With hurricane and wildfire season well underway across much of the country, state and local emergency managers say they have little idea how much support the federal government will provide if disaster strikes. And the recent deadly floods in Texas have shown just how dire the need can be.

President Donald Trump has imposed severe cuts on the Federal Emergency Management Agency and denied some states’ requests for disaster recovery funds. FEMA also has failed to issue grants that many emergency managers rely on to fund their agencies — or to communicate its plans.

Wyoming’s Office of Homeland Security, which responds to disasters, relies on the feds for 92% of its money, said Director Lynn Budd. With that federal support in question, the state could face a precarious situation when the current grants expire at the end of September.

“If we don’t get this funding, what are we going to do?” Budd said. “You’re taking our capability away.”

Budd serves as president of the National Emergency Management Association, a nonprofit focused on public safety. She said state officials have been told by Trump that they’ve become too dependent on federal support.

Trump and officials in his administration have repeatedly talked of scaling back FEMA and pushing states to take the lead in disaster response. But in the wake of this month’s devastating flooding in Texas, administration officials have backed off Trump’s claims that he would eliminate the agency altogether.

White House spokeswoman Abigail Jackson did not grant an interview request, but issued a statement calling on states to play a larger role in disaster response.

State and local officials say Trump has provided no clarity about which disasters will qualify for federal recovery funds. He has denied support for disasters that met the existing criteria. At the same time, FEMA has yet to issue federal grants that provide much of the funding for local emergency management agencies.

As local leaders in rural Saluda County, South Carolina, work to rebuild from last year’s Hurricane Helene, they say the recovery process has been slowed by Trump administration policies making it more difficult to access disaster aid. Worse, the county’s Emergency Management Division has no idea whether the feds will release the grant funding that makes up most of its budget.

“Are we going to see the help we need arriving?” said Josh Morton, director of Saluda County’s Emergency Management Division. “I don’t know. When we pick up the phone, is there gonna be anybody there to answer?”

Aside from the cuts to state funding, FEMA under Trump’s administration has lost about a quarter of its full-time staff, according to The New York Times. The agency also cut hundreds of contractors at call centers, The Times reported, resulting in thousands of missed calls in the days following the Texas flood.

Meanwhile, emergency managers say that Trump’s cuts to the National Weather Service could further impair their ability to respond to fast-moving disasters.

The feds pull back

Trump and his administration have frequently said states should take on more responsibility for responding to disasters.

Brian Hughes, a spokesman for the National Security Council, said in an April statement to Stateline that the federal government would provide support only for “truly catastrophic disasters,” adding that states should have “an appetite to own the problem.”

Emergency management experts say it would be inefficient for all 50 states to stockpile the resources, staff and recovery funding to handle disasters on their own. Having a national agency that can deploy where it’s needed is far less wasteful.

“There’s no reason for every state to have all the resources that FEMA has,” said Michael Coen, who served as chief of staff at FEMA during the Obama and Biden administrations.

He noted that FEMA also plays a key coordinating role with other federal agencies during disasters.

There’s no reason for every state to have all the resources that FEMA has. — Michael Coen, chief of staff at FEMA during the Obama and Biden administrations

Morton, the Saluda County official, echoed that concern. He also serves as first vice president with the International Association of Emergency Managers, a nonprofit representing professionals in the field.

“It would be impossible for every county in the U.S. to maintain an adequate disaster recovery fund on their own,” he said. “Right now, we have a disaster fund at the federal level, and that money is able to be moved around to where it’s needed in the moment. That really is the best bang for the buck for the American people.”

But that federal support is no longer a sure thing. Morton said recovery funds for Hurricane Helene — which walloped states from Florida to North Carolina — have been slower to materialize than for previous disasters. FEMA officials have required more paperwork, he said, and Homeland Security Secretary Kristi Noem’s insistence that she personally approve any expenditure over $100,000 has also slowed the process.

Disaster declarations

In other parts of the country, state officials have petitioned Trump for disaster declarations, only to be rejected altogether. Washington state’s request for disaster aid following storms last November that caused at least $34 million in damages met all the “very clear criteria to qualify,” said Democratic Gov. Bob Ferguson, but was denied by FEMA.

While Trump administration officials have proposed limiting the events that qualify for federal relief, they have yet to issue new criteria. State leaders say they have gotten no clarity from the feds about whether they can count on support.

“We really need some communication on what to expect,” said Budd, the Wyoming official. “If we know there’s no federal funding coming, that would be an awful situation, but at least we can plan for that.”

Some experts say states should prepare for disaster relief to be approved along partisan lines.

“We just have to be honest that this White House is going to spend more resources, time and effort on people who live in red states than in blue states,” said Juliette Kayyem, faculty chair of the Homeland Security Project at Harvard University’s Kennedy School of Government and a former Obama administration official.

“It’s a hard thing for me to admit, and I don’t know how to solve it, but if you look at his reaction to [the Los Angeles wildfires in] California as compared to Texas, it’s very clear.”

Since February, Trump has denied six of the 10 major-disaster requests he has received from Democratic governors, according to an analysis from Seattle National Public Radio affiliate KUOW. He has approved 14 of 15 requests he has received from Republican governors during that same period.

Meanwhile, FEMA has yet to release the preparedness grants that many state and local governments depend on to fund their emergency management agencies and conduct projects to prepare for disasters. Those grants were set to be issued in May under a spending bill passed by Congress.

Coen, the former FEMA official, noted that the Texas Division of Emergency Management received nearly $20 million in federal funding last year to support day-to-day operations.

“Texas hasn’t been able to apply for that grant this year,” he said. “If they never get that grant, are they going to have to lay off staff or cancel contracts?”

FEMA has also revoked another set of grants, totaling $3.6 billion, that was intended to help communities prepare their infrastructure to withstand disasters.

Weather agency cuts

Amid the uncertainty at FEMA, emergency managers are also alarmed by Trump’s cuts to the National Weather Service and the National Oceanic and Atmospheric Administration. NOAA has lost nearly 2,000 employees, The New York Times reported, 600 of whom worked for the weather service.

The cuts have left many forecasting offices understaffed, with some no longer able to operate overnight.

“The National Weather Service plays as big of a role in protecting lives as anyone else in government,” said Morton, the Saluda County official. “It would be very hard for emergency managers to do our jobs effectively without the National Weather Service. But if these cuts keep coming, you’re going to start to see deficiencies.”

Budd, the Wyoming official, said the weather agency is crucial during wildfires.

“That’s how we know when it’s time to alert our communities or evacuate an area,” she said. “You can put firefighters’ lives on the line very quickly if they don’t have notification that those winds are changing.”

She added that Trump’s cuts to the U.S. Forest Service and other land management agencies have added another layer of concern as wildfires begin cropping up throughout the West. With the loss of federal support, Budd said officials are likely to become increasingly reliant on state-to-state resource-sharing compacts that allow them to call on one another during emergency situations.

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

On his way to an Ultimate Fighting Championship event, Health and Human Services Secretary Robert F. Kennedy Jr. stopped by the home of podcaster Gary Brecka. The two spent time in a hyperbaric oxygen chamber and tried some intravenous nutrition drips that Brecka, a self-avowed longevity and wellness maven, sells and promotes on his show, “The Ultimate Human.”

Then the podcast taping started, and Kennedy — who was also on the mic — took aim at Big Pharma’s influence on federal health policy.

“We have a sick-care system in our country, and the etiology ultimately of all that disease is corruption,” Kennedy said before the show cut away to an ad for vitamin chips. “And it’s the capture of these agencies by the industries they are supposed to regulate.”

While Kennedy lambastes federal agencies he says are overly influenced by the pharmaceutical industry, he and some other figures of the “Make America Healthy Again,” or MAHA, movement — such as siblings Calley and Casey Means, Robert Malone, and Peter McCullough — have their own financial ties to a vast and largely unregulated $6.3 trillion global wellness industry they also support and promote.

Kennedy and those four advisers — three of whom have been tapped for official government roles — earned at least $3.2 million in fees and salaries from their work opposing Big Pharma and promoting wellness in 2022 and 2023, according to a KFF Health News review of financial disclosure forms filed with the U.S. Office of Government Ethics and the Department of Health and Human Services; published media reports; and tax forms filed with the IRS.

The total doesn’t include revenue from speaking fees, the sale of wellness products, or other income sources for which data isn’t publicly available.

The Means siblings have launched wellness companies that have raised more than $99 million from investors, according to company news releases as well as information from Clay, a customer research data company, and Tracxn, an information technology firm that provides access to a database of companies, funding rounds, and investor information.

