The Office of Personnel Management 65 insurance companies to provide monthly reports with detailed medical and pharmaceutical claims data of more than 8 million people enrolled in federal health plans, Â鶹ŮÓÅ Health News reported earlier this month. The request, which could dramatically expand the personally identifiable medical information OPM can access, alarmed health ethicists, insurance company executives, and privacy advocates.

Now, OPM Director Scott Kupor has two letters on his desk — one from 16 U.S. senators and another led by Rep. Robert Garcia, the top Democrat on the House Oversight Committee — asking him to drop the agency’s proposal.

“The collection of broad, personally identifiable data regarding medical care and treatment raises concerns that OPM could target certain federal employees seeking vital health care services that the Administration disagrees with on political grounds,” the Democratic House members , citing Â鶹ŮÓÅ Health News.

The letters from congressional Democrats alone are unlikely to reverse OPM’s plans. Republicans — who control Congress and, ultimately, any oversight activities — have not weighed in on OPM’s notice.

OPM did not immediately respond to a request for comment on the letters. The agency, which said in its notice that it will use the data for oversight and to manage the federal health plans, has not publicly addressed written concerns about its proposal.

The notice, posted and sent to insurers in December, states that insurers are legally permitted to disclose “protected health information” to OPM and does not provide instructions to redact identifying information, such as names or diagnoses, from the claims.

That data could be used to implement cost-saving measures, health policy experts told Â鶹ŮÓÅ Health News earlier this month. But it would also give the Trump administration — which has laid off or fired tens of thousands of federal workers — access to a vast trove of personal information.

In the letters, Democratic lawmakers lay out a number of concerns about potential consequences of OPM’s obtaining detailed medical claims for millions of federal workers.

The — led by Adam Schiff of California and Mark Warner of Virginia — argues that OPM is not equipped to safeguard such sensitive data and that the administration could share the records across government agencies, as it has done with personal information on millions of Medicaid enrollees.

They also assert that the agency does not have a legal right to the data and that insurers’ sharing the information with OPM would “violate the core principles of the Health Insurance Portability and Accountability Act.” HIPAA requires certain organizations that maintain identifiable health information — such as hospitals and insurers — to protect it from being disclosed without patient consent. The proposal, the senators warn, threatens patients’ relationships with their clinicians, especially “sensitive disclosures regarding mental health, chronic illness, or other deeply personal conditions.”

“For these reasons, we strongly urge you to cease any further consideration of this proposal,” states the letter, which was sent to Kupor on April 19.

The American Federation of Government Employees, the largest union for federal employees, to Â鶹ŮÓÅ Health News’ reporting. The union noted in a statement from its national president, Everett Kelley, that OPM’s proposal “comes in the context of coordinated attacks on federal employees and repeated stretching of the legal boundaries for sharing sensitive personal data across government agencies.

“The question of what this administration intends to do with eight million Americans’ most private health information is not academic,” the AFGE statement read. “It is urgent.”

In an emailed statement, Kelley applauded the congressional letters.

“We are pleased that Democratic lawmakers on the Hill are just as outraged as we are over this administration’s blatant attempt to breach the privacy of millions of Americans across the country,” Kelley wrote. “We share their concerns regarding potential misuse of the information to continue illegally targeting workers and their demand for OPM to withdraw this proposal.”

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In a humbling exercise, employees were waiting to test whether their entry badges still worked at the Department of Health and Human Services — or whether they’d be walked back out by security because they were among the 10,000 unlucky ones whose jobs had suddenly been eliminated.

I thought back to that day recently as I researched and reported on a significant, under-the-radar proposal from the Office of Personnel Management, which oversees federal workers. 

According to a  in December, OPM is seeking personally identifiable medical and pharmaceutical claims information on federal employees and retirees, as well as their family members, who are enrolled in the Federal Employees Health Benefits or Postal Service Health Benefits programs. Just over 8 million Americans get coverage through such plans.

Right now, 65 insurance companies maintain data the agency wants, including information on prescriptions, diagnoses, and treatments. That would put a tremendous amount of personal information about federal employees in the hands of an administration that has earned a reputation for taking  against some workers and sharing sensitive data across agencies as part of its immigration and fraud crackdowns.  

My colleague Maia Rosenfeld and I wanted to know what lawyers and ethicists who work on health policy issues think about this proposal.  

On the one hand, sources told us, this sort of detailed data could be used by the federal government to improve the largest employer-sponsored health insurance system in the country. 

But doubts about the Trump administration’s motives percolated through every conversation we had. 

“The concern here is the more information they have, they could use it to discipline or target people who are not cooperating politically,” Sharona Hoffman, a health law ethicist at Case Western Reserve University, told me.  

And, though the notice states that insurers are legally permitted to disclose “protected health information” to the agency for “oversight,” Hoffman and others raised questions about OPM’s access to such a sweeping database of medical records under federal health privacy laws.  

Insurance companies — several of which declined to comment — would have to provide monthly reports to OPM with data on their members. One insurer, CVS Health, said in a public comment that insurers would be breaking the law by providing the information for OPM’s “vague and broad general purposes.” The association that represents many of those companies also has voiced objections to the proposal, which has not yet been finalized.  

OPM spokespeople did not respond to our repeated requests for comment.

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A from the Office of Personnel Management could dramatically change which personally identifiable medical information the agency obtains, giving it the power to see prescriptions employees had filled or what treatment they sought from doctors. The regulation would require 65 insurance companies that cover more than 8 million Americans — including federal workers, retired members of Congress, mail carriers, and their immediate family members — to provide monthly reports to OPM with identifiable health data on their members.

The proposal is prompting unease from insurers as well as health policy and legal experts, who are concerned about the legality of OPM acquiring such a sweeping database of sensitive health information, and the agency’s ability to safeguard it.

OPM could use the data to analyze costs and improve the system, said Sharona Hoffman, a health law ethicist at Case Western Reserve University in Ohio.

“But,” she said, “they are going to get very, very detailed and granular data about everything that happens. The concern here is the more information they have, they could use it to discipline or target people who are not cooperating politically.”

OPM spokespeople did not respond to repeated requests for comment. The agency’s notice asks insurers that offer Federal Employees Health Benefits or Postal Service Health Benefits plans to furnish “service use and cost data,” including “medical claims, pharmacy claims, encounter data, and provider data.” It says the data will “ensure they provide competitive, quality, and affordable plans.”

The notice, posted and sent to insurers in December, does not instruct them to redact identifying information — a burdensome process that they would need federal guidance to complete.

Instead, it states that insurers are legally permitted to disclose “protected health information” to OPM. Several experts in health policy and law consulted by Â鶹ŮÓÅ Health News said they interpreted the request to mean the Trump administration was seeking identifiable data.

The ask comes a year into a Republican administration that has been defined by haphazard mass layoffs and firings of thousands of federal workers, who say they were in acts of or for the . Under President Donald Trump, the government has also routinely tested the legal bounds of sharing sensitive and personally identifiable tax or health information across government agencies in its efforts to carry out mass immigration arrests or pursue identify fraud.

“You can anticipate a scenario where this information on 8 million Americans is now in the hands of OPM and there’s a real concern of how they use it,” said Michael Martinez, senior counsel at Democracy Forward, an advocacy organization that filed a public comment opposing OPM’s proposal in February. Martinez previously worked at OPM.

“They’ve given no information about how they would treat that information once they have it,” he said.

Among Martinez’s concerns is how the administration might use information about employees who have sought abortions — 41 states have some type of abortion ban — or transgender treatment, medical care that the Trump administration has tried to curb.

The American Federation of Government Employees, the largest union representing federal workers, did not respond to requests for comment.

Martinez and others who reviewed the notice for Â鶹ŮÓÅ Health News said the proposal was so vague that they were uncertain, exactly, what medical records OPM wants to access.

At the very least, they said, the proposal would allow the agency to access the medical and pharmaceutical claims of patients with their identifying information, such as names and birth dates. Claims data also includes diagnoses, treatments, visit length, and provider information.

OPM’s request to view “encounter data” could allow the agency to look at “anything and everything,” Hoffman noted.

That could include detailed medical records, such as a doctor’s notes or after-visit summaries.

Jonathan Foley, who worked at OPM advising on the Federal Employees Health Benefits program during the Obama and Biden administrations, said he doubts the agency has the capability to ingest such minutiae.

The agency, however, could easily begin collection of personally identifiable medical and pharmaceutical claims information from insurers, he said.

Foley said he sees a benefit to OPM having broader access to de-identified claims data. In recent years, OPM has ramped up its analysis of claims data, which has allowed it to examine prescription drug costs and encourage plans to offer federal workers cheaper alternatives. He’s worried, though, that the Trump administration’s proposal goes too far, because it appears to seek identifiable data.

“It’s kind of shocking to think of them having protected health information without having strict guardrails,” he said.

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, requires certain organizations that maintain identifiable health information — such as hospitals and insurers — to protect it from being disclosed without patient consent.

Those entities can disclose such information without consent only in specific scenarios, with a justification that it is deemed “reasonable” or “necessary.” Even then, HIPAA mandates that they provide only the minimum amount of information required.

OPM argues in its notice that it is entitled to the information from insurers “for oversight activities.”

But several people who reviewed the notice questioned whether OPM’s explanation for requesting the information is sufficient.

“The language in it seems quite broad and encompasses potentially a lot of information and data and is sort of light on justification,” said Jodi Daniel, a digital health strategist who helped develop the legal framework for HIPAA privacy rules over two decades ago.

Several major insurers that offer federal employee health plans — including the Blue Cross Blue Shield Association, Kaiser Permanente, and UnitedHealthcare — declined to comment on their plans to comply with the notice or offer insight on where plans to implement the data sharing stood.

Only one insurer individually weighed in with a public comment on OPM’s plan. In March, CVS Health executive Melissa Schulman urged the federal agency to reconsider its proposal.

“OPM’s request raises substantial HIPAA compliance issues,” Schulman wrote, arguing that federal law allows the agency to examine records but not to collect data. Insurers would be breaking the law by providing personal health information for OPM’s “vague and broad general purposes,” she added.

Schulman, who did not respond to additional questions from Â鶹ŮÓÅ Health News, also raised concerns about a lack of data privacy protections. She noted that insurers could be liable for security breaches or other situations “where consumer health information is inappropriately shared and outside of our control.”

In 2015, OPM announced the personal records of roughly 22 million Americans had been in a data breach that has been blamed on the Chinese government.

The Association of Federal Health Organizations, which represents CVS Health and dozens of other federal health plan carriers, also weighed in with a 122-page comment opposing the notice. In it, AFHO Chair Kari Parsons emphasized that insurance carriers are bound by HIPAA to safeguard personal health information.

Federal law requires carriers “to furnish ‘reasonable reports’ OPM determines to be necessary,” Parsons wrote, “not to furnish the individual claims data of every individual.”

This isn’t the first time OPM has requested detailed data from insurers. In the AFHO comment, Parsons noted OPM had made a similar proposal in 2010, prompting HIPAA concerns. She described how, after several years of negotiations with AFHO, they discussed — but OPM never finalized — an agreement in 2019 for carriers to share de-identified data with OPM.

But since then, Parsons wrote, OPM has collected such detailed information on enrollees and their families that, with OPM’s new request, the agency may be able to trace even de-identified records to individuals.

OPM has not provided any update since closing comments in March. The agency would need to publish a final decision before anything officially changes.

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“I feel like I’m suffocating inside this shelter, trapped with no way out,” Carlos’ son said, according to one of the teens’ attorneys, when asked to describe how he felt after months at the Houston-area facility. “Every day, the same routine. Every day, feeling stuck. It makes me feel hopeless and terrified.”

During daily video calls, Carlos, who had temporary protected status, urged the siblings to be patient, to trust the process. Federal officials had vetted Carlos before he could be granted custody and told him his case was complete. He believed he would soon be back with his children, who, like him, had sought refuge from political violence in Venezuela.  

An immigration officer called Carlos on a Friday and asked him to attend a meeting at an ICE office the following Monday to discuss reunification with his children. Once Carlos arrived, officers tried to force him to sign documents he said he didn’t understand. When he refused, they stripped off his clothes, seized his ID and belongings, and chained him by the neck, waist, and legs.

