People demonstrate outside the main campus of the Centers For Disease Control and Prevention on April 1, 2025 in Atlanta, Georgia. Health and Human Services Secretary Robert F. Kennedy Jr. laid off thousands of employees across multiple agencies on April 1, as part of an overhaul announced in March. (Photo by Elijah Nouvelage/Getty Images)

A coalition of Democratic state officials sued the Trump administration Tuesday over plans to cut more than $11 billion in grants by the Department of Health and Human Services, on the same day thousands of HHS workers reportedly found they’d been swept up in a mass layoff.

In Washington, the Republican chairman and top Democrat on the Senate Health, Education, Labor and Pensions Committee wrote HHS Secretary Robert F. Kennedy Jr. asking him to appear before the panel and discuss his plans for the massive agency.

The federal suit, signed by 22 attorneys general and two Democratic governors, alleges Kennedy revoked, without warning, billions in grant funding appropriated by Congress during the COVID-19 pandemic, starting last week. That led to states scrambling to adjust plans for vaccination efforts, infectious disease prevention, mental health programs and more.

The sudden and chaotic rollout of the grant cuts foreshadowed a scene at HHS offices, including at big campuses in Maryland, on Tuesday morning. Termination notices to laid-off workers were reportedly emailed early Tuesday, but many workers did not see them before arriving at the office and finding out they’d lost their jobs when their key cards did not work.

Few specifics

Both the mass layoffs and the grant funding cuts challenged in the lawsuit stem from Kennedy’s March 27 announcement that the department would be “realigning,” by shuttering several offices and cutting 10,000 workers.

It was unclear Tuesday exactly what offices or employees were affected.

An HHS spokesperson responded to a request for comment by referring States Newsroom to Kennedy’s announcement, a press release and an accompanying fact sheet from March 27.

None provided a detailed breakdown but laid out plans to eliminate 3,500 full-time positions at the Food and Drug Administration, 2,400 employees at the Centers for Disease Control and Prevention, 1,200 staff at the National Institutes of Health and 300 workers at the Centers for Medicare and Medicaid Services.

The spokesperson did not respond to a follow-up inquiry requesting more details of the positions eliminated and other clarifications.

Efficiency doubted

In a written statement, Andrés Arguello, a policy fellow at Groundwork Collective, a think tank focused on economic equity, said the cuts would have “the exact opposite” effect of the administration’s stated goal of government efficiency.

“Gutting 10,000 public servants means higher costs, longer wait times, and fewer services for families already struggling with the rising cost of living,” Arguello, an HHS deputy secretary under former President Joe Biden, wrote. “Entire offices that support child care, energy assistance, and mental health treatment are being dismantled, leaving working families with fewer options and bigger bills. This isn’t streamlining—it’s abandonment, and the price will be paid by the sick, the vulnerable, and the poor.”

The lack of communication led to confusion among advocates and state and local health workers about the impacts of the staff cuts and cast doubt about the administration’s goals, speakers on a Tuesday press call said.

“There are so many more questions than answers right now,” Sharon Gilmartin, the executive director of Safe States Alliance, an anti-violence advocacy group, said. “They clearly are eliminating whole divisions and branches, which doesn’t speak to bureaucratic streamlining. It speaks to moving forward an agenda, which has not been elucidated for the public health community, it’s not been elucidated for the public.”

While specific consequences of the cuts were not yet known, Gilmartin and others said they would be felt at the state and local level.

“I think what we do know is that … when we’re cutting these positions at the federal level, we are cutting work in states and communities,” Gilmartin said.

Pain in the states

The lawsuit from Democratic officials is full of details about the impacts of the loss of federal funding on state programs.

The suit was brought in Rhode Island federal court by the attorneys general of Colorado, Rhode Island, California, Minnesota, Washington, Arizona, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon and Wisconsin and Govs. Andy Beshear of Kentucky and Josh Shapiro of Pennsylvania.

HHS revoked “more than half a billion dollars” of grants from Pennsylvania, the Democratic officials said, affecting more than 150 state employees and contracted staff. The grants funded work “to respond to and mitigate the spread of infectious disease across the Commonwealth” and mental health and substance abuse programs.

In Nevada, “HHS abruptly terminated at least six grants” that had funded epidemiology and lab capacity, immunization access and mental health services, according to the suit.

“These terminations led Nevada to immediately terminate 48 state employees and to order contractors working under these awards to immediately cease all activity,” the complaint reads. “The loss of funding will have substantial impacts on public health in Nevada.”

The cutoff of $13 million in unobligated grants for local communities in Minnesota will mean the shuttering of clinics to provide vaccines for COVID-19, measles, mumps, rubella, influenza and other diseases, the suit said.

“One local public health agency reported that it held 21 childhood vaccination clinics and provided approximately 1,400 vaccinations to children in 2024,” a paragraph in the complaint about Minnesota local vaccine clinics said. “It also held 87 general vaccination clinics in 2024. As a result of the termination of the … funds, it has immediately ceased all vaccination clinics for 2025.”

The grant terminations also affected state plans already in the works.

Rhode Island had received an extension from HHS for a grant with $13 million unspent, but that money was revoked last week.

“Accordingly, the state public health department developed a workplan for its immunization program that included an April 2025 vaccination clinic for seniors, provided salaries for highly trained technicians to ensure that vaccine doses are stored and refrigerated correctly to prevent waste of vaccines purchased with other tax-payer dollars, planned computer system upgrades, and covered printing costs for communications about vaccine campaigns,” the suit said.

Senators want RFK Jr. on the Hill

Democrats on Capitol Hill issued a slew of statements opposing the cuts and warning of their effects.

Republicans were more deferential to the administration, asking for patience as details of the cuts are revealed.

But the letter from the top members of the Health, Education, Labor and Pensions Committee also brought both sides together to write Kennedy asking him to testify before the committee to make those explanations plain.

“The hearing will discuss your proposed reorganization of the Department of Health and Human Services,” the letter from Louisiana Republican Bill Cassidy and Vermont independent Bernie Sanders said.

In a written statement, Cassidy said the hearing would be an opportunity for Kennedy to inform the public about the reorganization.

“The news coverage on the HHS reorg is being set by anonymous sources and opponents are setting the perceptions,” Cassidy said in a written statement. “In the confirmation process, RFK committed to coming before the committee on a quarterly basis. This will be a good opportunity for him to set the record straight and speak to the goals, structure and benefits of the proposed reorganization.”

Federal health officials temporarily froze Title X family-planning funds for some Planned Parenthood clinics, which provide reproductive health services ranging from birth control to STI testing, across the nation this week. (Photo by Michael M. Santiago/Getty Images) 

More than 1 million people seeking care such as contraception or testing for sexually transmitted diseases and cancer could be affected by the Trump administration withholding more than $27 million in Title X funding to Planned Parenthood clinics nationwide, according to estimates from the Guttmacher Institute.

Planned Parenthood state affiliates said they were notified that the funding they receive under the Title X family-planning program would be temporarily frozen, Politico first reported Monday night.

The U.S. Department of Health and Human Services, which is responsible for managing and distributing Title X funds, told States Newsroom via email that it is reviewing all Title X grant recipients to make sure they comply with federal law and President Donald Trump’s executive orders. The department is concerned about “the compliance of several awardees” that together receive $27.5 million, according to an HHS spokesperson, who added, “HHS expects all recipients of federal funding to comply with federal law.”

Letters received by some affiliates detailed possible violations of federal civil rights laws and executive orders recently issued by Trump, including the administration’s efforts to prohibit diversity, equity and inclusion initiatives and provide care regardless of a person’s immigration status.

“It is difficult to overstate how ridiculous it is that the administration is premising this funding freeze on a ‘DEI review,’” said Amy Friedrich-Karnik, Guttmacher’s director of federal policy, in a statement. “The entire point of the Title X program is to address disparities in access to contraception and other sexual and reproductive health care, including serving people with low incomes and those from other historically underserved communities. We need to see this for what it is — a direct attack on health equity.”

The Title X program was established in 1970 to provide reproductive health care for anyone who needs it. Federal law prohibits use of federal funds for abortion. Planned Parenthood clinics offer a broad range of non-abortion services.

No final decisions have been made regarding Title X funding for Planned Parenthood.

Affiliates in Alaska, California, Idaho, Hawaii, Maine, Mississippi, Missouri, Montana, Oklahoma, Tennessee, Utah and others reported receiving the notification, representing thousands of people served at each clinic every year and millions in funds. Guttmacher’s data shows that 83% of people who visited Title X-funded clinics in 2023 had family incomes at or below 250% of the federal poverty level.

In Missouri and Oklahoma alone, Title X funding totals nearly $8.5 million, according to a news release from Missouri Family Health Council.

“Withholding these critical funds, even temporarily, threatens the essential sexual and reproductive health care communities depend on,” said Michelle Trupiano, executive director of the council.

Kat Mavengere, spokesperson for Maine Family Planning, said the agency also received notice of a freeze affecting $1.92 million in funds. Planned Parenthood of Northern New England is a sub-grantee of Maine Family Planning. Mavengere told States Newsroom the notice from HHS identified two items on their website “related to documents that detail our commitment to health equity” as reasons for the funding review.

Nicole Clegg, CEO of the Northern New England Planned Parenthood affiliate, said it receives about $900,000 in funds between Maine and New Hampshire from the family-planning organization.

If people can’t seek basic reproductive health services at no cost, including wellness exams, Clegg said they go without.

“We’ve seen that. When Planned Parenthoods leave communities, the data just speaks to increases in STI transmission, increases in unintended pregnancy … there are very real consequences to a community when we’re no longer there,” Clegg said. 

A recent poll conducted by Perry Undem showed 77% of respondents were opposed to the idea of the Trump administration cutting funding for services like birth control for people with low incomes.

During his first term, Trump also cut Title X funds to clinics that provided abortions or referred people for abortions in 2019, causing one-third of participating providers to leave the program, according to KFF. The Biden administration reversed the policy two years later.

The U.S. Supreme Court is scheduled to hear arguments Wednesday in a case that will determine whether South Carolina government officials can remove Planned Parenthood clinics from the state’s Medicaid program because the organization provides abortions. If the court rules in South Carolina’s favor, other states that have tried to drain the organization’s funding for decades may follow suit.

Anti-abortion organizations celebrated the news of the Title X freeze for some Planned Parenthood clinics on Tuesday, including Susan B. Anthony Pro-Life America, which has been pushing efforts to “defund” Planned Parenthood in recent weeks in its fundraising emails. SBA was also involved in the drafting of the Heritage Foundation’s blueprint for the next conservative presidency, Project 2025, and identified this action as a priority.

“This is a big step in the right direction,” President Marjorie Dannenfelser told States Newsroom in a statement. “We thank President Trump for this bold action and urge further steps to eliminate all taxpayer funding for Planned Parenthood.”

Sen. Cory Booker started his speech on Monday at 7 p.m. and said he would continue as long as he is "physically able." (Photo by John Partipilo)

This story was updated at 7:16 CST

U.S. Sen. Cory Booker broke the record for longest floor speech in the history of the Senate on Tuesday, surpassing the 24-hour and 18-minute record set in 1957 when South Carolina’s Strom Thurmond attempted to prevent passage of the Civil Rights Act.

Booker, a Democrat who began his remarks Monday at 7 p.m. saying he wanted to highlight President Donald Trump’s “complete disregard for the rule of law,” by Tuesday at 7:20 p.m. was raspy-voiced, occasionally teary-eyed, and wearing what he called a “ripe” shirt.

It was New York Sen. Chuck Schumer, the Senate’s Democratic leader, who interrupted Booker to say he had broken Thurmond’s record.

“Do you know how proud this caucus is of you? Do you know how proud America is of you?” Schumer said to applause and a standing ovation from his fellow Democrats and visitors.

Booker noted that Thurmond with his 1957 filibuster “tried to stop the rights upon which I stand.”

“I’m not here, though, because of his speech. I’m here despite his speech. I’m here because, as powerful as he was, the people were more powerful,” Booker said.

Wyoming Sen. Cynthia Lummis was one of just two Republican lawmakers in the chamber at the time. Lummis joined Democrats in celebrating Booker’s accomplishment by standing and clapping.

Guests and staff are normally barred from any displays of support or disapproval while sitting in the gallery, but Utah Sen. John Curtis, a Republican who was presiding over the chamber, allowed it.

Booker finally yielded the floor a few minutes after 8 p.m. Tuesday.

Booker’s record-breaking speech comes as the Democratic Party faces criticism from voters who say the party’s leaders are not doing enough to stand up to Trump’s actions, especially those that experts say fly in the face of legal precedent.

“These are not normal times in our nation, and they should not be treated as such in the United States Senate,” said Booker, 55. “The threats to the American people and American democracy are grave and urgent, and we all must do more to stand against them.”

Booker, a Democrat first elected to the Senate in 2013, on Monday said he’d continue speaking as long as he is “physically able.” After his speech surpassed 20 hours, he looked exhausted, joked about his shirt being “ripe,” and took occasional breaks by yielding the floor for questions from his Democratic colleagues, who praised the former college football player for his endurance.

His speech comes as the Democratic Party faces criticism from voters who say the party’s leaders are not doing enough to stand up to Trump’s actions, especially those that experts say fly in the face of legal precedent.

“This is not right or left. It is right or wrong. This is not a partisan moment. It is a moral moment,” Booker said early Tuesday afternoon. “Where do you stand?”

Booker’s speech is one of the longest ever given on the Senate floor. The record was previously held by Strom Thurmond, a South Carolina Republican who held the floor for 24 hours and 18 minutes in 1957 in protest of the Civil Rights Act.

