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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But he said he welcomes the new CMS regulations.

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

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

Last Friday, the Trump administration reversed that policy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Trump proposal also touches on social issues.

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

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

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

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

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

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

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

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

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

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

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

La propuesta de Trump también impacta en cuestiones sociales.

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

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

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

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

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

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

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

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

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

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

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

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

USE OUR CONTENT

This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The ABCs of mRNA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Networks of Opposition

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

USE OUR CONTENT

This story can be republished for free (details).

The U.S. public health system has long been under strain, stymied by declines in funding as well as employees. And so state and local public health departments around the nation — tasked with monitoring and responding to disease outbreaks that threaten to sicken the masses — have relied on workers from the Centers for Disease Control and Prevention to help.

In February, the Trump administration abruptly fired many of them, a move that local and state officials said would undermine the nation’s continual effort to control the spread of infectious disease.

A few examples: Terminated CDC employees had helped prevent and respond to outbreaks such as dengue fever and the flu. They worked with local officials to quickly test for viruses — including Oropouche, an illness that doesn’t have a vaccine or effective treatment — and ensure that testing in public health labs complies with federal regulations. Others monitored potential cases of tuberculosis or provided health education to adolescents to prevent sexually transmitted infections.

The Trump administration’s Department of Government Efficiency, spearheaded by billionaire Elon Musk, is trying to slash the workforce across the Department of Health and Human Services and other federal agencies. The swift staff reductions targeted probationary employees, many hired within the past two years, who lack civil service protections against firings.

My colleague Noam N. Levey reported this week on layoffs at a division of the Centers for Medicare & Medicaid Services — the Center for Consumer Information and Insurance Oversight — that could hinder enforcement of a law to prevent surprise medical bills that Trump himself signed in his first term.

One of the CDC trainees let go was Gaël Cruanes, who had been working at New York City’s Department of Health and Mental Hygiene to detect cases of tuberculosis. Cruanes, who called the firings “unconscionable,” contacted newly arrived immigrants and refugees potentially at risk of spreading TB in hopes of getting them into the city’s clinics for screening. “It’s purely for the safety of the public at the end of the day,” Cruanes said.

The firings were communicated in mid-February in notices with identical language alleging workers had displayed poor performance and that their skills weren’t a match for the department’s current needs. Several people interviewed by KFF Health News disputed that characterization.

After our reporting was published, fired CDC workers in the training programs were notified March 4 that their terminations were rescinded and that they should start work again March 5, according to emails viewed by KFF Health News. “We apologize for any disruption that this may have caused,” said the emails, which were unsigned and sent from an internal CDC email address. The CDC didn’t respond to requests for comment.

The reversal came less than a week after a federal judge ruled the Trump administration’s widespread firings of probationary employees were likely illegal. But there’s still uncertainty. Although some workers were rehired, federal agencies are still drawing up plans for large-scale layoffs, a move that could encompass a much broader swath of workers.

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

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

USE OUR CONTENT

This story can be republished for free (details).

Panelists at a covid conference last fall were asked to voice their regrets — policies they had supported during the pandemic but had come to see as misguided. Covid contact tracing, one said. Closing schools, another said. Vaccine mandates, a third said.

When Marty Makary’s turn came, the Johns Hopkins University surgeon said, “I can’t think of anything,” adding, “The entire covid policy of three to four years felt like a horror movie I was forced to watch.”

It was a characteristic response for Makary, President Donald Trump’s nominee to lead the Food and Drug Administration, who looks set to be confirmed after a Senate committee hearing on Thursday. A decorated doctor and a brash critic of many of his medical colleagues, Makary drew Trump’s attention during the pandemic with frequent appearances on Fox News shows such as “Tucker Carlson Tonight,” in which he excoriated public health officials over their handling of covid.

Many former FDA officials and scientists with knowledge of the agency are optimistic about Makary — to a degree.

“He’s a world-class surgeon, and he has health policy expertise,” said Jennifer Nuzzo, a Brown University professor of epidemiology and former colleague of Makary’s at Johns Hopkins. “If you have pancreatic cancer, he’s the person you want to operate on you. The university is probably losing a lot of money to not have him doing that work.”

His critics say he at times exaggerated the harms of the covid vaccine and undersold the dangers of the virus, contributing to a pandemic narrative that led many Americans to shun the shots and other practices intended to curb transmission and reduce hospitalizations and deaths.

Should he take the reins at the FDA, transitioning from gadfly to the head of an agency that regulates a fifth of the U.S. economy, Makary would have to engage in the thorny challenges of governing.

“Makary spent the pandemic raving against the medical establishment as if he were an outsider, which he wasn’t,” said Jonathan Howard, a New York City neurologist and the author of “We Want Them Infected,” a book that criticizes Makary and other academics who opposed government policies. “Now he really is the establishment. Everything that happens is going to be his responsibility.”

At his confirmation hearing, Makary sounded a lower-key tone, extolling the FDA’s professional staff and promising to apply good science and common sense in the service of attacking chronic disease in the U.S., including by studying food additives and chemicals that could be contributing to poor health.

“We need more humility in the medical establishment. You have to be willing to evolve your position as new data comes in,” he testified. What makes a great doctor “is not how much you know; it’s your humility and your willingness to learn, as you go, from patients.”

Colleagues have applauded Makary’s skill and intelligence as a surgeon and medical policy thinker. He contributed to a 2009 surgery checklist believed to have prevented thousands of mistakes and infections in operating rooms. He wrote a widely cited 2016 paper claiming that medical errors were the third-leading cause of death in the United States, although some researchers said the assertion was overblown. He’s also founded or been a director for companies and said in the hearing that a surgical technique he invented eventually could help cure diabetes.

Humility, however, has not been Makary’s most obvious trait.

During the pandemic, he took to op-eds and conservative media with controversial positions on public health policy. Some proved astute, while others look less prescient in hindsight.

In December 2020, Makary defied established scientific knowledge and said that vaccination of 20% of the population would be enough to create “herd immunity.” In a February 2021 Wall Street Journal piece, he predicted that covid would virtually disappear by April because so many people would have become immune through infection or vaccination. The U.S. death toll from covid stood at 560,000 that April, with an additional 650,000 deaths to come. In June 2021, he said he had been unable to find evidence of a single covid death of a previously healthy child. By then there were many reports of such deaths, although children were much less likely than older people to suffer severe disease.

In February 2023, Makary testified in Congress that the lab-leak theory of covid’s origin was a “no brainer,” a surprisingly unequivocal statement for a scientist discussing a scientifically unresolved issue.

Some public health officials felt Makary gratuitously attacked authorities working in difficult circumstances.

“He went from being a pretty reasonable person to saying a lot of things that were over the top and unnecessary,” said Ashish Jha, dean of the Brown University School of Public Health, who was the White House covid-19 response coordinator under President Joe Biden.

And while almost everyone involved in fighting covid has admitted to getting things wrong during the pandemic, Jha said, “I never had any sense from Marty that he did.”

Makary did not respond to requests for comment.

Makary accused Biden administration officials of ignoring emerging evidence that previous infection with covid could be as or more effective against future infection than vaccination. While he was probably right, Nuzzo said, his statements seemed to encourage people to get infected.

“It’s reasonable to say that vaccine mandates weren’t the right approach,” she said. “But you can also understand that people were trying to blindly stumble our way out of the situation, and some people thought vaccine mandates would be expedient.”

