The prospect of deep Medicaid cuts has become a flashpoint in Congress, with leaders of both parties accusing their counterparts of lying.

House Democratic leader Hakeem Jeffries said Feb. 27 that a Republican budget measure would “set in motion the largest cut to Medicaid in American history,” and that Republicans are hiding the consequences.

“The Republicans are lying to the American people about Medicaid,” Jeffries said. “I can’t say it any other way. Republicans are lying. Prove me wrong.”

Republicans said Democrats were distorting the Republican budget. Rep. Steve Scalise (R-La.) said, “The word ‘Medicaid’ is not even in this bill.” House Speaker Mike Johnson said on CNN that Republicans don’t want to cut Medicaid, “and the Democrats have been lying about it.”

Republicans are looking for massive budget savings to meet their goal of fully extending President Donald Trump’s 2017 tax cuts. This is a separate process from Congress’ need to pass a continuing resolution to keep the government running by March 14 or face a federal government shutdown.

Here’s what we know so far about potential Medicaid cuts.

The House GOP Budget Plan Seeks $880 Billion in Cuts

Medicaid serves about 1 in 5 Americans. The health care program for low-income people is paid for by the federal government and partly by states. Louisiana, home to Johnson and Scalise, has one of the highest state proportions of Medicaid enrollees.

The House Republican budget plan adopted Feb. 25 opens the door to slashing Medicaid, even though it doesn’t name the program. The plan directs the House Energy and Commerce Committee to find ways to cut the deficit by at least $880 billion over the next decade.

The committee has jurisdiction over Medicaid, Medicare, and the Children’s Health Insurance Program, in addition to much smaller programs. CHIP offers low-cost health coverage to children in families that earn too much money to qualify for Medicaid.

Republicans ruled out cuts to Medicare, the health insurance program for seniors that leaders cut at their political peril. Medicare is about 15% of the federal budget, and Medicaid is about 8.6%.

When Medicare is set aside, Medicaid accounts for 93% of the funding under the committee’s jurisdiction, the nonpartisan Congressional Budget Office found in a March 5 analysis. That means it is impossible for the committee to find enough cuts that don’t affect Medicaid.

“It’s a fantasy to imply that federal Medicaid assistance won’t be cut very deeply,” said Allison Orris, an expert on Medicaid policy at the Center on Budget and Policy Priorities, a left-leaning think tank.

After Medicaid, the next-largest program under the committee’s jurisdiction is CHIP. Lawmakers don’t appear to be planning to wipe out CHIP, but even if they did, they would be only a “fraction of the way there,” said Joan Alker, an expert on Medicaid and CHIP at Georgetown University.

If Medicare cuts are off the table, the only way to achieve $880 billion in savings is through big Medicaid cuts, said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling, and news organization that includes KFF Health News.

Andy Schneider, a professor at Georgetown University who served in the Obama administration as a senior adviser at the Centers for Medicare & Medicaid Services, said even if the committee eliminated all those “other” programs entirely it could achieve only $381 billion in savings — about 43% of the target.

“In short, if they don’t want to cut Medicaid [or CHIP], and they don’t want to cut Medicare, the goal of cutting $880 billion is impossible,” Schneider said.

The $880 billion cut is not a done deal. House Republicans were able to pass their budget package, but Senate Republicans are taking a different approach, without proposing such significant cuts.

Any finalized budget blueprint would need Senate Republicans’ buy-in. Sen. Josh Hawley (R-Mo.) is among Republicans who have spoken against potential cuts; he told HuffPost, “I would not do severe cuts to Medicaid.”

The numbers are starting points that may lead to negotiation among at least Republicans, said Joseph Antos, a health care expert at the conservative American Enterprise Institute. “We are a long way from final legislation, so it’s not possible to predict how much any program will be cut,” he said.

“If the bill also includes extending the [Trump 2017] tax cuts, we are probably months away from seeing real language,” Antos said.

Once the House and Senate have reached an agreement on language and the resolution passes both chambers, the committees will work on detailed cuts. To enact such cuts, both chambers would need to approve a separate bill and receive Trump’s signature.

Why Eliminating Fraud Doesn’t Solve the Problem

Republican leaders have deflected concerns about Medicaid cuts by talking about a different target: Medicaid fraud.

“I’m not going to touch Social Security, Medicare, Medicaid. Now, we’re going to get fraud out of there,” Trump told Fox News’ Maria Bartiromo on March 9, in keeping with his campaign rhetoric that he would protect those programs.

At the same time, Trump on his Truth Social platform praised the House resolution that would make cuts highly likely: “The House Resolution implements my FULL America First Agenda, EVERYTHING, not just parts of it!”

Would eliminating fraud solve the Medicaid problem? No.

On CNN, Johnson said cutting fraud, waste, and abuse would result in “part of the savings to accomplish this mission.” He said the government loses $50 billion a year in Medicaid payments “just in fraud alone.”

Johnson conflated “fraud” with “improper payments.” The Government Accountability Office, the nonpartisan investigative arm that examines the use of public funds, found about $50 billion in improper payments in Medicaid and the same amount in Medicare in fiscal 2023.

Those improper payments were made in an incorrect amount (overpayment or underpayment), should not have been made at all, or had missing or insufficient documentation. But that doesn’t mean that there was $50 billion in Medicaid fraud, which would involve obtaining something through willful misrepresentation.

The system used to identify improper payments is not designed to measure fraud, so we don’t know what percentage of improper payments were losses due to fraud, said Schneider, the former Obama administration health adviser.

Plus, it’s a drop in the overall bucket of the potential $880 billion in cuts.

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DENVER. — Hace siete años, Erica Green se enteró a través de Facebook que le habían disparado a su hermano.

Corrió al hospital, uno gerenciado por Denver Health, el sistema de seguridad social de la ciudad, pero no pudo obtener información de los trabajadores de la sala de emergencias: se quejaron de que ella estaba generando un disturbio.

“Estaba afuera, angustiada y llorando, cuando Jerry salió por la puerta principal”, dijo.

Jerry Morgan es un rostro familiar en el barrio de Green, en Denver. Había ido al hospital después de que su pager lo alertara del tiroteo. Como profesional de la prevención de la violencia en el programa At-Risk Intervention and Mentoring (AIM), Morgan brinda su apoyo en el hospital a los pacientes víctimas de violencia con armas de fuego y a sus familias.

Es lo que hizo el día en que le dispararon al hermano de Green.

“Me ayudó a que atravesara mucho mejor esa experiencia traumática. Al punto que después pensé: yo también quiero dedicarme a eso”, contó Green.

Ahora, Green trabaja con Morgan como directora de AIM, un programa de intervención contra situaciones de violencia vinculado a los hospitales. AIM se puso en marcha en 2010 como una asociación entre Denver Health y la organización sin fines de lucro Denver Youth Program. Desde entonces, se ha ido ampliado para incluir el Hospital Infantil de Colorado y el Hospital de la Universidad de Colorado.

En todo el país existen docenas de programas de intervención contra la violencia vinculados a hospitales, como AIM. El objetivo de estos programas es identificar los factores sociales y económicos que contribuyeron a que una persona terminara en una sala de emergencias con una herida de bala, por ejemplo, la falta de una vivienda adecuada, la pérdida de empleo o sentirse inseguro en el propio vecindario.

Este tipo de programas, que abordan la lucha contra la violencia con armas de fuego desde una perspectiva de salud pública, han tenido éxito.

En San Francisco, uno de ellos logró reducir en un 75% la cantidad de personas que volvieron a sufrir heridas por hechos violentos en un período de seis años.

Pero las órdenes ejecutivas del presidente Donald Trump, que piden la revisión tanto de las políticas de armas de la administración Biden como de los billones de dólares en subvenciones y préstamos federales, han creado incertidumbre en torno a la financiación federal a largo plazo de estos programas. Algunos organizadores creen que no se verán afectados, pero otros ya están buscando asegurar fuentes de financiamiento alternativas.

“Nos preocupa que se produzca un efecto dominó, una reacción en cadena. Y nos preguntamos cómo nos afectará. Hay muchas incógnitas”, explica John Torres, director asociado de Youth Alive, una organización sin fines de lucro con sede en Oakland, California.

Los datos federales muestran que la violencia con armas de fuego se convirtió en una de las principales causas de muerte entre niños y adultos jóvenes a principios de esta década y que en 2022 estuvo relacionada con más de 48.000 muertes entre personas de todas las edades.

El pediatra de Nueva York Chethan Sathya, especializado en cirugía y traumatología, investiga cómo prevenir lesiones por armas de fuego, financiado por los Institutos Nacionales de Salud (NIH). Sathya sostiene que las estadísticas muestran que esta forma de violencia debe ser considerada como un problema de salud pública. “Está matando a demasiada gente”, argumentó.

Las investigaciones demuestran que haber sufrido una lesión violenta aumenta el riesgo de tener otras en el futuro. Y también que el riesgo de muerte aumenta significativamente luego de la tercera lesión violenta. Los datos surgen de un estudio de 2006 publicado en The Journal of Trauma: Injury, Infection and Critical Care.

Benjamin Li, médico de la sala de emergencias en Denver Health y director médico del sistema de salud de AIM, dijo que la emergencia es un entorno ideal para intervenir ante la violencia con armas de fuego, ya que permite investigar y comprender los eventos que llevaron a que un paciente haya sido baleado.

 “Si solo atendemos a la persona, la curamos y luego la enviamos de vuelta a vivir en las mismas condiciones, sabemos que es muy probable que vuelva a resultar herida”, explicó Li. “Es fundamental que abordemos los determinantes sociales de salud y tratemos de cambiar esa realidad”.

Eso podría significar que se proporcione a las víctimas de disparos soluciones alternativas para evitar que busquen venganza, opinó Paris Davis, director de programas de intervención de Youth Alive.

“Puede ser ayudarlos a mudarse a otra zona o facilitarles que consigan una vivienda. También colaborar para que puedan canalizar esa energía hacia la educación o el trabajo o, por ejemplo, iniciar una terapia familiar. Sean cuales fueren las necesidades en cada caso y en cada individuo en particular, nos aseguramos de brindarles el apoyo que necesitan”, dijo Davis.

El equipo de AIM que trabaja directamente con la comunidad visita a las víctimas de disparos en sus camas de hospital para tener lo que Morgan, el principal encargado de esta área del programa, describe como una conversación difícil pero libre de prejuicios respecto de cómo los pacientes llegaron a esa situación.

AIM utiliza esa información para ayudar a las personas a acceder a los recursos que necesitan para afrontar los grandes desafíos que los esperan después de que les den el alta, dijo Morgan. Esos desafíos pueden incluir volver a la escuela o al trabajo, o encontrar una nueva vivienda.

Los trabajadores comunitarios de AIM también pueden asistir a los procedimientos judiciales y ayudar con el transporte para que los pacientes acudan a las citas de atención médica.

“Tratamos de ayudar en la medida de lo posible, pero depende de lo que necesita el beneficiario”, dijo Morgan.

Desde 2010, AIM ha pasado de tener tres a tener nueve trabajadores sociales a tiempo completo, y este año ha abierto la REACH Clinic en el barrio Five Points de Denver. La clínica comunitaria ofrece kits para el cuidado de heridas, fisioterapia y atención de salud conductual, mental y ocupacional. En los próximos meses, tiene previsto agregar a sus servicios la extracción de balas.

El programa forma parte de un movimiento creciente de clínicas comunitarias centradas en lesiones violentas, como la Bullet Related Injury Clinic, en St. Louis.

Ginny McCarthy, profesora adjunta del Departamento de Cirugía de la Universidad de Colorado, describió REACH como una extensión del trabajo hospitalario, que ofrece un tratamiento integral en un solo lugar y fomenta la confianza entre los proveedores de salud y las comunidades minoritarias que históricamente han padecido prejuicios raciales en la atención médica.

Caught in the Crossfire, creado en 1994 y dirigido por Youth Alive en Oakland, es mencionado como el primer programa de la nación de intervención de violencia vinculado a un hospital; desde entonces ha inspirado a otros.

La Health Alliance for Violence Intervention, una red nacional iniciada por Youth Alive para promover soluciones de salud pública a la violencia con armas de fuego, en enero de este año contaba entre sus miembros con 74 programas de intervención de violencia vinculados a hospitales.

La directora ejecutiva de la alianza, Fatimah Loren Dreier, comparó el papel de la medicina en la lucha contra la violencia armada con el de la prevención de una enfermedad infecciosa como el cólera. “Esa enfermedad se propaga si no se cuenta con buenas condiciones sanitarias en los lugares donde se concentra la gente”, argumentó.

Dreier, que también es directora ejecutiva del Kaiser Permanente Center for Gun Violence Research and Education, dijo que la medicina identifica y rastrea los patrones que conducen a la propagación de una enfermedad o, en este caso, a la propagación de la violencia.

“Eso es lo que la atención sanitaria puede hacer realmente bien para cambiar la sociedad. Cuando lo implementamos, obtenemos mejores resultados para todos”, dijo Dreier.

La alianza, de la que AIM es miembro, ofrece asistencia técnica y formación para programas de intervención contra la violencia vinculados a hospitales y ha solicitado con éxito que sus servicios sean reconocidos para recibir reembolso de los seguros tradicionales.

En 2021, el presidente Joe Biden emitió una orden ejecutiva que abrió la puerta para que los estados utilizaran Medicaid para la prevención de la violencia. Varios estados, entre ellos California, Nueva York y Colorado, han aprobado leyes que establecen un beneficio de Medicaid para los programas de intervención contra la violencia vinculados a hospitales.

El verano pasado, el entonces cirujano general de los Estados Unidos, Vivek Murthy, declaró la violencia armada como una crisis de salud pública, y la Ley Bipartidista de Comunidades más Seguras de 2022 destinó $1.400 millones en fondos para una amplia gama de programas de prevención de la violencia hasta el próximo año.

Pero a principios de febrero, Trump emitió una orden ejecutiva en la que ordenaba al fiscal general de los Estados Unidos que llevara a cabo una revisión de 30 días de varias políticas de Biden sobre la violencia armada.

La Oficina de Prevención de la Violencia Armada de la Casa Blanca parece estar inactiva, y las recientes medidas para congelar las subvenciones federales han creado incertidumbre entre los programas de prevención que reciben financiación federal.

Según Li, AIM recibe el 30% de su financiación de su acuerdo operativo con la Oficina de Soluciones a la Violencia Comunitaria de Denver. El resto proviene de subvenciones, incluida la financiación de la Ley de Víctimas del Crimen, que llega a través del Departamento de Justicia. A mediados de febrero, las órdenes ejecutivas de Trump no habían afectado a la financiación actual de AIM.

Algunas de las personas que trabajan con los programas de prevención de la violencia vinculados a hospitales en Colorado confían en que un nuevo impuesto especial sobre las armas de fuego y las municiones, ya aprobado por los votantes en el estado, pueda ser una fuente adicional de financiación.

Se espera que genere unos $39 millones anuales y apoye a los servicios para las víctimas, pero no es probable que los ingresos del impuesto fluyan por completo hasta 2026, y no está claro cómo se asignará ese dinero.

Catherine Velopulos, cirujana de traumatología e investigadora de salud pública, que es la directora médica de AIM en el hospital de la Universidad de Colorado en Aurora, dijo que cualquier interrupción en la financiación federal, aunque sea durante unos meses, sería “muy difícil para nosotros”. Pero aseguró que la tranquilizaba el apoyo bipartidista al tipo de trabajo que hace AIM.

“La gente quiere simplificar demasiado el problema y dice: ‘Si nos deshacemos de las armas, todo se detendrá’ o ‘No importa lo que hagamos, porque de todos modos van a conseguir armas’”, afirmó. “Lo que realmente tenemos que pensar es por qué la gente siente tanto miedo que tiene que armarse”.

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DENVER — Seven years ago, Erica Green learned through a Facebook post that her brother had been shot.

She rushed to check on him at a hospital run by Denver Health, the city’s safety-net system, but she was unable to get information from emergency room workers, who complained that she was creating a disturbance.

“I was distraught and outside, crying, and Jerry came out of the front doors,” she said.

Jerry Morgan is a familiar face from Green’s Denver neighborhood. He had rushed to the hospital after his pager alerted him to the shooting. As a violence prevention professional with the At-Risk Intervention and Mentoring program, or AIM, Morgan supports gun-violence patients and their families at the hospital — as he did the day Green’s brother was shot.

