Wisconsin will now require additional coverage of breast cancer screenings for women with dense breast tissue, which puts them at a higher risk for cancer. 

Gov. Tony Evers signed SB 264, now Wisconsin Act 103, in the state Capitol Thursday while surrounded by the family of Gail Zeemer, a Neenah woman who advocated for the measure before she died in June 2024 at the age of 56 and for whom the law is named.

“The system failed Gail. However, in the face of adversity and unimaginable struggle, she chose to persevere,” Evers said. “Now, thanks to Gail, Wisconsin will have not one, but two laws on the books to protect women’s health.” He added that the bill would ensure that women at higher risk won’t “be left behind.”

Zeamer was diagnosed with Stage 3 breast cancer in 2016. According to WPR, she had been getting annual mammograms, but she was never told she had dense breast tissue or of the increased risks associated with breast density. According to the Breast Cancer Research Foundation, nearly half of women over 40 have dense breast tissue.

Zeamer headed up an advocacy effort for a measure that became law in 2017 that requires health care facilities to notify women if they have dense breast tissue. When they are notified, women are also encouraged to follow up to discuss risk and the potential need for further screening. 

According to a 2019 study from Susan G. Komen, the average out-of-pocket cost of a diagnostic mammogram was $234 on average and the average cost for a breast MRI was $1,021 on average. 

“Despite its prevalence, roughly a quarter of women with breast cancer are not diagnosed until the cancer has progressed to stage three. As a cancer survivor myself, my family and I were blessed to have caught it, but anyone who has faced this terrible disease knows that the key is getting as far ahead of it as you can,” said Evers, who was diagnosed with esophageal cancer and  underwent treatment for it in 2008. “Breast cancer is already one of the costliest cancers to treat. With these changes today, we’re ensuring no woman slips through the cracks because they weren’t able to afford additional tests that were covered by insurers.”

The law will require health insurance policies to provide coverage for diagnostic breast examinations and for supplemental breast screening examinations for women with dense breast tissue with no patient cost-sharing requirements.

The bill received unanimous support in the Assembly despite having previously been held up due to opposition from Assembly Speaker Robin Vos (R-Rochester). Vos had said recent federal changes made changes in breast cancer screening coverage unnecessary. Advocates disagreed.

Zeamer’s daughters, Claudia and Sophie, spoke about their mother’s strength in advocating for changes even as she battled cancer. 

“I feel very lucky knowing that my mom is now part of history, and I miss her more than ever, but I also know that she’s looking down on all of us with that big, beautiful smile of hers, knowing that we finished this for her,” Claudia said. “I wish more than anything that she could be here to see what she started and to see how many lives she’s going to help in the future.”

The American Cancer Society estimates that more than 6,000 women in Wisconsin will be diagnosed with breast cancer this year, and more than 600 lose their lives to cancer annually. Women with dense breast tissue are at higher risk and dense breast tissue can make it harder for radiologists to see cancer on mammograms, meaning that additional screening could help catch cancer earlier. 

“There was no doubt after she lost her battle, we would finish this for her,” Claudia said.  “She wasn’t doing it for attention or recognition. She did it because she cared so deeply about other people.” 

“My mom taught me what it really means to be selfless to do something,” she added, “not because you’ll get anything out of it, but because, you know, it might make someone else’s life better.” 

Sophie thanked the lawmakers, including bill coauthors Sen. Rachael Cabral-Guevara (R-Appleton) and Rep. Cindi Duchow (R-Town of Delafield), and advocacy groups including the American Cancer Society and Susan G. Komen.

“My family would like to extend our most heartfelt gratitude to everyone who helped make my mom’s final life’s work come to fruition,” she said. “This has been an emotional roller coaster for our family and for all involved, but persistence and the determination to make Wisconsin better for everyone has gotten us to this point today.”

The Early Detection Saves Lives Coalition, which advocated for the legislation, celebrated the signing in a statement. 

“Gail’s Law is a decisive step toward closing a critical gap in women’s health,” said Jyoti Gupta, who is the president and CEO of women’s health and X-ray for GE HealthCare. “No woman should face delays in breast cancer diagnosis because she cannot afford the imaging needed to complete her screening. By removing cost barriers to medically necessary exams, Wisconsin is helping ensure breast cancers are detected earlier, when treatment is most effective and survival rates are highest.”

As Evers signed the bill, Zeamer’s husband, Steve, wiped away tears. The crowd of advocates and lawmakers cheered.

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Gov. Tony Evers signed SB 23, now 2025 Wisconsin Act 102 on Wednesday, officially making Wisconsin the 49th state to provide a year of coverage for postpartum mothers on Medicaid. 

“It’s been a long time coming, but I’m darn proud we got it done,” Evers, who signed the bill at Children’s Hospital in Milwaukee, said in a statement. 

Evers first proposed Wisconsin submit a waiver to the federal government to extend Medicaid coverage from 60 days to 12 months in his 2019 state budget, but years of legislative gridlock on the issue made Wisconsin the second to last state to make the change. 

According to KFF, the Medicaid program pays for about four in 10 births in the U.S. and federal law had required states to provide Medicaid coverage for postpartum mothers through 60 days. The American Rescue Plan Act gave states the option to extend Medicaid postpartum coverage to 12 months, and most states took steps towards expansion.

“We knew from the get-go that getting this passed was an uphill battle, but we also weren’t going to let partisanship or politics stop us from continuing our work to build support for this important proposal, because we know just how high the stakes are,” Evers said in a statement. 

Assembly Speaker Robin Vos (R-Rochester), who is retiring, was the main reason for the hold up. Articulating his opposition to the expansion, which he previously refused to bring to the floor, he said he was opposed to expanding “welfare.” A group of Republican lawmakers, including lead authors Sen. Jesse James (R-Thorp) and Rep. Patrick Snyder (R-Weston), lobbied for Vos to let the bill through as Democratic lawmakers applied pressure through procedural moves to try and force votes on the legislation. A breakthrough came the night before Assembly lawmakers’ final regular floor session this year. 

The bill passed in the Assembly 95-1. It passed the Senate 32-1. Rep. Shae Sortwell (R-Two Rivers) and Sen. Chris Kapenga (Delafield) were the sole opposing votes.

The expanded coverage, which will be available starting on July 1, means low-income mothers on Medicaid and their babies, who automatically get a year of coverage, will have Medicaid coverage for the same length of time. The only state in the U.S. left that has not implemented the expansion is Arkansas. 

According to the Wisconsin Department of Health Services, about half of pregnancy-related deaths occur in the postpartum period and 95% of those deaths are preventable. Black mothers are more than twice as likely as their white, non-Hispanic peers to die from complications of pregnancy and childbirth.

“Research has shown us that expanding postpartum coverage leads to improved maternal and birth outcomes, thanks to more folks being able to access the care they need when they need it — and without breaking the bank,” Evers said. “Now more than ever, we should be working to make healthcare more affordable and more accessible, not making it more expensive and harder for folks — including new moms and families — to get the care they need.”

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A federal judge in Massachusetts has halted enforcement of several key vaccine policies imposed by Health Secretary Robert F. Kennedy Jr., ruling that the Trump administration illegally overhauled a Centers for Disease Control and Prevention committee dedicated to issuing immunization recommendations.

The decision, which comes in response to a lawsuit filed by the American Academy of Pediatrics last July, temporarily blocks the enforcement of all recommendations voted on by the panel. That includes the overhaul of a decades-old recommendation that all newborn babies receive a vaccine against hepatitis B, a push to emphasize the risks of COVID-19 vaccines and a ban on vaccine preservatives like thimerosal. 

The ruling also temporarily halts participation from 13 of the panel’s 15 members, complicating a meeting that was scheduled to begin later this week.

The CDC’s committee, known as the Advisory Committee on Immunization Practices, is charged with setting national guidelines around which people should be vaccinated against a wide range of preventable diseases and when those vaccines should be administered. The recommendations play a key role in determining which vaccines insurance companies are willing to cover and how accessible those immunizations are to the public.

Last June, Kennedy abruptly dismissed all 17 members of the committee and replaced them with a slate of hand-picked appointees, many of whom are seen as vaccine skeptics. In his Monday decision, District Court Judge Brian E. Murphy ruled that the Trump administration likely violated the Administrative Procedure Act by failing to appoint qualified, nonpartisan experts, as the panel’s charter requires.

By ignoring those requirements, “the Government has disregarded those methods and thereby undermined the integrity of its actions,” Murphy’s ruling reads.

Dr. Andrew Racine, the president of the American Academy of Pediatrics, celebrated the ruling, calling it “a historic and welcome outcome for children, communities, and pediatricians everywhere.”

“For decades, the AAP partnered closely with the federal government to advance our mission of attaining the optimal health and well-being of children and youth,” Racine added. “We would much prefer to return to that partnership and collaborate with federal healthcare agencies instead of litigating against them.”

A spokesperson for the U.S. Department of Health and Human Services did not immediately reply to a request for comment.

In an extraordinary break from the federal government, the public health departments of at least three states and New York City are joining the global alert network of the World Health Organization, spurred by President Donald Trump’s decision to remove the United States from the United Nations agency responsible for coordinating international public health.

So far, the state public health departments in California, Illinois, New York, as well as the public health agency in New York City, have joined the Global Outbreak Alert and Response Network (GOARN), which is part of the World Health Organization (WHO). The U.S. officially left the WHO this past January.

California joined GOARN in January, while Illinois, New York state and New York City joined last month.

GOARN, which includes more than 310 national public health agencies, United Nations agencies, academic institutions, and nongovernmental groups, helps identify and manage infectious disease outbreaks worldwide. Since it was established in 2000, GOARN says it has helped manage more than 175 global health emergencies across 114 countries.

GOARN maintains relationships with some medical and research institutions in the U.S., including the Tulane University School of Public Health and Tropical Medicine in New Orleans and university medical centers in Nebraska and Texas. Until now, however, state public health agencies have not been members, because they relied on the U.S. government’s participation in GOARN for information on global outbreaks.

Dr. Ali Khan, a medical epidemiologist who is the dean of the College of Public Health at the University of Nebraska Medical Center and a former member of the GOARN steering committee, said the COVID-19 pandemic highlighted how “disease has no borders” and the importance of sharing information globally to quash the spread of contagious diseases.

Khan said the Trump administration’s withdrawal from the WHO “throttles the information from WHO to the U.S. government, specifically the [federal Centers for Disease Control and Prevention], and which then flows to states. Those states are now left in a position where they’re joining the GOARN.”

“Let’s be clear, it doesn’t substitute for the U.S. withdrawal from the WHO, but it does allow states to directly get information about what’s going on globally that may impact their own citizens. So it allows them to sort of keep their own radar on when the U.S. has decided to no longer participate in this global information sharing.”

In explaining its decision to withdraw from WHO, the Trump administration said the U.S. had “for decades carried a disproportionate share of the organization’s financial burden.” It insisted the country would “continue to ensure detection and response to infectious disease outbreaks” without being a member of the organization.

“These are the same democrat-led states and cities that imposed unscientific school closures, toddler mask mandates, and vaccine passports during the COVID era,” Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, wrote in an email.

“They are the ones who destroyed public trust in public health that we are now restoring. We are working with the White House in a deliberative, interagency process on the path forward for global health and foreign assistance that first and foremost protects Americans.”

Dr. James McDonald, commissioner of the New York State Department of Health, told Stateline that the department’s decision to partner with GOARN was apolitical, and that it makes sense for New York because the state is “the world’s gateway to the country.”

“Everybody comes to the United States. Many come through JFK [John F. Kennedy International Airport], but an outbreak in the Democratic Republic of Congo does matter to me, so learning about it sooner helps protect New Yorkers and also helps protect the United States,” McDonald said.

McDonald added that New York is a part of a new public health consortium of Northeast states — the Northeast Public Health Collaborative — and plans to share any information it gathers from GOARN with fellow members Connecticut, Delaware, Maine, Maryland, Massachusetts, New Jersey, Pennsylvania, Rhode Island, and Vermont. New York City also is a member of the consortium.

“One of the things about scientists and health care providers is we’re used to just sharing information with each other, sharing knowledge. It’s not political,” McDonald said.

Doua Yang, a spokesperson for the California Department of Public Health, said that even before officially joining GOARN in January, the agency had been attending weekly operational calls for several months, and even made a presentation on how it has handled bird flu outbreaks.

“As the fourth-largest economy in the world, California cannot afford to let down its guard, or its people,” Yang wrote in an email. “Participating with GOARN is one step California is taking to maintain uninterrupted communication with WHO and protect the state from potential health threats.”

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

Twenty-nine states and the District of Columbia now reject at least some federal vaccine guidance as the federal Centers for Disease Control and Prevention continues to de-emphasize the importance of childhood vaccinations under U.S. Health and Human Services Secretary Robert F. Kennedy, Jr., according to research by KFF, a nonprofit health policy organization based in California and Washington, D.C. 

