A customer enters a CVS store in October 2023 in Los Angeles. Pharmacies in Black and Latino neighborhoods and those with more residents on Medicaid are less likely to regularly dispense buprenorphine — one of the main medications used to treat opioid use disorder. (Photo by Mario Tama/Getty Images)

Pharmacies in Black and Latino neighborhoods are less likely to dispense buprenorphine — one of the main treatments for opioid use disorder — even though people of color are more likely to die from opioid overdoses.

The drug helps reduce cravings for opioids and the likelihood of a fatal overdose.

While the nation as a whole has seen decreases in opioid overdose deaths in recent years, overdose deaths among Black, Latino and Indigenous people have continued to increase.

Many medical and health policy experts fear the broad domestic policy law President Donald Trump signed in July will worsen the problem by increasing the number of people without health insurance. As a result of the law, the number of people without coverage will increase by about 10 million by 2034, according to the Congressional Budget Office.

About 7.5 million of the people who will lose coverage under the new law are covered by Medicaid. Shortly before Trump signed the bill into law, researchers from the University of Pennsylvania and Boston University estimated that roughly 156,000 Medicaid recipients will lose access to medications for opioid addiction because of the cuts, resulting in approximately 1,000 more overdose deaths annually.

Because Black and Hispanic people are overrepresented on the rolls, the Medicaid cuts will have a disproportionate effect on communities that already face higher barriers to getting medications to treat addiction.

From 2017 to 2023, the percentage of U.S. retail pharmacies regularly dispensing buprenorphine increased from 33% to 39%, according to a study published last week in Health Affairs.

But researchers found the drug was much less likely to be available in pharmacies in mostly Black (18% of pharmacies) and Hispanic neighborhoods (17%), compared with mostly white ones (46%).

In some states, the disparity was even worse. In California, for example, only about 9% of pharmacies in Black neighborhoods dispensed buprenorphine, compared with 52% in white neighborhoods.

The researchers found buprenorphine was least available in Black and Latino neighborhoods across nearly all states.

Barriers to treatment

Dr. Rebecca Trotzky-Sirr, a family physician who specializes in addiction medicine, said many communities of color are “pharmacy deserts.” Even the pharmacies that do exist in those neighborhoods tend to “have additional barriers to obtain buprenorphine and other controlled substances out of a concern for historic overuse of some treatments,” said Trotzky-Sirr, who wasn’t involved in the study.

In addition to its federal classification as a controlled substance, buprenorphine is also subject to state regulations to prevent illegal use. Pharmacies that carry it know that wholesalers and distributors audit their orders, which dissuades some from stocking or dispensing it.

Dima Qato, associate professor of clinical pharmacy at the University of Southern California and an author of the Health Affairs study, said that without changes in policy, Black and Hispanic people will continue to have an especially hard time getting buprenorphine.

“If you don’t address these dispensing regulations, or regulate buprenorphine from the aspect of pharmacy regulations, people are still going to encounter barriers accessing it,” she said.

In neighborhoods where at least a fifth of the population is on Medicaid, just 35% of pharmacies dispensed buprenorphine, Qato and her team found. But in neighborhoods with fewer residents on Medicaid, about 42% of pharmacies carried the drug.

Medicaid covers nearly half — 47% — of nonelderly adults who suffer from opioid use disorder. In states that expanded Medicaid under the Affordable Care Act, another recent study found an increase in people getting prescriptions for buprenorphine.

“Medicaid is the backbone of care for people struggling with opioid use disorder,” said Cherlette McCullough, a Florida-based mental health therapist. “We’re going to see people in relapse. We’re going to see more overdoses. We’re going to see more people in the ER.”

Qato said the shortage of pharmacies in minority communities is likely to get worse, as many independent pharmacists are already struggling to stay open.

“We know they’re more likely to close in neighborhoods of color, so there’s going to be even fewer pharmacies that carry it in the neighborhoods that really need it,” she said.

‘There needs to be urgency’

Qato and her colleagues say states and local governments should mandate that pharmacies carry a minimum stock of buprenorphine and dispense it to anyone coming in with a legitimate prescription. As examples, they point to a Philadelphia ordinance mandating that pharmacies carry the opioid overdose-reversal drug naloxone and similar emergency contraception requirements in Massachusetts.

“We need to create expectations. We need to encourage our pharmacies to carry this to make it accessible, same day, and there needs to be urgency,” said Arianna Campbell, a physician assistant and co-founder of the Bridge Center, a California-based organization that aims to help increase addiction treatment in emergency rooms.

“In many of the conversations I have with pharmacies, when I’m getting some pushback, I have to say: ‘Hey, this person’s at the highest risk of dying right now. They need this medication right now.’”

She said patients frequently become discouraged due to barriers they face in getting prescriptions filled. The Bridge Center has been expanding its patient navigator program across the state, and helping other states start their own. The program helps patients identify pharmacies where they can fill their prescription fastest.

“There’s a medication that can help you, but at every turn it’s really hard to get it,” she said, calling the disparities in access to medication treatment “unacceptable.”

Trotzky-Sirr, the California doctor, fears the looming Medicaid cuts will cause many of her patients to discontinue treatment and relapse. Many of her patients are covered by Medi-Cal, the state’s Medicaid program.

“A lot of our patients are able to obtain medications for treatment of addiction like buprenorphine, because of the state covering the cost of the medication,” said Trotzky-Sirr, who also is a regional coordinator at the Bridge Center.

“They don’t have the resources to pay for it, cash, out of pocket.”

Some low-income patients switch between multiple providers or clinics as they try to find care and coverage, she added. These could be interpreted as red flags to a pharmacy.

Trotzky-Sirr argued buprenorphine does not need to be monitored as carefully as opioids and other drugs that are easier to misuse or overuse.

“Buprenorphine does not have those features and really needs to be in a class by itself,” she said. “Unfortunately, it’s hard to explain that to a pharmacist in 30 seconds over the phone.”

More is known about the medication now than when it was placed on the controlled substances list about two decades ago, said Brendan Saloner, a Bloomberg Professor of American Health in Addiction and Overdose at Johns Hopkins University.

Pharmacies are fearful of regulatory scrutiny and don’t have “countervailing pressure” to ensure patients get the treatments, he said.

On top of that fear, Medicaid managed care plans’ prior authorization processes may also be adding to the pharmacy bottleneck, he said.

“Black and Latino communities have higher rates of Medicaid enrollment, so to the extent that Medicaid prior authorization techniques are a hassle to pharmacies, that may also kind of discourage them [pharmacies] from stocking buprenorphine,” he said.

In some states, buprenorphine is much more readily available. In Maine, New Hampshire, Oregon, Rhode Island, Utah and Vermont, more than 70% of pharmacies carried the drug, according to the study. Buprenorphine availability was highest in states such as Oregon that have the least restrictive regulations for dispensing it.

In contrast, less than a quarter of pharmacies in Iowa, North Dakota, Texas, Virginia and Washington, D.C., carried the medication.

“We’re going to see more people becoming unhoused, because without treatment, they’re going to go back to those old habits,” McCullough, the Florida therapist, said. “When we talk about marginalized communities, these are the populations that are going to suffer the most because they already have challenges with access to care.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

President Donald Trump speaks to the media in the Oval Office on Sept. 2, 2025. (Photo by Alex Wong/Getty Images)

WASHINGTON — U.S. House Democrats on Monday revealed a lewd image and inscription they alleged was a birthday note that President Donald Trump provided for the late sex offender Jeffrey Epstein’s 50th birthday book compiled by the financier’s co-conspirator Ghislaine Maxwell.

The U.S. House Committee on Oversight and Government Reform, led by Kentucky Republican James Comer, obtained the drawing via a subpoena for records in the government’s 2019 federal sex trafficking case against Epstein.

“We got the Epstein note Trump says doesn’t exist. Time to end this White House cover-up,” Rep. Robert Garcia of California wrote on social media. Garcia is the top ranking Democrat on the Oversight Committee. 

Comer had not issued a comment or statement as of late Monday afternoon on social media or on the committee’s website, where the committee chair has been posting updates on the Epstein probe.

The image of the birthday note shows a cryptic message about a “wonderful secret” written within the outline of a woman’s body and breasts. A doodle depicting the name “Donald” — that appears similar to Trump’s signature — is placed in the location of the woman’s pubic hair. 

The Wall Street Journal first reported on the existence of the birthday message in July. Trump promptly sued the news outlet and denied that he created the note.

The Journal also published the image Wednesday.

White House press secretary Karoline Leavitt issued a statement on social media Wednesday criticizing the news outlet’s latest story as a “hatchet job” and asserting that the president’s lawyers “will continue to aggressively pursue litigation.”

“The latest piece published by the Wall Street Journal PROVES this entire ‘Birthday Card’ story is false. As I have said all along, it’s very clear President Trump did not draw this picture, and he did not sign it,” Leavitt wrote on X.

House Democratic Leader Hakeem Jeffries declined to comment on the birthday note at a previously scheduled press conference Monday afternoon.

Trump’s past relationship with Epstein has been under a microscope since the Department of Justice declared in July it would not be releasing any further information on the case, and that no incriminating client list of Epstein’s existed.

Epstein died in a Manhattan jail cell in August 2019, awaiting trial on federal charges of sex trafficking minors.

Trump campaigned on releasing what he and his followers call the “Epstein files.”

The uproar over the investigative materials related to the government’s case has revealed a rupture among Trump’s voter base and some House Republicans who have reliably supported him.

Victims who shared stories of abuse inflicted by Epstein and Maxwell, who was convicted on federal charges of sex trafficking minors, stood alongside Democrats and Republicans, including Rep. Thomas Massie of Kentucky and Marjorie Taylor Greene of Georgia, on Capitol Hill Sept. 2.

Massie’s discharge petition, co-led with Rep. Ro Khanna of California, to compel the release of all Epstein government files has the support of all Democrats, but is two Republican signatures short of forcing a floor vote on the issue. 

Rep. Sylvia Ortiz-Velez (D-Milwaukee) speaks at a press conference in January 2025. (Photo by Baylor Spears/Wisconsin Examiner)

Rep. Sylvia Ortiz-Velez of Milwaukee is leaving the Assembly Democratic caucus — a decision that comes after leadership alleged that she made comments about shooting three of her colleagues. 

Ortiz-Velez has been at the center of several disagreements over the last several weeks with her colleagues, including a public dispute with the newly-formed Hispanic Legislative Caucus over resolutions to highlight Hispanic Heritage Month. 

Ortiz-Velez said she was excluded from being an author on the resolution, though the leader of the caucus Rep. Priscilla Prado (D-Milwaukee) has said the caucus agreed to limit authors to members. Ortiz-Velez had earlier declined to be a part of the caucus. She decided to write her own resolution honoring Hispanic Heritage Month, and her resolution, which has Republican and Democratic cosponsors, is now being set up to be voted on this week.

Last week her access to the Wisconsin State Capitol was revoked due to an alleged threat, though Assembly Speaker Robin Vos’ office said the revocation was done in error, the threat was found to be not credible and her access restored. 

