Buried beneath every American city is a mysterious jumble of cables, pipes, and gas lines, entangled like a pair of wired headphones the moment you pull them out of your pocket. Every time a contractor sticks a shovel in the asphalt, they embark on a high-risk excavate-by-dots obstacle course, dodging color-coded clusters of spaghetti-like power lines, gas mains, sewers, and fiber-optic cables. A line of blue spray paint means water. Red means power. Yellow is gas. Orange is telecom. 

About 700,000 times a year — that’s once every 47 seconds — something goes wrong. 

A backhoe slices into a cable and cuts off a 911 call center, or a woman comes home to find her dryer and hot water heater on fire after a contractor pierced her electrical line. Just last week, a contractor accidentally severed a single telecommunication cable that proved critical enough to ground flights at some of the nation’s largest airports on the eve of the UN General Assembly, ensnaring even world leaders like Canadian Prime Minister Mark Carney in delays. 

The ground beneath our city streets has never been so crowded, driven by a furious race to lay fiber optic cables carrying the data that fills your social media feeds and transmits your ChatGPT queries. Nor have the systems we use to find out where it’s safe to dig — namely, a hotline and all that colorful spray paint — ever felt so catastrophically insufficient. 

“If the locator mismarked the line, if the line wasn’t marked, if there was no map that even said the line was there,” said Sarah Magruder Lyle, president of the Common Ground Alliance, a trade association focused on underground damage prevention, “there are a variety of issues that could happen before the excavator even puts a shovel or a backhoe in the ground.”

According to Common Ground, such incidents cost the US about $83.2 billion per year, roughly as much as we invest in public transit annually nationwide. But the actual financial toll may be even higher, because every time a crew stumbles across a mislabeled power line or a gas pipe everyone else forgot about, it can delay construction for months on end. As Magruder Lyle put it, “if they get out there and they find something that they’re not supposed to, you have to go back and reengineer the whole project.” 

Such surprises can also lead to tragedy. A 5-year-old named Alistair Lamb was killed in Missouri last spring after a contractor drilled into a gas line near his home, spewing fumes that leveled his house when his unsuspecting father flipped a light switch. And just this May, another unmarked gas line killed three people when contractors struck it, leading an apartment complex in Dallas to explode.

Yet the messy underbelly of our cities remains largely invisible, with accountability for issues foisted upon and at times evaded by a hodgepodge of finger-pointing private utility companies, agencies, and contractors. And that’s a shame because there is, in fact, a better way to bury the cables and pipelines that our modern lives depend on, and a multitude of better ways that we can find the ones we’ve already buried. 

What Disney World gets right about the stuff we bury

To understand one utopian vision for how all this could work, look no further than the happiest place on Earth. That’s a moniker Disney World has earned, in my mind, not for its Mickey Mouse waffles (though my niece may disagree), but for its world-class utility corridors, also known as utilidors.

Directly beneath the Magic Kingdom is a sprawling network of tunnels. Initially designed to shepherd around Mickey and his friends, the system now also serves as one of the largest utility corridors ever created. Unlike the rest of America, where cables are typically dumped in ditches before being covered with dirt, the electrical lines that power Cinderella’s castle quite literally get the princess treatment. 

Alongside water pipes, sewers, and animatronic control systems, these power lines lace the walls and ceilings of the utilidors, meaning they’re protected from weather and changes in the soil. They are also easy to monitor, catalog, and access if something needs fixing. While the cost of building a controlled system like this is much higher upfront than burying directly in the ground, the practice virtually eliminates the risk of accidentally rupturing a gas main or slicing a fiber optic cable during routine maintenance. Once they’re built, they can also drastically reduce costs in the long run because you no longer need to tear up a street every time a utility needs fixing. 

“Obviously, it’s expensive,” said Debra Laefer, a professor of civil and urban engineering at New York University, “but in the long term, it would be hugely cheaper,” especially “in areas where we are digging all the time, there’s a direct business case for moving towards these utilidors.”

As fantastical as Disney World’s imagineered system may seem — and it was, to be clear, predicated on a not-easily-reproducible master plan — the idea of storing utility lines in easy-to-access tunnels is not just for amusement parks. It is possible even in places where most of those lines are currently lying in the dirt, as Prague proved back in the 1970s, when the city decided it was fed up with destroying its precious cobblestone streets every time a buried pipe or cable needed fixing. The city now boasts a sprawling utility tunnel network, occasionally patrolled, evidently, by a couple of robot dogs tasked with mapping out every cable. 