At Johns Hopkins, for example, Nuzzo opposed a booster mandate for the campus in 2022 but understood the final decision to require it. School authorities were intent on bringing students back to campus and worried that outbreaks would force them to shut down again, she said.

“You can argue that seat belt laws are bad because they impinge on civil rights,” Howard said. “But a better thing to do would be to urge people to wear seat belts.”

Makary’s statements had “no grace,” he said. “These were people dealing with an overwhelming virus, and he constantly accused them of lying.”

Several public health officials were particularly upset by the way Makary cast aspersions on the Centers for Disease Control and Prevention’s vaccine safety program. In a Jan. 16, 2023, appearance on Tucker Carlson’s Fox News show, Makary said the CDC had “tried to quickly downplay” evidence of an increased risk of stroke in Medicare beneficiaries who got a covid booster. In fact, the CDC had detected a potential signal for additional strokes in one database, and in the interest of transparency it released that information, Nuzzo said. Further investigation found that there was no actual risk.

During Thursday’s hearing, Makary’s pandemic views were mostly left unexplored, but Democratic and Republican senators repeatedly probed for his views on the abortion drug mifepristone, which became easier to use without direct medical supervision because of a 2021 FDA ruling. Many Republicans want to reverse the FDA ruling; Democrats say there are reams of evidence that support the drug’s safety when taken by a woman at home.

Makary tried to satisfy both parties. He told Sen. Maggie Hassan (D-N.H.) he would be led by science and had no preconceived ideas about mifepristone’s safety. Questioned by Republican Bill Cassidy, chair of the Health, Education, Labor and Pensions Committee and an abortion foe, he said he would examine ongoing data on the drug from the FDA’s risk evaluation system, which gathers reports from the field.

The abortion pill question exemplifies the kind of dilemmas Makary will face at the FDA, Jha said.

“He’s going to have to decide whether he listens to the scientists in his administration, or his boss, who often disagrees with science,” he said. “He’s a smart, thoughtful guy and my hope is he’ll find his way through.”

“The two most important organs for the FDA commissioner are the brain and the spine,” said former FDA deputy commissioner Joshua Sharfstein. “The spine because there’s attempted influence coming from many directions, not just political but also commercial and from multiple advocacy communities. It’s very important to stand up for the agency’s success.”

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

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

USE OUR CONTENT

This story can be republished for free (details).

The Trump administration’s sudden firing of Centers for Disease Control and Prevention employees gutted training programs across the nation whose participants bolstered the workforce of state and local public health departments that for decades have been starved of resources.

The programs are designed to cultivate a new generation of public health leaders, many of whom have gone on to work at the CDC. That was far from its only purpose. Local and state officials said the departures threaten to undermine the nation’s constant effort to identify and control infectious disease outbreaks.

The terminated CDC employees helped prevent and respond to outbreaks such as dengue fever and the flu. They worked with local officials to quickly test for viruses and ensure that testing in public health labs complies with federal regulations. Others monitored potential cases of tuberculosis or provided health education to adolescents to prevent sexually transmitted infections, according to interviews with fired workers and local public health officials.

As a CDC public health adviser, Gaël Cruanes had been working at New York City’s Department of Health and Mental Hygiene to detect cases of tuberculosis, a serious illness that spreads through the air and usually attacks the lungs.

The Public Health Associate Program deploys recent college graduates and other early-career workers for two years. After starting his job in October, Cruanes said, he contacted newly arrived immigrants and refugees potentially at risk of spreading TB in hopes of getting them into the city’s clinics for screening.

“It’s purely for the safety of the public at the end of the day,” Cruanes said. He and other trainees were fired in mid-February.

“It’s unconscionable,” he said.

A spokesperson for the Department of Health and Human Services, Andrew Nixon, declined to comment. The White House and CDC didn’t respond to requests for comment.

The Trump administration’s swift staff reductions in February targeted probationary employees, many hired in the past two years, who lack civil service protections against firings. The administration on Feb. 26 ordered federal agencies to submit plans by mid-March for large-scale layoffs, a move that could encompass a much broader swath of workers.

After CNN published this article, at least some fired CDC workers in the training programs were notified on March 4 that their terminations had been rescinded.

Affected employees were cleared to work on March 5, according to emails viewed by KFF Health News. “You should return to duty under your previous work schedule. We apologize for any disruption that this may have caused,” said the emails, which were unsigned and sent from an internal CDC email address.

The reversal came less than a week after a federal judge ruled that the Trump administration’s widespread terminations of probationary employees were likely illegal.

Seven CDC employees — including from the associate program — assigned to the New York City health department were originally terminated, Michelle Morse, the agency’s acting commissioner, testified during a City Council hearing Feb. 19.

In an interview, Morse said the health department was exploring how to retain them.

“We’re looking into what the CDC could do,” she said, “but we are really just trying to use our own levers that we have within the health department to see what’s possible for those staff.”

Since its creation in 2007, the Public Health Associate Program has placed 1,800 people in nearly every state and territory, plus the District of Columbia, according to the CDC.

The sudden firings meant “there was no lead time to try to figure out what we’re going to do,” said Anissa Davis, the city health officer at the Long Beach Department of Health and Human Services in California.

Three participants of the associate program worked at the Long Beach department, Davis said. A CDC public health adviser was one of four employees working on sexually transmitted infections and HIV surveillance. Two others were with the 13-person communicable disease control team, which includes staff who respond to outbreaks in nursing homes, hospitals, restaurants, and schools, Davis said.

“They are invaluable,” Davis said. “Public health is always under-resourced so having these people really helps us.”

The U.S. public health system was already under severe strain at the onset of the covid-19 pandemic — tens of thousands of jobs disappeared after the 2007-09 recession hit, and spending also dropped significantly for state and local health departments, according to a KFF Health News investigation. The backlash against pandemic-era restrictions drove many more officials to resign or retire. Others were fired. Still, officials said the pandemic also inspired some to pursue public health careers.

Scientists in the CDC’s Laboratory Leadership Service program were also fired in February. The CDC in 2015 started the two-year training fellowship to improve lab safety and quality following a series of failures, including in 2014 when CDC staff in Atlanta were potentially exposed to anthrax. The program each year recruits a small number of doctorate-level scientists; several work in state or local health departments.

At least 16 of 24 fellows in the program were fired in mid-February, according to two scientists who were terminated and spoke on the condition of anonymity for fear of professional retaliation. “Now we can’t be a resource for these labs anymore,” one of them said.

Public health labs need the CDC scientists “because they’re underfunded, understaffed,” the other said. “They are at their capacity already.”

Lab fellows’ responsibilities included helping with outbreak investigations and responses, including by training local staff on how to safely run tests or analyzing samples to identify the cause of an illness. Fellows were recently involved in setting up a new test in Florida to detect Oropouche, a relatively unknown insect-borne disease that has no vaccine or effective treatment. The World Health Organization in December said more than 11,600 cases had been reported in 2024 in South America, the Caribbean, the U.S., Europe, Canada, and Panama. The Florida Department of Health didn’t respond to a request for comment.

Fellows also helped develop the capacity to test for dengue fever in American Samoa, one of them said.

“When new stuff happens that’s urgent, it’s almost all the time we get pivoted to it,” the person said.

Participants in different training programs received the same form letter notifying them of their terminations, according to documents viewed by KFF Health News.

