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2 to 3 Cups of Coffee a Day May Reduce Dementia Risk. But Not if It’s Decaf.

One to two cups of caffeinated tea per day helps too, researchers found after following nearly 132,000 people for 40 years.

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Public Health Workers Are Quitting Over Assignments to Guantánamo

Rebekah Stewart, a nurse at the U.S. Public Health Service, got a call last April that brought her to tears. She had been selected for deployment to the Trump administration’s new immigration detention operation at Guantánamo Bay, Cuba.

This posting combined Donald Trump’s longtime passion to use the offshore base to move “some bad dudes” out of the United States with a promise made shortly after his inauguration last year to hold thousands of noncitizens there. The naval base is known for the torture and inhumane treatment of men suspected of terrorism in the wake of 9/11.

“Deployments are typically not something you can say no to,” Stewart said. She pleaded with the coordinating office, which found another nurse to go in her place.

Other public health officers who worked at Guantánamo in the past year described conditions there for the detainees, some of whom learned they were in Cuba from the nurses and doctors sent to care for them. They treated immigrants detained in a dark prison called Camp 6, where no sunlight filters in, said the officers, whom KFF Health News agreed not to name because they fear retaliation for speaking publicly. It previously held people with suspected ties to al-Qaida. The officers said they were not briefed ahead of time on the details of their potential duties at the base.

Although the Public Health Service is not a branch of the U.S. armed forces, its uniformed officers — roughly 5,000 doctors, nurses, and other health workers — act like stethoscope-wearing soldiers in emergencies. The government deploys them during hurricanes, wildfires, mass shootings, and measles outbreaks. In the interim, they fill gaps at an alphabet soup of government agencies.

The Trump administration’s mass arrests to curb immigration have created a new type of health emergency as the number of people detained reaches record highs. About 71,000 immigrants are currently imprisoned, according to Immigration and Customs Enforcement data, which shows that most have no criminal record.

Homeland Security Secretary Kristi Noem has said: “President Donald Trump has been very clear: Guantanamo Bay will hold the worst of the worst.” However, several news organizations have reported that many of the men shipped to the base had no criminal convictions. As many as 90% of them were described as “low-risk” in a May progress report from ICE.

In fits and starts, the Trump administration has sent about 780 noncitizens to Guantánamo Bay, according to The New York Times. Numbers fluctuate as new detainees arrive and others are returned to the U.S. or deported.

While some Public Health Service officers have provided medical care to detained immigrants in the past, this is the first time in American history that Guantánamo has been used to house immigrants who had been living in the U.S. Officers said ICE postings are getting more common. After dodging Guantánamo, Stewart was instructed to report to an ICE detention center in Texas.

“Public health officers are being asked to facilitate a man-made humanitarian crisis,” she said.

Seeing no option to refuse deployments that she found objectionable, Stewart resigned after a decade of service. She would give up the prospect of a pension offered after 20 years.

“It was one of the hardest decisions I ever had to make,” she said. “It was my dream job.”

One of her PHS colleagues, nurse Dena Bushman, grappled with a similar moral dilemma when she got a notice to report to Guantánamo a few weeks after the shooting at the Centers for Disease Control and Prevention in August. Bushman, who was posted with the CDC, got a medical waiver delaying her deployment on account of stress and grief. She considered resigning, then did.

“This may sound extreme,” Bushman said. “But when I was making this decision, I couldn’t help but think about how the people who fed those imprisoned in concentration camps were still part of the Nazi regime.”

Others have resigned, but many officers remain. While they are alarmed by Trump’s tactics, detained people need care, multiple PHS officers told KFF Health News.

“We do the best we can to provide care to people in this shit show,” said a PHS nurse who worked in detention facilities last year.

“I respect people and treat them like humans,” she said. “I try to be a light in the darkness, the one person that makes someone smile in this horrible mess.”

The PHS officers conceded that their power to protect people was limited in a detention system fraught with overcrowding, disorganization, and the psychological trauma of uncertainty, family separations, and sleep deprivation.

“Ensuring the safety, security, and well-being of individuals in our custody is a top priority at ICE,” said Tricia McLaughlin, chief spokesperson for the Department of Homeland Security, in an emailed statement to KFF Health News.

Adm. Brian Christine, assistant secretary for health at the Department of Health and Human Services, which oversees the Public Health Service, said in an email: “Our duty is clear: say “Yes Sir!”, salute smartly, and execute the mission: show up, provide humane care, and protect health.” Christine is a recent appointee who, until recently, was a urologist specializing in testosterone and male fertility issues.

“In pursuit of subjective morality or public displays of virtue,” he added, “we risk abandoning the very individuals we pledged to serve.”

Into the Unknown

In the months before Stewart resigned, she reflected on her previous deployments, during Trump’s first term, to immigration processing centers run by Customs and Border Protection. Fifty women were held in a single concrete cell in Texas, she recalled.

“The most impactful thing I could do was to convince the guards to allow the women, who had been in there for a week, to shower,” she said. “I witnessed suffering without having much ability to address it.”

Stewart spoke with Bushman and other PHS officers who were embedded at the CDC last year. They assisted with the agency’s response to ongoing measles outbreaks, with sexually transmitted infection research, and more. Their roles became crucial last year as the Trump administration laid off droves of CDC staffers.

Stewart, Bushman, and a few other PHS officers at the CDC said they met with middle managers to ask for details about the deployments: If they went to Guantánamo and ICE facilities, how much power would they have to provide what they considered medically necessary care? If they saw anything unethical, how could they report it? Would it be investigated? Would they be protected from reprisal?

Stewart and Bushman said they were given a PHS office phone number they could call if they had a complaint while on assignment. Otherwise, they said, their questions went unanswered. They resigned and so never went to Guantánamo.

PHS officers who were deployed to the base told KFF Health News they weren’t given details about their potential duties — or the standard operating procedure for medical care — before they arrived.

Stephen Xenakis, a retired Army general and a psychiatrist who has advised on medical care at Guantánamo for two decades, said that was troubling. Before health workers deploy, he said, they should understand what they’ll be expected to do.

The consequences of insufficient preparation can be severe. In 2014, the Navy threatened to court-martial one of its nurses at Guantánamo who refused to force-feed prisoners on hunger strike, who were protesting inhumane treatment and indefinite detention. The protocol was brutal: A person was shackled to a five-point restraint chair as nurses shoved a tube for liquid food into their stomach through their nostrils.

“He wasn’t given clear guidance in advance on how these procedures would be conducted at Guantánamo,” Xenakis said of the nurse. “Until he saw it, he didn’t understand how painful it was for detainees.”

The American Nurses Association and Physicians for Human Rights sided with the nurse, saying his objection was guided by professional ethics. After a year, the military dropped the charges.

A uniformed doctor or nurse’s power tends to depend on their rank, their supervisor, and chains of command, Xenakis said. He helped put an end to some inhumane practices at Guantánamo more than a decade ago, when he and other retired generals and admirals publicly objected to certain interrogation techniques, such as one called “walling,” in which interrogators slammed the heads of detainees suspected of terrorism against a wall, causing slight concussions. Xenakis argued that science didn’t support “walling” as an effective means of interrogation, and that it was unethical, amounting to torture.

Torture hasn’t been reported from Guantánamo’s immigration operation, but ICE shift reports obtained through a Freedom of Information Act request by the government watchdog group American Oversight note concerns about detainees resorting to hunger strikes and self-harm.

“Welfare checks with potential hunger strike IA’s,” short for illegal aliens, says an April 30 note from a contractor working with ICE. “In case of a hunger strike or other emergencies,” the report adds, the PHS and ICE are “coordinating policies and procedures.”

“De-escalation of potential pod wide hunger strike/potential riot,” says an entry from July 8. “Speak with alien on suicide watch regarding well being.”

Inmates and investigations have reported delayed medical care at immigration detention facilities and dangerous conditions, including overcrowding and a lack of sanitation. Thirty-two people died in ICE custody in 2025, making it the deadliest year in two decades.

“They are arresting and detaining more people than their facilities can support,” one PHS officer told KFF Health News. The most prevalent problem the officer saw among imprisoned immigrants was psychological. They worried about never seeing their families again or being sent back to a country where they feared they’d be killed. “People are scared out of their minds,” the officer said.

No Sunlight

The PHS officers who were at Guantánamo told KFF Health News that the men they saw were detained in either low-security barracks, with a handful of people per room, or in Camp 6, a dark, high-security facility without natural light. The ICE shift reports describe the two stations by their position on the island, Leeward for the barracks and Windward for Camp 6. About 50 Cuban men sent to Guantánamo in December and January have languished at Camp 6.