“It made the situation of that traumatic experience so much better. After that, I was, like, I want to do this work,” Green said.

Today, Green works with Morgan as the program manager for AIM, a hospital-linked violence intervention program launched in 2010 as a partnership between Denver Health and the nonprofit Denver Youth Program. It since has expanded to include Children’s Hospital Colorado and the University of Colorado Hospital.

AIM is one of dozens of hospital-linked violence intervention programs around the country. The programs aim to uncover the social and economic factors that contributed to someone ending up in the ER with a bullet wound: inadequate housing, job loss, or feeling unsafe in one’s neighborhood, for example.

Such programs that take a public health approach to stopping gun violence have had success — one in San Francisco reported a fourfold reduction in violent injury recidivism rates over six years. But President Donald Trump’s executive orders calling for the review of the Biden administration’s gun policies and trillions of dollars in federal grants and loans have created uncertainty around the programs’ long-term federal funding. Some organizers believe their programs will be just fine, but others are looking to shore up alternative funding sources.

“We’ve been worried about, if a domino does fall, how is it going to impact us? There’s a lot of unknowns,” said John Torres, associate director for Youth Alive, an Oakland, California-based nonprofit.

Federal data shows that gun violence became a leading cause of death among children and young adults at the start of this decade and was tied to more than 48,000 deaths among people of all ages in 2022. New York-based pediatric trauma surgeon Chethan Sathya, a National Institutes of Health-funded firearms injury prevention researcher, believes those statistics show that gun violence can’t be ignored as a health care issue. “It’s killing so many people,” Sathya said.

Research shows that a violent injury puts someone at heightened risk for future ones, and the risk of death goes up significantly by the third violent injury, according to a 2006 study published in The Journal of Trauma: Injury, Infection and Critical Care.

Benjamin Li, an emergency medicine physician at Denver Health and the health system’s AIM medical director, said the ER is an ideal setting to intervene in gun violence by working to reverse-engineer what led to a patient’s injuries.

“If you are just seeing the person, patching them up, and then sending them right back into the exact same circumstances, we know it’s going to lead to them being hurt again,” Li said. “It’s critical we address the social determinants of health and then try to change the equation.”

That might mean providing alternative solutions to gunshot victims who might otherwise seek retaliation, said Paris Davis, the intervention programs director for Youth Alive.

“If that’s helping them relocate out of the area, if that’s allowing them to gain housing, if that’s shifting that energy into education or job or, you know, family therapy, whatever the needs are for that particular case and individual, that is what we provide,” Davis said.

AIM outreach workers meet gunshot wound victims at their hospital bedsides to have what Morgan, AIM’s lead outreach worker, calls a tough, nonjudgmental conversation on how the patients ended up there.

AIM uses that information to help patients access the resources they need to navigate their biggest challenges after they’re discharged, Morgan said. Those challenges can include returning to school or work, or finding housing. AIM outreach workers might also attend court proceedings and assist with transportation to health care appointments.

“We try to help in whatever capacity we can, but it’s interdependent on whatever the client needs,” Morgan said.

Since 2010, AIM has grown from three full-time outreach workers to nine, and this year opened the REACH Clinic in Denver’s Five Points neighborhood. The community-based clinic provides wound-care kits; physical therapy; and behavioral, mental and occupational health care. In the coming months, it plans to add bullet removal to its services. It’s part of a growing movement of community-based clinics focused on violent injuries, including the Bullet Related Injury Clinic in St. Louis.

Ginny McCarthy, an assistant professor in the Department of Surgery at the University of Colorado, described REACH as an extension of the hospital-based work, providing holistic treatment in a single location and building trust between health care providers and communities of color that have historically experienced racial biases in medical care.

Caught in the Crossfire, created in 1994 and run by Youth Alive in Oakland, is cited as the nation’s first hospital-linked violence intervention program and has since inspired others. The Health Alliance for Violence Intervention, a national network initiated by Youth ALIVE to advance public health solutions to gun violence, counted 74 hospital-linked violence intervention programs among its membership as of January.

The alliance’s executive director, Fatimah Loren Dreier, compared medicine’s role in addressing gun violence to that of preventing an infectious disease, like cholera. “That disease spreads if you don’t have good sanitation in places where people aggregate,” she said.

Dreier, who also serves as executive director of the Kaiser Permanente Center for Gun Violence Research and Education, said medicine identifies and tracks patterns that lead to the spread of a disease or, in this case, the spread of violence.

“That is what health care can do really well to shift society. When we deploy this, we get better outcomes for everybody,” Dreier said.

The alliance, of which AIM is a member, offers technical assistance and training for hospital-linked violence intervention programs and successfully petitioned to make their services eligible for traditional insurance reimbursement.

In 2021, President Joe Biden issued an executive action that opened the door for states to use Medicaid for violence prevention. Several states, including California, New York, and Colorado, have passed legislation establishing a Medicaid benefit for hospital-linked violence intervention programs.

Last summer, then-U.S. Surgeon General Vivek Murthy declared gun violence a public health crisis, and the 2022 Bipartisan Safer Communities Act earmarked $1.4 billion in funding for a wide array of violence-prevention programs through next year.

But in early February, Trump issued an executive order instructing the U.S. attorney general to conduct a 30-day review of a number of Biden’s policies on gun violence. The White House Office of Gun Violence Prevention now appears to be defunct, and recent moves to freeze federal grants created uncertainty among the gun-violence prevention programs that receive federal funding.

AIM receives 30% of its funding from its operating agreement with Denver’s Office of Community Violence Solutions, according to Li. The rest is from grants, including Victims of Crime Act funding, through the Department of Justice. As of mid-February, Trump’s executive orders had not affected AIM’s current funding.

Some who work with the hospital-linked violence prevention programs in Colorado are hoping a new voter-approved firearms and ammunition excise tax in the state, expected to generate about $39 million annually and support victim services, could be a new source of funding. But the tax’s revenues aren’t expected to fully flow until 2026, and it’s not clear how that money will be allocated.

Trauma surgeon and public health researcher Catherine Velopulos, who is the AIM medical director at the University of Colorado hospital in Aurora, said any interruption in federal funding, even for a few months, would be “very difficult for us.” But Velopulos said she was reassured by the bipartisan support for the kind of work AIM does.

“People want to oversimplify the problem and just say, ‘If we get rid of guns, it’s all going to stop,’ or ‘It doesn’t matter what we do, because they’re going to get guns, anyway,’” she said. “What we really have to address is why people feel so scared that they have to arm themselves.”

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President Donald Trump’s health officials want you to take your vitamins.

Mehmet Oz, the nominee to lead the Centers for Medicare & Medicaid Services, has fed calves on camera to tout the health wonders of bovine colostrum on behalf of one purveyor in which he has a financial stake. Janette Nesheiwat, the potential surgeon general, sells her own line of supplements.

Robert F. Kennedy Jr., the secretary of Health and Human Services, said he takes more vitamins than he can count — and has suggested he’ll ease restrictions on vitamins, muscle-building peptides, and more.

Their affection for supplements might lead to tangible consequences for Americans’ health regimens. Late in the 2024 campaign, Kennedy claimed the federal government was waging a “war on public health” by suppressing a vast array of alternative therapies — many of them supplements, like nutraceuticals and peptides.

In February, Trump announced the “President’s Make America Healthy Again Commission” with Kennedy at the helm, calling for “fresh thinking” on nutrition, “healthy lifestyles,” and other pathways toward combating chronic disease. Spokespeople for Kennedy did not reply to multiple requests for comment.

Supplements can be beneficial, particularly in aiding fetal development or warding off anemia, said Pieter Cohen, a general internist at the Cambridge Health Alliance, who researches supplements. “I recommend supplements routinely,” he said.

Still, “the majority of use is not necessary to improve or maintain health,” and due to only light regulations, supplement makers may make claims about their benefits without sufficient evidence, Cohen said. “No supplement needs to get tested or vetted by the FDA before it’s sold.”

Consumer watchdogs, regulators, and researchers have reported cases of finding traces of lead and other toxins in supplements. And a 2015 analysis from a team of federal health researchers attributed about 23,000 emergency department visits annually to supplement use. (The Council for Responsible Nutrition, the industry’s lobbying group, challenged the findings, arguing some visits were due to over-the-counter and homeopathic medicines that should not have been included.)

Nevertheless, many Americans are ready to buy in. Internet forums populated by biohackers, weight lifters, and enthusiasts of alternative medicine, along with supplement producers, applauded Kennedy’s elevation to health secretary. Many express hopes that he’ll loosen what they perceive as unwarranted restrictions on these products.

The Natural Products Association saluted Trump’s health nominees as a victory for “health freedom.”

“For the first time in our industry’s history, the top healthcare political appointees think it is important that Americans have the right to use nutritional supplements,” wrote Kyle Turk, the association’s vice president for government affairs.

The worlds of supplement users and the Trump team overlap substantially when it comes to being skeptical of the traditional health system.

Supplement use is part of “a broadening sort of health populist movement,” said Callum Hood, the head of research at the Center for Countering Digital Hate, a nonprofit that researches online disinformation, pointing to influencers who criticize conventional public health measures and offer alternatives like supplements, powders, or peptides.

To many supplement enthusiasts, Kennedy’s views align with theirs — particularly his dislike for Big Pharma and Big Food, which he characterizes as corrupt, profiting from Americans’ ill health.

Kennedy promotes supplements as a key part of good health. In a prerecorded interview aired this month, amid a growing measles outbreak that started in West Texas, he said doctors had had “very, very good results” by treating those patients with cod liver oil, which can be delivered in pill form, along with a steroid and an antibiotic. (Separately, he wrote in a Fox News op-ed that parents should discuss the vaccine with their doctors, adding, “The decision to vaccinate is a personal one.”)

“What we’re trying to do is really to restore faith in government and to make sure that we are there to help them with their needs and not particularly to dictate what they ought to be doing,” Kennedy said in a Fox News interview.

Kennedy spoke of federal officials delivering vitamin A to affected communities — a treatment he pushed in past remarks as chairman of the anti-vaccine group Children’s Health Defense.

“What is the cure for measles?” he told an audience in 2021 at an Amish country fair in Pennsylvania. “Chicken soup and vitamin A. And neither of those things can be patented.”

The World Health Organization advises people who contract measles to take vitamin A, which can prevent blindness and death — but it also strongly urges all children be vaccinated against the disease.

While the image of natural wellness has long evoked organic supermarket-patronizing, liberal types, supplement use is bipartisan — and now slightly more popular with Republicans. A December poll from Ipsos and Axios found that 63% of Republicans take supplements daily or most days, versus 58% of independents and 52% of Democrats.

Supplement companies sometimes explicitly court right-wing customers. In the days before Trump’s inauguration, the brand Nugenix posted an ad on the social platform X for its testosterone supplement with the president’s trademark red hat perched on the bottle, bearing the slogan “Make Your T-Levels Great Again.” (Adaptive Health, Nugenix’s parent company, did not respond to requests for comment.)

Some industry observers think the shift rightward happened during the pandemic. “During the covid era, Democrats became the party of science and establishment,” said John Roulac, a California-based supplements entrepreneur. In his telling, the party and especially its elected officials were more likely to trust the FDA and other big institutions — and to discount any potential contribution to health from supplements.

“Under RFK, you have people associated less with pharmaceutical drugs and more with healthier lifestyle choices, whether that’s eating organic food or using herbs or taking vitamins,” Roulac said.

Kennedy and others in Trump’s orbit have found a particularly warm reception among some of the biggest supplement evangelists: influencers, who often promote personal responsibility, in the form of vitamins and other products, as the key to health — and have provided plenty of airtime in recent years for Trump’s newly minted health officials.

On popular podcast host Lex Fridman’s show in 2023, Kennedy accepted praise for being in “great shape” and attributed it, in part, to his vitamin regimen. “I take a lot of vitamins,” he said. “I can’t even list them to you here because I couldn’t even remember them at all.”

In November, Oz endorsed Kennedy’s nomination on his TikTok channel — and then, in his next post, told viewers they need “an alphabet soup” of vitamins to protect their brains and power their organs.

Oz, who at the time had not yet been named to lead CMS, pointed viewers to a “trusted source” of vitamins: iHerb.

Federal ethics rules generally bar public officials from using their office for financial gain. Last month, in a letter to the health agency’s ethics official, Oz disclosed that he is an adviser to iHerb and holds a financial stake in the company. He wrote that, if he is confirmed, he plans to resign and divest from iHerb, as well as recuse himself from policy matters directly involving the company “until I have divested.”

Oz’s Senate confirmation hearing is scheduled for March 14. A spokesperson for Oz did not reply to multiple requests for comment.

Nesheiwat, Trump’s pick for surgeon general, has touted BC Boost, a combination of vitamins promising to toughen one’s immune system and rev energy. The supplement — which advertising claims was formulated by Nesheiwat herself — bears her name and portrait on the package.

“After years of educating my patients, now I made it a little easier to get all the nutrition you need to live strong and stay healthy,” reads a marketing quote attributed to Nesheiwat.

The surgeon general, considered “the nation’s doctor,” does not set policy but rather acts as a spokesperson for public health. During the Biden administration, Surgeon General Vivek Murthy outlined the ills from alcohol, loneliness, and social media.

Nesheiwat, whose financial disclosures are not yet public, did not reply to an inquiry to her website, nor did an HHS spokesperson reply to a request for comment.

It’s unclear what moves the administration might take to boost supplements. Industry officials say they hope the government will make it easier for everyday consumers to use health savings accounts to buy vitamins and other products. The FDA could also decide to allow manufacturers to make more aggressive claims about their wares’ health benefits.

Contrary to Kennedy’s claim of a “war on public health,” in recent years the supplements industry has seen its fortunes grow, and attempts to increase regulations have fallen short amid pressure from supplement makers.

According to the Nutrition Business Journal, revenues for the supplement industry surged during the pandemic, as customers became “more invested in their health,” said Journal analyst Erika Craft. Revenues have continued to increase since then, outpacing earlier industry expectations and boosting product sales to some $70 billion per year, she told KFF Health News.

One FDA attempt to put more stringent regulations — like registration — on businesses, during the 1990s, was defeated soundly after the industry and its clients lobbied Congress.

“It was one of the largest campaigns to Congress imaginable,” David Kessler, the FDA commissioner at the time, said in an oral history.

Grace Sparks, a survey analyst at KFF, the health policy research, polling, and news organization that includes KFF Health News, provided research assistance for the Ipsos-Axios poll.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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HHS announced today that it has stopped placement of unaccompanied alien children in shelters

After a patch of ice sent Marc Durocher hurtling to the ground, and doctors at UMass Memorial Medical Center repaired the broken hip that resulted, the 75-year-old electrician found himself at a crossroads.

He didn’t need to be in the hospital any longer. But he was still in pain, unsteady on his feet, unready for independence.

Patients nationwide often stall at this intersection, stuck in the hospital for days or weeks because nursing homes and physical rehabilitation facilities are full. Yet when Durocher was ready for discharge in late January, a clinician came by with a surprising path forward: Want to go home?

Specifically, he was invited to join a research study at UMass Chan Medical School in Worcester, Massachusetts, testing the concept of “SNF at home” or “subacute at home,” in which services typically provided at a skilled nursing facility are instead offered in the home, with visits from caregivers and remote monitoring technology.

Durocher hesitated, worried he might not get the care he needed, but he and his wife, Jeanne, ultimately decided to try it. What could be better than recovering at his home in Auburn with his dog, Buddy?

Such rehab at home is underway in various parts of the country — including New York, Pennsylvania, and Wisconsin — as a solution to a shortage of nursing home and rehab beds for patients too sick to go home but not sick enough to need hospitalization.

Staffing shortages at post-acute facilities around the country led to a 24% increase over three years in hospital length of stay among patients who need skilled nursing care, according to a 2022 analysis. With no place to go, these patients occupy expensive hospital beds they don’t need, while others wait in emergency rooms for those spots. In Massachusetts, for example, at least 1,995 patients were awaiting hospital discharge in December, according to a survey of hospitals by the Massachusetts Health & Hospital Association.

Offering intensive services and remote monitoring technology in the home can work as an alternative — especially in rural areas, where nursing homes are closing at a faster rate than in cities and patients’ relatives often must travel far to visit. For patients of the Marshfield Clinic Health System who live in rural parts of Wisconsin, the clinic’s six-year-old SNF-at-home program is often the only option, said Swetha Gudibanda, medical director of the hospital-at-home program.

