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Americans on Medicare now get better access to mental health care. Here's how
A new law brings in changes for mental health patients and providers.
Christophe Archambault/AFP via Getty Images
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Christophe Archambault/AFP via Getty Images
A new law brings in changes for mental health patients and providers.
Christophe Archambault/AFP via Getty Images
Starting Jan. 1, the more than 65 million Americans who rely on Medicare will have better access to mental health coverage.
Medicare now covers therapy appointments with licensed marriage and family counselors, and licensed professional counselors. These are two types of therapists who make up around 40% of the Master’s level mental health providers in the country, according to the American Counseling Association.
Victoria Kress, a professor at Youngstown State University and a licensed professional counselor, spoke with All Things Considered host Juana Summers about how this new law could affect patients and providers.
This interview has been lightly edited for length and clarity.
Interview highlights
Juana Summers: This seems like a bit of an obvious solution to me, I have to say. There’s a big group of people out there who need access to mental health care — and by that I mean Medicare recipients — and there’s another big group of providers who are able to do so. So why did it take so long do you think for this law to pass?
Victoria Kress: There have been many iterations of licensure and legislation that have been put forward, and many different legislative techniques and strategies that have been applied to try to get us at the table and to get this passed.
I think it was really money. When I would sit with legislators, the first question they would would ask is, “What is this costed out as? How is this going to impact us fiscally?” Obviously, when you have easier access to care and more people providing services, that’s going to increase the cost.
I think with COVID, with the pandemic, it really put a spotlight on mental health needs. And many people started to realize how critically important access to care is around mental health issues. And because of that, I think legislators felt an increasing pressure to provide access to care for those on Medicare.
Summers: We should just be frank here. The need for mental health care in this country is incredibly stark. The Department of Health and Human Services estimates that 169 million Americans are living in an area with a mental health provider shortage. So how much of a dent could this change make in what seems like massive need?
Kress: It’s profound. Yes, about half of America lives in an area with a severe shortage of providers. And I can tell you, as someone who works in an urban area, even in the urban areas they’re really walking the line and struggling to find enough providers to meet the demand for our services.
So 18% of Americans receive Medicare, and they’re going to overnight have access to so many more providers. So it’s really exciting, particularly when you think about the rural areas, where one in three people receive Medicare services, and there’s such a severe shortage of providers, it’s really going to be helpful to them.
Listen to All Things Considered each day here or on your local member station for more interviews like this.
Something else that we also don’t think a lot about is addictions. Many people in America struggle with addictions. Many older adults and people with chronic disabilities struggle with addictions. About a third of all inpatient hospitalizations for opioid use disorder are paid for by Medicare. And counselors are the primary provider of all addictions counseling services. So it’s been so difficult for people to access addictions care. And now with counselors being able to provide the services that we’re trained to provide, it’s really going to open up opportunities for people to access addiction services as well.
Summers: Medicare reimbursement rates are significantly lower than what many therapists can charge out of pocket. I mean, a single session can cost hundreds of dollars for in demand providers. Are you concerned that even though they’re able to, counselors now might not want to accept Medicare because of the lower payment rates?
Kress: Yeah, absolutely. And also with the legislative change, counselors, marriage and family therapists will be being paid about 75% of what a psychologist would make. And so that’s also a deterrent there.
So it’s going to be an ongoing issue to try to get providers to sign up for Medicare reimbursement. But you know, we also have challenges in terms of continuing to encourage people to go into the mental health helping professions. And educators have a responsibility to continue to pull folks in and to train them to meet the demand that’s out there. Counseling is actually one of the most needed professions right now, there’s a severe shortage all over the country.
Summers: I want to acknowledge here before I ask this question that, of course, senior citizens are not the only Medicare recipients, though they do make up the vast majority of that population. And we know that their mental health care needs are complex and seniors have faced obstacles to receiving mental health care for years. To what degree do you think that Medicare coverage from professional counselors and family therapists could help bridge the gap for that specific population?
