Category: The Conversation

Source: The Conversation – USA – By Michael A. Allen, Professor of Political Science, Boise State University

The fragile U.S.-Iran ceasefire announced on April 7, 2026, after 40 days of war came at an opportune time for the United States. Several reports indicate it is running out of weapons amid the conflict.

As a scholar focused on U.S. military deployments, these reports are concerning and somewhat surprising.

After all, the United States spends more money on its military – nearly US$1 trillion annually – than the next nine highest-spending countries combined.

How can the U.S. military be depleting its weapons against a largely isolated country that spends less than 1% of what the United States does?

I believe that gauging U.S. weapons stockpiles provides insight into how the U.S. military may be constrained in the future, and what countries such as Russia and China may learn from the Iran conflict.

The US has a missile problem

Operation Epic Fury, as the U.S. calls the military operation in Iran, has employed a large amount of military assets in a short time. Military analysts suggest the U.S. is running low on Tomahawk missiles, surface-to-surface missiles and air-defense interceptor missiles.

After a month of war, the U.S. had used over 850 Tomahawk missiles, the sea- or ground-launched cruise missile that has a 1,500-mile range.

That represents years of stockpile accumulation. The U.S., for instance, budgeted for 57 Tomahawk missiles in 2025 and procured 22 of them. The U.S. has built roughly 9,000 since the 1980s and may have deployed over 30% of its current stockpile since the start of the Iran war.

The U.S. military has used two types of surface-to-surface missiles at rates that are not sustainable if the Iran conflict were to continue at its previous intensity. These missiles have a range of 200 to 250 miles (320 to 400 km) and are used for precision strikes against military targets, such as air defenses or enemy troops.

The air-defense interceptor missiles used for the Patriot system, a ground-based air defense system, and terminal high-altitude area defense system, or THAAD, are used to protect bases, infrastructure and troops.

The U.S. has eight THAAD systems and has sent munitions from a Korean THAAD system to the Middle East for the Iran conflict.

THAAD systems operate by shooting a missile without an explosive payload. Instead, THAAD interceptors rely on kinetic energy, which is derived from its motion, to destroy incoming missiles. The U.S. has used between 50% to 80% of its THAAD stockpile in its war with Iran, according to the Center for Strategic and International Studies.

The rapid consumption of these resources has forced the U.S. to divert missiles from other regions while seeking new funding and contractors to build missiles. But producing and deploying missiles can take 18 to 24 months because certain components need to be manufactured before being assembled into a final product.

The U.S. has alternatives to these systems, such as the shorter-range, low-cost unmanned combat attack system that uses drones. They are known as LUCAS drones and are based on Iran’s Shahed drone design.

These lower-cost alternatives, however, are less effective and increase the danger to ships, service members and civilians.

Broader concerns

The Iran conflict is not the first time the U.S. has been reported to be depleting its weapons stockpiles. In part, that’s due to its role as the world’s largest supplier of arms, accounting for 43% of global arms exports.

The U.S. has supplied Ukraine with substantial military hardware – missile defense systems, missiles, tanks – for its war with Russia. That has led to delays in weapons shipments, including stinger missiles and Paladin howitzers, to Taiwan, where the U.S. has sent arms since the 1950s to deter China from invading it.

After pausing aid, the Trump administration resumed sending weapons to Ukraine in July 2025. And European support for Ukraine comes through the purchase of U.S. military equipment.

Israel’s war in Gaza and Lebanon has put additional pressure on the U.S. weapons stockpile. The U.S. provides $3.8 billion annually in military aid to Israel, in addition to $16.3 billion since the Oct. 7, 2023, Hamas attacks in Israel.

Whether the U.S. is depleting its weapons because it’s consuming its own stockpile or because of its global commitments, or both, it has ripple effects across the globe. A conflict in the Middle East and new demands on the supply chain for increased production mean there will be shortfalls in Europe and Asia, where U.S.-aligned countries rely upon arms exports for their security.

The US and other powers

The U.S., nonetheless, has evolved its approach to preparing for global threats since the end of the Cold War.

