Former Director of the Centers for Disease Control and Prevention Susan Monarez testifies before the Senate Committee on Health, Education, Labor, and Pensions in the Dirksen Senate Office Building on Sept.17, 2025 in Washington, DC. (Photo by Kevin Dietsch/Getty Images)

WASHINGTON — Former Centers for Disease Control and Prevention Director Susan Monarez testified before a U.S. Senate committee Wednesday that she was fired after just 29 days because she refused to pre-approve vaccine recommendations or fire career officials for no reason. 

Monarez, who was nominated by President Donald Trump earlier this year and confirmed by the Senate in July on a party-line vote, became a central figure in the country’s debate over public health last month after she refused to resign. 

Monarez testified that during a meeting in late August, Health and Human Services Secretary Robert F. Kennedy Jr. told her she needed to commit to approving upcoming recommendations from the Advisory Committee on Immunization Practices without reviewing any data or research. 

“He also directed me to dismiss career officials responsible for vaccine policy without cause. He said if I was unwilling to do both, I should resign,” Monarez said. “I responded that I could not pre-approve recommendations without reviewing the evidence and I had no basis to fire scientific experts.”

Monarez testified before the Health, Education, Labor and Pensions Committee during the nearly three-hour hearing that she told Kennedy if he didn’t trust her, then he could fire her.

During that same late August meeting, Monarez said Kennedy told her the childhood vaccine schedule would be changing in September and that she needed to be on board with that.

“We got into an exchange where I had suggested that I would be open to changing childhood vaccine schedules if the evidence or science was supportive,” Monarez testified. “And he responded that there was no science or evidence associated with the childhood vaccine schedule.”

ACIP is scheduled to meet Thursday and Friday at the CDC’s headquarters in Atlanta, Georgia. 

Kennedy testified before a separate Senate committee earlier this month that he did demand that Monarez fire career CDC scientists but said he didn’t tell her to accept the recommendations of the vaccine advisory panel without further review.

“What I asked her about is she had made a statement that she was going to not sign on and I wanted clarification about that,” Kennedy said at the time. “I told her I didn’t want her to have a role if she’s not going to sign onto it.”

Vaccine safety at issue

Monarez said that undermining vaccine safety will lead to an increase in preventable diseases, some of which have long-term or even lifelong consequences for children’s health. 

“I believe that we will have our children harmed for things that we know they do not need to be harmed by — polio, measles, diphtheria, chickenpox,” she said. 

Former CDC Chief Medical Officer Dr. Debra Houry told the committee there are significant ramifications if the new members of the Advisory Committee on Immunization Practices, who were appointed by Kennedy after he fired all of the former members, don’t use rigorous science and data to make their recommendations. 

“It’s going to be heartbreaking,” Houry said. “I think what concerns me is these aren’t harmless diseases. We just saw the case in California of a young child that died of encephalitis years after measles. These diseases have long-term consequences and in the U.S. we have gone so far in reversing this. We don’t want our children to die.”  

Houry was one of several CDC officials who resigned after learning about Monarez’s firing, which happened just weeks after a gunman opened fire at the CDC’s headquarters, killing a police officer. 

Both Monarez and Houry testified, in response to a question from Connecticut Democratic Sen. Chris Murphy, that confusion about vaccines and CDC recommendations had real consequences. 

“I myself was subject to threats,” Monarez said. “And I am very concerned that the further promulgation of misleading information will undermine not just the safety and health of our children, but it will also exacerbate some of these tensions — the willingness to commit harm if someone is affronted by a belief that the people like us that are trying to help them are actually not trying to help them.” 

Houry told the committee the gunman fired about 500 rounds, with approximately 180 of those hitting the building. 

“Each bullet was meant for a person, and each of my staff were very traumatized afterwards,” Houry said. “I had staff that were covering their kids in the day care parking lot. There were people that were out at the ride-share as bullets were passing over their head. I have many that won’t speak about vaccines now and removed their names off of the papers. They don’t wish to present publicly anymore because they feel they were personally targeted because of misinformation.”

‘Did we do something wrong?’

HELP Committee Chairman Bill Cassidy, R-La., said at the beginning of the hearing he intended to invite Kennedy and possibly other HHS officials to testify before his committee later in the year if they wanted to respond to what was said in the Wednesday hearing. 

He also raised concerns that Monarez was fired after less than a month in the role, despite her being nominated by Trump, confirmed by the Senate and Kennedy saying while swearing her in that she had “unimpeachable scientific credentials.”

“We as senators need to ask ourselves, did we look past something? Did we do something wrong?” Cassidy said. “It may be that we did nothing wrong, in which case, Dr. Monarez and Dr. Houry, the onus is upon you to prove that the criticisms leveled by the secretary are not true.”

Cassidy later added that “it may be impossible to learn who’s telling the truth.”

Vermont independent Sen. Bernie Sanders, ranking member on the committee, said the Trump administration’s decision to fire Monarez after less than a month in the CDC director’s role was because “she refused to act as a rubber stamp to implement Secretary Kennedy’s dangerous agenda to substantially limit the use of safe and effective vaccines that would endanger the lives of the American people and people throughout the world.”

Sanders raised concerns that the loss of career officials at the CDC and other federal health agencies could hamper the country from addressing disease outbreaks in the months and years ahead. 

Confusion over whether Monarez was recorded

There were a few awkward moments in the hearing, in addition to the serious discussion about the Trump administration’s approach to public health. 

One came after Florida Republican Sen. Ashley Moody mentioned twice during her five minutes of questions that Monarez had spoken with Cassidy about her firing, implying that was somehow improper.  

Cassidy gave a lengthy statement afterward, clarifying the record. 

“As chairman of the committee with jurisdiction over the CDC that favorably reported Dr. Monarez as the CDC director, it is entirely appropriate for someone with oversight concerns to contact my office, or me, or frankly any of us,” Cassidy said. “Upon receiving outreach from Dr. Monarez, I contacted both the secretary and the White House to inquire about what was happening and to express concerns about what was alleged. As soon as the director was fired, the HELP Committee began reviewing the situation, as it is our responsibility, and any and all communication with the witnesses was conducted by HELP staff in coordination with attorneys.”

Another somewhat uncomfortable and slightly confusing moment came after Oklahoma Republican Sen. Markwayne Mullin told Monarez that someone had recorded her meeting or meetings with Kennedy.

Mullin then repeatedly questioned her recollection of her conversations with Kennedy, implying that he had a different view because he had listened to the recording. 

The exchange led Cassidy to give another statement to the committee. He appeared somewhat frustrated that someone gave just one senator on the panel the recording, that Mullin had not shared it with any other members of the committee and that HHS had chosen not to give it to the committee in response to a request for documents related to Monarez’s firing. 

“If a recording does not exist, I ask Sen. Mullin to retract his line of questions,” Cassidy said. “I’ll also note that if he has it, I’m also curious why only one senator was given this and why we’re just hearing about it now.”

A few minutes later, Cassidy announced to the hearing room that Mullin told reporters elsewhere that he was mistaken about there being a recording of the meeting or meetings. 

Monarez lawyer

Several GOP senators on the panel also questioned Monarez at length about when and why she chose to hire legal representation and why she ultimately went with Mark Zaid, who has made public statements against Trump and his policies. 

Monarez testified that she wasn’t aware of Zaid’s political beliefs when she hired him and hasn’t spoken with him about politics. 

“I was seeking some critical counsel to be able to help me make sure that I was understanding and aware of everything that had transpired and preparing for what might be next, including this committee hearing,” Monarez said. “Mark and I have never spoken about politics. I never asked him about his politics. He has never asked me about my politics.”

In this photo illustration, a pharmacist holds a COVID-19 vaccine. States and clinicians are working on getting correct information on vaccines to vulnerable groups amid shifting federal guidance. (Photo illustration by Joe Raedle/Getty Images)

The state health department is recommending COVID-19 vaccines for all Wisconsinites 6 months and older and authorizing pharmacies to give the vaccine without an individual prescription.

In addition, Wisconsin’s insurance regulator issued guidance to health insurance companies that the shots are to be provided without a patient co-payment.

Both department declarations were issued Tuesday following Monday’s executive order from Gov. Tony Evers to protect vaccine access.

At the Department of Health Services (DHS), Dr. Ryan Westergaard, chief medical officer and state epidemiologist for communicable diseases, issued a standing medical order recommending the vaccine for all eligible Wisconsin residents this fall. With the order, no prescription is needed, DHS said.

The health department said its recommendation for the vaccine follows guidance from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.

States, public health organizations and agencies have been stepping in to recommend the vaccines for COVID-19 and for other communicable diseases following a shift at the federal Department of Health and Human Services (HHS) away from vaccine recommendations under the administration of President Donald Trump and HHS Secretary Robert F. Kennedy Jr.

Kennedy, who has long embraced anti-vaccine views, has replaced the members of a CDC committee on vaccination with vaccine skeptics, and the body is expected to consider softening or eliminating some recommendations for the COVID-19 vaccine and some childhood immunizations. 

The Food and Drug Administration has narrowed its recommendations for the COVID-19 vaccine to people 65 or older, while public health advocates have called for maintaining the vaccine schedule for all ages.

The DHS order states it “is also intended to authorize vaccination for other groups for whom professional society guidance supports vaccination — such as children, adolescents, pregnant people, and healthy adults under 65 — even though these uses are considered ‘offlabel.’”

“Everyone in Wisconsin should be able to make the choice to protect themselves and their families against COVID-19, and that choice should be based on the best available science and medical recommendations,” DHS Secretary Kirsten Johnson said in a department statement. “As the federal government limits access to the vaccine, we want to reassure Wisconsinites that recommendations from our nation’s leading medical associations are clear, and we will work every day to support access to care and resources to help families make the best decisions on how to protect themselves from illness and disease.”

The Office of the Commissioner of Insurance (OCI) said in a bulletin that based on “the evidence-based guidance” from DHS and state laws against discrimination in insurance coverage, “the commissioner continues to expect that all governmental self-funded and fully insured group health plans and individual health plans will cover, without cost sharing, all costs associated with administration of COVID-19 vaccinations for all policyholders.”

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U.S. Sen. Tammy Baldwin | Photo by Shauneen Miranda/States Newsroom

WASHINGTON — A trio of Senate Democrats urged Republican lawmakers at a Tuesday press conference to extend and make permanent the enhanced Affordable Care Act tax credits set to expire at the end of 2025.  

Senate Minority Leader Chuck Schumer of New York, along with Sens. Tammy Baldwin of Wisconsin and Jeanne Shaheen of New Hampshire, warned that the expiration of these credits would lead to “skyrocketing” costs for millions of enrollees unless the GOP-controlled Congress takes action. 

The credits are used by people who buy their own health insurance through the Affordable Care Act Marketplace.

Stopgap spending bill

The extension is among congressional Democrats’ broader health care demands in order to back any stopgap funding bill to avert a government shutdown before the next fiscal year begins Oct. 1. 

House GOP leadership did not negotiate with Democrats on the seven-week stopgap funding bill released on Tuesday.

Schumer, alongside House Minority Leader Hakeem Jeffries of New York, said in a joint statement Tuesday that “the House Republican-only spending bill fails to meet the needs of the American people and does nothing to stop the looming healthcare crisis.” 

They added that “at a time when families are already being squeezed by higher costs, Republicans refuse to stop Americans from facing double-digit hikes in their health insurance premiums.” 

At the press conference, Baldwin called for legislation she and Shaheen introduced earlier this year that would make the enhanced premium tax credits permanent to be included in the stopgap government funding bill. 

“Time is of the essence — families and businesses are planning for next year, and we need to get this done,” Baldwin said. “The only question is whether Republicans will join us and stand for lower costs for families or not.” 

Shaheen said that “as we near the deadline for government funding, I hope that our colleagues here in Congress will join us, that they will act to extend these tax credits and to keep health insurance affordable for millions of Americans.” 

Premiums expected to soar without action

The enhanced premium tax credits, established by Democrats in 2021 as part of a massive COVID-19 relief package, were extended in 2022 through the Inflation Reduction Act. They are set to expire at the end of 2025.

Premiums, on average, for enrollees would soar by more than 75% if the credits expire, according to the nonpartisan health research organization KFF. 

House Speaker Mike Johnson, R-La., said Tuesday at a press conference that “Republicans have concerns” about the credits because they have no income cap and certain high-income people can qualify for them. He also said Congress has until the end of the year to decide what to do.

At the Democrats’ press conference, Schumer said President Donald Trump “has taken a meat ax to our health care system,” adding that “it’s vicious, it’s cruel, it’s mean” and pointing to some of the repercussions of the GOP’s mega tax and spending cut law on Medicaid recipients. 

Meanwhile, open enrollment begins in November, meaning Congress would have to act before the end of the calendar year to avoid premium spikes.  

U.S. House Speaker Mike Johnson answers reporters' questions during a press conference in the Rayburn Room inside the Capitol building in Washington, D.C. on Tuesday, Sept. 16, 2025. Also pictured, from left to right, are California rancher and former president of the National Cattlemen's Beef Association Kevin Kester; Wisconsin Republican Rep. Tony Wied; Republican Whip Tom Emmer, R-Minn.; and Majority Leader Steve Scalise, R-La. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Republican leaders released a seven-week stopgap government funding bill Tuesday that’s intended to avoid a shutdown when the new fiscal year begins Oct. 1. 

