SUITLAND, Maryland — En una lavandería SuperSuds en el borde sur con Washington, D.C., un flujo constante de clientes cargaba ropa en lavadoras y secadoras un domingo por la mañana reciente, mientras esperaban mirando sus teléfonos o la televisión.

En medio del suave zumbido de la ropa centrifugándose, Adrienne Jones inició su ronda vistiendo una remera amarilla, preguntando a los clientes sobre sus necesidades de salud. “¿Tiene cobertura médica?”, preguntaba Jones, gerenta de extensión de Fabric Health, a Brendan Glover, de 25 años, que estaba lavando la ropa con su niño pequeño a cuestas.

Glover trabaja en la policía, pero perdió su cobertura en 2024 cuando terminó un trabajo. “Soy joven, así que no pienso en eso, pero sé que lo necesitaré”, dijo.

Jones anotó su número, le dio una tarjeta de regalo para una futura visita a la lavandería y prometió ayudarlo a encontrar una cobertura asequible. Los programas estatales de cobertura de Medicaid y la Ley de Cuidado de Salud a Bajo Precio (ACA) han tenido dificultades durante mucho tiempo para conectarse con los estadounidenses de bajos ingresos para ayudarlos a acceder a la atención médica.

Envían cartas y correos electrónicos, hacen llamadas telefónicas y publican en plataformas de redes sociales como Facebook y X.

Ahora, algunos de estos programas estatales están probando un enfoque alternativo: reunirse con las personas en las lavanderías o “laundromats”, adonde van regularmente y en donde suelen tener tiempo para charlar.

Fabric Health, una empresa emergente con sede en Washington, D.C., envía trabajadores comunitarios a lavanderías en Maryland, Pennsylvania, Nueva Jersey y, desde enero, al Distrito de Columbia, para ayudar a las personas a obtener y utilizar la cobertura médica, incluso ayudando a programar controles o atención de maternidad.

Los trabajadores, muchos de los cuales son bilingües, también visitan las lavanderías para establecer relaciones, generar confianza y conectar a las personas con la asistencia del gobierno.

Los planes de salud de Medicaid, incluidos los administrados por CareFirst BlueCross BlueShield en Maryland, UPMC en Pittsburgh y Jefferson Health en Philadelphia, pagan a Fabric Health para que se conecte con sus afiliados.

La Asociación de Organizaciones de Atención Médica Administrada de Maryland, el grupo comercial de planes de salud de Medicaid del estado, le paga a Fabric health para ayudar a las personas a recertificar su elegibilidad para Medicaid después que expiraran las protecciones de cobertura promulgadas durante la pandemia de covid.

Desde 2023, la empresa se ha conectado con más de 20.000 personas solo en Maryland y Pennsylvania, recopilando información de contacto y datos sobre sus necesidades sociales y de salud, dijo Allister Chang, cofundador y director de operaciones. Chang también forma parte de la Junta de Educación de D.C. como representante electo del Distrito 2.

Fabric Health no reveló a KFF Health News lo que cobra. La empresa está estructurada como una corporación de beneficio público, lo que significa que es una empresa con fines de lucro creada para brindar un beneficio social y no está obligada a priorizar la búsqueda de ganancias para los accionistas.

Pennie, el mercado de ACA de Pennsylvania, que abrió en 2020, contrató a Fabric Health para que hable con personas en las áreas de Philadelphia y Pittsburgh sobre las opciones de cobertura, y las inscriba. Una encuesta realizada el año pasado reveló que dos tercios de las personas sin seguro en el estado nunca habían oído hablar de Pennie, dijo Devon Trolley, directora ejecutiva del mercado de seguros.

“El enfoque de Fabric es muy novedoso y creativo”, dijo. “Van a donde están las personas que tienen algo de tiempo, desarrollan relaciones de base y hacen correr la voz sobre Pennie”.

Para los afiliados, las charlas en las lavanderías pueden ser más fáciles y rápidas que conectarse con el servicio de atención al cliente de sus planes de salud. Para los planes, pueden aumentar los pagos de desempeño del estado, que están vinculados a la satisfacción de los afiliados, y la eficacia a la hora de acercar servicios como exámenes de detección de cáncer a sus clientes.

“Nuestro argumento es: la gente pasa dos horas a la semana esperando en las lavanderías y ese tiempo de inactividad puede ser increíblemente productivo”, dijo Courtney Bragg, cofundadora y directora ejecutiva de Fabric Health.

