According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.

The Trump administration has said it wants to reverse this trend. President Donald Trump has called for “a new baby boom,” and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also the federal government’s only dedicated family planning program: Title X.

For more than five decades, Title X has been geared — with bipartisan support — toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the served more than 5 million patients a year. Title X clients have reported the program as their sole source of health care in a given year.

In early April, the Department of Health and Human Services for Title X grants for fiscal year 2027, which begins in October. The 67-page Notice of Funding Opportunity included only one mention of contraception — describing it as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”

The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.

While Title X will continue to help women “achieve healthy pregnancies,” the grant document does not explicitly reference preventing unintended pregnancies — a long-standing goal of the program.

Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.

“What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda,” Marcella said, noting that Trump eliminating Title X altogether.

Birth Rates and Fertility Trends

The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.

The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. “Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage,” she said.

Most American women, she said, still complete their childbearing years with an average of two children, suggesting a shift toward smaller families rather than an increase in childlessness.

“Having children has become more contingent and more planned,” she said.

Much of the decline since 2007 reflects women postponing births rather than forgoing them.

“The average number of babies women are having in their whole lives has not fallen. It’s still more than 2.0 for women aged 45,” said Philip Cohen, a professor of sociology at the University of Maryland.

Phillip Levine, an economist at Wellesley College, said the birth rate has declined due to shifts in how women approach work, leisure, and parenting. “Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy,” he said.

Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS press secretary Emily Hilliard said in a statement: “Applicants for the 2027 Title X funding cycle will be expected to align with the administration’s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law.”

Marcella said the new funding notice is the product of two converging forces: the Make America Healthy Again movement, with its skepticism of conventional medicine and emphasis on lifestyle and behavioral interventions, and a pronatalist agenda that seeks to boost birth rates by steering policy toward family formation.

The document’s language reflects both: It repeatedly invokes “optimal health” and “chronic disease” while sidelining the contraceptive services that have defined Title X for .

Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents health professionals focused on family planning, said tying Title X to birth-rate goals replaces individual decision-making with a government objective. The program “is designed to facilitate access to family planning services, including services to achieve and prevent pregnancy,” she said.

Title X’s New Focus

The administration’s changes have been welcomed on the right.

Emma Waters, a senior policy analyst at the conservative Heritage Foundation, who has advocated for what she calls “restorative reproductive medicine,” said the new funding notice reflects overdue attention to neglected aspects of women’s health.

“I was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X,” Waters said.

She described the notice as an expansion, not a narrowing, of the program’s mission: “I see this iteration of Title X as the fulfillment of its purpose. The goal was never just ‘more contraception’ but a wholesale empowerment of women to govern their own fertility.”

Waters also argued that untreated reproductive health problems may contribute to lower birth rates.

“One of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman’s desire to have kids,” she said, pointing to endometriosis.

An estimated of reproductive age have endometriosis, and of those, . Scientifically speaking, the relationship is an association, not a proven cause. Women aren’t screened for endometriosis if they don’t have symptoms, and the condition may be more prevalent than is recognized. Researchers still do not fully understand why some women with endometriosis struggle to conceive while others do not, and treating the disease does not reliably restore fertility.

Infertility rates in the U.S., meanwhile, have not risen. An found them essentially flat between 1995 and 2019, even as the national birth rate fell sharply — a divergence that points away from untreated reproductive disease as an explanation.

Meanwhile, in February, the American College of Obstetricians and Gynecologists enabling earlier diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. But the first-line treatment ACOG recommends is hormonal therapy, part of the same category of care the funding notice dismisses as part of an “overreliance on pharmaceutical and surgical treatments.” The effect, reproductive health experts say, is a contradiction: Title X is now prioritizing diagnosis of endometriosis while deemphasizing the drugs clinicians use to treat it.

Treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization, are . When President Richard Nixon signed Title X into law in 1970, as a way to expand access to family planning services — helping women determine the number and spacing of their children by making contraception and related preventive care more widely available, particularly for those who could not afford it. , not Title X, is the primary government health insurance program covering health care for low-income women, but, like many commercial insurance plans, it .

Many of the conditions prioritized in the funding notice deserve attention, said Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who helped write updated guidelines for the family planning program. But they fall outside the scope of what Title X can realistically provide.

“There’s not even enough funding to support the core premise of contraception,” Romer said. “And so, if you want to expand Title X funding, you can expand the scope, but you can’t move away from the foundation.”

The emergence of an anticontraception ideology within federal health policy is striking, she said, given how broadly the public supports access to birth control. Eight in 10 women of childbearing age surveyed by KFF in 2024 reported having in the previous 12 months.

Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, said, “If contraception is sidelined in Title X, it won’t just change language on paper but will show up as fewer options and more barriers for patients.” Funding could move away from providers who offer a full range of contraceptive care, she added, “toward organizations that are ideologically opposed to contraception and don’t deliver the same standard of health care services.”

The Stakes Are High

The United States already has one of the highest maternal mortality rates among wealthy nations — as of 2024. According to the CDC, in the U.S. may be preventable. Medical research shows that pregnancy carries substantially higher risks of blood clots, stroke, and cardiovascular complications than hormonal contraception.

And since the Supreme Court’s Dobbs decision in 2022, which overturned the constitutional right to abortion established by Roe v. Wade, access to abortion has been significantly curtailed across much of the country. While national abortion numbers have risen, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated , disproportionately among young women and women of color.

Dr. Christine Dehlendorf, who directs the Person-Centered Reproductive Health Program at the University of California-San Francisco, said “there is absolutely no evidence for any positive outcome of restricting access to contraception.” Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.

Since Trump returned to office, more than a dozen Title X grantees have had their grants frozen, forcing some health centers to stop delivering services, lay off staff, or close. During the first Trump administration, regulatory changes led to a decline in Title X participation from more than . The program grew slowly under the Biden administration, reaching about 3 million clients, before the current round of disruptions began.

The second Trump administration’s overhaul of the program, Marcella said, “directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It’s bad policy.”

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Científicos familiarizados con el proceso esperan que los CDC publiquen muchos más datos en las próximas semanas, lo que permitirá ver si Estados Unidos ha perdido su estatus de país libre de sarampión, logrado con tanto esfuerzo.

Los CDC retuvieron los datos durante meses mientras un equipo golpeado por despidos masivos y renuncias organizaba la información.

Pero ahora que los científicos de la agencia publicaron su primer lote de genomas completos del sarampión —el “mapa genético” de los virus—, el resto “debería empezar a fluir más fácilmente y a un ritmo más rápido”, dijo Kristian Andersen, virólogo evolutivo del Scripps Research Institute, que no participa en el trabajo de los CDC, pero lo sigue de cerca.

Los CDC no respondieron a las consultas de ���ϳԹ��� News sobre cuándo planean publicar los datos o análisis de la investigación. Sin embargo, una vez que toda la información sea pública, los científicos podrán hacer rápidamente que indiquen si los brotes registrados a lo largo del país el año pasado se debieron a la propagación continua entre estados o a casos aislados importados del extranjero.

Si se verifica que hubo transmisión continua durante un año, eso significa que Estados Unidos perdió su estatus de país libre de sarampión. Ese estatus, que mantiene desde el año 2000, es reflejo de las tasas de vacunación: dos dosis de la vacuna triple viral (sarampión, paperas y rubéola) previenen la mayoría de las infecciones y frenan la propagación de los brotes.

Los análisis más detallados toman semanas.

“En abril ya deberíamos tener un informe”, sostuvo Andersen, “en el caso de que no haya interferencias políticas”.

Esta es la primera vez que Estados Unidos aplica técnicas genómicas sofisticadas al sarampión, una enfermedad que prácticamente había desaparecido del país desde hacía unos 25 años gracias a la alta cobertura de vacunación.

La desinformación, la , y también los recortes presupuestarios y la respuesta tardía a los brotes durante la administración Trump han impulsado el resurgimiento de la enfermedad. Con al menos 2.285 casos en 44 estados, 2025 fue el peor año para el sarampión en más de tres décadas. Y este año va camino a superarlo, con 1.575 casos hacia fines de marzo.

Aunque valoran los datos científicos, los investigadores coinciden en que la prioridad del gobierno debería ser frenar la propagación del virus.

“Creo que es sumamente importante realizar la secuenciación del genoma completo cuando se presentan�� brotes. Pero, en realidad, no deberíamos tener que hacerlo en el caso del sarampión, ya que contamos con una vacuna extremadamente eficaz y segura”, señaló Andersen.

“El solo hecho de que estemos hablando de esto es una locura”, agregó.

Robert F. Kennedy Jr., secretario de Salud y Servicios Humanos (HHS), y otros funcionarios del gobierno “deberían dar la alarma por el regreso del sarampión y lanzar campañas de vacunación a nivel nacional”, explicó Rekha Lakshmanan, directora ejecutiva de , una organización sin fines de lucro de Houston que promueve el acceso a las vacunas.

“Aplaudo los avances científicos, pero lo más urgente es controlar el sarampión lo antes posible”, insistió.

En cambio, altos funcionarios han minimizado la gravedad de la enfermedad, y en los CDC de Kennedy se ha dado un nuevo impulso a ideas falsas sobre las vacunas. Esto incluye modificaciones repentinas en la información que brindan los sitios web de los CDC.

Según las asociaciones médicas, estas creencias no se basan en evidencia científica y ponen vidas en riesgo.

Kennedy sigue promoviendo medicamentos no probados que pueden hacer que los padres piensen que pueden dejar de vacunar a sus hijos sin consecuencias.

En el podcast , a fines de febrero, Kennedy habló largo rato sobre medidas para mejorar la salud en Estados Unidos, pero no mencionó las vacunas. Dijo que las medidas preventivas podrían incluir “la medicina holística, tomar vitaminas o tomar vitamina D, que, como se sabe, es casi milagrosa”.

“El riesgo de sarampión sigue siendo bajo para la mayor parte de Estados Unidos”, escribió Emily Hilliard, vocera del HHS. “Los CDC han puesto a disposición $8,5 millones para apoyar la respuesta a los brotes de sarampión en siete jurisdicciones”, expresó. “Los CDC, los principales funcionarios del HHS y el secretario han sido claros en que la vacuna triple viral (MMR) es la mejor forma de protegerse contra el sarampión”.

1.000 genomas

En diciembre, los CDC recurrieron a uno de los principales centros de secuenciación de virus del país, el Broad Institute, en Cambridge, Massachusetts. Importantes brotes de sarampión en Texas, Utah y South Carolina fueron causados por el mismo tipo de virus, identificado como D8-9171. Pero dado que este mismo tipo también circula en Canadá y México, los investigadores necesitan más datos para determinar si la propagación se produjo entre estados o si el virus ingresó a Estados Unidos desde el exterior en diferentes oportunidades.

La secuenciación del genoma completo aporta esa información porque los virus van cambiando con el tiempo. El virus del sarampión sufre una mutación cada dos a cuatro transmisiones entre personas, explicó Bronwyn MacInnis, directora de vigilancia de patógenos en el Broad Institute.

“Hay suficientes indicios en estos datos para desentrañar las cuestiones que nos ocupan”, dijo MacInnis. “La principal es si hay transmisión sostenida dentro del país”.

El equipo de MacInnis trabajó horas extra para secuenciar los genomas completos de virus del sarampión inactivados que se habían recogido en distintos estados en 2025 y 2026.

“Hemos analizado alrededor de unas 1.000 muestras y entregado los datos genómicos a los CDC, enviándolos de forma continua desde diciembre”, contó Bronwyn MacInnis. “Les corresponde a los CDC publicar esos datos”, explicó.

Los CDC no publicaron ni uno solo de esos genomas hasta fines de marzo, cuando aparecieron ocho en una base de datos pública del Centro Nacional de Información Biotecnológica (NCBI, por sus siglas en inglés). Para el 1 de abril, se habían subido otros 154.

“Los datos deberían estar publicados en el NCBI dentro de las dos semanas desde que se obtienen, y cuando hay un brote activo, desde luego, no deberían tardar más de un mes”, opinó Kristian Andersen.

