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

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

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

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

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

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

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

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

What are the changes?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The updated CDC site lists some of these new parameters:

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

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

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

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

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

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

What does shared clinical decision-making mean?

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

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

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

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

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

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

Will this impact access to shots?

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

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

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

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

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

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

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

Why are Kennedy and his HHS staff making these changes?

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

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

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

How are medical groups responding to the announcement?

AAP described the changes as “dangerous and unnecessary.”

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

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

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

Where can I get more information about vaccines?

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

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

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

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

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

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

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A child receives a COVID-19 shot in Annandale, Va., in 2021. A reduction in the list of federally recommended childhood immunization has sparked alarm among public health experts. (Photo by Chip Somodevilla/Getty Images)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

An appealing alternative

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

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

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

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

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

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

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

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

Regulatory hurdles

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

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

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

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

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

“Women are just left to figure things out.”

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

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

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

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

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

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

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

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

Alabama lawsuit

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

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

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

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

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

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

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

Struggles and solutions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He contends that 2026 can be different.

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

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

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

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

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

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

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

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

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

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

1. Wisconsin politics goes into overdrive

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

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

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

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

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

2. A  bipartisan state budget splits both parties

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

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

3. Public school troubles

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

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

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

4. Federal fallout from a new administration

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

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

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

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

5. Immigration arrests spark turmoil

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

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

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

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

6. Environment: Data centers, stewardship and PFAS conflicts

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

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

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

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

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

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

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

8. Prison reform struggles

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

9. Voting rights debates revive 2020 election denial

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

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

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

10. Flooding and disasters

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

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

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

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

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

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

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

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

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

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

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

(Getty Images)

This article first appeared on KFF Health News.

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

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

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

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

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

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

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

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

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

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

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

Hospitals’ pushback

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

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

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

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

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

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

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

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

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

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

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

Reduced competition

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ashley Murray contributed to this report. 

Banners from the group Save the Portage County Health Care Center. The group opposes which opposes the privatization of the county facility. (Photo courtesy of Karlene Ferrante)

As counties across Wisconsin sell off publicly-owned nursing homes to private companies, communities worry that privatization will bring understaffing, declining quality of care, and more regulatory violations, driving many residents to fight back.

After Karlene Ferrante broke her femur, she underwent major surgery and was transferred to a skilled nursing facility to recover. She spent a little over two months at the county-owned Portage County Health Care Center in Stevens Point, Wisconsin.

“​​I lucked out and got sent to the Portage County Healthcare Center. They took wonderful care of me for that whole summer and until I was able to go home,” Ferrante said. “Because of that great care that I got, I am able to walk. I have my leg. I didn’t get an infection and I didn’t fall. They were adequately staffed and they provided really good care.”

There are only two skilled nursing facilities in Stevens Point. The publicly-owned Portage County Health Care Center, which has served the community for nearly a century and has a five-star rating from the Center for Medicare and Medicaid Services (CMS), and the privately-owned Stevens Points Health Services, which has a one-star rating from CMS. Ferrante was relieved to get into the county-owned facility, but the relief faded when she returned home and learned that the county was considering selling Portage County Health Care Center to a private company.

“When I found out that they were trying to privatize it, I decided then that I’m going to work on this,” Ferrante said. “I’m not going to let that happen, because other people should be able to get the same kind of care that I got.”

Across Wisconsin, County Boards have been voting to sell their skilled nursing facilities as local communities fight the sales, especially in rural counties. In Portage County, retired professor Ferrante, a two-time patient at the Portage County Health Care Center, has joined the Save the Portage County Health Care Center group, which opposes the privatization of the county facility.

“We are the only five-star skilled nursing facility in Portage County,” said Nancy Roppe, a lifelong resident of Portage County and one of the group’s organizers. “The quality of care is stellar… people clamor to get their care here, because they know when they press the call button, somebody will respond.”

In 2018, Portage County residents approved a four-year, $5.6 million referendum to support the facility’s operations. Then, in 2022, they passed another measure authorizing tax increases to fund the construction of a new facility.

Roppe said the referendums signaled public strong support for Portage County Health Care Center, but Portage County is trying to sell the health care center to The Ensign Group, a private company which has purchased other nursing facilities in the state.

In Lincoln County, Wisconsin, the County Board voted over the summer to sell the county-owned Pine Crest Nursing Home, which had been serving the county for over 70 years, to Ensign. Just a few months after the transition from county to corporate ownership, members of the Lincoln County community have seen noticeable changes in the quality of care.

“We are already seeing the changes,” said Pastor Mike Southcombe, the senior pastor at St. Stephen’s United Church of Christ in Merrill, the county seat of Lincoln County. “The staffing is less than it was when the county ran it.”

Research consistently shows that publicly-owned facilities not only maintain higher staffing and care standards but also serve as essential safety nets for vulnerable populations, ensuring access to long-term care for residents who might otherwise be turned away by for-profit operators.

A 2022 report by the Center for Medicare Advocacy warned that privatizing county-owned nursing homes often led to lower staffing levels and diminished quality of care, as for-profit operators prioritized revenue over residents’ needs. The report found that promised cost savings rarely materialized, while accountability and public oversight were significantly reduced.

An academic study also found that privatizing county-owned nursing homes increased regulatory violations and reduced residents’ quality of care and quality of life, while failing to improve access for Medicaid recipients.

Working Class Storytelling reported that during a February town hall in Lincoln County, data presented by LeadingAge Wisconsin indicated that publicly-owned nursing homes in the state provide higher-quality care than private or nonprofit facilities.

While some Lincoln County officials said that the county did not have adequate funding to continue the operation of Pine Crest, Eileen Guthrie, a retired accountant who lives in Lincoln County and regularly volunteered at Pine Crest, crunched the numbers and found that Pine Crest was bringing in a profit.

“I started looking at all of the public records, whether they were from the finance committee or the county board, or online… I kept digging and digging,” said Guthrie, who was an active member with People for Pine Crest. When she looked through all the 2023 and 2024 financial statements, she found that Pine Crest had a positive balance upwards of $400,000 in 2023 and a positive balance above $550,000 in 2024. Guthrie said part of this positive balance was due to the state’s Medicaid reimbursement policies.

Lincoln County officials said the sale of Pine Crest would help relieve the county’s deficit, though they did not clarify what expenses were driving that deficit.

“I know not everybody’s happy about it. I understand that all of us, most of us, have people in Pine Crest, and I understand that, but I’m comfortable with Ensign, that they’ll be here and they’re going to serve the community properly,” said County Supervisor Greg Hartwig at a July County Board meeting, according to WXPR.

As the county pushed forward with the sale, many residents felt their voices were ignored. Among them was Scott Doerr, a Lincoln County resident who had worked in local factories for more than 30 years before retiring. Frustrated by the way local officials handled the Pine Crest sale, he filed paperwork to run for County Board Supervisor.

“I just felt that the county board wasn’t listening to the citizens,” Doerr said. “I’m probably going to be campaigning on giving the voice back to the people.”

The sale has raised deeper concerns about the future of the facility.

“Being county-owned was a comfort and now we have to wonder, year to year, if they’re going to sell it for profit and make things worse instead of better.” Doerr said.

That concern about the future of nursing care is shared by others who see the facility as more than just a business, but as a vital community resource.

