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As Lung Disease Threatens Workers, Lawmakers Seek Protections for Countertop Manufacturers

César Manuel González, 37, used to work with stone that was engineered to endure: dense, polished slabs designed to outlast the kitchens in which they were installed.

Engineered quartz countertops have surged in popularity in the home renovation market, with industry analysts estimating the global engineered stone market at around $30 billion. It’s continuing to expand as quartz surfaces replace natural stone in kitchens in the United States and worldwide.

When González was working, the dust that rose from his saw didn’t look extraordinary. It settled on his clothes, in his hair, across the shop floor. In a small countertop fabrication shop, he cut marble and granite before shifting to engineered stone after the 2008-09 recession, when demand for cheaper quartz countertops surged.

But the crystalline silica released while the engineered stone was cut and polished also settled into his lungs, scarring them beyond repair. What began as breathlessness hardened into silicosis, an irreversible disease that stiffens the lungs until even ordinary movement becomes effort.

A lung transplant was his path forward. The procedure can extend survival, but it redraws the boundaries of a life: anti-rejection drugs every day, constant monitoring, vulnerability to infection, the knowledge that breathing depends on the fragile acceptance of another person’s donated organ.

González, who was diagnosed with silicosis in 2023, is not alone in dealing with a disease that once was associated with miners at the end of long careers. It’s now prevalent among the much younger, often Hispanic men who work in this industry, physicians and public health officials say.

In the United States, cases are appearing in countertop fabrication shops from California to Texas, Florida, and the Northeast. Because silicosis is not a nationally reportable disease and surveillance varies by state, no comprehensive national count exists. But clinicians who treat occupational lung disease say the number of workers — often men in their 30s and 40s — diagnosed after cutting engineered stone has risen sharply over the past decade.

As of early March, California had identified 519 confirmed cases of engineered-stone-associated silicosis and 29 deaths since 2019. The median age at diagnosis is 46; at death, 49.

Doctors don’t debate whether working with engineered stone can scar lungs.

Manufacturers argue, though, that proper ventilation, wet cutting, and respirators can make fabrication safe. Workers, physicians, and plaintiffs’ attorneys counter that a material composed almost entirely of crystalline silica may be impossible to handle safely at scale.

“This is comparable to the tobacco industry saying cigarettes are safe,” said epidemiologist David Michaels, an assistant labor secretary under President Barack Obama who led the Occupational Safety and Health Administration.

More than 370 lawsuits have been filed by workers who say engineered stone manufacturers failed to warn employees about the risks or sold a product that cannot be fabricated safely. At the same time, members of Congress are considering legislation that would largely shield manufacturers from liability in those cases, turning a workplace health crisis into a national debate over regulation, responsibility, and the limits of civil litigation.

Gustavo Reyes, 36, is part of that debate. Like González, he spent the early years of his career cutting marble and granite before shifting to engineered stone, a quartz-based material that can contain up to 95% silica and generates far more hazardous dust when cut.

In the shop, he said, cutting was done with water to control the dust. But finishing work — sanding and shaping — generated heavy dust. He said he wore disposable respirator masks or a reusable elastomeric respirator with filters. A door was kept open. Fans ran overhead.

When he was diagnosed in 2021, he did not know what silicosis meant. The doctor told him that there was no medication and that he had three to five years to live. He received a lung transplant in 2023.

Asked who he believes is responsible, Reyes answered: “The industries who created the artificial stone, the product.” Manufacturers dispute that characterization. Major companies say engineered stone can be fabricated safely when employers follow OSHA dust controls, including wet cutting, ventilation, and respirator use.

An Old Disease, Reengineered

Silicosis is not new. It was synonymous with mining disasters and sandblasting, most notoriously in the Hawks Nest Tunnel tragedy, when hundreds of workers drilling through silica-rich rock in West Virginia in the early 1930s developed acute silicosis after months of unprotected exposure to dust. In 1938, Labor Secretary Frances Perkins advised that the disease could be prevented if dust controls were conscientiously applied.

What is new is the industry in which it has resurfaced.

Engineered stone, often marketed as “quartz,” is typically composed of crushed quartz bound with resins and pigments. Unlike marble, which contains little crystalline silica, engineered slabs contain very high levels of the substance.

Cutting changes the material.

“When you grind it, when you cut it, you’re pulverizing it,” said Robert Blink, an occupational and environmental medicine specialist who treats patients with advanced silicosis in Chicago and is a member of the Western Occupational and Environmental Medical Association. “You’re weaponizing the silica.”

Power tools fracture the surface into respirable particles small enough to lodge deep in the lungs. Repeated exposure triggers inflammation and fibrosis. Once scarring begins, it doesn’t reverse.

What Happens When You Look for It

In California, physicians say the pattern emerged gradually.

Robert Harrison, an occupational medicine physician at the University of California-San Francisco, helped identify the first cluster of engineered stone silicosis cases in California in 2019 after several workers from the same countertop fabrication shop died or were diagnosed with the disease. He described the crisis as “the largest outbreak of silicosis in decades.” What initially appeared as isolated cases of unexplained lung scarring in young men resolved into a recognizable occupational epidemic once work histories were examined.

Jane Fazio, a pulmonologist at UCLA, recalls seeing advanced fibrosis in otherwise healthy workers. “They have families. They were working full-time,” she said. Some experienced respiratory failure within a few years.

When doctors compared work histories, the pattern became unmistakable: Many of the men had worked in small shops cutting and polishing engineered stone countertops.

Sheiphali Gandhi, an occupational and environmental pulmonologist at UCSF, warned that the true burden remains uncertain. “We’re missing cases,” she said. “There’s no national surveillance system for this.”

California designated silicosis a reportable disease in 2025. Since 2019, statewide surveillance has identified hundreds of cases linked to engineered stone. The numbers probably underestimate the toll, though California’s dashboard makes the illness visible.

Outside California, there is no comparable tracking.

Early Warnings

California was not the first place this happened.

The earliest modern alarm came from Israel. Caesarstone, a company founded on a kibbutz in the late 1980s, helped popularize quartz countertops globally.

Israeli physicians began documenting aggressive silicosis in young countertop workers as early as 1997.

“We had never seen this before,” said Mordechai Kramer, a retired pulmonologist who previously worked at Rabin Medical Center in Israel. “In classic silicosis, you expect long exposure, decades. Here, it was much shorter.”

Several patients required lung transplantation.

Despite the warning signs, the market continued to expand.

Australia confronted the same pattern in the late 2010s.

Rather than wait for sporadic diagnoses, Australian regulators launched systematic CT-based screening of artificial-stone workers. Disease prevalence was far higher than anticipated.

Ryan Hoy, a respiratory physician and occupational health researcher at Australia’s Monash University, described severe disease in workers with relatively short exposures.

Authorities examined whether wet cutting, ventilation, and respirators could reduce exposure sufficiently. They ultimately concluded that even with controls, fabrication of high-silica engineered stone posed unacceptable risk.

In 2024, Australia prohibited the manufacture, supply, and installation of engineered stone containing high levels of crystalline silica. Manufacturers pivoted toward lower- and zero-silica formulations.

In the United States: Who’s To Blame?

Fabrication in the U.S. continues under OSHA’s silica standard, which relies on exposure limits, wet cutting, ventilation, and respiratory protection. Manufacturers argue that compliance works and that the problem lies with shops that fail to follow the rules.

OSHA first adopted silica limits in 1971 based on research from mining, quarrying, and foundry work. Although the agency updated the rule in 2016, it regulates crystalline silica broadly and does not distinguish between natural stone and high-silica engineered quartz.

The regulatory debate has now spilled into Congress. The Protection of Lawful Commerce in Stone Slab Products Act, introduced in September by Rep. Tom McClintock (R-Calif.), would largely shield manufacturers and distributors of engineered stone from civil lawsuits arising from the manufacture or sale of their products. McClintock’s office did not respond to a request for comment.

The bill was the subject of a January House Judiciary subcommittee hearing.

Supporters of the measure argue that manufacturers should not be held liable for injuries caused by employers who fail to follow OSHA standards. Opponents warn that removing litigation pressure would eliminate one of the few mechanisms capable of driving product reform if the material itself cannot be safely handled.

