A patient registers for care at a mobile dental and medical clinic in August 2025. Nationwide, the number of people buying health plans on Obamacare insurance marketplaces is down by about 833,000 compared with a year ago, according to state and federal data. (Photo by Spencer Platt/Getty Images)

Nationwide, the number of people buying health plans on Obamacare insurance marketplaces is down by about 833,000 compared with a year ago, according to federal data released this week.

Many states are reporting fewer new enrollees, more people dropping their coverage, and more people choosing cheaper and less generous health insurance plans with higher deductibles.

Across most states, Thursday was the last day to enroll for plans that start in February. But nine states and Washington, D.C., have deadlines later this month, so the numbers could change.

There are 21 states with state-run health insurance marketplaces, and the rest use the federal website. The vast majority of states have seen declines in enrollment so far, compared with around this time last year.

Preliminary data released Monday by the federal Centers for Medicare & Medicaid Services shows 22.8 million enrollees, down from a record total of 24.3 million last year.

Premiums have surged as a result of the expiration of enhanced federal subsidies first made available by the American Rescue Plan Act in 2021 and later extended through the end of 2025 by the Inflation Reduction Act. The availability of the subsidies spurred a sharp increase in the number of people buying health plans on the marketplaces. In 2020, 11.4 million people were enrolled in marketplaces through Obamacare, formally known as the Affordable Care Act. More than double that amount enrolled last year.

Congress failed to reach an agreement on extending the subsidies before the end of last year and still hasn’t reached one. As a result, premiums were expected to increase this year by 114% on average — from $888 last year to about $1,904, according to estimates made in September by health policy research organization KFF.

The higher costs appear to be driving many people to forgo insurance or opt for cheaper, less generous plans this year, health officials and analysts say. Several states with state-based marketplaces — including Georgia, Illinois, Minnesota, New York, Vermont, Virginia and Washington — are reporting fewer enrollments this year in comparison with enrollments through early January 2025, according to early data. Other states, such as California, are reporting fewer new enrollees.

“It’s important to consider that this is preliminary data, so this represents people who have signed up and selected the plan — but they probably haven’t received their first premium bill,” said Elizabeth Lukanen, executive director of the health policy research organization State Health Access Data Assistance Center at the University of Minnesota. “Once that happens, I think there’s concern — and it seems very possible — that people may decide to drop coverage. So, the decline could get bigger.

“On the other hand, open enrollment hasn’t closed, so you have two things sort of competing. It seems pretty likely that there will be a decline,” she said.

If the downward trend continues, the nation could see the first decline in enrollment since 2020, Lukanen said, adding that a full picture of income levels and demographics of people who have dropped coverage won’t be clear until the summer.

In Pennsylvania, data updated through Tuesday shows more than 15,000 previously enrolled adults between the ages of 55 and 64 have dropped coverage entirely — the most of any age bracket.

Pennsylvania’s state-based exchange, Pennie, has seen about 15% fewer new enrollments compared with last year. The state is also reporting 1,000 residents dropping coverage per day during open enrollment — with the most coverage losses among people with incomes 150% to 200% of the poverty level. These could include families of two adults and two children with an income between $48,225 and $64,300.

The state is seeing an “unprecedented” number of previously enrolled people dropping coverage, said Devon Trolley, executive director of the Pennsylvania Health Insurance Exchange Authority.

California is reporting 31% fewer new enrollees this year compared with last year, and more than a third of new enrollees are choosing bronze plans — the lowest, least generous coverage tier — up from less than a quarter at this time last year.

In Minnesota, data as of Dec. 3 shows more than half of active enrollees are opting to keep their coverage tier. But of those changing plans, more than a third — 37% — are going to cheaper plans. The state notes a full picture won’t be available until March.

Meanwhile, some states are seeing roughly the same number of enrollees or more. Texas, for example, is reporting about 4.1 million people enrolling this year compared with 4 million last year.

Charles Miller, health and economic mobility policy director at Texas 2036, a policy research nonprofit, said it’s unclear why enrollments are up, but pointed to some clues.

“Texas had a uniquely large population of uninsured individuals eligible for free and inexpensive plans that hadn’t enrolled previously … [and] has more affordable bronze and gold plans than many states,” he said.

He attributes that to a bipartisan state law, enacted in 2021, that had the effect of increasing subsidies for those plans, Miller said.

Nevada is seeing fewer enrollees overall. But compared with this time last year, the state is seeing 29% more people who are actively shopping the website to explore plans, said Katie Charleson, communications officer at the Nevada Health Authority Division of Consumer Health Services.

The state introduced a new public option, according to the Nevada Current, and health officials told lawmakers last week that about 1 in 5 active shoppers are opting for that plan.

In addition to the expiration of the subsidies, the cost of coverage has risen because of other factors, according to insurers. They say they’ve had to raise premiums because of rising prescription drug costs, inflation and workforce challenges, such as provider shortages.

But the enhanced premium tax credits were aimed at buffering those year-to-year changes for Americans with lower incomes, said Trolley, adding that the tax credit structure “helps make sure that [enrollees] don’t see those really larger drops that happen from time to time, sort of from those market forces.”

“When there are broader rate increases of … the total cost of the coverage, the tax credits are structured so that people who get a tax credit don’t feel a lot of that increase. They’re sort of sheltered from it on a year to year basis,” Trolley said. “The tax credit is tied to someone’s income and limits what they pay as part of their income, not necessarily tied to the cost of the coverage.”

She added that she’s also heard from some residents who say they are waiting to enroll in a plan to see if Congress takes action.

“People are leaving the ACA marketplace because the trade-offs have just become harder to justify,” Lukanen said. “What worries me is that when the coverage becomes unaffordable, it isn’t that people suddenly stop needing care. They just lose the protection that insurance offers, and those health care costs don’t go away.”

Lukanen added that if more people forgo coverage, health care services may end up costing the nation more overall.

“If people are going to the doctor and they don’t have insurance, these costs are then just shifted. They’re shifted to hospitals, ultimately to the community and the taxpayer.”

Trolley echoed that, saying she’s concerned about the overall burden on providers in rural counties, which are seeing the highest drops in Obamacare coverage in Pennsylvania.

“Any increase in the uninsured rate is going to further strain providers that are in rural areas, especially — further strain their financial situation,” she said. “We are very concerned about that in Pennsylvania.”

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

A young woman asks AI companion ChatGPT for help this month in New York City. States are pushing to prevent the use of artificially intelligent chatbots in mental health to try to protect vulnerable users. (Photo by Shalina Chatlani/Stateline)

Editor’s note: If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.

States are passing laws to prevent artificially intelligent chatbots, such as ChatGPT, from being able to offer mental health advice to young users, following a trend of people harming themselves after seeking therapy from the AI programs.

Chatbots might be able to offer resources, direct users to mental health practitioners or suggest coping strategies. But many mental health experts say that’s a fine line to walk, as vulnerable users in dire situations require care from a professional, someone who must adhere to laws and regulations around their practice.

“I have met some of the families who have really tragically lost their children following interactions that their kids had with chatbots that were designed, in some cases, to be extremely deceptive, if not manipulative, in encouraging kids to end their lives,” said Mitch Prinstein, senior science adviser at the American Psychological Association and an expert on technology and children’s mental health.

“So in such egregious situations, it’s clear that something’s not working right, and we need at least some guardrails to help in situations like that,” he said.

While chatbots have been around for decades, AI technology has become so sophisticated that users may feel like they’re talking to a human. The chatbots don’t have the capacity to offer true empathy or mental health advice like a licensed psychologist would, and they are by design agreeable — a potentially dangerous model for someone with suicidal ideations. Several young people have died by suicide following interactions with chatbots.

States have enacted a variety of laws to regulate the types of interactions chatbots can have with users. Illinois and Nevada have completely banned the use of AI for behavioral health. New York and Utah passed laws requiring chatbots to explicitly tell users that they are not human. New York’s law also directs chatbots to detect instances of potential self-harm and refer the user to crisis hotlines and other interventions.

More laws may be coming. California and Pennsylvania are among the states that might consider legislation to regulate AI therapy.

President Donald Trump has criticized state-by-state regulation of AI, saying it stymies innovation. In December, he signed an executive order that aims to support the United States’ “global AI dominance” by overriding state artificial intelligence laws and establishing a national framework.

Still, states are moving ahead. Before Trump’s executive order, Florida Republican Gov. Ron DeSantis last month proposed a “Citizen Bill of Rights For Artificial Intelligence” that, among many other things, would prohibit AI from being used for “licensed” therapy or mental health counseling and provide parental controls for minors who may be exposed to it.

“The rise of AI is the most significant economic and cultural shift occurring at the moment; denying the people the ability to channel these technologies in a productive way via self-government constitutes federal government overreach and lets technology companies run wild,” DeSantis wrote on social media platform X in November.

‘A false sense of intimacy’

At a U.S. Senate Judiciary Committee hearing last September, some parents shared their stories about their children’s deaths after ongoing interactions with an artificially intelligent chatbot.

Sewell Setzer III was 14 years old when he died by suicide in 2024 after becoming obsessed with a chatbot.

“Instead of preparing for high school milestones, Sewell spent his last months being manipulated and sexually groomed by chatbots designed by an AI company to seem human, to gain trust, and to keep children like him endlessly engaged by supplanting the actual human relationships in his life,” his mother, Megan Garcia, said during the hearing.

Another parent, Matthew Raine, testified about his son Adam, who died by suicide at age16 after talking for months with ChatGPT, a program owned by the company OpenAI.

“We’re convinced that Adam’s death was avoidable, and because we believe thousands of other teens who are using OpenAI could be in similar danger right now,” Raine said.

Prinstein, of the American Psychological Association, said that kids are especially vulnerable when it comes to AI chatbots.

“By agreeing with everything that kids say, it develops a false sense of intimacy and trust. That’s really concerning, because kids in particular are developing their brains. That approach is going to be unfairly attractive to kids in a way that may make them unable to use reason, judgment and restraints in the way that adults would likely use when interacting with a chatbot.”

The Federal Trade Commission in September launched an inquiry into seven companies making these AI-powered chatbots, questioning what efforts are in place to protect children.

​​“AI chatbots can effectively mimic human characteristics, emotions, and intentions, and generally are designed to communicate like a friend or confidant, which may prompt some users, especially children and teens, to trust and form relationships with chatbots,” the FTC said in its order.

Companies such as OpenAI have responded by saying that they are working with mental health experts to make their products safer and to limit chances of self-harm among its users.

“Working with mental health experts who have real-world clinical experience, we’ve taught the model to better recognize distress, de-escalate conversations, and guide people toward professional care when appropriate,” the company wrote in a statement last October.

Legislative efforts

With action at the federal level in limbo, efforts to regulate AI chatbots at the state level have had limited success.

Dr. John “Nick” Shumate, a psychiatrist at the Harvard University Beth Israel Deaconess Medical Center, and his colleagues reviewed legislation to regulate mental health-related artificial intelligence systems across all states between January 2022 and May 2025.

The review found 143 bills directly or indirectly related to AI and mental health regulation. As of May 2025, 11 states had enacted 20 laws that researchers found were meaningful, direct and explicit in the ways they attempted to regulate mental health interactions.

They concluded that legislative efforts tended to fall into four different buckets: professional oversight, harm prevention, patient autonomy and data governance.

“You saw safety laws for chatbots and companion AIs, especially around self-harm and suicide response,” Shumate said in an interview.

New York enacted one such law last year that requires AI chatbots to remind users every three hours that it is not a human. The law also requires the chatbot to detect the potential of self-harm.

“There’s no denying that in this country, we’re in a mental health crisis,” New York Democratic state Sen. Kristen Gonzalez, the law’s sponsor, said in an interview. “But the solution shouldn’t be to replace human support from licensed professionals with untrained AI chatbots that can leak sensitive information and can lead to broad outcomes.”

In Virginia, Democratic Del. Michelle Maldonado is preparing legislation for this year’s session that would put limits on what chatbots can communicate to users in a therapeutic setting.

“The federal level has been slow to pass things, slow to even create legislative language around things. So we have had no choice but to fill in that gap,” said Maldonado, a former technology lawyer.

She noted that states have passed privacy laws and restrictions on nonconsensual intimate images, licensing requirements and disclosure agreements.

New York Democratic state Sen. Andrew Gounardes, who sponsored a law regulating AI transparency, said he’s seen the growing influence of AI companies at the state level.

And that is concerning to him, he said, as states try to take on AI companies for issues ranging from mental health to misinformation and beyond.

“They are hiring former staffers to become public affairs officers. They are hiring lobbyists who know legislators to kind of get in with them. They’re hosting events, you know, by the Capitol, at political conferences, to try to build goodwill,” Gounardes said.​​

“These are the wealthiest, richest, biggest companies in the world,” he said. “And so we have to really not let up our guard for a moment against that type of concentrated power, money and influence.”

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

A trial over Missouri’s abortion regulations began Monday at the Jackson County Courthouse in Kansas City, Mo. Experts are watching the case, which could impact abortion access across the Midwest and South. (Photo by Kevin Hardy/Stateline)

KANSAS CITY, Mo. — The outcome of a trial over Missouri’s abortion regulations could ripple far beyond the state, potentially creating new availability for women in the Midwest and South who can’t access abortion close to home.

As a judge weighs the constitutionality of a litany of state restrictions on abortion, the stakes are clear for Missouri women: The decision could hamper access for nearly everyone in the state — or greatly broaden it in ways not seen in decades. That would allow women in a dozen nearby states with abortion bans to travel a shorter distance to access the procedure.

“Opening and reestablishing rights in the state of Missouri would help to alleviate some of the pressure that other states have since so many Southern states have banned abortion,” said Julie Burkhart, the co-owner of Hope Clinic in Granite City, Illinois. “It just seems logical that we would see a shift in migration patterns of patients in the country.”

At her clinic, about a 15-minute drive from downtown St. Louis, Missourians account for about half of all patients, Burkhart said. Though Missouri voters in 2024 enshrined a right to abortion in the state constitution, access has remained highly limited because of restrictive state laws. Only procedural abortions are available on a limited basis across three Planned Parenthood clinics in the state.

