This isn’t just a bad year for measles. It looks to be the start of a bad era. Confirmed measles cases just hit a 35-year high, and it’s only July. Together with last year, the number of cases has exceeded the combined total over the previous 25 years. The vast majority of cases stem from domestic outbreaks fueled by low rates of vaccination—and rates are declining.
For the first time in a quarter century, the U.S. no longer meets a main criterion for having eliminated measles as a public health threat. That status hinges on sporadic outbreaks fizzling out within a year. Utah’s outbreak has lasted for longer, since June 2025.
Nearly 400 people have been hospitalized with measles in the U.S. this year and last, three people have died, and at least three suffered brain swelling with lingering symptoms.
This month, the Centers for Disease Control and Prevention is set to finalize a comprehensive study of the nation’s measles situation, examining data from January 2025 through June 2026.
“I don’t think we could say with a straight face that there hasn’t been transmission over the past 12 months,” said a CDC scientist with knowledge of the agency’s measles report. (KFF Health News agreed not to name the researcher, who is concerned about retaliation.) The researcher said a national committee of measles specialists will review the CDC’s internal report, which then goes to the Pan American Health Organization, a group that evaluates the measles elimination status of countries throughout North, South, and Central America and the Caribbean.
PAHO will make its decisions at an annual meeting this fall, but scientists say the writing is on the wall. “The assessment for elimination isn’t until November, but that is a scheduling issue, basically,” said Anne Schuchat, who led the CDC’s immunization and respiratory disease group from 2006 to 2015.
“It’s just so sad, because some people will get brutally ill,” she said of measles’ return. “This is a wake-up call.”
Southwestern Utah has been hit hard by an ongoing measles outbreak that’s lasted for more than a year. (Amy Maxmen/KFF Health News)
Pediatricians in Utah have been on the front lines as measles and other vaccine-preventable ailments have returned to the U.S. In interviews with KFF Health News, six doctors shared insights on this new era of vaccine hesitancy — and what could be done to turn the situation around.
The conversations have been edited for clarity.
On Unvaccinated Children Hospitalized With Measles Complications
Emilie Morris, a hospital pediatrician in Salt Lake County and Utah County: When children come in, they’re often bent over. We call it tripoding, which is particular to upper respiratory infections and airway swelling. They have a rash — viruses cause rashes all the time — but in this context, the kid is hunched over, mouth open, drooling, crying, maybe not even producing tears, because they’re so dehydrated. Really labored breathing, kind of tugging in their belly, tugging between their ribs. Their eyes look kind of glazed over. It’s like they’re seeing through you.
Nathan Money, a hospital pediatrician in Salt Lake County and Utah County: If the child has a fever or trouble breathing, and they’re unvaccinated, I have to be way more aggressive from a medical standpoint, because they are at higher risk of having life-threatening illnesses. I have to do more blood work, or lumbar punctures to rule out meningitis. I have to do things which are painful, and it’s traumatic for the families.
I tell them, “Because your child doesn’t have vaccines, I have to be more worried about conditions like sepsis or meningitis, so therefore I need to do more workup.” The last thing I want to do is miss something. These are parents who love their children. They always tell me, “Do what you need to do to make sure my child is safe.”
On Treating Unvaccinated Children Hospitalized for Measles
Trahern W. Jones, a pediatric infectious disease specialist based in Salt Lake City: So I’m coming into a room and just hearing the most awful barking cough, just a cough and a high-pitch stridor as the child is trying to breathe. And he’s just coughing so hard it just makes you feel short of breath. He looks like he’s been beaten down for days, but he can’t rest, because the cough keeps him awake.
The parents tell me they’re not anti-vaccine, but in the past, somebody they know had a reaction to a vaccine — or something they thought was a reaction to a vaccine — and so they paused vaccines when the child was a baby. They were planning to catch up later.
In another case, the parent was stunned by how awful it was. I asked them what they knew about measles before their child was sick, and they said the only person who’d ever taught them anything about measles was their grandmother who had taken care of her kids with measles ages ago. That’s something I’ve heard from other parents. It’s such an awful illness. Even the best possible course is going to be one of the worst diseases most children ever go through.
There are multiple facets to it. Physically, the child has been beat down for multiple days by this virus. The parents don’t get to sleep, because they’re nursing their child. Then there’s the emotional component because the parent is regretting not getting the vaccine, not realizing how bad this was, and then feeling deeply ashamed, trying to reconcile with family members who are really upset at them for not getting their child vaccinated.
Morris: One child was from a family that was uninsured because they didn’t feel that they would need to use the medical system. They were faced with the high burden of cost of our healthcare system. The cost was playing into the parents’ decision on whether or not their child should receive necessary medical care. I said something like: “Please don’t go home. Your child needs oxygen. She has pneumonia. We will figure out a way to pay for this, because we acknowledge what we do is expensive.”
On top of that, the parent had several other children in the home who weren’t vaccinated. It was past the period where we could intervene with vaccines to try to prevent infection, so then our recommendation was to quarantine their children at home for 21 days: “Don’t interact with anybody else in your community. Don’t go to the grocery store, even with a mask. Please take this seriously.”
It takes time for parents to understand the level of concern I have, even when their child is physically ill in the hospital requiring ongoing care. It’s pretty indicative of the breakdown of trust between physicians and families. I say, “This is the gravity or severity of your child’s situation and how serious we need to be about protecting other people.”
It’s frustrating. How can I make people understand I have a very genuine concern for their child? And I know they share that concern, but maybe it’s not the same degree of concern, because they don’t understand the illness and how severe it can become.
Money: It’s heartbreaking to see these children struggling to survive when measles could have been easily prevented by a safe mechanism that is readily available and well studied. These are well-meaning parents who love their children, who have gotten bad information from federal leadership or from online sources. The saddest part to me is when I am caring for a child and the parent says, “I didn’t know that this could get so bad.”
On Conversations With Parents Who Don’t Vaccinate Their Children
Tim Duffy, a pediatrician in Salt Lake County: A lot of families aren’t aggressively anti-vax, but they’re hesitant. Younger parents who grew up in the digital age have done their research — “research” in quotation marks — for months. And they keep getting confirmation of their concerns on social media. They think they’re doing what’s best for their child.
I’ve told families: “You could do nothing I say as a pediatrician. You could sleep your child on their stomach. You could not put them in a car seat or, when they’re older, not use seat belts. You could do nothing I say, and for your individual child, they will probably be OK. But from my standpoint, where I’m taking care of thousands of kids, within a system that takes care of hundreds of thousands of kids, we will have bad outcomes. These children will show up at our facilities, and it’s so sad.”
Tim Duffy, a pediatrician in Salt Lake County, Utah, says many parents are concerned about incorrect claims about vaccines seen on social media. (Amy Maxmen/KFF Health News)
Pediatrician in southern Utah whom KFF Health News agreed not to name, because of concerns about harassment after being targeted by anti-vaccine activists in the past: A lot of parents are concerned about autism. I’ve told them that I’d be very concerned if there was any evidence that what we’re doing is causing autism. But if vaccines were causing autism, we should see more cases of autism in vaccinated kids compared to unvaccinated kids, and we’re just not seeing that.