But GOP leaders opted not to negotiate the legislation with Democrats, who may be needed to approve the bill in the House and will be required to get past the Senate’s 60-vote legislative filibuster. 

Democrats for weeks have called on Republicans to address what they view as critical health care issues, including the expiration of expanded Affordable Care Act tax credits at the end of the calendar year and the effects of the GOP’s “big, beautiful” law on Medicaid recipients.

Speaker Mike Johnson said during a press conference shortly before the bill was released that he views the ACA tax credits as “a December policy issue, not a September funding issue,” even though open enrollment begins in November. 

“They don’t expire until the end of the year and so we have until the end of December to figure all that out,” Johnson said. “But I can tell you that there’s real concern. I have concerns. Republicans have concerns about those policies. 

“If you look at how much they’ve been abused, in my estimation, in some ways. There’s no income cap on it. People who make $600,000 a year get a government subsidy for their health care. I don’t think that’s going to be a popular measure when people understand how that works. There’s a relatively small number of people that are affected by it. But that policy has real problems.”

The tax credits are used by people who purchase their own health care coverage through the Affordable Care Act Marketplace.

Schumer: Republicans ‘want to shut things down’

Senate Minority Leader Chuck Schumer, D-N.Y., said during a floor speech before the bill was publicly released that GOP leaders shouldn’t expect Democrats to help them advance any legislation they didn’t negotiate in a bipartisan way. 

“They can try and play the blame game, but their actions tell a different story. Their actions show clearly they want to shut things down because they don’t want to negotiate with Democrats,” Schumer said. “And it’s more than that. It means Republicans don’t want to help the American people with the crisis they’ve created raising people’s costs, particularly their health care costs.”

Senate Majority Leader John Thune, R-S.D., said the stopgap spending bill, which would keep the government running through Nov. 21, is needed to give lawmakers more time to work out final, bipartisan versions of the dozen full-year government funding bills. 

“The goal here should be to fund the government the way it was intended to be funded — through the normal appropriations process,” Thune said. 

House Appropriations Committee ranking member Rosa DeLauro, D-Conn., and Senate Appropriations ranking member Patty Murray, D-Wash., issued a joint statement shortly after the bill’s release, saying they’re ready to keep working with their Republican counterparts — House Chairman Tom Cole, R-Okla., and Senate Chairwoman Susan Collins, R-Maine — on a bipartisan stopgap spending bill.

“Instead of continuing to work through important issues with us on the continuing resolution and government funding to help the middle class and the working class, House Republican leadership has walked away from negotiations and are now threatening a shutdown by trying to jam through a funding bill on their terms alone,” DeLauro and Murray wrote.

Security for members of Congress

The 91-page stopgap spending bill also includes $30 million in additional funds to bolster safety and security for members of Congress following an increasingly violent year that included the killing of conservative commentator Charlie Kirk, the killing and attempted killing of Democratic state lawmakers in Minnesota as well as some of their family members and arson at the Democratic Pennsylvania governor’s mansion. 

Members of Congress, their staff and their families are subject to thousands of threats each year, according to data from the U.S. Capitol Police. 

Johnson told reporters shortly after his press conference that he views the member security funding as a start and that there will be “more to come” in the full-year Legislative Branch funding bill.

Johnson said he expects the House will vote on the stopgap bill before Friday, when both chambers of Congress are set to leave on a week-long break for the Rosh Hashanah holiday week. 

Lawmakers aren’t expected to return to Capitol Hill until Sept. 29, with just hours to avoid a partial government shutdown if they cannot approve a stopgap bill in the days ahead.

The legislation includes an additional $30 million for the U.S. Marshals Service, which is responsible for the safety of federal judges and courthouses, as well as $28 million “for the protection of the Supreme Court Justices.” A GOP summary of the bill says the Marshals Service funding will go toward “Executive Branch protective services.”

Gov. Tony Evers signed an executive order Monday that is aimed at protecting access to vaccines in Wisconsin. (Photo by George Frey/Getty Images)

Seeking to combat efforts of the U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and the Trump administration, Gov. Tony Evers signed an executive order Monday that is aimed at protecting access to vaccines in Wisconsin. 

“Vaccines save lives, folks. Spreading fear, distrust, and disinformation about safe and effective vaccines isn’t just reckless, it’s dangerous,” Evers said in a statement. “RFK and the Trump administration are inserting partisan politics into healthcare and the science-based decisions of medical professionals and are putting the health and lives of kids, families, and folks across our state at risk in the process.”

Kennedy in his role as the health secretary has taken aim at vaccines, including the COVID-19 vaccine. This week, a CDC committee with new members appointed by Kennedy who are skeptical of vaccines is expected to consider softening or eliminating some recommendations for the COVID-19 vaccine and some childhood immunizations. 

“Here in Wisconsin, we will continue to follow the science to ensure Wisconsinites have access to the healthcare they need when and where they need it to make their own healthcare decisions that are right for them,” Evers said. 

The order directs the state Department of Health Services to take several steps towards protecting access including monitoring and reviewing immunization recommendations, issuing guidance on the COVID-19 vaccine, determining additional measures that may be necessary to provide clarity and guidance on other routine vaccines.

The Office of the Commissioner of Insurance is also directed under the order to collaborate with health plans to make sure people have accurate, up-to-date information on access to vaccines and to help limit the costs of vaccines and to direct health insurers within their regulatory authority to provide coverage for the COVID-19 vaccine without cost-sharing.

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A 10-week-old infant drinks from a bottle. A new study found that when rural hospitals were acquired by larger health systems, they were 30% less likely to still offer labor and delivery services five years later. (Photo by John Moore/Getty Images)

Rural hospitals are less likely to offer obstetric services after they’ve been acquired by a larger health system, leading to mixed outcomes for mothers and babies, according to new research.

It’s part of an accelerating trend that’s reshaped how Americans get health care: Larger health systems gobble up smaller facilities in a bid for financial stability.

“The hospital industry has undergone tremendous transformation over the past few decades, with nearly 1,600 mergers between 1998 and 2021,” said Martin Gaynor, a coauthor of the study and emeritus professor of economics and public policy at Carnegie Mellon, in a statement.

Those large-scale changes to the health system can affect costs, quality and access to care, he said.

Over the past five years, more than 100 rural hospitals have stopped delivering babies or announced they’ll stop in 2025, according to the most recent data from the Center for Healthcare Quality & Payment Reform. Less than half of rural hospitals still offer labor and delivery services.

Gaynor and a team of researchers from Carnegie Mellon, Northwestern University and the University of Georgia examined how hospital mergers have affected access to obstetric care in rural areas, and the quality of that care. They found that rural hospitals were part of more than 450 mergers from 2006-2019.

Once those rural hospitals were acquired by larger systems, they were 30% less likely to still offer labor and delivery services five years later. Many of the shuttered obstetric departments were the sole local source of obstetric care.

That loss translated to fewer resources — such as practicing OB-GYNs — in the county where the acquired hospital was located, researchers found.

The number of births in those counties didn’t change; families just had to go elsewhere for care.

Less access to nearby care could explain those counties’ small increases in health problems among women during or after pregnancy and child birth, and higher rates of smoking among pregnant women, researchers said.

On the flip side, they found that some patients went to higher-quality facilities farther away. And in rural hospitals that didn’t close their obstetric departments following a merger, the quality of care tended to rise.

In recent years, officials in dozens of states have championed laws to increase oversight of mergers and other health care dealmaking.

In the wake of devastating hospital closures tied to corporate financial maneuvering, some states have strengthened their antitrust laws.

Last year alone, 22 states enacted at least 34 laws related to health system consolidation and competition, according to the National Conference of State Legislatures, an advisory think tank for lawmakers. Other states, meanwhile, have paved the way for health mergers in a bid to save failing rural hospitals.

At least 35 states now require hospitals, health systems, providers and private equity firms to notify a state official of proposed mergers or other contracts.

Earlier this month, California lawmakers passed a bill to expand the state’s authority in overseeing mergers and acquisitions in health care. It’s headed to Democratic Gov. Gavin Newsom’s desk, though Newsom vetoed a similar measure last year.

At the federal level, President Donald Trump’s administration has not signaled an interest in increasing antitrust oversight. But Trump’s recent tax and spending law did include $50 billion in funding over the next decade aimed at helping states strengthen rural health care. Massive cuts to Medicaid also in the law could have devastating impacts on rural hospitals struggling to stay afloat, however.

The Centers for Medicare & Medicaid Services this week announced that states have until Nov. 5 to apply for rural health funding. States must show that they’ll use the federal dollars in a way that aligns with certain CMS goals, including helping improve access to care and strengthening retention of health care workers.

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

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

WASHINGTON — Planned Parenthood clinics throughout the country began telling Medicaid patients Friday that their routine health care appointments will no longer be covered as a federal court order takes effect. 

The change, which could remain in place for months, if not longer, will likely impact the hundreds of thousands of Medicaid enrollees who go to Planned Parenthood clinics for health care not related to abortion. 

“This decision is devastating to patients here in the state and across this country. And it is compounding what is an already broken and overstretched health care system,” said Shireen Ghorbani, president and CEO of Planned Parenthood Association of Utah. “We know that cancers will go undetected, STIs will go untreated.”

Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts, said there is no plan for other health care providers to absorb the Medicaid enrollees. 

“There’s no one waiting in the wings to take care of our patients,” Lee said. “Planned Parenthood is the safety net.”

Planned Parenthood has identified at least 200 clinics out of about 600 that could close if they cannot treat Medicaid patients and receive reimbursements from the state-federal health program for lower-income people and some people with disabilities.

“We are working, you know, feverishly with our colleagues and teams to mitigate that number,” Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, said. “We have to remember 50% of Planned Parenthood patients use Medicaid for their health care insurance. And so that is a very meaningful impact to the health centers that also rely on reimbursement in the same way every other single health care provider relies on reimbursement for the services provided.” 

GOP law targets Planned Parenthood

Federal law for decades has barred funding from going toward abortion services with limited exceptions for rape, incest, or the life of the pregnant patient. 

Earlier this year, Republicans in Congress included a provision in their “big, beautiful” law that prevents Medicaid funding from going to certain health care organizations that provide abortions and received more than $800,000 in reimbursements from the program during a recent fiscal year. 

The language, which originally applied for 10 years but was reduced to one year in the final version of the bill, appeared to specifically target Planned Parenthood. It prevents the organization from receiving any Medicaid funding for health care services unrelated to abortion, like annual physicals, cancer screenings and STI testing.

Planned Parenthood quickly filed a lawsuit in the federal district court in Massachusetts in July, shortly after President Donald Trump signed the legislation.  

A district court judge issued a temporary restraining order and then a preliminary injunction that month, blocking the Department of Health and Human Services from implementing that one aspect of the law and allowing Medicaid patients to continue going to Planned Parenthood for routine health care services.

On Thursday, a three-judge panel from the U.S. 1st Circuit Court of Appeals overturned the lower court’s ruling, clearing the way for the Trump administration to stop reimbursing Planned Parenthood for Medicaid patients while the case continues. 

Peyton Humphreville, senior staff attorney at Planned Parenthood Federation of America and one of the lawyers handling the lawsuit, said on a call with reporters Friday the organization is evaluating all of its options but doesn’t expect additional rulings until later this year at the earliest. 

“The 1st Circuit Court of Appeals has entered a briefing schedule on the preliminary injunction appeal that will be fully briefed by mid-November,” Humphreville said. “From there, the court will schedule oral argument and will at some point after the oral argument rule on the preliminary injunction appeal.”

Wisconsin already doesn’t allow immigrants without legal authorization to apply to BadgerCare. There are two programs, Medicaid Emergency Services and BadgerCare Plus Prenatal Plan, that will provide coverage for those without legal status. (Photo by Thomas Barwick/Getty Images)

A Republican bill that seeks to stop Wisconsin from using public funds to support health services for immigrants who lack legal authorization to reside in the U.S. is poised to advance on Tuesday. 

The bill — AB 308 — would prohibit state, county, village, long-term care district and federal funds from being used to subsidize, reimburse or provide compensation for any health care services for a person not lawfully in the U.S.

It is the latest bill that Republican lawmakers have introduced targeting immigrants. Another bill introduced and passed earlier this year seeks to require local law enforcement officers to cooperate with Immigration and Customs Enforcement. 

The bill is coauthored by Rep. Alex Dallman (R-Markesan) and Sen. Van Wanggaard (R-Racine) and currently has 25 other Republican cosponsors. No Democrats are signed onto the bill. 

During the bill hearing last week, Dallman focused mostly on Wisconsin’s Medicaid program, BadgerCare, arguing that he wants to prevent the state from ever taking steps similar to Minnesota and other states that expanded their Medicaid programs to cover immigrants who lack legal status. Wisconsin already doesn’t allow immigrants without legal authorization to apply to BadgerCare.

In 2023, Minnesota expanded its Medicaid program to cover residents without citizenship or legal residency status, but that was repealed after Republicans threatened a government shutdown to force Democrats to eliminate the expansion. 

The cost estimate for the program was nearly $200 million, Dallman noted.

