In Johnson County, Iowa, the number of tuberculosis cases has increased in recent years — and so has the cost of containing it.

The cost of contact tracing and surveillance, traveling each day to patients’ homes to ensure they take their meds or booking hotel rooms to quarantine patients, has surged from $17,000 in 2020 to $65,000 last year.

That doesn’t include $13,000 spent last year for language translation, as many of the cases were among the local immigrant communities, said Danielle Pettit-Majewski, director of the Johnson County public health department. She said the rise in spending is directly tied to the increase in diagnoses since 2020, with latent infections tripling, from 27 that year to 90 last year.

Last week, the state informed the county that the greater number of cases had made it too costly to help pay for the home visits, forcing the county to pay for them on its own.

“I was kind of dumbfounded,” Pettit-Majewski said. “It was surprising.”

Tuberculosis cases have been rising nationwide since 2021, and in 2024 — the most recent year for which data is available — they reached the highest level since 2011. Thirty-four states and the District of Columbia reported increases in TB case counts and rates from 2023 to 2024, according to the federal Centers for Disease Control and Prevention.

In 2024, there were 10,347 reported cases nationwide, up 8% from the 9,622 cases reported the year before.

The case numbers for 2025 won’t be released until the end of March. But the Trump administration’s immigration crackdown last year might have dissuaded some people from seeking care, perhaps leading to fewer recorded diagnoses, some TB experts say.

Some states, however, are reporting preliminary data to the National Tuberculosis Coalition of America that shows that the number of cases grew from 2024 and 2025 by between 10% and 20%, said Donna Hope Wegener, the coalition’s executive director.

“There are a number of [tuberculosis] program managers that are reporting double-digit increases,” Wegener said, adding that the cost of antibiotics to treat TB is rising. “These back-to-back increases that states are contending with are certainly alarming.”

In San Antonio, Texas, case numbers have been steady, but the local public health department is still struggling to cover treatment costs.

Tommy Camden, health program manager at the City of San Antonio’s tuberculosis clinic, said the city has proposed eliminating a full-time specialist position that assists with TB contact tracing, blood draws and home visits.

Whatever the 2025 numbers show, many public health agencies are struggling to keep up, especially as they also contend with a growing measles outbreak that so far has affected 26 states.

Tuberculosis is a bacterial infection with both active and latent stages. A person with active tuberculosis disease, which can be deadly, can spread the disease. A person with a latent infection can’t, but they can develop the disease at any point.

Consistent, daily antibiotic treatment for four to nine months, with no skipped doses, is crucial to knocking it out. Skipping doses can allow the germs to mutate into drug-resistant TB, which is one reason health agencies spend so much to ensure patients take their medication.

In the U.S., the disease disproportionately affects people born in countries where it’s more common, as well as Hispanic, Black, Asian American, Pacific Islander and Indigenous communities, according to the CDC.

Immigrant communities tend to be disproportionately affected, in part because the disease can spread more easily in multigenerational households and other crowded home and work settings. Poverty, a lack of access to health care because of language, transportation and cultural barriers, and the stigma around the disease also can make those communities more vulnerable, Pettit-Majewski explained.

The California Department of Public Health says the cost of drugs to prevent a latent tuberculosis infection from turning into full-blown disease can be about $857 for what is usually three to four months of treatment. In contrast, diagnosing and treating one infected person who develops active tuberculosis disease can cost about $43,900.

While there is a vaccine for tuberculosis, it isn’t recommended for use in the U.S. because it can cause false positives in TB tests taken by skin sample. The vaccine also isn’t consistently effective against adult pulmonary tuberculosis.

Research has been underway for developing a new vaccine. But the Trump administration’s antipathy toward vaccines of all kinds is dampening investment in new products.

Immigration crackdown

Before the COVID-19 pandemic, tuberculosis was the world’s deadliest infectious disease, killing about 1.5 million people each year, according to the World Health Organization. It remains a leading infectious disease killer globally. Immigrants coming to the U.S. are screened for active TB and connected with treatment, and U.S. residents may be asked about travel abroad during routine checkups.

Many immigrants might be reluctant to seek care amid the Trump administration’s immigration crackdown, said Dr. Michael Lauzardo, a University of Florida associate professor at the division of infectious diseases and global medicine and director of the Florida TB Physicians Network.

“I think the numbers will be lower because people are afraid,” Lauzardo said of the soon-to-be-released 2025 data. “A lot of the people at risk for TB are not seeking care, I suspect.”

Munira Maalimisaq, a family nurse practitioner in Minneapolis, said such fear has been rampant across immigrant communities in her area. After President Donald Trump was elected, a health care center where she worked had to drop a routine question on patient intake forms that asked where a patient is from, because people were scared to answer it. The question was meant to assess exposure to TB in countries where it’s more common.

