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Democratic doctors and scientists ride the blue wave
The clinicians and researchers who will take office are ready to tackle the U.S. health care system.
Texas' Political Blue Wave Has a Soundtrack: 'Choosin' Texas'
'Choosin' Texas,' by Ella Langley, has taken on yet another new meaning: it's now the anthem for political revolution in Texas's midterm elections.
Vote Smart Empowers Human Judgment as AI Influences Politics
Elise Blum and Dr. Kyle Dell examine who selects the information behind AI-generated political answers and why citizens must retain the final judgmentDES MOINES, Iowa, Nov. 02, 2026 (GLOBE NEWSWIRE) -- As voters turn to artificial intelligence to research politics, Vote Smart board member and educator Elise Blum and Executive Director Dr. Kyle Dell are urging citizens to examine the sources, standards, and incentives behind the answers they receive. In their opinion essay, “Preserving Human Agen
What a blue wave means for North Carolina. Reporters, political watchers join Due South for post-election analysis
Due South’s Jeff Tiberii and a panel of reporters and political scientists dig into the election results and what they mean for our state and our country.
Missouri State celebrates grand opening of Roy Blunt Hall - News
Event marks completion of Phase II, a preservation-minded renovation of the original Temple Hall.
Science advocates react to Democrats' historic midterm rout: 'It's a new day in Washington'
Researchers and advocates say they hope the 'blue wave' could signal more accountability after two years of attacks on science
Silicon Valley‘s political spending spree meets a blue wave — and a data center revolt
Tech billionaires poured hundreds of millions into the midterms, but it didn’t buy them much.
Axa’s premiums, other revenues climb
France-headquartered Axa SA posted a 5% year-on-year growth in gross written premiums and other revenues to 93 billion euros ($104 billion) in the first three quarters of 2026…
Incumbent DA reelected by 3 to 1 margin in Hancock County
Incumbent District 7 top prosecutor Bob Granger of East Blue Hill swept up nearly three times as many Hancock County votes as his challenger, Steven Juskewitch, a Dedham attorney, on
Documentary winners shine at Naples International Film
The red carpet is furled, the #IamNIFF backdrops stowed for another year. Gleaming blue trophies in hand, filmmakers and actors head home or off to the next festival.
Happening in Boise: The Blues, Cell Block Tango and Cinema
Here’s a look at what’s happening around Boise from November 6 through November 8.
Analysis | Five races that will tell us where election night is headed
A handful of House, Senate and governor’s races could signal whether a blue wave is materializing.
Ken Paxton’s last stand
On the road with the Texas Republicans fearful their state could turn blue.
Here's the Food Named the Healthiest in the World by Science, and You Can Grow It on Your Windowsill
Not kale, not blueberries: the peppery green that topped a CDC-published ranking, and how to grow it at home. Every few years, a new superfood takes over grocery aisles and social feeds. Kale had its moment, then blueberries, then avocado. But when a researcher ranked fruits and vegetables by how many nutrients they deliver per calorie,...
Marni von Wilpert flips California House seat, bringing a personal health care fight to Congress
The bisexual lawmaker from California flipped a Republican-held seat amid an overwhelming blue wave.
Blue wave fizzles in Florida races: Inside Florida Politics podcast
Florida's GOP firmly keeps power including the state's first black governor Byron Donalds, and multiple Congressional and State legislative races.
As blue wave crashes, business leaders weigh impact of ballot measures
Chief concern for leaders was Colorado’s Amendment 87, which would end the state’s flat 4.4% income tax, replacing it with a graduated tax system that for some upper incomes would extend rates to beyond 8%.
Numbers Like Duke to Continue Winning Streak vs NC State
The Blue Devils are looking to win their seventh game of the year.