“Secretary Kennedy, and all HHS officials, fully comply with all ethics and financial disclosure laws,” agency spokesperson Emily Hilliard said in an email. “Any attempt to suggest impropriety is reckless and politically motivated.”

Some public health leaders and ethicists say the financial ties raise red flags, with the potential for personal profits to shape decision-making at the highest levels of federal health agencies.

“It’s becoming completely corrupted,” said Arthur Caplan, founding head of the medical ethics division at New York University’s Grossman School of Medicine. “You shouldn’t have a vested interest in making recommendations on wellness or supplements or health. It opens the door to all kinds of shenanigans. Big Wellness is no different than Big Pharma. They’re a well-organized political force.”

Unlike any other previous administration, President Donald Trump’s administration has elevated anti-vaccine and wellness leaders to positions at HHS from which they can steer federal policy. Adherents to the MAHA movement say the change is long overdue, arguing that previous administrations haven’t devoted sufficient attention to the potential harms of traditional medical approaches.

Critics including health policy leaders and physicians say they worry the revamped HHS and its agencies are now harming public health. For example, they point to a recent Kennedy decision to remove and replace all the members of a vaccine advisory group, a move the American Medical Association criticized as lacking transparency and proper vetting. Two of Kennedy’s newly named panel members — Malone and Martin Kulldorff — previously earned money as paid experts in vaccine lawsuits against Merck, as first reported by Reuters and the life-sciences news outlet BioSpace.

Calley Means, who has criticized the recommended U.S. vaccine schedule for youths and has no medical training, is a special government employee and a top health adviser to Kennedy. He also co-founded the wellness company Truemed.

The company enables people to spend pretax dollars from Flexible Spending Accounts and Health Savings Accounts to pay for wellness products, health food, and SoulCycle classes.

Truemed’s website says it can provide customers with a “Letter of Medical Necessity” for the items.

The IRS has warned consumers about companies that misrepresent wellness items like food as FSA-eligible when they are not, in fact, permitted medical expenses.

The IRS did not respond to questions about the status of that policy under the Trump administration.

In 2024, when Kennedy was running for president as an independent, he promoted Means’ company on his own podcast. Means also promoted his close connection with Kennedy last year on podcasts and on Instagram while also using social media to advance Truemed. And while working for the public as a special government employee since March, Means has used social and new media to promote podcasters who make money selling wellness products, to criticize specific pharmaceutical drugs, and to tout the wellness book he co-wrote, “Good Energy,” according to a KFF Health News review of social media posts and podcasts.

Means has also used podcasts and social media to rail against new injectable weight loss drugs. The Trump administration in April decided not to finalize a rule that would have allowed Medicaid and Medicare to cover the injectable drugs, putting them out of reach for millions of potential users.

Hilliard, the HHS spokesperson, didn’t respond to questions about whether Means, as a Kennedy adviser, has recused himself from decisions that could affect his business. Neither HHS nor the White House responded to requests to speak with him.

His sister, Casey Means, is Trump’s pick for surgeon general and was also an adviser to Kennedy during his 2024 presidential run. She co-founded Levels, a company valued at $300 million in 2022 that promotes glucose monitoring for nondiabetic, healthy individuals. Consumers pay $199 for a one-month supply of continuous glucose monitors.

She has used social media to call for public policy that would encourage blood sugar monitoring for healthy individuals, saying “tips to stabilize glucose should be on every billboard in America.” Research has found little evidence that such monitoring provides health benefits for people without diabetes.

Her company stands to benefit under the Trump administration. Kennedy said in April that he was considering a regulatory framework for federal health programs’ coverage of injectable weight loss drugs that would first require patients to try glucose monitoring or other options.

“And if they don’t work, then you would be entitled to the drug,” he told CBS News.

Casey Means isn’t a practicing doctor and doesn’t hold an active medical license, according to records from the Oregon Medical Board. And, as an online influencer, she “failed to disclose that she could profit” from sales of products she recommends, according to The Associated Press.

HHS spokesperson Hilliard didn’t answer questions about whether Casey Means would recuse herself from working on anything that would directly benefit her company, or why she didn’t disclose that she could profit from sales of products she recommends. HHS didn’t respond to questions about Means’ ties to Kennedy or agency support for glucose monitoring, nor did the agency respond to a request to speak directly to the Trump surgeon general pick.

Outside Advisers

McCullough, a former cardiac doctor who has financial ties to the wellness industry, has been part of Kennedy’s circle of informal advisers, according to people close to the secretary. He also has enough sway with some GOP lawmakers that they’ve had him testify before Congress. In May, he told a Senate subcommittee that mRNA covid-19 vaccines can lead to deaths that have been underreported. But the FDA says the covid vaccines are safe, with fewer than 1 in 200,000 vaccinated individuals experiencing a severe allergic reaction or heart problems like myocarditis or pericarditis.

He profits from his anti-covid-vaccine message. McCullough devised a protocol he says helps people detox from covid mRNA shots, selling the products through The Wellness Co. McCullough is the company’s chief scientific officer, draws a partial salary, and holds an equity stake.

For $89.99, consumers can purchase Ultimate Spike Detox supplements containing nattokinase, an enzyme from fermented soybeans. A two-month supply of Spike Support supplements sells on Amazon for about $62. More than 900 bottles have sold in the past month.

McCullough didn’t respond to an email seeking comment. HHS also didn’t respond to questions about his relationship with Kennedy.

Some health policy leaders and doctors say the financial connections federal health officials and advisers have to the wellness industry raise concerns.

“It’s exactly the problem RFK has taken up with the FDA, saying it’s too beholden to pharma,” said Pieter Cohen, an associate professor of medicine at Harvard University.

“When you’re in bed with supplement manufacturers, you are creating the same kinds of conflicts of interest, whether or not you directly profit,” he said. “You should be independently advocating for public health, not cheerleading for any particular industry.”

The wellness sector includes personal care, weight loss, health, nutrition, and wellness tourism.

Its lobbying influence is markedly smaller than the lobbying reach of pharmaceutical companies, according to OpenSecrets, a research organization that tracks money in U.S. politics. The nutritional and dietary supplements industry spent about $3.7 million on lobbying in 2024, for example, compared with the $387 million the pharmaceutical industry spent the same year.

It’s also gotten far less scrutiny. The industry is a growing political force with its own lobbyists, celebrities, and industry-backed advocacy groups, and research shows that public interest in wellness has grown since the pandemic. Eighty-four percent of U.S. consumers say wellness is a “top” or “important” priority, according to a survey released this year by McKinsey & Co.

Unlike with Big Pharma, there’s scant regulation of the industry. Companies can sell supplements and other products without notifying the FDA, and there’s little oversight by the Federal Trade Commission of their product claims.

“The wellness industry profiteers by undermining and creating distrust in science and regulated products,” said Andrea Love, an immunologist and microbiologist who founded ImmunoLogic, a science and health education organization. “They are messaging that the government and Big Pharma are hiding information and treatments or cures to keep us weak and vulnerable.”

Ethics and Disclosures

People on both sides of the issue say the industry has found its captain in Kennedy, an anti-vaccine activist with deep ties to the MAHA and wellness movements.

He has profited by referring people to law firms that are suing over alleged vaccine injury. For example, he gets a fee for referring potential clients to a Los Angeles personal injury firm, according to a January ethics statement to HHS and his financial disclosures. One of his adult sons works at the personal injury law firm.

When his nomination to the HHS secretary post was under consideration, Kennedy indicated in his ethics disclosure that he intended to continue profiting from lawsuits over Gardasil, a Merck vaccine that protects against HPV. After Democrats raised concerns with the financial relationship, he told Congress he would divest his interest and sign over the financial stake to one of his adult sons.

Federal ethics rules bar government employees from participating in matters in which they, their spouse, or their minor child has a financial stake. It doesn’t include adult children such as Kennedy’s sons.

“There are a lot of loopholes, and that is one of them,” said Cynthia Brown, senior ethics counsel at the Citizens for Responsibility and Ethics in Washington, a watchdog organization focused on U.S. government ethics and accountability. “It certainly is an appearance problem. Even if it’s not a technical violation, it is an ethical problem in terms of influence.”

Some lawmakers and ethics leaders weren’t mollified by Kennedy’s planned divestiture. Sen. Elizabeth Warren (D-Mass.) called on Kennedy to agree to a four-year, post-employment ban on accepting any compensation from lawsuits involving any entity regulated by HHS.

