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Health care and how much it costs is scary. But youre not alone with this stuff, and knowledge is power. An Arm and a Leg is a podcast about these issues, and is co-produced by KFF Health News.VISIT ARMANDALEGSHOW.COM

Federal law requires that all nonprofit hospitals have financial assistance policies also known as charity care to reduce or expunge peoples medical bills. New research from Dollar For, an organization dedicated to helping people get access to charity care, suggests that fewer than one-third of people who qualify for charity care actually receive it. 

An Arm and a Leg host Dan Weissmann talks with Dollar For founder Jared Walker about its recent work, and how new state programs targeting medical debt in places like North Carolina may change the way hospitals approach charity care. 

Plus, a listener from New York shares a helpful resource for navigating charity care appeals. Dan Weissmann @danweissmann Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting. Credits Emily Pisacreta Producer Claire Davenport Producer Adam Raymonda Audio wizard Ellen Weiss Editor Click to open the Transcript Transcript: New Lessons in the Fight for Charity Care Note: An Arm and a Leg uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there–

Clara lives in New York City with her husband Remy and their family. And, recently, over the course of a year, they had some … medical encounters. At hospitals.

Nothing super-dramatic: Remy broke his ankle in August of last year. Hello, emergency room. Hello, ER bill.

They had a second baby in November 2023 a boy! who ended up needing to spend a day in neonatal intensive care. He’s fine. They named him Isaac.

And one night early this year, Isaac just… wasn’t looking good. Lethargic. Had a fever.

Clara: We decided to give him Tylenol. Um, and he spit it all back out.

Dan: They took his temp again. A hundred and three point five.

Clara: We started Googling, um, what is like dangerously high fever for a baby

Dan: And yep. For a baby that little, a hundred three point five is starting to get iffy. Like possible risk of seizure. But it was late at night. No pediatrician, no urgent care. Hello new, unwelcome questions.

Clara: The last thing you want to be thinking about is, Oh shit, this is going to be really expensive. You want to be thinking about, let’s go to the ER right now, make sure he doesn’t have a seizure.

Dan: So they went. And the folks at the ER gave Isaac more tylenol, he didn’t spit it out, his fever went down. They went home, relieved about Isaac and a little anxious about the bills.

After insurance, they were looking at more than eight thousand dollars. Clara didn’t think her family could afford anything like that.

And the billing office didn’t offer super-encouraging advice.

Clara: basically every time I’ve called, they said, why don’t you start making small payments now so it doesn’t go into collections.

Dan: However. Clara listens to An Arm and a Leg. Where we’ve been talking about something called charity care for years. This summer, we asked listeners to send us their bills and tell us about their experience with charity care. Clara was one of the folks who responded.

Just to recap: Federal law requires all nonprofit hospitals to have charity care policies, also called financial assistance.

To reduce people’s bills, or even forgive them entirely, if their income falls below a level the hospital sets.

We’ve been super-interested in charity care here for almost four years, ever since a guy named Jared Walker blew up on TikTok spreading the word and offering to help people apply, through the nonprofit he runs, Dollar For.

Since then, we’ve learned a LOT about charity care. Dollar For has grown from an infinitesimally tiny organization — basically Jared, not getting paid much -to a small one, with 15 people on staff.

Jared says they’ve helped people with thousands of applications and helped to clear millions of dollars in hospital bills.

And in the past year, they’ve been up to a LOT and theyve been learning alot. Before we pick up Clara’s story which ends with her offering a new resource we can share let’s get a big download from Jared.

This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So the job we’ve chosen on this show is to take one of the most enraging, terrifying, depressing parts of American life- and bring you a show that’s entertaining, empowering and useful.

In early 2024, Dollar For put out a couple of big research reports documenting how much charity care doesn’t get awarded. And why people don’t receive it.

Jared: I feel like for a long time we have been looking around at the experts, right? Who are the experts? And where can we find them and what can we ask them?

Dan: Finally, they undertook a major research project of their own. They analyzed thousands of IRS filings from nonprofit hospitals, and compared what they found to a study from the state of Maryland based on even more precise data.

And they hired a firm to survey a sample of more than 11 hundred people. Then ran focus groups to dig in for more detail.

Jared: I think that what these reports have just revealed is like, we are the experts like dollar for actually knows more than everyone else about this.

Dan: The amount of charity care that hospitals do not give to people who qualify for it?

The data analysis produced a number: 14 billion dollars. Which Jared and his colleagues say is a conservative estimate.

The survey showed that more than half of people who qualify for charity care do not get it. About two thirds of those folks do not know that it exists. Some people who know about it just don’t apply. And some who do get rejected, even though they qualify.

Their conclusion: We found that only 29% of patients with hospital bills they cannot afford are able to learn about, apply for, and receive charity care. None of which surprised Jared.