The senator covered a breadth of topics: health care, Social Security, Medicaid, grocery prices, free speech, veterans, public education, world leaders, Elon Musk’s Department of Government Efficiency, and national security concerns. He read letters and comments from constituents and he quoted speeches from the late Rep. John Lewis — invoking Lewis’ famous call to action to “get in good trouble” — and the late Sen. John McCain.

Booker, a former mayor of Newark, also assailed Trump’s policies on immigration. He said the Trump administration is doing “outrageous things like disappearing people off of American streets, violating fundamental principles of this document” — here he held up a copy of the U.S. Constitution — “invoking the Alien Enemies Act from the 1700s that was last used to put Japanese Americans into internment camps.”

“Do we see what’s happening?” Booker asked.

He spent about a half-hour reading the account of Jasmine Mooney, a Canadian citizen who was detained by U.S. Immigration and Customs Enforcement for 12 days in March. He also noted that the Trump administration conceded Monday that it deported Kilmar Abrego Garcia, a 29-year-old Maryland man with protected legal status, to an El Salvador prison because of an “administrative error.”

“The government can’t walk up to a human being and grab them off the street and put them on a plane and send them to one of the most notorious prisons in the world, and just say, as one of our authorities did, ‘Oopsie,’” Booker said.

Sen. Chuck Schumer (D-New York), who asked about the impact of potential Medicaid cuts and tariffs about 15 hours into Booker’s speech, told Booker he has the support of the entire party.

“Your strength, your fortitude, your clarity has just been nothing short of amazing. All of America is paying attention to what you’re saying. All of America needs to know there’s so many problems — the disastrous actions of this administration in terms of how they’re helping only the billionaires and hurting average families — you have brought this forth with such clarity,” he said.

New Jersey Monitor is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. New Jersey Monitor maintains editorial independence. Contact Editor Terrence T. McDonald for questions: info@newjerseymonitor.com.

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Multiple Republican-led states have sued to rescind a federal rule keeping the records of those who sought legal reproductive care private, while a federal judge in Texas is questioning the constitutionality of the federal HIPAA law in its entirety. (Photo by Wichayada Suwanachun/Getty Images)

The decades-old federal law protecting the privacy of individual health information is threatened by multiple lawsuits that seek to throw out a rule restricting disclosure of information in criminal investigations, including for those seeking legal abortion and other reproductive health care.

In one of the cases, the Texas federal judge who has been at the center of several anti-abortion court battles appears to question the constitutionality and legality of the health privacy act in its entirety.

The Health Insurance Portability and Accountability Act — or HIPAA — established in 1996 to protect the privacy and security of patient health information, includes some exceptions under limited conditions, such as law enforcement investigations. But after the U.S. Supreme Court ended federal abortion rights in 2022 and more than a dozen states passed abortion bans, advocates worried that such records could be used by state officials and law enforcement to investigate and prosecute patients seeking an abortion and those who help them.

Health officials under former President Joe Biden’s administration enacted a HIPAA rule to keep health information private when the patient was in a state with legal access and the care was obtained legally. In order to release information related to this type of care, the entity subject to HIPAA rules must sign a document stating it is not released for one of the prohibited purposes.

“These cases may have been prompted by this newer rule, but they threaten more broadly the entire HIPAA system on which we all rely when accessing medical care,” said Carrie Flaxman, senior legal adviser for Democracy Forward, a nonprofit legal organization.

Two lawsuits seek to rescind that most recent rule, while another brought by Texas Attorney General Ken Paxton goes a step further, asking the court to remove the general rules established in 2000 about how much health information can be disclosed to law enforcement.

“The threats to the 2000 privacy rule would be a seismic shift that could erode patients’ trust entirely in their providers and dissuade them from wanting to seek out health care and be transparent about their symptoms,” said Ashley Emery, a senior policy analyst for the nonprofit Partnership for Women and Families. “A law enforcement officer could pressure a psychiatrist to share patient notes from therapy sessions without a subpoena, without a warrant, if the 2000 privacy rule is invalidated.”

The state of Missouri sued to rescind the Biden rule in January, and the state of Tennessee filed a similar action the same day that 14 other Republican attorneys general joined as plaintiffs: Alabama, Arkansas, Georgia, Idaho, Indiana, Iowa, Louisiana, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota and West Virginia. All but three of those states either heavily restrict or outright ban abortion, and if the lawsuits are successful, records kept by doctors and pharmacists in other states could be subpoenaed.

All of the lawsuits are filed against the U.S. Department of Health and Human Services, which is now under Republican President Donald Trump and HHS Secretary Robert F. Kennedy Jr. The Trump administration has so far followed the direction of the conservative Heritage Foundation’s Project 2025, which calls for the most recent HIPAA rule to be rescinded.

Amarillo judge ordered briefing on HIPAA’s constitutionality and legality

Three cases are still in motion, including one with a physician as the plaintiff. Dr. Carmen Purl, the sole owner of Dr. Purl’s Fast Care Walk In Clinic in Dumas, Texas, sued HHS because she said the rule creates a conflict with the laws requiring her to report child abuse.

“I consider both a pregnant woman and her unborn child to be human persons, and both are entitled to medical care and deserve the protection of the law,” Purl said in court documents. “I believe … that elective abortions harm patients’ health and public health.”

The location of Purl’s clinic puts her in the judicial district that has only one federal judge — U.S. District Judge Matthew Kacsmaryk, a Trump appointee. Most federal cases are assigned randomly to a group of judges in a district, but since Kacsmaryk is the only one, many advocates and attorneys have accused law firms like Alliance Defending Freedom, who is representing Purl in the case, of “judge shopping,” or finding a plaintiff in a certain area for the purpose of putting it in front of an ideologically friendly judge.

On Dec. 22, Kacsmaryk granted an injunction blocking enforcement of the rule against Purl while the case proceeds, and he is still considering whether to permanently block the law.

As part of the decision, Kacsmaryk also ordered the parties to submit briefs explaining how recent U.S. Supreme Court rulings that delegate more authority to Congress over administrative agencies “affect the constitutionality or legality of HIPAA and HHS’s authority to issue the 2024 rule.”

Kacsmaryk presided over a lawsuit in 2023 brought by a group of anti-abortion doctors seeking to revoke the U.S. Food and Drug Administration’s approval of mifepristone, one of two drugs commonly used to terminate pregnancies in the first trimester and to treat miscarriages. Kacsmaryk ruled in favor of removing its approval, but the U.S. Supreme Court unanimously overruled him in 2024.

Purl added that she thinks gender-affirming care is harmful to children, never medically necessary and a matter of concern for public health, though she has never treated a child with gender dysphoria. In the process of providing routine medical care, she said she could learn that a child was being subjected to gender-affirming treatments or procedures that could constitute child abuse, and she would be obligated to report it.

Purl’s clinic has fewer than 20 employees, and she has been licensed to practice family medicine in Texas since 1986. In that time, she said she has treated many patients who have been victims of abuse and neglect, and estimates she has personally treated more than 100 pediatric patients who were victims of sexual abuse.

“I have treated hundreds of girls under the age of consent who were either pregnant or reported sexual activity. During my career, I have delivered babies from mothers as young as 12 years old,” Purl wrote.

Purl said she has responded to Child Protective Services investigations between 10 and 12 times, and she fears that providing full, unredacted patient records in response to an entity such as CPS would violate the 2024 rule and subject her and the clinic to civil and criminal penalties, which often means hefty fines.

In a response filed by HHS in December, before Trump’s second term began, the department said the rule does nothing to prevent Purl from reporting suspected child abuse, and denied the other harms Purl said she would incur.

“Given the nature of her medical practice, Dr. Purl is highly unlikely to ever encounter a conflict between her obligations under state law and under the Rule,” the department said in court documents.

AGs from ban states are testing newly enacted shield laws

The Texas case led by Paxton has been on hold since February, after the U.S. Department of Justice asked the court to delay scheduling until the new administration could determine how to proceed. U.S. District Judge James Wesley Hendrix, a Trump appointee, ordered the parties to file a status report by May 1.

Attorneys general in states with abortions bans have already attempted to prosecute providers in other states for prescribing abortion pills via telehealth and prosecute women who obtained an abortion in another state without the consent of a male partner. Louisiana Gov. Jeff Landry signed an extradition warrant for a doctor in New York for prescribing and mailing abortion pills to residents of the state.

New York is one of 17 Democratic-led states that has a shield law to protect providers and patients from out-of-state legal actions for reproductive care and gender-affirming care, and the state government has so far refused to comply with Louisiana’s law enforcement efforts.

The coalition of states that joined Tennessee’s lawsuit claim the privacy rule harms their ability to investigate cases of waste, fraud and abuse, and “sharply limits state investigative authority.”

Chad Kubis, spokesperson for Tennessee Attorney General Jonathan Skrmetti, told States Newsroom via email that the office could not comment for this story because of the ongoing litigation.

“The final rule will hamper states’ ability to gather information critical to policing serious misconduct like Medicaid billing fraud, child and elder abuse, and insurance-related malfeasance,” the complaint says.

Attorneys at Democracy Forward have asked the courts to allow the clients they are representing to intervene as defendants in all four cases, arguing that the new administration is likely to either not defend the cases at all or defend them inadequately. They are representing the cities of Columbus, Ohio, and Madison, Wisconsin, as well as Doctors for America, an activist organization of physicians and medical students. None of the judges have ruled on their motions yet.

Partnership for Women and Families filed an amicus brief with 23 other advocacy organizations to support upholding the rule.

“We can’t count on the Trump administration to defend this regulation, given its longstanding record of hostility toward reproductive health and rights,” Emery said.

It’s possible the new leadership at HHS will rescind the 2024 rule, Emery said, but the lawsuits alone are concerning enough because of the threat posed to privacy protections. That’s part of the goal, said Emery and Flaxman — to present the threat and sow fear and intimidation in patients and providers. And the method of launching multiple lawsuits in various jurisdictions fits a pattern that has been observed in the fight for abortion rights, Emery said.

“Anti-abortion extremists’ legal campaign against HIPAA’s reproductive health privacy protections is designed to test out different legal venues and arguments to obtain the most favorable outcome possible,” she said.

Doctor who has been investigated before says intimidation tactics have an effect

Indiana OB-GYN Dr. Caitlin Bernard knows what it’s like to be the target of an investigation, and said she’s still in court fighting new attempts to instill fear in doctors and patients.

Bernard was an abortion provider in Indiana before the state enacted its ban in August 2023. She reported in 2022 that she had provided a medication abortion to a 10-year-old rape victim who traveled to Indiana from Ohio when the state briefly had a ban in place. She was accused of violating patient privacy laws and investigated by Indiana Attorney General Todd Rokita, and the state licensing board fined her $3,000 and reprimanded her for the incident after Rokita asked the board to revoke her license to practice medicine. She was found to have violated patient privacy, but the board determined the fine was sufficient and she kept her license.

“Now my case is held up as an example of what can happen to you if you speak out about abortion bans,” Bernard said. “I’ve spoken to many physicians across the country who are intimidated by that. They say, ‘Look at Dr. Bernard and what happened to her.’”

Now, Bernard is part of a lawsuit against the state to categorize terminated pregnancy records as medical records in state law that cannot be released to the public. Indiana has historically treated abortion reports as public record with certain details redacted, but Bernard said with the ban in place and so few people qualifying for its limited exceptions, that policy should change. The records include demographic information like age, ethnicity and education level, as well as information such as diagnoses and the date, location and physician who provided care.

“It also includes the county, so you could imagine in these very small counties, somebody could absolutely figure out who that person is,” Bernard said.

Ashley Emery, senior policy analyst at Partnership for Women and Families, said the lawsuits take aim at a deeply needed line of defense against abortion criminalization, and said it will disproportionately affect immigrants, people of color and low-income populations. Trust is already low between marginalized people and health care providers, Emery said, and this would further erode that trust.

“These challenges to HIPAA are designed to take protections away from patients and try to allow anti-abortion politicians to have more control, and I think that power deficit is really important to note, and it should be very chilling,” she said.

Editor’s note: This story has been corrected to say the Indiana state licensing board found Dr. Caitlin Bernard violated patient privacy laws but kept her license.

A new Wisconsin Hospital Association report finds continued challenges for hospitals seeking health care workers. In this January 2024 photo, an information screen for visitors at Sauk Prairie Hospital displays a recruiting message directed at health care workers. (Photo by Erik Gunn/Wisconsin Examiner)

As more Wisconsinites need more hospital care, the supply of health care workers to provide that care remains slim — and to change that outlook will take concerted effort, according to a new report released Monday.

“Wisconsin’s health care workforce must grow faster,” says the 2025 Wisconsin Health Care Workforce Report, produced by the Wisconsin Hospital Association (WHA).

“Health care employers are working hard to retain current employees, re-recruit those who left for what they thought might be greener pastures and attract new talent to health care fields in Wisconsin,” the report states.

The report finds some glimmers of improvement and promising pathways for hospitals to further address their need for more trained staff. Over the last two years hospital job vacancies have fallen slightly and employment has increased.

But filling jobs remains a challenge and will remain that way for years, the report states. It suggests  a combination of strategies to overcome current trends.

Some of the strategies involve  how hospitals themselves structure jobs and hiring practices. But the report contends other sectors — government, educational institutions, and the insurance companies and government programs that pay the lion’s share of health care bills — will also need to shift their policies.

Reimbursement rates are not keeping up with increased costs as hospitals and other providers weather rising payroll and supply expenses, for example, the report finds.

By far the dominant contributor to the workforce challenges hospitals and health systems face, however, is demographic, according to the report. Wisconsinites continue to get collectively older.