Singapore has also spent years building out walkable utility corridors that operate much like the Magic Kingdom’s, transmitting water, data, and energy from the safety of well-organized underground tunnels. Some of Tokyo’s largest districts store their cables and gas lines in huge concrete utility ducts, and many Parisian water lines and fiber optics are kept across the city’s centuries-old sewer system, a catacombs of waste made easily navigable by blue-and-white street signs that correspond to the avenues above. Many university campuses across the US also boast their own sprawling utilidors.

In most cases, cities chose not to relocate utilities all at once, a feat that would probably be financially prohibitive and deeply disruptive. Rather, they took advantage of all the times they’ve needed to relocate utility lines anyway, a standard (and expensive) practice for big building projects like the Wallis Annenberg Wildlife Crossing or the Second Avenue Subway, a major transportation project in New York City that’s been consistently delayed by unmapped utility lines. A group of graduate students found that building such a tunnel in parts of NYC would likely cost at least twice as much as dropping a utility line in the ground, but could recoup the costs within 47 years. 

“There are streets in New York City that have been excavated at least once a year, every year for the past 30 years,” Laefer said. If you just prioritize those streets, gathering the piping in a “big concrete box” underground, you could allow workers to complete most repairs without needing to disturb the streets or sidewalks above at all.

But building new utility tunnels would require that we first come to better understand the wires and piping already entangled under our cities, which if you recall, we have only a surprisingly flimsy picture of in most cities today. But if every surprise utility line is an opportunity to move it somewhere better, it is also an opportunity, at the very least, to map out where it is.

To that end, a few years ago, Laefer led a $1.2 million pilot funded by the National Science Foundation to create a test case for 3D-mapping New York City’s underground utilities, a project that’s since been adopted into a citywide initiative. The city says it plans to roll out the spruced up utilities locating system in 2028. The UK debuted a similar digital map of over 3 million kilometers of underground pipes and power, owned by hundreds of utilities and agencies a few years ago. The nation projects that it could help save over $500 million per year by minimizing delays and accidental damage. In places where Singapore has not yet stuffed its utilities into walkable tunnels, the city’s own mapping and utilities coordination has already saved it an estimated $230 million in avoided clashes since 2024. Not bad for an intervention that doesn’t even require any physical rebuilding.

So why hasn’t every American city copied London or Singapore?

Well, US cities tend to be plagued by even more private utilities and patchwork local and state norms and regulations than a nation like the United Kingdom. Getting them to pool together what they often consider proprietary underground data is challenging, and few local officials have opted to prioritize such efforts. But this may well change as more and more fiber optics go into the ground, more flights get canceled, more apartment complexes explode, more power lines flicker off, more sinkholes form, and more Americans come to be all too acquainted with the perils lurking just beneath our feet. 

“I think at this point, it’s more about political will and money than any technical obstacle,” Laefer said. “Technically, we’re there. It’s just a matter of doing it.”

Welcome to The Midterms, Actually. Every week I’ll be writing about two things: one big idea or trend I see forming across the 2026 primaries, and one thing I’m hearing from a voice on the ground. You can sign up here to get it in your inbox every week. Let’s get into it.

One big idea: Democrats’ Laken Riley vote is aging badly

Two things happened this week that reveal how quickly the politics of immigration enforcement are shifting.

First, Republican Sen. Jim Justice of West Virginia, a staunch ally of President Donald Trump, urged the administration to dial back its enforcement push. “Before you know it, you get people that get carried away in their job and whatever it may be, and all of a sudden, then you’re dragging people away that have lived on your street corner for 15 years,” Justice told Politico this week. “I don’t know that we need to be doing that stuff.” And he’s not the only red-state Republican who’s been pushing back on ICE lately, including some facing voters in tough races next month.

The second thing flew under the radar: Sen. Jon Ossoff, the Georgia Democrat running for reelection who has also been floated as a 2028 presidential candidate, struggled to explain himself when a reporter confronted him on camera about his vote for the Laken Riley Act in January 2025. Passed within days of Trump’s inauguration and signed nine days into his second term, the law requires ICE to detain undocumented immigrants who are merely arrested for or charged with theft-related crimes, before any conviction.

