Powerful U.S. officials past and present faced families, survivors and first responders Friday at ceremonies to honor the 25th anniversary of the day 2,977 Americans died in terrorist attacks in Virginia, New York and Pennsylvania.

At the Pentagon, Condoleezza Rice, who was serving at the time under President George W. Bush as national security advisor, told the crowd she wanted to share something “deeply personal.”

“Those of us in authority on that day did not see the nature of the danger in time to prevent the attack of 9/11. We did what we knew to do, but by definition, it was not enough. … I will always carry deep personal remorse for the pain that you, the families of the fallen, still feel, and for the trauma that our country endured,” she said.

Speakers at all three Sept. 11 milestone anniversary events recounted stories of courage and loss as people found themselves in an unimaginable circumstance. 

Some also flared with frustration at what they say is a lack of justice for those who planned the attacks.

President Donald Trump and Secretary of Defense Pete Hegseth, speaking at the memorial service for the 184 people who died when the hijacked United Airlines Flight 77 struck the Pentagon in Arlington, Virginia, highlighted the anniversary as a justification for their stagnant war with Iran. 

That nearly seven-month-old conflict has killed 18 U.S. service members, injured over 700 more and taken the lives of thousands of civilians across the Middle East.

“We will never, ever forget. That’s why we fight today. We don’t have a choice,” Trump said. “There can only be victory. We fight hard. We fight to win. We will always remember the victims and the families of September 11, 2001, very famous date, unfortunately.”

Hegseth told the crowd, which was only open to victims’ families, survivors and their families, that Americans were “ignorant of the Islamist threat” 25 years ago.

“Every day, enemies plot to curb our power and kill our citizens, including from Islamic terrorists abroad and at home, but we are ever vigilant,” he said, adding that the U.S. has killed Iran’s leaders and put their Navy “at the bottom of the sea.”

The deeply unpopular war has continued, despite early promises from Hegseth and Trump that it would not morph into the prolonged Middle East conflicts that followed the Sept. 11 attacks.

‘No justice’

At the site in Lower Manhattan where the World Trade Center’s twin towers once stood, families read names of the 2,753 victims who died inside the towers, on the ground and on the two hijacked airliners, American Airlines Flight 11 and United Airlines Flight 175.

Terry Strada, widow of the late Tom Strada, who died in the north tower, slammed recent presidential administrations of both parties for not holding Saudi Arabia accountable for allegations that the kingdom’s officials knew about the attacks.

“My husband Tom Strada, you are missed more with each year that passes. But how can it be 25 years and still we have no justice for the role that Saudi Arabia played in your murder?” she said to loud cheers from the crowd.

“For 25 years, administration after administration, including leaders in front of us here today, chose to protect the Saudis instead of standing with the 9/11 families,” she said. 

 

“President Trump can still change that. Tell the Saudis to stop lying. Tell them that if they want to be friends with the USA, they cannot continue to deny all of this, all of the pain, all of the destruction that we have all been suffering through. Vice President Vance, thank you for being here today. Please carry that message back,” she said, again receiving loud cheers.

Vice President JD Vance sat in a front row at the ceremony alongside former presidents Bush, Joe Biden, Barack Obama and Bill Clinton. 

Former first ladies Michelle Obama, Jill Biden and Hillary Clinton, also a former secretary of state, were seated in the row, as was former New York City Mayor Michael Bloomberg.

Neither the Embassy of Saudi Arabia nor the White House immediately responded to States Newsroom’s requests for a response.

Painful memories

Families at the site in Lower Manhattan shared memories seared in their minds.

Bob Lee, 67, was a firefighter in the Bronx that day. He remembers how many first responders had to gather together to clean up the dust and debris that had settled around the city.

“When you see the people that were down here, everybody’s eyes was … full of soot and dust, and their eyes were glowing like bright red because all the stuff that was in their eyes,” Lee said. “It was just a crazy scene.”

Lee moved to Kansas City, Missouri, shortly after 9/11. He was 42 at the time and realized he had been exposed to a lot of toxic air.

“I told them I was retiring,” Lee said recalling that he knew a lot of his colleagues would get sick. He was a union representative for his unit in the Bronx. 

“I lost hundreds of those guys. You know, it’s crazy … Quite a few friends have died of cancer.”

New York City Mayor Zohran Mamdani this week announced that his office had released around 170,000 pages of records that had been closed off over the last 25 years on the level of toxic air pollution people were exposed to in the aftermath of 9/11.

The records suggest that New Yorkers were misled about the air quality and that officials downplayed how dangerous it was to breathe the air. According to the Centers for Disease Control and Prevention, close to 50,000 people, including first responders and survivors, developed cancer in relation to the event. 

Christopher Santora, then 23, was a firefighter who responded to the attacks and was enveloped in debris as the towers fell. He lost his life trying to save people that day. His cousin Jason Roettger, 56, was chosen to read the names of people who had died during 9/11 at Friday’s ceremony.

Roettger said it was an honor to be a part of the event and to represent his cousin. He said he’s glad the air quality records were released.

“I think everyone that was here in the city, or even in New Jersey, everyone in this area knew the air wasn’t good,” Roettger said. “Even though the government said ‘No, the air is fine.’ I think everyone knew that that was a lie.”

Wanda Hernandez, 72, lost her daughter Monique de Jesus, who was 28 at the time. She was working at the World Trade Center. 

Hernandez said Friday she was focusing on all the beautiful moments she had with her daughter before that day.

“We went on vacation for my birthday before it happened, like a month before. Yeah. Yeah, we had a good time, you know, and we went to a wedding like a week before it happened,” Hernandez said. “Two weeks, so that was nice. Had a good time. I was a good mother. She was a good daughter.”

‘A vast empty space in the side of the Pentagon’

Over a 13-minute speech Friday morning at the Pentagon, Rice, who also served as secretary of state later in the Bush administration, painted a picture of administration officials caught completely off guard by the attacks, orchestrated by the well-known anti-American extremist terror network al-Qaeda.

