By Bram Sable-Smith and Oona Zenda, KFF Health News

Last winter, Amber Wingler started getting a series of increasingly urgent messages from the local hospital in Columbia, Missouri, letting her know her family’s health care might soon be upended.

MU Health Care, where most of her family’s doctors work, was mired in a contract dispute with Wingler’s health insurer, Anthem. The existing contract was set to expire.

Then, on March 31, Wingler received an email alerting her that the next day Anthem was dropping the hospital from its network. It left her reeling.

“I know that they go through contract negotiations all the time … but it just seemed like bureaucracy that wasn’t going to affect us. I’d never been pushed out-of-network like that before,” she said.

The timing was awful.

Wingler’s 8-year-old daughter, Cora, had been having unexplained troubles with her gut. Waitlists to see various pediatric specialists to get a diagnosis, from gastroenterology to occupational therapy, were long — ranging from weeks to more than a year.

(In a statement, MU Health Care spokesperson Eric Maze said the health system works to make sure children with the most urgent needs are seen as quickly as possible.)

Suddenly, the specialist visits for Cora were out-of-network. At a few hundred bucks a piece, the out-of-pocket cost would have added up fast. The only other in-network pediatric specialists Wingler found were in St. Louis and Kansas City, both more than 120 miles away.

So Wingler delayed her daughter’s appointments for months while she tried to figure out what to do.

Nationwide, contract disputes are common, with more than 650 hospitals having public spats with an insurer since 2021. They could become even more common as hospitals brace for about $1 trillion in cuts to federal health care spending prescribed by President Donald Trump’s signature legislation signed into law in July.

Patients caught in a contract dispute have few good options. “There’s that old African proverb: that when two elephants fight, the grass gets trampled. And unfortunately, in these situations, oftentimes patients are grass,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation, a nonprofit that helps people who are having trouble accessing health care.

If you’re feeling trampled by a contract dispute between a hospital and your insurer, here is what you need to know to protect yourself financially:

1. “Out-of-network” means you’ll likely pay more.

Insurance companies negotiate contracts with hospitals and other medical providers to set the rates they will pay for various services. When they reach an agreement, the hospital and most of the providers who work there become part of the insurance company’s network.

Most patients prefer to see providers who are “in-network” because their insurance picks up some, most, or even all of the bill, which could be hundreds or thousands of dollars. If you see an out-of-network provider, you could be on the hook for the whole tab.

If you decide to stick with your familiar doctors even though they’re out-of-network, consider asking about getting a cash discount and about the hospital’s financial assistance program.

2. Rifts between hospitals and insurers often get repaired.

When Brown University health policy researcher Jason Buxbaum examined 3,714 nonfederal hospitals across the U.S., he said, he found that about 18% of them had a public dispute with an insurance company sometime from June 2021 to May 2025.

About half of those hospitals ultimately dropped out of the insurance company’s network, according to Buxbaum’s preliminary data. But most of those breakups ultimately get resolved within a month or two, he added. So your doctors very well could end up back in the network, even after a split.

3. You might qualify for an exception to keep costs lower.

Certain patients with serious or complex conditions might qualify for an extension of in-network coverage, called continuity of care. You can apply for that extension by contacting your insurer, but the process may prove lengthy. Some hospitals have set up resources to help patients apply for that extension.

Some patients decide to put off appointments while they wait. Others keep their appointments and pay out-of-pocket. (Oona Zenda/KFF Health News/TNS)

Wingler ran that gauntlet for her daughter, spending hours on the phone, filling out forms, and sending faxes. But she said she didn’t have the time or energy to do that for everyone in her family.

“My son was going through physical therapy,” she said. “But I’m sorry, dude, like, just do your exercises that you already have. I’m not fighting to get you coverage too, when I’m already fighting for your sister.”

Also worth noting, if you’re dealing with a medical emergency: For most emergency services, hospitals can’t charge patients more than their in-network rates.

4. Switching your insurance carrier may need to wait.

You might be thinking of switching to an insurer that covers your preferred doctors. But be aware: Many people who choose their insurance plans during an annual open enrollment period are locked into their plan for a year. Insurance contracts with hospitals are not necessarily on the same timeline as your “plan year.”

Certain life events, such as getting married, having a baby, or losing a job, can qualify you to change insurance outside of your annual open enrollment period, but your doctors’ dropping out of an insurance network is not a qualifying life event.

