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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘A lawless president’

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

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

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

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

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

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

Epstein files

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

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

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

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

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

The Milwaukee Health Department and the Milwaukee Public Schools will spend the next year testing district schoolchildren for lead contamination.

On Tuesday, officials from the health department, the school district, City Hall and the federal Centers for Disease Control and Prevention met to review the ongoing program to address lead contamination in the school district.

The CDC has granted the health department $400,000 to expand its school lead-screening program at MPS. The grant will cover screening for up to 8,000 MPS students, the health department reported.

The school district is contracting with NOVIR to carry out screening clinics on the premises of district schools. Funds will also go to the Coalition on Lead Emergency (COLE) to inform school district families about the screening program.

“By bringing screening directly into schools, we’re making it easier for families to access testing and ensuring we stay focused on prevention, transparency, and long-term safety,” Milwaukee Mayor Cavalier Johnson said in a health department press release.

Members of the CDC’s lead poisoning and prevention team are reviewing the work done in the last year by the city, the health department and the school district, as well as their plans for screening children in the coming year.

After children at two MPS schools were found to have elevated levels of lead in their blood, the health department inspected the schools and found high levels of lead dust in the buildings. The schools were temporarily closed, and more testing found additional schools with contamination.

Early in the unfolding crisis, promised assistance from the CDC’s lead-prevention team was abruptly canceled, among numerous reversals that the Trump administration made in federal programs and funding. The CDC team was reinstated several weeks later and resumed working with the state and local health departments.

A city health department screening program found scores more children with elevated blood levels. According to the health department, the district’s subsequent cleanup program stabilized lead paint in 99 elementary schools by the end of 2025.

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Staff members at two Wisconsin mental health clinics are seeking union representation after what some employees describe as policy changes that have increased client caseloads and reduced one-on-one care for clients.

The clinics — one in Madison and one in West Allis — are owned by Wisconsin-based Rogers Behavioral Health. The Oconomowoc-based nonprofit organization operates a network of mental health hospitals, residential treatment clinics and outpatient clinics in 10 states.

Starting Monday, officials with the National Labor Relations Board will hold a hearing in Milwaukee to set union election dates for 63 employees in West Allis and 35 in Madison.

The hearing is expected to take up to three days, according to documents filed with the NLRB by a lawyer representing Rogers. The case will entail “extensive testimonial and documentary evidence” about which employees at each location should be included in the vote, the attorney stated in a motion to schedule the hearing and reserve the dates.

Workers at the West Allis and Madison locations want to join the National Union of Healthcare Workers. The California-based NUHW already represents Rogers employees at three locations in California as well as one in Pennsylvania.

Three employees at the West Allis clinic have been fired, according to the union, which has filed an unfair labor practice charge with the NLRB. The union is accusing Rogers of violating federal labor law by retaliating against the terminated health professionals for supporting the union.

The Wisconsin Examiner sent email messages to Rogers Friday morning, Feb. 20, seeking comment about the union drive, and at the invitation of the organization’s communications office sent five questions Friday afternoon. Rogers has not responded; this report will be updated with comments Rogers supplies.

Clinic employees cite increased caseloads

Employees involved in the union drive said in interviews that they and their colleagues enjoyed their jobs and caring for their patients. But recent changes, they said, have made their work more difficult and didn’t benefit patients.

“When I first started, people were pretty happy and satisfied with their roles,” said T’Anna Holst, a therapist who works at the West Allis clinic. “As time goes on, caseloads kept increasing for therapists.”

Other program changes reduced patients’ ability to have individual time with their clinicians, which “was really unfortunate for us, but also for the patients, who were expecting that when they come to our program,” Holst said.

“All of the changes were about increasing the number of patients that were coming into the building,” said Stephanie Lohman, a nurse practitioner. “It did not seem to have a cohesive plan and no plan would be communicated.”

Lohman said she is one of the three employees fired from the West Allis clinic, and that her termination came the Monday after she and nearly a dozen other coworkers had presented a petition seeking union recognition. When she directly asked the upper level executive who fired her, she said, she was explicitly told  she was being dismissed “without cause.”

“Our local leaders, including my direct boss, were not aware this was happening,” Lohman said, adding that she was not given time to prepare notes in order to transfer coverage for the patients in her care.

Patient advocacy

At the Madison clinic, Erin Quinlan is a behavioral specialist whose job includes assisting therapists and helping to conduct group therapy sessions.

“The people that I work with are incredible,” Quinlan said. “They care very, very deeply about the work that they do and having a positive impact on the lives of patients.”

After she was hired in July 2024, “Caseloads increased and individual time with patients was decreasing,” Quinlan said. “I just became concerned about how that was impacting our being able to support those patients.”

Coworkers shared those concerns, she said.

Employees said they were left with the impression that the changes that concerned them were coming from higher up in the organization’s hierarchy, not their local managers.

Lohman said that in measuring staff productivity, the organization moved to relying on “metrics like visits per day.” That replaced a system that took into account that some patients needed more time than others, she said.

Increased caseloads were presented as ways to increase the number of patients being served, Lohman said, but instead, employees were working “to their maximum capacity, ignoring actual patient or worker needs.”

At the clinic level, “Rogers is run by caring professionals,” she said. “Despite the corporate push to do metric care, patient-centered care continues to be done.”

All three employees said they and their coworkers believed forming a union and being able to bargain collectively would give them a stronger voice as advocates for their patients.

“I take being an advocate and speaking up as a very important part of my job,” Quinlan said. She added that she routinely sought to raise concerns with “anyone who would listen, including management.”

She said she got no response, however. “It was because I didn’t really see any return communication, that was when I made the decision to go to the union,” Quinlan said.

Both the Madison and West Allis groups initially petitioned for Rogers to voluntarily recognize the union, citing large majorities of supporters. The organization rejected those requests, and union supporters then sent petitions for elections to the NLRB.

Union represents other Rogers workers

The NUHW grew out of a California health care union that was founded in the 1930s and subsequently joined what would later become the Service Employees International Union. After an acrimonious split from SEIU in 2009, the National Union of Healthcare Workers formed as an independent union.

An unsigned memo from the organization urging employees to vote against the union was briefly posted at the Madison clinic in the days after members petitioned for union representation Jan. 23. The Wisconsin Examiner obtained a photograph of the memo, which employees said was later taken down.

The memo describes the union as having “no experience or connection in Wisconsin.” It does not state that Rogers employees in four other U.S. clinics are now represented by the union.

Employees at a Rogers mental health and addiction services clinic in Walnut Creek, California, voted for the union to represent them in 2023 and settled a first contract in 2024.

“It’s an excellent contract,” said NUHW’s communications director, Matt Artz, and included “substantial salary increases and caseload limits,” according to the union’s website.

After employees at Rogers clinics in Los Angeles and San Diego petitioned for union representation, the union was recognized voluntarily at those locations, which then negotiated contracts similar to the agreement at Walnut Creek, Artz said. In December 2025, a Rogers clinic in Philadelphia also voluntarily recognized the union after being petitioned by employees there. 

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On Friday, lawmakers in the Wisconsin Assembly voted in favor of a bill seeking Medicaid coverage for people in Wisconsin prisons and jails. Supporters hope it will help recently incarcerated people avoid addiction and overdoses. 

Rep. Shelia Stubbs (D-Madison) said her experience working for the Wisconsin Department of Corrections has given her firsthand knowledge about the impact AB 604 will have. She said it will improve access to treatment and case management and ease the financial burden on justice-involved Wisconsinites. 

The bill would give incarcerated people a greater chance of maintaining sobriety and preventing overdose after release from prison, Stubbs said. After a Minnesota study about the causes of death of recently incarcerated people, researcher Tyler Winkelman said that “substance use is clearly the main driver of death after release from both jail and prison.”

Medicaid is prohibited from paying for services provided during incarceration, barring some exceptions involving inpatient services or an eligible juvenile under 21 years old. The National Association of Counties published a toolkit critical of the “inmate exclusion policy,” arguing in part that it unfairly revokes federal health benefits from people who are being detained prior to trial and have not been found guilty.  

The bill would pursue a path offered by the federal government that allows for a partial waiver of the policy. 

The proposal directs the Department of Health Services to request a waiver to conduct a demonstration project; 19 states have approved waivers and nine states including Washington D.C. have pending waivers, as of November 21. 

A waiver would allow for prerelease health care coverage under the Medical Assistance program, which provides health services to people with limited finances, for up to 90 days before release of an eligible incarcerated person. Coverage would be provided for case management services, medication-assisted treatment for all types of substance use disorders and a 30-day supply of prescription medications. 

The bill garnered support from lawmakers from both parties and from WISDOM and EX-Incarcerated People Organizing, groups that advocate for incarcerated people. 

The Assembly’s vote to seek the coverage for incarcerated people comes on the heels of its vote to accept a federal expansion of Medicaid coverage for women for one year after they give birth. 

For the waiver, if the state seeks federal Medicaid coverage for services that are currently funded with state or local dollars, the state has to reinvest any savings in state or local funds. Savings would be invested in programs to increase access to or improve the quality of health care for incarcerated people. 

In the Department of Corrections fiscal estimate, the DOC said that in fiscal year 2025, the agency spent $500,000 on the 30-day medication supply dispensed for incarcerated people pre-release, $300,000 on pre-release medication assisted treatment medications and $3.9 million on the Opening Avenues to Reentry Success (OARS) program. The OARS program supports the transition from prison to the community of incarcerated people living with a severe and persistent mental illness who are at medium-to-high risk of reoffending. 

The agency estimated it may have over $750,000 in potential cost savings if the waiver is approved and implemented. 

Because not all incarcerated people will qualify, the estimate assumes that half of the medication supply and medication assisted treatment medications costs will be reimbursed, as well as 10% of the OARS program costs. There may be other costs DOC can have reimbursed.

AB 604 would require the Department of Health Services to submit the waiver request no later than Jan. 1, 2027. 

The bill now goes to the state Senate. Supporters of the bill include the Wisconsin Medical Society, the National Alliance on Mental Illness Wisconsin, the Medical College of Wisconsin and the Wisconsin Counties Association. 

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During its final planned day of legislative business this year, the Wisconsin Assembly passed a bill to ensure health care coverage of screenings for women at high risk of breast cancer and a bill to extend postpartum Medicaid coverage to a year.

Republican lawmakers announced Wednesday evening that they would vote on the bills, breaking gridlock on the issues which for years was held up by Assembly Speaker Robin Vos (R-Rochester). Vos, who announced his retirement at the beginning of the floor session Thursday, reversed his position and voted in favor of both bills.  

Each bill passed the Senate in nearly unanimous votes last year, and the Assembly concurring votes will send the bills to Gov. Tony Evers for a signature. 

