El gobierno federal no lleva un registro de cuántos niños han ingresado a este sistema como consecuencia de operativos de control migratorio, lo que dificulta saber con qué frecuencia ocurre.

En Oregon, hasta febrero, dos niños habían sido ubicados en hogares temporales luego de ser separados de sus padres en casos de detención migratoria, según Jake Sunderland, vocero del Departamento de Servicios Humanos del estado.

“Antes del otoño de 2025, esto nunca había ocurrido”, aseguró.

Hasta mediados de febrero, casi por el Servicio de Inmigración y Control de Aduanas (ICE, por sus siglas en inglés).

El récord de 73.000 personas detenidas en enero representó un comparado con el año anterior. Según una , hasta agosto de 2025, padres de 11.000 niños con ciudadanía estadounidense habían sido detenidos desde el inicio del mandato de Trump.

El medio NOTUS que por lo menos 32 niños de padres detenidos o deportados habían sido colocados en hogares temporales en siete estados.

Sandy Santana, director ejecutivo de Children’s Rights, una organización de defensa legal, dijo que sospechan que el número real es mucho mayor.

“Ese número nos parece realmente muy bajo”, dijo.

La separación de sus padres es profundamente traumática para los niños y suele provocar , incluido el trastorno de estrés postraumático. El estrés prolongado e intenso también puede causar infecciones más frecuentes en los niños y problemas en el desarrollo. Ese “estrés tóxico” también se asocia con daños en áreas del cerebro responsables del aprendizaje y la memoria, , una organización sin fines de lucro dedicada a la información en salud que incluye a ºÚÁϳԹÏÍø News.

Durante el primer mandato de Trump, . y modificaron algunas leyes para permitir que tutores recibieran derechos parentales temporales en casos relacionados con migración. Ahora, tras el regreso de Trump al poder el año pasado, el aumento en los controles migratorios está impulsando una nueva ola de respuestas estatales.

En Nueva Jersey, legisladores están considerando un proyecto para modificar estatal que permite que los padres designen tutores temporales para casos de muerte o incapacidad. La nueva versión agregaría como otra razón válida la separación por control migratorio federal.

El año pasado, Nevada y California aprobaron leyes para proteger a las familias separadas por acciones de control migratorio. La ley de California, llamada Ley del Plan de Preparación Familiar (), permite que los padres designen tutores y compartan derechos de custodia, en lugar de que sus derechos se suspendan mientras están detenidos. Si son liberados y pueden reunirse con sus hijos, recuperan sus derechos parentales completos.

Existen importantes obstáculos legales para la reunificación familiar una vez que un niño entra bajo custodia estatal, explicó Juan Guzman, director del tribunal de menores y tutela en Alliance for Children’s Rights, una organización de defensa legal en Los Ángeles.

Si el niño es colocado en cuidado temporal y ni el padre ni la madre pueden participar en los procesos judiciales requeridos porque están detenidos o han sido deportados, es menos probable que puedan volver a reunirse con su hijo, afirmó Guzman.

Se estima que que son ciudadanos estadounidenses viven con un padre u otro familiar que no tiene estatus migratorio legal, según investigaciones de Brookings Institution, un centro de estudios en Washington, D.C. Dentro de ese grupo, 2,6 millones de niños tienen a ambos padres sin estatus legal.

Santana dijo que es probable que el número de casos de separación familiar aumente a medida que el gobierno de Trump avance con su campaña migratoria. Por lo tanto, más niños corren el riesgo de terminar en el sistema de cuidado temporal.

Las exigen que la agencia se esfuerce en facilitar la participación de los padres detenidos en los procedimientos de los tribunales de familia, de bienestar infantil o de tutela, pero Santana indicó que no está claro que el ICE esté cumpliendo con estas normas.

Los funcionarios de ICE no respondieron a las solicitudes de comentarios para este artículo.

Antes de que cambiara la ley de California, la única razón por la que un padre podía compartir derechos de custodia con otro tutor era si tenía una enfermedad terminal, contó Guzman.

Ahora, si los padres preparan un plan con anticipación y designan a alguien de confianza que pueda hacerse cargo de sus hijos si llegara a ser necesario, la agencia estatal de bienestar infantil puede iniciar el proceso para entregar a los niños a esa persona sin tener que abrir un caso formal de cuidado temporal, agregó.

Aunque los legisladores de Nevada el año pasado ampliaron una ley de tutela ya existente para incluir el control migratorio, la medida exige que los padres presenten documentación notarial ante la oficina del secretario de estado, un trámite administrativo que puede resultar costoso, dijo Cristian González-Pérez, abogado en Make the Road Nevada, una organización sin fines de lucro que ofrece recursos a comunidades inmigrantes.

González-Pérez señaló que algunos inmigrantes dudan en completar formularios gubernamentales por temor a que el ICE pueda acceder a esa información y los persiga. Él les asegura a los miembros de la comunidad que los formularios estatales son confidenciales y solo pueden ser consultados por hospitales y tribunales.

El gobierno de Trump ha tomado para acceder a información sensible a través de los Centros de Servicios de Medicare y Medicaid, el Servicio de Impuestos Internos (IRS), el Programa de Asistencia Nutricional Suplementaria (SNAP), el Departamento de Vivienda y Desarrollo Urbano y otras entidades.

González-Pérez y Guzmán consideran que muchos padres inmigrantes no conocen sus derechos. Designar un tutor temporal y crear un plan familiar es una forma de no sentirse impotentes, afirmó González-Pérez.

“La gente no quiere hablar de esa cuestión”, reflexionó Guzman. “Que un padre tenga que hablar con un niño sobre la posibilidad de separarse da miedo. No es algo que nadie quiera hacer”, concluyó.

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“La primera vez, el teléfono suena sin parar. La siguiente, te manda al buzón de voz y se corta la llamada”, dijo la mujer de 48 años, que vive en Delaware. “A veces te contesta alguien que dice que no es la persona indicada. Te transfieren y se corta. A veces contestan y no hay nadie en la línea”.

Pasó meses tratando de averiguar si su cobertura de Medicaid había sido renovada. Hasta finales de marzo, todavía no le había llegado la renovación anual para el programa estatal y federal que ofrece seguro de salud a personas con bajos ingresos y con discapacidades.

Crouch, quien sufrió un aneurisma cerebral debilitante hace una década, también tiene Medicare, que cubre a personas de 65 años o más, o a aquellas con discapacidades. Medicaid pagaba sus deducibles mensuales de Medicare de $200, pero en los últimos tres meses ha tenido que cubrirlos ella misma, lo que ha afectado el ingreso fijo de su familia, contó.

Los problemas de Crouch con el centro de llamadas de Medicaid en Delaware no son un caso aislado. Las agencias estatales de Medicaid pueden tener dificultades para mantener suficiente personal que ayude a las personas a inscribirse en los beneficios y atender llamadas de afiliados con preguntas.

La falta de estos trabajadores puede impedir que las personas usen plenamente sus beneficios, dijeron investigadores de políticas de salud.

Ahora, la ley One Big Beautiful Bill Act de los republicanos aprobada por el Congreso, que el presidente Donald Trump firmó el verano pasado, pronto exigirá más al personal de las agencias estatales en los lugares donde los legisladores ampliaron Medicaid a más adultos con bajos ingresos, que son casi todos los estados y el Distrito de Columbia.

Según la ley, que se espera reduzca el gasto de Medicaid en casi $1.000 millones en los próximos ocho años, estos trabajadores deberán no solo determinar si millones de afiliados cumplen con los nuevos requisitos laborales del programa, sino también verificar con mayor frecuencia que califican: cada seis meses en lugar de una vez al año.

ºÚÁϳԹÏÍø News contactó a agencias que deberán implementar estas reglas de trabajo, y muchas dijeron que necesitarán más personal.

Estas exigencias pondrán más presión sobre una fuerza laboral ya sobrecargada, lo que podría dificultar que afiliados como Crouch reciban servicios básicos de atención al cliente. Y muchos podrían perder acceso a beneficios a los que tienen derecho por ley, según afirmaron defensores del consumidor e investigadores de políticas de salud, algunos con experiencia directa trabajando en agencias estatales.

Los estados ya están “teniendo grandes dificultades”, dijo Jennifer Wagner, directora de elegibilidad e inscripción de Medicaid en el Center on Budget and Policy Priorities y ex subdirectora del Departamento de Servicios Humanos de Illinois. “Habrá desafíos adicionales importantes por culpa de estos cambios”.

Largos tiempos de espera para recibir ayuda

Los republicanos sostienen que los cambios en Medicaid, que entrarán en vigencia el 1 de enero de 2027 en la mayoría de los estados, incentivarán a los afiliados a conseguir empleo. Investigaciones sobre otros programas con requisitos laborales en Medicaid han encontrado poca evidencia de que aumenten el empleo.

La Oficina de Presupuesto del Congreso (CBO, por sus siglas en inglés) provocarán que más personas pierdan la cobertura de salud para 2034: indicó que más de 5 millones de personas podrían verse afectadas.

Muchos estados no tienen suficiente personal para procesar solicitudes o renovaciones de Medicaid con rapidez, dijeron defensores.

Los Centros de Servicios de Medicare y Medicaid (CMS, por siglas en inglés) supervisan si los estados pueden procesar el tipo más común de solicitud de beneficios dentro de un plazo de 45 días.

En diciembre, alrededor del 30% de todas las solicitudes de Medicaid y del Programa de Seguro de Salud Infantil (CHIP, por sus siglas en inglés) en Washington, D.C., y Georgia en procesarse. Más de una cuarta parte tardó ese tiempo en Wyoming. En Maine, una de cada 5 solicitudes no cumplió ese plazo.

Los CMS comenzaron a compartir públicamente datos de los centros de llamadas de Medicaid en 2023, lo que mostró un sistema bajo presión, según investigadores y defensores.

En Hawaii, las personas esperaron más de tres horas al teléfono en diciembre. En Oklahoma, casi una hora, y en Nevada, más de una hora.

En 2023, las agencias estatales de Medicaid comenzaron a verificar que todavía calificaban a los afiliados que habían sido protegidos para que no perdieran su cobertura durante la pandemia de covid. Ese proceso no funcionó bien en muchos estados, y más de .

Investigadores y defensores dicen que implementar las nuevas reglas será un reto mayor. Las reglas laborales requerirán cambios amplios en los sistemas informáticos y capacitación para los trabajadores que verifican la elegibilidad en un plazo ajustado.

“Es un nivel mucho mayor de complejidad administrativa”, señaló Sophia Tripoli, directora de políticas en Families USA, una organización de defensa de salud del consumidor.

Después de meses intentando hablar con alguien, Crouch dijo que finalmente obtuvo respuestas sobre sus beneficios de Medicaid luego de escribir a la oficina de la representante federal Sarah McBride (demócrata de Delaware). La oficina contactó a la agencia estatal de Medicaid, que finalmente la llamó con una actualización, dijo.

Crouch en realidad no calificaba para Medicaid. Dijo que eso nunca había surgido en dos años de interacciones con el estado.

“No tiene ningún sentido que el estado no se haya dado cuenta antes”, dijo.

La agencia de Medicaid de Delaware no respondió a solicitudes de comentarios sobre su caso.

Estados con poco personal para Medicaid

A fines de marzo, algunos estados dijeron a ºÚÁϳԹÏÍø News, que necesitarán más personal para implementar las reglas laborales de manera efectiva.

Idaho informó que tiene 40 vacantes para trabajadores de elegibilidad. Nueva York estimó que necesitará 80 nuevos empleados para manejar el trabajo administrativo adicional, con un costo de $6,2 millones. Pennsylvania tiene casi 400 puestos vacantes en oficinas de servicios humanos de los condados. La agencia de Medicaid de Indiana tiene 94 vacantes. Maine quiere contratar 90 trabajadores adicionales, y Massachusetts busca sumar 70 más. Montana llenó 39 de los 59 puestos que dice que necesitará.

La agencia de servicios sociales de Missouri ha reducido personal y tiene 1.000 trabajadores de primera línea menos que hace aproximadamente una década, esto con más del doble de afiliados en Medicaid y en el Programa de Asistencia Nutricional Suplementaria (SNAP, por sus siglas en inglés), según comentarios de su directora, Jessica Bax,

“El departamento pensó que habría una mejora en la eficiencia gracias a las actualizaciones del sistema de elegibilidad”, dijo Bax. “Muchas de esas mejoras no se concretaron”.

Los estados podrían tener dificultades para encontrar personas interesadas en estos trabajos, que requieren meses de capacitación, pueden ser emocionalmente exigentes y generalmente ofrecen salarios bajos, afirmó Tricia Brooks, investigadora del Centro para Niños y Familias de la Universidad de Georgetown.

“Reciben muchos reclamos y gritos”, dijo Brooks, quien antes dirigió el programa de atención al cliente de Medicaid y CHIP en New Hampshire. “Las personas están frustradas. Lloran. Están preocupadas. Están perdiendo acceso a la atención médica, y no es un trabajo fácil cuando es difícil ayudar”.

Los estados están pagando millones de dólares a contratistas del gobierno para ayudar a cumplir con la nueva ley federal.

