On a weekday morning in a quiet Boston neighborhood, a kitchen bustled with activity. Volunteers sliced chicken breasts, stuffed bell peppers, filled trays, and carefully labeled each item. It was part of an experiment to offer nutritious and medically tailored meals to Medicaid patients who are unable to shop for groceries and cook for themselves.

“Once I started to eat these meals that were geared toward my illness, I built up my muscle mass again, built up my strength, built up my confidence in myself,” said Vanessa Georges, who is in remission from throat cancer and said she would struggle to consume enough calories without the deliveries. “These meals have given me a second chance.”

Georges said she noticed another benefit from the meals: She spends less time at the doctor’s office.

Researchers have found evidence backing her observation. About 1,900 Massachusetts residents who, like Georges, received medically tailored meals for at least three months needed less medical care, according to published in the journal Nature Medicine. They had 20% fewer emergency department visits and 31% fewer hospitalizations than similar patients who did not receive meals.

“It actually saves the healthcare system money,” said , a cardiologist and professor at Tufts University who led the study. “That’s a really big deal, because most things in healthcare don’t.”

The research from Massachusetts that medically tailored meals could save states money — in addition to improving health. Yet such programs could land on the chopping block as states look to tighten spending under Trump administration budget cuts, even as federal officials argue that food is a critical component of health.

Medicaid Budget Cuts Loom

The 2025 law known as the One Big Beautiful Bill Act slashed projected Medicaid funding by more than $900 billion. Many Republicans who backed the bill believe federal health spending is too high and riddled with fraud. Sen. John Kennedy, a Louisiana Republican, for example, has accused California of “outrageous fraud” for using Medicaid dollars to fund housing and nutrition programs.

, a policy analyst at KFF, said states will have to make tough choices in the next few years as they figure out how to fill funding gaps. “If states are not able to offset the loss of federal funds with new taxes or reductions in other state spending, they may have to make program cuts,” she said. (KFF is a health information nonprofit that includes �������ýҕ�l Health News.)

Thirteen states have received federal waivers to use Medicaid dollars to pay for meals — part of an approach known as “food is medicine.” Three other programs are awaiting federal approval.

President Donald Trump’s support for social services has wavered. While the first Trump administration allowed states to pursue medically tailored meals and other social supports, the second Trump administration for Medicaid initiatives that address social needs. It hasn’t detailed a new policy. Administration officials have warned that they will be more focused on the budget impacts of such initiatives.

“They signaled they’re going to be a lot more skeptical,” said , an assistant professor at the University of Massachusetts Chan Medical School who studies nutrition programs and helped lead the Massachusetts study. “Instead of using a broad-based approach nationwide, they’re going to make decisions on a state-by-state basis.”

At the same time, health leaders in Trump’s administration have made nutrition a major focus, including by promoting . Robert F. Kennedy Jr., who leads the Department of Health and Human Services, and Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, have to serve healthier foods to boost patient outcomes.

The healthcare system is often willing to pay for surgeries, Oz said in a social media video in June, “but not always willing to pay for the nutrition that might help prevent those outcomes in the first place. That’s bothered me my whole career.” He added that the agency is , including medically tailored meals, to prevent illness and hospitalization. CMS officials did not respond to several emailed requests for comment for this article.

, who studies social determinants of health at Harvard Law School’s Center for Health Law and Policy Innovation, said the lack of federal guidance is stirring uncertainty for states that want to pursue nutrition programs in Medicaid. “We’re still waiting to see that big step forward around ‘food is medicine’ interventions,” she said. “We need to see that step forward to resolve some of the uncertainty.”

Lawmakers have had a hard time engaging administration officials on medically tailored meals, said U.S. Rep. Jim McGovern, a Massachusetts Democrat who sponsored a bill that would pilot meal deliveries for some . The legislation has yet to come up for a vote.

“I had thought, based on some of his rhetoric before he entered the Trump administration, that RFK Jr. would be a natural ally on this,” McGovern said. “But we can’t seem to get his attention.”

The Costs of Poor Nutrition

Some companies have been accused of for meals that were neither healthy nor nutritious, raising concerns about lax regulation of these programs.

But at in Boston, the food is prepared with specific attention to sugar, salt, fat, vitamins, and minerals and is based on a person’s health needs, said , chief executive of the nonprofit. Many recipients require food that is mild or low in fiber, for example.

“What we’re able to do is to work with your healthcare provider to understand your health realities — what your diagnoses are, what your medications are, side effects, food allergies, cultural norms — and then prescribe a diet for you that is scratch-made,” Waters said.