Many of those state laws face legal scrutiny this week as a Missouri judge weighs the constitutionality of regulations targeting abortion providers. Those include a 72-hour waiting period between initial appointments and procedures, mandatory pelvic exams for medication abortions and a ban on telemedicine appointments for medication abortions.

Planned Parenthood affiliates in Missouri argue state restrictions are unconstitutional under 2024’s voter-approved constitutional amendment. Over decades, state restrictions have gutted Missouri’s provider networks, limited appointment availability and ultimately forced abortions to a halt in 2022, before a limited number resumed after the 2024 vote.

Experts and advocates are closely monitoring the Missouri case, which is expected to be appealed regardless of the outcome, because of its practical implications on access in the region. While many women now rely on abortion medication, procedural abortion is still crucial for those seeking later-term abortions or who prefer an in-clinic procedure.

But the two-week bench trial in downtown Kansas City also tests lawmakers’ ability to put in place rules so restrictive that they effectively ban abortion — a practice used by anti-abortion lawmakers in other states looking to limit access to the procedure.

“Judges do not operate in a vacuum,” Burkhart said, “ … and we know for a fact that judges look outside the borders of their state for information and for guidance. I do see this as having national importance.”

That’s especially true in other states also litigating abortion access, including Arizona, Michigan and Ohio, said Rebecca Reingold, an associate director at Georgetown University’s O’Neill Institute for National and Global Health Law.

While state judges are not bound by the decisions of judges in other states, their deliberations can be informed by court rulings, particularly involving novel legal questions or areas of the law that are evolving.

“There is little doubt that advocates and decision-makers in other states navigating similar legal challenges are closely monitoring the litigation over Missouri’s abortion regulations,” Reingold said.

Restrictions targeting abortion

In the first days of the trial, Planned Parenthood leaders argued that ever-changing state laws and agency regulations have drastically limited access, caused needless red tape and posed privacy risk for their patients.

Dr. Margaret Baum, chief medical officer with St. Louis-based Planned Parenthood Great Rivers, said the Missouri requirements specifically target abortion rather than all other kinds of medical care.

“I provide vasectomies routinely. … And I am not required to have a complication plan, contact a primary care physician, even ask the patient how many miles they live from the health center.”

Opening day of Missouri abortion-rights trial focuses on decades of state restrictions

Baum said state-mandated reporting rules unique to abortion require clinicians to ask the race, education level, marital status and specific location of each patient — none of which is relevant to their care.

Planned Parenthood Great Rivers would like to offer abortion services in Springfield, Baum testified. Access in that region would provide an option for rural Missourians, and also could help serve residents in nearby Arkansas, Oklahoma and Texas, where abortion is almost universally banned.

But the organization’s facilities there do not meet state abortion regulations for physical attributes, including hallway size, doorway size and the number of recliners in recovery rooms, Baum testified.

Lawyers for the state defended Missouri’s restrictions as commonsense safeguards aimed at protecting vulnerable women. The attorney general’s office argued that complication risks of abortion justify additional state regulation — despite professional medical associations saying it’s generally safe. The AG’s office also maintained that Planned Parenthood faced a conflict of interest because of its financial motivations.

“Abortion is a business,” Deputy Solicitor General Peter Donohue said during a procedural argument on Monday. “Your Honor, the plaintiffs are asking to deregulate their profession in order to make more money.”

The state was expected to call as witnesses anti-abortion doctors and activists later in the trial.

Patients traveling for care

Since the U.S. Supreme Court’s ruling that overturned federal constitutional protections for abortion in June 2022, the number of abortions has increased slightly across the country, according to the health research nonprofit KFF.

The group points to expanded telehealth, which can offer medication abortion more affordably through virtual appointments.

Since the 2022 ruling and subsequent state abortion bans, patients have experienced higher travel costs for abortions and delays in care, according to research published in the American Journal of Public Health in July.

Researchers from the University of California, San Francisco found that travel time to access abortion increased from 2.8 hours to 11.3 hours for residents in states with abortion bans. Travel costs increased from $179 to $372. And more than half of survey respondents said their abortion care required an overnight hotel stay, compared with 5% before an abortion ban.

In 2024, an estimated 7,880 Missourians traveled to Illinois and 3,960 traveled to Kansas to access abortion, according to the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights.

Those Missourians were among the approximate 155,000 people who crossed state lines to access abortion care that year, representing 15% of all abortions provided in states without total bans.

Ongoing uncertainty

Regardless of its outcome, the Missouri case is expected to be appealed. Even if the plaintiffs are ultimately successful, it may take a long time to restore care networks across the state, said Isaac Maddow-Zimet, a data scientist at the Guttmacher Institute.

“And that’s particularly the case when there are states that have a lot of legal uncertainty or restrictions coming into effect and then coming out of effect,” he said. “It’s not quick to open up a clinic. It’s not quick to even necessarily expand the kinds of services, or the kinds of the number of people that a clinic can see.”

Kimya Forouzan, the organization’s principal state policy adviser, said Missouri’s landscape is evidence that lawmakers can drastically curb abortion access without total bans. And despite an overwhelming vote to amend the constitution, legal battles can follow.

Even if the state’s laws are found unconstitutional, Forouzan said, lawmakers will likely still push anti-abortion measures. She noted that several bills have already been introduced in this year’s just-convened legislative session, and that Republican lawmakers are pushing a ballot measure to repeal 2024’s reproductive rights amendment.

“There’s very much a push to pass as many restrictions as possible and kind of see what happens later and how things shape up later. … Time will tell, but we do know that they’re still pushing forth restrictions,” she said.

Stateline reporter Kevin Hardy can be reached at khardy@stateline.org. Missouri Independent reporter Anna Spoerre can be reached at aspoerre@missouriindependent.com.

President Donald Trump addresses the Detroit Economic Club at the MotorCity Casino on Jan. 13, 2025. (Photo by Ben Solis/Michigan Advance)

WASHINGTON — President Donald Trump outlined his health care proposals to Congress on Thursday, asking lawmakers to approve several broad policy changes “without delay” — but left out any mention of enhanced tax credits whose expiration has left some Americans with skyrocketing costs. 

Health care costs, especially the rising price of health insurance, have become a frequent talking point for politicians from both political parties following last year’s government shutdown, when Democrats repeatedly called on Republicans to extend the now-expired enhanced tax credits for Affordable Care Act marketplace plans. 

Trump reiterated in a five-minute video that he wants Congress to give Americans money directly so they can use it to offset the cost of health insurance or health care, a proposal that has so far been unable to get the traction needed to advance on Capitol Hill. 

Trump didn’t detail any income caps on the direct payments, which would likely be sent to Health Savings Accounts as opposed to a simple check. He also didn’t say how much per month or annually he wants lawmakers to provide Americans, leaving it for members of Congress to hash out. 

“The government is going to pay the money directly to you. It goes to you, and then you take the money and buy your own health care,” Trump said. “Nobody has ever heard of that before, and that’s the way it is. The big insurance companies lose and the people of our country win.”

The enhanced ACA marketplace tax credits, first implemented by Democrats during the coronavirus pandemic, expired at the end of 2025. The subsidies helped to keep premiums lower than they would have otherwise been for about 22 million Americans on those health insurance plans. 

The House voted earlier this month to keep the enhanced tax credits going for another three years, but the bill has stalled in the Senate as a bipartisan group of lawmakers tries to reach consensus on two more years of the subsidies with significant changes. 

Lower drug prices

Trump said in the video that Congress should approve legislation that requires prescription drug companies to ensure Americans pay the lowest price in the world for pharmaceuticals, a policy known as “most favored nation” that he has pursued during his second term. 

“So instead of Americans paying the highest drug prices in the world, which we have for decades, we will now be paying the lowest cost paid by any other nation,” he said. “So any other nation that’s paying the lowest cost, that’s what we’re going to pay. And the American people will get the savings.”

Trump said the legislative request, which he dubbed “The Great Health Care Plan,” would require health insurance companies and health care providers to publicly share easy-to-understand information about what they charge and how much they make in profit.  

“As the saying goes, sunlight is the best disinfectant. That is why my plan orders all insurance companies to publish rate and coverage comparisons in very plain English,” Trump said. “It requires insurers to publish detailed information about how much of your money they’re going to be paying out in claims versus how much they’re taking in in profits.” 

Health insurance companies, he said, would be required to detail how many claims they deny and whether those refusals to pay for health care were overturned on appeal. 

“And most importantly, it will require any hospital or insurer who accepts Medicare or Medicaid to prominently post all prices at their place of business so that you are never surprised and you can easily shop for a better deal or better care,” Trump said, though a 2019 rule created a similar requirement. “We will have maximum price transparency and costs will come down incredibly.”

Path through Congress

A one-page outline of the proposal posted to the White House website doesn’t detail whether Trump wants Congress to approve the policy requests through the complex budget reconciliation process that Republicans used to approve the “big, beautiful” law this summer or to negotiate a bipartisan bill with Democrats. 

A White House official, speaking on background on a call with reporters to detail the plan and the next steps, said the administration believes the “proposals all have broad support from the American people.”

“We expect both Republicans and Democrats to be able to embrace them, so reconciliation would not be necessary,” the official said.

The framework is intended to provide “broad direction” to lawmakers, leaving negotiators the ability to take any bill they may write in different directions, the official said, adding the administration is “open to working” with Congress on the details. 

“We want to make progress,” the official said. “We’re not laying out a specific path.”

The official said the president leaving out any mention of the expired enhanced tax credits for people who purchase their health insurance from the Affordable Care Act marketplace was not intended to cut off ongoing bipartisan talks in the Senate. 

“This does not specifically address those bipartisan congressional negotiations that are going on,” the official said. “It does say that we have a preference that money goes to people, as opposed to insurance companies.”

Engaging drugmakers

Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said on the same call with reporters that the framework focused on “four pillars” the administration believes must be codified into law — solidifying most favored nation drug pricing, lowering health insurance costs, transparency from health insurance companies and more pricing information from health care providers. 

“Although we’re taking major action at CMS, including fines and the like, having Congress say, ‘This is how it’s going to be, this is a law of the land’ is important,” Oz said, adding that he really does believe there can be bipartisan support for at least some of the proposals. 

Oz said the administration’s approach to bring down the cost of prescription drugs to the lowest level offered anywhere in the world is not intended to impede innovation and reiterated that lawmaking is crucial for longer-term stability. 

“We believe by codifying it, we’ll make sure that the drug companies stay engaged for future administrations,” Oz said. “We also believe that by doing it correctly, we’ll not overreach and create challenges to life-saving drugs being continually evolved and developed in the United States.”

The Trump administration, he said, wants Congress to give the Food and Drug Administration more leeway to convert prescription medications to over-the-counter availability, possibly increasing competition and decreasing prices. 

Oz said the price transparency portion of the request would help Americans to have more information about how long it takes to get routine appointments and whether health insurance companies are able to keep their rates down by frequently denying claims.

(Darwin Brandis | iStock Getty Images Plus)

UPDATE 1/15/26: The Trump Administration has reportedly reversed up to $2 billion in cuts to grants that fund addiction treatment, after sending termination letters to programs across the country on Tuesday night. 

Nonprofits that address housing, addiction, mental health and other human service needs were notified this week that they will lose up to $2 billion in federal grant money, in a wave of termination letters issued to programs across the country. 

The cuts will make it more difficult for frontline groups to provide treatment and harm reduction care that has been crucial to combating overdose deaths, and breaking the cycles of addiction and housing insecurity. Resources like Narcan medication used to save lives by reversing overdoses, peer support, and treatment access could dry up, just as communities nationwide began to see reductions in overdose deaths.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), which issued the letters, hasn’t yet commented on the cuts. There are 30 SAMHSA-funded opioid treatment programs scattered across Wisconsin including in Appleton; Beloit, Eau Claire, Fond Du Lac, Green Bay, Madison, Milwaukee, Oshkosh, Kenosha, and others, according to the agency’s website. One of those programs, Vin Baker Recovery, is named after a Milwaukee Bucks basketball team player and assistant coach.

Milwaukee County Executive David Crowley condemned the sudden funding cuts. “The Trump administration’s cuts are not just numbers on a budget sheet; they are threats to the wellbeing of real people — our neighbors, our families, and our loved ones,” Crowley said in a statement. “While I will continue fighting for funding and resources to deliver results for our most vulnerable communities, the federal government must recognize the urgent need to preserve these vital services. These cuts cannot stand, because the lives of Wisconsinites depend on it.” 

A Milwaukee County Department of Health and Human Services (DHHS) spokesperson said that so far, no termination letters have been sent to the county. DHHS received $13.9 million in direct SAMHSA funds, with $6.2 million remaining as of December. The county also receives another $15.3 million in state mental health and substance use disorder grants which  partially consist of federal funding through SAMHSA.

In an emailed statement the spokesperson said that “any termination of SAMHSA funding would result in immediate termination of mental health and substance use services in Milwaukee County.” Wisconsin’s most populous county has no other funding alternatives, and the loss of federal grant money would lead to more hospitalizations and higher incarceration rates, the spokesperson warned.

Elizabeth Goodsitt, a spokesperson for Wisconsin’s Department of Health Services (DHS) wrote in an email statement Wednesday that the department was “notified late yesterday that effective January 13, the Tribes of Wisconsin Prescription Drugs/Opioid Overdose-Related Deaths Prevention Program (PDO) grant has been terminated by the federal government.” Goodsitt described this as “part of a much larger set of cancellations across the country for federally funded projects that provided life-saving mental health and substance use disorder services.” 

Wisconsin had received nearly $1 million to operate the PDO until August 2026. The program was in the third year of a five-year grant. “The goal of the PDO is to save lives,” said Goodsitt. “The funding supports training first responders and other key community sectors on overdose prevention strategies, and it supports the purchase and distribution of naloxone, the overdose reversal medication for opioids.” 

For now the Bad River Band of Lake Superior Chippewa, the Lac Courte Oreilles Band of Lake Superior Chippewa, Menominee Indian Tribe of Wisconsin and the University of Wisconsin Board of Regents have not received termination letters regarding SAMHSA funding. Native American communities are disproportionately affected by overdose deaths in Wisconsin at a rate of 75.4 people per 100,000 in 2023, as compared to a rate of 20 people per 100,000 for white Wisconsin residents. 