5. Doctor-shopping can be time-consuming.

If the split between your insurance company and hospital looks permanent, you might consider finding a new slate of doctors and other providers who are in-network with your plan. Where to start? Your insurance plan likely has an online tool to search for in-network providers near you.

But know that making a switch could mean waiting to establish yourself as a patient with a new doctor and, in some cases, traveling a fair distance.

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6. It’s worth holding on to your receipts.

Even if your insurance and hospital don’t strike a deal before their contract expires, there’s a decent chance they will still make a new agreement.

Some patients decide to put off appointments while they wait. Others keep their appointments and pay out-of-pocket. Hold on to your receipts if you do. When insurers and hospitals make up, the deals often are backdated, so the appointments you paid for out-of-pocket could be covered after all.

End of an ordeal

Three months after the contract between Wingler’s insurance company and the hospital lapsed, the sides announced they had reached a new agreement. Wingler joined the throng of patients scheduling appointments they’d delayed during the ordeal.

In a statement, Jim Turner, a spokesperson for Anthem’s parent company, Elevance Health, wrote, “We approach negotiations with a focus on fairness, transparency, and respect for everyone impacted.”

Maze from MU Health Care said: “We understand how important timely access to pediatric specialty care is for families, and we’re truly sorry for the frustration some parents have experienced scheduling appointments following the resolution of our Anthem contract negotiations.”

Wingler was happy her family could see their providers again, but her relief was tempered by a resolve not to be caught in the same position again.

“I think we will be a little more studious when open enrollment comes around,” Wingler said. “We’d never really bothered to look at our out-of-pocket coverage before because we didn’t need it.”

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. Share your story. The crowdsourced project is a joint production of NPR and KFF Health News.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By CORA LEWIS

NEW YORK (AP) — Online betting is more accessible than ever, with 14% of U.S. adults saying they bet on professional or college sports online either frequently or occasionally, according to a February poll by The Associated Press-NORC Center for Public Affairs Research. It’s also in the news, with a growing list of sports betting scandals making headlines.

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Public health advocates and personal finance advisers say it’s important to know the risks if you’re going to gamble online.

“Gambling and ‘responsibly’ seem to be oxymoronic, because if you’re gambling it’s all about risk,” said Caleb Silver, editor in chief of personal finance site Investopedia. “But people still do it. Online gambling and sports betting are only becoming more popular.”

Since the Supreme Court struck down a ban on sports betting in 2018, 38 states and Washington, D.C., have legalized gambling, according to the American Gaming Association.

For those new to online gambling, it can be helpful to set limits in advance on how much you’re willing to lose and how much time you’re willing to spend. Many of the platforms and apps that offer gambling, such as FanDuel and DraftKings, include optional safeguards to limit time or losses. Other apps can block access to the platforms for set amounts of time.

Here’s what to know:

Online gambling can be riskier than gambling in person

The potential losses of digital betting can occur more quickly than in a physical casino, according to Heather Eshleman, director of operations at the Maryland Center for Excellence on Problem Gambling, since people can bet so much so easily and quickly on the internet or apps, with less friction.

The new prevalence of prediction markets, such as PredictIt and Kalshi, has also created new opportunities to place wagers online on everything from election outcomes to celebrity news to the weather.

How to tell if you have a problem with online gambling

According to public health advocates, the biggest warning sign of a problem is if you’re devoting time to online betting that’s taking away from other things in your life — especially your relationships with friends, family, and work. If you’re spending money on gambling that could instead go towards unmet basic needs, that’s also a warning sign.

“We encourage people to only use money they would use for fun and entertainment, not money that should be used to pay the mortgage or the rent or to pay for food,” said Eshleman.

Silver echoed this.

“You have to know before you do it how much you can afford to lose,” he said. “What is your ‘tap out point?’ Those rules have to be firmly established.”

Ways to limit online gambling

Most sports betting platforms offer “responsible gambling tools,” according to Eshleman.

“You can set limits on time, money, deposits, wins, and losses,” she said. “The goal is to set those limits before you start, because if you don’t set them in advance, they’re not really going to work for you. Once you’re into the excitement of it, you’re not going to stop and use those tools.”

Eshleman recommends apps such as GambBan and BetBlocker, which limit access to gambling sites externally. She also directs those who suspect they may have a problem to use the 1-800-GAMBLER hotline or contact Gamblers Anonymous.

Know the risks and downsides

Silver, the head of Investopedia, said he started adding definitions of online betting and gambling terms to the personal finance site when he saw an increasingly “closer connection between sports betting, day trading, options trading, and cryptocurrency trading.” He encourages those who are interested in digital betting to make sure they know what they’re getting into.