CareFirst comenzó a trabajar con la empresa el año pasado para ayudar a las personas en Maryland a renovar la cobertura, programar controles y registrarse para otros beneficios, como asistencia con los pagos de la luz y cupones de alimentos.

Sheila Yahyazadeh, directora de operaciones externas del plan CareFirst, dijo que la iniciativa muestra la importancia de la interacción humana. “Existe la idea errónea de que la tecnología resolverá todo, pero un rostro humano es absolutamente fundamental para que este programa sea exitoso porque, al final del día, la gente quiere hablar con alguien y sentirse que se la escucha y atiende”, dijo.

En una visita anterior a SuperSuds, Jones, la trabajadora social de Fabric Health, conoció a Patti Hayes, de 59 años, de Hyattsville, Maryland, que está inscrita en el plan de salud de Medicaid operado por CareFirst, pero que no había visto a un médico de atención primaria en más de un año. Dijo que prefería ver a un médico de raza negra.

Después de que se conocieron en la lavandería, Jones la ayudó a encontrar un nuevo médico y programar una cita. También la ayudó a encontrar un terapeuta en la red de su plan.

“Esto es útil porque es más un toque personal”, dijo Hayes.

Fabric Health también envía mensajes de texto a las personas para que se mantengan en contacto y les digan cuándo volverán a la lavandería para encontrarse de nuevo en persona

Paola Flores, de 38 años, de Clinton, Maryland, le dijo a una trabajadora de Fabric Health que necesitaba ayuda para cambiar de plan de Medicaid para poder recibir una mejor atención para su hijo autista. Al comunicarse con ella en español, la trabajadora le dijo que la ayudaría, incluso concertando una cita con un pediatra.

“Es difícil encontrar buena ayuda”, dijo Flores.

Ryan Moran, director del Medicaid de Maryland, dijo que Fabric Health ayudó a mantener a las personas inscritas durante el proceso de desafiliación de Medicaid, cuando todos los que estaban en el programa tuvieron que renovar su inscripción después que expiraran las protecciones de la pandemia, que duraron tres años.

Los trabajadores comunitarios se centraron en las lavanderías de las ciudades que tenían altas tasas de personas que eran dadas de baja por razones de papeleo.

“No hay duda sobre el valor de la interacción entre humanos y la capacidad de estar en donde están las personas, lo que elimina barreras y hace que las personas se relacionen con nosotros”, dijo Moran.

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Greg Herbruck knew 6.5 million of his birds needed to die, and fast.

But the CEO of Herbruck’s Poultry Ranch wasn’t sure how the family egg producer (one of the largest in the U.S., in business for over three generations) was going to get through it, financially or emotionally. One staffer broke down in Herbruck’s office in tears.

“The mental toll on our team of dealing with that many dead chickens is just, I mean, you can’t imagine it,” Herbruck said. “I didn’t sleep. Our team didn’t sleep.”

The stress of watching tens of thousands of sick birds die of avian flu each day, while millions of others waited to be euthanized, kept everyone awake.

In April 2024, as his first hens tested positive for the highly pathogenic avian influenza H5N1 virus, Herbruck turned to the tried-and-true U.S. Department of Agriculture playbook, the “stamping-out” strategy that helped end the 2014-15 bird flu outbreak, which was the largest in the U.S. until now.

Within 24 to 48 hours of the first detection of the virus, state and federal animal health officials work with farms to cull infected flocks to reduce the risk of transmission. That’s followed by extensive disinfection and months of surveillance and testing to make sure the virus isn’t still lurking somewhere on-site.

Since then, egg farms have had to invest millions of dollars into biosecurity. For instance, employees shower in and shower out, before they start working and after their shifts end, to prevent spreading any virus. But their efforts have not been enough to contain the outbreak that started three years ago.

This time, the risk to human health is only growing, experts say. Sixty-six of the 67 total human cases in the United States have been just since March, including the nation’s first human death, reported last month.

“The last six months have accelerated my concern, which was already high,” said Nahid Bhadelia, an infectious diseases physician and the founding director of Boston University’s Center on Emerging Infectious Diseases.

Controlling this virus has become more challenging, precisely because it’s so entrenched in the global environment, spilling into mammals such as dairy cows, and affecting roughly 150 million birds in commercial and backyard flocks in the U.S.

Because laying hens are so susceptible to the H5N1 virus, which can wipe out entire flocks within days of the first infection, egg producers have been on the front lines in the fight against various bird flu strains for years. But this moment feels different. Egg producers and the American Egg Board, an industry group, are begging for a new prevention strategy.

Many infectious disease experts agree that the risks to human health of continuing current protocols are unsustainable, because of the strain of bird flu driving this outbreak.

