatment of corns and calluses, yet are often unable to access care outside the home, including visits to a podiatrist.

Under the legislation, nurses must demonstrate knowledge and clinical competency in foot and nail structure and function, common foot conditions, and appropriate care techniques. They must also be certified by a national professional organization, such as the American Foot Care Nurses Association (AFCNA), or an equivalent approved by the Rhode Island Department of Health. Additionally, two of the required 10 continuing education hours per certification period must focus specifically on foot care. In addition to CEUS, 30 hours of training with a podiatrist are required for certification.

“This bill is about expanding access for vulnerable Rhode Islanders who currently have no safe options for routine foot care,” said Sen. Urso. “While this care may seem simple to some, for others it is difficult or even impossible to perform safely on their own.” She noted that similarly trained nurses already provide this care in most other states, including Massachusetts, whose regulations served as a model for the legislation.

Urso also pointed to the state’s aging demographics. “With the City of Pawtucket joining the AARP Age-Friendly initiative, along with several other Rhode Island communities, it is imperative that we support residents who wish to age in place,” she said. “Rhode Island has more residents over age 65 than under age 20, and initiatives like this help meet their needs.”

Rep. Boylan emphasized the broader issue of healthcare access. While many Rhode Islanders are aware of shortages in primary care and specialty providers, she said, fewer realize that essential services like in-home foot care are largely unavailable. This gap leaves many older adults without safe options.

“It’s especially dangerous for individuals with diabetes, who are prone to infections and other foot problems that can lead to serious complications or even death,” Boylan said.

Strong Backing from Leadership and Advocates

House and Senate leadership, along with aging advocates, say the proposal addresses a longstanding gap in home- and community-based care.

“This legislation will provide a lifeline for vulnerable Rhode Islanders who rely on in-home health services and currently face significant barriers to receiving basic but essential foot care,” said Senate President Valarie J. Lawson. She described the bill as a common-sense solution that improves the quality of life for both patients and caregivers.

House Speaker K. Joseph Shekarchi  called the measure a practical response to a widespread problem. “As someone with diabetes, I understand the serious risks associated with a lack of routine care. This bill helps protect the health and safety of Rhode Islanders,” he said.

Tina McDonald, a registered nurse licensed in both Rhode Island and Massachusetts who is certified in foot care, testified in support of H. 7029A. With 12 years of experience in foot care nursing, she argued that there is a significant unmet need among homebound elderly and chronically ill residents who can no longer visit a podiatrist’s office.

“It’s not a question of doctor versus nurse. It is a matter of nurse versus no one,” McDonald told House lawmakers, warning that podiatrists are not filling this gap in care.

Addressing the primary opposition from podiatrists, she clarified that nurses would not be practicing medicine but instead addressing a “self-care deficit” within the established nursing scope of practice.

During her testimony, McDonald emphasized that nurses are highly trained in assessment, infection control, and wound care.

Carol Anne Costa, executive director of the Senior Agenda Coalition of Rhode Island (SACRI), said the legislation would benefit homebound and mobility-challenged residents and their caregivers.

“SACRI was proud to testify in strong support of this bill,” she said. “It represents a vital step toward ensuring that older adults have the care and support they need to age safely and with dignity in their communities.”

Costa noted that allowing trained nurses to provide limited foot care services at home supports both family caregivers and broader home- and community-based care systems. “Those needing these services are often older adults or individuals with disabilities who face mobility challenges, making it difficult to access care outside the home,” she said.

She added that aging and underlying health conditions can make nail care more difficult and increase the importance of proper foot care.

Catherine Taylor, AARP Rhode Island State Director, echoed those concerns. “Access to in-home foot care is critical for older adults facing mobility, vision, or chronic health challenges,” she said. “Without regular care, minor issues can progress into infections, pain, or mobility limitations that increase fall risk and lead to more serious conditions. Home-based care supports prevention, early detection, and aging in place.”

“The bill would provide relief not only to patients, but also to families and caregivers who are often forced to choose between going without care or attempting to provide it themselves,” Taylor added.

Mary Lou Moran, director of the Pawtucket Division of Senior Services at the Leon Mathieu Senior Center, highlighted the local impact.

“This bill removes unnecessary barriers to essential preventive care and helps close a significant service gap,” she said. “Many individuals we serve cannot safely perform their own foot care and face transportation, mobility, or financial challenges accessing clinic-based services.”

Moran added that regulated, in-home care provided by qualified nurses can help prevent avoidable complications, reduce healthcare costs, and improve quality of life.

Podiatry Association Flags Concerns

Following House passage of H 7029A, the Rhode Island Podiatric Medical Association (RIPMA) issued a statement acknowledging improvements in the bill while raising concerns.

“This issue has always been about ensuring patients can access care from certified and credentialed providers,” the statement read. “We appreciate the inclusion of language requiring nurses to be certified by an accredited organization approved by the Department of Health.”

The organization noted that the bill could benefit truly homebound patients by reducing the risk of self-injury, but emphasized that it is not a substitute for physician care. Patients who can access a podiatrist (in the home or office)—especially those with underlying medical conditions—should continue to receive regular professional treatment.

RIPMA also cited studies showing that Medicare patients with diabetes who receive podiatric care experience fewer hospitalizations and amputations. The group expressed interest in collaborating with certified nurses to ensure safe, appropriate care.

At the same time, Past RIPMA President Dr. Michael Reuter, DPM, FACFAS, voiced concerns about the legislation’s broader impact.

“The legislation aims to solve a problem, but I am concerned it may create new ones,” he said.

Reuter, a board-certified podiatric foot and ankle surgeon in Rhode Island, criticized the absence of a Rhode Island Department of Health recommendation requiring collaboration between nurses and podiatrists. He said such coordination is essential to ensure timely referrals when needed.

“I hope the Department of Health establishes strong safeguards and oversight for providers entering vulnerable patients’ homes,” he said.

He also noted potential cost implications. “Patients will have to pay out of pocket for these services, whereas visits to a podiatrist—whether in-office or through a home visit—are covered by insurance,” he said.

Here is the link to the Feb. 10th House Committee on Health and Human Services on H 7029 A, go to House Committee on Health & Human Services – RISE: 2-10-2026

Here is the link to the March 3rd Senate Committee on Health and Human Services on S. 2116 A, go to Senate Committee on Health & Human Services: 3-3-2026