Los datos genómicos contienen pistas sobre cómo comienzan y se propagan los brotes. Esta información permite que los investigadores desarrollen pruebas, tratamientos y vacunas, y también ayuda a detectar variantes que podrían evadirlos.

Ese tipo de datos fueron claves durante la pandemia de covid. Científicos de China y Australia el 10 de enero de 2020, apenas de haberlo secuenciado.

“Definitivamente la publicación de los datos genéticos del sarampión no debería llevarle meses a los CDC”, señaló Eddie Holmes, el virólogo australiano que colaboró en la publicación de la primera secuencia del coronavirus.

Una de las razones de la demora es que el laboratorio de sarampión de los CDC quedó con muy poco personal por los despidos masivos y otras turbulencias que sufrió la agencia durante el último año, dijo a ���ϳԹ��� News un científico de los CDC (���ϳԹ��� News aceptó no identificarlo por temor a represalias).

Otra razón, agregó el investigador, es la curva de aprendizaje: hasta ahora, los CDC y los departamentos de salud no habían tenido que secuenciar cientos de genomas completos de sarampión.

A diferencia de los CDC, el Laboratorio de Salud Pública de Utah ha compartido rápidamente los genomas del sarampión. La mayoría de los aproximadamente 970 genomas publicados en línea desde el 1 de enero de 2025 fueron secuenciados por ese estado. Las muestras provenían de Utah, Arizona, Carolina del Sur y otros estados dispuestos a compartirlas.

“Solo tenemos unas pocas muestras de Texas, recogidas más o menos en mitad del brote”, informó Kelly Oakeson, investigadora en genómica del Departamento de Salud y Servicios Humanos de Utah. Aunque son similares, los genomas de los virus del sarampión detectados en Texas y Utah presentan algunas diferencias. “Esto indica que faltan variantes intermedias del virus”, explicó Oakeson.

Si el código genético de los virus recogidos hacia el final del brote en Texas se parece más al de los de Utah, eso indicaría que la transmisión fue continua y que Estados Unidos podría haber perdido su estatus de país libre de sarampión. Los centenares de secuencias genómicas que aún se encuentran en los CDC probablemente contengan la respuesta.

Esperando a los CDC

Los CDC tenían previsto terminar su investigación antes de abril, según dijo Daniel Salas, director ejecutivo del programa de inmunización de la Organización Panamericana de la Salud (OPS), que trabaja con la Organización Mundial de la Salud (OMS). La OPS tenía previsto evaluar en ese momento la situación del sarampión en Estados Unidos.

Salas explicó que la entidad postergó la evaluación hasta la reunión anual de la organización, que será en noviembre, en parte porque los CDC necesitaban más tiempo para realizar el análisis genómico y porque también se está revisando la situación del sarampión en México, Bolivia y otros países. Celebrar reuniones escalonadas para cada país resulta poco práctico, agregó.

Estados Unidos es el único país que utiliza la secuenciación del genoma completo para responder si mantuvo la eliminación del sarampión, señaló Salas. Por lo general, los países clasifican los virus del sarampión según un pequeño fragmento de sus genes y luego asumen que los grandes brotes causados por el mismo tipo están relacionados.

Los genomas completos ofrecen una visión más precisa.

“Si Estados Unidos puede llenar los vacíos con datos genómicos, supone una suerte de avance”, dijo Salas. “Eso no significa que otros países vayan a ser capaces de implementar este tipo de análisis”, añadió. “Se necesitan muchos conocimientos especializados y recursos”.

El equipo para secuenciar y analizar genomas cuesta más de $100.000, y el costo de procesar cada muestra, incluyendo el pago a los investigadores, suele oscilar entre $100 y $500 por secuencia.

“Estoy a favor de la ciencia, pero no deberíamos tener que hacer esto”, dijo Theresa McCarthy Flynn, presidenta de la Sociedad de Pediatría de Carolina del Norte. “No tenemos por qué sufrir una epidemia de sarampión”.

Flynn contó que muy seguido recibe preguntas de padres preocupados por la desinformación difundida por Kennedy y los grupos antivacunas, incluido el que fundó el mismo secretario antes de incorporarse al gobierno de Trump. Los padres también han señalado cambios en las recomendaciones de los CDC y en el sitio web que contradicen el consenso científico.

Antes de que Kennedy asumiera, afirmaba en letras grandes que “las vacunas no causan autismo” y enumeraba que refutaban la existencia de una relación entre las vacunas y los trastornos del desarrollo.

El año pasado, el pasó a afirmar que “Las�� autoridades sanitarias han ignorado los estudios que respaldan la relación entre las vacunas y los trastornos de desarrollo”.

Las publicaciones científicas rigurosas fueron sustituidas por el informe de un único investigador vinculado a grupos antivacunas.

En un correo electrónico enviado a ���ϳԹ��� News, la vocera del HHS, Hilliard, repitió las erróneas afirmaciones sobre las vacunas publicadas en el sitio web, ignorando la amplia evidencia científica sobre el tema.

Flynn de la asociación pediátrica aseguró: “No puedo exagerar la gravedad de que los propios CDC estén difundiendo información errónea sobre las vacunas”.

Aunque el director en funciones de los CDC, Jay Bhattacharya, afirma que las vacunas son la mejor forma de prevenir el sarampión, él también ha socavado la política de vacunación. Por ejemplo, dijo que la polémica de reducir el número de vacunas recomendadas a los niños se basaba en “ciencia de referencia”. De hecho, el nuevo calendario convierte a Estados Unidos en entre naciones pares.

Hilliard escribió que el calendario actualizado estaba “alineando las directrices de Estados Unidos con las normas internacionales”.

El mes pasado, en respuesta a una demanda presentada por la Academia Americana de Pediatría y otros grupos, un tribunal federal dejó sin efecto temporalmente el nuevo calendario.

Bhattacharya no ha realizado conferencias ni con la prensa ni públicas sobre el repunte del sarampión este año ni tampoco activó los recursos de emergencia de los CDC.

“Normalmente, haríamos una gran campaña para aumentar las tasas de vacunación en las zonas donde son bajas. También haríamos una gran campaña en las redes sociales, publicaríamos anuncios sobre vacunación”, aseguró otro científico de los CDC con quien ���ϳԹ��� News también acordó no revelar su identidad.

“El personal de los CDC quiere hacer campañas, pero los funcionarios políticos de la agencia no lo permiten”, dijo.

Además, los recortes y retrasos de los fondos de salud pública aplicados por el gobierno de Trump han dificultado que las autoridades locales protejan a sus comunidades.

Philip Huang, director de Salud y Servicios Humanos del condado de Dallas, en Texas, dijo que el departamento perdió más de $4 millones cuando el gobierno federal retiró unos $11.000 millones de los departamentos de salud a principios del año pasado, justo cuando se producía un brote de sarampión en el estado.

“Perdimos a 27 empleados y tuvimos que cancelar más de 20 de nuestras campañas de vacunación comunitaria, incluidas las dirigidas a escuelas que ya tenían bajas tasas de vacunación. Se están produciendo ataques simultáneos contra las vacunas que dificultan nuestro trabajo”, afirmó.

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The Trump administration this week missed a deadline to nominate a new director for the Centers for Disease Control and Prevention. Without a nominee, current acting Director Jay Bhattacharya — who is also the director of the National Institutes of Health — has to give up that title, leaving no one at the helm of the nation’s primary public health agency.��

Meanwhile, a week after one federal judge blocked changes to the childhood vaccine schedule made by the Department of Health and Human Services, another blocked a proposed ban on gender-affirming care for minors.��

This week’s panelists are Julie Rovner of ���ϳԹ��� News, Rachel Cohrs Zhang of Bloomberg News, Lizzy Lawrence of Stat, and Shefali Luthra of The 19th.

Panelists

Among the takeaways from this week’s episode:

• A federal judge ruled against the Trump administration’s declaration intended to limit trans care for minors, though the ruling’s practical effects will depend on whether hospitals resume such care. And a key member of the remade federal vaccine advisory panel resigned as the panel’s activities — and even membership — remain in legal limbo.
• Two senior administration health posts remain unfilled, after President Donald Trump missed a deadline to fill the top job at the Centers for Disease Control and Prevention — and the Senate made little progress on confirming his nominee for surgeon general.
• The percentage of international graduates from foreign medical schools who match into U.S. residency positions has dropped to a five-year low. That’s notable given immigrants represent a quarter of physicians, many of them in critical but lower-paid specialties such as primary care — particularly in rural areas. Meanwhile, new surveys show that more than a quarter of labs funded by the National Institutes of Health have laid off workers and that federal research funding cuts have had a disproportionate effect on women and early-career scientists.
• And new data shows the number of abortions in the United States stayed relatively stable last year, for the second straight year — largely due to telehealth access to abortion care. And a vocal opponent of abortion in the Senate, with his eyes on a presidential run, introduced legislation to effectively rescind federal approval for the abortion pill mifepristone.

Also this week, Rovner interviews Georgetown Law Center’s Katie Keith about the state of the Affordable Care Act on its 16th anniversary.

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

Julie Rovner: Stat’s “,” by John Wilkerson.��

Shefali Luthra: NPR’s “,” by Tara Haelle.��

Lizzy Lawrence: The Atlantic’s “,” by Nicholas Florko.��

Rachel Cohrs Zhang: The Boston Globe’s “,” by Tal Kopan.��

Also mentioned in this week’s podcast:

• Stat’s “,’” by Jonathan Wosen.
• ���ϳԹ��� News’ “Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare,” by Sam Whitehead.
• Guttmacher’s “,” by Isaac Maddow-Zimet and Kimya Forouzan.
• United for Medical Research’s “.”

[Editor’s note:��This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]��

Julie Rovner:��Hello,��from ���ϳԹ��� News and WAMU Public Radio in Washington, D.C. Welcome to��What the Health?��I’m��Julie Rovner, chief Washington correspondent for ���ϳԹ��� News, and��I’m��joined by some of the best and smartest reporters��covering��Washington.��We’re��taping this week on Thursday,��March 26,��at 10��a.m.��As always, news happens fast, and things might have changed by the time you hear this. So,��here we go.��

Today,��we are joined via video conference by Rachel��Cohrs Zhang��of Bloomberg News.��

Rachel Cohrs Zhang:��Hi,��everybody.��

Rovner:��Shefali Luthra��of��The��19th.��

Shefali Luthra:��Hello.��

Rovner:��And Lizzy Lawrence of Stat News.��

Lizzy Lawrence:��Hello.��

Rovner:��Later in this episode��we’ll��have my interview with Katie Keith of Georgetown University about the state of the Affordable Care Act as it turns 16��—��old enough to drive in most states. But first,��this week’s news.��

So,��it has been another busy week at the Department of Health and Human Services. Last week, a federal judge in Massachusetts blocked the department’s vaccine policy,��ruling it had violated federal administrative procedures��regarding��advisory committees. This week, a federal judge in Portland, Oregon,��ruled the department also��didn’t��follow the required process to block federal reimbursement for transgender-related medical treatment. The case was brought by 21��Democratic-led states. Where does this leave the hot-button issue of care for transgender teens? Shefali,��you’ve��been following this.��

Luthra:��I mean, I think it’s still really up in the air.��A lot of this depends on how hospitals now respond��—��whether they feel confident in the court’s decision,��having staying��power enough to actually resume offering services.��Because a lot of them stopped.��And so that’s something we’re still waiting to actually see how this plays out in practice.��Obviously,��it’s��very symbolic, very legally meaningful, but whether this will translate into changes in practical health care access, I think, is��an open question still.��

Rovner:��Yeah, we will��definitely have��to see how��this one plays��out��— and,��obviously,��if and when��the administration��appeals��it. Well, speaking of that vaccine ruling from last week��—��which,��apparently,��the��administration has not yet appealed, but is going to��—��one of the most contentious members of that very contentious Advisory Committee on Immunization Practices has resigned. Dr.��Robert Malone, a physician and��biochemist, said he��didn’t��want to be part of the��“drama,”��air quotes.��But he caused a lot of��the drama, didn’t he?��

Cohrs Zhang:��He has been��pretty outspoken, and��I think he��isn’t��like a Washington person necessarily��—��isn’t��somebody��who’s��used to,��like,��being on a public stage and having your social media posts appear in large publications.��So��I think��it’s��questionable, like, whether he had a position to resign from.��I think his nomination��was stayed,��too.��But I think it is��…��the back-and-forth,��I think,��there is a good point that this limbo can be frustrating for people when meetings��are canceled��at��the last minute, and people have travel plans,��and it does��…��just changes the calculus for kind of making it worth it to serve on one of these advisory committees.��

Rovner:��And I’m not sure whether we mentioned it last week, but the judge’s ruling not only said that the people were incorrectly appointed to ACIP, but it also stayed any meetings of the advisory committee until there is further court action, until basically, the case is done or it’s overruled by a higher court. So��…��vaccine policy��definitely is��in limbo.����

Well, meanwhile, yesterday was the deadline for the administration to nominate someone to head the Centers for Disease Control and Prevention since Susan��Monarez��was abruptly dismissed, let��go, resigned, whatever, late last summer. Now that that deadline has passed, it means that acting��Director Jay Bhattacharya, who had added that title to his day job as head of the National Institutes of Health,��can no longer��remain��acting��director of CDC.��Apparently, though��he’s��going to��sort of remain��in charge, according to HHS spokespeople, with some authorities reverting to��[Health and Human Services]��Secretary��[Robert F.]��Kennedy��[Jr.].��What’s��taking so long to find a CDC director?����

To quote D.C.��cardiologist and frequent cable TV health policy commentator��,��“The problem here is that��there’s��no candidate��who’s��qualified, MAHA acceptable, and Senate confirmable. Those job requirements are mutually exclusive.”��That feels kind of accurate to me.��Is that actually��the��problem?��Rachel, I see you smiling.��

Cohrs Zhang:��Yeah.��I think it is tough to find somebody who checks all of those boxes.��And though it has been��210 days��since the clock��has started, I would just point out that there has been a significant leadership shake-up at HHS, like among the people who are kind of running this search, and they came in, you know, not that long ago.��It’s��only been, you know,��a��month and a half or so.��So��I think there certainly have been some��new faces��in the room who might have different opinions.��But��I think it��isn’t��a good look for them to miss this deadline when they have this much notice. But I think��there’s��also, like,��legal experts that��I’ve��spoken with��don’t��think that��there’s��going to be a huge��day-to-day��impact on the operations of the CDC. It��kind of reminds��me of that office where there’s,��like,��an��“assistant��to��the��regional��manager vibe”��going on, where, like,��Dr.��Bhattacharya is now acting in the capacity of CDC director, even though he��isn’t��acting��CDC director��anymore. So,��I think I��don’t��know that��it’ll��have a huge��day-to-day��impact, but it is��kind of hanging��over HHS at this point, as they are already struggling with the��surgeon��general nomination,��to get that through the Senate.��So��it just creates this backlog of nominations.��

Rovner:��I’ve��assumed��they’ve��floated some names, let us say, one of which is Ernie Fletcher, the former governor of Kentucky, also a former member of the House Energy and Commerce health subcommittee, with��some certainly medical chops, if not public health chops.��I think��the��head of the health department in Mississippi. There was one other who��I’ve��forgotten, who it is among the names that have been floated��…��

Cohrs Zhang:��Joseph Marine.��He’s��a cardiologist at Johns Hopkins, who has��—��is kind of like in the kind of Vinay Prasad world of critics of the FDA and,��like,��CDC’s covid��booster strategy.��

Rovner:��And yet, apparently, none of them could pass, I guess, all three tests. Do we think it might still be one of them? Or do we think there are other names that are yet��to come?��

Cohrs Zhang:��Our understanding is that there are other candidates whose names have not become public, and I think there’s also a possibility they don’t choose any of these candidates and just drag it on for a while because,��at this point, like, I don’t know what the rush is,��now that the deadline is passed.��

Lawrence:��Yeah, is there another deadline to miss?��

Cohrs Zhang:��I��don’t��think so.��

Lawrence:��I think this��was the only one.��

Cohrs Zhang:��This was the big one that they now have.��It’s��vacant, but it was vacant before as well. Like, I think, earlier in the��administration, when��Susan��Monarez��was nominated.��

Rovner:��But she, well��…��that’s��right, she was the��“acting,”��and then once she was nominated, she��couldn’t��be the acting anymore.��

Cohrs Zhang:��Yeah.��

Rovner:��So��I guess��it��was vacant while she was being considered.��

Cohrs Zhang:��It was.��So��it’s��not an unprecedented situation, even in this administration.��It’s��just not a good��look, I guess. And I think there is value in having a leader that can interface with the White House and with different leaders, and just having a direction for the agency, especially because it’s in Atlanta, it’s a little bit more removed from the everyday goings-on at HHS in general.��So��I think there’s definitely a desire for some stability over there.��

Rovner:��And we have measles spreading in lots more states.��I mean, every time I��…��open up my news feeds, it’s like, oh, now we have measles, you know, in Utah, I think,��in Montana.��Washtenaw County, Michigan,��had its first measles case recently.��So��this is something that the CDC should be on top of, and yet there is no one on top of the CDC. Well, Rachel, you already alluded to this, but it is also apparently hard to find a surgeon general who’s both acceptable to MAHA��and Senate confirmable, which is my way of saying that the Casey��Means nomination still appears to lack the votes to move out of the Senate, Health, Education, Labor��&��Pensions Committee. Do we have any latest��update��on that?��

Cohrs Zhang:��I think the latest update, I mean, my colleagues at Bloomberg Government just��kind of had��an update this week that��they’re��still not to��“yes” —��like,��there are some key senators that still��haven’t��announced their positions publicly.��So��I think a lot of the same things that��we’ve��been hearing��…��like��Sens.��Susan Collins and��Lisa Murkowski and Bill Cassidy obviously have not��stated��their positions publicly on the nomination.��Sen.��Thom Tillis, who you��know��is kind of in a lame-duck scenario and doesn’t really have anything to lose, has, you know, said he’s not really made a decision.��So��I think they’re kind of in this weird limbo where they, like, don’t have the votes to advance her, but they also have not made a decision to pull the nomination at this time. So either, I think,��they have to push harder on some of these senators, and I think senators see this as a leverage point that I don’t know that a lot of��—��that all of the complaints are about Dr.��Means specifically, but anytime that there is frustration with the wider department, then this is an opportunity for senators to have their voice heard, to��…��potentially extract some concessions. And��so��there’s��a question right now, are they going to change course again for this position, or are they going to, you know, sit down at the bargaining��table��and really cut some deals to advance her nomination? I just��don’t��think we know the answer to that yet.��

Rovner:��Yeah,��it’s��worth reminding that,��frequently,��nominations get held up for reasons that are totally disconnected from the person involved. We went��—��I should go back and look this up��— we went, like, four years in two different administrations without a confirmed head of the Centers for Medicare��&��Medicaid��Services because members of Congress were angry about other things, not because of any of the people who had actually been nominated to fill that position. But in this case, it does seem to be, I think,��both Casey��Means and,��you know, her connection to��MAHA,��and the fact that among those who haven’t declared their positions yet,��it’s the chairman of the committee, Bill Cassidy, who’s in this very tight primary to keep his seat.��So��we will keep��on that one.����

Also, meanwhile, HHS continues to push its��Make America��Healthy��Again priority. Secretary Kennedy hinted on the Joe Rogan podcast last month that the FDA will soon take unspecified action to make customized peptides easier to obtain from compounding pharmacies. These��mini-proteins��are part of a biohacking trend that many MAHA��adherents say can��benefit��health,��despite their not having been shown to be safe and effective in the normal FDA approval process. The FDA��has��also��formally��pulled��a proposed rule that would have banned teens from using tanning beds. We know that the��secretary is a fan of tanning salons, even though that��has��been shown to cause potential health problems,��like skin cancer. Lizzy,��is Kennedy just going to push as much MAHA��as he can until the courts or the White House stops him?��

Lawrence:��I guess so. I mean, we do have this new structure at HHS��now that’s trying to��—��clearly��…��there are warring factions with the MAHA agenda and the White House really trying to focus more on affordability and less on��…��vaccine scrutiny and the medical freedom movement that is really popular among Kennedy’s supporters.��…��I’m��very curious about��what’s��going to happen with peptides, because��it’s��a sign of Kennedy’s regulatory philosophy, where��there’s��some products that are good and some that are bad.��It’s��very atypical, of course, for��…��

Rovner:��And that he gets��to decide��rather than the scientists, because he��doesn’t��trust the scientists.��

Lawrence:��Right. Right.��But there has been, I mean, the FDA has kind of been pretty severe on GLP-1��compounders��Hims��&��Hers, so it’ll be interesting to see, you know, how much Kennedy is able to exert his will here, and how much FDA regulators will be able to push back and make their voices heard.��

Rovner:��My favorite piece of FDA��trivia��this week is that FDA is posting the jobs that are about to be vacant at the vaccine center, and one of the things that it actually says in the job description is that you don’t have to be immunized. I��don’t��know if��that’s��a signal or what.��

Lawrence:��Yeah,��I think it��said no telework, which Vinay Prasad famously was teleworking from San Francisco. So,��yeah, I��don’t��know.��But��this��was,��I think it��was for his deputy, although��I’m��sure, I mean, they do need a CBER��[Center for Biologics Evaluation and Research]��director as well.��

Rovner:��Yeah,��there’s��a lot of openings right now at HHS.��All right,��we’re��gonna��take a quick break. We will be right back.��

So��Monday was the 16th anniversary of the signing of the Affordable Care Act, which we will hear more about in my interview with Katie Keith.��But I wanted to highlight a��story by my��KFF��Health��News colleague Sam Whitehead��about older Americans nearing Medicare eligibility putting off preventive and other care until they qualify for federal coverage that will let them afford it. For those who listened to my interview last week with Drew Altman, this hearkens back to one of the big problems with our health system. There are so many quote-unquote��“savings”��that are��actually just��cost-shifting, and often that cost-shifting raises costs overall. In this case, because those older people can no longer afford their insurance or their deductibles,��they put off care until it becomes more expensive to treat. At that point,��because��they’re��on Medicare, the��federal taxpayer will foot a bill��that’s��even bigger than the bill that would have been paid by the insurance company.��So��the savings taxpayers gained by Congress cutting back the Affordable Care Act subsidies are lost on the Medicare end. Is this cost-shifting the inevitable outcome of addressing everything in our health care system except the actual prices of medical care?��

Cohrs Zhang:��I think��it’s��just another example of how people’s behavior responds to these weird incentives. And I think��we’re��seeing this problem, certainly among early retirees,��exacerbated��by the��expiration��of the Affordable Care Act subsidies that��we’ve��talked about very often on this podcast, because it affects these higher earners, and it can dramatically increase costs for coverage. And��I think people��just hope that they can hold on. But again, these��statutory deadlines that lawmakers make up sometimes,��not with a lot of forethought or rational��reasoning,��they have consequences.��And obviously, the Medicare program continues to pay beyond age 65 as well.��And I think��it’s��just another symptom of what the administration talks about when they talk about emphasizing, you know, preventative care and addressing chronic conditions��—��like,��that is a real problem. And,��yeah, I think��we’re��going to see these problems in this population continue to get worse as more people forgo care, as it becomes more expensive on the individual markets.��

Luthra:��I think you��also make a good point, though, Julie, because the increase in costs and cost sharing is not limited to people with marketplace plans, right? Also, people with employer-sponsored health care are seeing their out-of-pocket costs��go up. Employers are seeing what they pay for insurance��go��up as well. And there absolutely is something to be said about��it’s��been 16 years since the Affordable Care Act��passed,��we��haven’t��really had meaningful intervention on the key source of health care prices, right? Hospitals, providers, physicians. And it does seem, just thinking about where the public is and the politics are, that there is possibly��appetite��around this. You see a lot of talk about affordability, but a lot of��this feels, at least as an observer,��very focused��on insurance, which makes sense. Insurance is��a very easy��villain to cast.��But I think you’ve raised a��really good point:��that addressing these really potent burdens on individuals and eventually on the public just requires something��more systemic and more serious if we actually want to yield better outcomes.��

Rovner:��Yeah, there’s just, there’s so much passing the hat that, you know,��I don’t want to do this,��so��you��have to do this.��You know, inevitably, people need health care.��Somebody has to pay for it.��And I think that’s��sort of the��bottom line that nobody really seems to want to address.��

Well, the other theme of 2026 that I feel like I keep repeating is what funding cutbacks and other changes are doing to the future of the nation’s biomedical and medical workforces. Last week was Match Day.��That’s��when graduating medical school seniors find out if and where they will do their residency training. One big headline from this year’s match is that the percentage of non-U.S.��citizen graduates of foreign medical schools matching to a U.S.��residency position fell to a five-year low of 56.4%.��That compares to a 93.5% matching rate for U.S.��citizen graduates of U.S.��medical schools. Why does that matter? Well, a quarter of the U.S.��physician workforce are immigrants, and they are disproportionately represented, both in lower-paid primary care specialties, particularly in rural areas, both of which��U.S.��doctors tend to find less desirable. This would seem to be the result of a combination of new fees for visas for foreign professionals that��we’ve��talked about, a general reduction in visa approvals,��and some people��likely not��wanting to even come to the U.S.��to practice. But that rural health fund that Republicans say will revitalize rural health care��doesn’t��seem like��it’s��really going to work without an adequate number of doctors and nurses, I would humbly suggest.��

Lawrence:��Yeah, absolutely. I mean,��it’s��patients that suffer, right? I mean, you need the people doing the work. And��so��I think that the impacts will start being felt sooner rather than later. That is something that hopefully people will start to feel the pain from.��

Rovner:��I feel like when people think about the immigrant workforce, they think about lower-skilled, lower-paid jobs that immigrants do, and they don’t think about the fact that some of the most highly skilled, highly paid jobs that we have, like being doctors, are actually filled by immigrants, and that if we cut that back, we’re just going to exacerbate shortages that we already know we have.��

Luthra:��And training doctors takes, famously,��a very long��time. And��so��if you are disincentivizing people from coming here to practice, cutting off this key source of supply,��it’s��not as if you can��immediately��go out and say,��Here,��let’s��find some new people and make them doctors. It will take years to make that tenable, make that attractive,��and make that a reality. And it just seems,��to Lizzy’s point,��that even in the scenario where that was possible��—��which I would be somewhat doubtful;��medicine is a hard and difficult career;��it’s not like you can make someone want to do that overnight��—��patients will absolutely see the consequences. I��don’t��know if��it’s��enough to change how people think about immigration policy and ways in which we recruit and engage with immigrant workers, but��it’s��absolutely something that should be part of our discussion.��

Rovner:��Yeah, and I think��it’s��been left out.��Well,��meanwhile,��over at the National Institutes of Health, a��,��Lizzy,��found that more than a quarter have laid off laboratory workers. More than��2��in��5��have canceled research,��and two-thirds have counseled students to consider careers outside of academic research. A separate study published this week found that women and early-career scientists have been disproportionately affected by the NIH cuts, even though most of the money goes to men and to later-career scientists. As I keep saying,��this��isn’t��just about the��future of science. Biomedical research is a��huge piece of the U.S.��economy. Earlier this month, the group��United for��Medical��Research��,��finding��that every dollar invested produced $2.57 for the economy. Concerned members of Congress from both parties last week at an appropriations hearing got NIH Director Jay Bhattacharya to again promise to push all the money that they appropriated out the door.��But��it’s��not clear whether��it’s��going to continue to compromise the future workforce. I feel like, you know, we talk about all these missing people and nomination stuff, but��we’re��not really talking a lot about��what’s��going on at the National Institutes of Health, which is a, you know, almost��$50 billion-a-year enterprise.��

Lawrence:��Right.��In some labs, the damage has already been done. You��know, even if Dr.��Bhattacharya��[follows through],��try spending all the money that has been appropriated. There are young��researchers that have been shut out and people that have had to choose alternative career paths. And��I think this��is one of those things��that’s��difficult politically or, you know, in��the public��consciousness, because it is hard to see the immediate impacts��it’s��measured. And I think my colleague Jonathan wrote��[that]��breakthroughs��are��not��discovered��things, you know.��So��it’s��hard to know what��is being missed.��But the immediate impact of the workforce and��not missing this whole generation of scientists that has decided to go to another country or go to do something else, those impacts will be felt for years to come.��

Rovner:��Yeah, this is another one where you��can’t��just turn the spigot back on and have it��immediately��refill.����

Finally, this week, there is always��reproductive��health��news. This week,��we got the Alan Guttmacher Institute’s����for the year 2025,��which both sides of the debate consider the most accurate, and it found that for the second year in a row, the number of abortions in the U.S.��remained relatively stable, despite the fact that it’s outlawed or seriously restricted in nearly half the states.��Of course, that’s because of the use of telehealth, which abortion opponents are furiously trying to get stopped, either by the FDA itself or by Congress.��Last week, anti-abortion Sen.��Josh Hawley of Missouri introduced legislation that would��basically rescind��approval for the abortion pill mifepristone. But that legislation is��apparently giving��some Republicans in the Senate heartburn, as they really��don’t��want to engage this issue before the midterms.��And,��apparently,��the��Trump administration��doesn’t��either, given what we know about the FDA saying that��they’re��still studying this.��On the other hand, Republicans��can’t��afford to lose the backing of the anti-abortion activists either.��They put lots of time, effort,��and money into turning out votes, particularly in times like midterms. How big a controversy is this becoming, Shefali?��

Luthra:��This is a huge controversy, and��it’s��so interesting to watch this play out. When I saw Sen.��Hawley’s bill, I mean, that stood out to me as positioning for 2028.��He clearly wants to be a favorite among the anti-abortion��movement��heading into a future presidential primary. But at the same time, this is teasing out��really potent��and powerful dynamics among the anti-abortion movement and Republican lawmakers,��exactly what you said. Republican lawmakers know this is not popular. They do not want to talk about abortion, an issue at which they are at a huge disadvantage��with��the public. Susan B Anthony��List and other such organizations are trying to make the argument that if they are taken for granted,��as they feel as if they are, that will result in an enthusiasm gap.��Right? People will not turn out. They will not go door-knocking,��they��won’t��deploy their tremendous resources to get victories in a lot of these contested,��particularly Senate and House,��races. And obviously, the��president cares a lot about the midterms.��He’s��very concerned��about what happens��when��Democrats take control of Congress. But I think what Republicans are wagering, and��it’s��a fair thought, is that where would anti-abortion activists go? Are they going to go to Democrats,��who��largely support��abortion rights? And a lot of them seem confident that they would rather risk some people staying home and,��overall, not alienating a very large sector of the American public that does not support restrictions on abortion nationwide, especially those that many are concerned are not in keeping with the actual science.��

Rovner:��Yeah, I think the White House, as you said, would like to make this not front and center, let’s��put it that way,��for the midterms. But��yeah, and just to be clear, I mean, Sen.��Hawley introduced this bill. It��can’t��pass.��There’s��no way it gets 60 votes in the Senate.��I’d��be surprised if it could get 50 votes in the Senate.��So��he’s��obviously doing this just to turn up the heat on his colleagues, many of whom are not��very happy��about that.��

Luthra:��And anti-abortion activists are already thinking about 2028.��They are, in fact, talking to people like Sen.��Hawley, like the��vice��president, like Marco Rubio, trying to figure out who will��actually be��their champion in a post-Trump landscape. And so far, what��I’m��hearing,��is that they are��very optimistic��that anyone else could be better for them than the��president��is because they are just so dissatisfied with how little��they’ve��gotten.��

Rovner:��Although they did get the overturn of��Roe v.��Wade.��

Luthra:��That’s��true.��

Rovner:��But you know, it goes back to��sort of my��original thought for this week, which is that the number of abortions��isn’t��going down because of the��relatively easy��availability of abortion pills by mail. Well, speaking of which, in a��somewhat related��story, a woman in Georgia has been charged with murder for taking abortion pills later in pregnancy than��it’s��been approved for, and delivering a live fetus who��subsequently��died. But the judge in the case has already suggested the prosecutors have a giant hill to climb to convict her and set her bail at $1.��Are we going to see our first murder trial of a woman for inducing her own abortion?��We’ve��been��sort of flirting��with this possibility for a while.��

Luthra:��It seems possible.��I think it’s a really good question, and this moment certainly feels like a possible Rubicon, because going after people who get abortions is just so toxic for the anti-abortion movement.��They have promised they would not go after people who are pregnant, who get abortions.��And this is exactly what they are doing. And��I think what��really stands out to me about this case is so much of it depends on individual prosecutors and individual judges. You have��the law enforcement officials who decided to make this a case, and��they’re��actually using, not the abortion law, even though the language in the case,��right,��really resonates, reflects with the law in Georgia’s��six-week ban. Excuse me, with the��language��in Georgia’s��six-week ban. But then you have a judge who says this is very suspect. And what feels so significant is that your rights and your protection under abortion laws depend not only on what state you live in, but who happens to be the local prosecutor, the local cop, the local judge, and that’s just a level of micro-precision that I think a lot of Americans would be very surprised to realize they live under.��

Rovner:��Yeah, absolutely. We should point out that the woman has been charged but not yet indicted, because many, many people are watching this case very, very carefully.��And we��will��too.��

All right, that is this week’s news. Now��I’ll��play my interview with Katie Keith of Georgetown University Law Center, and then��we’ll��come back with our extra credits.��

I am pleased to welcome back to the podcast Katie Keith. Katie is the founding director of the Center for Health Policy and the��Law at the Georgetown University Law Center and a contributing editor at Health Affairs, where she keeps all of us up to date on the latest health policy, legal happenings. Katie, thanks for joining us again.��It’s��been a minute.��

Katie Keith:��Yeah.��Thanks for having me,��Julie,��and happy ACA anniversary.��

Rovner:��So��you are my��go-to for all things Affordable Care Act, which is why I wanted you this week in particular,��when the health law turned 16. How would you describe the state of the ACA today?��

Keith:��Yeah,��it’s��a great question. So,��the ACA��remains��a hugely important source of coverage for millions of people who do not have access to job-based coverage. I am thinking of��farmers,��and��self-employed people,��and small-business owners.��And you know, in 2025,��more than��24 million people��relied on the marketplaces all across the country for this coverage.��So��it��remains��a hugely��important place��where people get their health insurance. And we are already starting to see real erosion��in��the gains made under the Biden administration��as a result of, I think, three primary changes that were made in 2025.��So��the first would be Congress’��failure to extend the enhanced premium tax credits, which you have covered a ton,��Julie��and the team,��as having��a huge impact��there. The second is the changes from the��One��Big��Beautiful Bill��Act. And then the third is some of the administrative changes made by the Trump administration that��we’re��already seeing.��So��we��don’t��yet have full data to understand the impact of all three of those��things yet.��We’re��still waiting.��But the preliminary data shows that already enrollments��down��by more than a million people.��I’m��expecting that to drop further. There was some��KFF��survey data out last week that about��1��in 10 people are going uninsured from the marketplace already, and that’s not even, doesn’t even account for all the people who are paying more but getting less, which their survey data shows is about, you know,��3��in 10 folks.��So��you know what makes all of this really,��really tough, as you and I have discussed before, is, I think,��2025, was really a peak year. We saw peak enrollment at the ACA. We saw peak popularity of the law, which has been more popular than not ever since 2017,��when Republicans in Congress tried to repeal it the first time.��And��…��but now it feels like we’re sort of on this precipice for 2026,��watching what’s going to happen with the data into this really important source of coverage for so many people.��

Rovner:��And��…��there’s��been so much news that I think��it’s��been hard for people to absorb. You know, in 2017,��when Republicans tried to repeal the Affordable Care Act, they said��that,��We’re��trying to repeal the Affordable Care Act. Well,��the��2025 you know,��“Big,��Beautiful��Bill,”��they��didn’t��call it a repeal, but it had��pretty much the��same impact, right?��

