In summertime, cows wait under a canopy to be milked at Mark McAfee’s farm in Fresno, California. From his Cessna 210 Centurion propeller plane, the 63-year-old can view grazing lands of the dairy company he runs that produces products such as unpasteurized milk and cheese for almost 2,000 stores.

Federal regulators say it’s risky business. Samples of raw milk can contain bird flu virus and other pathogens linked to kidney disease, miscarriages, and death.

McAfee, founder and CEO of the Raw Farm, who also leads the Raw Milk Institute, says he plans to soon be in a position to change that message.

Robert F. Kennedy Jr., the anti-vaccine activist President Donald Trump has tapped to run the Department of Health and Human Services, recruited McAfee to apply for a job as the FDA’s raw milk standards and policy adviser, McAfee said. McAfee has already written draft proposals for possible federal certification of raw dairy farms, he said.

Virologists are alarmed. The Centers for Disease Control and Prevention recommends against unpasteurized dairy that hasn’t been heated to kill pathogens such as bird flu. Interstate raw milk sales for human consumption are banned by the FDA. A Trump administration that weakens the ban or extols raw milk, the scientists say, could lead to more foodborne illness. It could also, they say, raise the risk of the highly pathogenic H5N1 bird flu virus evolving to spread more efficiently, including between people, possibly fueling a pandemic.

“If the FDA says raw milk is now legal and the CDC comes through and says it advises drinking raw milk, that’s a recipe for mass infection,” said Angela Rasmussen, a virologist and co-editor-in-chief of the medical journal Vaccine and an adjunct professor at Stony Brook University in New York.

The raw milk controversy reflects the broader tensions President Donald Trump will confront when pursuing his second-administration agenda of rolling back regulations and injecting more consumer choice into health care.

Many policies Kennedy has said he wants to revisit — from the fluoridation of tap water to nutrition guidance to childhood vaccine requirements — are backed by scientific research and were established to protect public health. Some physician groups and Democrats are gearing up to fight initiatives they say would put people at risk.

Raw milk has gained a following among anti-regulatory conservatives who are part of a burgeoning health freedom movement.

“The health freedom movement was adopted by the tea party, and conspiracy websites gave it momentum,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has studied the history of the anti-vaccine movement.

Once-fringe ideas are edging into the mainstream. Vaccine hesitancy is growing.

Arkansas, Utah, and Kentucky are weighing legislation that would relax or end requirements for fluoride in public water. And 30 states now allow for the sale of raw milk in some form within their borders.

While only an estimated 3% of the U.S. population consumes raw milk or cheese, efforts to try to restrict its sales have riled Republicans and provided grist for conservative podcasts.

Many conservatives denounced last year’s execution of a search warrant when Pennsylvania agriculture officials and state troopers arrived at an organic farm tucked off a two-lane road on Jan. 4, 2024. State inspectors were investigating cases of two children sickened by E. coli bacteria and sales of raw dairy from the operation owned by Amish farmer Amos Miller, according to a complaint filed by the state’s agricultural department.

Bundled in flannel shirts and winter jackets, the inspectors put orange stickers on products detaining them from sale, and they left toting product samples in large blue-and-white coolers, online videos show. The 2024 complaint against Miller alleged that he and his wife sold dairy products in violation of state law.

The farm was well known to regulators. They say in the complaint that a Florida consumer died after being sickened in 2014 with listeria bacteria found in raw dairy from Miller’s farm. The FDA said a raw milk sample from the farm indicates it was the “likely source” of the infection, based on the complaint.

Neither Miller’s farm nor his lawyer returned calls seeking comment.

The Millers’ attorney filed a preliminary objection that said “shutting down Defendants would cause inequitable harm, exceed the authority of the agency, constitute an excessive fine as well as disparate, discriminatory punishment, and contravene every essential Constitutional protection and powers reserved to the people of Pennsylvania.”

Regulators in Pennsylvania said in a press release they must protect the public, and especially children, from harm. “We cannot ignore the illnesses and further potential harm posed by distribution of these unregulated products,” the Pennsylvania agricultural department and attorney general said in a joint statement.

Unpasteurized dairy products are responsible for almost all the estimated 761 illnesses and 22 hospitalizations in the U.S. that occur annually because of dairy-related illness, according to a study published in the June 2017 issue of Emerging Infectious Diseases.

But conservatives say raiding an Amish farm is government overreach. They’re “harassing him and trying to make an example of him. Our government is really out of control,” Pennsylvania Republican Sen. Doug Mastriano said in a video he posted to Facebook.

Videos show protesters at a February 2024 hearing on Miller’s case included Amish men dressed in black with straw hats and locals waving homemade signs with slogans such as “FDA Go Away.” A court in March issued a preliminary injunction that barred Miller from marketing and selling raw dairy products within the commonwealth pending appeal, but the order did not preclude sales of raw milk to customers out of state. The case is ongoing.

With Kennedy, the raw milk debate is poised to go national. Kennedy wrote on X in October that the “FDA’s war on public health is about to end.” In the post, he pointed to the agency’s “aggressive suppression” of raw milk, as one example.

McAfee is ready. He wants to see a national raw milk ordinance, similar to one that exists for pasteurized milk, that would set minimal national standards. Farmers could attain certification through training, continuing education, and on-site pathogen testing, with one standard for farms that sell to consumers and another for retail sales.

The Trump administration didn’t return emails seeking comment.

McAfee has detailed the system he developed to ensure his raw dairy products are safe. He confirmed the process for KFF Health News: cows with yellow-tagged ears graze on grass pastures and are cleansed in washing pens before milking. The raw dairy is held back from consumer sale until it’s been tested and found clear of pathogens.

His raw dairy products, such as cheese and milk, are sold by a variety of stores, including health, organic, and natural grocery chains, according to the company website, as well as raw dairy pet products, which are not for human consumption.

He said he doesn’t believe the raw milk he sells could contain or transmit viable bird flu virus. He also said he doesn’t believe regulators’ warnings about raw milk and the virus.

“The pharmaceutical industry is trying to create a new pandemic from bird flu to get their stock back up,” said McAfee, who says he counts Kennedy as a customer. His view is not shared by leading virologists.

In December, the state of California secured a voluntary recall of all his company’s raw milk and cream products due to possible bird flu contamination.

Five indoor cats in the same household died or were euthanized in December after drinking raw milk from McAfee’s farm, and tests on four of the animals found they were infected with bird flu, according to the Los Angeles County Department of Health.

In an unrelated case, Joseph Journell, 56, said three of his four indoor cats drank McAfee’s raw milk. Two fell sick and died, he said. His third cat, a large tabby rescue named Big Boy, temporarily lost the use of his hind legs and had to use a specialized wheelchair device, he said. Urine samples from Big Boy were positive for bird flu, according to a copy of the results from Cornell University and the U.S. Department of Agriculture.

McAfee dismissed connections between the cats’ illnesses and his products, saying any potential bird flu virus would no longer be viable by the time his raw milk gets to stores. He also said he believes that any sick cats got bird flu from recalled pet food.

Journell said he has hired a lawyer to try to recover his veterinary costs but remains a staunch proponent of raw milk.

“Raw milk is good for you, just not if it has bird flu in it,” he said. “I do believe in its healing powers.”

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States and the nation’s health industry were thrown into disarray after the Trump administration ordered Monday that the government freeze nearly all federal grants at 5 p.m. ET Tuesday, a sweeping directive that at least initially appeared to include funding for Medicaid, the state-federal health insurance program that covers more than 70 million Americans.

By midmorning Tuesday, state officials around the country reported they had been shut out of a critical online portal that allows states to access federal Medicaid funding.

Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee, said on the social media site Bluesky that the portals were down in all 50 states following the Trump administration’s order.

“This is a blatant attempt to rip away health care from millions of Americans overnight and will get people killed,” he wrote.

Around midday Tuesday, as state health officials pressed the federal government for clarity, the White House Office of Management and Budget — which issued the Monday memo — put out new guidance clarifying that “mandatory programs like Medicaid” were not included in the freeze.

Karoline Leavitt, the White House press secretary, declined to confirm that Medicaid was exempt when pressed by reporters during an early afternoon briefing.

But she later said in a post on the social platform X that “no payments have been affected” by what she described as a “portal outage.”

The possibility that federal Medicaid funding would be shut off overnight spooked advocates already on edge about the program’s future. President Donald Trump vowed on the campaign trail not to seek cuts for Medicare or Social Security, the nation’s major entitlement programs serving mostly retired people. But he did not make the same promise about Medicaid, which pays for health care for primarily low-income and disabled people — approximately 1 in 5 Americans.

Separate from the freeze, congressional Republicans are discussing cutting the nearly $900 billion program, arguing costs have ballooned with enrollment, notably including the program’s expansion to cover more low-income adults. Lawmakers are also eyeing ways to save money for Trump’s other legislative priorities — in particular, extending the tax cuts from his first term that expire at the end of this year.

The federal government pays most costs for Medicaid, which is operated by states. Medicaid pays for most long-term care for Americans and for about 40% of all U.S. births, and together with the related Children’s Health Insurance Program covers about 38 million children.

Federal funding for Medicaid does not go directly to individual enrollees but to the states, which then distribute it to providers, health plans, and other entities that serve Medicaid enrollees.

State officials can access that funding through internet portals.

Joan Alker, who is executive director of the Center for Children and Families at the Georgetown McCourt School of Public Policy, said on X Tuesday that the portal lockout is “a major crisis.”

She pointed out that many states access their federal funding at the end of the month — “i.e. this week,” she wrote.

The original freeze order came in the form of a vaguely worded two-page memo from the Office of Management and Budget to all federal agencies directing them to “temporarily pause all activities related to obligation or disbursement of all Federal financial assistance.”

“This temporary pause will provide the Administration time to review agency programs and determine the best uses of the funding for those programs consistent with the law and the President’s priorities,” the memo said. The only programs explicitly noted as exceptions were Medicare and Social Security, which left it unclear how states would continue to pay doctors, hospitals, nursing homes, and private health plans to manage Medicaid.

Around the nation, health officials scrambled to make sense of the order, which was scheduled to take effect at 5 p.m. ET Tuesday. A federal judge halted the freeze shortly before its implementation, blocking the change until next week.

Even as OMB clarified that Medicaid was not included, the immediate impacts to other critical health programs were becoming clear, especially for community health centers and medical research centers.

Democrats in Congress expressed outrage at the Trump administration for pausing federal funding not only to Medicaid but also to numerous other programs, including the Supplemental Nutrition Assistance Program, also known as food stamps, the WIC nutrition program for pregnant and postpartum women and infants, and school meal programs for low-income students.

“The Trump Administration’s action last night to suspend all federal grants and loans will have a devastating impact on the health and well-being of millions of children, seniors on fixed incomes, and the most vulnerable people in our country,” Sen. Bernie Sanders (I-Vt.) said in a statement Tuesday. “It is a dangerous move towards authoritarianism and it is blatantly unconstitutional.”

The National Association of Medicaid Directors and the major nursing home associations were among those seeking clarification from the White House on Tuesday about the order’s impact on Medicaid funding.

Numerous state officials and groups said they were considering or had already filed litigation challenging the order. One lawsuit was filed Tuesday against OMB in federal court in Washington, D.C., by the National Council of Nonprofits and the American Public Health Association, seeking a temporary restraining order to “maintain the status quo until the Court has an opportunity to more fully consider the illegality of OMB’s actions.”

Attorneys general in California, New York, and four other states announced Tuesday afternoon a joint lawsuit against the Trump administration over the order, which they said had already frozen systems for Medicaid, Head Start, and even child support enforcement across multiple states.

“There is no question this policy is reckless, dangerous, illegal, and unconstitutional,” said New York Attorney General Letitia James. She added that she and other Democratic attorneys general would seek a temporary restraining order to halt the OMB policy from going into effect.

Leavitt defended the freeze during her White House briefing — the first of the new administration — saying it was critical to ensuring that federal funding was being used appropriately.

“This is a very responsible measure,” she said.

Reporting contributed by Bram Sable-Smith, Jordan Rau, Renuka Rayasam, Brett Kelman, and Christine Mai-Duc.

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President Donald Trump has nominated Robert F. Kennedy Jr., an environmental lawyer with no formal medical or public health expertise, as secretary of Health and Human Sciences. Two Senate committees will question Kennedy this week on how his disproven views of science and medicine qualify him to run the $1.7 trillion, 80,000-employee federal health system.

Here are four considerations for lawmakers on the Senate Finance and Senate Health, Education, Labor and Pensions committees, which will host Kennedy for questioning on Wednesday and Thursday, respectively:

1) Kennedy’s unconventional health claims.

For decades, Kennedy has advocated for health-related ideas that are scientifically disproven or controversial. He created and was paid hundreds of thousands of dollars by Children’s Health Defense, a group that champions the false idea that vaccines cause autism and other chronic diseases and has sued to take vaccines off the market. Kennedy has said covid vaccines are the deadliest in history, antidepressants lead children to commit mass shootings, environmental contaminants may cause people to become trans, and HIV is not the only cause of AIDS. He also pushes the use of products that regulators consider dangerous, such as raw milk, and for broader use of some medicines, such as ivermectin and hydroxychloroquine, to treat conditions without FDA approval. He says public health agencies oppose their use only because of regulatory capture by big drug and food interests.

“He believes you can avoid disease if you have a healthy immune system. He sees vaccines and antibiotics as toxins,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. Top Trump health nominees — Kennedy, Marty Makary for FDA commissioner, Jay Bhattacharya for National Institutes of Health director, and former U.S. Rep. Dave Weldon for Centers for Disease Control and Prevention director — are generally disdainful of the agencies they’ll be leading, Offit said.

“They think they are going to go into office, pull back the curtain, find all this bad stuff, and reveal it to the American public,” he said.

During a measles epidemic in 2019 and 2020 that killed 83 people, mostly children, in Samoa, Kennedy, as chairman of Children’s Health Defense, warned the country’s prime minister against measles vaccination. This behavior alone “is disqualifying” for an HHS nominee, said Georges Benjamin, executive director of the American Public Health Association.

Equally problematic, in Benjamin’s view, was Kennedy’s legal effort in 2021 to get the covid vaccine pulled from the market. “He can’t say he’s not anti-vax,” Benjamin said. “He wasn’t following the evidence.”

A Kennedy spokesperson did not respond to a request for comment.

2) Kennedy’s chances appear good, despite opposition.

Kennedy’s nomination has emerged in a moment when Trump is on a roll and mistrust of public health and medical authority in the wake of the pandemic has created an opening for people with unorthodox views of science to seize the reins of the country’s health system.

After former Fox News personality Pete Hegseth was confirmed as Defense secretary last week despite his controversial qualifications for the job and stark warnings from former top military brass, many Washington observers think RFK Jr. is going to be hard to defeat. In a meeting on the Hill with Democratic senators and their aides last week, Offit said, “the feeling was that he would likely be confirmed.”

Trump has demanded that Republican senators line up behind his nominees and has so far succeeded. It’s thought that Sens. Lisa Murkowski of Alaska and Susan Collins of Maine could oppose Kennedy, based on their opposition to Hegseth. Sen. Mitch McConnell (R-Ky.), the other Hegseth “nay” vote, is a polio survivor who has not spoken publicly about Kennedy but said in December that opposing “proven cures” was dangerous. Other senators whose Kennedy votes are said to be in question include Sen. Bill Cassidy (R-La.), the HELP Committee chair, a physician who gave a lukewarm response after meeting Kennedy.