“This is going to be the future of medicine,” Gudibanda said.

But the concept is new, an outgrowth of hospital-at-home services expanded by a covid-19 pandemic-inspired Medicare waiver. SNF-at-home care remains uncommon, lost in a fiscal and regulatory netherworld. No federal standards spell out how to run these programs, which patients should qualify, or what services to offer. No reimbursement mechanism exists, so fee-for-service Medicare and most insurance companies don’t cover such care at home.

The programs have emerged only at a few hospital systems with their own insurance companies (like the Marshfield Clinic) or those that arrange for “bundled payments,” in which providers receive a set fee to manage an episode of care, as can occur with Medicare Advantage plans.

In Durocher’s case, the care was available — at no cost to him or other patients — only through the clinical trial, funded by a grant from the state Medicaid program. State health officials supported two simultaneous studies at UMass and Mass General Brigham hoping to reduce costs, improve quality of care, and, crucially, make it easier to transition patients out of the hospital.

The American Health Care Association, the trade group of for-profit nursing homes, calls “SNF at home” a misnomer because, by law, such services must be provided in an institution and meet detailed requirements. And the association points out that skilled nursing facilities provide services and socialization that can never be replicated at home, such as daily activity programs, religious services, and access to social workers.

But patients at home tend to get up and move around more than those in a facility, speeding their recovery, said Wendy Mitchell, medical director of the UMass Chan clinical trial. Also, therapy is tailored to their home environment, teaching patients to navigate the exact stairs and bathrooms they’ll eventually use on their own.

A quarter of people who go into nursing homes suffer an “adverse event,” such as infection or bed sore, said David Levine, clinical director for research for Mass General Brigham’s Healthcare at Home program and leader of its study. “We cause a lot of harm in facility-based care,” he said.

By contrast, in 2024, not one patient in the Rehabilitation Care at Home program of Nashville-based Contessa Health developed a bed sore and only 0.3% came down with an infection while at home, according to internal company data. Contessa delivers care in the home through partnerships with five health systems, including Mount Sinai Health System in New York City, the Allegheny Health Network in Pennsylvania, and Wisconsin’s Marshfield Clinic.

Contessa’s program, which has been providing in-home post-hospital rehabilitation since 2019, depends on help from unpaid family caregivers. “Almost universally, our patients have somebody living with them,” said Robert Moskowitz, Contessa’s acting president and chief medical officer.

The two Massachusetts-based studies, however, do enroll patients who live alone. In the UMass trial, an overnight home health aide can stay for a day or two if needed. And while alone, patients “have a single-button access to a live person from our command center,” said Apurv Soni, an assistant professor of medicine at UMass Chan and the leader of its study.

But SNF at home is not without hazards, and choosing the right patients to enroll is critical. The UMass research team learned an important lesson when a patient with mild dementia became alarmed by unfamiliar caregivers coming to her home. She was readmitted to the hospital, according to Mitchell.

The Mass General Brigham study relies heavily on technology intended to reduce the need for highly skilled staff. A nurse and physician each conducts an in-home visit, but the patient is otherwise monitored remotely. Medical assistants visit the home to gather data with a portable ultrasound, portable X-ray, and a device that can analyze blood tests on-site. A machine the size of a toaster oven dispenses medication, with a robotic arm that drops the pills into a dispensing unit.

The UMass trial, the one Durocher enrolled in, instead chose a “light touch” with technology, using only a few devices, Soni said.

The day Durocher went home, he said, a nurse met him there and showed him how to use a wireless blood pressure cuff, wireless pulse oximeter, and digital tablet that would transmit his vital signs twice a day. Over the next few days, he said, nurses came by to take blood samples and check on him. Physical and occupational therapists provided several hours of treatment every day, and a home health aide came a few hours a day. To his delight, the program even sent three meals a day.

Durocher learned to use the walker and how to get up the stairs to his bedroom with one crutch and support from his wife. After just one week, he transitioned to less-frequent, in-home physical therapy, covered by his insurance.

“The recovery is amazing because you’re in your own setting,” Durocher said. “To be relegated to a chair and a walker, and at first somebody helping you get up, or into bed, showering you — it’s very humbling. But it’s comfortable. It’s home, right?”

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The federal Consumer Financial Protection Bureau has taken major steps to help people with medical debt in its nearly 14-year history. It issued rules barring medical debt from Americans’ credit reports and went after debt collectors who pressured customers to pay bills they didn’t owe. But in early February, the Trump administration moved to effectively shutter the agency. 

“An Arm and a Leg” host Dan Weissmann talks with credit counselor Lara Ceccarelli about how the CFPB has helped clients at the nonprofit where she works, and how she’s navigating the sudden change.

Consumer rights advocate Chi Chi Wu, an attorney at the National Consumer Law Center, describes the court battle she and her colleagues are mounting to slow down the agency’s dismantling, and where things could go from here. 

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 Afi Yellow-Duk Editor Click to open the Transcript Transcript: Medical-Debt Watchdog Gets Sidelined by the New Administration

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.

Transcript: A medical-debt watchdog gets sidelined by the new administration

Dan: Hey there– 

Lara Ceccarelli works for American Financial Solutions. That’s a non-profit credit counseling agency. 

Lara spends her days talking with people who have bills they can’t pay, debt collectors chasing them, including for medical bills.

On a recent Sunday night, Lara was winding down her day the way she usually does.

Lara: I tend to read the news before bed. I usually find that it gives me less anxiety, uh, when I have a clear picture of, you know, what’s happening in the world and I don’t feel like I’m in the dark. And yeah, that Sunday was an exception. 

Dan: That Sunday was February 9, and that evening big news had broken about the Consumer Financial Protection Bureau– C F P B, for short. 

A federal agency that’s basically a watchdog for consumer rights of all kinds. 

So, for years, whenever Lara’s talked to a client, and it sounds like a debt collector is violating their rights — which happens a lot– she has referred the client to the CFPB. And it has worked. 

Lara: They’ve created these streamlined processes where consumers can submit complaints and see enforcement action taken right away. 

Dan: But that Sunday night, February 9, news broke that an official President Donald Trump had put in charge of the CFPB was basically shutting the agency down. Effective immediately.

Agency staff had gotten a memo telling them to — stop working. 

Lara: I felt my stomach sink through the floor. And my poor husband is active duty in the military, so he was preparing for a very long day the next day on his Navy ship, and he took one look at me and knew something was badly wrong, 

Dan: What did your husband say?

Lara: He tried to tell me that it was all going to be okay. I think he was, uh, doing his best to be as supportive as he could. 

Dan: How late were you up that night?

Lara: Oh, I didn’t sleep. I think I got maybe one or two hours of sleep. I Lay down and I, uh, looked at my awful popcorn ceiling and tried to sleep and just could not shut my brain off. 

Dan: She was thinking about how important the CFPB has been– how many clients she’s referred to them.

I talked with Lara just over a week after that Sunday night. We’ll hear how she managed that first week, how she started shifting what she tells clients– what other resources she’s still referring them to. 

And we’ll hear about a court case that has slowed down the Trump administration’s efforts to completely dismantle the CFPB. And where things COULD go from here.

But first, we should talk about why the CFPB has been such a big deal, especially for people with medical debts. 

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.

We’re gonna hear about what the CFPB has done about medical debts from somebody who’s been working on this issue since the beginning. 

Chi Chi Wu: My name is Chi Chi Wu. I’m a senior attorney at the National Consumer Law Center.

Dan: Actually, she’s been at this since before the beginning. Chi Chi Wu joined the National Consumer Law Center in 2001. 

The Consumer Financial Protection Bureau started out a half dozen years later, in 2007– as an idea. A proposal from a law professor named Elizabeth Warren. She thought financial institutions needed a watchdog– or as she called it, “a cop on the beat.”

In 2008, financial institutions crashed the economy. Barack Obama became president. In 2010 Congress passed a law to put some new restrictions on financial institutions– the “Dodd Frank Wall Street Reform and Consumer Protection Act”– which mandated the CFPB’s creation. 

Chi Chi Wu says it didn’t take long for medical debts to land in the agency’s cross-hairs..

Chi Chi Wu: In 2014, the Consumer Financial Protection Bureau did a study that found, if you look at the debt collection items on credit reports… 

Dan: In other words,if you ask: When people get put in collections, what are the bills actually for?

Chi Chi Wu: …over half of them are for medical debt. Half. It was a huge number.

Dan: In other words, a ton of people had lousy credit scores, not because they’d taken a cruise they couldn’t pay for. But because they’d gotten sick. 

Chi Chi Wu: It was a huge problem. People would try to be buying a house or a car trying to get a credit card and they’d have to pay more or even get turned down .

Dan: And now it was on the record, thanks to the CFPB. 

The next year a bunch of state attorneys general reached a “voluntary agreement” with the big three credit bureaus — Equifax, Experian, TransUnion. The big three agreed that, they’d wait 180 days — six months — before putting a medical debt on somebody’s credit report. 

Chi Chi Wu: So the idea was the consumer would have six months to straighten out the debt with insurance, figure out what they actually owed, maybe dispute it if they didn’t think they owed it. 

Dan: Meanwhile, the CFPB was working on another problem.

Chi Chi Wu: Sometimes people would have items on their credit reports, especially for small dollar amounts that they never knew about until they went to buy a car or refinance their house. 

Dan: This was called “parking,” and Chi Chi Wu says it was especially common with medical debts.

Chi Chi Wu: A debt collector would get a medical debt referred from a healthcare provider and they wouldn’t do anything with it.

They wouldn’t send a single letter. They wouldn’t make a single phone call. All they would do is report that debt to the credit bureaus and wait… would just wait until the consumer had to use their credit score for something, you know, refinance their mortgage, buy a car…

Dan: Rent an apartment. Apply for a job… 

Chi Chi Wu: Yes, yes, all of those. And then, their credit would get pulled, this medical debt would show up. And they’d be left scrambling because they would have to clear that debt from their credit report before they could get that mortgage or car loan or job or apartment, and even if they were like, ‘I paid that, or insurance should have paid that,’ they didn’t have time to deal with it. Because if you’re in the middle of this big important transaction, you don’t have time to wait 30 days for a credit reporting dispute to be resolved. And often it takes longer.

Dan: So, people paid up. They didn’t have a choice. 

Chi Chi Wu:  And the reason debt collectors do that is because it’s cheap. It’s cheap to do credit reporting. It’s expensive to send a letter because it costs you, what is the price of a stamp right now?

Dan: 73 cents! Plus whatever it costs you to print it out and stuff. A guy who used to be a debt collector once told me sending a bill costs two bucks. 

Chi Chi Wu says the CFPB started working on a rule banning “parking” during the second Obama administration. And finalized the rule in 2020, under Donald Trump. It takes a while.

When Joe Biden became President, he appointed a CFPB director who put extra focus on medical debts. The credit bureaus got the idea that they might be subject to some new rules on that topic, and volunteered to make some changes of their own. 

In May 2022 they announced: Instead of waiting just six months to put medical bills on credit reports, they were gonna wait a full year. 

Chi Chi Wu: Because six months sometimes is not enough to deal with an insurance dispute, right? I mean, sometimes it takes a lot longer. So they extended that to a year and then they agreed not to report medical debts under 500.

Dan: And that’s when I first talked with Lara Cecarelli for this show. 

I was trying to figure out: Was it really a big deal? The debts would still be on the books — collectors could still bug people about them. And tons of debts would stay on credit reports. 

Lara told me: YEP. That’s gonna be a big deal. 

When we talked this month, she told me she could see the impact of the CFPB in her work day to day.

Lara: We’ve seen a huge decrease in the number of complaints from consumers, or difficulty that consumers are having with medical debt. It’s still something that we see. But you know, I used to have at least one conversation about medical debt a day, usually more, and that’s not the case. You know, I’m having a couple of conversations per week, maybe, about medical debt. So we’ve seen the impact.

Dan: And she could see more on the horizon: 

In January, before the inauguration, the CFPB actually issued new rules about medical debt. Like we said, credit bureaus had already promised to remove everything below five hundred dollars. 

Now, under the new rules, all medical debts would come off. And lenders couldn’t look at medical debts when they made lending decisions. 

The CFPB had planned to start enforcing those rules in March.

Now– on that Sunday evening in February– Lara was seeing news: The whole agency was shutting down. Over the next few days, news outlets reported more than a hundred and fifty immediate layoffs — and the cancellation of more than $100 million in contracts. And rumors of much deeper cuts to come.   

Lara started doing this job during the first Tump administration. She says, this sweeping change is not just a swing of the pendulum back to how things were then.    

Lara: No, this is new territory. They were still robust, they were still responsive to client complaints. The enforcement and the protection was still there,

Dan: For right now, it’s gone. Coming up: What the first CFPB-free week was like for Lara and her colleagues. What she’s telling clients now. And what Chi Chi Wu and her colleagues are doing. 

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. We’re honored to work with them. 

Lara Ceccarelli says she’s had to revise what she’s used to telling clients. Because referring people to the CFPB was a pretty regular part of herday to day works.

Lara: It makes a difference feeling like you’ve got a powerhouse at your back. You say, you know, the CFPB is incredibly solid, they will help support you. You know, all you have to do is reach out. They’re communicative, and they are robust, and I can’t say that anymore. 

Dan: There’s still a website. There’s still a phone number. 

Lara: But you’re not getting a person right now. You’re getting voicemails. So at this point, we’re still advising clients that the CFPB is, you know, an important agency But we’re also informing them that right now the CFPB is basically going dark,

Dan: So, she’s telling people: Hey, it’s worth calling the CFPB, just in case somebody picks up. But meanwhile here are some other places to call. 

Lara: I had a client who had been threatened by a debt collector, and the debt that they’re collecting on is actually outside of the statute of limitations. It’s not collectible anymore. But they’re being harassed basically, you know, calling them at all hours of the day and night and advising them that, you know, they’re still subject to legal action, none of which is true.

Dan: Which means, Lara tells me, that collector is breaking a law called the Fair Debt Collection Practices Act. 

Lara: And normally I would have sent that client in the direction of the CFPB. 

Dan: Normally, you file a complaint with the CFPB, the company responds to you within 15 days, according to the agency’s website.

Lara says companies pay attention– because the CFPB has a big stick. In 2023, the agency shut down one medical-debt collection company for violating this very law.

That version of normal is gone for now. But Lara happens to know, the Federal Trade Commission — which is still up and running– also has authority to enforce that law. They’re not specialists, but they’ve got someone to answer the phones. So she encouraged her client to try them. 

Other folks, she’s referring to their state attorney general’s office. In a lot of states, consumer-protection is a big part of the state AG’s job. Some state’s have independent consumer protection bureaus. 

Lara and her colleagues respect the work they do. 

But it’s not the same as having a powerful, national agency that enforces federal law.

Lara: You know, it wasn’t something where somebody in Ohio has a different set of rules from somebody in California as far as where you go and who you contacted. Centralized enforcement and made it really easy for everybody to know where to go to get help with their particular issue. All these other different places, can sort of take up a piece of the enforcement action , but none of them have that same robust power that the CFPB had, or the direct focus specifically on financial institutions and and their interactions with consumers directly.

Dan: Lara and her colleagues are still there. She says their funding comes from private organizations, not the feds. 

Lara: We’re not worried about the lights going out here yet

We all tried to lift each other up and, you know, talk about the other resources that we have available, all of which are valuable. and we have to, you know, maintain some degree of equilibrium, when you’re speaking to clients that, you know, one of you could have a breakdown at a time, right?

And that’s never our turn. So, um, you know, you have to maintain some degree of optimism and positivity, because if you’re not optimistic and positive, for their outcomes. How can they possibly think there’s hope for the future? 

Dan: Lara says she’s doing her best at work– and working on keeping her balance.  

Lara:  I’ve got a beautiful little paint mare that I ride um, and I get to go out and play with her whenever the, uh, news gets too bleak. Normally, she gets, uh, one or two days without, you know, having to put up with me, but right now the need is dire.

Dan: Meanwhile, Chi Chi Wu is fighting. On two fronts. 

I mentioned earlier: Biden’s CFPB took a big parting shot in early January. The agency finalized a rule banning medical debts from credit reports.