Assembly Minority Leader Greta Neubauer (D-Racine) initially confirmed that Ortiz-Velez had left the caucus but declined to speak on the issue. 

On Friday, however, eight Democratic leaders, including Neubauer, said in a statement to the Journal Sentinel that Ortiz-Velez “made a comment about shooting three members of our caucus who she has had personal disagreements with.”

“This is unacceptable behavior, especially given the heightened political environment and the murder of Representative Melissa Hortman and her husband earlier this year,” the lawmakers said. “We are not in a position to ignore comments like these and referred it to Human Resources. After conversations with the Speaker’s office, we spoke with Capitol Police as well. We appreciated them looking into the matter and handling it from there.”

Former Minnesota Rep. Melissa Hortman and her husband were the victims of a politically-motivated assassination in June. 

Ortiz-Velez told the Journal Sentinel that she did not make a threat, but rather used a “poorly worded hyperbole.” 

“What I was trying to express is that I want peace with people, but others seem to keep attacking me, and if they attack me, I have a right to defend myself. And if someone perceived it differently, I’m very sorry, and I will be certain to refrain from that kind of language in the future,” Ortiz-Velez said. 

Ortiz-Velez has previously split from her caucus on other votes. She was the only Democrat to vote for the new legislative maps that were drawn by Gov. Tony Evers and that Republican lawmakers decided to adopt, she was one of a handful of Democrats to vote for the recent state budget in July and also recently was the only Democrat on a bill, vetoed by Evers, that would have declared gig workers to be independent contractors.

According to WisPolitics, Ortiz-Velez also alleges that her colleagues were trying to keep her from testifying on AB 306, a Republican bill that would restrict an executive emergency powers, because she plans to accuse Milwaukee County Executive David Crowley, who plans to run for governor, of abusing his power during the COVID-19 pandemic. 

“I left the caucus because they’ve been terrible to me,” Ortiz-Velez told WisPolitics.

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Federal agents block people protesting an immigration raid at a licensed cannabis farm on near Camarillo, California, on July 10, 2025 . (Photo by Mario Tama/Getty Images.)

WASHINGTON — The U.S. Supreme Court on Monday lifted a lower court’s ban on immigration agents’ racial profiling of Latinos in Southern California, backing President Donald Trump’s immigration crackdown.

The order is temporary as the suit continues in lower courts, but it indicates a majority of the court is likely to side with the Trump administration’s defense against a complaint that targeting Latino and Spanish-speaking workers for immigration enforcement violated the U.S. Constitution’s Fourth Amendment that bars unreasonable search and seizure.

The high court ruled that the officers could use “apparent ethnicity” as one factor in determining reasonable suspicion, as long as it is not the only factor.

“Whether an officer has reasonable suspicion depends on the totality of the circumstances,” Justice Brett Kavanaugh wrote for the majority.

“Here, those circumstances include: that there is an extremely high number and percentage of illegal immigrants in the Los Angeles area; that those individuals tend to gather in certain locations to seek daily work; that those individuals often work in certain kinds of jobs, such as day labor, landscaping, agriculture, and construction, that do not require paperwork and are therefore especially attractive to illegal immigrants; and that many of those illegally in the Los Angeles area come from Mexico or Central America and do not speak much English,” he continued.

Justice Sonia Sotomayor, the first Latin American member of the court, wrote a scathing dissent that the two other liberal justices, Elena Kagan and Ketanji Brown Jackson, joined.

“We should not have to live in a country where the Government can seize anyone who looks Latino, speaks Spanish, and appears to work a low wage job,” Sotomayor wrote. 

Los Angeles Mayor Karen Bass also slammed Monday’s decision from the Supreme Court. 

“Today, the highest court in the country ruled that the White House and masked federal agents can racially profile Angelenos with no due process, snatch them off the street with no evidence or warrant, and take them away with no explanation,” she said in a statement. “This decision will lead to more working families being torn apart and fear of the very institutions meant to protect – not persecute – our people.” 

California Gov. Gavin Newsom said in a statement that the decision from the high court will cause “racial terror in Los Angeles.” 

“Trump’s private police force now has a green light to come after your family — and every person is now a target — but we will continue fighting these abhorrent attacks on Californians,” Newsom, a Democrat, said.

Temporary ruling

The ruling responded to an emergency appeal the administration made to the court last month, seeking to put on hold a temporary restraining order from Central California U.S. District Judge Maame Ewusi-Mensah Frimpong. 

The case in the lower court is ongoing.

The lower court blocked immigration agents from using “apparent ethnicity” as a method for determining if an individual violated immigration law. 

Agents used a broad variety of factors to determine someone’s apparent ethnicity, including speaking Spanish or accented English, certain types of work and locations such as bus stops or car washes.

Kavanaugh also said that the civil rights groups and individuals targeted by immigration agents who brought the suit against the Department of Homeland Security lacked legal standing for the challenge “to seek a broad injunction restricting immigration officers from making these investigative stops.”

‘Fair game to be seized at any time’

Sotomayor penned the dissent, criticizing Monday’s order for violating Fourth Amendment rights and allowing Latinos to be racially profiled.

“The Government, and now the concurrence, has all but declared that all Latinos, U. S. citizens or not, who work low wage jobs are fair game to be seized at any time, taken away from work, and held until they provide proof of their legal status to the agents’ satisfaction,” she continued. 

And she questioned Kavanaugh’s assumption that anyone who is a U.S. citizen and is questioned by an immigration officer will simply be let go once their citizenship is explained.

“That blinks reality,” she wrote, noting that two U.S. citizen plaintiffs in the suit tried to explain their citizenship status to an immigration officer. 

“One was then pushed against a fence with his arms twisted behind his back, and the other was taken away from his job to a warehouse for further questioning,” she wrote. 

Sotomayor said the decision would create a second-class citizen status and require people to carry around proof of citizenship or legal status.

She added that the Fourth Amendment “prohibits exactly what the Government is attempting to do here: seize individuals based solely on a set of facts that ‘describe[s] a very large category of presumably innocent’ people.”

“The Fourth Amendment protects every individual’s constitutional right to be ‘free from arbitrary interference by law officers,’” she wrote. “After today, that may no longer be true for those who happen to look a certain way, speak a certain way, and appear to work a certain type of legitimate job that pays very little.”

National Guard responds to protests over tactics

The administration’s mass raids this summer on Los Angeles-area Home Depot stores and other sites where day laborers gather sparked massive protests in the city that were the basis of National Guard troops and U.S. Marines deploying to the city, over Newsom’s objection. 

A federal judge last week said the military members’ conduct violated a law against military personnel conducting domestic law enforcement.

The president has also deployed the National Guard of the District of Columbia and has directed thousands of federal law enforcement officers to set up checkpoints in the city to inquire about immigration status. 

Thousands in the district on Saturday protested the deployment. 

Further deployments?

The president has threatened to send National Guard members to more predominantly Democratic cities such as Baltimore, Chicago, New Orleans, New York, and Portland, Oregon. He has said those deployments would  help contain crime — despite violent crime in those cities decreasing in recent years — while also highlighting immigration enforcement.

Trump over the weekend posted an artificial intelligence-generated image that referenced the Vietnam War film “Apocalypse Now.” 

The image is of Trump in a military uniform in front of the Chicago skyline with flames in the background. 

The caption read: “I love the smell of deportations in the morning… Chicago about to find out why it’s called the Department of WAR,” referring to the new secondary name Trump gave the Defense Department on Friday. 

Speaking at an event at the Museum of the Bible in Washington, D.C., Monday morning, Trump said that he “would love to go into Chicago” but was waiting on a request from Illinois Gov. J.B. Pritzker before he sent troops there. Pritzker, a Democrat, has been adamant that the city did not need or want National Guard troops.

E. Jean Carroll leaves the courthouse on Sept. 6, 2024, in New York City.  (Photo by Alex Kent/Getty Images)

WASHINGTON — A federal appeals court on Monday upheld that President Donald Trump must pay an $83 million penalty for defaming writer E. Jean Carroll in 2019, rejecting Trump’s argument that presidential immunity shields him from the punishment.

The U.S. Court of Appeals for the 2nd Circuit in Manhattan reaffirmed a lower court decision denying Trump’s claim that the 2024 U.S. Supreme Court decision granting presidential immunity protects him, and his assertion that the monetary punishment was excessive. 

The three-judge panel wrote that Trump never argued “absolute” presidential immunity as the defamation case proceeded in 2020, and “hence, he may not do so now.” At the time, he argued for temporary immunity until he was out of office.

The decision was unsigned. The appeal was before Judges Denny Chin, who was appointed to the bench in 2010 by President Barack Obama; Sarah A. L. Merriam, appointed by President Joe Biden in 2022; and Maria Araújo Kahn, appointed by Biden in 2023. 

Trump statements

The case centered on Trump’s statements about Carroll after New York magazine published an excerpt of the writer’s new book in June 2019, in which she alleged Trump sexually assaulted her in a fitting room at the Bergdorf Goodman department store in 1996. 

Trump repeatedly made public statements and social media posts claiming Carroll’s story was “totally fabricated” and that he didn’t know her, despite being previously photographed with her. 

Trump began to claim absolute presidential immunity in December 2022, years into the case, and a district court denied his request for a summary judgement, ruling that he had waived any claim to it by failing to raise it in previous court filings.

Trump appealed to the 2nd Circuit and argued in a September 2024 brief that “presidential immunity is fatal to Carroll’s claims” and that Trump cannot be held liable for defamatory statements he made.

The Supreme Court ruled in a 6-3 decision in July 2024 that former U.S. presidents enjoy absolute criminal immunity for “core Constitutional” powers and are “entitled to at least presumptive immunity from prosecution for all his official acts,” but are not immune from criminal prosecution for “unofficial acts.”

Trump escalated the question of presidential immunity to the Supreme Court after being federally indicted on defrauding the American public by claiming falsely that he won the 2020 presidential election and allegedly conspiring to overturn the result.

‘Extraordinary and unprecedented conduct’

Trump had also argued the dollar amount the jury awarded to Carroll — $65 million of which was for punitive damages — was “grossly excessive.”

The appeals court rejected that claim, highlighting that Trump continued to make defamatory remarks about Carroll during the yearslong litigation. 

“For nearly five years, Trump never wavered or relented in his public attacks on Carroll,” the judges wrote, even though he was found guilty in a separate but closely related civil case — a jury in 2023 found Trump liable for sexually abusing Carroll in the mid-1990s.

“The statements all shared common themes: Trump continued to assert that Carroll was lying about the 1996 sexual assault and that she was motivated to do so for personal, financial, and political reasons, and to imply that Carroll was too unattractive to be sexually assaulted. He also began to claim that Carroll’s lawsuit was part of a conspiracy to interfere with the 2024 election, and vowed to continue to make similar statements in the future.”

The judges said Trump’s behavior amounted to “extraordinary and unprecedented conduct.”

The U.S. Supreme Court on Oct. 29, 2024. (Photo by Jane Norman/States Newsroom)

WASHINGTON — The Trump administration on Monday asked the Supreme Court to overturn a lower court’s ruling and allow it to withhold $4 billion in foreign aid that was previously approved by Congress.