Michaels, the former OSHA official, sees the stakes as historical. “Litigation drives change,” he said, pointing to past battles over asbestos and tobacco.

Plaintiffs’ attorneys argue that compliance with the OSHA silica standard does not eliminate risk.

“It’s not a few bad actors,” said Raphael Metzger, a product liability attorney who has filed roughly 200 silicosis-related injury cases and a class action seeking medical monitoring. He said the issue is the product’s composition, not isolated regulatory noncompliance.

James Nevin, a tort attorney representing workers in silicosis cases, framed the congressional debate as a fight over accountability. “When it comes to causation, there’s no question,” he said, arguing that the wave of cases explains why manufacturers are now seeking what he calls “a manufacturer bailout.”

In mid-2025, Caesarstone US introduced its first products containing less than 1% silica. In response to questions, Irene Williams, a spokesperson for Caesarstone, said, “The company is not responding as these are matters of pending litigation.”

The U.S. engineered stone market is dominated by a handful of large brands — including Caesarstone, Spain-based Cosentino, and U.S.-based Cambria — while the volume of slabs imported from Asian manufacturers is growing.

Cosentino, too, is moving to low-silica products: “One third of the portfolio, including most new collections, contain less than 10% of crystalline silica,” said Kamela Kettles, a Cosentino spokesperson. “Cosentino will not be providing additional commentary at this time,” she said.

Commenting on behalf of Cambria, Mark Duffy, a communications consultant for the company, wrote, “Reckless employers are criminally violating the law, exposing workers to deadly working conditions.” He added that engineering and administrative controls, when properly used, are effective in reducing exposures below OSHA limits and said Cambria maintains exposures below the OSHA Action Level in its own facilities.

While Caesarstone and Cosentino are headquartered overseas, Cambria is based in Minnesota. Its chief executive, Marty Davis, has been a major Republican political donor, contributing millions of dollars to President Donald Trump’s election campaigns as well as to other Republican candidates and political action committees, according to federal campaign finance records. Davis has also contributed to the campaign of Rep. Brad Finstad (R-Minn.), a co-sponsor of the legislation. Finstad’s office did not respond to a request for comment.

Nevin, the attorney, said the bill would give manufacturers “free rein” from civil liability.

He also questions whether regulatory enforcement alone can address the problem. Even before the Trump administration’s funding and staffing cuts, “you had a better chance of being struck by lightning than being visited by OSHA,” he said, arguing that inspections are too infrequent to prevent disease in an industry composed largely of small shops.

Breathing on Borrowed Time

For González, the debate arrives after the fact. The dust he inhaled has already reshaped his life.

And Reyes’ transplanted lungs may last years, but not decades. The median survival time for transplanted lungs is about eight years, UCSF’s Gandhi said.

Reyes said he hopes people shopping for countertops understand that buying artificial stone “will harm the worker. The one who cuts it, the one who manufactures it.”

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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Primary Care Is in Trouble. So Doctors Band Together To Boost Their Market Power.

Western Massachusetts, a patchwork of rural communities and low-income cities, is a difficult place to find a primary care doctor if you don’t already have one. Frustrated patients often turn to online forums, asking for leads or advice on how to find a practice that is accepting new patients.

One name repeatedly crops up in these discussions: Valley Medical Group.

With four locations in the Connecticut River Valley, the practice has been a mainstay of family medicine since the 1990s. Valley Medical’s flagship office in Florence can be found right on Main Street, next door to a pizza restaurant and near a Friendly’s.

Valley has 90 medical providers — including doctors, nurse practitioners, and physician assistants — and on-site labs, X-rays, and vision care. With tens of thousands of patients, it’s become one of the largest independent practices in western Massachusetts.

It forms a key part of the region’s health care infrastructure, yet Valley Medical has rarely been under more strain than it is now. In January, the practice laid off 40 employees — 10% of its 400-person staff — mostly in support positions.

Despite patient demand — there are waiting lists to be seen — primary care providers take on more clinical responsibilities, and for less pay, than most medical specialists, said the group’s CEO, primary care physician Paul Carlan. Rates are outlined in the group’s contracts with insurance providers.

“It has to do with the fact that our contracts don’t pay as well as we think they should,” Carlan said. “The cost of everything is going up.”

Valley Medical Group is far from alone in this predicament. Thousands of primary care practices, a key gateway to the medical system, are fighting to remain financially viable — and independent.

In response, many are banding together to form Independent Physician Associations, or IPAs. The goal is to increase their market power, change the way they get paid, and retain control over how they treat patients.

Threats to Physician Autonomy

Primary care practices in the U.S. are in serious trouble, according to workforce surveys. The American Association of Medical Colleges estimates a deficit of up to 86,000 primary care doctors by 2036, as more primary care doctors retire and fewer enter the field.

The number of people who can’t find a primary care doctor has grown by 20% in the past decade, according to a recent JAMA Internal Medicine report.

Lower relative salaries and higher professional stress are disincentives when medical students consider a career in primary care. Newly minted doctors can earn more in specialties such as cardiology or surgery.

Financial stresses in U.S. health care, exacerbated by the covid pandemic, have led to the closure of many primary care practices, according to the AAMC.

The Massachusetts Health Policy Commission released a report in 2025 partly blaming the crisis on the relatively low insurance reimbursement rates for primary care. The revenue problem for primary care is projected to get worse when the Republican-backed cuts to Medicaid start to take effect later this year.

As they seek financial security, many primary care practices have merged with large hospital systems, with doctors becoming employees of those systems.

But the doctors at Valley Medical Group were determined to avoid that fate. Joining a health system takes away the autonomy doctors need to make the best clinical decisions for their patients, Carlan said. It also siphons off income into the larger hospital system.

“Our priorities get muddled up,” he said. “And I think when you’re part of a health system, you’re constantly being asked to bend for the needs of the organization. Hospitals get paid when their beds are full.”

By contrast, primary care providers need time and money to manage or prevent illness, Carlan said, and their insurance reimbursement rates should take that into account.

In December, Valley Medical Group announced it would be joining an Independent Physician Association. Like a union, an IPA combines individual primary care offices, giving them power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies.

“It’s a moment of transition,” said Lisa Bielamowicz, chief clinical officer of TrustWorks Collective, an independent health care consultancy that works with health systems and physician groups.

IPAs are gaining momentum as older doctors retire, especially following the challenging years of the covid pandemic, Bielamowicz said. “As the baby boomers move out and younger physicians take leadership roles, these kinds of models become more attractive.”

The American Academy of Family Physicians, a trade group, is hearing from practice owners who joined hospital systems but now want to break off and return to being a smaller practice.

“So if independent IPAs can create the infrastructure support to make independent practice viable, then that’s a good thing,” said Karen Johnson, a vice president at AAFP.

IPAs can bring more clout to the table when negotiating rates with insurance companies. Some insurers say they like working with these partnerships because they help stabilize primary care practices, maintaining access and options for insured patients.

Otherwise, some doctors shift their business model to “direct primary care,” which bypasses insurance altogether.

“We’re looking at independent practices that aren’t buoyed by …. these large health systems and can support members in the community in the ways that they want to be supported,” said Lisa Glenn, a vice president with Blue Cross Blue Shield of Massachusetts.

A Different Payment Model

When those independent practices band together, Glenn said, Blue Cross can offer “value-based” contracts. Instead of getting a payment for each visit or procedure, the medical practice is given a budgeted amount for each patient’s care, which provides an incentive to keep them healthy so they need fewer treatments.

Medical providers “make different kinds of choices than they would if they’re paid for every procedure, every visit, every widget,” TrustWorks’ Bielamowicz said.

If there is money left at the end of the year, it’s split between the practice and the insurer.

The catch, Glenn said, is that a value-based contract works only if there’s a big enough pool of patients to spread out the risk, in case a few get really sick. Otherwise, she said, “the risk of ending up above or below the budget becomes somewhat subject to random variation rather than performance.”

Value-based contracts were supposed to be the next big thing when the Affordable Care Act passed in 2010, an innovative way to bring costs down for the health system as a whole.

But they were slow to catch on; the traditional fee-for-service payment model was too entrenched. Experts say that could still change, if enough primary care providers work together to build market power through IPAs.

