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Oz Escalates Medicaid Fraud Claims Against States After Focus on Minnesota

Bram Sable-Smith — Fri, 20 Mar 2026 09:00:00 +0000

The Trump administration has signaled a willingness to halt billions of dollars in federal health payments to multiple states, mirroring moves they made against Minnesota.

The , the public health insurance program that pairs state and federal money. Federal officials have announced unprecedented actions in Minnesota this year, declaring they could withhold over $2 billion in payments slated for the state and claw back nearly $260 million from last year.

The actions in Minnesota came as part of the administration’s declared crackdown on fraud, but critics have likened them to using a bludgeon instead of a scalpel, probably harming patients who rely on Medicaid for care but are not responsible for fraud in the program.

“It’s going to hurt a lot of people if they end up going through with this,” said Sumukha Terakanambi, a 27-year-old who has Duchenne muscular dystrophy and works as a public policy consultant with the Minnesota Council on Disability.

“Of course we support going after fraud,” Terakanambi said, but “this overly aggressive action is missing the point. It’s not punishing fraudsters. It’s punishing the people.”

Longtime Medicaid observers also doubt the federal actions will achieve their purported objective. , a senior managing director with the consulting firm Manatt, that actions of this magnitude by the federal government are unprecedented, partly because punitive measures against states have “really never been an effective way to address fraud.”

Meanwhile, fraud prosecutions as the U.S. attorney’s office there grapples with the exodus of nearly half its attorneys and a surge in cases from the Trump administration’s immigration crackdown.

Despite these concerns, Centers for Medicare & Medicaid Services head Mehmet Oz said the techniques the federal government is using in Minnesota could be applied to other states, and he has launched social media campaigns alleging high-dollar public benefit fraud��in , , , and . And a February release of by the Trump administration’s Department of Government Efficiency appears to be part of a campaign to paint the program as riddled by fraud, Guyer said.

, a research professor at Georgetown University’s Center for Children and Families, said that campaign by the administration seems particularly focused on services designed to keep people with disabilities out of institutions, and he described withholding $2 billion from Minnesota’s Medicaid program as “.”

A ‘Political Football’

Scrutiny of Minnesota’s public benefit programs began early in the Biden administration, years before the most recent investigations. The spotlight on the state’s Medicaid system grew after FBI raids in December 2024.

The following May, an into Medicaid housing stabilization services in Minnesota prompted further scrutiny from federal prosecutors, and from Gov. Tim Walz.

Under the Democratic governor, the state launched investigations into 85 autism providers, ordered a third-party audit of 14 types of Medicaid services deemed to be “high-risk” for fraud, and delayed payments for those services for up to 90 days. Many of the services are ones people with disabilities receive at home, making them more difficult to monitor. ��

Terakanambi worried the state’s “heavy-handed approach” would destabilize the entire home care system. While his own care was not disrupted — his parents provide the 10 hours of daily personal care he qualifies for through Medicaid — other Minnesotans with disabilities have said they experienced interruptions and .

In December, one man was after losing his in-home care services amid the crackdown.

“We’re losing sight of the people that have done nothing wrong, that rely on these supports and services to live in the community,” said Sue Schettle, chief executive of , a Minnesota nonprofit that represents organizations supporting people with disabilities. “It becomes a political football.”

Schettle said she took her concerns about the crackdown to state officials, who have since met routinely with her and other advocates. The subsequent federal actions, however, have left her “shell-shocked,” she said.

The ‘Nuclear Option’

In December, a , with help from state Republicans, supercharged the issue in Minnesota, alleging widespread fraud in child care centers owned by members of the Somali community. A follow-up state investigation of the child care centers that were featured in the video determined that all were “.”

On Jan. 6, CMS’ Oz sent Walz a letter alleging Minnesota’s Medicaid program was out of compliance with federal rules on fraud, waste, and abuse, setting the stage for the Trump administration’s move to withhold over $2 billion in federal Medicaid funds to Minnesota this year, about 18% of what the state received the year before.

Minnesota is appealing.

The Republican-aligned Paragon Health Institute, a think tank that recently published a calling for similar enforcement actions across the country, applauded the federal moves.

“That will spur states to take necessary action, thus ensuring that Medicaid funds go to those who are truly eligible,” said , a legal research analyst who co-authored the brief.

Georgetown’s Schneider questioned the necessity and effectiveness of withholding the money.

“I don’t see any relationship between that and actually reducing fraud against the Minnesota Medicaid program, given the state has already taken a lot of action,” he said.

In late February, Oz went further, announcing that on top of withholding $2 billion in future payments to Minnesota, the administration was in federal Medicaid payments to the state.

“We have notified the state that we will give them the money, but we are going to hold it and only release it after they propose and act on a comprehensive corrective action plan to solve the problem,” Oz said at with Vice President JD Vance.

Minnesota the deferment in court.

“We’re waiting for feedback from CMS on our corrective action plan, which is why we were surprised and confused when Dr. Oz said in a news conference with the vice president last week that we needed to provide one,” Minnesota Medicaid director John Connolly said at a March 3 news briefing.

‘Another Minnesota’

Oz and Vance both said during the February news conference that they are not specifically targeting Democratic-led states. Oz noted Florida has a “big fraud problem” and in mid-March sent a letter to state officials with a list of questions about their Medicaid program. Until then, the letters and most of Oz’s social media videos had been limited to California, Maine, and New York, all led by Democrats.

“We might have another Minnesota on our hands,” Oz said in posted the same day as sent to Maine Gov. Janet Mills, a Democrat, requesting information on how the state was addressing Medicaid fraud.

“And if we’re not satisfied with their progress, we reserve the right to cut off payments entirely,” Oz said in the video.

The video and letter were prompted by a in Maine that found the state had made at least $45.6 million in improper Medicaid payments. Similar audits in , , and had comparable findings.

In , Mills called Oz’s letter a “pretense to send ICE and other weaponized federal agents into states led by Democrats.”

CMS spokesperson Chris Krepich said the agency does not take funding actions lightly. “The focus is on strengthening oversight, improving accountability, and ensuring that vulnerable patients receive the services they are entitled to,” Krepich said.

But Terakanambi said it’s not difficult to see how federal actions like those in Minnesota could put services in jeopardy. The amount of money Minnesota could lose from the CMS actions announced this year is already equivalent to about two-thirds of the state’s rainy-day fund.

Many states are looking to reduce or even eliminate funding for home care services over much smaller budget shortfalls. And further cuts are anticipated, with congressional Republicans’ One Big Beautiful Bill Act, signed into law last year, expected to reduce federal Medicaid spending by more than $900 billion over the next decade.

“People will die,” Terakanambi said. “People will lose critical supports and will no longer be able to participate in their community the way they want to.”

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Oz Says California’s Not Fighting Health Care Fraud, but Data Shows It’s Part of a Larger Battle

Don Thompson — Thu, 19 Mar 2026 09:00:00 +0000

SACRAMENTO, Calif. — For weeks, Mehmet Oz has been waging a public feud with California leaders over health care fraud, accusing the blue state of failing to adequately combat such abuse.

Oz, who heads the U.S. Centers for Medicare & Medicaid Services, there was approximately $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone. “This administration under President [Donald] Trump is not going to tolerate taxpayer dollars being stolen because people aren’t paying attention anymore. We’re focused on this,” . He claimed the fraud was largely orchestrated by the “Russian, Armenian mafia” and said that most of the money spent on home and community-based services across California “might be fraudulent.”

However, CMS clarified that not all billing activities referenced by Oz were presumed to be improper. And a review of the most recent available data shows that there are hotbeds of health care fraud across the country and across practice areas, most of them allegedly perpetrated by health insurers and other domestic actors, and that California outperforms most other states in recovering fraud dollars.

As the temperature heats up in the conflict between the Trump administration and California, a handful of Republican state lawmakers have entered the fray, accusing Gov. Gavin Newsom in of allowing “rampant fraud.” Democratic state officials insist they aggressively combat fraud, and Newsom has filed a against Oz, calling language in the allegations “baseless and racially charged.”

“The Trump Administration is attempting to take the issue of fraud — a very real, and national issue — and weaponize it against Democratic states,” California Attorney General Rob Bonta said in an early February statement.

Oz said that he would halt “hundreds of millions of dollars” in payments to California if he didn’t get satisfactory answers from state officials. He and Vice President JD Vance announced in late February that they would delay about $260 million in Medicaid payments , another Democratic-led state, over fraud allegations there, and the state is now suing.

Oz has also launched social media campaigns alleging high-dollar public benefit fraud in Democratic-led Maine and New York. On March 17, he added a Republican-led state to his target list: Florida.

Georgetown University professor Andy Schneider, who served as a senior adviser primarily on Medicaid integrity issues during the Obama administration, said fraud has always been an issue across states, dating back decades. About $3.4 billion in Medicare and Medicaid fraud across the country was , according to the most recent report available. Insurers have paid the highest settlements in alleged health care fraud schemes.

“Bad actors trying to steal public health care funds have been around for a long time,” Schneider said.

How California Stacks Up

The federal government is responsible for Medicare, which primarily benefits older people, while Medicaid, which primarily serves people with lower incomes, is a joint federal-state program. Melissa Rumley, a spokesperson for the Department of Health and Human Services’ Office of Inspector General, said the office could not make state-by-state data on Medicare fraud available because the federal probes often cross jurisdictions.

States file annual reports on actions by Medicaid anti-fraud units that are jointly funded with the federal government and run by state attorneys general. They investigate fraud as well as abuse and neglect of Medicaid patients.

These reports provide a sense of the scale of Medicaid fraud across states. In fiscal 2024, states recovered , compared with $949 billion in total Medicaid spending, according to from the HHS Office of Inspector General. California recouped an outsize share, recovering more than 50% of all the criminal recoveries made by the anti-fraud units nationwide in fiscal 2024 even though the state made up only about 17% of enrollment.

California ranked fourth in the U.S. in 2024 in dollars recovered per Medicaid enrollee across civil and criminal investigations, behind the District of Columbia, Montana, and Delaware. It led all the most populous states, followed in order by Texas, Florida, and New York. (California and federal officials noted that state recovery data varies significantly year to year, often because of the length of investigations.)

Vulnerability of Hospice Care

One aspect of health care fraud that has been at the center of Oz’s attack on California is hospice fraud, which has plagued Republican and Democratic administrations.

The use of hospice, intended to provide care to patients expected to die within six months, increased by over 8% from fiscal 2020 to 2024, to about 1.84 million Medicare beneficiaries, significantly.

To combat fraud, the Biden administration in 2023 of hospices in California, Arizona, Nevada, and Texas. The Trump administration Ohio and Georgia.

CMS spokesperson Chris Krepich did not say specifically what criteria were used to choose which states to monitor, only that the decision was based on “activity typically indicative of hospice-related fraud.” As of June, the agency had revoked the Medicare enrollment of 122 hospices in the original four states, but Krepich said a breakdown by state was not available.

While Oz stated there was some $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone, his agency clarified that the number is for overall Medicare billing related to hospice and home health services. Krepich said that “not all billing activity referenced in the remarks is presumed to be improper” and added that the agency could not identify the amount of fraudulent activity until an “evidence-based” investigation was completed.

That’s not to say there is no truth to allegations of hospice fraud.

A published in 2022 found “numerous indicators” of large-scale fraud in Los Angeles County, and a highlighted nearly 500 hospices within a 3-mile radius, including 89 companies registered to a single building in Van Nuys. that “hospice fraud has become an epidemic in California.” He noted that state officials have been aggressively combating it for years, including with .

In January, the state in Monterey County with hospice fraud. That follows hospice scam cases in and .

However, California public health officials are overdue in adopting that were supposed to be . The state’s Department of Public Health is currently revising the regulations, according to spokesperson Mark Smith.

In the interim, the state has revoked the licenses of more than 280 hospices over the past two years and is evaluating an additional 300 hospices, . California had licensed hospice agencies as of 2022, according to the state audit.

Civil Rights Complaint

Meanwhile, Newsom is pushing back on Oz. The governor filed his discrimination complaint with the at HHS, which oversees CMS. The office said it will first decide whether it has the authority to investigate, then, if so, will gather information through interviews and documents. However, the process seems designed to aid individuals who have lost a job to discrimination, or to correct a specific policy, and it is unclear whether there could be any real-world consequences.

The governor wants the agency to address “systematic bias from their leadership,” said Newsom spokesperson Marissa Saldivar.

Krepich said CMS “does not target communities, ethnic groups, or states” and bases its decisions on “confirmed investigative findings.” The allegations of organized fraud refer to “documented criminal cases,” Krepich said, providing a link to in which California residents were convicted of using the identities of foreign nationals to steal almost $16 million from Medicare.

It’s unclear what cases Oz was referring to when he spoke of the Russian and Armenian mafia.

Ciaran McEvoy, a spokesperson for the U.S. attorney’s office for the Central District of California, which includes Los Angeles County, said it doesn’t track whether hospice fraud defendants are alleged to be foreign nationals, but he pointed to the office’s online prosecution announcements. None alleged involvement by foreign influences or organized crime.

The state audit references by the U.S. Justice Department under President Barack Obama that an “Armenian-American organized crime enterprise” was behind a nationwide health care scam.

Federal officials at the time described an “international organized crime enterprise” based in Los Angeles and New York but with roots in Russia and Armenia. The scheme involved billing for unneeded medical treatments, not hospice fraud.

A revealed fraud schemes in which hospice operators recruited patients who were not actually terminally ill, then paid kickbacks to doctors who falsely certified these patients as dying so the hospices could bill Medicare. There was no mention of foreign involvement.

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Doctores alertan sobre una complicación mortal asociada a los brotes de sarampión

Rae Ellen Bichell — Mon, 16 Mar 2026 09:46:00 +0000

La primera señal apareció cuando Deepanwita Dasgupta tenía 5 años y empezó a tropezar más a menudo mientras jugaba en su casa en Bangalore, en el sur de India. La niña siempre estaba haciendo algo; por eso sus padres pensaron que los golpes y moretones extra eran simplemente parte de una infancia activa.

Quizás, pensaron, se trataba de unos zapatos que no le quedaban bien.

Los familiares describían a la niña amante de los unicornios como inteligente, cariñosa y a veces un poco traviesa. Antes de aprender el alfabeto, ya había descubierto cómo encontrar su programa favorito, Blippi, en un teléfono. También era conocida por sacar mantequilla del refrigerador a escondidas para disfrutarla lamiéndose los dedos.

Pero luego sus extremidades empezaron a sacudirse. Una punción lumbar reveló sarampión en su líquido cefalorraquídeo. El virus que probablemente tuvo cuando era bebé había llegado en secreto a su cerebro. Ahora, con 8 años, Deepanwita está paralizada y no puede hablar.

El sarampión causa complicaciones —que van desde diarrea hasta la muerte— en infectadas, según la Sociedad de Enfermedades Infecciosas de América (IDSA, por sus siglas en inglés). Algunas aparecen de inmediato, mientras que otras tardan semanas o meses en manifestarse. La que está experimentando Deepanwita es la encefalitis esclerosante subaguda (PEES); por lo general, tarda años en aparecer.