A Navy hospital on the base mainly serves the military and other residents who aren’t locked up — and in any case, its capabilities are limited, the officers said. To reduce the chance of expensive medical evacuations back to the U.S. to see specialists quickly, they said, the immigrants were screened before being shipped to Guantánamo. People over age 60 or who needed daily drugs to manage diabetes and high blood pressure, for example, were generally excluded. Still, the officers said, some detainees have had to be evacuated back to Florida.

PHS nurses and doctors said they screened immigrants again when they arrived and provided ongoing care, fielding complaints including about gastrointestinal distress and depression. One ICE monthly progress report says, “The USPHS psychologist started an exercise group” for detainees.

Doctors’ requests for lab work were often turned down because of logistical hurdles, partly due to the number of agencies working together on the base, the officers said. Even a routine test, a complete blood count, took weeks to process, versus hours in the U.S.

DHS and the Department of Defense, which have coordinated on the Guantánamo immigration operation, did not respond to requests for comment about their work there.

One PHS officer who helped medically screen new detainees said they were often surprised to learn they were at Guantánamo.

“I’d tell them, ‘I’m sorry you are here,’” the officer said. “No one freaked out. It was like the ten-millionth time they had been transferred.” Some of the men had been detained in various facilities for five or six months and said they wanted to return to their home countries, according to the officer. Health workers had neither an answer nor a fix.

Unlike ICE detention facilities in the U.S., Guantánamo hasn’t been overcrowded. “I have never been so not busy at work,” one officer said. A military base on a tropical island, Guantánamo offers activities such as snorkeling, paddleboard yoga, and kickboxing to those who aren’t imprisoned. Even so, the officer said they would rather be home than on this assignment on the taxpayer’s dime.

Transporting staff and supplies to the island and maintaining them on-base is enormously expensive. The government paid an estimated $16,500 per day, per detainee at Guantánamo, to hold those accused of terrorism, according to a 2025 Washington Post analysis of DOD data. (The average cost to detain immigrants in ICE facilities in the U.S. is $157 a day.)

Even so, the funding has skyrocketed: Congress granted ICE a record $78 billion for fiscal year 2026, a staggering increase from $9.9 billion in 2024 and $6.5 billion nearly a decade ago.

Last year, the Trump administration also diverted more than $2 billion from the national defense budget to immigration operations, according to a report from congressional Democrats. About $60 million of it went to Guantánamo.

“Detaining noncitizens at Guantanamo is far more costly and logistically burdensome than holding them in ICE detention facilities within the United States,” wrote Deborah Fleischaker, a former assistant director at ICE, in a declaration submitted as part of a lawsuit brought by the American Civil Liberties Union early last year. In December, a federal judge rejected the Trump administration’s request to dismiss a separate ACLU case questioning the legality of detaining immigrants outside the U.S.

Anne Schuchat, who served with the PHS for 30 years before retiring in 2018, said PHS deployments to detention centers may cost the nation in terms of security, too. “A key concern has always been to have enough of these officers available for public health emergencies,” she said.

Andrew Nixon, an HHS spokesperson, said the immigration deployments don’t affect the public health service’s potential response to other emergencies.

In the past, PHS officers have stood up medical shelters during hurricanes in Louisiana and Texas, rolled out covid testing in the earliest months of the pandemic, and provided crisis support after the deadly shooting at Sandy Hook Elementary School and the Boston Marathon bombing.

“It’s important for the public to be aware of how many government resources are being used so that the current administration can carry out this one agenda,” said Stewart, one of the nurses who resigned. “This one thing that’s probably turning us into the types of countries we have fought wars against.”

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.

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4 Dead in Mushroom Poisoning Outbreak in California

State health officials discouraged foraging this year, saying that toxic mushrooms can easily be confused with safe ones to eat.

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Kennedy Makes Unfounded Claim That Keto Diet Can ‘Cure’ Schizophrenia

The claim vastly overstates preliminary research into whether the high-fat, low-carbohydrate diet might help people with the disorder, experts said.

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Hims & Hers Withdraws Knockoff Weight-Loss Pill After Regulatory Scrutiny

Federal officials had warned that the new product from the online provider of weight loss drugs might be illegal.

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Psychiatrist Says Kennedy Was ‘Not Accurate’ in Discussing His Keto Studies

Dr. Christopher M. Palmer said in an interview that the keto diet, while promising, did not “cure” schizophrenia as the health secretary had claimed.

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Journalists Describe Drivers of High Health Costs and Spell Out the Science of Protein

KFF Health News senior correspondent Renuka Rayasam discussed concerns about health care costs following the expiration of enhanced Affordable Care Act tax credits on CBS News’ CBS News 24/7 on Feb. 5. Rayasam also discussed rising health insurance costs on WUGA’s The Georgia Health Report on Jan. 30.

KFF Health News editor-at-large for public health Céline Gounder discussed protein intake on CBS News Texas on Feb. 2.

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.

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Federal Vaccine Advisers Take Aim at Covid Shots

One panelist accused the F.D.A. of withholding data on potential harms. The advisers also are reviewing research on vaccines given to pregnant women.

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Con ICE usando datos de Medicaid, hospitales y estados están en medio de una encrucijada: informar o no a sus pacientes inmigrantes

La decisión del gobierno de Trump de dar a funcionarios encargados de deportaciones acceso a los datos de Medicaid está poniendo a los hospitales y a estados en un aprieto, ya que deben decidir si advierten a sus pacientes inmigrantes que toda su información personal, incluida la dirección de su casa, podría utilizarse para expulsarlos del país.

Ponerlos al tanto de estos riesgos podría disuadirlos de inscribirse en un programa llamado Medicaid de Emergencia, a través del cual el gobierno reembolsa a los hospitales el costo de la atención médica de urgencias a inmigrantes que no califican para la cobertura regular de Medicaid.

Pero si los hospitales no revelan que la información personal de los pacientes se comparte con las autoridades migratorias federales, estos podrían no saber que su cobertura médica los expone al riesgo de ser localizados por el Servicio de Inmigración y Control de Aduanas (ICE).

“Si los hospitales le dicen a la gente que sus datos de Medicaid de Emergencia se compartirán con el ICE, es previsible que muchos inmigrantes simplemente dejen de buscar tratamiento médico de emergencia”, afirmó Leonardo Cuello, profesor investigador del Centro para Niños y Familias de la Universidad de Georgetown.

“La mitad de los casos de Medicaid de Emergencia son partos de bebés ciudadanos estadounidenses. ¿Queremos que esas madres eviten ir al hospital cuando comienzan el trabajo de parto?”, agregó.

Durante más de una década, hospitales y estados aseguraron a los pacientes que su información personal, incluyendo su estatus migratorio y la dirección de su casa, no sería compartida con funcionarios de inmigración cuando solicitaban cobertura médica federal.

Un memorando de política del ICE de 2013 garantizaba que la agencia no usaría información de solicitudes de cobertura médica para actividades de control migratorio.

Pero eso cambió el año pasado, luego de que el presidente Donald Trump regresara a la Casa Blanca y ordenara una de las campañas de represión migratoria más agresivas de la historia reciente. Su administración empezó a canalizar datos de varias agencias gubernamentales al Departamento de Seguridad Nacional, incluida la información fiscal enviada al Servicio de Impuestos Internos (IRS).

Los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés), que forman parte del Departamento de Salud y Servicios Humanos, aceptaron en la primavera pasada darle a ICE acceso directo a una base de datos de Medicaid que incluye las direcciones y el estatus migratorio de las personas inscritas.

Veintidós estados, todos gobernados por demócratas excepto uno, presentaron demandas para bloquear ese acuerdo de intercambio de datos de Medicaid, que no había sido anunciado formalmente por el gobierno hasta que un juez federal ordenó hacerlo el verano pasado. El juez falló en diciembre que, en esos estados, ICE solo podría acceder a la información de la base de datos de Medicaid correspondiente a personas que están en el país de forma irregular.

KFF Health News contactó a más de una docena de hospitales y asociaciones hospitalarias en estados y ciudades que han sido objeto de operativos del ICE. Muchos se negaron a comentar si, luego del fallo judicial, habían actualizado sus políticas de divulgación.

De los que respondieron, ninguno dijo que estuviera advirtiendo directamente a los pacientes que su información personal podía ser compartida con el ICE si solicitaban cobertura de Medicaid.

“No ofrecemos asesoramiento legal sobre el intercambio de datos entre agencias del gobierno federal”, escribió por correo electrónico Aimee Jordon, vocera del sistema hospitalario M Health Fairview, con sede en Minneapolis. “Recomendamos a los pacientes que tengan preguntas sobre prestaciones o inquietudes relacionadas con temas migratorios que busquen orientación en los recursos estatales adecuados y con asesores legales calificados”.