“They tricked me,” Carlos said in a phone call from an immigration detention center in El Paso, Texas, where he was held for several months. “They used my children to grab me,” he said.  

In reporting on the family’s story, Â鶹ŮÓÅ Health News reviewed court documents, spoke with the family’s immigration attorneys, interviewed Carlos, and reviewed statements from his children, translated from Spanish. Carlos is a pseudonym, being used at the request of attorneys concerned that speaking out could jeopardize Carlos’ immigration case or further delay his reunion with his family.

Using Children to Arrest Parents

Since 2003, the Department of Health and Human Services’ Office of Refugee Resettlement has cared for immigrant children under 18 who arrive in the country without their parents, often fleeing violence, abuse, or trafficking. The office, which in February had more than 2,300 children in shelters or with foster families across the country, is supposed to promptly release them to vetted caregivers, typically parents or other family members already living in the country.

Congress placed this responsibility with the health agency over 20 years ago to prioritize the well-being of unaccompanied children and separate their care from immigration enforcement priorities.

Now the second Trump administration is using migrant children held by the resettlement office to lure their parents, such as Carlos, whether or not they have a criminal record. A Â鶹ŮÓÅ Health News investigation found the resettlement office, , coordinates with the Department of Homeland Security to arrest people seeking custody of migrant children.

Arrest documents show Homeland Security Investigations, the arm of the agency that normally focuses on organized criminals and traffickers, will interview parents or other caregivers then arrest them if they are in the country illegally. Before Donald Trump returned to the White House, the resettlement office prohibited data sharing and collaboration with immigration enforcement, and it did not deny caregivers custody of children solely because of their immigration status. Those last year.

It’s unclear exactly how many caregivers have been baited into arrest. LAist indicating more than 100 have been arrested while trying to get their kids out of detention, but Â鶹ŮÓÅ Health News could not independently verify that number with federal agencies.

Since February, the Department of Health and Human Services, Department of Homeland Security, and Justice Department have not responded to questions about caregiver arrests. Prior to leaving DHS last month, Assistant Secretary Tricia McLaughlin said the administration protects children from being released to people who shouldn’t care for them. Andrew Nixon, an HHS spokesperson, referred questions related to immigration enforcement to DHS.

At the same time, the resettlement office has that make it harder for caregivers to gain custody of unaccompanied children. These include narrowing the range of accepted documents, requiring fingerprint-based background checks for every adult in the home and backup caregivers, and requiring in-person appointments to verify identification documents, sometimes with ICE agents present. The requirements keep “children safe from traffickers and other bad, dangerous people,” Nixon said.

As of January, the agency had detained at least 300 children already placed with vetted sponsors and asked their caregivers to reapply, according to the National Center for Youth Law and the Democracy Forward Foundation. The advocacy groups filed calling these actions “a quieter, new form of family separation.” 

Reverse Separation

Dulce, a Guatemalan mother in Virginia, said her 8-year-old son was sent to a government shelter after he was detained during a traffic stop last summer while visiting family members in a different state.

At first, Dulce expected to get her son back within days — she had passed the government’s sponsorship requirements in 2024 and was reunited with him three weeks after he first crossed the border. But resettlement agency officials asked her to repeat the entire process and resubmit documents, Dulce said. It took eight months to get him back.

Dulce is a pseudonym being used at her request because she fears speaking out could get her deported.

At one point, Dulce was told to attend an interview at an ICE office to show her identification as part of the process of reuniting with her son. She refused out of fear that she too might be detained, because she doesn’t have legal status. She believes ICE agents visited her home at one point.

“I stopped going home,” Dulce said. “I lived with some of my friends for days.”

Even though she lived just 45 minutes away, Dulce was allowed to visit her son only twice a month.

Until recently, most unaccompanied children landed in government custody after being detained at the border. But border crossings started to fall in 2024, and the number of people coming to the U.S. has dropped precipitously in President Trump’s second term.

Now, hundreds of kids have been taken to government shelters after being swept up inside the country, often during immigration raids or traffic stops, according to the advocates’ lawsuit. Many were already living with relatives, including guardians already vetted by the resettlement agency.

Releases have grinded nearly to a halt. According to the resettlement office, children in its custody stayed in government shelters or foster care for an average of one month in 2024. As of February, that had jumped to more than half a year.

When children do get released, it’s often only after their attorneys file a lawsuit in federal court challenging their detention as unconstitutional.

Authorities released Dulce’s son to her in February after the boy’s attorneys filed such a petition. Dulce said she’s relieved to have him back but still anxious that ICE could show up at their house.

Immigrants at Risk

During Trump’s first term, his administration was criticized for of children who had been released from custody. President Joe Biden was blamed for how his administration processed a surge of unaccompanied children that peaked in 2021 with about 22,000 in the resettlement office’s custody. Though most children were placed with legitimate sponsors, some were placed with people who hadn’t cleared , putting them at risk of .

The Trump administration says it is checking on those , and the Justice Department has prosecuted . On March 1, Homeland Security Secretary Kristi Noem, who is set to leave her role at the , touted a , including the resettlement office, that DHS said had tracked down 145,000 unaccompanied children who had been placed with caregivers during Biden’s term.

Yet internal HHS reports about that initiative obtained by Â鶹ŮÓÅ Health News show that nearly 11,800 of those migrant children and nearly 500 of their caregivers were arrested as of Jan. 29. Only 125 of those migrant children and 55 of those caregivers were arrested for alleged criminal activity, suggesting the majority were for immigration violations.

HHS referred questions about the figures in the reports to DHS, which did not respond to requests for comment about the data. However, Michelle Brané, who was a DHS official in the Biden administration, said the figures show that most of the arrests were to detain and deport migrants. Previously, the administration targeted parents and caregivers who had paid for children to cross the border, trying to levy smuggling charges against them.

“They have really dropped that pretense in a lot of ways, and they are going for anyone openly,” Brané said. “These numbers clearly reflect that this is not about public safety or about safety of the children.”

Case on Hold

Carlos left Venezuela in 2022 because of death threats and, like thousands of others fleeing that country, was granted what’s called temporary protected status under the Biden administration. That protection for most Venezuelans by the Trump administration.

In January 2025, days before Trump was sworn in for his second term, Carlos’ children crossed the border from Mexico to the U.S., turned themselves over to border authorities, and were immediately placed in the resettlement agency’s custody. Carlos spent months submitting paperwork to reunite with them. He said he’s their only parent, because their mother left when they were toddlers.  

Officials visited his home twice and determined he was fit to care for them, according to court documents petitioning for his release from detention. He passed DNA testing, proving he’s the biological father, one of his attorneys said. His arrest documents show he has “no criminal history.” In July, Carlos was told his reunification case was complete and being sent for approval. But then, with little explanation, the case was put on hold.

Before his arrest by ICE, Carlos said, he drove 14 hours each way from his home to visit his children. Once there, he could see them for only one hour. When he was in detention, he said, he spoke to them about every two weeks in quick, monitored phone calls.

He’s trying to stay hopeful, but it’s hard.

According to documents completed by ICE officers during his arrest and submitted in his court case, Carlos was arrested under an initiative called Operation Guardian Trace, which requires immigration officers to detain potential caregivers if they are in the country without legal authorization and recommend that they be deported.

“This operation is designed to force parents to make an impossible choice between reuniting with their children and seeking safety,” said one of Carlos’ attorneys, Chiqui Sanchez Kennedy of the Galveston-Houston Immigrant Representation Project, a nonprofit that helps low-income immigrants.

‘I’m Going to Wait’

In March, a federal judge said officials had unlawfully detained Carlos and he was released on bond.

But his children still face an uncertain future for now. Government shelters often lack sufficient resources, , and social workers say lengthy stays in these facilities can result in additional trauma.

“Not only is it bad, full stop, but the longer you’re there, the worse it gets,” said Jonathan Beier, associate director of research and evaluation for the Acacia Center for Justice’s Unaccompanied Children Program, which coordinates legal services for unaccompanied minors.

Carlos’ children could also be sent back to the country they fled. Because of his detention, Carlos will have to redo much of the process to reunite with them, according to an attorney for the children, Alexa Sendukas, also with the Galveston-Houston Immigrant Representation Project.

In statements shared through Sendukas, Carlos’ daughter said she no longer wants to be around others and spends most of the time in her room. His son, now 15, described having panic attacks and feeling that he’s missing out on life, whether it’s the opportunities he longs for — to learn English, to study science — or watching basketball with his family.

“I remember when I first arrived at this shelter, I was so hopeful and had faith that I would be reunited with my dad soon,” he said.

Carlos’ daughter spent the day crying in bed when the siblings learned their father had been detained. For days, they didn’t know where he was. Now, they fear the only way out is through adoption or foster care.

“I am afraid,” she said. “I’m going to wait for my dad forever.”

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“I have these conversations with children starting at 8, 10, 12 years old: What do you want to be when you grow up?” Duane said. If you’re a child who wants to be a doctor, for instance, “there are things you need to put in place. If you hope to have children one day, there are things that you need to consider and have the conversation early.”

The proposal from Duane, a specialist in who is affiliated with the anti-abortion Charlotte Lozier Institute, got a warm reception from the audience gathered for the Trump administration’s inaugural .

The three-day event hosted by the Department of Health and Human Services last week was designed to “explore breakthroughs in research, prevention, diagnosis, and treatment of health conditions that affect women across the lifespan.” Government officials hosted an eclectic mix of wealthy philanthropists, alternative medicine influencers, health tech executives, and medical researchers to discuss a wide range of issues, from Lyme disease to gut health.

Seeking to reach women at a moment when President Donald Trump’s among a key voting bloc, the Make America Healthy Again movement, the administration-sponsored event elevated perspectives outside conventional standards of medical care and counter to many women’s health choices.

For example, during a 40-minute panel hosted by Alexis Joel, the wife of musician Billy Joel, several doctors raised concerns about how frequently hormonal birth control is used to treat women’s health symptoms. Two female physicians on the panel said they were uncomfortable with the idea of using birth control pills for their own treatment, noting that their “values” or “cultural perspective” did not align with use of the medication.

Nearly a third of U.S. women ages 18 to 49 report having used birth control pills in the previous 12 months, according to a . In addition to their use as a contraceptive, the pills are prescribed for , including preventing anemia from heavy periods and treating uterine fibroids.

Joel, who has about her experience with endometriosis, brought her own doctor, Tamer Seckin, to discuss the common, painful condition, in which thick tissue develops outside of the uterus. Seckin said women’s concerns about menstrual pain are often dismissed by doctors, leading to missed diagnoses.

Asima Ahmad, a doctor who specializes in fertility and co-founded Carrot, a company that offers job-based fertility benefits, offered another explanation for why the disease is overlooked.

“As providers, we should learn how to treat it, rather than covering it up with birth control pills or progesterone,” she said.

Hormonal birth control pills, which help slow the growth of new tissue, are for treating endometriosis, according to the American College of Obstetricians and Gynecologists.

Andrea Salcedo, a California OB-GYN on the panel who said she has endometriosis as well, said she declined birth control as a treatment. She noted her decision aligned with her “values,” in particular her desire to have more children.

“Is this all that we can do?” Salcedo said of being offered birth control.

Salcedo said she prescribes alternative treatments to her patients because she believes the root cause of infertility is directly related to gut health. Cod liver oil and vitamin A top her list, she said.

whether there is an association between vitamin deficiencies and endometriosis. Taking too much vitamin A can cause health problems, including if taken while pregnant.

Those supplements have been touted by HHS Secretary Robert F. Kennedy Jr. — including, falsely, as during an outbreak in Texas last year.

About a quarter of U.S. adults wrongly believe vitamin A can prevent measles infections, according to a .

The panel also coalesced around the idea that a lack of knowledge is the root problem: Girls do not receive enough education on how to become pregnant or identify the warning signs of infertility, the doctors suggested.

Education has become too hyperfocused on preventing pregnancy, Ahmad said.

“I was in junior high, and I was learning about trying not to get pregnant, and I was scared that if I sit in a room with a guy alone, I will,” she said. “They put all of this fear into it, but family planning isn’t just about preventing pregnancy. It’s about learning about how to build your family.”