In the exchange with a reporter from Drop Site News, Ossoff talked about his Senate work investigating alleged ICE abuses, but didn’t directly address his vote after being asked if he regretted it. “Laken Riley was my constituent and what happened to her should happen to no American, to no person in this world,” Ossoff said. “I think that immigration enforcement should be focused on those who are convicted or charged with serious crimes.” He excused himself to walk into a meeting as the reporter pressed him on whether the law undermined due process. 

In both cases, you see changing winds of electoral politics. Back in 2025, when Ossoff and 11 other Senate Democrats joined Republicans in supporting Trump’s immigration bill, they implicitly validated Trump’s premise on immigration enforcement: that not only was the border out of control, but that there also needed to be new efforts to step up interior enforcement through expanding agencies like ICE. In the year-plus since that vote, Trump has hired more ICE officers, launched sweeping raids in cities like Minneapolis, Chicago, and Los Angeles, and fueled a cauldron of chaos that’s led to shootings across the country. Politically, it has now put Democrats like Ossoff in a pickle, one that will matter more the closer we get to 2028.

How do you explain giving more immigration powers to a Stephen Miller-led White House? How can one argue you couldn’t have seen this coming?

In some ways, you can understand the political logic of the time. Ossoff, who is running in a state Trump carried, and many of the congressional Democrats who supported the Laken Riley law were in competitive races, and Democrats left the 2024 election thinking they had misread the electorate on the issue, particularly after Latino voters swung hard toward the right. But given what’s happened since, it’s clear many congressional Democrats made a familiar mistake: prioritizing political triangulation over standing on their values of protecting marginalized communities.

Take a look at some of the Democrats who have already had to walk back their votes. In the Democratic primary for Minnesota’s open Senate seat, Lt. Gov. Peggy Flanagan made US Rep. Angie Craig’s vote for the law a key focus of her campaign, calling it “disqualifying.” The attacks were so effective that Craig eventually expressed remorse, saying, “I wanted to be honest with the people of Minnesota. I will tell you when I get it wrong, and I got that one wrong.” Craig lost the August 11 primary to Flanagan.

Maryland’s April McClain Delaney, another congressional Democrat, also said she regretted her vote: “I will say that this was in the beginning of my term. And I never thought that ICE immigration and the horror of what has happened would happen.” (She survived her primary, defeating David Trone by 6 points.)

It’s easy to see where the buyer’s remorse is emanating from. Trump’s ICE is broadly unpopular. And as we’ve talked about on this Substack and in our reporting on America, Actually, Trump is doing worse and worse with Latino voters, with both prices and immigration enforcement driving the slide. A Hart Research poll for TelevisaUnivision of 1,500 Latino registered voters in battleground House districts (August 6–17) found 63 percent disapprove of Trump’s job performance and 62 percent disapprove of his handling of immigration enforcement and deportations. Sixty-four percent view ICE unfavorably. 

When I recently talked to Stephanie Valencia of Equis Research, she said this: 

The people who feel most regretful who voted for Trump in 2024 are most regretful because of immigration. They feel like there was a broken promise there. Like, they were told he was gonna focus on the border, which everybody agreed was chaos, and he was gonna focus on violent criminals and serious threats, and at the end of the day, he has not complied with that.

But while the shift in public opinion helps explain the elected officials’ political logic, it doesn’t change the material harm of their votes. Just this week, ICE announced plans to hire 5,000 more employees, most of them deportation officers, by the end of the year as enforcement continues to ramp up.

And these raids have a lasting effect on targeted communities, like in Maine, the Chicago area, and Texas. It’s the No. 1 issue that has come up in my conversations with local reporters. The chief architect of this chaos is the president, but make no mistake: Trump had help from shortsighted Democrats.

One thing I’m hearing 

Maya Miller is a Report for America corps member covering democracy and government for the Gulf States Newsroom, a public radio collaboration that includes Louisiana’s WWNO and WRKF. She’s been reporting on Mississippi’s redistricting fight and what residents are saying about their representation and the upcoming midterms.

