Vaccine misinformation pushed by Secretary of Health and Human Services Robert F. Kennedy Jr. could put American lives at risk. (Eric Harkleroad/KFF Health News)

President Donald Trump’s administrations have been notorious for an array of “alternative facts” — ranging from the relatively minor (the size of inaugural crowds) to threats to U.S. democracy, such as who really won the 2020 election.

And over the past six months, the stakes have been life or death: Trump’s health officials have been endorsing alternative facts in science to impose policies that contradict modern medical knowledge.

It is an undeniable fact — true science — that vaccines have been miraculous in preventing terrible diseases from polio to tetanus to measles. Numerous studies have shown they do not cause autism. That is accepted by the scientific community.

Yet Secretary of Health and Human Services Robert F. Kennedy Jr., who has no medical background or scientific training, doesn’t believe all that. The consequences of such misinformation have already been deadly.

For decades, the vast majority Americans willingly got their shots — even if a significant slice of parents had misgivings. A 2015 survey found that 25% of parents believed that the measles, mumps, and rubella (MMR) vaccine could cause autism. (A 1998 study that suggested the connection has been thoroughly discredited.) Despite that concern, just 2% of children entering kindergarten were exempted from vaccinations for religious or philosophical objections. Kids got their shots.

But more recently, poor government science communication and online purveyors of misinformation have tilled the soil for alternative facts to grow like weeds. In the 2024-25 school year, rates of full vaccination for those entering kindergarten dropped to just over 92%. In more than a dozen states, the rate was under 90%, and in Idaho it was under 80%. And now we have a stream of measles cases, more than 1,300 from a disease declared extinct in the U.S. a quarter-century ago.

It’s easy to see how both push and pull factors led to the acceptance of bad science on vaccines.

The number of recommended vaccines has ballooned this century, overwhelming patients and parents. That is, in large part, because the clinical science of vaccinology has boomed (that’s good). And in part because vaccines, which historically sold for pennies, now often sell for hundreds of dollars, becoming a source of big profits for drugmakers.

In 1986, a typical child was recommended to receive 11 vaccine doses — seven injections and four oral. Today, that number has risen to between 50 and 54 doses by age 18.

The Advisory Committee on Immunization Practices, which renders judgments on vaccines, makes a scientific risk-benefit assessment: that the harm of getting the disease is greater than the risk of side effects. That does not mean that all vaccines are equally effective, and health officials have done a lackluster job of fostering public understanding of that fact.

Older vaccines — think polio and measles — are essentially 100% effective; diseases that parents dreaded were wiped off the map. Many newer vaccines, though recommended and useful (and often heavily advertised), don’t carry the same emotional or medical punch.

Parents of the current generation haven’t experienced how sick a child could be with measles or whooping cough, also called pertussis. Mothers didn’t really worry about hepatitis B, a virus generally transmitted through sex or intravenous drug use, infecting their child.

That lack of understanding spawned skeptics. For example, since 2010, the vaccine for influenza, which had been around for decades, has been recommended annually for all Americans at least 6 months old. In the 2024-25 season, the rate of flu vaccination was only between 36% and 54% in adults; in other years, it has been lower than that. “I got the flu vaccine, and I still got the flu” has been a common refrain of skeptics.

“Pre-covid, there were people who took everything but flu,” said Rupali Limaye, an associate professor at Johns Hopkins University’s Bloomberg School of Public Health, who studies vaccine demand and acceptance. “Then it became everything but covid. Now it’s everything — including MMR and polio.”

Even as the first Trump administration’s Operation Warp Speed helped develop covid vaccines, conservative media outlets created doubts that the shots were needed: doubts that mRNA technology had been sufficiently tested; doubts that covid-19 was bad enough to merit a shot; concerns that the vaccines could cause infertility or autism.

