August is the best time of the year to take a dip in Lake Michigan, when its waters hover in the balmy upper 60s. Experts say so, and Chicago’s crowded beaches offer proof. But an invisible hazard can quickly turn a sunny day out into a sick night in.

In 2024, over 300 beaches across the Great Lakes closed to visitors or issued swim bans or advisories due to the presence of bacteria in the water — mostly E. coli, from nearby surface runoff or sewer system overflows, especially during heavy rain — according to state and federal data.

Bacteria levels triggered 83 advisories or closures in Illinois last summer, making it the second worst in the Midwest, with 71 in Lake County’s 13 lakefront beaches and 12 across nine beaches in Cook County. As of Thursday, Lake County beaches have had 49 advisories this summer, according to data from the state’s Department of Public Health. There has been at least one beach advisory in Cook County so far, according to Evanston officials.

“What we want, really want, to see is not that people say, ‘Well, that’s just the way it is.’ It shouldn’t have to be this way,” said Nancy Stoner, senior attorney at the Environmental Law and Policy Center, who focuses on clean water issues. “It’s pollution that can be controlled and should be controlled, because people deserve to be able to know that they can swim safely in the Great Lakes.”

In Wisconsin, 90 beaches closed or had advisories between May and September 2024 — representing the most lakefront locations affected — followed by Illinois, Ohio with 67, Michigan with 62, Indiana with 20 and Minnesota with 17, according to data from the U.S. Environmental Protection Agency’s Beach Advisory and Closing Online Notification system, which ELPC analyzed.

Even these numbers are just a starting point. In addition to different frequencies in testing among municipalities, there can also be a lag time by states in filing this information to the U.S. EPA. For instance, the federal agency’s system lists no advisories or closures for Illinois in 2024, data that currently can only be found on the state website. According to a spokesperson, the IDPH attempted a submission, which was rejected because of formatting compatibility issues. The state agency said it continues to work to rectify the situation with the U.S. EPA.

“Beachgoers should be able to rely upon the information provided by U.S. EPA to find out whether the beach they want to go to is safe for swimming,” Stoner said. “They can’t do that right now, and the fact that wrong information is being provided by U.S. EPA makes the situation even worse. U.S. EPA needs to fix this problem right away so that beachgoers don’t unknowingly swim in contaminated water and risk getting sick.”

Known as the BEACON system, it is supported by federal grant funding that allows officials to monitor water quality and bacteria levels. Symptoms in humans exposed to this and similar pathogens can include nausea, diarrhea, ear infections and rashes. According to scientists, each year, there are 57 million cases of people getting sick in the United States from swimming in contaminated waters.

When a certain safety threshold set by the U.S. EPA is exceeded, local officials can decide to issue a swim ban or advisory. Three locations, all north of Chicago, exceeded the EPA’s threshold on at least 25% of days tested last year: North Point Marina Beach, Waukegan North Beach and Winnetka Lloyd Park Beach, according to data from BEACON analyzed in a July report by advocacy nonprofit Environment America.

Chicago tests the water in all its public lakefront beaches every day of the summer, unlike communities in Lake County, which only test four days a week. The report also found that, on the city’s 26 miles of public lakefront during the 2024 season, at least four beaches had potentially unsafe levels between 14% and 21% of the days that the water was tested, including 31st Street Beach, Calumet South Beach, 63rd Street Beach and Montrose Beach.

Most of the funding for testing and monitoring comes from the BEACH Act, or the Beaches Environmental Assessment and Coastal Health Act, which has protected public health in recreational waters across the country since its unanimous passing 25 years ago. Since then, the U.S. EPA has awarded over $226 million in grants for these programs.

“(It) is a small program for a federal program, but a lot in funding” impact, Stoner said.

However, in its 2026 proposed budget, the administration of President Donald Trump suggested slashing the EPA’s budget and clean water programs. In July, the House Appropriations Committee approved a 25% cut in the agency’s Clean Water State Revolving Fund, which helps states manage wastewater infrastructure to ensure the cleanliness of waterways.

The proposed cuts come at a time when humid weather and heavier storms, intensified by human-made climate change, are overwhelming outdated sewer systems and releasing human waste into waterways. Stormwater can carry runoff pollution and manure from industrial livestock operations into beaches. E. coli also grows faster in warmer water, so increasing lake temperatures pose a growing risk to swimmers.

Advocates say that — for the sake of public health and recreation — the federal government must continue to ensure funding for these programs and support the staff and institutions that uphold environmental protections.

“The BEACH Act is a piece of it. That’s about monitoring and public notification. That’s important,” Stoner said, “but really, funding the underlying work that needs to be done is essential. So, funding the EPA, funding the staff at the EPA, funding these labs throughout the Great Lakes, funding NOAA … There’s a whole system.”

While it doesn’t often do so, Chicago is one of 158 communities authorized to discharge sewage into the Great Lakes.

Besides Chicago, cities like Milwaukee, Grand Rapids, Michigan, and Toledo, Ohio, have also updated their sewer systems and reduced the raw sewage they send flowing into the Great Lakes, thanks in no small part to federal infrastructure funding. These systems, advocates say, might offer a blueprint for the safety of beachgoers across the basin.

“There are solutions. We just have to invest for them to happen,” Stoner said. “So, it’s not a technological problem. It’s a … failure to decide that we want to solve this problem with solutions that exist.”

Emily Kowalski, outreach and engagement manager at the research and education center of Environment America in Illinois, said investments should go beyond upgrading sewage systems and focus on green infrastructure or natural, permeable surfaces like green roofs, parks and wetlands, which can help absorb rainwater and reduce flooding.

“A lot of these problems are things that we know how to fix and mitigate, but they do take money,” she said.

A report released by the U.S. EPA last year found the country needs at least $630 billion to address wastewater, stormwater and clean water infrastructure needs over the next 20 years.

“We need Congress to fully fund the Clean Water State Revolving Fund so that we can enjoy Chicago’s beaches, but also so (that) when we are on vacation on other shorelines or coastlines, we can enjoy beaches that are safe for swimming,” Kowalski said.

Sewage and animal waste

Every morning between Memorial Day and Labor Day, a handful of University of Illinois Chicago students head out to the city’s public beaches. As the sun rises and the day starts, they wade into the lake at each location and collect water in two plastic bottles.

The samples are then tested in a laboratory to detect the presence of genetic material from Enterococci — bacteria that, like E. coli, live in the intestines of warm-blooded animals such as humans. While Enterococci are not considered harmful to humans, scientists test for their presence in water as an indicator that other disease-causing microbes like E. Coli might be present from possible fecal contamination. In a few hours, the results allow the Chicago Park District to issue the necessary water quality advisories for any of its beaches.

If the concentration of Enterococci in water samples from a beach registers an estimated illness rate of 36 per 1,000 swimmers, following U.S. EPA criteria, the Park District will issue a swim advisory. But the agency rarely issues full-on swim bans based on water quality; for that to happen, test results need to correspond with an event when sewage flows into the lake, said Cathy Breitenbach, natural resources director at the Chicago Park District.

“Our river flows backwards. Sewer overflows are pretty rare these days, and even when they do occur, they don’t go into the lake,” Breitenbach said.

That is, unless intense precipitation levels overwhelm sewers already overflowing within the city, and officials open the locks between the river and the lake and reverse that flow.

“Then we’d issue a systemwide ban until we test below the threshold,” she said.

The last time this occurred and a ban was issued in Chicago was in July 2023. The locks near Navy Pier were opened to relieve the pressure on the sewer system during heavy rainfall, allowing more than 1.1 billion gallons of murky, bacteria-laden waste to flow into Lake Michigan.

While sewage contamination from heavy storms attracts the most attention, waste from animals, such as seagulls and even dogs, can be washed by rain into the lake and is often the biggest source of bacterial concentrations across Chicago beaches.

“We have so many beautiful buildings, but when water falls on our city, that water runs off of our roads into our waterways, picking up pollutants along the way,” Kowalski said.

Runoff can contaminate Lake County beaches, too, when waste from waterfowl makes its way into the lake.

“Some of it is very localized,” said Alana Bartolai, ecological services program coordinator at the Lake County Health Department. North Point Marina Beach, she said, is well-known in the community because “the seagulls and the gulls love it.”

It’s a recurring observation among department staff when they conduct monitoring at the county’s lakefront beaches. Waukegan Beach has the same issue.

“When we take samples … we routinely are recording 300-plus gulls on the beach,” at those two locations, Bartolai said.

North Point Marina and Waukegan beaches accounted for almost half of all bacteria-related advisories and closures issued in Lake County last summer and so far this summer.

Bartolai said most of the advisories and swim bans in 2024 were weather-related. “Even though we were in drought conditions, we did still have heavy rain events,” she said.

Because swimmers at a lakefront beach are engaging in an activity in a natural body of water, “there’s no such thing as no risk,” Breitenbach said.

Earlier this month, at a beach in Portugal, over 100 people had to be treated for nausea and vomiting after swimming.

“When you see reports like this, you’re really thankful that Chicago is so ahead and has been doing (testing) for over a decade now,” said Abhilasha Shrestha, a University of Illinois Chicago research assistant professor of environmental and occupational health sciences who leads the laboratory testing for the city’s public beaches.