Lawmakers honor Gail Zeemer as they pass breast cancer screening bill

SB 264 requires health insurance policies to provide coverage for diagnostic breast examinations and for supplemental breast screening examinations for women with dense breast tissue. The bill would require coverage to include no patient cost-sharing. 

The family of Gail Zeemer, a Neenah woman who spent time advocating for the legislation before her death from breast cancer in 2024, sat in the Assembly gallery. Zeemer, who had dense breast tissue, was diagnosed with cancer at a late stage after not receiving additional screening. She battled cancer for eight years and passed away in June 2024 at the age of 56.

Lawmakers applauded her family after voting to concur in the bill, named “Gail’s Law.” It passed in a unanimous 96-0 vote.  

Rep. Robyn Vining (D-Wauwatosa) spoke about listening to testimony from Zeemer during a hearing on the bill prior to her death in the Assembly Health committee.

“She was full of strength and determination,” Vining said. “This year, as we’ve heard testimony, her absence was felt in the room. Today is the day that she fought for, and I am so sorry that Gail is not here with us today. Gail’s law will save lives. It will prevent preventable deaths.”

“You didn’t give up. You didn’t take no for an answer,” Vining said of Zeemer’s family and other advocates for the bills.

Several lawmakers, including Rep. Nate Gustafson (R-Omro) and Rep. Amanda Nedweski (R-Pleasant Prairie), teared up as they spoke of their support for the legislation.

“It’s about families,” Nedweski said of the bill. “Too many husbands have lost their wives to breast cancer, too many parents have had to say goodbye to a daughter too soon, and too many children have seen their mother’s hair fall out and have had to cry themselves to sleep while their mothers went through chemo, surgery and radiation, sometimes only to be told the cancer is back, and there are no other options.” 

Nedweski said the bill takes an important step to “help children keep their moms.” 

“Mammography simply does not work for everyone,” she added. 

Nedweski said the bill is a “wise investment,” noting that it is why Texas and Florida have adopted similar policies. “Gail’s law is not only life-saving, it is cost-saving. Detecting cancer early not only drastically increases survival rates, it means that treatment costs will be lower for patients and for families.” 

Women with dense breast tissue have a higher risk of breast cancer and it can make it harder for radiologists to see cancer on mammograms, according to the American Cancer Society. 

Insurance policies in Wisconsin are already required to provide coverage for two mammograms for women between the ages of 45 and 49 and annual screenings for women over the age of 50, but insurance companies are not required to cover additional screenings for women with dense breast tissue or at higher risk. 

Bipartisan support for the bill did not prevent partisan bickering during debate. Republican lawmakers complained in a press conference announcing the bill scheduling and again on the floor about Democratic lawmakers’ prior actions urging a vote.

Rep. Barbara Dittrich (R-Oconomowoc) said that the eight Republican Assembly lawmakers were the “true heroes who fought for where we are today.” 

“I celebrate them, rather than the tantrum throwing we saw leading up to this,” she said.

Others highlighted the bipartisan nature of the bills. 

Rep. Lee Snodgrass (D-Appleton) thanked Sen. Rachael Cabral-Guevara (R-Appleton), a key supporter of the legislation, and Rep. Dean Kaufert (R-Neenah), who called for lawmakers to go to partisan caucus to discuss the measure on Wednesday. GOP lawmakers credit discussion during the caucus for the recent breakthrough. 

“I know that this body is contentious often. I know that some of us don’t even like each other, but when we can come together and do something good for women’s health and the people of Wisconsin,” Snodgrass said, “it’s truly a victory.” 

Some lawmakers said that Wisconsin still needs to do more to ensure that people can access health care in the state.

Margaret Arney (D-Wauwatosa) called the passage of the bill a “victory” but a “small step on a long road.” 

“We need to seriously stare in the face of what it takes for people to afford health care,” Arney said. “All the people in Wisconsin deserve to have health security and I invite us to take that step together.” 

Postpartum Medicaid extension

Wisconsin is poised to become the 49th state to accept a federal expansion of Medicaid coverage for women for one year after they give birth after the state Assembly approved SB 23. 

The bill passed 95-1. Rep. Shae Sortwell (R-Two Rivers) is the only lawmaker who voted against the bill. 

Evers, who most recently called on lawmakers to pass the bill and send it to him at his State of the State address on Tuesday evening, is likely to sign it.

Pregnant women can receive Medicaid coverage in Wisconsin if they have an annual income of up to 306% of the federal poverty level, however, currently they risk losing that coverage 60 days after giving birth. 

Rep. Patrick Snyder (R-Weston), the lead Assembly author on the bill, said he picked up the “mantle” on the issue because of what he heard while knocking doors during the campaign cycle. A previous author on the bill was former Republican Rep. Donna Rozar, who lost her reelection bid in 2024. 

Snyder also doubled down on criticizing Democratic lawmakers for their efforts to force a vote on the issue. “I had a night’s sleep and I realized that a lot of my Democrat colleagues who I’m friends with are following orders,” he said. 

“Thank goodness we beat Arkansas,” Snyder said, referring to the only other state in the U.S. that has not extended postpartum Medicaid coverage for a year. “Strong families will mean strong Wisconsin. That’s what I put my faith in, not trying to score political points.” 

Rep. Deb Andraca (D-Whitefish Bay) struck a more cordial tone. 

“I want to thank everyone here who changed their mind,” Andraca said. “That’s not easy.”

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WASHINGTON — Kentucky Gov. Andy Beshear’s faith calls him to address hunger, health access and community care, he said during an event Thursday at the progressive Center for American Progress that previewed a potential campaign in the 2028 cycle.

The Trump administration has “hijacked” faith, the Democrat said, leading to harm instead of helping people. He pointed to the repercussions of the major tax cuts and spending package Republicans passed last year that paid for tax cuts by making changes to food assistance and health care that will result in millions of people losing access to those safety nets.

“Are we using faith to help people or to hurt people?” he said. “It’s that simple.”

More than 100,000 people are expected to be kicked off SNAP and 25 rural hospitals are at risk of closing in Kentucky alone, he said.

“The reason why I talk about faith is it motivates me. (It’s) why I’m willing to get up no matter how mean and cruel the world has gotten and fight to make it just a little bit better,” he said.

Upcoming White House bid?

Beshear, 48, is widely expected to make a presidential run in 2028, and did not rule out a bid when members of the audience asked how he would govern if he won the presidency. 

Like previous presidential hopefuls, he’s gearing up for a book tour. He told the think tank his upcoming book explores how his Christian faith has led him through challenging times as governor, from the beginning of the coronavirus pandemic to deadly tornadoes, and how he believes those values can heal the deep polarization of the country.

“In the end, where we’ve got to go is … I hope that you would say that you are an American long before you’d say you are a Democrat or Republican,” Beshear said.

Beshear was a top candidate for 2024 Democratic nominee Kamala Harris’ running mate before she selected Minnesota Gov. Tim Walz.

Immigration

An audience member asked Beshear how he would address immigration if he were president. The issue has dominated political discourse since the deadly shootings of two U.S. citizens by federal immigration agents in Minneapolis last month. 

Beshear said that every federal immigration officer needs to be retrained, and he expressed concerns about what he called constitutional violations, such as agents entering private residences without a judicial warrant.

“What we see with (Immigration and Customs Enforcement) is an out-of-control law enforcement agency,” he said. “They are so overly aggressive compared to any other law enforcement group in the nation.”

He said enforcement operations like the one in Minneapolis “will continue in other places if the current leadership continues and if they are not fully retrained.”

Beshear said the country needs comprehensive immigration reform that addresses long-term undocumented immigrants in the country and also provides a steady workforce. 

“I think that there is a reasonable way to go forward on immigration,” he said. 

RFK as campaign model

Another audience member asked Beshear if a potential 2028 Democratic presidential run would resemble Robert F. Kennedy’s 1968 campaign style that aimed to unite the country deeply divided in the midst of the Vietnam War, massive poverty and the Civil Rights Movement. Kennedy was a top candidate for the Democratic nomination before his June 1968 assassination.

Beshear said he would.

“Absolutely,” he said. “When I think about his campaign … you think about hope, you think about connection. He made you feel that progress was possible, that we could go up against huge adversaries like poverty and we could do better.”

Ten Democratic-leaning states are using their own money to help people buy Obamacare health plans, at least partially replacing the federal tax credits that expired at the end of last year.

The state assistance, some of it offered through programs that existed before the federal subsidies expired, is helping hundreds of thousands of people lower their monthly premium payments, which otherwise would have surged to double or even triple what they were before the expiration of the federal aid. The savings can total hundreds of dollars per month.

But only New Mexico is completely filling the gap left by the expiration of the federal help by offering it to people of all incomes; for most Americans buying Obamacare plans, the end of the federal aid means much higher prices. And New Mexico and the other states that are trying to cushion the blow for their residents will face increasing budget pressures as health care costs continue their inexorable rise.

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

The enhanced federal subsidies were made available by the American Rescue Plan Act in 2021 and later extended through the end of 2025 by the Inflation Reduction Act. Designed as a temporary pandemic-era measure, they helped boost the number of people buying health coverage from the insurance marketplaces created under the Affordable Care Act — Obamacare’s formal name — from 11.4 million people in 2020 to 24.3 million last year.

The enhanced subsidies were available to everyone, regardless of income. Additional federal aid provided to some of the lowest-income households entirely eliminated premium payments for some people.

Congressional leaders let the subsidies expire on Dec. 31. As of the end of last month, the number of people enrolled in marketplace coverage was down by about 1.2 million compared with last year, according to federal data.

Last year, the Congressional Budget Office estimated that the expiration of the federal subsidies would increase the number of people without insurance by 4.2 million by 2034.

Under the Affordable Care Act, each state can either use the federal government’s online insurance marketplace, HealthCare.gov, or operate its own state-run exchange. Only the 21 states plus the District of Columbia with state-run marketplaces can offer state-funded tax credits or subsidies, and at least 10 of them (California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, New York, Vermont and Washington) are doing so.

Matt McGough, a policy analyst at health care research group KFF, said many of the people who buy Obamacare plans “have fallen between the cracks of the health care system.”

“They might not work a job or work enough hours at a job to be eligible for health benefits. They are too young for Medicare. They make too much to be eligible for Medicaid, and they really have no other option but to go to the marketplace,” McGough said.

He warned that relatively healthy people are the ones most likely to forgo marketplace coverage rather than pay more for it. That will leave the exchanges with the people who have the greatest health needs, raising costs and premiums for everyone. To avoid that scenario, he said, states “want to be able to keep as many people in the marketplace as possible.”