“People have been paying taxes on [Pine Crest], volunteering at it, supporting it, all those years, with the expectation that it would be around for them when they needed it, or be around for family members when they needed it,” Southcombe said. “The population up here, as it is everywhere, is aging. The elementary schools are shrinking. The need for nursing homes in home care and just general health services is just going to increase. And we’re also going to need people to work at those places.”

For Guthrie, the sale of Pine Crest is not necessarily the end of the fight for better community services.

“The loss was significant, but there is a win in there,” Guthrie said. “All of these people worked together for the good of the community, for the good of the employees and the residents. And maybe that’ll be enough to say, okay, yeah, we lost, but there are other things that we can do, so I’m hoping that there will be more to come.”

As the Save the Portage County Health Care Center group has watched other sales, like those in Lincoln County, happen, they are working to get creative about spreading the word across the county ahead of deciding votes. They have started sharing information in newspaper ads, billboards, and online videos.

“We’ve had to go and reinvent the wheel. We’ve come up with new ways to reach the public. And how does the public react when they know? They are angry,” Ferrante said. “They’re surprised. After voting twice to support the referendums and paying the taxes to have the nursing home continue and be rebuilt, people have been shocked to learn that the current administration in the county is just selling it.”

With the county’s vote looming this week, local community advocates said the stakes feel like a matter of life and death, and they aren’t slowing down.

“Where do we find the energy to fight [for Portage County Health Care Center]? For me, I feel like I owe them,” Ferrante said. “They kind of saved my life.”

This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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A sign advertises the availability of flu and COVID-19 vaccines at a pharmacy in Madison, Wisconsin. (Wisconsin Examiner photo)

Vaccination rates for influenza and COVID-19 are low in Wisconsin, and on Thursday, the Wisconsin Department of Health Services announced that two children have died within the last month: one from the flu in northeast Wisconsin and one from COVID-19 in the western part of the state.

Citing concerns for family privacy, DHS is not releasing the ages of the children. At a media briefing, Tom Haupt, the DHS respiratory epidemiologist, said they were the first deaths of people under 18 from those illnesses since the start of the flu season Oct. 1.

Although year-to-year comparisons in mid-season are difficult, “we are definitely seeing an increase in influenza and COVID-19 at this particular point,” Haupt said.

Haupt said DHS has not yet verified whether either of the two children were vaccinated. Both had “some underlying conditions that would increase their risk” for more serious illness, he said.

Five people under 18 died from flu in January and early February 2025, Haupt said. DHS monitors certain illnesses, including flu and COVID-19, through data from hospital emergency rooms, lab tests and studying municipal wastewater for evidence of the viruses responsible.

Vaccination is the best tool for preventing serious illness from both flu and COVID-19, Haupt said.

“Our vaccination status for children for both COVID-19 and influenza are very low,” he said. “We want them to be increased significantly.”

Across all ages, about 28% of Wisconsinites have been vaccinated against the flu and 10.6% against COVID-19. “These numbers are lower than what we’ve seen over the past few years and that’s very unfortunate,” Haupt said.

DHS recommends both vaccines for everyone 6 months or older. The COVID-19 and the flu shots can both be given at the same time.

Flu can have outcomes much worse than its usual symptoms.

“Influenza could lead to cardiac problems for both children and adults. It can lead to encephalitis,” Haupt said. “So, it’s not only the acute acute part of influenza, it’s what can happen later on.” With vaccination people are “protecting yourself and protecting those people who are around you.

For a third serious respiratory illness, respiratory syncytial virus, or RSV, DHS recommends the maternal RSV vaccine for expectant mothers who are 32 to 36 weeks pregnant, to protect their infants after they’re born.

DHS recommends the RSV vaccine for infants younger than 8 months if they were born to mothers who did not get the vaccine during pregnancy. DHS also recommends the vaccine for children 8 to 19 months old with a higher risk of RSV, as well as for adults 75 and older and for adults 50 to 74 years old who have an increased risk for the virus.

Haupt said doctors have told DHS that they’re encountering more vaccine hesitancy in the general public than in the past. One cause appears to be confusion about shifting recommendations from the federal Centers for Disease Control and Prevention and the CDC advisory council that makes recommendations on vaccines, he said.

Haupt said that for people hesitating about getting vaccines for themselves or their children, the “most accurate sources” for information are the state health department, local public health departments, community clinics, pharmacies and primary care doctors.

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Medical Assistant Janet Casamichana gives a flu shot to a child in Coral Gables, Fla., in September. Measles cases nationwide rose to 1,958 this year as of Dec. 16. (Photo by Joe Raedle/Getty Images)

The number of measles cases is continuing to grow, reaching 1,958 confirmed cases in 43 states through Dec. 16 and threatening to undo next year the United States’ status as a nation that has eradicated the disease, according to a report released Dec. 17 by the federal Centers for Disease Control and Prevention.

The increase of 46 cases in one week, including dozens more in South Carolina alone, raises concerns for holiday travelers.

Cases have now reached 803 in Texas, 182 in Arizona, 142 in South Carolina, 122 in Utah, and 100 in New Mexico this year.

West Texas has been the epicenter this year, but recently South Carolina has seen measles “spread quickly in unvaccinated households” in the Spartanburg County area, and 168 people were quarantined as of Dec. 16, according to the state health department.

The state urged employers to accommodate people with quarantine orders to help avoid more spread, warning that the disease is highly contagious for days before a person is aware of being sick.

Towns with low vaccination rates along the Arizona/Utah border also have seen recent outbreaks.

By July, national case numbers had already surpassed a 2019 outbreak, bringing this year’s caseload to the largest in 33 years. The last time there were more cases was 1992, when there were 2,126, according to the CDC report.

The continued outbreak, reflecting a worldwide increase in the disease but also a rise in vaccine hesitancy that has been encouraged at times by U.S. Secretary of Health Robert F. Kennedy Jr. threatens the hard-won measles eradication declared in 2000 for the United States.

The status has already been taken away from Canada, where the Pan American Health Organization found an outbreak lasting 12 months invalidated the “eradicated” status, and the United States faces an assessment next year. The CDC maintained in November that it was still possible to eliminate measles in the U.S. by ensuring every child has two doses of vaccine, but vaccination rates have been falling further away from the 95% minimum rate that limits spread.

Even as cases have risen this year, the CDC has communicated less about the highly contagious disease on social media, according to Johns Hopkins University research published this month.

The agency posted 10 times on social media this year between January and August, compared with an average of 46 times in the previous four years, according to the report, despite a rising number of cases.

Ruth Lynfield, Minnesota state epidemiologist, said vaccine hesitancy may not be the whole story of low vaccination rates, in a video interview published Dec. 16 by Contagion, an infectious disease news service. Minnesota has 26 measles cases this year, down from 70 last year.

“Overall, there is vaccine confidence. Ninety-two percent of our kids [nationally] are vaccinated against measles. However, in particular communities, that number can be quite low,” Lynfield said. “One of the reasons is not that people may be vaccine hesitant, but they have other priorities.”

Physicians can counteract some of the low rates by gaining trust and listening to concerns, she said, and also just by making things simpler with reminders and easy choices.

“One thing we can do is ensure that we can make it as simple and convenient as possible for parents and families to bring kids in to get vaccinated,” she said.

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

Recruiters discuss jobs with students at a July 2024 jobs fair at St. Edward's University in Austin, Texas. A new jobs report shows jobs nationwide rebounded after October losses, with a 64,000 gain in November. (Photo Courtesy of St. Edward’s University)

A shutdown-delayed jobs report released Dec. 16 showed an increase of 64,000 jobs in November, rebounding from a large loss of 105,000 jobs in October. Unemployment ticked higher to 4.6%, the highest since September 2021.