The rapid test the Chicago Park District is now using cuts the wait time down to only three to four hours, providing the most up-to-date information to ensure the safety of beachgoers. Before the city’s partnership with UIC began with a pilot program in 2015, testing relied solely on culturing E. coli, a laboratory process that incubates live cells in an artificial, controlled environment — with results available in 18 to 24 hours.

“It didn’t really make sense, because you were telling people what the water was like yesterday and doing the closure or advisory the day after,” Shrestha said.

But some municipalities say they can’t afford the more expensive rapid test.

“Not every community has the funding or has the setup where their beaches get tested every single day,” said Kowalski of Environment America in Illinois.

The Lake County Health Department uses the more time-consuming culture method to test water samples for E. coli — largely due to resources and funding constraints to adopting the faster methodology, officials said.

“The cost of it is almost like 10 times the cost of running an E. coli sample in our lab,” Bartolai said. “But we are looking at it, because there is that need to have that quicker turnaround.”

She said many Lake County suburbs take precautions such as raking the sand at their beaches to clear droppings from geese and seagulls “so that when it rains, it’s not getting washed in.”

In Chicago, Park District staff clean the public beaches daily, starting before dawn. Operations include tractors pulling raking machines, supporting crews of laborers who pick up litter and empty trash cans by hand and beach sweepers who clear paths for pedestrians and bike trail users. Kowalski said beachgoers can also help by picking up after dogs and ensuring babies wear swim diapers.

“(We) ask people to help, to do their part, to keep the water quality good and the beaches clean,” Breitenbach said. “Put your garbage away, don’t feed the birds, listen to the lifeguards.”

More information

Beachgoers across the Great Lakes can find water quality monitoring results on state government websites such as the Illinois Department of Public Health’s BeachGuard page or from volunteer-led efforts in nonprofits such as SwimGuide.

Beach advisories in Chicago are updated on the Park District’s website and with an on-site color-coded flag system that indicates whether conditions are safe for people to swim. These can change throughout the day due to bacteria levels in the water, as well as weather like lightning or high winds, and surf conditions like high waves.

In Chicago public beaches, three colored flags indicate three different things: red for a swim ban, yellow for a swim advisory, which means that swimming is allowed with caution, and green for permitted swimming. On any given day, the flag color between noon and 1:30 p.m. likely indicates the most recent information from water quality test results.

adperez@chicagotribune.com

By Amanda Hernández, Stateline.org

For years, state lawmakers have taken the lead on regulating kratom — the controversial herbal supplement used for pain relief, anxiety and opioid withdrawal symptoms. Some states have banned it entirely. Others have passed laws requiring age limits, labeling and lab testing.

At least half of the states and the District of Columbia have enacted some form of regulation on kratom or its components — building a patchwork of policies around a product largely unaddressed by the federal government.

But that may soon change. The U.S. Food and Drug Administration is pushing to ban 7-hydroxymitragynine, or 7-OH — a powerful compound found in small amounts in kratom and sometimes concentrated or synthesized in products sold online, at smoke shops or behind gas station counters.

Federal health officials announced last month that the compound poses serious public health risks and should be classified as a Schedule I controlled substance, alongside heroin and LSD.

The move marks a significant shift in how federal regulators are approaching kratom, which they attempted to ban in 2016. It also has sparked debate about how the change could impact the growing 7-OH industry and its consumers.

This year, at least seven states have considered bills to tighten kratom regulations, including proposals for bans, age restrictions and labeling requirements.

Kratom, which originates from the leaves of a tree native to Southeast Asia, can have a wide range of mental and bodily effects, according to federal officials, addiction medicine specialists and kratom researchers. Reports of fatal kratom overdoses have surfaced in recent years, though kratom is often taken in combination with other substances.

Kratom and 7-OH are distinct products with separate markets, but they are closely connected. 7-OH is a semi-synthetic compound derived from kratom and only emerged on the market in late 2023, while kratom itself has been available for decades.

Leading kratom researchers also say more research is needed to fully understand the long-term effects of using both substances.

“There’s much we don’t know, unfortunately, on all sides,” said Christopher R. McCurdy, a professor of medicinal chemistry at the University of Florida. McCurdy is a trained pharmacist and has studied kratom for more than 20 years.

Research suggests kratom may help with opioid withdrawal and doesn’t seem to cause severe withdrawal on its own. Smaller amounts seem to act as a stimulant, while larger doses may have sedative, opioidlike effects. Very little is known about the risks of long-term use in humans, according to McCurdy.

As for 7-OH, it shows potential for treating pain, but it hasn’t been studied in humans, and it may carry a high risk of addiction. Researchers don’t yet understand how much is safe to take or how often it should be used, McCurdy told Stateline.

While some leading kratom experts agree that kratom and 7-OH should be regulated, they caution that placing 7-OH under a strict Schedule I classification would make it much harder to study — and argue it should instead be classified as Schedule II like some other opioids.

A federal survey from 2023 estimated that about 1.6 million Americans age 12 and older used kratom in the year before the study. The American Kratom Association, a national industry lobbying group, estimated in 2021 that between 11 million and 16 million Americans safely consume kratom products each year.

Since gaining popularity in recent years, 7-OH has appeared in a growing number of products. Some researchers and addiction medicine specialists say many consumers, especially those new to kratom, sometimes don’t understand the difference between products.

“It’s a pure opioid that’s available without a prescription, so it’s akin to having morphine or oxycodone for sale at a smoke shop or a gas station,” McCurdy said. “This is a public health crisis waiting to happen.”

Federal crackdown targets 7-OH, not kratom

In late July, the U.S. Department of Health and Human Services recommended that the federal Drug Enforcement Administration place 7-OH in Schedule I, citing a high potential for abuse. The classification would not apply to kratom leaves or powders with naturally occurring 7-OH.

“We’re not targeting the kratom leaf or ground-up kratom,” FDA Commissioner Marty Makary said at a news conference. “We are targeting a concentrated synthetic byproduct that is an opioid.”

Makary acknowledged that there isn’t enough research or data to fully understand how widespread 7-OH’s use or impact may be. Still, he said the Trump administration wants to be “aggressive and proactive” in addressing the issue before it grows into a larger public health problem.

While only small amounts of 7-OH occur naturally in the kratom plant, federal officials have raised concerns about U.S. products containing synthetic or concentrated forms of the compound because it’s more potent than morphine and primarily responsible for kratom’s opioidlike effects.

The FDA’s recommendation to schedule 7-OH will now go to the DEA, which oversees the final steps of the process — including issuing a formal proposal and opening a public comment period.

If finalized, the rule could affect both companies selling enhanced kratom products and consumers in states where those products are currently legal.

The DEA backed off scheduling kratom compounds in 2016 after widespread public opposition.

Kirsten Smith, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University who is studying kratom’s effects in humans, said she was surprised by the FDA’s push to schedule 7-OH.

“We don’t really have a public health signal of a lot of adverse events for either kratom or for 7-OH at this time,” she told Stateline. “I was, frankly, always surprised that kratom was pushed toward scheduling at an earlier time point. … I don’t know that we have data to support scheduling even now.”

Still, some advocacy groups, including the Holistic Alternative Recovery Trust, argue the push to schedule 7-OH is driven more by corporate interests than public health, suggesting the kratom industry is trying to sideline competition from 7-OH products.

“We think that this is just happening because of the legacy kratom manufacturers losing market share and wanting to gin up a crisis with this,” said Jeff Smith, the national policy director for the group, who said he has used 7-OH for sleep and pain management.

While his organization supports regulation and safe consumption, members worry the federal government’s move could drive people to riskier substances or push the market underground.

“It’s made a profound difference in my life,” Smith said. “We think it would be tragic to cut it off based on such a paucity of data when there’s so much potential for this product to help people.”

Public health concerns

Federal health officials say a key concern is the growing use of kratom and 7-OH products among teens and young adults.

Some officials and addiction medicine specialists have pointed out that these products often come in flavors and packaging designed to appeal to younger buyers, with few controls over where or how they’re sold. In some states without clear regulations, kratom and 7-OH products are available at gas stations or online, sometimes without any age verification.

“Whenever you go into a gas station and even though it’s behind the glass, it’s kind of eye level, and it has all of these bright colors — it has all of these things that really attract the visual of a kiddo,” said Socorro Green, a prevention specialist with Youth180, a nonprofit focused on youth substance use prevention in Dallas.

Green added that kratom and 7-OH products may be even more accessible to young people in rural communities, where gas stations and convenience stores are often among the few available retailers.

Some researchers and experts say that certain products may not clearly or accurately disclose their 7-OH content and are sometimes marketed or mistaken for traditional kratom.

Some cities, counties and states have responded by banning kratom or raising the minimum purchase age to 18 or 21. But in many areas, enforcement remains inconsistent, and some addiction specialists say clearer federal and state guidance is needed — especially as more people are using kratom and 7-OH to manage pain, anxiety or withdrawal symptoms on their own.

“There needs to be some kind of oversight, including some way of maybe helping to ensure that people know what they’re getting,” said Terrence Walton, the executive director and chief executive officer of NAADAC, the Association for Addiction Professionals.