Maximus, un contratista de servicios gubernamentales, brinda apoyo en elegibilidad, como la gestión de centros de llamadas, en 17 estados que ampliaron Medicaid y atiende a casi 3 de cada 5 personas inscritas en el programa a nivel nacional, según la empresa.

Durante una llamada de resultados en febrero, la empresa dijo que puede cobrar según el número de gestiones que realiza para los afiliados, independientemente de cuántas personas estén inscritas en el programa en un estado.

Maximus no tiene “un enfoque único” para los servicios que ofrece ni para cómo cobra por ellos, dijo su vocera Marci Goldstein a ºÚÁϳԹÏÍø News.

La empresa, que reportó ingresos de $1.760 millones en 2025 en el área que incluye trabajo relacionado con Medicaid, espera que esos ingresos sigan creciendo, incluso si menos personas permanecen en el programa, “debido a las gestiones adicionales que serán necesarias”, señaló David Mutryn, director financiero y tesorero de Maximus.

Perder la cobertura de Medicaid no es solo una molestia, ya que muchas personas inscritas probablemente no ganan lo suficiente para pagar atención médica por su cuenta y pueden no calificar para ayuda financiera bajo la Ley de Cuidado de Salud a Bajo Precio (ACA), dijo Elizabeth Edwards, abogada del National Health Law Program.

Las personas podrían no poder pagar medicamentos o recibir atención esencial, lo que podría tener impactos “devastadores” en la salud, dijo.

“Lo que está en juego son las vidas de las personas”, concluyó.

Los corresponsales de ºÚÁϳԹÏÍø News Katheryn Houghton y Samantha Liss contribuyeron con este artículo.

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The federal government doesn’t track how many children have entered foster care because of immigration enforcement actions, leaving it unclear how often it happens. In Oregon, as of February two children had been placed in foster care after being separated from their parents in immigration detention cases, according to Jake Sunderland, a spokesperson for the Oregon Department of Human Services.

“Before fall 2025, this simply had never happened before,” Sunderland said.

As of mid-February, nearly by Immigration and Customs Enforcement. The record 73,000 people in detention in January represented an compared with one year before. According to , parents of 11,000 children who are U.S. citizens were detained from the beginning of Trump’s term through August.

The news outlet NOTUS that at least 32 children of detained or deported parents had been placed in foster care in seven states.

Sandy Santana, executive director of Children’s Rights, a legal advocacy organization, said he thinks the actual number is much higher.

“That, to us, seems really, really low,” he said.

Separation from a parent is deeply traumatic for children and can lead to , including post-traumatic stress disorder. Prolonged, intense stress can lead to more-frequent infections in children and developmental issues. That “toxic stress” is also associated with responsible for learning and memory, according to KFF.

, and amended existing laws during Trump’s first term to allow guardians to be granted temporary parental rights for immigration enforcement reasons. Now the enforcement surge that began after Trump returned to office last year has prompted a new wave of state responses.

In New Jersey, lawmakers are considering to amend a state law that allows parents to nominate standby, or temporary, guardians in the cases of death, incapacity, or debilitation. The bill would add separation due to federal immigration enforcement as another allowable reason.

Nevada and California passed laws last year to protect families separated by immigration enforcement actions. California’s law, called the , allows parents to nominate guardians and share custodial rights, instead of having them suspended, while they’re detained. They regain their full parental rights if they are released and are able to reunite with their children.

There are significant legal barriers to reunification once a child is placed in state custody, said Juan Guzman, director of children’s court and guardianship at the Alliance for Children’s Rights, a legal advocacy organization in Los Angeles.

If a parent’s child is placed in foster care and the parent cannot participate in required court proceedings because they are in detention or have been deported, it’s less likely they will be able to reunite with their child, Guzman said.

are U.S. citizens who live with a parent or family member who does not have legal immigration status, according to research from the Brookings Institution, a Washington, D.C.-based think tank. Within that group, 2.6 million children have two parents lacking legal status.

Santana said he expects the number of family separation cases to grow as the Trump administration continues its immigration enforcement campaign, putting more children at risk of being placed in foster care.

the agency to make efforts to facilitate detained parents’ participation in family court, child welfare, or guardianship proceedings, but Santana said it’s uncertain whether ICE is complying with those rules.

ICE officials did not respond to requests for comment for this report.

Before the change in California’s law, the only way a parent could share custodial rights with another guardian was if the parent was terminally ill, Guzman said.

If parents create a preparedness plan and identify an individual to assume guardianship of their children, the state child welfare agency can begin the process of placing the children with that individual without opening a formal foster care case, he added.

While Nevada lawmakers expanded an existing guardianship law last year to include immigration enforcement, the measure requires the parents to file notarized paperwork with the secretary of state’s office, an administrative step that may be burdensome, said Cristian Gonzalez-Perez, an attorney at Make the Road Nevada, a nonprofit that provides resources to immigrant communities.

Gonzalez-Perez said some immigrants are still hesitant to fill out government forms, out of fear that ICE might access their information and target them. He reassures community members that the state forms are secure and can be accessed only by hospitals and courts.

The Trump administration has taken through the Centers for Medicare & Medicaid Services, the IRS, the Supplemental Nutrition Assistance Program, the Department of Housing and Urban Development, and other entities.

Gonzalez-Perez and Guzman said that not enough immigrant parents know their rights. Nominating a temporary guardian and creating a plan for their families is one way they can prevent feelings of helplessness, Gonzalez-Perez said.

“Folks don’t want to talk about it, right?” Guzman said. “The parent having to speak to a child about the possibility of separation, it’s scary. It’s not something anybody wants to do.”

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Researchers say the children at about a mile away pay the price. They discovered the students there and at other elementary schools near major pollution sites in Pennsylvania had than other children in the state.

Residents and environmental advocates saw reason for hope and relief in the form of a designed to tamp down on coke oven plant pollution. But even before it took effect, President Donald Trump granted in the U.S. — including the one in Clairton — a from the standards.

Trump and Republicans have sought to align themselves with the Make America Healthy Again movement’s populist ideals, such as improving Americans’ food choices and reducing corporate harm to the environment. But the administration is ratcheting up its attacks on the very environmental protections that MAHA followers hold dear.

Taken together, these anti-environmental initiatives will lead to more pollution-related illnesses and higher health care spending, health researchers say. They could also have political ramifications, eroding MAHA’s support for GOP candidates in the November midterm elections if followers believe the party is more beholden to industry than to the movement’s agenda.

, including about a quarter of Republicans, support rolling back environmental regulations, according to a poll by the Energy Policy Institute at the University of Chicago and The Associated Press-NORC Center for Public Affairs Research.

Some MAHA supporters believe voters will support Republicans because the Trump administration is delivering on other goals important to the movement.

“MAHA has a pretty diverse set of policy goals, ranging from medical freedom to food and the environment,” said David Mansdoerfer, who served in Health and Human Services leadership during Trump’s first term. “In totality, the Trump administration has strongly delivered on much of the MAHA agenda.”

While MAHA voters have been upset at some of the administration’s actions that promote industry, it’s hard to know how that may play out in the midterms, said Christopher Bosso, a professor of public policy and politics at Northeastern University. Many were disillusioned by a Trump they viewed as promoting glyphosate, which HHS Secretary Robert F. Kennedy Jr. has .

“The glyphosate thing really ticks off a lot of them; they’re really upset,” Bosso said. “Kennedy said it was poison. If it is a poison, why aren’t we regulating it? That’s where the tension plays out.”

The situation with the Clairton coke plant and the others granted exemptions from regulations underscores the potential public health risks. Six of the 11 factories had “high priority” violations of the Clean Air Act as of last May, according to a ºÚÁϳԹÏÍø News analysis. Five coke oven plants logged major violations every quarter for at least three years straight.

“Poisoning continues to some of the most vulnerable residents of Allegheny County,” , who had lived in nearby Glassport, Pennsylvania, said at a about the coke plant.

Environmental Protection Agency spokesperson Brigit Hirsch said the president gave companies extra time because the technology needed to meet a new standard isn't ready yet.

“Forcing plants to comply before the tools exist doesn't make the air cleaner, it just shuts down facilities and kills jobs with nothing to show for it,” Hirsch said.

But environmental groups disagree that the plants were unable to comply at a reasonable cost, and they say the exemption from the EPA requirements shows the Trump administration is prioritizing the coal industry at the expense of public health.

“The Trump administration’s relentless actions to dismantle lifesaving environmental protections are a gut punch to the administration’s own promise to Make America Healthy Again,” said Cathleen Kelly, a senior fellow at the Center for American Progress, a liberal think tank.

Hard Times in Clairton

Sprawled across , the Clairton plant operates ovens in which coal is heated to as much as 2,000 degrees Fahrenheit to make up to 4.3 million tons annually of the carbon-rich fuel known as coke. The product is used in blast furnaces to produce iron.

It’s a dirty operation. The process leads to hazardous emissions of that the Centers for Disease Control and Prevention says can lead to anemia and leukemia, as well as , which can trigger severe asthma.

The Clairton operation has had repeated problems with its emissions and operations, including and of toxic chemicals. The plant has received more than from the Allegheny County Health Department since 2022, stemming largely from a fire in 2018 that led to high emissions, and violated the Clean Air Act in each of the last , with the last compliance monitoring in July 2025, according to the EPA.

Nippon Steel Corp. last year acquired U.S. Steel, which now operates as a subsidiary. The company didn’t respond to an email seeking comment. U.S. Steel said it spends $100 million annually on environmental compliance at Clairton.

“Environmental stewardship is a core value at U. S. Steel, and we remain committed to the safety of our communities,” spokesperson Andrew Fulton said in a written statement.

Clairton was once bustling with movie theaters, a mix of grocery stores, and riverside parks, with a dance pavilion and . But the decline of steel hit hard. The town’s population dwindled from more than in the mid-20th century to as of 2024. until they were razed and replaced with signs saying to keep out. The 1978 movie , which depicts a hardscrabble industrial town, is partly set there. Today, about 33% of residents live in poverty.

While the plant brings jobs and revenue, residents of the town and the surrounding areas have long complained about health problems they attribute to its emissions.

“My parents are gone. My mom had cancer, my dad,” , a Clairton resident, said at a 2025 County Council meeting. “I lost a lot of loved ones and seen other ones pass because of this mill.”

Pediatric allergist looked into asthma rates among 1,200 children who attended school near major pollution sites in the area — including students at Clairton Elementary School. They had nearly triple the national rate of asthma, with the highest rate among African American youth, according to she led.

“We were shocked,” she said. “It was double or triple what we expected. The people are proud of their industrial background. We need steel, but they’re not running a good enough operation.”

A found children with asthma living near the coke plant had an 80% higher chance of missing school when sulfur dioxide pollution was elevated.

Allegheny County, which includes Clairton and Pittsburgh, is home to a number of industrial plants, and to increased deaths, chronic heart disease, and adverse birth outcomes. It was ranked in the top 1% of counties in the nation for cancer risk from stationary industrial air pollutants in a 2018 .

Clairton has an age-adjusted cancer death rate of 170 per 100,000 people, higher than the broader county’s rate of 150 deaths per 100,000 people, based on a ºÚÁϳԹÏÍø News analysis of .

The American Lung Association in 2025 gave the county an F rating for its particle pollution levels. PennEnvironment, an environmental group that was party to a settlement with U.S. Steel involving the Clairton plant, says the coke operation caused of toxic releases in 2021, which amounted to 60% of all such releases in the county that year.

From 2020 through 2025, the Clairton plant racked up more in fines from Clean Air Act penalties than any other coke oven facility nationwide, costing U.S. Steel over $10 million, according to EPA facility reports.

“We are deeply concerned with exemptions, which allow air toxics to affect public health,” Allegheny County Health Department spokesperson Ronnie Das said in a statement.

The Clairton plant provides and hundreds of millions of dollars in tax revenue to the area. The jobs help generate nearly $3 billion in annual economic output, according to estimates from the Pennsylvania Manufacturers’ Association.

Some community members and advocacy groups hoped air quality would improve after the coke plant was sold. has pledged to upgrade facilities in the Monongahela River Valley.

Politics, Waivers, and Environmental Concerns

Under the Biden-era rule, coke plants were supposed to start meeting from the lids and doors of ovens that heat coal. They would also have had to monitor for benzene at their property lines and take steps to lower emissions of the carcinogen if they exceeded certain levels. Compliance deadlines were set for July 2025.

The Trump administration, which has sought to revive the coal industry, intervened. Last year, it , including coke plants such as Clairton’s, to seek from issued in 2024 by the EPA.

Then Trump in November went further, granting all coke plants a two-year compliance break.

The reprieve was necessary, the EPA spokesperson Hirsch said, because the requirements would have meant extra costs for the industry when standards already in effect work “extremely well” at reducing pollution.

Hirsch also said the agency under Trump is protecting the environment, pointing to action the administration has taken to called PFAS, prevent lead poisoning, strengthen chemical safety, and protect Americans’ food and water supply.

“We are building a future where the next generation of Americans is the healthiest in our nation's history, and they inherit the cleanest air, land and water in the world,” Hirsch said.

However, the administration has taken several steps that environmental advocates say weaken health protections.

