State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly known as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a �鶹Ů�� Health News investigation showed.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax-and-spending law. The changes will add red tape and restrictions. They are coming at a steep price ― both in the cost to taxpayers and coverage losses ― according to state documents obtained by �鶹Ů�� Health News and interviews.

The documents show��government agencies��will spend millions��to save��considerably��more��by��removing��people from��health benefits.��While states��sign��eligibility system contracts with companies��and��work with them to manage��updates, the federal government��foots��most of the bill.

The law’s Medicaid policies will cause����to��become uninsured��by 2034, according to the nonpartisan Congressional Budget Office.��Roughly����will lose��access to��monthly cash��assistance��for��food, including those with children.��

In five states��alone,����for state officials��and reviewed by �鶹Ů�� Health News��show that changes��will cost at least $45.6��million��combined.��

The law��requires most states��to��tie��Medicaid coverage��for some adults��to��having��a��job,��and��imposes other restrictions that will make it harder for��people��with low incomes��to stay enrolled.��SNAP restrictions began to take effect in 2025. Major Medicaid provisions��begin��later this year.��

Documents��prepared by consulting company Deloitte��estimate��that a pair of��computer system��changes��for��Medicaid work requirements��in Wisconsin��will����. Two other changes��related��to the state’s SNAP program will cost an additional $4.2��million, according to the documents, which for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, , a consulting company that��operates��the state’s��eligibility system.��

Optum��—��which��operates��the platform Vermont residents use��for Medicaid and marketplace��health��plans under the Affordable Care Act��—����������to��evaluate and��incorporate��new��health��coverage restrictions.��

Initial changes in Kentucky, which has had a contract with Deloitte since 2012,����������. And in Illinois,����will cost at least $12 million.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a �鶹Ů�� Health News investigation showed.

These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat — or going without.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price — both in the cost to taxpayers and coverage losses — according to state documents obtained by �鶹Ů�� Health News and interviews.

The documents show government agencies will spend millions to save considerably more by removing people from health benefits. While states sign eligibility system contracts with companies and work with them to manage updates, the federal government foots most of the bill.

The law’s Medicaid policies will cause to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly will lose access to monthly cash assistance for food, including those with children.

In five states alone, for state officials and reviewed by �鶹Ů�� Health News show that changes will cost at least $45.6 million combined.

“This is a pretty big payday,” said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard’s T.H. Chan School of Public Health.

The law, which grants tax breaks to the nation’s wealthiest people, requires most states to tie Medicaid coverage for some adults to having a job, and imposes other restrictions that will make it harder for people with low incomes to stay enrolled. SNAP restrictions began to take effect in 2025. Major Medicaid provisions begin later this year.

Documents prepared by consulting company Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will . Two other changes related to the state’s SNAP program will cost an additional $4.2 million, according to the documents, which for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, , a consulting company that operates the state’s eligibility system.

Optum — which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act — to evaluate and incorporate new health coverage restrictions.

Initial changes in Kentucky, which has had a contract with Deloitte since 2012, . And in Illinois, will cost at least $12 million.

A Historic Mandate

For six decades after President Lyndon Johnson created the government insurance program in 1965, Congress had never mandated that Medicaid enrollees have a job, volunteer, or go to school.

That will change next year. The tax and spending law enacted by Trump and congressional Republicans requires millions of Medicaid enrollees in 42 states and the District of Columbia to prove they’re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. The CBO projected, based on an early version of the bill, that 18.5 million adults would be subject to the new rules — .

Vermont Medicaid officials expect it will cost $5 million in fiscal 2027 to implement changes in response to the federal law, said Adaline Strumolo, deputy commissioner of the Department of Vermont Health Access. About $1.8 million is for Optum to make eligibility system adjustments. Optum is a subsidiary of UnitedHealth Group.

The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements — about a third of the state’s enrollees.

The law forced the state “to essentially drop everything else we were doing,” Strumolo said in an interview. “This is a big, big lift.”

Optum’s contract with the state was as of October.

of adult Medicaid enrollees nationally are already working, according to �鶹Ů��. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they’re complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.