State regulations

At least seven states have considered or enacted legislation this year related to kratom — ranging from age restrictions and labeling requirements to outright bans.

In New York, lawmakers passed two bills: one requiring warning labels and prohibiting kratom products from being labeled as “all natural,” and another raising the minimum purchase age to 21. Neither has been sent to the governor.

In Colorado, a new measure, which was signed into law in May, prohibits kratom from being sold in forms that resemble candy or appeal to children, increases labeling requirements, limits concentrations of 7-OH, and bans the manufacture and distribution of synthetic or semi-synthetic kratom.

In Mississippi, a new law that took effect in July raised the minimum purchase age for kratom to 21. It also bans synthetic kratom extracts and products with high concentrations of 7-OH. Lawmakers in Montana and Texas introduced similar legislation this year, but neither proposal advanced.

Louisiana is the latest state to enact a kratom ban, which took effect Aug. 1. Meanwhile, in July, Rhode Island became the first state to reverse its ban. The new law establishes a regulatory framework for the manufacturing, sale and distribution of kratom products, set to take effect in April 2026.

As of this year, Washington, D.C., and seven states — Alabama, Arkansas, Indiana, Louisiana, Rhode Island (until April 2026), Vermont and Wisconsin — have banned kratom. At least half of U.S. states now regulate kratom or its components in some way.

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

By Madison Czopek, KFF Health News

For parents of school-aged children, the fall to-do list can seem ever-growing. Buy school supplies. Fill out endless school forms. Block off parent-teacher nights. Do the kids’ tennis shoes still fit?

Somewhere, at some point, you might remember flu shots. Get your flu shot. Get their flu shots. Or should you? Can you? Is that still a thing?

Amid political chatter about vaccines and the government entities that oversee them, it’s understandable to wonder where all this leaves the 2025-26 flu vaccine.

In short: Yes, the flu shot is still a thing. And doctors we spoke to said they recommend you get your flu shot this year.

Here are some answers to common questions:

Q: I heard the Trump administration could be changing vaccine recommendations. Does that apply to the flu vaccine?

There have been no substantial changes to the federal government’s flu vaccine recommendation: The Centers for Disease Control and Prevention still says that people 6 months old and up should get an annual flu vaccine.

That means most insurers will cover it, and it should soon be widely available.

Health and Human Services Secretary Robert F. Kennedy Jr., who has opposed vaccines, agreed that most people should get the flu vaccine. He followed a recommendation from the board that advises the federal government on vaccine policy; Kennedy replaced the members with his own.

The panel voted against recommending multidose flu shots that contained the preservative thimerosal, but the preservative had already been removed from most vaccines, including most flu shots.

Q: Who should not get the flu shot?

Doctors acknowledged there are always exceptions to broad guidance. For example, people with severe allergies to flu vaccine components should not get vaccines that contain those components.

You should discuss your health situation with your physician for personalized guidance.

Q: Is this season’s flu shot different from last season’s?

Yes. The flu shot was updated for the upcoming flu season, but the changes weren’t drastic. Like last year’s flu shot, this year’s vaccine is known as a three-component or trivalent vaccine that protects against three influenza viruses — two influenza A viruses and one influenza B virus.

This season’s vaccine was altered to target a specific strain of the influenza A/H3N2 virus expected to circulate this season, said Ryan Maves, a professor of medicine at Wake Forest University and a member of the Infectious Diseases Society of America. Those changes align with what the World Health Organization has recommended.

Q: When is the best time to get vaccinated?

September, October, or early November. This allows your body time to build up its protective antibodies as flu season begins and ensures your protection doesn’t wane before it ends.

In the U.S., influenza infection typically peaks in February, so you want to make sure you’re vaccinated and your protection is still strong through February and into March, said William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center.

Q: Is this season’s flu vaccine guaranteed to protect against the influenza strain that’s circulating?

Guarantee all protection? No.

Reduce risk of death? Yes.

Similar to the COVID-19 vaccine, flu vaccines are best at “protecting us from the most severe consequences of influenza,” Schaffner said. That means the flu vaccine is most effective at keeping people out of the hospital or the intensive care unit and keeping people from dying.

“A flu vaccine may not guarantee perfect protection against the flu, but skipping your flu shot simply guarantees you’ll have no protection at all,” said Benjamin Lee, a pediatric infectious diseases physician at the University of Vermont Children’s Hospital and an associate professor at the University of Vermont Larner College of Medicine.

Q: Will the flu shot be readily available this year?

All signs point to yes.

The FDA passed its formula recommendations to vaccine manufacturers March 13 — early enough that the agency expected there would be “ an adequate and diverse supply.” The people and places that administer flu shots should have them soon, typically beginning in September, said Flor Muñoz, a Baylor College of Medicine associate professor of pediatrics and infectious diseases.

Q: I heard Kennedy canceled $500 million in funding for vaccine development. Could this affect future flu vaccines?

Kennedy announced the cancellation of funding for mRNA vaccine development. Some companies have been researching combined mRNA flu and COVID shots, but there are currently no approved mRNA flu vaccines.

Still, experts said the federal government’s changes — funding cuts, vaccine committee purges, deviations from existing procedures — are increasing uncertainty.

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

By Julie Appleby, KFF Health News

People thinking about starting a business or retiring early — before they’re old enough for Medicare — may want to wait until November, when they can see just how much their Affordable Care Act health insurance will cost next year. Sharp increases are expected.

Premiums for ACA health plans, also known as Obamacare, which many early retirees and small-business owners rely on for coverage, are going up, partly due to policy changes advanced by the Trump administration and Congress. At the same time, more generous tax subsidies that have helped most policyholders pay for coverage are set to expire at the end of December.

After that, subsidies would return to what they were before the covid-19 pandemic. Also being reinstated would be an income cap barring people who earn more than four times the federal poverty level from getting any tax credits to help them purchase coverage. Although Congress potentially could act to extend the credits, people weighing optional life changes should factor in the potential cost if lawmakers fail to do so.

“I would hate for people to make a big decision now and then, in a few months, realize, ‘I’m not even going to qualify for a tax credit next year,’” said Lauren Jenkins, an insurance agent whose brokerage helps people sign up for coverage in Oklahoma. “Coupled with the rate increases, that could be significant, especially for someone at or near retirement, when it could easily cost over $1,000 a month.”

Still, how things play out in the real world will vary.

The key factor is income, as the subsidy amount people receive is primarily based on household income and local insurance costs.

People experiencing the biggest dollar increase in out-of-pocket premiums next year will be those who lose subsidies altogether because they earn more than 400% of the federal poverty level. This year, that’s $62,600 for a single person and $84,600 for a couple.

This “subsidy cliff” was removed in the legislation first enacted during the covid pandemic to create enhanced subsidies, but it will be back next year if they expire. About 1.6 million people who earn more than 400% of the poverty threshold bought ACA plans this year, many of them getting some tax credits to help with the premiums, according to KFF data. KFF is a health information nonprofit that includes KFF Health News.

“A lot of small-biz owners fall around that level of income,” said David Chase, vice president of policy and advocacy for the Small Business Majority, a Washington, D.C.-based advocacy group, which is urging Congress to extend the credits.

And a good chunk of ACA enrollment consists of small-business owners or their employees because, unlike larger firms, most small businesses don’t offer group health plans.

In the Washington metropolitan area, “seven out of 10 people who qualify for lower premiums [because of the tax credits] are small-business owners,” said Mila Kofman, executive director of the DC Health Benefit Exchange Authority.

Congress must decide by the end of December whether to extend the subsidies a second time. Permanently doing so could cost taxpayers $335 billion over the next decade, but not acting could cause financial pain for policyholders and pose political repercussions for lawmakers.

Because new premiums and smaller subsidies would take effect in January, the potential fallout has some Republican lawmakers worried about the midterm elections, according to news reports.

Republican pollsters Tony Fabrizio and Bob Ward warned the GOP in a memo that extending the enhanced credits could mean the difference between success and failure in some midterm races, because support for the premium help “comes from more than two-thirds of Trump voters and three-quarters of Swing voters.”

While supporters credit the enhanced subsidies for a record 24 million sign-ups for this year’s ACA plans, critics have blamed them for instances in which sales brokers or consumers engaged in improper enrollment.

“The expanded subsidies were a temporary covid pandemic policy enacted by congressional Democrats on a party-line vote and scheduled to end after 2025,” said Brian Blase, president of the Paragon Health Institute, a conservative think tank. “They have led to tremendous fraud and waste, they reduce employer coverage, and they should be permitted to expire.”

Ed Haislmaier, a senior research fellow at the conservative Heritage Foundation, acknowledged that people earning more than 400% of the poverty level would not be happy with losing access to subsidies, but he expects most to stay enrolled because they want to avoid huge medical bills that could threaten their businesses or savings.

“They are middle-class or upper-income people who are self-employed, or early retirees with significant income, which means they have a lot of assets behind that income,” he said. “These are people who view insurance as financial protection.”

He thinks lawmakers would win political support from voters in this category by addressing two of their other major ACA concerns: that annual deductibles are too high and insurers’ networks of doctors and hospitals are too small.