That rule got hit immediately with lawsuits from ACA International — that’s the industry association for debt collectors — and the credit bureaus.

Chi Chi Wu and her colleagues at the National Consumer Law Center figured: The Trump Administration might not defend those lawsuits. 

So they started preparing motions to intervene: basically asking the court’s permission to take over the defense. On the Sunday evening when Lara Ceccarelli read about the CFPB shutdown on the news, Chi Chi Wu was not watching the news.

Chi Chi Wu: I had been working like a mad woman that weekend 

Dan: Drafting documents for that motion to intervene.

Chi Chi Wu: So I was kind of busy all weekend, writing, not watching the Super Bowl

Dan: She got word from colleagues that Trump’s people had shut down the CFPB, and she was like, “OK. That going into this document I’m writing..”

Chi Chi Wu: …Because that was more support saying, well, the, this new CFPB is not going to defend this rule and so you should let us defend the rule.

Dan: Let us — the NCLC — defend the rule in court. 

So OK, that was material for her fight on one front. But of course it opens up another front, another legal battle. 

In this one, NCLC is actually a plaintiff — along with a union representing CFPB employees, and a couple other non profits. On February 13– four days after the CFPB went dark — they asked a federal judge, basically to stop the CFPB shutdown. 

The next day, the judge issued a temporary order, telling the CFPB to hold off on three things:

One. No more mass firings.

Two: Don’t destroy data — or take data down from public websites.

And three: Don’t return money to congress.

That order lasts just over two weeks, then there’s a hearing scheduled. That’s happening a few days after we publish this episode, and we’ll be watching.  . 

The other lawsuit, about the CFPB’s rule on medical debt– it’s on a slower timetable. 

Meanwhile, Chi Chi Wu says there are other fronts to fight on, and not just for her.

Chi Chi Wu: This is where states can step in and protect the consumers in their state. Nine states have already banned medical debt from credit reports. New York, Colorado, California, Rhode Island, even Virginia — a purple state. And so, if your listeners are wondering what can they do —  I mean, you know, obviously contact their members of Congress to support the CFPB — but also, you know, if they are in a state that doesn’t have one of these laws, they can try to get their state legislatures to pass a law to protect them from medical debts on credit reports.

Dan: We are gonna do our best to stay on top of this story.A few days after we publish this episode, there’ll be that  hearing in federal court on the lawsuit opposing the CFPB’s shutdown.  

I’ll post updates on the social networking site BlueSky — it’s kind of a Twitter substitute, and you can find me there at danweissmann (spelled with two esses and two enns)

Next week’s First Aid Kit newsletter will include a roundup of what we know, and what resources are available. If you’re not signed up for First Aid Kit yet, just head to arm and a leg show, dot com, slash, first aid kit.

And we’ll be back in a few weeks, with an episode about one listener’s fight — successful fight — against a six thousand dollar charge. 

Megan: I didn’t need to be an expert on this. I just needed to have access to the tools and the podcast would remind me of them. So I was like, okay, I’m so confident that I do not owe this  and so that would get me, like, really amped up and angry about it.

Till then, take care of yourself.

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with

help from Emily Pisacreta and Claire Davenport — and edited by Afi Yellow-Duke. 

Ellen Weiss is our series editor.

Adam Raymonda is our audio wizard. 

Our music is by Dave Weiner and Blue Dot Sessions. 

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.

You can join in any time at: https://armandalegshow.com/support/

Thanks! And thanks for listening.

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

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Rebecca Smith-Bindman, a professor at the University of California-San Francisco medical school, has spent well over a decade researching the disquieting risk that one of modern medicine’s most valuable tools, computerized tomography scans, can sometimes cause cancer.

Smith-Bindman and like-minded colleagues have long pushed for federal policies aimed at improving safety for patients undergoing CT scans. Under new Medicare regulations effective this year, hospitals and imaging centers must start collecting and sharing more information about the radiation their scanners emit.

About 93 million CT scans are performed every year in the United States, according to IMV, a medical market research company that tracks imaging. More than half of those scans are for people 60 and older. Yet there is scant regulation of radiation levels as the machines scan organs and structures inside bodies. Dosages are erratic, varying widely from one clinic to another, and are too often unnecessarily high, Smith-Bindman and other critics say.

“It’s unfathomable,” Smith-Bindman said. “We keep doing more and more CTs, and the doses keep going up.”

One CT scan can expose a patient to 10 or 15 times as much radiation as another, Smith-Bindman said. “There is very large variation,” she said, “and the doses vary by an order of magnitude — tenfold, not 10% different — for patients seen for the same clinical problem.” In outlier institutions, the variation is even higher, according to research she and a team of international collaborators have published.

She and other researchers estimated in 2009 that high doses could be responsible for 2% of cancers. Ongoing research shows it’s probably higher, since far more scans are performed today.

The cancer risk from CT scans for any individual patient is very low, although it rises for patients who have numerous scans throughout their lives. Radiologists don’t want to scare off patients who can benefit from imaging, which plays a crucial role in identifying life-threatening conditions like cancers and aneurysms and guides doctors through complicated procedures.

But the new data collection rules from the Centers for Medicare & Medicaid Services issued in the closing months of the Biden administration are aimed at making imaging safer. They also require a more careful assessment of the dosing, quality, and necessity of CT scans.

The requirements, rolled out in January, are being phased in over about three years for hospitals, outpatient settings, and physicians. Under the complicated reporting system, not every radiologist or health care setting is required to comply immediately. Providers could face financial penalties under Medicare if they don’t comply, though those will be phased in, too, starting in 2027.

When the Biden administration issued the new guidelines, a CMS spokesperson said in an email that excessive and unnecessary radiation exposure was a health risk that could be addressed through measurement and feedback to hospitals and physicians. The agency at the time declined to make an official available for an interview. The Trump administration did not respond to a request for comment for this article.

The Leapfrog Group, an organization that tracks hospital safety, welcomed the new rules. “Radiation exposure is a very serious patient safety issue, so we commend CMS for focusing on CT scans,” said Leah Binder, the group’s president and CEO. Leapfrog has set standards for pediatric exposure to imaging radiation, “and we find significant variation among hospitals,” Binder added.

CMS contracted with UCSF in 2019 to research solutions aimed at encouraging better measurement and assessment of CTs, leading to the development of the agency’s new approach.

The American College of Radiology and three other associations involved in medical imaging, however, objected to the draft CMS rules when they were under review, arguing in written comments in 2023 that they were excessively cumbersome, would burden providers, and could add to the cost of scans. The group was also concerned, at that time, that health providers would have to use a single, proprietary tech tool for gathering the dosing and any related scan data.

The single company in question, Alara Imaging, supplies free software that radiologists and radiology programs need to comply with the new regulations. The promise to keep it free is included in the company’s copyright. Smith-Bindman is a co-founder of Alara Imaging, and UCSF also has a stake in the company, which is developing other health tech products unrelated to the CMS imaging rule that it does plan to commercialize.

But the landscape has recently changed. ACR said in a statement from Judy Burleson, ACR vice president for quality management programs, that CMS is allowing in other vendors — and that ACR itself is “in discussion with Alara” on the data collection and submission. In addition, a company called Medisolv, which works on health care quality, said at least one client is working with another vendor, Imalogix, on the CT dose data.

Several dozen health quality and safety organizations — including some national leaders in patient safety, like the Institute of Healthcare Improvement — have supported CMS’ efforts.

Concerns about CT dosing are long-standing. A landmark study published in JAMA Internal Medicine in 2009 by a research team that included experts from the National Cancer Institute, the Department of Veterans Affairs, and universities estimated that CT scans were responsible for 29,000 excess cancer cases a year in the United States, about 2% of all cases diagnosed annually.

But the number of CT scans kept climbing. By 2016, it was estimated at 74 million, up 20% in a decade, though radiologists say dosages of radiation per scan have declined. Some researchers have noted that U.S. doctors order far more imaging than physicians in other developed countries, arguing some of it is wasteful and dangerous.

More recent studies, some looking at pediatric patients and some drawing on radiation exposure data from survivors of the atomic bomb attacks on Hiroshima and Nagasaki in Japan, have also identified CT scan risk.

Older people may face greater cancer risks because of imaging they had earlier in life. And scientists have emphasized the need to be particularly careful with children, who may be more vulnerable to radiation exposure while young and face the consequences of cumulative exposure as they age.

Max Wintermark, a neuroradiologist at the MD Anderson Cancer Center in Houston, who has been involved in the field’s work on appropriate utilization of imaging, said doctors generally follow dosing protocols for CT scans. In addition, the technology is improving; he expects artificial intelligence to soon help doctors determine optimal imaging use and dosing, delivering “the minimum amount of radiation dose to get us to the diagnosis that we’re trying to reach.”

But he said he welcomes the new CMS regulations.

“I think the measures will help accelerate the transition towards always lower and lower doses,” he said. “They are helpful.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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As part HHS' ongoing efforts to advance the Secretary’s mission to Make America Healthy Again, OGC will consolidate the number of Regional Offices

Kirk Vartan pays more than $2,000 a month for a high-deductible health insurance plan from Blue Shield on Covered California, the state’s Affordable Care Act marketplace. He could have selected a cheaper plan from a different provider, but he wanted one that includes his wife’s doctor.

“It’s for the two of us, and we’re not sick,” said Vartan, general manager at A Slice of New York pizza shops in the Bay Area cities of San Jose and Sunnyvale. “It’s ridiculous.”

Vartan, who is in his late 50s, is one of millions of Californians struggling to keep up with health insurance premiums ballooning faster than inflation.

Average monthly premiums for families with employer-provided health coverage in California’s private sector nearly doubled over the last 15 years, from just over $1,000 in 2008 to almost $2,000 in 2023, a KFF Health News analysis of federal data shows. That’s more than twice the rate of inflation. Also, employees have had to absorb a growing share of the cost.

The spike is not confined to California. Average premiums for families with employer-provided health coverage grew as fast nationwide as they did in California from 2008 through 2023, federal data shows. Premiums continued to grow rapidly in 2024, according to KFF.

Small-business groups warn that, for workers whose employers don’t provide coverage, the problem could get worse if Congress does not extend enhanced federal subsidies that make health insurance more affordable on individual markets such as Covered California, the public marketplace that insures more than 1.9 million Californians.

Premiums on Covered California have grown about 25% since 2022, roughly double the pace of inflation. But the exchange helps nearly 90% of enrollees mitigate high costs by offering state and federal subsidies based on income, with many families paying little or nothing.

Rising premiums also have hit government workers — and taxpayers. Premiums at CalPERS, which provides insurance to more than 1.5 million of California’s active and retired public employees and family members, have risen about 31% since 2022. Public employers pay part of the cost of premiums as negotiated with labor unions; workers pay the rest.

“Insurance premiums have been going up faster than wages over the last 20 years,” said Miranda Dietz, a researcher at the University of California-Berkeley Labor Center who focuses on health insurance. “Especially in the last couple of years, those premium increases have been pretty dramatic.”

Dietz said rising hospital prices are largely to blame. Consumer costs for hospitals and nursing homes rose about 88% from 2009 through 2024, roughly double the overall inflation rate, according to data from the Department of Labor. The rising cost of administering America’s massive health care system has also pushed premiums higher, she said.

Insurance companies remain highly profitable, but their gross margins — the amount by which premium income exceeds claims costs — were fairly steady during the last few years, KFF research shows. Under federal rules, insurers must spend a minimum percentage of premiums on medical care.

Rising insurance costs are cutting deeper into family incomes and squeezing small businesses.

The average annual cost of family health insurance offered by private sector companies was about $24,000, or roughly $2,000 a month, in California during 2023, according to the U.S. Department of Health and Human Services. Employers paid, on average, about two-thirds of the bill, with workers paying the remaining third, about $650 a month. Workers’ share of premiums has grown faster in California than in the rest of the nation.

Many small-business workers whose employers don’t offer health care turn to Covered California. During the last three decades, the percentage of businesses nationwide with 10 to 24 workers offering health insurance fell from 65% to 52%, according to the Employee Benefit Research Institute. Coverage fell from 34% to 23% among businesses with fewer than 10 employees.

“When an employee of a small business isn't able to access health insurance with their employer, they're more likely to leave that employer,” said Bianca Blomquist, California director for Small Business Majority, an advocacy group representing more than 85,000 small businesses across America.

Kirk Vartan said his pizza shop employs about 25 people and operates as a worker cooperative — a business owned by its workers. The small business lacks negotiating power to demand discounts from insurance companies to cover its workers. The best the shop could do, he said, were expensive plans that would make it hard for the cooperative to operate. And those plans would not offer as much coverage as workers could find for themselves through Covered California.

“It was a lose-lose all the way around,” he said.

Mark Seelig, a spokesperson for Blue Shield of California, said rising costs for hospital stays, doctor visits, and prescription drugs put upward pressure on premiums. Blue Shield has created a new initiative that he said is designed to lower drug prices and pass on savings to consumers.

Even at California companies offering insurance, the percentage of employees enrolled in plans with a deductible has roughly doubled in 20 years, rising to 77%, federal data shows. Deductibles are the amount a worker must pay for most types of care before their insurance company starts paying part of the bill. The average annual deductible for an employer-provided family health insurance plan was about $3,200 in 2023.

During the last two decades, the cost of health insurance premiums and deductibles in California rose from about 4% of median household income to about 12%, according to the UC Berkeley Labor Center, which conducts research on labor and employment issues.

As a result, the center found, many Californians are choosing to delay or forgo health care, including some preventive care.

California is trying to lower health care costs by setting statewide spending growth caps, which state officials hope will curb premium increases. The state recently established the Office of Health Care Affordability, which set a five-year target for annual spending growth at 3.5%, dropping to 3% by 2029. Failure to hit targets could result in hefty fines for health care organizations, though that likely wouldn’t happen until 2030 or later.

Other states that imposed similar caps saw health care costs rise more slowly than states that did not, Dietz said.

“Does that mean that health care becomes affordable for people?” she asked. “No. It means it doesn’t get worse as quickly.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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A year ago, a new head of Social Security set out to stop the agency from financially devastating many of the people it was meant to help.

The agency had long made it a practice to reduce or halt benefit checks to recoup billions of dollars in payments it sent recipients but later said they never should have received.

Martin O’Malley, then the Social Security Administration commissioner, announced in March 2024 the agency would no longer cut off people’s monthly old-age, survivors, and disability checks to recoup money they had allegedly been overpaid — a pattern he called “clawback cruelty.” Instead, it would default to withholding 10% of monthly benefits. The new policy allowed people who already live on little to pay their rent and keep food on the table.

Last Friday, the Trump administration reversed that policy.

Beginning March 27, to recover new overpayments, the Social Security Administration will automatically withhold 100% of recipients’ monthly benefits, the agency announced.

The agency said it was acting in the interest of fiscal responsibility and that the reversal would save the government about $7 billion over a decade.

“It is our duty to revise the overpayment repayment policy back to full withholding, as it was during the Obama administration and first Trump administration, to properly safeguard taxpayer funds,” acting Commissioner Lee Dudek said in a news release.

Advocates for Social Security beneficiaries described the action as cruel and harmful.

“The results are predictable: more unnecessary suffering,” said Kathleen Romig, who worked at the Social Security Administration under O’Malley and is now director of Social Security and disability policy at the Center on Budget and Policy Priorities.

Kate Lang of the advocacy group Justice in Aging said she was heartbroken.

“Those who are most vulnerable, with the fewest resources, are the ones who will feel the harsh impacts of this change,” she said. Many “are going to be unable to buy food or keep the roof over their head,” she said.

In 2023, after an investigation by KFF Health News and Cox Media Group cast a spotlight on overpayments and clawbacks, lawmakers from both parties called on the Social Security Administration to change its approach.

The policy change a year ago was inspired in part by the plight of people such as Denise Woods, who was sleeping in her Chevy in Savannah, Georgia, in December 2023 while contending with lupus and congestive heart failure after the government cut off her disability benefits. The government was demanding she repay almost $58,000.

Many overpayments are the result of government error. It can take the government years to figure out it has been paying someone too much, and by then, the amount the government says it is owed can grow far beyond a beneficiary’s ability to repay. And it has often demanded that recipients repay the full amount within 30 days.

As of October, the SSA was withholding at least a portion of monthly benefit payments from hundreds of thousands of people, according to data the SSA provided last fall to KFF Health News and Cox Media Group. The agency said it was withholding up to 10% from 669,903 people to recoup an overpayment. Asked whether those numbers covered all types of benefits administered by the SSA, the agency’s press office didn’t say.