An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the .

In Wisconsin, state officials estimate could lose coverage after work requirements take effect. Not covering those people would in Medicaid spending for one year.

Wisconsin’s eligibility system for Medicaid and SNAP — known as CARES — in 1994, and initially was a transfer system from Florida, according to a 2016 state document.

Deloitte submitted its cost estimates for Medicaid and SNAP changes to the state in September and December. Elizabeth Goodsitt, a spokesperson for the Wisconsin Department of Health Services, declined to answer questions about whether additional changes will be needed, how much it will cost to make all eligibility system changes to comply with the new federal law, and whether the state negotiated prices with Deloitte.

Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested “very little” to help people navigate the Medicaid eligibility process, which soon will become more difficult.

“But they’re very willing to throw $6 million to their contractors to create the bells and whistles,” Peterson said. “That’s where I feel a sense of frustration.”

New Hurdles for Vets and Homeless People

Medicaid work requirements are only one change required by Trump’s tax law that will make it harder to obtain safety-net benefits.

Starting in October, the law prohibits several immigrant populations from accessing Medicaid and ACA coverage, including people who have been granted asylum, refugees, and certain survivors of domestic violence or human trafficking. Beginning Dec. 31, states must verify eligibility twice a year for millions of adults — doubling state officials’ workload. And the law restricts SNAP benefits by requiring more adult recipients to work and by removing work exemptions for veterans, homeless people, and former foster youth.

Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state’s integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year . , initial changes costing $1.6 million were labeled a “high priority” and approved on an “emergency” basis, with some of the changes to the nation’s largest food aid program going into effect almost immediately.

Officials with Kentucky’s Cabinet for Health and Family Services declined to answer a detailed list of questions, including how much it will cost to make all the modifications needed.

Deloitte spokesperson Karen Walsh said the company is working with states to implement new requirements but declined to answer questions about cost estimates in several states. “We are delivering the value and investments we committed to,” Walsh said.

In most states, government agencies rely on contractors to build and run the systems that determine eligibility for Medicaid. Many of those states also use such computer systems for SNAP. But the federal government — that is, taxpayers — to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.

“Five, 10 years ago, I’m not sure if you would hear much mention of SNAP from a Medicaid director,” Melisa Byrd, Washington, D.C.’s Medicaid director, said in November at an annual conference of Medicaid officials. “And particularly for those with integrated eligibility systems — as D.C. is —­ I’m learning more about SNAP than I ever thought.”

The federal law was the topic du jour at last year’s gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.

Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference’s corporate sponsors, emblazoned its logo on hotel escalators. Companies set up booths with materials promoting how they could help states and handed out snacks and swag.

“Conduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,” read one such handout from another contractor. “Together, we can better serve residents at every step of their health journeys.” Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to �鶹Ů�� Health News.

In handouts, Deloitte touted its role in “building a new era in state health care” and as “a national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.” �鶹Ů�� Health News found that Deloitte, a global consultancy that generated in revenue in fiscal 2025, dominates this slice of government business.

“With Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,” added another brochure. “Deloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.”

A $20.3 Million Bill in Iowa

Before Trump signed the One Big Beautiful Bill Act, Iowa lawmakers wanted to impose their own version of work requirements. They would have applied to 183,000 people before any exemptions. The new law would necessitate a change to Iowa’s Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa’s system through a .

Adding the ability to verify work status would cost up to $7 million, . By July, the cost to implement the One Big Beautiful Bill Act’s work requirements and other Medicaid provisions . Accenture’s analysis said the federal law necessitated . Making employment a condition of Medicaid benefits could cause an estimated 32,000 Iowans to lose coverage, according to a

Cutting 32,000 people from coverage in one year, a fraction of the Iowa and the federal government spend on Medicaid in a given year.

In Cedar Rapids, most of Eastern Iowa Health Center’s patients rely on Medicaid, CEO Joe Lock said. He questioned the government’s logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.

Most of the health center’s patients live at or below the federal poverty level — currently .