You’ve been reporting from redistricting hearings in Mississippi. What are residents most concerned about, and is there a conversation or moment that captures the mood?

Residents are most concerned about their representation. In Mississippi in particular, race and party are strongly intertwined, and Black residents worry that by being drawn into new districts, voters may elect a Republican candidate. There was a bit of secrecy around redistricting earlier this summer, with Gov. Tate Reeves, a Republican, canceling a special session to redraw judicial lines. So advocates created the People’s Hearings, a series of meetings held across the state to voice concerns and create a public record of testimonies from Mississippians. Quickly after, lawmakers decided to host their own public hearings, and at these hearings, hundreds of residents showed up, mostly to urge them not to redistrict.

“It seems to me that the threat of losing representation has made people more aware of the moving parts.”

At one hearing, I spoke to Joyce Arceneaux-Mathis, president of the Natchez NAACP. She’s frustrated that the state is going to spend millions on new maps when people are struggling with day to day expenses. And Ramona Sanders of Meridian, Mississippi, has a lot of concerns on whether mid-decade redistricting is illegal. While it’s not, she says that lawmakers are opening themselves up to legal action. I haven’t heard anything from voter advocacy groups that points to future lawsuits, but only time will tell, if and when lawmakers redraw the maps, if these maps are constitutional or not.

Redistricting is often covered as a fight over which party wins more seats. What would these changes mean for the communities you cover and their ability to have a voice in Congress?

One change that could happen is that residents who are Democrats might lose the state’s only Democrat leader. Out of four congressmen, there’s only one Democrat, Bennie Thompson, who represents District 2. His district spans much of the west, from the capital city of Jackson to most of the Mississippi Delta and southwest Mississippi. It’s a heavily Black district, somewhere around 63 percent Black. He’s held this seat for 33 years and has brought millions to the district for health care, infrastructure, and agriculture. 

So residents are worried that Republicans are trying to edge him out and replace him with a more conservative leader who may not have the same concerns as the community. 

How are these fights affecting people’s interest in the midterms? Are you hearing more determination to vote, more doubt that voting matters, or something else?

People are fired up. They’re incredibly engaged. I’m hearing from a lot of people who are more determined to vote in November than when I covered redistricting in Alabama in 2024. It seems to me that the threat of losing representation has made people more aware of the moving parts. So they’re attending hearings, participating in rallies, registering to vote and checking their registration, phoning a friend and making plans to be at the polls on November 3.

What is the national conversation about redistricting missing that becomes clear when you spend time in these communities?

I think the national conversation is missing the voice of the community. It’s one thing to report on the politics of redistricting, but there’s a layer of real concern from residents that shouldn’t be ignored. They’re worried about hospitals closing. They’re worried about public schools losing funding. They’re worried about the rising cost of groceries and gas. I find that talking to and listening to residents helps me understand a community more than calling up a lawmaker and asking them their thoughts. There’s a place for that side of the conversation, of course, but I’ve always tried to center people who will be most impacted in my reporting, and I feel that leads to a better story for our listeners.

After moving to West Virginia last year, Steve Kuo signed up for a new insurance plan that would cost him $500 a month. But there was one upside: He knew he was entitled to a free preventive visit. He wanted to take advantage of it, so he made an appointment at a clinic near his new home.

But then when he got there, they asked about his medical history and he mentioned prior kidney problems. When he received a bill a few weeks later, he had been charged twice for the same appointment: Once as that free preventive visit, once as an “office sick visit” because of the kidney conversation. He was flummoxed — and very annoyed, as he shared on social media. “No copayment means no copayment, exactly as stated in the insurance guidelines,” Kuo told me over email. “What is written and agreed upon should be honored.”

He is far from alone. On Reddit, I easily found more than a dozen examples in just the past year of people getting a surprise bill for what they thought was going to be a free visit. 

One woman posted a nearly $1,000 bill she’d received for what she thought was going to be a preventive gynecology visit. Another woman said that she ended up facing roughly $3,000 bills because she was given an ultrasound (which she said she didn’t request) at a preventive visit, and then her blood draw was sent to an out-of-network lab. Another person lamented that they had been billed $170 for an office visit because they had briefly mentioned back stiffness.