The October loss was the largest since December 2020, during a COVID-19 surge when jobs dropped by 183,000, according to a Stateline analysis of federal records.

The most recent report shows health care and construction added jobs in November — 46,000 and 28,000 jobs, respectively — while transportation and entertainment lost the most.

Transportation lost almost 18,000 jobs, mostly couriers and messengers, while entertainment and recreation lost 12,000 jobs, mostly in the amusement, gambling and recreation industries. The federal government dropped 6,000 jobs, while state governments gained 3,000 jobs.

State-by-state unemployment for November will be released Jan. 7 in the shutdown-affected schedule. October unemployment reports were canceled; the numbers for September showed rates rising in 25 states and falling in 21 compared with last year.

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

The U.S. Capitol in Washington, D.C., on Oct. 1, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — Republican leaders in the U.S. House will face a floor vote in early 2026 on Democrats’ plan to extend enhanced Affordable Care Act tax credits for three more years, after passing their own legislation Wednesday night that has little chance of a future in the Senate and does not address the tax credits.

The House vote on that legislation will be required after a handful of moderate Republicans signed on to a discharge petition Wednesday morning. Their dissent with leadership sent a strong signal they are frustrated with the majority’s policies and the rising cost of health care for their constituents. 

Speaker Mike Johnson, R-La., said after a morning vote series on the floor, where he was seen in a heated exchange with Republican Rep. Mike Lawler, that the two “just had some intense fellowship” and “it’s all good.”

Lawler is one of the four centrist Republicans who signed the discharge petition, putting it over the threshold of 218 to force a vote on the legislation. 

“We’re working through very complex issues as we do here all the time,” Johnson said. “Everybody’s working towards ideas — we’re keeping the productive conversation going.” 

The speaker also mounted his own defense, saying he has “not lost control of the House.”

That chamber has seen chaos and intraparty divides in the aftermath of the government shutdown, when Johnson opted to send lawmakers home for nearly two months. 

“We have the smallest majority in U.S. history,” Johnson said. “These are not normal times — there are processes and procedures in the House that are less frequently used when there are larger majorities, and when you have the luxury of having 10 or 15 people who disagree on something, you don’t have to deal with it, but when you have a razor-thin margin, as we do, then all the procedures in the book people think are on the table, and that’s the difference.”

Republicans push through ‘extremely modest’ bill

House debate on Republican leaders’ health care bill later in the day was largely along party lines, with members of both parties talking nearly as much about the Affordable Care Act as they did about the policy in the new legislation. 

Energy and Commerce Committee Chairman Brett Guthrie, R-Ky., said he believes that law, enacted during President Barack Obama’s first term, “has proven to be unaffordable and unsustainable.” 

Guthrie rebuked Democrats for approving the enhanced ACA marketplace tax credits during the coronavirus pandemic and scheduling them to expire at the end of this year, leading to the current deadlock in Congress. 

“Democrats leveraged a public health emergency to shovel hundreds of billions of dollars to big health insurance plans to mask the risk of rising unaffordability of coverage,” Guthrie said.

House Minority Leader Hakeem Jeffries, D-N.Y., urged Johnson to put the three-year ACA extension bill up for a vote this week, instead of in the new year. 

“Republicans need to bring the Affordable Care Act tax credit extension bill to the floor today,” Jeffries said. “Under no circumstances should we leave this Capitol this week, before voting on an extension of the Affordable Care Act tax credit bill that we know will pass.” 

California Republican Rep. Kevin Kiley, one of the centrists looking for bipartisan solutions on the expiring tax credits, expressed dismay at how debate on health care costs has been handled during the past few months by leaders in both political parties. 

“This whole issue encapsulates what is wrong with this institution, where party leaders focus most of their time and energy on trying to blame problems on the other side rather than trying to solve those problems,” Kiley said. 

The House Republican bill, he said, is “extremely modest and it has no chance of becoming law because it was hastily thrown together without, apparently, any bipartisan input when bipartisan support is necessary to pass any measure like this.”

“What are we supposed to tell these folks? ‘Oh, don’t worry, it’s Obama’s fault.’ Or, ‘Oh no don’t worry, we did a show vote on this Lower Health Care Premiums for All Americans Act.’ Is that going to be any consolation?” Kiley said. 

New Jersey Democratic Rep. Frank Pallone called the House GOP bill a “sham” and said without a vote to extend the expiring ACA tax credits millions of Americans will have to decide if they can afford health insurance coverage. 

“They will see prices double, triple and even quadruple,” Pallone said. “It will leave millions with the difficult decision of going without coverage because they simply cannot afford rising costs.”

The House voted 216-211 to approve the Republican health care bill, sending it to the Senate, where it’s highly unlikely it would get the bipartisan support needed to advance without significant revision. 

Senate approach

Senate Majority Leader John Thune, R-S.D., said earlier in the day he hadn’t yet decided whether to put the House Democrats’ bill on the floor if it is passed and arrives. 

“Well, we’ll see. I mean, we obviously will cross that bridge when we come to it,” Thune said. “Even if they have a sufficient number of signatures, I doubt they vote on it this week.”

Thune said the discharge petition on the three-year ACA tax credits extension is far different from the discharge petition that forced a House floor vote on a bill to require the release of the Epstein files. Files related to Jeffrey Epstein, who died in jail in 2019 awaiting federal trial on sex trafficking charges, have become a target of Congress and victims in recent months.

“That came over here pretty much unanimously, 427 to 1,” Thune said. 
“And my assumption is this discharge petition is going to be a very, probably, partisan vote.”

The Senate voted earlier this month on Democrats’ three-year ACA tax credits legislation, a move that Thune agreed to in order to get enough Democratic votes to end the government shutdown. That bill, which is identical to the House version, was unable to get the 60 votes needed to advance on a 51-48 vote. 

Both chambers are set to leave Capitol Hill later this week for their two-week winter break and won’t return to work until the week of Jan. 5. 

‘We have to do something’ 

Sen. Jeanne Shaheen said she sees the House discharge petition reaching the 218-signature threshold as “constructive.” 

The New Hampshire Democrat said “bipartisan, bicameral talks continue that are also constructive, so hopefully we can see some movement.” 

Though she is “hopeful” for a deal in January, Shaheen said “obviously, there’s a lot that needs to happen in order to get something done, but people need relief,” adding that “people in both houses and on both sides of the aisle are hearing from constituents that they want to see something done.” 

Missouri Sen. Josh Hawley — one of four Republicans who voted with Democrats to advance the three-year extension plan — reiterated his calls for lawmakers to take action to address the looming premium spikes. 

“I just think we have to do something on the cost of premiums, and I’m not locked into any one thing,” he said, acknowledging that he voted for both Democrats’ proposal and his GOP colleagues’ alternative bill. That effort also failed, at 51-48, to garner the 60 votes needed to move forward.  

“I mean, advance any solution — that’s my view, but what I think we should not do is just sit back and say, ‘Well, you know, good luck. We wish you all the best.’” 

Frustration breaks through

The House Republican bill, which Johnson released Friday evening, doesn’t extend the enhanced ACA marketplace tax credits.