A big commitment in New Mexico

In New Mexico, Democratic Gov. Michelle Lujan Grisham and state lawmakers earlier this year tapped the state’s 5-year-old Health Care Affordability Fund for an additional $17.3 million so they could entirely replace the expired federal subsidies through June 30 for all enrollees, regardless of income.

The vast majority of the 82,400 New Mexicans who buy coverage from the state marketplace are eligible for state help. Perhaps as a result, New Mexico is one of only a handful of states where the number of people buying Obamacare plans has increased this year: Enrollment is up 18% in New Mexico, while there have been single-digit increases in the District of Columbia, Maryland and Texas.

“We feel really great about having come together to really focus on these affordability challenges for New Mexicans, and really proud of the gains that we’ve made in coverage while we’re seeing losses elsewhere,” said Kari Armijo, cabinet secretary for the New Mexico Health Care Authority. She noted that a handful of Republican state lawmakers have joined Democrats in supporting the aid.

The money in New Mexico’s Health Care Affordability Fund comes from a 3.75% surtax levied on insurance companies. When the fund was created, the surtax was expected to generate about $165 million in new revenue annually.

Currently, the state uses nearly half of the revenue from the surtax to fund other parts of its budget. But the New Mexico House earlier this month approved a bill that would gradually increase the portion of the surtax allocated to the Health Care Affordability Fund, from the current 55% to 100% in 2028.

Legislative financial analysts recently questioned the long-term sustainability of that approach. Armijo acknowledged that continuing to replace the expired federal subsidies “will deplete the fund over time.”

“It is a pretty substantial amount of money, and it is going to strain the programs that we can provide with that funding,” Armijo said.

Paul Gessing, president of the Rio Grande Foundation, a conservative-leaning think tank in New Mexico, said the state is “flush with oil and gas money” now, enabling it to “spend money in ways that don’t make a great deal of sense for the population as a whole and instead benefits a small sliver of relatively well-off New Mexicans.”

Gessing said the state should focus on reducing health care spending by recruiting and retaining more doctors and nurses to lessen its shortage of providers and by overhauling medical malpractice laws.

“I don’t think the state should make it a practice to use state funds to fill in the gap when federal funding is shifted or eliminated,” Gessing said.

Other states

In California, where 1.9 million people were enrolled on the state’s exchange in 2025, enrollment is already down by 32% from last year, according to state figures.

The state has opted this year to spend $190 million to fully replace the lost federal subsidies for people earning up to 150% of the federal poverty level ($23,940 for an individual), and partially replace them for people making between 150% and 165% of the federal poverty level — just above eligibility for Medicaid in the state. About 390,000 enrollees are receiving the state-based subsidies this year.

Like New Mexico, California in 2021 created a Health Care Affordability Reserve Fund, funded through general revenue and penalties some people have to pay when they file their taxes.

The state budget Democratic Gov. Gavin Newsom proposed last month envisions a “modest projected deficit” of $2.9 billion for fiscal year 2026-2027, but that could grow to $22 billion the next year. California has a total annual budget of about $350 billion.

“Any amount of money that you can put into affordability is meaningful,” said Jessica Altman, executive director of California’s marketplace. “Thinking about those trade-offs is a challenging conversation, but an important one at the state level.”

In Colorado, the state is offering financial help through a new program called the Colorado Premium Assistance program. It came together during an August 2025 special session, when Colorado lawmakers approved up to $110 million this year to partially replace the federal subsidies. Help will be available to anyone making between 133% and 400% of the federal poverty level, or between $43,890 and $132,000 for a family of four.

“It is clear that this is a value for Coloradans. And having a state based marketplace like we do in Colorado, it really allows us to develop state-specific solutions and have our policies and changes driven by the needs of the people who live here,” said Nina Schwartz, chief policy and external affairs officer for Colorado’s marketplace.

Schwartz emphasized, however, that the state help won’t entirely replace the expired federal aid, and that as a result, the number of people buying coverage on the exchange is declining. Cancellations are up 83% compared with last year.

“We’re seeing an increase in the number of cancellations, with the number of people nearly doubling who canceled their plans during open enrollment compared to last year,” she said.

Other states also are opting for limited assistance. Connecticut, for example, is offering aid to households with incomes up to 200% of the federal poverty level, and the state announced it would spend $115 million in 2026 to partially offset the expiration of the federal subsidies.

Massachusetts has set aside $250 million to enhance its existing state subsidy program, helping to keep around 270,000 enrollees with incomes below 400% of the federal poverty level enrolled with stable premiums. As of early January, around 25,000 people in Massachusetts had already canceled their marketplace plans.

Maryland has a new premium assistance program that fully replaces the federal aid for enrollees earning below 200% of the federal poverty level and partly replaces it for those earning between 200% and 400% of the federal poverty level. Since last year, New York has offered help to marketplace enrollees with incomes up to 400% of the federal poverty level. And since 2023, Washington has offered state subsidies to anyone earning below 250% of the federal poverty level.

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

With three measles cases in three different Wisconsin communities since New Year’s Day, the state could be vulnerable to a larger outbreak, according to public health experts.

“We’ve gotten three cases in the state of Wisconsin so far in 2026, and there’s been many years in which we had zero,” said Dr. Joe McBride, a pediatric infectious disease physician at UW Health Kids and assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health. If the cases spread, “those are incredibly, incredibly difficult for us to slow down and to prevent.”

“There may be only three people with measles, but the cases are occurring in three different places,” said Ajay Sethi, director of the Master of Public Health Program at the UW medical school. “These are three separate public health responses, and that is significant given the potential for spread to others from just one person with measles.”

In January, state health officials reported a measles infection in a Waukesha resident. This month, measles infections have been identified in Dane County and in a person who traveled through Milwaukee County’s Mitchell International Airport to Walworth County. The Wisconsin Department of Health Services has also identified possible locations when other people might have been exposed in the Dane County and Mitchell Airport cases. All three were described as connected to travel. 

“It’s good, in that they don’t seem to be related, and we don’t see an outbreak,” McBride said. “But it’s also bad because that means there’s a lot of measles,” he added. “It’s kind of a tinderbox, and we have large cohorts of our population who are not immune.”

The year 2025 saw a resurgence of measles nationwide, approaching 2,000 cases, Stateline reported in December, with outbreaks in Texas, Arizona, South Carolina, Utah and New Mexico.

Sethi said an August 2025 cluster of cases in Oconto County started with a case in St. Croix County in someone who was visiting from out of state. Across Wisconsin in 2025, “Ultimately 36 people got measles, and two of them needed hospitalization,” he said.

‘Incredibly infectious’ illness

Although most widely known for its trademark rash, the measles virus “is a respiratory virus, just like really any other cough and cold virus that we think about,” said McBride. “However, it’s incredibly, incredibly infectious.”

The virus is airborne, McBride said, and can hang in the air for up to two hours. In one landmark case, at the 1991 Special Olympics at the Minneapolis Metrodome, a participant on the field had measles, McBride said, “and people who were susceptible to the infection got the infection who were sitting in the upper deck.”

Vaccination is the primary tool to stop measles, and in Wisconsin as well as in much of the U.S. vaccination rates are below the 95% that public health practitioners say allows for widespread “herd immunity.”

The measles vaccine is usually given in combination with mumps and rubella vaccines, first at the age of 1 with a booster by the time a child is 5.  

Some people aren’t eligible for the vaccine, either because they’re younger than 6 months old or because they have a compromised immune system due to another illness.

“It’s a live vaccine, and live vaccines have the potential of causing infections in people who are immune-compromised, like bone marrow transplant recipients or a patient with AIDS” or people on medications that suppress the immune system, McBride said.

That makes it even more important for people who are eligible to get the vaccine, public health experts say.

A national map produced by ABC News in collaboration with Boston Children’s Hospital, Harvard Medical School and Icahn School of Medicine at Mount Sinai in New York shows that none of the counties in Wisconsin has as many as 90% of  5-year-olds fully vaccinated for measles.

The lowest rates of measles vaccinations for that age group are in Portage and Columbia counties, with fewer than 60%. A cluster of counties around Oshkosh have vaccination rates in the low 60s; another cluster around Eau Claire in the mid-60s, and Milwaukee, Racine and Waukesha counties have vaccination rates in the high 60s. In the rest of the state, vaccination rates for children 5 or younger are in the range of 70% to more than 80%.

“The decision to get vaccinated is still very nuanced,” Sethi said — influenced by a variety of factors. Those include complacency, which may lead people to dismiss the need for a vaccine, he said. Other factors include how convenient it may be to get the shot, confidence in the vaccine’s effectiveness and a sense of community responsibility.

HHS shift, CDC silence

One source of shakier confidence has been a shift at the U.S. Department of Health and Human Services and the Center for Disease Control and Prevention (CDC), in the agencies’ stance on vaccines under HHS Secretary Robert F. Kennedy Jr., who had a history of anti-vaccine campaigning for years before his appointment.

Kennedy has made some appeals for people to get the measles vaccine, and in an appearance on CNN Sunday, Dr. Mehmet Oz, director of the Centers for Medicare & Medicaid Services, urged viewers, “Take the vaccine, please.”

But researchers at Johns Hopkins University in a report published in December documented that amid the 2025 measles surge, CDC social media accounts “have gone quiet, creating a ‘void’ in online health communication. In this vacuum, measles messaging has been dominated by news media rather than expert health authorities, resulting in polarized and potentially inaccurate information.” 

By the year 2000, measles vaccination had become so widespread that the U.S. was identified as having eliminated the disease. Canada, which also had that status, lost it in 2025, and the U.S. appears to be on the verge of losing it as well, Sethi said.

Yet the measles vaccine is both extraordinarily effective and essentially the only weapon against the virus.

“There isn’t any kind of other medicine that can abort it,” McBride said. “It is completely dependent on either preventing it or having natural infection and supporting the individual through it.”

The infection itself can be extremely serious, however, he said. In addition to fevers, cough and the rash, which is painful, secondary complications can do much more bodily damage. Those can include bacterial infections, pneumonia, vision and neurological damage and cardiovascular system harm as well.

In about one of every 1,000 cases, a delayed neurological condition can arise 10 years after a person is infected “that is completely fatal,” McBride added. Among the hundreds of cases across the U.S. now, “there certainly is somebody who’s walking around today who will be dead of measles in 10 years, who doesn’t know it. And that’s incredibly scary.”

People born before 1957 are more likely to have natural immunity from having been exposed to measles in childhood. “After 1957 we can’t really make that claim for people,” McBride said. “And so our immunity is dependent on vaccine status.”

