Science & Health

History is unfolding in the Atlantic Ocean right now. Hurricane Melissa has spun up into an extraordinarily dangerous Category 5 storm with maximum sustained winds of 175 mph, and is set to strike Jamaica Monday night before marching toward Cuba. This is only the second time in recorded history that an Atlantic hurricane season has spawned three hurricanes in that category. Melissa has already killed at least three people in Haiti and another in the Dominican Republic.

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The threats to Jamaica will come from all sides. The island could see up to 30 inches of rain as the storm squeezes moisture from the sky, like a massive atmospheric sponge, potentially causing “catastrophic flash flooding and numerous landslides,” according to the National Hurricane Center. Melissa also will bulldoze ashore a storm surge of up to 13 feet — essentially a wall of water that will further inundate coastal areas. “No one living there has ever experienced anything like what is about to happen,” writes Brian McNoldy, a hurricane scientist at the University of Miami.

It will take some time for scientists to determine exactly how much climate change supercharged Melissa, but they can already say that the storm has been feeding on warm ocean temperatures made up to 800 times more likely by global heating. This is how climate change is worsening these tropical cyclones overall: The hotter the ocean gets — the seas have absorbed 90 percent of the extra heat that humans have pumped into the atmosphere — the more energy that can transfer into a storm. “The role climate change has played in making Hurricane Melissa incredibly dangerous is undeniable,” Marc Alessi, a climate attribution science fellow at the Union of Concerned Scientists, said in a statement.

Scientists can already estimate that climate change has increased Melissa’s wind speeds by 10 mph, in turn increasing its potential damage by 50 percent. “We’re living in a world right now where human-caused climate change has changed the environment in which these hurricanes are growing up and intensifying,” said Daniel Gilford, a climate scientist at the research group Climate Central. “Increasing temperatures of the atmosphere is increasing how much moisture is in the atmosphere, which will allow Melissa to rain more effectively and efficiently over the Caribbean, and could cause more flooding than otherwise would have occurred.”

Making Melissa extra dangerous is the fact that it’s undergone rapid intensification, defined as a jump in sustained wind speeds of at least 35 mph in a day, having doubled its speed from 70 to 140 mph in less than 24 hours. This makes a hurricane all the more deadly not only because stronger winds cause more damage, but because it can complicate disaster preparations — officials might be preparing for a weaker storm, only to suddenly face one far worse. Research has shown a huge increase in the number of rapid intensification events close to shore, thanks to those rising ocean temperatures, with Atlantic hurricanes specifically being twice as likely now to rapidly intensify.

At the same time, hurricanes are able to produce more rainfall as the planet warms. For one, the atmosphere can hold 7 percent more moisture per degree Celsius of warming. And secondly, the faster the wind speeds, the more water a hurricane can wring out, like spinning a wet mop. Accordingly, hurricanes can now produce 50 percent more precipitation because of climate change. “A more intense hurricane has stronger updrafts and downdrafts, and the amount of efficiency by which the storm can rain basically scales with how intense the storm is,” Gilford said. Making matters worse, Melissa is a rather slow-moving storm, so it will linger over Jamaica, inundating the island and buffeting it with winds.

As Melissa drops rain from above, its winds will shove still more water ashore as a storm surge. The coastlines of the Caribbean have already seen significant sea level rise, which means levels are already higher than before. (Warmer oceans have an additional effect here, as hotter water takes up more space, a phenomenon known as thermal expansion.) All of this means the baseline water levels are already higher, which the storm surge will pile on top of. “Just small, incremental, marginal changes in sea level can really drive intense changes,” Gilford said.

Jamaica has an added challenge in its mountainous terrain. Whereas water will accumulate on flat terrain, it behaves much more unpredictably when it’s rushing downhill because it easily gains momentum. “When you get a storm like this that is approaching the higher echelons of what we have observed, it’s harrowing, especially because it is pointing at a populated island with complex terrain,” said Kim Wood, an atmospheric scientist at the University of Arizona. “You’re dealing with a funneling effect, where that water, as it falls, will then join other water that’s coming down the mountainside and exacerbate the impacts.”

Maybe the only good news here is that the National Hurricane Center was able to accurately predict that Melissa would rapidly intensify. And in general, scientists have gotten ever better at determining how climate change is supercharging hurricanes, so they can provide ever more accurate warnings to places like Jamaica. But that requires continuous governmental support for this kind of work, while the Trump administration has slashed scientific budgets and jobs. “We couldn’t do this without continued investment in the enterprise that supports advances in not just science, but forecasting and communicating the outcomes of those forecasts,” Wood said.

This article originally appeared in Grist at https://grist.org/extreme-weather/how-hurricane-melissa-got-so-dangerous-so-fast/.

Grist is a nonprofit, independent media organization dedicated to telling stories of climate solutions and a just future. Learn more at Grist.org

Speaking to reporters on Air Force One on Monday morning, October 27, President Donald Trump confirmed that he had recently received an MRI (magnetic resonance imaging) at Walter Reed National Military Medical Center in Bethesda, Maryland.

The 79-year-old Trump, with Secretary of State Marco Rubio standing beside him, told the journalists, "I did, I got an MRI. It was perfect. We had an MRI, and the machine — you know, the whole thing — and it was perfect."

Later that morning, Dr. Jonathan Reiner — a CNN medical analyst, professor of medicine and surgery at George Washington University, former White House physician, and ex-cardiologist for former Vice President Dick Cheney — discussed the MRI with CNN hosts Wolf Blitzer and Pamela Brown.

Noting that MRIs are "not routine" during regular checkups, Blitzer asked Reiner why Trump "might have had an MRI during this checkup."

"MRI is never part of a routine evaluation whether you're president of the United States or whether you're just a civilian," Reiner told Blitzer and Brown. "So we don't know why his doctors asked him to undergo that test. And that's a big question. The other question is: Why did they decide not to inform the public that they were doing that? Why was that deliberately left out?"

Reiner continued, "There are a lot of things that can prompt an MRI. And typically, they're prompted by symptoms. That can be neurologic[al] symptoms that prompt an MRI. There could be back pain that prompts an MRI. There can be issues with the heart that would prompt an MRI. And for those reasons, the public should really be told, you know: why did the president undergo the test? What consultants he saw, and what was the result of the testing?"

When the CNN hosts noted recent bruising on the back of Trump's hand, Reiner cited "medications" — especially blood thinners — as the most common reason for that type of bruising in someone who is Trump's age. Reiner added that blood thinners are taken for a "variety of reasons," from "pulmonary embolism" to clots to "atrial fibrillation."

"To me," Reiner told Blitzer and Brown, "I think… just as important why he had the test as it is what the test showed."

The city of Clyde sits about two hours west of Fort Worth on the plains of north Texas. It gets its water from a lake by the same name a few miles away. Starting in 2022, scorching weather caused its levels to drop further and further. Within a year, officials had declared a water conservation emergency and, on August 1 of last year, they raised the warning level again. That meant residents rationing their spigot use even more tightly, especially lawn irrigation. The restrictions weren’t, however, the worst news that day: The city also missed two debt payments.

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Municipal bond defaults of any kind are extraordinarily rare, let alone those linked to a changing climate. But, with about 4,000 residents and an annual budget of under $10 million, Clyde has never had room to absorb surprises. So when poor financial planning collided with the prolonged dry spell, the city found itself stretched beyond its limits.

The drought meant that Clyde sold millions of gallons less water, even as it imported more of it from neighboring Abilene, at about $1,200 per day. Worse, as the ground dried, it cracked, destroying a sewer main and bursting another, quarter-million dollar, hole in the town budget. Within days of Clyde missing its payments, rating agency Standard & Poor’s slashed the city’s bond ratings, which limited its ability to borrow more money. Within weeks, officials had hiked taxes and water rates to help staunch the financial bleeding.

“There’s more to a drought than just the cost of water,” said Rodger Brown, who was mayor at the time and is now interim city manager. “It tanks your credibility.”

Drought, of course, isn’t the only climate-driven disaster hitting places like Clyde. Hurricanes, floods and fires are bankrupting cities across America. After flames ripped through Paradise, California in 2018, the town’s redevelopment agency defaulted on some of its obligations. Naples, Florida resorted to selling $11 million in bond to rebuild its pier after Hurricane Ian in 2022. Earlier this year, the Los Angeles Department of Water and Power had a harder time raising money after massive fires swept the city. Kerr County, Texas is in the midst of raising taxes after devastating floods in July.

Each episode underscores how climate shocks once seen as exceptional are now straining local budgets. But drought may be the most insidious of these threats. Compared to other types of disasters, it often hits everyone in a community, affects large areas, and can last months, if not years. There are also fewer defenses and relatively limited government assistance. Experts worry that drought could ultimately prove an enormous risk to the $4 trillion municipal bond market that underwrites everything from roads and schools to the water running through millions of taps.

“I personally think this is a dark horse in the conversation right now,” said Evan Kodra, the head of climate research for the financial data company Intercontinental Exchange, or ICE. “It should be a bigger deal.”

This year alone has seen droughts in at least 43 states, from Vermont to California, affecting 125 million people. And ICE projects that more of the currently outstanding municipal debt will be located in areas prone to drought by 2040 than hurricanes, floods and wildfires combined. The financial effects of prolonged water woes can mount in ways not seen in one-off events, said Jeremy Porter, the chief economist at First Street Foundation, a nonprofit climate research firm.

“Drought is one of those things, if there is an impact, there’s a step-function impact,” he said. “You just don’t have the capacity to cover the risk.”

Also unlike with its headline-grabbing cousins, drought has a much weaker federal safety net when something does go wrong. The Department of Agriculture offers some aid to farmers, but there’s little funding for individuals or municipalities. The Federal Emergency Management Agency, or FEMA, hasn’t issued a drought-related emergency or disaster declaration in the United States since 1993, despite states requesting aid. “There is no adapting to drought,” said Porter. “The federal government is probably not going to come in.”

As the planet warms, the dry conditions that sent Clyde into the financial abyss are only set to become more frequent and more intense. Intercontinental Exchange researchers found that even in a ‘best-case’ climate scenario, drought, heat stress and water stress will place billions of dollars of municipal bonds at risk by 2040. Under a worst-case situation, that number could reach hundreds of billions. While Clyde’s default was relatively tiny, municipal debt is the bedrock of everything from hedge funds to retirement accounts, making a string of such events potentially catastrophic for the economy.

But well before dramatic rolling defaults, the financial pressures of drought will likely alter daily life in many regions. That’s already the reality for one community in Arizona, where the rush for water has turned into a years-long financial and political standoff.

Rio Verde Foothills lies on the outskirts of Scottsdale. Residents there have been trucking water in from its larger neighbor ever since the unincorporated, “wildcat” development was founded in the early 2000s. The arrangement worked well until 2021, when a severe drought gripped the area and Scottsdale decided it could no longer spare the dwindling resource. Cut off residents of Rio Verde scrambled and eventually signed a $12 million contract with the state’s largest private water company, Epcor Utilities, to build a permanent supply line.

Three years later, though, the feud continues. Scottsdale agreed to keep providing water through the end of this year while Epcor Utilities built new infrastructure. But construction is months behind schedule and Scottsdale is sticking to its deadline — leaving the foothills once again facing a cutoff. (Epcor remains confident this won’t happen.)

Even when the new line is connected, Rio Verde Foothills residents could see their water bills double or triple. Hikes like that are going to be a far wider concern across the West than outright disconnection, says Sara Fletcher, an environmental engineer at Stanford University who works on water scarcity issues. “Water prices are going up, and up, and up,” she said. “They are going to go up much faster than inflation for the past decade.”

The irony of drought is that as people conserve water to combat it, there is less money for the utility, whose costs remain relatively fixed. That results in “drought surcharges”, or other fees, for customers. It’s a cycle that was on full display in Clyde.

By August, 2023, the wave of aridity that hit West Texas had stretched for months, and officials in Clyde declared a stage 2 water emergency, which targets a 20 percent decrease in demand. By the following year they raised it to stage 3, or a 30 percent decline — one step below mandatory rationing. The measures worked, but at a cost. “Water sales are one of the main things that a city, almost any city, has,” said Brown. “That’s big for a city’s revenue generation.”

According to Clyde’s financial statements, it sold 7 million gallons less in 2023 than the year prior. It also had to import water from nearby Abilene at a premium of around $3 per thousand gallons. While Brown didn’t know exactly how much Clyde bought, he said it wasn’t as much as in some previous droughts but still significant. The bigger blow came when the parched ground split, shifted, and ruptured a major sewer line. The roughly $250,000 repair bill turned the cracks in the town’s finances into crevasses

“You can’t have people out here without the services. So we had to fix it,” he said. These new liabilities and dwindling income came on top of millions of dollars in debt that Clyde had amassed over the years, despite having kept taxes or utility prices relatively flat. It created what Brown called a “perfect storm.”

On August 1, 2024, the city missed two bond payments — one for $354,325, another for $308,400 — and filed a claim on its bond insurance to cover them. By the end of the year Clyde had failed to meet a total of $1.4 million in liabilities. Standard & Poor’s slashed the ratings of the bonds with missed payments from A- to D, and the city’s creditworthiness to B, moves that will raise future borrowing costs for the city.

So far residents have absorbed the added costs, which has allowed the city to continue to operate. But the spiral from expensive, inaccessible, or nonexistent water could have been much worse. High bills can lead to compromises in daily life, whether that be letting parks wither or skipping showers. Over time, those inconveniences could make a town a less desirable place to live, which, in turn, might result in lower property values, a dwindling tax base, and, consequently, more financial troubles.

“If you don’t have water, if you don’t have a functioning city, there is a vicious cycle dynamic that could come into play,” said Kodra at Intercontinental Exchange. “Once your property tax base is decently lower than it was, then it’s harder to borrow money to dig out of that hole.”

“We haven’t hit the point yet where people can’t get access to water,” said Porter. But there are inklings of that future, especially in the West. In Arizona, for example, water supply requirements for new developments are already beginning to halt some new construction.. According to Fletcher, “the fraction of the population that will face unaffordable water in the future is likely to increase unless we do something major.”

First Street also provided Grist with county-level data showing how the risk of prolonged water scarcity will change over the next 30 years. Of the 10 counties with the largest jump over that timeframe, seven are in Texas and three are in Florida. By 2055, more than 20 counties across the West will have a one in five chance of being in severe drought for at least 11 months out of the year. Over 500 counties could see 6 or more months.According to Fletcher, “the fraction of the population that will face unaffordable water in the future is likely to increase unless we do something major.”

Solutions won’t be easy to come by, and certainly won’t be painless. One logical conclusion might be that municipalities that are at risk of climate-impacts — like Clyde with drought or Tampa Bay with hurricanes — should simply pay more for their debt. In most sectors risk and interest rates traditionally correspond but, according to multiple studies, that’s not the case with municipal bonds.

“Climate poses a systemic credit risk to the municipal industry, of which it has never experienced,” said Thomas Doe, founder of Municipal Market Analytics. “[But] the marketplace is not pricing climate risk into bonds.”

The conundrum arises from the fact that people primarily buy municipal bonds to receive tax-exempt dividends. Demand, therefore, isn’t particularly sensitive to the price of the bond, but rather the risk of default, which remains extremely low. Another major bulwark against climate-pricing has been the federal government, which pumps billions of disaster aid into communities across the country — money that would have otherwise come out of state or municipal budgets.

“Bonds initially dip in price on the news of the event. Then they end up recovering because the federal government essentially rebuilds,” explained Doe. That support is in jeopardy with President Donald Trump’s deep cuts to government spending and that could eventually trickle into the municipal market. In the absence of aid, Doe says, bonds could start being priced in accordance with the risk.

Not all climate-debt, however, is bad.

This fall Norfolk, Virginia is planning to break ground on a $2.6 billion flood protection system, featuring a nearly 9-mile long seawall. The city is responsible for roughly $1 billion of that cost and is expected to issue new debt to help cover it. But Doe says that this type of climate-adaptation debt is generally considered good and should be encouraged, explaining that, “if it’s proactive, credit ratings look favorably.”

While you can’t build a wall against drought, the same principle applies for the admittedly limited tools that are available. Cities could, for instance, spend money making their water system more efficient, or building grey water recycling projects. Green infrastructure can also help keep rain from running off. More drastic steps might involve relocating people, or repurposing especially dry land for other uses, such as clean energy.