“We are assessing all avenues possible to ensure the federal government is following all requirements in these existing funding agreemets,” said Goodsitt. “While there continues to be much uncertainty about this evolving situation, we will keep working to serve Wisconsinites and support their behavioral health needs. We will continue to closely monitor this situation and will share more information as it becomes available.” 

This story was updated Thursday morning to reflect the Trump Administration’s decision to reverse the grant cuts. 

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Planned Parenthood and other providers got word in March that millions they anticipated in Title X funding would be withheld. The money was eventually released last year, though some providers say damage was still done. (Getty Images)

Planned Parenthood clinics in Utah resumed family planning services after the Trump administration unfroze millions in federal funds.

The American Civil Liberties Union on Tuesday submitted a brief to dismiss a lawsuit filed on behalf of the National Family Planning and Reproductive Health Association after the federal government notified nine Planned Parenthood affiliates and other family planning providers in March it would withhold annual Title X funding. 

Shireen Ghorbani, president and CEO of Planned Parenthood Association of Utah, said in a statement Monday that the restored funding does not erase all of the damage caused by nine months without it. Title X funds are meant to provide affordable family planning services, such as birth control, cancer screening, and STI tests and treatment. 

Ghorbani noted that the Utah affiliate has been the only Title X grant recipient in the state since 1985. 

“We are thrilled that Title X funding is restored to Utah for now, allowing more Utahns to get critical family planning services,” Ghorbani said. “But we cannot ignore the fact that too many Utahns have already felt the devastating effects of the Trump administration’s unwarranted decision to withhold this funding for the last nine months. Many of the 26,000 Utahns who rely on the program were forced to pay more for their health care or go without care altogether.”

Crucially, she said, the affiliate closed two health centers, in St. George and Logan, among dozens that have closed because of the withheld Title X funding and are unlikely to reopen, according to Planned Parenthood. 

Some grantees had their funding restored over the summer, Politico reported, while others remained under investigation for possibly violating the Trump administration’s new rules around so-called diversity, equity and inclusion practices until December. That’s when the U.S. Department of Health and Human Services informed Planned Parenthood affiliates that they would receive their promised funds dating back to last April, with no explanation beyond unspecified “clarifications made by, and actions taken by, the grantees.” 

Planned Parenthood’s Utah affiliate said that on Jan. 9 it received $2 million in Title X funding for the current grant year that had been withheld since April.

In the lawsuit over the Title X funding, plaintiffs argued that the federal government withholding 22 federal Title X grants from Planned Parenthood and other family planning organizations was illegal and unjustified. 

“Our lawsuit succeeded in holding the administration accountable for its unlawful acts, and today, NFPRHA members’ grants have been restored. We are relieved all of our members now have access to their promised funds, but we know the fight for contraceptive access in this country goes on,” said Clare Coleman, president & CEO of the National Family Planning and Reproductive Health Association, in a statement Tuesday. 

She estimated that 865 family planning service sites were unable to provide Title X-funded services to an estimated 842,000 patients across nearly two dozen states.

While some states have fought to restore Title X family planning funding, Idaho last year declined its annual $1.5 million federal Title X funding, leaving patients statewide without free and low-cost contraception and reproductive health care services.

At least 20 more Planned Parenthood clinics have also closed because of last year’s budget reconciliation bill, which effectively blocked Planned Parenthood and other nonprofit reproductive health care providers from being able to participate in Medicaid, reducing low-income health care options throughout the country. Litigation remains ongoing in several cases over that Medicaid rule.

A screenshot of the HealthCare.gov marketplace. Enrollment for 2026 fell in Wisconsin and nationwide as premium costs rose and enhanced subsidies ended at the end of 2025.

With premium costs sharply increased and enhanced subsidies to reduce them no longer available, the number of people signing up for health care in the federal marketplace is behind last year by more than 5%, according to a preliminary report.

The federal Centers for Medicare & Medicaid, which manages the HealthCare.gov enrollment, reported this week that Wisconsin enrollment fell by more than 17,000 below 2025’s record enrollment, which topped 310,000. As of Jan. 3, 289,213 Wisconsin residents had enrolled in plans for 2026.

HealthCare.gov is the marketplace created as part of the Affordable Care Act. It is a platform for people to purchase health insurance who aren’t covered by an employer or by some other health plan, such as Medicare or Medicaid.

Nationwide, enrollment for 2026 is 22.77 million, CMS reported — a decline of about 1.5 million from 2025.

The loss of enhanced premium tax credits, which cut the cost of health insurance purchased at HealthCare.gov, has been predicted to lead many to drop out of the marketplace. The enhanced subsidies expired at the end of 2025. Smaller subsidies remain in place, but premiums have also risen in cost, for several reasons.

According to insurance analysts, one factor in that increase was that insurance companies expected the higher prices to drive some people out of the marketplace — particularly those with fewer health concerns who are willing to take the chance that they won’t need coverage.

The remaining population is expected to have more serious health needs, making their care more expensive but also raising the cost for insuring the entire remaining pool of customers.

The U.S. House has passed a bill that would extend the enhanced subsidies another three years. Its future in the U.S. Senate isn’t clear.

Open enrollment through HealthCare.gov is still available until Thursday, Jan. 15, with coverage starting Feb. 1. For consumers who enrolled by Dec. 15, 2025, coverage began Jan. 1.

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Two Wisconsin hospital systems have paused gender-affirming medication and hormone care for minors. (Getty Creative)

Two Wisconsin hospital systems have paused providing gender-affirming health care for minors, according to a published report, prompting state lawmakers to urge them to reconsider.

“Wisconsin values include fairness, compassion and looking out for one another,” said state Sen. Melissa Ratcliff (D-Cottage Grove) and state Reps. Ryan Clancy (D-Milwaukee), Margaret Arney (D-Wauwatosa) and Lee Snodgrass (D-Appleton) in a joint statement Monday afternoon.

“This decision moves us away from those values by placing additional burdens on families who are already navigating complex medical health needs. Parents should be able to make informed decisions in consultation with qualified health care providers without political interference or fear,” the lawmakers said.  

The statement was issued under the umbrella of the Legislature’s Transgender Parent and Nonbinary Advocacy Caucus.

The group responded to reporting Monday in the Milwaukee Journal Sentinel that Children’s Wisconsin, a children’s hospital and health system in suburban Milwaukee, and UW Health, in Madison had both paused prescribing gender-affirming medication such as puberty blockers and hormones for minors.

The news story initially attributed word of the changes to anonymous sources. Representatives of both hospital systems subsequently confirmed the facilities had taken action to stop providing care, except in the area of behavioral health.

On Dec. 18, the U.S. Health and Human Services Department announced that the federal government would stop all Medicaid and Medicare payments to hospitals and clinics that provide gender-affirming care for patients under the age of 18.

“At Children’s Wisconsin, we strongly believe everyone, including LGBTQ+ kids, should be treated with the support, respect, dignity and compassion they deserve,” a Children’s spokesperson told the Journal Sentinel. “We are communicating to patients that due to escalating legal and federal regulatory risk facing systems and providers across the nation, we are currently unable to provide gender affirming pharmacologic care.” Children’s Wisconsin will continue mental health and behavioral health services, the spokesperson said.

A UW Health spokesperson told the newspaper in a statement that the system “is committed to providing high-quality, compassionate and patient-centered care to our patients and families, including LGBTQ+ patients.”

The statement acknowledged that because of federal actions, “UW Health is pausing prescribing puberty blockers and hormone therapy as part of gender-affirming care for patients under 18 years of age.”

The lawmakers’ caucus statement, which did not name the medical systems, said that halting care could harm the mental health of young people receiving that care.

“Removing access to this care increases the risk of anxiety, depression, and suicidal thoughts among young people who already are facing disproportionate mental health challenges,” the caucus statement said. It urged the health systems “to reconsider their decision.”

Abigail Swetz, executive director of the LGBTQ+ advocacy organization Fair Wisconsin, said in a statement that the Trump administration has been engaged in “disgusting” attacks on trans people since before taking office.

In pausing care the hospital systems made “an awful decision, and I believe it is the wrong decision — it’s a decision that is putting young patients, their families, and even their own providers in a very tough place,” Swetz said. “And at the same time, these clinics should never have been bullied by this federal administration into making any kind of decision in the first place, especially one that reduces access to this life-affirming care.”

Swetz said Fair Wisconsin was organizing public comment opposing the federal proposed rule and urged Wisconsinites to join the effort.

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House Minority Leader Hakeem Jeffries, D-N.Y., speaks as U.S. Senate Minority Leader Chuck Schumer, D-N.Y., looks on during a news conference at the U.S. Capitol on Jan. 8, 2026 in Washington, D.C. Schumer and Jeffries spoke to reporters on topics including upcoming floor legislation extending health insurance subsidies. (Photo by Kevin Dietsch/Getty Images)

WASHINGTON — The U.S. House approved a bipartisan bill Thursday to resurrect the enhanced tax credits that expired at the end of last year for people who purchase their health insurance from the Affordable Care Act marketplace.

The 230-196 vote sends the legislation to the Senate, where Republican leadership is unlikely to put it on the floor without considerable changes, which a bipartisan group of senators appears close to finalizing. Seventeen Republicans voted with every Democrat to pass the bill. 

House GOP leaders didn’t want to bring the bill up in their chamber, but a handful of their own members signed a discharge petition in December, forcing the vote amid rising health care costs. 

Massachusetts Democratic Rep. Jim McGovern said during floor debate on Wednesday evening “it’s about damn time” the chamber took up a bill to address the now-expired tax credits, arguing lawmakers have a “moral obligation to act” to help people afford health insurance.

“This Congress musters up the will to spend trillions of dollars on tax breaks for billionaires and to send the Pentagon billions of dollars more than they even asked for. And the administration came up with tens of billions of dollars to bail out Argentina, for God’s sake,” McGovern said. “But somehow helping moms and dads, grandparents and kids afford trips to the doctor is a step too far for this Republican leadership.”

New York GOP Rep. Mike Lawler said he only backed the bill after Republican leaders declined to bring up a bipartisan two-year compromise bill he helped negotiate last year. 

“I am voting in favor of this discharge and of this legislation to send it to the Senate so that the Senate will have the opportunity to put forth a reform package that can pass Congress and become law,” Lawler said. 

Republicans and Democrats, he said, agree that the country’s health care system is in need of a serious overhaul. He called on his colleagues to find solutions to the bigger, more structural issues. 

“Enough of the blame game on both sides,” Lawler said. “Let’s focus on actually delivering affordable health care for Americans.”

Prolonged fight over ACA tax credits 

Democrats originally established the enhanced ACA marketplace tax credits during the coronavirus pandemic in an attempt to get more people health insurance coverage. They set the subsidies to expire at the end of 2025.

The debate over the sunset date simmered in the background for much of last year but surged to the forefront in October after Democrats shut down the government and repeatedly demanded GOP leaders negotiate an extension to the expiring enhanced tax credits.

The shutdown ended in mid-November after Senate Majority Leader John Thune, R-S.D., agreed to give Democrats a vote on a health care bill of their choosing in December. 

Senate Minority Leader Chuck Schumer, D-N.Y., ultimately decided to bring up a three-year extension of the enhanced tax credits without any changes, but it failed to get the 60 votes needed to advance.

A proposal from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo, both Republicans, that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027 also failed to move toward final passage. 

A House Republican health care bill passed that chamber last month, but doesn’t have the bipartisan support to move through the Senate and become law. 

Senate problems

Thune said Tuesday any renewal of the enhanced ACA marketplace subsidies would need reforms to move through that chamber.

The bill, he said, would need to set income limits on who qualifies for the enhanced tax credit and eliminate ACA health insurance plans that have $0 premiums, a feature Republicans allege allowed insurance companies to enroll people without their knowledge to receive the subsidy. 

“And then the second component would be some sort of a bridge to (Health Savings Accounts). An expansion of HSAs so that you’re getting more money into the pockets of the American people, the patients, if you will, the consumers, as opposed to insurance companies,” Thune said. “And then finally you’ve got to deal with the Hyde issue.”

The Hyde Amendment has been a feature of government spending bills for decades, preventing federal dollars from going to abortions unless the pregnancy is the result of rape, or incest, or threatens the woman’s life. 

Republicans want the prohibition to apply to all ACA marketplace health insurance plans without any way for Americans to pay for the coverage themselves, the way they do now. Democrats have rejected the change as a non-starter that would restrict abortion access in blue states. 

‘Be a little flexible on Hyde,’ says Trump

President Donald Trump waded into that debate this week, telling House Republicans during a policy retreat at the Kennedy Center they must be “flexible” about the Hyde Amendment in order to broker a health care deal that can reach his desk. 

“You have to be a little flexible on Hyde. You know that. You’ve got to be a little flexible,” Trump said. “You’ve got to work something. You’ve got to use ingenuity. You’ve got to work. We’re all big fans of everything, but you’ve got to have flexibility.”

Susan B. Anthony Pro-Life America President Marjorie Dannenfelser rebuked Trump for the comment, writing in a statement that to “suggest Republicans should be ‘flexible’ is an abandonment of this decades-long commitment. If Republicans abandon Hyde, they are sure to lose this November.”

States have a patchwork of laws addressing abortion coverage in ACA  marketplace health insurance plans, with 25 prohibiting coverage with certain exceptions and 12 requiring abortion coverage, according to analysis from the nonpartisan health research organization KFF.

“In states that do not bar coverage of abortions on plans available through the Marketplace, insurers may offer a plan that covers abortions beyond the permissible Hyde amendment situations when the pregnancy is a result of rape, or incest or the pregnant person’s life is endangered, but this coverage cannot be paid with federal dollars.”

Any ACA marketplace health insurance plan that offers abortion coverage in circumstances outside those three exceptions must charge each enrollee $1 for that coverage, according to KFF.

Behind the scenes in the Senate

A bipartisan group of senators has been talking behind the scenes for months about how to extend the ACA marketplace subsidies with changes. 