“If we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system,” said Chris Kryder, CEO of Arches Medical IPA in Cambridge, Massachusetts, the IPA specializing in value-based contracts that Valley Medical joined. “And we create more income for the PCPs [primary care providers], which is dreadfully needed.”

These contracts also allow more flexibility in staffing, Kryder said, because nurses, physical therapists, and medical assistants can take on some of the less complex medical tasks, saving the practice money.

IPAs Can Help, Depending on Who’s in Charge

But IPAs are not a panacea for primary care’s problems, according to some health care leaders.

There are hundreds of IPAs, but not all offer the independence and autonomy that many doctors crave. Some IPAs are actually owned by hospital systems, or even private equity companies, and they’re less focused on preventive care.

The American Academy of Family Physicians advises its members to seek out IPAs with “integrity,” ones that give doctors a strong role in decision-making.

“Who’s calling the shots, who’s making the decisions, and is it really focused on the best interests and long-term benefit of physicians in practice and their patients?” asked AAFP’s Johnson.

Arches Medical is owned entirely by physicians and focused specifically on primary care, Kryder said. But to be more effective, Arches needs to recruit more practices that want value-based contracts.

That can be a hard sell, said Glenn, of Blue Cross. Under that payment model, doctors might see a lag of more than a year from the time they provide care to the moment they realize savings.

“It doesn’t happen overnight, and it does take an investment,” she said.

That lag is one reason Valley Medical Group had to lay off staff after joining the Arches IPA, said CEO Carlan. But he has faith that, after some time, the practice will become more financially stable, be able to offer higher salaries, and, most important, keep the doctors in charge.

This article is from a partnership with New England Public Media and NPR.

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Banks Are Becoming Bulwarks Against Scams for Vulnerable Seniors

The first call came just before Thanksgiving last year. She didn’t recognize the phone number, but she answered anyway.

“The person said he was an officer of the Department of Criminal Investigations looking into drug trafficking and money laundering,” the woman recalled. He seemed to know a lot about her: the states where she and her late husband had lived; his name and occupation; and her current address in Washington County, Rhode Island.

On her phone, he showed her a convincing badge and a photo ID with his name (“‘Frank’ something”), plus an article describing the supposed investigation. The woman, a 76-year-old retiree, denied any involvement.

“You can hire a very expensive criminal defense attorney, or you can cooperate with me,” Frank told her.

“Now, when you think about it, it doesn’t make any sense,” the woman acknowledged recently. But persuaded by the badge and ID, she agreed to cooperate. Otherwise, “I thought they were going to come and arrest me.”

Frank called each morning to learn where she was going, what she was doing. His team would be watching, he warned. The woman, feeling “petrified,” started looking around as she drove to garden club meetings. Was somebody following her?

It was all a scam.

Because victims’ sense of shame often leaves them reluctant to report such crimes, the extent of elder financial exploitation is hard to calculate. The Federal Trade Commission reported losses of $2.4 billion in 2024, largely driven by investment and romance scams and impersonations, with total losses much higher.

Americans age 60 and older lose more than $28 billion annually to financial exploitation, AARP estimated in 2023.

As those numbers rise, because the population is aging and predators are growing increasingly resourceful, banks and investment firms are becoming the first line of defense.

Frank’s initial target: her account at Fidelity Investments. He instructed her to shift about $250,000 into her checking account, telling the financial adviser at her local office that she and her family intended to buy real estate.

That scheme fizzled when the adviser said Fidelity could not approve the transaction without more information on the property.

So Frank sent her to her local branch of Washington Trust Company to take $70,000 in cash from a home-equity line of credit. “We don’t give out that much in cash,” the teller said, quietly messaging the branch manager, who had known the woman and her husband for years.

The manager ushered the woman into her office to talk, and the scam stopped there, with a call to the local police. The woman’s assets remained intact, but the experience proved so mortifying that she has not told even her family how close she came to losing much of her life savings. The New York Times is withholding her name to spare her embarrassment.

“I felt so stupid,” she said. “I felt like a fool.”

Financial predators targeting older adults represent “a heightened focus for us now,” said Mary Noons, president and chief operating officer of Washington Trust.

A regional community bank, Washington Trust cranked up its efforts last fall to advise older customers and their families about finances, including the dangers of elder fraud and exploitation. It published and distributed a booklet called “Age With Wisdom” and brought in an expert on dementia to speak with staff members.

And it became one of the 1,500 financial institutions to date to use BankSafe, a free AARP video program that trains front-line employees to spot the red flags indicating possible elder exploitation and to intervene. Everyone at the branch where the 76-year-old banked had taken the training.

“Some older customers visit their bank far more frequently than they see their health care providers,” Noons pointed out.

Until recent years, financial institutions placed “more of an emphasis on the autonomy of the client,” said Pamela Teaster, director of the Virginia Tech Center for Gerontology and an elder abuse researcher. Their approach was, “an adult has the capacity to make poor choices, and we’re going to let them make them,” she added.

But changes in government and industry policies and practices have encouraged greater vigilance. Congress passed the Senior Safe Act in 2018, protecting banks and financial firms from liability if they reported suspected exploitation to authorities.

That year, the Financial Industry Regulatory Authority began requiring member firms to ask for a trusted contact person when investors open or update accounts. (The account holder isn’t obliged to provide one, however.) And since 2022, it has allowed firms to place holds on older investors’ transactions if they suspect exploitation is involved.

About half of states have enacted laws that permit financial institutions to deny suspicious transactions or impose holds for specified periods to allow investigations, said Jilenne Gunther, the director of BankSafe.

“It adds friction,” she explained. “With space and time, the criminal gets worried and might move on. And the potential mark has time to stop and think.”

Teaster’s analysis of data from BankSafe, during a six-month pilot in 82 financial institutions, found that participants were much more likely to report suspected cases and save customers money than a control group was.

Not all of older adults’ losses result from predators, however. They can, on their own, get caught up in investment fads, take on too much debt, or make otherwise unwise decisions, even without criminals pulling the strings or relatives looting their accounts.

Managing finances presents complex cognitive challenges, said Mark Lachs, co-chief of geriatrics and palliative medicine at Weill Cornell Medicine. “It requires a lot of brain,” he said, including: “Memory, remembering that a bill is due. Executive function, the ability to manage your time. Abstraction, hypothesizing about your future.”

He added, “Financial errors are not infrequently the first sign of impending dementia or a neurocognitive disorder.”

A 2024 study by the Federal Reserve Bank of New York, for instance, found an increased probability of delinquent payments and deteriorating credit ratings in the five years before a dementia diagnosis. Those errors can reduce seniors’ access to credit and raise their interest rates on loans at the very point when caregiving expenses are likely to soar.

Lachs has called on fellow doctors to recognize what he calls Age-Associated Financial Vulnerability, a syndrome that can affect even older people with normal cognition, especially if they contend with medical illnesses, sensory deficits, or social isolation.

And he remains skeptical about the financial industry’s claims of heightened attention to its oldest customers. “I still see concerning financial transactions executed that should have received far greater scrutiny,” he said.

Training more front-line staff members and increasing emphasis on establishing trusted contacts for older customers would help, Gunther said, because “once the money leaves the account, it’s near impossible to ever retrieve it.” More states could enact laws allowing financial institutions to deny suspicious transactions or impose holds.

Several related bills with bipartisan support are working their way through Congress. The National Strategy for Combating Scams Act would require the FBI to coordinate efforts to protect seniors. A bill that restores an IRS deduction would at least provide the consolation of excusing scam victims from paying taxes on money they no longer have.

However, new weapons like artificial-intelligence voice cloning — in which the supposed grandson four states away who urgently needs $5,000 in gift cards actually sounds like the victim’s grandson — keep advocates and bankers awake at night.

In the Washington Trust branch where the Rhode Island woman didn’t lose her money, employees just days earlier had stopped a scam similar to the one that had targeted her.

But more recently, nobody spotted any danger signs when an older woman withdrew $9,000 for a kitchen renovation, until it went to a scammer instead of a contractor.

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

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Florida no amplió Medicaid, pero igual algunos legisladores quieren imponer requisitos de trabajo

En los estados que desde hace años se han negado a ampliar Medicaid para cubrir a un número mayor de adultos de bajos ingresos, quienes ya están en el programa no están sujetos a las nuevas reglas de la Ley One Big Beautiful Bill, que les exigirían demostrar que están trabajando para poder obtener y mantener la cobertura.