Although Clyde isn’t yet at a point where it’s climate-proofing its infrastructure, Lake Clyde is spilling over this year. That has provided the city a respite during which it can financially heal. Brown says the city has repaid its bond insurer, is back on track with debt payments, and is slowly rebuilding its emergency funds. The hope is that higher prices making the city’s recovery possible will mean less pain the next time the water runs low.

“We haven’t dug completely out,” said Brown. “But we’re still digging.”

This article originally appeared in Grist at https://grist.org/cities/drought-is-quietly-pushing-american-cities-toward-a-fiscal-cliff/.

Grist is a nonprofit, independent media organization dedicated to telling stories of climate solutions and a just future. Learn more at Grist.org

SARASOTA, Fla. — Florida plans to end nearly a half-century of required childhood immunizations against diseases that have killed and maimed millions of children. Many critics of the decision, including doctors, are afraid to speak up against it.

With the support of Republican Gov. Ron DeSantis, Surgeon General Joseph Ladapo on Sept. 3 announced his plan to end all school-age vaccination mandates in the state.

“Every last one of them is wrong and drips with disdain and slavery,” he told a cheering crowd of vaccination foes in Tallahassee. “Who am I, as a government or anyone else,” he said, “to tell you what you should put in your body?”

History shows that mandates increase the use of vaccines. Lower vaccination rates will mean increased rates of diseases like measles, hepatitis, meningitis, and pneumonia — and even the return of diphtheria and polio. Many of these diseases threaten not just the unvaccinated but also those they come in contact with, including babies and older people with weakened immunity.

But that scientific fact is being left unsaid in Florida. Health officials have largely been silent in the face of Ladapo’s campaign — and not because they agree with him. The University of Florida muzzled infectious disease experts, said emeritus professor Doug Barrett, formerly the university’s chief of pediatrics and senior vice president for health affairs.

“They’re told not to speak to anyone without permission from supervisors,” he said. University spokespeople didn’t respond to requests for comment.

County-level Department of Health officials across the state got the same message, said John Sinnott, a retired professor at the University of South Florida who is friends with one of the county health leaders.

Sarasota County’s health department referred a reporter to state officials in Tallahassee, who responded with a statement that vaccines will “remain available” to families who want them. The state did not respond to other requests for comment or for an interview with Ladapo.

Many pediatricians are silent, too, at least in public.

“A lot of them don’t take a strong stance on whether kids need to be vaccinated,” said Neil Manimala, a urologist and the president-elect of the Hillsborough County Medical Association. “They don’t want to lose business. And there are enough anti-vax people who can lambaste you on Google, spreading stories about clinicians who ‘want to instill the poison jabs.’”

History of Modern Vaccine Mandates

Several states ended vaccination mandates early last century when smallpox was the only widely given vaccine, said historian Robert Johnston of the University of Illinois-Chicago. None has done so since other vaccines were added to the schedule. (Routine smallpox vaccination ended in 1972).

In the 1970s, persistent measles outbreaks provoked officials to strengthen child protection with enforced school mandates in every state. Today the partisan split on vaccine policy in the wake of the covid outbreak has changed the equation. This is nowhere more the case than in Florida, although legislators in Texas and Louisiana are also considering ending mandatory vaccination, and Idaho enables parents to get an exemption just by asking for it.

“This is really going to be a watershed moment for families who already were not sure they want to do vaccines and now are being told they don’t need them,” said Jennifer Takagishi, vice president of the Florida branch of the American Academy of Pediatrics.

It’s hard to know how fast vaccine-preventable diseases might return if Florida ends its mandates — or how the public will respond. Asked in an interview whether his office had modeled disease outcomes before his September announcement, Ladapo said “Absolutely not.” Parental freedom of choice isn’t a scientific matter, he said. “It’s an issue of right and wrong.”

Ladapo’s Department of Health did not respond a month later when asked whether it was making contingency plans for outbreaks. During a 2024 measles outbreak in Broward County, Ladapo sent parents a letter granting them permission to send unvaccinated children to school, defying the science-supported advice from the federal Centers for Disease Control and Prevention.

In 1977, a measles epidemic that killed two children in Los Angeles County spurred a dramatic crackdown on vaccine-shunning across the country. But during an epidemic this year that killed two Texas children and 14 people in Mexico, Republican Gov. Greg Abbott of Texas signed a bill making it easier for parents to opt out of getting required shots.

“When are we going to have enough of a groundswell of people dying or becoming severely ill that leads people to push back and say, ‘No, no, we want the vaccines?’” Takagishi said. “I don’t know if we know the tipping point yet.”

“I don’t have the answer,” said Emory University emeritus professor Walter Orenstein, who worked on measles for many of his 26 years at the CDC and led the agency’s immunization program from 1988 to 2004. “Measles resurgences created the political will to support our overall immunization program. For some reason it hasn’t worked this time. It’s just sad.”

Youngsters in Florida are already among the least vaccinated in the nation, because of relatively lax enforcement, the post-covid backlash against shots, and the libertarian attitude of state officials. Statewide, only about 89% of kindergartners are fully vaccinated, with Sarasota County having the lowest rate, at about 80%. To be safe from the spread of measles, a community must be 95% immunized.

With Health and Human Services Secretary Robert F. Kennedy Jr. cutting vaccine research, filling the health agency with anti-vaccine activists and spreading doubt about vaccination’s safety and value, little stands in the way of decisions by Florida officials that are likely to cause rates to sink further.

Ladapo’s department is ending mandates for shots against hepatitis B, chickenpox, and the bacteria causing meningitis and pneumonia. Early next year, the Florida Legislature is expected to take up reversal of a 1977 law requiring kids at school and day care to be vaccinated against seven other diseases that can kill children: whooping cough, measles, polio, rubella, mumps, diphtheria, and tetanus.

After Measles, Which Disease Returns Next?

In the face of these attacks, scientists are attempting to predict which diseases are likely to make a resurgence and when.

A study published in April by Stanford epidemiologist Mathew Kiang and colleagues estimated that even at current vaccination levels, measles, declared eliminated from the United States in 2000, is likely to become a routine illness again. If measles vaccination rates drop by an additional 10%, there could be an average of about 450,000 cases yearly, with hundreds of deaths and cases of brain damage.

But the study may exaggerate the threat, said Shaun Truelove, an epidemic disease modeler at Johns Hopkins University who said he’s worried about losing public trust with alarmist predictions. Still, he said, an intensification of measles outbreaks seems certain. The country is already in the midst of its worst measles year in three decades, with more than 1,500 cases and current outbreaks in South Carolina and Minnesota.

“You don’t really need to model measles if vaccines stop,” Truelove said. “In the pockets where there are outbreaks, every kid who isn’t vaccinated will get infected.”

Measles is the “canary in the coal mine” for other vaccine-preventable diseases, said Sal Anzalone, a pediatrician with Healthcare Network in Naples, Florida. “When you start seeing measles, there’s more to come behind that.”

People who want vaccinations will still be able to get them if mandates are eliminated, Ladapo has said.

But the state’s message confuses parents, especially the poor and underserved, Anzalone said. It’s typically hard for them to get children to appointments unless they have to, he said, noting that 80% of his patients are insured through Medicaid. If policies put more of the payment burden on parents, fewer will vaccinate, he said.

And if vaccinations fall and infections increase, children won’t be the only people affected. Cancer patients and people in Florida’s numerous elderly communities would be at risk. Schools and businesses would be disrupted. Disease could disrupt the tourism industry, which brought 143 million people to the state last year. (The Florida Chamber of Commerce did not respond to requests for comment.)

“Infectious diseases don’t stop with the people who say they are willing to bear the risk,” said Meagan Fitzpatrick, a University of Maryland vaccinologist. Because of their unpredictable spread, she said, “with an infectious disease, vaccination is never an individual choice.”

Clinicians fear that an end to mandates could allow hepatitis B, a chronic liver disease, to return with force, since an estimated 2 million Americans carry the virus. They also foresee a return to the days when infants with high fever had to undergo a painful and risky lumbar puncture and blood draw to rule out meningitis, as well as a blood infection caused by the bacteria Haemophilus influenzae type B that routine vaccination has prevented since the 1990s.

Barbara Loe Fisher, who co-founded the modern movement against vaccine mandates in the early 1980s after her son suffered a reaction to the pertussis vaccine then in use (and since replaced with a safer shot), is skeptical that Floridians will abandon vaccination en masse, despite the end to mandates.

Fisher, president of the National Vaccine Information Center, moved from Virginia to southwestern Florida in 2020. She said she believes that vaccine injuries are undercounted and that children are vaccinated without informed consent. She acknowledged that mandates have increased coverage but said their removal will increase trust in public health and medicine.

“It is time to allow biological products like vaccines to be subject to the law of supply and demand,” she said, “just like any other product sold in the marketplace.”

Sinnott, for his part, anticipates measles will come roaring back, along with intensified whooping cough, influenza, and covid outbreaks.

“They think nothing will happen. Maybe they’re right,” said Sinnott, the retired professor. “It’s an experiment.”

Polio could return, and that is not an abstraction for Sinnott, 77.

He was 7 years old when he contracted the disease, spending six months in a wheelchair. In recent years he’s suffered from post-polio syndrome — difficulty swallowing, and tightness and pain in his limbs.

The first polio vaccine was licensed in 1955, the year he got sick. “I remember one time my mother telling me, ‘The line was too long,’” he said.

Sinnott forgives his parents, and parents today who waver on vaccination. He’s less tolerant of certain public health leaders. They should know better, he said.

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

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This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The idea that Affordable Care Act marketplaces are riddled with fraud has become a major talking point among Republicans, as lawmakers in Congress argue about whether to extend the enhanced tax credits that are helping offset the cost of health care marketplace coverage for low- and middle-income people. Those ACA subsidies expire at the end of the year and have become a flash point in the government funding showdown.

“The tax credits go to some people deservedly. And we think the tax credits actually go to a lot of waste and fraud within the insurance industry,” said Vice President JD Vance during a recent interview on CBS News. “We want to make sure that the tax credits go to the people who need them.”

Key to the Republican argument of widespread fraud is a report published in August by the Paragon Health Institute, a Republican-aligned think tank. The report focuses on “phantom enrollees” in the ACA marketplaces.

Paragon president Brian Blase said these “phantom enrollees,” who don’t use any medical care in a year, exceed the percentages of “what you would expect in a normal, functioning health insurance market.”

Blase and his team say they have quantified the percentage of zero-claim enrollees in the ACA marketplace by analyzing Centers for Medicare & Medicaid Services data released in August.

This highlights one of the central issues with the CMS data: It tracks the number of plan enrollments rather than individual enrollees.

The federal data that Paragon analyzed could count enrollees twice if they’ve switched plans during the year, said Cynthia Cox, a vice president and the director of the Program on the ACA at KFF, a health information nonprofit that includes KFF Health News.

Per that data, in 2021, the percentage of enrollments without any medical claims was 19%. That percentage jumped to 35% in 2024.

To Blase and Paragon, this increase in zero-claim enrollments is evidence of fraud. It indicates, they say, that rogue insurance brokers are signing up people who don’t exist, don’t qualify, or have other insurance and don’t need ACA coverage.

“Basically, what happened is you had insurers benefit, brokers benefit financially, and just massive numbers of people got put on the program,” Blase said. That’s where these phantoms come in. “They have no idea that they’re enrolled, and, as such, they use no medical care.”

In 2021, former President Joe Biden signed into law the American Rescue Plan Act, which included enhanced ACA subsidies that made plans available at low or no cost to certain low-income individuals and expanded eligibility for subsidies to some middle-income people. Those credits were extended through 2025 as part of the Inflation Reduction Act, signed in 2022.

News stories show how simple it could be for insurance brokers in certain states to sign people up for zero-cost ACA insurance plans, unbeknownst to the consumers. The Department of Health and Human Services has tried to crack down on those fraudulent practices.

But health policy experts and analysts have cautioned against reading too deeply into the numbers of zero-claim enrollees.

“It’s not that he’s wrong, but I think he’s overinterpreting,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute, of Blase’s analysis.

Cox said there’s evidence that plan-switching has increased, due in part to extended open enrollment periods. Increased plan-switching could make the number of people being double-counted higher in the federal data and increase the percentage of zero-claim enrollees over the years. Some enrollees also may have been on an ACA plan for only part of the year, which would make them less likely to make a claim.

“We’re not trying to argue there is no fraud. It’s a real thing. But the question is, how big of a scale is this problem?” Cox said. “Just suggesting that anyone who’s not using health care is a fraudulent enrollee — that’s not true. Plenty of people don’t use health care.”

It’s not uncommon for healthy people in an insurance marketplace not to use their insurance in a given year, according to health policy experts. And with the enhanced ACA subsidies, more people signed up for marketplace coverage. Enrollment data shows that it made the marketplace population younger, and younger enrollees may be less likely to use their insurance. A recent report found that each year from 2018 to 2022, an average of 23% of enrollees in employer-sponsored plans didn’t use their health insurance.

“Somehow the idea that people not using health insurance is some sort of a problem — it might be. But in principle it isn’t,” said Joseph Antos, a health policy expert and senior fellow emeritus at the right-leaning American Enterprise Institute. “The point is that for insurance to work, you need some people who are not making claims on the insurance.”

The main trade associations for insurers and hospitals, AHIP and the American Hospital Association, have also disputed Paragon’s characterization of the federal data and even published blog posts breaking down their arguments. AHIP pushed back on the idea that the insurance industry is profiting from the enhanced subsidies by stating that existing law caps health plan profits.

Paragon was started by Blase in 2021 and has become widely influential in Republican health policy circles. Alumni of the organization are staffers in the Trump administration and in House Speaker Mike Johnson’s office, so it follows that the group’s takeaways would become Republican talking points.

It’s also not new for the GOP to say that government programs are full of fraud. During the negotiations over the One Big Beautiful Bill, Republican lawmakers insisted Medicaid wouldn’t be cut to pay for the tax cuts, but that “waste, fraud, and abuse” in the health program would be eliminated.

Now, the ACA is center stage in the ongoing federal government shutdown, with Democrats pushing for Congress to extend the current ACA subsidies, which are set to expire at the end of the year. And fraud, again, is a centerpiece of the argument for Republicans. Democrats take a different view on the amount of fraud in the program, instead emphasizing how the subsidies’ expiration will increase insurance premiums.

“It’s become a boondoggle. It’s a subsidy for insurance companies,” Speaker Johnson said of the ACA subsidies at a shutdown press conference last week. “When you subsidize the health care system, and you pay insurance companies more, the prices increase. That’s been the problem.”

KFF Health News senior correspondent Julie Appleby contributed to this report.

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

President Donald Trump's critics are accusing him of transforming government power into an instrument of retaliation, arguing that his administration’s pursuit of “retribution” against perceived enemies signals a departure from legal norms and erodes institutional independence.

In an article for The New Republic published Sunday, Paul Starr, a professor of Sociology at Princeton University, argued that Trump’s focus on revenge is not just a personal obsession but a political strategy rooted in a broader cultural reaction against decades of social change.

"The air is thick with talk of revenge, and it’s not limited to Donald Trump’s personal vendetta against individual enemies like James Comey, Letitia James, and John Bolton," the article read.

Starr wrote that Trump’s call for “retribution” against his enemies and the institutions he claims have “betrayed” his followers reflects a deep current of resentment within American politics.

Trump’s threats and acts of retaliation, Starr said, have helped him consolidate control over the Republican Party and intimidate other institutions.

Starr added that Trump’s appeal to revenge resonates with supporters who feel disempowered by the liberal and progressive movements that reshaped American life since the mid-twentieth century. The social revolutions that advanced racial equality, women’s rights, LGBTQ rights, and secular values, he argued, disrupted long-standing hierarchies and provoked backlash among those who saw their traditional privileges eroded.

"For years he had been telling his followers that they had been betrayed by the nation’s leaders on diversity policies, trade, immigration, foreign wars, and much else. He would be their instrument for a historic settling of scores," Starr said of Trump.

Trump’s promise of payback, Starr wrote, channels those grievances into a demand for the restoration of lost status and dominance.

Tracing the roots of this backlash, Starr noted that earlier Republican leaders like Richard Nixon and Ronald Reagan courted conservative resentment but did not seek to overturn liberal reforms entirely.

Nixon’s policies, he observed, often extended the liberal project, while Reagan’s conservatism, though economically transformative, stopped short of a full social counterrevolution.

Starr argued that the decisive shift toward Trump-style politics emerged in the 1990s, when the conservative movement and Republican Party increasingly turned to fear and aggression as organizing principles. In that evolution, he argued, the politics of revenge became central to the identity of the American right.