People living in Wisconsin can look up their immunization status on the Wisconsin Immunization Registry, McBride said. Some people’s records might be incomplete, either because they received a vaccine in another state or because they got a vaccine before 1999, when the registry was launched. Earlier vaccines were logged on paper by health providers, according to the Wisconsin Department of Health Services.

Interest in the MMR vaccine appears to be rising. News reports and public health announcements drawing attention to recent measles cases and the importance of the vaccine “certainly raises new awareness and attention to it,” he said.

More patients are asking about the shot and more doctors and nurses are asking whether there needs to be any changes to the current vaccine schedules recommended by the American Academy of Pediatrics or the state health department.

McBride said the current cases in Wisconsin don’t point to any change in those recommendations, however. For health care providers, “The most helpful interventions would be to evaluate your patients and make sure they are up to date with the measles vaccine.”

Last month, the parents of a 7-year-old girl whose nose wouldn’t stop bleeding took her to Portland Adventist Health in Portland, Oregon, for urgent care. Before the family could get through the doors, federal immigration agents reportedly detained them in the parking lot and took them to a detention center in Texas.

At Hennepin County Medical Center in Minneapolis, workers say U.S. Immigration and Customs Enforcement officers hang around the campus, asking patients and employees for proof of citizenship. Last month, tensions came to a head when ICE agents used handcuffs to shackle a 31-year-old Mexican immigrant to his hospital bed. ICE claimed the man, who had broken bones in his face and a fractured skull, had run headfirst into a wall on purpose while handcuffed and trying to flee.

And last summer, ICE agents chased an immigrant into the Ontario Advanced Surgery Center in Ontario, California, precipitating a confrontation with two surgery center workers wearing scrubs. The two workers were later indicted by a federal grand jury, charged with assaulting and interfering with federal immigration officers.

As the Trump administration intensifies its immigration crackdown, health care workers in multiple states say ICE is increasing its presence in health care facilities, deterring people from seeking medical care and creating chaos that jeopardizes the safety of their patients.

Even before Trump took office last year, Republican-led states such as Florida and Texas began mixing health care and immigration enforcement by requiring hospitals to ask patients about their immigration status. Now that ICE has extended its enforcement activities to hospitals and health care facilities — areas that were largely off-limits during the Biden administration — an increasing number of Democratic-led states are pushing back.

Last month, Massachusetts Democratic Gov. Maura Healey filed legislation “to keep ICE out of courthouses, schools, child care programs, hospitals and churches,” and signed an executive order to limit ICE actions on state-owned property.

In December, Illinois Democratic Gov. JB Pritzker signed a measure that bars health care providers from sharing sensitive health information with federal immigration agents and requires hospitals to develop policies around how they will interact with agents.

And in September, California Democratic Gov. Gavin Newsom signed legislation that makes immigration status and place of birth protected health information, and prohibits agents from entering nonpublic, patient-sensitive areas of health care facilities without a warrant signed by a judge.

Other Democratic states — including Maine, New Jersey, New York, Oregon and Washington — are considering similar bills.

Meanwhile, Republican lawmakers in Arizona are pushing legislation that would require hospitals accepting Medicaid patients to include a question on intake forms about immigration status.

Skipping medical care

Whether or not ICE presence is actually increasing at health care facilities, it’s clear that people living in the country illegally are being deterred from seeking medical care, said Drishti Pillai, director of immigrant health policy at the health policy research group KFF.

A KFF and New York Times survey released last November showed that 43% of respondents identifying as immigrant parents living in the country illegally skipped or delayed health care for their children over a 12-month period because they were concerned about immigration enforcement. Even among lawfully present immigrants,10% said that they avoided seeking medical care for their children due to immigration-related concerns.

Pillai also pointed to the Trump administration’s efforts 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.

“We are expecting that these fears have further been exacerbated this year since the data sharing agreement was made public, and there are certain concerns around privacy of data going forward,” Pillai told Stateline.

Dr. Paula Latortue, an OB-GYN in Washington, D.C., who volunteers with the Migrant Clinicians Network, a nonprofit group that provides health care to immigrants, said it’s unclear how many people are avoiding health care, and how often.

“The one part that is really hard to know is people who are not showing up to the hospital when they usually would for some sort of urgent or emergency complaint,” Latortue said in an interview. “But I think there’s a concern for many physicians in the community that has happened.”

States step in to protect sensitive locations

The Biden and Obama administrations directed ICE to avoid enforcement activities in “sensitive” places such as hospitals, schools and churches unless it received permission from top leaders at the U.S. Department of Homeland Security.

In January 2025, however, the Trump administration rescinded those guidelines, opening up these spaces to immigration enforcement.

Stateline reached out to the White House and the Department of Homeland Security multiple times but did not receive a response. When the administration changed the guidelines, the Department of Homeland Security said that opening up “sensitive” areas to agents “empowers the brave men and women in CBP [Customs and Border Protection] and ICE to enforce our immigration laws.”

The previous guidelines didn’t prohibit ICE from operating in those locations, but it did “strongly discourage” them, according to Sophia Genovese, a legal fellow specializing in immigration law at Georgetown University.

She added, however, that states and cities can enact laws to protect such spaces, even though they are limited in their capacity to “infringe and engage in immigration lawmaking.”

“Warrants are always needed to conduct searches or investigations in private, nonpublic areas, and these warrants need to be signed by a judge. This is just a basic Fourth Amendment right,” Genovese said. “When it comes to ICE entering hospitals and gaining access to private areas of hospitals, that’s an issue of individual hospital policy.”

Genovese said states also can require that hospitals standardize their policies on where law enforcement agents can go within a medical facility and create protocols to ensure agents are presenting a warrant before entering the premises.

Health care workers want protections

Those moves are exactly what health care workers in many states are asking for.

“There’s a high level of fear and anxiety. Nurses see the videos of what’s happening around the country, and nurses have experienced it themselves,” Peter Starzynski, spokesperson for the Oregon Nurses Association, told Stateline.

Last month’s incident involving the 7-year-old girl and her parents in Portland highlighted the importance of protecting health care spaces from ICE, he said.

“That should never happen. That’s disgusting,” Starzynski said.

The Oregon Nurses Association also has condemned ICE’s presence at Legacy Emanuel Medical Center in Portland, claiming agents are violating hospital policies, including on access to patients. Legacy has disputed the union’s allegations, saying that no ICE officers have entered its facilities “unless accompanying a patient in custody.”

“Nurses in emergency rooms deal with local law enforcement on a regular basis, and those relationships are built on mutual respect, where law enforcement understands what they need to do once they enter a hospital,” Starzynski said. “That has changed with the increase in federal agents in Oregon.”

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

Roger Williams Medical Center in Providence, R.I. A new study shows that women with breast cancer living in Rhode Island and other states that expanded Medicaid eligibility were less likely to die from the disease. (Photo by Michael Salerno/Rhode Island Current)

Women with breast cancer living in states that expanded Medicaid eligibility were less likely to die from the disease — but not everyone benefited equally, according to a recent study published in the medical journal JAMA Network Open.

Researchers from Howard University, the University of Alabama, Henry Ford Hospital in Michigan, and others looked at data from about 1.6 million women ages 40 to 64 who were diagnosed with breast cancer between 2006 and 2021.

They compared survival rates among women living in states that expanded Medicaid eligibility under the Affordable Care Act, commonly known as Obamacare, with the rates in states that did not expand. About 58% of the women lived in expansion states, and roughly 42% lived in nonexpansion states. States began expanding Medicaid in 2014.

The researchers found that Medicaid expansion was associated with lower overall mortality — no matter the disease stage, race or ethnicity, or neighborhood income of the women. Women in expansion states whose cancer had spread to other organs — the most advanced stage of disease — saw the most significant decline in deaths.

Among racial and ethnic groups, the largest relative gains were among Hispanic women — they were 19% less likely to die if they lived in an expansion state. There were smaller gains among non-Hispanic Black women and residents of low-income areas. The smallest difference was among white women.

Hispanic women’s large gains could be due to many previously lacking insurance, said Dr. Oluwasegun Akinyemi, senior research fellow at the Howard University College of Medicine’s Clive O. Callender Outcomes Research Center and a coauthor of the study.

Black women have higher breast cancer death rates compared to white women, even though there are fewer cases among them, partly because they are often diagnosed with the disease at a later stage.

Overall, Black women with breast cancer benefitted less from Medicaid expansion than other groups because they are disproportionately located in the South, where most states have not expanded, Akinyemi noted. The expansion holdout states include Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee and Texas.

The remaining three nonexpansion states are Kansas, Wisconsin and Wyoming.

The researchers also compared mortality rates in low- and high-income neighborhoods. Women living in the highest-income neighborhoods, as well as those who received immunotherapy treatment, had lower mortality rates. Akinyemi said that result suggests that coverage leads to greater access to treatment.

In July, President Donald Trump signed a broad tax and spending bill  that will cut federal Medicaid funding by more than $900 billion over the next decade. As a result, about 15 million people may lose Medicaid coverage, according to estimates by the Center on Budget and Policy Priorities.

Editor’s Note: Because of inaccurate information provided to Stateline, an earlier version of this story misstated the position of Dr. Oluwasegun Akinyemi. Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Robert F. Kennedy Jr. promotes "real food" at a rally in Harrisburg, Penn., last month. Over the next decade, obesity rates across the nation could surge to close to half of U.S. adults, a new study says. (Photo by Whitney Downard/Pennsylvania Capital-Star)

Over the next decade, obesity rates across the nation could surge to close to half of U.S. adults, a new study published in the medical journal JAMA estimates.

Researchers at the University of Washington conducted the analysis using body mass index data from the National Health and Nutrition Examination Survey and self-reported weight data from a national survey of adults ages 20 and older. They examined the 2022 rates and created estimates for 2035 based on current trends. The researchers also looked at race, ethnicity and state-level data, finding wide disparities across states and racial groups.

About a fifth of U.S. adults were living with obesity in 1990. By 2022, the percentage increased to nearly 43%. Obesity was more prevalent in states in the Midwest and South.

If current trends continue, about 47% of U.S. adults will be living with obesity by 2035, according to the researchers. Obesity rates are projected to increase among Americans of all ages and racial groups.

In 2022, non-Hispanic Black women had the highest age-standardized obesity rate, at about 57%, followed by Hispanic women at 49%. Hispanic males, non-Hispanic white males and females, and non-Hispanic Black males had similar rates, ranging from about 40% to nearly 43%.

The study comes amid exploding demand for weight-loss drugs, and as U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. continues to push his Make America Healthy Again campaign.

HHS and the U.S. Department of Agriculture last month made changes to the federal food pyramid, placing a greater emphasis on animal protein, dairy and fats. Like the previous guidelines, the new pyramid discourages the consumption of processed foods, which can cause weight gain.

