By Breana Noble, The Detroit News

Hundreds of used vehicles rolled through the auction aisles of Manheim Detroit on Thursday as dealers in person and online scrambled to make their bids to shore up inventories in anticipation of price increases.

Average used vehicle list prices are up slightly year-over-year at $25,547, according to Cox Automotive Inc., a dealer digital services provider that owns Manheim and its 79 U.S. auction sites, which handle more than 7 million vehicles per year. The increase represents a reversal as used prices had fallen over the past couple of years after hitting a peak during the pandemic. But President Donald Trump’s tariffs have spooked buyers, prompting a surge in new and used vehicle purchases with consumers hoping to get ahead of larger price increases.

“We’re trying to get caution out there, but we’re not trying to spread any kind of concern that there’s a collapse coming,” said Charlie Chesbrough, a senior economist at Cox, which is forecasting a 1% increase in used vehicle sales in 2025 compared to last year. “It’s just going to be a challenging couple of months here over the summer.”

The Manheim Used Vehicle Value Index that assesses the wholesale prices of used vehicles at Manheim auctions reversed course in April after declining in February and March. It spiked 2.7% month-over-month compared to a typical monthly movement of about 0.3%, as prices rose almost 5% on average. The frenzy has slowed a bit since April with the index falling 1.1% in a mid-May report shared this week. But the index still remains 4.4% higher than it was a year ago.

It typically takes four to six weeks before changes at auction are reflected in retail transactions, Chesbrough said: “Our expectation is over the course of the summer, those prices are going to rise even more quickly.”

In Carleton on Thursday morning, auctioneers rambled 250 to 400 words per minute to secure bids within 1 minute from dealers across the country for used vehicles from automakers like Ford Motor Co. and General Motors Co., rental car companies, banks and other dealers. About 72% of Manheim’s vehicle sales are done online.

Established in 1992, the 250-acre Manheim Detroit has three sales days per week for licensed dealers. Whether a company vehicle, a trade-in, a repossession or a fleet retirement, 1,800 vehicles or more hit the block each of those days. Vehicles sell anywhere from $200 to salvage dealers to $450,000 for a Lamborghini recently. Most vehicles passing through are about three years old.

“Every car will sell,” said Keith Winningham, assistant general manager at Manheim Detroit. “It may not be today. Maybe it’s next week. The market’s constantly changing.”

Manheim Detroit is unique because of the business it does with manufacturers and the Canadian dealers that sell in its auction. Despite tariffs and trade tensions between the United States and Canada, sales from Canadian dealers are up this year, said Noel Kitsch, general manager of Manheim Detroit Market Center.

Most vehicles sold in Canada are made in the United States (designated by their vehicle identification numbers beginning with a one, four or five). Those can return to the United States tariff-free, Kitsch said, while more Canadian- and Mexican-built vehicles are staying in Canada because of Trump’s 25% auto tariff.

“They started adjusting in October,” Kitsch said about the Canadian sellers. “We have not seen a decrease in Canadian vehicles. As a matter of fact, we’re up year over year in Canadian sales in the Michigan area.”

High interest rates, improved new-vehicle inventories and inflation on other goods contributed to falling used vehicle prices over the past couple of years. The spring usually sees an increase in demand with tax returns hitting consumer pockets, Chesbrough said, and prices have stayed high.

“The used vehicle market is still looking very, very strong in terms of sales out there,” he said. “But the inventory has been drawn down, and that’s creating a situation where the inventory is lean on dealer lots, and they’re going to be less likely to make a deal, because their sales have been going quite well, and their existing inventory is now worth more money, because they know the incoming replacement inventory is going to cost a little bit more.”

Days of used-vehicle supply nationwide is in the 40s, he said, which is down about 20% from recent weeks.

More than a third — 34% — of Americans plan to buy a car in the next 12 months, the highest since 2023, according to auto lender Santander Consumer USA’s Paths to Prosperity survey. Some have pulled ahead those purchases in anticipation of increased prices, said Betty Jotanovic, the lender’s president of auto relationships.

But this comes as auto loan delinquency rates have returned to pre-COVID levels. Default rates remain below the norm, but it’s an indication of consumer economic stress, Jotanovic said.

“The consumer is getting behind on their payments,” she said, “but still prioritizing the auto loan over their mortgage or credit card.”

Adding in the uncertainty around tariffs, buyers may adjust their purchases, Jotanovic said: “You’re going to see a shift where maybe your typical new buyer goes to a one- or two-year-old used car, or maybe that one- or two-year-old used buyer goes to a three- or four-year-old used vehicle.”

Fewer younger vehicles are returning to dealer lots in 2025. A sharp drop in leasing through 2022 and 2023 amid a microchip shortage and other supply-chain disruptions, Ivan Drury, director of insights for auto information website Edmunds.com Inc., wrote in a report released Thursday.

In the first three months of 2025, the average sales price of a three-year-old used vehicle surpassed $30,000 for the first time since the second quarter of 2023.

“Due to unexpected market swings,” Drury wrote, “3-year-old lease-return values are coming in higher than automakers originally forecasted — offering some drivers unexpected trade-in advantages.”

That’s incentive for vehicle sellers to send their inventory to auction, and it’s keeping the 320 Manheim Detroit employees busy. The facility has a mechanic shop, a body shop to repair dented and scratched panels, and a paint shop able to spruce up as many as 50 vehicles per day. Manheim inspects about 150 vehicles to grant AAA certification daily.

“If there’s heavy collision on a vehicle, most of those assets are going to be sold as is,” Winningham said. “Most of what we do are cosmetic repairs. If a dealer is out in the lanes, and they’re looking at the car, and the bumper is scratched, it’s got a dent in the door, he’s got to calculate in his head what he’s got to spend on that car No. 1. No. 2, he has to get it repaired. Most body shops at most dealerships are very, very busy. And for him to have to get that into a shop and get it sold takes time. Obviously when they buy a car, the whole concept is to sell it as quickly as possible.”

Ninety-five percent of auctioned vehicles here are detailed on-site. Fixed imaging tunnels leverage 44 cameras and artificial intelligence to help identify damage on the vehicles and pick the best dozen of 2,000 photos captured as the vehicle travels under 10 mph through the tunnel. The chosen images are uploaded within minutes to Manheim’s website for dealers to check out.

Vehicles on average spend less than 30 days at Manheim before heading to a buyer. If a vehicle doesn’t sell, it might go to an auction next week or at another location. Certain electric vehicles stick around longer because of lower demand and to balance out losses for the seller, Kitsch said.

Whether buying at auction or from a trade-in, dealers like Walt Tutak, general manager at Matthew Hargreaves Chevrolet in Royal Oak, have upped their supply of used vehicles. Tutak is at 200 vehicles and could increase his stock to 225, up from a typical 150, in anticipation of tariffs affecting new-vehicle inventories.

“It hasn’t affected (demand) for used cars,” Tutak said about tariffs. “But we need to pay our bills one way or another. If inventories are going to get lowered, we want to be covered selling used cars.”

Tutak isn’t the only one thinking like that, and he recognized that used car prices are going up. But he said he’s willing to compromise on margins per vehicle if he’s selling more of them, he noted, seeing it as a long-term investment in the business.

“They’re going to come back to our dealership,” he said, “and tell friends and family and come to our service department and body shop and parts department. It’s a snowball effect.”

By Jackie Fortiér and Arthur Allen, KFF Health News

In the dim basement of a Salt Lake City pharmacy, hundreds of amber-colored plastic pill bottles sit stacked in rows, one man’s defensive wall in a tariff war.

Independent pharmacist Benjamin Jolley and his colleagues worry that the tariffs, aimed at bringing drug production to the United States, could instead drive companies out of business while raising prices and creating more of the drug shortages that have plagued American patients for several years.

Jolley bought six months’ worth of the most expensive large bottles, hoping to shield his business from the 10% across-the-board tariffs on imported goods that President Donald Trump announced April 2. Now with threats of additional tariffs targeting pharmaceuticals, Jolley worries that costs will soar for the medications that will fill those bottles.

In principle, Jolley said, using tariffs to push manufacturing from China and India to the U.S. makes sense. In the event of war, China could quickly stop all exports to the United States.

“I understand the rationale for tariffs. I’m not sure that we’re gonna do it the right way,” Jolley said. “And I am definitely sure that it’s going to raise the price that I pay my suppliers.”

Squeezed by insurers and middlemen, independent pharmacists such as Jolley find themselves on the front lines of a tariff storm. Nearly everyone down the line — drugmakers, pharmacies, wholesalers, and middlemen — opposes most tariffs.

Slashing drug imports could trigger widespread shortages, experts said, because of America’s dependence on Chinese- and Indian-made chemical ingredients, which form the critical building blocks of many medicines. Industry officials caution that steep tariffs on raw materials and finished pharmaceuticals could make drugs more expensive.

“Big ships don’t change course overnight,” said Robin Feldman, a UC Law San Francisco professor who writes about prescription drug issues. “Even if companies pledge to bring manufacturing home, it will take time to get them up and running. The key will be to avoid damage to industry and pain to consumers in the process.”

Trump on April 8 said he would soon announce “a major tariff on pharmaceuticals,” which have been largely tariff-free in the U.S. for 30 years.

“When they hear that, they will leave China,” he said. The U.S. imported $213 billion worth of medicines in 2024 — from China but also India, Europe, and other areas.

Trump’s statement sent drugmakers scrambling to figure out whether he was serious, and whether some tariffs would be levied more narrowly, since many parts of the U.S. drug supply chain are fragile, drug shortages are common, and upheaval at the FDA leaves questions about whether its staffing is adequate to inspect factories, where quality problems can lead to supply chain crises.

On May 12, Trump signed an executive order asking drugmakers to bring down the prices Americans pay for prescriptions, to put them in line with prices in other countries.

Meanwhile, pharmacists predict even the 10% tariffs Trump has demanded will hurt: Jolley said a potential increase of up to 30 cents a vial is not a king’s ransom, but it adds up when you’re a small pharmacy that fills 50,000 prescriptions a year.

“The one word that I would say right now to describe tariffs is ‘uncertainty,’” said Scott Pace, a pharmacist and owner of Kavanaugh Pharmacy in Little Rock, Arkansas.

To weather price fluctuations, Pace stocked up on the drugs his pharmacy dispenses most.

“I’ve identified the top 200 generics in my store, and I have basically put 90 days’ worth of those on the shelf just as a starting point,” he said. “Those are the diabetes drugs, the blood pressure medicines, the antibiotics — those things that I know folks will be sicker without.”

Pace said tariffs could be the death knell for the many independent pharmacies that exist on “razor-thin margins” — unless reimbursements rise to keep up with higher costs.

Unlike other retailers, pharmacies can’t pass along such costs to patients. Their payments are set by health insurers and pharmacy benefit managers largely owned by insurance conglomerates, who act as middlemen between drug manufacturers and purchasers.

Neal Smoller, who employs 15 people at his Village Apothecary in Woodstock, New York, is not optimistic.

“It’s not like they’re gonna go back and say, well, here’s your 10% bump because of the 10% tariff,” he said. “Costs are gonna go up and then the sluggish responses from the PBMs — they’re going to lead us to lose more money at a faster rate than we already are.”

Smoller, who said he has built a niche selling vitamins and supplements, fears that FDA firings will mean fewer federal inspections and safety checks.

“I worry that our pharmaceutical industry becomes like our supplement industry, where it’s the wild West,” he said.

Narrowly focused tariffs might work in some cases, said Marta Wosińska, a senior fellow at the Brookings Institution’s Center on Health Policy. For example, while drug manufacturing plants can cost $1 billion and take three to five years to set up, it would be relatively cheap to build a syringe factory — a business American manufacturers abandoned during the covid-19 pandemic because China was dumping its products here, Wosińska said.

