SAN FRANCISCO, California — Organizaciones de salud sin fines de lucro e intérpretes médicos advierten que los recortes federales han eliminado docenas de puestos de trabajadores comunitarios en California, que ayudan a quienes no hablan inglés a obtener cobertura médica y a navegar el sistema de salud.

Al mismo tiempo, las personas con dominio limitado del inglés están pidiendo menos servicios lingüísticos, lo que los defensores de la atención de salud atribuyen en parte a la ofensiva migratoria del presidente Donald Trump y a su orden ejecutiva declarando al inglés como idioma nacional.

Estos cambios en las políticas y la financiación podrían dejar a algunas personas sin atención vital, especialmente a niños y adultos mayores.

“Las personas tendrán dificultades para acceder a beneficios a los que tienen derecho y que necesitan para vivir de forma independiente”, expresó Carol Wong, abogada senior de derechos humanos de Justice in Aging, un grupo nacional de defensa.

Cerca de 69 millones de personas en el país hablan un idioma que no es inglés, y 26 millones de ellas hablan inglés a un nivel por debajo de “muy bien”, según los datos más recientes disponibles de 2023 de la Oficina del Censo de Estados Unidos.

Una encuesta de KFF-Los Angeles Times de ese año reveló que los inmigrantes con un dominio limitado del inglés reportaron más obstáculos para acceder a la atención médica y peor salud que los que hablan mejor inglés.

Los defensores de salud temen que, sin el apoyo adecuado, millones de personas con un dominio limitado del inglés sean más propensas a sufrir errores médicos, diagnósticos equivocados, negligencia y otros resultados adversos.

Al inicio de la pandemia en 2020, ProPublica informó que una mujer con síntomas de coronavirus murió en Brooklyn luego de no recibir tratamiento oportuno porque el personal de emergencias no pudo comunicarse con ella en húngaro.

Y, en el punto álgido de la crisis, The Virginian-Pilot fue el primero en informar que una traducción al español en un sitio web estatal afirmaba erróneamente que la vacuna contra covid-19 no era necesaria.

En el año 2000, el presidente Bill Clinton firmó una orden ejecutiva destinada a mejorar el acceso a los servicios federales para las personas con inglés limitado. Investigaciones muestran que la asistencia lingüística se traduce en una mayor satisfacción del paciente, y también en una reducción de errores médicos, diagnósticos equivocados y consecuencias adversas para la salud.

Los servicios de interpretación de idiomas también ahorran dinero al sistema de salud al reducir las estadías en el hospital y los reingresos.

La orden de Trump derogó la directiva de Clinton y dejó en manos de cada agencia federal la decisión de mantener o adoptar una nueva política sobre lenguas. Algunas ya han reducido sus servicios: según se ha informado, el Departamento de Seguridad Nacional y la Administración del Seguro Social redujeron los servicios de idiomas, y el Departamento de Justicia afirma estar revisando las directrices. El enlace a su plan de lenguas no funciona.

No está claro qué pretende hacer el Departamento de Salud y Servicios Humanos (HHS). El HHS no respondió a las preguntas de KFF Health News.

Un plan del HHS implementado durante la presidencia de Joe Biden, que incluye directrices durante emergencias y desastres de salud pública, ha sido archivado, lo que significa que podría no reflejar las políticas actuales. Sin embargo, la Oficina de Derechos Civiles del HHS sigue informando a los pacientes sobre su derecho a recibir servicios de asistencia en sus idiomas nativos cuando recogen una receta médica, solicitan un seguro de salud o van al médico.

Además, en julio pasado, la oficina agregó protecciones que prohíben a los proveedores de salud utilizar personal no capacitado, familiares o niños para brindar interpretación durante las consultas médicas. También requiere que un traductor humano calificado revise traducciones de información confidencial  realizadas con herramientas de inteligencia artificial (IA), para garantizar su precisión.

La administración Trump podría anular estas salvaguardas, afirmó Mara Youdelman, directora general del National Health Law Program, una organización nacional de defensa de políticas legales y de salud. “Hay un proceso que debe seguirse”, agregó, refiriéndose a la implementación de cambios con la participación del público.

“Les insto encarecidamente a que consideren las graves consecuencias cuando las personas no tienen una comunicación efectiva”, enfatizó.

Youdelman dijo que, incluso si el gobierno federal finalmente no ofrece servicios de idiomas al público, los hospitales y proveedores de salud están obligados a proporcionar esta asistencia a los pacientes de manera gratuita. El Título VI de la Ley de Derechos Civiles de 1964 prohíbe la discriminación por raza u origen nacional, y sus protecciones se extienden al idioma. Además, la Ley de Cuidado de Salud a Bajo Precio (ACA) de 2010, que amplió la cobertura médica para millones de estadounidenses y adoptó numerosas protecciones al consumidor, exige que los proveedores de salud que reciben fondos federales ofrezcan servicios de idiomas, incluyendo traducción e interpretación.

“El inglés puede ser el idioma oficial y las personas aún tienen derecho a obtener servicios de idiomas cuando acceden a la atención médica”, dijo Youdelman. “Nada en la orden ejecutiva cambió la ley vigente”.

Las aseguradoras aún deben incluir eslóganes multilingües en la correspondencia a sus miembros, explicando cómo pueden acceder a los servicios de idiomas.

Los centros de salud deben colocar avisos visibles que informen a los pacientes sobre los servicios de asistencia lingüística, y garantizar intérpretes certificados y calificados.

Los gobiernos estatales y locales podrían ampliar sus propios requisitos de acceso a idiomas. Algunos estados han tomado medidas similares en los últimos años, y los legisladores estatales de California están considerando un proyecto de ley que establecería un director de acceso lingüístico, exigiría la revisión humana de las traducciones de IA y mejoraría las encuestas que evalúan las necesidades lingüísticas.

“Con la creciente incertidumbre a nivel federal, las leyes y políticas de acceso estatales y locales son aún más importantes”, afirmó Jake Hofstetter, analista de políticas del Migration Policy Institute.

En California, el Departamento de Salud Pública de Los Ángeles y la Oficina de Participación Cívica y Asuntos de Inmigrantes de San Francisco afirmaron que sus servicios de idiomas no se han visto afectados por la orden ejecutiva de Trump ni por los recortes de fondos federales.

Sin embargo, la demanda ha disminuido. Aurora Pedro, de Comunidades Indígenas en Liderazgo, una de las pocas intérpretes médicas en Los Ángeles que habla akatek y qʼanjobʼal, lenguas mayas de Guatemala, dijo que recibe menos llamadas solicitando sus servicios desde que asumió Trump.

Y otras áreas de California han reducido los servicios lingüísticos por los recortes de fondos federales.

Hernán Treviño, vocero del Departamento de Salud Pública del condado de Fresno, dijo que el condado redujo el número de trabajadores de salud comunitarios a más de la mitad, de 49 a 20 puestos. Esto ha limitado la disponibilidad de guías locales que hablan español, hmong o lenguas indígenas de Latinoamérica, y que ayudan a los inmigrantes a inscribirse en planes de salud y programar exámenes de rutina.

Treviño indicó que, en las oficinas del condado, el personal sigue disponible para atender a los residentes en español, hmong, lao y panyabí. También hay una línea telefónica gratuita disponible para ayudar a acceder a servicios en el idioma preferido.

Mary Anne Foo, directora ejecutiva de la Asian and Pacific Islander Community Alliance del condado de Orange, informó que la Administración de Servicios de Abuso de Sustancias y Salud Mental congeló los $394.000 restantes de un contrato de dos años para mejorar los servicios de salud mental. Como resultado, la alianza planea despedir a 27 de sus 62 terapeutas, psiquiatras y administradores de casos bilingües. La alianza atiende a más de 80.000 pacientes que hablan más de 20 idiomas.

“Solo podemos mantenerlos hasta el 30 de junio”, dijo Foo. “Todavía estamos tratando de ver si podremos cubrir a las personas”.

Orozco Rodríguez reportó desde Elko, Nevada.

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In early April, President Donald Trump gathered dozens of hard-hat-clad coal miners around him in the White House East Room. He joked about arm-wrestling them and announced he was signing executive orders to boost coal production, “bringing back an industry that was abandoned,” and to “put the miners back to work.”

Trump said he calls it “beautiful, clean” coal. “I tell my people never use the word ‘coal’ unless you put ‘beautiful, clean’ before it.”

That same day, the Trump administration paused implementation of a rule that would help protect coal miners from an aggressive form of black lung disease. Enforcement of the new protections is officially halted until at least mid-August, according to a federal announcement that came a few days after a federal court agreed to put enforcement on hold to hear an industry challenge. But even if the rule takes full force after the delay, the federal agency tasked with enforcing it in Appalachia and elsewhere may not be up to the task after sweeping layoffs and office closures.

Deaths from black lung — a chronic condition caused by inhaling coal dust — had been in decline since the introduction of federal regulations over a half-century ago. But in recent decades, cases have risen precipitously. By 2018, the Centers for Disease Control and Prevention estimated that the lungs of about 1 in 5 coal miners in central Appalachia showed evidence of black lung. It is being diagnosed in younger miners. And the deadliest form, progressive massive fibrosis, has increased tenfold among long-term miners.

Silica is the primary culprit. Exposure to it has increased since mining operations began cutting through more sandstone to reach deeper coal deposits. The stone breaks into sharp particles that, when airborne, can become trapped in lung tissue and cause a debilitating, sometimes fatal condition.

The new rule was set to take effect in April, cutting the allowable level of silica dust in the air inside mines by half — to the limit already in place for other industries — and set stricter guidelines for enforcement.

Years in the making, advocates for miners heralded the new standards as a breakthrough. “It is unconscionable that our nation’s miners have worked without adequate protection from silica dust despite it being a known health hazard for decades,” acting Labor Secretary Julie Su said when the rule was announced last spring under the Biden administration.

The rule pause came on top of another blow to mine safety oversight. In March, the Department of Government Efficiency, created by a Trump executive order, announced it would end leases for as many as three dozen field offices of the Department of Labor’s Mine Safety and Health Administration, with the future of those employees undetermined. That agency is responsible for enforcing mining safety laws.

Then in April, two-thirds — nearly 900 — of the workers at the National Institute of Occupational Safety and Health, an agency within the Department of Health and Human Services, were fired. As a result, NIOSH’s Coal Workers’ Health Surveillance Program, which offered miners free screenings from a mobile clinic, ceased operations.

An announcement by MSHA of the silica rule delay cited the “unforeseen NIOSH restructuring and other technical reasons” as catalysts for the pause but didn’t mention the federal court decision in the case seeking to rescind the rule.

Separately, on May 7, attorney Sam Petsonk filed a class-action lawsuit against Health and Human Services and its head, Robert F. Kennedy Jr., to reinstate the program. His client in the case, Harry Wiley, a West Virginia coal miner, was diagnosed with an early stage of black lung and applied to NIOSH for a transfer to an environment with less dust exposure but never received a response. He continues to work underground.

