A police officer uses the Flock Safety license plate reader system. Many left-leaning states and cities are trying to protect their residents’ personal information amid the Trump administration's immigration crackdown, but a growing number of conservative lawmakers also want to curb the use of surveillance technologies. (Photo courtesy of Flock Safety)

As part of its deportation efforts, the Trump administration has ordered states to hand over personal data from voter rolls, driver’s license records and programs such as Medicaid and food stamps.

At the same time, the administration is trying to consolidate the bits of personal data held across federal agencies, creating a single trove of information on people who live in the United States.

Many left-leaning states and cities are trying to protect their residents’ personal information amid the immigration crackdown. But a growing number of conservative lawmakers also want to curb the use of surveillance technologies, such as automated license plate readers, that can be used to identify and track people.

Conservative-led states such as Arkansas, Idaho and Montana enacted laws last year designed to protect the personal data collected through license plate readers and other means. They joined at least five left-leaning states — Illinois, Massachusetts, Minnesota, New York and Washington — that specifically blocked U.S. Immigration and Customs Enforcement from accessing their driver’s license records.

In addition, Democratic-led cities in Colorado, Illinois, Massachusetts, New York, North Carolina, Texas and Washington last year terminated their contracts with Flock Safety, the largest provider of license plate readers in the U.S.

The Trump administration’s goal is to create a “surveillance dragnet across the country,” said William Owen, communications director at the Surveillance Technology Oversight Project, a nonprofit that advocates for stronger privacy laws.

“We’re entering an increasingly dystopian era of high-tech surveillance,” Owen said. Intelligence sharing between various levels of government, he said, has “allowed ICE to sidestep sanctuary laws and co-opt local police databases and surveillance tools, including license plate readers, facial recognition and other technologies.”

A new Montana law bars government entities from accessing electronic communications and related material without a warrant. Republican state Sen. Daniel Emrich, the law’s author, said “the most important thing that our entire justice system is based on is the principle against unlawful search and seizure” — the right enshrined in the Fourth Amendment to the U.S. Constitution.

“It’s tough to find individuals who are constitutionally grounded and understand the necessity of keeping the Fourth Amendment rights intact at all times for all reasons — with minimal or zero exceptions,” Emrich said in an interview.

ICE did not respond to Stateline’s requests for comment.

Automated license plate readers

Recently, cities and states have grown particularly concerned over the use of automated license plate readers (ALPRs), which are high-speed camera and computer systems that capture license plate information on vehicles that drive by. These readers sit on top of police cars and streetlights or can be hidden within construction barrels and utility poles.

Some cameras collect data that gets stored in databases for years, raising concerns among privacy advocates. One report from the Brennan Center for Justice, a progressive think tank at New York University, found the data can be susceptible to hacking. Different agencies have varying policies on how long they keep the data, according to the International Association of Chiefs of Police, a law enforcement advocacy group.

Supporters of the technology, including many in law enforcement, say the technology is a powerful tool for tracking down criminal suspects.

Flock Safety says it has cameras in more than 5,000 communities and is connected to more than 4,800 law enforcement agencies across 49 states. The company claims its cameras conduct more than 20 billion license plate reads a month. It collects the data and gives it to police departments, which use the information to locate people.

Holly Beilin, a spokesperson for Flock Safety, told Stateline that while there are local police agencies that may be working with ICE, the company does not have a contractual relationship with the agency. Beilin also said that many liberal and even sanctuary cities continue to sign contracts with Flock Safety. She noted that the cameras have been used to solve some high-profile crimes, including identifying and leading police to the man who committed the Brown University shooting and killed an MIT professor at the end of last year.

“Agencies and cities are very much able to use this technology in a way that complies with their values. So they do not have to share data out of state,” Beilin said.

Pushback over data’s use

But critics, such as the American Civil Liberties Union, say that Flock Safety’s cameras are not only “giving even the smallest-town police chief access to an enormously powerful driver-surveillance tool,” but also that the data is being used by ICE. One news outlet, 404 Media, obtained records of these searches and found many were being carried out by local officers on behalf of ICE.

Last spring, the Denver City Council unanimously voted to terminate its contract with Flock Safety, but Democratic Mayor Mike Johnston unilaterally extended the contract in October, arguing that the technology was a useful crime-fighting tool.

The ACLU of Colorado has vehemently opposed the cameras, saying last August that audit logs from the Denver Police Department show more than 1,400 searches had been conducted for ICE since June 2024.

“The conversation has really gotten bigger because of the federal landscape and the focus, not only on immigrants and the functionality of ICE right now, but also on the side of really trying to reduce and or eliminate protections in regards to access to reproductive care and gender affirming care,” Anaya Robinson, public policy director at the ACLU of Colorado.

“When we erode rights and access for a particular community, it’s just a matter of time before that erosion starts to touch other communities.”

Jimmy Monto, a Democratic city councilor in Syracuse, New York, led the charge to eliminate Flock Safety’s contract in his city.

“Syracuse has a very large immigrant population, a very large new American population, refugees that have resettled and been resettled here. So it’s a very sensitive issue,” Monto said, adding that license plate readers allow anyone reviewing the data to determine someone’s immigration status without a warrant.