Información sobre las solicitudes

En algunos estados, las solicitudes de Medicaid de Emergencia  preguntan específicamente por el estatus migratorio del paciente, pero aseguran a las personas que su información se mantendrá protegida y fuera del alcance de los funcionarios de inmigración.

Por ejemplo, hasta el 3 de febrero, la solicitud de California aún incluía un texto en el que se informaba a los solicitantes que su información migratoria era “confidencial”.

“Solo la usamos para determinar si califica para un seguro médico”, explica el formulario de 44 páginas que el programa estatal de Medicaid, conocido como Medi-Cal, publicó en redes sociales en enero.

Anthony Cava, vocero del Departamento de Servicios de Atención Médica de California, dijo en una declaración que la agencia, que supervisa Medi-Cal, se asegurará de que los californianos tengan información precisa sobre la privacidad de sus datos, “incluyendo, si es necesario, la revisión de otras publicaciones”.

Hasta finales de enero, el sitio web de Medicaid en Utah también aseguraba que el programa de Medicaid de Emergencia no compartía información con funcionarios migratorios. Después de que KFF Health News contactara a la agencia estatal, la vocera Kolbi Young anunció el 23 de enero que esa información sería retirada de inmediato. Fue eliminada ese mismo día.

El sistema hospitalario Oregon Health & Science University, con sede en Portland, ofrece a pacientes inmigrantes un documento de preguntas y respuestas desarrollado por el programa estatal de Medicaid para quienes tienen dudas sobre el uso de su información. El documento no indica de manera explícita que la información de quienes se inscriben en Medicaid será compartida con el ICE.

Los hospitales dependen del Medicaid de Emergencia para que les reembolsen el tratamiento de personas que cumplirían con los requisitos para Medicaid si no fuera por su estatus migratorio, ya sea que estén en el país sin papeles o dispongan de una presencia legal temporal, como visas de estudiante o de trabajo. Esta cobertura solo paga por atención médica de urgencia y servicios relacionados con el embarazo. Por lo general, representantes del hospital ayudan a los pacientes a presentar la solicitud mientras están en el hospital.

El programa principal de Medicaid, que cubre una gama mucho más amplia de servicios para más de 77 millones de personas con bajos ingresos o discapacidades, no cubre a quienes están en el país sin autorización.

Por lo tanto, examinar los registros de inscripción en el Medicaid de Emergencia es la forma más efectiva que tienen los funcionarios de deportación para identificar a los inmigrantes, incluidos aquellos que podrían no residir legalmente en los Estados Unidos.

Rich Danker, vocero del Departamento de Salud y Servicios Humanos, dijo por correo electrónico que los CMS —que supervisa Medicaid, un programa conjunto federal y estatal— están compartiendo datos con el ICE tras la decisión del juez. Pero no explicó cómo se asegura de compartir solo información sobre personas sin residencia legal, como exige el fallo judicial.

Dado que el ICE ahora tiene acceso directo a la información personal de millones de personas inscritas en Medicaid, los hospitales —aunque “están en una posición muy difícil”— deberían ser transparentes sobre los cambios, dijo Sarah Grusin, abogada del National Health Law Program, un grupo de defensa legal.

“Deben decirle a la gente que el juez ha autorizado compartir la información —incluida sus direcciones— en el caso de quienes no residen legalmente en el país”, afirmó. “Una vez enviada, esa información ya no puede protegerse para evitar que sea divulgada”.

Grusin dijo que recomienda a las familias que midan la importancia de buscar atención médica frente al riesgo de que sus datos sean compartidos con el ICE.

“Queremos dar información sincera y honesta, incluso si eso significa que las personas se vayan a ver obligadas a tomar decisiones muy difíciles”, destacó.

Quienes se hayan inscrito anteriormente en Medicaid o cuya dirección pueda encontrarse fácilmente en internet deben asumir que los funcionarios de inmigración ya conocen esos datos, agregó.

Medicaid de Emergencia

La cobertura de Medicaid de Emergencia se estableció a mediados de la década de 1980, cuando una ley federal comenzó a exigir que los hospitales atendieran y estabilizaran a cualquier persona que llegara con una condición que pusiera en riesgo su vida.

En 2023, el gasto del gobierno federal en Medicaid de Emergencia fue de casi $4.000 millones, lo que representa aproximadamente el 0,4% del gasto total federal en Medicaid.

Los estados envían informes mensuales al gobierno federal con información detallada sobre quiénes se inscriben en Medicaid y qué servicios reciben.

El fallo judicial de diciembre limitó lo que los CMS pueden compartir con el ICE a datos básicos, incluyendo direcciones, de los afiliados a Medicaid en los 22 estados que llevaron a la Justicia el acuerdo de intercambio de datos. El ICE no tiene permitido acceder a información sobre los servicios médicos que reciben las personas, según la orden del juez.

El juez también prohibió a la agencia compartir los datos de ciudadanos estadounidenses o inmigrantes con residencia legal en esos estados.

En los otros 28 estados, los funcionarios de deportación tienen acceso a la información personal de los inscritos en Medicaid.

La agencia federal de salud no ha aclarado cómo garantiza que la información sobre ciudadanos y residentes legales de ciertos estados no sea compartida con el ICE. Pero expertos en Medicaid dicen que sería casi imposible separar esos datos, lo que genera dudas sobre si el gobierno de Trump está cumpliendo con la orden judicial.

Los esfuerzos de la administración Trump por deportar a inmigrantes que viven en el país sin autorización han afectado a familias inmigrantes que buscan atención de salud.

Cerca de un tercio de los adultos nacidos fuera de los Estados Unidos dijeron haber evitado o pospuesto atención médica en el último año, según una encuesta de KFF y The New York Times publicada en noviembre. (KFF es una organización sin fines de lucro dedicada a la información sobre salud, que incluye a KFF Health News).

Bethany Pray, directora legal y de políticas del Colorado Center on Law and Policy, advirtió que el hecho de compartir datos de Medicaid con funcionarios de deportación obligará a muchas familias a tomar decisiones aún más difíciles.

“Esto es muy preocupante”, opinó Pray. “La gente no debería tener que elegir entre dar a luz en un hospital y preguntarse si eso significa correr el riesgo de enfrentar la deportación”.

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.

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Effective but Underprescribed: HIV Prevention Meds Aren’t Reaching Enough People

Listen: More than 2 million Americans could benefit from PrEP, but only about a quarter of them are getting the HIV prevention medication. On Feb. 4, during WAMU’s “Health Hub,” KFF Health News reporter Zach Dyer shared tips for overcoming common hurdles to care.

Billing mistakes. Stigma. Doctors who aren’t keeping up with the latest research. Those are just some of the hurdles that keep HIV prevention medication out of reach for many Americans.

The Centers for Disease Control and Prevention estimates more than 2 million Americans could benefit from a treatment known as PrEP, but only a quarter of them are getting a form of the drug. Zach Dyer appeared on WAMU’s “Health Hub” on Feb. 4 to share tips patients can use to avoid those pitfalls and find a doctor who knows more about PrEP.

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.

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F.D.A. Relaxes Rules on ‘Naturally Derived’ Dyes as Kennedy Pushes Protein

Food makers will now be able to claim that their products have “no artificial colors,” so long as they use dyes that are not petroleum based.

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Newsom ajusta su discurso sobre la salud de inmigrantes enfocado en una posible candidatura presidencial

El gobernador de California, Gavin Newsom, que aspira a presentarse en las elecciones presidenciales, ha enfurecido tanto a demócratas como a republicanos por su posición sobre la atención médica para los inmigrantes en su estado. La situación revela el delicado camino político que tiene por delante.

Por segundo año, el demócrata pidió a los legisladores estatales que eliminen la cobertura para un sector de los inmigrantes ante los recortes federales al gasto en Medicaid y un déficit presupuestario de aproximadamente $3.000 millones.

Muchos analistas advierten que, si estalla la burbuja de la inteligencia artificial, el déficit podría empeorar.

Newsom propuso que el estado no intervenga cuando, a partir de octubre, el gobierno federal deje de brindar cobertura médica a unos 200.000 residentes legales, entre ellos solicitantes de asilo y refugiados.

Legisladores progresistas y activistas afirmaron que esos recortes representan un alejamiento de la promesa de Newsom de garantizar “salud para todos”. Por otro lado, los republicanos siguen criticándolo porque utiliza fondos públicos para cubrir a personas que no son ciudadanas.

Según el Departamento de Finanzas, la propuesta más reciente de Newsom permitiría un ahorro estimado de $786 millones en este año fiscal y de $1.100 millones anuales en los años siguientes, dentro de un presupuesto proyectado de $349.000 millones.

La senadora estatal Caroline Menjivar, una de las dos demócratas que el año pasado votaron en contra de los recortes de Newsom, dijo que le preocupa que las ambiciones políticas del gobernador estén pesando más que lo que es mejor para los californianos.