The Massachusetts researchers found that the meals — at a cost of $125 per person per week — essentially paid for themselves. Patients with heart disease used about $10,000 less in healthcare services over six months, and patients with kidney disease used $12,000 less in healthcare. There were also savings for people with diabetes, depression, and anxiety.

“Those are pretty big numbers when you think of how expensive those diseases can be and the prevalence in the population,” Waters said.

Nationally, , 10 million Americans would benefit from medically tailored meals, though only a small fraction are enrolled.

“Poor nutrition is the top cause of poor health in this country. It’s the top cause of preventable healthcare spending,” said Mozaffarian, director of the Food is Medicine Institute at Tufts. He has estimated that medically tailored meals could help patients avoid 1.6 million hospitalizations and in healthcare costs each year.

A Weekly Delivery That Makes a Difference

Steve Honyotski receives 10 meals at his Boston home each week, cooked fresh and delivered cold or flash-frozen. They’re ready to eat after just a couple of minutes in the microwave.

“The carrot ginger soup is my favorite,” Honyotski said.

Honyotski, 71, lives with several chronic conditions, including diabetes, obesity, and high blood pressure. He said he’s noticed improvements in his health since he started eating medically tailored meals. He needs less insulin to control his diabetes, and he’s lost enough weight to delay a knee replacement surgery.

For now, those meals will keep coming. And Massachusetts’ Medicaid director, Ryan Schwarz, said the state will seek federal approval to continue medically tailored meals in the coming years. “We feel very strongly committed to continuing these services,” he said.

In North Carolina, researchers found that food and housing supports lowered Medicaid spending over time. Yet even with federal approval for medically tailored meals, and evidence that the meals — along with housing and transportation support — were helping people, North Carolina state lawmakers suspended the services in 2025 over budget worries. After budget deliberations this summer, state legislators changed course and decided to the program.

“To me, that’s a signal of what might occur in other states as these Medicaid cuts hit,” said Hager, the UMass researcher. “Even though they have the authority to run these programs, it might be a lot harder for the states to actually implement them.”

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She and her husband have not had health coverage for the past two years, Bates said, because their employment is unsteady and they earn too much to qualify for Medicaid, the public health insurance for those with disabilities or low incomes.

When the GOP-led Congress allowed enhanced Affordable Care Act subsidies — which helped lower the cost of plans sold on the marketplace — to expire at the end of last year, Bates’ mother-in-law dropped her plan, too.

Bates and her husband have a 2-year-old son. The mother-in-law also cares for a son who has autism. They all live together in a trailer home, spending about a third of their family income on prescription medications and opting for trips to the emergency room — often their main destination for medical care, since they aren’t billed up front.

It’s stressful, Bates said. Yet despite their situation, she said she remains “all in” for President Donald Trump. But she also said she’s recognizing flaws in his leadership.

“He’s trying,” Bates said. “It’s just a lot more other things have his attention.”

Georgia’s 14th District is the . It’s the district Marjorie Taylor Greene, who rose to prominence as one of Trump’s most vocal and loyal supporters, represented from 2021 to January 2026.

Greene made a notable pivot from the president last year when she publicly bashed Republicans’ handling of the enhanced ACA subsidies, which helped — along with her own adult children, she said — afford healthcare.

The following month, after Greene Trump of focusing too much on “foreign wars” and ignoring Americans’ economic struggles, the president attacked Greene and said he would no longer support her. Soon after, she announced that from Congress.

Still, many others in this semirural, exurban district, like Bates, remain loyal to Trump, even as more people go uninsured and face rising costs as a result.

Bates isn’t alone in feeling the pinch of healthcare costs this year. Nationally, 37% of Republican voters surveyed in June for said healthcare costs were “extremely important.” More than half of Republicans and Republican-leaning independents who support the Make America Great Again movement said that Congress did the wrong thing by letting the enhanced subsidies expire, according to released in March. And 62% of ACA marketplace enrollees put the most blame for the expiration on Republicans (30%) or Trump (32%).

But, as the November midterm elections approach, policy experts don’t anticipate the issue of healthcare costs will lead to a major shift in how people vote in deeply conservative areas like Georgia’s 14th District, even as policies that once benefited them are rolled back.

“They’re willing to stick with the party line,” said , a professor of political science at the University of Georgia. “As long as Donald Trump and other Republicans are saying Obamacare is bad, they’re going to continue to buy into that idea,” Bullock said, “even when it’s against their economic self-interest.”

Obamacare Still a ‘Dirty Word’

When the ACA was passed in 2010, voted for it. Now, 16 years later, Obamacare is still a “dirty word” for many conservatives, said , a professor of social medicine at the University of North Carolina-Chapel Hill.