It would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

Johnson decided Tuesday not to allow the House to debate any amendments to the bill, blocking moderate Republicans from having their bipartisan proposal to extend the ACA marketplace tax credits with modifications taken up. 

That led to considerable frustration, and Wednesday morning, Pennsylvania Republican Reps. Brian Fitzpatrick, Rob Bresnahan and Ryan Mackenzie, along with New York’s Lawler, signed the Democrats’ discharge petition, putting it at the 218 signatures needed to force a floor vote in that chamber. 

“We’ve worked for months with both parties, in both chambers, and with the White House, all in good faith, to balance all equities and offer a responsible bridge that successfully threaded the needle,” Fitzpatrick wrote in a statement.   

“Our only request was a Floor vote on this compromise, so that the American People’s voice could be heard on this issue,” Fitzpatrick added. “That request was rejected. Then, at the request of House leadership I, along with my colleagues, filed multiple amendments, and testified at length to those amendments. House leadership then decided to reject every single one of these amendments. As I’ve stated many times before, the only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge. Unfortunately, it is House leadership themselves that have forced this outcome.”

Jeffries introduced petition

The discharge petition, introduced last month by House Democratic Leader  Jeffries, sat just below the signatures needed for weeks as centrist Republicans tried to broker a deal that could become law. 

When that logjam broke with the moderates’ signatures, it set up a House floor vote, but any legislation must move through the Senate as well and gain President Donald Trump’s signature. 

Without a law to extend the enhanced ACA marketplace subsidies, roughly 22 million Americans will see their health insurance premiums spike by thousands of dollars next year, if they can fit the rise in costs into their budgets. 

U.S. House Speaker Mike Johnson, R-La., talks with reporters inside the U.S. Capitol on Tuesday, Oct. 21, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Speaker Mike Johnson said Tuesday he will not allow a floor vote this week on a bipartisan amendment supported by moderate Republicans that would extend the Affordable Care Act enhanced tax credits. 

Johnson was confident that blocking the amendment would not lead centrist GOP lawmakers to oppose the Republican health care bill scheduled to get a vote Wednesday. 

“There’s about a dozen members in the conference that are in these swing districts who are fighting hard to make sure they reduce costs for all of their constituents. And many of them did want to vote on this Obamacare, COVID-era subsidy the Democrats created,” Johnson said. “We looked for a way to try to allow for that pressure release valve and it just was not to be.”

The enhanced ACA tax credits are set to expire at the end of the year, sharply increasing the cost of health insurance for the roughly 22 million Americans who purchase plans through the exchange and benefit from the subsidies. 

The House Republican health care bill wouldn’t extend those tax credits, frustrating GOP lawmakers in that chamber who are most at risk of losing their reelection bids during the November midterm elections. 

Johnson said he expects that GOP bill will pass, though he didn’t address its prospects in the Senate, where bipartisanship is needed for nearly all bills to advance under that chamber’s 60-vote legislative filibuster. 

The nonpartisan Congressional Budget Office and the staff of the Joint Committee on Taxation’s analysis of the bill shows it would reduce the federal deficit by $35.6 billion during the next decade. 

An average of 100,000 people per year would lose health insurance between 2027 and 2035, while  gross benchmark premiums for health insurance would drop by 11% on average through 2035, according to the joint analysis. 

‘Idiotic and shameful’

New York Republican Rep. Mike Lawler said in a speech on the House floor that GOP leaders’ decision to let the enhanced ACA tax credits expire was “idiotic and shameful,” especially after changes were added to address fraud and reduce costs. 

“So we have been forced to sign onto two discharge petitions,” he said. “And yet my Democratic colleagues will not join us, but for those that were at the negotiation table.”

Lawler then criticized House Minority Leader Hakeem Jeffries, of New York, for not encouraging Democrats to sign onto the bipartisan discharge petitions, noting that would likely get the 218 signatures needed to force a floor vote. He argued that’s because Jeffries “doesn’t actually want to solve the problem, he wants the issue.”

“This place is disgraceful,” Lawler said. “Everybody wants the upper hand.  Everybody wants the political advantage. They don’t actually want to do the damn work. This problem could be solved today if everybody who says they care about extending this signs the discharge.”

GOP-only bill in 2026?

When the House returns from its two-week holiday break next year, Johnson said, leaders may try to use the complex reconciliation process they used to enact the “one big, beautiful bill” to address health care. 

“What we anticipate going into the first quarter of next year is, possibly in a reconciliation package or in regular order a stand-alone, ideas just like this,” Johnson said after being asked a question about Health Savings Accounts. “We have a long list of things that we know will reduce premiums, increase access and quality of care.” 

President Donald Trump said Monday he wants Republicans to use the reconciliation process or to eliminate the Senate’s legislative filibuster to address health care and other policy priorities. 

“Republicans should knock out the filibuster and we should approve a lot of things,” Trump said. 

Senate Majority Leader John Thune, R-S.D., has said repeatedly he doesn’t intend to change or scrap the filibuster.

Direct payments or tax breaks

Trump also reiterated during the Oval Office event he would like to see Congress send direct payments to Americans to help them buy health insurance or afford health care. 

“I want all money going to the people and let the people buy their own health care. It’ll be unbelievable,” Trump said. “They’ll do a great job. They’ll get much better health care at a much lower cost.”

The Senate voted last week on two health care bills, one from Republicans and one from Democrats, but neither received the support needed to move toward a final passage vote. 

Republicans’ bill would have provided direct payments to some people enrolled in either bronze or catastrophic ACA marketplace plans with up to $1,500 in payments annually for 2026 and 2027. 

Democrats’ legislation would have extended the enhanced ACA marketplace tax credits for three years. 

Cost most urgent issue, poll finds

A bipartisan group of senators is trying to find solutions that bridge the political divide, though they are unlikely to achieve consensus on the details before the end of this week.

Thune said during a press conference Tuesday he believes there’s a way to address the rising costs of health care if Democrats continue negotiations with Republicans. 

“Our views on health care and the Democratic views on health care are very different. And I think that’s a difficult challenge that we have to figure out how to overcome,” Thune said. “But if they’re willing to accept changes that actually would put more power and control and resources in the hands of the American people and less of that in the pockets of the insurance companies, then I think there is a path forward.”

Thune acknowledged that Congress cannot pass anything this week but said he believes “there’s a potential pathway in January if Democrats are willing to come to the table on things that will actually drive down the costs of health care.”

Senate Minority Leader Chuck Schumer, D-N.Y., didn’t entirely rule out using the Jan. 30 government funding deadline to force a partial shutdown over health care, though he implied nothing can be done on the ACA tax credits after they expire at the end of December. 

“Once it expires, the toothpaste is out of the tube,” Schumer said. 

A poll released Monday by the West Health-Gallup Center on Healthcare in America shows that cost is the “most urgent” health issue facing the country, followed by access and then obesity. 

Just 57% of those polled said they were satisfied with how much they pay for their own health care and only 16% were satisfied with the total cost of health care.

Nearly two-thirds of those in the survey said they believe it’s the federal government’s responsibility “to make sure all Americans have healthcare coverage,” while 33% said it’s not. 

The first deadline for people to sign up for health insurance in 2026 through the federal health care marketplace passed Monday. With the loss of enhanced federal subsidies coverage is forecast to decline after rising for several years. (FS Productions/Getty Images)

When Chiquita Brooks-LaSure stepped into her job overseeing the federal health insurance marketplace in 2021, about 12 million Americans were purchasing their health coverage there.