Neighbors helping families, businesses impacted by devastating fire in Blue Island
Saudi Re’s profits, written premiums leap more than 50%
Saudi Reinsurance Company SJSC’s net profit after zakat surged 63% year on year to 194 million Saudi Arabian riyal ($52 million) for the first three quarters of 2026, driven by growth across its…
Power Players: Innovators in Women’s Sports — Laura Correnti, Deep Blue Sports + Entertainment
Power Players: Innovators in Women’s Sports — Laura Correnti, Deep Blue Sports + Entertainment
National blue wave brings a high tide for Dems in the high desert
By Pat Davis, New Mexico Political Report — President Donald Trump told voters heading into the 2026 midterm elections to “pretend I’m on the ballot.” They did just that. In a national rebuke of Trump’s policies, voters gave Democrats a clear majority in the House and Senate and flipped a half-dozen governors’ mansions and every […]
Fall sports postseason preview: Duke men's soccer
With postseason play around the corner for the fall sports teams, the Blue Zone is here to preview each team. First up is Duke men's soccer who begins its ACC Tournament play Wednesday against Clemson.
Stock market winners and losers from 'blunami' midterm elections
US stocks jumped after the sweeping Democratic victory in the midterms. Bond yields edged lower, while stocks in areas like neoclouds and defense fell.
With iOS 27.3, Apple will start checking iCloud public links for ‘harmful content’
iOS 27.3 makes a change to how public iCloud links work, with the aim of preventing harmful content from being shared. Here are the details.
Sudan: Humanitarian Health and Nutrition Bulletin: Blue Nile Under Strain: Displacement, Malaria and Attacks on Civilians Drive an Acute Health Emergency
Situation Report in English on Sudan about Health and Protection and Human Rights; published on 2 Nov 2026 by SAPA
WTW’s net income jumps 13% in Q3
U.K.-headquartered Willis Towers Watson plc adjusted net income grew 13% year on year to $339 million in three months ended Sept. 30, Reinsurance News reported. Group revenue increased 8% to $2.5…
Perspective | Access to care: Investing in health and affordability for North Carolina
Blue Cross and Blue Shield Foundation of North Carolina President Colleen Briggs reflects on the foundation's strategy: Access to Care.
Blue whales have gone missing off the Galápagos. Scientists think El Niño could be why.
Blue whale sightings have fallen off dramatically near the Galápagos. El Niño may be to blame.
What Wall Street billionaires are saying about Democrats' midterm sweep
Billionaire political spending met criticism from ... billionaires in the wake of Tuesday's blue wave election.
How a blue wave crushed the tech right
The Democratic wins that swept America on election night was a backlash against data centers, and a rebuke to Silicon Valley elites.
Erika Kirk channels Charlie with blunt message to conservatives after GOP midterm losses
Erika Kirk invoked her late husband Charlie Kirk's words, urging conservatives to stay positive and avoid infighting after election setbacks.
Intermountain Health St. James Hospital Upgrades Hyperbaric Chamber to Offer Latest Treatment Options for Patients
“It felt like someone was pulling a curtain over my eye,” said Carol Barney, of Butte. What was happening to Barney is called an eye stroke, or retinal artery occlusion, which occurs when blood flow to the retina is blocked. Symptoms can include sudden vision loss or blurred vision in one eye. Like a stroke affecting the brain, eye stroke i...
'Bad politics': Blue tsunami visible months before it emerged
Voters across the political spectrum became increasingly irritated by President Trump's flippant governance, which congressional Republicans enabled.
Biz leaders react as a 'blunami' sweeps America on Election Night
Business leaders and tech executives are now weighing in on what the new political landscape could mean for their industries.
Jordan Mailata gives blunt assessment of O-line after loss to Commanders
Jordan Mailata gave a blunt assessment of the Eagles’ OL after their loss to the Commanders.
Democrats 'Blue Wave' of victories in midterms to change political landscape
A sweeping night of Democratic victories across the country has left the party poised to take control of both the House and Senate.
A blue tsunami wipes out Republicans
Jonathan Freedland and Shrai Popat run through the results of the US midterms, on a historic night for Democrats and a night to forget for Republicans
iPad Mini 8 Reviewer Isn't Satisfied With Apple's Excuse for Lack of 120Hz Display
The new iPad mini has an OLED display, but the device does not support ProMotion, meaning the display's refresh rate is limited to 60Hz instead of 120Hz. Apple said OLED displays still have significantly faster pixel response times compared to LCDs, resulting in reduced motion blur, but The Verge's David Pierce is not entirely satisfied.