“The one we’re battling today is unique,” said David Swayne, former director of the Southeast Poultry Research Laboratory at the USDA’s Agricultural Research Service and a leading national expert in avian influenza.

“It’s not saying for sure there’s gonna be a pandemic” of H5N1, Swayne said, “but it’s saying the more human infections, the spreading into multiple mammal species is concerning.”

For Herbruck, it feels like war. Ten months after Herbruck’s Poultry Ranch was hit, the company is still rebuilding its flocks and rehired most of the 400 workers it laid off.

Still, he and his counterparts in the industry live in fear, watching other farms get hit two, even three times in the past few years.

“I call this virus a terrorist,” he said. “And we are in a battle and losing, at the moment.”

When Biosecurity Isn’t Working … or Just Isn’t Happening

So far, none of the 23 people who contracted the disease from commercial poultry have experienced severe cases, but the risks are still very real. The first human death was a Louisiana patient who had contact with both wild birds and backyard poultry. The person was over age 65 and reportedly had underlying medical conditions.

And the official message to both backyard farm enthusiasts and mega-farms has been broadly the same: Biosecurity is your best weapon against the spread of disease.

But there’s a range of opinions among backyard flock owners about how seriously to take bird flu, said Katie Ockert, a Michigan State University Extension educator who specializes in biosecurity communications.

Skeptics think that “we’re making a mountain out of a molehill,” Ockert said, or that “the media is maybe blowing it out of proportion.” This means there are two types of backyard poultry enthusiasts, Ockert said: those doing great biosecurity, and those who aren’t even trying.

“I see both,” she said. “I don’t feel like there’s really any middle ground there for people.”

And the challenges of biosecurity are completely different for backyard coops than massive commercial barns: How are hobbyists with limited time and budgets supposed to create impenetrable fortresses for their flocks, when any standing water or trees on the property could draw wild birds carrying the virus?

Rosemary Reams, an 82-year-old retired educator in Ionia, Michigan, grew up farming and has been helping the local 4-H poultry program for years, teaching kids how to raise poultry. Now, with the bird flu outbreak, “I just don’t let people go out to my barn,” she said.

Reams even swapped real birds with fake ones for kids to use while being assessed by judges at recent 4-H competitions, she said.

“We made changes to the fair last year, which I got questioned about a lot. And I said, ‘No, I gotta think about the safety of the kids.’”

Reams was shocked by the news of the death of the Louisiana backyard flock owner. She even has questioned whether she should continue to keep her own flock of 20 to 30 chickens and a pair of turkeys.

“But I love ’em. At my age, I need to be doing it. I need to be outside,” Reams said. “That’s what life is about.” She said she’ll do her best to protect herself and her 4-H kids from bird flu.

Even “the best biosecurity in the world” hasn’t been enough to save large commercial farms from infection, said Emily Metz, president and CEO of the American Egg Board.

The egg industry thought it learned how to outsmart this virus after the 2014-15 outbreak. Back then, “we were spreading it amongst ourselves between egg farms, with people, with trucks,” Metz said. So egg producers went into lockdown, she said, developing intensive biosecurity measures to try to block the routes of transmission from wild birds or other farms.

Metz said the measures egg producers are taking now are extensive.

“They have invested hundreds of millions of dollars in improvements, everything from truck washing stations — which is washing every truck from the FedEx man to the feed truck — and everything in between: busing in workers so that there’s less foot traffic, laser light systems to prevent waterfowl from landing.”

Lateral spread, when the virus is transmitted from farm to farm, has dropped dramatically, down from 70% of cases in the last outbreak to just 15% as of April 2023, according to the USDA.

And yet, Metz said, “all the measures we’re doing are still getting beat by this virus.”

The Fight Over Vaccinating Birds

Perhaps the most contentious debate about bird flu in the poultry industry right now is whether to vaccinate flocks.

Given the mounting death toll for animals and the increasing risk to humans, there’s a growing push to vaccinate certain poultry against avian influenza, which countries like China, Egypt, and France are already doing.

In 2023, the World Organization for Animal Health urged nations to consider vaccination “as part of a broader disease prevention and control strategy.”

Swayne, the avian influenza expert and poultry veterinarian, works with WOAH and said most of his colleagues in the animal and public health world “see vaccination of poultry as a positive tool in controlling this panzootic in animals,” but also as a tool that reduces chances for human infection, and chances for additional mutations of the virus to become more human-adapted.

