In the heart of Appalachia, law enforcement is often seen as being on the front line of the addiction crisis.

Bre Dolan, a 35-year-old resident of Hardy County, West Virginia, understands why. Throughout her childhood, when her dad had addiction and mental health crises, police officers were often the first ones to respond. Dolan calls them “good men and women” who “care about seeing their community recover.”

But she’s skeptical that they can mitigate the root causes of an addiction epidemic that has racked her home state for decades.

“Most of the busts that go down are addicts,” she said — people who need treatment, not prison.

Dolan’s father was one of them. And so was she.

Now 14 years into recovery, she’s been surprised to see many local officials spending opioid settlement money — an influx of cash from companies accused of fueling the overdose crisis — on police Tasers, cruisers, night vision gear, and more.

“How is that really tackling an issue?” Dolan said. “How will it help families battling addiction?”

Nationwide, more than $61 million in opioid settlement funds were spent on law enforcement-related efforts in 2024, according to a yearlong investigation by KFF Health News and researchers at the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a national nonprofit focused on addiction. That included initiatives that public health experts largely support, such as hiring social workers to accompany officers on overdose calls, as well as actions they’re more skeptical of, such as beefing up police arsenals.

Over nearly two decades, state and local governments are set to receive more than $50 billion in opioid settlement money, which is intended to be used to fight addiction. The settlement agreements even outlined suggested uses and established other guardrails to limit unrelated uses of the funds — as happened with the Tobacco Master Settlement Agreement of the 1990s.

But there’s still significant flexibility with these dollars, and what constitutes a good use to one person can be deemed waste by another.

To Stephen Loyd, an addiction medicine doctor who was once addicted to opioids and has served as an expert in several opioid lawsuits, some law enforcement expenses fall into that second category.

Drones and police officer salaries are not “in the spirit of what we wanted to use the money for when we were fighting for it,” Loyd said.

“People died for this money. Families were torn apart for this money. And to not spend it to try to make our system better, so that people don’t have to experience those losses going forward, to me, is unconscionable,” he said.

As part of this investigation, KFF Health News and its partners compiled the most comprehensive national database of opioid settlement spending to date, featuring more than 10,500 examples of how the money was used (or not) last year. The team filed public records requests, scoured government websites, and extracted expenditures, which were then sorted into categories, such as treatment or prevention. The findings include:

• Nearly $2.7 billion — that’s the amount states and localities spent or committed in 2024, according to public records. The lion’s share went to investments addiction experts consider crucial, including about $615 million to treatment, $279 million to overdose reversal medications and related training, and $227 million to housing-related programs for people with substance use disorders.
• Smaller, though notable, amounts funded law enforcement initiatives — such as creating a shooting range and tinting patrol car windows — and prevention programs that experts called questionable, such as putting on a fishing tournament.
• Some jurisdictions paid for basic government services, such as firefighter salaries.
• The money is controlled by different entities in each state, and about 20% of it is untrackable through public records.

This year’s database, including the expenditures and untrackable percentages, should not be compared with the one KFF Health News and its partners compiled last year, due to methodology changes and state budget quirks. The database cannot present a full picture because some jurisdictions don’t publish reports or delineate spending by year. What’s shown is a snapshot of 2024 and does not account for decisions in 2025.

Still, the database helps counteract the secrecy among some of those in charge of settlement money and confusion among those tracking it.

‘How My Population Would Like Me To Vote’

Dolan has seen intergenerational addiction up close. When her father was high, he sometimes kicked teenage Dolan out of the house with her toddler siblings. She started drinking early and progressed to other drugs, eventually landing in prison.

Although she managed to find recovery on her own, even landing a job as an EMT, she wants to make the path easier for others.

If settlement money were used to hire social workers or build family recovery programs, it could change the course of a kid’s life, she said.

“Maybe people could have helped my dad get into recovery and gave him therapy,” she said. “Anything could have happened.”

But many local officials say law enforcement is one of the few tools they have, especially in rural areas. And their constituents believe it’s effective.

“If the goal was treatment and prevention, it would have been better to throw [the money] into a big grant system and give it to treatment centers,” said Cris Meadows, city manager of Oak Hill, West Virginia, which paid more than $67,000 for a drone and surveillance cameras for its police department. “Unfortunately, local governments are really not set up to do that.”

Clarkdale, Arizona, Town Manager Susan Guthrie said her town bought nearly $15,000 worth of drones because they help with enforcement — such as recording crime scenes and conducting search-and-rescue operations — as well as education, when officers interact with kids at community events.

Similar perspectives nationwide have led to spending that includes:

• About $12,000 for rifle suppressors (also known as silencers) in Alexandria, Indiana.
• About $21,000 for Tasers in Mooresville, Indiana.
• About $49,000 to replace outdated body cameras and Tasers in Hardy County, West Virginia.
• Nearly $70,000 in Lewisburg, West Virginia, to add a police officer to the county’s drug task force, replace that officer locally, buy guns and vehicles, and tint car windows.

Several elected officials said their choices reflect local politics.

That’s “how my population would like me to vote,” Hardy County Commissioner Steven Schetrom said of his commission’s goal to spend about a quarter of its settlement money on law enforcement.

Mooresville Town Council President Tom Warthen told KFF Health News, “People have petitioned our government for less taxes but have never petitioned for less services” from the local police force. With federal and state budget cuts looming, the town must be resourceful, he said, adding that the Tasers were bought with a portion of settlement funds that have no restrictions.

After these purchases, an Indiana commission issued a list of law enforcement equipment that it cautioned against buying with restricted settlement dollars. California, Kansas, and Virginia have released similar lists.

Research backs those restrictions. Studies have shown that drug busts and arrests can exacerbate the overdose crisis. Officers responding to overdoses often arrest people, making people who use drugs fearful of calling 911 or seeking treatment through police.

In contrast, equipping police officers with overdose reversal medications has been shown to save lives. That’s a key component of an $18 million effort in Texas, the state with the highest percentage of reported law enforcement spending.

Police and Firefighter Salaries

Some places used settlement funds to maintain basic first responder services.

For example, Mantua Township, New Jersey, used about $79,000 to “offset police salary and wages” and, according to its public spending report, plans to do so annually. Township officials did not respond to requests for comment.

Los Angeles County allocated $1 million to cover a portion of firefighter salaries and benefits last year and estimates it will use another $1 million this year.

County fire department spokesperson Heidi Oliva said opioid funds were used to fill a budget gap until revenue kicked in from a new tax voters approved last November.

The use of funds was “appropriate,” she said in an email, because “the opioid crisis presents a significant burden to EMS response, from dispatch through arrival at hospitals, clinician mental health/burnout, and a variety of other factors.”

Using opioid money to replace other revenue is legal in most places. But it’s considered bad practice.

“I don’t want to see this money used to make up for stuff that would be paid for anyway,” said Daniel Busch, chair of the FED UP! Coalition, a national advocacy organization representing many parents who’ve lost children to addiction.

Settlement dollars are “the only financial representation from the governments and from the drug companies” of families’ losses, Busch said. To see that money used to maintain the status quo is “painful” and “distressing.”

Busch fears this practice will become more common as states grapple with federal budget cuts.

Already in New Jersey, lawmakers allocated $45 million in settlement funds to health systems to cushion against anticipated Medicaid losses — a move opposed by the state’s attorney general, opioid settlement advisory council, and advocates.

However, some states are taking proactive steps.

Colorado released guidance this year against such actions.

“These dollars can’t be part of budget games where we simply backfill existing programs,” state Attorney General Phil Weiser told KFF Health News. “We have to build on whatever we’re doing because it hasn’t been enough.”

Other states, such as Maine, Maryland, and Kentucky, are newly requiring local governments to report how they spend the money, which may make it easier to spot disputed practices. Officials in Delaware, Hawaii, Massachusetts, and Missouri said they expect to revamp their public reporting systems to increase transparency by early 2026.

In Mississippi, which produced no substantive public reports last year, the attorney general’s office has set up a website that will host spending information after Dec. 1.

Jennifer Twyman is anxious to see some positive changes.

“We have people literally dying on our sidewalks,” said the Louisville, Kentucky, advocate.

Twyman struggled with opioid misuse for 20 years and now works with Vocal-KY to end homelessness and the war on drugs. To her, any spending that doesn’t directly help people with addiction betrays the settlement’s purpose.

“It is the blood from many of my friends, people that I care deeply about,” she said. “That money could have been me, could have been my life.”

Read the methodology behind this project.

KFF Health News’ Henry Larweh; Shatterproof’s Kristen Pendergrass and Lillian Williams; and the Johns Hopkins Bloomberg School of Public Health’s Abigail Winiker, Samantha Harris, Isha Desai, Katibeth Blalock, Erin Wang, Olivia Allran, Connor Gunn, Justin Xu, Ruhao Pang, Jirka Taylor, and Valerie Ganetsky contributed to the database featured in this article.

The Johns Hopkins Bloomberg School of Public Health has taken a leading role in providing guidance to state and local governments on the use of opioid settlement funds. Faculty from the school collaborated with other experts in the field to create principles for using the money, which have been endorsed by over 60 organizations.

Shatterproof is a national nonprofit that addresses substance use disorder through distinct initiatives, including advocating for state and federal policies, ending addiction stigma, and educating communities about the treatment system.

Shatterproof is partnering with some states on projects funded by opioid settlements. KFF Health News, the Johns Hopkins Bloomberg School of Public Health, and the Shatterproof team that worked on this report are not involved in those efforts.

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.

USE OUR CONTENT

This story can be republished for free (details).

Officials in Irvington, New Jersey, had an idea. To raise awareness about the dangers of opioid use and addiction, the township could host concerts with popular R&B artists like Q Parker and Musiq Soulchild. It spent more than $600,000 in 2023 and 2024 to pay for the shows, even footing the bill for VIP trailers for the performers. It bought cotton candy and popcorn machines.

In many cases, this type of community event would be unremarkable. But Irvington’s concerts stood out for their funding source: settlement money from companies accused of fueling the opioid overdose crisis.

As part of national settlements, more than a dozen companies that sold prescription painkillers are expected to pay state and local governments upward of $50 billion over nearly two decades. Governments are supposed to spend most of the windfall combating addiction. Officials who negotiated the settlements even outlined suggested uses and established other guardrails to avoid a repeat of the Tobacco Master Settlement Agreement of the 1990s, from which paltry amounts went to anti-smoking programs.

But there’s still significant flexibility with these dollars, and what constitutes a good use to one person can be deemed waste by another.

In Irvington, township officials said they used the money appropriately because the concerts reduced stigma around addiction and connected people to treatment. But acting state Comptroller Kevin Walsh called the concerts a “waste” and “misuse” of the settlements, which resulted from the overdose deaths of hundreds of thousands of Americans.