U Maine Political Science chair calls Jackson campaign “impressive” even with “blue wave” help
ABI spoke to University of Maine Political Science Chair Mark Brewer on Wednesday to get his take on how the national environment played a role in deciding Maine’s senate race.
Expedition records no blue whales near the Galapagos for nine months
A nine-month expedition near the Galapagos recorded no blue whales amid unusually warm El Niño waters. Researchers suggest the animals may have shifted south toward cooler, more productive waters.
Munich Re Specialty launches Australian commercial cover
London-headquartered Munich Re Specialty has entered Australia’s primary specialty insurance market, initially offering property, construction and engineering, mining and surety cover for commercial…
Apple is reportedly doubling orders for a new MacBook Neo
The MacBook Neo was a massive success. If component suppliers can be believed, Apple expects the second-gen model to do twice as well.
Scor’s profit slips 6%
France-based Scor SE’s net income for the first nine months of 2026 fell 6% year on year to 603 million euros ($673 million), Reinsurance News reported. Group insurance revenue dropped 4% to €11.2…
Underwater technology showcase brings ocean researchers and industry to URI Narragansett Bay Campus
KINGSTON, R.I. — Nov. 2, 2026 — The National Oceanic and Atmospheric Administration Ocean Exploration Cooperative Institute, based at the URI Narragansett Bay Campus, hosted an underwater systems and autonomy showcase with two blue technology companies, Sonardyne and Voyis, in early October. The two-day event brought together oceanographers, ocean engineers, industry experts, and other participants […]
It was a big night for doctors to win seats in Congress, riding the blue wave
Historically, most physicians who served in the House or Senate have been Republicans. In the next Congress, physicians who are Democrats made significant gains.
Le Havre fans call for American owners to leave after coach's suspension and president's exit
Le Havre fans are calling for the American owners the Blue Crow Sports Group to leave the club
Harvard Street Neighborhood Health Center breaks ground on new building on Old Road
A ceremony was held last Thursday (Oct. 29) to break ground at the future site of a 49,000-square-foot, three-story building on Old Road that will house operations of the existing Harvard Street Neighborhood Health Center on Blue Hill Avenue.
Scientists build whole-Earth simulation to help find life on other planets
It's a dizzyingly busy time for scientists searching for life on distant planets. To date, astronomers have cataloged more than 6,000 planets beyond our solar system and are searching the atmospheres ...
Hanwha to offer premium discounts to shipowners with strong cybersecurity
South Korea’s Hanwha General Insurance Company Ltd. has partnered with Busan-based Cytur Inc. to develop an integrated system that rewards shipowners with preferential insurance terms for…
Marsh plans captive management operations in Bahrain
U.S.-headquartered Marsh McLennan Companies Inc. plans to launch captive insurance management services in Bahrain, which would make it the first international broker to provide such capabilities in…
CVS Health Is Breaking Up. Is The Blue Wave To Blame?
A Democratic Congress would have tried to force the breakup.
What Democratic control of Congress means for healthcare in 2027
Tuesday’s forecast-busting blue wave puts wind in the sails of Democrats who have promised a stark departure from Trump-era healthcare policy—though whether or not the shifts will be incremental or | Tuesday’s forecast-busting blue wave puts wind in the sails of Democrats who have promised a stark departure from Trump-era healthcare policy—though whether or not the shifts will be incremental or seismic hinges on intra-party debates and the president’s veto.
Arizona Democrats celebrate, Republicans mourn power shift in state politics
Democrats point toward affordability, education and water as key priorities if the Arizona Legislature goes blue. Some key statehouse race results are still pending.
Sukoon profits surge 45%
United Arab Emirates-based Sukoon Insurance PJSC posted a 45% year-on-year surge in third-quarter profit before tax to 438 million Emirati dirham ($119 million), Gulf News reported.
Trump’s billionaire-blue collar coalition has been smashed by class politics
As tech bosses get richer and ordinary Americans struggle, Democrats put the case against the US’s grotesque unfairness – and voters responded, says Guardian columnist Aditya Chakrabortty
New on DVD: Nic Cage classics land on 4K Blu-ray
The 4K Ultra HD Blu-ray SteelBook release of "Con Air" and "National Treasure," two of the most beloved Nicolas Cage films, tops the release calendar for the week of Nov.