“These are enormous price tags for individuals who are not here lawfully. This condition should not be the case here in Wisconsin with a state budget that is currently already very lean,” Dallman said. “We must prioritize our citizens over those who are here unlawfully. While Wisconsin currently does not allow undocumented immigrants to enroll in BadgerCare, this bill preemptively… ensures that Wisconsin does not become like Minnesota or Illinois.”

Dallman noted that the bill includes a carve out to ensure that it won’t lose Wisconsin money or put it out of step with federal law.

According to the Legislative Fiscal Bureau summary, the prohibitions in the bill would not apply to the extent that a payment is required under federal law or the application of the prohibitions would result in the loss of any federal funds.

“This bill is not about immigration,” Dallman said, but it is about “protecting our constituents and their hard-earned tax dollars that they send into our state.”

In written testimony, Wanggaard said the bill would extend the current restrictions to “all other health services paid for by the State of Wisconsin.” Wanggaard, who did not attend the public hearing, wrote that the bill would ensure Wisconsin “is not the next test dummy extending health benefits to illegal aliens.”

Democrats and advocates said they are concerned about the sweeping effects the bill could have on all Wisconsinites. 

William Parke-Sutherland, government affairs director at Kids Forward, said the bill would be unworkable as law and would affect every health care provider in the state.

“This bill is entirely short sighted, and nobody has thought about how this would create a state in which we do not want to live,” Parke-Sutherland said. “If a child is at the school and is sick, does the school nurse need to figure out how to verify their status before they provide any degree of care?… I just don’t think that people have thought through the consequences of us in Wisconsin having to live in a situation where we all need to carry our papers.” 

Parke-Sutherland noted that there are already strict citizenship requirements people need to meet to enroll in nearly all Medicaid programs.

The Wisconsin Department of Health Services (DHS) outlines the restrictions on its website as well as  two programs available to noncitizens. One is Medicaid Emergency Services, which provides short-term medical coverage for people who have a medical emergency and aren’t eligible for BadgerCare Plus or Wisconsin Medicaid, and the other is BadgerCare Plus Prenatal Plan, which provides health care coverage for pregnant mothers who are not eligible for BadgerCare Plus due to immigration status or being in prison or jail.

“This is trying to solve a problem that doesn’t exist, and it’s creating way, way, way more problems,” Parke-Sutherland said. “If you are creating a situation where you’re prohibiting funding for services for people who are unlawfully present, then you are creating a need for people to verify their status in order to receive health care.” 

In a fiscal analysis, the Department of Corrections said it is concerned the bill could violate the 8th Amendment. A 1976 Supreme Court decision in Estelle v. Gamble established that the deliberate failure to deal with an inmate’s medical needs constitutes cruel and unusual punishment. 

Wanggaard refuted the analysis in written testimony, saying the bill language means it would only apply to state programs that require enrollment. 

“It does not mean that, for example, an illegal immigrant in the state prison system could not receive health care services from DOC,” Wanggaard said. 

The language of the bill, however, says that “no funds of this state or of any county, village, town, or long-term care district… and no federal funds passing through the state treasury shall be authorized for or paid to any person to subsidize, reimburse, or otherwise provide compensation for any health care services for an individual who is not lawfully present in the United States.”

Rep. Karen Kirsch (D-Greenfield) said her Republican colleagues are taking a page from President Donald Trump and his administration by downplaying the effect of the bill. 

“They’re watching how Trump handles things,” Kirsch said. “They’re pushing the envelope on every interpretation of every word and every piece of legislation to go target people, to go after people… They’re watching how he handles things, and I think that they’re mimicking that at the state. They’re trying to make it sound like, ‘Well, this is all so reasonable. This is not a big deal. Don’t worry about it.’ And then if it passes, then we’re going to see it’s way… way worse.”

Kirsch said she is concerned about the potential “chilling effect” that the bill could have, discouraging individuals and families from seeking care when they need it. 

“[Republicans are] trying to raise this to the public consciousness, and then people are going to be confused,” Kirsch said. “‘Is this a way that they’re going to find me, if I’m an undocumented person?… Even if I do qualify for care, maybe something’s going to happen to me?’ It can have this overall chilling effect of confusion of whether or not people feel safe enough to get care.”

Kirsch took issue with the argument that the bill would protect taxpayers’ money. 

“When they do have access to health care, that also keeps our health care prices down because they’re not showing up in our emergency rooms, they’re doing preventative care, they’re taking care of their diabetes, and they’re not showing up with some serious diabetes complication in our emergency room,” Kirsch said. 

Kirsch also noted that undocumented immigrants pay sales tax and contribute to the state’s economy. She referenced a 2024 report from the University of Wisconsin School for Workers that found that undocumented immigrants specifically contributed $240 million in state and local taxes in 2022.

According to the Wisconsin Lobbying website, the American Civil Liberties Union of Wisconsin, Inc., Kids Forward, the Wisconsin chapter of the National Association of Social Workers, the Wisconsin Association of School Nurses and the Wisconsin Council of Churches are registered against the bill. The only group registered in favor is FGA Action, a Florida-based nonprofit that advocates for conservative policies in statehouses around the country.

David Gwidt, Deputy Communications Director for the ACLU of Wisconsin, said in a statement to the Examiner that the legislation if enacted “could result in absurd circumstances for medical and mental health providers across the state and exacerbate this fear and uncertainty experienced by our immigrant neighbors.” 

The Assembly State Affairs Committee plans to vote on whether to advance the legislation Tuesday, setting it up for a floor vote later this week.

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A customer enters a CVS store in October 2023 in Los Angeles. Pharmacies in Black and Latino neighborhoods and those with more residents on Medicaid are less likely to regularly dispense buprenorphine — one of the main medications used to treat opioid use disorder. (Photo by Mario Tama/Getty Images)

Pharmacies in Black and Latino neighborhoods are less likely to dispense buprenorphine — one of the main treatments for opioid use disorder — even though people of color are more likely to die from opioid overdoses.

The drug helps reduce cravings for opioids and the likelihood of a fatal overdose.

While the nation as a whole has seen decreases in opioid overdose deaths in recent years, overdose deaths among Black, Latino and Indigenous people have continued to increase.

Many medical and health policy experts fear the broad domestic policy law President Donald Trump signed in July will worsen the problem by increasing the number of people without health insurance. As a result of the law, the number of people without coverage will increase by about 10 million by 2034, according to the Congressional Budget Office.

About 7.5 million of the people who will lose coverage under the new law are covered by Medicaid. Shortly before Trump signed the bill into law, researchers from the University of Pennsylvania and Boston University estimated that roughly 156,000 Medicaid recipients will lose access to medications for opioid addiction because of the cuts, resulting in approximately 1,000 more overdose deaths annually.

Because Black and Hispanic people are overrepresented on the rolls, the Medicaid cuts will have a disproportionate effect on communities that already face higher barriers to getting medications to treat addiction.

From 2017 to 2023, the percentage of U.S. retail pharmacies regularly dispensing buprenorphine increased from 33% to 39%, according to a study published last week in Health Affairs.

But researchers found the drug was much less likely to be available in pharmacies in mostly Black (18% of pharmacies) and Hispanic neighborhoods (17%), compared with mostly white ones (46%).

In some states, the disparity was even worse. In California, for example, only about 9% of pharmacies in Black neighborhoods dispensed buprenorphine, compared with 52% in white neighborhoods.

The researchers found buprenorphine was least available in Black and Latino neighborhoods across nearly all states.

Barriers to treatment

Dr. Rebecca Trotzky-Sirr, a family physician who specializes in addiction medicine, said many communities of color are “pharmacy deserts.” Even the pharmacies that do exist in those neighborhoods tend to “have additional barriers to obtain buprenorphine and other controlled substances out of a concern for historic overuse of some treatments,” said Trotzky-Sirr, who wasn’t involved in the study.

In addition to its federal classification as a controlled substance, buprenorphine is also subject to state regulations to prevent illegal use. Pharmacies that carry it know that wholesalers and distributors audit their orders, which dissuades some from stocking or dispensing it.

Dima Qato, associate professor of clinical pharmacy at the University of Southern California and an author of the Health Affairs study, said that without changes in policy, Black and Hispanic people will continue to have an especially hard time getting buprenorphine.

“If you don’t address these dispensing regulations, or regulate buprenorphine from the aspect of pharmacy regulations, people are still going to encounter barriers accessing it,” she said.

In neighborhoods where at least a fifth of the population is on Medicaid, just 35% of pharmacies dispensed buprenorphine, Qato and her team found. But in neighborhoods with fewer residents on Medicaid, about 42% of pharmacies carried the drug.

Medicaid covers nearly half — 47% — of nonelderly adults who suffer from opioid use disorder. In states that expanded Medicaid under the Affordable Care Act, another recent study found an increase in people getting prescriptions for buprenorphine.

“Medicaid is the backbone of care for people struggling with opioid use disorder,” said Cherlette McCullough, a Florida-based mental health therapist. “We’re going to see people in relapse. We’re going to see more overdoses. We’re going to see more people in the ER.”

Qato said the shortage of pharmacies in minority communities is likely to get worse, as many independent pharmacists are already struggling to stay open.

“We know they’re more likely to close in neighborhoods of color, so there’s going to be even fewer pharmacies that carry it in the neighborhoods that really need it,” she said.

‘There needs to be urgency’

Qato and her colleagues say states and local governments should mandate that pharmacies carry a minimum stock of buprenorphine and dispense it to anyone coming in with a legitimate prescription. As examples, they point to a Philadelphia ordinance mandating that pharmacies carry the opioid overdose-reversal drug naloxone and similar emergency contraception requirements in Massachusetts.

“We need to create expectations. We need to encourage our pharmacies to carry this to make it accessible, same day, and there needs to be urgency,” said Arianna Campbell, a physician assistant and co-founder of the Bridge Center, a California-based organization that aims to help increase addiction treatment in emergency rooms.

“In many of the conversations I have with pharmacies, when I’m getting some pushback, I have to say: ‘Hey, this person’s at the highest risk of dying right now. They need this medication right now.’”

She said patients frequently become discouraged due to barriers they face in getting prescriptions filled. The Bridge Center has been expanding its patient navigator program across the state, and helping other states start their own. The program helps patients identify pharmacies where they can fill their prescription fastest.

“There’s a medication that can help you, but at every turn it’s really hard to get it,” she said, calling the disparities in access to medication treatment “unacceptable.”

Trotzky-Sirr, the California doctor, fears the looming Medicaid cuts will cause many of her patients to discontinue treatment and relapse. Many of her patients are covered by Medi-Cal, the state’s Medicaid program.

“A lot of our patients are able to obtain medications for treatment of addiction like buprenorphine, because of the state covering the cost of the medication,” said Trotzky-Sirr, who also is a regional coordinator at the Bridge Center.

“They don’t have the resources to pay for it, cash, out of pocket.”

Some low-income patients switch between multiple providers or clinics as they try to find care and coverage, she added. These could be interpreted as red flags to a pharmacy.

Trotzky-Sirr argued buprenorphine does not need to be monitored as carefully as opioids and other drugs that are easier to misuse or overuse.

“Buprenorphine does not have those features and really needs to be in a class by itself,” she said. “Unfortunately, it’s hard to explain that to a pharmacist in 30 seconds over the phone.”

More is known about the medication now than when it was placed on the controlled substances list about two decades ago, said Brendan Saloner, a professor at the Brown University School of Public Health.

Pharmacies are fearful of regulatory scrutiny and don’t have “countervailing pressure” to ensure patients get the treatments, he said.

On top of that fear, Medicaid managed care plans’ prior authorization processes may also be adding to the pharmacy bottleneck, he said.

“Black and Latino communities have higher rates of Medicaid enrollment, so to the extent that Medicaid prior authorization techniques are a hassle to pharmacies, that may also kind of discourage them [pharmacies] from stocking buprenorphine,” he said.

In some states, buprenorphine is much more readily available. In Maine, New Hampshire, Oregon, Rhode Island, Utah and Vermont, more than 70% of pharmacies carried the drug, according to the study. Buprenorphine availability was highest in states such as Oregon that have the least restrictive regulations for dispensing it.

In contrast, less than a quarter of pharmacies in Iowa, North Dakota, Texas, Virginia and Washington, D.C., carried the medication.

“We’re going to see more people becoming unhoused, because without treatment, they’re going to go back to those old habits,” McCullough, the Florida therapist, said. “When we talk about marginalized communities, these are the populations that are going to suffer the most because they already have challenges with access to care.”

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

This story was updated to include Brendan Saloner’s current academic affiliation.

Sen. Tammy Baldwin (D-Wis.) speaks Friday at a press conference to promote her legislation that would extend enhanced tax breaks on the cost of insurance purchased through the Affordable Care Act. Business owners Kyle LaFond, left, and Evan Dannells also spoke in favor of extending the tax credits. (Photo by Erik Gunn/Wisconsin Examiner)

Federal legislation that would hold down the cost of health insurance for millions of Americans and nearly a quarter-million Wisconsin residents has quiet support from Republicans in the Senate, according to Sen. Tammy Baldwin (D-Wisconsin).

So far, however, none of them have spoken out, Baldwin said at a news conference in Madison on Friday.