On May 13, U.S. District Judge Irene Berger issued a preliminary injunction to reinstate the surveillance program employees. The next day, Kennedy said the administration would reverse the firings of 328 NIOSH employees. That day, they were back at work.

“Remaining in a dusty job may reduce the years in which Mr. Wiley can walk and breathe unassisted, in addition to hastening his death,” Berger wrote. “It is difficult to imagine a clearer case of irreparable harm.”

MSHA officials declined to respond to specific questions about the silica rule or plans to implement and enforce it, citing the ongoing litigation.

In an emailed statement, Labor Department spokesperson Courtney Parella said, “The Mine Safety and Health Administration is confident it can enforce all regulations under its purview. MSHA inspectors continue to conduct legally required inspections and remain focused on MSHA’s core mission to prevent death, illness, and injury from mining and promote safe and healthful workplaces for U.S. miners.”

Wes Addington is quick to say a career in the mines isn’t necessarily a death sentence. He comes from generations of miners. One of his great-grandfathers worked 48 years underground and died at 88.

But Addington also said protecting the safety and health of miners requires diligence. He’s executive director of the Appalachian Citizens’ Law Center, a Whitesburg, Kentucky, nonprofit that represents and advocates for miners and their families. A study the center conducted found that staffers at the MSHA offices scheduled to close performed almost 17,000 health and safety inspections from January 2024 through February 2025.

Addington said NIOSH provided the data to document worsening conditions over the past few decades.

Addington’s organization has advocated for the new silica rule for 17 years. “We didn’t think it was perfect,” he said. He would have preferred lower exposure limits and more stringent monitoring requirements. “But, as it was, it was going to save lives.”

The cuts to the agency, Addington said, could affect every American worker who might be exposed to harmful elements in the workplace. NIOSH approves respirators prescribed by Occupational Safety and Health Administration regulations.

With fewer inspectors, miners are “more likely to get hurt on the job and those injuries could be fatal,” he said.

“And if you’re a miner that’s lucky enough to navigate that gantlet and make it through a 20-, 25-year career,” Addington said, “the likelihood that you develop disabling lung disease that ultimately kills you at an early age is much increased.”

The black lung clinic at Stone Mountain Health Services in southwestern Virginia has diagnosed 75 new cases of progressive massive fibrosis in the past year, according to its medical director, Drew Harris.

“People are dying from a dust-related disease that’s 100% preventable, and we’re not using all the things we could use to help prevent their disease and save their lives,” Harris said. “It’s just all very disheartening.”

He believes it would be a mistake for Kennedy to reorganize NIOSH as he has proposed, shifting the surveillance program team’s responsibilities to other employees.

“It’s a very unique expertise,” Harris said. The agency would be “losing the people that know how to do this well and that have been doing this for decades.”

Rex Fields first went to work in the mines in 1967, a year before an explosion killed 78 miners near the small town of Farmington, West Virginia. His wife, Tilda Fields, was aware of the hazards her husband would encounter — the safety issues, the long-term health concerns. Her dad died of black lung when she was 7. But it meant a well-paying job in a region that has forever offered precious few.

Rex, 77, now lives with an advanced stage of black lung disease. He’s still able to mow his lawn but is easily winded when walking uphill. It took him several weeks and two rounds of antibiotics to recover from a bout with bronchitis in March.

Throughout his career, Rex advocated for his fellow miners: He stepped in when he saw someone mistreated; he once tried, unsuccessfully, to help a unionization effort. For these efforts, he said, “I got transferred from the day shift to the third shift a time or two.”

Today, the Fieldses lobby on behalf of miners and share information about occupational dangers. Tilda organized a support group for families and widows. She worries about the next generation. Two of the Fieldses’ sons also went into mining.

“People in the mountains here, we learn to make do,” Tilda said. “But you want better. You want better for your kids than what we had, and you surely want their safety.”

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On Christmas Day at the WaTiki indoor water park, Hans Wirt was getting winded from following his son up the stairs to the waterslides.

Wirt’s breathing became more labored once they returned to the nearby hotel where they and Wirt’s girlfriend were staying while visiting family in Rapid City, South Dakota.

Then he grew nauseated and went pale. Wirt thought the cause might have been the altitude change between his home in Deltona, Florida — 33 feet above sea level — and Rapid City, at the edge of the Black Hills. But his 12-year-old son was worried and called for an ambulance.

“I could tell by the look in his eyes that there was something a little more to this,” Wirt said. “So I can kind of thank my son for saving my life.”

It turned out the 62-year-old was having a heart attack. A “lousy Christmas present,” Wirt said.

Medics stabilized Wirt before taking him to Monument Health — the only hospital in Rapid City with an emergency room — where he was treated over two days.

Then the bill came.

The Medical Procedure

Paramedics used a defibrillator to restore a normal heart rhythm. Doctors at the hospital gave Wirt various medications, used an electrocardiograph and other diagnostic and monitoring devices, and inserted stents into his arteries to improve blood flow to his heart.

The Final Bill

$95,523.73, including $32,998.90 for medical supplies, mostly related to the stents, and $28,879 for treatment in a cardiac catheterization lab. After unspecified hospital adjustments to the bill, Wirt owed $77,574.44.

The Billing Problem: Medicaid Across State Lines

Wirt is covered by Florida’s Medicaid program through Sunshine Health, a managed-care plan. But the South Dakota hospital refused to submit the bill to his out-of-state Medicaid plan, instead sending it to Wirt and eventually threatening to send the debt to a collection agency.

Medicaid, the government health insurance program primarily for low-income people and those with disabilities, is jointly funded by the federal government and states. States are responsible for administering Medicaid, and most contract with private insurance companies like Sunshine Health.

Federal law says state Medicaid programs must reimburse out-of-state hospitals for beneficiaries’ care in an emergency.

Many hospitals bill out-of-state Medicaid plans in such situations. If they don’t, they risk not being reimbursed at all, since Medicaid recipients probably won’t be able to afford large bills, said Katy DeBriere, who was legal director for the Florida Health Justice Project when she spoke with KFF Health News in April.

But there’s no federal law that requires them to do so, she said.

Federal court opinions have noted that hospitals are not required to bill Medicaid for every individual beneficiary they treat, even if they generally accept Medicaid.

Monument Health didn’t bill Wirt’s insurance because the hospital isn’t enrolled as a health care provider with Florida Medicaid, said hospital spokesperson Stephany Chalberg. She told KFF Health News that Monument bills Medicaid plans only in South Dakota and four bordering states: Wyoming, Montana, Nebraska, and Minnesota.

The hospital’s website says Medicaid patients who are not enrolled in one of those states “are responsible for any charges.”

“Due to the significant credentialing requirements of our multiple hospitals and hundreds of physicians we do not participate with all states,” a hospital representative wrote in a message to Wirt.

According to Florida’s Medicaid website, out-of-state providers who have treated one of its enrollees must submit five documents to bill the program, including a six-page application, a copy of the provider’s license, and a claim form.

The process is different in each state, and many Medicaid programs reimburse out-of-state providers at lower rates than those that are in-state, according to the Medicaid and CHIP Payment and Access Commission, a federal agency that advises Congress.

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Provider enrollment barriers leave “beneficiaries in an untenable situation, preventing them from accessing the coverage to which they are legally entitled,” Chalberg said.

Wirt decided to submit his bill to his Medicaid plan on his own. But he said Sunshine Health told him it can only process bills received directly from providers.

Elizabeth Boyd, a spokesperson for Sunshine Health, told KFF Health News that its staff contacted the hospital on Wirt’s behalf. She did not respond when asked why the plan can’t process bills submitted by patients or what more it could have done to help Wirt.

The Resolution

A few days after KFF Health News emailed officials at Monument Health for this story, Wirt noticed his balance due fell from more than $77,000 to $0.

Chalberg told KFF Health News that Monument Health covered Wirt’s bill through its charity care program. She said that “appropriate patients” are told about the program and that “before any bill is sent to collections, it is evaluated to determine whether the patient may qualify for our financial assistance policy.”

To retain tax-exempt status, nonprofit hospitals must have programs that provide free or discounted care to patients who can’t afford their bills.

But Wirt said that when he first contacted Monument Health after receiving his bill and said he couldn’t afford to pay it, officials didn’t mention the program. He said they didn’t share any resources when he asked whether there were outside groups that could help him pay the bill. Wirt said hospital officials just recommended setting up a payment plan, but the monthly bills were still too high for him to afford. “There’s a reason why I’m on Medicaid,” Wirt said. “It’s just beyond me how they can expect somebody who had Medicaid to come up with that kind of money. It’s unrealistic.”

The Takeaway

Sarah Somers, legal director at the National Health Law Program, said the various “cogs in the Medicaid system” didn’t operate correctly in Wirt’s situation. “Nobody’s exerting themselves enough to just smooth the way for this person.”

States are responsible for managing Medicaid and are therefore the main “cog,” Somers said. She said Medicaid managed-care companies are also supposed to intervene.

Somers and DeBriere said Medicaid recipients who receive bills they don’t think they owe should file a complaint with their state’s Medicaid program and, if they have one, their managed-care plan. They can also ask whether there is a Medicaid or managed-care caseworker who can advocate on their behalf.

The attorneys said patients should also contact a legal aid clinic or a consumer protection firm that specializes in medical debt. DeBriere said those organizations can help file complaints and communicate with the hospital.

DeBriere said that, had she assisted Wirt, she would have immediately sent a letter to Monument Health ordering it to stop billing him and to either register with Florida Medicaid to submit his bill or offer him charity care.

Wirt said the doctors who treated him and the medical care he received at Monument Health were excellent. He said he spoke out about the hospital’s billing practices because he doesn’t want others to endure the same experience.

“If I get sick and have a heart attack, I have to be sure that I do that here in Florida now instead of some other state,” he joked.

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

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SAN FRANCISCO — Health nonprofits and medical interpreters warn that federal cuts have eliminated dozens of positions in California for community workers who help non-English speakers sign up for insurance coverage and navigate the health care system.

At the same time, people with limited English proficiency have scaled back their requests for language services, which health care advocates attribute in part to President Donald Trump’s immigration crackdown and his executive order declaring English as the national language.

Such policy and funding changes could leave some without lifesaving care, particularly children and seniors. “People are going to have a hard time accessing benefits they’re entitled to and need to live independently,” said Carol Wong, a senior rights attorney for Justice in Aging, a national advocacy group.

Nearly 69 million people in the U.S. speak a language other than English, and 26 million of them speak English less than “very well,” according to the most recent U.S. Census data available, from 2023. A KFF-Los Angeles Times survey from that year found that immigrants with limited English proficiency reported more barriers accessing health care and worse health than English-proficient immigrants.

Health advocates fear that, without adequate support, millions of people in the U.S. with limited English proficiency will be more likely to experience medical errors, misdiagnosis, neglect, and other adverse outcomes. During the start of the pandemic in 2020, ProPublica reported that a woman with coronavirus symptoms died in Brooklyn after missing out on timely treatment because emergency room staffers could not communicate with her in Hungarian. And, at the height of the crisis, The Virginian-Pilot first reported that a Spanish translation on a state website erroneously stated that the covid-19 vaccine was not necessary.