France weighs ‘riot tax’ on auto and business premiums
The French government is considering adding a “riot tax” to citizens’ insurance bills to cover the cost of recurring civil unrest after recent riots affected more than 3,000…
The brain’s hidden fear mechanism may explain anxiety and PTSD
A surprising new discovery suggests that fear may cause the brain to blur the line between danger and safety rather than distinguish them more clearly. By observing brain activity in mice using augmented reality, scientists found that memories of threatening and harmless environments began to overlap, potentially allowing faster responses to danger. This "better safe than sorry" survival mechanism could help explain why people with anxiety or PTSD sometimes experience intense fear in completely safe situations.
UAPB associate professor appointed to Minority Health Commission
Leonard Williams Jr., Ph.D., a tenured associate professor at the University of Arkansas at Pine Bluff, was recently appointed by Arkansas Gov. Sarah Huckabee Sanders to the Arkansas Minority Health Commission. In this role, he supports the commission’s mission of addressing health disparities, promoting health education, and improving health outcomes among minority and underserved communities […]
Palm Beach Improv brings big laughs to Wellington
The Palm Beach Improv has reopened in Wellington with an intimate 450-seat venue and sister restaurant (Copper Blues Rock Pub & Kitchen) next door.
Election Day National Politics
Jonathan Lemire, co-host of "Morning Joe" on MSNOW; writer for MSNOW and contributing writer to The Atlantic, talks about what the Democrats are planning if the blue wave in Congress materializes, plus what the Trump administration has in store for the post-election time.
Democratic doctors and scientists ride the blue wave
The clinicians and researchers who will take office are ready to tackle the U.S. health care system.
Democrat Bob Brooks wins election to U.S. House in Pennsylvania's 7th Congressional District
2026 ELECTION COVERAGE: Watch Live | Poll Closing Times | All Live Results | Live Updates | Live Fact Check Democrat Bob Brooks won election Tuesday to the U.S. House of Representatives representing Pennsylvania's 7th Congressional District, defeating Republican incumbent Ryan Mackenzie. Brooks, who worked as a firefighter and union leader, concentrated on his blue-collar background, saying he understood the affordability issues facing voters in the Lehigh Valley battleground district. Mackenzie's ties to President Donald
Aon, Munich Re launch pandemic reinsurance facility
Aon plc and Germany’s Munich Re have launched a first-of-its-kind parametric pandemic reinsurance facility covering hospitality risks across Indonesia and the Philippines, Artemis reported.
Jefferson Heath will leave Horizon Blue Cross Blue Shield of New Jersey’s network on March 1 without a new contract
In addition to Horizon, New Jersey's largest insurer, Jefferson is in high-stakes contract talks with at least two other major insurers, Highmark and Independence Blue Cross.
Texas Democrats pull off the breakthrough they’ve chased for decades
For decades, Texas Democrats have dreamt of turning the state blue, rallying around exciting candidates who drew big crowds and big money but could not ultimately overcome the state’s stubborn conservative majority.
‘Has No Business Being on an NBA Court,’ ‘Should Be Waived Immediately’ – NBA Fans Rip Bronny James After JJ Redick’s Blunt Comment on Lakers’ Collapse
Bronny James was among the Los Angeles Lakers reserves who let a 15-point lead shrink to five in about 40 seconds on Sunday night, before the starters returned to close out a 131-125 win over the Toronto Raptors. That late stretch has some NBA fans asking whether the Lakers guard belongs on the roster at all.
Midterms 2026 live updates: Election Day voters head to the polls as Democrats look to flip GOP control of the House and Senate
Democrats need a net gain of four seats in each chamber to take control of Congress as Republicans fight to hold on to their majorities and President Trump looks to help the GOP avert a so-called blue...
Urbanite Theatre's 'Ahoy-Hoy' Dials Up Fun
Alexander Graham Bell invented the telephone, right? Maybe not, in Jenny Stafford's often hysterical comedy.
Political science professor weighs in on Northwest Arkansas races
Andrew Dowdle, a University of Arkansas political science professor, says a nationwide blue wave hit Northwest Arkansas.
Canada Regulates Health-Product Claims. But What Does ‘Science-Backed’ Actually Mean?
