A medical worker prepares to vaccinate people at a pop-up COVID-19 vaccination clinic in a rural Delta community in April 2021 in Leland, Miss. The Mississippi State Department of Health, like other state health departments, is concerned about the potential loss of federal funding. (Photo by Spencer Platt/Getty Images)

Between 2016 and 2022, as congenital syphilis cases rose nationally and especially in the South, Mississippi saw a one thousand percent increase — from 10 to 110 — in the number of newborn babies who were hospitalized after contracting the disease, known to cause developmental issues, intellectual disabilities, and even death.

So in 2023, the state Department of Health mandated that all medical practitioners screen for the disease in pregnant mothers, and it has been running advertisements to spread awareness.

Annual congenital syphilis cases in Mississippi rose from 62 in 2021 to 132 in 2023, according to state data. The number fell to 114 last year. There have been 33 cases so far this year.

That work won’t stop despite potential budget cuts, Dr. Daniel Edney, Mississippi’s state health officer, said in an interview. “We’re going to keep doing what we have to do, you know, to keep it under control.”

State by state, public health departments take a similar approach: They monitor, treat and try to stem preventable diseases, alongside their host of other duties. But in the coming year, health department officials — with their agencies already strapped for cash — fear they’ll find it much more difficult to do their jobs.

President Donald Trump’s budget proposal for fiscal year 2026 would cut the federal Centers for Disease Control and Prevention budget by more than half, from $9.3 billion to $4.2 billion. The proposal serves as a wish list from the administration, a blueprint for the Republican-controlled Congress as it works through upcoming spending legislation.

If lawmakers hew to Trump’s vision, then state and county public health departments would be hit hard. States contribute to their own health departments, but a lot of them rely heavily on federal funding.

And around half of local public health department funding comes from federal sources, primarily the CDC, as noted in a 2022 report from the National Association of County & City Health Officials.

Medicaid cuts are likely to worsen mental health care in rural America

“The federal government provides a lot of funding, but the actual implementation of public health programs happens at the state and local level,” said Josh Michaud, associate director of global health policy at KFF, a health policy research group. “Each state has its own approach, in many ways, to how public health programs are overseen, how they’re funded, how they are implemented.”

In announcing his department’s share of the proposed budget, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said Trump’s goals align with “new priorities in reversing the chronic disease epidemic.”

But many local health leaders point to the longtime mission of state public health departments in preventing the spread of disease.

“Local public health is on the front lines preventing communicable disease, operating programs to prevent chronic disease, ensuring our septic and well water systems are safe,” said Dr. Kelly Kimple, acting director of North Carolina’s Division of Public Health within the Department of Health and Human Services.

“I’m very concerned,” Kimple said, “especially given the magnitude of funding that we’re talking about, as we can’t keep doing more with less.”

Clawing back COVID-era grants

Other federal budget cuts also have states worried.

Many state public health departments grew alarmed when the Trump administration announced in March that it would be clawing back $11.4 billion in COVID-era funding for grants that were slated to extend into 2026.

Twenty-three states and the District of Columbia sued. A federal district court in Rhode Island temporarily blocked the cuts, and the case remains tied up in court.

The court’s preliminary injunction may not protect temporary staff or contractors, though. Public health departments have been laying off staff, cutting lab capacity and reducing immunization clinics, said Dr. Susan Kansagra, chief medical officer for the Association of State and Territorial Health Officials.

Historically, public health departments receive funding in “boom and bust” cycles, meaning they tend to get more federal support during emergencies, said Michaud, of KFF. But “since the Great Recession of 2008, there was a general decline in public health support funding until the COVID pandemic.”

For example, KHN and The Associated Press reported that between 2010 and 2019, spending on state public health departments declined by 16% per capita and spending for local health departments fell by 18%.

Nationally, syphilis cases reached historic lows in the 2000s, thanks to robust prevention efforts and education from public health officials. By 2022, however, cases reached their highest numbers nationally since the 1950s.

“In the wake of the COVID emergency, you’ve seen a sort of backlash to what people had been calling the overreach of public health and imposing vaccination requirements and lockdowns and other public health measures,” Michaud told Stateline.

Smallpox, cholera and typhoid

Public health departments and officials go back to the 19th century, when there was a greater emphasis on sanitation efforts to prevent spread of diseases such as smallpox, cholera and typhoid, which were rampant at the time.

By the end of the century, 40 states had established health departments, which to this day are responsible for water sanitation, tracking the spread of disease, administering vaccinations, furnishing health education, providing screenings for infants and some prenatal care for moms at local clinics, offering family planning services, and tracking and treating sexually transmitted infections, among other things.