Jared: It’s like, Oh, like our assumptions have been correct on this. Like people don’t know about charity care. The process sucks. Um, a lot of people that should get it, don’t get it. Um, and hospitals have put all the pain and all of the responsibility on the patient

Dan: Those topline findings put Dollar For’s accomplishments in context.

Jared: Like we have submitted over 20, 000 of these financial assistance applications.

Dan: 20, 000 people. That’s spectacular. That’s I know you’re counting the money. How much money is it that you’re talking about so far?

Jared: I think we’re closing in on 70 million, 70 million in medical debt relief. So

Dan: Right. It’s a start.

Jared: there you go.

Dan: Its a start.

Jared: It sounds great, and then you see the 14 billion number and you’re like, oh, shoot. What are we doing? What are we doing?

Dan: laugh crying emoji.

Jared: Yeah, yeah, yeah.

Dan: And so, for most of the year, Jared and his team have been testing a strategy to take on a 14 billion dollar problem.

Jared: We have spent the year trying to work with hospitals. We came at this how do we put a dent in the 14 billion? If it’s not going to be through TikTok, and it’s not going to be through individual patint advocacy, then what if we moved further upstream, and instead of patients finding out about us one to three months after they get a bill, what if they heard about us at the hospital?

Dan: Jared envisioned patients getting evaluated for charity care, and getting referred to Dollar For for help applying, before they check out. He thought

Jared: Maybe we could make a bigger dent into that 14 billion. And, I think that that was wishful thinking.

Dan: Wishful thinking. That’s how Jared now describes his hopes that hospitals would see that they could do better by patients, with his help, and sign right up to work with him.

Jared: Um, well they haven’t, Dan. So, we don’t have, uh, you know, we’ve got one hospital.

We’ve got one hospital. I don’t know if there’s a smaller hospital in the United States. It is Catalina Island Health. It is a small hospital on an island off the coast of California

And when patients go in there, they tell them about Dollar For, and they send them over. Um, that was what we were hoping to do with these larger systems.

Dan: Jared talked to a lot of hospitals. He went to conferences for hospital revenue-department administrators. He didn’t get a lot of traction

Jared: You know, this is one thing where I’m like, I don’t want to be totally unfair to the hospitals.

They’re huge entities that you can’t just move quickly like that.

it is going to take a lot more on their end than it would on our end, we could spin up one of these partnerships in a week.

And. They’re going to need a lot of time and it’s going to, you know, how do we implement this? Um, you know, with a small Catalina Island hospital it was easy, but if you’re talking to Ascension

Dan: Ascension Healthcare– a big Catholic hospital system. A hundred thirty-six hospitals. More than a hundred thirty thousand employees. Across 18 states, plus DC. Jared says they might get thousands of charity care applications a month. A deal to steer folks to Jared isnt a simple handshake arrangement.

Jared: How do you, how do you do that? You know, how do you implement that? I mean, it’s a pain in the ass. And these hospitals, and more so, hospitals are not motivated to figure this out.

Dan: Yeah. Right.

Jared: Unless you’re in North Carolina,

Dan: North Carolina. In 2023, North Carolina expanded Medicaid. In July 2024, Governor Roy Cooper announced a program that would use Medicaid money to reward hospitals for forgiving Medical debt.

Gov. Roy Cooper: under this program. Hospitals can earn more by forgiving medical debt than trying to collect it. This is a win win win.

Dan: Under the program, hospitals can get more Medicaid dollars if they meet certain conditions. One, forgive a bunch of existing medical debts. Another: Make sure their charity care policies protect patients who meet income threhholds set by the state.

A third: they have to pro-actively identify patients who are eligible for charity care — and notify those patients before sending a bill, maybe even before they leave the hospital.

Jared: I’m very excited to see how that looks in the future. Because if you remember, the big four, like our shit list, is Texas, Florida, Georgia, North Carolina.

Dan: Jared’s shit list. The states where, over the years, he has heard from the greatest number of people who have difficulty getting hospital charity care. Where he often has to fight hardest to help them get it.

Jareds shit list, the big four, were the four biggest states (by population) that had rejected the expansion of Medicaid under the Affordable Care Act.

Because of how the ACA was written, no Medicaid expansion means a lot more people who don’t have a lot of money and just don’t have ANY insurance at all.

It’s a giant problem. And North Carolina was one of those states where it was toughest.

Jared: And in, you know, the span of a year, North Carolina has expanded Medicaid, and created one of the best medical debt charity care policies in the country.

This law essentially says that they have to identify them early. So that’s like on paper, you know, it sounds amazing.

Dan: Onpaper it sounds amazing. We’ll come back to that. But first, let’s make clear: This wasn’t a sudden transformation. The governor, Roy Cooper, who we heard in that clip? He spent like seven years pushing the state to expand Medicaid.