Others have reported that Sens. Cory Booker (D-N.J.), who shares Kennedy’s concern with the spread of obesity and chronic illness, and Sheldon Whitehouse (D-R.I.), who attended law school with Kennedy, might vote for him. Neither senator’s office responded to a request for comment. Advancing American Freedom, a conservative advocacy group founded by former Vice President Mike Pence, has fought Kennedy’s nomination with a major ad buy.

3) The hearings are going to be heated.

Democratic senators are coming with plenty of ammunition. Sen. Elizabeth Warren (D-Mass.) sent Kennedy a 34-page letter containing 175 questions on everything from his anti-vaccine statements and actions to his waffling positions on abortion to his stances on Medicare, drug prices, and the cause of AIDS.

While public health and medical groups did not coordinate with Pence’s conservative organization, questions about Kennedy’s earlier stance in support of abortion rights could raise hackles on the GOP side of the aisle. Although his group is far from Pence on reproductive rights, Benjamin said, “if it helps derail him, I hope some senators are listening to Pence. Any shelter in a storm.”

“The hearings are going to be very difficult for him because he’s told a web of untruths as he’s marched across the offices,” said Leslie Dach, executive chair of Protect Our Care, a Democratic-aligned advocacy group.

Public opinion reflects leeriness of Kennedy on health, though not excessively. In a poll released Tuesday by KFF, 43% of respondents said they trusted him to make the right health recommendations. About 81% of Republicans in the poll said they trusted Kennedy — almost as many as trust their own doctor.

4) What happens if Kennedy takes office.

At the NIH, FDA, and other federal health agencies, nervous scientists speak of early retirement or jumping to industry should Kennedy and his agency heads take office.

The pharmaceutical industry has kept quiet on the nomination, as has the American Medical Association. Many patient advocacy groups are worried, but wary of creating friction with an administration they can’t ignore or defeat.

Kennedy’s comments on AIDS — suggesting that gay men’s use of stimulants, rather than the HIV virus, were its cause — are troubling to Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. But “I don’t know if he’s going to get confirmed or not,” he said. “If he does, we look forward to working with him and educating him.”

At the J.P. Morgan Healthcare conference earlier this month, Emma Walmsley, CEO of GSK, a leading vaccine maker, said she’d “wait and see what the facts are” before predicting what Kennedy would do. Vaccines, she noted, are “not our biggest business.”

GSK is one of a handful of vaccine makers remaining on the U.S. market. That number could shrink further if the Trump administration and Congress undo a 1986 law that provided legal protection for vaccine makers — as Kennedy has advocated.

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HELENA, Mont. — As part of a proposed revamping of the state’s behavioral health system, Republican Gov. Greg Gianforte’s administration is looking into moving a facility for people with developmental disabilities, beefing up renovations at the Montana State Hospital, and creating a Helena unit of that psychiatric hospital.

The changes, backers say, would fill gaps in services and help people better prepare for life outside of the locked, secure setting of the two state facilities before they reenter their own communities.

“I think part of the theme is responsibly moving people in and out of the state facilities so that we create capacity and have people in the appropriate places,” state Sen. Dave Fern (D-Whitefish) said of the proposed capital projects during a recent interview.

Fern served on the Behavioral Health System for Future Generations Commission, a panel created by a 2023 law to suggest how to spend $300 million to revamp the system. The law set aside the $300 million for improving state services for people with mental illness, substance abuse disorders, and developmental disabilities.

Gianforte’s proposed budget for the next two years would spend about $100 million of that fund on 10 other recommendations from the commission. The capital projects are separate ideas for using up to $32.5 million of the $75 million earmarked within the $300 million pool of funds for building new infrastructure or remodeling existing buildings.

The state Department of Public Health and Human Services and consultants for the behavioral health commission presented commission members with areas for capital investments in October. In December, the commission authorized state health department director Charlie Brereton to recommend the following projects to Gianforte:

• Move the 12-bed Intensive Behavior Center for people with developmental disabilities out of Boulder, possibly to either Helena or Butte, at an estimated cost of up to $13.3 million.
• Establish a “step-down” facility of about 16 beds, possibly on the campus of Shodair Children’s Hospital in Helena, to serve adults who have been committed to the Montana State Hospital but no longer need the hospital’s intensive psychiatric services.
• Invest $19.2 million to upgrade the Montana State Hospital’s infrastructure and buildings at Warm Springs, on top of nearly $16 million appropriated in 2023 for renovations already underway there in an effort to regain federal certification of the facility.

The state Architecture & Engineering Division is reviewing the health department’s cost estimates and developing a timeline for the projects so the information can be sent to the governor. Gianforte ultimately must approve the projects.

Health department officials have said they plan to take the proposals to legislative committees as needed. “With Commission recommendation and approval from the governor, the Department believes that it has the authority to proceed with capital project expenditures but must secure additional authority from the Legislature to fund operations into future biennia,” said department spokesperson Jon Ebelt.

The department outlined its facility plans to the legislature’s health and human services budget subcommittee on Jan. 22 as part of a larger presentation on the commission’s work and the 10 noncapital proposals in the governor’s budget. Time limits prevented in-depth discussion and public comment on the facility-related ideas.

One change the commission didn’t consider: moving the Montana State Hospital to a more populated area from its rural and relatively remote location near Anaconda, in southwestern Montana, in an attempt to alleviate staffing shortages.

“The administration is committed to continuing to invest in MSH as it exists today,” Brereton told the commission in October, referring to the Montana State Hospital.

The hospital provides treatment to people with mental illness who have been committed to the state’s custody through a civil or criminal proceeding. It’s been beset by problems, including the loss of federal Medicaid and Medicare funding due to decertification by the federal government in April 2022, staffing issues that have led to high use of expensive traveling health care providers, and turnover in leadership.

State Sen. Chris Pope (D-Bozeman) was vice chair of a separate committee that met between the 2023 and 2025 legislative sessions and monitored progress toward a 2023 legislative mandate to transition patients with dementia out of the state hospital. He agreed in a recent interview that improving — not moving — MSH is a top priority for the system right now.

“Right now, we have an institution that is failing and needs to be brought back into the modern age, where it is located right now,” he said after ticking off a list of challenges facing the hospital.

State Sen. John Esp (R-Big Timber) also noted at the October commission meeting that moving the hospital was likely to run into resistance in any community considered for a new facility.

Fern, the Whitefish senator, questioned in October whether similar concerns might exist for moving the Intensive Behavior Center out of Boulder. For more than 130 years, the town 30 miles south of Helena has been home, in one form or another, to a state facility for people with developmental disabilities. But Brereton said he believes relocation could succeed with community and stakeholder involvement.

The 12-bed center in Boulder serves people who have been committed by a court because their behaviors pose an immediate risk of serious harm to themselves or others. It’s the last residential building for people with developmental disabilities on the campus of the former Montana Developmental Center, which the legislature voted in 2015 to close.

Drew Smith, a consultant with the firm Alvarez & Marsal, told the commission in October that moving the facility from the town of 1,300 to a bigger city such as Helena or Butte would provide access to a larger labor pool, possibly allow a more homelike setting for residents, and open more opportunities for residents to interact with the community and develop skills for returning to their own communities.

Ideally, Brereton said, the center would be colocated with a new facility included in the governor’s proposed budget, for crisis stabilization services to people with developmental disabilities who are experiencing significant behavioral health issues.

Meanwhile, the proposed subacute facility with up to 16 beds for state hospital patients would provide a still secure but less structured setting for people who no longer need intensive treatment at Warm Springs but aren’t yet ready to be discharged from the hospital’s care. Brereton told the commission in October the facility would essentially serve as a less restrictive “extension” of the state hospital. He also said the agency would like to contract with a company to staff the subacute facility.

Health department officials don’t expect the new facility to involve any construction costs. Brereton has said the agency believes an existing building on the Shodair campus would be a good spot for it.

The state began leasing the building Nov. 1 for use by about 20 state hospital patients displaced by the current remodeling at Warm Springs — a different purpose than the proposed subacute facility.

Shodair CEO Craig Aasved said Shodair hasn’t committed to having the state permanently use the building as the step-down facility envisioned by the agency and the commission.

But Brereton said the option is attractive to the health department now that the building has been set up and licensed to serve adults.

“It seems like a natural place to start,” he told the commission in December, “and we don’t mind that it’s in our backyard here in Helena.”

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In his return to the White House this week, President Donald Trump issued a flurry of executive orders on immigration, including declaring an emergency at the U.S.-Mexico border, suspending refugee admissions, and calling to roll back birthright citizenship.

His administration rescinded a long-standing policy not to arrest people without legal status at or near sensitive locations, including hospitals. That has left different states offering starkly different guidelines to hospitals, community clinics, and other health facilities for interacting with immigrant patients.

• California is advising health care providers to avoid including patients’ immigration status in bills and medical records and telling them that, while they should not physically obstruct immigration agents, they are under no obligation to assist with an arrest. The guidance from Democratic Attorney General Rob Bonta also encourages facilities to post information about patients’ right to remain silent and provide patients with contact information for legal-aid groups “in the event that a parent is taken into immigration custody.”
• Meanwhile, Florida and Texas are requiring health care facilities to ask the immigration status of patients and tally the cost to taxpayers of providing care to immigrants living in the U.S. without authorization. Still, patients can refuse to answer questions about their immigration status without losing access to care.

Some health care providers fear immigration authorities will disrupt their work at health facilities and cause patients, particularly children, to skip medical care. They point to examples from Trump’s first term, when agents arrested a child during an ambulance transfer, a young man leaving the hospital, and a woman waiting for emergency surgery.

“You are instilling fear into folks who may defer care, who may go without care, whose children may not get the vaccines they need,” said Minal Giri, a pediatrician and the chair of the Refugee/Immigrant Child Health Initiative at the Illinois chapter of the American Academy of Pediatrics.

On Tuesday, Trump directed the U.S. Department of Justice to investigate state and local officials who don’t cooperate with immigration enforcement.

But no matter the guidelines that states issue, hospitals around the U.S. stress one thing: Patients won’t be turned away for care because of their immigration status.

“None of this changes the care patients receive,” said Carrie Williams, a spokesperson for the Texas Hospital Association, which represents hospitals and health care systems in the state. “We don’t want people to avoid care and worsen because they are concerned about immigration questions.”

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For decades, the United States has held considerable power in determining the direction of global health policies and programs. President Donald Trump issued three executive orders on his first day in office that may signal the end of that era, health policy experts said.

Trump’s order to withdraw from the World Health Organization means the U.S. will probably not be at the table in February when the WHO executive board next convenes. The WHO is shaped by its members: 194 countries that set health priorities and make agreements about how to share critical data, treatments, and vaccines during international emergencies. With the U.S. missing, it would cede power to others.

“It’s just stupid,” said Kenneth Bernard, a visiting fellow at the Hoover Institution at Stanford University who served as a top biodefense official during the George W. Bush administration. “Withdrawing from the WHO leaves a gap in global health leadership that will be filled by China,” he said, “which is clearly not in America’s best interests.”

Executive orders to withdraw from the WHO and to reassess America’s approach to international assistance cite the WHO’s “mishandling of the COVID-19 pandemic” and say that U.S. aid serves “to destabilize world peace.” In action, they echo priorities established in Project 2025’s “Mandate for Leadership,” a conservative policy blueprint from the Heritage Foundation.

The 922-page report says the U.S. “must be prepared” to withdraw from the WHO, citing its “manifest failure,” and advises an overhaul to international aid at the State Department. “The Biden Administration has deformed the agency by treating it as a global platform to pursue overseas a divisive political and cultural agenda that promotes abortion, climate extremism, gender radicalism, and interventions against perceived systemic racism,” it says.

As one of the world’s largest funders of global health — through both international and national agencies, such as the WHO and the U.S. Agency for International Development — America’s step back may curtail efforts to provide lifesaving health care and combat deadly outbreaks, especially in lower-income countries without the means to do so alone.

“This not only makes Americans less safe, it makes the citizens of other nations less safe,” said Tom Bollyky, director of global health at the Council on Foreign Relations.

“The U.S. cannot wall itself off from transnational health threats,” he added, referring to policies that block travelers from countries with disease outbreaks. “Most of the evidence around travel bans indicates that they provide a false sense of security and distract nations from taking the actions they need to take domestically to ensure their safety.”

Less Than 1%

Technically, countries cannot withdraw from the WHO until a year after official notice. But Trump’s executive order cites his termination notice from 2020. If Congress or the public pushes back, the administration can argue that more than a year has elapsed.

Trump suspended funds to the WHO in 2020, a measure that doesn’t require congressional approval. U.S. contributions to the agency hit a low of $163 million during that first year of covid, falling behind Germany and the Gates Foundation. Former President Joe Biden restored U.S. membership and payments. In 2023, the country gave the WHO $481 million.

As for 2024, Suerie Moon, a co-director of the global health center at the Geneva Graduate Institute, said the Biden administration paid biennium dues for 2024-25 early, which will cover some of this year’s payments.

“Unfairly onerous payments” are cited in the executive order as a reason for WHO withdrawal. Countries’ dues are a percentage of their gross domestic product, meaning that as the world’s richest nation, the United States has generally paid more than other countries.

Funds for the WHO represent about 4% of America’s budget for global health, which in turn is less than 0.1% of U.S. federal expenditures each year. At about $3.4 billion, the WHO’s entire budget is roughly a third of the budget for the Centers for Disease Control and Prevention, which got $9.3 billion in core funding in 2023.

The WHO’s funds support programs to prevent and treat polio, tuberculosis, HIV, malaria, measles, and other diseases, especially in countries that struggle to provide health care domestically. The organization also responds to health emergencies in conflict zones, including places where the U.S. government doesn’t operate — in parts of Gaza, Sudan, and the Democratic Republic of the Congo, among others.

In January 2020, the WHO alerted the world to the danger of the covid outbreak by sounding its highest alarm: a public health emergency of international concern. Over the next two years, it vetted diagnostic tests and potential drugs for covid, regularly updated the public, and advised countries on steps to keep citizens safe.

Experts have cited missteps at the agency, but numerous analyses show that internal problems account for the United States’ having one of the world’s highest rates of death due to covid. “All nations received the WHO’s alert of a public health emergency of international concern on Jan. 30,” Bollyky said. “South Korea, Taiwan, and others responded aggressively to that — the U.S. did not.”

‘It’s a Red Herring’

Nonetheless, Trump’s executive order accuses the WHO of “mishandling” the pandemic and failing “to adopt urgently needed reforms.” In fact, the WHO has made some changes through bureaucratic processes that involve input from the countries belonging to it. Last year, for example, the organization passed several amendments to its regulations on health emergencies. These include provisions on transparent reporting and coordinated financing.

“If the Trump administration tried to push for particular reforms for a year and then they were frustrated, I might find the reform line credible,” Moon said. “But to me, it’s a red herring.”

“I don’t buy the explanations,” Bernard said. “This is not an issue of money,” he added. “There is no rationale to withdraw from the WHO that makes sense, including our problems with China.”

Trump has accused the WHO of being complicit in China’s failure to openly investigate covid’s origin, which he alludes to in the executive order as “inappropriate political influence.”

“The World Health Organization disgracefully covered the tracks of the Chinese Communist Party every single step of the way,” Trump said in a video posted to social media in 2023.

On multiple occasions, the WHO has called for transparency from China. The agency doesn’t have the legal authority to force China, or any other country, to do what it says. This fact also repudiates Trump’s warnings that a pandemic treaty under negotiation at the WHO impinges on American sovereignty. Rather, the accord aims to lay out how countries can better cooperate in the next pandemic.

Trump’s executive order calls for the U.S. to “cease negotiations” on the pandemic agreement. This means the pharmaceutical industry may lose one of its staunchest defenders as discussions move forward.

