By Ryan Tarinelli, CQ-Roll Call

WASHINGTON — One federal employee has taken out a bank loan. Another says she’s planning to seek help from a food pantry. A third says his family will likely need to take out loans, or incur credit card debt, to get by.

Those stories and more were detailed in court filings this week in a lawsuit challenging the legality of Trump administration efforts to lay off federal employees connected to the partial government shutdown.

Judge Susan Illston of the U.S. District Court for the Northern District of California already has issued a temporary ruling blocking the government from laying off an array of federal workers during the government shutdown.

The employee declarations were filed as labor groups, which brought the federal lawsuit, ask the court for a more permanent block that will last while the case is pending.

They contain examples of the searing toll of the shutdown and the termination notices, outlining deep worries about their ability to pay expenses and alarm over what would happen if they lose their health care.

Daniel T. Ronneberg, an U.S. Air Force veteran who works at the Federal Aviation Administration as a regulation analyst, was furloughed earlier this month and wrote that he’s terrified that he will lose his health care coverage if he is laid off.

Ronneberg, who received a life-saving kidney transplant days before the partial government shutdown, framed that outcome as a life and death matter, saying he will not be able to afford his post-surgery treatment if he loses his job and health care coverage.

The medications he currently takes would cost him about $9,360 a month without health care insurance, he wrote. He also has to take laboratory tests each week and see various physicians to monitor kidney function.

Any break in health care coverage, particularly one due to a termination during the government shutdown, is enough to put his life “in serious jeopardy,” Ronneberg wrote.

“If I am terminated, I will not be able to simply budget my finances or miss medications and doctor’s appointments. If I am terminated, my life will be at risk and, at the very least, my family will face financial ruin,” he wrote.

“I cannot afford to live without my health insurance—literally. Therefore, if I were to receive a RIF notice, I would need to immediately try to find another job with comparable health insurance which would be extremely difficult to do in the current job market that is flooded with other skilled and highly educated former federal employees,” Ronneberg wrote.

Dorothy Roper, an IT specialist at the Centers for Disease Control and Prevention, wrote that she’s already had to take out a bank loan to pay for day-to-day expenses and her child’s college tuition.

Roper, who has more than four decades of experience in the federal government, said she has medical debt, and worries that her credit score would be impacted if she’s not able to continue making payments.

“I cannot afford to incur any further debt,” Roper wrote. “I am attempting to move money out of my retirement account, assuming that is even possible during the shutdown, to help cover my expenses in (the) short term.”

“I am worried that this will negatively impact my long-term financial health, but I have no choice,” she wrote.

Roper, 63, also expressed concerns it would be tough for her to find another job, in part she said because employers usually prioritize younger employees.

LaMarla Stevens, a management analyst in the Office of Housing Counseling, was on maternity leave when she received a termination notice earlier this month. The notice said her last day would be in December.

Stevens wrote that she expected to have several more months of maternity leave to care for her son. Now, she’ll have to go back into the workforce earlier than anticipated.

“Even if I am able to find a job, going back to work means incurring months of childcare expenses that I had not planned for and that I don’t know if I will be able to afford,” Stevens wrote.

On top of that, her husband and children rely on her federal health care insurance.

“Having a new baby is already extraordinarily stressful, but the idea of losing our insurance at a time when we have so many medical expenses has made it even more overwhelming,” Stevens wrote.

The filings contained other stories too. An administrative officer with the CDC said she and her husband were already living paycheck-to-paycheck. They were on the verge of paying off debt from the birth of her daughter in January. But instead of paying that down, they used the money for diapers and formula.

A program analyst at the Minority Business Development Agency said she’s planning to seek help from a food pantry and forgo paying her student loans. “I don’t feel like I can plan my life more than one week at a time,” she said.

The employee had previously received a termination notice before in April, only to be reinstated in June, she wrote. After the first notice, she wrote that she could no longer afford rent, had to break her lease and live on her sister’s couch.

“I am worried about retaliation from the administration for speaking up. But I decided to speak up because right now I am more worried about food and housing than I am worried about retaliation,” she wrote in the declaration.

©2025 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.

By Kyle Ingram, The News & Observer (Raleigh)

RALEIGH, N.C. — Last week, North Carolina Republicans unveiled a plan, backed by President Donald Trump, to redraw the state’s congressional map in order to pick up another seat for the GOP in the 2026 midterms. Less than a week later, that map became law.

During the intervening six days, lawmakers held no public forums in the affected areas, did no outreach to voters whose districts would be changed and heard roughly two total hours of public comment during committee hearings in Raleigh where each speaker was limited to one minute.

Despite that, the legislature received over 12,000 public comments via an online portal it set up.

A cursory review of the comments, which were released to the public by House Minority Leader Robert Reives, show an overwhelming opposition to the new map.

Commenters accused Republicans of bowing to Trump, disenfranchising Black voters and shutting out the public.

A smaller group of commenters supported the map, saying that Republicans deserved another seat in Congress.

Asked if he’d reviewed the comments, Republican House Speaker Destin Hall said he saw a few and had some sent to him.

“This issue, it’s obviously going to animate folks on the left a lot,” he told reporters. “… I just disagree with them.”

The News & Observer has compiled a sampling of the comments, organized by the key themes that motivated their responses.

‘Abuse of power’

A large portion of the reviewed comments criticized Republicans for openly drawing maps intended to help their own party and Trump in the midterms.

“This is a blatant and egregious abuse of power,” one commenter, who said they were from Wilson County, wrote. “… You are more worried about cheating for a dictator who doesn’t care about you or the American people … History will remember that you only win by cheating. I teach my students that CHEATERS never win in the long run. Don’t take away our voices because you’re scared. Win fairly or lose with dignity.”

Another commenter accused Republicans of being “afraid of fair elections.”

“Clearly, they know that they cannot win unless they rig the system by picking their own voters, because surveys show that more than half the voters disagree with their policies,” the commenter continued. “This cheating may work over the short term, but it will fail over time. It is very sad that the once-proud GOP has become a lapdog for a lawless, vengeful, power-mad president.”

Throughout the week’s hearings and votes, Republicans repeatedly and explicitly stated that they decided to redraw North Carolina’s map because Trump asked for it.

Senate leader Phil Berger, who faces a contentious primary election against Rockingham County Sheriff Sam Page, has denied claims that he agreed to redraw the state’s map in exchange for an endorsement from Trump.

A deviation from process

Other commenters lambasted lawmakers for deviating from the traditional redistricting process, in which maps are drawn every 10 years after the census and voters are given ample time to provide public input on proposed changes.

“This is horrifying to me,” one comment said. “Redistricting happens every ten years after the census. Republicans know this. I am a registered Republican and as much as I hate the direction Democrats have gone, I will be voting Democrat if this happens. People are rapidly turning and will do the same as me. We know the law. Those who were ignorant to the law are now researching and seeing the laws being broken and are extremely hurt, angry and feel stabbed in the back.”

“You claim to accept public comments, but your actions betray you,” another wrote. “You release maps only at the eleventh hour, you schedule few public hearings, and you rush this process while almost every corner of the state is watching. That is disrespectful, dismissive, and undemocratic.”

One comment said the process “appears to be happening in the shadows, with the intent to rush through changes before voters can react.”

Allegations of racism

Other commenters noted that the redistricting plan primarily affects the 1st Congressional District, located in northeastern North Carolina, home to the state’s historic “Black belt.”

For over 30 years, the 1st district has elected Black members of Congress, including current Democratic Rep. Don Davis. But under the new map, the influence of Black voters is diminished as the 1st district is redrawn to include Republican-leaning counties along the coast.

“This new redistricting plan is intended to further dilute the Black vote in our state, which is racist and immoral,” one comment said. “We need fairly drawn districts to fairly represent all North Carolinians. Districts should not be drawn to benefit one party over another or to curb the voting power of any particular demographic. Proceeding forward with this redistricting plan is deeply undemocratic.”

Another comment called the map a “shameless discriminatory gerrymander, surgically diluting the power of Black voters and cracking communities apart.”

“They packed and cracked the state’s most urban and diverse communities, diminishing the voting power of these areas, despite the fact that they have driven population growth over the past decade,” they continued. “Towns and communities are senselessly split for no other reason than to give politicians an unfair advantage. Counties with vastly different issues and values are now grouped together in far-reaching districts. Residents in Rocky Mount and residents in the Outer Banks face very different problems — how can one lawmaker fairly represent both communities? They won’t.”

Support for independent redistricting

Many comments expressed support for establishing an independent redistricting commission, a process used in several states that is intended to take the politics out of the mapmaking process.

“I urge you to support and advocate for the establishment of an independent redistricting commission and ensure that any future redistricting efforts are guided by fairness, transparency, and the principle of ‘one person, one vote,’” one comment wrote.

North Carolina’s redistricting process has always been carried out by the state legislature, which has frequently been found to have illegally gerrymandered maps under both Republican and Democratic rule.

The state constitution also prohibits the governor from vetoing electoral maps, meaning they become law after achieving a simply majority in both chambers of the General Assembly.

“If North Carolina prioritized democracy, federalism, and political fairness, it would overhaul its redistricting process to ensure transparency, equity, and accountability,” another comment said. “First, it should establish an independent redistricting commission to remove partisan influence and draw maps based on nonpartisan criteria like compactness, community integrity, and compliance with the Voting Rights Act. The process should be open to public input, with hearings and online feedback tools… This isn’t a radical process, just a commonsense approach for a good democracy.”

Misguided priorities

Commenters consistently derided lawmakers for focusing on enacting a new congressional map instead of passing a comprehensive state budget.

Republican leaders in the House and Senate have been unable to reach a budget deal since the fiscal year ended over three months ago.

“This is just plain, flat out, despicable and amounts to election theft,” one commenter wrote. “The budget, which was supposed to be passed by July 1, is still not passed and teachers and other state employees have not been given a raise, but you have found time to rig the election for King Trump. You are nothing short of despicable and worthless.”

Lawmakers have passed some smaller spending bills this session, but have failed to enact across-the-board teacher raises or efforts to fund Medicaid.

“For the life of me, I do not understand the priorities of our legislature,” another comment said. “For the last year, I heard you consistently say that Bidenomics destroyed our state and that things were too expensive. So to me, I voted for the party that I believe would help reduce those costs and make things more affordable. But instead of doing that, here we are redrawing a map AGAIN. What are you scared of? If you are doing the right thing, you should not worry about losing power.”

Support for the map

While debating the bill on Wednesday, Democratic Rep. Pricey Harrison said that after reviewing most of the comments, her assistant was able to find only three in support of the map.

Likewise, The N&O found few comments in favor of the map in its review of the data.

“I am in total support of your proposed district changes!” one commenter wrote. “Thank you for your efforts! Now, let’s get it done! Districting should have never been race-based.”

Courts have historically interpreted Section 2 of the Voting Rights Act to require the creation of majority-minority districts in some circumstances. An upcoming case from the U.S. Supreme Court could gut that law, though.

Some comments in favor of the map were more general, such as “proud of you guys” or “Great! Keep going. I agree with the redistricting plan.”

Another commenter wrote that the new map “better reflects the values and voices of the majority of our state.”

“This adjustment would help ensure fair representation, strengthen conservative leadership, and keep North Carolina moving in the right direction,” they continued. “Thank you for standing up for our communities and for your hard work on this issue.”

©2025 Raleigh News & Observer. Visit newsobserver.com. Distributed by Tribune Content Agency, LLC.

By Tom Schoenberg, Bloomberg News

WASHINGTON — It’s one thing to be cleared by the president. It’s another to be cleared by the bank.

Republican fundraiser Elliott Broidy was pardoned at the end of President Donald Trump’s first term after a conviction for violating a U.S. lobbying law. Yet when he applied for an American Express Co. credit card this year, the lender denied him, citing his criminal history.

Mahmoud Reza Banki, the former chief financial officer of social media company X, says he ran into a similar problem. He claims JPMorgan Chase & Co. sought to close his accounts, citing a 15-year-old conviction for making false statements. He, too, had been pardoned at the end of Trump’s first term.

Both men are suing the financial institutions, claiming they were “debanked” even after their White House reprieves.

The separate cases, brought by lawyers who have represented an advocacy group co-founded by White House Deputy Chief of Staff Stephen Miller, are testing the bounds of forgiveness and if clemency is truly meant to wipe the slate clean. At stake is whether a pardon, meant to erase the legal stain of a conviction, can override the risk assessments of private lenders that are required to guard against money laundering, fraud and other financial crimes.

It’s a critical question as clemency becomes all the more common. President Joe Biden granted more than 4,000 commutations and pardons in his four-year term, a record. Trump has followed with more than 1,600 of his own in nine months since taking office, including for participants in the Jan. 6, 2021, riots at the U.S. Capitol. Just last week, he commuted the sentence of Republican lawmaker George Santos, who was serving time after being convicted of stealing campaign funds.

While pardons can spring someone from prison — or keep them out of it to begin with — they don’t necessarily end all repercussions from the case. Evidence of wrongdoing remains in the public record, and financial institutions routinely consider such information to evaluate their potential liabilities.

“A pardon is not a finding of innocence. It doesn’t in any way mean your conviction was not validly imposed or that you were not guilty of the crime,” said Liz Oyer, who was the Justice Department’s top pardon attorney for three years before being fired in March after refusing to recommend that actor and Trump ally Mel Gibson have his gun rights restored.

Oyer, who was a public defender before joining the government, said losing bank access is very common for people who have been accused of wrongdoing, whether convicted or not. “I certainly had clients who were dropped by their banks just because of an investigation initiated by the government,” she said.

But the idea that conservatives are being debanked for their political beliefs has become an obsession among some members of Trump’s MAGA movement, including the president himself. The Trump Organization sued Capital One Financial Corp. in March, accusing it of threatening the real estate business by abruptly canceling hundreds of accounts after his first term ended in 2021. (Capital One has denied wrongdoing and moved for the case to be dismissed.) Since taking office for his second term, Trump has threatened firms with investigations and penalties over debanking.

In August, the president issued an executive order mandating federal agencies involved in bank supervision stop considering reputation risk, which critics said financial companies used as a general catch-all for closing accounts. The order also requires regulators to make efforts to identify and reinstate former clients who were denied service “through a politicized or unlawful debanking action.”

Some banks, meanwhile, have been making changes on their own. JPMorgan updated its policies beginning last year to prohibit discriminating against customers for “religious views” and “political opinions, speech or affiliations.”

Jay Surgent, a criminal defense lawyer who helped secure a pardon from Trump for reality television couple Todd and Julie Chrisley, said banks may have the upper hand legally, but are under pressure “in this political atmosphere.”