“There is no benefit to this population,” Lock said.

Danielle Sample, a spokesperson for Iowa’s Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state’s separate SNAP eligibility system.

In Illinois, the state’s work this year is largely focused on meeting major provisions of the One Big Beautiful Bill Act. The state estimates that as many as 360,000 residents could lose Medicaid, largely due to the work requirements, said Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services.

Kula confirmed that — priced at $12 million — is related to Trump’s law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.

The Trump administration has acknowledged that the work is coming at a cost. In January, top officials for the Centers for Medicare & Medicaid Services said government contractors, including Deloitte, Accenture, and Optum, have and reduced rates through 2028 to help states incorporate system changes.

“The companies were extremely excited to do this,” , the top CMS Medicaid official. “Everyone’s really focused on getting to work.”

CMS spokesperson Catherine Howden declined to answer questions about the discounts.

Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky’s Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.

It’s unclear what discounts, if any, Deloitte and Accenture have offered to individual states. Walsh, the Deloitte spokesperson, declined to answer detailed questions about the discounts the Trump administration announced this year. Accenture did not respond to repeated requests for comment.

Strumolo, the Vermont health official, said state officials discussed the announcement with Optum “in detail.”

Optum for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean “moving to a new system when we don’t have to.” When asked about whether the company offered discounts, Strumolo said “not explicitly.”

In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements “with a range of options to meet their unique cost and policy needs.”

He declined to specify whether Optum discounted Vermont’s rates and how it calculated the costs of doing its work. “Optum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time — supporting better outcomes for individuals covered by Medicaid,” Mason said.

Strumolo said Optum’s initial changes in Vermont cover items that take effect this year and in 2027 — Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.

“There’s a lot more that could come,” she said.

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The past year has been rough for the National Institutes of Health, which underwent cuts to its workforce and research funding. Now, the NIH is facing a new challenge: brain drain.

Thousands of employees totaling about 20% of the agency’s staff have left in the tumult of President Donald Trump’s second term. Some scientists fear this exodus will mean fewer new treatments and diminish the government’s ability to respond to disease outbreaks and other public health crises.

�鶹Ů�� Health News senior correspondent Rachana Pradhan appeared on WAMU’s “Health Hub” to explain why some scientists decided to quit or retire early, and what it could mean for the future of biomedical research in the United States.

Katheryn Houghton contributed reporting.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

Philip Stewart, un investigador de Rocky Mountain Laboratories enfocado en enfermedades transmitidas por garrapatas, dijo que se jubiló dos años antes de lo planeado debido a obstáculos que hacían demasiado difícil hacer bien su trabajo.

Alexa Romberg, científica dedicada a la prevención de adicciones enfocada en el tabaco, dijo que “perdió gran parte” de la investigación que supervisaba cuando desaparecieron las subvenciones federales.

“Si uno piensa en la agenda de ‘Make America Healthy Again’ y en la prevención de enfermedades crónicas”, dijo Romberg, “el consumo de tabaco es el principal factor que contribuye a la enfermedad y la muerte temprana que podemos prevenir”.

Los Institutos Nacionales de la Salud (NIH, por sus siglas en inglés) son el mayor financiador público de investigación biomédica en el mundo. es “mejorar la salud, prolongar la vida y reducir las enfermedades”.

Durante décadas, el valor de los NIH ha sido quizá una de las pocas cosas en las que todos en Washington han estado de acuerdo. Los legisladores han aumentado su financiamiento de forma constante.

“Estoy muy complacido de estar asociado con los NIH”, dijo el senador Roy Blunt, republicano de Missouri y uno de los mayores defensores de la institución en el Congreso, , poco antes de retirarse.

Pero durante el segundo mandato del presidente Donald Trump, los NIH han visto un éxodo masivo de científicos como Ernstoff, Stewart y Romberg. Datos federales muestran que los NIH perdieron alrededor de 4.400 personas, más del 20% de su fuerza laboral.

Los científicos dicen que estas salidas afectan la capacidad de Estados Unidos para responder a brotes de enfermedades, desarrollar tratamientos para enfermedades crónicas y enfrentar los problemas de salud pública más urgentes del país.

