The Host Julie Rovner KFF Health News @jrovner 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.

A week into the reorganization of the Department of Health and Human Services announced by Secretary Robert F. Kennedy Jr., the scope of the staff cuts and program cutbacks is starting to become clear. Among the biggest targets for reductions were the nation’s premier public health agencies: the Centers for Disease Control and Prevention, the National Institutes of Health, and the FDA.

Meanwhile, Kennedy did not show up as invited to testify before the Senate Health, Education, Labor and Pensions Committee, known as HELP, but he did visit families in Texas whose unvaccinated children died of measles in the current outbreak and called for an end to water fluoridation during a stop in Utah.

This week’s panelists are Julie Rovner of KFF Health News, Victoria Knight of Axios, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

Panelists Victoria Knight Axios @victoriaregisk Read Victoria's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Sandhya Raman CQ Roll Call @SandhyaWrites Read Sandhya's stories.

Among the takeaways from this week’s episode:

• Amid a dearth of public information about federal health cutbacks, HHS employees currently on administrative leave report they were given no opportunity to hand off their responsibilities, suggesting important work will simply be discontinued. Critical staff members have been cut from the FDA offices funded by user fees, for instance — affecting the drugmakers that pay the fees in exchange for timely evaluation of their products, as well as the patients hoping for access to those drugs. Even if the cuts were reversed, the damage could linger, especially in areas where there will be gaps in data such as disease surveillance.
• Meanwhile, the temporary public communications freeze implemented in the Trump administration’s early days apparently has not ended. State officials, desperate for information from federal health officials about ongoing programs, are receiving no response as they seek guidance from offices in which most or all staffers were laid off.
• President Donald Trump issued an executive order this week that instructs federal department heads to summarily repeal any regulation they deem “unlawful.” The order threatens to effectively short-circuit the federal regulatory process, which involves public notices and opportunities to comment. Businesses rely on that process to make decisions, and Trump’s order could create further instability for health care and other industries.
• And Kennedy traveled West this week, using his public appearances to call for removing fluoride from the water supply and to discuss the measles outbreak. He issued his strongest endorsement of the measles vaccine yet, but he also praised doctors who have used alternative and unapproved remedies to treat measles patients. Senators had called him to testify before Congress this week about the ongoing upheaval at HHS, but the hearing was canceled.
• Legislators in a growing number of states are introducing abortion bans that would punish women seeking abortions as well as abortion providers, suggesting a long game for abortion opponents that goes well beyond overturning a nationwide right to the procedure.

Also this week, Rovner interviews Georgetown Law School professor Stephen Vladeck about the limits of presidential power.

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

Julie Rovner: The New York Times’ “Why the Right Still Embraces Ivermectin,” by Richard Fausset.  

Victoria Knight: Wired’s “Dr. Oz Pushed for AI Health Care in First Medicare Agency Town Hall,” by Leah Feiger and Steven Levy.  

Alice Miranda Ollstein: The Guardian’s “‘We Are Failing’: Doctors and Students in the US Look to Mexico for Basic Abortion Training,” by Carter Sherman.  

Sandhya Raman: CQ Roll Call’s “In Sweden, a Focus on Smokeless Tobacco,” by Sandhya Raman. 

Also mentioned in this week’s podcast:

• The New York Times’ “The Three States That Are Especially Stuck if Congress Cuts Medicaid,” by Sarah Kliff and Margot Sanger-Katz.
• The AP’s “Ex-Official Says He Was Forced out of FDA After Trying To Protect Vaccine Safety Data From RFK Jr.,” by Matthew Perrone.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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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MAHA tour press release AZ, Utah, NM

Mass firings at the FDA have decimated divisions tasked with releasing public records generated by the agency’s regulatory activities in sectors including tobacco, food, medical devices, and veterinary medicine.

But as the dust settled on the layoff melee, a notable exception emerged among the agency’s staff charged with responding to Freedom of Information Act requests. The cuts spared at least some workers who furnish documents in response to court orders in FOIA lawsuits involving the FDA division that regulates vaccines, which includes litigation brought by an ally of Health and Human Services Secretary Robert F. Kennedy Jr.’s who represents anti-vaccine interests, according to four current or former agency employees.

KFF Health News agreed not to name the workers because they are not authorized to speak to the press and fear retaliation.

Lawyer Aaron Siri filed the FOIA lawsuits, on behalf of the nonprofit Public Health and Medical Professionals for Transparency, in 2021 and 2022 against the FDA to obtain records related to Pfizer’s and Moderna’s covid-19 vaccines. Siri was Kennedy’s lawyer during his 2024 presidential campaign and has represented prominent anti-vaccine activists in numerous lawsuits.

The FDA has released millions of pages of documents about the vaccines after a federal judge in Texas ruled against the agency and set deadlines for furnishing the records. The judge, Mark Pittman of the U.S. District Court for the Northern District of Texas, wrote in January that the nonprofit’s request seeking materials about Pfizer’s covid vaccine is “arguably the most important FOIA request in American history.”

In a Jan. 3 court filing, Department of Justice lawyers said the lawsuit’s plaintiffs had received roughly 4.5 million pages of covid vaccine records and the agency still had at least 1.2 million pages to process in one of the cases. The agency hired about a dozen workers in 2023 and 2024 to help process the records, in addition to one part-time and nine full-time contractors at a cost of $3.5 million. Public Health and Medical Professionals for Transparency has been posting documents on its website.

The FDA faces a June 30 court-ordered deadline to finish releasing documents. Staff members who work on FOIA litigation in the FDA’s vaccine division “are pretty much exclusively working on Siri litigation,” one worker said.

HHS spokesperson Andrew Nixon declined to answer specific questions from KFF Health News about layoffs of FDA FOIA workers. The questions sought responses to accounts of firings provided by current and former employees.

“These claims are untrue and unfounded,” Nixon said.

“FDA FOIA staff, including those working on litigation involving CBER, were impacted as part of HHS’ reorganization,” Nixon said, using the acronym for the Center for Biologics Evaluation and Research, the FDA division that regulates vaccines. He declined to elaborate.

“The simple fact is that FOIA offices throughout the Department were previously siloed and did not communicate with one another, which is inefficient and not effective. Under Secretary Kennedy’s vision for a more efficient HHS, these offices will be streamlined into one place and the work will continue to increase radical transparency for the American people,” Nixon said in an emailed statement.

Three workers bristled at Nixon’s characterization of the cuts. “There’s plenty of ways they could be impacted without being fired,” one of them said.

Siri did not respond to requests for comment for this article.

Details of the fallout of the firings on FDA’s FOIA operations, which have largely ground to a halt, are based on interviews with half a dozen current or former employees.

The move to keep FDA staff working to furnish government records related to its approval of covid vaccines came amid a purge of FOIA workers across federal health agencies, including the FDA, the National Institutes of Health, and the Centers for Disease Control and Prevention. HHS laid off the entire CDC office handling that agency’s FOIA requests and significantly cut staff at the NIH and FDA, according to eight current or former federal workers. Overall, as part of its plans to shrink the department by 20,000 people, HHS officials said 10,000 employees would be laid off, 3,500 of them from the FDA.

Nikhel Sus, deputy chief counsel at Citizens for Responsibility and Ethics in Washington, a legal advocacy group, said, “It’s very concerning that an agency would be prioritizing requests for political reasons.” For years, Kennedy has peddled falsehoods about vaccines — including that “no vaccine” is “safe and effective,” and that “there are other studies out there” showing a connection between vaccines and autism, a link that has repeatedly been debunked.

“That is not what FOIA is meant to do,” Sus said. CREW this month sued the CDC for firing its entire FOIA office.

The layoffs gutted the workforce that process FOIA requests across FDA centers overseeing vaccines, drugs, tobacco, medical devices, and food, current and former employees said. During the 2024 fiscal year — October 2023 through September 2024 — the FDA provided at least some records in response to more than 12,000 requests, according to HHS’ annual FOIA report.

The firings have been inconsistent across offices. Within the FDA division that regulates vaccines, public records staffers who proactively release certain documents, such as information about approved products, were fired, three of the workers said. But in the FDA’s drug division, they were not, two workers said.

At least some who handle FOIA litigation in the FDA offices regulating vaccines and drugs kept their jobs, according to four workers.

By contrast, FDA workers who handled FOIA litigation in other FDA offices, including those that focus on tobacco and medical devices, were fired as part of the mass layoffs, according to one former and two current employees. The former employee said they had been working on litigation in which a court order required documents to be produced monthly, among other FOIA responsibilities.

“Because we were cut, those things stopped abruptly,” the former employee said. “There was no plan in place to take care of the work.”

FOIA is a transparency law signed in 1966 that guarantees public access to the inner workings of federal agencies by requiring officials to disclose government documents. It has been used by researchers, companies, law firms, advocates, and journalists to review public records and the work of agencies, hold officials accountable, and uncover harm, corruption, and political meddling in policymaking.

Health care experts and transparency advocates have said that HHS’ mass firing of FOIA staff across agencies will hamper public access to government records that document the handling of illnesses, faulty products, and safety lapses at health facilities, putting the health and safety of Americans at risk.

At the height of the covid pandemic, in late 2020, the FDA granted emergency use authorization of Pfizer’s and Moderna’s covid vaccines, before granting full approvals in 2021 and 2022, respectively. Covid vaccines are credited with saving millions of lives in the U.S., but Kennedy has rejected the science behind them and questioned their safety.

While speaking to Louisiana lawmakers in 2021, he falsely claimed that the covid vaccine was “the deadliest vaccine ever made.” During one of his Senate confirmation hearings in January, he said, “I don’t know,” when Sen. Bernie Sanders (I-Vt.) pressed him about whether covid vaccines were good. “We don’t have the science to make that determination,” Kennedy said.

In a June 2021 post on the social platform X, Kennedy publicized a petition to the FDA to remove covid vaccines’ emergency use authorizations that was submitted by Children’s Health Defense, an anti-vaccine nonprofit he founded and chaired until December.

Pittman, the federal judge in Texas considering the two Public Health and Medical Professionals for Transparency cases against the FDA, was appointed in 2019 by President Donald Trump. Pittman ordered the FDA to release records related to approval of Pfizer’s and Moderna’s covid-19 vaccines on an accelerated schedule.

Siri for years has fought vaccination requirements, including challenging a Massachusetts flu shot mandate and a covid vaccine mandate in public schools in San Diego. His clients have included the Informed Consent Action Network, a prominent anti-vaccine group founded in 2016 by activist Del Bigtree. Bigtree worked as communications director for Kennedy’s presidential campaign and is a major player in Kennedy’s “Make America Healthy Again” movement.

 Like Kennedy, Siri has spread misinformation about vaccines and questioned their safety. During a 2023 legislative hearing in South Carolina, Siri said, “There are actually a number of studies that do show correlation between autism and vaccines,” even though claims of such a link have been repeatedly debunked. During one of his Senate confirmation hearings, Kennedy refused to say vaccines do not cause autism.

“We must be able to raise valid questions about vaccines without fear that anyone who deviates from the accepted orthodoxy will be smeared as a radical. There are many issues that divide Americans, but drug and vaccine safety should unite us,” Siri wrote in a Wall Street Journal opinion piece following a story in The New York Times that he had petitioned the FDA on behalf of ICAN to revoke approval of the polio vaccine.

And in early January, Siri responded to a CDC social media post by saying: “CDC’s message for the new year is get a C19 vaccine. Their worship of vaccines as the path to safety and health is a cult.”

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

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

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The settlement marks the 6th enforcement action in OCR’s HIPAA Risk Analysis Initiative.

Las agresivas tácticas de deportación han aterrorizado a los trabajadores agrícolas, que son el centro de la estrategia nacional contra la gripe aviar, según afirman trabajadores de salud pública.

Los trabajadores de las industrias láctea y avícola han representado la mayoría de los casos de gripe aviar en el país, y prevenir y detectar los casos entre ellos es clave para evitar una pandemia. Sin embargo, los especialistas en salud pública afirman que tienen dificultades para llegar a los trabajadores agrícolas porque muchos tienen miedo de hablar con desconocidos o de salir de casa.

“La gente tiene mucho miedo de salir, incluso para comprar alimentos”, dijo Rosa Yáñez, trabajadora social de Strangers No Longer, una organización católica con sede en Detroit que apoya a inmigrantes y refugiados en Michigan con problemas legales y de salud, incluida la gripe aviar. “La gente está preocupada por perder a sus hijos, o por que sus hijos pierdan a sus padres”.

“Solía ​​hablarle a la gente sobre la gripe aviar, y los trabajadores estaban contentos de recibir esa información”, dijo Yáñez. “Pero ahora solo quieren conocer sus derechos”.

Los trabajadores comunitarios que capacitan a los trabajadores agrícolas sobre la gripe aviar, les proporcionan equipo de protección y los conectan con las pruebas afirman haber notado un cambio drástico —primero en California, el estado más afectado por la gripe aviar— luego de las redadas de inmigración que comenzaron el 7 de enero, un día después que el Congreso certificara la victoria electoral del presidente Donald Trump.

Fue entonces cuando agentes de la Patrulla Fronteriza detuvieron indiscriminadamente a unos 200 trabajadores agrícolas y jornaleros latinos en el Valle Central de California, según informes locales citados en una demanda presentada posteriormente por la Unión Americana de Libertades Civiles (ACLU) en nombre del sindicato United Farm Workers y varias personas que fueron detenidas.

“Los agentes de la Patrulla Fronteriza se lanzaron a una expedición de pesca” en una redada de tres días llamada “Operación Devolución al Remitente” (operation Return to Sender), que “separó a familias y aterrorizó a la comunidad”, alega la demanda.

Entre las personas detenidas se encontraba Yolanda Aguilera Martínez, trabajadora agrícola y abuela que reside legalmente en Estados Unidos y no tiene antecedentes penales. Iba a una cita médica conduciendo a la velocidad límite cuando agentes vestidos de civil en vehículos sin identificación la detuvieron, le ordenaron que bajara del coche, la empujaron al suelo y la esposaron, según la demanda.

Los agentes finalmente liberaron a Aguilera Martínez, pero la demanda indica que otras personas que enfrentaban la deportación fueron detenidas durante días en “celdas frías y sin ventanas” antes de ser trasladadas a México, y abandonadas.

No se les explicó el motivo de su arresto, ni se les dio la oportunidad de defenderse, ni se les permitió llamar a un abogado ni a sus familias, alega la demanda. Indica que los cuatro hijos de un padre deportado, sin antecedentes penales, “se han vuelto silenciosos y temerosos”, y que las convulsiones de uno de los hijos con epilepsia “han empeorado”.

La noticia de la redada se difundió rápidamente en California, donde viven aproximadamente 880.000 trabajadores agrícolas, principalmente latinos. Las lecherías que emplean mano de obra inmigrante producen casi el 80% del suministro de leche de Estados Unidos, según una encuesta de 2014.