I’ve also had families who say they want to be natural, or that they’re concerned about what is in the shots. A frequently asked question is: “Did you vaccinate your children?” I say that knowing what I know, I’m confident giving this to my kids. They’re all vaccinated.
On the Influence of Politics on Vaccine Hesitancy
Jones: Vaccines have become a political football. That wasn’t true 20 years ago. But now it’s used to drive a wedge between groups of people, which is unfortunate. Vaccines are one of the main reasons why we don’t have to worry about losing our kids.
Southern Utah pediatrician: People don’t know who to believe. If politics comes up, I tell parents that my messaging on vaccines is not politically motivated. When parents ask about changes to the vaccine schedule, I’m transparent. [In January, the Department of Health and Human Services controversially recommended reducing the number of vaccines given to children. A few months later, a federal judge blocked those changes.]
I’ve said there was a process for the approval of immunizations through ACIP [the Advisory Committee on Immunization Practices], which is made up of scientists, public health experts, and doctors, and all those people were let go, and a new panel was selected. A couple of individuals changed the recommendation outside of the time-tested, evidence-based process for evaluating vaccines. That raises concerns for me as a doctor. I tell parents that the American Academy of Pediatrics, the American Academy of Family Physicians, and several other professional organizations have issued statements saying that these changes are not based on evidence.
Ellie Brownstein, pediatrician in Salt Lake County and president-elect of the Utah chapter of the American Academy of Pediatrics: I avoid talking about politics, but what’s being said has added another layer to our work. One family asked me about changes to vaccine recommendations, so instead of just telling them what immunizations are due, I talk with them about why physicians and researchers have followed a different schedule for years, about the reasoning and the science behind it. I explain that I trust these experts over someone without a lot of experience.
The Southwest Utah Public Health Department stocks vaccines against measles, whooping cough, tetanus, hepatitis B, and other diseases. (Amy Maxmen/KFF Health News)
Money: People are not vaccinated, because they’ve lost trust in the medical community. They’re placing trust elsewhere. Rebuilding trust is a complicated process, but it comes from consistent messaging at every level, from the pediatrician to local health departments to community leaders, city leadership, district leadership, religious leadership, educational leadership.
We need consistent messaging from state leadership, which has been pretty absent. I want to see commercials on TV about the safety of the MMR [measles, mumps, and rubella] vaccine and the dangers of the measles, sponsored by my state leadership. I’d like to see this on billboards and in schools, in public buildings and grocery stores. I want to go to a sports event and see messages about the measles and the MMR vaccine. Right now, people have to go out of their way to find information from reputable sources.
We also need policy changes to support vaccination. This train is going in the wrong direction, and it can feel like a helpless situation, because we’re just not seeing the public messaging and leadership that’s needed to turn this around.
Advice on Talking With Parents Who Don’t Vaccinate Their Children
Jones: Approach them with as much compassion as you possibly can. Ask open-ended questions to learn about their experiences that led them to have these concerns. I think it’s really important to not come down on them, citing facts and figures and pointing to guidelines on why they need to get their kids vaccinated. But try to direct their attention to the fact that you’re a real person with your own real experiences and knowledge. I point out to families that I have my own kids, and I would never recommend something for your kids that I wouldn’t do for mine.
Southern Utah pediatrician: I’ve learned that if you come down hard, you’re going to lose people who need care. My number one goal now is to build bridges and maintain a relationship with families, because that’s what’s going to allow me to convince some of them.
I approach people differently depending on where they are. Parents who are very skeptical or anti-vax will say no when I tell them their child is due for immunizations. I’ll say: “Fine. You guys get to choose. You’re the parents. But I’m curious to know what your reasoning is.” Sometimes they’re just like, “It’s something I’ve decided.” They don’t want to have a conversation.
It’s a good day if I can have a conversation with someone who doesn’t want to vaccinate, even if I don’t convince them. I try to help them think through things rather than shoving anything down their throat. When they’re done talking, I’ll ask, “Can I share my perspectives on this?” Some will say yes enthusiastically, and others will say yes because they’re being polite.
A lot of parents aren’t sure what to do, and those are the people I focus most of my time on. I focus our conversation on their specific concerns, and I’m open about specific side effects that different immunizations can have. For example, I’ll tell them that some children get a fever after a vaccine, which is OK. The fever is not harmful, but it can make babies feel crummy as their body is building up antibodies against viruses and bacteria.
Brownstein: I don’t like the idea of excluding unvaccinated kids from my practice. I know some do that. But what that does is it ends any future discussion. I can’t keep talking with parents about vaccines if I kick them out of my practice, and if these parents find like-minded doctors, this situation will get worse.
On Being on the Front Lines of Measles’ Comeback in the U.S.
Money: I wish that people could see what I see. Everyone else sees what people post on Instagram. Or they think, “Someone I know had measles when they were a kid and they were fine.” But as a hospital-based pediatrician, I see what happens when things go poorly. I see what happens when children with measles aren’t able to breathe on their own, and they’re in a hospital bed with a cannula in their nose, struggling to breathe, an IV in their arm because they can’t drink on their own. And the child is terrified, and the parents are scared that their child might die.
It’s heartbreaking as a pediatrician and as a father to know that the entire situation could have been easily prevented.
Duffy: Even though parents say vaccination is their choice, I still feel personally responsible if something bad happens that’s preventable, because I feel like I didn’t say the right thing, I didn’t ask the right questions. Maybe I let it drop because of the look on a parent’s face.
Morris: Every pediatrician I know cares so deeply about what they do. Sometimes people forget that we are human beings practicing this discipline, and we bring all our concerns for our community into this space. I’m trying to navigate a lot of complex human emotions, like how it feels to hold grief with a family when something bad happens that was preventable — which is the worst situation, because you think, “Could I have done something differently?”
Jones: I think we’ll see more diseases start coming back that we thought we had gotten rid of. I think it’s going to take dramatic changes to actually prevent those outcomes. I’m not necessarily seeing those changes being done by those in power.
I think of that quote from The Lord of the Rings. It’s something like, you don’t get to choose the time that you’re born into, but you get to choose what you’re going to do about it. And if there’s any comfort that I have, it’s in knowing that there are right decisions to make and that I’m going to make them, and I’m going to help others make them, too.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
SIKESTON, Mo. — Not everyone at Lloyd Gilmore’s funeral knew him well. One woman, who had ironed her clothes two days in advance, said she just wanted to be there for his family. School-age children, guided by their parents, approached his open casket in the sanctuary of Cornerstone Baptist Church and peeked inside. Other people looked away.
On that rainy Friday afternoon, hundreds of such mourners gathered to honor the man who went to the police department for help and didn’t come back.
“Stay woke. Stay guarded,” his daughter Lania Gilmore told the church full of mourners in this city of fewer than 16,000 with a long, troubled history of racial violence. “Be there for your family and love on one another.”
Her father, a 44-year-old Sikeston resident, died in police custody on June 10. During a quick, physical altercation involving seven Sikeston police officers, he was shocked with a Taser and put into hobble restraints, which allow officers to hogtie a person’s feet and hands, according to a police report obtained by KFF Health News through a public records request. Two autopsies were performed, but they — and Gilmore’s cause of death — had not been released as of mid-July while the result of a toxicology report remained pending.
