“We saw a turnaround in his behavior, and our other children,” said Burkhammer, who has adopted or fostered 10 kids with his wife. “There are real impacts on real kids.”

The Republican turned his experience into legislation, sponsoring a bill to from food sold in the state. It became law in March, making West Virginia the first state to institute such a ban from all food products.

The bill was among a slew of state efforts to regulate synthetic dyes. In 2025, roughly 75 bills aimed at food dyes were introduced in 37 states, according to .

Chemical dyes and nutrition are just part of the broader “Make America Healthy Again” agenda. Promoted by Health and Human Services Secretary Robert F. Kennedy Jr., MAHA ideas have made their deepest inroads at the state level, with strong support from Republicans — and in some places, from Democrats. The $50 billion — created last year as part of the GOP’s One Big Beautiful Bill Act to expand health care access in rural areas — offers incentives to states that implement MAHA policies.

Federal and state officials are seeking a broad swath of health policy changes, including rolling back routine vaccinations and expanding the use of drugs such as ivermectin for treatments beyond their approved use. State lawmakers have introduced dozens of bills targeting vaccines, fluoridated water, and PFAS, a group of compounds known as “forever chemicals” that have been linked to cancer and other health problems.

In addition to West Virginia, six other states have targeted food dyes with new laws or executive orders, requiring warning labels on food with certain dyes or banning the sale of such products in schools. California has had a law regulating food dyes since 2023.

Most synthetic dyes used to color food have been . Some clinical studies have found a link between their use and . And in early 2025, in the last days of President Joe Biden’s term, the Food and Drug Administration known as Red No. 3.

Major food companies including have gotten on board, pledging to eliminate at least some color additives from food products over the next year or two.

“We anticipate that the momentum we saw in 2025 will continue into 2026, with a particular focus on ingredient safety and transparency,” said John Hewitt, the senior vice president of state affairs for the Consumer Brands Association, a trade group for food manufacturers.

This past summer, the group called on its members to from their products by the end of 2027.

“The state laws are really what’s motivating companies to get rid of dyes,” said , regulatory counsel for the Center for Science in the Public Interest, a nonprofit health advocacy group.

, the senior director of state health policy for the Association of State and Territorial Health Officials, said the bipartisan support for bills targeting food dyes and ultraprocessed food struck him as unusual. Several red states have proposed legislation modeled on California’s 2023 law, which bans four food additives.

“It’s not very often you see states like California and West Virginia at the forefront of an issue together,” Baker-White said.

Although Democrats have joined Republicans in some of these efforts, Kennedy continues to drive the agenda. He appeared with Texas officials when the state enacted a package of food-related laws, including one that bars individuals who participate in the Supplemental Nutrition Assistance Program — SNAP, or food stamps — from using their benefits to buy candy or sugary drinks. In December, the U.S. Department of Agriculture approved similar . Eighteen states will block SNAP purchases of those items in 2026.

There are bound to be more. The Rural Health Transformation Program also offers incentives to states that implemented restrictions on SNAP.

“There are real and concrete effects where the rural health money gives points for changes in SNAP eligibility or the SNAP definitions,” Baker-White said.

In October, California Gov. Gavin Newsom signed a bill that sets a and will phase them out of schools. It’s a move that may be copied in other states in 2026, while also providing fodder for legal battles. In December, San Francisco City Attorney David Chiu , accusing them of selling “harmful and addictive” products. names specific brands — including cereals, pizzas, sodas, and potato chips — linking them to serious health problems.

Kennedy has also for chronic diseases. But even proponents of the efforts to tackle nutrition concerns don’t agree on which foods to target. MAHA adherents on the right haven’t focused on sugar and sodium as much as policymakers on the left. The parties have also butted heads over some Republicans’ championing of , which can spread harmful germs, and the consumption of , which contributes to .

Policymakers expect other flash points. Moves by and the in October. Meanwhile, more red states may eliminate vaccine mandates for employees; . And Florida Gov. Ron DeSantis is pushing to .

Even as Kennedy advocates eliminating artificial dyes, the Environmental Protection Agency has on chemicals and pesticides, leading MAHA activists to calling on President Donald Trump to fire EPA Administrator Lee Zeldin.

Congress has yet to act on most MAHA proposals. But state lawmakers are poised to tackle many of them.

“If we’re honest, the American people have lost faith in some of our federal institutions, whether FDA or CDC,” said Burkhammer, the West Virginia lawmaker. “We’re going to step up as states and do the right thing.”

Ñî¹óåú´«Ã½Ò•îl 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 .

