The James H. Shannon Building (Building One), on the National Institutes of Health campus in Bethesda, Maryland. (Photo by Lydia Polimeni,/National Institutes of Health)
The Trump administration will review frozen grants to universities without using its controversial standards that discouraged gender, race and sexual orientation initiatives and vaccine research.
In a settlement agreement filed in Massachusetts federal court Monday, the National Institutes of Health and a group of Democratic attorneys general who’d challenged the new criteria for grant funding said the NIH would consider grant applications made up to Sept. 29, 2025, without judging the efforts related to diversity, equity and inclusion, or DEI, or vaccines.
The settlement provides an uncontested path for the agency while courts decide whether the administration can use its controversial analysis. The administration did not agree to permanently ditch its campaign to evaluate health research funding decisions based on schools’ DEI programs.
NIH officials “will complete their consideration of the Applications in the ordinary course of NIH’s scientific review process, without applying the Challenged Directives,” the settlement said, adding that the agency would “evaluate each application individually and in good faith.”
The settlement was signed by U.S. Department of Justice lawyers and the attorneys general of Massachusetts, California, Maryland, Washington, Arizona, Colorado, Delaware, Hawaii, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island and Wisconsin.
In a Tuesday statement, Massachusetts Attorney General Andrea Joy Campbell said the agreement commits the Department of Health and Human Services to resume “the usual process for considering NIH grant applications on a prompt, agreed-upon timeline.”
The 17 attorneys general sued in April over $783 million in frozen grants.
A trial court and appeals court in Massachusetts sided with the states, but the U.S. Supreme Court ruled in August that the trial judge lacked the authority to compel the grants to be paid, especially in light of a similar decision involving the Education Department.
A U.S. Postal Service employee sorts packages inside the Los Angeles Mail Processing & Distribution Center in December. A new USPS rule on postmarks took effect on Dec. 24 that says mail might not be postmarked on the day it’s dropped off. (Photo by Mario Tama/Getty Images)
The U.S. Postal Service has adopted a new rule that could create doubt about whether some ballots mailed by voters by Election Day will receive postmarks in time to be counted.
A USPS rule that took effect on Dec. 24 says mail might not receive a postmark on the same day the agency takes possession of it. The postal service says it isn’t changing its existing postmark practices and is merely clarifying its policy, but some election officials have looked to postmarks as a guarantee that mail ballots were cast before polls closed.
The new rule holds implications for 14 states and Washington, D.C., that count ballots arriving after Election Day if they are postmarked on or before that day — commonly called a “ballot grace period.” In these states, ballots placed in the mail by voters before the deadline may not be counted if the postal service applies a postmark after Election Day.
The USPS rule says that “the postmark date does not necessarily indicate the first day that the Postal Service had possession of the mailpiece.”
The USPS rule comes as the U.S. Supreme Court prepares to consider a case that could eliminate ballot grace periods nationwide. The court’s decision, expected late this spring or next summer, could render the issues raised by the postmark rule moot.
Mail-in voting surged in 2020’s general election amid the COVID-19 pandemic, when 43% of voters cast their votes by mail. The percentage of voters mailing their ballots has fallen from that peak but remains above pre-pandemic levels. About 30% of voters cast mail ballots in 2024, according to data gathered by the U.S. Election Assistance Commission.
While the vast majority of mail ballots were successfully cast last year, hundreds of thousands weren’t counted. During the 2024 election, 584,463 mail ballots returned by voters were rejected by election officials — 1.2% of returned mail ballots. About 18% of those ballots were rejected because they didn’t arrive on time.
The USPS defended the change in a lengthy response to criticisms published in the Federal Register. The agency emphasized that it does not administer elections and doesn’t advocate for or against voting by mail.
The postal service repeated its advice that voters mail their completed ballots at least a week before Election Day. And it noted that voters may request a manual postmark at their local post office free of charge.
“If customers are aware that the postmark date may not align with the date on which the Postal Service first accepted possession of a mailpiece, they will be better equipped to adjust their plans accordingly,” the response reads.
“And if policymakers or other entities that create rules utilizing the postmark date are aware of what the postmark date signifies, they are better equipped to determine whether their rules adequately serve their purposes.”
Stateline reporter Jonathan Shorman can be reached at jshorman@stateline.org.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
As Congress debates whether to extend the temporary federal subsidies that have helped millions of Americans buy health coverage, a crucial underlying reality is sometimes overlooked: Those subsidies are merely a band-aid covering the often unaffordable cost of health care.
California, Massachusetts, Connecticut and five other states have set caps on health care spending in a bid to rein in the intense financial pressure felt by many families, individuals and employers who every year face increases in premiums, deductibles and other health-related expenses.