Trump did little to correct these dangerous misperceptions and got booed by supporters when he said that he’d been vaccinated. Once vaccine mandates came into play, Trump strongly opposed them, reframing belief in the vaccine as a question of personal liberty. And if the government couldn’t mandate the covid shot for school, it followed that officials shouldn’t — couldn’t — mandate others.

Thus 100 years of research proving the virtues of vaccination got dropped into a stew of alternative facts. You were either pro- or anti-vaccine, and that signaled your politics. Suddenly, the anti-vax crowd was not a small fringe of liberal parents, but a much larger group of conservative stalwarts who believed that being forced to vaccinate their kids to enter school violated their individual rights.

Even within the Trump administration, there have been some who (at least partly) decried the trend. While Marty Makary, the Food and Drug Administration commissioner, defended Kennedy’s decision to roll back the recommendation that all Americans get annual covid boosters — saying the benefits were unproven — he noted it should not be a signal to stop taking other shots.

As “public trust in vaccination in general has declined,” he wrote, the reluctance to vaccinate had harmed “vital immunization programs such as that for measles–mumps–rubella (MMR) vaccination, which has been clearly established as safe and highly effective.”

Nonetheless, Makary’s boss, Kennedy, continued to promote bad science about vaccines broadly, even as he sometimes grudgingly acknowledged their utility in cases like a measles outbreak. He has funded new research on the already disproven link between MMR shots and autism. He has halted $500 million in grants for developing vaccines using mRNA technology, the novel production method used for the first covid vaccines and a technique scientists believe holds great promise for preventing deaths from other infectious diseases.

In my 10 years practicing as a physician, I never saw a case of measles. Now there are cases in 40 states. More than 150 people have been hospitalized, and three, all unvaccinated, have died.

Alternative facts have formed what David Scales, a physician and sociologist at Weill Cornell Medical College who studies misinformation, calls “an unhealthy information system.” It is an alternative scientific universe in which too many Americans live. And some die.

This story can be republished for free (details).

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

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Office of Management and Budget Director Russ Vought testifies before the Senate Homeland Security and Governmental Affairs Committee on Jan. 15, 2025. (Screenshot from committee webcast)

WASHINGTON — A federal judge on Monday ordered the Trump administration to once again publish details about the pace at which it plans to spend money approved by Congress.

U.S. District Court for the District of Columbia Judge Emmet Sullivan wrote in his ruling that Congress “has sweeping authority” to require the president to post a website detailing how it doles out taxpayer dollars throughout the year.

“As explained in this Memorandum Opinion, there is nothing unconstitutional about Congress requiring the Executive Branch to inform the public of how it is apportioning the public’s money,” he wrote. “Defendants are therefore required to stop violating the law!”

The ruling won’t take effect until Thursday at 10 a.m. Eastern, giving the Trump administration time to appeal and to seek the ruling be put on hold during the appeals process.

Sullivan was appointed to the federal district court by President Bill Clinton but was selected for two prior judicial appointments by President Ronald Reagan and President George H. W. Bush.

Website pulled down

More than two years ago, Congress began requiring the White House budget office to publicly post apportionment information and the Biden administration took that step, though Trump officials pulled down the website in March.

That decision led to two separate lawsuits, one from Citizens for Responsibility and Ethics in Washington and another from the Protect Democracy Project.

Apportionments are the first step the executive branch takes when spending money appropriated by Congress. The documents and their footnotes usually detail how quickly, or how slowly, departments and agencies plan to send money out the door throughout the fiscal year.

The documents and the public website would have been a window into whether the Trump administration was impounding, or refusing to spend, funding that lawmakers have said it should allocate on behalf of taxpayers.

Trump administration protested provision

An attorney for the Department of Justice argued during a May hearing the Trump administration believes the provision is unconstitutional and seeks to micromanage how the executive branch spends federal funds throughout the year.

The DOJ lawyer also said posting the information within two business days, as called for in the law, would require the White House budget office to divert staff from other work.