“Only Wisconsin’s population over 65 has grown between the 2010 and 2020 census,” said Ann Zenk, senior vice president of workforce and clinical practice for the hospital association. The working-age population ages 18 to 65 decreased in that same period.

Those younger than 40 go to the hospital once a year on average. From ages 40 to 65 that ticks up to three times a year. After 65, “it doubles to six visits a year,” Zenk  said.

“As we age, we need more health care,” she said. “That is going to be a double challenge for hospitals because our available workers are a smaller pool and our demand is even greater.”

The population preparing to enter the workforce — people ages 19 and younger — “is not large enough to replace retiring baby boomers,” the report states. “Growing the health care workforce needed to respond to this demographic challenge will require increasing in-migration, ensuring access to career pathways and increasing interest in hospital careers.”

That starts with giving students in high school or even earlier “the opportunity to have exposure — you’re walking in the shoes of what it’s like to be a health care professional,” Zenk said.

Then there’s the education process itself — “making sure that educational pathways remain accessible,” Zenk said. The report urges policymakers not to add requirements to training programs that would make them longer, more complex or more expensive.

One promising training innovation, said Zenk, is the use of an apprenticeship program to prepare new registered nurses, pioneered in the last few years in Wisconsin by UW Health and the state Department of Workforce Development.

While the program stretches over four years for the equivalent of a two-year associate degree, she said, it also allows the participating students to “earn while you learn.” The concept is being expanded to prepare respiratory therapists.

The report also identifies generational shifts in what people expect from their jobs. Zenk said addressing demands for more flexible and family-friendly schedules can make it possible to hire and retain more successfully. But those changes may also mean demand for even more personnel.

“So where you need a roster of 10 nurses, you need 15 now to cover the exact same shift,” Zenk said.

The report also sees technology offering some relief.

Some of that might be replacing people for tasks such as registering at the front desk for a medical visit, Zenk said. But another example is monitoring equipment that could go home with a patient and be checked remotely, with nurses and clinicians visiting the patient at home every day, she observed.

Zenk said some regulations in health care can be reexamined and streamlined without endangering safety or the quality of care.

Physician assistants, for example, collaborate with and are overseen by a medical doctor. Zenk said in the past a physician could supervise no more than four PAs. That has since been relaxed, making it less burdensome for both doctor and PA alike, she said.

Zenk said another form of regulation has gotten worse, however: When health insurers interpose an increasing number of steps for them to sign off on the care a doctor or hospital provides.

“That requires staff to make those phone calls or enter that data, or requires physicians to document more and more and more to justify the care that they want to provide and that the patient needs,” she said.

She’s seen insurer-driven requirements increase in the last five years.

“That’s a major tug-of-war on clinicians’ time,” Zenk said, “and for patients also very frustrating.”

In the end, however, there’s no single silver bullet to resolve what is likely to be a persistent challenge for hospitals or their employees.

“There’s no one answer. We’re more than likely not going to be able to grow ourselves out of this one fast enough,” Zenk said. “But anything we can do to grow the workforce faster is going to help.”

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Gov. Tony Evers speaks at a round table discussion on the state budget in February. On Friday, Evers' office said the state will lose $210 million in federal funds for health care previously approved by Congress but part of $12 billion cut this week by the Trump administration. (Photo by Erik Gunn/Wisconsin Examiner)

Wisconsin will lose more than $210 million in federal funds that were to be used for mental health, substance abuse prevention and bolstering emergency medical services, state officials said Friday.

The money involved is Wisconsin’s share of $12 billion to combat infectious disease and other serious health problems that the U.S. Department of Health and Human Services has summarily cut off, NBC News and the New York Times reported this week.

In Wisconsin, the funds were to be used for suicide prevention; substance abuse prevention; public health departments, programs and laboratories, including EMS services; and the Wisconsin Immunization Registry, the office of Gov. Tony Evers said Friday.

The governor’s office discussed the health funds cutback along with  other programs targeted for reductions or considered vulnerable under the Trump administration, including education funding, farm programs and in the Department of Veterans Affairs. On Thursday, the Trump administration announced it will cut 10,000 employees from the U.S. Department of Health and Human Services.

“Reckless cuts by President Trump and Elon Musk to help pay for tax cuts for millionaires and billionaires are causing devastating consequences for Wisconsin’s kids, families, and communities and services they depend on every day,” Evers said in a statement released Friday.

“With threats to Medicaid and Medicare, cuts to researching cures for Alzheimer’s disease and cancer, efforts to undermine food and drug safety, and continued attacks on the Affordable Care Act, the Trump Administration is jeopardizing health and access to health care in Wisconsin and across our country,” Evers said.

State Rep. Greta Neubauer (D-Racine), the Assembly minority leader, said Friday that the cuts “will be devastating for Wisconsinites who rely on these essential programs.”

“President Trump and Elon Musk are selling out Wisconsin families and communities, threatening our health and safety just to pay for unnecessary tax cuts for their billionaire friends,” said state Rep. Lisa Subeck (D-Madison), the ranking Democrat on the Assembly Health, Aging and Long-Term Care Committee and chair of the Assembly’s Democratic caucus.

“This reckless move by the Trump Administration, coupled with cuts to vital medical research and threats to the future of Medicaid and Medicare, will have a devastating impact on the health of our state,” Subeck said.

Evers said his administration will explore “every legal option available to us” to fight the cuts.

The $12 billion that HHS cut this week was authorized by Congress through COVID-19 relief bills enacted in the first two years of the pandemic. The funds were later allowed for public health needs outside the pandemic, the New York Times reported this week.

The World Health Organization reports that “COVID-19 continues to circulate widely . . . presenting significant challenges to health systems worldwide. Tens of thousands of people are infected or re-infected with SARS-CoV-2 each week.”

The UN-affiliated public health agency emphasizes continued surveillance of the viral pandemic. “It is vital that countries sustain the public health response to COVID-19 amid ongoing illness and death and the emergence of SARS-CoV-2 variants, adapting it to the requirements based on the current COVID-19 situation and risk,” WHO says. 

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ABC for Health, a public interest law firm, argues that a Dane County health assessment should have addressed the problem of medical debt. (Getty Images)

ABC for Health, the public interest law firm, has filed a complaint with the IRS, charging a team of hospitals led by UW Health of falling short of federal standards when they filed a Community Health Needs Assessment required of health nonprofits under federal law.

Late last year, the hospitals  released their report on the health needs of Dane County.

Federal law requires nonprofit health care providers to file such a  document every three years. The December report covered reproductive care, chronic illness, mental health and substance abuse, along with special sections about health concerns for children and youth as well as the elderly.

But in 63 pages, the report included no discussion of how the cost of care and medical debt have burdened people without money and hampered their access to the health care system.

For Bobby Peterson, that was a glaring omission — and on Thursday, Peterson and ABC for Health, the firm he founded and directs, filed a complaint with the IRS, charging the report doesn’t live up to the federal law’s requirement for a Community Health Heeds Assessment (CHNA).

ABC for Health focuses on health care access along with helping people overcome or avoid medical debt.

The organization’s complaint argues that failing to address that issue in the Dane County health needs document violates the collective responsibility of UW Health and the other three nonprofit hospital systems that produced it.

“Their insistence to exclude medical debt from consideration during the CHNA betrays many principles and requirements of non-profit hospitals,” the complaint states. “We maintain that UW Health’s intentional indifference towards the medical debt epidemic stems from a value for their own revenue at the expense of their community. That value is at odds with UW Health’s duty towards its community.”

Sara Benzel, media relations manager for UW Health, defended the report Thursday as well as the hospital system’s handling of medical debt.

“UW Health stands behind the priorities identified in the community health needs assessment process,” Benzel told the Wisconsin Examiner in an email message.

“Regarding the UW Health Financial Assistance Policy, we are proud of the work we do every day to make this support accessible, and the work we have done to simplify the process and lower barriers to accessing financial support.”

She said the hospital system’s financial assistance program is posted online in English and Spanish.

“The application has been simplified over the years using an equity lens, requires minimal supporting documents, and goes up to 600% of the federal poverty level, well above others in the state,” Benzel said.

Medical debt critic

ABC for Health has been a longstanding critic of hospitals’ handling of medical debt and has published several reports finding fault with how hospital systems address the problem of patients unable to pay their health care bills.

While hospitals have programs for financial help when a patient has no insurance and can’t afford to pay out of pocket, ABC has argued those programs are too often needlessly complex. The organization also contends that hospitals’ financial counselors don’t take actions that could circumvent a problem — such as helping patients enroll in Medicaid if they qualify.

The requirement for a Community Health Heeds Assessment is a little-noticed provision in the 2010 Affordable Care Act — the legislation nicknamed Obamacare that has helped drive down the numbers of uninsured Americans since its passage 15 years ago. Nonprofit health care systems must  produce a CHNA report for their communities every three years.

“The IRS is regulating this because they are looking at their tax-exempt status,” Peterson said Thursday. “And to be a tax-exempt organization, to be able to step away from all the property tax requirements that many of us face, they have a responsibility then to give back.”

He sees a hospital’s approach to medical debt as a direct measure of how they give back.

“They have a community benefit that they need to provide, and part of that benefit is making sure that they’re providing enough charity care and services to the vulnerable in a community,” Peterson said.

The 2025-2027 CHNA report, like several previous editions, was the work of Healthy Dane Collaborative, a coalition of the county’s four hospital systems: Unity Point-Meriter, SSM Health-St. Mary’s Hospital, Stoughton Health and UW Health. The report’s drafters conducted a survey, collected and analyzed data, met with a variety of community organizations and held focus groups

The final report included discussions of health care disparities by race, income and gender. It called attention to the health care needs of the LGBTQ and immigrant communities, including undocumented migrants.

Early on, the text of the report emphasized concern for health equity — “ensuring fair distribution of health resources, outcomes, and opportunities across different communities.”

Seeking a voice

At an ABC for Health symposium Thursday on Medicaid and health care access, Peterson said the report’s priorities were “good things” and were all important.

“But what we wanted to see was access to health care coverage,” Peterson said, along with a discussion about improving financial assistance policies and better coordination among providers. “It wasn’t there. That’s not part of what they wanted to give out to the community.”

Peterson said ABC started reaching out more than a year and a half ago to offer input for the CHNA report.

“We wanted to make sure that the people that are in the planning process understand what the access to health care coverage needs are, what the barriers in the financial assistance process are, and how can we make it better. What can we do to improve that process?” Peterson said.

“We thought this is a real opportunity for us to make sure that all these issues that we see every day can be put up in this Community Health Needs Assessment process,” he added. “We wanted our voice and the voice of our clients to be heard.”

The IRS complaint includes email messages ABC Health sent various people about the assessment process starting in mid-2023.

In a message Aug. 13, 2024, Peterson told Adrian Jones, UW Health Director of Community Health Improvement, “ABC remains eager to engage in Dane County’s 2024 CHNA process.”

The message asked for updates on the CHNA “process and timeline” and mentioned that ABC for Health was “preparing a report with recommendations to provide input, from the perspective of our clients, to inform Dane County’s CHNA process.”

In her Aug. 14 reply, Jones invited Peterson to “share your report with us.” She wrote that “we have also held our own community input sessions and survey and have analyzed a lot of quantitative and qualitative data.”

Peterson followed up with an email Aug. 16 that included a half-dozen questions about the data being collected, when and where community meetings had been conducted, whether more community meetings were planned and the timeline for completing the assessment document.

“ABC for Health is eager to continue engagement with the Dane County CHNA process,” Peterson wrote. “Please keep us posted about future community input sessions and meetings.”

Correspondence ends

There was no further response, and “the Dane County hospitals quietly released the CHNA report in late 2024, without ABC’s input that we maintain failed to take into account the perspective of the many communities we represent,” the complaint to the IRS states.

“Unsurprisingly, this report ignored access to health care coverage issues. The report lacks any recommendations to improve financial assistance policies, practices, and processes to equitably serve populations negatively affected by health disparities. It fails to address the impact of medical debt on Dane County patients,” the complaint states.

“It lacks broad community input and instead reflects a hospital-driven marketing piece that ignores and sidesteps Affordable Care Act requirements. ABC was largely shunned despite our multiple efforts over the past 2 years to provide client-based input.”

ABC for Health released its report shortly after Peterson learned that the CNHA report was published. Its critique was unsparing.

“Dane County hospitals must do more to justify extensive tax breaks and better serve patients impacted by health disparities,” the report states. “In 2023, Dane County hospitals spent an average of only 0.7% of their gross patient revenues on charity care. The national average is 2.3%.”

ABC for Health bases its calculations for Dane County charity care on Wisconsin Hospital Association data, and the national average on a 2022 Wall Street Journal report.

Peterson sent a letter reiterating ABC for Health’s concerns and the organization’s complaint about its lack of input in the CNHA report to UW Health’s CEO, Alan Kaplan, in January. He said there was no response.

ABC for Health also invited Kaplan and other hospital leaders to the ABC for Health event Thursday. The invitations were ignored or declined, Peterson said.

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Robert F. Kennedy Jr., secretary of Health and Human Services, testifies during his Senate Finance Committee confirmation hearing at the Dirksen Senate Office Building on Jan. 29, 2025, in Washington, D.C. (Photo by Win McNamee/Getty Images)

WASHINGTON — The Trump administration announced a sweeping plan Thursday to restructure the Department of Health and Human Services by cutting an additional 10,000 workers and closing down half of its 10 regional offices.

The overhaul will affect many of the agencies that make up HHS, including the Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health and the Centers for Medicare and Medicaid Services. HHS overall will be downsized from a full-time workforce of 82,000 to 62,000, including those who took early retirement or a buyout offer.