Keith:��It had��a quite��significant impact. And I think a lot,��like,��you know, there was so much coverage about how Democrats in Congress and the White House learned,��in doing the Affordable Care Act, learned from the failed effort of the Clinton health reform in the��’90s. I think similarly here you saw Republicans in Congress, in the White House, learn from the failed effort in 2017 to be successful here. And��so��you’re exactly right. You did not hear any talk of��“repeal and replace,”��by any stretch of the imagination. I think in 2017 Republicans were judged harshly��—��and appropriately so, in my opinion��—��by the��“replace”��portion��of what,��you know, what they were going to do, and it just��wasn’t��there. And��so��you did not see that kind of framing this time around. Instead, it really is an attempt to do death by��a thousand��paper cuts and impose administrative burdens and a real focus on��kind of who��—��you can’t see me, but air quotes,��you know��—��who��“deserves”��coverage and a focus on immigrant populations. So��…��those changes,��when you layer all of them on��—��changes to Medicaid coverage, Medicaid financing, paperwork burdens, all across all these different programs��—��you know, the��One��Big��Beautiful Bill��Act,��it really does erect new barriers that fundamentally change how Medicaid and the Affordable Care Act will work for people. And��so��it’s��not repealed. I think those programs will still be there, but they will look very different than how they have and,��you know, the CBO��[Congressional Budget Office]��at the time, the coverage losses almost��…��they look quite close to, you know, the skinny repeal that we all remember in the middle of the morning��—��early,��like,��late night,��Sen.��John McCain with his thumbs down.��The coverage losses were almost the same,��and you’ve got��the��CBO now saying,��estimating about 35 million uninsured people by 2028,��which,��you know,��is not��…��it’s just��erasing, I think, not all, but a lot of the gains we’ve made over the past 15, now 16,��years under the Affordable Care Act.��

Rovner:��And now the Trump��administration is proposing still more changes to the law, right?��

Keith:��Yep,��that’s��right.��They’re��continuing, I think, a lot of the same.��There’s��several changes that, you know, go back to the first Trump administration that��they’re��trying to reimpose. Others are sort of��new ideas.��I’m��thinking some of the same ideas are some of the paperwork burdens. So really, in some cases, building��off of��what has been pushed in Congress.��What’s��maybe new��this time around for 2027 that��they’re��pushing is a significant expansion of catastrophic plans. So huge, huge, high-deductible plans that,��you know,��really��don’t��cover much until you hit��tens��of��thousands��of dollars in out-of-pocket costs. You get your preventive services and three primary care visits, but��that’s��it.��You’re��on the hook for anything else you might need until you hit these��really catastrophic��costs.��They’re��punting to��the states on core things like network adequacy. You know, again, some of��it’s��sort of new. Some of��it’s��a throwback to the first Trump administration, so not as surprising. And then on the legislative front, I��don’t��know what the prospects are, but you do continue to see President��[Donald]��Trump call for, you know,��health��savings��account expansions. We think, I think, you know, the idea is to send people money to buy coverage, rather than send the money to the insurers, which I think folks have interpreted as health savings accounts.��There’s��a continued focus on funding cost-sharing reductions, but that issue continues to be snarled by abortion restrictions across the country. So��that’s��something that continues to be discussed, but I��don’t��know if it will ever happen. And you know anything else that’s��kind of under��the so-called��Great��Healthcare��Plan that the White House has put out.��

Rovner:��You mentioned that 2025 was the peak not just of enrollment but of popularity.��And we have seen in poll after poll that the changes that the Trump administration��and��Congress��is��making are not popular with the public, including��the vast majority of��independents and many, many Republicans as well. Is there any chance that Congress and President Trump might relent on some of these changes between now and the midterms?��We did see a bunch of Republicans, you know, break with the rest of the party to try to extend the, you know, the enhanced premiums. Do you see any signs that��they’re��weakening��or��are��we off onto other things entirely��right now?��

Keith:��It’s��a great question.��I think you��probably need��a different analyst to ask that��question to. I��don’t��think my crystal ball covers those types of predictions. But to your point, Julie, I thought that if there would have been time for a compromise and��sort of a��path forward, it would have been around the enhanced premium tax credits. And it was remarkable, you know, given what the history of this law has been��and��the politics��surrounding it, to see 17 Republicans join all Democrats in the House to vote for a clean three-year extension of the premium tax credits. But no, I think especially thinking about where those enhanced tax credits have had the most benefit, it is states like Georgia, Florida, Texas, and I thought that��maybe would,��could have moved the needle if there was a needle to be moved.��So��I,��it seems like��there’s��much more focus on prescription drugs and other issues, but anything can happen.��So��I guess��we’ll��all��stay tuned.��

Rovner:��Well,��we’ll��do this again for the 17th anniversary. Katie Keith, thank you so much.��

Keith:��Thanks,��Julie.��

Rovner:��OK,��we’re��back.��It’s��time for our��extra-credit��segment.��That’s��where we each recognize��a��story we read this��week��we think you should read too.��Don’t��worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Lizzy, why don’t you start us off this week?��

Lawrence:��Sure.��So��my extra credit is by��Nick��[Nicholas]��Florko, former��Stat-ian,��in��The Atlantic,��“”��I��immediately��read this��piece, because��this is something��that’s��been driving me��kind of crazy. Just seeing��—��if��you’ve��missed it��—��there have been��…��HHS has been posting AI-generated videos of Secretary Kennedy wrestling a Twinkie,��wearing waterproof jeans,��all of��these things. And this has been, this is not unique to HHS��—��[the]��White House in general has really embraced AI slop as a genre, and I��can’t��look away. And��so��I thought��Nick did��a good job��just acknowledging how crazy this is, and then also what goes��unsaid in these videos.��I think I��personally am just very curious if this resonates with people, or if��it’s��kind of disconcerting��for the average American��seeing these videos like,��Oh, my government is��making��AI slop.��Like I,��you know, social media strategy is so important, so��maybe for��some��people are��really��liking��this. But��yeah,��I’m��just��kind of curious��about public sentiment.��

Rovner:��I know I would say, you know, the National Park Service and the Consumer Product Safety Commission have been��sort of famous��for their very cutesy social media posts, but��not quite to��this extent. I mean,��it’s��one thing to be cheeky and funny. This is��sort of beyond��cheeky and funny.��I agree with you. I have no idea how this is going over the public, but they keep doing it.��It’s a really good story.��Rachel.��

Cohrs Zhang:��Mine is a story in The Boston Globe, and the headline is��“”��by��Tal Kopan.��And this was a really good profile of Tony Lyons, who is Robert F.��Kennedy Jr.’s book publisher, and he’s kind of had the role of institutionalizing all the political energy behind RFK Jr.��and trying to make this into a more enduring political force.��So��I think he��is, like, mostly a behind-the-scenes guy, not really like a D.C.��fixture, more of like a New York book publishing figure.��But I think his efforts and what they’re using, all the money they’re raising for, I think,��is a really important thing to watch in the midterms, and like, whether they can actually leverage this beyond a Trump administration, or beyond however long Secretary Kennedy will be in his position.��So��I think it��was just a good overview of��all the tentacles of institutional MAHA��that are trying to, you know, find their footing here, potentially for the long term.����

Rovner:��I had��never heard of him, so I was glad to read this story.��Shefali.��

Luthra:��My story is from NPR. It is by��Tara��Haelle. The headline is��“.”��Story says exactly what it promises, that if you have an infant, babies��under��6��months, then getting a covid vaccine while you are pregnant will��actually protect��your baby, which is great because there is no vaccine for infants that young. I love this because it’s a good reminder of something that we were starting to see, and now it just really underscores that this is true, and in the midst of so much conversation around vaccines and safety and effectiveness, it’s a reminder that really, really good research can show us that it is a very good idea to take this vaccine, especially if you��are pregnant.��

Rovner:��More fodder for the argument, I guess. All��right,��my extra credit this week is a clever story from��Stat’s John Wilkerson called��“.”��And,��spoiler,��that loophole is that��one way��companies can avoid running afoul of their promise not to charge other countries less for their products than they charge��U.S.��patients is for them to simply delay launching those drugs in those other countries that have price controls.��Already, most drugs are launched in the U.S.��first, and��apparently some��of the companies that have done deals with the administration limited their promises to three years,��anyway. That way they can charge��U.S.��consumers however much they think the market will bear before they take their smaller profits overseas. Like I said,��clever.��Maybe that’s��why so many companies were ready to do those deals.��

All right, that is this week’s show.��As always, thanks to our editor,��Emmarie��Huetteman;��our producer-engineer, Francis Ying;��and our interview producer,��Taylor Cook.��A��reminder:��What the��Health?��is now available on WAMU platforms, the NPR app,��and wherever you get your podcasts, as well as,��of course,��kffhealthnews.org. Also, as always, you can email��us��your comments or questions.��We’re��at��whatthehealth@kff.org.��Or you can still find me on��X����or��on Bluesky��. Where are you folks hanging these days?��Shefali?��

Luthra:��I am on��Bluesky��.��

Rovner:��Rachel.��

Cohrs Zhang:��On��X��, or��.��

Rovner:��Lizzy.��

Lawrence:��I’m��on��X����and����and��.��

Rovner:��We will be back in your feed��next week.��Until then, be healthy.��

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According to a recording obtained by ���ϳԹ��� News, Bhattacharya at one point suggested to CDC staff that Trump could name a new leader for the agency as soon as Thursday. “But if not, I don’t think much will change,” he said.

Though his official position as acting director was set to expire Wednesday, Bhattacharya will continue to lead the agency until the top spot is filled. Meanwhile, news outlets including and reported that the administration was postponing filling the permanent director job amid the challenges of gaining Senate confirmation and other political pressures.

Bhattacharya opened the meeting by acknowledging the struggles the beleaguered agency has gone through over the past year. Workers faced waves of job losses, and a gunman attacked the CDC’s Atlanta campus in August, killing a police officer and causing significant property damage. “I want to acknowledge very honestly that I know that it has been such a difficult year for the CDC and for every single one of you here,” Bhattacharya said.

He said the agency has begun to fill its leadership gaps. During his first meeting with the agency’s top leaders, he said, “I noticed almost every single one of them is acting.”

“We’ve made progress in filling key roles across the agency,” he said. “Leadership stability is essential to delivering our mission.”

The aim, he said, is to leave the agency in “a solid, secure place” so it can do its work “without so much of the turmoil that we’ve seen the last year.”

Bhattacharya invited questions from the CDC staffers, who repeatedly asked about staffing losses, morale, and their job security, as well as Trump’s decision to withdraw from the World Health Organization.

“The politics of WHO withdrawal are above my pay grade,” Bhattacharya said. “What I do know is that without the CDC, the world will be in much worse health.”

Workforce Concerns

One employee told Bhattacharya the agency had lost a “huge amount” of “internal capacity and expertise in the past year” and it “continues to be very challenging for staff to do their jobs,” adding that “certain conditions are a bit demoralizing.”

The CDC can “function without leaders,” another speaker said. “We function without directors. And this entire team will make CDC run without you if you’re not here.”

Schedule F, an effort to reclassify certain federal employees in policy-related roles and reduce their civil service protections, drew some of the strongest statements from the staff. While it’s not fully implemented, the policy could make it easier for Trump to fire thousands of federal workers.

“What’s scaring the hell out of us right now is Schedule F,” an employee said. “We are terrified that ‘at will’ means you’re gone, you’re not here, you’re fired.”

“The Schedule F fight’s above my level,” Bhattacharya replied. He said his focus is on making sure the “work is supported.”

He said the agency should seek to “depoliticize what we do fundamentally” so that “every American sees us as working for their benefit.”

“When I say ‘depoliticize,’ I don’t mean you can’t say the hard or talk about the hard things,” he added. “I mean that you’re free to talk about the hard things without fear that you’re gonna be retaliated against.”