In the negotiations so far, the U.S. and the European Union have sided with lobbying from the pharmaceutical industry to uphold strict patent rights on drugs and vaccines. They have opposed efforts from middle-income countries in Asia, Africa, and Latin America to include licensing agreements that would allow more companies to produce drugs and vaccines when supplies are short in a crisis. A study published in Nature Medicine estimated that more than a million lives would have been saved had covid vaccines been available around the world in 2021.

“Once the U.S. is absent — for better and for worse — there will be less pressure on certain positions,” Moon said. “In the pandemic agreement negotiations, we may see weakening opposition towards more public-health-oriented approaches to intellectual property.”

“This is a moment of geopolitical shift because the U.S. is making itself less relevant,” said Ayoade Alakija, chair of the Africa Union’s Vaccine Delivery Alliance. Alakija said countries in Asia and Africa with emerging economies might now put more money into the WHO, change policies, and set agendas that were previously opposed by the U.S. and European countries that are grappling with the war in Ukraine. “Power is shifting hands,” Alakija said. “Maybe that will give us a more equitable and fairer world in the long term.”

Echoes of Project 2025

In the near term, however, the WHO is unlikely to recoup its losses entirely, Moon said. Funds from the U.S. typically account for about 15% of its budget. Together with Trump’s executive order that pauses international aid for 90 days, a lack of money may keep many people from getting lifesaving treatments for HIV, malaria, and other diseases.

Another loss is the scientific collaboration that occurs via the WHO and at about 70 centers it hosts at U.S. institutions such as Columbia University and Johns Hopkins University. Through these networks, scientists share findings despite political feuds between countries.

A third executive order commands the secretary of state to ensure the department’s programs are “in line with an America First foreign policy.” It follows on the order to pause international aid while reviewing it for “consistency with United States foreign policy.” That order says that U.S. aid has served “to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations.”

These and executive orders on climate policies track with policy agendas expressed by Project 2025. Although Trump and his new administration have distanced themselves from the Heritage Foundation playbook, CBS News reviewed the work histories of the 38 named primary authors of Project 2025 and found that at least 28 of them worked in Trump’s first administration. One of Project 2025’s chief architects was Russell Vought, who served as director of the Office of Management and Budget during Trump’s first term and has been nominated for it again. Multiple contributors to Project 2025 are from the America First Legal Foundation, a group headed by Trump adviser Stephen Miller that’s filed complaints against “woke corporations.”

Project 2025 recommends cutting international aid for programs and organizations focused on climate change and reproductive health care, and steering resources toward “strengthening the fundamentals of free markets,” lowering taxes, and deregulating businesses as a path to economic stability.

Several experts said the executive orders appear to be about ideological rather than strategic positioning.

The White House did not respond to questions about its executive orders on global health. Regarding the executive order saying U.S. aid serves “to destabilize world peace,” a spokesperson at USAID wrote in an email: “We refer you to the White House.”

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

The second Trump presidency launched with a bang at the Department of Health and Human Services, where a traditional pause on public communications was expanded to an effective stoppage of scientific work, as health agencies were ordered to cancel meetings, travel, and efforts on outside publications. It is unclear how long the order will stay in effect; President Donald Trump’s nominee to run the department, Robert F. Kennedy Jr., won’t go before Senate committees for his confirmation hearings until the end of the month. 

Meanwhile, starting on his first day in office, the new president issued a raft of executive orders aimed at reversing Biden administration policy — but, notably, none directly addressing abortion, which has been a traditional focus every time the White House changes parties. 

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Roubein of The Washington Post, and Rachel Cohrs Zhang of Stat.

Panelists Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Rachel Roubein The Washington Post @rachel_roubein Read Rachel's stories. Rachel Cohrs Zhang Stat News @rachelcohrs Read Rachel's stories.

Among the takeaways from this week’s episode:

• The Trump administration took a very firm grip on federal agencies this week, sowing uncertainty with blanket cancellations of upcoming meetings and travel — as well as by implementing a broad pause on external communications. The cancellations reached deep into agencies’ core functions, affecting, for instance, meetings to review grant applications for federally funded research.
• Kennedy’s confirmation hearings to be Health and Human Services secretary are scheduled for Jan. 29 and 30. Yet questions remain about his nomination, including more recent revelations about conflicts of interest — such as his financial stake in ongoing litigation with Merck & Co. related to the HPV vaccine.
• Trump issued a slew of executive orders this week. (It is worth noting that executive orders largely instruct federal agencies to start making a change, rather than constituting the change themselves.) Of note on health, Trump’s orders instructed the removal of the U.S. from the World Health Organization; revoked a Biden administration order to reduce drug prices; and laid the groundwork to undermine health care for transgender people. Notably, though, none of the orders directly addressed abortion.

Also this week, Rovner interviews Rodney Whitlock, a consultant with McDermott+ and an adjunct faculty member at the George Washington University Milken Institute School of Public Health. Whitlock is a former House and Senate staffer and provides a primer on how Congress’ convoluted budget reconciliation process is supposed to work.

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

Julie Rovner: CNN’s “With Bird Flu Cases Rising, Certain Kinds of Pet Food May Be Risky for Animals — And People,” by Brenda Goodman.  

Rachel Roubein: The Washington Post’s “Antiabortion Advocates Look for Men To Report Their Partners’ Abortion,” by Caroline Kitchener.  

Rachel Cohrs Zhang: The Washington Post’s “In Florida, a Rebellion Against Fluoride Is Winning,” by Fenit Nirappil.  

Alice Ollstein: The Los Angeles Times’ “Now That You Can Return Home After the Fires, How Do You Clean Up Safely?” by Karen Garcia and Tony Briscoe. 

Also mentioned in this week’s podcast:

The Texas Tribune’s “Longtime Planned Parenthood President Cecile Richards Dies After Battle With Brain Cancer,” by Eleanor Klibanoff.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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California está aconsejando a los proveedores de atención médica que no pongan el estatus migratorio de los pacientes en las facturas y los registros médicos, y enfatiza que no tienen que ayudar a los agentes federales durante arrestos. Algunos hospitales y clínicas de Massachusetts están colgando carteles sobre derechos de privacidad en las salas de emergencia y de espera, en español y en otros idiomas.

Mientras tanto, Florida y Texas están exigiendo a las instalaciones de atención médica que pregunten el estatus migratorio de los pacientes y calculen el costo para los contribuyentes de brindar atención a inmigrantes que viven en Estados Unidos sin papeles.

Donald Trump regresó a la Casa Blanca declarando una emergencia nacional en la frontera entre Estados Unidos y México, suspendiendo las admisiones de refugiados; y cuestionando la ciudadanía por derecho de nacimiento: la política de otorgar la ciudadanía a toda persona nacida en el país.

Mientras inicia la “operación de deportación más grande” en la historia de la nación, estados han emitido pautas marcadamente diferentes a los hospitales, clínicas comunitarias y otros centros de salud, sobre cómo actuar con pacientes inmigrantes.

Trump también ha anulado una política de larga data de no arrestar a personas indocumentadas en o cerca de lugares sensibles, incluidas escuelas, iglesias y hospitales. Una propuesta para formalizar estas protecciones fracasó en el Congreso en 2023.

Pero, independientemente de las directrices que emitan los estados, todos los hospitales del país afirman que no rechazarán a los pacientes por su estatus migratorio.

“Nada de esto cambia la atención que reciben los pacientes”, dijo Carrie Williams, vocera de la Texas Hospital Association, que representa a los hospitales y sistemas de atención médica del estado. “No queremos que la gente evite la atención y empeore porque les preocupan las cuestiones de inmigración”.

Durante el primer mandato de Trump, agentes de inmigración arrestaron a personas que recibían atención de emergencia en hospitales y a un niño durante un traslado en ambulancia. En Texas, arrestaron a una mujer que esperaba una cirugía cerebral en un hospital de Fort Worth. En Portland, Oregon, detuvieron a un joven que salía de un hospital, y en San Bernardino, California, una mujer tuvo que manejar ella misma al hospital para dar a luz luego que su marido fuera arrestado en una gasolinera.

Se estima que 11 millones de inmigrantes viven en Estados Unidos sin papeles, y la mayor cantidad está en California, Texas, Florida, Illinois, Nueva York y Nueva Jersey, según el Pew Research Center.

Es probable que la mitad de los inmigrantes indocumentados no tengan seguro médico, en comparación con menos de uno de cada 10 ciudadanos, según la Encuesta de Inmigrantes de KFF-Los Angeles Times de 2023, la encuesta no gubernamental más grande sobre inmigrantes realizada en Estados Unidos hasta la fecha.

Si bien algunos estados están enfatizando los gastos de atención médica en los que incurren los inmigrantes, un informe de KFF indicó que este grupo contribuye más al sistema, a través de las primas de sus planes médicos y de los impuestos, de lo que lo utilizan. Los inmigrantes también tienen costos de atención médica más bajos que los ciudadanos.

Algunos proveedores de atención médica temen que los agentes de Inmigración y Control de Aduanas (ICE) interrumpan su trabajo en instalaciones de salud y causen que los pacientes, en particular los niños, se salteen la atención médica.

En el primer día de Trump, el presidente republicano emitió una orden ejecutiva destinada a poner fin a la ciudadanía por derecho de nacimiento para los niños nacidos de un padre sin autorización legal o con visa, lo que podría dejarlos sin derecho a programas sociales y de salud federales.

La orden fue impugnada de inmediato por estados y por un grupo de derechos civiles.

“Está infundiendo miedo en personas que pueden postergar la atención, que decidan quedarse sin atención, cuyos hijos pueden no recibir las vacunas que necesitan, que pueden no poder recibir tratamiento para una infección de oído o una cirugía”, dijo Minal Giri, pediatra y presidenta de la Refugee/Immigrant Child Health Initiative del capítulo de Illinois de la Academia Americana de Pediatría.

Una encuesta reciente realizada por el Im/migrant Well-Being Research Center de la Universidad del Sur de Florida halló que el 66% de las personas que no son ciudadanas reportaron dudar más a la hora de buscar atención después que, en 2023, el gobernador de Florida, Ron DeSantis, firmara una ley que requiere que los hospitales que aceptan Medicaid pregunten sobre el estatus legal de un paciente. Eso se compara con solo el 27% de los ciudadanos.

“Realmente me alarmó ver cómo esta ley hizo que la gente dudara en ir al médico, incluso en caso de emergencia”, dijo Liz Ventura Molina, coautora de la encuesta y el informe.

Al firmar la ley, DeSantis la promocionó como la legislación “antiinmigración ilegal más ambiciosa” del país. Este mes, el gobernador republicano convocó a una sesión especial de la Legislatura estatal para ayudar a respaldar la agenda de inmigración de Trump.

Jackson Health System, un proveedor de red de seguridad pública en Miami, dijo en un comunicado que los informes trimestrales al estado no contienen información individual de los pacientes. “Nos adherimos a toda la cooperación requerida con las agencias policiales, incluido ICE, como parte de cualquier investigación criminal, entendiendo que las leyes de privacidad exigen que sólo divulguemos información privada de pacientes mediante una orden judicial”.

En agosto, el gobernador de Texas, el republicano Greg Abbott, emitió una orden ejecutiva similar a la ley de Florida para registrar los costos de atención médica incurridos por inmigrantes sin autorización legal. Se espera que todos los hospitales que reciben fondos de Medicaid o del Programa de Seguro de Salud Infantil (CHIP) comiencen a informar los datos al Departamento de Salud y Servicios Humanos de Texas en marzo.

Incluso las ciudades controladas por demócratas están transitando por una línea delgada. El alcalde de la ciudad de Nueva York, Eric Adams, se reunió en diciembre con Tom Homan, entrante “zar de la frontera” de Trump, y se comprometió a expulsar a los inmigrantes que hayan sido condenados por un delito grave y carezcan de estatus legal para permanecer en el país.

Al mismo tiempo, Adams propuso una campaña de concientización para que los inmigrantes y los solicitantes de asilo sepan que es seguro utilizar los sistemas hospitalarios de la ciudad.

Algunos estados van más allá y aconsejan a las instalaciones de salud que hagan todo lo posible para proteger a los pacientes inmigrantes.

En diciembre, el fiscal general de California, el demócrata Rob Bonta, publicó un documento de 42 páginas en el que recomendaba a los proveedores que evitaran incluir el estatus migratorio de los pacientes en las facturas y los registros médicos. La guía también enfatizaba que, si bien los proveedores no deberían obstruir físicamente a los agentes de inmigración, no tienen la obligación de ayudar con un arresto.

Según el documento, los centros de atención médica deberían publicar información sobre el derecho de los pacientes a permanecer en silencio y se les anima a proporcionar a los pacientes información de contacto de grupos de ayuda legal “en caso de que un padre sea detenido por inmigración”.

Agrega que, si es posible, el centro debería designar un enlace de asuntos de inmigración para ayudar a capacitar al personal y brindar asesoramiento no legal a las familias.

“No podemos permitir que la máquina de deportación de Trump cree una cultura de miedo y desconfianza que impida a los inmigrantes acceder a servicios públicos vitales”, dijo Bonta.

El martes 21 de enero, la administración Trump ordenó al Departamento de Justicia que investigara a los funcionarios estatales y locales que no cooperaran con la aplicación de la ley de inmigración.

Durante el primer mandato de Trump, California limitó la cooperación con las autoridades federales, citando preocupaciones de seguridad pública y confianza de la comunidad. El departamento, entonces bajo el mando de Jeff Sessions, presentó una demanda para bloquear la ley, pero el estado ganó en un tribunal federal, argumentando que los estados tienen la autoridad de decidir si se utilizan recursos locales para hacer cumplir la ley federal.

La administración Trump apeló, pero la Corte Suprema rechazó la petición.

Según la ley de California, las instalaciones de atención médica estatales deben adoptar políticas para limitar su participación en la aplicación de las leyes de inmigración, y se alienta a las entidades privadas a seguir protocolos similares.

David Simon, vocero de la California Hospital Association, que representa a más de 400 hospitales, dijo que sus miembros han incorporado estas normas, lo que garantiza la privacidad del paciente.

“Los hospitales no llaman al ICE por los pacientes”, agregó Simon.

California se está preparando para una nueva ronda de enfrentamientos con Trump. El gobernador Gavin Newsom y otros líderes estatales demócratas acordaron reservar $50 millones para litigios y subvenciones a grupos inmigrantes sin fines de lucro.

Legisladores de Nueva Jersey están considerando una legislación para limitar que los centros de salud pregunten sobre el estatus migratorio de un paciente. El proyecto de ley también exigiría al fiscal general del estado que establezca políticas para los hospitales y los centros de atención médica a fin de garantizar el acceso de los pacientes.

En la ciudad de Nueva York, administradores de hospitales están ordenando al personal que busque la orientación de un “enlace de inmigración” si se presentan autoridades de inmigración, y que tome fotografías y videos de cualquier acción si no pueden comunicarse con ellos primero. También están desalentando al personal de ayudar activamente a una persona a esconderse del ICE.

En Massachusetts, algunas clínicas y hospitales están capacitando al personal sobre cómo leer las órdenes judiciales del ICE, y planean exigir a los agentes que se identifiquen y presenten una orden judicial si quieren entrar a un área privada.

“No se puede actuar desesperados en el momento”, dijo Altaf Saadi, neuróloga que codirige una clínica para solicitantes de asilo en el Hospital General de Massachusetts. “Tenemos que prepararnos para los peores escenarios, y esperamos que no sucedan, pero debemos estar preparados”.