“Muchas personas piensan: ‘Si nos da sarampión, estaremos bien, porque conozco a un vecino que lo tuvo y está bien’”, dijo , quien dirige la Sociedad de Neurología Infantil (Child Neurology Society) a nivel nacional, pero habló con ��ýҕ�l Health News en su papel como doctora en Nueva York con experiencia en enfermedades neurológicas.

Porque el sarampión puede ser peligroso. Un tendrá que volver a aprender a caminar después de sufrir una de las complicaciones más inmediatas: inflamación del cerebro.

Y, a veces, el virus deja una bomba de tiempo en el sistema nervioso.

Una persona puede recuperarse del sarampión y continuar con su vida normal, ya no contagiar y no presentar síntomas identificables —a veces durante una década o más— antes de que aparezcan problemas. Aunque algunos pacientes quedan gravemente discapacitados por un tiempo, Khakoo dijo que la enfermedad casi siempre es mortal.

Antes de la aparición de vacunas eficaces y de uso masivo, esta complicación ocurría con suficiente frecuencia en Estados Unidos como para que, en la década de 1960, un doctor creara un de pacientes con PEES.

Los que aproximadamente 1 de cada 10.000 personas que contraen sarampión desarrollará PEES, pero el riesgo es mucho mayor para quienes se infectan antes de los 5 años. En países muy poblados donde el virus es endémico, como India, los casos se ven con regularidad.

Ahora, doctores e investigadores temen que, a medida que bajan las tasas de vacunación y el sarampión se propaga en Estados Unidos, los casos de esta complicación debilitante también aumenten.

Desde el inicio de 2025, los Centros para el Control y la Prevención de Enfermedades (CDC) —más que en toda la década anterior— en su mayoría en personas no vacunadas. Muchos eran niños.

El año pasado, doctores en Connecticut y, en California, otro en edad escolar que había tenido sarampión cuando era bebé .

“Es probable que veamos más casos de PEES en el futuro, especialmente si no controlamos esto”, dijo , miembro del Comité de Enfermedades Infecciosas de la Academia Americana de Pediatría y autor del libro .

La preocupación por la PEES fue lo suficientemente grande como para que en enero la Child Neurology Society para educar a los médicos estadounidenses sobre la enfermedad. Los doctores que han visto estos casos también están advirtiendo a sus colegas.

“No tenemos una forma de saber quién la va a desarrollar, ni una manera muy efectiva de tratarla”, señaló , profesor de neurología en la Escuela de Medicina de la New York University Grossman. “Lo mejor que podemos hacer, idealmente, es evitar que los niños tengan que pasar por esto en primer lugar”.

La vacuna contra el sarampión recomendada en dos dosis reduce el riesgo de que una persona expuesta contraiga el virus contagioso del��y, por lo tanto, disminuye la posibilidad de desarrollar PEES.

Las vacunas tienen pequeños riesgos de y un , pero el sarampión tiene un riesgo mayor de causar ambos.

Casos en Estados Unidos

Un sobre niños en California que desarrollaron PEES después de un brote de sarampión ocurrido años antes determinó que se diagnostica 1 caso por cada aproximadamente 1.400 casos conocidos de sarampión en niños menores de 5 años, y 1 por cada 600 bebés infectados.

Los investigadores también encontraron que, con los años, los doctores habían pasado por alto algunos casos en pacientes que murieron con enfermedades neurológicas no diagnosticadas.

La posibilidad de que casos futuros pasen desapercibidos llevó a y a sus colegas a publicar un comunicado en septiembre cuando un niño del condado de Los Ángeles .

“Hemos tenido muy pocos casos de sarampión en los últimos 25 años en este país”, dijo Yeganeh, directora médica del Vaccine Preventable Disease Control Program del departamento de salud pública del condado de Los Ángeles, quien ha tenido dos pacientes con PEES. “Desafortunadamente, eso está cambiando y queríamos asegurarnos de que todos supieran de esta complicación a largo plazo”.

El niño de California que murió había contraído sarampión cuando era bebé, dijo Yeganeh, antes de que pudiera recibir la vacuna.

El sarampión es altamente contagioso, por lo que al menos el 95 % de la población debe ser inmune para proteger a las personas vulnerables de la infección, incluidos bebés demasiado pequeños para vacunarse y personas con sistemas inmunológicos debilitados.

“Este es un ejemplo de alguien que hizo todo bien, que quería proteger a su hijo contra esta infección y, lamentablemente, terminó perdiendo a su hijo porque no teníamos inmunidad colectiva”, agregó Yeganeh.

Poco después de que el grupo de Yeganeh publicara el comunicado en California, Nelson también estaba tratando de difundir la información.

Recientemente había visto a un niño de 5 años cuya familia había viajado a Estados Unidos para recibir atención médica después de que el pequeño empezara a tropezar, a tener sacudidas, a alucinar con insectos y animales y a sufrir convulsiones. El niño había contraído sarampión cuando era bebé, cuando todavía era demasiado pequeño para vacunarse. Nelson le diagnosticó PEES.

“Imagínese: tener un hijo sano y feliz que empieza a hablar cada vez menos y finalmente ya no puede caminar”, dijo Nelson. “Es algo muy triste”.

Pensó que solo encontraría esta enfermedad en los libros de texto de la escuela de medicina, como una reliquia del pasado. Sin embargo, en octubre terminó presentando el caso en la conferencia nacional de la Child Neurology Society y participó en el video de la organización sobre la enfermedad.

“Ahora he visto algo que nunca debería haber visto en toda mi carrera”, dijo.

Señales de advertencia desde India

A nivel mundial, el número de brotes de sarampión en los últimos años, y médicos en lugares como el e han visto recientemente grupos de casos de PEES.

El alto costo humano de la propagación del sarampión es especialmente evidente en India. Aunque el número total de casos no se registra, alrededor de 200 familias que cuidan a personas con PEES, incluida la familia de Deepanwita, participan en un mismo grupo de chat en el área de Bangalore.

En Nueva Delhi, Sheffali Gulati estudia y atiende a unos 10 nuevos pacientes al año con esta enfermedad, lo que ella llama el “eco tardío” de los brotes de sarampión. El paciente más joven que ha visto tenía 3 años.

“Las edades y la muerte o un estado vegetativo pueden desarrollarse entre seis meses y cinco años después del inicio”, dijo Gulati, quien dirige el programa de neurología pediátrica del y hasta hace poco dirigía la .

Gulati no ha encontrado tratamientos que reviertan el curso de la SSPE, solo algunos que pueden ralentizar su progreso. A menudo termina aconsejando a los padres: es una situación catastrófica, no es culpa de ellos y no pueden hacer nada más que aceptarlo.

Los familiares de Deepanwita tratan de encontrar momentos de alegría donde pueden. Creen que la niña sonrió cuando su primo favorito la llamó recientemente. Anindita Dasgupta, su madre, dijo que Deepanwita mueve las manos y los pies por sí sola y a veces gira la cabeza, especialmente cuando su padre entra a la habitación.

La niña se comunica con sus padres con los ojos y algunos sonidos.

Pero está muy lejos de cómo estaba en 2022. En el cumpleaños de un primo, unos meses antes de que empezaran los síntomas evidentes, Deepanwita fue quien cantó la canción de cumpleaños más fuerte.

En su propia fiesta de cumpleaños número ocho el año pasado, Deepanwita, con un vestido rosa y un tubo nasal, solo podía parpadear y mover los ojos mientras estaba sentada frente a dos pasteles que no podía comer. Ya no puede tragar, así que su mamá le puso un poco de glaseado en la lengua.

Investigación que no debería ser necesaria

, biólogo molecular de la Clínica Mayo en Rochester, Minnesota, ha estudiado la PEES durante años. Recientemente utilizó tejido cerebral obtenido después de la muerte para mapear cómo el virus del sarampión puede propagarse desde la corteza frontal hasta colonizar todo el cerebro.

Aun así, dijo que sigue siendo una “caja negra” entender exactamente qué hace el virus durante los años en que permanece inactivo entre la infección inicial y la aparición de síntomas de daño neurológico.

Es posible que el virus se replique en el cerebro durante todo ese tiempo sin ser detectado y vaya destruyendo neuronas. Pero con tantas neuronas en el cerebro humano —10 veces más que el número de personas que viven en el planeta— el cerebro puede encontrar formas de adaptarse, dijo Cattaneo, hasta que finalmente ya no puede.

Ahora ha solicitado financiamiento para continuar investigando la enfermedad y posibles tratamientos, aunque en realidad desearía no tener que hacerlo. Las herramientas para eliminar esta enfermedad ya existen.

“El problema podría resolverse con la vacunación”, dijo Cattaneo. “Estados Unidos no debería tener ningún caso de PEES. Es simplemente doloroso”.

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Doctors Warn of a Deadly Complication From Measles Outbreaks

Rae Ellen Bichell — Fri, 13 Mar 2026 09:00:00 +0000

The first sign came when Deepanwita Dasgupta was 5 and started stumbling more while playing at her home in Bangalore in southern India. The girl was always up to something, so her parents figured extra bumps and bruises were just symptoms of an active childhood. Maybe, they thought, it was ill-fitting shoes.

Relatives described the unicorn-loving child as smart, affectionate, and occasionally rascally. Before she learned the alphabet, she had figured out how to find her favorite show, Blippi, on a phone. She was known to sneak butter from the fridge to enjoy a few finger licks.

But then her limbs started jerking. A spinal tap revealed measles in her cerebrospinal fluid. The virus she probably had as an infant had secretly made its way to her brain. Now 8 years old, Deepanwita is paralyzed, unable to talk.

Measles causes complications — ranging from diarrhea to death — in , according to the Infectious Diseases Society of America. Some are immediate, while others take weeks or months to appear. The one Deepanwita is experiencing, subacute sclerosing panencephalitis, or SSPE, typically takes years to rear its head.

“People think, ‘Oh, you know, if we get measles, then we’ll be fine, because I know my neighbor had it and they’re fine,’” said , who leads the national Child Neurology Society but spoke to ��ýҕ�l Health News in her capacity as a New York City doctor with expertise in neurologic conditions.

Measles, though, can be dangerous: A will have to relearn how to walk after enduring one of the more immediate complications, brain swelling. And every so often, the virus plants a ticking time bomb in the nervous system. A person can recover from measles and continue life as usual, no longer contagious and without any identifiable symptoms — sometimes for a decade or more — before problems appear. While some patients end up severely disabled for a while, Khakoo said, the condition is almost always fatal.

Before the advent of widespread and effective vaccines, the complication occurred enough in the U.S. that in the 1960s a doctor created of SSPE patients. Researchers about 1 in 10,000 people who get measles will develop SSPE, but the risk is significantly higher for those who contract measles before age 5. Populous nations where the virus is endemic, including India, see cases routinely.

Now, doctors and researchers fear that as vaccination rates drop and measles spreads in the U.S., cases of this debilitating complication will also rise here. Since the start of 2025, the over 3,500 measles cases — more than in the entire preceding decade — mostly people who were unvaccinated. Many were children. Last year, Connecticut doctors with SSPE, and in California, a school-age child who’d had measles as an infant .

“We are likely to see SSPE cases going forward, especially if we don’t get this under control,” said , a member of the American Academy of Pediatrics’ Committee on Infectious Diseases and author of the book .

Concern about SSPE was great enough that in January, the Child Neurology Society to educate U.S. clinicians about the condition, and doctors who have seen such cases are warning their peers.

“We don’t have a way of knowing who’s going to get it, and we don’t have a way of very effectively treating it,” said , a professor of neurology with the New York University Grossman School of Medicine. “The one best thing that we can do, ideally, is to prevent children from having to go through it in the first place.”

The recommended two-dose measles vaccine slashes an exposed person’s risk of getting the contagious virus from — and thus reduces the chance of SSPE. The vaccines carry small risks of and a , but measles itself has a higher risk of causing both.

Cases in the U.S.

A of California children who developed SSPE after a measles outbreak there years ago determined that 1 case is diagnosed for about every 1,400 known cases of measles in children under age 5, and 1 for every 600 infected babies.

The researchers also found that, over the years, doctors had missed some cases among patients who had died with undiagnosed neurologic illness.

The possibility that future cases could go undiagnosed spurred and her colleagues to publish a news release in September when a Los Angeles County child .

“We’ve had very few cases of measles in the last 25 years in this country,” said Yeganeh, who is the medical director with the Vaccine Preventable Disease Control Program at the Los Angeles County public health department and has had two patients with SSPE. “Unfortunately, that’s changing, and so we wanted to make sure that everyone was aware of this long-term complication.”

The California child who died had gotten measles as an infant, Yeganeh said, before the child could receive the vaccine. Measles is highly contagious, so at least 95% of the population must be immune to it to protect vulnerable people — including babies too young to vaccinate and people who are immunocompromised — from infection.

“This is an example of someone who did everything right, wanted to protect their child against this infection, and unfortunately ended up losing their child because we didn’t have herd immunity for them,” Yeganeh said.

Shortly after Yeganeh’s group published the news release in California, Nelson was working to get the word out, too.

He had recently seen a 5-year-old whose family had traveled to the U.S. for medical care after the child started stumbling, jerking, hallucinating about bugs and animals, and having seizures. The child had contracted measles as an infant and had been too young to be vaccinated. Nelson diagnosed the child with SSPE.

“Imagine that: Having a child who is healthy and happy, moving to talking less and less, eventually not able to walk,” Nelson said. “It’s a very sad thing.”

He thought he would encounter the condition only in medical school textbooks, as a relic of the past. Instead, in October he found himself presenting the case at the Child Neurology Society’s national conference and participating in the society’s video about the condition. “I’ve now seen something I shouldn’t have ideally seen ever in my career,” he said.

Warning Signs From India

Globally, the number of measles outbreaks in recent years, and physicians in places including and have recently seen clusters of SSPE.

The high human cost of measles’ spread is especially evident in India. While total cases aren’t tracked, about 200 families caring for people with SSPE, including Deepanwita’s, are in a single chat group in the Bangalore area.

In New Delhi, Sheffali Gulati and sees about 10 new patients a year with the condition, what she calls the “delayed echo” of measles outbreaks. The youngest she has seen was 3 years old.

“The ages are , and a death or a vegetative state can develop as soon as in six months to five years of onset,” said Gulati, who leads the pediatric neurology program at the and until recently led India’s .

Gulati hasn’t found any treatments that reverse SSPE’s course, only some that slow its progress. She’s found herself counseling parents: It’s catastrophic, it’s not their fault, and they can do nothing but accept it.

Deepanwita’s relatives try to find joy where they can. They think they noticed the girl smiling when her favorite cousin called recently. Anindita Dasgupta, her mother, said Deepanwita moves her hands and feet on her own and sometimes turns her head, especially when her father enters the room. The girl communicates with her parents through her eyes and a few sounds.

But it’s far from where she was in 2022: At a cousin’s birthday, a few months before noticeable symptoms started, Deepanwita started the birthday song and sang the loudest.

At her own 8th-birthday gathering last year, Deepanwita, wearing a pink eyelet dress and a nasal tube, could only blink and move her eyes as she sat propped up before two cakes that she would not be able to eat. She can no longer swallow, so her mom dabbed a bit of icing on her tongue.