“Las personas sufrirán las consecuencias”, señaló Sylvia Chou, científica que trabajó en el Instituto Nacional del Cáncer (NCI, por sus siglas en inglés) en Rockville, Maryland, durante más de 15 años antes de irse en enero. “Habrá muchos más problemas de salud e incluso muertes, porque necesitamos la ciencia para ayudar a las personas a estar sanas”.

Por qué se están yendo

�鶹Ů�� Health News entrevistó a media docena de científicos que dijeron que dejaron sus trabajos años antes de lo planeado debido a la agitación de 2025.

Hace apenas unos años, la fuerza laboral de los NIH crecía de forma constante, pasando de unos 17.700 empleados en el año fiscal 2019 a alrededor de 21.100 en el año fiscal 2024, según datos federales. Con Trump, ese crecimiento se redujo.

El gobierno de Trump implementó una campaña para sacar a trabajadores del gobierno considerados desleales al presidente. Algunas personas fueron despedidas o presionadas para irse. Los funcionarios también establecieron un congelamiento de contrataciones que duró varios meses.

La fuerza laboral de los NIH cayó a unas 17.100 personas, su nivel más bajo en al menos dos décadas. La mayoría de quienes se fueron no fueron despedidos. Aproximadamente 4 de cada 5 se jubilaron, renunciaron, terminaron sus nombramientos o encontraron otro trabajo, según datos federales.

Los científicos observaron con preocupación cómo a sus colegas se les obligaba a cancelar fondos de investigación para temas que el gobierno de Trump consideraba prohibidos. En los laboratorios de los NIH, el trabajo rutinario se detuvo.

También dijeron que enfrentaron grandes retrasos para acceder a equipos y suministros. Las autorizaciones de viaje se retrasaban o se negaban.

Al personal de la agencia se le ordenó no comunicarse con nadie fuera de la institución. Cuando volvieron a poder hacerlo, se les impusieron más restricciones sobre lo que podían presentar al público.

Y bajo la agenda del gobierno para eliminar la “diversidad, equidad e inclusión”, se sacaron referencias a minorías o a la equidad en salud en investigaciones financiadas por los NIH. También se eliminaron iniciativas destinadas a proteger la salud de los estadounidenses.

Entre ellas: apoyo a científicos que comienzan su carrera, estrategias para prevenir daños por VIH o por adicciones, y estudios sobre cómo los sistemas inmunológicos de distintas poblaciones responden a enfermedades.

En publicado en enero, Chou y Romberg estuvieron entre un grupo de científicos de los NIH que dijeron que renunciaron en protesta contra un gobierno “que trata la ciencia no como un proceso para construir conocimiento, sino como un medio para impulsar su agenda política”.

Una “destrucción fundamental”

Emily Hilliard, vocera del Departamento de Salud y Servicios Humanos (HHS por sus siglas en inglés), dijo en un comunicado que la agencia cambió su enfoque para priorizar la investigación basada en evidencia en lugar de “agendas ideológicas”.

Agregó que los NIH siguen contratando a “los mejores y más brillantes” y avanzando en ciencia de alta calidad para “lograr avances para el pueblo estadounidense”. El departamento supervisa los NIH.

“Era necesario un reinicio importante. El HHS ha tomado medidas para simplificar las operaciones, reducir duplicaciones y volver a los niveles de empleo previos a la pandemia”, dijo Hilliard.

Sin embargo, muchos científicos dudan de que los NIH aún puedan cumplir su misión pública.

“Ha habido una destrucción fundamental”, observó Daniel Dulebohn, investigador que pasó casi dos décadas en Rocky Mountain Laboratories en Hamilton, Montana. “Va a tomar muchísimo tiempo reconstruirlo”.

Dulebohn dejó el Instituto Nacional de Alergias y Enfermedades Infecciosas (NIAID, por sus siglas en inglés) en septiembre.