The president's executive order on glyphosate, an herbicide the World Health Organization has linked to cancer, which touched off a furor among MAHA enthusiasts who said they felt betrayed. The EPA has decided to stop considering the of reducing pollution when making policy decisions, instead focusing on the cost to industry of complying with rules. The agency also rescinded the legal and scientific basis that had long established as dangerous to public health.

The actions have rankled some MAHA enthusiasts who counted on the administration to tackle chronic disease, especially among children. A petition to Trump on with more than 15,000 signatures called for the removal of EPA Administrator Lee Zeldin, it said supported corporations over MAHA goals.

Some MAHA enthusiasts have sounded off on social media.

“No one should believe that MAHA is being upheld at the EPA at this point,” , a leader of American Regeneration, which focuses on a conservation approach to farming, said Feb. 8 on X.

, host of a , also aired her concerns on X, saying “there is something really freaking spooky going on at the EPA and I refuse to let the American people be gaslit into thinking they’re upholding the MAHA agenda.”

“A significant number of people who supported Trump are worried these rollbacks are going to hurt their health,” said , a Democratic strategist and the founder of the communications firm Third Degree Strategies. “The MAHA voters, especially women, are very sensitive to this. Republicans have put themselves in a bind.”

MAHA supporters shouldn’t be surprised by a Trump administration that doesn’t prioritize environmental protections over industry, because the president has always championed fossil fuels, said Kyle Kondik, managing editor of Sabato’s Crystal Ball, a nonpartisan election forecasting newsletter published by the University of Virginia Center for Politics.

The coke plant exemptions have disappointed some community members, environmental groups, and regulators concerned about public health and emissions.

Nearly 300,000 people live within 3 miles of the 11 active coke plants across the U.S., according to EPA data compiled by the Environmental Defense Fund.

Weakening environmental rules has helped boost Trump with the U.S. coal industry. In February, mining industry executives and lobbyists gathered at the White House, .

Coal miners, including some in white hard hats bedecked with American flags, with a bronze-colored trophy emblazoned “The Undisputed Champion of Beautiful Clean Coal.”

At the event, Trump praised their work. “We love clean, beautiful coal,” he said.

ºÚÁϳԹÏÍø 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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This story can be republished for free (details).

In a humbling exercise, employees were waiting to test whether their entry badges still worked at the Department of Health and Human Services — or whether they’d be walked back out by security because they were among the 10,000 unlucky ones whose jobs had suddenly been eliminated.

I thought back to that day recently as I researched andÌýreported onÌýa significant, under-the-radar proposal from the Office of Personnel Management, which oversees federal workers.Ìý

According to aÌýÌýin December, OPM isÌýseekingÌýpersonally identifiable medical and pharmaceutical claims information on federal employees and retirees, as well as their family members, who are enrolled in the Federal Employees Health Benefits or Postal Service Health Benefits programs. Just over 8 million Americans get coverage through such plans.

Right now, 65 insurance companiesÌýmaintainÌýdata the agency wants, including information on prescriptions, diagnoses, and treatments. That would put a tremendous amount of personal information about federal employees in the hands of an administration that has earned a reputation for takingÌýÌýagainst some workers andÌýsharing sensitive dataÌýacross agencies as part of its immigration and fraud crackdowns.ÌýÌý

My colleague Maia Rosenfeld and I wanted to know what lawyers and ethicists who work on health policy issues think about this proposal.ÌýÌý

On the one hand, sources toldÌýus,Ìýthis sort of detailed data could be used by the federal government to improve the largest employer-sponsored health insurance system in the country.Ìý

But doubts about the Trump administration’s motives percolated through every conversation we had.Ìý

“The concern here is the more information they have, theyÌýcould use it to discipline or target people who are not cooperating politically,” Sharona Hoffman, a health law ethicist at Case Western Reserve University, told me.ÌýÌý

And, though the notice states that insurers are legallyÌýpermittedÌýtoÌýdiscloseÌý“protected health information” to the agency for “oversight,” Hoffman and others raised questions about OPM’s access to such a sweeping database of medical records under federal health privacy laws.ÌýÌý

Insurance companies — several of which declined to comment — would have to provide monthly reports to OPM with data on their members. One insurer, CVS Health, said in a public comment that insurers would be breaking the law by providing the information for OPM’s “vague and broad general purposes.” The association thatÌýrepresentsÌýmany of those companies also has voiced objections to the proposal, which has not yet beenÌýfinalized.ÌýÌý

OPM spokespeople did not respond to our repeated requests for comment.

ºÚÁϳԹÏÍø 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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This story can be republished for free (details).

At the Trump administration’s request, a federal judge in Louisiana this week agreed to delay a ruling affecting the continued availability of the abortion drug mifepristone. That angered anti-abortion groups that want the drug, if not banned, at least more strictly controlled. But the administration clearly wants to avoid big abortion fights in the run-up to November’s midterm elections.

Meanwhile, the administration’s proposed budget for fiscal year 2027 calls for more than $15 billion in cuts to programs at the Department of Health and Human Services. It’s a significant number, but less drastic than cuts it proposed for fiscal 2026.

This week’s panelists are Julie Rovner of ºÚÁϳԹÏÍø News, Lauren Weber of The Washington Post, Alice Miranda Ollstein of Politico, and Maya Goldman of Axios.

Panelists

Among the takeaways from this week’s episode:

• The Trump administration says it is conducting a thorough scientific review of the abortion pill mifepristone at the Food and Drug Administration. Yet advocates on both sides of the abortion debate think the administration is just trying to buy time to avoid a controversial decision about medication abortion before November’s midterm elections.
• It’s budget time on Capitol Hill. With the unveiling of the president’s spending plan for fiscal 2027, Cabinet secretaries will make their annual tour of congressional committee hearings. HHS Secretary Robert F. Kennedy Jr., whose Hill appearances have been few during his tenure, is scheduled to testify before six separate House and Senate committees before the end of the month.
• Back at HHS, Kennedy appears to be trying to reconstitute the Advisory Committee on Immunization Practices in a way that will enable him to restock it with vaccine skeptics without running afoul of a March court ruling that he violated federal procedures with his replacements last year.
• Continuing his efforts to promote his Make America Healthy Again agenda, Kennedy announced this week that he will launch his own biweekly podcast. He also announced efforts to combat microplastics in the water supply and to get hospitals to stop serving ultraprocessed food to patients.

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

Julie Rovner: The Atlantic’s “,” by Katherine J. Wu.

Maya Goldman: ºÚÁϳԹÏÍø News’ “Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records,” by Amanda Seitz and Maia Rosenfeld.

Lauren Weber: CNN’s “,” by Holly Yan.

Alice Miranda Ollstein: Politico’s “,” by Simon J. Levien.

Also mentioned in this week’s podcast:

• JAMA Internal Medicine’s “,” by Lauren J. Ralph, C. Finley Baba, Katherine Ehrenreich, et al.
• ºÚÁϳԹÏÍø News’ “Immigrant Seniors Lose Medicare Coverage Despite Paying for It,” by Vanessa G. Sánchez, El Tímpano.
• The New York Times’ “,” by Ellen Barry.
• Stateline’s “,” by Nada Hassanein.
• The Washington Post’s “,” by Lena H. Sun.

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

Julie Rovner:ÌýHello, from ºÚÁϳԹÏÍø News and WAMU Public Radio in Washington, D.C. Welcome toÌýWhat the Health?ÌýI’mÌýJulie Rovner, chief Washington correspondent for ºÚÁϳԹÏÍø News, andÌýI’mÌýjoined by some of the best and smartest health reporters covering Washington.ÌýWe’reÌýtaping this week on Thursday,ÌýApril 9, at 9:30Ìýa.m.ÌýAs always, news happens fast, and things might have changed by the time you hear this. So here we go.Ìý

Today, we are joined via video conference by Lauren WeberÌýofÌýThe Washington Post.Ìý

Lauren Weber:ÌýHello,Ìýhello.Ìý

Rovner:ÌýAlice MirandaÌýOllsteinÌýof Politico.Ìý

Alice MirandaÌýOllstein:ÌýHi,Ìýeverybody.Ìý

Rovner:ÌýAnd my fellow Michigan Wolverine this national championship week,ÌýMaya Goldman of Axios.ÌýGo,ÌýBlue!Ìý

Maya Goldman:ÌýGo,ÌýBlue.Ìý

Rovner:ÌýNo interview this week, but plenty of news.ÌýSoÌýlet’sÌýget rightÌýtoÌýit.ÌýWe’reÌýgoing to start with reproductive health. On Tuesday, a federal judge in Louisiana ruled for the Trump administration and against anti-abortion forces in a lawsuit over the availability of the abortion pillÌýmifepristone.ÌýWait, what? Please explain,ÌýAlice,Ìýhow the administration and anti-abortion groups ended up on opposite sides of an abortion pill lawsuit.Ìý

Ollstein:ÌýYeah.ÌýSoÌýthis has been building for a while, and it is not the only lawsuit of its kind out there. There are several.ÌýAÌýbunch of different state attorneys general,Ìýwho are very conservative and anti-abortion, have been suing the FDAÌýin an attempt toÌýeither completely getÌýrid of the availabilityÌýof the abortion pillÌýmifepristoneÌýor reimpose previous restrictions on it.ÌýSo right now, at least according to federal rules, not according to every state’sÌýrules,Ìýyou can get it via telehealth.ÌýYou can get it delivered byÌýmail. You can pick it up at a retailÌýpharmacy. YouÌýdon’tÌýhave to get it in person handed to you from a doctor like you used to.ÌýSoÌýthese lawsuits areÌýattemptingÌýto bring back those restrictions or get the kind of national ban that a lot of groups want.ÌýAndÌýsoÌýyou haveÌýother onesÌýpending:ÌýFlorida, Texas,ÌýMissouri,Ìýyou have a bunch of ones.ÌýSoÌýthis is the Louisiana version. And the Trump administration,Ìýit’sÌýimportant to note, they are not defending the FDA or the abortion pill on the merits. They are saying,ÌýweÌýdon’tÌýwant this lawsuit and this court to force us to do something.ÌýWe want to go through our own careful process and do our own internal review of the safety of mifepristone, and then we may decide to impose restrictions. ButÌýthey’reÌýasking courts to give them the time and space to complete that process and saying, you know,ÌýThisÌýis our power we should have in the executive branch. And so,Ìýin this case, the judge,Ìýin ruling for the Trump administration,Ìýbasically justÌýhit pause. ThisÌýdoesn’tÌýget rid of the case. It just putsÌýa stay on it for now, andÌýthat’sÌýimportant.ÌýIn some of these other cases, the Trump administration has asked the courts to throw out the case, but that was not the situation here.ÌýSoÌýthisÌýdoesn’tÌýmean that abortion pills are going to be available forever. ThisÌýdoesn’tÌýmeanÌýnothing’sÌýgoing to happen,ÌýandÌýthey’reÌýgoing to be banned. This just means, you know,Ìýwe’reÌýkicking the can down the road.ÌýÌý

Rovner:ÌýI was saying,Ìýjust to be clear. I mean, we know that this FDA quote-unquoteÌý“study”Ìý—Ìýwhether it is or isn’t going onÌý—Ìýis part of, kind of,Ìýa delaying tactic by the administration, because they don’t want to really make abortion a big front-and-center issue in the midterms.ÌýSoÌýthey’reÌýtrying toÌýsort of runÌýthe clock out here. Is that notÌýsort of theÌýinterpretationÌýthat’sÌýgoing on right now?ÌýÌý

Ollstein:ÌýThat’sÌýwhat people on both sides assume is going on.ÌýIt’sÌýreally been fascinating how everyone is being kept in the dark aboutÌýwhat’sÌýhappening inside the FDAÌý—Ìýand if this review is even happening, ifÌýit’sÌýreal, ifÌýit’sÌýin good faith, what is it based on? AndÌýsoÌýit’sÌýbecome this sort of Rorschach test,Ìýwhere people on the left are saying, you know,ÌýThey’reÌýlaying the groundwork to do a national ban. This is justÌýpoliticalÌýcover. They just want to wait until after the midterms, and thenÌýthey’reÌýgoing to go for it. And people on the right are saying, you know,ÌýTheÌýadministration is cowardly, and theyÌýaren’tÌýreally doing anything, andÌýthey’reÌýjust trying to get us to shut up and be patient. WeÌýdon’tÌýknow if either of those interpretations orÌýneither ofÌýthemÌýare true.ÌýÌý

Rovner:ÌýLauren,ÌýyouÌýwant to add something?Ìý

Weber:ÌýI just think it’sÌýpretty clearÌýthis is also just on aÌý[Health and Human Services Secretary Robert F.]ÌýKennedyÌý[Jr.]Ìýpriority.ÌýI mean,Ìýlet’sÌýgo back. The manÌý…Ìýcomes from oneÌýofÌýthe top Democratic political families originally. You know,Ìýthere’sÌýobviously been a lot of chatter around his anti-abortion beliefs. Now, obviously,Ìýhe’sÌýon a Republican ticket. I think some of that plays into this as well. And he already has his hand on the stove on so many otherÌýhot issuesÌýthat,Ìý[if]ÌýI had to guess,ÌýIÌýdon’tÌýthink thatÌýthey’reÌýtrying to rock the boat on this one.Ìý…ÌýI think, some background context too, to some ofÌýwhat’sÌýgoing on.ÌýÌý