Lawyers for CREW and Protect Democracy Project told the judge the White House was in clear violation of the law and that the data is valuable information that helps the organizations monitor if a president were to cease spending on programs funded by Congress.

The watchdog organization attorneys noted during that hearing the Government Accountability Office is looking into dozens of instances where the administration held onto congressionally approved funding instead of spending it.

They said the Freedom of Information Act, or FOIA, wasn’t a helpful alternative to the website since it can take months or years for organizations to get a response to their request.

Public’s right to see decisions

Sullivan wrote in the 60-page ruling the Trump administration “complaining about the extra work” that goes along with posting the information on a public website represents “a management issue; not a constitutional one.”

“Here, Congress has determined that OMB’s apportionment decisions should be publicly available so that, among other things, it and the public can see whether they are consistent with congressional appropriations,” Sullivan wrote, adding the website aids Congress with “its undisputed oversight role.”

“The Acts do not dictate how OMB should apportion funds, nor do they establish a congressional management role in the administration of apportionments,” Sullivan wrote. “The Acts merely require that the final apportionment decisions be made publicly available to provide transparency to Congress and the public.”

Sullivan rejected an argument from the Trump administration that publicly sharing details about the pace at which it’s spending taxpayer dollars was unconstitutional because it required “the disclosure of privileged information.”

“There is no evidence in the record remotely supporting the notion that the apportionment documents are presidential communications or are in any way subject to the presidential communications privilege,” Sullivan wrote. “Accordingly, the Court rejects this constitutional claim.”

Advocates applaud ruling

Cerin Lindgrensavage, counsel for Protect Democracy Project, wrote in a statement the judge’s ruling “makes clear that the executive branch cannot simply ignore appropriations laws they disagree with on policy grounds, no matter what President (Donald) Trump or OMB Director Russell Vought thinks.

“Congress passed a law making sure the American public could see how their taxpayer dollars are being spent, and we will continue to hold the administration accountable for making good on that promise.”

Nikhel Sus, deputy chief counsel at CREW, wrote in a separate statement that the organization applauds “the court’s thorough and well-reasoned decision, which reaffirms Congress’s constitutional authority to require public disclosure of how taxpayer dollars are spent.

“Americans have a right to know how taxpayer money is being spent. Ensuring public access to this information serves as a critical check on the executive branch’s abuse and misuse of federal funds.”

Rachel Cauley, communications director for the White House Office of Management and Budget, wrote in a statement the administration strongly disagrees with the ruling.

“This leftist, anti-Trump judge undermines the President’s ability to effectively manage his agencies,” Cauley wrote. “Moreover, these progressive dark money groups have zero standing to claim injury for not having access to this privileged internal information.”

The Department of Justice did not return a request for comment about the ruling or whether the administration would appeal to the Circuit Court.

U.S. Senate Appropriations Committee ranking member Patty Murray, D-Wash., wrote in a statement that “the law is clear as day: every president is required to show the public how they are spending taxpayer dollars, and it is past time President Trump and Russ Vought get the website they illegally ripped down back up.”

Senate Appropriations Chairwoman Susan Collins, R-Maine, didn’t immediately return a request for comment. 

A 2024 provision under the Health Insurance Portability and Accountability Act (HIPAA) protects reproductive health information from disclosure to law enforcement when care was legally obtained, such as in another state with abortion access. (Photo by Dave Whitney/Getty Images)

Two pending lawsuits over a 2024 federal rule protecting certain reproductive health information from disclosure are on hold while the Trump administration decides whether to appeal a Texas judge’s June decision that declared the rule unlawful and void.

U.S. District Judge Matthew Kacsmaryk issued an opinion nullifying the federal rule that shielded reproductive health information from law enforcement when care was legally obtained, such as in another state with abortion access. In this case, Dr. Carmen Purl argued that the U.S. Health and Human Services rule conflicted with the laws requiring her to report child abuse. Purl said in court documents she believes abortion and gender-affirming care fall under the definitions of child abuse.