The legislature finally agreed in 2023. And then Cooper and his team spent months this year figuring out how to bake medical-debt relief into the plan. It took a ton of maneuvering.

Our pals at KFF Health News covered the process. Here’s Ames Alexander, who reported that story with Noam Levy, describing the process on a public radio show called “Due South.”

Coopers team started out by trying to quietly bounce their ideas off a few hospitals..

Ames Alexander KFF Health News: But then word got back to the hospital industry’s powerful lobbying group. That’s the North Carolina Healthcare Association. And the Association was not at all happy about it. .

Dan: They raised a stink. And claimed the whole thing would be illegal, the feds shouldn’t approve it.

Cooper and his health secretary Cody Kinsley got kept going– and they did get the feds to sign off on the plan. So it was legal.

But it wasn’t mandatory. They were offering hospitals money, but those hospitals needed to say yes. And that didn’t happen right away.

Ames Alexander KFF Health News: When Cooper and Kinsley unveiled this plan on July 1st, there wasn’t a single hospital official who would join them there for the press conference. Ultimately, though, all 99 of the state’s hospitals signed on. And it’s not, it’s not really hard to understand why they stood to lose a lot of federal money.

Dan: Lose OUT on a ton of NEW federal money. A ton. According to KFF’s reporting, a single hospital system stands to gain like 800 million dollars a year for participating.

And you know, thinking about that — how much money hospitals were considering turning down — kind of puts into perspective Jared’s experience trying to get them to work with him. He wasn’t offering anybody 800 million dollars a year.I said to Jared: Seems like this would be hard to replicate elsewhere. Other states aren’t going to be able to put that kind of new federal money on the table. And Jared said:

Jared: I think before like, Oh, can we replicate it? I’m just like, how do we make it? How do we make it work in North Carolina?

Dan: That is: How to make sure when it gets implemented, that it really works? Remember, Jared said before: This all sounds amazing ON PAPER. We’ll have some of his caveats after the break. Plus the rest of Clara’s story.

An Arm and a Leg is a co-production of Public Road Productions and KFF Health News — that’s a nonprofit newsroom covering health issues in America. KFF’s reporters do amazing work — you just heard one of them breaking down how North Carolina put that deal together. I’m honored to work with them.

Jared loves the idea behind North Carolina’s initiative on charity care: Hospitals have to screen people while they’re on site, and let them know before they leave the hospital what kind of help they may be eligible for.

Jared: Making sure that a patient knows what is available to them before they leave is very powerful. , like, that’s where the responsibility should be. Um, but how do you do it? And what happens if you don’t? Right?

Dan: In other words, Jared says, the devil is in implementation, and in systems of accountability. He’s seen what happens when those systems are pourous.

Jared: In Oregon, they had that law that was like, Oh, you can’t sue patients without first checking to see if they’re eligible for charity care. . And then you find all these people that are being sued that were never screened.

Dan: Yeah, Oregonpassed a law in 2019 that required hospitals to evaluate patients for charity care before they could be sued over a bill. Jared’s colleague Eli Rushbanks analyzed a sample of hospital-bill lawsuits in one county. He could only see patients income in a few of them– but in almost half of those, that income was definitely low enough that the debt shouldve been forgiven.

He also took a big-picture look: In the years after the law took effect, two thirds of hospitals gave out LESS charity care than they had given before. Probably not what lawmakers had hoped for.

Hospitals in North Carolina will have two years to fully implement the screening requirement, called “presumptive eligibility.”

Some hospitals around the country already use automated systems for this: They check your credit, pull other data. Some of them use AI.

Jared says he’s seen some hospitals over-rely on the tech.

Jared: Some hospitals that are using presumptive eligibility tools will use that as a way to say, Oh, we already screened you. You can’t apply, but the patient is sitting there going, well, I’m eligible.

Your tool must have got it wrong. Cause these things are not a hundred percent accurate, or think of something like this, you lose your job, or maybe you’re at the hospital because you just gave birth to another human. So now you’re a household of four. It’s a four instead of three.

And obviously the presumptive eligibility tool isn’t going to be able to know that and calculate that. So if you go to the hospital and say, now I want to apply and they say, well, you don’t get to apply because we already screened you and you’re not eligible. That’s bullshit.

Dan: So, as North Carolina hospitals bring their systems online, Jared wants to push for a process where patients can appeal a machine-made decision. Jared: I’d love to be able to test that

how does that impact how many people are getting charity care and that 14 billion?

Dan: What do you think is your best shot for the next year of kind of moving towards 14 billion?

Jared: We are trying to figure that out. Um, obviously the election will play into that, but I think that if I had to guess where we would land, um, I think that we will double down on our patient advocacy work.