“Está pendiente de lo que van a opinar Arkansas o Tennessee, cuando lo que piensa California es algo completamente diferente”, se quejó Menjivar, quien contó que sus críticas anteriores le costaron ser apartada temporalmente de un subcomité clave del presupuesto. “Esa es mi perspectiva sobre lo que está ocurriendo aquí”, agregó.

Mientras tanto, el senador estatal republicano Tony Strickland criticó a Newsom por restar importancia al déficit estructural del estado que, según funcionarios estatales, podría crecer hasta los $27.000 millones el próximo año. Además, lo acusó de seguir ofreciendo cobertura a residentes de California que viven en el país sin autorización. “Lo único que quiere es relanzarse políticamente, proyectar una nueva imagen”, dijo Strickland.

Es una cuerda floja política que se irá tensando aún más a medida que disminuya el apoyo federal y sigan aumentando los gastos en atención médica, afirmó Guian McKee, codirector del Proyecto de Políticas de Salud de la Escuela de Asuntos Públicos Miller de la Universidad de Virginia.

“Newsom tiene que hacer malabares con tres o cuatro temas delicados al mismo tiempo”, opinó  McKee. Si decide postularse, agregó: “las prioridades de los votantes demócratas en las primarias —que en gran medida reflejan estados progresistas como California— son muy distintas a las del electorado en general, que está mucho más dividido”.

En Estados Unidos, las opiniones sobre si el gobierno debería ofrecer cobertura médica a personas sin papeles están muy divididas.

En una encuesta de KFF realizada el año pasado, una pequeña mayoría —54%— se opuso a una disposición que establecía sanciones a los estados que utilizaban sus propios recursos para brindar atención médica a inmigrantes. Había grandes diferencias según la afiliación política. Finalmente, esa disposición no fue incluida en la versión final del proyecto de ley aprobado por el Congreso y promulgado por el presidente Donald Trump.

Incluso en California, la idea de ofrecer atención médica perdió apoyo a causa de los problemas presupuestarios.

En una encuesta que hizo el  Instituto de Políticas Públicas de California en mayo, el 41% de los adultos expresó estar de acuerdo con ofrecer cobertura médica a inmigrantes sin papeles, una caída significativa con respecto al 55% que lo respaldaba en 2023.

Trump, el vicepresidente JD Vance, otros funcionarios del gobierno y legisladores republicanos han acusado en repetidas ocasiones a California y a otros estados demócratas de usar fondos públicos para dar atención médica a inmigrantes, un tema que enardece a la base del Partido Republicano.

Mehmet Oz, administrador de los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés), acusó a California de “manipular el sistema” para recibir más fondos federales, liberando recursos estatales para su programa de Medicaid, conocido como Medi-Cal, que ha inscrito a cerca de 1,6 millones de inmigrantes en situación irregular.

“Si usted es un contribuyente en Texas o Florida, sus impuestos podrían haberse usado para financiar la atención médica de inmigrantes ilegales en California”, dijo en octubre.

Funcionarios de California negaron esas acusaciones y afirmaron que solo se utilizan fondos estatales para dar servicios de salud general a personas indocumentadas, ya que la ley prohíbe usar fondos federales.

Newsom ha convertido esto en un “motivo de orgullo”, ya que ampliar la cobertura a inmigrantes, según su administración, mantiene a las personas más saludables y ayuda a evitar costosas visitas a salas de emergencia que muchas veces se terminan pagando con dinero público.

“Ninguna administración ha hecho más que ésta para ampliar la cobertura total de Medicaid para nuestras comunidades diversas, con y sin estatus migratorio”, dijo Newsom a periodistas en enero. “Hay quienes han construido toda su carrera política criticando mi postura”.

Newsom advirtió sobre el “carnaval de caos” del gobierno federal al aprobar la ley One Big Beautiful Bill Act de Trump. Esa ley, sostuvo, pone a 1,8 millones de californianos en riesgo de perder su cobertura médica debido a la implementación de requisitos laborales, otras reglas de elegibilidad y nuevos límites al financiamiento federal para los estados.

Según la Oficina de Presupuesto del Congreso, desde ahora y hasta 2034, a nivel nacional, 10 millones de beneficiarios podrían perder su cobertura.

Economistas especializados en política sanitaria han señalado que un número mayor de personas sin seguro —en especial aquellas que están relativamente sanas— podría concentrar la cobertura en pacientes más enfermos, lo que potencialmente elevaría los costos de las primas y los costos hospitalarios en general.

Organizaciones que trabajan con los inmigrantes señalan que es especialmente cruel dejar sin atención médica a quienes pudieron haber huido de situaciones de violencia o sobrevivido a la trata o a situaciones de abuso.

Las normas federales actuales exigen que los programas estatales de Medicaid cubran a “no ciudadanos calificados”, incluidos solicitantes de asilo y refugiados, explicó Tanya Broder, del National Immigration Law Center. Pero la One Big Beautiful Bill Act, impulsada por los republicanos, puso fin a esa cobertura, lo que afectaría a unos 1,4 millones de inmigrantes legales en todo el país.

Como muchos gobernadores estatales aún no han presentado sus propuestas de presupuesto, no está claro cómo piensan cubrir los recortes al financiamiento, dijo Broder.

Por ejemplo, funcionarios de Colorado estiman que unos 7.000 inmigrantes legales podrían perder cobertura por los cambios en la ley. En el estado de Washington, las autoridades calculan que 3.000 refugiados, solicitantes de asilo y otros inmigrantes con autorización legal se quedarán sin cobertura de Medicaid.

Ambos estados, al igual que California, ampliaron la cobertura completa a todos los residentes elegibles por ingresos, sin importar su situación migratoria. Ahora, sus funcionarios electos están en la incómoda posición de tener que explicar por qué algunos inmigrantes legales podrían perder su cobertura médica mientras que otros sin estatus legal podrían conservarla.

El año pasado, el aumento de los costos en atención médica y los recortes presupuestarios llevaron a los gobernadores demócratas de Illinois y Minnesota —JB Pritzker y Tim Walz, dos potenciales aspirantes a la presidencia— a suspender o cancelar la cobertura para inmigrantes sin papeles.

También en 2025, legisladores de California votaron por la eliminación de la cobertura dental y congelaron nuevas inscripciones para personas sin documentos. A partir del próximo año también se cobrará una prima mensual a quienes mantengan su cobertura.

Aun así, se estima que el estado gastará $13.800 millones de su fondo general en atención médica para inmigrantes no cubiertos por el gobierno federal, según H.D. Palmer, vocero del Departamento de Finanzas.

En enero, en una conferencia de prensa en San Francisco, Newsom defendió estas medidas y dijo que eran necesarias por “prudencia fiscal”. Evitó responder preguntas sobre la cobertura para solicitantes de asilo y refugiados, y minimizó la importancia de su propuesta, al decir que podría revisarla cuando tuviera la oportunidad de actualizar el presupuesto en mayo.

Kiran Savage-Sangwan, directora ejecutiva de la California Pan-Ethnic Health Network, señaló que el estado aprobó una ley en la década de 1990 que le exige cubrir con Medi-Cal a inmigrantes legales cuando los fondos federales de Medicaid no están disponibles. Esto incluye a personas con residencia permanente que aún no cumplen con el período de espera de cinco años para inscribirse en Medicaid.

Savage-Sangwan calificó la propuesta del gobernador como “arbitraria y cruel” y criticó su decisión de priorizar los depósitos del fondo de emergencia para tiempos difíciles en vez de mantener la cobertura. Agregó que culpar al gobierno federal era engañoso.

También consideró que es un gran retroceso respecto de lo que ella esperaba que California pudiera lograr el primer día de Newsom en el cargo, hace siete años, cuando el gobernador declaró su apoyo a un sistema de salud con financiamiento público integral y propuso ampliar los subsidios para pagar el seguro médico para la clase media.

“Tenía esperanza y celebramos los avances que impulsó el gobernador”, afirmó Savage-Sangwan. “Por eso estoy aún más decepcionada”.

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.

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Poison at Play: Unsafe Levels of Lead Found in Half of New Orleans Playgrounds

NEW ORLEANS — Sarah Hess started taking her toddler, Josie, to Mickey Markey Playground in 2010 because she thought it would offer a refuge from lead.

After a routine doctor visit revealed Josie had lead poisoning, Hess quickly traced the source to the crumbling paint in her family’s century-old home in the Bayou St. John neighborhood. While it underwent lead remediation, the family stayed in a newer, lead-free house near Markey.

“Everyone was telling us the safest place to play was outside at playgrounds, so that’s where we went,” Hess said. Josie became a Markey regular, playing on the swings and slides.