“It would be insufficient for RFK Jr. to only divest his interest in the Gardasil case while leaving the window open to profit from other anti-vax lawsuits, including future cases he could bring after leaving office,” she said in a statement.

Kennedy also made money on the MAHA name by applying in September to register it as a trademark. He transferred trademark ownership to a limited liability company led by friend and MAHA ally Del Bigtree after making about $100,000 off the phrase, according to his financial disclosure.

HHS’ Hilliard didn’t answer questions about whether Kennedy had signed over his interest in fees from legal referrals to his son, the money he made by registering MAHA as a trademark, or whether he agreed with Warren’s request that upon leaving office he accept a four-year ban on accepting money from lawsuits involving entities regulated by HHS.

Bigtree is executive director of the Informed Consent Action Network, or ICAN, an anti-vaccination group. He was communications director for Kennedy’s failed presidential campaign, and as an informal adviser to the secretary he helped vet candidates for HHS jobs. Bigtree’s salary at the nonprofit was $234,000 for the 2023 fiscal year, according to documents filed with the IRS. ICAN paid $6 million in legal fees to Siri & Glimstad in 2023. The firm’s managing partner, Aaron Siri, focuses on vaccine injury. He has been Kennedy’s personal lawyer and adviser, and also helped vet candidates for the secretary.

Brown, an ethics counselor, said the transfer and ongoing advisory relationship could raise questions about who is influencing Kennedy. Bigtree, at a Politico event in February, called on Kennedy to recruit scientists to HHS who believe vaccines cause autism, for example. One of Kennedy’s early actions at HHS was the launch of a study on the causes of autism.

ICAN didn’t respond to an email seeking comment. HHS also didn’t respond to questions about Kennedy’s transfer of the MAHA trademark to Bigtree.

“This is the type of Washington wheeling and dealing that raises questions about integrity in government,” Brown said. “If it was trademarked before he became a public official, there may be no law broken. But by transferring it to someone he knows, it illustrates the constant trickle of influence among those in power.”

Past administrations have faced similar criticism over health regulators’ ties to Big Pharma. Alex Azar, who led HHS during the previous Trump administration, worked for drugmaker Eli Lilly before entering public office. Robert Califf, FDA commissioner during the Biden administration, was a consultant to drug companies.

Scott Gottlieb, who was FDA commissioner from 2017 to 2019 and an adviser to Trump’s presidential campaign, stepped down to join the board of the drugmaker Pfizer.

“Big Pharma is well off. But, in general, financial conflicts don’t depend on how much the organizations are spending,” said Zeke Emanuel, a bioethicist who served on a covid advisory board under President Joe Biden. “The question is, is there a reasonable concern that financial or other concerns are affecting their judgment?”

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

One of the world’s biggest genetic databases comprises DNA data donated over the years by more than a million retired military service members. It’s part of a project run by the Department of Veterans Affairs.

The initiative, dubbed the Million Veteran Program, is a “crown jewel of the country,” said David Shulkin, a physician who served as VA secretary during the first Trump administration. Data from the project has contributed to research on the genetics of anxiety and peripheral artery disease, for instance, and has resulted in hundreds of published papers. Researchers say the repository has the potential to help answer health questions not only specific to veterans — like who is most vulnerable to post-service mental health issues, or why they seem more prone to cancer — but also relevant to the nation as a whole.

“When the VA does research, it helps veterans, but it helps all Americans,” Shulkin said in an interview.

Researchers now say they fear the program is in limbo, jeopardizing the years of work it took to gather the veterans’ genetic data and other information, like surveys and blood samples.

“There’s sort of this cone of silence,” said Amy Justice, a Yale epidemiologist with a VA appointment as a staff physician. “We’ve got to make sure this survives.”

Genetic data is enormously complex, and analyzing it requires vast computing power that VA doesn’t possess. Instead, it has relied on a partnership with the Energy Department, which provides its supercomputers for research purposes.

In late April, VA Secretary Doug Collins disclosed to Sen. Richard Blumenthal, the top Democrat on the Senate Veterans’ Affairs Committee, that agreements authorizing use of the computers for the genomics project remained unsigned, with some expiring in September, according to materials shared with KFF Health News by congressional Democrats.

Spokespeople for the two agencies did not reply to multiple requests for comment. Other current and former employees within the agencies — who asked not to be identified, for fear of reprisal from the Trump administration — said they don’t know whether the critical agreements will be renewed.

One researcher called computing “a key ingredient” to major advances in health research, such as the discovery of new drugs.

The agreement with the Energy Department “should be extended for the next 10 years,” the researcher said.

The uncertainty has caused “incremental” damage, Justice said, pointing to some Million Veteran Program grants that have lapsed. As the year progresses, she predicted, “people are going to be feeling it a lot.”

Because of their military experience, maintaining veterans’ health poses different challenges compared with caring for civilians. The program’s examinations of genetic and clinical data allow researchers to investigate questions that have bedeviled veterans for years. As examples, Shulkin cited “how we might be able to better diagnose earlier and start thinking about effective treatments for these toxic exposures” — such as to burn pits used to dispose of trash at military outposts overseas — as well as predispositions to post-traumatic stress disorder.

“The rest of the research community isn’t likely to focus specifically” on veterans, he said. The VA community, however, has delivered discoveries of importance to the world: Three VA researchers have won Nobel Prizes, and the agency created the first pacemaker. Its efforts also helped ignite the boom in GLP-1 weight loss drugs.

Yet turbulence has been felt throughout VA’s research enterprise. Like other government scientific agencies, it’s been buffeted by layoffs, contract cuts, and canceled research.

“There are planned trials that have not started, there are ongoing trials that have been stopped, and there are trials that have fallen apart due to staff layoffs — yes or no?” said Sen. Patty Murray (D-Wash.), pressing Collins in a May hearing of the Senate Veterans’ Affairs Committee.

The agency, which has a budget of roughly $1 billion for its research arm this fiscal year, has slashed infrastructure that supports scientific inquiry, according to documents shared with KFF Health News by Senate Democrats on the Veterans’ Affairs Committee. It has canceled at least 37 research-related contracts, including for genomic sequencing and for library and biostatistics services. The department has separately canceled four contracts for cancer registries for veterans, creating potential gaps in the nation’s statistics.

Job worries also consume many scientists at the VA.

According to agency estimates in May, about 4,000 of its workers are on term limits, with contracts that expire after certain periods. Many of these individuals worked not only for the VA’s research groups but also with clinical teams or local medical centers.

When the new leaders first entered the agency, they instituted a hiring freeze, current and former VA researchers told KFF Health News. That prevented the agency’s research offices from renewing contracts for their scientists and support staff, which in previous years had frequently been a pro forma step. Some of those individuals who had been around for decades haven’t been rehired, one former researcher told KFF Health News.

The freeze and the uncertainty around it led to people simply departing the agency, a current VA researcher said.

The losses, the individual said, include some people who “had years of experience and expertise that can’t be replaced.”

Preserving jobs — or some jobs — has been a congressional focus. In May, after inquiries from Sen. Jerry Moran, the Republican who chairs the Veterans’ Affairs Committee, about staffing for agency research and the Million Veteran Program, Collins wrote in a letter that he was extending the terms of research employees for 90 days and developing exemptions to the hiring freeze for the genomics project and other research initiatives.

Holding jobs is one thing — doing them is another. In June, at the annual research meeting of AcademyHealth — an organization of researchers, policymakers, and others who study how U.S. health care is delivered — some VA researchers were unable to deliver a presentation touching on psychedelics and mental health disparities and another on discrimination against LGBTQ+ patients, Aaron Carroll, the organization’s president, told KFF Health News.

At that conference, reflecting a trend across the federal government, researchers from the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality also dropped out of presenting. “This drop in federal participation is deeply concerning, not only for our community of researchers and practitioners but for the public, who rely on transparency, collaboration, and evidence-based policy grounded in rigorous science,” Carroll said.

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

The Trump administration’s broadsides against scientific research have caused unprecedented upheaval at the National Cancer Institute, the storied federal government research hub that has spearheaded advances against the disease for decades.

NCI, which has long benefited from enthusiastic bipartisan support, now faces an exodus of clinicians, scientists, and other staffers — some fired, others leaving in exasperation.

After years of accelerating progress that has reduced cancer deaths by a third since the 1990s, the institute has terminated funds nationwide for research to fight the disease, expand care, and train new oncologists. “We use the word ‘drone attack’ now regularly,” one worker said of grant terminations. “It just happens from above.”

The assault could well result in a perceptible slowing of progress in the fight against cancer.