"There have been other dark times in America’s past and other dangers we have faced and overcome. We need the courage and determination that others before us have shown in leading the country through darkness to the other side," he concluded.

Mary Catherine Johnson is a retired small-business owner from outside Rochester, New York. She voted for Donald Trump three times.

Lexy Mealing, who used to work in a physician’s office, is from Long Island. She’s a Democrat.

But the women share a common bond. They both survived breast cancer.

And when the American Cancer Society Cancer Action Network organized its annual citizen lobby day in Washington last month, Johnson and Mealing were among the more than 500 volunteers pushing Congress to keep cancer research and support for cancer patients at the top of the nation’s health care agenda.

The day is something of a ritual for groups like the cancer organization.

This year, it came as Democrats and Republicans in Washington slid toward a budget impasse that shut down the federal government. But these volunteers transcended their political differences and found common ground.

“Not one person here discussed if you’re a Democrat, if you’re a Republican,” said Mealing, one of 27 volunteers in the New York delegation. “Cancer doesn’t care.”

Every one of the volunteer lobbyists had been touched in some way by the deadly disease, which is expected to kill more than 600,000 people in the U.S. this year.

Johnson said each of her mother’s 10 siblings died from cancer, as did a lifelong friend who died at age 57, leaving behind his wife and two young daughters.

Like many of the New York volunteers, Johnson also said she’s worried about the state of politics today.

“I think we’re probably the most divided that we’ve ever been,” she said. “That scares me. Scares me for my grandchildren.”

Katie Martin, a cancer volunteer from outside Buffalo, also worries. She and her daughter recently drove past political protesters screaming at one another on the street.

 “My daughter is silent and then starts asking, ‘What is this?’ And I don’t know how to explain it, because it doesn’t even make sense to me,” she said. “It’s very heartbreaking.”

Mealing said she can barely watch the news these days. “A lot of Americans are very stressed out. There’s a lot of things going on.”

Americans are indeed split over many issues — immigration, guns, President Trump. But helping people with cancer and other serious illnesses retains broad bipartisan support, polls show.

In one recent survey, 7 in 10 voters said it’s very important for the federal government to fund medical research. That included majorities of Democrats and Republicans.

“It’s rare in today’s environment to see numbers like that,” said Jarrett Lewis, a Republican pollster who conducted the survey for patient groups. “But almost everybody in this country knows somebody who’s had cancer.”

Similarly, a recent KFF poll found that three-quarters of U.S. adults, including most Republicans who align with the Make America Great Again, or MAGA, movement, want Congress to extend subsidies that help Americans buy health insurance through Affordable Care Act marketplaces.

These subsidies, which are critical to people with chronic illnesses such as cancer, are among the main sticking points in the current budget impasse in Congress.

As the cancer volunteers gathered in a conference hotel in Washington, they focused on their shared agenda: increasing funding for cancer research, retaining insurance subsidies, and expanding access to cancer screening.

“We may not see eye to eye politically. We might not even see eye to eye in social circumstances,” said Martin, the Buffalo-area volunteer. “But we can see beyond those differences because we’re here for one cause.”

The state delegations practiced the pitches they would make to their members of Congress. They ran through the personal stories they would share. And they swapped tips for how to deal with resistant staff and how to ask for a photo with a lawmaker.

On the morning of their lobby day, they reconvened in a cavernous ballroom, decked out in matching blue polo shirts and armed with red information folders to leave at each office they would visit.

They got a pep talk from a pair of college basketball coaches. Then they headed across town to Capitol Hill.

The army of volunteers — from every state in the country — hit 484 of the 535 Senate and House offices.

Not every visit was an unqualified victory. Many Republican lawmakers object to extending the insurance subsidies, arguing they’re too costly.

But lawmakers from both parties have backed increased research funding and support for more cancer screening.

And the New Yorkers felt good about the day. “It was amazing,” Mealing said as the day wrapped up. “You could just feel the sense of, ‘Everybody stronger together.’”

When evening came, the volunteers met on the National Mall for a candlelight vigil. It was raining. Bagpipes played.

Around a pond near the Lincoln Memorial, some 10,000 tea lights glimmered in little paper bags. Each luminary had a name on it — a life touched by cancer.

John Manna, another New Yorker, is a self-described Reagan Republican whose father died from lung cancer. He reflected on the lessons this day could offer a divided nation.

“Talk to people,” he said. “Get to know each other as people, and then you can understand somebody’s positions.  We have little disagreements, but, you know, we don’t attack each other. We talk and discuss it.”

Manna said he would be back next year.

Subscribe to KFF Health News' free Morning Briefing.

The phrase that has come to define the Trump administration’s message on climate change was born in Durham, New Hampshire, on December 16, 2023.

Flanked by flannel-clad supporters holding “Live free or die” signs, then-candidate Donald Trump wished the crowd a Merry Christmas before launching into what he saw as the biggest faults of the current administration. He swung at President Biden himself (“crooked Joe”) and the state of the economy (“Bidenomics”). About 10 minutes in, he arrived at Biden’s climate policies, which he said were “wasting trillions of dollars on Green New Deal nonsense.”

But Trump wasn’t satisfied with his choice of insult, perhaps recognizing that echoing “Green New Deal” served to amplify his opponents’ pro-climate action rallying cry. So in front of the crowd, he began riffing on ways to undermine it in real time.

“They don’t know what they’re doing, but you’re going to be in the poorhouse to fund his big government Green New Deal, which is a socialist scam. And you know what? You have to be careful. It’s going to put us all in big trouble,” he said. “The Green New Deal that doesn’t work. It’s a Green New Scam. Let’s call it, from now on, the ‘Green New Scam.'”

The crowd roared, shaking their signs in approval. “I do like that term, and I just came up with that one,” Trump said. “The Green New Scam. It will forever be known as the Green New Scam.”

There’s been plenty of attention on Trump’s purge of climate change language, and for good reason: Government workers are tiptoeing around vocabulary they once used freely. “Clean energy,” “climate science,” and “pollution” are on the list of “woke” words federal agencies have told employees to avoid. Recently, a memo circulated at the Department of Energy’s renewable energy office advised employees to remove or rephrase basic terms including “climate change,” “emissions,” and “green.” But the administration is doing more than making these phrases disappear. It’s also introducing new language designed to undermine the foundations upon which trust in climate science and policy is built.

In the nine months since Trump began his second presidency, the phrase “Green New Scam” — always capitalized — has appeared in White House fact sheets and press statements, echoed across federal agencies and by Republicans in Congress.

“He’s quite effective at creating sticky phrases and using repetition to amplify them,” said Renee Hobbs, a communications professor at the University of Rhode Island who wrote a book on modern propaganda. “That’s the classic propaganda strategy, right? You repeat the phrases that you want to stick, and you downplay, ignore, minimize, or censor the concepts that don’t meet your agenda.”

It’s part of a broader effort to erase information about how the planet is changing. In recent months, the administration has axed entire pages about climate change and how to adapt to it, said Gretchen Gehrke, who monitors federal websites with the Environmental Data and Governance Initiative. The 400 experts working on the government’s next official climate report were dismissed, then all the past reports vanished, too. The administration has proposed stopping long-running projects that monitor carbon dioxide levels, and the Environmental Protection Agency is no longer collecting greenhouse gas emissions data from polluting companies.

You could see it as a three-pronged strategy. First, erase language related to climate change. Second, dismantle the scientific foundation supporting it. Third, fill the void with a message that matches Trump’s political priorities — like the “Green New Scam.”

“We’ve always understood language shapes reality, and language can create unreal realities,” Hobbs said. “And I think that’s what Trump is doing with his language of climate change.”

In Trump’s growing arsenal of anti-climate catchphrases, “Green New Scam” remains a go-to weapon. The Green New Deal concept was a ripe target for Trump because it serves as a catch-all for progressive positions, said Josh Freed, senior vice president for climate and energy at the think tank Third Way. “That was the target that I think Trump honed in on and flipped the script on, and turned it into a vulnerability and catchphrase for what he felt the public would see as positions that were extreme,” he said.

Trump has taken the idea to an international audience. In his speech to the United Nations General Assembly last month, he spent a full 10 minutes ranting off-script about climate policy, deriding renewables and international efforts to address climate change. “If you don’t get away from this green scam, your country is going to fail,” he told the world leaders in attendance.

In the same speech, he went on to call climate change “the greatest con job ever perpetrated on the world.” He also claimed that “the carbon footprint is a hoax made up by people with evil intentions.”

Conspiracy theories are a common tool in propaganda, according to Hobbs. “Conspiracy theories are catnip because they postulate this malevolent actor who’s doing something secretly to hurt people, and humans are hardwired to pay attention to stuff like that,” she said. Studies have shown that fake news about climate change is more compelling to people than scientific facts.

Still, Trump is fighting an uphill battle trying to paint climate change as fake. About 70 percent of Americans acknowledge that global warming is happening. Meanwhile, recent polling found that most Americans don’t trust Republicans on the environment, with only 23 percent preferring the party’s plan for tackling environmental issues.

But if a phrase gets repeated often enough, it can begin to bend reality, even if it’s inaccurate. It’s a rule that Trump intuitively understands, and a driving force behind his linguistic prescriptions. “I have a little standing order in the White House — never use the word ‘coal,’ only use the words ‘clean, beautiful coal,’” Trump said in his speech to the U.N. “Sounds much better, doesn’t it?”

Coal may be dirty by basically every yardstick people use to decide whether something is clean, but the phrase “clean coal” could still change people’s associations with the fuel. “If you can control vocabulary, you’re controlling thought,” said Kathleen Hall Jamieson, a professor of communication at the University of Pennsylvania who has spent decades studying campaign messaging. Once we adopt a new set of terms, those words start doing the thinking for us, she said. People absorb the assumptions that are baked into them, often without even noticing.

Jamieson says it’s part of a broader strategy to boost fossil fuels over renewable energy sources like solar and wind. The Trump administration has canceled billions of funding in clean energy projects while simultaneously fast-tracking permits for new pipelines and other fossil fuel infrastructure. Last month, the Energy Department announced it would pour $625 million into rescuing the coal industry, which has been dying as natural gas and renewables have taken off.

“The administration is trying to align the vocabulary through which we talk about the environment with policies that are consistent with increased drilling,” Jamieson said. “You don’t have to do much work to see the relationship between the policies and the language.”

As for how to respond to propaganda, Hobbs said that turning to facts — like scientists and journalists often do — is not the most effective strategy. Research has long shown that feelings are more important than facts in changing people’s minds. “You fight propaganda with propaganda, right?” she said. Climate advocates are increasingly connecting climate change to inflation and the rising cost of living, in an effort to reach Americans struggling with high electricity bills.

On the micro level, Hobbs said she’s seen success in online experiments where people engaged in genuine, open conversations about different propaganda topics, from free speech rights to the role of social media influencers. The format prompted people to talk about conspiracy theories they’ve encountered, what feelings those stories evoked, and which ones were harmful. Participants were encouraged to open up about their uncertainties and where they were coming from — and in doing so, they often came to their own realization that their beliefs might be influenced by propaganda. Hobbs said that people decreased their fear of others who thought differently and became more critical about the information they were receiving.

“We can’t help but be exposed to propaganda,” Hobbs said, “but how we react to it is up to us.”

This article originally appeared in Grist at https://grist.org/language/strategy-behind-trump-climate-catchphrase-green-new-scam/.

Grist is a nonprofit, independent media organization dedicated to telling stories of climate solutions and a just future. Learn more at Grist.org

This summer, at dinner with her best friend, Jacki Barden raised an uncomfortable topic: the possibility that she might die alone.

“I have no children, no husband, no siblings,” Barden remembered saying. “Who’s going to hold my hand while I die?”

Barden, 75, never had children. She’s lived on her own in western Massachusetts since her husband passed away in 2003. “You hit a point in your life when you’re not climbing up anymore, you’re climbing down,” she told me. “You start thinking about what it’s going to be like at the end.”

It’s something that many older adults who live alone — a growing population, more than 16 million strong in 2023 — wonder about. Many have family and friends they can turn to. But some have no spouse or children, have relatives who live far away, or are estranged from remaining family members. Others have lost dear friends they once depended on to advanced age and illness.

More than 15 million people 55 or older don’t have a spouse or biological children; nearly 2 million have no family members at all.

Still other older adults have become isolated due to sickness, frailty, or disability. Between 20% and 25% of older adults, who do not live in nursing homes, aren’t in regular contact with other people. And research shows that isolation becomes even more common as death draws near.

Who will be there for these solo agers as their lives draw to a close? How many of them will die without people they know and care for by their side?

Unfortunately, we have no idea: National surveys don’t capture information about who’s with older adults when they die. But dying alone is a growing concern as more seniors age on their own after widowhood or divorce, or remain single or childless, according to demographers, medical researchers, and physicians who care for older people.

“We’ve always seen patients who were essentially by themselves when they transition into end-of-life care,” said Jairon Johnson, the medical director of hospice and palliative care for Presbyterian Healthcare Services, the largest health care system in New Mexico. “But they weren’t as common as they are now.”

Attention to the potentially fraught consequences of dying alone surged during the covid-19 pandemic, when families were shut out of hospitals and nursing homes as older relatives passed away. But it’s largely fallen off the radar since then.

For many people, including health care practitioners, the prospect provokes a feeling of abandonment. “I can’t imagine what it’s like, on top of a terminal illness, to think I’m dying and I have no one,” said Sarah Cross, an assistant professor of palliative medicine at Emory University School of Medicine.

Cross’ research shows that more people die at home now than in any other setting. While hundreds of hospitals have “No One Dies Alone” programs, which match volunteers with people in their final days, similar services aren’t generally available for people at home.

Alison Butler, 65, is an end-of-life doula who lives and works in the Washington, D.C., area. She helps people and those close to them navigate the dying process. She also has lived alone for 20 years. In a lengthy conversation, Butler admitted that being alone at life’s end seems like a form of rejection. She choked back tears as she spoke about possibly feeling her life “doesn’t and didn’t matter deeply” to anyone.

Without reliable people around to assist terminally ill adults, there’s also an elevated risk of self-neglect and deteriorating well-being. Most seniors don’t have enough money to pay for assisted living or help at home if they lose the ability to shop, bathe, dress, or move around the house.

Nearly $1 trillion in cuts to Medicaid planned under President Donald Trump’s tax and spending law, previously known as the “One Big Beautiful Bill Act,” probably will compound difficulties accessing adequate care, economists and policy experts predict. Medicare, the government’s health insurance program for seniors, generally doesn’t pay for home-based services; Medicaid is the primary source of this kind of help for people who don’t have financial resources. But states may be forced to eviscerate Medicaid home-based care programs as federal funding diminishes.

“I’m really scared about what’s going to happen,” said Bree Johnston, a geriatrician and the director of palliative care at Skagit Regional Health in northwestern Washington state. She predicted that more terminally ill seniors who live alone will end up dying in hospitals, rather than in their homes, because they’ll lack essential services.

“Hospitals are often not the most humane place to die,” Johnston said.

While hospice care is an alternative paid for by Medicare, it too often falls short for terminally ill older adults who are alone. (Hospice serves people whose life expectancy is six months or less.) For one thing, hospice is underused: Fewer than half of older adults under age 85 take advantage of hospice services.

Also, “many people think, wrongly, that hospice agencies are going to provide person power on the ground and help with all those functional problems that come up for people at the end of life,” said Ashwin Kotwal, an associate professor of medicine in the division of geriatrics at the University of California-San Francisco School of Medicine.

Instead, agencies usually provide only intermittent care and rely heavily on family caregivers to offer needed assistance with activities such as bathing and eating. Some hospices won’t even accept people who don’t have caregivers, Kotwal noted.

That leaves hospitals. If seniors are lucid, staffers can talk to them about their priorities and walk them through medical decisions that lie ahead, said Paul DeSandre, the chief of palliative and supportive care at Grady Health System in Atlanta.

If they’re delirious or unconscious, which is often the case, staffers normally try to identify someone who can discuss what this senior might have wanted at the end of life and possibly serve as a surrogate decision-maker. Most states have laws specifying default surrogates, usually family members, for people who haven’t named decision-makers in advance.

If all efforts fail, the hospital will go to court to petition for guardianship, and the patient will become a ward of the state, which will assume legal oversight of end-of-life decision-making.

In extreme cases, when no one comes forward, someone who has died alone may be classified as “unclaimed” and buried in a common grave. This, too, is an increasingly common occurrence, according to “The Unclaimed: Abandonment and Hope in the City of Angels,” a book about this phenomenon, published last year.