Limiting banks’ ability to consider customers’ past criminal behavior risks exposing them to money laundering, fraud and sanctions violations, according to Richard Crone, a financial payments consultant in San Francisco. Crone said financial institutions have the right to carefully consider whether to work with known fraudsters, even if they’ve been pardoned. He questioned what would happen if someone like the late Ponzi scheme operator Bernie Madoff was given clemency.

Even with a pardon, Crone said, “risk-based assessments could still block someone like Madoff from being banked or extended credit.”

Those who lose banking over criminal allegations will usually seek workarounds, such as using accounts owned by family, friends, or perhaps an accountant or a lawyer, said Russell Duncan, a partner at Clark Hill in Washington. “They’ll go to smaller institutions that are perhaps under less regulatory scrutiny or have more flexible standards,” said Duncan, a former federal prosecutor.

JPMorgan cited reputational risk when moving to close two accounts owned by Banki in September 2024, according to documents filed by the bank in federal court in Jacksonville, Florida. That decision stemmed from Banki’s 2010 conviction for violating US sanctions on Iran as well as operating an unlicensed money transfer business and making false statements to investigators. He spent 22 months in prison before most of his conviction was overturned on appeal.

Banki filed cases last year against JPMorgan and Bank of America, alleging they denied him credit based on his dual US-Iranian citizenship. He also accused JPMorgan of seeking to close his First Republic Bank accounts, which JPMorgan acquired when that firm collapsed in 2023. He filed a third lawsuit against several entities, including Fidelity Brokerage Services, alleging they refused to let him open a college tuition savings account without saying why.

In a filing last year, a Chase executive told the court that it closed the accounts “as a result of the negative media and possible reputational risk to the bank from Mr. Banki.”

After Banki sought a temporary restraining order, JPMorgan this year reversed its decision and agreed to keep his former First Republic accounts open. Fidelity settled the matter with him this year. Bank of America and Banki reached an impasse in their settlement talks, according to a recent court filing, and are now proposing a trial date in August 2026.

Patricia Wexler, a spokeswoman for JPMorgan, said the bank decided to leave the former First Republic accounts open “given the successful appeal and the time that had passed without additional criminal charges.”

A Bank of America spokesman declined to comment. In a court filing, the lender said it didn’t discriminate against the plaintiff based on his national origin, but denied him credit “in light of his criminal background and associated banking history.”

Banki and his lawyers didn’t respond to messages seeking comment. Fidelity declined to comment.

Broidy, 68, is the chairman and chief executive officer of Broidy Capital Holdings, an investment firm in Boca Raton, Florida. He’s also been a key figure in the Republican National Committee, serving as finance chairman for three years beginning in 2005, then as deputy finance chairman for two years during the first Trump administration. He stepped down from that role in 2018 after he agreed to pay $1.6 million to a former Playboy model who became pregnant during an affair.

In October 2020, Broidy pleaded guilty to illegally lobbying Trump’s administration to help fugitive Malaysian businessman Jho Low block an investigation into the 1MDB investment fund and aid Low’s push on behalf of China for the US to extradite Guo Wengui, a wealthy exile who criticized China’s government. Low, whose scheme is alleged to have siphoned $4.5 billion from Malaysia’s state wealth fund, initially paid $8 million to Broidy and promised $75 million more if he succeeded in persuading the Justice Department to walk away from its civil forfeiture case, according to a transcript of Broidy’s plea hearing.

As part of a plea deal with federal prosecutors, Broidy agreed to forfeit $6.6 million. He faced as much as five years in prison. Before he was sentenced, Trump pardoned him along with more than 70 others on the final day of his first term.

Broidy Capital has a corporate account with American Express in the name of its operations manager. In February, Broidy sought to secure an additional card on that account in his name, but was denied. The lender said it was due to his history with American Express. Broidy in his lawsuit claims he never had a negative issue with American Express and had an excellent payment history. He alleges the firm violated the Equal Credit Opportunity Act by not giving him a specific explanation.

An American Express spokeswoman said the company doesn’t comment on individual clients or specific account decisions, which are guided by “data-driven, risk based and financial factors.” “We do not make credit decisions based on personal views or political affiliations,” she added.

In late August, American Express in a legal filing said Broidy was aware that it previously canceled three of his accounts because they were “not being used for their intended purpose.” The lender didn’t explain further other than saying the cancellations followed Broidy’s October 2020 guilty plea.

Broidy and his lawyers didn’t respond to messages seeking comment.

For now, American Express argues in court documents that any challenge to its decision not to issue a card must be handled in arbitration, not a court, per its customer agreement. A judge has scheduled a hearing for Oct. 23.

With assistance from Paige Smith and Kara Wetzel.

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By Tony Leys, KFF Health News

Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as being available to treat the plans’ members, a new federal watchdog report says.

The investigators allege that some insurers effectively set up “ghost networks” of psychologists, psychiatrists, and other mental health professionals who purportedly have agreed to treat patients covered by the publicly financed Medicare and Medicaid plans. In fact, many of those professionals do not have contracts with the plans, do not work at the locations listed, or are retired, the investigators said.

The Office of Inspector General for the Department of Health and Human Services, which oversees the giant Medicare and Medicaid health programs, released its findings in a recent report.

The report focuses on insurers the government pays to cover people in Medicare Advantage plans and in privately managed Medicaid plans. About 30% of all Americans are covered by such insurance, the report says. The government pays the insurers hundreds of billions of dollars annually.

The companies are paid set rates per person they cover and are allowed to keep whatever money they don’t spend on patient care. The insurers are required to have adequate numbers of health care professionals under contract to serve patients in each region they cover.

But the new report found that 55% of mental health professionals listed as in-network by Medicare Advantage plans were not providing such care to any of the plans’ members. The figure was 28% for Medicaid managed care plans.

Some mental health professionals told investigators they shouldn’t have been listed as in-network care providers for the insurers’ members, because they no longer worked at the locations listed or because they didn’t participate in the Medicare Advantage or Medicaid managed care plans. Others said they were working as administrators and no longer providing patient care.

In one case, the report says, a private Medicaid plan listed a mental health professional as providing care in 19 practice locations. But when the investigators checked, a receptionist at one of the clinics said the person had retired a few years ago.

Jeanine Simpkins of Mesa, Arizona, learned how skimpy the networks can be when a 40-year-old family member was in crisis this fall. Simpkins struggled to find a drug rehabilitation program that would accept the Medicare Advantage insurance the relative is on because of a disability.

Simpkins said she contacted about 20 rehab programs, none of which would take the Medicare insurance plan. “You feel kind of dropped,” she said. “I was pretty surprised, because I thought we had something good in place for her.”

Simpkins’ relative eventually enrolled in part-time hospital care instead of an inpatient rehabilitation center.

It can be challenging for patients to find timely, nearby care, for all kinds of health problems, from colds to cancer.

But Jodi Nudelman, a regional inspector general who helped write the federal report, said in an interview that the stakes can be especially high for patients seeking mental health care.

“They can be particularly vulnerable,” she said. It can be daunting for people to acknowledge they need such care, and any roadblock can discourage them from trying to find help, she said.

She added that taxpayers aren’t getting their money’s worth if insurers fail to meet obligations to provide sufficient care options for Medicare and Medicaid participants in the plans.

The federal report focused on a sample of 10 counties in five states: Arizona, Iowa, Ohio, Oregon, and Tennessee. It included urban and rural areas. It did not identify the insurers whose networks were checked.

Susan Reilly, vice president of communications for the Better Medicare Alliance, a trade group representing Medicare Advantage plans, said managed care companies support federal efforts to improve access to mental health services. “While this report looks at a small sample of plans, we agree there’s more work to do and are committed to continuing that progress together with policymakers,” she said in a statement.

The report’s authors said their sample was a good representation of the national situation. It looked at 40 Medicare Advantage plans and 20 Medicaid managed care plans.

The report recommends government administrators make more use of medical billing data to confirm whether health professionals listed as in-network are providing care to patients covered by private Medicare and Medicaid insurance plans.

The watchdogs also recommend that federal regulators create a national, searchable directory of mental health providers, listing which Medicare and Medicaid insurance plans each one accepts. Such a directory would help patients find care and would make it easier to double-check the accuracy of plans’ listings of in-network providers, they said.

Federal administrators overseeing Medicare and Medicaid have taken steps toward creating such a directory, the authors said. Reilly, the industry representative, said managed care companies support the effort.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Stephanie Armour, KFF Health News

While plowing a wheat field in rural Washington state in the 1990s, William Wallace spotted a gray plane overhead that he believed was releasing chemicals to make him sick. The rancher began to suspect that all white vapor trails from aircraft might be dangerous.

He shared his concern with reporters, acknowledging it sounded a little like “The X Files,” a science fiction television show.

Academics cite Wallace’s story as one of the catalysts behind a fringe concept that has spread among adherents to the Make America Healthy Again, or MAHA, movement and is gaining traction at the highest levels of the federal government. Its treatment as a serious issue underscores that under President Donald Trump, unscientific ideas have unusual power to take hold and shape public health policy.

The concept posits that airplane vapor trails, or contrails, are really “chemtrails” containing toxic substances that poison people and the terrain. Another version alleges planes or devices are being deployed by the federal government, private companies, or researchers to trigger big weather changes, such as hurricanes, or to alter the Earth’s climate, emitting hazardous chemicals in the process.

Several GOP lawmakers and leaders in the Trump administration remain convinced the concepts are legitimate, though scientists have sought to discredit such claims.

Health and Human Services Secretary Robert F. Kennedy Jr. is planning to investigate climate and weather control, and is expected to create a task force that will recommend possible federal action, according to a former agency official, an internal agency memo obtained by KFF Health News, and a consultant who helped with the memo.

The plans, along with comments by top GOP lawmakers, show how rumors and conspiracy theories can gain an air of legitimacy due to social media and a political climate infused with falsehoods, some political scientists and researchers say.

“When we have low access to information or low trust in our sources of information, a lot of times we turn to our peer groups, the groups we are members of and we define ourselves by,” said Timothy Tangherlini, a folklorist and professor of information at the University of California-Berkeley. He added that the government’s investigation of conspiracy theories “gives the impression of having some authoritative element.”

HHS is expected to appoint a special government employee to investigate climate and weather control, according to Gray Delany, former head of the agency’s MAHA agenda, who said he drafted the memo. The agency has interviewed applicants to lead a “chemtrails” task force, said Jim Lee, a blogger focused on weather and climate who Delany said helped edit the memo, which Lee confirmed.

“HHS does not comment on future or potential policy decisions and task forces,” agency spokesperson Emily Hilliard said in an email.

The memo alleges that “aerosolized heavy metals such as Aluminum, Barium, and Strontium, as well as other materials such as sulfuric acid precursors, are sprayed into the atmosphere under the auspices of combatting global warming,” through a process of stratospheric aerosol injection, or SAI.

“There are serious concerns SAI spraying is leading to increased heavy metal content in the atmosphere,” the memo states.

The memo claims, without providing evidence, that the substances cause elevated heavy-metal content in the atmosphere, soil, and waterways, and that aluminum is a toxic product used in SAI linked to dementia, attention-deficit/hyperactivity disorder, asthma-like illnesses, and other chronic illnesses. The July 14 memo was addressed to White House health adviser Calley Means, who didn’t respond to a voicemail left by a reporter seeking comment.

High-level federal government officials are presenting false claims as facts without evidence and referring to events that not only haven’t occurred but, in many cases, are physically impossible, said Daniel Swain, a climate scientist at the University of California.

“That is a pretty shocking memo,” he said. “It doesn’t get more tinfoil hat. They really believe toxins are being sprayed.”

Kennedy has previously promoted debunked chemtrail theories. In May, he was asked on “Dr. Phil Primetime” about chemicals being sprayed into the stratosphere to change the Earth’s climate.

“It’s done, we think, by DARPA,” Kennedy said, referring to a Department of Defense agency that develops emerging technology for the military’s use. “And a lot of it now is coming out of the jet fuel. Those materials are put in jet fuel. I’m going to do everything in my power to stop it. We’re bringing on somebody who’s going to think only about that.”

DARPA officials didn’t return a message seeking comment.

Federal messaging

Deploying chemtrails to poison people is just one of many baseless conspiracy theories that have found traction among Trump administration health policy officials led by Kennedy, a longtime anti-vaccine activist before entering politics. He continues to promote a supposed link between vaccines and autism, as well as make statements connecting fluoride in drinking water to arthritis, bone fractures, thyroid disease, and cancer. The World Health Organization says fluoride is safe when used as recommended.

Delany, who was ousted in August from HHS, said Kennedy has expressed strong interest in chemtrails.

“This is an issue that really matters to MAHA,” said Delany, referring to the informal movement associated with Kennedy that is composed of people who are skeptical of evidence-based medicine.

The memo also alleges that “suspicious weather events have been occurring and have increased awareness of the issue to the public, some of which have been acknowledged to have been caused by geoengineering activities, such as the flooding in Dubai in 2024.” Geoengineering refers to intentional large-scale efforts to change the climate to counteract global warming.

“It is unconscionable that anyone should be allowed to spray known neurotoxins and environmental toxins over our nation’s citizens, their land, food and water supplies,” Delany’s memo states.

Scientists, meteorologists, and other branches of the federal government say these assertions are largely incorrect. Some points in the memo are accurate, including concerns that commercial aircraft contribute to acid rain.

But critics say the memo builds on kernels of truth before veering into unscientific fringe theories. Efforts to control the weather are being made, largely by states and local governments seeking to combat droughts, but the results are modest and highly localized. It isn’t possible to manipulate large-scale weather events, scientists say.

Severe flooding in the United Arab Emirates in 2024 couldn’t have been caused by weather manipulation because no technology could create that kind of rainfall event, Maarten Ambaum, a meteorologist at the University of Reading who studies Gulf region rainfall patterns, said in a statement on the floods. Similar debunked claims emerged this year after central Texas experienced devastating floods.

The Government Accountability Office concluded in a 2024 report that questions remain as to the effectiveness of weather modification.

Research into changing the climate has been conducted, including work by one private company that engaged in field tests. Still, federal agencies say no ongoing or large-scale projects are underway. Study of the concept remains in the research phase. The Environmental Protection Agency says there are no large-scale or government efforts to affect the Earth’s climate.

“Solar geoengineering is not occurring via direct delivery by commercial aircraft and is not associated with aviation contrails,” the agency says on its website.

Widespread misinformation

Misperceptions about weather, climate control, and airplane contrails extend beyond the Trump administration, scientists said.