The case is one of many lawsuits challenging the White House’s efforts to supersede Congress’ spending authority by canceling funding without lawmakers’ explicit approval.  

This particular case became more complicated in late August when the Trump administration sent Congress a rescission request, asking lawmakers to cancel billions in foreign aid, including some of the funding subject to this lawsuit. 

This “pocket rescission,” as it’s sometimes called, came within 45 days of the end of the fiscal year. Under the Trump administration’s interpretation of the law, they believe that allows them to cancel the funding even if Congress refuses to go along with the proposal. 

The move is considered illegal by the nonpartisan Government Accountability Office and evoked ire from senior lawmakers, including Senate Appropriations Chairwoman Susan Collins, R-Maine.

“Article I of the Constitution makes clear that Congress has the responsibility for the power of the purse,” Collins wrote in a statement. “Any effort to rescind appropriated funds without congressional approval is a clear violation of the law.”

Administration sees executive branch ‘at war with itself’

The appeal to the Supreme Court filed Monday urges the justices to let the legislative and executive branches figure out the spending dispute on their own and criticizes a federal district court for ordering the Trump administration to spend the money. 

“The injunction requires the Executive Branch to rush to obligate the same $4 billion that the President has just proposed rescinding between now and September 30, and thus puts the Executive Branch at war with itself,” wrote Solicitor General D. John Sauer. “Just as the President is pressing for rescission and explaining to Congress that obligating these funds would harm U.S. foreign policy interests, his subordinates are being forced to proceed to identify and even negotiate with potential recipients.”

The pocket rescissions request at the center of this case is separate from the one Trump sent Congress in early June that asked members to eliminate funding for numerous foreign aid accounts and the Corporation for Public Broadcasting. Lawmakers approved that proposal in July after preserving full funding for the President’s Emergency Plan for AIDS Relief, or PEPFAR.

Congress has yet to act on the second rescissions request as its leaders look for ways to fund the government ahead of an Oct. 1 shutdown deadline. 

Attorneys for the organizations that brought the lawsuit — the AIDS Vaccine Advocacy Coalition and Global Health Council — wrote in a brief to the Supreme Court submitted Monday that they opposed the Trump administration’s request to overturn the lower court’s preliminary injunction. 

“USAID and the State Department have been under a duty to obligate these funds since at least March 2024, when Congress enacted the appropriations; they chose not to act sooner,” they wrote. “The government faces no cognizable harm from having to take steps to comply with the law for the short period while this Court considers its stay application.”

Protesters in Milwaukee take part in a 2019 march demanding action to address climate change. Fifteen young people are suing the state of Wisconsin for harming their future by allowing pollution that hastens climate change. (Photo by Isiah Holmes/Wisconsin Examiner)(

Kaarina Dunn has grown up hearing stories of the Wisconsin winters her parents and grandparents got to enjoy. Winters with enough snow cover that the family of ski-enthusiasts could get on the slopes from Thanksgiving to Easter. 

But despite the state’s continued connection with ice and snow, winters like those of her family’s past are gone. Climate change has caused Wisconsin’s winters to warm more than any other season. A number of recent winters have seen drought conditions with little to no snow across the northern part of the state — severely damaging winter tourism and canceling or modifying events such as the American Birkebeiner. While data shows that the amount of snowfall on average is similar to decades past, the weather doesn’t stay as cold throughout the winter, meaning that the snow melts before it can accumulate to the truly deep levels of previous generations. 

“I hear all these great stories about how they got to ski over Thanksgiving, how they skied past Easter time, how they went on all these great trips around the state of Wisconsin to all these ski hills, mountains, all these amazing places,” Dunn, a 17-year-old Onalaska resident, tells the Wisconsin Examiner. “And I can’t help but feel incredibly saddened by this. I will never experience these things. These are family traditions, trips that my family would go on, with family members, with friends, and do all these amazing and fun things. And honestly, I do feel left out. I feel let down by my state. I can no longer enjoy these things due to the direct results of fossil fuels in the environment.” 

Dunn is one of 15 young people suing the state of Wisconsin, arguing that state laws violate their constitutional rights and worsen climate change. The lawsuit mirrors a similar lawsuit from children in Montana, who successfully argued that the state had to consider the greenhouse gas emissions and climate change impact of permits involving fossil fuels. 

The children are represented in the lawsuit by Madison-based Midwest Environmental Advocates and Oregon-based Our Children’s Trust. 

In Wisconsin, the suit argues that state lawmakers have made a number of declarations that the state’s energy production should be decarbonized and the greenhouse gas emissions of that production should be reduced, but state laws prevent that from happening. 

The state’s law for siting power plants requires that the state Public Service Commission determine that “[t]he proposed facility will not have undue adverse impact on other environmental values such as, but not limited to, ecological balance, public health and welfare, historic sites, geological formations, the aesthetics of land and water and recreational use.” However the law also prohibits the PSC from considering air pollution, including from greenhouse gas emissions, in that determination. 

Additionally, the state set a goal in 2005 that 10% of Wisconsin’s energy come from renewable sources by 2015. That goal was met in 2013. However, now that the goal has been met, state law treats it as a ceiling on renewable energy the PSC can require. 

“The Commission cannot require any electric provider to increase its percentage of renewable energy generation above the required level,” the lawsuit states, meaning that for more than a decade, Wisconsin’s energy regulators have been unable to push the state’s power companies to develop more renewable energy sources. 

Coal and natural gas make up 75% of the energy produced in Wisconsin and renewable sources make up 17%. 

Skylar Harris, an attorney for Midwest Environmental Advocates, says that children today are going to spend most of their lives dealing with the effects of climate change on their health and lifestyles yet don’t yet have the ability to vote and influence environmental policy. 

“I think people are really starting to acknowledge the direness of the situation that we’re in and the situation that climate change is causing, and how it impacts our inherent rights such as life and liberty and the pursuit of happiness,” Harris says. “And courts are really starting to see that without the right to a stable climate, which is what we’re arguing for in this case, the rights to life, the rights to liberty, the rights to the pursuit of happiness, they mean nothing, because people can’t pursue them to the fullest extent.” 

Harris says that if the lawsuit is successful, she believes that the PSC will use its new authority to deny permits for new or expanded fossil fuel burning power plants and push the state’s power companies to expand their renewable capacities. 

In the Montana lawsuit, officials argued that the state can’t be held responsible for the effects of climate change on the children in that lawsuit because climate change is caused by emissions from across the globe. Harris says that yes, climate change is a global problem, but it gets fixed by individual governments doing something about it. 

“Climate change is a global problem, but there is no such thing as a global government,” she says. “So if we are to address this global issue, that means every individual, every business and every government, including the state of Wisconsin, has to step forward and do its part. And that’s what we’re trying to make sure is happening with this lawsuit.”

The 15 children in the lawsuit represent a wide swathe of Wisconsin. They live in urban and rural parts of the state and include athletes who have had wildfire smoke affect their sports, farm kids who have had droughts and heavy rains affect their families’ livelihoods and members of the state’s Native American tribes who have seen their cultural traditions put at risk. 

Dunn has spent much of her childhood fighting for environmental causes as president of her local 4-H club and has won three grants for environmentally focused projects from the Bloomberg Philanthropies Climate Action Fund. She says she joined the lawsuit because it can help her community and kids like her across the state. 

“I began my environmental work because I always believed in doing the right thing,” she says. “I believe in fighting for my community, fighting for my family, fighting for my siblings, fighting for everyone, fighting for youth and fighting for families.”

She adds that the PSC “knows that what they are doing is wrong. The governor and the Wisconsin Legislature have indicated that they want renewable energy, and the Public Service Commission simply isn’t changing the laws, and the Legislature isn’t changing the laws.” 

Dunn’s family has lived western Wisconsin’s Driftless Region for generations and she spent most of her childhood in Vernon County. She says the Mississippi River is “almost a family member.”

But massive rain events causing flooding and erosion triggered a massive boulder to tumble down a bluff and into her backyard, making her family fear that it wasn’t safe in their home anymore. They moved north to La Crosse County. 

“We felt very unsafe in the childhood home that I planned to live my entire life in. We made the difficult decision to move cities, move counties, move school districts,” she says. 

A member of her school’s tennis team, Dunn says hotter summers and poor air quality caused by wildfires elsewhere on the continent have forced her to change how and when she practices. Flooding has prevented her and her family from swimming off the dock at her grandparents’ home and affected the work done at their walnut tree farm. 

Dunn says that for her, joining the lawsuit is about standing up and trying to force her state government to admit it has a role to play in mitigating climate change and responding to the ways in which climate change has harmed her life and the lives of the other kids in the suit. 

“Ultimately, our country knows the science that is creating climate change, the fossil fuel industry, and especially Wisconsin, they can no longer stand behind saying, ‘There’s nothing we can do. We don’t know about it. There’s nothing that we can do,’” she says. “But ultimately, we have the science and technology to make changes and to save my life and my future children’s life and have a safe and healthy environment.”

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Sen. Tammy Baldwin (D-Wis.) speaks Friday at a press conference to promote her legislation that would extend enhanced tax breaks on the cost of insurance purchased through the Affordable Care Act. Business owners Kyle LaFond, left, and Evan Dannells also spoke in favor of extending the tax credits. (Photo by Erik Gunn/Wisconsin Examiner)

Federal legislation that would hold down the cost of health insurance for millions of Americans and nearly a quarter-million Wisconsin residents has quiet support from Republicans in the Senate, according to Sen. Tammy Baldwin (D-Wisconsin).

So far, however, none of them have spoken out, Baldwin said at a news conference in Madison on Friday.

Baldwin has introduced a bill that would extend tax credits that have cut the health insurance costs for people who buy coverage on the federal marketplace, HealthCare.gov.

When the Affordable Care Act (ACA) was enacted in 2010 and the HealthCare.gov marketplace was launched to make it easier and cheaper for people without health insurance to buy coverage, the law included tax credits to lower the cost of premiums for people with incomes up to 400% of the federal poverty guideline.

In 2021, the premium tax credits were supercharged to impart far greater savings to people buying insurance through the marketplace. The enhanced tax credits were extended in 2022 with a sunset at the end of this year.

The extra tax breaks helped insurance coverage through the HealthCare.gov marketplace rise to record highs in the last few years, both in the U.S. and in Wisconsin.

“This tax break, the enhanced premium tax credit, saves more than 230,000 Wisconsinites an average of $500 every single month” on their insurance premiums, Baldwin said. “Not extending these tax breaks and jacking up costs on the open marketplace will crush families — but also small businesses that are the fabric of our communities.”

In January Baldwin and New Hampshire Sen. Jeanne Shaheen (D-N.H.) introduced legislation to make the enhanced tax credits permanent, in place of the lower tax credits that will resume when the enhanced credits expire Dec. 31.

A paper published Sept. 3 by the Georgetown University Law School Center on Poverty and Inequality reported that according to the Congressional Budget Office, without the enhanced credits 30 million more people will lack health insurance by 2034 — an average of 3.8 million a year.