“If you just give these people money by extending subsidies, it’s only addressing one of their problems, and it’s the one they are least upset about,” Haislmaier said. “That is the political dynamics of this.”

Here’s how the expiration of subsidies could play out for some hypothetical consumers.

People in households earning less than four times the poverty rate would still get subsidies — just not as generous as the current ones.

For example, those whose earnings are at the lower end of the income scale — say, just over 150% of the poverty threshold, or about $23,000 — will go from paying a national average of about $2 a month, or $24 toward coverage for the year, to $72 a month, or $864 a year, according to a KFF online calculator.

On the other end of the income spectrum, a 55-year-old Portland, Oregon, couple with a household income of $85,000 would also take a big hit on the cost of their benchmark plan. They currently pay about $600 a month in premiums — about 8.5% of their household income — with subsidies kicking in about $1,000 to cover the remainder.

Next year, if the tax credits expire, the same couple would not get any federal help because they earn over four times the poverty limit. They would pay the full monthly premium, with no subsidies, which would be about $1,800, based on initial 2026 premium rates filed with state regulators, said Jared Ortaliza, a policy analyst at KFF.

People should begin to see insurance rates late this fall, and certainly by Nov. 1, when the ACA’s open enrollment season begins, said Jenkins, the Oklahoma insurance agent. That gives them time to mull over whether they want to make changes in their plan — or in their lives, such as quitting a job that has health insurance or retiring early. This year, open enrollment extends to Jan. 15. Under new legislation, that open period will shorten by about a month, starting with the 2027 sign-up period.

Those who do enroll for 2026, especially the self-employed and people retiring early, should closely track their incomes during the year, she said.

It would be easy to bust through that income cap, she said.

If they do, they’ll have to pay back any tax credits they initially qualified for. Their income might rise unexpectedly during the year, for example, pushing them over the limit. An income bump could come from drawing down more money from retirement accounts than planned, landing a new customer account, or even from winning big at the casino.

“Maybe they win $5,000 at the casino, but that puts them $500 over the limit for the year,” Jenkins said. “They might have to pay back $12,000 in tax credits for winning a few thousand at the casino.”

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

By Christine Mai-Duc, KFF Health News

Jacob Sweidan has seen his patients through the federal immigration raids of the 1990s, a sitting governor’s call to abolish birthright citizenship, and the highly publicized workplace crackdowns and family separation policies of President Donald Trump’s first term.

But in his 40 years as a pediatrician in Southern California serving those too poor to afford care, including many immigrant families, Sweidan said he’s never seen a drop-off in patient visits like this.

“They are scared to come to the offices. They’re getting sicker and sicker,” said Sweidan, who specializes in neonatology and runs five clinics in Los Angeles and Orange counties. “And when they are near collapsing, they go to the ER because they have no choice.”

In the last two months, he has sent young children to the emergency room because their parents worked up the courage to call his office only after several days of high fever. He said he attended to a 14-year-old boy in the ER who was on the verge of a diabetic coma because he’d run out of insulin, his parents too frightened to venture out for a refill.

Sweidan had stopped offering telehealth visits after the COVID-19 pandemic, but he and other health care providers have brought them back as ramped-up immigration enforcement drives patients without legal status — and even their U.S. citizen children — deeper into the shadows.

Patients in need of care are increasingly scared to seek it after Trump rescinded a Biden-era policy that barred immigration officials from conducting operations in “sensitive” areas such as schools, hospitals, and churches. Clinics and health plans have taken a page out of their COVID playbooks, revamping tested strategies to care for patients scared to leave the house.

Sara Rosenbaum, professor emerita of health law and policy at George Washington University, said she’s heard from clinic administrators and industry colleagues who have experienced a substantial drop in in-person visits among immigrant patients.

“I don’t think there’s a community health center in the country that is not feeling this,” Rosenbaum said.

At St. John’s Community Health clinics in the Los Angeles area, which serve an estimated 30,000 patients without legal status annually, virtual visits have skyrocketed from roughly 8% of appointments to about 25%, said Jim Mangia, president and chief executive officer. The organization is also registering some patients for in-home health visits, a service funded by private donors, and has trained employees how to read a warrant.

“People are not picking up their medicine,” Mangia said. “They’re not seeing the doctor.”

Mangia said that, in the past eight weeks, federal agents have attempted to gain access to patients at a St. John’s mobile clinic in Downey and pointed a gun at an employee during a raid at MacArthur Park. Last month, Immigration and Customs Enforcement contractors sat in a Southern California hospital waiting for a patient and federal prosecutors charged two health center workers they say interfered with immigration officers’ attempts to arrest someone at an Ontario facility.

C.S., an immigrant from Huntington Park without legal status, said she signed up for St. John’s home visit services in July because she fears going outside. The 71-year-old woman, who asked to be identified only by her initials for fear of deportation, said she has missed blood work and other lab tests this year. Too afraid to take the bus, she skipped a recent appointment with a specialist for her arthritic hands. She is also prediabetic and struggles with leg pain after a car hit her a few years ago.

“I feel so worried because if I don’t get the care I need, it can get much worse,” she said in Spanish, speaking about her health issues through an interpreter. A doctor at the clinic gave her a number to call in case she wants to schedule an appointment by phone.

Officials at the federal Department of Health and Human Services did not respond to questions from KFF Health News seeking comment about the impact of the raids on patients.

There’s no indication the Trump administration intends to shift its strategy. Federal officials have sought to pause a judge’s order temporarily restricting how they conduct raids in Southern California after immigrant advocates filed a lawsuit accusing ICE of deploying unconstitutional tactics. The 9th U.S. Circuit Court of Appeals on Aug. 1 denied the request, leaving the restraining order in place.

In July, Los Angeles County supervisors directed county agencies to explore expanding virtual appointment options after the county’s director of health services noted a “huge increase” in phone and video visits. Meanwhile, state lawmakers in California are considering legislation that would restrict immigration agents’ access to places such as schools and health care facilities — Colorado’s governor, Democrat Jared Polis, signed a similar bill into law in May.

Immigrants and their families will likely end up using more costly care in emergency rooms as a last resort. And recently passed cuts to Medicaid are expected to further stress ERs and hospitals, said Nicole Lamoureux, president of the National Association of Free & Charitable Clinics.

“Not only are clinics trying to reach people who are retreating from care before they end up with more severe conditions, but the health care safety net is going to be strained due to an influx in patient demand,” Lamoureux said.

Mitesh Popat, CEO of Venice Family Clinic, nearly 90% of whose patients are at or below the federal poverty line, said staff call patients before appointments to ask if they plan to come in person and to offer telehealth as an option if they are nervous. They also call if a patient doesn’t show five minutes into their appointment and offer immediate telehealth service as an alternative. The clinic has seen a roughly 5% rise in telehealth visits over the past month, Popat said.

In the Salinas Valley, an area with a large concentration of Spanish-speaking farmworkers, Clinica de Salud del Valle de Salinas began promoting telehealth services with Spanish radio ads in January. The clinics also trained people how to use Zoom and other digital platforms at health fairs and community meetings.

CalOptima Health, which covers nearly 1 in 3 residents of Orange County and is the biggest Medi-Cal benefits administrator in the area, sent more than a quarter-million text messages to patients in July encouraging them to use telehealth rather than forgo care, said Chief Executive Officer Michael Hunn. The insurer has also set up a webpage of resources for patients seeking care by phone or home delivery of medication.

“The Latino community is facing a fear pandemic. They’re quarantining just the way we all had to during the COVID-19 pandemic,” said Seciah Aquino, executive director of the Latino Coalition for a Healthy California, an advocacy group that promotes health access for immigrants and Latinos.

But substituting telehealth isn’t a long-term solution, said Isabel Becerra, chief executive officer of the Coalition of Orange County Community Health Centers, whose members reported increases in telehealth visits as high as 40% in the past month.

“As a stopgap, it’s very effective,” said Becerra, whose group represents 20 clinics in Southern California. “Telehealth can only take you so far. What about when you need lab work? You can’t look at a cavity through a screen.”

Telehealth also brings a host of other challenges, including technical hiccups with translation services and limited computer proficiency or internet access among patients, she said.

And it’s not just immigrants living in the country unlawfully who are scared to seek out care. In southeast Los Angeles County, V.M., a 59-year-old naturalized citizen, relies on her roommate to pick up her groceries and prescriptions. She asked that only her initials be used to share her story and those of her family and friends out of fear they could be targeted.

When she does venture out — to church or for her monthly appointment at a rheumatology clinic — she carries her passport and looks askance at any cars with tinted windows.

“I feel paranoid,” said V.M., who came to the U.S. more than 40 years ago and is a patient of Venice Family Clinic. “Sometimes I feel scared. Sometimes I feel angry. Sometimes I feel sad.”

She now sees her therapist virtually for her depression, which began 10 years ago when rheumatoid arthritis forced her to stop working. She worries about her older brother, who has high blood pressure and has stopped going to the doctor, and about a friend from the rheumatology clinic, who ices swollen hands and feet because she’s missed four months of appointments in a row.

“Somebody has to wake up or people are going to start falling apart outside on the streets and they’re going to die,” she said.

This article was produced by KFF Health News , which publishes California Healthline , an editorially independent service of the California Health Care Foundation .