Hospitals and other health care providers are citing Republicans’ One Big Beautiful Bill Act, signed by President Donald Trump in July, as one more reason to challenge those limits.
The law is expected to reduce federal Medicaid spending by more than $900 billion over a decade, which mathematically should help the overall health care system meet the caps. But the law is also expected to increase the number of uninsured Americans, mostly Medicaid beneficiaries, by an estimated 10 million people. Health care analysts predict hospitals and other providers will raise prices to cover the double whammy of lost Medicaid revenue and the cost of caring for an influx of newly uninsured patients.
Whether regulators in some states will allow providers to justify higher prices and exceed the spending caps is unclear. Only California and Oregon can penalize providers financially if they fail to meet targets.
“Are we going to say, ‘That’s OK’? Or are we going to say, ‘Well, you exceeded the target. We’re still going to penalize you for that’?” said Richard Pan, a former state lawmaker and a member of the California Office of Health Care Affordability’s board. “That has not yet been decided.”
The California Hospital Association, the industry’s main state lobbying group, filed a lawsuit in October asking a state court to strike down the spending caps, which it argued fail to account for all the cost pressures hospitals face. Those pressures, it said, include an aging, sicker population; the rising cost of labor; expensive advances in medical technology; large capital outlays on required seismic retrofitting; and changes in federal policy, including the One Big Beautiful Bill Act. The hospital group’s lawsuit also asserted that the state affordability office, by hastily imposing ill-considered cost-cutting targets, was undermining its other key mission of improving health care access, quality and equity.
California’s affordability office last year set a five-year target to cap statewide spending growth, starting at 3.5% in 2025 and declining to 3% by 2029. The annual caps apply to a wide range of health care entities, including hospitals, medical groups, insurers and other payers.
Earlier this year, it imposed much lower spending growth caps — starting at 1.8% in 2026 and declining to 1.6% by 2029 — for seven “high-cost” hospitals.
“The spending caps set by politically appointed bureaucrats could force cuts that result in many Californians traveling farther for care, facing longer emergency room wait times, experiencing more overcrowding and losing access to critical services,” Carmela Coyle, the hospital association’s president and CEO, said in an October press release.
The California attorney general’s office, which will represent the affordability agency, has not yet filed a response to the hospital group’s complaint and did not respond to a request for comment.
Hospitals’ pushback
California is not the only state taking a close look at hospital prices, which are widely considered a primary driver of health care costs.
“States, armed with information that points to payments to hospitals as a driver of what is way beyond affordable commercial premiums, have begun to take increasingly targeted actions focused on commercial hospital prices,” said Michael Bailit, founder of the Needham, Massachusetts-based consultancy Bailit Health, which has advised multiple states, including California, on ways to tame health care spending. “It is not surprising that the hospital industry is going to oppose such state actions.”
In its lawsuit, the California Hospital Association said the affordability office’s own report showed that pharmaceutical and insurance companies are largely responsible for high costs.
Hospitals in some states with cost growth limits, including Connecticut and Massachusetts, have expressed objections similar to the ones raised in the California lawsuit. They could follow their counterparts in California if their lawsuit succeeds, said Peter Lee, who led California’s Affordable Care Act marketplace, Covered California, for over a decade and is now a senior scholar at Stanford Medicine’s Clinical Excellence Research Center.
Lee said the work of California’s affordability office and similar agencies in other states is just about the only systemwide effort being made to cut health care costs. They are basically saying, “‘Look, health care is taking money away from education, it is taking money away from the environment, it is taking money away from everything in the public sector, and in the private sector it is taking money away from wages,’” he said. “‘We don’t know how you, the health system, are going to do it, but it is your job not just to provide quality but to lower costs. Here’s the target.’”
To be sure, achieving the cost savings that California and those other states are seeking is no easy lift. It will ultimately require persuading large, financially powerful players that compete fiercely for health care dollars to adopt a different mindset and begin cooperating to reduce costs instead. And that, in many cases, will mean lower revenue.
But the status quo, as many people know all too well, means continued financial pain for millions.
In early 2020, Estevan Rodriguez, a bartender at California’s Monterey Beach Hotel, had surgery for a staph infection in his leg. The bill came to nearly $168,000. His insurance paid most of it, but he still owed $5,665, which took him two years to pay, more than $200 every month. “It may not be a lot to some people, but it was a lot to me,” Rodriguez said.
He said he dropped his Hulu subscription, switched to a lower-cost cellphone, and got cheaper car insurance. He started going to food banks rather than the grocery store, he said, and had a lot less time with his kids, because he was constantly working to pay off the hospital bill.