“Luego de la Operación Devolución al Remitente, los trabajadores lácteos se mostraron aún más reacios a hablar, incluso anónimamente, sobre la falta de protección en las granjas lecheras y la falta de días por enfermedad cuando se contagian”, declaró Antonio De Loera-Brust, vocero de la Unión de Trabajadores Agrícolas.

Trabajadores comunitarios en otros estados reportan un efecto intimidatorio similar debido a las redadas y las políticas migratorias aprobadas tras la toma de posesión de Trump, quien degradó repetidamente a los inmigrantes y prometió deportaciones masivas durante la campaña electoral. “No son humanos, son animales”, dijo refiriéndose a los inmigrantes que se encontraban sin autorización en Estados Unidos el pasado abril.

La primera medida legislativa de Trump fue promulgar la Ley Laken Riley, que ordena la detención federal de inmigrantes acusados ​​de cualquier delito, independientemente de si hayan sido o no condenados.

El 20 de enero, el Departamento de Seguridad Nacional anuló la política de “áreas protegidas”, permitiendo a los agentes arrestar a personas sin papeles en escuelas, hospitales o iglesias. En marzo, la administración Trump deportó a más de 100 venezolanos y otras personas sin una audiencia previa, ignorando una orden judicial que que obligaba frenar los aviones que los trasladaban a El Salvador.

Las consecuencias para la salud pública de la desaparición de los trabajadores agrícolas son potencialmente enormes: científicos especializados en enfermedades infecciosas afirman que prevenir el contagio de gripe aviar y detectar los casos son fundamentales para prevenir una pandemia. Por eso, el gobierno ha financiado iniciativas para proteger a estos trabajadores, y monitorearlos para detectar signos de gripe aviar, como ojos rojos o síntomas similares a los de la gripe.

“Cada vez que un trabajador se enferma, juega el azar, así que protegerlo es en el interés de todos”, dijo De Loera-Brust. “Al virus no le importa lo que digan tus documentos de inmigración”.

Potencial de pandemia

Aproximadamente 65 trabajadores lácteos y de granjas de aves de corral han dado positivo para la prueba de gripe aviar desde marzo de 2024, pero el número real de infecciones es mayor. Una investigación de KFF Health News descubrió que la vigilancia deficiente provocó que casos pasaran desapercibidos en las granjas el año pasado, y estudios han revelado indicios de infecciones previas en trabajadores agrícolas que no se habían realizado la prueba.

Los departamentos de salud estatales y locales estaban empezando a superar las barreras del año pasado para las pruebas de gripe aviar, dijo Salvador Sandoval, médico que se jubiló recientemente del departamento de salud del condado de Merced, en California. Ahora, dijo, “la gente ve una unidad móvil de pruebas y piensa que es la Patrulla Fronteriza”.

El año pasado, las organizaciones de divulgación se conectaron con los trabajadores agrícolas en lugares donde se reunían, como en eventos de distribución de alimentos, pero estos ya no tienen mucha concurrencia, dijeron Sandoval y otros.

“Independientemente de su estatus migratorio, las personas con apariencia de inmigrantes sienten mucho miedo en este momento”, dijo Hunter Knapp, director de desarrollo de Project Protect Food Systems Workers, una organización de defensa de los trabajadores agrícolas en Colorado que realiza actividades de divulgación sobre la gripe aviar. Knapp explicó que algunos trabajadores de salud comunitarios latinos han reducido sus esfuerzos de divulgación por temor a ser acosados ​​por las autoridades o el público.

Una trabajadora comunitaria latina en Michigan, que habló bajo condición de anonimato por temor a represalias contra su familia, dijo: “Mucha gente no va al médico en este momento debido a la situación migratoria”.

“Prefieren quedarse en casa y dejar que el dolor, el enrojecimiento del ojo o lo que sea desaparezca”, agregó. “La situación se ha intensificado mucho este año y la gente está muy, muy asustada”.

Los Centros para el Control y Prevención de Enfermedades (CDC) han reportado muchos menos casos humanos desde que Trump asumió el cargo. Durante los tres meses previos al 20 de enero, la agencia confirmó dos docenas de casos. Desde entonces, solo se han detectado tres, incluidas dos personas con casos lo suficientemente graves como para ser hospitalizadas.

Los CDC han afirmado que continúan monitoreando la gripe aviar, pero Jennifer Nuzzo, directora del Centro de Pandemias de la Universidad de Brown, señaló que la baja de los casos podría deberse a que se hacen menos pruebas. “Me preocupa que estemos observando una disminución en la vigilancia y no necesariamente una disminución en la propagación del virus”.

Las infecciones no detectadas representan una amenaza para los trabajadores agrícolas y para el público en general.

Dado que los virus evolucionan mutando dentro del cuerpo, cada infección es como presionar la palanca de una máquina tragamonedas. Una persona que falleció a causa de la gripe aviar en Louisiana en diciembre ilustra este punto: la evidencia científica sugiere que los virus de la gripe aviar evolucionaron dentro del paciente, generando mutaciones que podrían aumentar su capacidad de propagación entre humanos. Sin embargo, debido a que el paciente estuvo aislado en un hospital, los virus más peligrosos no se transmitieron a otros.

Esto podría no ocurrir si los trabajadores agrícolas enfermos no reciben tratamiento y viven en hogares hacinados o en centros de detención sin ventanas donde podrían infectar a otros, señaló Angela Rasmussen, viróloga de la Universidad de Saskatchewan, en Canadá.

Aunque la gripe aviar aún no se propaga fácilmente entre personas por aire, como la gripe estacional, podría diseminarse ocasionalmente cuando las personas están en espacios reducidos, y evolucionar para hacerlo con más eficiencia.

“Me preocupa que no nos demos cuenta de que esto está sucediendo hasta que algunas personas enfermen gravemente”, dijo Rasmussen. “En ese momento, las cifras serían tan altas que podrían descontrolarse”.

El virus pouede no evolucionar nunca para propagarse fácilmente, pero podría pasar. Rasmussen afirmó que el resultado sería “catastrófico”. Basándose en lo que se sabe sobre las infecciones humanas, ella y sus colegas predicen en un nuevo informe que una pandemia de gripe aviar H5N1 “colapsaría los sistemas de salud” y “causaría millones de muertes más” que la pandemia de covid-19.

Entrega de vacunas

A fines del año pasado, los CDC lanzaron una campaña de vacunación contra la gripe estacional dirigida a más de 200.000 trabajadores ganaderos. La esperanza era que la vacunación contra la gripe redujera la probabilidad de que un trabajador agrícola se infectara simultáneamente con los virus de la gripe estacional y la gripe aviar.

La coinfección permite que ambos virus intercambien genes, creando potencialmente un virus de la gripe aviar que se propagaría con la misma facilidad que la variante estacional.

Sin embargo, Sandoval afirmó que la vacunación contra la gripe disminuyó inmediatamente después del operativo de enero en California.

Funcionarios de Aduanas y Protección Fronteriza informaron en un comunicado que arrestaron a 78 inmigrantes que se encontraban “ilegalmente en Estados Unidos” durante el operativo de tres días.

Entre ellos se encontraba un delincuente sexual convicto y otras personas con antecedentes penales, como vandalismo y hurtos menores, según el comunicado. La agencia no especificó las acusaciones contra cada persona ni si todos habían sido acusados. Ex funcionarios de la administración Biden, que se encontraba en sus últimos días cuando ocurrieron los arrestos, tomarán distancia del operativo en entrevistas con Los Angeles Times.

Mayra Joachin, abogada de la ACLU del Sur de California, afirmó que el operativo era diferente a otros del gobierno de Biden, ya que se trataba de arrestos indiscriminados por parte de la Patrulla Fronteriza en el interior del país.

“Encaja con la campaña más amplia de la administración Trump de infundir miedo en las comunidades inmigrantes”, declaró, “como se vio en la campaña electoral y en acciones posteriores que atacaban a cualquiera que se percibiera como extranjero en el país”.

En marzo, David Kim, subjefe de la unidad de la Patrulla Fronteriza que dirigió el operativo, lo calificó como una “prueba de concepto”.

“Sabemos que ahora podemos superar ese límite en cuanto a distancia”, declaró al medio de comunicación del sur de California Inewsource.

El Departamento de Seguridad Nacional no respondió a las solicitudes de comentarios. En un correo electrónico, Kush Desai, vocero de la Casa Blanca, escribió: “A pesar de lo que creen los ‘expertos’, combatir la epidemia de gripe aviar y hacer cumplir nuestras leyes de inmigración no son mutuamente excluyentes”.

Anna Hill Galendez, abogada gerente del Michigan Immigrant Rights Center, entidad que participa en la difusión de información sobre la gripe aviar, afirmó que las tácticas inusualmente agresivas de los agentes del Servicio de Inmigración y Control de Aduanas (ICE) disuadieron a los trabajadores lácteos enfermos de la Península Superior de Michigan de salir de sus hogares para recibir atención médica a finales de enero. Se pusieron en contacto con el centro para solicitar ayuda.

“Querían atención médica. Querían vacunas contra la gripe. Querían [equipo de protección personal]. Querían hacerse la prueba”, declaró Hill Galendez. “Pero tenían miedo de ir a cualquier parte debido a las medidas de control migratorio”.

Lynn Sutfin, funcionaria de información pública del Departamento de Salud y Servicios Humanos de Michigan (MDHHS), respondió a las preguntas sobre la situación en la península en un correo electrónico a KFF Health News: “Los trabajadores agrícolas no aceptaron la oferta de pruebas del departamento de salud local ni del MDHHS”.

Los CDC se negaron a comentar sobre el impacto de las medidas migratorias en la labor de divulgación con trabajadores agrícolas.

Para adaptarse a la nueva realidad, Yanez ahora destaca sus consejos sobre la gripe aviar en Michigan, combinándolos con información sobre los derechos de los inmigrantes.

En Colorado, Knapp dijo que su organización está cambiando su enfoque y dejando de lado la divulgación sobre la gripe aviar en eventos donde se congregan trabajadores agrícolas, ya que esto podría percibirse como una trampa: el tipo de evento que atraería a los agentes de ICE.

Los trabajadores de divulgación que viven en las mismas comunidades que los trabajadores agrícolas también se están retirando un poco. “Como latinos, siempre nos identifican”, dijo el trabajador comunitario, quien habló bajo condición de anonimato. “Tengo una visa que me protege, pero las cosas están cambiando muy rápidamente bajo la administración Trump, y la verdad es que nada es seguro”.

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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Fentanyl, the deadly synthetic opioid driving the nation’s high drug overdose rates, is also caught up in another increasingly serious problem: misinformation.

False and misleading narratives on social media, in news reports, and even in popular television dramas suggesting people can overdose from touching fentanyl — rather than ingesting it — are now informing policy and spending decisions.

In an episode of the CBS cop drama “Blue Bloods,” for instance, Detective Maria Baez becomes comatose after accidentally touching powdered fentanyl. In another drama, “S.W.A.T.,” Sgt. Daniel “Hondo” Harrelson warns his co-workers: “You touch the pure stuff without wearing gloves, say good night.”

While fentanyl-related deaths have drastically risen over the past decade, no evidence suggests any resulted from incidentally touching or inhaling it, and little to no evidence that any resulted from consuming it in marijuana products. (Recent data indicates that fentanyl-related deaths have begun to drop.)

There is also almost no evidence that law enforcement personnel are at heightened risk of accidental overdoses due to such exposures. Still, there is a steady stream of reports — which generally turn out to be false — of officers allegedly becoming ill after handling fentanyl.

“It’s only in the TV dramas” where that happens, said Brandon del Pozo, a retired Burlington, Vermont, police chief who researches policing and public health policies and practices at Brown University.

In fact, fentanyl overdoses are commonly caused by ingesting the drug illicitly as a pill or powder. And most accidental exposures occur when people who use drugs, even those who do not use opioids, unknowingly consume fentanyl because it is so often used to “cut” street drugs such as heroin and cocaine.

Despite what scientific evidence suggests about fentanyl and its risks, misinformation can persist in public discourse and among first responders on the front lines of the crisis. Daniel Meloy, a senior community engagement specialist at the drug recovery organizations Operation 2 Save Lives and QRT National, said he thinks of misinformation as “more of an unknown than it is an anxiety or a fear.”

“We’re experiencing it often before the information” can be understood and shared by public health and addiction medicine practitioners, Meloy said.

Some state and local governments are investing money from their share of the billions in opioid settlement funds in efforts to protect first responders from purported risks perpetuated through fentanyl misinformation.

In 2022 and 2023, 19 cities, towns, and counties across eight states used settlement funds to purchase drug detection devices for law enforcement agencies, spending just over $1 million altogether. Two mass spectrometers were purchased for at least $136,000 for the Greeley, Colorado, police department, “to protect those who are tasked with handling those substances.”

Del Pozo, the retired police chief, said fentanyl is present in most illicit opioids found at the scene of an arrest. But that “doesn’t mean you need to spend a lot of money on fentanyl detection for officer safety,” he said. If that spending decision is motivated by officer safety concerns, then it’s “misspent money,” del Pozo said.

Fentanyl misinformation is affecting policy in other ways, too.

Florida, for instance, has on the books a law that makes it a second-degree felony to cause an overdose or bodily injury to a first responder through this kind of secondhand fentanyl exposure. Similar legislation has been considered by states such as Tennessee and West Virginia, the latter stipulating a penalty of 15 years to life imprisonment if the exposure results in death.

Public health advocates worry these laws will make people shy away from seeking help for people who are overdosing.

“A lot of people leave overdose scenes because they don’t want to interact with police,” said Erin Russell, a principal with Health Management Associates, a health care industry research and consulting firm. Florida does include a caveat in its statute that any person “acting in good faith” to seek medical assistance for someone they believe to be overdosing “may not” be arrested, charged, or prosecuted.

And even when public policy is crafted to protect first responders as well as regular people, misinformation can undermine a program’s messaging.

Take Mississippi’s One Pill Can Kill initiative. Led by the state attorney general, Lynn Fitch, the initiative aims to provide resources and education to Mississippi residents about fentanyl and its risks. While it promotes the availability and use of harm reduction tools, such as naloxone and fentanyl test strips, Fitch has also propped up misinformation.

At the 2024 Mississippi Coalition of Bail Sureties conference, Fitch said, “If you figure out that pill’s got fentanyl, you better be ready to dispose of it, because you can get it through your fingers,” based on the repeatedly debunked belief that a person can overdose by simply touching fentanyl.

Officers on the ground, meanwhile, sometimes are warned to proceed with caution in providing lifesaving interventions at overdose scenes because of these alleged accidental exposure risks. This caution is often evidenced in a push to provide first responders with masks and other personal protective equipment. Fitch told the crowd at the conference: “You can’t just go out and give CPR like you did before.” However, as with other secondhand exposures, the risk for a fentanyl overdose from applying mouth-to-mouth is negligible, with no clinical evidence to suggest it has occurred.

Her comments underscore growing concerns, often not supported by science, that officers and first responders increasingly face exposure risks during overdose responses. Her office did not respond to questions about these comments.