“Before anyone even gets an online (gambling) account, they should be required to know the fundamental terms and rules about the way sports betting works,” he said. “What’s the ‘money line’ or ‘parlay?’ How do odds work? What is the maximum I could lose on this bet?”

The other thing to do is to “play with no expectation of a return,” he said. “The likelihood is that you will lose. So, if you’re willing to lose, how much are you willing to lose?”

Cory Fox, senior vice president of public policy and sustainability at FanDuel, who handles the site’s responsible gambling initiatives, compares using the safeguards to wearing a seatbelt when driving in a car and said FanDuel is committed to setting standards for being a responsible operator in the online gambling space.

Lori Kalani, chief responsible gaming officer at DraftKings, said the site is committed to the same goal and compared using the limit-setting tools to taking Ubers instead of driving on a night when you know you’ll be drinking.

Fox added that responsible gambling tools are important to help allow FanDuel to maintain its social license. He said that it’s in the interest of the site to make sure its users can be on the site and play for a long time to come.

Make sure it’s not a coping mechanism

“If you’re taking care of your mental health, you’re less likely to have a problem with gambling,” Eshleman said.

Rather than turning to the thrill of placing online bets, Eshleman encourages people to find positive ways to cope with stress — listening to music, taking walks, getting more sleep and exercise, and spending more time socializing. Social gambling is safer than hidden, private gambling, she said.

“If you’re doing it alone, that’s a red flag that it’s not an activity that’s healthy for you,” said Eshleman. “It all ties in to our basic wellness. I think if people focus on wellness, it will prevent a lot of gambling.”

The Associated Press receives support from the Charles Schwab Foundation for educational and explanatory reporting to improve financial literacy. The independent foundation is separate from Charles Schwab and Co. Inc. The AP is solely responsible for its journalism.

Lawmakers approved a plan Wednesday to rezone a 54-block swath of the Queens waterfront neighborhood, including industrial lots where new housing was previously restricted.

Anable Basin in Long Island City—once eyed by retail giant Amazon for its Queens headquarters before the controversial plan fell apart—is part of the rezoning area. (Adi Talwar/City Limits)

The City Council approved a plan Wednesday to rezone a stretch of Long Island City, including industrial lots where new housing was previously restricted—what officials say will spur nearly 15,000 new apartments in the coming years, as the city struggles to fill a historic housing shortage.

The so-called OneLIC plan will update zoning rules for 54 blocks near the East River waterfront, including along Anable Basin (the inlet where retail giant Amazon once planned its controversial “HQ2” offices.) It’s expected to create more housing than any neighborhood-specific rezoning in the last 25 years, officials said; around 4,350 of the new units will be income-restricted.

The deal also includes $650 million for a range of local projects, including funds for a new waterfront esplanade, sewer upgrades, and repairs at the nearby NYCHA Queensbridge Houses.

“The approval of this plan opens the door for more New Yorkers of all income levels to live and work here—and to benefit from new open space and community investments,” City Planning Commissioner Dan Garodnick said in a statement Wednesday.

The neighborhood rezoning is the fifth passed under Mayor Eric Adams, who leaves office at the end of the year. It’s also the second in Queens: in late October, the Council approved a plan to allow more housing in Downtown Jamaica, what officials say will help address a dire need as New Yorkers struggle to afford increasingly high rents, and more than 100,000 people sleep in shelters each month.

Areas rezoned for residential under the OneLIC plan will be subject to the city’s Mandatory Inclusionary Housing (MIH) rules for the first time, requiring at least 20 to 25 percent of new units built on private sites are affordable.

Those apartments will be reserved for households earning up to either 40 or 60 percent of the Area Median Income, or AMI (equivalent to $58,320 or $87,480 a year for a three-person household, respectively). The city also plans to develop 1,000 affordable units on public land within the rezoning area, at least half of which must be set aside for “Extremely” and “Very Low-Income” households—or those earning no more than 50 percent AMI.

Long Island City is no stranger to development: the neighborhood’s population grew by 60 percent between 2013 and 2023, according to the Long Island City Partnership, a local business advocacy group. Glossy apartment towers have bloomed along the area’s waterfront.

The waterfront along Hunters Point just south of the rezoning area, where many new buildings have risen over the last several years. (Adi Talwar/City Limits)

That existing growth is why some locals have opposed the rezoning, saying an influx of new residents will further strain local infrastructure that already hasn’t kept up.