Nearly 2 million Americans are diagnosed with malignancies every year. In 2023, cancer killed more than 613,000 people, making it the second-leading cause of death after heart disease. But the cancer fight has also made enormous progress. Cancer mortality in the U.S. has fallen by 34% since 1991, according to the American Cancer Society. There are roughly 18 million cancer survivors in the country.

That trend “we can very, very closely tie to the enhanced investment in cancer science by the U.S. government,” said Karen Knudsen, CEO of the Parker Institute for Cancer Immunotherapy and a globally recognized expert on prostate cancer.

“We’re winning,” Knudsen said. “Why we would let up, I really don’t understand.”

This article is based on interviews with nearly two dozen current and former NCI employees, academic researchers, scientists, and patients. KFF Health News agreed not to name some government workers because they are not authorized to speak to the news media and fear retaliation.

“It’s horrible. It’s a crap show. It really, really is,” said an NCI laboratory chief who has worked at the institute for three decades. He’s lost six of the 30 people in his lab this year: four scientists, a secretary, and an administrator.

“If we survive I will be somewhat surprised,” he said.

After a mandate by the Department of Health and Human Services and the Department of Government Efficiency to slash contract spending by more than a third, the cancer institute is cutting contracts to maintain precious biological specimens used in its research, according to three scientists. “The required contract cuts are going to be devastating,” a senior scientist said.

On the NCI campus in Bethesda, Maryland, scientists describe delays in getting essential supplies — “literally anything that goes into a test tube or a petri dish,” a recently departed clinician said — because of staffing cuts and constant changes in policies about what they can order.

Even the websites that publish new evidence on cancer treatment and diagnosis aren’t being updated, because HHS fired workers who managed them. And when NCI scientists do communicate with outsiders, what they say has been severely restricted, according to documents viewed by KFF Health News. Forbidden topics include mass firings, President Donald Trump’s executive orders, and “DEIA” – diversity, equity, inclusion, and accessibility.

The turmoil at the National Institutes of Health’s largest arm could haunt the country and the world for years to come.

“I really, really don’t understand what they’re trying to achieve,” said Sarah Kobrin, chief of NCI’s health systems and interventions research branch. “It just doesn’t make sense.”

“Efforts that are lifesaving now are being curtailed,” one scientist said. “People will die.”

Years of Bipartisan Support

Initially, some workers said, they thought the cancer institute might be spared. HHS Secretary Robert F. Kennedy Jr. has called chronic disease — cancer is one — “ an existential threat” to the country. Cancer research, with multiple NCI-funded breakthroughs in genetics and immunotherapy, has sidestepped the political minefields around other public health issues, like vaccination.

“People who care about cancer might be the biggest lobby in the country,” said Paul Goldberg, editor and publisher of The Cancer Letter, which has monitored oncology science and policy since 1973.

Count Mike Etchamendy, 69, of Big Bear Lake, California, as part of that lobby. Since 2013 he’s flown to the East Coast scores of times to participate in five clinical trials at the cancer wing of NIH’s Clinical Center.

“They call it the House of Hope,” Etchamendy said. Between drugs, therapeutic vaccines, and expert treatment for his rare bone cancer, called chordoma, he said, he believes he’s gained at least 10 years of life. He’s proud to have served as a “lab rat for science” and worries about NCI’s future.

“People come from all over the world to learn there,” Etchamendy said. “You cut funding there, you’re going to cut major research on cancer.”

In response to a list of detailed questions from KFF Health News about the cuts and chaos at NCI, HHS spokesperson Andrew Nixon said the reporting amounted to a “biased narrative” that “misrepresents a necessary transformation at the National Cancer Institute.” Nixon declined to elaborate but said research into cancer and other health conditions continues to be a high priority “for both NIH and HHS.”

“We are refocusing resources on high-impact, evidence-based research — free from ideological bias or institutional complacency. While change can be uncomfortable for those invested in the status quo, it is essential to ensure that NCI delivers on its core mission,” he said.

Much of NCI’s work is authorized by the National Cancer Act of 1971, which expanded its mandate as part of President Richard Nixon’s “War on Cancer.” Three of four of the cancer institute’s research dollars go to outside scientists, with most of the remainder funding more than 300 scientists on campus.

And Congress was generous. Harold Varmus, one of more than 40 Nobel laureates whose work was funded by NCI, said budgets were usually handsome when he was NIH director from 1993 through 1999. President Bill Clinton “would say to me, ‘I’d like to give you a bigger increase, Harold, but your friends in Congress will bring it up.’ He’d offer me a 5% increase,” Varmus recalled, but “I’d end up getting more like 10%” from Congress.

Congress appropriated $2 billion to NCI in fiscal 1993. By 2025, funding had risen to $7.22 billion.

Rat on Your Colleagues

During a May 19 town hall meeting with NIH staff members, Jay Bhattacharya, the institute’s new director, equivocated when asked about funding cuts for research into improving the health of racial and ethnic minorities — cuts made under the guise of purging DEI from the government.

According to a recording of the meeting obtained by KFF Health News, Bhattacharya said the agency remained “absolutely committed to advancing the health and well-being of every population, including minority populations, LGBTQ populations, and every population.”

Research addressing the health needs of women and minorities is “an absolute priority of mine,” he said. “We’re going to keep funding that.” But a study considering whether “structural racism causes poor health in minority populations” is “not a scientific hypothesis.”

“We need scientific ideas that are actionable, that improve the health and well-being of people, not ideological ideas that don’t have any chance of improving the health and well-being of people,” he said. That comment angered many staffers, several said in interviews. Many got up and walked out during the speech, while others, watching remotely, scoffed or jeered.

Several current and former NCI scientists questioned Bhattacharya’s commitment to young scientists and minorities. Staffing cuts early in the year eliminated many recently hired NCI scientists. At least 172 National Cancer Institute grants, including for research aimed at minimizing health disparities among racial minorities or LGBTQ+ people, were terminated and hadn’t been reinstated as of June 16, according to a KFF Health News analysis of HHS documents and a list of grant terminations by outside researchers.

Those populations have higher rates of certain cancer diagnoses and are more likely to receive diagnoses later than white or heterosexual people. Black people are also more likely to die of many cancer types than all other racial and ethnic groups.

Jennifer Guida, a researcher who focuses on accelerated aging in cancer survivors, said she recently left NCI after a decade in part because of the administration’s DEI orders. According to several workers and internal emails viewed by KFF Health News, those included an HHS edict in January to report their colleagues who worked on such issues, and flagging grants that included DEI-related terms because they didn’t align with Trump’s priorities.

‘I’m not going to put my name attached to that. I don’t stand for that. It’s not OK,” said Guida, who added that it amounted to a “scrubbing of science.”

Racial discrimination is one factor that contributes to accelerated aging. “There are a growing number of cancer survivors in the U.S.,” Guida said, and “a significant number of those people who will become cancer survivors are racial and ethnic minorities.”

“Those people deserve to be studied,” she said. “How can you help those people if you’re not even studying them?”

In May, NCI informed leaders of the Comprehensive Partnerships to Advance Cancer Health Equity, a program that links 14 large U.S. cancer centers with minority-serving colleges and universities, that their funding would be cut. The project’s Notice of Funding Opportunity — the mechanism the government uses to award grants — had been suddenly taken offline, meaning NCI staffers couldn’t award future funding, according to three sources and internal communications viewed by KFF Health News. These “unpublishings” have often occurred without warning, explanation, or even notification of the grantee that no more money would be coming.

The cancer partnerships have trained more than 8,500 scientists. They’re designed to address widely documented disparities in cancer care by having top medical schools place students from rural, poor, and minority-serving schools and community clinics in research, training, and outreach.

Research shows that patients from racial and ethnic minorities receive better medical care and have improved outcomes when their clinicians share their background.

“I’m from an immigrant family, the first to graduate in my family,” said Elena Martinez, a professor of family medicine and public health at the University of California-San Diego, who leads one of the partnerships with colleagues at largely Hispanic Cal State-San Diego. “I wouldn’t be here without this kind of program, and there won’t be people like me here in the future if we cut these programs.”

Silencing the Science Communicators

In early April, when the dust settled after mass firings across HHS, workers in NCI’s communications office were relieved they still had their jobs.

It didn’t last. A month later, HHS fired nearly all of them, three former workers said. Combined with retirements and other departures, a skeleton crew of six or seven remain of about 75 people. “We were all completely blindsided,” a fired worker said. NCI leadership “had no idea that this was happening.”