The letters said that terminated people had shown poor performance: “Unfortunately, the Agency finds that you are not fit for continued employment because your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate to justify further employment at the Agency.”

However, the fellows’ supervisors had written memos and emails saying they were in good standing, according to documents viewed by KFF Health News. Cruanes said he had not had a performance evaluation when he was terminated — his first was supposed to be Feb. 18, three days after he received his notice. He was among the CDC staff reinstated on March 4.

In Minneapolis, a CDC public health adviser had been providing sexual and reproductive health education in two high schools, as well as doing citywide work on STI testing, said Barbara Kyle, the city’s school-based clinic manager. The department was trying to shift those responsibilities to remaining personnel. “We’re right now just scrambling,” she said.

The city has relied on trainees through the CDC program for more than a decade, Kyle said.

“These two years of learning public health, on-the-ground experience, has really been such a positive move for our country,” she said. “So that concerns me if we lose that pipeline.”

Healthbeat reporter Eliza Fawcett contributed to this report from New York City.

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

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

USE OUR CONTENT

This story can be republished for free (details).

The Justice Department’s years-long court battle to force UnitedHealth Group to return billions of dollars in alleged Medicare Advantage overpayments hit a major setback Monday when a special master ruled the government had failed to prove its case.

In finding for UnitedHealth, Special Master Suzanne Segal found that the DOJ had not presented evidence to support its claim that the giant health insurer exaggerated how sick patients were to illegally pocket more than $2 billion in overpayments.

“A mere possibility of an overpayment is not enough for the government to carry its burden,” Segal wrote in an initial ruling. She recommended that UnitedHealth’s motion to dismiss the case be granted. The recommendation, which is to be presented to the federal judge handling the case, can be appealed within two weeks.

The civil fraud case against UnitedHealth Group, the nation’s largest Medicare Advantage insurer, was filed in 2011 by whistleblower Benjamin Poehling, a former company employee. The DOJ took over the case in 2017. Medicare Advantage is the privately run alternative to the traditional Medicare program for seniors.

“After more than a decade of DOJ’s wasteful and expensive challenge to our Medicare Advantage business, the Special Master concluded there was no evidence to support the DOJ’s claims we were overpaid or that we did anything wrong,” UnitedHealth spokesperson Heather Soule said in a statement.

Wyn Hornbuckle, a spokesperson for the Justice Department, said the agency wouldn’t comment on the ruling, which was filed in federal court in Los Angeles. Attorneys for whistleblower Poehling had no comment.

Medicare pays Advantage health plans higher rates to cover sicker patients but requires that their conditions be properly documented in medical records.

The DOJ alleges Medicare paid UnitedHealth Group more than $7.2 billion from 2009 through 2016 based on the company’s efforts to boost revenue by reviewing patient records to find additional diagnoses and adding medical billing codes to their files. According to the DOJ, Medicare would have paid the company $2.1 billion less if it had deleted unsupported billing codes.

The Justice Department also alleged that in these chart reviews, the health insurance giant ignored overcharges that might have reduced bills.

But the special master, who was appointed by U.S. District Judge Fernando Olguin, concluded the government’s case “depends entirely on speculation and assumptions about what the codes found by the United coders actually mean.”

“If this stands, I think it is a major defeat for the government,” said William Hanagami, an attorney who represented a different whistleblower in one of the earliest cases alleging billing fraud by a Medicare Advantage insurance company. Hanagami said he expects the government to appeal the decision.

Segal noted that UnitedHealth executives told Centers for Medicare & Medicaid Services officials about its chart review policies at an April 2014 meeting. At the time, CMS was considering a regulation to restrict use of chart reviews, but the agency backed off the regulation under pressure from the insurance industry. At the time, a CMS official described the industry’s response as an “uproar.”

The special master noted that United had requested the meeting with CMS officials, which she called “the opposite of concealment.”

“The problem with the government’s allegations is that the government knew of the very chart review practices which it now claims United prevented it from learning, and thus the government cannot have been duped into relying on any action or inaction by United in determining whether it had been the victim of overpayments,” Segal wrote.

Segal noted CMS audits of UnitedHealth’s Medicare Advantage plans had found that about 89% of billing codes were supported by patient medical records. The audit findings “undercut” the government’s claim that the company engaged in widespread overbilling.

“This litigation has been pending for more than a decade,” she wrote, “and the government has had ample opportunity to develop evidence in support of its theories. It has not.”

The decision comes as UnitedHealth faces renewed investigations into its handling of Medicare Advantage coding, including a new Justice Department review.

Medicare Advantage insurance plans have grown explosively in recent years and now enroll about 33 million members, more than half of people eligible for Medicare.

The industry has been the target of dozens of whistleblower lawsuits and government audits alleging that the plans cost taxpayers too much money, including a demand last month by Senate Judiciary Committee chair Chuck Grassley (R-Iowa) that UnitedHealth explain its billing practices.

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

USE OUR CONTENT

This story can be republished for free (details).

As President Donald Trump wrapped up his first term in 2020, he signed legislation to protect Americans from surprise medical bills. “This must end,” Trump said. “We’re going to hold insurance companies and hospitals totally accountable.”

But the president’s wide-ranging push to slash government spending, led by billionaire Elon Musk, is weakening the federal office charged with implementing the No Surprises Act.

Some 15% of those working at the federal Center for Consumer Information and Insurance Oversight, or CCIIO, were fired two weeks ago, according to the agency’s former deputy director in charge of operations, Jeff Grant.

And while the full impact of the cutbacks is still coming into focus, the retrenchment is threatening work at an agency already laboring to run an overstretched system for resolving sometimes very large bills from out-of-network medical providers.

“It’s a hot mess,” Grant said of the job cuts in an interview with KFF Health News. “The chaos has put everyone in a tailspin.”

The cuts, which affected 82 of the federal office’s employees, also risk delaying critical new rules designed to speed the process of adjudicating disputes over surprise bills between health plans and medical providers.

Grant, who was the top career official at CCIIO, retired last week after 41 years in government. He blasted the layoffs as a “grievous error” in a strongly worded letter to the acting human resources director, criticizing him for cutting jobs without regard for the qualifications of employees or the needs of the agency.

Health insurers have also raised concerns about maintaining the agency’s work on surprise bills.

Spokespeople for the Department of Health and Human Services, led by Robert F. Kennedy Jr., did not respond to questions about the job cuts.

The CCIIO, a small part of the federal health agency, was created by the 2010 Affordable Care Act and charged with ensuring that health insurance plans meet standards established by the law to protect patients.

After Congress passed the No Surprises Act in 2020, the office assumed additional responsibility for setting up and administering the complex process for protecting patients from surprise bills.

The work drew support from Democrats and Republicans, who’d been inundated with stories of patients hit by huge bills from emergency physicians, anesthesiologists, and other providers who were not in patients’ insurance networks, even when patients received care at in-network hospitals.

“We will end surprise medical billing,” Trump promised on the campaign trail in 2020. “The days of ripping off patients are over.”

The law barred medical providers in most cases from pursuing patients over surprise bills. This prohibition is not directly affected by the recent job cuts ordered by Musk’s Department of Government Efficiency, created by Trump through an executive order.

But the CCIIO had been working to streamline a system established by the No Surprises Act to resolve disagreements between health plans and medical providers over out-of-network bills. This key protection was put in place so patients would not be caught in the middle of billing disputes.