HHS Secretary Robert F. Kennedy, Jr. released a written statement along with the announcement, saying the changes would benefit Americans.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said. “This Department will do more — a lot more — at a lower cost to the taxpayer.”  

The U.S. Senate voted to confirm Kennedy as the nation’s top public health official in mid-February.

Democrats immediately reacted with deep concern.

Senate Appropriations Committee ranking member Patty Murray, D-Wash., said that she was “stunned at the lack of thought about what they are doing to the American public and their health.”

Murray said the committee, which controls about one-third of all federal spending, “absolutely” has an oversight role to play in tracking HHS actions.

Wisconsin Sen. Tammy Baldwin, the top Democrat on the Appropriations subcommittee that funds HHS, said she believes HHS has overstepped its authority and expects the panel will look into its actions.

“These individuals who are going to be terminated under this plan play vital roles in the health of Wisconsinites and people nationally,” Baldwin said. “And I believe that they do not have the authority, the Trump administration does not have the authority to do this wholesale reorganization without working with Congress.”

Maryland Democratic Sen. Angela Alsobrooks, whose constituents in suburban Washington likely hold many of the jobs in question, wrote in a statement the HHS’ restructuring plans are “dangerous and deadly.”

“I warned America that confirming RFK Jr. would be a mistake,” Alsobrooks wrote. “His blatant distrust of science and disregard for research and advancement makes him completely unqualified.”

Cuts across department

The announcement says reorganizing HHS will cut its $1.7 trillion annual budget by about $1.8 billion, in part, by lowering overall staff levels.

Staffing cuts will be spread out over HHS and several of the agencies it oversees. The restructuring plans to eliminate 3,500 full-time workers at the FDA, 2,400 employees at the CDC, 1,200 staff at the NIH and 300 workers at the Centers for Medicare and Medicaid Services.

“The consolidation and cuts are designed not only to save money, but to make the organization more efficient and more responsive to Americans’ needs, and to implement the Make America Healthy Again goal of ending the chronic disease epidemic,” according to a fact sheet.

Senate Health, Education, Labor and Pensions, or HELP, Committee Chairman Bill Cassidy, R-La., wrote in a statement that he looks “forward to hearing how this reorganization furthers these goals.”

“I am interested in HHS working better, such as lifesaving drug approval more rapidly, and Medicare service improved,” Cassidy wrote.

Regional offices, divisions affected

HHS did not immediately respond to a request from States Newsroom about which five of its 10 regional offices would shutter or when those closures would take effect.

Its website shows the offices are located in Boston; New York City; Philadelphia; Atlanta; Chicago; Dallas; Kansas City, Missouri; Denver; San Francisco; and Seattle.

HHS plans to reduce its divisions from 28 to 15 while also establishing the Administration for a Healthy America, or AHA.

That new entity will combine the Office of the Assistant Secretary for Health, Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Agency for Toxic Substances and Disease Registry and National Institute for Occupational Safety and Health.

That change will “improve coordination of health resources for low-income Americans and will focus on areas including, Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce development. Transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs,” according to the announcement.

HHS will roll the Administration for Strategic Preparedness and Response into the CDC.

The department plans to create a new assistant secretary for enforcement, who will be responsible for work within the Departmental Appeals Board, Office of Medicare Hearings and Appeals and Office for Civil Rights.

House speaker says HHS is ‘bloated’

U.S. House Speaker Mike Johnson, R-La., posted on social media that he fully backed the changes in store for HHS.

​​”HHS is one of the most bureaucratic and bloated government agencies,” Johnson wrote. “@SecKennedy is bringing new, much-needed ideas to the department by returning HHS to its core mission while maintaining the critical programs it provides Americans.”

Advocates shared Democrats’ concern about the staff cutbacks.

Stella Dantas, president of the American College of Obstetricians and Gynecologists, released a statement saying the organization was “alarmed by the sudden termination of thousands of dedicated HHS employees, whose absence compounds the loss of thousands of fellow employees who have already been forced to leave U.S. health agencies.”

“Thanks to collaboration with HHS, ACOG has been able to contribute to advances in the provision of maternal health care, broadened coverage of critical preventive care, increased adoption of vaccines, raised awareness of fetal alcohol syndrome, strengthened STI prevention efforts, and more,” Dantas wrote. “This attack on public health—and HHS’ ability to advance it—will hurt people across the United States every single day.”

Dr. Sterling Johnson of the University of Wisconsin-Madison speaks at a forum on NIH funding cuts conducted by U.S. Senate Democrats on Wednesday. (Photo courtesy of Sen. Tammy Baldwin's office)

Drastic funding cuts at the National Institutes of Health (NIH) have disrupted biomedical research, potentially setting back projects that could advance treatment and prevention efforts for cancer, Alzheimer’s disease and other major causes of illness and death, researchers and patients told Democratic Senators Wednesday.

“We are hearing from researchers, research institutions, and patients about the ongoing attacks on NIH,” said Sen. Tammy Baldwin (D-Wisconsin), at the start of a  two-and-a-half hour forum she chaired as the ranking Democrat on a Senate subcommittee that oversees NIH.

“Understandably, most are reluctant to publicly speak out because the Trump administration is actively extorting institutions of all types, including major research universities,” Baldwin said. “This administration is seeking to dismantle the NIH and destroy the hopes of millions of Americans who are counting on life-saving treatments and cures.”

Witnesses who testified Wednesday warned that with projects being canceled in midstream, years of research data would likely be wasted and the role of the NIH as the world’s leading funder of biomedical research was at risk of being displaced.

NIH-funded advances have contributed to reductions in death rates from cancer, heart attacks and stroke in the U.S., said Dr. Monica Bertagnolli, who was director of NIH in the Biden administration and stepped down in January.

“This progress would not have happened without taxpayer support,” Bertagnolli said.

But in the first two months of the Trump administration, she said, more than 300 grants have been terminated and $1.5 billion in funding has been delayed.

In the last year, Bertagnolli told Sen. Patty Murray (D-Washington), NIH identified women’s health as “a high priority area” and “launched many new programs to really begin to address the deficiencies that we’ve had in women’s health.” Since the change in administration, however, “nothing new has moved forward.”

Dr. Sterling Johnson, the associate director of the Wisconsin Alzheimer’s Disease Research Center and a professor at the University of Wisconsin, said NIH funding over the last two decades helped make it possible to diagnose Alzheimer’s disease through blood tests and brain imaging scans rather than having to wait until after the patient’s death to be certain.

The NIH also funded clinical trials on surgical procedures involving the brain that can slow symptoms of the condition, he said, as well as trials on potential preventive therapies.

“These discoveries are changing the way we diagnose and treat Alzheimer’s and related causes of dementia,” Johnson said, but there is growing concern about how to sustain those gains.

In the last few months, he said, there have been delays in peer review and funding approvals for some projects.

“There are proposed cuts that threaten major ongoing studies, including treatment trials, risking the loss of millions of dollars already invested and setting our patients back,” Johnson said. With cuts threatening to slow down studies, “we will lose ground on hard-won progress.”

Senators as well as witnesses recounted stories of research that was cut off that involved investigations of health disparities.

Poorer counties across the country have “a persistent problem with poorer outcomes for all kinds of health issues,” Bertagnolli said, with maternal and fetal health among the most visible. “And without targeting those particular populations to understand the reasons behind the disparities, how can we ever even begin to overcome them?”

Research that considered members of the LGBTQ+ community and how illness affects racial and ethnic groups differently have been recurring targets in the Trump administration NIH, several said.

Dr. Whitney Wharton, an Alzheimer’s researcher at Emory University, said the Trump administration’s NIH has canceled research projects that she and other colleagues were conducting on Alzheimer’s in racial and ethnic minority groups, including LGBTQ+ people.

Previous research by her lab found Black Americans were 64% more likely than non-Hispanic whites to get Alzheimer’s disease and are living with the disease longer, she said.

“The systematic elimination of these high-risk” groups of patients from research “will only serve to increase the total number of [Alzheimer’s] patients every year,” Wharton said. Understanding those disparities is especially important, she added, because with shifting demographics racial and ethnic minority groups will represent the majority of the population.

“These terminations will have very grave consequences for patients, for families, for communities, and for taxpayers,” Wharton said.

Wharton read from a letter she received Feb. 28 that canceled another project she was in the midst of.

“It cites transgender issues,” Wharton said. “And it says, ‘Research programs based on gender identity are often unscientific, have little identifiable return on investment and do nothing to enhance the health of many Americans. Many such studies ignore rather than seriously examine biological realities. It is a policy of NIH not to prioritize these research programs.’”

Sen. Sheldon Whitehouse (D-Rhode Island) said the cancelation of grants, such as one on mental health therapies for LGBTQ people and other on LGBTQ cancer survivors, appear to violate a federal court order blocking the NIH from withholding grants that were already in progress.

He urged panelists to let the senators know if funds aren’t released when they’re supposed to be. “We need to know when they’re jammed because you can’t believe anything that the Trump administration tells you about the progress of the funds unless the funds are actually flowing,” Whitehouse said.

Wharton and Johnson both said the turmoil for NIH-funded research was at risk of driving away a generation of researchers.

“These cuts are very, very devastating and they’re very scary for young investigators, for students, whether they’ve been affected or not,” Wharton said. “These young scientists may leave research altogether because they’re nervous.”

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Jayanta Bhattacharya, President Donald Trump's nominee to be director of the National Institutes of Health, speaks at his confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions on Capitol Hill on March 5, 2025 in Washington, D.C. (Photo by Andrew Harnik/Getty Images)

This report was updated at 7:59 p.m. EDT.

WASHINGTON — The U.S. Senate confirmed President Donald Trump’s nominees to lead the Food and Drug Administration and the National Institutes of Health.

Senators voted 53-47 along party lines Tuesday evening to confirm Jayanta Bhattacharya as director of the NIH before voting 56-44 to approve Martin Makary as FDA commissioner.

Democratic Sens. Dick Durbin of Illinois as well as Maggie Hassan and Jeanne Shaheen of New Hampshire were the only three members of their party to vote for Makary.

Shaheen said during an interview Wednesday that while she has reservations about how the Trump administration might try to change access to medication abortion, she felt Makary was qualified to lead the FDA.

“Well, I’m very concerned about what this administration might do about mifepristone,” Shaheen said. “But, I thought it was important to have someone in that role who has the scientific background and ability to run the agency.”

Hassan declined to answer questions about her vote when asked about it Wednesday afternoon by States Newsroom. Her office declined to send a written statement from the senator, offering only a response from a spokesperson. 

“The opioid epidemic has devasted communities across New Hampshire, and the FDA has made mistakes over the years that fueled this epidemic,” the spokesperson wrote in an email. “Senator Hassan voted for Dr. Makary as Commissioner of the FDA following his clear commitment to ensuring that the agency learns from its past mistakes and acts aggressively to tackle this crisis.”

Senate confirmation came just weeks after the Health, Education, Labor and Pensions, or HELP, Committee voted to advance Makary and Bhattacharya.

Sen. John Hickenlooper, D-Colo., voted in committee to send Makary’s nomination to the floor, but switched to opposing his confirmation on Tuesday.

Hickenlooper said during a brief interview with States Newsroom on Wednesday that he ultimately couldn’t support Makary over his comments about medication abortion. But he said nothing significant happened between his yes vote in committee and his no vote on the floor.

“I agonized over it. I could have easily gone back and voted yes,” Hickenlooper said. “You know, at some point when I see him, I’ll apologize and say, ‘You know, that was a hard vote for me. But I really wish you would have been more demonstrative about specifically mifepristone, because I think that’s a big issue that the FDA is going to take on.’”

Hickenlooper said he spoke with his staff and his wife over Makary’s comments about access to medication abortion before he cast his no vote on the Senate floor.

“I realized that he serves at the pleasure of the president, so what the president says he’s probably going to have to do,” Hickenlooper said. “But for me, I just became more and more uncomfortable that he wouldn’t make a few statements to say that, you know, this is not something that is a medical reinterpretation for political purposes. He should have said something.”

Abortion pill

Makary will have considerable authority at the FDA to determine if access to medication abortion remains as it is now, if the agency changes prescribing guidelines, or even pulls its approval.

During his confirmation hearing in early March, Makary testified he hadn’t yet decided how he would approach that aspect of the job.

“I have no preconceived plans on mifepristone policy except to take a solid, hard look at the data and to meet with the professional career scientists who have reviewed the data at the FDA,” Makary said at the time.

Medication abortion is a two-drug regimen consisting of mifepristone and misoprostol that accounts for about 63% of all pregnancy terminations within the United States, according to research from the Guttmacher Institute.

The FDA originally approved mifepristone in 2000 and changed its prescribing guidelines in 2016 and 2021. It is currently approved for use up to 10 weeks gestation and can be prescribed via telehealth and shipped to patients.

Sixteen major medical organizations — including the American College of Obstetricians and Gynecologists, the American Medical Association and the Society for Maternal-Fetal Medicine — affirmed to the U.S. Supreme Court last year that mifepristone is safe and effective.

“The scientific evidence is overwhelming: major adverse events occur in less than 0.32% of patients,” the medical organizations wrote in a 45-page brief. “The risk of death is almost non-existent.”

Goals for NIH

Bhattacharya testified during his confirmation hearing that he has five goals for the NIH, including focusing the agency’s research on chronic diseases and funding the “most innovative biomedical research agenda possible.”

“The NIH is the crown jewel of American biomedical sciences, with a long and illustrious history of supporting breakthroughs in biology and medicine,” Bhattacharya said at the time. “I have the utmost respect for the NIH scientists and staff over the decades who have contributed to this success.”

But, he said, “American biomedical sciences are at a crossroads” following the coronavirus pandemic.