Ohio Republican Sen. Bernie Moreno said Thursday he expects the group, which has agreed on a “framework,” to release a bill next week, though he cautioned that’s just one small step. 

“We have agreement that we think we have a skeleton of a deal. But it’s all fun and games until you have it on paper in a bill form,” Moreno said. “So we have to do that. And then we have to go sell the heck out of it to our conference. And again, look, this is politics. There’s people on both sides that want this to fail. So we have to get past that massive mountain.”

Moreno said the tentative plan is to revive the enhanced ACA marketplace tax credit for another two years with modifications.

The bill would also: 

• Extend open enrollment for this year until March 1.
• Cap the enhanced subsidy for people making under 700% of the federal poverty level, or about $109,550 in annual income for one person, according to the guidelines for 2025.
• Require people eligible for the enhanced tax credit to pay at least $5 per month or $60 per year for their health insurance to ensure the enrollee knows about their coverage.
• Fine insurance companies $1,000 for “deliberately causing fraud, meaning signing someone up without their consent.”

ACA marketplace enrollees eligible for the enhanced tax credit would have a choice in 2027 to either keep the lower premium that stems from the health insurance company receiving the subsidy, or move to a Health Savings Account where they would receive the money from the government. 

“The final piece, which I think is the biggest sweetener to the whole deal, is putting back in place cost-sharing reduction payments, which, according to (the Congressional Budget Office), reduce premiums for everybody in the exchange by 11% and save the federal government money,” Moreno said, later clarifying that would happen in 2027.  

There is not yet a final proposal regarding how ACA marketplace plans handle abortion coverage in states where it’s allowed, he said. 

The handshake agreement, Moreno said, is intended to give Congress time to overhaul the bigger issues facing the country’s health insurance and health care systems in a way that reduces costs.

Gang of negotiators

Moreno said the core group of negotiators, which he nicknamed the EPTCOG gang on his text chain, includes six Democrats and five of his Republican Senate colleagues. There are 24 senators total in the “extended OG” gang. 

Moreno believes one of his advantages in the negotiations is that he hasn’t been around the Senate that long, having just been elected in 2024. He said senators are also handling the details themselves, instead of deferring much of the work to staff. 

“This has been principals only. We don’t even allow staff in meetings,” Moreno said. “And the idea is if we can’t work it out, there’s really no point in tasking this with staff.”

New Hampshire Democratic Sen. Jeanne Shaheen, one of the negotiators, said Wednesday she wasn’t aware of a deadline for the negotiators to release a bill. She also brushed aside the possibility of changes to how the ACA handles abortion coverage. 

“There is no need to come to a compromise because it’s already been dealt with in the Affordable Care Act,” Shaheen said. “There is very specific language on how it is dealt with. And I think that applies to whatever happens with the Affordable Care Act.”

Shaheen said Thursday the House vote “provides momentum” for Senate negotiators.

A nurse gives a vaccine to a child. (Getty Images)

State health officials won’t change their recommendations for childhood vaccines, endorsing the guidance of the American Academy of Pediatrics, the Wisconsin Department of Health Services announced Thursday.

The announcement comes three days after the federal Centers for Disease Control and Prevention on Monday scaled back its list of recommended childhood vaccines — reducing the number of diseases for which vaccines are recommended for all children from 17 to 11.

The scaled-down recommendation has alarmed public health organizations and providers across the country.

“No new clinical data on either safety or effectiveness were presented that would justify these changes,” wrote Dr. Ryan Westergaard, the DHS chief medical officer and state epidemiologist for communicable disease, in a memo sent Thursday to providers and organizations that offer vaccination services in Wisconsin.

In place of the revised CDC recommendation, DHS is recommending that health providers refer to the immunization schedule published by the American Academy of Pediatrics “as the standard of care when they provide care to children and adolescents,” Westergaard said Thursday afternoon. 

“We update recommendations when new, high-quality evidence shows that a change would improve safety or effectiveness,” he told reporters at a media briefing. “We’ve not seen any new evidence that would justify changing long-standing recommendations that have successfully protected children in the United States for decades.”

In the CDC’s new list, some vaccines formerly recommended for all children were reclassified as primarily for “certain high risk groups,” Westergaard said. Other vaccines were assigned a category to be considered “only after an individualized risk assessment.”

After reviewing those changes, however, DHS concluded there was no reason to change Wisconsin’s childhood vaccination recommendations.

“In the past 48 hours, multiple state health departments and leading health and medical organizations have independently reached the same conclusion and issued similar public statements,” Westergaard said. 

The immunization schedules by themselves don’t create legal requirements or mandates. But they have historically been based on “rigorous, transparent processes to evaluate vaccine safety, effectiveness,” he said. “Parents and health care professionals deserve information that’s accurate, credible and consistent.”

Public health professionals have been concerned about declining vaccination rates in Wisconsin, including among children, in recent years. “They’re not as high as we wish they were,” Westergaard said. While most parents do get their children fully vaccinated, “we want that to be as close to 100% as we can.”

But he said he hopes the federal changes will not deter families from getting their children vaccinated. Since the CDC announcement, state and local health departments along with health professionals’ organizations “are speaking with one voice” on the importance of vaccine schedules and the evidence to support them “as the best ways to keep our children healthy,” he said.

Although the CDC has stopped requiring states to report vaccination rates, he said DHS will continue to track that information.

Comparing other countries

The CDC’s revisions followed a directive in December from President Donald Trump to look to other developed countries, including Denmark, in revising the U.S. vaccine schedule. Federal officials said the change was based on that review and called the U.S. a “global outlier” for the number of diseases and vaccine doses in its recommendations.  

“Copying another country’s schedule without its health and social infrastructure will not produce the same health outcomes,”  DHS Secretary Kirsten Johnson said in a statement Thursday. “It creates chaos and confusion and risks the health of Wisconsin’s youngest and most vulnerable citizens.”

While some other countries have fewer routinely recommended vaccines on their schedules, Westergaard said those comparisons ignored other important factors. 

Denmark, for instance, has a smaller and less diverse population, with disease risks that are different from the U.S., and with “a health system that has universal access and very strong primary care continuity,” he said.

“Vaccine schedules are designed around local disease epidemiology and health system capacity,” Westergaard said. “So what works well in Denmark does not automatically translate to a large, diverse country like the United States, which faces different risks, different barriers to other types of preventive care. That’s why US vaccine recommendations should be based on U.S. data and U.S. public health realities.”

Until now, the CDC’s vaccine advisors “have focused on those on-the-ground public health realities, equity concerns, economic concerns in the United States,” he added. “That lens was not used by the federal government” when making its latest changes.

Overcoming confusion

He suggested that parents who may be confused by the new differences between CDC recommendations and those being made by Wisconsin health officials should talk to their personal physicians. 

“We want to communicate to Wisconsin families and communities that the science hasn’t changed and our recommendations haven’t changed,” Westergaard said. The department is also sending the message to the medical community that the state and local health departments along with other health care leaders all agree on maintaining the past recommendations. 

He suggested that the CDC decision to reclassify some diseases that were previously targeted for universal vaccination as better left to  “shared decision-making” on the part of providers and patients is problematic.

“I am very pro-shared clinical decision-making,” said Westergaard, calling informed consent an “ironclad ethical principle” in medical care. 

A universal vaccine schedule doesn’t take that away, he said. But in the past, the CDC and its vaccine advisory panel has distilled a deep reservoir of scientific literature to identify vaccines for which the evidence is especially strong, making them appropriate for virtually the entire population with only limited exceptions. 

In those evaluations, “shared clinical decision-making has been a flag to say, ‘Well, the evidence might not be quite as strong,’” Westergaard said — warranting individual doctor-patient discussions.

For a vaccine that has already passed muster as widely beneficial, the universal recommendation “can save us a lot of time rather than for individual clinicians to look at data, to look up articles, look up reviews for individual vaccines,” he said. 

The science behind the schedule before the CDC made its changes this week “hasn’t changed at all,” Westergaard said, and the AAP’s schedule reflects the longstanding consensus process. 

“That’s the type of thoroughness that is absent from the memo that the federal government released this week that we wanted to draw attention to, and why we shouldn’t change practice based on that — because it hasn’t used that same consensus-building process,” Westergaard said.

DHS administers Wisconsin’s Medicaid programs and said the health insurance program for people with low incomes will cover all the recommended vaccines, including for newborns. They will also remain covered under the Vaccines for Children program.

The Office of the Commissioner of Insurance issued a reminder Thursday that state law requires individual, small group and self-funded health plans to cover immunizations for patients and their dependents from birth without a copayment.

• To check on a child’s vaccine status and recommended vaccines see the  Wisconsin Immunization Registry.
• For clinicians, refer to the DHS Recommended Vaccination Schedule for Wisconsinites.

This report was updated following a DHS media briefing on its announcement Thursday. 

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DOC Secretary Jared Hoy (Isiah Holmes/Wisconsin Examiner)

Jared Hoy, Secretary of the Department of Corrections (DOC), appeared before the Assembly Committee on Corrections Wednesday morning to discuss a third-party study of DOC facilities, policies and practices. “The report clearly shows our agency and our staff are working hard getting a lot right, but as expected we also learned of several areas we need to make improvements on,” said Hoy, calling the report conducted by Falcon Correctional and Community Services Inc. “a critical and necessary step forward” after he succeeded former Secretary Kevin Carr in 2024. 

Hoy said that the Falcon Report focused on behavioral health, correctional practices, health care, employee wellness, leadership development, agency culture, recruitment of staff and problems in the restrictive housing unit, otherwise known as solitary confinement. The review lasted nearly a year, and highlighted a number of positive changes within DOC that Hoy listed, including: 

• Developing an objective custody classification system in 2023;
• Restructuring the Bureau of Health Services in 2024,
• Expanding the earned release program,
• Transitioning the Waupun Correctional Institution to having all single cells,
• Reforming restrictive housing in 2024 by enhancing training and increasing security rounds, 
• Implementing new systems to track the number and frequency of security rounds, 
• Retraining medication distribution and documentation, 
• Performing security audits,
• Requiring supervisory meetings at Waupun at the beginning of each shift,
• Implementing a new restrictive housing policy. 

It wasn’t an entirely rosy picture, however. “As noted in the report, our agency is at a period of transition,” said Hoy. “We are not alone in navigating this unique point in time following the operational disruptions of the pandemic and the related staffing shortages that followed.” 

Hoy urged people to view the report in that context as he went into the areas of improvement it suggested. High vacancy rates for staff at different institutions remains an issue, although the DOC has been able to fill more security positions due to pay raises approved by the state Legislature. This has created a “new and unique concern,” Hoy said, in that many staff are new and do not have much correctional experience. Additionally, many staff members were hired during the COVID-19 pandemic, and thus have skewed perceptions of what normal DOC procedures look like. The highly restrictive, atypical protocols intended to stifle the spread of COVID-19 became the formative experience of this new generation of DOC guards and staff. 

Mental health needs among DOC residents was another area of concern. Hoy noted that “44% of male persons in our care and 91% of female persons in our care have a mental health condition.” As a result of the study, DOC is working towards updating its mental health classification system, creating specific mental health units, better monitoring and collecting mental health data, and improving conditions within the restrictive housing unit, otherwise known as solitary confinement, and increasing programming and recreation. 

“So while the results of this study are both informative and valuable, they represent only the starting point,” said Hoy. “The true measure of our agency’s success will be determined by how thoughtfully and effectively we act upon the recommendations that follow.” DOC is currently planning another contract with Falcon to develop a framework to review the report’s key findings, and implement its recommendations. Although many of the changes will need to cover the entire DOC, Hoy said the state agency will also look at specific institutions to “reimagine” their functions, and begin implementing changes at five “pilot sites” before expanding to other facilities. 

Hoy took questions from corrections committee members. Public comment in response to the secretary’s presentation was not allowed. Lawmakers pointed out that the DOC remains overcrowded, with over 23,000 people spread across various prisons. Some highlighted the need for more uniformity among DOC policies across facilities, as well as a need for increased and centralized data analysis. 

Hoy acknowledged that there are ongoing problems with placing people in appropriate facilities, such as people who should be in minimum or medium-security prisons being placed in maximum security institutions, or people with severe mental health needs not being cared for adequately. He also noted that because DOC is generally a paramilitary organization, staff are often “craving” direction and vision from their leadership. Hoy said that there is more work to be done to change the culture among DOC staff, emphasizing that “we need to treat everybody with dignity and respect, to treat people as human beings, and see that person no matter whether they have a cap and gown and they’re graduating and ready to walk out the door, or if they’re sitting at rock bottom in restrictive housing, that they are still a human being.”

Hygiene and feminine product access in prison

The Corrections Committee also heard testimony on three bills which were open to public comment. One Republican bill (AB 297) would provide pay bonuses to DOC probation and parole officers based on their ability to increase employment rates among their clients under supervision. Rep. Benjamin Franklin (R – De Pere), the bill’s author and a member of the corrections committee, said the bill would help reduce the recidivism rate. Franklin was questioned by fellow lawmakers about whether the bill would adversely affect people who have small children at home, or who need to prioritize substance abuse treatment and mental health care over finding immediate employment. 

There were also questions about how probation and parole officers might abuse the incentive structure such as by creating revolving doors where clients get and lose jobs, only to be hired somewhere else, earning another bonus for their probation agent. 

The bill was backed by Cicero Action, a policy advocacy group whose board of directors is chaired by Joe Lonsdale, a billionaire co-founder of the data and surveillance company Palentir. Lonsdale has called for the use of public hangings to demonstrate “masculine leadership.”

Members of the public who attended the hearing, including members of the criminal justice reform advocacy groups Dream.org, Ladies of SCI, Ex-Incarcerated People Organizing, and others testified that people on probation and parole already have lives dictated by the whims of their agents. One woman gave an example of a formerly incarcerated loved one who had to take time out of their day for a three hour bus ride to check in with a probation agent for just a few minutes. Others shared firsthand experiences of being placed in unfulfilling jobs for which they were ill suited by their probation agents, or being discouraged from applying for certain kinds of work. 