By the start of 2025, that number had doubled.

Brooks-LaSure served as the administrator for the federal Center for Medicare & Medicaid Services in the Biden administration. In addition to managing the federal health insurance programs for people over 65 and people living at or below the federal poverty guidelines, CMS also manages HealthCare.gov — the health insurance marketplace created by the 2010 Affordable Care Act.

The purpose of the marketplace was to make it easier for people who had neither employer-provided  health insurance nor  Medicare or Medicaid to purchase a policy that would cover them.

 The ACA set standards for what the insurance plans are required to cover, and it established a system of nonprofit navigators to guide buyers as they sought to match their own health needs with the coverage that was available to them on the marketplace.

Early during President Joe Biden’s term, Congress passed and Biden signed legislation that increased tax credit subsidies making insurance plans purchased at HealthCare.gov much more affordable. Those enhanced tax credits brought in a flood of new insurance coverage.

“By the time we left, there were 24 million people who were enrolled” in marketplace health plans purchased through HealthCare.gov, Brooks-LaSure said during a video call with reporters last week. The call was organized by Opportunity Wisconsin, an economic issues messaging and organizing group aligned with the Democratic Party.

The federal move to give people on marketplace health plans larger  tax credits drove that increase in enrollment, health policy watchers agree.

Now the enhanced tax credits are due to expire at the end of this year. So far attempts in Congress to extend them, whether permanently or even temporarily, have gone nowhere.

On average, Brooks-LaSure said, premiums for 2026 have gone up by 26%. “For many people, they will choose to not buy health insurance coverage at all,” she said. “But others may choose to buy coverage that doesn’t cover all of their health care needs.”

Monday was the first of two red-letter days in the current history of the ACA and the health care marketplace. People hoping to get coverage starting Jan. 1 were required to sign up by the end of the day.

People can still sign up between now and Jan. 15, but policies won’t take effect until Feb. 1.

After four years of increases in the population with health insurance, the Congressional Budget Office has forecast about 4 million people will drop their coverage in 2026 without the higher subsidies.

“For 275,000 Wisconsinites, these tax credits have saved them on average almost $600 every month,” said Sen. Tammy Baldwin in another call with reporters. “Without them, these Wisconsinites will pay double, triple, or even worse for their premiums next year. And for 30,000 Wisconsinites, the price will be just too high. And they’ll choose to go without insurance.”

That was a decision that Shana Verstegen of Madison said she and her husband briefly considered. Verstegen spoke on Baldwin’s call about the choices the couple is having to make on behalf of themselves and their two sons, ages 7 and 10.

She and her husband both work for a small community gym, Verstegen said. Their employer has too few employees to be able to purchase a group health policy, so they went to the ACA marketplace.

This year they pay $460 a month, already a squeeze, but that will increase to more than $700 a month in 2026, she said.

“It’s an amount we just simply can’t afford,” Verstegen said. Realizing that they could not risk the family’s health by going without coverage, they’ve looked at other options — including possibly giving up work that has been a long-term career in order to find a job with employer-sponsored health insurance.

In the end, Verstegen said, the couple decided to increase their work hours and cancel some events in 2026 to save money to afford their higher-priced health plan.

“These are really tough and frustrating emotional and scary choices,” Verstegen said. “We’re a middle-class, healthy, hard-working family and like so many others we’re simply struggling to keep up.”

Forecasts are murky

The most recent “snapshot” from CMS on HealthCare.gov enrollment covers Nov. 1-29 this year. In Wisconsin, it shows enrollment down by almost 4,000 people compared to Nov. 1-30, 2024.

Nationally, however, the numbers are up — 5.76 million in November this year compared with 5.36 million a year ago. There isn’t enough data to confidently forecast a trend, however.

Of the people signing up in November, “a lot of those folks were probably people who already had coverage and were either renewing it or picking a new plan, but there were also likely some new enrollees,” said Louise Norris, a health policy analyst at healthinsurance.org, an insurance information website.

Norris said there could be a large upswing in enrollment ahead of Monday’s deadline for coverage starting Jan. 1. “Then again you’ll see another sort of surge as we get to mid-January” — the Jan. 15 deadline for coverage starting Feb. 1, Norris said.

Both Norris and Brooks-LaSure said that initial enrollment numbers also don’t tell the whole story.

“The people who are enrolling right now are people who absolutely know they need to have coverage,” Brooks-LaSure said. “But the number always drops when people have to pay their premiums. And so, it’s really the number in January, once people are enrolled, that we think that will be the important number to know about coverage.”

People who are not changing plans may be automatically renewed in their current plans, which can explain some of the initial signups, said Brooks-LaSure. In addition, she said, some people signing up may be opting for less expensive — but also less generous — health insurance than they purchased in the past.

HealthCare.gov classifies health plans as Gold, Silver or Bronze. Gold plans have costlier premiums but more generous coverage with lower deductibles and less cost-sharing required of patients. Bronze plans have lower premiums with higher deductibles and more cost-sharing, and Silver plans are in between.

Brooks-LaSure said she has heard anecdotally from people stepping down from Silver to Bronze plans, for example.

“Coverage is really important, of course, but your ability to actually pay when you go to the doctor is equally, if not more, important,” she said. “It may be that we don’t see the drop in the uninsured rate. We see people shifting to less generous coverage.”

Kelley Bruns, a Sawyer County resident who spoke on Baldwin’s call, said she and her husband took that route for 2026.

Bruns said her husband, a veteran and career firefighter, had to end his career early due to work injuries and resulting disabilities.

When the premium for the policy they had in 2025 rose to more than $1,600 a month — 40% of their monthly income — they opted for a less expensive plan for 2026. That plan, however, has copayments of up to $100, a $15,000 deductible and a cap on out-of-pocket expenses of more than $21,000.

“We have to pray we don’t need surgery or any other major medical procedure,” Bruns said, “since our out-of-pocket maximum is almost half of our annual income and would be a catastrophic expense for our family.” 

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U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured are, from left, Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Republicans released a health care bill Friday evening they hope will help curb rising costs, though the measure doesn’t have the level of Democratic support needed to get through the Senate. 

The 111-page bill will likely move to the House floor next week, where Speaker Mike Johnson will need nearly every one of his members to vote to pass the legislation, an uphill battle given the vastly different views among centrists and far-right members of the party on health care issues. 

The Louisiana Republican said in a statement the bill offers “clear, responsible alternatives that will lower premium costs and increase access and health care options for all Americans.”

Democrats have been pressing for a three-year extension of the enhanced tax credits for people who purchase their insurance through the Affordable Care Act marketplace. 

So far, House and Senate Republican leadership hasn’t gotten on board with any extension of those subsidies, arguing they have led to a sharp rise in the cost of health insurance. 

GOP lawmakers have instead pursued their own legislation, but without at least some backing from Democrats, no bill will make it through the Senate’s 60-vote procedural hurdles. 

Senate Republicans tried to advance a bill earlier this week from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo but fell short of the votes needed. 

Democrats were also unsuccessful trying to move their bill to extend the ACA marketplace tax credits for three years. 

The House Republican bill, sponsored by Iowa Republican Mariannette Miller-Meeks, is unlikely to break the logjam in Congress over the rising cost of health insurance and health care, potentially leaving the issue as one the parties can debate leading up to next year’s midterm elections. 