On hiring and operations, he pointed to ongoing efforts but acknowledged delays. The Department of Health and Human Services, which oversees the CDC, is “moving at the speed of bureaucracy,” he said, adding that he’s trying his best. “We have to move past the last year, and I think we now have an opportunity really to do that.”

Vaccine Policy

On vaccines, Bhattacharya said one of the first things he did in his role as acting CDC director was to record a video “strongly encouraging parents to vaccinate their kids from measles.”

He said rebuilding trust requires engagement. That means working with communities without denigrating them, and respecting how “they think and their values,” he said.

Bhattacharya said he would like the NIH and CDC to coordinate more, particularly on HIV prevention. He described his approach as “an implementation science strategy so that we can use these two pieces of the HIV tool kit to actually end the HIV pandemic.”

The search for a permanent CDC director is being led by HHS officials on behalf of the White House and Health and Human Services Secretary Robert F. Kennedy Jr.

Bhattacharya said he’s friends with Kennedy and called “the caricature of him that I’ve seen in the press” unfair. Kennedy “really does have a deep desire to make America healthy,” he said.

For now, Bhattacharya said, he expects to stay in place at the CDC, as “either acting director or acting in the capacity of the director, whatever the heck that means.”

He joked about the ambiguity: “It’s like an Office episode, you know?”

���ϳԹ��� 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 .

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Boim lost her job in the first big wave of CDC firings — more than 1,000 people were last February.

“This is the termination letter. I also printed off my performance review from 2024,” she said. “I knew I wouldn’t have access to it, and everything was so chaotic that I needed proof of what was happening.”

Boim worked in the , handling communications about radon, substances known as forever chemicals, lead poisoning, and other health threats.

Rereading her termination letter, she still can’t believe what it says.

“The agency finds 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,” the emailed letter reads.

“And that floored me,” Boim said, “because my performance was rated outstanding, and I even got a raise. It was just deeply insulting. So I was more upset than I think I was prepared to be.”

The Trump administration later brought back some of the workers who were fired in the first round, but it has also cut more staff and funding.

The CDC has been without a permanent director for more than six months. Recently the Trump administration made Jay Bhattacharya the CDC’s , while he also runs the National Institutes of Health.

The leadership uncertainty comes amid a year of disruption and dismissals at the Atlanta-based institution, from which more than 3,000 public health workers are now gone. That includes staffers the Trump administration terminated and workers who accepted early retirement.

Ripple effects of the turmoil are still hitting the Atlanta region.

By the end of 2025, the CDC had lost roughly a quarter of its workforce.

Boim now works as a contractor in the health field, while also working a non-health-related freelance job. But she mourns the cuts at the CDC, and how the loss of expertise and resources will trickle down to communities. A goes directly to .

“It will cause generational harm, which always makes me tear up,” Boim said. “The harm that’s going to come to people that don’t even know what CDC was protecting them from.”

“But for Atlanta, there’s a lot of us; there are thousands of CDC employees that live here,” she added. “We are your friends, your neighbors, your family, and — with the lost income — it has an impact on local businesses also.”

At the SriThai restaurant across the street from the main CDC campus, more than a third of the customers are CDC employees, said manager Nathan Chanthavong.

The restaurant saw a “small dip” in business in 2025 after the mass firings, and also during the government shutdown, he said.

“Typically, we would get a catering order for the CDC. We saw it less, less, and less. It’s not a really big impact, but catering is a big order; it is a lot of money,” he said. “So it does affect us.”

The CDC falls under the purview of the .

“HHS under the Biden administration became a bloated bureaucracy, growing its budget by 38% and its workforce by 17%,” HHS spokesperson Andrew Nixon said of the cuts and attrition. “The Department continues to close wasteful and duplicative entities, including those that are at odds with the Trump administration’s Make America Healthy Again agenda.”

Since the mass firings began, former CDC workers and their supporters have protested outside the agency’s main entrance during the afternoon rush hour.

On a recent Tuesday, a bigger crowd than usual — about 75 people — lined up along the sidewalk. It had been a year since the first massive cuts, which occurred in mid-February 2025. CDC workers dubbed it the “Valentine’s Day massacre.”

Protesters waved handmade signs with slogans such as “We love CDC workers” and “Save Public Health.” Passing drivers honked in solidarity.

Among the protesters was Ben McKenzie, who is still employed as a CDC researcher.

“It’s been heartbreaking to see so many talented, able colleagues be forced out or leave,” he said.

Current employees also need support, he said, especially after a man opened fire on CDC buildings last summer. The DeKalb County police officer David Rose before killing himself.

“I think we’ve all felt the emotional impact of being targets,” McKenzie said. “Right now, to work at CDC is in a lot of ways to be a target.”

Multiple CDC employees told ���ϳԹ��� News and NPR the federal government has yet to fully fix the damage to the windows and buildings hit in last year’s shooting.

McKenzie helps run a , one of several that have sprung up in Atlanta. He said the group has distributed more than $200,000 to help former CDC workers with rent and other needs.

This article is from a partnership with and .

���ϳԹ��� 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 .

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Después de que Robert F. Kennedy Jr., secretario del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), despidiera a Susan Monarez, directora de los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglé), por negarse a lo que sus abogados calificaron , Newsom para ayudar a modernizar el sistema de salud pública de California.

También dio trabajo a Debra Houry, ex directora científica y médica de la agencia, quien había renunciado en protesta pocas horas después del despido de Monarez.

Newsom también se asoció con los gobernadores demócratas Tina Kotek, de Oregon; Bob Ferguson, de Washington; y Josh Green, de Hawaii para formar la , una agencia regional de salud pública.

Los gobernadores que sus recomendaciones “defenderán la integridad científica en la salud pública mientras Trump destruye” la credibilidad de los CDC. Newsom argumentó que crear la alianza independiente era vital mientras Kennedy lidera el retroceso de las recomendaciones nacionales de vacunación de la administración Trump.

Más recientemente, California se convirtió en el primer estado en de respuesta a brotes coordinada por la Organización Mundial de la Salud (OMS), seguido por Illinois y Nueva York. Colorado y Wisconsin indicaron que planean unirse.

Esto ocurrió después de que el presidente Donald Trump a Estados Unidos de la agencia, argumentando que la OMS “se ha desviado de su misión principal y ha actuado en contra de los intereses de Estados Unidos para proteger al público estadounidense en múltiples ocasiones”.

Newsom dijo que unirse al consorcio liderado por la OMS permitirá a California responder más rápido a brotes de enfermedades contagiosas y a otras amenazas a la salud pública.

Aunque otros gobernadores demócratas y líderes de salud pública han criticado abiertamente al gobierno federal, pocos han sido tan directos como Newsom, quien considera postularse a la presidencia en 2028 y está en su segundo y último mandato como gobernador.

Miembros de la comunidad científica han elogiado su esfuerzo por construir una defensa de salud pública frente a los recortes de financiamiento y la reducción de las recomendaciones de vacunas por parte del gobierno federal.

Lo que está haciendo Newsom “es una gran idea”, dijo Paul Offit, crítico de Kennedy y experto en vacunas que anteriormente formó parte del comité asesor de vacunas de la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés), pero fue removido bajo la administración Trump en 2025.

“La salud pública se ha puesto de cabeza”, dijo Offit. “Tenemos a un activista antivacunas y negador de la ciencia al frente del Departamento de Salud y Servicios Humanos. Es peligroso”.

La Casa Blanca no respondió a preguntas sobre la postura de Newsom y el HHS rechazó solicitudes para entrevistar a Kennedy.

En cambio, funcionarios federales de salud criticaron a los demócratas en general y argumentaron que los estados gobernados por demócratas están participando en fraude y mala administración de fondos federales en programas de salud pública.

Emily Hilliard, vocera del HHS, dijo que la administración está actuando contra “estados gobernados por demócratas que impulsaron confinamientos sin base científica, mandatos de máscaras para niños pequeños y estrictas tarjetas de vacunación durante la era del covid”. Señaló que esas medidas “han erosionado completamente la confianza del pueblo estadounidense en las agencias de salud pública”.

Salud pública guiada por la ciencia

Desde que Trump regresó al poder, Newsom ha criticado al presidente y a su administración por impulsar políticas que considera una amenaza para la salud y la seguridad públicas. Ha calificado a los líderes federales como “extremistas” que intentan “usar los CDC como arma y difundir desinformación”.

También a funcionarios federales por vincular erróneamente a las vacunas con el autismo y que la administración está poniendo en peligro la vida de bebés y niños pequeños al reducir las recomendaciones de vacunas infantiles. Además, argumentó que la Casa Blanca está generando “caos” en el sistema de salud pública de Estados Unidos al retirarse de la OMS.

El gobernador rechazó una solicitud de entrevista. Marissa Saldivar, vocera de Newsom, dijo que es una prioridad del gobernador “proteger la salud pública y brindar a las comunidades orientación basada en ciencia y evidencia, no en política ni conspiraciones”.

Las acciones de la administración Trump han generado incertidumbre financiera que, según funcionarios locales, ha reducido la moral dentro de los departamentos de salud pública y ha dejado a los estados menos preparados para brotes de enfermedades y .

El año pasado, la Casa Blanca propuso recortar el gasto del HHS en , incluidos . En enero, el Congreso rechazó en gran medida esos recortes, aunque para programas centrados en determinantes sociales de la salud, como el acceso a alimentos, vivienda y educación.

La administración Trump anunció que retiraría en fondos de salud pública de California, Colorado, Illinois y Minnesota, argumentando que los estados liderados por demócratas financiaban iniciativas “woke” que no reflejaban las prioridades de la Casa Blanca.

En cuestión de días, y un juez el recorte.

“De repente siguen cancelando subvenciones y luego se revierte en los tribunales”, dijo Kat DeBurgh, directora ejecutiva de la Asociación de Oficiales de Salud de California. “Gran parte del daño ya está hecho porque los condados ya dejaron de hacer el trabajo”.

Según un análisis de 2025 de KFF, una organización sin fines de lucro de información sobre salud que incluye a ���ϳԹ��� News, el financiamiento federal representa de los presupuestos de los departamentos de salud estatales y locales en todo el país. Ese dinero se destina a combatir el VIH y otras infecciones de transmisión sexual, prevenir enfermedades crónicas y fortalecer la preparación en salud pública y la respuesta a enfermedades contagiosas.

Los fondos federales representan $2.400 millones del presupuesto de salud pública de $5.300 millones de California, lo que dificulta que Newsom y los legisladores estatales compensen posibles recortes. Ese dinero ayuda a financiar operaciones estatales y es vital para los departamentos de salud locales.

Los recortes afectan a todos

Barbara Ferrer, directora de salud pública del condado de Los Ángeles, dijo que si el gobierno federal logra recortar esos $600 millones, el condado —con casi 10 millones de residentes— perdería unos $84 millones en los próximos dos años, además de otras subvenciones para la prevención del VIH y otras infecciones de transmisión sexual.

Ferrer señaló que el condado depende de casi $1.000 millones en financiamiento federal al año para rastrear y prevenir enfermedades contagiosas y combatir problemas crónicos de salud, incluidos la hipertensión y la diabetes. El condado el cierre de que ofrecían vacunación y pruebas de enfermedades, en gran parte por pérdidas de financiamiento relacionadas con recortes a subvenciones federales.

“Es una estrategia mal informada”, dijo Ferrer. “La salud pública no se preocupa por si tu afiliación política es republicana o demócrata. No se preocupa por tu estatus migratorio ni por tu orientación sexual. La salud pública tiene que estar disponible para todos”.

Un solo caso de sarampión requiere que los trabajadores de salud pública rastreen a unas 200 personas que pudieron haber estado en contacto con el paciente, dijo Ferrer.

Estados Unidos , pero está cerca de perder ese estatus debido al escepticismo sobre las vacunas y a la desinformación difundida por sus críticos. El año pasado hubo , la mayor cifra desde 1991, con un 93% en personas no vacunadas o cuyo estado de vacunación era desconocido.

Este año, la enfermedad altamente contagiosa se ha reportado en , y en .

Funcionarios de salud pública esperan que la West Coast Health Alliance ayude a contrarrestar las políticas de Trump al generar confianza mediante recomendaciones de salud pública basadas en evidencia.