In September, a congressional House committee hearing titled “Playing God With the Weather — A Disastrous Forecast” involved two hours of debate on the once-fringe idea. Rep. Marjorie Taylor Greene (R-Ga.), who chaired the hearing, has introduced legislation to ban weather and climate control, with a fine of up to $100,000 and up to five years in prison.

Some Democrats objected to the nature of the discussion. Rep. Melanie Stansbury (D-N.M.) accused Greene of using “the platform of Congress to proffer anti-science theories, to platform climate denialism.”

Frequently citing chemtrails, GOP lawmakers have introduced legislation in about two dozen states to ban weather modification or geoengineering. Florida passed a bill to establish an online portal so residents can report alleged violations.

“The Free State of Florida means freedom from governments or private actors unilaterally applying chemicals or geoengineering to people or public spaces,” GOP Florida Gov. Ron DeSantis said in a press statement this spring.

Meanwhile, the chemtrail conspiracy has permeated popular culture. The title track on singer Lana Del Ray’s seventh studio album is entitled “Chemtrails Over the Country Club.” Bill Maher dove into the chemtrail myth on his podcast “Club Random,” saying, “This is nuts. It’s just nuts.” And “Chemtrails,” a psychological thriller, wrapped filming in July.

Social media has given wing to the chemtrails concept and other fringe ideas involving public health. They include an outlandish belief that Anthony Fauci, who advised both Trump and President Joe Biden on the government response to the covid-19 pandemic, created the AIDS epidemic. There is no evidence of such a link, public health leaders say.

Researchers say another false belief by those on the far right holds that people who received covid vaccines could shed the virus, causing infertility in the unvaccinated. There is no evidence of such a connection, scientists and researchers say.

More severe weather events due to global warming may be driving some of the baseless theories, scientists say. And risks occur when such ideas take hold among the general population or policymakers, some public health leaders say. Climate researchers, including Swain, say they’ve received death threats.

Lee, the blogger, said he disagrees with some of the more far-fetched beliefs and is aware of the harm they can cause.

“There are people wanting to shoot down planes because they think they are chemtrails,” said Lee, adding that some believers are afraid to venture outside when plane vapor trails are visible overhead.

There is also no evidence that plane contrails cause health problems or are related to intentional efforts to control the climate, according to the EPA and other scientists.

The memo and focus at HHS on climate and weather control are alarming because they perpetuate conspiracies, said David Keith, a professor of geophysical sciences at the University of Chicago.

“It’s unmoored to reality,” he said. “I expected there were documents like this, but seeing it in print is nevertheless shocking. Our government is being driven by nonsensical dreck from dark corners of social media.”

©2025 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC. ©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Alex Brown, Stateline.org

For years, Western leaders have debated the creation of a regional energy market: a coordinated grid to pool solar power in Arizona, wind in Wyoming, hydro in Washington and battery storage in California.

The shared resources would meet the demands of 11 different states, bolstering utilities’ local power plants with surplus energy from across the region.

With the passage of a landmark new law in California, that market is finally on its way to becoming a reality. Proponents say it has the potential to lower energy costs, make the grid more resilient and speed up the deployment of clean energy.

But the market’s success, experts agree, depends heavily on which states and utilities decide to opt in. As energy issues have become increasingly politicized, it’s uncertain whether Western leaders can buy into a common vision for meeting the region’s power needs.

“As we move toward weather-dependent renewables to run our grid, we’ve got to have a grid that is bigger than a weather pattern,” said California Assemblymember Cottie Petrie-Norris, a Democrat who sponsored the legislation aimed at establishing the new market. “A Western energy market is critical.”

The California measure earned bipartisan support, and leaders in conservative and liberal states alike have long touted the benefits of a region-wide market.

But some skeptics worry about merging the power systems of states with varying climate goals. And some fear the new market could give federal regulators appointed by President Donald Trump an opening to interfere and mandate more fossil fuel-powered plants that can be turned on regardless of the weather.

A bigger market

Across the 11 Western states that straddle or sit west of the Rocky Mountains, 37 separate private and public utilities operate portions of the grid.

This fragmented structure differs from the grid systems in Eastern and Midwestern states, where regional transmission organizations, or RTOs, coordinate and plan for energy needs across vast swaths of the country.

Backers of a Western market argue that a region-wide approach would be much more efficient.

Under the current system, each utility is required by state public utility commissions to build enough power to meet peak energy demands. That could mean building gas plants that only turn on a few times a year during extreme heat waves.

As part of a West-wide market, utilities could manage those high-demand events by importing power from other parts of the region that are generating surplus electricity. Such agreements could also prevent the periodic shutdowns of wind and solar farms when they produce more energy than local utilities can use.

“We could be drawing on the solar resources from the Southwest during the day, and then in the evening the wind resources in Montana and Wyoming are a great benefit,” said Austin Scharff, senior energy policy specialist with the Washington State Department of Commerce. “We have a lot of hydro resources, and we can help make sure the regional grid stays balanced when those are needed.”

Some industry leaders say such trading would allow states to pull in cheap electricity from elsewhere, rather than building expensive new power plants.

“When you have this bigger market, not everybody has to build to their peak in the same way,” said Leah Rubin Shen, managing director with Advanced Energy United, an industry group focused on energy and transportation. “Everybody’s able to share.”

Western states do trade electricity on a bilateral basis between individual utilities. Utilities spanning much of the West also transact through a real-time market that allows them to address pressing short-term demand issues. Some are poised to join a new day-ahead market that will conduct planning based on daily demand and production forecasts.

But some lawmakers and officials believe the region needs a larger vision that goes beyond moment-by-moment needs, a market that can plan interstate transmission lines and energy projects to serve the whole region in the decades to come.

“We’re facing really rapidly growing energy demand,” said Nevada Assemblymember Howard Watts, a Democrat. “The best way for us to meet that is to effectively move energy all across the Western U.S. The only way we can do that is through an RTO.”

Watts sponsored a bill, enacted in 2021, that requires Nevada to join an RTO by 2030. Colorado also passed a law that year with a 2030 deadline for utilities to join an RTO.

“Any future is better than our status quo, which is 37 separate grids in the West,” said Chris Hansen, a former Democratic senator who sponsored the Colorado legislation. “We can lower costs and provide greater reliability if we’re sharing resources.”

Hansen now serves as CEO of La Plata Electric Association, an electric cooperative in southwestern Colorado.

A new market

The push for a West-wide market had always faced one major hurdle: Any market would likely include the massive geographical footprint and energy supply managed by the California Independent System Operator, or CAISO. As the West’s largest grid operator, CAISO manages the flow of electricity across most of the Golden State. It’s governed by a five-member board appointed by California’s governor, and other states were unlikely to sign up for a market in which they have no representation.

The law passed by California legislators last month allows for a new organization with independent governance from across the region to oversee Western energy markets.

“This legislation is a key reset and has been the largest sticking point in building a regional market,” said Amanda Ormond, managing director of the Western Grid Group, which advocates for a more efficient grid. “This is a primary concern of a lot of folks that has now been solved.”

The law sets in motion a yearslong process that will task regional leaders with establishing the organization’s governance and navigating a series of regulatory procedures. The new market could be in place by 2028.

State leaders across the West say the California law is a long-awaited development.

“You get this really good benefit from being able to optimize across a larger footprint than an individual utility can,” said Tim Kowalchik, research director with the Utah Office of Energy Development. “Those resources can play really well together.”

Utah led a study in 2021, collaborating with other Western states, exploring the potential for energy markets in the region. State officials say the research has helped drive the current effort.

“It was fascinating how substantial the benefits were,” said Letha Tawney, chair of the Oregon Public Utility Commission. “The interdependence of the West started to become much more apparent, and it really changed the conversation.”

The study looked at a variety of market options and found that an RTO would have significant benefits, lowering costs for electricity customers and promoting clean energy. Based on the study’s projections, the market would produce roughly $2 billion in gross benefits per year, largely by saving utilities from building extra capacity.

Another study in 2022, conducted by a pair of consulting firms, found that an RTO would create as many as 657,000 permanent jobs and bolster the region’s economy.

While Western leaders say the potential benefits are massive, no states outside of Nevada and Colorado have committed to joining a regional RTO. State leaders say they’ll be watching carefully to see what emerges from the new California law. While the decision on joining the market will largely be left to individual utilities, state regulators can play a major role by directing them to conduct an economic analysis of such a move.

State sovereignty

The push for a regional market has also faced opposition from skeptics who fear it undermines states’ power to set their own energy and climate goals. Some point to Eastern governors’ frustration with PJM Interconnection, the RTO that manages the grid across a swath of the Midwest and Mid-Atlantic.

“It’s very dangerous,” said Jamie Court, president of Consumer Watchdog, a California-based nonprofit advocacy group. “We’re giving up control of our sovereignty. Once a state’s in, it’s not the state that has the control.”

Some experts fear that states with significant coal or gas industries may be hesitant to join a market that could incentivize their utilities to import cheap solar power from elsewhere. On the flip side, some climate advocates in California are wary of plugging into a market that could support coal power from out of state.

“Some states are parochial-minded: ‘This is a California thing, and we don’t want anything to do with California,’” said Vijay Satyal, deputy director of markets and transmission with Western Resource Advocates, a nonprofit climate-focused group. “That one state’s government will not decide how a market will be operated, it’s a seismic shift in the industry.”

Backers of an RTO argue that it can incorporate states’ varying energy goals. They point to research showing that the market will support renewable power. But others fear merging fates with coal-heavy states could give federal regulators more leverage to intervene in favor of fossil-fuel power.

Even if Trump is out of office when the market comes online, the regulators he appoints to the Federal Energy Regulatory Commission will still be serving out their terms. Some believe FERC could set rules that require the new market to favor fossil fuel-powered resources.

“When you have a mixed market with a lot of coal plants, it creates opportunities for the Trump administration to rejigger the rules to favor coal,” said Matthew Freedman, renewables attorney with The Utility Reform Network, a California-based consumer advocacy group. “In another reality, this would have sounded like a hysterical concern, but it’s pretty obvious where [Trump’s appointees to the Federal Energy Regulatory Commission] want to go.”

Freedman’s group pushed California lawmakers for protections that would have given states more flexibility to withdraw from the market, while also prohibiting “resource adequacy” mandates that could be used by the feds to prop up coal. While those elements were included in a Senate version of the bill, they were stripped from the Assembly bill that ultimately was passed.

Supporters of the bill say such concerns are overblown, and the new market is structured to avoid the pitfalls facing other RTOs.

“The simple economic fact is that right now clean energy resources are the cheapest in the world,” said Petrie-Norris, the law’s sponsor. “We’re going to see solar displacing dirty fuels rather than the reverse.”

Much depends on convincing states and utilities it’s in their best interests to join the market. The strength-in-numbers advantages of an RTO depend on widespread participation. While many Western leaders have long touted a region-wide market, the opportunity is arising at a time where energy has become a partisan issue.

Meanwhile, the long-awaited market emerging from California is facing new competition from the east. The Southwest Power Pool, an Arkansas-based RTO serving the middle of the country, is expanding its footprint in the West, with several utilities poised to join its day-ahead market.

“Anytime you have two neighboring utilities in different markets, you have seams that create a lot of friction and inefficiency,” said Rubin Shen, with the energy industry group. “Whether or not everybody can come together and be all-in on a full West-wide market, it’s too soon to tell.”

Stateline reporter Alex Brown can be reached at abrown@stateline.org.

---

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Hannah Elliott, Bloomberg News

There’s something fundamentally American about the freedom to get in your car and drive.

Driving is self-determination. The liberty to set your own course. The power to move under your own willpower, whether for duty or sheer pleasure. Despite some decline among Gen Zers, plenty of teens still eagerly anticipate getting their driver’s license. In many American towns, where public transportation and walkability are scarce, driving is what empowers you to explore.

Some motoring enthusiasts worry self-driving vehicles threaten that ideal. These robot autos, run by Google and China and Elon Musk, use AI and radars to navigate without human input; they could replace our car-centric culture with faceless communal bots controlled by opaque entities. Even worse, self-driving vehicles present safety concerns and other vulnerabilities, such as being hacked or spoofed by malicious agents at home or abroad.

I’ve covered the car industry for 20 years, and I would hate to see our sports coupes and road trips disappear. The risks associated with relinquishing control over my mobility also give me pause. Or they did. I took a Waymo for the first time recently in Los Angeles and … I haven’t stopped using it since. Rather than replace our cool cars, self-driving vehicles will, I predict, become a welcome complement to modern life, first as part of ride-sharing platforms and then as privately owned transport. Why? Because they offer an excellent solution for something nobody likes: commuting.

If driving is heaven, commuting is hell. Not even the hardest-core drivers like it. So the question isn’t whether self-driving will replace our favorite cars (I think not), but rather, will it remove the burden of our most mundane trips? And could it replace other ride-sharing platforms like Uber? I certainly hope so.

Waymo LLC, the self-driving car service subsidiary of Alphabet Inc., Google’s parent company, was founded in 2009 with a mission to explore what self-driving technology could offer. It now has more than 2,000 electric vehicles operating across its markets, which include LA, Phoenix and San Francisco, plus Austin and Atlanta, where Waymo rides are hailed via Uber. In 2026, Dallas, Denver, Miami, Nashville and Washington, DC, will join the ranks with Waymos on their streets. New York City just granted the company permission to continue testing there until the end of the year, and Seattle is in the works too. Waymo provides more than 250,000 trips each week, and regulators are already adapting. A new California law will soon authorize police to issue “notices of autonomous vehicle noncompliance” when they see driverless cars breaking traffic rules.

Beyond Waymo, robo-taxis and -shuttles are also running in China, Singapore and the Middle East, and they’re being tested across Europe. The vehicles are expected to become commercially available in the U.S. at a large scale by 2030, according to the research firm McKinsey.

But they’re a long way from being ubiquitous. A world of self-driving cars will require billions of dollars of development, improved navigation systems, increased charging infrastructures and new regulations to amend traffic laws. Ford, General Motors and Volkswagen have all canceled autonomous taxi programs they once funded by the billions. (GM is planning to renew exploring autonomous cars for personal use, rather than as a robotaxi service. Later this year, the autonomous mobility subsidiary of Volkswagen Group of America Inc. will begin testing electric autonomous ID. Buzz AD vehicles, with plans to offer rides via Uber 2026 in LA. The vehicles will use human operators during their testing and launch phases.) Tesla’s Robotaxis aren’t open to the public. Given the company’s proclivity for extensive delays, it’s unclear when they will be.

As self-driving options develop, consumer demand shouldn’t be a problem, according to experts; most people who try it like it. Waymo reports a 98% satisfaction rating among users in LA. Proponents note that more than 1.3 million deaths occur around the world annually in traffic accidents, whereas self-driving vehicles eliminate the human errors that cause more than 90% of those deaths, according to research by Global Market Insights.