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President Donald Trump’s early actions on health care signal his likely intention to wipe away some Biden-era programs to lower drug costs and expand coverage under public insurance programs.

The orders he issued soon after reentering the White House have policymakers, health care executives, and patient advocates trying to read the tea leaves to determine what’s to come. The directives, while less expansive than orders he issued at the beginning of his first term, provide a possible road map that health researchers say could increase the number of uninsured Americans and weaken safety net protections for low-income people.

However, Trump’s initial orders will have little immediate impact. His administration will have to take further regulatory steps to fully reverse Biden’s policies, and the actions left unclear the direction the new president aims to steer the U.S. health care system.

“Everyone is looking for signals on what Trump might do on a host of health issues. On the early EOs, Trump doesn’t show his cards,” said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling, and news organization that includes KFF Health News.

A flurry of executive orders and other actions Trump issued on his first day back in office included rescinding directives by his predecessor, former President Joe Biden, that had promoted lowering drug costs and expanding coverage under the Affordable Care Act and Medicaid.

Executive orders “as a general matter are nothing more than gussied up internal memoranda saying, ‘Hey, agency, could you do something?’” said Nicholas Bagley, a law professor at the University of Michigan. “There may be reason to be concerned, but it’s down the line.”

That’s because making changes to established law like the ACA or programs like Medicaid generally requires new rulemaking or congressional action, either of which could take months. Trump has yet to win Senate confirmation for any of his picks to lead federal health agencies, including Robert F. Kennedy Jr., the anti-vaccine activist and former Democratic presidential candidate he has nominated the lead the Department of Health and Human Services. On Monday, he appointed Dorothy Fink, a physician who directs the HHS Office on Women’s Health, as acting secretary for the department.

During Biden’s term, his administration did implement changes consistent with his health orders, including lengthening the enrollment period for the ACA, increasing funding for groups that help people enroll, and supporting the Inflation Reduction Act, which boosted subsidies to help people buy coverage. After falling during the Trump administration, enrollment in ACA plans soared under Biden, hitting record highs each year. More than 24 million people are enrolled in ACA plans for 2025.

The drug order Trump rescinded called on the Centers for Medicare & Medicaid Services to test ways to lower drug costs, such as setting a flat $2 copay for some generic drugs in Medicare, the health program for people 65 and older, and having states try to get better prices by banding together to buy certain expensive cell and gene therapies.

That might indicate Trump expects to do less on drug pricing this term or even roll back drug price negotiation in Medicare.

The White House did not respond to a request for comment.

Biden’s experiments in lowering drug prices didn’t fully get off the ground, said Joseph Antos of the American Enterprise Institute, a right-leaning research group. Antos said he’s a bit puzzled by Trump’s executive order ending the pilot programs, given that he has backed the idea of tying drug costs in the U.S. to lower prices paid by other nations.

“As you know, Trump is a big fan of that,” Antos said. “Lowering drug prices is an easy thing for people to identify with.”

In other moves, Trump also rescinded Biden orders on racial and gender equity and issued an order asserting that there are only two sexes, male and female. HHS under the Biden administration supported gender-affirming health care for transgender people and provided guidance on civil rights protections for transgender youths. Trump’s missive on gender has intensified concerns within the LGBTQ+ community that he will seek to restrict such care.

“The administration has forecast that it will fail to protect and will seek to discriminate against transgender people and anyone else it considers an ‘other,’” said Omar Gonzalez-Pagan, senior counsel and health care strategist at Lambda Legal, a civil rights advocacy group. “We stand ready to respond to the administration’s discriminatory acts, as we have previously done to much success, and to defend the ability of transgender people to access the care that they need, including through Medicaid and Medicare.”

Trump also halted new regulations that were under development until they are reviewed by the new administration. He could abandon some proposals that were yet to be finalized by the Biden administration, including expanded coverage of anti-obesity medications through Medicare and Medicaid and a rule that would limit nicotine levels in tobacco products, Katie Keith, a Georgetown University professor who was deputy director of the White House Gender Policy Council under Biden, wrote in an article for Health Affairs Forefront.

“Interestingly, he did not disturb President Biden’s three executive orders and a presidential memorandum on reproductive health care,” she wrote.

However, Trump instructed top brass in his administration to look for additional orders or memorandums to rescind. (He revoked the Biden order that created the Gender Policy Council.)

Democrats criticized Trump’s health actions. A spokesman for the Democratic National Committee, Alex Floyd, said in a statement that “Trump is again proving that he lied to the American people and doesn’t care about lowering costs — only what’s best for himself and his ultra-rich friends.”

Trump’s decision to end a Biden-era executive order aimed at improving the ACA and Medicaid probably portends coming cuts and changes to both programs, some policy experts say. His administration previously opened the door to work requirements in Medicaid — the federal-state program for low-income adults, children, and the disabled — and previously issued guidance enabling states to cap federal Medicaid funding. Medicaid and the related Children’s Health Insurance Program cover more than 79 million people.

“Medicaid will be a focus because it’s become so sprawling,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It’s grown after the pandemic. Provisions have expanded, such as using social determinants of health.”

The administration may reevaluate steps taken by the Biden administration to allow Medicaid to pay for everyday expenses some states have argued affect its beneficiaries’ health, including air conditioners, meals, and housing.

One of Trump’s directives orders agencies to deliver emergency price relief and “eliminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.” (Rent-seeking is an economic concept describing efforts to exploit the political system for financial gain without creating other benefits for society.)

“It is not clear what this refers to, and it will be interesting to see how agencies respond,” Keith wrote in her Health Affairs article.

Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans are working on budget proposals that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.

Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed to Congress: “On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes. But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid.”

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California is advising health care providers not to write down patients’ immigration status on bills and medical records and telling them they don’t have to assist federal agents in arrests. Some Massachusetts hospitals and clinics are posting privacy rights in emergency and waiting rooms in Spanish and other languages.

Meanwhile, Florida and Texas are requiring health care facilities to ask the immigration status of patients and tally the cost to taxpayers of providing care to immigrants living in the U.S. without authorization.

Donald Trump returned to the White House declaring a national emergency at the U.S.-Mexico border, suspending refugee admissions, and challenging birthright citizenship, or the policy of giving U.S. citizenship to anyone born in the U.S. As he begins carrying out the “largest deportation operation” in the nation’s history, states have offered starkly different guidelines to hospitals, community clinics, and other health facilities for immigrant patients.

Trump has also rescinded a long-standing policy not to arrest people without legal status at or near sensitive locations, including schools, churches, and hospitals. A proposal to formalize such protections died in Congress in 2023.

But no matter the guidelines that states issue, hospitals around the U.S. say patients won’t be turned away for care because of their immigration status. “None of this changes the care patients receive,” said Carrie Williams, a spokesperson for the Texas Hospital Association, which represents hospitals and health care systems in the state. “We don’t want people to avoid care and worsen because they are concerned about immigration questions.”

During Trump’s first term, immigration agents arrested people receiving emergency care in hospitals and a child during an ambulance transfer. Immigration officers in Texas arrested a woman awaiting brain surgery in a hospital in Fort Worth. In Portland, Oregon, officers arrested a young man leaving a hospital, and in San Bernardino, California, a woman drove herself to the hospital to give birth after her husband was arrested at a gas station.

An estimated 11 million immigrants live in the United States without authorization, with the largest numbers in California, Texas, Florida, New York, New Jersey, and Illinois, according to Pew Research Center.

Half of immigrant adults likely without authorization are uninsured, compared with fewer than 1 in 10 citizens, according to the 2023 KFF-Los Angeles Times Survey of Immigrants, the largest nongovernmental survey of immigrants in the U.S. to date. While some states are highlighting health care expenses incurred by immigrants, a KFF brief noted that immigrants contribute more to the system through health insurance premiums and taxes than they use. Immigrants also have lower health care costs than citizens.

Some health care providers fear Immigration and Customs Enforcement agents will disrupt their work at health facilities and cause patients, particularly children, to skip medical care. On Trump’s first day, the Republican president issued an executive order aimed at ending birthright citizenship for children born to a parent without legal authorization or on a visa, which could leave them ineligible for federal health and social programs. The order was immediately challenged by states and a civil rights group.

“You are instilling fear into folks who may defer care, who may go without care, whose children may not get the vaccines they need, who may not be able to get treatment for an ear infection or surgery,” said Minal Giri, a pediatrician and the chair of the Refugee/Immigrant Child Health Initiative at the Illinois chapter of the American Academy of Pediatrics.

A recent survey conducted by the Im/migrant Well-Being Research Center at the University of South Florida found that 66% of noncitizens reported increased hesitation in seeking care after Florida Gov. Ron DeSantis signed a law in 2023 requiring hospitals that accept Medicaid to ask about a patient’s legal status. That’s compared with just 27% for citizens.

“That really was alarming to me to see how this law made people hesitant to go to the doctor, even in an emergency,” said Liz Ventura Molina, a co-author of the survey and report.

In signing the law, DeSantis touted it as “the most ambitious anti-illegal immigration” legislation in the nation. This month, the Republican governor called for a special session of the state legislature to help support Trump’s immigration agenda.

Jackson Health System, a public safety net provider in Miami, said in a statement that quarterly reports to the state don’t contain individual patient information. “We do adhere to all required cooperation with law enforcement agencies, including ICE, as part of any criminal investigations, understanding that privacy laws mandate we only release private patient information through a court-ordered warrant.”

In August, Texas Gov. Greg Abbott, a Republican, issued an executive order similar to Florida’s law to record health care costs incurred by immigrants without legal authorization. All hospitals that receive funding from Medicaid or the Children’s Health Insurance Program are expected to begin reporting the data to Texas Health and Human Services in March.

Even cities controlled by Democrats are walking a fine line. New York City Mayor Eric Adams met in December with Trump’s incoming “border czar,” Tom Homan, and pledged to remove immigrants who have been convicted of a major felony and lack legal status to remain in the country.

At the same time, Adams proposed an awareness campaign to let immigrants and asylum-seekers know they are safe to use the city’s hospital systems.

Some states are going further by advising health facilities to do all they can to protect immigrant patients.

In December, California Attorney General Rob Bonta released a 42-page document recommending providers avoid including patients’ immigration status in bills and medical records. The guidance also emphasized that while providers should not physically obstruct immigration agents, they are under no obligation to assist with an arrest.

According to the document, health care facilities should post information about patients’ right to remain silent and are encouraged to provide patients with contact information for legal-aid groups “in the event that a parent is taken into immigration custody.” If feasible, it says, the facility should designate an immigrant-affairs liaison to help train staff and provide nonlegal advice to families.

“We cannot let the Trump deportation machine create a culture of fear and mistrust that prevents immigrants from accessing vital public services,” said Bonta, a Democrat.

On Tuesday, the Trump administration directed the Department of Justice to investigate state and local officials who don’t cooperate with immigration enforcement. During Trump’s first term, California limited cooperation with federal authorities, citing public safety and community trust concerns. The department, then under Jeff Sessions, sued to block the law but the state won in federal court, arguing that states have the authority to decide whether local resources are used to enforce federal law. The Trump administration appealed, but the Supreme Court turned down the petition.

Under California law, state-run health care facilities are required to adopt policies to limit their participation in immigration enforcement, and private entities are encouraged to follow similar protocols. David Simon, a spokesperson for the California Hospital Association, which represents more than 400 hospitals, said members have incorporated such policies, ensuring patient privacy.

“Hospitals don’t call ICE about patients,” Simon said.

California is bracing for a new round of clashes with Trump. Gov. Gavin Newsom and fellow Democratic state leaders have agreed to set aside $50 million for litigation and grants to nonprofit immigrant groups.

Lawmakers in New Jersey are considering legislation to limit health care facilities from asking about a patient’s immigration status. The bill would also require the state attorney general to establish policies for hospitals and health care facilities for ensuring patient access.

In New York City, hospital administrators are directing staff to seek guidance from an “immigration liaison” if immigration authorities show up, and to take photos and videos of any enforcement actions if they can’t reach them first. They are also discouraging staff from actively helping a person hide from ICE. In Massachusetts, some clinics and hospitals are training staff on how to read ICE warrants and plan to require ICE agents to identify themselves and present a warrant if they want to enter a private area.

“You can’t be scrambling in the moment,” said Altaf Saadi, a neurologist who co-directs a clinic for asylum-seekers at the Massachusetts General Hospital. “We have to prepare for these worst-case scenarios, and we hope that they don’t happen, but we do need to be prepared.”

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DENVER — Outside HCA HealthONE Rose medical center, the snow is flying. Inside, on the third floor, there’s a flurry of activity within the labor and delivery unit.

“There’s a lot of action up here. It can be very stressful at times,” said Kristina Fraser, an OB-GYN in blue scrubs.

Nurses wheel a very pregnant mom past.

“We’re going to bring a baby into this world safely,” Fraser said, “and off we go.”

She said she feels ready in part due to a calming moment she had just a few minutes earlier with some canine colleagues.

A pair of dogs, tails wagging, had come by a nearby nursing station, causing about a dozen medical professionals to melt into a collective puddle of affection. A yellow Lab named Peppi showered Fraser in nuzzles and kisses. “I don’t know if a human baby smells as good as that puppy breath!” Fraser had said as her colleagues laughed.

The dogs aren’t visitors. They work here, too, specifically for the benefit of the staff. “I feel like that dog just walks on and everybody takes a big deep breath and gets down on the ground and has a few moments of just decompressing,” Fraser said. “It’s great. It’s amazing.”

Hospital staffers who work with the dogs say there is virtually no bite risk with the carefully trained Labradors, the preferred breed for this work.

The dogs are kept away from allergic patients and washed regularly to prevent germs from spreading, and people must wash their hands before and after petting them.

Doctors and nurses are facing a growing mental health crisis driven by their experiences at work. They and other health care colleagues face high rates of depression, anxiety, stress, suicidal ideation, and burnout. Nearly half of health workers reported often feeling burned out in 2022, an increase from 2018, according to the Centers for Disease Control and Prevention. And the percentage of health care workers who reported harassment at work more than doubled over that four-year period. Advocates for the presence of dogs in hospitals see the animals as one thing that can help.

That includes Peppi’s handler, Susan Ryan, an emergency medicine physician at Rose.

Ryan said years working as an emergency room doctor left her with symptoms of PTSD. “I just was messed up and I knew it,” said Ryan, who isolated more at home and didn’t want to engage with friends. “I shoved it all in. I think we all do.”

She said doctors and other providers can be good at hiding their struggles, because they have to compartmentalize. “How else can I go from a patient who had a cardiac arrest, deal with the family members telling them that, and go to a room where another person is mad that they’ve had to wait 45 minutes for their ear pain? And I have to flip that switch.”

To cope with her symptoms of post-traumatic stress disorder, Ryan started doing therapy with horses. But she couldn’t have a horse in her backyard, so she got a Labrador. 

Ryan received training from a national service dog group called Canine Companions, becoming the first doctor trained by the group to have a facility dog in an emergency room. Canine Companions has graduated more than 8,000 service dogs.

The Rose medical center gave Ryan approval to bring a dog to work during her ER shifts. Ryan’s colleagues said they are delighted that a dog is part of their work life.

“When I have a bad day at work and I come to Rose and Peppi is here, my day’s going to be made better,” EMT Jasmine Richardson said. “And if I have a patient who’s having a tough day, Peppi just knows how to light up the room.”

Nursing supervisor Eric Vaillancourt agreed, calling Peppi “joyful.”

Ryan had another dog, Wynn, working with her during the height of the pandemic. She said she thinks Wynn made a huge difference. “It saved people,” she said. “We had new nurses that had never seen death before, and now they’re seeing a covid death. And we were worried sick we were dying.”