In the 1990s, Washington’s strategy was to be prepared to fight wars in two regions simultaneously. The U.S. has scaled back this 1990s strategy to focus on conflict against a single adversary in a single theater.

The Iran war has nonetheless exposed the limits of U.S. military dominance. And rivals such as China and Russia are learning lessons from the Iran conflict at the United States’ expense.

Michael A. Allen received grant research funding from the Department of Defense’s Minerva Initiative, the US Army Research Laboratory, and the US Army Research Office from 2017 to 2021.

– ref. Can the nearly $1 trillion-a-year US military really be depleting key weapons in Iran? – https://theconversation.com/can-the-nearly-1-trillion-a-year-us-military-really-be-depleting-key-weapons-in-iran-280986

Source: The Conversation – USA – By Emily J. Whitted, Ph.D. Candidate in Early American History, UMass Amherst

At the time of his death in 1831, Stephen Girard – a Philadelphia merchant, banker and philanthropist – was the wealthiest man in the United States. In his will, he left the city of Philadelphia an extraordinary gift of roughly US$6 million, which is almost $227 million today.

Girard also left instructions to use a portion of this gift to found a boarding school for poor, orphaned white boys. Today, this K-12 institution is known as Girard College, and it now admits students from underserved communities regardless of race or gender. Girard College inherited Girard’s material possessions, including furniture, personal papers and clothing – including this pair of heavily repaired silk stockings.

Their survival might make you wonder: Why was the wealthiest man in America walking around in mended clothing?

As a textile historian who writes about the labor of mending in early America, I studied the stitches used to repair Girard’s stockings along with his expansive archival records.

Together, this historical evidence helped me unravel new details about the value of textiles in early America, but also the women – including those who worked in Girard’s household — who made the country’s expansive economic growth possible.

Lessons from a rich man’s socks

Textiles were used every day by virtually every single early American, and were at the time usually the most valuable items one could own.

Prior to widespread mechanization, textiles were expensive due to the cost of materials and skilled labor needed to produce fabric, and they were often sourced abroad. In the late 18th and early 19th centuries, the U.S. had a growing domestic textile industry, but many Americans still imported fabrics from other countries like Great Britain, France and India. Bills from Girard’s household show that he regularly purchased many articles of his clothing, including silk stockings, from France.

The high value of textiles at this time meant that even the wealthiest households rarely discarded damaged clothes. Instead, they repaired them, using sewing needles and thread. While some men did mend, the overwhelming majority of textile repair was completed by women.

The menders: Sally, Polly and Hannah

In Girard’s household, at least three women would have mended his silk stockings and other clothes.

While Girard did marry, his wife, Mary, was institutionalized for mental illness at the Pennsylvania Hospital in 1790, and they had no children. In Mary’s absence, Girard had several mistresses who served as his housekeepers: Sally Bickham, a Quaker woman described by Girard in a letter as a “tayloress” or seamstress, and Polly Kenton, who was a laundress. As part of their labor, they managed Girard’s household affairs and shopping to keep his life running smoothly.

In addition, a Black woman named Hannah Brown from Saint-Domingue, a former French colony in what is now Haiti, was enslaved in Girard’s household for more than 40 years. This was the case even though Pennsylvania’s Gradual Abolition Act in 1780 should have ensured her freedom within six months of her arrival in the U.S. Pennsylvania unevenly enforced gradual abolition, and enslavers like Girard were able to skirt its implementation. Girard’s will granted Brown her freedom.

All three women labored in Girard’s household to mend his stockings, run his household’s daily activities and maintain his home. Three different mending techniques on Girard’s stockings – such as Swiss darning or duplicate knit stitch, woven darning and reinforced heels – are also material expressions of their work alongside paper records like household bills, letters and receipts.

Many early American women both free and enslaved completed unpaid labor in homes, but their labor was a central force in the national economic growth of the early 19th century. Across the country, men like Girard encouraged and profited from widespread industrialization and expanded commercial opportunities, but women’s unpaid domestic labor made their participation and profits possible.

While Philadelphians today may not find their names on prominent street signs or city buildings, Sally, Polly and Hannah’s combined efforts — hidden inside Girard’s shoes and behind his looming historical legacy in Philadelphia – were integral to Girard’s economic success.