Community Hospital of the Monterey Peninsula, where Rodriguez had his surgery, is one of the seven hospitals identified by California’s affordability office as high-cost. A study by the office attributed high hospital prices in Monterey County to a lack of market competition “rather than higher operating costs or superior quality of care.”
The Monterey hospital referred a request for comment about its “high-cost” designation to the California Hospital Association. CHA spokesperson Jan Emerson-Shea declined to comment beyond the language of the lawsuit and Coyle’s press release statement.
Reduced competition
Health care analysts worry the One Big Beautiful Bill Act will reduce market competition even further by stressing already weak hospitals, leading some to shut services, merge with larger health systems, or close. One study estimates 338 rural hospitals are at risk of closing nationwide.
Less competition, in addition to fewer Medicaid dollars and an increase in uninsured patients, will only strengthen the incentive of health systems with the requisite market clout to raise their commercial prices, increasing premiums for employers and individuals.
“We think commercial prices will continue to increase as health care providers, and hospitals in particular, will seek to preserve or increase their revenue,” said Rachel Block, a program officer at the Milbank Memorial Fund, a foundation that focuses on health equity.
That in turn could pose a challenge to state affordability regulators tasked with overseeing compliance with growth targets for health care spending.
California’s affordability office is required to consider mitigating factors, including changes in federal and state laws. But some of its board members have expressed skepticism about letting hospitals offset Medicaid losses with higher commercial prices.
“There’s a lot of talk about using HR 1 and other federal policies as an excuse to raise prices on commercial payers,” Ian Lewis, an affordability office board member and policy director for UNITE HERE Local 2, a hospitality workers union in the Bay Area, said at the agency’s July board meeting, referring to the One Big Beautiful Bill. “There’s no more blood to be squeezed from this stone.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. Learn more about KFF.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
(The Center Square) – One of Milwaukee’s most prominent education reformers says it is good to hear Milwaukee Public Schools’ new superintendent talk about closing school buildings, but he says she needs to do more than talk.
(The Center Square) – Wisconsin Department of Public Instruction Superintendent Jill Underly continued her attacks of an investigation of her department’s handling of sexual misconduct allegations related to teachers this week, saying “that headline was completely false” regarding a series…
(The Center Square) – A new Wisconsin law requires both parties in a child support or maintenance agreement to notify the other parent within 10 days of a significant change in gross income or a change of job.
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ATECH opened over a decade ago to create a pipeline of students interested in advanced manufacturing careers.
Many students at the charter school like the hands-on classes, take advantage of paid apprenticeships and earn free college credits.
But school leaders say they struggle to attract students, fight a stigma that surrounds technical education and afford equipment and tools.
A cacophony of humming, drilling, banging and buzzing fills Appleton Technical Academy’s cavernous lab.
In one corner, a student drills ventilation holes in a piece of metal that will eventually be a firepit ring. Another cuts through a thin piece of metal with clippers. Shrouded by red vinyl curtains, several students weld metal, sending blue sparks flying through the air.
As more schools embrace career and technical education, scenes like these are increasingly common in high schools nationwide: fewer students gripping pencils at desks; more wielding expensive tools and receiving hands-on training for their future career.
Part of that trend, Appleton Technical Academy (ATECH) opened a decade ago to ease the region’s shortage of advanced manufacturing workers. Today, many of the students love their hands-on classes, enroll in paid apprenticeships and collect free college credit before continuing on to trade school.
Carrie Giauque, a technology education instructor for Appleton Technical Academy, teaches students how to use a piece of equipment on Dec. 3, 2025. (Mike Roemer for Wisconsin Watch)
But it hasn’t been without difficulties. The school has struggled to attract students, combat a persistent stigma around technical education and afford the pricey equipment and tools it requires. Plus, it’s hard to determine if the school has met the original goal of producing local manufacturing employees.
What’s happening at ATECH shows how preparing Wisconsin teenagers to eventually fill workforce holes, especially amid the state’s dearth of skilled trade workers, can be a tall task.
ATECH lead teacher Paul Endter spends his lunch breaks and free time trying to grow local support for the school and get more students interested.
“I continue to tell people we’re the best-kept secret in the Fox Valley, and that’s not by design,” Endter said. “I wish I had more people who wanted to get involved.”
Born from industry needs
In the early 2010s, Jared Bailin, CEO of Appleton-based Eagle Performance Plastics, was struggling to find enough advanced manufacturing workers. The plastic manufacturing leader thought introducing high schoolers to the jobs would help.