Dan: Jared says theyll definitely also continue to work with advocates and officials on policy proposals. But

Jared: The only reason anyone cares about what we have to say about policy is because we know what the patient experiences. So I think that if the, the more people we help, the more opportunity we will have to push policies forward that we want to see happen

Dan: So, this is a good place to note: If you or anybody you know has a hospital bill thats scaring you, Dollar For is a great first stop. Well have a link to their site wherever youre listening to this. Theyve got a tool that can help you quickly figure out if you might qualify for charity care from your hospital. Plus tons of how-tos. And theyve got dedicated staff to help you if you get stuck.

And we just heard Jared say theyre not backing away from that work, even as they aim to influence policy.

About policy Jared does have one other thought about their work in that area

Jared: We think that we’re going to get a little bit more feisty, uh, moving forward. So I’m, I’m excited about that.

Dan: I talked with Jared less than a week after the election. We didn’t know yet which party would take the House of Representatives, and of course there’s still a LOT we don’t know about what things look like from here. Jared had just one prediction.

Jared: I think we’re going to be needed, you know, that much more.

Dan: I think we’re all gonna need each other more than ever. Which is why I’m pleased to bring us back to Clara’s story from New York.

You might remember: Her family had three hospital adventures in the space of a year.

The first one, where her husband broke his ankle, got her started. The bill was eighteen hundred dollars, after insurance. A LOT for their family. But she had a few things going for her.

One, she knew charity care existed. Not because the hospital mentioned it.

Clara: No, I know about it from an arm and a leg,

Dan: And two, she had the skills. Because by training, she’s a librarian. And you may already know this but people come to libraries looking for a lot more than just books.

Clara: People all the time, will come in and bring in a form or need help navigating different systems and, and even just looking and trying to see where to start.

Dan: So, she went and found her hospital’s financial assistance policy online. Saw that her family met their income requirements. Found the form. Submitted it. Got offered a discount… that still left her family on the hook for more than they could comfortably pay.

And decided to see if she could ask for more. Was there an appeals process? There was.

But she didn’t find all of the information she needed online. The process wasn’t quick.

Clara: A lot of phone tag. And I don’t know if the bill pay phone lines are staffed better than the financial aid phone lines. But, you know, you get an answering machine a lot. You have to call back. The person doesn’t remember you. They’re not able to link your account.

All the things that I just feel like they’re really greasing the wheels of the paying for the bill option, but actually not making it especially accessible to do the financial aid and appeal process.

Dan: Clara hung in there. Heres what she told my colleague Claire Davenport.

Clara: Being a listener of the podcast, I feel like I’m part of a community of people who are sort of maneuvering through the crazy healthcare system. And I do kind of have Dan’s voice in my head, like, this is nuts. This is not your fault. This is crazy and not right.

Dan: Also, when she was angling for more help on her husband’s ER bill, she knew anything she learned could come in handy: She was due to give birth at the same hospital pretty soon.

Her persistence paid off. In the end, the hospital reduced that 1800 dollar bill to just 500 dollars.

Two weeks later, Isaac was born. And spent an extra day in the NICU. That, plus the late-night fever that sent them to the ER left Clara’s family on the hook for about 6500 dollars.

Clara used what she’d learned the first time through as a playbook. Apply, then appeal to ask for more help. She says that made it a little simpler. But not simple, and not quick.

Isaac was born in November 2023. His ER visit was in April 2024. When Clara talked with our producer in early August 2024, she was still waiting to hear the hospital’s decision about her appeal. Was it gonna be approved?

Clara: In the event that it’s not, I think we just put it on like the longest payment plan we can. Maybe we would ask family for help.

Dan: Update: A few days after that conversation, the hospital said yes to Clara’s appeal. Her new total, 650 dollars. About a tenth of that initial amount.

Which, yes, is a nice story for Clara and her family. But the reason I’m so pleased to share her story is this:

Clara: Actually, I made a template that you can let your listeners use for making an appeal letter. I’ll share it with you.

Dan: Clara thought it might be useful because part of the application and appeal process — not all of it was just facts and figures and pay stubs. There was also an opportunity to write a letter. Which opened up questions.

Clara: I feel like It’s not totally clear what you’re supposed to put in the letter and who you’re appealing to and how emotional you’re supposed to make it versus how technical

Dan: Here’s how she approached it.

Clara: I was trying to think about if I was reading the letter, what would help paint the picture of this bill in context of everything else. trying to put myself in their shoes, reading it, what would be useful t kind of add more depth to our story than just the bill. And then also I just tried to be really grateful and express authentic gratitude for the great care we received.

Dan: She also included a realistic estimate of what her family could actually pay. Which the hospital ended up agreeing with.

And yes, Clara shared that template with us. We’ll post a link to it wherever you’re listening to this. Please copy and paste, and fill in the blanks, and please-tell us if it works for you.