Read more of our stories about Philadelphia and Pennsylvania, and sign up for our Philadelphia newsletter on Substack.

Emily J. Whitted currently receives funding from The Library Company of Philadelphia.

– ref. Stockings once worn by Philly’s wealthiest man show the value of women’s mending in early America – https://theconversation.com/stockings-once-worn-by-phillys-wealthiest-man-show-the-value-of-womens-mending-in-early-america-279724

Source: The Conversation – USA (2) – By James Densley, Professor of Criminal Justice, Metropolitan State University

There have been 63 school shootings – meaning any time there is gunfire on a school campus – so far in 2026.

They happen so often that preparing for one has become normal. Students as young as 4 years old routinely practice for the possibility of a school shooting with lockdown drills – typically, hiding in the corner of a dark classroom, behind a locked door.

Pauls Valley High School in Pauls, Oklahoma, went into lockdown on April 7, 2026, after an armed gunman fired shots inside the building. Kirk Moore, the school’s principal, tackled the gunman and got shot in the leg.

The lockdown and Moore’s heroism clearly prevented any further violence in this rare school shooting situation with a positive ending. But by and large, do lockdowns typically work to keep students safe?

As a criminologist who studies violence and mass shootings, I think it is important to keep in mind that there are no federal requirements guiding how often, or even how, lockdown drills should be conducted across schools in the U.S.

Different approaches to lockdowns

Most states have some sort of requirements for a minimum number of lockdown drills a year. In Minnesota, the number is five. New York mandates four, while Arizona law calls for three.

There’s also a lot of variation in how schools interpret the term “lockdown drill.” In some places, it’s used loosely to cover a range of situations – everything from a medical emergency to an animal loose in the building. But that broader usage can obscure what these drills are actually designed for.

In practice, lockdown drills are synonymous with preparing for an active shooter or similarly serious threat of violence. That’s why many people refer to them directly as “active shooter drills.”

Guidance from the I Love U Guys Foundation reinforces this point. Its widely adopted Standard Response Protocol defines a lockdown as locking doors, turning off lights, staying out of sight and remaining silent – measures intended specifically to maximize time and distance from a violent intruder until first responders arrive.

In 2025, Minnesota, where I live, passed the first law in the country that defines an active shooter drill as a form of lockdown, and distinguishes it from an active shooter simulation.

A drill, in this law’s context, “means an emergency preparedness drill designed to teach students, teachers, school personnel, and staff how to respond in the event of an armed intruder on campus or an armed assailant in the immediate vicinity of the school.”

That is different from an active shooter simulation, which incorporates “sensorial components, activities, or elements mimicking a real life shooting.” The law says that students can be mandated to participate in the former, but not in a simulation, where you might have crisis actors involved or the sights and sounds of a real tragedy.

Based on my research, any drill must be conducted in a measured, age appropriate and trauma-informed way, so children are not harmed by the practices. There is a difference between a teacher calming walking students through the procedure, versus having a police officer in tactical gear pounding on the door or jiggling the handle to check if it is locked.

Unclear effect on kids

Most schools started doing lockdowns after the shootings at Sandy Hook Elementary School in Connecticut in 2012 and at Marjory Stoneman Douglas High School in Parkland, Florida in 2018. This is the first generation of students who have practiced what to do if a school shooter comes to kill them – and they have been practicing since pre-K. We don’t yet know what that does to a person over a lifetime.

So far, the available research shows mixed evidence on whether these drills help students feel more prepared or whether they scare them. Studies looking at the mental, emotional and behavioral health outcomes of school active shooter drills tell us that there are short-term gains of reduced fear when drills are carefully designed, and that they do build procedural knowledge that can reduce panic. At the same time, research has captured heightened fear, anxiety and other trauma responses to these drills, especially among children and staff that already have developmental disabilities or have trauma histories.

Lockdown drills have limits

Most school shooters are current or former students at the school. They know where kids hide because they themselves were trained in lockdown response. The shooter at the Annunciation Catholic School in Minneapolis in 2025 even wrote in their journal about how active shooter drills were “useful” because of the lessons they learned from them.