As a result, websites, newsletters, and other resources for patients and doctors about the latest evidence in cancer treatment aren’t being updated. They include Cancer.gov and NCI’s widely used Physician Data Query, which compile research findings that doctors turn to when caring for cancer patients.

Gary Kreps, founding director of the Center for Health and Risk Communication at George Mason University, said he relied on Physician Data Query when his father was diagnosed with advanced stomach cancer, taking PDQ printouts when he met with his dad’s doctors. “It made a huge difference,” Kreps said. “He ended up living, like, another three years” — longer than expected — “and enjoyed the rest of his life.”

As of May 30, banners at the top of the Cancer.gov and PDQ websites said, “Due to HHS restructuring and reduction in workforce efforts, the information on this website may not be up to date and pages will indicate as such.” The banners are gone, but neither website was being updated, according to a fired worker with knowledge of the situation.

Outdated PDQ information is “really very dangerous,” Kreps said.

Wiping out NCI’s communications staff makes it harder to share complex and ever-changing information that doctors and patients need, said Peter Garrett, who headed NCI’s communications before retiring in May. Garrett said he left because of concerns about political interference.

“The science isn’t finished until it’s communicated,” he said. “Without the government playing that role, who’s going to step in?”

A Budget To ‘Destroy Clinical Research’

Following court decisions that blocked some NIH grant cancellations or rendered them “void” and “illegal,” NIH official Michelle Bulls in late June told staffers to stop terminating grants. However, NCI workers told KFF Health News they continue to review grants flagged by NIH to assess whether they align with Trump administration priorities. Courts have ordered NIH to reinstate some terminated grants, but not all of them.

At NCI and across NIH, staffers remain anxious.

The White House wants Congress to slash the cancer institute’s budget by nearly 40%, to $4.53 billion, as part of a larger proposal to sharply reduce NIH’s fiscal 2026 coffers.

Bhattacharya has said he wants NIH to fund more big, breakthrough research. Major cuts could have the opposite effect, Knudsen said. When NCI funding shrinks, “it’s the safe science that tends to get funded, not the science that is game changing and has the potential to be transformative for cures.”

Usually the president’s budget is dead on arrival in Congress, and members of both parties have expressed doubt about Trump’s 2026 proposal. But agency workers, outside scientists, and patients fear this one may stick, with devastating impact.

It would force NCI to suspend all new grants or cut existing grants so severely that the gaps will close many labs, said Varmus, who ran NCI from 2010 to 2015. Add that to the impact on NCI’s contracts, clinical trials, internal research, and salaries, he said, and “you can reliably say that NCI will be unable to keep up in any way with the promise of science that’s currently underway.”

The NCI laboratory chief, who has worked at the institute for decades, put it this way: “If the 40% budget cut passes in Congress, it will destroy clinical research at NCI.”

KFF Health News correspondent Rae Ellen Bichell contributed to this report.

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

The vast tract of land off Route 85 was meant to be a symbol of Made-in-America manufacturing. A billion-dollar battery factory was going to rise, bringing thousands of new jobs. The business announced, “Get Ready Arizona,” the governor said the state was thrilled and even the U.S. president gave the project a shoutout.

But here, in the boomtown of Buckeye, less than an hour away from Phoenix, the 214-acre lot sits empty. Work on the site had started, said Shelby Lizarraga, who manages the gas station next door, “but then it went all quiet.”

Four years after the fanfare, battery maker Kore Power Inc. abandoned its plans for a plant in Buckeye. The company’s chief executive officer stepped down and a promised $850 million federal loan was cancelled.

Kore isn’t alone in its dashed ambitions. In Massachusetts, a wind turbine cable factory set to be built on the site of a former coal power plant was scrapped. In Georgia, the construction of a facility that would have made parts for electric vehicle batteries was suspended more than halfway through. And in Colorado, a lithium-ion battery maker said it wouldn’t go forward with its factory there, at least for now.

They’re among the dozens of planned green factories that have been cancelled, with more delayed or downsized, all hit by soaring costs, high interest rates and slow-growing EV demand. About 9% of the $261 billion in green factory investment announced since 2021 has been shelved — most of it since President Donald Trump returned to office in January — according to research firm Atlas Public Policy. Energy Secretary Chris Wright has said his agency doesn’t plan to move forward with some of the big-dollar loans that had been made to green manufacturing plants during President Joe Biden’s term.

Now there’s another, major threat to the sector: Trump’s massive tax-and-spending package, which rolls back Biden’s generous green subsidies.

Signed into law by Trump on Friday, it phases out credits for producing solar and wind energy years before they were designed to expire. It also ends federal tax credits for electric vehicles this September instead of in 2032.

Under Biden, a Democratic Congress passed the Bipartisan Infrastructure Law in 2021 and the Inflation Reduction Act a year later, setting aside hundreds of billions of dollars in incentives for clean-energy projects. New factories were announced from South Carolina to Michigan to Arizona, set to churn out EVs, batteries and clean-energy parts. Biden and Democrats sought to bring manufacturing back to the U.S. and make the country independent of, and competitive with, fast-electrifying China.

Many of the projects would be in red and purple states, shielding the policy against GOP attacks — or so the thinking went. That idea has now collapsed. (Among the members of Congress who voted for Trump’s bill was Paul Gosar, a Republican who represents Buckeye.)

Trump said at the signing that the country “is going to be a rocketship economically.” But fallout is likely to include more clean energy projects and the jobs they provide, or could have. Tesla Inc. Chief Elon Musk had lambasted the package on X as “severely damaging” to “industries of the future.”

The U.S. pulling back now means it will lag other countries that have invested in green technologies, and that will hurt economic growth and boost reliance on overseas manufacturers long term, said Hannah Hess of Rhodium Group, a research firm.

“There’s also the risk of stranded investments, a sizable amount,” she said.

Lithium-ion battery manufacturers like Kore face strict rules on using foreign components, plus knock-on effects from the solar and EV credit phaseouts. Because of the former, fewer grid batteries will be installed over the next decade, according to the research group Energy Innovation. The demise of the EV credit will likely dent consumer appetite for electric vehicles — and by extension, demand for the batteries they run on.

Buckeye — a former farming town named by settlers from Ohio — is a hotbed of building activity. Close to the Kore site is the suburban sprawl that’s come to characterize the Phoenix area’s rapid growth. Concrete is being poured in foundations and piles of rebar are stacked on construction sites, where tracts of desert are being transformed into new neighborhoods.

Executives at Kore had scoured 300 sites across the country before settling on Buckeye. Land was cheap, it was close to major West Coast ports and Arizona’s dry climate wouldn’t impair the chemistry of lithium-ion batteries. The company announced its factory in 2021, planning to start construction that year and roll out batteries in 2023. It would be Buckeye’s biggest employer, creating 3,000 jobs.

But as executives drew up construction plans, inflation hiked costs, while rising interest rates made financing more expensive. And the project got mired in the same slow permitting that stalls projects nationwide.

Costs swelled to $1.25 billion from $1 billion, so the company made adjustments to control expenses — even downsizing the factory — and worked aggressively to keep the project alive, Kore’s current CEO Jay Bellows said in a telephone interview. “We were trying to move as fast as we could,” Bellows said. “But ultimately, the costs were just really high.” The battery maker later got a loan commitment from the Energy Department.

Kore ended up getting approvals to move forward with construction in 2024, almost a year after it had wanted to start producing batteries. And then uncertainty loomed over the fate of federal green incentives if Trump were to win the election.

In Buckeye’s city hall, about 10 minutes away from Kore’s site, Mayor Eric Orsborn sensed that things were amiss. The project’s timeline kept getting longer and delays dragged out. “Things slipped a little bit more, a little bit more,” he said in an interview in his office.

Kore then said it was ending its plans to build in Buckeye, 10 days after Trump was sworn in. It’s one of 53 out of 715 green factories announced since 2021 that have been cancelled, according to Atlas Public Policy.

The outlook for green enterprises has darkened as policy shifts unsettle manufacturers, with EV makers feeling it the most, said Matt Shanahan of Marathon Capital, an investment bank focused on the energy transition. “The rules have changed,” he said.

The pace of cancellations and delays depends on how the market reacts to the law, he added, but early-stage projects are especially at risk. “To break ground on a new facility — I think it’s very challenging right now.” Energy storage may remain more resilient thanks to surging data center demand, he said.

Kore is now on the hunt for an existing building to move into, with power and infrastructure in place so it can save money and get to market faster, Bellows said. Looking back, he said he learned the need to move more quickly and efficiently. The company tried, he said, but “it’s a long, arduous process” to go from dirt to a fully operating factory.