Pero eso no ha detenido a legisladores de Florida que, de todos modos, están tratando de imponer requisitos de trabajo para acceder a Medicaid. Hasta ahora, es la única Legislatura de un estado que no ha ampliado el programa que está considerando una medida de esa naturaleza.

“Tienes que ir a trabajar si quieres que tus amigos y vecinos paguen tu atención médica”, sentenció el senador estatal republicano Don Gaetz, impulsor de la propuesta de imponer requisitos laborales para Medicaid que se debate en la Legislatura estatal.

La medida desconcierta a defensores de la atención médica y a expertos en Medicaid. Algunos dudan, incluso, que sea legal bajo la principal ley de política interna del presidente Donald Trump.

“No se pueden cambiar los términos del requisito de trabajo”, afirmó Leo Cuello, abogado y profesor de la Escuela McCourt de Políticas Públicas de la Universidad de Georgetown, citando las directrices emitidas por los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés).

Para Cuello, la situación es clara: “Es un no rotundo”.

Los requisitos de trabajo de Medicaid afectan a Washington, D.C., y a los 40 estados que ampliaron la elegibilidad a todos los adultos sin discapacidad entre 19 y 64 años con ingresos de hasta el 138% del nivel federal de pobreza, como establece la Ley de Cuidado de Salud a Bajo Precio (ACA). Eso equivale a un ingreso de $22.025 al año para una persona sola.

A partir de enero de 2027, esos estados deberán exigir a las personas beneficiadas por la ampliación que informen por lo menos 80 horas de trabajo mensuales, educación o servicio comunitario para calificar y mantener la cobertura de Medicaid.

Alrededor de 4 millones de personas están inscritas en el programa de Florida y Gaetz calcula que unas 147.000 son adultos que “podrían y deberían trabajar”.

“Son personas sanas, no tienen niños pequeños en casa y no están cuidando a una persona mayor o a alguien con discapacidad”, dijo. “Sin embargo, reciben beneficios de Medicaid”.

Quienes resultarían afectados por el proyecto de ley del Senado serían principalmente padres de niños de 14 años o más, así como algunos jóvenes de 19 y 20 años, explicó. Un proyecto similar en la Cámara de Representantes de Florida impondría los requisitos de trabajo de Medicaid a padres de niños de 6 años en adelante.

Para calificar para Medicaid en Florida, un adulto en edad laboral sin discapacidad generalmente debe estar cuidando a un niño o a un familiar mayor o con discapacidad, y no puede ganar más del 26% del nivel federal de pobreza, o unos $592 mensuales para una familia integrada por tres personas.

La mayoría de los adultos que no tienen discapacidad y reciben Medicaid ya trabajan, y muchas personas con empleos mal pagados no reciben seguro de salud a través de un empleador, según KFF, una organización sin fines de lucro de información sobre salud que incluye a KFF Health News.

En Florida, en 2024, entre los adultos solteros de 19 a 64 años que ganaron menos de $15.000 al año, cerca del 17% tenía seguro de salud a través del trabajo.

Los críticos dicen que la propuesta de Florida probablemente dejaría a algunas personas sin seguro, aunque cumplan con el requisito laboral. Esto se debe a que el límite de ingresos para acceder a Medicaid en ese estado es tan bajo que trabajar las 80 horas mensuales exigidas probablemente haría que esas personas superaran el tope permitido y perdieran el derecho a la cobertura.

Sin embargo, tampoco ganarían lo suficiente como para poder acceder a un plan subsidiado en el mercado de ACA.

Michelle Mastrototaro dijo que perdió su cobertura de Medicaid en noviembre del año pasado después de aceptar un trabajo de medio tiempo como asistente de maestra en una escuela primaria de Tampa. Mastrototaro, de 47 años, cuida a un hijo adolescente con discapacidad y probablemente no tendría que cumplir con el requisito de trabajo propuesto en Florida.

Pero dijo que su salario quincenal por trabajar unas 17 horas a la semana la hizo superar el límite de ingresos de Medicaid. Desde entonces ha tenido dificultades para pagar sus medicamentos recetados.

“Lo que estoy ganando es casi nada”, contó Mastrototaro. “Estoy rebuscándomelas como puedo para apenas llegar a fin de mes”.

La propuesta liderada por Gaetz ignora “las duras realidades de lo que implica calificar para Medicaid en Florida”, dijo Scott Darius, director ejecutivo de Florida Voices for Health, una organización sin fines de lucro que promueve la ampliación de Medicaid. “A simple vista no tiene sentido”, señaló.

Expertos en Medicaid dicen que la ley federal de reconciliación presupuestaria establece que los estados que no han ampliado Medicaid no pueden exigir requisitos de trabajo.

Un estado que no ha agregado más adultos de bajos ingresos a su programa de Medicaid no puede imponer requisitos laborales a quienes ya tienen cobertura, ratificó Cuello.

Los estados deben cubrir categorías específicas de personas de bajos ingresos —como niños, mujeres embarazadas, algunos padres, adultos mayores y personas con discapacidad— para recibir financiamiento federal para sus programas.

Los estados que han ampliado Medicaid a un grupo limitado de adultos de bajos ingresos, específicamente Georgia y Wisconsin, están obligados a imponer requisitos de trabajo a los nuevos beneficiarios.

El programa de ampliación parcial de Georgia, lanzado en julio de 2023, ya incluye un requisito para que los adultos que ahora son elegibles demuestren al menos 80 horas de trabajo o participación comunitaria. La aprobación federal para el programa expira a finales de diciembre y el estado ha solicitado una prórroga. El programa de Wisconsin deberá implementar los requisitos laborales antes del 1 de enero.

Carolina del Sur solicitó en junio la aprobación federal para ampliar la elegibilidad de Medicaid a padres y cuidadores sin discapacidad de entre 19 y 64 años que ganen entre el 67% y el 100% del nivel federal de pobreza. Eso equivale aproximadamente a entre $18.300 y $27.300 al año para una familia de tres miembros. La solicitud del estado está pendiente ante los CMS y, si se aprueba, implementaría requisitos de trabajo para los adultos que cumplan con las nuevas condiciones.

Gaetz dijo que, si la legislación de Florida se aprueba, el estado desarrollaría un “plan de negocios” para implementar los requisitos de trabajo y luego solicitaría la aprobación de los CMS.

No está claro cuánto costaría, pero la experiencia en estados que ya han aplicado requisitos laborales en Medicaid sugiere que la implementación demandaría un gasto elevado. Los estados deben actualizar sus sistemas de elegibilidad e inscripción, contratar personal adicional e informar al público sobre las nuevas exigencias.

Georgia, por ejemplo, gastó en cambios administrativos alrededor de $54,2 millones, de un total de $80,3 millones destinados al programa entre octubre de 2020 y marzo de 2025, según un informe de la Oficina de Rendición de Cuentas del Gobierno de EE.UU. (GAO, por sus siglas en inglés). La mayor parte del gasto administrativo —unos $47,4 millones, o 88%— provino del gobierno federal.

La experiencia de Georgia refleja la de otros estados, según un análisis de 2019 de la GAO sobre estados que recibieron la aprobación para implementar requisitos de trabajo de Medicaid durante la primera administración de Trump.

Ese informe se centró en cinco estados —Arkansas, Indiana, Kentucky, New Hampshire y Wisconsin— y estimó que los costos totales serían de $408 millones. Oscilaban entre $6 millones en New Hampshire y más de $270 millones en Kentucky, aunque esas cifras no incluían todos los costos estatales.

“La infraestructura informática de Florida para la recopilación y verificación de información, así como para determinar la elegibilidad, tiene más de 30 años de antigüedad y está siendo reemplazada. Se espera que el proceso se complete en 2028 y que cueste más de $180 millones.

Un análisis legislativo del proyecto de Gaetz estimó que, si 1 de cada 4 personas afectadas por el requisito de trabajo propuesto perdiera la cobertura de Medicaid, el estado podría ahorrar unos $80 millones al año.

Darius, de Florida Voices for Health, dijo que esos posibles ahorros difícilmente parezcan justificar el esfuerzo.