Similar disputes are intensifying nationwide as officials begin spending settlement money in earnest — all while grappling with slashed federal grants and looming cuts to Medicaid, the state-federal public insurance program that is the largest payer for addiction treatment.

To shed light on these discussions, KFF Health News and researchers at the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a national nonprofit focused on addiction, conducted a yearlong effort to document settlement spending in 2024. The team filed public records requests, scoured government websites, and extracted expenditures, which were then sorted into categories such as treatment or prevention.

The result is a database of more than 10,500 ways settlement cash was used (or not) last year — the most comprehensive national resource of its kind. Some highlights include:

• States and localities spent or committed nearly $2.7 billion in 2024, according to public records. The bulk went to investments addiction experts consider crucial, including about $615 million to treatment, $279 million to overdose reversal medications and related training, and $227 million to housing-related programs for people with substance use disorders.
• Smaller, though notable, amounts funded law enforcement gear, such as night vision equipment, and prevention efforts that experts called questionable, such as hiring a drug awareness magician.
• Some jurisdictions paid for basic government services, such as firefighter salaries.
• The money is controlled by different entities in each state, and about 20% of it is untrackable through public records.

This year’s database, including expenditures and untrackable percentages, should not be compared with the one KFF Health News and its partners compiled last year, due to methodology changes and state budget quirks. The database cannot present a full picture because some jurisdictions don’t publish reports or delineate spending by year. What’s shown is a snapshot of 2024 and does not account for decisions in 2025.

Still, the database helps counteract a tendency toward secrecy among some of those in charge of settlement money and confusion among people trying to track it.

More than $237 million — about 9% of all trackable spending in 2024 — went to efforts broadly aimed at preventing addiction, according to public records. These ranged from putting on community awareness events, like the concerts in Irvington, to hiring mental health counselors in schools.

Many of the examples raised red flags for researchers, including:

• Suffield, Connecticut, held a 1950s-style sock hop, at which kids and seniors wore poodle skirts, posed with inflatable guitars, and pledged to remain drug-free.
• Vernon, Connecticut, hosted a mixed martial arts demonstration, at which a fighter spoke about his experience with addiction.
• Hardy County, West Virginia, spent $60,000 to repair a school track.

“There is no evidence” to back those efforts, said Linda Richter, who leads prevention-oriented research at the nonprofit Partnership to End Addiction.

Elected officials like the events because “you can announce to the community that you did something,” she said. But unless they’re part of larger initiatives that incorporate other approaches, such as screening students for mental health concerns or supporting parents struggling with addiction, they’re unlikely to have lasting impact.

And when settlement funds pay for those one-offs, there’s less left for strategies “that we do know work,” Richter added.

School assembly speakers were also popular, with three Connecticut towns spending more than $30,000 total for former Boston Celtic Chris Herren to share his addiction story with students.

“You get 1,200 kids in the gym and you can hear a pin drop when he talks,” said Joe Kobza, superintendent of schools in Monroe. He described Herren’s talks to students and parents as “pretty impactful.”

But emotional impact isn’t necessarily effective, Richter said. Speakers often talk about drugs messing up their lives even though they’ve become wealthy celebrities. “The messages are so mixed,” she said.

Many local officials admitted their spending decisions weren’t evidence-based. But they meant well, they said. And they received little to no guidance on how to use the money.

Kelly Giannuzzi, Suffield’s former director of youth services, who organized the sock hop, said the goal was to raise awareness and combat loneliness.

Hardy County Commissioner Steven Schetrom said spending money on track repairs made sense, since he’d seen the positive impact the sport had on his son’s life. He wanted other kids to have the same opportunity.

David Owens, a spokesperson for Vernon, said the town’s mixed martial arts event was the kickoff to an ongoing campaign, meant to show people that athletics can help them build connections and avoid drugs. The event brought out young men, who are often difficult to reach, he said.

But the town has no way of knowing if the event had lasting traction.

In New Jersey, acting Comptroller Walsh released a report this summer calling on Irvington township officials to repay the settlement money spent on the concerts.

“If they’re going to hold big parties, that’s up to them and the taxpayers,” Walsh told KFF Health News. “But they can’t use opioid money for that.”

He also suggested the concerts were political rallies for the mayor, Tony Vauss.

Irvington officials strongly objected to the report and unsuccessfully sued Walsh to try to block its release. Vauss told KFF Health News it was “misleading and flat-out wrong.”

Vauss said the township distributed overdose reversal medications at the concerts and spread messages about seeking help. At least four people sought treatment on-site, the township said in its lawsuit.

“We felt as though we did everything correctly,” Vauss said.

However, some of the research Irvington cited in the lawsuit to support its case appeared irrelevant, such as a study in rural Ghana and a graduate thesis.

Irvington officials did not respond to questions about those citations.

As this dispute — and others like it nationwide — continue, people affected by the crisis say it’s crucial to remember the moral weight of these settlements.

It’s “blood money,” said Stephen Loyd, an addiction medicine doctor who was once addicted to opioids and has served as an expert in several opioid lawsuits.

He’s seen many family members lose parents, children, and siblings.

“I don’t know how I would look a family in the face” if this money isn’t used to prevent more losses, he said.

Read the methodology behind this project.

KFF Health News’ Henry Larweh; Shatterproof’s Kristen Pendergrass and Lillian Williams; and the Johns Hopkins Bloomberg School of Public Health’s Abigail Winiker, Samantha Harris, Isha Desai, Katibeth Blalock, Erin Wang, Olivia Allran, Connor Gunn, Justin Xu, Ruhao Pang, Jirka Taylor, and Valerie Ganetsky contributed to the database featured in this article.

The Johns Hopkins Bloomberg School of Public Health has taken a leading role in providing guidance to state and local governments on the use of opioid settlement funds. Faculty from the school collaborated with other experts in the field to create principles for using the money, which have been endorsed by over 60 organizations.

Shatterproof is a national nonprofit that addresses substance use disorder through distinct initiatives, including advocating for state and federal policies, ending addiction stigma, and educating communities about the treatment system.

Shatterproof is partnering with some states on projects funded by opioid settlements. KFF Health News, the Johns Hopkins Bloomberg School of Public Health, and the Shatterproof team that worked on this report are not involved in those efforts.

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.

USE OUR CONTENT

This story can be republished for free (details).

The Trump administration has ordered states to investigate certain individuals enrolled in Medicaid to determine whether they are ineligible because of their immigration status, with five states reporting they’ve together received more than 170,000 names — an “unprecedented” step by the federal government that ensnares the state-federal health program in the president’s immigration crackdown.

Advocates say the push burdens states with duplicative verification checks and could lead people to lose coverage just for missing paperwork deadlines. But the administrator of the Centers for Medicare & Medicaid Services, Mehmet Oz, said in a post on the social platform X on Oct. 31 that more than $1 billion “of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants” in five states and Washington, D.C.

Medicaid’s overall spending topped $900 billion in fiscal year 2024.

It wasn’t clear from Oz’s statement or an accompanying video over what period the spending happened, and CMS spokespeople did not immediately respond to questions, either for an earlier version of this article or after Oz’s statement was posted.

Only U.S. citizens and some lawfully present immigrants are eligible for Medicaid, which covers low-income and disabled people, and the closely related Children’s Health Insurance Program. Those without legal status are ineligible for federally funded health coverage, including Medicaid, Medicare, and plans through the Affordable Care Act marketplaces.

At least one state said it disagreed with Oz’s comments.

“Our payments for coverage of undocumented individuals are in accordance with state and federal laws,” said Marc Williams, a spokesperson for Colorado’s Department of Health Care Policy & Financing, which administers the state’s Medicaid program. “The $1.5 million number referenced by federal leaders today is based on an incorrect preliminary finding, and has been refuted with supporting data by our Department experts.”

He added: “It is disappointing that the administration is announcing this number as final when it is clearly overstated and the conversations are very much in the education and discussion phase.”

In August, CMS began sending states the names of people enrolled in Medicaid that the agency suspected might not be eligible, demanding state Medicaid agencies check their immigration status.

KFF Health News in October reached out to Medicaid agencies in 10 states. Five provided the approximate number of names they had received from the Trump administration, with expectations of more to come: Colorado had been given about 45,000 names, Ohio 61,000, Pennsylvania 34,000, Texas 28,000, and Utah 8,000. More than 70 million people are enrolled in Medicaid.

Most of those states declined to comment further. Medicaid agencies in California, Florida, Georgia, New York, and South Carolina refused to say how many names they were ordered to review or did not respond.

Oz said in his X post that California had misspent $1.3 billion on care for people not eligible for Medicaid, while Illinois spent $30 million, Oregon $5.4 million, Washington state $2.4 million, Washington, D.C., $2.1 million, and Colorado $1.5 million.

“We notified the states, and many have begun refunding the money,” he said. “But what if we had never asked?”

Washington, D.C.’s Medicaid director, Melisa Byrd, said CMS had identified administrative expenses for the district program that covers people regardless of immigration status that should not have been billed to the federal government and her agency has already fixed some of those areas. “We run a big program that is very complex and when mistakes or errors happen, we fix them,” she said.

The program plans to pay $654,014 back to CMS by mid-November.

All five states, plus Washington, D.C., are led by Democrats, and President Donald Trump didn’t win any of them in the 2024 election.

In recent days, Deputy Health and Human Services Secretary Jim O’Neill began posting pictures on X of people he said are convicted criminals living in the U.S. without authorization who had received Medicaid benefits.

O’Neill could not be reached for comment.

“We are very concerned because this seems, frankly, to be a waste of state resources and furthers the administration’s anti-immigrant agenda,” said Ben D’Avanzo, senior health advocacy strategist with the National Immigration Law Center, an advocacy group. “This duplicates what states already do,” he said.

As part of the administration’s crackdown on people in the U.S. without authorization, President Donald Trump in February directed federal agencies to take action to ensure they are not obtaining benefits in violation of federal law.

In June, advisers to Health and Human Services Secretary Robert F. Kennedy Jr. ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security, drawing a lawsuit by some states alarmed that the administration would use the information for its deportation campaign against unauthorized residents.

In August, a federal judge ordered HHS to stop sharing the information with immigration authorities.

State Medicaid agencies use databases maintained by the Social Security Administration and Department of Homeland Security to verify enrollees’ immigration status.

If states need to go back to individuals to reverify their citizenship or immigration status, it could lead some to fall off the rolls unnecessarily — for example, if they don’t see a letter requesting paperwork or fail to meet a deadline to respond.

“I am not sure that evidence suggests there really is a need for this” extra verification, said Marian Jarlenski, a health policy professor at the University of Pittsburgh School of Public Health.

Oz made clear that the Trump administration disagrees.