But vaccination could put poultry meat exporters (whose birds are genetically less susceptible to H5N1 than laying hens) at risk of losing billions of dollars in international trade deals. That’s because of concerns that vaccination, which lowers the severity of disease in poultry, could mask infections and bring the virus across borders, according to John Clifford, a former chief veterinary officer of the USDA. Clifford is currently an adviser to the USA Poultry and Egg Export Council.

“If we vaccinate, we not only lose $6 billion potentially in exports a year,” Clifford said. “If they shut us off, that product comes back on the U.S. market. Our economists looked at this and said we would lose $18 billion domestically.”

Clifford added that would also mean the loss of “over 200,000 agricultural jobs.”

Even if those trade rules changed to allow meat and eggs to be harvested from vaccinated birds, logistical hurdles remain.

“Vaccination possibly could be on the horizon in the future, but it’s not going to be tomorrow or the next day, next year, or whatever,” Clifford said.

Considering just one obstacle: No current HPAI vaccine is a perfect match for the current strain, according to the USDA. But if the virus evolves to be able to transmit efficiently from human to human, he said, “that would be a game changer for everybody, which would probably force vaccination.”

Last month, the USDA announced it would “pursue a stockpile that matches current outbreak strains” in poultry.

“While deploying a vaccine for poultry would be difficult in practice and may have trade implications, in addition to uncertainty about its effectiveness, USDA has continued to support research and development in avian vaccines,” the agency said.

At this point, Metz argued, the industry can’t afford not to try vaccination, which has helped eradicate diseases in poultry before.

“We’re desperate, and we need every possible tool,” she said. “And right now, we’re fighting this virus with at least one, if not two, arms tied behind our back. And the vaccine can be a huge hammer in our toolbox.”

But unless the federal government acts, that tool won’t be used.

Industry concerns aside, infectious diseases physician Bhadelia said there’s an urgent need to focus on reducing the risk to humans of getting infected in the first place. And that means reducing “chances of infections in animals that are around humans, which include cows and chickens. Which is why I think vaccination to me sounds like a great plan.”

The lesson “that we keep learning every single time is that if we’d acted earlier, it would have been a smaller problem,” she said.

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

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

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A measles outbreak is growing in a Texas county with dangerously low vaccination rates.

In late January, two school-age children from Gaines County were hospitalized with measles. Since an estimated 1 in 5 people with the disease end up in the hospital, the two cases suggested a larger outbreak.

As of Feb. 7, there were 14 confirmed and six probable cases, said Zach Holbrooks, executive director of the South Plains Public Health District, which includes Gaines. The department is investigating many other potential cases among close contacts, he said, in hopes of treating people quickly and curbing the spread of the virus.

Public health practitioners warn such outbreaks will become more common because of scores of laws around the U.S. — pending and passed — that ultimately lower vaccine rates. Many of the measures allow parents to more easily exempt their children from school vaccine requirements, and a swell of vaccine misinformation has led to record rates of exemptions.

As Robert F. Kennedy Jr., one of the most influential purveyors of dangerous vaccine misinformation, prepares to take the helm of the Department of Health and Human Services, researchers say such bills have a higher chance of passing and that more parents will refuse vaccines because of false information spread at the highest levels of government.

“Mr. Kennedy has been an opponent of many health-protecting and life-saving vaccines, such as those that prevent measles and polio,” scores of Nobel Prize laureates wrote in a letter to the Senate. Having him head HHS, they wrote, “would put the public’s health in jeopardy.”

Most people who aren’t protected by vaccination will get measles if exposed. Gaines County has one of the lowest rates of childhood vaccination in Texas. At a local public school district in the community of Loop, only 46% of kindergarten students have gotten vaccines against measles, mumps, and rubella. Vaccination rates may be even lower at private schools and within homeschool groups, which don’t always report the information.

Holbrooks’ team is scrambling to track transmission, ensure that kids and babies seek prompt care, and offer measles vaccines to anyone who hasn’t yet gotten them.

“We are going to see more kids infected. We will see more families taking time off from work. More kids in the hospital,” said Rekha Lakshmanan, chief strategy officer for The Immunization Partnership in Houston, a nonprofit that advocates for vaccine access. “This is the tip of the iceberg.”

As a rule, at least 95% of people need to be vaccinated against measles for a community to be well protected. That threshold is high enough to protect infants too young for the vaccine, people who can’t take the vaccine for medical reasons, and anyone who doesn’t mount a strong, lasting immune response to it.