Research That Shouldn’t Be Needed

, a molecular biologist at the Mayo Clinic in Rochester, Minnesota, has been for years. He recently used postmortem brain tissue to map how the measles virus can spread from the frontal cortex to colonize the entire brain. Still, he said it’s a “black box” what exactly measles is doing in those dormant years between the initial infection and when the symptoms of neurologic damage crop up.

It’s possible the virus replicates in the brain that whole time, undetected, killing off neurons. But with so many neurons in the human brain — 10 times as many as people living on the planet — the brain may find a way to adjust, Cattaneo said, until finally it can’t anymore.

He’s applying for funding to continue research on the disease and possible treatments, though ultimately, he wishes he didn’t have to. The tools to obliterate the condition already exist.

“The problem could be solved with vaccination,” Cattaneo said. The U.S. should have no cases of SSPE, he said. “It’s just painful.”

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What the Health? From ��ýҕ�l Health News: RFK Jr.’s Very Bad Week

Thu, 12 Mar 2026 18:35:00 +0000

The Host

Julie Rovner ��ýҕ�l Health News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of ��ýҕ�l Health News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

It’s been a tough week for Health and Human Services Secretary Robert F. Kennedy Jr. In addition to Kennedy having surgery to repair a torn rotator cuff, personnel issues continue to plague the department: The nominee to become surgeon general, an ally of Kennedy’s, may lack the votes for Senate confirmation. The controversial head of the Food and Drug Administration’s vaccine center will be resigning next month. And a new survey finds Americans have less trust in HHS leaders now than they did during the pandemic.

Meanwhile, the Trump administration continues its crackdown over claims of rampant health care fraud. In addition to targeting the Medicaid programs in states led by Democratic governors, the Centers for Medicare & Medicaid Services is also taking aim at previously sacrosanct Medicare Advantage plans.

This week’s panelists are Julie Rovner of ��ýҕ�l Health News, Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, and Shefali Luthra of The 19th.

Panelists

Anna Edney Bloomberg News Joanne Kenen Johns Hopkins University and Politico Shefali Luthra The 19th

Among the takeaways from this week’s episode:

Americans feel more confident in career scientists at federal health agencies than in the agencies’ leaders, according to a new survey from the Annenberg Public Policy Center at the University of Pennsylvania. Yet the survey also sheds more light on the erosion of trust in public health officials and scientific research.
The FDA’s vaccine chief, Vinay Prasad, is leaving — again. Prasad was a critic of the agency before he joined it, and his tenure has been shaped by the same attitude, affecting career officials’ morale and the agency’s interactions with outside companies.
The Trump administration has extended its fraud crackdown campaign into Medicare Advantage plans. The privately run alternative to traditional Medicare coverage has been a GOP darling from the get-go. Yet President Donald Trump is nudging the party away from its pro-business stance on private insurance, arguing the government should give money to patients rather than insurers — a justification for policies undermining the Affordable Care Act.
And Wyoming became the latest state to enact a six-week abortion ban, a move that’s being challenged in court. The development points to the fact that while federal policymaking on abortion has largely stalled, the issue is still very much in play in the states as abortion opponents keep pushing back on access to the procedure.

Also this week, Rovner interviews Andy Schneider of Georgetown University about the Trump administration’s crackdown on what it alleges is rampant Medicaid fraud in Democratic-led states.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Marshall Project’s “,” by Shannon Heffernan, Jesse Bogan, and Anna Flagg.

Anna Edney: The Wall Street Journal’s “,” by Christopher Weaver, Tom McGinty, and Anna Wilde Mathews.

Shefali Luthra: The New York Times’ “,” by Apoorva Mandavilli.

Joanne Kenen: The Idaho Capital Sun’s “,” by Laura Guido.

Also mentioned in this week’s podcast:

The Annenberg Public Policy Center’s “.”
��ýҕ�l Health News’ “Six Federal Scientists Run Out by Trump Talk About the Work Left Undone,” by Rachana Pradhan and Katheryn Houghton.
Bloomberg Law’s “,” by Sandhya Raman.
The 19th’s “,” by Shefali Luthra.
The Georgetown University McCourt School of Public Policy Center for Children and Families’ “,” by Andy Schneider.

Clarification:��This page was updated at 5:10 p.m. ET on March 12, 2026, to clarify that Vinay Prasad, the FDA’s vaccine chief, will be leaving his job in April. In an email after publication, William Maloney, an HHS spokesperson, said Prasad is “leaving of his own accord.”

click to open the transcript Transcript: RFK Jr.’s Very Bad Week

[Editor’s note:��This transcript��was generated��using both transcription software and a human’s light touch. It has��been edited��for style and clarity.]��

Julie Rovner:��Hello from��KFF��Health��News and WAMU��public radio��in Washington, D.C. Welcome to��What the��Health?��I’m��Julie Rovner,��chief Washington correspondent for��ýҕ�l Health��News, and��I’m��joined by��some of��the best and smartest reporters covering Washington. We are taping this week on Thursday, March 12, at 10��a.m.��As always, news happens fast and things might have changed by the time you hear this. So,��here we go.��

Today��we��are joined��via videoconference by Shefali Luthra��of the 19th.��

Shefali Luthra:��Hello.��

Rovner:��Anna��Edney of��Bloomberg News.��

Anna Edney:��Hi,��everybody.��

Rovner:��And��Joanne��Kenen��at the Johns Hopkins Bloomberg School of Public Health and��Politico��Magazine.��

Joanne Kenen:��Hi,��everybody.��

Rovner:��Later in this episode,��we’ll��have my interview with Andy Schneider of Georgetown University, who will try to explain how the federal government’s fraud crackdown on blue-state Medicaid programs��is something��completely different from any fraud-fighting effort��we’ve��seen before. But first,��this week’s news��—��and��some of��last��week’s.��

Let’s��start at the Department of Health and Human Services, where I think��it’s��safe to say Secretary Robert F Kennedy Jr.��is not having��a great week. The��secretary��reportedly had��to have his rotator cuff surgically repaired on Tuesday.��It’s��not clear if he injured it during one of his famous video workouts. But it is clear, at least according to��from the University of Pennsylvania’s Annenberg Center, that the American public is not buying what��he’s��selling when it comes to policy. According to the survey, public trust in HHS agencies, which already took a dive during the pandemic, has fallen even more since Kennedy took over the department. Although, interestingly, public trust in career HHS officials is higher than it is for their political leaders. And trust in outside professional health organizations, places like the American Heart Association and the American Academy of Pediatrics, is higher than for any of the government entities.��

Perhaps related to that is another piece of HHS��news from��this week.��The FDA��[Food and Drug Administration]��approved a label change for the drug leucovorin, which Secretary Kennedy last fall very aggressively touted as a potential treatment for autism. But the drug��wasn’t��approved��to treat autism. Rather, the label changes to treat a rare genetic condition. Kennedy bragged about leucovorin, by the way, at��the same press conference that President��[Donald]��Trump urged pregnant women not to take Tylenol, which has not��been shown��to contribute to the rise in autism.��Maybe it’s��fair to say the public is paying attention to the��news��and that helps explain the results of this Annenberg Center survey?��

Luthra:��Maybe.��I was just thinking, we do know that Tylenol prescriptions for people who are pregnant did go down,��right? There’s research that shows,��after that press conference,��behaviors did change. And��so��to your point,��it’s��clear there is��a lot of��confusion, and confusion��maybe breeds��mistrust. But I��don’t��know that we can necessarily say that American voters and the public at large are very obviously informed as��much��as they are��perhaps disenchanted��by things that seem as if they��were told��would restore trust and make things clearer and in fact have not done so.��

Rovner:��That’s��a��fair assessment.��Anna.��

Edney:��Yeah, I think��there’s a lot of overpromising and underdelivering, and that can kind of create this issue where this administration��—��and RFK Jr.��has been doing this as well��—��kind of is making these decisions from the top, rather than having these normal conversations with the career scientists and things like that, where the public can kind of follow along on why the scientific decisions are being made if they so choose to,��or at least��have an idea that there was a discussion out there. And��that’s��not happening. So��that’s��not something��that’s��creating��a lot of��trust.��I think people��are seeing that as unscientific and chaotic.��

Rovner:��I was��particularly interested in one of the findings in the survey,��is that Dr.��Fauci, Dr.��Tony Fauci, who was��sort of��the��bête noire��of the pandemic, has a higher approval rating than either RFK Jr.��or��some of��his top deputies.��Joanne, I see you nodding.��

Kenen:��Yeah��that was so��stri—��I mean,��it’s��still not high. It was,��I believe it��was��—��I’m��looking for my note��—��but I��think��was 54%,��which is not great. But it��was better than��Dr.��[Mehmet]��Oz��[head of the Centers for Medicare & Medicaid Services]. It was better than Kennedy. It��was better than a bunch of people.��So,��but it also shows that��half��the country still��doesn’t��trust him.��It was��a really interesting��survey, but the gaps in trust in credible science are still significant. What was interesting is the declining trust in our government officials in health��care, but��there’s��still,��nationally, the U.S.��population,��there’s��still��a lot of��skepticism of science and public health. Maybe not as bad as it was, but still��pretty bad.��

Luthra:��And Julie, you alluded to these famous push-up and workout videos. And part of what��you’re��getting at��—��right?��—��is that the communications that we see��are targeted��toward a not necessarily��very large��audience.��It is these people who are hyper-online,��in particular internet��spaces and communities, and that’s��somewhat divorced��from most people and how they live their lives.��And when you focus��your message and you’re campaigning on this very particular slice, it’s just��a lot��easier to lose sight of where people are and what they want from their government and what they will��actually appreciate.��

Rovner:��It’s��true.��The online��America is very separate from the rest of America, which is a��whole lot bigger.��Well—��

Kenen:��And��there’s��also the young people who��probably��aren’t��in these surveys who,��teenagers,��who��are getting��a lot of��information on TikTok about supplements and raw milk.��And the young men and the teenage boys and the supplements��is a big deal, and��that’s��online. And��also��we have been��seeing��for a while, but I think��it’s��probably creeping��up,��the recommendations about psychedelics.��So��there’s��all this stuff out there that��isn’t��going to��be picked��up by that poll. But yes, it was an interesting poll.��

Rovner:��All right. Well, meanwhile over at the Food and Drug Administration, in-again��out-again in-again��vaccine chief Vinay Prasad is��apparently out��again, or��will be as of later this spring. I feel like Prasad’s very rocky��tenure has been��kind of a��microcosm for the difficulties this administration has had working with��career��scientists at FDA and elsewhere, at HHS.��Anna, what made him so controversial?��

Edney:��Well, I think, Prasad was an FDA critic before he came to the agency. And so��essentially,��when he was out in public, particularly during covid, but there were even criticisms he had before that.��He was criticizing these career scientists at the agency. And��so��he got there, and the way he appeared to��operate��was that he knew��best��and he��didn’t��need to talk to any of these people that had been there,��some��for decades, and that was getting him in��a lot of��trouble. But he was��being defended��and protected by FDA��Commissioner Martin Makary, and he really supported Prasad, and he called him a genius and wanted him to stay on.��So��the first time Prasad left, he convinced him to come back. And now this time, I think, things��maybe just��went��a bridge too far when there was sort of this behind-the-scenes but very public fight with a company trying to make a rare-disease drug. And this is something that,��particularly,��several��senators really, really hate, is when the FDA is getting in the way of a rare-disease drug getting to market, because they don’t think that that’s something the agency should be trying to do unless the drug is��maybe wholly��unsafe. But they think��anyone��should be able to try it. And��so��when this exploded and FDA officials were and HHS officials were behind the scenes, but very publicly, calling this company a liar, it was just a bridge too far.��

Rovner:��Well, and he,��this was,��this incredibly unusual��in which he tried to not be quoted by name, but kind of hard when the head of the agency, or the head of the��center at FDA is basically trashing a company,��trying to do it on background. Was that kind of the last straw?��

Edney:��Yeah, I think so. And��sort of an��aside��on��that.��I’m��curious how that phone call��even��was��allowed��to be set up and called.��Because,��it’s��not like he did it on his own. There��were,��there was an infrastructure around him that helped him set that up.��So��I’m��curious about why that even went down, but��I think that��was��definitely what��pushed him out the door. You know, this company wanted to get this drug approved. The FDA had said,��No, not unless you do this extremely difficult trial, which the company said would require drilling holes in people’s heads,��for what they were trying to get approved, and that it would be a placebo, essentially, for some of those patients, even when you get a hole drilled in your head, and this could be a 10-hour sham surgery, is what the company said. And then��Prasad comes��out and��says:��No,��they’re��lying.��That��definitely could��be a half-hour.��No big deal.��And��I just think that there��were��senators frustrated with this, the White House��not wanting to��see another thing blow��up over rare-disease drugs, because that has, there��have��been��a lot of��issues at FDA under his tenure, of just drugs not being able to get to market. Or��having issues with vaccines that have been years in development not being able to��get even reviewed, and then that��being reversed.��So��it was��just,��that was��kind of the��last straw.��

Rovner:��And��of��course��President Trump himself has been a big proponent of this whole Right to Try effort,��that it should be easier for people with, particularly with terminal diseases to be able to try drugs that may or may not help.��Joanne, you want to add something.��

Kenen:��Also��wasn’t��he still,��Prasad, still living in California and running up��really huge��travel bills and—��

Rovner:��Yes.��

Kenen:��—not being at the FDA very much, at a time when everybody else has��been forced��to come back to work?��So,��but I do confess that I keep looking at my phone to check if��he’s��still out or��is he��already back again.��

Rovner:��Right.��

Kenen:��I’m��really not��totally convinced that this is the end of Prasad, but��yeah.��

Rovner:��Yeah,��I was not kidding when I said��on-again��off-again on-again��off-again. All right. Well, moving over to the National Institutes of Health, which also has a director��that’s��doing more than one job in more than one place. I know there’s so much news that it’s hard to keep track of it all, but I do think it’s important to continue to follow things that look to��be settled, like funding for the NIH,��which Congress��actually increased��in the spending bill that passed at the end of January. To that end, a shout-out to our podcast panelist��Sandhya Raman, formerly of CQ,��now at Bloomberg, for��grant funding that still pays for most of the nation’s basic biomedical research is still being held up. This is months after it��was ordered��resumed by courts and appropriated by Congress.��

Shout-out as well to my��ýҕ�l Health��News colleagues��Rachana Pradhan��and Katheryn��Houghton for��their project��on the people and research projects that have been disrupted by all the cuts at NIH,��as well as new bureaucratic hurdles put in place. I feel like if there weren’t so much else going on, what’s happening at��basically the��economic and health engine of NIH would be getting much,��much,��much��more attention, particularly because of the continuing brain drain with researchers moving to other countries and students choosing different careers rather than becoming researchers. I wonder if this sort��of drip,��drip, drip at NIH is going to turn into a very long-term hole��that’s��going to be��very difficult��to fill.��A��lot of��these things have years-��if not decades-long runways.��These great scientific achievements start somewhere, and it looks like��they’re��just��sort of pulling��out the whole starting part.��

Kenen:��It’s��already affecting the pipeline. In graduate schools,��many��schools fund their PhD candidates, and��it’s��NIH money, or partly NIH money.��It’s��different��—��I’m��not an expert in every single school’s��support��systems��for PhD candidates, but I do know that the pipeline has��been shrunken��in��some��fields at��some��schools, and��that’s��been��reported��on��widely. And��there’s��been��a lot of��coverage about years and��years of research. You��can’t��just restart a multiyear,��complicated clinical trial or research project. Once you stop it,��you’re��losing everything to date, right? You��can’t��just��sort of say,��Oh,��I’ll��put it on hold for a couple of years and resume it.��You��can’t��do that.��So��we’ve already reached��some kind of��a��critical��point.��It’s��just a matter of how much worse it gets, or whether the ship begins to stabilize in any way going forward. But there’s already damage.��

Rovner:��I say,��are you guys as surprised as I am, though, that this isn’t��—��the NIH has been this sort of bipartisan jewel that everybody has supported over the decades that I’ve been covering it, and now it’s��basically being��dismantled in front of our eyes, and nobody’s saying very much about��it.��

Kenen:��It’s��also an engine of economic growth.��You see different ROI��[return on investment]��numbers when you look at NIH, but I think the lowest number you hear is��two and a half dollars of benefit for every dollar we invest. And��I’ve��seen��reports��up to $7.��I��don’t��know what the magic number is, but this is an engine of economic growth in the United States. This is basic biomedical research that the private sector or the academic sector cannot do.��It��has to��come from the government.��And I��don’t��think any of us have really gotten our heads around��— why harm the NIH��when it is��bipartisan,��it is economically successful,��and it has humanitarian value.��It’s��the basis.��The drug companies develop the drug and bring it to the market. But that basic, basic,��earlier��what’s��called bench science,��that’s��funded by the��NIH.��

Rovner:��I know.��It’s��a mystery. Well, adding to RFK Jr.’s bad week are the growing divisions within his base,��the��Make America��Healthy��Again��movement. While the White House, seeing that the public doesn’t really support��MAHA’s��anti-vaccine positions,��is trying to get HHS to tone it down, there was a major MAHA��meetup just blocks from the White House this week, with sessions urging a complete end to the childhood vaccine schedule and the removal of all vaccines from the market, quote, until they can be proven��“safe and effective.”��By the way,��most��of��them have��been already. Meanwhile,��lots of��MAHA��followers are still angry that the White House is supporting the continuing production of glyphosate, the weed killer sold commercially as Roundup. Democrats,��, are trying to exploit the divisions in the MAHA movement, which leads to the question:��Will��MAHA��be a net plus or a net minus for this fall’s midterm elections?��On the one hand,��I think Trump��appointed Kennedy because he was hoping that��the MAHA movement would be��a boost to turnout.��On the other hand, MAHA��seems��pretty split��right now.��

Edney:��Well, I think��that’s��the million-dollar question,��is��which way��they’re��going to swing if they swing at all. And it’s hard to say right now, because��I think they��are angry at certain aspects of things this administration is doing,��the two things you mentioned,��on��Roundup and on vaccines, kind of telling RFK to kind of talk a little bit less about those. But will they be able to then vote for Democrats instead? I��think,��it’s��only March,��so��it’s��so difficult to say��what will happen between now and then.��I think there’s still things that the health secretary could do on food that��he’s��talked about, that could draw attention away from that anger, that might make��many��of them happy.��I think there��were��some��things he��kind of started��doing early in his term��that��hasn’t��been talked��about as much.��And also, I think there’s still the prospect of Casey��Means becoming��surgeon��general��—��or not��—��out there, and that’s��kind of a��big piece of this.��If she is to get into the administration, and that is sort of up in the��air��right now, then that could��kind of give��them something else to focus on, because she is a large part of this playbook of the MAHA movement.��

Rovner:��That’s��right.��And we are waiting to see sort of if she can get the votes even to get out of committee, much less get to the floor, see��whether we’re going to have, as��some��are saying, the first��surgeon��general who does not have an active license to practice medicine. Shefali, you wanted��to add something.��

Luthra:��No, I just think��we’ve��talked about this before on the podcast, that the food stuff is much more popular than the vaccine stuff. The vaccine components of��MAHA��remain very unpopular.��It’s��difficult to really see or say sort of what the White House can do on food in a sustained, focused way,��without going��off-script, that is also popular. But I think to Anna’s point,��it’s��just so hard to say to what extent this��ultimately matters��in November, because there are just so many concerns right now. People��can’t��afford their health insurance, and gas prices are going up. And��I just think we��have to��wait and see to what extent people are voting based on food policy.��

Rovner:��Yeah, well, we will see. All��right,��we’re��going to take a quick break. We will be right back.��

OK, turning to another Trump administration priority, fighting fraud. This week, the administration accused another��Democratic-led state, New York, of not policing Medicaid fraud forcefully enough. This comes after the Centers for Medicare��&��Medicaid Services said it will withhold hundreds of millions of dollars from Minnesota, which our guest,��Andy Schneider,��will talk about at more length. Minnesota, by the way, last��week sued the federal government over its Medicaid efforts. So that fight will continue for a while. But��it’s��not just blue states, and��it’s��not just Medicaid. In something I��didn’t��have on my bingo card, this administration is also going after fraud in the Medicare Advantage��program, which has long been a Republican darling.��

Last week, CMS banned the Medicare Advantage plan��operated��by��Elevance��Health, which has��nearly 2��million Medicare patients currently enrolled,��from adding any new enrollees starting March 31,��for what the agency described as, quote,��“substantial and persistent noncompliance with Medicare Advantage risk adjustment data.”��And on Tuesday, the��congressional Joint Economic Committee reported that overpayments to those Medicare Advantage��plans raised premiums by an estimated $200 per Medicare enrollee annually��—��and��that’s��all Medicare enrollees, not just those in the private Medicare Advantage plans. Is this the end of the honeymoon for Medicare Advantage? Joanne, you were there with me when Republicans were pushing this.��

Kenen:��I’ve��been surprised, as you have,��Julie, because��basically Medicare��Advantage has been the��darling, and it��is popular with people.��It’s grown and grown and grown,��not because the government forced people in. It has good marketing and��some��benefits for the younger, healthier post-65 population, gyms and things like that.��But��—��and vision and dental, which��are a big deal. But��we’ve��also seen a backlash, in��some��ways, because there’s the prior authorization issues in Medicare Advantage have gotten��a lot of��attention��the last couple of years. But not just am I surprised by��sort��of��the��swing��that��we’re��hearing��about��generally.��I’m��surprised by Dr.��Oz, because when he ran for Senate a couple��years��ago in Pennsylvania, and��much��of his public persona has been really, really,��really gung-ho, pro Medicare Advantage.��

And yet,��some of��you were at or,��like me, watched the live stream of��—��he did��a very interesting, thoughtful, and,��I’ve mentioned this at least one time before, hourlong conversation with��a lot of��Q&A at the Aspen Institute here in D.C.��a couple of months ago. And one of the questions was someone said:��Dr.��Oz,��you’ve��just turned 65.��Are you doing Medicare Advantage, or��are��you doing traditional Medicare?��And the expected answer for me was, well, I knew that��he’s��on government insurance now.��So��he, you��have to,��at 65 you��have to��go into Medicare Advanta—��Medicare A,��whether��you��—��that’s automatic.��That’s��the hospital part. But you have the choice. But if��you’re��still working and getting insurance or government��—��he’s��on a government plan. He��doesn’t��have to do that. But��he actually, and��he pointed that out, but the next sentence really surprised me, because he said:��I��don’t��know. My wife and I are still talking about that.��And I thought that was��A)��a��very honest answer. He��didn’t��have to even��say. But it was also,��it just was interesting to me that after all that��Rah-rah��Medicare Advantage��we were hearing about, his own personal choice��was,��Not��sure if that one’s right for me.��So��—��

Rovner:��I was going to say,��I feel like the Republicans are sort of twisting right now between Medicare Advantage, which they’ve always pushed��—��they want to privatize Medicare because they don’t like government health insurance��—��and then there’s��the current populist��push against big insurance companies, because, of course, all those Medicare Advantage��plans belong to those big insurance companies that Republicans are suddenly saying are too big and getting too much money.��So��they’re��sort of caught��between��trying to have it both ways.��I’ll��be interested to see how they come down. One of the things that did strike me, though, even before Dr.��Oz��sort of started��his little crusade against Medicare Advantage, was,��I think it��was at Kennedy’s confirmation hearing that Sen.��Bill Cassidy was suddenly questioning Medicare Advantage. That was, I think, the first Republican I saw to like,��Oh.��That made me raise my eyebrows.��And I think since then, I’ve��kind of seen��why.��

Kenen:��The��populist talk��against��insurance companies,��not giving money to insurance companies,��is part of the Republican��—��and,��specifically, President Trump’s��—��desire to not extend the ACA,��the Affordable Care Act,��enhanced subsidies. That was the basic:��Well,��we’re��not going to do this,��because��we’re��just throwing money at these insurance companies. And we��don’t��want to do that. We want to empower��the patients.��That was��the,��I’m��not, and the missing piece of that argument is:��Yes, the ACA subsidies go to insurance companies. However, all of us are benefiting in��some��way or other from government policies that��benefit��insurance companies.��The tax breaks our employers get. The tax breaks we get for our insurance.��And then the biggie, of course, is Medicare Advantage.��

We are paying Medicare Advantage more than we are paying traditional Medicare.��So��Medicare Advantage is��private��insurance��companies, and the government has��been just��sending them��lots��and��lots of��money for years.��So��I’m not sure it’s��—��this Medicare Advantage thing is just bubbling up, and we’re not��really sure��how this plays out. But��I think that��the rhetoric��against insurance companies��is��the rhetoric��against the ACA.��

Rovner:��Oh, it is.��

Kenen:��Rather that��hasn’t��yet��been connected��to the Medicare Advantage. I think��they’re,��yes, we all know��they’re��connected. But I think the political debate, it’s��not Medicare��Advantage��is bad because insurance companies are bad.��It’s the��ACA is bad because it enriches insurance companies.��There’s��a different ideological parade going down the road.��

Rovner:��I was going to say,��it’s��important to remember at the beginning of Medicare Advantage, which was a Republican proposal back in 2003,��they purposely overpaid it. They gave it more money because they know that when they give them more money, the insurance companies��are required��to��return��some of��that money to beneficiaries in the form of these extra benefits.��That’s��why there are gym memberships and dental and vision and hearing coverage in these Medicare Advantage plans. It does make them popular, so people sign up. And that was��sort of Republicans’��intent at the beginning. It was to��sort of not��so much push people into it but entice people into it.��

Kenen:��And��then—��

Rovner:��And then maybe cut it back later.��

Kenen:��No, but��it’s exceeded��expectations.��

Rovner:��Absolutely.��

Kenen:��The number of people going into Medicare Advantage has been��really high, higher than people expected.��And��it’s��also hard to get out, depending on what state you live in.��It’s��not impossible, but��it’s��costly and difficult, except for��a few,��I think��it’s��seven or eight��states��make it��pretty easy. But also remember that the earlier version of what we now call Medicare Advantage was��—��which��was the��’90s, right Julie?��—��I think the Medicare Part C,��and that failed.��So��—��

Rovner:��Well after,��that failed because they cut it when they were��—��

Kenen:��Right.��Right.��

Rovner:��They cut all the funding when they were balancing the budget��—��

Kenen:��Right.��

Rovner:��—��in��1997.��

Kenen:��But that��gave them��the��excu—��right.��

Rovner:��They made it��fail.��

Kenen:��That��gave them an excuse to give them more money later that, when they revived it, renamed it,��and launched it��in��2003 legislation,��that initial push to give them a ton of money, because they could say,��Well, we didn’t give them enough money, and that’s why they��fa—.��There��are��all sorts of political��things going on that��weren’t��strictly money. But��yeah,��it was part of the narrative of��Why we��have to��give them more money,��is��They need it.��

Rovner:��Yeah.��Anyway,��we’ll��also watch that space. Well, finally, this week, there’s news on the reproductive health front, because there’s always news on the reproductive health front. Shefali,��Wyoming has become the latest state to enact a so-called heartbeat ban, barring abortions when cardiac activity can��be detected.��That’s��often around six weeks, which is before��many��people are even aware of being pregnant. I thought the Wyoming Supreme Court said just this past January that its constitution prevents abortion bans.��So��what’s��up here?��

Luthra:��They did, in fact, say that, and so we are seeing this law taken to court.��It was��actually added��in a court filing to a preexisting case challenging other abortion restrictions in the state.��I’m��sure��that’s��going to play out for quite��some��time. But��what’s��interesting about the Wyoming��Constitution��—��right?��—��is that it protects the right to make health care decisions,��in an effort to��sort��of��fight against the ACA. That was this��conservative approach that now has come to really��benefit��abortion rights supporters as well. But what I think��this underscores��is that even as we are seeing��fairly little��abortion policy in Washington, at least in a meaningful way,��a lot��is still happening on the state level. That really is where the bulk of action is, whether you see that in Wyoming,��in Missouri, where��they’re��trying to undo the abortion rights protections there, and just—��

Rovner:��The ones that passed by voters.��

Luthra:��Exactly. And��so��what we’re really thinking about is anti-abortion activists are not really that confident in the��president’s desire, interest, ability, what have you, to get their agenda items done. And for now, they are really focusing on the states, and that is where their interest, I think, will only remain, at least until the primary for the next presidential race begins in earnest.��

Rovner:��Well,��Shefali,��I also want to ask you about��this week on just how many things ripple out economically from abortion restrictions. Now��it’s��having an impact on rent prices?��Please explain.��

Luthra:��I thought��this was so interesting. It was this��NBER��[National Bureau of Economic Research]��paper that came out this week, and they looked at comparably trending rental markets in states with abortion bans and those without them. And what they saw was that after the��Dobbs��decision, rental prices declined��relative��to places without bans, compared to those in those that had them.��And this is��really interesting.��It just��sort of continues.��Rental prices went down,��and also��vacancies went up.��And what the researchers say is this is��a very, very dramatic��and clear relationship, and it illustrates that people, when they have a choice, are considering abortion rights in terms of where they want to live. And anecdotally, we know that,��because��we’ve��seen residents make choices about where they will practice.��We’ve��seen doctors decide where they will live. We have seen people move. Companies offer relocation benefits if people want them. And this is more data that illustrates that��actually that��affects the economy of communities, and it really underscores that where we live just simply will look different based on things��like abortion rights and abortion policy and other of these things that��are treated��as social but really do affect people’s economic behaviors.��

Rovner:��And as we pointed out before,��it’s��not just about quote-unquote��“abortion,”��because when doctors choose not to live in a certain place,��it’s��other types of health��care.��It’s��all��health��care. And we know that doctors tend to marry or partner with other doctors. So sometimes if an OB GYN��doesn’t��want to move to a certain place, then that OB-GYN’s��partner, who may be��some��completely other type of��doctor,��isn’t��going to move there either.��So��we are starting to see��some of��these geographical shifts going on.��

Luthra:��And one point��actually that��the researcher made that I thought was so interesting was that abortion policy, it can be emblematic, in and of itself, a reason people choose not to live somewhere, but people may also be making these decisions because of what it represents. Do I look at an abortion policy and say,��Oh, this reflects social values or gender beliefs?��Or does it also suggest��maybe more��anti-LGBTQ+��laws?��And all of that can create a picture that is broader than simply abortion or��not, and��determine��where and how people want to live their lives.��

Rovner:��It’s��a really interesting��story.��We will��link��to it.��All right, that is this week’s news. Now��I’ll��play my interview with Andy Schneider of Georgetown University, and then we will be back to do our extra credits.��

Rovner:��I am pleased to welcome to the podcast Andy Schneider, a research professor of the practice at the Georgetown University McCourt School of Public Policy. And he spent��many��years on Capitol Hill helping write and shape Medicaid law as a top aide to California Democratic��congressman��Henry Waxman��—��and��many��hours explaining it to me.��I have asked him here to help untangle the Medicaid fraud fight now taking place between the federal government and,��at least so far, mostly��Democratic-led states. Andy, thanks for being here.��

Andy Schneider:��Thanks for having me,��Julie.��

Rovner:��So,��it’s��not like fraud in Medicaid��—��and other health programs,��for that matter��—��is anything new.��Who are the major perpetrators of health care fraud?��It’s��not usually the��patients, is it?��

Schneider:��No,��it’s��usually��some��bad-actor providers or bad-actor businesspeople.��

Rovner:��So how are fraud-fighting efforts at both the federal and state level, since Medicaid funding��is shared, supposed to work?��How does the federal government and the state government��sort of try��and make fraud as minimal as possible? Since��presumably they’re��never going to get��rid of it.��

Schneider:��Unfortunately, I��don’t��think��you’re��ever going to get rid of it in Medicaid or Medicare or private insurance or in other��walks of life. There are bad actors out there.��They’re��going to try to take��advantage.��So��you need your defenses up.��So��the short of this is,��Medicaid��is administered��on a day-to-day basis by the states. The federal government��pays for��a majority of��it and oversees how the states run their programs. In that context, the state Medicaid agency and the state��fraud��control��unit have a��primary role in��identifying��where there might be fraud, investigating,��and then,��in��appropriate cases,��prosecuting. The federal government also has a role, however. Depending on the scope of the fraud, it could involve the FBI. It could involve the Office of Inspector General at the Department of Health and Human Services.��So��there’s��both federal and state presence, but the primary responsibilities were the��states’.��

Rovner:��We know that Minnesota has been experiencing a Medicaid fraud problem,��because both the state and the federal government have been working on it for more than a year now. What is the Trump administration doing in Minnesota?��And why is��this��different from what the federal government has traditionally done when��it’s��trying to ensure that states are appropriately trying to minimize fraud?��

Schneider:��Well, usually the��vice��president of the United States does not get up at a White House press conference and announce he and the Centers for Medicare��&��Medicaid��Services are��withholding $260 million in federal funds,��called��a��deferral. That is highly, highly unusual. And normally��the��head of the Centers��for Medicare��&��Medicaid Services does not��go and make��videos in the state before something like this��is announced.��So��I would say that this is��way out��of the ordinary, and��I think it��has to do with��some��animus in the administration towards��Gov.��[Tim]��Walz and his administration.��

Rovner:��Right.��Gov.��Walz, for those who��don’t��remember, was the��vice presidential��candidate in 2024 running against President Trump, who did win, in fact. But there have been two different efforts to withhold Medicaid money for Minnesota, right?��

Schneider:��Yeah. Now��you’re��into��the Medicaid��weeds, but since you asked the question,��I’ll��take you there. So in January, the��administra—��the Center for Medicare��&��Medicaid Services��—��we’ll call them CMS here��—��they announced they were going to withhold about��$2 billion��a year going forward, not looking back��but going forward,��in matching funds that the federal government would otherwise pay to the state of Minnesota for the services that it was providing to its over 1 million beneficiaries. In February at this White House press conference, what the��vice��president announced was withholding temporarily��—��we’ll see how temporary it is��—��but withholding temporarily��$260 million in federal Medicaid matching funds that applied to state spending that’s already occurred, happened in the past, happened in the quarter ending Sept.��30, 2025.��So��both the past expenditures and future expenditures are targets for these CMS actions.��

Rovner:��So��what happens if the federal government��actually doesn’t��pay the state this money? I assume more than people who are committing fraud would��be��impacted.��

Schneider:��Well,��let’s��be clear.��The��amounts of money here,��there’s��no relationship between those and however��much��fraud is going on in Minnesota. And there has been fraud against Medicaid in Minnesota.��Everybody’s��clear about that. The state is clear about it. The feds are clear about it. But��$2 billion��going forward in a year,��$1 billion��going,��looking backwards,��$260 million times four��—��there’s��no relationship between those amounts, right? Should they��come to pass��—and all of this is still in process��—��should those amounts��come to pass, you’re looking at, depending on who’s doing the estimates, between��7��and 18% of the amount of money the federal government pays,��helps the state with,��each year in Medicaid.��That’s��just an enormous hole for a state to fill, and it��doesn’t��have��many��good options. It can cut eligibility. It can cut services. It can cut reimbursement rates. Filling in that hole with state revenues,��that’s��going to be a real stretch.��

Rovner:��So��it’s��not just Minnesota. Now the administration says it is seeing concerning things going on in New York and has launched a probe��there. Is there any��indication��that this administration is going after states that��are not run��by Democrats?��

Schneider:��So��the only letters that��we’ve��seen from the administration have been to California, New York,��and Maine. There may be other letters out there. We only access the public��record.��So��so��far, based on what we know,��it’s��just��been��Democratically��run��states.��

Rovner:��As long as��I’ve��been covering this, which is now a long time, fraud-fighting has been��pretty bipartisan.��It’s��been something that Congress has worked on, Democrats and Republicans in Congress, Democrats and Republicans in the��states.��What’s��the danger of politicizing fraud-fighting,��which is what��certainly seems to be��going on right now?��

Schneider:��Yeah,��that’s��a terrific point.��So��it��always has��been��bipartisan, because��money is green.��It’s��not red.��It’s��not blue.��It’s��green. And trying to keep bad actors from ripping it off from Medicaid or Medicare��has always been a bipartisan undertaking. The reason that’s important, particularly in a program like Medicaid, where the federal government and the state��have to��talk to one another when they are flagging potential fraud, when they’re investigating it, when they’re prosecuting it, you don’t want the agencies tripping all over one another. You want them��sharing��information��as necessary,��etc.��When that gets politicized,��it’s��very bad��for the results and for the effective operation of the program.��

Rovner:��Well��we will keep watching this space, and��we’ll��have you back to explain it more. Andy Schneider, thank��you very much.��

Schneider:��Julie��Rovner, thank you very much.��

Rovner:��OK,��we’re��back.��Now��it’s��time for our��extra-credit��segment.��That’s��where we each recognize the story we read this��week��we think you should read,��too.��Don’t��worry if you miss it. We will post the links in our show notes on your phone or other mobile device. Anna, why don’t you start us off��this week?��

Edney:��Sure.��Mine is in��The Wall Street Journal.��It’s��[“”].��This is a look at the booming business of providing therapy to children with autism. And��that’s��particularly��been big in the Medicaid��program. And I��don’t��want to give away too much, because there��are��just so many jaw-dropping details��in��this.��So��I guess the reporters��were able to��kind of go��through the data and billing records in a way that showed��some of��these companies and what they were doing and how they were becoming millionaires, people who had never done anything in autism before.��So��if you enjoy a sort of jaw-dropping read, I think you should��take a look��at it.��

Rovner:��Yeah, jaw-dropping is��definitely the��right description.��Joanne.��

Kenen:��So��I��sort of rummaged��around the internet to the less widely read sources, and I came across this��great story��from the Idaho��Capital��Sun by Laura Guido. It has a long headline.��Reminder that 988 is the mental health crisis line and suicide help. The headline is:��“”��The story is that a 15-year-old boy named Jace��Woods called��two years ago��—��so this still��hasn’t��been fixed��after two years��—��and they cut��him��off. They��sort of gently��cut��him��off. But they��can’t��talk to these kids who have,��who are in crisis,��without parental consent. They do a quick assessment. If they think someone’s life is��immediately��in��danger��right then and there, they can stay on. But a kid��who’s��what they call suicidal ideation, seriously depressed and at risk, and knows��he’s��at risk or��she’s��at risk, and made this phone��call,��they��don’t��talk to them unless they think��it’s��imminent.��So��it also affects,��these parental,��it affects sexual health and STDs and abortion and��whole��lot of other��things.��

Rovner:��That’s��what it was for.��

Kenen:��That was the��initial��reason, but it got bigger.��So��a kid who calls in a crisis can get no help at all. And even in those emergency situations where they can stay on the line and try to get emergency help if they do��think��a��kid’s��in imminent danger,��they’re��not allowed to make a follow-up call to make sure��they’re��OK.��So��this kid has been trying for two years.��There’s��a state lawmaker.��They’re��refining a law. They say��it’s,��they’re��refining a bill.��They say��it’s��going to go through. But really this,��talk about unintended consequences. We have a national mental health crisis, particularly acute for teens. This is not solving any problems.��

Rovner:��It is not.��Shefali.��

Luthra:��My story is in��The New York Times. It is by��Apoorva��Mandavilli. The headline is��“.”��And��it’s��just��a good story��about what is happening with the Ryan White AIDS��Drug��Assistance��Programs, which people use to get their HIV medications paid for or for free. They get insurance support. And these are��really important.��Funding has been��pretty flat��for quite��some��time because they’re funded by Congress.��And what the story gets into is that with growing financial pressure on these programs, there is more-expensive drugs, there are more-expensive insurance premiums, more people might be losing Medicaid. States are having to make��very difficult��choices, and they are cutting benefits. They are changing who is eligible, because��it’s��getting more expensive and there is more need and there is no support coming. And I wasn’t really on top of this and did not know what was going on, and I just thought it was interesting and��a very useful��look at��some of��the consequences of the policy choices that are making��all of��these health programs more expensive and health care,��in general, harder to afford.��

Rovner:��My extra credit this week is from��The Marshall Project.��It’s��called��“.”��It’s��by Shannon��Heffernan��and Jesse��Bogan��and Anna Flagg. It answers the question that I’ve been wondering about since the whole immigration crackdown began, which is:��What happens to the people who��are snatched��off the streets or out of their cars or homes,��flown to a distant state, and then someone says:��Oops, sorry. You can go.��How do you get home from Texas or Louisiana to Minnesota or Massachusetts? Authorities��don’t��give you plane or even bus tickets��to get back to where you��were picked��up, even though��that’s��where��most of��those��being released��are��required��to go to report back to immigration authorities. It turns out��there’s��a small network of charities that is helping. But as the story details��pretty vividly, the harm to these families��doesn’t��end when their detention��does./��

OK.��That’s��this week’s show. As always, thanks to our editor,��Emmarie Huetteman,��and our producer-engineer.��Francis Ying. A��reminder:��What the��Health?��is now available on WAMU platforms, the NPR app,��and wherever you get your podcasts, as well as, of course,��kffhealthnews.org.��Also, as always, you can email��us��your comments or questions.��We’re��at whatthehealth@kff.org.��Or you can still find me on��X,��, or on��Bluesky,��. Where are��you guys��hanging these days?��Shefali?��

Luthra:��I am at Bluesky,��.��

Rovner:��Anna.��

Edney:��and��,��@annaedney.��

Rovner:��Joanne.��

Kenen:��A��little bit of��and more on��,��@joannekenen.��

Rovner:��We��will��be back in your feed next week. Until then, be healthy.��

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As Lung Disease Threatens Workers, Lawmakers Seek Protections for Countertop Manufacturers

Céline Gounder — Thu, 12 Mar 2026 09:00:00 +0000

César Manuel González, 37, used to work with stone that was engineered to endure: dense, polished slabs designed to outlast the kitchens in which they were installed.

Engineered quartz countertops have surged in popularity in the home renovation market, with industry analysts estimating the global engineered stone market at . It’s continuing to expand as quartz surfaces replace natural stone in kitchens in the United States and worldwide.

When González was working, the dust that rose from his saw didn’t look extraordinary. It settled on his clothes, in his hair, across the shop floor. In a small countertop fabrication shop, he cut marble and granite before shifting to engineered stone after the 2008-09 recession, when demand for cheaper quartz countertops surged.

But the crystalline silica released while the engineered stone was cut and polished also settled into his lungs, scarring them beyond repair. What began as breathlessness hardened into silicosis, an irreversible disease that stiffens the lungs until even ordinary movement becomes effort.

A lung transplant was his path forward. The procedure can extend survival, but it redraws the boundaries of a life: anti-rejection drugs every day, constant monitoring, vulnerability to infection, the knowledge that breathing depends on the fragile acceptance of another person’s donated organ.

González, who was diagnosed with silicosis in 2023, is not alone in dealing with a disease that once was associated with miners at the end of long careers. It’s now prevalent among the much younger, often Hispanic men who work in this industry, physicians and public health officials say.

In the United States, cases are appearing in countertop fabrication shops from California to Texas, Florida, and the Northeast. Because silicosis is not a nationally reportable disease and surveillance varies by state, no comprehensive national count exists. But clinicians who treat occupational lung disease say the number of workers — often men in their 30s and 40s — diagnosed after cutting engineered stone has risen sharply over the past decade.

As of , California had identified 519 confirmed cases of engineered-stone-associated silicosis and 29 deaths since 2019. The median age at diagnosis is 46; at death, 49.

Doctors don’t debate whether working with engineered stone can scar lungs.

Manufacturers argue, though, that proper ventilation, wet cutting, and respirators can make fabrication safe. Workers, physicians, and plaintiffs’ attorneys counter that a material composed almost entirely of crystalline silica may be impossible to handle safely at scale.

“This is comparable to the tobacco industry saying cigarettes are safe,” said epidemiologist David Michaels, an assistant labor secretary under President Barack Obama who led the Occupational Safety and Health Administration.

More than 370 lawsuits have been filed by workers who say engineered stone manufacturers failed to warn employees about the risks or sold a product that cannot be fabricated safely. At the same time, members of Congress are that would largely shield manufacturers from liability in those cases, turning a workplace health crisis into a national debate over regulation, responsibility, and the limits of civil litigation.

Gustavo Reyes, 36, is part of that debate. Like González, he spent the early years of his career cutting marble and granite before shifting to engineered stone, a quartz-based material that can contain up to 95% silica and generates far more hazardous dust when cut.

In the shop, he said, cutting was done with water to control the dust. But finishing work — sanding and shaping — generated heavy dust. He said he wore disposable respirator masks or a reusable elastomeric respirator with filters. A door was kept open. Fans ran overhead.

When he was diagnosed in 2021, he did not know what silicosis meant. The doctor told him that there was no medication and that he had three to five years to live. He received a lung transplant in 2023.

Asked who he believes is responsible, Reyes answered: “The industries who created the artificial stone, the product.” Manufacturers dispute that characterization. Major companies say engineered stone can be fabricated safely when employers follow OSHA dust controls, including wet cutting, ventilation, and respirator use.