“Whether willful or not, the states’ conduct highlights a terrifying reality: American taxpayers have been footing the bill for illegal immigrants’ Medicaid coverage, despite many Democrats and the media insisting otherwise,” Oz said in his X post.

In an August press release, CMS said it would ask states to verify eligibility for enrollees whose immigration status could not be confirmed via federal databases. “We expect states to take quick action and will monitor progress on a monthly basis,” the agency said.

Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, called the CMS order to states “unprecedented” in the Medicaid program’s 60-year history.

He said the federal government may have been unable to verify certain individuals’ immigration status because names were misspelled or outdated, such as when a beneficiary is identified by their maiden instead of married name. The names may also include people helped by Emergency Medicaid, a program that covers the cost of hospital emergency services, including labor and delivery, for people regardless of immigration status.

“CMS is conducting pointless immigration status reviews for people whose hospital bills were paid by Emergency Medicaid,” Cuello said.

Oz noted in his post that federal law “does permit states to use Medicaid dollars for emergency treatment, regardless of patients’ citizenship or immigration status,” and that states can “legally build Medicaid programs for illegal immigrants using their own state tax dollars, so long as no federal tax dollars are used.”

The states Oz mentioned all run their own such programs.

The verification checks create an added burden for state Medicaid agencies that are already busy preparing to implement the tax and policy law Trump signed in July. The measure, which Republicans call the One Big Beautiful Bill Act, makes many changes to Medicaid, including adding a work requirement in most states starting by 2027. The law also requires most states to more frequently check the eligibility of many adult Medicaid enrollees — at least twice a year.

“I fear states may do unnecessary checks that create a burden for some enrollees who will lose health coverage who should not,” Cuello said. “It’s going to be a whole lot of work for CMS and states for very little pay dirt.”

Cuello said the effort may have “greater political value than actual value.”

Brandon Cwalina, a spokesperson for the Pennsylvania Department of Human Services, which runs Medicaid in the state, said the state already requires every Medicaid applicant to verify their citizenship or, where applicable, their eligible immigration status.

However, he said, the directive issued by CMS “constitutes a new process, and DHS is carefully reviewing the list in order to take appropriate actions.”

Oz did not name Pennsylvania, which Trump won in 2024, in his post.

If a lawful resident does not have a Social Security number, the state confirms their legal status by checking a database from Homeland Security, as well as verifying specific immigration documents, he said.

Other state Medicaid agencies said they also needed to regroup before reaching out to enrollees.

“Our teams just received this notice and are working through a process by which we will perform these reviews,” Jennifer Strohecker, then Utah’s Medicaid director, told a state advisory board in August.

Renuka Rayasam and Rae Ellen Bichell contributed reporting.

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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KFF Health News Washington health policy reporter Amanda Seitz discussed Affordable Care Act open enrollment uncertainty on Houston Public Media’s “Hello Houston” on Oct. 30.

• Click here to watch Seitz on “Hello Houston.”
• Read Seitz and Julie Appleby’s “A Ticking Clock: How States Are Preparing for a Last-Minute Obamacare Deal.”

KFF Health News senior correspondent Phil Galewitz discussed the federal government shutdown on FOX 5’s “On The Hill” on Oct. 26.

• Click here to watch Galewitz on “On The Hill.”

KFF Health News contributor Patricia Kime discussed potential cancer clusters on nuclear missile bases on NBC Montana on Oct. 22.

• Click here to watch Kime on NBC Montana.
• Read Kime’s “Nuclear Missile Workers Are Contracting Cancer. They Blame the Bases.”

KFF Health News senior contributing editor Elisabeth Rosenthal discussed why the U.S. health care system is so complicated and what you need to know about ACA open enrollment on CNN’s “Chasing Life with Dr. Sanjay Gupta” on Oct. 17 and Oct. 21, respectively.

• Listen to Rosenthal discuss the U.S. health care system on “Chasing Life with Dr. Sanjay Gupta.”
• Listen to Rosenthal discuss ACA open enrollment on “Chasing Life with Dr. Sanjay Gupta.”

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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This story can be republished for free (details).

The Trump administration’s overhaul of the nation’s largest food assistance program will cause millions of people to lose benefits, strain state budgets, and pressure the nation’s food supply chain, all while likely hindering the goals of the administration’s “Make America Healthy Again” platform, according to researchers and former federal officials.

Permanent changes to the Supplemental Nutrition Assistance Program are coming regardless of the outcome of at least two federal lawsuits that seek to prevent the government from cutting off November SNAP benefits. The lawsuits challenge the Trump administration’s refusal to release emergency funds to keep the program operating during the government shutdown.

A federal judge in Rhode Island ordered the government to use those funds to keep SNAP going. A Massachusetts judge in a separate lawsuit also said the government must use its food aid contingency funds to pay for SNAP, but gave the Trump administration until Nov. 3 to come up with a plan.

Amid that uncertainty, food banks across the U.S. braced for a surge in demand, with the possibility that millions of people will be cut off from the food program that helps them buy groceries.

On Oct. 28, a vanload of SpaghettiOs, tuna, and other groceries arrived at Gateway Food Pantry in Arnold, Missouri. It may be Gateway’s last shipment for a while. The food pantry south of St. Louis largely serves families with school-age children, but it has already exhausted its yearly food budget because of the surge in demand, said Executive Director Patrick McKelvey.

New Disabled South, a Georgia-based nonprofit that advocates for people with disabilities, announced that it was offering one-time payments of $100 to $250 to individuals and families who were expected to lose SNAP benefits in the 14 states it serves.

Less than 48 hours later, the nonprofit had received more than 16,000 requests totaling $3.6 million, largely from families, far more than the organization had funding for.

“It’s unreal,” co-founder Dom Kelly said.

The threat of a SNAP funding lapse is a preview of what’s to come when changes to the program that were included in the One Big Beautiful Bill Act that President Donald Trump signed in July take effect.

The domestic tax-and-spending law cuts $187 billion within the next decade from SNAP. That’s a nearly 20% decrease from current funding levels, according to the Congressional Budget Office.

The new rules shift many food and administrative costs to states, which may lead some to consider withdrawing from the program, which helped about 42 million people buy groceries last year. Separate from the new law, the administration is also pushing states to limit SNAP purchases by barring such things as candy and soda.

All that “puts us in uncharted territory for SNAP,” said Cindy Long, a former deputy undersecretary at the Department of Agriculture who is now a national adviser at the law firm Manatt, Phelps & Phillips.

The country’s first food stamps were issued at the end of the Great Depression, when the poverty-stricken population couldn’t afford farmers’ products. Today, instead of stamps, recipients use debit cards. But the program still buoys farmers and food retailers and prevents hunger during economic downturns.

The CBO estimates that about 3 million people will lose food assistance as a result of several provisions in the budget law, including applying work requirements to more people and shifting more costs to states. Trump administration leaders have backed the changes as a way to limit waste, to put more people to work, and to improve health.

This is the biggest cut to SNAP in its history, and it is coming against the backdrop of rising food prices and a fragile labor market.

The exact toll of the cuts will be difficult to measure, because the Trump administration ended an annual report that measures food insecurity.

Here are five big changes that are coming to SNAP and what they mean for Americans’ health:

1. Want food benefits? They will be harder to get.

Under the new law, people will have to file more paperwork to access SNAP benefits.

Many recipients are already required to work, volunteer, or participate in other eligible activities for 80 hours a month to get money on their benefit cards. The new law extends those requirements to previously exempted groups, including homeless people, veterans, and young people who were in foster care when they turned 18. The expanded work requirements also apply to parents with children 14 or older and adults ages 55 to 64.

Starting Nov. 1, if recipients fail to document each month that they meet the requirements, they will be limited to three months of SNAP benefits in a three-year period.

“That is draconian,” said Elaine Waxman, a senior fellow at the Urban Institute, a nonprofit research group. About 1 in 8 adults reported having lost SNAP benefits because they had problems filing their paperwork, according to a December Urban Institute survey.

Certain refugees, asylum-seekers, and other lawful immigrants are cut out of SNAP entirely under the new law.

2. States will have to chip in more money and resources.

The federal law drastically increases what each state will have to pay to keep the program.

Until now, states have needed to pay for only half the administrative costs and none of the food costs, with the rest covered by the federal government.

Under the new law, states are on the hook for 75% of the administrative costs and must cover a portion of the food costs. That amounts to an estimated median cost increase for states of more than 200%, according to a report by the Georgetown Center on Poverty and Inequality.

A KFF Health News analysis shows that a single funding shift related to the cost of food could put states on the hook for an additional $11 billion.

All states participate in the SNAP program, but they could opt out. In June, nearly two dozen Democratic governors wrote to congressional leaders warning that some states wouldn’t be able to come up with the money to continue the program.

“If states are forced to end their SNAP programs, hunger and poverty will increase, children and adults will get sicker, grocery stores in rural areas will struggle to stay open, people in agriculture and the food industry will lose jobs, and state and local economies will suffer,” the governors wrote.

3. Will the changes lead to more healthy eating?

The Trump administration, through its “Make America Healthy Again” platform, has made healthy eating a priority.

Health and Human Services Secretary Robert F. Kennedy Jr. has championed the restrictions on soda and candy purchases within the food aid program. To date, 12 states have received approval to limit what people can buy with SNAP dollars.

Federal officials previously blocked such restrictions, because they were difficult for states and stores to implement and they boost stigma around SNAP, according to a 2007 USDA report. In 2018, the first Trump administration rejected an effort from Maine to ban sugar-sweetened drinks and candy.

A store may decide that hassle isn’t worth participating in the program and drop out of it, leaving SNAP recipients fewer places to shop.

People who receive SNAP are no more likely to buy sweets or salty snacks than people who shop without the benefits, according to the USDA. Research shows that encouraging healthy food choices is more effective than regulating purchases.

When people have less money to spend on food, they often resort to cheaper, unhealthier alternatives that keep them sated longer rather than paying for more expensive food that is healthy and fresh but quick to perish.

4. How will SNAP cuts affect health?

Advocacy organizations working to end hunger in the nation say the cuts will have long-term health effects.

Research has found that kids in households with limited access to food are more likely to have a mental disorder. Similarly, food insecurity is linked to lower math and reading skills.

Working-age people with food insecurity are more likely to experience chronic disease. That long list includes high blood pressure, arthritis, diabetes, asthma, and chronic obstructive pulmonary disease.

Those health issues come with costs for individuals. Low-income adults who aren’t on SNAP spend on average $1,400 more a year on health care than those who are.

About 47 million people lived in households with limited or uncertain access to food in 2023.

5. What does this mean for the nation’s food supply chain?

SNAP spending directly boosts grocery stores, their suppliers, and the transportation and farming industries. Additionally, when low-income households have help accessing food, they’re more likely to spend money on other needs, such as prescriptions or car repairs. All that means that every dollar spent through SNAP generates at least $1.50 in economic activity, according to the USDA.