“Under Trump’s leadership, Social Security has reinstated a cruel policy of clawing back Social Security overpayments with no regard for an American’s ability to pay or whether the overpayment was an error by the agency,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee.

The new plan to completely withhold monthly benefits from recipients who were allegedly overpaid does not extend to the Supplemental Security Income program, one of two Social Security programs for people with disabilities. SSI, as the agency explains, covers “people with disabilities and older adults who have little or no income or resources.”

The government’s estimate that cutting people off completely will save $7 billion over a decade implies it expects many more overpayments in the years ahead.

The SSA’s March 7 announcement was part of a broader dismantling of Biden-era policies under President Donald Trump. It was also part of a broader upheaval at the Social Security Administration, which announced In February that it would cut its staff from about 57,000 to 50,000.

In an interview Monday, O’Malley predicted that the public will experience much longer wait times trying to get through to the agency by phone and longer waits for disability determinations.

Social Security runs on a very old computer system, he said, and driving people out of the agency who understand it “can only result in system collapse.”

“The risk of totally shutting down the agency is greatly increased by people mucking around that don’t know what they’re doing,” O’Malley said.

On the PBS NewsHour last week, he advised recipients to save money to prepare for an interruption of benefits.

Trump deputy Elon Musk has boasted of taking a chainsaw to the federal government and has called Social Security a Ponzi scheme. In a signed declaration filed in federal court last week, a recently retired SSA official, Tiffany Flick, said she “witnessed a disregard for critical processes” as members of DOGE — the Department of Government Efficiency, which Trump established by executive order — demanded access to sensitive Social Security systems, including files that contain beneficiaries’ banking information.

New management at the SSA called its workforce “bloated.” But, under the previous administration, the agency was telling a starkly different story.

A year ago, O’Malley told lawmakers that, as the number of people receiving benefits increased, “historic underfunding and understaffing” at the agency had created a “service delivery crisis.”

Late last year, the agency provided data to KFF Health News showing that in September its workforce was near a 50-year low. As of last month, applicants for disability benefits were waiting an average of more than seven months for a decision, according to the SSA website.

The staffing cuts will lead to more overpayments than ever and will make it harder for the people affected to clear up mistakes, said Jen Burdick, an attorney at Community Legal Services of Philadelphia.

As KFF Health News and Cox Media Group revealed in 2023, about 2 million people a year were receiving notices from the SSA that they were overpaid and owed money back.

People can appeal overpayment notices, request a lower withholding rate, or ask the SSA to waive collection altogether, the agency said. The SSA does not pursue recoveries while an initial appeal or waiver request is pending, it said.

Shortly before O’Malley left the SSA in November, the agency implemented changes that made it easier for beneficiaries to get overpayments waived. The agency spelled out grounds for determining the beneficiary was not at fault — for instance, if the agency continued to issue overpayments after the beneficiary reported a change in their financial circumstances that should have led to a reduction in benefits. Those policy changes remain intact.

Several Republicans who expressed concern about clawbacks in the aftermath of 2023 news coverage did not respond to inquiries for this article or declined to comment. One of them was Sen. Rick Scott (R-Fla.), who is now chair of the Senate’s Special Committee on Aging.

“Hardworking American taxpayers pay into Social Security all of their lives so that they can depend on it in the time they need it most,” Scott said in a 2023 letter to the agency. “The fact that the SSA’s actions are leaving some of them worse off, through no fault of their own, is absolutely unacceptable.”

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When congressional Republicans in 2017 pushed to repeal the Affordable Care Act and slash Medicaid, dozens of physician groups, patient advocates, hospitals, and others rallied to defend the law and the safety-net program.

Eight years later, two industry groups have been notably restrained as GOP lawmakers consider sweeping new Medicaid cuts: the American Medical Association and the American Health Care Association, which represents nursing homes.

At the same time, the two groups are lobbying Republicans, seeking support on other priorities.

The AMA is lobbying lawmakers to reverse a nearly 3% cut in Medicare’s fees for physicians. And the AHCA has pushed Congress to roll back regulations enacted under President Joe Biden that mandate better staffing ratios at nursing homes.

Representatives of the two groups declined to comment on the record about any connections between the Medicaid fight and their other legislative priorities.

But AHCA spokesperson Rachel Reeves said the nursing home group, which has issued a statement defending Medicaid, is communicating with lawmakers about the importance of the program for people with low incomes and disabilities. “We will make sure that the voices of our community are heard and that the message is loud and clear: Congress must protect our seniors who rely on Medicaid,” she said. Medicaid is the primary payer for nursing home care, covering more than 6 in 10 nursing home residents.

Nevertheless, other advocates and congressional Democrats said they’re frustrated by the two groups. “The time to speak out is now,” Sen. Ron Wyden, the senior Democrat on the Senate Finance Committee, told KFF Health News. “Americans will know which organizations stood up against harmful cuts to Medicaid when this fight is over.”

Medicaid, a state-federal insurance plan that together with the related Children’s Health Insurance Program covers about 80 million Americans, is in the crosshairs as congressional Republicans seek to trim several trillion dollars in federal spending to offset the $4.5 trillion cost of extending tax cuts enacted in President Donald Trump’s first term.

Medicaid cuts on the scale being contemplated would put coverage for millions of Americans at risk. That has alarmed advocates who work with people covered by the program, including children, Americans with disabilities, and low-income older adults. Other advocacy organizations who work with these patients have been much more active.

Last week, more than 400 pediatricians traveled to Washington, D.C., to speak to members of Congress about the importance of Medicaid. More than 100 leaders of safety-net hospitals that serve low-income patients around the country did the same.

Patients’ advocates such as the American Cancer Society Cancer Action Network have defended Medicaid. Last month, state medical societies sent a letter to congressional leaders warning of dire consequences if Medicaid cuts are enacted. And this week, more than 750 members of the American College of Obstetricians and Gynecologists are expected in Washington, where the group says they’ll be lobbying to preserve Medicaid funding.

“Slicing hundreds of billions of dollars from federal funding will force states to cut the care children and families depend on or raise taxes on hard-working Americans,” said Chip Kahn, chief executive of the Federation of American Hospitals, another trade group fighting to defend Medicaid.

Building coalitions was critical in previous health care debates, said Ron Pollack, the former head of patient advocacy group Families USA. Pollack helped lead the push for the 2010 Affordable Care Act. “We succeeded in the past because we stuck together,” he said.

Eight years ago, the AMA and AHCA were key members of the coalition that turned back Republican efforts to repeal the Affordable Care Act, often called Obamacare.

The AMA, the nation’s largest physician group, sent multiple letters to Congress throughout 2017, warning lawmakers in a March 17, 2017, letter that they should “keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans.”

And the AHCA’s president was a leading voice opposing repeal, which at one point he called “the biggest threat that the sector has faced in at least 20 to 25 years.”

This year, the AMA hasn’t sent a single letter or issued any news releases opposing Medicaid cuts. By contrast, the group has issued seven news releases since January on the lack of congressional action on physician fees.

The AHCA issued its first public defense of Medicaid in this year’s debate — a document it called a fact sheet — only the day after House Republicans adopted a budget resolution that threatens the program’s funding. When the group issued its 2025 policy priorities last week, “Priority #1” focused on staffing, including repealing the Biden-era staffing mandate. “Protecting Medicaid” was “Priority #2.”

The Medicaid debate will likely drag on for months as GOP leaders in the House and Senate try to cobble together a bill to extend tax cuts.

Medicaid’s defenders say they’re still looking for more voices to speak up.

“Republicans have said outright that silence is consent,” Wyden said. “If health care organizations don’t speak out against the GOP’s plans to cut health care, Republican lawmakers are going to assume those organizations are on board with their agenda.”

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The Trump administration issued its first major set of proposed changes to the Affordable Care Act on Monday that federal officials said are intended to crack down on fraud in the program. Policy experts said they will make it harder for consumers to sign up for coverage, potentially reducing enrollment.

Details were released Monday after a draft press release was inadvertently posted earlier.

About 24 million Americans signed up for insurance plans sold under the ACA, known popularly as Obamacare, for 2025. The Biden administration achieved record enrollment levels after increasing premium subsidies for many lower-income people, which resulted in reducing the monthly cost of some plans to $0. It also made it easier for some very low-income people to sign up at any time of year, instead of waiting for an enrollment period each fall. But the program became plagued by fraudulent enrollment last year, generating about 274,000 consumer complaints through August, most focused on rogue insurance agents and other bad actors, to the Centers for Medicare & Medicaid Services.

The Trump administration said in a statement Monday that the new regulations include “critical and necessary steps to protect people from being enrolled in Marketplace coverage without their knowledge or consent, promote stable and affordable health insurance markets, and ensure taxpayer dollars fund financial assistance only for the people the ACA set out to support.”

Policy experts said the changes, though, will impose new paperwork burdens likely to hamper enrollment.

“Under this banner of trying to crack down on the bad actions of some insurance brokers, they are penalizing consumers, particularly low-income consumers, with more burdensome requirements and more limits on their access to coverage,” said Sabrina Corlette, a research professor and the co-director of the Center on Health Insurance Reforms at Georgetown University.

Among other new requirements, consumers would have to provide more information proving their eligibility for special enrollment periods and for premium subsidies when they enroll. The regulation would also shorten the annual enrollment period by a month. And it touches on social issues, limiting eligibility for “Dreamers” — a nickname for immigrants in the country illegally who were brought here as children, based on never-passed proposals in Congress called the DREAM Act.

The proposal would eliminate the year-round opportunity for a special enrollment period for people with very low incomes. But it would also set new requirements for the remaining special enrollment periods, which allow people to sign up after major life events, such as when their income changes, they lose their job-based coverage, or they get divorced, marry, or move. They would now have to provide evidence of their eligibility when applying under those special situations.

People auto-reenrolled into zero-premium plans during the regular enrollment period would be charged a small monthly payment until they confirm or update their information.

The ACA marketplaces, according to the proposal, would have to seek additional data from consumers, including the self-employed or gig workers, who estimate their income for the coming year but don’t have tax return data filed with the IRS for previous years.

The Biden administration made changes to reduce fraudulent enrollment last year including requiring three-way calls among insurance brokers, their clients, and the federal insurance marketplace, healthcare.gov, when certain sign-ups or coverage changes were made.

Some of the Trump administration’s proposed changes could help warn certain consumers that they’ve been unknowingly enrolled in an ACA plan, such as a requirement that some customers on even the least expensive plans receive a small, monthly premium bill.

However, the additional paperwork and other eligibility requirements “will probably have a downward effect on enrollment,” said Cynthia Cox, a vice president and the director of the Program on the ACA at KFF, a health information nonprofit that includes KFF Health News. “Some of that could be protecting enrollees who were fraudulently signed up or don’t realize they’re still signed up.”

Still, it could prove difficult for some people if they’re not able to document an expected change in income. “They might have a legitimate claim but have a hard time demonstrating it,” Cox said.

The annual open enrollment period would end Dec. 15, a month earlier than this year. The designated period is when most people sign up and is intended to prevent people from waiting until they get sick to enroll, a move that helps slow premium growth.

The Trump proposal also touches on social issues.

It would reverse the Biden administration policy that allows Dreamers to qualify for subsidized ACA coverage. That decision is already the subject of a court challenge brought by 19 states seeking to overturn it.

Also under the Trump proposal, gender-affirming care would not be considered part of the “essential health benefits” that all plans must cover.

According to an FAQ that accompanied the initial press release of the proposed regulations, the provision could “lead to increased out-of-pocket costs for individuals requiring sex-trait modification services, as they may need to seek plans that offer this coverage as a non-EHB or pay for services out-of-pocket.”

As a proposed rule, the measures now face a public comment period and potential revision before being finalized.

“None of it will go into effect right away,” said Katie Keith, director of the Center for Health Policy and the Law at Georgetown University. “The question is how much will apply in 2025 versus 2026.”

The FAQ acknowledged that some of the proposed changes, including ending year-round enrollment for very low-income people, “may increase the administrative burden for consumers associated with enrollment and verification processes or could deter some eligible low-income individuals from enrolling.”

But, it continued, “we believe that enhancing program integrity and reducing improper enrollments outweighs these potential impacts on access to coverage.”

Some lawmakers and conservative groups have pointed to the concerns about unauthorized enrollment and the role, if any, that ACA subsidies or enrollment periods have in fueling the problem.

The right-leaning Paragon Health Institute, for example, released a report in June that, among other things, called for the Biden administration’s expansion of the special enrollment period for low-income people to be reversed.

“There is substantial amounts of fraud and waste in the ACA exchanges and the Biden administration pursued the enrollment-at-all costs strategy, and was tolerant of the waste, fraud and abuse,” said Brian Blase, a former health aide during Trump’s first presidency who is president of the Paragon Health Institute and influential within the current Trump administration. “Clearly a different approach to protect legitimate enrollees and taxpayers is needed.”

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HHS is taking steps to enhance the FDA’s oversight of ingredients considered to be Generally Recognized as Safe (GRAS) so Americans know what is in their food.

La administración Trump publicó el lunes 10 de marzo su primer conjunto importante de cambios propuestos a la Ley de Cuidado de Salud a Bajo Precio (ACA). Funcionarios federales dicen que tienen como objetivo acabar con el fraude en el programa. Pero expertos aseguran que dificultará la inscripción, lo que terminará logrando que muchos consumidores no busquen cobertura.

Los detalles se dieron a conocer después que un borrador de la propuesta se hiciera público inadvertidamente.

Alrededor de 24 millones de estadounidenses se inscribieron en planes médicos para 2025 en los mercados de seguros de salud establecidos por ACA, conocida popularmente como Obamacare.

El gobierno de Biden logró niveles récord de inscripción después de aumentar los subsidios para pagar las primas para muchas personas de bajos ingresos, lo que resultó en reducir el costo mensual de algunos planes a literalmente $0.

También facilitó que algunas personas de ingresos muy bajos se inscribieran en cualquier momento del año, en lugar de esperar al período de inscripción cada otoño.

Pero el año pasado, el programa se vio afectado por inscripciones fraudulentas, lo que hizo que los Centros de Servicios de Medicare y& Medicaid (CMS) recibieran cerca de 274.000 quejas de consumidores, hasta agosto, la mayoría centradas en agentes de seguros deshonestos y otros actores de dudosa moralidad.

La administración Trump dijo en el comunicado del lunes que las nuevas regulaciones incluyen “pasos críticos y necesarios para proteger a las personas de ser inscritas en la cobertura del mercado sin su conocimiento o consentimiento, promover mercados de seguros de salud estables y asequibles, y garantizar que el dinero de los contribuyentes financie la asistencia financiera solo para las personas a las que ACA debe apoyar”.

Pero expertos en políticas dijeron que estos cambios impondrán nuevas cargas de papeleo que probablemente obstaculicen la inscripción.

“Bajo esta bandera de intentar acabar con las malas acciones de algunos corredores de seguros, están penalizando a los consumidores, particularmente a los de bajos ingresos, con requisitos más onerosos y más límites a su acceso a la cobertura”, dijo Sabrina Corlette, profesora de investigación y codirectora del Centro de Reformas de Seguros de Salud en la Universidad de Georgetown.

Entre otros nuevos requisitos, los consumidores tendrían que proporcionar al momento de inscribirse más información que demuestre su elegibilidad para períodos de inscripción especiales y para calificar para recibir subsidios.

La regulación también acortaría un mes el período de inscripción anual. Y toca temas sociales, limitando la elegibilidad de los “Dreamers” (el nombre dado a los inmigrantes que fueron traídos sin papeles al país cuando eran niños), en base en propuestas nunca aprobadas en el Congreso llamadas DREAM Act.

La propuesta eliminaría la oportunidad de poder inscribirse en cualquiera momento del año para personas con ingresos muy bajos. Pero también establecería nuevos requisitos para los períodos de inscripción especiales restantes, que permiten a las personas inscribirse después de experimentar eventos de vida importantes, como cuando sus ingresos cambian, pierden su cobertura basada en el trabajo o se divorcian, se casan o se mudan. Ahora tendrían que proporcionar más evidencia de su elegibilidad al presentar la solicitud en esas situaciones especiales.