Baldwin has introduced a bill that would extend tax credits that have cut the health insurance costs for people who buy coverage on the federal marketplace, HealthCare.gov.

When the Affordable Care Act (ACA) was enacted in 2010 and the HealthCare.gov marketplace was launched to make it easier and cheaper for people without health insurance to buy coverage, the law included tax credits to lower the cost of premiums for people with incomes up to 400% of the federal poverty guideline.

In 2021, the premium tax credits were supercharged to impart far greater savings to people buying insurance through the marketplace. The enhanced tax credits were extended in 2022 with a sunset at the end of this year.

The extra tax breaks helped insurance coverage through the HealthCare.gov marketplace rise to record highs in the last few years, both in the U.S. and in Wisconsin.

“This tax break, the enhanced premium tax credit, saves more than 230,000 Wisconsinites an average of $500 every single month” on their insurance premiums, Baldwin said. “Not extending these tax breaks and jacking up costs on the open marketplace will crush families — but also small businesses that are the fabric of our communities.”

In January Baldwin and New Hampshire Sen. Jeanne Shaheen (D-N.H.) introduced legislation to make the enhanced tax credits permanent, in place of the lower tax credits that will resume when the enhanced credits expire Dec. 31.

A paper published Sept. 3 by the Georgetown University Law School Center on Poverty and Inequality reported that according to the Congressional Budget Office, without the enhanced credits 30 million more people will lack health insurance by 2034 — an average of 3.8 million a year.

For people with incomes between 100% and 150% of the federal poverty guideline, insurance premiums will go up by 7.9% between 2026 and 2034, the Georgetown researchers calculated.

For people with incomes between 150% and 400% of the federal poverty guideline, premiums would rise between 29% and 160% in the same period, according to the report.

The report also notes without the enhanced tax credits, people who lose Medicaid coverage due to cuts in the Republican megabill President Donald Trump signed on July 4 could be unable to afford insurance on HealthCare.gov.

‘Encouraged by conversations’

“There are, in the Senate, Republicans who have quietly indicated that they want to extend breaks to make [HealthCare.gov] marketplace insurance affordable,” Baldwin said. “I don’t have a count yet to tell you that we have enough, but I’m encouraged by the conversations I’m having.”

In the U.S. House, a bipartisan bill has been introduced extending the enhanced credits for a year — “notably getting them past the midterm elections,” Baldwin said. But that’s not long enough for her.

“I don’t think this should be political,” Baldwin said. “I think this should be something that Democrats and Republicans should agree on, that people should be able to afford their health care coverage.”

Baldwin’s press conference was held at Access Community Health Center, which serves low-income Wisconsin residents. Joining Baldwin, Madison chef and restaurant owner Evan Dannells said that the passage of the ACA and the opening of the HealthCare.gov marketplace made health care newly available in his industry after years of the youngest group of workers going uninsured.

Before the ACA, for people who entered hospitality jobs in their late teens or early 20s, “it was essentially, fundamentally understood that you wouldn’t have health care until you were in your 30s,” Dannells said.

The ACA required insurers to cover young people on their parents’ plans up to the age of 26, then made it possible for them to find more affordable coverage at HealthCare.gov after that.

“I have a half dozen full time employees over the age of 26 at a restaurant, and so what they’re going to do is they’re going to leave for corporate jobs that have the buying power to get their premiums down,” Dannells said — something not possible for small employers.

“This is essentially the beginning of the dismantlement of the Affordable Care Act with no plan and process for the future,” Dannells said.

Kyle LaFond, owner of a Middleton manufacturing firm that makes custom cosmetic products for celebrity brands, said the ACA and the HealthCare.gov was “a godsend” for small employers such as his company. “These subsidies are important because, of course, now more than ever, folks are living paycheck to paycheck,” he said.

Baldwin said she will campaign to attach her proposal to one of “several must-pass bills coming up in the days and the weeks ahead.”

Avoiding the ‘cliff’

While the enhancements increased the value of the tax credits for people with incomes up to 400% of the poverty guideline, they also made tax credits available for the first time to people with higher incomes — up to more than 1000% of the guideline.

Baldwin told the Wisconsin Examiner that those higher income groups were added to avoid “what we call a cliff.” That occurs when a person’s income rises even slightly above a benefit’s income ceiling — suddenly cutting off the benefit and possibly demanding they make a repayment. Many safety-net programs have cliffs, she explained.

In Wisconsin, most Medicaid programs have income limits, and many are only available to people with incomes up to the federal poverty guideline, she said. People who may work several part-time jobs and usually qualify for Medicaid can find themselves kicked off the program if they have a brief boost in their income, due to overtime work, for instance.

“Then you have to do all sorts of work to get back on, and then you have to be very mindful that you don’t get an extra hour or a raise” that could lead to being kicked off again, Baldwin said.

“So we were trying to avoid there being the sort of equivalent cliff in the Affordable Care Act marketplace tax credits,” Baldwin said.

For that reason, her bill would continue the tax credits available to the higher income population, she said, “and I would be committed to not reintroducing a cliff.”

Baldwin criticized GOP lawmakers for passing the Republican megabill that extended Trump’s 2017 tax cuts without considering an extension of the enhanced ACA credits.

“You would think including tax breaks for tens of millions of families to afford health care would be a centerpiece of that legislation. Right? Wrong,” Baldwin said.

Instead, she charged, the bill made cuts to Medicaid and the federal nutrition program SNAP to pay for tax cuts “in favor of the biggest corporations and the wealthiest Americans.”

 

A pharmacy advertises COVID-19 testing and vaccinations on Sept. 4 in the Brooklyn borough of New York City. Several states, including New York, are breaking with restrictive eligibility policies the U.S. Food and Drug Administration has imposed on newly approved COVID-19 vaccines for the fall season. (Photo by Spencer Platt/Getty Images)

Several states, including Colorado, Massachusetts, New Mexico, New York and Pennsylvania, announced this week that they would be breaking with restrictive eligibility policies unveiled last week by the U.S. Food and Drug Administration on the newly approved COVID-19 vaccines for the fall season.

In New York, Democratic Gov. Kathy Hochul signed an executive order Friday morning to authorize pharmacists to provide the shot to anyone who desires it for the next 30 days, which can be renewed.

“When they said that they are not going to be requiring COVID shots and other vaccinations for our families, I said, ‘No, here in New York we will make parents have the option.’ If you want your child to have a COVID shot, it should be available to you and it should be covered by insurance,” Hochul said during a news conference Friday morning, where she signed the order.

“So what I’m doing now is signing an executive order, because extreme times call for extreme measures. And this is the power I have to use in the interim until we are able to have the legislature get back in January and pass legislation that mandates this.”

Previous FDA policy recommended that COVID-19 vaccine booster shots be made available to anyone 6 months or older regardless of their health status. But in August, the federal agency announced restrictions for the new shot.

The FDA limited access to the vaccines to people who are 65 and older and to younger people with at least one underlying health condition, such as asthma or obesity, that would put them at risk of developing a severe illness without a booster shot. Children are eligible only if a medical provider is consulted. Additionally, the Pfizer vaccine, one of the three that were approved, will no longer be available for any child under 5.

“The American people demanded science, safety, and common sense. This framework delivers all three,” U.S. Health and Human Services Secretary Robert F. Kennedy Jr. wrote on social media platform X on Aug. 27.

Other states are also taking measures to ensure more people can get access to the vaccines.

On Thursday, Massachusetts Democratic Gov. Maura Healey ordered health insurers in the state to continue covering the vaccine. The state also issued an order to allow pharmacies to continue providing shots to residents above the age of 5.

Massachusetts is “leading efforts to create a public health collaboration with states in New England and across the Northeast committed to safeguarding public health as the federal government backs away from its responsibilities,” the governor’s office said in a release.

This week, the State Board of Pharmacy in Pennsylvania held a special meeting to vote to bypass federal vaccine recommendations and allow pharmacists to continue administering COVID-19 vaccines.

“Health care decisions should be up to individuals — not the federal government and certainly not RFK Jr. My Administration will continue to protect health care access for all Pennsylvanians,” Pennsylvania Democratic Gov. Josh Shapiro said.

Colorado and New Mexico took similar steps this week, with state officials signing public health orders asking state agencies to take steps necessary to require insurers to cover the vaccines and instructing pharmacists to provide the shots without a doctor’s note.

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

Jimmy Novy, 77, hangs onto a canopy to hold himself up July 29, 2025, in Hillsboro, Wis. Novy is one of 312 permanently and totally disabled individuals in Wisconsin and has been collecting worker’s comp checks from the state since his injury in his late 20s. (Photo by Joe Timmerman/Wisconsin Watch)

Jimmy Novy grew up on a farm with corn, cattle and chickens in Wisconsin’s smallest municipality. Yuba, in the Driftless Area northwest of Madison, covers a third of a square mile. Novy correctly quotes its population in the last census: 53.

In 1967, at age 19, married with a child, Novy got a job at the Rayovac plant in nearby Wonewoc. It made batteries used in walkie-talkies in the Vietnam War.

In his late 20s, Novy learned he had been exposed to manganese, a key component in batteries. He suffered neurological problems that affected his left leg, severely limiting his ability to walk or even maintain his balance.

“The nerves from the brain to my leg, they can’t do nothing about that,” he said.

With four children to raise, Novy turned to Wisconsin’s first-in-the-nation worker’s compensation system. After three years of legal back-and-forth, the state agreed that Novy was permanently and totally disabled (PTD), meaning he was among the worst-off of Wisconsin workers injured on the job. As a result, he qualified for worker’s comp checks for life.

But there was no guarantee of how often those checks would increase.

Now 77, widowed, remarried and using hearing aids and a cane, Novy hasn’t seen an increase in his $1,575 monthly worker’s compensation check — nor have the other more than 300 other PTD recipients — since 2016.

“I can’t make it,” Novy told Wisconsin Watch in mid-July. “I got $8 left in my checkbook right now to last me through the last week of the month.”

“The wife buys food and stuff, otherwise I’d be starving to death,” he added.

Had Novy’s worker’s comp payment kept pace with inflation, which rose 34%, he would have received nearly $21,000 more over the past nine years, according to calculations by University of Wisconsin-Madison economist Menzie Chinn.

Meanwhile, Wisconsin employers have seen their premiums for worker’s compensation insurance decrease 10 years in a row, saving them $206 million in the past year and over $1 billion since 2017, according to the Wisconsin Hospital Association, which is part of the state Worker’s Compensation Advisory Council.

Twenty-three states, including Illinois, Michigan and Minnesota, provide automatic cost-of-living raises for PTD recipients. In Wisconsin, raises have been provided only when they are included in a wide-ranging worker’s compensation “agreed bill,” proposed every two years, and only if the bill becomes law.

That moment might be at hand.

The advisory council has recommended raises for PTD recipients in the next agreed bill, which is being drafted.

The bill still has to be approved by the Republican-controlled Legislature and signed by Democratic Gov. Tony Evers.

Making history, creating PTD raises

In 1911, Wisconsin became the first state to adopt a comprehensive worker’s compensation law that was upheld as constitutional. Before that, the burden was on the worker to prove that a job injury was the employer’s fault. Now it’s a no-fault system. Workers injured on the job can receive regular payments based on their salary, plus coverage of medical bills to treat their injuries.

Wisconsin’s system has received high marks for getting injured workers back on the job quickly and for worker satisfaction in health care for their injuries.

The money for worker’s compensation checks comes from worker’s compensation insurance companies and from employers who are self-insured for worker’s comp. No tax dollars are involved.

About 21,000 people annually receive Wisconsin worker’s comp checks, the vast majority of them for a temporary period. Only about 500 people receive PTD benefits, and only 300 of them, like Novy, are eligible for raises.

That’s because the 2016 agreed bill limits raises, known as supplementary benefits, only to PTD recipients injured before Jan. 1, 2003.

How PTD raises are decided

The process that determines whether PTD raises are granted is not unlike the bargaining that an employer and a union do to reach a contract. Both sides have priorities, and there is horse trading and eventually compromise, at least on some issues.

The Worker’s Compensation Advisory Council is composed mainly of five representatives from management and five from organized labor, though it also includes nonvoting members representing insurance, health care and the Legislature.

Every odd year, the council develops a bill proposing multiple changes to worker’s comp. The process typically takes months of negotiations, said John Dipko, the council’s non-voting chair and administrator of worker’s compensation for the state Department of Workforce Development.

If approved by the Legislature and the governor, the bill becomes law the next year.

That process has produced 11 PTD raises since 1972. The 2016 raise put the maximum PTD payment at $669 per week.

‘The most severely changed’

Circumstances have left PTD recipient Scott Meyer better off financially than Novy, but delays in raises have forced Meyer to dip into savings and, as his health conditions worsen, worry about the future.

Meyer grew up outside of Milwaukee, playing in the woods and farm fields of rural Washington County. He was a member of the hockey team at West Bend West High School.

In 1993, at age 19, Meyer was working on a loading dock when a co-worker backing a semi-trailer pinned Meyer between the trailer and the dock. Meyer closed his eyes and tried to remain calm, thinking his right leg was broken.

“One of the paramedics in the ambulance thought that I was unconscious and said to the other paramedic that this was going to be his first fatality call,” Meyer recalled. “And I immediately then knew that something more major had happened.”