Measles is extremely contagious, so health workers preemptively treated infants too young to be vaccinated who had shared the emergency room with children later diagnosed with the virus, said Katherine Wells, public health director in Lubbock, Texas. Some children from Gaines were hospitalized in that county. The disease can cause severe complications, and about one of every thousand children with measles die.

An outbreak among a largely unvaccinated population in Samoa in 2019 and 2020 caused 83 deaths, mainly among children, and more than 5,700 cases. Kennedy, who peddles misinformation about measles vaccines, had visited the island earlier on a trip arranged by a Samoan anti-vaccine influencer, according to a 2021 blog post by Kennedy.

Without evidence, Kennedy cast doubt on the fact that measles caused the tragedy in Samoa. “We don’t know what was killing them,” he said at his first confirmation hearing. Samoa’s top health official denounced this evasion as “a complete lie,” in an interview with The Associated Press.

Last school year, the number of kindergartners exempted from a vaccine requirement — 3.3% — was higher than ever reported before, according to the Centers for Disease Control and Prevention. Numbers were far higher than that in Gaines County, where nearly 1 in 5 children in kindergarten had a vaccine exemption for philosophical or religious reasons in 2023-24.

Over the past couple of years, several states have allowed more parents to obtain exemptions. Already, about 25 bills have been filed in the 2025 Texas legislative session that could limit vaccination in various ways.

“We’re seeing a level of momentum this legislative session that we’ve never seen in the past,” Lakshaman said. Changes are afoot at the local level, too. For example, a school board in the Houston area voted to remove references to vaccines in its curriculum. “There is a top-down and bottom-up assault on these protections,” Lakshaman said.

About 80% of the public believes that the benefits of the measles, mumps, and rubella vaccines outweigh the risks, according to a 2025 KFF poll.

“Lawmakers who put forth dangerous policies need to know the people they hear from don’t represent the majority,” Lakshaman said. Her group offers resources on its website to help people influence decisions on vaccination policies.

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

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Valentino Valdez was given his birth certificate, his Social Security card, a T-shirt, and khaki pants when he was released from a Texas prison in 2019 at age 21. But he didn’t have health insurance, mental health medications, or access to a doctor, he said.

Three years later, he landed in an inpatient hospital after expressing suicidal thoughts.

After more than a decade cycling through juvenile detention, foster care placements, and state prisons, Valdez realizes now that treatment for his mental health conditions would have made life on his own much easier.

“It’s not until you’re put in, like, everyday situations and you respond adversely and maladaptive,” he said, “you kind of realize that what you went through had an effect on you.”

“I was struggling with a lot of mental stuff,” said Valdez, now 27.

For years, people like Valdez have often been left to fend for themselves when seeking health care services after their release from jail, prison, or other carceral facilities. Despite this population’s high rate of mental health problems and substance use disorders, they often return to their communities with no coverage, which increases their chances of dying or suffering a lapse that sends them back behind bars.

A new federal law aims to better connect incarcerated children and young adults who are eligible for Medicaid or the Children’s Health Insurance Program to services before their release. The goal is to help prevent them from developing a health crisis or reoffending as they work to reestablish themselves.

“This could change the trajectory of their lives,” said Alycia Castillo, associate director of policy for the Texas Civil Rights Project. Without that treatment, she said, many young people leaving custody struggle to reintegrate into schools or jobs, become dysregulated, and end up cycling in and out of detention facilities.

Medicaid has historically been prohibited from paying for health services for incarcerated people. So jails, prisons, and detention centers across the country have their own systems for providing health care, often funded by state and local budgets and not integrated with a public or private health system.

The new law is the first change to that prohibition since the Medicare and Medicaid Act’s inception in 1965, and it came in a spending bill signed by President Joe Biden in 2022. It took effect Jan. 1 this year, and requires all states to provide medical and dental screenings to Medicaid- and CHIP-eligible youths 30 days before or immediately after they leave a correctional facility. Youths must continue to receive case management services for 30 days after their release.

More than 60% of young people who are incarcerated are eligible for Medicaid or CHIP, according to a September 2024 report from the Center for Health Care Strategies. The new law applies to children and young adults up to age 21, or 26 for those who, like Valdez, were in foster care.

Putting the law into practice, however, will require significant changes to how the country’s thousands of correctional facilities provide health care to people returning to communities, and it could take months or even years for the facilities to be fully in compliance.

“It’s not going to be flipping a switch,” said Vikki Wachino, founder and executive director of the Health and Reentry Project, which has been helping states implement the law. “These connection points have never been made before,” said Wachino, a former deputy administrator of the Centers for Medicare & Medicaid Services.