“I was at my desk at the White House that day when my executive assistant, a young Army officer, told me that a plane had hit the World Trade Center. ‘What a strange accident,’ I thought,” Rice said.

“I called President Bush, who was reading to children at an education event in Florida. He too thought that it must have just been an accident. But within 17 minutes, a second plane hit the World Trade Center,” she continued.

What followed, according to Rice, was a whirlwind as officials rushed to secure locations — Bush to Air Force One, Rice and Vice President Dick Cheney to a White House bunker and CIA Director George Tenet to an undisclosed location. 

Then-Secretary of State Colin Powell was in Peru “and trying to get home.” Those in the White House “Situation Room,” Rice recalled, just heard the “ringing and ringing and ringing” of Defense Secretary Donald Rumsfeld’s phone at the Pentagon, where he had been hosting a congressional breakfast. 

The late Rumsfeld would end up outside assisting in rescue efforts “as his security detail begged him to flee,” she said.

“I remember turning to a television screen, and the horror and the shock that I felt. There was a smoking crater, a vast empty space, in the side of the Pentagon.”

Fight with hijackers

A morning observance program was also held at the Flight 93 National Memorial near Shanksville, Pennsylvania, to mark 25 years since 40 passengers and crew members died when the hijacked United Airlines Flight 93 crashed in a rural field. 

Families read aloud the names of the victims during the ceremony.

Members of Flight 93 fought with hijackers over Western Pennsylvania and forced the flight to crash, which prevented the hijacked aircraft from hitting the intended destination of the U.S. Capitol.

Others expected to speak Friday afternoon included Pennsylvania Gov. Josh Shapiro and U.S. Interior Secretary Doug Burgum.

Gordon Felt, brother of Edward Porter Felt, one of the 40 people who died on Flight 93, was set to speak, along with retired United Airlines Capt. Morrie Wiener, who piloted Flight 93 prior to the attacks on Sept. 11, 2001, and Jessica Bowron, acting director of the National Park Service.

Mullin ties mass deportation to Sept. 11

Outside of the Department of Homeland Security headquarters in Washington, D.C., Homeland Security Secretary Markwayne Mullin used the anniversary to promote the Trump administration’s mass deportation campaign, and said that lack of cooperation from so-called sanctuary cities is what could lead to another 9/11.

“It’s a safe haven that incubates terrorist activity and it doesn’t just stay local,” he said.

He specifically called out Democratic-led cities of Seattle, Boston and New York City.

“It shouldn’t be political,” he said. “When we start looking at the 25th anniversary, if there’s anything we should agree on, it should be that. Why should the Department of Homeland Security be controversial? We’re taking care of your backyard.”

Immigration enforcement agencies under the department have been roiled in scandal and carried out alleged illegal orders since Trump’s second term began. 

The events have included allowing deportation flights to take off against a judge’s order, erroneous deportations of individuals with legal protections, and the killing by immigration agents of two American citizens, Renee Good and Alex Pretti, of Minneapolis. 

The latest scrutiny of the department comes after a $20 million no-bid contract was extended in Kentucky to outfit agents with electric shock gloves.

Courage and ‘selfless service’

Despite the lasting pain, speakers Friday noted that relatives of those killed in the attacks found ways to move forward and persevere.

Chairman of the Joint Chiefs of Staff Gen. Dan Caine at the Pentagon said the milestone anniversary was not only about remembering those lost, but “it is also a story of great American courage, selfless service, and those who’ve made the choice to carry those memories forward.” 

“The courage of those extraordinary Americans in Pennsylvania, in New York, and right here on these hallowed grounds, did not end when the smoke cleared and the fires went out, because survivors and families have carried it forward through service, through sacrifice, and through remembrance,” Caine told the crowd.

On a rural stretch of land in Somerset County, Pennsylvania, an open meadow filled with bright wildflowers, a memorial grove of trees and a giant boulder marks the spot where United Airlines Flight 93 crashed on Sept. 11, 2001.

States Newsroom’s Pennsylvania Capital-Star Editor-in-Chief Tim Lambert recently revisited the national memorial on this field — where he happened to own a piece of land that was part of more than three dozen acres that made up the crash site.

“It’s always hard to come back here, but it’s always a chance to remember the sacrifices made by the passengers and crew of Flight 93 on that day,” Lambert said. “I think it’s important 25 years later to remember what they did and why they did it. They decided to act on a day that America was under attack.”

On that day, al-Qaida terrorists hijacked four commercial planes. They slammed two into the World Trade Center towers in New York City and another into the Pentagon in Arlington, Virginia. The fourth — Flight 93 — crashed in an open clearing near Shanksville, Pennsylvania.

The 40 passengers and crew are remembered for sacrificing their lives when they tried to wrest control of the plane from the hijackers and stop them from hitting what was believed to be their intended target: the U.S. Capitol.

Nearly 3,000 people were killed in what is the deadliest terror attack on U.S. soil. Forty-four people, including the four hijackers, died aboard Flight 93.

At the time, Lambert worked as a reporter for a public radio station in Harrisburg, Pennsylvania.

“It was around 4:30 in the afternoon — among the chaos of the newsroom — and I looked up at this TV that was on a cabinet, and the reporter from one of the national outlets was standing at the corner of the Lambertsville (and) Shanksville Road,” Lambert recalled. “And it was at that moment, I stopped and thought, ‘Wait, we still own land near Shanksville, and it’s awfully close to that intersection.’”

The next morning, Lambert said, he listened to a voice message on his home answering machine from his dad, who recognized the crash site on television, realizing that it was their family property.

Lambert was in a unique situation. While reporters across the nation and around the world were covering the tragic event, he was the only journalist who had access to the Flight 93 crash site. He realized he had a huge responsibility.

“I was well aware that history was at the door, and I wanted to do things the right way,” he said.

Lambert not only reported on the crash, but also assisted first responders and met with the families of the passengers and crew. He remembered what the land looked like that day. The plane had plowed into the ground at a high rate of speed, with the aircraft disintegrating into tiny bits and pieces, leaving a large crater.