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

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By Julie Appleby, KFF Health News

Medicare enrollees who buy the optional Part D drug benefit may see substantial premium price hikes — potentially up to $50 a month — when they shop for next year’s coverage.

Such drug plans are used by millions of people who enroll in what is called original Medicare, the classic federal government program that began in 1965 and added a drug benefit only in 2006. The drug plans are offered through private insurers, and enrollees must pay monthly premiums.

It’s not known whether insurers will pursue the maximum increase allowed, as premium prices for next year won’t be revealed until closer to open enrollment, which starts Oct. 15.

Increases are expected to mainly affect stand-alone Part D plans, not the drug coverage offered as part of Medicare Advantage, the private sector alternative to original Medicare. More on that later.

Policy experts say premiums are likely to go up for several reasons, including increased use of some higher-cost prescription drugs; a law that capped out-of-pocket spending for enrollees; and changes in a program aimed at stabilizing price increases that the Trump administration has continued but made less generous.

One thing is surer than ever, say many policy experts: Beneficiaries should not simply roll over their existing stand-alone Medicare drug plans.

“Everyone should shop plans in open enrollment,” said Stacie Dusetzina, a professor of health policy at Vanderbilt University Medical Center.

Here are three reasons prices would rise.

1. It’s the Spending!

Every year, insurers keep an eye on what they’re spending on drugs so they can build that into their premium estimates. Spending covers both the prices charged by drugmakers and volume, meaning how many people take the medications and how often.

And it’s up. Spending by insurers and government programs for prescription drugs in 2024 across the market grew more than 10%, which is slightly greater than in recent years, according to a research report published in last month’s issue of the American Journal of Health-System Pharmacy. Estimates are not yet available for this year’s trends.

Still, in 2024, researchers found that drug prices overall decreased slightly. Spending rose because of drugs coming on the market and increased utilization, especially for pricey weight loss drugs and another category of medications that treat various autoimmune conditions, such as rheumatoid arthritis.

Such increased use is evident in Medicare. Many beneficiaries, for example, are treated for autoimmune conditions. And even though Medicare doesn’t cover treatment for weight loss, many members have diabetes or other conditions that a new type of weight loss drugs can treat.

The Trump administration, according to The Washington Post, is considering a five-year pilot program in which Medicare Part D plans could voluntarily expand access to the drugs, which can cost more than $1,000 a month without insurance. Details have not yet been provided, but the pilot program would not begin in Medicare until 2027.

Another wild card for insurers is the Trump administration’s tariffs on businesses that purchase products made overseas, which could boost drug prices because the U.S. imports a lot of its pharmaceuticals. Much, however, remains unknown about whether drugmakers will pass along any additional tariff costs to consumers.

So, while rising spending is one factor, it isn’t the only reason next year’s premium prices are expected to go up.

2. New Out-of-Pocket Caps for Consumers

Changes made to Medicare aimed at helping people with high out-of-pocket costs for expensive medications may be a bigger factor.

Here’s why: Starting this year, Medicare enrollees have a limit on how much they must pay out-of-pocket for prescription drugs. It’s capped at $2,000, a threshold that will rise each year to cover inflation.

Lawmakers in Congress set those changes in the Inflation Reduction Act under President Joe Biden. The law also shifted a larger share of the cost of drugs used by Medicare beneficiaries from the federal program to insurers.

That $2,000 cap is a big change from previous years, when people taking expensive drugs had a higher threshold to meet annually and were on the hook to pay 5% of the drug’s cost even after meeting that amount. Those additional 5% payments ended last year under the provisions of the IRA.

Before that law passed, “people would spend $10,000 or $15,000 out-of-pocket each year just for a single drug,” Dusetzina said. “The Inflation Reduction Act was necessary to make Part D proper health insurance, but there’s a cost to do so.”

While the cap is a big help for affected consumers, the reduced amounts paid by some beneficiaries — coupled with the cost shift to insurers — could lead plans to spread their increased expenses across all policyholders through higher premiums. A growing number of health plans have also begun to require enrollees to pay a percentage of a drug’s cost, rather than a flat-dollar copay, which can lead to larger-than-expected costs at the pharmacy counter, Dusetzina said.

While consumers not currently taking high-cost specialty drugs may not see a benefit in the $2,000 cap initially, they might one day, say policy experts, who note that drugmaker prices continue to rise and that enrollees could fall ill with a condition like cancer or multiple sclerosis for which they need a very high-priced drug.

“It’s important to think not just in context of those groups who hit the cap every year, but also people are paying more in premiums to protect their future selves as well,” said Casey Schwarz, the senior counsel for education and federal policy at the Medicare Rights Center, an advocacy group.

The new prescription drug cap and other changes apply to both the stand-alone Part D drug plans and Medicare Advantage plans. But those Medicare Advantage plans are not expected to increase the drug portion of their premiums, partly because the private sector plans are paid more per member than what it costs taxpayers for the traditional program.

That means Advantage plans have far more money to add benefits, such as vision and dental coverage, which traditional Medicare does not include, or to use them to cushion the impact of rising spending on drug costs, thus limiting premium increases.

Those additional benefits are advertised to attract customers to Medicare Advantage, which also sometimes offers plans with minimal or no monthly premium costs. There are other differences between traditional Medicare and private sector plans. For example, Advantage members must stick to doctors and hospitals in the plan’s networks, and they may face more prior authorization or other hurdles than in the traditional program.

The growing difference between premiums — fueled by the extra rebates flowing to the private sector plans — “is increasingly tilting coverage toward Medicare Advantage and making traditional Medicare plus a stand-alone PDP [prescription drug plan] unaffordable for many enrollees,” said Juliette Cubanski, deputy director of the program on Medicare policy at KFF, a health information nonprofit that includes KFF Health News.

3. Trump Administration Reduced Funding Meant To Slow Premium Growth

The final factor in the premium increase equation is a program set up to slow the rise of premiums in stand-alone Part D plans.

It began under the Biden administration to offset premium increases tied to changes in the Inflation Reduction Act by temporarily injecting additional federal dollars to help insurers adjust to the new rules.

That plan sent just over $6 billion this year to Part D insurers.

And it had an effect.

The average monthly premium for a stand-alone Part D drug plan dropped 9%, from $43 last year to $39 this year, according to KFF, even when factoring in that some plans raised prices by up to $35 a month, the maximum increase allowed under the stabilization plan for this year.

In a memo released in late July, the Trump administration said it would continue the program for next year, while shaving about 40% of the funding. A government official told The Wall Street Journal that the administration felt that keeping the full funding would have mainly benefited the insurers and cost taxpayers an “enormous, excess amount.”

The stabilization effort next year will send $10 a month per enrollee to Part D insurers to help keep premiums in check, down from $15 this year. Among other changes, it allows insurers to raise premiums by as much as $50 a month, up from the $35 allowed this year.

That would be a substantial increase, Cubanski noted, although it is not clear just how many insurers would pursue the full amount.

“We did see some plans this year were taking premium increases of that $35 amount in 2025, and I fully expect we will see some plans with increases up to $50 a month” next year, she said.

Another reason to take a close look at all the options once open enrollment begins.

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

By KATHERINE ROTH

NEW YORK (AP) — Summer can be a time of big transitions for kids. It’s often the season for moving to a new home or preparing for a different school. And that brings worry and stress.

Parents and families can help make things feel more manageable. If kids feel supported, they might even look forward to some of the changes and gain confidence, experts say.

“When routines, familiar places and even knowing where things are in the house are suddenly gone, it forces youth to relearn their daily lives from scratch,” which can be stressful, says Victoria Kress, a professional counselor and president of the American Counseling Association.

At the same time, “this can invite exciting opportunities for growth,” she says.

Author Nadine Haruni’s book “Freeda the Frog is on the Move” aims to help school-age kids deal with moving. Haruni, who guided her own family through moves and changes, tells the story of a mother frog who helps her little tadpoles adjust as they leave their hometown and settle in a new one.

“It’s really important to recognize that transitions take time and that is totally normal. It’s OK to feel nervous and sad and anxious and maybe all of those things all at once, and even adults feel that way sometimes,” says Haruni.

“If you listen, you might be surprised. What matters to a child is not always what you might think it is,” she says.

Moves can be especially difficult if accompanied by other significant changes, such as a death, divorce or loss of family income.

Haruni’s book was inspired by her family’s big, multifaceted transition. She was moving from Manhattan to New Jersey with her then-5-year-old daughter and 8-year-old son, and getting married all in the same week, a big transition for her kids and three teenage stepdaughters. In addition, the kids were starting at a new school the following week.

“The kids were very sad and worried at first. Life is about change, and it’s really hard to address that sometimes. Luckily, the kids discovered that they loved having more space and, like the tadpoles in the book, they happily adapted,” she says.

Here are some tips to reduce the stress of a move or other big transition for kids:

Talk it out

“Communicating and listening can alleviate a lot of anxiety,” Haruni says. “Let kids share their feelings and know that they are being heard, so they know that they matter. That really helps them feel like they have some control.”

Explain why a move is necessary, and preview what’s ahead. Discuss the destination ahead of time, especially its good points. Familiarity can help kids feel more confident, the experts say.