Josie’s next blood test was a shock. “It skyrocketed,” Hess said. Josie’s lead levels had leaped to nearly five times the national health standard. The likely culprit, according to scientists at the time, was Josie’s favorite park. Soil testing found it had dangerously high levels of lead.

City officials took no action to inform Markey’s users or make the park safe. But parents started posting warning signs at the park and flooded City Hall with calls and emails. With Josie on her hip, Hess made an impassioned speech at a City Council meeting.

In short order, the city hired a company to test Markey and other parks and pledged to fix the lead problem wherever it was found.

“My impression was they were going to make them all lead-free parks,” Hess said.

But a Verite News investigation conducted over four months in 2025 found that lead pollution in New Orleans parks not only persists — it is more widespread than previously known. Dozens of city parks with playgrounds remain unsafe, including Markey and other parks that underwent a city-sponsored lead remediation in 2011.

The findings indicate that city officials fell short in their cleanup efforts then, and that a very large number of New Orleans children are exposed to excessive amounts of lead, said Howard Mielke, a retired Tulane University toxicologist and one of the nation’s top experts on lead contamination.

“It’s a failed program,” he said. “They didn’t do what they needed to do to bring the lead levels down in a single park.”

Verite News reporters tested hundreds of soil samples from 84 city parks with playgrounds in fall 2025. Adrienne Katner, a lead-contamination researcher with Louisiana State University, verified the results. The testing found that about half the parks had lead concentrations that exceeded the federal hazard level established in 2024 for soil in urban areas.

“If there’s evidence of kids playing in soils that are as high as you described, that’s kind of horrifying,” Gabriel Filippelli, an Indiana University biochemist who studies lead exposure, told Verite News.

Public health researchers and doctors say that children under 6 absorb lead-laden dust more easily than adults, contaminating their blood and harming the long-term development of their brains and nervous systems. There is no known safe exposure level for children, and even trace amounts can result in behavioral problems and lower cognitive abilities.

Larry Barabino is the CEO of the New Orleans Recreation Development Commission, which oversees most of the city’s parks. He said the city doesn’t routinely test for lead in parks, and he confirmed that the last significant effort to do so was in 2011.

He called Verite’s results “definitely concerning” and pledged to work with city officials, local experts, and a city environmental consultant, Materials Management Group, to potentially remediate unsafe parks.

“It’s definitely concerning if it’s at the level that’s considered a true risk or threat, and we would get it to Capital Projects immediately to get MMG out there,” Barabino said, referring to the News Orleans Capital Projects Administration. “If there’s anything that’s a true environmental concern or risk, that’s something that we believe in definitely making sure we take action.”

But New Orleans is in financial straits, with a budget deficit of about $220 million, and it’s unclear what resources new mayor Helena Moreno would be able to devote to restart lead remediation efforts. In response to the financial crisis, Moreno has already eliminated dozens of positions and plans to furlough 700 employees one day per pay period to save money. Moreno’s administration did not respond to requests for comment.

Andrea Young heard pledges similar to Barabino’s 15 years ago. Like Hess, Young had a child who frequented Markey and had high lead levels in her blood. Alongside other mothers, she helped push the city to take action. Young thought they had succeeded but said she now realizes that the city didn’t do enough.

“It makes me question the value” of the work the city did, Young said, “and the safety we felt in letting our kids play there again.”

Testing New Orleans Parks

Lead is typically found in very small amounts in natural soil. The average lead abundance in U.S. soils is 26 parts per million, equivalent to less than an ounce of lead per ton of soil.

But New Orleans, like many other cities, has a long history of lead contamination in its soil, from sources including lead-based paint, leaded gasoline, and emissions from waste incinerators and other industrial facilities. Lead particles spread easily by wind, eventually settling in the topsoil.

The federal hazard level for lead in soil was 400 ppm until early 2024, when the Environmental Protection Agency lowered it to 200 ppm for most residential areas and 100 ppm in urban areas like New Orleans with multiple sources of lead exposure. Last fall, the Trump administration eliminated the lower 100-ppm limit, arguing it was confusing to have two thresholds. It didn’t argue that the 100-ppm level was safe.

More of a guide than a mandate, the EPA screening levels can steer federal cleanup actions and are often adopted by state and city governments to inform local responses to lead contamination. California has long had a much lower standard of 80 ppm.

Mielke said the Trump administration’s change doesn’t align with the science, which has long shown that children are harmed when exposed to soil with levels below 100 ppm. He was one of several scientists who had pushed for lower thresholds after the EPA established its first screening levels more than 30 years ago.

He said the 100-ppm level should still be applied in urban areas, especially New Orleans.

Verite conducted soil tests on the 84 city parks that property inventories and maps list as having play structures. Samples were taken from surface soil, which is most likely to come into contact with children’s hands and toys or be inhaled when kicked up during play or blown by the wind.

The average soil sample collected by Verite contained lead levels of about 121 ppm. Elevated lead levels tended to follow the age of the neighborhood. The city’s older neighborhoods, including the Irish Channel and Algiers Point, had some of the highest lead levels, while places like Gentilly and New Orleans East, developed mostly after the 1950s, tended to have lower levels, according to Verite’s findings.

The highest lead levels were found at Evans Park in the Freret neighborhood. Beside a low-hanging oak branch, on ground worn bare by children’s play, Verite recorded lead at 5,998 ppm, nearly 60 times the 100-ppm urban soils threshold.

Verite spoke to more than a dozen parents at playgrounds throughout the city, and most were surprised at the levels of lead in the parks.

In the Irish Channel, Meg Potts watched her son run around the dusty Brignac playground. All of Verite’s samples at that park surpassed the threshold the EPA deemed safe for urban areas, reaching nearly 600 ppm.

Potts knew high lead levels existed in the city but said she didn’t realize her neighborhood park could be a source of exposure for her son.

“ I’m just, like, thinking about all of this now because he’s had to go in and have his lead tested,” she said. “He’s like right on the cusp of having too-high lead.”

Katner, the LSU researcher, said Verite’s results can serve as a starting point for city officials to conduct more comprehensive testing in parks, noting that even a single lead hot spot in a park is concerning.

“The kid playing in that part of the park is going to get the highest dose,” she said.

A Legacy of Lead

Before the 1970s, lead was ubiquitous. A 2022 study estimated that most of the U.S. population born before the 1980s was poisoned by dangerously high levels of lead in early childhood, resulting in an average loss of at least one IQ point.

Lead pollution from cars spread into areas near roads, especially major thoroughfares, until leaded gasoline was phased out by 1996. Similarly, emissions from trash incinerators and industrial sites contaminated the surrounding soil in some New Orleans neighborhoods until they were closed in the 1970s and ’80s.

Today, the most pervasive source of lead in soil is degraded paint. Lead-based paint was used extensively for homes and buildings until it was banned in 1978. In New Orleans, most of the houses were built before 1980, according to the 2024 American Community Survey. As the paint deteriorates, Tulane University epidemiologist Felicia Rabito said, it can chip or turn into toxic dust.

“ The leaded paint goes straight into the dust and it goes straight into the soils, which is a major source of exposure for young children in the city,” said Rabito, who studies lead poisoning and other health conditions.

Children under 6 are especially vulnerable, in part because they like to stick their hands in their mouths. A child eating a dropped Cheerio or putting their thumb in their mouth after playing on a seesaw can be enough to cause harm. Rabito recommended that parents avoid contaminated playgrounds.

The only way to know whether a child has lead poisoning is a medical test. By state law, Louisiana health care providers are required to ensure every child between 6 months and 6 years of age receives at least two blood tests, recommended at age 1 and age 2.

But the law does not include a way to enforce those testing requirements, so many health care providers don’t test, according to a 2017 report from the Louisiana Department of Health. In 2022, fewer than 1 in 10 children under 6 were screened for lead poisoning in the city, according to data from the Centers for Disease Control and Prevention.

“ There’s not anything that we can say about lead poisoning or lead levels in children in Orleans Parish with any scientific certainty,” Rabito said. “ Parents really need to get their children tested.”

Limited Soil Testing, Patchy Fixes

In 2011, the last time there was outcry over lead pollution in parks, the New Orleans health commissioner at the time, Karen DeSalvo, said the city should do “everything we can to understand what the risk might be and to remediate it.” But she also called it “not the greatest challenge, honestly,” according to The Times-Picayune.

Then-Mayor Mitch Landrieu promised a comprehensive response.

“The city will take all necessary measures to investigate possible lead contamination in other parks and playgrounds and remediate them as soon as possible,” he said in March 2011.

Two months later, testing and remediation were completed at several parks. Parents brought their children back to the reopened playgrounds.

Despite city leaders’ assurances of a broad response, only 16 parks were tested in 2011 and the city’s piecemeal cleanup covered only patches of contaminated soil rather than entire parks, according to documents obtained through public records requests.