“When we sign a contract with someone who is collecting data on the citizens who live in a city, we have to be hyper-focused on exactly what they are doing while we’re also giving police departments the tools that they need to also solve homicides, right?” Monto said.

“Certainly, if license plate readers are helpful in that way, I think the scope is right. But we have to make sure that that’s what we’re using it for, and that the companies that we are contracting with are acting in good faith.”

Emrich, the Montana lawmaker, said everyone should be concerned about protecting constitutional privacy rights, regardless of their political views.

“If the government is obtaining data in violation of constitutional rights, they could be violating a whole slew of individuals’ constitutional rights in pursuit of the individuals who may or may not be protected under those same constitutional rights,” he said.

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

Boxes of the diabetes drug Ozempic rest on a pharmacy counter in Los Angeles. Drugs like Ozempic have grown in popularity to treat obesity, prompting more than a dozen states to pay for them. But with major budget pressures, several state Medicaid agencies are either stopping coverage altogether or restricting who can get access to the therapy. (Photo illustration by Mario Tama/Getty Images)

Some states are rethinking their coverage of GLP-1 drugs for weight loss as budgets tighten and Medicaid programs brace for the cuts included in President Donald Trump’s broad tax and spending law.

As of Oct. 1, 16 state Medicaid programs covered GLP-1s for obesity treatment, up from 13 last year, according to a survey of Medicaid directors by KFF, a health policy research group. But some states have announced they will discontinue coverage or restrict who can qualify for it.

Many doctors and patient advocates say the drugs will save money in the long run by reducing obesity-related diseases such as heart disease and diabetes. Many states, however, have concluded they just can’t afford them.

North Carolina Medicaid ended coverage of GLP-1s for obesity last month, citing shortfalls in state funding. California, New Hampshire and South Carolina have said they will end coverage on Jan. 1. Starting next year, Michigan Medicaid will limit coverage to people who are “morbidly obese.” Pennsylvania, Rhode Island and Wisconsin also are considering new restrictions.

In last year’s KFF survey, about half the states said they were interested in covering GLP-1s for weight loss, according to Elizabeth Williams, a senior policy manager at KFF who focuses on Medicaid. This year, most states are moving in the opposite direction.

“This likely reflects recent state budget challenges and the significant, significant costs associated with coverage,” Williams said. “After a number of years of robust revenue growth right after the pandemic, states are starting to see slowing revenues, increasing spending demands and a lot of fiscal uncertainty due in part to recent federal actions.”

In April, the Trump administration scrapped a Biden-era proposal that would have required state Medicaid programs to pay for some GLP-1s for obesity treatment. Earlier this month, Trump announced that his administration had reached agreements with the manufacturers of Wegovy and Zepbound to reduce the prices of the drugs for Medicaid, Medicare and consumers buying the drugs directly, But it’s unclear whether the deals will reduce costs for states.

Health plans for state workers also are reassessing their coverage of the drugs for obesity. North Carolina, for example, ended GLP-1 obesity coverage for state workers last year, and West Virginia canceled a 1,000-person pilot program.

GLP-1 medications, which balance blood sugar levels, have long been prescribed to patients with Type 2 diabetes and cardiovascular conditions. All state Medicaid programs, which are funded jointly by the states and the federal government, cover GLP-1s for those uses.

But the drugs also curb hunger signals and can help people lose significant amounts of weight. Medications such as Ozempic, Wegovy and Zepbound have become wildly popular for that purpose.

Between 2019 and 2023, the number of outpatient Medicaid prescriptions for select GLP-1s to treat diabetes and obesity grew from 755,300 to 3.8 million, according to KFF. During the same period, Medicaid spending on those drugs increased from $597.3 million to $3.9 billion.

A study published last year in The BMJ, the journal of the British Medical Association, found that the number of patients without diabetes who started GLP-1 treatment in the United States increased from roughly 21,000 in 2019 to 174,000 in 2023, or more than 700%.

More than 2 in 5 U.S. adults have obesity, according to the federal Centers for Disease Control and Prevention. The CDC defines obesity as having a body mass index — a calculated measure of body weight relative to height — of 30 or higher. Obesity costs the U.S. health care system almost $173 billion per year, according to the agency.

Recently, the manufacturers of some GLP-1s have lowered their prices, selling them directly to consumers for $500 or less per month. But many patients cannot afford to pay that much out of pocket.

States in a tough financial position

In North Carolina, Dr. Jennifer McCauley, a weight management physician at UNC Health, said Medicaid coverage of GLP-1s was “incredibly helpful for our patients.”

“Now they’ve stopped coverage, so those people are now going back, regaining some of the weight, because they’re unable to obtain these medications, and also are suffering the health consequences of obesity,” McCauley told Stateline.

Some critics of expansive GLP-1 coverage say it isn’t cost effective, because many patients gain back the weight they lost when they stop treatment. But McCauley said the “downstream effects of obesity are even higher.”

“There are definitely vulnerable populations that probably would not be able to obtain weight loss without these medications.”