A las personas que se reinscriban automáticamente en planes de primas cero durante el período de inscripción regular se les cobraría un pequeño pago mensual hasta que confirmen o actualicen su información.

Según la propuesta, los mercados de ACA tendrían que buscar datos adicionales de los consumidores, incluidos los trabajadores autónomos o por encargo, que estiman sus ingresos para el año siguiente pero no tienen datos de declaraciones de impuestos presentados ante el IRS para años anteriores.

El año pasado, la administración Biden implementó cambios para reducir las inscripciones fraudulentas, entre ellos, la exigencia de llamadas tripartitas entre los corredores de seguros, sus clientes y el mercado de seguros federal, cuidadodesalud.gov, cuando se realizaban ciertas inscripciones o cambios en la cobertura.

Algunos de los cambios propuestos por el gobierno de Trump podrían ayudar a advertir a ciertos consumidores de que han sido inscritos sin saberlo en un plan de ACA, como el requisito de que algunos clientes, incluso en los planes menos costosos, reciban una pequeña factura de sus primas mensuales.

Sin embargo, el papeleo adicional y otros requisitos de elegibilidad “probablemente tendrán un efecto en bajar la inscripción”, dijo Cynthia Cox, vicepresidenta y directora del Programa sobre ACA en KFF, una organización sin fines de lucro de información de salud que incluye a KFF Health News.

“Parte de eso podría proteger a los inscritos que se inscribieron de manera fraudulenta o que no se dan cuenta de que todavía están inscritos”, agregó Cox.

Aun así, podría resultar difícil para algunas personas si no pueden documentar un cambio esperado en los ingresos. “Pueden tener una reclamación legítima, pero que les resulta difícil demostrarlo”, dijo Cox.

El período anual de inscripción abierta finalizaría el 15 de diciembre, un mes antes que este año. Esa ventana anual es cuando la mayoría de las personas se inscriben y tiene como objetivo evitar que las personas esperen hasta enfermarse para inscribirse, una medida que ayuda a frenar el aumento de las primas.

La propuesta de Trump también impacta en cuestiones sociales.

Revertiría la política de la administración Biden que permite a los Dreamers calificar para la cobertura subsidiada de ACA. Esa decisión está siendo desafiada en los tribunales, en una demanda presentada por 19 estados que buscan revocarla.

También bajo la propuesta de Trump, la atención de afirmación de género no se consideraría parte de los “beneficios de salud esenciales” que todos los planes deben cubrir.

Según una sección de preguntas frecuentes que acompañó al comunicado de prensa inicial de las regulaciones propuestas, la disposición podría “llevar a mayores gastos de bolsillo para las personas que requieren servicios de modificación de rasgos sexuales, ya que podrían necesitar buscar planes que ofrezcan esta coberturas, como un plan sin beneficios esenciales o pagar los servicios de su bolsillo”.

Como regla propuesta, las medidas ahora enfrentan un período de comentarios públicos y una posible revisión antes de finalizarse.

“Nada de esto entrará en vigencia de inmediato”, dijo Katie Keith, directora del Centro de Política y Derecho de Salud en la Universidad de Georgetown. “La pregunta es cuánto se aplicará en 2025 en comparación con 2026”.

En las preguntas frecuentes se reconoció que algunos de los cambios propuestos, incluida la eliminación de la inscripción durante todo el año para las personas de ingresos muy bajos, “puede aumentar la carga administrativa para los consumidores asociada con los procesos de inscripción y verificación o podrían disuadir a algunas personas de bajos ingresos elegibles de inscribirse”.

Pero, continuó, “creemos que mejorar la integridad del programa y reducir las inscripciones indebidas supera estos posibles impactos en el acceso a la cobertura”.

Algunos legisladores y grupos conservadores han señalado las preocupaciones sobre la inscripción no autorizada y el papel que podrían tener los subsidios o los períodos de inscripción de ACA en que este problema se agudizara.

Por ejemplo, el Paragon Health Institute, de tendencia derechista, publicó un informe en junio que, entre otras cosas, pedía que se revirtiera la expansión del período de inscripción especial para personas de bajos ingresos que impulsó la administración Biden.

“Hay cantidades sustanciales de fraude y despilfarro en los mercados de ACA y la administración Biden siguió la estrategia de inscripción a cualquier costo y fue tolerante con el despilfarro, el fraude y el abuso”, dijo Brian Blase, ex asistente de salud durante la primera presidencia de Trump, quien es presidente del Paragon Health Institute y tiene influencia dentro de la actual administración Trump.

“Es evidente que se necesita un enfoque diferente para proteger a los inscritos legítimos y a los contribuyentes”, concluyó Blase.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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BOLIGEE, Ala. — Green lights flickered on the wireless router in Barbara Williams’ kitchen. Just one bar lit up — a weak signal connecting her to the world beyond her home in the Alabama Black Belt.

Next to the router sat medications, vitamin D pills, and Williams’ blood glucose monitor kit.

“I haven’t used that thing in a month or so,” said Williams, 72, waving toward the kit. Diagnosed with diabetes more than six years ago, she has developed nerve pain from neuropathy in both legs.

Williams is one of nearly 3 million Americans who live in mostly rural counties that lack both health care and reliable high-speed internet, according to an analysis by KFF Health News, which showed that these people tend to live sicker and die younger than others in America.

Compared with those in other regions, patients across the rural South, Appalachia, and remote West are most often unable to make a video call to their doctor or log into their patient portals. Both are essential ways to participate in the U.S. medical system. And Williams is among those who can do neither.

This year, more than $42 billion allocated in the 2021 Infrastructure Investment and Jobs Act is expected to begin flowing to states as part of a national “Internet for All” initiative launched by the Biden administration. But the program faces uncertainty after Commerce Department Secretary Howard Lutnick last week announced a “rigorous review” asserting that the previous administration’s approach was full of “woke mandates.”

High rates of chronic illness and historical inequities are hallmarks of many of the more than 200 U.S. counties with poor services that KFF Health News identified. Dozens of doctors, academics, and advocates interviewed for this article unanimously agreed that limited internet service hinders medical care and access.

Without fast, reliable broadband, “all we’re going to do is widen health care disparities within telemedicine,” said Rashmi Mullur, an endocrinologist and chief of telehealth at VA Greater Los Angeles. Patients with diabetes who also use telemedicine are more likely to get care and control their blood sugar, Mullur found.

Diabetes requires constant management. Left untreated, uncontrolled blood sugar can cause blindness, kidney failure, nerve damage, and eventually death.

Williams, who sees a nurse practitioner at the county hospital in the next town, said she is not interested in using remote patient monitoring or video calls.

“I know how my sugar affects me,” Williams said. “I get a headache if it’s too high.” She gets weaker when it’s down, she said, and always carries snacks like crackers or peppermints.

Williams said she could even drink a soda pop — orange, grape — when her sugar is low but would not drink one when she felt it was high because she would get “kind of goozie-woozy.”

‘This Is America’

Connectivity dead zones persist in American life despite at least $115 billion lawmakers have thrown toward fixing the inequities. Federal broadband efforts are fragmented and overlapping, with more than 133 funding programs administered by 15 agencies, according to a 2023 federal report.

“This is America. It’s not supposed to be this way,” said Karthik Ganesh, chief executive of Tampa, Florida-based OnMed, a telehealth company that in September installed a walk-in booth at the Boligee Community Center about 10 minutes from Williams’ home. Residents can call up free life-size video consultations with an OnMed health care provider and use equipment to check their weight and blood pressure.

OnMed, which partnered with local universities and the Alabama Cooperative Extension System, relies on SpaceX’s Starlink to provide a high-speed connection in lieu of other options.

A short drive from the community center, beyond Boligee’s Main Street with its deserted buildings and an empty railroad depot and down a long gravel drive, is the 22-acre property where Williams lives.

Last fall, Williams washed a dish in her kitchen, with its unforgiving linoleum-topped concrete floors. A few months earlier, she said, a man at the community center signed her up for “diabetic shoes” to help with her sore feet. They never arrived.

As Williams spoke, steam rose from a pot of boiling potatoes on the stove. Another pan sizzled with hamburger steak. And on a back burner simmered a mix of Velveeta cheese, diced tomatoes, and peppers.

She spent years on her feet as head cook at a diner in Cleveland, Ohio. The oldest of nine, Williams returned to her family home in Greene County more than 20 years ago to care for her mother and a sister, who both died from cancer in the back bedroom where she now sleeps.

Williams looked out a window and recalled when the landscape was covered in cotton that she once helped pick. Now three houses stand in a carefully tended clearing surrounded by tall trees. One belongs to a brother and the other to a sister who drives with her daily to the community center for exercise, prayers, and friendship with other seniors.

All the surviving siblings, Williams said, have diabetes. “I don’t know how we became diabetic,” she said. Neither of their parents had been diagnosed with the illness.

In Greene County, an estimated quarter of adults have diabetes — twice the national average. The county, which has about 7,600 residents, also has among the nation’s highest rates for several chronic diseases such as high blood pressure, stroke, and obesity, Centers for Disease Control and Prevention data shows.

The county’s population is predominately Black. The federal CDC reports that Black Americans are more likely to be diagnosed with diabetes and are 40% more likely than their white counterparts to die from the condition. And in the South, rural Black residents are more likely to lack home internet access, according to the Joint Center for Political and Economic Studies, a Washington-based think tank.

To identify counties most lacking in reliable broadband and health care providers, KFF Health News used data from the Federal Communications Commission and George Washington University’s Mullan Institute for Health Workforce Equity. Reporters also analyzed U.S. Census Bureau, CDC, and other data to understand the health status and demographics of those counties.

The analysis confirms that internet and care gaps are “hitting areas of extreme poverty and high social vulnerability,” said Clese Erikson, deputy director of the health workforce research center at the Mullan Institute.

Digital Haves vs. Have-Nots

Just over half of homes in Greene County have access to reliable high-speed internet — among the lowest rates in the nation. Greene County also has some of the country’s poorest residents, with a median household income of about $31,500. Average life expectancy is less than 72 years, below the national average.

By contrast, the KFF Health News analysis found that counties with the highest rates of internet access and health care providers correlated with higher life expectancy, less chronic disease, and key lifestyle factors such as higher incomes and education levels.

One of those is Howard County, Maryland, between Baltimore and Washington, D.C., where nearly all homes can connect to fast, reliable internet. The median household income is about $147,000 and average life expectancy is more than 82 years — a decade longer than in Greene County. A much smaller share of residents live with chronic conditions such as diabetes.

One is 78-year-old Sam Wilderson, a retired electrical engineer who has managed his Type 2 diabetes for more than a decade. He has fiber-optic internet at his home, which is a few miles from a cafe he dines at every week after Bible study. On a recent day, the cafe had a guest Wi-Fi download speed of 104 megabits per second and a 148 Mbps upload speed. The speeds are fast enough for remote workers to reliably take video calls.

Americans are demanding more speed than ever before. Most households have multiple devices — televisions, computers, gaming systems, doorbells — in addition to phones that can take up bandwidth. The more devices connected, the higher minimum speeds are needed to keep everything running smoothly.

To meet increasing needs, federal regulators updated the definition of broadband last year, establishing standard speeds of 100/20 Mbps. Those speeds are typically enough for several users to stream, browse, download, and play games at the same time.

Christopher Ali, professor of telecommunications at Penn State, recommends minimum standard speeds of 100/100 Mbps. While download speeds enable consumption, such as streaming or shopping, fast upload speeds are necessary to participate in video calls, say, for work or telehealth.

At the cafe in Howard County, on a chilly morning last fall, Wilderson ordered a glass of white wine and his usual: three-seeded bread with spinach, goat cheese, smoked salmon, and over-easy eggs. After eating, Wilderson held up his wrist: “This watch allows me to track my diabetes without pricking my finger.”

Wilderson said he works with his doctors, feels young, and expects to live well into his 90s, just as his father and grandfather did.

Telehealth is crucial for people in areas with few or no medical providers, said Ry Marcattilio, an associate director of research at the Institute for Local Self-Reliance. The national research and advocacy group works with communities on broadband access and reviewed KFF Health News’ findings.

High-speed internet makes it easier to use video visits for medical checkups, which most patients with diabetes need every three months.

Being connected “can make a huge difference in diabetes outcomes,” said Nestoras Mathioudakis, an endocrinologist and co-medical director of Johns Hopkins Medicine Diabetes & Education Program, who treats patients in Howard County.

Paying More for Less

At Williams’ home in Alabama, pictures of her siblings and their kids cover the walls of the hallway and living room. A large, wood-framed image of Jesus at the Last Supper with his disciples hangs over her kitchen table.

Williams sat down as her pots simmered and sizzled. She wasn’t feeling quite right. “I had a glass of orange juice and a bag of potato chips, and I knew that wasn’t enough for breakfast, but I was cooking,” Williams said.

Every night Williams takes a pill to control her diabetes. In the morning, if she feels as if her sugar is dropping, she knows she needs to eat. So, that morning, she left the room to grab a peppermint, walking by the flickering wireless router.

The router’s download and upload speeds were 0.03/0.05 Mbps, nearly unusable by modern standards. Williams’ connection on her house phone can sound scratchy, and when she connects her cellphone to the router, it does not always work. Most days it’s just good enough for her to read a daily devotional website and check Facebook, though the stories don’t always load.

Rural residents like Williams paid nearly $13 more a month on average in late 2020 for slow internet connections than those in urban areas, according to Brian Whitacre, an agricultural economics professor at Oklahoma State University.

“You’re more likely to have competition in an urban area,” Whitacre said.

In rural Alabama, cellphone and internet options are limited. Williams pays $51.28 a month to her wireless provider, Ring Planet, which did not respond to calls and emails.

In Howard County, Maryland, national fiber-optic broadband provider Verizon Communications faces competition from Comcast, a hybrid fiber-optic and cable provider. Verizon advertises a home internet plan promising speeds of 300/300 Mbps starting at $35 a month for its existing mobile customers. The company also offers a discounted price as low as $20 a month for customers who participate in certain federal assistance programs.

“Internet service providers look at the economics of going into some of these communities and there just isn’t enough purchasing power in their minds to warrant the investment,” said Ross DeVol, chief executive of Heartland Forward, a nonpartisan think tank based in Bentonville, Arkansas, that specializes in state and local economic development.

Conexon, a fiber-optic cable construction company, estimates it costs $25,000 per mile to build above-ground fiber lines on poles and $60,000 to $70,000 per mile to build underground.

Former President Joe Biden’s 2021 infrastructure law earmarked $65 billion with a goal of connecting all Americans to high-speed internet. Money was designated to establish digital equity programs and to help low-income customers pay their internet bills. The law also set aside tens of billions through the Broadband Equity Access and Deployment Program, known as BEAD, to connect homes and businesses.

That effort prioritizes fiber-optic connections, but federal regulators recently outlined guidance for alternative technologies, including low Earth orbit satellites like SpaceX’s Starlink service.

Funding the use of satellites in federal broadband programs has been controversial inside federal agencies. It has also been a sore point for Elon Musk, who is chief executive of SpaceX, which runs Starlink, and is a lead adviser to President Donald Trump.

After preliminary approval, a federal commission ruled that Starlink’s satellite system was “not reasonably capable” of offering reliable high speeds. Musk tweeted last year that the commission had “illegally revoked” money awarded under the agency’s Trump-era Rural Digital Opportunity Fund.

In February, Trump nominated Arielle Roth to lead the federal agency overseeing the infrastructure act’s BEAD program. Roth is telecommunications policy director for the Senate Committee on Commerce, Science, and Transportation. Last year, she criticized the program’s emphasis on fiber and said it was beleaguered by a “woke social agenda” with too many regulations.

Commerce Secretary Lutnick last week said he will get rid of “burdensome regulations” and revamp the program to “take a tech-neutral approach.” Republicans echoed his positions during a U.S. House subcommittee hearing the same day.

When asked about potentially weakening the program’s required low-cost internet option, former National Telecommunications and Information Administration official Sarah Morris said such a change would build internet connections that people can’t afford. Essentially, she said, they would be “building bridges to nowhere, building networks to no one.”

'That Hurt’

Over a lunch of tortilla chips with the savory sauce that had been simmering on the stove, Williams said she hadn’t been getting regular checkups before her diabetes diagnosis.

“To tell you the truth, if I can get up and move and nothing is bothering me, I don’t go to the doctor,” Williams said. “I’m just being honest.”