That stunned the vocal group of parents who had pushed for cleaning up the Markey playground. Young, one of the mothers, said the scope of the 2011 testing and remediation was much more limited than she thought.

“If the majority of the parks they tested were high, what would make them think all the others are fine?” she said.

Verite’s testing found high levels of lead at several playgrounds that were remediated in 2011, including Markey.

The results disturbed Mielke, the Tulane toxicologist.

In 2010, Mielke led an effort to reduce lead exposure at 10 private child care center playgrounds in New Orleans. He and his team covered the entire footprint of each playground with water-pervious plastic fabric and then 6 inches of Mississippi River sediment from the Bonnet Carré Spillway, a source of clean, cheap, and easily accessible soil. Lead levels fell, with most playgrounds testing below 10 ppm.

In contrast, the city’s remediation was mostly limited to areas with lead levels above 400 ppm, leaving many hazardous areas exposed. Testing and remediation reports obtained by Verite typically showed MMG focused on two or three spots in each park, with the rest going untreated.

At Easton Park in Bayou St. John, for instance, the 2011 remediation covered four areas totaling about 4,700 square feet, but the park’s playground was left untouched. Verite measured four samples around the playground that exceeded the 100-ppm threshold, including 1,060-ppm and 603-ppm readings near Easton’s swing set.

One park, Evans in the Freret neighborhood, wasn’t remediated despite lead levels as high as 610 ppm in 2011. The reason wasn’t clear in progress reports submitted by MMG. In Verite’s 2025 tests, Evans recorded the highest level, with 5,998 ppm in one location.

MMG did not respond to requests for comment.

Landrieu did not respond to a request for comment. DeSalvo, who retired last summer as Google’s chief health officer, said “extremely limited resources” forced the city to weigh its response to lead contamination in parks with the many other health threats residents faced.

“We worked to address the range of exposures whenever possible with the resources we could muster,” she said.

A Road Map for Cleanup?

Filippelli, of Indiana University, said the city should conduct comprehensive testing of every park and do regular checkups.

But because lead contamination in New Orleans parks is extensive and city leaders are struggling to close a large budget deficit, Filippelli recommends that the city remediate the worst parks first.

He and Mielke don’t believe the city must go the expensive route of full remediation, which involves digging up lead-tainted soil and trucking it to a hazardous waste landfill. It’s usually unnecessary if a park is properly capped with clean soil, Filippelli said.

Verite obtained cost estimates for 10 of the 13 parks targeted for remediation in 2011. The total cost was $83,000 in 2011, or about $120,000 today. The work covered just more than 1.3 acres across the 10 properties. Filippelli estimated that similar work could be done today for about $20,000 per acre — about a fifth of what was spent to remediate just over an acre at New Orleans parks.

Remediation should be coupled with efforts to reduce contamination from nearby sources, primarily old houses shedding lead-based paint, Rabito said.

“When you clean up soil, you’re not going to do it much good if you haven’t identified what’s contaminating the soil,” she said.

Cleaning up New Orleans parks is also likely to require sustained public pressure, said the parents involved with the lead issue in 2011.

“I was not intending to kick butts or make anybody look bad,” Claudia Copeland said of her efforts to alert parents about the dangers at Markey. “But nothing would have happened unless all these parents were calling in to the city.”

Methodology

Verite News reporters Tristan Baurick and Halle Parker were trained to use an X-ray fluorescence analyzer, or XRF, a handheld device that can detect the unique traits of lead at trace levels, down to 10 parts per million. The analyzer is widely used by government and university scientists.

The reporters tested 531 soil samples over a month in late 2025, following protocols developed by retired Tulane University toxicologist Howard Mielke and vetted by three other lead-contamination researchers. The reporters tested surface soil in and around play structures and other areas of parks that children use. Of the more than 110 parks in New Orleans, Verite concentrated on the 84 that city property inventories and maps list as having play structures. The reporters took between three and 11 samples at each park, depending on the size, site accessibility, and levels of contamination. A GPS device was used to record each sample’s location.

Verite’s results were reviewed by Adrienne Katner, a lead-contamination researcher at Louisiana State University. She verified the accuracy of the testing by comparing it with a smaller set of park soil samples collected by her team last summer.

While valid, the method did have limitations. The results can’t be used to determine the state of a whole park. But even one elevated soil sample can provide a starting point for city officials to conduct more comprehensive testing.

This article was produced in collaboration with Verite News. The four-month investigation was supported by a Kozik Environmental Justice Reporting grant funded by the National Press Foundation and the National Press Club Journalism Institute. It was also produced as a project for the USC Annenberg Center for Health Journalism’s National Fellowship fund and Dennis A. Hunt Fund for Health Journalism.

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.

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‘Bridgerton’ Tackles the Orgasm Gap

Sex therapists say a character’s struggle to reach her “pinnacle” could help viewers better understand women’s sexuality.

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When the Doctor Needs a Checkup

He was a surgical oncologist at a hospital in a Southern city, a 78-year-old whose colleagues had begun noticing troubling behavior in the operating room.

During procedures, he seemed “hesitant, not sure of how to go on to the next step without being prompted” by assistants, said Mark Katlic, director of the Aging Surgeon Program at Sinai Hospital in Baltimore.

The chief of surgery, concerned about the doctor’s cognition, “would not sign off on his credentials to practice surgery unless he went through an evaluation,” Katlic said.

Since 2015, when Sinai inaugurated a screening program for surgeons 75 and older, about 30 from around the country have undergone its comprehensive two-day physical and cognitive assessment. This surgeon “did not come of his own accord,” Katlic recalled.

But he came. The tests revealed mild cognitive impairment, often but not necessarily a precursor to dementia. The neuropsychologist’s report advised that the surgeon’s difficulties were “likely to impact his ability to practice medicine as he is doing presently, e.g. conducting complex surgical procedures.”

That didn’t mean the surgeon had to retire; a variety of accommodations would allow him to continue in other roles. “He retained a lifetime of knowledge that had not been impacted by cognitive changes,” Katlic said. The hospital “took him out of the OR, but he continued to see patients in the clinic.”

Such incidents are likely to become more common as America’s physician workforce ages rapidly. In 2005, more than 11% of doctors who were seeing patients were 65 or older, the American Medical Association said. Last year, the proportion reached 22.4%, with nearly 203,000 older practitioners.

Given physician shortages, especially in rural areas and key specialties like primary care, nobody wants to drive out veteran doctors with skills and experience.

Yet researchers have documented “a gradual decline in physicians’ cognitive abilities starting in their mid-60s,” said Thomas Gallagher, an internist and bioethicist at the University of Washington who has studied late-career trajectories.

At older ages, reaction times slow; knowledge can become outdated. Cognitive scores vary greatly, however. “Some practitioners continue to do as well as they did in their 40s and 50s, and others really start to struggle,” Gallagher said.

A few health organizations have responded by establishing late-career practitioner programs mandating that older doctors be screened for cognitive and physical deficits.

UVA Health at the University of Virginia began its program in 2011 and has screened about 200 older practitioners. Only in four cases did the results significantly change a doctor’s practice or privileges.

Stanford Health Care launched its late-career program the following year. Penn Medicine at the University of Pennsylvania also put in place a testing program.

Nobody has tracked how many exist; Gallagher guesstimated as many as 200. But given that the United States has more than 6,000 hospitals, those with late-career programs constitute “a vast minority,” he said.

The number may actually have shrunk. A federal lawsuit, along with the profession’s lingering reluctance, appears to have put the effort to regularly assess older doctors’ abilities in limbo.

Late-career programs typically require those 70 and older to be evaluated before their privileges and credentials are renewed, with confirmatory testing for those whose initial results indicate problems. Thereafter, older doctors undergo regular rescreening, usually every year or two.

It’s fair to say such efforts proved unpopular among their intended targets. Doctors frequently insist that “‘I’ll know when it’s time to stand down,’” said Rocco Orlando, senior strategic adviser to Hartford HealthCare, which operates eight Connecticut hospitals and began its late-career practitioner program in 2018. “It turns out not to be true.”

When Hartford HealthCare published data from the first two years of its late-career program, it reported that of the 160 practitioners 70 and older who were screened, 14.4% showed some degree of cognitive impairment.

That mirrored results from Yale New Haven Hospital, which instituted mandatory cognitive screening for medical staff members starting at age 70. Among the first 141 Yale clinicians who underwent testing, 12.7% “demonstrated cognitive deficits that were likely to impair their ability to practice medicine independently,” a study reported.

Proponents of late-career screening argued that such programs could prevent harm to patients while steering impaired doctors to less demanding assignments or, in some cases, toward retirement.

“I thought as we got the word out nationally, this would be something we could encourage across the country,” Orlando said, noting that Hartford’s program cost only $50,000 to $60,000 a year.