Meyer underwent multiple surgeries, spent more than a year in the hospital and dropped to under 100 pounds. He was left a paraplegic.

Though unable to work, Meyer became an Alpine skier in Colorado, where he now lives, competing in the 2014 Paralympics in Sochi, Russia.

Meyer, 51, said he receives about $2,300 per month from worker’s compensation – nearly $370 per month less than what he was paid on the job in 1993.

Meyer, who owns a condominium with his wife, a mental health therapist, said he has been able to live comfortably only by preserving savings, including from a one-time payout he received from his former employer for his injury. But with no raises in nine years, he has had to dip into savings to get by.

Earlier this year, both Novy in an email and Meyer in a video asked the Worker’s Compensation Advisory Council to recommend raises for PTD recipients.

“These are people whose lives are the most severely changed and are legitimately dependent upon these funds,” Meyer told Wisconsin Watch. “We’re talking about pennies on the dollar to the kind of money that is in the system.”

The process that results in PTD raises involves negotiations on a variety of worker’s compensation issues. That has made the road to another raise rocky in recent years.

Delayed raises and a possible breakthrough

The Worker’s Compensation Advisory Council’s agreed bill for 2018 would have raised the maximum weekly PTD payment to $711 from $669 and made more PTD people eligible for raises. But the bill also proposed a “fee schedule,” generally opposed by health care organizations, to limit how much health care providers can charge for worker’s comp care. The bill did not pass the Legislature.

Since then, the labor side of the advisory council continued to propose PTD raises, while the management side continued to seek a fee schedule. Wisconsin is one of only a handful of states without one. The two sides did not agree to include PTD raises in their 2020, 2022 and 2024 agreed bills.

A key barrier was cleared when a fee schedule for worker’s comp was included in the 2025-27 state budget adopted in July.

Days later, the advisory council proposed raises for current PTD recipients and made more PTD recipients eligible for raises.

Under the 2026 agreed bill, the injury date for PTD recipients to be eligible for raises would change from Jan. 1, 2003, to Jan. 1, 2020 — making an estimated 210 more people eligible for raises.

The bill would also raise the maximum weekly benefit for PTD recipients to $1,051 from $669 effective Jan. 1, 2026.

And it would add raises each Jan. 1, though those amounts would not be set until shortly before they become effective.

For individuals, the raise amounts would vary based on when they were injured.

For example, a PTD recipient injured in 1985 and receiving $535 a week would get a 57% increase to $840. The increase would amount to nearly $16,000 per year.

Once it’s drafted, the new agreed bill would need a final vote from the advisory council, which is expected in September. Then the bill would be submitted to the labor committees of the state Senate and Assembly.

Council management representatives didn’t reply to calls and emails requesting comment. Wisconsin AFL-CIO President Stephanie Bloomingdale, the lead labor representative, said she understands the frustration over delayed raises. But she said the advisory council system, with management and labor hashing out worker’s compensation issues, provides stability.

Without it, “it would be up to the Legislature, and the whims of the political winds would determine the policy,” she said.

Dipko, the DWD administrator, said the department is sympathetic.

“We agreed that an increase is overdue,” he said.

After waiting this long, Novy isn’t sure what to think. He’s happy he and wife share a $125,000 brick house they own “with the bank,” as he puts it, and for his monthly $1,635 Social Security check, which increases each year. But he has filed for bankruptcy three times, most recently in 2020. He feels that at this stage of his life, he should be more secure, and a raise in worker’s comp would help.

“The Legislature should be — forget Republican, Democrat — just vote for what’s good,” he said.

“I can’t see how come they can’t give us a little raise every year,” he added.

This article first appeared on Wisconsin Watch and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.  To republish, go to the original and consult the Wisconsin Watch republishing guidelines.

A 3-year-old girl gets an MMR vaccine at a clinic in Texas in March. Texas was among the states with the most public funding grants canceled by the Trump administration earlier this year. (Photo by Jan Sonnenmair/Getty Images)

After the Trump administration slashed billions in state and local public health funding from the federal Centers for Disease Control and Prevention earlier this year, the eventual impact on states split sharply along political lines.

Democratic-led states that sued to block the cuts kept much of their funding, while Republican-led states lost the bulk of theirs, according to a new analysis from health research organization KFF.

The uneven fallout underscores how politics continues shaping health care in the United States. The nearly 700 CDC grants were worth about $11 billion and had been allocated by Congress during the COVID-19 pandemic. Since then, state and local health departments had spent or planned to spend the money not just on COVID-related efforts, but also on prevention of other infectious diseases, support for mental health and substance use, shoring up aging public health infrastructure, and other needs.

The CDC grant terminations initially affected red and blue states about evenly, according to KFF. California, the District of Columbia, Illinois and Massachusetts — all led by Democrats — had among the largest numbers of terminated grants.

But then nearly two dozen blue states and the District of Columbia sued the Trump administration in April, asking the court to block the grant terminations. They argued the federal government lacked the authority to rescind funding it had already allocated.

“The Trump administration’s illegal and irresponsible decision to claw back life-saving health funding is an attack on the well-being of millions of Americans,” said New York Attorney General Letitia James in an April statement announcing the lawsuit.

“Slashing this funding now will reverse our progress on the opioid crisis, throw our mental health systems into chaos, and leave hospitals struggling to care for patients.”

A federal judge sided with the blue states and blocked the cancellations  — but she limited her injunction to the jurisdictions that filed in the lawsuit.

Nearly 80% of the grant cuts have now been restored in blue states, according to the KFF analysis, compared with less than 5% in red states.

Now four of the five states with the most canceled grants are led by Republicans: Georgia, Ohio, Oklahoma and Texas. California, which is dominated by Democrats, kept all of its grants that had been initially terminated.

In the West and Midwest, Democratic-led Colorado — which joined the lawsuit — had 10 of its 11 grant terminations reversed. Its Republican-led neighbors that did not sue, including Kansas, Nebraska, Oklahoma, Utah and Wyoming, lost all of their grants, according to the KFF analysis.

Editor’s note: This story has been updated to correct the photo caption. Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org

A man waits for health care at a temporary health clinic in Terre Haute, Ind. President Donald Trump’s new tax and spending law will likely force more than half the states to reduce payments to doctors and hospitals that treat Medicaid patients, a change critics warn could reduce health care options for people in rural areas. (Photo by Spencer Platt/Getty Images)

President Donald Trump’s new tax and spending law will likely force more than half the states to reduce payments to doctors and hospitals that treat Medicaid patients, a change critics warn will be particularly harmful to rural hospitals struggling to stay afloat.

Medicaid, the joint state-federal health insurance program for low-income people, reimburses doctors, hospitals and nursing facilities for treating enrollees. But in many cases, the program doesn’t fully cover the cost of care, straining providers that serve a large share of Medicaid patients.

To help providers cover losses and continue to serve poorer populations, the federal government allows the 41 states, plus the District of Columbia, that have contracted with Medicaid managed care organizations (MCOs) to run their Medicaid programs to direct them to pay providers more — in some cases, as much as commercial plans.

Ultimately, taxpayers cover the costs of these so-called state directed payments — and those costs are growing. As of August 2024, the higher payments were projected to add $110.2 billion per year to Medicaid spending, nearly 60% more than the previous year’s projection.

That higher spending attracted the attention of conservatives on Capitol Hill.

Beginning in 2028, the One Big Beautiful Bill Act will cap the payments, forcing state Medicaid programs to reduce reimbursement rates by 10 percentage points each year until they reach either 100% or 110% of what Medicare pays. States that expanded Medicaid under the Affordable Care Act would be capped at the lower rate.

The new law will reduce Medicaid spending by $149 billion over the next decade, according to the Congressional Budget Office, and reduce Medicaid provider payments in as many as 31 states, according to KFF, a health policy research group. A separate analysis by The Commonwealth Fund, another research group, found that Medicaid payments to hospitals would drop by at least 20% in 19 of the 25 states that had publicly available data.

Critics say the change could be disastrous for hospitals, many of them in rural areas, that see a large share of Medicaid patients.

“This is all on top of an already pretty strained financial situation for rural hospitals,” Alexa McKinley Abel, director of government affairs and policy at the National Rural Health Association, a group representing rural health care providers, said in an interview. “We are worried about seeing service line closures at hospitals in an environment where OB-GYN and chemotherapy service lines are already being cut.”

Covering the cost of care

Supporters of the change say the extra payments inflate federal spending on the Medicaid program, giving hospitals “windfall profits.”

“Not only do these programs sidestep the truly needy on Medicaid and favor special interests instead, but all this is financed by growing the federal debt, leading to inflation and higher interest rates for all Americans,” the Paragon Health Institute, a conservative think tank that helped draft the bill, stated in a policy brief.

Hospital leaders dispute that. Earlier this year, the American Hospital Association asserted that without the extra payments, Medicaid managed care organizations in 2023 only covered about two-thirds of the actual cost of care.

Cindy Samuelson, senior vice president of the Kansas Hospital Association, said the additional payments are especially critical in a rural state such as Kansas, where some researchers have found that 87% of rural hospitals are in the red. Kansas is one of 10 states that did not expand Medicaid, and like other nonexpansion states, it will have to begin reducing direct payments to 110% of what Medicare pays starting in 2028.

“Over time, commercial payers are paying less and less,” Samuelson said. “Many hospitals in our state are at risk of closure.”

Samuelson said that in rural areas, health care providers see fewer patients, which makes it hard to spread out the cost of care and make up for losses that come from serving underinsured, Medicaid and Medicare patients. One result is that rural hospitals are trimming services. A report published this year by Chartis, a health care consulting firm, found that between 2011 and 2023, nearly 300 rural hospitals across the country stopped offering obstetrics care, and 424 rural hospitals ceased chemotherapy services.

In Hutchinson, Kansas, Benjamin Anderson, CEO of the rural and community-owned Hutchinson Regional Health System, said his hospital barely broke even this year, and lower Medicaid payments will take a toll. The 190-bed hospital serves more than 65,000 people in the central Kansas region, and sees a lot of patients who are struggling with mental health issues and substance use disorders.

“We are closely managing our workforce expenses. We’re going to be relying more heavily on philanthropy,” Anderson said, adding that the hospital wouldn’t lay off staff but would reduce the number of workers by not filling open positions.

He said his hospital has some cash reserves that should enable it to keep going, but that many other rural hospitals lack such a cushion.

“When we think about the cuts to Medicaid, it isn’t simply about cutting services to the poor. It’s threatening services to everyone, because in a rural community, we all get care in the same place,” he said. “If we cut out the safety net that’s sustaining these hospitals, everyone’s health care is threatened.”

Searching for answers

Three hours northeast of Hutchinson is the rural town of Holton, where about 3,400 people live. Holton Community Hospital is a 14-bed critical access hospital, meaning that it provides emergency care around the clock for a rural community. For the past two years, it has been struggling, according to Carrie Lutz, the hospital’s CEO.

Lutz said the hospital is not part of a broader health care group, and it relies on philanthropy and local taxes. Due to financial strains, it’s in the process of selling off its home and hospice services to another health care facility. The cap on extra payments will be an additional barrier, she said.

Samuelson said Kansas is applying for money under the five-year, $50 billion Rural Health Transformation Program, which Congress added to the One Big Beautiful Bill Act amid concerns about its impact on rural hospitals. She expects Kansas to get at least $500 million between 2026 and 2030.

Rural hospitals in Mississippi also hope to tap into those funds. The Mississippi Hospital Association, which is advising state leaders on their application, said it expects Mississippi to get at least $500 million over the next five years.

Like Kansas, Mississippi did not expand Medicaid under the Affordable Care, a decision that deprived it of additional Medicaid patients and thus extra revenue.

“A few years ago, we had several rural hospitals that were facing some imminent closure challenges, and so our enhanced supplemental payment based on the average commercial rate has been a lifeline,” said Richard Roberson, president and CEO of the Mississippi Hospital Association.

“What we’re concerned about is that when those payments start to decrease, then we’re going to be right back to where we were in 2022, with concerns about rural hospitals again.”

Roberson said Medicaid, with the additional payments, had become “one of the best payers, if not the best payer, for our hospitals over the last two years,” and helped a lot of hospitals stay out of the red.

He said the new rural health care fund is promising, but noted that Mississippi will decide where to spend any money it gets, and some rural hospitals might miss out.

“We want to make sure we’re working with the state to provide sustainable solutions, not one-time fixes,” Roberson said. “The big wild card is the Rural Health Transformation fund and what the state chooses to do with that money.”

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

Health and Human Services Secretary Robert F. Kennedy Jr. appears before the Senate Finance Committee at the Dirksen Senate Office Building on Sept. 4, 2025 in Washington, D.C. (Photo by Andrew Harnik/Getty Images)

WASHINGTON — Health and Human Services Secretary Robert F. Kennedy Jr.  vehemently defended his actions on vaccines and other public health issues under questioning by both Republican and Democratic senators during a contentious hearing Thursday.

Kennedy, confirmed on a mostly party-line vote earlier this year, repeatedly justified firing everyone on an influential vaccine advisory panel, as well as the president’s decision to remove a Centers for Disease Control and Prevention director who’d served for less than a month after confirmation by the Senate.