James Werner, a spokesperson at the North Carolina Department of Health and Human Services, blamed the coverage change on the state legislature’s failure to budget enough money for Medicaid.

In an email to Stateline, Werner said coverage of GLP1s for weight loss “would be reconsidered if Medicaid is fully funded.”

Some states are trying to maintain at least some coverage of the expensive drugs by tightening the eligibility requirements for a prescription, according to Colleen Becker, a project manager at the National Conference of State Legislatures, a policy research group.

“States are really looking at how to balance access and provide that access to patients, but they’re stewards of their budgets, and they need to be good stewards of it,” Becker said.

Michigan and Pennsylvania are among the states considering such options. Meanwhile, Connecticut has decided to maintain coverage of weight-loss drugs for state employees, but to require beneficiaries to try online weight-loss counseling before they can get a prescription.

Some future possibilities

One state, North Dakota, has taken a different approach to GLP-1 coverage after legislation that would have required the state’s Medicaid program to cover the drug failed. Instead, North Dakota this year became the first state to mandate that insurers on the state’s Affordable Care Act marketplace cover the drugs for weight loss.

North Dakota Deputy Insurance Commissioner John Arnold said the insurance department calculated that the mandate wouldn’t cause insurance premiums to rise significantly.

“It’s not that anybody can walk into the doctor’s office and say, ‘Hey, I want to have this covered,’” Arnold said. “It is really for those who have a medical need for the drugs, then it would be covered.”

The insurance department had to ask the legislature for permission to make the change, according to North Dakota Republican House Speaker Robin Weisz. He said insurance carriers were concerned that it was going to be “open season for everybody who could lose 20 or 30 pounds.”

He said it will take time to see whether the policy raises insurance premiums.

“If the carriers can come in a couple years and say, ‘Wow, here’s what we’ve spent on these … we’ll take a hard look at it,” Weisz said. “But, it’s way too early to tell at this point.”

Arnold says other states may have the flexibility to consider mandating ACA insurers to cover the drugs.

“Our biggest concern was reducing those comorbidities and the long-term impact that that has on the cost of insurance in general, because more comorbidities means more claims,” Arnold said, referring to diseases and conditions associated with obesity.

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

A medical worker pushes a stretcher through a hallway at Mount Sinai Hospital in New York City. States are passing laws to target private equity transactions of health care facilities, such as hospitals. (Photo by Spencer Platt/Getty Images)

As more private equity firms buy health care physician practices and facilities, states are pushing back on acquisitions that some critics say could potentially gut health care infrastructure. 

This year alone at least seven states, including California, Indiana, Massachusetts, Maine, New Mexico, Oregon and Washington, have enacted laws requiring more oversight over private equity acquisitions in health care. Private equity involves pooling resources from pension funds, endowments, sovereign wealth funds and wealthy individuals to buy controlling stakes in companies and boost their value — often with the goal of selling at a profit within a few years.

Private equity firms argue that their role in upgrading technology and increasing efficiency helps health care access, especially in rural and other underserved areas.

Private equity interest in health care has been around for a while, but really started to grow in the past decade, said John McDonough, a professor of public health practice at the Harvard T.H. Chan School of Public Health. Now there are private equity interests “in every imaginable iteration of medical care,” from hospitals to nursing homes, hospice care, physician practices and even veterinary care, he said. 

This year, several states have passed laws to increase oversight and transparency of private equity’s continuing acquisitions. 

Massachusetts and California enacted laws requiring more groups that were not included under previous reporting requirements, such as private equity firms, real estate investment trusts and management service organizations, to now notify the state if they make a health care acquisition and to give the attorney general more power to investigate the transactions. Indiana passed a law that gives the attorney general authority to investigate market concentration. 

Oregon passed an oversight law that not only limits how much private equity firms can buy up a health care market, but also bars private equity firms from having any control over clinical operations. The law also gives the state power to block any pending transitions that violate the law. California also enacted another law that prohibits private investors from interfering with the judgment of physicians and dentists. 

New Mexico passed a law that strengthened its 2024 Health Care Consolidation Oversight Act, which temporarily gave the state regulators more oversight over transactions. The new law makes that oversight authority permanent and more expansive, while also establishing penalties for non-compliance with reporting requirements. And Washington state passed a transparency law creating a registry of all health care entities. 

Maine passed a law to impose a one-year moratorium on all private equity or real estate investment trust purchases of hospitals. 

“The purpose of the dealmaking is to enrich the owners as quickly as possible, and then get out and move on to your next conquest,” McDonough said. “And so there’s a fundamental conflict there between duty to patients as a primary obligation and return on profits to shareholders.” 

According to researchers from the University of California, Berkeley, the number of acquisitions of physician practices rose from 816 in 2012, to 5,779 in 2021. Researchers also found that some single private equity firms captured 30-50% of specialty practices in local markets.

With limited congressional oversight on private equity actions in health care, states play a critical role in reining in predatory practices, said Michael Fenne, senior policy coordinator at the Private Equity Stakeholder Project, a watchdog group that monitors private equity activity.

“There’s not really federal law that targets private equity acquisitions in the same way [as laws] that states have been passing recently,” he said. 

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