Shoshana Ungerleider, a physician, founded End Well, an organization committed to improving end-of-life experiences. She suggested people make concerted efforts to identify seniors who live alone and are seriously ill early and provide them with expanded support. Stay in touch with them regularly through calls, video, or text messages, she said.

And don’t assume all older adults have the same priorities for end-of-life care. They don’t.

Barden, the widow in Massachusetts, for instance, has focused on preparing in advance: All her financial and legal arrangements are in order and funeral arrangements are made.

“I’ve been very blessed in life: We have to look back on what we have to be grateful for and not dwell on the bad part,” she told me. As for imagining her life’s end, she said, “it’s going to be what it is. We have no control over any of that stuff. I guess I’d like someone with me, but I don’t know how it’s going to work out.”

Some people want to die as they’ve lived — on their own. Among them is 80-year-old Elva Roy, founder of Age-Friendly Arlington, Texas, who has lived alone for 30 years after two divorces.

When I reached out, she told me she’d thought long and hard about dying alone and is toying with the idea of medically assisted death, perhaps in Switzerland, if she becomes terminally ill. It’s one way to retain a sense of control and independence that’s sustained her as a solo ager.

“You know, I don’t want somebody by my side if I’m emaciated or frail or sickly,” Roy said. “I would not feel comforted by someone being there holding my hand or wiping my brow or watching me suffer. I’m really OK with dying by myself.”

Subscribe to KFF Health News' free Morning Briefing

Why do some people endorse claims that can easily be disproved? It’s one thing to believe false information, but another to actively stick with something that’s obviously wrong.

Remnants of a powerful typhoon swept into Western Alaska’s Yukon-Kuskokwim Delta on Oct. 12, 2025, producing a storm surge that flooded villages as far as 60 miles up the river. The water pushed homes off their foundations and set some afloat with people inside, officials said. More than 50 people had to be rescued in Kipnuk and Kwigillingok, hundreds were displaced in the region, and at least one person died.

A fringe British cardiologist who advises U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. claims to know why Preisdent Donald Trump has allegedly been suffering from "dementia" and swollen ankles, according to a report in The Daily Beast.

Dr. Aseem Malhotra was an advisor to Kennedy's Make America Healthy Again (MAHA) movement before stepping down last week to become chief medical and scientific adviser to the new European health activism organization Make Europe Healthy Again (MEHA).

In a speech to the European Parliament last week, Malhotra, a known anti-vaxxer, claimed that Trump's apparent health issues are caused by the cholesterol lowering statins and aspirin he takes, The Daily Beast says.

"Malhotra has waged a long and controversial campaign against the lack of transparency in the widespread prescription of statins and the dangers of their overuse," The Daily Beast says.

"Medical consensus largely disregards his claims, but that has not discouraged Trump’s health secretary from seeking his counsel, and the pair have become friends," the note.

Trump, the oldest sitting president in U.S. history, has been the focus of much speculation over his health and cognitive decline, as well as bruising he has covered up with makeup, brushed off by the White House as the effects of handshaking, and a recent diagnosis of chronic venous insufficiency that causes swollen ankles.

Despite that, his acolytes and staff insist that he is the picture of perfect health, as they did Friday when the president stopped by Walter Reed National Military Medical Center for what was the second "annual" check-up in six months, at which he received both the flu and COVID booster shots, much to MAHA's dismay.

Malhotra’s campaign against the overuse of statins has, says The Daily Beast, highlighted their significant side effects, which the FDA says can include “cognitive impairment,” such as “memory loss, forgetfulness, amnesia, memory impairment, confusion”—and a paper hosted by the NIH says can cause muscle inflammation, or swelling."

Most medical experts call Malhotra egregiously wrong, including the British Heart Foundation, which calls his studies, "misleading and wrong."

Malhotra says if Trump stopped taking statins and aspirin, his "brain fog" would “cease… within just a few weeks.”

"The first step would be to stop his aspirin and the cholesterol lowering medications he’s taking that are likely shortening his lifespan and giving him fatigue,” the doctor claims.

Malhotra also alleges that according to a study he co-authored, the higher the cholesterol in a person over 60, the longer they will live.

"By using statins, it’s probably doing Trump more harm than good [because] of their side effects. Why take that risk?" the doctor asks.

Malhotra is no stranger to controversial diagnoses debunked by medicine and science. "Last month, Malhotra made headlines by suggesting that King Charles III may have developed cancer through the jab despite no evidence to support the claim,' The Daily Beast says.

Even the White House agreed that this was a fringe take.

“So-called medical ‘experts’, especially foreign ones with no relevance or involvement with the Administration, should stop beclowning themselves and marring their credibility by pitching their idiotic hot takes with Fake News outlets that have nothing better to cover," spokesman Kush Desai told The Daily Beast.

In her new book, "The Nature of Pain: Roots, Recovery, and Redemption Amid the Opioid Crisis," author and Kentucky native Mandi Fugate Sheffel describes her recovery from addiction and the opioid struggles that continue to plague Appalachia. Sheffel also describes those struggles in an article published by Salon on October 11.

"I want to write about the first time I did a pill," Sheffel explains. "It was a turning point, one of those things you'll think you’ll never forget. But I can't. I don't remember. I don't remember any of my first-time meetings with drugs except for OxyContin. It was my junior year of high school, and OxyContin was showing up everywhere — in the hallways at school, parties on the weekend and in medicine cabinets all over central Appalachia. I was with my cousin Eric, who was like a brother, the first time I did an OC."

Sheffel notes that that she might seem an unlikely candidate for addiction, as she was senior vice president of her high school in Kentucky and graduated with a 4.0 GPA in 1999.

"I was not supposed to be a drug addict," Sheffel recalls. "But that's exactly what I became. In 2002, after my third failed attempt at college and living away from home, I returned to Eastern Kentucky — and I had no way of knowing what I was coming home to. Over the past year and a half, I had no communication with my friends in the region. OxyContin was everywhere. People I had known my whole life who would have never considered drugs were now full-fledged addicts…. After years of active addiction and struggle, I finally found recovery through rehab and working the 12 steps."

Sheffel continues, "I'm now a small business owner in Hazard, Kentucky; I run a small independent bookshop called the Read Spotted Newt, which fuels my creativity and offers me a way to make amends to the community I abused for years."

The struggles in Appalachia, from poverty and unemployment to addiction, were a prominent theme of now-Vice President J.D. Vance's 2016 book, "Hillbilly Elegy: A Memoir of a Family and Culture in Crisis."

The book was published during Trump's first presidential campaign. Vance, at the time, was conservative-leaning but not far-right and not MAGA — in fact, he was quite critical of Trump. And the book's admirers, including a fair amount of liberals, hailed it as a gripping account of the problems Appalachia was facing.

After giving himself an ultra-MAGA makeover and becoming a strident Trump ally, Vance was elected to the U.S. Senate and, in 2024, became Trump's running mate. Vance, during the campaign, drew heavily on the "Hillbilly Elegy" themes while joining Trump in promising to go after opioid trafficking.

But now, almost nine months into Trump's second presidency, critics of his drug policies are arguing that he places too much emphasis on going after traffickers but doesn't pay enough attention to either drug treatment programs or the socioeconomic conditions in a region like Appalachia — conditions described in "Hillbilly Elegy" and more recently, in Sheffel's book.

Sheffel, in her Salon article, laments that the addiction crisis continues to plague Appalachia many years after her own struggle.

"People have lost their family homes, and there's no one to fall back on when times get hard," Sheffel observes. "People are living on the streets, and the faces change every day.… Thirty years later, we are still learning how to navigate this epidemic. Gone are the old adages of tough love and hitting bottom. Now, we approach this disease with community — with meeting people where they are. That's why it's important for me to live my recovery out loud. To give hope and instill empathy in those who are tempted to give up the fight."

Mandi Fugate Sheffel's full article for Salon is available at this link.

“Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of health care benefits to illegal aliens.” --Vice President JD Vance in a Sept. 28, 2025, Fox News interview

As the U.S. headed for a government shutdown, Republicans repeatedly accused Democrats of forcing the closure because they want to give health care access to immigrants in the U.S. illegally.

“Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of health care benefits to illegal aliens,” Vice President JD Vance said Sept. 28 on “Fox News Sunday.”

President Donald Trump, House Speaker Mike Johnson, and Republican members of Congress have repeated this line.

It’s wrong.

Democrats have refused to vote for Republicans’ resolution to extend the federal spending deadline, and their position does, in part, hinge on health care spending. Democrats want to extend covid pandemic-era Affordable Care Act subsidies that are set to expire at the end of the year and roll back Medicaid cuts in the tax and spending bill that Trump signed into law this summer.

The Democrats’ proposal wouldn’t give health care to immigrants who lack legal status; that population is already largely ineligible for federally funded health care. Instead, the proposal would restore access to certain health care programs for legally present immigrants who will lose access under the Republican law.

The White House did not respond to PolitiFact’s request for comment for this fact check. Vance addressed criticism of his talking point in another interview by saying it was included in the Democrats’ spending proposal. It’s not.

A White House X account followed up with screenshots of the Democratic proposal repealing a section of the Republican law labeled “alien Medicaid eligibility.” It’s important to know that these changes would not give Medicaid access to immigrants who lack lawful status.

Vance defended his statement again in an Oct. 1 White House press conference, saying former President Joe Biden “waived away illegal immigration status” that helped migrants access federal assistance. It’s important to note that many people granted lawful status through humanitarian parole or Temporary Protected Status programs don’t automatically qualify for Medicaid; TPS recipients aren’t eligible, and many people who entered the U.S. on humanitarian parole are required to wait five years before accessing it.

The Trump administration has ended humanitarian parole and Temporary Protected Status for many people, rendering them ineligible for Medicaid and health plans on the Affordable Care Act marketplace.

We did not find evidence that Democrats want to spend “hundreds of billions” in costs for insuring migrants with unlawful presence.

Immigrants Lacking Legal Status Are Already Ineligible

Most federal health care dollars cannot be spent on health care for people in the U.S. who lack legal status. They cannot enroll in Medicaid or Medicare, and they are ineligible to purchase health care coverage through the Affordable Care Act marketplace. A small Medicaid program reimburses hospitals for uninsured emergency care, which can include immigrants in the country without authorization but is not exclusive to them.

States such as California and Illinois expanded Medicaid coverage for people regardless of their immigration status, and the states pay for that. Federal law already banned states from using federal money for these programs. An earlier version of the Republican spending law would have penalized such states by withholding funding, but that provision didn’t last.

People in the country without permission might receive some federally funded health care in emergency cases; in those situations, hospitals must provide care even if a person is uninsured or in the country illegally. Emergency Medicaid covers hospital care for immigrants who would be eligible for Medicaid if not for their immigration status. The Republican tax and spending law reduced the amount hospitals can receive for emergency immigrant care.

Most Emergency Medicaid spending is used on childbirth. In all, it represented less than 1% of total Medicaid spending in fiscal year 2023, according to KFF, a health information nonprofit that includes KFF Health News.

GOP Law Limited Care Access for Immigrants With Legal Status

The Republican tax and spending law made several changes to health care eligibility for immigrants living in the country with permission. An estimated 1.4 million legal immigrants are expected to lose their health insurance, according to a KFF analysis of Congressional Budget Office projections.

Starting October 2026, the law will restrict eligibility for Medicaid and the Children’s Health Insurance Program to lawfully permanent residents, people from the Marshall Islands, Micronesia, or Palau who lawfully reside in the U.S. under an international agreement, and certain Cubans and Haitians.

Previously, a broad group, described as “qualified noncitizens,” was eligible for Medicaid and its related Children’s Health Insurance Program, known as CHIP, including refugees and people granted asylum.

Some immigrants eligible for Medicaid and CHIP, such as lawful permanent residents, are required to wait five years before accessing the benefits.

The law also limited Affordable Care Act marketplace eligibility to the same group eligible for Medicaid and CHIP beginning Jan. 1, 2027. Previously, people who were described as “lawfully present” were eligible. That group included the “qualified noncitizens” eligible for Medicaid and people with short-term statuses, such as Temporary Protected Status or international students.

Beneficiaries of the Deferred Action for Childhood Arrivals program, known as DACA, for immigrants who entered the U.S. without authorization as children were previously eligible for Affordable Care Act coverage and its subsidies. They are ineligible since a Trump administration rule took effect in August.

Democrats’ Proposal Would Restore Legal Immigrants’ Access

The Democrats’ Sept. 17 budget proposal would, in part, permanently extend the Affordable Care Act subsidies and roll back billions in Republican cuts to Medicaid and other health programs.

The change would make Medicaid, CHIP, and Affordable Care Act coverage available to all legal immigrants who were previously eligible for it, such as refugees and people granted asylum.

The Democratic proposal would not broaden eligibility to federally funded health care programs to immigrants lacking legal status.

Vance said the Democratic policies would “give hundreds of billions of dollars of health care benefits to illegal aliens,” and the White House did not offer its source for that figure. When Johnson was pressed to support a similar talking point, he referenced the Congressional Budget Office. The KFF analysis of CBO estimates found that the Republican law’s provisions related to legal immigrants would reduce federal spending by $131 billion; this projection did not include an estimate for people without legal status.

Our Ruling

Vance said, “Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of health care benefits to illegal aliens.”

Immigrants in the U.S. illegally are largely ineligible for the federally funded health care programs Medicare and Medicaid, and they cannot seek coverage in the Affordable Care Act marketplace or apply for subsidies.

The Democrats’ budget proposal would not change that.

The Democrats want to restore access to certain health care programs to legal immigrants who will lose access under the Republican tax and spending law — among other measures aimed at making Medicaid and Affordable Care Act insurance plans easier to keep.

Their proposal would not grant federally supported health care benefits to people in the U.S. illegally, because they did not have access to them in the first place. The small amount of funding designated for Emergency Medicaid reimburses hospitals that provide emergency care to immigrants who would be eligible for Medicaid if not for their immigration status. Finally, we did not find evidence for Vance’s assertion that Democrats want “hundreds of billions” in health benefits for migrants in the country illegally.

We rate the statement False.

Our Sources

Fox News, “JD Vance Slams ‘Preposterous’ Claims on Comey Indictment: ‘Lied Under Oath’, Sept. 28, 2025.

The White House, “President Trump Delivers an Announcement,” Sept. 30, 2025.

President Donald Trump, Truth Social post, Sept. 29, 2025.

U.S. House of Representatives bill, accessed Oct. 1, 2025.

Congressional Budget Office, “Distributional Effects of Public Law 119-21,” Aug. 11, 2025.

PolitiFact, “Newsom Championed Medicaid for Immigrants in California Illegally. Now He Wants To Cut It Back,” May 16, 2025.

KFF, “Health Provisions in the 2025 Federal Budget Reconciliation Bill,” July 8, 2025.

KFF, “Potential Impacts of 2025 Budget Reconciliation on Health Coverage for Immigrant Families,” June 17, 2025.

KFF, “Key Facts on Health Coverage of Immigrants,” Jan. 15, 2025.

KFF, “1.4 Million Lawfully Present Immigrants Are Expected To Lose Health Coverage Due to the 2025 Tax and Budget Law,” Sept. 25, 2025.

U.S. Citizenship and Immigration Services, “Information for SAVE Users: Cuban-Haitian Entrants,” accessed Oct. 1, 2025.

U.S. Citizenship and Immigration Services, “Status of Citizens of the Freely Associated States of the Federated States of Micronesia and the Republic of the Marshall Islands Fact Sheet,” accessed Oct. 1, 2025.

Healthcare.gov, “Coverage for Lawfully Present Immigrants,” accessed Oct. 1, 2025.

Federal Register, “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability,” June 25, 2025.

John Galgiani has been waiting for this call.

The 79-year-old physician is sitting on a chair in a side office at a health clinic in Phoenix, Arizona, long legs crammed under the table in front of him, hands folded at his stomach, when his cell phone rings. “There’s my guy,” he says.

The man on the other end, a physician who works in Tucson, is a touch less relaxed. One of his patients has been in and out of the hospital with a respiratory infection so severe that at one point she coughed up blood. Her skin is flaking, she’s losing her hair, and now the ventricles in her heart are taking too long to refill with blood between beats. The physician suspects some of these symptoms are being caused not by her underlying condition, but by the medication he has her on. The problem is, her insurance is refusing to cover a more expensive alternative.

Galgiani, the country’s leading expert on the disease they’re talking about, quickly cuts him off. Take the patient off the medication, he says, and see how she does. If she improves, show the insurance company proof and force its hand. “That’s actually a good idea,” the doctor replies.