Health care experts say they are not against providing first responders with protective equipment, but that fentanyl misinformation is clouding policy and risks delaying critical interventions such as CPR and rescue breathing.

“People are afraid to do rescue breathing because they’re like, ‘Well, what if there’s fentanyl in the person’s mouth,’” Russell said. Hesitating for even a moment because of fentanyl misinformation could delay a technique that “is incredibly important in an overdose response.”

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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Because of past fraud by rogue brokers, some Affordable Care Act policyholders may get an unexpected tax bill this season.

But that isn’t the only potential shock. Other changes coming soon — stemming from proposals by the administration of President Donald Trump — could affect their coverage and its cost. And sorting out related problems and challenges may take longer as federal workers are laid off and funding for assistance programs is cut.

First up: Taxes

Tax season is when some consumers learn they were fraudulently enrolled in an ACA plan or switched to a different one without their knowledge.

Those unauthorized enrollments or changes took off in late 2023 and continued through last year, drawing more than 274,000 complaints in the first eight months of 2024 to the Centers for Medicare & Medicaid Services, mostly about rogue agents or call centers.

Tax problems can arise if those enrollments resulted in premium tax credits exceeding the amount the consumer should have received. In those cases, consumers may have to pay all or part of those credits back. The amount owed could range from a few hundred dollars to thousands, with some caps based on income.

The first clue some people have is when they get a 1095-A form in the mail.

Those documents are sent out by the state and federal marketplaces to the IRS and ACA enrollees, showing any tax credit payments made to health insurers on a taxpayer’s behalf. Taxpayers use the premium tax credit information from the 1095-A when completing their return.

Returns can be held up if the IRS has information indicating the taxpayer has ACA coverage that they failed to report on their return, or if there are other discrepancies.

The Biden administration last year took steps to slow the fraudulent switching, including requiring a three-way call between the broker, client, and marketplace for some enrollment issues.

“While we may be seeing less [fraud], we’re still dealing with 2024 taxes,” said Erin Kinard, director of systems and intake for the Health and Economic Opportunity Program at Pisgah Legal Services, a nonprofit serving western North Carolina that offers both legal help and assistance with ACA problems.

Consumers who suspect they were fraudulently enrolled should immediately call their federal or state ACA marketplace, experts say. Some consumers will be referred to special federal caseworkers through the marketplaces. But some of those caseworkers are now part of the broad reduction in force by the Trump administration.

In recent days, “they laid off two divisions on the Affordable Care Act side,” said Jeffrey Grant, who oversaw ACA issues as CMS’ deputy director for operations in the Center for Consumer Information and Insurance Oversight before leaving in February.

With fewer caseworkers, “it will take longer to get problems taken care of,” said Grant, who is now president of Schedule F Healthcare Strategies, a consulting group that aims to help laid-off federal workers find new jobs. “The marketplace is twice as big as it was the last time the Trump administration was here, and now they are cutting caseworkers to less than were around then.”

And these cases are difficult because the rogue brokers who enrolled consumers sometimes misstated their income so they would qualify for the largest tax credits possible. Other consumers have found they were enrolled even though they had affordable employer coverage, making them ineligible for ACA subsidies.

That’s what happened to Anthony Akra and his wife, Ashley Zukoski, in Charlotte, North Carolina. They were enrolled in a plan without their knowledge in 2023, by a broker in Florida with whom they had never spoken. The couple had health insurance through Zukoski’s employer. The broker listed an income that qualified the household for a large subsidy that fully offset the monthly premium cost, so the couple never received a bill. One day, a 1095-A form showed up in their mailbox.

“I didn’t know what the hell it was,” said Akra, who said the form showed that he had been receiving hundreds of dollars a month in premium tax credits. He would owe a big chunk of that back unless he could get the plan retroactively canceled.

Because their pharmacy, part of a national chain, had switched them to the new plan, also without telling them, they had used the new coverage every time they filled a prescription. That inadvertent use of the policy complicated their efforts to get the fraudulent coverage revoked. Meanwhile, the IRS withheld more than $4,000 from their tax refund based on the information sent through that 1095-A form. Months passed, but with assistance from a “navigator” program — a government-funded nonprofit that helps people deal with insurance problems — they were able to get the incorrect insurance canceled and a refund at the end of October.

It is not unusual for people to spend weeks or even months trying to sort out the mess, said Kinard, whose organization is similar to the one that helped Akra.

While navigator programs nationwide are still operating to help people sign up for health coverage or address issues, the Trump administration has targeted their funding for a 90% cut.

Meanwhile, ACA enrollees may face a range of other surprises due to policy and budget steps proposed by the Trump administration.

More Potential Changes

Congress must decide whether to extend premium tax credits that were enhanced during the covid pandemic, which expanded eligibility for the credits and made them larger for many enrollees. Keeping them in place would be expensive, with the nonpartisan Congressional Budget Office and Joint Committee on Taxation estimating it would add $335 billion to the deficit through 2034.

That debate will come amid another deficit-affecting decision: whether to extend tax cuts enacted during the first Trump administration, which would add trillions to the budget deficit through 2034.

If the enhanced subsidies are not renewed, monthly premium costs would rise by an average of over 75%, according to KFF, a health information nonprofit that includes KFF Health News. Premiums could more than double in some states, including many GOP-led ones, such as Texas, Mississippi, Utah, Wyoming, and West Virginia.

That could spark a political backlash. Additionally, the enhanced subsidies are seen as a main reason for strong enrollment growth, leading to more than 24 million people signing up for ACA plans for this year. A recent KFF study found the 15 states with the most enrollment growth since 2020 were all won by Trump in 2024.

A proposed rule released last month by the Trump administration includes provisions to shorten the annual enrollment period, get rid of a special open enrollment period that allows low-income people to sign up year-round, and require stricter verification of income and other information when people apply for coverage. The administration says most of these steps are needed to reduce fraud in the system.

The administration estimates that 750,000 to 2 million fewer people would enroll in coverage as a result of the changes.

The new rule, if finalized, will make it harder for people to enroll, said Xonjenese Jacobs, director of Florida Covering Kids & Families at the University of South Florida College of Public Health. Losing the year-round enrollment for very low-income people, for example, would affect people short on cash who move often to stay with relatives or friends, and those who have unsteady employment, making it hard to know when or where to enroll and what their income might be in the coming year.

“They don’t have the same ability to plan,” Jacobs said. “It’s definitely going to make a difference for a lot of the individuals that we service.”

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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Aggressive deportation tactics have terrorized farmworkers at the center of the nation’s bird flu strategy, public health workers say.

Dairy and poultry workers have accounted for most cases of the bird flu in the U.S. — and preventing and detecting cases among them is key to averting a pandemic. But public health specialists say they’re struggling to reach farmworkers because many are terrified to talk with strangers or to leave home.

“People are very scared to go out, even to get groceries,” said Rosa Yanez, an outreach worker at Strangers No Longer, a Detroit-based Catholic organization that supports immigrants and refugees in Michigan with legal and health problems, including the bird flu. “People are worried about losing their kids, or about their kids losing their parents.”

“I used to tell people about the bird flu, and workers were happy to have that information,” Yanez said. “But now people just want to know their rights.”

Outreach workers who teach farmworkers about the bird flu, provide protective gear, and connect them with tests say they noticed a dramatic shift — first in California, the state hit hardest by the bird flu — after immigration raids beginning on Jan. 7, the day after Congress certified President Donald Trump’s election victory. That’s when Border Patrol agents indiscriminately stopped about 200 Latino farmworkers and day laborers in California’s Central Valley, according to local reports cited in a lawsuit subsequently filed by the American Civil Liberties Union on behalf of the United Farm Workers union and several people who were stopped and detained.

“Border Patrol agents went on a fishing expedition” in a three-day raid called “Operation Return to Sender” that “tore families apart and terrorized the community,” the lawsuit alleges.

Among those stopped was Yolanda Aguilera Martinez, a farmworker and grandmother who lives legally in the U.S. and has no criminal record. She was driving at the speed limit on her way to a doctor’s appointment when plainclothes agents in unmarked vehicles pulled her over, ordered her out of the car, pushed her to the ground, and handcuffed her, the lawsuit says. Agents eventually released Aguilera Martinez, but the lawsuit says others who faced deportation were detained for days in “cold, windowless cells” before they were transported to Mexico and abandoned.

They weren’t told why they had been arrested, given an opportunity to defend themselves, or allowed to call a lawyer or their families, the lawsuit alleges. It says that the four children of one deported father, who had no criminal record, “have become quiet and scared” and that his epileptic son’s “seizures have worsened.”

News of the raid spread quickly in California, where an estimated 880,000 mainly Latino farmworkers live. Dairies that employ immigrant labor produce nearly 80% of the U.S. milk supply, according to a 2014 survey.

“After Operation Return to Sender, dairy workers became even less willing to speak about the lack of protection on dairy farms and the lack of sick pay when they’re infected — even anonymously,” said Antonio De Loera-Brust, a spokesperson for the United Farm Workers.

Outreach workers in other states report a similar chilling effect from raids and immigration policies passed after Trump took office. He repeatedly degraded immigrants and pledged mass deportations on the campaign trail. “They’re not humans, they’re animals,” he said of immigrants illegally in the U.S. last April.

Trump’s first legislative action was to sign the Laken Riley Act into law, mandating federal detention for immigrants accused of any crime, regardless of whether they’re convicted. On Jan. 20, the Department of Homeland Security rescinded the “protected areas” policy, allowing agents to arrest people who don’t have legal status while they’re in schools, churches, or hospitals. Last month, the Trump administration deported more than 100 Venezuelans and others without a hearing, ignoring a court order to turn around planes flying the men to El Salvador.

The public health ramifications of farmworkers shrinking from view are potentially massive: Infectious disease scientists say that preventing people from getting bird flu and detecting cases are critical to warding off a bird flu pandemic. That’s why the government has funded efforts to protect farmworkers and monitor them for signs of bird flu, like red eyes or flu-like symptoms.

“Every time a worker gets sick, you’re rolling the die, so it’s in everyone’s interest to protect them,” De Loera-Brust said. “The virus doesn’t care what your immigration papers say.”

Pandemic Potential

About 65 dairy and poultry workers have tested positive for the bird flu since March 2024, but the true number of infections is higher. A KFF Health News investigation found that patchy surveillance resulted in cases going undetected on farms last year, and studies have revealed signs of prior infections in farmworkers who hadn’t been tested.

State and local health departments were beginning to overcome last year’s barriers to bird flu testing, said Salvador Sandoval, a doctor who retired recently from the Merced County health department in California. Now, he said, “people see a mobile testing unit and think it’s Border Patrol.”

Last year, outreach organizations connected with farmworkers at places where they gathered, like at food distribution events, but those are no longer well attended, Sandoval and others said.

“Regardless of immigration status, people who look like immigrants are feeling a lot of fear right now,” said Hunter Knapp, the development director at Project Protect Food Systems Workers, a farmworker advocacy organization in Colorado that does bird flu outreach. He said some Latino community health workers have scaled back their outreach efforts because they worry about being harassed by the authorities or members of the public.

A Latina outreach worker in Michigan, speaking on the condition of anonymity because she’s worried about retaliation against her family, said, “Many people don’t go to the doctor right now, because of the immigration situation.”

“They prefer to stay at home and let the pain or redness in the eye or whatever it is go away,” she said. “Things have really intensified this year, and people are very, very scared.”

The Centers for Disease Control and Prevention has reported far fewer human cases since Trump took office. During the three months before Jan. 20, the agency confirmed two dozen cases. Since then, it’s detected only three, including two people with cases severe enough to be hospitalized.

The CDC has said it continues to track the bird flu, but Jennifer Nuzzo, director of the Pandemic Center at Brown University, said the slowdown in cases might be due to a lack of testing. “I am concerned that we are seeing a contraction in surveillance and not necessarily a contraction in the spread of the virus.”

Undetected infections pose a threat to farmworkers and to the public at large. Because viruses evolve by mutating within bodies, each infection is like a pull of a slot machine lever. A person who died of the bird flu in Louisiana in December illustrates that point: Scientific evidence suggests that bird flu viruses evolved inside the patient, gaining mutations that may make the viruses more capable of spreading between humans. However, because the patient was isolated in a hospital, the more dangerous viruses didn’t transmit to others.

That might not happen if sick farmworkers don’t receive treatment and live in crowded households or windowless detention centers where they might infect others, said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. Although the bird flu doesn’t yet have the ability to spread easily between people through the air, like the seasonal flu, it might occasionally spread when people are in close quarters — and evolve to do so more efficiently.

“I worry that we might not figure out that this is happening until some people get severely sick,” Rasmussen said. “At that point, the numbers would be so large it could go off the rails.”

The virus might never evolve to spread easily, but it could. Rasmussen said that outcome would be “catastrophic.” Based on what’s known about human infections, she and her colleagues predict in a new report that an H5N1 bird flu pandemic “would overwhelm healthcare systems” and “cause millions more deaths” than the covid-19 pandemic.

Vaccinations Drop Off

Late last year, the CDC rolled out a seasonal flu vaccine campaign targeted at more than 200,000 livestock workers. The hope was that flu vaccinations would lessen the chance of a farmworker being infected by seasonal flu and bird flu viruses simultaneously. Co-infection gives the two flu viruses a chance to swap genes, potentially creating a bird flu virus that spreads as easily as the seasonal variety.

Yet Sandoval said flu vaccine uptake dropped immediately after the January operation in California.

U.S. Customs and Border Protection officials said in a statement that they arrested 78 immigrants “unlawfully present in the U.S.” during the three-day operation. They included a convicted sex offender and others with criminal histories including vandalism and petty theft, the statement said. The agency did not name allegations against each person and did not say whether all had been charged.

Former officials with the Biden administration, which was in its waning days as the arrests occurred, distanced itself from the operation in interviews with the Los Angeles Times.

Mayra Joachin, an attorney at the ACLU of Southern California, said the operation was unlike others under the Biden administration in that these were indiscriminate arrests by Border Patrol in the interior of the country. “It fits with the Trump administration’s broader campaign of instilling fear in immigrant communities,” she said, “as seen in the election campaign and in subsequent actions attacking anyone perceived to be a noncitizen in the country.”

In March, an assistant chief in the Border Patrol unit that conducted the operation, David Kim, called the operation a “proof of concept.”

“We know we can push beyond that limit now as far as distance goes,” he told the Southern California news outlet Inewsource.

The Department of Homeland Security did not respond to requests for comment. In an email, White House spokesperson Kush Desai wrote, “Despite what the ‘experts’ believe, combatting the Avian flu epidemic and enforcing our immigration laws are not mutually exclusive.”

Anna Hill Galendez, a managing attorney at the Michigan Immigrant Rights Center, which is involved in bird flu outreach, said unusually aggressive tactics by Immigration and Customs Enforcement agents deterred sick dairy workers in Michigan’s Upper Peninsula from leaving their homes for care in late January. They contacted the center for help.