Waymo uses a proprietary AI system for autonomous driving that has been installed on a fleet of Jaguar I-PACEs equipped with dozens of cameras and sensors. The technology is more robust than the hands-free driving systems we have in our own cars, combining AI learning with LiDAR, radar, cameras and high-definition maps to read and anticipate the environment.

There are still significant limitations to Waymo vehicles’ range and their ability to adapt to real-life scenarios. But after a week of Waymo rides, which I ordered easily via an app, other ride-sharing platforms seemed woefully outdated.

My first trip was not perfect. Our house in Hollywood sits outside Waymo’s range, so my gallant husband had to drive me about a mile down the hill to a cafe on Hollywood Boulevard, where I ordered the car. It took 26 (!) minutes to arrive—precious time lost because of high rider volume on a Monday morning. An Uber would have been there within a few minutes. But the vehicle showed up at exactly the time it had promised, unlike Uber, which tends to miss arrival estimates. A spokesperson from Uber did not comment.

Synched with my iPhone, the car unlocked automatically when it pulled up, waiting until I clicked my seat belt and pushed a green button on a screen in the rear to commence the journey. Icons in the app would have let me open the trunk, had I wanted, and allowed me to adjust the sound and temperature in the car.

Any drama I expected to feel from being alone in a moving vehicle just didn’t exist. No driver? No problem. I forgot about it before I even hit Santa Monica Boulevard, and my 44-minute ride to the office proved delightfully uneventful while my productivity soared: I stretched my legs; checked email; made phone calls and wrote to-do lists—all things I cannot do when driving myself to the newsroom each morning. The trip cost $23.28, almost half the price of an Uber Black ($41.25) or UberX ($42.95) at the same hour.

There were a few hiccups. The car froze momentarily behind a truck parked illegally, causing other drivers to honk erratically. More annoyingly, it didn’t drop me at the address I requested but in a hotel valet line across an intersection and down the next block. I’ve learned that Waymos often leave passengers on side streets or one block past a chosen destination, depending on how busy the drop-off point seems. (This is because the cars are programmed to prioritize safety and efficiency rather than moving swiftly in hectic traffic.) That would have been frustrating had it been raining, or an unfamiliar neighborhood, or had I been wearing heels.

There’s room for improvement in the car’s ability to take a direct route to a destination rather than zig-zagging or circling the arrival spot before stopping, as it did one evening when trying to avoid busy corners to drop me off in Hollywood. It made for a slightly longer drive than if I had done it myself. Indeed, the logistical challenges of using Waymo are its biggest problem. One night it wouldn’t let me change my destination just 15 minutes into a 55-minute journey, even though the new destination was far closer. (It would have allowed me to cancel the ride, leaving me on the street corner.)

I’m hoping all this will improve as Waymo expands its range—and incorporates highways and Interstates, which it currently does not—because the privacy, punctuality and peace inside the cabin are delightful. I found myself scheduling Waymos to take me to dinner in West Hollywood or to try on shoes at Reformation on Melrose Avenue. It was freeing not to stress about parking or bad drivers.

If more folks used self-driving cars, it would lead to more parking; reduce road rage, drunk driving and traffic accidents; and alleviate noise pollution and congestion. Waymo is a far better driver than most of the ride-sharing and taxi drivers I’ve had. It’s certainly more courteous, gliding elegantly through yellow lights, and moving up in line at stoplights if the vehicle behind it wants to turn right. The car remained smooth and predictable even in tight traffic, navigating tiny neighborhood streets with ease. I was so relaxed I started dozing.

One morning I even walked myself 20 minutes down to the Hollywood coffee shop so I could take a Waymo again to work. I didn’t love the hike, but I wanted that solitary ride. (Mornings when I needed to be in the office at a specific time, I drove myself.)

The solitude is the top benefit I hear from everyone I speak with about the service—especially women and gay and trans friends who worry about being accosted, harassed or ogled by drivers. Self-driving cars offer a way to ride alone in safety. We just need the services to be bigger and better and more flexible.

It’s encouraging to see the industry growing, with companies like Zoox, Pony Ai and WeRide working to expand the technology. In 2024 the global market for self-driving cars was valued at $1.7 trillion, according to Global Market Insights. It’s expected to hit $3.9 trillion by 2034.

As for me, I’ll plan to hold on to my cars and use Waymo for my daily commute and mundane chores. If I’m lucky, I’ll never have to take an Uber again.

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By Nada Hassanein, Stateline.org

CHANDLER, Ariz. — Art Martinez has seen the power of ceremony.

Martinez, a clinical psychologist and member of the Chumash Tribe, helped run an American Indian youth ceremonial camp. Held at a sacred tribal site in Northern California, it was designed to help kids’ mental health. He remembers a 14-year-old girl who had been struggling with substance use and was on the brink of hospitalization.

On the first day of the four-day camp, Martinez recalled, she was barely able to speak. In daily ceremonies, she wept. The other kids gathered around her. “You’re not alone. We’re here for you,” they’d say.

Traditional tribal healing practices are diverse and vary widely, unique from tribe to tribe. Many include talking circles, sweat lodge ceremonies with special rituals, plant medicine and herb smudging, along with sacred ceremonies known only to the tribe.

Martinez and the girl’s counselor saw her mental health improve under a treatment plan combining tribal traditional healing and Western medicine.

“By the end of the gathering, she had broken through the isolation,” Martinez said. “Before, she would barely shake hands with kids, and she was now hugging them, they were exchanging phone numbers. Her demeanor was better, she was able to articulate.”

Indigenous health advocates have long known the health benefits of integrating their traditional healing practices, and studies have also shown better health outcomes.

Now, for the first time, tribal traditional healing practices are eligible for Medicaid coverage in California and three other states under a new initiative. Last October, the federal government approved Medicaid and Children’s Health Insurance Program coverage of traditional healing practices at tribal health facilities and urban Indian organizations in Arizona, California, New Mexico and Oregon.

These were approved under a federal program that allows states to test new pilot health programs and ways to pay for them.

Arizona’s waiver went into effect this month. While California’s waiver currently only covers patients with substance use disorder, like the girl in Martinez’s camp, any Medicaid enrollee who is American Indian or Alaska Native is eligible in the other three states. Officials have said California’s program will expand to have such coverage in the future.

Under the waivers, each tribe and facility decides which traditional healing services to offer for reimbursement. Services can also take place at sacred sites and not necessarily inside a clinic, explained Virginia Hedrick, executive director of the California Consortium for Urban Indian Health.

“If a healing intervention requires being near a water source — the ocean, creek, river — we can do that,” said Hedrick, who is of the Yurok Tribe and of Karuk descent. “It may involve gathering medicine in a specific place on the land itself.”

Tribes long had to practice out of sight. The U.S. government’s assimilation policies had targeted tribal languages, cultural and religious practices — including healing. It wasn’t until 1978, when the American Indian Religious Freedom Act was enacted under President Jimmy Carter, that they regained their rights.

“It was illegal to practice our ways until 1978 … the year I was born,” said Dr. Allison Kelliher, a family and integrative medicine physician, who is Koyukon Athabascan, Dena. “Traditional healing means intergenerational knowledge that have origins in how our ancestors and people lived generationally to promote health, so it’s a holistic way of looking at well-being.”

Last month, Kelliher and hundreds of others gathered at the National Indian Health Board’s health conference on Gila River Indian Community land in Chandler, Arizona. During a panel discussion about the waivers, tribal members discussed how health centers will bill for services, ways to protect the sacredness of certain ceremonies, and how to measure and collect data around the effectiveness of the treatments, a federal requirement under the waivers.

But teasing out those new protocols didn’t dull the enthusiasm.

“This is where we really start intersecting the Western medicine as well as traditional healing, and it’s exciting,” said panelist Dr. Naomi Young, CEO of the Fort Defiance Indian Hospital Board in Arizona.

The Trump administration announced earlier this year that it doesn’t plan to renew certain other Medicaid waiver programs approved under the Biden administration. But it hasn’t announced any changes around the traditional healing waivers.

Studies have found that incorporating sweat lodge ceremonies and other cultural practices in treatments led to substance use recovery and emotional health, and better quality diets when incorporating traditional foods, according to analyses of research by the National Council of Urban Indian Health.

“When there is an opportunity to braid traditional healing with Western forms of medicine, it’s very possible, and the research is indicating, we may get better health outcomes,” Hedrick said.

Traditional practices

Decades of historical trauma, such as displacement and forced assimilation in boarding schools — where American Indian and Alaska Native people were forbidden from speaking their languages — are behind their disproportionate rates of chronic illness and early deaths today, tribal health experts say.

Tribes have long offered traditional healing — both outside brick-and-mortar health care settings as well as within many clinics. But health centers have been paying out of pocket or budgeting for the services, said retired OB-GYN Dr. John Molina, director of the Arizona Advisory Council on Indian Health Care and member of the Pasqua Yaqui and Yavapai Apache Tribes.

Molina said the new Arizona waiver may help clinics afford to serve more patients or staff more traditional healers, and build infrastructure, including sacred spaces and sweat lodges. For other clinics, “They’ve been wanting to start, but perhaps don’t have the revenue to start it,” he said.

“I’m hoping that when people engage in traditional healing services, a lot of it is to bring balance back into the lifestyle, to give them some hope,” Molina said.

That’s the effect traditional healing practices have had on Harrison Jim, who is Diné. Now a counselor and traditional practitioner at Sage Memorial Hospital in Arizona, Jim, 70, said he remembers his own first all-night sweat lodge ceremony when he returned from a military tour.

“I [felt] relieved of everything that I was carrying, because it’s kind of like a personal journey that I went through,” he said. “Through that ceremony, I had that experience of freedom.”

Kim Russell, the hospital’s policy adviser, who also spoke on the panel about the traditional healing waivers, told Stateline her team hopes to bring on another practitioner along with Jim.

Tribal health leaders have expressed concern about people without traditional knowledge posing to offer healing services. But Navajo organizations, including Diné Hataałii Association Inc., aim to protect from such co-opting as it provides licensures for Native healers, Jim said.

Push in Washington

Facilities covered under the new waivers include Indian Health Service facilities, tribal facilities, or urban Indian organization facilities. In Arizona, urban Indian organizations can get the benefit only if they contract with an Indian Health Service or other tribal health facility.

In Oregon, Yellowhawk Tribal Health Center spokesperson Shanna Hamilton said that while the center can’t speak on behalf of other tribes or clinics, many are still in the early stages of developing programs and protocols. She called the waivers a “meaningful step forward in honoring Indigenous knowledge and healing practices.”

Meanwhile, in neighboring Washington state, a bill that would have required the state to submit an application for a waiver by Sept. 1 died in committee.

But the state doesn’t need the legislative OK to apply. It’s still going to submit an application by the end of the year, the Washington State Health Care Authority told Stateline in a statement, emphasizing that each tribe would determine its own traditional health services available for reimbursement.

Azure Bouré, traditional food and medicine program coordinator for the Suquamish Tribe, a community along the shores of Washington’s Puget Sound, called the waivers “groundbreaking.”

“We’re proving day in and day out that Indigenous knowledge is important. It’s real, it’s worthy, and it’s real science,” Bouré said.

On a brisk summer day in 2009, Bouré recalled, she had attended a family camp hosted by Northwest Indian College. It was then she tasted the salal berry for the first time. A sweet, dark blue berry, it’s long been used by Pacific Northwest tribes medicinally, in jams, and for dyeing clothing.

“It was just that one berry, that one day, that reignited that wonderment,” Bouré said. For her, it unlocked the world of Indigenous plant medicine and food sovereignty, a people’s right to the food and food systems of their land.

She got her bachelor’s in Native American environmental science and now runs an apothecary, teaches traditional cooking classes, recommends herbs to members with ailments and processes foraged foods.

One day she could be chopping pumpkins or other gourds and the next, cleaning and peeling away the salty-sweet meat from dozens of sea cucumbers harvested by shellfish biologist divers employed by the tribe.

Bouré’s grandmother died when her mom was 12 years old. “That’s a whole generation of knowledge that she lost,” she said. One way she unearths that lost knowledge is by learning tribal medicine and teaching it, and holding on to memories like watching her great-grandmother Cecelia, who wove traditional sweetgrass dolls even when she was blind.

“I think that I come from a long line of healers,” she said.

Dr. Gary Ferguson, who is Unangax̂ (Aleut), is the director of integrative medicine at the Tulalip Health Clinic about 40 miles north of Seattle. He’s certified in naturopathic medicine in Washington and Alaska.

His health center already has a variety of integrative medicine offerings, he said, including traditional ones grounded in Coast Salish traditions of the Pacific Northwest. He said he hopes the waivers and continued support for Indigenous ways of healing will help tribes address health disparities.

“These ceremonies and ways are part of that deeper healing,” he said.

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

---

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Churchill Ndonwie, Miami Herald

Lawyers for the federal government say the government shutdown prevents them from working and are requesting that an appellate court pause a lawsuit over the controversial detention center in the Florida Everglades, the so-called Alligator Alcatraz.

In a filing Friday, Department of Justice lawyers asked the Atlanta-based 11th Circuit Court of Appeals to pause proceedings in the appeal filed by the administration of Gov. Ron DeSantis to overturn a lower-court decision siding with environmental groups who said the government had circumvented federal environmental regulations when building the makeshift facility.

“Absent an appropriation, Department of Justice attorneys are prohibited from working, even on a voluntary basis, except in very limited circumstances, including “emergencies involving the safety of human life or the protection of property,” the federal government lawyers stated.

The environmental groups disagreed with the request. They argued that if the appeals case is paused, the site’s operations and construction — which were allowed to continue after the appellate court overturned the lower court’s injunction — could cause more harm to the surrounding Everglades wetlands during the shutdown, the length of which is unknown.

“The balance of harms favors denying an indefinite stay in this case, which would cause Plaintiffs ongoing and irreversible harm,” the lawyers for the environmental group said. Any further construction and operation of the facility “imperils sensitive wetlands, endangered Species, and communities in the area,” they added.

The federal government shutdown has now added another obstacle to one of the multiple lawsuits challenging the legality of the tent detention facility built on the airstrip of the Dade-Collier Training and Transition Airport.

Environmental groups and the Miccosukee Tribe sued this summer, accusing the federal and state governments of failing to adhere to the National Environmental Policy Act, which requires a federal environmental impact assessment for large federal projects. A lower district judge agreed with the environmental groups and ordered the site effectively shut down within 60 days.