“Requiere que el estado construya este enorme marco regulatorio y reconstruya sistemas y contrate a numeroso personal para perseguir al pequeño número de personas que finalmente se verían afectadas por esto”, explicó.

¿Tienes dificultades para pagar tu seguro médico? ¿Has decidido renunciar a la cobertura? Haz clic aquí para contactar a KFF Health News y compartir tu historia.

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Newsom Picks a Dogfight With Trump and RFK Jr. on Public Health

SACRAMENTO, Calif. — California Gov. Gavin Newsom has positioned himself as a national public health leader by staking out science-backed policies in contrast with the Trump administration.

After Health and Human Services Secretary Robert F. Kennedy Jr. fired Centers for Disease Control and Prevention Director Susan Monarez for refusing what her lawyers called “the dangerous politicization of science,” Newsom hired her to help modernize California’s public health system. He also gave a job to Debra Houry, the agency’s former chief science and medical officer, who had resigned in protest hours after Monarez’s firing.

Newsom also teamed up with fellow Democratic governors Tina Kotek of Oregon, Bob Ferguson of Washington, and Josh Green of Hawaii to form the West Coast Health Alliance, a regional public health agency, whose guidance the governors said would “uphold scientific integrity in public health as Trump destroys” the CDC’s credibility. Newsom argued establishing the independent alliance was vital as Kennedy leads the Trump administration’s rollback of national vaccine recommendations.

More recently, California became the first state to join a global outbreak response network coordinated by the World Health Organization, followed by Illinois and New York. Colorado and Wisconsin signaled they plan to join. They did so after President Donald Trump officially withdrew the United States from the agency on the grounds that it had “strayed from its core mission and has acted contrary to the U.S. interests in protecting the U.S. public on multiple occasions.” Newsom said joining the WHO-led consortium would enable California to respond faster to communicable disease outbreaks and other public health threats.

Although other Democratic governors and public health leaders have openly criticized the federal government, few have been as outspoken as Newsom, who is considering a run for president in 2028 and is in his second and final term as governor. Members of the scientific community have praised his effort to build a public health bulwark against the Trump administration’s slashing of funding and scaling back of vaccine recommendations.

What Newsom is doing “is a great idea,” said Paul Offit, an outspoken critic of Kennedy and a vaccine expert who formerly served on the Food and Drug Administration’s vaccine advisory committee but was removed under Trump in 2025.

“Public health has been turned on its head,” Offit said. “We have an anti-vaccine activist and science denialist as the head of U.S. Health and Human Services. It’s dangerous.”

The White House did not respond to questions about Newsom’s stance and HHS declined requests to interview Kennedy. Instead, federal health officials criticized Democrats broadly, arguing that blue states are participating in fraud and mismanagement of federal funds in public health programs.

HHS spokesperson Emily Hilliard said the administration is going after “Democrat-run states that pushed unscientific lockdowns, toddler mask mandates, and draconian vaccine passports during the covid era.” She said those moves have “completely eroded the American people’s trust in public health agencies.”

Public Health Guided by Science

Since Trump returned to office, Newsom has criticized the president and his administration for engineering policies that he sees as an affront to public health and safety, labeling federal leaders as “extremists” trying to “weaponize the CDC and spread misinformation.” He has excoriated federal officials for erroneously linking vaccines to autism, warning that the administration is endangering the lives of infants and young children in scaling back childhood vaccine recommendations. And he argued that the White House is unleashing “chaos” on America’s public health system in backing out of the WHO.

The governor declined an interview request. Newsom spokesperson Marissa Saldivar said it’s a priority of the governor “to protect public health and provide communities with guidance rooted in science and evidence, not politics and conspiracies.”

The Trump administration’s moves have triggered financial uncertainty that local officials said has reduced morale within public health departments and left states unprepared for disease outbreaks and prevention efforts. The White House last year proposed cutting HHS spending by $33 billion, including $3.6 billion from the CDC. Congress largely rejected those cuts last month, although funding for programs focusing on social drivers of health, such as access to food, housing, and education, were axed.

The Trump administration announced that it would claw back more than $600 million in public health funds from California, Colorado, Illinois, and Minnesota, arguing that the Democratic-led states were funding “woke” initiatives that didn’t reflect White House priorities. Within days, the states sued and a judge temporarily blocked the cut.

“They keep suddenly canceling grants and then it gets overturned in court,” said Kat DeBurgh, executive director of the Health Officers Association of California. “A lot of the damage is already done because counties already stopped doing the work.”

Federal funding has accounted for more than half of state and local health department budgets nationwide, with money going toward fighting HIV and other sexually transmitted infections, preventing chronic diseases, and boosting public health preparedness and communicable disease response, according to a 2025 analysis by KFF, a health information nonprofit that includes KFF Health News.

Federal funds account for $2.4 billion of California’s $5.3 billion public health budget, making it difficult for Newsom and state lawmakers to backfill potential cuts. That money helps fund state operations and is vital for local health departments.

Funding Cuts Hurt All

Los Angeles County public health director Barbara Ferrer said if the federal government is allowed to cut that $600 million, the county of nearly 10 million residents would lose an estimated $84 million over the next two years, in addition to other grants for prevention of HIV and other sexually transmitted infections. Ferrer said the county depends on nearly $1 billion in federal funding annually to track and prevent communicable diseases and combat chronic health conditions, including diabetes and high blood pressure. Already, the county has announced the closure of seven public health clinics that provided vaccinations and disease testing, largely because of funding losses tied to federal grant cuts.

“It’s an ill-informed strategy,” Ferrer said. “Public health doesn’t care whether your political affiliation is Republican or Democrat. It doesn’t care about your immigration status or sexual orientation. Public health has to be available for everyone.”

A single case of measles requires public health workers to track down 200 potential contacts, Ferrer said.

The U.S. eliminated measles in 2000 but is close to losing that status as a result of vaccine skepticism and misinformation spread by vaccine critics. The U.S. had 2,281 confirmed cases last year, the most since 1991, with 93% in people who were unvaccinated or whose vaccination status was unknown. This year, the highly contagious disease has been reported at schools, airports, and Disneyland.

Public health officials hope the West Coast Health Alliance can help counteract Trump by building trust through evidence-based public health guidance.

“What we’re seeing from the federal government is partisan politics at its worst and retaliation for policy differences, and it puts at extraordinary risk the health and well-being of the American people,” said Georges Benjamin, executive director of the American Public Health Association, a coalition of public health professionals.

Robust Vaccine Schedule

Erica Pan, California’s top public health officer and director of the state Department of Public Health, said the West Coast Health Alliance is defending science by recommending a more robust vaccine schedule than the federal government. California is part of a coalition suing the Trump administration over its decision to rescind recommendations for seven childhood vaccines, including for hepatitis A, hepatitis B, influenza, and covid-19.

Pan expressed deep concern about the state of public health, particularly the uptick in measles. “We’re sliding backwards,” Pan said of immunizations.

Sarah Kemble, Hawaii’s state epidemiologist, said Hawaii joined the alliance after hearing from pro-vaccine residents who wanted assurance that they would have access to vaccines.

“We were getting a lot of questions and anxiety from people who did understand science-based recommendations but were wondering, ‘Am I still going to be able to go get my shot?’” Kemble said.

Other states led mostly by Democrats have also formed alliances, with Pennsylvania, New York, New Jersey, Massachusetts, and several other East Coast states banding together to create the Northeast Public Health Collaborative.

HHS’ Hilliard said that even as Democratic governors establish vaccine advisory coalitions, the federal Advisory Committee on Immunization Practices “remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and gold standard science, not the failed politics of the pandemic.”

Influencing Red States

Newsom, for his part, has approved a recurring annual infusion of nearly $300 million to support the state Department of Public Health, as well as the 61 local public health agencies across California, and last year signed a bill authorizing the state to issue its own immunization guidance. It requires health insurers in California to provide patient coverage for vaccinations the state recommends even if the federal government doesn’t.

Jeffrey Singer, a doctor and senior fellow at the libertarian Cato Institute, said decentralization can be beneficial. That’s because local media campaigns that reflect different political ideologies and community priorities may have a better chance of influencing the public.

A KFF analysis found some red states are joining blue states in decoupling their vaccine recommendations from the federal government’s. Singer said some doctors in his home state of Arizona are looking to more liberal California for vaccine recommendations.