Gilmore had approached an officer in the parking lot of the police station, according to the report, speaking words the officer said he could not understand. Lania Gilmore said that her dad, who had mental health issues, had asked her to call the police department and that he ran there seeking help.
“I kind of trusted the fact that he was OK because he was at the police station,” she told KFF Health News.
Lloyd Gilmore, a 44-year-old Sikeston resident, had been looking for a safe space on the day he died, said his daughter Lania Gilmore. He told her to call the police department for help. Before he died, the police shocked him with a Taser and put him into hobble restraints. (Lania Gilmore)
Some of Lloyd Gilmore’s children embrace during his funeral on June 26 at Cornerstone Baptist Church in Sikeston. “Stay woke. Stay guarded,” his daughter Lania Gilmore (left) told the church full of mourners. “Be there for your family and love on one another.” (Cara Anthony/KFF Health News)
A plaque is displayed during Lloyd Gilmore’s funeral. Hundreds of mourners gathered in his honor. (Cara Anthony/KFF Health News)
At his funeral, hardly anyone spoke of the police — and, at the family’s request, the funeral home declined to ask police to provide traffic assistance as they usually would. A preacher did his best to comfort Gilmore’s family. “Sometimes we need not talk,” the Rev. Tommy Robinson Jr. told the crowd. “We just need to listen.”
But after years of expressing concerns of racial bias within the city’s police department, some Black Sikeston residents wonder if anyone is listening at all anymore. They want justice even as the national reckoning over police brutality has faded from public view.
“We need the police. We just need them to do their jobs correctly and leave Black people alone,” said Mark Wiggins, president of Sikeston’s NAACP branch. “They know it. We know it. The truth of the matter is there’s a lot of unwarranted cop killings of Black men in America.”
Mark Wiggins, president of the local NAACP branch, sits outside his Sikeston, Missouri, home. Wiggins grew up in the city, which has a history of racial violence. After Lloyd Gilmore died in police custody on June 10, Wiggins protested alongside other residents and civil rights activists. (Cara Anthony/KFF Health News)
But despite worldwide protests in 2020 in the wake of high-profile police-involved killings of Black people, the public paid little attention when a prestigious group released a report last year about deaths in custody, said Roger Mitchell Jr., a forensic pathologist finishing his term as president of the National Medical Association, which represents African American physicians. The report from the National Academies of Sciences, Engineering, and Medicine urged Congress to require states to collect and report data on all in-custody deaths, a problem that Mitchell said disproportionately affects Black men.
“We are in an anti-diversity environment,” Mitchell said. “We’re in a war.”
Upon returning to the White House last year, President Donald Trump immediately signed an executive order that targeted diversity, equity, and inclusion programs. As a result of that and other measures, funding for racial equity has dwindled, researchers who once studied violence as a public health issue have redirected their work to less politically charged topics, and a growing fear of professional and political retaliation has made it increasingly difficult to sustain the momentum.
Kevin Myles, a civil rights leader based in Georgia who has trained tens of thousands of activists around the country, said he saw a shift in priorities around racial equity before Trump was reelected. Since then, it has escalated, he said, and he has lost at least half his funding for his work on equity, child welfare, and mass incarceration.
“I don’t think we really were prepared. It’s not that we didn’t take it seriously. I don’t think we were psychologically prepared for what this means,” Myles said. “Everything we have done before now was practice. The game has just started.”
Sikeston, located in the rural area of southeastern Missouri known as the Bootheel, has a history of racial violence, including the brutal lynching of a Black man named Cleo Wright in 1942. Another Black man, Undraus Nabors, was found dead in a grain silo months after heading out to pick up his white girlfriend in 1999. In April 2020, less than a month before George Floyd’s murder in Minneapolis, an unarmed Black man, Denzel Taylor, was shot at least 18 times by Sikeston police officers. The city was the subject of the 2024 “Silence in Sikeston” documentary film and podcast by KFF Health News, Retro Report, and WORLD.
The “Silence in Sikeston” documentary film explores how the nation’s first federally investigated lynching and a police killing 78 years apart haunt the same rural Missouri community. The film from KFF Health News and Retro Report explores the lasting impact of such trauma — and what it means to speak out about it.
Larry McClellon, a longtime Sikeston resident who founded a civil rights group called And Justice for All, has expressed concerns about the integrity of his city’s police department for decades. He’s also convinced that being vocal about racism in Sikeston comes with a price.
“It’s a dark side of Sikeston that a lot of people do not know and don’t prefer to know,” McClellon told KFF Health News in 2021 after police fatally shot Denzel Taylor. “But I’ve walked the streets.”
He believes someone burned down the headquarters of And Justice for All in 2019. A report from the city’s public safety department said the fire was “suspicious in nature.” The electricity in his building wasn’t on when flames erupted, he said, so he wasn’t satisfied when an investigator called it an electrical fire. He asked the department to take another look. No one was charged.
The headquarters of And Justice for All, a civil rights advocacy group in Sikeston, was destroyed in a 2019 fire. A report from the city’s public safety department says the 2019 fire was “suspicious in nature.” Larry McClellon, a longtime Sikeston resident who founded the group, has expressed concerns about racial violence in the community. (Cara Anthony/KFF Health News)
James McMillen, the city’s police chief, told KFF Health News in 2021 that he had plans to improve policing before Taylor died. At the time, McMillen, who is white, said he and his department had “a poor relationship” with Black residents in the city. He started some community meetings after Taylor’s death, but he said in 2024 that people had stopped showing up.
“We have tried,” the chief said during a City Council meeting this month. “But, as my daddy would say, a relationship is a two-way street. And so I don’t know what else I can do.”
During the meeting, Lania Gilmore pleaded with the city to release more information about her father’s case. Other residents wanted to know why the officers involved were not placed on administrative leave immediately after Gilmore died.
“It depends on the circumstances. It does,” McMillen told them. “You’re assuming a certain set of details that you don’t know.”
Another resident asked the city about training for officers. McMillen said his officers are trained. Nationwide, many communities have created specialized non-law enforcement teams to assist people in crisis.
“Chief does not want anybody to be mistreated at all. Period,” Sikeston Mayor Greg Turnbow, who is white, said at the meeting. “And I guarantee you, I put my life in his hands. I’d do it today.”
McMillen declined to comment on KFF Health News’ questions about Gilmore’s case and the community’s concerns about the department. The Missouri State Highway Patrol investigated the death and planned to refer the results to the Cape Girardeau County prosecuting attorney, Sgt. Bradley Germann said.
Lloyd Gilmore’s friends Tawanna and Willie Wilson wore custom T-shirts to his funeral. (Cara Anthony/KFF Health News)
Andre Young and his 5-year-old son view Gilmore’s body during the funeral. (Cara Anthony/KFF Health News)
Cynthia Gilmore sits in the front row of her son’s funeral at Cornerstone Baptist Church. (Cara Anthony/KFF Health News)
The day Gilmore died, his daughter said, he had been anxious and was looking for a “safe space.” So, she said, he had spent much of the day watching her braid hair at the salon where she works, then he went with her to her eyelash extension appointment. Lania Gilmore said he was still feeling undone, but she needed some space, so he asked her to call the police instead. She said she did, then she watched him run toward the police station.