Purl lives in the judicial district where Kacsmaryk — who has taken anti-abortion stances in the past — is the only judge. His ruling applied nationwide and took effect immediately.

Without the rule, law enforcement officials in states with abortion bans may issue subpoenas for records related to reproductive health care obtained legally in another state, as some have already recently tried to do. According to health policy nonprofit KFF, 22 states and the District of Columbia have laws limiting what reproductive health information can be obtained, but others with legal abortion access do not, such as New Hampshire and Virginia.

Abortion-rights advocates say it’s largely an intimidation tactic meant to sow fear in patients and providers. Since the Dobbs decision in 2022,  anti-abortion attorney Jonathan Mitchell filed nine petitions in Texas seeking to legally question abortion funds, providers and researchers, and two individual women who sought abortions in other states, according to the Texas Tribune.

Carmel Shachar, a Harvard law professor who has extensively researched data privacy and health policy, said it’s possible for a patient to travel to a state with legal access and have that information stored in their medical records that is shared with their providers back home.

“Without the reproductive privacy rule, the concern will be, ‘OK, will some of these states that have taken a very strong stance against abortion be able to pinpoint where residents of their states travel to receive abortion care?’” Shachar said.

Tennessee plaintiffs push for separate ruling after Texas decision

Two lawsuits challenging the legality of the rule are frozen at least until the government’s Aug. 18 deadline to appeal. One case is in Missouri, and Texas Attorney General Ken Paxton filed the other. Paxton’s office had also challenged the legality of the underlying privacy rule or HIPAA established in 2000, which could have opened more avenues for state investigations if a judge agreed to throw it out. But according to recent court filings, the state is no longer asking the court to do that.

A Tennessee lawsuit includes 17 other states that heavily restrict or ban abortion as plaintiffs. Their attorneys general asked the court to find the 2024 rule unlawful because they said it impedes their right to investigate cases of waste, fraud and abuse. In the most recent court brief, attorneys for Tennessee Attorney General Jonathan Skrmetti said the case can still be decided by U.S. District Judge Katherine Crytzer, an appointee of Republican President Donald Trump.

Until judgment is affirmed on appeal and no further appellate review is available or the deadline to appeal passes, “the plaintiff states’ claims remain live and ready for this court to resolve,” the brief said.

Legal organization continues attempts to intervene so they can appeal

The Health Insurance Portability and Accountability Act (HIPAA) allows law enforcement to obtain health information for investigation purposes. But the addition of the 2024 provision under former Democratic President Joe Biden prohibited disclosure of protected health information in investigations against any person for the mere act of seeking, obtaining, or facilitating reproductive health care, to impose criminal or civil liabilities for that conduct, or to identify the person involved in seeking or obtaining that care. It also applied to gender-affirming care.

The U.S. Department of Justice did not respond to a request for comment. Whether it appeals Kacsmaryk’s ruling is in question, as the Justice Department under Trump did not address whether it thought the 2024 rule was proper and lawful prior to Kacsmaryk’s decision. Attorneys instead said they were reviewing the rule but had no other updates. In the Missouri and Tennessee cases, DOJ attorneys have argued for dismissal for other legal reasons, but also have not defended the 2024 rule itself.

In March, the DOJ dropped the case that argued the federal law mandating stabilizing emergency care should apply to those who need emergency abortion care. And in early June, U.S. Health and Human Services rescinded guidance that said that care should be required in emergencies.

Attorneys for Democracy Forward, a nonprofit legal organization, are representing Doctors for America and the cities of Columbus, Ohio, and Madison, Wisconsin, and attempted to intervene in the case because they did not expect the government to defend the rule. If they were allowed to intervene, they could appeal Kacsmaryk’s opinion striking down the rule regardless of the Trump administration’s decision.