In 2000, President Bill Clinton signed an executive order aimed at improving access to federal services for people with limited English proficiency. Research shows language assistance results in higher patient satisfaction, as well as fewer medical errors, misdiagnoses, and adverse health outcomes. Language services also save the health care system money by reducing hospital stays and readmissions.

Trump’s order repealed Clinton’s directive and left it up to each federal agency to decide whether to maintain or adopt a new language policy. Some have already scaled back: The Department of Homeland Security and the Social Security Administration reportedly reduced language services, and the Justice Department says it is reviewing guidance materials. A link to its language plan is broken.

It’s unclear what the Department of Health and Human Services intends to do. HHS did not respond to questions from KFF Health News.

An HHS plan implemented under President Joe Biden, including guidance during public health emergencies and disasters, has been archived, meaning it may not reflect current policies. However, HHS’s Office for Civil Rights still informs patients of their right to language assistance services when they pick up a prescription, apply for a health insurance plan, or visit a doctor.

And the office added protections in July that prohibit health providers from using untrained staff, family members, or children to provide interpretation during medical visits. It also required that translation of sensitive information using artificial intelligence be reviewed by a qualified human translator for accuracy.

Those safeguards could be undone by the Trump administration, said Mara Youdelman, a managing director at the National Health Law Program, a national legal and health policy advocacy organization. “There’s a process that needs to be followed,” she said, about making changes with public input. “I would strongly urge them to consider the dire consequences when people don’t have effective communication.”

Even if the federal government ultimately doesn’t offer language services for the public, Youdelman said, hospitals and health providers are required to provide language assistance at no charge to patients.

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race or national origin, protections that extend to language. And the 2010 Affordable Care Act, which expanded health coverage for millions of Americans and adopted numerous consumer protections, requires health providers receiving federal funds to make language services, including translation and interpretation, available. 

“English can be the official language and people still have a right to get language services when they go to access health care,” Youdelman said. “Nothing in the executive order changed the actual law.”

Insurers still need to include multi-language taglines in their correspondence to enrollees explaining how they can access language services. And health facilities must post visible notices informing patients about language assistance services and guarantee certified and qualified interpreters.

State and local governments could broaden their own language access requirements. A few states have taken such actions in recent years, and California state lawmakers are considering a bill that would establish a language access director, mandate human review of AI translations, and improve surveys assessing language needs.

“With increasing uncertainty at the federal level, state and local access laws and policies are even more consequential,” said Jake Hofstetter, policy analyst at the Migration Policy Institute.

The Los Angeles Department of Public Health and San Francisco’s Office of Civic Engagement and Immigrants Affairs said their language services have not been affected by Trump’s executive order or federal funding cuts.

Demand, however, has dropped. Aurora Pedro of Comunidades Indígenas en Liderazgo, one of the few medical interpreters in Los Angeles who speaks Akatek and Qʼanjobʼal, Mayan languages from Guatemala, said she has received fewer calls for her services since Trump took office.  

And other pockets of California have reduced language services because of the federal funding cuts. 

Hernán Treviño, a spokesperson for the Fresno County Department of Public Health, said the county cut the number of community health workers by more than half, from 49 to 20 positions. That reduced the availability of on-the-ground navigators who speak Spanish, Hmong, or Indigenous languages from Latin America and help immigrants enroll in health plans and schedule routine screenings.

Treviño said staffers are still available to support residents in Spanish, Hmong, Lao, and Punjabi at county offices. A free phone line is also available to help residents access services in their preferred language.

Mary Anne Foo, executive director of the Orange County Asian and Pacific Islander Community Alliance, said the federal Substance Abuse and Mental Health Services Administration froze $394,000 left in a two-year contract to improve mental health services. As a result, the alliance is planning to let go 27 of its 62 bilingual therapists, psychiatrists, and case managers. The organization serves more than 80,000 patients who speak over 20 languages.

“We can only keep them through June 30,” Foo said. “We’re still trying to figure it out — if we can cover people.”

Orozco Rodriguez reported from Elko, Nevada.

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

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HHS settlement resolves investigation into potential HIPAA security rule failures exploited by a malicious insider.

Colton George felt sick. The 9-year-old Indiana boy told his parents his stomach hurt. He kept running to the bathroom and felt too ill to finish a basketball game.

Days later, he lay in a hospital bed, fighting for his life. He had eaten tainted salad, according to a lawsuit against the lettuce grower filed by his parents on April 17 in federal court for the Southern District of Indiana.

The E. coli bacteria that ravaged Colton’s kidneys was a genetic match to the strain that killed one person and sickened nearly 90 people in 15 states last fall. Federal health agencies investigated the cases and linked them to a farm that grew romaine lettuce.

But most people have never heard about this outbreak, which a Feb. 11 internal FDA memo linked to a single lettuce processor and ranch as the source of the contamination. In what many experts said was a break with common practice, officials never issued public communications after the investigation or identified the grower who produced the lettuce.

From failing to publicize a major outbreak to scaling back safety alert specialists and rules, the Trump administration’s anti-regulatory and cost-cutting push risks unraveling a critical system that helps ensure the safety of the U.S. food supply, according to consumer advocates, researchers and former employees at the FDA and U.S. Department of Agriculture.

The investigation into the illnesses began near the end of the Biden administration but work on the lettuce outbreak wasn’t completed until Feb. 11. At that time, the decision was made by the Trump administration not to release the names of the grower and processor because the FDA said no product remained on the market.

The administration also has withdrawn a proposed regulation to reduce the presence of salmonella in raw poultry, according to an April USDA alert. It was projected to save more than $13 million annually by preventing more than 3,000 illnesses, according to the proposal.

Officials from the Department of Health and Human Services have said that food safety is a priority, and FDA Commissioner Marty Makary said in an April 29 interview with the newsletter Inside Medicine that the recent job cuts would not affect agency operations.

“The FDA had 9,500 employees in 2007. Last year it was nearly 19,000. Has the 100% increase in employees increased approval times, innovation, AI, food safety, or agency morale?” Makary asked. “No, it hasn’t. In fact, it’s increased regulatory creep.”

The FDA referred questions to HHS, which declined to comment or make Makary available for an interview. In a statement, the agency said “protecting public health and insuring food safety remain top priorities for HHS. FDA inspectors were not impacted [by job cuts] and this critical work will continue.”

Public health advocates warn companies and growers will face less regulatory oversight and fewer consequences for selling tainted food products as a result of recent FDA actions.

The administration is disbanding a Justice Department unit that pursues civil and criminal actions against companies that sell contaminated food and is reassigning its attorneys. Some work will be assumed by other divisions, according to a publicly posted memo from the head of the department’s criminal division and a white paper by the law firm Gibson Dunn.

The Justice Department did not respond to an email requesting comment.

“They need the DOJ to enforce the law,” said Sarah Sorscher, director of regulatory affairs at the Center for Science in the Public Interest, a nonprofit consumer advocacy group. “For an executive investing in food safety, the knowledge they could go to jail if they don’t is a really strong motivator.”

Federal regulators also want states to conduct more inspections, according to two former FDA officials, who spoke on the condition of anonymity out of fear of retaliation. But some Democratic lawmakers say states lack the resources to take over most food safety inspections.

“Handing that duty to state and local agencies is really troubling,” said Rep. Shontel M. Brown (D-Ohio). “They don’t have the resources, and it creates a potentially unsafe situation that puts families in Ohio and America at risk.”

The High Cost of Foodborne Illnesses

Foodborne illnesses exact a major economic toll in the United States, according to federal data, and cost thousands of lives each year. The U.S. Department of Agriculture estimates the deaths, chronic illness, medical treatment, and lost productivity from food-related illnesses amounted to $75 billion in 2023.

Each year, about 48 million people in the U.S. get sick with foodborne illnesses, 128,000 are hospitalized, and 3,000 die, according to the Centers for Disease Control and Prevention.

In its first few months, the administration has suspended a program known as the Food Emergency Response Network Proficiency Testing that ensures food-testing labs accurately identify pathogens that can sicken or kill, according to a former FDA official.

In March, the agency said it would delay from January 2026 to July 2028 compliance with a Biden-era rule that aims to speed up the identification and removal of potentially contaminated food from the market.

However, the FDA is taking aim at foreign food manufacturing, saying in a May 6 notice that it would expand unannounced inspections overseas. “This expanded approach marks a new era in FDA enforcement — stronger, smarter, and unapologetically in support of the public health and safety of Americans,” the notice said.

Some former FDA and USDA officials said that goal isn’t realistic, because U.S. inspectors often need to obtain travel visas that can wind up alerting companies to their arrival.

“It’s really, really difficult to do surprise inspections,” said Brian Ronholm, director of food policy for Consumer Reports and a former USDA deputy undersecretary for food safety. “The visa process can alert the local authority.”

HHS declined to address Ronholm’s concerns.

The FDA hasn’t met the mandated targets for inspecting food facilities in the U.S. since fiscal year 2018, and the agency has consistently fallen short of meeting its annual targets for foreign inspections, according to a January report by the U.S. Government Accountability Office.

Foodborne illness can turn serious. Listeria bacteria in cucumbers sickened dozens of people in April and May and left at least nine people hospitalized, according to the FDA. Salmonella in peanut butter killed nine in 2008 and 2009, resulting in criminal charges against company executives. And E. coli in cookie dough sickened more than 70 people in 2009, including a Nevada mother who died of complications from eating the raw dough.

‘Life or Death for Our Son’

E. coli, commonly found in feces, can be especially dangerous to children like Colton, the boy from Avon, Indiana, who ate contaminated lettuce. The bacteria can damage blood vessels and cause clots that destroy the kidneys, leading to strokes and comas. Consumers sickened by E. coli can pass it along to others, and, in some cases, the bacteria end up killing victims who never consumed the contaminated food.

By the time Colton’s mother brought him to the emergency room that November day, the bacteria were releasing toxins and damaging his blood cells and kidneys, according to his father, Chris George.

Colton was sent to Riley Hospital for Children in Indianapolis. Chris said doctors told him and his wife, Amber George, that their son was in kidney failure and the next 24 to 72 hours would determine whether he would survive, the father recalled.

“They said it was life or death for our son, and I was like, wait, he was just playing basketball,” said Chris, a firefighter. “I told them, ‘You do what you need to do to save my son.’”

Usually, the FDA alerts the public and identifies growers and food manufacturers when there are outbreaks like the one that sickened Colton. The FDA said in its February internal summary that the grower wasn’t named because no product remained on the market.

But Bill Marler, a Seattle lawyer who specializes in food-safety litigation and represents the George family, said the information is still important because it can prevent more cases, pressure growers to improve sanitation, and identify repeat offenders.

It also gives victims an explanation for their illnesses and helps them determine whom they might take legal action against, he said.

“Normally we would see the information on their websites,” Marler said, adding that the agency’s investigatory findings on the outbreak were “all redacted” and he obtained them through a Freedom of Information Act request.