He took the idea to Greg Hartjes, who was principal of Appleton West High School at the time. Hartjes is now the school district’s superintendent and has always worried about students who don’t mesh with traditional high school education structure — students who, he says, “perhaps didn’t want to sit in English class and read Shakespeare,” but rather wanted “their hands in the work that they were doing.”
Together, they built ATECH, a tuition-free charter school inside Appleton West that aims to prepare students for manufacturing jobs. They secured state grants to fund the launch, and Appleton voters approved a district referendum that put $2.4 million toward renovating labs and classroom spaces.
Izzy Chappell, a senior at Appleton West High School and Appleton Technical Academy, works on a metal sculpture on Dec. 3, 2025. (Mike Roemer for Wisconsin Watch)
The school opened in the 2014-15 school year. Here’s how it works: Students can apply to the school at any point, but most enroll their freshman year. They choose to specialize in one of four growing industries: electronics and automated manufacturing, machining, mechanical design or welding.
At first, students take a small number of classes that introduce them to the basics of manufacturing alongside the traditional courses required of all high schoolers, such as language arts and math. Students gradually take on more courses aligned to their specialization, such as programming for electronics students or blueprint reading for machining students.
Beginning their junior year, students take free college classes that earn both high school and Fox Valley Technical College credit. The classes chip away at a certificate in their focus area, which can shave thousands off tuition for students who enroll in technical college after graduation. Some juniors and seniors can work for local employers as paid youth apprentices during part of the school day, earning money and gaining work experience.
“ATECH kids are kids that wanted to use their hands along with their brain in learning,” Hartjes said.
That’s the reason senior Izzy Chappell enrolled. On an early December morning, she dipped into one of the lab’s eight welding booths wearing a helmet to protect from the harsh UV rays and flying sparks. She put the finishing touches on a welded metal skull sculpture she entered in a regional SkillsUSA competition that night.
“Other classes are hard,” Chappell said. “This comes easy to me.”
Getting students excited a struggle
ATECH leaders hoped the school would be a magnet for students, but getting them interested has been a challenge.
The school debuted with 56 students. Enrollment has fluctuated a bit over the decade, never reaching the district’s goal of 120. In the 2024-25 school year — the most recent year with available state data — 68 students enrolled.
Leaders chalk the lower-than-desired enrollment up to several difficulties: The district doesn’t provide transportation to charter schools, meaning these students typically have to find their own way to school. A jump start toward a career simply doesn’t resonate with many teenagers as young as 14, who Endter said are more motivated by sports or where their friends go to school.
And most of all,ATECH leaders find many families still see college degrees as the gold standard. Despite growing investment in career and technical education programs nationwide and the critical need for skilled workers in Wisconsin, they say a stigma still plagues technical education, leading many to believe it’s for students who don’t perform well in school.
Students who attend ATECH specialize in one of four areas: electronics and automated manufacturing, machining, mechanical design or welding. (Mike Roemer for Wisconsin Watch)
“I think a misconception often is that it’s not rigorous, and it’s not for students that have an aptitude or are intelligent,” Hartjes said. “That’s not the case. We’ve given kids an opportunity to really learn using both their hands and their head.”
When ATECH was brand new, a state grant helped the school afford TV commercials and mailers. That money is long gone. Nowadays, Endter visits nearby middle schools to talk to students about career education. They organize tours and career fairs, where ATECH leaders try to entice students with the spacious labs and high-tech equipment.
“It’s not for lack of trying, you know?” Endter said. “But again, as an incoming eighth grader, charter schools represent something different. For some kids, different is good. And for some kids, different is not. So many kids don’t know what could or should be the best pathway for them.”
Meeting workforce needs?
Sophomore Noah Siong enrolled in ATECH because his brother graduated from the school and went on to open his own car repair shop.
“That kind of opened the gateway to me,” Siong said. “It was like, ‘Oh, this stuff is pretty cool.’”
Paul Endter, lead instructor for Appleton Technical Academy, smiles in the charter school’s lab on Dec. 3, 2025. Endter spends his free time searching for industry mentors, seeking donations from local businesses for ATECH and spreading the word about the school. (Mike Roemer for Wisconsin Watch)
Siong wants to pursue a career in metal fabrication after graduation. Hartjes estimates hundreds of students like Siong have learned “skills that have prepared them for careers” over the last decade. But it’s difficult to know exactly how many students have gotten jobs that use the skills they learned at ATECH.
Wisconsin, like many states, doesn’t have a system connecting education and employment data, according to a 2024 Education Commission of the States analysis. The evidence ATECH leaders collect is largely anecdotal, but Endter said it indicates the vast majority either continue to technical college to finish their programs or turn their youth apprenticeships into full-time jobs after graduation. Endter estimates about 10% pursue a four-year degree.