A big lesson here is, don’t take no for a final answer. Don’t take “We’ll help you this much” for a final answer. Clara discovered one other thing: Don’t give up if it looks like you may have missed a deadline. She missed one.

Clara: So I called them and said, I’m really worried. ” I didn’t send it in time. It might be off by a couple days. Is this going to be a huge problem? And they said, No, don’t worry about it.

It’s totally fine. Just send it. So I’m thinking, Okay, wait. There are so many people who are going to get cut off or get their bill and realize, Oh, well, I totally missed the window. So let’s go for the payment plan option. When actually,

Dan: If you’ve got the chutzpah, and the time, and the patience to make the next call and ask… you may get a different answer.

It sucks that it’s this hard. But I appreciate every clue that it’s not impossible. And I appreciate Clara sharing her story — and her template with us.

I told Jared about it.

Jared: Yeah, that’s amazing. I mean, I love, uh, it’s so funny. it’s just the idea of you have this patient that is going through all of this stuff and is so busy trying to focus on their own health, do their own thing, and they’re out here making templates so that other people can , you know, jump through the same hoops because we know We’re all going to have to jump through the hoops, uh, is just, man, how frustrating is that?

But how amazing is it that you have, you have built a community of people that are, you know, willing to, uh, take those kind of crappy, not kind of, very terrible experiences and, um, and turn it into something that is helpful for other people. I think that’s amazing.

Dan: Me too! So this is where I ask you to help keep a good thing going. We’ve got so much to do in 2025, and your donations have always been our biggest source of support. After the credits of this episode, youll hear the names of some folks who have pitched in just in the last few weeks.

And this is The Time to help us build. The place to go is arm and a leg show dot com, slash, support.

That’s arm and a leg show dot com, slash, support .

We’ll have a link wherever you’re listening.

Thank you so much for pitching in if you can.

We’ll be back with a brand new episode in a few weeks.

Till then, take care of yourself.

This episode of An Arm and a Leg was produced by Claire Davenport and me, Dan Weissmann, with help from Emily Pisacreta — and edited by Ellen Weiss.

Adam Raymonda is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Gabrielle Healy is our managing editor for audience. Bea Bosco is our consulting director of operations.

Lynne Johnson is our operations manager.

An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor. They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially.

An Arm and a Leg is a co-production of KFF Health News and Public Road Productions.

To keep in touch with An Arm and a Leg, subscribe to its newsletters. You can also follow the show on Facebook and the social platform X. And if youve got stories to tell about the health care system, the producers would love to hear from you.

To hear all KFF Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts. Twitter Facebook LinkedIn Email Print Related Topics Health Care Costs Multimedia An Arm and a Leg Podcasts Contact Us Submit a Story Tip

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Politics

Angela Rayner admits she should have paid more stamp duty on flat purchase – and considered resigning

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Angela Rayner admits she should have paid more stamp duty on flat purchase - and considered resigning

Angela Rayner has admitted she did not pay the right amount of stamp duty on the purchase of her second home and has referred herself to the independent adviser on ministerial standards. 

Speaking to Sky News’ political editor Beth Rigby on the Electoral Dysfunction podcast, the deputy prime minister became tearful as she claimed she received incorrect tax advice and spoke to her family about “packing it all in”.

Ms Rayner, who is also the housing secretary, has been under scrutiny after a report in The Daily Telegraph claimed she avoided £40,000 in stamp duty on a flat in Hove by removing her name from the deeds of another property in Greater Manchester.

In a lengthy statement released today, she said it was a “complex living arrangement” as her first home was sold to a trust following her divorce to provide stability for her teenage son, who has lifelong disabilities and is the sole beneficiary of the trust.

She said initial legal advice was that the standard rate of stamp duty applied, but following media reports, she sought expert counsel who said more tax is due.

She added that these matters were confidential but she applied to a court yesterday to get this lifted in the interests of public transparency.

In a subsequent interview with Beth Rigby, a visibly upset Ms Rayner said: “I’ve been in shock, really, because I thought I’d done everything properly, and I relied on the advice that I received and I’m devastated because I’ve always upheld the rules and always have felt proud to do that.

“That it is devastating for me and the fact that the reason why those confidential clauses were in place was to protect my son, who, through no fault of his own, he’s vulnerable, he’s got this life changing, lifelong conditions and I don’t want him or anything to do with his day-to-day life, to be subjected to that level of scrutiny.”

Asked if she thought about quitting rather than disclose the details about her son, the cabinet minister added: “I spoke to my family about it. I spoke to my ex-husband, who has been an incredibly supportive person because he knows that all I’ve done is try and support my family and help them.”

Allies jump to Rayner’s defence

Her comments came shortly before the first PMQs following the summer recess. Tory leader Kemi Badenoch said Sir Keir Starmer should fire his deputy.

“If he had backbone, he would sack her,” she said.