The FDA, USDA, and CDC play central roles in overseeing food safety, including inspections and investigations. The FDA and CDC have been rocked by job cuts that are part of a reduction of 20,000 staff at HHS, their parent agency. The Agriculture Department has also shrunk its workforce.

Staffing cuts mean delays in publicizing deadly outbreaks, said Susan Mayne, an adjunct professor at Yale School of Public Health who retired from the FDA in 2023.

“Consumers are being notified with delays about important food safety notifications,” she said, referring to a recent outbreak in cucumbers. “People can die if there are pathogens like listeria, which can have a 30% fatality rate.”

Makary has said the cuts wouldn’t touch inspectors, reviewers, or scientists at the agency.

But the FDA laid off scientists in April who worked at food safety labs in Chicago and San Francisco, where they performed specialized analysis for food inspectors, former FDA officials said. The FDA later restored some positions.

“No scientists were fired? That was incorrect,” Mayne said.

Siobhan DeLancey, who worked in the agency’s Office of Foods and Veterinary Medicine for more than 20 years before she also was laid off in April, said new requirements for reviewing agency announcements became so arduous that it took weeks to get approval for alerts that should have been going out much sooner.

She said some employees who were laid off include communications specialists and web staff who do consumer outreach aimed at preventing illness. The USDA and FDA have been bringing some workers back or are asking some who accepted deferred resignations to take back their decisions.

“It’s all about destruction and not about efficiency,” DeLancey said. “We’re going to see the effects for years. It will cost lives.”

HHS did not respond to an email seeking a response to DeLancey’s comments.

For 13 days, Colton stayed on dialysis at the hospital, initially unable to eat or drink. His mother wet a sponge to moisten his lips and tongue.

He turned 10 in the hospital. Chris George bought paint markers to make signs on the windows of his son’s room.

“I am not happy with the CDC and FDA,” Chris George said. “Victims have a right to know who made them sick. This is my kid. He’s my life.”

Colton was able to leave the hospital almost three weeks after first eating the contaminated lettuce but still has nightmares about the ordeal and is seeing a therapist.

“The whole ‘Make America Healthy Again,’ the focus on taking food color dyes out of cereal?” said Chris George, who objects to the Trump administration’s decision to redact information about the grower in the February report. “How about we take E. coli out of our lettuce, so it doesn’t kill our kids?”

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GLOBE, Ariz. — Like many residents of this copper-mining town in the mountains east of Phoenix, Debbie Cox knows plenty of people on Medicaid.

Cox, who is a property manager at a real estate company in Globe, has tenants who rely on the safety-net program. And at the domestic violence shelter where she volunteers as president of the board, Cox said, staff always look to enroll women and their children if they can.

But Cox, who is 65, has mixed feelings about Medicaid. “It’s not that I don’t see the need for it. I see the need for it literally on a weekly basis,” she said. “I also see a need for revamping it significantly because it’s been taken advantage of for so long.”

It wasn’t hard to find people in Globe like Cox with complicated views about Medicaid.

Gila County, where Globe is located, is a conservative place — almost 70% of voters went for President Donald Trump in November. And concerns about government waste run deep.

Like many rural communities, it’s also a place where people have come to value government health insurance. The number of Gila County residents on Medicaid and the related Children’s Health Insurance Program has nearly doubled over the past 15 years, according to data from the Georgetown University Center for Children and Families. Today, almost 4 in 10 residents are on one of the plans for low- and moderate-income people or those with disabilities.

So as congressional Republicans consider plans to cut more than $700 billion from Medicaid, the debate over the program hits close to home for many Globe residents, even as some welcome the prospect of tighter rules and less government spending.

For Heather Heisler, the stakes are high. Her husband has been on Medicaid for years.

“We’re ranchers, and there’s not much money in ranching,” said Heisler, who gets her own health care from the Indian Health Service. “Most people think there is, but there isn’t.”

Heisler was selling handicrafts outside the old county jail in Globe on a recent Friday night when the town hosted a downtown street fair with food trucks and live music.

She said Medicaid was especially helpful after her husband had an accident on the ranch. A forklift tipped over, and he had to have part of his left foot amputated. “If anything happens, he’s able to go to the doctor,” she said. “Go to the emergency room, get medicines.”

She shook her head when asked what would happen if he lost the coverage. “It would be very bad for him,” she said.

Among other things, proposed tax legislation written by House Republicans would require working-age Medicaid enrollees to prove they are employed or seeking work. The bill, which passed the House and has advanced to the Senate, would also mandate more paperwork from people to prove they’re eligible.

Difficult applications can dissuade many people from enrolling in Medicaid, even if they’re eligible, researchers have found. And the nonpartisan Congressional Budget Office estimates more than 10 million people will likely lose Medicaid and CHIP insurance under the House Republican plan.

That would reverse big gains made possible by the 2010 Affordable Care Act, which has allowed millions of low-income, working-age adults in places like Globe to get health insurance.

Nationally, Medicaid and CHIP have expanded dramatically over the past two decades, with enrollment in the programs surging from about 56 million in 2005 to more than 78 million last year, according to federal data.

“Medicaid has always played an important role,” said Joan Alker, who runs the Georgetown University Center for Children and Families. “But its role has only grown over the last couple of decades. It really stepped in to address many of the shortcomings in our health care system.”

That’s particularly true in rural areas, where the share of people with disabilities is higher, residents have lower incomes, and communities are reliant on industries with skimpier health benefits such as agriculture and retail.

In Globe, former mayor Fernando Shipley said he’s seen this firsthand.

“A lot of people think, ‘Oh, those are the people that aren’t working.’ Not necessarily,” said Shipley, who operates a State Farm office across the road from the rusted remains of the Old Dominion copper mine. “If you’re a single parent with two kids and you’re making $20 an hour,” he added, “you’re not making ends meet. You’ve got to pay rent; you’ve got to feed those kids.”

Not far away, at the local hospital, some low-wage workers at the registration desk and in housekeeping get health care through Medicaid, chief financial officer Harold Dupper said. “As much as you’d like to pay everyone $75,000 or $80,000 a year, the hospital couldn’t stay in business if that was the payroll,” he said, noting the financial challenges faced by rural hospitals.

The growing importance of Medicaid in places like Globe helps explain why Republican efforts to cut the program face so much resistance, even among conservatives.

“There’s been a shift in the public’s attitude, and particularly voters on the right, that sometimes government plays a role in getting people health care. And that’s OK,” said pollster Bob Ward. “And if you take away that health care, people are going to be angry.” Ward’s Washington, D.C., firm, Fabrizio Ward, works for Trump. He also polls for a coalition trying to protect Medicaid.

At the same time, many of the communities where Medicaid has become more vital in recent years remain very conservative politically.

More than two-thirds of nearly 300 U.S. counties with the biggest growth in Medicaid and CHIP since 2008 backed Trump in the last election, according to a KFF Health News analysis of voting results and enrollment data from Georgetown. Many of these counties are in deep-red states such as Kentucky, Louisiana, and Montana.

Voters in places like these are more likely to be concerned about government waste, polls show. In one recent national survey, 75% of Republicans said they think waste, fraud, and abuse in Medicaid is a major problem.

The actual scale of that waste is hotly debated, though many analysts believe relatively few enrollees are abusing the program.

Nevertheless, around Globe, Republican arguments that cuts will streamline Medicaid seemed to resonate.

Retiree Rick Uhl was stacking chairs and helping clean up after lunch at the senior center. “There’s a lot of waste, of money not being accounted for,” Uhl said. “I think that’s a shame.” Uhl said he’s been saddened by the political rancor, but he said he’s encouraged by the Trump administration’s aggressive efforts to cut government spending.

Back at the street fair downtown, David Sander, who is also retired, said he doubted Medicaid would really be trimmed at all.

“I’ve heard that they really aren’t cutting it,” Sander said. “That’s my understanding.”

Sander and his wife, Linda, were tending a stall selling embroidery that Linda makes. They also have a neighbor on Medicaid.

“She wouldn’t be able to live without it,” Linda Sander said. “Couldn’t afford to have an apartment, make her bills and survive.”

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HHS Secretary Kennedy and Argentine Minister of Health Lugones issue joint statement about the withdrawal of the US and Argentina from the WHO.

Kristin Kramer woke up early on a Tuesday morning 10 years ago because one of her dogs needed to go out. Then, a couple of odd things happened.

When she tried to call her other dog, “I couldn’t speak,” she said. As she walked downstairs to let them into the yard, “I noticed that my right hand wasn’t working.”

But she went back to bed, “which was totally stupid,” said Kramer, now 54, an office manager in Muncie, Indiana. “It didn’t register that something major was happening,” especially because, reawakening an hour later, “I was perfectly fine.”

So she “just kind of blew it off” and went to work.

It’s a common response to the neurological symptoms that signal a TIA, a transient ischemic attack or ministroke. At least 240,000 Americans experience one each year, with the incidence increasing sharply with age.

Because the symptoms disappear quickly, usually within minutes, people don’t seek immediate treatment, putting them at high risk for a bigger stroke.

Kramer felt some arm tingling over the next couple of days and saw her doctor, who found nothing alarming on a CT scan. But then she started “jumbling” her words and finally had a relative drive her to an emergency room.

By then, she could not sign her name. After an MRI, she recalled, “my doctor came in and said, ‘You’ve had a small stroke.’”

Did those early-morning aberrations constitute a TIA? Might a 911 call and an earlier start on anticlotting drugs have prevented her stroke? “We don’t know,” Kramer said. She’s doing well now, but faced with such symptoms again, “I would seek medical attention.”

Now, a large epidemiological study by researchers at the University of Alabama-Birmingham and the University of Cincinnati, published in JAMA Neurology, points to another reason to take TIAs seriously: Over five years, study participants’ performance on cognitive tests after a TIA drops as steeply as it does among victims of a full-on stroke.

“If you have one stroke or one TIA, with no other event over time and no other change in your medical status, the rate of cognitive decline is the same,” said Victor Del Bene, a neuropsychologist and lead author of the study.

An accompanying editorial by Eric Smith, a neurologist at the University of Calgary, was pointedly headlined “Transient Ischemic Attack — Not So Transient After All!”

The study showed that even if the symptoms resolve — typically within 15 minutes to an hour — TIAs set people on a different cognitive slope later in life, Smith said in an interview: “a long-lasting change in people’s cognitive ability, possibly leading to dementia.”

The study, analyzing findings from data on more than 30,000 participants, followed three groups of adults age 45 or older with no history of stroke or TIA. “It’s been a hard group to study because you lack the baseline data of how they were functioning prior to the TIA or stroke,” Del Bene said.

With this longitudinal study, however, researchers could separate those who went on to have a TIA from a group who went on to suffer a stroke and also from an asymptomatic control group. The team adjusted their findings for a host of demographic variables and health conditions.

Immediately after a TIA, “we don’t see an abrupt change in cognition,” as measured by cognitive tests administered every other year, Del Bene said. The stroke group showed a steep decline, but the TIA and control group participants “were more or less neck and neck.”