The conversation is so routine, its conclusion — a change of medication — so anodyne, it’s easy to forget that the patient they’re talking about is battling a deadly and incurable fungus.

Doctors have been searching for a cure for coccidioidomycosis, the disease afflicting the patient, since the 1890s, when an Argentine soldier was hospitalized with skin lesions that returned with a zombie-like vengeance after being scrubbed or cut off. Not long after, an immigrant farmworker landed in a San Francisco hospital with the same mutilating disease. Both patients eventually died.

It would be decades before medical researchers and public health officials connected the dots between those cases and reports of a mysterious disease referred to simply as “desert rheumatism” by the waves of settlers, immigrants, and farmworkers that rippled through the West on the heels of the Gold Rush, the completion of the transcontinental railroad, and the Dust Bowl. In California’s San Joaquin Valley, the disease was known as “San Joaquin Valley Fever,” and “valley fever” became the colloquial name of the infection Galgiani later dedicated his life to studying.

By the 1930s, scientists understood that valley fever and the disease that killed the two immigrant farmworkers were different stages of one illness caused by the same fungal pathogen. They had also begun to grasp the basics of transmission. The fungus that causes the disease, called coccidioides or cocci (pronounced “cox-ee”) for short, grows in the top few inches of undisturbed earth throughout the Western U.S. and flourishes during cool, rainy periods. Then, in the summertime heat of the desert, its delicate fungal threads desiccate. Once they’re dry, any disturbance of the topsoil — a foot kicking up earth, a bulldozer digging a foundation, an earthquake shaking loose clouds of dust — sends infinitesimal spores swirling into the air, where they can be sucked through the nasal passages and into the lungs of passing humans or animals.

Most people who breathe in cocci spores — about 6 in 10 — won’t develop symptoms. But the 40 percent of exposed people whose immune systems can’t or won’t fight off the fungus develop symptoms such as fatigue, muscle aches, coughing, and rash that can last weeks or months. In the 5 to 10 percent of symptomatic cases where the fungus invades the vital organs, the death rate is as high as 25 percent. The pathogen is so powerful the U.S. army weighed whether to develop it into a bioterrorism weapon in the 1960s.

Valley fever is endemic to southern Washington, Oregon, California, Nevada, Utah, New Mexico, Texas, and parts of Central and South America, but nowhere are cases of the disease more common than in Arizona. After Arizona started mandatory laboratory reporting for valley fever in 1997, registered cases ticked up and down. But the number began trending upward dramatically in 2016. Then, in 2024, cases in the state exploded, hitting their second-highest total ever. More than 15,000 infections were reported — a 37 percent increase over 2023. California, which runs just behind Arizona in its annual valley fever caseload, registered a record-breaking 12,637 cases in 2024, representing a 39 percent increase over the previous year, which had already smashed a record set in 2019.

Some portion of the rise in reported cases represents growing awareness among physicians and an associated surge in testing. The pace of new construction in untouched areas also plays a role.

But the recent increase in cases has been so dramatic, Galgiani and other researchers across the West who study the fungus think another factor may be driving the trend: supersoaker winter monsoons followed by scorching summer heat and drought, a cycle made more intense by climate change.

Because warmer air holds more moisture, monsoons and other major rainfall events pull in larger quantities of water vapor and produce heavier downpours as the planet warms. This physical fact has fueled a spate of monster floods across the U.S. and around the world in recent years. But the same warmth can conversely lead to drought by making the atmosphere “thirstier,” or capable of absorbing more water from the land’s surface. Both conditions facilitate the spread of valley fever — the wetter conditions by encouraging growth of the spores, and the drier by facilitating desiccation and soil disturbance.

“The main driver for us is certainly this very clear association for coccidioides between heavy precipitation cycles followed by drought,” said George Thompson, a professor of medicine at the University of California, Davis, School of Medicine who specializes in fungal diseases.

And it’s not just valley fever that may increase its spread thanks to climate change. Peer reviewed research shows that fungal threats of all kinds are poised to emerge and thrive in a warming world.

Since many valley fever cases are asymptomatic or diagnosed as something else, the numbers of infected people reported by states every year are widely considered underestimates. The Centers for Disease Control and Prevention says that the true burden of valley fever in the U.S. is 10 to 18 times higher than reported, meaning tens or hundreds of thousands of people in Arizona and California have been touched by these latest spikes. Cases reported so far this year are surging in both states.

This is the kind of challenge Galgiani has spent the better part of three decades preparing for. Since 1996, Galgiani has served as director of a Tucson-based center he founded at the University of Arizona called the Valley Fever Center for Excellence, where a small army of researchers, doctors, and veterinarians works closely with county and state public health agencies and research universities on developing solutions to the state’s multifaceted valley fever problem. Years of dogged work are finally beginning to yield momentum that could prevent thousands of infections and dozens of deaths every year.

What might become the world’s first-ever fungal vaccine, discovered by Galgiani and a team of researchers at the Center for Excellence in 2013, is nearing the end of the long federal regulatory process for use against valley fever in dogs. A pharmaceutical company has already initiated the process of adapting it for use in humans.

Galgiani and his colleagues also teamed up with researchers at Arizona State University to develop a valley fever surveillance prototype that uses data from National Weather Service weather stations to track the environmental conditions that spur cases of the disease. He designed a clinical education program that trains physicians how to more quickly and accurately diagnose valley fever in their patients. The program was put to use in urgent care clinics in Phoenix and Tucson owned by Banner Health, one of the biggest nonprofit healthcare systems in the U.S.

But these efforts, some of the first homegrown examples of researchers and health professionals collaborating to protect their communities against a climate-driven health threat in the U.S., are on a collision course with the Trump administration’s new policies. In the months since Donald Trump was elected president, his administration has systematically undermined the infrastructure that supports the country’s public health systems, ordering deep cuts to government funding for vaccines, research, and personnel, and even taking aim at the systems that track and publish data on new cases of infectious disease.

For decades, Galgiani thought the work he was doing at the Valley Fever Center for Excellence was building a solid foundation that Arizona would be able to depend on in the hotter years to come. The first nine months of the second Trump administration have made that foundation look more like a Jenga tower. The infrastructure supporting everyone Galgiani works with — the research to develop a vaccine that may one day become widely available for human use, the valley fever surveillance tools that rely on government weather data to operate, and the federal funding that pays for Arizona’s public health initiatives, public universities, and research labs — is starting to wobble.

The quest to free Arizona of its fungal scourge, never closer to bearing fruit, has also never been more at risk.

As Sharon Filip, a healthy woman in her 50s, was preparing to depart Washington state for a two-week vacation in Arizona in 2001, she checked the state’s Department of Health website to find out what she should be aware of before her trip. As a result, she arrived in Tucson prepared to avoid scorpions at all costs. Nothing she read indicated that a deadly fungal disease lurked in the soil.

A week after returning home, Filip could barely lift her head off her pillow. “Every bone in my body, every muscle in my body, every part of my body, my organs — everything hurt,” she said. Her doctors had no idea what was wrong.

Filip’s son, David, took care of her, and her illness resolved on its own over the course of months, as many cases do. There is no cure for the disease, though a round of strong antifungals, which come with their own suite of painful side effects, can provide the immune system with an assist as it tries to destroy the spores. Filip said it took her 10 years to fully “come back to the world of the living.” She and her son formed a group called Valley Fever Survivor, which has served as a meeting place of sorts for people desperate for more information and guidance.

Arizona has accounted for at least two-thirds of all cases reported in the U.S. for decades, although California is beginning to reach parity as the fungus spreads. Maricopa County in particular — Arizona’s most populous and diverse county, housing four of the five biggest cities in the state, including Phoenix — is located on what appears to be a massive fungal reservoir. Half of all of the nation’s cases start in Maricopa. But even in Maricopa County, getting an accurate valley fever diagnosis often depends on whether either the patient or the doctor is aware that such a disease exists.

“I went to a hospital four different times between three different locations before I was taken seriously,” someone wrote in a valley fever support group on Facebook recently. “As a native to Arizona who has only heard of valley fever and does not know anyone who has had this, I find it all incredibly shocking.”

Unlike nearby California, Arizona has passed no workers’ protection legislation aimed at controlling one of its most commonly reported infectious diseases. The state legislature, controlled almost exclusively by a Republican majority since the mid-1960s, approved just $300,000 for valley fever surveillance in 2007. No new funding has been approved by the legislature since, though the Arizona Board of Regents, the state senate-confirmed board that governs Arizona’s university system, used $3.3 million in taxpayer dollars to fund valley fever research across six projects starting in 2022.

Sharon and David Filip are scathing about Arizona’s efforts to contain the disease, which have largely amounted to improving detection of valley fever in people who already have it, rather than preventing those infections from happening in the first place. They think the state has that backward.

“It seems like it’s more important to actually fund the protection of the people than it is to just keep track of how they’re dying and getting sick,” David Filip said. But preventing cases of valley fever — a disease that people contract simply by breathing in the wrong place at the wrong time — is a monumental job for a public health department.

When asked what Arizona is doing to combat valley fever, Irene Ruberto, who manages the Arizona Department of Health Services’ vector-borne and zoonotic disease team, pointed to the department’s efforts to raise awareness about the disease, such as the week the state dedicates to “Valley Fever Awareness” every November, as well as its ongoing work reviewing, counting, and publishing cases reported by counties. Ruberto had no firm answers to questions about the ways that new construction is exposing more residents to the fungus, and what else might be done to reach the demographics most at risk of developing the most severe form of the disease, nodding instead to research being conducted by scientists on those topics at places like the Valley Fever Center for Excellence, which the department supports.

The department of health has a small pot of funding that’s already stretched thin between competing priorities. Arizona, which spent $28 per person on public health funding in 2023, less than half the national average, uses very little of its own money on its health infrastructure. If federal funding were to disappear — county health departments are funded largely by Medicaid — the state’s public health system would functionally collapse.

Those are the conditions in which Galgiani has worked for the past three decades.

“There’s a fungus amongus,” reads a small decal tucked among the various framed awards and pictures hanging on the walls of his office at the Valley Fever Center for Excellence. Galgiani spends most of the week in Tucson, but on Tuesday nights, he and his wife drive two hours north to Phoenix to an apartment they own on the bottom floor of a building a five-minute drive from one of Banner Health’s clinics. On Wednesday mornings, Galgiani goes to the clinic to see patients and train doctors.

Since 2018, Banner Health urgent care facilities in Phoenix and Tucson have been following a new clinical program Galgiani designed that aims to increase the number of people being tested for valley fever. Too often, doctors assume that patients who present with the early symptoms of valley fever have garden-variety pneumonia, and they administer antibiotics without realizing that the patient is suffering from a fungal infection that will only respond to an antifungal medication.

A retrospective study of more than 800 patients in Arizona found that more than 40 percent of them waited more than a month after their first doctor’s visit for an accurate diagnosis; many received useless prescriptions for antibacterial drugs in the interim. The costs associated with the roughly 10,000 cases of the disease that were diagnosed in the state in 2019, including direct healthcare costs and working hours lost, topped $700 million.

After Galgiani’s protocol was implemented, the percentage of Banner Health clinics enrolled in the program ordering 50 or more valley fever blood tests per year rose significantly, from 11 percent in 2018 to 78 percent in 2021 — a strong signal of progress and one that will likely withstand any changes unfolding at the federal level: The program is cheap and doesn’t rely on federal funding to run. But the Banner Health facilities using this new strategy constitute just 4 percent of the health clinics in the Phoenix and Tucson metropolitan areas. The long term goal, one the state of California is currently trying to accomplish via legislation just passed by that state’s senate, is to require doctors to automatically test most patients who present with pneumonia symptoms in an endemic area for the disease.

But getting more hospitals and clinics across the southern part of Arizona, which encompasses most of the state’s fungal hotspots, to implement updated valley fever testing protocols is a constant battle against inertia. “A lot of doctors have learned to treat all pneumonias as bacterial infections,” Galgiani said. “To get them to change, they have to unlearn what they were already told was the right way to go.” He fears that, as the federal government takes a hatchet to the funding it sends to states for a wide array of public health initiatives, the momentum he and others in Arizona have been trying to sustain will lag and efforts to combat valley fever will fall to the wayside.

In late March, Robert F. Kennedy Jr., head of the Department of Health and Human Services, or HHS, ordered deep cuts to Centers for Disease Control and Prevention grant programs for states across the country. Although Arizona’s attorney general challenged that decision alongside 19 other state attorneys general, the Supreme Court handed down a brief ruling in August permitting the lion’s share of those cuts to go through. The White House’s proposed budget for fiscal year 2026 would further weaken the state’s public health and research infrastructure: Arizona stands to lose an estimated $135 million annually in funding from the National Institutes of Health, or NIH, for infectious disease research at universities and hospitals, according to an analysis by the Science and Community Impacts Mapping Project.

These cuts won’t affect the Valley Fever Center for Excellence, which is funded primarily by philanthropic dollars and was established by the Arizona Board of Regents, not the federal government. But what’s happening at the federal level is destabilizing the network of people and institutions Galgiani relies on to keep the valley fever solutions machine running, including the public health departments he works with and his collaborators at universities in California, Arizona, and Texas.

“It feels like there’s an ax hanging over our heads and we never know when it’s going to drop,” said Bridget Barker, a professor of biological sciences at Northern Arizona University who runs a valley fever project funded by NIH.

When Thursday morning rolls around, Galgiani is back at his desk in Tucson logging onto a Zoom call with a group of people who meet monthly to discuss valley fever in Arizona. Thomas Williamson, a valley fever epidemiologist at the state’s department of health, starts the meeting with a roll call. Representatives from public health departments across the state — Maricopa, Pinal, and Pima counties — are there to report their monthly valley fever numbers to the group of roughly two dozen. An infectious disease specialist from the Mayo Clinic is listening in. Galgiani is prepared to present the most recent data from his work with Banner Health clinics.

Williamson ticks down his list of invitees. “How about the CDC?” he asks. A long silence follows. Someone jumps in and asks if the Centers for Disease Control and Prevention was told about the meeting.

“They were sent the updates and the meeting link,” Williamson replies. “It’s up to them, really.”

It’s unclear if the federal government’s absenteeism is a result of a lack of interest or whether it can be chalked up to disarray and lack of personnel. At least seven staffers and research fellows have left the CDC’s Mycotic Diseases Branch — including the branch chief, Tom Chiller — a small division within the agency that maintains a fungal identification and testing lab and helps states with funding, disease surveillance, and public health communication surrounding fungal pathogens. Either way, Galgiani says later, the absence is unusual.

Also tuning into the Zoom call are Tanner Porter and Dave Engelthaler, two researchers who have been using air filters — initially installed around the Phoenix metropolitan area following the violence of September 11, 2001, to sense a bioterrorism attack — to measure the concentration of cocci in the air. It’s the first-ever effort to forecast where and when the spores are present across a metropolitan area.

Interest is intense among the meeting attendees as Porter and Engelthaler, who both work at a nonprofit medical research group called the Translational Genomics Research Institute, report that their preliminary findings indicate that airborne fungus is most concentrated close to new construction sites. The spores, they say, are present even on days when the wind isn’t blowing and there is no visible dust in the air.

Phoenix and other endemic areas undergoing a lot of landscape changes are a bit like minefields. Construction in places where the fungus is present, particularly when soil moisture is low and wind is blowing, can produce invisible clouds of spores that hang suspended in the air within a 1.5-mile radius. Anyone who walks through them could be at risk. Larger construction sites can send the spores swirling even further afield.

The researchers are in the midst of training a machine-learning algorithm to identify disturbed land in real time and identify where infections are likely to occur. It’s the kind of research that could help the Maricopa County public health department put out warnings in high-risk areas and encourage people to wear N95 masks, which have been shown to help reduce the risks of contracting the disease.

But the work Porter and Engelthaler are doing depends in part on dust storm records kept in a little-known database called the Storm Events Database. That database is run by the National Centers for Environmental Information, housed within the National Oceanic and Atmospheric Administration, or NOAA, which also runs an hourly weather data program that the researchers are pulling from to run their modeling. The Trump administration has severely weakened NOAA’s weather forecasting capabilities, which will have knock-on effects for any ongoing efforts to use federal weather data to predict where and when valley fever will emerge.

The biggest unknown in the stack of unknowns is the future of the vaccine Galgiani discovered several years ago — the holy grail of the valley fever world. Without it, there is no long-term protection for Arizonans, Californians, and anyone else exposed to a disease poised to run amok as communities push further into a desert landscape made more hospitable to coccidioides by climate change.