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Starmer defends Rayner amid calls for sacking

However, the prime minister defended Ms Rayner, saying he is “very proud” to sit alongside her.

“She’s gone over and above in setting out the details, including yesterday afternoon asking a court to lift a confidentiality order in relation to her own son,” the prime minister said.

“I am very proud to sit alongside a deputy prime minister who is building 1.5m homes, who is bringing the biggest upgrade to workers’ rights in a generation, and has come from a working-class background to become deputy prime minister of this country.”

Liberal Democrat leader Sir Ed Davey also came out in support of Ms Rayner, saying as the parent of a disabled child himself he trusts that she was acting in her family’s interests.

“I understand it is normally the role of opposition leaders to jump up and down and call for resignations – as we’ve seen plenty of from the Conservatives already,” he said.

“Obviously if the ethics advisor says Angela Rayner has broken the rules, her position may well become untenable.

“But as a parent of a disabled child, I know the thing my wife and I worry most about is our son’s care after we have gone, so I can completely understand and trust that the deputy prime minister was thinking about the same thing here.

“Perhaps now is a good time to talk about how we look after disabled people and how we can build a more caring country.”

Ms Rayner was also backed by Paul Nowak, the general secretary of the TUC, who told Sky News’ chief political correspondent Jon Craig that he thinks attacks against her are driven by a “heavy dose of misogyny”.

He said: “Angela Rayner comes under sustained coverage because she’s a working-class woman in a way that frankly Nigel Farage, leading members of the shadow cabinet, never would.

“I think there’s a real heavy dose of misogyny when it comes to Angela. As far as I’m concerned, the prime minister’s got faith in her and I think the country’s got faith in her as well.”

Health Secretary Wes Streeting also came to her defence, telling BBC Radio 5 Live that she acted in “good faith” and it would be an “absolutely travesty” if she had to resign.

Prime Minister Sir Keir Starmer defended Angela Rayner in PMQs. Pic: PA
Image:
Prime Minister Sir Keir Starmer defended Angela Rayner in PMQs. Pic: PA

Key points from Rayner statement

In her statement, Ms Rayner said that following the divorce from her husband in 2023, they agreed to a nesting arrangement where their children would remain in their family home, in Ashton-under-Lyne, while they alternated living there.

She said she sold her interest in that home to a trust earlier this year, before buying the property in Hove.

Angela Rayner arrived in Downing Street for Cabinet on Tuesday. Pic: PA
Image:
Angela Rayner arrived in Downing Street for Cabinet on Tuesday. Pic: PA

The trust was originally set up in 2020 to manage a payment to one of her sons after a “deeply personal and distressing incident” as a premature baby that left him with lifelong disabilities

The home had been adapted for her son and the sale to the trust was to give him “the security of knowing the home is his”, Ms Rayner said.

She went on to say that she did not own any other home when she bought the flat in Hove, and her understanding “on advice from lawyers, was that my circumstances meant I was liable for the standard rate of stamp duty”.

She added: “However, given the recent allegations in the press I have subsequently sought further advice from a leading tax counsel to review that position and to ensure I am fully compliant with all tax provisions.

“I have now been advised that although I did not own any other property at the time of the purchase, the application of complex deeming provisions which relate to my son’s trust gives rise to additional stamp duty liabilities.”

Ms Rayner said she is working with HMRC to establish what is owed, claiming her arrangements “reflect the reality that family life is rarely straightforward”.

She concluded: “I deeply regret the error that has been made. I am committed to resolving this matter fully and providing the transparency that public service demands.

“It is for that reason I have today referred myself to the Independent Adviser on Ministerial Standards, and will provide him with my fullest cooperation and access to all the information he requires.”

Watch and listen to the full Electoral Dysfunction interview on Wednesday afternoon – www.podfollow.com/electoraldysfunction

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Fake documents, debt and student visas – inside the UK’s immigration system

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Fake documents, debt and student visas - inside the UK's immigration system

Coaching on Zoom, “fake” documents to secure a visa and “don’t panic” advice during questions at immigration – this is the story of one family’s attempt to get to the UK.

Sky News follows the journey of a family who came from India on student and dependent visas – obtained they say from “agents” using false documents – but have now spent two years waiting for a decision on their leave to remain.

“110% fake,” says Sami. “The agent put the money in the account – which is fake. It’s nothing. But he creates the document like I have the money.”

Sami – not his real name – is explaining how he came to the UK with his wife and two young children on student and dependent visas which he says were obtained by agents – or criminal gangs – in India using fake bank statements.

It is a rare insight into claims of abuse of Britain’s immigration system.

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Sami says the agents coached them on how to speak to immigration officers in the UK if questioned
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Sami says the agents coached them on how to speak to immigration officers in the UK if questioned

How they got here

Sami says the family needed to show they could support themselves financially in the UK – which they couldn’t.