A report by associations representing convenience stores, grocers, and the food industry estimated it could cost grocers $1.6 billion to comply with the new SNAP restrictions.

Advocates warn stores may pass the costs on to shoppers, or they may close.

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Saturday is the day that nearly 24 million customers can start purchasing health plans on healthcare.gov and the state-run Obamacare exchanges. 

Higher prices and uncertainty await many of those shoppers. 

Average premiums are expected to more than double. The directors who manage marketplace enrollment in states including Maryland, California, Pennsylvania, and Idaho told me and my colleague Julie Appleby that people are wondering how they’ll scrape together hundreds — or even thousands — of dollars more next year to pay for these plans. Some people are considering plans with five-figure deductibles, like one Virginia Beach, Virginia, family facing a $20,000 deductible to keep their monthly premiums near $70. 

“They might look cheap premium-wise, but the coverage itself is going to end up costing that family a lot,” Deepak Madala, the director of Enroll Virginia, told me this month. 

Even as Americans weigh high-priced plans, there’s the very real possibility that everything could change if Congress strikes a last-minute deal to extend the subsidies before the end of open enrollment, which runs through Jan. 15 in most states. 

Behind the scenes, the directors of state-based exchanges are drawing up contingency plans. 

In Idaho, the state exchange director says he has “notices ready to go” should Congress work something out. California and Maryland are preparing to temporarily close open enrollment if lawmakers agree to extend the subsidies. 

On Capitol Hill, insurers are warning lawmakers that time is running out. 

“If things go past the first week of December, it does get much more operationally complicated,” Kris Haltmeyer, the vice president for legislative and regulatory policy at the Blue Cross Blue Shield Association, told me. 

Still, a month into the government shutdown, Congress appears no closer to a deal to extend the extra subsidies that have made marketplace health insurance more affordable since 2021, when Democrats first approved a law that provided significant assistance to pay premiums. 

Republican and Democratic leaders have expressed a desire to find a solution before those subsidies lapse at year’s end. 

But, as is typical with Congress, each party has different ideas about what a deal might look like. And lawmakers haven’t agreed even on how to take a first step. Democrats have demanded an agreement on the ACA subsidies before they will vote to fund the federal government. Republicans, meanwhile, have balked, saying they’ll negotiate only after the government is reopened. 

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The FDA announced actions to restrict the sale of unapproved ingestible fluoride prescription drug products for children.

VENICE, Fla. — MAGA and MAHA are happily married in Florida, and nowhere more at home than in Sarasota County, where on a humid October night a crowd of several hundred gathered to honor state Surgeon General Joseph Ladapo, his wife, and an unlicensed Canadian radiologist who treats cancer with horse paste.

The event, titled “The 3 Big C’s: Courage, Censorship & Cancer,” was sponsored by the We the People Health and Wellness Center, a clinic, funded by a Jan. 6 marcher, where patients can bask in red light, sit in ozone-infused steam baths, or get their children treated for autism with an experimental blood concentrate.

In Venice, in Sarasota County, a “medical freedom” movement forged in opposition to covid lockdowns blends wellness advocates, vaccine-haters, right-wing Republicans, and angry parents in a stew of anti-government absolutism and mystical belief.

Ladapo’s wife, Brianna, a self-proclaimed “spiritual healer” who says she speaks with angels and has prophetic visions, chaired a panel at the event at the Venice Community Center. The keynote speech was by William Makis, a litigious covid conspiracist who, after losing his medical license in 2019, has made a living treating cancer patients with antiparasitic drugs including ivermectin, which was also championed in some circles as a covid treatment during the pandemic.

Clinical trials showed that ivermectin didn’t work, but covid skeptics viewed medicine’s rejection of it as part of a conspiracy by Big Pharma against a cheap, off-patent drug. Some of the patients in his care have what he calls “turbo cancers,” Makis says, blaming alleged impurities in mRNA vaccines that he says have killed millions of people.

For Makis, it’s all one big conspiracy — the virus, the vaccine, and the suppression of his therapies.

Brianna Ladapo has her own take on medicine, based on the idea of good and bad spiritual energy. She wrote in a memoir that as the pandemic began she intuited that it had been planned by “sinister forces” to “frighten the masses to surrender their sovereignty to a small group of tyrannical elites.” She has written that the government hides vaccination’s risks.

She sees “dark forces” all over the place, including, she said in a podcast interview earlier this year, in “chemtrails” shaped like a pentagram. “They’ve been plastering it in the sky right outside our house for the last few weeks,” Ladapo said. The chemtrails “they are dumping on us,” she said, had sickened her and her three sons. “The dark side are no fans of ours.”

(“Chemtrails” are a favorite topic of conspiracy theorists who say they think that contrails, the condensation formed around commercial airplane exhaust, contain toxic substances poisoning people and the terrain. Although there is zero evidence of that, Health and Human Services Secretary Robert F. Kennedy Jr. plans to look into whether they are part of a clandestine effort to use toxic chemicals to change the weather.)

Ladapo’s husband hasn’t publicly endorsed all her beliefs, but as surgeon general he’s reversing decades of accepted public health practice in Florida and embracing untested therapies. “We’re done with fear,” Joseph Ladapo said after being named surgeon general in 2021. He wants to ban mRNA vaccines in Florida, and on Sept. 3 he announced plans to end childhood vaccination mandates in the state.

A few days after the Venice event, Ladapo said he hoped to support Makis’ work — though his treatments are unproven and potentially dangerous — through a new $60 million cancer research fund created by Florida Gov. Ron DeSantis and his wife, Casey.

Vic Mellor, CEO of a local concrete business, founded and owns We the People. He’s an associate of retired Army Lt. Gen. Michael Flynn, who was briefly President Donald Trump’s national security adviser in 2017 before being dismissed for lying to the FBI about his contacts with Russians. Trump later pardoned him, and Flynn since has become a leader of the Christian nationalist movement.

We the People provides vitamin shots but no vaccines. In fact, many of its offerings are treatments for supposed vaccine injuries. Part of the We the People building is a broadcasting studio, where conservatives hold forth on what they see as the villainy of liberals and the American Academy of Pediatrics.

Mellor was at the U.S. Capitol during the riot on Jan. 6, 2021 — he said he “just knocked on front doors,” according to a Facebook post described by The Washington Post. He returned home and started building a 10-acre complex that hosts weddings and right-wing assemblies, with playgrounds, a butterfly garden, a zip line over a pond visited by alligators, and an attached, separately owned gun range.

Visitors who travel down a dirt road to The Hollow — named for the hollow-core concrete that made Mellor wealthy — can enter the compound through a dark, cavernous passage lined with neon signs illuminating maxims from the likes of Thomas Jefferson, Thomas Paine, and Flynn.

The Hollow has hosted clinics for unvaccinated kids and events for Ladapo, anti-vaccine activist Sherri Tenpenny (who in 2021 told legislators at an Ohio House hearing that covid vaccine made people magnetic), and other “medical freedom” advocates. Mellor created a medical home for such ideas by opening We the People in 2023.

The year before, three “medical freedom” candidates had won seats on the board overseeing Sarasota’s public hospital and health care system, after protests over the hospital’s refusal to treat covid patients with ivermectin and other drugs of choice for covid contrarians.

On a recent afternoon at The Hollow, manager Dan Welch was clearing brush when approached by KFF Health News. As a foe of vaccinations, he welcomed Ladapo’s move to end vaccine mandates. “Maybe in their inception, vaccines were created to prevent what they were supposed to prevent,” Welch said. “But now there’s so much more in there, the metals, aluminum, mercury. Since they started vaccination, the autism rate went through the roof, and I believe these vaccines are part of it.”

The theory that vaccines cause autism has been debunked, and manufacturers removed mercury from childhood vaccines 24 years ago, although Welch said he doesn’t believe it.

Vaccination faces additional challenges in a century-old Sarasota County neighborhood of low-slung bungalows called Pinecraft, home to about 3,000 Mennonites — and double that number when Amish snowbirds arrive in the winter. Pastor Timothy Miller said that while Sarasota’s Mennonites are less culturally isolated than the Mennonite community in West Texas, site of a measles outbreak in January, many in his community also shun vaccination.

His cousin Kristi Miller, 26, won’t vaccinate her 9-month-old daughter or any of the other children she hopes to have, she said, because she thinks vaccines probably cause autism and other harms.

As for vaccine-preventable diseases like measles, she doesn’t worry about them. Like the Ladapos, “I don’t live in fear,” she said. “I have a God who’s bigger than everything.”

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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For more than a year, Diane Hunter, now 72, had been experiencing vague symptoms — pain in her spine and hips, nausea, exhaustion, thirst, and frequent urination. Her primary care physician had ruled out diabetes before finally chalking up her ailments to getting older.

But months of intense back pain eventually landed her in the emergency room, where a doctor suggested that Hunter might have multiple myeloma. Hunter’s first question was, “What is that?”

Multiple myeloma is a cancer that develops in bone marrow plasma cells, crowding out healthy blood cells and damaging the bones. It is one of the most common blood cancers — and the most diagnosed among African Americans. The mortality rate from multiple myeloma also is higher among African American patients than white people, with a number of studies showing that, in addition to disease biology, societal factors such as socioeconomic status and lack of access to health insurance or medical services delay timely diagnoses.

A belated diagnosis is what happened to Hunter, a Black woman in Montgomery, Alabama. She said her primary care doctor dismissed a recommendation from her endocrinologist to refer her to a hematologist after finding high protein counts in her blood. Then, she said, he also refused to order a bone marrow biopsy after the ER doctor suggested she might have multiple myeloma. Fed up, she said, she found a new doctor, got tested, and learned she indeed had the disease.

Monique Hartley-Brown, a multiple myeloma researcher at the Dana-Farber Cancer Institute in Boston, said Hunter’s experience is fairly common, particularly among Black patients who live in underserved communities.

“On average, patients see their primary doctor three times before being accurately diagnosed,” Hartley-Brown said. “The delay from symptom onset to diagnosis is even longer for Black Americans. Meanwhile, the disease is wreaking havoc — causing fractures, severe anemia, fatigue, weight loss, kidney problems.”

Black and Hispanic patients are also less likely to receive the newest therapies, according to the Multiple Myeloma Research Foundation, and, when they do, they are more likely to do so later in the course of their disease than white patients. An analysis published in 2022 of racial and ethnic disparities in multiple myeloma drug approval trials submitted to the FDA concluded that Black patients made up only 4% of participants despite being roughly 20% of those living with the disease.