The vaccine has been licensed to a pet healthcare pharmaceutical company called Anivive Lifesciences, which is developing it for use in dogs — animals that are particularly susceptible to the disease because they spend so much time with their noses to the ground. The company counts former Republican Speaker of the House Kevin McCarthy, who represented much of California’s cocci-rich Central Valley, on its board.

If everything goes exactly right, the vaccine Anivive is developing will be approved by the Animal and Plant Health Inspection Service, a branch of the United States Department of Agriculture, for use in canines by the middle of next year. In trials, two doses of the live attenuated vaccine, which contains a weakened form of the fungus, gave dogs near-total protection. Adapting the mechanism that makes the dose work in dogs to provide the same protection for humans could take another five years or more. But the federal government appears interested in making that happen — or, at least, it did.

Last year, Anivive received a contract worth up to $33 million from a division of the National Institutes of Health to initiate the process for a human phase 1 clinical trial. Once someone has recovered from valley fever, they’re more or less protected from reinfection for life, making the fungus a good vaccine candidate. The funding from NIH is in the form of a legal contract, not a grant, meaning it theoretically can’t be rescinded the same way billions of dollars worth of grant funding have been cancelled by the federal government. So far, NIH has been meeting its payments to Anivive, though they’ve been slower than usual since Trump took office.

It’s not lost on Edward Robb, chief strategy officer at Anivive and leader of the company’s valley fever vaccine project, that he’s developing a vaccine for a relatively unknown infectious disease at the same time as one of the world’s most prominent opponents of vaccines has begun reshaping America’s immunization policies.

Since taking office as secretary of health and human services, Kennedy has rolled back federal recommendations and endorsements for COVID-19 and some flu vaccines and fired all 17 independent members of a vaccine policy panel at the CDC, replacing many of them with known anti-vaccine campaigners. HHS has little say over vaccines developed for use in animals, but it could derail the regulatory process by which that vaccine is adapted for humans, a process so long and so expensive it’s often referred to as “the valley of death.”

“We’re nervous but we have no data or anything to say that things have changed,” Robb said. “Have I had lost sleep? Have I had anxiety? Have there been weeks when we think we’re doomed? Yeah.”

If NIH continues funding this phase of the project as it’s contracted to and the vaccine shows promise, there’s still the matter of finding the funding to conduct phases 2 and 3 of the approval process, when the vaccine is tested on hundreds and then thousands of people. The estimated cost of such an endeavor, Robb says, is $300 million. Anivive can’t do it alone. A major biopharmaceutical company like Pfizer or Moderna would need to step in to take it over the finish line.

“Will a major step up and say ‘put me in, coach’?” he asked. It’s looking less likely by the day. In early August, Kennedy canceled close to $500 million in mRNA vaccine contracts with more than a dozen vaccine makers including Pfizer, Moderna, and AstraZeneca, a move that could further dampen new vaccine research and investment.

For Galgiani, this kind of retreat from vaccine development is irrational. “It makes sense to me that state and federal support for a vaccine would be good for both public health and the economies of endemic regions,” he said.

Whether a vaccine for valley fever moves forward matters not only for the hundreds of thousands of Americans who are likely to get the disease in the coming years, but also for the 6.5 million people who get invasive fungal infections annually around the world. As with valley fever, the overall number of fungal infections is growing as climate change makes the whole Earth warmer on average.

“Unlike humans, many pathogenic fungi are thriving as the Earth’s temperature increases,” the authors of a study published last year in the peer-reviewed British medical journal The Lancet wrote. Fungi that cause disease are “quickly adapting to higher temperatures and becoming more virulent and potent.”

A growing portion of these cases are caused by fungi that have become resistant to antifungal medications. Candida auris, a relatively new yeast that has already infected over 2,800 Americans this year, is multi-drug resistant. Ninety percent of the Candida auris found in the U.S. is resistant to fluconazole, one of the most commonly used antifungals.

“If we can make a fungal vaccine for valley fever, could one of these companies make a vaccine against Candida infections?” asked Thompson, the fungal disease specialist from the University of California, Davis. “It may just be the first example of vaccines in this field, but it really may lead to some big changes and big improvements for our patients down the road.”

But that’s only if the valley fever vaccine survives the Trump administration.

Correction: This story originally misstated Sharon Filip’s age when she contracted valley fever.

This article originally appeared in Grist at https://grist.org/health/valley-fever-arizona-fungus-climate-change/.

As the debate over vaccine mandates heats up in Florida, there’s a push in the Legislature and the administration of Gov. Ron DeSantis to broaden the use of ivermectin.

A Republican legislator from Spring Hill has filed legislation to allow the over-the-counter sale of ivermectin suitable for human use even though the U.S. Food and Drug Administration has not authorized or approved ivermectin for use in preventing or treating COVID-19 in humans or animals.

Ivermectin is an effective treatment for parasites in animals and for use by humans to treat parasites such as head lice and scabies, according to the National Institutes of Health (NIH).

The FDA has not approved Ivermectin for treatment or prevention of COVID-19, and so far recommends against taking it for COVID-19, instead suggesting people get vaccinated for protection.

Nevertheless, there was buzz during the pandemic about using it for treatment for COVID-19.

HB 29 sponsor Rep. Jeff Holcomb, R-Spring Hill, did not immediately return Florida Phoenix’s request for comment. If approved, Florida would join the ranks of Tennessee, Arkansas, Louisiana, Idaho, and Texas in approving the medication for over the counter sales.

The governor, First Lady Casey DeSantis, state Surgeon General Joseph Ladapo, and Agency for Health Care Administration Secretary Shevaun Harris held a press conference at the University of South Florida Health College of Medicine to recognize World Cancer Research Day and to highlight $60 million in new cancer research grant opportunities.

There, the first lady said she expected some portion of the new grant funding to be used for cancer research on ivermectin.

“I know we should look at it. I know we should look at the benefits of it. We shouldn’t just speculate and guess,” DeSantis said.

Ladapo, seconded the idea.

“There’s been a lot of chatter about it, and this very simple drug that happens to be very safe, by the way, has unfortunately, you know it’s so much it’s been weighed down by all this politics, especially during the Biden administration.”

Ivermectin is not approved by the FDA for cancer treatment.

The FDA also warns large doses of ivermectin can be dangerous. “Even doses of ivermectin for approved human uses can interact with other medications, like blood-thinners. You can also overdose on ivermectin, which can cause nausea, vomiting, diarrhea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma, and even death.”

Ladapo and DeSantis defend no mandate push

Meanwhile, Ladapo and his boss DeSantis defended their push to eliminate vaccine mandates from Florida law, rules, and regulations.

“I hope that we continue to reject the normal and we pursue a path that feels righteous, that feels like we’re actually, you know, aiming toward the thing that we want to improve,” Ladapo said.

“That opportunity is there. Thankfully, we have leadership, uniquely in this state, to do it. And I hope it spreads like, like all those minor viruses that my critics are afraid of, or something.”

The minor viruses Ladapo referred to includes measles. The Centers for Disease Control and Prevention reports 1,514 confirmed measles cases this year as of Sept. 23. Six of those confirmed cases were in Florida. There were 11 confirmed measles cases in Florida in 2024.

Measles and other disease outbreaks occur as the percentage of school-age children in Florida who are vaccinated against measles, mumps, and rubella dips. While the target rate for MMR vaccination is 95%, Florida’s 2024-2025 rate was 88.8%.

That’s a near 5% point change from the 2019-2020 year, a KFF analysis shows, and well below the targeted 95% needed for herd immunity.

Ladapo and DeSantis avoided directly answering whether their children have been vaccinated. Ladapo said reporters should be asking substantive questions and likened the questions about the children to “silly games.”

“I actually don’t care about sharing information about that. I really don’t care at all. But I won’t. And I won’t because I’m not going to participate in the silly games that so much of the media chooses to partake in instead of the substantive parts of the issues.”

In addition to defending his anti-vaccine mandate push, Ladapo appears on board with the Trump administration’s announcement that autism rates are up because pregnant women are taking acetaminophen, the active ingredient in Tylenol, during their pregnancies.

“They acknowledge that not all the studies show harm, but some of them do show relation. And it’s not a total explanation for autism by any means, but it does appear to be that it’s reasonable to conclude that it may be contributing to the prevalence of autism in children,” Ladapo said.

When asked whether he intended to issue any guidance he said: “We’re still looking at it. So, we may have some more guidance, but it would probably be very much in line with where the FDA is.”

As soon as she fell, Deborah Buttgereit knew she couldn’t avoid going to the hospital.

“I could hear the bones moving around in my elbow,” said Buttgereit, who was 60 when she slipped on a patch of ice in December outside her apartment in Bozeman, Montana.

Emergency room scans showed she had fractured her left arm near the joint. Doctors told her she needed surgery to repair it.

At the time, Buttgereit didn’t have health insurance — she had struggled to afford coverage after her husband’s death. The local health system, Bozeman Health, estimated Buttgereit would have to pay $50,560 out-of-pocket for the outpatient surgery to have her elbow pieced back together.

The estimate noted: “You could be charged more if complications or special circumstances occur.”

Four days after her fall, Buttgereit went in for surgery, which took about three hours. During a follow-up visit, she said, her doctor told her the procedure ended up being more complicated than expected.

Then the bill came.

The Medical Procedure

Buttgereit broke her humerus, the upper-arm bone that meets two other bones and forms the elbow. The way the bone splintered is known as a distal humerus fracture. It’s rare as far as breaks go, accounting for only about 2% of all fractures among adults. But older people, as well as kids in high-contact sports, are more prone to the big falls that lead to such fractures. The injury is painful and can make it impossible to move the elbow.

Some of these types of fractures heal with time in a splint, but most often surgery is the only fix. The patient is put under anesthesia while a surgeon repositions fragmented bones with plates and screws.

The Final Bill

$97,998. That includes at least $44,300 for the operating room and anesthesia administration, plus more than $50,000 for medical supplies and implants, such as screws and plates. After the hospital applied a self-pay discount, Buttgereit was on the hook for $78,398.40.

The Problem: Surprise Complications, Surprising Charges

The hospital said the price for Buttgereit’s surgery increased because doctors encountered complications midprocedure.

In particular, the fall had shattered Buttgereit’s bone into more pieces than her surgeon anticipated, according to operating notes. That meant it took more time, skill, and supplies to reconstruct her elbow. And, since she was uninsured, Buttgereit alone faced the burden to pay the higher costs.

“I’ll make payments the rest of my life to pay it all off,” she said.

Buttgereit’s husband died suddenly in 2023. About a year later, she left her job with the company that had employed them both. The memories of him in that space were too difficult, she said. That also meant leaving behind her health coverage. She moved to Bozeman to be closer to one of her daughters and found a health plan at healthcare.gov that the federal government subsidized because of her limited income.

But she also faced a higher cost of living in Bozeman than her Social Security benefits could cover, and she needed part-time work. While that new income helped pay her bills, Buttgereit said, she no longer qualified for the same level of subsidized coverage and couldn’t afford her plan. So she dropped her health insurance.

About two months later, she fell.

After getting the surgery bill, Buttgereit began calling and emailing the hospital’s customer service team, asking how the price had risen from the $50,560 estimate to nearly $98,000. The hospital had automatically applied the self-pay discount of $19,600 to Buttgereit’s bill — 20% of the total. But that still left her with a tab of more than $78,000.

After more time to think pain-free, she said, she also wanted to know why the initial estimate was much steeper than those she found online for similar procedures.

Specifically, Buttgereit asked how to dispute her bill. When she felt she wasn’t making progress contesting the charges with the hospital, she asked about her options under the No Surprises Act, a federal consumer protection law.

According to emails reviewed by KFF Health News, a Bozeman Health billing employee incorrectly told Buttgereit the law applies only to ER services. The employee later said Buttgereit had the right to dispute the bill but gave her an incorrect deadline.

Hospital staffers recommended Buttgereit set up a payment plan and apply to the health system’s financial aid program.

Erin Schaible, a spokesperson with Bozeman Health, told KFF Health News that online estimates don’t reflect the specific details of a patient’s care. In addition to the shattered bones noted in Buttgereit’s surgery notes, Schaible said the physician identified nerve damage midsurgery that required additional work to fix.

“This situation highlights the importance of clear and compassionate communication,” Schaible said. “In response, our team leaders are revising internal protocols for escalating patient concerns and are reeducating staff on best practices for communicating cost estimate changes.”

The Resolution

Buttgereit refused to apply for financial aid, opting instead to challenge what she sees as inflated pricing. Using Healthcare Bluebook, an online price comparison tool that draws on insurance claims data, Buttgereit found similar procedures ranged from $8,000 to $40,000.

She said she believes that there are also errors on her bill and that the complications didn’t justify the price.

“I felt like going through financial assistance means that I’m OK with the price of the bill,” she said. “I want to get the bill reduced on the front end and then, if I need financial assistance, go through it.”

A billing employee emailed Buttgereit in May to offer an additional $7,000 discount if she set up a payment plan. If she later qualified for financial assistance, “we will adjust the amount accordingly,” the email said.

In June, the employee told Buttgereit her account would be put on hold before a collection process was initiated, “so that you have time to decide what to do.”

Buttgereit agreed to a payment plan of $100 a month, though she continued to contest the total charges.

At that rate, it would take about 60 years to pay off the debt — or longer, if the health system were to charge interest.

Buttgereit made one more bid for help: She emailed the White House.

This month, in the same week she got a detailed letter from the hospital standing by its charges, Buttgereit said she received a call from an official with the Centers for Medicare & Medicaid Services, saying she could dispute the bill to federal health officials.

The Takeaway

The best time to push back against a price is before surgery, upon receiving a hospital’s best guess on costs, known as a “good faith estimate.” Otherwise, undergoing surgery is considered tacit acceptance of that price as a baseline.

Patricia Kelmar, director of health care campaigns at the national consumer advocacy group U.S. PIRG, follows ways in which people get tangled financially in the health industry. She said patients should compare cost estimates by searching their hospital’s online pricing tool (as well as those of nearby hospitals) to see whether the estimates align. But not every procedure makes those lists, especially those for uncommon injuries, nor is every hospital’s list easy to access and navigate.

Post-surgery, patients have few resources to fight big bills, but a little-known rule in the No Surprises Act could help, Kelmar said.

The law, which took effect in 2022, is best known for protecting patients from surprise bills for out-of-network, emergency care. But it also created a formal dispute process for uninsured patients, or those paying completely out-of-pocket for nonemergency procedures, if their final tab is $400 or more than the initial estimate.

“This is a valid, important part of making sure that patients who are cash-pay have a watchdog,” Kelmar said.

People can start the patient-provider dispute process online, through the CMS website, by providing medical records and paying a $25 fee. Patients must initiate the process within 120 days of receiving the bill, and the bill may not be sent to a collection agency while under review.

An independent reviewer evaluates whether the final price is drastically different from what a health insurance company would have paid and whether the complication was predictable. If the review finds that the health provider erred on either front, federal health officials could require them to reduce the bill to match the original estimate or the median price insurers pay.

Buttgereit said she initially opted against pursuing that formal dispute process because, after such a review, the floor would be the hospital’s initial estimate, and she still had questions about how it would work. But after hearing from CMS, Buttgereit said it’s the path she plans to take.

“You’ve got to fight for yourself,” she said. “I don’t know where this is going to end up, but I feel a little bit more hopeful.”

Ann Bauer, a researcher who studies Tylenol and autism, felt queasy with anxiety in the weeks leading up to the White House’s much-anticipated autism announcement.

In August, Bauer and her colleagues published an analysis of 46 previous studies on Tylenol, autism, and attention-deficit/hyperactivity disorder. Many found no link between the drug and the conditions, while some suggested Tylenol might occasionally exacerbate other potential causes of autism, such as genetics.

Bauer, an epidemiologist at the University of Massachusetts-Lowell, and her team called for more judicious use of the drug until the science is settled.

On Monday, President Donald Trump stood beside Health and Human Services Secretary Robert F. Kennedy Jr. for what he called a “historic” announcement on autism. “If you’re pregnant, don’t take Tylenol, and don’t give it to the baby after the baby is born,” Trump said. “There are certain groups of people that don’t take vaccines and don’t take any pills that have no autism,” he added, without providing evidence. “They pump so much stuff into those beautiful little babies, it’s a disgrace.”