The tally as of March 10 reflects states that have announced they will go their own way on childhood vaccines since last May, when Kennedy began to make changes to the vaccine schedule. Those changes culminated with a reduction in recommended routine childhood vaccinations, from 13 to 7, as of January. 

New state-by-state recommendations reflect a partisan divide, as all states with Democratic governors have rejected federal childhood vaccine guidance while many Republican states have not. 

Virginia announced in February that it would not follow CDC guidelines, a change after the inauguration of Democratic Gov. Abigail Spanberger, who took over after a Republican predecessor. Spanberger had campaigned on the issue, saying she would not support a rollback of childhood vaccinations.

In Florida, the state Senate passed a bill March 9 making it easier for parents to let their children go unvaccinated, though state House leaders have said they will not consider a similar bill despite support for it from Republican Gov. Ron DeSantis. 

In Louisiana, the state has adopted a policy of not promoting vaccines or holding clinics. Republican U.S. Sen. Bill Cassidy, a physician who reluctantly agreed to Kennedy’s confirmation despite objecting to his views on vaccines, is facing a primary fight. 

Fifteen Democrat-led states sued Kennedy in federal court in February, seeking a reversal of the new vaccine guidelines. A preliminary hearing is scheduled May 29.

Some states have created formal alliances to share health information. The Northeast Public Health Collaborative, composed of Connecticut, Maine, Maryland, Massachusetts, New Jersey, New York state, Pennsylvania, Rhode Island, Vermont and New York City, said in January it will continue following guidance from the American Academy of Pediatrics instead of the federal government.

The American Academy of Pediatrics released its immunization schedule for 2026, which kept in place the schedule as it was before HHS’s overhaul. Twelve medical professional organizations endorsed the academy’s schedule. 

And governors of 14 states have formed another alliance to share public health information, including on vaccines. The updated CDC guidance “creates confusion and introduces unnecessary barriers for families who want to protect their children from serious illness,” said the Governors Public Health Alliance in a January news release. The governors are all Democrats, though the group says it is nonpartisan.

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

Thousands of low-income people living with HIV could be losing drug coverage as states impose limitations on HIV assistance programs amid constrained budgets — raising alarms over consistent access to lifesaving medications.

Many factors are putting budget constraints on state programs, including federal funding — which has remained flat for years and hasn’t been adjusted for inflation — increased drug costs and rising insurance premiums.

The Ryan White HIV/AIDS Program is the national safety-net program supporting more than 600,000 low-income people living with HIV across the nation. States receive federal grants and drug rebate money — the latter making up the bulk of state program budgets — to, among other things, help pay for medications and support community groups and specific populations, such as women and children.

Congress has kept key drug assistance funding at $900.3 million annually since 2014. New enrollments for state programs jumped 30% from 2022 to 2024, in part because states cut off pandemic-era Medicaid assistance.

As of January, at least 18 states have pulled back their Ryan White AIDS Drug Assistance Programs, known as ADAPs, in some way, according to a March 2 analysis by health research group KFF and a report by the National Alliance of State and Territorial AIDS Directors, which offers consultation for states.

There are roughly 1.2 million people in the United States living with HIV, and about 1 in 4 people get support from a state drug assistance program.

A disproportionate number of HIV/AIDS patients are gay, bisexual and other men who have male-to-male sexual contact, according to the federal Centers for Disease Control and Prevention. LGBTQ+ communities have been targeted in recent years by some federal and state policies, including the rollback of civil rights, shutting down a youth mental health hotline, restricting health care access, and imposing discussion and book bans in public schools.

Florida has introduced the most dramatic restrictions on income eligibility for its HIV drug program — cutting individual eligibility for the program from 400% of the federal poverty level to 130%. That means uninsured and underinsured people up to that 400% poverty line no longer have coverage under the program.

That’s roughly slashing maximum annual income of $63,840 for an individual down to $20,748. The state says the change will prevent a $120 million shortfall.

“(That) creates an immense coverage cliff,” for example, for childless adults not eligible for Medicaid, said Amber Tynan, CEO of Big Bend Cares, a North Florida Ryan White provider. Florida is among the 10 states that haven’t expanded Medicaid eligibility under the Affordable Care Act.

Florida’s department of health didn’t respond to Stateline’s request for comment.

Delaware, Kansas, Pennsylvania and Rhode Island have also reduced income eligibility for their programs, but to a lesser extent, according to KFF. For example, Kansans with HIV/AIDS whose incomes are above 250% of the federal poverty level won’t be eligible for help with Obamacare insurance premiums. That change will affect about 230 people, the National Alliance of State and Territorial AIDS Directors estimates.

In Pennsylvania, about 1,600 people will lose HIV drug assistance coverage as the state imposes income eligibility caps at 350% of the federal poverty level.

“We cannot continue to provide services at a certain level when the funding to do so does not exist,” Neil Ruhland, Pennsylvania Department of Health press secretary, told Stateline in a statement. He pointed to drug costs and enrollment numbers that are “steadily rising while funding remains stagnant.”

Florida also is removing the brand-name drug Biktarvy, which is the only single-tablet HIV medication regimen recommended by national guidelines for those starting treatment and is the most widely prescribed antiretroviral medication nationally. There is no generic form.

The medication is highly effective at reducing a person’s viral load, meaning the virus is undetectable in blood tests and untransmittable to others.

Eighty percent of Floridians with HIV who are in the state’s program use Biktarvy, Tynan said.

“Not having the opportunity to stay on lifesaving treatment is creating quite the panic and crisis for our population,” Tynan said. “For decades we’ve worked to turn HIV from a fatal diagnosis into a manageable chronic condition, and that progress depends on one thing: consistent access to treatment. When that stability is disrupted like it has (been) in Florida, it creates real risk for patients and for public health.”

Other states (Arizona, Michigan, Pennsylvania, Rhode Island, Virginia and Washington, plus the District of Columbia) also are considering limiting which drugs they cover, according to the alliance’s report.

And several other states may impose other limits to their drug assistance program. Health agencies in Hawaii, Idaho, Montana, New Jersey, South Carolina, Virginia and Washington are considering cutting funding for core medication and support services. Others are considering implementing a six-month recertification period, restricting eligibility, putting caps on expenditures, changing covered medications and lowering assistance for insurance premiums.

While no state has implemented a waiting list for drug assistance, three states — Arkansas, Louisiana and New Jersey — are considering one as a future cost-containment measure, according to the national alliance’s report.

Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center, said many of her HIV patients are under-resourced and rely on her state’s Ryan White program. She added that she’s relieved Massachusetts’ program hasn’t announced any changes as of February, when the alliance’s report was released, but that she’s worried for patients in the other states.

“We’ve taken HIV from a very serious virus, a deadly virus when it was first discovered in the ’80s, to a very manageable chronic condition because of the medicines,” she said. “It is concerning to see … that we’re sort of moving backwards by not providing that kind of care that’s so much needed, and that’s lifesaving.”

Florida bypassed a rulemaking process when it announced its changes days before open enrollment ended. In late January, the AIDS Healthcare Foundation, a global nonprofit agency, sued the state department of health over the changes. The U.S. Centers for Medicare & Medicaid Services opened a new enrollment period for Floridians losing coverage to enroll in a different marketplace plan.

In late February, Florida issued an emergency rule putting the new eligibility requirements into effect. About 32,000 Floridians get help from the state program in some way — whether it’s through local health departments or the state helping to pay for insurance premiums.

Half of those, around 16,000, will lose coverage entirely — but many others will be affected in other ways, such as losing access to Biktarvy.

“So if you remain in the program, there’s a very high likelihood that you’re still going to be impacted by some of the other changes, like the dropping of the premium assistance, the elimination of Biktarvy from the formulary,” said Tim Horn, director of medication access for the National Alliance of State and Territorial AIDS Directors. “When you take a look at all of these changes in the net, the vast majority of Florida ADAP clients are going to be impacted by this, one way or another.”

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

Fewer Wisconsin children and adolescents got vaccinated last year for many childhood illnesses, raising the risk of outbreaks and clusters that could lead to more widespread illness, the state health department reported Monday.

Vaccination rates for a group of seven childhood diseases that public health experts recommend in the first two years after birth fell to 66.9% in 2025. In 2024, the rate was 68.8%, according to the Department of Health Services.

“While nearly seven out of every 10 children had the recommended vaccines in this series by 24 months of age, we know that three out of 10 kids did not,” said Stephanie Schauer, who manages the Wisconsin immunization program for DHS. That’s a decline of almost 2 percentage points — about 1,200 children, she said at an online press briefing Monday.

“We use data like this as an alert system,” said Paula Tran, state health officer and administrator at the DHS Division of Public Health, said in a DHS statement. “Today that alert system is sending a clear signal that the health and well-being of Wisconsin kids and communities are at risk.”

Details of vaccination rates for children and adolescents are published on the Department of Health Services website. 

In 2025, 79.8% of children 2 or younger were fully vaccinated against measles — dropping below 80% for the first time. In 2013, 88.2% of Wisconsin 2-year-olds were fully vaccinated with the MMR vaccine, which protects against mumps and rubella as well as measles.

“Measles is a very infectious disease and really requires a very high level of immunity in a community such that it won’t spread,” Schauer. “So it is something that we are concerned with as we continue to see that drop.”

Measles outbreaks have been popping up across the country in the last year especially. The MMR vaccination rate in Wisconsin has been slowly but steadily declining over the last dozen years, and last year it fell by 1.6 percentage points from 2024.

“That’s headed in the wrong direction. We need more children protected, not fewer,” Schauer said. “We really need to be closer up around 95% of a community protected so that we don’t have an outbreak if measles is introduced into a community.”

With spring break coming soon and with it travel plans, the health department is also encouraging families to review their children’s measles immunization records, Schauer said, because most recent measles outbreaks and clusters across the country “are due to individuals who have been traveling where measles is occurring and then bringing them back.”

There have been some positive trends, Schauer said. In contrast to most other vaccine types, the rates of vaccine against meningitis — which is given in adolescence — have been increasing over the last decade and the last couple of years in particular.

She attributed the increase both to increased awareness and to the health department’s addition of the vaccine in 2024 to the list of required shots for students going into grades 7 and 12. Previous attempts to add the meningitis vaccine to the required list were blocked by the Republican majority on the state Legislature’s Joint Committee for the Review of Administrative Rules.

With more families asking about the meningitis vaccine and more doctors talking about it with their patients, “that shows that school immunization requirements can and do help ensure that our kids are protected,” Schauer said

Schauer said there are two broad reasons for the decrease in vaccinations: public mistrust and lack of access.

“We understand that there’s a lot of misinformation and disinformation out there, that maybe people are questioning vaccines, or they may be delaying or spreading vaccines out,” she said.

To overcome mistrust, the state health department looks to health care providers to serve as the best messengers to the families in their care. Research has shown that 86% of the public “had a fair degree of confidence in their primary health care providers to provide them information on public health matters, and that would include vaccines,” Schauer said.

“We continue to recognize that parents have questions, and that’s appropriate and OK, but we want to make sure that they’re getting those questions answered,” Schauer said.

The message to families is to encourage them to turn to their health providers with questions, she added, “so that they can feel reassured that providing vaccines is really the most safe and effective way of preventing some of these really nasty diseases.”

Others, however, may lack any information at all about vaccines, have difficulty getting access to them because they lack regular access to health care.

Vaccines for Children, a program in place for more than 30 years, is intended to make it possible for families whose health care is covered by Medicaid or who have no insurance or inadequate insurance to get the vaccines they need, Schauer said. The program is also available to Alaska Native and American Indian children.

DHS lists providers across the state who participate in the Vaccines for Children program. More than 720 pharmacies and other providers take part, and the department continues to recruit more.

“We don’t want any children to go without vaccines because they weren’t aware of this program,” Schauer said.

DHS also funds 25 community organizations and tribal health departments in a program to make connections in their communities. Those agencies are “the trusted messenger and talking about vaccines and vaccine safety and why they are important in their communities,” she said.

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Nearly one-third of the nation’s private sector workers are covered by paid leave programs as more states require employers to provide medical and family leave, according to a new analysis released this week.

Currently, the District of Columbia and 13 states have passed laws requiring paid leave for many workers, according to a report from the National Partnership for Women & Families, a nonprofit that advocates for reproductive rights, health and economic justice, and workplace equality.

“States have shifted the paradigm now that more than 46 million workers across the U.S. are covered by paid family and medical leave programs, pointing the way forward for the rest of the country,” Jessica Mason, senior policy analyst at the organization, said in a news release. 

The programs vary in design, but generally guarantee paychecks while workers take time off for illness or to care for a child or other loved one. They’re funded through employer and employee premiums similar to unemployment insurance or payroll taxes that cover a portion of employee wages when they take leave.

The report cites research showing multistate employers often respond to local paid sick leave laws by providing paid sick leave to their workers even in places without such requirements.