It’s not supposed to be like this. Americans don’t get much when it comes to our healthcare, but most of us are supposed to be entitled to at least one thing: Once every year, no matter your health insurance, you can go to the doctor with the goal of preventing future health problems by discussing important vaccinations, cancer screenings, and cardiovascular health screenings. The Affordable Care Act made that the law in 2010.

But more than 15 years later, people all over the country are walking into their doctor’s office, thinking they’re entitled to that one free visit every year, and walking out being billed for a sick visit, blood labs, and more. Researchers estimate that Americans spend tens of millions, maybe hundreds of millions of dollars every year on services that are supposed to be free under the ACA.

Dr. Yalda Jabbarpour, a family physician in the Washington, DC, area and medical director of the Robert Graham Center for Policy Studies, told me she still deals all the time with people’s confusion about what a preventive visit really means.

“Every single time I’m in the clinic, this issue comes up with a patient. And it’s sad that it comes up,” Jabbarpour told me. “In my mind, the blame is not to be put on the patient. The blame is not to be put on the physician. Really, this points to a bigger system issue that we need to solve.”

How could a seemingly simple promise of one free annual doctor’s visit result in a situation so convoluted that patients and doctors are still struggling with it nearly two decades later? And how might we fix it?

Patients are getting surprise bills from their doctors — and they’re pissed off

The goal of the ACA was to expand coverage and make sure health insurance would be comprehensive to actually help people stay healthy. As part of that project, the authors of the law added a mandate for insurers to cover those services, including an annual wellness exam. The problem is, they did not define what the parameters of that preventive visit actually were, said Alex Hoagland, a healthcare economist at the University of Toronto. 

“It didn’t establish a clear definition of…all the diagnosis codes and procedure codes and how frequently you get that combination within a year,” he said. “They don’t define what actually is preventive care and what’s not.”

That has left each insurer to define a preventive visit on their own — and that’s where the perverse incentives that leave patients in a lurch begin. Preventive visits are supposed to be reserved strictly for screenings and talking about other preventive measures you can take to protect your long-term health, but you may get billed for an “office visit” or a “sick visit” if you talk about any specific symptom you’re experiencing, the same as if you had come in because you had the flu. 

Health insurers have an incentive to keep the definition of preventive care as narrow as possible, so they have to pay fewer claims without any contribution from the patient. At the same time, doctors want to be paid for the actual services that they are providing. If somebody does bring up a bigger health problem during a preventive visit, then the doctor reasonably wants to be paid accordingly. 

“I know, particularly in the healthcare space, it’s really popular to blame one party or another, and here I don’t think it’s a matter of corporate greed or physician incompetence or whatever,” Hoagland said. “It’s just a natural mismatch of incentives.”

So the reality is that “one free doctor’s visit” sounds straightforward, but, in practice, it’s much more complicated. You as the patient might think of it as one visit, but in our fee-for-service healthcare system, where providers bill based on each specific thing they do, it’s not. The conversation about your vaccination may be free — but asking about your back pain is not. If you get blood tests ordered, that’s another line item. The list goes on. “It’s not like you walk into a doctor’s office and it’s just one thing that happens, right?” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “It’s multiple different things that are happening when you go into a doctor’s office.”

Part of the problem may be that it’s one free visit. We Americans are consumers at heart: Tell us we’re going to get something for free and we want to take advantage of it. But having just one free visit may also lead to people bringing a laundry list of questions to that preventive visit, because they think of it as their only chance to ask everything of their doctor. 

That makes it easy for the discussion to tip over into a sick visit — and not only does that lead to a surprise bill, it can also crowd out the conversation about prevention that the visit is supposed to be focused on.

“What ends up happening a lot…is that a patient comes in for their annual visit, and in their mind, that is their time to bring up every single thing that’s been happening during the year, because they see it as the free visit to bring up everything that’s happened during the year. For some patients, that takes up the entire visit,” Jabbarpour told me. “They leave, and it’s like, ‘Oh my god, we forgot to do all the screening things: the vaccinations, the cancer screenings, and the cardiovascular risk screening.’ And then something happens down the line because you never address those screenings.”

A 2021 study by Hoagland and Paul Shafer, both of Boston University at the time, estimated that Americans with employer-sponsored insurance had in 2018 alone paid between $75 million and $219 million in medical bills that should have been free. They were more likely to be charged for things like contraception or cholesterol and diabetes screenings, with individuals sometimes paying hundreds of dollars for those services.