She said her hospital system has lost a couple of physicians to suicide in the past two years, which HCA confirmed to KFF Health News and NPR. Ryan hopes the canine connection can help with trauma. “Anything that brings you back to the present time helps ground you again. A dog can be that calming influence,” she said. “You can get down on the ground, pet them, and you just get calm.”

Ryan said research has shown the advantages. For example, one review of dozens of original studies on human-animal interactions found benefits for a variety of conditions including behavioral and mood issues and physical symptoms of stress. 

Rose’s president and CEO, Casey Guber, became such a believer in the canine connection he got his own trained dog to bring to the hospital, a black Lab-retriever mix named Ralphie.

She wears a badge: Chief Dog Officer.

Guber said she’s a big morale booster. “Phenomenal,” he said. “It is not uncommon to see a surgeon coming down to our administration office and rolling on the ground with Ralphie, or one of our nurses taking Ralphie out for a walk in the park.”

This article is from a partnership that includes CPR News, NPR, and KFF Health News.

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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Tus bocadillos podrían ser blanco del nuevo gobierno de Trump.

Durante años, el gobierno federal ha evitado regular la comida chatarra, la comida rápida y los alimentos ultraprocesados.

Ahora, las actitudes están cambiando. Algunos miembros del círculo íntimo del presidente Donald Trump se están preparando para luchar contra las “grandes empresas alimentarias”, es decir, las compañías que producen la mayor parte de los alimentos y bebidas que se consumen en el paía.

Los candidatos a las principales agencias de salud están apuntando a los alimentos ultraprocesados, que representan aproximadamente el 70% del suministro de alimentos de Estados Unidos.

Según declaraciones recientes, una variedad de posibles opciones de normas con carga política para regular los alimentos ultraprocesados ​​pueden llegar al menú del equipo de Trump, incluidas las etiquetas de advertencia, los cambios en los subsidios a la agroindustria y los límites a los productos que los consumidores pueden comprar con la ayuda alimentaria del gobierno.

El impulso para reformar la dieta estadounidense está siendo impulsado en gran medida por los conservadores que han asumido la causa que durante mucho tiempo ha sido la favorita de la izquierda.

Los partidarios de Trump, como Robert F. Kennedy Jr., cuya controversial nominación para dirigir el Departamento de Salud y Servicios Humanos aún enfrenta la confirmación del Senado, están adoptando un concepto que defiende los alimentos naturales y la medicina alternativa.

Es un movimiento que han denominado “MAHA”, o Make America Healthy Again (Hagamos a América saludable de nuevo). Su interés ha cobrado impulso porque sus objetivos tienen un apoyo bipartidista bastante amplio, incluso en medio de un Congreso amargamente dividido en el que los legisladores de ambos partidos se centraron en el tema el año pasado.

Es probable que sea una batalla campal porque la industria alimentaria ejerce una inmensa influencia política y ha frustrado con éxito los esfuerzos anteriores por regular sus productos o su comercialización. La categoría de “empresas de procesamiento y venta de alimentos”, que incluye a Tyson Foods y Nestlé SA, registró un gasto de $26,7 millones en actividades de lobby en 2024, según OpenSecrets. En 1998 fueron $10 millones.

“Han sido absolutamente instrumentales y muy, muy exitosos en retrasar cualquier efectividad en la regulación en Estados Unidos”, dijo Laura Schmidt, profesora de política de salud en la Universidad de California-San Francisco. “Realmente parece que debe haber un momento de ajuste de cuentas aquí donde la gente comience a preguntarse, ‘¿Por qué tenemos que vivir así?’”

“Alimentos ultraprocesados” es un término ampliamente utilizado que significa cosas diferentes para distintas personas y se utiliza para describir artículos que van desde refrescos hasta muchas comidas congeladas. Estos productos a menudo contienen grasas, almidones y azúcares agregados, entre otras cosas. Los investigadores dicen que el consumo de alimentos ultraprocesados ​​está vinculado, en diferentes niveles de intensidad, a enfermedades crónicas como diabetes, cáncer, problemas de salud mental y muerte prematura.

Los líderes en nutrición y salud son optimistas de que ya se está llevando a cabo un ajuste de cuentas. Kennedy se ha comprometido a eliminar los alimentos procesados ​​de los almuerzos escolares, restringir ciertos aditivos alimentarios como los colorantes en los cereales y redireccionar los subsidios agrícolas federales de los cultivos básicos ampliamente utilizados en los alimentos ultraprocesados.

La intensificación de la atención en Washington ha desencadenado un nuevo nivel de interés en el frente legal, ya que los abogados exploran casos para enfrentarse a los principales fabricantes de alimentos por vender productos que, según ellos, provocan enfermedades crónicas.

Bryce Martínez, que ahora tiene 18 años, presentó una demanda en diciembre contra casi una docena de fabricantes de alimentos como Kraft Heinz, The Coca-Cola Co. y Nestlé USA. Desarrolló diabetes y enfermedad del hígado graso no alcohólico a los 16 años, y está tratando de hacerlos responsables de sus enfermedades.

Según la demanda, presentada en el Tribunal de Causas Comunes de Philadelphia, las empresas sabían o deberían haber sabido que los alimentos ultraprocesados ​​eran dañinos y adictivos. La demanda señalaba que Martínez creció comiendo alimentos de marca muy publicitados que son básicos en la dieta estadounidense: refrescos azucarados, Cheerios y Lucky Charms, Skittles y Snickers, comidas congeladas y envasadas, por nombrar solo algunos.

Nestlé, Coca-Cola y Kraft Heinz no respondieron a los correos electrónicos en los que se solicitaban comentarios para este artículo. La Consumer Brands Association, una asociación comercial para fabricantes de bienes de consumo envasados, cuestionó las acusaciones.

“Intentar clasificar los alimentos como poco saludables simplemente porque están procesados, o demonizar los alimentos ignorando su contenido nutricional completo, engaña a los consumidores y exacerba las disparidades en materia de salud”, dijo Sarah Gallo, vicepresidenta sénior de política de productos, en una declaración.

Otros bufetes de abogados están a la caza de niños o adultos que creen que fueron perjudicados por consumir alimentos ultraprocesados, lo que aumenta la probabilidad de demandas.

Un grupo de abogados de Indiana especializado en lesiones personales dice en su sitio web: “estamos investigando activamente casos de alimentos ultraprocesados ​​(UPF)”. Y abogados litigantes de Texas también están estudiando la posibilidad de emprender acciones legales contra los reguladores federales que, según ellos, no han controlado los alimentos ultraprocesados.

“Si usted o su hijo han sufrido problemas de salud que su médico ha vinculado directamente con el consumo de alimentos ultraprocesados, Queremos escuchar su historia”, dicen en su sitio web.

Mientras tanto, el 14 de enero la Administración de Drogas y Alimentos (FDA)  anunció que propone exigir que aparezca una etiqueta en la parte de adelante del paquete en la mayoría de los alimentos envasados ​​para que la información sobre el contenido de grasas saturadas, sodio y azúcar agregado de un alimento sea fácilmente visible para los consumidores.

Y en el Capitolio, los senadores Bernie Sanders (independiente de Vermont), Ron Johnson (Republicano de Wisconsin) y Cory Booker (demócrata de New Jersey) están haciendo sonar la alarma sobre los alimentos ultraprocesados.

En 2024, Sanders introdujo una legislación que podría conducir a una prohibición federal de la publicidad de comida chatarra dirigida a niños, una campaña nacional de educación y etiquetas en alimentos ultraprocesados ​​que digan que los productos no están recomendados para pequeños. Booker firmó la legislación junto con los senadores Peter Welch (demócrata de Vermont) y John Hickenlooper (demócrata de Colorado).

En diciembre, el Comité de Salud, Educación, Trabajo y Pensiones del Senado tuvo una audiencia para examinar los vínculos entre los alimentos ultraprocesados ​​y las enfermedades crónicas, durante la cual el comisionado de la FDA, Robert Califf, pidió más fondos para la investigación.

Las empresas alimentarias han aprovechado “los mismos circuitos neuronales que intervienen en la adicción a los opioides”, dijo Califf en la audiencia.

Sanders, que presidió la audiencia, dijo que hay “evidencia creciente” de que “estos alimentos están diseñados deliberadamente para ser adictivos”, y afirmó que los alimentos ultraprocesados ​​han impulsado epidemias de diabetes y obesidad, y cientos de miles de millones de dólares en gastos médicos.

La investigación sobre los alimentos y la adicción “se ha acumulado hasta el punto de haber alcanzado una masa crítica”, dijo Kelly Brownell, profesora emérita de Stanford y una de las editoras de un manual académico sobre el tema.

Los ataques de tres bandos —abogados, el Congreso y la administración Trump, todos aparentemente interesados ​​en presentar batalla— podrían generar suficiente presión para desafiar a las grandes empresas alimentarias y posiblemente impulsar mejores resultados de salud en Estados Unidos, que tiene la más baja expectativa de vida entre los países de altos ingresos.

“Tal vez deshacerse de los alimentos altamente procesados ​​en algunas cosas podría realmente cambiar rápidamente el porcentaje de la población estadounidense que es obesa”, dijo el virólogo Robert Redfield, que dirigió los Centros para el Control y Prevención de Enfermedades (CDC) durante la administración Trump anterior, en comentarios en un evento en diciembre organizado por The Heritage Foundation, un grupo de expertos conservador.

Las acusaciones de que las grandes empresas alimentarias fabricaron y vendieron a sabiendas productos adictivos y nocivos se parecen a las acusaciones formuladas contra las grandes tabacaleras antes de que se alcanzara el histórico acuerdo de $206.000 millones, en 1998.

“Supuestamente, estas empresas utilizan el manual de estrategias de la industria tabacalera para dirigirse a los niños, especialmente a los niños negros e hispanos, con vínculos de marketing integrados con dibujos animados, juguetes y juegos, junto con publicidad en las redes sociales”, dijo a KFF Health News René Rocha, uno de los abogados de Morgan & Morgan que representa a Martínez.

La demanda de Martínez contra los fabricantes de alimentos, de 148 páginas, se basa en documentos que se hicieron públicos en un litigio contra las empresas tabacaleras que eran dueñas de algunas de las marcas más importantes de la industria alimentaria.

Se hicieron acusaciones similares contra los fabricantes, distribuidores y minoristas de opioides antes de que aceptaran pagar decenas de miles de millones de dólares en un acuerdo de 2021 con los estados.

La FDA finalmente impuso restricciones al etiquetado y la comercialización del tabaco, y la epidemia de opioides condujo a una legislación que aumentó el acceso a medicamentos que salvan vidas para tratar la adicción.

Pero el celo de la administración Trump al enfrentarse a las grandes empresas alimentarias puede enfrentar desafíos únicos.

La capacidad de la FDA para imponer regulaciones se ve obstaculizada en parte por la financiación. Mientras que la división de medicamentos de la agencia recauda tasas de usuario de la industria, su división de alimentos depende de un presupuesto más limitado determinado por el Congreso.

El cambio puede llevar tiempo porque la agencia avanza, según algunos críticos, a ritmo de tortuga. El año pasado, la FDA revocó una regulación que permitía el aceite vegetal bromado en productos alimenticios. La agencia determinó en 1970 que el aditivo no era generalmente reconocido como seguro.

Los esfuerzos para limitar la comercialización de alimentos ultraprocesados ​​podrían impulsar demandas que aleguen que cualquier restricción viola la libertad de expresión comercial protegida por la Primera Enmienda. Y Kennedy —si es confirmado como secretario del Departamento de Salud y Servicios Sociales (HHS)—  puede tener dificultades para obtener el apoyo de un Congreso liderado por  republicanos, que defiende una menor regulación federal, y de un presidente que durante su mandato anterior sirvió comida rápida en la Casa Blanca.

“La pregunta es: ¿podrá RFK marcar una diferencia?”, dijo David L. Katz, médico fundador de True Health Initiative, un grupo sin fines de lucro que combate la desinformación sobre salud pública. “Ninguna administración anterior ha hecho mucho en este ámbito, y RFK está vinculado a una administración particularmente antirregulatoria”.

Mientras tanto, la población estadounidense es reconocida como una de las más obesas del mundo y tiene la tasa más alta de personas con múltiples enfermedades crónicas entre los países de altos ingresos.

“Hay un gran esfuerzo de base debido a lo enfermos que estamos”, dijo Jerold Mande, quien se desempeñó como subsecretario adjunto para la seguridad alimentaria en el Departamento de ASgricultura entre 2009 y 2011.

“En gran parte, esto se debe a que la gente no debería estar tan enferma tan temprano en la vida. Tienes suerte si llegas a los 18 años sin una enfermedad crónica. Es extraordinario”, observó.

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The new Trump administration could be coming for your snacks.

For years, the federal government has steered clear of regulating junk food, fast food, and ultra-processed food.

Now attitudes are changing. Some members of President-elect Donald Trump’s inner circle are gearing up to battle “Big Food,” or the companies that make most of the food and beverages consumed in the United States. Nominees for top health agencies are taking aim at ultra-processed foods that account for an estimated 70% of the nation’s food supply. Based on recent statements, a variety of potential politically charged policy options to regulate ultra-processed food may land on the Trump team menu, including warning labels, changes to agribusiness subsidies, and limits on which products consumers can buy with government food aid.

The push to reform the American diet is being driven largely by conservatives who have taken up the cause that has long been a darling of the left. Trump supporters such as Robert F. Kennedy Jr., whose controversial nomination to lead the Department of Health and Human Services still faces Senate confirmation, are embracing a concept that champions natural foods and alternative medicine. It’s a movement they’ve dubbed “MAHA,” or Make America Healthy Again. Their interest has created momentum because their goals have fairly broad bipartisan support even amid a bitterly divided Congress in which lawmakers from both sides of the aisle focused on the issue last year.

It’s likely to be a pitched battle because the food industry wields immense political influence and has successfully thwarted previous efforts to regulate its products or marketing. The category of “food processing and sales companies,” which includes Tyson Foods and Nestle SA, tallied $26.7 million in spending on lobbying in 2024, according to OpenSecrets. That’s up from almost $10 million in 1998.

“They have been absolutely instrumental and highly, highly successful at delaying any regulatory effectiveness in America,” said Laura Schmidt, a health policy professor at the University of California-San Francisco. “It really does feel like there needs to be a moment of reckoning here where people start asking the question, ‘Why do we have to live like this?’”

“Ultra-processed food” is a widely used term that means different things to different people and is used to describe items ranging from sodas to many frozen meals. These products often contain added fats, starches, and sugars, among other things. Researchers say consumption of ultra-processed foods is linked — in varying levels of intensity — to chronic conditions like diabetes, cancer, mental health problems, and early death.

Nutrition and health leaders are optimistic that a reckoning is already underway. Kennedy has pledged to remove processed foods from school lunches, restrict certain food additives such as dyes in cereal, and shift federal agricultural subsidies away from commodity crops widely used in ultra-processed foods.

The intensifying focus in Washington has triggered a new level of interest on the legal front as lawyers explore cases to take on major foodmakers for selling products they say result in chronic disease.

Bryce Martinez, now 18, filed a lawsuit in December against almost a dozen foodmakers such as Kraft Heinz, The Coca-Cola Co., and Nestle USA. He developed diabetes and non-alcoholic fatty liver disease by age 16, and is seeking to hold them accountable for his illnesses. According to the suit, filed in the Philadelphia Court of Common Pleas, the companies knew or should have known ultra-processed foods were harmful and addictive.