Despite disparities between men and women and between racial groups, HHS says its nutrition strategy moves away from the “health equity” focus of the Biden administration, in favor of making “the health of all Americans the primary goal.”

For Hispanic people, obesity rates were generally higher in states in the Midwest and the South in 2022, a pattern that is expected to continue through 2035.

In 2022, the obesity rate for Hispanic women was highest in Oklahoma, at about 54%. For Hispanic men, the rate was highest in Indiana, at roughly 47%. In 2035, Indiana is projected to have the highest rate of obesity among Hispanic men at about 54%, while the highest rate for Hispanic women, nearly 60%, is expected to be in South Dakota.

The Midwest and South also had high rates of obesity for non-Hispanic white men and women. In 2022, West Virginia had the highest obesity rates for white men and women — about 47% and 49%, respectively. In 2022, obesity rates for white men and women were lowest in the District of Columbia, at roughly 24% for men and 26% for women.

Among Black women, obesity rates were over 50% for all states, except Hawaii, in 2022. That pattern is expected to continue through 2035. Black men have lower obesity rates than Black women across all states. In 2022, the highest obesity rate for Black men was in Oklahoma, at about 44%. That rate projected to rise to 49% in 2035.

“While no locations were predicted to have decreases in obesity prevalence between 2022 and 2035, there were many with small increases over this time,” the authors wrote. They pointed to Mississippi, where Black women had the highest obesity rates between 1990 and 2022, but are projected to see one of the smallest changes — an increase of about 1.8% — by 2035.

“Predictions in states with historically high levels of obesity, such as Mississippi, suggest that the prevalence of obesity may be plateauing in some locations,” the researchers wrote.

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

U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. speaks during a policy announcement event at the U.S. Department of Health and Human Services on Jan. 8, 2026 in Washington, DC.  (Photo by Anna Moneymaker/Getty Images)

WASHINGTON — Congress has approved the first public health funding bill since President Donald Trump began his second term, with lawmakers largely rejecting his proposed spending cuts and the elimination of dozens of programs. 

A bipartisan group of negotiators instead struck a deal to increase funding on several line items within the Department of Health and Human Services’ annual appropriations bill, including for major initiatives at the National Institutes of Health and the Centers for Disease Control and Prevention. 

“When you look at the differences between what was proposed and what was agreed to, it is astonishing,” House Appropriations Committee ranking member Rosa DeLauro, D-Conn., said during a hearing on the bill in late January.

The Trump administration’s budget request, released in May, called on Congress to cut funding for the Department of Health and Human Services by $33 billion, or 26.2%.

The president asked lawmakers to implement an $18 billion funding cut to the NIH, which he argued would bring the agency in line with the Make America Healthy Again agenda. 

The Trump administration proposed a $3.6 billion cut for CDC programs, including the elimination of the National Center for Chronic Diseases Prevention and Health Promotion, National Center for Injury Prevention and Control, and Public Health Preparedness and Response, all of which it said could “be conducted more effectively by States.”

The budget request said more than $1 billion should be cut from the Substance Abuse and Mental Health Services Administration, though it said the administration was “committed to combatting the scourge of deadly drugs that have ravaged American communities.”

Trump also requested lawmakers zero out any funding for the Low Income Home Energy Assistance Program, or LIHEAP, which he deemed “unnecessary.” The federal program helps millions of low-income households meet their home energy needs, via states and tribes.

The final spending bill Congress approved rejected nearly all of the major cuts. 

Collins, Murray both praise final product

Senate Appropriations Committee Chairwoman Susan Collins, R-Maine, said the bills “reflect months of hard work and deliberation and contributions from members of both parties and on both sides of the Capitol.”

“Funding for NIH is not decreased, as was proposed in the administration’s budget,” she said. “Rather, it is increased by $415 million, including increases of $100 million for Alzheimer’s research and $10 million more for diabetes research, with a focus on type 1 diabetes.” 

Collins also touted an increase in “funding for low-income heating assistance, which is absolutely crucial for states like Maine and is an issue that I have worked for years on with my Democratic colleague Jack Reed of Rhode Island.”

Senate Appropriations Committee ranking member Patty Murray, D-Wash., said the difference between Trump’s budget request and the final bills was like the difference between “night and day.”

“Our bill rejects President Trump’s asks to rubber stamp his public health sabotage,” she said. “Instead, it doubles down on lifesaving public health investments. It rejects Trump’s efforts to slash opioid response funds. It rejects his proposal to chop the CDC in half. It rejects his call to end programs like title X, the teen pregnancy program, essential HIV initiatives, and more.” 

Rare bipartisan agreement in Trump’s second term

Senators from both political parties indicated last summer they weren’t fully on board with Trump’s budget proposal and used a hearing with HHS Secretary Robert F. Kennedy Jr. in May and a separate hearing with NIH Director Jay Bhattacharya in June to highlight their concerns. 

The Senate Appropriations Committee approved its HHS spending bill on a broadly bipartisan vote in July, while the House Appropriations Committee approved its funding bill in September without any Democratic support.

Neither of the original bills went to the floor for debate and amendment votes, though negotiations to find compromise on a final bill began late last year after the record-breaking government shutdown ended in November. 

Republicans and Democrats brokered a final agreement on the HHS funding bill in late January, the first time bipartisan agreement was reached during Trump’s second term. 

Congress previously approved a series of stopgap spending bills to keep HHS up and running, mostly on funding levels and policies last set during the Biden administration. 

The House originally voted on Jan. 22 to send the package that included funding for HHS to the Senate. But it stalled after federal immigration agents shot and killed a second U.S. citizen in Minnesota and Democrats demanded changes to the spending bill for the Department of Homeland Security. 

The Senate voted 71-29 on Jan. 30 to send the package back to the House after removing the full-year DHS spending bill and replacing it with a two-week stopgap. The House then voted 217-214 on Tuesday to clear the package for Trump, who signed it later in the day, ending a four-day partial government shutdown.  

The package also holds funding for the departments of Defense, Education, Housing and Urban Development, Labor, State, Transportation and Treasury. 

‘Months of hard work turned into results’

House Appropriations Chairman Tom Cole, R-Okla., said during floor debate last month the process that led to the final bills proved lawmakers “can make tough decisions.”

“This is where months of hard work turned into results,” Cole said. “You see, we aren’t here for just another stopgap temporary fix. We’re here to finish the job by providing full-year funding and specifically this package addresses core areas of national consequence — defense; labor, health and education; and transportation and housing development.”

Congress is supposed to pass the dozen full-year appropriations bills by the start of the fiscal year on Oct. 1, though it hasn’t completed all of its work on time in decades. 

Last fiscal year, it didn’t complete its work at all, making March 2024 the last time Congress approved all of the funding bills. 

Cole said during debate the programs funded “aren’t abstract concepts on a page, they affect how Americans live, work, learn and travel every day.”

DeLauro said the package of bills represents “a strong bipartisan, bicameral agreement that rejects the Trump administration’s efforts to eviscerate public services and reasserts Congress’ power of the purse.”

“It provides funding levels, removing ambiguity that the White House sought to exploit in the past,” DeLauro said. “It establishes deadlines for required spending, provides minimum staffing thresholds to prevent agencies from being hollowed out and increases notification requirements to ensure the administration is complying with the laws that Congress makes.” 

HHS ends up with $210 million bump

The bill provides HHS with more than $116 billion, $210 million more in discretionary funding than the previous level and a rejection of Trump’s request to cut $33 billion, according to a summary from Murray’s office. 

NIH will receive $48.7 billion in funding, $415 million more than its current spending level, showing that lawmakers were unwilling to slice its budget by $18 billion as requested. 

Congress bolstered funding for the Substance Abuse and Mental Health Services Administration by $65 million to a total of $7.4 billion, according to Murray’s summary. Trump asked lawmakers to reduce its allocation by more than $1 billion. 

A $3.6 billion funding cut for the CDC was also rejected, with appropriators agreeing to provide the Atlanta-based agency with $9.2 billion.

A summary of the bill from DeLauro’s office says negotiators were able to keep funding for domestic and global HIV/AIDS activities, Firearm Injury and Mortality Prevention Research and Tobacco Prevention and Control, among other programs that House Republicans originally proposed to zero out. 

The legislation bolstered, instead of eliminated, funding for the Low Income Energy Assistance Program, or LIHEAP, according to a summary from Cole’s office. 

The bill, it said, “reprioritizes taxpayer dollars where they matter most: into lifesaving biomedical research and resilient medical supply chains, classrooms and technical programs that set Americans up for success, and rural hospitals and primary health care to support strong and healthy families.”

CDC program axed

The legislation does eliminate the CDC’s Social Determinants of Health program, which the agency’s website states are “nonmedical factors that influence health outcomes.” Those can include whether a person has access to clean air and water, a well-balanced diet, exercise, a good education, career opportunities, economic stability and a safe place to live.

HHS’ Office of Disease Prevention and Health Promotion writes that “people who don’t have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods.” 

Cole’s summary of the HHS spending bill says that program “promoted social engineering while distracting grant recipients from combating infectious and chronic diseases.” 

The American Public Health Association urged Congress to approve the bill, writing in a statement the compromise “rightly maintains funding for most public health agencies and programs.”

“While the bill is not perfect and we disagree with cuts to several HHS agency programs included, overall, the agreement rejects the devastating cuts and nonsensical agency reorganizations proposed by the Trump administration and is a positive outcome,” APHA wrote. “Importantly, the bill also includes language to ensure that CDC and other health agencies maintain an adequate level of staffing to carry out their statutory responsibilities. 

“The bill will also ensure that Congress exercises its oversight over any future proposed agency reorganizations.”

Rep. Lisa Subeck (D-Madison) is proposing that Wisconsin require crisis pregnancy centers to get express written permission before releasing a person’s private health information. (Photo by Baylor Spears/Wisconsin Examiner)

Rep. Lisa Subeck (D-Madison) is proposing that Wisconsin require crisis pregnancy centers to get express written permission before releasing a person’s private health information. Those who have given permission would also be able to withdraw their permission at any time under the bill. 

“Many people assume that when they seek care for pregnancy or other reproductive health services that that information is protected, just like any other medical records under HIPAA, and while that is true at your doctor’s office or at the hospital, it’s not always true when you visit other providers,” Subeck said at a press conference Thursday.

Concerns about information being gathered about women’s reproductive health, including by crisis pregnancy centers, have surged in the years since Roe v. Wade was overturned by the U.S. Supreme Court, especially in states where abortion has been criminalized. 