The rest unfolded within 30 minutes, according to the police report and 911 call logs. The police report said that, amid an ensuing scuffle, Gilmore bit one officer’s hand — “but did not break the skin.”
After the police stunned and restrained Gilmore, a paramedic gave him a sedative, and the emergency medical services took him to a hospital, according to the police report. The report listed five victims — all police — and accused Gilmore of third-degree assault and resisting arrest.
Lania Gilmore said police told her that her father overdosed. But she said she doesn’t understand how that would have been possible, given the short time between when he left her and an ambulance was called.
The city’s police force knew Gilmore had mental health issues, his daughter said. Police officers in a neighboring community “excessively tased” and beat him in 2020, courtrecords show. He received a $65,000 settlement five years later, and she said that experience left a mark.
After Gilmore died, Louis Houston, a longtime Sikeston resident, said he decided to move 30 minutes outside the city to a neighboring community, where he feels safer. He said hearing about other Black Sikeston residents being harassed by the police department had started to affect his mental health.
“I got on away from here,” said Houston, who returned to Sikeston for the funeral.
Louis Houston moved to Sikeston almost 20 years ago but recently decided to move away after Lloyd Gilmore died in police custody. He says the way the police department treats Black residents was affecting his mental health. (Cara Anthony/KFF Health News)
Houston’s already thinking about the conversations he will have with his young children about how to respond if they ever interact with a police officer. He has a script in mind.
“Be careful,” Houston plans to tell them. “They can help you, but they also can kill you.”
Every family has secrets. I spent the past few years reporting about racial violence in Sikeston, Missouri. Interviewing Black families there helped me uncover my family’s traumatic past, too.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Agency scientists are advising against allowing widespread use of several peptide injections. Robert F. Kennedy Jr., the health secretary, has said people should be free to experiment.
The administration canceled federal grants to organizations across the country, accusing them of encouraging premarital sex. New criteria say programs should stress abstinence.
The Trump administration is forging ahead with a controversial plan to collect the medical records of millions of federal workers and retirees, as well as their family members.
The Office of Personnel Management said in a notice posted last month that it will begin routinely collecting identifiable, personal health information on more than 8 million people — despite concerns from privacy advocates and Democrats, who have demanded the agency drop the plan. The notice will go into effect July 24, allowing OPM to begin its collection at any point afterward.
In reaction to privacy concerns raised by insurers and others, OPM now says the identities of enrollees will be “pseudonymized” — meaning names, addresses, and Social Security numbers will be removed — before the agency’s analysts review the massive new health datasets it will soon begin receiving.
Birth years of enrollees will be retained, and the agency’s “technical staff” will receive member IDs that it will scramble into different, unique numbers before releasing them to other staffers, according to the notice.
But the notice also specifies that OPM retains the right to reidentify the records.
Sixty-five insurance companies will be required to routinely send OPM detailed data — including names, addresses, doctor information, diagnoses, prescriptions filled, and payment details — on health care services paid through the Federal Employees Health Benefits and Postal Service Health Benefits programs.
In a change to its original proposal, first reported by KFF Health News, the agency says it also wants to peek at records kept by Medicare, the federally funded health insurance for older and disabled Americans, to examine claims from federal employees and retirees, and their families, who depend on both programs.
In its latest notice, OPM argues that the vast trove of data is necessary to ferret out fraud and overpayments in the FEHB and PSHB programs. Those programs cost roughly $80 billion a year, with about $50 billion covered by the federal government and $30 billion funded by enrollees. The Trump administration has ramped up efforts, led by Vice President JD Vance, to curtail what it says is rampant fraud and misuse of publicly funded health benefits.
The effort still faces criticism that it doesn’t go far enough to protect the privacy of federal workers and their families.
“Clearly, this administration has not earned our trust with Americans’ sensitive data,” Sen. Mark Warner (D-Va.) said in an emailed statement to KFF Health News. “If OPM wants to work in good faith to reduce fraud, they should come to Congress, including to folks like me who are engaged on this issue and represent many federal workers and retirees and their families, and work to build consensus and trust before implementing these sweeping changes.”
The original notice, posted in December, sparked concerns in part because it did not specify what the Trump administration planned to do with the sensitive health information it receives — and did not instruct insurers to redact identifying information.
OPM General Counsel Kurt Dykstra said the detailed records are critical to the administration’s mission of rooting out fraud and could help identify fraud perpetrated not only by medical providers but also by enrollees.
But when pressed for instances of workers, retirees, or their relatives committing such fraud, Dykstra only noted generally that healthcare fraud does occur.
The information could demonstrate “potential anomalies in usage patterns that could be related to the individual, but really also could be related to the provider, the treater, the clinic — whoever it is that’s actually providing the care,” Dykstra told KFF Health News in an interview.
Records deemed suspicious by OPM’s data analysts could then be referred to the agency’s Office of the Inspector General for further investigation, which could include “determining who’s involved and what the potential issues are, what the ramifications look like,” Dykstra said.
OPM’s plan to collect and analyze medical records has prompted unease among unions and federal workers, who have been subjected to mass firings and layoffs — in some cases, they say, driven by political retribution — since President Donald Trump took office.
Health privacy lawyers say, too, that while pseudonymizing workers’ details is a step in the right direction, it might not go far enough to protect their privacy.
OPM’s notice mostly complies with the Health Insurance Portability and Accountability Act, the federal law commonly called HIPAA that protects sensitive health data from being shared, said Matt Fisher, a health privacy lawyer. But he noted one exception: The member ID that insurers provide enrollees can be used to identify them.
“The described process arguably comes down to trusting internal controls in OPM to ensure that data is walled off as proposed,” Fisher said in an email. “The ideal would be for only truly de-identified information to be shared in the first place.”
Insurers regularly share information about claims with employers who offer health plans to employees, in efforts to control costs. But since employers themselves are not covered by HIPAA, large datasets are typically de-identified, meaning the insurers remove identifying information such as employees’ names or addresses, to comply with the law.
Employers, too, have been accused of using health information to target employees for dismissals. Most recently, a group of Meta employees filed a lawsuit accusing the tech giant of using artificial intelligence to target for layoffs those who had taken medical or family leave.
Pseudonymizing details such as names or addresses would go only so far to protect privacy, since medical conditions in particular can make it very easy to identify certain employees, said Joseph Lorenzo Hall, a technologist at the Center for Democracy & Technology, a nonprofit that advocates for data privacy.
“The richer the data, the more likely it is going to be identifying,” Hall said.
“In this case, you may be the only person in a region that has that particular kind of medical procedure, condition, or even prescription,” he said. “All of those things can be extremely identifying, even when you remove or obfuscate or pseudonymize direct identifiers.”
Most federal retirees decide to continue with FEHB plans and enroll in Medicare once they turn 65, which provides more comprehensive coverage and allows family members to remain enrolled in FEHB plans, said John Hatton, the staff vice president for policy and programs at the National Active and Retired Federal Employees Association.