“That was a big barrier, because people would just not answer that question, or would not even want to engage and say ‘yes’ or ‘no,’” said Maalimisaq, CEO of a nonprofit health care center in Minneapolis, Inspire Change Clinic.

She said such fear could cause more active cases later on, as people with latent TB may not get diagnosed or get care — increasing the risk that they’ll develop the disease and become contagious.

“The whole thing delays seeking care,” she said. “If I don’t get screened for it, there’s no way that my provider is going to diagnose me.”

In Iowa, Pettit-Majewski said she hopes that Johnson County residents won’t be scared to seek care.

“If you are a Johnson County resident, you are our neighbor, and it is our responsibility to keep you safe and healthy — and we take that very seriously,” said Pettit-Majewski. “We want to make sure that folks are able to get the best care, regardless of immigration status, regardless of where you came from.”

People in detention or correctional facilities also are disproportionately at risk of infection. In recent weeks, two tuberculosis cases cropped up at a U.S. Immigration and Customs Enforcement facility in El Paso, Texas. Last year, California, Alaska and Arizona also saw cases at ICE detention facilities.

ICE didn’t respond to Stateline’s questions about the recent two cases at the El Paso facility. On a recent visit to the detention center, Democratic U.S. Rep. Veronica Escobar, who represents El Paso, said she saw agents go into a community pod, which can hold between 30 to 70 detainees, without protective attire.

“I was about to walk into a pod with the ICE agents, and the security guard said, ‘No, no, ma’am, you don’t want to walk in there. They’ve not been tested for TB yet,’” Escobar told Stateline.

“But I did see contractor staff coming in and out of the pod, and so I asked, ‘Why are they not wearing [personal protective equipment]? Why aren’t they wearing a mask?’ And my concerns were pretty much dismissed, and I was told it’s their choice and they don’t have to if they don’t want to.”

Cuts to public health funding 

Earlier this month, the Trump administration told Congress it intends to rescind $600 million in public health funds to four Democratic-led states: California, Colorado, Illinois and Minnesota. Many of the grants targeted HIV, and some also targeted tuberculosis.

The four states have sued to stop the cuts, arguing that the administration is targeting them with “devastating funding cuts to basic public health infrastructure based on political animus and disagreements about unrelated topics such as federal immigration enforcement.”

A federal judge has temporarily halted the cuts, saying the administration’s statements suggest “hostility to what the federal government calls ‘sanctuary jurisdictions’ or ‘sanctuary cities.’” An agency action, U.S. District Judge Manish S. Shah said, can’t be honored “if it is arbitrary or capricious.”

One of the California grants affected is a grant to the Tuberculosis Elimination Alliance, a partnership of community-based organizations that conduct outreach and education about tuberculosis.

The group received notice Feb. 11 that its grants were ending — putting in jeopardy $100,000 the alliance distributes to groups serving high-risk communities across California, Illinois, Washington state, the District of Columbia and U.S. island territories.

One of the largest tuberculosis outbreaks in recent weeks occurred at a San Francisco Bay Area high school, where latent TB was detected in more than 200 students and staff.

“It’s just such a scary and confusing time for our communities,” said Chibo Shinagawa, associate director of infectious diseases at the Association of Asian Pacific Community Health Organizations, which leads the Tuberculosis Elimination Alliance.

“The instability, the uncertainty right now — it’s such a disruption to public health, to the trust we’ve built in our communities.”

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

Roger Williams Medical Center in Providence, R.I. A new study shows that women with breast cancer living in Rhode Island and other states that expanded Medicaid eligibility were less likely to die from the disease. (Photo by Michael Salerno/Rhode Island Current)

Women with breast cancer living in states that expanded Medicaid eligibility were less likely to die from the disease — but not everyone benefited equally, according to a recent study published in the medical journal JAMA Network Open.

Researchers from Howard University, the University of Alabama, Henry Ford Hospital in Michigan, and others looked at data from about 1.6 million women ages 40 to 64 who were diagnosed with breast cancer between 2006 and 2021.

They compared survival rates among women living in states that expanded Medicaid eligibility under the Affordable Care Act, commonly known as Obamacare, with the rates in states that did not expand. About 58% of the women lived in expansion states, and roughly 42% lived in nonexpansion states. States began expanding Medicaid in 2014.

The researchers found that Medicaid expansion was associated with lower overall mortality — no matter the disease stage, race or ethnicity, or neighborhood income of the women. Women in expansion states whose cancer had spread to other organs — the most advanced stage of disease — saw the most significant decline in deaths.