Even sharing some photos or a map is helpful in easing jitters.

“Can they meet a few kids in the new neighborhood ahead of time?” Haruni asks.

Involve kids in the move itself

“Involving children in age-appropriate moving tasks — such as packing their own belongings or helping to choose new room decorations — can give them a sense of control and security during an uncertain time,” says Kress.

Kids can help plan meals, organize their space or continue family traditions.

“Frame it as an adventure,” says Haruni. “Let them help choose things for their new room if they are moving, but also bring a few items that feel familiar and comforting.”

Keep up daily routines

Sticking to some daily routines creates structure when things feel new and scary.

“The thing with moves is they disrupt everyone’s life. Too much change at once discombobulates everybody, so keeping meals at the same time and bedtime rituals the same can really help a lot,” says George M. Kapalka, a clinical psychologist and professor at the California School of Professional Psychology.

Arrange common areas similarly to how they were before the move, says Kress. Place favorite toys, blankets or pictures where your child expects to find them.

Consider getting help from a professional

Adapting to change takes time, and patience. Let kids know that’s normal, that they will get through it, and that they are being heard and have some control over things, says Haruni.

And know when to seek help.

“Some sadness, worry, or adjustment difficulties are normal after a move. But if symptoms persist for more than a few weeks, worsen over time, or disrupt daily life, then counseling is advisable,” says Kress.

By Charles E. Ramirez, MediaNews Group

A human case of the West Nile virus was detected in Kent County, health officials said Thursday.

“We’ve confirmed the first human case of West Nile virus in a county resident this season, which sadly resulted in death,” Brendan Earl, Supervising Sanitarian for the Kent County Health Department, said in a statement.

“Our deepest condolences go out to the family and loved ones of this individual. This tragic outcome is a reminder that mosquitoes in our area are active and capable of spreading serious illness. Prevention remains our best protection.”

Earl said the death marks the first from the virus in Kent County since May 2024.

Officials did not release identifying information for health privacy reasons.

Earl added it also follows recent detections of the virus in local mosquito samples, including one collected 3,000 feet from where the latest victim lived.

Last month, the department reported it confirmed the virus in zip codes in Grand Rapids, Walker, and Plainfield Township — the first detection of the virus this year.

The virus is spread via mosquitoes that have bitten an infected bird before biting a human, according to officials. They said most people show no symptoms, and about one in five people develop mild, flu-like illness such as fever, headache, body aches, or rash. About one in 150 people develops severe illness affecting the central nervous system, which can sometimes be fatal.

There is no vaccine or specific treatment for the virus. Experts said the best way for people to protect themselves is to use a registered insect repellent, remove standing water in their surroundings, wear long-sleeve shirts and pants, cover holes in windows and doors, and limit time outside during the hours between dusk and dawn when mosquitoes are most active.

The Kent County case is the latest confirmation of West Nile cases in Michigan.

On Monday, health officials said they detected a case in an Oakland County resident, the county’s first of the season.

Last month, Macomb County officials said they detected their first case of the virus in mosquitoes.

By MIKE STOBBE, Associated Press

NEW YORK (AP) — At least 600 employees of the Centers for Disease Control and Prevention are receiving permanent termination notices in the wake of a recent court decision that protected some CDC employees from layoffs but not others.

The notices went out this week and many people have not yet received them, according to the American Federation of Government Employees, which represents more than 2,000 dues-paying members at CDC.

Officials with the U.S. Department of Health and Human Services did not immediately respond to a request for comment.

AFGE officials said they are aware of at least 600 employees being cut.

But “due to a staggering lack of transparency from HHS,” the union hasn’t received formal notices of who is being laid off,” the federation said in a statement on Wednesday.

The permanent cuts include about 100 people who worked in violence prevention. Some employees noted those cuts come less than two weeks after a man fired at least 180 bullets into the CDC’s campus and killed a police officer.

“The irony is devastating: The very experts trained to understand, interrupt and prevent this kind of violence were among those whose jobs were eliminated,” some of the affected employees wrote in a blog post last week.

On April 1, the HHS officials sent layoff notices to thousands of employees at the CDC and other federal health agencies, part of a sweeping overhaul designed to vastly shrink the agencies responsible for protecting and promoting Americans’ health.

Many have been on administrative leave since then — paid but not allowed to work — as lawsuits played out.

A federal judge in Rhode Island last week issued a preliminary ruling that protected employees in several parts of the CDC, including groups dealing with smoking, reproductive health, environmental health, workplace safety, birth defects and sexually transmitted diseases.

But the ruling did not protect other CDC employees, and layoffs are being finalized across other parts of the agency, including in the freedom of information office. The terminations were effective as of Monday, employees were told.

Affected projects included work to prevent rape, child abuse and teen dating violence. The laid-off staff included people who have helped other countries to track violence against children — an effort that helped give rise to an international conference in November at which countries talked about setting violence-reduction goals.

“There are nationally and internationally recognized experts that will be impossible to replace,” said Tom Simon, the retired senior director for scientific programs at the CDC’s Division of Violence Prevention.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By Daniel Chang and Sam Whitehead, Kaiser Health News

MIAMI — GOP lawmakers in the 10 states that refused the Affordable Care Act’s Medicaid expansion for over a decade have argued their conservative approach to growing government programs would pay off in the long run.

Instead, the Republican-passed budget law that includes many of President Donald Trump’s priorities will pose at least as big a burden on patients and hospitals in the expansion holdout states as in the 40 states that have extended Medicaid coverage to more low-income adults, hospital executives and other officials warn.

For instance, Georgia, with a population of just over 11 million, will see as many people lose insurance coverage sold through ACA marketplaces as will California, with more than triple the population, according to estimates by KFF, a health information nonprofit that includes KFF Health News.

The new law imposes additional paperwork requirements on Obamacare enrollees, slashes the time they have each year to sign up, and cuts funding for navigators who help them shop for plans. Those changes, all of which will erode enrollment, are expected to have far more impact in states like Florida and Texas than in California because a higher proportion of residents in non-expansion states are enrolled in ACA plans.

The budget law, which Republicans called the “One Big Beautiful Bill,” will cause sweeping changes to health care across the country as it trims federal spending on Medicaid by more than $1 trillion over the next decade. The program covers more than 71 million people with low incomes and disabilities. Ten million people will lose coverage over the next decade due to the law, according to the nonpartisan Congressional Budget Office.

Many of its provisions are focused on the 40 states that expanded Medicaid under the ACA, which added millions more low-income adults to the rolls. But the consequences are not confined to those states. A proposal from conservatives to cut more generous federal payments for people added to Medicaid by the ACA expansion didn’t make it into the law.

“Politicians in non-expansion states should be furious about that,” said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank.

The number of people losing coverage could accelerate in non-expansion states if enhanced federal subsidies for Obamacare plans expire at the end of the year, driving up premiums as early as January and adding to the rolls of uninsured. KFF estimates as many as 2.2 million people could become uninsured just in Florida, a state where lawmakers refused to expand Medicaid and, partly as a result, now leads the nation in ACA enrollment.

For people like Francoise Cham of Miami, who has Obamacare coverage, the Republican policy changes could be life-altering.

Before she had insurance, the 62-year-old single mom said she would donate blood just to get her cholesterol checked. Once a year, she’d splurge for a wellness exam at Planned Parenthood. She expects to make about $28,000 this year and currently pays about $100 a month for an ACA plan to cover herself and her daughter, and even that strains her budget.

Cham choked up describing the “safety net” that health insurance has afforded her — and at the prospect of being unable to afford coverage if premiums spike at the end of the year.

“Obamacare has been my lifesaver,” she said.

If the enhanced ACA subsidies aren’t extended, “everyone will be hit hard,” said Cindy Mann, a health policy expert with Manatt Health, a consulting and legal firm, and a former deputy administrator for the Centers for Medicare & Medicaid Services.

“But a state that hasn’t expanded Medicaid will have marketplace people enrolling at lower income levels,” she said. “So, a greater share of residents are reliant on the marketplace.”

Though GOP lawmakers may try to cut Medicaid even more this year, for now the states that expanded Medicaid largely appear to have made a smart decision, while states that haven’t are facing similar financial pressures without any upside, said health policy experts and hospital industry observers.

KFF Health News reached out to the governors of the 10 states that have not fully expanded Medicaid to see if the budget legislation made them regret that decision or made them more open to expansion. Spokespeople for Republican Gov. Henry McMaster of South Carolina and Republican Gov. Brian Kemp of Georgia did not indicate whether their states are considering Medicaid expansion.

Brandon Charochak, a spokesperson for McMaster’s office, said South Carolina’s Medicaid program focuses on “low-income children and families and disabled individuals,” adding, “The state’s Medicaid program does not anticipate a large impact on the agency’s Medicaid population.”

Enrollment in ACA marketplace plans nationwide has more than doubled since 2020 to 24.3 million. If enhanced subsidies expire, premiums for Obamacare coverage would rise by more than 75% on average, according to an analysis by KFF. Some insurers are already signaling they plan to charge more.

The CBO estimates that allowing enhanced subsidies to expire will increase the number of people without health insurance by 4.2 million by 2034, compared with a permanent extension. That would come on top of the coverage losses caused by Trump’s budget law.