Five years later, the picture was different. People who had experienced TIAs were cognitively better off than those who had suffered strokes. But both groups were experiencing cognitive decline, and at equally steep rates.

After accounting for various possible causes, the researchers concluded that the cognitive drop reflected not demographic factors, chronic illnesses, or normal aging, but the TIA itself.

“It’s not dementia,” Del Bene said of the decline after a TIA. “It may not even be mild cognitive impairment. But it’s an altered trajectory.”

Of course, most older adults do have other illnesses and risk factors, like heart disease, diabetes, or smoking. “These things together work synergistically to increase the risk for cognitive decline and dementia over time,” he said.

The findings reinforce long-standing concerns that people experiencing TIAs don’t respond quickly enough to the incident. “These events are serious, acute, and dangerous,” said Claiborne Johnston, a neurologist and chief medical officer of Harbor Health in Austin, Texas.

After a TIA, neurologists put the risk of a subsequent stroke within 90 days at 5% to 20%, with half that risk occurring in the first 48 hours.

“Feeling back to normal doesn’t mean you can ignore this, or delay and discuss it with your primary care doctor at your next visit,” Johnston said. The symptoms should prompt a 911 call and an emergency room evaluation.

How to recognize a TIA? Tracy Madsen, an epidemiologist and emergency medicine specialist at the University of Vermont, promotes the BE FAST acronym: balance loss, eyesight changes, facial drooping, arm weakness, speech problems. The “T” is for time, as in don’t waste any.

“We know a lot more about how to prevent a stroke, as long as people get to a hospital,” said Madsen, vice chair of an American Heart Association committee that, in 2023, revised recommendations for TIAs.

The statement called for more comprehensive and aggressive testing and treatment, including imaging, risk assessment, anticlotting and other drugs, and counseling about lifestyle changes that reduce stroke risk.

Unlike other urgent conditions, a TIA may not look dramatic or even be visible; patients themselves have to figure out how to respond.

Karen Howze, 74, a retired lawyer and journalist in Reno, Nevada, didn’t realize that she’d had several TIAs until after a doctor noticed weakness on her right side and ordered an MRI. Years later, she still notices some effect on “my ability to recall words.”

Perhaps “transient ischemic attack” is too reassuring a label, Johnston and a co-author argued in a 2022 editorial in JAMA. They suggested that giving a TIA a scarier name, like “minor ischemic stroke,” would more likely prompt a 911 call.

The experts interviewed for this column all endorsed the idea of a name that includes the word “stroke.”

Changing medical practice is “frustratingly slow,” Johnston acknowledged. But whatever the nomenclature, keeping BE FAST in mind could lead to more examples like Wanda Mercer, who shared her experience in a previous column.

In 2018, she donated at the bloodmobile outside her office in Austin, where she was a systems administrator for the University of Texas, then walked two blocks to a restaurant for lunch. “Waiting in line, I remember feeling a little lightheaded,” she said. “I woke up on the floor.”

Reviving, she assured the worried restaurant manager that she had merely fainted after giving blood. But the manager had already called an ambulance — this was smart move No. 1.

The ER doctors ran tests, saw no problems, gave Mercer intravenous fluids, and discharged her. “I began to tell my colleagues, ‘Guess what happened to me at lunch!’” she recalled. But, she said, she had lost her words: “I couldn’t articulate what I wanted to say.”

Smart move No. 2: Co-workers, suspecting a stroke, called the EMTs for the second time. “I was reluctant to go,” Mercer said. “But they were right.” This time, emergency room doctors diagnosed a minor stroke.

Mercer has had no recurrences. She takes a statin and a baby aspirin daily and sees her primary care doctor annually. Otherwise, at 73, she has retired to an active life of travel, pickleball, running, weightlifting, and book groups.

“I’m very grateful,” she said, “that I have a happy story to tell.”

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HAMILTON, Mont. — Scientists are often careful to take off their work badges when they leave the campus of one of the nation’s top research facilities, here in southwestern Montana’s Bitterroot Valley.

It’s a reflection of the long-standing tension caused by Rocky Mountain Laboratories’ improbable location in this conservative, blue-collar town of 5,000 that was built on logging.

Many residents are proud of the internationally recognized research unfolding at the National Institutes of Health facility and acknowledge that Rocky Mountain Labs has become an economic driver for Hamilton. But a few locals resent what they consider the elitest scientists at the facility, which has employed about 500 people in recent years. Or they fear the contagious pathogens studied there could escape the labs’ well-protected walls.

That split widened with the covid-19 pandemic and the divisions that emerged from mask mandates and vaccine development. In 2023, Matt Rosendale, a Republican who was then a U.S. representative from Montana, falsely tied the lab to the origins of covid in an attempt to cut its funding. Now, Hamilton is a prime example of how the Trump administration’s mass federal layoffs and cancellation of research grants are having ripple effects in communities far from Washington, D.C.

On an April afternoon, hundreds of people filled the sidewalks at an intersection of Hamilton’s usually quiet downtown, waving signs that read “Hands Off Federal Workers” and “Stop Strangling Science.” Some driving by honked in support, rolled their windows down, and cheered. Others flipped off the rallygoers and cast insults at them. A passing bicyclist taunted protesters with chants of “DOGE” — short for the Department of Government Efficiency, the federal initiative led by billionaire Elon Musk to cut costs that has driven mass layoffs and slashed programs.

Kim Hasenkrug, a former Rocky Mountain Labs researcher of 31 years, who retired in 2022, joined the crowd. He slammed President Donald Trump’s promise to let Health and Human Services Secretary Robert F. Kennedy Jr. “go wild” on health issues.

“We’re beginning to see what ‘going wild’ looks like,” Hasenkrug said. “These cuts will not streamline research. They will throttle it.”

As of early May, 41 Rocky Mountain Labs workers had been let go or told their contracts would end this summer, and nine more had retired early, according to researchers employed by the facility. KFF Health News spoke with 10 current or former Rocky Mountain Labs workers who requested anonymity to speak about information that has not been publicly released. The federal government has also slashed billions of dollars for research, including at least $29 million in grants to Montana recipients, ranging from university scientists to the state health department. That’s according to HHS data confirmed by KFF Health News.

Scientists who remain in Hamilton said research has slowed. They’ve struggled to buy basic gear amid federal directives that changed how orders are placed. Now, more cuts are planned for workers who buy and deliver critical, niche supplies, such as antibodies, according to researchers at the labs.

The Department of Health and Human Services didn’t respond to repeated requests for more information on the government’s cuts to research, including questions about the changes in Hamilton. Deputy press secretary Emily Hilliard said the department is committed to the “continuity of essential research.”

Some within the lab feel as if they’ve become public enemies or outcasts, unable to defend themselves without risking their jobs. Postdoctoral scientists just starting their careers are seeing options dwindle. Some workers whose employment contracts expire within days or weeks have been in the dark about whether they’ll be renewed. At least one Rocky Mountain Labs scientist moved to another country to research infectious disease, citing “current turmoil,” according to an email sent from the scientist to co-workers that was reviewed by KFF Health News.

“The remaining staff has been discredited, disrespected, and discouraged from remaining in public service,” Hasenkrug said.

The National Institutes of Health is the largest public funder of biomedical research in the world. It has 27 institutes and centers focused on understanding illness and disabilities and improving health. The agency’s research has helped lead to vaccines against major diseases — from smallpox to covid — and has been behind the majority of medicines approved for the U.S. market. That research also generated more than $94.5 billion in new economic activity nationwide, according to United for Medical Research, a coalition of research groups and advocates.

The Trump administration aims to eliminate roughly 1,200 jobs at the NIH and shrink its budget by 40%. The administration’s budget proposal to cut NIH funding calls the agency’s spending “wasteful,” deems its research “risky,” and accuses it of promoting “dangerous ideologies.”

It’s a dramatic political turnabout for the NIH, which for decades enjoyed bipartisan support in Washington. From 2015 to 2023, its annual budget grew by more than $17 billion.

As of 2023, Rocky Mountain Labs was one of only 51 facilities in the world with the highest level of biosafety precautions, according to the Global BioLabs mapping project. In April, HHS indefinitely stalled work at another of those labs, the Integrated Research Facility in Frederick, Maryland, Wired reported.

Kennedy has said the nation should pause funding infectious disease research, and the White House has said it plans to intensify scrutiny of gain-of-function research, which involves altering a pathogen to study its spread.

Hamilton, in Ravalli County, is a place of scientists, ranchers, and outdoor recreationists. Here, 1 in 8 people live below the federal poverty line. Nearly 70% of county residents who participated in the 2024 presidential election voted for Trump, and Trump signs still dot U.S. Highway 93 leading to town. In the thick of the covid pandemic, the sheriff and county commissioners refused to enforce a statewide mandate to mask in public spaces while Rocky Mountain Labs researchers worked to understand the virus.

The lab’s work dates to 1900, and even early on it was controversial. Rocky Mountain spotted fever was killing people in the valley. Researchers found the cause — ticks — and worked to eradicate the disease-carrying bugs by requiring ranchers to treat their cattle.

That created resentment among locals who “already harbored a healthy distrust of government-imposed programs,” according to an NIH account. The tension came to a head in 1913 when a “dipping vat” used to chemically treat cattle was blown up with dynamite and another damaged with sledgehammers.

Now, some residents and local leaders are worried about the economic consequences of an exodus of federal workers and their salaries. Most of the county is government-managed public land, and the first wave of federal cuts hit U.S. Forest Service workers who do everything from clear trails to fight wildfires.

Rocky Mountain Labs generates hundreds of millions of dollars for the local economy by creating more work for industries including construction and bringing more people into the city’s shops, a 2023 University of Montana study found. The rural community is also a base for international vaccine developer GSK due to the lab’s presence. Kathleen Quinn, a vice president of communications for the company, said GSK’s business with government agencies “continues as usual” for now amid federal changes and that it’s “too early to say what any longer-term impact could be.”

“Our community is impacted more than most,” said City Councilor Darwin Ernst. He spoke during an overflowing March town hall to discuss the federal government cuts. Hundreds of people turned out on the weeknight asking city councilors to do something.

Ernst, a former researcher at the lab who now works as a real estate broker and appraiser, said in an interview he’s starting to see more homes enter the market, which he attributed to the atmosphere of uncertainty and former federal workers’ having to find jobs elsewhere.

“Someone recently left with her entire family. Because of the layoffs, they can’t afford to live here,” he said. “Some people retire here but that’s not everyone.”

Jane Shigley said she’s been a Hamilton resident for more than 30 years and initially thought the government would find “some inefficiencies, no big deal.” But now she’s worried about her hometown’s future.

“Something’s going on that we can’t control,” Shigley said. “And the people that it’s happening to aren’t allowed to talk to us about it.”

The City Council sent a letter to federal officials in April asking for formal consultation prior to any significant changes, given Hamilton’s “interdependence” with Rocky Mountain Labs and the federally controlled lands surrounding Hamilton. As of May, city leaders hadn’t received a response.