“Science is never settled, and there are a lot of areas of this country where there are differences of opinion,” Singer said. “This can help us challenge our assumptions and learn.”

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Viral Outbreaks Take a Common Path from Animals to People, Study Finds

Researchers have devised a new tool for discerning between naturally occurring viral outbreaks and those resulting from lab accidents.

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Journalists Explain a Spat Over Sugary Coffee and How Measles Fools Doctors

KFF Health News senior correspondent Renuka Rayasam discussed excited delirium on Vox Media Podcast Network’s Criminal on March 6.

Click here to hear Rayasam on Criminal.
Read Rayasam’s “As More States Target Disavowed ‘Excited Delirium’ Diagnosis, Police Groups Push Back.”

On CBS News’ CBS Mornings on March 5, Céline Gounder, KFF Health News’ editor-at-large for public health, discussed the Massachusetts governor’s retort to comments by Health and Human Services Secretary Robert F. Kennedy Jr. about popular coffee chains.

Click here to watch Gounder on CBS Mornings.

KFF Health News California correspondent Christine Mai-Duc discussed Affordable Care Act premium increases on CapRadio’s Insight With Vicki Gonzalez on March 2.

KFF Health News rural health reporter Andrew Jones discussed how younger doctors are struggling to diagnose measles on KMOX’s Total Information AM on Feb. 27.

KFF Health News South Dakota correspondent Arielle Zionts discussed the $50 billion Rural Health Transformation Program on Marketplace’s Make Me Smart podcast on Feb. 19.

Click here to hear Zionts on Make Me Smart.
Read Zionts’ “States Race To Launch Rural Health Transformation Plans,” co-reported with Sarah Jane Tribble and Maia Rosenfeld.

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From 2001: Beate Uhse, 81, Entrepreneur in the Business of Erotic Goods

She developed Europe’s biggest emporium of erotic goods and opened a three-story sex museum in Germany.

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This Doctor-Senator Who Backed RFK Jr. Now Faces a Fight for His Job — And His Legacy

BATON ROUGE, La. — The ambitious liver doctor would go just about anywhere in his home state to give people the hepatitis B vaccine.

Bill Cassidy offered jabs to thousands of inmates at Louisiana’s maximum-security prison in the early 2000s. A decade before that, he set up vaccine clinics in middle schools, a model hailed nationally as a success.

“He got that whole generation immunized in East Baton Rouge,” said Holley Galland, a retired doctor who worked with Cassidy vaccinating schoolchildren.

About the same time, a lawyer and environmental activist with a famous last name was starting to build the loyal anti-vaccine coalition that, two decades later, would move President Donald Trump to nominate him as the nation’s top health official.

Today, a year after now-Sen. Cassidy warily cast the vote that ensured Robert F. Kennedy Jr.’s ascension to that role, the Louisiana Republican’s life’s work — in medicine and in politics — is unraveling.

Newborn hepatitis B vaccination rates in the U.S. had plunged to 73% as of August, down 10 percentage points since a February 2023 high, according to research published in JAMA last month. In December, the Centers for Disease Control and Prevention’s Advisory Committee for Immunization Practices — remade by Kennedy — voted to revoke a two-decade-old recommendation that all newborns get the shot.

The next month, Trump endorsed U.S. Rep. Julia Letlow, a Cassidy challenger in what’s shaping up to be a competitive Republican Senate primary. Letlow’s foray into politics began in 2021 when she took the seat won by her husband, left vacant after he died from covid.

KFF Health News made multiple requests for comment from Cassidy over three months. His staff declined to make him available for an interview or provide comment. Letlow’s campaign did not respond to requests for comment.

Rise of the Skeptics

As the May primary nears, some Louisiana doctors are worried they’ve begun a long trek down a dark road when it comes to vaccine-preventable diseases.

Last year, on the day Kennedy was sworn in a thousand miles away in Washington, Louisiana’s health department stopped promoting vaccines, halting its clinics and advertising. Its communications about an ongoing whooping cough outbreak in the state have nearly ceased. It took months for the state to announce last year that two infants had died from the illness. A Louisiana child’s death from the flu was confirmed this January, and a couple of cases of measles were reported last year.

Spokespeople for the Louisiana Department of Health did not respond to questions.

“It’s so hard to see children get sick from illnesses that they should have never gotten in the first place,” said Mikki Bouquet, a pediatrician in Baton Rouge. “You want to just scream into the void of this community over how they failed this child.”

As anti-vaccine forces have taken hold of the state and federal health departments, Cassidy has lamented the consequences.

“Families are getting sick and people are dying from vaccine-preventable deaths, and that tragedy needs to stop,” he wrote on social media last fall.

But while it is Cassidy’s duty as chairman of the Senate’s Health, Education, Labor, and Pensions Committee to conduct oversight of the health department, Kennedy has appeared before the committee just once since he was confirmed.

The secretary speaks at a “regular clip” with Cassidy, said Department of Health and Human Services spokesperson Andrew Nixon.

Kennedy’s department has elevated Louisiana vaccine skeptics. The state surgeon general who terminated Louisiana’s vaccine campaign, Ralph Abraham, was named deputy director of the CDC. (He left the role in February.) And Kennedy handpicked Evelyn Griffin, a Baton Rouge OB-GYN who later replaced Abraham as the state surgeon general, for an appointment to ACIP. Griffin has suggested the covid vaccine had dangerous side effects for young patients.

Research has shown that serious side effects from the vaccinations are rare and that the shots saved millions of lives during the pandemic.

Cassidy “has really not had an outspoken chorus of policy supporters” when it comes to inoculating people, said Michael Henderson, a professor of political communication at Louisiana State University. “There’s not a lot of political stakes in doing that in Louisiana if you’re a Republican.”

Louisiana Gov. Jeff Landry reprimanded Cassidy after the senator called for the state’s health department to ease access to covid shots.

“Why don’t you just leave a prescription for the dangerous Covid shot at your district office and anyone can swing by and get one!” the Republican quipped on X in September.

On ‘Eggshells’ in the Exam Room

On a sunny February afternoon, as Carnival floats were readied to parade the streets of New Orleans, pediatrician Katie Brown approached a basement apartment on a well-child visit. Cowboy boot pendants dangled from her ears, and a pack of diapers were clutched tightly in her arms.

The patient, a toddler who waved at the sight of visitors, was up to date on her immunizations. But when Brown suggested a covid vaccine, the girl’s mother quickly declined, noting she had never gotten the shot either.

Many of Brown’s young patients — seen through Nest Health, which offers in-home visits covered by Louisiana’s Medicaid program — are current with their vaccines. Brown said home visits make parents more comfortable immunizing their children, but she’s still spending more time these days explaining what they’re getting in those shots.

“After covid vaccines, that’s when some people just decided, ‘I don’t know if I trust vaccines, period,’” she said.

Across the state, vaccination rates have declined since the pandemic, falling short of the levels scientists say are required to achieve herd immunity for some deadly diseases, including measles. About 92% of Louisiana’s kindergartners have had the recommended two doses of the measles, mumps, and rubella vaccine.

The New Orleans Health Department has tried to step up with a $100,000 immunization campaign of its own, with clinics and billboards, during this year’s flu season, said Jennifer Avegno, the department’s director.

But the state’s absence is felt. Other parishes across Louisiana have not taken similar action, leaving doctors largely on their own to promote immunizations.

“I’ll say that with certainty,” Avegno said. “It’s been a blow to not have a statewide coordination.”

A day after Brown’s home visit, a mother in Baton Rouge shook her head when Bouquet offered a flu shot for her 10-year-old daughter in an exam room.

In the waiting room, parents could thumb through a handmade book that offers scientific facts to counter fears about vaccines. A laminated guide placed in each exam room explained the benefits of each recommended immunization.

Bouquet said she’s experimenting with ways to educate parents about vaccines without seeming overbearing. She still hasn’t figured out a surefire formula. Some parents now shut down any vaccine talk, and she worries others skip scheduling appointments to avoid the topic entirely.

“We’re having to walk on eggshells a bit to determine how to get that trust back,” Bouquet said. “And maybe these discussions can come up in future visits.”