Instead, he has seen “zero progress” in recent years. “Probably we’ve gone backward,” he said.

A key reason: In 2020, the federal Equal Employment Opportunity Commission sued Yale New Haven over its testing efforts, charging age and disability discrimination. The legal action continues (the EEOC declined to comment on its status), as does the hospital’s late-career program.

But the suit led several other organizations to pause or shut down their programs, including those at Hartford HealthCare and at Driscoll Children’s Hospital in Corpus Christi, Texas, while few new ones have emerged.

“It made lots of organizations uncomfortable about sticking their necks out,” Gallagher said.

Instituting later-career programs has always been an uphill effort. “Doctors don’t like to be regulated,” Katlic acknowledged. Late-career programs have “in some cases been very controversial, and they’ve been blocked by influential physicians,” he said.

As health systems wait to see what happens in federal court, most national medical organizations have recommended only voluntary screening and peer reporting.

“Neither works very well at all,” Gallagher said. “Physicians are hesitant to share their concerns about their colleagues,” which can involve “challenging power dynamics.”

As for voluntary evaluation, since cognitive decline can affect doctors’ (or anyone’s) self-awareness, “they’re the last to know that they’re not themselves,” he added.

In a recent commentary in The New England Journal of Medicine, Gallagher and his co-authors recommended procedural policies to promote fairness in late-career screening, based on an analysis of such programs and interviews with their leaders.

“How can we design these programs in a way that’s fair and that therefore physicians are more apt to participate in?” he said. The authors emphasized the need for confidentiality and safeguards, such as an appeals process.

“There are all sorts of accommodations” for doctors whose assessments indicate the need for different roles, Gallagher noted. They could adopt less onerous schedules or handle routine procedures while leaving complex six-hour surgeries to their colleagues. They might transition to teaching, mentoring, and consulting.

Yet a substantial number of older doctors head for the exits and retire rather than face a mandated evaluation, he said.

The future, therefore, might involve programs that regularly screen every practitioner. That would be inefficient (few doctors in their 40s will flunk a cognitive test) and, with current tests, time-consuming and consequently expensive. But it would avoid charges of age discrimination.

Faster reliable cognitive tests, reportedly in the research pipeline, may be one way to proceed. In the meantime, Orlando said, changing the culture of health care organizations requires encouraging peer reporting and commending “the people who have the courage to speak up.”

“If you see something, say something,” he continued, referring to health care professionals who witness doctors (of any age) faltering. “We are overly protective of our own. We need to step back and say, ‘No, we’re about protecting our patients.’”

The New Old Age is produced through a partnership with The New York Times.

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.

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NIH Grant Disruptions Slow Down Breast Cancer Research

Inside a cancer research laboratory on the campus of Harvard Medical School, two dozen small jars with pink plastic lids sat on a metal counter. Inside these humble-looking jars is the core of Joan Brugge’s current multiyear research project.

Brugge lifted up one of the jars and gazed at it with reverence. Each jar holds samples of breast tissue donated by patients after they underwent a tissue biopsy or breast surgery — samples that may reveal a new way to prevent breast cancer.

Brugge and her research team have analyzed the cell structure of more than 100 samples.

Using high-powered microscopes and complex computer algorithms, they diagram each stage in the development of breast cancer: from the first sign of cell mutation to the formation of tiny clusters, well before they are large enough to be considered tumors.

Their quest is to prevent breast cancer, a disease that afflicts roughly 1 in 8 U.S. women over their lifetimes, as well as some men. Their ultimate goal is to relieve the pain, suffering, and risk of death that accompany this disease. And their painstaking work, unspooling across six years of a seven-year, $7 million federal grant, has yielded results.

In late 2024, Brugge and her colleagues identified specific cells in breast tissue that contain the genetic seeds of breast tumors.

And they discovered that these “seed cells” are surprisingly common. In fact, they are present in the normal, healthy tissue of every breast sample her lab has examined, Brugge said, including samples from patients who haven’t had breast cancer but have had surgery for other reasons, such as breast reduction or a biopsy that proved benign.

The next research challenge for Brugge’s lab is clear: Find ways to detect, isolate, and terminate the mutant cells before they can spread and form tumors.

“I’m excited about what we’re doing right now,” Brugge said. “I think we could make a difference, so I don’t want to stop.”

Work in Brugge’s lab slowed significantly last year. In April, her $7 million grant from the National Cancer Institute at the National Institutes of Health was frozen, along with virtually all other federal money awarded to Harvard researchers.

The Trump administration said it was withholding the funds over the university’s handling of antisemitism on campus.

Some of Brugge’s lab staff lost federal fellowships that funded their work. Brugge told others funded through the NIH grant that she couldn’t guarantee their salaries. In all, Brugge lost seven of her 18 lab employees.

In September, the funding for the NIH grant was restored. But in the intervening months, the Trump administration said Brugge and other Harvard researchers needn’t bother applying for the next round of multiyear grants.

A federal judge lifted that ban, but Brugge had missed the deadline to apply for renewal. So her current funding will end in August.

Brugge scrambled to secure private funding from foundations and philanthropists. She was then able to reinstate two positions for at least a year — but job applicants are wary.

Across the United States, the future of federal funding for cancer research is uncertain.

President Donald Trump has proposed cutting the NIH budget by nearly 40% in the 2026 fiscal year.

In a budget message, the White House said the “NIH has broken the trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health.”

But Congress has other plans: The Senate and House Appropriations Committees released a compromise bill on Jan. 20 that would set the NIH’s budget at $48.7 billion, $415 million more than in the 2025 fiscal year.

In the meantime, advocates such as Mark Fleury with the American Cancer Society are reminding lawmakers that the cancer death rate has declined — by 34% since the early 1990s — due in part to federally funded research advances.

“But we still have an incredible ways to go before we can say that we’ve changed the trajectory of cancer,” Fleury said. “There are still cancer types that are fairly lethal, and there are still populations of people for whom their experience of cancer is vastly different from other groups.”

Reductions in research funding will have a direct impact on treatment options for patients, Fleury said. For example, a 10% cut to the NIH budget would eventually result in two fewer new drugs or treatments per year, according to a projection from the nonpartisan Congressional Budget Office.

A recent study looked at drugs that were developed through NIH-funded research and approved by the Food and Drug Administration since 2000. More than half those drugs would probably not have been developed if the NIH had been operating with a 40% smaller budget.

“We can’t say, ‘But for that grant, that [specific] drug would not have come into existence,’” said Pierre Azoulay, a co-author of the study and a professor at the Massachusetts Institute of Technology. But fewer drugs would have made it to market, he said. “It makes us at least want to pause and say, ‘What are we doing here? Are we shooting ourselves in the foot?’”

Amid all the uncertainty, Brugge has trouble focusing on her goal of finding new ways to prevent breast cancer.

Nowadays, she spends about half her time searching for new sources of funding, managing her remaining employees’ anxieties, and monitoring the most recent news about Harvard, the Trump administration, and the NIH and other federal agencies that have experienced grant freezes, staff layoffs, and other disruptions.

She’d rather return her attention to her ongoing investigations, which she’s confident could eventually save lives.

The breakdown of Brugge’s lab highlights another problem: The U.S. is kneecapping the next generation of cancer researchers. Her employees included staff scientists, postdocs, and graduate students. Of the seven who left the lab in 2025, one left the U.S., one took a job at a health care management company, four went back to school, and one is still looking for work.

One of Brugge’s former staffers, Y., is a computational biologist. She helped design and run a tool that analyzes millions of breast tissue cells from the samples in the pink-lidded jars.

Y. moved to Switzerland in October to begin a PhD program. KFF Health News and NPR are identifying her by her middle initial because she plans to return to the U.S. for scientific conferences and worries that speaking publicly about her experience could risk future visa approvals.

“I thought the U.S. would be a safe place for scientists to learn and grow,” said Y., who moved to Boston from abroad for Harvard’s master’s degree program in bioinformatics. “I really hope that those who have the opportunities to study this further can fill in those missing pieces in cancer research.”

Brugge is no longer accepting job applicants from outside the U.S., even if they are top candidates, because she can’t afford to pay the Trump administration’s new $100,000 fee on visas for some foreign researchers.

The Association of American Universities and the U.S. Chamber of Commerce have filed a legal challenge, claiming the fee is misguided and illegal. The Trump administration said the fee would discourage reliance on foreign workers and improve opportunities for Americans.

Brugge doubts work in her lab will ever return to normal.

“There’ll always be, now, this existential threat to the research,” Brugge said. “I will definitely be concerned because we don’t know what’s going to happen in the future that might trigger a similar kind of action.”

Brugge has thought about shutting down her lab. But she still employs staff members whose future scientific careers are tied to finishing some of the research. And when she looks at those pink-lidded jars, she still sees so much promise.