People in town are split on how badly the federal cuts will affect Hamilton.

Julie Foster, executive director of the Ravalli County Economic Development Authority, said the community survived the decline of logging, and she thinks Rocky Mountain Labs will survive, too.

“It will be here. There may be bumps in the road, but this is a resilient place,” Foster said.

Even amid the cuts, Rocky Mountain Labs is in the process of a building expansion that, so far, hasn’t stopped. And researchers’ work continues. This spring, scientists there helped make the first identification in Montana of a species of tick known to carry Lyme disease.

KFF Health News correspondent Rae Ellen Bichell contributed to this report.

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

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KFF Health News chief Washington correspondent Julie Rovner discussed Medicaid cuts in the House budget bill on CBS News on May 22.

• Click here to watch Rovner on CBS News.

Céline Gounder, KFF Health News’ editor-at-large for public health, discussed weight loss drugs and covid-19 vaccines on CBS’ “CBS Mornings” on May 22 and May 21, respectively.

• Click here to watch Gounder discuss weight loss drugs on “CBS Mornings.”
• Click here to watch Gounder discuss covid vaccines on “CBS Mornings.”

KFF Health News senior correspondent Renuka Rayasam discussed end-of-life incarceration on WUGA’s “The Georgia Health Report” on May 16.

• Click here to hear Rayasam on “The Georgia Health Report.”
• Read Rayasam’s “Prisons Routinely Ignore Guidelines on Dying Inmates’ End-of-Life Choices.”

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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OCR Releases Notice of Violation to Columbia University

HHS Secretary Robert F. Kennedy, Jr. to Visit Argentina

A blockbuster lawsuit from the federal Department of Justice alleges that insurers Aetna, Elevance Health (formerly Anthem), and Humana paid “hundreds of millions of dollars in kickbacks” to large insurance brokerages eHealth, GoHealth, and SelectQuote. The payments, made from 2016 to at least 2021, were incentives to steer patients into the insurer’s Medicare Advantage plans, the lawsuit alleges, while discouraging enrollment of potentially more costly disabled beneficiaries. 

All the insurers and brokers named in the case have denied the allegations and say they will fight them in court. 

Policy experts say the lawsuit, filed May 1, will add fuel to long-running concerns about whether Medicare enrollees are being encouraged to select the coverage that is best for them — or the one that makes the most money for the broker.  

In other Medicare news, The Wall Street Journal last week, citing unnamed sources, reported that a separate insurer, UnitedHealth Group, was being investigated by the Justice Department regarding unspecified potential Medicare violations. UnitedHealth pushed back, calling the article “deeply irresponsible” and saying it had not been notified by the DOJ as to any such investigation. 

Regardless of how this attention shakes out, Medicare Advantage, the private sector alternative to original Medicare, is likely to continue to draw scrutiny because it covers more than half of those enrolled. But the plans, which often include benefits not covered by the traditional government program, cost taxpayers more per enrollee and have drawn criticism for requiring patients to get prior authorization for certain services, something rarely required in original Medicare. 

The DOJ lawsuit alleges insurers made large payments they called “marketing” or “sponsorship” fees to get around rules that set caps on broker commissions. The payments, according to the lawsuit, added incentives — often more than $200 per enrollee — for brokers to direct Medicare beneficiaries toward their coverage “regardless of the quality or suitability of the insurers’ plans.” 

The case joins the DOJ in a previously filed whistleblower lawsuit brought by a then-employee of eHealth, Andrew Shea. The whistleblower’s attorney, Gregg Shapiro, said his client is grateful the DOJ chose to intervene: “People with Medicare must know that when an insurance agent recommends a plan, that recommendation is based solely on the client’s individual needs and preferences,” Shapiro said in an emailed statement. 

While encouraged that the Trump administration filed the case under investigations initiated by the Biden administration, policy experts say Congress and insurers need to do more. 

“What we see in this lawsuit highlights the terrible incentives that desperately need Congress to reform,” said Brian Connell, a vice president at the Leukemia & Lymphoma Society, an advocacy group. 

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

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

With only a single vote to spare, the House passed a controversial budget bill that includes billions of dollars in tax cuts for the wealthy, along with billions of dollars of cuts to Medicaid, the Affordable Care Act, and the food stamp program — most of which will affect those at the lower end of the income scale. But the bill faces an uncertain future in the Senate.

Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. released a report from his commission to “Make America Healthy Again” that described threats to the health of the American public — but notably included nothing on threats from tobacco, gun violence, or a lack of health insurance.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Sarah Karlin-Smith of the Pink Sheet, and Alice Miranda Ollstein of Politico.

Panelists Anna Edney Bloomberg News @annaedney @annaedney.bsky.social Read Anna's stories. Sarah Karlin-Smith Pink Sheet @SarahKarlin @sarahkarlin-smith.bsky.social Read Sarah's stories. Alice Miranda Ollstein Politico @AliceOllstein @alicemiranda.bsky.social Read Alice's stories.

Among the takeaways from this week’s episode:

• House Republicans passed their “big, beautiful” bill 215-214 this week, with one Republican critic voting present. But the Senate may have its own “big, beautiful” rewrite. Some conservative senators who worry about federal debt are concerned that the bill is not fully paid for and would add to the budget deficit. Others, including some red-state Republicans, say the bill’s cuts to Medicaid and food assistance go too far and would hurt low-income Americans. The bill’s cuts would represent the biggest reductions to Medicaid in the program’s 60-year history.
• Many of the bill’s Medicaid cuts would come from adding work requirements. Most people receiving Medicaid already work, but such requirements in Arkansas and Georgia showed that people often lose coverage under these rules because they have trouble documenting their work hours, including because of technological problems. The nonpartisan Congressional Budget Office estimated an earlier version of the bill would reduce the number of people with Medicaid by at least 8.6 million over a decade. The requirements also could add a burden for employers. The bill’s work requirements are relatively broad and would affect people who are 19 to 64 years old. 
• People whose Medicaid coverage is canceled also would no longer qualify for ACA subsidies for marketplace plans. Medicare also would be affected, because the bill would be expected to trigger an across-the-board sequestration cut.
• The bill also would impact abortion by effectively banning it in ACA marketplace plans, which would disrupt a compromise struck in the 2010 law. And the bill would block funding for Planned Parenthood in Medicaid, although that federal money is used for other care such as cancer screenings, not abortions. In the past, the Senate parliamentarian has said that kind of provision is not allowed under budget rules, but some Republicans want to take the unusual step of overruling the parliamentarian.
• This week, FDA leaders released covid-19 vaccine recommendations in a medical journal. They plan to limit future access to the vaccines to people 65 and older and others who are at high risk of serious illness if infected, and they want to require manufacturers to do further clinical trials to show whether the vaccines benefit healthy younger people. There are questions about whether this is legal, which products would be affected, when this would take effect, and whether it’s ethical to require these studies. 
• HHS released a report on chronic disease starting in childhood. The report doesn’t include many new findings but is noteworthy in part because of what it doesn’t discuss — gun violence, the leading cause of death for children and teens in the United States; tobacco; the lack of health insurance coverage; and socioeconomic factors that affect access to healthy food.

Also this week, Rovner interviews University of California-Davis School of Law professor and abortion historian Mary Ziegler about her new book on the past and future of the “personhood” movement aimed at granting legal rights to fetuses and embryos.

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

Julie Rovner: The Washington Post’s “White House Officials Wanted To Put Federal Workers ‘in Trauma.’ It’s Working,” by William Wan and Hannah Natanson.

Alice Miranda Ollstein: NPR’s “Diseases Are Spreading. The CDC Isn’t Warning the Public Like It Was Months Ago,” by Chiara Eisner.

Anna Edney: Bloomberg News’ “The Potential Cancer, Health Risks Lurking in One Popular OTC Drug,” by Anna Edney.

Sarah Karlin-Smith: The Farmingdale Observer’s “Scientists Have Been Studying Remote Work for Four Years and Have Reached a Very Clear Conclusion: ‘Working From Home Makes Us Happier,’” by Bob Rubila.

Also mentioned in this week’s podcast:

• The New York Times’ “As Congress Debates Cutting Medicaid, a Major Study Shows It Saves Lives,” by Sarah Kliff and Margot Sanger-Katz.
• NBC News’ “Georgia Mother Says She Is Being Forced To Keep Brain-Dead Pregnant Daughter Alive Under Abortion Ban Law,” by Minyvonne Burke.
• The Washington Post’s “Trump and GOP’s Tax Bill Would Force Cuts to Medicare, CBO Says,” by Jacob Bogage and Abha Bhattarai.
• The New England Journal of Medicine’s “An Evidence-Based Approach to Covid-19 Vaccination,” by Vinay Prasad and Martin A. Makary.

Credits Francis Ying Audio producer Rebecca Adams 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.

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La emblemática legislación del presupuesto del presidente Donald Trump castigaría a 14 estados que ofrecen cobertura de salud a personas que viven en el país sin papeles.

Estos estados, la mayoría liderados por demócratas, dan seguro médico a algunos inmigrantes de bajos ingresos —a menudo niños—, independientemente de su estatus migratorio. Defensores argumentan que la política es humanitaria y que, en última instancia, ahora costos.

Sin embargo, la legislación federal, que los republicanos han denominado One Big Beautiful Bill (Un hermoso gran proyecto de ley), recortaría drásticamente los reembolsos federales de Medicaid a esos estados en miles de millones de dólares anuales en total, a menos que reduzcan esos beneficios.

El proyecto de ley fue aprobado por un estrecho margen en la Cámara de Representantes el jueves 22 de mayo, y ahora pasa al Senado.

Si bien avanza gran parte de la agenda nacional de Trump, incluyendo grandes recortes de impuestos que benefician principalmente a los estadounidenses más ricos, la legislación también realiza recortes sustanciales del gasto en Medicaid que, según los responsables del presupuesto del Congreso, dejará a millones de personas de bajos ingresos sin seguro médico.

De ser aprobados por el Senado, estos recortes representarían un complejo obstáculo político y económico para los estados y Washington, DC, que utilizan sus propios fondos para brindar seguro médico a algunas personas que viven en Estados Unidos sin autorización.

Estos estados verían reducidos en 10 puntos porcentuales los reembolsos federales para las personas cubiertas por la expansión de Medicaid que se realize bajo la Ley de Cuidado de Salud a Bajo Precio (ACA).

Estos recortes le costarían a California, el estado que más tiene que perder, hasta $3 mil millones al año, según un análisis de KFF, una organización sin fines de lucro dedicada a información de salud que incluye a KFF Health News.

En conjunto, los 15 lugares afectados (los 14 estados y DC) cubren a aproximadamente 1.9 millones de inmigrantes sin papeles, según KFF. La entidad indica que la sanción también podría aplicarse a otros estados que cubren a inmigrantes con residencia legal.

Dos de los estados, Illinois y Utah, tienen leyes de “activación” que exigen terminar con sus expansiones de Medicaid si el gobierno federal reduce su aporte de fondos. Esto significa que, a menos que esos estados deroguen sus leyes de activación o dejen de cubrir a las personas sin estatus migratorio legal, muchos más estadounidenses de bajos ingresos podrían quedarse sin seguro.