OPM wants to analyze medical records for those dual enrollees as well. The agency is asking for all of their cost and service use records from the Centers for Medicare & Medicaid Services.
Still, Hatton said, OPM’s latest notice provides more details about how the agency says it will use the sensitive health information it receives and safeguard it.
“It’s a big improvement over the last notice, which was very lacking in detail and explanation for why they wanted all the medical claims data and how they’re going to protect the privacy of the data,” Hatton said.
“We’d be open to seeing even more security around the privacy of the data so there really is a clear wall,” he added.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Genetic prediction models are poised to revolutionize medicine. But because they have been trained on European DNA, they threaten to widen health care disparities.
BELZONI, Miss. — Harmony Ball-Stribling’s path to pregnancy had been turbulent, from an endometriosis diagnosis to an arduous in vitro fertilization process and sky-high blood pressure. But as her due date approached in the summer of 2021, her health improved and those storm clouds seemed to scatter.
“It was just too perfect,” said her mother, Shenelle Ball-Green, of those calm, hot weeks.
Then, early on July 5, four days shy of her scheduled cesarean section, Ball-Stribling began experiencing complications from preeclampsia, a potentially life-threatening blood pressure disorder. Speeding up to 110 mph, her husband drove her to the nearest hospital 25 miles away from their home in Belzoni, a Mississippi Delta town of about 1,900 people.
Minutes before reaching the facility, Ball-Stribling suffered a seizure in the passenger seat. Her husband pulled her from the car and performed CPR on the side of the road. It was too late. She and the couple’s unborn daughter, Harper, died on the side of U.S. Route 49.
The tragedy might have had a different outcome if the hospital in Belzoni, a five-minute drive from Ball-Stribling’s home, hadn’t closed 13 years ago. Today, Humphreys County has no hospital, no emergency room, no urgent care clinic, and no county health department. It is one of more than 100 rural hospitals in the U.S. that have fully closed since 2005.
In Belzoni, self-proclaimed “The Heart of the Delta,” and its surrounding area, communities are close-knit, and Harmony’s story is well known. Now, her death has galvanized local and state leaders determined to bring a hospital back to the county that has suffered without one.
“It was a tremendous eye-opener for this community,” said state Rep. Timaka James-Jones, a Democrat who represents the district that includes Belzoni and is Ball-Stribling’s aunt. “It brought to light how we are so without.”
Poverty often shapes the health disparities Humphreys County residents experience. Approximately 1 in 7 Humphreys County residents under age 65 lack health insurance coverage, compared with about 1 in 11 people nationwide. Humphreys County also has the highest rate of Medicaid enrollment of any Mississippi county, reflecting the economic challenges many residents face. These disparities are evident in the county’s infant mortality rate, which is among the highest in the state at roughly 15 deaths for every 1,000 births.
James-Jones has watched these circumstances influence the lives — and deaths — of her loved ones. She said she wants to see a hospital reestablished before her four-year term is up in early 2028.
But that may be easier said than done. In Belzoni, local leaders hoping to restore healthcare services face a tangled web of policy challenges that are especially demanding for a small town with limited resources. Its story reflects what many healthcare policy experts warn: Once a rural community loses a hospital, bringing it back can be nearly impossible.
Belzoni, Mississippi (Vickie D. King/Mississippi Today)
Humphreys County’s Healthcare Losses
Humphreys County Memorial Hospital opened in Belzoni in 1951 as part of a nationwide hospital building boom fueled by a Truman-era law called the Hill-Burton Act. The legislation provided billions of dollars in grants and loans to build and modernize healthcare facilities. At the time, roughly 40% of all U.S. counties had no hospital. When the building boom began to subside by 1970, all but seven counties in Mississippi had at least one hospital.
But by the 2000s, many rural hospitals in the U.S. confronted financial difficulties. Low patient volumes, an increase in outpatient care, and meager revenues left many on precarious footing. Many had high rates of uninsured patients or those covered through government programs such as Medicaid, which typically reimburse providers at lower rates than commercial insurers.
Humphreys County’s hospital was among those struggling facilities. It was burdened with millions of dollars in debt, and county officials sold it in 2008 to a private company. It was renamed the Patients’ Choice Medical Center. The hospital shut down five years later after Ray Shoemaker, the company’s CEO, was convicted on healthcare fraud charges related to another hospital he owned.
“I do hope they reopen,” Shoemaker wrote in a recent text message to Mississippi Today. “The community needs a hospital.” He said he stepped down from the company before going to prison in 2012.
In 2017, the University of Mississippi Medical Center partnered with the county supervisors and U.S. Rep. Bennie Thompson, a Democrat whose district includes Humphreys County, to secure a nearly $1 million grant from the U.S. Department of Agriculture to open an after-hours acute care clinic in Belzoni. The clinic shut down in 2020, and UMMC officials declined to say why.
G.A. Carmichael Family Health Center, a Canton-based federally qualified health center with five other locations in Mississippi, took it over but did not maintain the extended hours, again leaving Humphreys County residents without after-hours care. Other public health services in the county have closed outright. Three years ago, the county’s health department stopped providing clinical services, said Greg Flynn, a spokesperson for the Mississippi State Department of Health. The county department closed entirely last year, citing staffing shortages and low patient volumes.
In the years since the hospital closed, the county has lost a fourth of its population, falling to 7,000 people, according to census data. James-Jones said she does not believe the community can experience growth until healthcare services are reestablished.
“I don’t know how I can see us growing any other way,” she said.
Shenelle Ball-Green lost her daughter, Harmony Ball-Stribling, and unborn grandchild in July 2021 during a medical emergency as Ball-Stribling was en route with her husband to the nearest hospital, 25 miles away. (Vickie D. King/Mississippi Today)
‘Something’s Way Better Than Nothing’
Months after losing her daughter and unborn granddaughter, Ball-Green climbed the steps of the stately, tan, brick Humphreys County Courthouse to attend a crowded Board of Supervisors meeting.
She stood at the dais and urged the supervisors to reestablish emergency healthcare services in the county to protect other residents from the fates of her loved ones.
“I wanted to let them know at any given moment that could be your child, your mother,” she said. “We’re a small town. Everyone knows everyone.”
She remembered the disappointment she felt when the supervisors told her there was nothing they could do. But when the board’s makeup changed after the 2023 elections, she said, she saw these attitudes shift.
The Humphreys County Courthouse is located in Belzoni, Mississippi. (Vickie D. King/Mississippi Today)
Among the newly elected officials was Reggie Pinkston, who is now the president of the board and previously worked as an EMT when the hospital was open. His own family has suffered the consequences of limited healthcare access. A cousin living in Louise, a town about 20 miles south of Belzoni in the county, had a stroke in 2021 and waited an hour for an ambulance to arrive. She died two days later.
Pinkston said witnessing residents’ delays in care has made expanding access to healthcare services one of his priorities.
“We’re losing too many people in our county because of lack of healthcare,” Pinkston said.
The board enlisted several consultants to develop a strategy for expanding healthcare access and identifying funding sources to support these efforts. In late 2025, Thompson secured approximately $1 million for Humphreys County through the congressional Community Project Funding process, which allows lawmakers to request federal support for specific projects.