Rovner:ÌýWe’llÌýget to some of those hotter issues. But,Ìýmeanwhile, the Journal of the American Medical AssociationÌý[Internal Medicine]Ìýhas aÌýÌýsuggesting that medication abortion is so safe that it could be provided over the counterÌý—Ìýthat’sÌýwithout any consultation with a medical professional, either in person or online. ThisÌýdoesn’tÌýfeel likeÌýit’sÌýgoing to happen anytime soon, though, right? WhileÌýwe’reÌýstill debating the existence of medication abortion in general.Ìý

Ollstein:ÌýThat’sÌýright. I mean, there are a lot of people whoÌýcan’tÌýget this medication prescribed by a valid doctor right now, let alone over the counter. I will say it is common in a lot of parts of the world to get it over the counter,ÌýwhereasÌýin the United States, the most common way to have a medication abortion is with a two-pill combination,ÌýmifepristoneÌýand misoprostol. In a lot of parts of the world, people just use misoprostol alone, and it isÌýeffectiveÌýand it isÌýlargely safe.ÌýIt’sÌýslightly less safe than using both pills together. AndÌýsoÌýI thinkÌýthere’sÌýa lot of international data out there, and people point to that and advocate for this. And I will say there are activist groups in the United States who are setting up networks, underground networks, to get these pills to people with no doctor’s involvement. And so that is already going on. I think that a lot of people would prefer to get it from a doctor if they could.ÌýBut because of bans and restrictions, theyÌýcan’t. AndÌýsoÌýpeople are turning to these activist groups.Ìý

Rovner:ÌýI will point out, as a person who covered the entirety of the fight to have emergency contraceptionÌý—Ìýwhich is not the abortion pillÌý—Ìýmade over theÌýcounter,Ìýit took like, 15 years. It shortened myÌýlifeÌýcovering that story. Lauren, did youÌýwant to add something?ÌýÌý

Weber:ÌýYeah, I just wanted to say I find itÌýreally interesting.ÌýObviously, reproductive issues end up taking 15 years, as you pointed out, to make it over the counter.ÌýBut there are a lot of things that are considered potentially more dangerous that you canÌýorder upÌýinÌýa pretty basic telehealth visit or even just buy in not-so-sketchy ways that the administration is also even looking to deregulate.ÌýSoÌýI think the differencesÌýofÌýaccessÌýofÌýthis compared to other less studied, potentially more unsafe medication is quite striking.Ìý

Goldman:ÌýPart ofÌý[President Donald]ÌýTrump’sÌý“GreatÌýHealthcareÌýPlan”Ìýis making more medications available over the counter.ÌýSoÌýthis is certainly something that they have said they want to do, in general.ÌýThis is a political nightmare, though, to do that for abortion.Ìý

Ollstein:ÌýYeah,Ìýand people have been pointing to this and a lot of other policies for a while to argue about something they call abortion exceptionalism, in which people apply a different standard to anything related to abortion, a different safety standard, a different standard of scrutiny than they do to medications for lots of other purposes.ÌýAndÌýyou’veÌýseen that, and that comes up in lawsuits and political arguments about this. And I think,Ìýyou know, people can point to this as another example.Ìý

Rovner:ÌýSo last week, weÌýtalked about the federal family planning programÌýTitleÌýX, which finally got funded after months of delays. But Alice, you warned us that the administration was planning to make someÌýbig changesÌýto the program, and now those have finally been announced. Tell us what the plan is for a program that’s provided birth control and other types of primary and preventive care since the early 1970s.Ìý

Ollstein:ÌýWell, the changes haveÌýsort ofÌýbeen announced. They’veÌýmore been teased. What we are still waiting for is an actual rule,Ìýlike we saw in the first Trump administration, that would impose conditions on the program. AndÌýsoÌýwhat we saw recently, it was part of a wonky document called aÌý“Notice of Funding Opportunity,”Ìýor NOFO, for those in the D.C.Ìýlingo. AndÌýbasicallyÌýit was signaling that when groups reapplyÌý—Ìýthey just got this year’s money,Ìýbut when they reapply for next year’s moneyÌý—Ìýit sets upÌýsort of newÌýpriorities and a new focus for the entire program. And what was really striking to me is, youÌýknow,Ìýthis is a family planning program. It was created in the 1970s and it is primarily about delivering contraception to people who can’t afford it around the country, providing it to millions of peopleÌýwhoÌýdepend on this program, and the wordÌý“contraception”Ìýdid not appear in the entire 70-page document other than an assertion that it is overprescribed and has bad side effects. And instead, they signaled that they want to shift the program to focus on, quote,Ìý“family formation.”ÌýSoÌýthis is really striking to me.ÌýI think weÌýsaw some signs that something like this was coming. You know, about a year ago, there was someÌýTitleÌýXÌýmoney approved to focus on helping people struggling with infertility.ÌýBut that wasÌýsort of justÌýa subset of the program, and now it looks like they want to make that, you know, an overriding focus of the program.ÌýSoÌýI think when the actual rule to this effect drops, and weÌýdon’tÌýknow when that will beÌý—Ìýwill they wait till after the midtermsÌýto, you know, avoid blowback? Who knows? I think there will certainly be lawsuits then.ÌýBut I think right now, this is just sort of a sign of where they want to go in the future.ÌýAndÌýit’sÌýimportant to note that it came very quickly on the heels of a big backlash from the anti-abortion movement over the approval of this year’s funding going out toÌýall ofÌýthe clinics that got it before, including Planned ParenthoodÌýclinics.ÌýTheÌýanti-abortion groups were agitating for Planned Parenthood to be cut off at once, you know, not in the future,Ìýright now.Ìý

Rovner:ÌýJust to remind people that the ban on Planned ParenthoodÌýfunding fromÌýlast year was for Medicaid, not for theÌýTitleÌýXÌýprogram.Ìý

Ollstein:ÌýRight.ÌýÌý

Rovner:ÌýAnd that’s why Planned Parenthood got money.Ìý

Ollstein:ÌýYes, and Planned Parenthood is not allowed to use any Medicaid orÌýTitleÌýXÌýmoneyÌýfor abortions, but the anti-abortion groups say it functions like a backdoor subsidy, and so they wanted it to beÌýcutÌýoff.ÌýSoÌýthey were very pissed that this money went out to Planned Parenthood. And so very quickly after,Ìýthe administration put out this document, saying,ÌýLook, we are taking things in another direction, and it is not the direction of Planned Parenthood.Ìý

Rovner:ÌýLauren,ÌýyouÌýwant to add something?Ìý

Weber:ÌýOh, I just wanted to say Alice has really been owning the beat on all theÌýTitleÌýXÌýcoverage, soÌý…Ìý

Rovner:ÌýAbsolutely.ÌýÌý

Weber:Ìý…Ìýglad weÌýare able toÌýhave her explain it to us.ÌýButÌýjust wanted to throw outÌýaÌýkudos for breaking all the news on that front.ÌýÌý

Goldman:ÌýYeah, great coverage.Ìý

Rovner:ÌýYes.ÌýVery happyÌýto have youÌýforÌýthis. Turning to the budget, which is normally the major activity for CongressÌýin the spring, we finally got President Trump’s spending blueprint last week. It does propose cuts to discretionary spending at the Department of Health and Human Services to the tune of aboutÌý$15 billion,Ìýbut those cuts are far less deep than those proposed last year.ÌýAnd,Ìýas we have noted, Congress didn’tÌýactually cutÌýthe HHS budget last year by much at all.ÌýAnd many programs, like the National Institutes of Health,Ìýactually gotÌýsmall increases. Is this budget a reflection of the fact that the administration is recognizing that cuts toÌýHealth andÌýHumanÌýServices programsÌýaren’tÌýactually popularÌýwith the public or with Congress, for that matter, going into a midterm election?Ìý

Weber:ÌýI thinkÌýit’sÌýthat last little piece you mentioned there, Julie. I thinkÌýit’sÌýtheÌý“going into the midterm election.”ÌýI think youÌýhit the nail on the headÌýthere. Cuts are also not good economically for many Republicans.ÌýYou know, we saw Katie Britt be one of theÌý— theÌýAlabama Republican senatorÌý—Ìýbe one of the most outspoken senators in general about some of the cuts that were floated for the budget for HHS last year.ÌýSoÌýI think whatÌýyou’reÌýhinting at, and whatÌýwe’reÌýgetting at, is thatÌýit’sÌýnot politicallyÌýpopular,Ìýit can be economically problematic, on top of the scientific advances that are not found.ÌýSoÌýI suspect you are rightÌýonÌýthat.Ìý

Ollstein:ÌýThe administration knows that this isÌý“hopes and dreams”Ìýand will not become reality. It did not become reality last year. It almost never becomes reality. And I think you can see the sort of acknowledgement that this is about sending a message more than actually making policy in things likeÌýTitleÌýX, because at the sameÌýtime they put out this guidance from HHS about the future ofÌýTitleÌýX, moving away from contraception,Ìýin theÌýpresident’s budget heÌýproposed completely getting rid ofÌýTitleÌýX, completely defunding it, which he has in the past as well. And so why would they put out guidance for a program thatÌýdoesn’tÌýexist?Ìý

Goldman:ÌýI think,Ìýalso, this is the second budget thatÌýthey’reÌýputting out in this administration, right? So now they are just a little more used toÌýwhat’sÌýgoing on, and they have more of their feet under them.Ìý

Weber:ÌýAsÌýa preview for listeners,Ìýtoo,ÌýI’mÌýsure we will have Kennedy asked about this budget when he appears in a series of so many hearings next week and the week after. And there were a lot of fireworks last year with him and various members of Congress about the budget.ÌýSoÌýI am sure that we will hear a lot more on this front in theÌýweeks to come.Ìý

Rovner:ÌýYeah, I would say that’s one thing that the budget process does, is when theÌýpresident finally puts out a budget, the CabinetÌýsecretaries travel to all of the various committees on Capitol Hill to, quote,Ìý“defend theÌýpresident’s budget,”Ìýwhich is sometimes or,ÌýI guess in the case of Kennedy, one of the few chances that they get to actually have him in person to ask him questions. But in the meantime, you know, we have the budget, then we have the president himself, who at an Easter lunch last weekÌý—Ìýthat was supposed to be private, but ended up beingÌýlive-streamedÌý—Ìýsaid, and I quote,Ìý“It’s not possible for us to take care of dayÌýcare, Medicare, Medicaid, all these individual things.” The president went on to say that states should take over all that social spending, and the only thing the federal government should fund is, quote,Ìý“military protection.”ÌýDidÌýI justÌýhearÌýa thousandÌýDemocratic campaign ads bloom?Ìý

Goldman:ÌýI think thisÌýis a prime example of when you should take Trump seriously, butÌýnot literally. IÌýdon’tÌýthink thatÌýthere’sÌýany world, at least in theÌýforeseeable future, where the federal governmentÌýisn’tÌýfunding Medicare.ÌýBut,Ìýyou know, you certainlyÌýhave toÌýwatch atÌýthe margins.ÌýIt’sÌýlike,Ìýit’sÌýnot a secret that this is something thatÌýthey’reÌýinterested in cutting backÌýspending on.ÌýIt’sÌýsuper politically difficult to do that, and they know that, and that’s part of why, whichÌýI’mÌýsureÌýwe’llÌýtalk about in a little bit,Ìýthey bumped up the payment rate for 2027 to Medicare Advantage plans.ÌýÌý

Rovner:ÌýWhich we will get to.Ìý

Goldman:ÌýYeah, so I mean,Ìýit’sÌýcertainly an eye-opening statement, and you should remember it. But IÌýdon’tÌýthink thatÌýwe’reÌýin immediate jeopardy here.Ìý

Rovner:ÌýThis is theÌýpresident who ran in 2024,Ìýyou know, saying that he was going to protect Medicare and Medicaid. I mean,Ìýit’sÌýbeen, you know, against some of the recommendations of his own administration. I was justÌýsort of shockedÌýto see these words come out of his mouth. Lauren,Ìýyou wantedÌýto sayÌýsomething?ÌýÌý

Weber:ÌýI mean,Ìýit’sÌýnotÌýthat surprising, though. I mean, look at what theÌýOneÌýBigÌýBeautiful BillÌý[Act]Ìýdid to Medicaid.ÌýHe’sÌýalready pushed through massive Medicaid cuts, which areÌýessentially beingÌýoffloaded to the states.ÌýSo, I mean, I think this ideology has alreadyÌýborneÌýout and will continue to bear out, and obviouslyÌýit’sÌýhappening amid the backdrop of a war. So that plays into, obviously, the commentary as well.ÌýÌý

Rovner:ÌýWell, meanwhile,ÌýRepublicans are still talking about doing another budget reconciliation bill, the 2.0 version of last year’sÌýBigÌýBeautifulÌýBill, except this time it’s essentially just to fund the military andÌýICEÌý[Immigration and Customs Enforcement]ÌýandÌýborderÌýcontrol, because Democrats won’t vote for those things, at least they won’t vote for additional military spending.ÌýWhat are the prospects for that toÌýactually happen?ÌýAnd would Republicans really be able to do it if those programs are paid for with more cuts to Medicare and/or Medicaid, as someÌýhave suggested?Ìý