Bhattacharya said during his hearing he would ensure NIH’s scientific research is replicable, that it has a culture that respects “free speech in science and scientific dissent” and that it regulates “risky research that has the possibility of causing a pandemic.”

“While the vast majority of biomedical research poses no risk of harm to research subjects or the public, the NIH must ensure that it never supports work that might cause harm.”

A sign at the entrance for Mahaska Health, a hospital in Oskaloosa, Iowa, that has received funding from the U.S. Department of Agriculture. (Photo by Cecilia Lynch/USDA). 

WASHINGTON — Americans living in rural communities throughout the country could see their access to health care diminish if Congress changes eligibility for Medicaid or significantly reduces its federal funding.

While rural residents who depend on the state-federal program for lower income people would experience the most substantial impacts, those who have private health insurance or have other coverage, like Medicare, would likely encounter changes as well.

Rural hospitals and primary care physicians’ incomes would likely go down if Medicaid patients are no longer able to afford the same level of health care, potentially leading to reductions in services offered for everyone or even closures, according to experts.

Whitney Zahnd, assistant professor in the Department of Health Management and Policy at the University of Iowa, said that cuts to Medicaid “will disproportionately hit rural communities,” where 24% of people are covered by the program, including 47% of all births and a majority of nursing home patients.

“This is something that’s going to impact them more than those in urban areas and that’s on top of the already lower access to care, higher need for care, older populations,” Zahnd said. “It’s just going to make things that are already a challenge even more challenging for rural communities.”

The Federal Office of Rural Health Policy categorizes about 20.3% of Americans, or 62.8 million people, as living in rural areas, based on 2020 Census data.

Hospital closings in rural America

Rural areas have seen hospitals close their doors at higher rates than facilities in non-rural areas and that trend doesn’t appear likely to reverse any time soon.

The Cecil G. Sheps Center for Health Services Research at University of North Carolina at Chapel Hill has an interactive map showing where 87 rural hospitals have closed completely since 2010, while an additional 65 “no longer provide in-patient services, but continue to provide some health care services.”

And a report from the Center for Healthcare Quality and Payment Reform released in February shows that more “than 700 rural hospitals — one-third of all rural hospitals in the country — are at risk of closing because of the serious financial problems they are experiencing.”

Losing income from Medicaid patients could lead to a “domino effect,” Zahnd said, exacerbating budget challenges for rural health care providers and potentially communities overall.

“Economically in a lot of rural communities, the hospital is the largest employer,” Zahnd said. “So if you have a hospital close, it’s not just that people are losing access to health care, they might be losing their job or their family member may be losing their job.”

Rural health care providers that are able to stay open might have to cut the services they offer to keep their accounts from going too far into the red. Such a decision wouldn’t just harm Medicaid patients, but anyone living in a rural community who goes to that doctor or hospital.  

“So those are some risks we would anticipate if there are these big cuts to Medicaid,” Zahnd said.

Winners and losers

Timothy McBride, co-director of the Center for Health Economics and Policy at the Institute for Public Health at Washington University in St. Louis, Missouri, said during a briefing on Medicaid in mid-March that financial margins for rural hospitals are “razor-thin.”

“Even in the urban hospitals, they’re probably just a few percentage points, but in rural hospitals, they can be just a percentage point or 2 or negative,” McBride said. “So if you take away the Medicaid dollars, they’re certainly going to go negative. And if you wonder why rural hospitals close, that’s why.”

McBride also made the point during a March 13 briefing hosted by SciLine, a service for journalists and scientists based at the American Association for the Advancement of Science, that Medicaid provides funding for a lot of rural health care providers.

“In an economic system, if we cut the spending, we can go, ‘Oh, that’s great. We cut $880 billion.’ But whose income is that? It’s income to hospitals, it’s income to doctors,” McBride said. “And that’s going to, you know, be really hard on rural systems and on rural hospitals and urban systems.

“Yeah, it’s going to help the taxpayers, but, you know, just be mindful of who is going to be hurt. There’s winners and losers here.”

Budget process

Republicans in Congress are planning to use the complicated budget reconciliation process to extend the 2017 tax cuts they enacted during President Donald Trump’s first term to the tune of about $4.5 trillion in new deficits. They also want to boost spending on defense and border security by hundreds of billions of dollars and rewrite energy policy.

In order to pay for some of the package, the House’s budget resolution instructs the committee that oversees Medicaid to cut $880 billion in spending during the next decade — the figure cited by McBride.

Republicans in the Senate haven’t yet agreed to that outline, with several expressing concerns about how steep cuts to federal funding would affect their constituents.

Census data shows that more than 85% of the United States remains rural, meaning every one of the 53 Republican senators represents a state with at least some rural areas.

The Senate in the weeks ahead is expected to debate the budget resolution the House voted along party lines to approve in February. Senators are likely to make changes and send it back across the Capitol for the House to give final approval.

Once the two chambers vote to adopt the same budget resolution with identical reconciliation instructions, Congress can formally begin advancing legislation that could restructure Medicaid. But the GOP will need to stay united throughout the process.

Republicans hold a paper-thin majority in the House of Representatives, requiring that any proposed changes to Medicaid garner the support of centrist and far-right GOP lawmakers.

Even a few defections over Medicaid changes, or other elements in the bill, would stop the package from becoming law.

Avoiding high medical costs, bankruptcy

Joan Alker, executive director of the Georgetown University Center for Children and Families, said that in addition to being “a critical backbone to our healthcare system,” Medicaid helps prevent lower-income Americans from going into medical debt and reduces the number of people landing in emergency departments for conditions that can be managed by primary care providers.

“We spend a lot of time, of course, rightly, thinking about Medicaid and the question of access. But fundamentally, Medicaid is an economic support — a critical piece of the puzzle for families who are struggling to pay bills with the high cost of housing and food,” Alker said. “And so that’s the number one most important thing: If you are uninsured in this country, unless you are a billionaire, you are going to be exposed to high medical costs, and those can lead to debt, and even bankruptcy.”

When people lose access to health insurance or programs like Medicaid, they tend to delay or avoid going to primary care providers, who can diagnose issues early and help patients manage chronic conditions.

“That’s not the way we want our health system to work,” Alker said. “Their condition will have worsened. They won’t have had access to prescription drugs that they needed to address chronic conditions, like asthma or diabetes or hypertension. And so they get worse and show up in the emergency room.”

Medicaid also covers health care for about half of the children in the United States and more than 40% of the births, making the program a significant source of income for both pediatricians and OBGYNs. They would see their budgets decreased if patients lose access to the program.

“There are already challenges, and these kinds of cuts will really exacerbate those for families living in these communities, whether they’re enrolled in Medicaid or not,” Alker said.

Entire community affected

Megan Cole, associate professor in the Department of Health Law, Policy and Management at Boston University School of Public Health, said during the SciLine briefing that if Congress cuts Medicaid, it would have wide-ranging effects on rural health care. 

“I think these cuts will have impacts not just on Medicaid recipients but on whole economies and health systems; so particularly safety net health systems, community health centers, rural hospitals,” Cole said. “As those institutions have less patient revenue. They may face reductions in services. They may close certain sites depending on finances. They may eliminate staff. So that affects not just the Medicaid enrollees, but also affects anyone who is otherwise served by those providers.”

A sign for the Oneida Community Health Center in Hobart, Wis. | Photo by Jason Kerzinski for Wisconsin Examiner

Wisconsin state Sen. Eric Wimberger (R-Oconto) and Rep. Joy Goeben (R-Hobart) heard concerns about potential Medicaid cuts and gambling at a listening session Monday in Oneida, Wis. 

A woman at the session said her son receives Medicaid through the Katie Beckett program, which serves children under 19 who live at home and have certain health care needs. She said that “with the $880 billion that is going to be reduced in the federal budget, it is without a doubt going to impact Medicaid in our state.” 

A budget proposal approved by the House in late February requires lawmakers to cut spending to offset tax breaks, likely requiring Medicaid cuts, KFF Health News reported. The committee that oversees spending on Medicaid and Medicare is instructed to cut $880 billion over the next decade.

The Congressional Budget Office found House Republicans’ budget goals would require cuts to Medicaid, CBS News reported on March 6. 

The woman said she’s wondering what’s happening in the state budget to “plan for these shortcomings that are going to be coming from the federal level.” 

“I don’t know on the federal side, what’s going on there,” Wimberger said. “…I can’t imagine that we’d let any sort of tragedy happen to people who—if there’s a cut of any kind, so we’ll have to adjust to it.”

Medicaid is funded by both federal and state governments. Proposals that would reduce the amount of money paid by the federal government would not require states to pay more to make up the difference, and most states will not likely increase their health care spending, according to an opinion article by the president of the health policy research and news outlet KFF.  

Wimberger is a member of the state Legislature’s Joint Committee on Finance, which is responsible for reviewing state appropriations and revenues. The committee will hold listening sessions on April 2 in Kaukauna, April 4 in West Allis, April 28 in Hayward and April 29 in Wausau.

Oneida Nation requests anti-gambling efforts, grant funding

Brandon Stevens, the vice-chairman of the Oneida Nation in northeast Wisconsin, spoke at the listening session. One topic discussed was online and in-person gambling. 

In Wisconsin, tribes have the exclusive right to operate Class III games, through compacts with the state. Class III includes banking card games, electronic games of chance, including slot machines and, generally, high-stakes, casino-style games. 

Tana Aguirre from the Oneida Nation’s intergovernmental affairs and communications office sent the Examiner a statement that covers a few of the tribe’s budget priorities. 

The Oneida Nation is requesting an increase in funding to help address illegal/unregulated gambling activities, according to Aguirre. The tribe requests compliance and/or enforcement measures “to help deal with illegal gambling machines and practices throughout Wisconsin.” 

“We’re paying a premium for exclusivity through the gaming compact [between the tribe and the state]. It’s basically a violation of the compact if they’re allowed to game at a particular level,” Stevens said. 

Aguirre said the Oneida Nation and other tribes want to see increased funding for a tribal elderly transportation grant program. The grant gives the state’s 11 federally recognized tribes financial assistance for transportation services for tribal elders on and off the reservation. 

The Oneida Nation also wants funding to go toward an intergovernmental training program, Aguirre said. 

The program “is meant to enhance the skill set and understanding between state and tribal officials.” It aims to promote the different governments engaging in “meaningful and productive” consultations and discussions. 

Aguirre said that for the items included in his email, the tribe is requesting that funding come from Oneida Nation gaming revenue that the state of Wisconsin receives.

Tribes submit gaming-related payments to the state. A variety of state programs receive state funding from tribal payments, such as gaming regulation in the Department of Administration and law enforcement in the Department of Justice. Gaming revenue has been put toward tribal family services grants, a tribal law enforcement grant program and other programs. 

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Oneida Community Health Center in Hobart, Wisconsin. | Photo by Jason Kerzinski for Wisconsin Examiner

As Congress mulls potentially massive cuts to federal Medicaid funding, health centers that serve Native American communities, such as the Oneida Community Health Center near Green Bay, Wisconsin, are bracing for catastrophe.

That’s because more than 40% of the about 15,000 patients the center serves are enrolled in Medicaid. Cuts to the program would be detrimental to those patients and the facility, said Debra Danforth, the director of the Oneida Comprehensive Health Division and a citizen of the Oneida Nation.

“It would be a tremendous hit,” she said.

The facility provides a range of services to most of the Oneida Nation’s 17,000 people, including ambulatory care, internal medicine, family practice, and obstetrics. The tribe is one of two in Wisconsin that have an “open-door policy,” Danforth said, which means that the facility is open to members of any federally recognized tribe.

But Danforth and many other tribal health officials say Medicaid cuts would cause service reductions at health facilities that serve Native Americans.

Indian Country has a unique relationship to Medicaid, because the program helps tribes cover chronic funding shortfalls from the Indian Health Service, the federal agency responsible for providing health care to Native Americans.

Medicaid has accounted for about two-thirds of third-party revenue for tribal health providers, creating financial stability and helping facilities pay operational costs. More than a million Native Americans enrolled in Medicaid or the closely related Children’s Health Insurance Program also rely on the insurance to pay for care outside of tribal health facilities without going into significant medical debt. Tribal leaders are calling on Congress to exempt tribes from cuts and are preparing to fight to preserve their access.

“Medicaid is one of the ways in which the federal government meets its trust and treaty obligations to provide health care to us,” said Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, a nonprofit policy advocacy organization for 33 tribes spanning from Texas to Maine. Malerba is a citizen of the Mohegan Tribe.

“So we view any disruption or cut to Medicaid as an abrogation of that responsibility,” she said.

Tribes face an arduous task in providing care to a population that experiences severe health disparities, a high incidence of chronic illness, and, at least in western states, a life expectancy of 64 years — the lowest of any demographic group in the U.S. Yet, in recent years, some tribes have expanded access to care for their communities by adding health services and providers, enabled in part by Medicaid reimbursements.

During the last two fiscal years, five urban Indian organizations in Montana saw funding growth of nearly $3 million, said Lisa James, director of development for the Montana Consortium for Urban Indian Health, during a webinar in February organized by the Georgetown University Center for Children and Families and the National Council of Urban Indian Health.

The increased revenue was “instrumental,” James said, allowing clinics in the state to add services that previously had not been available unless referred out for, including behavioral health services. Clinics were also able to expand operating hours and staffing.

Montana’s five urban Indian clinics, in Missoula, Helena, Butte, Great Falls, and Billings, serve 30,000 people, including some who are not Native American or enrolled in a tribe. The clinics provide a wide range of services, including primary care, dental care, disease prevention, health education, and substance use prevention.

James said Medicaid cuts would require Montana’s urban Indian health organizations to cut services and limit their ability to address health disparities.