The funds will be used to expand services at G.A. Carmichael’s Belzoni location in a county-owned building on U.S. Route 49, Pinkston said. Expansion plans include extending its hours of operation overnight to 5 a.m., purchasing equipment, and a possible renovation of the facility. It could begin its expanded operations by September, said James Coleman Jr., the health center’s CEO.
Establishing an after-hours urgent care clinic is a starting point toward reestablishing emergency care services or a hospital, James-Jones said.
“Something’s way better than nothing,” she said.
Mississippi state Rep. Timaka James-Jones, a Democrat who represents the district that includes Belzoni, is one of the community leaders spearheading an effort to reestablish a hospital in Humphreys County. (Vickie D. King/Mississippi Today)
‘Not for the Faint of Heart’
Despite that encouraging first step, Humphreys County faces steep obstacles to opening a hospital.
At the University of North Carolina-Chapel Hill, George Pink is a senior research fellow at the Cecil G. Sheps Center for Health Services Research and tracks rural hospital closures across the U.S. He said he’s aware of only a few communities that have successfully reopened a hospital after it closed.
“I can count that on one hand,” said Pink, who knows of roughly five such examples.
Communities face significant hurdles to reestablishing a hospital, including securing financing for construction or renovation, recruiting qualified staff, and covering substantial operating expenses during the licensing process before the facility can treat patients and generate revenue, said Brock Slabach, the National Rural Health Association’s chief operations officer and a former rural hospital administrator in southwestern Mississippi.
“Reopening a hospital is not for the faint of heart,” Slabach said. “Once they close, it’s very difficult to reopen them.”
To finance a potential hospital project in Humphreys County, local and state leaders said they plan to seek funding through the Rural Health Transformation Program, a federal initiative that will distribute $50 billion to states over five years. The federal government allocated Mississippi nearly $206 million in December for the program’s first year.
The program is meant to offset budget cuts passed into law last summer that could harm rural hospitals. Republicans’ One Big Beautiful Bill Act will cut the federal government’s Medicaid spending by $911 billion over 10 years and increase the number of uninsured people by 10 million, according to Congressional Budget Office estimates. Mississippi hospitals are projected to lose roughly $160 million annually beginning in 2029, according to Cindy Bradshaw, executive director of the Mississippi Division of Medicaid.
But according to federal guidelines, the program’s funding cannot be used for construction or major building expansions. Officials said the county will instead consider applying for funds through the program to support the recruitment of healthcare professionals.
The federal Rural Emergency Hospital designation is another way rural communities can keep emergency and outpatient services. Hospitals in that program receive over $3 million annually from the federal government and a higher Medicare reimbursement rate, but they cannot offer inpatient care.
Research by Pink’s team shows that many hospitals that converted to the model, which was established in 2023, saw an increase in profitability.
But there’s a catch. To receive the designation, a hospital must have been open in 2020, making Humphreys County ineligible. Mississippi’s junior U.S. senator, Republican Cindy Hyde-Smith, introduced legislation in 2024 to extend the cutoff to 2014, a threshold that would have still excluded Humphreys County.
James-Jones said county leaders have urged Hyde-Smith to amend the proposed legislation so Humphreys County could qualify. Hyde-Smith did not respond to a request for comment for this article.
Belzoni, Mississippi, is self-proclaimed “The Heart of the Delta.” (Vickie D. King/Mississippi Today)
For county leaders, the path to widening healthcare access means navigating a thicket of state and federal policies, funding streams, and regulatory hurdles.
Some recent state-level policy changes have created opportunities for healthcare expansion in Humphreys County. In March, Republican Gov. Tate Reeves signed legislation exempting Humphreys County from Mississippi’s certificate of need requirements, which are meant to prevent unnecessary healthcare expansions.
The exemption could make the county more attractive to prospective healthcare providers. But the financial challenges that contributed to the closure of Patients’ Choice Medical Center in 2013 remain, and Mississippi lawmakers have continued to reject Medicaid expansion, limiting a potential source of reimbursement for rural hospitals and clinics.
Industry officials expect hospitals’ financial pressures to intensify as Medicaid funding cuts take effect. The latest challenge is predicting how these cuts will affect the bottom lines of these facilities and whether additional cuts will come in the future, said Richard Roberson, president and CEO of the Mississippi Hospital Association.
“If someone’s trying to run a business, they’ve got to be able to know what those numbers look like,” Roberson said. “And it’s really hard to try to project that out right now.”
The G.A. Carmichael Family Health Center, a federally qualified health center with five other locations in Mississippi, took over an acute care clinic in Belzoni, which shut down in 2020. (Vickie D. King/Mississippi Today)
‘Now I Understand’
For Ball-Green, giving in to these obstacles would be a disservice to the Humphreys County residents who face health emergencies similar to the one her daughter experienced.
It has been five years since the funeral, but Ball-Green remembers it clearly. The day was stormy, but attendees brightened the gathering by wearing yellow, Ball-Stribling’s favorite color.
As friends and family gathered to pay their respects, her mother thought back on a relative’s funeral four months earlier. At that service, Ball-Stribling sang the gospel classic You Are My Strength to a roomful of mourners.
“She was singing, and she looked at me,” Ball-Green said, describing a peaceful but eerie expression on her daughter’s face in that moment — a sign of something to come, though she didn’t yet know what. “She turned around, and it was just that look, you know?”
Months later, as she sat at her daughter’s funeral, she began to interpret the foreboding glance differently. She came to believe it was a sign that Ball-Stribling’s gift for helping others by sharing her story would not end with her death.
That purpose had taken shape years earlier in her work as a teacher and continued as she shared candid social media posts about her fertility struggles and IVF journey in the final months of her life. Ball-Green said the community became deeply invested in her and Harper’s story.
In the years since, this gift has endured, she said. Ball-Stribling’s story has continued to resonate throughout Humphreys County, serving as a reminder of what residents stand to lose if they do not reopen the hospital.
“I think back on when she looked back at me,” Ball-Green said. “Now I understand.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
The F.D.A. is planning to inspect farms and a lettuce shredding facility to determine how lettuce supplied by the produce company Taylor Farms to Taco Bell became contaminated and where it was shipped.
One year after the Trump administration announced that dozens of health insurers had signed a six-part pledge promising to reduce barriers to doctor-recommended care, some insurers now say they won’t implement all the promised initiatives.
Meanwhile, patients, their advocates, and clinicians say little has improved.
“It has never been this bad for patients,” said U.S. Rep. Greg Murphy (R-N.C.), a physician who co-chairs the GOP Doctors Caucus.
The overarching intent of the June 2025 pledge was to improve a controversial process called prior authorization, which regularly requires patients or someone on their medical team to seek approval from insurers before proceeding with treatment.
According to AHIP, the health insurance industry trade group, health plans have eliminated 6.5 million prior authorizations for patients — equal to an 11% reduction — since the announcement.
But critics remain skeptical. Sally Nix, a patient advocate who has a chronic disease, described the voluntary pledge as “performative.” And Murphy, who participated in the news conference with Health and Human Services Secretary Robert F. Kennedy Jr. announcing the pledge last year, said it has “no teeth.”
Voluntary insurer pledges rarely make things better for patients, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.