Even so, other green facilities in the region are forging ahead. In Queen Creek, another fast-growing community that’s about 80 miles to the west of Buckeye, construction is underway on a $3 billion EV battery facility by LG Energy Solution. Cranes tower over the sprawling site, while bulldozers kick up plumes of desert dust as forklifts scuttle by. The project has faced its own challenges — construction was paused for some time last year as the company scrapped plans for a bigger plant.

But now the factory is set to open next year, and LG plans to employ 1,500 workers there by 2027. The company said in an April press release that it aims to contribute to a “local battery ecosystem” and that it will hire locally.

“It’s a manufacturing powerhouse,” Queen Creek Mayor Julia Wheatley said in an interview, adding that the town is seeing strong interest from companies looking to move near the plant.

On a Monday in late June, the empty Kore plot scorched in 100F-plus heat. Nearby, desert gave way to parcels of farmland, discount stores and palm-tree-lined neighborhoods. Dairy cows took shade from the heat, while trucks stacked with hay bales hurtled by.

Across the road, Joe Skoog, who runs a trucking company, said he would have liked to have pitched his business to Kore had the factory gone ahead. But he didn’t see the cancellation as much of a setback for the growing region. “Come back in five, 10 years’ time, and there will be more manufacturers and warehouses, and fewer farms,” he said.

Orsborn, Buckeye’s mayor, said he was disappointed, but not disheartened. He enthused about Buckeye’s population boom, fueled by Californian transplants, the big-box retailers and movie theaters opening up and how Kore’s shovel-ready site — with power, water and infrastructure now installed — is now even more attractive for other businesses that want to move in.

“Maybe another green energy one will,” he said.

©2025 Bloomberg News. Visit at bloomberg.com. Distributed by Tribune Content Agency, LLC.

The two engines on the Air India flight shut down within one second of each other before the Boeing 787 Dreamliner crashed last month in Ahmedabad, India, killing at least 260 people, according to a preliminary report released Friday.

Both engine fuel control switches that, if pulled while in flight, cut power to the engines, transitioned from the “run” to “cutoff” settings as the plane took off, according to the report.

In the recovered cockpit voice recording, one of the pilots is heard asking the other why he cut off fuel to the engine. The other pilot responded that he didn’t, according to the 15-page report.

The preliminary report, released by India’s Aircraft Accident Investigation Bureau, comes 30 days after the fatal crash, following guidelines from the International Civil Aviation Organization, a United Nations agency that recommends practices for the industry.

The new information matches media reports this week that, citing anonymous sources, said that investigators were focused on the engine fuel control switches.

On June 12, the Boeing 787 crashed in the northwestern Indian city of Ahmedabad less than a minute after takeoff, killing 241 of the 242 people on board and 19 people on the ground, according to the most recent estimates from local authorities.

The Everett-built plane crashed into a medical hostel roughly 1 mile from the airport. It was the first fatal crash involving a Boeing 787 Dreamliner, the jet maker’s smaller widebody plane.

India’s civil aviation authority is leading the investigation, with support from the U.S. and the U.K., which had several citizens on board the London-bound plane.

The switches moved back to “run” and one engine was regaining thrust when the plane crashed.

The report doesn’t specify which of the two pilots asked the other about the switches. Both pilots had an adequate rest period before the flight, underwent preflight breath analyzer tests and were deemed fit to fly, according to the report. The first officer was flying the plane and the captain was monitoring during takeoff.

The takeoff weight was within the allowable limits, and there were no “dangerous goods” on the plane, according to the report. There was no significant bird activity in the flight path.

Boeing and engine maker General Electric offered to support the investigation and Air India. Both companies have been limited in what they can say as the investigation is ongoing.

The report said at this investigation stage, there are no recommended actions for Boeing Dreamliner or General Electric engine operators and manufacturers.

With few official updates from accident investigators, the aviation industry and flying public have been searching for answers about what went wrong.

Aviation experts who spoke with The Seattle Times over the last month shared a long list of possibilities and were reluctant to rule anything out, noting that the circumstances of the crash were unusual.

©2025 The Seattle Times. Visit seattletimes.com. Distributed by Tribune Content Agency, LLC.

MIAMI — On Sunday, two men stood in front of Alligator Alcatraz to show support for the detention center. One held a sign that read, “Welcome to Paradise. Don’t feed the animals.”

The jokes about alligators attacking immigrants while in detention have been casually tossed around by President Donald Trump, Gov. Ron DeSantis and conservative and far-right influencers. The Florida GOP and Attorney General James Uthmeier are cashing in on “Alligator Alcatraz” merchandise, some that prominently feature alligators, to fundraise for campaigns. The ‘gators, in this case, are the good guys. The folks inside the detention center, no matter their story or status, are tempting treats for Florida’s newly deputized reptilian law enforcement.

The mocking of immigrant detainees harks back to “the worst parts of our history” when similar jokes and tropes, such as “gator bait,” were used to dehumanize Black people and desensitize people to the harm and violence inflicted upon them, says ACLU Florida Executive Director Bacardi Jackson.

The “gator bait” trope, which has been well-documented by the Jim Crow Museum in Big Rapids, Michican, implied that Black people don’t deserve protection against the hazards of nature. In the museum’s archive are articles detailing how Black babies, referred to by the slur pickaninnies, were used as bait to lure and kill Florida alligator.

The National Museum of African American History and Culture’s archive features postcards depicting Black children sitting near swamps to lure alligators. And the same disregard for humanity is now being applied to detainees who will be housed in the detention center, historian Marvin Dunn told the Miami Herald. “Basically, the same kind of anger, the same kind of resentment is now being transferred to immigrants,” he said.

“These kinds of tropes and jokes were made as a way to keep people from thinking of Black people as human. And now, when we are in this situation where what is happening to immigrant people, who are largely Black and brown people, it’s the same exact thing. It’s the dehumanization,” said Jackson. “It’s the desensitizing [of] folks in the hopes of not having people rise up against such cruelty and treatment of others.”

Jackson said when people see political leaders make light of real danger to people, it gives others permission to be “callous, cold and hateful,” similar to when Gov. Ron Desantis told drivers it was OK to hit protesters during the recent No Kings protests against Trump if they felt they were being endangered.

“You have a right to flee for your safety, and so if you drive off and you hit one of these people, that’s their fault for impinging on you,” DeSantis told a podcast last month.

“It’s the invitation for others to see people as less than human,” Jackson said. “That one creates the environment where a government can come up with more cruel and harmful policies.”

Dunn said the term “gator bait” never left the lexicon, particularly in the South. White nationalists use the term all the time and it is an “inside” joke among certain groups. “Gator bait” entered the national conversation in 2020 amid George Floyd protests nationwide when University of Florida president Kent Fuchs issued a statement saying the university would no longer do their “Gator bait” cheer, which involved fans doing the Gator chomp with their arms to taunt opponents.

Concern about the treatment and conditions the detainees were facing at the detention center caused several state officials to appear outside Alligator Alcatraz and demand entry last week.

Florida state Sen. Shevrin Jones was among five elected state officials who attempted to enter the facility but were shut out. He will return Saturday during a scheduled visit for state legislators. Jones said he’s refusing to call the site “Alligator Alcatraz,” and questions the treatment of immigrants who are kept at the facility.

“It’s baffling to me that individuals have made this a Democrat or Republican issue when we’re talking about humanity and ensuring that individuals are being treated humanely,” said Jones, a Democrat who represents Miami Gardens and other areas in northern Miami-Dade. “It has turned so political where now individuals are justifying inhumane treatment for human beings.”

Jackson said the dehumanization of one group opens the door for more harm to come to everyone.

“Silence is consent. We have to pay attention to what’s happening,” she said.

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

When North Dakota state Sen. Ryan Braunberger first introduced a slate of tenant protection bills this year, he knew the odds of passage weren’t in his favor. Braunberger, a Democratic lawmaker in a Republican-controlled legislature who represents a renter-heavy district in Fargo, spent years as a housing advocate — walking tenants through eviction court, helping them navigate late fees and lease violations.

But inside the statehouse, he was an outlier: one of the only legislators who rents his home.

By the end of the legislative session, just one of his five proposals passed. But that one might prove to be a major overhaul of the state’s eviction process.

The bill came together thanks to an unlikely lawmaking alliance: a renter and housing advocate with deep policy knowledge, and a Republican who hadn’t previously focused on eviction law but quickly saw its impact in his district.

Co-sponsored by Republican state Sen. Jeff Barta, the legislation allows tenants to petition to have eviction records sealed after seven years, if they’ve resolved any outstanding rent or damages and stayed eviction-free during that time.