“Lo que estamos viendo del gobierno federal son políticas partidistas en su peor forma y represalias por diferencias sobre políticas públicas; esto pone en un riesgo extraordinario la salud y el bienestar del pueblo estadounidense”, dijo Georges Benjamin, director ejecutivo de la Asociación Estadounidense de Salud Pública (APHA, por sus siglas en inglés), una coalición de profesionales de salud pública.

Un calendario de vacunación más sólido

Erica Pan, principal funcionaria de salud pública de California y directora del Departamento de Salud Pública de California, dijo que la West Coast Health Alliance está defendiendo la ciencia al recomendar un calendario de vacunación más sólido que el del gobierno federal.

California forma parte de una coalición que por su decisión de retirar las recomendaciones de siete vacunas infantiles, incluidas las de la hepatitis A, la hepatitis B, la influenza y covid-19.

Pan expresó una profunda preocupación por la situación de la salud pública, especialmente por el aumento de casos de sarampión.

“Estamos retrocediendo”, dijo Pan sobre las inmunizaciones.

Sarah Kemble, epidemióloga estatal de Hawaii, dijo que el estado se unió a la alianza después de escuchar a residentes que apoyan las vacunas y quieren tener la seguridad de que seguirán teniendo acceso a ellas.

“Recibíamos muchas preguntas de personas con ansiedad que sí entendían las recomendaciones basadas en la ciencia, pero se preguntaban: ‘¿Todavía voy a poder ir a ponerme mi vacuna?’”, dijo Kemble.

Otros estados liderados principalmente por demócratas también han formado alianzas. Pennsylvania, Nueva York, Nueva Jersey, Massachusetts y varios otros estados de la costa este se unieron para crear el .

Hilliard, del HHS, dijo que aunque los gobernadores demócratas establezcan coaliciones asesoras sobre vacunas, el Comité Asesor sobre Prácticas de Inmunización federal “sigue siendo el organismo científico que guía las recomendaciones de vacunación en este país, y el HHS garantizará que la política se base en evidencia rigurosa y ciencia de alto nivel, no en la política fallida de la pandemia”.

Influencia en estados republicanos

Por su parte, Newsom aprobó una asignación anual recurrente de casi $300 millones para apoyar al Departamento de Salud Pública de California, así como a las 61 agencias locales de salud pública en el estado. El año pasado también que autoriza al estado a emitir sus propias recomendaciones de inmunización.

La ley exige que las aseguradoras de salud en California cubran las vacunas recomendadas por el estado, incluso si el gobierno federal no las recomienda.

Jeffrey Singer, doctor y investigador principal del Cato Institute, un centro de pensamiento libertario, dijo que la descentralización puede ser beneficiosa. Esto se debe a que las campañas informativas locales que reflejan distintas ideologías políticas y prioridades comunitarias pueden tener más posibilidades de influir en el público.

Un análisis de KFF encontró que algunos estados republicanos se están sumando a estados demócratas para desvincular sus recomendaciones de vacunación del gobierno federal. Singer dijo que doctores en su estado natal de Arizona están mirando a California, más liberal, para guiarse sobre consejos de vacunación.

“La ciencia nunca está completamente establecida y hay muchas áreas de este país donde existen diferencias de opinión”, dijo Singer. “Esto puede ayudarnos a cuestionar nuestras suposiciones y aprender”.

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After Health and Human Services Secretary Robert F. Kennedy Jr. fired Centers for Disease Control and Prevention Director Susan Monarez for refusing what her lawyers called “,” Newsom to help modernize California’s public health system. He also gave a job to Debra Houry, the agency’s former chief science and medical officer, who had resigned in protest hours after Monarez’s firing.

Newsom also teamed up with fellow Democratic governors Tina Kotek of Oregon, Bob Ferguson of Washington, and Josh Green of Hawaii to form the , a regional public health agency, whose guidance would “uphold scientific integrity in public health as Trump destroys” the CDC’s credibility. Newsom argued establishing the independent alliance was vital as Kennedy leads the Trump administration’s rollback of national vaccine recommendations.

More recently, California became the a global outbreak response network coordinated by the World Health Organization, followed by Illinois and New York. Colorado and Wisconsin signaled they plan to join. They did so after President Donald Trump officially from the agency on the grounds that it had “strayed from its core mission and has acted contrary to the U.S. interests in protecting the U.S. public on multiple occasions.” Newsom said joining the WHO-led consortium would enable California to respond faster to communicable disease outbreaks and other public health threats.

Although other Democratic governors and public health leaders have openly criticized the federal government, few have been as outspoken as Newsom, who is considering a run for president in 2028 and is in his second and final term as governor. Members of the scientific community have praised his effort to build a public health bulwark against the Trump administration’s slashing of funding and scaling back of vaccine recommendations.

What Newsom is doing “is a great idea,” said Paul Offit, an outspoken critic of Kennedy and a vaccine expert who formerly served on the Food and Drug Administration’s vaccine advisory committee but was removed under Trump in 2025.

“Public health has been turned on its head,” Offit said. “We have an anti-vaccine activist and science denialist as the head of U.S. Health and Human Services. It’s dangerous.”

The White House did not respond to questions about Newsom’s stance and HHS declined requests to interview Kennedy. Instead, federal health officials criticized Democrats broadly, arguing that blue states are participating in fraud and mismanagement of federal funds in public health programs.

HHS spokesperson Emily Hilliard said the administration is going after “Democrat-run states that pushed unscientific lockdowns, toddler mask mandates, and draconian vaccine passports during the covid era.” She said those moves have “completely eroded the American people’s trust in public health agencies.”

Public Health Guided by Science

Since Trump returned to office, Newsom has criticized the president and his administration for engineering policies that he sees as an affront to public health and safety, labeling federal leaders as “extremists” trying to “weaponize the CDC and spread misinformation.” He has for erroneously linking vaccines to autism, the administration is endangering the lives of infants and young children in scaling back childhood vaccine recommendations. And he argued that the White House is unleashing “chaos” on America’s public health system in backing out of the WHO.

The governor declined an interview request. Newsom spokesperson Marissa Saldivar said it’s a priority of the governor “to protect public health and provide communities with guidance rooted in science and evidence, not politics and conspiracies.”

The Trump administration’s moves have triggered financial uncertainty that local officials said has reduced morale within public health departments and left states unprepared for disease outbreaks and . The White House last year proposed cutting HHS spending , including . Congress largely rejected those cuts last month, although funding for programs focusing on social drivers of health, such as access to food, housing, and education, .

The Trump administration announced that it would claw back in public health funds from California, Colorado, Illinois, and Minnesota, arguing that the Democratic-led states were funding “woke” initiatives that didn’t reflect White House priorities. Within days, and a judge the cut.

“They keep suddenly canceling grants and then it gets overturned in court,” said Kat DeBurgh, executive director of the Health Officers Association of California. “A lot of the damage is already done because counties already stopped doing the work.”

Federal funding has accounted for of state and local health department budgets nationwide, with money going toward fighting HIV and other sexually transmitted infections, preventing chronic diseases, and boosting public health preparedness and communicable disease response, according to a 2025 analysis by KFF, a health information nonprofit that includes ���ϳԹ��� News.

Federal funds account for $2.4 billion of California’s $5.3 billion public health budget, making it difficult for Newsom and state lawmakers to backfill potential cuts. That money helps fund state operations and is vital for local health departments.

Funding Cuts Hurt All

Los Angeles County public health director Barbara Ferrer said if the federal government is allowed to cut that $600 million, the county of nearly 10 million residents would lose an estimated $84 million over the next two years, in addition to other grants for prevention of HIV and other sexually transmitted infections. Ferrer said the county depends on nearly $1 billion in federal funding annually to track and prevent communicable diseases and combat chronic health conditions, including diabetes and high blood pressure. Already, the the closure of that provided vaccinations and disease testing, largely because of funding losses tied to federal grant cuts.

“It’s an ill-informed strategy,” Ferrer said. “Public health doesn’t care whether your political affiliation is Republican or Democrat. It doesn’t care about your immigration status or sexual orientation. Public health has to be available for everyone.”

A single case of measles requires public health workers to track down 200 potential contacts, Ferrer said.

The U.S. but is close to losing that status as a result of vaccine skepticism and misinformation spread by vaccine critics. The U.S. had , the most since 1991, with 93% in people who were unvaccinated or whose vaccination status was unknown. This year, the highly contagious disease has been reported at , , and .

Public health officials hope the West Coast Health Alliance can help counteract Trump by building trust through evidence-based public health guidance.

“What we’re seeing from the federal government is partisan politics at its worst and retaliation for policy differences, and it puts at extraordinary risk the health and well-being of the American people,” said Georges Benjamin, executive director of the American Public Health Association, a coalition of public health professionals.

Robust Vaccine Schedule

Erica Pan, California’s top public health officer and director of the state Department of Public Health, said the West Coast Health Alliance is defending science by recommending a vaccine schedule than the federal government. California is part of a coalition over its decision to rescind recommendations for seven childhood vaccines, including for hepatitis A, hepatitis B, influenza, and covid-19.

Pan expressed deep concern about the state of public health, particularly the uptick in measles. “We’re sliding backwards,” Pan said of immunizations.

Sarah Kemble, Hawaii’s state epidemiologist, said Hawaii joined the alliance after hearing from pro-vaccine residents who wanted assurance that they would have access to vaccines.

“We were getting a lot of questions and anxiety from people who did understand science-based recommendations but were wondering, ‘Am I still going to be able to go get my shot?’” Kemble said.

Other states led mostly by Democrats have also formed alliances, with Pennsylvania, New York, New Jersey, Massachusetts, and several other East Coast states banding together to create the .

HHS’ Hilliard said that even as Democratic governors establish vaccine advisory coalitions, the federal “remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and gold standard science, not the failed politics of the pandemic.”

Influencing Red States

Newsom, for his part, has approved a recurring annual infusion of nearly $300 million to support the state Department of Public Health, as well as the 61 local public health agencies across California, and last year authorizing the state to issue its own immunization guidance. It requires health insurers in California to provide patient coverage for vaccinations the state recommends even if the federal government doesn’t.

Jeffrey Singer, a doctor and senior fellow at the libertarian Cato Institute, said decentralization can be beneficial. That’s because local media campaigns that reflect different political ideologies and community priorities may have a better chance of influencing the public.

A KFF analysis found some red states are joining blue states in decoupling their vaccine recommendations from the federal government’s. Singer said some doctors in his home state of Arizona are looking to more liberal California for vaccine recommendations.

“Science is never settled, and there are a lot of areas of this country where there are differences of opinion,” Singer said. “This can help us challenge our assumptions and learn.”

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Bill Cassidy offered jabs to thousands of inmates at Louisiana’s maximum-security prison in the early 2000s. A decade before that, he set up vaccine clinics in middle schools, a model as a success.

“He got that whole generation immunized in East Baton Rouge,” said Holley Galland, a retired doctor who worked with Cassidy vaccinating schoolchildren.

About the same time, a lawyer and environmental activist with a famous last name was starting to build the loyal anti-vaccine coalition that, two decades later, would move President Donald Trump to nominate him as the nation’s top health official.��

Today, a year after now-Sen. Cassidy warily cast the vote that ensured Robert F. Kennedy Jr.’s ascension to that role, the Louisiana Republican’s life’s work — in medicine and in politics — is unraveling.��

Newborn hepatitis B vaccination rates in the U.S. had plunged to 73% as of August, down 10 percentage points since a February 2023 high, published in JAMA last month. In December, the Centers for Disease Control and Prevention’s Advisory Committee for Immunization Practices — remade by Kennedy — voted to revoke a two-decade-old recommendation that all newborns get the shot.

The next month, Trump endorsed U.S. Rep. Julia Letlow, a Cassidy challenger in what’s shaping up to be a competitive Republican Senate primary. Letlow’s foray into politics began in 2021 when she took the seat won by her husband, left vacant after he died from covid.