Although the majority of the plane shattered and few bodies were recovered, authorities were able to identify the passengers and crew. More than 1,500 response members under the direction of the Federal Bureau of Investigation recovered fragments of the plane: twisted pieces of metal, tires, seat frames, luggage, clothing — most of which were no larger than a notebook.

The field was essentially a cemetery, and family members wanted to protect it. Only family members and some park rangers can visit the actual crash site. But the public can walk along the tall concrete walls of the nearby memorial, etched with the names of people who perished in the crash. Visitors can also go to a museum and walk through parts of the field to an overlook to view the crash site.

Through the years, Lambert has visited the site to pay his respects.

“It’s been a while since I’ve been here, so it’s almost like a little homecoming to visit with old friends, even if it’s just looking out on the field and remembering those who gave their lives that day,” he said.

The museum features photos of family members of passengers and crew, with details about their lives and memorabilia, including photographs, jewelry and uniforms. For example, the husband of flight attendant Lorraine Bay donated her United Airlines ID and one of her uniforms, along with a wine bottle corkscrew she used for in-flight service.

“You know, with these exhibits, I want to take something that’s very large and abstract and offer different avenues for different people to come in and relate to it,” said Betsy Keene, curator for the National Parks for Western Pennsylvania, which includes the Flight 93 National Memorial.

“Families say they want their loved one to be remembered as an individual person, as more than just this one day.”

She said there are about 9,300 objects collected from the crash site and from families that are cataloged at the memorial, including 800 pieces of the aircraft curated over the years.

“We want to have these objects to help people relate and to pull them into the story and to help them understand who these people were, what happened here, and what it meant to the world at the time,” Keene said.

Memorial Superintendent Stephen Clark said more than 400,000 visitors annually come to the park, owned and operated by the federal government and managed by the National Park Service.

“I think that this memorial, albeit 25 years, it’s still a glimpse. It’s still a blink of an eye in our nation’s history,” Clark said. “But I still think that even as the years roll on, this story will continue to be told.”

Through the years, Lambert said he’s had many chances to meet families whose loved ones died that day. As the 25th anniversary approaches, he said he plans to reflect on their stories.

“The memorial is beautiful. The memorial is very fitting. It’s a great tribute, and it’s a respectful tribute to the passengers and crew of Flight 93. But for me, I think about watching the land heal over the 25-year period,” Lambert said.

“To watch them sort of heal as the site heals through nature, and watch that sort of in tandem, is something that I will always think about anytime I look over that field.”

Pennsylvania Capital-Star reporter Peter Hall contributed to this report. Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

In 14 states, the closure of the closest rural hospital or its obstetric unit would force many Medicaid patients to drive an hour or more to get to another hospital that provides inpatient maternity care, according to an analysis released this week.

Nationwide, the median drive time between hospitals providing inpatient maternity care to Medicaid enrollees and the closest in-state alternative is 43 minutes for rural hospitals compared with 13 minutes for urban hospitals, the analysis found.

The study by KFF, a healthcare research organization, suggests that the closure of rural obstetrics units will accelerate as a result of the healthcare changes included in the broad tax and spending measure President Donald Trump signed last summer. That law will reduce some payments to hospitals and cut Medicaid enrollment by introducing work requirements.

Already, rural obstetric services are diminishing at a rapid rate: From 2010 to 2022, 238 rural hospitals closed their obstetrics units while only 26 hospitals opened new units. In 2023, almost half of rural counties did not have a hospital offering obstetrics services.

A 2022 report by the Government Accountability Office cited low Medicaid reimbursement rates and the challenge of recruiting and retaining providers as major factors.

Brittni Frederiksen, the lead KFF researcher for the report, said in an interview that rural hospitals already operate on thin margins, and that the additional cuts could push some of them over the edge.

“There are likely going to be rural hospitals that close their obstetric units or have to close the entire hospital, and so people will have greater distances to travel to safely deliver a baby,” said Frederiksen, an associate director at KFF who specializes in women’s health policy.

The states with the longest potential driving times, according to the KFF analysis, are Alaska, Nevada and North Dakota. The other states where the median trip would be an hour or more are Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia, and Wyoming.

The states with the shortest drive times are New Jersey, Louisiana, and Ohio.

A lack of access to maternity care can lead to increased maternal mortality, low birthweight and premature births.

The United States has one of the worst maternal mortality rates among higher-income countries, at 17.9 deaths per 100,000 live births in 2024, according to the federal Centers for Medicare and Medicaid Services. The U.S. rate is double, or even triple, the rate in most other high-income countries, according to The Commonwealth Fund, a philanthropic and research group.

Outcomes are even worse for women on Medicaid, the government insurance program for people with lower incomes. A recent survey of Medicaid patients who gave birth in 2023 and 2024 found that those patients experienced more complications, such as high blood pressure and gestational diabetes, than women with private insurance.

“We already have a maternal health crisis in this country, and already have very poor outcomes when it comes to delivering babies safely in this country. And then in rural areas, in particular, people already have to travel long distances to deliver,” Frederiksen said.

“Anytime you increase the distance to delivery, you know the likelihood that it could result in poor outcomes increases.”

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

Part 1 of an occasional series on how people are being affected by the expiration of Affordable Care Act subsidies.

EDWARDS, Miss. — Every now and then a freight train rumbles through, creaking and groaning on the rusted tracks that run along the edge of the largely deserted downtown. On some days, that train is just about the only thing moving.

Grandma’s Ice Cream Shoppe, an ice cream parlor owned by a retired preacher and his wife, gets only one or two customers per day. There is a small barber shop, and the empty ruins of a former thrift store. The sugary, smoky red meat at Lee’s Heavenly Barbecue and the fried shrimp and catfish at the M & L Fish Hut draw some folks. But the ellipticals and treadmills are silent, as usual, at the 4-year-old Kut-N-Fit Wellness Club on Vicksburg Street.

Derrick Clark, 51, has lived in Edwards his whole life.

Clark has always struggled with his weight and he readily describes himself as obese. About two decades ago, he was diagnosed with Type 2 diabetes.