This year, Delaware, Maine and Minnesota began or planned to start offering benefits through new paid leave programs. And the report cites growing momentum in six more states: Hawaii, Illinois, Nevada, New Mexico, Pennsylvania and Virginia. If those states were to implement paid leave policies, 44% of workers nationwide would have access to paid family and medical leave, according to the analysis. 

In Virginia, lawmakers in both chambers have approved bills guaranteeing up to 12 weeks of paid family leave. While previous efforts were vetoed by former Republican Gov. Glenn Youngkin, current Democratic Gov. Abigail Spanberger is expected to sign a bill once a final version makes it to her desk, the Virginia Mercury reported. 

In a January address to the legislature, Spanberger said that “being pro-business and being pro-worker are not mutually exclusive.”

“We can support business growth and invest in our workforce. We can attract new companies and protect workers. … That is why we will create a statewide paid family and medical leave program.” 

Virginia is projected to spend about $116.51 million in startup costs over the 2027 and 2028 fiscal years. By 2031, the program is expected to spend $2.1 billion per year in benefits — funded by payroll tax collections. 

Opponents frequently cite the costs of paid leave programs and the burdens they place on businesses. Last month, Virginia Republican state Del. Michael Webert said large corporations may be able to afford new costs and administrative burdens, but not smaller employers. 

“The impact will not fall evenly,” he said ahead of the House vote last month.

Across much of the Midwest and South, state laws prohibit local governments from requiring employers to provide paid sick leave. In 18 states, cities are effectively stripped of the power to enact their own labor protections.

Stateline reporter Kevin Hardy can be reached at khardy@stateline.org.

Attending the State of the Union Address last month as Congresswoman Gwen Moore’s guest was, in a word, surreal.

As a child care provider and small business leader in Wisconsin, I spend my days thinking about how rising costs affect my staff and the families whose children we care for. I never imagined I would one day sit in the Capitol for an address like this.

Watching at home does not capture the scale of it: the formality, the history, the gravity of the room.

Last year, for the first time in my life, I began speaking publicly about health care affordability. For years, I relied on Affordable Care Act enhanced tax credits to afford my own coverage. When those credits expired, I watched members of my team face impossible decisions: pay dramatically higher premiums or go without health insurance altogether. That is not an abstract policy debate for us; it is a real and immediate stressor.

Congresswoman Moore invited me to share those experiences. She  and I had many conversations about the realities facing working families, including how the expiration of those tax credits is affecting millions of Americans, particularly the educators and families I see every day. We talked about the pressure of rising rent, utilities, groceries, child care and other costs, and how health care is increasingly becoming the expense that pushes families over the edge.

So when I took my seat in the Capitol, surrounded by university presidents, members of the military and leaders from across the country, I listened carefully.

I hoped to hear a serious plan to address health care costs.

Instead, health care received only brief mention in what I later learned was the longest State of the Union address in American history.

The President spoke about a “golden age” and a booming economy. But for whom? And in what parts of the country?

That’s not the reality I see.

Certainly not in the everyday lives of the people who form the foundation of our workforce: the teachers, farmers, caregivers, service workers and small business owners I interact with every day.

A golden era for a select few does not make a golden era for a country.

Not for teachers standing in classrooms.

Not for farmers working their fields.

Not for the caregivers, service workers and small business owners whose work sustains our communities.

They are the threads in the quilt that holds this country together. When policies ignore their struggles or make basic necessities like health care more expensive, those threads begin to fray.

Nearly 44% of U.S. adults say it is difficult to afford health care right now. Premiums have doubled, tripled or even quadrupled for millions of families following the expiration of enhanced ACA tax credits, a policy decision now affecting nearly 22 million Americans.

More than one million Americans have already dropped coverage, including more than 20,000  Wisconsinites.

We all know there are people behind those numbers.

They are assistant teachers deciding whether they can risk going uninsured. They are kitchen staff weighing premiums against rent. They are parents of toddlers delaying doctors’ appointments because another bill is already overdue.

In child care, those decisions ripple far beyond a single household. When educators cannot afford health care, they leave the field, and when they leave, classrooms close and parents lose the care they rely on to go to work. In that way, health care affordability is not just a personal issue; it is a workforce issue and an economic issue for the entire country.

At the same time, proposed cuts of more than $1 trillion from Medicaid and the Affordable Care Act are putting enormous pressure on the health care system itself. Across the country, over 750 hospitals, maternity wards and nursing homes are facing service cuts or closure because of these changes.

Every closure, every service reduction and every essential worker lost means higher costs, longer delays for care and greater risk for families.

None of that made it into the speech.

Meanwhile, billionaires have seen their wealth increase by $1 trillion, and pharmaceutical companies reported more than $130 billion in profits last year alone.

But the working families I know are making impossible trade-offs.

I attended the State of the Union hoping to hear that relief was coming —  that health care affordability would be treated as the urgent economic issue it is for my family, the families we serve at the daycare and for all working families.

Instead, I heard a version of the economy that does not match the reality I see every day.

In our corner of America, parents are postponing appointments. Employees are calculating whether they can risk going uninsured. Small business owners are wondering how long they can keep absorbing rising costs.

Being present in the Capitol did not change that reality.

Because for those of us entrusted with caring for children and for the families who rely on us, health care affordability is not a political talking point.

It is basic survival.

And Americans do not need to be told that we are living in a golden era.

We need to feel it.

That means passing legislation, making real investments, and taking meaningful action that improves the daily lives of the people who hold this country together. It means proving, not just promising, that the American people are worth investing in.

Because a truly golden era is not measured in stock market gains or applause in a chamber.

It is measured in whether everyday families can afford to live, work and care for one another with dignity.

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State Medicaid budgets will be reduced by a total of $665 billion over the next decade, after President Donald Trump’s One Big Beautiful Bill Act cuts federal investment in the health insurance program, according to a new analysis.

Researchers from RAND Health, a policy and research nonprofit, analyzed state and federal data to estimate how much the loss of federal money will affect state Medicaid budgets, publishing their findings late last month. Medicaid is the public health insurance program for people with low incomes, jointly funded by state and federal money.

Overall, the net impact on state budgets, apart from their Medicaid programs, will be a reduction of $86 billion, according to the report. That number is lower than the total reduction in Medicaid budgets because while some states will have to spend more money from their general funds to cover Medicaid losses, others will have to spend less.

New federal rules such as work requirements for some Medicaid enrollees are designed to reduce the number of people on Medicaid, which means states that cover those people would no longer have to pay their share of those medical bills, saving them money. But many states use financial strategies, such as “provider taxes,” to qualify for extra federal Medicaid money. The new law limits their ability to do that, and that will force them to dip into their general funds to cover the loss of revenue.

“The effects of the law on Medicaid budgets and enrollment are substantial, but will vary widely across states, and in some cases may be at least partially offset by savings to the state general fund,” said Preethi Rao, a senior economist at RAND and lead author of the study, in a statement.

By 2034, Medicaid will have 7.6 million fewer enrollees, the authors estimated. The federal government will save about $714 billion from 2025-2034.

Arizona, Iowa and Nevada will see their Medicaid budgets reduced by more than 15%.

California and New York will see the biggest total drop in their Medicaid budgets, $112 billion and $63 billion, respectively.

At the other end of the spectrum, states that don’t rely as heavily on financing strategies like state-directed payments and provider taxes, won’t see such a significant impact. Florida is likely to see less than half a percent change to its Medicaid budget, the report found. North Dakota and Nebraska are also likely to see minimal impacts because their losses are expected to be offset by increased federal rural health funding.

State general funds in Tennessee, Mississippi, Oklahoma and Kentucky could see more than a 2% savings due to lowering Medicaid enrollment or reducing the types of care covered, the report found.

A few states with small Medicaid populations are expected to see an increase in their budgets due to that rural health program funding, including Wyoming and South Dakota.

“As states plan for the upcoming changes in funding and eligibility, understanding these state-specific differences will be important,” Rao said.

Stateline reporter Anna Clare Vollers can be reached at avollers@stateline.org

Editor’s note: This is the first report in an ongoing series.

The patient came in with a belly full of blood, Dr. Leilah Zahedi-Spung recalled. Her pregnancy was ectopic, no longer viable, and could have killed her if left untreated. But when she went to a mobile pregnancy help center offering free care in an RV in St. Louis, she was told the pregnancy could be saved.

By the time she saw Zahedi-Spung days later, her fallopian tube had ruptured.

In North Lauderdale, Florida, Ieshia Scott was pregnant and in the throes of postpartum depression. She thought she’d arrived at an abortion clinic. She told the staff she might hurt herself if she had another baby. They told her God would give her strength.

A woman and her partner in Sheboygan, Wisconsin, went to a pregnancy help center by mistake. When they made it to a Planned Parenthood clinic across the street, the pregnant patient handed Dr. Kristin Lyerly a copy of the sonogram. But the scan was not of her uterus. It was her bladder.

All three patients had gone to crisis pregnancy centers, organizations that advertise free pregnancy tests and ultrasounds but dissuade women from pursuing abortions and contraceptive options. Since the U.S. Supreme Court ended national abortion access in June 2022, the centers have seen an infusion of taxpayer dollars in many Republican-led states. But medical experts have urged lawmakers to reconsider the state support, as the centers can endanger public health by “causing delays in accessing legitimate health care,” according to the American College of Obstetricians and Gynecologists. 

States Newsroom conducted a 50-state investigation examining state and federal budgets, as well as the tax records of these organizations, finding that while the magnitude of public funding for them is growing, oversight is not. 

Twenty-one states funneled nearly a half-billion dollars, or $491 million, of taxpayer money to crisis pregnancy center organizations between fiscal years 2022 and 2025. That figure does not include millions some states diverted from federal programs like Temporary Assistance for Needy Families, and it does not include multimillion-dollar tax credit programs launched after federal protections for abortion rights were overturned. 

Nearly $1.3 billion in local, state or federal government grants were awarded to 1,259 crisis pregnancy centers in total between 2019 and 2024, according to States Newsroom’s analysis of tax records. The actual figure may be higher, as digital records are not comprehensive or entirely up to date.

Yet that largesse hasn’t been matched by corresponding regulation. Oversight of taxpayer funding remains weak, either blocked by legislators or ignored by state agencies. 

The centers are most often faith-based nonprofits that say they provide much-needed support for pregnant clients at no cost. An estimated 2,633 crisis pregnancy centers were operating in the United States as of March 31, 2024, according to research from the University of Georgia. 

John Mize, CEO of Americans United for Life, argues that pregnancy centers are important for people who really don’t want an abortion, and for anyone who regrets their abortion to find support. 

“I am strongly of the opinion that most women that have abortions do it because they don’t feel like they have any other option,” Mize said.

But critics and researchers say the pregnancy centers mislead potential clients about their services or pose as medical clinics despite lacking proper licensure. They sometimes promote treatments like abortion pill reversal, which is unproven and potentially dangerous. 

“Often, patients are lured in by this idea of getting free care,” said Dr. Rachel Jensen, Darney-Landy complex family planning fellow at the American College of Obstetricians and Gynecologists. “It’s free, because it’s often subsidized by taxpayer dollars. Free health care sounds amazing. It should be available to all people. But the problem is, then, that the CPCs are unregulated — and they operate outside of ethical principles and best care practices.”

Firsthand accounts: ‘What’s your plan for this pregnancy?’ Comfort, shame and a missed diagnosis

Indiana state Sen. Shelli Yoder, a Democrat, said access to maternal health care in her state continues to decrease while support for crisis pregnancy centers increases. Indiana boosted its budget for the centers from $250,000 in 2021 to $2 million, then doubled it to $4 million by 2024. The state’s maternal mortality rate is among the worst in the country. 

“It’s not that these centers don’t serve a purpose. But they certainly are not a replacement for maternal health care, and they are not health care centers, and yet our state is using taxpayer money to fund them as if they are,” Yoder said. “And we are sending a message to moms, or to women, that they are health care centers, and they are not.”  

Zahedi-Spung was working an emergency room shift in 2019 at a St. Louis hospital, not too far from the pregnancy center housed in an RV and frequently parked in front of a Planned Parenthood clinic. She said she was horrified to learn the patient with the ruptured ectopic pregnancy had been told at the mobile crisis pregnancy center a few days before that it could be saved. A tubal ectopic pregnancy is never viable.

Today, Zahedi-Spung works in Colorado as a high-risk OB-GYN. But that experience in the ER still haunts her.

“They’re a private organization providing medical care without a medical license, so they are not liable for anything they tell anyone,” she said.

Andrea Trudden, spokesperson for Heartbeat International, one of the largest pregnancy center networks in the U.S., said that as of 2025, more than 75% of Heartbeat affiliates offer medical services and are different from pregnancy resource centers, which offer parenting classes and material aid but not medical services.

“Medical affiliates that provide limited obstetrical ultrasound or other services follow applicable state laws, professional standards, and clinical protocols,” Trudden said in a written statement.