Bailin, the Eagle Performance Plastics CEO, said ATECH hasn’t produced as many local manufacturing employees as he hoped when he helped create the school.
“It didn’t really come out the way I would have hoped,” Bailin said. Eagle has hired between one and three apprentices from ATECH each year. He estimates roughly half have moved into full-time jobs, but it hasn’t been enough to produce the pipeline of machining employees he wanted. The company is no longer closely tied to the school, Bailin said.
In a measure of its academic performance, ATECH’s state rating has averaged a score of 58, which the Department of Public Instruction (DPI) defines as “meets few expectations.” Hartjes said the hands-on skills students learn are notreflected in the state’s rating system. For example, the college classes students take, however advanced, don’t factor into the school’s rating.
“If they were … tested on their aptitude for mechanics, I guarantee you that they would outscore many other students across our state,” Hartjes said. “If they were being tested on those different things that we focused on, I guarantee you that their knowledge, their experience and their aptitude is going to shine through. But, you know, they don’t.”
‘Just can’t fund all of this’
“I’m going to teach you about different kinds of metal!” technology education teacher Carrie Giauque shouts so students hear her in the noisy lab. She pulls scraps out of a large trash barrel filled to the brim, identifying them to the students crowded around her: “Carbon! Steel! Aluminum! Galvanized steel! Copper!”
Behind them, sheets of metal are stacked floor to ceiling. The school goes through countless sheets teaching students the basics of welding and metal fabrication. It’s ATECH’s largest expense.
“It’s a lot less costly to have 30 students sit in math class,” Hartjes said.
Technology education instructor Loren Daane, center, helps sophomore Joshua Bellman with a project at Appleton Technical Academy on Dec. 3, 2025. (Mike Roemer for Wisconsin Watch)
Despite needing costly materials, ATECH’s state funding is determined by the same formula as all other schools in the district, so it relies on grants and donations to make up the difference. To date, the school has received $266,000 in donations toward equipment and curriculum.
“A lot of the learning exhausts materials, exhausts some of our resources,” Hartjes said. “(We’re) having to get support from our local manufacturing community, from a financial aspect, because as a school district, we just can’t fund all of this.”
Endter said ATECH also badly needs mentoring from industry employees, who can teach students and teachers how to use the complicated technology they receive as donations. In one classroom, a large robot sits untouched in a locked box after a college donated it. ATECH employees don’t have enough experience with the programming language to teach students how to use it.
For their part, employers are often stretched too thin to offer up staff to mentor teachers and students. Eagle Performance Plastics used to send someone to ATECH to teach students about a pricey machine it helped buy, but there weren’t enough interested students to make the trip worth it, Bailin said.
Students at Appleton West High School walk past a sponsor wall for Appleton Technical Academy on Dec. 3, 2025. Two-thirds of the spaces are empty. Lead instructor Paul Endter jokes that he wears “27 hats” trying to find additional support for ATECH. (Mike Roemer for Wisconsin Watch)
Inside ATECH, a “sponsor wall” is decorated with the logos of organizations and employers that have invested in the school. Two-thirds of the spaces are empty — a visual reminder of the school’s need for added support.
Endter jokes he wears “27 hats” trying to find it.
“Every hour that I am not teaching, including working through my lunch hour, is dedicated to phone calls, emails, site visits, networking, cold calls,” he said. “You name it. I am doing it.”
The work could soon pay off. Beginning in 2024, Appleton students between kindergarten and fifth grade began taking weekly STEM classes. Endter hopes that will spark interest in career and technical education.
“I’m on the precipice,” Endter said. “And I’m hoping that there’s going to be this giant surge of students who are looking for opportunities.”
“Other classes are hard. This comes easy to me,” said Izzy Chappell, a senior at Appleton Technical Academy. (Mike Roemer for Wisconsin Watch)
Wisconsin is one of five states that don’t designate state funding for career and technical education programs, relying solely on federal funding. Many states allocate more funding to school districts specifically for these programs because the federal dollars alone cannot meet the costs, according to Advance CTE, a nonprofit representing state career and technical education leaders.
“In Wisconsin, we have used (the federal funds) to, generally speaking, keep the lights on,” said Sara Baird, DPI’s career and technical education director.
State Superintendent of Public Instruction Jill Underly requested the 2025-27 state budget include about $45 million in career and technical education grants to districts. Gov. Tony Evers suggested a pared-down version of $10 million, whichwasscrubbed by the Legislature’s Republican-controlled Joint Finance Committee and not included in the final bill.