It’s not surprising that giants such as Novartis and Eli Lilly have promised Trump they’ll invest billions in U.S. plants, she said, since much of their final drug product is made here or in Europe, where governments negotiate drug prices. The industry is using Trump’s tariff saber-rattling as leverage; in an April 11 letter, 32 drug companies demanded European governments pay them more or face an exodus to the United States.

Brandon Daniels, CEO of supply chain company Exiger, is bullish on tariffs. He thinks they could help bring some chemical manufacturing back to the U.S., which, when coupled with increased use of automation, would reduce the labor advantages of China and India.

“You’ve got real estate in North Texas that’s cheaper than real estate in Shenzhen,” he said at an economic conference April 25 in Washington, referring to a major Chinese chemical manufacturing center.

But Wosińska said no amount of tariffs will compel makers of generic drugs, responsible for 90% of U.S. prescriptions, to build new factories in the U.S. Payment structures and competition would make it economic suicide, she said.

Several U.S. generics firms have declared bankruptcy or closed U.S. factories over the past decade, said John Murphy, CEO of the Association for Accessible Medicines, the generics trade group. Reversing that trend won’t be easy and tariffs won’t do it, he said.

“There’s not a magic level of tariffs that magically incentivizes them to come into the U.S.,” he said. “There is no room to make a billion-dollar investment in a domestic facility if you’re going to lose money on every dose you sell in the U.S. market.”

His group has tried to explain these complexities to Trump officials, and hopes word is getting through. “We’re not PhRMA,” Murphy said, referring to the powerful trade group primarily representing makers of brand-name drugs. “I don’t have the resources to go to Mar-a-Lago to talk to the president myself.”

Many of the active ingredients in American drugs are imported. Fresenius Kabi, a German company with facilities in eight U.S. states to produce or distribute sterile injectables — vital hospital drugs for cancer and other conditions — complained in a letter to U.S. Trade Representative Jamieson Greer that tariffs on these raw materials could paradoxically lead some companies to move finished product manufacturing overseas.

Fresenius Kabi also makes biosimilars, the generic forms of expensive biologic drugs such as Humira and Stelara. The United States is typically the last developed country where biosimilars appear on the market because of patent laws.

Tariffs on biosimilars coming from overseas — where Fresenius makes such drugs — would further incentivize U.S. use of more expensive brand-name biologics, the March 11 letter said. Biosimilars, which can cost a tenth of the original drug’s price, launch on average 3-4 years later in the U.S. than in Canada or Europe.

In addition to getting cheaper knockoff drugs faster, European countries also pay far less than the United States for brand-name products. Paradoxically, Murphy said, those same countries pay more for generics.

European governments tend to establish more stable contracts with makers of generics, while in the United States, “rabid competition” drives down prices to the point at which a manufacturer “maybe scrimps on product quality,” said John Barkett, a White House Domestic Policy Council member in the Biden administration.

As a result, Wosińska said, “without exemptions or other measures put in place, I really worry about tariffs causing drug shortages.”

Smoller, the New York pharmacist, doesn’t see any upside to tariffs.

“How do I solve the problem of caring for my community,” he said, “but not being subject to the emotional roller coaster that is dispensing hundreds of prescriptions a day and watching every single one of them be a loss or 12 cents profit?”

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

By Robbie Sequeira, Stateline.org

In the wake of President Donald Trump’s executive order aiming to reinstate “common sense” school discipline, more states may follow and expand the authority of teachers and school officials to deal with disruptive students.

The order, signed in April, repeals prior federal guidance that encouraged schools to address racial disparities in discipline, arguing that such policies promoted “discriminatory equity ideology” and compromised school safety by pressuring administrators to underreport serious student misconduct.

In some states, new legislation already is trending toward giving teachers more authority to address student misbehavior.

In West Virginia, for example, a new law creates a structured process for responding to violent, threatening or disruptive behavior among students in grades K-6.

Under the law, a student exhibiting such behavior can be immediately removed from class, evaluated by counselors or behavioral specialists and placed on an individualized behavior plan. If there’s no improvement after two rounds of intervention, the student could be moved into a behavioral intervention program or an alternative learning environment.

West Virginia Gov. Patrick Morrisey, a Republican, and supporters say the law empowers teachers to maintain safe classrooms.

“This legislation provides teachers with the tools to regain control of the classroom and ensure safe learning environments for our kids,” Morrisey said at the bill’s signing.

In April, the Texas House of Representatives passed a bill referred to as the “Teacher’s Bill of Rights” with a bipartisan vote of 124-20.

That bill, now sitting in the Senate’s education committee, would significantly expand the grounds for out-of-school suspensions, allowing students to be suspended for repeated disruptions or threats beginning in third grade. It would reverse earlier changes that limited suspensions for younger students. It also would mandate that students making terroristic threats or assaulting school employees be placed in alternative education programs for at least 30 days.

Texas civil rights groups argue that the bill would impose a one-size-fits-all punitive approach, rather than addressing students’ developmental and behavioral needs.

Alycia Castillo, associate director of policy at the Texas Civil Rights Project and a former teacher, said state lawmakers are taking the wrong approach by mandating sweeping discipline policies for a state as diverse as Texas.

During the 2020-21 school year, according to the latest data available from the U.S. Department of Education, Black students faced the highest rates of disciplinary action across all categories — suspension and expulsion — among all racial and ethnic groups.

They were 39% more likely than white students to receive in-school suspensions, 70% more likely to face out-of-school suspensions, and 71% more likely to be expelled.

The disparities were even starker for Black students with disabilities, who experienced suspension and expulsion rates far exceeding those of both their white peers and non-disabled students.

Reviving old, harsh disciplinary policies risks disproportionately harming students of color, students with disabilities and those from low-income backgrounds, Castillo said.

“What works in Austin may not work in West Texas,” Castillo said.

“Children are naturally disruptive — that’s part of their development,” she added. “Excluding them only harms their growth into functional adults.”

Restorative justice models

In recent years, some other states have passed laws promoting restorative practices in schools, in which students and teachers work through problems and focus on repairing the harm caused by disruptions or conflict.

Michigan’s 2017 law requires schools to consider restorative approaches before suspensions or expulsions, aiming to repair harm rather than exclude students. Nevada began mandating restorative justice approaches in 2019, but scaled back that approach in 2023.

This year, Maryland passed a law requiring the state to establish “restorative practices schools,” specific schools with trained educators who use the approach in everyday discipline.

Kimberly Hellerich, an assistant professor at Sacred Heart University and a former K-12 teacher, said discipline policies should go beyond punitive measures to foster accountability and community healing.

“Adding restorative practices to accompany codes of conduct can allow students to recognize the impact of their actions on themselves, peers, the teacher, the class and the school community,” Hellerich said.

In her own classrooms, Hellerich used what she called “community circles” to guide students in processing behavior, offering apologies and rebuilding trust. “The apology served as a way to restore the student’s relationship with the entire class community,” she said.

Calls for a cultural shift on expectations

While lawmakers debate discipline procedures, other education advocates warn that an even deeper issue is unfolding inside classrooms: the gradual erosion of behavioral expectations and academic rigor.

Jessica Bartnick, co-founder and CEO of the Dallas-based mentorship program Foundation for C.H.O.I.C.E., said that declining school discipline and lowered standards are quietly undermining educational outcomes.

“Discipline is the backbone of effective learning,” Bartnick, who supports the Texas legislation, told Stateline in an email. “Without it, classrooms become chaotic, instructional time is lost and teachers are forced to shift their focus from instruction to behavior management.”

Bartnick said efforts to promote equity sometimes inadvertently lower behavioral standards and deprive teachers of the tools they need to maintain safe learning environments.

She also criticized lenient grading policies and unlimited test retakes, arguing that they diminish the value of preparation, responsibility and resilience.

“If students are shielded from the discomfort of failure, they are also shielded from the growth that comes with it,” she wrote. “If we want to prepare students for a world that will not offer endless second chances, we must return to a classroom culture grounded in discipline, responsibility, and rigor.”

Stateline reporter Amanda Hernández contributed to this report. Stateline reporter Robbie Sequeira can be reached at rsequeira@stateline.org.

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

By Kevin Hardy, Stateline.org

In submitting her updated budget proposal in March, Arizona Gov. Katie Hobbs lamented the rising costs of the state’s school vouchers program that directs public dollars to pay private school tuition.

Characterizing vouchers as an “entitlement program,” Hobbs said the state could spend more than $1 billion subsidizing private education in the upcoming fiscal year. The Democratic governor said those expenses could crowd out other budget priorities, including disability programs and pay raises for firefighters and state troopers.

It’s a dilemma that some budget experts fear will become more common nationwide as the costs of school choice measures mount across the states, reaching billions of dollars each year.

“School vouchers are increasingly eating up state budgets in a way that I don’t think is sustainable long term,” said Whitney Tucker, director of state fiscal policy research at the Center on Budget and Policy Priorities, a think tank that advocates for left-leaning tax policies.

Vouchers and scholarship programs, which use taxpayer money to cover private school tuition, are part of the wider school choice movement that also includes charter schools and other alternatives to public schools.

Opponents have long warned about vouchers draining resources from public education as students move from public schools to private ones. But research into several programs has shown many voucher recipients already were enrolled in private schools. That means universal vouchers could drive up costs by creating two parallel education systems — both funded by taxpayers.

In Arizona, state officials reported most private school students receiving vouchers in the first two years of the expanded program were not previously enrolled in public schools. In fiscal year 2024, more than half the state’s 75,000 voucher recipients were previously enrolled in private schools or were being homeschooled.

“Vouchers don’t shift costs — they add costs,” Joshua Cowen, a professor of education policy at Michigan State University who studies the issue, recently told Stateline. “Most voucher recipients were already in private schools, meaning states are paying for education they previously didn’t have to fund.”

Voucher proponents, though, say those figures can be misleading. Arizona, like other states with recent expansions, previously had more modest voucher programs. So some kids who were already enrolled in private schools could have already been receiving state subsidies.

In addition to increasing competition, supporters say the programs can actually save taxpayer dollars by delivering education at a lower overall cost than traditional public schools.

One thing is certain: With a record number of students receiving subsidies to attend private schools, vouchers are quickly creating budget concerns for some state leaders.

The rising costs of school choice measures come after years of deep cuts to income taxes in many states, leaving them with less money to spend. An end of pandemic-era aid and potential looming cuts to federal support also have created widespread uncertainty about state budgets.

“We’re seeing a number of things that are creating a sort of perfect storm from a fiscal perspective in the states,” said Tucker, of the Center on Budget and Policy Priorities.

Last year, Arizona leaders waded through an estimated $1.3 billion budget shortfall. Budget experts said the voucher program was responsible for hundreds of millions of that deficit.

A new universal voucher program in Texas is expected to cost $1 billion over its next two-year budget cycle — a figure that could balloon to nearly $5 billion by 2030, according to a legislative fiscal note.

Earlier this year, Wyoming Republican Gov. Mark Gordon signed a bill expanding the state’s voucher program. But last week, he acknowledged his own “substantial concerns” about the state’s ability to fund vouchers and its public education obligations under the constitution.

“I think the legislature’s got a very tall task to understand how they’re going to be able to fund all of these things,” he said in an interview with WyoFile.

Voucher proponents, who have been active at the state level for years, are gaining new momentum with support from President Donald Trump and congressional Republicans.

In January, Trump ordered federal agencies to allow states, tribes and military families to access federal money for private K-12 education through education savings accounts, voucher programs or tax credits.

Last week, Republicans on the House Ways and Means Committee voted in favor of making$20 billion available over the next four years for a federal school voucher program. Part of broader work on a bill to extend Trump’s 2017 tax cuts, the measure would need a simple majority in the House and the Senate to pass.