Kacsmaryk denied their motion, while a decision in the other three cases is pending. Carrie Flaxman, senior legal adviser for Democracy Forward, said they have appealed that denial to a higher court. Given that the Department of Justice attorneys chose not to defend the rule on the merits in court proceedings, Flaxman said, she thinks they have a good argument for appeal.

Repealing the rule was a directive in Project 2025, the blueprint document for the next presidential administration published by the conservative Heritage Foundation. Several prominent anti-abortion organizations were part of the panel that drafted Project 2025, and many of the individuals involved in writing the 900-page document now work for the Trump administration.

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Reading Time: 2 minutes

Artificial intelligence is a fraught topic for journalists — just ask the guy who <ahem> “wrote” this year’s summer reading list for the Chicago Sun-Times.

But for all its risks, AI also presents opportunities we are just now starting to understand. For example, Wisconsin Watch has been an early user and partner with Gigafact on an AI-powered tool they have built that can help analyze the thousands of hours of podcasts, social media videos and talk radio programs that could be spreading misinformation every day.

The tool, known as Parser, can process an hourlong audio file in a matter of minutes and not only provide a transcript, but also identify specific claims made during the audio segment and even the person making the claim.

Wisconsin Watch fact briefs reporter Tom Kertscher has been using Parser to make it easier to find surprising and dubious claims. Before Parser he would listen to those hourlong podcasts and radio shows himself, trying to pick up on what Wisconsin politicians were saying. In tracking how much time it took to produce a fact brief, we found in some cases almost half the time was spent just searching for a claim.

Parser has sped up that process, making it possible to scan through far more audio recordings of interviews.

“We can cover so much more ground with Parser, checking many more politicians and interviews than we could manually,” Kertscher said.

Gigafact began developing Parser after Wisconsin Watch provided that feedback on how much time it can take to stay on top of every claim that every politician makes. But the problem of misinformation is far bigger than just keeping tabs on politicians.

Last year the investigative journalism class at UW-Madison worked on a project about talk radio in Wisconsin. One of the key findings was the notable amount of misinformation being spread on the airwaves, especially among conservative pundits.

To do that project, students spent a significant amount of time listening to six radio hosts whose viewpoints spanned the political spectrum. They took four hours for each host from the week after the Super Bowl — 24 hours of audio total — and manually processed the audio into a database of claims. Even with a transcription tool, the process took easily over 100 hours to produce a list of claims to fact-check.

Earlier this year, I worked with Gigafact using Parser to process 24 hours from the same hosts the week after this year’s Super Bowl. We came up with a list of claims in two hours.

Wisconsin Watch and Gigafact presented that case study in using AI at a recent Journalism Educators Institute conference hosted by the University of Wisconsin-Madison’s School of Journalism and Mass Communication. We’ll present it again this week at the Investigative Reporters and Editors conference in New Orleans.

And if you haven’t read it yet, add our investigative journalism project Change is on the Air to your summer reading list. Unfortunately, for the students who devoted so many hours to listening and re-listening to those talk radio hosts, it was not produced using AI. But maybe next time.

How AI helps us fact-check misinformation on the air is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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Just hours after Minnesotans learned that Democratic House leader Melissa Hortman had been assassinated, right-wing influencer Collin Rugg, who has 1.8 million followers on X, posted a report that hinted that she’d been killed because of a recent vote on ending undocumented adults’ ability to enroll in MinnesotaCare, a subsidized health insurance for the working poor.

Mike Cernovich, another right-wing influencer who has 1.4 million followers on X, took Rugg’s post and amped it up, but in the “just asking questions” style of many conspiracy theories:

“Did Tim Walz have her executed to send a message?”

They were deeply ignorant about the MinnesotaCare issue.

Walz and Hortman — who was instrumental in passing legislation allowing undocumented people to sign up for MinnesotaCare as speaker of the House in 2023 — negotiated a compromise with Republicans in the Minnesota Legislature to end eligibility for adults, but keep it for children. They did so to win necessary Republican support in the 67-67 House to pass a state budget. Without it, state government would have shut down on July 1.