He says the agents created fake bank documents purporting to show the family had a lump sum of £10,000 in one bank account and a loan of nearly £25,000 in a second account – to cover living expenses in the UK. None of this was true.

He says he paid agents in India nearly all his life savings – more than £20,000 – to arrange a place on a master’s course for his wife.

“I sell my house, then secondly I sell my motorbike – Yamaha – thirdly I sell my wife’s whole gold – earrings, the chain, and some rings,” Sami tells us.

They arrived in early 2023 but when his wife failed to attend the university, they were sent a letter by the Home Office telling them their visas had been cancelled, and they would have to leave the UK by October that year.

Sami says agents helped to create this document that appears to show the family had over £10,000 - money they never had
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Sami says agents helped to create this document that appears to show the family had over £10,000 – money they never had

Since then, they have been in a cycle of rejections and reapplying for leave to remain, and their case remains unresolved.

A poor man from India, Sami says it was always his dream to live in the UK. So he began researching how to get here.

“UK is my dream country. So that’s why I was choosing the UK. Cricket – Ashes, like England and Australia. My favourite cricketer and bowler, Andrew Flintoff. Greenery, lots of people moving in London. London, then, I decided this is a good place to move.”

Sami admits his wife never intended to attend university in the UK
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Sami admits his wife never intended to attend university in the UK

Training sessions

When they found the agents to arrange their passage to Britain, Sami says his wife was even given coaching via Zoom while still in India ahead of any potentially difficult questions by UK immigration officials at Heathrow.

In the videos, Sami’s wife repeats her lines again and again.

“Why UK?” asks the woman doing the training. “UK is a multicultural country,” says Sami’s wife.

At another coaching session – this time in the agent’s office, and filmed by Sami – she rehearses: “My hobbies are gardening, reading, newspaper, cooking, baking etc.”

The agents – or criminal gangs – also provided a crib sheet of written tips titled “don’t get panic at the time of immigration”. It contains handwritten notes suggesting things to say about university courses.

But having been granted visas to come to the UK, Sami admits it was never their intention that his wife would study.

Ever since our first meeting, Sami has always clung on to the hope that with two young children – one needing medical treatment – the Home Office is unlikely to send them back to India.

“There is a condition that if your kids are with you, they are not going to detain or deport you. Maybe they give you a chance,” he says.

“My application is still in the Home Office. The government will decide.”

When we first met Sami and his family they lived in a house with at least nine other people
Image:
When we first met Sami and his family they lived in a house with at least nine other people

Sami says he is happy they came to the UK – but when we first met four months ago, he and his family were living in one room in a house shared by 13 people.

He isn’t sure of the exact number of people living in the house – or their legal status – but signals: “Upstairs – the bachelors.”

Sami’s wife is cooking in what is basically a cupboard.

“This is a small single room,” he says. “I sleep on the floor, My daughter, and my son, they sleep on the bed.”

Sami's wife cooked dinners out of a cupboard in the one bedroom the family lived in
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Sami’s wife cooked dinners out of a cupboard in the one bedroom the family lived in

Relying on food banks

Subsequently, social services became involved in their case – declaring them destitute because of their immigration status and have provided them with new accommodation.

Sami has been using a food bank run by Asma Haq of the Marks Gate Relief Project.

She says: “As far as they’re concerned they haven’t done anything wrong. But the reality only hits them when they are left penniless.

“They have no accommodation, they don’t know where to go, and the agent stops making contact with them. That’s when they come to food banks like ourselves.”

Asma Haq runs Marks Gate Relief Project
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Asma Haq runs Marks Gate Relief Project

‘There needs to be a tightened leash’

But Asma tells us she believes Sami is not an isolated case – she believes one in 10 of the people who use the food bank have come to the country illegally or have over-stayed legal visas.

“I just feel like the Home Office’s policies have been quite relaxed and there needs to be a tightened leash. It’s just visas that have been given left, right and centre so easily and so quickly,” she says.

“And the follow-up on the people who have entered into the country on those visas has been poor. Sometimes – I know because I deal with clients – some of them, as far as the Home Office is concerned, they’ve arrived legally.

“But then the paperwork they’ve supplied to the Home Office is actually fake paperwork, fake documentation that they’ve got processed back home.”

A Home Office spokesperson said: “Since we have not been supplied with any identifying information in relation to this case, we are not in a position to comment on the claims made.

“However, stringent systems are in place to identify and prevent fraudulent student visa applications, and we will continue to take tough action against companies and agents who are seeking to abuse, exploit or defraud international students.”

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How many people are coming to Britain on student visas?

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How many people are coming to Britain on student visas?

In the few short years since Brexit, numerous rule changes have impacted the number and type of students coming to the UK.

In January 2023, Sami and his two children arrived from India as dependents of his wife, who was accepted to study on a master’s course in London.