Another issue is that drills tend to assume a single type of scenario, even though school shootings can unfold in very different ways. Practicing for only one eventuality could unintentionally put students in greater harm. The 2022 Uvalde School shooting in Texas is a good example. Children were placed behind a locked door, but then the shooter was in the room with them and murdered them all. The better response, in hindsight, would be to evacuate the building.

More than anything, I think there is a risk that drills normalize school shootings. We have handed school safety to teachers and students with the lights off. Hiding presupposes a seeker. Even young children understand the logic of hide-and-seek (someone is looking for you, and if they find you, you lose). Drills cast students as prey being hunted. That reality alone is a tragedy for American society.

James Densley has received funding from the National Institute of Justice, the Joyce Foundation, and the Sandy Hook Promise Foundation.

– ref. Students are taught to hide in closets and under tables if there is a school shooting – but does practicing for this possibility keep kids safe? – https://theconversation.com/students-are-taught-to-hide-in-closets-and-under-tables-if-there-is-a-school-shooting-but-does-practicing-for-this-possibility-keep-kids-safe-281614

Source: The Conversation – USA (2) – By Jennifer C. Greenfield, Associate Professor of Social Work, University of Denver

In Colorado, more than 600,000 workers received benefits through the Supplemental Nutrition Assistance Program, known as SNAP, in October 2025. This federal program protects low-income children, disabled adults and workers from hunger by providing money to help them buy groceries.

Thousands of Coloradans employed by major corporations, including 2,300 Amazon workers and more than 1,000 workers at King Soopers, use SNAP benefits.

There are also hundreds of recipients who work for local organizations, including nearly 600 employees of the Denver Public Schools system, according to data I evaluated after it was obtained by The Conversation from the Colorado Department of Human Services.

“The findings are a sobering reflection of the economic pressures facing Denver Public Schools staff and K-12 educators everywhere,” said Scott Pribble, director of external communications for Denver Public Schools, in an email to The Conversation.

Denver Public Schools offers some of the highest teacher pay in Colorado and has a minimum hourly rate of $20 for all staff, according to Pribble.

“While we are proud of our current compensation packages, we recognize the need to do more. We are constantly striving to provide higher wages for all staff members,” Pribble wrote.

The data provided by the state has limitations. It does not show how many hours each SNAP recipient works — so we don’t know how many of the workers mentioned above are part-time or seasonal employees.

But the reality is that even full-time workers can receive SNAP benefits. Workers earning at or near the state minimum wage often qualify because their wages, even for full-time work, are still low.

As a social work researcher, I study policies that support working families. I have examined how health and household economic security are affected by paid family and medical leave, universal basic income and childcare subsidies for low- and middle-income workers.

A national problem that’s acute in Colorado

More than 16 million workers across the U.S. rely on programs like SNAP to fill in the gaps.

The U.S. Government Accountability Office reported in October 2020 that more than two-thirds of people in the SNAP program work full time for 50 or more weeks per year. Using data I obtained from the U.S. Census Bureau, I confirmed that in 2024 there were more than 254,000 Colorado workers who received SNAP benefits, and they worked an average of 35 hours per week at an average of around $17.70 per hour.

The reason so many full-time workers still rely on SNAP is rooted in a fundamental gap between wages and the cost of living. Even a single adult with no dependents working 40 hours a week at Colorado’s minimum wage, which is $15.16 per hour, may qualify for SNAP benefits. In fact, earning the state minimum wage and working 52 weeks, they would qualify if they missed just 14 hours of work in the entire year. Colorado law requires employers to provide a maximum of 48 hours of paid sick time to minimum wage workers, but more than half of workers at the minimum have no paid vacation time. As a result, missing more than seven days of work in a year due to illness or other unavoidable circumstances could push wages low enough to qualify a single worker for SNAP.

Households with dependents qualify for SNAP at even higher wages than the state minimum because the annual income threshold, which is $31,320 for a single worker with no dependents, rises with household size.

In short, the state-mandated minimum wage is simply inadequate to meet families’ basic needs, and many full-time workers must rely on SNAP to put food on the table.