According to a report from the Charlotte Lozier Institute, 37% of 2,775 crisis pregnancy centers provided testing for sexually transmitted infections, and 29% provided STI treatment in 2024. The institute, which is the research arm of one of the largest anti-abortion policy groups, Susan B. Anthony Pro-Life America, found that 81% of surveyed centers provided ultrasound services in 2024. The report notes that 28% of paid center staff have medical licenses, along with 12% of volunteers.

The only option for miles

In North Florida’s largely rural Wakulla County, there are no full-time practicing OB-GYNs. Wakulla Pregnancy Center is in Crawfordville, the county seat of about 4,800 people. Many women in the area lack transportation, said the center’s director, Pam Pilkinton. They have to travel about 20 miles north to Tallahassee for prenatal care.

Run by a local ministry, the center has a blue-and-white sign that advertises “Free Pregnancy Tests.” Inside, a cozy living room furnished with sofas leads to a counseling room and donation space, where moms peruse a range of free baby clothes and supplies. Most of the center’s clients have low incomes, and are on Medicaid or uninsured.

When Florida passed a six-week abortion ban in 2023, legislators simultaneously increased state funding for crisis pregnancy centers by 455% — from $4.5 million to $25 million. The following legislative session, they added another $4.5 million. 

The funds go to the Florida Pregnancy Care Network, which manages contracts with more than 100 crisis pregnancy centers across the state. The organization is required to report the amount and types of services provided and the expenditures to the governor and state legislature once a year. But it is not required to make any noncompliance findings public. 

The public money for centers in Florida doesn’t end there. Wakulla Pregnancy Center received a separate allocation in the 2025 budget of $136,000. According to the funding request, $60,000 is allocated for a building asbestos issue, and $58,000 pays for the salary and benefits of the executive director and client coordinator. The rest is for pregnancy tests, educational materials, ultrasound referrals and other supplies. 

But Pilkinton is clear about one point: The center does not provide medical care in this maternal health care desert. 

“We’re not a medical facility, and that is something that we let everyone know up front,” Pilkinton said. “We provide material support, education, information and peer counseling.”

That doesn’t include practices like referring a patient to an OB-GYN for prenatal care after a positive test, for example, “because we’re not a medical facility,” she said.

Wakulla County’s severe maternal hospitalization rates ranked among the worst in the state in 2023 and 2024.

Like in other states, maternal health care has continued to flounder in Florida — and shortages are likely to worsen. Nearly half of 1,500 OB-GYNs who responded to a state survey say they plan to stop delivering babies within the next two years. 

The money Florida allocated for pregnancy centers might have covered more maternity care across the state, said Democratic state Rep. Anna V. Eskamani.

“We do need to strengthen our safety nets when it comes to supporting new moms,” Eskamani said. “Instead of addressing those gaps and investing in those areas, we continue to dole out millions of dollars to these unregulated and often religiously affiliated anti-abortion centers that are not addressing any of these disparities.”

In previous legislative sessions, Eskamani filed bills to repeal state funding and introduce regulation of existing centers. The bills have yet to receive a hearing, but she and her colleagues have filed them again.

“These not-for-profit organizations run with very little federal or state oversight, and sometimes they don’t even have licensed medical staff on site,” she said. “At this point, it’s a blank check.”

Big checks, little oversight

Much of the state funding for pregnancy centers did not exist before the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision ended federal protections for abortion rights in June 2022. 

Conservative-led states — such as Texas — that already allocated tens of millions to pregnancy centers have doubled or tripled their budgets for pregnancy resource groups since 2022. In Missouri, lawmakers have budgeted nearly $50 million since fiscal year 2022 from the general fund and federal block grant dollars. Texas’ allocation ballooned from $140 million in fiscal years 2024 and 2025 to $180 million in 2026 and 2027. 

In southwest Missouri, Republican state Rep. Christopher Warwick’s support of the centers is a focus of his reelection campaign.

“I think it’s important that we fund organizations that are willing to save life,” he said.

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Louisiana lawmakers directed $4 million from the state’s general fund to pregnancy centers for 2025, as part of its Pregnancy and Baby Care Initiative. But an audit found the state doled out the maximum amount per center allowed by state law — $100,800 — to most of the groups without requiring them to fully document how they spent it.

Auditors were concerned Louisiana paid the centers more than the cost of the actual services provided.

In Oklahoma, state auditors discovered in 2022 that an anti-abortion nonprofit called Oklahoma Pregnancy Care Network disbursed less than 7% of the $1.6 million it promised to nonprofits under the state’s Choosing Childbirth program. A month and a half before its contract was scheduled to end, the group had served 524 women, less than 6% of the 9,300 Oklahoma women it initially projected it would serve. An administrator with the nonprofit told The Oklahoman she was unaware there were problems.

Despite those findings, state lawmakers later directed nearly $18 million — a quarter of the state health department’s entire budget — toward Choosing Childbirth through November 2027. More than $4 million of it went to the Oklahoma Pregnancy Care Network. The network did not respond to States Newsroom’s requests for comment.

Inner workings

Lyerly, the OB-GYN in Sheboygan, Wisconsin, said the couple with the mislabeled sonogram came into her Planned Parenthood clinic in the early months of 2022. It wasn’t uncommon for patients with appointments at Planned Parenthood to accidentally go to the crisis pregnancy center across the street. This couple sought an abortion, she said, but came in with the ultrasound image of the woman’s bladder rather than her uterus. On top of the mislabeled ultrasound, they felt misled, because they were told the pregnancy was just a few weeks along when it was much more advanced.

“This was a challenging situation for them, was emotional and frustrating and upsetting to them, and it was so unnecessary,” said Lyerly. She stopped providing abortions in Wisconsin later that year when a state law banning the procedure went back into effect after the Dobbs decision.

Many centers are affiliated with umbrella organizations, including Care Net, Heartbeat International (formerly Alternatives to Abortion International) and National Institute of Family and Life Advocates, but often do not disclose that connection on their website. The parent companies provide guidance for operations, including yearly conferences, along with training for limited ultrasounds and other services. Training and funding for many of these centers’ ultrasound programs also come from national religious groups like Focus on the Family and the Knights of Columbus.

Heartbeat International is the largest of the three, with more than 4,000 affiliated service providers across the U.S. and in more than 100 countries, according to Trudden.

Trudden said Heartbeat International offers professional training and practical resources for affiliates, who determine their own governance, leadership and location and must agree to a set of standards also shared by Care Net and the National Institute of Family and Life Advocates. Those standards include practicing honesty and confidentiality with clients and complying with all legal and regulatory requirements. 

Some pregnancy centers are staffed with licensed professionals trained in sonography. The National Institute of Family and Life Advocates says it has trained more than 6,000 health care professionals “in the medical and legal ‘how to’s’ of limited obstetrical ultrasound.” But at its national conference last year, leaders discouraged centers from performing ultrasounds on women who they suspect have ectopic pregnancies to avoid liability. The guidance came in the wake of a lawsuit against a Massachusetts center, in which the plaintiffs alleged that center staff failed to diagnose an ectopic pregnancy that ruptured, prompting emergency surgery. The clinic reached a settlement with the patient. 

Some centers offer more medical services, like prenatal support and testing and treatment for STIs, such as Idaho’s Stanton Healthcare, which is accredited by the Accreditation Association for Ambulatory Health Care and does not receive any public funding. 

“We have caught ectopic pregnancies. … I can think of three in the last eight months off the top of my head,” said Angela Dwyer, Stanton’s director of client services. 

But advocacy groups such as Campaign for Accountability have raised alarms about how many clinics do not have to follow federal health privacy laws, including the Health Insurance Portability and Accountability Act, known as HIPAA.

Clinics that offer free services and do not bill insurance face no penalty for disclosing a client’s information. 

In contrast, Jessica Scharfenberg, CEO of Healthfirst Network in central Wisconsin, said if any of her 10 reproductive health clinics violated HIPAA, they would face steep federal fines and possible jail time for staffers. 

“If my entity broke HIPAA, we would have federal consequences, even though we also have an internal policy for it,” Scharfenberg said. “They have their internal policies. They break HIPAA, there’s no consequences for it.”

The websites of some centers give the appearance of being HIPAA compliant even though they aren’t, States Newsroom has reported. 

The other two main umbrella organizations did not respond to multiple requests for comment by email and phone. 

‘So much help’

In North Lauderdale, Ieshia Scott would stare at her 6-month-old, unable to hold the baby when she cried. Scott, who also had a 10-year-old, felt overwhelmed by a constant cloud of stress and sadness, all while trying to keep up with college classes.

When she found out she was pregnant again, Scott searched for an abortion clinic in the city, and a pregnancy resource center came up in the search results. That 2018 visit would last nearly three hours, during which she fielded dozens of questions about why she wanted an abortion. Scott had suicidal thoughts and was depressed but felt totally unheard. 

“I really was disregarded,” said Scott, now 36. “I was actually saying to her, like — ‘I don’t know, I might hurt myself, I might hurt the baby.’”

The center didn’t refer her to a psychiatrist, therapist or OB-GYN. The staff member instead reminded her of the Ten Commandments.

“I’m literally telling her, I can’t — I can’t do it. And she was like, ‘You can, you can. And there’s so much help.’”

Mental health is a contributing factor in about 23% of the nation’s maternal deaths, reports from the federal Centers for Disease Control and Prevention show.

Scott eventually went to a clinic to get the care she needed. But she worries for women who can’t. 

More than a dozen states passed abortion bans after Dobbs, and efforts continue nationwide to dismantle what access remains. Several states with abortion bans — including Missouri, South Carolina and Texas — have moved to cut Planned Parenthood out of state Medicaid programs as well, after the U.S. Supreme Court ruled last year that excluding the organization did not violate Medicaid’s provision requiring freedom of choice in providers. Florida legislators are also discussing cutting Planned Parenthood out of the state Medicaid program.

In 2025, at least 51 Planned Parenthood locations closed or limited medical services after losing state and federal support. Those communities lost access not only to abortion services but also to other reproductive and primary medical care. Independent clinics such as Maine Family Planning stopped offering primary care services for about 600 patients because of a funding loss of about $1.9 million, even though none of the Medicaid dollars were used for abortion.

‘Government handouts’

Lawmakers are not only opening public coffers to provide direct financial support to pregnancy centers, but they’re also creating tax breaks, drawing on federal sources and shifting funds meant to help low-income families to aid the anti-abortion organizations — with few regulations.

Some legislators have resisted stronger oversight. 

In Missouri, state Rep. Warwick opposed a colleague’s suggestion to require the centers to report how they spend their donations in a tax credit program, saying he wanted to limit bureaucracy. He said in a February 2025 legislative hearing that the tax credit keeps the state from having to “verify what programs work.” 

“I don’t think they’re funded enough to be able to mishandle their money,” he told States Newsroom in December. “At least not the ones I’m familiar with.”

Warwick proposed raising the tax credit for pregnancy center donations from 70% to 100% in 2025, meaning someone donating to a pregnancy center could reduce their state tax bill by the exact amount donated. 

The credits that Missourians redeemed shot up from about $2 million to an average of more than $7 million per year after lawmakers removed a cap on credits in 2021, according to a fiscal note attached to Warwick’s bill. State officials estimated a 100% tax credit just for pregnancy center donations would cost the state more than $10.7 million in the first year.

Missouri also funnels more than $2 million per year in state and federal dollars to pregnancy resource centers and similar organizations through its Alternatives to Abortion program. That’s in addition to what the centers receive from Missouri’s federal Temporary Assistance for Needy Families fund — $10.3 million in this fiscal year.

Although Warwick’s 100% pregnancy center tax credit failed, he plans to try again in this year’s session. “I don’t think it (a 100% tax credit) would significantly hurt the state, especially when we’re talking about protecting life, protecting the birth of children,” he said.

Nebraska Sen. Joni Albrecht, a Republican who also sponsored a six-week abortion ban, said the centers were a valuable investment when she sought to create a $10 million tax credit program that was revised down to $1 million in 2024. 

Of the 13 pregnancy centers approved for tax credits in Nebraska, four provided less than $150,000 in services, according to tax returns, and one had three consecutive state audit reports with findings of deficiencies in controlling and complying with federal grant funding requirements.

In Montana, a state without an abortion ban, Republican Gov. Greg Gianforte found another way to give taxpayer money to pregnancy centers by donating a portion of his annual salary. In 2020, he pledged to give his salary to nonprofit organizations and charities, and has for the past three years included pregnancy centers in that list for a total of more than $60,000.

Idaho state Sen. Ben Adams, a Republican who sponsored a bill to establish a grant fund of $1 million for crisis pregnancy centers in 2025, told States Newsroom he felt it was important to put resources into helping people choose to have a baby. 