“In your confirmation hearings, you promised to uphold the highest standards for vaccines. Since then, I’ve grown deeply concerned,” said Senate Majority Whip John Barrasso, R-Wyo. “The public has seen measles outbreaks. Leadership of the National Institutes of Health questioning the use of mRNA vaccines. The recently confirmed director of the Centers for Disease Control and Prevention fired. Americans don’t know who to rely on.”

Video courtesy of C-SPAN.

Barrasso, an orthopedic surgeon, sought to reinforce support for vaccines to Kennedy during the Senate Finance Committee hearing, saying they “are estimated to have saved 154 million lives worldwide.”

Louisiana Republican Sen. Bill Cassidy, a physician who received several concessions from Kennedy in exchange for voting to confirm him as HHS secretary, raised numerous questions about Kennedy’s behavior. Cassidy is the chairman of the Health, Education, Labor and Pensions Committee.

Cassidy appeared to box in Kennedy on the COVID-19 vaccine by saying President Donald Trump should receive the Nobel Prize for Operation Warp Speed, which led to the development of the shot during his first term. 

Kennedy agreed Trump should “absolutely” get the prize, leading Cassidy to question why he’d taken actions as HHS secretary to erode trust and eliminate funding for vaccine development activities. 

“It surprises me that you think so highly of Operation Warp Speed when, as an attorney, you attempted to restrict access,” Cassidy said. “It also surprises me because you’ve canceled, or HHS did, but apparently under your direction, $500 million in contracts using the mRNA vaccine platform that was critical to Operation Warp Speed.”

Cassidy said the cancellation represents not only “an incredible waste of money but it also seems like a commentary upon what the president did in Operation Warp Speed, which is to create a platform by which to create vaccines.”

Cassidy also questioned Kennedy’s actions eliminating everyone on the CDC’s Advisory Committee on Immunization Practices and replacing them with his own choices. 

“If we put people who are paid witnesses for people suing vaccines, that actually seems like a conflict of interest,” Cassidy said. 

Kennedy disagreed, testifying that “it may be a bias. And that bias, if disclosed, is okay.”

Tillis asks RFK Jr. to respond in writing

North Carolina Republican Sen. Thom Tillis asked Kennedy a series of questions but said he wanted the secretary to submit his answers in writing in order to clarify several of his positions. 

“Some of your statements seem to contradict what you said in the prior hearing,” Tillis said. “You said you’re going to empower the scientists at HHS to do their job. I’d just like to see evidence where you’ve done that, and I’m sure that you will have some.”

Tillis said he wanted Kennedy to respond to reports that he’s gone back on his commitments to senators to not do anything “that makes it difficult or discourages people from taking vaccines” and that Kennedy would not “impose my belief over any of yours.”

“That, again, seems to be contradictory to the firing of the CDC director, the canceling of mRNA research contracts, firing advisory board members, attempting to stall NIH funding, eliminating funding for I think a half a billion dollars for further mRNA research,” he said, referring to the National Institutes of Health. 

Tillis said he was having difficulty understanding why former CDC Director Susan Monarez, whom Trump nominated in March and the Senate voted to confirm in late July, had been fired so quickly. 

“I don’t see how you go … from a public health expert with unimpeachable scientific credentials, a long-time champion of MAHA values, caring and compassionate and brilliant microbiologist — and four weeks later, fire her,” Tillis said. 

CDC shooting, Monarez firing probed

Georgia Democratic Sen. Raphael Warnock questioned Kennedy at length over the firing of Monarez as well as a shooting at the Atlanta-based agency this summer. 

Kennedy testified that he doesn’t believe he criticized Monarez during a meeting in late August over her comments following the CDC shooting that “misinformation can be dangerous.”

During that meeting, Kennedy said he did demand that Monarez fire career CDC scientists but testified he didn’t tell her to accept the recommendations of the vaccine advisory panel without further review.

“What I asked her about is, she had made a statement that she was going to not sign on and I wanted clarification about that,” Kennedy said. “I told her I didn’t want her to have a role if she’s not going to sign onto it.”

Monarez wrote in an op-ed published in the Wall Street Journal just hours before the hearing began that during the meeting with Kennedy she “was told to preapprove the recommendations of a vaccine advisory panel newly filled with people who have publicly expressed antivaccine rhetoric.”

“That panel’s next meeting is scheduled for Sept. 18-19,” Monarez wrote. “It is imperative that the panel’s recommendations aren’t rubber-stamped but instead are rigorously and scientifically reviewed before being accepted or rejected.”

Warnock asked Kennedy if he said that the CDC was the “most corrupt federal agency in the history of the world.” 

Kennedy testified he didn’t say that exactly but did say “it’s the most corrupt agency at HHS and maybe the government.” 

Warnock concluded his five minutes of questions telling Kennedy that “it’s clear you’re carrying out your extremist beliefs” and that he represents “a threat to the public health of the American people.”

“For the first time, we’re seeing deaths from children from measles,” Warnock said. “We haven’t seen that in two decades. We’re seeing that under your watch. You are a hazard to the health of the American people.”

Lankford, Daines ask about medication abortion

Several senators, including Oklahoma Republican James Lankford and Montana Republican Steve Daines, asked Kennedy about the ongoing review of mifepristone, one of two prescription pharmaceuticals used in medication abortion. 

Kennedy said he spoke with FDA Commissioner Marty Makary about the topic just yesterday and committed to keeping senators informed, but didn’t appear to know much more than that. 

“I don’t know if they’re going to do an insurance claim study. That’s one way to do it. I don’t know exactly whether they’re doing epidemiological studies or observational studies. I don’t know exactly what they’re doing,” Kennedy said. “But I know I talked to Marty Makary about it yesterday, and he said those studies are progressing and that they’re ongoing. So I will keep your office informed at every stage.”

Kennedy testified that he didn’t know when exactly the studies would be completed. 

The FDA first approved mifepristone in 2000 before updating the prescribing guidelines in 2016 and during the coronavirus pandemic. 

It’s currently approved for up to 10 weeks gestation and can be prescribed via telehealth and shipped to patients. Mifepristone is the first pharmaceutical of medication abortion and is typically followed by misoprostol. 

Medication abortion accounted for about 64% of all abortions in 2023, according to research from the Guttmacher Institute. 

The Supreme Court rejected an effort to limit access to medication abortion last year in a case originally filed by four anti-abortion medical organizations and four anti-abortion doctors that were represented by Alliance Defending Freedom.

Justice Brett Kavanaugh wrote the opinion that “federal conscience laws have protected pro-life doctors ever since FDA approved mifepristone in 2000.”

Numerous medical organizations, including the American College of Obstetricians and Gynecologists and the American Medical Association, wrote briefs to the Supreme Court in that case attesting to the safety and efficacy of mifepristone. 

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

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There are not tens of millions of unauthorized immigrants in the U.S. receiving federal health care benefits.

The unauthorized population reached a record 14 million in 2023, according to an August 2025 research estimate. 

Unauthorized immigrants are not eligible to enroll in federally funded health coverage. 

That includes Medicaid (low-income people), Medicare (age 65 and over) and the Children’s Health Insurance Program (CHIP). And they aren’t eligible to buy coverage through the Affordable Care Act (Obamacare) marketplaces.

Federal Medicaid can reimburse hospitals for providing emergency care to unauthorized immigrants, but that is not coverage for individuals.

Vice President JD Vance said Aug. 28 in La Crosse, Wisconsin, that health care benefits can’t be sustained “if you allow tens of millions of people” into the U.S. without authorization “and give them those benefits.”

White House spokespersons did not return requests for comment.

This fact brief is responsive to conversations such as this one.

Sources

• Pew Research Center: U.S. Unauthorized Immigrant Population Reached a Record 14 Million in 2023
• Congressional Research Service: Noncitizens’ Access to Health Care
• Migration Policy Institute: Immigrants’ Eligibility for U.S. Public Benefits: A Primer
• KFF: Key Facts on Health Coverage of Immigrants
• Migration Policy Institute: Immigrants and the Use of Public Benefits in the United States
• HealthCare.gov: Health coverage for immigrants
• KFF: 5 Key Facts About Immigrants and Medicaid
• Right Side Broadcasting Network: Vice President JD Vance Delivers Remarks in La Crosse, WI – 8/28/25

Do tens of millions of unauthorized immigrants receive federal health benefits? 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 health care worker fills a syringe with the MMR vaccine at a vaccine clinic in Texas in March. Florida announced plans to end all state vaccine mandates, while three Western states — California, Oregon and Washington — are forming an alliance to issue their own vaccine guidelines amid federal upheaval. (Photo by Jan Sonnenmair/Getty Images)

The Democratic governors of California, Oregon and Washington said Wednesday they are forming an alliance to coordinate vaccine recommendations for their states.

Meanwhile, Florida announced plans to become the first state to phase out all vaccine mandates, including ending requirements that kids be vaccinated against dangerous diseases before enrolling in schools.

Public health experts have relied on vaccines, including school mandates, for decades to limit the spread of communicable diseases and keep kids and adults safe.

The contrasting moves come amid turmoil at the U.S. Centers for Disease Control and Prevention, where several top leaders resigned last week to protest efforts by Health and Human Services Secretary Robert F. Kennedy Jr., a vaccine skeptic, to dismiss CDC Director Susan Monarez for pushing back against Kennedy’s vaccine policies.

Accompanied by Florida Republican Gov. Ron DeSantis, state Surgeon General Dr. Joseph A. Ladapo said at a news conference Wednesday that vaccine mandates are “wrong” and “immoral,” the Florida Phoenix reported.

“Your body is a gift from God. What you put into your body is because of your relationship with your body and your God,” Ladapo said.

“They do not have the right to tell you what you put in your body. They don’t have the right to tell you what your kids have to put in [their] body. They do not have the right. Do not give it to them. Take it away from them. And we’re going to be starting that here in Florida.”

The Florida Department of Health can eliminate some vaccine mandates on its own, Ladapo said, but the Florida legislature would have to scrap other ones. He did not mention specific vaccines, but repeated that his goal was to end “all of them. Every last one of them.”

“Every last one of them is wrong and drips with disdain and slavery,” Ladapo said.

The goal of the new West Coast Health Alliance, governors said, is to disseminate evidence-based recommendations about who should get immunized, as well as to provide vaccine education throughout the three states. In the coming weeks, the states will coordinate and finalize immunization guidelines that are in line with leading medical organizations.

In their announcements, California Gov. Gavin Newsom, Oregon Gov. Tina Kotek and Washington Gov. Bob Ferguson criticized recent Trump administration actions, including the firing of scientists and the upheaval at the CDC.

“When federal agencies abandon evidence-based recommendations in favor of ideology, we cannot continue down that same path,” Washington Secretary of Health Dennis Worsham said in a statement.

Worsham added that “public health at its core is about prevention — preventing illness, preventing the spread of disease, and preventing early, avoidable deaths.”

Last week, the U.S. Food and Drug Administration restricted access to updated COVID-19 shots. In June, Kennedy ousted all 17 members of the vaccine advisory committee at the CDC, replacing them with some members who are vaccine skeptics. Many states rely on the committee to form vaccination guidelines.

And in May, Kennedy rescinded recommendations for children and pregnant women to get vaccinated against COVID-19 — sidestepping the usual process for issuing official recommendations.

The three Western states said the “dismantling” of the CDC has created “a vacuum of clear, evidence-based vaccine guidance,” hampering health care providers, disrupting manufacturers’ production plans and creating uncertainty for families.

In 2020, at the start of the COVID-19 pandemic, the three states, along with Nevada, created a similar workgroup that emphasized the scientific rigor behind the Pfizer COVID-19 vaccine in an effort to boost confidence in the shot.

“President Donald Trump’s mass firing of CDC doctors and scientists — and his blatant politicization of the agency — is a direct assault on the health and safety of the American people,” the joint statement from the three governors’ offices said.

“The CDC has become a political tool that increasingly peddles ideology instead of science, ideology that will lead to severe health consequences. California, Oregon, and Washington will not allow the people of our states to be put at risk.”

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

Florida Surgeon General Joseph Ladapo and his boss, Gov. Ron DeSantis, want to eliminate all vaccine mandates from Florida law as well as rules and regulations. (Stock photo by Getty Images)

School children, college students, and even nursing home residents would no longer have to be vaccinated against infectious diseases and viruses if Florida Surgeon General Joseph Ladapo and his boss, Gov. Ron DeSantis, have their way.

The DeSantis administration rolled out the proposed change on Wednesday and, if they’re successful, the state would be the first in the nation to completely eliminate vaccine requirements that many health experts credit with nearly eliminating some diseases.

“Your body is a gift from God. What you put into your body is because of your relationship with your body and your God,” said Ladapo, attacking the government mandates.

“It’s wrong, it’s immoral. They do not have the right to tell you what you put in your body. They don’t have the right to tell you what your kids have to put in [their] body. They do not have the right. Do not give it to them. Take it away from them. And we’re going to be starting that here in Florida.”

’Choose a side’

Neither Ladapo nor DeSantis discussed with legislative leadership their intent in the 2026 legislative session to push to eliminate vaccine mandates from the books before making the announcement.