���ϳԹ��� News made multiple requests for comment from Cassidy over three months. His staff declined to make him available for an interview or provide comment. Letlow’s campaign did not respond to requests for comment.

Rise of the Skeptics

As the May primary nears, some Louisiana doctors are worried they’ve begun a long trek down a dark road when it comes to vaccine-preventable diseases.

Last year, on the day Kennedy was sworn in a thousand miles away in Washington, Louisiana’s health department stopped promoting vaccines, halting its clinics and advertising. Its communications about an ongoing whooping cough outbreak in the state have nearly ceased. It took months for the state to announce last year that two infants had died from the illness. A Louisiana child’s death from the flu was confirmed this January, and a couple of cases of measles were reported last year.

Spokespeople for the Louisiana Department of Health did not respond to questions.

“It’s so hard to see children get sick from illnesses that they should have never gotten in the first place,” said Mikki Bouquet, a pediatrician in Baton Rouge. “You want to just scream into the void of this community over how they failed this child.”

As anti-vaccine forces have taken hold of the state and federal health departments, Cassidy has lamented the consequences.

“Families are getting sick and people are dying from vaccine-preventable deaths, and that tragedy needs to stop,” he last fall.

But while it is Cassidy’s duty as chairman of the Senate’s Health, Education, Labor, and Pensions Committee to conduct oversight of the health department, Kennedy has appeared before the committee just once since he was confirmed.

The secretary speaks at a “regular clip” with Cassidy, said Department of Health and Human Services spokesperson Andrew Nixon.

Kennedy’s department has elevated Louisiana vaccine skeptics. The state surgeon general who terminated Louisiana’s vaccine campaign, Ralph Abraham, was named deputy director of the CDC. (He left the role in February.) And Kennedy handpicked Evelyn Griffin, a Baton Rouge OB-GYN who later replaced Abraham as the state surgeon general, for an appointment to ACIP. Griffin the covid vaccine had dangerous side effects for young patients.

Research has shown that serious side effects from the vaccinations are rare and that the shots saved millions of lives during the pandemic.

Cassidy “has really not had an outspoken chorus of policy supporters” when it comes to inoculating people, said Michael Henderson, a professor of political communication at Louisiana State University. “There’s not a lot of political stakes in doing that in Louisiana if you’re a Republican.”

Louisiana Gov. Jeff Landry reprimanded Cassidy after the senator called for the state’s health department to ease access to covid shots.

“Why don’t you just leave a prescription for the dangerous Covid shot at your district office and anyone can swing by and get one!” the Republican in September.

On ‘Eggshells’ in the Exam Room

On a sunny February afternoon, as Carnival floats were readied to parade the streets of New Orleans, pediatrician Katie Brown approached a basement apartment on a well-child visit. Cowboy boot pendants dangled from her ears, and a pack of diapers were clutched tightly in her arms.

The patient, a toddler who waved at the sight of visitors, was up to date on her immunizations. But when Brown suggested a covid vaccine, the girl’s mother quickly declined, noting she had never gotten the shot either.

Many of Brown’s young patients — seen through Nest Health, which offers in-home visits covered by Louisiana’s Medicaid program — are current with their vaccines. Brown said home visits make parents more comfortable immunizing their children, but she’s still spending more time these days explaining what they’re getting in those shots.

“After covid vaccines, that’s when some people just decided, ‘I don’t know if I trust vaccines, period,’” she said.

Across the state, vaccination rates have declined since the pandemic, falling short of the levels scientists say are required to achieve herd immunity for some deadly diseases, including measles. About have had the recommended two doses of the measles, mumps, and rubella vaccine.

The New Orleans Health Department has tried to step up with a $100,000 immunization campaign of its own, with clinics and billboards, during this year’s flu season, said Jennifer Avegno, the department’s director.

But the state’s absence is felt. Other parishes across Louisiana have not taken similar action, leaving doctors largely on their own to promote immunizations.

“I’ll say that with certainty,” Avegno said. “It’s been a blow to not have a statewide coordination.”

A day after Brown’s home visit, a mother in Baton Rouge shook her head when Bouquet offered a flu shot for her 10-year-old daughter in an exam room.

In the waiting room, parents could thumb through a handmade book that offers scientific facts to counter fears about vaccines. A laminated guide placed in each exam room explained the benefits of each recommended immunization.

Bouquet said she’s experimenting with ways to educate parents about vaccines without seeming overbearing. She still hasn’t figured out a surefire formula. Some parents now shut down any vaccine talk, and she worries others skip scheduling appointments to avoid the topic entirely.

“We’re having to walk on eggshells a bit to determine how to get that trust back,” Bouquet said. “And maybe these discussions can come up in future visits.”

Pro-Vax, Pro-Anti-Vaxxer

Children’s Health Defense, the nonprofit that Kennedy helmed, worked to erode vaccine trust during the pandemic — falsely claiming, for instance, that covid shots cause organ damage and that polio vaccines were at fault for a rise in the disease. The organization also sued the federal government over the mRNA-based covid shots, hoping to get their emergency authorizations from the Food and Drug Administration revoked.

When Kennedy came before Cassidy’s committee in January 2025 as Trump’s nominee for health secretary, the senator-doctor saw risks if the prominent anti-vaccine lawyer was confirmed.

Cassidy described a time years ago when he loaded an 18-year-old onto a helicopter to get an emergency liver transplant. The young woman had acute hepatitis B, an incurable disease that is spread primarily through blood or bodily fluids and can lead to liver failure.

It was “the worst day of my medical career,” he said, addressing Kennedy at the witness table in front of him. “Because I thought, $50 of vaccines could have prevented this all.”

Cassidy started in politics in 2006 as a state senator, winning election to the U.S. House two years later. When he first ran for the U.S. Senate, in 2014, he charmed Louisiana voters with campaign ads showing him , talking about his work with Hurricane Katrina evacuees and patients at Baton Rouge’s public hospital.

But some Republicans soured on Cassidy after he voted to convict Trump on an article of impeachment charging him with inciting the Jan. 6, 2021, insurrection at the U.S. Capitol.

The impeachment vote has hampered Cassidy’s reelection bid this year in a state where Trump captured 60% of the vote in 2024.

“Cassidy has things that are associated with his name: the impeachment vote in 2021,” Henderson said.

Cassidy’s loyalty to Trump was tested again with Kennedy’s nomination. Cassidy said he endorsed Kennedy after extracting pledges that he wouldn’t tinker with the nation’s vaccination program.

But since taking office, Kennedy has largely ignored those promises, and Cassidy hasn’t publicly rebuked him.

Former Texas congressman Michael Burgess served for years with Cassidy in the House, where they were founding members of the GOP Doctors Caucus, started in 2009. He said Cassidy’s discomfort with some of Kennedy’s actions is palpable.

“You could hear some of the pain in Sen. Cassidy’s voice when he was addressing that the secretary wanted to drop the birth dose of hepatitis B,” Burgess said. “You got cases to nearly zero on hepatitis B. It was painful to him to think about taking this away from the population.”

Retired Baton Rouge nurse practitioner Elizabeth Britton has switched her party affiliation so she can vote in the closed Republican primary for Cassidy, with whom she vaccinated inmates decades ago.

She doesn’t quite understand the “mess” in Washington that resulted in the senator voting to confirm a vaccine critic.

Watching Kennedy and others promulgate doubts about shots she once administered has made her “profoundly sad” and “angry,” she said, but most of all worried.

“It puts a pit in my stomach, because I know the consequences of people not getting the vaccine,” she said.

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We Have Invested Too Much To Let Research Programs Die Quietly

I have dedicated my life to research, but now that work, along with the trust, data, and progress behind it, is at risk (“NIH Grant Disruptions Slow Down Breast Cancer Research,” Feb. 3).

As a rheumatologist and researcher, I have spent decades studying lupus — a chronic autoimmune disease that can affect nearly every organ system, producing symptoms that are often unpredictable and difficult to manage. Its impact on a patient’s quality of life is profound: Nearly 90% of people with lupus report being unable to maintain full-time work, while many also face interruptions in education or career progression.

But funding uncertainty from the National Institutes of Health, the Centers for Disease Control and Prevention, and other federal programs means that the thousands of patients involved in my research, along with millions of patients nationwide, are at risk. While I appreciate the increase in lupus research funding included in the recently passed congressional funding package, funding disruptions persist nationwide, and recovery takes time.

Increased funding is not like a light switch that we can just turn back on. It will take a lot of time to recruit back those we lost. That doesn’t include the young investigators who would have entered the field and are now lost. It takes time to build back the broken trust and infrastructure needed to keep participants engaged and ensure reliable data.

Medical research connects the bedside to the database to the policymaker’s desk. Without it, we are blind to the very problems we most urgently need to solve. The window to save these programs is closing. We must act now before it’s too late.

— S. Sam Lim, Atlanta

Knocking Down Barriers to Long-Term Hospital Care

For many Americans, being released from their initial hospital stay is just the beginning of their care journey. Depending on the complexity of one’s condition and the clinical need for more specialized post-acute services such as ventilation, long-term care hospitals, or LTCHs, offer highly personalized care to individuals recovering from a catastrophic illness or injury (Broken Rehab: “They Need a Ventilator To Stay Alive. Getting One Can Be a Nightmare,” Dec. 2).

LTCHs play a critical role in the nation’s health care system by providing complex, resource-intensive care to patients leaving acute-care hospitals but who still need sustained support and treatment. Not only do LTCHs help patients who are dependent on ventilation, have complex wounds, or have multiple organ failure, they also serve as a relief valve in our nation’s hospital system by helping free up beds and resources at general hospitals.

However, the ability to access this vital form of care is becoming increasingly difficult — underscoring the need for lawmakers in Washington to act. Since 2016, over 100 LTCHs have closed due to chronic underpayments amid higher costs. This has been exacerbated by Congress’ decision to implement changes to how it reimburses LTCHs for its beneficiaries. As a result, patients have fewer options, and the facilities that remain open are often far away from home for patients and families, particularly in rural areas. Furthermore, insurance company barriers — such as prior authorization requirements put in place by Medicare Advantage plans — are creating harmful delays and denials of necessary and time-sensitive patient care. Consequently, many patients are denied access to an LTCH setting — or transferred to other post-acute care settings like rehabilitation or skilled nursing facilities that aren’t equipped to care for patients with highly complex needs like ventilation.

America’s sickest patients deserve the right level of care at the right time. As this need becomes more urgent by the day, policymakers must work to address these challenges and strengthen access to LTCHs, which help patients get transferred out of the hospital quicker, reduce hospital overcrowding, and ultimately save lives.

— Jim Prister, Chicago; president and CEO of RML Specialty Hospital; chair of the American Hospital Association’s Post-Acute Care Steering Committee

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Covid, for instance, is now linked in studies to in children of mothers who were infected during pregnancy, as well as a decline in mental cognition and greater risk of heart problems. It’s even been shown to trigger the awakening of dormant cancer cells in people who are in remission.����

Policies around covid and vaccination have economic ramifications. The annual average burden of the disease’s long-term health effects is estimated at $9,000 per patient in the U.S., according to a in November in the journal NPJ Primary Care Respiratory Medicine. In this country, the annual lost earnings are estimated to be about $170 billion.��

The virus that causes covid, SARS-CoV-2, leaves damage that can linger for months and sometimes years. In the brain, the virus leads to an immune response that triggers inflammation, can damage brain cells, and can even shrink brain volume, according to published in March 2022 in the journal Nature.����

, a clinical epidemiologist who has studied longer-term health effects from covid, estimated the virus may have increased the number of adults in the U.S. with an IQ less than 70 from 4.7 million to 7.5 million — dealing with “a level of cognitive impairment that requires significant societal support,” he wrote.��

Meanwhile, data from more than a suggests covid vaccines can help reduce risk of severe infection as well as longer-lasting health effects, although researchers say more study is needed. But last May, Health and Human Services Secretary Robert F. Kennedy Jr. said on X that the Centers for Disease Control and Prevention would for , citing a . The FDA has since issued new guidelines limiting the vaccines to people 65 and older and individuals 6 months or older with at least one risk factor, though many states continue to make them more widely available.��

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