Goldman:ÌýYou know, my co-worker Peter Sullivan wrote about this last week, and there was a lot ofÌýblowbackÌýfrom politicos, from advocates, from, you know,Ìýkind of acrossÌýthe spectrum of groups there. I think that it would be extremely politically unpopular, especially going into the midterms, to use healthÌýcare as an offset. But I would say that Republicans areÌýpretty goodÌýat rhetoric, right?ÌýThat’sÌýone of the things thatÌýthey’reÌýknown for right now, andÌýthere’sÌýalways a way to spin it.Ìý

Rovner:ÌýAlice and I spoke to a group earlier this week, and I went out on a limb and predicted that IÌýdidn’tÌýthink Republicans could get the votes for another big budget reconciliation this year. I mean, look at how close it was last year. The idea of cutting any deeper seems to me unlikely, just given the margins that they have.Ìý

Goldman:ÌýAndÌýI think thatÌýis something that youÌýdo inÌýbetween election years.ÌýThat’sÌýnot something you do in anÌýelection year.Ìý

Rovner:ÌýThat’sÌýtrue, yesÌý…Ìýyou do tend to see these bigger bills in the odd-numbered years rather than the even-numbered years, but …Ìý

Ollstein:ÌýAndÌýI thinkÌýit’sÌýimportant to remember that the reason Republicans are in this bind and that they feel like theyÌýhave toÌýkeep reconciliation nearly focused on funding immigration enforcement is because Democrats refuse to fund immigration enforcement.ÌýAndÌýsoÌýthey feel pressured to put all their effort and political capital towards that, andÌýdon’tÌýwant to mess that up by adding a bunch of otherÌýhealthÌýcare things that could cause fights and loseÌýthemÌývotes.ÌýÌý

Goldman:ÌýThe moneyÌýhas got toÌýcome from somewhere.Ìý

Rovner:ÌýAndÌýhealthÌýcare is where all the money is.ÌýSpeaking of Medicare and Medicaid,Ìýwhere most of the money is,Ìýthere is news on those fronts,Ìýtoo.ÌýMaya, as you hinted on Medicare, the administration is out with its payment rule for private Medicare Advantage plans for next year. And remember,Ìýwe talked about how HHS was going to really go after overbilling in Medicare Advantage and cut reimbursement dramatically?ÌýWell, you can forget all that. The final rule will provide plans with a 2.48% pay bump next year.ÌýThat’sÌýcompared to the less than 1% increase in the proposed rule.ÌýThat’sÌýa difference of aboutÌý$13 billion.ÌýThe final rule alsoÌýeliminatedÌýmany of the safeguards that were intended to prevent overbilling. What happened to the crackdown on Medicare Advantage?ÌýAre theirÌýlobbyists really that good?Ìý

Goldman:ÌýTheir lobbyists areÌýpretty good. This was a year where there wereÌý—ÌýI think CMSÌý[the Centers for Medicare & Medicaid Services]Ìýsaid there were a record number of public comments on their proposed rate, flat rate increase, flat rate update. But I thinkÌýit’sÌýalso not that surprising. Historically, the final rate announcement for Medicare Advantage isÌýalmost alwaysÌýa little higher than the proposed because they incorporateÌýadditionalÌýdata from the end of the previous year thatÌýwasn’tÌýavailable when first rate is proposed, theÌýinitialÌýrate isÌýproposed.ÌýButÌýcertainlyÌýthey backed away fromÌýa big changeÌýto risk adjustment, or,Ìýlike, the way to adjust payment based on how sick aÌýplan’sÌýenrollees are. You get more payÌý…ÌýÌý

Rovner:ÌýBecauseÌýthat’s where the overbilling was happening,Ìýthat we’d seen a lot of these wonderful stories that plans were basically, you know, inventing diagnoses for patients who didn’t necessarily have them or didn’t have a severeÌýillness, andÌýusing that to get additional payments.Ìý

Goldman:ÌýRight.ÌýAnd they did move forward with a plan to prevent diagnoses that are not linked to informationÌýthat’sÌýin a patient’s medical chart from being used for risk adjustment. But a lot of plansÌýhadÌýsaid, like,ÌýYeah, this is,Ìýthat’sÌýthe right thing to do, andÌýit’sÌýnot going to be that impactful for us. You know, overall, this is a win for health insurance. I think one thing to note is that Chris Klomp, the director of Medicare, said,ÌýWe’reÌýstill really focused on trying to right-size this program.ÌýThat’sÌýstill a priority for us as anÌýadministration, but we also want to safeguard it. AndÌýsoÌýI think insurersÌýare notÌýoff the hook entirely.ÌýThere’sÌýstill going to be a lot of scrutiny, but their lobbyists areÌýpretty good. And you know, no one wants to be seen as the candidate that cuts Medicare.Ìý

Rovner:ÌýAnd we haveÌýseen this before, that when Congress cutsÌý“overfunding”Ìýfor Medicare Advantage, the plans,Ìýseeing that theyÌýcan’tÌýmake its big profits,Ìýdrop out or they cut back on those extra benefits. And the beneficiaries complain because they’re losing their plans, or they’re losing their extra benefits, and they don’t really want to do that in an election year either, because there are a lot of people, many millions of people, who vote who are on these plans. So,Ìýin some ways, the plans have the administration over a political barrel, in addition to how good their lobbyists are.ÌýÌý

Well, apparently, oneÌýgroup that HHS is still cracking down on are legal immigrants with Medicare. Most of the publicity around the health cuts in last year’s budget bill focused on the cuts to Medicaid.ÌýButÌýwe at ºÚÁϳԹÏÍø News have a story this weekÌýabout legal immigrantsÌýwho’veÌýpaid into the Medicare system with their payroll taxes for years and are now being cut off from their Medicare coverage. This isÌýapparently theÌýfirst time an entire category of beneficiariesÌýareÌýhaving their Medicare taken away.ÌýI’mÌýsurprised thereÌýhasn’tÌýbeen more attention to this, orÌýifÌýit’sÌýjust tooÌýmuchÌýall happening at once.Ìý

Ollstein:ÌýI mean,Ìýthere’sÌýa lot happening at once, and even just in the space of immigrants’Ìýaccess to health care, there is so much happening at once. AndÌýsoÌýthis is obviously havingÌýa huge impactÌýon a lot of people, but so are 100 other things. And I think, you know, the zone has been flooded as promised. And really, state officials who are also dealing withÌýa thousandÌýother things, Medicaid cuts, you know, theseÌýfederal changes,Ìýwork requirements,Ìýare grappling with thisÌýas well.Ìý

Rovner:ÌýLauren,Ìýyou wantedÌýto add something?Ìý

Weber:ÌýYeah. I mean, I thought it was, there was a striking quote in the story from MichaelÌýCannon, whoÌýbasically said,ÌýTheÌýreason thisÌýisn’tÌýresonating is because thisÌýwon’tÌýupset the Republican base. And I thinkÌýthat’sÌýa striking quote to beÌýconsidered.Ìý

Rovner:ÌýMichaelÌýCannon, libertarian health policy expert,ÌýjustÌýkind of anÌýobserver to this one. ButÌýyeah, I thinkÌýthat’sÌýtrue. I mean, or at least the perception is that these are not Republican voters, although, you know, asÌýwe’ve seen, you know, Congress has tried to take aim at people they think aren’t their voters, and it’s turned out that those are their voters.ÌýSoÌýwe will see how this all plays out.ÌýÌý

Well,Ìýat the same time thatÌýthis is all going on, the folks over at the newsletterÌý“HealthcareÌýDive”Ìýare reporting that the Centers for MedicareÌý&ÌýMedicaid Services are trying to embark on all these new initiatives on fraud,Ìýand work requirements,Ìýand artificial intelligence with a diminished workforce.ÌýWhile CMS lost far fewer workers in theÌýDOGE [Department of Government Efficiency]Ìýcuts last year than many other of the HHS agenciesÌý—Ìýit was in the hundreds rather than theÌýthousandsÌý—ÌýCMS has long been understaffed,Ìýgiven the fact that it manages programs that provide health insurance to more than 160 million Americans through not just Medicare andÌýMedicaid, but also the Children’s Health Insurance Program and the Affordable Care Act. I know last week, FDAÌýCommissioner MartyÌýMakaryÌýsaid he wants to hire more workers to replace the 3,000 who wereÌýRIF’edÌýor took early retirement there at the FDA.ÌýAnd CMS does have lots of job openingsÌýbeing advertised.ÌýButÌýit’sÌýhard to see how replacing trained and experienced workers with untrained, inexperienced onesÌýareÌýgoing to improve efficiency, right?Ìý

Goldman:ÌýTangentially, I was talking to a health insurance executive yesterday who was saying that his team is so much bigger than CMS, and they cover a fraction of the market, and they’re often the ones coming to CMS and proposing ideas and working with CMS on it. IÌýdon’t,ÌýI think thatÌýis a dynamic that far predates this administration, butÌý…Ìý

Rovner:ÌýOh, absolutely.Ìý

Goldman:ÌýButÌýit’sÌýcertainly interesting. AndÌý…ÌýCMS hasÌývery ambitiousÌýplans, and not that many people to carry them out. But, you know, I think one thing that I also want to note is that when I talk to trade associations and stakeholders about thisÌýCMS, they are generally like, pretty support-Ìý…Ìýlike,Ìýthey say that they think they’re being heard, and they think that CMS and the career staff are doing, you know, the same kind of caliber of work that they’ve been doing, which I think is notable.Ìý

Rovner:ÌýAnd as we have mentioned many times, you know, Dr.Ìý[Mehmet]ÌýOz, the head of CMS, is very serious about his job and doing a lot ofÌýreally interestingÌýthings.ÌýIt’sÌýjust,Ìýit’sÌýhard, you know, in the federal government, if youÌýdon’tÌýhave the resources that you want toÌý…Ìýif youÌýdon’tÌýhave the resources to match your ambitions.ÌýLet’sÌýput it that way.ÌýÌý

Well, meanwhile, on the Medicaid front,Ìýwe’reÌýalready seeing states cutting back, and some of the results of those cutbacks.ÌýÌýonÌýhow psychiatric units are at risk of being shut down due to the Medicaid cuts, since they often serve a disproportionate number of low-income peopleÌýand alsoÌýtend to lose money.ÌýAndÌýThe New York Times has aÌýÌýof an Idaho Medicaid cutback of a program that had provided home visits to people living in the community with severe mental illness, until those people who lost the services began to die or to end up back in more expensive institutional care. Now the state has resumedÌýfundingÌýtheÌýprogram, butÌýobviously will end up having to cut someplace else instead. I know when Republicans in Congress passed the cuts last year, they said that people on Medicaid who were not the able-bodied working-age populationsÌýwouldn’tÌýsee their services cut. ButÌýthat’sÌýnot how this is playing out, right?ÌýÌý

Weber:ÌýI justÌýthink the story by Ellen Barry, who you should always readÌýonÌýmental health issues inÌýThe New York Times,Ìý“,”Ìýis such anÌýillustrative example of unintended consequences from these cuts.ÌýAnd the reason thatÌýthey’reÌýbeing reversedÌý—Ìýby Republican legislators, no lessÌý—Ìýin Idaho, is becauseÌýit’sÌýmore expensive to have cut the money from it than it is efficient. I mean, what they found was, isÌýthat after they cut the money to the schizophrenia program, they saw this massive uptick in law enforcement cases and hospitalizations, uninsured hospitalizations,Ìýthat this avoided. And I thinkÌýit’sÌýa real canary in the coalÌýmineÌýsituation, becauseÌýwe’reÌýonly starting to see these states cut these things off. And this wasÌýa pretty immediateÌýmultiple-death consequence. And I thinkÌýwe’reÌýgoing to see a lot of stories like this, of a variety of programs that we allÌýdon’tÌýeven have any idea thatÌýexistÌýin the safety net across the country thatÌýareÌýbeingÌýchipped away at.ÌýÌý

Rovner:ÌýWell, turning toÌýother news from the Department of Health and Human Services,Ìýwe’reÌýgetting some more competition here atÌýWhatÌýthe Health?ÌýHealthÌýsecretary Kennedy has announcedÌýhe’llÌýbe unveiling his own podcast,ÌýcalledÌýThe Secretary KennedyÌýPodcast, next week. He promises to,Ìýaccording to the trailer posted online on Wednesday, quote,Ìý“name the names of the forces that obstruct the paths to public health.”ÌýOKÌýthen,Ìýwe look forward to listening.ÌýÌý

Meanwhile, in actual secretarial work, theÌýsecretary this week also unveiled changes to the charter of the Advisory Committee onÌý[Immunization]ÌýPractices after a federal judge last month invalidated both the replacement members that he’d appointed lastÌýyearÌýand the changes made to theÌýfederally recommended vaccine schedule.ÌýSoÌýwhat’sÌýgoing to happen hereÌýnow?ÌýWill this get around the judge’s ruling by watering down theÌýexpertiseÌýthat members of this advisory committee are supposed to have in vaccines? And why hasn’t the administrationÌýappealedÌýthe judge’sÌýruling yet?Ìý