Both Hortman and Walz signed the compromise agreement in mid-May. This week, Hortman spoke tearfully about how difficult the vote was for her, but she was bound to vote yes on the issue because of the prior agreement.

Rugg and Cernovich’s posts were shared widely and just the start of the disinformation.

Once law enforcement sources began revealing a suspect, right-wing influencers ran with an insignificant detail: That Vance Luther Boelter was a “Walz appointee.”

Like many states, but even more so here, Minnesota is home to hundreds of nonpartisan and bipartisan boards and commissions, which are composed of thousands of people who typically win the appointment by simply volunteering. There are currently 342 open positions on Minnesota boards and commissions. Boelter was appointed to the Workforce Development Council by Walz’s predecessor Gov. Mark Dayton and reappointed by Walz.

It was the equivalent of calling a Sunday school volunteer an “appointee of the bishop.”

No matter, the Murdoch media machine, specifically the New York Post, had their headline: “Former appointee of Tim Walz sought….”

Cernovich had his greasy foil hot dog wrapper and began constructing a hat:

“The Vice President candidate for the Democrat party is directly connected to a domestic terrorist, that is confirmed, the only question is whether Tim Walz himself ordered the political hit against a rival who voted against Walz’s plan to give free healthcare to illegals.”

Walz had no such plan. He had signed an agreement to end eligibility for undocumented adults.

Joey Mannarino, who has more than 600,000 followers on X, was more crass:

“Rumor has it she was preparing to switch parties. The Democrats are VIOLENT SCUM.”

It was a ridiculous “rumor.” One of the last photos of Hortman alive was an image of her at the Democratic-Farmer-Labor’s big annual fundraising event, the Humphrey-Mondale dinner, which took place just hours before her assassination.

No matter, Cernovich wanted his new friends in federal law enforcement to act:

“The FBI must take Tim Walz into custody immediately.”

Finally, fresh off his humiliating defeat at the hands of President Donald Trump, world’s richest man Elon Musk quote-tweeted someone again falsely alleging Hortman was killed by “the left”  and added:

“The far left is murderously violent.” 

The suspect’s “hit list,” according to an official who has seen the list, comprised Minnesotans who have been outspoken in favor of abortion rights. CNN reported that it also included several abortion clinics, which doesn’t sound like the work of “the left.”

Right-wing influencers marred Hortman’s death and smeared Walz on a pile of lies.

In a different, saner world, they would be humiliated and slink away. But the smart money is that during the next moment of national crisis and mourning, they will again lie for profit.

Minnesota Reformer is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Minnesota Reformer maintains editorial independence. Contact Editor J. Patrick Coolican for questions: info@minnesotareformer.com.

A decision is imminent in three of the four cases that will determine whether individual health information for legal reproductive care remains protected by a 2024 federal rule.

Dr. Eve Espey has many stories she can tell about patients who travel to her clinic in New Mexico from their homes in Texas, where abortion laws are some of the most restrictive in the country.

In one recent case, Espey said a patient flew from Texas to Albuquerque for an abortion after her doctor advised that an autoimmune disease she has made being pregnant incredibly dangerous. At the same time, she had an IUD placed as future contraception.

Shortly after returning home, the patient had some cramping and discomfort that prompted her to have the placement of the IUD checked and make sure it hadn’t moved. But her doctor turned her away because she’d had an abortion.

“She flew back to New Mexico to get her IUD examined,” Espey told States Newsroom.

In this case, Espey’s patient voluntarily told her doctor that she’d had an abortion. But if a rule exempting reproductive health information from law enforcement investigations is struck down or altered by one of three federal cases brought by Republican attorneys general from more than a dozen states, that information could become mandatory to disclose.