The state and federal governments argued that NEPA does not apply to the state, and the appellate court agreed with them, suspending the lower court’s decision pending arguments on the merits of the appeal and wresting the case from District Judge Kathleen Williams until the appeal is resolved.

The appellate court expedited the case, and the state’s opening brief was due to be filed on Oct. 24, with oral arguments scheduled for January.

The federal government lawyers told the court in their Friday filing that they would resume “as soon as Congress has appropriated funds for the Department.”

Lawyers for the environmental groups said, “It is indeed regrettable that the lapse in appropriations has disrupted the Department of Justice,” but maintained that there was an urgency to address the “irreversible harms” to the environment, given the ongoing construction at the facility.

On Tuesday, the environmental groups filed a related lawsuit against the Florida Division of Emergency Management for failing to disclose records regarding its agreements with the federal government to receive reimbursement from the Federal Emergency Management Agency for expenses related to Alligator Alcatraz.

On Sept. 30, FEMA approved the DeSantis administration’s $608 million grant request to cover the cost of operations at Alligator Alcatraz and other immigration detention facilities, including Deportation Depot.

The transfer of funds between the federal government and the state was a key point in the appeal judges’ decision to support the government’s claim that NEPA does not apply to states.

“When the Court of Appeals issued its order pausing the trial court’s order halting operations at the detention center, the Court of Appeals said more than once that the Florida Department of Emergency Management had not applied for federal funding,” Paul Schwiep of Coffey Burlington, the lawyer for the environmental groups, said in a statement.

“We now know this was wrong.”

©2025 Miami Herald. Visit miamiherald.com. Distributed by Tribune Content Agency, LLC.

By Rae Ellen Bichell, KFF Health News

Stacey Knoll thought the court summons she received was a scam. She didn’t remember getting any medical bills from Montrose Regional Health, a nonprofit hospital, after a 2020 emergency room visit.

So she was shocked when, three years after the trip to the hospital, her employer received court orders requiring it to start funneling a chunk of her paychecks to a debt collector for an unpaid $881 medical bill — which had grown to $1,155.26 from interest and court fees.

The timing was terrible. After leaving a bad marriage and staying in a shelter, she had just gotten full custody of her three children, steady housing in Montrose, Colorado, and a job at a gas station.

“And that’s when I got that garnishment from the court,” she said. “It was really scary. I’d never been on my own or raised kids on my own.”

KFF Health News reviewed 1,200 Colorado cases in which judges, over a two-year period from Feb. 1, 2022, through Feb. 1, 2024, gave permission to garnish wages over unpaid bills. At least 30% of the cases stemmed from medical care — even when patients’ bills should have been covered by Medicaid, the public insurance program for those with low incomes or disabilities. That 30% is likely an underestimate since medical debt is often hidden behind other types of debt, such as from credit cards or payday loans. But even that minimum would translate to roughly 14,000 cases a year in Colorado in which courts approved taking people’s wages because of unpaid medical bills.

Among the other findings:

• Patients were pursued for medical bills ranging from under $30 to over $30,000, with most of the bills amounting to less than $2,400. As the cases rolled through the legal system, accumulating interest and court fees, the amount that patients owed often grew by 25%. In one case, it snowballed by more than 400%.
• Cases trailed people for up to 14 years after they received medical care, with debt collectors reviving their cases even as they moved from job to job.
• Medical providers of all stripes are behind these bills — big health care chains, small rural hospitals, physician groups, public ambulance services, and more. In several cases, hospitals won permission to take the pay of their own employees who had unpaid bills from treatment at the facilities.

Colorado has company. It is one of 45 states that allow wage garnishment for unpaid medical bills. Only Delaware, New York, North Carolina, Pennsylvania, and Texas have banned wage garnishment for medical debt.

As KFF Health News has reported, medical debt is devastating for millions of people across the country. And now the problem is likely to grow more pressing nationwide. Millions of Americans are expected to lose health insurance in the coming years due to Medicaid changes in President Donald Trump’s tax and spending law and if Congress allows some Affordable Care Act subsidies to expire. That means health crises for the newly uninsured could lead them, too, into a spiral of medical debt.

And the hurt will linger: Large unpaid medical bills are staying on credit reports in most states after a July decision from a federal judge reversed a new rule aimed at protecting consumers.

“If you can’t maintain your health, how are you going to work to pay back a debt?” said Adam Fox, deputy director of the Colorado Consumer Health Initiative, a nonprofit aimed at lowering health costs. “And if you fundamentally can’t pay the bill, wage garnishment isn’t going to help you do that. It’s going to put you in more financial distress.”

Flying blind on medical debt

When someone fails to pay a bill, the creditor that provided the service — whether for a garage door repair, a car loan, or medical care — can take the debtor to court. Creditors can also pass the debt to a debt collector or debt buyer, who can do the same.

“At any given point, about 1% of working adults are being garnished for some reason,” said Anthony DeFusco, an economist at the University of Wisconsin-Madison, who studied paycheck data from ADP, a payroll processor that distributes paychecks to about a fifth of private sector U.S. workers. “That’s a big chunk of the population.”

But specific research into the practice of garnishing wages over medical debt is scant. Studies in North Carolina, Virginia, and New York have found that nonprofit hospitals commonly garnish wages from indebted patients, with some studies finding those patients tend to work in low-wage occupations.

Marty Makary, who led research on medical debt wage garnishment in Virginia at Johns Hopkins University before joining Trump’s cabinet as Food and Drug Administration commissioner, has called the practice “aggressive.” He co-authored a study that found 36% of Virginia hospitals, mostly nonprofit and mostly in urban areas, were using garnishment to collect unpaid debts in 2017, affecting thousands of patients.

The Colorado findings from KFF Health News show that hospitals are far from the only medical providers going after patients’ paychecks, though.

Researchers and advocates say that, in addition to a dearth of court case data, another phenomenon tends to obscure how often this happens. “People find debt shameful,” said Lester Bird, a senior manager at the Pew Charitable Trusts who specializes in courts. “A lot of this exists in the shadows.”

Without data on how often this tactic is employed, lawmakers are flying blind — even as a 2024 Associated Press-NORC poll showed about 4 in 5 U.S. adults believe it’s important for the federal government to provide medical debt relief.

‘Blood from a turnip’

Colorado was among the first of 15 states to scratch medical debt from credit reports. Debt buyers in the state aren’t allowed to foreclose on a patient’s home. If qualified patients opt to pay in monthly installments, those payments shouldn’t exceed 6% of their household income — and the remaining debt gets wiped after about three years of paying.

But if they don’t agree to a payment plan, Coloradans can have up to 20% of their disposable earnings garnished. The National Consumer Law Center gave the state a “D” grade for state protections of family finances.

Consumer advocates said they aren’t sure how well even those Colorado requirements are being followed. And people wrote letters to the courts saying wage garnishment would exacerbate their already dire financial situations.

“I have begun to fall behind on my electricity, my gas, my water my credit cards,” wrote a man in western Colorado in a letter to a judge that KFF Health News obtained in the court filings. Court records show he was working in construction and at a rent-to-own store, with about $8,000 in medical debt. He wrote to the judge that he was paying close to $1,000 a month. “The way things are going now I will lose everything.”

The people being sued in KFF Health News’ Colorado review worked in a wide array of jobs. They worked in school districts, ranching, mining, construction, local government, even health care. Several worked at stores such as Walmart and Family Dollar, or at gas stations, restaurants, or grocery stores.

“You’re really kicking people when they’re down,” said Lois Lupica, a former attorney working with the Denver-based Community Economic Defense Project and the Debt Collection Lab at Princeton. “They’re basically suing the you-can’t-get-blood-from-a-turnip population.”

In 2022, court records show, Valley View health system based in Glenwood Springs was allowed to garnish the wages of one of its patients over a $400 medical bill. The patient was working at a local organization that the health system supported as part of the community benefits it provides to keep its tax-exempt status. Nonprofit hospitals like Valley View are required to provide community benefits, which can also include charity care that covers patients’ bills.

Stacey Gavrell, the health system’s chief community relations officer, said it offers options such as interest-free payment plans and care at reduced or no cost to families with incomes up to 500% of the federal poverty level.

“As our rural region’s largest healthcare provider, it is imperative to the health and well-being of our community that Valley View remains a financially viable organization,” she said. “Most of our patients work with us to develop a payment plan or pursue financial assistance.”

The collection agency that took the employee to court, A-1 Collection Agency, advertises itself on its website as empathetic: “We understand times are tough and money is tight.”

Pilar Mank, who oversees operations at A-1’s parent company, Healthcare Management, said it accepts payment plans as small as $50 a month and that most of the hospitals it works with allow it to offer a discount if patients pay all at once.

“Suing a patient is the absolute last resort,” she said. “We try everything we can to work with the patient.”

If you can’t maintain your health, how are you going to work to pay back a debt?

Hospitals sometimes also garnish wages from their own employees for care they provided them. In one case, a hospital employee worked her way up from housekeeper to registrar to quality analyst. She even participated in public events representing her employer and appeared on the hospital’s website as a featured employee — while the court issued writs of garnishment until her $10,000 in medical bills from the hospital was paid off.

“Hospital care costs money to deliver,” said Colorado Hospital Association spokesperson Julie Lonborg about hospitals’ garnishing their own employees’ wages. “In some ways, I think it’s funny to be asked the question. I would understand if someone said, ‘Why aren’t you garnishing their wages?’”

Studies show that hospital debt collection efforts through wage garnishment bring in only about 0.2% of hospital revenues, said April Kuehnhoff, a senior attorney with the National Consumer Law Center, which advocates for people with low incomes.

“We also know that there are states that don’t allow this at all,” she said. “Hospitals are continuing to provide medical care to consumers.”

Smooth sailing for collectors —but not for patients

Health care providers appeared as the plaintiffs in only 2% of the medical debt cases. Instead, cases were filed almost entirely by third-party debt collectors and buyers, with BC Services and Professional Finance Company behind more than half of the cases, followed by A-1 Collection Agency and Wakefield & Associates.

Debt buyers make money by buying debt from providers who’ve given up on getting paid then collecting what they can of the money owed, plus interest. Debt collectors get paid a percentage of what they recover. Some companies do a bit of both.

BC Services declined to comment, and Wakefield & Associates did not respond to questions.

Charlie Shoop, president of Professional Finance Company, said his company initiates wage garnishment on less than 1% of all accounts placed with it for collection.

Health care providers in Colorado can no longer hide behind debt collectors’ names when they sue people, according to a 2024 state law prompted by a 9News-Colorado Sun investigation in partnership with a Colorado News Collaborative-KFF Health News reporting project.

In many states, the path for filing a case against a debtor and garnishing their wages is relatively smooth — especially if the debtor doesn’t appear in court.

“It’s unbelievably easy,” said Dan Vedra, a lawyer in Colorado who often represents consumers in debt cases. “If you have a word processor and a spreadsheet, you can mass-produce thousands of lawsuits in a matter of hours or minutes.”

Within KFF Health News’ sample, nearly all the medical debt cases were default judgments, meaning the patient did not defend themselves in court or in writing. Missing a court date can happen for a variety of reasons, such as not receiving the notice in the mail, assuming it was a scam, knowingly ignoring it, or not having the time to take off from work.

Vedra and other debt law experts said a high rate of default judgments indicates a system that favors the pursuers over the pursued — and increases the chances someone will be harmed by an erroneous bill.

But in New Hampshire, creditors now have to keep going to court for each paycheck they want to garnish, because the state allows creditors to garnish only wages that have already been earned, said Maanasa Kona, an associate research professor at the Center on Health Insurance Reforms at Georgetown University.

“It might not look like much on paper,” she said. “It’s just not worth it if they have to keep going back to court.”

If you have a word processor and a spreadsheet, you can mass-produce thousands of lawsuits in a matter of hours or minutes.

Wrongly pursued for bills

The nation’s medical billing setup is already prone to errors due to its complexity, according to Barak Richman, a law professor at George Washington University and a senior scholar at Stanford Medicine who has studied medical debt collection practices in several states. “Bills are not only noncomprehensible, but often wrong,” Richman said.

Indeed, Colorado’s Health Care Policy & Financing Department, which runs Medicaid in the state, said it sent out nearly 11,000 letters in the past fiscal year to health providers and collectors that erroneously went after patients on Medicaid. Bills for Medicaid recipients are supposed to be sent to Medicaid, not the patients, who typically pay a nominal amount, if anything, for their care.

Shoop said his industry has pushed Colorado, without success, for access to a database that would allow them to confirm if patients had Medicaid coverage.

Colorado’s Medicaid program declined to comment.

Patricia DeHerrera in Rifle, Colorado, had to prove that she and her children had Medicaid when they received care at Grand River Health — but only after A-1 contacted her employer at the time, the gas station chain Kum & Go, with court-approved paperwork to take a portion of her paychecks.

She contacted the state, which sent letters to the hospital and the collector notifying them they were engaging in “illegal billing action” and telling the collector to stop. The companies did.

Theresa Wagenman, controller for Grand River Health, said if a patient can present a letter from a Medicaid caseworker saying they’re eligible, then their bills get removed from the collections pipeline. Wagenman also said patients get at least eight letters in the mail and several phone calls before Grand River gives the go-ahead for the collector to send them to court.

DeHerrera’s main advice to others in this situation: “Know your rights. Otherwise, they’re going to take advantage of you.”

Yet fighting back isn’t easy.

Nicole Silva, who lives in the 900-person town of Sanford in south-central Colorado, said she and her family were all on Medicaid when her daughter was in a car crash. Still, court records show, her wages were garnished for a $2,181.60 ambulance ride, which grew to more than $3,000 from court fees and interest.

She tried to prove the bill was wrong, contacting her county’s social services office, but Silva said it wasn’t helpful and she wasn’t able to reach the right person at a state office. The state Medicaid program confirmed to KFF Health News that her daughter was covered at the time of the wreck.

Fighting the bill felt like too much for Silva and her husband to handle while parenting a growing number of kids, one of them severely disabled, and working — she as a preschool teacher and he as a rancher.

Not receiving the roughly $500 a month that she said came out of her pay was enough to affect their ability to pay other bills. “It was deciding to buy groceries or pay the electric bill,” Silva said.

When their electricity got shut off, she said, they had to scramble to borrow money from colleagues and friends to get it turned back on — with an extra fee.

She said the saga makes her hesitant to call an ambulance in the future.

Fox, of the Colorado Consumer Health Initiative, said consumers often think they cannot do anything to stop their wages from being garnished, but they can contest it in court, for example by pointing out they should have qualified for discounted — or charity — care if the hospital that provided the treatment is a nonprofit.