Analizaba cómo interactúan moléculas y proteínas en enfermedades como la enfermedad de Lyme, el VIH y el Alzheimer, información clave para desarrollar nuevos tratamientos. Dulebohn era una fuente para científicos que enfrentaban dificultades para entender, por ejemplo, si ciertas moléculas podían prevenir infecciones o responder a un tratamiento.

Ahora él y su esposa viven de sus ahorros en México con sus tres niños pequeños. Dulebohn está pensando en qué hará después. Una opción: bienes raíces.

El experto en análisis bioquímico operaba equipos que pocas personas saben usar. Su salida reduce aún más los recursos en esta especialidad.

“Está claro cuando alguien crea un medicamento y se cura una enfermedad. Pero nunca sabes cuáles podrían haberse curado”, dijo Dulebohn. “No sabemos lo que hemos perdido”.

Laura Stark, profesora asociada en la Universidad Vanderbilt, especializada en la historia de la medicina y la ciencia, dijo que eliminar personal de los NIH impulsará un cambio hacia la investigación del sector privado, con fines de lucro, “en lugar de realmente ayudar a la salud de los estadounidenses”.

“Simplemente ya no tenemos personas que puedan dedicarse a investigar por el bien público”, señaló Stark.

De apoyo a escrutinio

Stark dijo que las bases de los NIH actuales se establecieron durante la Segunda Guerra Mundial, cuando el gobierno de Estados Unidos lideró un esfuerzo para producir en masa el antibiótico penicilina y salvar a soldados de infecciones.

La agencia ha tenido un papel central en descubrimientos y tratamientos que salvan vidas, incluidos avances para afecciones del corazón, cáncer, diabetes y enfermedades genéticas como la fibrosis quística.

Con apoyo bipartidista en el Congreso, el presupuesto de los NIH ha crecido con el tiempo y alcanza los $48,7 mil millones para el año fiscal 2026.

Los NIH destinan aproximadamente el 11% de su presupuesto a científicos de la agencia. Alrededor del 80% se otorga a universidades y otras instituciones.

El dinero puede existir, pero las personas encargadas de asignarlo ya no están, dijeron los científicos.

Jennifer Troyer dejó el Instituto Nacional de Investigación del Genoma Humano (NHGRI, por sus siglas en inglés) en Bethesda, Maryland, el 31 de diciembre, después de trabajar en varios cargos en los NIH durante unos 25 años.

La división que dirigía revisa investigaciones y supervisa subvenciones a organizaciones que estudian el genoma humano —el conjunto completo de genes de una persona— y cómo puede usarse para mejorar la salud.

Dijo que el año pasado su división perdió cerca de dos tercios de su personal.

“Realmente no hay suficientes personas allí ahora para hacer el trabajo”, dijo Troyer. “Es un daño extremo”.

Decidió renunciar el día en que Trump emitió una en agosto que prohibía el uso de subvenciones para “financiar, promover, fomentar, subsidiar o facilitar” lo que describió como “valores antiestadounidenses”. También permitió que funcionarios políticos revisaran todas las decisiones de financiamiento.

“Yo no estaba dispuesta a dirigir una división bajo esas órdenes”, añadió Troyer. Aún no sabe cuál será su próximo paso profesional.

“Ya es suficiente”

Incluso investigaciones alineadas con las prioridades declaradas del gobierno se han visto afectadas.

El secretario de Salud y Servicios Humanos, Robert F. Kennedy Jr., ha dicho que el diagnóstico y tratamiento de la enfermedad de Lyme —una infección transmitida por garrapatas que puede causar síntomas debilitantes de por vida— son .

En diciembre, Kennedy dijo que el gobierno durante mucho tiempo ha ignorado a pacientes afectados por esta enfermedad, que se diagnostica cada año a en el país.

Ese mismo mes, Stewart, quien dedicó su carrera a estudiar garrapatas y la enfermedad de Lyme como científico federal, se jubiló antes de tiempo. Había trabajado para el gobierno durante 27 años.

Stewart dijo que los recortes de personal y los retrasos en los viajes frenaron sus esfuerzos por confirmar hasta dónde se habían extendido las garrapatas que transmiten Lyme, información que podría ayudar a los doctores a reconocer síntomas más rápido.