Si continúan cubriendo a personas sin papeles, a partir del año fiscal 2027, los estados restantes y Washington, DC, tendrían que aportar millones o miles de millones de dólares adicionales cada año, para compensar las reducciones en sus reembolsos federales de Medicaid.

Después de California, Nueva York podría perder la mayor parte de la financiación federal: cerca de 1.600 millones de dólares anuales, según KFF.

El senador estatal de California, Scott Wiener, demócrata y presidente del Comité de Presupuesto del Senado, afirmó que la legislación de Trump ha sembrado el caos mientras los legisladores estatales trabajan para aprobar su propio presupuesto antes del 15 de junio.

“Tenemos que mantenernos firmes”, declaró. “California ha decidido que queremos una atención médica universal y que vamos a garantizar que todos tengan acceso a la atención médica, y que no vamos a permitir que millones de personas indocumentadas reciban atención primaria en salas de emergencia”.

El gobernador de California, el demócrata Gavin Newsom, declaró en un comunicado que el proyecto de ley de Trump devastaría la atención médica en su estado.

“Millones de personas perderán cobertura, los hospitales cerrarán y las redes de seguridad social podrían colapsar bajo ese peso”, dijo Newsom.

En su propuesta de presupuesto del 14 de mayo, Newsom instó a los legisladores a recortar algunos beneficios para inmigrantes sin papeles, citando el aumento desmedido de los costos del programa estatal de Medicaid. Si el Congreso recorta los fondos para la expansión de Medicaid, el estado no estaría en condiciones de cubrir los gastos, afirmó el gobernador.

Newsom cuestionó si el Congreso tiene la autoridad para penalizar a los estados por cómo gastan su propio dinero, y afirmó que su estado consideraría impugnar la medida en los tribunales.

El representante estatal de Utah, Jim Dunnigan, republicano que ayudó a impulsar un proyecto de ley para cubrir a los niños en su estado independientemente de su estatus migratorio, afirmó que Utah necesita mantener la expansión de Medicaid que comenzó en 2020.

“No podemos permitirnos, ni monetaria ni políticamente, que se recorten nuestros fondos federales para la expansión”, declaró. Dunnigan no especificó si cree que el estado debería cancelar su cobertura para inmigrantes si la disposición republicana sobre sanciones se convierte en ley.

El programa de Utah cubre a unos 2.000 niños, el máximo permitido por su ley. Los inmigrantes adultos sin estatus legal no son elegibles. La expansión de Medicaid de Utah cubre a unos 75.000 adultos, quienes deben ser ciudadanos o inmigrantes con residencia legal.

Matt Slonaker, director ejecutivo del Utah Health Policy Project, una organización de defensa del consumidor, afirmó que el proyecto de ley de la Cámara federal deja al estado en una posición difícil.

“Políticamente, no hay grandes alternativas”, declaró. “Es el dilema del prisionero: cualquier movimiento en cualquier dirección no tiene mucho sentido”.

Slonaker apuntó que un escenario probable es que los legisladores estatales eliminen su ley de activación, y luego encuentren la manera de compensar la pérdida de fondos federales para la expansión.

Utah ha financiado su parte del costo de la expansión de Medicaid con impuestos sobre las ventas y los hospitales.

“El Congreso pondría al estado de Utah en posición de tener que tomar una decisión política muy difícil”, declaró Slonaker.

En Illinois, la sanción del Partido Republicano tendría incluso consecuencias más graves. Esto se debe a que podría llevar a que 770.000 adultos perdieran la cobertura médica que obtuvieron con la expansión estatal de Medicaid.

Stephanie Altman, directora de justicia sanitaria del Shriver Center on Poverty Law, un grupo de defensa con sede en Chicago, afirmó que es posible que su estado, liderado por demócratas, derogue su ley de activación antes de permitir que se dé por terminada la expansión de Medicaid.

Agregó que el estado también podría eludir la sanción solicitando a los condados que financien la cobertura para inmigrantes. “Obviamente, sería una situación difícil”, declaró.

Altman indicó que el proyecto de ley de la Cámara de Representantes parece redactado para penalizar a los estados controlados por demócratas, ya que estos suelen brindar cobertura a inmigrantes sin importar su estatus migratorio.

Agregó que la disposición demuestra la “hostilidad de los republicanos contra los inmigrantes” y que “no quieren que vengan aquí y reciban cobertura pública”.

Mike Johnson, el presidente de la Cámara de Representantes de Estados Unidos, declaró en mayo que los programas estatales que brindan cobertura pública a personas sin importar su estatus migratorio actúan como un “felpudo abierto”, invitando a más personas a cruzar la frontera sin autorización. Afirmó que los esfuerzos para eliminar estos programas cuentan con el apoyo de las encuestas públicas.

Una encuesta de Reuters-Ipsos realizada entre el 16 y el 18 de mayo reveló que el 47% de los estadounidenses aprueba las políticas migratorias de Trump y el 45% las desaprueba. La encuesta reveló que el índice de aprobación general de Trump ha caído 5 puntos porcentuales desde que regresó al cargo en enero, hasta el 42%, con un 52% de los estadounidenses desaprobando su gestión.

ACA, también conocida como Obamacare, impulsó a los estados a ampliar Medicaid a adultos con ingresos de hasta el 138% del nivel federal de pobreza, o $21.597 por persona este año. Cuarenta estados y Washington, DC, ampliaron su cobertura, lo que contribuyó a reducir la tasa nacional de personas sin seguro a un mínimo histórico.

El gobierno federal ahora cubre el 90% de los costos de las personas incluidas en Medicaid gracias a la ampliación del Obamacare.

En los estados que cubren la atención médica de inmigrantes sin autorización, el proyecto de ley republicano reduciría la contribución del gobierno federal del 90% al 80% del costo de la cobertura para cualquier persona que se incorpore a Medicaid bajo la expansión de ACA.

Por ley, los fondos federales de Medicaid no pueden utilizarse para cubrir a personas que se encuentran en el país papeles, excepto para servicios de embarazo y emergencias.

Los otros estados que utilizan sus propios fondos para cubrir a personas sin importar su estatus migratorio son: Colorado, Connecticut, Maine, Massachusetts, Minnesota, Nueva Jersey, Oregon, Rhode Island, Vermont y Washington, según KFF.

Ryan Long, director de relaciones con el Congreso del Paragon Health Institute, un influyente grupo político conservador, afirmó que incluso si utilizan sus propios fondos para la cobertura de inmigrantes, los estados aún dependen de los fondos federales para “apoyar sistemas que faciliten la inscripción de inmigrantes indocumentados”.

Long afirmó que la preocupación por que los estados con leyes de activación puedan ver finalizada la expansión de Medicaid es una “pista falsa”, ya que los estados tienen la opción de eliminar sus activadores, como hizo Michigan en 2023.

La sanción por ofrecer cobrtura de salud a personas en el país sin papeles es una de las distintas maneras en que el proyecto de ley de la Cámara de Representantes recorta el gasto federal en Medicaid.

La legislación también trasladaría más costos de Medicaid a los estados al exigirles que verifiquen si los adultos cubiertos por el programa trabajan. Los estados también tendrían que recertificar la elegibilidad de los beneficiarios de la expansión de Medicaid cada seis meses, en lugar de una vez al año o menos, como lo hacen actualmente la mayoría.

El proyecto de ley también congelaría la práctica de los estados de gravar con impuestos a hospitales, residencias de adultos mayores, planes de atención médica administrada y otras compañías de atención médica para financiar su parte de los costos de Medicaid.

En una estimación preliminar del 11 de mayo, la Oficina de Presupuesto del Congreso (CBO) indicó que, según el proyecto de ley aprobado por la Cámara de Representantes, alrededor de 8,6 millones de personas más perderían la cobertura médica en 2034.

Esa cifra aumentará a casi 14 millones, según la CBO, después que la administración Trump finalice las nuevas regulaciones de ACA y, si el Congreso, liderado por los republicanos, como se prevé, se niegue a extender los subsidios mejorados para ayudar a pagar las primas de los planes de salud comerciales vendidos a través de los mercados del Obamacare.

Los subsidios mejorados, una prioridad del ex presidente Joe Biden, eliminaron por completo las primas mensuales para algunas personas que adquirieran planes de Obamacare. Y expiran a fin de año.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

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

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President Donald Trump’s signature budget legislation would punish 14 states that offer health coverage to people in the U.S. without authorization.

The states, most of them Democratic-led, provide insurance to some low-income immigrants — often children — regardless of their legal status. Advocates argue the policy is both humane and ultimately cost-saving.

But the federal legislation, which Republicans have titled the “One Big Beautiful Bill,” would slash federal Medicaid reimbursements to those states by billions of dollars a year in total unless they roll back the benefits.

The bill narrowly passed the House on Thursday and next moves to the Senate. While enacting much of Trump’s domestic agenda, including big tax cuts largely benefiting wealthier Americans, the legislation also makes substantial spending cuts to Medicaid that congressional budget scorekeepers say will leave millions of low-income people without health insurance.

The cuts, if approved by the Senate, would pose a tricky political and economic hurdle for the states and Washington, D.C., which use their own funds to provide health insurance to some people in the U.S. without authorization.

Those states would see their federal reimbursement for people covered under the Affordable Care Act’s Medicaid expansion cut by 10 percentage points. The cuts would cost California, the state with the most to lose, as much as $3 billion a year, according to an analysis by KFF, a health information nonprofit that includes KFF Health News.

Together, the 15 affected places cover about 1.9 million immigrants without legal status, according to KFF. The penalty might also apply to other states that cover lawfully residing immigrants, KFF says.

Two of the states — Utah and Illinois — have “trigger” laws that call for their Medicaid expansions to terminate if the feds reduce their funding match. That means unless those states either repeal their trigger laws or stop covering people without legal immigration status, many more low-income Americans could be left uninsured.

The remaining states and Washington, D.C., would have to come up with millions or billions more dollars every year, starting in the 2027 fiscal year, to make up for reductions in their federal Medicaid reimbursements, if they keep covering people in the U.S. without authorization.

Behind California, New York stands to lose the most federal funding — about $1.6 billion annually, according to KFF.

California state Sen. Scott Wiener, a Democrat who chairs the Senate budget committee, said Trump’s legislation has sown chaos as state legislators work to pass their own budget by June 15.

“We need to stand our ground,” he said. “California has made a decision that we want universal health care and that we are going to ensure that everyone has access to health care, and that we’re not going to have millions of undocumented people getting their primary care in emergency rooms.”

California Gov. Gavin Newsom, a Democrat, said in a statement that Trump’s bill would devastate health care in his state.

“Millions will lose coverage, hospitals will close, and safety nets could collapse under the weight,” Newsom said.

In his May 14 budget proposal, Newsom called on lawmakers to cut some benefits for immigrants without legal status, citing ballooning costs in the state’s Medicaid program. If Congress cuts Medicaid expansion funding, the state would be in no position to backfill, the governor said.