DeFusco, the economist, believes filing for Chapter 7 bankruptcy is an underused option for debtors. It halts garnishment in its tracks, though not always permanently, and it comes with other consequences. But he understands it’s a Catch-22: It’s a complex process and typically necessitates hiring a lawyer.

“To get rid of your debt, you need money,” he said. “And the whole reason you’re in this situation is because you don’t have money.”

Methodology

We wanted to know how often Coloradans get their wages garnished due to medical debt. Courts don’t compile this information, and researchers and advocates haven’t tracked it systematically.

So we created our own database. We requested a list of all civil cases across the state in which judges gave permission for a person’s earnings to be garnished — known as writs of garnishment in court lingo — from Feb. 1, 2022, through Feb. 1, 2024. The Colorado Supreme Court Library provided a list from all courts except for Denver County Court, which provided its own records. The combined list comprised nearly 90,000 unique court cases. We split up the cases by county population — small (fewer than 10,000 people), medium (10,000 to 100,000 people), and large (more than 100,000 people) — then generated a random sample of 400 cases from each group to ensure we evaluated medical debt across counties of all sizes.

To identify medical debt cases, we looked at the original creditors named in court records, primarily the complaints or affidavits of indebtedness. Often, this information was available through a state website. When it wasn’t available online, we asked county courthouses to send us supporting documents. We counted dentists as medical providers. We excluded 14 cases in which the debt wasn’t exclusively medical.

We looked only at cases in which courts approved money to be garnished from someone’s paycheck, as opposed to from other sources such as their bank accounts. We did not review garnishment cases involving child support, taxes, or federal student loans.

KFF Health News intern Henry Larweh, data editor Holly K. Hacker, Mountain States editor Matt Volz, and web editor Lydia Zuraw contributed to this report.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Gregory Korte, Bloomberg News

WASHINGTON — The White House still employs 45 staffers for Elon Musk’s Department of Government Efficiency despite the Tesla Inc. CEO’s departure in May — and they’re exempt from being furloughed during the government shutdown.

The arrangement was revealed in a memo released Thursday from the White House Office of Administration detailing the staffing plan while funding from Congress remains in limbo.

The White House shutdown plan also highlights a pattern of shifting definitions of essential and non-essential workers under President Donald Trump, who has furloughed 514 fewer White House staffers than he did during the last government shutdown under his watch in 2018.

Under the earlier plan, which former President Joe Biden also adopted but never had to implement, about 61% of staff in the Executive Office of the President were temporarily laid off. The current plan furloughs only 32% of the staff.

Despite keeping more of the White House staff on-the-job during the shutdown, Trump has said he is looking to lay off federal workers, instead of just furloughing them. The White House has said the cuts could number in the “thousands.”

Among the offices fully open despite the shutdown is DOGE, the government cost-cutting operation once led by Musk before he and Trump had a falling out over the president’s support of a deficit-expanding tax cut bill.

After Musk’s departure in May, the White House said DOGE had been decentralized, and that its teams throughout the government would report to their presidentially appointed agency heads. But the shutdown plan reveals that 45 DOGE staffers still work in the US DOGE Service, a component within the Executive Office of the President.

The memo from Joshua Fisher, the director of the White House Office of Administration, did not explain why the DOGE staffers were exempt from furloughs. But DOGE’s predecessor office, the US Digital Service, was able to function through previous shutdowns because it had a separate source of funding from fees it charged other government agencies for its work.

Other parts of the White House are also seeing fewer furloughs this time. The Office of Management and Budget keeps 437 employees on duty, compared with 161 under the 2018 plan. The tax cut law — dubbed the One Big Beautiful Bill — provided $100 million in long-term funding for the budget office.

The White House Office itself — the president’s immediate staff — holds on to 175 aides, slightly more than the 156 in the last shutdown. And Trump has almost doubled the number of retained workers in the executive residence to 40.

At the same time, Trump officials have signaled they will use the lapse in funding to pare back or shutter programs they oppose — especially in states that voted for his opponent last year. And the White House has threatened to permanently fire thousands of federal employees in the coming days, citing the lack of congressional funding.

The White House press office did not respond to a request for comment on the shutdown plan, but instead sent an automated out-of-office reply echoing the administration’s political talking points.

“Due to staff shortages resulting from the Democrat Shutdown, the typical 24/7 monitoring of this press inbox may experience delays,” the message said. “Thank you for your attention to this matter.”

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By Cerys Davies, Los Angeles Times

On Monday, YouTube became the latest media and tech company to settle one of President Donald Trump’s lawsuits.

The Google-owned streamer agreed to pay $24.5 million to settle a lawsuit Trump filed after his account was banned following the Jan. 6, 2021, riots at the U.S. Capitol. That brings Trump’s haul from media and tech companies to more than $90 million in the last year.

Some of these suits deal with conflicts the president has experienced with news networks such as ABC and CBS. Others confront the fallout from the attack on the U.S. Capitol.

Some of the settlement money will pay for renovations to a presidential library Trump is building on 2.6 acres of waterfront property in Miami. Other funds will go to the nonprofit Trust for the National Mall, with the intention of building a Mar-a-Lago-style ballroom, which is expected to cost $200 million overall.

Here’s a rundown of the payouts:

YouTube: $24.5 million

After the Jan. 6 attack on the U.S. Capitol, YouTube suspended the president’s account on the platform because of Trump’s alleged role in the insurrection. At the time, the company had cited “concerns about the ongoing potential for violence” and violation of its “policies for inciting violence.”

Trump’s lawsuit, filed in 2021 at the U.S. District Court in Northern California, argued the account’s suspension was “censorship.” Before the case was settled, YouTube had already lifted its suspension on Trump in March 2023, in light of the then-upcoming presidential race.

In court documents filed Monday, Alphabet, the parent company of YouTube and Google, did not admit any wrongdoing in the matter. The company did not agree to make any policy or product changes in the deal.

Of the $24.5 million, $22 million is going to Trump, who will contribute the money to the Trust for the National Mall, which is “dedicated to restoring, preserving, and elevating the National Mall” as well as supporting the construction of the White House State Ballroom, according to the filing.

Alphabet will also have to pay an additional $2.5 million to other plaintiffs in the case, including the American Conservative Union and writer Naomi Wolf.

Meta and Twitter (X): $35 million

Social media platforms Facebook (now Meta) and Twitter (now X) had suspended Trump’s accounts over Jan. 6, 2021. At the time, Twitter put out a statement, saying that recent tweets from his “account and the context around them — specifically how they are being received and interpreted on and off Twitter” had to be suspended to avoid “the risk of further incitement of violence.”

Mark Zuckerberg of Meta also posted a statement on Facebook after banning Trump’s Meta accounts. He wrote, “We believe the risks of allowing the President to continue to use our service during this period are simply too great.”

In July of that year, Trump sued the companies for “censorship.”

By January 2023, Meta had reinstated Trump’s Facebook and Instagram accounts, as had X in 2022.

Shortly before Trump was going to take office for his second term, in January 2025, Meta decided to pay the incoming president $25 million to settle the lawsuit. Elon Musk, who had purchased Twitter and renamed it “X” in the interim, agreed to pay $10 million to settle its Trump case.

Paramount Global: $16 million

Paramount Global agreed to pay $16 million to resolve Trump’s legal salvo against “60 Minutes” over the editing of an interview with his 2024 opponent, then-Vice President Kamala Harris.

Trump claimed “60 Minutes” edited an interview with Harris to make her look better and bolster her chances in the election. CBS denied the claims, saying the edits were standard and the case was viewed as frivolous by 1st Amendment experts.

Trump wrote on Truth Social that CBS “did everything possible to illegally elect Kamala, including completely and corruptly changing major answers to Interview questions, but it just didn’t work for them.”

Last May, CBS offered $16 million to settle the civil suit filed in Texas. The lump sum included the president’s legal fees and an agreement that “60 Minutes” will release transcripts of interviews with future presidential candidates.

Less than a month after the settlement, the FCC approved Skydance Media’s acquisition of Paramount, which owns CBS.

Disney: $16 million

Earlier this year, ABC news anchor George Stephanopoulos appeared on the network’s “This Week” news program and asserted that Trump was found liable for raping writer E. Jean Carroll. In May 2023, a jury in New York declined to find Trump liable for rape, but did find him liable for sexual abuse of Carroll.

Trump responded to the on-air comments with a defamation lawsuit filed in federal court in Florida. The lawsuit was settled by ABC News, owned by Disney, last December. Disney agreed to pay $15 million toward Trump’s presidential library and $1 million of Trump’s legal fees.

The settlement also included an editor’s note, posted on the ABC News website, expressing regret for Stephanopoulos’ comments.

(Los Angeles Times staff writer Stephen Battaglio contributed to this report.)

©2025 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

By Jackie Fortiér, KFF Health News

The Trump administration is continuing its push to revise federal guidelines to delay the hepatitis B vaccine newborn dose for most children. This comes despite a failed attempt to do so at the most recent meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Both President Donald Trump and some newly appointed ACIP members have mischaracterized how the liver disease spreads, according to medical experts, including those working at the CDC. The ACIP panel’s recommendations can determine insurance coverage for immunizations.

At a White House press conference on Sept. 22, Trump, in advocating for delaying the newborn vaccine dose, falsely claimed that hepatitis B is solely a sexually transmitted infection.

“Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. So I would say wait till the baby is 12 years old and formed and take hepatitis B,” Trump said.

Hepatitis B is a highly infectious virus that attacks the liver and is transmitted through contact with infected bodily fluids, including blood. It can also be passed from mother to baby.

A reporter asked if Trump had spoken with Health and Human Services Secretary Robert F. Kennedy Jr., who oversees the CDC, about making the change, and Trump said he had, as Kennedy looked on.

Although hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, health experts, including career CDC scientists, note that the virus can be transmitted in ordinary situations too, including among young children.

At the latest ACIP meeting, held Sept. 18 and 19, members debated postponing the hepatitis B newborn dose until 1 month of age.

CDC scientist Adam Langer outlined research showing incidences of unvaccinated children born in the U.S. to mothers who tested negative, later becoming infected with hepatitis B. Langer serves as acting principal deputy director for the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention.

Langer told the vaccine advisory panel that the virus can survive for over seven days outside the body on surfaces. During that time, contact with even microscopic traces of infected blood on a school desk or on playground or sporting equipment is enough for a child to be infected. This means unvaccinated children not considered at high risk can still be exposed in everyday environments, or by an infected caregiver.

“We do have data that says that it can happen and that it is likely to happen,” he said. Though the exact cause of infection may not be clear in documented cases of children of hepatitis B-negative mothers becoming infected, “I can tell you that it didn’t come from the mother and it didn’t come from injection drug use and it didn’t come from sexual contact, so that means that it had to have been some kind of casual contact,” Langer said.

Yet during the debate, some members gave little credence to the risk of transmission to children through household contact.

“This is a very, very important vaccine that should be given to the high-risk populations,” said ACIP voting member Retsef Levi, a professor of operations management at the MIT Sloan School of Management. “The high-risk populations seem to be babies born to hep B-positive mothers, drug addicts, and other populations at high risk,” he said, despite Langer’s presentation highlighting other avenues of possible transmission.

Contrary to research that was presented, Levi later said the risk of not vaccinating children of hepatitis B-negative mothers was “probably close to zero” in the first few years of life.

The CDC estimates 2.4 million people in the U.S. have hepatitis B and half do not know they are infected. The disease can range from an acute, mild infection to a chronic infection, often with few to no symptoms. The disease has no cure and, if left untreated, can lead to serious conditions like cirrhosis, liver failure, and liver cancer later in life.

During debate on the vote to delay the newborn dose, ACIP member Joseph Hibbeln said that the proposed one-month gap would leave some children vulnerable to the virus, even if their mothers test negative for hepatitis B.

“This assumes implicitly that all the infections are coming from moms,” Hibbeln said. “You can’t decide on that simply by the mother’s status. You would have to look at the entire household’s status.”

ACIP member Evelyn Griffin, an obstetrician and gynecologist, asserted that doctors could ascertain an entire household’s hepatitis B status by asking the mother.

“How are they going to know?” Hibbeln said. “If 50% of people don’t know that they are hepatitis B-positive, you can ask all you want, and nobody knows.”

The committee members, all handpicked by Kennedy, ultimately decided to table the vote on whether to delay the newborn dose after Hibbeln brought up inconsistencies in the wording of the text of the resolution.

“The notion that hepatitis B is only confined to transmission for prostitutes, drug users, etc. is such an ignorant and uninformed way of approaching infectious disease,” internist Jason Goldman, the president of the American College of Physicians and its liaison to ACIP, said when reached after the meeting.

“The virus does not care what your behavior or lifestyle is. The virus goes from person to person through bodily fluids,” Goldman said. It can be transmitted when an unvaccinated person touches infected bodily fluids on common surfaces and then accidentally touches the eyes or mouth. “What if someone was in a car accident and got exposed to blood?”

“It is not only mother-to-fetus transmission, it is not only certain risk groups,” he said. “This is why it’s universal; everyone should get this for their protection, and it is unfortunate that it is being politicized into a sexually transmitted disease and that’s it. That’s not an appropriate way to evaluate science.”

Pediatric vaccination recommendations are widely credited with nearly eliminating the virus in American-born children.

Babies infected at birth have a 90% chance of developing chronic hepatitis B, and a quarter of those children go on to have severe complications, like liver cancer, or to die from the disease.

In 1991, federal health officials determined newborns should receive their first dose of a hepatitis B vaccine within 24 hours of birth, which can block the virus from taking hold if transmitted during delivery. From 1990 to 2022, case rates of hepatitis B declined by more than 99%. While parents may opt out of the shots, many day care centers and school districts require proof of hepatitis B vaccination for enrollment.

The next meeting of the ACIP is scheduled to begin Oct. 22. Agendas are usually posted weeks in advance, but so far, no information on the substance of the upcoming meeting has appeared on the CDC’s website. The agenda for the September meeting was posted less than a week before the meeting’s start.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Erik Wasson, Bloomberg News

President Donald Trump and top congressional leaders have strong political incentives to stoke the ongoing stalemate during a White House meeting Monday even as they drive the U.S. to its first government shutdown in nearly seven years.

Democrats are keen to use the shutdown battle to frame the next election around rising costs, particularly for health care. Republicans are equally eager to blame the Democrats and show them to be poor stewards of the government and the U.S. economy ahead of the 2026 midterms.

Progressive Democrats are putting party leaders under enormous pressure to show they are willing to fight the Trump administration. Those leaders are confident they can unite their caucus behind the health care issue and prevent a defection by the eight Democrats needed to pass the Republican bill, which would keep the government funded until Nov. 21.