“In the absence of clear rules, policies, standards, and mandates,” she said, insurance companies are “going to do what makes sense for them to do financially.”
The Department of Health and Human Services did not respond to questions for this report. It isn’t clear how, or whether, the Trump administration is holding insurers accountable.
‘Zero Faith’
Prior authorization — sometimes called preauthorization or precertification — has been around for decades. The insurance industry has long argued that the practice, which varies by company, helps control costs, reduces waste and fraud, and prevents potential harm to patients. It’s regularly invoked for a huge swath of services, ranging from low-cost urgent care to expensive cancer treatment.
“Prior authorization is a vital patient safeguard,” said Chris Bond, a spokesperson for AHIP.
The 2024 killing of UnitedHealthcare CEO Brian Thompson sparked a national groundswell of anger about insurance denials, with patients and doctors becoming increasingly vocal about the tactics they say insurance companies use to boost profits at the expense of care.
Prior authorization reform is one of the rare healthcare issues Democrats and Republicans tend to agree on. On July 15, the House Ways and Means Committee unanimously advanced a bill that would force Medicare Advantage plans to provide to the federal government a list of all items and services that are subject to prior authorization, and to report data about denials and grievances, among other requirements.
Last year’s industry pledge was organized as a direct response to public anger, Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said when it was announced. “There’s violence in the streets over these issues,” he said.
“Americans are upset about it,” Oz said, later adding, “I’m looking forward to seeing the results.”
Mike Gartner, founder of Health Access Innovation, an organization that helps patients overturn insurance denials, said he doubts that insurance companies are changing their policies in meaningful ways. The 11% reduction in prior authorization cited by AHIP “hides a lot of nuance,” Gartner said.
Patients who need the costliest services, such as cancer treatment, are still being disproportionately denied access to doctor-recommended care, he said.
AHIP said its data included reductions in prior authorization for medical services, not prescription medicines. The trade group didn’t provide details explaining which services have been dropped from prior authorization or how those reductions differ across individual insurers.
Last year, Oz said the federal government would be “evaluating progress” toward the pledge and “driving accountability,” and he foreshadowed “public dashboards.” But no such dashboards exist, and federal officials did not respond to questions about how they’re holding companies accountable.
Murphy, the North Carolina congressman, said he has “zero faith” in the industry policing itself.
He didn’t believe insurance companies then, he said, “and I don’t believe them now.”
‘At War’ With an Insurer
In February, days after Betsy Adler and Justin Young’s daughter Coco was born with a serious heart defect, the Stillwater, Minnesota, family received paperwork showing they were racking up out-of-network costs.
During Adler’s pregnancy, the family had switched insurers, moving to Medica, a for-profit company based in Minnetonka, Minnesota, and one of many insurers that initially signed the industry pledge. Adler said she’d checked with her employer’s human resources department and on Medica’s website to make sure her maternal-fetal specialists and hospital were in-network before their new health plan went into effect earlier this year.
But then, the insurance company started processing some claims as out-of-network. By mid-March, the family had accrued more than $4,000 in out-of-network charges, on top of more than $3,000 for in-network bills. And the bills kept coming.
Shortly after Betsy Adler’s daughter Coco was born with a serious heart defect, she started receiving estimates showing her family could owe thousands of dollars in out–of-network costs. (Justin Young)
Adler had switched insurers to Medica during her pregnancy and said she was assured that her care would be covered at in-network rates. (Justin Young)
When Adler, a psychotherapist, called to figure out what was going on, she said, an insurance company representative said she hadn’t submitted a referral from her primary care provider beforehand. Attempts to fix the problem went nowhere. At one point, Adler said, Medica required her to visit a clinic she’d never been to before to obtain a referral. But she said a Medica representative told her the referral was never received, because the insurer’s fax machine was down.
“I have a critically ill child,” Adler remembered thinking shortly after Coco was discharged from the cardiovascular intensive care unit. “I can either spend my emotional energy at war with Medica, or I can let it go and just enjoy my time with my daughter.”
Medica spokesperson Greg Bury said he wouldn’t discuss the case, citing patient privacy rules. In an emailed statement, he wrote the company is “committed to working with her to ensure she understands what is covered under her benefits and our responsibilities.”
One of six specific promises all insurers made when they signed the pledge was to honor a 90-day grace period when patients switch insurance plans, starting Jan. 1 of this year. Often called “continuity of care,” this grace period allows patients to temporarily continue receiving services and medications that were authorized under a previous insurer.
But that applies only in some circumstances, Georgetown’s Corlette said. The wording of the pledge suggests that insurance companies aren’t obligated to honor another company’s network parameters. When Adler and Young switched insurers, for example, Medica was not obligated to cover the cost of out-of-network providers as if they were in-network, even though they were in-network under the family’s old plan.
Adler and Young switched insurance companies again when Coco was a month old, to avoid accruing more out-of-network costs.
Denial After Approval
Sally Nix with her service dog, Jon Snow, at home in Statesville, North Carolina. Nix, a patient advocate, recently had her health insurer process, then later deny, a claim for injections to relieve her chronic nerve pain. She’s skeptical about industry promises to reform the health insurance denial process. (Logan Cyrus for KFF Health News)
The percentages cited by AHIP don’t tell the whole story, said Nix, the patient advocate. Insurers are “not including the data for the loopholes they create,” she said.
For example, nothing in the pledge prevents insurance companies from retroactively denying payment, even when care is preapproved. “Patients are going to see a lot more retroactive denials,” said Nix, who recently had her insurer process, then later deny, a claim for injections to relieve her nerve pain.
Something similar recently happened to Jocelyn Austin, 49, of Amherst, New York. Over the course of nearly 20 years, she developed an addiction to sleeping and anxiety pills prescribed to her by a doctor. Last year, she spent weeks at an inpatient treatment center for substance abuse. Her insurer, Independent Health, had approved the admission. Austin said she has been substance-free since her discharge.
But the facility sent her a bill for more than $12,000 in December showing her insurer had not paid for the treatment she received, according to documents Austin shared with KFF Health News. This was in addition to the $10,000 she paid at the beginning of her treatment to satisfy her out-of-network deductible. The approval letters from Independent Health had specified that “authorization is not a guarantee of claim payment.”
Frank Sava, a spokesperson for Independent Health, said a denial was issued and upheld in this case because the services provided “were inconsistent with the care that was authorized” and “the medical record did not sufficiently support what was billed.” He said those findings were reviewed and confirmed by an outside consultant.
An explanation of benefits issued by the insurer last summer indicated the “provider,” not the patient, was responsible for the cost of her treatment. And yet the treatment facility has continued to pressure her for payment, she said.
Austin, who has not paid her outstanding bill, said insurance companies “should be held accountable.”
‘Significant Work Ahead’
Another one of the six commitments insurers made last year was to adopt new technology that would standardize the electronic submission of prior authorization requests. During the news conference announcing the pledge last summer, Chris Klomp, the director of Medicare and a deputy CMS administrator, said more than 50% of prior authorizations are still paper-based and processed by phone or fax machine.