Goldman:ÌýYou know, I don’t have actual answers to this, but I do wonder and speculate that this is going to end up being some kind of legal whack-a-mole situation where theÌýsecretary and HHSÌýsays,ÌýOK, you don’t like it that way?ÌýWe’llÌýdo it this way, and thenÌýthey’llÌýdo it another way, and advocates will sue, andÌýwe’llÌýsee how this plays out going forward in the courts.ÌýI think thisÌýis not the end of the story.ÌýEven though the judge’s decision was a big win for vaccine advocates,Ìýit’sÌýjustÌýwe’reÌýin the midpoint, if that.Ìý

Rovner:ÌýAnd Lauren, speaking of vaccines, your colleague LenaÌýH. Sun hasÌýÌýon HHS and vaccine policy.Ìý

Weber:ÌýYeah, LenaÌýSun is always delivering.ÌýShe found out that the acting director of the CDCÌý[Centers for Disease Control and Prevention]Ìýat the time delayed publication of a report showing that the covid-19 vaccine[s]Ìýcut the likelihood of emergency department visits and hospitalizations for healthy adults last winter by about half. So even though Kennedy is not talking more about vaccines, it appears that, based on this reporting,Ìýthat some of his underlings are not necessarily touting the benefits ofÌývaccine, so to speak.ÌýAnd I’m very curious, going back to Kennedy’s podcast, I found the rollout of that so interesting because the teaserÌýwas veryÌýleaning intoÌýthe KennedyÌýthat got elected, you know, someone who speaks about, you know, dark truths that are hidden from the public,Ìýand so on. And then the press team had these statements of,Ìýlike,ÌýKennedy will investigate the affordability of healthÌýcosts and foodÌýand nutrition.ÌýAnd I think this dichotomy of who Kennedy is and who theÌýWhite House and the press secretary and HHS want Kennedy to be before the midterms really could come to a head in this podcast.ÌýSoÌýI think we will all be listening to hear how that goes.Ìý

Rovner:ÌýYeah, we keep hearing aboutÌýhow theÌýsecretary is being, you know,Ìýsort of putÌýon a leash, if you will. And, you know, told to downplay some of his anti-vaccine views and things like this. And that seems quiteÌýat oddsÌýwith him having his own podcast. Alice,Ìýdo you wantÌýto …?Ìý

Weber:ÌýI guess, it depends onÌýwho’sÌýediting the podcast and who they have on.ÌýI’mÌýjust veryÌý…Ìýyou could even tell from the trailer to how his press secretary presented it, there was an interesting differential in framing, and I am curious how that plays out as we seeÌýguests on it.Ìý

Ollstein:ÌýI mean,Ìýit’sÌýalso worth noting that this is an administration of podcasters. I mean, you haveÌýKashÌýPatel,Ìýyou have so many of these folks who have a history of podcasting,Ìýclearly have a passion for it, justÌýcan’tÌýlet it go while working aÌýfull-time, high-pressureÌýgovernment job.ÌýÌý

Rovner:ÌýWe shall see.ÌýMeanwhile, HHS, together with the Environmental Protection Agency, is wagingÌýwarÌýon microplastics, thoseÌýnearly tooÌýimpossibleÌýtoÌýdetect bits of plastic that are getting into our lungs and stomachs and body tissues throughÌýair and waterÌýand food. The plan here seems to be to find ways to detect exactly how much microplastics we are all getting in our water and what the health impacts might be, since weÌýdon’tÌýhave enough information to regulate them yet.ÌýI would think this would be one of those things thatÌýpleasesÌýboth MAHAÌý[Make America Healthy Again]Ìýand the science community, right? Or is it just,Ìýas one MAHAÌýsupporterÌýcalled it,Ìýtheater?Ìý

Goldman:ÌýI think thisÌýisÌýa great exampleÌýof the,Ìýyou know, part of theÌýreason whyÌýMAHAÌýis so interesting to such a wide swath of people.ÌýLike,Ìýthere’sÌýa lot of legitimate concern, not that other concernsÌýaren’tÌýnecessarily legitimate, butÌýthere’sÌýa lot of concern over,Ìýfrom the scientific community, over microplastics.ÌýI’mÌýhonestly surprised thatÌýwe’reÌýthis far into the administration with this announcement. I would have thought that thisÌýisÌýsomething they would have done sooner, but they obviously had other prioritiesÌýas well.Ìý

Rovner:ÌýWell. Finally, this week, speaking of other priorities, HHS Secretary Kennedy and CMS Administrator Dr.ÌýOz are declaring war on junk food in hospitals. Again, this seems like a popular andÌýfairly harmlessÌýcrusade;ÌýhospitalsÌýshouldn’tÌýbe serving their patientsÌýultraprocessedÌýfood.ÌýExcept,Ìýalmost as soon as the announcement came out, I saw tons of pushback online from doctors and nurses who worried about patients for whom sugary food or drinks are actually medically indicated, or who,Ìýbecause of medications they’re taking, or illnesses they have, can only eat, or will only eat, highly palatable, often processed food. Nothing in healthÌýcare is as simple as it seems, right?ÌýÌý

Weber:ÌýI thinkÌýwhat’sÌýalso interesting is one of my favorite examples in the memo they put out was they hope that every hospital, as an example, could serve quinoa and salmon. And IÌýjust amÌýcurious to see how fast that gets implemented. AndÌýit’sÌýa veryÌývalidÌý—Ìýa lot of people complain about hospital food.ÌýIt’sÌýa very valid thing to push for better food. But I also question, as I understandÌýit,Ìýthis seems more like a carrot than a stick when it comes to the regulation they put out.Ìý

Rovner:ÌýAs it were.Ìý

Weber:ÌýAs it were.ÌýAndÌýsoÌýI’mÌýcurious to see how it gets implemented. That said, there are hospitals that have taken it upon themselvesÌý—Ìýthe NorthwellÌý[Health]Ìýexample in New York is a good exampleÌý—Ìýto really improve their hospital food. And frankly,Ìýit’sÌýa money maker. If your food’s better, people come to your hospital, especiallyÌýinÌýan urban area where there is hospital competition.ÌýSoÌýyou know, like most MAHAÌýtopics, there’s a lot of interesting points in there, and then there’s a lot of what’sÌýthe realityÌýand what’Ìýactually goingÌýto happen. AndÌýsoÌýI’Ìývery curious to see how this continues to play.Ìý

Rovner:ÌýIÌýdidÌýa bigÌýstory,Ìýlike,Ìý10 years ago on a hospital chain that had its ownÌýgardens,ÌýthatÌýliterally grewÌýits own healthy food.ÌýSoÌýthis is not completely new but,Ìýagain, interesting.Ìý

All right, that is this week’s news. NowÌýit’sÌýtime for ourÌýextra-creditÌýsegment.ÌýThat’sÌýwhere we each recognize a story we read thisÌýweekÌýwe think you should read,Ìýtoo.ÌýDon’tÌýworry if you miss it. We will post the links in our show notes on your phone or other mobile device. Alice, why don’t you start us off this week?Ìý

Ollstein:ÌýIÌýhave a piece from my co-worker SimonÌý[J.]ÌýLevien, and it is calledÌý“.”ÌýThis is aboutÌýthousands of doctors around the country who are from other countries that are placed on, you know, a list by the Trump administration of places where they want to scrutinize and limit the number of immigrants coming from there. And so these are people who are already here, already practicing, have poured years into their training, have been living here, and,Ìýin some cases, are the only folks willing to work in certain areas that have a lot of medical shortages, and they just can’t practice because their paperwork isn’t getting processed in time. AndÌýsoÌýthey’reÌýsort of inÌýthis scary limbo, andÌýthat’sÌýputting these hospitals and clinics that they work in in aÌýreally toughÌýbind. AndÌýsoÌýthey’reÌýhammering the Trump administration to give them answers about what their fate is. You know,Ìýthey’reÌýnot trying to deport them yet, butÌýthey’reÌýnot allowing them to continue working either.ÌýÌý

Rovner:ÌýFor anÌýadministration that’s been pushingÌýreally hardÌýto improve rural health care, this does not seem to be a way to improve rural health care.ÌýMaya.Ìý

Goldman:ÌýMy extra credit this week is calledÌý“Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records.”ÌýIt’sÌýa greatÌýKFFÌýHealthÌýNewsÌýscoopÌýfrom Amanda Seitz andÌýMaia Rosenfeld. It’s a really great example of the administration, you know, sort of moving in silence,ÌýdoingÌýthese small regulatory announcements that could haveÌýbigÌýimpact.ÌýBasically, theÌýOffice of Personnel Management is asking for personally identifiable medical information from health insurers, and its reasoning is to analyze costs and improve the health system, but they could getÌývery detailedÌýmedical information from federal employees, including things like, did they get an abortion? Are they undergoing gender-affirming care? And,Ìýobviously,Ìýthere is a strongÌýconcern thatÌýthat could be used against them.ÌýÌý

Rovner:ÌýYeahÌý…Ìýthis was quite a scoop. Really,ÌýreallyÌýinterestingÌýstory. Lauren.Ìý

Weber:ÌýMineÌýwasÌýa pretty alarmingÌýstory by Holly Yan at CNN:Ìý“.”ÌýAnd basically there’s this type of drug test that the scientists have found is not that effective, and it’s led to things like bird poop being scraped off a man’s car appearing on a drug test as cocaine, a great-grandmother’s medication testing positive for cocaine, and a toddler’s ashes registering as meth orÌýecstasy, and horrible legal and other consequences of thisÌýkind of misdiagnosis in the field. And the reason these drug tests are often done is becauseÌýthey’reÌýcheaper.ÌýThere’sÌýa more expensive, moreÌýaccurateÌýversion, but these are cheaper.ÌýThey’reÌýdone in the field.ÌýBut the potential side effects and horrible, wrongly accused effects are quite large, and soÌýColorado has passed this law to try and move away from this. AndÌýit’sÌýcurious to see if otherÌýstates will follow suit.Ìý

Rovner:ÌýYeah, this was something I knew nothing about until I read this story. My extra credit this week is fromÌýThe Atlantic byÌýKatherineÌý[J.] Wu,ÌýandÌýit’sÌýcalledÌý“.” And it’s about how some of the very top career officials from the NIHÌý[National Institutes of Health],Ìýthe CDC,Ìýand other agencies have, after having been put on leave more than a year ago, finally been reassigned toÌýfar-flungÌýoutposts of the Indian Health Service in the western United States. They got news of their proposed reassignments with little description of their new roles and only a couple of weeks to decide whether to move across the country or face termination. Now,Ìýif these officials’Ìýskills matched those needed by the Indian Health Service, this all might make some sense.ÌýBut whatÌýthe IHSÌýmostÌýneedsÌýare active clinicians:Ìýdoctors and nurses and social workers and lab technicians.ÌýAnd those who are now being reassigned are largely managers, includingÌý—Ìýand here I’m reading from the story,ÌýquoteÌý— “the directors of several NIH institutes, leaders of several CDC centers, aÌýtop-rankingÌýofficial from the FDA tobacco-productsÌýcenter, a bioethicist, a human-resources manager, a communications director,Ìýand a technology-information officer.”ÌýTheÌýNative populations who areÌýostensibly beingÌýhelped hereÌýaren’tÌývery happyÌýabout this, either. Former Biden administration Interior Secretary Deb Haaland, a Native AmericanÌýwho’sÌýnow running for governor in New Mexico, called the reassignment proposals, quote,Ìý“shameful”ÌýandÌý“disrespectful.”ÌýAlso, and this is myÌýaddition, not a very efficient use of human capital.Ìý

OK, that’s this week’s show.ÌýThanksÌýthis week to our fill-in editor,ÌýMary-EllenÌýDeily, and our producer-engineer,ÌýFrancis Ying.ÌýA reminder:ÌýWhat the Health?Ìýis now available on WAMU platforms, the NPR app, and wherever you get your podcasts — as well as, of course,Ìýkffhealthnews.org. Also,Ìýas always, you can emailÌýusÌýyour comments or questions.ÌýWe’reÌýat whatthehealth@kff.org.ÌýOr you can find me on XÌý, or on BlueskyÌý.ÌýWhere doÌýyou guysÌýhangÌýthese days? Maya.Ìý

Goldman:ÌýI am on LinkedIn under my first and last name,Ìý, and onÌýXÌýatÌý.Ìý

Rovner:ÌýAlice.Ìý

Ollstein:ÌýI’mÌýonÌýBlueskyÌýÌýand onÌýXÌý.Ìý

Rovner:ÌýLauren.Ìý

Weber:ÌýStillÌý@LaurenWeberHPÌýonÌýbothÌýÌýandÌý.Ìý

Rovner:ÌýWe will be back in your feed next week.ÌýUntil then, be healthy.

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“The first time, it’ll ring interminably. Next time, it’ll go to a voice mail that just hangs up on you,” said the 48-year-old, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”

She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.

Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.

Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.

Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.

Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.

ºÚÁϳԹÏÍø News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.

The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.

States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”

Long Wait Times for Help

Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.

The Congressional Budget Office would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.

Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.

The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.

In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.

CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.

In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.

In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and lost their benefits.

Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.

“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.

After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride (D-Del.). McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.

Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.

“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.

Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.