GOP leaders say they can negotiate after the short-term bill is passed, but Democrats have said they don’t trust Trump or the Republican leaders to keep that promise. White House Press Secretary Karoline Leavitt told Fox News Monday that Trump has leverage in the fight because the public dislikes government shutdowns.

“There is zero good reason for Democrats to vote against this clean continuing resolution,” Leavitt said. “The president is giving Democrats one last chance to be reasonable today. Look, there is nothing to negotiate when you have a clean CR look.”

Democrats want to spend $350 billion to permanently extend Obamacare tax credits to middle-class families, to avoid a premium spike on Jan. 1. They also want the bill to repeal Medicaid cuts in the giant Trump tax bill, including new work requirements and a crackdown on an accounting gimmick that has allowed states to increase their Medicaid reimbursement rates. They also want to reverse cuts to medical research and block the White House from rescinding previously enacted appropriations.

“Our position has been very clear: cancel the cuts, lower the cost, save health care so we can address the issues that really matter to the American people in an environment where the cost of living is too high,” House Minority Leader Hakeem Jeffries said Sunday on ABC’s This Week.

Trump has tied Democrats’ demands to the hot-button issue of migration, accusing them of seeking to funnel $1 trillion in taxpayer funds for undocumented immigrants.

That claim is wildly exaggerated, but based lon an aspect of the Democratic proposal, which would effectively increase federal Medicaid reimbursements to states that pay for emergency care for undocumented migrants.

The non-partisan Congressional Budget Office estimates the current restriction saves $28 billion over 10 years. They also want to repeal a separate provision that clarifies parolees and asylum seekers with temporary permission to remain the U.S. can’t receive Obamacare subsidies would save $119 billion over 10 years.

Trump gave no indication Sunday that the meeting would offer an easy resolution.

“I just don’t know how we are going to solve this issue,” Trump said in a phone interview with CBS News. He continued his criticism of Democrats’ negotiation posture, saying “they’re not interested in fraud, waste and abuse,” which is the only thing Republicans claim they are cutting from the budget.

The Trump administration has also threatened Democrats with mass firings of federal workers in the wake of any shutdown, supercharging a downsizing overseen by White House budget Director Russ Vought.

Instead of merely furloughing non-essential workers, as is usual during a shutdown, the administration is preparing to permanently end a number of jobs likely in the areas of the environment, agriculture and labor regulation.

Senate Minority Leader Chuck Schumer on Sunday dismissed the threat as something Trump was going to do anyway. October layoffs were already in the works and the shutdown could allow the White House to blame Democrats for any economic fallout from the layoffs, while satisfying small-government conservatives in the party base.

Leavitt on Monday said that there won’t be any layoffs if the government remains open.

Democrats such as Senator Amy Klobuchar told reporters last week that the party is not demanding its entire proposal in exchange for voting for a GOP bill to keep the lights on through Nov. 21. The talks Monday signal the pressure on the White House to at least meet with Democrats worked.

“We never said that we need to have every single thing and that every single thing’s a red line. We want to negotiate with them to make this health care crisis less bad,” Klobuchar, the No. 3 Senate Democrat, said Friday.

She and other senators said this weekend that a mere promise from the GOP to talk later won’t suffice.

But that is precisely what Senate Majority Leader John Thune is suggesting.

“We can have that conversation. But before we do, release the hostage. Set the American people free. Keep the government open, and then let’s have a conversation about those premium tax credits,” Thune said on NBC’s Meet the Press. He said any possible deal on Obamacare subsidies isn’t ready.

Republicans are divided on the Obamacare issue. Twelve swing-district House Republicans have signed onto a bill to extend them by a year, while Alaska Senator Lisa Murkowski is spearheading an effort to extend them by two years. Other moderates say they want to phase in an income limit to prevent high earners from claiming the benefit and introduce greater fraud controls.

Conservatives are standing firm, arguing that the COVID pandemic-era subsidies were meant to be temporary. Some argue that any deal on the premiums would have to include new restrictions preventing Obamacare plans from covering abortion and transgender-related procedures.

House Speaker Mike Johnson said Sunday on CNN’s State of the Union that the meeting on Monday will be an opportunity for Trump to tell Democrats to drop their demands.

“Think of it, troops won’t be paid because Chuck Schumer needs political cover. I mean, it’s really that simple and I think everybody is going to see that clearly,” Johnson said. “The president wants to talk with him about that and say, ‘Don’t do that.’”

Schumer said he expects a substantive meeting.

“We’ll see on Monday — are they serious about negotiating with us,” he said.

With assistance from Lauren Dezenski and Josh Wingrove.

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By Craig Mauger

MediaNews Group

U.S. Rep. John James, a GOP candidate to be Michigan’s next governor, told a group Monday that he “was screwed” in his 2020 U.S. Senate race and suggested he’ll pursue “consequences” for those who had wronged Republicans five years ago.

The comments, made at a meet-and-greet gathering in Kent County that was not open to reporters, provided new insight into how James of Shelby Township views lingering but unproven claims of widespread election fraud in the battleground state he’s seeking to lead.

During the event inside the Kent County GOP office, an attendee asked James about the voting system in Michigan being “totally corrupt” and Republican state senators investigating the 2020 vote but finding no evidence of systematic fraud.

“How about this: Get you a governor who was screwed in 2020 and you’ll get consequences for those who did you wrong,” James replied, according to an audio recording of the discussion obtained by The Detroit News.

The remarks clashed with the fact that James publicly conceded his loss to Democratic U.S. Sen. Gary Peters of Bloomfield Township three weeks after the 2020 election and won a closer contest in 2022 for the U.S. House.

In 2020, Peters beat James by 1.7 percentage points statewide, 49.9%-48.2%, or by more than 92,000 votes. In 2022, James defeated Democrat Carl Marlinga for the 10th District U.S. House seat by less than 1 percentage point, 48.8%-48.3%, or 1,600 votes.

In a Wednesday interview, Secretary of State Jocelyn Benson, a Democratic candidate for governor and Michigan’s top election official, labeled the comments by James “disqualifying for anyone who seeks to lead the state.”

“The 2020 election was safe, secure,” Benson said. “It is the most audited election in Michigan history, with over 250 audits all reaffirming the election results, which is that James lost, (Republican President Donald) Trump lost. And it’s high time that all leaders in the state abandon conspiracy theories about the election.”

The bipartisan Board of State Canvassers certified the 2020 election results in a 3-0 vote in which Republican canvasser Aaron Van Langevelde joined the two Democratic canvassers in approving the results, while Republican canvasser Norm Shinkle abstained.

The James campaign didn’t directly respond to a series of questions from The News about his speech in Kent County. Instead, James posted on X that Benson “illegally altered election rules at the eleventh hour.”

“As governor, I will rigorously investigate and expose past government overreach and partisan abuses in Lansing,” James added. “My administration will restore integrity, implement robust election oversight, rebuild public trust and promote transparent, impartial governance to protect the rights of every Michigander.”

Over the last five years, President Donald Trump has maintained that there was “massive fraud” in Michigan’s 2020 election, but he hasn’t provided evidence to prove his claims. The comments by James this week appeared to be his most direct, alleging there was wrongdoing in the vote five years ago.

In 2020, Trump lost the state to Democrat Joe Biden by 3 percentage points, 48%-51%, or about 154,000 votes. The Republican president’s advisers sought to overturn the result, and Trump himself pressured two Republican members of the Wayne County Board of Canvassers not to sign the certification.

Because James’ loss to Peters was tighter than Trump’s defeat, it was significant that James conceded to Peters on Nov. 24, as Trump continued to contest the election in Michigan.

“It’s too late for me,” James said on Nov. 24, 2020. “While I look forward to participating in efforts to secure both reasonable franchise and integrity in our election in the near future, today is the right time for me to congratulate Sen. Gary Peters.”

A lawyer for the James campaign had previously told the Wayne County Board of Canvassers he had “very serious concerns” about the way the election was administered in Democratic-dominated Wayne County. Republicans have also repeatedly criticized Benson’s decision to send absentee ballot applications to all of Michigan’s registered voters in 2020, but the courts upheld her power to do so.

During the Monday event, James said if Republicans don’t win next year’s gubernatorial election, Benson, who’s been the state’s top election official since 2019, “is going to be your governor.”

“You think she stole one election?” James then asked. “Just wait.”

Someone in the crowd could be heard responding, “Unless she’s in jail,” according to the recording reviewed by The News.

James then answered, “How’s that going to happen? Somebody who’s going to hold her accountable for their crimes, right?”

Benson said James’ remarks were “dangerous and disqualifying.”

“It’s particularly dangerous at a time when political violence is on the rise,” the Democratic secretary of state said.

Benson is in a three-candidate race for the Democratic nomination for governor against Lt. Gov. Garlin Gilchrist II of Detroit and Genesee County Sheriff Chris Swanson of Fenton.

Curtis Hertel, chairman of the Michigan Democratic Party, said James was “repeating Trump’s election denial conspiracy theories and dangerously suggesting there will be ‘consequences’ if he’s elected.”

“Michiganders have rejected James’ extremism twice before, and if he somehow makes it out of his messy primary and to the general election, James will lose statewide again,” Hertel said.

A Kent County Republican official at Monday’s event specifically asked members of the media to “depart at this time” before James began his address, according to the recording.

Among the people who remained inside the venue was Jarret Jakubowski, a member of the Kent County GOP’s executive committee. James’ comments about the 2020 election were “red meat” for party members, Jakubowski said, referring to his interpretation of them.

“The 2020 election was not the most secure and the most safe ever,” Jakubowski said.

Of the person in the crowd who suggested Benson might be sent to jail, Jakubowski said he didn’t know who made the remark. People tend to be “over-the-top” in their wishful thoughts, he added.

By Kevin Hardy, Stateline.org

NORTH CONWAY, N.H. — The conversations in French having given them away, the group of motorcyclists immediately stood out as foreigners over a Saturday breakfast in the White Mountains of New Hampshire.

In the restaurant, the server was pleased, thanking them for coming. Because these days, tariffs and White House rhetoric have left Canadians a rare breed of visitors in New England, usually a hotspot vacation destination from the nearby province of Quebec.

“There’s a lot of people staying in Canada because of that,” said Dave Gingras, a 35-year-old biker from Saguenay, about two hours north of Quebec City.

While other Canadians are avoiding buying American products or traveling to the States, the group of 11 decided to leave politics behind on their road trip through New England.

“We are just keeping it neutral and trying to enjoy,” Gingras told Stateline.

After breakfast, they donned helmets and mounted an assortment of dusty Yamaha, BMW and Triumph bikes.

“We drive and when we’re tired, we stop and raise up a tent and relax with a beer,” Gingras said before pulling into a line of crawling traffic on the White Mountain Highway, the scenic byway dotted with quaint inns, old-timey stores and Colonial and Victorian homes.

Across Northeastern states, business owners and state officials have labored to maintain key economic connections with Canada despite the rhetoric coming out of the White House. President Donald Trump’s trade war, aggressive immigration enforcement and talk of making their country the 51st state has offended many Canadians. While concerns are acute in New England, tourism hubs from Hawaii to New York are reeling from a decrease in Canadian visitors.

To quell tensions, Maine leaders erected signs in French to welcome Canadian visitors and New Hampshire’s governor just returned from a Canadian trip she took to strengthen trade and tourism.

But hospitality businesses this summer reported a sharp decline in visitors from the North — Canadian travel to New Hampshire is down about 30% this year, according to state officials. Border crossings into Vermont hit their lowest levels since 2021, according to federal data, as the Canadian government reported a 34% drop in the number of August car visits into the U.S. compared with the same month last year.

New England businesses remain concerned as the region turns the page on the summer vacation season to its vibrant autumn, known for luring leaf-peeping travelers from across the globe.

Tourism is vital for White Mountain Valley communities like North Conway. While it’s home to only about 2,300 people, the village is a historic travel hotspot known for outdoor activities, tax-free shopping and family-friendly theme parks.

While many people think of the area as a winter ski destination, summers are actually the largest travel draw, said Chris Proulx, executive director of the Mt. Washington Valley Chamber of Commerce.

The drop in Canadian tourism has been especially evident during less popular travel times for Americans. For example, Canada’s Victoria Day, a late May holiday celebrating that queen’s birthday, has traditionally brought big crowds to the Northeast.

“Our retail outlets are a very, very popular destination for them during that time,” Proulx said. “And our retail outlets have reported that it was basically nonexistent this year.”

Proulx said local businesses have tried to lure travelers from close-by regions like the Boston area to help make up for the loss of Canadian tourists, “so it’s not an unrecoverable loss.” But the absence of visitors from parts North is hard to ignore.

“It almost feels like a birder might feel if they find a rare species,” he said. “If you see someone with a Canadian license plate, you notice it right away. It gives you a little bit of a smile.”

Aside from the economic loss, Proulx said he worries about longstanding relationships.

This scenic valley is nostalgic for many visitors from the U.S. and Canada alike. He said many people return again and again, sharing fond memories of their first camping trip along the Saco River, childhood trips to the Santa’s Village amusement park and picturesque rides on the Conway Scenic Railroad.

“So we just don’t want anybody thinking that they’re not welcomed here. That’s our biggest thing,” he said. “We want everybody to be able to call this their second home, to be able to visit and reconnect and feel welcomed.”

‘Towns are quieter’

In the heart of North Conway, tourists picnic on the grass in Schouler Park, look into the 1874-era train station and meander into shops selling hokey souvenirs and homemade fudge. Framing the village is the imposing Mount Washington, which at 6,288 feet boasts the tallest peak in the Northeast.

At one of the town’s busiest intersections, the crowds come in waves to the North Conway 5&10 Store. But even as families line up, employee Polly Howe said she hadn’t seen many Canadians this summer.

“It’s a shame,” she said, bouncing between the cash register, the candy counter and stocking staples like toys and hats.

In a building listed on the National Register of Historic Places, the souvenir shop has been around for 86 years and features a false-front facade, the kind made famous in boomtowns of the Old West. Manager Terri Johnson said she had encountered a good number of Canadians inside the shop, but said she didn’t blame any who felt put off by the political climate.

“I’m thankful they still come after all that,” she said.

It’s not just international relations that have changed tourism here.

A rainy start to the summer season didn’t help, and business owners say anxiety over the domestic economy and inflation have pinched travel budgets.

Mark Lahood says family travel has dipped at the three hotels he operates in the area.

“Towns are quieter,” he said this summer. “They’re not quiet, but they’re much quieter than years’ past.”

Some summer weekends, which traditionally sell out entirely, the three hotels had 30% vacancies, he said. And travelers are more keen for weekend trips than their weeklong road trips of previous seasons.