Two Democratic bills (AB 736 and AB 741) focused on increasing hygiene products across DOC facilities and expanding access to menstrual products for incarcerated women. Reps. Shelia Stubbs (D-Madison), Robyn Vining (D-Wauwatosa) and Sen. LaTonya Johnson (D-Milwaukee) presented the bills to the committee. 

Stubbs said that “good hygiene is both a matter of health and dignity, especially for those incarcerated.” AB 741 would require the DOC to provide culturally sensitive products ranging from shampoos to shaving cream, bar soap, natural conditioners, and other products through the commissary at no more than 125% of the price at the highest-grossing retail chain in Wisconsin, or no more than 100% of the sales price, depending on the product. Incarcerated people would also be given a $25 monthly stipend to help purchase hygiene products. The bill would also require sheriffs overseeing jails to provide a stipend and products to people held within jails. 

During testimony, some formerly incarcerated people  shared experiences of witnessing fellow incarcerated people fight because of bad hygiene. Family members of incarcerated people said that the costs to purchase commissary items, make phone calls and other expenses amount to unsustainable drains on their household budgets. 

AB 736 would expand access to safe and appropriate menstrual products to incarcerated women. Although some prisons and jails take it upon themselves to provide such products to their residents, not all of them do so consistently nor do they provide a range of appropriate products. In some cases, women can bleed through their clothing in prisons and jails, creating embarrassing and awkward situations in which correctional staff may or may not be sympathetic to their needs. 

“In this way, menstruation becomes a monthly cycle of humiliation solely borne by women simply because they are women,” said Johnson. “And that’s not fair.” Johnson called providing menstrual products to incarcerated women “a minimum standard of care in more than two dozen states,” adding that the federal prison system guarantees women access to tampons and pads in correctional facilities. “States that have implemented these policies report minimal cost and improved conditions including fewer medical complications, fewer grievances, and safer, more sanitized facility environments.”

Lawmakers, as well as members of the public, pushed the committee to consider providing menstruation cups as well as more common products like tampons, and to evaluate whether products are safe or if they come with a risk of exposing incarcerated women to toxins. Many in the committee pointed out that if public bathrooms — including those in the Capitol — provide women with menstrual products for free, then why can’t jails and prisons? 

“For far too long meaningful conversations about menstruation have been avoided due to stigma, and it is my hope that as leaders in the state of Wisconsin, we can change that,” Vining said in a statement. “We need to talk about this issue now because women are one of the fastest growing populations in the U.S. And over the last 25 years, the number of women in Wisconsin’s prisons and jails has quadrupled. Our state jails and prisons, and their policies and programs, were simply not designed to safely and humanely incarcerate women.”

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"What major purchase does anyone in this room make without knowing the cost before you make the purchase? It is inconceivable to me that we do not know what something is going to cost of that magnitude before we actually consent to the cost,” Sen. Mary Felzkowski said. (Photo by Baylor Spears/Wisconsin Examiner)

A bill to implement state-level enforcement of federal hospital price transparency requirements in Wisconsin, with the goal of bringing down the cost of health care, received pushback from hospital representatives and support from employers on Wednesday.

Sen. Julian Bradley (R-New Berlin) told the Senate Licensing, Regulatory Reform, State and Federal Affairs Committee that ensuring that the cost of services provided would help with health care affordability.  

“When hospitals clearly share pricing information, patients can make informed decisions. Trust in the system grows and costs come down naturally,” Bradley said, adding that the bill would ensure Wisconsin “reaps the benefits” of changes made by the Trump administration. 

During his first term, President Donald Trump’s administration implemented rules to require hospitals to post pricing information online. The effects of the changes on patients’ costs have been mixed. At the start of his second term, Trump signed an executive order intended to bolster the effort and in December, the administration proposed a new rule that aims to simplify how price data is organized and shared with people. 

SB 383 would instruct the Wisconsin Department of Health Services to enforce federal price transparency requirements for hospitals. 

Bradley and Rep. Robert Wittke (R-Caledonia), the bill coauthors, said it is needed to help ensure that federal policies are being followed.

“Sometimes we need to take action to make sure that it goes all the way through the state and all of our residents have access to the things that are expected through federal law,” Wittke said. 

Bradley said the lawmakers aren’t trying to penalize hospitals, just ensure people have access to information. 

If a hospital is found to be out of compliance under the bill, Wisconsin DHS would be able to take several actions including providing a written notice to the hospital, requesting a corrective action plan or imposing a financial penalty. DHS would also need to keep a public list of any hospitals that have violated the requirements.

Hospitals would also need to be certified as being in compliance with the requirements when seeking judgment from a court against a patient who owes a debt for services.

Lawmakers introduced a similar bill in 2023, but it failed to receive a floor vote in the Senate and advance in the Assembly.

The current version of the bill includes a provision that says that if federal laws change and are eliminated, then provisions in the bill that establish state level requirements for publishing prices will take effect.

Under those provisions, each hospital would need to make a list of “shoppable services” — ones that can be scheduled in advance such as a knee replacement — available with the standard charge for each item that would be publicly available. A hospital’s list would need to include at least 300 “shoppable services,” and if a hospital doesn’t provide that many, it must list all of its shoppable services.

The change is meant to avoid overlapping and varying requirements, though hospital representatives expressed concerns that would happen anyway.

The Wisconsin Hospital Association (WHA) opposes the bill. Christian Moran, the WHA vice president of Medicaid and payer reimbursement policy, said during the hearing that the organization’s opposition to the bill is not opposition to price transparency.

“Our opposition is to the added regulatory complexity that is created by layering on state level enforcement and state level regulations and unlimited fines on Wisconsin hospitals when robust federal regulation and enforcement already exists,” Moran said.

Moran said no Wisconsin hospitals have been fined for noncompliance since the first federal regulations went into effect. 

“Personal experience, it’s somewhat inevitable: if you pass legislation on the state level that mirrors the federal level it will eventually not match up,” John Russell, president and CEO of Prairie Ridge Health, said. 

Hospital representatives also expressed concerns that not enough attention was being given to the role of health insurance companies. 

“The solution proposed to you in [SB] 383 is to double up on existing enforcement for hospitals while ignoring the state’s current responsibility to enforce and monitor insurance compliance,” Moran said.

Brian Stephens, CEO of the Door County Medical Center, said the state should be more focused on the “middlemen” including insurance providers, saying that bolstering the transparency of hospital costs has its limitations. He spoke to the work that his medical center has done over many years to improve transparency of prices.

“There’s a disconnect in this country between the concerted efforts of health care providers to provide reasonable and transparent prices and the costs that people are paying for health insurance. Unfortunately, hospital price transparency efforts have not put a dent in that dichotomy,” Stephens said. “Perhaps we need to be asking for more transparency from health insurance companies and other middlemen to understand the real drivers of health care costs in our country. Perhaps hospitals have just become a good punching bag for folks who need an effective sound bite. The reality is that, despite our wholehearted commitment to providing reasonable upfront prices, transparency has its limitations. What are the odds that a person waking up with pain will take the time to bring out his or her phone and search the most affordable hospital or clinic prior to seeking treatment.”

Sen. Steve Nass (R-Whitewater) said the testimony focused on the insurance companies’ role sounded like “a lot of finger-pointing.” 

Several other states have adopted laws or are in the process of advancing bills to bolster price transparency including Colorado, Washington State and Ohio. 

Patrick Neville, a former Republican state representative in Colorado who helped pass a similar law in his state, testified on the Wisconsin bill, saying provisions in his home state have already helped. He told the story of one patient who was charged nearly $80,000 for a hysterectomy, but didn’t have to pay the cost.

“Because we had the consumer protections in this bill in Colorado, and they weren’t compliant with price transparency. They couldn’t actually collect that $80,000,” Neville said. “That was really important and powerful for the actual consumer in this case, and so it’s actually working in Colorado.” 

Neville added that the Colorado legislation did not codify the federal rules, but he wishes it had. 

“Any president could get rid of those rules at any point and I think the way this bill is crafted… It’s hugely important,” Neville said. “That’s a clever way to craft it.” 

Several employers testified in favor of the legislation. 

Erik Sonju, president of Fitchburg-based Power System Engineering, described the unpredictable jumps in health care costs that his company has grappled with since 2018 when he started in his position. He said that 2023 was the year the “straw broke” as they dealt with a 20% increase in insurance rates and he wasn’t able to get clear answers about the rising cost. 

Sen. Mary Felzkowski (R-Tomahawk) told the committee that the cost of health care is too high. 

“This is common sense. What major purchase does anyone in this room make without knowing the cost before you make the purchase? It is inconceivable to me that we do not know what something is going to cost of that magnitude before we actually consent to the cost,” Felzkowski said.  

Felzkowski is the lead coauthor on two of the other bills the committee took up. SB 796 would require insurers to submit information about claims to the Wisconsin Health Information Organization (WHIO), a nonprofit organization that collects health care claims data, and SB 797 would provide a $600,000 grant for the WHIO to establish an online dashboard of health care claims information and to add new payer data.

The committee also took testimony on SB 703, coauthored by Wittke and Sen. Rob Hutton (R-Brookfield), which would establish that employers who sponsor group health insurance plans have a right to data relating to the employees and dependents covered under those plans, including claims data, utilization reports and other information necessary to understand and manage health care costs.

Wittke said the bill will maintain privacy protections by requiring employers to designate a HIPAA compliance privacy officer and ensure that the Office of the Commissioner of Insurance maintains oversight. The bill also includes a provision prohibiting data from being sold to any party without the permission of the plan sponsor and the person to whom the claims data relates.

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A change in federal recommendations for childhood vaccines has concerned public health experts nationwide. (Getty Images)

This story was originally reported by Barbara Rodriguez of The 19th. Meet Barbara and read more of their reporting on gender, politics and policy.

The federal government is reducing the number of vaccines it formally recommends to all children in the United States, which public health experts say is an abrupt, potentially dangerous change that will sow confusion among families.

The Centers for Disease Control and Prevention said Monday that the agency now recommends vaccines against 11 diseases instead of the 17 previously suggested under America’s childhood vaccine schedule. Acting Director Jim O’Neill says the decision is based on a “comprehensive scientific assessment,” though the agency publicly bypassed a key federal vaccine panel that has long voted on recommendations that shape vaccine policy.

Federal officials claim the altered vaccine schedule will not impact vaccine access for the general public. But medical groups say they’re still determining how it might impact long-term vaccine supply, access and insurance coverage. And they worry how families with small children — many of whom are vaccinated against multiple diseases within the first two years — are interpreting the changes.

“We recognize parents are hearing a lot of information right now, and a lot of it is really confusing and really misleading,” said Dr. Sean T. O’Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics during a media briefing Monday. “Our role as pediatricians is to cut through all that noise and understand what the science actually shows so that parents can make informed decisions with confidence alongside with their pediatrician.”

Wisconsin health department: Vaccine recommendation changes spark ‘great concern’

Here’s what we know about the changes so far and what they mean for families with young kids.

What are the changes?

The childhood vaccine schedule is a series of recommended shots, historically set by the medical community and the federal government, for children as they age. Vaccines are not mandated in the United States, but the CDC’s recommendations impact the cost and availability for everyday people, since insurance companies turn to agency guidance to determine what they will cover. Individual states also require immunizations against several diseases in settings where infections can spread quickly, including at schools and day cares.

The CDC now recommends vaccines to all children against 11 diseases:

• Diphtheria
• Tetanus
• Acellular pertussis (whooping cough)
• Haemophilus influenzae type b (Hib)
• Pneumococcal conjugate
• Polio
• Measles
• Mumps
• Rubella
• Human papillomavirus (HPV)
• Varicella (chickenpox)

Officials will also recommend just one dose of the HPV vaccine instead of two. (A study published last month by the New England Journal of Medicine found one dose is highly effective).

Federal officials are recommending children who are part of “certain high-risk groups or populations” get vaccinated against six diseases:

• Respiratory syncytial virus (RSV)
• Hepatitis A
• Hepatitis B
• Dengue (the vaccine for this disease was already recommended only to children with a history of dengue infection or in an area where the disease is common)
• Meningococcal ACWY
• Meningococcal B

Officials will also recommend immunizations based on “shared clinical decision-making” for several vaccines that were once suggested for all:

• Rotavirus
• COVID-19
• Influenza
• Meningococcal disease
• Hepatitis A
• Hepatitis B

Previously, COVID-19, influenza and rotavirus were all included in general vaccine recommendations. The change comes amid an uptick in flu activity around the country. And before the rotavirus vaccine — which helps prevent a disease that causes severe diarrhea in young children — there were reportedly 70,000 related hospitalizations.

The changes, according to the CDC, are effective immediately and aimed at aligning the U.S. childhood vaccine schedule to those of “peer” countries. That follows a directive last month from President Donald Trump, after weeks of spreading disinformation about vaccines, to better reflect America’s schedule with other countries, including Denmark — an idea that public health experts warn is ignoring the United States’ lack of a comprehensive health care system.

The change was celebrated by Health and Human Services Secretary Robert F. Kennedy Jr., who has repeatedly dismissed the effectiveness of routine childhood vaccines.

“This decision protects children, respects families, and rebuilds trust in public health,” he said in a statement.

Who is considered part of a high-risk group or population?

Vaccination against six diseases is now recommended only for children part of “certain high-risk groups or populations.”

HHS said in accompanying documentation that for people in this category, “risk factors can include unusual exposure to the disease, underlying comorbidities, or the risk of disease transmission to others.”

The updated CDC site lists some of these new parameters:

• RSV: Children should get one dose if their birthing parent did not get a shot during pregnancy. Children should get a second dose at 8 to 19 months if they have a medical condition like chronic lung disease.
• Hepatitis A: Children should get vaccinated against the disease if they’re planning international travel to areas with high or intermediate cases of hepatitis A.
• Hepatitis B: Children whose birthing parent tests positive for the disease or whose status is unknown should vaccinate their newborn and continue the multi-dose series. This follows a CDC advisory panel’s recent recommendation to end a universal newborn shot.
• Dengue: Vaccination is recommended if a child is living in areas with endemic dengue or have a confirmed lab test of a previous infection.
• Meningococcal ACWY: Vaccination is recommended for children with anatomic or functional asplenia or HIV infection, and those traveling to countries with hyperendemic or epidemic meningococcal disease, and first-year college students living in residential housing.
• Meningococcal B: Vaccination is recommended for children with anatomic or functional asplenia and during outbreaks.

Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a co-inventor of the rotavirus vaccine, said some of these new definitions lack critical context. He noted people can get hepatitis A through food contamination.

“So basically you’re in a high-risk group for hepatitis A assuming you eat food,” he said. “Are they going to make that clear?”

Dr. Lori Handy, an associate director at the same center as Offit, said the new recommendations do not have the typical level of detail that accompanies the immunization schedule.

Handy added that the RSV monoclonal antibodies were previously recommended for all newborns, with a second dose during the next RSV season recommended for high-risk children.

“In my clinical opinion, all infants are at high risk of RSV infection, being that virtually all children are infected by age 2,” she said.

What does shared clinical decision-making mean?

HHS says shared clinical decision-making is between a health care provider and the patient, or the parent or guardian: “It is not always possible or pragmatic for public health officials to clearly define who will benefit from a vaccine, who has the relevant risk factors, or who are at risk for exposure. Parents and physicians, who know the child, may be better placed to make that judgment.”

On a CDC website dated January 2025, shared clinical decision-making is defined as “individually based and informed by a decision process between the health care provider and the patient or parent/guardian that may be informed by factors like an individual’s “characteristics, values, and preferences” and a health care provider’s clinical discretion as well as the “characteristics of the vaccine being considered.”

O’Leary said “shared clinical decision-making” is a confusing phrase for parents and health care providers.

“The fact is, pediatricians already do this all day every day. They routinely have long, detailed conversations with families about vaccines,” he said. “Changing a recommendation to shared clinical decision-making doesn’t change that. It just makes things more confusing for parents and clinicians.”

Survey data released last year by the Annenberg Public Policy Center (APPC) on the general public’s understanding of new COVID-19 guidelines found there was confusion over what such decision-making means.

“Expecting parents to engage in shared decision-making with health care providers about routine, thoroughly studied childhood vaccinations suggests that the public health community has doubts about the safety and efficacy of these vaccines when it does not,” said Patrick E. Jamieson, director of APPC’s Annenberg Health and Risk Communication Institute, in a statement. “These vaccines have been part of the recommended childhood schedule because the benefits of taking them substantially outweigh the risks.”

Will this impact access to shots?

HHS officials claim that anyone who wants a vaccine as previously recommended will be able to access it without additional cost, adding that all vaccines will still be covered by insurance companies.

“While non-consensus immunizations are not routinely recommended for all children, all these vaccines will continue to be available for anyone who wants them and will be covered by Medicaid, CHIP, the Vaccines for Children Program, and private health insurance,” according to HHS.

O’Leary said that claim doesn’t take into account some potential downstream consequences. He worries that some clinicians, who already face logistical costs with ordering and storing certain vaccines, may decide to stop stocking vaccines that are now under shared clinical decision-making because there could be a drop in demand. He also worries that pharmacists in certain pockets of the country may be unable to administer vaccines that are not universally recommended because of local laws and rules over who gives shots and under what circumstances. Others have noted that some combination shots are for diseases that now fall under different CDC categories.

If I want my child to receive vaccinations against diseases listed beyond the reduced 11 universal recommendations, will that be possible?

Given HHS’s claim that this altered schedule will not impact access for anyone, that technically means a parent who wants a vaccine that isn’t part of the non-consensus category — whether as a high-risk group or population or under shared clinical decision-making — should be able to access it.

“Parents can still choose to give their children all of the Vaccinations, if they wish, and they will still be covered by insurance,” Trump wrote on this Truth Social account on Monday. His post included a reference to “MAHA Moms” who he seemed to credit for the change, alongside Kennedy and other federal officials.

A spokesperson for HHS did not immediately respond to a request for clarification about access changes, but several officials emphasized on Monday that all vaccines listed on the schedule under any category would be available at no-cost. A major insurance group said last year that they would cover vaccines recommended through September 2025 into the end of 2026.

Why are Kennedy and his HHS staff making these changes?

Trump and Kennedy have both claimed without evidence that childhood vaccines are unsafe and that the country is an outlier compared to other nations — though the number of vaccines available in the United States is similar to countries like Australia and Germany. It follows years of anti-vaccine activism by Kennedy, who previously helped run an anti-vaccine group.

With Monday’s announcement, federal officials including Kennedy claimed the change would restore trust in vaccines — an assertion that medical groups said ignored the impact of vaccine messaging by Kennedy himself. Those groups have criticized Kennedy’s handling of a measles outbreak that began last year and continues to spread.

In the final months of the year, Kennedy directed the CDC to update its website to claim, without evidence, that vaccines cause autism. That follows his department’s guidance in the fall to warn pregnant people that taking over-the-counter pain relief medication could cause autism, which is false.

How are medical groups responding to the announcement?

AAP described the changes as “dangerous and unnecessary.”

Dr. Ronald G. Nahass, president of the Infectious Diseases Society of America, called it “irresponsible” for the federal government “to haphazardly change vaccine recommendations without a solid scientific basis and transparent process.” He worried it would further decrease vaccination rates and increase disease.

The Big Cities Health Coalition, whose members represent local health departments with roughly 61 million residents, said the announcement makes those local officials’ jobs harder amid confusion.

“We will continue to do everything in our power to ensure that those who live in our jurisdictions continue to have access to vaccines that protect their health and save lives,” said the group in a statement.

Where can I get more information about vaccines?

O’Leary noted that AAP continues to publish its own vaccination schedule. Several states, particularly those run by Democrats, have announced regional health alliances — both in the west and east — aimed at ensuring access to vaccines recommended by groups like AAP.

“It remains the trusted gold standard for keeping children healthy,” he said. “Following our schedule on time remains the best way to ensure children receive the strongest possible protection.”

Offit said parents with young children should turn to their pediatrician or family doctor, many of whom already seek guidance from groups like AAP, if they have questions about the changes and future availability.

“I do think that on the ground, I’ll be curious to see how much things change,” he said. “We’ll see.”

O’Leary added that AAP will be working with its partners across medicine and public health to ensure that parents have “credible science-backed vaccine recommendations they can trust.”

“Tragically, our federal government can no longer be trusted in this role,” he said.

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A child receives a COVID-19 shot. A reduction in the list of federally recommended childhood immunization has sparked alarm among public health experts. (Photo by Chip Somodevilla/Getty Images)

A federal government announcement this week dropping some vaccines from the list recommended for routine childhood immunization has drawn opposition from medical professionals nationwide and concern from the Wisconsin health department.

The Wisconsin Department of Health Services is reviewing information from the Centers for Disease Control and Prevention (CDC) about the change in vaccine recommendations “and is doing so with great concern for the health of children in our state,” Jennifer Miller, a DHS communications specialist, told the Wisconsin Examiner in an email message Tuesday.

“Health professionals and parents deserve accurate, credible information,” Miller wrote. “We have not yet seen new scientific evidence that would justify changes to longstanding recommendations that have and continue to protect the health of children in the United States.”

The decision to stop recommending certain vaccines is “dangerous and unnecessary,” the president of the American Academy of Pediatrics said in a statement posted Monday at the professional association’s website.

What does the new childhood vaccine schedule actually mean for your family?

Among the diseases dropped from those recommended for routine immunization are hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), flu, and meningococcal disease.

“AAP continues to recommend that children be immunized against these diseases, and for good reason; thanks to widespread childhood immunizations, the United States has fewer pediatric hospitalizations and fewer children facing serious health challenges than we would without this community protection,” said Dr. Andrew Racine, AAP president, in the statement.

Miller said that DHS will continue its assessment of the CDC’s recommendation changes as well as those from “other trusted medical and public health agencies.” The department plans to issue more information on Thursday, she said.

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Sarah Simmons, a midwife and co-owner of Maple Street Birth Center in rural Okanogan County, Wash., holds a newborn. Freestanding birth centers can address maternal health inequities, but many are facing mounting financial and regulatory pressures. (Photo courtesy of Sarah Simmons)

Dr. Heather Skanes opened Alabama’s first freestanding birth center in 2022 in her hometown of Birmingham. Skanes, an OB-GYN, wanted to improve access to maternal health care in a state that’s long had one of the nation’s highest rates of maternal and infant mortality.

Those rates are especially high among Black women and infants. Skanes’ Oasis Family Birthing Center opened in a majority-Black neighborhood, offering midwifery services as well as medical care.

But about six months after the center’s first delivery — a girl who was Alabama’s first baby born in a freestanding birth center — the state health department ordered Skanes to shut it down. A department representative informed her that by holding deliveries at the birth center, she was operating an “unlicensed hospital,” she said.

Hospital labor and delivery units are shuttering across the nation — including more than two dozen in 2025 alone. Freestanding birth centers like Skanes’ could help fill the gaps, but they too are struggling to stay open.

They face some of the same financial pressures that bedevil hospitals’ labor and delivery units, including payments from insurers that don’t cover the full cost of providing maternity care.

Birth center owners also must contend with arcane state rules and antipathy from politically powerful hospitals that view them as competition, especially in rural areas with few births.

Nationwide, the number of freestanding birth centers doubled between 2012 and 2022, but more recently the pressures have taken a toll: About two dozen centers have closed since 2023, bringing the total number down to about 395, according to the most recent data from the American Association of Birth Centers.

In November, Pennsylvania Lifecycle Wellness and Birth Center announced it would shut down birth center services, citing pressure from regulatory challenges and sharp surges in malpractice premiums. It had served Philadelphia for 47 years. And New Mexico’s longest-operating freestanding birth center stopped delivering babies in December.

“When a new business opens, within the first three to five years you expect a certain number will close,” said Kate Bauer, executive director of the American Association of Birth Centers. “But we’ve had several long-standing birth centers close [in 2025] and that hits particularly hard.”

In California, which has some of the strictest birth center licensing rules in the country, concern over the closure of at least 19 birth centers between 2020 and 2024 prompted the state legislature to pass a law in October to streamline birth center licensure.

An appealing alternative

Freestanding birth centers are not attached to hospitals and aim to provide a more homelike, less traditional medical setting. They employ midwives and focus on low-risk pregnancies and births. Some also have an OB-GYN or family medicine doctor on staff, and they often have partnerships with nearby hospitals and doctors if more specialized care is required.

Some Black and Indigenous midwives and doulas say birth centers can be helpful alternatives to their community members, many of whom have had experiences in more medicalized settings that left them feeling marginalized, dismissed or unsafe.

Midwife Jamarah Amani, executive director of Southern Birth Justice Network, runs a mobile midwifery clinic serving majority-Black and Latino neighborhoods in Miami-Dade County, Florida. The nonprofit, which aims to make midwife and doula care more accessible, recently bought a building for a freestanding birth center it aims to open in 2027.

“[Midwifery] presents like a luxury concierge-type of service, and our goal is to really change that and to bring it back to the community in a very grassroots way,” Amani said. She added that expanding access to prenatal care could help address inequities in maternal health, as maternal death rates among Black women are three times higher than those among white women.

Freestanding birth centers also can be a solution for communities without a hospital nearby.

The closest hospital to the Colville Indian Reservation, located in northern Washington state, is half an hour away, said Faith Zacherle-Tonasket, founder of the nonprofit xa?xa? Indigenous Birth Justice.

So far, the group has trained nearly a dozen tribal doulas and midwives to serve the area. In the next few years, it plans to open a freestanding birth center. Zacherle-Tonasket said Indigenous-run birth centers are crucial alternatives for tribal women, who also have some of the highest maternal mortality rates in the nation and often face prejudice in clinical settings.

“They don’t feel safe. So a lot of them just don’t get prenatal care,” said Zacherle-Tonasket. “Bringing traditional midwives that are from our own communities, that were born and raised in our communities, that know the families — we know that those babies will be birthed with love.”

Regulatory hurdles

When the Georgia legislature relaxed state health care regulations in 2024, it felt like a long-awaited win for Katie Chubb. A registered nurse and mother of three who’s worked in health and nonprofits, Chubb has spent years trying to open a birth center in Augusta.

The state denied her application to open the center in 2021. Georgia, like many states, requires health care providers to get state approval, called a certificate of need, before they can build a new facility or expand services. Rival providers, like other hospitals, can challenge an application, effectively vetoing their local competition.

That happened in Chubb’s case: Two local hospitals filed letters of opposition against her and refused to say they’d accept emergency transfers from her birth center, another requirement for opening.

Georgia currently has three freestanding birth centers, a fraction of the more than two dozen that operate in neighboring Florida.

“We’re seeing women giving birth in hospital hallways or at home unassisted, because there’s no in-between option like a birth center,” Chubb said. In October, Georgia lost another labor and delivery unit at a rural hospital two hours north of Augusta.

“Women are just left to figure things out.”

In Kentucky, the Republican-controlled legislature passed a bill in March that aimed to clear the way for freestanding birth centers by exempting them from the certificate of need process.

But Republican lawmakers attached a last-minute anti-abortion amendment to the bill, prompting Democratic Gov. Andy Beshear to veto it. The legislature eventually overrode his veto. Midwifery advocates hope the new law will help make it easier to open a birth center in the state.

Georgia legislators similarly revised Georgia’s certificate of need rules in 2024, exempting freestanding birth centers. Chubb, who championed the new law, hoped it would clear the path for herself and others.

But they hit another roadblock. The state still requires birth centers to secure a written agreement with a local hospital to accept transfers of clients in emergencies. Chubb and at least one other prospective birth center owner have been unable to get their local hospitals to sign such transfer agreements.

“We’re still fighting,” Chubb said. “Behind closed doors we’re still working very hard on getting legislation and regulations changed to make opening birth centers more equitable.”

Some hospitals view birth centers as a threat to the viability of their labor and delivery units, siphoning off patients and revenue from a service that’s already unprofitable for most hospitals.

Daniel Grigg, CEO of Wallowa Memorial Hospital, a 25-bed critical access hospital in northeast Oregon, said there aren’t enough births in the area for both hospitals and birth centers.

“When you’ve got a small-volume community like we have, every birth helps the providers keep their skills up and their competency,” he said. “When you’ve got a midwife taking, say, 10 patients out of that pool,” it can have an impact on physicians and hospitals.