Stewart fue el científico principal en una investigación publicada el año pasado que —también conocida como garrapata del venado— en Montana. Fue la primera vez que se confirmó en ese estado la garrapata más conocida por transmitir la enfermedad.

Él quería determinar si el hallazgo era un caso aislado o una señal de que la especie estaba expandiéndose.

“El consejo que hemos recibido es: ‘Bajen la cabeza debajo de la línea de la trinchera. No miren. No se asomen y se arriesguen a que les disparen’”, dijo Stewart. “¿En qué momento dices finalmente: ‘Ya es suficiente’ y ‘Ya no estamos siendo efectivos’?”

Los científicos dijeron que quienes comienzan sus carreras están buscando empleo y capacitación en el extranjero.

Los que quieren quedarse en Estados Unidos enfrentan dificultades para ser contratados debido a los recortes en subvenciones de investigación y la incertidumbre sobre el financiamiento.

En conjunto, los expertos que estudian enfermedades advierten que Estados Unidos podría perder su posición histórica como líder mundial en investigación biomédica, con un impacto devastador.

Stanley Perlman, virólogo de la Universidad de Iowa que estudia enfermedades infecciosas pediátricas, dijo que ese liderazgo le dio al país más que prestigio: atrajo a científicos de todo el mundo para estudiar enfermedades que afectan especialmente a las personas aquí.

No hay garantía de que la investigación que se ha frenado se retome en otro lugar, ya sea en la industria privada o en otros países. Y si otros realizan ese trabajo, los estadounidenses podrían enfrentar retrasos para ver los beneficios, dijo.

“Si no tienes acceso a cómo se hizo el trabajo”, agregó Perlman, “es más difícil reproducirlo y adaptarlo para tu país”.

La editora de datos de �鶹Ů�� Health News, Holly K. Hacker, contribuyó con este artículo.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

Among them: scientists who pioneered cancer treatments, researched tick-borne diseases, or worked to prevent tobacco use.��

We spoke to a half dozen scientists who said they left the agency because of the tumult of 2025 and talked about the work they left behind. They say the exodus from the world’s largest public funder of biomedical research will harm the nation’s ability to respond to illness.��

“People are going to get hurt,” said Sylvia Chou, a scientist who worked at the National Cancer Institute in Rockville, Maryland, for over 15 years before she left in January. “There’s going to be a lot more health challenges and even deaths, because we need science in order to help people get healthy.”��

The NIH consists of 27 institutes and centers, each with a different focus. Major research areas include cancer; infectious diseases; aging-related diseases such as Alzheimer’s; heart, lung, and blood diseases; and general medicine.��

Over decades, the value of the NIH may be the one thing everyone in Washington has agreed on. Lawmakers have routinely boosted its funding — even for this fiscal year, in defiance of the White House, which had proposed cutting the agency’s funding by 40%.��

Our reporting showed that, nonetheless, the Trump administration’s actions to curb certain research and push out scientists perceived as disloyal are having far-reaching repercussions. The NIH workforce stands at about 17,100 people — its lowest level in at least two decades.��

Scientists across specializations outlined challenges that made them decide to leave. They included delays in accessing research equipment and supplies, the termination of funds for topics the Trump administration deemed off-limits, and delayed or denied travel authorizations.��

Even research aligned with the Trump administration’s stated priorities has suffered, they said. They questioned whether the NIH could continue to fulfill its mission to “enhance health, lengthen life, and reduce illness.”��

“It’s clear when someone comes out with a drug and now you’ve just cured a disease. But you never know which ones could have been cured,” said Daniel Dulebohn, a researcher who spent nearly two decades at Rocky Mountain Laboratories in Hamilton, Montana. “We don’t know what we’ve lost.”��

Dulebohn left the NIH’s infectious disease and allergy institute in September and is considering leaving the scientific field altogether.

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Philip Stewart, a Rocky Mountain Laboratories researcher focused on tick-borne diseases, said he retired two years earlier than planned because of hurdles that made it too challenging to do his job well.