They were among the 657,000 people granted student and dependant visas in the year to June 2023, the highest number in figures collected since 2006.

Nearly 200,000 of those – 28% of the total – were from India, making it the top nationality, followed by Nigeria and China. Together, these three nationalities accounted for two thirds of all student visas granted.

Sami – which is not his real name – claims that agents in India helped to create fake financial documents to secure the family’s visa approval, and that these were used in their application to the Home Office.

Sami also says his wife never intended to study.

While many of the students who arrive in the UK have legitimate documentation, it is impossible to know exactly how many do not – the Home Office collects figures on detected cases but does not publish them, while Sami’s case was allegedly undetected.

The number of student visas granted has since fallen by a third from its 2023 peak, to 436,000 in the latest figures for the year ending June 2025, though remains higher than the average 305,000 per year from 2012 to 2021.

In 2023, there were 154,000 visas granted for the dependents of students, for example partners and children – more than one dependant for every three main student visas granted. By 2025, the number of had fallen to 18,000.

This was largely driven by rule changes introduced by the Conservatives in January 2024, limiting students’ ability to bring dependents with them to the UK – meaning this option would now be closed to Sami’s family.

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Sami says he wants to stay in the UK
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Sami says he wants to stay in the UK

New rules to prevent visa switching

Sami says he paid all his savings to agents in India who told him that he and his wife would easily be able to switch their visas when they arrived and pursue their dream of settling in the UK.

Indeed, from around 2019, the practice of visa switching became increasingly common with students more likely to move to a work or other visa either before their course finished or at the end of their studies. They were also more likely to stay in the UK for longer.

A quarter of international students who first came to study in 2019 were still in the UK five years later in 2024 with valid leave to remain – the highest proportion since the Home Office began keeping records in 2008.

Similarly, students who arrived in 2021 were far more likely to remain in the UK at the end of three years than their predecessors, increasing from around 34% from 2011 to 2018, to 59% by 2021.

And those who were still in the UK after three years were for the first time more likely to be working than still studying.

The Home Office says the increase can be explained by a larger number of students at master’s level transitioning to the graduate and other work routes.

Attempts by Sami and his family to switch visa have so far been unsuccessful, as their original visas were cancelled when his wife failed to register on her master’s course.

Rules brought in by Rishi Sunak’s government from July 2023 now prevent people from arriving on student visas switching to work ones before completing their studies.

Universities supported closing this “loophole”, says Jamie Arrowsmith, director of Universities UK International, as it was “not in the university’s interest if individuals come on a study visa and then leave their courses after three months”.

The government now plans to reduce the time that graduates can stay on to work after their studies from two years to 18 months.

Stricter rules are also in place from this month around visa refusal and course completion rates that universities must meet, with penalties for universities and sponsors that fail to meet targets.

“Effectively, the government is tightening regulation that already exists. That will be challenging for universities, and it will take time, but ultimately those changes are going to be implemented, and we’ve been working closely with government,” Mr Arrowsmith told Sky News.

Sami's wife cooked dinners out of a cupboard in the one bedroom the family lived in
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Sami’s wife cooked dinners out of a cupboard in the one bedroom the family lived in

Asylum claims

Sami and his family have applied for asylum and are currently awaiting a decision on their case, in the hope of securing valid leave to remain in the UK.

Sami has told us he wants to be able to work in the UK, but as he is currently without a valid visa or asylum, he’s not legally allowed to.

The family were assessed as destitute by social services and received support from council and charities.

The number of asylum claims from people who originally arrived on student visas has increased more than those on other visa types in recent years, with 14,800 asylum claims in the year ending June 2025, though down from a peak of 16,500 in the year to June 2023.

For every 50 student visas granted between 2021 and 2025, one person applied for asylum who had originally held a student visa.

There isn’t data available on the proportion of those claims that were successful.

Home Secretary Yvette Cooper has said she wants to “clamp down” on people claiming asylum at the end of their study visa, and the government is actively contacting international students to warn them not to overstay their visa.

In the year to June 2025, 10,441 people were returned voluntarily, or forcibly removed, who had previously applied for asylum, though not all of those would have applied for asylum within that year.

Universities rely on international fees

Fee income from international students has been an important part of universities’ funding models since 2018/19, says Mr Arrowsmith, as successive governments have chosen not to increase student funding in line with inflation.

This has meant that universities have had to make up the shortfall in other ways, which has been mostly through international student fee income.

Foreign students’ fees contributed 23% of universities total income in 2023/24, at £12.1bn, increasing from 16% of university income in 2018/19.

“We have seen a decline in the last two years of the number of international students coming to the UK, and that does pose challenges for finances of UK universities,” Mr Arrowsmith said.

“Ultimately what we need is a more sustainable funding settlement for our universities”.


The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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