“We have, for a very long time, primarily through the federal government, essentially funded abortion through funding for Planned Parenthood and all these different organizations,” Adams said. “We say we’re going to restrict a woman’s access to abortion and that we’re pro-life. Well then, we actually have to be investing in those folks who are choosing life and show them that we mean it when we say we want them to choose life.”

For decades, the Hyde Amendment, a provision Congress has renewed annually, has prohibited the use of federal funding for abortions, except in cases of rape, incest and to save the mother’s life.

Idaho is one of a few states with an abortion ban that isn’t providing government support for crisis pregnancy centers. Adams’ bill failed by one vote in committee and faced opposition from many constituents, including a former board chairman of a crisis pregnancy center in Idaho who said subsidizing nonprofit entities with taxpayer dollars is not the proper role of government.

“Providing taxpayer funds on either side of this moral question is inappropriate,” said John Crowder in his testimony to the legislative committee, prefacing his comments by saying he is a Christian who believes life begins at conception. “Such decisions to lend financial support should be left to churches and individuals, not the government.”

Based on his knowledge of the finances of that center, Crowder said, it was clear they could meet the goals of their mission with the donations they received and “without government handouts.” 

Stateline reporter Amanda Watford contributed to this report. 

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

METHODOLOGY: To identify government grant funding received by nonprofit crisis pregnancy centers (CPCs), a team of States Newsroom reporters used multiple data sources. Reporters reviewed state and federal budgets and legislation to identify public funding allocated to CPCs between 2019 and 2025, with a particular focus on the period following the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June 2022, as well as in prior years, as applicable. The team did not include federal funding from sources such as Temporary Assistance for Needy Families in the nationwide analysis, and state tax credit programs were also excluded.

Data reporter Amanda Watford cleaned and analyzed a publicly available dataset of CPCs originally collected by the nonprofit advocacy group Reproductive Health and Freedom Watch. Organizations that appeared to be permanently closed or did not report enough revenue to file a full IRS Form 990 were removed from the States Newsroom analysis. Watford extracted filings from ProPublica’s Nonprofit Explorer for about 2,000 organizations, covering 2019 to 2025. Government grant totals were only available for 217 organizations for 2023 and 2024 due to data infrastructure limitations. A separate analysis using the GivingTuesday 990 database captured basic financial and government grant data for 1,243 organizations between 2019 and 2023. Watford combined the 2019-2023 GivingTuesday data and 2023-2024 ProPublica data. The total amount of government funding provided to CPCs was calculated for each year, yielding a grand total of nearly $1.3 billion across 1,259 CPCs between 2019 and 2024.

This analysis is not comprehensive. Some IRS Form 990 filings were unavailable digitally, and some organizations did not report any government grant funding, so grant funding reported outside the available electronic filings was not fully captured. Financial information available through IRS Form 990 filings is self-reported by organizations to the IRS and is not independently audited. Additionally, there is a lag between when organizations are expected to file returns and when filings are publicly available. Due to these factors, the States Newsroom  findings likely undercount the total amount of public, government funding directed to CPCs. An estimated 2,633 CPCs were operating in the United States in 2024, according to research from the University of Georgia.

The bulk of the money Missouri gives to its crisis pregnancy centers comes from federal funds meant to assist families experiencing poverty with basic necessities and child care, Republican Rep. Jason Smith said on the U.S. House floor in January.

As many as $3 of every $4 for pregnancy centers in Missouri was from the federal Temporary Assistance for Needy Families program in 2024, and in the 2026 fiscal year, it will be $2 out of $3. The amount of TANF funding has steadily increased since 2022, from $4.3 million then to $10.3 million in fiscal year 2026. 

At least eight states have given TANF funds to crisis pregnancy centers in recent years, even before the U.S. Supreme Court overturned federal protections for abortion rights in 2022. According to data from the consulting firm Health Management Associates, more than $102 million from TANF went to the centers in those eight states between 2017 and 2023, including $22.5 million in Ohio, $11.75 million in Indiana and $12 million in Texas. 

The federal government gives TANF funds to each state as a lump sum, and states get to decide how to spend it. There are broad rules for how the funds can be used, but federal law specifies they should assist with facilitating housing or employment; prevent and reduce “out-of-wedlock pregnancies”; and help form and maintain two-parent families. The U.S. House passed a bill in January that would explicitly lay out that crisis pregnancy centers can be a recipient of the funds. It hasn’t been taken up by the Senate yet.

Diana Rodin, associate principal at Health Management Associates, said block grants like the ones associated with TANF can be used broadly, and there isn’t much oversight after the funds are distributed. 

“You have some states that might say in their state plan, ‘We are spending this much on our Alternatives to Abortion program,’ but there’s some states where it’s going to them (crisis pregnancy centers), but there’s nothing you can find,” Rodin said. 

Conservative advocacy groups and lawmakers say anti-abortion crisis pregnancy centers provide many free goods and services and are deserving of TANF funds. 

Former Democratic President Joe Biden’s administration proposed regulatory changes that would have required states to show how allocations to pregnancy centers accomplished the purpose of TANF but withdrew them in early January 2025, shortly before Republican President Donald Trump was sworn in. 

On the House floor, Smith said that if the Biden administration had been successful, it would have been detrimental. Yet most crisis pregnancy centers do not provide any medical services beyond nondiagnostic ultrasounds and do not provide prenatal care from physicians. 

“Think of what would’ve happened to maternal care in this country,” Smith said. “One of the few places women can get care and support would have been closed.”

More money on the way

Crisis pregnancy centers are nonprofit organizations, often affiliated with religious groups, that have a mission of preventing people from terminating a pregnancy. A nationwide States Newsroom analysis found that 21 states funneled nearly a half-billion dollars in public money to crisis pregnancy center organizations between 2022 and 2025, and more in the form of tax credit programs. That figure did not include the millions in TANF distributions allocated by those eight states. 

More pregnancy centers are also tapping into federal sources, such as grants for abstinence-only education programs, teen pregnancy prevention, and U.S. Housing and Urban Development funds. 

Read our investigation: Taxpayer dollars flood pregnancy centers. Oversight hasn’t followed.

Medical organizations, including the American College of Obstetricians and Gynecologists, object to the misleading and deceptive practices of many pregnancy centers. Federal audits have also shown that some are not properly managing the public funds they receive.

Two centers in California and Washington identified in States Newsroom’s analysis doubled the amount of grants received for abstinence-focused sex education programs in the past two years, according to federal records. In Louisiana, the Department of Children and Family Services shifted $2.26 million in TANF funds to its pregnancy center grant program for fiscal year 2026 after lawmakers cut the program’s state funding by the same amount because more than two-thirds of it went unused, according to a recent state audit.

Millions more in federal dollars are likely to be accessible if the Trump administration changes rules for Title X family planning funding, as it did during the first term in 2019, allowing organizations to receive funds without offering birth control. Under current rules, Title X requires clinics to prescribe birth control and provide other family planning services to low-income populations for free or at low cost. Most pregnancy centers do not prescribe or refer for birth control, which is considered an essential aspect of reproductive health care by the medical community. 

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, said she and her staff are prepared for the administration to propose a rule change that would allow providers to not offer or refer for birth control, abortion or other family planning services as a condition of receiving the funding. 

“We’re expecting it any day now,” she said. 

Crisis pregnancy centers and other anti-birth control organizations will be better prepared to apply for the funding if the change is adopted, Coleman said. “And that’s not something our folks really had to deal with before, so we’re quite concerned.”

Audit finds mismanagement

Federal records show millions of federal dollars flow to crisis pregnancy centers under the Title V Sexual Risk Avoidance Education program, which focuses on abstinence and relationship development for teens. Some states apply for the grant dollars, but individual organizations can also apply for a portion of the funding in a competitive award process. 

A major recipient is The Obria Group and its affiliates, including RealOptions in California. Obria, a chain of pregnancy centers that offers some medical services like testing and treatment for sexually transmitted infections, operates largely in states with strong protections for reproductive rights. Those states typically do not provide state funding for pregnancy centers, but the centers have tapped into federal funding. Under the first Trump administration, Obria received a $1.7 million grant from the Title X program, with the possibility of two more years of funding for a total of $5.1 million, despite Obria’s unwillingness to provide birth control. 

Obria did not respond to a request for comment from States Newsroom.

RealOptions has received nearly $4 million in Title V funding for an abstinence-only education program since 2020, federal records show, including $900,000 in 2024 and 2025 — double the amount received in prior years. 

 

 

A routine federal audit published in October found RealOptions had placed more than $127,000 of the funding in the wrong budget year. The company did not have adequate policies and procedures for ensuring federal awards were tracked, according to the audit, and RealOptions also failed to complete a form detailing how grant funds were spent as required by law.

In their findings, auditors said the lack of sufficient oversight on the funds created a “high risk” that the company would be out of compliance with federal regulations, and the errors would not be caught or corrected in a timely manner.

RealOptions did not respond to questions from States Newsroom about the audit.

Sex ed funding  

In Washington state, a crisis pregnancy center called Life Choices of Yakima runs a program with abstinence-focused funding called Think Twice Yakima. It has received at least $335,000 per year in Title V federal funding for the program since 2019, and partners with several local schools to administer the curriculum. In early December, the website included the logo of the Washington State Department of Children, Youth & Families in a list of its partners. 

When States Newsroom reached out to the state agency to ask about the partnership, spokesperson Nancy Gutierrez said it was not a partner, and the organization was asked to remove the logo, which it did. 

Life Choices of Yakima did not respond to a request for comment from States Newsroom. 

Like many of the abstinence programs, Life Choices uses a curriculum from the Dibble Institute, a nonprofit organization in Berkeley, California, that provides a spectrum of sex education materials for licensing. Kay Reed, president and executive director of the institute, said clients include Planned Parenthood and centers like Life Choices, as well as various universities and colleges. The Dibble Institute recently released an abstinence-only curriculum to align with executive orders from the Trump administration. 

The funding, Reed said, dates back to former President George H.W. Bush, a Republican. 

“It’s been around a long time, and it’s part of the push and pull between Republicans and Democrats,” she said. 

But the curriculum has grown more restrictive now than with prior administrations, Reed said, pushing for abstinence only “until marriage.” 

Federal housing dollars

Other crisis pregnancy center groups are moving into less common areas of federal funding. Georgia Wellness Group received $450,000 from U.S. Housing and Urban Development block grant funds in July to help build a maternity home in the Atlanta area. County commissioners approved the grant despite vocal opposition from community members, who called it a fake clinic and alleged it deceives people about its true anti-abortion intentions. 

At a public hearing in August, Georgia Wellness CEO Robin Mauck said the grant will be used to purchase a residential home to accommodate up to six women and their children for up to eight months after birth. In January, the group applied for nearly $636,000 in new HUD grant funding for the 2026 cycle, which is under consideration by the county. 

Firsthand accounts: ‘What’s your plan for this pregnancy?’ Comfort, shame and a missed diagnosis

The organization used to be affiliated with The Obria Group, a national chain of crisis pregnancy centers that has been criticized for its practices, including by a former leader of the organization. Mauck said at the August hearing that it was a relationship they used to help them “transition to prenatal care.” 

In addition to the HUD dollars, Georgia Wellness Group received more than $1.27 million from the Title V Sexual Risk Avoidance Education program between 2021 and 2023, and another $445,000 in 2024. U.S. Rep. Lucy McBath, a Georgia Democrat, helped the organization apply for the federal funding that year with a letter of support, when it was still affiliated with Obria Medical Clinics. The program received another grant of the same amount in 2025.

Attorneys for Georgia Wellness Group sent cease-and-desist letters to people for tying them to Obria during public hearings and for saying the group misleads patients about the services they provide. One of those letters was sent to Allison Glass, state campaign director for the Amplify Georgia Collaborative, a group of reproductive rights advocacy organizations. She shared a copy with States Newsroom.

“There’s a huge housing need in Georgia, and especially around Atlanta, for affordable housing, but that should not come with the shame and deception,” Glass said. “They are so good at being so deceptive about who they are and truly what kind of services they provide and what credentials they have, that they really have unfortunately been able to really dupe a lot of stakeholders and decision-makers in Georgia.” 

Glass said this is the first time she and other advocates know of in which a crisis pregnancy center has received HUD funding. 

Mauck did not respond to a request for comment from States Newsroom. 

The group is one of few crisis pregnancy centers that says it has medical professionals who are fully licensed and overseen by a board-certified OB-GYN, offering many more health services, including breast and cervical cancer screenings, sexually transmitted infection testing and treatment, and prenatal care. But Georgia Wellness does not list birth control as an offered service, only IUD removal. 

A former medical director for the organization, Dr. Marc Jean-Gilles, has said the clinic is misleading people about its ability to provide obstetrical care, because it does not have admitting privileges and patients are told to seek emergency services elsewhere when they are in labor. He also said surrounding hospitals refuse to coordinate care with the organization because of alleged unethical practices. Those statements were read aloud at the August public hearing to approve the first installment of HUD funding.  