Phrases like “science-backed” can sound reassuring, but consumers deserve to see what kind of evidence actually stands behind health-product claims.
NC State a 4.5-point underdog against Duke
NC State has had a rough time against Duke lately, and I’m not so sure that’s going to change this week. The Pack’s a 4.5-point underdog to the Blue Devils in Vegas, while SP+ has Duke by six. Duke is coming off a 47-2 win over Boston College, which is a very funny final score, […]
Turkey flood losses hit $229M
Insured losses related to the Oct. 14 and 15 floods in Turkey have reached at least 11.5 billion Turkish lira ($229 million), with Istanbul accounting for 90% of the total, according to the Insurance…
IceCube detects ghost particles with 10 billion times the energy of solar neutrinos
Mysterious particles called neutrinos constantly stream through our bodies, and scientists are now detecting incredibly powerful versions arriving from distant cosmic sources using a massive observatory buried in Antarctic ice. These elusive “ghost particles” could hold extraordinary clues about the Big Bang, extreme cosmic events, and some of the universe’s greatest mysteries.
The US political colours and logos explained
The BBC's Lucy Woodham explains why a blue donkey and a red elephant are used in US politics.
Beware the ‘red mirage’ if California Republicans have an election night lead
Don’t be fooled by early election returns. It can take California weeks to tally votes, leading to ‘red mirages’ and ‘blue shifts.’
European cat pricing tumbling ahead of January 2027 renewals
European catastrophe rates are falling by high single to low double digits for the January 2027 renewals, while rates for loss-hit lines such as marine, energy and war are rising sharply…
Jimmy Kimmel celebrates Democrats’ ‘blue tsunami’ with brutal Trump dig
Jimmy Kimmel ripped into President Donald Trump and Vice President JD Vance while celebrating the Democrats’ blue tsunami wins on Tuesday evening.
Elon Musk's business empire braces for Democratic wave as Texas flips blue
Musk, who urged his followers on X to vote Republican as recently as Tuesday, now faces a resurgent Democratic Party that he has spent years antagonizing.
AIG agrees to buy Everest’s Chile business
American International Group Inc. has agreed to buy Everest Compañía de Seguros Generales Chile SA from Bermuda-based Everest Group Ltd. after completing its purchase of Everest’s Colombian insurance…
Commercial premium growth slows amid stiff competition: Report
Australian commercial gross written premiums are projected to grow just 1% this year, continuing a trend of slower growth amid intense competition and rising claims costs, according to Australia-based…
‘In the trenches’: Wisconsin’s struggling small businesses could turn a Trump ally’s district blue
Affordability and small businesses’ economic woes feature heavily in the House race for Wisconsin’s third district
Data center risks outstrip insurance capacity, says Scor chief
Hyperscale data centers carry total insurable values of up to $30 billion for construction alone, but insurers can currently provide only about $15 billion in capacity per risk…
Duke Head Coach Called Intriguing Option for Job Opening
Duke Blue Devils head coach Manny Diaz was named an 'intriguing' option for the Florida State head coach job.
Watch CNN’s coverage of Election Night in 5 minutes
The 2026 midterms results have revealed a blue tsunami as Democrats take back control of Congress. CNN’s coverage over the night highlights the stunning turn of the tides for Donald Trump’s Republican Party.
Wawanesa rolls out WSI after buying Everest’s Canada business
Canadian firm The Wawanesa Mutual Insurance Company has launched WSI, A Wawanesa Company, after acquiring Everest Insurance Company of Canada from Bermuda-based Everest Group Ltd., Beinsure reported.
Steam Is Tightening Its Game Submission Rules As AI Slop Floods The Store
Steam wants developers to actually play their games before submitting them.
Hurricanes Get Honest Assessment on What They Lacked vs. Predators
The Carolina Hurricanes had gone four games without a loss, having defeated the Winnipeg Jets 7-0, the Columbus Blue Jackets 3-2, the Boston Bruins 2-1, and the St. Louis Blues 4-0 in their previous four outings. However, their streak ended on Tuesday, November 3, when they suffered a 4-1 defeat to the Nashville Predators. Following […] The post Hurricanes Get Honest Assessment on What They Lacked vs. Predators appeared first on HEAVY.
AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.
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