American Indian and Alaska Native people under age 65 are more likely to be uninsured than white people under 65, but 30% rely on Medicaid compared with 15% of their white counterparts, according to KFF data for 2017 to 2021. More than 40% of American Indian and Alaska Native children are enrolled in Medicaid or CHIP, which provides health insurance to kids whose families are not eligible for Medicaid. KFF is a health information nonprofit that includes KFF Health News.

A Georgetown Center for Children and Families report from January found the share of residents enrolled in Medicaid was higher in counties with a significant Native American presence. The proportion on Medicaid in small-town or rural counties that are mostly within tribal statistical areas, tribal subdivisions, reservations, and other Native-designated lands was 28.7%, compared with 22.7% in other small-town or rural counties. About 50% of children in those Native areas were enrolled in Medicaid.

The federal government has already exempted tribes from some of Trump’s executive orders. In late February, Department of Health and Human Services acting general counsel Sean Keveney clarified that tribal health programs would not be affected by an executive order that diversity, equity, and inclusion government programs be terminated, but that the Indian Health Service is expected to discontinue diversity and inclusion hiring efforts established under an Obama-era rule.

HHS Secretary Robert F. Kennedy Jr. also rescinded the layoffs of more than 900 IHS employees in February just hours after they’d received termination notices. During Kennedy’s Senate confirmation hearings, he said he would appoint a Native American as an assistant HHS secretary. The National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for tribes, in December endorsed elevating the director of the Indian Health Service to assistant secretary of HHS.

Jessica Schubel, a senior health care official in Joe Biden’s White House, said exemptions won’t be enough.

“Just because Native Americans are exempt doesn’t mean that they won’t feel the impact of cuts that are made throughout the rest of the program,” she said.

State leaders are also calling for federal Medicaid spending to be spared because cuts to the program would shift costs onto their budgets. Without sustained federal funding, which can cover more than 70% of costs, state lawmakers face decisions such as whether to change eligibility requirements to slim Medicaid rolls, which could cause some Native Americans to lose their health coverage.

Tribal leaders noted that state governments do not have the same responsibility to them as the federal government, yet they face large variations in how they interact with Medicaid depending on their state programs.

President Donald Trump has made seemingly conflicting statements about Medicaid cuts, saying in an interview on Fox News in February that Medicaid and Medicare wouldn’t be touched. In a social media post the same week, Trump expressed strong support for a House budget resolution that would likely require Medicaid cuts.

The budget proposal, which the House approved in late February, requires lawmakers to cut spending to offset tax breaks. The House Committee on Energy and Commerce, which oversees spending on Medicaid and Medicare, is instructed to slash $880 billion over the next decade. The possibility of cuts to the program that, together with CHIP, provides insurance to 79 million people has drawn opposition from national and state organizations.

The federal government reimburses IHS and tribal health facilities 100% of billed costs for American Indian and Alaska Native patients, shielding state budgets from the costs.

Because Medicaid is already a stopgap fix for Native American health programs, tribal leaders said it won’t be a matter of replacing the money but operating with less.

“When you’re talking about somewhere between 30% to 60% of a facility’s budget is made up by Medicaid dollars, that’s a very difficult hole to try and backfill,” said Winn Davis, congressional relations director for the National Indian Health Board.

Congress isn’t required to consult tribes during the budget process, Davis added. Only after changes are made by the Centers for Medicare & Medicaid Services and state agencies are tribes able to engage with them on implementation.

The amount the federal government spends funding the Native American health system is a much smaller portion of its budget than Medicaid. The IHS projected billing Medicaid about $1.3 billion this fiscal year, which represents less than half of 1% of overall federal spending on Medicaid.

“We are saving more lives,” Malerba said of the additional services Medicaid covers in tribal health care. “It brings us closer to a level of 21st century care that we should all have access to but don’t always.”

This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

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

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

Vivent Health conducts tests for HIV and other sexually transmitted infections. Federal funds that cover the cost of those tests and other HIV prevention services are being considered for drastic reductions. (Photo courtesy of Vivent Health)

Wisconsin stands to lose at least $1.2 million a year to help prevent the spread of HIV if the federal government follows through on reported plans to drastically cut HIV prevention.

The Wall Street Journal reported this week that the administration of President Donald Trump was planning sharp reductions at the U.S. Centers for Disease Control and Prevention (CDC) and the Division of HIV Prevention housed there.

The U.S. spends about $1.3 billion annually on HIV prevention. That includes just over $1.2 million that goes to the Wisconsin division of Vivent Health, a multistate nonprofit specializing in care for people who have HIV or are at risk of being infected.

Vivent Health’s federal HIV prevention grant comes through the Wisconsin Department of Health Services. A department spokesperson said the agency could not provide the total it receives each year in federal HIV prevention funds by the end of the day Thursday.

At Vivent, the money has helped reach tens of thousands of people across the state to help them avoid infection with the human immunodeficiency virus, said Bill Keeton, Vivent’s vice president and chief advocacy officer.

The funds are used for outreach to people who are vulnerable for HIV, he said. They cover the costs of testing for HIV and other sexually transmitted infections. They also cover services to help people who are candidates for medication that can prevent HIV infection as well as medication after being exposed to the virus.

“We do thousands of tests a year throughout the state,” said Keeton. Vivent has 10 clinics around in Wisconsin and additional mobile clinics for outreach to people who use drugs. Drug use can heighten the risk of transmitting HIV, he said.

In addition, HIV prevention funds cover condom distribution and other methods of  harm reduction, Keeton said, along with education to help people learn how to use condoms properly and other ways to protect themselves from HIV infection.

“These are services and programs that are designed to reach out and provide education, testing and resources  designed to prevent HIV from occurring,” Keeton said. “These dollars that we get from the federal government comprise the lion’s share of the resources we get to do this work.”

In 2024, Vivent in Wisconsin provided 2,200 HIV tests, about half that number for Hepatitis C and nearly 1,900 for other primary sexually transmitted infections. The organization distributed 300,000 condoms and 2.7 million clean syringes for drug users. 

Vivent assisted 369 people with navigating the decision to use pre-exposure prophylaxis, or PrEP, daily medication to ward off the HIV virus in a person who is not already infected. Vivent has 678 patients in Wisconsin using PrEP.

The CDC has reported HIV infections have fallen by 12% nationally, from 36,300 in 2018 to 31,800 in 2022. Cutting off prevention funds could reverse that trend, Keeton said, and would be a setback to efforts to end HIV — an objective that has been embraced by the last three presidential administrations, including Trump’s in his first term.

“New diagnoses will increase,” Keeton said. “New transmissions will occur — unfortunately, that means people will take on $500,000 in lifetime health care costs managing their HIV.”

People will get sick, deaths will increase along with the difficulty of managing chronic illness that would otherwise be avoidable, he said, along with increasing health costs.  

“American taxpayers and health care consumers will bear the brunt of these shortsighted policy changes,” Keeton said.

With continued support, however, those outcomes can be avoided. “We have the tools, we have the science, we have the interventions that can work to end HIV,” he said. “What we lack is the resources.”

Keeton told the Wisconsin Examiner that Vivent and other providers of HIV-related care started getting word earlier this week that the HIV prevention division was “getting a lot of attention” in the White House.

He acknowledged that replacing the federal money would be a challenge given the $1 billion price tag it would carry nationally. Other organizations involved in HIV health care and advocacy are looking at mounting a court challenge if the Trump administration follows through on the proposal to cut the prevention programs.

For now, however, Vivent’s focus is on heading off the potential cuts. Keeton said the organization is advocating with members of Congress and encouraging them to “weigh in with the administration” to keep prevention programs funded. 

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A woman receives a flu vaccination at a recent clinic in Cambridge, Mass., conducted by health care providers from the Cambridge Health Alliance. Flu-related deaths are at a seven-year high as vaccination levels fall, according to a Stateline analysis. (Courtesy of the City of Cambridge)

As vaccine skepticism gains a greater foothold in the Trump administration and some statehouses, some Americans may already be paying the price, with deaths from influenza on the rise.

Flu-related deaths hit a seven-year high in January and February, the two months that usually account for the height of flu season, according to a Stateline analysis of preliminary federal statistics. There were about 9,800 deaths across the country, up from 5,000 in the same period last year and the most since 2018, when there were about 10,800.

Despite that, the U.S. Department of Health and Human Services has canceled or postponed meetings to prepare for next fall’s flu vaccine, when experts talk about what influenza strains they expect they’ll be battling.

The cancellations raised protests from medical professionals and state and federal officials. U.S. Sen. Kirsten Gillibrand, a New York Democrat, said in a statement that her state is having its worst flu season in at least 15 years, with more deaths from flu and other causes as the state’s health care system struggles under the strain of flu patients.

Some experts say putting off vaccine planning will only feed false narratives that discourage lifesaving vaccinations.

“These delays not only weaken pandemic preparedness but also undermine public confidence in vaccination efforts,” said Dr. Akram Khan, an Oregon pulmonologist and associate professor at Oregon Health & Science University who has studied attitudes toward vaccines.

U.S. Health and Human Services Secretary Robert Kennedy Jr. has expressed doubt about the need for vaccines, including flu vaccines, despite evidence that they reduce deaths and hospitalizations.

Deaths fluctuate naturally from year to year depending on the severity of current flu strains and the effectiveness of that year’s vaccines. But some see a hesitancy to use any vaccine, fed by misinformation and political mistrust of government, already taking a toll on lives.

“It’s been a bad winter for viral respiratory infections, not just in the United States but across the Northern Hemisphere,” said Mark Doherty, a vaccine scholar and former manager for GlaxoSmithKline Biologicals, a vaccine manufacturer.

“The U.S. does appear to be hit a bit harder, and it’s possible lower vaccination coverage is contributing to that,” Doherty said.

Flu vaccine distribution in the United States has been declining in recent years, and as of the first week of 2025 was down 16% from 2022, according to federal statistics.

The flu was a factor in 9,800 deaths in January and February, according to the analysis, using provisional data collected by states and compiled by the federal Centers for Disease Control and Prevention.

The highest death rates were in Oklahoma, Minnesota, Pennsylvania, South Dakota and Kentucky, all at about four deaths per 100,000 population so far this year. Some counties in Florida, New Jersey and Pennsylvania, as well as Oklahoma and Kentucky, were even higher — at about six deaths per 100,000.

The highest rates have been among older people. Statistics show the deaths hit white people and American Indians especially hard.

Tragedies are happening across the country to people of all ages and races, however. A 43-year-old Indiana father died after a brief bout of the flu, according to family members. After two 10-year-olds died in Prince George’s County, Maryland, area schools drew crowds to vaccine clinics.

Doug Sides, a pastor at Yulee Baptist Church in northern Florida, has held funerals for three congregation members who died from flu — all within one month, all of them over 70 years old. That compares with only one victim of COVID-19 from his congregation during the pandemic, he said.

“Flu death is a reality,” Sides told Stateline on a phone call from a Jacksonville hospital, where he was visiting another 84-year-old congregation member who was rescued from her home with severe pneumonia from an unknown cause.

“I encourage my church members to keep their hands clean, use hand sanitizer and to stay home if they’re feeling sick,” he said. He said he hasn’t personally gotten a flu vaccine recently because he gets conflicting advice about it — some doctors tell him to avoid them because he and some family members have cancer, while another “rides me all the time about getting a flu shot.”

“We’re all getting conflicting advice. We’re living in strange-o times,” he said. (The American Cancer Society says vaccination for people with cancer may or may not be recommended depending on individual circumstances.)

Many states are relaxing vaccine requirements as public skepticism rises. But many are taking action to warn residents and reassure them that vaccinations are safe and can help prevent deaths, despite misinformation to the contrary.

Burlington County, New Jersey, has had the highest flu-associated death rate of any county this year, according to the analysis, with 31 deaths among fewer than 500,000 people. The county held 30 free vaccine clinics from September to January, then extended them into February because of the severity of the flu season, said Dave Levinsky, a spokesperson for the county health department.

In Oklahoma, death rates are highest in the eastern part of the state where the Cherokee Nation is centered. A state publicity campaign stresses that flu shots are safe, effective and free at many community health centers. However, vaccination rates in the state are low compared with other states as of December, according to federal statistics: Only about 16% of Oklahoma residents had gotten flu vaccinations by then. Rates were even lower in Louisiana (just under 16%), Mississippi (12%) and Texas (10%).

States with the highest flu vaccination rates by December were Maine (37%), Connecticut and Vermont (33%), and Wisconsin and Minnesota (31%). But even those were down since 2022.

People have become less likely to get vaccinated in recent years, a phenomenon researchers call “vaccine hesitancy.”

A report published last year in the medical journal Cureus found three-quarters of patients in a rural New York state community refused flu vaccine with comments such as “I do not trust vaccines” or “I do not believe in vaccines.” The most common reasons cited were that earlier vaccinations made them feel sick, that they got the flu anyway, or that they thought they shouldn’t need a new shot every year. (Doctors recommend flu vaccinations annually and note that even vaccinated patients who get the flu usually face less severe forms.)

And in a paper published in February in the journal Vaccine, researchers found that people refuse flu vaccinations for many of the same reasons they refused COVID-19 shots: a feeling of “social vulnerability” that leads to distrust of government and medical guidance. One hopeful sign, the report noted, is that vaccine recommendations from trusted health care professionals can turn around such attitudes.

“Unfortunately, vaccine hesitancy is deeply entangled with misinformation, political rhetoric and public distrust,” said Khan, the Oregon pulmonologist and the study’s author. “Scientific data alone may not be enough to shift public perceptions, as many vaccine decisions are driven by gut feelings and external influences rather than evidence.”