For people with incomes between 100% and 150% of the federal poverty guideline, insurance premiums will go up by 7.9% between 2026 and 2034, the Georgetown researchers calculated.

For people with incomes between 150% and 400% of the federal poverty guideline, premiums would rise between 29% and 160% in the same period, according to the report.

The report also notes without the enhanced tax credits, people who lose Medicaid coverage due to cuts in the Republican megabill President Donald Trump signed on July 4 could be unable to afford insurance on HealthCare.gov.

‘Encouraged by conversations’

“There are, in the Senate, Republicans who have quietly indicated that they want to extend breaks to make [HealthCare.gov] marketplace insurance affordable,” Baldwin said. “I don’t have a count yet to tell you that we have enough, but I’m encouraged by the conversations I’m having.”

In the U.S. House, a bipartisan bill has been introduced extending the enhanced credits for a year — “notably getting them past the midterm elections,” Baldwin said. But that’s not long enough for her.

“I don’t think this should be political,” Baldwin said. “I think this should be something that Democrats and Republicans should agree on, that people should be able to afford their health care coverage.”

Baldwin’s press conference was held at Access Community Health Center, which serves low-income Wisconsin residents. Joining Baldwin, Madison chef and restaurant owner Evan Dannells said that the passage of the ACA and the opening of the HealthCare.gov marketplace made health care newly available in his industry after years of the youngest group of workers going uninsured.

Before the ACA, for people who entered hospitality jobs in their late teens or early 20s, “it was essentially, fundamentally understood that you wouldn’t have health care until you were in your 30s,” Dannells said.

The ACA required insurers to cover young people on their parents’ plans up to the age of 26, then made it possible for them to find more affordable coverage at HealthCare.gov after that.

“I have a half dozen full time employees over the age of 26 at a restaurant, and so what they’re going to do is they’re going to leave for corporate jobs that have the buying power to get their premiums down,” Dannells said — something not possible for small employers.

“This is essentially the beginning of the dismantlement of the Affordable Care Act with no plan and process for the future,” Dannells said.

Kyle LaFond, owner of a Middleton manufacturing firm that makes custom cosmetic products for celebrity brands, said the ACA and the HealthCare.gov was “a godsend” for small employers such as his company. “These subsidies are important because, of course, now more than ever, folks are living paycheck to paycheck,” he said.

Baldwin said she will campaign to attach her proposal to one of “several must-pass bills coming up in the days and the weeks ahead.”

Avoiding the ‘cliff’

While the enhancements increased the value of the tax credits for people with incomes up to 400% of the poverty guideline, they also made tax credits available for the first time to people with higher incomes — up to more than 1000% of the guideline.

Baldwin told the Wisconsin Examiner that those higher income groups were added to avoid “what we call a cliff.” That occurs when a person’s income rises even slightly above a benefit’s income ceiling — suddenly cutting off the benefit and possibly demanding they make a repayment. Many safety-net programs have cliffs, she explained.

In Wisconsin, most Medicaid programs have income limits, and many are only available to people with incomes up to the federal poverty guideline, she said. People who may work several part-time jobs and usually qualify for Medicaid can find themselves kicked off the program if they have a brief boost in their income, due to overtime work, for instance.

“Then you have to do all sorts of work to get back on, and then you have to be very mindful that you don’t get an extra hour or a raise” that could lead to being kicked off again, Baldwin said.

“So we were trying to avoid there being the sort of equivalent cliff in the Affordable Care Act marketplace tax credits,” Baldwin said.

For that reason, her bill would continue the tax credits available to the higher income population, she said, “and I would be committed to not reintroducing a cliff.”

Baldwin criticized GOP lawmakers for passing the Republican megabill that extended Trump’s 2017 tax cuts without considering an extension of the enhanced ACA credits.

“You would think including tax breaks for tens of millions of families to afford health care would be a centerpiece of that legislation. Right? Wrong,” Baldwin said.

Instead, she charged, the bill made cuts to Medicaid and the federal nutrition program SNAP to pay for tax cuts “in favor of the biggest corporations and the wealthiest Americans.”

 

U.S. President Donald Trump stands with Secretary of Education Linda McMahon after signing an executive order to reduce the size and scope of the Education Department during a ceremony in the East Room of the White House on March 20, 2025 in Washington, D.C. The order instructs McMahon to shrink the department, which cannot be dissolved without congressional approval. (Photo by Chip Somodevilla/Getty Images)

WASHINGTON — President Donald Trump’s aim to shutter the Education Department faces steep hurdles in Congress, where Republicans’ legislative efforts to abolish the agency remain stalled and appropriators have rejected many of his proposed cuts to education spending.

After campaigning last year on a pledge to shut down the department, Trump came into office promising to follow through, and made some preliminary moves.

He said he wanted Education Secretary Linda McMahon to “put herself out of a job” and signed a sweeping executive order in March calling on her to facilitate the closure of the Education Department to the extent she is permitted to by law.

He won a key victory in the U.S. Supreme Court in July that temporarily cleared the way for the administration to move ahead with mass layoffs at the agency, a plan to dramatically downsize the department outlined in that March executive order and his directive to transfer certain services to other agencies. 

Court documents show that the department is planning to bring back more than 260 Office for Civil Rights staff affected by those sweeping layoffs stemming from a separate legal challenge against the administration’s actions earlier this year. 

But after a dizzying array of cuts and changes in the months since Trump took office looking to dismantle the agency, the GOP-controlled Congress — the only body that can abolish the 45-year-old department it created — is throwing up roadblocks to elimination.

Bills stalled

For starters, the handful of GOP bills in Congress to close down the department face a difficult path in the Senate, which requires at least 60 senators to advance most legislation. 

Republicans hold just 53 Senate seats. 

In the House, at least four Republicans — Thomas Massie of Kentucky, David Rouzer of North Carolina, Barry Moore of Alabama and Nathaniel Moran of Texas — have introduced bills this year to eliminate the department. Those bills were referred to the House Committee on Education and Workforce, which has not voted on any of them. 

In a brief interview at the Capitol on Sept. 3, the committee’s chair, Michigan Republican Tim Walberg, said he still intended to eventually dismantle the agency, but had not committed to any particular bill.

“Our intentions are to ultimately dissolve the Department of Education — we know we have to do that in a way that makes sense and so, we’ll take a look at all bills,” Walberg told States Newsroom. 

“I can’t say whether they will all come up or not, but we know that, working with the secretary of Education, we’re going to right-size it, and some things we’ll eliminate, other things we’ll shift, as we’ve done already, over to the Department of Labor to take on some workforce areas,” the Michigan Republican said. 

The chair acknowledged that there would not be enough votes in the Senate to abolish the agency. 

“So what we can do that seems right for our students, for our parents and for our teachers, we’ll do,” Walberg said. 

GOP efforts to dismantle the department are also underway in the Senate. 

Sen. Mike Rounds of South Dakota, alongside Sens. Jim Banks of Indiana and Tim Sheehy of Montana, reintroduced a measure in April to abolish the agency. 

Kentucky Sen. Rand Paul also reintroduced a bill in March with Sens. Mike Lee of Utah and Bernie Moreno of Ohio to shutter the department. The measure is a companion bill to Massie’s legislation. 

A spokesperson for Sen. Bill Cassidy, who chairs the Senate Committee on Health, Education, Labor and Pensions, said the Louisiana Republican is “working with the administration and colleagues on how Congress can best codify the President’s reforms into law,” in a statement to States Newsroom.

The spokesperson noted that “President Trump and Republicans are committed to returning education authority to local communities best equipped to meet the needs of students and families.” 

Senate rebuffs Trump spending cuts

The administration’s attempts to dramatically scale back funding for the department in fiscal 2026 have not been met with much enthusiasm by appropriators in the Senate. 

The House and Senate Appropriations committees share jurisdiction over the bill to fund the department for the coming fiscal year. 

The Senate committee advanced a bipartisan bill in July, which largely rejects Trump’s proposed cuts to education spending and his attempt to dismantle the department. 

The bill tightens requirements for the department to have the necessary staffing levels to fulfill its statutory responsibilities and prevents the agency from transferring certain programs to other federal agencies. 

The legislation also allocates $79 billion in discretionary funding for the coming fiscal year, roughly the same as the current level, which could be seen as a slap in the face to the administration’s budget request that called for $12 billion in spending cuts at the agency. 

House includes deep cuts but keeps Pell spending

Meanwhile, the House Appropriations subcommittee dealing with education spending advanced its spending proposal for the agency on Sept. 2, sending the bill to the broader panel. 

The bill aligns much more with the administration’s spending cut priorities and education agenda, calling for $67 billion in discretionary funding at the department.

Part of the bill also reduces funding for Title I grants — which support school districts with high percentages of students who come from low-income families — by $5.2 billion, according to a summary from committee Republicans. 

The majority notes that “despite outsized investment, America’s public schools continue to fail children and families.”

But spending proposals in both the House and Senate reject the administration’s request to significantly reduce the maximum award for the Pell Grant, a government subsidy that helps low-income students pay for college. 

Instead, each proposal maintains the maximum award at $7,395. 

House and Senate appropriators have several steps to go before they can even reach the negotiating phase on the bill — which also includes spending on other agencies like the Department of Health and Human Services — and get it closer to becoming law.

It’s possible there might not even be a final agreement for months as lawmakers struggle to come to an overall agreement on how much to spend in the coming fiscal year, but the Senate’s bipartisan plan might give that chamber more of an advantage if those negotiations take place. 

UVALDE, TEXAS - MAY 25: A child crosses under caution tape at Robb Elementary School on May 25, 2022 in Uvalde, Texas. According to reports, during the mass shooting, 19 students and 2 adults were killed, with the gunman fatally shot by law enforcement. (Photo by Brandon Bell/Getty Images)

As a former county reporter in northwest Wisconsin, I always tried to find a local angle to a national or regional story.

I’ve been  thinking the two former papers I used to work for – Spooner Advocate and Sawyer County Record – were probably looking for readers who have friends or relatives with some connection to the recent mass shooting Wednesday, Aug. 27, at the Annunciation Catholic Church in South Minneapolis that left two youngsters dead and 21 others injured.

I  Googled the church’s location and realized that I had been just six blocks from it early this spring when I visited the Russian Art Museum. The church is also 10 or 15 minutes north of where my sister, Charlotte, lives.

Later, Charlotte called me and said she and my other sister, Alma, had attended the church for Christmas Eve or New Year’s Eve mass. Charlotte mentioned that a neighbor had a daughter who attended the same pre-K-8 Catholic school as the students who were  fired upon.

Without knowing any victims, just the proximity of the church to my previous visit and my sisters’ and the neighbors’ experience, there is some connection I have with that tragedy, be it ever so thin.

A couple of years ago, when I worked for the Sawyer County Record, I did a story on a woman who works in Hayward whose son had been attending Michigan State University when a man went on a short shooting rampage in February 2023 on campus.

It was after doing that story of the local boy to the Michigan State University shooting, that it hit me that more and more of us are having some connection to a gun shooting, especially school shootings.

We may not have witnessed the shooting, and we hopefully didn’t have any loved one injured or traumatized, but still we might be one or two or three or four persons removed from the tragedy, like the  woman whose son was in proximity to the Michigan State shooter.