Years ago, Williams recalled, “my head was hurting me so bad I had to just lay down. I couldn’t stand up, walk, or nothing. I’d get so dizzy.”

Williams thought it was her blood pressure, but the doctor checked for diabetes. “How did they know? I don’t know,” Williams said.

As lunch ended, she pulled out her glucose monitor. Williams connected the needle and wiped her finger with an alcohol pad. Then she pricked her finger.

“Oh,” Williams said, sucking air through her teeth. “That hurt.”

She placed the sample in the machine, and it quickly displayed a reading of 145 — a number, Williams said, that meant she needed to stop eating.

Click to open the Methodology Methodology

Here’s how KFF Health News did its analysis for the “Dead Zone” series, which pinpointed counties that lag behind the rest of the United States in access to broadband service and health care providers.

To identify “dead zones,” KFF Health News consulted two main data sources.

• The Federal Communications Commission National Broadband Map was used to identify broadband deserts as of June 2024. We used the FCC’s minimum speed standard of 100 Mbps download and 20 Mbps upload, and followed its definition of reliable broadband: service accessible via wired (fiber optics, cable, DSL) or licensed fixed wireless technology. It’s the standard for grants awarded through the federal Broadband Equity, Access, and Deployment Program, known as BEAD. The FCC data shows whether such service is available, and not necessarily whether households subscribe to it.
• Data from George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity was used to determine counties with health provider shortages. GWU’s data on primary care providers (family and internal medicine doctors, pediatricians, obstetricians and gynecologists, physician assistants, and nurse practitioners) reflects providers who serve at least one person enrolled in Medicaid. We used the most recent years available: 2020 for 44 states, and 2019 data for Texas. Five states — Delaware, Florida, Maine, Minnesota, and New Hampshire — were excluded from analysis because they lacked reliable data for either year.

GWU’s data for behavioral health providers reflects psychiatrists, psychologists, counselors, therapists, and addiction medicine specialists, regardless of whether their patients receive Medicaid. We used data from 2021, the most recent year available.

We classified counties as “dead zones” if they met these criteria:

• Fewer than 70% of homes had access to fast, reliable broadband.
• They ranked in the bottom third of Medicaid primary care providers, defined as the number of Medicaid enrollees per provider.
• They ranked in the bottom third of behavioral health providers, defined as the number of residents per provider.

A total of 210 counties met those criteria. At the other extreme, we defined 203 counties as “most served” if they had the most residences with broadband access (at least 96.7%) and ranked in the top third of Medicaid primary care and behavioral health provider ratios.

We also compared the health outcomes and demographics of dead zone counties relative to others using several data sources:

• U.S. Census Bureau, for data on household income, education levels, and other demographics.
• County Health Rankings & Roadmaps, part of the University of Wisconsin Population Health Institute, for data on life expectancy and the percentage of residents living in rural areas.
• U.S. Centers for Disease Control and Prevention, for data on diabetes, high blood pressure, and other chronic health conditions.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Joseph Shea, who sells athletic wear in Myrtle Beach, South Carolina, wonders and worries about the food he eats.

The chemical ingredients with mystifying names. The references on product labels to unspecified natural or artificial flavors. The junk food that fits his budget but feels addictive and makes him feel unwell.

Shea, one of 1,310 people who responded to a poll the health policy research group KFF conducted on health care priorities, said he assumes the FDA is making sure the ingredients are safe.

In many cases, it is not.

The FDA’s restraints on food ingredients are limited and relatively feeble, especially compared with those in Europe, a KFF Health News examination found. There are at least 950 substances in our food that are not permitted in Europe, according to one expert’s estimate, and chemicals linked to health concerns show up in hundreds of products that line the shelves of American supermarkets.

Robert F. Kennedy Jr., the new head of the Department of Health and Human Services, has railed about the risks of food additives for years and has said he wants to end “the mass poisoning of American children.” At a March 6 confirmation hearing, Marty Makary, President Donald Trump’s nominee to head the FDA, expressed concern about foods “with a lot of molecules that do not appear in nature.”

“These are chemicals that the industry insists are safe, a subset of which are concerning,” he said.

But the Trump administration’s initial moves to reduce staff at the FDA led the director of its food safety unit, Jim Jones, to resign last month and raised fears among food safety specialists that the administration could weaken oversight.

To a great extent, the FDA leaves it to food companies to determine whether their ingredients and additives are safe. Companies don’t have to tell the FDA about those decisions, and they don’t have to list all ingredients on their product labels.

Though pharmaceutical companies are required to share research on humans with the FDA, the agency is largely blind to what food-makers know about their products.

“The food industry does massive amounts of research that we have no access to,” Robert Califf told a Senate committee in December on his way out as FDA commissioner.

As a result: The FDA’s oversight of food additives is much weaker than its oversight of prescription drugs.

“There is good reason to be concerned about the chemicals that are routinely included in much of our food,” Califf testified.

Food is a big business. American consumers spend almost $1.7 trillion annually on food and beverages, according to Circana, a research and advisory firm.

Yet American food companies keep secret much of what they put in their products.

KFF Health News asked nine of the largest food manufacturers — The Coca-Cola Co., Conagra Brands, General Mills, Kellanova (successor to Kellogg), The Kraft Heinz Co., Mondelēz International, Nestlé, PepsiCo, and Unilever — for the number of ingredients, if any, that go unnamed on their product labels and the names of those ingredients deemed safe without involvement by the FDA, and substances used in their products in the United States but not in Europe, and vice versa.

None provided answers to those questions.

“We focus on the quality of the ingredients that we use, and all comply with applicable regulatory requirements,” Nestlé spokesperson Dana Stambaugh said.

Chemicals such as titanium dioxide and potassium bromate, whose safety has been debated, are allowed in foods in the United States but not in Europe.

Corporations may turn a blind eye to potential dangers, a July 2024 FDA-funded report warned.

Potentially harmful ingredients “are not necessarily required to be named on a product label,” the Reagan-Udall Foundation for the FDA, an adjunct to the agency, said in the report, which was based largely on interviews with representatives of companies across the food supply chain.

“Companies may choose not to track the presence of these ingredients/compounds due to concern about future litigation,” the report said.

Some additives can remain hidden from the public behind such catchall terms as “spices” and “artificial flavors,” as the Center for Science in the Public Interest has reported, or shrouded by other exemptions from disclosure requirements.

And some ingredients that should have been listed on product labels — potential allergens such as milk, wheat, eggs, and dyes — have at times gone undisclosed, according to a series of food recalls. Gaps in oversight have alarmed political leaders on both sides of the aisle, the U.S. Government Accountability Office, watchdog groups such as the CSPI, and academic researchers.

Adding to the concern: the profusion of ultra-processed foods, which use a wide array of chemicals to add flavor and color, extend shelf life, reduce cost, control texture or consistency, and generally tempt people to eat more. Ultra-processed foods now make up 73% of the U.S. food supply, researchers have estimated. Sen. Bernie Sanders of Vermont, the ranking member of the Senate Health, Education, Labor and Pensions Committee, has said there’s growing evidence they are “deliberately designed to be addictive,” contributing to an epidemic of obesity — a rare point of agreement between him and Kennedy.

At his confirmation hearing, Makary said some ingredients cause a chronic, low-grade inflammatory reaction in the gastrointestinal tract. “And what are we doing? We are drugging our nation’s children at scale,” he said.

The KFF poll found that 58% of respondents want the Trump administration to prioritize setting stricter limits on chemicals in the U.S. food supply.

The Consumer Brands Association, which represents many of the largest food-makers, defends the regulatory system as “rigorous,” “evidence-based,” and “proven.” The system enables companies “to innovate to meet consumer demand,” Sarah Gallo, the association’s senior vice president of product policy, said in a statement to KFF Health News.

“Food manufacturers attest to the safety of an ingredient through the development of extensive scientific evidence and third-party expert review,” Gallo added.

More than a decade ago, Pew Charitable Trusts estimated that there were about 10,000 additives allowed in food in the United States — and that the FDA had not reviewed the safety of about 3,000 of them.

“The system is fundamentally broken,” said Thomas Neltner, one of the authors of the Pew study. “It’s so bad, nobody knows — not even FDA knows — what’s in our food.”

Banned Abroad

The FDA allows titanium dioxide to be used to enhance the appearance of foods, among other purposes. According to an Environmental Working Group database, it’s listed as an ingredient in more than 1,900 products, including many candies.

The European Union takes a more cautious approach. In 2021, an EU regulatory panel concluded that titanium dioxide “can no longer be considered as safe when used as a food additive.” The panel said it couldn’t rule out the possibility that titanium dioxide could damage chromosomes.

The FDA allows potassium bromate to be used in baking, and, according to the EWG database, it’s listed as an ingredient in more than 200 products, including bread, buns, and bagels.

Potassium bromate has been banned from food in many countries, including those of the European Union, Canada, India, and Peru. In 2023, California banned it from food effective in 2027. The United Kingdom prohibited it in 1990. The International Agency for Research on Cancer identified it as possibly carcinogenic more than 25 years ago. A joint committee of the United Nations and the World Health Organization identified it as a “genotoxic carcinogen” in 1992.

On its website, the FDA says it has worked with industry to minimize potassium bromate levels and is reviewing the chemical, among others.

The EWG says that it created the database to help consumers make healthier choices and that the raw data on product labels is supplied by Label Insight — which is owned by NielsenIQ, a major provider of data to industry. The EWG has called for tighter regulation of foods.

Based on a review of FDA and European Commission databases, it appears that at least 950 more additives are used in foods in the United States than are allowed in the European Union, said Erik Millstone, an emeritus professor at the University of Sussex in England who has been studying food safety policy since the 1970s.

Direct comparisons are difficult because the two regulatory systems and the way they keep their records differ greatly.

A definitive count is elusive because the FDA doesn’t require industry to inform it of everything used in foods in the United States.

“That kind of casual neglect totally would be unacceptable in Europe,” Millstone said.

‘Several Decades Behind Europeans’

When the FDA formally approves substances for use in food, it can let decades pass without reassessing them — even when subsequent research raises doubts about their safety.

In January, when the FDA banned Red Dye No. 3 from foods, it cited research published in 1987. (The FDA said it had no evidence the dye puts people at risk; invoking one of the stricter consumer protections, it said a law from 1960 prohibits the use of additives found to induce cancer in animals.)

In the European Union, substances used in foods must pass regulatory approval before being introduced. The EU has also required that its regulators reassess all additives that were on the market before Jan. 20, 2009, a process that is ongoing.

“In the FDA, although we have authorization to do post-market reviews, there’s no statutory mandate to do them,” Jones, the former deputy commissioner of the FDA’s Human Foods Program, told a Senate committee in December. “We are several decades behind Europeans and our Canadian counterparts because they have legal mandates to reevaluate chemicals that have been authorized at some point in the past.”

The FDA website lists 19 post-market determinations since 2010 that substances were not “generally recognized as safe.” Four involve chemical constituents of one mushroom and the mushroom itself. Others include an anabolic steroid, caffeinated alcoholic beverages, cannabidiol (CBD), Ginkgo biloba, melatonin, and partially hydrogenated oils.

Meanwhile, trichloroethylene, banned by the Environmental Protection Agency in December as “an extremely toxic chemical known to cause liver cancer, kidney cancer, and non-Hodgkin’s lymphoma,” is still allowed under FDA rules for use as a solvent in the production of foods.

FDA spokesperson Enrico Dinges said the agency will work with new leadership at HHS “to safeguard the food supply through pre-market and post-market safety evaluations of chemicals in the food supply.”

‘The Loophole Swallowed the Law’

The biggest gap in the FDA’s oversight of foods goes back generations.

In 1958, Congress mandated that, before additives could be used in foods, manufacturers had to prove they were safe and get FDA approval. However, Congress carved out an exception for substances “generally recognized as safe,” which came to be known simply as GRAS.

As conceived, GRAS promised regulatory relief for standard ingredients like salt, sugar, vinegar, and baking powder — along with many chemicals.

Over time, “the loophole swallowed the law,” said a 2014 report by Neltner and Maricel Maffini for the Natural Resources Defense Council.

Companies can unilaterally decide their ingredients are already recognized as safe and use them without asking the FDA for permission or even informing the agency.

A better translation of GRAS would be “Generally Recognized as SECRET,” the Natural Resources Defense Council report said.

A federal watchdog reached a similar conclusion. “GRAS substances can be marketed without FDA’s approval or even its knowledge,” the Government Accountability Office warned in 2010.

That spared the FDA from spending time reviewing countless substances.

For advice on whether ingredients are GRAS, companies may convene panels of specialists. The FDA has noted that panel members could be paid by the companies commissioning the review, but, in guidance to industry, it says “such compensation is not itself an unacceptable conflict.”

About 3,000 flavoring ingredients have been deemed GRAS by a panel of scientists working for an industry group, the Flavor and Extract Manufacturers Association of the United States, known as FEMA, said George Southworth, the organization’s executive director.

The scientists on the FEMA panel “adhere to stringent conflict-of-interest policies,” and their GRAS determinations are submitted to the FDA, which includes them in an online database, Southworth said.

Southworth described the panel as independent, and the FEMA website says panel members have never been employees of companies in the food industry.

Asked how many times FEMA’s panel found that a flavoring didn’t meet the test, Southworth wouldn’t say. He indicated that some reviews are called off before a conclusion is reached.

“Publicly reporting these numbers without full context could lead to misinterpretations about the safety of substances,” he added.

Another Way

Food companies have another option: They can voluntarily notify the FDA that they believe their product is GRAS for its intended use and lay out their reasons — giving the FDA a heads up and essentially seeking its blessing.

If they take that route, they don’t have to wait for an answer from the FDA to begin marketing the product, the agency has said.

And they don’t risk much. If the FDA spots weaknesses in a company’s argument or reasons to worry about a chemical’s safety, it routinely calls off its review instead of declaring the substance unsafe.

FDA records posted on the agency’s website show that the FDA often coaches companies to ask the agency to cease its evaluation. That, too, leaves the company free to sell the product, food watchdogs said.

For companies that voluntarily run their products past the FDA, victory is a letter saying the agency has no questions.

But if companies market products as “generally recognized as safe” without firm grounds, they run the risk that the FDA could one day take enforcement action, such as issuing a warning or stopping sales. That’s if the FDA notices.

Psyched Out

On March 8, 2022, a Canadian company, Psyched Wellness, issued a news release saying it had a green light to market products in the United States.

An “independent review panel of scientific experts” concluded that an extract the company developed, AME-1, was “Generally Recognized As Safe,” paving the way for it to be sold in bulk and used as an ingredient, the company said.

The company described the panel’s judgment as a successful “certification” and “a key milestone.” The extract was derived from a hallucinogenic mushroom, Amanita muscaria, which the company said “has incredible healing and medicinal powers.” As the company later put it in a news release, it had obtained “self-Gras status.”

In June 2024, the company announced that it would soon release Amanita muscaria watermelon gummies.

However, the FDA later took issue with the company and its product.

In a memo dated Sept. 9, 2024, an FDA toxicologist said Psyched Wellness’ claim of GRAS certification was false. The firm failed to show that its extract was generally recognized as safe, the FDA memo said.

Speaking of the mushroom, its extracts, and its known “pharmacologically active constituents,” the FDA memo posted on the agency’s website said they have “potential for serious harm and adverse effects on the central nervous system.”

The FDA was focusing on the mushroom against the backdrop of a spate of medical problems linked to another company’s “Diamond Shruumz” brand chocolate bars, gummies, and infused cones. When it recalled those products in June 2024, that other company announced that a chemical found in Amanita mushrooms was a possible cause of symptoms, including seizures and loss of consciousness.

The FDA memo discussed that recall and said one death and 30 hospitalizations might have been related.

The memo did not connect Psyched Wellness to the outbreak or the Diamond Shruumz products.

The chief executive of Psyched Wellness, Jeffrey Stevens, did not respond to an interview request or written questions.

As recently as Feb. 1, Psyched Wellness said in a securities filing that it will “continue to market its products in the U.S. using the Self-GRAS designation.”

‘Probably Poisoning Us’

If food ingredients cause acute reactions — sending people to emergency rooms, for example — the potential dangers may be relatively easy to identify, and regulatory action might naturally follow. Some critics of the system say they worry more about health effects that could take years or decades to develop.

Then, when it’s too late, it could be hard to trace the harm to any particular ingredient.