Jean-Gilles told States Newsroom in February that he has no problem with the organization receiving HUD funding if they are using it to shelter people, but from a patient safety standpoint, he said all clinics providing prenatal care should be able to coordinate with local hospitals. 

“My whole take is, it doesn’t matter if you’re a crisis pregnancy center or not. I think when you delve into the realm of prenatal care and delivery, if you can’t provide a provider who’s going to deliver … then you’re doing a disservice to the patients,” Jean-Gilles said. 

Grant Adams, a staff member at Georgia Wellness, said any allegations that the organization misleads anyone about its clinical capabilities are false, as are claims that the youth outreach program is “abstinence only.” During the August public hearing, Adams, who teaches the program to Atlanta-area middle and high school students, said the curriculum includes “medically accurate information about contraception” and tells young people about the risks of early sexual activity so they can make healthy decisions. 

“It doesn’t matter how loud a claim is made, that doesn’t make it true. It doesn’t matter how often a claim is made, that doesn’t make it true,” he said. 

Stateline reporter Anna Claire Vollers contributed to this report.

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

For nearly 60 years, crisis pregnancy centers have been a pillar of the anti-abortion movement.

Largely staffed by volunteers or part-time workers, these centers — sometimes referred to as pregnancy resource centers — offer limited services related to pregnancy and are guided by a religious mission to stop people from considering abortion.

States Newsroom conducted a 50-state investigation examining state and federal funding for these centers. Between 2022, when the U.S. Supreme Court overturned federal protections for abortion rights, and the end of fiscal year 2025, 21 states have funneled nearly a half-billion dollars to crisis pregnancy centers. Physicians and researchers told reporters they’re concerned about the magnitude of public money crisis pregnancy centers are receiving while Planned Parenthood clinics and other community clinics offering reproductive health care are defunded.

Read our investigation: Taxpayer dollars flood pregnancy centers. Oversight hasn’t followed.

As part of an ongoing series to shed light on the issue, States Newsroom spoke with dozens of doctors, patients and people who found themselves in crisis pregnancy centers. These are some of their stories.

Alabama

When Valkyrie Brodt, 30, became pregnant for the first time last year, she did an online search to find a clinic that would take someone without insurance. She and her husband were waiting to be approved for health insurance, and she was hoping to find a provider who would confirm her pregnancy and check that it looked healthy so far. In her search results, she found what she thought was a pregnancy-focused medical clinic a couple of blocks from the hospital in her hometown of Huntsville, Alabama. She booked an appointment. 

The couple arrived and began to fill out the clinic’s paperwork, but Brodt said something felt off.

“A lot of the questions were less about medical history and more so faith-based questions, and other questions like, ‘What’s your relationship with the baby’s father?’ ‘What’s your plan for this pregnancy?’ I think it did specifically ask what your religion was.

“At that point I realized, OK, this is clearly a Christian-run kind of place. I grew up Church of Christ, and I have a lot of religious trauma from the way that I grew up. I would not consider myself religious at this point. I’m very open-minded towards people who are religious, no bias other than just not wanting it shoved on me.

“I was also under the impression they were going to do the blood test analysis to confirm pregnancy, but it was just another urine sample. And I was like, well, I’ve already done four of these, and they were all positive.

“Then when they called us back, she (the clinic staffer) literally used the words ‘divide and conquer.’’’

Brodt was taken to one room, while a male counselor took her husband to another room. She said she understands why staff might want to separate them, in case of concerns about possible domestic violence or coercion. But Brodt said she was never asked about the couple’s relationship or whether she felt safe. The counselor confirmed that Brodt wanted to keep the baby, asked more faith-related questions, and told her that if she attended counseling sessions she could earn “baby bucks” to redeem on baby items from their store.

“At one point, towards the end, she (the counselor) said, ‘Well, if you know anybody who’s thinking about getting an abortion, send them our way.’ So it was very clear at that point that that was their goal. They gave us probably three or four different pamphlets, and only one of them was a piece of paper with the pregnancy confirmation on it. The rest was ministry stuff, like faith-based parenting classes.”

The clinic scheduled an ultrasound for her, but she and her husband decided not to go back.

“It felt very predatory to me as a 30-year-old woman that’s married. So I can’t imagine how it would feel to a teen mom or a single mom having to walk in there by herself.” 

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Idaho

Dr. Cate Heil knew people in her hometown who worked at crisis pregnancy centers, and she didn’t have much of an opinion about the centers, other than they seemed like good places for pregnancy counseling. 

That perspective changed.

During her training to become a family medicine physician in Idaho in 2020, she saw a 17-year-old patient who had gone to a pregnancy center, where she received a transabdominal ultrasound. The center told the patient there was “a lot of fluid.” 

“Based on her period, she would’ve been about eight weeks and three days. It didn’t seem like they told her much else. 

“We did a transvaginal ultrasound and saw some concerning things. This patient had a molar pregnancy, which shows up pretty characteristically on ultrasound and is considered a pre-malignancy. Her uterus at supposedly eight weeks was 1 centimeter above her pubic bone, which is much larger than would be expected. She underwent surgery the next week.

“It was concerning to me that this wasn’t recognized as something that’s abnormal. This is not quite an emergency, but it’s something that needs to be managed within a week or so, or needs immediate referral for a surgeon — and that made me nervous.

“Is there other stuff that we’re missing? This is a fairly rare thing, but it’s not unheard of, and it should be able to be recognized by people who are operating an ultrasound, in my opinion. … It made me want to double-check things when someone has gone to a crisis pregnancy center.”

Oregon

Emily Gartman wanted to keep her baby. Unexpectedly pregnant at 21, a friend recommended a pregnancy center, saying nice people would quickly confirm the pregnancy without an appointment. She took a test there, but before the results came back, Gartman said the staff asked her what she would do if she were pregnant. 

They showed her pictures of how an embryo develops into a fetus and told her that it would respond to painful stimuli at 13 weeks, an idea that is not supported by science. Multiple studies have shown that a fetus does not have the capacity to experience pain until at least 24 weeks’ gestation.

“They just kept driving home that if I got an abortion, my baby would be in pain. That it would feel itself being chopped up.

“I was 11 weeks pregnant, and they were clearly trying to make me feel like a piece of s— if I did get an abortion because I was hurting the baby. I wasn’t sure what I wanted to do, but they basically told me if I waited any longer, I wouldn’t have a choice.

“There’s a very high chance that I would’ve kept it. The person I was pregnant by had Marfan syndrome, and the thing I wanted to wait for was an amniocentesis.”

Severe forms of Marfan syndrome, a connective tissue disorder, can cause fatal heart problems. Gartman had wanted more information about her options. An amniocentesis is typically performed between 15 and 20 weeks of pregnancy.

“I ended up having that abortion three days later. I felt like if I didn’t do it right away, I was going to have no choice, and that they’d be right, that I would be a monster.”

Despite many years passing, Gartman, 45, of Portland, said the trauma she endured is one of the main reasons she never had any children. The shame stuck with her, she said, and she thought she had no right to try to have another baby after having an abortion.

“Seeing public money going to these places pisses me off a lot. That’s my money. I don’t want my money being used to do this to someone else.

“My experience with them has been to just tell everybody I know who’s going to go to them to just not do it. I would never set foot in one of those places again.”

North Carolina

After Carley Causey discovered she was pregnant last year, she wanted to know how far along she was. 

So she searched online for a place to “get an ultrasound to try and date how pregnant” she was. 

Causey, 36, said she had originally called an OB-GYN’s office, but she was told that she couldn’t get an appointment for at least seven weeks. 

“Well, most doctors’ offices won’t see you until you’re, like, 12 weeks pregnant. I did call, and they were like, like, not very helpful, because they were like, ‘You’re not far enough along,’” Causey said. 

So she ended up calling a crisis pregnancy center. 

“And this place is totally free. If you wanted to go to the ER and get an ultrasound, that’s like hundreds of dollars. And this is a community resource that charges you nothing, right?” 

Causey said center volunteers told her that it may be too early to do an ultrasound and that she could potentially have an ectopic pregnancy for which she would have to go to the emergency room. But she wanted a transvaginal ultrasound, and she found out that she was almost two months pregnant. 

Causey said her mom used to volunteer at “pregnancy support centers,” and she felt more comfortable going there. And as a Christian woman and family ministries director at a church in Durham, North Carolina, she said she felt awkward going to a place like Planned Parenthood, which she associated with abortion, although it offers a range of medical services. 

“I know that they (pregnancy centers) totally have this reputation of trying to scare women into not having abortions, but that’s just not been my experience with the people who work there,” Causey said. “And I want to give space for that, because I don’t know all these Christian pregnancy centers, but the truth is like, yeah, they do value life, but they also want to provide resources that make it seem possible.” 

Florida

Taylor Biro was sleeping under bridges all over Tallahassee when she found out she was pregnant in 2006. She called a local pregnancy center, telling them she was homeless and seeking an abortion. 

“I was 19 … I was pregnant, and I had no business having a child — I had a lot of difficult things going on around me at the time.

“I remember being very clear. I talked to them on the phone. I told them what I wanted to do. They said, ‘Great, come on in.’

“I went in, and they counseled me — and it ended up not being an actual place that helps, or had any means to help, with abortions. They were more like a faith-based group and wasted a lot of my time. I ended up passing the window when I was able to get an abortion.’’

It was “degrading” when she’d have to attend their classes to earn “mommy bucks” before she could have a few diapers — not even a full pack, she said. 

“Less than a week after I gave birth, I was working at a sandwich shop. I remember standing there taking someone’s lunch order, hoping the pad in my underwear was thick enough to last till my break. For the first five years of my son’s life, I worked four jobs and made less than $11,000 a year. I was exhausted and trying to hold on to some version of myself before all this.”

Being pregnant and giving birth as a homeless teen, Biro experienced violence.

“It forces you to play into relationships that you probably never would have had to endure. You don’t have all the safety nets. It opened me up to domestic violence; it opened me up to sexual violence.”

Biro went on to start her own drop-in center for runaway and homeless youth. She and her team raised money for teens who needed abortions and provided Plan B for those over age 18. 

After her experience with the crisis pregnancy center, she made diapers much more accessible for the new parents who came to the drop-in center, telling them: “You want to take five packs of diapers? Take six.”

She also worked with officers investigating sexual violence and human trafficking of youth, and helped write legislation requiring special training for law enforcement interviewing victims of sexual assault. Biro works with the National LGBTQ Task Force, and also founded Bread and Roses Collective, a team of grant writers for social justice organizations. Her child is now 18.

“It took me years to understand that the shame was never mine to carry. A Christian organization manipulated a homeless teenager into having a child when it was not safe, but (I) should be embarrassed? I know now that my struggle and trauma was not some penance for being young and irresponsible. But that experience, being tricked out of health care, was my origin story.

“It’s strange that even now, I feel compelled to preface it all by saying how much I love my son. As if naming my trauma or the loss of my autonomy could mean I love him less. That guilt buries stories like mine. We hear more about how a child ‘saved’ someone, when the truth is my life had meaning on its own.”

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

With rising costs for health insurance purchased through the Affordable Care Act, Democrats in the Legislature are proposing another tactic to help more people afford health coverage.

Rep. Tara Johnson (D-Town of Shelby) announced legislation Tuesday that would enable members of the public buy into the state’s BadgerCare Plus health insurance plan.

BadgerCare Plus is Wisconsin’s name for Medicaid and is available to families and individuals with household incomes up to the federal poverty guideline — $15,960 for a single person and $33,000 for a family of three.

Johnson’s bill would expand BadgerCare’s coverage by creating a “public option” — allowing families with higher incomes to pay for the health plan out of pocket. Democrats in Wisconsin have offered similar proposals in the past that have not advanced. At the same time, the idea has been catching on in some other states, Stateline reports, although not all of them are connected to Medicaid. 

“When this law is passed, Wisconsinites will have an affordable option instead of the sky-high premiums and massive deductibles currently available from private insurance carriers,” Johnson said at a news conference in the Capitol Tuesday morning. “Public health care keeps prices down because it is not beholden to insurance company stockholders or bonuses for executives, and those savings will get passed on to Wisconsinites.”

“This will dramatically increase, for a large number of people, the number of affordable insurance options at a time when there is a crisis in affordability generally, and health care is one of the top reasons why,” said Robert Kraig, executive director of the advocacy group Wisconsin Citizens Action.

Sen. Chris Larson (D-Milwaukee) said the bill would provide an affordable health care alternative for people who had relied on plans purchased through the federal marketplace, HealthCare.gov, that was created by the Affordable Care Act. Enhanced subsidies that had lowered the cost of policies bought through the marketplace expired at the end of 2025.

On HealthCare.gov policies, “average premiums more than doubled when Republicans in Congress allowed those enhanced subsidies to expire at the end of last year,” Larson said. The subsidies were eliminated for families with incomes of more than 400% of the federal poverty guideline — around $86,000 for a couple.