“That is problematic and scary for us,” said Eric Boley, president of the Wyoming Hospital Association.

He said his state, which did not expand Medicaid, has a relatively small population and hasn’t been the most attractive for insurance providers — few companies currently offer plans on the ACA exchange — and he worried any increase in the uninsured rate would “collapse the insurance market.”

As the uninsured rate rises in non-expansion states and the budget law’s Medicaid cuts loom, lawmakers say state funds will not backfill the loss of federal dollars, including in states that have refused to expand Medicaid.

Those states got slightly favorable treatment under the law, but it’s not enough, said Grace Hoge, press secretary for Kansas Gov. Laura Kelly, a Democrat who favors Medicaid expansion but who has been rebuffed by GOP state legislators.

“Kansans’ ability to access affordable health care will be harmed,” Hoge said in an email. “Kansas, nor our rural hospitals, will not be able to make up for these cuts.”

For hospital leaders in other states that have refused full Medicaid expansion, the budget law poses another test by limiting financing arrangements states leveraged to make higher Medicaid payments to doctors and hospitals.

Beginning in 2028, the law will reduce those payments by 10 percentage points each year until they are closer to what Medicare pays.

Richard Roberson, president of the Mississippi Hospital Association, said the state’s use of what’s called directed payments in 2023 helped raise its Medicaid reimbursements to hospitals and other health institutions from $500 million a year to $1.5 billion a year. He said higher rates helped Mississippi’s rural hospitals stay open.

“That payment program has just been a lifeline,” Roberson said.

The budget law includes a $50 billion fund intended to insulate rural hospitals and clinics from its changes to Medicaid and the ACA. But a KFF analysis found it would offset only about one-third of the cuts to Medicaid in rural areas.

Trump encouraged Florida, Tennessee and Texas to continue refusing Medicaid expansion in his first term, when his administration gave them an unusual 10-year extension for financing programs known as uncompensated care pools, which generate billions of dollars to pay hospitals for treating the uninsured, said Allison Orris, director of Medicaid policy for the left-leaning think tank Center on Budget and Policy Priorities.

“Those were very clearly a decision from the first Trump administration to say, ‘You get a lot of money for an uncompensated care pool instead of expanding Medicaid,’” she said.

Those funds are not affected by Trump’s new tax-and-spending law. But they do not help patients the way insurance coverage would, Orris said. “This is paying hospitals, but it’s not giving people health care,” she said. “It’s not giving people prevention.”

States such as Florida, Georgia, and Mississippi have not only turned down the additional federal funding that Medicaid expansion brings, but most of the remaining non-expansion states spend less than the national average per Medicaid enrollee, provide fewer or less generous benefits, and cover fewer categories of low-income Americans.

Mary Mayhew, president of the Florida Hospital Association, said the state’s Medicaid program does not adequately cover children, older people and people with disabilities because reimbursement rates are too low.

“Children don’t have timely access to dentists,” she said. “Expectant moms don’t have access nearby to an OB-GYN. We’ve had labor and delivery units close in Florida.”

She said the law will cost states more in the long run.

“The health care outcomes for the individuals we serve will deteriorate,” Mayhew said. “That’s going to lead to higher cost, more spending, more dependency on the emergency department.”

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

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

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By Carol Thompson, MediaNews Group

The Michigan Department of Environment, Great Lakes, and Energy launched an online resource to help state residents understand, prepare for and deal with wildfire smoke.

Smoke from Canadian wildfires has blanketed Michigan this summer, prompting state air quality meteorologists to issue a warning on 31 days for at least part of Michigan. In 2023, there were fewer warnings issued but the concentrations of smoke were higher.

The state’s new webpage, Michigan.gov/EGLEWildfireSmoke, includes links to the MiAir tool that shows air quality readings at state air monitors, a signup page for the state’s air quality notification system and answers to common wildfire questions.

Exposure to wildfire smoke is dangerous for people’s health. The smoke is made of very small particles, some of which can get into people’s lungs and bloodstreams.

The U.S. Centers for Disease Control and Prevention said particulate matter exposure can cause coughing, difficulty breathing, irregular heartbeats, asthma attacks and more. University of Michigan researchers also linked wildfire smoke exposure to dementia.

Children, adults over 60 and people with lung or heart disease are most at risk of exposure. Pregnancy and working outdoors also increases risk.

While people can’t control wildfire smoke that drifts into their communities, they can take steps to protect themselves from exposure, EGLE said.

For instance, people can try to stay indoors when wildfire smoke is present, or can wear an N-95 mask while outdoors to avoid inhaling the pollutant. They can avoid exercising outdoors when air quality is bad.

To keep indoor air safe, they can use window air conditioning units on the “recirculate” setting or run forced air systems on “fan” or “cooling” settings, EGLE said.

People also can limit outdoor activities like campfires or running gas-powered vehicles or limit the indoor use of gas-powered appliances to limit exposure to particle pollution, EGLE said.

Climate scientists say Canadian wildfires will continue as humans continue to use fossil fuels that release greenhouse gases and warm the atmosphere. Climate change causes hotter, dryer conditions that make wildfires more likely.

Good wildfire management can help, but it’s expensive and difficult in the remote regions of northern Canada.

EGLE has three meteorologists who develop air quality forecasts for particulate matter pollution and ozone pollution, EGLE said in a press release about its new website. They use weather models to make their predictions and share their forecasts with the National Weather Service and news media.

They categorize air quality as good, unhealthy for sensitive groups, unhealthy, very unhealthy or hazardous. They issue advisories when forecasts say air quality will be unhealthy for sensitive groups. They issue warnings when they predict it will be worse.

Harry Black, Bloomberg News

Artificial intelligence, touted for its potential to transform medicine, led to some doctors losing skills after just a few months in a new study.

AI helped health professionals to better detect pre-cancerous growths in the colon, but when the assistance was removed, their ability to find tumors dropped by about 20% compared with rates before the tool was ever introduced, according to findings published Wednesday.

Health care systems around the world are embracing AI with a view to boosting patient outcomes and productivity. Just this year, the UK government announced £11 million ($14.8 million) in funding for a new trial to test how AI can help catch breast cancer earlier.

The AI in the study probably prompted doctors to become over-reliant on its recommendations, “leading to clinicians becoming less motivated, less focused, and less responsible when making cognitive decisions without AI assistance,” the scientists said in the paper.

They surveyed four endoscopy centers in Poland and compared detection success rates three months before AI implementation and three months after. Some colonoscopies were performed with AI and some without, at random. The results were published in The Lancet Gastroenterology and Hepatology journal.

Yuichi Mori, a researcher at the University of Oslo and one of the scientists involved, predicted that the effects of de-skilling will “probably be higher” as AI becomes more powerful.

What’s more, the 19 doctors in the study were highly experienced, having performed more than 2,000 colonoscopies each. The effect on trainees or novices might be starker, said Omer Ahmad, a consultant gastroenterologist at University College Hospital London.

“Although AI continues to offer great promise to enhance clinical outcomes, we must also safeguard against the quiet erosion of fundamental skills required for high-quality endoscopy,” Ahmad, who wasn’t involved in the research, wrote a comment alongside the article.

A study conducted by MIT this year raised similar concerns after finding that using OpenAI’s ChatGPT to write essays led to less brain engagement and cognitive activity.

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

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By ADITHI RAMAKRISHNAN

NEW YORK (AP) — After a summer of vacations and late nights, it’s time to set those back-to-school alarms.

A good night’s sleep helps students stay focused and attentive in class. Experts say it’s worth easing kids back into a routine with the start of a new school year.

“We don’t say ‘ get good sleep ’ just because,” said pediatrician Dr. Gabrina Dixon with Children’s National Hospital. “It really helps kids learn and it helps them function throughout the day.”

The amount of sleep kids need changes as they age. Preschoolers should get up to 13 hours of sleep. Tweens need between nine and 12 hours. Teenagers do best with eight to 10 hours of shut-eye.

Set an earlier bedtime

Early bedtimes can slip through the cracks over the summer as kids stay up for sleepovers, movie marathons and long plane flights. To get back on track, experts recommend setting earlier bedtimes a week or two before the first day of school or gradually going to bed 15 to 30 minutes earlier each night.

Don’t eat a heavy meal before bed and avoid TV or screen time two hours before sleep. Instead, work in relaxing activities to slow down like showering and reading a story.

“You’re trying to take the cognitive load off your mind,” said Dr. Nitun Verma, a spokesperson for the American Academy of Sleep Medicine. “It would be like if you’re driving, you’re slowly letting go of the gas pedal.”

Parents can adjust their back-to-school plans based on what works best for their child. Nikkya Hargrove moves her twin daughters’ bedtimes up by 30 minutes the week before school starts.

Sometimes, her 10-year-olds will negotiate for a few extra minutes to stay up and read. Hargrove said those conversations are important as her children get older and advocate for themselves. If they stay up too late and don’t have the best morning, Hargrove said that can be a learning experience too.

“If they’re groggy and they don’t like how they feel, then they know, ‘OK, I have to go to bed earlier,’” said Hargrove, an author and independent bookstore owner from Connecticut.