Some employers, like Amazon, point to the federal minimum wage, and the differences in SNAP eligibility from state to state, as the root cause of the issue.

“Amazon pay is among the best in the industry – well over double the federal minimum wage and significantly more than other retailers,” said Eileen Hards, an Amazon spokesperson, in an email. “As we’ve said for years, what really needs to happen is a significant and large increase in the federal minimum wage — that would be a big boost for American families.”

With the federal minimum wage set at $7.25 per hour, a rate established in 2009, doubling the minimum wage would still qualify many full-time Amazon workers for SNAP in 28 states, including Colorado.

Colorado cost of living soars

Ten years ago, Colorado voted to increase the state’s minimum hourly wage. Voters had already approved a constitutional amendment in 2006 tying the minimum wage to the cost of living, and the 2016 ballot initiative established a new floor of $12 per hour, starting in 2020, which would increase annually to keep pace with inflation. Since the 2016 vote, as costs have soared, the minimum wage has kept pace with the official consumer price index for Colorado, rising from $12 in 2020 to $15.16 in 2026.

Some Colorado cities have increased it further. For instance, Denver’s minimum wage is $19.29, and Boulder’s is $16.82.

Employers like Amazon and Kroger, which operates King Soopers, offer higher wages than the state and local minimum wages. Kroger, which employs 24,000 people in Colorado, has an average hourly wage of $24.58 and approximately $32 an hour when benefits are included, according to Jessica Trowbridge, head of corporate affairs at King Soopers.

“Our associates also have an average tenure of 16 years, reflecting the meaningful, long-term career opportunities we strive to provide,” she said in an email to The Conversation. “Additionally, supporting the communities we serve is central to our mission, and within a year we’ve donated more than 27 million meals locally to help address food insecurity.”

But Colorado’s cost of living has risen faster than the U.S. average, and even with yearly cost-of-living increases to the state’s minimum wage, wages are not high enough to pay for basic needs. The Living Wage project at MIT estimates that a single worker with no dependents in Colorado needs $26 per hour to meet their basic needs, while a family with two workers and two children needs $34.04 per hour per worker.

Meanwhile, the median wage across all households in Colorado is $23.77 per hour.

The mismatch between incomes and the cost of living is not only a problem for families trying to make ends meet. It is increasingly a problem for state budgets as well, especially as changes to the SNAP program, passed by Congress in 2025, take effect. An estimated 298,000 Coloradans will lose some or all SNAP benefits by January 2027 due to changes passed as part of tax and spending bill in July 2025. The changes will also add an estimated $178 million to the Colorado state budget by shifting costs from the federal budget to states.

The broad eligibility for SNAP among even full-time workers highlights a fundamental issue: At the current minimum wage, workers are not making enough to pay for essentials like housing, food and childcare. Those with dependents face especially difficult choices about how to juggle working and parenting, especially when childcare alone costs $1,645 per month in some counties in Colorado – or about two-thirds of the income of a full-time worker earning the minimum wage in the state.

Colorado, and the U.S. overall, has a wage problem. Costs continue to rise, while incomes, even in states that have adjusted minimum wage guidelines, increasingly fail to bring households out of poverty.

Policymakers face a tough set of questions. Is adjusting the minimum wage the answer? Should major employers be held accountable when their employees rely on taxpayer-funded public programs to fill the gap between their paychecks and the cost of their basic needs? Or do other policy levers hold more potential to close the gap between incomes and household costs?

As Americans watch prices rise at the gas pump and on grocery store shelves, answers to these important questions are urgently needed.

Read more of our stories about Colorado.

Jennifer Greenfield received funding from the Colorado Women’s College and the Women’s Foundation of Colorado to support research on the 2016 minimum wage ballot initiative mentioned in this article. She currently receives funding from the Women’s Foundation of Colorado to support research on women’s wellbeing in the state.

– ref. Thousands of employed Colorado workers need SNAP benefits to make ends meet – https://theconversation.com/thousands-of-employed-colorado-workers-need-snap-benefits-to-make-ends-meet-277826

Source: The Conversation – USA (3) – By Marc Cohen, Professor of Gerontology, UMass Boston

Mehmet Oz, the Centers for Medicare & Medicaid Services administrator, is ordering all states to step up their efforts to crack down on Medicaid fraud.