Martin Lueken, the director of the Fiscal Research and Education Center at EdChoice, a nonprofit that advocates for school choice measures, argues school choice measures can actually deliver savings to taxpayers.

Lueken said vouchers are not to blame for state budget woes. He said public school systems for years have increased spending faster than inflation. And he noted that school choice measures make up a small share of overall state spending — nationally about 0.3% of total state expenditures in states with school choice, he said.

“Public schooling remains one of the largest line items in state budgets,” he said in an interview. “They are still the dominant provider of K-12 education, and certainly looking at the education pie, they still receive the lion’s share.

“It’s not a choice problem. I would say that it’s a problem with the status quo and the public school system,” he said.

Washington, D.C., and 35 states offer some school choice programs, according to EdChoice. That includes 18 states with voucher programs so expansive that virtually all students can participate regardless of income.

But Lueken said framing vouchers as a new entitlement program is misleading. That’s because all students, even the wealthiest, have always been entitled to a public education — whether they’ve chosen to attend free public schools or private ones that charge tuition.

“At the end of the day, the thing that matters most above dollars are students and families,” he said. “Research is clear that competition works. Public schools have responded in very positive ways when they are faced with increased competitive pressure from choice programs.”

Public school advocates say funding both private and public schools is untenable.

In Wisconsin, Republican lawmakers are considering a major voucher expansion that would alter the funding structure for vouchers, potentially putting more strain on the state’s general fund.

The state spent about $629 million on its four voucher programs during the 2024-2025 school year, according to the Wisconsin Association of School Business Officials, which represents employees in school district finance, human resources and leadership.

The association warns proposed legislation could exacerbate problems with the “unaffordable parallel school systems” in place now by shifting more private schooling costs from parents of those students to state taxpayers at large.

Such expansion “could create the conditions for even greater funding challenges for Wisconsin’s traditional public schools and the state budget as a whole,” the association’s research director wrote in a paper on the issue.

In Arizona, Hobbs originally sought to eliminate the universal voucher program — a nonstarter in the Republican-controlled legislature. She has since proposed shrinking the program by placing income limits that would disqualify the state’s wealthiest families.

That idea also faced Republican opposition.

Legislators are now pushing to enshrine access to vouchers in the state constitution.

Marisol Garcia, president of the Arizona Education Association, the state’s 20,000-member teachers union, noted that vouchers and public education funds are both sourced from the general fund.

“So it almost immediately started to impact public services,” she said of the universal voucher program.

While the union says vouchers have led to cutbacks of important resources such as counselors in public schools, Garcia said the sweeping program also affects the state’s ability to fund other services like housing, transportation and health care.

“Every budget cycle becomes where can we cut in order to essentially feed this out-of-control program?” she said.

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 Robert Snell, The Detroit News

A band of alleged mail thieves stole $63 million worth of checks from the U.S. Postal Service and sold them on the black market, federal prosecutors said Friday.

Federal court records describe an inside job from October 2022 through December 2023 that involved four people, including a popular Metro Detroit rapper and two U.S. Postal Service employees accused of stealing checks as well as other “negotiable instruments” deposited in the mail. That included a large volume of IRS tax refund checks.

The checks were, in turn, given to co-conspirators on consignment before being sold on Telegram Messenger, a cloud-based instant messaging service. The checks were sold on two Telegram channels: “Whole Foods Slipsss” and “Uber Eats Slips.”

The stolen checks — known on the street as “slips” — were sold at a deep discount, often for pennies on the dollar, prosecutors allege.

“When public employees break the public trust, they enrich themselves at the expense of the American taxpayer and undermine the institution itself,” Interim U.S. Attorney Jerome Gorgon said in a statement. “We will find and prosecute those who exploit their position for personal gain.”

Four people were charged with conspiracy to aid and abet bank and wire fraud, a 30-year felony. They were charged in a criminal information, a type of federal charge that indicates a guilty plea is expected soon.

Those charged are:

∎ Rapper Jaiswan Williams, 31, of Rochester Hills, who prosecutors say was the administrator of the “Whole Foods Slipsss” channel, which advertised high-dollar stolen checks

∎ Daquan Foreman, 30, of Eastpointe, who was the “Uber Eats Slips” channel administrator, according to the government.

∎ Vanessa Hargrove, 39, of Detroit, a mail processing clerk at the postal service’s Detroit Processing & Distribution Center.

∎ Ohio resident Crystal Jenkins,31, of Detroit, a mail processing clerk at the postal service’s Dayton Processing & Distribution Center in Ohio.

Williams’ lawyer, Steve Fishman, declined comment Friday. Lawyers for the others were not listed in court records.

Subscribers to the Telegram channels would buy the checks using various methods, including the mobile financial services platforms Cash App and Apple Pay and Bitcoin.

“The total face value of the checks posted to ‘Whole Foods Slipsss’ and ‘Uber Eats Slips’ during the time period covered by the information was over $63 million,” according to the criminal case.

People who bought the checks would try to deposit them at banks and use information found on the checks to create counterfeit checks, according to the government.

Williams also is accused of laundering money generated by the conspiracy and wire fraud by illegally obtaining pandemic assistance.

By Aya Fayad, The Detroit News

At only 25, after having served his country in the Vietnam War, James McMahon decided to become a police officer in Southfield, graduating the academy as class president while balancing the roles of oldest brother and son.

In 1971, only two months into his service, the Michigan native died while on duty. On Friday, 54 years after his death, city officials honored the fallen officer in a Memorial Day ceremony to show how his sacrifice, and that of others dedicated to service, is not forgotten.

“He was so loved,” said Dennis McMahon, James McMahon’s younger brother, who attended. “He was so young when he died, when he served his country.”

On Jan. 23, 1971, James McMahon was hit by an intoxicated driver while setting up road flares on Telegraph Road near what is now known as Interstate 696, city officials said.

He is one of two fallen police officers in Southfield’s history.

“He was so loved,” said Dennis McMahon, James McMahon’s younger brother, who was in attendance. “He was so young when he died, when he served his country.”

Held at the city’s Council Chambers early Friday, the ceremony kicked off with a presentation of colors by the Southfield Fire Department Color Guard, and a speech from Police Chief Barren, a Vietnam War veteran who touted the “brave soldiers who served their country,” urging the community not to take their service for granted.

“It’s a service that sacrifices out of love,” Barren said. “I’m excited to be a part of the city of Southfield, because it’s a city that recognizes the importance of honoring our veterans. We make these commitments like ‘never forgotten,’ and that means, annually, recognizing the lives that were lost and sacrificed.”

During the ceremony, Dennis McMahon attended and accepted a special plaque on his brother’s behalf.

James McMahon, born to Anna Mae and James L. McMahon, a retired Detroit police officer, was the oldest of five, including siblings Julie, Kathleen and Eileen.

Prior to his Southfield police tenure, he had also served in the Navy during the Vietnam War, according to officials.

“My brother was a great guy. He was a great older brother and a great police officer who really cared about his community,” Dennis McMahon said. “This is for the community, for them to remember not only my brother, but all the veterans and officers that serve this country and gave their lives for it.”

Southfield Mayor Kenson Siver described the event as significant.

The city, he said, has “two fallen police officers, and may we never have more, but we continue to keep their memory. The city of Southfield wants to honor those who served and those who fell in service, to show our thanks to them.”

Joseph Person, chair of the Southfield Lathrup Village Democratic Club and a U.S. Army veteran, said such remembrances are important to “honor who we’ve lost and recognize whose shoulders (the country) stands on.”

“Even we veterans stand on the soldiers of great veterans who came before us, those who served in the Vietnam era, the Korean War era, World War II, World War I,” Person said. “They are so deserving of this honor and respect.”

The ceremony also included an invocation and benediction provided by Rev. Steve Bancroft of St. David’s Episcopal Church in Southfield and a speech by chairperson of the Southfield Veteran’s Commission, Rodney Caruthers, who lauded “the brave souls who step up for their country.”

“We just want to make sure we honor, give back to those who served us,” Caruthers said.

Jennifer Young, Dennis McMahon’s wife, said her family appreciated Southfield’s efforts.

“We are so, so grateful,” the Dearborn resident said. “It’s so important to remember these people who gave their lives, who sacrificed so much for the country, just like (James). They deserve to be remembered.”

By Tony Leys, KFF Health News

SPENCER, Iowa — This town’s hospital is a holdout on behalf of people going through mental health crises. The facility’s leaders have pledged not to shutter their inpatient psychiatric unit, as dozens of other U.S. hospitals have.

Keeping that promise could soon get tougher if Congress slashes Medicaid funding. The joint federal-state health program covers an unusually large share of mental health patients, and hospital industry leaders say spending cuts could accelerate a decades-long wave of psychiatric unit closures.

At least eight other Iowa hospitals have stopped offering inpatient mental health care since 2007, forcing people in crisis to seek help in distant facilities. Spencer Hospital is one of the smallest in Iowa still offering the service.

CEO Brenda Tiefenthaler said 40% of her hospital’s psychiatric inpatients are covered by Medicaid, compared with about 12% of all inpatients. An additional 10% of the hospital’s psychiatric inpatients are uninsured. National experts say such disparities are common.

Tiefenthaler vows to keep her nonprofit hospital’s 14-bed psychiatric unit open, even though it loses $2 million per year. That’s a significant loss for an organization with an overall annual budget of about $120 million. But the people who use the psychiatric unit need medical care, “just like people who have chest pains,” Tiefenthaler said.

Medicaid covers health care for about 72 million Americans with low incomes or disabilities. Tiefenthaler predicts that if some of them are kicked off the program and left without insurance coverage, more people would delay treatment for mental health problems until their lives spin out of control.

“Then they’re going to enter through the emergency room when they’re in a crisis,” she said. “That’s not really a solution to what we have going on in our country.”

Republican congressional leaders have vowed to protect Medicaid for people who need it, but they also have called for billions of dollars in cuts to areas of the federal budget that include the program.

The U.S. already faces a deep shortage of inpatient mental health services, many of which were reduced or eliminated by private hospitals and public institutions, said Jennifer Snow, director of government relations and policy for the National Alliance on Mental Illness. At the same time, the number of people experiencing mental problems has climbed.

“I don’t even want to think about how much worse it could get,” she said.

The American Hospital Association estimates nearly 100 U.S. hospitals have shuttered their inpatient mental health services in the past decade.

Such closures are often attributed to mental health services being more likely to lose money than many other types of health care. “I’m not blaming the hospitals,” Snow said. “They need to keep their doors open.”

Medicaid generally pays hospitals lower rates for services than they receive from private insurance or from Medicare, the federal program that mostly covers people 65 or older. And Medicaid recipients are particularly likely to need mental health care. More than a third of nonelderly Medicaid enrollees have some sort of mental illness, according to a report from KFF, a nonprofit health policy organization that includes KFF Health News. Iowa has the highest rate of mental illness among nonelderly Medicaid recipients, at 51%.

As of February, just 20 of Iowa’s 116 community hospitals had inpatient psychiatric units, according to a state registry. Iowa also has four freestanding mental hospitals, including two run by the state.

Iowa, with 3.2 million residents, has a total of about 760 inpatient mental health beds that are staffed to care for patients, the state reports. The Treatment Advocacy Center, a national group seeking improved mental health care, says the “absolute minimum” of such beds would translate to about 960 for Iowa’s population, and the optimal number would be about 1,920.

Most of Iowa’s psychiatric beds are in metro areas, and it can take several days for a slot to come open. In the meantime, patients routinely wait in emergency departments.

Sheriff’s deputies often are assigned to transport patients to available facilities when treatment is court-ordered.

“It’s not uncommon for us to drive five or six hours,” said Clay County Sheriff Chris Raveling, whose northwestern Iowa county includes Spencer, a city of 11,000 people.

He said Spencer Hospital’s mental health unit often is too full to accept new patients and, like many such facilities, it declines to take patients who are violent or charged with crimes.