A 2022 TIME Magazine report found that crisis pregnancy centers have been collecting information including sexual and reproductive histories, test results, ultrasound photos, and information shared during consultations, parenting classes, or counseling sessions, from women they interact with through telephone and online chats. They are not required to follow federal health data privacy laws. The report led to U.S. Sen. Elizabeth Warren requesting an examination of the practices by crisis pregnancy centers.

The bill, coauthored by Sen. LaTonya Johnson (D-Milwaukee), would also require centers to disclose in “plain language” that they are not a HIPAA-covered entity for the purpose of federal privacy regulations as well as disclosing any data breach that exposes individual digital health information.

Subeck said the centers can “look and feel an awful lot like a traditional medical clinic,” noting that they might offer ultrasounds, pregnancy tests and claim to have counselors on staff. However, she said “many of these centers are not licensed medical providers, and therefore they are not covered by HIPAA privacy protections.”

Subeck said that changes in reproductive health laws have raised concerns about the misuse of health related information and data. She said the bill would not close unregulated pregnancy centers, limit the services they can provide or limit speech. Rather, she said, it “simply sets some basic privacy expectations and protections for unsuspecting individuals.”

Subeck noted that lawmakers in other states, including Pennsylvania, have introduced similar measures, though none have become law.

Subeck said the violations of the provisions in the bill would be treated as “unfair and deceptive practices” under existing state law.

Laura Hanks, an OB-GYN and legislative chair for American College of Obstetricians and Gynecologists, said at the press conference that the bill shouldn’t be political.

“It’s about privacy, honesty and safe, medically accurate care. Unregulated pregnancy centers often look like clinics, but they aren’t held to the basic medical privacy rules,” Hanks said. “This means they lack regulation, medical oversight or standard confidentiality rules. Too many people are walking in and assuming their health care information is protected when it isn’t. This bill sets commonsense guardrails.”

The headline on this report has been revised for clarity. 

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A sign at a University of Utah health clinic warns visitors about the spread of measles. Under the Trump administration, federal health officials have cut back the number of recommended vaccines, and more states are offering exemptions for parents who don't want to vaccinate children entering public schools. (Photo by McKenzie Romero/Utah News Dispatch)

States that were leaders in childhood vaccination before the pandemic are among those losing ground as exemptions and unfounded skepticism take hold, encouraged by the Trump administration’s stance under U.S. Health and Human Services Secretary Robert F. Kennedy Jr.

Expanded exemptions for parents are likely to drop both Mississippi and West Virginia from the top national rankings they held before the pandemic, according to a Stateline analysis of federal data. Other states like Florida, Idaho, Louisiana and Montana also are pushing the envelope on vaccine choice.

At least 33 states were below herd immunity in the 2024-25 school year, compared with 28 states before the pandemic in 2018-2019, the analysis found. Herd immunity refers to the percentage of people who must be vaccinated or otherwise immune from an infectious disease to limit its spread.

Research shows that in the case of measles — a highly contagious disease — states need to maintain at least 95% vaccination rates to protect people who can’t get vaccinated. Other diseases have similar herd immunity rates. People who can’t be vaccinated might include infants too young to receive certain vaccines and those with underlying health conditions.

Misinformation and expressions of distrust from influential leaders have an effect on parents, doctors say, as do new state exemptions making it easier for families to avoid the vaccines.

Some people who never questioned vaccines before notice a national debate and get confused, said Dr. Patricia Tibbs, a pediatrician in rural Mississippi and president of the Mississippi chapter of the American Academy of Pediatrics. New religious exemptions may already be fueling an increase in pertussis, also known as whooping cough, in Mississippi, she said.

“If they hear something about it in the news, then it must be right, they think,” Tibbs said. “We’re just following the guidelines and informing patients that this is a scientific discussion. Nothing has changed about the science. But people who don’t know science are making decisions.”

Under Kennedy’s leadership, federal support for vaccination has continued to slide, and many states have joined a movement to set their own course by following more science-based recommendations from doctors. On Jan. 26 the Governors Public Health Alliance, a group of 15 Democratic governors, endorsed child and adolescent vaccination standards from the American Academy of Pediatrics rather than the federal government.

Federal health officials in Trump’s administration have cut back the number of recommended vaccines. The chair of a vaccine advisory committee, pediatric cardiologist Kirk Milhoan, suggested in a Jan. 22 podcast that individual freedom was more important than protecting community health with vaccines, even for measles and polio.

New leading states

Before the pandemic, Mississippi and West Virginia had the highest kindergarten vaccination rates in the nation, according to the Stateline analysis. About 99% of kindergartners in each state had their required vaccinations before entering public schools in the 2018-2019 school year.

In the latest statistics for the 2024-25 year, Connecticut gained the No. 1 spot, followed by New York and Maine. Those states have reined in exemptions to school vaccine requirements, while Mississippi and West Virginia have begun to allow more exemptions.

West Virginia didn’t report vaccinations to the federal Centers for Disease Control and Prevention for the 2024-25 school year. The state department of health told Stateline the data wouldn’t be available until later this year.

But the state is likely to be pushed out of the top 10. Republican Gov. Patrick Morrisey issued an executive order a year ago giving parents the right to ask for religious exemptions. To date, the state has approved 693 such requests for the current school year, spokesperson Gailyn Markham wrote in an email. That alone is enough to shift the state’s ranking significantly.

Stateline computed an average of required kindergarten vaccination rates to compare states. The analysis uses 2018-19 as a pre-pandemic baseline because a large number of states did not report the information in 2019-20 in the chaos that followed the early COVID-19 spikes and school closings.

A January study published by JAMA Pediatrics found increased vaccination rates among kindergartners in states that had repealed nonmedical exemptions, suggesting the repeals “played a role in maintaining vaccination coverage in repeal states during a period of heightened vaccine hesitancy.”

Requirements and exemptions

All 50 states and the District of Columbia require students to have certain vaccines before attending public school. They also all allow exemptions for children who cannot receive vaccinations for medical reasons, and most states allow nonmedical exemptions, often for religious or sometimes personal reasons. But Florida Republican Gov. Ron DeSantis’ administration has proposed dropping all requirements, and Idaho enacted a 2025 law allowing vaccination exemptions for any reason. Idaho had the lowest rate of kindergarten vaccination, about 80% in the 2024-25 school year before the law took effect in July last year.

Louisiana in 2024 enacted a law dropping COVID-19 vaccine requirements for public schools, and the state has opted to halt publicity about flu vaccination and end public vaccine clinics.

A Florida bill that progressed out of committee in January would maintain school vaccine requirements but expand exemptions to include “conscience” as well as medical and religious reasons.

Dr. Jennifer Takagishi, a Tampa pediatrician and vice president of the Florida chapter of the American Academy of Pediatrics, said the organization opposes both the DeSantis administration proposal to revoke vaccine requirements and the bill that would expand exemptions. Florida’s kindergarten vaccination rate fell from 94% before the pandemic to about 90% in 2024-25, according to the Stateline analysis.

“They’re ignoring the 90% of their constituents who want vaccines and want to stay safe,” said Takagishi. “The legislators are listening to the louder voice of those who want to oppose vaccines instead of the majority. We also know that there are teachers in the school system and school nurses who are fighting this because it puts them at risk.”

All states except Montana report kindergarten vaccine statistics to the federal government. Montana enacted a 2021 law making vaccine status private and unavailable for statistical reports, over the objections of medical experts. The law also made medical exemptions easier for families who think their children have been injured by vaccines.

Dr. Lauren Wilson, a pediatrician and then-vice president of the Montana chapter of the American Association of Pediatrics, said in a hearing that the law would make “vaccination information unavailable for responding to and mitigating public health emergencies.”

“Vaccines have saved millions of lives. I personally have seen cases of tetanus, pertussis, measles and meningitis and the tragedies that these mean for families,” Wilson said in her testimony.

A 2023 court order forced Mississippi to accept religious exemptions. West Virginia allows religious exemptions following the governor’s order last year.

Tibbs, who practices pediatrics in rural Jones County, Mississippi, said she has been seeing more pertussis than usual, and thinks vaccine exemptions could be a factor.

In Mississippi, which reported 394 religious exemptions for the 2024-25 school year, overall rates remained high enough that year, at about 97.8%, to ensure “herd immunity” in most cases.

Mississippi has granted 617 religious vaccination exemptions for kindergartners this school year, about 1.8% of the class, according to Amanda Netadj, immunizations director for the state health department. About 96.3% of kindergartners have all required vaccinations this year.

But the state’s whooping cough cases last year were the highest they’d been in at least decade, and in September health officials announced an infant had died of the disease — the state’s first whooping cough death in 13 years.

“We do have a lot of people getting the religious exemption,” Tibbs said. ”But still, on any given day, the majority of my patients will still get their vaccines. We are keeping our fingers crossed that the numbers stay high enough.”

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

The number of people enrolling in health plans through the Affordable Care Act's HealthCare.gov website has fallen in 2026, according to the federal government. (Getty Images)

After a record number of Wisconsin residents signed up for health insurance through the federal health care marketplace in 2025,  enrollment for 2026 is down by 7%, according to the federal government.

Enrollment could fall farther, if people who have signed up decide they can’t afford the cost when the first bill for insurance arrives, an independent analyst warns.

Health insurance — whether purchased through the federal marketplace or elsewhere — is costing people more in 2026. The price of plans purchased through the HealthCare.gov marketplace has gone up. In addition, enhanced federal tax subsidies that became available in 2021 and dramatically lowered the cost for most marketplace customers have expired.

The Affordable Care Act, enacted in 2010, created HealthCare.gov to help reduce the number of Americans without health insurance. The marketplace was designed to make it easier and more affordable for people without health coverage through an employer or through government programs to purchase a health plan for themselves and their families.

After enhanced tax-credit-based subsidies were enacted in 2021, enrollment through the marketplace began setting new records each year, nationally and in Wisconsin. Several efforts by Democrats in Congress last year to extend the subsidies past their Dec. 31, 2025, expiration date failed when the Republican majorities in both houses of Congress declined to take up the proposals.

Legislation that would revive the enhanced subsidies for another three years has now passed the U.S. House, but its future in the U.S. Senate remains uncertain.

“Without the subsidies — that’s what makes it really affordable — many small business owners and others would not have access to health care,” U.S. Rep. Mark Pocan (D-Black Earth) said during a media call in January with Protect Our Care and Main Street Alliance.

Protect Our Care campaigns for preserving and improving the Affordable Care Act and other federal health care programs. Main Street Alliance is a small business organizing group that supports the ACA along with the act’s provision to expand Medicaid by raising the income cap to 138% of the federal poverty guideline.

“We need to keep the Affordable Care Act in place, and the only way you keep it in place so it’s affordable for small business owners and many others is by having those credits,” Pocan said.