“I didn’t know much about this process, but when Sen. Braunberger reached out to me, I looked into just how much an eviction from years ago was possibly affecting renters and constituents in my district,” said Barta. “As a new lawmaker, you’re still getting settled in, so it was good to dive into an issue that hits home to my district.”

Nationally, North Dakota has joined a slow but steady stream of states that seal or expunge eviction records.

Eviction filings are public and often lack case outcomes or context, yet they’re widely used by screening companies, creating barriers even when tenants win or cases are dismissed. A 2020 study of 3.6 million eviction records across a dozen states by Princeton University’s Eviction Lab found that 22% of the records were ambiguous or falsely represented a tenant’s past.

Black women, especially those with children, are disproportionately affected by evictions. Young children and infants are affected more than any other age group.

Barta noted that many North Dakotans are evicted for financial reasons or may be fleeing domestic violence, and that holding old evictions against tenants prevents them from rebuilding stability.

“That’s really what caught my eye,” Barta said. “I need to be aware of what my constituents are facing. Some people weren’t evicted for being irresponsible. They were fleeing violence or hit by one bad break.”

Grand Forks, which is in Barta’s district, is more than 50% renter-occupied, making it one of the most tenant-heavy in the state, thanks in part to its proximity to the University of North Dakota. Grand Forks has also seen rents climb and vacancy rates tighten, while evictions — sometimes stemming from as little as a few hundred dollars of unpaid rent — can leave permanent marks on a tenant’s record.

“Most landlords wouldn’t even give people a second chance once they saw an eviction on someone’s record,” Braunberger said. “It didn’t matter if the case was from a decade ago or if it had been resolved. That record stuck to them like glue.”

The North Dakota Apartment Association opposed the measure, citing concerns that it could allow sealing of eviction records even when the eviction stemmed from issues beyond domestic violence, such as nonpayment or other lease violations. Lobbyist Jeremy Petron testified that the bill could undermine property managers’ ability to assess tenant risk through background checks.

“Property owners and property managers rely on background checks for decisions on prospective tenant approvals for the safety of neighbors and the property, and the business investment risk,” Petron testified.

Compromises

Passage of North Dakota’s law required not only bipartisanship but also key compromises outside the legislature. Early drafts proposed full expungement, a term that drew sharp criticism from the North Dakota judiciary, which warned the language implied a permanent erasure of legal history without proper oversight.

In response, lawmakers worked with the state Supreme Court and housing groups to shift toward sealing records instead, a more limited measure than expungement.

Most states tend to seal records rather than expunge them.

North Dakota’s Administrative Rule 41, which governs access to court records, is now being updated to reflect the new law. Sealed eviction records will be categorized as confidential, but they won’t be deleted outright. And not all evictions will qualify: Tenants must have no further evictions within seven years, and must resolve any unpaid rent or damages related to the original filing.

“After talking with the Supreme Court and apartment associations, we landed on a compromise: sealing,” Braunberger said. “It preserves judicial records while still giving tenants a fair shot at moving on.”

Sara Behrens, a staff attorney with the State Court Administrator’s Office, said the final version addressed the court’s concerns.

“Without these amendments, any eviction could be sealed following seven years regardless of further evictions or outstanding judgments,” she said. “That was a serious flaw we were able to correct.”

Despite North Dakota’s Republican supermajority, the legislation passed with overwhelming support: 35-12 in the Senate and 88-5 in the House. Both Barta and Braunberger attributed the success to North Dakota’s relatively open political culture.

“Even though we have a supermajority, there’s not a ton of separation,” Barta said. “We talk. We listen.”

Braunberger echoed that sentiment. “If I want any policy to move, I have to collaborate,” he said. “That’s almost a given here.”

Yet the sealing law was only a partial win in a broader tenant rights agenda for Braunberger. Three other bills — ranging from caps landlords can impose on late rent fees to investigations into tenant-landlord matters — died in committee or failed to gain traction. Braunberger said he plans to reintroduce some of them next session.

“It’s a civil matter, so people don’t have a right to counsel,” Braunberger said of tenant legal proceedings. “That’s something I’d love to change. No one should lose their home without legal help.”

Both lawmakers pointed to next steps beyond legislation. Barta emphasized the need for better communication and education to help tenants understand leases, rights and processes. Braunberger wants more incentives for mediation, saying it can reduce financial losses for both landlords and renters and keep disputes out of court.

Elsewhere

Last year, Idaho, Maryland and Massachusetts enacted laws to seal certain eviction records from public scrutiny and from tenant screening companies. Massachusetts’ law just went into effect in May, while Maryland’s law is scheduled for October.

In Indiana, a new law allows courts to seal eviction filings automatically in three circumstances: dismissal of the case, judgment in favor of a tenant or reversal on appeal. The automatic sealing reduces the burden on tenants to petition on their own.

Hawaii, Kansas, Oklahoma, Pennsylvania and South Carolina are among states that introduced eviction-sealing laws this year. Those bills, which still await passage in both legislative chambers, vary on the conditions of sealing.

This June, Nevada Republican Gov. Joe Lombardo vetoed two high-profile tenant protection bills. One would have automatically sealed certain eviction records, and another sought to slow the state’s fast-track summary eviction process.

In his veto of the eviction sealing bill, Lombardo said it was “lopsided, red-tape laden, and would have disastrous consequences on Nevada’s housing market.”

He argued the bill would overburden courts, eliminate judicial discretion and “risks punishing” property owners by shifting procedural responsibilities onto them.

Pennsylvania’s proposal, which would keep fault-based eviction records public for seven years, would limit access to records of no-fault evictions, in which a landlord asks a tenant to move out for reasons such as wanting occupancy or to sell the property. It passed the House by 105-98, thanks to a few Republican votes.

Kansas’ proposal would offer automatic expungement after two years unless debts remain, and South Carolina’s bill would seal all eviction records in circumstances in which an eviction case is filed but doesn’t lead to an actual eviction order within 30 days, or six years after a case was closed.

North Dakota’s bipartisan success with its new sealing law positions the state as one with lawmakers finding common ground on housing problems.

“We have a housing crisis,” Braunberger said. “Some areas can’t even attract employers because there’s no place for workers to live. Until we fix that, housing policy isn’t just social policy, it’s economic policy.”

Stateline reporter Robbie Sequeira can be reached at rsequeira@stateline.org.

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

The giant tax and spending bill President Donald Trump signed into law over the weekend includes the biggest health care spending cuts in U.S. history. In response, states are scrambling to shield their hospitals from the looming loss of hundreds of millions in federal funding.

In Georgia, a key state panel late last month took steps to send more state Medicaid money to hospitals, hoping to maximize federal matching dollars before the cuts take effect. Other states are considering new grant programs that would funnel additional money to rural hospitals. Some state legislatures likely will reconvene to discuss how to fill holes in their Medicaid budgets.

The tax and spending bill cuts more than $1 trillion from Medicaid, the public health insurance program for people with low incomes that’s jointly funded by states and the federal government. Under the measure, payments to hospitals or nursing facilities would probably decrease in at least 29 states, according to an analysis by KFF, a nonprofit health policy group.

Facing such budget shortfalls, states may have to stop offering optional Medicaid benefits such as vision and dental, reduce the rates they pay providers — which could shrink access for Medicaid enrollees — and change eligibility requirements so that fewer people qualify for coverage.

State policymakers and health experts worry the loss of funding also will endanger hospitals, particularly those in rural areas, driving up uncompensated care and forcing them to cut services or close entirely.

“Ultimately, when these hospitals close, what happens? People have to now travel longer for care. They might not even make it,” Dr. Anahita Dua, a vascular surgeon at Massachusetts General Hospital and Southern New Hampshire Medical Center, told reporters last week during a news conference hosted by Defend America Action, a group launched to oppose Trump administration policies.

“This is ultimately not only going to affect the lives of the people that are not going to get the care, but also the majority of the hospitals that provide this care, and the people that are employed by those locations,” she said.

Earlier this month, an analysis by the State Health and Value Strategies program at Princeton University estimated that hospitals would lose 18% of their Medicaid funding, nearly $665 billion over the next 10 years.

Republicans have hailed the megabill — officially titled the One Big Beautiful Bill Act — as one that will cut waste, fraud and abuse in federal programs, secure the U.S. border and spur economic growth. The measure will add at least $3 trillion to the national debt over the next decade, according to the Congressional Budget Office, and has been scored by some independent economists as likely having little impact on growth. Dollars diverted from Medicaid will go toward the tax cuts prioritized by Trump, along with new spending on immigration control and defense projects.