The federal CMS under the Biden administration did not respond to a question about how the agency planned to enforce the law.

It’s also unclear whether the Trump administration will force states to comply. In 2018, President Donald Trump signed legislation requiring states to enroll eligible youths in Medicaid when they leave incarceration, so they don’t experience a gap in health coverage. The law Biden signed built on that change by requiring facilities to provide health screenings and services to those youths, as well as ones eligible for CHIP.

Even though the number of juveniles incarcerated in the U.S. has dropped significantly over the past two decades, more than 64,000 children and young adults 20 and younger are incarcerated in state prisons, local and tribal jails, and juvenile facilities, according to estimates provided to KFF Health News by the Prison Policy Initiative, a nonprofit research organization that studies the harm of mass incarceration.

A ‘Neglected Part of the Health System’

The federal Bureau of Justice Statistics estimates that about a fifth of the country’s prison population spent time in foster care. Black youths are nearly five times as likely as white youths to be placed in juvenile facilities, according to the Sentencing Project, a nonprofit that advocates for reducing prison and jail populations.

Studies show that children who receive treatment for their health needs after release are less likely to reenter the juvenile justice system.

“Oftentimes what pulls kids and families into these systems is unmet needs,” said Joseph Ribsam, director of child welfare and juvenile justice policy at the Annie E. Casey Foundation and a former state youth services official. “It makes more sense for kids to have their health care tied to a health care system, not a carceral system.”

Yet many state and local facilities and state health agencies nationwide will have to make a lot of changes before incarcerated people can receive the services required in the law. The facilities and agencies must first create systems to identify eligible youths, find health care providers who accept Medicaid, bill the federal government, and share records and data, according to state Medicaid and corrections officials, as well as researchers following the changes.

In January, the federal government began handing out around $100 million in grants to help states implement the law, including to update technology.

Some state officials are flagging potential complications.

In Georgia, for example, the state juvenile justice system doesn’t have a way to bill Medicaid, said Michelle Staples-Horne, medical director for the Georgia Department of Juvenile Justice.

In South Dakota, suspending someone’s Medicaid or CHIP coverage while they are incarcerated instead of just ending it is a challenge, Kellie Wasko, the state’s secretary of corrections, said in a November webinar on the new law. That’s a technical change that’s difficult to operationalize, she said.

State Medicaid officials also acknowledged that they can’t force local officials to comply.

“We can build a ball field, but we can’t make people come and play ball,” said Patrick Beatty, deputy director and chief policy officer for the Ohio Department of Medicaid.

States should see the law as a way to address a “neglected part of the health system,” said Wachino, the former CMS official. By improving care for people transitioning out of incarceration, states may spend less money on emergency care and on corrections, she said.

“Any state that is dragging its feet is missing an opportunity here,” she said.

‘Our System Is Making People Worse’

The Texas Department of Family Services took custody of Valdez when he was 8 because his mother’s history of seizures made her unable to care for him, according to records. Valdez said he ran away from foster care placements because of abuse or neglect.

A few years later, he entered the Texas juvenile justice system for the first time. Officials there would not comment on his case. But Valdez said that while he was shuffled between facilities, his antidepressant and antipsychotic medications would be abruptly stopped and his records rarely transferred. He never received therapy or other support to cope with his childhood experiences, which included sexual abuse, according to his medical records.

Valdez said his mental health deteriorated while he was in custody, from being put in isolation for long periods of time, the rough treatment of officials, fears of violence from other children, and the lack of adequate health care.

“I felt like an animal,” Valdez said.

In August, the U.S. Department of Justice released a report that claims the state exposes children in custody to excessive force and prolonged isolation, fails to protect them from sexual abuse, and fails to provide adequate mental health services. The Texas Juvenile Justice Department has said it is taking steps to improve safety at its facilities.

In 2024, 100% of children in Texas Juvenile Justice Department facilities needed specialized treatment, including for problems with mental health, substance use, or violent behavior, according to the department.

Too often, “our system is making people worse and failing to provide them with the continuity of care they need,” said Elizabeth Henneke, founder and CEO of the Lone Star Justice Alliance, a nonprofit law firm in Texas.

Valdez said trauma from state custody shadowed his life after release. He was quick to anger and violence and often felt hopeless. He was incarcerated again before he had a breakdown that led to his hospitalization in 2022. He was diagnosed with post-traumatic stress disorder and put on medication, according to his medical records.

“It helped me understand that I wasn’t going crazy and that there was a reason,” he said. “Ever since then, I’m not going to say it’s been easy, but it’s definitely been a bit more manageable.”