“They wanted medical care. They wanted flu vaccines. They wanted [personal protective equipment]. They wanted to get tested,” Hill Galendez said. “But they were afraid to go anywhere because of immigration enforcement.”

Lynn Sutfin, a public information officer at the Michigan Department of Health and Human Services, responded to queries about the situation in the peninsula in an email to KFF Health News, saying, “The farmworkers did not take the local health department and MDHHS up on the testing offer.”

The CDC declined to comment on the impact of immigration actions on farmworker outreach.

To adapt to the new reality, Yanez now draws attention to her advice on the bird flu in Michigan by pairing it with information on immigrant rights. Knapp, in Colorado, said his organization is shifting its approach away from bird flu outreach at events where farmworkers congregate, because that could be perceived as a setup — and could inadvertently become one if ICE agents targeted such an event.

Outreach workers who live among farmworkers are withdrawing a little, too. “Being Latinos, we are always identified,” said the outreach worker who spoke on the condition of anonymity. “I have a visa that protects me, but things are changing very quickly under the Trump administration, and the truth is, nothing is certain.”

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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Más de una docena de clínicas de vacunación se cancelaron en el condado de Pima, en Arizona.

También una campaña en medios para que los niños de bajos recursos del condado de Washoe, en Nevada, se pusieran al día con sus vacunas.

Otras clínicas planificadas se cancelaran en Texas, Minnesota y Washington, entre otros lugares.

Los esfuerzos de inmunización en todo el país se vieron afectados después que, a fines de marzo, los Centros para el Control y Prevención de Enfermedades (CDC) cancelaran abruptamente $11.400 millones en fondos relacionados con covid-19 para los departamentos de salud estatales y locales.

Un juez federal bloqueó temporalmente los recortes a principios de abril, pero muchas de las organizaciones que reciben los fondos dijeron que deben proceder como si ya no hubiera más dinero, lo que genera preocupación en medio de un resurgimiento del sarampión, un aumento en la reticencia a las vacunas, y una creciente desconfianza en las agencias de salud pública.

“Me preocupa especialmente la accesibilidad de las vacunas para las poblaciones vulnerables”, declaró a KFF Health News Jerome Adams, ex cirujanos general de Estados Unidos. Adams formó parte del primer gobierno del presidente Donald Trump. “Sin altas tasas de vacunación, estamos exponiendo a esas poblaciones y comunidades a daños prevenibles”.

El Departamento de Salud y Servicios Humanos (HHS), bajo el cual operan los CDC, no hace comentarios sobre litigios en curso, según la vocera Vianca Rodríguez Feliciano. Sin embargo, envió un comunicado sobre la medida original, afirmando que el HHS realizó los recortes porque la pandemia de covid-19 ha terminado: “El HHS ya no malgastará miles de millones de dólares de los contribuyentes respondiendo a una pandemia inexistente que los estadounidenses superaron hace años”.

El punto es que las clínicas han utilizado ese dinero para abordar otras enfermedades prevenibles como la gripe, mpox (virus símica) y el sarampión. Más de 500 casos de sarampión en un brote en Texas hasta la fecha han provocado 57 hospitalizaciones y la muerte de dos niños en edad escolar.

En el condado de Pima, Arizona, las autoridades se enteraron de que uno de sus programas de vacunación tendría que interrumpirse debido a que el gobierno federal retiró el millón de dólares restante de la subvención. El condado tuvo que cancelar unos 20 eventos de vacunación que ya tenía programados, que ofrecían vacunas contra covid-19 y la gripe, según informó Theresa Cullen, directora del departamento de salud del condado. Y no puede planificar más, agregó.

El condado alberga a Tucson, la segunda ciudad más grande de Arizona. También abarca extensas zonas rurales, incluyendo parte de la Nación Tohono O’odham, que están lejos de muchas clínicas de salud y farmacias, explica Cullen.

El condado de Pima utilizó la subvención federal para ofrecer vacunas gratuitas en zonas principalmente rurales, en general los fines de semana o después del horario laboral habitual entre semana, explicó Cullen. Los programas se realizan en organizaciones comunitarias, durante ferias y otros eventos, o en autobuses convertidos en clínicas de salud móviles.

La cancelación de las subvenciones relacionadas con las vacunas tiene un impacto que va más allá de las tasas de inmunización, afirmó Cullen. Los eventos de vacunación también son una oportunidad para ofrecer educación sanitaria, conectar a las personas con otros recursos que puedan necesitar y fomentar la confianza entre las comunidades y los sistemas de salud pública, apuntó.

Los líderes del condado sabían que los fondos se agotarían a finales de junio, pero Cullen explicó que el departamento de salud había estado en conversaciones con las comunidades locales para hallar la manera de continuar con los eventos. Ahora, “les hemos dicho: ‘Lo sentimos, teníamos un compromiso con ustedes y no podemos cumplirlo'”, declaró.

Cullen afirmó que el departamento de salud no reanudará los eventos a pesar de que un juez bloqueó temporalmente los recortes de fondos.

“La subvención para la equidad en las vacunas es una subvención que va de los CDC al estado y a nosotros”, explicó. “El estado es quien nos dio la orden de suspender actividades”.

El impacto total de los recortes de los CDC aún no está claro en muchos lugares. Funcionarios del Departamento de Salud Pública de California estimaron que la cancelación de las subvenciones resultaría en pérdidas de al menos $840 millones en fondos federales para su estado, incluyendo $330 millones destinados al monitoreo del virus, pruebas, vacunas infantiles y la atención a las disparidades en salud.

“Estamos trabajando para evaluar el impacto de estas medidas”, declaró Erica Pan, directora del Departamento de Salud Pública de California.

En el condado de Washoe, en Nevada, los recortes sorpresivos de fondos federales implican la pérdida de dos empleados contratados que organizan y anuncian los eventos de vacunación, incluyendo las vacunas obligatorias para el regreso a clases contra enfermedades como el sarampión.

“Nuestro equipo principal no puede estar en dos lugares a la vez”, declaró Lisa Lottritz, directora de la división de servicios de salud comunitaria y clínica del Departamento de Salud Pública del Norte de Nevada.

Esperaba retener a los contratistas hasta junio, fecha prevista de vencimiento de las subvenciones. El distrito de salud se apresuró a encontrar fondos para mantener a los dos trabajadores unas semanas más. Consiguieron suficiente para pagarles solo hasta mayo.

Lottritz canceló de inmediato una campaña publicitaria enfocada en que los niños con seguro médico público estuvieran al día con sus vacunas. Los eventos de vacunación en la clínica de salud pública continuarán, pero serán muy reducidos y con menos personal, dijo.

Las enfermeras que ofrecen vacunas en iglesias, centros para personas mayores y bancos de alimentos dejarán de hacerlo en mayo, cuando se agote el dinero para pagar a los trabajadores.

“El personal tiene otras responsabilidades. Realizan visitas de cumplimiento, gestionan nuestra clínica, así que no tendré los recursos para organizar eventos como ese”, dijo Lottritz.

El efecto de las cancelaciones se sentirá durante mucho tiempo, dijo Chad Kingsley, oficial de salud del distrito de Salud Pública del Norte de Nevada, y podrían pasar años hasta que se sienta el alcance total de la disminución de la vacunación.

“Nuestra sociedad no tiene un conocimiento colectivo de esas enfermedades y lo que causaron”, dijo.

El sarampión es una preocupación prioritaria en Missouri, donde una conferencia sobre el fortalecimiento de los esfuerzos de inmunización a nivel estatal se canceló abruptamente debido a los recortes.

La Coalición de Inmunización de Missouri, que organizó el evento del 24 y 25 de abril, también tuvo que despedir a la mitad de su personal, según la presidenta de la junta, Lynelle Phillips. Esta coalición, que coordina la promoción y educación sobre vacunación en todo el estado, ahora debe encontrar financiación alternativa para seguirá operando.

“Es simplemente cruel y completamente incorrecto hacer esto en medio de un resurgimiento del sarampión en el país”, declaró Phillips.

Dana Eby, del departamento de salud del condado de New Madrid, en Missouri, tenía previsto compartir en la conferencia consejos sobre cómo generar confianza en las vacunas en las comunidades rurales, incluyendo el uso de enfermeras escolares y el programa Vacunas para Niños, financiado por los CDC.

New Madrid tiene una de las tasas de vacunación infantil más altas del estado, a pesar de pertenecer a la región mayoritariamente rural de “Bootheel”, conocida por sus malas condiciones sanitarias. Más del 98% de los niños de kínder del condado recibieron la vacuna contra el sarampión, las paperas y la rubéola en el ciclo escolar 2023-24, en comparación con el promedio estatal de alrededor del 91% y tasas tan bajas como el 61% en otros condados.

“Diré que creo que el sarampión será un problema antes de jubilarme”, dijo Eby, de 42 años.

También estaba previsto que hablara en el evento de Missouri el ex director general de servicios de salud, Adams, quien comentó que planeaba enfatizar la necesidad de la colaboración comunitaria y la importancia de la vacunación para proteger la salud pública y reducir las enfermedades prevenibles. Agregó que el momento era especialmente oportuno dado el aumento repentino de casos de sarampión en Texas y el aumento de casos y muertes por tos ferina en Louisiana.

“No podemos hacer a Estados Unidos más saludable retrocediendo en nuestras tasas de vacunación históricamente altas”, afirmó Adams. “No puedes morir de enfermedades crónicas a los 50 años si ya has muerto de sarampión, polio o tos ferina a los 5”.

Christine Mai-Duc, corresponsal en California, colaboró con este artículo.

Nos gustaría hablar con personal en funciones y ex empleados del Departamento de Salud y Servicios Humanos o sus agencias que crean que el público debe comprender el impacto de lo que está sucediendo dentro de la burocracia federal de salud. Por favor, envía un mensaje a KFF Health News en Signal al (415) 519-8778 o contáctanos aquí.

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EUTAW, Ala. — Leroy Walker arrived at the county hospital short of breath. Walker, 65 and with chronic high blood pressure, was brought in by one of rural Greene County’s two working ambulances.

Nurses checked his heart activity with a portable electrocardiogram machine, took X-rays, and tucked him into Room 122 with an IV pump pushing magnesium into his arm.

“I feel better,” Walker said. Then: Beep. Beep. Beep.

The Greene County Health System, with only three doctors, has no intensive care unit or surgical services. The 20-bed hospital averages a few patients each night, many of them, like Walker, with chronic illnesses.

Greene County residents are some of the sickest in the nation, ranking near the top for rates of stroke, obesity, and high blood pressure, according to data from the federal Centers for Disease Control and Prevention.

Patients entering the hospital waiting area encounter floor tiles that are chipped and stained from years of use. A circular reception desk is abandoned, littered with flyers and advertisements.

But a less visible, more critical inequity is working against high-quality care for Walker and other patients: The hospital’s internet connection is a fraction of what experts say is sufficient. High-speed broadband is the new backbone of America’s health care system, which depends on electronic health records, high-tech wireless equipment, and telehealth access.

Greene is one of more than 200 counties with some of the nation’s worst access to not only reliable internet, but also primary care providers and behavioral health specialists, according to a KFF Health News analysis. Despite repeated federal promises to support telehealth, these places remain disconnected.

During his first term, President Donald Trump signed an executive order promising to improve “the financial economics of rural healthcare” and touted “access to high-quality care” through telehealth. In 2021, President Joe Biden committed billions to broadband expansion.

KFF Health News found that counties without fast, reliable internet and with shortages of health care providers are mostly rural. Nearly 60% of them have no hospital, and hospitals closed in nine of the counties in the past two decades, according to data collected by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill.

Residents in these “dead zone” counties tend to live sicker and die younger than people in the rest of the United States, according to KFF Health News’ analysis. They are places where systemic poverty and historical underinvestment are commonplace, including the remote West, Appalachia, and the rural South.

“It will always be rural areas with low population density and high poverty that are going to get attended to last,” said Stephen Katsinas, director of the Education Policy Center at the University of Alabama. “It’s vital that the money we do spend be well deployed with a thoughtful plan.”

Now, after years of federal and state planning, Biden’s $42 billion Broadband Equity Access and Deployment, or BEAD, program, which was approved with bipartisan support in 2021, is being held up, just as states — such as Delaware — were prepared to begin construction. Trump’s new Department of Commerce secretary, Howard Lutnick, has demanded “a rigorous review” of the program and called for the elimination of regulations.

Trump’s nominee to lead the federal agency overseeing the broadband program, Arielle Roth, repeatedly said during her nomination hearing in late March that she would work to get all Americans broadband “expeditiously.” But when pressed by senators, Roth declined to provide a timeline for the broadband program or confirm that states would receive promised money.

Instead, Roth said, “I look forward to reviewing those allocations and ensuring the program is compliant with the law.”

Sen. Maria Cantwell (D-Wash.), the Senate commerce committee’s ranking minority member, said she wished Roth had been more committed to delivering money the program promised.

The political wrangling in Washington is unfolding hundreds of miles from Greene County, where only about half of homes have high-speed internet and 36% of the population lives below the poverty line, according to the U.S. Census Bureau.

Walker has lived his life in Alabama’s Black Belt and once worked as a truck driver. He said his high blood pressure emerged when he was younger, but he didn’t take the medicine doctors prescribed. About 11 years ago, his kidneys failed. He now needs dialysis three times a week, he said.

While lying in the hospital bed, Walker talked about his dialysis session the day before, on his birthday. As he talked, the white sheet covering his arm slipped and revealed where the skin around his dialysis port had swollen to the size of a small grapefruit.

Room 122, where Walker rested, is sparse with a single hospital bed, a chair, and a TV mounted on the wall. He was connected to the IV pump, but no other tubes or wires were attached to him. The IV machine’s beeping echoed through the hallway outside. Staffers say they must listen for the high-pitched chirps because the internet connection at the hospital is too slow to support a modern monitoring system that would display alerts on computers at the nurses’ station.

Aaron Brooks, the hospital’s technology consultant, said financial challenges keep Greene County from buying monitoring equipment. The hospital reported a $2 million loss on patient care in its most recent federal filing. Even if Greene could afford a system, it does not have the thousands of dollars to install a high-speed fiber-optic internet connection necessary to operate it, he said.

Lacking central monitoring, registered nurse Teresa Kendrick carries a portable pulse oximeter device, she said — like ones sold at drugstores that surged in popularity during the covid-19 pandemic.

Doing her job means a “continuous spot-check,” Kendrick said. Another longtime nurse described her job as “a lot of watching and checking.”

Beep. Beep.

The beeping in Room 122 persisted for more than two minutes as Walker talked. He wasn’t in pain — he was just worried about the beeping.

About 50 paces down the hall — past the pharmacy, an office, and another patient room — registered nurse Jittaun Williams sat at her station behind plexiglass. She was nearly 20 minutes past the end of her 12-hour shift and handing off to the three night-shift nurses.