Alabama lawsuit

After the Alabama Department of Public Health shut down Skanes’ birth center in 2023, she joined with two other women who had also been attempting to open birth centers in Alabama: Dr. Yashica Robinson, an OB-GYN in North Alabama, and Stephanie Mitchell, a licensed midwife in Alabama’s rural and economically disadvantaged Black Belt region. Together they sued the Alabama Department of Public Health over what they called a de facto ban on birth centers.

The state insisted its tighter regulations would ensure that birth center facilities are safe. The birth center owners said the state’s rules were overly burdensome and clinically unnecessary for the low-risk, nonsurgical births that are attended by midwives. And, they said, the rules prevented more families from accessing care where it’s desperately needed. The state has lost at least three hospital labor and delivery units since 2020.

“Entire swaths of the state are maternity care deserts without access to essential health care,” said Whitney White, a staff attorney with the American Civil Liberties Union, which is representing the birth center owners and their co-plaintiff, the Alabama affiliate of the American College of Nurse-Midwives.

“Hospital labor and delivery units are closing, and pregnant folks are reporting they’re really struggling to access the care they need, struggling to get appointments, struggling to find a provider,” White said.

Last May, an Alabama trial court permanently blocked the state from regulating freestanding birth centers as hospitals. Birth center staff are still overseen by state boards of midwifery and nursing.

All three Alabama centers are now open. But their licensed midwives are delivering babies under a cloud of uncertainty about the future.

The state appealed the ruling in November. The case is ongoing.

Struggles and solutions

Bauer, of the American Association of Birth Centers, said many centers face the same financial barriers. Uncomplicated births at freestanding birth centers cost less than they do at hospitals, but research has shown that insurers, including Medicaid, reimburse centers at lower rates. Some state Medicaid programs don’t cover some of the nonclinical services, such as lactation consultants and doulas, that birth centers may provide. And malpractice premiums are rising.

“We’re volunteering our time, essentially, to keep the birth center open as a service to the community,” said Sarah Simmons, co-owner of Maple Street Birth Center in rural Okanogan County, Washington. The center can’t afford to hire a front-desk staffer or another midwife, Simmons said. She added that on average, the center makes less than a third of what the local hospital makes for providing the same obstetric service.

But there may be solutions to some of these financial problems. For example, the Center for Healthcare Quality and Payment Reform, a national health care policy center, has recommended that health insurance plans, both Medicaid and commercial, pay hospitals and birth centers monthly or quarterly “standby capacity payments” per woman of childbearing age covered by that health plan in the facility’s service area. It also recommends that plans pay a separate delivery fee for each birth.

In 2024, Democratic U.S. senators proposed a bill to allow for a similar payment model.

Standby payments could help freestanding birth centers, especially those that fill gaps in maternity care deserts — but not unless centers receive payments that are comparable to those that hospitals get, said Simmons, whose center serves four sparsely populated counties along with the Colville tribal communities.

“This would be most beneficial to freestanding birth centers if pay parity laws were enforced, so rural freestanding birth centers were paid the same rates for the same services as rural hospitals, ” she said.

State grants also can help, but birth centers say a one-time infusion won’t be enough. In 2024, Washington opened grant applications for distressed hospital labor and delivery units and freestanding birth centers.

Ashley Jones, of True North Birth Center and president of the Washington chapter of the American Association of Birth Centers, said the grant has helped keep their doors open.

Meanwhile, Chubb, the Georgia nurse, recently had to take another job to support her family while her birth center remains in legal limbo.

“I’m just waiting until the government figures out what they’re doing.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org. Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Enrique Casiano addresses a rally at the Wisconsin State Capitol on Sept. 4, 2025, during a strike by UAW-represented employees against Mercyhealth East Clinic in Janesville. (Photo courtesy of Enrique Casiano)

Among the Democrats running for the chance to challenge the Republican incumbent in Wisconsin’s 1st Congressional District are a nurse, a union leader, a working class activist and a Hispanic professional.

A fifth candidate, Enrique Casiano of Janesville, happens to check all four of those boxes. A 47-year-old registered nurse, Casiano said his decision to join the Democratic field of hopefuls for the 1st District seat arose during a four-month strike at the Mercyhealth East Clinic in Janesville, where he is a leader in United Auto Workers Local 95.

The walkout of UAW-represented nurses, physical therapists, medical assistants and maintenance employees at the clinic started July 2, centered on health care costs, wages and security for employees.

“When September came around we were still on strike,” Casiano recalled. “I was thinking to myself, What in the world is going on? Why would a company do this to their employees? Why would this even be allowed?”

He and fellow union members blamed federal labor laws. Casiano said they have “no teeth” and don’t hold employers accountable.

“That has to be changed at a national level,” Casiano said. “That’s what motivated me to get out there and run for Congress.”

The strike ended Nov. 3, when the clinic management and the union ratified a new contract. The agreement led to raises that were higher than nonunion employees received elsewhere in the Mercyhealth system, Casiano said, although still less than what the union had originally sought. Health care costs for employees will be “basically three times” what they were previously, he added.

“This was a big concession,” Casiano said. “Something I told the membership, this should be a wake-up call for everybody to vote for someone who’s going to do something about the health care crisis in our nation.”

Casiano argues that health care is a human right and government should do more to prevent health care costs from leaving people in debt or sending them into bankruptcy.

“If you have the money, you’ll get care,” he said. “If you don’t have the money, I’ve seen how many people end up being homeless or go into great debt because of their health.”

He supports Medicare for All, but also favors giving states greater freedom to regulate the health care systems. He opposes consolidation among health care groups and favors breaking up large hospital and health care systems, as well as keeping for-profit businesses, including private equity and venture capital firms, out of health care.

“The current system rewards profiting from people’s health care crisis,” Casiano said. “It is not a system of prevention and rewarding the best health care outcomes and practices.”

Casiano said that updating the 1930s-era National Labor Relations Act with laws that would strengthen the rights of workers to union representation is a top priority of his. If elected he would also seek to enact stronger federal laws against wage theft and against misclassifying workers as independent contractors with fewer protections. He said that he also wants “real tax relief to the working class” instead of the wealthy.

Casiano is one of five Democrats vying for the chance to challenge U.S. Rep. Bryan Steil, the Republican incumbent in the 1st District now in his fourth term.

“I’m part of the working class. I’m not a lawyer. I’m not a politician,” Casiano said — although he readily acknowledged that every other Democrat competing for the nomination could make the same claim.

“Pretty much everybody running this time around, we’re all just working class people who want to see a change in the 1st District,” he said.

The rest of the Democratic field includes ironworker Randy Bryce, emergency room nurse Mitchell Berman, Racine community activist Gage Stills and university administrator Miguel Aranda.

As he shapes his campaign, Casiano is leaning into his background as a health care professional, a union activist and also a member of the Hispanic community.

He said the Trump administration’s round-ups of immigrants — which has caught up U.S. citizens in addition to people without legal immigration status — has a personal dimension.

“It’s sad that I, when I go to Milwaukee, can be stopped [by police] just because of the way I look and the way I talk,” he said. “At the national level, we’re attacking specific [ethnic groups of] people, which we’ve never done before.”

The 1st Congressional District has been solidly Republican since the mid-1990s. Steil succeeded Paul Ryan in the office when Ryan stepped aside  in 2018 after a 20-year tenure. A corporate lawyer and former Ryan aide, Steil won with margins of 9 to 10 points in 2022 and 2024.

The Cook Political Report has rated the district as likely Republican in 2026, and gives the GOP a 2-point advantage based on past presidential elections.

Casiano contends political apathy accounts for Steil’s success. “In the last election, many of my coworkers, they just did not go out to vote,” he said. “It’s not winnable, somebody told me [because] it’s all about the money.”

He contends that 2026 can be different.

“What’s changed now is the Trump administration and how messed up everything is going,” Casiano said. “Only people that have blinders on will say everything is OK, because it’s not.”

Casiano said he knows he’s a long-shot candidate, but he believes Steil is vulnerable and that people can be motivated to vote if candidates reach out to them.

“I know he has let down a lot of his constituents,” Casiano said. “We know he’s not out there for the farmers, or some of the small businesses” in the district, he added. “That’s the big message we’ve got to bring forward.”

He believes enough people have stayed away from the polls in the past to make a difference in the outcome for 2026.

“We have to go and start talking to Black and brown people in our community and get them out to vote,” Casiano said. “This is what I’m going to be fighting for.”

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Democratic and Republican candidates for governor appeared for a joint forum in early November. Shown are, from left, Matt Smith of WISN-12, Francesca Hong, Sara Rodriguez, Kelda Roys, David Crowley and Missy Hughes, all Democrats, and Josh Schoemann, a Republican. Republican Tom Tiffany did not participate. Since that event two more Democrats have entered the contest, former Lt. Gov. Mandela Barnes and former cabinent member Joel Brennan. (Photo by Baylor Spears/Wisconsin Examiner)

A popular two-term governor decides to retire, and triggers a flood of prospective replacements. Democrats vow to flip the Republican-majority Legislature. A state Supreme Court race blows the doors off spending records, and another one is waiting in the wings.

Each of those could be considered a big story by itself in Wisconsin, but they’re all part of this year’s single biggest story in government and politics. And that story — that it was a really big year for Wisconsin politics — wasn’t just about 2025: It set the stage for 2026.

The  three-stories-in-one about Wisconsin politics are just the beginning of the news that flooded our pages in 2025. Wisconsin Examiner’s five-person staff published 550 stories in 2025, a total that includes opinion columns by Editor Ruth Conniff, but doesn’t include briefs that also appeared under the bylines of Conniff, Erik Gunn, Isiah Holmes, Henry Redman, Baylor Spears and Criminal Justice Fellows Andrew Kennard and Frank Zufall.

Herewith, then, our list of 10 big stories that the Wisconsin Examiner covered over the course of the last year.

1. Wisconsin politics goes into overdrive

Democratic Gov. Tony Evers put an end to the last Wisconsin governor’s quest for a third term when he defeated Republican Scott Walker in 2018. Midway through his own second term, Evers surprised many by deciding to call it quits when his current  term ends rather than run again.

The decision created the first open race for governor in more than a decade and opened the floodgates, with a bevy of Democrats entering the fray. By contrast, the Republican field was down to two at year’s end, with one early contender dropping out after the entry of Congressman Tom Tiffany.

In the Wisconsin Legislature, Democrats, having narrowed the Republicans’ majority in 2024 thanks to new maps that undid the state’s 15 years of GOP gerrymandering, launched twin efforts to flip both the Assembly and the Senate in 2026. Republicans vowed to maintain their majority in both houses.

The new Senate and Assembly maps were made possible after the 2023 state Supreme Court election flipped the seven-member Court’s ideological majority from conservative to liberal. With the balance of the Court  at stake again after liberal Justice Ann Walsh Bradley retired in 2025, Democrats went all out, electing Dane County Judge Susan Crawford to the nominally nonpartisan Court and handily overcoming the efforts of billionaire Elon Musk who spent millions  supporting Crawford’s opponent, former state Attorney General Brad Schimel. The contest set both state and national records for campaign spending in a U.S. judicial election, and maintained the one-vote liberal majority. Now supporters of the current Court majority have their eyes on extending that ideological advantage in 2026. 

Chris Taylor, currently a District IV appeals court judge and a former Democratic state representative, is running to succeed sharply conservative Rebecca Bradley. Bradley opted not to seek a new term on the Court, and conservative Appeals Court Judge Maria Lazar has announced plans to seek the post.

2. A  bipartisan state budget splits both parties

Evers went into the 2025-27 state budget process with an ambitious list of goals. Lengthy negotiations between the Democratic governor and Republican lawmakers produced a deal. While the final result fell well short of his original vision, Evers claimed victory nevertheless, with gains on paper for child care funding and for public school special education funding.

Both, however, left their strongest advocates disappointed, and by the end of the year, the special education funding did not live up to the promises made when the budget was signed.

3. Public school troubles

The budget’s lack of additional school aid for regular classes was especially upsetting to public school advocates, and was exacerbated by the state’s expanding school choice systems that use tax dollars to pay for private schools and charter schools outside the common public schools. It also underscored the extent to which local communities have been voting to raise their own property taxes to support their school systems.

The defeat of some school referendum requests further accentuated the sense of crisis, while Republican lawmakers called for new restrictions on the referendum process. And in the state’s largest system, Milwaukee Public Schools, an audit called for sweeping changes in response to a range of challenges, from declining enrollments and staff turnover to the continuing pressure of having to fund the parallel voucher and charter systems.

Throughout the year, the state Department of Public Instruction came under intense scrutiny from Republican lawmakers over policies ranging from school performance evaluations to the handling of sexual abuse complaints against school employees.

4. Federal fallout from a new administration

With the inauguration of President Donald Trump to a second term in the White House, the fallout from new federal actions reached Wisconsin in a myriad of ways. The giant legislation to cut taxes (mostly for the wealthy) and spending (much of it for health care) that Trump signed in July was one cause, setting the stage for future cuts to Medicaid and to health care under the Affordable Care Act, while also imposing new restrictions on programs aimed at reducing hunger.

But there were other reductions as well, some coming from the actions of the “Department of Government Efficiency” or DOGE that Trump authorized, and others from unilateral — and often legally challenged — actions by the administration itself. Clean energy and climate change projects, scientific research, education assistance, help with removing lead from public schools, community service, child care, economic policies, numerous federal agencies and the federal workforce itself along with countless other federal initiatives were swept up in the administration’s first year.

The record-long federal shutdown — when Congress failed to agree on a temporary spending plan and the GOP majority refused to extend extra tax breaks for Affordable Care Act health plans into 2026 — added to the chaos, with a temporary halt to the federal SNAP food assistance program.

Wisconsinites joined people from across the country in the recurring protests that started just weeks into the Trump presidency, culminating in the Oct. 18 “No Kings” rallies from coast to coast that some analysts identified as the largest mass protest ever in the United States.