The surgeon general praised the Legislature and went so far as saying he “loves our lawmakers.” But Ladapo issued an ultimatum.

“They’re going to have to make decisions, right? That’s the way that this becomes possible. So, people are going to have to make a decision. People are going to have to, have to choose a side. And I am telling you right now that you know the moral side is, it’s so simple.”

Patients would remain free to take shots if they like.

Democratic officials quickly blasted the announcement, deeming it a “reckless” decision that could lead to a drop in those immunized in the state. Florida has already seen its immunization rate for school-aged children tick down in recent years, although more than three-quarters of school children have received shots.

“This is ridiculous. Florida already has broad medical and religious exemptions for childhood vaccines, so any family that has a sincere opposition to vaccination can opt-out. Removing the mandate wholesale is dangerous, anti-science, and anti-child. Nobody wants to go back to the days of iron lungs,” Senate Democratic leader Sen. Lori Berman, from Boynton Beach, said in a statement.

“Republicans have gone from entertaining anti-science conspiracy theories to fully endorsing an anti-science health policy. As a member of the Senate Health Policy Committee, I’ll be doing everything in my power to protect our kids from these reckless attempts to harm them.”

Sen. Shevrin Jones, a Democrat from Miami Gardens, also criticized the announcement.

“Ending vaccine mandates poses a grave public health risk and will likely lead to a resurgence of preventable diseases. This reckless move jeopardizes the health and lives of countless Floridians — from children to seniors — especially those too young to be vaccinated or those with compromised immune systems. The DeSantis administration is actively undermining public health, making communities more vulnerable to outbreaks and increasing the burden on healthcare systems.”

Public Citizen’s Health Research Group Director Robert Steinbrook said ending all vaccine mandates is a “recipe for disaster” and goes in the wrong direction. He urged the Legislature to stand against the DeSantis administration.

“High immunization rates against dangerous infectious diseases such as measles and polio protect individuals as well as their communities. If this plan moves forward, Florida will terminate one of the most effective means of limiting the spread of infectious diseases and embolden U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. to wreak even more havoc on vaccinations nationally. The Florida Legislature and state residents must vociferously reject these plans,” Steinbrook said in a prepared statement.

Current requirements

Florida law contains a number of immunization requirements for the young and the old.

Immunization for poliomyelitis, diphtheria, rubeola, rubella, pertussis, mumps, and tetanus are required for entry and attendance in Florida schools, childcare facilities, and family daycare homes. The state allows exemptions for valid medical reasons but also for religious and certain belief systems and, in some cases, allows personal exemptions for philosophical beliefs.

Florida law also requires school districts to develop and disseminate parent guides that include information about the importance of student health and available immunizations and vaccinations, including, but not limited to, recommended immunization schedules in accordance with federal recommendations.

The school guide must include detailed information regarding the causes, symptoms, and transmission of meningococcal disease and the availability, effectiveness, known contraindications, and appropriate age for the administration of any required or recommended vaccine against that infection.

The Florida Education Association issued a statement warning that changing the rules would endanger students and faculty.

“When leaders talk about pulling back vaccines, they’re talking about disrupting student learning and making schools less safe. State leaders say they care about reducing chronic absenteeism and keeping kids in school — but reducing vaccinations does the opposite, putting our children’s health and education at risk,” the union said.

“We’re reviewing the potential impacts on public schools and our communities. But, make no mistake, FEA will continue to stand up for our students, our educators, and our public schools.”

College students who reside in on-campus housing must provide documentation of vaccinations against meningococcal meningitis and hepatitis B. Again, the law contains exemptions and students who refuse the vaccines are required to sign waivers.

Nursing homes are required to assess residents within five business days post admission of eligibility for pneumococcal vaccinations or revaccinations. If indicated, the resident must be be vaccinated or revaccinated within 60 days after admission, in accordance with the recommendations of the U.S. Centers for Disease Control and Prevention, subject to exemptions for medical contraindications and religious or personal beliefs.

Immunization may not be provided to a resident who provides documentation that he or she has been immunized. A resident may elect to receive the immunization from his or her personal physician and, if so, the resident needs to provide proof of the immunization to the facility. The agency may adopt and enforce any rules necessary to comply.

2025 efforts fall short

The 2026 legislative session begins in January, which is when the DeSantis administration will work with the Legislature in hopes of accomplishing its goal. But the Department of Health will also revise rules for a handful of vaccines that are mandated in rule but not in statue.

A substantially scaled-back effort to address vaccine mandates fell short during the 2025 session.

The DOH this spring championed a broad bill (HB 1299) continuing a law initially passed in 2021 that banned businesses, government entities, and education institutions from denying people entry or service based on vaccination status or requiring people to wear masks. HB 1299 extended the ban for two years.

The bill expanded the Patient’s Bill of Rights and Responsibilities statutes to prohibit providers and facilities from denying admission, care, or services to a patient based solely on vaccination status.

Although the House agreed to the language, passing HB 1299 by a near-unanimous vote, state Sen. Gayle Harrell, a Republican from Stuart whose late husband was a physician, warned that the requirement would open doctors to increased liability. Sen. Jason Pizzo, a Hollywood lawmaker with no party affiliation, said the mandate to treat patients would have contradicted a law DeSantis championed that guarantees Florida physicians legal protections to not treat patients on the basis of their conscience.

The Senate deleted the language before passing the proposal and the House ultimately agreed to the Senate’s version.

Ladapo the lightning rod

Ladapo is a well known vaccine skeptic. He emphasized parents’ rights to send their kids to school unvaccinated in spring after a measles case in a Miami-Dade County high school. He altered a DOH COVID-19 vaccine study to exaggerate the risks of cardiac death for young men

His positions on vaccinations aren’t the only reason he’s become a public health lightning rod.

The DOH last month announced 21 cases of Campylobacter and E. coli infections tied to raw milk consumption in the central and northeast portions of the state, and said that seven people had been hospitalized. Six of the cases were reported in children under age 10. Nevertheless, Ladapo didn’t warn against consuming raw milk.

Two days later, Florida Agriculture Commissioner Wilton Simpson issued a statement encouraging residents to stick to pasteurized milk.

And in 2021, Ladapo made national headlines when he refused to don a mask during a meeting with state Sen. Tina Polsky, who was being treated for cancer and requested that he wear one. At the time, Ladapo was up for Senate confirmation.

Polsky, a Democrat from Boca Raton, lambasted Ladapo’s announcement Wednesday.

“Vaccines are crucial for our children because they protect them from deadly diseases and keep entire communities safe through herd immunity,” she said in a written statement.

Diseases, including polio, that once destroyed our children’s health and futures, will have the chance to return under this dangerous policy change. I voted against Dr. Ladapo’s confirmation in 2023 because he has a habit of misrepresenting science and making decisions that affect the health of Floridians. He remains determined to prioritize political dogma over smart health decisions.”

Florida Make America Healthy Again Commission

Ladapo’s announcement dovetails with DeSantis’ news that he has created a Florida Make America Healthy Again Commission that will recommend the integration of U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr.’s Make America Healthy Again effort. The Florida Commission will be co-chaired by  first lady Casey DeSantis and Lt. Gov. Jay Collins.

Meanwhile, at the end of August, the Food and Drug Administration approved updated vaccines for COVID-19. While previous versions of the vaccine were recommended to individuals 6 months of age and older, access to the FDA’s newly approved vaccines is limited to individuals 65 and older and individuals between the age of 5 and 64 with an underlying condition placing them at high risk for severe COVID-19.

Florida Phoenix reporter Jay Waagmeester contributed to this report.

This story has been updated with reaction from lawmakers, the Florida Education Association, and the Public Citizen’s Health Research Group.

This story has been corrected to reflect HB 1299 extended by two years the ban on businesses discriminating against people who refuse to take mNRA vaccines. 

Health and Human Services Secretary Robert F. Kennedy Jr. speaks alongside President Donald Trump at a news conference on May 12. (Andrew Harnik/Getty Images)

Public health and access to lifesaving vaccines are on the line in a high-stakes leadership battle at the Centers for Disease Control and Prevention.

Health and Human Services Secretary Robert F. Kennedy Jr.’s push to fire CDC director Susan Monarez is more than an administrative shake-up. The firing marks a major offensive by Kennedy to seize control of the agency and impose an anti-vaccine, anti-science agenda that will have profound effects on the lives and health of all Americans, public health leaders say.

Kennedy wants to see the Pfizer and Moderna messenger RNA-based covid-19 vaccines pulled from the market, according to two people familiar with the planning who asked not to be identified because they’re not authorized to speak to the press. He’s also set his sights on restricting or halting access to some pediatric immunizations, some public health leaders say.

His actions have already reduced federal help to states, creating the potential for more infectious disease outbreaks and incidences of foodborne illness. Some public health leaders say they expect Kennedy will use the CDC to publicize health information that isn’t grounded in science.

“It’s crazy season,” said Richard Besser, former acting CDC director during the Obama administration. “People want information they can trust to make critical decisions about their health. Until now, we’ve been able to say look at the CDC. Unfortunately, we’re not able to do that anymore.”

HHS spokesperson Emily Hilliard disputed the criticism.

“Secretary Kennedy remains firmly committed to delivering on President Trump’s promise to Make America Healthy Again, dismantling the failed status quo that fueled a nationwide chronic disease epidemic and eroded public trust in our public health institutions,” Hilliard said in a statement.

White House spokesperson Kush Desai said Kennedy and Commissioner of Food and Drugs Marty Makary have reiterated that covid shots will remain available for Americans who need and want them.

“The Trump administration is restoring Gold Standard Science as the sole guiding principle of health decision-making,” Desai said in an email. “Only the Fake News could ignore these facts to continue pushing Democrat talking points and hysteria.”

Behind the ouster

The shake-up began last week, when Kennedy sought to fire Monarez, a microbiologist who’d just been confirmed by the Senate in July. She refused to leave the position, and her lawyers said Kennedy sought to oust her because she wouldn’t fire senior staff or follow unscientific directives. Four top career officials at the CDC resigned on Aug. 27 in protest.

Career staffers at the CDC and some public health groups had hoped President Donald Trump would intervene and put the brakes on Kennedy. Instead, the White House backed Kennedy, saying Monarez was fired.

Trump on Sept. 1 demanded that drug companies show that covid vaccines work, in a further sign he’s not set on defending the shots.

“I hope OPERATION WARP SPEED was as ‘BRILLIANT’ as many say it was. If not, we all want to know about it, and why???” Trump said on Truth Social.

Operation Warp Speed was the initiative that Trump himself announced in 2020 to accelerate the development of covid vaccines, including the Pfizer and Moderna shots. The vaccines have proved safe and effective in multiple clinical trials; a study published in JAMA Health Forum estimated that they saved about 2.5 million lives worldwide.

CDC staffers are worried the agency’s next director won’t fight for science, according to an employee who asked not to be identified for fear of professional retaliation.

Trump’s support for Monarez’s ouster was a watershed moment that signaled there are no checks on Kennedy and his agenda, public health advocates say. Leading congressional Democrats such as Senate Minority Leader Chuck Schumer called for Kennedy’s firing. Hundreds of HHS staffers have also implored Congress to intervene, saying Kennedy threatens science and public health. He is slated to testify Sept. 4 before the Senate Finance Committee.

Kennedy said in a message to CDC staff that his focus is on boosting the agency’s reputation and leadership. The Atlanta-based agency was already reeling after the Trump administration pushed out thousands of its staff and a gunman who reportedly believed the covid vaccine had caused him health problems fired hundreds of rounds at its campus last month, killing a police officer.

“The CDC must once again be the world’s leader in communicable disease prevention. Together, we will restore trust,” Kennedy wrote. “Together, we will rebuild this institution into what it was always meant to be: a guardian of America’s health and security.” He said his deputy, Jim O’Neill, would serve as acting CDC director.

Nine former CDC directors or acting directors who served under both Republicans and Democrats criticized Kennedy in the aftermath of the Monarez firing, saying in an op-ed in The New York Times that the impact on public health is “unacceptable, and it should alarm every American, regardless of political leanings.”

HHS spokesperson Hilliard took exception with this point, listing four covid vaccines that continue to get the nod for use.

However, the Food and Drug Administration last

week approved updated covid mRNA boosters only for people 65 or older and others at high risk of complications. The CDC has also stopped recommending the shots for healthy children and pregnant women. Previously, the shots had been advised for anyone 6 months or older.

As a result, many people who don’t meet the criteria but want the vaccine will have to get prescriptions or consult with their doctors. Insurance may not always cover the shots, which can run around $200. Major drugstores such as Walgreens and CVS have said the shots may not be available at all pharmacies and may require a prescription.

The American Academy of Pediatrics on Aug. 19 broke with the administration, recommending that all young children get the covid vaccine. Insurance still may not cover the cost in some cases and parents could face obstacles in getting the vaccines without a prescription.

Next move: The advisory committee

Kennedy and his team changed official covid vaccine recommendations even though there have been no new safety issues. A dose of the 2023-24 covid mRNA vaccine prevented significant illness and death across all age groups, according to a study published in August led by a University of Michigan researcher. The virus killed about 1,000 people a week in the U.S. in mid-January, and cases are rising again and expected to accelerate this winter.