The lawsuit noted that Martinez grew up eating heavily advertised, brand-name foods that are staples of the American diet — sugary soft drinks, Cheerios and Lucky Charms, Skittles and Snickers, frozen and packaged dinners, just to name a few.

Nestle, Coca-Cola, and Kraft Heinz didn’t return emails seeking comment for this article. The Consumer Brands Association, a trade association for makers of consumer packaged goods, disputed the allegations.

“Attempting to classify foods as unhealthy simply because they are processed, or demonizing food by ignoring its full nutrient content, misleads consumers and exacerbates health disparities,” said Sarah Gallo, senior vice president of product policy, in a statement.

Other law firms are on the hunt for children or adults who believe they were harmed by consuming ultra-processed foods, increasing the likelihood of lawsuits.

One Indiana personal injury firm says on its website that “we are actively investigating ultra processed food (UPF) cases.” Trial attorneys in Texas also are looking into possible legal action against the federal regulators they say have failed to police ultra-processed foods.

“If you or your child have suffered health problems that your doctor has linked directly to the consumption of ultra-processed foods, we want to hear your story,” they say on their website.

Meanwhile, the FDA on Jan. 14 announced it is proposing to require a front-of-package label to appear on most packaged foods to make information about a food’s saturated fat, sodium, and added sugar content easily visible to consumers.

And on Capitol Hill, Sens. Bernie Sanders (I-Vt.), Ron Johnson (R-Wis.), and Cory Booker (D-N.J.) are sounding the alarm over ultra-processed food. Sanders introduced legislation in 2024 that could lead to a federal ban on junk food advertising to children, a national education campaign, and labels on ultra-processed foods that say the products aren’t recommended for children. Booker cosigned the legislation along with Sens. Peter Welch (D-Vt.) and John Hickenlooper (D-Colo.).

The Senate Committee on Health, Education, Labor and Pensions held a December hearing examining links between ultra-processed food and chronic disease during which FDA Commissioner Robert Califf called for more funding for research.

Food companies have tapped into “the same neural circuits that are involved in opioid addiction,” Califf said at the hearing.

Sanders, who presided over the hearing, said there’s “growing evidence” that “these foods are deliberately designed to be addictive,” and he asserted that ultra-processed foods have driven epidemics of diabetes and obesity, and hundreds of billions of dollars in medical expenses.

Research on food and addiction “has accumulated to the point where it’s reached a critical mass,” said Kelly Brownell, an emeritus professor at Stanford who is one of the editors of a scholarly handbook on the subject.

Attacks from three sides — lawyers, Congress, and the incoming Trump administration, all seemingly interested in taking up the fight — could lead to enough pressure to challenge Big Food and possibly spur better health outcomes in the U.S., which has the lowest life expectancy among high-income countries.

“Maybe getting rid of highly processed foods in some things could actually flip the switch pretty quickly in changing the percentage of the American public that are obese,” said Robert Redfield, a virologist who led the Centers for Disease Control and Prevention during the previous Trump administration, in remarks at a December event hosted by the Heritage Foundation, a conservative think tank.

Claims that Big Food knowingly manufactured and sold addictive and harmful products resemble the claims leveled against Big Tobacco before the landmark $206 billion settlement was reached in 1998.

“These companies allegedly use the tobacco industry’s playbook to target children, especially Black and Hispanic children, with integrated marketing tie-ins with cartoons, toys, and games, along with social media advertising,” Rene Rocha, one of the lawyers at Morgan & Morgan representing Martinez, told KFF Health News.

The 148-page Martinez lawsuit against foodmakers draws from documents made public in litigation against tobacco companies that owned some of the biggest brands in the food industry.

Similar allegations were made against opioid manufacturers, distributors, and retailers before they agreed to pay tens of billions of dollars in a 2021 settlement with states.

The FDA ultimately put restrictions on the labeling and marketing of tobacco, and the opioid epidemic led to legislation that increased access to lifesaving medications to treat addiction.

But the Trump administration’s zeal in taking on Big Food may face unique challenges.

The ability of the FDA to impose regulation is hampered in part by funding. While the agency’s drug division collects industry user fees, its division of food relies on a more limited budget determined by Congress.

Change can take time because the agency moves at what some critics call a glacial pace. Last year, the FDA revoked a regulation allowing brominated vegetable oil in food products. The agency determined in 1970 that the additive was not generally recognized as safe.

Efforts to curtail the marketing of ultra-processed food could spur lawsuits alleging that any restrictions violate commercial speech protected by the First Amendment. And Kennedy — if he is confirmed as HHS secretary — may struggle to get support from a Republican-led Congress that champions less federal regulation and a president-elect who during his previous term served fast food in the White House.

“The question is, will RFK be able to make a difference?” said David L. Katz, a doctor who founded True Health Initiative, a nonprofit group that combats public health misinformation. “No prior administration has done much in this space, and RFK is linked to a particularly anti-regulatory administration.”

Meanwhile, the U.S. population is recognized as among the most obese in the world and has the highest rate of people with multiple chronic conditions among high-income countries.

“There is a big grassroots effort out there because of how sick we are,” said Jerold Mande, who served as deputy undersecretary for food safety at the Department of Agriculture from 2009 to 2011. “A big part of it is people shouldn’t be this sick this young in their lives. You’re lucky if you get to 18 without a chronic disease. It’s remarkable.”

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 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.

Incoming President Donald Trump’s inauguration is Monday, yet the new GOP-led Congress is already rushing to work his priorities into legislation, eyeing cuts to Medicaid to pay for new tax and immigration priorities. But even in its waning days, the Biden administration continues to make big policy moves, including a possible order for tobacco companies to dramatically decrease the amount of nicotine in cigarettes. 

Meanwhile, the fires in Los Angeles are drawing new attention to the health dangers of not just smoke from organic matter, but also toxic substances released by burning plastic and other man-made materials — as well as the threat posed to both air and water quality.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins University Bloomberg School of Public Health and Politico Magazine, and Sandhya Raman of CQ Roll Call.

Panelists Anna Edney Bloomberg @annaedney Read Anna's stories. Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Sandhya Raman CQ Roll Call @SandhyaWrites Read Sandhya's stories.

Among the takeaways from this week’s episode:

• Republican lawmakers are weighing options to cut federal spending on Medicaid, the nearly $900-billion-a-year government program that covers 1 in 5 Americans. They could use the savings to bolster Trump priorities, such as extending the 2017 tax cuts. The GOP made splashy but unsuccessful attempts to cut Medicaid when Trump first took office and the party held a larger House majority — though the party seems more aligned with Trump today than it was then.
• Congress has gotten down to business on messaging bills: It advanced legislation this week that would ban trans athletes from girls’ school sports and, separately, a measure to detain and even deport immigrants who are living in the U.S. without legal status and have been charged with, though not convicted of, minor crimes such as shoplifting.
• The Supreme Court has agreed to hear a case later this year about the U.S. Preventive Services Task Force — an independent body of experts that issues recommendations in disease prevention and medicine. A ruling against its authority could strip coverage for key preventive health services from not just those with Affordable Care Act coverage, but also those on employer-sponsored health plans. The question stands: If not this task force, who would make the determinations about what preventive care should be covered?
• And the outgoing Biden administration issued a slew of health regulations this week, including a ban on the dye Red No. 3 in food and other ingested products, as well as an early regulation limiting the amount of nicotine in tobacco products. The incoming Trump administration could upend these and more regulations, though some do align with its policy interests.

Also this week, Rovner interviews Harris Meyer, who reported and wrote the latest KFF Health News “Bill of the Month” feature, about a colonoscopy that came with a much larger price tag than estimated. If you have a mystifying or outrageous medical bill you’d like to share with us, you can do that here.

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

Julie Rovner: KFF Health News’ “Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?” by Felice J. Freyer.

Anna Edney: Bloomberg News’ “It’s Not Just Sunscreen. Toxic Products Line the Drugstore Aisles,” by Anna Edney.

Joanne Kenen: The Atlantic’s “A Secret Way To Fight Off Stomach Bugs,” by Daniel Engber.

Sandhya Raman: Nature’s “New Obesity Definition Sidelines BMI To Focus on Health,” by Giorgia Guglielmi.

Also mentioned in this week’s podcast:

• MedPage Today’s “ABIM Revokes Certification of Another Doctor Who Made Controversial COVID Claims,” by Kristina Fiore.
• The Atlantic’s “What Happens When a Plastic City Burns,” by Zoë Schlanger.
• ProPublica’s “The Second Trump White House Could Drastically Reshape Infectious Disease Research. Here’s What’s at Stake,” by Anna Maria Barry-Jester.
• The New York Times’ “Don’t Call Kennedy a Vaccine Skeptic. Call Him What He Is: A Cynic,” by Paul A. Offit.
• The Federal Trade Commission’s “Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies.”

Credits Taylor Cook Audio producer Lonnie Ro Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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

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

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SACRAMENTO, Calif. — As the nation braces for potential policy shifts under President-elect Donald Trump’s “Make America Healthy Again” mantra, the nation’s most populous state and largest health care market is preparing for a few changes of its own.

With supermajorities in both houses, Democrats in the California Legislature passed — and Democratic Gov. Gavin Newsom signed — laws taking effect this year that will erase medical debt from credit reports, allow public health officials to inspect immigrant detention centers, and require health insurance companies to cover fertility services such as in vitro fertilization.

Still, industry experts say it was a relatively quiet year for health policy in the Golden State, with more attention on a divisive presidential election and with several state legislators seeking to avoid controversial issues as they ran for Congress in competitive swing districts.

Newsom shot down some of legislators’ most ambitious health care policies, including proposals that would have regulated pharmaceutical industry middlemen and given the state more power to stop private equity deals in health care.

Health policy experts say advocates and legislators are now focused on how to defend progressive California policies such as sweeping abortion access in the state and health coverage for immigrants living in the U.S. without authorization.

“I think everyone’s just thinking about how we’re going to enter 2025,” said Rachel Linn Gish, a spokesperson with the consumer health advocacy group Health Access California. “We’re figuring out what is vulnerable, what we are exposed to on the federal side, and what do budget changes mean for our work. That’s kind of putting a cloud over everything.”

Here are some of the biggest new health care laws Californians should know about:

Medical debt

California becomes the eighth state in which medical debt will no longer affect patients’ credit reports or credit scores. SB 1061 bars health care providers and debt collectors from reporting unpaid medical bills to credit bureaus, a practice that supporters of the law say penalizes people for seeking critical care and can make it harder for patients to get a job, buy a car, or secure a mortgage.

Critics including the California Association of Collectors called the measure from Sen. Monique Limón (D-Santa Barbara) a “tremendous overreach” and successfully lobbied for amendments that limited the scope of the bill, including an exemption for any medical debt incurred on credit cards.

The Biden administration has finalized federal rules that would stop unpaid medical bills from affecting patients’ credit scores, but the fate of those changes remains unclear as Trump takes office.

Psychiatric hospital stays for violent offenders

Violent offenders with severe mental illness can now be held longer after a judge orders them released from a state mental hospital.

State officials and local law enforcement will now have 30 days to coordinate housing, medication, and behavioral health treatment for those parolees, giving them far more time than the five-day deadline previously in effect.

The bill drew overwhelming bipartisan support after a high-profile case in San Francisco in which a 61-year-old man was charged in the repeated stabbing of a bakery employee just days after his release from a state mental hospital. The bill’s author, Assembly member Matt Haney (D-San Francisco), called the previous five-day timeline “dangerously short.”

Cosmetics and ‘forever chemicals’

California was the first state to ban PFAS chemicals, also known as “forever chemicals,” in all cosmetics sold and manufactured within its borders. The synthetic compounds, found in everyday products including rain jackets, food packaging, lipstick, and shaving cream, have been linked to cancer, birth defects, and diminished immune function and have been increasingly detected in drinking water.

Industry representatives have argued that use of PFAS — perfluoroalkyl and polyfluoroalkyl substances — is critical in some products and that some can be safely used at certain levels.

Immigration detention facilities

After covid-19 outbreaks, contaminated water, and moldy food became the subjects of detainee complaints and lawsuits, state legislators gave local county health officials the authority to enter and inspect privately run immigrant detention centers. SB 1132, from Sen. María Elena Durazo (D-Los Angeles), gives public health officials the ability to evaluate whether privately run facilities are complying with state and local public health regulations regarding proper ventilation, basic mental and physical health care, and food safety.

Although the federal government regulates immigration, six federal detention centers in California are operated by the GEO Group. One of the country’s largest private prison contractors, GEO has faced a litany of complaints related to health and safety. Unlike public prisons and jails, which are inspected annually, these facilities would be inspected only as deemed necessary.

The contractor filed suit in October to stop implementation of the law, saying it unconstitutionally oversteps the federal government’s authority to regulate immigration detention centers. A hearing in the case is set for March 3, said Bethany Lesser, a spokesperson for California Attorney General Rob Bonta. The law took effect Jan. 1.

Doctors vs. insurance companies using AI

As major insurance companies increasingly use artificial intelligence as a tool to analyze patient claims and authorize some treatment, trade groups representing doctors are concerned that AI algorithms are driving an increase in denials for necessary care. Legislators unanimously agreed.

SB 1120 states that decisions about whether a treatment is medically necessary can be made only by licensed, qualified physicians or other health care providers who review a patient’s medical history and other records.

Sick leave and protected time off

Two new laws expand the circumstances under which California workers may use sick days and other leave. SB 1105 entitles farmworkers who work outdoors to take paid sick leave to avoid heat, smoke, or flooding when local or state officials declare an emergency.

AB 2499 expands the list of reasons employees may take paid sick days or use protected unpaid leave to include assisting a family member who is experiencing domestic violence or other violent crimes.

Prescription labels for the visually impaired

Starting this year, pharmacies will be required to provide drug labels and use instructions in Braille, large print, or audio for blind patients.

Advocates of the move said state law, which already required translated instructions in five languages for non-English speakers, has overlooked blind patients, making it difficult for them to monitor prescriptions and take the correct dosage.

Maternal mental health screenings

Health insurers will be required to bolster maternal mental health programs by mandating additional screenings to better detect perinatal depression, which affects 1 in 5 people who give birth in California, according to state data. Pregnant people will now undergo screenings at least once during pregnancy and then six weeks postpartum, with further screenings as providers deem necessary.

Penalties for threatening health care workers (abortion clinics)

With abortion care at the center of national policy fights, California is cracking down on those who threaten, post personal information about, or otherwise target providers or patients at clinics that perform abortions. Penalties for such behavior will increase under AB 2099, and offenders can face felony charges, up to three years in jail, and $50,000 in fines for repeat or violent offenses. Previously, state law classified many of those offenses as misdemeanors.

Insurance coverage for IVF

Starting in July, state-regulated health plans covering 50 employees or more would be required to cover fertility services under SB 729, passed and signed last year. Advocates have long fought for this benefit, which they say is essential care for many families who have trouble getting pregnant and would ensure LGBTQ+ couples aren’t required to pay more out-of-pocket costs than straight couples when starting a family.

In a signing statement, Newsom asked legislators to delay implementation of the law until 2026 as state officials consider whether to add infertility treatments to the list of benefits that insurance plans are required to cover.

It’s unclear whether legislators intend to address that this session, but a spokesperson for the governor said that Newsom “clearly stated his position on the need for an extension” and that he “will continue to work with the legislature” on the matter.

Plans under CalPERS, the California Public Employees’ Retirement System, would have to comply by July 2027.

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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If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

BIRMINGHAM, Ala. — Frank Wampol had a dark realization when he came across some alarming data a few years ago: Over 5,000 male construction workers die from suicide annually — five times the number who die from work-related injuries, according to several studies. That’s considerably more than the suicide rate for men in the general population.