A decision is imminent in three of the four cases that will determine whether individual health information for legal reproductive care remains protected by a 2024 federal rule under the Health Insurance Portability and Accountability Act (HIPAA), including a case in Texas before the same judge who tried to revoke government approval of an abortion drug.

The plaintiffs in the cases, which include 17 states that heavily restrict or outright ban abortion, say the rule undermines their state rights to investigate waste, fraud and abuse. Chad Kubis, spokesperson for Tennessee Attorney General Jonathan Skrmetti, told States Newsroom via email that the office could not comment because of the ongoing litigation. But the complaint in the case led by Tennessee said, “The final rule will hamper states’ ability to gather information critical to policing serious misconduct like Medicaid billing fraud, child and elder abuse, and insurance-related malfeasance.”

HIPAA is a federal law passed nearly 30 years ago to protect the privacy and security of patient health information, especially as that information travels between clinics in an increasingly all-digital world. It includes some exceptions under limited conditions, such as law enforcement investigations. After the 2022 Dobbs decision returned abortion regulation to the states, prompting more than a dozen to pass abortion bans, advocates worried that such records could be used by state officials and law enforcement to investigate and prosecute patients seeking an abortion and those who help them.

Former Democratic President Joe Biden’s administration sought to remedy those concerns by adding a rule to the HIPAA law in 2024 restricting disclosure of the information. Meanwhile, states with legal abortion passed their own shield laws to protect providers and patients from out-of-state investigations.

In New Mexico, doctors like Espey are protected by a shield law that covers patients, providers and those who help someone obtain an abortion. Even with that, Espey worries and makes sure she’s careful with the notes she puts into writing. Lawmakers in New Mexico have considered going further with the shield law to require patient consent for any release of reproductive health records, but that could become an issue in emergencies.

“That is a colossal barrier to a provider,” Espey said. “Somebody could come into the ER and you can’t access the fact that they had an abortion two days ago.”

Lauren Paulk, senior research counsel for If/When/How, a nonprofit that offers legal support to those seeking reproductive health care, said the rule is important to keep intact because it helps patients and providers feel safe. Without it, more people will be turned away from clinics and hospitals, she said.

“Since Dobbs, there have been documented cases of at least seven people who have died in part because they were afraid to seek care or were denied care. We know that patients see these stories too,” Paulk said. “We also run a help line, so we hear people calling in every day who are scared to seek health care.”

For many years, people have considered health privacy to be a basic right, Paulk said, and have taken it for granted that when they see a doctor, the information shared will be confidential. But she said it’s vital that it stays that way.

“Having the state involved in health care poisons the well of the patient-provider relationship,” Paulk said. “When I go to my health care provider and I can’t be frank with them, it means I’m not going to get care to the extent that I need.”

Since Republican President Donald Trump’s administration took office in January and Secretary Robert F. Kennedy Jr. is now at the helm of U.S. Health and Human Services, the agency that administers the rule, the suits have become more complicated, including how the government is responding to each case.

They are:

State of Missouri v. U.S. Department of Health and Human Services: Republican Missouri Attorney General Andrew Bailey filed this lawsuit in January, claiming that the rule infringes on state powers to investigate fraud, abuse and public health violations. U.S. District Judge John A. Ross, who was appointed by former Democratic President Barack Obama, is weighing the Trump administration’s request to dismiss the case for lack of standing. 

State of Tennessee v. HHS: Republican Tennessee Attorney General Jonathan Skrmetti filed this lawsuit in January, also claiming that the rule infringes on state powers of investigation. Republican attorneys general in 14 other states joined as plaintiffs. U.S. District Judge Katherine A. Crytzer, an appointee of Republican President Donald Trump, has been asked by the Trump administration to dismiss the case for lack of standing or grant the states’ request to block the rule. 