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Medicaid Expansion Now Could Save Some States Money

At least, that was the plan. But five days after Republican Gov. Jan Brewer signed it into law, President Obama signed the new health law. That had the effect of voiding Arizona’s effort. The federal health care act bars states from lowering eligibility requirements for either CHIP or Medicaid over the next several years. Otherwise, they risk losing Medicaid funding altogether.

Because Arizona’s cuts hadn’t officially taken effect, state lawmakers now have to cancel them to comply with federal requirements. That will leave a $400 million hole in their new budget. All told, Arizona officials estimate the federal law will cost the state $11.6 billion over the next 10 years.

Brewer calls that “financially devastating.” She signed a bill Thursday that gives her the authority to sue the federal government over the law, even though the state’s attorney general has refused to do so.

Many other states – nearly all of which are facing budget shortfalls – are similarly concerned about how much the health law will end up costing them. States that have traditionally offered lower levels of coverage, such as Arizona, will no longer have the option of cutting health spending much in tough times.

And, because states will operate major portions of the federal expansion, they face other challenges. California predicts that the cost of administering the new programs alone will run the state $2 billion to $3 billion.

“There’s no way, in my view, that this is not going to cost states,” says Scott Pattison, executive director of the National Association of State Budget Officers.

Putting The Pieces Together

State-run exchanges are one of the cornerstones of the new law. These will be marketplaces where individuals and small businesses sign up for private insurance plans. The idea is that they’ll work like travel Web sites such as Orbitz and Expedia, giving individuals and human resource managers their pick among several competing plans.

But the exchanges aren’t simply one-stop shopping tools. They will also determine how much government assistance each person is entitled to. The federal government will subsidize private insurance for individuals who earn up to 400 percent of the poverty level, on a sliding scale. The exchanges will determine how much help each person should get.

The exchanges also will figure out whether an individual, even though she may be applying for private coverage, actually meets the requirements for CHIP or Medicaid. That means states need to get often outmoded database systems talking to each other.

States that have tried to synchronize applications across various assistance programs have found it rough going, even on a much smaller scale, says Jeff Smith, a health consultant with the Lewin Group in Virginia. Under the health law, states will collectively process income and eligibility information for up to 30 million families, he says.

“It’s very, very difficult to bring all the disparate pieces into one system and make them work together,” he says. “I don’t think states fully understand the magnitude of what’s involved here.”

Experience Matters It can be done. After passing a similar individual-mandate law in 2006, Massachusetts got its exchange up and running within six months. Under the federal law, other states have until 2014. (Utah is the only other state with an existing exchange.)

But Massachusetts started out with many advantages. Its uninsured population was relatively small and the state boasts the nation’s largest number of physicians per capita.

States that have already expanded coverage in recent years, including Massachusetts and Maine, have learned how to reach out to working populations and negotiate with private insurers.

Not all states have that experience. States such as Arizona and Alabama, which historically haven’t provided broad coverage, have reason to worry about how they’re going to bring their administrative and health system capacity up to speed – and how they’re going to pay for it.

“If you’ve been running a fairly basic program and you imagine a major influx of people coming into Medicaid, you’re wondering who is going to provide care to those people and how are we even going to sign them up,” says Alan Weil, executive director of the National Academy for State Health Policy. “The magnitude of the task is definitely greater in the states that have not taken those steps, to learn a lot of lessons about expanding coverage.”

Learning New Tricks

Leaving aside constitutional challenges brought by 14 state attorneys general, this is the real fault line dividing opinion about the new federal law among states. Some states are confident they have the ability and expertise to meet its challenges, while others remain wary. Some are having to shift gears entirely, from making big program cuts to preparing for vast expansions.

Cindy Mann, who oversees Medicaid and CHIP for the federal government, recognizes that states will have additional costs under the law, but she points out that states will receive help on implementing – and paying for – their new coverage responsibilities. The feds will not only pick up the tab for newly eligible Medicaid recipients but devote more dollars to CHIP as well. “This helps states avoid other costs they would bear if the Medicaid program wasn’t there,” Mann says, such as underwriting care for the uninsured at community health centers.

But Carol Steckel, Alabama’s Medicaid commissioner, says her state can barely afford its share of Medicaid costs now. She predicts the new law will bring 400,000 more people into her state’s Medicaid system by 2014 – doubling its size. That means even greater costs for the state down the road, despite increased federal subsidies for Medicaid.

“I’m going through my mourning period of how much work there’s going to be,” she says. “We’re for bleepin’ sure going to have to think outside the box.”

Ñî¹óåú´«Ã½Ò•îl 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 .

USE OUR CONTENT

This story can be republished for free (details).