They discussed plans for patients’ care, reviewing electronic records and flipping through paper charts. The nurses said the hospital’s internal and external computer systems are slow. They handwrite notes on paper charts in a patient’s room and duplicate records electronically. “Our system isn’t strong enough. There are many days you kind of sit here and wait,” Williams said.

Broadband dead zones like Greene County persist despite decades of efforts by federal lawmakers that have created a patchwork of more than 133 funding programs across 15 agencies, according to a 2023 federal report.

Alabama’s leaders, like others around the U.S., are actively spending federal funds from the Biden-era American Rescue Plan Act, according to public records. And Greene County Hospital is on the list of places waiting for ARPA construction, according to agreements provided by the Alabama Department of Economic and Community Affairs.

“It is taking too long, but I am patient,” said Alabama state Sen. Bobby Singleton, a Democrat who represents the district that includes Greene County Hospital and two others he said lack fast-enough connectivity. Speed bumps such as a need to meet federal requirements and a “big fight” to get internet service providers to come into his rural district slowed the release of funds, Singleton said.

Alabama received its first portion of ARPA funds in June 2021, which Singleton said included money for building fiber-optic cables to anchor institutions like the hospital. Alabama’s awards require the projects to be completed by February 2026 — nearly five years after money initially flowed to the state.

Singleton said he now sees fiber lines being built in his district every day and knows the hospital is “on the map” to be connected. “This doesn’t just happen overnight,” he said.

Alabama Fiber Network, a consortium of electric cooperatives, won a total of $45.7 million in ARPA funding specifically for construction to anchor institutions in Greene and surrounding counties. James Hoffman, vice president of external affairs for AFN, said the company is ahead of schedule. It plans to offer the hospital a monthly service plan that uses fiber-optic lines by year’s end, he said.

Greene County Health System chief executive Marcia Pugh confirmed that she had talked with multiple companies but said she wasn’t sure the work would be complete in the time frame the companies predicted.

“You know, you want to believe,” Pugh said.

Beep. Beep.

Nurse Williams had finished the night-shift handoff when she heard beeps from Walker’s room.

She rushed toward the sound, accidentally ducking into Room 121 before realizing her mistake.

Once in Walker’s room, Williams pressed buttons on the IV pump. The magnesium flowing in the tube had stopped.

“You had a little bit more left in the bag, so I just turned it back on,” Williams told Walker. She smiled gently and asked if he was warm enough. Then she hand-checked his heart rate and adjusted his sheets. At the bottom of the bed, Walker’s feet hung off the mattress and Williams gently moved them and made sure they were covered.

Walker beamed. At this hospital, he said, “they care.”

As rural hospitals like Greene’s wait for fast-enough internet, nurses like Williams are “heroes every single day,” said Aaron Miri, an executive vice president and the chief digital and information officer for Baptist Health in Jacksonville, Florida.

Miri, who served under both Democratic and Republican administrations on Department of Health and Human Services technology advisory committees, said hospitals need at least a gigabit of speed — which is 1,000 megabits per second — to support electronic health records, video consultations, the transfer of scans and images, and continuous remote monitoring of patients’ heartbeats and other vital signs.

But Greene’s is less than 10% of that level, recorded on the nurses’ station computer as nearly 90 megabits per second for upload and download speeds.

It’s a “heartbreaking” situation, Miri said, “but that’s the reality of rural America.”

The Beeping Stopped

Michael Gordon, one of the hospital’s three doctors, arrived the next morning for his 24-hour shift. He paused in Room 122. Walker had been released overnight.

Not being able to monitor a cardiovascular patient’s heart rhythm, well, “that’s a problem,” Gordon said. “You want to know, ‘Did something really change or is that just a crazy IV machine just beeping loud and proud and nobody can hear it?’”

Despite the lack of modern technology tools, staffers do what they can to take care of patients, Pugh said. “We show the community that we care,” she said.

Pugh, who started her career as a registered nurse, arrived at the hospital in 2017. It was “a mess,” she said. The hospital was dinged four years in a row, starting in 2016, with reduced Medicare payments for readmitting patients. Pugh said that at times the hospital had not made payroll. Staff morale was low.

In 2021, federal inspectors notified Pugh of an “immediate jeopardy” violation — grounds for regulators to shut off federal payments — because of an Emergency Medical Treatment and Labor Act complaint. Among seven deficiencies inspectors cited, the hospital failed to provide a medical screening exam or stabilizing treatment and did not arrange appropriate transfer for a 23-year-old woman who arrived at the hospital in labor, according to federal reports.

Inspectors also said the hospital failed to ensure a doctor was on duty and failed to create and maintain medical records. An ambulance took the woman to another hospital, where the baby was “pronounced dead upon arrival,” according to the report.

Federal inspectors required the hospital to take corrective actions and a follow-up inspection in July 2021 found the hospital to be in compliance.

In 2023, federal inspectors again cited the hospital’s failure to maintain records and noted it had the “potential to negatively affect patients.”

Inspectors that year found that medical records for four discharged patients had been lost. The “physical record” included consent forms, physician orders, and treatment plans and was found in another department, where it had been left for two months.

Pugh declined to comment on the immediate jeopardy case. She confirmed that a lack of internet connectivity and use of paper charts played a role in federal findings, though she emphasized the charts were discharge papers rather than for patients being treated.

She said she understands why federal regulators require electronic health records but “our hospitals just aren’t the same.” Larger facilities that can “get the latest and greatest” compared with “our facilities that just don’t have the manpower or the financials to purchase it,” she said, “it’s two different things.”

Walker, like many rural Americans, relies on Medicaid, a joint state and federal insurance program for people with low incomes and disabilities. Rural hospitals in states such as Alabama that have not expanded Medicaid coverage to a wider pool of residents fare worse financially, research shows.

During Walker’s stay, because the hospital can’t afford to modernize its systems, nurses dealt with what Pugh later called an “astronomical” number of paper forms.

Later, at Home

Walker sat on the couch in the modest brick home he shares with his sister and nephew. In a pinch, Greene County Hospital, he said, is good “for us around here. You see what I’m saying?”

Still, Walker said, he often bypasses the county hospital and drives up the road to Tuscaloosa or Birmingham, where they have kidney specialists.

“We need better,” Walker said, speaking for the 7,600 county residents. He wondered aloud what might happen if he didn’t make it to the city for specialty care.

Sometimes, Walker said, he feels “thrown away.”

“People done forgotten about me, it feels like,” he said. “They don’t want to fool with no mess like me.”

Maybe Greene County’s health care and internet will get better, Walker said, adding, “I hope so, for our sake out in a rural area.”

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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More than a dozen vaccination clinics were canceled in Pima County, Arizona.

So was a media blitz to bring low-income children in Washoe County, Nevada, up to date on their shots.

Planned clinics were also scuttled in Texas, Minnesota, and Washington, among other places.

Immunization efforts across the country were upended after the federal Centers for Disease Control and Prevention abruptly canceled $11.4 billion in covid-related funds for state and local health departments in late March.

A federal judge temporarily blocked the cuts last week, but many of the organizations that receive the funds said they must proceed as though they’re gone, raising concerns amid a resurgence of measles, a rise in vaccine hesitancy, and growing distrust of public health agencies.

“I’m particularly concerned about the accessibility of vaccines for vulnerable populations,” former U.S. surgeon general Jerome Adams told KFF Health News. Adams served in President Donald Trump’s first administration. “Without high vaccination rates, we are setting those populations and communities up for preventable harm.”

The Department of Health and Human Services, which houses the CDC, does not comment on ongoing litigation, spokesperson Vianca Rodriguez Feliciano said. But she sent a statement on the original action, saying that HHS made the cuts because the covid-19 pandemic is over: “HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago.”

Still, clinics have also used the money to address other preventable diseases such as flu, mpox, and measles. More than 500 cases of measles so far in a Texas outbreak have led to 57 hospitalizations and the deaths of two school-age children.

In Pima County, Arizona, officials learned that one of its vaccination programs would have to end early because the federal government took away its remaining $1 million in grant money. The county had to cancel about 20 vaccine events offering covid and flu shots that it had already scheduled, said Theresa Cullen, director of the county health department. And it isn’t able to plan any more, she said.

The county is home to Tucson, the second-largest city in Arizona. But it also has sprawling rural areas, including part of the Tohono O’odham Nation, that are far from many health clinics and pharmacies, she said.

The county used the federal grant to offer free vaccines in mostly rural areas, usually on the weekends or after usual work hours on weekdays, Cullen said. The programs are held at community organizations, during fairs and other events, or inside buses turned into mobile health clinics.

Canceling vaccine-related grants has an impact beyond immunization rates, Cullen said. Vaccination events are also a chance to offer health education, connect people with other resources they may need, and build trust between communities and public health systems, she said.

County leaders knew the funding would run out at the end of June, but Cullen said the health department had been in talks with local communities to find a way to continue the events. Now “we’ve said, ‘Sorry, we had a commitment to you and we’re not able to honor it,’” she said.

Cullen said the health department won’t restart the events even though a judge temporarily blocked the funding cuts.

“The vaccine equity grant is a grant that goes from the CDC to the state to us,” she said. “The state is who gave us a stop work order.”

The full effect of the CDC cuts is not yet clear in many places. California Department of Public Health officials estimated that grant terminations would result in at least $840 million in federal funding losses for its state, including $330 million used for virus monitoring, testing, childhood vaccines, and addressing health disparities.

“We are working to evaluate the impact of these actions,” said California Department of Public Health Director Erica Pan.

In Washoe County, Nevada, the surprise cuts in federal funding mean the loss of two contract staffers who set up and advertise vaccination events, including state-mandated back-to-school immunizations for illnesses such as measles.

“Our core team can’t be in two places at once,” said Lisa Lottritz, division director for community and clinical health services at Northern Nevada Public Health.

She expected to retain the contractors through June, when the grants were scheduled to sunset. The health district scrambled to find money to keep the two workers for a few more weeks. They found enough to pay them only through May.

Lottritz immediately canceled a publicity blitz focused on getting children on government insurance up to date on their shots. Vaccine events at the public health clinic will go on, but are “very scaled back” with fewer staff members, she said. Nurses offering shots out and about at churches, senior centers, and food banks will stop in May, when the money to pay the workers runs out.

“The staff have other responsibilities. They do compliance visits, they’re running our clinic, so I won’t have the resources to put on events like that,” Lottritz said.

The effect of the cancellations will reverberate for a long time, said Chad Kingsley, district health officer for Northern Nevada Public Health, and it might take years for the full scope of decreasing vaccinations to be felt.

“Our society doesn’t have a collective knowledge of those diseases and what they did,” he said.

Measles is top of mind in Missouri, where a conference on strengthening immunization efforts statewide was abruptly canceled due to the cuts.

The Missouri Immunization Coalition, which organized the event for April 24-25, also had to lay off half its staff, according to board president Lynelle Phillips. The coalition, which coordinates immunization advocacy and education across the state, must now find alternative funding to stay open.

“It’s just cruel and unthinkably wrong to do this in the midst of a measles resurgence in the country,” Phillips said.

Dana Eby, of the health department in New Madrid County, Missouri, had planned to share tips about building trust for vaccines in rural communities at the conference, including using school nurses and the Vaccines for Children program, funded by the CDC.

New Madrid has one of the highest childhood vaccination rates in the state, despite being part of the largely rural “Bootheel” region that is often noted for its poor health outcomes. Over 98% of kindergartners in the county received the vaccine for measles, mumps, and rubella in 2023-24 compared with the state average of about 91%, and rates in some other counties as low as 61%.

“I will say I think measles will be a problem before I retire,” Eby, 42, said.

Also slated to speak at the Missouri event was former surgeon general Adams, who said he had planned to emphasize the need for community collaboration and the importance of vaccinations in protecting public health and reducing preventable diseases. He said the timing was especially pertinent given the explosion in measles cases in Texas and the rise in whooping cough cases and deaths in Louisiana.

“We can’t make America healthy again by going backwards on our historically high U.S. vaccination rates,” Adams said. “You can’t die from chronic diseases when you’re 50 if you’ve already died from measles or polio or whooping cough when you’re 5.”

California correspondent Christine Mai-Duc contributed to this article.

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

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

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Christopher Julian’s opioid journey is familiar to many Americans.

He was prescribed painkillers as a teenager for a series of sports injuries. He said the doctor never warned him they could be addictive. Julian didn’t learn that fact until years later, when he was cut off and began suffering withdrawal symptoms. At that point, he started siphoning pills from family members and buying them from others in his southern Maine community.

After his brother died of brain cancer in 2011, Julian used opioids to cope with more than physical pain.

He stole to support his addiction, cycled in and out of jail and treatment, and overdosed 10 times, he said. His mother once gave him CPR on their bathroom floor.

Life was “hell on Earth,” said Julian, now 43 and in long-term recovery.

Like tens of thousands of others who have suffered similarly, Julian filed claims for compensation from pharmaceutical companies accused of fueling the opioid crisis.

Earlier this year, he received his first payout: $324.58.

That’s enough to fill his car with gas about eight times or pay about a tenth of the rent for an apartment he shares with his fiancee and two children.

Meanwhile, Maine’s Cumberland County, where Julian lives, has received more than $700,000 in opioid settlement money and expects nearly $1.6 million more in the coming years, according to a newly updated database from KFF Health News. Jurisdictions throughout his state have received more than $68 million to date, and governments nationwide have raked in upward of $10 billion, the database shows.

That discrepancy between individuals’ and governments’ compensations highlights a sense of injustice felt by people directly affected by the crisis who say their suffering is the reason that governments secured these settlements.

Opioid settlements with companies like Purdue Pharma, Walmart, and Johnson & Johnson have led to headline-grabbing multibillion-dollar payouts, but most of the windfall is flowing to state and local governments, not directly to victims of the crisis.

Only a handful of companies — those that filed for bankruptcy, including Purdue Pharma, Mallinckrodt, Endo, and Rite Aid — have set aside payouts for individuals. To qualify, people must have filed claims within a certain window and provided documents proving they were prescribed painkillers from that company. Even then, many victims will receive just a few thousand dollars, lawyers and advocates estimate. Most of these companies have not started paying yet, so victims might have to wait months or years more before seeing the cash.

In contrast, state and local governments have already received settlement money. To understand the size of those payouts, KFF Health News in January downloaded data from BrownGreer, the court-appointed firm administering many national opioid settlements, and used it to update a searchable database that allows users to determine how much their city, county, or state has received or expects to receive each year.

Governments are receiving that money because attorneys general argued that their states’ public safety, health, and social service systems were harmed by the opioid crisis. Jurisdictions are supposed to spend settlement money on addiction treatment, recovery, and prevention programs. But many affected individuals and families say governments have failed to adhere to that mission.

“At the very minimum, they could spend these dollars right to prevent the future loss of life,” said Ryan Hampton, a national recovery advocate and previous co-chair of a committee in the Purdue Pharma bankruptcy case, where he represented victims. “That is the opposite of what we’ve seen to date.”

In Pennsylvania, a group of bereaved family members raised similar concerns to Democratic Gov. Josh Shapiro, who finalized opioid settlements when he was attorney general.