Alexa Romberg, an addiction prevention scientist focused on tobacco, said she “lost a great deal” of the research she oversaw when federal grants vanished.

“If one is thinking about the ‘Make America Healthy Again’ agenda and the prevention of chronic disease,” Romberg said, “tobacco use is the No. 1 contributor to early morbidity and mortality that we can prevent.”

The National Institutes of Health is the largest public funder of biomedical research in the world, with a to “enhance health, lengthen life, and reduce illness.”

Over decades, the value of the NIH may be the one thing everyone in Washington has agreed on. Lawmakers have routinely boosted its funding.

“I’m so pleased to be associated with NIH,” former Sen. Roy Blunt, a Missouri Republican and one of the NIH’s biggest champions in Congress, shortly before he retired.

But in President Donald Trump’s second term, the NIH has seen an exodus of scientists like Ernstoff, Stewart, and Romberg. Federal data shows the NIH lost about 4,400 people — more than 20% of its workforce. Scientists say the departures harm the U.S.’ ability to respond to disease outbreaks, develop treatments for chronic illnesses, and confront the nation’s most pressing public health problems.

“People are going to get hurt,” said Sylvia Chou, a scientist who worked at the National Cancer Institute in Rockville, Maryland, for over 15 years before she left in January. “There’s going to be a lot more health challenges and even deaths, because we need science in order to help people get healthy.”

Why They’re Leaving

�鶹Ů�� Health News interviewed a half dozen scientists who said they quit their jobs years before they’d planned to because of the tumult of 2025.

Only a few years ago, the NIH workforce was steadily growing, from roughly 17,700 employees in fiscal year 2019 to around 21,100 in fiscal 2024, federal data shows. Under Trump, those gains have been slashed.

The Trump administration enacted a campaign to purge government workers perceived as disloyal to the president. People were fired or encouraged to leave. Officials instituted a months-long freeze on hiring.

The NIH workforce has plummeted to about 17,100 people — its lowest level in at least two decades. Most who left weren’t fired. Roughly 4 in 5 either retired, quit, had appointments that expired, or transferred to a different job, according to federal data.

Scientists watched with dread as their colleagues were forced to terminate research funds for topics the Trump administration deemed off-limits. Across NIH labs, routine work stalled. They said they faced major delays in accessing equipment and supplies. Travel authorizations were slowed or denied.

Agency staff were instructed not to communicate with anyone outside the agency. When they could talk again, they were subject to greater constraints on what they could present to the public.

And under the administration’s agenda to eliminate “diversity, equity, and inclusion,” references to minorities or health equity were purged from NIH-funded research. Initiatives to protect Americans’ health were gutted. Among them: support for early-career scientists, ways to prevent harm from HIV or substance use, and efforts to study how different populations’ immune systems respond to disease.

, Chou and Romberg were among a group of NIH scientists who said they resigned in protest of an administration “that treats science not as a process for building knowledge, but as a means to advance its political agenda.”

A ‘Fundamental Destruction’

Health and Human Services spokesperson Emily Hilliard said in a statement that the agency had shifted to focus on evidence-based research over “ideological agendas.” She said the NIH is still recruiting “the best and brightest” and advancing high-quality science to “deliver breakthroughs for the American people.” The federal health department oversees NIH.

“A major reset was overdue. HHS has taken action to streamline operations, reduce redundancies, and return to pre-pandemic employment levels,” Hilliard said.

Many scientists, however, question whether the NIH can still fulfill its public mission.

“There’s been a fundamental destruction,” said Daniel Dulebohn, a researcher who spent nearly two decades at Rocky Mountain Laboratories in Hamilton, Montana. It’s going to “take a very, very long time to rebuild.”

Dulebohn left the NIH’s infectious disease and allergy institute in September.

He analyzed how molecules and proteins interact in diseases, such as Lyme disease, HIV, and Alzheimer’s — information that’s key for new treatments. Dulebohn was a resource for scientists when they hit walls trying to understand, for example, if molecules could prevent infection or react to a treatment.