For a 55-year-old couple at that income level, the premiums on the second-tier of plans sold at HealthCare.gov would increase “from $601 a month to $2,311 per month this year,” Larson said — or about $20,000 a year.

The legislation would “move us closer to the point where we need to get, where health care is a right for all and anyone can get the care that they deserve without a speck of fear that they are going to go broke just so that they can survive,” Larson said. “The fact that that is an open question right now is shameful for our state. It’s shameful for our country.”

The bill also would allow small businesses with fewer than 50 employees to enroll in BadgerCare plans. Madison chef and restaurateur Evan Danells said some of his employees had relied on ACA plans but were also confronted with increased premiums that many would have trouble being able to afford. Danells is a member of Main Street Alliance, a small business group that has organized support for the ACA among other policies.

“One of the coolest things about having a public option is it allows people to go in and get affordable preventative care,” Danells said. As a result, “they don’t become wards of the state health care system when they’re all of a sudden broke and the problem has snowballed.”

Indiana Hauser of La Crosse said she works two part-time jobs, neither of which provides health insurance. Last year she was able to purchase health coverage for $12 a month with the enhanced subsidies. “This year it went up to $400 a month for worse coverage,” said Hauser, who is active with the advocacy group Citizens Action of Wisconsin.

Hauser said she has life-long health complications due to a traumatic brain injury when she was a teenager. Nevertheless, she said, she has had to go without insurance this year because she cannot afford it.

An affordable community clinic helps her, she added, but many communities don’t have such resources.  While rationing her medications and visits to the doctor, Hauser worries that she’s “one small accident away from a financial crisis,” she said.

“Across the state, there are people and families making life or death decisions, and it doesn’t have to be that way,” Hauser said. “The BadgerCare public option could change my life and the lives of people all across our state.”

Larson and Kraig said that due to changes made by the federal tax- and spending-cut bill that President Donald Trump signed in July 2025, the likely premiums people would pay for BadgerCare under the Public Option haven’t yet been calculated. A 2025 analysis by the Legislative Fiscal Bureau projected premiums could cost about $971 a month, but also noted that a variety of factors could increase or reduce that cost.

According to the Feb. 17, 2025, fiscal bureau memo, “It is possible that the purchase option population could be, on average, less costly, which could make the premium lower” compared with the medical needs of BadgerCare patients who qualify for Medicaid. “If, on the other hand, the purchase option attracts older individuals or individuals with more significant health conditions, the premiums may be similar to, or even higher than, the average cost of BadgerCare Plus coverage.”

With the legislation being introduced after the Assembly has already wrapped up its floor period for 2026, the proposal seems unlikely to advance this year.

“I would say it’s always a good idea to introduce good bills,” Johnson said when asked about the timing of the announcement. Gov. Tony Evers, she noted, earlier Tuesday called for a special session to pass a resolution against gerrymandering the state’s legislative maps.

“We have five days on the calendar in March. We have five days in the calendar in April, I think it’s three days in May,” Johnson said. “There’s no reason that we cannot take up this legislation.”

Then she corrected herself. “Well, there is one reason, and it’s because the speaker chooses not to call us into session,” Johnson said.

“A lot of these bills are sitting in Google Drives,” added Rep. Supreme Moore Omokunde (D-Milwaukee). “All this session, we have bills ready to go. It’s a matter of will they be heard? It’s a matter of what is the appetite to have the debate about them? We know that this is something that Wisconsinites care about. They want us to stay here. They want us to get this done.”

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Nearly two decades ago, progressives fought to include a so-called public option — a government-run health plan — in the broad health care overhaul known as Obamacare. That effort failed, defeated by heavy lobbying from the insurance industry and opponents who decried it as a government takeover of health care.

But the final Affordable Care Act, which President Barack Obama signed in 2010, didn’t bar states from adding a public option plan to their state-run insurance marketplaces. In recent years, several states have done so — and others might follow as rising health care costs, the expiration of federal subsidies and Medicaid cuts make coverage less affordable and available for millions of Americans.

This year Nevada became the third state, after Colorado in 2023 and Washington in 2021, to add a public option plan to its marketplace. So far, 10,762 people have signed up, according to figures provided by the Nevada Health Authority.

The goal of such efforts, said Christine Monahan, an assistant research professor at the McCourt School of Public Policy at Georgetown University, is to provide an alternative to profit-driven private insurance companies, “and to give people an option that doesn’t have that kind of capitalistic incentive in place.”

The results so far have been mixed, however. It’s still too early to say whether the states’ public option plans, which are public-private partnerships rather than purely government-run, will significantly lower costs for consumers or pay enough to providers to ensure their continued participation.

Meanwhile, other states’ efforts to create public options have stalled. In 2024, Minnesota delayed the creation of a public option amid concerns about the lack of a dedicated funding source. Efforts in Maine and New Mexico also have faltered.

“It’s really too early to see what the right combination of design of a public option is,” said Andrew Shermeyer, a doctoral candidate in health policy at the University of Minnesota and the author of a study on the Colorado plan. “We don’t know what works and what doesn’t. So that’s a real challenge for policy makers.”

Different approaches

As public-private partnerships, the public option plans in Washington, Colorado and Nevada rely on the participation of private insurers as well as health care providers. And they have to compete for customers with the purely private plans offered on the exchanges.

“We all know health insurance is extremely, extremely unaffordable and expensive. So the challenge behind it is you have to find something that’s attractive to consumers,” Shermeyer said. “You have to find something that insurers will comply with, and you have to find something that providers will feel adequately compensated for.”

States have used a combination of carrots and sticks to make sure those things happen.

In Washington state, private insurers that sell plans on the state marketplace can choose to offer the public option plan, which is called Cascade Select, but they don’t have to. To keep costs down and premiums low, the state mandates that participating insurers pay providers within a certain range.

In the first two years that Cascade Select plans were available, many providers were unwilling to participate. So in 2023, Washington began requiring that hospitals contract with at least one public option plan. The change has expanded the availability of Cascade Select plans — as of last year, they were available in every county — and boosted enrollment: Last year, about 30% of Washingtonians who purchased coverage on the marketplace enrolled in a Cascade Select plan, up from 1% in 2021.

Laura Kate Zaichkin, director of market competition and affordability at the Washington Health Benefit Exchange, said that figure is up to 40% this year. In 2021, Zaichkin said, Cascade Select premiums were a bit higher than for many other plans on the exchange. This year, they are about $100 per month cheaper, she said.

Zaichkin said the public option is more important than ever, because of the recent expiration of federal tax credits that had dramatically lowered the costs of purchasing marketplace coverage, as well as looming Medicaid cuts.

“I would say that it is a really important lever,” she said. “It always has been, and it is even more so right now, when individual market coverage is under threat and when customers cannot afford their premiums.”

Unlike in Washington, every private insurer that participates in Colorado’s marketplace must offer versions of the state’s public option plan, which is called the Colorado Option, in every county where it sells its own plans. Colorado Option plans all offer the same benefits across insurance carriers, so companies compete based on premiums, their networks of providers and customer service.

To keep premiums relatively low, participating health insurers are required to negotiate with providers to keep costs down. If state regulators think premiums are getting too high, they can take charge of the negotiations and mandate that hospitals or providers lower their reimbursement rates.

About 14% of marketplace enrollees chose the Colorado Option in 2023 when the plan launched. In 2025, the public option accounted for nearly half of the roughly 282,500 enrollees on the exchange, the state said.

But Julie Lonborg, senior vice president and chief of staff of the Colorado Hospital Association, said limiting payments to providers could end up reducing services and access to care for patients.

“Overall, enrollment continues to grow in the program, so it is having some success from the purchasers,” Lonborg said in an email. “But it is built on a fundamentally flawed policy of rate setting on hospitals that will result in consequences. Hospitals have felt pressured into rate reductions at a time when threats to health care funding are escalating.”

One of the arguments for a public option is that it introduces competition that pushes down premiums for all marketplace enrollees, no matter what plan they choose. But in his study of the Colorado marketplace, researcher Shermeyer said the Colorado Option only lowered premiums for people who were receiving the federal subsidies; unsubsidized enrollees saw higher prices compared with people living in other states.

Kyla Hoskins, a deputy commissioner who oversees the Colorado Option program at the state’s division of insurance, disputes that finding. Hoskins cited other research that found premiums across the state, even for private plans, declined by more than $100 after the Colorado Option was introduced.

She said more people are buying the Colorado Option plan because it’s more affordable and because of its simplicity.

“Your deductibles, your maximum out-of-pocket costs, the amount you pay when you see your primary care [provider] or fill a prescription — that cost sharing is the same no matter which health insurance company is offering the plan,” Hoskins said.

“And I think that clarity that standardization provides, has been a value to consumers,” Hoskins said.

Slow start in Nevada

Like in Washington, insurers in Nevada don’t have to offer a public option plan, called Battle Born State Plans (after the state’s nickname). However, the state has given them a strong incentive to do so by tying it to Medicaid.

Around 75% of Nevada’s Medicaid enrollees receive coverage through managed care. In order to remain eligible for Medicaid managed care contracts, insurers have to submit a bid to offer a public option plan that meets certain requirements.

Those Medicaid contracts are worth “millions if not billions to carriers,” said Stacie Weeks, director of the Nevada Health Authority, which oversees the state’s Medicaid program and its insurance marketplace. “Essentially, this new contractual arrangement leverages the state’s purchasing power with its Medicaid carriers to get a better deal for consumers in the private market.”

To ensure the participation of providers, Nevada’s law requires them to be in-network with at least one public option plan to remain eligible for Medicaid, public employee and workers’ compensation payments, according to the Century Foundation, a liberal-leaning think tank. Instead of regulating reimbursement rates, Nevada hopes to keep premiums low by mandating that they be at least 5% below those of private plans.

Nevertheless, enrollment has been slower than expected.

State officials predicted that around 35,000 people would sign up in the first enrollment period. The actual number is less than a third of that. And so far, only three out of the state’s eight health insurance companies on the state’s exchange have picked up the plan.

“We expect to see this number grow over time as public awareness increases and as Nevadans continue to seek quality coverage options that help reduce their monthly costs, regardless of their income,” Weeks said. She added that many Nevadans automatically reenrolled in their previous health plans, and may not know about the public option yet.

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

OTTUMWA, Iowa — Leisa and Kent Walker recently received a disturbing notice: The private company managing their son’s Medicaid coverage intends to cut nearly 40% of what it spends for caregivers who help him live at home instead of in a nursing home.

Sam Walker, 35, has severe autism and other disabilities. He is deaf and cannot speak. Sometimes when he’s frustrated, he hits himself or others.

Medicaid provides about $8,500 a month for health workers who visit his apartment in the basement of his parents’ home. The staffers help him with everyday tasks, including dressing, bathing, and eating. They also take Walker on outings, such as dining at restaurants, volunteering at Goodwill, and exercising at a recreation center or on park trails. They stick to a strict routine, which soothes him.

His parents say that without the in-home services, their son would need to move to a specialized residential facility in another state. Sending him away would break their hearts and cost taxpayers much more money. They strive to keep him home because they know change makes him anxious.

“The last thing I want is to put him into some kind of care facility, where he’ll just get kicked out,” said his mother, Leisa. The Iowa Department of Health and Human Services did not respond to KFF Health News’ questions about the Walkers’ case.

Federal cuts raise pressure

Patient advocates say state administrators in Iowa appear to be reining in Medicaid spending by cutting what are known as home and community-based services for people with disabilities, and they’ve heard of multiple families facing battles like the Walkers’.

Disability rights advocates expect the pressure to intensify as states respond to reductions in federal Medicaid funding called for under the Trump administration’s signature tax and spending law, which passed last year.

June Klein-Bacon, CEO of the Brain Injury Association of Iowa, said the cuts and proposed rule changes appear to be part of a quiet attempt to save money in response to the state’s budget deficit and expected reductions in federal Medicaid funding.

Medicaid, jointly financed by the federal and state governments, covers people with low incomes or disabilities. Walker is one of nearly 2 million people served by “Medicaid waiver” programs, which pay for care that allows people with disabilities or who are at least 65 to live at home.

Unlike most parts of Medicaid, waiver programs are optional for states. Idaho’s governor noted that fact in January, when he suggested legislators consider cutting them. Disability rights groups fear other states will do the same. Leaders in Colorado, Missouri, and Nebraska have considered such cuts this year.

Leisa Walker has heard Trump administration officials claim the national Medicaid cuts are intended to reduce waste, fraud, and abuse. That’s not how it will play out, she said. “These are real people, real families, and this causes real suffering when you do this to people,” she said. “It’s a very scary time.”

Iowa Total Care, a private insurance company that manages Sam Walker’s Medicaid benefits, intends to cut his in-home care coverage by about $3,200 per month, his mother said. Company leaders told a judge they are following state officials’ direction, but they did not dispute Leisa Walker’s math.