Kress: Counselors are uniquely trained to meet the needs of older adults. As counselors, we receive training and counseling for people across the lifespan. But we’ve not been able to work with older adults, despite our training, because of difficulties with Medicare reimbursement. So this is really exciting.
One of the things that makes counselors unique from other mental health professionals is that we have a focus on mental health. And what that means is we focus on people’s strengths, their resources and their capacities within themselves, within their families, within their communities and within society. And we focus on those and we pull those into our treatment plans and how we go about helping them make the changes that they want to make.
So I think our focus on developments, our focus on mental health, our focus on being holistic, our focus on wellness is really unique to the older adult population. I think it really resonates with them. And I think that our presence in this market is going to be really well received.
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Video: Minnesota Governor Condemns ICE Shooting
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transcript
transcript
Minnesota Governor Condemns ICE Shooting
Governor Tim Walz of Minnesota slammed the fatal shooting of a woman by an immigration agent. President Trump said that the agents had acted in self-defense.
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This morning, we learned that an ICE officer shot and killed someone in Minneapolis. We have been warning for weeks that the Trump administration’s dangerous, sensationalized operations are a threat to our public safety, that someone was going to get hurt. Just yesterday, I said exactly that. What we’re seeing is the consequences of governance designed to generate fear, headlines and conflict. It’s governing by reality TV. And today, that recklessness cost someone their life.
By Jiawei Wang
January 8, 2026
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U.S. to exit 66 international organizations in further retreat from global cooperation
The symbol of the United Nations is displayed outside the Secretariat Building on Feb. 28, 2022, at United Nations Headquarters.
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John Minchillo/AP
WASHINGTON — The Trump administration will withdraw from dozens of international organizations, including the U.N.’s population agency and the U.N. treaty that establishes international climate negotiations, as the U.S. further retreats from global cooperation.
President Trump on Wednesday signed an executive order suspending U.S. support for 66 organizations, agencies, and commissions, following his administration’s review of participation in and funding for all international organizations, including those affiliated with the United Nations, according to a White House release.

Most of the targets are U.N.-related agencies, commissions and advisory panels that focus on climate, labor, migration and other issues the Trump administration has categorized as catering to diversity and “woke” initiatives. Other non-U.N. organizations on the list include the Partnership for Atlantic Cooperation, the International Institute for Democracy and Electoral Assistance and Global Counterterrorism Forum.
“The Trump Administration has found these institutions to be redundant in their scope, mismanaged, unnecessary, wasteful, poorly run, captured by the interests of actors advancing their own agendas contrary to our own, or a threat to our nation’s sovereignty, freedoms, and general prosperity,” Secretary of State Marco Rubio said in a statement.

Trump’s decision to withdraw from organizations that foster cooperation among nations to address global challenges comes as his administration has launched military efforts or issued threats that have rattled allies and adversaries alike, including capturing autocratic Venezuelan leader Nicolás Maduro and indicating an intention to take over Greenland.
U.S. builds on pattern of exiting global agencies
The administration previously suspended support from agencies like the World Health Organization, the U.N. agency for Palestinian refugees known as UNRWA, the U.N. Human Rights Council and the U.N. cultural agency UNESCO. It has taken a larger, a-la-carte approach to paying its dues to the world body, picking which operations and agencies it believes align with Trump’s agenda and those that no longer serve U.S. interests.
“I think what we’re seeing is the crystallization of the U.S. approach to multilateralism, which is ‘my way or the highway,’” said Daniel Forti, head of U.N. affairs at the International Crisis Group. “It’s a very clear vision of wanting international cooperation on Washington’s own terms.”

It has marked a major shift from how previous administrations — both Republican and Democratic — have dealt with the U.N., and it has forced the world body, already undergoing its own internal reckoning, to respond with a series of staffing and program cuts.