The system, known as independent dispute resolution, or IDR, has been inundated with hundreds of thousands of cases. In 2023, more than 650,000 new disputes were filed, according to a recent analysis published in the journal Health Affairs.

“The No Surprises Act has protected millions of Americans from receiving surprise medical bills,” said Jennifer Jones, who directs legislative policy at the Blue Cross Blue Shield Association, an insurance trade group. “But issues with the independent dispute resolution process,” she added, “are driving up costs for patients and employers.”

Also overwhelmed has been a consumer reporting system designed to allow patients to lodge complaints if they feel they have been unfairly targeted with a surprise bill.

Under former President Joe Biden, the CCIIO had been working on new rules to make dispute resolution more efficient, which experts said would make a difference.

“If this rule becomes final and works as well as intended, it should help more out-of-network claims get resolved,” said Jack Hoadley, an emeritus research professor at Georgetown University, who has studied surprise medical billing.

But the new rules weren’t finished before Biden left office. And the senior official overseeing this work left his job in January. The recent cuts hit the remaining CCIIO staffers working on the No Surprises Act, according to Grant and other sources familiar with the layoffs, who asked not to be identified out of fear of professional retaliation.

Grant said senior CCIIO officials were since able to shift some employees around and got permission to recall some of the 82 people let go. But he said there is no guarantee that all of them will want to come back to the diminished agency.

Even more concerning, Grant said, are deeper cuts that the White House has told federal agencies to prepare for by March 13.

“These cuts were pretty bad,” Grant said. “What happens next will be even more important.”

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

USE OUR CONTENT

This story can be republished for free (details).

Chikao Tsubaki had been having a terrible time.

In his mid-80s, he had a stroke. Then lymphoma. Then prostate cancer. He was fatigued, isolated, not all that steady on his feet.

Then Tsubaki took part in an innovative care initiative that, over four months, sent an occupational therapist, a nurse, and a handy worker to his home to help figure out what he needed to stay safe. In addition to grab bars and rails, the handy worker built a bookshelf so neither Tsubaki nor the books he cherished would topple over when he reached for them.

Reading “is kind of the back door for my cognitive health — my brain exercise,” said Tsubaki, a longtime community college teacher. Now 87, he lives independently and walks a mile and a half almost every day.

The program that helped Tsubaki remain independent, called Community Aging in Place: Advancing Better Living for Elders, or CAPABLE, has been around for 15 years and is offered in about 65 places across 26 states. It helps people 60 and up, and some younger people with disabilities or limitations, who want to remain at home but have trouble with activities like bathing, dressing, or moving around safely. Several published studies have found the program saves money and prevents falls, which the Centers for Disease Control and Prevention says contribute to the deaths of 41,000 older Americans and cost Medicare about $50 billion each year.

Despite evidence and accolades, CAPABLE remains small, serving roughly 4,600 people to date. Insurance seldom covers it (although the typical cost of $3,500 to $4,000 per client is less than many health care interventions). Traditional Medicare and most Medicare Advantage private insurance plans don’t cover it. Only four states use funds from Medicaid,the federal-state program for low-income and disabled people. CAPABLE gets by on a patchwork of grants from places like state agencies for aging and philanthropies.

The payment obstacles are an object lesson in how insurers, including Medicare, are built around paying for doctors and hospitals treating people who are injured or sick — not around community services that keep people healthy. Medicare has billing codes for treating a broken hip, but not for avoiding one, let alone for something like having a handy person “tack down loose carpet near stairs.”

And while keeping someone alive longer may be a desirable outcome, it’s not necessarily counted as savings under federal budget rules. A 2017 Centers for Medicare & Medicaid Services evaluation found that CAPABLE had high satisfaction rates and some savings. But its limited size made it hard to assess the long-term economic impact.

It’s unclear how the Trump administration will approach senior care.

The barriers to broader state or federal financing are frustrating, said Sarah Szanton, who helped create CAPABLE while working as a nurse practitioner doing home visits in west Baltimore. Some patients struggled to reach the door to open it for her. One tossed keys to her out of a second-story window, she recalled.

Seeking a solution, Szanton discovered a program called ABLE, which brought an occupational therapist and a handy worker to the home. Inspired by its success, Szanton developed CAPABLE, which added a nurse to check on medications, pain, and mental well-being, and do things like help participants communicate with doctors. It began in 2008. Szanton since 2021 has been the dean of Johns Hopkins University School of Nursing, which coordinates research on CAPABLE. The model is participatory, with the client and care team “problem-solving and brainstorming together,” said Amanda Goodenow, an occupational therapist who worked in hospitals and traditional home health before joining CAPABLE in Denver, where she also works for the CAPABLE National Center, the nonprofit that runs the program.

CAPABLE doesn’t profess to fix all the gaps in U.S. long-term care, and it doesn’t work with all older people. Those with dementia, for example, don’t qualify. But studies show it does help participants live more safely at home with greater mobility. And one study that Szanton co-authored estimated Medicare savings of around $20,000 per person would continue for two years after a CAPABLE intervention.

“To us, it’s so obvious the impact that can be made just in a short amount of time and with a small budget,” said Amy Eschbach, a nurse who has worked with CAPABLE clients in the St. Louis area, where a Medicare Advantage plan covers CAPABLE. That St. Louis program caps spending on home modifications at $1,300 a person.

Both Hill staff and CMS experts who have looked at CAPABLE do see potential routes to broader coverage. One senior Democratic House aide, who asked not to be identified because they were not allowed to speak publicly, said Medicare would have to establish careful parameters. For instance, CMS would have to decide which beneficiaries would be eligible. Everyone in Medicare? Or only those with low incomes? Could Medicare somehow ensure that only necessary home modifications are made — and that unscrupulous contractors don’t try to extract the equivalent of a “copay” or “deductible” from clients?

Szanton said there are safeguards and more could be built in. For instance, it’s the therapists like Goodenow, not the handy workers, who put in the work orders to stay on budget.

For Tsubaki, whose books are not only shelved but organized by topic, the benefits have endured.

“I became more independent. I’m able to handle most of my activities. I go shopping, to the library, and so forth,” he said. His pace is slow, he acknowledged. But he gets there.

Kenen is the journalist-in-residence and a faculty member at Johns Hopkins University School of Public Health. She is not affiliated with the CAPABLE program.

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

USE OUR CONTENT

This story can be republished for free (details).

A growing number of states have made it easier for doctors who trained in other countries to get medical licenses, a shift supporters say could ease physician shortages in rural areas.

The changes involve residency programs — the supervised, hands-on training experience that doctors must complete after graduating medical school. Until recently, every state required physicians who completed a residency or similar training abroad to repeat the process in the U.S. before obtaining a full medical license.

Since 2023, at least nine states have dropped this requirement for some doctors with international training, according to the Federation of State Medical Boards. More than a dozen other states are considering similar legislation.

About 26% of doctors who practice in the U.S. were born elsewhere, according to the Migration Policy Institute. They need federal visas to live in the U.S., plus state licenses to practice medicine.

Proponents of the new laws say qualified doctors shouldn’t have to spend years completing a second residency training. Opponents worry about patient safety and doubt the licensing change will ease the doctor shortage.