“Long Island City has not avoided development. So why is all this new development coming here?” said Lisa Goren, a member of the Long Island City Coalition/Hunters Point Community Coalition.

“The City of Yes was supposed to distribute housing equitably,” she added, in reference to Mayor Adams’ plan passed last year, which overhauled zoning rules citywide to make it easier to build.

The Coalitions have been advocating for an alternative plan, dubbed the Hunters Point North Vision Plan for Resiliency, which calls for a robust waterfront park and climate resiliency measures along the shoreline. They say that any new housing should be built further inland, outside the floodplain, noting that the area was hit hard by flooding during Hurricane Sandy.

“We have to do resiliency and we have to house people. We can do both. And that’s what we’re saying,” Goren said. “We’re saying that we’re given a false choice in this plan.”

But city officials argue the rezoning area has been held back by outdated rules that restrict new housing in a neighborhood that’s prime for more homes, pointing to its proximity to Manhattan and access to multiple subway and bus lines.

Councilmember Julie Won, who represents the area, said she fought to secure millions in community benefits as part of the deal, like the upgrades to the nearby Queensbridge Houses and improved sewer infrastructure.

A view of the Queensboro Bridge from Vernon Boulevard. (Adi Talwar/City Limits)

The city has also pledged to open 1,300 new school seats and add five acres of open space under the Queensboro Bridge—including comprehensive renovations to Queensbridge Baby Park, a once popular neighborhood space which has fallen into disrepair.

This and the planned new waterfront esplanade will result in a continuous stretch of open space along the neighborhood’s waterfront, Won noted, linking Queensbrige Park north of the rezoning area to Gantry Plaza State Park and Hunters Point South Park to the south.

“All that is long overdue,” Won said ahead of the Council’s vote on the plan Wednesday. “Finally, through this project, we will become one Long Island City to integrate current and future residents in all corners of this neighborhood.”

To reach the editor, contact Jeanmarie@citylimits.org. Want to republish this story? Find City Limits’ reprint policy here.

A previous version of this story misspelled Lisa Goren’s last name. City Limits apologizes for the error.

The post 15K New Homes for Long Island City? Council Approves Major Rezoning Plan appeared first on City Limits.

By MICHAEL CASEY, Associated Press

BOSTON (AP) — After years of living on the street and crashing on friends’ couches, Quantavia Smith was given the keys to a studio apartment in Los Angeles that came with an important perk — easy access to public transit.

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The 38-year-old feels like she went from a life where “no one cares” to one where she has a safe place to begin rebuilding her life. And the metro station the apartment complex was literally built upon is a lifeline as she searches for work without a car.

“It is more a sense of relief, a sense of independence,” said Smith, who moved in July. She receives some government assistance and pays 30% of her income for rent — just $19 a month for an efficiency with a full-market value of $2,000.

“Having your own space, you feel like you can do anything.”

Metro areas from Los Angeles to Boston have taken the lead in tying new housing developments to their proximity to public transit, often teaming up with developers to streamline the permitting process and passing policies that promote developments that include a greater number of units.

City officials argue building housing near public transit helps energize neglected neighborhoods and provide affordable housing, while ensuring a steady stream of riders for transit systems and cutting greenhouse gas emissions by reducing the number of cars on the road.

“Transit-oriented development should be one of, if not the biggest solution that we’re looking at for housing development,” said Yonah Freemark, research director at the Urban Institute’s Land Use Lab, who has written extensively on the topic.

“It takes advantage of all of this money we’ve spent on transportation infrastructure. If you build the projects and don’t build anything around the areas near them, then it’s kind of like money thrown down the drain,” Freemark said.

Transit housing projects from DC to LA

The Santa Monica and Vermont Apartments where Smith lives is part of an ambitious plan by the Los Angeles County Metropolitan Transportation Authority to build 10,000 housing units near transit sites by 2031 — offering developers land discounts in exchange for affordable housing development and other community benefits.

A family arrives at a metro station next to the Santa Monica and Vermont Apartments in Los Angeles, Monday, Nov. 10, 2025. (AP Photo/Jae C. Hong)

In Washington D.C., the transit authority has completed eight projects since 2022 that provided nearly 1,500 apartments and a million square feet of office space. About half were in partnership with Amazon, which committed $3.6 billion in low-cost loans and grants for affordable housing projects in Washington, as well as Nashville, Tennessee, and the Puget Sound area in Washington state. Almost all are within a half-mile of public transit.