Data released last week by the Centers for Medicare & Medicaid Services showed that 291,336 Wisconsin residents had enrolled in plans through HealthCare.gov by Jan. 15, the final open enrollment deadline. That is about 7.1% below 2025 enrollment of 313,579 for the state.

Nationally, 2026 enrollment fell by 1.3 million from 2025, a drop of more than 5%.

Difficult choices for HealthCare.gov customers

For Sydney Badeau, an advocate for people with disabilities, affordable insurance through HealthCare.gov made it possible for her to work part-time for two different Wisconsin advocacy groups. In 2026, that has changed.

Badeau calculated that her 2026 premium would cost her around $450 a month — more than she could afford. She told the Wisconsin Examiner she was able to shift her work arrangement, taking a full-time position with one of her employers, The Arc Wisconsin, which now provides her health benefits, while remaining as a part-timer for her other employer, People First Wisconsin.

Most health plans sold at HealthCare.gov are classified Gold, Silver or Bronze based on a combination of their coverage, premium cost and the out-of-pocket costs that patients incur.

Nancy Peske, a Milwaukee-area freelance writer, editor and consultant, said she has always purchased a bronze plan with a $7,500 deductible. Thanks to the enhanced subsidy, her insurance cost her $370 a month in 2025, she said, instead of about $900 a month.

For 2026, her premium has risen to $1,164 a month — with no subsidy any more.

Peske has stopped contributing to her retirement account. “It will probably push back retirement for a couple of years for me,” she said.

Amanda Sherman, a Mequon real estate broker’s assistant, purchased a mid-level Silver plan in 2025 with a $7,500 deductible. Enhanced subsidies reduced her monthly premium by about $250, to $222 a month.

The health plan also helped cover some expensive medications for her complex autoimmune disorder, Sherman said.  

For 2026 she wound up with a Bronze plan that has a $9,500 deductible. Although she no longer has an enhanced subsidy, she does qualify for a smaller subsidy that still exists, of about $185 dollars — lowering her premium that would have been $538 a month to $353 a month — $120 more than she was paying in 2025.

When she went to enroll for 2026, Sherman’s previous insurer had left the HealthCare.gov marketplace where she lived. In picking a replacement plan, she said, she found herself having to choose between an option with better coverage for her medications — or one that included the same providers and specialists she had grown to trust.

Making that choice was a struggle, but keeping that care team was important, she decided. “I feel like that’s invaluable,” Sherman said.

Enrollment could fall off further

Nationally and in Wisconsin, the total HealthCare.gov enrollment numbers could still shrink further, according to Charles Gaba, an independent researcher who monitors enrollment and coverage under the Affordable Care Act.

In addition to monitoring open enrollment data at his website, acasignups.net, Gaba regularly posts information on a number of other data points. One of those is “effectuated enrollment” — active coverage for which the person enrolling has paid the monthly premium. Effectuated enrollment data lags by several months.

In a post Jan. 29, Gaba wrote that “it’s important to remember that up to 10 MILLION of the [approximately] 19.6M enrollees who re-enrolled did so by passively auto-renewing, which means millions of them received massive sticker shock when they received their January invoice.”

Gaba told the Wisconsin Examiner that for Wisconsin — which uses the federal HealthCare.gov marketplace rather than standing up its own state marketplace — the first batch of effectuated enrollment data might not be available until July at the earliest.

In the Jan. 29 post, however, Gaba wrote that in states with their own marketplaces, “at least a half-dozen of the state-based exchanges have warned that they’re already seeing much higher cancellations than they usually do, and that they expect this trend to continue as people are no longer able to keep up with the dramatically higher premium payments.”

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• Federal immigration officials could gain access to sensitive Medicaid data — but not yet. A judge has temporarily limited what information the Department of Homeland Security can access in states, like Wisconsin, that are suing to block a data-sharing agreement. 

• Advocates warn the data-sharing risks chilling health care access — potentially even discouraging some from enrolling in programs for which they’re eligible. 

• Undocumented immigrants are categorically ineligible for full Medicaid, but two narrower options exist. In Wisconsin, emergency care and prenatal coverage are available regardless of immigration status, covering about 3,200 people as of late 2025.

• State Republicans unsuccessfully sought to ban any public funding for health care for people without legal immigration status, citing rising Medicaid costs. Gov. Tony Evers vetoed the proposal, arguing it would create confusion and solve problems that don’t exist.

Can federal immigration officials access personal data on every Wisconsinite enrolled in Medicaid? 

Not for now, but the question is winding its way through federal courts.  

The U.S. Department of Health and Human Services last summer signed an agreement with the Department of Homeland Security to give immigration enforcement officers broad access to Medicaid data, which includes names, addresses, claim information and banking details. Trump administration officials claim the agreement is needed “to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them.”

Wisconsin joined 21 other states in a lawsuit challenging the agreement last year. 

“Millions of individuals’ health information was transferred without their consent,” the lawsuit argues. “In doing so, the Trump administration silently destroyed longstanding guardrails that protected the public’s sensitive health data.” 

In December, a federal judge in California ordered that, in states involved in the lawsuit, DHS can only access the names and contact information of undocumented immigrants in states involved in the lawsuit. 

But patient advocates say it’s unclear how the agency could separate the records of undocumented immigrants from those of immigrants with legal status.

“The sharing of data is dangerous for all of us at the end of the day,” said Esther Reyes, movement-building director with the national advocacy group Protecting Immigrant Families. 

How does immigration status affect eligibility for Medicaid and other health programs? 

Federal law bars undocumented immigrants and many other recent immigrants from receiving full-benefits Medicaid coverage. Most legal permanent residents and new arrivals with legal status become eligible for full Medicaid coverage only after five years in the U.S. A list of exceptions to that rule shrank last year when President Trump signed his trademark “big beautiful bill” into law. 

But the White House claims many undocumented immigrants still access Medicaid benefits, largely citing state-funded health care programs — including a now-shuttered program in Illinois — that provided coverage for undocumented adults. While those programs must operate without federal dollars to avoid running afoul of federal law, the Trump administration argues a tax “loophole”, which it moved to close last week, made them possible.

Medicaid rules make one exception for immigrants ineligible for full coverage: Under federal law, hospitals must provide emergency care for any uninsured patient. Emergency Medicaid coverage can reimburse hospitals for those costs, meaning people of any legal status can receive temporary coverage in dire circumstances — though receiving that emergency coverage is not guaranteed.

“Emergency Medicaid is exclusively available when you go to the emergency room if you don’t qualify for Medicaid because of your immigration status, and it covers services that states by law are required to cover — life or death situations,” Reyes said.

Absent that reimbursement, hospitals may distribute the costs of emergency care for people without insurance across other patients. 

Some states also rely on the federal Children’s Health Insurance Program, which is separate from Medicaid, to cover prenatal care for pregnant patients regardless of immigration status. 

How do those programs work in Wisconsin, and how much do they cost?

In Wisconsin, those two options are called Medicaid Emergency Services and BadgerCare Plus Prenatal, respectively. The prenatal program is open both to immigrants ineligible for other coverage and to pregnant inmates in Wisconsin’s prisons and jails.

Immigrant patients can receive emergency services coverage until their “condition is no longer considered an emergency,” according to state guidelines. Patients enrolled in the prenatal plan remain covered through their pregnancy, though many then become eligible for two months of emergency care coverage.

Roughly 3,200 people were enrolled in the two programs combined in October 2025, according to Wisconsin’s Department of Health Services’ data. That marked the programs’ lowest monthly enrollment since the start of the COVID-19 pandemic.

The state paused reviews of Medicaid recipients’ eligibility during the pandemic, allowing some enrollees in the emergency services and prenatal programs to remain insured beyond the standard cutoff, but enrollment plummeted after Wisconsin DHS resumed reviews in June 2023 in a process often called the “unwinding.”

Not all patients enrolled in the programs are undocumented, and Wisconsin DHS records do not break down enrollment by legal status.

Spending on the two programs dipped from about $60 million in fiscal year 2024 to about $57 million in 2025 — less than 0.4% of the state’s overall medical assistance spending that year.

Why did Wisconsin Republicans try to block state-funded health care for undocumented immigrants last year?

The Republican-controlled Legislature voted last year to bar Wisconsin agencies and local governments from funding any form of health services for undocumented immigrants. 

Rep. Alex Dallman, R-Markesan, one of the bill’s co-sponsors, pointed to Illinois’ expansion of health coverage to some undocumented adults as reason for Wisconsin to preemptively block any similar expansion; the Illinois program’s costs consistently exceeded projections, prompting the state to end the program last year.

“We’re in such a deficit on Medicaid already that it’s hard to keep up as it is,” he told Wisconsin Watch. Wisconsin is on track to overspend its Medicaid budget by $213 million by the end of the current budget cycle, state DHS Secretary-designee Kirsten Johnson wrote in a letter to state lawmakers at the end of December.

Dallman noted that the bill made an exception for health care spending required under federal law. “If they go to the emergency room, they are still going to get emergency care,” he said. As he understood it, Dallman said, that language in the bill would have shielded emergency Medicaid.

But opponents say it isn’t clear that Wisconsin’s emergency services program would have been left untouched. Some also argue that the proposal could also require immigration status checks to access any form of subsidized health care, spanning far beyond hospitals alone.

“If a child is at school and they’re sick… does the school nurse need to figure out how to verify their status before they provide health care?” asked William Parke-Sutherland, government affairs director of Kids Forward, which advocates for low-income and minority families.  

“It would have affected health care services for people if they are in need of emergency services like EMTs,” he added. “We have a primarily county-based crisis mental health system — I think that this would have applied to those as well.”

Gov. Tony Evers vetoed the bill in December, arguing that it sought to solve problems that “do not exist.” 

Could sharing Medicaid data deter patients from seeking health care?

Health outreach workers warn that giving federal immigration officials access to even some Medicaid patient data could discourage people from enrolling in programs for which they are eligible — including U.S. citizens.

The database shared with immigration authorities, called the Transformed Medicaid Statistical Information System, doesn’t clearly distinguish between undocumented immigrants and immigrants with legal status who are ineligible for full-coverage Medicaid for various reasons.

In December, U.S. District Court Judge Vince Chhabria of northern California ruled that immigration authorities may access data only on undocumented immigrants — and only if it can be separated from data on citizens and eligible immigrants. 

It’s still unclear whether officials can do that.

Regardless, the data-sharing agreement alone is enough to make many immigrants — and some citizens with immigrant family members — “think twice about whether they actually access programs like Medicaid,” Reyes said.

But health care navigators say skipping coverage can be far riskier than the potential for their address to land in the hands of immigration enforcement officers.