His April 21, 2026, announcement expanded on the Trump administration’s related enforcement actions, such as withholding Medicaid funds from Minnesota and threatening to do that for New York, California and Maine.

The Trump administration says there’s a big problem with fraud tied to government-funded care delivered in a person’s home or in the community, officially known as home and community-based services, along with nonmedical transportation, behavioral health and new or high billing providers.

The agency Oz leads is now asking states to immediately “revalidate” providers they claim are “high risk.” That is, states are supposed to require providers to prove that they remain eligible to participate in Medicaid and bill the program. The providers primarily offer at-home care, transportation, behavioral health and other services.

Related legislative initiatives, sponsored by Republicans, are also pending in Congress.

We are health services researchers who study the development and growth of the Medicaid home and community-based services program. One of us (Barkoff) previously served in the role of administrator and assistant secretary for aging of the Administration for Community Living.

We strongly believe that it is sensible and necessary for the government to take steps to prevent, root out and punish Medicaid fraud. But we are mindful that the government’s anti-fraud strategies and tactics could unnecessarily disrupt the very services that people depend on day to day.

We aren’t alone. Many researchers, advocates and policy experts are alarmed by this White House policy.

What’s at stake

All told, Medicaid provides health insurance coverage for about 75 million low-income Americans, including many who are at least 65 years old.

More than 5 million Americans benefit from government-funded home care, which is aimed at keeping low-income people with disabilities and frail older people living in their own homes and communities. Medicaid pays for most home care, covering nearly two-thirds of all such spending in 2023.

When home care works well, people become less likely to have to move into nursing homes or other assisted living facilities. If a home care aide doesn’t show up, the consequences are immediate and can be dire.

An older adult may be unable to get out of bed. A person with disabilities may miss meals or medications. A family caregiver may have to take time off without notifying their employer in advance and lose wages.

That’s why the federal government’s actions – particularly those targeting services provided in a person’s home or community – could endanger millions of people.

Supreme Court ruling

Home and community-based services include help with bathing, dressing, eating, medication management and mobility – services that allow people to remain in their homes rather than moving into nursing facilities. A shift toward home-based care has been underway for decades, driven by both costs and civil rights protections.

One reason for the shift was the 6-3 ruling in 1999 by the Supreme Court in the Olmstead v. L.C. case. The majority affirmed the right of people with disabilities to live in their own homes and communities when possible.

Today, most Medicaid long-term care spending covers the cost of services provided in a person’s home or local community, rather than in an institution. These services cost less and lead to better outcomes. Research and program data consistently show that fraud in these programs is relatively rare.

This is especially true due to safeguards like electronic visit verification, which ensures providers are actually providing services in the home.

Another safeguard in place is that most states contract with and approve
fiscal intermediaries, which act as payroll, payment and compliance managers, to make sure that there are verifiable records, payment controls and audit trails in place for the Medicaid program.

Not all ‘improper payments’ are fraudulent

A central problem in the Trump administration’s strategy to root out alleged Medicaid fraud is a basic mischaracterization of many things as fraud that aren’t fraudulent.

Federal agencies are tracking “improper payments” and incorrectly equating them with fraud. The Centers for Medicare & Medicaid Services makes clear that most improper payments stem from documentation errors or administrative issues – not intentional wrongdoing.

The Government Accountability Office, a nonpartisan government agency that produces in-depth research, notes that while fraud does lead to improper payments, the reverse is not necessarily true. That is, improper payments can have a cause besides fraud, such as administrative errors and eligibility processing mistakes.

Blurring the distinction between improper payments and fraud can make it seem like providers are illegally taking advantage of the system. And when that happens, policymakers may turn to blunt solutions that do little to punish actual fraudsters, such as cutting or withholding funding, rather than fixing administrative problems.

Exaggerating the scope of Medicaid fraud

In our view, proposals to overhaul Medicaid’s enforcement methods should be grounded in strong and objective data. Yet much of the argument for structural reform relies on anecdotal examples, isolated cases and select audit findings without broader context.