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The tensions risk fraying Kennedy’s dynamic MAHA coalition, potentially driving away critical supporters who helped fuel President Donald Trump’s 2024 election win.

The movement’s grassroots membership includes suburbanites, women, and independents who are generally newer entrants to the GOP and laser-focused on achieving certain results around the nation’s food supply and vaccines.

Promoting healthy foods tops their list and will be at the center of the White House’s pitch to voters during the midterm election cycle.

“President Trump’s mass appeal partly lies in his willingness to question our country’s broken status quo,” White House spokesperson Kush Desai said in a statement. “That includes food standards and nutrition guidelines that have helped fuel America’s chronic disease epidemic. Overhauling our food supply and nutrition standards to deliver on the MAHA agenda remains a key priority for both the President and his administration.”

At the same time, with most Americans , the White House has cooled on Kennedy’s aggressive policies to curb vaccines and MAHA’s interest in tamping down environmental chemicals that are linked to disease.

The result: Republicans are realizing just how demanding the MAHA vote can be. Moms Across America leader Zen Honeycutt warned that Republicans are facing their biggest setback yet with the MAHA movement, after Trump signed an executive order to support production of glyphosate, a herbicide the World Health Organization has .

“It has caused the biggest uproar in MAHA,” Honeycutt said during a CNN interview in late February.

A White House Warning

Trump’s top pollster, Tony Fabrizio, cautioned in December that an embrace of Kennedy’s anti-vaccine policies could cost politicians their jobs this year.

Eight in 10 MAHA voters and 86% of all voters believe vaccines save lives, his poll of 1,000 voters in 35 competitive districts found.

“In the districts that will decide the control of the House of Representatives next year, Republican and Democratic candidates who support eliminating long standing vaccine requirements will pay a price in the election,” on the poll stated.

The White House has since shaken up senior staffing at HHS, including removing from the deputy secretary role and his job as acting director of the Centers for Disease Control and Prevention, in which he curtailed the agency’s childhood vaccination recommendations. Ralph Abraham, a vaccine skeptic who as Louisiana’s surgeon general suspended its vaccination promotion program last year, stepped down as the CDC’s principal deputy director in late February.

, a doctor who said in congressional testimony that he doesn’t believe vaccines cause autism, is now running the CDC in addition to directing the National Institutes of Health.

Though Trump himself has frequently espoused doubts and mistruths about vaccines, polling around anti-vaccine policy has undoubtedly shaken the White House’s confidence during a tough midterm election year, said former , an Indiana Republican and retired doctor who left Congress last year.

Bucshon said Republicans can’t risk alienating voters, especially parents of young children who might be moved by Democratic attack ads on the topic at a time when hundreds of measles cases are popping up across the U.S.

“That’s the reason you’re seeing the White House get nervous about it,” Bucshon said. “This is just the political reality of it.”

Kennedy built some of his MAHA following with calls to end federal approval and recommendations for the covid vaccines during the pandemic. The Advisory Committee on Immunization Practices, a federal panel of outside experts who were handpicked by Kennedy to develop national vaccine recommendations, is expected to review and possibly withdraw its recommendation for covid shots. Its February meeting was postponed and is now scheduled for March 18-19, when the panel plans to discuss injuries from covid vaccines, HHS spokesperson Andrew Nixon confirmed on March 11.

“I’m not deaf to the calls that we need to get the covid vaccine mRNA products off the market. All I can say is stay tuned and wait for the upcoming ACIP meeting,” ACIP Vice Chair Robert Malone , a conservative account on the social platform X, before the meeting was postponed. “If the FDA won’t act, there are other entities that will.”

No Fury Like Scorned MAHA Moms

Bipartisan support is also extremely high — above 80% — for another core tenet of the MAHA agenda: eliminating the use of certain pesticides on crops.

But MAHA leaders were incensed when Trump issued a Feb. 18 promoting the production of glyphosate, a chemical used in weed killers sprayed on U.S. crops and which Kennedy has railed against and sued over because of its reported links to cancer.

“There’s gonna be ups and downs, and there is zero question that this week was a down,” Calley Means, a senior adviser to the health secretary and a former White House employee, told a MAHA rally in Austin, Texas, on Feb. 26. “I am not going to gaslight or sugarcoat it: This glyphosate thing was extremely disappointing. Bobby’s disappointed.”

Despite deep unhappiness from MAHA followers, Kennedy endorsed Trump’s executive order defending access to such pesticides.

“I support President Trump’s Executive Order to bring agricultural chemical production back to the United States and end our near-total reliance on adversarial nations,” Kennedy .

Without offering policy changes, Kennedy promised a future agricultural system that “is less dependent on harmful chemicals.”

White House officials are now trying to downplay the executive order.

“The President’s executive order was not an endorsement of any product or practice,” Desai said in a statement.

But that’s done little to dampen criticism from leading MAHA influencers who had hoped, with Kennedy’s influence in the administration, that the chemical would be banned.

Some Democrats see an opening.

of Maine earned cheers from MAHA loyalists for co-sponsoring legislation with Rep. Thomas Massie (R-Ky.) to undo the executive order.

“The Trump Admin. cannot keep paying lip service to while propping up Big Chemical like this and choosing corporate profits over Americans’ health,” .

, a prominent MAHA influencer who promotes healthy eating, responded on X with a “HELL YES.”

‘Eat Real Food’

The White House and Kennedy are refocusing their messaging to emphasize one of the most popular elements of the MAHA platform: food.

At the start of the year, Kennedy unveiled new dietary guidelines that emphasize vegetables, fruits, and meats while urging Americans to avoid ultraprocessed foods.

Kennedy has leaned into his new “Eat Real Food” campaign, launching a nationwide tour in January. Ahead of the late-February MAHA rally, he stopped at a barbecue joint in Austin where he took photos with stacks of smoked ribs and grilled sausages. Large “Eat Real Food” signs have been provided for crowds of supporters to hold up during major announcements at HHS’ headquarters this year.

Focusing on nutrition will please MAHA moms, suburban swing voters, and conservatives alike, said , a physician and former Republican representative from Texas.

“They keep them happy by talking about the food pyramid,” Burgess said. “That’s an area where there is broad, bipartisan support.”

Indeed, Fabrizio’s poll shows equal support — 95% — among respondents who voted for former Vice President Kamala Harris and those who voted for Trump for requiring labeling of harmful ingredients in ultraprocessed foods.

Trump is keenly aware that Kennedy’s MAHA movement is key to his political survival. At a Cabinet meeting in January, Kennedy rattled off a list of his agency’s efforts researching autism and tackling high drug prices.

Trump leaned in at the table.

“I read an article today where they think Bobby is going to be really great for the Republican Party in the midterms,” , “so I have to be very careful that Bobby likes us.”

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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 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, 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.

Â鶹ŮÓÅ 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 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 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 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 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 , 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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One year after taking charge of the nation’s health department, Health and Human Services Secretary Robert F. Kennedy Jr. hasn’t held true to many of he made while appealing to U.S. senators concerned about the longtime anti-vaccine activist’s plans for the nation’s care.

Kennedy squeaked through a narrow Senate vote to be confirmed as head of the Department of Health and Human Services, only after making a number of public and private guarantees about how he would handle vaccine funding and recommendations as secretary.

Here’s a look at some of the promises Kennedy made during his confirmation process.

The Childhood Vaccine Schedule

In two hearings in January 2025, Kennedy repeatedly assured senators that he supported childhood vaccines, noting that all his children were vaccinated.

Sen. Elizabeth Warren (D-Mass.) about the money he’s made in the private sector from lawsuits against vaccine makers and accused him of planning to profit from potential future policies making it easier to sue.

“Kennedy can kill off access to vaccines and make millions of dollars while he does it,” Warren said during the Senate Finance Committee hearing. “Kids might die, but Robert Kennedy can keep cashing in.”

Warren’s statement prompted an assurance by Kennedy.

“Senator, I support vaccines,” he said. “I support the childhood schedule. I will do that.”

Days later, Sen. Bill Cassidy of Louisiana, chair of the Senate Health, Education, Labor, and Pensions Committee, declared Kennedy had pledged to maintain existing vaccine recommendations if confirmed. Cassidy, a physician specializing in liver diseases and a vocal supporter of vaccination, had questioned Kennedy sharply in a hearing about his views on shots.

“If confirmed, he will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ recommendations without changes,” Cassidy said during a speech on the Senate floor explaining his vote for Kennedy.

A few months after he was confirmed, Kennedy fired all the incumbent members of the vaccine advisory panel, known as ACIP, and appointed new members, including several who, like him, oppose some vaccines. The panel’s recommendations soon changed drastically.

Last month, the CDC removed its universal recommendations for children to receive seven immunizations, those protecting against respiratory syncytial virus, meningococcal disease, flu, covid, hepatitis A, hepatitis B, and rotavirus. The move followed a memorandum from the White House calling on the CDC to cull the schedule.

Now, those vaccines, which researchers estimate have prevented thousands of deaths and millions of illnesses, are recommended by the CDC only for children at high-risk of serious illness or after consultation between doctors and parents.

In response to questions about Kennedy’s actions on vaccines over the past year, HHS spokesperson Andrew Nixon said the secretary “continues to follow through on his commitments” to Cassidy.

“As part of those commitments, HHS accepted Chairman Cassidy’s numerous recommendations for key roles at the agency, retained particular language on the CDC website, and adopted ACIP recommendations,” Nixon added. “Secretary Kennedy talks to the chairman at a regular clip.”

Cassidy and his office have repeatedly rebuffed questions about whether Kennedy, since becoming secretary, has broken the commitments he made to the senator.

Vaccine Funding Axed

Weeks after Kennedy took over the federal health department, the CDC pulled back $11 billion in covid-era grants that local health departments were using to fund vaccination programs, among other initiatives.

That happened after Kennedy pledged during his confirmation hearings not to undermine vaccine funding.

Kennedy replied “Yes” when Cassidy asked him directly: “Do you commit that you will not work to impound, divert, or otherwise reduce any funding appropriated by Congress for the purpose of vaccination programs?”

A federal judge later ordered HHS to distribute the money.

The National Institutes of Health, part of HHS, also yanked dozens of research grants supporting studies of vaccine hesitancy last year. Kennedy, meanwhile, ordered the cancellation of a half-billion dollars’ worth of mRNA vaccine research in August.

A Discredited Theory About Autism

Cassidy said in his floor speech that he received a guarantee from Kennedy that the CDC’s website would not remove statements explaining that vaccines do not cause autism.

Technically, Kennedy kept his promise not to remove the statements. The website still says that vaccines do not cause autism.

But late last year, new statements sprung up on the same webpage, baselessly casting doubt on vaccine safety. “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism,” the now misleadingly reads.

The webpage also states that the public has largely ignored studies showing vaccines do cause autism.

That is false. Over decades of research, scientific studies have repeatedly concluded that there is no link between vaccines and autism.

A controversial 1998 study that captured global attention did link the measles, mumps, and rubella vaccine to autism. It was retracted for being fraudulent — though not until a decade after it was published, during which there were sharp declines in U.S. vaccination rates.

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Warning patients could deter them from signing up for a program called Emergency Medicaid, through which the for the cost of emergency treatment for immigrants who are ineligible for standard Medicaid coverage.

But if hospitals don’t disclose that the patients’ information is shared with federal law enforcement, they might not know that their medical coverage puts them at risk of being located by Immigration and Customs Enforcement.

“If hospitals tell people that their Emergency Medicaid information will be shared with ICE, it is foreseeable that many immigrants would simply stop getting emergency medical treatment,” said , a research professor at Georgetown University’s Center for Children and Families. “Half of the Emergency Medicaid cases are for the delivery of U.S. citizen babies. Do we want these mothers avoiding the hospital when they go into labor?”

For more than a decade, hospitals and states have assured patients that their personal information, including their home addresses and immigration status, would not be shared with immigration enforcement officials when they apply for federal health care coverage. guaranteed the agency would not use information from health coverage applications for enforcement activities.