It’s just logical with more and more of these mass shootings more of us would have these connections.

There are those directly impacted by mass shootings, the victims and their families, but there are scores more that are indirectly connected, and because of those connections the tragedy has more importance. The event becomes less abstract as you hear about a friend’s daughter or niece or cousin who had to hide under her desk to avoid rounds of gunfire echoing through the halls of education. It becomes less abstract as the mother of the Michigan State University student describes her fear when she heard about the gunman and knew her son might be shot.

After a mass shooting happens, we hear people argue  that it’s not the guns causing the deaths but the shooters, and then others advocate for legislation that would keep guns out of the hands of people likely to commit such atrocities.

After a mass shooting, we’ve become too familiar with how this debate over guns unfolds, and many of us are frustrated that very little ever changes.

However, I believe we will have sensible gun legislation so those with mental illnesses don’t have access to a gun, and red flag laws will help law enforcement identify those who are more likely to go on a shooting spree and secure weapons before a tragedy occurs.

I think it is inevitable because attitudes are going to change as more and more of us have these direct and indirect connections to mass shootings.

And a connection to a tragedy changes attitudes.

When drug overdose deaths were a thing that appeared to mostly happen in far-away cities, there wasn’t that much support in rural Wisconsin for attacking the problem. But when overdose deaths began to occur in the suburbs and rural communities, the reality of the drug epidemic hit home, and widespread support for addressing it grew. 

We are slowly, incrementally, each finding some point of connection to a mass shooting just because there have been so many of them: 503 mass shootings in 2024 alone.

The question in my mind is not if the legislation will happen, but how many people will have to die before enough of us, regardless of political affiliation, demand  sensible gun legislation.

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Duck on the Menominee River | Laina G. Stebbins

State agencies are warning Wisconsinites to limit the amount of ducks that they eat, or to avoid certain birds entirely, due to PFAS contamination. Waterfowl harvested around Green Bay were shown to have high levels of the man-made “forever chemicals,” which persist in the environment forever and have been linked to several chronic diseases including cancers. 

The Department of Natural Resources (DNR) and Department of Health Services (DHS) are advising people not to eat mallards from around lower Green Bay from Longtail Point to Point au Sable, and south of the mouth of the Fox River. Additionally, mallards and wood ducks living around Green Bay from the city of Marinette across to Sturgeon Bay should not be consumed frequently — no more more often than once per month for mallards and only one meal per week for wood ducks. 

Back in 2022 levels of polychlorinated biphenyls (PCBs), another man-made chemical, in waterfowl led to similar advisories in lower Green Bay. Further assessments found concentrations of PFAS in breast muscle tissue, according to a DNR press release. In 2023 and 2024, more samples were taken from ducks, with all samples taken during July and August when the birds were most likely to represent local breeding populations. Those efforts revealed elevated levels of perfluorooctane sulfonate (PFOS), which is a type of PFAS, in the breast muscles of the birds. The inquiry suggested that both adult and juvenile ducks in lower Green Bay have higher concentrations of PFOS than in the northern portion of the bay. 

PFAS chemicals were first developed as part of U.S. government nuclear and atomic weapons research during the Manhattan Project. After the project ended private companies, particularly DuPont, began researching the compounds for commercial use. Over the subsequent decades, PFAS was used in products including  non-stick Teflon pans, fast food wrappers, and firefighting foam. The chemicals do not degrade in the environment, nor within the body, and have been linked to cancers and other chronic diseases. 

The DNR tracks PFAS consumption advisories spanning multiple species including deer, fish and waterfowl. On Sept. 4, deer and fish advisories for PFAS were issued for the Town of Stella and surrounding waterbodies in Oneida County. All fish in the Moen Lake Chain were included in a “do not eat” advisory due to PFAS contamination, and a similar warning was distributed against the consumption of deer liver near the Town of Stella.

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An aerial of the the Pentagon, May 12, 2021. (Photo by Air Force Tech. Sgt. Brittany A. Chase)

President Donald Trump signed an executive order Friday to rename the Department of Defense as the Department of War.

Just before Trump signed the order in the Oval Office late Friday afternoon, he and Pete Hegseth, the secretary in charge of the department, who stood next to Trump during the signing, said the renaming reflected their intention to return to a more aggressive mindset for the military.

“It’s restoring, as you’ve guided us to, Mr. President, restoring the warrior ethos,” Hegseth said. “The War Department is going to fight decisively, not endless conflicts. It’s going to fight to win, not not to lose. We’re going to go on offense, not just on defense. Maximum lethality, not tepid legality. Violent effect, not politically correct. We’re going to raise up warriors, not just defenders.”

The text of the order calls “Secretary of War” a “secondary” title for Hegseth. “The Secretary of Defense is authorized the use of this additional secondary title — the Secretary of War — and may be recognized by that title in official correspondence, public communications, ceremonial contexts, and non-statutory documents within the executive branch,” reads the order.

Defense Department history

The Department of War and the Department of the Navy were Cabinet departments from the nation’s founding until 1947, when Congress combined them, along with the Department of the Air Force, into a new National Military Establishment. Congress changed that name to the Defense Department two years later.

Trump said Friday that renaming 76 years ago revealed a “political correctness” in the military that contributed to poorer results on the battlefield. The U.S. has not won a major war since the reorganization, he said.

“We could have won every war, but we really chose to be very politically correct or wokey, and we just fight forever and then, we wouldn’t lose, really, we just fight to sort of tie,” he said. “We never wanted to win wars that every one of them we would have won easily with just a couple of little changes or a couple of little edicts.”

Congress to be asked to act

Because the department’s name came from an act of Congress, it’s unclear if Trump has the power to rename it with an executive order. 

The president said Friday he didn’t know if it would be necessary for Congress to be involved, but that he would ask lawmakers to approve the change.

“I don’t know, but we’re going to find out,” he said when asked if Congress would codify the renaming. “But I’m not sure they have to … There’s a question as to whether or not they have to, but we’ll put it before Congress.”

Trump added that the cost of replacing signage and other materials associated with the department would be minimal.

The order says: “Within 60 days of the date of this order, the Secretary of War shall submit to the President, through the Assistant to the President for National Security Affairs, a recommendation on the actions required to permanently change the name of the Department of Defense to the Department of War. This recommendation shall include the proposed legislative and executive actions necessary to accomplish this renaming.”

Sen. Mitch McConnell of Kentucky, the chair of the Appropriations subcommittee with jurisdiction over the department who has often clashed with Trump, including on defense spending, said on social media that the name change was not meaningful without greater financial investment. 

“If we call it the Dept. of War, we’d better equip the military to actually prevent and win wars,” the former Senate Republican leader wrote. “Can’t preserve American primacy if we’re unwilling to spend substantially more on our military than Carter or Biden. ‘Peace through strength’ requires investment, not just rebranding.”

Marchers sang protest songs and led "Trump must go now" chants as they walked down 16th Street NW in Washington, D.C., on Sept. 6, 2025 during the "We Are All DC" demonstration against the deployment of National Guard troops in the nation's capital. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — Thousands marched in Washington, D.C., Saturday to protest President Donald Trump’s continued deployment of National Guard troops and the increased federal law enforcement on the streets of the nation’s capital.

The large demonstration, dubbed by organizers as the “We Are All DC” march, trailed down the district’s 16th Street NW toward the White House and came after several days of Trump’s heightened threats to send National Guard troops to Chicago, Boston, Baltimore, New Orleans and other Democratic-led cities.

The district’s Democratic attorney general sued the Trump administration Thursday arguing the ongoing presence of National Guard troops amounts to illegal military occupation.

Guard members from the District of Columbia and seven states had already been deployed in Washington as of this week when Georgia Gov. Brian Kemp announced Friday he would add 300 soldiers and 16 support staff, becoming the eighth state to send troops.

On Friday, Trump added Portland, Oregon, to the list of cities where he wants to deploy the Guard.

Demonstrators carried signs bearing the message “End the Occupation,” “Free DC” and “Get the ICE Out,” in reference to recent U.S. Immigration and Customs Enforcement arrests in the district.

Marchers walked down H Street NW in Washington, D.C., on Sept. 6, 2025 during the “We Are All DC” demonstration . (Video by Ashley Murray/States Newsroom)

Dozens of organizations participated in the march, including labor unions, faith-based organizations, immigration advocates, the League of Women Voters D.C. chapter and the D.C. Democratic Party.

Gail Hansen, 71, of Washington, D.C., said she wants to see a decreased ICE presence.

“I believe in freedom, and I think we’ve all gotta let everybody know that what’s happening on our streets is unacceptable,” Hansen told States Newsroom. “ICE needs to go home. The National Guard needs to go home. FBI needs to get out of our streets. We are doing just fine in D.C.” 

Charlotte Stone, 18, of Virginia Beach, Virginia, held a cardboard sign above her head depicting a caricature of Trump with a Hitler mustache and a message that read “Ignoring it is what the Germans did.”

“I’m disgusted with this country, I’m here with my friends, and we’re freshmen at George Washington University, and we’re disgusted. We need to do something about it,” Stone told States Newsroom.

The Washington Metropolitan Police Department released statistics Tuesday claiming overall crime had decreased by 8% in the district over the previous seven days. 

Protesters carry Banksy-style banner depicting a man throwing a sandwich as a nod to former Justice Department employee Sean Dunn, who threw a Subway hoagie at federal agents on Aug. 10 at 14th & U St NW in Washington, D.C. The marchers were part of the “We Are All DC” demonstration on Saturday, Sept. 6, 2025. (Video by Ashley Murray/States Newsroom) 

Trump’s 30-day emergency to federalize law enforcement in D.C. ends Sept. 10. On Tuesday, district Mayor Muriel Bowser announced an agreement with the administration to continue a collaboration between local police and federal law enforcement.

On Saturday morning, Trump posted an AI-generated image of himself with a burning Chicago skyline behind him and a message referring to the 1979 Vietnam War film “Apocalypse Now.” 

He wrote on his platform Truth Social, “‘I love the smell of deportations in the morning…’ Chicago about to find out why it’s called the Department of WAR,” in reference to his unofficial renaming of the Department of Defense on Friday.

A sign is seen outside the FEMA Disaster Recovery Center at Weaverville Town Hall on March 29, 2025 in Weaverville, North Carolina. (Photo by Allison Joyce/Getty Images)

WASHINGTON — A broadly bipartisan bill to overhaul and elevate the Federal Emergency Management Agency is heading toward the U.S. House floor after a key committee approved the legislation. 

The Transportation and Infrastructure panel voted 57-3 Sept. 3 to advance the measure, which would make dozens of changes to how the federal government prepares for and responds to natural disasters.

“FEMA is where Americans look for help after what is the worst day in their lives, so it is critical that the agency be postured to respond at all times,” said Arizona Democratic Rep. Greg Stanton, one of the co-sponsors. “This bill gives FEMA independence and tools it needs to respond to disaster.”