Many independent nongovernmental agencies — some that work with the United Nations — have cited many project closures because of the U.S. administration’s decision last year to slash foreign assistance through the U.S. Agency for International Development, or USAID.
Despite the massive shift, the U.S. officials, including Trump himself, say they have seen the potential of the U.N. and want to instead focus taxpayer money on expanding American influence in many of the standard-setting U.N. initiatives where there is competition with China, like the International Telecommunications Union, the International Maritime Organization and the International Labor Organization.
The latest global organizations the U.S. is departing
The withdrawal from the U.N. Framework Convention on Climate Change, or UNFCCC, is the latest effort by Trump and his allies to distance the U.S. from international organizations focused on climate and addressing climate change.
UNFCC, the 1992 agreement between 198 countries to financially support climate change activities in developing countries, is the underlying treaty for the landmark Paris climate agreement. Trump — who calls climate change a hoax — withdrew from that agreement soon after reclaiming the White House.

Gina McCarthy, former White House National Climate Adviser, said being the only country in the world not part of the treaty is “shortsighted, embarrassing, and a foolish decision.”
“This Administration is forfeiting our country’s ability to influence trillions of dollars in investments, policies, and decisions that would have advanced our economy and protected us from costly disasters wreaking havoc on our country,” McCarthy, who co-chairs America Is All In, a coalition of climate-concerned U.S. states and cities, said in a statement.
Mainstream scientists say climate change is behind increasing instances of deadly and costly extreme weather, including flooding, droughts, wildfires, intense rainfall events and dangerous heat.
The U.S. withdrawal could hinder global efforts to curb greenhouse gases because it “gives other nations the excuse to delay their own actions and commitments,” said Stanford University climate scientist Rob Jackson, who chairs the Global Carbon Project, a group of scientists that tracks countries’ carbon dioxide emissions.

It will also be difficult to achieve meaningful progress on climate change without cooperation from the U.S., one of the world’s largest emitters and economies, experts said.
The U.N. Population Fund, the agency providing sexual and reproductive health worldwide, has long been a lightning rod for Republican opposition, and Trump cut funding for it during his first term. He and other GOP officials have accused the agency of participating in “coercive abortion practices” in countries like China.
When President Biden took office in January 2021, he restored funding for the agency. A State Department review conducted the following year found no evidence to support GOP claims.
Other organizations and agencies that the U.S. will quit include the Carbon Free Energy Compact, the United Nations University, the International Cotton Advisory Committee, the International Tropical Timber Organization, the Partnership for Atlantic Cooperation, the Pan-American Institute for Geography and History, the International Federation of Arts Councils and Culture Agencies and the International Lead and Zinc Study Group.
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GOP gearing up to face tough midterms. And, Pentagon reviews women in ground combat
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Today’s top stories
President Trump continues to suggest that the U.S. will have a lengthy and active role in Venezuela after capturing the ousted president Nicolás Maduro. Trump has proposed several plans for Venezuela’s future government and economy. In those proposals, U.S. companies are expected to play a key role.
President Trump dances as he departs after speaking during a House Republican retreat at The John F. Kennedy Center for the Performing Arts on Jan. 6, 2026, in Washington, DC. House Republicans will discuss their 2026 legislative agenda at the meeting.
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- 🎧 Trump and his aides are unclear about the future of Venezuela, NPR’s Franco Ordoñez tells Up First. When the president says the U.S. will run the country, many eyes are on Stephen Miller, Trump’s deputy chief of staff for policy. Miller, known for his stringent immigration policies, is one of the U.S. officials overseeing Venezuela. Ordoñez also says Miller has more recently described ruling over the hemisphere by force.
- ➡️ Last night, Trump posted on social media that Venezuela will turn over between 30 million and 50 million barrels of sanctioned oil to the U.S. While seizing current oil production is one thing, overhauling Venezuela’s oil industry requires a far greater effort. Here’s why.