But that changed last year, after President Donald Trump returned to the White House and ordered one of the most aggressive immigration crackdowns in recent history. His administration began funneling data from a variety of government agencies to the Department of Homeland Security, including filed with the IRS.

The Centers for Medicare & Medicaid Services, part of the Department of Health and Human Services, agreed last spring to give ICE officials direct access to a Medicaid database that includes enrollees’ addresses and citizenship status.

Twenty-two states, all but one led by Democratic governors, the Medicaid data-sharing agreement, which the administration did not formally announce until a federal judge ordered it to do so last summer. The judge that in those states, ICE could access information in the Medicaid database only about people in the country unlawfully. Â鶹ŮÓÅ Health News contacted more than a dozen hospitals and hospital associations in states and cities that have been targets of ICE sweeps. Many declined to comment on whether they’ve updated their disclosure policies after the ruling.

Of those that responded, none said they are directly warning patients that their personal information may be shared with ICE when they apply for Medicaid coverage.

“We do not provide legal advice about federal government data-sharing between agencies,” Aimee Jordon, a spokesperson for M Health Fairview, a Minneapolis-based hospital system, said in an email to Â鶹ŮÓÅ Health News. “We encourage patients with questions about benefits or immigration-related concerns to seek guidance from appropriate state resources and qualified legal counsel.”

Information on Applications

Some states’ Emergency Medicaid applications specifically ask for a patient’s immigration status — and still assure people that their information will be kept secure and out of the hands of immigration enforcement officials.

For example, as of Feb. 3, California’s application still included language advising applicants that their immigration information is “confidential.”

“We only use it to see if you qualify for health insurance,” states the 44-page form, which the state’s Medicaid program, known as Medi-Cal, in January.

California Department of Health Care Services spokesperson Anthony Cava said in a statement that the agency, which oversees Medi-Cal, will “ensure that Californians have accurate information on the privacy of their data, including by revising additional publications as necessary.”

Until late January, Utah’s Medicaid website also claimed its Emergency Medicaid program did not share its information with immigration officials. After Â鶹ŮÓÅ Health News contacted the state agency, Kolbi Young, a spokesperson, said Jan. 23 that the language would be taken down immediately. It was removed that day.

Oregon Health & Science University, a hospital system based in Portland, offers immigrant patients developed by the state Medicaid program for those with concerns about how their information might be used. The document does not directly say that Medicaid enrollees’ information is shared with ICE officials.

Hospitals rely on Emergency Medicaid to reimburse them for treating people who would qualify for Medicaid if not for their citizenship status — those in the country illegally and lawfully present immigrants, such as those with a student or work visa. The coverage pays only for emergency medical and pregnancy care. Typically, hospital representatives help patients apply while they are still in the medical facility.

The main Medicaid program, which covers a much broader range of services for over 77 million low-income and disabled people, does not cover people living in the country illegally.

Examining Emergency Medicaid enrollment is the most obvious way, then, for deportation officials to identify immigrants, including those who might not reside in the U.S. lawfully.

HHS spokesperson Rich Danker said in an email that CMS — which oversees Medicaid, a joint state-federal program — is sharing data with ICE after the judge’s ruling. But he would not answer how the agency is ensuring it is sharing information only on people who are not lawfully present, as the judge required.

With ICE now getting direct access to the personal information of millions of Medicaid enrollees, hospitals — while “definitely in a tough position” — should be up-front about the changes, said Sarah Grusin, at the National Health Law Program, an advocacy group.

“They need to be telling people that the judge has permitted sharing of information, including their address, for people who are not lawfully residing,” she said. “Once this information is submitted, you can’t protect it from disclosure at this point.”

Grusin said she advises families to weigh the importance of seeking medical care against the risk of having their information shared with ICE.

“We want to give candid, honest information even if it means the decision people have to make is really hard,” she said.

Those who have previously enrolled in Medicaid or can easily search their address online should assume that immigration officials already have their information, she added.

Emergency Medicaid

Emergency Medicaid coverage was established in the mid-1980s, when a federal law began requiring hospitals to treat and stabilize all patients who show up at their doors with a life-threatening condition.

Federal government spending on Emergency Medicaid accounted for nearly $4 billion in 2023, or of total federal spending on Medicaid.

States send monthly reports to the federal government with detailed information about who enrolls in Medicaid and what services they receive. The judge’s ruling in December limited what CMS can share with ICE to only basic information, including addresses, about Medicaid enrollees in the 22 states that sued over the data-sharing arrangement. ICE officials are not supposed to access information about the medical services people receive, per the judge’s order.

The judge also prohibited the agency from sharing the data of U.S. citizens or lawfully present immigrants from those states.

Deportation officials have access to personal Medicaid information of all enrollees in the remaining 28 states.

The federal health agency has not clarified how it is ensuring that certain states’ information on citizens and legal residents is not shared with ICE. But Medicaid experts say it would be nearly impossible for the agency to separate the data, raising questions about whether the Trump administration is complying with the judge’s order.

The Trump administration’s efforts to deport immigrants living in the country illegally have had implications on immigrant families seeking care. About a third of adult immigrants reported skipping or postponing health care in the past year, according to a released in November. (Â鶹ŮÓÅ is a health information nonprofit that includes Â鶹ŮÓÅ Health News.)

Bethany Pray, the chief legal and policy officer at the Colorado Center on Law and Policy, warned that sharing Medicaid data directly with deportation officials will force even tougher decisions upon some families.

“This is very concerning,” Pray said. “People should not have to choose between giving birth in a hospital and wondering if that means they risk deportation.”

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Those same dollars can’t be used, though, to pay for most baby formulas, toothbrushes — or insurance premiums.

President Donald Trump and some Republicans are pitching the accounts as an alternative to expiring enhanced federal subsidies that have lowered insurance premium payments for most Americans with Affordable Care Act coverage. But legal limits on how HSAs can and can’t be used are prompting doubts that expanding their use would benefit the predominantly low-income people who rely on ACA plans.

The Republican proposals come on the heels of a White House-led change to extend HSA eligibility to more ACA enrollees. One group that would almost certainly benefit: a slew of companies selling expensive wellness items that can be purchased with tax-free dollars from the accounts.

There is also deep skepticism, even among conservatives who support the proposals, that the federal government can pull off such a major policy shift in just a few weeks. The enhanced ACA subsidies expire at the end of the year, and Republicans are still debating among themselves whether to simply extend them.

“The plans have been designed. The premiums have been set. Many people have already enrolled and made their selections,” Douglas Holtz-Eakin, the president of the American Action Forum, a conservative think tank, warned senators on Nov. 19. “There’s very little that this Congress can do to change the outlook.”

Cassidy’s Plan

With health savings accounts, people who pay high out-of-pocket costs for health insurance are able to set aside money, without paying taxes, for medical expenses.

For decades, Republicans have promoted these accounts as a way for people to save money for major or emergent medical expenses without spending more federal tax dollars on health care.

The latest GOP proposals would build on included in Republicans’ One Big Beautiful Bill Act, which makes millions more ACA enrollees eligible for health savings accounts. Starting Jan. 1, those enrolled in Obamacare’s cheapest coverage may open and contribute to HSAs.

Now Republicans are making the case that, in lieu of the pandemic-era enhanced ACA subsidies, patients would be better off being given money to cover some health costs — specifically through deposits to HSAs.

The White House has yet to release a formal proposal, though suggested it could include HSA contributions as well as temporary, more restrictive premium subsidies.

Sen. Bill Cassidy — a Louisiana Republican who chairs the Senate Health, Education, Labor, and Pensions Committee and is facing a potentially tough reelection fight next year — has proposed loading HSAs with federal dollars sent directly to some ACA enrollees.

“The American people want something to pass, so let’s find something to pass,” Cassidy said on Dec. 3, pitching his plan for HSAs again. “Let’s give power to the patient, not profit to the insurance company.”

He has promised a deal can be struck in time for 2026 coverage.

Democrats, whose support Republicans will likely need to pass any health care measure, have widely panned the GOP’s ideas. They are calling instead for an extension of the enhanced subsidies to control premium costs for most of the nearly 24 million Americans enrolled in the ACA marketplace, a larger pool than the 7.3 million people the Trump administration estimates soon will be eligible for HSAs.

HSAs “can be a useful tool for very wealthy people,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee. “But I don’t see it as a comprehensive health insurance opportunity.”

Who Can Use HSAs?

The IRS sets restrictions on the use of HSAs, which are typically managed by banks or health insurance companies. For starters, on the ACA marketplace, they are available only to those with the highest-deductible health insurance plans — the bronze and catastrophic plans.

There are limits on how much can be deposited into an account each year. In 2026 it will be $4,400 for a single person and $8,750 for a family.

Flexible spending accounts, or FSAs — which are typically offered through employer coverage — work similarly but have lower savings limits and cannot be rolled over from year to year.

The law that established HSAs prohibits the accounts from being used to pay insurance premiums, meaning that without an overhaul, the GOP’s proposals are unlikely to alleviate the problem at hand: skyrocketing premium payments. Obamacare enrollees who receive subsidies are projected to more out-of-pocket for their premiums next year on average, absent congressional action.

Even with the promise of the government depositing cash into an HSA, people may still opt to go without coverage next year once they see those premium costs, said , an economics professor at the University of Michigan who worked in the Biden administration.

“For people who stay in the marketplace, they’re going to be paying a lot more money every month,” he said. “It doesn’t help them pay that monthly premium.”

Others, Buchmueller noted, might be pushed into skimpier insurance coverage. Obamacare bronze plans come with the highest out-of-pocket costs.

An HHS Official’s Interest

Health savings accounts can be used to pay for many routine medical supplies and services, such as medical and dental exams, as well as emergency room visits. In recent years, the government has expanded the list of applicable purchases to include over-the-counter products such as Tylenol and tampons.

Purchases for “general health” are not permissible, such as fees for dance or swim lessons. Food, gym memberships, or supplements are not allowed unless prescribed by a doctor for a medical condition or need.

Americans are as their insurance deductibles rise, according to Morningstar. The investment research firm found that assets in HSAs grew from $5 billion 20 years ago to $146 billion last year. President George W. Bush signed the law establishing health savings accounts in 2003, with at the time that they would “help more American families get the health care they need at a price they can afford.”

Since then, the accounts have become most common for wealthier, white Americans who are healthy and have employer-sponsored health insurance, according to released by the nonpartisan Government Accountability Office in September.

Now, even more money is expected to flow into these accounts, because of the One Big Beautiful Bill Act. Companies are taking notice of the growing market for HSA-approved products, with major retailers such as Amazon, Walmart, and Target developing online storefronts dedicated to devices, medications, and supplies eligible to be purchased with money in the accounts.

Startups have popped up in recent years dedicated to helping people get quick approval from medical providers for various — and sometimes expensive — items, memberships, or fitness or health services.

Truemed — a company co-founded in 2022 by Calley Means, a close ally of Health and Human Services Secretary Robert F. Kennedy Jr. — has emerged as one of the biggest players in this niche space.

A $9,000 red cedar ice bath and a $2,000 hemlock sauna, for example, are available for purchase with HSA funds through Truemed. So, too, is the $1,700 bassinet, designed to automatically respond to the cries of a newborn by gently rocking the baby back to sleep.

Truemed’s executives say its most popular products are its smaller-dollar fitness offerings, which include kettlebells, supplements, treadmills, and gym memberships.

“What we’ve seen at Truemed is that, when given the choice, Americans choose to invest their health care dollars in these kinds of proven lifestyle interventions,” Truemed CEO Justin Mares told Â鶹ŮÓÅ Health News.

Means joined the Department of Health and Human Services in November after a stint earlier this year at the White House, where he worked when Trump signed the One Big Beautiful Bill Act into law in July. Truemed’s general counsel, Joe Vladeck, said Means left the company in August.

Asked about Means’ potential to benefit from the law’s expansion of HSAs, HHS spokeswoman Emily Hilliard said in a statement that “Calley Means will not personally benefit financially from this proposal as he will be divesting from his company since he has been hired at HHS as a senior advisor supporting food and nutrition policy.”

Truemed is privately held, not publicly traded, and details of how Means will go about divesting have not been disclosed.