Lawmakers in Republican- and Democratic-leaning states have approved the idea at a time when many other immigration-related programs are under attack. They include Florida, Iowa, Idaho, Illinois, Louisiana, Massachusetts, Tennessee, Virginia, and Wisconsin.

President Donald Trump has defended a federal visa program that many foreign doctors rely on, but they could still be hampered by his broad efforts to tighten immigration rules.

Supporters of the new licensing laws include Zalmai Afzali, an internal medicine doctor who finished medical school and a residency program in Afghanistan before fleeing the Taliban and coming to the U.S. in 2001.

He said most physicians trained elsewhere would be happy to work in rural or other underserved areas.

“I would go anywhere as long as they let me work,” said Afzali, who now treats patients who live in rural areas and small cities in northeastern Virginia. “I missed being a physician. I missed what I did.”

It took Afzali 12 years to obtain copies of his diploma and transcript, study for exams, and finish a three-year U.S.-based residency program before he could be fully licensed to practice as a doctor in his new country.

But a commission of national health organizations questions whether loosening residency requirements for foreign-trained doctors would ease the shortage. Doctors in these programs could still face licensing and employment barriers, it wrote in a report that makes recommendations without taking a stance on such legislation.

Erin Fraher, a health policy professor at the University of North Carolina who advises the commission and studies the issue, said lawmakers who support the changes predict they will boost the rural health workforce. But it’s unclear whether that will happen, she said, because the programs are just getting started.

“I think the potential is there, but we need to see how this pans out,” Fraher said.

Afzali struggled to support his family while trying to get his medical license. His jobs included working at a department store for $7.25 an hour and administering chemotherapy for $20 an hour. Afzali said nurse practitioners at the latter job had less training than him but earned nearly four times as much.

“I do not know how I did it,” he said. “I mean, you get really depressed.”

Many of the state bills to ease residency requirements have been based on model legislation from the Cicero Institute, a conservative think tank that sent representatives to testify to legislatures after proposing such programs in 2020.

The new pathways are open only to internationally trained physicians who meet certain conditions. Common requirements include working as a physician for several years after graduating from a medical school and residency program with similar rigor to those found in the U.S. They also must pass the standard three-part exam that all physicians take to become licensed in the U.S.

Those who qualify are granted a restricted license to practice, and most states require them to do so under supervision of another physician. They can receive full licensure after several years.

About 10 of the laws or bills also require the doctors to work for several years in a rural or underserved area.

But states without this requirement, such as Tennessee, may not see an impact in rural areas, researchers from Harvard Medical School and Rand Corp. argued in the New England Journal of Medicine. In addition to including that condition, states could offer incentives to rural hospitals that agree to hire doctors from the new training pathways, they wrote.

Lawmakers, physicians, and health organizations that oppose the changes say there are better ways to safely increase the number of rural doctors.

Barbara Parker is a registered nurse and former Republican lawmaker in Arizona, where the legislature is considering a bill for at least the fourth year in a row.

“It’s a really poor answer to the doctor shortage,” said Parker, who voted against the legislation last year.

Parker said making it easier for foreign-trained physicians to practice in the U.S. would unethically poach doctors from countries with greater health care needs. And she said she doubts that all international residencies are on par with those in the U.S. and worries that granting licenses to physicians who trained in them could lead to poor care for patients.

She is also concerned that hospitals are trying to save money by recruiting internationally trained doctors over those trained in the U.S. The former often will accept lower pay, Parker said.

“This is driven by corporate greed,” she said.

Parker said better ways to increase the number of rural doctors include raising pay, expanding loan repayment programs for those who practice in rural areas, and creating accelerated training for nurse practitioners and physician assistants who want to become doctors.

The advisory commission — recently formed by the Federation of State Medical Boards, the Accreditation Council for Graduate Medical Education, and Intealth, a nonprofit that evaluates international medical schools and their graduates — published its recommendations to help lawmakers and medical boards make sure these new pathways are safe and effective.

The commission and Fraher said state medical boards should collect data on the new rules, such as how many doctors participate, what their specialties are, and where they work once they gain their full licenses. The results could be compared with other methods of easing the rural doctor shortage, such as adding residency programs at rural hospitals.

“What is the benefit of this particular pathway relative to other levers that they have?” Fraher said.

The commission noted that while state medical boards can rely on an outside organization that evaluates the strength of foreign medical schools, there isn’t a similar rating for residency programs. Such an effort is expected to launch in mid-2025, the commission said.

The group also said states should require supervising physicians to evaluate participants before they’re granted a full license.

Afzali, the physician from Afghanistan, said some internationally trained primary care doctors have more training than their U.S. counterparts, because they had to practice procedures that are done only by specialists in the U.S.

But he agreed with the commission’s recommendation that states require doctors who did residencies abroad to have supervision while they hold a provisional license. That would help ensure patient safety while also helping the physicians adjust to cultural differences and learn the technical side of the U.S. health system, such as billing and electronic health records, the commission wrote.

Fraher noted that doctors in programs with supervision requirements need to find an experienced colleague with the time and interest in providing this oversight at a health facility willing to hire them.

The commission pointed out other potential hurdles, such as malpractice insurers possibly declining to cover physicians who obtain state licenses without completing a U.S. residency. The commission and the American Board of Medical Specialties also pointed to the issue of specialty certification, which is managed by national organizations that have their own residency requirements.

Physicians who aren’t eligible to take board exams could lose out on employment opportunities, and patients might have concerns about their qualifications, the board wrote. But it said a majority of its member boards would consider certifying these doctors if states added requirements it recommended.

Lawmakers’ plans to use these new licensing pathways to increase the number of rural doctors will require the foreign-trained doctors to navigate all these obstacles and unknowns, Fraher said.

“There’s a lot of things that need to happen to make this a reality,” she said.

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

USE OUR CONTENT

This story can be republished for free (details).

Cada vez más estados están facilitando que médicos que se formaron en otros países obtengan licencias médicas, un cambio que, según los partidarios, podría aliviar la escasez de doctores en áreas rurales.

Los cambios involucran a los programas de residencia: la experiencia práctica y supervisada que los médicos deben completar después de graduarse de la escuela de medicina. Hasta hace poco, todos los estados exigían que los médicos que completaban una residencia o una capacitación similar en el extranjero repitieran el proceso aquí en Estados Unidos, antes de obtener una licencia médica completa.

Pero desde 2023, al menos nueve estados han eliminado este requisito para algunos médicos con formación internacional, según la Federación de Juntas Médicas Estatales. Más de una docena de otros estados están considerando legislaciones similares.

Alrededor del 26% de los médicos que ejercen en el país nacieron en otro lugar, según el Instituto de Política Migratoria. Necesitan visas para vivir en Estados Unidos, además de licencias estatales para ejercer la medicina.

Defensores de las nuevas leyes dicen que los médicos calificados no deberían tener que pasar años completando una segunda residencia. Los opositores se preocupan por la seguridad del paciente y dudan que el cambio de licencia alivie la escasez de médicos.

Tanto legisladores de estados con tendencia republicana como demócrata han aprobado la idea en un momento en que muchos otros programas relacionados con la inmigración están bajo ataque. Entre ellos se incluyen Florida, Iowa, Idaho, Illinois, Louisiana, Massachusetts, Tennessee, Virginia y Wisconsin.

El presidente Donald Trump ha defendido un programa de visas federales del que dependen muchos médicos extranjeros, pero aún podrían verse obstaculizados por sus amplios esfuerzos por endurecer las normas de inmigración.