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Since 1954, women in Waupaca and the surrounding areas could give birth at the local hospital.

No longer.

Last year, the health care system Thedacare that runs the hospital merged with another system, Froedtert Health. Last month, that newly formed health care system closed the delivery unit there.

The closest birthing center to Waupaca is now more than 30 miles to the northwest in Stevens Point. But many pregnant women will have to go even farther — to the Fox Valley to the east — to reach a hospital that accepts their insurance, said Dr. Russell Butkiewicz, who worked as a family physician at the Waupaca hospital for more than 30 years, including over a decade of delivering babies in the now-closed birthing center, before retiring from medicine last year.

“There’s going to be a delay in care,” he said. “And that delay in care could result in an adverse outcome. It could mean harm to the mother. It could mean harm to the fetus.”

Closures are common after mergers, and a particularly sticky problem in more rural communities, which have fewer people and thus make less financial sense for profit-driven organizations, said Peter Carstensen, a professor emeritus in the UW-Madison Law School who focuses on competition policy. When competitors merge, they look for areas to reduce cost.

“It almost always means eliminating some overlapping activities,” he said.

In Waupaca, that means goodbye to the delivery unit. And that’s a problem for folks in the area. One that has repeated itself across the state and country.

The community tried to offer solutions to the health care system and keep the birthing center open, Butkiewicz said. The Waupaca City Council asked the health care system in December to reconsider the closure.

The health care system told the press it was struggling to recruit physicians and other specialists for the unit and said that most women in Waupaca were already delivering their babies in urban hospitals. But they also did not show data to back up those assertions, according to news reports.

The health care system did not respond to messages from The Badger Project seeking comment.

The past and the future

For more than 70 years, the community’s babies were born at the hospital in Waupaca. Thedacare took control of the hospital in 2006, but kept on delivering. Until the merger.

While the newly formed health care system is technically nonprofit, it is still driven by making money, Carstensen said. High-level employees must still be compensated competitively by nonprofit organizations.

“They’re really run in the interest of the executives and doctors, who are the managers, the owners of the not-for-profit,” he continued. “The goal is to increase your profits and lower your costs.”

Butkiewicz and others worry the Thedacare delivery unit in Waupaca won’t be the only casualty of the merger.

They also fear the closing of the birthing center at the Thedacare medical center in nearby small-town Berlin, with its relative proximity to larger hospitals in Oshkosh and Fond du Lac, could be next.

A closure there would again increase the size of the territory in central Wisconsin without a birthing center, Butkiewicz noted, further extending drive times and escalating the dangers of problematic deliveries.

The health care system did not respond to questions about Berlin or anything else.

The problem of profit-centered health care, the dominant model in the U.S., not wanting to serve less-profitable areas is a consistent problem; solutions do exist.

When the free market does not fill a need, the government can step in to help, Carstensen said.

That can take the form of direct payments to a health care system to help provide the needed care, or a government promise that the organization will have a monopoly in the area as long as they offer certain services to the public.

Something similar is happening in the state regarding high-speed internet. Across rural Wisconsin and also much of the rural United States, for-profit telecommunications providers mostly have been uninterested in making the necessary investments to bring fast internet access to the thinly populated customers here. Republicans controlling Wisconsin state government initially gave very little funding toward the problem. But after Gov. Tony Evers, a Democrat, was elected in 2018, he and the GOP-controlled state Legislature massively increased the amount of grants for internet providers to rural areas in the state.

The idea of government stepping in to subsidize the free market is generally one more appealing to Democrats than the GOP.

State Sen. Rachael Cabral-Guevara, a Republican from Appleton who represents Waupaca and also runs her own health care practice as a nurse practitioner, has some other ideas for helping health care thrive, or at least survive, in rural areas.

“Patients deserve access, but first we need to make sure providers — particularly in high-demand areas like nursing — are incentivized to provide these critical services in needed areas,” she said via email. “This includes cutting unneeded red tape in the health care industry, especially for primary care providers.”

To specifically tackle this shortage of health care providers, particularly in rural areas, she argued for allowing them more independence to offer more services, enhancing investments in nursing student recruitment and retention, and supporting a tax credit for nurse educators.

State Rep. Kevin Petersen, a Republican who also represents the area, did not respond to messages seeking solutions.

Whatever happens, rural health care will need some help from somewhere, or much of it might go away, experts say.

“It’s going to involve a lot more regulatory oversight,” Carstensen said. “It’s the only way we’re going to get the results I think are essential.”

Former President Joe Biden’s administration had been very aggressive on business competition issues for the past four years, including challenging many attempts by large companies and nonprofits to merge, often arguing the results would be worse for consumers. It remains to be seen how strongly President Donald Trump’s administration will enforce antitrust law in his second term, though early moves have been promising, Carstenen noted.

This article first appeared on The Badger Project and is republished here under a Creative Commons license.

The Badger Project is a nonpartisan, citizen-supported journalism nonprofit in Wisconsin.

Two health care systems merged, then closed the only birthing center for miles is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Photo by Adam Gault/Getty Images

The latest manufactured outrage from the far right? “Transgender mice.”

It’s the perfect viral talking point — designed to sound absurd, evoke outrage and make people believe that the government is wasting their money on nonsense. But it’s a lie.

The real story? The National Institutes of Health allocated funding to study biological sex differences in the brain — research that helps us understand mental health conditions, neurological disorders, and yes, gender identity.

Of the $8 million in research funding they are mocking, only $1.4 million went specifically toward transgender research. The rest? It was spent on studies of Alzheimer’s, PTSD, and depression — research that could save lives. But that’s not what they want you to focus on.

This isn’t just about defunding a study. This is about erasing science that doesn’t fit a political agenda.

Why this research matters

If you’ve heard people say that being trans is just a trend, ask yourself: Why do so many trans people say they have always felt this way? Why does gender dysphoria show up in childhood, long before social influences?

Because gender identity isn’t a fad — it’s neurological.

Here’s what we do know:

Autistic people are between six- and seven times more likely to be transgender or nonbinary. Nearly 25% of gender-diverse youth are autistic. Neurological and genetic factors play a role in gender identity — this isn’t just psychology, it’s biology.

Why does this matter? Because if we can understand how gender identity develops in the brain, we can better support trans youth, improve mental health care, and help autistic individuals who experience gender dysphoria.

This funding wasn’t about “making mice trans.” It was about understanding how the brain processes gender. And that knowledge could help millions of people.

If you’re worried about government waste, look at the real problem

If conservatives were really concerned about wasteful spending, they’d look at something far more harmful: the White House’s own anti-trans propaganda.

Donald Trump’s administration isn’t just cutting funding for trans research — it’s publishing misleading, politically motivated attacks on transgender people using taxpayer dollars.

A recent article posted on WhiteHouse.gov dangerously misrepresented science, promoting debunked claims about gender identity and paving the way for rolling back health care protections for trans people, banning gender-affirming care nationwide and erasing legal rights for trans students.

This isn’t about science. It’s about a larger, dangerous narrative that transgender people aren’t real, that research on gender identity should be defunded and that trans people don’t deserve health care or legal protections.

If you want to talk about wasteful spending, then look at this administration’s efforts to push misinformation while ignoring the real issues affecting Americans.

Defend the science. Defend the truth.

The next time someone brings up “transgender mice,” ask them:

Do you believe in funding neuroscience research on gender identity?Do you support medical studies that could help autistic and trans youth? Why are you mad about this funding, but not billions wasted on government propaganda?

If you believe in truth, science and protecting vulnerable communities, you should care about this. It isn’t about mice. It’s about erasing science that doesn’t fit a political agenda.

Don’t fall for it. Science matters. People matter. The truth matters.

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As Congress considers cuts to Medicaid, advocates warn that proposals will hike state costs or reduce services for people with no other resources. (Getty Images)

Of the laundry list of proposed Medicaid cuts circulating on Capitol Hill, policy watchers say some stand out as the most likely to be implemented because they’ve either been tried before, frequently embraced, or both.

Advocates argue that none of the ideas will actually help the program do a better job of its central mission: make it possible for poor and low-income people to get either primary or long-term health care. Instead, they contend, the outcome would be to transfer the costs to states unwilling to cut services or kick people off the rolls who have no other health care resources.

Broad outlines of the proposed Medicaid wish list for Congressional Republicans were outlined in a U.S. House memo that Politico published in mid-January, along with 50 pages of details. The memo is the basis for a summary of those proposed cuts from policy analysts and advocates at the Georgetown University Center for Children and Families.

Among the proposals that have garnered the most attention and concern are:

• Instituting work requirements for Medicaid recipients.
• Capping the current federal contribution to a state’s Medicaid budget, also known as turning Medicaid funds into a state block grant.
• Lowering the federal government’s minimum share of the cost of Medicaid, currently 50%.
• Ending the increased federal government match for states that have adopted Medicaid expansion under the Affordable Care Act (ACA)

Additional proposals would make other changes to how the federal matching rate is calculated or applied and reverse several Biden administration rules that made Medicaid enrollment easier and broadened access to benefits, according to the Georgetown summary.

Medicaid is funded by a combination of federal and state money. Proposals that lower the federal share would require states to pick up a larger share of the cost to avoid reducing coverage.

“The scale of the cuts Congress is contemplating is so large it really will cause fiscal peril for the state,” says Tamara Jackson of the Wisconsin Board for People with Developmental Disabilities.

Medicaid work requirements

The congressional proposals include imposing work requirements for “able-bodied” people as a condition of receiving Medicaid.

The congressional memo specifies that work requirements would not include “pregnant women, primary caregivers of dependents, individuals with disabilities or health-related barriers to employment, and full-time students.” It pegs the savings from a work requirement at $100 billion over 10 years.

According to KFF, a nonpartisan, nonprofit health policy research organization, however, more than two-thirds of Medicaid recipients are working, and those who aren’t would largely fall into the groups the memo says would be exempt.

The first Trump administration approved state Medicaid program waivers that included work requirements, while the Biden administration withdrew its approval. Among them was a requirement in Wisconsin dating from the administration of former Gov. Scott Walker.

The GOP majority in the Wisconsin Legislature passed a bill in 2022 that included a Medicaid work-requirement variation, but it was vetoed by Gov. Tony Evers.

According to KFF, a Congressional Budget Office analysis of a 2023 U.S. House proposal to institute Medicaid work requirements found that while it would save the federal government $109 billion, it would also increase the number of uninsured people by 600,000 without increasing employment. An Arkansas work requirement instituted in 2018 but later found unlawful by a federal court led 18,000 people to lose coverage.

“What we know is, even though people are working or would be technically subject to exemptions, there are very significant administrative burdens on enrollees to prove that or be found ineligible,” says Richelle Andrae, associate director of government relations for the Wisconsin Primary Health Care Association. The organization represents federally qualified health centers that serve low-income patients, including those on BadgerCare Plus and those who are uninsured.

“More time-sensitive paperwork and steps that are hard for people to understand or do and lots of people trying to complete administrative tasks at the same time are a recipe for mistakes, by individuals and government agencies that must do the work,” says Jackson. “That is how policies like work requirements and more frequent eligibility checks save money. Eligible people lose coverage or struggle to get in.”

Block grants

Currently Medicaid pays states at least 50% of all Medicaid costs, with states paying the balance.

In President Donald Trump’s first term, his administration attempted to replace that long-standing guarantee with a block grant — a fixed amount of money per Medicaid beneficiary in the state, regardless of the actual cost.

That per-patient cap on federal funds “would instead radically restructure Medicaid financing,” according to the Georgetown summary.

The cost would be felt across the board, from long-term care in nursing homes or in the community home care to primary health care through BadgerCare Plus, health care providers say, to the detriment of patients.

“Whatever the proposals are that are at the federal level — changing the formula, [per-patient] caps, at the end of the day they they’re all aimed at reducing funding for the Medicaid program, and it really is a vital lifeline for long-term care services and support,” says Lisa Davison, executive director of LeadingAge Wisconsin. The organization represents nursing homes and assisted living providers in the nonprofit, publicly owned and for profit sectors.

Reducing support would send some patients who now have Medicaid coverage back into the pool of uninsured people, says Patricia Sarvela, chief development officer for Partnership Community Health Center, a federally qualified health center in the Fox Valley that serves uninsured people as well as BadgerCare recipients.

Lacking health insurance, people are likely to put off addressing symptoms until their condition worsens enough for them to go to the emergency room, Sarvela says.

Directly or indirectly, taxpayers will likely wind up having to cover the cost of that care, however. “There might be short-term federal savings but ultimately at the end of the day it’s going to cost the taxpayers a lot more because patients will then not have health insurance,” Sarvela says.

Changes to federal match

Several proposed changes relate to the amount of the federal Medicaid match or how it’s calculated.

A proposal published by the Paragon Institute in July 2024 calls for reducing the federal match below 50% of the costs. The Paragon Institute has close ties to the Heritage Foundation, which produced Project 2025, the 900-page document that, although disavowed by Trump last year, has been echoed in numerous actions since he took office.

In 10 states the federal match is at the minimum and would likely be lowered, the Georgetown summary says, adding: “These states would likely have to make deep cuts to their Medicaid programs in response.”

The states are California, Colorado, Connecticut, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Washington and Wyoming.

Other states receive a higher federal match; Wisconsin gets 60% of its costs covered. It’s not clear whether those states’ matches would also be reduced under the proposal or other Medicaid reduction proposals.

Medicaid expansion

Another likely cut would be to reduce the additional federal match for Medicaid recipients whose incomes are between 100% and 138% of the federal poverty line.

The additional match was included in the Affordable Care Act, enacted in 2010. Originally Medicaid expansion was mandatory under the act, but a subsequent U.S. Supreme Court ruling that upheld the ACA made Medicaid expansion voluntary.