Now he and his wife are living off savings in Mexico with their three young kids. Dulebohn’s thinking about what’s next. One option: real estate.

The expert in biochemical analysis operated equipment few others know how to use. His exit further depletes resources in the specialty.

“It’s clear when someone comes out with a drug and now you’ve just cured a disease. But you never know which ones could have been cured,” Dulebohn said. “We don’t know what we’ve lost.”

Laura Stark, a Vanderbilt University associate professor who specializes in the history of medicine and science, said wiping out NIH staff will propel a shift toward private-industry research, with its profit motives, “as opposed to actually helping American health.”

“We just don’t have people who are now able to pursue research for the public good,” Stark said.

From Support to Scrutiny

Stark said the seeds of the present-day NIH were planted during World War II when the U.S. government spearheaded an effort to mass-produce the antibiotic penicillin to save soldiers from infections.

The agency has played a central role in lifesaving discoveries and treatments — including for heart disease, cancer, diabetes, and genetic diseases such as cystic fibrosis.

With bipartisan backing from Congress, the NIH budget has grown significantly over time, sitting at $48.7 billion for fiscal 2026. The NIH allocates roughly 11% of its budget for agency scientists. About 80% is awarded to universities and other institutions.

The money may be there, but the people who get it out the door are not, scientists said.

Jennifer Troyer left the National Human Genome Research Institute in Bethesda, Maryland, on Dec. 31, after working in various positions at the NIH for about 25 years. The division she led reviews research and oversees grants to organizations studying the human genome — or a person’s complete set of genes — and how it can be used to benefit health.

Last year, she said, her division lost about two-thirds of its staff. “There really are not enough people there right now to actually get the work done,” Troyer said. “It’s extreme harm.”

She decided to quit the day Trump issued an in August that prohibited the use of grants to “fund, promote, encourage, subsidize, or facilitate” what it described as “anti-American values.” It also allowed political appointees to review all funding decisions.

“I wasn’t going to operate a division under those orders,” Troyer said. She hasn’t figured out her next career steps.

‘Enough Is Enough’

Research aligned with the administration’s stated priorities has suffered.

HHS Secretary Robert F. Kennedy Jr. has called the diagnosis and treatment of Lyme disease — a tick-borne infection that can cause debilitating lifelong symptoms — . In December, Kennedy said the government had long dismissed patients burdened with a disease that in the U.S. are diagnosed with annually.

That same month, Stewart, who had dedicated his career to ticks and Lyme disease as a federal scientist, retired early. He’d worked for the government for 27 years. Stewart said workforce cuts and travel delays stalled his efforts to confirm how far Lyme-carrying ticks had spread — information that could help doctors recognize symptoms sooner.

Stewart was a lead scientist on research published last year , or deer tick, in Montana. It was the first time the tick best known for transmitting Lyme disease had been confirmed in the state. He wanted to determine if the discovery was a fluke or an indicator that the species was gaining ground.

“The advice we’ve been getting is, ‘Put your head down below the trench line. Don’t look. Don’t peek over and risk getting shot,’” Stewart said. “At what point do you finally say, ‘Enough is enough’ and ‘We’re not being effective anymore’?”

Scientists said those early in their careers are looking abroad for jobs and training. People who want to stay in the U.S. are running into problems getting hired because of cuts to research grants and uncertainty about funding.

Collectively, people studying diseases warn the U.S. could lose its long-held position as the global leader in biomedical research, with devastating impact.

Stanley Perlman, a University of Iowa virologist who studies pediatric infectious diseases, said that title earned the nation more than prestige; it drew top scientists from the world over to the U.S. to study diseases that particularly affect people here.

There’s no guarantee halted research will be picked up elsewhere, whether by private industry or other countries. If others are doing that work, Americans could face delays in seeing benefits, he said.

“If you don’t have access to how the work was done,” Perlman said, “it’s harder to reproduce and adapt it for your country.”

�鶹Ů�� Health News data editor Holly K. Hacker contributed to this report.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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