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The Office of Personnel Management 65 insurance companies to provide monthly reports with detailed medical and pharmaceutical claims data of more than 8 million people enrolled in federal health plans, Â鶹ŮÓÅ Health News reported earlier this month. The request, which could dramatically expand the personally identifiable medical information OPM can access, alarmed health ethicists, insurance company executives, and privacy advocates.

Now, OPM Director Scott Kupor has two letters on his desk — one from 16 U.S. senators and another led by Rep. Robert Garcia, the top Democrat on the House Oversight Committee — asking him to drop the agency’s proposal.

“The collection of broad, personally identifiable data regarding medical care and treatment raises concerns that OPM could target certain federal employees seeking vital health care services that the Administration disagrees with on political grounds,” the Democratic House members , citing Â鶹ŮÓÅ Health News.

The letters from congressional Democrats alone are unlikely to reverse OPM’s plans. Republicans — who control Congress and, ultimately, any oversight activities — have not weighed in on OPM’s notice.

OPM did not immediately respond to a request for comment on the letters. The agency, which said in its notice that it will use the data for oversight and to manage the federal health plans, has not publicly addressed written concerns about its proposal.

The notice, posted and sent to insurers in December, states that insurers are legally permitted to disclose “protected health information” to OPM and does not provide instructions to redact identifying information, such as names or diagnoses, from the claims.

That data could be used to implement cost-saving measures, health policy experts told Â鶹ŮÓÅ Health News earlier this month. But it would also give the Trump administration — which has laid off or fired tens of thousands of federal workers — access to a vast trove of personal information.

In the letters, Democratic lawmakers lay out a number of concerns about potential consequences of OPM’s obtaining detailed medical claims for millions of federal workers.

The — led by Adam Schiff of California and Mark Warner of Virginia — argues that OPM is not equipped to safeguard such sensitive data and that the administration could share the records across government agencies, as it has done with personal information on millions of Medicaid enrollees.

They also assert that the agency does not have a legal right to the data and that insurers’ sharing the information with OPM would “violate the core principles of the Health Insurance Portability and Accountability Act.” HIPAA requires certain organizations that maintain identifiable health information — such as hospitals and insurers — to protect it from being disclosed without patient consent. The proposal, the senators warn, threatens patients’ relationships with their clinicians, especially “sensitive disclosures regarding mental health, chronic illness, or other deeply personal conditions.”

“For these reasons, we strongly urge you to cease any further consideration of this proposal,” states the letter, which was sent to Kupor on April 19.

The American Federation of Government Employees, the largest union for federal employees, to Â鶹ŮÓÅ Health News’ reporting. The union noted in a statement from its national president, Everett Kelley, that OPM’s proposal “comes in the context of coordinated attacks on federal employees and repeated stretching of the legal boundaries for sharing sensitive personal data across government agencies.

“The question of what this administration intends to do with eight million Americans’ most private health information is not academic,” the AFGE statement read. “It is urgent.”

In an emailed statement, Kelley applauded the congressional letters.

“We are pleased that Democratic lawmakers on the Hill are just as outraged as we are over this administration’s blatant attempt to breach the privacy of millions of Americans across the country,” Kelley wrote. “We share their concerns regarding potential misuse of the information to continue illegally targeting workers and their demand for OPM to withdraw this proposal.”

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In a humbling exercise, employees were waiting to test whether their entry badges still worked at the Department of Health and Human Services — or whether they’d be walked back out by security because they were among the 10,000 unlucky ones whose jobs had suddenly been eliminated.

I thought back to that day recently as I researched and reported on a significant, under-the-radar proposal from the Office of Personnel Management, which oversees federal workers. 

According to a  in December, OPM is seeking personally identifiable medical and pharmaceutical claims information on federal employees and retirees, as well as their family members, who are enrolled in the Federal Employees Health Benefits or Postal Service Health Benefits programs. Just over 8 million Americans get coverage through such plans.

Right now, 65 insurance companies maintain data the agency wants, including information on prescriptions, diagnoses, and treatments. That would put a tremendous amount of personal information about federal employees in the hands of an administration that has earned a reputation for taking  against some workers and sharing sensitive data across agencies as part of its immigration and fraud crackdowns.  

My colleague Maia Rosenfeld and I wanted to know what lawyers and ethicists who work on health policy issues think about this proposal.  

On the one hand, sources told us, this sort of detailed data could be used by the federal government to improve the largest employer-sponsored health insurance system in the country. 

But doubts about the Trump administration’s motives percolated through every conversation we had. 

“The concern here is the more information they have, they could use it to discipline or target people who are not cooperating politically,” Sharona Hoffman, a health law ethicist at Case Western Reserve University, told me.  

And, though the notice states that insurers are legally permitted to disclose “protected health information” to the agency for “oversight,” Hoffman and others raised questions about OPM’s access to such a sweeping database of medical records under federal health privacy laws.  

Insurance companies — several of which declined to comment — would have to provide monthly reports to OPM with data on their members. One insurer, CVS Health, said in a public comment that insurers would be breaking the law by providing the information for OPM’s “vague and broad general purposes.” The association that represents many of those companies also has voiced objections to the proposal, which has not yet been finalized.  

OPM spokespeople did not respond to our repeated requests for comment.

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A from the Office of Personnel Management could dramatically change which personally identifiable medical information the agency obtains, giving it the power to see prescriptions employees had filled or what treatment they sought from doctors. The regulation would require 65 insurance companies that cover more than 8 million Americans — including federal workers, retired members of Congress, mail carriers, and their immediate family members — to provide monthly reports to OPM with identifiable health data on their members.

The proposal is prompting unease from insurers as well as health policy and legal experts, who are concerned about the legality of OPM acquiring such a sweeping database of sensitive health information, and the agency’s ability to safeguard it.

OPM could use the data to analyze costs and improve the system, said Sharona Hoffman, a health law ethicist at Case Western Reserve University in Ohio.

“But,” she said, “they are going to get very, very detailed and granular data about everything that happens. The concern here is the more information they have, they could use it to discipline or target people who are not cooperating politically.”

OPM spokespeople did not respond to repeated requests for comment. The agency’s notice asks insurers that offer Federal Employees Health Benefits or Postal Service Health Benefits plans to furnish “service use and cost data,” including “medical claims, pharmacy claims, encounter data, and provider data.” It says the data will “ensure they provide competitive, quality, and affordable plans.”

The notice, posted and sent to insurers in December, does not instruct them to redact identifying information — a burdensome process that they would need federal guidance to complete.

Instead, it states that insurers are legally permitted to disclose “protected health information” to OPM. Several experts in health policy and law consulted by Â鶹ŮÓÅ Health News said they interpreted the request to mean the Trump administration was seeking identifiable data.

The ask comes a year into a Republican administration that has been defined by haphazard mass layoffs and firings of thousands of federal workers, who say they were in acts of or for the . Under President Donald Trump, the government has also routinely tested the legal bounds of sharing sensitive and personally identifiable tax or health information across government agencies in its efforts to carry out mass immigration arrests or pursue identify fraud.

“You can anticipate a scenario where this information on 8 million Americans is now in the hands of OPM and there’s a real concern of how they use it,” said Michael Martinez, senior counsel at Democracy Forward, an advocacy organization that filed a public comment opposing OPM’s proposal in February. Martinez previously worked at OPM.

“They’ve given no information about how they would treat that information once they have it,” he said.

Among Martinez’s concerns is how the administration might use information about employees who have sought abortions — 41 states have some type of abortion ban — or transgender treatment, medical care that the Trump administration has tried to curb.

The American Federation of Government Employees, the largest union representing federal workers, did not respond to requests for comment.

Martinez and others who reviewed the notice for Â鶹ŮÓÅ Health News said the proposal was so vague that they were uncertain, exactly, what medical records OPM wants to access.

At the very least, they said, the proposal would allow the agency to access the medical and pharmaceutical claims of patients with their identifying information, such as names and birth dates. Claims data also includes diagnoses, treatments, visit length, and provider information.

OPM’s request to view “encounter data” could allow the agency to look at “anything and everything,” Hoffman noted.

That could include detailed medical records, such as a doctor’s notes or after-visit summaries.

Jonathan Foley, who worked at OPM advising on the Federal Employees Health Benefits program during the Obama and Biden administrations, said he doubts the agency has the capability to ingest such minutiae.

The agency, however, could easily begin collection of personally identifiable medical and pharmaceutical claims information from insurers, he said.

Foley said he sees a benefit to OPM having broader access to de-identified claims data. In recent years, OPM has ramped up its analysis of claims data, which has allowed it to examine prescription drug costs and encourage plans to offer federal workers cheaper alternatives. He’s worried, though, that the Trump administration’s proposal goes too far, because it appears to seek identifiable data.

“It’s kind of shocking to think of them having protected health information without having strict guardrails,” he said.

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, requires certain organizations that maintain identifiable health information — such as hospitals and insurers — to protect it from being disclosed without patient consent.

Those entities can disclose such information without consent only in specific scenarios, with a justification that it is deemed “reasonable” or “necessary.” Even then, HIPAA mandates that they provide only the minimum amount of information required.

OPM argues in its notice that it is entitled to the information from insurers “for oversight activities.”

But several people who reviewed the notice questioned whether OPM’s explanation for requesting the information is sufficient.

“The language in it seems quite broad and encompasses potentially a lot of information and data and is sort of light on justification,” said Jodi Daniel, a digital health strategist who helped develop the legal framework for HIPAA privacy rules over two decades ago.

Several major insurers that offer federal employee health plans — including the Blue Cross Blue Shield Association, Kaiser Permanente, and UnitedHealthcare — declined to comment on their plans to comply with the notice or offer insight on where plans to implement the data sharing stood.

Only one insurer individually weighed in with a public comment on OPM’s plan. In March, CVS Health executive Melissa Schulman urged the federal agency to reconsider its proposal.

“OPM’s request raises substantial HIPAA compliance issues,” Schulman wrote, arguing that federal law allows the agency to examine records but not to collect data. Insurers would be breaking the law by providing personal health information for OPM’s “vague and broad general purposes,” she added.

Schulman, who did not respond to additional questions from Â鶹ŮÓÅ Health News, also raised concerns about a lack of data privacy protections. She noted that insurers could be liable for security breaches or other situations “where consumer health information is inappropriately shared and outside of our control.”

In 2015, OPM announced the personal records of roughly 22 million Americans had been in a data breach that has been blamed on the Chinese government.

The Association of Federal Health Organizations, which represents CVS Health and dozens of other federal health plan carriers, also weighed in with a 122-page comment opposing the notice. In it, AFHO Chair Kari Parsons emphasized that insurance carriers are bound by HIPAA to safeguard personal health information.

Federal law requires carriers “to furnish ‘reasonable reports’ OPM determines to be necessary,” Parsons wrote, “not to furnish the individual claims data of every individual.”

This isn’t the first time OPM has requested detailed data from insurers. In the AFHO comment, Parsons noted OPM had made a similar proposal in 2010, prompting HIPAA concerns. She described how, after several years of negotiations with AFHO, they discussed — but OPM never finalized — an agreement in 2019 for carriers to share de-identified data with OPM.

But since then, Parsons wrote, OPM has collected such detailed information on enrollees and their families that, with OPM’s new request, the agency may be able to trace even de-identified records to individuals.

OPM has not provided any update since closing comments in March. The agency would need to publish a final decision before anything officially changes.

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“I feel like I’m suffocating inside this shelter, trapped with no way out,” Carlos’ son said, according to one of the teens’ attorneys, when asked to describe how he felt after months at the Houston-area facility. “Every day, the same routine. Every day, feeling stuck. It makes me feel hopeless and terrified.”

During daily video calls, Carlos, who had temporary protected status, urged the siblings to be patient, to trust the process. Federal officials had vetted Carlos before he could be granted custody and told him his case was complete. He believed he would soon be back with his children, who, like him, had sought refuge from political violence in Venezuela.  

An immigration officer called Carlos on a Friday and asked him to attend a meeting at an ICE office the following Monday to discuss reunification with his children. Once Carlos arrived, officers tried to force him to sign documents he said he didn’t understand. When he refused, they stripped off his clothes, seized his ID and belongings, and chained him by the neck, waist, and legs.