All that leaves Joseph Shea of Myrtle Beach in a tough spot.

For a while, Shea tried shopping at a market that has a lot of organic offerings, he said in an interview. That proved too expensive.

Shea said the entire picture is “incredibly frustrating.”

“They’re probably poisoning us, and we don’t know,” he said. “We’ll figure it out 30 years down the road when we get sick.”

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Jennifer Pahlka is perhaps best known as the founder of Code for America, a widely respected nonprofit that helped formalize the principles of civic tech, a movement leveraging design and technology expertise to improve public access to government services and data. Notably, the organization reimagined the online application for California’s food assistance program, which once had one of the country’s lowest participation rates, transforming it from a 45-minute endeavor requiring a computer to a mobile-friendly process that can be completed in under 10 minutes.

Pahlka’s 2023 book, “Recoding America,” outlines her views on why the government so often fails to achieve its policy goals in the digital age. In it, she argues that “archaeological” layers of policies, regulations, and processes center the bureaucracy, not the public.

As a deputy chief technology officer under President Barack Obama, Pahlka helped launch the United States Digital Service, a unit within the White House that paired top technology talent with federal agencies to make government services more efficient and user-friendly. It was the predecessor to Elon Musk’s “Department of Government Efficiency,” or DOGE. On Feb. 25, 21 employees resigned from the renamed service, saying they would not “carry out or legitimize DOGE’s actions.”

Pahlka believes bolstering the government’s tech chops and relying less on contractors could save taxpayer dollars. However, as the administration looks to slash spending, she worries that DOGE’s “very indiscriminate” approach to date could wind up harming people who rely on public benefits such as Medicaid.

KFF Health News spoke to Pahlka, now a senior fellow at the nonpartisan Niskanen Center, about what she sees as “irresponsible transformation” and how best to fast-track government reform. This interview, conducted in mid-February, has been edited for length and clarity.

Q: You’ve made a career of bringing Silicon Valley talent into the public sector to improve the delivery of government services. What have you learned from mixing tech with government?

A: It’s really easy to look from the outside of government and say, “That’s crazy it works that way. I’m going to go in and fix it.” And when you get in, it’s that way for a reason, and you gain so much more empathy and sympathy for people in public service. You realize that people who you thought were obstructionists actually are just trying to do their jobs.

Civil servants deserve respect. We’re just not transforming government fast enough.

Q: What are the key changes you think would speed things up?

A: One, you have to be able to hire the right people and fire the wrong ones.

You also have to be able to reduce procedural bloat. When the unemployment insurance crisis hit, every state’s labor commissioner got called in front of the legislature and yelled at for the backlog. Rob Asaro-Angelo in New Jersey brought boxes and boxes of paper — 7,119 pages of active regs. And when they kept yelling, he kept pointing them to them and saying, “You can’t be scalable with 7,119 pages of regulations.”

The third pillar is investment in digital and data infrastructure.

And the fourth is closing the loop between policy and implementation. In California, you get thousands of bills introduced every year in the legislature. We don’t need that many. We need legislators to follow up on bills that have already been passed, see if they’re working, tweak them if they’re not. They need to go into agencies and say, “If this is hard for you to do, what mandates and constraints can we remove so you can make this a priority?”

Q: Civic technologists pushed through layers of bureaucracy in California to boost participation in the Supplemental Nutrition Assistance Program. How did that process unfold?

A: When we started working on California’s SNAP application, it was 212 questions. It started from, “What are all the policies that we need to comply with?” Instead of, “How would this be easy for someone to use?”

I think it can always be helpful to have fresh eyes on something. If those eyes have experience in consumer technology, they’re going to see through that lens of, “How do we deliver something that is easy for people to use?”

Q: House Republicans are considering deep financial cuts to safety net programs such as SNAP and Medicaid, and restricting eligibility. In recent years, organizations including Code for America have received hundreds of millions in private funding to modernize social safety net programs and make them more accessible. How optimistic do you feel that these efforts will progress over the next four years?

A: Let me say what I hope for: I hope that the states now get that when we don’t transform fast enough in a responsible way, you are inviting irresponsible transformation. I hope this gives governors and mayors all over the country a kick in the butt to say, “Whatever we have done so far, it has been insufficient. We really need to work on the capacity of our state to deliver in a modern era.”

Q: What do you mean by irresponsible transformation?

A: Maybe there is good stuff that DOGE is doing now that I don’t know about or good stuff that they will do in the future. I don’t have a crystal ball. But I do see that there is a huge difference between illegally stopping payments without Congress’ permission and making an IT system work better.

Q: To that point, DOGE’s purview seems to have shifted from modernizing government systems to, ostensibly, rooting out fraud, waste, and abuse. What do you make of that change?

A: I think the thesis that better technology could reduce waste, fraud, and abuse is sound, but you want to see both better use of technology to ensure that taxpayer dollars aren’t wasted, and that people who need their benefits are going to get them. You need a North Star that includes both of those things.

Q: And you’re not seeing that in DOGE?

A: They have not expressed great care for what damage can happen to people who rely on benefits. I’m just seeing large, very indiscriminate cuts.

They have signaled that government needs its own internal tech capacity and that it’s shocking how reliant on contractors our government is. I would agree with that.

We have a very dysfunctional government technology contracting ecosystem. There’s this set of big firms that we’ve outsourced our technology to that get to charge taxpayers a shocking amount of money to implement changes.

Q: Thousands of federal workers are now being pushed out. In light of your view that we outsource too much, what are your feelings on that?

A: We’ve overrelied on the idea that we should bring people in from the outside and underinvested in helping career civil servants to do transformation work themselves.

When I wrote my book, the biggest hero was Yadira Sánchez, who I think now has been at the Centers for Medicare & Medicaid Services for 25 years. She’s a leader who really pushes for the kinds of decisions that are going to make a service for doctors that’s going to be usable. She gets pushback and comes back and says, “If you make that decision, we are going to alienate doctors. They’re going to stop taking Medicare patients. And we’ve got to do it this different way.”

We need more of her, and we need to empower lots of people like that.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Researchers racing to develop bird flu vaccines for humans have turned to a cutting-edge technology that enabled the rapid development of lifesaving covid shots.

There’s a catch: The mRNA technology faces growing doubts among Republicans, including people around President Donald Trump.

Legislation aimed to ban or limit mRNA vaccines was introduced this year by GOP lawmakers in at least seven states. In some cases, the measures would hit doctors who give the injections with criminal penalties, fines, and possible revocation of their licenses.

Some congressional Republicans are also pressing regulators to revoke federal approval for mRNA-based covid shots, which President Donald Trump touted as one of the signature achievements of his first term.

The opposition comes at a critical juncture because vaccines using mRNA have applications well beyond avian flu and covid. They hold the promise of lifesaving breakthroughs to treat many diseases, from melanoma to HIV to Zika, according to clinical trials. The proposed bans could block access to these advances.

MRNA is found naturally in human cells. It is a molecule that carries genetic material and, in a vaccine, trains the body’s immune system to fight viruses, cancer cells, and other conditions. An advantage of mRNA technology is that it can be developed more quickly to target specific variants and is safer than developing a vaccine made from inactivated virus.

“Right now, if we had a bird flu pandemic, we would have a shortage of the vaccine we need,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “The one thing that could save us is mRNA vaccine. The challenge would be if mRNA is banned. This is truly dangerous policy.”

The pushback conflicts with innovations championed by Trump. He assembled tech tycoons at the White House just after his inauguration to announce Stargate, a $500 billion artificial intelligence initiative that could help transform cancer treatment by creating tumor-targeting mRNA vaccines. The fledging partnership between Oracle, SoftBank Corp., and OpenAI, co-founded by Elon Musk, envisions leveraging AI in part to improve health outcomes. Patients would undergo blood tests and AI would be used to find cancer.

Scientists would examine the DNA and RNA (RNA and mRNA serve different functions in a cell) of a specific patient’s tumor to create a vaccine to teach that person’s immune system to target and destroy cells driving cancer growth.

“Imagine early cancer detection, the development of a cancer vaccine for your particular cancer aimed at you, and have that vaccine available in 48 hours,” Oracle co-founder Larry Ellison said at the White House event.

Scores of mRNA clinical trials for cancer vaccines are underway and some have shown dramatic results, cutting the risk of death and recurrence roughly in half for certain patients. In research led by the Yale School of Medicine, for example, patients with advanced kidney cancer remained cancer-free about three years after an mRNA-based treatment in an early-phase trial.

But some politically conservative doctors, lawmakers, and researchers question the safety of mRNA vaccines, especially covid shots made with the technology. Robert F. Kennedy Jr. unsuccessfully petitioned the FDA in 2021 to rescind approval for covid shots and called them “the deadliest vaccine ever made” — a controversial statement that has been refuted.

Now that he’s newly confirmed as Health and Human Services secretary, Kennedy is poised to oversee federal approvals of vaccines, with the power to shape policy such as immunization schedules and appoint vaccine opponents to committees that advise on the approval of shots.

Bloomberg reported late last month that Trump administration health officials were reevaluating a $590 million contract for bird flu shots that the Biden administration awarded to Moderna as part of its push to examine spending on mRNA vaccines.

HHS and White House spokespeople didn’t return emails seeking comment.

Support for an mRNA ban is coming from other sources too. Florida Gov. Ron DeSantis on March 5 urged the Centers for Disease Control and Prevention to stop recommending the covid-19 vaccine for children and called for a state ban on mRNA vaccine mandates. In February, Rep. Thomas Massie (R-Ky.) said on X that the “FDA should immediately revoke approval of these shots,” and Sen. Ron Johnson (R-Wis.) is leading an investigation into the safety of the vaccines. Trump in February signed an order to strip federal funds from schools that require covid shots for attendance.

Vaccine skepticism has become pronounced among Republicans since the pandemic. Four in 10 Republicans who responded to a KFF poll published in January said it was “probably” or “definitely true” that “more people have died from covid-19 vaccines than from the virus itself.” Just a quarter of Republicans reported holding that view in 2023.

The effort is also finding traction at the local level. A district health department outside Boise, Idaho, last year banned its health department from administering covid-19 vaccines, and local lawmakers in Franklin County, Washington, passed a resolution in February against mRNA vaccines.

The ABCs of mRNA

The CDC recommends covid vaccines for anyone 6 months and older, especially seniors and people who are immunocompromised. About 29 million doses had been administered to adults in the 2024-25 season in retail pharmacies and doctors’ offices through Feb. 8, based on federal data.

Given as a shot, mRNA enters muscle cells and teaches them to produce a spike protein found on the surface of a virus. The body’s immune system then targets the spike protein, priming it to identify and fight the virus — in this case, the coronavirus that causes covid. The body’s cells then break down the mRNA and remove it, according to federal health researchers.

More than 13 billion covid vaccines had been administered worldwide as of August 2024.

Researchers say the vaccinations saved countless lives — estimates for the first year alone go as high as 19.8 million — in the throes of a pandemic that had hospitals ordering refrigerated mobile morgues and deliberating over which patients to put on ventilators. Two University of Pennsylvania scientists credited with developing the mRNA technology behind the shots were awarded the Nobel Prize for medicine in 2023.

The FDA says the covid vaccines are safe, with fewer than 1 in 200,000 vaccinated individuals experiencing a severe allergic reaction or heart problems like myocarditis or pericarditis, and the agency notes that “inaccurate information about these vaccines, particularly the mRNA COVID-19 vaccines, continues to circulate.”

While many people hadn’t heard of the mRNA platform until the covid shots were rolled out, it was discovered in the 1960s. The first mRNA flu vaccines were tested in mice in the 1990s. A clinical trial involving direct injection of mRNA to fight cancer occurred in 2008. Clinical trials involving the covid mRNA vaccines involved tens of thousands of volunteers.

Reviews of mortality data showed “no unusual patterns of death were detected that might suggest a potential safety concern,” based on a September 2024 report by a technical working group that provided guidance to the CDC.

But those calling for a ban on all mRNA vaccines say there is a dearth of long-term safety data, and they say covid vaccines by Pfizer-BioNTech and Moderna were hastily approved without proper vetting. They assert without strong evidence that the vaccines cause serious injuries to the heart, nerves, and immune and reproductive systems, and can lead to cancer.

The vaccine has been linked to rare cases of heart inflammation and inflammation of the sac surrounding the heart, although the severity has varied and most patients fully recovered, the CDC says.

“The allegations are beyond reason,” said Anne Schuchat, a career scientist who worked on covid and who twice served stints as acting director of the CDC. “The mRNA covid vaccines were extensively studied after use and do not have those problems.”

“I’m concerned about the whole mRNA technology. I don’t trust anything that fools the body,” said Stephanie Seneff, a computer scientist and anti-vaccine activist at the Massachusetts Institute of Technology. “I’m really glad people are waking up and realizing it’s not the thing to do anymore.”

Vaccines generally work by tricking the body into producing antibodies to fight illnesses.

Pfizer spokespeople didn’t return an email seeking comment. A Moderna spokesperson, Chris Ridley, said legislative efforts to ban or restrict mRNA medicines are largely driven by misunderstandings about their safety profile and mechanism of action. While mRNA-based shots do not modify DNA, for example, that misconception is frequently cited in support of restrictions, Ridley said.

“If enacted, these measures could hinder important research and limit patient access to innovative treatments, potentially delaying life-changing medical advancements,” Ridley said in a written statement.

Networks of Opposition

Groups opposed to the mRNA technology have built a vast and well-funded legal, marketing, and social media network. Members hold conferences to discuss strategies, fund lawsuits against vaccine mandates, and produce reports on the covid vaccines.

As for state legislative efforts, measures introduced this year have varied and their progress has been mixed. Montana’s measure, for instance, was blocked. Idaho lawmakers in February held a hearing on its bill, which calls for a 10-year moratorium on mRNA vaccines. Idaho’s proposal, likely to be amended, as well as Iowa’s and Montana’s have featured criminal penalties for providers who administer all or certain mRNA vaccines. In addition, some state bills, such as legislation in Pennsylvania and Tennessee, focused on the use of the vaccine in livestock and food production.

Various bills are pending in the Texas Legislature to restrict mRNA vaccines in both livestock and humans. South Carolina’s pending bill would require anyone administering certain covid mRNA vaccines to inform patients that the shot is contaminated with fragments of “bacterial plasmid DNA.”

Covid mRNA shots may have minute amounts of residual DNA from production processes but they are heavily degraded and pose no risk, according to the Global Vaccine Data Network, which evaluates vaccine safety concerns.

Speakers at some legislative proceedings have included representatives from Children’s Health Defense, an activist, anti-vaccine group founded by Kennedy.

The Florida surgeon general in January 2024 called for a halt in the use of covid mRNA vaccines. And in Texas, Attorney General Ken Paxton in January moved to appeal a lawsuit he filed claiming Pfizer misrepresented the safety of its mRNA shot.

Efforts to restrict the shots have raised the profile of groups such as the Independent Medical Alliance, which advocates for mRNA-based covid vaccines to be withdrawn from the market.

“We should stop it and test it more before we move forward,” said pediatric cardiologist Kirk Milhoan, a senior fellow at the alliance.

Groups opposed to mRNA shots are pointing to a recent study to urge more caution. Yale University researchers reported in February that they found spike protein still circulating in a subset of individuals with a debilitating, post-vaccination condition. Some of the individuals who experienced chronic illness after getting the shots had detectable levels of spike protein more than 700 days after vaccination. This study was small — 42 participants — and not peer-reviewed.

Its findings also don’t show the spike protein is a health risk or a cause of vaccine injury.

“It’s an initial, provocative study in which you can’t draw conclusions,” said William Schaffner, past medical director of National Foundation for Infectious Diseases. “This is one of the most widely used vaccines around the globe. It’s the furthest thing from an experimental vaccine.”

But what this growing pushback shows, according to some researchers, is that distrust isn’t coming only from fringe groups anymore.

“There are truly amazing mRNA cancer vaccines out there,” said Kate Broderick, chief innovation officer at Maravai LifeSciences, which works on vaccine development. “My fear as a scientist is that it’s been tainted in the public.”

We’d like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what’s happening within the federal health bureaucracy. Please message KFF Health News on Signal at (415) 519-8778 or get in touch here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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HHS OCR is investigating four medical schools and hospitals for operating medical education, training or scholarship programs with race-or sex-based criteria.