Pro-Vax, Pro-Anti-Vaxxer

Children’s Health Defense, the nonprofit that Kennedy helmed, worked to erode vaccine trust during the pandemic — falsely claiming, for instance, that covid shots cause organ damage and that polio vaccines were at fault for a rise in the disease. The organization also sued the federal government over the mRNA-based covid shots, hoping to get their emergency authorizations from the Food and Drug Administration revoked.

When Kennedy came before Cassidy’s committee in January 2025 as Trump’s nominee for health secretary, the senator-doctor saw risks if the prominent anti-vaccine lawyer was confirmed.

Cassidy described a time years ago when he loaded an 18-year-old onto a helicopter to get an emergency liver transplant. The young woman had acute hepatitis B, an incurable disease that is spread primarily through blood or bodily fluids and can lead to liver failure.

It was “the worst day of my medical career,” he said, addressing Kennedy at the witness table in front of him. “Because I thought, $50 of vaccines could have prevented this all.”

Cassidy started in politics in 2006 as a state senator, winning election to the U.S. House two years later. When he first ran for the U.S. Senate, in 2014, he charmed Louisiana voters with campaign ads showing him dressed in scrubs and a white lab coat, talking about his work with Hurricane Katrina evacuees and patients at Baton Rouge’s public hospital.

But some Republicans soured on Cassidy after he voted to convict Trump on an article of impeachment charging him with inciting the Jan. 6, 2021, insurrection at the U.S. Capitol.

The impeachment vote has hampered Cassidy’s reelection bid this year in a state where Trump captured 60% of the vote in 2024.

“Cassidy has things that are associated with his name: the impeachment vote in 2021,” Henderson said.

Cassidy’s loyalty to Trump was tested again with Kennedy’s nomination. Cassidy said he endorsed Kennedy after extracting pledges that he wouldn’t tinker with the nation’s vaccination program.

But since taking office, Kennedy has largely ignored those promises, and Cassidy hasn’t publicly rebuked him.

Former Texas congressman Michael Burgess served for years with Cassidy in the House, where they were founding members of the GOP Doctors Caucus, started in 2009. He said Cassidy’s discomfort with some of Kennedy’s actions is palpable.

“You could hear some of the pain in Sen. Cassidy’s voice when he was addressing that the secretary wanted to drop the birth dose of hepatitis B,” Burgess said. “You got cases to nearly zero on hepatitis B. It was painful to him to think about taking this away from the population.”

Retired Baton Rouge nurse practitioner Elizabeth Britton has switched her party affiliation so she can vote in the closed Republican primary for Cassidy, with whom she vaccinated inmates decades ago.

She doesn’t quite understand the “mess” in Washington that resulted in the senator voting to confirm a vaccine critic.

Watching Kennedy and others promulgate doubts about shots she once administered has made her “profoundly sad” and “angry,” she said, but most of all worried.

“It puts a pit in my stomach, because I know the consequences of people not getting the vaccine,” she said.

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Listen: What To Do When Health Insurance Slips Out of Reach

LISTEN: Can’t afford health insurance this year? Don’t be afraid to talk to your doctor about money and the cost of care. On WAMU’s “Health Hub” on March 4, KFF Health News correspondent Sam Whitehead shared tips for people seeking affordable options without skipping care.

Health insurance could be out of reach for many Americans in 2026.

About a million fewer people signed up for Affordable Care Act marketplace coverage this year. The Congressional Budget Office told lawmakers that more could opt out in coming years after the GOP-led Congress let expire subsidies that helped many afford a plan. Meanwhile, plan premiums jumped, and new, stricter Medicaid eligibility rules kicked in.

If you lost health insurance this year, there may be ways to see the doctor without breaking the bank. On March 4, in conversation with WAMU host Esther Ciammachilli, KFF Health News correspondent Sam Whitehead shared tips on navigating care without coverage.

Renuka Rayasam and Taylor Cook contributed reporting.

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$2.5 Million Rift Pits Cannabis Pioneer Against Group That Backed Her

A dispute between the nonprofit Housing Works and the owner of a cannabis dispensary shows the risks for businesses in an industry that is locked out of traditional financing and resources.

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In Sierra Leone, a New Maternal Hospital Aims to be the Blueprint

The country has one of the highest maternal mortality rates in the world. Isata Dumbuya, a nurse and midwife, has made it her mission to change that.

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Most Patients Keep Weight Off With Fewer GLP-1 Shots, Study Finds

In a recent review, a small group of patients received the injections less frequently but still maintained weight loss and health benefits.

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Lawmakers, Health Groups Resist Their States’ Rural Health Fund Plans

In the final days of 2025, governors around the country trumpeted the hundreds of millions of federal dollars they won from a new, $50 billion rural health fund.

But plans to spend those nine-digit awards aren’t all warmly received.

At least one group of Republican state lawmakers appears to have scuttled an initiative preapproved by federal officials. And at least one hospital association persuaded its state health leaders to alter who greenlights spending. Other critics are taking a more cautious approach.

That’s because the Centers for Medicare & Medicaid Services, which manages the five-year Rural Health Transformation Program, says states could lose money if they make major changes to the plans approved in their applications. Changes could also delay states’ ability to get projects rolling in time to show the agency that they’re meeting progress deadlines.

“During the application period, states were advised to only propose initiatives and state policy actions that the state deemed feasible,” said CMS spokesperson Catherine Howden, who noted that the agency will work with states case by case.

The recent pushback reflects “tension” over state plans — which were approved by the federal government — from state lawmakers and health leaders who want more input amid tight deadlines, said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association, the largest organization representing rural hospitals and clinics.

Cochran-McClain said many states must pass a bill to allow federal dollars to be spent and added that because the program rolled out so quickly “there’s important work that still needs to be done in some states between the legislatures and the governors.”

State lawmakers want to have a say, she said, in “how the funding is being allocated — how the implementation will go.”

Congressional Republicans created the program as a last-minute sweetener to include in their One Big Beautiful Bill Act, signed into law last summer. The funding was intended to offset concerns about the outsize fallout anticipated in rural communities from the law, which is expected to slash Medicaid spending by nearly $1 trillion over a decade.

CMS officials announced first-year funding — ranging from $147 million for New Jersey to $281 million for Texas — on Dec. 29, after scoring applications. Federal officials will begin evaluating progress in late summer and announce 2027 allocations at the end of October.

A chorus of critics say the program won’t make up for harm caused by Medicaid cuts.

The program is “a complete sham,” Sen. Ron Wyden (D-Ore.) said at a rural policy conference in February.

Medicaid, a joint federal-state program for low-income and disabled Americans, serves nearly 1 in 4 rural residents, and many rural hospitals depend on it to stay afloat.

But the rural health program tilts toward seeding innovative projects and technologies, not shoring up rural hospital finances. States can use only up to 15% of their funding to pay providers for patient care.

That hasn’t stopped some federal officials and lawmakers from framing the program as a rural hospital rescue.

For example, the White House website says, “President Trump secured $50 billion in funding for rural hospitals.”

Now that applications have been approved, some state Republican lawmakers — who are more likely to represent rural voters than Democrats are — and hospital associations are upset that the political rhetoric doesn’t match what they see.

They’re also lobbing criticisms at specific aspects of their states’ plans, including the proposed projects, what’s not included, and the spending approval process.

In Wyoming, lawmakers didn’t just criticize an initiative from their state’s application. They moved to kill it.

State Rep. John Bear, a Republican, said he and other lawmakers declined to fund “BearCare,” a proposed state-sponsored health insurance plan that patients could use only after medical emergencies. But they did approve other aspects of the rural health program.

The Wyoming Department of Health won’t “proceed with BearCare without express legislative authority to do so,” said spokesperson Lindsay Mills.

While Wyoming lawmakers removed an initiative from their state’s rural health plan, a group in Ohio wants to add something.

Ohio Rep. Kellie Deeter and other Republican lawmakers asked their governor to use the maximum allowed funding for provider payments — 15% — to support 13 independent, rural hospitals.

“We understand that the rural transformation fund is not designed to be given directly to prop up hospitals,” Deeter said. “We just want to capitalize on the mechanism of the fund that can be utilized for that purpose.”

Those hospitals “operate with very, very narrow margins, and it’s just difficult and, frankly, unsustainable,” she added.

Ken Gordon, a press secretary responding for the governor’s office and the state health department, said, “It’s still very early in this process, and many details are being worked out.”