One of the more egregious cases perpetrated by providers was a home care agency in Pennsylvania that billed fraudulent claims between 2020-2023 totaling US$1.8 million. Another was the Minnesota provider penalized in 2025 after billing for services not delivered.

But those infractions do not justify characterizing an entire category of services that helps tens of millions of Americans remain in their homes as rife with fraud and in need of dramatic changes.

By contrast, as we explained in Health Affairs ForeFront in March 2026, federal oversight bodies – including the Centers for Medicare & Medicaid Services, the Government Accountability Office and the Health and Human Services’ inspector general – produce systematic, data-driven analyses.

These sources consistently caution against equating improper payments with fraud and emphasize targeted approaches to program integrity.

The government designated some 6% of the annual payments by Medicaid as improper payments between 2022-2025, which were worth about $37 billion. Yet, more than 3 in 4 improper payments resulted from insufficient documentation, which usually doesn’t indicate fraud or abuse.

What’s more, Medicaid fraud is regularly subject to enforcement actions. In 2025, Medicaid fraud control units reported 1,185 convictions for fraud nationwide, and combined recoveries from criminal and civil cases totaled about $2 billion.

Emphasis on high-profile cases

Again, a few widely publicized fraud cases in Minnesota and a few other states do not prove that fraud is a chronic problem for Medicaid billing in home care programs.

In an agency as big as Medicaid, which spends nearly $1 trillion annually, some level of fraud will occur. The key question is whether fraud is widespread, systemic or goes unpunished.

Available evidence suggests Medicaid fraud is none of those things.

For example, large-scale home care programs serving hundreds of thousands of people report extremely low rates of confirmed fraud cases. Enforcement data from Medicaid Fraud Control Units, which investigate and prosecute Medicaid fraud, show that when fraud occurs, it is investigated and prosecuted.

In other words, the presence of enforcement activity is evidence that oversight systems are working – not that they’re failing.

A better approach

We believe that many strategies that are better than those that the Trump administration is embracing are readily available. Some examples include improved data analytics, stronger referral systems within managed care plans, enhanced provider screening and documentation standards, and continued support for Medicaid Fraud Control Units.

These approaches target fraud directly without jeopardizing access to the essential Medicaid services that help tens of millions of older adults and disabled people remain where they want to be: in their own homes instead of in more expensive nursing homes.

Given that the U.S. spends about $930 billion a year on the program, we don’t question the wisdom of engaging in its oversight.

But we are concerned that the policy response to alleged fraud could harm the very people that the Trump administration says its efforts are meant to protect.

Marc Cohen receives funding from the RRF Foundation for Aging.

Alison Barkoff receives funding from the Commonwealth Fund.

Jane Tavares receives funding from the RRF Foundation for Aging.

Sara Rosenbaum receives funding from the Commonwealth Fund.

– ref. Trump’s Medicaid fraud crackdown may sound sensible, but it could harm Americans who require long-term care – https://theconversation.com/trumps-medicaid-fraud-crackdown-may-sound-sensible-but-it-could-harm-americans-who-require-long-term-care-281500

Source: The Conversation – USA (3) – By Carey S. Cadieux, Associate Professor of Nursing, Binghamton University, State University of New York

When the U.S. Department of Justice moved to reclassify medical marijuana to a Schedule III drug on April 23, 2026, it set the stage for a vast amount of medical research that has been hobbled for decades by its more restrictive Schedule I classification.

The Justice Department also called for an expedited federal rescheduling process, with proceedings expected to begin in late June 2026, but for now cannabis at the federal level remains a Schedule I drug.

I’m an associate professor of nursing and I edited a textbook for nurses about providing care with cannabis. Cannabis is the umbrella term for the plant genus that includes both marijuana and hemp – two varieties of the same plant distinguished primarily by their content of THC, one of the active components of cannabis.

Moving cannabis to a Schedule III drug ushers in the end of the cannabis prohibition era and the beginning of the regulation era, potentially creating promising opportunities around research and new therapeutics.

How are drugs regulated by ‘schedule’?