Now, even though significant progress has been made in understanding the biology of multiple myeloma and how to treat it, those racial gaps may grow larger amid federal cuts to cancer research and the backlash against diversity and inclusion efforts. While few multiple myeloma experts were willing to talk on the record about the impact of the funding cutbacks, Michael Andreini, president and CEO of the Multiple Myeloma Research Foundation, has written that cuts to the National Institutes of Health and its National Cancer Institute put future innovations at risk.

“Even before these potential cuts, funding for myeloma lagged behind,” he wrote before the cuts were finalized. “The myeloma specific budget has decreased significantly. Myeloma is almost 2% of all cancers, yet receives less than 1% of the NCI’s budget.”

The disease is already hard to diagnose. Because multiple myeloma is usually diagnosed when a patient is over 65 (African Americans tend to be diagnosed five years younger, on average), common symptoms such as lower back pain and fatigue are often chalked up to just getting older.

That’s what happened to Jim Washington of Charlotte, North Carolina. He was 61 when excruciating hip pain brought his regular tennis games to a sudden stop.

“I figured I’d done something to injure myself,” Washington said. “But I’d been playing tennis all my life, and this pain was different from anything I’d ever felt before.”

Washington was fortunate to have a concierge doctor and premium health insurance. In quick succession, he underwent X-rays that revealed a lesion on his spine and received a referral to an oncologist, who identified a cancerous tumor. A subsequent biopsy and blood tests confirmed he had multiple myeloma.

Washington had weeks of high-dose chemotherapy, followed by what is known as an autologous stem cell transplant, which used his own stem cells to regrow healthy blood cells in his body. It was a grueling process that ultimately left him with a clean bill of health. For the next several years, his doctors monitored him closely, including conducting an annual bone marrow biopsy.

Before treatment, he said, myeloma had infiltrated 60% of his blood cells. The stem cell transplant brought those levels down to zero. After about five years, however, his multiple myeloma level had crept back up to 10% and required more treatment.

But Washington had closely followed the latest research and believed he had reason to be optimistic. The FDA had approved the first CAR T-cell therapy for multiple myeloma in 2021.

Hartley-Brown said the lack of Black patients in multiple myeloma drug approval trials raises concerns about whether the trial results are equally applicable to the Black population and may help explain why treatment advances have been less effective in Black patients.

She cited multiple causes for the low trial participation rate, including historical distrust of the medical establishment and a lack of available clinical trials. “If you are living in an underserved or underrepresented area, the hospital or community doctor may not have clinical trials available, or that patient may have limitations getting to that location affiliated with the clinical trial,” she said.

Washington, a Black patient, appears to have avoided this trap, having benefited from the latest treatments both times. In January, he began six weeks of chemotherapy with a three-drug combination of Velcade, Darzalex, and dexamethasone before undergoing CAR T-cell therapy.

For that, doctors collected Washington’s T cells, a type of white blood cell, and genetically modified them to better recognize and destroy the cancer cells before reinfusing them into his body. He didn’t require hospitalization post-transplant and could do daily blood draws at home. His energy levels were much higher than during his first treatment.

“I’ve been in a very privileged position,” Washington said. “The prognosis is very positive, and I’m feeling good about where I am at this point.”

Hunter, too, considers herself lucky despite receiving a delayed diagnosis. After her diagnosis in January 2017, she underwent five months of immunotherapy with a three-drug combination (Revlimid, Velcade, and dexamethasone) followed by a successful stem cell transplant and two weeks in the hospital. She has been in remission since July 2017.

Hunter, now a support group co-leader and patient advocate, said that stories like Washington’s and her own provide hope despite the research cuts.

In the eight years since her treatment, she said, she’s seen the thinking around multiple myeloma — long described as a treatable but incurable disease — begin to shift as a growing subset of patients remain disease-free for many years. She said she has even met people living with the disease for 30 years.

“The word ‘cure’ is now being heard,” Hunter said.

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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The Host Julie Rovner KFF Health News @jrovner @julierovner.bsky.social Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Open enrollment for 2026 Affordable Care Act insurance plans starts in most states Nov. 1, with no resolution in Congress about whether to continue more generous premium tax credits expanded under President Joe Biden or let them expire at the end of this year. It is unclear whether the backlash from millions of enrollees seeing skyrocketing premiums will move Democrats or Republicans to back away from entrenched positions that are keeping most of the federal government shut down.

Meanwhile, the Trump administration — having done away earlier this year with a Biden-era regulation that prevented medical debt from being included on consumers’ credit reports — is now telling states they cannot pass their own laws to bar the practice.

This week’s panelists are Julie Rovner of KFF Health News, Paige Winfield Cunningham of The Washington Post, Maya Goldman of Axios, and Alice Miranda Ollstein of Politico.

Panelists Paige Winfield Cunningham The Washington Post @pw_cunningham Read Paige's stories. Maya Goldman Axios @mayagoldman_ @maya-goldman.bsky.social Read Maya's stories Alice Miranda Ollstein Politico @AliceOllstein @alicemiranda.bsky.social Read Alice's stories.

Among the takeaways from this week’s episode:

• Tens of millions of Americans are bracing to lose government food aid on Nov. 1, after the Trump administration opted not to continue funding the Supplemental Nutrition Assistance Program during the shutdown. President Donald Trump and senior officials have made no secret of efforts to penalize government programs they see as Democratic priorities, to exert political pressure as the stalemate continues on Capitol Hill.
• People beginning to shop for next year’s plans on the ACA marketplaces are experiencing sticker shock due to the expiration of more generous premium tax credits that were expanded during the covid pandemic. The federal government will also take a particular hit as it covers growing costs for lower-income customers who will continue to receive assistance regardless of a deal in Congress.
• In state news, after killing a Biden-era rule to block medical debt from credit reports, the Trump administration is working to prevent states from passing their own protections. In Florida, doctors who support vaccine efforts are being muffled, and the state’s surgeon general says he did not model the outcomes of ending childhood vaccination mandates before pursuing the policy — a risky proposition as public health experts caution that recent measles outbreaks are a canary in the coal mine for vaccine-preventable illnesses.
• And in Texas, the state’s attorney general, who is also running for the U.S. Senate as a Republican, is suing the maker of Tylenol, claiming the company tried to dodge liability for the medication’s unproven ties to autism. The lawsuit is the latest problem for Tylenol, with recent allegations undermining confidence in the common painkiller, the only one recommended for pregnant women to reduce potentially dangerous fevers and relieve pain.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: KFF Health News’ “Many Fear Federal Loan Caps Will Deter Aspiring Doctors and Worsen MD Shortage,” by Bernard J. Wolfson.

Alice Miranda Ollstein: ProPublica’s “Citing Trump Order on ‘Biological Truth,’ VA Makes It Harder for Male Veterans With Breast Cancer To Get Coverage,” by Eric Umansky.

Paige Winfield Cunningham: The Washington Post’s “Study Finds mRNA Coronavirus Vaccines Prolonged Life of Cancer Patients,” by Mark Johnson.

Maya Goldman: KFF Health News’ “As Sports Betting Explodes, States Try To Set Limits To Stop Gambling Addiction,” by Karen Brown, New England Public Media.

Also mentioned in this week’s podcast:

• The Washington Post’s “Average Obamacare Premiums Are Set To Rise 30 Percent, Documents Show,” by Paige Winfield Cunningham
• KFF Health News’ “Doctors Muffled as Florida Moves To End Decades of Childhood Vaccination Mandates,” by Arthur Allen.
• CBS News’ “The Quiet Collapse of America’s Reproductive Health Safety Net,” by Céline Gounder.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

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En los últimos meses, agentes federales han acampado en el vestíbulo de un hospital del sur de California, custodiado a pacientes detenidos —algunos de ellos esposados— en habitaciones de hospital y perseguido a un jardinero inmigrante hasta dentro de un centro quirúrgico.

Agentes del Servicio de Inmigración y Control de Aduanas (ICE) también se han presentado en clínicas comunitarias.

Proveedores de salud dicen que intentaron entrar en un estacionamiento donde había una clínica móvil, apuntaron a las caras de médicos que atendían a personas sin hogar y detuvieron a un transeúnte, subiéndolo a un auto sin identificación, frente a un centro comunitario de salud.

En respuesta a estas actividades de control migratorio alrededor de clínicas y hospitales, el gobernador demócrata Gavin Newsom promulgó el mes pasado la ley SB 81, que prohíbe a los centros médicos permitir el acceso de agentes federales a áreas privadas, incluidos los lugares donde los pacientes reciben tratamiento o hablan sobre temas de salud, sin una orden judicial o de registro válidas.

Si bien el proyecto de ley recibió un amplio apoyo de grupos médicos, trabajadores de salud y defensores de los derechos de los inmigrantes, expertos legales afirman que California no puede impedir que las autoridades federales realicen sus funciones en lugares públicos, como vestíbulos y salas de espera de hospitales, estacionamientos de centros de salud y vecindarios aledaños: lugares donde las recientes actividades del ICE han generado indignación y temor.

En enero, la administración Trump revocó las restricciones federales previas sobre la aplicación de las leyes de inmigración en o cerca de áreas sensibles, incluidos los establecimientos de salud.

“El problema que enfrentan los estados es la cláusula de supremacía”, dijo la abogada Sophia Genovese, profesora en la Facultad de Leyes de Georgetown. Explicó que el gobierno federal tiene derecho a realizar actividades de control migratorio y que existen límites a lo que el estado puede hacer para impedirlas.

La ley de California designa el estatus migratorio y el lugar de nacimiento de un paciente como información protegida, la cual, al igual que los expedientes médicos, no puede divulgarse a las autoridades sin una orden judicial.

Además, requiere que los centros de salud establezcan procedimientos claros para gestionar los pedidos de las autoridades de inmigración, incluyendo la capacitación del personal para notificar de inmediato a un administrador designado o a un asesor legal si los agentes intentan entrar a un área privada o revisar los expedientes de los pacientes.

Otros estados gobernados por demócratas han promulgado leyes para proteger a los pacientes en hospitales y centros de salud.

En mayo, el gobernador de Colorado, Jared Polis, promulgó la  Protect Civil Rights Immigration Status, que penaliza a los hospitales por compartir sin autorización información sobre personas que se encuentran en el país de manera irregular y prohíbe a los agentes del ICE ingresar a áreas privadas de los centros de salud sin una orden judicial.

En junio, entró en vigencia en Maryland una ley que exige al fiscal general crear directrices para mantener al ICE fuera de los centros de salud. Nuevo México ha implementado nuevas protecciones para los datos de pacientes, y Rhode Island ha prohibido a los establecimientos de salud preguntar a los pacientes sobre su estatus migratorio.

Los estados gobernados por republicanos se han alineado con los esfuerzos federales para evitar que se gaste en atención médica de inmigrantes sin papeles.