“My grandmother, my uncle, my dad are all diabetics, and I’ve had some relatives that have gotten some of their limbs cut off because of their diabetes,” Clark said. “When it’s a hereditary disease that runs in the family, it’s kind of hard.”

Last year, Clark was reelected as the at-large member of the Edwards Board of Aldermen. But the part-time job only pays about $500 a month. His family owns a small sports bar in town, but it’s only open for a few hours a day and doesn’t generate much additional income.

He has no health insurance.

As is the case with many chronic diseases, the worst consequences of diabetes — such as blindness and amputations — can be prevented with routine care. Clark and many other diabetes patients in Mississippi were getting that care over the past few years through subsidized Affordable Care Act insurance plans.

But Congress allowed the so-called enhanced subsidies to expire at the end of last year. Now the number of diabetic Mississippians without insurance, and thus regular care, is once again on the rise: According to state data, enrollment in ACA plans has fallen by nearly two-thirds in just eight months. The medical and financial consequences could be dire — for individual patients like Clark and for the state.

Mississippi maladies

Designed as a temporary pandemic-era measure, the enhanced subsidies were made available by the American Rescue Plan Act in 2021 and later extended through the end of 2025 by the Inflation Reduction Act.

 

 

In 49 states (all but New Mexico), the number of people enrolled in ACA plans, also known as Obamacare, has declined since the subsidies expired and coverage became more expensive. Nationwide, participation has declined this year by nearly 3 million people, to about 19.2 million from 21.8 million in 2025, according to the Trump administration. The 2025 figure was the highest ever recorded, after six years of steady increases.

But few if any states are feeling the absence of the subsidies as acutely as Mississippi.

By many measures, Mississippi is the poorest state, with more than 14% of its families living below the federal poverty line. Its traditional Medicaid program has strict income limits, and excludes nearly all non-disabled adults, including Clark. And it is among the 10 states that have not expanded Medicaid to single adults and higher-income parents under the Affordable Care Act.

Mississippi is also one of the unhealthiest states. The federal Centers for Disease Control and Prevention has identified a “diabetes belt,” where people are most likely to have the chronic disease. It includes 644 counties across 15 states, primarily in the South; Mississippi is the only state where every county made the list.

In addition to its high diabetes rate, Mississippi has the nation’s second-highest heart disease mortality rate, and it is one of only two states, along with West Virginia, with an obesity rate above 40%.

Black people make up more than 36% of Mississippi’s population — the highest percentage of any state — and Black Americans are more likely than other racial groups to have chronic diseases, including diabetes. That’s largely because Black people are more likely to live in poverty, to have trouble accessing healthcare, and to be exposed to pollution and chronic stress.

 

 

When the subsidies significantly lowered the cost of Obamacare coverage — making it free or nearly free for some people with low incomes — Mississippi state health officials made a concerted effort to get residents to enroll. Dr. Daniel Edney, Mississippi’s state health officer, said the state launched a public information campaign to encourage people to sign up at their local health departments.

It worked. The number of Mississippians enrolled in Obamacare plans more than tripled, from fewer than 99,000 people in 2020, the year before the subsidies went into effect, to more than 338,000 at the end of 2025, according to state data.

“Our uninsured rate went down significantly, and I’m convinced it’s one of the reasons why our overall population health scoring has improved,” Edney said in an interview in his office in downtown Jackson.

In its 2025 public health report card, the Mississippi State Department of Health reported lower rates of opioid-related deaths, HIV, syphilis, congenital syphilis, teen births and accidental deaths. Health officials acknowledged that the state had made less progress on chronic conditions such as hypertension and obesity, but also noted that it went from dead last in overall national health rankings three years ago to 48th last year.

But when the subsidies expired at the end of last year, Mississippi’s Obamacare enrollment numbers plunged: Roughly 134,000 residents were still enrolled as of Aug. 21, about 40% of last year’s total. And the state projects that the number will fall to around 127,000 next year.

Many of the Mississippians who dropped their coverage have diabetes or other chronic conditions. Without insurance, they are likely to put off routine care, Edney said.

“What’s gonna happen to them? Probably present to the emergency room, eventually showing up once their vision is blurry, or they start having chest pain, or they have a sore on their foot that won’t heal,” he said. “At that point, you’re scrambling to get them placed into care.”

The Obamacare subsidies made a huge difference for Clark, who is unmarried and does not have any children. With coverage, his insulin and medications to control his blood pressure and blood sugar cost him about $15 per month, he said. But he could no longer afford his insurance plan when the subsidies expired and his premiums went up by “hundreds of dollars.”

Without insurance, he says his medications now cost him about $200 per month — and that’s with discounts he gets from medical clinics. Sometimes, he said, family members give him insulin they don’t plan to use.

At some point, he said, he might have to choose between paying for medications and paying his other bills.

“I still have utilities and water and gas and food and still have to buy my medicine monthly out of pocket,” Clark said. “I’m just praying for a better day and trying to lose some weight so I can try to get my diabetes in control.”

Opening a gym 

Like Clark, 49-year-old hair stylist and salon owner Angie Myles-Griffin grew up in Edwards, and she never really wanted to leave. But the limitations of living in a small town hit home after she gave birth to her third child and she set out to lose some of the weight she had gained: She had to drive more than an hour round trip to Jackson to find a gym and a grocery store selling healthy food.

Frustrated by the back and forth, Myles-Griffin decided to do something about it: She became a certified personal trainer and opened her own gym in Edwards, the Kut-N-Fit Wellness Club, right down the street from Lee’s Heavenly Barbecue.

“I became very passionate about health and just fitness overall,” Myles-Griffin said. “So I wanted to bring that back to my community, so people wouldn’t have that excuse of having to drive.”

Myles-Griffin said that in 2024 she partnered with the University of Mississippi Medical Center in Jackson to lead a yearlong diabetes prevention program for 20 Edwards-area women. Myles-Griffin gave participants fitness and nutrition coaching at her new gym and even brought in dieticians to show them how to prepare healthy meals. A dozen people stuck with it.