“With a seven-day trip, by the time they were all in, it’s a lot of driving, it’s a lot of gas money, it’s a lot of meals, it’s a lot of hotels,” he said. “And I think it’s just too much.”

To help with rising costs, he ran a free breakfast promotion for kids earlier in the summer. And he increased an existing international discount for Canadian guests.

“Did it help anything? Probably not. But you know, when you view it from a Canadian traveler, at least you made an effort.”

The decline in Canadian visitors has allowed for more local, spontaneous travel, said Genn Anzaldi, who owns J-Town Deli & Country Store in Jackson, New Hampshire.

“More day trippers for sure,” she said. “So maybe not as many people spending the night or as many nights.”

The scent of sizzling bacon and toasting panini fills her shop, which offers hot meals along with handmade gifts and convenience store staples.

Anzaldi, who also runs a cooperative marketing effort for a group of independent restaurants, said the local restaurant business was down, but not significantly.

The reason?

“Canadians,” she said. “I wouldn’t say it’s the economy. That seems to be going well.”

About nine miles away from North Conway, things are a bit quieter in Jackson, home to a famed one-lane covered bridge. With its spas and boutique hotels, Anzaldi said the community is more known as a destination for weddings, romantic stays and outdoor getaways.

While Anzaldi said she hopes Canadian tensions settle soon, she noted that the matter lies in the political domain and there’s little business owners can do but carry on.

“We have to run, right?” she said. “We’re not personally going to go up and advertise.”

States try to ease federal tension

To maintain tourism and trade, Democratic and Republican politicians in the Northeast have made overtures to their counterparts in Canada.

Since Trump’s inauguration, Maine Democratic Gov. Janet Mills has met with Maine businesses near the border, embarked on a diplomatic Canadian tour and even installed “Bienvenue Canadiens” welcome signs near border crossings. But on her trip this summer, she was reminded that it’s not just tariffs that have irked Canadians — many are also worried about the Trump administration’s aggressive immigration enforcement.

“Lots of people don’t feel safe in the U.S. right now and for good reason,” Susan Holt, the premier of the New Brunswick province, told Mills, according to local news accounts. Holt has encouraged her constituents to avoid traveling to the United States.

Last year, the state said some 800,000 Canadians visited Maine. On her June trip, Mills asked Canadians to remember those who rely on the tourism industry.

“To the extent people feel angst about coming to Maine, just remember that if they aren’t coming to Maine, the ones that they’re hurting are the small mom and pop businesses,” the governor told News Center Maine while in Halifax.

Mills’ office did not respond to Stateline’s requests for comment.

Similarly, New Hampshire Republican Gov. Kelly Ayotte said ahead of a trade mission that she aimed to welcome Canadians to the Granite State, the New Hampshire Bulletin reported.

“That’s one of the things I’m going to just continue to promote on behalf of New Hampshire,” Ayotte said last month. “Not only that they’re welcome here — the Canadians — but we have open arms to them.”

Ayotte’s office did not respond to Stateline’s requests for comment about her trip.

René Sylvestre, the Quebec province’s delegate to New England, said those gestures are appreciated. He spends much of his time meeting with state and business leaders. Last month, he met numerous state lawmakers at the annual meeting of the National Conference of State Legislatures in Boston, where he is posted.

But he said calming federal tensions will be key to seeing a rebound in tourism.

“What we can see right now is people in Quebec are really sad with the whole situation,” he told Stateline. “But they’re saying, ‘Maybe we should stay and spend more time in Canada these days.’ So this is really the impact that we’ve seen, and we think that it’s going to take a while before it’s back to normal.”

A decline in international travel has hit border communities across the country — from New York state to Washington state. North Dakota estimated that Canadian visitors spent about $14.4 million less in the first half of the year compared with last year, as the number of personal vehicles crossing the border from Canada declined by 30%. Other hubs for international visitors, including Las Vegas and Hawaii, are also seeing significant declines.

“Right now, it’s hard to turn back federal policy,” Hawaii state Sen. Ron Kouchi told Stateline in August.

Kouchi, a Democrat and president of the state Senate, said Canada has traditionally been among Hawaii’s top five travel markets. The state has sent tourism officials to trade shows and is trying to show Canadians, like all visitors, the Aloha State’s iconic hospitality. But he said that message hasn’t been persuasive, even coming from leaders of the solidly liberal state.

“While we argue about Republicans or Democrats, in other nations they simply look at Americans and they don’t see it as an R or a D thing,” he said. “It’s an American thing.”

A stormy beach season

Old Orchard Beach in Maine is a favorite of New Englanders and Canadians alike.

Part of the Portland metropolitan area, the vacation town sports a seaside amusement park and seven miles of sandy beaches. But some Canadians started to cancel their summer reservations to the area early on in Trump’s term.

Sean Nickless, who co-owns the 30-room Crest Motel with his family, said Canadians began calling off trips in January and February,

Those cancellations and poor weather foretold a slower summer. “It’s not as steady,” Nickless said, noting business had been inconsistent with shorter stays.

Like many of the other beachfront properties here, the retro Crest Motel relies heavily on repeat customers, filled out by the occasional road tripper who ducks in from the angled carport to ask about an available room.

“The best you can do is let Canadians know they’re still welcome here,” he said from the motel’s small lobby scented with the aroma of a drip coffeemaker and a bright popcorn machine.

At the height of summer, rain ushered in what should have been a booming weekend along the Atlantic’s Saco Bay. Crest Motel guests swam, but only under the cover of the pool’s rolling roof.

Down the way, five teenagers stood listlessly inside a walkup Dairy Queen with no customers to serve. On the pier, arcade games, $1-per-visit restrooms and barstools sat idle. Few took up heavily advertised offers for pizza by the slice, $15 lobster rolls or fried clam cakes.

“I’ve never driven around Old Orchard Beach in the summer and seen ‘vacancy signs.’ I have this year,” said state Sen. Donna Bailey, who represents the community. “I mean, you just never see that in the middle of July — all you see is ‘no vacancy’ signs.” A Democrat, Bailey emphasized that Canada isn’t some far-off destination for Mainers. People routinely cross the border for health care and work. They have friends and family on both sides.

“I mean, there’s some places up in northern Maine that the nearest hospital is in Canada, as opposed to in the United States. You know, some people have their babies over in Canada.”

But aside from emphasizing existing bonds, Bailey said Maine residents and officials were largely at the mercy of the federal government’s actions.

“I think it’s helpful to remind the Canadians of our personal relationship and that we are Maine and we’re Mainers, and so we’re not necessarily the same as the federal government,” she said. “But, yeah, it does only go so far.”

---

Stateline reporter Kevin Hardy can be reached at khardy@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Craig Mauger

MediaNews Group

Lansing — Gov. Gretchen Whitmer called on the leaders of a fiercely divided Michigan Legislature to “work together” to approve a new budget Tuesday, 14 days before a deadline that could trigger a shutdown of state government.

During a 20-minute speech inside the Michigan Capitol’s Heritage Hall, Whitmer, a second-term Democrat who returned from a trade mission to Asia and Germany in recent days, made her most direct plea to lawmakers yet, amid a months-long budget battle.

She also appeared to pull closer than before to Senate Majority Leader Winnie Brinks, D-Grand Rapids, who’s been in a political standoff with House Speaker Matt Hall, R-Richland Township.

“While we stand on different sides of the aisle, we all basically want the same things: Happy, healthy children, good-paying jobs, food on the table, safe communities and a strong future,” Whitmer said at one point. “That is our task at hand. Let’s get it done. Let’s get to work.”

The governor’s speech focused on economic turmoil facing the country and Michigan, contending that tariffs imposed by Republican President Donald Trump’s administration and the lack of a budget were both sources of uncertainty that were bad for residents, businesses and job creation.

“We must work together to get certainty here in Michigan,” Whitmer said.

Whitmer has previously touted her ability to work across the aisle, but there’s been little bipartisan cooperation in Lansing since Republicans won control of the state House last November.

Hall, who has prioritized trimming spending, and Brinks have struggled to agree on budget priorities and missed the Legislature’s self-imposed deadline of July 1 to approve a new financial plan for state agencies, K-12 schools and universities. The House didn’t pass its own budget proposal until Aug. 26, months later than the chamber normally would.

Now, Whitmer and lawmakers face a constitutional deadline of Oct. 1, when the state’s next fiscal year begins. Without a budget in place by then, thousands of state workers would likely be laid off, state parks would close, some daycare programs might shutter and liquor purchases could be limited.

Hall has frequently promoted his relationship with Whitmer, but he wasn’t present for her speech Tuesday. Instead, Brinks and House Minority Leader Ranjeev Puri, D-Canton Township, were in the front row.

“I know that Leader Brinks is available and ready,” Whitmer said during her remarks. “My team and I are ready to go. We can still do this on time.”

The governor didn’t harshly criticize Hall by name but said she wouldn’t sign the $79 billion budget plan that House Republicans put forward that would bring large cuts to an array of state programs, including the Michigan State Police, the Department of Natural Resources, the attorney general’s office, civil rights operations and hospitals.

After the speech, Brinks said the Senate stood with Whitmer “committed to getting a budget done” but, she added, there were “delays and obstruction” coming from the House.

“The reality is Democrats … control of the Senate,” Brinks said. “Democrats control the governor’s office.

Of Hall, she said, “And he needs to work with us to come up with a compromise. If he is unwilling to do that, he is not doing his job for the people of Michigan.”

In February, Whitmer put forth an $83.5 billion budget for next year.

Both Hall and Whitmer have said they want to find $3 billion in additional funding for roads in next year’s plan. Hall would achieve it through redirecting money from other state spending, while Whitmer and Brinks prefer a mixture of cuts and new revenue, likely from some form of tax increases.

Also, Whitmer called on Tuesday for additional “job creation tools” to make it easier to build factories in the state, to retain jobs and to incentivize innovation.

Whitmer has previously championed a program she launched during her first term called the Strategic Outreach and Attraction Reserve (SOAR) Fund to provide dollars to pay for cash incentives for businesses bringing jobs to Michigan and to prepare large sites for development.

A wide-ranging tax law Whitmer signed in 2023 provided $500 million in annual funding for SOAR over three years. This current year is the final one in which the funding is reserved.

“We have to do something to deliver more wins for Michigan because competition is fierce,” Whitmer said.

Brinks referenced SOAR’s expiration after the speech.

“It doesn’t mean that we should be without any tools,” Brinks said. “So that is the subject of some conversation.”

Brinks told reporters there is still a path to get the budget done on time. But, she said, she wants to see a “change in approach” from the House.

“Should that not happen, we will get our leadership team together and make some decisions about what the best course forward is,” Brinks said.

In a statement Tuesday, Senate Minority Leader Aric Nesbitt, R-Porter Township, who’s campaigning to be Michigan’s next governor, said he was glad Whitmer is “finally back from another taxpayer-funded trip overseas because the clock is ticking.”

“It’s time to lead Democrats to the bargaining table to pass a balanced budget that fixes Michigan’s crumbling roads and bridges, puts kids first by focusing on reading and math and respects taxpayers enough to not reach deeper into their pockets,” Nesbitt said. “Republicans have put forward real plans to do this.”

By Nada Hassanein, Stateline.org

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

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

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

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

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

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

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

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

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

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

Barriers to treatment

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

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

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

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

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

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

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

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

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

‘There needs to be urgency’

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

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

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

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

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

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

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

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

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

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

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

More is known about the medication now than when it was placed on the controlled substances list about two decades ago, said Brendan Saloner, a Bloomberg Professor of American Health in Addiction and Overdose at Johns Hopkins University.

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

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

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

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

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

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

---

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

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Jake McMahon, Lexington Herald-Leader

In a small building tucked in a quiet Fort Mitchell neighborhood, more than 1,200 retirees have found a home.

But they aren’t people — at least, not when they’re not on stage. They are dummies and dolls that serve as the largest collection of ventriloquism memorabilia in the world.

The Vent Haven museum in Northern Kentucky claims to be the only ventriloquism museum in the world. Open since 1973, it has grown from 500 dummies in founder William Shakespeare Berger’s collection to its current size of 1,242 dummies.

The museum was in Berger’s house until three years ago, when the collection was moved to a neighboring building. Lisa Sweasy, curator of the Vent Haven Museum, described the collection as the “Mecca of ventriloquism.”

“Every ventriloquist, whether they’re a hobbyist, amateur, paraprofessional or professional, has been here. This is their home,” Sweasy said. “There are lots of puppetry museums, but for ventriloquists, this is that narrow slice of the puppetry community where we focus strictly on ventriloquism.”

Sweasy said a common reason people visit the museum is the scare factor. She said guests are often made uneasy by the dolls’ uncanny valley effect — a phenomenon where objects become repulsive as they approach realistic, human-like features.

“When a face is static, like it is here, you perceive that you’re being stared at when you’re not,” Sweasy said.

That unease tends to dissipate, though, after the first exhibit, when the “brain becomes saturated of the normalcy of what you’re seeing,” Sweasy said.

The collection at Vent Haven stretches from the Civil War era to modern-day ventriloquism. Dummies used by popular modern ventriloquists like Jeff Dunham and Darci Lynne sit alongside dolls voiced by classic artists like Edgar Bergen and Paul Winchell.

Some of the older dummies in the museum, mostly in the vaudevillian era section spanning from the late 1800s to the early 1900s, portray racist stereotypes, which Sweasy said was common for ventriloquism acts of the time. Sweasy said ventriloquists often emphasized the stereotypes to showcase their “vocal gymnastics.”

The dolls take up spots in the exhibit and are viewable to guests in the museum. Sweasy said it was important for Vent Haven not to hide the history.

“Most museum guidelines are to tell the truth about the pieces and tell them within context,” Sweasy said. “Hiding it is worse.”

Sweasy said the museum draws people of all ages, and sees people visiting the museum for many reasons. Some groups come with no knowledge of ventriloquism, and some come to reminisce on memories of watching popular ventriloquists of the past.

Along with the collection, Vent Haven hosts the annual VentCon, the International ventriloquism convention, and the Vent Haven 5k “Dummy Run.” Both events have already been held this year.

Sweasy said Vent Haven is a must see attraction because of its “uniqueness.”

“I think a lot of people like one-off attractions. You can go to an art museum in any city that you visit,” she said. “There are places in our country that are just these great little niche museums … I think we’re in that crowd.”

If you go

Vent Haven Museum

Where: 33 West Maple Ave, Fort Mitchell, KY, 41011

When: May-September, tours by appointment only

Online: https://www.venthaven.org/

©2025 Lexington Herald-Leader. Visit kentucky.com. Distributed by Tribune Content Agency, LLC.