Among racial and ethnic groups, the largest relative gains were among Hispanic women — they were 19% less likely to die if they lived in an expansion state. There were smaller gains among non-Hispanic Black women and residents of low-income areas. The smallest difference was among white women.

Hispanic women’s large gains could be due to many previously lacking insurance, said Dr. Oluwasegun Akinyemi, senior research fellow at the Howard University College of Medicine’s Clive O. Callender Outcomes Research Center and a coauthor of the study.

Black women have higher breast cancer death rates compared to white women, even though there are fewer cases among them, partly because they are often diagnosed with the disease at a later stage.

Overall, Black women with breast cancer benefitted less from Medicaid expansion than other groups because they are disproportionately located in the South, where most states have not expanded, Akinyemi noted. The expansion holdout states include Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee and Texas.

The remaining three nonexpansion states are Kansas, Wisconsin and Wyoming.

The researchers also compared mortality rates in low- and high-income neighborhoods. Women living in the highest-income neighborhoods, as well as those who received immunotherapy treatment, had lower mortality rates. Akinyemi said that result suggests that coverage leads to greater access to treatment.

In July, President Donald Trump signed a broad tax and spending bill  that will cut federal Medicaid funding by more than $900 billion over the next decade. As a result, about 15 million people may lose Medicaid coverage, according to estimates by the Center on Budget and Policy Priorities.

Editor’s Note: Because of inaccurate information provided to Stateline, an earlier version of this story misstated the position of Dr. Oluwasegun Akinyemi. Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Robert F. Kennedy Jr. promotes "real food" at a rally in Harrisburg, Penn., last month. Over the next decade, obesity rates across the nation could surge to close to half of U.S. adults, a new study says. (Photo by Whitney Downard/Pennsylvania Capital-Star)

Over the next decade, obesity rates across the nation could surge to close to half of U.S. adults, a new study published in the medical journal JAMA estimates.

Researchers at the University of Washington conducted the analysis using body mass index data from the National Health and Nutrition Examination Survey and self-reported weight data from a national survey of adults ages 20 and older. They examined the 2022 rates and created estimates for 2035 based on current trends. The researchers also looked at race, ethnicity and state-level data, finding wide disparities across states and racial groups.

About a fifth of U.S. adults were living with obesity in 1990. By 2022, the percentage increased to nearly 43%. Obesity was more prevalent in states in the Midwest and South.

If current trends continue, about 47% of U.S. adults will be living with obesity by 2035, according to the researchers. Obesity rates are projected to increase among Americans of all ages and racial groups.

In 2022, non-Hispanic Black women had the highest age-standardized obesity rate, at about 57%, followed by Hispanic women at 49%. Hispanic males, non-Hispanic white males and females, and non-Hispanic Black males had similar rates, ranging from about 40% to nearly 43%.

The study comes amid exploding demand for weight-loss drugs, and as U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. continues to push his Make America Healthy Again campaign.

HHS and the U.S. Department of Agriculture last month made changes to the federal food pyramid, placing a greater emphasis on animal protein, dairy and fats. Like the previous guidelines, the new pyramid discourages the consumption of processed foods, which can cause weight gain.

Despite disparities between men and women and between racial groups, HHS says its nutrition strategy moves away from the “health equity” focus of the Biden administration, in favor of making “the health of all Americans the primary goal.”

For Hispanic people, obesity rates were generally higher in states in the Midwest and the South in 2022, a pattern that is expected to continue through 2035.

In 2022, the obesity rate for Hispanic women was highest in Oklahoma, at about 54%. For Hispanic men, the rate was highest in Indiana, at roughly 47%. In 2035, Indiana is projected to have the highest rate of obesity among Hispanic men at about 54%, while the highest rate for Hispanic women, nearly 60%, is expected to be in South Dakota.

The Midwest and South also had high rates of obesity for non-Hispanic white men and women. In 2022, West Virginia had the highest obesity rates for white men and women — about 47% and 49%, respectively. In 2022, obesity rates for white men and women were lowest in the District of Columbia, at roughly 24% for men and 26% for women.

Among Black women, obesity rates were over 50% for all states, except Hawaii, in 2022. That pattern is expected to continue through 2035. Black men have lower obesity rates than Black women across all states. In 2022, the highest obesity rate for Black men was in Oklahoma, at about 44%. That rate projected to rise to 49% in 2035.

“While no locations were predicted to have decreases in obesity prevalence between 2022 and 2035, there were many with small increases over this time,” the authors wrote. They pointed to Mississippi, where Black women had the highest obesity rates between 1990 and 2022, but are projected to see one of the smallest changes — an increase of about 1.8% — by 2035.

“Predictions in states with historically high levels of obesity, such as Mississippi, suggest that the prevalence of obesity may be plateauing in some locations,” the researchers wrote.

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