States Short-Staffed for Medicaid

Some states told ºÚÁϳԹÏÍø News in late March that they’ll need more staff to roll out the work rules effectively.

Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.

As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.

Missouri’s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made in November.

“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”

States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.

“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

States are paying government contractors millions of dollars to help them comply with the new federal law.

Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.

During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.

Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told ºÚÁϳԹÏÍø News.

The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.

Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.

People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.

“The human stakes of this are people’s lives,” she said.

ºÚÁϳԹÏÍø News correspondents Katheryn Houghton and Samantha Liss contributed to this report.

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But she also wasn’t expecting the Planned Parenthood in Marquette to shut down last spring. Roughly 1,100 patients relied on that clinic each year for cancer screenings, IUD insertions, and medication abortions. Now the area has no other in-person resource for abortions. “It’s a 500-mile stretch of no access,” Brown said.

So the doctor, who describes herself as “individually pro-life,” added medication abortions to Marquette Medical Urgent Care’s already busy practice, which treats a steady flow of kids with the flu, college students with migraines, and tourists with skiing injuries.

At least 38 abortion clinics shut down last year in states where they’re still legal, according to data collected by , a project supported by a number of nonprofits that helps people find abortion options. Even states that recently protecting abortion rights, such as Michigan, have had clinics close since the U.S. Supreme Court overturned Roe v. Wade in 2022. And as shutter , patients are losing access to pregnancy care. “You cannot have a high-risk pregnancy up here,” Brown said. “It’s a scary place.”

Now communities are coming up with alternatives, such as Brown’s urgent care.

The idea that urgent cares “could be an untapped solution to closures for abortion clinics across the country is really exciting,” said Kimi Chernoby, the chief operating and legal officer at , a national nonprofit that works to improve professional training and patient outcomes for women in emergency medicine.

One patient at the Marquette urgent care on a recent day was a woman whom ºÚÁϳԹÏÍø News agreed to identify by only her first initial, “A,” to protect her medical privacy. She drove more than an hour on snowy backroads while her kids were in day care to get to her appointment.

Her youngest is still a baby, A said, and she got pregnant again while taking the progestin-only birth control pill, which is less likely to interfere with breast milk production but slightly less effective than the regular pill.

“Financials, housing, vehicles — it’s a lot,” she said. And another baby is “just not something that we could really do even at this time.”

She said she was making the long round trip because receiving abortion care in an office felt more secure than being treated by “someone that I’ve never met, or receiving meds that were just shipped to me.”

Face-to-Face Care

In one of the urgent care’s exam rooms, A sat in a chair against the wall, waiting quietly for the doctor. Viktoria Koskenoja, an emergency medicine physician, knocked on the door and then greeted her warmly, pulling up a stool across from her.

“Are you confident in your decision that you want to go ahead? Or do you want to talk about options?” she said.

“No, I’m pretty set on it,” A said.

Koskenoja previously worked at Planned Parenthood. When she learned its Marquette clinic was closing, she started crying and making calls. She recalled asking everyone she knew in health care in Marquette: “What are we going to do?”

One of her first calls was to Brown, a friend and fellow emergency medicine doctor. Their families harvest maple syrup together each spring.

In the wake of the Planned Parenthood closure, Koskenoja convened a community meeting downtown at the Women’s Federated Clubhouse, an 1880s-era building where guests sip from gold-rimmed china teacups on lace tablecloths. The goal: brainstorm new ways to provide abortion access in the Upper Peninsula.

officials said that growing financial challenges and the Trump administration’s cuts to funding, including for the public insurance program Medicaid, had prompted the closures of some brick-and-mortar clinics in the state.

Plus, the availability of pills by mail exploded after the 2022 Dobbs v. Jackson Women’s Health Organization decision overturned Roe. As abortion became illegal in many states, telehealth abortions went from 5% of all abortions provided to 25% by the end of 2024, , a national reporting project that tracks shifts in abortion volume.

Planned Parenthood of Michigan’s telehealth appointments increased 13% for patients in the Upper Peninsula after the Marquette location closed, said Paula Thornton Greear, president and CEO of Planned Parenthood in the state.

All the abortion patients Koskenoja sees at the urgent care have one thing in common: They want to talk to someone in person.

“I had a patient order the pills online and then get scared to use them because they felt like they were going to screw it up, or they weren’t sure they could rely on the pills,” she said. “So they literally came in here with the pills in their hand.”

Others have medical complications or need an ultrasound to determine how far along they are with the pregnancy.

“It annoys me that telehealth is considered an acceptable thing in rural areas,” Koskenoja said. “As though we’re not the human beings that like talking to human beings and looking someone in the eye, especially when something serious is going on.”

The Urgent Care Option

The options presented at that community clubhouse meeting were limited. The few family medicine doctors and OB-GYNs in the area were either already putting patients on months-long waitlists or were too “rightward leaning,” Brown said.

But urgent cares are designed to fill gaps in the system, she said, ready to take walk-ins who aren’t already patients.

Brown knew from her years in the emergency room that medication abortions aren’t that complicated. The for first-trimester and are essentially the same: one dose of mifepristone, followed by misoprostol after 24 to 48 hours.

“Clinically, I was never worried about it,” she said.

The biggest hurdle was getting medical malpractice insurance, Brown said. At first, insurers balked, demanding “onerous and unrealistic” documentation and additional training, she said. Then they quoted a $60,000 annual premium for medication abortions — about three times the cost of insuring the entire urgent care. Ultimately, Brown said, the urgent care’s broker pushed back, providing data that medication abortions didn’t add “significant liability.”

The company agreed to a premium of about $6,000 per year, she said.

The community pitched in, too. A local donor covered an ultrasound machine. And supporters started a nonprofit to help pay for the costs of the medication and additional staffing, bringing the price for patients down from about $450 to an average of about $225, based on a sliding scale.

Word spread quickly once Marquette Medical began offering medication abortions, Brown said. Now the office provides as many as four per week, with patients traveling from as far away as Louisiana. The clinic is on track to match the volume of abortion patients treated at the local Planned Parenthood office before its closure, Brown said.

As pills by mail become the next major target for abortion opponents, Chernoby said, it will be critical to offer more care in more brick-and-mortar places. Brown said the Marquette clinic has already fielded questions from a large academic medical center that plans to start providing medication abortion at its own urgent cares later this year.

“It’s a wonderful idea, but it’s potentially got major pitfalls,” said David Cohen, a professor at the Drexel University Kline School of Law who studies abortion access.

Urgent cares that provide medication abortion would have to abide by state-specific laws — some mandate 24-hour waiting periods or facility structural requirements — and federal regulations, such as the FDA’s requirement that mifepristone prescribers be certified by the drug’s distributors and obtain signed patient agreements.

If abortion access isn’t a core part of a health organization’s mission, “do you want to be on that list? I don’t know if you do,” Cohen said. “There’s just a very particular regulatory environment” around abortion.

Making a Choice

In the exam room, Koskenoja listened as A talked about why she decided to seek an abortion. She has four kids at home, including the baby.

“You OK if we do an ultrasound, just confirm how far along you are, make sure it’s not an ectopic pregnancy?” Koskenoja asked.Ìý

“Yeah,” A said.

Koskenoja noted A’s reaction to the question. “OK. You’re making a face?”

“Yeah, I just don’t — yeah, it’s fine. I just don’t want to see it.”

“Oh, you don’t have to see it,” Koskenoja said.

“I just don’t want to hear a heartbeat or anything like that,” A said.

“Definitely not,” Koskenoja said.

After the ultrasound, Koskenoja stepped out into the hall to give A time to call her partner.

When A said she was ready, Koskenoja stepped in and asked her how she was feeling. A had made up her mind. She said that her partner would be supportive of whatever she decided and that she didn’t want to have another baby right now.

“As much as I know this baby would be loved no matter what, it’s just not a good time,” A said quietly, her hands in her lap.

“Most people who get abortions love babies,” Koskenoja said. And you can still have more in the future, she assured A.Ìý

This kicked off a long conversation about the mental load of parenting and the pros and cons of various birth control options. A said she wanted to get her tubes tied, but Koskenoja suggested her partner consider a vasectomy instead. It’s a much less invasive procedure, she said. “You’ve had a lot of kids. I feel like it could be his turn to take some responsibility.”

Koskenoja handed her a small, handsewn “comfort bag” that all medication abortion patients receive. It was filled with the pills, reminders about when to take them, a handwritten note of support from local community members, pain meds, comfortable socks, and a heating pad.

“Call us if you need anything,” she told A. “Any questions?”

“No,” A said.

“OK. Good luck,” Koskenoja said before A walked out past the waiting room, filled with sick babies and other patients, to drive back to her kids.

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A from the Office of Personnel Management could dramatically change which personally identifiable medical information the agency obtains, giving it the power to see prescriptions employees had filled or what treatment they sought from doctors. The regulation would require 65 insurance companies that cover more than 8 million Americans — including federal workers, retired members of Congress, mail carriers, and their immediate family members — to provide monthly reports to OPM with identifiable health data on their members.

The proposal is prompting unease from insurers as well as health policy and legal experts, who are concerned about the legality of OPM acquiring such a sweeping database of sensitive health information, and the agency’s ability to safeguard it.

OPM could use the data to analyze costs and improve the system, said Sharona Hoffman, a health law ethicist at Case Western Reserve University in Ohio.

“But,” she said, “they are going to get very, very detailed and granular data about everything that happens. The concern here is the more information they have, they could use it to discipline or target people who are not cooperating politically.”

OPM spokespeople did not respond to repeated requests for comment. The agency’s notice asks insurers that offer Federal Employees Health Benefits or Postal Service Health Benefits plans to furnish “service use and cost data,” including “medical claims, pharmacy claims, encounter data, and provider data.” It says the data will “ensure they provide competitive, quality, and affordable plans.”

The notice, posted and sent to insurers in December, does not instruct them to redact identifying information — a burdensome process that they would need federal guidance to complete.

Instead, it states that insurers are legally permitted to disclose “protected health information” to OPM. Several experts in health policy and law consulted by ºÚÁϳԹÏÍø News said they interpreted the request to mean the Trump administration was seeking identifiable data.

The ask comes a year into a Republican administration that has been defined by haphazard mass layoffs and firings of thousands of federal workers, who say they were in acts of or for the . Under President Donald Trump, the government has also routinely tested the legal bounds of sharing sensitive and personally identifiable tax or health information across government agencies in its efforts to carry out mass immigration arrests or pursue identify fraud.

“You can anticipate a scenario where this information on 8 million Americans is now in the hands of OPM and there’s a real concern of how they use it,” said Michael Martinez, senior counsel at Democracy Forward, an advocacy organization that filed a public comment opposing OPM’s proposal in February. Martinez previously worked at OPM.

“They’ve given no information about how they would treat that information once they have it,” he said.

Among Martinez’s concerns is how the administration might use information about employees who have sought abortions — 41 states have some type of abortion ban — or transgender treatment, medical care that the Trump administration has tried to curb.

The American Federation of Government Employees, the largest union representing federal workers, did not respond to requests for comment.

Martinez and others who reviewed the notice for ºÚÁϳԹÏÍø News said the proposal was so vague that they were uncertain, exactly, what medical records OPM wants to access.

At the very least, they said, the proposal would allow the agency to access the medical and pharmaceutical claims of patients with their identifying information, such as names and birth dates. Claims data also includes diagnoses, treatments, visit length, and provider information.

OPM’s request to view “encounter data” could allow the agency to look at “anything and everything,” Hoffman noted.

That could include detailed medical records, such as a doctor’s notes or after-visit summaries.

Jonathan Foley, who worked at OPM advising on the Federal Employees Health Benefits program during the Obama and Biden administrations, said he doubts the agency has the capability to ingest such minutiae.

The agency, however, could easily begin collection of personally identifiable medical and pharmaceutical claims information from insurers, he said.

Foley said he sees a benefit to OPM having broader access to de-identified claims data. In recent years, OPM has ramped up its analysis of claims data, which has allowed it to examine prescription drug costs and encourage plans to offer federal workers cheaper alternatives. He’s worried, though, that the Trump administration’s proposal goes too far, because it appears to seek identifiable data.

“It’s kind of shocking to think of them having protected health information without having strict guardrails,” he said.

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, requires certain organizations that maintain identifiable health information — such as hospitals and insurers — to protect it from being disclosed without patient consent.

Those entities can disclose such information without consent only in specific scenarios, with a justification that it is deemed “reasonable” or “necessary.” Even then, HIPAA mandates that they provide only the minimum amount of information required.

OPM argues in its notice that it is entitled to the information from insurers “for oversight activities.”

But several people who reviewed the notice questioned whether OPM’s explanation for requesting the information is sufficient.

“The language in it seems quite broad and encompasses potentially a lot of information and data and is sort of light on justification,” said Jodi Daniel, a digital health strategist who helped develop the legal framework for HIPAA privacy rules over two decades ago.

Several major insurers that offer federal employee health plans — including the Blue Cross Blue Shield Association, Kaiser Permanente, and UnitedHealthcare — declined to comment on their plans to comply with the notice or offer insight on where plans to implement the data sharing stood.

Only one insurer individually weighed in with a public comment on OPM’s plan. In March, CVS Health executive Melissa Schulman urged the federal agency to reconsider its proposal.