Republican Reps. Tim Burchett of Tennessee, Eric Burlison of Missouri and Scott Perry of Pennsylvania voted against reporting the bill to the House floor. Their offices didn’t respond to requests for comment asking why they opposed the legislation. 

The 207-page measure, formally called the Fixing Emergency Management for Americans (FEMA) Act of 2025, would remove FEMA from the Department of Homeland Security and make it a Cabinet-level agency.

The legislation would create one application for federal natural disaster assistance from FEMA, the Department of Agriculture, Department of Health and Human Services, Department of Housing and Urban Development and the Small Business Administration. 

It would also give local and state governments more flexibility in deciding which types of emergency housing best meet the needs of their residents following different natural disasters. 

Republicans and Democrats on the committee praised the various changes the measure would make during a two-hour markup that offered an increasingly rare example of bipartisanship on Capitol Hill. 

Donations from charities and FEMA

North Carolina Republican Rep. David Rouzer and California Democratic Rep. Laura Friedman both spoke in support of a provision reversing a policy that they said penalized people who received assistance from charities following a natural disaster. 

“Too many families who accept a donation from a charity or take an SBA loan to keep the lights on find out later that accepting those essential resources prevents them from receiving other assistance later for which they otherwise would be eligible,” Rouzer said. “This bill makes clear that SBA loans and private charitable donations are not considered duplicative for FEMA individual assistance.”

Friedman said she was shocked to learn that FEMA counted charitable donations against disaster survivors following the Los Angeles wildfires.

That led her to introduce the Don’t Penalize Victims Act with Mississippi Republican Rep. Mike Ezell, which was rolled into the FEMA overhaul bill. 

“I want to thank all the members of this committee, and particularly Chair (Sam) Graves and ranking member (Rick) Larsen, for their understanding of the importance of this measure to victims, who were seeing the charity that their churches, that their friends are raising for them be counted as income and deducted from the amount they were getting from FEMA,” Friedman said. 

Oregon Democratic Rep. Val Hoyle spoke in support of making FEMA a Cabinet-level department, saying that it’s been bogged down in the Department of Homeland Security since just after the Sept. 11 terrorist attacks. 

“After being folded into the Department of Homeland Security, it became buried in layers of bureaucracy,” Hoyle said. “DHS’s sprawling mission — cybersecurity, counterterrorism, immigration enforcement, transportation security and more — has left FEMA less able to act with the speed and agility disaster-stricken communities need.”

Hoyle said the legislation restoring FEMA’s “independence will help insulate disaster relief from” the types of “political pressures” that exist throughout the Homeland Security Department.

Permitting reform

Despite the broadly bipartisan support for the legislation within the committee, it will likely undergo some changes in the weeks and months ahead. 

House Natural Resources Chairman Bruce Westerman, R-Ark., and ranking member Jared Huffman, D-Calif., who both sit on the Transportation and Infrastructure Committee, raised concerns with elements in the FEMA overhaul bill during the markup. 

Westerman said he voted for the bill but expected the Transportation and Infrastructure Committee’s leadership to work with him to address concerns over “permitting reform issues” that fall under his panel’s jurisdiction. 

“There is one provision on the Endangered Species Act that we have concerns with actually being executable the way it’s written,” Westerman said. “Again, that’s something that’s fixable, and we look forward to working with you as we move forward on the bill.”

Huffman said he had concerns about how the FEMA overhaul bill addresses “environmental review statutes,” which fall under the Natural Resources Committee’s purview. 

“I, of course, share the goal of cutting red tape. We want disaster-stricken families to be able to rebuild faster. There are ways to do that that also ensure that recovery is durable, resilient and sustainable. That we rebuild once. These are things that (the National Environmental Policy Act) helps to ensure. So I look forward to continuing to work with the committee on this as the bill advances. This is a problem that can be fixed, and I hope it will,” Huffman said. 

Potomac River water 

Transportation and Infrastructure Committee members offered just two amendments to the bill — one adopted by voice vote and one withdrawn. 

Indiana Democratic Rep. André Carson received broad support for his amendment to require FEMA to inform members of Congress about grants within their districts, a practice he said has changed during the Trump administration. 

“We should not need to mandate transparency and accountability, but if FEMA fails to provide this information, my amendment codifies the traditional notifications to Congress,” Carson said. 

Democratic Del. Eleanor Holmes Norton, who represents the District of Columbia, offered and then withdrew an amendment that would have required FEMA “to submit to Congress a plan to supply emergency drinking water to the nation’s capital region during any period the Potomac River becomes unusable.”

Offering and then withdrawing an amendment is a common way for members to highlight issues without forcing a vote. 

Norton said the Army Corps of Engineers, which is responsible for the city’s water supply, only has sufficient reserves for one day should something happen. 

“If the Potomac River becomes unusable, which could happen at any moment whether through manmade or natural events, it would pose a significant risk to the residents of the nation’s capital, the operations of the federal government, national security and the region’s economy,” Norton said. 

Congress has partially funded a study to identify a backup drinking water supply and additional water storage facilities. But, Norton said, “any solution is years away.”

A pharmacy advertises COVID-19 testing and vaccinations on Sept. 4 in the Brooklyn borough of New York City. Several states, including New York, are breaking with restrictive eligibility policies the U.S. Food and Drug Administration has imposed on newly approved COVID-19 vaccines for the fall season. (Photo by Spencer Platt/Getty Images)

Several states, including Colorado, Massachusetts, New Mexico, New York and Pennsylvania, announced this week that they would be breaking with restrictive eligibility policies unveiled last week by the U.S. Food and Drug Administration on the newly approved COVID-19 vaccines for the fall season.

In New York, Democratic Gov. Kathy Hochul signed an executive order Friday morning to authorize pharmacists to provide the shot to anyone who desires it for the next 30 days, which can be renewed.

“When they said that they are not going to be requiring COVID shots and other vaccinations for our families, I said, ‘No, here in New York we will make parents have the option.’ If you want your child to have a COVID shot, it should be available to you and it should be covered by insurance,” Hochul said during a news conference Friday morning, where she signed the order.

“So what I’m doing now is signing an executive order, because extreme times call for extreme measures. And this is the power I have to use in the interim until we are able to have the legislature get back in January and pass legislation that mandates this.”

Previous FDA policy recommended that COVID-19 vaccine booster shots be made available to anyone 6 months or older regardless of their health status. But in August, the federal agency announced restrictions for the new shot.

The FDA limited access to the vaccines to people who are 65 and older and to younger people with at least one underlying health condition, such as asthma or obesity, that would put them at risk of developing a severe illness without a booster shot. Children are eligible only if a medical provider is consulted. Additionally, the Pfizer vaccine, one of the three that were approved, will no longer be available for any child under 5.

“The American people demanded science, safety, and common sense. This framework delivers all three,” U.S. Health and Human Services Secretary Robert F. Kennedy Jr. wrote on social media platform X on Aug. 27.

Other states are also taking measures to ensure more people can get access to the vaccines.

On Thursday, Massachusetts Democratic Gov. Maura Healey ordered health insurers in the state to continue covering the vaccine. The state also issued an order to allow pharmacies to continue providing shots to residents above the age of 5.

Massachusetts is “leading efforts to create a public health collaboration with states in New England and across the Northeast committed to safeguarding public health as the federal government backs away from its responsibilities,” the governor’s office said in a release.

This week, the State Board of Pharmacy in Pennsylvania held a special meeting to vote to bypass federal vaccine recommendations and allow pharmacists to continue administering COVID-19 vaccines.

“Health care decisions should be up to individuals — not the federal government and certainly not RFK Jr. My Administration will continue to protect health care access for all Pennsylvanians,” Pennsylvania Democratic Gov. Josh Shapiro said.

Colorado and New Mexico took similar steps this week, with state officials signing public health orders asking state agencies to take steps necessary to require insurers to cover the vaccines and instructing pharmacists to provide the shots without a doctor’s note.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Jimmy Novy, 77, hangs onto a canopy to hold himself up July 29, 2025, in Hillsboro, Wis. Novy is one of 312 permanently and totally disabled individuals in Wisconsin and has been collecting worker’s comp checks from the state since his injury in his late 20s. (Photo by Joe Timmerman/Wisconsin Watch)

Jimmy Novy grew up on a farm with corn, cattle and chickens in Wisconsin’s smallest municipality. Yuba, in the Driftless Area northwest of Madison, covers a third of a square mile. Novy correctly quotes its population in the last census: 53.

In 1967, at age 19, married with a child, Novy got a job at the Rayovac plant in nearby Wonewoc. It made batteries used in walkie-talkies in the Vietnam War.

In his late 20s, Novy learned he had been exposed to manganese, a key component in batteries. He suffered neurological problems that affected his left leg, severely limiting his ability to walk or even maintain his balance.

“The nerves from the brain to my leg, they can’t do nothing about that,” he said.

With four children to raise, Novy turned to Wisconsin’s first-in-the-nation worker’s compensation system. After three years of legal back-and-forth, the state agreed that Novy was permanently and totally disabled (PTD), meaning he was among the worst-off of Wisconsin workers injured on the job. As a result, he qualified for worker’s comp checks for life.

But there was no guarantee of how often those checks would increase.

Now 77, widowed, remarried and using hearing aids and a cane, Novy hasn’t seen an increase in his $1,575 monthly worker’s compensation check — nor have the other more than 300 other PTD recipients — since 2016.

“I can’t make it,” Novy told Wisconsin Watch in mid-July. “I got $8 left in my checkbook right now to last me through the last week of the month.”

“The wife buys food and stuff, otherwise I’d be starving to death,” he added.

Had Novy’s worker’s comp payment kept pace with inflation, which rose 34%, he would have received nearly $21,000 more over the past nine years, according to calculations by University of Wisconsin-Madison economist Menzie Chinn.

Meanwhile, Wisconsin employers have seen their premiums for worker’s compensation insurance decrease 10 years in a row, saving them $206 million in the past year and over $1 billion since 2017, according to the Wisconsin Hospital Association, which is part of the state Worker’s Compensation Advisory Council.

Twenty-three states, including Illinois, Michigan and Minnesota, provide automatic cost-of-living raises for PTD recipients. In Wisconsin, raises have been provided only when they are included in a wide-ranging worker’s compensation “agreed bill,” proposed every two years, and only if the bill becomes law.

That moment might be at hand.

The advisory council has recommended raises for PTD recipients in the next agreed bill, which is being drafted.

The bill still has to be approved by the Republican-controlled Legislature and signed by Democratic Gov. Tony Evers.

Making history, creating PTD raises

In 1911, Wisconsin became the first state to adopt a comprehensive worker’s compensation law that was upheld as constitutional. Before that, the burden was on the worker to prove that a job injury was the employer’s fault. Now it’s a no-fault system. Workers injured on the job can receive regular payments based on their salary, plus coverage of medical bills to treat their injuries.

Wisconsin’s system has received high marks for getting injured workers back on the job quickly and for worker satisfaction in health care for their injuries.

The money for worker’s compensation checks comes from worker’s compensation insurance companies and from employers who are self-insured for worker’s comp. No tax dollars are involved.