“To say this is a crisis would be an understatement,” said Wampol, vice president of safety and health at BL Harbert International, a construction company based in Birmingham with over 10,000 employees.

Since then, the company has added mental health first-aid training for on-site supervisors and distributed information about suicide prevention to laborers in the field. The efforts are part of a larger push led by the industry and supported by unions, research institutions, and federal agencies to address construction workers’ mental health.

But initiatives to combat this mental health crisis are tougher to implement than protocols for hard hats, safety vests, and protective goggles. And some of the potential solutions, such as paid sick leave, have drawn pushback from the industry as it eyes costs.

Safety experts have long been concerned about the physical hazards of construction work. The “Fatal Four” hazards are falls, electrocutions, being struck by an object like a brick or a crane boom, and getting caught between two objects, according to the Occupational Safety and Health Administration.

Only in recent years have the psychosocial hazards of construction work moved onto the public radar. Studies paint a grim picture, said Douglas Trout, an occupational medicine physician and deputy director of the Office of Construction Safety and Health at the National Institute for Occupational Safety and Health.

In addition to high suicide rates, drug use is rampant, especially opioids such as heroin and fentanyl. A recent study from the Centers for Disease Control and Prevention found that construction ranks highest in overdose deaths by occupation.

“Rates of suicides and overdose deaths are some of the worst outcomes related to mental health conditions,” Trout said. “And unfortunately, these are the more measurable ones.”

Less measurable but also prevalent among construction workers are anxiety and depression, which often remain undiagnosed. Almost half of construction workers have experienced symptoms of both, a rate higher than that of the general U.S. population, according to a preliminary 2024 study by the Center for Construction Research and Training, an arm of North America’s Building Trades Unions. But fewer than 5% of construction workers reported seeing a mental health professional, compared with 22% of all U.S. adults, according federal statistics.

The combination of high-hazard environments and organizational factors puts construction workers at particular risk for mental health issues, Trout said. Construction is a high-stress occupation involving long hours, extended separation from family and friends, and low job security due to the industry’s cyclical nature.

Even though health insurance and workers’ compensation are offered by some contractors, paid sick leave for laborers, craft workers, and mechanics is not standard. While 18 states and Washington, D.C., have approved laws requiring paid sick leave and federal contractors have to offer it, the mandates don’t apply to many construction workers. And industry advocates are pushing back against such legal requirements, claiming they don’t fit the transient and seasonal nature of construction work.

If workers get injured, they often “try to tough it out and get back to the job as quickly as possible,” said Nazia Shah, director of safety and health services at the Associated General Contractors of America, the country’s largest construction trade association.

To manage pain from injuries, workers often resort to prescription opioids. Some then develop a dependency and turn to street drugs. “It’s a vicious cycle,” Shah said.

If a worker is fatigued, distracted by pain or personal issues, or impaired by some type of substance, the results can be catastrophic, said Wampol, a 20-year industry veteran who went into construction after retiring from a career as a firefighter and paramedic.

The biggest step, Shah said, is “breaking the stigma and normalizing conversations around mental health.”

The hurdles are particularly high in this male-dominated field, where harassment and bullying are common and speaking up about emotional hardships is often considered a sign of weakness, Shah said.

Several organizations, including the Associated Builders and Contractors, have created short “toolbox talks” to review the signs and symptoms of mental health issues, the risks of self-medicating with drugs and alcohol, and the resources available through health insurance and employee assistance programs.

Some, such as the AGC’s Missouri Chapter, hand out hard-hat stickers, cards, and “hope coins” — small tokens that symbolize support. They all serve as conversation starters and include information on the 988 Suicide & Crisis Lifeline in English and Spanish.

Many contractors hold regular stand-downs, with supervisors halting work at a construction site to provide on-the-spot training related to a specific mental health issue. Others, such as BL Harbert, offer health education fairs and team with local health clinics for lunch-and-learn events.

But Stanley Wheat, an on-site safety manager at BL Harbert, said that even the best policies, procedures, and training materials won’t stick without making an effort on the ground. “A PowerPoint presentation alone won’t cut it. You’ve got to know your people, and you’ve got to engage them.”

Wheat, a military veteran who has worked in construction for over two decades, said it’s important to make rounds several times a day at a job site — getting to know the workers and observing changes in their behaviors.

“You start noticing the guy who’s isolating himself, sitting alone at lunch, not talking with anybody,” he said.

Wheat can relate. His uncle died by suicide, but his family would never talk about it. During his time in the military, Wheat said, he went to rehab for drug and alcohol addiction. He dropped out of college to work in construction.

“I’ve been there,” he said. “I skinned my knuckles. I pulled my back. I worked injured.”

Wheat tries to strike up conversations with workers who he thinks are having a rough time. He listens, sometimes shares his personal story, and suggests resources for help.

Peer-to-peer support is among the more promising concepts in the effort to curb the mental health crisis in construction. Workers often don’t want to talk with management or outsiders, Trout said, “but they usually trust each other.”

One successful model is Mates, a program for mental health and suicide prevention that originated in Australia in 2008. The idea is to train on-site personnel — workers, foremen, superintendents — to spot and support co-workers in crisis, offer a confidential space to talk, and guide them to help if needed. The volunteers, called “connectors,” are typically identified by green hard hat stickers. Efforts are underway to bring a formalized Mates program to the U.S., Trout said.

Other, often small and local initiatives are being implemented, too. Some contractors have hired full-time wellness coordinators or bring mental health care providers to construction sites so employees can start appointments immediately. A few companies have put dedicated trailers on their job sites that serve as quiet rooms, with lounge chairs, board games, and video consoles, so workers can take a moment to decompress.

Many contractors also have added naloxone — an emergency medication used to reverse opioid overdoses, often known by the brand Narcan — to on-site medical kits.

Going forward, as President-elect Donald Trump takes office next week, the industry faces major uncertainties, including possible ripple effects from tariffs, mass deportations, tax cuts, and deregulation.

No matter what comes, Wampol said, the construction industry needs to understand that the investment in mental wellness and suicide prevention programs creates “a healthier, more productive workforce” — and, ultimately, a better bottom line.

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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Una de las tareas del oncólogo es preparar a los pacientes con cáncer para tomar decisiones difíciles cuando se acerca el final. Sin embargo, no siempre se acuerdan de hacerlo.

En el sistema de salud de la Universidad de Pennsylvania (Penn Medicine), un algoritmo de inteligencia artificial (IA) que predice las probabilidades de muerte de los pacientes impulsa a los médicos a hablar con ellos sobre el tratamiento y sus preferencias al final de la vida.

Pero esta IA dista mucho de ser una herramienta fácil de usar, que se configura y listo.

Según un estudio de 2022, una revisión tecnológica de rutina descubrió que el algoritmo se había deteriorado durante la pandemia de covid, y que su precisión había bajado un 7% a la hora de predecir cuáles pacientes morirían.

Es probable que este deterioro haya tenido consecuencias concretas en la vida real. Ravi Parikh, oncólogo de la Universidad Emory y autor principal del estudio, explicó a KFF Health News que, en cientos de casos, la herramienta no logró alertar a los médicos para que comenzaran conversaciones cruciales con los pacientes, que podrían haberles evitado quimioterapias innecesarias.

Parikh cree que varios algoritmos diseñados para mejorar la atención médica se vieron afectados durante la pandemia, no sólo el de Penn Medicine. “Muchas instituciones no están monitoreando sistemáticamente el rendimiento de sus sistemas”, explicó.

Las fallas de los algoritmos son solo una parte de un dilema que los especialistas en informática y los médicos tienen desde hace tiempo, pero que ahora está empezando a desconcertar a los directivos de los hospitales y a los investigadores.

Los sistemas de inteligencia artificial requieren una supervisión continua y una dotación de personal altamente capacitado tanto para su implementación como para garantizar que funcionen bien.

En resumen: se necesitan más máquinas y más personas para asegurarse de que las nuevas herramientas no cometan errores.

“Todo el mundo piensa que la IA mejorará el acceso, aumentará la capacidad de los sistemas de salud y optimizará la atención, y eso suena muy bien”, dijo Nigam Shah, jefe de Datos Científicos en Stanford Health Care. “Pero, si el costo de la atención aumenta en un 20%, ¿es realmente viable?”.

A los funcionarios de gobierno les preocupa que los hospitales no tengan recursos para monitorear rigurosamente estas tecnologías. “He buscado por todas partes”, afirmó Robert Califf, comisionado de la Administración de Drogas y Alimentos (FDA), en una reciente mesa redonda sobre IA. “No creo que en Estados Unidos haya un solo sistema de salud que sea capaz de validar un algoritmo de IA implementado en un sistema de atención clínica”, agregó.

Sin embargo, la IA ya está ampliamente presente en el sector de la salud. Los algoritmos se usan para anticipar el riesgo de muerte o el deterioro de los pacientes, sugerir diagnósticos o clasificar la atención según la urgencia, registrar y resumir consultas para facilitar el trabajo de los médicos, e incluso para evaluar los reclamos de las aseguradoras.

Si los entusiastas de la tecnología están en lo cierto, la tecnología se volverá omnipresente… y rentable.

La empresa de inversión Bessemer Venture Partners ha identificado unas 20 startups de IA centradas en salud que están en vías de facturar $10 millones en un año cada una. La FDA ha aprobado cerca de mil productos de inteligencia artificial.

Evaluar si estas herramientas funcionan es todo un reto. Determinar si siguen funcionando bien —o si tienen fallas en sus sistemas operativos— es aún más complicado.

Por ejemplo, un estudio reciente de Yale Medicine analizó seis “sistemas de alerta precoz”, que avisan a los médicos cuándo es probable que un paciente se deteriore rápidamente.

Dana Edelson, médica de la Universidad de Chicago y cofundadora de una empresa que proporcionó un algoritmo para esta investigación, dijo que una supercomputadora revisó los datos durante varios días. El proceso fue fructífero, ya que mostró enormes diferencias de rendimiento entre los seis productos.

Para los hospitales y proveedores no es fácil seleccionar los mejores algoritmos en base a sus necesidades. No es habitual que los médicos tengan una supercomputadora a su disposición y no existe nada equiparable a un Consumer Reports para la IA.

“No tenemos normas”, aseguró Jesse Ehrenfeld, ex presidente de la Asociación Médica Estadounidense. “No existe nada que hoy se pueda señalar como una norma en relación con la forma de evaluar, supervisar o analizar el rendimiento de un modelo de algoritmo, con o sin inteligencia artificial, cuando se implementa”.

Quizás el producto de IA más común en las consultas médicas sea la “documentación ambiental”, un asistente tecnológico que escucha y transcribe las interacciones entre el médico y el paciente.

El año pasado, los inversores de Rock Health registraron un flujo de $353 millones en inversiones dirigidas hacia estas empresas de registros médicos. Pero, según Ehrenfeld, “actualmente no hay una pauta que permita comparar los resultados de estas herramientas”.

Esto es un problema, ya que incluso pequeños errores pueden ser devastadores. Un equipo de la Universidad de Stanford intentó usar grandes modelos lingüísticos —la tecnología que sustenta herramientas de IA populares como ChatGPT— para resumir el historial médico de los pacientes.

Más tarde, compararon los resultados con lo que hubiera escrito un médico.

“Incluso en el mejor de los casos, los modelos tenían una tasa de error del 35%”, explicó Shah, de Stanford. “Y en medicina, cuando estás escribiendo una historia clínica y te olvidas de una palabra, como por ejemplo ‘fiebre‘, se plantea un verdadero problema”, reflexionó.

A veces, las razones por las que los algoritmos fallan son bastante lógicas. Por ejemplo, las alteraciones en los datos estructurales pueden disminuir su efectividad, por ejemplo, cuando un hospital cambia de proveedor de laboratorio.

Sin embargo, en muchas otras ocasiones los problemas surgen sin un motivo aparente.

Sandy Aronson, ejecutivo tecnológico del programa de medicina personalizada del Mass General Brigham de Boston, contó que cuando su equipo probó una aplicación destinada a ayudar a los consejeros en genética a localizar bibliografía relevante sobre variantes del ADN, el producto sufrió “no determinismo”. Esto significa que, cuando se le hacía varias veces la misma pregunta en un breve período de tiempo, daba resultados diferentes.

Aronson está entusiasmado con el potencial de los grandes modelos lingüísticos para resumir conocimientos que simplifiquen el trabajo de los sobrecargados consejeros, pero considera que “la tecnología tiene que mejorar”.

Si hay pocas métricas y estándares, y los errores pueden surgir por razones raras, ¿qué deben hacer las instituciones? Invertir en una gran cantidad de recursos. En Stanford, Shah comentó que les llevó entre ocho y diez meses revisar solo dos modelos en términos de equidad y confiabilidad.

Expertos entrevistados por KFF Health News plantearon la idea de que la inteligencia artificial supervise a la inteligencia artificial, y que algún genio (humano) en datos supervise a ambas.

Todos reconocieron que esto requeriría que las organizaciones gastaran aún más dinero, una pretensión difícil de satisfacer dada la realidad de los presupuestos hospitalarios y la limitada oferta de especialistas en tecnología de IA.

“Es estupendo tener una perspectiva en la que estamos haciendo un esfuerzo colosal para poder monitorear un modelo con otro modelo”, dijo Shah. “Pero ¿es eso realmente lo que se quería? ¿Cuánta gente más vamos a necesitar?”.

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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Throughout her childhood, Julia Lo Cascio dreamed of becoming a pediatrician. So, when applying to medical school, she was thrilled to discover a new, small school founded specifically to train primary care doctors: NYU Grossman Long Island School of Medicine.

Now in her final year at the Mineola, New York, school, Lo Cascio remains committed to primary care pediatrics. But many young doctors choose otherwise as they leave medical school for their residencies. In 2024, 252 of the nation’s 3,139 pediatric residency slots went unfilled and family medicine programs faced 636 vacant residencies out of 5,231 as students chased higher-paying specialties.

Lo Cascio, 24, said her three-year accelerated program nurtured her goal of becoming a pediatrician. Could other medical schools do more to promote primary care? The question could not be more urgent. The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care doctors by 2036. This means many Americans will lose out on the benefits of primary care, which research shows improves health, leading to fewer hospital visits and less chronic illness.

Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.

The driving force is often money, said Andrew Bazemore, a physician and a senior vice president at the American Board of Family Medicine. “Subspecialties tend to generate a lot of wealth, not only for the individual specialists, but for the whole system in the hospital,” he said.

A department’s cache of federal and pharmaceutical-company grants often determines its size and prestige, he said. And at least 12 medical schools, including Harvard, Yale, and Johns Hopkins, don’t even have full-fledged family medicine departments. Students at these schools can study internal medicine, but many of those graduates end up choosing subspecialties like gastroenterology or cardiology.

One potential solution: eliminate tuition, in the hope that debt-free students will base their career choice on passion rather than paycheck. In 2024, two elite medical schools — the Albert Einstein College of Medicine and the Johns Hopkins University School of Medicine — announced that charitable donations are enabling them to waive tuition, joining a handful of other tuition-free schools.

But the contrast between the school Lo Cascio attends and the institution that founded it starkly illustrates the limitations of this approach. Neither charges tuition.

In 2024, two-thirds of students graduating from her Long Island school chose residencies in primary care. Lo Cascio said the tuition waiver wasn’t a deciding factor in choosing pediatrics, among the lowest-paid specialties, with an average annual income of $260,000, according to Medscape.

At the sister school, the Manhattan-based NYU Grossman School of Medicine, the majority of its 2024 graduates chose specialties like orthopedics (averaging $558,000 a year) or dermatology ($479,000).