“OPM’s request raises substantial HIPAA compliance issues,” Schulman wrote, arguing that federal law allows the agency to examine records but not to collect data. Insurers would be breaking the law by providing personal health information for OPM’s “vague and broad general purposes,” she added.

Schulman, who did not respond to additional questions from ºÚÁϳԹÏÍø News, also raised concerns about a lack of data privacy protections. She noted that insurers could be liable for security breaches or other situations “where consumer health information is inappropriately shared and outside of our control.”

In 2015, OPM announced the personal records of roughly 22 million Americans had been in a data breach that has been blamed on the Chinese government.

The Association of Federal Health Organizations, which represents CVS Health and dozens of other federal health plan carriers, also weighed in with a 122-page comment opposing the notice. In it, AFHO Chair Kari Parsons emphasized that insurance carriers are bound by HIPAA to safeguard personal health information.

Federal law requires carriers “to furnish ‘reasonable reports’ OPM determines to be necessary,” Parsons wrote, “not to furnish the individual claims data of every individual.”

This isn’t the first time OPM has requested detailed data from insurers. In the AFHO comment, Parsons noted OPM had made a similar proposal in 2010, prompting HIPAA concerns. She described how, after several years of negotiations with AFHO, they discussed — but OPM never finalized — an agreement in 2019 for carriers to share de-identified data with OPM.

But since then, Parsons wrote, OPM has collected such detailed information on enrollees and their families that, with OPM’s new request, the agency may be able to trace even de-identified records to individuals.

OPM has not provided any update since closing comments in March. The agency would need to publish a final decision before anything officially changes.

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Vestida con ropa de senderismo y collares de cuentas, Carranza, de 67 años, se movía entre árboles y niños en una mañana soleada de diciembre. “Agárrate de esa rama”, dijo en español. “¡Tú puedes, mi amor!”.

Carranza, profesional especializada en desarrollo infantil que creció columpiándose entre árboles y nadando en ríos en El Salvador, dijo que se siente como en casa en el bosque del preescolar al aire libre que cofundó. Ha trabajado con niños y adolescentes como cuidadora y educadora durante más de tres décadas, el tiempo suficiente para saber cuándo intervenir y cuándo dar un paso atrás para que sus estudiantes encuentren su propio equilibrio.

Cuando pasó a trabajar medio tiempo el año pasado, Carranza contaba con recibir Medicare y cheques del Seguro Social, beneficios otorgados a trabajadores estadounidenses e inmigrantes con presencia legal cuando se retiran, si de historial laboral y edad, o si tienen alguna discapacidad.

Carranza ha aportado decenas de miles de dólares a Medicare y al Seguro Social durante 24 años, según su registro de ingresos de la Administración del Seguro Social, revisado por El Tímpano y ºÚÁϳԹÏÍø News. Pero Carranza es una de un estimado de 100.000 inmigrantes con papeles que pronto quedarán excluidos de Medicare.

La ley One Big Beautiful Bill Act del Partido Republicano, firmada en julio pasado por el presidente Donald Trump, prohíbe que ciertas categorías de inmigrantes con presencia legal — incluidos beneficiarios del estatus de protección temporal (TPS), refugiados, solicitantes de asilo, sobrevivientes de violencia doméstica, víctimas de trata y personas con visas de trabajo — accedan a Medicare.

Quienes ya están en el programa, como Carranza, serán dados de baja antes del 4 de enero, una medida de legisladores republicanos para reducir el gasto de Medicare, ya que, junto con Trump, han argumentado que el dinero de los contribuyentes no debe usarse para pagar la atención médica de inmigrantes sin autorización.

“Los demócratas quieren que los inmigrantes ilegales, muchos de ellos CRIMINALES VIOLENTOS, reciban atención médica GRATIS”, dos meses después de firmar la ley. “¡No podemos permitir que esto suceda!”

Sin embargo, las categorías de inmigrantes que ahora perderán cobertura sí tienen estatus legal. Ni la Casa Blanca ni el Departamento de Salud y Servicios Humanos (HHS) respondieron a una pregunta sobre si era justo sacar de Medicare a residentes legales.

Los inmigrantes sin estatus legal ya no eran elegibles para Medicare ni para la mayoría de los beneficios públicos financiados por el gobierno federal.

Carranza teme que también pueda perder el permiso legal para vivir en Estados Unidos si la administración Trump pone fin al TPS para salvadoreños, como intentó hacer durante .

Si eso ocurre, Carranza perdería su residencia legal y podría estar en riesgo de pasar tiempo en un centro de detención migratorio o ser deportada.

“Esto es como una película de terror, una pesadilla completa”, dijo Carranza. “No es así como imaginé envejecer”.

“Bajo ataque constante”

Carranza dejó El Salvador en 1991 durante una guerra civil brutal, dejando atrás a tres hijos pequeños, para ganar dinero y enviarlo a su familia. Permaneció en el país después de que venciera su visa hasta 2001, cuando calificó para el TPS, luego de dos terremotos que azotaron El Salvador, y desplazando a 1,3 millones.

El TPS fue aprobado por el Congreso y promulgado en 1990 por el presidente republicano George H.W. Bush.

Este estatus permite que personas como Carranza, provenientes de ciertos países afectados por conflictos armados, guerras civiles o desastres climáticos, vivan y trabajen en Estados Unidos, si regresar a su país representa un riesgo.

Carranza se perdió la graduación de jardín de infantes de su hija menor y su primera medalla en atletismo. Trabajó turnos nocturnos cuidando recién nacidos y luego como maestra sustituta en escuelas públicas del Área de la Bahía de San Francisco para pagar la educación de sus hijos en El Salvador, así como sus propios estudios en el City College of San Francisco, donde obtuvo un título en desarrollo infantil.

También cuidó a decenas de niños de 3, 4 y 5 años que miraban con asombro mientras descubrían pequeños tesoros en el bosque de secuoyas del parque de Oakland donde cofundó Escuelita del Bosque, un preescolar de inmersión en español que enseña al aire libre.

Se suponía que la recompensa sería una jubilación tranquila. Pero el Congreso limitó la elegibilidad de Medicare a ciudadanos, residentes permanentes legales, nacionales cubanos y haitianos, y personas amparadas por los Compacts of Free Association, acuerdos entre Estados Unidos y naciones insulares del Pacífico.

La medida siguió a los intentos de Trump de excluir a algunos inmigrantes con presencia legal de Medicaid, de los subsidios en el mercado de seguros de salud y de servicios de apoyo social, como asistencia alimentaria, ayuda para vivienda y visitas médicas en centros de salud financiados por el gobierno federal. En total, se proyectaba que 1,4 millones de inmigrantes con presencia legal perderían el seguro de salud, según KFF, una organización sin fines de lucro de información de salud que incluye a ºÚÁϳԹÏÍø News.

Taylor Haulsee, vocero del presidente de la Cámara de Representantes, Mike Johnson, no respondió a solicitudes de comentarios.

Michael Cannon, director de estudios de política de salud en el Cato Institute, un centro de tendencia libertaria, dijo que los republicanos querían implementar recortes de impuestos y eliminar el seguro de salud para inmigrantes porque no afectaría a su base.

“No quieren convertir a Estados Unidos en un imán de asistencia social”, opinó. “Y les molesta que el gobierno les haga pagar por un estado de bienestar”.

Aunque no hay datos sobre inmigrantes con presencia legal, los inmigrantes sin papeles aportaron y $25,7 mil millones al Seguro Social en 2022, según el Institute on Taxation and Economic Policy.

La Oficina de Presupuesto del Congreso estimó que solo las restricciones a Medicare reducirían el gasto federal en para 2034.

Expertos en salud dicen que eliminar la cobertura para inmigrantes con estatus legal .

“En realidad, esta es la primera vez que el Congreso le quita Medicare a algún grupo”, dijo Drishti Pillai, directora de políticas de salud para inmigrantes en KFF. “Este cambio está afectando a inmigrantes con presencia legal en Estados Unidos, muchos de los cuales ya han trabajado y contribuido al sistema durante décadas”.

A medida que adultos mayores como Carranza pierdan su cobertura de Medicare, los médicos anticipan que retrasarán su atención, lo que llevará a un aumento de pacientes gravemente enfermos, especialmente en salas de emergencia.

Los adultos mayores pueden enfermarse de forma repentina y rápida, y son más vulnerables a enfermedades cardiovasculares como afecciones del corazón y presión arterial alta, especialmente si posponen la atención de rutina, dijo Theresa Cheng, médica de emergencias en Zuckerberg San Francisco General Hospital y profesora clínica adjunta de medicina de emergencias en la Universidad de California-San Francisco.

“Es bastante fácil que sufran un deterioro crítico de su salud”, dijo Cheng.

Carranza hace senderismo y se considera saludable, pero reconoce que está envejeciendo y comenzando a tener dificultades para seguir el ritmo de los niños en el bosque.

A finales del año pasado le diagnosticaron hipertensión, y en enero despertó con una presión en el pecho y fue a un centro de urgencias porque su presión había subido a niveles peligrosos. Unas semanas después, tropezó mientras caminaba y se cayó. Al día siguiente despertó con el pie hinchado. En el hospital local, un médico le dijo que tenía artritis.

Dijo que fueron momentos preocupantes, pero estaba agradecida de pagar solo $10 por la visita a urgencias y $5 por ver a su médico de atención primaria. Sin embargo, eso cambiará cuando pierda Medicare a principios del próximo año.

El estrés de saber que perderá su seguro de salud y posiblemente su estatus legal, mientras agentes federales detienen a inmigrantes como ella en todo el país, ha afectado su salud mental, contó. Está buscando terapia y servicios de acupuntura para tratar su insomnio y ansiedad, y la sensación de estar “bajo un ataque constante”.

Sin un lugar a donde ir

En California, hogar del mayor número de , Carranza podría haberse inscrito en un seguro patrocinado por el estado, pero este año la inscripción para adultos de 19 años o más que tienen TPS, están en el país sin autorización o son solicitantes de asilo. Otros estados con gobernadores demócratas como también han reducido sus programas de salud para inmigrantes por presiones presupuestarias.

En enero, el gobernador de California, Gavin Newsom, propuso un presupuesto estatal que no compensaría los recortes federales de atención médica para unos 200.000 inmigrantes con presencia legal, señalando el costo anual de $1.1 mil millones y déficits presupuestarios estatales.

“Dadas estas presiones fiscales, la administración no puede compensar este cambio en la política federal”, dijo H.D. Palmer, vocero del Departamento de Finanzas de California.

Pero algunos legisladores demócratas y defensores de los consumidores dicen que el estado debería intervenir. La asambleísta Mia Bonta, quien preside el Comité de Salud de la Asamblea, dijo que está trabajando en una solución presupuestaria legislativa para incluir en Medi-Cal — la versión estatal de Medicaid — a los inmigrantes que perderán su cobertura, incluidos los adultos mayores.

La demócrata de East Bay está especialmente preocupada por personas como Carranza, “que han vivido aquí durante décadas y han contribuido a esta economía, que han aportado a nuestro tejido cultural y a nuestras comunidades, que han formado familias y vidas y que ahora quieren tener la posibilidad de retirarse con dignidad y vivir con dignidad y tener la atención médica que necesitan”.

Una señal del futuro

En abril pasado, Carranza vislumbró lo que podría significar perder su cobertura de salud y beneficios de jubilación, después de que la Administración del Seguro Social le enviara una carta informándole que ya no calificaba para beneficios de jubilación porque no tenía presencia legal en el país, aunque sí la tenía. Luego Medicare dejó de pagar a su plan de salud, que como resultado la dio de baja.

Como beneficiaria de TPS con permiso de trabajo, sabía que se trataba de un error. Aun así, sin su cheque, Carranza no tuvo dinero para pagar la renta durante un mes. Compensó ese pago cuidando a los hijos de sus arrendadores. En mayo pasado, la oficina de la representante federal Lateefah Simon (demócrata de Oakland) ayudó a Carranza a recuperar sus beneficios de jubilación, pero tomó meses recuperar su seguro de salud.

La experiencia la dejó afectada.

“Es como recibir una bofetada en la cara después de más de 30 años trabajando para el sistema aquí”, dijo Carranza. “Y a cambio, esto es lo que tenemos ahora”.

Por las noches permanece despierta imaginando el futuro: aquí, donde ha pasado la mitad de su vida, sin seguro de salud y posiblemente sin beneficios del Seguro Social; o en El Salvador, donde están dos de sus tres hijos. Su hija, residente permanente que vive en Texas, espera convertirse en ciudadana para poder solicitar la residencia permanente para Carranza, pero el proceso puede tardar años.

También está la posibilidad que más teme: la detención indefinida o la deportación.

En una mañana reciente en su estudio en el sótano en Oakland, Carranza sacó una caja del fondo de su clóset. Dentro había una pila alta de tarjetas de identificación que incluían licencias de conducir antiguas, su tarjeta del Seguro Social y decenas de permisos de trabajo emitidos por el gobierno federal.

“Mi vida está en esta caja”, dijo.

Este artículo fue producido en colaboración con , una organización cívico-mediática que sirve y cubre a las comunidades inmigrantes latinas y mayas del Área de la Bahía.

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