An Old Disease, Reengineered

Silicosis is not new. It was synonymous with mining disasters and sandblasting, most notoriously in the , when hundreds of workers drilling through silica-rich rock in West Virginia in the early 1930s developed acute silicosis after months of unprotected exposure to dust. In 1938, advised that the disease could be prevented if dust controls were conscientiously applied.

What is new is the industry in which it has resurfaced.

Engineered stone, often marketed as “quartz,” is typically composed of crushed quartz bound with resins and pigments. Unlike marble, which contains little crystalline silica, engineered slabs contain very high levels of the substance.

Cutting changes the material.

“When you grind it, when you cut it, you’re pulverizing it,” said Robert Blink, an occupational and environmental medicine specialist who treats patients with advanced silicosis in Chicago and is a member of the Western Occupational and Environmental Medical Association. “You’re weaponizing the silica.”

Power tools fracture the surface into respirable particles small enough to lodge deep in the lungs. Repeated exposure triggers inflammation and fibrosis. Once scarring begins, it doesn’t reverse.

What Happens When You Look for It

In California, physicians say the pattern emerged gradually.

Robert Harrison, an occupational medicine physician at the University of California-San Francisco, helped identify the of engineered stone silicosis cases in California in 2019 after several workers from the same countertop fabrication shop died or were diagnosed with the disease. He described the crisis as “the largest outbreak of silicosis in decades.” What initially appeared as isolated cases of unexplained lung scarring in young men resolved into a recognizable occupational epidemic once work histories were examined.

Jane Fazio, a pulmonologist at UCLA, recalls seeing advanced fibrosis in otherwise healthy workers. “They have families. They were working full-time,” she said. Some experienced respiratory failure within a few years.

When doctors compared work histories, the pattern became unmistakable: Many of the men had worked in small shops cutting and polishing engineered stone countertops.

Sheiphali Gandhi, an occupational and environmental pulmonologist at UCSF, warned that the true burden remains uncertain. “We’re missing cases,” she said. “There’s no national surveillance system for this.”

California designated silicosis a reportable disease . Since 2019, statewide surveillance has identified hundreds of cases linked to engineered stone. The numbers probably underestimate the toll, though makes the illness visible.

Outside California, there is no comparable tracking.

Early Warnings

California was not the first place this happened.

The earliest modern alarm came from Israel. Caesarstone, a company founded on a kibbutz in the late 1980s, helped popularize quartz countertops globally.

Israeli physicians began in young countertop workers as early as 1997.

“We had never seen this before,” said Mordechai Kramer, a retired pulmonologist who previously worked at Rabin Medical Center in Israel. “In classic silicosis, you expect long exposure, decades. Here, it was much shorter.”

Several patients required lung transplantation.

Despite the warning signs, the market continued to expand.

Australia confronted the same pattern in the late 2010s.

Rather than wait for sporadic diagnoses, Australian regulators launched systematic CT-based screening of artificial-stone workers. Disease prevalence was far higher than anticipated.

Ryan Hoy, a respiratory physician and occupational health researcher at Australia’s Monash University, described severe disease in workers with relatively short exposures.

Authorities examined whether wet cutting, ventilation, and respirators could reduce exposure sufficiently. They ultimately concluded that even with controls, fabrication of high-silica engineered stone posed unacceptable risk.

In 2024, Australia prohibited the manufacture, supply, and installation of engineered stone containing high levels of crystalline silica. Manufacturers pivoted toward lower- and zero-silica formulations.

In the United States: Who’s To Blame?

Fabrication in the U.S. continues under OSHA’s silica standard, which relies on exposure limits, wet cutting, ventilation, and respiratory protection. Manufacturers argue that compliance works and that the problem lies with shops that fail to follow the rules.

OSHA first adopted silica limits based on research from mining, quarrying, and foundry work. Although the agency updated the rule , it regulates crystalline silica broadly and does not distinguish between natural stone and high-silica engineered quartz.

The regulatory debate has now spilled into Congress. , introduced in September by Rep. Tom McClintock (R-Calif.), would largely shield manufacturers and distributors of engineered stone from civil lawsuits arising from the manufacture or sale of their products. McClintock’s office did not respond to a request for comment.

The bill was the subject of a January .

Supporters of the measure argue that manufacturers should not be held liable for injuries caused by employers who fail to follow OSHA standards. Opponents warn that removing litigation pressure would eliminate one of the few mechanisms capable of driving product reform if the material itself cannot be safely handled.

Michaels, the former OSHA official, sees the stakes as historical. “Litigation drives change,” he said, pointing to past battles over asbestos and tobacco.

Plaintiffs’ attorneys argue that compliance with the OSHA silica standard does not eliminate risk.

“It’s not a few bad actors,” said Raphael Metzger, a product liability attorney who has filed roughly 200 silicosis-related injury cases and a class action seeking medical monitoring. He said the issue is the product’s composition, not isolated regulatory noncompliance.

James Nevin, a tort attorney representing workers in silicosis cases, framed the congressional debate as a fight over accountability. “When it comes to causation, there’s no question,” he said, arguing that the wave of cases explains why manufacturers are now seeking what he calls “a manufacturer bailout.”

In mid-2025, Caesarstone US introduced its first products containing less than 1% silica. In response to questions, Irene Williams, a spokesperson for Caesarstone, said, “The company is not responding as these are matters of pending litigation.”

The U.S. engineered stone market is dominated by a handful of large brands — including Caesarstone, Spain-based Cosentino, and U.S.-based Cambria — while the volume of slabs imported from Asian manufacturers is growing.

Cosentino, too, is moving to low-silica products: “One third of the portfolio, including most new collections, contain less than 10% of crystalline silica,” said Kamela Kettles, a Cosentino spokesperson. “Cosentino will not be providing additional commentary at this time,” she said.

Commenting on behalf of Cambria, Mark Duffy, a communications consultant for the company, wrote, “Reckless employers are criminally violating the law, exposing workers to deadly working conditions.” He added that engineering and administrative controls, when properly used, are effective in reducing exposures below OSHA limits and said Cambria maintains exposures below the OSHA Action Level in its own facilities.

While Caesarstone and Cosentino are headquartered overseas, Cambria is based in Minnesota. Its chief executive, Marty Davis, has been a major Republican political donor, to President Donald Trump’s election campaigns as well as to other Republican candidates and political action committees, according to federal campaign finance records. Davis has also contributed to the campaign of Rep. Brad Finstad (R-Minn.), a co-sponsor of the legislation. Finstad’s office did not respond to a request for comment.

Nevin, the attorney, said the bill would give manufacturers “free rein” from civil liability.

He also questions whether regulatory enforcement alone can address the problem. Even before the Trump administration’s funding and staffing cuts, “you had a better chance of being struck by lightning than being visited by OSHA,” he said, arguing that inspections are too infrequent to prevent disease in an industry composed largely of small shops.

Breathing on Borrowed Time

For González, the debate arrives after the fact. The dust he inhaled has already reshaped his life.

And Reyes’ transplanted lungs may last years, but not decades. The median survival time for transplanted lungs is about eight years, UCSF’s Gandhi said.

Reyes said he hopes people shopping for countertops understand that buying artificial stone “will harm the worker. The one who cuts it, the one who manufactures it.”

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Newsom Picks a Dogfight With Trump and RFK Jr. on Public Health

Angela Hart — Mon, 09 Mar 2026 09:00:00 +0000

SACRAMENTO, Calif. — California Gov. Gavin Newsom has positioned himself as a national public health leader by staking out science-backed policies in contrast with the Trump administration.

After Health and Human Services Secretary Robert F. Kennedy Jr. fired Centers for Disease Control and Prevention Director Susan Monarez for refusing what her lawyers called “,” Newsom to help modernize California’s public health system. He also gave a job to Debra Houry, the agency’s former chief science and medical officer, who had resigned in protest hours after Monarez’s firing.

Newsom also teamed up with fellow Democratic governors Tina Kotek of Oregon, Bob Ferguson of Washington, and Josh Green of Hawaii to form the , a regional public health agency, whose guidance would “uphold scientific integrity in public health as Trump destroys” the CDC’s credibility. Newsom argued establishing the independent alliance was vital as Kennedy leads the Trump administration’s rollback of national vaccine recommendations.

More recently, California became the a global outbreak response network coordinated by the World Health Organization, followed by Illinois and New York. Colorado and Wisconsin signaled they plan to join. They did so after President Donald Trump officially from the agency on the grounds that it had “strayed from its core mission and has acted contrary to the U.S. interests in protecting the U.S. public on multiple occasions.” Newsom said joining the WHO-led consortium would enable California to respond faster to communicable disease outbreaks and other public health threats.

Although other Democratic governors and public health leaders have openly criticized the federal government, few have been as outspoken as Newsom, who is considering a run for president in 2028 and is in his second and final term as governor. Members of the scientific community have praised his effort to build a public health bulwark against the Trump administration’s slashing of funding and scaling back of vaccine recommendations.

What Newsom is doing “is a great idea,” said Paul Offit, an outspoken critic of Kennedy and a vaccine expert who formerly served on the Food and Drug Administration’s vaccine advisory committee but was removed under Trump in 2025.

“Public health has been turned on its head,” Offit said. “We have an anti-vaccine activist and science denialist as the head of U.S. Health and Human Services. It’s dangerous.”

The White House did not respond to questions about Newsom’s stance and HHS declined requests to interview Kennedy. Instead, federal health officials criticized Democrats broadly, arguing that blue states are participating in fraud and mismanagement of federal funds in public health programs.

HHS spokesperson Emily Hilliard said the administration is going after “Democrat-run states that pushed unscientific lockdowns, toddler mask mandates, and draconian vaccine passports during the covid era.” She said those moves have “completely eroded the American people’s trust in public health agencies.”

Public Health Guided by Science

Since Trump returned to office, Newsom has criticized the president and his administration for engineering policies that he sees as an affront to public health and safety, labeling federal leaders as “extremists” trying to “weaponize the CDC and spread misinformation.” He has for erroneously linking vaccines to autism, the administration is endangering the lives of infants and young children in scaling back childhood vaccine recommendations. And he argued that the White House is unleashing “chaos” on America’s public health system in backing out of the WHO.

The governor declined an interview request. Newsom spokesperson Marissa Saldivar said it’s a priority of the governor “to protect public health and provide communities with guidance rooted in science and evidence, not politics and conspiracies.”

The Trump administration’s moves have triggered financial uncertainty that local officials said has reduced morale within public health departments and left states unprepared for disease outbreaks and . The White House last year proposed cutting HHS spending , including . Congress largely rejected those cuts last month, although funding for programs focusing on social drivers of health, such as access to food, housing, and education, .

The Trump administration announced that it would claw back in public health funds from California, Colorado, Illinois, and Minnesota, arguing that the Democratic-led states were funding “woke” initiatives that didn’t reflect White House priorities. Within days, and a judge the cut.

“They keep suddenly canceling grants and then it gets overturned in court,” said Kat DeBurgh, executive director of the Health Officers Association of California. “A lot of the damage is already done because counties already stopped doing the work.”

Federal funding has accounted for of state and local health department budgets nationwide, with money going toward fighting HIV and other sexually transmitted infections, preventing chronic diseases, and boosting public health preparedness and communicable disease response, according to a 2025 analysis by KFF, a health information nonprofit that includes ��ýҕ�l Health News.

Federal funds account for $2.4 billion of California’s $5.3 billion public health budget, making it difficult for Newsom and state lawmakers to backfill potential cuts. That money helps fund state operations and is vital for local health departments.

Funding Cuts Hurt All

Los Angeles County public health director Barbara Ferrer said if the federal government is allowed to cut that $600 million, the county of nearly 10 million residents would lose an estimated $84 million over the next two years, in addition to other grants for prevention of HIV and other sexually transmitted infections. Ferrer said the county depends on nearly $1 billion in federal funding annually to track and prevent communicable diseases and combat chronic health conditions, including diabetes and high blood pressure. Already, the the closure of that provided vaccinations and disease testing, largely because of funding losses tied to federal grant cuts.

“It’s an ill-informed strategy,” Ferrer said. “Public health doesn’t care whether your political affiliation is Republican or Democrat. It doesn’t care about your immigration status or sexual orientation. Public health has to be available for everyone.”

A single case of measles requires public health workers to track down 200 potential contacts, Ferrer said.

The U.S. but is close to losing that status as a result of vaccine skepticism and misinformation spread by vaccine critics. The U.S. had , the most since 1991, with 93% in people who were unvaccinated or whose vaccination status was unknown. This year, the highly contagious disease has been reported at , , and .

Public health officials hope the West Coast Health Alliance can help counteract Trump by building trust through evidence-based public health guidance.

“What we’re seeing from the federal government is partisan politics at its worst and retaliation for policy differences, and it puts at extraordinary risk the health and well-being of the American people,” said Georges Benjamin, executive director of the American Public Health Association, a coalition of public health professionals.

Robust Vaccine Schedule

Erica Pan, California’s top public health officer and director of the state Department of Public Health, said the West Coast Health Alliance is defending science by recommending a vaccine schedule than the federal government. California is part of a coalition over its decision to rescind recommendations for seven childhood vaccines, including for hepatitis A, hepatitis B, influenza, and covid-19.

Pan expressed deep concern about the state of public health, particularly the uptick in measles. “We’re sliding backwards,” Pan said of immunizations.

Sarah Kemble, Hawaii’s state epidemiologist, said Hawaii joined the alliance after hearing from pro-vaccine residents who wanted assurance that they would have access to vaccines.

“We were getting a lot of questions and anxiety from people who did understand science-based recommendations but were wondering, ‘Am I still going to be able to go get my shot?’” Kemble said.

Other states led mostly by Democrats have also formed alliances, with Pennsylvania, New York, New Jersey, Massachusetts, and several other East Coast states banding together to create the .

HHS’ Hilliard said that even as Democratic governors establish vaccine advisory coalitions, the federal “remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and gold standard science, not the failed politics of the pandemic.”

Influencing Red States

Newsom, for his part, has approved a recurring annual infusion of nearly $300 million to support the state Department of Public Health, as well as the 61 local public health agencies across California, and last year authorizing the state to issue its own immunization guidance. It requires health insurers in California to provide patient coverage for vaccinations the state recommends even if the federal government doesn’t.

Jeffrey Singer, a doctor and senior fellow at the libertarian Cato Institute, said decentralization can be beneficial. That’s because local media campaigns that reflect different political ideologies and community priorities may have a better chance of influencing the public.

A KFF analysis found some red states are joining blue states in decoupling their vaccine recommendations from the federal government’s. Singer said some doctors in his home state of Arizona are looking to more liberal California for vaccine recommendations.

“Science is never settled, and there are a lot of areas of this country where there are differences of opinion,” Singer said. “This can help us challenge our assumptions and learn.”

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As ICE Moved In, Minnesotans Set Up a Shadow Medical System. It’s a Lesson for Other Cities.

Arthur Allen and Kate Wells — Thu, 05 Mar 2026 10:00:00 +0000

MINNEAPOLIS — Gabi has big brown eyes, pigtails, and a genetic condition that makes her bones brittle. They fracture easily, leaving the 2-year-old in such pain that her mother quit her job cleaning offices to stay home and cradle her in the one-bedroom apartment they share with six relatives.