A fact sheet released alongside the White House briefing cited Bauer’s analysis. But she was alarmed by Trump’s comments. If prenatal Tylenol has any association, which it may not, it would help account for only a fraction of cases, she said. Further, research has not deeply examined Tylenol risks in young children, and many rigorous studies refute a link between vaccines and autism.

Bauer worries such statements will cut both ways: People may put themselves at risk to avoid vaccines and Tylenol, the only safe painkiller for use during pregnancy. And she frets that scientists might outright reject her team’s measured concerns about Tylenol in a backlash against misleading remarks from Trump and other members of his “Make America Healthy Again” movement.

“I’m really concerned about how this message is going to play out,” she said. “It’s a sound-bite universe, and everyone wants a simple solution.”

Autism experts at the Centers for Disease Control and Prevention were neither consulted for the White House’s long-awaited autism announcement nor asked to review a draft of the findings and recommendations, CDC scientists told KFF Health News, which agreed not to identify them because they fear retaliation.

“Typically, we’d be asked to provide information and review the report for accuracy, but we’ve had absolutely no contact with anyone,” one CDC researcher said. “It is very unusual.”

Trump and Kennedy promised this year that under their leadership the federal government would swiftly figure out what causes autism. Scientists who work in the field have been skeptical, noting that decades of research has shown that no single drug, chemical, or other environmental factor is strongly linked to the developmental disorder. In addition, both Trump and Kennedy have repeated the scientifically debunked notion that childhood vaccines may cause autism.

Helen Tager-Flusberg, director of the Center for Autism Research Excellence at Boston University, called Trump’s comments dangerous. Fevers can harm the mother and the developing fetus, she said, adding that fevers are more strongly associated with autism than Tylenol.

In an emailed response to queries, HHS spokesperson Andrew Nixon said, “We are using gold-standard science to get to the bottom of America’s unprecedented rise in autism rates.”

White House spokesperson Kush Desai wrote, “President Trump pledged to address America’s rising rate of autism, and to do so with Gold Standard Science.”

Had CDC scientists been allowed to brief Kennedy, they say they would have cautioned that simple fixes won’t make a dent in the number of autism cases in the United States: As many as 1 in 31 8-year-old children had autism spectrum disorder in 2022.

Systemic changes, such as regulations on air pollution, which has been linked to asthma and developmental disabilities including autism, and assistance for parents of disabled children, could improve lives for far more Americans with autism and other conditions than actions taken by the Trump administration on Sept. 22, researchers say.

One federal action is to consider updating the label on Tylenol and to “encourage clinicians to exercise their best judgment in use of acetaminophen for fevers and pain in pregnancy by prescribing the lowest effective dose for the shortest duration.” The American College of Obstetricians and Gynecologists already recommends acetaminophen “as needed, in moderation, and after consultation with a doctor.”

‘Political Crusade’

Despite Kennedy’s many years of speaking about autism, he rarely cites credible autism research or expert recommendations, Tager-Flusberg said. Instead, Kennedy repeats fringe, scientifically debunked theories linking vaccines to autism, despite rigorous studies published in peer-reviewed journals that refute a link.

At the Sept. 22 briefing, Trump said he spoke with Kennedy about autism 20 years ago: “We understood a lot more than a lot of people who studied it,” he said. Ahead of Trump’s first term in 2017, Kennedy said he met with the president to consider a commission on vaccine safety and autism. It didn’t happen then. But soon after Kennedy was confirmed as health secretary, he called autism “preventable,” pointed to “environmental toxins,” and contradicted the results of a CDC study finding that the main driver of rising autism diagnoses was that doctors increasingly recognize the disorder.

At a televised Cabinet meeting in April, Kennedy told Trump, “By September, we will know what has caused the autism epidemic and we’ll be able to eliminate those exposures.”

“You stop taking something, you stop eating something, or maybe it’s a shot,” Trump replied.

“He is on a political crusade,” Tager-Flusberg said of Kennedy, adding that vaccines, Tylenol, aluminum, and food dyes make for simple targets to rally against. “We know genetics is the most significant risk factor,” she said, “but you can’t blame Big Pharma for genetics, and you can’t build a political movement on genetics research and ride to victory.”

“RFK makes our work harder,” said Peter Hotez, a vaccine researcher and the author of a book about his autistic daughter, “Vaccines Did Not Cause Rachel’s Autism.” He said the book stemmed from conversations with Kennedy in 2017, in which Hotez shared studies pinpointing more than a hundred genes linked to autism, and research into the complex interplay between genetics, biological processes, and things that children and fetuses encounter during development.

“I sat down with him and explained what the science says, but he was unwilling or incapable of thinking deeply about it,” Hotez said. “He is extremely careless.”

In addition to its focus on Tylenol, the White House said it would move to update “prescribing information” on leucovorin — a medication related to the B vitamin folate — to reflect its use as an autism treatment. A small clinical trial in 2012-13 suggested the drug may help treat language problems in some children with autism. Tager-Flusberg said the findings warrant further study but clarified these were “old data, not a breakthrough.”

Likewise, studies finding a modest association between autism and prolonged Tylenol use were published years ago. Researchers have suggested the medicine might occasionally exacerbate factors associated with autism, such as genetics and oxidative stress, a biological condition that occurs for a variety of reasons that scientists are still unraveling.

Still, these studies couldn’t rule out the possibility that fevers prompting women to take Tylenol, rather than the medicine itself, might instead be to blame. Fevers and infections — including those prevented by vaccines — have also been linked to autism.

Nonetheless, Bauer’s recommendation would be to pause before taking acetaminophen while pregnant — blanket advice that doctors give for all medications during that period, but which may be ignored. “Try to alleviate discomfort in some other ways, like with a cold compress, hydration, or massage, before taking it,” Bauer said.

She welcomed the White House’s motion to consider labeling Tylenol to emphasize judicious use of the drug but worries about how the MAHA movement might distort a careful message. On Sept. 2, the right-wing news outlet One America News Network posted an interview with newly appointed CDC vaccine adviser Robert Malone, writing that Malone “speculates RFK Jr. may have an important announcement this month regarding a potential link between Tylenol, multiple vaccinations and autism in children.”

“I was sick to my stomach,” Bauer said, concerned that Kennedy would link her study to discredited theories, causing doctors and scientists to reject her far more measured work.

‘The Boy Who Cried Wolf’

Several medical and scientific associations have called for Kennedy’s removal or resignation. Many scientists are skeptical of what he says because much of it has been misleading or wrong. For example, he’s said HIV isn’t the only cause of AIDS (it is), that antidepressant drugs cause mass shootings (they don’t), that older adults don’t have severe autism (some do), that the measles vaccine causes brain swelling (it doesn’t), that covid vaccines were the deadliest vaccines ever made (they aren’t), that vaccines aren’t safety-tested (they are), and that vaccines contribute to autism (they don’t).

“This is like the boy who cried wolf,” said Brian Lee, an epidemiologist at Drexel University. “One day he might be right about something and Americans who are not prone to conspiracies won’t trust it because it’s coming from RFK’s mouth. And that could be a problem.”

What’s more, the Trump administration is eroding scientists’ ability to probe the safety of pharmaceuticals, said Robert Steinbrook, head of health research at Public Citizen, a nonprofit consumer protection group.

“Public Citizen is very supportive of research on medications that could be linked to diseases,” he said. “But it needs to be through an open process, which looks at scientific evidence, and which doesn’t cherry-pick studies to support a preconceived point of view.”

Steinbrook said the administration has undermined his confidence in the government’s ability to conduct credible work. The Food and Drug Administration has held less than a third the number of advisory committee meetings this year as it did last, meaning fewer opportunities for experts to discuss research on the risks and benefits of drugs. The Trump administration has fired hundreds of career scientists at the CDC and FDA and cut millions of dollars in research funds, including to projects studying autism.

In early September, the CDC issued an unusual contract with the Rensselaer Polytechnic Institute to analyze datasets for signs that vaccinated children were more likely to have autism. Unlike with other research initiatives, the CDC didn’t post an open call for applications in advance. This allows agency experts to review proposals and select studies best designed to answer the question at hand.

CDC researchers told KFF Health News that experts in the agency’s autism and disability group weren’t aware of the contract or asked to review the proposal. That’s important, they said, because researchers digging through data to find clues about autism must show how they’ll rule out biological and environmental exposures that muddy the results, and ensure that children have been accurately diagnosed. One researcher said, “It absolutely looks like Kennedy has subverted the grantmaking process.”

The CDC and HHS did not respond to KFF Health News’ requests for information on the grant, including through a Freedom of Information Act request.

The new vaccine study is separate from Kennedy’s autism data-science initiative, which was posted as an open call at the National Institutes of Health. “The hope is that something good comes of it, and that the government won’t cherry-pick or censor what scientists find out,” Lee said.

Bauer said she didn’t apply to be part of the initiative because of Kennedy’s outsize presence at HHS.

“I would not take his funding because it could take away from the credibility of my study,” she said, “in the same way that taking money from pharmaceutical companies does."

Small local organizations called Active Clubs have spread widely across the U.S. and internationally, using fitness as a cover for a much more alarming mission. These groups are a new and harder-to-detect form of white supremacist organizing that merges extremist ideology with fitness and combat sports culture.

Active Clubs frame themselves as innocuous workout groups on digital platforms and decentralized networks to recruit, radicalize and prepare members for racist violence. The clubs commonly use encrypted messaging apps such as Telegram, Wire and Matrix to coordinate internally. For broader propaganda and outreach they rely on alternative social media platforms such as Gab, Odysee, VK and sometimes BitChute. They also selectively use mainstream sites such as Instagram, Facebook, X and TikTok, until those sites ban the clubs. Active Club members have been implicated in orchestrating and distributing neo-Nazi recruitment videos and manifestos. In late 2023, for instance, two Ontario men, Kristoffer Nippak and Matthew Althorpe, were arrested and charged with distributing materials for the neo-Nazi group Atomwaffen Division and the transnational terrorist group Terrorgram. Following their arrests, Active Club Canada’s public network went dark, Telegram pages were deleted or rebranded, and the club went virtually silent. Nippak was granted bail under strict conditions, while Althorpe remains in custody.As a sociologist studying extremism and white supremacy since 1993, I have watched the movement shift from formal organizations to small, decentralized cells – a change embodied most clearly by Active Clubs.

An investigation by the Canadian Broadcasting Corporation tracks down two Ontario-based Active Clubs that recruit and train young men to fight.

White nationalism 3.0

An actor reconstructs how British broadcaster ITV News infiltrated and secretly filmed inside Active Club England, documenting its recruiting process, activities and goals.

‘You need to learn how to fight’
Active Club messaging glorifies discipline, masculinity and strength – a “warrior identity” designed to attract young men. “The active club is not so much a structural organization as it is a lifestyle for those willing to work, risk and sweat to embody our ideals for themselves and to promote them to others,” Rundo explained via his Telegram channel. “They never were like, ‘You need to learn how to fight so you can beat up people of color.’ It was like, ‘You need to learn how to fight because people want to kill you in the future,’” a former Active Club member told Vice News in 2023.These cells are deliberately small – often under a dozen members – and self-contained, which gives them greater operational security and flexibility. Each club operates semi-autonomously while remaining connected to the broader ideology and digital network.

Expanding globally and deepening ties
Active Clubs maintain strategic and ideological connections with formal white supremacist groups, including Patriot Front, a white nationalist and neofascist group founded in 2017 by Thomas Rousseau after the Unite the Right rally in Charlottesville, Virginia.Active Clubs share extremist beliefs with these organizations, including racial hierarchy and the “Great Replacement” theory, which claims white populations are being deliberately replaced by nonwhite immigrants. While publicly presenting as fitness groups, they may collaborate with white supremacist groups on recruitment, training, propaganda or public events. Figures connected to accelerationist groups – organizations that seek to create social chaos and societal collapse that they believe will lead to a race war and the destruction of liberal democracy – played a role in founding the Active Club network. Along with the Rise Above Movement, they include Atomwaffen Division and another neo-Nazi group, The Base – organizations that repackage violent fascism to appeal to disaffected young white men in the U.S.

Brotherhood as a cover
By downplaying explicit hate symbols and emphasizing strength and preparedness, Active Clubs appeal to a new generation of recruits who may not initially identify with overt racism but are drawn to a culture of hypermasculinity and self-improvement.Anyone can start a local Active Club chapter with minimal oversight. This autonomy makes it hard for law enforcement agencies to monitor the groups and helps the network grow rapidly. Shared branding and digital propaganda maintain ideological consistency. Through this approach, Active Clubs have built a transnational network of echo chambers, recruitment pipelines and paramilitary-style training in parks and gyms.Club members engage in activities such as combat sports training, propaganda dissemination and ideological conditioning. Fight sessions are often recorded and shared online as recruitment tools.Members distribute flyers, stickers and online content to spread white supremacist messages. Active Clubs embed themselves in local communities by hosting events, promoting physical fitness, staging public actions and sharing propaganda. Potential members first see propaganda on encrypted apps such as Telegram or on social media. The clubs recruit in person at gyms, protests and local events, vetting new members to ensure they share the group’s beliefs and can be trusted to maintain secrecy.

From fringe to functioning network
Based on current information from the Global Project Against Hate and Extremism, there are 187 active chapters within the Active Club Network across 27 countries – a 25% increase from late 2023. The Crowd Counting Consortium documented 27 protest events involving Active Clubs in 2022-2023. However, precise membership numbers remain difficult to ascertain. Some groups call themselves “youth clubs” but share similar ideas and aesthetics and engage in similar activities. Active Club members view themselves as defenders of Western civilization and masculine virtue. From their perspective, their activities represent noble resistance rather than hate. Members are encouraged to stay secretive, prepare for societal collapse and build a network of committed, fit men ready to act through infiltration, activism or violence.

Hiding in plain sight
Law enforcement agencies, researchers and civil society now face a new kind of domestic threat that wears workout clothes instead of uniforms.Active Clubs work across international borders, bound by shared ideas and tactics and a common purpose. This is the new white nationalism: decentralized, modernized, more agile and disguised as self-improvement. What appears to be a harmless workout group may be a gateway to violent extremism, one pushup at a time.

Art Jipson, Associate Professor of Sociology, University of Dayton This article is republished from The Conversation under a Creative Commons license. Read the original article.

ST. LOUIS — Lying on top of an operating room table with his chest exposed, Larry Black Jr. was moments away from having his organs harvested when a doctor ran breathlessly into the room.

“Get him off the table,” the doctor recalled telling the surgical team at SSM Health Saint Louis University Hospital as the team cleaned Black’s chest and abdomen. “This is my patient. Get him off the table.”

At first, no one recognized Zohny Zohny in his surgical mask. Then he told the surgical team he was the neurosurgeon assigned to Black’s case. Stunned by his orders, the team members pushed back, Zohny said, explaining that they had consent from the family to remove Black’s organs.

“I don’t care if we have consent,” Zohny recalled telling them. “I haven’t spoken to the family, and I don’t agree with this. Get him off the table.”

Black, his 22-year-old patient, had arrived at the hospital after getting shot in the head on March 24, 2019. A week later, he was taken to surgery to have his organs removed for donation — even though his heart was beating and he hadn’t been declared brain-dead, Zohny said.

Black’s sister Molly Watts said the family had doubts after agreeing to donate Black’s organs but felt unheard until the 34-year-old doctor, in his first year as a neurosurgeon, intervened.

Today, Black, now 28, is a musician and the father of three children. He still needs regular physical therapy for lingering health issues from the gun injury. And Black said he is haunted by what he remembers from those days while he was lying in a medically induced coma.

“I heard my mama yelling,” he recalled. “Everybody was there yelling my name, crying, playing my favorite songs, sending prayers up.”

He said he had tried to show everyone in his hospital room that he heard them. He recalled knocking on the side of the bed, blinking his eyes, trying to show that he was fighting for his life.

Organ transplants save a growing number of lives in the U.S. every year, with more than 48,000 transplants performed in 2024, according to the Organ Procurement and Transplantation Network, which oversees the nation’s transplant system. And thousands die awaiting donations that never come.

But organ donation has also faced ongoing criticism, including reports of patients showing alertness before planned organ harvesting. The results of a federal investigation into a Kentucky organ donation nonprofit, first disclosed by The New York Times in June, found that during a four-year period, medical providers had planned to harvest the organs of 73 patients despite signs of neurological activity. Those procedures ultimately didn’t take place, but federal officials vowed in July to overhaul the nation’s organ donation system.

“Our findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “The entire system must be fixed to ensure that every potential donor’s life is treated with the sanctity it deserves.”