“Big cities face the greatest challenges when it comes to traffic congestion and high housing costs,” Freemark said. “Building new homes near transit helps address both problems by encouraging people to take transit while increasing housing supply.”

Among projects Boston has built, the Pok Oi Residents in Chinatown is a 10-minute walk to the subway and a half-dozen bus stops. That’s a draw for Bernie Hernandez, who moved his family there from a Connecticut suburb after his daughter got into a Boston university.

“The big difference is commuting. You don’t need a car,” said Hernandez, who said he can walk to the grocery story and pharmacy. His 17-year-old daughter takes the subway to school. Now, his car mostly sits idle, saving him money on gas and time spent in traffic.

“You get to go to different places very quickly. Everything is convenient,” Hernandez said.

States take aim at zoning regulations

States from Massachusetts to California are passing laws targeting restrictive zoning regulations that for decades prohibited building multifamily developments and contributed to housing shortages.

Last month, California Gov. Gavin Newsom signed a state law allowing taller apartment buildings on land owned by transit agencies and near bus, train and subway lines.

Land owner Ricky Cannizzo drives a backhoe through his property, which was approved to be developed into residential units and commercial space, Jan. 28, 2025, in Lexington, Mass. (AP Photo/Charles Krupa)

“Building more homes in our most sustainable locations is the key to tackling the affordability crisis and locking in California’s success for many years to come,” said State Sen. Scott Wiener, a Democrat who authored the bill.

California joins Colorado, which requires cities to allow an average of 40 housing units per acre within a quarter-mile of transit, and Utah, which mandates about 50 units per acre. In Washington, the governor signed a bill this year allowing taller housing developments in mixed-use commercial zones near transit.

“We want to ensure that there are mixed-income, walkable, vibrant homes all around those transit investments and that people have the option of using cars less to improve the environmental health of our communities,” said Democratic Rep. Julia Reed, who authored the Washington bill.

“It’s about giving people the opportunity to drive less and live more.”

Housing takes center stage in Massachusetts

Massachusetts Democratic Gov. Maura Healey has made housing a priority.

Among her most potent tools is a 2021 law that requires 177 towns or communities nearby to create zoning districts allowing multi-family housing. The state provided nearly $8 million to more than 150 communities to help create these zones, while threatening to cut funding for those that don’t. More than 6,000 housing units are in development as a result.

“You put housing nearby public transit” Healey said. “It’s great for people. They can literally get up, leave their home, walk to a commuter rail and get to work.”

Bernie Hernandez, who lives at the Pok Oi Residences, poses in his Chinatown neighborhood, Oct. 17, 2025, in Boston. (AP Photo/Charles Krupa)

Among the first to comply was Lexington, which has approved 10 projects, including a $115 million complex with 187 housing units and retail space.

Walking past earth-moving equipment and dump trucks at the construction site earlier this year, project manager Quinlan Locke said: “This is a landscape yard. It’s commercial. It’s meant for trucking.”

But, he added, in “two years from now, it’s going to be meant for people who live here, work here and play here. This is going to become someone’s home.”

Opposition to zoning changes

Some advocates argue the lofty goals of transit housing are falling short due to fierce local resistance and lack of funding and support at the federal and state levels.

Higher mortgage interest rates, more government red tape, rising construction costs and lack of investment at transit stations also have contributed to a troubling trend — nine times more housing units built far from public transit versus near it in the past two decades, according to a 2023 Urban Institute study.

In Massachusetts, 19 communities still haven’t created new zones. Some unsuccessfully sued the state to halt the law, while residents rejected new zones in others. Lexington eventually shrank its zone from 227 acres to 90 acres after residents complained.

“If we allow the state to come in and dictate how we zone, what else are they going to come in and dictate?” said Anthony Renzoni, a selectman from the town of Holden, which sued the state and is drawing up a new zoning map after residents rejected the first one.

New housing, a new life

In Los Angeles, the six-story complex where Smith lives in East Hollywood is home to 300 new residents since opening in February. It’s revitalizing the area around the metro site, with a Filipino grocery, medical clinic and farmers market opening early next year.

Half the 187 units are reserved for formerly homeless residents like Smith, who had been living in a rundown motel paid for with a voucher and before that on the street. She’s been assigned a case worker and is getting help with basic life skills, budgeting and finding work.

Equally important: Smith, who can’t afford a car, doesn’t need one.

“I’m very very fortunate to be somewhere where the transit takes me where I want to go,” she said. “Where I want to go is not that far.”