Newsom questioned whether Congress has the authority to penalize states for how they spend their own money and said his state would consider challenging the move in court.

Utah state Rep. Jim Dunnigan, a Republican who helped spearhead a bill to cover children in his state regardless of their immigration status, said Utah needs to maintain its Medicaid expansion that began in 2020.

“We cannot afford, monetary-wise or policy-wise, to see our federal expansion funding cut,” he said. Dunnigan wouldn’t say whether he thinks the state should end its immigrant coverage if the Republican penalty provision becomes law.

Utah’s program covers about 2,000 children, the maximum allowed under its law. Adult immigrants without legal status are not eligible. Utah’s Medicaid expansion covers about 75,000 adults, who must be citizens or lawfully present immigrants.

Matt Slonaker, executive director of the Utah Health Policy Project, a consumer advocacy organization, said the federal House bill leaves the state in a difficult position.

“There are no great alternatives, politically,” he said. “It’s a prisoner’s dilemma — a move in either direction does not make much sense.”

Slonaker said one likely scenario is that state lawmakers eliminate their trigger law then find a way to make up the loss of federal expansion funding.

Utah has funded its share of the cost of Medicaid expansion with sales and hospital taxes.

“This is a very hard political decision that Congress would put the state of Utah in,” Slonaker said.

In Illinois, the GOP penalty would have even larger consequences. That’s because it could lead to 770,000 adults’ losing the health coverage they gained under the state’s Medicaid expansion.

Stephanie Altman, director of health care justice at the Shriver Center on Poverty Law, a Chicago-based advocacy group, said it’s possible her Democratic-led state would end its trigger law before allowing its Medicaid expansion to terminate. She said the state might also sidestep the penalty by asking counties to fund coverage for immigrants. “It would be a hard situation, obviously,” she said.

Altman said the House bill appeared written to penalize Democratic-controlled states because they more commonly provide immigrants coverage without regard for their legal status.

She said the provision shows Republicans’ “hostility against immigrants” and that “they do not want them coming here and receiving public coverage.”

U.S. House Speaker Mike Johnson said this month that state programs that provide public coverage to people regardless of immigration status serve as “an open doormat,” inviting more people to cross the border without authorization. He said efforts to end such programs have support in public polling.

A Reuters-Ipsos poll conducted May 16-18 found that 47% of Americans approve of Trump’s immigration policies and 45% disapprove. The poll found that Trump’s overall approval rating has sunk 5 percentage points since he returned to office in January, to 42%, with 52% of Americans disapproving of his performance.

The Affordable Care Act, widely known as Obamacare, enabled states to expand Medicaid to adults with incomes of up to 138% of the federal poverty level, or $21,597 for an individual this year. Forty states and Washington, D.C., expanded, helping reduce the national uninsured rate to a historic low.

The federal government now pays 90% of the costs for people added to Medicaid under the Obamacare expansion.

In states that cover health care for immigrants in the U.S. without authorization, the Republican bill would reduce the federal government’s contribution from 90% to 80% of the cost of coverage for anyone added to Medicaid under the ACA expansion.

By law, federal Medicaid funds cannot be used to cover people who are in the country without authorization, except for pregnancy and emergency services.

The other states that use their own money to cover people regardless of immigration status are Colorado, Connecticut, Maine, Massachusetts, Minnesota, New Jersey, Oregon, Rhode Island, Vermont, and Washington, according to KFF.

Ryan Long, director of congressional relations at Paragon Health Institute, an influential conservative policy group, said that even if they use their own money for immigrant coverage, states still depend on federal funds to “support systems that facilitate enrollment of illegal aliens.”

Long said the concern that states with trigger laws could see their Medicaid expansion end is a “red herring” because states have the option to remove their triggers, as Michigan did in 2023.

The penalty for covering people in the country without authorization is one of several ways the House bill cuts federal Medicaid spending.

The legislation would shift more Medicaid costs to states by requiring them to verify whether adults covered by the program are working. States would also have to recertify Medicaid expansion enrollees’ eligibility every six months, rather than once a year or less, as most states currently do.

The bill would also freeze states’ practice of taxing hospitals, nursing homes, managed-care plans, and other health care companies to fund their share of Medicaid costs.

The Congressional Budget Office said in a May 11 preliminary estimate that, under the House-passed bill, about 8.6 million more people would be without health insurance in 2034. That number will rise to nearly 14 million, the CBO estimates, after the Trump administration finishes new ACA regulations and if the Republican-led Congress, as expected, declines to extend enhanced premium subsidies for commercial insurance plans sold through Obamacare marketplaces.

The enhanced subsidies, a priority of former President Joe Biden, eliminated monthly premiums altogether for some people buying Obamacare plans. They are set to expire at the end of the year.

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

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

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HHS OCR finds Columbia University violated Title VI by failing to address harassment of Jewish students since October 7, 2023.

ST. LOUIS — Kevin Hines has been living in a house without a roof in the days since a tornado devastated his community. He has seen some of his neighbors sleeping in their cars. A different man has spent untold hours on a bench.

In the aftermath of the May 16 tornado, Hines, 60, has a blue tarp covering his home. Still, rain came in three days later — an expected problem in a house without a roof. But he didn’t think wildlife would be an issue. Then a bird landed on his television. He spotted a squirrel on the sofa.

He already has enough to handle. He’s not sure when his home will be repaired. A toppled tree destroyed the purple Jeep he bought only months ago. His job told employees not to come into work because the building was damaged.

The tornado cut a 23-mile-long path, touching down in the affluent suburb of Clayton, Missouri, before ripping through the north side of the city of St. Louis then across the Mississippi River through communities in western Illinois. At least five people were killed, 38 more were injured, and about 5,000 structures were damaged, according to St. Louis Mayor Cara Spencer. The twister caused more than $1.6 billion in estimated property damage.

While the impact was felt throughout the area, it will take some neighborhoods longer than others to recover. Kayla Reed, a community activist who runs the Action St. Louis nonprofit, which is coordinating help for storm victims, said residents in the predominantly Black area known as North City especially face a long set of challenges in the days ahead.

“A natural disaster met a created one and a systemic one,” Reed said. “They’ve sort of been in a long-term storm all of their lives. If you live in this footprint, you know this is where infant mortality is highest. This is where incarceration rates are highest. This is where poverty rates are highest.”

Food and water aid provide some relief, Reed said, but the community needs more than that. “I can’t put into words how long it’s going to take to stabilize some of these families and how much trauma they are navigating,” she said.

A possible source of major aid is the federal government, which can unlock resources at the president’s discretion. But Missouri is already waiting for President Donald Trump to approve federal assistance for damage left by three sets of storms in March and April that killed 19 people in the state. Trump has denied major disaster requests from West Virginia and Washington this year, and initially denied one for storm and tornado damage in Arkansas before reversing course and approving the request May 13.

Black families here in North St. Louis are worried that their community will not be prioritized.

On May 19, Missouri Gov. Mike Kehoe, a Republican, requested that Trump issue a federal emergency declaration, which would authorize about $5 million in federal assistance for cleanup efforts. Kehoe also requested that the Federal Emergency Management Agency conduct a preliminary damage assessment, a necessary step to securing a “major disaster declaration,” which would provide federal resources for homeowners and renters, reimburse local government efforts, and pay for damaged public infrastructure.

FEMA was on the ground two days later helping conduct damage assessments. But a disaster declaration could take weeks, if it comes.

“Bringing FEMA in, it’s my understanding, is not going to be a quick process,” the mayor said at a May 21 press conference. “All elected officials at every level here are doing everything they can to make that process as quick as possible.”

That includes Republican U.S. Sen. Josh Hawley, who asked Homeland Security Secretary Kristi Noem during an oversight hearing May 20 to help expedite the pending aid requests from Missouri’s three previous storms and for the recent tornado. “Yes, absolutely,” she responded.

While the city waits, thousands of volunteers have shown up to the parking lot of the YMCA’s O’Fallon Park Rec Complex in North St. Louis in what they are calling the “People’s Response” to help residents in need. So far, they’ve helped more than 5,000 families. Volunteers have collected more than 17,280 pounds of food, according to Action St. Louis.

The last time such an outpouring occurred around here, according to locals, was in 2014 after the police killing of Michael Brown in nearby Ferguson. Rasheen Aldridge, an alderman who represents part of the storm-affected area, said some of the same activists who showed up then made it a point to help now.

Hines, too, looked for ways to help his neighbors. He became an unofficial traffic director at the YMCA as thousands of cars streamed into the area to get help — or provide it.

“It’s not about me,” Hines said. “I’m staying until no one is here because there’s nothing to do at my house. I have no power.”

Residents in North City described the moments after the storm as chaos: trees down everywhere; power lines damaged; limited cellphone service, making it hard to connect with loved ones. Then the sun went down, cloaking corners of the city in complete darkness.

Five days after the tornado, people still needed candles, flashlights, and batteries to make it through the night. Piles of debris filled street corners. Exterior walls were ripped off homes, exposing the inside of closets, bedrooms, and living rooms to passersby on the street. Some buildings were leveled. The downed trees in the tornado’s path left a scar in the city’s canopy visible from miles away.

The tornado flipped a semitrailer outside a new gas station and strip mall that had been scheduled to open this fall. One evening, Charles Stanford, a security guard for the property, sat in the parking lot to make sure no one tried to enter what remained of the building. Stanford said the project had been nearly complete. Now, it is surrounded by rubble and debris.

A giant tree crashed into the house of one of Hines’ neighbors. He said the woman recently had heart surgery and had been recovering at home. But then she went back to the hospital, and he thinks stress after the tornado may be why. Hines was planning to bring her a few Hershey’s Kisses, her favorite candy, to lift her spirits.

Shannette BoClair, 52, said she found her infirm father, Albert Noble, on the floor in the fetal position after the tornado passed her parents’ home. A window had imploded and strong winds knocked him down. BoClair called 911 but, she said, first responders were overwhelmed by calls for help and tree-blocked streets. Her father needed medical attention right away, she said, so his family helped him hobble a mile to his grandson, who drove him to a triage station that had been set up for tornado victims.

They learned he had broken his hip, she said. He had surgery within days.

BoClair, who works as a health and wellness director at the YMCA, said she’s helping care for her mother, who remained at home after the storm. BoClair is depending on meals provided by volunteers and staffers at the YMCA but said she had also spent about $500 on DoorDash meals to feed her family since the tornado hit.

As far as federal aid goes, BoClair said she hopes it comes soon. The community needs dumpsters for the debris, reconstruction, and more.

But the outpouring of support from volunteers amazed her. The People’s Response drew so many volunteers that lines of cars snaked outside of the YMCA parking lot in North City. The smell of barbecue wafted through the air as residents without electricity grilled food for one another before it spoiled.

“I’m so proud of our community,” BoClair said. “They say we don’t care. We do care.”

Reed said volunteers would be stationed in the YMCA’s parking lot for a few more days. But, she said, that doesn’t mean the job ends there. The community will need more help to rebuild.

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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