Targeting ‘real drivers’ of cost increases

Johnson rebuked Democrats in his statement for enacting the Affordable Care Act during President Barack Obama’s first term, saying the law hasn’t made health care cost less. 

House Republicans’ new legislation, Johnson said, will address “the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation’s health care system for all Americans.”

The bill would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

The House Rules Committee is scheduled to prepare the bill for floor debate on Tuesday by considering whether to allow any amendments to be considered on the floor. 

The full House will then debate the legislation later in the week before departing for the two-week holiday break. 

Trump wants direct payments

President Donald Trump, speaking from the Oval Office shortly after the bill was released, reiterated his preference that the federal government send payments directly to Americans.

“We want to give the money to the people and let the people buy their own great health care, and they’ll save a lot of money, and it’ll be great,” he said.

But Trump also appeared to signal he is going to stay out of negotiations in Congress, saying, “I leave it to them and hopefully they’re going to put great legislation on this desk right here.”

Wisconsin's health department is sticking with a recommendation that children receive the hepatitis B vaccine at birth. (Photo by John Moore/Getty Images)

Wisconsin’s health department is reaffirming longstanding recommendations that all newborns get a vaccination for hepatitis B.

The Department of Health Services announced Thursday it has sent a memo to Wisconsin vaccination providers about the vaccine.

“DHS continues to recommend that all newborns receive the hepatitis B vaccine within 24 hours of birth, and then go on to complete the standard three-dose series within the first 18 months of life,” said Dr. Ryan Westergaard, chief medical officer in the DHS bureau of communicable diseases, at a media briefing Thursday.

Hepatitis B, a viral infection, can lead to lifelong liver disease, Westergaard said, including cirrhosis and liver cancer.

“Infants and young children are particularly at high risk,” he said. A baby infected with the virus has up to a 90% chance of developing chronic liver disease, he said.

Infants can be exposed during birth or through close contact with adults and caregivers “who may not even know that they carry the virus,” Westergaard added. “That’s why vaccination early in life is so important.”

DHS issued the announcement following a federal shift in vaccine policy, eliminating a recommendation in place since 1991 for newborns to receive the hepatitis B shot. The recommendation was eliminated Dec. 5 in a vote by the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.

In June, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. replaced all 17 members of the advisory committee with a new group of appointees, many of whom are seen as vaccine skeptics.

CDC vaccine committee overturns decades-old hepatitis B recommendation for newborns

The decision to end the recommendation for all newborns to get the hepatitis B shot dismayed the leaders of  medical organizations, including the American Medical Association and the Association of State and Territorial Health Officials.

“For more than 30 years, the hepatitis B vaccine has been used safely and effectively in newborns,” Westergaard said Thursday. Since the 1991 recommendation was put in place, hepatitis B infections in children have declined by 99%, he said.

“This recommendation is grounded in decades of research showing that the vaccine is safe and effective, and it aligns with guidance of the American Academy of Pediatrics and other leading medical groups,” Westergaard said. “So, our message today is straightforward, hepatitis B and its long-term health consequences are preventable. And routine childhood vaccination remains one of our most effective tools we have to protect children’s health and prevent lifelong disease.”

Westergaard said there has been no change in insurance coverage for the vaccine and that the hepatitis B shot remains among the vaccines available through the Vaccine for Children’s program for patients without health insurance.

ACIP also recommended blood testing for antibodies before giving the rest of the hepatitis B series shots for infants and young children, but Westergaard said that recommendation is not supported by scientific evidence.

The presence of hepatitis B antibodies in adults is a good indicator that they are protected against an infection, he said. “There’s no science suggesting that that same strategy works for newborns and children,” he added.

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The Senate on Thursday rejected legislation to extend Affordable Care Act tax credits, essentially guaranteeing that millions of Americans will see a steep rise in costs at the beginning of the year.

Senators rejected a Democratic bill to extend the subsidies for three years and a Republican alternative that would have created new health savings accounts — an unceremonious end to a monthslong effort by Democrats to prevent the COVID-19-era subsidies from expiring on Jan. 1.

Ahead of the votes, Senate Democratic Leader Chuck Schumer of New York warned Republicans that if they did not vote to extend the tax credits, “there won’t be another chance to act,” before premiums rise for many people who buy insurance off the ACA marketplaces.

“Let’s avert a disaster,” Schumer said. “The American people are watching.”

Republicans have argued that Affordable Care Act plans are too expensive and need to be overhauled. The health savings accounts in the GOP bill would give money directly to consumers instead of to insurance companies, an idea that has been echoed by President Donald Trump.

Senate Majority Leader John Thune, R-S.D., said ahead of the vote that a simple extension of the subsidies is “an attempt to disguise the real impact of Obamacare’s spiraling health care costs.”

But Democrats immediately rejected the GOP plan, saying that the accounts wouldn’t be enough to cover costs for most consumers.

The dueling Senate votes are the latest political messaging exercise in a Congress that has operated almost entirely on partisan terms, as Republicans pushed through a massive tax and spending cuts bill this summer using budget maneuvers that eliminated the need for Democratic votes. In September, Republicans tweaked Senate rules to push past a Democratic blockade of all of Trump’s nominees.

The Senate voted 51-48 not to move forward on the Democratic bill, with four Republicans — Maine Sen. Susan Collins, Missouri Sen. Josh Hawley and Alaska Sens. Lisa Murkowski and Dan Sullivan — voting with Democrats. The legislation needed 60 votes to proceed, as did the Republican bill, which was also blocked on a 51-48 vote.

No interest in compromise

Some Republicans have pushed their colleagues to extend the credits, including Sen. Thom Tillis of North Carolina, who said they should vote for a short-term extension so they can find agreement on the issue next year. “It’s too complicated and too difficult to get done in the limited time that we have left,” Tillis said Wednesday.

But there appeared to be little interest in compromise. Despite the potential for bipartisan agreement, Republicans and Democrats have never engaged in meaningful or high-level negotiations on a solution, even after a small group of centrist Democrats struck a deal with Republicans last month to end the 43-day government shutdown in exchange for a vote on extending the ACA subsidies. Most Democratic lawmakers opposed the move as many Republicans made clear that they wanted the tax credits to expire.

Still, the deal raised hopes for bipartisan compromise on health care. But that quickly faded with a lack of any real bipartisan talks.

An intractable issue

The votes were also the latest failed salvo in the debate over the Affordable Care Act, President Barack Obama’s signature law that Democrats passed along party lines in 2010 to expand access to insurance coverage.

Republicans have tried unsuccessfully since then to repeal or overhaul the law, arguing that health care is still too expensive. But they have struggled to find an alternative. In the meantime, Democrats have made the policy a central political issue in several elections, betting that the millions of people who buy health care on the government marketplaces want to keep their coverage.

“When people’s monthly payments spike next year, they’ll know it was Republicans that made it happen,” Schumer said in November, while making clear that Democrats would not seek compromise.

Even if they view it as a political win, the failed votes are a loss for Democrats who demanded an extension of the benefits as they forced a government shutdown for six weeks in October and November — and for the millions of people facing premium increases on Jan. 1.

Maine Sen. Angus King, an independent who caucuses with Democrats, said the group tried to negotiate with Republicans after the shutdown ended. But, he said, the talks became unproductive when Republicans demanded language adding new limits for abortion coverage that were a “red line” for Democrats. He said Republicans were going to “own these increases.”