“They tricked me,” Carlos said in a phone call from an immigration detention center in El Paso, Texas, where he was held for several months. “They used my children to grab me,” he said.  

In reporting on the family’s story, Â鶹ŮÓÅ Health News reviewed court documents, spoke with the family’s immigration attorneys, interviewed Carlos, and reviewed statements from his children, translated from Spanish. Carlos is a pseudonym, being used at the request of attorneys concerned that speaking out could jeopardize Carlos’ immigration case or further delay his reunion with his family.

Using Children to Arrest Parents

Since 2003, the Department of Health and Human Services’ Office of Refugee Resettlement has cared for immigrant children under 18 who arrive in the country without their parents, often fleeing violence, abuse, or trafficking. The office, which in February had more than 2,300 children in shelters or with foster families across the country, is supposed to promptly release them to vetted caregivers, typically parents or other family members already living in the country.

Congress placed this responsibility with the health agency over 20 years ago to prioritize the well-being of unaccompanied children and separate their care from immigration enforcement priorities.

Now the second Trump administration is using migrant children held by the resettlement office to lure their parents, such as Carlos, whether or not they have a criminal record. A Â鶹ŮÓÅ Health News investigation found the resettlement office, , coordinates with the Department of Homeland Security to arrest people seeking custody of migrant children.

Arrest documents show Homeland Security Investigations, the arm of the agency that normally focuses on organized criminals and traffickers, will interview parents or other caregivers then arrest them if they are in the country illegally. Before Donald Trump returned to the White House, the resettlement office prohibited data sharing and collaboration with immigration enforcement, and it did not deny caregivers custody of children solely because of their immigration status. Those last year.

It’s unclear exactly how many caregivers have been baited into arrest. LAist indicating more than 100 have been arrested while trying to get their kids out of detention, but Â鶹ŮÓÅ Health News could not independently verify that number with federal agencies.

Since February, the Department of Health and Human Services, Department of Homeland Security, and Justice Department have not responded to questions about caregiver arrests. Prior to leaving DHS last month, Assistant Secretary Tricia McLaughlin said the administration protects children from being released to people who shouldn’t care for them. Andrew Nixon, an HHS spokesperson, referred questions related to immigration enforcement to DHS.

At the same time, the resettlement office has that make it harder for caregivers to gain custody of unaccompanied children. These include narrowing the range of accepted documents, requiring fingerprint-based background checks for every adult in the home and backup caregivers, and requiring in-person appointments to verify identification documents, sometimes with ICE agents present. The requirements keep “children safe from traffickers and other bad, dangerous people,” Nixon said.

As of January, the agency had detained at least 300 children already placed with vetted sponsors and asked their caregivers to reapply, according to the National Center for Youth Law and the Democracy Forward Foundation. The advocacy groups filed calling these actions “a quieter, new form of family separation.” 

Reverse Separation

Dulce, a Guatemalan mother in Virginia, said her 8-year-old son was sent to a government shelter after he was detained during a traffic stop last summer while visiting family members in a different state.

At first, Dulce expected to get her son back within days — she had passed the government’s sponsorship requirements in 2024 and was reunited with him three weeks after he first crossed the border. But resettlement agency officials asked her to repeat the entire process and resubmit documents, Dulce said. It took eight months to get him back.

Dulce is a pseudonym being used at her request because she fears speaking out could get her deported.

At one point, Dulce was told to attend an interview at an ICE office to show her identification as part of the process of reuniting with her son. She refused out of fear that she too might be detained, because she doesn’t have legal status. She believes ICE agents visited her home at one point.

“I stopped going home,” Dulce said. “I lived with some of my friends for days.”

Even though she lived just 45 minutes away, Dulce was allowed to visit her son only twice a month.

Until recently, most unaccompanied children landed in government custody after being detained at the border. But border crossings started to fall in 2024, and the number of people coming to the U.S. has dropped precipitously in President Trump’s second term.

Now, hundreds of kids have been taken to government shelters after being swept up inside the country, often during immigration raids or traffic stops, according to the advocates’ lawsuit. Many were already living with relatives, including guardians already vetted by the resettlement agency.

Releases have grinded nearly to a halt. According to the resettlement office, children in its custody stayed in government shelters or foster care for an average of one month in 2024. As of February, that had jumped to more than half a year.

When children do get released, it’s often only after their attorneys file a lawsuit in federal court challenging their detention as unconstitutional.

Authorities released Dulce’s son to her in February after the boy’s attorneys filed such a petition. Dulce said she’s relieved to have him back but still anxious that ICE could show up at their house.

Immigrants at Risk

During Trump’s first term, his administration was criticized for of children who had been released from custody. President Joe Biden was blamed for how his administration processed a surge of unaccompanied children that peaked in 2021 with about 22,000 in the resettlement office’s custody. Though most children were placed with legitimate sponsors, some were placed with people who hadn’t cleared , putting them at risk of .

The Trump administration says it is checking on those , and the Justice Department has prosecuted . On March 1, Homeland Security Secretary Kristi Noem, who is set to leave her role at the , touted a , including the resettlement office, that DHS said had tracked down 145,000 unaccompanied children who had been placed with caregivers during Biden’s term.

Yet internal HHS reports about that initiative obtained by Â鶹ŮÓÅ Health News show that nearly 11,800 of those migrant children and nearly 500 of their caregivers were arrested as of Jan. 29. Only 125 of those migrant children and 55 of those caregivers were arrested for alleged criminal activity, suggesting the majority were for immigration violations.

HHS referred questions about the figures in the reports to DHS, which did not respond to requests for comment about the data. However, Michelle Brané, who was a DHS official in the Biden administration, said the figures show that most of the arrests were to detain and deport migrants. Previously, the administration targeted parents and caregivers who had paid for children to cross the border, trying to levy smuggling charges against them.

“They have really dropped that pretense in a lot of ways, and they are going for anyone openly,” Brané said. “These numbers clearly reflect that this is not about public safety or about safety of the children.”

Case on Hold

Carlos left Venezuela in 2022 because of death threats and, like thousands of others fleeing that country, was granted what’s called temporary protected status under the Biden administration. That protection for most Venezuelans by the Trump administration.

In January 2025, days before Trump was sworn in for his second term, Carlos’ children crossed the border from Mexico to the U.S., turned themselves over to border authorities, and were immediately placed in the resettlement agency’s custody. Carlos spent months submitting paperwork to reunite with them. He said he’s their only parent, because their mother left when they were toddlers.  

Officials visited his home twice and determined he was fit to care for them, according to court documents petitioning for his release from detention. He passed DNA testing, proving he’s the biological father, one of his attorneys said. His arrest documents show he has “no criminal history.” In July, Carlos was told his reunification case was complete and being sent for approval. But then, with little explanation, the case was put on hold.

Before his arrest by ICE, Carlos said, he drove 14 hours each way from his home to visit his children. Once there, he could see them for only one hour. When he was in detention, he said, he spoke to them about every two weeks in quick, monitored phone calls.

He’s trying to stay hopeful, but it’s hard.

According to documents completed by ICE officers during his arrest and submitted in his court case, Carlos was arrested under an initiative called Operation Guardian Trace, which requires immigration officers to detain potential caregivers if they are in the country without legal authorization and recommend that they be deported.

“This operation is designed to force parents to make an impossible choice between reuniting with their children and seeking safety,” said one of Carlos’ attorneys, Chiqui Sanchez Kennedy of the Galveston-Houston Immigrant Representation Project, a nonprofit that helps low-income immigrants.

‘I’m Going to Wait’

In March, a federal judge said officials had unlawfully detained Carlos and he was released on bond.

But his children still face an uncertain future for now. Government shelters often lack sufficient resources, , and social workers say lengthy stays in these facilities can result in additional trauma.

“Not only is it bad, full stop, but the longer you’re there, the worse it gets,” said Jonathan Beier, associate director of research and evaluation for the Acacia Center for Justice’s Unaccompanied Children Program, which coordinates legal services for unaccompanied minors.

Carlos’ children could also be sent back to the country they fled. Because of his detention, Carlos will have to redo much of the process to reunite with them, according to an attorney for the children, Alexa Sendukas, also with the Galveston-Houston Immigrant Representation Project.

In statements shared through Sendukas, Carlos’ daughter said she no longer wants to be around others and spends most of the time in her room. His son, now 15, described having panic attacks and feeling that he’s missing out on life, whether it’s the opportunities he longs for — to learn English, to study science — or watching basketball with his family.

“I remember when I first arrived at this shelter, I was so hopeful and had faith that I would be reunited with my dad soon,” he said.

Carlos’ daughter spent the day crying in bed when the siblings learned their father had been detained. For days, they didn’t know where he was. Now, they fear the only way out is through adoption or foster care.

“I am afraid,” she said. “I’m going to wait for my dad forever.”

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“I have these conversations with children starting at 8, 10, 12 years old: What do you want to be when you grow up?” Duane said. If you’re a child who wants to be a doctor, for instance, “there are things you need to put in place. If you hope to have children one day, there are things that you need to consider and have the conversation early.”

The proposal from Duane, a specialist in who is affiliated with the anti-abortion Charlotte Lozier Institute, got a warm reception from the audience gathered for the Trump administration’s inaugural .

The three-day event hosted by the Department of Health and Human Services last week was designed to “explore breakthroughs in research, prevention, diagnosis, and treatment of health conditions that affect women across the lifespan.” Government officials hosted an eclectic mix of wealthy philanthropists, alternative medicine influencers, health tech executives, and medical researchers to discuss a wide range of issues, from Lyme disease to gut health.

Seeking to reach women at a moment when President Donald Trump’s among a key voting bloc, the Make America Healthy Again movement, the administration-sponsored event elevated perspectives outside conventional standards of medical care and counter to many women’s health choices.

For example, during a 40-minute panel hosted by Alexis Joel, the wife of musician Billy Joel, several doctors raised concerns about how frequently hormonal birth control is used to treat women’s health symptoms. Two female physicians on the panel said they were uncomfortable with the idea of using birth control pills for their own treatment, noting that their “values” or “cultural perspective” did not align with use of the medication.

Nearly a third of U.S. women ages 18 to 49 report having used birth control pills in the previous 12 months, according to a . In addition to their use as a contraceptive, the pills are prescribed for , including preventing anemia from heavy periods and treating uterine fibroids.

Joel, who has about her experience with endometriosis, brought her own doctor, Tamer Seckin, to discuss the common, painful condition, in which thick tissue develops outside of the uterus. Seckin said women’s concerns about menstrual pain are often dismissed by doctors, leading to missed diagnoses.

Asima Ahmad, a doctor who specializes in fertility and co-founded Carrot, a company that offers job-based fertility benefits, offered another explanation for why the disease is overlooked.

“As providers, we should learn how to treat it, rather than covering it up with birth control pills or progesterone,” she said.

Hormonal birth control pills, which help slow the growth of new tissue, are for treating endometriosis, according to the American College of Obstetricians and Gynecologists.

Andrea Salcedo, a California OB-GYN on the panel who said she has endometriosis as well, said she declined birth control as a treatment. She noted her decision aligned with her “values,” in particular her desire to have more children.

“Is this all that we can do?” Salcedo said of being offered birth control.

Salcedo said she prescribes alternative treatments to her patients because she believes the root cause of infertility is directly related to gut health. Cod liver oil and vitamin A top her list, she said.

whether there is an association between vitamin deficiencies and endometriosis. Taking too much vitamin A can cause health problems, including if taken while pregnant.

Those supplements have been touted by HHS Secretary Robert F. Kennedy Jr. — including, falsely, as during an outbreak in Texas last year.

About a quarter of U.S. adults wrongly believe vitamin A can prevent measles infections, according to a .

The panel also coalesced around the idea that a lack of knowledge is the root problem: Girls do not receive enough education on how to become pregnant or identify the warning signs of infertility, the doctors suggested.

Education has become too hyperfocused on preventing pregnancy, Ahmad said.

“I was in junior high, and I was learning about trying not to get pregnant, and I was scared that if I sit in a room with a guy alone, I will,” she said. “They put all of this fear into it, but family planning isn’t just about preventing pregnancy. It’s about learning about how to build your family.”