But since the medical center concluded its sponsorship, most of Myles-Griffin’s clients have melted away. Even though Kut-N-Fit is conveniently located, she said most Edwards residents just don’t have the “mindset” to work out regularly. And Edwards residents still have to drive about a half hour to get to a grocery store with a wide selection of healthy offerings, she said.

Unfortunately, a lack of transportation is one of the many challenges that Edwards residents face.

“If you don’t have transportation, you can’t get to a job, and if you can’t get to a job, there’s no income,” Myles-Griffin said. “And so when there’s nothing going on, it’s like a lack of motivation.”

Poverty, a lack of exercise, obesity, diets high in sugar, unhealthy fats and processed ingredients — that confluence of factors exists in many Mississippi communities. It’s a recipe for Type 2 diabetes, and it’s costing Mississippi billions of dollars.

Diagnosed cases of diabetes cost the state an estimated $5.1 billion annually — $3.4 billion from direct medical expenses and another $1.7 billion from lost productivity in 2022, according to the American Diabetes Association.

And when diabetics don’t get regular care, because they don’t have insurance or don’t have easy access to a doctor, the most extreme — and expensive — health outcomes become more likely. Mississippi’s lower extremity amputation rate is about twice the national rate, according to the American Heart Association.

Irena McClain, the executive director of the nonprofit Diabetes Foundation of Mississippi, said that since the subsidies expired, her organization has been receiving more calls from people asking for help. Without insurance, medical care for diabetes can cost people upward of $1,000 per month, according to a 2022 study.

“I had someone call me up last week, whose doctor wants her on an insulin pump to control her Type 1 diabetes, and she doesn’t have any insurance. She can’t get a pump unless someone donates a pump to us,” McClain said. “And there’s certainly a lot of people who need help much more than the amount that these charities have to give. I don’t know what’s going to happen.”

In Jackson, McClain said, charities, free clinics and community health centers are struggling to provide care to all the diabetes patients who have lost their Obamacare coverage.

Mississippi hospitals also are feeling the pinch, according to Richard Roberson, president and CEO of the Mississippi Hospital Association. In 2023, the most recent year for which numbers are available, Mississippi hospitals provided more than $600 million in “uncompensated care,” or care for which they received no payment from either the patient or an insurer.

“That trajectory of costs combined with the trajectory of uninsureds is just going to really exacerbate the challenges for hospitals,” Roberson said. He added that changes to hospital funding included the broad tax and spending law President Donald Trump signed last summer, the One Big Beautiful Bill Act, will increase the financial strain.

“We’re just going to start seeing that decrease in revenue, increase in cost, and at some point on the axis, they’re going to cross, and it’s going to be bad,” he said.

No help coming

Meanwhile, the cost of Obamacare coverage keeps going up. Next year, the median proposed premium increase is expected to be close to 15%, the second consecutive year of a double-digit premium hike.

In addition to the expiration of the federal subsidies, prices have increased because of other factors, including labor shortages and the rising cost of prescription drugs, driven in part by the growing demand for GLP-1 drugs such as Ozempic and Wegovy.

At least 10 states are using their own money to help people buy Obamacare health plans, partially replacing the expired subsidies. But Mississippi isn’t one of them.

“It’s not that there’s a big money room in the basement where we can go get the money that we’re keeping from everyone,” Mississippi Republican state Rep. Lee Yancey, who serves on the House’s public health and human services committee, told Stateline. “It’s just there’s a limited amount, and there’s only so much you can do.”

Yancey expressed sympathy for Mississippians who can’t afford Obamacare plans without the subsidies. However, he added, he doesn’t believe that “just because a problem exists the government is the one that has to fix it.”

Without the Obamacare plan he used to have, Clark said he has little choice but to drive to Jackson every month to get discounted medications at the Jackson-Hinds Comprehensive Health Center.

“Sometimes you got to do what you got to do, and with this high price of gas and food … it’s just rough,” Clark said as he stood outside the clinic.

“If you go in there, you see it’s not about a race thing,” he said. “It’s just poor people — the working poor.”

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

This story was updated to clarify that poverty, a lack of exercise, obesity and diets high in sugar, unhealthy fats and processed ingredients are risk factors for Type 2 diabetes, not diabetes generally.

This story is part of “Uninsured in America,” a project led by Public Health Watch, a nonprofit newsroom based in Texas. The project focuses on life in America’s health-coverage gaps and the impact of potential Medicaid cuts and other changes.

The number of refugees admitted to the United States during the first 10 months of the fiscal year is on pace to hit its lowest level on record, according to a new analysis.

The new numbers reflect a steep decline in refugee admissions since President Donald Trump began his second term, according to a new analysis of State Department data by the Pew Research Center.

The U.S. has admitted 10,258 refugees — nearly all of them white South Africans — in the first 10 months of the fiscal year, which ends on Sept. 30. During fiscal 2025, part of which overlapped with President Joe Biden’s term, the U.S. admitted 38,102 refugees. In the previous year, during which Biden was president the entire time, 100,034 refugees were admitted.

The Trump administration, which has sought to limit immigration of all types, has capped refugee admissions for fiscal 2026 at 17,500, the lowest level in the past 25 years.

Refugee admissions have fluctuated over time. They declined sharply after the Sept. 11 terrorist attacks, when President George W. Bush temporarily halted application processing. And they fell again during Trump’s first term, when he restricted immigration from majority-Muslim countries. However, the U.S. admitted an average of 50,000 refugees per year between 2001 and 2026.

In February 2025, Trump issued an executive order prioritizing refugee admissions for Afrikaners — white South Africans descended from Dutch, German and French colonial settlers. Afrikaners were the primary architects of apartheid, a rigid system of racial segregation that lasted from 1948 to 1994.

About 80% of South Africans are Black. Trump’s order asserts that the country’s Black leaders have discriminated against the Afrikaners and demonstrated a “shocking disregard” for their rights by seizing their farmland without compensation. South African leaders deny that Afrikaners have been subjected to systemic persecution.