Entre los partidarios de facilitar la obtención de licencias se encuentra Zalmai Afzali, médico de medicina interna que terminó la escuela de medicina y un programa de residencia en Afganistán antes de huir de los talibanes y venir a Estados Unidos en 2001.

Dijo que la mayoría de los médicos formados en otros lugares estarían encantados de trabajar en zonas rurales u otras zonas desatendidas.

“Iría a cualquier parte siempre que me dejaran trabajar”, dijo Afzali, que ahora trata a pacientes que viven en zonas rurales y pequeñas ciudades del noreste de Virginia. “Extrañaba ser médico. Extrañaba lo que hacía”.

Afzali tardó 12 años en obtener copias de su diploma y expediente académico, estudiar para los exámenes y terminar un programa de residencia de tres años en Estados Unidos, antes de poder obtener la licencia completa para ejercer como médico en su nuevo país.

Pero una comisión de organizaciones nacionales de salud se pregunta si la flexibilización de los requisitos de residencia para los médicos formados en el extranjero aliviaría la escasez. Los médicos de estos programas podrían seguir enfrentándose a barreras de licencia y empleo, escribió en un informe que hace recomendaciones sin adoptar una postura sobre dicha legislación.

Erin Fraher, profesora de política sanitaria de la Universidad de Carolina del Norte que asesora a la comisión y estudia el tema, dijo que los legisladores que apoyan los cambios predicen que impulsarán la fuerza laboral sanitaria rural. Pero no está claro si eso sucederá, dijo, porque los programas recién están comenzando.

“Creo que el potencial está ahí, pero tenemos que ver cómo se desarrolla esto”, dijo Fraher.

Afzali luchó para mantener a su familia mientras intentaba obtener su licencia médica. Sus trabajos incluyeron trabajar en una tienda departamental por $7.25 la hora y administrar quimioterapia por $20 la hora. Dijo que las enfermeras practicantes en este último trabajo tenían menos capacitación que él, pero ganaban casi cuatro veces más.

“No sé cómo lo hice”, dijo. “Te deprimes mucho”.

Muchos de los proyectos de ley estatales para aliviar los requisitos de residencia se han basado en la legislación modelo del Instituto Cicero, un grupo de expertos conservador que envió representantes a testificar ante las legislaturas después de proponer estos programas en 2020.

Las nuevas vías están abiertas solo para médicos capacitados internacionalmente que cumplan ciertas condiciones. Los requisitos comunes incluyen trabajar como médico durante varios años después de graduarse de una escuela de medicina y un programa de residencia con un rigor similar a los de aquí. También deben aprobar el examen estándar de tres partes que todos los médicos toman para obtener la licencia en Estados Unidos.

A los que califican se les otorga una licencia para ejercer restringida, y la mayoría de los estados les exigen que lo hagan bajo la supervisión de otro médico. Pueden recibir la licencia completa después de varios años.

Alrededor de 10 de las leyes o proyectos de ley también requieren que los médicos trabajen durante varios años en un área rural o desatendida.

Pero los estados sin este requisito, como Tennessee, pueden no ver un impacto en las áreas rurales, argumentaron investigadores de la Facultad de Medicina de Harvard y Rand Corp. en el New England Journal of Medicine. Además de incluir esa condición, los estados podrían ofrecer incentivos a los hospitales rurales que acepten contratar médicos de los nuevos programas de capacitación, escribieron.

Los legisladores, médicos y organizaciones de salud que se oponen a los cambios dicen que hay mejores formas de aumentar de forma segura el número de médicos rurales.

Barbara Parker es enfermera titulada y ex legisladora republicana en Arizona, donde la legislatura está considerando un proyecto de ley por al menos el cuarto año consecutivo.

“Es una respuesta realmente pobre a la escasez de médicos”, dijo Parker, quien votó en contra de la legislación el año pasado.

Parker dijo que facilitar que los médicos formados en el extranjero ejerzan en aquí sería una forma poco ética de robar médicos de países con mayores necesidades de atención médica. Y dijo que duda que todas las residencias internacionales estén a la par con las Estados Unidos, lo que podría repercutir en los pacientes.

También le preocupa que los hospitales estén tratando de ahorrar dinero al contratar médicos formados en el extranjero en lugar de los formados aquí. Los primeros a menudo aceptan salarios más bajos, dijo Parker.

“Esto está impulsado por la codicia corporativa”, agregó.

Parker dijo que las mejores maneras de aumentar el número de médicos rurales incluyen aumentar los salarios, expandir los programas de pago de préstamos para quienes ejercen en áreas rurales y crear una capacitación acelerada para enfermeras practicantes y asistentes médicos que quieran convertirse en médicos.

La comisión asesora, recientemente formada por la Federación de Juntas Médicas Estatales, el Consejo de Acreditación para la Educación Médica de Posgrado e Intealth, una organización sin fines de lucro que evalúa las escuelas de medicina internacionales y sus graduados, publicó sus recomendaciones para ayudar a los legisladores y las juntas médicas a asegurarse de que estas nuevas vías sean seguras y efectivas.

La comisión señaló que, si bien las juntas médicas estatales pueden confiar en una organización externa que evalúa la solidez de las escuelas de medicina extranjeras, no existe una clasificación similar para los programas de residencia. Se espera que tal esfuerzo se lance a mediados de 2025, dijo la comisión.

El grupo también dijo que los estados deberían exigir a los médicos supervisores que evalúen a los participantes antes que se les conceda una licencia completa.

Afzali, el médico de Afganistán, dijo que algunos médicos de atención primaria capacitados internacionalmente tienen más capacitación que sus contrapartes estadounidenses, porque tuvieron que practicar procedimientos que solo realizan especialistas en Estados Unidos.

Pero estuvo de acuerdo con la recomendación de la comisión de que los estados exijan que los médicos que hicieron residencias en el extranjero tengan supervisión mientras tengan una licencia provisional.

Eso ayudaría a garantizar la seguridad del paciente y, al mismo tiempo, ayudaría a los médicos a adaptarse a las diferencias culturales y aprender el aspecto técnico del sistema de salud estadounidense, como la facturación y los registros médicos electrónicos, escribió la comisión.

Fraher señaló que los médicos en programas con requisitos de supervisión deben encontrar un colega experimentado con el tiempo y el interés en brindar esta supervisión en un centro de salud dispuesto a contratarlos.

La comisión señaló otros obstáculos potenciales, como la posibilidad de que las aseguradoras de mala praxis se nieguen a cubrir a los médicos que obtengan licencias estatales sin completar una residencia en Estados Unidos. La comisión y la Junta Estadounidense de Especialidades Médicas también señalaron la cuestión de la certificación de especialidades, que está gestionada por organizaciones nacionales que tienen sus propios requisitos de residencia.

Los médicos que no sean elegibles para tomar los exámenes de la junta podrían perder oportunidades de empleo, y los pacientes podrían tener dudas sobre sus calificaciones, escribió la junta. Pero dijo que la mayoría de las juntas considerarían la certificación de estos médicos si los estados agregaran los requisitos que recomendó.

Los planes de los legisladores de utilizar estas nuevas vías de obtención de licencias para aumentar el número de médicos rurales requerirán que los médicos formados en el extranjero superen todos estos obstáculos e incógnitas, dijo Fraher.