“We’re seeing tremendous growth and tremendous interest in expanding CTE,” Smith said. Still, school district leaders are frustrated by the lack of funding for it. “They are feeling like their hands are tied behind their back,” she said.
“We can’t do this alone … Every school has a tech ed teacher who is desperately trying to get kids excited about career pathways,” Endter said. “They need business support. They need donations. They need mentors in the classroom.”
Miranda Dunlap reports on pathways to success in northeast Wisconsin, working in partnership with Open Campus. Email her at mdunlap@wisconsinwatch.org.
Wisconsin Watch is a nonprofit, nonpartisan newsroom. Subscribe to our newsletters for original stories and our Friday news roundup.
Wisconsin Assembly Speaker Robin Vos predicted Tuesday that Republicans will take over the governorship in 2026, but wouldn’t confirm whether or not he’ll run for reelection himself.
The Milwaukee Admirals, a professional ice hockey team in the American Hockey League, will take on the Iowa Wild at an outdoor hockey rink in Hastings, Minnesota, on Jan. 23.
ATECH students like hands-on classes, enroll in paid apprenticeships and collect free college credit before continuing on to trade school. But the school has struggled to attract students, combat a persistent stigma around technical education and afford equipment and tools.
A vacant hallway at Vaughan Regional Medical Center in Selma, Alabama, on Tuesday, Sep. 3, 2024 in Selma, Alabama. (Will McLelland for Alabama Reflector)
WASHINGTON — President Donald Trump’s administration unveiled Monday hundreds of millions of dollars each state will receive this fiscal year as part of a massive $50 billion rural health fund baked into Republicans’ “big, beautiful” law.
The five-year Rural Health Transformation Program — authorized under GOP lawmakers’ mega tax and spending cut package Trump signed into law in July — is designed to offset the budget impacts on rural areas due to sweeping Medicaid cuts.
Half of the $50 billion will be distributed equally among each state between fiscal years 2026 and 2030, according to the Centers for Medicare and Medicaid Services.
The agency under the U.S. Department of Health and Human Services said the remaining $25 billion, doled out over the same time period, is being allocated to states based on several factors, such as steps states are taking to improve access to care in rural communities.
Texas will get the highest first-year award at $281.3 million, followed by Alaska at $272.2 million, California at $233.6 million, Montana at $233.5 million and Oklahoma, at $223.5 million.
New Jersey is receiving the lowest first-year award, at $147.2 million.
“Thanks to Congress establishing this investment and President Trump for his leadership, states are stepping forward with bold, creative plans to expand rural access, strengthen their workforces, modernize care, and support the communities that keep our nation running,” CMS Administrator Dr. Mehmet Oz said in a statement alongside the announcement.
Oz added that “CMS is proud to partner with every state to turn their ideas into lasting improvements for rural families.”
Meanwhile, the nonpartisan health research organization KFF found that the program would only offset a little more than one-third of the package’s estimated $137 billion cut to federal Medicaid spending in rural areas over the next decade.
(The Center Square) – A group of Wisconsin lawmakers are looking to make it easier for 70 or older bus drivers to maintain their ability to be school bus drivers.
(The Center Square) – Wisconsin schools must now inform the parents by the end of the day if they receive a credible report that their child was the victim or target of sexual misconduct by a member of school staff.
(The Center Square) -- Some of the people who ride the bus in Milwaukee could soon be paying a lot more after County Executive David Crowley announced he signed a new MCTS service plan for 2026.
On a warm fall afternoon, dairy farmer Chris Kestell pushes through prairie brambles taller than himself, tracing a path overgrown with thickets and swarming with bees as he hikes toward a hidden waterway.
Though the route is unidentifiable to the untrained eye, Kestell, 47, has lived here, in the small town of Waldo, Wisconsin, for nearly all his life. His father first walked this path 70 years ago, and his two young boys, 8 and 10 years-old, mark the third generation to follow this practiced journey.
After several minutes, he comes to rest beside a fallen tree. In its petrified tangle of roots, guarded by a tiny plastic gnome, a collection of spoons, bowls, and mugs fit like perfect puzzle pieces. Kestell takes a silver ladle from the snarl and kneels over a wall of dirt, from which a steady trickle emerges.
These are the headwaters of the Milwaukee River, known locally as Nichols Creek. According to Milwaukee Riverkeeper data, it is the “most pristine” monitored waterway in the entire 900 square-mile rivershed, and one of the only regional waters where brook trout reproduce naturally.
As he has done since he was a young boy, Kestell brings the water to his lips. “By a certain age, everybody drinks here,” he says. “The creek is a landmark for this area. When you’re a kid, you’re like, ‘Wow, this is pretty awesome.’ It’s a special place.”