In recent years, the majority of refugees to the U.S. have come from the Democratic Republic of Congo, which has seen ongoing war and displacement. Many refugees also have come from countries such as Syria, Ukraine, Bhutan, Iraq, Afghanistan, Sudan, Venezuela, Eritrea, Myanmar and Guatemala.

In a 2025 Pew Research Center survey of 10,357 Americans, about 36% of respondents said that it was very or extremely important to take in refugees escaping violence in other countries. Another 39% said it was somewhat important.

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

On June 11,  ICE agents trailed a car into the parking lot of Commodore John Rodgers Elementary/Middle School in Baltimore. For the family riding in that car, an everyday school drop off quickly devolved into chaos.

ICE agents pulled Jesus Acevedo Sanchez from the vehicle, pinned him to the ground and arrested him for being in the country illegally. They also handcuffed and detained his wife, Adriana Gavilan Sanchez, as the couple’s two daughters watched from the back seat and school staff whisked other students away from the scene.

A Department of Homeland Security spokesperson later told CNN that Acevedo Sanchez “refused lawful commands, violently resisted arrest, and used his vehicle to evade law enforcement, dragging an ICE offer in the process.”

But two weeks ago, a federal judge ordered Immigration and Customs Enforcement to release him, ruling that agents did not have probable cause to make the arrest. In the courtroom, Judge Julie Rubin rebuked the ICE officers for failing to follow due process and described the incident outside the school as a “stomach churner.”

Since President Donald Trump began his second term with a vow to crack down on illegal immigration, more than a dozen states have enacted laws designed to keep ICE away from schools. But the incident in Baltimore was a stark illustration of the limits of state and local authority when it comes to immigration enforcement.

Both Maryland and the city of Baltimore have enacted such measures, but neither one prevented ICE agents from making arrests in full view of arriving students at the Commodore John Rodgers Elementary/Middle School.

“Schools are places where children should feel safe, where parents should be able to drop off their kids without fear, and where educators should be able to focus on teaching — not where federal agents carry out immigration enforcement actions in front of children,” Maryland Democratic Gov. Wes Moore said in a statement he released on the day of the incident.

In a phone interview, Zeke Cohen, the Democratic president of the Baltimore City Council, said “the behavior of ICE has been tragic, traumatic, and in violation of all of the principles that we hold dear in Baltimore.”

“They are reckless, they are lawless, and they do whatever they please,” Cohen said. “It’s a challenging situation for cities like Baltimore that prize diversity and inclusion when you have a government that does the opposite.”

The day after its inauguration, the Trump administration announced that it would reverse guidance in place since 2011 that restricted migrant arrests at “sensitive locations,” including schools, hospitals and places of worship. Since then, there have been at least 17 ICE encounters on school grounds, according to a tracker maintained by K-12 Dive, an education news website.

Katherine Currie, a spokesperson for the Department of Homeland Security, said that ICE is not targeting schools, but that immigration enforcement “is a clear federal responsibility” under the U.S. Constitution.

“ICE is not going to schools to arrest children — we are protecting children. Criminals are no longer able to hide in America’s schools to avoid arrest,” Currie wrote in an email.

“If a dangerous illegal alien felon were to flee into a school, or a child sex offender is working as an employee, there may be a situation where an arrest is made to protect public safety.”

Warrant required

The state and city restrictions on ICE activity in schools don’t challenge the supremacy of the federal government under the Constitution. Instead, they mostly limit what state, local and school officials can do to assist ICE, often specifying that federal agents should not be granted access to school property without a judicial warrant.

Matthew Lopas, director of state advocacy at the National Immigration Law Center, a nonprofit that advocates for immigrants, said blocking ICE agents from entering school premises without a warrant “is not in conflict with federal law.”

“It is merely saying that this is not a place where immigration enforcement should be coming on fishing expeditions,” Lopas said.

Verjeana McCotter-Jacobs, executive director and CEO of the National School Boards Association, said there are very few situations in which ICE would be justified in showing up at a school.

“We don’t see a need for law enforcement to be executing any activities on school grounds, unless it’s in response to an emergency situation,” McCotter-Jacobs said. ,“It causes stress and distractions to learning, which impacts every single child and every child in the building as well as staff.”

She added that when it does happen, it’s crucial for school officials to be on the same page with state and local law enforcement.

“Some states are unfortunately aligned with the feds in executing arrests on school grounds, and so that leaves the local school district kind of perplexed as to what they’re supposed to do,” she said.

Indiana, for example, enacted a sweeping law this year that bars school districts and universities from implementing any measure that prohibits or restricts public employees from cooperating with ICE. In November, Republican state Attorney General Todd Rokita sued the Indianapolis Public Schools for violating the law.

Ohio is another Republican-led state where political leaders are largely supportive of the Trump administration’s immigration policy, and it has not enacted a law restricting ICE activities on school grounds. But Chad Springer, superintendent of the Athens City School District in Chauncey, said his district’s immigration enforcement policy does focus on whether agents have a warrant.

As soon the Trump administration reversed the “sensitive location” policy last year, Springer said, he visited each of his campuses to explain how the district wanted them to respond in case of an ICE enforcement action.

“At any given time, there’s always a central office staff that’s going to respond if immigration did show up to a campus, and then we would be the ones to deal directly with immigration officials,” Springer explained. “And our board policy dictates we ask them, unless a judicial warrant is involved, to conduct business outside of the school day, not on school grounds.”

Springer said that every school board across the country should be crystal clear about how it would handle any law enforcement activity on campus. He said he understands his own district’s policy, but he’d welcome more direction from the state.

“In the absence of clarity, you have unclear measures, and that leads to confusion,” Springer said. “I would appreciate clear, explicit guidelines from lawmakers as to when we allow or don’t allow [officers] to be there…right now, all I can lean on is board policy.”