While meeting with House Republicans yesterday, Trump attempted to offer his party a roadmap to victory in this year’s midterm elections. The president acknowledged the possibility of his party losing the majority in the House this year. Trump said in his speech that the president’s party often loses the midterms.
- 🎧 NPR’s Domenico Montanaro says that while it’s true the midterms are hard on the president’s party, it is even worse when a president’s approval rating is below 50%. Trump is facing his lowest second-term approval ratings, largely due to the rising cost of living. During yesterday’s speech, the president didn’t offer much on the topic. When he did discuss the economy, it was about how the stock market is at historic highs. He also touted his tariffs, which have actively raised prices on many things. People have informed pollsters for months that they believe the president’s policies have harmed the economy. Montanaro says one area where Trump and Republicans could take action is legislation on health care.
The Pentagon is preparing a six-month review to evaluate what it calls the military “effectiveness” of women serving in ground combat roles. Undersecretary Anthony Tata requested that the Army and Marine Corps submit data on the readiness, training, performance, casualties and command climate of ground combat units and personnel by Jan. 15. The effort aims to determine how gender integration has influenced operational success over the last decade.
Special series
Trump has tried to bury the truth of what happened on Jan. 6, 2021. NPR built a visual archive of the attack on the Capitol, showing exactly what happened through the lenses of the people who were there. “Chapter 3: Assault on the Capitol,” lays out the timeline of key moments throughout the day as the riot unfolded.
On the morning of Jan. 6, 2021, Trump held a “Save America” rally at the Ellipse, a site near the White House and U.S. Capitol. Multiple speakers promoted voter fraud myths and urged Vice President Mike Pence to overturn the election. Meanwhile, a group of 200 Proud Boys marched toward the Capitol. Before Trump’s speech ended, violence erupted on Capitol grounds. The Jan. 6 attack on the Capitol “was the most videotaped crime in American history, if not world history,” according to Greg Rosen, a former federal prosecutor who led the Justice Department unit that investigated the riot. But conspiracy theories still falsely label the assault a “normal tourist visit.” NPR’s review of thousands of court videos shows rioters assaulting officers with weapons, calling for executions and looting the building. These videos show the exact timing of events as they occurred. Corresponding maps show the locations where the conflict took place.
To learn more, explore NPR’s database of federal criminal cases from Jan. 6. You can also see more of NPR’s reporting on the topic.
Picture show
The tin soldier, a marionette puppet made by Nicolas Coppola and the main character in “The Steadfast Tin Soldier” show at Puppetworks.
Anh Nguyen for NPR
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Anh Nguyen for NPR
For more than 30 years, Puppetworks has staged classics like The Tortoise and the Hare, Pinocchio, Aladdin and more in Brooklyn’s Park Slope neighborhood. Every weekend, children gather on foam mats and colored blocks to watch wooden renditions of the shows. The company’s founder and artistic director, 90-year-old Nicolas Coppola, has been a professional puppeteer since 1954. The theater has puppets of all types, including marionettes, swing, hand, and rod. They transport attendees back to the 1980s, when most of these puppets were made. Over the years, Coppola has updated the show’s repertoire to better meet the cultural moment. Step inside his world with these images.
3 things to know before you go
This tiny forest in Los Angeles, CA is one of many micro-forests around the world offering green space and contributing to local biodiversity.
Demian Willette/Loyola Marymount University
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Demian Willette/Loyola Marymount University
- Scientists are establishing micro-forests in big cities to boost biodiversity and rejuvenate compromised land. Short Wave producer Rachel Carlson visited California’s largest micro-forest. Tune in to hear her account of the experience.
- The Hungarian arthouse director Béla Tarr has died at 70. He’s best known for his bleak, existential, and challenging films, including Sátántangó.
- While we often associate serendipity with luck or happy accidents, its origin suggests it’s more than just happenstance. This week, NPR’s Word of the Week explores the historical impact of serendipity and offers tips on how to cultivate it.
This newsletter was edited by Suzanne Nuyen.
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