“Instead of directing funds toward evidence-based solutions, you and your administration have allowed counties to divert these resources into law enforcement, ineffective programs, and initiatives that already have other funding streams available — disrespecting both our families and the lives lost,” they wrote in a letter dated Feb. 14. “Meanwhile, bereaved families — many of whom have lost everything — have no financial relief.”

‘Governments Were Way More Powerful’

To be sure, many governments have spent millions of settlement dollars on treatment programs, recovery supports, distribution of overdose reversal medications, and other efforts. Some officials in charge of the money say those services, which reach many residents, can have a greater impact than individual payouts.

Will Simons, a spokesperson for the Pennsylvania governor, said in a statement that the Shapiro administration has invested nearly $90 million of settlement funds into treatment, recovery, harm reduction, and prevention initiatives, including prevention programs for youths, a drug and alcohol call center, and loan repayment programs aimed at retaining workers in the addiction treatment and recovery field.

Many of the awarded organizations “support families who have lost loved ones to this crisis, providing counseling and other family supports,” Simons said.

A few jurisdictions have created fairly modest funds directed at individuals, such as one in Boston to aid families who have lost loved ones to addiction, and a fund in Alabama for grandparents having to raise children because of parental substance use.

But nationwide, there’s little that resembles the widespread cash payments that many advocates, like Hampton, originally envisioned.

In the mid-2010s, Hampton said, he and other advocates considered filing class action lawsuits against pharmaceutical companies but realized they didn’t have the resources.

A few years later, when state attorneys general began pursuing cases against those companies, victims were thrilled, thinking they would finally get compensation alongside their governments. Hampton and other advocates held rallies, shared their stories publicly, and galvanized support for the states’ lawsuits.

In 2019, when Hampton became co-chair of the Official Committee of Unsecured Creditors in Purdue Pharma’s bankruptcy and arrived at the negotiating table with state attorneys general and other entities, he thought “everybody was there to take on the big bad pharmaceutical company and to put victims’ interests first,” he said. But as the negotiation proceeded among various creditors vying for the company’s assets, he said, “governments were way more powerful than victims and believed that they were more harmed than victims in terms of cost.”

Details of the Purdue settlement are still being finalized, and payments are unlikely to start until next year, but estimates suggest state and local governments will receive the lion’s share, while more than 100,000 victims will split a fraction of the bankruptcy payout.

Mallinckrodt, a manufacturer of generic opioids, is the only company that had begun paying victims as of early 2025, said Frank Younes, a partner at the Nebraska-based law firm High & Younes, which is representing personal injury claimants in several opioid bankruptcies.

After paying roughly 25% in administrative fees to the national trust overseeing the bankruptcy and an additional 40% in attorney fees, some of his clients have received between $400 and $700, Younes said.

He expects payouts from two other companies — Endo and Rite Aid — “will be even lower.”

But many victims won’t receive anything. Some didn’t know they could file claims until it was too late. Others struggled to obtain medical records from shuttered doctors’ offices or pharmacies that didn’t retain older documents.

Out of nearly 20,000 people who contacted Younes’ firm to participate in the various opioid bankruptcies, he said, only about 3,500 were able to file.

‘Do Something for These Families’

John McNerney was told his Purdue Pharma claim didn’t qualify, because he hadn’t been prescribed enough OxyContin to meet the threshold. He submitted claims for Mallinckrodt and Endo instead.

McNerney, 60, who lives in Boca Raton, Florida, said he suffered a spinal injury decades ago from a fall during a plumbing repair. For years afterward, he was prescribed various painkillers. Once his doctors cut him off, he began using pills a friend bought off the street. McNerney spent about $30,000 on rehabs before he entered long-term recovery.

Now when he sees governments spending settlement money on police cars or library books about addiction “instead of putting 100% of it into rehab,” he said, “it really bothers the heck out of me.”

“I haven’t received a nickel,” he said.

In Ohio, a group of affected families were similarly frustrated that money wasn’t reaching them or the places where they thought it was needed most.

The families teamed up with local nonprofits to submit grant applications to the OneOhio Recovery Foundation, which controls most of the state’s opioid settlement funds. They asked for several million dollars to put toward family support groups, training for family members who take in children whose parents have substance use disorders, and emergency cash aid for families to buy cribs or school supplies and cover funeral costs.

Jackie Lewis, a member of the group, said that when her 34-year-old son, Shaun, died of an overdose, she had to pay his funeral costs by credit card. She has filed a claim in the opioid bankruptcies but hasn’t received any money yet.

“Too many families didn’t have a credit card to do that with,” Lewis said. “There are families I’ve talked to that couldn’t do flowers. Some had to do a cremation instead of a traditional funeral.”

Her group did not receive funding in the first round of grants from the OneOhio Recovery Foundation.

Connie Luck, a spokesperson for the foundation, said the legal documents that established the foundation do not allow direct payments to individuals affected by the crisis. The foundation has awarded over $45 million to 245 projects throughout the state, including dozens that provide family support services like child care and rental assistance.

“We deeply empathize with those who have lost loved ones to the opioid epidemic — their pain is real, and it fuels the Foundation’s mission to end this crisis and prevent it from happening again,” Luck said in a statement.

In Maine, Julian has made peace with his $325 payout, deciding to consider it a surprise bonus rather than compensation for his years of suffering.

But he hopes governments will use their more substantial sums to provide real help — food and rental assistance for people in recovery and more treatment beds so no one has to wait six months to enter rehab as he once did.

“They’re getting millions of dollars,” said Julian, who has lost numerous close friends to overdose. “They could do something for these families that have suffered great losses.”

KFF Health News data editor Holly K. Hacker contributed to this article.

Methodology

For more than two years, KFF Health News has been tracking how state and local governments use — and misuse — billions of dollars in opioid settlement funds. This database marks our third update of data showing how much money state and local governments have received through national settlements with companies that made or distributed prescription painkillers.

BrownGreer, the court-appointed firm administering many national opioid settlements, tracks how much money it has delivered to various state and local governments, as well as how much is allocated to those jurisdictions for future years. It initially kept this information private.

In 2023, KFF Health News negotiated to obtain that information and made it public for the first time. Five months later, BrownGreer began posting updated versions of the information on a public website.

Last year, KFF Health News downloaded BrownGreer’s data on payouts from pharmaceutical distributors AmerisourceBergen (now called Cencora), Cardinal Health, and McKesson, as well as opioid manufacturer Janssen (now known as Johnson & Johnson Innovative Medicine), and used the state-by-state spreadsheets with separate entries for each settling company to create a searchable database.

This year, KFF Health News has updated that database with new data from BrownGreer, including payouts from opioid manufacturers Allergan and Teva, as well as CVS, Walgreens, and Walmart pharmacies.

KFF Health News downloaded data from BrownGreer’s website between Jan. 20 and 24, 2025, concerning payouts from all companies. Users can use the database to determine the total dollar amount their city, county, or state has received or expects to receive each year.

Although this is the most comprehensive data available at a national scale, it provides just a snapshot of all opioid settlement payouts. Other settlements, including with OxyContin manufacturer Purdue Pharma, are still pending. This data does not reflect additional settlements that some state and local governments have entered into beyond the national deals, such as the agreement between Illinois, Indiana, Kentucky, Michigan, and Ohio and regional supermarket chain Meijer. As such, this database undercounts the amount of opioid settlement money most places have received and will receive.

Payment details for some states are not available, because those states were not part of national settlement agreements, had unique settlement terms, or opted not to have their payments distributed via BrownGreer. A few examples:

• West Virginia declined to join several national settlements and instead reached individual settlements with many of these companies.• Texas and Nevada were paid in full by Janssen outside the national settlement, so their payout data reflects payments only from other companies with which they entered national settlements.• Florida, Louisiana, and Pennsylvania, among others, opted to receive a lump-sum payment via BrownGreer then distribute the money to localities themselves.

BrownGreer shows that several states received some of their anticipated 2027 payment from the distributors (AmerisourceBergen — now called Cencora — Cardinal Health, and McKesson) early in 2024. However, for three states — Colorado, Michigan, and Washington — BrownGreer does not provide data on how much of this prepayment went to each locality. As such, locality payments in these states may be undercounted for 2024 and overcounted for 2027.

For Oregon, BrownGreer shows 2024 payments from Walmart as fully paid in its statewide data but lists some August 2024 payments for localities as “projected.” Since the data was downloaded well past that August 2024 date, we have included those “projected” amounts in the 2024 paid total for Oregon localities. No other states had this discrepancy.

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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When the catastrophic Los Angeles fires broke out, John Volckens suspected firefighters and residents were breathing toxic air from the burning homes, buildings, and cars, but it was unclear how much risk the public faced. So, the professor of environmental health at Colorado State University devised a plan to get answers.

Volckens shipped 10 air pollution detectors to Los Angeles to measure the amounts of heavy metals, benzene, and other chemicals released by the flames, which burned more than 16,000 homes, businesses, and other structures, making it one of the country’s costliest natural disasters.

“These disaster events keep happening. They release pollution into the environment and to the surrounding community,” said Volckens, who shared his results with local air regulators. “We have this kind of traumatic experience, and then we’re left with: Well, what did we just breathe in?”

Scientists and public health officials have long tracked the pollutants that cause smog, acid rain, and other environmental health hazards and shared them with the public through the local Air Quality Index. But the monitoring system misses hundreds of harmful chemicals released in urban fires, and the Los Angeles fires have led to a renewed push for state and federal regulators to do more as climate change drives up the frequency of these natural disasters.

It’s questionable whether the Trump administration will act, however. Last month, Environmental Protection Agency Administrator Lee Zeldin announced what he described as the “biggest deregulatory” action in history, which critics warn will lead to a rollback of environmental health regulations.

While Air Quality Index values are a good starting place for knowing what’s in the air, they don’t provide a full picture of pollutants, especially during disasters, said Yifang Zhu, a professor of environmental health sciences at UCLA. In fact, the AQI could be in a healthy range, “but you could still be exposed to higher air toxins from the fires,” she added.

In February, nearly a dozen lawmakers from California called on the EPA to create a task force of local and federal authorities to better monitor what’s in the air and inform the public. Locals are “unsure of the actual risks they face and confused by conflicting reports about how safe it is to breathe the air outside, which may lead to families not taking adequate protective measures,” the lawmakers wrote in a letter to James Payne, who was then the acting EPA administrator. The EPA press office declined to comment in an e-mail to KFF Health News.

Lawmakers have also introduced bills in Congress and in the California legislature to address the gap. A measure by U.S. Rep. Mike Thompson (D-Calif.) and U.S. Sen. Jeff Merkley (D-Ore.) would direct the EPA to allocate grant money to local air pollution agencies to communicate the risks of wildfire smoke, including deploying air monitors. Meanwhile, a bill by Democratic state Assembly member Lisa Calderon would create a “Wildfire Smoke Research and Education Fund” to study the health impacts of wildfire smoke, especially on firefighters and residents affected by fires.

The South Coast Air Quality Management District, a regional air pollution control agency, operates about 35 air monitoring stations across nearly 11,000 square miles of the Los Angeles region to measure pollutants like ozone and carbon monoxide.

During the fires, the agency, which is responsible for the air quality of 16.8 million residents, relied on its network of stations to monitor five common pollutants, including PM2.5, the fine particles that make up smoke and can travel deep inside the body. After the fires, the South Coast AQMD deployed two mobile monitoring vans to assess air quality in cleanup areas and expanded neighborhood-level monitoring during debris removal, said Jason Low, head of the agency’s monitoring and analysis division.

Local officials also received the data collected by Volcken’s devices, which arrived on-site four days after the fires broke out. The monitors — about the size of a television remote control and housed in a plastic cover the size of a bread loaf — were placed at air monitoring stations around the fires’ perimeters, as well as at other sites, including in West Los Angeles and Santa Clarita. The devices, called AirPens, monitored dozens of air contaminants in real time and collected precise chemical measurements of smoke composition.

Researchers replaced the sensors every week, sending the filters to a lab that analyzed them for measurements of volatile organic compounds like benzene, lead, and black carbon, along with other carcinogens. Volcken’s devices provided public health officials with data for a month as cleanup started. The hope is that the information provided can help guide future health policies in fire-prone areas.

“There’s not one device that can measure everything in real time,” Low said. “So, we have to rely on different tools for each different type of purpose of monitoring.”

ASCENT, a national monitoring network funded by the National Science Foundation, registered big changes after the fires. One monitor, about 11 miles south of the Eaton fire in the foothills of the San Gabriel Mountains, detected 40 times the normal amount of chlorine in the air and 110 times the typical amount of lead in the days following the fires. It was clear the chemical spikes came from urban wildfire smoke, which is more dangerous than what would be emitted when trees and bushes burn in rural areas, said Richard Flagan, the co-principal investigator at the network’s site in Los Angeles.

“Ultimately, the purpose is to get the data out there in real time, both for the public to see but also for people who are doing other aspects of research,” said Flagan, adding that chemical measurements are critical for epidemiologists who are developing health statistics or doing long-term studies of the impact of air pollution on peoples’ health.

Small, low-cost sensors could fill in gaps as government networks age or fail to adequately capture the full picture of what’s in the air. Such sensors can identify pollution hot spots and improve wildfire smoke warnings, according to a March 2024 U.S. Government Accountability Office report.

Although the devices have become smaller and more accurate in the past decade, some pollutants require analysis with X-ray scans and other costly high-level equipment, said J. Alfredo Gómez, director of the Natural Resources and Environment team at the GAO. And Gómez cautioned that the quality of the data can vary depending on what the devices monitor.

“Low-cost sensors do a good job of measuring PM2.5 but not such a good job for some of these other air toxins, where they still need to do more work,” Gómez said.

UCLA’s Zhu said the emerging technology of portable pollution monitors means residents — not just government and scientists — might be able to install equipment in their backyards and broaden the picture of what’s happening in the air at the most local level.

“If the fires are predicted to be worse in the future, it might be a worthwhile investment to have some ability to capture specific types of pollutants that are not routinely measured by government stations,” Zhu said.

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

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Rural hospital leaders are questioning whether they can continue to afford to do business with Medicare Advantage companies, and some say the only way to maintain services and protect patients is to end their contracts with the private insurers.

Medicare Advantage plans pay hospitals lower rates than traditional Medicare, said Jason Merkley, CEO of Brookings Health System in South Dakota. Merkley worried the losses would spark staff layoffs and cuts to patient services. So last year, Brookings Health dropped all four contracts it had with major Medicare Advantage companies.

“I’ve had lots of discussions with CEOs and executive teams across the country in regard to that,” said Merkley, whose health system operates a hospital and clinics in the small city of Brookings and surrounding rural areas.

Merkley and other rural hospital operators in recent years have enumerated a long list of concerns about the publicly funded, privately run health plans. In addition to the reimbursement issue, their complaints include payment delays and a resistance to authorizing patient care.