The result is that people are held in jail on minor charges stemming from their mental illnesses or addictions, the sheriff said. “They really shouldn’t be in jail,” he said. “Did they commit a crime? Yes. But I don’t think they did it on purpose.”

Raveling said authorities in many cases decide to hold people in jail so they don’t hurt themselves or others while awaiting treatment. He has seen the problems worsen in his 25 years in law enforcement.

Most people with mental health issues can be treated as outpatients, but many of those services also depend heavily on Medicaid and could be vulnerable to budget cuts.

Jon Ulven, a psychologist who practices in Moorhead, Minnesota, and neighboring Fargo, North Dakota, said he’s particularly worried about patients who develop psychosis, which often begins in the teenage years or early adulthood. If they’re started right away on medication and therapy, “we can have a dramatic influence on that person for the rest of their life,” he said. But if treatment is delayed, their symptoms often become harder to reverse.

Ulven, who helps oversee mental health services in his region for the multistate Sanford Health system, said he’s also concerned about people with other mental health challenges, including depression. He noted a study published in 2022 that showed suicide rates rose faster in states that declined to expand their Medicaid programs than in states that agreed to expand their programs to cover more low-income adults. If Medicaid rolls are reduced again, he said, more people would be uninsured and fewer services would be available. That could lead to more suicides.

Nationally, Medicaid covered nearly 41% of psychiatric inpatients cared for in 2024 by a sample of 680 hospitals, according to an analysis done for KFF Health News by the financial consulting company Strata. In contrast, just 13% of inpatients in those hospitals’ cancer programs and 9% of inpatients in their cardiac programs were covered by Medicaid.

If Medicaid participants have mental crises after losing their coverage, hospitals or clinics would have to treat many of them for little or no payment. “These are not wealthy people. They don’t have a lot of assets,” said Steve Wasson, Strata’s chief data and intelligence officer. Even though Medicaid pays hospitals relatively low rates, he said, “it’s better than nothing.”

Birthing units, which also have been plagued by closures, face similar challenges. In the Strata sample, 37% of those units’ patients were on Medicaid in 2024.

Spencer Hospital, which has a total of 63 inpatient beds, has maintained both its birthing unit and its psychiatric unit, and its leaders plan to keep them open. Amid a critical shortage of mental health professionals, it employs two psychiatric nurse practitioners and two psychiatrists, including one providing care via video from North Carolina.

Local resident David Jacobsen appreciates the hospital’s efforts to preserve services. His son Alex was assisted by the facility’s mental health professionals during years of struggles before he died by suicide in 2020.

David Jacobsen knows how reliant such services are on Medicaid, and he worries that more hospitals will curtail mental health offerings if national leaders cut the program. “They’re hurting the people who need help the most,” he said.

People on Medicaid aren’t the only ones affected when hospitals reduce services or close treatment units. Everyone in the community loses access to care.

Alex Jacobsen’s family saw how common the need is. “If we can learn anything from my Alex,” one of his sisters wrote in his obituary, “it’s that mental illness is real, it doesn’t discriminate, and it takes some of the best people down in its ugly swirling drain.”

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

By Arthur Allen, KFF Health News

The Trump administration’s unprecedented $500 million grant for a broadly protective flu shot has confounded vaccine and pandemic preparedness experts, who said the project was in early stages, relied on old technology and was just one of more than 200 such efforts.

Health and Human Services Secretary Robert F. Kennedy Jr. shifted the money from a pandemic preparedness fund to a vaccine development program led by two scientists whom the administration recently named to senior positions at the National Institutes of Health.

While some experts were pleased that Kennedy had supported any vaccine project, they said the May 1 announcement contravened sound scientific policy, appeared arbitrary, and raised the kinds of questions about conflicts of interest that have dogged many of President Donald Trump’s actions.

Focusing vast resources on a single vaccine candidate “is a little like going to the Kentucky Derby and putting all your money on one horse,” said William Schaffner, a Vanderbilt University professor and past president of the National Foundation for Infectious Diseases. “In science we normally put money on a number of different horses because we can’t be entirely sure who’s going to win.”

Others were mystified by the decision, since the candidate vaccine uses technology that was largely abandoned in the 1970s and eschews techniques developed in recent decades through funding from the Department of Health and Human Services and the Defense Department.

“This is not a next-generation vaccine,” said Rick Bright, who led HHS’ Biomedical Advanced Research and Development Authority, or BARDA, in the first Trump administration. “It’s so last-generation, or first-generation, it’s mind-blowing.”

The vaccine is being developed at the National Institute for Allergy and Infectious Diseases by Jeffery Taubenberger, whom Trump named as acting chief of the institute in late April, and his colleague Matthew Memoli, a critic of U.S. COVID-19 policy whom Trump picked to lead the NIH until April 1, when Jay Bhattacharya took office. Bhattacharya named Memoli his principal deputy.

Taubenberger gained fame as an Armed Forces Institute of Pathology scientist in 1997 when his lab sequenced the genome of the 1918 pandemic influenza virus, using tissue samples from U.S. troops who died in that plague. He joined the NIH in 2006.

In a May 1 news release, HHS called the Taubenberger-Memoli vaccine initiative “Generation Gold Standard,” saying it represented “a decisive shift toward transparency, effectiveness, and comprehensive preparedness.” Bhattacharya said it represented a “paradigm shift.”

But the NIH vaccine-makers’ goal of creating a shot that protects against multiple or all strains of influenza — currently vaccines must be given each year to account for shifts in the virus — is not new.

Then-NIAID Director Anthony Fauci launched a network of academic researchers in pursuit of a broadly protective flu vaccine in 2019. In addition to that NIH-led consortium, more than 200 flu vaccines are under development in the U.S. and other countries.

Many use newer technologies, and some are at more advanced stages of human testing than the Taubenberger vaccine, whose approach appears basically the same as the one used in flu vaccines starting in 1944, Bright said.

In the news release, HHS described the vaccine as “in advanced trials” and said it would induce “robust” responses and “long-lasting protection.” But Taubenberger and his colleagues haven’t published a complete human study of the vaccine yet. A study showing the vaccine protected mice from the flu appeared in 2022.

For Operation Warp Speed, which led to the creation of the COVID vaccine during Trump’s first term, government scientists reviewed detailed plans and data from academic and commercial laboratories vying for federal money, said Greg Poland, a flu expert and president of the Atria Health Academy of Science and Medicine. “If that’s happening here, it’s opaque to me,” he said.

When asked what data beyond its press release supported the decision, HHS spokesperson Andrew Nixon pointed to the agency’s one-page statement. Asked whether the decision would curtail funding for the Fauci-created consortium or other universal vaccine approaches, Nixon did not specifically respond. “Generation Gold Standard is the most promising,” he said in an email.

Taubenberger did not respond to a request for comment. Nixon and NIH spokesperson Amanda Fine did not respond to requests for an interview with Taubenberger or Memoli.

The HHS statement stressed that by developing the vaccine in-house, the government “ensures radical transparency, public accountability, and freedom from commercial conflicts of interest.” While any vaccine would eventually have to be made commercially, NIH involvement through more stages of development could give the government greater influence on any vaccine’s eventual price, Schaffner said.

If the mRNA-based COVID shots produced by Moderna and Pfizer-BioNTech represented the cutting edge of vaccine technology, applying ultra-sophisticated approaches never before seen in an inoculation, the approach by Taubenberger and Memoli represents a blast from the past.

Their vaccine is made by inactivating influenza viruses with a carcinogenic chemical called beta-propiolactone. Scientists have used the chemical to neutralize viruses since at least the 1950s. This whole-virus inactivation method, mostly using other chemicals, was the standard way to make flu vaccines into the 1970s, when it was modified, partly because whole-virus vaccines caused high fevers or even seizures in children.

The limited published data from the Taubenberger vaccine, from an initial safety trial involving 45 patients, showed no major side effects. The scientists are testing the vaccine as a regular shot and as an intranasal spray with the idea of stopping the virus in the respiratory tract before it causes a broad infection.

“The notion of a universal influenza A pandemic vaccine is a good one,” said Poland, who called Taubenberger an excellent scientist. But he added: “I’m not so sure about the platform, and the dollar amount is a puzzler. This vaccine’s in very early development.”

Paul Friedrichs, a retired Air Force general who led the Office of Pandemic Preparedness and Response Policy in President Joe Biden’s White House, said that “giving $500 million upfront with very little data to support it is unlike anything I’ve ever seen.”

“The technology for developing vaccines has tremendously evolved over many decades,” Friedrichs said. “Why would we go back to an approach historically associated with greater or more frequent adverse events?”

The government appeared to be transferring the money for the Taubenberger vaccine development from an existing $1.3 billion vaccine fund at Project NextGen, a mostly COVID-focused program at BARDA, Friedrichs said. Most of that money was earmarked to support advanced research on COVID and other viral vaccines, including those protecting against emerging diseases.

It is “very concerning that we’re de-emphasizing COVID, which we may live to regret,” Poland said. “It assumes we won’t have a COVID variant that escapes the current moderately high levels of COVID immunity.”

Nixon said Project NextGen, for which some funds were earmarked for mRNA research, is under review. Kennedy is critical of mRNA vaccines, once claiming, falsely, that they are the deadliest vaccines in history.

Ted Ross, director of global vaccine development at the Cleveland Clinic, said he was “happy to see them investing in respiratory vaccines, including a universal flu vaccine, with all the programs they’ve been cutting.”

“But I don’t think this is the only approach,” Ross said. “Other universal flu vaccines are in progress, and their success and failure are not known yet.”

His team, part of the NIAID-funded flu vaccine consortium, is using artificial intelligence and computer modeling to design vaccines that produce the broadest immunity to influenza, including seasonal and pandemic strains.

As interim director, Memoli oversaw the start of the administration’s massive cuts at the NIH, with the elimination of some 800 agency grants worth over $2 billion. More than 1,200 NIH employees have been fired, and many researchers, including Ross, are in limbo.

His lab is close to testing a candidate vaccine on people, Ross said, while waiting to find out about its NIH funding. “I’m not sure whether my contract is on the chopping block,” he said.

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

By Henry Larweh, KFF Health News

Fentanyl, the deadly synthetic opioid driving the nation’s high drug overdose rates, is also caught up in another increasingly serious problem: misinformation.

False and misleading narratives on social media, in news reports, and even in popular television dramas suggesting people can overdose from touching fentanyl — rather than ingesting it — are now informing policy and spending decisions.

In an episode of the CBS cop drama “Blue Bloods,” for instance, Detective Maria Baez becomes comatose after accidentally touching powdered fentanyl. In another drama, “S.W.A.T.,” Sgt. Daniel “Hondo” Harrelson warns his co-workers: “You touch the pure stuff without wearing gloves, say good night.”

While fentanyl-related deaths have drastically risen over the past decade, no evidence suggests any resulted from incidentally touching or inhaling it, and little to no evidence that any resulted from consuming it in marijuana products. (Recent data indicates that fentanyl-related deaths have begun to drop.)

There is also almost no evidence that law enforcement personnel are at heightened risk of accidental overdoses due to such exposures. Still, there is a steady stream of reports — which generally turn out to be false — of officers allegedly becoming ill after handling fentanyl.

“It’s only in the TV dramas” where that happens, said Brandon del Pozo, a retired Burlington, Vermont, police chief who researches policing and public health policies and practices at Brown University.

In fact, fentanyl overdoses are commonly caused by ingesting the drug illicitly as a pill or powder. And most accidental exposures occur when people who use drugs, even those who do not use opioids, unknowingly consume fentanyl because it is so often used to “cut” street drugs such as heroin and cocaine.