Primary care typically gets little respect. Professors and peers alike admonish students: If you’re so smart, why would you choose primary care? Anand Chukka, 27, said he has heard that refrain regularly throughout his years as a student at Harvard Medical School. Even his parents, both PhD scientists, wondered if he was wasting his education by pursuing primary care.

Seemingly minor issues can influence students’ decisions, Chukka said. He recalls envying the students on hospital rotations who routinely were served lunch, while those in primary care settings had to fetch their own.

Despite such headwinds, Chukka, now in his final year, remains enthusiastic about primary care. He has long wanted to care for poor and other underserved people, and a one-year clerkship at a community practice serving low-income patients reinforced that plan.

When students look to the future, especially if they haven’t had such exposure, primary care can seem grim, burdened with time-consuming administrative tasks, such as seeking prior authorizations from insurers and grappling with electronic medical records.

While specialists may also face bureaucracy, primary care practices have it much worse: They have more patients and less money to hire help amid burgeoning paperwork requirements, said Caroline Richardson, chair of family medicine at Brown University’s Warren Alpert Medical School.

“It’s not the medical schools that are the problem; it’s the job,” Richardson said. “The job is too toxic.”

Kevin Grumbach, a professor of family and community medicine at the University of California-San Francisco, spent decades trying to boost the share of students choosing primary care, only to conclude: “There’s really very little that we can do in medical school to change people’s career trajectories.”

Instead, he said, the U.S. health care system must address the low pay and lack of support.

And yet, some schools find a way to produce significant proportions of primary care doctors — through recruitment and programs that provide positive experiences and mentors.

U.S. News & World Report recently ranked 168 medical schools by the percentage of graduates who were practicing primary care six to eight years after graduation.

The top 10 schools are all osteopathic medical schools, with 41% to 47% of their students still practicing primary care. Unlike allopathic medical schools, which award MD degrees, osteopathic schools, which award DO degrees, have a history of focusing on primary care and are graduating a growing share of the nation’s primary care physicians.

At the bottom of the U.S. News list is Yale, with 10.7% of its graduates finding lasting careers in primary care. Other elite schools have similar rates: Johns Hopkins, 13.1%; Harvard, 13.7%.

In contrast, public universities that have made it a mission to promote primary care have much higher numbers.

The University of Washington — No. 18 in the ranking, with 36.9% of graduates working in primary care — has a decades-old program placing students in remote parts of Washington, Wyoming, Alaska, Montana, and Idaho. UW recruits students from those areas, and many go back to practice there, with more than 20% of graduates settling in rural communities, according to Joshua Jauregui, assistant dean for clinical curriculum.

Likewise, the University of California-Davis (No. 22, with 36.3% of graduates in primary care) increased the percentage of students choosing family medicine from 12% in 2009 to 18% in 2023, even as it ranks high in specialty training. Programs such as an accelerated three-year primary care “pathway,” which enrolls primarily first-generation college students, help sustain interest in non-specialty medical fields.

The effort starts with recruitment, looking beyond test scores to the life experiences that forge the compassionate, humanistic doctors most needed in primary care, said Mark Henderson, associate dean for admissions and outreach. Most of the students have families who struggle to get primary care, he said. “So they care a lot about it, and it’s not just an intellectual, abstract sense.”

Establishing schools dedicated to primary care, like the one on Long Island, is not a solution in the eyes of some advocates, who consider primary care the backbone of medicine and not a separate discipline. Toyese Oyeyemi Jr., executive director of the Social Mission Alliance at the Fitzhugh Mullan Institute of Health Workforce Equity, worries that establishing such schools might let others “off the hook.”

Still, attending a medical school created to produce primary care doctors worked out well for Lo Cascio. Although she underwent the usual specialty rotations, her passion for pediatrics never flagged — owing to her 23 classmates, two mentors, and her first-year clerkship shadowing a community pediatrician. Now, she’s applying for pediatric residencies.

Lo Cascio also has deep personal reasons: Throughout her experience with a congenital heart condition, her pediatrician was a “guiding light.”

“No matter what else has happened in school, in life, in the world, and medically, your pediatrician is the person that you can come back to,” she said. “What a beautiful opportunity it would be to be that for someone else.”

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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Los incendios forestales que se propagan rápidamente y han transformado gran parte del condado de Los Ángeles en un infierno en llamas no solo están alterando las vidas de decenas de miles de residentes y dueños de negocios. También están poniendo a prueba a los hospitales, clínicas de salud, socorristas y hogares de adultos mayores de la región.

Al menos una clínica médica se ha incendiado por completo. Pacientes mayores han sido evacuados de hogares de vida asistida en ambulancias, mientras las brasas volaban alrededor de ellos y de sus proveedores. Consultorios médicos han cerrado y se han cancelado citas de rutina.

Algunos proveedores han perdido sus hogares o han tenido que ser evacuados, lo que en muchos casos les impide trabajar y dificulta que algunos centros de salud tengan el personal suficiente para atender.

Pero en medio del caos, médicos, enfermeros y otros cuidadores no dejaron de hacer su trabajo.

El martes 7 de enero por la noche, Ravi Salgia, oncólogo del City of Hope Duarte Cancer Center, vio cómo la casa situada más arriba de la suya, en Eaton Canyon, se incendiaba. Mientras caían escombros y chispas, él, su esposa y su hija mayor calcularon que solo tenían unos siete minutos para salir.

En plena noche, Salgia recibió una llamada informándole que el hospital se había convertido en un centro de comando de emergencias y que corría el riesgo de tener que evacuar, lo que significaba que debía ayudar a evaluar a los pacientes y preparar las altas.

Salgia llegó al hospital a las 2:30 am del miércoles. Lo acompañaron sus colegas, muchos de los cuales también habían sido evacuados de sus hogares.

“Todos sentimos con fuerza que necesitábamos cuidar a nuestros pacientes, sin importar lo que nos estuviera pasando física y emocionalmente, o lo que les estuviera pasando a nuestras casas. Necesitábamos asegurarnos de que las personas a las que servimos recibieran atención”, dijo Salgia en una entrevista.

Al cierre de este artículo, todavia no sabia si su casa seguía en pie.

En Pacific Palisades, se quemó por completo la St. John’s Physician Partners, una clínica de atención primaria y pediátrica afiliada a Providence Health & Services, según informó Patricia Aidem, vocera de la gran cadena de hospitales católicos con sede en Renton, Washington.

No lejos del extremo este del incendio de Palisades, Providence St. John’s Health Center en Santa Mónica, uno de los principales hospitales del grupo en el área de Los Ángeles, estuvo tan cerca de evacuar que llamó a otros hospitales de la zona para encontrar espacio para pacientes que iban a ser desplazados, dijo Aidem. El hospital USC Verdugo Hills, en Glendale, también enfrentó una posible evacuación, junto con otros centros de salud de la región.

“Todos los hospitales ubicados cerca de los incendios siguen en alerta máxima y están preparados para evacuar si las condiciones empeoran”, dijo la Hospital Association of Southern California en un comunicado.

“Los incendios están creando obstáculos operativos significativos”, agregó la entidad.

También informó que los servicios de emergencia se han visto afectados por un alto volumen de llamadas, mientras que los cierres de carreteras han dificultado el traslado de pacientes, suministros y trabajadores de salud.

Algunas instalaciones de salud se han quedado sin luz, a la vez que “muchos miembros del personal están directamente afectados por las evacuaciones y las interrupciones relacionadas con los incendios, lo que complica aún más las operaciones”.

El jueves, el Departamento de Atención Médica Administrada de California ordenó a los planes de salud que garantizaran el acceso de sus miembros afectados por los incendios a todos los servicios médicos necesarios, incluido el surtido de medicamentos recetados.

Aidem dijo que algunos médicos y otros trabajadores de salud de Providence St. John’s en Santa Mónica y Providence Holy Cross Medical Center en el Valle de San Fernando han perdido sus casas o han sido evacuados: por todo esto tener suficiente personal se ha vuelto un desafío.

Hospitales en todo el condado informaron que sus salas de emergencia habían atendido pacientes con quemaduras, problemas por inhalación de humo e irritación en los ojos.

Más de 700 personas —y posiblemente muchas más— han sido evacuadas de hogares de adultos mayores y de otras instalaciones de atención, según el Departamento de Salud Pública de California.

El miércoles, el West Valley Health Center, operado por el Departamento de Servicios de Salud del condado de Los Ángeles, cerró a causa de un corte de luz, dijo el departamento. Y UCLA Health informó que el cierre de algunas de sus clínicas en Pasadena y en el lado oeste de Los Ángeles se debió en parte a “cortes de servicios públicos”.

El Hospital Infantil de Los Ángeles informó que dos de sus clínicas de atención especializada, en Encino y Santa Mónica, estuvieron cerradas el jueves “a causa de los impactos de la tormenta de viento, los cortes de luz y los incendios”.

Providence también cerró varias clínicas esta semana.

Los dos incendios más grandes, el de Palisades en las áridas colinas costeras del oeste del condado de Los Ángeles y el de Eaton en el lado este, han quemado juntos más de 50 millas cuadradas, destruido miles de estructuras, reducido a cenizas importantes sitios culturales, matado al menos a 10 personas y herido gravemente a muchas más.

Los vientos descomunales que alimentaron la explosión de los incendios el martes y miércoles han comenzado a menguar, aunque se esperan ráfagas significativas que seguirán complicando la tarea de los bomberos.

Por todo esto, es probable que miles de personas no puedan recibir atención de rutina en los próximos días.

Kaiser Permanente, el gigante proveedor de atención médica, dijo que el jueves tuvo que cerrar múltiples sitios médicos por los incendios, incluidas una farmacia, un laboratorio y una clínica oftalmológica.

El Hospital Huntington en Pasadena, cerca del incendio de Eaton, informó que algunas de sus oficinas ambulatorias se vieron afectadas por avisos de evacuación y por el denso humo.

Dignity Health, otro gran sistema de salud, informó que algunos de sus hospitales estaban operando con generadores debido a los fuertes vientos, y algunos, como el Glendale Memorial Hospital, habían cancelado cirugías electivas.

Otros hospitales, como USC Verdugo Hills y Providence St. John’s, suspendieron temporalmente las cirugías no urgentes a causa del impacto de los incendios forestales.

La enfermera Christine Kirmsse evacuó su hogar en Santa Mónica el miércoles por la noche y está en un hotel a una hora de distancia. Pero dijo que siente la necesidad de ir a trabajar.

“Obviamente se necesita mucha ayuda”, dijo Kirmsse. “Y es importante para mí porque tengo la capacidad para poder ayudar. En momentos como este, es cuando la comunidad es más poderosa”.

Chaseedaw Giles y Tarena Lofton de KFF Health News colaboraron con este artículo.

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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The rapidly spreading wildfires that have transformed much of Los Angeles County into a raging hellscape are not only upending the lives of tens of thousands of residents and business owners, but also stressing the region’s hospitals, health clinics, first responders, and nursing homes.

At least one medical clinic burned down. Senior patients were evacuated by ambulance from nursing facilities as embers swirled around them and their providers. Medical offices have closed, and routine appointments have been canceled. Some providers have lost homes or had to evacuate their neighborhoods, keeping them from work in many cases and making it a challenge for some health care centers to maintain sufficient staffing.

Amid the maelstrom, doctors, nurses, and other caregivers did their jobs.

On Tuesday night, Ravi Salgia, an oncologist at City of Hope Duarte Cancer Center, saw the house above his Eaton Canyon home go up in flames. As debris and sparks fell, he, his wife, and their older daughter estimated they had no more than seven minutes to get out. In the middle of the night, Salgia got a call that the hospital had become an emergency command center and was at risk of evacuation, meaning he needed to help evaluate patients and make discharge preparations.

Salgia arrived at the hospital at 2:30 a.m. Wednesday. He was joined by colleagues, many of whom had also evacuated their homes.

“We all felt very strongly that we needed to take care of our patients — no matter what’s happening to us physically and emotionally, what’s happening to our houses — that we need to make sure that the people we serve were taken care of,” Salgia said in an interview.

He doesn’t know if his house is still standing.

In Pacific Palisades, St. John’s Physician Partners, a primary care and pediatric clinic affiliated with Providence Health & Services, burned down, said Patricia Aidem, a spokesperson for the large Catholic hospital chain based in Renton, Washington.

Not far from the eastern edge of the Palisades Fire, Providence St. John’s Health Center in Santa Monica, one of the group’s major LA-area hospitals, was so close to evacuating that it called other hospitals in the area to find space for patients who would be displaced, Aidem said. USC Verdugo Hills Hospital, in Glendale, also faced potential evacuation, along with other hospitals in the region.

“All hospitals in close proximity to the fires remain on high alert and are prepared to evacuate if conditions worsen,” the Hospital Association of Southern California said in a statement. “The fires are creating significant operational hurdles,” the association added.

The association also said emergency services have been strained by high call volumes, while road closures have impeded the transport of patients, supplies, and health care workers. Some health facilities have been hit by power outages, the association said, while “many staff members are directly impacted by evacuations and fire-related disruptions, further complicating operations.”

The California Department of Managed Health Care on Thursday ordered health plans to ensure enrollees affected by wildfires have access to all needed medical services, including prescription drug refills.

Aidem said some doctors and other health workers at Providence St. John’s in Santa Monica and Providence Holy Cross Medical Center in the San Fernando Valley have lost homes or been evacuated, making them miss work and creating challenges to ensure adequate staffing.

Hospitals across the county said their emergency rooms had treated patients for burns, smoke inhalation, and eye irritation.

Over 700 people — and possibly far more — have been evacuated from nursing homes and other care facilities, according to the California Department of Public Health.

On Wednesday, West Valley Health Center, operated by Los Angeles County’s Department of Health Services, closed due to a power outage, the department said. And UCLA Health said the closure of some of its clinics in Pasadena and on L.A.’s Westside was due partly to “utility shutoffs.”

Children’s Hospital Los Angeles said two of its specialty care clinics, in Encino and Santa Monica, were closed Thursday “due to the impacts from the wind storm, power outages and wild fires.”

Providence also has shut several clinics this week.

The two biggest blazes, the Palisades Fire in the parched coastal hills of western L.A. County and the Eaton Fire on the Eastside, have together torched more than 50 square miles, burned thousands of structures, reduced beloved cultural landmarks to ashes, killed at least 10 people, and severely injured many more.

The monster winds that fueled the explosion of the fires on Tuesday and Wednesday have begun to quiet down, though significant gusts are still expected to complicate the task of firefighters for the next several days.

Routine medical care will likely be disrupted for thousands in the days ahead.

Kaiser Permanente, the giant HMO and medical provider, said it closed multiple medical sites Thursday due to the fires, including a pharmacy and laboratory and an eye clinic.

Huntington Hospital in Pasadena, close to the Eaton Fire, said some of its outpatient offices were affected by evacuation notices and heavy smoke.

Dignity Health, another large health system, said some of its hospitals were operating on generator power due to high winds, and some, including Glendale Memorial Hospital, had canceled elective surgeries. Other hospitals, including USC Verdugo Hills and Providence St. John’s, temporarily halted nonemergency surgeries due to the impact of the wildfires.

Christine Kirmsse, a registered nurse, evacuated her Santa Monica home on Wednesday night and is staying at a hotel an hour away. But she said she feels strongly that she needs to come into work.

“There’s obviously so much help that’s needed,” Kirmsse said. “And it’s important to me because I have the skills to be able to help. In times like this, this is when community is the most powerful.”

KFF Health News’ Chaseedaw Giles and Tarena Lofton contributed to this report.

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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This story can be republished for free (details).