About 21,000 people annually receive Wisconsin worker’s comp checks, the vast majority of them for a temporary period. Only about 500 people receive PTD benefits, and only 300 of them, like Novy, are eligible for raises.

That’s because the 2016 agreed bill limits raises, known as supplementary benefits, only to PTD recipients injured before Jan. 1, 2003.

How PTD raises are decided

The process that determines whether PTD raises are granted is not unlike the bargaining that an employer and a union do to reach a contract. Both sides have priorities, and there is horse trading and eventually compromise, at least on some issues.

The Worker’s Compensation Advisory Council is composed mainly of five representatives from management and five from organized labor, though it also includes nonvoting members representing insurance, health care and the Legislature.

Every odd year, the council develops a bill proposing multiple changes to worker’s comp. The process typically takes months of negotiations, said John Dipko, the council’s non-voting chair and administrator of worker’s compensation for the state Department of Workforce Development.

If approved by the Legislature and the governor, the bill becomes law the next year.

That process has produced 11 PTD raises since 1972. The 2016 raise put the maximum PTD payment at $669 per week.

‘The most severely changed’

Circumstances have left PTD recipient Scott Meyer better off financially than Novy, but delays in raises have forced Meyer to dip into savings and, as his health conditions worsen, worry about the future.

Meyer grew up outside of Milwaukee, playing in the woods and farm fields of rural Washington County. He was a member of the hockey team at West Bend West High School.

In 1993, at age 19, Meyer was working on a loading dock when a co-worker backing a semi-trailer pinned Meyer between the trailer and the dock. Meyer closed his eyes and tried to remain calm, thinking his right leg was broken.

“One of the paramedics in the ambulance thought that I was unconscious and said to the other paramedic that this was going to be his first fatality call,” Meyer recalled. “And I immediately then knew that something more major had happened.”

Meyer underwent multiple surgeries, spent more than a year in the hospital and dropped to under 100 pounds. He was left a paraplegic.

Though unable to work, Meyer became an Alpine skier in Colorado, where he now lives, competing in the 2014 Paralympics in Sochi, Russia.

Meyer, 51, said he receives about $2,300 per month from worker’s compensation – nearly $370 per month less than what he was paid on the job in 1993.

Meyer, who owns a condominium with his wife, a mental health therapist, said he has been able to live comfortably only by preserving savings, including from a one-time payout he received from his former employer for his injury. But with no raises in nine years, he has had to dip into savings to get by.

Earlier this year, both Novy in an email and Meyer in a video asked the Worker’s Compensation Advisory Council to recommend raises for PTD recipients.

“These are people whose lives are the most severely changed and are legitimately dependent upon these funds,” Meyer told Wisconsin Watch. “We’re talking about pennies on the dollar to the kind of money that is in the system.”

The process that results in PTD raises involves negotiations on a variety of worker’s compensation issues. That has made the road to another raise rocky in recent years.

Delayed raises and a possible breakthrough

The Worker’s Compensation Advisory Council’s agreed bill for 2018 would have raised the maximum weekly PTD payment to $711 from $669 and made more PTD people eligible for raises. But the bill also proposed a “fee schedule,” generally opposed by health care organizations, to limit how much health care providers can charge for worker’s comp care. The bill did not pass the Legislature.

Since then, the labor side of the advisory council continued to propose PTD raises, while the management side continued to seek a fee schedule. Wisconsin is one of only a handful of states without one. The two sides did not agree to include PTD raises in their 2020, 2022 and 2024 agreed bills.

A key barrier was cleared when a fee schedule for worker’s comp was included in the 2025-27 state budget adopted in July.

Days later, the advisory council proposed raises for current PTD recipients and made more PTD recipients eligible for raises.

Under the 2026 agreed bill, the injury date for PTD recipients to be eligible for raises would change from Jan. 1, 2003, to Jan. 1, 2020 — making an estimated 210 more people eligible for raises.

The bill would also raise the maximum weekly benefit for PTD recipients to $1,051 from $669 effective Jan. 1, 2026.

And it would add raises each Jan. 1, though those amounts would not be set until shortly before they become effective.

For individuals, the raise amounts would vary based on when they were injured.

For example, a PTD recipient injured in 1985 and receiving $535 a week would get a 57% increase to $840. The increase would amount to nearly $16,000 per year.

Once it’s drafted, the new agreed bill would need a final vote from the advisory council, which is expected in September. Then the bill would be submitted to the labor committees of the state Senate and Assembly.

Council management representatives didn’t reply to calls and emails requesting comment. Wisconsin AFL-CIO President Stephanie Bloomingdale, the lead labor representative, said she understands the frustration over delayed raises. But she said the advisory council system, with management and labor hashing out worker’s compensation issues, provides stability.

Without it, “it would be up to the Legislature, and the whims of the political winds would determine the policy,” she said.

Dipko, the DWD administrator, said the department is sympathetic.

“We agreed that an increase is overdue,” he said.

After waiting this long, Novy isn’t sure what to think. He’s happy he and wife share a $125,000 brick house they own “with the bank,” as he puts it, and for his monthly $1,635 Social Security check, which increases each year. But he has filed for bankruptcy three times, most recently in 2020. He feels that at this stage of his life, he should be more secure, and a raise in worker’s comp would help.

“The Legislature should be — forget Republican, Democrat — just vote for what’s good,” he said.

“I can’t see how come they can’t give us a little raise every year,” he added.

This article first appeared on Wisconsin Watch and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.  To republish, go to the original and consult the Wisconsin Watch republishing guidelines.

Union workers in Rhode Island protest a Trump administration stop-work order at an offshore wind farm under construction in August. Friday's jobs report shows the fewest gains in August since 2010. (Photo by Laura Paton/Rhode Island Current)

The United States added only 22,000 jobs in August, and previously reported gains in June were revised down to a loss of 13,000 jobs in a Bureau of Labor Statistics report issued Friday morning.

The August jobs increase was the lowest for that month since 2010 in the aftermath of the Great Recession. June’s decrease was the first jobs loss since a December 2020 COVID-19 surge shuttered restaurants and hotels.

A recent Stateline analysis showed that Virginia and New Jersey may be among the states most affected by recent hiring slowdowns, based on surveys and layoff reports, while California and Texas appeared to continue job gains.

Job openings fell to a 10-month low in July, according to a separate government report issued Sept. 3, and there were more unemployed people than jobs available for the first time since 2021.

Last month’s revisions to the jobs report enraged President Donald Trump when they first appeared Aug. 1. The revisions showed the nation had 258,000 fewer jobs than initially reported in May and June.

In response, Trump declared the numbers were wrong, fired the Bureau of Labor Statistics chief, Erika McEntarfer. He offered as a replacement E.J. Antoni, a loyalist who has proposed suspending the jobs report entirely. Trump falsely said in a Truth Social post at the time that the revised jobs numbers were “RIGGED in order to make the Republicans, and ME, look bad.”

Friday’s report showed August job losses in business and professional services (-17,000), government (-16,000), manufacturing (-12,000), wholesale trade (-11,700) and construction (-7,000), but gains in health care and social assistance (+46,800) and hospitality (+28,000).

The unemployment rate in August ticked up to 4.3%, from 4.2% in July and 4.1% in June. It increased the most for people with less than a high school diploma, up from 5.5% in July to 5.7% in August.

Unemployment ticked up for Black workers (to 7.5% from 7.2%) and Hispanic workers (to 5.3% from 5.0% in July). The rate went down for Asian workers (to 3.6% from 3.9%) and remained the same for white workers at 3.7%.

Editor’s note: This story was updated to add details about changes in industry job numbers and the unemployment rate.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

A 3-year-old girl gets an MMR vaccine at a clinic in Texas in March. Texas was among the states with the most public funding grants canceled by the Trump administration earlier this year. (Photo by Jan Sonnenmair/Getty Images)

After the Trump administration slashed billions in state and local public health funding from the federal Centers for Disease Control and Prevention earlier this year, the eventual impact on states split sharply along political lines.

Democratic-led states that sued to block the cuts kept much of their funding, while Republican-led states lost the bulk of theirs, according to a new analysis from health research organization KFF.

The uneven fallout underscores how politics continues shaping health care in the United States. The nearly 700 CDC grants were worth about $11 billion and had been allocated by Congress during the COVID-19 pandemic. Since then, state and local health departments had spent or planned to spend the money not just on COVID-related efforts, but also on prevention of other infectious diseases, support for mental health and substance use, shoring up aging public health infrastructure, and other needs.

The CDC grant terminations initially affected red and blue states about evenly, according to KFF. California, the District of Columbia, Illinois and Massachusetts — all led by Democrats — had among the largest numbers of terminated grants.

But then nearly two dozen blue states and the District of Columbia sued the Trump administration in April, asking the court to block the grant terminations. They argued the federal government lacked the authority to rescind funding it had already allocated.

“The Trump administration’s illegal and irresponsible decision to claw back life-saving health funding is an attack on the well-being of millions of Americans,” said New York Attorney General Letitia James in an April statement announcing the lawsuit.

“Slashing this funding now will reverse our progress on the opioid crisis, throw our mental health systems into chaos, and leave hospitals struggling to care for patients.”

A federal judge sided with the blue states and blocked the cancellations  — but she limited her injunction to the jurisdictions that filed in the lawsuit.

Nearly 80% of the grant cuts have now been restored in blue states, according to the KFF analysis, compared with less than 5% in red states.

Now four of the five states with the most canceled grants are led by Republicans: Georgia, Ohio, Oklahoma and Texas. California, which is dominated by Democrats, kept all of its grants that had been initially terminated.

In the West and Midwest, Democratic-led Colorado — which joined the lawsuit — had 10 of its 11 grant terminations reversed. Its Republican-led neighbors that did not sue, including Kansas, Nebraska, Oklahoma, Utah and Wyoming, lost all of their grants, according to the KFF analysis.

Editor’s note: This story has been updated to correct the photo caption. Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org

A man waits for health care at a temporary health clinic in Terre Haute, Ind. President Donald Trump’s new tax and spending law will likely force more than half the states to reduce payments to doctors and hospitals that treat Medicaid patients, a change critics warn could reduce health care options for people in rural areas. (Photo by Spencer Platt/Getty Images)

President Donald Trump’s new tax and spending law will likely force more than half the states to reduce payments to doctors and hospitals that treat Medicaid patients, a change critics warn will be particularly harmful to rural hospitals struggling to stay afloat.

Medicaid, the joint state-federal health insurance program for low-income people, reimburses doctors, hospitals and nursing facilities for treating enrollees. But in many cases, the program doesn’t fully cover the cost of care, straining providers that serve a large share of Medicaid patients.

To help providers cover losses and continue to serve poorer populations, the federal government allows the 41 states, plus the District of Columbia, that have contracted with Medicaid managed care organizations (MCOs) to run their Medicaid programs to direct them to pay providers more — in some cases, as much as commercial plans.

Ultimately, taxpayers cover the costs of these so-called state directed payments — and those costs are growing. As of August 2024, the higher payments were projected to add $110.2 billion per year to Medicaid spending, nearly 60% more than the previous year’s projection.

That higher spending attracted the attention of conservatives on Capitol Hill.