Estos inmigrantes no son elegibles para la cobertura integral de Medicaid, pero los estados sí facturan al gobierno federal por la atención de emergencia en ciertos casos. Bajo una ley que entró en vigencia en 2023, Florida exige que los hospitales que aceptan Medicaid pregunten sobre el estatus migratorio del paciente. En Texas, los hospitales ahora deben informar cuánto gastan en la atención de inmigrantes indocumentados.

“Los texanos no deberían tener que asumir el costo de la atención médica de los inmigrantes ilegales”, declaró el gobernador Greg Abbott al emitir su orden ejecutiva el año pasado.

Los esfuerzos de California por limitar la aplicación de la ley federal se producen en un momento en que el estado, donde más de una cuarta parte de los residentes han nacido en el extranjero, se ha convertido en blanco de la represión migratoria del presidente Donald Trump.

Newsom promulgó la SB 81 como parte de un paquete de leyes que prohíbe a los agentes de inmigración entrar en las escuelas sin una orden judicial, exige que los agentes se identifiquen y prohíbe el uso de máscaras. La SB 81 se aprobó con una votación partidista sin oposición formal.

“No somos Corea del Norte”, expresó Newsom durante una ceremonia de firma de leyes en septiembre. “Estamos rechazando estas tendencias y acciones autoritarias de esta administración”.

Algunos partidarios del proyecto de ley y expertos legales afirmaron que la ley de California puede impedir que el ICE viole los derechos de privacidad de los pacientes ya existentes.

Entre estos derechos se incluye la Cuarta Enmienda, que prohíbe los registros sin orden judicial en lugares donde las personas tienen una expectativa razonable de privacidad. Las órdenes judiciales válidas deben ser emitidas por un tribunal y firmadas por un juez. Sin embargo, con frecuencia los agentes del ICE utilizan órdenes administrativas para intentar acceder a áreas privadas para las que no tienen autoridad, dijo Genovese.

“La gente no siempre entiende la diferencia entre una orden administrativa, que es un simple documento, y una orden judicial, que es ejecutable”, dijo Genovese. Añadió que las órdenes judiciales rara vez se emiten en casos de inmigración.

El Departamento de Seguridad Nacional (DHS) ha dicho que no acatará la prohibición del uso de máscaras ni los requisitos de identificación para los agentes del orden público en California, calificándolos de inconstitucionales. El departamento no respondió a la solicitud de comentarios sobre las nuevas normas estatales para centros de salud, que entraron en vigencia de inmediato.

Tanya Broder, asesora principal del National Immigration Law Center, afirmó que las detenciones de inmigrantes en centros de salud parecen ser relativamente raras. Sin embargo, la decisión federal de revocar las protecciones en torno a áreas sensibles, dijo, “ha generado temor e incertidumbre en todo el país”.

Muchos de los informes periodísticos más destacados sobre agentes de inmigración en centros de salud ocurrieron en California, principalmente en relación con pacientes detenidos que habían sido trasladados a un establecimiento de salud para recibir atención médica.

La California Nurses Association, el sindicato de enfermeras más grande del estado, copatrocinó el proyecto de ley y expresó su preocupación por el trato que recibió Milagro Solis-Portillo, una salvadoreña de 36 años que estuvo bajo vigilancia constante del ICE en el Hospital Glendale Memorial durante el verano.

Los líderes sindicales también condenaron la presencia de agentes en el California Hospital Medical Center, al sur del centro de Los Ángeles. Según Anne Caputo-Pearl, enfermera de parto y representante sindical principal del hospital, los agentes llevaron a una paciente el 21 de octubre y permanecieron en su habitación durante casi una semana. El diario Los Angeles Times informó que a Carlitos Ricardo Parias, creador de contenido de TikTok, lo llevaron al hospital ese mismo día tras resultar herido durante un operativo de control migratorio en el sur de Los Ángeles.

La presencia del ICE intimidó tanto a enfermeras como a pacientes, aseguró Caputo-Pearl, y motivó restricciones de visitas en el hospital. “Queremos una explicación más clara”, dijo. “¿Por qué se permite que estos agentes estén en la habitación?”.

Sin embargo, representantes de hospitales y clínicas dijeron que ya cumplen con los requisitos de la ley, los cuales refuerzan en gran medida las extensas directrices publicadas por el fiscal general del estado, Rob Bonta, en diciembre.

Las clínicas comunitarias a lo largo del condado de Los Ángeles, que atienden a más de dos millones de pacientes al año, incluyendo una gran proporción de inmigrantes, han estado implementando las directrices del fiscal general durante meses, según dijo Louise McCarthy, presidenta y directora ejecutiva de la Asociación de Clínicas Comunitarias del Condado de Los Ángeles.

Agregó que la ley debería ayudar a garantizar estándares unificados en todos los establecimientos de salud a los que las clínicas derivan pacientes y brindarles la tranquilidad de que hay procedimientos para protegerlos.

Aun así, no se puede evitar que se produzcan redadas migratorias en la comunidad, lo que ha provocado que algunos pacientes e incluso trabajadores de salud teman salir a la calle, señaló McCarthy. Se han producido algunos incidentes cerca de clínicas, incluyendo el arresto de un transeúnte frente a una clínica en el este de Los Ángeles, que un guardia de seguridad grabó en video, contó.

“Hemos escuchado a personal de las clínicas preguntar: ‘¿Es seguro para mí salir?'”, dijo.

En St. John’s Community Health, una red de 24 centros de salud comunitarios y cinco clínicas móviles en el sur de Los Ángeles y el Inland Empire, el director ejecutivo Jim Mangia coincidió en que la nueva ley no puede prevenir toda la actividad de control migratorio, pero afirmó que sí les brinda a las clínicas una herramienta para defenderse si se presentan agentes, algo que su personal ya ha tenido que hacer.

Mangia dijo que el personal de St. John’s tuvo dos encuentros con agentes de inmigración durante el verano. En uno de ellos, impidió que agentes armados ingresaran a un estacionamiento con rejas en un centro de rehabilitación de adicciones donde médicos y enfermeras atendían a pacientes en una clínica móvil.

Otro incidente ocurrió en julio, cuando agentes de inmigración llegaron a MacArthur Park a caballo y en vehículos blindados, en una demostración de fuerza por parte del gobierno de Trump.

Mangia dijo que agentes enmascarados con equipo táctico completo rodearon una carpa de atención médica callejera donde el personal de St. John’s atendía a personas sin hogar, les gritaron que se fueran y les apuntaron con un arma. Según Mangia, los proveedores quedaron tan conmocionados por el incidente que tuvieron que recurrir a profesionales de salud mental para ayudarlos a sentirse seguros al regresar de nuevo a la calle.

Un vocero del DHS declaró a CalMatters que, en raras ocasiones, cuando los agentes entran a ciertos lugares sensibles, los oficiales necesitan la aprobación de un supervisor secundario.

Desde entonces, St. John’s ha intensificado sus esfuerzos para brindar apoyo y capacitación al personal y ha ofrecido a los pacientes con miedo a salir la opción de visitas médicas a domicilio y entrega de alimentos. Los temores de los pacientes y la actividad del ICE han disminuido desde el verano, afirmó Mangia, pero con el DHS planeando contratar a 10.000 agentes adicionales, duda que esta situación se mantenga.

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CLARKSTON, Ga. — After fleeing the war-torn Democratic Republic of Congo, Antoinette landed in the Atlanta area last November and began to find her footing with federal help.

Separated from her adult children and grieving her husband’s death in the war, she started a job packing boxes in a warehouse, making just enough to cover rent for her own apartment and bills.

Antoinette has been relying on the Supplemental Nutrition Assistance Program, formerly known as food stamps, for her weekly grocery trips.

But now, just as life is starting to stabilize, she will have to deal with a new setback.

President Donald Trump’s massive budget law, which Republicans call the One Big Beautiful Bill Act, slashes $187 billion — or nearly 20% — from the federal budget for SNAP through 2034. And separate from any temporary SNAP stoppages due to the federal shutdown, the law cuts off access completely for refugees and other immigrant groups in the country lawfully. The change was slated to take effect immediately when the law was signed in July, but states are still awaiting federal guidance on when to stop or phase it out.

For Antoinette, 51, who did not want her last name used for fear of deportation and likely persecution in her native country, the loss of food aid is dire.

“I would not have the means to buy food,” she said in French through a translator. “How am I going to manage?”

Throughout its history, the U.S. has admitted into the country refugees like Antoinette, people who have been persecuted, or fear persecution, in their homelands due to race, religion, nationality, political opinions, or membership in a particular social group. These legal immigrants typically face an in-depth vetting process that can start years before they set foot on U.S. soil.

Once they arrive — often with little or no means — the federal government provides resources such as financial assistance, Medicaid, and SNAP, outreach that has typically garnered bipartisan support. Now the Trump administration has pulled back the country’s decades-long support for refugee communities.

The budget law, which funds several of the president’s priorities, including tax cuts to wealthy Americans and border security, revokes refugees’ access to Medicaid, the state-federal health insurance program for people with low incomes or disabilities, starting in October 2026.

But one of the first provisions to take effect under the law removes SNAP eligibility for most refugees, asylum seekers, trafficking and domestic violence victims, and other legal immigrants. About 90,000 people will lose SNAP in an average month as a result of the new restrictions narrowing which noncitizens can access the program, according to the Congressional Budget Office.

“It doesn’t get much more basic than food,” said Matthew Soerens, vice president of advocacy and policy at World Relief, a Christian humanitarian organization that supports U.S. refugees.

“Our government invited these people to rebuild their lives in this country with minimum support,” Soerens said. “Taking food away from them is wrong.”

Not Just a Handout

The White House and officials at the United States Department of Agriculture did not respond to emails about support for the provision that ends SNAP for refugees in the One Big Beautiful Bill Act.

But Steven Camarota, director of research for the Center for Immigration Studies, which advocates for reduced levels of immigration to the U.S., said cuts to SNAP eligibility are reasonable because foreign-born people and their young children disproportionately use public benefits.

Still, Camarota said, the refugee population is different from other immigrant groups. “I don’t know that this would be the population I would start with,” Camarota said. “It’s a relatively small population of people that we generally accept have a lot of need.”

Federal, state, and local spending on refugees and asylum seekers, including food, health care, education, and other expenses, totaled $457.2 billion from 2005 to 2019, according to a February 2024 report from the Department of Health and Human Services. During that time, 21% of refugees and asylum seekers received SNAP benefits, compared with 15% of all U.S. residents.

In addition to the budget law’s SNAP changes, financial assistance given to people entering the U.S. by the Office of Refugee Resettlement, a part of HHS, has been cut from one year to four months.

The HHS report also found that despite the initial costs of caring for refugees and asylees, this community contributed $123.8 billion more to federal, state, and local governments through taxes than they received in public benefits over the 15 years.