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

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Un brote de sarampión está diseminándose en un condado de Texas que tiene tasas de vacunación peligrosamente bajas.

A fines de enero, dos niños escolares del condado de Gaines fueron internados con sarampión. Ya que se estima que 1 de cada 5 personas con la enfermedad termina en el hospital, los dos casos sugirieron un brote más grande.

Al 7 de febrero, había 14 casos confirmados y seis probables, informó Zach Holbrooks, director ejecutivo del Distrito de Salud Pública de South Plains, que incluye a Gaines. Agregó que el departamento está investigando muchos otros casos potenciales entre contactos cercanos, con la esperanza de tratar a las personas rápidamente y frenar la propagación del virus.

Profesionales de salud pública advierten que estos brotes se volverán más comunes: decenas de leyes en todo Estados Unidos —pendientes y aprobadas— podrían seguir reduciendo las tasas de vacunación.

Muchas de las medidas permiten a los padres eximir más fácilmente a sus hijos de los requisitos de vacunación escolar, y una oleada de desinformación sobre las vacunas ha llevado a tasas récord de exenciones.

Mientras Robert F. Kennedy Jr., uno de los más influyentes diseminadores de desinformación peligrosa sobre las vacunas, se prepara para tomar el mando del Departamento de Salud y Servicios Humanos (HHS), investigadores dicen que estos proyectos de ley tienen más posibilidades de aprobarse, y que más padres rechazarán las vacunas por la información falsa difundida en los niveles más altos del gobierno.

“El señor Kennedy se ha opuesto a muchas vacunas que protegen la salud y salvan vidas, como las que previenen el sarampión y la polio”, escribieron decenas de premios Nobel en una carta al Senado. Tenerlo al frente del HHS, escribieron, “pondría en peligro la salud pública”.

La mayoría de las personas que no están protegidas por la vacunación contraerán sarampión si se exponen. El condado de Gaines tiene una de las tasas más bajas de vacunación infantil en Texas. En un distrito escolar público local en la comunidad de Loop, solo el 46% de los alumnos de kinder han sido vacunados contra el sarampión, las paperas y la rubeola.

Las tasas de vacunación pueden ser incluso más bajas en las escuelas privadas y en los grupos de educación en el hogar, que no siempre informan sobre inmunizaciones.

El equipo de Holbrooks está trabajando para rastrear la transmisión, garantizar que los niños y los bebés busquen atención médica inmediata, y ofrecer vacunas contra el sarampión a cualquiera que aún no las haya recibido.

“Vamos a ver más niños infectados. Veremos más familias teniendo que tomarse días en el trabajo. Más niños en el hospital”, dijo Rekha Lakshmanan, directora de estrategia de The Immunization Partnership en Houston, una organización sin fines de lucro que aboga por el acceso a las vacunas. “Esta es la punta del iceberg”.

Como regla general, al menos el 95% de las personas deben vacunarse contra el sarampión para que toda una comunidad esté bien protegida. Ese umbral es lo suficientemente alto como para proteger a los bebés que son demasiado pequeños para vacunarse, a las personas que no pueden hacerlo por razones médicas, y a cualquiera que no desarrolle una respuesta inmunitaria fuerte y duradera a la vacuna.

El sarampión es extremadamente contagioso, por eso se trató preventivamente a los bebés demasiado pequeños para ser vacunados que habían estado en la misma sala de emergencias que los niños a los que luego se les diagnosticó el virus, dijo Katherine Wells, directora de salud pública en Lubbock, Texas. Algunos niños de Gaines fueron internados en ese condado. La enfermedad puede causar complicaciones graves y aproximadamente uno de cada 1.000 niños con sarampión muere.

Un brote entre una población en Samoa en 2019 y 2020, que no estaba mayormente vacunada, causó 83 muertes, principalmente entre niños, y más de 5.700 casos. Kennedy, que difunde información errónea sobre las vacunas contra el sarampión, había visitado la isla anteriormente en un viaje organizado por un influencer antivacunas samoano, según una publicación de 2021 del blog de Kennedy.

Sin pruebas, Kennedy puso en duda el hecho de que el sarampión fuera el causante de la tragedia en Samoa. “No sabemos qué los estaba matando”, dijo en su primera audiencia de confirmación. El principal funcionario de salud de Samoa denunció esto como “una mentira absoluta”, en una entrevista con The Associated Press.