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The tensions risk fraying Kennedy’s dynamic MAHA coalition, potentially driving away critical supporters who helped fuel President Donald Trump’s 2024 election win.

The movement’s grassroots membership includes suburbanites, women, and independents who are generally newer entrants to the GOP and laser-focused on achieving certain results around the nation’s food supply and vaccines.

Promoting healthy foods tops their list and will be at the center of the White House’s pitch to voters during the midterm election cycle.

“President Trump’s mass appeal partly lies in his willingness to question our country’s broken status quo,” White House spokesperson Kush Desai said in a statement. “That includes food standards and nutrition guidelines that have helped fuel America’s chronic disease epidemic. Overhauling our food supply and nutrition standards to deliver on the MAHA agenda remains a key priority for both the President and his administration.”

At the same time, with most Americans , the White House has cooled on Kennedy’s aggressive policies to curb vaccines and MAHA’s interest in tamping down environmental chemicals that are linked to disease.

The result: Republicans are realizing just how demanding the MAHA vote can be. Moms Across America leader Zen Honeycutt warned that Republicans are facing their biggest setback yet with the MAHA movement, after Trump signed an executive order to support production of glyphosate, a herbicide the World Health Organization has .

“It has caused the biggest uproar in MAHA,” Honeycutt said during a CNN interview in late February.

A White House Warning

Trump’s top pollster, Tony Fabrizio, cautioned in December that an embrace of Kennedy’s anti-vaccine policies could cost politicians their jobs this year.

Eight in 10 MAHA voters and 86% of all voters believe vaccines save lives, his poll of 1,000 voters in 35 competitive districts found.

“In the districts that will decide the control of the House of Representatives next year, Republican and Democratic candidates who support eliminating long standing vaccine requirements will pay a price in the election,” on the poll stated.

The White House has since shaken up senior staffing at HHS, including removing from the deputy secretary role and his job as acting director of the Centers for Disease Control and Prevention, in which he curtailed the agency’s childhood vaccination recommendations. Ralph Abraham, a vaccine skeptic who as Louisiana’s surgeon general suspended its vaccination promotion program last year, stepped down as the CDC’s principal deputy director in late February.

, a doctor who said in congressional testimony that he doesn’t believe vaccines cause autism, is now running the CDC in addition to directing the National Institutes of Health.

Though Trump himself has frequently espoused doubts and mistruths about vaccines, polling around anti-vaccine policy has undoubtedly shaken the White House’s confidence during a tough midterm election year, said former , an Indiana Republican and retired doctor who left Congress last year.

Bucshon said Republicans can’t risk alienating voters, especially parents of young children who might be moved by Democratic attack ads on the topic at a time when hundreds of measles cases are popping up across the U.S.

“That’s the reason you’re seeing the White House get nervous about it,” Bucshon said. “This is just the political reality of it.”

Kennedy built some of his MAHA following with calls to end federal approval and recommendations for the covid vaccines during the pandemic. The Advisory Committee on Immunization Practices, a federal panel of outside experts who were handpicked by Kennedy to develop national vaccine recommendations, is expected to review and possibly withdraw its recommendation for covid shots. Its February meeting was postponed and is now scheduled for March 18-19, when the panel plans to discuss injuries from covid vaccines, HHS spokesperson Andrew Nixon confirmed on March 11.

“I’m not deaf to the calls that we need to get the covid vaccine mRNA products off the market. All I can say is stay tuned and wait for the upcoming ACIP meeting,” ACIP Vice Chair Robert Malone , a conservative account on the social platform X, before the meeting was postponed. “If the FDA won’t act, there are other entities that will.”

No Fury Like Scorned MAHA Moms

Bipartisan support is also extremely high — above 80% — for another core tenet of the MAHA agenda: eliminating the use of certain pesticides on crops.

But MAHA leaders were incensed when Trump issued a Feb. 18 promoting the production of glyphosate, a chemical used in weed killers sprayed on U.S. crops and which Kennedy has railed against and sued over because of its reported links to cancer.

“There’s gonna be ups and downs, and there is zero question that this week was a down,” Calley Means, a senior adviser to the health secretary and a former White House employee, told a MAHA rally in Austin, Texas, on Feb. 26. “I am not going to gaslight or sugarcoat it: This glyphosate thing was extremely disappointing. Bobby’s disappointed.”

Despite deep unhappiness from MAHA followers, Kennedy endorsed Trump’s executive order defending access to such pesticides.

“I support President Trump’s Executive Order to bring agricultural chemical production back to the United States and end our near-total reliance on adversarial nations,” Kennedy .

Without offering policy changes, Kennedy promised a future agricultural system that “is less dependent on harmful chemicals.”

White House officials are now trying to downplay the executive order.

“The President’s executive order was not an endorsement of any product or practice,” Desai said in a statement.

But that’s done little to dampen criticism from leading MAHA influencers who had hoped, with Kennedy’s influence in the administration, that the chemical would be banned.

Some Democrats see an opening.

of Maine earned cheers from MAHA loyalists for co-sponsoring legislation with Rep. Thomas Massie (R-Ky.) to undo the executive order.

“The Trump Admin. cannot keep paying lip service to while propping up Big Chemical like this and choosing corporate profits over Americans’ health,” .

, a prominent MAHA influencer who promotes healthy eating, responded on X with a “HELL YES.”

‘Eat Real Food’

The White House and Kennedy are refocusing their messaging to emphasize one of the most popular elements of the MAHA platform: food.

At the start of the year, Kennedy unveiled new dietary guidelines that emphasize vegetables, fruits, and meats while urging Americans to avoid ultraprocessed foods.

Kennedy has leaned into his new “Eat Real Food” campaign, launching a nationwide tour in January. Ahead of the late-February MAHA rally, he stopped at a barbecue joint in Austin where he took photos with stacks of smoked ribs and grilled sausages. Large “Eat Real Food” signs have been provided for crowds of supporters to hold up during major announcements at HHS’ headquarters this year.

Focusing on nutrition will please MAHA moms, suburban swing voters, and conservatives alike, said , a physician and former Republican representative from Texas.

“They keep them happy by talking about the food pyramid,” Burgess said. “That’s an area where there is broad, bipartisan support.”

Indeed, Fabrizio’s poll shows equal support — 95% — among respondents who voted for former Vice President Kamala Harris and those who voted for Trump for requiring labeling of harmful ingredients in ultraprocessed foods.

Trump is keenly aware that Kennedy’s MAHA movement is key to his political survival. At a Cabinet meeting in January, Kennedy rattled off a list of his agency’s efforts researching autism and tackling high drug prices.

Trump leaned in at the table.

“I read an article today where they think Bobby is going to be really great for the Republican Party in the midterms,” , “so I have to be very careful that Bobby likes us.”

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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 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, 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.

Â鶹ŮÓÅ 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 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 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 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 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 , 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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One year after taking charge of the nation’s health department, Health and Human Services Secretary Robert F. Kennedy Jr. hasn’t held true to many of he made while appealing to U.S. senators concerned about the longtime anti-vaccine activist’s plans for the nation’s care.

Kennedy squeaked through a narrow Senate vote to be confirmed as head of the Department of Health and Human Services, only after making a number of public and private guarantees about how he would handle vaccine funding and recommendations as secretary.

Here’s a look at some of the promises Kennedy made during his confirmation process.

The Childhood Vaccine Schedule

In two hearings in January 2025, Kennedy repeatedly assured senators that he supported childhood vaccines, noting that all his children were vaccinated.

Sen. Elizabeth Warren (D-Mass.) about the money he’s made in the private sector from lawsuits against vaccine makers and accused him of planning to profit from potential future policies making it easier to sue.

“Kennedy can kill off access to vaccines and make millions of dollars while he does it,” Warren said during the Senate Finance Committee hearing. “Kids might die, but Robert Kennedy can keep cashing in.”

Warren’s statement prompted an assurance by Kennedy.

“Senator, I support vaccines,” he said. “I support the childhood schedule. I will do that.”

Days later, Sen. Bill Cassidy of Louisiana, chair of the Senate Health, Education, Labor, and Pensions Committee, declared Kennedy had pledged to maintain existing vaccine recommendations if confirmed. Cassidy, a physician specializing in liver diseases and a vocal supporter of vaccination, had questioned Kennedy sharply in a hearing about his views on shots.

“If confirmed, he will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ recommendations without changes,” Cassidy said during a speech on the Senate floor explaining his vote for Kennedy.

A few months after he was confirmed, Kennedy fired all the incumbent members of the vaccine advisory panel, known as ACIP, and appointed new members, including several who, like him, oppose some vaccines. The panel’s recommendations soon changed drastically.

Last month, the CDC removed its universal recommendations for children to receive seven immunizations, those protecting against respiratory syncytial virus, meningococcal disease, flu, covid, hepatitis A, hepatitis B, and rotavirus. The move followed a memorandum from the White House calling on the CDC to cull the schedule.

Now, those vaccines, which researchers estimate have prevented thousands of deaths and millions of illnesses, are recommended by the CDC only for children at high-risk of serious illness or after consultation between doctors and parents.

In response to questions about Kennedy’s actions on vaccines over the past year, HHS spokesperson Andrew Nixon said the secretary “continues to follow through on his commitments” to Cassidy.

“As part of those commitments, HHS accepted Chairman Cassidy’s numerous recommendations for key roles at the agency, retained particular language on the CDC website, and adopted ACIP recommendations,” Nixon added. “Secretary Kennedy talks to the chairman at a regular clip.”

Cassidy and his office have repeatedly rebuffed questions about whether Kennedy, since becoming secretary, has broken the commitments he made to the senator.

Vaccine Funding Axed

Weeks after Kennedy took over the federal health department, the CDC pulled back $11 billion in covid-era grants that local health departments were using to fund vaccination programs, among other initiatives.

That happened after Kennedy pledged during his confirmation hearings not to undermine vaccine funding.

Kennedy replied “Yes” when Cassidy asked him directly: “Do you commit that you will not work to impound, divert, or otherwise reduce any funding appropriated by Congress for the purpose of vaccination programs?”

A federal judge later ordered HHS to distribute the money.

The National Institutes of Health, part of HHS, also yanked dozens of research grants supporting studies of vaccine hesitancy last year. Kennedy, meanwhile, ordered the cancellation of a half-billion dollars’ worth of mRNA vaccine research in August.

A Discredited Theory About Autism

Cassidy said in his floor speech that he received a guarantee from Kennedy that the CDC’s website would not remove statements explaining that vaccines do not cause autism.

Technically, Kennedy kept his promise not to remove the statements. The website still says that vaccines do not cause autism.

But late last year, new statements sprung up on the same webpage, baselessly casting doubt on vaccine safety. “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism,” the now misleadingly reads.

The webpage also states that the public has largely ignored studies showing vaccines do cause autism.

That is false. Over decades of research, scientific studies have repeatedly concluded that there is no link between vaccines and autism.

A controversial 1998 study that captured global attention did link the measles, mumps, and rubella vaccine to autism. It was retracted for being fraudulent — though not until a decade after it was published, during which there were sharp declines in U.S. vaccination rates.

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Warning patients could deter them from signing up for a program called Emergency Medicaid, through which the for the cost of emergency treatment for immigrants who are ineligible for standard Medicaid coverage.

But if hospitals don’t disclose that the patients’ information is shared with federal law enforcement, they might not know that their medical coverage puts them at risk of being located by Immigration and Customs Enforcement.

“If hospitals tell people that their Emergency Medicaid information will be shared with ICE, it is foreseeable that many immigrants would simply stop getting emergency medical treatment,” said , a research professor at Georgetown University’s Center for Children and Families. “Half of the Emergency Medicaid cases are for the delivery of U.S. citizen babies. Do we want these mothers avoiding the hospital when they go into labor?”

For more than a decade, hospitals and states have assured patients that their personal information, including their home addresses and immigration status, would not be shared with immigration enforcement officials when they apply for federal health care coverage. guaranteed the agency would not use information from health coverage applications for enforcement activities.