When federal immigration agents descended on their city, officers deported Gabi’s father and detained her aunt.

Gabi was born in the U.S. and is an American citizen. Her best chance to stand, or even walk, someday is a complex surgery on her legs and feet that was scheduled for January. But her mother, too terrified to take out the garbage let alone venture through the city to a hospital, canceled the procedure. ��ýҕ�l Health News agreed to only partially identify the patients and their families in this article because they fear becoming targets of President Donald Trump’s immigration crackdown.

“I want more than anything for my baby to walk,” her mother said in Spanish, as Gabi cooed and wriggled in her arms, a feeding tube snaking from her stomach to an IV pole. “But with the situation that’s happening, I canceled the surgery and all the physical therapy appointments” that would have followed. “Because I’m afraid to leave.”

The Department of Homeland Security has declared an end to what it called Operation Metro Surge, carried out by officers with the Immigration and Customs Enforcement and Customs and Border Protection agencies. Even so, health care workers say, immigration agents are still camping out in hospital parking lots. And drones fly overhead in agricultural areas beyond Minneapolis, where Somali and Latino immigrants have settled in recent years.

The Minnesota crackdown revealed the sweep of the surveillance and capture system the Trump administration is using to uproot immigrant communities in the United States, and the effect of its powerful brake on the medical system.

Similar health crises surfaced wherever immigration officers massed in the past year. In Dallas, public health clinics administered about 6,000 vaccinations to Latinos last August, half as many as during a similar program a year earlier. In Chicago, doctors rerouted patients daily from clinic to clinic depending on ICE activity. Across the country, crackdowns suppressed immigrants’ health care visits.

In Minnesota, medical systems have reported cancellation and no-show rates of up to 60% since December.

Tricia McLaughlin, a spokesperson for the Department of Homeland Security, blamed protesters for the disruption. “If anyone is impeding Americans from making appointments or picking up prescriptions,” she said, “its [sic] violent agitators who are blocking roadways, ramming vehicles, and vandalizing property.”

While Minnesotans rose up to oppose the surge in the streets, doctors and nurses have quietly operated informal, underground medical networks, dodging detection to care for patients at home.

“I used to look somebody in the eyes and say, with good faith, ‘You will be fine at the hospital,’” said Emily Carroll, a nurse practitioner at HealthFinders Collaborative, a community clinic in Faribault, some 50 miles south of Minneapolis. “But now, I can’t make that guarantee.”

As thousands of federal agents move on from Minneapolis, other communities need to prepare, said Minnesota Democratic state Sen. Alice Mann, a physician.

“I know it sounds crazy,” she said, but health care providers “need to start an underground network of how to get people care in their homes. Because letting people die at home or come close to death because they are terrified to go into the hospital, in 2026, is outrageous.”

The Surge Delivers Harm

Home visits, clinicians say, may be the only way to reach those who still feel under siege. In Los Angeles, starting last June, St. John’s Community Health brought medical care to some 2,000 immigrant families too frightened to leave home during an immigration sweep after the clinic’s no-show rates ballooned to more than 30%, said Jim Mangia, the organization’s president.

Many of Minnesota’s large health institutions have relied on telemedicine and only dabbled in home care.

Not Munira Maalimisaq, co-founder of Inspire Change Clinic in Minneapolis’ Ventura Village neighborhood. After about one-third of her patients stopped showing up for appointments, “I was like, ‘We have to do something,’” the nurse practitioner said. So she called a physician friend. What if they just started seeing patients at home?

“And she’s like, ‘You know what? Let’s do it.’”

They now have about 150 doctors — a volunteer “rapid response” team that has made more than 135 home visits. The first call was a woman whose husband had been deported. She was home with her children, was 39 weeks pregnant, and was in labor. Maalimisaq called an obstetrician volunteer, and they rushed to the patient’s house.

“She was 8 centimeters dilated,” Maalimisaq said, “and did not want us to call an ambulance. She says, ‘Can I have the baby here?’”

The woman was not a good candidate for a home birth, Maalimisaq said. They persuaded her to ride to the hospital in Maalimisaq’s car, a “small Tesla, white seats. Everything that could go wrong was there.”

But they made it to the hospital in time, and the woman had a safe, healthy delivery. “If we were not there, I can only imagine what would have happened.”

Maalimisaq’s caregiving follows a Hippocratic logic: “Someone was in need. I cannot just do nothing. And we cannot call an ambulance against her will and have her shoved in there. We had no choice but to do something, and that was the only thing that we could do safely.”

In other visits, she has seen “people so stressed out they pulled the hair out of their skull.” She said she met a mother who’d been rationing her child’s seizure medicine despite the child having experienced “one seizure after another.”

The Trump administration says its Minnesota operation improved public safety. “Since Operation Metro Surge began, our brave DHS law enforcement have arrested over 4,000 criminal illegal aliens including vicious murderers, rapists, child pedophiles and incredibly dangerous individuals,” according to McLaughlin, the DHS spokesperson. DHS announced last month that McLaughlin was leaving her post.

Minnesota correctional officials say many people accused of crimes were released directly to ICE by state or county prisons and jails. And of people arrested by ICE nationwide in January had criminal convictions, according to DHS data. Far fewer were convicted of violent crimes.

Agents Outside Hospitals, Clinics

On the first day of his second term, President Donald Trump rescinded a 2011 policy that prohibited immigration enforcement in “sensitive locations” such as schools, hospitals, and churches.

In Northfield, about 45 miles south of Minneapolis, ICE agents have been sitting in their cars for hours at least twice a week outside health clinics, including one run by the local hospital, said Carroll, the nurse practitioner. Agents have made arrests in the area almost every day, Carroll and her colleagues said.

“ICE does not conduct enforcement at hospitals — period,” McLaughlin said.

One recent morning, three ICE vehicles sat in a Baptist church parking lot across the street from an elementary school in Northfield as volunteers ferried 35 children of immigrants back and forth to the school so their parents could avoid going out, Carroll said.

“ICE is not going to schools to arrest children — we are protecting children,” McLaughlin said.

Drones that Carroll and others believe are operated by immigration agents hover most nights, and sometimes during the day, over a trailer park that mostly houses immigrants who have moved to the area to work in agriculture and manufacturing over the past 15 years. Families paper over trailer windows, Carroll said.

“You cannot feel safe anywhere,” she said. “On the way to school, on the way to clinic, you might pass ICE. The sort of crushing fear and feeling of being trapped that these families are going through is outrageous.”

That fear means patients with diabetes and heart disease are missing blood sugar and blood thinner tests. Patients aren’t getting exercise, and the chronically ill are getting sicker, said Calla Brown, a Minneapolis pediatrician.

At the Faribault clinic where Carroll works, staff members deliver medicine, food, and other necessities to patients. A staffer drives 12 middle and high school kids to and from class every day in a clinic van.

Some patients are treated at home. Carroll recently diagnosed a baby with influenza, telling the parents it wasn’t an immediate threat — yet.

“‘If you see the baby struggling to breathe, if the baby’s not eating, if the baby isn’t making wet diapers, you have to go to the hospital,’” Carroll said she told them. “‘I cannot promise it’s safe. But you’ve got to go.’”

‘We’re Nice to Each Other’

In Minneapolis, nurse-midwife Fernanda Honebrink spends most of her daylight hours calling, coordinating, and shuttling between a ballooning group of fearful people stuck in their homes. She prefers not to call it a medical underground.

“It’s more like, that’s how we function in Minnesota,” said Honebrink, a U.S. citizen who emigrated from Ecuador 23 years ago. “We’re nice to each other.”

Honebrink spent a recent afternoon at the home of a family with a baby boy. His parents, Alex and Isa, desperately want him to receive vaccinations and blood tests at his one-year well-child appointment.

But they haven’t left their apartment for more than a month. “You don’t know what is most important: whether to go out for his well-being, or to go out and think that you might not come back,” Alex said.

The couple, who were interviewed in Spanish, entered the U.S. legally from Venezuela in 2024 under a program called Humanitarian Parole, which Trump ended in May. Since then, federal agents have detained and deported workers at a company where Alex, a mechanical engineer by training, worked in construction.

Alex and Isa have seen government vehicles outside their home. They knew of a man, they said, who had legitimate work papers but was picked up while walking to church one Sunday, flown to Texas, then put on a plane to Venezuela. It was a terrifying prospect for those who’ve fled that country’s dictatorship and economic chaos.

“It feels like a psychological attack,” Alex said. “The possibility of being separated from your family.”

Isa, a lawyer back in Venezuela, has endured postpartum depression, cooped up for weeks in their apartment. The state program that provided health insurance to all immigrants ended Jan. 1. A therapist checks in occasionally by phone, free of charge.

She has tried to keep the family afloat by selling homemade cakes and necklaces, and babysitting.

Her worst fear is being separated from her son, who was born in the U.S. and is a citizen. The possibility hadn’t occurred to her until an acquaintance urged her to to designate someone to have temporary custody if she were deported.

“It was something I never imagined,” said Isa, who sobbed as she recalled the moment. “He’s my baby! He’s not someone else’s! What? My baby would remain here with someone?’’

Honebrink suddenly piped up: “I will guarantee him. I’ll sign the form.”

She later told a reporter, “I told my husband I wouldn’t do that. I’ve already signed as a sponsor for four kids.”

As soon as she left the apartment, Honebrink jumped back on the phone and traded favors with local pediatricians, clinic schedulers, and volunteers. Within hours, she’d set up a new well-child visit for the baby and found a vetted driver to transport the family.

“A white person,” Honebrink explained.

Two days later, Honebrink sent a picture of her small victory: Alex and Isa’s baby boy with a Band-Aid on his legs. “He got his vaccines,” she said via text. “I’m so happy.”

But other medical needs cannot be as swiftly addressed. One February evening, Honebrink greeted Gabi and her mother with a trunk full of donated baby wipes, diapers, and toys.

Gabi’s surgery is rescheduled for August. Her mother said she hoped by then it would be safe to leave home.

“I used to take the kids to the park, but now we don’t leave at all,” she said. “They grab people, they mistreat them. How I wish it would end soon!”

��ýҕ�l Health News’ Jackie Fortiér contributed to this report.

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Con la presencia del ICE, habitantes de Minnesota crearon un sistema médico en las sombras. Un aprendizaje para otras ciudades

Arthur Allen and Kate Wells, Michigan Public — Thu, 05 Mar 2026 10:00:00 +0000

MINNEAPOLIS. — Gabi tiene grandes ojos color café, trenzas y una afección genética que hace que sus huesos sean frágiles. Se fracturan con facilidad, lo que le provoca a la niña de 2 años tanto dolor que su madre dejó su trabajo limpiando oficinas para quedarse en casa y cargarla por el apartamento de una habitación que comparten con seis familiares.

Cuando agentes federales de inmigración llegaron a su ciudad, deportaron primero al padre de Gabi y luego a su tía.

Gabi nació en Estados Unidos y es ciudadana estadounidense. Su mejor oportunidad de algún día pararse, o incluso caminar, es una cirugía compleja en las piernas y los pies que estaba programada para enero.

Pero su madre, quien está tan asustada que ni siquiera se anima a sacar la basura, y mucho menos a atravesar la ciudad hasta el hospital, canceló el procedimiento. (En este artículo, ��ýҕ�l Health News y NPR acordaron identificar solo parcialmente a los pacientes y a sus familias porque temen convertirse en blanco de la ofensiva migratoria del presidente Donald Trump).

“Quiero más que nada, mi deseo, es que mi bebé empiece a caminar”, dijo su madre, mientras Gabi se movía en sus brazos, con una sonda de alimentación que salía de su estómago conectada a un soporte de suero intravenoso. “Pero con la situación que está pasando, cancelé la cita de cirugía porque le van a hacer cirugía en sus piernas y todas las citas de terapia física; lo cancelé todo. Porque tengo miedo de salir”.

El Departamento de Seguridad Nacional (DHS, por sus siglas en inglés) declaró el fin de lo que llamó Operation Metro Surge (Operación Metro Surge), llevada a cabo por agentes del Servicio de Inmigración y Control de Aduanas (ICE, por sus siglas en inglés) y de la Oficina de Aduanas y Protección Fronteriza (CBP, por sus siglas en inglés). Aun así, trabajadores de salud dicen que los agentes de inmigración siguen apostados en los estacionamientos de hospitales. Y drones sobrevuelan zonas agrícolas en las afueras de Minneapolis, donde inmigrantes somalíes y latinos se han establecido en los últimos años.

La ofensiva en Minnesota mostró el alcance del sistema de vigilancia y detención que la administración Trump está utilizando para desarraigar a comunidades inmigrantes del país y su fuerte impacto en el sistema de salud.

Crisis de salud similares surgieron dondequiera que se concentraron oficiales de inmigración en el último año.

En Dallas, clínicas de salud pública administraron unas 6.000 vacunas a latinos en agosto pasado, la mitad que en un programa similar un año antes. En Chicago, a diario, doctores redirigieron a los pacientes de una clínica a otra dependiendo de la actividad de ICE.

En todo el país, las redadas redujeron las visitas de inmigrantes a servicios de salud.

En Minnesota, los sistemas de salud reportaron tasas de cancelación y ausencias de hasta el 60 % desde diciembre. Un vocero del DHS culpó a los manifestantes por la interrupción. “Si alguien está impidiendo que los estadounidenses asistan a citas o recojan recetas, es un agitador violento que está bloqueando carreteras, embistiendo vehículos y dañando propiedad”, dijo.

Mientras residentes de Minnesota protestaban en las calles contra el operativo, doctores y enfermeras organizaron en silencio redes médicas informales para atender a pacientes en sus casas y evitar ser detectados.

“Antes miraba a alguien a los ojos y decía, de buena fe: ‘Estarás bien en el hospital’”, dijo Emily Carroll, enfermera especializada en HealthFinders Collaborative, una clínica comunitaria en Faribault, a unas 50 millas al sur de Minneapolis. “Pero ahora no puedo garantizar eso”.

A medida que miles de agentes federales se retiran de Minneapolis, otras comunidades deben prepararse, dijo la senadora estatal demócrata de Minnesota, Alice Mann, quien es médica.

“Sé que suena extraño”, dijo, pero los proveedores de salud “necesitan empezar una red clandestina para llevar atención médica a las casas. Porque dejar que la gente muera en su hogar o que esté al borde de la muerte por miedo a ir al hospital, en 2026, es inaceptable”.

El operativo causa daños

Los médicos dicen que las visitas a domicilio pueden ser la única forma de llegar a quienes todavía se sienten bajo amenaza. En Los Ángeles, desde junio, St. John’s Community Health llevó atención médica a unas 2.000 familias inmigrantes demasiado asustadas para salir durante un operativo migratorio, después de que las ausencias a citas superaran el 30%, dijo Jim Mangia, presidente de la organización.

Muchas de las grandes instituciones de salud de Minnesota han recurrido a la telemedicina y han usado menos la atención en el hogar.

No así Munira Maalimisaq, cofundadora de Inspire Change Clinic en el vecindario Ventura Village de Minneapolis. Después de que cerca de un tercio de sus pacientes dejara de ir a sus citas, “pensé: ‘Tenemos que hacer algo’”, dijo la enfermera especializada. Entonces llamó a una amiga doctora. ¿Y si empezaran a ver pacientes en sus casas?