A plethora of plans, but little agreement

Republicans have used the looming expiration of the subsidies to renew their longstanding criticisms of the ACA, also called Obamacare, and to try, once more, to agree on what should be done.

Thune announced earlier this week that the GOP conference had decided to vote on the bill led by Louisiana Sen. Bill Cassidy, the chairman of the Senate Health, Labor, Education and Pensions Committee, and Idaho Sen. Mike Crapo, the chairman of the Senate Finance Committee, even as several Republican senators proposed alternate ideas.

In the House, Speaker Mike Johnson, R-La., has promised a vote next week. Republicans weighed different options in a conference meeting on Wednesday, with no apparent consensus.

Republican moderates in the House who could have competitive reelection bids next year are pushing Johnson to find a way to extend the subsidies. But more conservative members want to see the law overhauled.

Rep. Kevin Kiley, R-Calif., has pushed for a temporary extension, which he said could be an opening to take further steps on health care.

If they fail to act and health care costs go up, the approval rating for Congress “will get even lower,” Kiley said.

Wisconsin Watch is a nonprofit and nonpartisan newsroom. Subscribe to our newsletters to get our investigative stories and Friday news roundup. This story is published in partnership with The Associated Press.

U.S. Senate rejects health care subsidy extension as costs are set to rise for millions of Americans 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.

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• Free clinics like Bread of Healing in Milwaukee and Open Arms Free Clinic in Walworth County serve as a final safety net for community members who can’t afford health care.

• They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.

• Clinic staff say they may need more resources to meet demand. 

• The U.S. Senate on Thursday rejected dueling plans related to helping people pay for plans on the federal marketplace.

Editor’s note: This story has been updated to note the U.S. Senate’s rejection on Thursday of legislation to address the expected rise in health care premiums.

Cars filled the small parking lot outside of Milwaukee’s Cross Lutheran Church on a recent Monday afternoon. The church’s pews sat empty, but downstairs visitors waited around folding tables. Not to hear a sermon, but to see a volunteer physician. 

Staff and volunteers walked patients past a row of dividers used to separate the “waiting room” from the folding tables where doctors and counselors filled out paperwork. 

In front of the free health clinic’s four exam rooms, two phones rang. 

“This is the Bread of Healing Clinic. Can you hold for a moment?” asked Diane Hill Horton, the free health clinic’s assistant.

Across from Hill Horton, another staff member scheduled an appointment in Spanish. 

On a typical Monday, the clinic sees up to 30 patients. Bread of Healing treated 2,400 patients in 2024 across three clinics it runs in Milwaukee. Patients typically lack any health coverage and aren’t asked to pay for their visits.

“We don’t turn anyone away,” Hill Horton said.

But without action from lawmakers in Washington, clinic staff worry that it will become harder to answer every call.

Free clinics like Bread of Healing serve as a final safety net for community members who can’t afford health care. They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.

Affordable Care Act premiums in Wisconsin will increase on average by 17.4% next year, a previous Wisconsin Watch analysis showed, with wide variation depending on age, income, family status and geography. Meanwhile, experts estimate more than 270,000 Wisconsinites rely on the enhanced premium tax credit to make insurance more affordable. It will expire at the end of the month without intervention. 

People without insurance are less likely to get preventative care. Bread of Healing focuses on treating chronic conditions to prevent people from overwhelming emergency rooms, said Executive Director Erica Wright.

“If we don’t try our best to move with that demand, we’re not going to be able to see as many people, and there’s going to be a lot of folks falling through the cracks,” she said.

Wright oversees all three Bread of Healing locations. While the clinics have some room to take on more patients right now, she wants to significantly increase their capacity over the next year — adding money and volunteers to serve a possible “monsoon” of demand.

“We’re never going to be able to serve everybody, we know that,” Wright said. “But I don’t want it to be where our phones are ringing off the hook and we just can’t meet at least a good chunk of the demand.”

Higher premiums and shrinking options

Ashley Bratz paid about $545 a month for a low-deductible marketplace plan this year. That same plan cost over $700 when she went to sign up for 2026.

Even with her job at Open Arms Free Clinic in Walworth County covering a portion of her health care costs, the only option in Bratz’s price range had deductibles higher than what she expects to spend.

 “It’s supposed to be reasonable, and this is not reasonable,” Bratz said.

Bratz, who works as the nurse clinic coordinator, said she did not receive enhanced marketplace subsidies this year. Those who did will face a particular shock as the tax credit expires — while also confronting rising prices and shrinking options.

The income-based tax credits have lowered some marketplace enrollees’ monthly premium payments since they became available in 2014.

In 2021, the federal government expanded those subsidies, further bringing costs down for lower-income enrollees and extending smaller subsidies to people making over four times the  federal poverty level — $62,600 a year for one person in 2025.

Without an extension, monthly premiums are expected to more than double on average nationally for subsidized enrollees, according to KFF, an independent source for health policy research.

A quarter of enrollees surveyed by KFF said they were “very likely” to go without insurance if their premiums doubled.

The U.S. Senate on Thursday rejected a Democratic plan to extend marketplace subsidies. Republicans, who have long criticized the Affordable Care Act (ACA), have instead called for a broader overhaul. The Senate also rejected a Republican plan that would have expanded access to high-deductible insurance plans and deposit $1,000 to $1,500 in enrollees’ health savings accounts — without renewing enhanced subsidies.

Sara Nichols, Open Arms Clinic executive director, is forging ahead regardless. When Bratz told her about her shrinking affordable coverage options, Nichols started working with an insurance broker to find a new plan for the clinic’s small team of paid staff.

“We cannot have health care workers not have health insurance,” Nichols said.

The move left Bratz relieved. Now she’s preparing to help more clients who can’t afford coverage or just need help navigating the complicated system.

They face challenges beyond lost subsidies and premium hikes. President Donald Trump’s “big” bill-turned law included additional changes to Medicaid funding and the ACA that are expected to increase the number of people without insurance by 10 million over the next decade, according to the Congressional Budget Office.

“We always take what is thrown at us and we figure out how to handle it,” Bratz said. “Do I think we could also use more help? Yes.”

Resources needed to meet demand

Open Arms Free Clinic is already seeing higher demand, Nichols said. 

It operates a dental clinic five days a week, and she’s considering whether further demand would require opening its medical clinic for an additional day.

That would take more volunteers and money. 

While the Legislature sent state dollars to free clinics in its latest budget, private grants and donations have been harder to secure this year, Nichols said. She expects the clinic will have to get even leaner next year.

But she won’t start turning patients away.

The clinic provides dental, medical and behavioral health to low-income people who live and work in Walworth County. Its 250 volunteers help with things like translating, nursing, greeting patients and connecting people to the clinic. They also provide vision and pharmacy services.

“I know that we have enough smart people and kind people that we’re going to come up with a solution to anything that comes up,” Nichols said.

This is far from the first time Wisconsin’s free clinics have faced big changes, said Dennis Skrajewski, the executive director of the Wisconsin Association of Free and Charitable Clinics. 

Free clinics adapted to the COVID-19 pandemic, operating with fewer volunteers and switching to telehealth services and opening vaccine programs, Skrajewski said. Then clinics prepped for increased demand in 2023 after Medicaid unwinding.

“We’re used to waking up and the world changed yesterday, so we’ll adjust,” Skrajewski said.

Wisconsin’s free and charitable clinic association is collaborating with other safety net health providers as part of the Wisconsin Owns Wellbeing initiative, which will host statewide planning meetings to strengthen the state’s safety net services. 