This article is from a partnership that includes WBUR, NPR, and KFF Health News.

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.

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Your Next Primary Care Doctor Could Be Online Only, Accessed Through an AI Tool

When her doctor died suddenly in August, Tammy MacDonald found herself among the roughly 17% of adults in America without a primary care physician. 

MacDonald wanted to find a new doctor right away. She needed refills for her blood pressure medications and wanted to book a follow-up appointment after a breast cancer scare. 

She called 10 primary care practices near her home in Westwood, Massachusetts. None of the doctors, nurse practitioners, or physician assistants was taking new patients. A few offices told her that a doctor could see her in a year and a half or two years.

“I was just shocked by that, because we live in Boston and we’re supposed to have this great medical care,” said MacDonald, who is in her late 40s and has private health insurance. “I couldn’t get my mind around the fact that we didn’t have any doctors.”

The shortage of primary care providers is a national problem, but it’s particularly acute in Massachusetts. The state’s primary care workforce is shrinking faster than in most states, according to a January 2025 report.

Some health networks, including the state’s largest hospital chain, Mass General Brigham, are turning to artificial intelligence for solutions.

In September, right when MacDonald was running out of blood pressure medications, MGB launched a new AI-supported program, Care Connect. MacDonald had received a letter from MGB, telling her no primary care providers in the network were taking new patients for in-person care. At the bottom of the letter was a link to Care Connect.

MacDonald downloaded the app and requested a telehealth appointment with a doctor. She then spent about 10 minutes chatting with an AI agent about why she wanted to see a physician. Afterward, the AI tool sent a summary of the chat to a primary care doctor who could see MacDonald by video.

“I think I got an appointment the next day or two days later,” she said. “It was just such a difference from being told I had to wait two years.”

Round-the-Clock Convenience

MGB says the AI tool can handle patients seeking care for colds, nausea, rashes, sprains, and other common urgent care requests, as well as mild to moderate mental health concerns and issues related to chronic diseases. After the patient types in a description of the symptoms or problem, the AI tool sends a doctor a suggested diagnosis and treatment plan.

Care Connect employs 12 physicians to work with the AI. They log in remotely from around the U.S., and patients can get help round-the-clock, seven days a week.

Care Connect is one of many AI-based tools that hospitals, doctors, and administrative staff are testing for a range of routine medical tasks, including note-taking, reviewing diagnostic results, billing, and ordering supplies.

Proponents argue that these AI programs can help relieve staff burnout and worker shortages by reducing time spent on medical records, referrals, and other administrative tasks. But there’s debate about when and how to use AI to improve diagnoses. Critics worry that AI agents miss important details about overlapping medical conditions.

Critics also point out that AI tools can’t assess whether patients can afford follow-up care or get to that appointment. They have no insight into family dynamics or caretaking needs, things that primary physicians come to understand through long-term personal relationships.

Since her first foray on the app in September, MacDonald has used Care Connect at least three more times. Two of those interactions led to an eventual conversation with a remote doctor, but when she went online to book an appointment for travel-related shots, she interacted only with the AI chatbot before visiting the travel clinic.

MacDonald likes the convenience.

“I don’t have to leave work,” she said. “And I gained some peace of mind, knowing that I have a plan between now and me finding another in-person doctor.”

So while she hunted for that person, MacDonald planned to stay with Care Connect.

“This is a logical solution in the short term,” MacDonald said. “At the end of the day, it’s the patient who’s feeling the aftermath of all of the bigger things going on in health care.”

Scarcity and Burnout

Many factors contribute to the shortage of providers. Many primary care doctors, such as pediatricians, internists, and family medicine physicians, are dissatisfied with their pay. They earn about 30% to 50% less, on average, than specialists such as surgeons, cardiologists, and anesthesiologists. 

At the same time, their workload has been increasing. Primary care doctors often describe days packed with complex patient visits, followed by evenings spent updating medical records and responding to patient messages.

When MacDonald signed onto Care Connect, she was one of 15,000 patients in the Mass General Brigham system without a primary care provider. That number has grown as primary care doctors have left MGB for rival hospital networks.

Madhuri Rao, a primary care physician at an MGB health center in Chelsea, Massachusetts, said she’s staying at MGB for now, but she’s grown frustrated with the system’s leaders.

“They don’t make any effort to ease the shortage,” said Rao, who is also part of an effort to unionize MBG’s primary care doctors. “They put their money into specialties. Primary care feels like a peripheral part of the system, when it really should be a central part.”

Last year, MGB pledged to spend $400 million over five years on primary care services — though that includes the multiyear contract with Care Connect.

“Care Connect is just one solution among many in this broader strategy to alleviate the primary care capacity crisis,” Ron Walls, MGB’s chief operating officer, said in an emailed statement. “Our investment supports retaining our current physicians as well as recruiting new ones.”

Walls said MGB has increased staffing support for primary care physicians, implemented other AI tools, and hired a new executive for primary care. Some of these changes are based on recommendations from their own primary care doctors.

But some of those doctors say they would like other changes, and salary increases in particular.

Walls would not disclose the exact amount MGB is spending on Care Connect.

Bridge to Better Care or a ‘Band-Aid’?

MGB has rolled out other AI tools, including one that can transcribe a doctor’s in-person conversations with patients. Rao isn’t using that tool. She worries that patient information could be leaked and medical privacy violated, and she doesn’t want her conversations with patients to be used to help develop the next generation of AI medical tools.

“What if they’re just using my interactions with patients to train their AI and boot me out of my job?” she said.

That’s not the goal, said Helen Ireland, a primary care physician who manages the program for MGB. All decisions about patient care are still made by real doctors, she said.

“We are not replacing our in-person primary care,” she said. “It’s still important, and the majority of patients still have in-person primary care.”

But the fear among some primary care doctors at MGB is that Care Connect will gradually erode access to in-person primary care visits. Of the $400 million pledged by MGB for primary care, they want less spent on AI and more used to attract and increase pay for primary care staffers.

Michael Barnett, an MGB internist who is also involved in the unionizing effort, said the use of Care Connect can only fill a gap. “That sounds like a band-aid for a broken system to me,” he said.

Expanding AI Tools

As of mid-December, the Care Connect doctors were each seeing 40 to 50 patients a day. By February, the MGB network plans to make Care Connect available to all Massachusetts and New Hampshire residents who have health insurance, and to hire more doctors to staff the program as needed. 

Patients can use the program like an urgent care service, Ireland said. They can also decide to make one of the remote doctors their permanent primary care provider.

“Some patients want in-person care,” Ireland said. “But I do believe there’s a subset of patients who will appreciate the 24-hour, seven-day-a-week model and choose to be a part of this.”

Care Connect isn’t for patients who need emergency care or a physical exam, she said. And patients who need tests or imaging are referred to the network’s clinics or labs.

But the remote doctors can manage some of the same routine issues that all primary care doctors do, Ireland said, including moderate respiratory infections, allergies, and chronic conditions such as diabetes, high cholesterol, and depression. 

Steven Lin says only immediate, not ongoing, health problems should be on that list. Lin is chief of primary care at the Stanford University School of Medicine and founded Stanford’s Healthcare AI Applied Research Team.

“In its current state, the safest use of this tool is for more urgent care issues,” Lin said. “Your upper respiratory tract infections. Your urinary tract infections. Your musculoskeletal injuries. Your rashes.”

For patients with multiple chronic conditions such as high blood pressure and diabetes — or for patients with especially serious conditions like heart disease or cancer — Lin said nothing beats a human who sees you regularly.

Still, Lin agrees that the chat summary generated after an AI encounter can help a physician be more efficient. For patients, Lin understands the practical appeal of a virtual option.

“I would rather these patients get care, if that care can be safe,” he said, “than not get care at all.”

The company that developed the AI platform for Care Connect, K Health, contends the program is delivering safe, effective care to patients with complex, chronic ailments — many of whom have no other option besides a hospital emergency room.

“America’s got a big problem with health care, issues with cost, quality, and access,” said Allon Bloch, the company’s CEO. “To solve it, you need to start with primary care, and you have to use technology and AI.”

In addition to Mass General Brigham, K Health partners with five other health networks, including the highly ranked Mayo Clinic and Los Angeles-based Cedars-Sinai.

In a small and limited study funded by K Health, Cedars-Sinai researchers compared several hundred diagnosis and treatment recommendations made by AI with those made by physicians.

The researchers found the AI to be slightly better at identifying “critical red flags” and recommending care based on clinical guidelines, though the physicians were better at adjusting their treatment recommendations as they spoke more with the patient.

This article is from a partnership that includes WBUR, NPR, and KFF Health News.

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.

USE OUR CONTENT

This story can be republished for free (details).



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