In April, AHIP released an update related to that technology initiative, explaining that participating insurers would adopt the new standards on a rolling basis. Health insurers agreed to implement the pledge’s various commitments by predetermined deadlines, and this initiative is scheduled to be operational by Jan. 1, 2027. But eight insurers that initially signed the pledge last year didn’t sign the technology update when it was announced in April, AHIP told KFF Health News.
Those insurers are Alignment Health Plan, EmblemHealth, HealthFirst, Independent Health, Medica, MVP Health Care, Point32Health, and SummaCare. Their beneficiaries span the country, from California to New York. None of those eight insurers agreed to interviews for this report, but most sent KFF Health News emailed statements indicating that they remain committed to prior authorization reform.
AHIP’s approach to continuity of care “would have required the transfer of confidential member health information through a non-standardized process involving third-party participation,” wrote Jerry Slowey, a spokesperson for Alignment Health, which offers Medicare Advantage policies in Arizona, California, Nevada, North Carolina, and Texas. “We do not believe that level of data sharing was contemplated in the original commitment.”
Bury, the spokesperson for Medica, which covers beneficiaries in Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, and Wisconsin, said the company “supports the goal of these standardization efforts.” But the April update “raised a significant technical and operational hurdle that we are not able to commit to at this time,” he said.
Alex Gomez, a spokesperson for EmblemHealth, said in late June the company “will sign onto the commitment” after KFF Health News posed questions about why it had not endorsed the April update.
“We anticipate more plans will be added over the coming months,” said Bond, the AHIP spokesperson. Health plans are “working continuously to implement their commitments to simplify and improve the experience.” He acknowledged that “there is still significant work ahead.”
The original pledge also included a promise that insurance companies would enhance transparency and use “clear, easy-to-understand explanations” when communicating to patients — something they were already supposed to be doing under the Affordable Care Act.
Yet companies still regularly neglect to explain why care has been denied, and their communications often contain “inconsistent and contradictory information,” said Gartner, of Health Access Innovation. He and Murphy also said they suspect insurance companies are increasingly using artificial intelligence to generate denials.
“They craft the pathways to basically deny things immediately with the hope that people will give up,” Murphy said.
The congressman said he wishes President Donald Trump would sign executive orders addressing some of these issues. “The problem is the insurance industry is the strongest lobby in this town.”
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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Erica Schwartz, President Donald Trump’s nominee to lead the Centers for Disease Control and Prevention, expressed support for vaccines — including mRNA-based covid shots — in a Senate hearing on Wednesday, though she didn’t dispel concerns the agency has lost any independence from the White House.
“I have been vaccinating people throughout my entire career in uniformed services. I believe in vaccines,” Schwartz said at the hearing. “I do believe that mRNA technology is safe and effective.”
Her position contrasts with that of Health and Human Services Secretary Robert F. Kennedy Jr., who ousted Trump’s previous CDC director, Susan Monarez, after she sparred with him over vaccines. Kennedy, a longtime anti-vaccine activist, has baselessly called mRNA vaccines the deadliest ever made.
Schwartz “has dedicated her career to protecting the health of the American people.” Emily Hilliard, an HHS spokesperson, said in an emailed statement. “The president nominated her because of that exemplary record, and Secretary Kennedy looks forward to working with her to advance the Administration’s public health priorities.”
The CDC has had a Senate-confirmed leader for only about one month during Trump’s second term, and the agency has been roiled over the administration’s cuts to public health funding, firings of scientists and other career employees, and efforts to scale back childhood vaccines and access to covid shots.
Schwartz, who was deputy surgeon general in Trump’s first administration and is a former chief medical officer for the Coast Guard, has support in the public health community, where it’s hoped she can restore credibility at the agency she would lead.
“I will follow the science wherever it leads,” Schwartz told senators. “My first priority will be restoring trust in public health institutions.”
Democrats and some Republicans have expressed doubt that Schwartz will maintain any more independence from Kennedy than Monarez, who has said she was fired in August after refusing to sign off on changes Kennedy demanded to vaccine recommendations and personnel cuts. In a series of emails released by Sen. Bernie Sanders (I-Vt.), it was revealed Kennedy had pressured Monarez to change CDC guidance regarding the universal childhood flu vaccine.
Monarez “refused to act as a rubber stamp for Secretary Kennedy’s very dangerous agenda,” Sanders said July 15 at the Health, Education, Labor and Pensions Committee’s confirmation hearing for Schwartz. “Frankly, she stood up for protecting the well-being of the American people.”
The chairman of the HELP Committee, Sen. Bill Cassidy (R-La.), pressed Schwartz on whether she would push back against rhetoric or policies not based in science.
“We need unbiased leaders who make decisions based upon science, not politics or ideology,” Cassidy said. “This is not a theoretical.”
Cassidy, a physician, has also quarreled with Kennedy over vaccines. He lost a Republican primary for reelection in May after Trump endorsed one of his opponents. Despite his rupture with the White House, Schwartz almost certainly needs Cassidy’s support to win confirmation. That requires publicly committing to support vaccination and mainstream science.
Schwartz told the committee she would “never compromise” on science.
“The president would never ask me to not follow the law,” she said. “But I will always follow the law.”
Sen. Bill Cassidy (R-La.), chairman of the Health, Education, Labor and Pensions Committee, questioned Schwartz on her support of vaccines and her willingness to push back against her would-be boss, health secretary Robert F. Kennedy Jr. (Eric Harkleroad/KFF Health News)
Many Democrats on the committee raised concerns about the administration’s politicization of public health. Sen. Tammy Baldwin (D-Wis.) asked about the “political scrubbing” of research grants. Trump officials have canceled many research grants under the CDC and the National Institutes of Health for political reasons, including targeting diversity, equity, and inclusion efforts.
“Restoring trust to the CDC is my No. 1 priority,” Schwartz said. “Scientific integrity is core.”
The American Public Health Association’s CEO, Georges Benjamin, endorsed Schwartz in April, saying she “possesses the medical background and public health knowledge to understand that the Centers for Disease Control and Prevention must be guided by evidence-based science.”
The APHA has fought many of Trump’s initiatives on public health. After Monarez’s resignation, the organization issued a news release titled “Kennedy’s attack on public health must be stopped.”
Schwartz told the committee that if she is confirmed, she is committed to “radical transparency” and modernization.
Schwartz expressed support for one Kennedy initiative: She told senators she believes nutrition education and physical fitness assessments are important.
“I am all in on the Make America Healthy Again agenda,” she said.
At the July 15 hearing, Schwartz faced questioning alongside Trump’s pick for HHS assistant secretary for preparedness and response, Sean Kaufman.
Schwartz testifies alongside President Donald Trump’s pick for the role of Health and Human Services assistant secretary for preparedness and response, Sean Kaufman. (Eric Harkleroad/KFF Health News)
Cassidy called out Kaufman for past comments casting doubt on the efficacy of vaccines. The senator raised his voice as he accused Kaufman of spreading “those damn lies.”
Kaufman was conciliatory. “Let me be clear: Vaccines save lives,” he said. “They are safe and effective.”
If confirmed by the Senate, Schwartz will replace Jay Bhattacharya, who is performing the duties of CDC director but is not officially the acting director. Bhattacharya is also the director of the NIH.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
July 24, 2026
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