“Y ella dijo: ‘¿Sabes qué? Hagámoslo’”.

Ahora cuentan con unos 150 doctores, un equipo voluntario de “respuesta rápida” que ha realizado más de 135 visitas domiciliarias. Su primera llamada fue para ver a una mujer cuyo esposo había sido deportado. Estaba en casa con sus hijos, con 39 semanas de embarazo y en trabajo de parto. Maalimisaq llamó a una obstetra voluntaria y fueron a la casa.

“Tenía 8 centímetros de dilatación”, dijo Maalimisaq, “y no quería que llamáramos a una ambulancia. Decía: ‘¿Puedo tener al bebé aquí?’”.

La mujer no era una buena candidata para un parto en casa, dijo Maalimisaq. La convencieron de ir al hospital en el auto de Maalimisaq, un Tesla pequeño con asientos blancos. “Todo lo que podía salir mal, estaba ahí”.

Pero llegaron al hospital a tiempo y la mujer tuvo un parto seguro y saludable. “Si no hubiéramos estado allí, no puedo imaginar lo que habría pasado”.

En otras visitas, dijo, ha visto “personas tan estresadas que se arrancaban el cabello”. Contó que conoció a una madre que estaba racionando el medicamento anticonvulsivo de su hijo, aunque el niño había tenido “una convulsión tras otra”.

La administración Trump afirma que su operativo en Minnesota mejoró la seguridad pública. “Desde que comenzó la Operación Metro Surge, nuestros valientes agentes del DHS han arrestado a más de 4.000 extranjeros indocumentados con antecedentes penales, incluidos asesinos, violadores, pedófilos y personas extremadamente peligrosas”, dijo Tricia McLaughlin, vocera del DHS.

El DHS anunció la semana del 16 de febrero que McLaughlin dejará su cargo.

Funcionarios correccionales de Minnesota dijeron que muchas personas acusadas de delitos fueron entregadas directamente a ICE por prisiones y cárceles estatales o del condado. Y en enero fueron personas con condenas penales, según datos del DHS. Muchos menos habían sido condenados por delitos violentos.

Agentes afuera de hospitales y clínicas

En el primer día de su segundo mandato, el presidente Donald Trump anuló una política de 2011 que prohibía la aplicación de leyes migratorias en “lugares sensibles” como iglesias, escuelas y hospitales.

En Northfield, a unas 45 millas al sur de Minneapolis, agentes del ICE han estado sentados en sus autos durante horas, al menos dos veces por semana, fuera de clínicas de salud, incluida una que opera el hospital del pueblo, dijo Carroll. Los agentes han realizado arrestos en la zona casi todos los días, según Carroll y sus colegas.

“El ICE no realiza operativos en hospitales, punto”, dijo McLaughlin.

Una mañana reciente, tres vehículos del ICE estaban en el estacionamiento de una iglesia bautista frente a una escuela primaria en Northfield, mientras voluntarios transportaban a 35 hijos de inmigrantes hacia y desde la escuela para que sus padres no tuvieran que salir, dijo Carroll.

“El ICE no va a las escuelas para arrestar a niños; estamos protegiendo a los niños”, dijo McLaughlin.

Drones sobrevuelan la mayoría de las noches y a veces durante el día, sobre un parque de casas móviles donde viven principalmente inmigrantes que se mudaron a la zona para trabajar en agricultura y manufactura en los últimos 15 años. Las familias cubren las ventanas con papel, dijo Carroll.

“No puedes sentirte seguro en ningún lugar”, dijo. “Camino a la escuela, camino a la clínica, puedes encontrarte con el ICE. El miedo y la sensación de estar atrapados que viven estas familias son inaceptables”.

Ese miedo significa que pacientes con diabetes y enfermedades cardíacas están perdiendo controles de azúcar en sangre y de anticoagulación. No están haciendo ejercicio y las personas con enfermedades crónicas están empeorando, dijo Calla Brown, pediatra en Minneapolis.

En la clínica de Faribault, donde trabaja Carroll, el personal entrega medicamentos, comida y otras necesidades a los pacientes. Un empleado transporta cada día a 12 estudiantes de escuela media y secundaria en una camioneta de la clínica.

Algunos pacientes reciben atención en casa. Carroll diagnosticó recientemente a un bebé con influenza y les dijo a los padres que no era una amenaza inmediata, por ahora.

“‘Si ven que el bebé tiene dificultad para respirar, si no está comiendo, si no moja pañales, tienen que ir al hospital’”, contó Carroll que les dijo. “‘No puedo prometer que sea seguro. Pero tienen que ir’”.

“Somos amables entre nosotros”

En Minneapolis, la enfermera partera Fernanda Honebrink pasa la mayor parte del día llamando, coordinando y trasladándose entre un grupo creciente de personas con miedo que permanecen en sus casas. Prefiere no llamarlo una red médica clandestina.

“Es más bien así como funcionamos en Minnesota”, dijo Honebrink, ciudadana estadounidense que emigró de Ecuador hace 23 años. “Somos amables entre nosotros”.

Honebrink pasó una tarde reciente en la casa de una familia con un bebé. Sus padres, Alex e Isa, quieren que reciba vacunas y análisis de sangre en su cita de control cuando cumpla 1 año.

Pero no han salido de su apartamento en más de un mes. “No sabes qué es más importante: salir por su bienestar o salir pensando que quizás no regreses”, dijo Alex.

La pareja venezolana entró legalmente a Estados Unidos en 2024 bajo un programa llamado Humanitarian Parole, que Trump finalizó en mayo. Desde entonces, agentes federales han detenido y deportado trabajadores de una empresa donde Alex, ingeniero mecánico, trabajaba en construcción.

Han visto vehículos del gobierno afuera de su casa. Dijeron conocer a un hombre que tenía documentos de trabajo válidos, pero fue detenido cuando caminaba a la iglesia un domingo, trasladado a Texas y luego enviado en avión a Venezuela. Era una perspectiva aterradora para quienes huyeron de la dictadura y la crisis económica de ese país.

“Se siente como un ataque psicológico”, dijo Alex. “La posibilidad de ser separado de tu familia”.

Isa, abogada en Venezuela, ha sufrido depresión posparto, encerrada durante semanas en su apartamento. El programa estatal que proporcionaba seguro médico a todos los inmigrantes terminó el 1 de enero. Una terapeuta la llama ocasionalmente sin costo.

Ha intentado sostener a la familia vendiendo pasteles y collares hechos en casa y cuidando niños.

Su mayor temor es que la separen de su hijo, que nació en Estados Unidos y es ciudadano. No había considerado esa posibilidad hasta que un conocido le sugirió firmar para designar a alguien para la custodia temporal en caso de que fuera deportada.

“Fue algo que nunca imaginé”, dijo Isa, llorando al recordarlo. “¡Es mi bebé! ¡No es de otra persona! ¿Qué? ¿Mi bebé se quedaría aquí con alguien más?’’

Honebrink intervino de inmediato: “Yo me haré responsable de él. Firmaré el formulario”.

Más tarde dijo a una reportera: “Le dije a mi esposo que no haría eso. Ya he firmado como patrocinadora de cuatro niños”.

En cuanto salió del apartamento, Honebrink volvió al teléfono y coordinó con pediatras, programadores de clínicas y voluntarios locales. En pocas horas, había conseguido una nueva cita de control para el bebé y había encontrado un conductor verificado para transportar a la familia.

“Una persona blanca”, explicó Honebrink.

Dos días después, envió una foto de su pequeña victoria: el bebé de Alex e Isa con una curita en las piernas. “Recibió sus vacunas”, escribió por mensaje de texto. “Estoy muy feliz”.

Pero otras necesidades médicas no pueden resolverse con la misma rapidez. Una noche de febrero, Honebrink visitó a Gabi y a su madre con el baúl del auto lleno de toallitas húmedas, pañales y juguetes donados.

La cirugía de Gabi fue reprogramada para agosto. Su madre dijo que espera que para entonces sea seguro salir de casa.

“Antes llevaba a los niños al parque, pero ahora no salimos para nada”, dijo. “Agarran a la gente y la maltratan. Da miedo salir. ¡Ojalá que se termine pronto lo que está pasando!”.

Jackie Fortiér, de ��ýҕ�l Health News, colaboró con este artículo.

[Aclaración: Este artículo fue revisado a las 11 am ET del 6 de marzo de 2026, para aclarar que agentes del Servicio de Inmigración y Control de Aduanas de Estados Unidos se habían posicionado cerca de clínicas, incluida una propiedad de un hospital].

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‘You Aren’t Trapped’: Hundreds of US Nurses Choose Canada Over Trump’s America

Brett Kelman — Thu, 26 Feb 2026 10:00:00 +0000

Last month, Justin and Amy Miller packed their vehicles with three kids, two dogs, a pet bearded dragon, and whatever belongings they could fit, then drove 2,000 miles from Wisconsin to British Columbia to leave President Donald Trump’s America.

The Millers resettled on Vancouver Island, their scenic refuge accessible only by ferry or plane. Justin went to work in the emergency room at Nanaimo Regional General Hospital, where he became one of at least 20 U.S.-trained nurses hired since April.

Fear of Trump, some of the nurses said, was why they left.

“There are so many like-minded people out there,” said Justin, who now works elbow to elbow with Americans in Canada. “You aren’t trapped. You don’t have to stay. Health care workers are welcomed with open arms around the world.”

The Millers are part of a new surge of American nurses, doctors, and other health care workers moving to Canada, and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April. As the Trump administration enacts increasingly authoritarian policies and decimates funding for , insurance, and medical research, many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system.

Additionally, some nurses were incensed last year when the Trump administration said it would reclassify nursing as a , which would impose strict federal limits on the loans nursing students could receive.

Canada is poised to capitalize. Two of its most populous provinces, Ontario and British Columbia, have streamlined the licensing process for American nurses since Trump returned to the White House. British Columbia also launched a last year to recruit nurses from California, Oregon, and Washington state.

“With the chaos and uncertainty happening in the U.S., we are seizing the opportunity to attract the talent we need,” Josie Osborne, the province’s health minister, said in a statement announcing the campaign.

Fears Realized

Amy Miller, a nurse practitioner, said she and her husband were determined to move their children out of the country because they felt Trump’s second term would inevitably spiral into violence.

First, the Millers got nursing licenses in New Zealand, but when the job search took too long, they pivoted to Canada.

Justin was offered a job within weeks.

Amy found one within three months.

So they moved. And just a few days later, the Millers watched with horror from afar as their fears came true.

As federal immigration forces clashed with protesters in Minneapolis on Jan. 24, federal agents fatally shot an ICU nurse, Alex Pretti, as he filmed a confrontation and appeared to be trying to shield a woman who was knocked down. Video of the killing showed border agents pinning Pretti to the ground before seizing his concealed, licensed handgun and opening fire on him.

The Trump administration quickly called Pretti a “domestic terrorist” who intended to kill federal agents.��That allegation was disputed by eyewitness videos that circulated on social media and spurred widespread outrage, including from nurses and nursing organizations, some of whom invoked the profession’s duty to care for the vulnerable.

“I don’t want to say it was expected, but that’s why we are here,” Amy Miller said. “Even our oldest kid, she was like: ‘It’s OK, Mom, because we are not there anymore. We are safe here.’ So she recognizes that, and she’s not even in middle school yet.”

Both the U.S. and Canada have a severe need for nurses. The U.S. is projected to be short about 270,000 registered nurses, plus at least 120,000 licensed practical nurses, by 2028, according to from the Health Resources and Services Administration. In Canada, nursing job vacancies tripled from 2018 to 2023, when they reached nearly 42,000, according to from the Montreal Economic Institute, a Canadian think tank.

When asked to comment, the White House noted that shows the number of nurses licensed in the U.S. increased in 2025. It dismissed accounts of nurses moving to Canada as “anecdotes of individuals with severe cases of Trump derangement syndrome.”

“The American health care workforce is the finest in the world, and it continues to expand under President Trump,” White House spokesperson Kush Desai said. “Employment opportunities in the American health care system remain robust, with career advancement and pay that far exceed that of other developed nations.”

‘A Sense of Relief’

It is unknown precisely how many American nurses have moved north since Trump returned to office, because some Canadian provinces do not track or release such statistics.

British Columbia, which has done the most to recruit Americans, approved the licensing applications of 1,028 U.S.-trained nurses from when the province’s streamlined application process took effect in April 2025 through January, according to the British Columbia College of Nurses and Midwives. In all of 2023, only 112 applicants from the U.S. were approved, the agency said. In 2024, it was 127.

Increased interest from American nurses was also confirmed by nursing associations in Ontario and Alberta, as well as by the nationwide Canadian Nurses Association.

Angela Wignall, CEO of Nurses and Nurse Practitioners of British Columbia, said American nurses used to move north because they had fallen in love with Canada (or a Canadian). But more recently, she said, she had met nurses who feared the White House would spur violence and vigilantism, particularly against families that included same-sex couples.

“Some of them were living in fear of the administration, and they shared a sense of relief when crossing the border,” Wignall said. “As a Canadian, it’s heartbreaking. And also a joy to welcome them.”

Vancouver Island, which has a population of about 860,000, has gained 64 U.S.-trained nurses since April, including those at Nanaimo Regional, said Andrew Leyne, a spokesperson for the island’s health agency.

One of the nurses was Susan Fleishman, a Canadian who moved to the U.S. as a child, then worked for 23 years in American emergency rooms before leaving the country in November.

Fleishman said hateful rhetoric from Trump has fueled an angry division that has permeated and soured American life.

“It wasn’t an easy move — that’s for sure. But I think it’s definitely worth it,” she said, happily back in Canada. “I find there is a lot more kindness here. And I think that will keep me here.”

Brandy Frye, who also worked for decades in American ERs, said she moved to Vancouver Island last year after waiting to see whether Mark Carney would become Canada’s prime minister. Carney’s rise was widely viewed as a rejection of Trumpism.

Meanwhile, Frye said, the California hospital where she worked had been stripping words associated with diversity and equity out of its paperwork to appease the Trump administration. She couldn’t stand it.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Like many of the American nurses who have moved to Vancouver Island, Frye was first wooed to the area by a that was meant to attract tourist dollars but ended up doing much more.

About a year ago, Tod Maffin, a and former CBC Radio host, invited Americans to the port city of Nanaimo for a weekend event designed to offset the impact of Trump’s tariffs on the local economy.

Maffin said about the April event.

“A lot of them were health care workers looking for an escape route,” Maffin said. “They were there to help support our economy but also to look into Canada.”

Maffin saw an opportunity. He repurposed the event website into a recruiting tool and launched a Discord chatroom to help Americans relocate.

Maffin said he believes the campaign helped about 35 health care workers move to Vancouver Island. Volunteers in have since duplicated his website in an effort to attract their own American nurses and doctors.

“There are communities across Canada where the emergency room closes at night because one nurse is out. That’s how thin staffing is,” Maffin said.

“One new nurse in a small town, or in a midsized city like Nanaimo,” he said, “makes a difference.”

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