The headwaters of the Milwaukee River, known in Waldo, Wis. as Nichols Creek — one of the only regional waters where brook trout reproduce naturally. (Christian Thorsberg / Circle of Blue)
Deep in this quiet wooded alcove, Nichols Creek is a cultural touchstone and habitat of ecological importance. Safe and secure for generations, residents fear it is suddenly at risk of severe damage from a new era of energy transition in Wisconsin.
The waterway — along with drinking water wells, protected woods and wetlands, and newly restored floodplains — is caught in the spreading network of high-voltage power lines.
According to Wisconsin Public Service Commission (PSC) documents, more than 400 miles of new high-voltage power lines are either under review or approved in Wisconsin. Similar projects have also been greenlit in Minnesota, Michigan, Illinois, Ohio, and the other three Great Lakes states in recent months, together totaling well over 1,000 miles.
As part of its Plymouth Reliability Project, the American Transmission Company (ATC), a local electric utility, plans to install seven miles of high-capacity lines through the Waldo area. Part of the route would pass directly over Nichols Creek, raising concerns over deforestation around the county’s only stream designated as “outstanding” by the Wisconsin Department of Natural Resources.
Meanwhile, a second ATC expansion, the Ozaukee County Distribution Interconnection project, proposes the construction of five new energy substations and corresponding transmission lines just southeast of Waldo. The preferred route would require the clear-cutting of old-growth forest and intersect the Cederberg Bog Wilderness — “the most intact large bogs in southeastern Wisconsin,” according to the Wisconsin DNR, and a registered National Natural Landmark by the U.S. Department of the Interior.
“Our entire business is based on people coming away from the city and spending the weekend here in the trees,” said Katy Rowe, who co-owns Abloom Farms, a resort and wedding venue located on the northern edge of the bog. “Eminent domain should not be used as a weapon against normal American citizens that have decided to live a quiet life in the country.”
According to ATC’s website, these projects are “needed to ensure electric reliability and address current and future energy needs in the community and the surrounding area.” But those needs aren’t due from the smattering of dairy farms, lonely county roads, and modest old homes that comprise rural Waldo, population 467.
Nearly two dozen data centers in southeastern Wisconsin alone are either proposed, built, or in-development, but the two newest are not like the others. More than 20 miles away, in the city of Port Washington, a 672-acre campus built by Vantage Data Centers broke ground on Dec. 17. Even farther, some 70 miles south, Microsoft is building a 315-acre facility near Racine.
Chris Kestell drinks from Nichols Creek. (Christian Thorsberg / Circle of Blue)
Though seemingly far enough away to be irrelevant to Waldo, the new sites’ thirst for power knows few bounds. When fully built, the Vantage and Microsoft locations will together require a 24/7 electricity supply totaling 3.2 gigawatts — greater than all of Wisconsin’s homes combined.
Power generated by natural gas, nuclear, coal, solar, wind, and battery storage stations across the state’s central and eastern regions are all in the mix to bring data center campuses online. Transmission lines, running through Waldo, will transport the electricity they demand.
When reached, ATC declined to comment on the Plymouth Reliability project.
But the company in public testimony has downplayed the project’s potential effects on wetlands and says it will take measures to minimize the impact.
The project as proposed “will not directly impact stream channels or have direct discharges to streams,” Erika Biemann, senior environmental project manager for ATC, wrote in testimony before Wisconsin’s PSC.
Existing transmission lines near Abloom Farms in Saukville, Wisconsin. (Christian Thorsberg / Circle of Blue)
Waldo’s story is not a one-off. New state and federal legislation are incentivizing data center development and encouraging power lines’ rapid rise across the region, potentially running roughshod over other communities.
In February, Illinois — which by one count leads the Great Lakes region with more than 200 data centers — enacted a law allowing tax incentives for the construction of new battery storage facilities and high-voltage transmission lines. A month later, lawmakers in Indiana (75 data centers) enacted a law aiming to make transmission lines more efficient and cost-effective to construct. Similar legislation went into effect in Ohio (192 data centers) in August.
On a national scale, President Trump signed an executive order this January declaring an energy emergency and ordering agencies to “expedite the completion of all authorized and appropriated” energy infrastructure. The order directs the U.S. Army Corps of Engineers to speed up their review of permit applications to develop wetlands for transmission lines and other energy projects. The Corps is reviewing such permits for new lines in Wisconsin and other states.
In late October, U.S. Secretary of Energy Chris Wright directed the Federal Energy Regulatory Commission to change permitting and rulemaking procedures to “significantly reduce” the amount of time and oversight required to bring data centers onto the grid.