Kimple pointed to measles as a current example of a disease that’s spreading fast. When North Carolina’s health department detected a case in the state, she said, the department “identified and contacted everyone who might have been exposed, helped people get tested, worked with doctors to make sure they knew how to respond.”

That’s the legacy of local public health, Michaud said.

“The federal government cannot decide, ‘This public health program will happen in this state, but not that state,’ that kind of thing. And cannot declare a national lockdown. The COVID pandemic tested a lot of those boundaries. It really is a state and local responsibility to protect public health. And that’s always been the case, since the beginning of our country,” Michaud said.

“And what we’re seeing now is a complete upheaval of the funding going into public health.”

A major cut in services

Kimple said she’s seen recent progress in her state in the support for funding public health.

“North Carolinians viewed our work as highly important to improving health and well-being in the state, and appreciated the local presence, the reliable information, the role in prevention and efforts to protect, in particular, vulnerable communities,” she said.

Similarly, Edney said that Mississippi state lawmakers were showing more support, despite some setbacks in 2016 and 2017. New federal cuts could throw a wrench in the health department’s economic plans and its ability to reach small communities.

“Now the federal rug is being pulled out from under us,” he said.

Edney said he expects the federal share of his department’s public health funding to fall from its current 65% to around 50%.

Edney said he’s been trying to strengthen Mississippi health department’s longevity by diversifying its revenue streams by, for example, accepting private donations.

The state will not stop doing its “core” work, he said, regardless of federal funding.

“We’re not going to cut back on services at the county health department, because what we do now is all mission critical,” Edney said.

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

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

The U.S. Capitol building in Washington, D.C., is pictured on Sunday, June 29, 2025, as the reconciliation package was under debate. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — A majority of Americans believe Republicans’ “big, beautiful” law will either hurt them or not make much of a difference, according to a poll released Thursday by the nonpartisan health research organization KFF.

The survey shows 46% of people expect the new tax and spending cuts law will generally hurt them or their family, while 28% said it likely won’t make much difference and 26% said it will help them.

Those beliefs were skewed by political parties, with 54% of Republicans saying the law will help them or their family, compared to 19% of independents and 7% of Democrats.

People enrolled in Medicaid, the state-federal health program for lower income individuals and people with disabilities, have significant concerns about how changes to the program will impact them.

Sixty-five percent of Medicaid patients under the age of 65 said they expect the law to hurt them or their family. Another 17% said it won’t make much of a difference for them and 18% expect the policy changes to help.

The law makes more than a dozen changes to how Medicaid is run, resulting in a $1.058 trillion spending cut to the program during the next decade, according to an analysis released earlier this week by the nonpartisan Congressional Budget Office.

The report projects that 10 million people will lose access to health insurance before 2034.

The law made permanent the 2017 tax cuts from President Donald Trump’s first term and provided billions to carry out his plans of mass deportations, an immigration crackdown and increased defense spending.

Some know little about new law

KFF’s survey shows most Americans know at least something about the new law, though 9% of those polled said they know nothing at all and 23% said they know just a little.

Democrats had the highest percent of respondents who said they knew either a lot, 35%, or some, 45%, about the law. Twenty-two percent of Republicans said they knew a lot about their party’s top legislative achievement this year, with 44% saying they knew something, 27% saying they knew a little and 7% saying they knew nothing.

Social media

The vast majority of those polled, 78%, said they saw information about Republicans’ new law on social media during the last month.

Facebook and YouTube were the more popular social media platforms for people to see information about the tax and spending cuts law, followed by Instagram, TikTok, X and Reddit.

Forty-seven percent of those surveyed said the content they saw on social media opposed the policy changes included in the law, while 41% said it was mixed and 11% said it supported the GOP’s work.

Republicans said 26% of what they viewed on social media was in support of the law, with 53% mixed and 21% opposed. Democrats polled said 76% of what they saw was opposed, 21% mixed and 3% was supportive.

Most of those surveyed said the social media content helped them understand what the new law actually does. Sixteen percent said it was very helpful, 46% said it was somewhat helpful, 27% said it was not too helpful and 11% said it wasn’t helpful at all. 

The U.S. Capitol in Washington, D.C., on Thursday, April 18, 2024. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — Republicans and backers of President Donald Trump’s Make America Great Again platform support the party’s “big, beautiful bill” as passed by the U.S. House, though Americans overall view the legislation unfavorably, according to a poll released Tuesday by the nonpartisan health research organization KFF.

The survey shows that nearly two-thirds of those polled, or 64%, don’t support the tax policy changes and spending cuts Republicans have included in the sweeping House version of the bill that the Senate plans to take up this month.