In the morning, soaking in some daylight by sitting at a window or going outside can help train the brain to power up, Verma said.

Squash back-to-school sleep anxiety

Sleep quality matters just as much as duration. First-day jitters can make it hard to fall asleep no matter how early the bedtime.

Dixon says parents can talk to their kids to find out what is making them anxious. Is it the first day at a new school? Is it a fear of making new friends? Then they might try a test run of stressful activities before school starts to make those tasks feel less scary — for example, by visiting the school or meeting classmates at an open house.

The weeks leading up can be jam-packed and it’s not always possible to prep a routine in advance. But kids will adjust eventually so sleep experts say parents should do what they can. After all, their kids aren’t the only ones adjusting to a new routine.

“I always say, ‘Take a deep breath, it’ll be OK,’” Dixon said. “And just start that schedule.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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By Anna Claire Vollers, Stateline.org

As more hospitals have gobbled up private physician practices, costs for childbirth and other services have gone up, according to a new study.

Since the early aughts, the share of physicians in the United States working for hospitals has nearly doubled, according to the study published by the National Bureau of Economic Research, a nonprofit research organization.

And as fewer doctors work in physician-owned practices, patients or their insurers end up paying more, the study’s authors found.

For example: Two years after a hospital buys an OB-GYN practice, prices for labor and delivery jump an average of $475 and physician prices rise by $502, according to the study. Researchers focused on births, which are the most common reason for hospital admission among people with private insurance.

This rapid acquisition by hospitals is reshaping a U.S. industry once dominated by tens of thousands of small, physician-owned practices.

Only about 42% of U.S. physicians work in a physician-owned private practice, according to the most recent survey data from the American Medical Association. Nearly 47% work for hospitals, a sharp rise over the past several years. Most emergency room physicians are now employed by hospital systems or by private equity-owned staffing groups.

The new research offers further evidence for how hospital acquisitions of private practices “can result in anticompetitive price increases,” said Matthew Grennan, one of the study’s authors and an associate professor of economics at Emory University, in a news release.

“As a result, I think economists and others in the antitrust community are likely to give more careful consideration to these potential sources of harm,” he said.

Medical debt is a leading cause of bankruptcy in the United States, with about 14 million Americans owing more than $1,000 in medical debt, according to research nonprofit KFF.

These post-merger price increases are driven by reduced competition, Grennan and his fellow researchers found. Yet there’s been little effort by federal or state regulators to halt hospital mergers that could lead to higher prices for consumers.

But states have taken some steps toward lowering medical costs in recent years.

Bipartisan groups of lawmakers in more than a dozen states have addressed so-called “facility fees,” which are charges that some hospitals tack on for patient visits to hospital-owned physician offices.

This year in Oklahoma, Republican lawmakers passed a bill requiring hospitals to make the cost of many of their services more transparent to patients so they’re aware of the costs. Providers can face penalties for noncompliance. A similar Oklahoma law authored by Democrats and passed last year requires debt collectors to submit evidence of a hospital’s compliance with price transparency rules before filing to collect on medical debts from patients.

Some states have capped the rates hospitals or physicians can charge. Colorado sets provider and hospitals rates based on a specific formula if insurance plans aren’t able to lower peoples’ premiums to a certain level, while Montana and Oregon limited the amount hospitals and other providers can charge for their state employee health plan.

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

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

By MATTHEW PERRONE, Associated Press Health Writer

WASHINGTON (AP) — Health Secretary Robert F. Kennedy Jr. is vowing to “fix” the federal program for compensating Americans injured by vaccines, opening the door to sweeping changes for a system long targeted by anti-vaccine activists.

Health experts and lawyers say updates are needed to help clear a backlog of cases in the Vaccine Injury Compensation Program, created by Congress in 1986 as a no-fault payment system for presumed vaccine injuries.

But they also worry Kennedy’s changes will reflect his history as a leader in the anti-vaccine movement, which has alternately called for abolishing the program or expanding it to cover unproven injuries and illnesses that aren’t connected to vaccines.

Kennedy and other critics believe the program is “too miserly in what it considers to be a vaccine injury,” said Jason Schwartz, a public health expert at Yale University. “That’s created great concern that he could expand what’s included.”

Anti-vaccine groups have long suggested a link between vaccines and autism, despite scientific consensus that childhood vaccines don’t cause the condition. Adding autism to the list of injuries covered by the plan “would dramatically increase the number of compensable cases, potentially bankrupting it,” Schwartz said.

Program is credited with saving the U.S. vaccine industry

Signed into law under President Ronald Reagan, the compensation program is designed to provide quick, efficient compensation to Americans who report known injuries associated with vaccines, such as rare allergic reactions. At the time of its creation, a number of vaccine-makers were exiting the business due to risks of class action lawsuits.

In a recent social media post, Kennedy called the program “broken” and accused federal lawyers and adjudicators who run it of “inefficiency, favoritism and outright corruption.”

Kennedy didn’t specify the changes he’s seeking. But some of the people he’s enlisted to help have a history of bringing vaccine injury cases.

In June, the Department of Health and Human Services awarded a $150,000 contract to an Arizona law firm for “expertise” in the program. The firm’s Andrew Downing, an attorney specializing in vaccine injury cases, was listed in the HHS staff directory for a time.

“We just brought a guy in this week who is going to be revolutionizing the Vaccine Injury Compensation Program,” Kennedy told Tucker Carlson shortly after the award.

Revamping the program would be the latest in a string of decisions that have upended U.S. vaccine policy, including this week’s cancellation of research funding for vaccines using mRNA technology.

Downing and Kennedy have had roles in HPV vaccine lawsuits

Downing has had a leading role in lawsuits against Merck alleging injuries from its HPV vaccine, Gardasil, including a rare movement disorder.

In a podcast last year for people with the condition, Downing lamented that the injury compensation program “has taken a hard line” against such cases, leading lawyers to file injury lawsuits in civil court. Approximately 70% of the Gardasil cases against Merck started as claims filed by Downing in the federal injury program, according to court records.

A judge dismissed more than 120 of those cases, citing “a paucity of evidence” that Gardasil caused patients’ problems.

A spokesman for Kennedy declined to comment on Downing’s hiring.

Kennedy himself has been involved in the Gardasil litigation, as both an attorney and consultant.

Before joining the government, Kennedy received payments for referring potential Gardasil clients to Wisner Baum, one of the law firms suing Merck. Following questions about the agreement during his confirmation hearings, Kennedy agreed to give up his stake in the deal and transfer any future fees to “a nondependent, adult son,” according to his financial disclosures.

One of Kennedy’s sons is an attorney at Wisner Baum.

Experts see need for reform

Experts who study vaccine compensation say real changes are needed to modernize the 40-year-old program.

The cap on compensation remains $250,000 for injury or death, the same as in 1986. Similarly, the program still has eight adjudicators, known as special masters, to review all cases before the government. On average, the process takes two to three years.

The fund has paid out $5.4 billion, compensating about 40% of all people who filed claims.

The U.S. has an “ethical obligation” to promptly pay those harmed by government-recommended vaccines, says Dorit Reiss, a professor at the University of California Hastings College of the Law.

“Plus, I think it increases trust in the vaccination program if you have quick, generous compensation,” Reiss said.

One possible change: Adding injuries

As health secretary, Kennedy has broad powers to reshape the program.

One approach could be adding new diseases and illnesses to the government table of payable injuries.

In the early 2000s, the program ruled against more than 5,000 claims from families who said vaccines led to their children’s autism, citing hundreds of scientific studies discrediting the link.

Critics of Kennedy say he could claim that he has new evidence of harm — perhaps from a large autism study he’s commissioned — and add the condition to the program.

In response, the federal government might have to increase taxes on vaccines to replenish the compensation fund, which would make the shots more expensive and less accessible.

“Then you will start to watch the vaccine program infrastructure in this country disintegrate until someone steps in,” Dr. Paul Offit, a vaccine researcher at Children’s Hospital of Philadelphia who has clashed with Kennedy for years.

A recent Senate hearing titled “Voice of the Vaccine Injured” appeared to make the case for expanding the program. Witnesses included two representatives from Children’s Health Defense, the nonprofit group that Kennedy previously chaired and has repeatedly sued the government over vaccines.

The group’s chief science officer, Brian Hooker, told lawmakers he tried unsuccessfully for 16 years trying to get compensation for his son’s autism, which he attributes to the measles-mumps-rubella vaccine.

Another possible change: Removing vaccines

Another approach would involve removing certain vaccines from the program, making it easier to bring lawsuits against vaccine-makers. Under current law, people claiming injuries from vaccines covered by the program must first pursue a compensation claim before they can sue.

In cases where the science doesn’t support a connection to vaccines, lawyers might be more successful before a jury.

“Jury trials take advantage of the fact that most jurors don’t know anything about science or medicine,” Offit said. “They are not going to be as easily moved by the data.”

Still, attorneys who bring cases before the compensation program say the process has become more burdensome and adversarial over the years.

Even small changes could improve things. For instance, the statute of limitations for claims could be extended beyond the current three years, which lawyers say cuts off many potential clients.

“I’m hoping there will be changes put in place that make the program easier for petitioners to navigate” said Leah Durant, a vaccine injury attorney.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.