Walker has been on the waiver program for three decades. It covers assistance from workers known as “direct service providers” — one of whom has been with him for 25 years. His parents receive no pay for the hours they spend caring for him when the aides aren’t working.

On a February morning, Leisa and Kent Walker drove an hour and a half to Des Moines for an appeal hearing. An administrative law judge sat behind a wooden desk in a conference room as the Walkers and their lawyer faced off against three representatives from Iowa Total Care, a subsidiary of the national insurer Centene Corp.

Leisa testified that her son is 6 feet tall and weighs 230 pounds. Although he knows some sign language, he has trouble communicating, she said. When he becomes frustrated or his routine is interrupted, he sometimes wails and hits himself or other people. “It’s devastating to watch,” she testified.

He’s not a bad person, she said. “He doesn’t understand how strong he is.”

She said her family would try to keep his main caregiver employed under the planned Medicaid reduction but would have to drop others who cover nights and weekends. She said no residential facility near their southern Iowa home could address her son’s complicated needs. She said a case manager told her that a Florida facility might be the closest one that could safely handle him.

Leisa Walker testified that the state’s Medicaid program would pay about $22,000 per month to put him in an institution, more than double what the program spends on his home care.

Sam Walker’s longtime psychiatrist, Christopher Okiishi, testified that Walker’s family and their support staff spent years developing a “fragile” but stable existence for him.

Lori Palm, a senior manager for Iowa Total Care, testified that Sam Walker gets about 16 hours of daily assistance financed by Medicaid. Palm said much of that time amounts to “supervision.” She said state officials recently advised her company that the program should pay mainly for “skill-building” time, not supervision.

The Walkers showed the judge a 2018 document in which a previous Iowa Medicaid director stipulated that supervision of people with disabilities is an allowable service for workers paid under the program.

Judge Rachel Morgan asked the Iowa Total Care representatives if the recent policy change was made in writing by the state Department of Health and Human Services. They said it was not and that they couldn’t specify who at the department had given them the new guidance.

The judge suggested during the hearing that for someone like Sam Walker, learning to regulate emotions could be an important form of skill-building. Three days later, the judge ruled in the Walkers’ favor, writing that the insurer’s attempt to cut care hours was improper. The insurer appealed the decision to the director of the Iowa Department of Health Human Services, who could overrule it. The dispute could eventually wind up in district court.

Iowa Total Care and the state Department of Health and Human Services did not respond to questions about the reports that many other Iowans with disabilities face reductions in care hours covered by Medicaid. Department spokesperson Danielle Sample said in an email that the agency supports home and community-based services, which, she noted, help “states save money by avoiding expensive long-term facility care.”

Spokespeople for the federal Department of Health and Human Services, which oversees Medicaid nationally, did not respond to a request for comment on the issue.

Medicaid waiver programs started in the 1980s, after President Ronald Reagan heard about an Iowa girl with a disability who was forced to live in a hospital for months because Medicaid wouldn’t pay for home care. The Republican president thought it was outrageous that the girl, Katie Beckett, had to live that way, even though home care would have been cheaper.

Members of Congress approved allowing states to use their Medicaid programs to pay for in-home care. But they made the change optional, to offer states flexibility and encourage innovation.

Designating such spending as optional “waiver programs” also made the change more politically palatable, said Kim Musheno, senior director of Medicaid policy for The Arc of the United States, which represents people with intellectual and developmental disabilities.

Prospects were much different for babies born with serious disabilities before the change, Musheno said. “Doctors instructed families to forget they existed, and to put them in an institution.”

Waivers have been cut before

All states have Medicaid waiver programs, but benefits and the number of people covered vary significantly. Applicants often wait months or years to get into the programs because of limited funding. More than 600,000 Americans were on waiting lists or “interest lists” for waiver services in 2025, according to KFF, a health information nonprofit that includes KFF Health News.

Disability rights advocates and care providers have fought for decades to maintain funding for the programs, but a national leader said the threat feels especially severe now.

“When Medicaid is cut, people with disabilities are at the center of the impact,” said Barbara Merrill, CEO of the American Network of Community Outcomes and Resources, which represents agencies that care for people with intellectual disabilities or autism.

That’s what happened after Congress reduced Medicaid funding in 2011, according to a recent paper published by Health Affairs.

States could again rein in waiver programs by limiting enrollment, reducing covered services, or cutting pay for caregivers, who already are in short supply.

However, states that try to cut the in-home care programs could face legal challenges, Musheno said. The U.S. Supreme Court declared in 1999 that people with disabilities have a right to live outside of institutions if possible. The decision, in the case of Olmstead v. L.C., has been cited in lawsuits against states that fail to provide care options apart from nursing homes and similar facilities.

Several Iowans who belong to a Facebook group for Medicaid participants have posted in recent weeks that their families were notified of impending cuts in coverage of home care services for people with disabilities.

Sam Walker’s main caregiver, Andy Koettel, has worked with him since Walker was in fourth grade. Koettel, who works full-time, knows how to keep Walker calm in most situations and soothe him during a blowup. Their relationship took years to build, and it is a key reason Walker can continue to live at home with his parents, Koettel said.

“If I was not there, it would be incredibly difficult for all of them,” he said.

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.

Nearly a quarter of pregnant women aren’t getting prenatal care in the early stages of pregnancy, according to a new analysis from the U.S. Centers for Disease Control and Prevention.

The share of pregnant women getting prenatal care had been improving: It rose between 2016 and 2021 to a high of more than 78%, but then declined to 75.5% by 2024, wiping out previous gains.

The trend is worrying because getting care early in pregnancy can improve the likelihood of a healthy pregnancy and baby.

The decrease in early prenatal care held true for nearly all race and ethnic groups, but the drops were sharpest for Native Hawaiian and Other Pacific Islanders, Black women and American Indian and Alaska Native women.

By 2024, less than half of Native Hawaiian and Other Pacific Islander mothers received prenatal care in their first trimester — the first three months of pregnancy.

Anne Markus, a professor at George Washington University’s Milken Institute School of Public Health, said that because the statistically significant decline began around 2021, two events could explain some of the decrease: the COVID pandemic, with its associated stay-at-home orders, and the U.S. Supreme Court’s Dobbs decision in 2022 that dismantled the constitutional right to abortion.

“Both disproportionately affected, and continue to affect, communities of color, and the decline in early entry into prenatal care has been disproportionately bigger for racial and ethnic minorities since 2021,” said Markus, whose work focuses on public policy and access to health care. She was not involved in the analysis.

A lack of early prenatal care has also been disproportionately seen in “very young women who are more likely to have a pregnancy that they do not want,” Markus said. “The Dobbs decision and the fear and uncertainty it generated could be particularly relevant in explaining this disproportionate effect observed in the data.”

The share of women getting late care — beginning in the seventh month of pregnancy or later — or no care at all increased in more than half of states from 2021-2024. Utah saw the biggest rise in late or no care, followed by Massachusetts and Rhode Island. The number of Utah women getting late or no prenatal care jumped 54%, up to nearly 6% of women.

More than 1 in 10 women had late or no prenatal care by 2024 in Florida, Georgia, Hawaii, New Mexico and Texas.

“Geographic and financial barriers to accessing care are often behind late entry to recommended care, including prenatal care,” Markus said.

Late or no prenatal care decreased in six states: Arkansas, New Hampshire, South Carolina, Tennessee, West Virginia and Wisconsin.

The CDC compiled the report based on information from birth certificates, and includes information for all births that occurred in the United States.

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

A parents’ advocacy group is giving mixed reviews to the latest developments in addressing the ongoing issue of lead contamination in Milwaukee Public Schools.

On the plus side, Lead Safe Schools MKE supports a new lead testing initiative at MPS that officials announced this week.

“We applaud the efforts at testing children and increasing testing penetration,” Kristen Payne of Lead Safe Schools MKE told the Wisconsin Examiner in an email message. “This will help to ascertain the extent to which children in Milwaukee suffer from elevated blood lead levels.”

Payne said the organization wants to see testing and evaluation expanded from elementary schools to the rest of the school system.

Caroline Reinwald, the public information officer for the Milwaukee Health Department, said that the MPS work started with elementary schools because younger children are at higher risk for lead exposure, which can lead to developmental problems. MPS is planning to evaluate other schools, she said in an email message, with the health department overseeing and guiding the process.

An MPS Lead Reports and Plan webpage outlines the district’s project for addressing potential lead exposure in the school system.

Payne said Lead Safe Schools MKE wants MPS to adopt a stronger standard for evaluating drinking water for the presence of lead than it currently uses — 15 parts per billion — noting that public health experts say that no level of lead in drinking water is safe for humans.

MPS media relations manager Stephen Davis said that the district tested drinking water from all fountains, faucets, dispensers and other fixtures in 2016, and that 94% of fountains “met EPA standards.” Fountains that did not were turned off and eventually replaced.

Davis said there are no lead service lines providing water to MPS school buildings. The district also has filtration systems on all water fountains.

Payne said that her group wants to see the district use a standard from the American Academy of Pediatrics of less than 1 ppb.

The organization also wants MPS to continue dust-wipe sampling in the buildings that the district has declared stabilized to ensure that they remain safe.

Reinwold said the health department “supports continued vigilance and will continue working with MPS to ensure stabilization work remains protective over time and that any new deterioration is addressed promptly.”

In addition, Lead Safe Schools MKE has sought more testing of soil on MPS school grounds, which Payne called “an overlooked pathway of potential exposure.”

Davis said the school district has evaluated areas where children may “come into contact with bare soil” including playgrounds, courtyards and unpaved outdoor spaces.

Payne said Lead Safe Schools MKE also has concerns about communication and transparency in the ongoing project to address lead exposure concerns in the school system.

“There are serious gaps in the data available to the public and no clear accountability processes in place to be sure information gets published,” she said.

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WASHINGTON — Some congressional Democrats boycotted President Donald Trump’s State of the Union address Tuesday night, opting to attend counter-programming to protest the administration’s actions.

Lawmakers took to alternative stages in Washington, D.C., in rebukes of what they see as Trump’s lack of regard for constitutional norms, immigration enforcement tactics and response to the affordability crisis hitting American families.  

“Our democracy is wilting under ceaseless attack from a president who wants to be a despot,” said Sen. Chris Murphy of Connecticut at the “People’s State of the Union” rally on the National Mall.

“Millions of Americans are losing their health care because the president has chosen corruption to pad the pockets of his billionaire friends instead of helping average Americans,” said Murphy, who serves as the top Democrat on the Homeland Security Appropriations Subcommittee. 

The rally, hosted by progressive media company MeidasTouch and progressive advocacy group MoveOn, countered the president’s address to Congress. Lawmakers brought their own guests to the event, who rebuffed ongoing actions by the administration. 

Tuesday night also featured the “State of the Swamp” at the National Press Club, hosted by DEFIANCE.org, a resistance effort against Trump; the Portland Frog Brigade, a coalition of “artist-activists” and COURIER, an advocacy media network. 

The “State of the Swamp” event brought in several Democratic lawmakers, former Trump administration officials, current and former Democratic state leaders, as well as leading voices against the administration. 

‘A lawless president’

Sen. Ruben Gallego, an Arizona Democrat, described the State of the Union as a “state of denial” during the event on the National Mall. 

“What’s going to happen under that Capitol is a bunch of lies — lies that Donald Trump and the Republicans are going to tell us about how great this country is doing right now,” he said. “But what is true, what is happening right now, is that Donald Trump and the Republicans have made this country sicker, poorer and less secure.”

Democratic lawmakers continued to blast the administration’s immigration enforcement tactics.

Those criticisms grew even louder after federal agents fatally shot two U.S. citizens last month in Minneapolis. 

The Department of Homeland Security is shut down as Congress and the administration try to iron out a solution to Democrats’ demands for additional restraints on immigration enforcement following the deaths of Renee Good and Alex Pretti.

“Now we know the state of our union,” said Sen. Chris Van Hollen, a Maryland Democrat. “We know it is under attack from a lawless president who is shredding our Constitution and who is attacking our democracy — a president whose private (Immigration and Customs Enforcement) army executes Americans and then calls the victims domestic terrorists.” 

Epstein files

Democrats also lambasted the administration’s handling of the files related to the late sex offender Jeffrey Epstein, which faced criticism for its piecemeal rollout of the files and heavy redactions. 

Several Democratic lawmakers invited survivors of Epstein as their guests to Trump’s State of the Union address. 

“We should be crystal clear about right now what is happening in our country,” said Rep. Robert Garcia of California, the top Democrat on the House Committee on Oversight and Government Reform, during the rally on the National Mall. 

“We have a president who is leading the single largest government cover-up in modern history — we have the single largest sex trafficking ring in modern history right now being covered up by Donald Trump and (Attorney General) Pam Bondi in the Department of Justice,” Garcia said. 

Trump, who has appeared in several of the files, had a well-documented friendship with Epstein, but has maintained he had a falling-out with the disgraced financier and was never involved in any alleged crimes.