Literally caught in the middle of a new epoch of surging energy demand and supply in the Great Lakes region, residents say they are contending with powerful economic trends that could be devastating to the environment, and already are weighing on their spirits.
Back at his family home, Kestell points to a large rock on his front lawn. The new power lines, Kestell said, would run right over his uncle’s final resting place.
“This is not rural electrification anymore, bringing power to poor farms” said Kestell’s father, Tom, also a farmer in Waldo. “This is an elite, wealthy class of people who are invested in these power stations and data centers, who are going to make probably trillions of dollars off this. And the people who they infringe on in the meantime? They’re just collateral damage.”
Homes and ponds face risk
JoAnne Friedman’s two-acre retention pond. (Christian Thorsberg / Circle of Blue)
What’s developing in Waldo is a case in point. The wetland area through which Nichols Creek flows is the source of local residents’ well water.
“Water comes, goes back down into the ground, and then becomes a collection of underground springs,” said JoAnne Friedman, the town chairperson of Lyndon, Wisconsin. “When you try to imagine how much water is underground here, it is a phenomenal amount.”
The water recharge process, and the natural filtration trees and other plants provide, is threatened by the right-of-way easements that the 138-kilovolt power lines require. All vegetation between 60 feet and 110 feet to either side of the lines would need to be cleared during their construction.
The loss of maple and cedar tree cover, Kestell said, threatens both the warming of Nichols Creek and soil erosion on the side of county roads that already slump and flood when storms roll through.
“With all of these projects, they don’t realize how much mitigation people who have these properties have done to prevent erosion,” said Friedman, who has needed to enlarge her property’s 20-foot-deep retention pond from half an acre to two acres to manage gushing ephemeral streams during springtime snowmelt and heavy rains.
Living at the bottom of a small sloped valley, she said she has planted so many trees she “lost count,” all to help redirect flows from damaging her home. If ATC’s transmission line route is built, she said, this cover would all be clear-cut.
Hundred-year-old trees would also be razed from the backyard of Randy Pietsch, a retired dairy farmer who has lived along the banks of Nichols Creek for more than 50 years. The trout pond he keeps on his property has long been open to friends and family for fishing, though he closed it several years ago and has no plans now of reopening.
“I’m not hopeful for anything,” he said. “Why they have to come through here is beyond me. I can’t imagine that electric line’s good for fish. They just want to steal the land, that’s all. It’s sad, it’s stressful. You lose a lot of sleep at night.”
Randy Pietsch stands on the banks of Nichols Creek, which flows through his backyard. (Christian Thorsberg / Circle of Blue)
ATC says the project will not significantly affect the creek.
“The loss of forested riparian habitat along Nicholas Creek would not be significant, especially considering the large riparian forest buffer both upstream and downstream from the proposed route crossing,” Biemann, the ATC environmental project manager, wrote in public testimony.
Olivia Poelmann, a PSC environmental analysis and review specialist, testified that the project’s cumulative environmental effects are “not expected to be significant and are mostly temporary, with a large majority of impacts occurring primarily during the construction phase of the project.”
But most startling, residents say, are the effects of ATC’s preferred route on their properties, many of which have been in their families for multiple generations.
In some cases, the transmission lines’ right-of-way easements extend several feet inside peoples’ homes. One resident, Nolan Harp, said that the lines would run within 40 feet of his front door, placing half of his house within an easement. As a result, five 40-foot tall trees in his yard would be cut down, and his private well would need to be moved.
“That’s my sole source of water. It’s an old well, but it works, it’s clean, and it’s good,” Harp said. “But you can’t have something like that under power lines.”
Harp said that ATC has offered to dig up the open well, its casing, tank, and pump, and replace them elsewhere on his property. But the headache of additional construction, and the obvious hazard of power lines running above his house, has him considering other options.
“I don’t want to move, but if they insist on putting that power line up, I don’t think I can live here,” Harp said.
In late January, the $33.5 million Plymouth project was approved by the PSC, though it added a condition that prevents ATC from using eminent domain to build their power lines. ATC subsequently petitioned to reopen the application on the grounds that PSC cannot revoke that right, which is protected under Wisconsin state law. In April, this petition was granted.
Kestell, who founded an organization called Neighbors 4 Neighbors to fight against the project in court, estimates that residents have spent $250,000 of their own money on legal fees.
At the end of the day, their homes and health are the most important concerns.
“When they put these towers in, some of them are going down 30 or 40 feet, possibly hitting the aquifer when they’re digging foundations,” said Kestell, who estimates his own front door will be within roughly 20 feet of an easement. “We’re just not sure about contamination.”
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