But that changed last year, after President Donald Trump returned to the White House and ordered one of the most aggressive immigration crackdowns in recent history. His administration began funneling data from a variety of government agencies to the Department of Homeland Security, including filed with the IRS.

The Centers for Medicare & Medicaid Services, part of the Department of Health and Human Services, agreed last spring to give ICE officials direct access to a Medicaid database that includes enrollees’ addresses and citizenship status.

Twenty-two states, all but one led by Democratic governors, the Medicaid data-sharing agreement, which the administration did not formally announce until a federal judge ordered it to do so last summer. The judge that in those states, ICE could access information in the Medicaid database only about people in the country unlawfully. Â鶹ŮÓÅ Health News contacted more than a dozen hospitals and hospital associations in states and cities that have been targets of ICE sweeps. Many declined to comment on whether they’ve updated their disclosure policies after the ruling.

Of those that responded, none said they are directly warning patients that their personal information may be shared with ICE when they apply for Medicaid coverage.

“We do not provide legal advice about federal government data-sharing between agencies,” Aimee Jordon, a spokesperson for M Health Fairview, a Minneapolis-based hospital system, said in an email to Â鶹ŮÓÅ Health News. “We encourage patients with questions about benefits or immigration-related concerns to seek guidance from appropriate state resources and qualified legal counsel.”

Information on Applications

Some states’ Emergency Medicaid applications specifically ask for a patient’s immigration status — and still assure people that their information will be kept secure and out of the hands of immigration enforcement officials.

For example, as of Feb. 3, California’s application still included language advising applicants that their immigration information is “confidential.”

“We only use it to see if you qualify for health insurance,” states the 44-page form, which the state’s Medicaid program, known as Medi-Cal, in January.

California Department of Health Care Services spokesperson Anthony Cava said in a statement that the agency, which oversees Medi-Cal, will “ensure that Californians have accurate information on the privacy of their data, including by revising additional publications as necessary.”

Until late January, Utah’s Medicaid website also claimed its Emergency Medicaid program did not share its information with immigration officials. After Â鶹ŮÓÅ Health News contacted the state agency, Kolbi Young, a spokesperson, said Jan. 23 that the language would be taken down immediately. It was removed that day.

Oregon Health & Science University, a hospital system based in Portland, offers immigrant patients developed by the state Medicaid program for those with concerns about how their information might be used. The document does not directly say that Medicaid enrollees’ information is shared with ICE officials.

Hospitals rely on Emergency Medicaid to reimburse them for treating people who would qualify for Medicaid if not for their citizenship status — those in the country illegally and lawfully present immigrants, such as those with a student or work visa. The coverage pays only for emergency medical and pregnancy care. Typically, hospital representatives help patients apply while they are still in the medical facility.

The main Medicaid program, which covers a much broader range of services for over 77 million low-income and disabled people, does not cover people living in the country illegally.

Examining Emergency Medicaid enrollment is the most obvious way, then, for deportation officials to identify immigrants, including those who might not reside in the U.S. lawfully.

HHS spokesperson Rich Danker said in an email that CMS — which oversees Medicaid, a joint state-federal program — is sharing data with ICE after the judge’s ruling. But he would not answer how the agency is ensuring it is sharing information only on people who are not lawfully present, as the judge required.

With ICE now getting direct access to the personal information of millions of Medicaid enrollees, hospitals — while “definitely in a tough position” — should be up-front about the changes, said Sarah Grusin, at the National Health Law Program, an advocacy group.

“They need to be telling people that the judge has permitted sharing of information, including their address, for people who are not lawfully residing,” she said. “Once this information is submitted, you can’t protect it from disclosure at this point.”

Grusin said she advises families to weigh the importance of seeking medical care against the risk of having their information shared with ICE.

“We want to give candid, honest information even if it means the decision people have to make is really hard,” she said.

Those who have previously enrolled in Medicaid or can easily search their address online should assume that immigration officials already have their information, she added.

Emergency Medicaid

Emergency Medicaid coverage was established in the mid-1980s, when a federal law began requiring hospitals to treat and stabilize all patients who show up at their doors with a life-threatening condition.

Federal government spending on Emergency Medicaid accounted for nearly $4 billion in 2023, or of total federal spending on Medicaid.

States send monthly reports to the federal government with detailed information about who enrolls in Medicaid and what services they receive. The judge’s ruling in December limited what CMS can share with ICE to only basic information, including addresses, about Medicaid enrollees in the 22 states that sued over the data-sharing arrangement. ICE officials are not supposed to access information about the medical services people receive, per the judge’s order.

The judge also prohibited the agency from sharing the data of U.S. citizens or lawfully present immigrants from those states.

Deportation officials have access to personal Medicaid information of all enrollees in the remaining 28 states.

The federal health agency has not clarified how it is ensuring that certain states’ information on citizens and legal residents is not shared with ICE. But Medicaid experts say it would be nearly impossible for the agency to separate the data, raising questions about whether the Trump administration is complying with the judge’s order.

The Trump administration’s efforts to deport immigrants living in the country illegally have had implications on immigrant families seeking care. About a third of adult immigrants reported skipping or postponing health care in the past year, according to a released in November. (Â鶹ŮÓÅ is a health information nonprofit that includes Â鶹ŮÓÅ Health News.)

Bethany Pray, the chief legal and policy officer at the Colorado Center on Law and Policy, warned that sharing Medicaid data directly with deportation officials will force even tougher decisions upon some families.

“This is very concerning,” Pray said. “People should not have to choose between giving birth in a hospital and wondering if that means they risk deportation.”

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Those same dollars can’t be used, though, to pay for most baby formulas, toothbrushes — or insurance premiums.

President Donald Trump and some Republicans are pitching the accounts as an alternative to expiring enhanced federal subsidies that have lowered insurance premium payments for most Americans with Affordable Care Act coverage. But legal limits on how HSAs can and can’t be used are prompting doubts that expanding their use would benefit the predominantly low-income people who rely on ACA plans.

The Republican proposals come on the heels of a White House-led change to extend HSA eligibility to more ACA enrollees. One group that would almost certainly benefit: a slew of companies selling expensive wellness items that can be purchased with tax-free dollars from the accounts.

There is also deep skepticism, even among conservatives who support the proposals, that the federal government can pull off such a major policy shift in just a few weeks. The enhanced ACA subsidies expire at the end of the year, and Republicans are still debating among themselves whether to simply extend them.

“The plans have been designed. The premiums have been set. Many people have already enrolled and made their selections,” Douglas Holtz-Eakin, the president of the American Action Forum, a conservative think tank, warned senators on Nov. 19. “There’s very little that this Congress can do to change the outlook.”

Cassidy’s Plan

With health savings accounts, people who pay high out-of-pocket costs for health insurance are able to set aside money, without paying taxes, for medical expenses.

For decades, Republicans have promoted these accounts as a way for people to save money for major or emergent medical expenses without spending more federal tax dollars on health care.

The latest GOP proposals would build on included in Republicans’ One Big Beautiful Bill Act, which makes millions more ACA enrollees eligible for health savings accounts. Starting Jan. 1, those enrolled in Obamacare’s cheapest coverage may open and contribute to HSAs.

Now Republicans are making the case that, in lieu of the pandemic-era enhanced ACA subsidies, patients would be better off being given money to cover some health costs — specifically through deposits to HSAs.

The White House has yet to release a formal proposal, though suggested it could include HSA contributions as well as temporary, more restrictive premium subsidies.

Sen. Bill Cassidy — a Louisiana Republican who chairs the Senate Health, Education, Labor, and Pensions Committee and is facing a potentially tough reelection fight next year — has proposed loading HSAs with federal dollars sent directly to some ACA enrollees.

“The American people want something to pass, so let’s find something to pass,” Cassidy said on Dec. 3, pitching his plan for HSAs again. “Let’s give power to the patient, not profit to the insurance company.”

He has promised a deal can be struck in time for 2026 coverage.

Democrats, whose support Republicans will likely need to pass any health care measure, have widely panned the GOP’s ideas. They are calling instead for an extension of the enhanced subsidies to control premium costs for most of the nearly 24 million Americans enrolled in the ACA marketplace, a larger pool than the 7.3 million people the Trump administration estimates soon will be eligible for HSAs.

HSAs “can be a useful tool for very wealthy people,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee. “But I don’t see it as a comprehensive health insurance opportunity.”

Who Can Use HSAs?

The IRS sets restrictions on the use of HSAs, which are typically managed by banks or health insurance companies. For starters, on the ACA marketplace, they are available only to those with the highest-deductible health insurance plans — the bronze and catastrophic plans.

There are limits on how much can be deposited into an account each year. In 2026 it will be $4,400 for a single person and $8,750 for a family.

Flexible spending accounts, or FSAs — which are typically offered through employer coverage — work similarly but have lower savings limits and cannot be rolled over from year to year.

The law that established HSAs prohibits the accounts from being used to pay insurance premiums, meaning that without an overhaul, the GOP’s proposals are unlikely to alleviate the problem at hand: skyrocketing premium payments. Obamacare enrollees who receive subsidies are projected to more out-of-pocket for their premiums next year on average, absent congressional action.

Even with the promise of the government depositing cash into an HSA, people may still opt to go without coverage next year once they see those premium costs, said , an economics professor at the University of Michigan who worked in the Biden administration.

“For people who stay in the marketplace, they’re going to be paying a lot more money every month,” he said. “It doesn’t help them pay that monthly premium.”

Others, Buchmueller noted, might be pushed into skimpier insurance coverage. Obamacare bronze plans come with the highest out-of-pocket costs.

An HHS Official’s Interest

Health savings accounts can be used to pay for many routine medical supplies and services, such as medical and dental exams, as well as emergency room visits. In recent years, the government has expanded the list of applicable purchases to include over-the-counter products such as Tylenol and tampons.

Purchases for “general health” are not permissible, such as fees for dance or swim lessons. Food, gym memberships, or supplements are not allowed unless prescribed by a doctor for a medical condition or need.

Americans are as their insurance deductibles rise, according to Morningstar. The investment research firm found that assets in HSAs grew from $5 billion 20 years ago to $146 billion last year. President George W. Bush signed the law establishing health savings accounts in 2003, with at the time that they would “help more American families get the health care they need at a price they can afford.”

Since then, the accounts have become most common for wealthier, white Americans who are healthy and have employer-sponsored health insurance, according to released by the nonpartisan Government Accountability Office in September.

Now, even more money is expected to flow into these accounts, because of the One Big Beautiful Bill Act. Companies are taking notice of the growing market for HSA-approved products, with major retailers such as Amazon, Walmart, and Target developing online storefronts dedicated to devices, medications, and supplies eligible to be purchased with money in the accounts.

Startups have popped up in recent years dedicated to helping people get quick approval from medical providers for various — and sometimes expensive — items, memberships, or fitness or health services.

Truemed — a company co-founded in 2022 by Calley Means, a close ally of Health and Human Services Secretary Robert F. Kennedy Jr. — has emerged as one of the biggest players in this niche space.

A $9,000 red cedar ice bath and a $2,000 hemlock sauna, for example, are available for purchase with HSA funds through Truemed. So, too, is the $1,700 bassinet, designed to automatically respond to the cries of a newborn by gently rocking the baby back to sleep.

Truemed’s executives say its most popular products are its smaller-dollar fitness offerings, which include kettlebells, supplements, treadmills, and gym memberships.

“What we’ve seen at Truemed is that, when given the choice, Americans choose to invest their health care dollars in these kinds of proven lifestyle interventions,” Truemed CEO Justin Mares told Â鶹ŮÓÅ Health News.

Means joined the Department of Health and Human Services in November after a stint earlier this year at the White House, where he worked when Trump signed the One Big Beautiful Bill Act into law in July. Truemed’s general counsel, Joe Vladeck, said Means left the company in August.

Asked about Means’ potential to benefit from the law’s expansion of HSAs, HHS spokeswoman Emily Hilliard said in a statement that “Calley Means will not personally benefit financially from this proposal as he will be divesting from his company since he has been hired at HHS as a senior advisor supporting food and nutrition policy.”

Truemed is privately held, not publicly traded, and details of how Means will go about divesting have not been disclosed.

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