5. Immigration arrests spark turmoil

The Trump administration’s immigration crackdown reverberated in Wisconsin from Inauguration Day. At the start of this term, Editor Ruth Conniff traveled to Mexico, documenting the longstanding relationships Wisconsin farmers have had with migrants who provide 70% of the labor that the state’s dairy industry has relied on.

Republican lawmakers called for cementing the state’s relationship with the newly unleashed Immigration and Customs Enforcement — ICE — agency , while the Evers administration resisted those calls. Individual counties signed on to assist ICE, sometimes facing opposition, but while Wisconsin was less in the national spotlight than other states, it wasn’t immune to periodic episodes of immigration enforcement.

Visa cancellations caught up students from overseas, and migrant arrests rose across the state. Immigration enforcement officers focused on the Milwaukee County Courthouse in their search for immigrants to take into custody, prompting criticism from advocates who warned the result would drive migrants underground rather than encouraging them to show up for court dates as witnesses, plaintiffs or defendants.

After a four-day trial in December, Milwaukee County Judge Hannah Dugan was convicted on a felony charge of obstruction but acquitted of a misdemeanor charge of concealing a man who had appeared in her courtroom in April and was targeted by immigration officials. The case had national repercussions as the Trump administration targets judges it sees as opponents to its policies.

6. Environment: Data centers, stewardship and PFAS conflicts

In Wisconsin a statewide — indeed, nationwide — the rush to embrace massive data centers to serve emerging artificial intelligence-based technology sparked widespread debate over water use, electricity demands and power generation.

Meanwhile, a longstanding and widely popular land preservation program — the Knowles-Nelson Stewardship fund — hovered on the verge of collapse as Republican lawmakers demanded the power to veto stewardship decisions after a state Supreme Court ruling in 2024 removed the Legislature from the process.

After a running battle against rerouting an Enbridge oil pipeline, the Army Corps of Engineers approved permits for the project over the strenuous objections of opponents, only to be sued by the Bad River Band of Lake Superior Chippewa.

A standoff between the Evers administration and the Legislature’s Republican leaders over how to address PFAS “forever chemicals” was eased by a state Supreme Court ruling allowing the Wisconsin Department of Natural Resources to apply Wisconsin’s spills law to PFAS contamination, along with a bipartisan bill that would require the DNR to notify local and tribal officials about groundwater PFAS contamination.

7.  Law enforcement: Investigating themselves, surveillance of the public

A lengthy investigation by Isiah Holmes of the Wisconsin Examiner in partnership with Type Investigations documented how the Milwaukee Area Investigative Team, assigned to probe death investigations for people killed by metro Milwaukee police officers, use protocols that grant officers privileges not afforded to the general public.

Among many other issues involving policing and law enforcement in Wisconsin, police surveillance was a recurring matter, with debates arising over facial recognition technology, department interest in expanding phone-tracking resources and increasing attention to how police agencies make use of widespread surveillance cameras.

8. Prison reform struggles

Evers’ budget proposal included a sweeping plan for prison reform, but the  result was more limited, leaving advocates dissatisfied. One concrete element is the start of a project to close the Green Bay Correctional Institution, a longtime objective, but divisions remain between the governor and GOP lawmakers about the details.

9. Voting rights debates revive 2020 election denial

With the return of President Donald Trump to the White House, the conspiracy theories that were amplified after his reelection loss in November 2020 got a new burst of energy. The Wisconsin Elections Commission twice rejected an administration demand for the personal identifying information of Wisconsin voters.

Trump issued a largely symbolic pardon of the Republicans who signed certificates falsely stating he won the 2020 presidential election in Wisconsin, while a Dane County judge kept alive a criminal case against three men charged with orchestrating the fake elector scheme.

Although bipartisan lawmakers in the Assembly sought common ground over absentee ballot drop boxes and a measure to allow election clerks to begin counting absentee ballots on the Monday before Election Day, their efforts stalled.

10. Flooding and disasters

August flooding in Southeast Wisconsin that followed torrential storms and was centered on the metro Milwaukee area left behind devastation, damaging nearly 2,000 homes and some $34 million worth of public infrastructure.

The Trump administration’s Federal Emergency Management Agency approved $30 million in initial relief to support the victims of flood damage, but the administration denied a subsequent request for aid to mitigate future disasters.

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The James H. Shannon Building (Building One), on the National Institutes of Health campus in Bethesda, Maryland. (Photo by Lydia Polimeni,/National Institutes of Health)

The Trump administration will review frozen grants to universities without using its controversial standards that discouraged gender, race and sexual orientation initiatives and vaccine research.

In a settlement agreement filed in Massachusetts federal court Monday, the National Institutes of Health and a group of Democratic attorneys general who’d challenged the new criteria for grant funding said the NIH would consider grant applications made up to Sept. 29, 2025, without judging the efforts related to diversity, equity and inclusion, or DEI, or vaccines.

The settlement provides an uncontested path for the agency while courts decide whether the administration can use its controversial analysis. The administration did not agree to permanently ditch its campaign to evaluate health research funding decisions based on schools’ DEI programs.

NIH officials “will complete their consideration of the Applications in the ordinary course of NIH’s scientific review process, without applying the Challenged Directives,” the settlement said, adding that the agency would “evaluate each application individually and in good faith.”

The settlement was signed by U.S. Department of Justice lawyers and the attorneys general of Massachusetts, California, Maryland, Washington, Arizona, Colorado, Delaware, Hawaii, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island and Wisconsin.

In a Tuesday statement, Massachusetts Attorney General Andrea Joy Campbell said the agreement commits the Department of Health and Human Services to resume “the usual process for considering NIH grant applications on a prompt, agreed-upon timeline.” 

The 17 attorneys general sued in April over $783 million in frozen grants. 

A trial court and appeals court in Massachusetts sided with the states, but the U.S. Supreme Court ruled in August that the trial judge lacked the authority to compel the grants to be paid, especially in light of a similar decision involving the Education Department.

(Getty Images)

This article first appeared on KFF Health News.

As Congress debates whether to extend the temporary federal subsidies that have helped millions of Americans buy health coverage, a crucial underlying reality is sometimes overlooked: Those subsidies are merely a band-aid covering the often unaffordable cost of health care.

California, Massachusetts, Connecticut and five other states have set caps on health care spending in a bid to rein in the intense financial pressure felt by many families, individuals and employers who every year face increases in premiums, deductibles and other health-related expenses.

Hospitals and other health care providers are citing Republicans’ One Big Beautiful Bill Act, signed by President Donald Trump in July, as one more reason to challenge those limits.

The law is expected to reduce federal Medicaid spending by more than $900 billion over a decade, which mathematically should help the overall health care system meet the caps. But the law is also expected to increase the number of uninsured Americans, mostly Medicaid beneficiaries, by an estimated 10 million people. Health care analysts predict hospitals and other providers will raise prices to cover the double whammy of lost Medicaid revenue and the cost of caring for an influx of newly uninsured patients.

Whether regulators in some states will allow providers to justify higher prices and exceed the spending caps is unclear. Only California and Oregon can penalize providers financially if they fail to meet targets.

“Are we going to say, ‘That’s OK’? Or are we going to say, ‘Well, you exceeded the target. We’re still going to penalize you for that’?” said Richard Pan, a former state lawmaker and a member of the California Office of Health Care Affordability’s board. “That has not yet been decided.”

The California Hospital Association, the industry’s main state lobbying group, filed a lawsuit in October asking a state court to strike down the spending caps, which it argued fail to account for all the cost pressures hospitals face. Those pressures, it said, include an aging, sicker population; the rising cost of labor; expensive advances in medical technology; large capital outlays on required seismic retrofitting; and changes in federal policy, including the One Big Beautiful Bill Act. The hospital group’s lawsuit also asserted that the state affordability office, by hastily imposing ill-considered cost-cutting targets, was undermining its other key mission of improving health care access, quality and equity.

California’s affordability office last year set a five-year target to cap statewide spending growth, starting at 3.5% in 2025 and declining to 3% by 2029. The annual caps apply to a wide range of health care entities, including hospitals, medical groups, insurers and other payers.

Earlier this year, it imposed much lower spending growth caps — starting at 1.8% in 2026 and declining to 1.6% by 2029 — for seven “high-cost” hospitals.

“The spending caps set by politically appointed bureaucrats could force cuts that result in many Californians traveling farther for care, facing longer emergency room wait times, experiencing more overcrowding and losing access to critical services,” Carmela Coyle, the hospital association’s president and CEO, said in an October press release.

The California attorney general’s office, which will represent the affordability agency, has not yet filed a response to the hospital group’s complaint and did not respond to a request for comment.

Hospitals’ pushback

California is not the only state taking a close look at hospital prices, which are widely considered a primary driver of health care costs.

“States, armed with information that points to payments to hospitals as a driver of what is way beyond affordable commercial premiums, have begun to take increasingly targeted actions focused on commercial hospital prices,” said Michael Bailit, founder of the Needham, Massachusetts-based consultancy Bailit Health, which has advised multiple states, including California, on ways to tame health care spending. “It is not surprising that the hospital industry is going to oppose such state actions.”

In its lawsuit, the California Hospital Association said the affordability office’s own report showed that pharmaceutical and insurance companies are largely responsible for high costs.

Hospitals in some states with cost growth limits, including Connecticut and Massachusetts, have expressed objections similar to the ones raised in the California lawsuit. They could follow their counterparts in California if their lawsuit succeeds, said Peter Lee, who led California’s Affordable Care Act marketplace, Covered California, for over a decade and is now a senior scholar at Stanford Medicine’s Clinical Excellence Research Center.

Lee said the work of California’s affordability office and similar agencies in other states is just about the only systemwide effort being made to cut health care costs. They are basically saying, “‘Look, health care is taking money away from education, it is taking money away from the environment, it is taking money away from everything in the public sector, and in the private sector it is taking money away from wages,’” he said. “‘We don’t know how you, the health system, are going to do it, but it is your job not just to provide quality but to lower costs. Here’s the target.’”

To be sure, achieving the cost savings that California and those other states are seeking is no easy lift. It will ultimately require persuading large, financially powerful players that compete fiercely for health care dollars to adopt a different mindset and begin cooperating to reduce costs instead. And that, in many cases, will mean lower revenue.

But the status quo, as many people know all too well, means continued financial pain for millions.

In early 2020, Estevan Rodriguez, a bartender at California’s Monterey Beach Hotel, had surgery for a staph infection in his leg. The bill came to nearly $168,000. His insurance paid most of it, but he still owed $5,665, which took him two years to pay, more than $200 every month. “It may not be a lot to some people, but it was a lot to me,” Rodriguez said.

He said he dropped his Hulu subscription, switched to a lower-cost cellphone, and got cheaper car insurance. He started going to food banks rather than the grocery store, he said, and had a lot less time with his kids, because he was constantly working to pay off the hospital bill.

Community Hospital of the Monterey Peninsula, where Rodriguez had his surgery, is one of the seven hospitals identified by California’s affordability office as high-cost. A study by the office attributed high hospital prices in Monterey County to a lack of market competition “rather than higher operating costs or superior quality of care.”

The Monterey hospital referred a request for comment about its “high-cost” designation to the California Hospital Association. CHA spokesperson Jan Emerson-Shea declined to comment beyond the language of the lawsuit and Coyle’s press release statement.

Reduced competition

Health care analysts worry the One Big Beautiful Bill Act will reduce market competition even further by stressing already weak hospitals, leading some to shut services, merge with larger health systems, or close. One study estimates 338 rural hospitals are at risk of closing nationwide.

Less competition, in addition to fewer Medicaid dollars and an increase in uninsured patients, will only strengthen the incentive of health systems with the requisite market clout to raise their commercial prices, increasing premiums for employers and individuals.

“We think commercial prices will continue to increase as health care providers, and hospitals in particular, will seek to preserve or increase their revenue,” said Rachel Block, a program officer at the Milbank Memorial Fund, a foundation that focuses on health equity.

That in turn could pose a challenge to state affordability regulators tasked with overseeing compliance with growth targets for health care spending.

California’s affordability office is required to consider mitigating factors, including changes in federal and state laws. But some of its board members have expressed skepticism about letting hospitals offset Medicaid losses with higher commercial prices.

“There’s a lot of talk about using HR 1 and other federal policies as an excuse to raise prices on commercial payers,” Ian Lewis, an affordability office board member and policy director for UNITE HERE Local 2, a hospitality workers union in the Bay Area, said at the agency’s July board meeting, referring to the One Big Beautiful Bill. “There’s no more blood to be squeezed from this stone.”

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

A vacant hallway at Vaughan Regional Medical Center in Selma, Alabama, on Tuesday, Sep. 3, 2024 in Selma, Alabama. (Will McLelland for Alabama Reflector)

WASHINGTON — President Donald Trump’s administration unveiled Monday hundreds of millions of dollars each state will receive this fiscal year as part of a massive $50 billion rural health fund baked into Republicans’ “big, beautiful” law. 

The five-year Rural Health Transformation Program — authorized under GOP lawmakers’ mega tax and spending cut package Trump signed into law in July — is designed to offset the budget impacts on rural areas due to sweeping Medicaid cuts.  

Half of the $50 billion will be distributed equally among each state between fiscal years 2026 and 2030, according to the Centers for Medicare and Medicaid Services.

The agency under the U.S. Department of Health and Human Services said the remaining $25 billion, doled out over the same time period, is being allocated to states based on several factors, such as steps states are taking to improve access to care in rural communities. 

Texas will get the highest first-year award at $281.3 million, followed by Alaska at $272.2 million, California at $233.6 million, Montana at $233.5 million and Oklahoma, at $223.5 million. 

New Jersey is receiving the lowest first-year award, at $147.2 million. 

“Thanks to Congress establishing this investment and President Trump for his leadership, states are stepping forward with bold, creative plans to expand rural access, strengthen their workforces, modernize care, and support the communities that keep our nation running,” CMS Administrator Dr. Mehmet Oz said in a statement alongside the announcement. 

Oz added that “CMS is proud to partner with every state to turn their ideas into lasting improvements for rural families.” 

Meanwhile, the nonpartisan health research organization KFF found that the program would only offset a little more than one-third of the package’s estimated $137 billion cut to federal Medicaid spending in rural areas over the next decade.

Ashley Murray contributed to this report.