The coming school year

In Ohio and elsewhere, the Trump administration’s announcement late last month that it will terminate Temporary Protected Status for more than 330,000 Haitians living in the U.S. will heighten the potential for ICE enforcement at schools.  In Ohio alone, there are about 30,000 Haitians who formerly had that status, which allows people from certain countries to live and work in the U.S. if returning to their home country would be dangerous.

Jeff Wensing, president of the Ohio Education Association, said educators, particularly in cities such as Springfield with large Haitian populations, are concerned about what the new year might bring.

“So we gave guidance to our members in Springfield: ‘Here are your rights,’” Wensing said. “I don’t care who you are — if you are a stranger, including ICE agents, we have a policy, we’re not letting strangers into the school.”

As far as he’s concerned the law is clear.

“They have a legal right to attend a public school, regardless of their immigration status,” Wensing said. “When you make children pawns in a bigger game, that’s never a good thing.”

This story has been updated to correct the title of Verjeana McCotter-Jacobs. Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

In 49 states, the number of people enrolled in Obamacare plans has declined since Congress made coverage more expensive by allowing federal subsidies to expire at the end of last year.

The lone exception was New Mexico, the only state that has used its own money to fully replace the expired aid, according to a new analysis by KFF, a health policy research group.

Late last month, the Trump administration announced that overall participation in the health insurance marketplaces created under Obamacare, officially called the Affordable Care Act, had declined by nearly 3 million people, to about 19.2 million from 21.8 million in 2025. That 2025 figure, the highest ever recorded, was the culmination of six years of steady increases.

In announcing the figures, the Trump administration blamed much of the growth since 2021 — the year former President Joe Biden took office — on “improper, phantom and fraudulent enrollment.” It said the number of people in those categories peaked at 5.6 million last year, and that this year’s decline was the result of its efforts to eliminate enrollees who misstated their income to gain access to free plans.

But KFF connected this year’s decline to the expiration of the enhanced federal subsidies. Designed as a temporary pandemic-era measure, the subsidies were made available by the American Rescue Plan Act in 2021 and later extended through the end of 2025 by the Inflation Reduction Act.

The enhanced subsidies were available to everyone, regardless of income. Additional federal aid provided to some of the lowest-income households entirely eliminated premium payments for some people. Congressional leaders let the subsidies expire on Dec. 31.

Under the Affordable Care Act, each state can either use the federal government’s online insurance marketplace, HealthCare.gov, or operate its own state-run exchange. In states with their own exchanges, including some that used their own money to partially replace the expired federal subsidies, the average enrollment drop was 6%, according to KFF. In states using the federal marketplace, the average decline was 15%.

Enrollment fell the most in Ohio and Oklahoma (32%), Arizona (30%), South Carolina (29%), Indiana (28%), Michigan and Minnesota (27%), and Louisiana and Mississippi (26%).

Enrollment in Connecticut, the District of Columbia, Idaho, Illinois, Massachusetts, Pennsylvania and Texas was flat or fell by less than 5%. In New Mexico, enrollment grew by 14%.

Justin Lo, a KFF senior researcher who co-authored the report, said in an email that the number of fraudulent enrollees in Obamacare is likely in the “hundreds of thousands,” rather than the millions. Higher estimates, he said, are based on “suspicious patterns that could be explained by fraud or by legitimate factors, the most notable of which is greater subsidies making coverage more affordable.”

“We had a huge growth in the marketplace uptake because a lot of people were seeing that they could now qualify for very cheap plans,” Lo said. “So now, when we’re looking at the loss…it’s people who had marketplace coverage now having to evaluate whether they want to continue it.”

The KFF report examined not just the number of people who enrolled in Obamacare plans this year compared with last year, but also how many maintained that coverage as the year went on. Many people, the group noted, enroll but then end up dropping coverage when they can’t make the first premium payment.

This year, Mississippi had the lowest rate of enrollees maintaining coverage past January, at around 61%, while South Carolina, Louisiana, Indiana and Oklahoma also had rates below 70%. In New Mexico, California, Nevada, Vermont, and Idaho — all states with their own marketplaces — at least 95% of enrollees kept their coverage.

Lo said it’s hard to predict how enrollment figures may look in a year, as some insurers that currently offer plans on the marketplaces “are reassessing their positions and their commitment” to participating.

“So, if insurers are pulling out, people who are seeking marketplace coverage might have fewer choices,” Lo said.

Obamacare insurers are proposing a median premium increase of 14% for 2027, which would be a double-digit hike for the second year in a row, according to a new analysis of preliminary rate filings. Rates should be finalized later this summer.

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

The number of cases of cyclosporiasis — a parasitic infection linked to contaminated water or food that causes severe intestinal issues — has more than doubled to over 4,173 cases across 41 states this week, up from the 1,645 confirmed cases in 34 states reported last week by the federal Centers for Disease Control and Prevention.

Cyclosporiasis causes symptoms that include watery or “explosive” diarrhea, nausea and stomach cramps. The surge in cases had made 2026 the worst year for the infection on record.

The CDC estimates that there are likely more than 7,400 additional cases that have not yet been confirmed. No deaths have been reported, but 308 people have been hospitalized, more than double the 141 hospitalizations reported last week.

State and federal officials suspect there are multiple sources of the outbreak, but they had reported that the cases in Indiana, Kentucky, Michigan, Ohio and West Virginia were connected to shredded iceberg lettuce grown in central Mexico and sold by Taylor Farms. On Monday, however, federal officials said tests making the connection were a false positive.

Michigan, the first state to report an outbreak, reported 7,171 cases and 102 hospitalizations as of July 16. Indiana, New York, North Carolina, Ohio, and Indiana also have seen high case counts, alongside New York City.

The Association of State and Territorial Health Officials, which represents public health agencies across the country, said labs have a hard time tracking case connections because cyclospora is a parasitic genome that is more complex than the bacterial pathogens that cause other foodborne illnesses. As a result, state and local heath investigators must resort to reviewing restaurant and grocery receipts, menus and supply chain records, according to the organization.

“Case interviews and traceback investigations are often time intensive, creating a burden on state and local public health infrastructure,” senior analyst Heather Tomlinson and environmental health director Courtney Anderson wrote.