State lawmakers around the country are also trying to ensure the federal program’s dollars benefit rural areas.

In North Dakota, Rep. Bill Tveit, a Republican who lives in a town with about 2,000 residents, introduced a bill that would have required the state to reserve its funding for programs located more than 35 miles from urban areas and small cities.

During a hearing, lawmakers appeared sympathetic to Tveit’s concerns but quickly shot down his idea.

State Sen. Brad Bekkedahl said the North Dakota health department already committed to prioritizing funding for the most pressing rural health needs. He also said he’s concerned any significant changes could cause the state to lose funding because CMS already reviewed and approved the plan.

Meanwhile, Republican lawmakers in Michigan and North Carolina have criticized their states’ definitions of “partially rural” or “rural,” saying that counties that include urban population centers could take money from lower-density counties, according to Michigan Advance and North Carolina Health News.

Lawmakers aren’t the only ones speaking out.

The Colorado Hospital Association wrote a letter to state lawmakers denouncing how the state created its plan and two of its proposed initiatives.

“Not only were Colorado’s rural hospitals’ recommendations disregarded,” president and CEO Jeff Tieman wrote, but the plan includes ideas “they actively oppose and believe will harm the communities they serve.”

The department responded to one of the association’s concerns by adding rural health leaders to the funding approval committee.

Meanwhile, in Michigan and Nebraska, some health groups are upset that their states’ plans lack specific funding streams for rural hospitals.

Lauren LaPine-Ray, who oversees rural health policy at the Michigan Health & Hospital Association, predicted the state’s rural hospitals will compete with other organizations, such as academic centers and health clinics, for funding. She said about 65% of the group’s rural members have never applied for a state grant before.

“The rural hospitals, the ones that really need the funding the most, will not be well equipped to apply for and pull down these dollars,” LaPine-Ray said.

Jed Hansen, executive director of the Nebraska Rural Health Association, said the federal funding won’t go to “rural hospitals, rural clinics, and rural providers in a meaningful way.”

“Rural Health Transformation will not save a single hospital in our state,” he said. “I don’t think it will save a hospital nationally.”

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A Danish Program Takes On the Stigma of Mental Illness

One of Us, run by Denmark’s health ministry, works with people with mental health conditions to share their stories in schools, hospitals and police stations, helping turn fear into understanding.

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As Kennedy Turns From Vaccines, MAHA Allies See a ‘Betrayal’

As the midterm elections approach, the health secretary is focusing on “real food.” Anger is rising among some of his supporters.

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States Move to Limit Access to H.I.V. Treatment

Citing shortfalls in federal support, about 20 states are toughening eligibility requirements for patients in drug assistance programs.

from NYT > Health https://ift.tt/hRmenXp

Medicaid Is Paying for More Dental Care. GOP Cuts Threaten To Reverse the Trend.

Star Quinn moved to Kingsport, Tennessee, in 2023, the same year the state began covering dental costs for about 600,000 low-income adults enrolled in Medicaid.

But when Quinn chipped a tooth and it became infected, she could not find a dentist near her home who would accept her government health coverage and was taking new patients.

She went to an emergency room, receiving painkillers and antibiotics, but she remained in agonizing pain weeks later and paid a dentist $200 to extract the tooth.

Years later, it still hurts to chew on that side, she said, but Quinn — a 34-year-old who has four children and, with her husband, earns about $30,000 a year — still can’t find a dentist nearby.

“You should be able to get dental care,” she said, “because at the end of the day dental care is health care.”

The federal government has long required states to offer dental coverage for children enrolled in Medicaid, the joint state-federal health program for people who are low-income or disabled. Paying for adults’ dental care, though, is optional for states.

In recent years, several states have opted to expand the coverage offered by their Medicaid programs, seeking to boost access in recognition of its importance to overall health. So far, increasing adult dental care is a work in progress: In a sampling of six of those states by KFF Health News, fewer than 1 in 4 adults on Medicaid see a dentist at least once a year.

But under congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last year, the federal government is expected to reduce Medicaid spending by more than $900 billion over the next decade. The expected 10-year losses for individual states range from about $184 million for Wyoming to about $150 billion for California.

State Medicaid programs typically expand or reduce benefits depending on their finances, and such massive federal cuts could force some to shrink or eliminate what they offer, including dental benefits.

“We will lose all the gains we have made,” said Shillpa Naavaal, a dental policy researcher at Virginia Commonwealth University in Richmond.

Tennessee’s Medicaid program, for instance, spent nearly $64 million on its dental coverage in 2024 and saw a 20% decrease in dental-related ER visits, said Amy Lawrence, the program’s spokesperson.

But under the new law, Tennessee is projected to lose about $7 billion in federal funding over the next decade.

As of last year, 38 states and the District of Columbia offered enhanced dental benefits for adult Medicaid beneficiaries, according to the American Dental Association. Most of the others offer limited or emergency-only care. Alabama is the only state that offers no dental coverage for adult beneficiaries.

Since 2021, 18 states have enhanced their coverage to include checkups, X-rays, fillings, crowns, and dentures, while loosening annual dollar caps for benefits.

Use of dental benefits in states with the enhanced benefits is greater than in states with only limited or emergency coverage, though still low overall, according to an ADA report with the latest data as of December. No more than a third of adult Medicaid recipients saw a dentist in 2022 in any state.

To review more recent progress, KFF Health News asked one-third of the states that have expanded their benefits in the past five years for their most recent data on the percentage of adults on Medicaid who visit a dentist at least once a year:

Maryland — 22% (in 2024)
Oklahoma — 16% (in 2025)
Maine — 13% (in 2025)
New Hampshire — 19% (in 2025)
Tennessee — 16% (in 2024)
Virginia — 21% (in 2025)

In comparison, about 50% to 60% of adults with private dental coverage see a dentist at least once a year, according to the ADA.

Nationwide, 41% of dentists reported participating in Medicaid in 2024, a share that has remained stable over the past decade despite the dental benefit expansions in many states, the ADA says. Many participating dentists, though, limit the number of Medicaid enrollees they treat, and some will not accept new patients on Medicaid.

Reimbursement rates have not kept up with costs, deterring dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president at the ADA Health Policy Institute.

Because of a lack of dentists who take Medicaid in southwestern Virginia, the Appalachian Highlands Community Dental Center in Abingdon sees patients who travel more than two hours for care — and must turn many away, said Elaine Smith, its executive director.

The center’s seven residents treated about 5,000 patients last year, most of them on Medicaid. About 3,000 people are on its waitlist, waiting up to a year to be seen.

“It’s sad because they have the means now to see a dentist, but they still don’t have a dental home,” Smith said.

Low-income adults face other barriers to dental care, including a lack of transportation, child care, or time off work, she said.

The inability to see a dentist has consequences broader than tooth pain. Poor dental health can contribute to a host of other significant health problems, such as heart disease and diabetes. It can also make it harder to do things like apply for jobs and generally lead a healthy life.

Robin Mullins, 49, who has been off and on Medicaid since 2013, said a lack of regular dental visits contributed to her losing her bottom teeth. Unable to find a dentist near her home in rural Clintwood, Virginia, she drives almost 90 minutes to Smith’s clinic — that is, when she can afford to get time away from driving for DoorDash or find help watching her daughter, who has special needs.

She gets by with partial dentures but misses her natural teeth, she said. “It’s absolutely horrible, as you can’t chew your food properly.”

In New Hampshire, though, the challenges have more to do with low demand than a low supply of dentists, said Tom Raffio, chief executive of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added new dentists to its list of participating providers, along with two mobile dental units that traverse the state, he said.

Raffio said Northeast Delta Dental also has publicized the state benefits using radio advertising and social media, among other efforts.

Until 2023, New Hampshire Medicaid covered only dental emergencies.

“Culturally, it’s going to take a while,” he said, “as people just are used to not going to the dentist, or going to the ER when have dental pain.”

Brooks Woodward, dental director at Baltimore-based Chase Brexton Health Care, called Maryland’s rate of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 “pretty good” considering the benefits had been enhanced only since 2023.

Woodward said many adults on Medicaid believe that you go to a dentist only when you’re in pain. “They’ve always just not gone to the dentist, and that’s just the way they had it in their life,” he said.

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