Despite what scientific evidence suggests about fentanyl and its risks, misinformation can persist in public discourse and among first responders on the front lines of the crisis. Daniel Meloy, a senior community engagement specialist at the drug recovery organizations Operation 2 Save Lives and QRT National, said he thinks of misinformation as “more of an unknown than it is an anxiety or a fear.”

“We’re experiencing it often before the information” can be understood and shared by public health and addiction medicine practitioners, Meloy said.

Some state and local governments are investing money from their share of the billions in opioid settlement funds in efforts to protect first responders from purported risks perpetuated through fentanyl misinformation.

In 2022 and 2023, 19 cities, towns, and counties across eight states used settlement funds to purchase drug detection devices for law enforcement agencies, spending just over $1 million altogether. Two mass spectrometers were purchased for at least $136,000 for the Greeley, Colorado, police department, “to protect those who are tasked with handling those substances.”

Del Pozo, the retired police chief, said fentanyl is present in most illicit opioids found at the scene of an arrest. But that “doesn’t mean you need to spend a lot of money on fentanyl detection for officer safety,” he said. If that spending decision is motivated by officer safety concerns, then it’s “misspent money,” del Pozo said.

Fentanyl misinformation is affecting policy in other ways, too.

Florida, for instance, has on the books a law that makes it a second-degree felony to cause an overdose or bodily injury to a first responder through this kind of secondhand fentanyl exposure. Similar legislation has been considered by states such as Tennessee and West Virginia, the latter stipulating a penalty of 15 years to life imprisonment if the exposure results in death.

Public health advocates worry these laws will make people shy away from seeking help for people who are overdosing.

“A lot of people leave overdose scenes because they don’t want to interact with police,” said Erin Russell, a principal with Health Management Associates, a health care industry research and consulting firm. Florida does include a caveat in its statute that any person “acting in good faith” to seek medical assistance for someone they believe to be overdosing “may not” be arrested, charged, or prosecuted.

And even when public policy is crafted to protect first responders as well as regular people, misinformation can undermine a program’s messaging.

Take Mississippi’s One Pill Can Kill initiative. Led by the state attorney general, Lynn Fitch, the initiative aims to provide resources and education to Mississippi residents about fentanyl and its risks. While it promotes the availability and use of harm reduction tools, such as naloxone and fentanyl test strips, Fitch has also propped up misinformation.

At the 2024 Mississippi Coalition of Bail Sureties conference, Fitch said, “If you figure out that pill’s got fentanyl, you better be ready to dispose of it, because you can get it through your fingers,” based on the repeatedly debunked belief that a person can overdose by simply touching fentanyl.

Officers on the ground, meanwhile, sometimes are warned to proceed with caution in providing lifesaving interventions at overdose scenes because of these alleged accidental exposure risks. This caution is often evidenced in a push to provide first responders with masks and other personal protective equipment. Fitch told the crowd at the conference: “You can’t just go out and give CPR like you did before.” However, as with other secondhand exposures, the risk for a fentanyl overdose from applying mouth-to-mouth is negligible, with no clinical evidence to suggest it has occurred.

Her comments underscore growing concerns, often not supported by science, that officers and first responders increasingly face exposure risks during overdose responses. Her office did not respond to questions about these comments.

Health care experts say they are not against providing first responders with protective equipment, but that fentanyl misinformation is clouding policy and risks delaying critical interventions such as CPR and rescue breathing.

“People are afraid to do rescue breathing because they’re like, ‘Well, what if there’s fentanyl in the person’s mouth,’” Russell said. Hesitating for even a moment because of fentanyl misinformation could delay a technique that “is incredibly important in an overdose response.”

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

By Sam Whitehead, Phil Galewitz and Katheryn Houghton, KFF Health News

For many years, Eric Wunderlin’s health issues made it hard to find stable employment.

Struggling to manage depression and diabetes, Wunderlin worked part-time, minimum-wage retail jobs around Dayton, Ohio, making so little he said he sometimes had to choose between paying rent and buying food.

But in 2018, his CareSource Medicaid health plan offered him help getting a job. It connected him to a life coach, who helped him find full-time work with health benefits. Now, he works for a nonprofit social service agency, a job he said has given him enough financial stability to plan a European vacation next year.

“I feel like a real person and I can go do things,” said Wunderlin, 42. “I feel like I pulled myself out of that slump.”

Republicans in Congress and several states, including Ohio, Iowa, and Montana, are pushing to implement work requirements for nondisabled adults, arguing a mandate would encourage enrollees to find jobs. And for Republicans pushing to require Medicaid enrollees to work, Wunderlin’s story could be held up as evidence that government health coverage can help people find employment and, ultimately, reduce their need for public assistance.

Yet his experience is rare. Medicaid typically does not offer such help, and when states do try to help, such efforts are limited.

And opponents point out that most Medicaid recipients already have jobs and say such a mandate would only kick eligible people off Medicaid, rather than improve their economic prospects. Nearly two-thirds of Medicaid enrollees work, with most of the rest acting as caregivers, going to school, or unable to hold a job due to disability or illness, according to KFF, a health information nonprofit that includes KFF Health News.

Existing efforts to help Medicaid recipients get a job have seen limited success because there’s not a lot of “room to move the needle,” said Ben Sommers, a professor of health care economics at the Harvard T.H. Chan School of Public Health. Most Medicaid enrollees already work — just not in jobs with health benefits, he said.

“The ongoing argument that some folks make is that there are a lot of people freeloading in Medicaid,” he said. “That’s just not supported by the evidence.”

Using health programs to encourage work

The GOP-controlled Congress could allow or require states to implement a Medicaid work requirement as part of revamping and downsizing Medicaid. The first Trump administration encouraged those work mandates, but many were struck down by federal judges who said they were illegal under federal law.

Policy experts and state officials say more attention should be paid to investments that have helped people find better jobs — from personalized life coaching to, in some cases, health plans’ directly hiring enrollees.

They argue work requirements alone are not enough. “The move to economic mobility requires a ladder, not a stick,” said Farah Khan, a fellow with the Brookings Institution, a nonpartisan think tank.

While Medicaid work requirements have been debated for decades, the issue has become more heated as 40 states and Washington, D.C., have expanded Medicaid eligibility under the Affordable Care Act to the vast majority of low-income adults. More than 20 million adults have gained coverage as a result — but Republicans are now considering eliminating the billions in extra federal funding that helped states extend eligibility beyond groups including many children, pregnant women, and disabled people.

Only Georgia and Arkansas have implemented mandates that some Medicaid enrollees work, volunteer, go to school, or enroll in job training. But a study Sommers co-authored showed no evidence work requirements in Arkansas’ program led to more people working, in part because most of those who could work already were.

In Arkansas, more than 18,000 people lost coverage under the state’s requirement before the policy was suspended by a federal judge in 2019 after less than a year. Those who lost their Medicaid health care reported being unaware or confused about how to report work hours. Since 2023, Arkansas has been giving Medicaid health plans financial incentives to help enrollees train for jobs, but so far few have taken advantage.

Some plans, including Arkansas Blue Cross and Blue Shield’s, offer members $25 to $65 to complete a “career readiness” certificate. In 2024, some Arkansas health plans offered enrollees educational videos about topics including taxes and cryptocurrency.

Health plans don’t have an incentive to help someone find a better-paying job, because that could mean losing a customer if they then make too much to qualify for Medicaid, said Karin VanZant, a vice president at Clearlink Partners, a health care consulting company.

Rather than offering incentives for providing job training, some states, such as California and Ohio, require the insurance companies that run Medicaid to help enrollees find work.

In Montana, where some lawmakers are pushing to implement work requirements, a promising optional program nearly collapsed after state lawmakers required it be outsourced to private contractors.

Within the program’s first three years, the state paired 32,000 Medicaid enrollees with existing federally funded job training programs. Most had higher wages a year after starting training, the state found.

But enrollment has plummeted to just 11 people, according to the latest data provided by the state’s labor department.

Sarah Swanson, who heads the department, said several of the nonprofit contractors that ran the program shuttered. “There was no real part in this for us to deliver direct services to the folks that walked through our door,” she said. The state hopes to revive job training by allowing the department to work alongside contractors to reach more people.

The hunt for results

State officials say they don’t have much data to track the effectiveness of existing job programs offered by Medicaid plans.

Stephanie O’Grady, a spokesperson for the Ohio Department of Medicaid, said the state does not track outcomes because “the health plans are not employment agencies.”

Officials with CareSource, which operates Medicaid plans in multiple states, say it has about 2,300 Medicaid and ACA marketplace enrollees in its JobConnect program — about 1,400 in Ohio, 500 in Georgia, and 400 in Indiana.

The program connects job seekers with a life coach who counsels them on skills such as “showing up on time, dressing the part for interviews, and selling yourself during the interview,” said Jesse Reed, CareSource’s director of life services in Ohio.

Since 2023, about 800 people have found jobs through the program, according to Josh Boynton, a senior vice president at CareSource. The health plan itself has hired 29 Medicaid enrollees into customer service, pharmacy, and other positions — nearly all full-time with benefits, he said.

In 2022, California started offering nontraditional health benefits through Medicaid — including help finding jobs — for enrollees experiencing homelessness or serious mental illness, or who are otherwise at risk of avoidable emergency room care. As of September, it had served nearly 280,000 enrollees, but the state doesn’t have data on how many became employed.

The University of Pittsburgh Medical Center, which is among the largest private employers in Pennsylvania, running both a sprawling hospital system and a Medicaid plan, has hired over 10,000 of its Medicaid enrollees since 2021 through its training and support services. Among other jobs, they took positions as warehouse workers, customer service representatives, and medical assistants.

The vast majority left low-paying jobs for full-time positions with health benefits, said Dan LaVallee, a senior director of UPMC Health Plan’s Center for Social Impact. “Our Pathways to Work program is a model for the nation,” he said.

Josh Archambault, a senior fellow with the conservative Cicero Institute, said Medicaid should focus on improving the financial health of those enrolled.

While the first Trump administration approved Medicaid work requirements in 13 states, the Biden administration or federal judges blocked all except Georgia’s.

“I don’t think states have been given ample chance to experiment and try to figure out what works,” Archambault said.

KFF Health News senior correspondent Angela Hart contributed to this report.

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

By Shalina Chatlani, Stateline.org

Republicans in Congress are eyeing $880 billion in cuts to Medicaid, the joint federal-state government health care program for lower-income people.

Depending on how states respond, a Republican proposal that would slash the 90% federal contribution to states’ expanded Medicaid programs would end coverage for as many as 20 million of the 72 million people on Medicaid — or cost states $626 billion over the next decade to keep them on the rolls. More than 5 million people could lose coverage if the feds impose work requirements.

In recent months, this complicated government program has increasingly come under the spotlight, so Stateline has put together a guide explaining what Medicaid is and how it operates.

1. Medicaid is not Medicare.

Medicaid serves people with lower incomes or who have a disability. Medicare focuses primarily on older people, no matter their income.

Medicaid and Medicare were created in 1965 under President Lyndon B. Johnson. Medicare is the federal health insurance program for people who are 65 or older, though younger people with special circumstances, such as permanent kidney failure or ALS, may be eligible earlier.

Medicare is a supplemental insurance program that’s limited in scope. It doesn’t pay for long-term care, most dental care or routine physical exams. Around 68.4 million people are enrolled in Medicare.

Medicaid is a more comprehensive government insurance plan that’s jointly funded by the federal government and states. Medicaid covers most nursing home care as well as home- and community-based long-term care. People on Medicaid generally don’t have any copayments. Only people and families with incomes under certain thresholds are eligible for Medicaid. About 72 million people, or a fifth of people living in the United States, receive Medicaid benefits.

2. Medicaid eligibility varies from state to state.

In its original form, Medicaid was generally only available to children and parents or caretakers of eligible children with household incomes below 100% of the federal poverty line ($32,150 for a family of four in 2025). Over the years, the program was expanded to include some pregnant women, older adults, blind people and people with disabilities.