Beginning in 2028, the One Big Beautiful Bill Act will cap the payments, forcing state Medicaid programs to reduce reimbursement rates by 10 percentage points each year until they reach either 100% or 110% of what Medicare pays. States that expanded Medicaid under the Affordable Care Act would be capped at the lower rate.

The new law will reduce Medicaid spending by $149 billion over the next decade, according to the Congressional Budget Office, and reduce Medicaid provider payments in as many as 31 states, according to KFF, a health policy research group. A separate analysis by The Commonwealth Fund, another research group, found that Medicaid payments to hospitals would drop by at least 20% in 19 of the 25 states that had publicly available data.

Critics say the change could be disastrous for hospitals, many of them in rural areas, that see a large share of Medicaid patients.

“This is all on top of an already pretty strained financial situation for rural hospitals,” Alexa McKinley Abel, director of government affairs and policy at the National Rural Health Association, a group representing rural health care providers, said in an interview. “We are worried about seeing service line closures at hospitals in an environment where OB-GYN and chemotherapy service lines are already being cut.”

Covering the cost of care

Supporters of the change say the extra payments inflate federal spending on the Medicaid program, giving hospitals “windfall profits.”

“Not only do these programs sidestep the truly needy on Medicaid and favor special interests instead, but all this is financed by growing the federal debt, leading to inflation and higher interest rates for all Americans,” the Paragon Health Institute, a conservative think tank that helped draft the bill, stated in a policy brief.

Hospital leaders dispute that. Earlier this year, the American Hospital Association asserted that without the extra payments, Medicaid managed care organizations in 2023 only covered about two-thirds of the actual cost of care.

Cindy Samuelson, senior vice president of the Kansas Hospital Association, said the additional payments are especially critical in a rural state such as Kansas, where some researchers have found that 87% of rural hospitals are in the red. Kansas is one of 10 states that did not expand Medicaid, and like other nonexpansion states, it will have to begin reducing direct payments to 110% of what Medicare pays starting in 2028.

“Over time, commercial payers are paying less and less,” Samuelson said. “Many hospitals in our state are at risk of closure.”

Samuelson said that in rural areas, health care providers see fewer patients, which makes it hard to spread out the cost of care and make up for losses that come from serving underinsured, Medicaid and Medicare patients. One result is that rural hospitals are trimming services. A report published this year by Chartis, a health care consulting firm, found that between 2011 and 2023, nearly 300 rural hospitals across the country stopped offering obstetrics care, and 424 rural hospitals ceased chemotherapy services.

In Hutchinson, Kansas, Benjamin Anderson, CEO of the rural and community-owned Hutchinson Regional Health System, said his hospital barely broke even this year, and lower Medicaid payments will take a toll. The 190-bed hospital serves more than 65,000 people in the central Kansas region, and sees a lot of patients who are struggling with mental health issues and substance use disorders.

“We are closely managing our workforce expenses. We’re going to be relying more heavily on philanthropy,” Anderson said, adding that the hospital wouldn’t lay off staff but would reduce the number of workers by not filling open positions.

He said his hospital has some cash reserves that should enable it to keep going, but that many other rural hospitals lack such a cushion.

“When we think about the cuts to Medicaid, it isn’t simply about cutting services to the poor. It’s threatening services to everyone, because in a rural community, we all get care in the same place,” he said. “If we cut out the safety net that’s sustaining these hospitals, everyone’s health care is threatened.”

Searching for answers

Three hours northeast of Hutchinson is the rural town of Holton, where about 3,400 people live. Holton Community Hospital is a 14-bed critical access hospital, meaning that it provides emergency care around the clock for a rural community. For the past two years, it has been struggling, according to Carrie Lutz, the hospital’s CEO.

Lutz said the hospital is not part of a broader health care group, and it relies on philanthropy and local taxes. Due to financial strains, it’s in the process of selling off its home and hospice services to another health care facility. The cap on extra payments will be an additional barrier, she said.

Samuelson said Kansas is applying for money under the five-year, $50 billion Rural Health Transformation Program, which Congress added to the One Big Beautiful Bill Act amid concerns about its impact on rural hospitals. She expects Kansas to get at least $500 million between 2026 and 2030.

Rural hospitals in Mississippi also hope to tap into those funds. The Mississippi Hospital Association, which is advising state leaders on their application, said it expects Mississippi to get at least $500 million over the next five years.

Like Kansas, Mississippi did not expand Medicaid under the Affordable Care, a decision that deprived it of additional Medicaid patients and thus extra revenue.

“A few years ago, we had several rural hospitals that were facing some imminent closure challenges, and so our enhanced supplemental payment based on the average commercial rate has been a lifeline,” said Richard Roberson, president and CEO of the Mississippi Hospital Association.

“What we’re concerned about is that when those payments start to decrease, then we’re going to be right back to where we were in 2022, with concerns about rural hospitals again.”

Roberson said Medicaid, with the additional payments, had become “one of the best payers, if not the best payer, for our hospitals over the last two years,” and helped a lot of hospitals stay out of the red.

He said the new rural health care fund is promising, but noted that Mississippi will decide where to spend any money it gets, and some rural hospitals might miss out.

“We want to make sure we’re working with the state to provide sustainable solutions, not one-time fixes,” Roberson said. “The big wild card is the Rural Health Transformation fund and what the state chooses to do with that money.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

LeVar Wilson, a Milwaukee glazer, describes how a project labor agreement that included requirements for local hiring made it possible for him to learn his trade and build a career. A bill to repeal a state ban on project labor agreements is part of a "Build a Stronger Wisconsin" package that Democratic lawmakers proposed Thursday. (Photo by Erik Gunn/Wisconsin Examiner)

Democrats in the state Legislature began circulating draft legislation Thursday that they said would strengthen the state’s economy by supporting workers and undoing policies that undercut union-represented employees.

The package includes four bills: restoring Wisconsin’s prevailing wage law, repealing a ban on project labor agreements, repealing the state’s “right to work” law, and strengthening laws against wrongly classifying employees as independent contractors.

“We know that these are popular policies that the people of Wisconsin need to be able to thrive in our state,” said Assembly Minority Leader Greta Neubauer (D-Racine) at a press conference in the Assembly chamber Thursday morning. “We  have all 60 members of the Assembly Democrats and the Senate Democrats signed onto these bills.”

A crowd of union members and supporters occupied the Assembly, packed in rows where the body’s leaders usually sit as well as bunched throughout the seats that lawmakers typically use during floor sessions.

One draft bill would undo Wisconsin’s “right-to-work” law enacted during former Gov. Scott Walker’s second term. The law bars employers and unions from requiring in their labor contracts that all union-represented employees pay union dues or fees to cover the union’s operational expenses.

Sen. Mark Spreitzer (D-Beloit) said the law “allows private sector workers to benefit from union protections without paying their share of union dues.” Spreitzer recalled he was in his first Assembly term when the measure was enacted in 2015 and spoke twice against it during an all-night floor session.

“Under federal law, unions are required to represent all employees in a workplace, but right-to-work laws like Wisconsin’s allow non-dues paying employees to receive the benefits of belonging to a union — such as bargain contracts for higher wages and union representation in employment disputes —without having to pay union dues,” Spreitzer said.

“That is not fair. It is well past time to return to the requirement that every union represented worker pays their dues for that privilege in Wisconsin,” he added.

Nurse Colin Gillis, a member of SEIU Wisconsin, called the law’s name “a misnomer.” Union members deride such laws as “right-to-work for less” because they tend to weaken wage gains, he said.

Right-to-work laws were first enacted in the segregated South after World War II. “Right-to-work laws were designed to divide and conquer and prevent us from joining together and increase living standards for working families from all races and backgrounds,” Gillis said. “Repealing ‘right to work for less’ will give me and my union siblings back the freedom to organize.”

A second bill would repeal another Walker-era law, enacted in 2017, that bars state and local governments from requiring contractors on public works projects to sign a project labor agreement with relevant unions. It also forbids government bids that require the bidder to have a union contract.

“Repealing the ban on project labor agreements, or PLAs, gives power to local and state governments to utilize a tool that would streamline the building process for public construction projects,” said Rep. Joan Fitzgerald (D-Fort Atkinson).

LeVar Wilson, a journeyman glazer represented by the Painters Union in Milwaukee, said he got his start as an apprentice 25 years ago when the Milwaukee baseball stadium, then known as Miller Park, was being built. The stadium project labor agreement guaranteed a percentage of jobs would go to Milwaukee County residents.

“I was one of those workers hired under this provision,” Wilson said. “It led me to a sustainable career that’s allowed me to raise a family of four without the struggle of poverty that I went through when I was a child.”

A third bill would increase enforcement and penalties for businesses that misclassify workers as independent contractors.

State Rep. Christine Sinicki (D-Milwaukee) said that when employers misclassify workers, they dodge state and federal payroll taxes, evade minimum wage laws and overtime payment requirements, and don’t pay into the worker’s compensation and unemployment insurance programs.

“By avoiding these costs, dishonest employers often successfully undercut their competitors with very low bids,” Sinicki said. “In this way, misclassification harms the law-abiding employers and their employees and also the taxpayers who have to pick up the slack.”

The draft bill would increase the penalties for lawbreakers and expand outreach both to contractors and the public about misclassification.

The legislation would “level the playing field for business owners like us, who play by the rules,” said Larry Statz, a second-generation union painting contractor with 30 employees who said that he’s seen more contractors misclassify employees in recent years.

“We refuse to break the law or shortchange our workers. But it’s getting harder to compete with dishonest companies who cut corners,” Statz said. “State laws on misclassification do not have enough teeth in them, and these cheating companies too often avoid being caught.”

The fourth bill would reinstate Wisconsin’s prevailing wage law, which set a standard for what workers on state and local government projects are paid. The prevailing wage law was repealed in the state budget Walker signed in 2017.

State Sen. Bob Wirch (D-Somers) said Republican lawmakers who voted to repeal the law “promised it would save the taxpayers money. Well, the opposite has happened.”

A study published in 2020 by the Midwest Economic Policy Institute found that  in the years that followed the repeal, construction workers’ wages fell by about $2,600 a year and highway construction costs increased.

At the time the report was published, a co-author, economist Kevin Duncan, said that the findings “underscore the longstanding academic consensus” that doing away with prevailing wage requirements leads to a lower-skilled, lower-wage workforce and doesn’t save money.

“Instead, it creates new inefficiencies in the form of workforce turnover, quality, cost overruns and safety problems,” Duncan said in a news release announcing the report. 

Senate Minority Leader Dianne Hesselbein (D-Middleton) said she has sought to persuade GOP Senate Majority Leader Devin Le Mahieu (R-Oostburg) to pursue bipartisan lawmaking.

“I do not know if the Senate Republicans have caucused on any of these measures, but I’d encourage them to do so,” Hesselbein said.

Neubauer said the Assembly Democrats would continue advocating for the measures, but also tacitly acknowledged that they might not advance until after the 2026 election — when Democratic leaders are hoping to flip one or both chambers.

“We will continue pushing for them as long as it takes,” Neubauer said of the bills. “And if that’s next session, so be it.”

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