“Hay muchas cosas que deben suceder para que esto se haga realidad”, dijo.

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

USE OUR CONTENT

This story can be republished for free (details).

Los Angeles County homelessness leaders last year reported nearly 30,000 permanent housing placements — an annual high for the sprawling region of 10 million residents. Thousands more got into shelter and short-term housing.

Gov. Gavin Newsom and local leaders celebrated the progress as evidence that an unprecedented multibillion-dollar public investment to move people off the streets was working.

Then the wildfires hit.

Early evidence suggests that the January disaster is reversing hard-fought gains to get people into permanent housing. Local leaders say that as the devastating blazes displaced thousands, some who were barely making their bills and couldn’t find affordable housing have now become homeless amid an already strained housing supply.

“We’re already seeing some people have moved into their vehicles because they don’t have the money to pay for even temporary housing,” said Va Lecia Adams Kellum, CEO of the Los Angeles Homeless Services Authority.

Among those displaced were formerly homeless people such as Alexandria Castaneda, 29, who lived at a sober-living home in Altadena called Art House as she recovered from a methamphetamine addiction. She and dozens of other residents evacuated safely and watched the two-story house go up in flames on live television. The nonprofit that operates Art House is now trying to rehouse those displaced.

“It’s constant stress of not knowing if I’m going to be in a stable housing situation,” said Castaneda, who moved into temporary shelter after the fires.

Much of the progress Los Angeles County has made has been due in part to locally approved measures that have injected billions of dollars into housing efforts. But it’s also a result of the state’s staggering $27 billion investment in addressing homelessness statewide.

Local officials and state lawmakers say the state must provide additional homelessness funding. But those calls are running up against political demands for results.

Newsom wants accountability over how homelessness funds are spent.

The two-term governor, who has made homelessness a central focus of his administration, says he’s open to negotiations, contingent on strict requirements for cities and counties to use the funding to clear encampments and dismantle tents crowding freeway underpasses, city sidewalks, and riverbeds.

Without more focus on unsheltered homelessness, “I am not inclined to continue to support the funding to the cities and counties,” Newsom said in a news conference Feb. 24. “We have been too permissive as it relates to encampments and tents.”

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

USE OUR CONTENT

This story can be republished for free (details).

El vestíbulo de la clínica comunitaria St. John’s Community Health en el sur de Los Ángeles está repleto de pacientes, pero a la trabajadora de salud comunitaria Ana Ruth Varela le preocupa que todo se vuelva mucho más tranquilo. Dijo que muchos pacientes tienen miedo de salir de sus casas.

“El otro día hablé con una de las pacientes. Me dijo: ‘No sé. ¿Debería ir a mi cita? ¿Debería cancelarla? No sé qué hacer’. Y le dije: ‘Simplemente ven’”.

Desde el regreso de Donald Trump a la Casa Blanca, el temor a las deportaciones masivas llevadas a cabo por el Servicio de Inmigración y Control de Aduanas de Estados Unidos (ICE) se ha apoderado de las comunidades inmigrantes.

Durante años, una política de larga data impedía a los agentes federales de inmigración realizar arrestos en o cerca de lugares sensibles, incluidas escuelas, lugares de culto, hospitales y centros de salud. Fue una de las primeras normas que Trump revocó en enero, a apenas horas de haber jurado como el nuevo presidente.

Benjamine Huffman, secretario interino del Departamento de Seguridad Nacional (DHS, revocó la directiva el 21 de enero. En un comunicado de prensa adjunto, un vocero del DHS dijo que la medida ayudaría a los agentes a buscar inmigrantes que hayan cometido delitos. “La administración Trump no atará las manos de nuestra valiente policía y, en cambio, confía en que usen el sentido común”, decía el comunicado.

La rapidez del cambio tomó por sorpresa a Darryn Harris.

“Pensé que teníamos más tiempo”, dijo Harris, director de asuntos gubernamentales y relaciones comunitarias en St. John’s.

Harris está entrenando velozmente a más de 1.000 trabajadores de St. John’s sobre cómo leer las órdenes judiciales mientras se capacitan para un nuevo papel: enseñar a los pacientes sus derechos constitucionales.

El demócrata Rob Conta, fiscal general de California, está aconsejando a las clínicas que publiquen información sobre el derecho de los pacientes a permanecer en silencio y que les proporcionen información sobre grupos de ayuda legal.

Bonta también insta a los proveedores de atención médica a no incluir el estatus migratorio de los pacientes en las facturas y los registros médicos. Su oficina indica que, si bien el personal no debe obstruir físicamente a los agentes de inmigración, no tienen la obligación de ayudar en un arresto.

Aunque durante el primer mandato de Trump hubo arrestos por inmigración en hospitales, la política general seguía siendo de respeto a los “lugares sensibles”. Pero ahora, el DHS afirma que las reglas anteriores obstaculizaron los esfuerzos de aplicación de la ley al crear sitios donde las personas sin estatus legal podían evadir la detención.

Matt Lopas, director de defensa estatal y asistencia técnica para el National Immigration Law Center, dijo que para que los oficiales de inmigración accedan a la información de salud o ingresen a espacios privados como las salas de examen, deben presentar una orden firmada por un juez.

“Es increíblemente importante que cada centro de atención médica tenga a alguien capacitado para poder leer esas órdenes” y determinar su validez, enfatizó Lopas.

En el Área de la Bahía de San Francisco, Zenaida Aguilera ha sido elegida para leer las órdenes de arresto para La Clínica de La Raza. Aguilera es la oficial de cumplimiento, privacidad y riesgo de la red de clínicas. Si los agentes de inmigración se presentan, ella está de guardia en las 31 clínicas comunitarias de la organización.

Ahora, Aguilera también está a cargo de la capacitación de cientos de empleados de salud. Ya ha capacitado a unos 250, pero la mayor parte de ese trabajo aún está por venir.

“Probablemente tengamos alrededor de mil empleados más”, dijo.

Aguilera teme que la administración Trump tenga en la mira a California para aplicar las leyes de inmigración debido a sus aproximadamente 2 millones de residentes sin papeles, la cifra más alta de cualquier estado, según el Pew Research Center. En 2022, 11 millones de personas estaban en Estados Unidos sin documentos legales.

Y agregó que La Clínica planea colocar afiches con los derechos constitucionales de los pacientes en los vestíbulos de las clínicas, y proporcionará recursos como información de contacto para grupos de asistencia legal.

“Nos gustaría simplemente hacer el trabajo de cuidar a nuestros pacientes en lugar de capacitar a nuestro personal sobre qué hacer si hay un funcionario de ICE que intenta ingresar a nuestras clínicas”, dijo Aguilera.

Ese artículo es parte de una alianza que incluye a NPR y 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.

USE OUR CONTENT

This story can be republished for free (details).

ALTADENA, Calif. — As flames engulfed a nearby canyon, dozens of residents in a sober-living home fled to an unoccupied building about 30 miles south. The evacuees, many of whom were previously homeless, watched helplessly as their home burned on live TV.

When they awoke on air mattresses the next morning, loss set in. Some feared uncertainty. Others were jolted back to lives they thought they’d left behind.

“I had nothing but the clothes on my back. It just brought back all of those feelings of being homeless and a drug addict,” said one resident, Sean Brown. “Kind of like I was back at square one.”