When broken down by political affiliation, just 13% of Democrats and 27% of independents view the legislation favorably. Those numbers are in sharp contrast to Republicans, with 61% supporting the bill and 72% of those who identify as MAGA supporters.

But those views fluctuated when the people surveyed were asked specific questions about certain elements of the package and the real-world impacts of the legislation:

• The overall percentage of those surveyed with an unfavorable view of the bill increased from 64% to 67% when they were told it would lower federal spending on Medicaid by more than $700 billion, an estimate by the nonpartisan Congressional Budget Office.
• Dislike of the legislation rose to 74% when those polled were told policy changes would lead to 10 million people losing their health insurance coverage, another estimate from the CBO analysis.
• Opposition rose to 79% when people were told the legislation would reduce funding for local hospitals.

“The public hasn’t had much time to digest what’s in the big, beautiful, but almost incomprehensible bill as it races through Congress, and many don’t have a lot of information about it,” KFF President and CEO Drew Altman wrote in a statement. “Our poll shows that views toward the bill and its health-care provisions can shift when presented with more information and arguments about its effects, even among MAGA supporters.”

Senators wrestling with what to do

The House voted mostly along party lines to approve its 11-bill package in late May, sending the legislation to the Senate.

GOP senators have spent weeks internally debating which parts of the House legislation to keep, which to change and which to remove, while also conducting closed-door meetings with the parliamentarian to determine which parts of the bill comply with the rules for the complex reconciliation process.

Senate Majority Leader John Thune, R-S.D., plans to bring his chamber’s version of the package to the floor next week, though that timeline could slip. Before the Senate can approve the rewritten bill, lawmakers will spend hours voting on dozens of amendments during what’s known as a vote-a-rama.

Significant bipartisan support for Medicaid

The KFF poll released Tuesday shows that 83% of Americans support Medicaid, slated for an overhaul and spending reductions by GOP lawmakers.

That support remains high across political parties, with 93% of Democrats, 83% of independents and 74% of Republicans holding a favorable opinion of the state-federal health program for lower-income people and some with disabilities.

Those surveyed appeared supportive of a provision in the House bill that would require some people on Medicaid to work, participate in community service, or attend an educational program at least 80 hours a month.

The change is supported by about two-thirds of those surveyed, though the numbers shift depending on how the question is asked.

For example, when told that most adults on Medicaid already work and that not being able to complete the paperwork associated with the new requirement could cause some to lose coverage, 64% of those polled opposed the new requirement. 

Planned Parenthood

There was also broad opposition, 67% overall, to language in the House bill that would block any Medicaid funding from going to Planned Parenthood for routine health care. There is a long-standing prohibition on federal funding from going toward abortion with exceptions for rape, incest, or the life of the pregnant patient.

Opposition to the Planned Parenthood provision increased to 80% when those polled were told that no federal payments to Planned Parenthood go directly toward abortion and that ending all Medicaid payments to the organization would make it more challenging for lower-income women to access birth control, cancer screenings and STD testing.

Republicans are more supportive of that change, with 54% backing the policy and 46% opposing the new block on Medicaid patients going to Planned Parenthood. But 78% of independent women and 51% of Republican women oppose the change.

Food assistance program

Those surveyed also had concerns about how changes to the Supplemental Nutrition Assistance Program, or SNAP, would impact lower-income people’s ability to afford food, with 70% saying they were either very or somewhat concerned.

Democrats held the highest level of concern at 92%, followed by independents at 74% and Republicans at 47%.

Overall, Republicans hold the highest share of people polled who believe the dozens of GOP policy changes in the “big, beautiful bill” will help them or their family.

A total of 32% of Republicans surveyed believe the legislation will benefit them, while 47% said it will not make much of a difference and 21% said it will hurt them or their family.

Thirteen percent of independents expect the legislation will help them, while 39% said it likely won’t make a difference and 47% expect it will harm them or their family.

Of Democrats polled, just 6% said they expect the GOP mega-bill to help them, while 26% said it wouldn’t matter much and 66% expected it to hurt them or their family.

When asked whether the bill would help, not make much of a difference, or hurt certain groups of people, the largest percentage of those polled expect it to help wealthy people.

Fifty-one percent of those surveyed said they expect wealthy people will benefit from the bill, 21% believe it will help people with lower incomes and 20% said they think middle-class families will benefit.

Seventeen percent think it will help immigrants, 14% expect it to help people who buy their own health insurance, 13% believe it will help people on Medicaid, 13% think it will help people on SNAP and 8% expect it will benefit undocumented immigrants.

KFF conducted the poll June 4 – 8, both online and by telephone, among a nationally representative sample of 1,321 U.S. adults. The margin of error is plus or minus 3 percentage points for the full sample size.