North Carolina had confirmed more than 560 cyclosporiasis cases as of July 20. Dr. Carl Williams, state public health veterinarian for the North Carolina Department of Health and Human Services, told reporters on Tuesday that the state has relied heavily on its 86 local health departments to track cases.

Williams said twice weekly calls with the CDC also have been helpful.

“The CDC has been very responsive to us and the other states,” Williams said during the briefing. “But as you can imagine, I mean, it’s a lot to go through.”

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

As the Trump administration continues its crackdown  on illegal immigration, states and cities that have pushed back with so-called sanctuary policies have faced a barrage of lawsuits from the U.S. Department of Justice.

The administration has filed a total of 27 lawsuits against more than 20 cities, counties and states with such policies since Trump returned to the White House in January 2025, according to the Justice Department. In just the past three months, the administration has sued at least a half dozen jurisdictions, including Connecticut, Maryland, New Jersey, New York, a county in Michigan, and the city of Philadelphia, for seeking to place limits on the activities of  U.S. Immigration and Customs Enforcement agents.

These policies tend to focus on restricting immigration enforcement in public spaces, limiting how local law enforcement can cooperate with federal immigration authorities, and barring both local and federal immigration agents from wearing masks or otherwise concealing their identity while on duty.

“These sanctuary policies are most times created to help make communities safer. They promote a greater level of trust and cooperation between communities and public institutions of all kinds,” said Cassandra Charles, senior staff attorney at the National Immigration Law Center, an advocacy group.

Some cities have had sanctuary policies since the 1980s, but Charles said many states and cities are creating new protections as the Trump administration has ramped up its deportation campaign. She described the current swell of litigation as “unprecedented.”

Charles said the administration is misinterpreting the Supremacy Clause of the U.S. Constitution, which states that federal law trumps state law. That clause, she argued, does not allow the federal government to dictate what laws states can pass, nor does it “create a duty for the states to help the federal government enforce federal law.”

But the Justice Department argues that sanctuary laws violate longstanding constitutional precedent and prevent the federal government from conducting lawful enforcement activities.

“As explained in DOJ’s briefs in these cases, states and localities do not have a right to obstruct federal law enforcement, to regulate the federal government, or to discriminate against the federal government,” Kiersten Pels, an agency spokesperson wrote in an email. “These and other cases simply seek to vindicate that fundamental aspect of our constitutional structure.”

The lawsuits have yielded mixed results.

In May 2025, the Justice Department sued four New Jersey cities (Hoboken, Jersey City, Newark and Paterson) to challenge their policies curtailing local cooperation with federal immigration agents. The next month, a U.S. district judge in New Jersey, appointed by President Joe Biden, tossed out the suit, arguing the cities’ policies didn’t impede ICE activities because of the state’s existing sanctuary laws.

But earlier this month, a U.S. district judge in Pennsylvania sided with the administration in a lawsuit challenging a new Philadelphia policy.

Last month, the administration sued to stop the city of Philadelphia from implementing a new policy barring immigration agents from wearing masks, concealing their badges, or using unmarked vehicles while on the job. Last week, the judge—a Trump appointee—cited the Supremacy Clause in siding with the administration, issuing a preliminary injunction blocking the city from moving forward.

When the Philadelphia City Council approved the policy, the judge ruled, “it attempted to sidestep the Constitution’s clear mandate and disregarded this fundamental principle of law that has informed American jurisprudence for over 200 years.”

The new policy barring officers from concealing their identities was part of a package of seven ICE-related bills the council approved in April. Rue Landau, the city council member who sponsored the package, noted that the other measures have taken effect.

“If the federal government won’t protect their residents, local leaders have the obligation to step up to the plate, and that’s exactly what we did here in Philadelphia,” Landau said. “Great news for Philadelphia: We’ve got six laws on the books, and right now we are working on ensuring that the city of Philadelphia clearly spells out how we’re implementing these laws.”

In late April, the administration filed a similar lawsuit against the state of New Jersey to challenge a law, enacted in March, that prohibits immigration agents from shielding their identity while on duty.

Maryland is the latest state to face a DOJ lawsuit.

Its new law, in effect since May 31, prohibits state and local correctional officers and law enforcement agents from inquiring about or investigating a person’s immigration status. It also bars them from detaining or transferring a person to federal authorities for a suspected immigration violation without a warrant or court order.

Last week, the Justice Department sued Maryland to stop the law, arguing that its “purpose and effect is to obstruct federal law enforcement.”

“Such blatant disregard for federal laws that have been on the books for decades is not merely a political disagreement or passive abstention; it is deliberate, disruptive action that jeopardizes the public safety for all Americans,” the lawsuit states.

In May, local sheriffs from 17 counties in Maryland also sued the state to halt the new law. Their complaint argues that the law puts them in “an impossible and unconstitutional position.”

“If Plaintiffs follow the Act, they are effectively forced to shield removable aliens from federal custody,” the lawsuit states, while “if they continue cooperating with ICE as they have for years, they risk state penalties and lawsuits.”

In some sections, the sheriffs’ lawsuit and the DOJ lawsuit against Maryland employ identical language.

Chris Hajec, head of litigation at the Federation for American Immigration Reform, which favors stricter immigration enforcement and filed the lawsuit on behalf of the sheriffs, said the Maryland law “puts (the sheriffs) in a dilemma.”

“Either they’re violating the state law and they’re going to get sued by their attorney general, or they’re violating the federal criminal law and they could be prosecuted,” Hajec said.

But Maryland Democratic state Sen. Clarence Lam, the Senate sponsor of the new law, dismissed that argument. Lam said the law only limits what state officers can do, without obstructing ICE from carrying out its duties.

“We think that these efforts to block the implementation are bogus,” Lam told Stateline. “We as a state are wholly within our right and jurisdiction to be able to place limitations on what state and local law enforcement agencies can do. There’s nothing that prevents us from doing so, and that’s all this does.”

“Our state taxpayer dollars should not go towards having local law enforcement enforce federal immigration law.”

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