“You’re protecting the life of your child — and yours” by enrolling in the prenatal program, said Francisco Guerrero, a health coverage navigator with the Wisconsin Institute for Public Policy and Service.

For now, advocates are urging people to be cautious when deciding whether to drop their coverage. If people are already enrolled in the emergency or prenatal programs and haven’t changed their address, leaving the program won’t wipe their information from the database, Reyes said. U.S. citizens don’t have to disclose the immigration status of anyone in their household, she added, and immigrant parents enrolling U.S.-born children do not need to share their own legal status.

“We want people to make informed decisions and understand the risks,” Reyes said. “We understand, though, that it’s really critical to get the care that you need for yourself and for your children.”

Can immigration officials access your Medicaid data? What it means for Wisconsin patients 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.

A Planned Parenthood clinic in Salt Lake City on Wednesday, July 31, 2024. (Photo by McKenzie Romero/Utah News Dispatch)

WASHINGTON — A federal judge on Monday closed the lawsuit Planned Parenthood filed last summer after Republicans’ “big, beautiful” law blocked Medicaid patients from visiting its clinics for any health care appointments for one year. 

Planned Parenthood filed notice with the court Friday that it had dismissed “without prejudice all claims against” the Trump administration in the case. Massachusetts District Court Judge Indira Talwani issued an electronic order Monday closing the case “Pursuant to Plaintiffs’ Notice of Voluntary Dismissal without Prejudice.”

The law prevents people on Medicaid from being seen at Planned Parenthood facilities through early July, when the one-year period would expire.

Planned Parenthood Federation of America President and CEO Alexis McGill Johnson wrote in a statement released last week that President Donald Trump “and his allies in Congress have weaponized the federal government to target Planned Parenthood at the expense of patients —  stripping people of the care they rely on. 

“Through every attack, Planned Parenthood has never lost sight of its focus: ensuring patients can get the care they need from the provider they trust. That will never change. Care continues, as does our commitment to fighting for everyone’s freedom to make their own decisions about their bodies, lives, and futures.”

The Department of Justice did not immediately respond to a request for comment from States Newsroom. 

Talwani originally ruled for Planned Parenthood in the case, temporarily blocking the defunding provision from taking effect. But an appeals court later overturned that decision, allowing the Trump administration to legally withhold Medicaid funding from going to Planned Parenthood. 

Talwani was nominated by former President Barack Obama.

The provision in Republicans’ “big, beautiful” law that blocks all Medicaid funding from going to Planned Parenthood was originally slated to last for a decade, but the final version covered one year. 

Federal law for decades has barred spending from covering abortions with limited exceptions for rape, incest, or the woman’s life. 

So the new language prevented Medicaid patients from scheduling appointments at Planned Parenthood for other types of health care, like annual physicals, cancer screenings, or birth control appointments. 

Shireen Ghorbani, president and CEO of Planned Parenthood Association of Utah, which filed the lawsuit along with Planned Parenthood League of Massachusetts and Planned Parenthood Federation of America, wrote in a statement that its health care providers would “continue to see patients and deliver on our mission to provide high-quality care and education to everyone who needs it, no matter where they live or how much money they make.” 

A Planned Parenthood spokesperson, who did not want to comment on the record, said that certain clinics may choose to cover the cost of treating Medicaid patients, even though the clinic will not receive reimbursement from the federal government under the law. 

Angela Vasquez-Giroux, vice president of communications at Planned Parenthood Federation of America, wrote in a statement that the organization’s “health centers initially shielded the overwhelming majority of patients who rely on Medicaid from the harm of this cruel law. Unfortunately, the consequences for patients will worsen considerably over time as health centers close, costs rise, and access to their trusted provider is pushed further out of reach.”

Wisconsin health officials have confirmed the first measles case in the state in 2026. (Photo by George Frey/Getty Images)

Wisconsin’s first case of measles in 2026 was confirmed this week in a Waukesha resident, state health officials have reported.

The Wisconsin Department of Health Services (DHS) reported that the individual’s illness was “related to international travel.” Citing privacy concerns, the department withheld all other information, including demographic information about the patient and whether or not the individual was vaccinated.

DHS and the Waukesha County Health and Human Services department are working to identify and notify people who might have been exposed to the individual. DHS reported that no public places where others might have been exposed have been identified.

The illness was the first confirmed case of measles in Wisconsin for 2026, according to DHS, and was confirmed by the Wisconsin State Laboratory of Hygiene. 

The department is urging state residents to get a measles vaccination if they haven’t done so already.

A report in mid-December from the federal Centers for Disease Control and Prevention found there had been 1,958 confirmed cases of measles in 43 states last year through Dec. 16, and a sharp increase in December raised concerns for holiday travelers, Stateline reported.

State health officials are urging Wisconsin residents to check their vaccination status “to make sure they are protected from measles.” The department is advising people with winter vacation plans to check measles activity in the places they plan to visit and confirm that they and any traveling companions are up to date on needed vaccines.

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In Walworth County, Wisconsin, a grassroots effort is reimagining what care can look like across generations. A local community group has launched the “Nursery to Nursing Home” campaign, a proposal to transform a vacant wing of the county’s nursing home into a combined child care center and living space for older adults, addressing caregiving shortages.

“Some of the issues we’ve seen as top concerns in Walworth County include a lack of child care, a lack of senior care and the loneliness that comes with living in a rural community with an aging population and harsh winters. Together, it all creates a perfect storm for feeling isolated,” said Maddie Sweetman, who lives in Walworth County. “(The intergenerational care center) would be a beautiful way to not only address the need for seats and beds, but also to bring these two vulnerable communities together.”

The Lakeland Health Care Center, a county-owned skilled nursing facility in Elkhorn, has had a vacant wing since 2019 when staff shortages forced the facility to downsize. Now, Groundswell Collective, a local community group with a track record of advocating for older residents, is leading an effort to turn that space into 12 apartments for older people and a child care center that serves 60 to 70 children. After nearly a year of community organizing around the proposal, the Walworth County Board approved funding for a feasibility study in November for the intergenerational care center, a major step in advancing the project.

“In Walworth County, all 2,240 licensed child care slots, spread across the 35 active centers listed on the DCF (Department of Children and Families) website, are already full. That leaves nearly 2,680 children without stable care,” said Abriana Krause, who lives and works in East Troy as a child care provider, at a board committee meeting. “At the same time, Wisconsin is projected to need 30,000 additional senior beds by 2030 .… We are facing two parallel crises, child care and senior care, and the vacant wing at Lakeland Health Care Center offers us a rare opportunity to address both at once.”

As part of the proposal, county employees would get priority for child care slots.

Sweetman, a mother of two who is a full-time student and employee at the University of Wisconsin-Whitewater, knows firsthand how valuable this benefit could be for parents. When Sweetman’s children were younger, her husband worked at Lakeland Health Care Center as a certified nursing assistant while he completed nursing school. Unable to afford child care, Sweetman stayed home with her young children.

“I wonder whether having a child care facility under the same roof would have given me more access to child care, allowing me to return to school work sooner, graduate sooner, and be working full time now,” Sweetman said. “I also think about how that might have changed our overall trajectory, and what it would have meant for me personally as I managed two kids under two on my own and all the mental health challenges that came with that.”

Now, Sweetman is part of Groundswell Collective and advocating for other families to have the opportunity she did not.

“That (child care opportunity) didn’t happen for us, but I think about how it could happen for people going forward and for our community, not just for those who have children but also for seniors and for people who may soon need assisted living,” Sweetman said.

Groundswell Collective has leaned heavily on research to make its case.

“We have looked into the evidence-based benefits of intergenerational care,” said Deb Gill-Dorgan, a retired speech language pathologist and member of Groundswell Collective. “We know that adults report less loneliness, better health, a renewed sense of purpose in life, and it improves children’s social skills and educational outcomes.”

Research shows that intergenerational care sites boost well-being for both children and older people, reducing isolation, improving cognitive and physical health for older people, and cultivating empathy and connection in young children. Studies also find that these programs create cost efficiencies, especially when facility expenses and other operational costs can be shared.

Jill Juris, Ph.D., professor and chair of the Department of Recreation Management and Physical Education at Appalachian State University, is seeing these benefits through her research with BRIDGE2Health, an intergenerational mentoring program. The program is a collaboration between the Cooperative Extensions in Ohio and Virginia that connects high school students with older adults and is generating qualitative and quantitative data demonstrating increases in social connections and life skills.

“These findings align with other research indicating intergenerational interaction improves empathy, peer relationships and academic performance in younger populations, while increasing the quality of life and sense of purpose for older adults,” Juris said. “By bridging the gap between ages, these programs truly make a difference, improving the all-around well-being of everyone involved.”

Sheri Steinig, director of strategic initiatives and communications at Generations United, said that intergenerational care fosters relationships that transcend age that can serve the community as a whole.

“There’s a breakdown of age stereotypes that we see at a very young age when babies and toddlers are around older people,” Steinig said. “There are these characteristics of care, compassion and empathy that ripple out into both the families and the communities.”

In intentionally creating spaces that bring older and younger people together, these benefits organically emerge in daily interactions.

“By eliminating or reducing barriers that we’ve unintentionally put up between connecting younger and older people, there’s just a wealth of benefits that we can see in terms of educational outcomes, well-being, physical and mental health,” Steinig said.

“Intergenerational spaces offer opportunities for meaningful interactions through repeated connections that foster lasting relationships,” Juris said. “Children and older adults seeing each other within a daily routine allows for magical moments of interaction to occur.”

Those benefits extend to the caregiving staff. Steinig said that daily interaction with both children and older adults can enhance the work environment and make intergenerational centers more rewarding for staff.

Gill-Dorgan said she hopes that prioritizing county employees for child care placements at the proposed intergenerational center will help retain nursing staff, who can experience high turnover while managing their own family caregiving responsibilities.

For many involved in Groundswell Collective, the intergenerational center proposal offers a path forward on common ground at a time of uncertainty.

“As gaps widen at the federal level, I feel like there’s this turn to local solutions and our local government, and how can we fill the gaps? I see this intergenerational facility as part of that effort,” Sweetman said.

Pastor Lily Brellenthin, a mother of three who leads a Lutheran church in Walworth that serves an older congregation, has found hope through her community work with Groundswell Collective.

“In a world that’s so divided, to have some people now linking arm and arm to come together in our little place of the world is so uplifting,” said Brellenthin. “I feel like it’s proving that we are stronger in community.”

“We hope this is just the beginning,” Gill-Dorgan said. “We hope something like this will be seen as being beneficial and a wonderful idea, and hopefully other people will get involved and build more such centers.”

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and The Commonwealth Fund.

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

‘Nursery to nursing home’: Walworth County group envisions shared care across generations 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.