Even before this latest investigation, Black’s case showed Zohny that the organ donation system needed to improve. He was initially hesitant to talk to KFF Health News when contacted in July about Black. But Zohny said his patient’s story had stuck with him for years, highlighting that while organ donation must continue, little is understood about human consciousness. And determining when someone is dead is the critical but confusing question at play.

“There was no bad guy in this. It was a bad setup. There’s a problem in the system,” he said. “We need to look at the policies and make some adjustments to them to make sure that we’re doing organ donation for the right person at the right time in the right place, with the right specialists involved.”

LJ Punch, a former trauma surgeon who was not involved with the case but reviewed Black’s medical records for KFF Health News, questioned whether Black’s injury — from gunfire — possibly contributed to how he was treated. Young Black men like Larry Black are disproportionately victims of gun trauma in the United States, and research on such violence is scant. His experience exemplifies “the general neglect” of Black men’s bodies, Punch said.

“That’s what comes up for me,” Punch said. “Structurally, not individually. Not any one doctor, not any one nurse, not any one team. It’s a structural reality.”

The hospital declined to comment on the details of Black’s case. SSM Health’s Kim Henrichsen, president of Saint Louis University Hospital and St. Mary’s Hospital-St. Louis, said the hospital system approaches “all situations involving critical illness or end-of-life care with deep compassion and respect.”

Mid-America Transplant, the federally designated organ procurement organization serving the St. Louis region, does not comment on individual donor cases, according to Lindsey Speir, executive vice president for organ procurement. She did tell KFF Health News that her organization has walked away from cases when patients’ conditions change — though not as late as when they are in the operating room for harvesting.

“Let me be clear about that. It happens way before then,” she said. “It definitely happens multiple times a year where we get consent. The family has made the decision, we approach, we get consent, it’s all appropriate, and then a day or so later they improve and we’re like, ‘Whoa.’”

But Speir said the recent media stories about the nation’s donation system are prompting a lot of questions about a process that also does a lot of good.

“We’re losing public trust right now,” Speir said of the industry. “And we’re going to have to regain that.”

Blink Twice for a Chance at Life

It was a Sunday afternoon when gunshots rang out in downtown St. Louis. Black had been on his way to his sister’s apartment.

“I didn’t know I was shot at first,” Black said, sitting in his living room six years later. “I literally ran like a block or two away.”

He collapsed moments later, he said, crawling to the back door of a woman’s home, where he asked for help. He said he asked the woman to give him two large towels, one covered in rubbing alcohol and another soaked with hydrogen peroxide. He wrapped those towels around the back of his head.

When his sister Macquel Payne found him, he was lying on the ground near the leasing office of her apartment complex, a crowd gathered around him.

Before an ambulance took him to the hospital, Black told his sister not to worry about him.

“I’m hearing Larry say, ‘I’m good, sis,’” Payne recalled. “‘I’m OK.’”

Black said he went in and out of consciousness on the way to the hospital and once he was there.

“I got to hitting my hand on the side of the ICU bed,” Black said. “They was like: ‘That’s just the reaction, the side effects of the medicine. Ask him some questions.’”

Payne said she asked her brother to blink twice if he could remember his first pet, a dog named “Little Black” that looked like the Chihuahua from the Taco Bell commercials.

Black said he remembers blinking twice. His sisters remember the same.

Payne asked him another question. This time she wanted to know whether her brother recognized their family. Black said he blinked twice when he saw his mom and sister standing nearby.

Black said his sister then asked him “the main question” that everyone needed him to answer.

“She’s like, ‘If you want them to pull a plug, if you tired and you giving up, blink once,’” Black recalled. “‘If you still got some fight in you, blink more than once.’”

Black said he started blinking and hit the bed to let his family know that he was still with them.

The sisters said hospital staffers told them the movements were involuntary.

‘Not Right Now’

In a waiting room steps away from the hospital’s intensive care unit, a woman carrying brochures explained to Payne and the rest of the family that Black had identified himself as a possible organ donor on his ID.

The woman wanted to know whether the family wished to move forward with the process if Black died, Payne said.

“I remember my mom saying, ‘Not right now,’” Black’s sister recalled. “‘It’s kind of too soon.’”

Payne said the woman persisted.

“She was like, ‘Well, can I at least leave you some brochures or something?’” Payne recalled. “Then my mom got a little agitated because it felt like she was being, like, pushy.”

The family was already acquainted with the organ donation process. In 2007, Black’s teenage brother Miguel Payne drowned at a local lake. His organs were donated, Macquel Payne said, noting the family was told that his body parts and tissues helped multiple people.

“I believe in saving lives,” Payne said. “But don’t be pushy about it.”

Mid-America Transplant handles the organ transplant process for 84 counties in parts of Illinois, Arkansas, and Missouri, including St. Louis. Like the Kentucky organization, it is one of 55 federally designated nonprofits that facilitate organ donations throughout the country.

The nonprofit has never pressured a family into organ donation, Speir said. Registering to be an organ donor is legally binding, she said, but Mid-America has walked away from cases when families didn’t want to move forward.

She said her staff tries to dispel myths about organ donation and alleviate concerns. “We want to have the families leave with a positive experience,” Speir said.

Despite the family’s initial ambivalence, they ultimately consented to moving forward with donating Black’s organs. Watts said members of her brother’s care team had told the family that her brother was at “the end of the road.”

The family was told to prepare for Black’s “last walk of life,” Payne said. Also known as an honor or hero’s walk, the tradition honors the life of an organ donor before the harvesting process begins.

At the time, Payne said, she thought her brother still had a fighting chance. She asked the hospital staffers to take another look at him before he was wheeled down the hall.

“I’m like, ‘My brother’s in there tapping on the bed,’” Payne said. “They said, ‘That’s just his nerves.’ But I’m like, ‘No, something’s not right.’ It’s like he was too alert. He was letting us know: ‘Please don’t let them do this to me. I’m here. I can fight this.’ They were saying that’s what the medicine will do, it affects his nerves.”

After the family had agreed to move forward with the organ donation process, the two sisters said, an especially helpful member of Black’s medical team no longer treated them the same way. She became standoffish, they said.

“You could tell the dynamics had changed,” Watts said.

‘#RIPMyBrother’

The family put on blue jumpers for the walk of life. “We just walked around the floor, and everybody was, like, acknowledging him,” Payne said. “We just thought this was the end.”

A friend Black went to high school with filmed part of the ritual. In a short clip, Black is seen being wheeled on a stretcher down a hallway in the hospital. His eyes are half-open. People are crying.

False rumors then started to swirl outside the hospital.

Brianna Floyd said she went into shock when she heard that her friend was dead. She knew that Black had been shot in the head. But a few days earlier, a local newspaper had reported that he was in stable condition.

Floyd checked Facebook to see whether the news of his death was true. Her timeline was flooded with farewell posts for Black, so she decided to write one, too.

“I Love You So Much Brother,” Floyd wrote. “#RIPMyBrother. Never Thought I Would Say That.”

Black’s father rushed to the hospital when he heard a rumor that his son was being wheeled to the morgue.

“‘He’s gone,’” Lawrence Black Sr. recalled being told. “‘He’s going to the freezer now.’”

Black Sr. said he refused to believe that his son was dead. The thought was devastating. He had already experienced that kind of loss to gun violence.

“You wake up and nothing’s the same,” Black Sr. said. “The spirit is lingering for about a week, and you can feel it, you know?”

Overwhelmed with emotion, he prayed for his son to live.

‘I Can’t Kill Your Son’

Zohny, the neurosurgeon, said he heard an announcement about a “hero’s walk” over a loudspeaker in the hospital. He wasn’t familiar with the term, so he asked about it. Medical residents in the hospital explained and told Zohny that the walk was possibly for his patient Larry Black.

“No, that can’t be my patient,” Zohny said he told them. “I didn’t agree.”

That’s when Zohny called the ICU to check on Black’s status. A person who answered the phone told him that Black was being wheeled to an operating room, he said.

“This is my first year,” Zohny said. “Your first year out as a neurosurgeon is the riskiest time for you. Any mistakes, anything small, basically derails your career. So the moment this happened, my legs went weak and I was very nervous because, at the end of the day, your job as a doctor is to be perfect.”

KFF Health News, Zohny, and Punch all reviewed the medical files given to Black from his hospitalization. It’s not clear from the records what led to that moment.

“In every case, the patient must be declared legally dead by the hospital’s medical team before organ procurement begins. This is not negotiable,” Mid-America Transplant’s CEO and president, Kevin Lee, wrote in an Aug. 21 blog post on the nonprofit’s website, responding to the news and federal comments about the investigation centered in Kentucky. “Mid-America Transplant strictly follows all laws, regulations, and hospital protocols throughout the process.”

He said in a statement to KFF Health News that a person can be pronounced dead in two ways. A person is legally dead if their heart stops beating and they stop breathing, which is when donation after cardiac death can occur. A person can also become an organ donor if their brain, including the brain stem, has irreversibly ceased functioning, which is when brain death donation can occur.

“Every hospital has their own process in declaring both types of death,” Speir said in a statement. “Mid-America Transplant ensures hospitals follow their policies.”

But Black didn’t fall into either category, Zohny said. And, he said, Black hadn’t had what is known as a brain death exam.

Zohny said he immediately informed his chairman about the situation, then started running to the operating room. Black’s family was waiting in the hallway, unaware of the drama happening behind a set of closed silver doors.

Then Zohny emerged, pulling Black’s family into an empty operating room that was nearby.

“I remember he told my mama, ‘I can’t kill your son,’” Payne recalled. “She said, ‘Excuse me?’”

Zohny put an image of Black’s brain on a screen. Then he circled the part of his brain that was damaged. He explained that Black’s gunshot wound was something that he could possibly recover from, though he might need therapy. He asked the family whether they were willing to give Black more time to heal from the injury, instead of withdrawing care.

“In my opinion, no family would ever consent to organ donation unless they were given an impression that their family member had a very poor prognosis,” Zohny said. “I never had a conversation with the family about the prognosis, because it was too early to have that discussion.”

Zohny knew that he was taking a professional risk when he ran into the operating room.

“The worst-case scenario for me is that I lose my job,” he recalled thinking. “Worst-case scenario for him, he wrongfully loses his life.”

Later, Zohny said, a hospital worker who transported Black from the ICU to the operating room told Zohny that something had seemed off.

 “I remember him looking at me and saying, ‘I’m so glad you stopped that,’” Zohny recalled. “And I said, ‘Why?’ And he said: ‘I don’t know. His eyes were open the whole time, and I just felt like he was looking at me. His eyes didn’t move, but it felt like he was looking at me.’”

‘Back From the Dead’

After Zohny’s intervention, Black was wheeled back to the ICU. Zohny said the medical team held back all medications that caused his sedation.

Black woke up two days later, Zohny said, and started speaking. Within a week, the neurosurgeon said, he was standing.

“I had to learn how to walk, how to spell, read,” Black said. “I had to learn my name again, my Social, birthday, everything.”

Zohny continued to care for Black during what remained of his 21 days in the hospital. During a follow-up appointment, he posed for a photo with Black and his older sister, Watts. Next to Zohny, Black is standing up, a brace on his leg.

“It’s a miracle that despite flawed policy we were able to save his life,” Zohny said. “It was an absolute miracle.”

Zohny, who was working as a fellow and assistant professor at the time, left Saint Louis University Hospital for another job later that year when his fellowship ended. He said Black’s story made him question what we know about consciousness.

He’s now working on a new method that quantifies consciousness. Zohny said it could possibly be used to help measure consciousness from brain signals, such as with an electroencephalogram, or EEG, a test that measures electrical activity in the brain. Zohny said his method still needs rigorous validation, so he recently started a medical research company called Zeta Analytica, separate from his work at the West Virginia University Rockefeller Neuroscience Institute, which he’ll begin in October.

“We don’t understand the brain to the level that we should, especially with all of the technology we have now,” Zohny said.

Today, Black is trying to move forward. He said he has seizures if the bullet fragments in his head move around too much. He said he easily overheats because of the injury.

He doesn’t blame his family for their decision. But he questions the organ transplantation process. “It’s like they choose people’s destiny for them just because they have an organ donor ribbon on their ID,” Black said. “And that’s not cool.”

To help him process everything that happened to him in 2019, he makes music under the name BeamNavyLooney. “I am back from the dead,” he recently wrote in a song about his experience.

Earlier this year, Black celebrated the birth of another son, who was sleeping peacefully at home as Black recounted his story.

“He doesn’t really cry,” Black said. “He just makes noises.”

Black sat with a firearm within reach. He said he keeps the gun close to protect his family. It’s still hard for him to sleep at night. Nightmares about what happened — both on the street and in the hospital — keep him awake.

He said he no longer wants to be on the organ donor registry.

As Republican lawmakers attempt to rebrand the budget law that slashed $1 trillion for Medicaid to help pay for tax cuts for the rich—unable to ignore the blaring message from angry town hall participants and polls showing Americans do not support the so-called One Big Beautiful Bill Act—research released Friday suggests the GOP should brace for even more outrage from voters across the country.

According to the analysis by the Center for American Progress (CAP), no state or congressional district will be spared from the cuts the OBBBA makes to healthcare, and every district in the US is projected to see a rise in the number of uninsured people by 2034.

"Every member of Congress, regardless of party or geography, will see tens of thousands of their constituents lose coverage under this law," said the group.

CAP's report builds on analysis from the nonpartisan Congressional Budget Office (CBO), which found last month that the law's Medicaid work requirements, expiration of the Affordable Care Act's enhanced premium tax credits, and termination of reforms that benefit low-income Medicare beneficiaries will increase the number of uninsured Americans by 14.2 million over the next decade.

"Families, communities, and health systems nationwide will feel the consequences of these cuts."

The center-left think tank also expanded on a subsequent KFF report that showed how the 14.2 million figure would be spread out across states, finding that the uninsured rate would rise by at least 3% in 34 states and Washington, DC.

CAP's district-by-district analysis found that congressional districts will have an average of 33,000 more people who are uninsured by 2034 due to the OBBBA's healthcare provisions. Those with more than 30% of their under-65 population enrolled in Medicaid are projected to see particularly large increases in the number of uninsured constituents, with Democratic Rep. Yassamin Ansari's district in Arizona expected to have about 80,000 more uninsured residents by 2034—the most of any district in the country.

Ansari launched an "Accountability Summer" town hall tour in her state in July, holding events in Republican-led districts where she spoke with Arizonans about how their "Republican representatives have failed" them by supporting the OBBBA, in some cases after having expressed concerns about the impact it would have on their constituents.

One district Ansari visited, represented by Rep. Eli Crane (R-Ariz.), is also among the districts expected to see a major increase in the number of uninsured residents, at 54,000.

Other Republicans are expected see people they represent lose their coverage in large numbers due to the law, including Reps. Daniel Newhouse (R-Wash.) and Hal Rogers (R-Ky.). About 66,000 of Newhouse's constituents are projected to lose coverage, along with 64,000 of people in Rogers' district.

Rep. Randy Fine (R-Fla.), who touted the OBBBA as a "generational win for working families," will see 54,000 of his constituents lose their insurance, according to CAP.

The think tank found that California, Florida, and Texas will have the highest increases in their uninsured population, with more than 1 million people in each state losing coverage.

The losses caused by the OBBBA are projected to reverse "more than a decade of progress in expanding coverage," said CAP.

"Every lawmaker will see thousands of constituents lose coverage under this law," added the group. "Families, communities, and health systems nationwide will feel the consequences of these cuts."

In addition to attempting to reframe the OBBBA to boost its popularity, some Republicans are attempting to backpedal on the provision ending ACA tax credits that have helped millions of Americans afford their health coverage, which is scheduled to go into effect at the end of the year.

Reps. Tom Kean Jr. (R-NJ), Rob Bresnahan (R-Penn.), and Juan Ciscomani (R-Ariz.) have proposed a bill to extend the credits for one year, hoping to delay until after the midterm elections the provision that could cause some monthly premiums to skyrocket by 75% and leave more than 4 million Americans without health coverage.

"Congressional Republicans voted to rip health coverage from millions of Americans. They don't get brownie points for attempting to kick the can down the road on their own harmful and unpopular agenda because it's convenient for them," said Leor Tal, campaign director for Unrig Our Economy.

"If Republicans in Congress were serious about protecting people's care," added Tal, "they would vote to make these vital healthcare tax credits permanent and they wouldn't have passed the largest cut to Medicaid in history to pay for tax breaks for billionaires."

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