El año escolar pasado, el número de niños de kinder exentos de un requisito de vacuna (3,3%) fue el más alto en la historia, según los Centros para el Control y Prevención de Enfermedades (CDC). Las cifras fueron mucho más altas que las del condado de Gaines, donde casi 1 de cada 5 niños en kinder tuvo una exención de vacunas por razones filosóficas o religiosas en 2023-24.

En los últimos años, varios estados han permitido que más padres obtengan exenciones. Ya se han presentado alrededor de 25 proyectos de ley en la sesión legislativa de Texas de 2025 que podrían limitar la vacunación de diversas formas.

“Estamos viendo un momentum en esta sesión legislativa que nunca hemos visto en el pasado”, dijo Lakshaman. También se están produciendo cambios a nivel local. Por ejemplo, una junta escolar en el área de Houston votó para eliminar las referencias a las vacunas en su plan de estudios. “Hay un ataque de arriba hacia abajo y de abajo hacia arriba contra estas protecciones”, dijo Lakshaman.

Alrededor del 80% del público cree que los beneficios de as vacunas contra el sarampión, las paperas y la rubeola supera a los riesgos, según una encuesta de KFF de 2025.

“Los legisladores que proponen políticas peligrosas deben saber que las personas a las que escuchan no representan a la mayoría”, dijo Lakshaman. Su grupo ofrece recursos en su sitio web para ayudar a las personas a influir en las decisiones sobre las políticas de vacunación.

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

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

Confusion continues to reign at the Department of Health and Human Services, where policies seem to be changing at a breakneck pace even before a new secretary or other senior officials are confirmed by the Senate. Some federal grantees report payments are still paused, outside communications are still canceled, and many workers are being threatened with layoffs if they don’t accept a buyout offer that some observers call legally dubious.

 Meanwhile, that new HHS secretary may soon arrive, given the Senate Finance Committee approved Robert F. Kennedy Jr.’s nomination this week on a party-line vote — including an “aye” vote from Sen. Bill Cassidy (R-La.), a doctor who had strongly condemned Kennedy’s anti-vaccine activism.

 This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Panelists Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Lauren Weber The Washington Post @LaurenWeberHP Read Lauren's stories.

Among the takeaways from this week’s episode:

• In Washington, the Trump administration’s federal funding freeze, buyout offers to scores of federal workers, and disabling of federal agency websites have left more questions than answers. A tangle of legal issues and lack of communication have only served to sow confusion around the nation and globe for health providers, researchers, and foreign aid groups — to name a few.
• As the Trump administration runs through many of the disruptive policy changes prescribed last year in the Heritage Foundation’s presidential transition playbook, Project 2025, some people are asking: Where are the Democrats? Lawmakers have taken up mostly individual efforts to question and protest the administration’s changes, but, thus far, Democrats are still pulling together a unified approach in Washington to counter the Trump administration’s break-it-to-change-it approach.
• Faced with threats to crucial federal funding, some in the health industry are falling in line with President Donald Trump’s executive orders even as they’re challenged in the courts. Notably, some hospitals have stopped providing treatment to transgender minors in Democratic-run states such as New York.
• Meanwhile, a doctor in New York is facing a criminal indictment over providing the abortion pill to a Louisiana patient. The doctor is protected by a state shield law, and the indictment escalates the interstate fight over abortion access. And a Trump order barring federal funding from being used to pay for or “promote” abortions is not only rolling back Biden-era efforts to protect abortion rights, but also going further than any modern president to restrict abortion — after Trump repeatedly said on the campaign trail that abortion policy would be left to the states.

Also this week, Rovner interviews KFF Health News’ Julie Appleby, who reported the latest “Bill of the Month” feature about a young woman, a grandfathered health plan, and a $14,000 IUD. If you have an outrageous or baffling medical bill you’d like to share with us, you can do that here.

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

Julie Rovner: The New York Times’ “How R.F.K. Jr. and ‘Medical Freedom’ Rose to Power,” on “The Daily” podcast.  

Lauren Weber: CNN’s “Human Brain Samples Contain an Entire Spoon’s Worth of Nanoplastics, Study Says,” by Sandee LaMotte.  

Alice Miranda Ollstein: The Washington Post’s “Did RFK Jr. or Michelle Obama Say It About Food? Take Our Quiz,” by Lauren Weber. 

Also mentioned in this week’s podcast:

• KFF Health News’ “Trump’s Already Gone Back on His Promise To Leave Abortion to States,” by Julie Rovner.
• STAT’s “Removal of DEI Content From a Microbiology Group’s Website Shows Reach of Trump Executive Orders,” by Usha Lee McFarling.

Credits Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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

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

USE OUR CONTENT

This story can be republished for free (details).