It’s in the country’s best interest to continue to support them, said Krish O’Mara Vignarajah, president and CEO of Global Refuge, a nonprofit refugee resettlement agency.

“This is not what we should think about as a handout,” she said. “We know that when we support them initially, they go on to not just survive but thrive.”

Food Is Medicine

Food insecurity can have lifelong physical and mental health consequences for people who have already faced years of instability before coming to the U.S., said Andrew Kim, co-founder of Ethnē Health, a community health clinic in Clarkston, an Atlanta suburb that is home to thousands of refugees.

Noncitizens affected by the new law would have received, on average, $210 a month within the next decade, according to the CBO. Without SNAP funds, many refugees and their families might skip meals and switch to lower-quality, inexpensive options, leading to chronic health concerns such as obesity and insulin resistance, and potentially worsening already serious mental health conditions, he said.

After her husband was killed in the Democratic Republic of Congo, Antoinette said, she became separated from all seven of her children. The youngest is 19. She still isn’t sure where they are. She misses them but is determined to build a new life for herself. For her, resources like SNAP are critical.

From the conference room of New American Pathways, the nonprofit that helped her enroll in benefits, Antoinette stared straight ahead, stone-faced, when asked about how the cuts would affect her.

Will she shop less? Will she eat fewer fruits and vegetables, and less meat? Will she skip meals?

“Oui,” she replied to each question, using the French for “yes.”

Since arriving in the U.S. last year from Ethiopia with his wife and two teen daughters, Lukas, 61, has been addressing diabetes-related complications, such as blurry vision, headaches, and trouble sleeping. SNAP benefits allow him and his family to afford fresh vegetables like spinach and broccoli, according to Lilly Tenaw, the nurse practitioner who treats Lukas and helped translate his interview.

His blood sugar is now at a safer level, he said proudly after a class at Mosaic Health Center, a community clinic in Clarkston, where he learned to make lentil soup and balance his diet.

“The assistance gives us hope and encourages us to see life in a positive way,” he said in Amharic through a translator. Lukas wanted to use only his family name because he had been jailed and faced persecution in Ethiopia, and now worries about jeopardizing his ability to get permanent residency in the U.S.

Hunger and poor nutrition can lower productivity and make it hard for people to find and keep jobs, said Valerie Lacarte, a senior policy analyst at the Migration Policy Institute.

“It could affect the labor market,” she said. “It’s bleak.”

More SNAP Cuts To Come

While the Trump administration ended SNAP for refugees effective immediately, the change has created uncertainty for those who provide assistance.

State officials in Texas and California, which receive the most refugees among states, and in Georgia told KFF Health News that the USDA, which runs the program, has yet to issue guidance on whether they should stop providing SNAP on a specific date or phase it out.

And it’s not just refugees who are affected.

Nearly 42 million people receive SNAP benefits, according to the USDA. The nonpartisan Congressional Budget Office estimates that, within the next decade, more than 3 million people will lose monthly food dollars because of planned changes — such as an extension of work requirements to more people and a shift in costs from the federal government to the states.

In September, the administration ended a key report that regularly measured food insecurity among all U.S. households, making it harder to assess the toll of the SNAP cuts.

The USDA also posted on its website that no benefits would be issued for anyone starting Nov. 1 because of the federal shutdown, blaming Senate Democrats. The Trump administration has refused to release emergency funding — as past administrations have done during shutdowns — so that states can continue issuing benefits while congressional leaders work out a budget deal. A coalition of attorneys general and governors from 25 states and the District of Columbia filed a lawsuit on Oct. 28 contesting the administration’s decision.

Cuts to SNAP will ripple through local grocery stores and farms, stretching the resources of charity organizations and local governments, said Ted Terry, a DeKalb County commissioner and former mayor of Clarkston.

“It’s just the whole ecosystem that has been in place for 40 years completely being disrupted,” he said.

Muzhda Oriakhil, senior community engagement manager at Friends of Refugees, an Atlanta-area nonprofit that helps refugees resettle, said her group and others are scrambling to provide temporary food assistance for refugee families. But charity organizations, food banks, and other nonprofit groups cannot make up for the loss of billions of federal dollars that help families pay for food.

“A lot of families, they may starve,” she said.

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In recent months, federal agents have camped out in the lobby of a Southern California hospital, guarded detained patients — sometimes shackled — in hospital rooms, and chased an immigrant landscaper into a surgical center.

U.S. Immigration and Customs Enforcement agents have also shown up at community clinics. Health providers say that officers have tried to enter a parking lot hosting a mobile clinic, waved a machine gun in the faces of clinicians serving the homeless, and hauled a passerby into an unmarked car outside a community health center.

In response to such immigration enforcement activity in and around clinics and hospitals, Democratic Gov. Gavin Newsom last month signed SB 81, which prohibits medical establishments from allowing federal agents without a valid search warrant or court order into private areas, including places where patients receive treatment or discuss health matters.

But while the bill received broad support from medical groups, health care workers, and immigrant rights advocates, legal experts say California can’t stop federal authorities from carrying out duties in public places, which include hospital lobbies and general waiting areas, health facility parking lots, and surrounding neighborhoods — places where recent ICE activities have sparked outrage and fear. Previous federal restrictions on immigration enforcement in or near sensitive areas, including health care establishments, were rescinded by the Trump administration in January.

“The issue that states encounter is the supremacy clause,” said Sophia Genovese, a supervising attorney and clinical teaching fellow at Georgetown Law. She said the federal government does have the right to conduct enforcement activities, and there are limits to what the state can do to stop them.

California’s law designates a patient’s immigration status and birthplace as protected information, which like medical records cannot be disclosed to law enforcement without a warrant or court order. And it requires health care facilities to have clear procedures for handling requests from immigration authorities, including training staff to immediately notify a designated administrator or legal counsel if agents ask to enter a private area or review patient records.

Several other Democratic-led states have also taken up legislation to protect patients at hospitals and health centers. In May, Colorado Gov. Jared Polis signed the Protect Civil Rights Immigration Status bill, which penalizes hospitals for unauthorized sharing of information about people in the country illegally and bars ICE agents from entering private areas of health care facilities without a judicial warrant. In Maryland, a law requiring the attorney general to create guidance on keeping ICE out of health care facilities went into effect in June. New Mexico has instituted new patient data protections, and Rhode Island has prohibited health care facilities from asking patients about their immigration status.

Republican-led states have aligned with federal efforts to prevent health care spending on immigrants without legal authorization. Such immigrants are not eligible for comprehensive Medicaid coverage, but states do bill the federal government for emergency care in certain cases. Under a law that took effect in 2023, Florida requires hospitals that accept Medicaid to ask about a patient’s legal status. In Texas, hospitals now have to report how much they spend on care for immigrants without legal authorization.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Gov. Greg Abbott said in issuing his executive order last year.

California’s efforts to rein in federal enforcement come as the state, where more than a quarter of residents are foreign-born, has become a target of President Donald Trump’s immigration crackdown. Newsom signed SB 81 as part of a bill package prohibiting immigration agents from entering schools without a warrant, requiring law enforcement officers to identify themselves, and banning officers from wearing masks. SB 81 was passed on a party-line vote with no formal opposition.

“We’re not North Korea,” Newsom said during a September bill-signing ceremony. “We’re pushing back against these authoritarian tendencies and actions of this administration.”

Some supporters of the bill and legal experts said California’s law can prevent ICE from violating existing patient privacy rights. Those include the Fourth Amendment, which prohibits searches without a warrant in places where people have a reasonable expectation of privacy. Valid warrants must be issued by a court and signed by a judge. But ICE agents frequently use administrative warrants to try to gain access to private areas they don’t have the authority to enter, Genovese said.

“People don’t always understand the difference between an administrative warrant, which is a meaningless piece of paper, versus a judicial warrant that is enforceable,” Genovese said. Judicial warrants are rarely issued in immigration cases, she added.

The Department of Homeland Security has said it won’t abide by California’s mask ban or identification requirements for law enforcement officers, slamming them as unconstitutional. The department did not respond to a request for comment on the state’s new rules for health care facilities, which went into immediate effect.

Tanya Broder, a senior counsel with the National Immigration Law Center, said immigration arrests at health care facilities appear to be relatively rare. But the federal decision to rescind protections around sensitive areas, she said, “has generated fear and uncertainty across the country.” Many of the most high-profile news reports of immigration agents at health care facilities have been in California, largely involving detained patients brought in for care.

The California Nurses Association, the state’s largest nurses union, was a co-sponsor of the bill and raised concerns about the treatment of Milagro Solis-Portillo, a 36-year-old Salvadoran woman who was under round-the-clock ICE surveillance at Glendale Memorial Hospital over the summer.

Union leaders also condemned the presence of agents at California Hospital Medical Center south of downtown Los Angeles. According to Anne Caputo-Pearl, a labor and delivery nurse and the chief union representative at the hospital, agents brought in a patient on Oct. 21 and remained in the patient’s room for almost a week. The Los Angeles Times reported that a TikTok streamer, Carlitos Ricardo Parias, was taken to the hospital that day after he was wounded during an immigration enforcement operation in South Los Angeles.

The presence of ICE was intimidating for nurses and patients, Caputo-Pearl said, and prompted visitor restrictions at the hospital. “We want better clarification,” she said. “Why is it that these agents are allowed to be in the room?”

Hospital and clinic representatives, however, said they are already following the law’s requirements, which largely reinforce extensive guidance put out by state Attorney General Rob Bonta in December.

Community clinics throughout Los Angeles County, which serve over 2 million patients a year, including a large portion of immigrants, have been implementing the attorney general’s guidelines for months, said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County. But she said the law should help ensure uniform standards across health facilities that clinics refer out to and reassure patients that procedures are in place to protect them.

Still, it can’t prevent immigration raids from happening in the broader community, which have made some patients and even health workers afraid to venture outside, McCarthy said. Some incidents have occurred near clinics, including an arrest of a passerby outside a clinic in East Los Angeles, which a security guard caught on video, she said.

“We’ve had clinic staff say, ‘Is it safe for me to go out?’” she said.

At St. John’s Community Health, a network of 24 community health centers and five mobile clinics in South Los Angeles and the Inland Empire, CEO Jim Mangia agreed that the new law can’t prevent all immigration enforcement activity, but he said it does give clinics a tool to push back if agents show up, something his staff has already had to do.

Mangia said St. John’s staff had two encounters with immigration agents over the summer. In one, he said, staff stopped armed officers from entering a gated parking lot at a drug and alcohol recovery center where doctors and nurses were seeing patients at a mobile health clinic.