Reconvening legislatures

Health policy experts anticipate at least some states will have to pull their legislatures back into session to address gaping budget holes due to the Medicaid cuts.

States can expect to lose 3%-18% of their federal Medicaid funding over 10 years under the law, according to the State Health and Value Strategies program report. Arizona, Kentucky and Virginia would see the largest shares of their Medicaid dollars evaporate.

Colorado Democratic Gov. Jared Polis has said he’s likely to reconvene the legislature.

“Almost certainly if some of these big cuts to Medicaid go through … we would likely need to reconvene, depending on what Congress does,” Polis said at a news conference in May.

Policymakers in some states have tried to get ahead of expected shortfalls.

In late June, the Georgia Department of Community Health’s advisory board held an emergency meeting. In a unanimous vote, the board approved several measures aimed at increasing the state’s federal Medicaid reimbursement rate.

For example, the state wants to significantly increase Medicaid payments to hospitals that achieve certain goals, such as training Georgia doctors and delivering babies. The move would draw down an additional $2.1 billion per year in federal money.

“We’re doing our best to be responsive to the Medicaid conversations in Washington,” department Commissioner Russel Carlson told the board at the meeting. “Not overreacting in this 24/7 news cycle, but gathering the best information we can, reading the political environment the best we can, and acting responsibly.”

Other states have filed similar requests with the federal Centers for Medicare & Medicaid Services, and received approval in recent months.

“Of all the Medicaid discussions happening in Washington,” Carlson said, “one of the policy decisions that could potentially, depending on how it ultimately lands, impact Georgians the most is the discussion surrounding directed payment programs.”

Grants for hospitals

Some of the biggest federal savings in the new law come from limiting states’ use of a financing tool, known as a provider tax, that enables them to draw down more federal dollars. States use the extra money to boost reimbursement rates for hospitals and to expand coverage.

Some congressional Republicans have decried the maneuver as a “ money laundering scheme,” but lowering provider taxes will likely punch big holes in state Medicaid budgets.

Meanwhile, some state legislatures are looking at alternate ways to shore up funding for hospitals. A bipartisan bill still under consideration in Pennsylvania would create a rural health care grant program to help pay off student loans for rural doctors, nurses and dentists. Indiana and Oklahoma also considered bills this session to create grant programs for rural hospitals.

In April, Texas Republican Gov. Greg Abbott announced the state would release more than $6 million in grants to support struggling rural hospitals.

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.

After Robert F. Kennedy Jr. became the nation’s top health official in February, pediatrician Jeff Couchman started getting a lot of questions from worried parents.

“They’d ask: ‘Are vaccines going to be available? Can we give my kid every possible shot today just to make sure?’” said Couchman, who practices at Mesquite Pediatrics in Tucson, Arizona.

So, for the first time, Couchman and his colleagues have started offering vaccines on an accelerated schedule. They’re giving a second dose of the MMR vaccine to prevent measles, mumps and rubella as early as 15 months of age, though it’s not typically recommended until age 4. And they’re offering shots to prevent HPV, a common sexually transmitted infection that can cause cancer, starting at age 9, two years earlier than the government suggests.

There are risks to giving shots too early. Government vaccine advisers developed the schedule for childhood shots by looking at the results of clinical studies and scrutinizing how the human immune system changes from infancy to adulthood, among other factors. For some vaccines, like the ones Couchman is doling out ahead of schedule, doctors know adjusting the timing by a few months or even years makes little difference. But for others, deviating from the schedule means the shot won’t be fully effective, or could pose other problems that haven’t yet been discovered.

Pediatricians across the U.S. interviewed by Bloomberg said they’re now working with parents to carefully weigh those risks against the threat posed by Health and Human Services Secretary Kennedy’s leadership. Their key concern is that after Kennedy fired some of the government’s top vaccine experts and appointed replacements who have promoted dubious theories about the safety and efficacy of shots, the U.S. may ultimately stop calling for their use. That could lead to higher costs for patients or shortages.

“I’m worried that any moment now vaccines will not be recommended anymore,” said Eli Fels-McDowell in Lexington, Kentucky, who recently got her daughter a second dose of the MMR vaccine earlier than usual, at age 3, and a COVID vaccine after Kennedy said it was no longer recommended for healthy kids. “We’re trying to limbo under the bar really quickly.”

It’s hard to get precise numbers on how many vaccines are given early. It’s not tracked by the Centers for Disease Control and Prevention or by several state health departments contacted by Bloomberg News. But interviews with pediatricians and parents across the country reveal an emerging trend: a surge of requests for childhood vaccines before they are typically given, citing Kennedy as a reason why.

On a weekend in March, Mesquite held a special clinic for parents who wanted earlier vaccines for their kids. About 45 families showed up, a significant number for a relatively small pediatrician, Couchman said. Overall, his practice has given early second doses of the measles vaccine to about 227 children between 1 and 4, or about 70% of patients in that age range.

In Marin County, just north of San Francisco, pediatrician Nelson Branco said about 20% of families that he sees are requesting an early dose of MMR vaccine. In Charleston, South Carolina, pediatrician Eliza Varadi has seen a rise of requests from parents to give the HPV vaccine to their 7- and 8-year-olds because they’re worried it will no longer be approved or covered by insurance — something she’d never seen before February. And in Florida, pediatricians have been getting parental requests for early shots “more and more,” said Rana Alissa, president of the Florida Chapter of the American Academy of Pediatrics.

“Parents are coming in confused about so many things,” Alissa said. “They are mentioning RFK by name.”

Last month, an influential seven-person vaccine advisory panel handpicked by Kennedy said it would form a committee to review childhood vaccines. If the group reverses course and opts to no longer back the well-established childhood shot schedule, it will affect access to those vaccines.

The panel, known as the Advisory Committee on Immunization Practices, helps guide which shots insurance companies fully cover and whether manufacturers are shielded from legal liability over side effects. It also helps determine whether vaccines are available for free through the Vaccines for Children program, a taxpayer-backed initiative to ensure every child has access to lifesaving shots. About half of U.S. kids are eligible for the program.

There are reasons to believe Kennedy’s panel will stray from medical precedent. The panel also voted last month against recommending flu shots with a preservative long considered by scientists to be safe, but falsely believed by so-called anti-vaxxers to cause autism. Kennedy has also suggested kids now get too many shots and raised doubts about their safety, falsely claiming the measles vaccines causes deaths each year.

The committee’s moves were a clear sign that some childhood vaccines are in jeopardy, said Sean O’Leary, chair of the infectious disease committee at the American Academy of Pediatrics.

“Based on what we saw, it’s absolutely well-founded for parents to worry that vaccines will get taken away,” he said.

Giving a vaccine early can still fall within government guidelines. The CDC recommends a child get the second MMR vaccine dose between age 4 and 6, but says it can be sooner if it’s at least 28 days after the first. While the HPV vaccine series is recommended at 11 or 12, the CDC says it can be started at age 9.

Still, deviating too far from the schedule can make pediatricians uncomfortable. In some cases, giving a shot well before the recommended age poses unknown risks.

“When you deviate from that schedule, then you’re kind of in unstudied territory,” said Branco, the Marin County pediatrician.

There are potential downsides to giving children shots too soon. Researchers have found infants are born with maternal antibodies that may prevent the measles vaccine from working long-term if they get it before they turn 1. A first measles vaccine dose before that age should only be done in special circumstances, like before traveling to a place with an outbreak, and shouldn’t count toward the normal two-dose schedule, pediatricians say.

In such cases, parents would be giving a child an extra dose of a vaccine that has potential rare side effects like allergic reaction, febrile seizure and a blood-clotting issue that can cause bruising and bleeding.

Some parents still believe it’s better to accept those risks than to possibly leave their children unvaccinated.

In February, Bridget Butler, a 40-year-old mother of three, asked her pediatrician about vaccinating her youngest son early during the measles outbreak. Butler, who lives in North Carolina, said she grew concerned as measles ripped through West Texas and cases cropped up in nearby states.

But Kennedy’s recent move to fire government vaccine advisers has also worried her. Her son turns 1 in August, when he’s due for his first dose of the MMR vaccine. She’s concerned that her insurance won’t cover shots if the U.S. government no longer recommends them and is weighing whether to get him the shot ahead of schedule.

“It’s a hot mess,” Butler said.

©2025 Bloomberg News. Visit at bloomberg.com. Distributed by Tribune Content Agency, LLC.