But rural hospitals abandoning their Medicare Advantage contracts can leave local patients without nearby in-network providers or force them to scramble to switch coverage.

Medicare is the main federal health insurance program for people 65 or older. Participants can enroll in traditional, government-run Medicare or in a Medicare Advantage plan run by a private insurance company.

In 2024, 56% of urban Medicare recipients were enrolled in a private plan, according to a report by the Medicare Payment Advisory Commission, a federal agency that advises Congress. While just 47% of rural recipients enrolled in a private plan, Medicare Advantage has expanded more quickly in rural areas.

In recent years, average Medicare Advantage reimbursements to rural hospitals were about 90% of what traditional Medicare paid, according to a new report from the American Hospital Association. And traditional Medicare already pays hospitals much less than private plans, according to a recent study by Rand Corp., a research nonprofit.

Carrie Cochran-McClain, chief policy officer at the National Rural Health Association, said Medicare Advantage is particularly challenging for small rural facilities designated critical access hospitals. Traditional Medicare pays such hospitals extra, but the private insurance companies aren’t required to do so.

“The vast majority of our rural hospitals are not in a position where they can take further cuts to payment,” Cochran-McClain said. “There are so many that are just really in a precarious financial spot.”

Nearly 200 rural hospitals have ended inpatient services or shuttered since 2005.

Mehmet Oz — doctor, former talk show host, and newly confirmed head of the Centers for Medicare & Medicaid Services — has promoted and worked for the private Medicare industry and called for “Medicare Advantage for all.” But during his recent confirmation hearing, he called for more oversight as he acknowledged bipartisan concerns about the plans’ cost to taxpayers and their effect on patients.

Cochran-McClain said some Republican lawmakers want to address these issues while supporting Medicare Advantage.

“But I don’t think we’ve seen enough yet to really know what direction that’s all going to take,” she said.

Medicare Advantage plans can offer lower premiums and out-of-pocket costs for some participants. Nearly all offer extra benefits, such as vision, hearing, and dental coverage. Many also offer perks, such as gym memberships, nutrition services, and allowances for over-the-counter health supplies.

But a recent study in the Health Services Research journal found that rural patients on private plans struggled to access and afford care more often than rural enrollees on traditional Medicare and urban participants in both kinds of plans.

Susan Reilly, a spokesperson for the Better Medicare Alliance, said a recent report published by her group, which promotes Medicare Advantage, found that private plans are more affordable than traditional Medicare for rural beneficiaries. That analysis was conducted by an outside firm and based on a government survey of Medicare recipients.

Reilly also pointed to a study in The American Journal of Managed Care that found the growth of private plans in rural areas from 2008-2019 was associated with increased financial stability for hospitals and a reduced risk of closure.

Merkley said that’s not what he’s seeing on the ground in rural South Dakota.

He said traditional Medicare reimbursed Brookings Health System 91 cents for every dollar it spent on care in 2023, while Medicare Advantage plans paid 76 cents per dollar spent. He said his staff tried negotiating better contracts with the big Medicare Advantage companies, to no avail.

Patients who remain on private plans that no longer contract with their local hospitals and clinics may face higher prices unless they travel to in-network facilities, which in rural areas can be hours away. Merkley said most patients at Brookings Health switched to traditional Medicare or to regional Medicare Advantage plans that work better with the hospital system.

But switching from private to traditional Medicare can be unaffordable for patients.

That’s because in most states, Medigap plans — supplemental plans that help people on traditional Medicare cover out-of-pocket costs — can deny coverage or base their prices on patients’ medical history if they switch from a private plan.

Some rural health systems say they no longer work with any Medicare Advantage companies. They include Great Plains Health, which serves parts of rural Nebraska, Kansas, and Colorado, and Kimball Health Services, which is based in two small towns in Nebraska and Wyoming.

Medicare Advantage plans often limit the providers patients can see and require referrals and prior authorization for certain services. Requesting referrals, seeking preauthorization, and appealing denials can delay treatment for patients while adding extra work for doctors and billing staff.

“The unique rural lens on that is that rural providers really tend to be pretty bare-bone shops,” Cochran-McClain said. “That kind of administrative burden pulls people away from really being able to focus on providing quality care to their beneficiaries.”

Jonathon Green, CEO of Taylor Health Care Group in rural Georgia, said his system had to set up a team to deal solely with coverage denials, mostly from Medicare Advantage companies. He said some plans frequently decline to authorize payments before treatments, refuse to cover services they already approved, and deny payment for care that shouldn’t need approval.

In these cases, Green said, the companies argue that the care wasn’t appropriate for the patient.

“We hear that term constantly — ‘It’s not medically necessary,’” he said. “That’s the catchall for everything.”

Green said Taylor Health Care Group has considered dropping its Medicare Advantage contracts but is keeping them for now.

Cochran-McClain said her group supports policy changes, such as a federal bill that aims to streamline prior authorization while requiring Medicare Advantage companies to share data about the process. The 2024 bill was co-sponsored by more than half of U.S. senators, but needs to be reintroduced this year.

Cochran-McClain said rural-health advocates also want the government to require private plans to pay critical access hospitals and similar rural facilities as much as they would receive from traditional Medicare.

Green and Merkley stressed that they aren’t against the concept of private Medicare plans; they just want them to be fairer to rural facilities and patients.

Green said rural and independent hospitals don’t have the leverage that urban hospitals and large chains do in negotiations with giant Medicare Advantage companies.

“We just don’t have the ability to swing the pendulum enough,” he said.

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Public access to government records that document the handling of illnesses, faulty products, and safety lapses at health facilities will slow after mass firings at the federal Department of Health and Human Services swept out staff members responsible for releasing records, according to transparency advocates and health experts.

HHS Secretary Robert F. Kennedy Jr.’s layoffs across health agencies in recent days eliminated workers who handled Freedom of Information Act requests at the Centers for Disease Control and Prevention and cut FOIA staff at the FDA and the National Institutes of Health, said six current and former federal workers KFF Health News agreed not to name because they fear retaliation and are not authorized to speak to the press.

FOIA is a transparency law that guarantees public access to the inner workings of federal agencies by requiring officials to release government documents. The 1966 law is a crucial tool for law firms, advocates, businesses, journalists, and the general public. It has been used to hold officials accountable and uncover harm, corruption, and political meddling in policymaking.

At HHS, FOIA requests are used to obtain a litany of records, including detailed CDC information about large outbreaks of food and waterborne illnesses, and FDA inspection reports of facilities that make food, drugs, medical devices, and dental products.

Peter Lurie, president of the Center for Science in the Public Interest, said the FOIA cuts would have “an enormous effect on patient safety” and are “antithetical” to Kennedy’s promise to bring “radical transparency” to federal health agencies.

“It is simply not possible to honorably make that claim while decimating the staff,” Lurie said. “Can we rely particularly on this government to be forthcoming about the number of cases in an outbreak? You need FOIA to be able to take the lid off of that.”

HHS officials declined to answer questions about plans for the agencies to fulfill FOIA requests. In an emailed statement, HHS spokesperson Vianca Rodriguez Feliciano said, “The FOIA offices throughout the Department were previously siloed and did not communicate with one another. Under Secretary Kennedy’s vision for a more efficient HHS, these offices will be streamlined, and the work will continue.”

Gunita Singh, staff attorney for the Reporters Committee for Freedom of the Press, said the FOIA layoffs were almost certain to further slow the release of public records, which often took months or years before the cuts.

“What we need to be doing is the opposite of what’s happening now: hiring more staff,” she said.

Many records are disclosed only in response to FOIA requests. For example, during the covid-19 pandemic, FOIA requests forced the FDA to release internal documents showing little evidence to support using hydroxychloroquine to treat covid, even though President Donald Trump heavily promoted the drug.

Scientific researchers have used the law to obtain clinical trial data to assess whether drugs are safe and effective, or to get more details about adverse events associated with drugs and medical devices. Lurie said obtaining more information about adverse events is particularly important in serving as a bulwark against cherry-picking data or manipulating what’s available online to spread disinformation about the safety of vaccines and other products.

All these efforts will be slowed by the purge of FOIA offices, said Michael Morisy, CEO of MuckRock, a nonprofit group that helps journalists and others file public records requests. Scientists will have less to study. Attorneys and advocates will struggle to build cases and fight for causes. Simply, Americans will know less about their government and the industries it regulates and be less able to hold them both to account.

“I think one thing we’ve learned is that if there’s less watchdogging over an issue, that issue gets worse,” Morisy said. “I really do think that we are going to see companies become more lax with food safety, companies become more lax with consumer safety.”

Thousands of pending FOIA requests are likely to be affected.

During fiscal 2024 — from October 2023 through September 2024 — the CDC, FDA, and NIH received more than 15,000 FOIA requests and provided at least some records in response to more than 10,000, according to HHS’ most recent annual FOIA report.

Those requests were submitted by university researchers, state governments, laboratories, pharmaceutical companies, animal rights groups, law firms, and news organizations, including KFF Health News. Records sought by law firms appear related to investigations of illnesses, outbreaks, drugs, medical devices, and products used by countless Americans.

Morisy and Singh said filling requests is more complicated than many realize, often requiring an in-depth understanding of complex agencies. That’s why it’s important to house FOIA staff within each agency rather than consolidate them.

“We are sacking the entire staff and sacking all of that knowledge,” Morisy said. “And I just don’t see how these things continue to function.”

David Rousseau, the publisher of KFF Health News, serves on the board of the Center for Science in the Public Interest.

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

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Underscoring the massive scale of America’s medical debt problem, a New York-based nonprofit has struck a deal to pay off old medical bills for an estimated 20 million people.

Undue Medical Debt, which buys patient debt, is retiring $30 billion worth of unpaid bills in a single transaction with Pendrick Capital Partners, a Virginia-based debt trading company. The average patient debt being retired is $1,100, according to the nonprofit, with some reaching the hundreds of thousands of dollars.

The deal will prevent the debt being sold and protect millions of people from being targeted by collectors. But even proponents of retiring patient debt acknowledge that these deals cannot solve a crisis that now touches around 100 million people in the U.S.

“We don’t think that the way we finance health care is sustainable,” Undue Medical Debt chief executive Allison Sesso said in an interview with KFF Health News. “Medical debt has unreasonable expectations,” she said. “The people who owe the debts can’t pay.”

In the past year alone, Americans borrowed an estimated $74 billion to pay for health care, a nationwide West Health-Gallup survey found. And even those who benefit from Undue’s debt relief may have other medical debt that won’t be relieved.

This large purchase also highlights the challenges that debt collectors, hospitals, and other health care providers face as patients rack up big bills that aren’t covered by their health insurance.

Pendrick’s chief executive, Chris Eastman, declined several requests to be interviewed about the debt sale, which has not been previously reported. But Eastman acknowledged in a 2024 podcast episode that collecting medical debts has grown more challenging as regulators have restricted how collectors can pursue patients.

Pendrick has now shuttered, which Sesso said provided strong motivation for this deal. “This was a really great opportunity to get a debt buyer out of the market,” she said.

Undue Medical Debt pioneered its debt relief strategy a decade ago, leveraging charitable donations to buy medical debt from debt trading companies at steeply discounted prices and then freeing patients from the obligation to pay.

The nonprofit now buys debts directly from hospitals, as well. And it is working with about two dozen state and local governments to leverage public money to relieve medical debt in communities from Los Angeles County to Cleveland to the state of Connecticut.

The approach has been controversial. And Undue Medical Debt’s record-setting purchase — financed by a mix of philanthropy and taxpayer dollars — is likely to stoke more debate over the value of paying collectors for medical debts.

“The approach is just treating the symptoms and not the disease,” said Elisabeth Benjamin, a vice president at the Community Service Society of New York, a nonprofit that has led efforts to restrict aggressive hospital collections. Benjamin and other advocates say systemic changes such as ensuring hospitals offer sufficient financial aid to patients and reining in high medical prices would be more valuable in preventing people from sinking into debt.

But many government officials see retiring people’s unpaid medical bills as part of a larger strategy to make it easier for patients to avoid debt in the first place.

“Turning off the tap is what’s really important in the long run,” said Naman Shah, a physician who directs medical affairs at the Los Angeles County Department of Public Health. The county is working to improve local hospital financial aid programs for patients. But Shah said debt relief is key, as well.

 “It’s easy to criticize band-aids when you’re not the one who’s cut,” he said. “As a physician, I take care of people who have cuts, and I know the importance of stitching them back up.”

Undue Medical Debt’s latest deal, which it is spending $36 million to close, will help patients nationwide, according to the nonprofit. But about half the estimated 20 million people whose debts Pendrick owned live in just two states: Texas or Florida.

Neither has expanded Medicaid coverage through the 2010 Affordable Care Act, a key tool that researchers have found bolsters patients’ financial security by protecting them from big medical bills and debt.

The patients eligible for debt relief have incomes at or below four times the federal poverty level, about $63,000 for a single person, or debts that exceed 5% of their incomes.

About half the debts are also more than seven years old. These have been donated to Undue Medical Debt by Pendrick, the group reported.

The nonprofit plans to pay for the rest of the debts over the next year and a half, though all collections have stopped against patients. It also plans to spend an additional $40 million — or $2 a person — to process the debts, find patients, and inform them that their debts have been relieved.

Sesso, Undue’s chief executive, said she hopes the debt purchase will keep policymakers focused on enacting longer-term solutions to the nation’s medical debt crisis.

She applauded state leaders for taking steps to bar medical debts from their residents’ credit scores. But she said action is also needed in Washington, D.C. However, the Trump administration has suspended regulations enacted under former President Joe Biden that would have barred credit reporting of medical debt nationally, and congressional Republicans are now moving to revoke the new rules.

“There is a limit to what state and local governments can do to solve this problem,” Sesso said. “It’s really a national problem that has to be solved at the national level.”

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MANSFIELD, La. — When Desoto Regional Health System took out $36 million in loans last year to renovate a rural hospital that opened in 1952, officials were banking on its main funding source remaining stable: Medicaid, the joint federal-state health program for low-income people and the disabled.

But those dollars are now in jeopardy, as President Donald Trump and the GOP-controlled Congress move to shrink the nearly $900 billion health program that covers more than 1 in 5 Americans.

Desoto CEO Todd Eppler said Medicaid cuts could make it harder for his hospital to repay the loans and for patients to access care.

“I just hope that the people who are making these decisions have thought deeply about it and have some context of the real-world implications,” he said, “because it’s going to affect us as a hospital and going to affect our patients.”

One of the decision-makers is Eppler’s representative in Congress: House Speaker Mike Johnson, who lives about 35 miles north of here. He said he knows the Republican leader and his staff understand hospitals’ plight: The mother of Johnson’s chief of staff is CEO of a rural hospital in the district.

“I’ve never met a congressman yet that wanted a rural hospital in their district to close, and certainly Mike is no exception to that rule,” Eppler said.

Last year nearly 290,000 people in Johnson’s district were enrolled in Medicaid, about 38% of the total population, according to data compiled by KFF, the health information nonprofit that includes KFF Health News.