Hoagland told me he had been billed for preventive visits because he has type 1 diabetes and the system automatically categorized his appointment as a diabetic visit. Earlier this year, he co-authored a study that found people with chronic conditions were more likely to be charged for preventive care. Corlette said that she too had recently been charged for what was supposed to be a preventive visit after she mentioned an issue as an aside. And these are folks who study health care for a living.

“It was literally maybe a 10-second conversation where I would ask the doctor a question about something,” she said. “And that triggered it.”

Colonoscopies are another dramatic example of how this issue plays out in real life; Corlette told me the procedure was one of the first services where this fuzzy line between prevention and treatment under the ACA became obvious. People go under for what is supposed to be a preventive colonoscopy. But then their doctor finds a polyp and decides to remove it — good clinical practice, but as a result, their patient could end up being charged thousands of dollars because the colonoscopy was no longer preventive once that polyp was snipped.

“All of a sudden, that would trigger what the patient thought was a preventive service into a cost-sharing obligation,” Corlette said. “Colonoscopies can be thousands of dollars. That was when we were first like, ‘Oh, yeah, this is a more complicated area than I think the lawmakers that drafted this provision originally envisioned.’”

How the US could fix our preventive visit headaches

The ACA’s preventive visit promise was clearly well-intentioned and it’s worth remembering that, if you look in the aggregate, more Americans are getting more free preventive care than they did before the law was passed. The problem, as much as anything, is expectations: People think they’re entitled to a free visit and are understandably frustrated when they get billed for it.

“The difference is before the Affordable Care Act, maybe they anticipated some kind of cost-sharing,” Hoagland said. “But after, they expect it to be free.”

It doesn’t have to be this way. Corlette’s team at Georgetown University recently released a proposal that Americans be entitled to three primary care and two urgent care visits every year with no cost-sharing. This approach has two virtues, she told me: It will help people feel like they are actually getting value from their insurance — the very complaint that Steve Kuo raised — and, because we know primary care helps prevent problems down the road, it should also improve people’s health in the long term. Take the pressure off that one free visit and let people see the doctor a few times a year without worrying about being charged.

“In employer-based insurance, a lot of people feel like, ‘What the hell am I getting for my premium each month?’” Corlette said. “We wanted people to feel like they’re getting good value, and we wanted to get to better population health.”

Hoagland also endorsed the idea of at least one free physician’s visit every year, no matter what’s discussed. In the long term, Jabbarpour said she’d like to see copays eliminated entirely for primary care. 

But any payment reforms are not going to happen immediately. What can we do right now?

For one, doctor offices could make an effort to be as transparent as possible. Jabbarpour’s MedStar system has started calling people a couple of days before their appointment with a brief script that tells the patient that they could be charged if the conversation with their doctor touches on additional medical problems. If your doctor’s office doesn’t proactively bring it up, ask when you schedule your appointment or when they call you to confirm it. Worst-case scenario, ask your provider what they consider preventive care when your visit begins. You might also want to educate yourself on what services are generally considered preventive and should be available for free: Your insurer may make that information available on their website, or KFF has a database you can peruse.

It’s not a perfect solution. “What ends up happening is patients come in, and they say, ‘I know I’m not supposed to talk to you about anything else, so I’m not going to tell you about anything else.’ And you don’t want that to happen,” Jabbarpour said. You should ask your doctor directly: What do you consider to be preventive care? Establish boundaries at the start. That way, you can at least be aware if you are going to get charged because the conversation crossed the line to discussing an active health problem.

And if you want to see the underlying laws change, start organizing. Contact your state and federal reps and ask them what they are doing to ensure this stops happening. Things could be different: Jabbarpour said she hopes to one day work in a health system where the cost of a single primary care visit isn’t so high-stakes, where doctors and their patients can manage their health according to their particular needs, rather than worry about how to bill for one specific conversation that covers the whole range of somebody’s health — like primary care is supposed to do.

“I think some patients can be managed by seeing us once every year, once every two years, and some patients need to see us monthly,” Jabbarpour told me. “To put all patients in the same box and say you can only see your primary care physician once a year if you want it paid for, it makes zero sense.”

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.