States that have accepted the expansion got a 90% federal match for the added beneficiaries. The Congressional memo proposes ending the higher match, and some states that have expanded are already considering ending expansion if that happens.

Wisconsin never accepted Medicaid expansion, however, so that change would not directly affect the state. Although Evers first ran in 2018 on a vow to accept Medicaid expansion after Walker rejected it, he’s been blocked from doing so by the GOP majority in the Legislature.

As he has with every budget he’s proposed since taking office, Evers has included accepting Medicaid expansion in his 2025-27 budget proposal.

In an interview with the Wisconsin Examiner last month after a visit with constituents in Port Washington to promote his budget, Evers said he didn’t consider leaving out Medicaid expansion, despite predictions that it would be pulled back by Republicans.

“First of all, we don’t know if it’s going to go away,” Evers said. Under the current 90% match, he said, Wisconsin would get about $2 billion in additional federal money every two years and the additional people covered in the state “would get better health insurance, so it’s a win-win-win.”

Evers acknowledged that in the current Congress, there’s a risk for sharp reductions in Medicaid.

If that happens, “it would be disastrous,” Evers said. “We have lots of people on Medicaid in the state of Wisconsin.”

Among states, Wisconsin’s Medicaid profile is “pretty average,” he added.

“There are places in the country where Medicaid is a huge, huge player, and if they would get rid of Medicaid, our health care system would implode. There’s just no question about that. That’s the thing that concerns me.”

This story is Part Three in a series.

Read Part One: Wisconsin patients, families are wary as Congress prepares for Medicaid surgery

Read Part Two: How Medicaid fuels an economic engine for caregivers, family members and patients

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• Two women incarcerated at Taycheedah Correctional Institution have died following hospital stays that began Feb. 22. 

• Family members of both women say hospital staff linked the deaths to pneumonia. They said both women started mentioning health issues over the phone around a month ago.

• Corrections officials briefly locked down part of Taycheedah due to an increase in respiratory illnesses.

Two women incarcerated at Taycheedah Correctional Institution have died following hospital stays that began Feb. 22. The Wisconsin Department of Corrections has shared limited information about their deaths, frustrating family members and those locked up at the maximum- and medium-security women’s prison. 

Shawnee Reed, 36, died Feb. 23, a day after arriving at an area hospital. Brittany Doescher, 33, died Thursday after spending nearly two weeks on life support, according to an online corrections database and family members. 

Both women were mothers, family members said. 

Two prisoners at Taycheedah told Wisconsin Watch and WPR that a third incarcerated woman was hospitalized around the same time as Reed and Doescher. The online corrections  database shows the woman they identified was “out to facility” on Feb. 23. She returned to Taycheedah in the same week.

Reed and Doescher’s official causes of death are pending, said Dr. Adam Covach, Fond du Lac County’s chief medical examiner. Family members of both women say hospital staff linked the deaths to pneumonia. Reed and Doescher’s relatives asked not to be identified to avoid drawing more attention to their families. 

Doescher’s relative said she learned of Doescher’s hospitalization two days after it began. She arrived to find Doescher chained to a bed with blisters around her ankles. 

Following discussions with doctors, Doescher’s family member believes earlier treatment could have prevented the death, particularly because she was so young. 

Asked about the deaths, department spokesperson Beth Hardtke wrote in an email to WPR and Wisconsin Watch: “The federal Centers for Disease Control is seeing ‘high’ numbers of respiratory illness cases in Wisconsin, and the Department of Corrections (DOC) is taking a number of steps to prevent the spread of respiratory illnesses to staff and persons in our care.”

People incarcerated at Wisconsin prisons, including Taycheedah, were recently tested and treated for Influenza A, Hardtke added.

Relatives said both women started mentioning health issues over the phone around a month ago.

Questions about the illnesses are swirling within the prison. Three incarcerated women told WPR and Wisconsin Watch they learned Reed had died but heard different versions of the cause. 

Corrections officials locked down part of Taycheedah — limiting prisoner movement — on Feb. 28. That was due to an increase in respiratory illnesses, according to an internal memo from Warden Michael Gierach. The department lifted the lockdown Thursday. 

Wisconsin typically charges prisoners a $7.50 copay for each face-to-face medical visit, among the highest in the country. Citing the surge of respiratory visits, the department lifted copays for visits beginning Feb. 28, five days after Reed died.

“DOC health care staff recently reminded employees and those in our care of ways to protect themselves as influenza, COVID-19, pneumonia and RSV continue to circulate,” Hardtke wrote.  

The prisons are providing vaccines, masks and soap for regular hand washing, Hardtke added. Anyone who tests positive for a respiratory illness is quarantined for at least seven days.

While women at Taycheedah did receive information about respiratory illness precautions, the department shared no details about the hospitalizations and deaths, said Kady Mehaffey, who is incarcerated.

“Which is kind of maddening because of the amount of people that are filling in the blanks about what happened,” Mehaffey said.

The department did not publicly announce the women’s deaths, which WPR and Wisconsin Watch learned about from women incarcerated at the facility.  

Online records showed the women had died but little other information. The department has since provided basic information, including the women’s names, ages, death dates, and that they died in an “area hospital.”

States including Minnesota, Iowa and Nebraska publicly announce prisoner deaths, sharing the person’s name, prison, where they died, and in some cases, details related to their cause of death. 

Wisconsin is not the only state to limit the release of such details, but doing so is problematic, said Michele Deitch, director of the Prison and Jail Innovation Lab at the University of Texas at Austin.

“There’s no greater responsibility that prisons have than keeping the people inside safe and alive and when there’s a failure to do that the public has a right to know,” Deitch said.

Hardtke wrote that her department follows best practices to protect the privacy of people who are incarcerated and their families. What’s more, it’s up to county coroners or medical examiners to investigate causes of deaths.

The Department of Corrections does confirm deaths and release names after family is notified, but the department can’t release other details, including cause of death, because of privacy laws, Hardtke said.

Deitch said prison systems often interpret privacy laws broadly and then point to such protections to justify withholding information. 

While the department updates its online database to note prisoner deaths, someone seeking information about a death would first need to know the prisoner’s name. That database was used to confirm the March 4 death of a prisoner at Waupun Correctional Institution — Damien Evans, the seventh Waupun prisoner to die in custody since June 2023. 

Fourteen prisoners residing at Wisconsin’s adult institutions have died this year, Hardtke wrote. The prisons saw 61 deaths in all of 2024 and 54 deaths in 2023.  

Reed and Doescher both participated in a program to help with substance abuse and facilitate an early release, according to relatives and court documents. Doescher expected her release within months, her relative said.

“She was hoping to come home and start her own business,” the relative said. “She wanted to counsel other girls in situations like her.”

Both Reed and Doescher enjoyed jewelry making while at Taycheedah.

“I don’t know how (Reed) did it, but she would get like thread and threaded around like a plastic piece or something like that and she could make these really cool designs,” Mehaffey said. “She was good with the small intricate things.”

Both women have children.

“We’re going to miss her and I certainly hope the prison system can be reformed because there’s no call for this,” Doescher’s family member said. “I feel for any other parent that has to go through this.”

Families seek answers after deaths of two women incarcerated at Taycheedah prison is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

An expectant mom waits at a health clinic with her 1-year-old daughter. Republicans in multiple states are introducing bills to grant embryos and fetuses the same rights as children. (Angel Valentin/Getty Images)

As state legislative sessions grind on, conservative lawmakers have filed a new batch of bills that would grant legal rights to fetuses and fertilized embryos.

Lawmakers in at least eight states — Georgia, Idaho, Indiana, Kentucky, North Dakota, Oklahoma, South Carolina and Texas — have considered bills to go even further, to punish women who seek abortions.

Most of these states have already banned abortion. But new criminalization bills would allow women to face homicide charges for obtaining abortions. The bills would classify an embryo or fetus as an “unborn” or “preborn child” who can be a victim of homicide. Many of the bills would repeal parts of state laws that explicitly exempt women from being punished for seeking abortions.

“If we truly believe in the equal humanity of the preborn, then our laws must uphold that truth in practice,” Idaho state Sen. Brandon Shippy, a Republican, told fellow lawmakers while introducing his bill in February. The bill would allow women who seek abortions to be prosecuted under the state’s homicide laws.

“Justice requires accountability for intentional actions,” Shippy said. “To exempt any group from accountability actually undermines the law’s integrity and diminishes the value of the life being protected.”

Shippy did not answer requests for comment.

Most lawmakers, including Shippy, admit this type of legislation is a long shot. His bill is sitting in an Idaho Senate committee, although the chamber’s Republican leaders have indicated they wouldn’t move it forward. But similar bills are still pending in five other states — Georgia, Indiana, Kentucky, South Carolina and Texas.

Meanwhile, conservative lawmakers in several states are introducing less punitive bills that are structured around the same legal concept: fetal personhood.

A longtime cornerstone of the anti-abortion movement, fetal personhood is the idea that a fetus, embryo or fertilized egg has the same legal rights as a newborn. If the law considers fetuses to be people, then abortion should legally be considered murder.

But experts and reproductive rights advocates have long warned of the legal chaos that could result from fetal personhood laws, with potential implications extending far beyond abortion.

“In some ways it’s a hornet’s nest,” said Rebecca Kluchin, a history professor at California State University, Sacramento, whose research has focused on fetal personhood efforts. “If you establish fetal personhood, it raises all of these questions. Do you recognize a fetus on your taxes? How do you calculate the census? What do you do about miscarriages? What about alimony? It is really messy.”

And this year, less than two months after voters approved a state constitutional amendment guaranteeing the right to abortion, a Republican legislator introduced a fetal personhood bill that would put the question on the ballot again in 2026.

If the bill is approved by two-thirds of the state legislature, the question would ask Montanans whether they support amending the state constitution to grant full rights to all people “at any stage of development, beginning at the state of fertilization or conception.”

The measure passed out of committee last month along party lines.

At a legislative hearing, Montana residents expressed concern that a personhood ballot measure would not only outlaw abortion but also eliminate access to in vitro fertilization and expose women who miscarry to possible criminal prosecution. An estimated 10% to 20% of known pregnancies end in miscarriage, though the percentage is likely higher for all pregnancies, since many losses happen before a woman knows she’s pregnant.

Defenders of such legislation have downplayed its impact on IVF and insist that states have a duty to protect all life.

“For those of you who believe that a human life begins at conception and deserves legal protection, because the right to life is the foremost of unalienable rights, I don’t see how any of us could be satisfied with having a law on the books that does not actually protect human life beginning with the biological beginnings of human life, which is fertilization,” South Carolina Republican state Sen. Richard Cash told fellow legislators in February while introducing his bill.

Critics also worry criminalization bills could drive medical providers out of state and cause women to delay seeking medical care over fear of being punished for pregnancy complications. They say personhood language could even threaten individuals’ end-of-life decisions, such as “do not resuscitate” directives, which are often used by people with terminal illnesses.

Child support and tax credits

Many personhood bills are not, at face value, about banning abortion. Yet they ultimately could have the same effect. Some experts say that any attempt to weave fetal personhood language into state law could set the stage for stricter abortion laws.

A new Ohio bill would let taxpayers claim “conceived children” as dependents on their taxes. And Republican lawmakers in Kansas introduced a bill to guarantee child support payments to mothers from the moment of conception.

“These bills often look, on their face, like they’re trying to be helpful to pregnant people,” said Carmel Shachar, faculty director of the Health Law and Policy Clinic at Harvard Law School’s Center for Health Law and Policy Innovation. “But oftentimes the way they’re drafted, they’re almost impossible to take advantage of.”

For instance, Georgia’s Department of Revenue has interpreted the state’s anti-abortion law as allowing residents to claim a fetus with a detectable heartbeat as a state tax deduction. But the maximum tax savings is only about $150, according to the Urban-Brookings Tax Policy Center. And because it’s a deduction, rather than a refundable tax credit, it’s not available to many families with low incomes.

At least 19 states — either through state law, criminal statutes or case law — have declared fetuses at some state of pregnancy to be people, according to a 2023 report from Pregnancy Justice, a nonprofit that conducts research and advocates for the rights of pregnant people, including the right to abortion.

Fetal personhood language in state law has allowed prosecutors to press murder charges for the killing of a fetus after the killing of a pregnant woman in multiple states, including New Hampshire and Oklahoma. Laws also have allowed women in several states to be prosecuted for child endangerment for substance use while pregnant.

Anti-abortion discord

Historically, anti-abortion laws that carry criminal and civil penalties have targeted abortion care providers, such as physicians. Yet bills that would allow broader criminal prosecution of abortion are not unheard of; they’ve popped up over the years in conservative-led states, such as North Dakota.

But they aren’t widely popular, even within the anti-abortion movement.

In February, a representative from the North Dakota Catholic Conference spoke against a Republican-sponsored fetal personhood bill that would add “unborn child” to state laws relating to murder, assault and wrongful death lawsuits. The conference’s co-director told lawmakers that while his group opposes abortion, it doesn’t support punishing women who seek one. The bill made it to the House floor, where it eventually failed.

“There’s a real division in the pro-life movement,” said Kluchin, the history professor. “To some folks, abortion is murder, so anyone who commits abortion, whether a provider or pregnant person, should be accused. But most of the pro-life movement doesn’t go that way. Their thought is, how can you be compassionate if you accuse a woman of murder? That’s not going to get the general public on your side.”

Many lawmakers proposing the homicide bills acknowledge they’re unlikely to garner widespread support, even among their fellow conservatives.

“But it’s a way to say, ‘Here are my pro-life bona fides,’” Kluchin said. “I’m not sure it matters that it isn’t going to get out of committee.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

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