Kennedy has handpicked a vaccine advisory committee for the CDC that is reviewing mRNA-based covid vaccines, which he falsely claimed in 2021 were “the deadliest vaccine ever made.” The covid vaccine review is being led by Retsef Levi, a professor of operations management at the Massachusetts Institute of Technology who has said without evidence that the shots cause serious harm, including death. If the committee recommends against them, Kennedy and the FDA could then begin the process of removing them from the market.

Taking mRNA-based covid shots off the market would leave consumers with fewer options for protection. Paxlovid, an antiviral medication that treats the infection in high-risk adults, would be available.

The CDC advisory committee reviewing the covid shots is also probing a long-debunked link between aluminum, used in many childhood immunizations such as those for hepatitis A and pneumonia, and autism or allergies.

The group’s findings are expected to support the erroneous link, some public health officials say. HHS could then require drugmakers to undertake costly reformulations of the shots or stop manufacturing them altogether.

“That would set up the elimination of all childhood vaccines,” Besser said.

The advisory group’s next meeting is set for Sept. 18, although Sen. Bill Cassidy (R-La.) has called for the meeting to be indefinitely delayed. Cassidy, a physician who chairs the Senate Health, Education, Labor and Pensions Committee, voted for Kennedy’s confirmation as HHS secretary after receiving assurances, he said, that the longtime vaccine opponent wouldn’t disrupt the U.S. vaccination system. Kennedy’s promises, Cassidy said, included that he wouldn’t change the CDC’s Advisory Committee on Immunization Practices.

Kennedy removed all of the panel’s members in June and replaced them with his own appointees, including anti-vaccine activists.

Kennedy’s move to put his stamp on the CDC means states that have long relied on the agency’s expertise and help in crises such as disease outbreaks will largely be left to fend for themselves, said Ashish Jha, who served as President Joe Biden’s covid response coordinator from 2022 to 2023.

“States are going to be left on their own,” Jha said. “States will struggle with the CDC incapable and dysfunctional. Our system is not designed for states to go it alone.”

The CDC typically plays a critical role by assisting states with disease surveillance, public health interventions, and outbreak response, especially when a crisis spills across state lines. An outbreak of measles this year led to more than 1,400 cases nationwide, and states including Texas, where the outbreak was identified, struggled to get help from the CDC.

A CDC program that has long tracked pathogens in food has already reduced the number of hazards it looks for from eight to two, which public health leaders say is making it harder to identify outbreaks. Staff overseeing a CDC program that tracks outdoor pollution that can exacerbate asthma also have been cut.

The agency runs a hotline that doctors around the country can call to get treatment and other types of advice. Under Kennedy’s watch, the CDC has had to pare assistance because of staffing reductions, said Wendy Armstrong, vice president at the Infectious Diseases Society of America.

“Lives are 100% at stake, no question about it,” Armstrong said. “That you can no longer trust the recommendations out of the CDC is just devastating. It’s appalling to think we can’t trust that information is science-based anymore.”

Kennedy wants to shake up CDC leadership because he sees the agency as the heart of corruption and resistance within the federal health bureaucracy, according to people familiar with his planning. Kennedy has said the agency suffers from malaise and bias.

Many public health leaders, however, view the CDC as under siege by an administration they say is corrupting science for its own ends. HHS staffers signed onto a letter that now has more than 6,800 signatures, saying Kennedy is “endangering the nation’s health by repeatedly spreading inaccurate health information.”

Kennedy has also been fending off mounting criticism of his response to the shooting at the CDC’s headquarters. He responded to the attack on social media, hours later, after first posting pictures of himself fly-fishing.

Some younger staffers are considering leaving and some workers feel like the shooting accelerated Kennedy’s overhaul of the agency, the CDC employee said.

With the battle for control of the CDC still raging, public health leaders are now looking to Congress to put the brakes on Kennedy. Some Republican lawmakers have called for a review of Kennedy’s actions.

“These high profile departures will require oversight by the HELP Committee,” Cassidy said Aug. 27 on the social platform X. Cassidy had backed Monarez to lead the agency.

Renuka Rayasam, KFF Health News senior correspondent, and Andy Miller contributed to this article.

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

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

A child gets an MMR vaccine at a clinic put on by Lubbock Public Health Department in Lubbock, Texas, in March. States have been reporting steady increases in vaccination exemption requests for kids. (Photo by Jan Sonnenmair/Getty Images)

Dr. Rana Alissa hears it daily in the clinic.

“It’s better for my kid to get the virus than get the vaccine.”

“The more you [doctors] vaccinate, the more money you get.”

“I did not vaccinate any of my kids, and I’m not going to vaccinate this one. So, please, don’t waste your time.”

The Jacksonville, Florida, pediatrician said on average, she’d hear vaccine skepticism from a couple of parents a month, at most, before the COVID-19 pandemic. “Now, it’s every day,” said Alissa, who is also president of the Florida Chapter of the American Academy of Pediatrics.

Medical experts say hesitancy is likely to increase further as a result of misinformation pouring from the Trump administration — and turmoil at the federal agency largely responsible for setting vaccine policy.

On Thursday, three top officials were escorted out of the Atlanta headquarters of the federal Centers for Disease Control and Prevention.

All three officials resigned to protest the effort by Secretary of Health and Human Services Robert F. Kennedy Jr. to dismiss CDC Director Susan Monarez for pushing back against Kennedy’s vaccine policies.

One of the officials, Dr. Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, posted on X that he’s resigning because “the intentional eroding of trust in low-risk vaccines” will cause the nation to suffer.

Earlier this week, the U.S. Food and Drug Administration restricted access to updated COVID-19 shots. The new rules include limitations for young children that the American Academy of Pediatrics called “deeply troubling.” The FDA only approved COVID-19 vaccines for people who are 65 and older and those who are known to be at risk for a severe case. Consultation with a medical provider will be required before the shot is given to healthy children under 18, meaning parents can’t simply take their kids to a vaccination clinic or pharmacy.

In June, Kennedy ousted all 17 members of the vaccine advisory committee at the CDC, replacing them with some members who are vaccine skeptics. Many states use the committee’s recommendations to develop their vaccine requirements. And in May, Kennedy rescinded recommendations for kids to get vaccinated against COVID-19.

In his books, experts say, Kennedy appears to promote his own version of miasma theory, an obsolete belief dating back to ancient times that diseases are caused by vapors from rotting organic matter. Scientists have since proven that microbes, not bad air, cause infectious diseases.

Experts say Kennedy’s actions are likely to make vaccination rates worse, paving the way for more outbreaks.

“Every vaccine that we give prevents a serious and life-threatening disease,” New York pediatrician Dr. Jesse Hackell, chair of the Committee on Pediatric Workforce at the American Academy of Pediatrics, told Stateline. “I don’t want to force anybody, but I do want to make sure that the information they’re getting is quality information — and that’s not what is coming from HHS.”

Nonmedical exemptions

Every state requires kids to get certain shots to attend school. All states exempt children who can’t be immunized for medical reasons, but nonmedical exemptions for religious or personal reasons vary from state to state.

Vaccination rates among kids are declining. Flu vaccinations, for example, hit their lowest rate since 2019. And since the beginning of the pandemic, exemption requests have increased across the country.

Among kindergarteners, nonmedical exemptions have increased each year since 2020, from 1.9% in the first year of the pandemic to 3.4% in the 2024-25 school year, according to the latest data from the federal Centers for Disease Control and Prevention. Exemptions increased in 36 states and Washington, D.C. Seventeen states reported exemption rates over 5%.

The changes may seem small. But experts say even slight increases in exemptions and decreases in vaccinations make a big difference.

“With a disease that’s as infectious as measles … small increases in vaccination rates could really go a long way,” epidemiologist Sophia Newcomer, a University of Montana associate professor, said in a recent panel discussion hosted by Montana Families for Vaccines.

Alissa and other experts say rampant confusion around the shots, including federal officials casting doubt, is exacerbating the problem. Often, parents aren’t sure whom they can trust, finding conflicting information and unreliable sources, she said.

“[Parents] come to our clinic and the hospitals and they say, ‘We looked it up, and we just don’t want it,’” she said. “There’s different kinds of reasoning: the ingredients of the vaccine, the side effects of the vaccine, ‘vaccines don’t work.’”

But research consistently shows vaccines protect children from serious illness. Shots also protect the most vulnerable who can’t get vaccinated, such as babies who are too young, or children and adults who are immunocompromised. Babies up to age 2 are more likely to get very sick from COVID-19, making up the most hospitalizations among kids.

Ultimately, Alissa said, “We are endangering each other.”

In Florida, where Alissa practices, religious exemptions have increased monthly, according to a state report that tracked the numbers through April. Some counties have higher rates of children with religious exemptions than others, ranging from about 1.5% to 15%, the state department of health reported. Among kindergarteners in the state, the rate of nonmedical exemptions rose from 2.7% in the 2020-21 school year to 4.8% in the 2024-25 school year, CDC data shows.

Five states — California, Connecticut, Maine, New York and West Virginia — don’t allow nonmedical exemptions, according to the National Conference of State Legislatures. Two West Virginia families with immunocompromised kids brought lawsuits over Republican Gov. Patrick Morrisey’s January executive order mandating religious exemptions despite state law.

Kennedy defended religious exemptions and endorsed the governor’s order in a post on X. His agency also sent letters to West Virginia health departments warning of civil rights violations if they don’t allow such exemptions.

“There’s a ton of variability across states in how easy it is to not get vaccinated,” Newcomer, of the University of Montana, said. Some states require parental vaccine education as part of the exemption request while others don’t.

“Increased exemptions needs to be fought at every level — working to make sure there’s access, to make sure that there’s good information, and to make sure that there’s strong policy at the state level, so that people aren’t exploiting exemption loopholes,” Northe Saunders, American Families for Vaccines president, said during the panel discussion.

Other vaccines

Doctors are worried that other vaccines will be targeted by the Trump administration, such as those for whooping cough. By April, preliminary CDC data showed more than 9,000 cases this year, about twice as many compared with the same time last year and more than there were right before the pandemic. Whooping cough, or pertussis, can be deadly for babies. Vaccines help prevent severe whooping cough illness.

Hackell said that when he was training in the 1970s, there were no pneumococcal and haemophilus vaccines. Babies would come in with 104-degree fevers and they were immediately tested for the infections, he recalled. For babies under age 2, those bacterial infections can show up as only a high fever, but the infection can rapidly turn fatal without treatment, he told Stateline.

“When I trained, we didn’t have these vaccines, and these kids kept us up at night,” Hackell said. “I never want to practice in those days. I never want to go back to that. … To me, that is unacceptable to submit my patients to those risks that we’ve been able to reduce.”

This week the FDA removed one of the available COVID-19 vaccines for young children, limiting the Spikevax vaccine to only kids with at least one serious health issue. Moderna’s shot is still available for children 6 months and older. Pfizer’s shot is no longer available for kids under 5, as the FDA is ending its emergency use authorization for the age group.

But the American Academy of Pediatrics recommends COVID-19 shots for children 6 months to 2 years. It also recommends them for older children with underlying health issues. Healthy children whose parents want them to get the shot should also be offered them, the AAP says.

Hackell is concerned by the FDA’s new limitations on the shot.

“As a parent, as a grandparent and as a physician who takes care of vulnerable kids, it disgusts me,” Hackell said.

He’s also concerned about vulnerable kids who get their shots through the federal Vaccines for Children (VFC) Program, which covers shots if parents can’t afford them and follows federal vaccine advisory recommendations.

“If you’re covered by VFC, which is basically kids on Medicaid and a few other populations, then you’re out of luck,” Hackell said. “To me, that’s a huge inequity in access to care, which is indefensible.”

He added that the move breaks with the administration’s emphasis on individual decision-making, saying the new restrictions limit parental decisions.

‘Normalization’ of outbreaks

During the Montana panel discussion, Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, pointed to CDC data showing that over the past year alone, about 1 in 5 children and adolescents hospitalized with COVID-19 were put in the ICU. And between September 2023 and last August, 152 children died of COVID-19 and 213 children died of the flu.

While Texas officially declared its measles outbreak over — which means the state hasn’t reported a new case in six weeks — neighboring New Mexico continues to see new cases.

“What we’re going to see is, you know, sadly, a normalization of these outbreaks,” said Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, a Texas-based vaccine education organization. “We need to make sure that kids are protected against the diseases that they can be protected against, because we truly are in a vulnerable state right now.”

Newcomer, the Montana epidemiologist, said that under-vaccination trends are usually due to disparities in access, such as challenges in reaching vaccine providers in rural communities. At rural health care centers lacking staff and technology, it’s harder to automate vaccination reminders for patients — which can increase the likelihood patients show up for appointments but require technical infrastructure, she explained.

Adding misinformation to the mix only makes matters worse, experts say.

“Parents are confused and understandably concerned,” Offit told Stateline. “It’s the most vulnerable among us that will suffer, and that will be our children.”

He added that he’s also wary about the federal administration’s removal of data, concerned that vaccination figures will be next.

“It’s nightmarish,” he said. “What worries me the most is we’re not going to know the degree that we’re suffering. We’re not, because the CDC is losing its capacity to do adequate surveillance across the country.”

Stateline reporter Nada Hassanein can be reached at nhassanein@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.