States have to follow broad federal guidelines to receive federal funding. But they have significant flexibility in how they design and administer their programs, and they have different eligibility rules and offer varying benefits.

In 2010, President Barack Obama signed into law the Affordable Care Act, also known as Obamacare, which allowed states to expand their eligibility thresholds to cover adults with incomes up to 138% of the federal poverty line (about $21,000 for one person today), in exchange for greater federal matching funds. The District of Columbia covers parents and caretakers who earn up to 221% of the federal poverty line.

Only 10 states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming) have chosen not to expand coverage. In the non-expansion states, eligibility for caretakers and parents ranges from 15% of the federal poverty line in Texas to 105% in Tennessee. In Alabama, people can only get Medicaid if they earn at or below 18% of the federal poverty line — $4,678 a year for a three-person household.

3. Traditional Medicaid exists alongside a health insurance program for children called CHIP.

Low-income children have always been eligible for Medicaid. But in 1997, Congress created CHIP, or the Children’s Health Insurance Program. The law gave states an opportunity to draw down enhanced federal matching funds to extend Medicaid coverage to children within families who earn too much money to qualify for traditional Medicaid coverage, but make too little money to afford commercial health care.

Like Medicaid, CHIP is jointly funded by the federal government and states, but it’s not an entitlement program. CHIP is a block grant program, meaning states receive a fixed amount of federal money every year and aren’t obligated to cover everyone who meets the eligibility requirements. States get to decide, within broad federal guidelines, how their CHIP programs will work and what the income limits will be. Some states have chosen to keep their CHIP and Medicaid programs separate, while others have decided to combine them by using CHIP funds to expand Medicaid eligibility.

4. Medicaid and CHIP are significant portions of state budgets.

In 2024, the federal government spent less on Medicaid and CHIP than on Medicare, with Medicare spending accounting for 12%, or $847.5 billion, of the federal benefit budget, and Medicaid and CHIP accounting for 8%, or $584.5 billion.

But at the same time, Medicaid is the largest source of federal funds for states, accounting for about a third of state budgets, on average, and 57% of all federal funding the states received last year.

5. Federal funding varies by state.

Before the Affordable Care Act, federal Medicaid funding to states mostly depended on a formula known as the FMAP, or the federal medical assistance percentage, which is based on the average personal income of residents. States with lower average incomes get more financial assistance. For example, the federal government reimburses Mississippi, which is relatively poor, nearly $8 for every $10 it spends, for a net state cost of $2. But New York is only reimbursed $5. By law the FMAP can’t be less than 50%.

The ACA offered states the opportunity to expand eligibility and receive an even greater federal matching rate. In expansion states, the federal government covers 90% of costs for expansion adults. If Republicans in Congress reduce that percentage, states would have to use their own money to make up for lost federal dollars. They might have to scale back Medicaid coverage for some groups, eliminate optional benefits or reduce provider payment rates. Alternatively, they could raise taxes or make cuts in other large budget items, such as education.

Another possibility is that states that have adopted Medicaid expansion would reverse it. Nine states (Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia) already have “trigger” laws in place that would automatically rescind expansion if the federal match rate dips below 90%. Other states are considering similar legislation.

One new analysis from KFF, a health research policy group, found that if Congress reduced the federal match for the expansion population to the percentages states get for the traditional Medicaid population— 50% for the wealthiest states and 77% for the poorest ones — it would cost states $626 billion over the next decade to keep everyone eligible under Medicaid expansion on the rolls.

6. Medicaid is the largest source of health coverage, especially for people with low incomes.

Medicaid is the single largest health payer in the nation, and is particularly important for people in poverty. Almost a fifth of people living in the United States are covered through Medicaid. But nearly half of all adults with incomes at or below the federal poverty line are insured through the program. Medicaid covers 4 out of every 10 children overall, but it covers 8 out of every 10 children below the federal poverty line. Medicaid also provides coverage for people experiencing homelessness or who are leaving incarceration.

7. Medicaid covers essential services, such as childbirth.

In exchange for receiving federal funds, states are obligated to cover essential health care services, including inpatient and outpatient hospital services, doctor visits, laboratory work and home health services, among other things. States get to decide which optional services, such as prescription drugs and physical therapy, they want to cover.

Medicaid is a significant payer of essential services. For example, the program covers 41% of all childbirths in the U.S. and covers health care services for the 40% of all adults ages 19-65 with HIV.

8. The majority of Medicaid spending goes to people with disabilities and to pay for long-term care.

ACA expansion adults — about 1 out of every 4 enrollees — accounted for 21% of total Medicaid expenditures in 2021. Children, who make up about 1 out of every 3 enrollees, only accounted for 14% of spending.

People who qualify for Medicaid because of a disability or because they are over the age of 65 make up about 1 out of every 4 enrollees. But they accounted for more than half of all Medicaid spending. That’s because these populations typically experience higher rates of chronic illness and require more complex medical care. Older people are also more likely to use nursing homes and other long-term care facilities, which can be expensive.

Cuts could also mean that older people relying on Medicaid for home-based care and long-term nursing home services could be significantly affected.

9. Some state Medicaid programs cover people who are living in the country illegally.

People who are in the country illegally are ineligible for traditional Medicaid or CHIP. But some states have carved out exceptions to extend coverage to them using state dollars.

As of January, 14 states and the District of Columbia provide Medicaid coverage to children regardless of their immigration status. And 23 states plus the District of Columbia use CHIP to cover pregnant enrollees regardless of their immigration status.

Also, seven states provide Medicaid to some adults who are here illegally. New York opted to cover those who meet the income requirements and are over the age of 65, regardless of immigration status And California provides coverage to any adults ages 19-65 who are under the income threshold, regardless of immigration status.

10. The majority of the public holds favorable views of Medicaid.

According to surveys from KFF, two-thirds of Americans say that someone close to them has received health coverage from Medicaid at some point in their lives. Half of the public also say they or someone in their family have been covered through Medicaid.

Generally, around 3 out of every 4 people — regardless of political party — say that Medicaid is very important, though Republicans are less likely than Democrats and independents to share that opinion. At the same time, a third or less of people want to see any decrease in spending on the Medicaid program. In fact, the majority of people living in states that have not expanded Medicaid under the ACA want their states to do so.

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

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

By Natalie Skowlund, KFF Health News

SILVERTHORNE, Colo. — When Adolfo Román García-Ramírez walks home in the evening from his shift at a grocery store in this central Colorado mountain town, sometimes he thinks back on his childhood in Nicaragua. Adults, he recollects, would scare the kids with tales of the “Mona Bruja,” or “Monkey Witch.” Step too far into the dark, they told him, and you might just get snatched up by the giant monstrous monkey who lives in the shadows.

Now, when García-Ramírez looks over his shoulder, it’s not monster monkeys he is afraid of. It’s U.S. Immigration and Customs Enforcement officers.

“There’s this constant fear that you’ll be walking down the street and a vehicle rolls up,” García-Ramírez, 57, said in Spanish. “They tell you, ‘We’re from ICE; you’re arrested,’ or, ‘Show me your papers.’”

Silverthorne, a commuter town between the ski meccas of Breckenridge and Vail, has been García-Ramírez’s home for the past two years. He works as a cashier at the grocery and shares a two-bedroom apartment with four roommates.

The town of nearly 5,000 has proved a welcome haven for the political exile, who was released from prison in 2023 after Nicaragua’s authoritarian government brokered a deal with the U.S. government to transfer more than 200 political prisoners to the U.S. The exiles were offered temporary residency in the U.S. under a Biden administration humanitarian parole program.

García-Ramírez’s two-year humanitarian parole expired in February, just a few weeks after President Donald Trump issued an executive order to end the program that had permitted temporary legal residency in the U.S. for hundreds of thousands of Cubans, Haitians, Nicaraguans, and Venezuelans, putting him at risk of deportation. García-Ramírez was stripped of his Nicaraguan citizenship when he came to the U.S. Just over a year ago, he applied for political asylum. He is still waiting for an interview.

“I can’t safely say I’m calm, or I’m OK, right now,” García-Ramírez said. “You feel unsafe, but you also feel incapable of doing anything to make it better.”

Vail and Breckenridge are world famous for their ski slopes, which attract millions of people a year. But life for the tourism labor force that serves Colorado’s mountain resorts is less glamorous. Residents of Colorado’s mountain towns experience high rates of suicide and substance use disorders, fueled in part by seasonal fluctuations in income that can cause stress for many in the local workforce.

The Latino communities who make up significant proportions of year-round populations in Colorado’s mountain towns are particularly vulnerable. A recent poll found more than 4 in 5 Latino respondents in the Western Slope region, home to many of the state’s rural ski resort communities, expressed “extremely or very serious” concern about substance use. That’s significantly higher than in rural eastern Colorado’s Morgan County, which also has a sizable Latino population, and in Denver and Colorado Springs.

Statewide, concerns about mental health have surged among Latinos in recent years, rising from fewer than half calling it an extremely or very serious problem in 2020 to more than three-quarters in 2023. Health care workers, researchers, and community members all say factors such as language differences, cultural stigma, and socioeconomic barriers may exacerbate mental health issues and limit the ability to access care.

“You’re not getting regular medical care. You’re working long hours, which probably means that you can’t take care of your own health,” said Asad Asad, a Stanford University assistant professor of sociology. “All of these factors compound the stresses that we all might experience in daily life.”

Add sky-high costs of living and an inadequate supply of mental health facilities across Colorado’s rural tourist destinations, and the problem becomes acute.

Now, the Trump administration’s threats of immigration raids and imminent deportation of anyone without legal U.S. residency have caused stress levels to soar. In communities around Vail, advocates estimate, a vast majority of Latino residents do not have legal status. Communities near Vail and Breckenridge have not experienced immigration raids, but in neighboring Routt County, home to Steamboat Springs, at least three people with criminal records have been detained by ICE, according to news reports. Social media posts falsely claiming local ICE sightings have further fueled concerns.

Yirka Díaz Platt, a bilingual social worker in Silverthorne originally from Peru, said a pervasive fear of deportation has caused many Latino workers and residents to retreat into the shadows. People have begun to cancel in-person meetings and avoid applying for government services that require submitting personal data, according to local health workers and advocates. In early February, some locals didn’t show up to work as part of a nationwide “day without immigrants” strike. Employers wonder whether they will lose valuable employees to deportation.

Some immigrants have stopped driving out of fear they will be pulled over by police. Paige Baker-Braxton, director of outpatient behavioral health at the Vail Health system, said she has seen a decline in visits from Spanish-speaking patients over the last few months.

“They’re really trying to keep to themselves. They are not really socializing much. If you go to the grocery stores, you don’t see much of our community out there anymore,” Platt said. “There’s that fear of, ‘No, I’m not trusting anyone right now.’”

Juana Amaya is no stranger to digging in her heels to survive. Amaya immigrated to the Vail area from Honduras in 1983 as a single mother of a 3-year-old and a 6-month-old. She has spent more than 40 years working as a house cleaner in luxury condos and homes around Vail, sometimes working up to 16 hours a day. With barely enough time to finish work and care for a family at home, she said, it is often hard for Latinos in her community to admit when the stress has become too much.

“We don’t like to talk about how we’re feeling,” she said in Spanish, “so we don’t realize that we’re dealing with a mental health problem.”

The current political climate has only made things worse.

“It’s had a big impact,” she said. “There are people who have small children and wonder what they’ll do if they’re in school and they are taken away somewhere, but the children stay. What do you do?”

Asad has studied the mental health impacts of deportation rhetoric on Latino communities. He co-authored a study, published last year in the journal Proceedings of the National Academy of Sciences, that found escalated deportation rhetoric may cause heightened levels of psychological distress in Latino noncitizens and even in Latino citizens.