Purl, M.D. v. HHS: Dr. Carmen Purl, the sole owner of Dr. Purl’s Fast Care Walk In Clinic in Dumas, Texas, sued in October because she said the rule creates a conflict with the laws requiring her to report child abuse. The case is before U.S. District Judge Matthew Kacsmaryk, an appointee of Republican President Donald Trump. Kacsmaryk granted a preliminary injunction, but is expected to rule soon on a permanent injunction. 

State of Texas v. HHS: Republican Texas Attorney General Ken Paxton sued in September, claiming the 2024 rule violates state investigative authority. Paxton argued the underlying 2000 HIPAA rule should be struck down as well — a move that could open many more avenues for state investigations if it is granted. U.S. District Judge James Wesley Hendrix, a Trump appointee, has given the federal health agency two extensions of time to decide whether they want to rescind and rewrite the rule.

The judges presiding over the cases in Missouri and Tennessee, as well as the Purl case in Texas, could issue decisions at any time Missouri filed its lawsuit alone, while 14 other states with Republican attorneys general joined Tennessee’s lawsuit as plaintiffs: Alabama, Arkansas, Georgia, Idaho, Indiana, Iowa, Louisiana, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota and West Virginia. All but three of those states either heavily restrict or outright ban abortion, and if the lawsuits are successful, records kept by doctors and pharmacists in other states could be subpoenaed.

If the underlying 2000 HIPAA privacy rule is somehow altered by court rulings in Texas, it could have even more effects, Paulk said. If/When/How receives phone calls from therapists living in states with abortion bans who are afraid of facing criminal charges just for talking about abortion with a patient, or for not reporting a person considering an abortion to the police, she said. That’s not true under existing laws, but if privacy rules change, records like therapy notes could also be subject to investigation.

“It’s clear to me that the folks who are pursuing the overturn of these laws and the folks who are in states where they’re trying to get access to health information are seeking to criminalize people and further stigmatize health care like abortion and gender-affirming care,” Paulk said. “They want people to be afraid to access care and providers to be afraid to provide it, and they’re using this specter of punishment to do that.”

DOJ asked two courts to dismiss Republican-led lawsuits

Democracy Forward, a nonprofit legal organization, is representing the cities of Columbus, Ohio, and Madison, Wisconsin, and Doctors for America, and has attempted to intervene in all four cases — Kacsmaryk denied the request, but the other three are still pending. If any of the motions are granted, attorneys for Democracy Forward could defend the rule, because they do not think the DOJ attorneys will adequately defend it, said Carrie Flaxman, the nonprofit’s senior legal adviser.

The cities and Doctors for America filed a friend-of-the-court brief after Kacsmaryk’s denial, arguing that HIPAA is vital to protecting patient confidentiality, including the 2024 rule.

At the end of March, Trump’s Department of Justice attorneys asked the federal courts in Missouri and Tennessee to dismiss the cases for lack of standing, saying the states have not demonstrated any harm.

“Missouri’s complaint vaguely alleges that the rule impedes state investigations and requires the state to expend resources to comply with the rule’s requirements,” the motion to dismiss says. “But absent from the complaint are any concrete facts supporting these conclusory assertions of harm, which one would expect to see if the rule truly posed the risks that the state alleges.”

In Texas, Kacsmaryk ordered the Department of Justice to provide an update about the health services agency’s review of the Biden-era rule in May, and asked if they wished to pause the court proceedings while they conduct that review. Acting Assistant Attorney General Yaakov Roth told the court in a brief that the rule remains “under consideration” but no imminent action on the rule is expected. He added that they were not requesting any pause in the case.

That response differed in Paxton’s suit, which was already on hold. DOJ attorneys asked for more time to “evaluate the agency’s position in this case and determine how best to proceed.” The judge granted the extension, and another update is expected in July.

“Blocking either or both of these rules could pave the way for government investigations by Attorney General Paxton or others and threaten the foundations of medical privacy that we all rely on,” Flaxman said. “Patients nationwide should be concerned about investigations … into the most personal of their medical records.”