Clinic co-founder: ‘I just wish it weren’t needed’ 

Rick Cesar started working as a parish nurse at Cross Lutheran Church in the 1990s. He took people’s blood pressure at a weekly food pantry and ran an HIV testing site and needle exchange out of the church’s basement.

He helped co-found the Bread of Healing Clinic in 2000, a decade before the ACA passed. 

“There were so many people that had no coverage,” Cesar said.

Demand for free services persisted even after more people enrolled in marketplace plans. The clinic expanded to two other locations and hired paid staff. Cesar retired from nursing in 2019 but still regularly volunteers. He feels proud watching the clinic grow.

“I just wish it weren’t needed,” he said.

The clinic is adaptable, Cesar said, whether it’s responding to a pandemic with vaccine drives or helping clients navigate ACA changes.

“We’re going to be here and do as much as we can,” Cesar said. “But those resources, you never know how long they are going to last when the demand is so great.”

‘We don’t turn anyone away’: Wisconsin’s free clinics fill gaps as thousands expected to go uninsured 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.

Senate Majority Leader John Thune, R-S.D., center, joined by Senate Majority Whip John Barrasso, R-Wyo., left, and Sen. James Lankford, R-Okla., speaks to reporters following a Senate Republican policy luncheon at the U.S. Capitol on Dec. 9, 2025 in Washington, D.C.  (Photo by Heather Diehl/Getty Images)

WASHINGTON — The U.S. Senate in long-anticipated votes failed to advance legislation Thursday that would have addressed the rising cost of health insurance, leaving lawmakers deadlocked on how to curb a surge in premiums expected next year. 

Senators voted 51-48 on a Republican bill co-sponsored by Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027. 

They then voted 51-48 on a measure from Democrats that would have extended enhanced tax credits for people who purchase their health insurance from the Affordable Care Act Marketplace for three years. A group of Senate Democrats in November agreed to end a government shutdown of historic length in exchange for a commitment by Republicans to hold a vote on extending the enhanced subsidies.

Republican Sens. Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska voted for the Democrats’ bill. Sen. Rand Paul, R-Ky., voted against both bills. 

Neither bill received the 60 votes needed to advance under the Senate’s legislative filibuster rule. 

Senate Majority Leader John Thune, R-S.D., criticized the ACA marketplace and the subsidies for leading to large increases in the costs of health insurance. 

“Under Democrats’ plan insurance premiums will continue to spiral, American taxpayers will find themselves on the hook for ever-increasing subsidy payments,” Thune said. “And don’t think that all those payments are going to go to vulnerable Americans.”

Thune argued Democrats’ bill was only an extension of the “status quo” of a “failed, flawed, fraud program that is increasing costs at three times the rate of inflation. 

Thune said the Republican bill from Cassidy and Crapo would “help individuals to meet their out-of-pocket costs and for many individuals who don’t use their insurance or who barely use it, it would allow them to save for health care expenses down the road.”

Schumer calls GOP plan ‘mean and cruel’

Senate Minority Leader Chuck Schumer, D-N.Y., said the three-year extension bill was the only option to avoid a spike in costs for people enrolled in ACA marketplace plans. 

“By my last count, Republicans are now at nine different health care proposals and counting. And none of them give the American people the one thing they most want — a clean, simple extension of these health care tax credits,” Schumer said. “But our bill does extend these credits cleanly and simply and it’s time for Republicans to join us.”

Schumer referred to the Cassidy-Crapo proposals as “stingy” as well as “mean and cruel.”

“Under the Republican plan, the big idea is essentially to hand people about $80 a month and wish them good luck,” Schumer said. “And even to qualify for that check, listen to how bad this is, Americans would be forced onto bare-bones bronze plans with sky-high deductibles; $7,000 or $10,000 for an individual, tens of thousands for a couple.”

After the votes failed, Schumer outlined some of the guardrails Democrats would put in place regarding negotiations with GOP colleagues.

“They want to talk about health care in general and how to improve it — we’re always open to that, but we do not want what they want — favoring the insurance companies, favoring the drug companies, favoring the special interests and turning their back on the American people,” he said. 

Health Savings Accounts in GOP plan

The Cassidy-Crapo bill would have the Department of Health and Human Services deposit money into Health Savings Accounts for people enrolled in bronze or catastrophic health insurance plans purchased on the ACA marketplace in 2026 or 2027, according to a summary of the bill. 

Health Savings Accounts are tax-advantaged savings accounts that consumers can use to pay for medical expenses that are not otherwise reimbursed. They are not health insurance products.

ACA marketplace enrollees who select a bronze or catastrophic plan and make up to 700% of the federal poverty level would receive $1,000 annually if they are between the ages of 18 and 49 and $1,500 per year if they are between the ages of 50 and 64. 

That would set a threshold of $109,550 in annual income for one person, or $225,050 for a family of four, according to the 2025 federal poverty guidelines. The numbers are somewhat higher for residents of Alaska and Hawaii.  

The funding could not go toward abortion access or gender transitions, according to the Republican bill summary. 

Members of Congress have introduced several other health care proposals, including two bipartisan bills in the House that would extend the enhanced ACA marketplace tax credits for at least another year with some modifications. 

Speaker Mike Johnson, R-La., has been reluctant to bring either bipartisan bill up for a floor vote, though he may not have the option if a discharge petition filed earlier this week garners the 218 signatures needed. 

Pennsylvania Republican Rep. Brian Fitzpatrick wrote in a statement the legislation represents a “solution that can actually pass—not a political messaging exercise.”

“This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term,” Fitzpatrick wrote. “Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”

But Johnson said Wednesday that he will put a package of bills on the House floor next week that he believes “​​will actually reduce premiums for 100% of Americans who are on health insurance.” Details of those bills have not been disclosed.

Thune told reporters that if “somebody is successful in getting a discharge petition and a bill out of the House, obviously we’ll take a look at it. But at the moment, you know, we’re focused on the action here in the Senate, which is the side-by-side vote we’re going to have later today.” 

Alaska’s Murkowski said lawmakers can find a compromise on health care by next week “if we believe it is possible.”

Political costs

The issue of affordability and rising health care costs is likely to be central to the November midterm elections, where Democrats hope to flip the House from red to blue and gain additional seats in the Senate. 

The Democratic National Committee isn’t waiting to begin those campaigns, placing digital ads in the hometown newspapers of several Republicans up for reelection next year, including Maine’s Collins and Ohio’s Jon Husted. 

“Today’s Senate vote to extend the ACA tax credits could be the difference between life and death for many Americans,” DNC Chair Ken Martin said in a press release. “Over 20 million Americans will see their health care premiums skyrocket next year if Susan Collins, John Cornyn, Jon Husted, and Dan Sullivan do not stand with working families and vote to extend these lifesaving credits.”

White House press secretary Karoline Leavitt blasted Senate Democrats’ proposal during Thursday’s press briefing, calling it a “political show vote” meant to provide cover for Democrats, whom she blamed for creating the problem. 

Trump and Republicans would “unveil creative ideas and solutions to the health care crisis that was created by Democrats,” she said. “Chuck Schumer is not sincerely interested in lowering health care costs for the American people. He’s putting this vote on the floor knowing that it will fail so he can have another talking point that he can throw around without any real plan or action.”

Shauneen Miranda and Jacob Fischler contributed to this report.