Asad found that both groups may experience increased stress levels, and research has borne out the negative consequences of a parent’s lack of documentation on the health and educational attainment of their children.

“The inequalities or the hardships we impose on their parents today are the hardships or inequalities their children inherit tomorrow,” Asad said.

Despite heightened levels of fear and anxiety, Latinos living and working near Vail still find ways to support one another and seek help. Support groups in Summit County, home to Breckenridge and less than an hour’s drive from Vail, have offered mental health workshops for new immigrants and Latina women. Building Hope Summit County and Olivia’s Fund in Eagle County, home to Vail, help those without insurance pay for a set number of therapy sessions.

Vail Health plans to open a regional inpatient psychiatric facility in May, and the Mobile Intercultural Resource Alliance provides wraparound services, including behavioral health resources, directly to communities near Vail.

Back in Silverthorne, García-Ramírez, the Nicaraguan exile, takes things one day at a time.

“If they deport me from here, I’d go directly to Nicaragua,” said García-Ramírez, who said he had received a verbal death threat from authorities in his native country. “Honestly, I don’t think I would last even a day.”

In the meantime, he continues to make the routine trek home from his cashier job, sometimes navigating slick snow and dark streets past 9 p.m. When nightmarish thoughts about his own fate in America surface, García-Ramírez focuses on the ground beneath his feet.

“Come rain, shine, or snow,” he said, “I walk.”

This article was published with the support of the Journalism & Women Symposium (JAWS ) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

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

By Kacie Goff, Bankrate.com

Per the 2024 National Association of Realtors (NAR) Member Profilec, a typical agent had 10 transactions in the last year. With roughly one deal closing per month, the agent you hire should theoretically have bandwidth to provide you with the best possible service.

If that doesn’t ring true for your current experience, however, it could be time for a change. You might be wondering when to fire your Realtor. Or, more pressingly, how to fire your real estate agent.

Let’s take a look at when to make that call — and how to navigate a firing legally.

How to know when to fire your Realtor

We’re all only human, so it’s OK if an agent makes a mistake or two. But you may want to consider finding a new real estate rep if you spot several of these red flags:

• They don’t communicate well. Your agent should be reachable and communicative with you. If they take a long time to get back to you, it can impact your ability to see listings and put in offers before the competition. And if you feel like they’re not being straightforward with you, or possibly even lying, that’s a deal-breaker. Speaking in jargon is another issue — politely ask them to explain anything you don’t understand.
• They’re not marketing your home well. Today, real estate pros have a wide range of options they can use to get the word out about your listing. If your home isn’t turning up on leading listing sites or is otherwise poorly positioned, you might want to figure out how to fire your real estate agent.
• There’s a personality clash. Your agent is navigating one of the biggest decisions of your life with you. You want to feel comfortable working with them. If your personalities don’t mesh well, you might be better served by finding someone else. Trust your instincts. If it doesn’t feel right, it probably isn’t.
• They’re overly pushy or aggressive. An agent’s job is to advocate for you — not against you. Someone who is argumentative or tries to pressure you into things you feel uncomfortable with is not a good fit.
• They act unprofessional. Everyone has a different work style, but there are a few behaviors that just won’t fly. If they consistently show up late to appointments (or not at all), come unprepared, lack knowledge about the property or seem distracted during your interactions, be wary. This shows a lack of respect for you as a client.
• They’re unfamiliar with the market. A good agent stays informed about their local market. If they don’t know about current market trends in your area, how can they help you find the best place or make the best deal possible? Make sure to arrange regular and continual updates from your agent on market conditions, recent sales, new listings, available inventory and price trends.
• They demonstrate a lack of skills. Whether it’s helping you stage your for-sale home or negotiating on price, you want an agent who knows what they’re doing. No one likes to feel like they left money on the closing table, whether you’re the buyer or the seller.

How to fire your real estate agent

Don’t leap to a firing right away. If you’re unhappy with your agent, you may still be able to mend the relationship: Try communicating with them openly in a non-confrontational way about the issues you have. If the issues persist, it’s probably time to let them go. You’ll need to do so legally, ensuring you’re in compliance with any agreements or contracts you signed. The last thing you want is an expensive court battle.

Once you know when to fire your Realtor or real estate agent, you can take certain steps. Those vary slightly between buyers and sellers, so we outline them separately below.

If you follow these steps, be polite and respectful. Your dissatisfaction with the agent will reflect badly on them and probably hurt their career, so be mindful not to make the impact of your feedback worse.

If you’re a buyer

If you had someone helping you buy a home, figuring out how to fire your real estate agent means:

• Checking if you’ve signed anything: If nothing’s in writing and your dealings with the agent have remained informal, then you’re in the clear to walk away.
• Reviewing what you’ve signed: If you’ve signed a buyer’s agent agreement, you’re bound by the criteria in that agreement.
• Pursuing termination rights: Agreements do typically spell out termination rights, though, so review those carefully. If the agent hasn’t held up their end of the bargain (e.g., has missed appointments or made mistakes on documentation), you may be within your legal rights to terminate the relationship before the agreement ends. If you have a real estate attorney, you may want to have them write the termination letter to avoid any complications or liability.
• Trying to make things work: If you have a written agreement with the agent that you can’t get out of, go directly to the agent. Tell them what you need to see change. Writing a list of the issues at hand might help them understand the situation and where they need to make adjustments. Then, give the agent some time to see if they improve. Be constructive and show them you’re interested in creating a positive relationship that works for both of you.
• Escalating the issue as needed: If you’re somewhat stuck and can’t get anywhere with the agent on your own, now’s a good time to escalate the issue to the agent’s brokerage, or the company for which they work. The broker there functions somewhat like the agent’s boss, and may be able to help you and the agent find a better path forward.
• Seeing if they’ll agree to termination: Sometimes, the agent or their broker will allow you to terminate your agreement early when things aren’t going well. You can request that and hope they agree.
• Waiting out the timeline: Buyer’s agreements usually tie you to your agent until the time period specified in the agreement runs out. That probably means sticking with that agent for several months if you haven’t found resolution with them or their broker.

If you’re a seller

For folks who’ve been working with an agent to sell, the process is similar but comes with some differences. Go through these steps if you’re a seller trying to figure out how to fire your real estate agent.

• Checking if you’ve signed anything: If you’ve just been informally chatting, you’re under no obligation. But if your home is already on the market, you’ve likely signed with a listing agent. A listing agent, also called a seller’s agent, usually invests more time and effort in your property upfront, such as pulling comps, marketing the home and holding open houses. This investment makes it trickier to break up with them.
• Figuring out what you’ve signed: The most common agreement a seller would have with a listing agent is an exclusive right to sell, meaning the agent is solely responsible for bringing in prospective buyers and selling your property. It also usually means you’re responsible for paying their commission.
• Seeing if you can get out of it: Your agreement with the agent might lay out requirements for them, and termination rights for you if they don’t live up to those. Make sure they are unambiguous. You may be able to dissolve the agreement if any of those termination rights apply to your situation.
• Raising your complaints with the agent: If no termination rights apply, write down what’s going wrong for you. Craft a letter or list you can share with the agent to help them understand what you need from them. Sharing this with them in a face-to-face, non-confrontational discussion is probably best. Don’t be accusatory or attempt to place blame.
• Going to their broker: Real estate agents legally have to work under the supervision of a broker. This person essentially acts as their boss, so getting them involved can help redirect the agent. They don’t want to lose the listing or suffer the reputational damage, so they should go out of their way to solve the problems and accommodate you.
• Asking for termination: With your list of issues in hand, you can ask the agent and/or their broker if they’re willing to terminate your agreement with them early. If the situation is difficult, they might agree. If they agree, get a written release and a waiver of liability. Also, get a list of all the people they have shown your home to. If any of those people subsequently buy your house, you’ll have to pay a commission.
• Waiting out the agreement: If nothing else works, you’ll need some patience. Your exclusive right to sell agreement should have an expiration date. After that point, you’re free to work with another agent.

Tips for hiring the right agent

You’ve been burned — it’s OK, it happens. But now you want to make sure it doesn’t happen again, and find someone who you really click with.

When you’re looking for a new real estate agent, make sure you do your research. Ask friends and family for recommendations. Search online and read reviews. Once you narrow it down to a few candidates, schedule time to interview them, and don’t be afraid to ask questions. Find out about their experience and market knowledge. And trust your gut — working with someone you genuinely like is always best.

Bottom line

Know the signs of a bad real estate agent. You don’t have to settle for someone you don’t like and don’t work well with, or someone who isn’t doing a good job for you. Walk away or figure out how to terminate or wait out the contract. Then, take your time to find a new agent who will meet your needs and work to get you what you want.

FAQs

How do you write a termination letter to a real estate agent?

The letter should have a header that provides your contact information so the brokerage can know which agreement you want to terminate. In the letter, explain why you’re terminating the agreement. Refer specifically to the factual elements that are the basis for termination. Don’t elaborate or exaggerate. Make sure to also mention the specific termination clause from the agreement that you’re calling on.

How do you deal with an unprofessional Realtor?

First, be clear and direct with them. If they’re late for an appointment, for example, tell them that it made you feel disrespected as a client. If they don’t respond to your feedback, escalate the issue to their broker. It is always good to keep a written record of issues and conversations with the agent.

What is unethical Realtor behavior?

If someone is a Realtor, it means they’ve agreed to abide by the NAR’s Code of Ethics. Anything outside of that code, then, is considered unethical. Some common issues here include misrepresenting or concealing facts, discriminating, an unwillingness to work with other agents when it best serves the client and not being transparent about any kickbacks they receive.

©2025 Bankrate.com. Distributed by Tribune Content Agency, LLC.

By Vinod Sreeharsha, Miami Herald

Carnival Corp. is putting the finishing touches on a new destination for cruise passengers.

Beginning in July, Doral-based Carnival will send ships between PortMiami and Celebration Key, a private development in the Bahamas.

Described by the cruise ship company as “a new destination from the ground up,” Celebration Key is on the southern side of Grand Bahama island and about 17 miles northeast of Freeport.

When finished, the resort will have its own pier with two berths where Carnival’s largest ships can dock. In 2026, the pier at Celebration Key will add two more berths so a total of four Carnival ships can dock at the same time.

The resort will feature water slides for kids, scuba diving and other sports, and excursions. And there will be restaurants and bars that passengers can reach by walking or swimming.

Costing $600 million, the destination is the latest in major cruise carriers betting big time on private islands or resorts built from the ground up. The new stops give cruisers more beach time, expand group activities and bring in more money.

Royal Caribbean, also based in Miami, is developing a third private space in Mexico that’s expected to be ready in 2027. The company’s other two private resorts are in Labadee, Haiti, and Coco Cay in the Bahamas. Norwegian Cruise Line has Great Stirrup Cay, also in the Bahamas.

Carnival is so keen on Celebration Key that 20 of its 27 ships plan to sail there, including all five ships that call PortMiami home: Carnival Celebration, Carnival Horizon, Carnival Sunrise, Carnival Conquest and Carnival Magic. Ships sailing from Baltimore, New Orleans and Galveston will also head there this year.

Carnival Conquest, which does three-and four-day trips to the Bahamas, will be the first PortMiami-based ship to visit Celebration Key, departing South Florida on July 18.

At the construction site

“Celebration Key represents a new chapter for Carnival and its construction builds on our close partnership with the Bahamas,” Christine Duffy, president of Carnival Cruise Line, said in a statement. “Seeing it transform from vision to reality is incredible.”

Duffy visited the under-construction Celebration Key in February, along with Carnival Corp. Chief Executive Officer Josh Weinstein and Chief Maritime Officer Lars Ljoen. The cruise executives joined leaders from the organization Plant a Tree and replanted about 1,000 sabal palms, a nod to the role their industry needs to play in increasing sustainability.