The large two-story Altadena house, known to staff and residents as Art House, was surrounded by fruit trees and rugged mountains. For many, it was a safe space that enabled them to achieve and maintain sobriety, rebuild relationships, and hold down jobs.

Brown, 35, was among nearly 50 people displaced in January after the massive Eaton Fire destroyed one property and damaged another operated by the nonprofit Los Angeles Centers for Alcohol and Drug Abuse. Supported by public dollars, the organization provides housing and behavioral health treatment to people struggling with addiction, many who had been living on the streets. Operators say both properties are uninhabitable and that they are searching for permanent housing for those displaced.

“Our residents are still in temporary lodging. Right now we’re looking for something on an interim basis, but we still need to identify long-term housing for them,” said Juan Navarro, CEO of the nonprofit. “And we need even more beds. We’re seeing even bigger demand for treatment and services after the fires.”

In the weeks since one of the nation’s costliest natural disasters, it’s become evident that the Los Angeles wildfires have not only displaced people who had dug themselves out of homelessness and gotten into housing, but also dealt a blow to the region’s homelessness response. That far-reaching system of care formed by government agencies and local nonprofits has been buoyed by billions of dollars from the city, county, and state in recent years to combat California’s homelessness epidemic.

Now, wildfires are adding pressure to a system already under tremendous strain in getting chronically homeless people indoors. Homeless service operators and street medicine providers have been putting pressure on state and local leaders to allocate more funding to house people on the streets, but they are running up against competing demands for wildfire recovery — and tighter budgets.

“Many of the people we work with have already lost everything and they’re trying to rebuild their lives, and now there’s a whole other group of people doing the same thing and competing for the same resources,” said Jennifer Hark Dietz a licensed clinical social worker and the CEO of PATH, which provides services and housing for homeless people.

In recent years, state and local leaders have leveraged unprecedented investments to open thousands of shelters and temporary and permanent units. That’s helped Los Angeles County and the state notch meaningful gains, even as more than 187,000 people remain homeless in California, including 75,000 people across Los Angeles County.

The 2024 homelessness tally showed a 45% increase in the number of people who in the past year moved off the streets into permanent housing, and the number who moved from tents into temporary housing rose 32%, according to Va Lecia Adams Kellum, CEO of the Los Angeles Homeless Services Authority, which leads the countywide homelessness response system. That’s nearly 30,000 permanent housing placements across Los Angeles County.

And while homelessness rose 18% nationwide from 2023 to 2024, according to the most recent federal estimate, it increased only 3% in California. More strikingly, Los Angeles County reduced overall homelessness, albeit slightly.

The number of people living outside fell 5.1% in Los Angeles County, and in the city of Los Angeles, the number of unsheltered people dropped 10.4%.

That hard-fought progress is now in peril as the wildfires displaced tens of thousands of Los Angeles residents and destroyed more than 16,000 structures. Affordable housing, already in short supply, is being further strained.

Formerly homeless people who have experienced addiction, domestic violence, or mental illness now worry they won’t be prioritized for placements, despite losing their homes and qualifying for state and local homelessness initiatives to get people indoors. Many homeless people who have long waited for housing will be forced to wait even longer, as more displaced people face homelessness and compete for costly housing.

Homeless Again

It’s unclear how many formerly homeless people are homeless again. Street medicine providers and other front-line workers say some are temporarily living in hotels, while others moved in with friends or family members.

There’s evidence that some have fallen back into homelessness.

“We’re already seeing some people have moved into their vehicles because they don’t have the money to pay for even temporary housing,” Adams Kellum said. “Before the fires, we were already seeing very vulnerable people unable to manage their rents, so this competition for housing puts people at even greater risk for homelessness.”

Adams Kellum said coordinating resources and services across a vast region has led to major progress but that more money is needed to help move people from short-term to permanent housing.

For now, residents of the burned-down Art House will be allowed to reside in an empty building in Santa Fe Springs that the nonprofit had planned to redevelop for residential treatment, Navarro said. He said the nonprofit is looking for more stable housing for those displaced but that rehousing them at Art House remains out of reach for now.

Residents grieve the loss of the Art House’s transformative setting, which they call an “empowerment campus.” Brown said that he has embraced that ethos, even as he has been displaced and remains traumatized by the wildfires. He is currently working two jobs and taking classes toward a bachelor’s degree.

Paul Rosales, a 24-year-old in recovery from meth, said Art House was a place of healing. “That’s where I found myself; it’s where I built my recovery. There was a beautiful orange tree, and the mountains were just a short walk away where you could meditate and watch the sunset.

“It was away from Skid Row. I knew I was safe,” Rosales said. “That’s all gone now.”

Residents say they’re grateful they aren’t on the streets, but anxiety grows by the day, especially for queer and transgender people who had formed a community there.

“It’s constant stress of not knowing if I’m going to be in a stable housing situation,” said Alexandria Castaneda, 29, who was addicted to meth but got sober after getting indoors.

Battle for Resources

Sarah Hoppmeyer, chief program officer for Union Station Homeless Services, which provides housing for people on the streets, said she worries about dwindling resources. She and other providers stressed the importance of not overlooking people currently stuck in homelessness, many of whom have been waiting years for housing.

“We don’t want the wildfires to de-prioritize people who were already experiencing homelessness,” she said.

Elected leaders have pledged to preserve the gains Los Angeles County has made in reducing homelessness by allocating existing resources and demanding more. Several voter-approved initiatives in Los Angeles are critical, they say, but so too is lobbying for state support.

“Without continued and expanded support and resources, we risk losing ground” in reducing the number of people living on the streets, said Los Angeles County Supervisor Kathryn Barger, chair of the county board.

Previous massive fires have led to increases in homelessness, including in 2018 in Sonoma County and in 2024 on Maui, whose homelessness rate soared the year after fires.

State Sen. Sasha Renée Pérez, a Democrat whose district includes parts of Los Angeles County that burned in the wildfires, said she will continue pressing for additional homelessness funding as a member of the Senate budget committee. While Gov. Gavin Newsom’s administration says the state has plowed an unprecedented $27 billion into local homelessness response and prevention initiatives, he didn’t include any new money for battling the homelessness crisis in his proposal this year.

“Unfortunately, this year we didn’t see additional money being placed into that fund,” Pérez said. “But we have to keep making these investments.”

Newsom said Monday the state should not continue to “fund failure.” He said he is open to negotiations with cities, counties, and state lawmakers so long as any new homelessness funding comes with greater accountability, meaning that local governments use the money to clear encampments, dismantle tents, and reduce unsheltered homelessness.

Newsom officials stressed that the state budget is tight — it’s narrowly balanced and under greater strain than in previous years, with threats from the Trump administration and the potential loss of critical federal funding for programs such as Medicaid. The governor said he is “hopeful that we can land on an agreement,” but he warned the state could claw back funding if local governments aren’t adequately addressing street homelessness.

“We have been too permissive as it relates to encampments and tents. We need them cleaned up,” Newsom said. “We’re providing unprecedented support. Now we need to see unprecedented results.”

Assembly member John Harabedian, another Los Angeles-area Democrat, said additional homelessness spending is critical for wildfire victims and to continue combating the crisis statewide.

“Those folks who were already homeless, who just got into some sort of housing stability but then lost it again — they’re going to need immediate attention,” he said. “Our system is failing people.”

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.

USE OUR CONTENT

This story can be republished for free (details).