About 118,000 of them are in the program thanks to the Affordable Care Act, which allowed states including Louisiana to expand Medicaid to cover low-income adults, many of whom were working in low-paying jobs that don’t provide health insurance.

Louisiana ranks second in Medicaid enrollment, at nearly 32% — a reflection of the state’s high poverty rate. As Republicans weigh cuts, their actions could have dramatic consequences for their constituents here. Of the eight GOP-held House districts with the most Medicaid enrollees due to the expansion, four are in Louisiana. Johnson’s largely rural district ranks sixth in expansion enrollees.

Among them is Chloe Stovall, 23, who works in the produce aisle at the SuperValu grocery store in Vivian, Louisiana. She said her take-home wage working full time is $200 a week. She doesn’t own a car and walks a mile to work.

The store provides health coverage, but she said she won’t qualify until she’s worked there for a full year — and even then, it will cost more than Medicaid, which is free.

“I’m just barely surviving,” she said.

In February, Johnson pushed a budget resolution through the House that calls for cutting at least $880 billion over a decade from a pool of funding that includes Medicaid, to help fund an extension of Trump’s tax cuts and his border priorities. Republicans in Congress are now considering where to make cuts, and Medicaid is likely to take a big hit.

Defending the plan, Johnson said that Medicaid is “not for 29-year-old males sitting on their couches playing video games.”

Stovall said almost everyone she knows on Medicaid works at least one job. “I don’t even own a TV,” she said.

Contacted for comment, Johnson’s office pointed to his remarks at a conference in Washington last month. “We’re going to be very careful not to cut a benefit for anyone who is eligible to receive it and relies upon it,” Johnson said.

KFF Health News spoke with two dozen Medicaid enrollees in Johnson’s district. Most said they were unaware their congressman is leading the Republican charge to upend the program. Those informed of the Republican plan said it scares them.

Some GOP members of Congress want to eliminate the ACA’s Medicaid expansion funding, which led to 20 million working-age adults gaining coverage and helped slash the nation’s uninsured rate to its lowest level in history. Forty states and the District of Columbia have agreed to the change, which promised extra federal funding in exchange for expanding eligibility.

In this heavily Republican district, where Johnson won with 86% of the vote in November, 22% of residents live in poverty.

Like Trump, Johnson says he wants cuts to Medicaid but hasn’t elaborated other than saying the program should not cover “able-bodied” adults without imposing a work requirement.

“Everybody is committed” to preserving Medicaid benefits “for those who desperately need it and deserve it and qualify for it,” Johnson said at a news conference in February. “What we’re talking about is rooting out the fraud, waste, and abuse.”

Medicaid recipients in Johnson’s district, told about GOP plans to cut the program, said their lives are hard enough in a state where the minimum wage is $7.25 an hour. Without Medicaid, they said, they couldn’t afford health coverage.

In Vivian, near the borders with Arkansas and Texas, close to half of the 2,900 residents live in poverty. The main-street shops are mostly shuttered, except for a thrift store and a mom-and-pop restaurant that specializes in fried pork chops.

“Most everybody you know is on Medicaid here,” said Doris Luccous, 24.

Luccous said she makes $250 a week after taxes as a housekeeper at a nursing home while raising her 2-year-old daughter in her childhood home. While shopping with her father — who doesn’t work, because of a disability — she said she counts on Medicaid for her bipolar medicines and to pay for therapy appointments.

“I don’t know where I would be without it,” she said.

Neither Luccous nor Stovall said they voted in the last election, and neither knew that Johnson is their representative in Congress.

Vivian has few large employers, and most employers pay the minimum wage, which hasn’t changed since 2009. “We are just stuck,” Stovall said.

Still, she said, “it’s a community where everybody knows everybody, and people are always willing to lend a hand because so many are in difficult financial circumstances.”

Willie White is CEO of David Raines Community Health Centers, which operates six outpatient clinics in northwestern Louisiana that serve primarily Medicaid enrollees. He said that Louisiana already ranks among the worst states for people’s health and that Medicaid cuts would only worsen the situation.

“You cannot expect health outcomes to improve if people can’t afford to access care,” White said.

While the clinics provide primary and dental care on a sliding fee scale for uninsured patients, signing them up for Medicaid gives them better access to specialists and brings the health centers revenue to cover the cost of delivering care.

Many of the centers’ patients gained coverage through Medicaid expansion. Afterward, rates of screenings for colon and cervical cancer went from 10% to 50%, White said. 

But if Congress cuts Medicaid, the health centers would be forced to cut services, he said.

“Mike Johnson has been here and knows us, and he and his office have been responsive about our issues,” White said. “The message in prior years was, ‘We need additional funding,’ but now it is asking for no cuts.”

Community health centers, which in 2023 provided care nationally to more than 32 million mostly low-income people, have seen funding increases from Republicans and Democrats for decades.

“Everyone is supportive, but the question remains what that support will look like under the current administration,” White said. “If there are to be reductions, they need to be done with a scalpel.”

Expecting cuts, the health centers have already restricted travel and put a hold on filling vacant positions, White said.

Sitting in a David Raines clinic in Bossier City, Benjamin Andrade, 57, said having Medicaid has been a lifesaver since he needed heart surgery in 2020. Andrade is a chef and said he supports his wife and two children on $14 an hour.

He had not heard about any potential cuts to the program. Without Medicaid, he said, “it would be very hard for me to pay for all the medicines I take.”

Dominique Youngblood, 31, who was at the clinic for a dental checkup, said she’s had Medicaid most of her life. “Medicaid helps me so I don’t have to pay out-of-pocket going to the doctors,” she said.

Youngblood, who has two children, makes $12 an hour at a day care center. Asked about GOP efforts to scale back the program, she said, “It’s not fair, because it helps a lot of people who cannot afford medications and emergency room trips, and those are costs you can’t control.”

Back in Mansfield, Eppler’s hospital is more than just a health facility — it’s where many people in town come for lunch. The cafeteria was packed on a recent Friday as workers served boiled shrimp, fried okra, and baked fish.

Eppler said he’s aware Republicans in Congress are targeting a system of taxes that some states, including Louisiana, levy on hospitals and other health providers to draw down more federal Medicaid funding. That money helps finance what are known as supplemental payments to providers. Some conservatives belittle the extra funding as “money laundering.”

But that money accounts for about 15% of the DeSoto health system’s budget, said Eppler, a retired Air Force lieutenant colonel who has been CEO for a dozen years. “We are using that money to invest in the next 50 years of Desoto Parish, to build a hospital that they can have that will be sustainable,” he said.

The supplemental payments, for example, help pay to provide mental health services at three outpatient clinics. “If that $4 million went away, we would have to limit services — it’s just that simple,” he said.

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Subrayando la magnitud del problema de la deuda médica en el país, una organización sin fines de lucro con sede en Nueva York ha llegado a un acuerdo para liquidar viejas facturas médicas de aproximadamente 20 millones de personas.

Undue Medical Debt, que compra deudas de pacientes, está liquidando $30 mil millones en facturas impagas en una sola transacción con Pendrick Capital Partners, una empresa de comercialización de deuda con sede en Virginia. Según la organización, La deuda promedio de los pacientes que se liquida es de $1.100, y en algunos casos alcanza los cientos de miles de dólares.

El acuerdo evitará la venta de la deuda y protegerá a millones de personas de ser blanco de los cobradores. Pero incluso quienes defienden la liquidación de la deuda de los pacientes reconocen que estos acuerdos no pueden resolver una crisis que ya afecta a unas 100 millones de personas en Estados Unidos.

“No creemos que la forma en que financiamos la atención médica sea sostenible”, dijo Allison Sesso, directora ejecutiva de Undue Medical Debt, en una entrevista con KFF Health News. “La deuda médica genera expectativas desproporcionadas”, agregó. “Quienes tienen deudas no pueden pagar”.

Solo el año pasado, los estadounidenses pidieron prestado aproximadamente $74 mil millones para pagar la atención médica, según una encuesta nacional de West Health-Gallup. Incluso quienes se benefician de la reducción de deuda de Undue podrían tener otras deudas médicas que no se beneficiarán de este acuerdo.

Esta gran compra también resalta los desafíos que enfrentan los cobradores de deudas, los hospitales y otros proveedores de atención médica, ya que los pacientes acumulan facturas grandes que no están cubiertas por su seguro médico.

Chris Eastman, director ejecutivo de Pendrick, rechazó varias solicitudes de entrevista sobre la venta de deuda, que no se había informado previamente. Sin embargo, Eastman reconoció en el episodio de un podcast de 2024 que el cobro de deudas médicas se ha vuelto más difícil a medida que los reguladores han restringido la forma en que los cobradores pueden perseguir a los pacientes.

Pendrick ya ha cerrado, lo que, según Sesso, fue una fuerte motivación para este acuerdo. “Esta fue una gran oportunidad para sacar del mercado a un comprador de deuda”, afirmó.

Undue Medical Debt fue pionera en la estrategia de alivio de deuda hace una década, aprovechando donaciones benéficas para comprar deuda médica de empresas de comercialización de deuda a precios muy reducidos y liberando así a los pacientes de la obligación de pago.

La organización sin fines de lucro ahora también compra deudas directamente de los hospitales. Además, colabora con unas dos docenas de gobiernos estatales y locales para movilizar fondos públicos y aliviar la deuda médica en comunidades desde el condado de Los Ángeles hasta Cleveland y el estado de Connecticut.

El enfoque ha sido controversial. Y es probable que la compra récord de Undue Medical Debt, financiada con una combinación de filantropía y dinero de los contribuyentes, avive aún más el debate sobre la importancia de pagar a los cobradores por las deudas médicas.

“El enfoque se centra únicamente en tratar los síntomas, no la enfermedad”, afirmó Elisabeth Benjamin, vicepresidenta de la Sociedad de Servicios Comunitarios de Nueva York, una organización sin fines de lucro que ha liderado iniciativas para restringir la estrategia de cobros agresiva de deudas hospitalarias.

Benjamin y otros defensores aseguran que cambios sistémicos, como garantizar que los hospitales ofrezcan suficiente ayuda financiera a los pacientes y controlar los altos precios médicos, serían más valiosos para evitar que las personas se endeuden.

Pero muchos funcionarios del gobierno ven la eliminación de las facturas médicas impagas como parte de una estrategia más amplia para facilitar que los pacientes eviten las deudas en primer lugar.

“Cerrar el grifo es lo realmente importante a largo plazo”, dijo Naman Shah, doctor que dirige asuntos médicos en el Departamento de Salud Pública del condado de Los Ángeles. El condado está trabajando para mejorar los programas locales de ayuda financiera de los hospitales para los pacientes. Pero Shah afirmó que el alivio de la deuda también es clave.

“Es fácil criticar los vendajes cuando no eres tú quien se corta”, dijo. “Como médico, atiendo a personas con cortes y sé lo importante que es coserlos”.

El último acuerdo de Undue Medical Debt, en el que se están invirtiendo $36 millones, ayudará a pacientes de todo el país, según la organización sin fines de lucro. Pero aproximadamente la mitad de las cerca de 20 millones de personas cuyas deudas Pendrick poseía viven en solo dos estados: Texas o Florida.

Ninguno de los dos estados ha ampliado la cobertura de Medicaid a través de la Ley de Cuidado de Salud a Bajo Precio de 2010, una herramienta clave que, según han hallado los investigadores, refuerza la seguridad financiera de los pacientes al protegerlos de grandes facturas médicas y deudas.

Los pacientes elegibles para el alivio de la deuda tienen ingresos iguales o inferiores a cuatro veces el nivel federal de pobreza, aproximadamente $63.000 para una persona soltera, o deudas que superan el 5% de sus ingresos.

Aproximadamente la mitad de las deudas también tienen más de siete años. Estas han sido donadas a Undue Medical Debt por Pendrick, informó el grupo.

La organización sin fines de lucro planea pagar el resto de las deudas durante el próximo año y medio, aunque se han suspendido todos los cobros contra los pacientes. También planea invertir $40 millones adicionales, o $2 por persona, para procesar las deudas, localizar pacientes e informarles que sus deudas han sido condonadas.

Sesso, directora ejecutiva de Undue, expresó su esperanza de que la compra de deuda mantenga a los legisladores enfocados en implementar soluciones a largo plazo para la crisis de deuda médica del país.

Aplaudió a los líderes estatales por tomar medidas para excluir las deudas médicas de las calificaciones de crédito de sus residentes. Pero afirmó que también se necesitan medidas en Washington, D.C.

Sin embargo, la administración Trump ha suspendido las regulaciones promulgadas durante el gobierno del ex presidente Joe Biden que habrían prohibido la presentación de informes crediticios sobre deudas médicas a nivel nacional, y los republicanos del Congreso ahora están trabajando para revocar las nuevas normas.

“Hay un límite a lo que los gobiernos estatales y locales pueden hacer para resolver este problema”, dijo Sesso. “Es realmente un problema nacional que debe resolverse a nivel nacional”.

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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Since returning to the White House, President Donald Trump has made combating fraud a centerpiece of his administration. Trump has said he will target fraud in Medicare, Medicaid, and Social Security programs, and his Republican allies in Congress have made combating fraud a key argument in their plans to slash Medicaid. Trump also has empowered the Elon Musk-led Department of Government Efficiency to make massive cuts to government spending, often claiming to snuff out fraud and waste in the process. 

Trump’s present-day crackdown starkly contrasts with his history of showing leniency to convicted fraudsters. In his first and second terms, Trump has granted pardons or commutations to at least 68 people convicted of fraud crimes or interfering with fraud investigations, according to a KFF Health News review of court and clemency records, Department of Justice press releases, and news reports. At least 13 of those fraudsters were convicted in cases involving more than $1.6 billion in fraudulent claims filed with Medicare and Medicaid, according to the DOJ. 

In interviews with KFF Health News, two experts on health care fraud said that Trump’s claimed focus appears to be a pretext for slashing spending that was legally appropriated by Congress. 

“What’s been the focal point to date of the administration is not what anybody has ever referred to as health care fraud,” said Jacob Elberg, a former assistant U.S. attorney and law professor at Seton Hall University. “There is a real blurring — a seemingly intentional blurring — between what is actually fraud and what is just spending that they are not in favor of.” 

Jerry Martin, who served as a U.S. attorney for the Middle District of Tennessee under President Barack Obama and now represents health care fraud whistleblowers, said Trump’s stepped-up interest may embolden informants to come forward. 

“I’ve had clients repeat back to me ‘President Trump says fraud is a priority,’” Martin said. “People are listening to it. But I don’t know that what he’s saying translates into what they believe.” 

Even so, Trump’s past leniency to fraudsters might discourage the Justice Department from pursuing the whistleblowers’ claims, Martin said. 

“There are a lot of rank-and-file people who are operating at the lowest point in their professional careers, where they’ve seen a lot of their work essentially be water under the bridge,” Martin said. “That’s got to be really demoralizing.” 

The White House did not respond to requests for comment. 

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).