Duffy also took part in “the ceremonial filling of one of two expansive freshwater lagoons, the largest in the Caribbean.” These will be sustained by Celebration Key’s desalination system that converts seawater into freshwater. The lagoons span over seven acres and hold about seven million gallons of water.

Carnival broke ground on the project less than three years ago. About 500 Bahamian workers are on the 65-acre site around the clock to make sure the resort is ready by July.

The cruises from Miami that will stop at Celebration Key range from a three-day weekend cruise on Carnival Conquest to a 13-day trip starting from Barcelona on Carnival Journeys. Carnival Celebration will offer a variety of seven-day cruises to the eastern and western Caribbean that stop at the new resort.

The resort expects to have more than 30 restaurants and bars, from full-service sit-downs to self-ordering food trucks.

The development is broken down into different areas.

Paradise Plaza is the welcoming area. Starfish Lagoon has recreation and relaxation. Calypso Lagoon has an adult-only area with a DJ island and a large swim-up bar. Pearl Cove Beach Club is a premium adult-only space with an infinity pool and beachfront cabanas. Pearl Cove Beach Club will offer beachfront daybeds, private cabanas and Super Villas, each of which includes access to the club’s open bar service, infinity pool, full-service restaurant and beachfront.

Here is a rundown on the food and drinks:

Food on Carnival’s Celebration Key

Calypso Lagoon

—Mingo’s Tropical Bar & Kitchen, named after the Bahamas’ national bird the flamingo, is a full-service, Carnival-run restaurant offering Bahamian favorites including fried fish and conch fritters, as well as burgers, seafood, tacos, steak and sandwiches. Mingo’s bar will serve tropical frozen drinks and cocktails.

—Mingo’s Express food truck, just outside the restaurant, has self-ordering kiosks and shaded seating, and to-go hamburgers, salads and fish sandwiches.

—Surf N’ Sauce BBQ & Brews is a full-service dining spot serving slow-smoked meat prepared in an outdoor smoker. A full-service bar pours craft beer from Bahamian breweries.

Starfish Lagoon

—Gill’s Grill, a full-service restaurant and full bar, cooks up Caribbean seafood including seafood baskets, local fish, lobster, steamed crab and shrimp, chicken, burgers and kids’ meals.

—Captain’s Galley Food Hall features five outlets serving burgers, hot dogs, fried chicken, pizza, Mediterranean bowls, tacos and burritos.

—Food trucks with self-ordering kiosks offer chicken sandwiches, burgers and conch fritters.

Pearl Cove Beach Club

—Pearl Cove Beach Club restaurant in an area for guests 18 and older.

Beverages on Celebration Key

Calypso Lagoon

—Long Necks Bar is where you can grab one of 100 seats and order a frozen drink, beer or Bahamian cocktail while a DJ spins tunes.

—The Sunshine Swings Bar has 40 swings and offers a “chill vibe.”

—The Parrotfish Swim-Up Bar has seating in-water and out-of-water and serves frozen cocktails and mocktails with tropical fruit juice.

Pearl Cove Beach Club

—An infinity pool overlooks the beach and a swim-up bar

Paradise Plaza

—A welcome area where you can get your caffeine fix or energy boost with coffee and ice cream.

Carnival cruise reservations

You can book sailings taking place into 2027. To learn more about sailings and make reservations, visit the Carnival website at carnival.com.

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

By Scott S. Greenberger, Stateline.org

Working-age adults who live in small towns and rural areas are more likely to be covered by Medicaid than their counterparts in cities, creating a dilemma for Republicans looking to make deep cuts to the health care program.

About 72 million people— nearly 1 in 5 people in the United States — are enrolled in Medicaid, which provides health care coverage to low-income and disabled people and is jointly funded by the federal government and the states. Black, Hispanic and Native people are disproportionately represented on the rolls, and more than half of Medicaid recipients are people of color.

Nationwide, 18.3% of adults who are between the ages of 19 and 64 and live in small towns and rural areas are enrolled, compared with 16.3% in metro areas, according to a recent analysis by the Center for Children and Families at Georgetown University.

In 15 states, at least a fifth of working-age adults in small towns and rural areas are covered by Medicaid, and in two of those states — Arizona and New York — more than a third are. Eight of the 15 states voted for President Donald Trump.

Twenty-six Republicans in the U.S. House represent districts where Medicaid covers more than 30% of the population, according to a recent analysis by The New York Times. Many of those districts have significant rural populations, including House Speaker Mike Johnson’s 4th Congressional District in Louisiana.

Republican U.S. Rep. David Valadao of California, whose Central Valley district is more than two-thirds Hispanic and where 68% of the residents are enrolled in Medicaid, has spoken out against potential cuts.

“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid, and I will not support a final reconciliation bill that risks leaving them behind,” Valadao said to House members in a recent floor speech.

U.S. House Republicans are trying to reduce the federal budget by $2 trillion as they seek $4.5 trillion in tax cuts. GOP leaders have directed the House Energy and Commerce Committee, which oversees Medicaid and Medicare, to find $880 billion in savings.

Trump has ruled out cuts to Medicare, which covers older adults. That leaves Medicaid as the only other program big enough to provide the needed savings — and the Medicaid recipients most likely to be in the crosshairs are working-age adults. But targeting that population would have a disproportionate impact on small towns and rural areas, which are reliably Republican.

Furthermore, hospitals and other health care providers in rural communities are heavily reliant on Medicaid. Many rural hospitals are struggling, and nearly 200 have closed or significantly scaled back their services in the past two decades.

Before the Affordable Care Act was enacted in 2010, there were far fewer working-age adults on the Medicaid rolls: The program mostly covered children and their caregivers, people with disabilities and pregnant women. But under the ACA, states are allowed to expand Medicaid to cover adults making up to 138% of the federal poverty level — about $21,000 a year for a single person. As an inducement to expand, the federal government covers 90% of the costs — a greater share than what the feds pay for the traditional Medicaid population.

Last year, there were about 21.3 million people who received coverage through Medicaid expansion.

One GOP cost-saving idea is to reduce the federal match for that population to what the feds give states for the traditional Medicaid population, which ranges from 50% for the wealthiest states to 77% for the poorest ones. That would reduce federal spending by $626 billion over a 10-year period, according to a recent analysis by KFF, a health research group.

Nine states — Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia — have so-called trigger laws that would automatically end Medicaid expansion if the feds reduce their share. Three other states — Idaho, Iowa and New Mexico — would require other cost-saving steps.

“States will not be able to cover those shortfalls,” said Jennifer Driver, senior director of reproductive rights at the State Innovation Exchange, a left-leaning nonprofit that advocates on state legislative issues. “It’s not cutting costs. It is putting people in real danger.”

Studies have shown that Medicaid expansion has improved health care for a range of issues, including family planning, HIV care and prevention, and postpartum health care.

Another idea is to require able-bodied Medicaid recipients to work. That would affect an average of 15 million enrollees each year, and 1.5 million would lose eligibility for federal funding, resulting in federal savings of about $109 billion over 10 years.

In heavily rural North Carolina, which has a trigger law, there are about 3 million people on Medicaid, and 640,000 of them are eligible under the state’s expansion program. About 231,000 of the expansion enrollees live in rural counties. Black residents make up about 36% of new enrollees under the state’s eligibility expansion, but only about 22% of the state’s population.

Brandy Harrell, chief of staff at the Foundation for Health Leadership & Innovation, an advocacy group based in Cary, North Carolina, that focuses on rural issues, said the proposed Medicaid cuts would “deepen the existing disparities” between white people and Black people and urban and rural residents.

“It would have a profound effect on working families by reducing access to essential health care, increasing financial strain and jeopardizing children’s health,” Harrell said. “Cuts could lead to more medical debt, and also poorer health outcomes for our state.”

Two of the North Carolina lawmakers with about 30% of their constituents on Medicaid, U.S. Reps. Virginia Foxx and Greg Murphy, represent heavily rural districts in western and coastal North Carolina, respectively.

Foxx has supported GOP budget priorities in social media posts. Murphy, a physician and co-chair of the GOP Doctors Caucus in the House, has focused his statements on taking care of what he says is abuse and fraud in the Medicaid system.

But North Carolina Democratic Gov. Josh Stein sent a letter to U.S. House and Senate leaders of both parties, saying the state’s rural communities disproportionately rely on Medicaid and that cuts would upend an already fragile landscape for rural hospitals in the state.

“The damage to North Carolina’s health care system, particularly rural hospitals and providers, would be devastating, not to mention to people who can no longer afford to access health care,” Stein wrote.

In Nebraska, 27% of residents live in rural areas, and state lawmakers are already scrambling to make up for reduced federal Medicaid funding.

Dr. Alex Dworak, a family medicine physician who works at an Omaha health clinic that serves low-income and uninsured people, said a dearth of health care options in rural Nebraska already hurts residents. He has one patient who drives up to three hours from his rural community to the clinic.

“It wouldn’t be just bad for marginalized communities, but it would be worse for marginalized communities — because things were already worse for them,” Dworak said of proposed Medicaid cuts. “It will be an utter disaster.”

Stateline reporter Nada Hassanein and Stateline’s Barbara Barrett contributed to this report. Scott S. Greenberger can be reached at sgreenberger@stateline.org.

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

By Mia Taylor, TravelPulse

Anxiety surrounding air travel has been growing among the public in recent weeks and months.

With the deadly crash in Washington, D.C., earlier this year and several near misses, as well as FAA staff being slashed by the new U.S. president, it’s not exactly surprising that uneasiness is spiking.

If turbulence is one of the factors that causes you anxiety when flying, here is some news to notice: A new study has been released that identifies the most turbulent air travel routes globally.

The study was conducted by turbulence tracking company Turbli and is based on a review of turbulence forecast data provided by NOAA and the UK Met Office. The result of this effort is a ranking of the most unstable flight routes worldwide.

And coming in at the top of the list (meaning the most turbulent flight route) is the route from Mendoza, Argentina, and Santiago, Chile. The eddy dissipation rate (EDR), which is essentially turbulence intensity, associated with this route is 24.684.

To put that into some context, that’s 4 EDR greater than the second most turbulent flight path identified by the research. Coming in second is the route between Cordoba, Argentina and Santiago, Chile, which has an EDR of 20.214.

As it turns out the third most turbulent route on the list is also an Argentina-based route. It is the route between Mendoza, Argentina and Salta, Argentina. This flight route has an EDR of 19.825.

Turbulence is an irregular motion of the air resulting from eddies and vertical currents, according to the National Weather Service.

“Turbulence is one of the most unpredictable of all the weather phenomena that are of significance to pilots,” says the National Weather Service website. “It may be as insignificant as a few annoying bumps or severe enough to momentarily throw an airplane out of control or to cause structural damage.”

Turbulence is associated with fronts, wind shear and thunderstorms.

Here are the top 10 most turbulent routes globally

• Mendoza (MDZ) – Santiago (SCL) 
EDR: 24.684
• Cordoba (COR) – Santiago (SCL) 
EDR: 20.214
• Mendoza (MDZ) – Salta (SLA) 
EDR: 19.825
• Mendoza (MDZ) – San Carlos de Bariloche (BRC) 
EDR: 19.252
• Kathmandu (KTM) – Lhasa (LXA) 
EDR: 18.817
• Chengdu (CTU) – Lhasa (LXA) 
EDR: 18.644
• Santa Cruz (VVI) – Santiago (SCL) 
EDR: 18.598
• Kathmandu (KTM) – Paro (PBH) 
EDR: 18.563
• Chengdu (CTU) – Xining (XNN) 
EDR: 18.482
• San Carlos de Bariloche (BRC) – Santiago (SCL) 
EDR: 18.475

©2025 Northstar Travel Media, LLC. Visit at travelpulse.com. Distributed by Tribune Content Agency, LLC.