The Controlled Substances Act of 1970 categorizes all substances regulated under existing federal law into one of five schedules. The act regulates the manufacturing, importation, possession, use and distribution of substances on each schedule.

Several factors determine schedule placement, including the drug’s medical use, scientific evidence of its benefits and pharmacological effects, patterns and history of abuse, public health risk level, degree of physical or psychological addiction potential, and whether the drug can be used to make another controlled substance.

The Drug Enforcement Administration’s rescheduling of marijuana will move it from its current classification as a Schedule I drug, defined as having a high risk for abuse and no accepted medical use, to a Schedule III drug under the Controlled Substances Act. While still tightly regulated, Schedule III drugs are considered to have moderate to low risk for physical and psychological dependence and to have some medical benefits.

Other Schedule I drugs include heroin, psilocybin, LSD, peyote and MDMA, or ecstasy. These drugs cannot be dispensed or prescribed, with some exceptions. Current Schedule III drugs include ketamine, anabolic steroids, testosterone, products with less than 90 milligrams of codeine per dosage unit and some cannabinoids.

The move to reclassify medical marijuana products as Schedule III drugs applies only to those products certified by state-level medical cannabis programs. All other cannabis products remain a federal Schedule I drug, including those available from states’ recreational cannabis programs.

Impacts of cannabis reclassification

This legal order acknowledges that medical marijuana has some medical value and asserts that it has a lower potential for abuse than under the previous Schedule I classification.

The reclassification also ensures that state-registered medical cannabis patients continue to be permitted to purchase medical cannabis products without changes to their current certification or recommendation.

One of the challenges with this new law is that states have not standardized medical cannabis regulations, and each state will have its own quality and testing standards. In Maine, for instance, medical cannabis is not tested for molds, fungus, heavy metals or pesticides, while recreational cannabis is.

This means that the Schedule III medical cannabis in Maine could be contaminated, while the state’s testing of recreational cannabis makes it much safer to consume.

What are the implications for marijuana research?

For decades, researchers have struggled to conduct high-quality research studies due to their lack of access to the cannabis products that patients actually use and restrictions on their processes.

With the reclassification, researchers who are registered with the DEA to research cannabis will be able to obtain cannabis flower and plant material, as well as manufactured cannabis products, such as tinctures and edibles, directly from state-licensed businesses that are DEA-registered.

This means researchers will no longer need to rely on the federal DEA registry for access to cannabis products for research, which were often inferior in quality and variety in comparison to the everyday products medical cannabis patients typically have access to. Instead, they will be able to study cannabis products that patients use in daily life, such as vapes and various edible products.

This shift in access will now allow researchers to undertake the gold standard of research approaches: the randomized controlled trial.

Randomized controlled trials will help researchers like my colleagues determine how effective cannabis is in treating people with complex medical needs. This includes patients who experience nausea and pain while undergoing cancer treatments, multiple sclerosis patients with severe muscle spasm and stiffness, and chronic pain patients who strive to find relief without using opioids.

Might rescheduling send mixed signals?

Rescheduling may lead people to believe that cannabis is safe for all people to consume.

However, a growing body of research points to possible adverse effects from cannabis use, particularly in vulnerable groups, such as people who are pregnant, adolescents, people with preexisting mental health conditions such as schizophrenia or psychosis, and those with cardiac issues.

Cannabis can also lead to adverse drug interactions. Therefore, medical patients should use it with discretion and under the guidance of a healthcare professional.

For most medical cannabis patients, THC doses should start low and gradually be increased.

Rescheduling will be a big step toward helping researchers build a greatly needed solid body of evidence around both the benefits and potential harms of cannabis. But rescheduling should not be interpreted as a signal that cannabis is harmless.

Carey S. Cadieux is affiliated with the American Cannabis Nurses Association as a volunteer who consults with them on federal and state-level cannabis policy, and the editor of the textbook Cannabis: A handbook for nurses, published by Wolters Kluwer.

– ref. Reclassification of marijuana opens doors for much-needed medical research into the benefits and risks of the drug – https://theconversation.com/reclassification-of-marijuana-opens-doors-for-much-needed-medical-research-into-the-benefits-and-risks-of-the-drug-281403