Another occurred in July, when immigration agents descended upon MacArthur Park on horses and in armored vehicles, in a show of force by the Trump administration. Mangia said masked officers in full tactical gear surrounded a street medicine tent where St. John’s providers were tending to homeless patients, screamed at staff to get out, and pointed a gun at them. The providers were so shaken by the episode, Mangia said, that he had to bring in mental health professionals to help them feel safe going back out on the street.

A DHS spokesperson told CalMatters that in the rare instance where agents enter certain sensitive locations, officers would need “secondary supervisor approval.”

Since then, St. John’s has doubled down on providing support and training to staff and has offered patients afraid to go out the option of home medical visits and grocery deliveries. Patient fears and ICE activity have decreased since the summer, Mangia said, but with DHS planning to hire an additional 10,000 ICE agents, he doubts that will last.

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In late October, Maine Family Planning announced three rural clinics in northern Maine would close by month’s end. These primary care and reproductive health clinics served about 800 patients, many uninsured or on Medicaid.

“People don’t realize how much these clinics hold together the local health system until they’re gone,” said George Hill, the group’s president and CEO. “For thousands of patients, that was their doctor, their lab, and their lifeline.”

Maine Family Planning’s closures are among the first visible signs of what health leaders call the biggest setback to reproductive care in half a century. The U.S. Department of Health and Human Services’ Office of Population Affairs, which administers the Title X family planning program, has been effectively shut down. At the same time, Medicaid cuts, the potential lapse of Affordable Care Act subsidies, as well as cuts across programs in the Health Resources and Services Administration and Centers for Disease Control and Prevention are eroding the broader safety net.

“When you cut OPA, HRSA, and Medicaid together, you’re removing every backup we have,” said Clare Coleman, president of the National Family Planning and Reproductive Health Association. “It’s like taking EMTs off the road while closing the emergency rooms.”

Asked about the cutbacks, HHS press secretary Emily G. Hilliard said, “HHS will continue to carry out all of OPA’s statutory functions.”

How the Safety Net Frays

For more than 50 years, Title X has underwritten a national network of clinics, now numbering over 4,000, that provide contraception, pregnancy testing, testing and treatment for sexually transmitted infections, cancer screening, and other primary and preventive care to nearly 3 million low-income or uninsured patients annually. OPA managed nearly $400 million in grants, issued clinical guidance, and ensured compliance.

In mid-October, OPA’s operations went dark amid federal layoffs that also affected hundreds of CDC staffers. “Under the Biden administration, HHS became a bloated bureaucracy — expanding its budget by 38% and its workforce by 17%,” a spokesperson for the department said at the time, adding, “HHS continues to eliminate wasteful and duplicative entities, including those inconsistent with the Trump administration’s Make America Healthy Again agenda.”

According to Jessica Marcella, who led OPA under the Biden administration, the office was previously staffed by 40 to 50 people. Now, she says, only one U.S. Public Health Service Commissioned Corps officer remains.

“The structure to run the nation’s family planning program disappeared overnight,” said Liz Romer, OPA’s former chief clinical adviser.

“This isn’t just about government jobs,” Coleman said. “It’s a patient care crisis. Every safety net program that touches reproductive health is being weakened.”

A Policy Linking Health, Autonomy, and Opportunity

Created in 1970 under President Richard Nixon and rooted in President Lyndon Johnson’s War on Poverty, Title X was designed as a cornerstone of preventive public health, not a partisan cause. Nixon called family planning assistance key to a “national commitment to provide a healthful and stimulating environment for all children,” and Congress agreed overwhelmingly across party lines.

Sara Rosenbaum, a professor of health law at George Washington University, said the program reflected a pivotal shift in how policymakers understood health itself.

“By the late 1960s, there was a deep appreciation that the ability to time and space pregnancies was absolutely essential to women’s and children’s health,” she said. “Title X represented the idea that reproductive care wasn’t a privilege or a moral issue. It was basic health care.”

UCLA economist Martha Bailey later found that children born after the first federally funded family planning programs were 7% less likely to live in poverty, and had household incomes 3% higher, than those born before. Research by Bailey just published by the National Bureau of Economic Research showed that when low-income women can access free birth control, unintended pregnancies drop by 16% and abortions drop by 12% within two years.

Those findings underscore what Rosenbaum calls “one of the great public health achievements of the 20th century — a program that linked economic opportunity to health and autonomy.”

That bipartisan foundation and evidence-based mission, Rosenbaum said, make today’s unraveling especially striking.

“What was once common sense, that access to family planning is essential to a functioning health system, has become politically fragile,” she noted. “Title X was built for continuity, but it’s being undone by neglect.”

The Hidden Health Risks Behind Unplanned Pregnancies

Family planning is central to maternal and infant health because it gives women the time to optimize medical conditions like high blood pressure, diabetes, and heart disease before pregnancy, and allows them to safely space out their births.

“Pregnancy is the ultimate stress test,” said Andra James, a maternal-fetal medicine specialist who advised the CDC on its contraceptive guidelines. “It increases the heart’s workload by up to 50%. For people with heart disease, diabetes, or hypertension, that stress can be dangerous.”

Brianna Henderson, a Texas mother, learned this firsthand. Weeks after delivery, she developed peripartum cardiomyopathy, a form of heart failure that can occur during or after pregnancy. She survived. Her sister, who had the same undiagnosed condition, died three months after giving birth to her second child. Those kids are now 12 and 16, and they’re growing up without a mom. Their dad and his mother look after the kids now.

“Contraception has been a lifesaving option for me,” Henderson said.

James and other specialists warn that without CDC-informed guidance on contraceptive safety for complex conditions, clinicians and patients are left without clear, current standards.

What History and the Data Predict Happens Next

Title X clinics provide millions of STI tests each year and are often the only cancer screening sites for uninsured women. Cuts to Medicaid and ACA subsidies will make it even harder for people to afford preventive visits.

“If these clinics close, we’ll see more infections, more unplanned pregnancies, and more maternal deaths, especially among Black, Indigenous, and rural communities,” said Whitney Rice, an expert on reproductive health at Emory University.

And the geographic gaps are large already. Power to Decide, a nonprofit reproductive rights group, counts more than 19 million women living in “contraceptive deserts,” where there’s no reasonable access to publicly supported birth control. 

“These are places where the nearest clinic might be 60 or 100 miles away,” said Power to Decide interim co-CEO Rachel Fey. “For many families, that distance might as well be impossible.”

The High Price of Short-Term Savings

Each pregnancy averted through Title X saves about $15,000 in public spending on medical and social services, according to an analysis by Power to Decide. And an analysis by the Guttmacher Institute shows that every $1 invested in publicly funded family planning programs saves roughly $7 in Medicaid costs.

Cutting federal funding for reproductive health services “isn’t saving money. It’s wasting it,” said Brittni Frederiksen, an associate director with KFF’s Women’s Health Policy program and a former OPA health scientist. “We’ll spend far more fixing the problems these cuts create.” KFF is a health information nonprofit that includes KFF Health News.

Supporters of cuts argue federal spending must be reduced and states should set their own priorities.

Strain on the Ground

Affirm, Arizona’s Title X grantee, oversees a statewide network of clinics that provide family planning services to more than 33,000 patients each year.

Affirm CEO Bré Thomas said the state could lose $6.1 million in Title X funding if federal appropriations expire after March 31. It’s a cut that would reduce access to care across the network. “That’s $6.1 million for Arizona,” she said. “That means over 33,000 patients in our state could lose access to services.”

Thomas noted that two consecutive funding reductions, combined with 11 years of flat federal support and rising health care costs, have already strained operations. Without new funding, she warned, clinics may be forced to limit contraceptive options to cheaper methods, reduce preventive care, and lay off staff, especially in rural communities. “We’re talking about impacts to people’s jobs and their ability to access the care they need,” she said.

Megan Kavanaugh, a scientist at the Guttmacher Institute, underscored those limits.

“Federally Qualified Health Centers do not have the capacity to absorb the number of patients who will lose care,” she said, referring to federally funded community-based clinics for underserved populations. “Some people may find another clinic, but a large share simply won’t, and we’ll see that reflected in higher rates of unintended pregnancy, untreated infections, and later-stage disease.”

Hospitals are beginning to absorb the spillover.

“The safety net is shrinking, and hospitals can’t absorb everyone,” said Sonya Borrero, a reproductive health expert at the University of Pittsburgh School of Medicine and a former chief medical and scientific adviser at OPA. “Wait times will get longer, and preventable problems will rise.”

Funding Frozen, Oversight Halted

With OPA offline, Title X dollars already awarded can be spent, but no new funds are moving.

“Most programs can hang on for a few months,” Romer said. “By spring, many won’t have enough money to stay open.”

The halt also suspends compliance reviews and technical assistance tied to CDC-aligned guidelines.

Marcella, the former OPA leader, warned of a “backdoor dismantling.”

“If there aren’t people to administer the grants, then the administration can later argue the program isn’t working and redirect the funds elsewhere,” she said. “This is a functional elimination, done quietly.”

Kavanaugh called the moment “one more step toward dismantling the public health infrastructure that has supported people’s reproductive health for decades.”

Without staff to move money and guidance, she said, “that’s how a system collapses.”

What Can Still Be Done

According to the National Association of Community Health Centers, Federally Qualified Health Centers can still use HRSA money that was already approved, even during the government shutdown. But no new funding is being released, similar to the freeze on Title X funds. At the same time, HRSA has stopped first-quarter payments for its Title V Maternal and Child Health program, which limits how states can provide preventive care and services for children and young people with special health needs.

Some states — California, New Mexico, Washington — are plugging holes with state dollars, and health systems are expanding telehealth, but most jurisdictions cannot replace federal support at scale.

“Private donors can’t replace the federal government,” said Hill, of Maine Family Planning. “You can’t crowdfund your way to a working health system.”

Congress could restore Title X and rebuild OPA’s staffing, but without administrators in place, money can’t reach clinics quickly. States have a short window to bridge care by stabilizing Medicaid coverage, shoring up community health centers, and protecting contraceptive access.

“This isn’t a political debate,” Romer said. “It’s women showing up for care and finding the doors locked.”

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FDA announced significant action to make it faster and less costly to develop biosimilar medicines, which are lower-cost “generic” alternatives to biologic drugs

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

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

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

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

The timing was awful.

The query: When a Missouri mom’s health insurance company couldn’t come to an agreement with her hospital, most of her doctors were suddenly out-of-network. She wondered how she would get her kids’ care covered or find new doctors. “For a family of five, … where do we even start?”

— Amber Wingler, 42, in Columbia, Missouri

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

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

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

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

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

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

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

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

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

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

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

2. Rifts between hospitals and insurers often get repaired.

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

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

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

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

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

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

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

4. Switching your insurance carrier may need to wait.

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

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

5. Doctor-shopping can be time-consuming.

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

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

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

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

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

End of an Ordeal

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

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

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

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

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

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

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