While previously the GOP’s goal was to “repeal and replace” the ACA, the current political strategy is “effectively rolling back some of the coverage gains,” he said.

According to a dashboard from NYU Langone Health’s Department of Population Health, of people younger than 65 living in Georgia’s 14th District were uninsured in 2024, which is higher than the . And in 2023, relied on Medicaid or the Children’s Health Insurance Program, known as CHIP, according to Georgetown University’s Center for Children and Families.

Last summer, Congress passed the One Big Beautiful Bill Act, which restricted ACA enrollment periods, added monthly fees, and imposed new documentation requirements for enrollees. The Congressional Budget Office estimated that the number of uninsured people in the U.S. would increase by about 15 million people over 10 years as a result of the new law, the expiration of the ACA subsidies, and other ACA changes. With the enhanced subsidies expiring at the end of 2025, ACA enrollment fell by this year. In Georgia, enrollment dropped by .

Greene’s not a fan of the ACA. She said her family’s health insurance premiums skyrocketed after it became law in 2010. But last year she surprised those on both sides of the aisle when she openly criticized her Republican colleagues over the subsidies.

“I’m going to go against everyone on this issue,” she wrote in an , “because when the tax credits expire this year my own adult children’s insurance premiums for 2026 are going to DOUBLE, along with all the wonderful families and hard-working people in my district.”

In a June interview with �������ýҕ�l Health News in Cumming, Georgia, Greene described the end of the subsidies as “catastrophic.”

“All over the country, people are constantly outraged over the cost of health insurance,” she said.

Like Greene, Bates has also wavered in her support for Trump. In addition to her frustration about the ACA subsidies expiring, she said the Iran war and inflation have also hit her wallet.

“I just don’t feel like he’s doing the best he could,” she said. “He did great his first term. But this term, it’s just not OK.”

While Republicans’ policies have made it more difficult for people to qualify for Medicaid and led to the end of the subsidies that made ACA marketplace plans more affordable, a clear plan to improve the U.S. healthcare system hasn’t emerged, Greene and policy experts say.

In December, House Speaker the Lower Health Care Premiums for All Americans Act. Touted as an alternative to extending ACA subsidies, was intended to lower premiums and increase healthcare access.

But the Congressional Budget Office found the bill would people by 100,000 a year from 2027 to 2035. While the House passed the measure in December, nearly nine months later the Senate hasn’t voted on it.

“It’s a Republican-controlled House, Republican-controlled Senate, Republican-controlled White House,” Greene said. “If Republicans had a plan, this was the perfect scenario to get it passed. You should have all the votes — get it done. And they’re not doing anything.”

Sticking to the Party Line

Despite such criticisms of Republicans for lacking a healthcare plan, voters in deeply conservative areas such as Georgia’s 14th District are sticking with Trump and his allies.

In April, the district elected Trump-backed Clay Fuller to replace Greene, though he won with than she had. He’s up for election again in November for a full congressional term. The University of Georgia’s Bullock said flipping the district from red to blue is unlikely.

Fuller’s office did not respond to interview requests for this report. But in a Q&A with the ahead of his April runoff with Democrat Shawn Harris, Fuller said that the expanded ACA subsidies, introduced under the Biden administration during the covid pandemic, were not a “a long-term solution.” Lowering healthcare costs would come from increasing competition and reducing federal overreach, he said.

Harris, who’s facing off with Fuller again in November, told �������ýҕ�l Health News that the GOP strategy for the midterms is to continue to play off Republicans’ long-standing negative perceptions about Obamacare.

When people in the community are asked whether they support Obamacare, “they’re probably going to say no,” Harris said. But when asked about the Affordable Care Act, people tend to say, “‘Oh, yes, I need to have that,’” he said.

“They don’t realize it’s one in the same,” Harris said, adding that Republicans “sold everybody a bill of goods.”

As candidates campaign, they need to be in tune with their constituents, Greene said.

“That’s where I think they’re completely missing the mark,” she said. “They’re totally tone deaf to what Americans’ needs really are. And we need a serious solution.”

Bates considers healthcare among her top concerns. She said she doesn’t think anybody, including Trump, can make healthcare more affordable. But she hopes politicians will talk with people like her to better understand the burdens that consumers face.

“I honestly wish Congress would actually spend time in the life that we live,” she said. “They just sit behind their desks, and they don’t know what’s really going on in life, because they make so much money.”

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Still, Montana’s health department decided last year that Hailstone is no longer eligible for low-cost disability health coverage through Medicaid. The department switched her coverage to the state’s Children’s Health Insurance Program, another Medicaid program — three months before she aged out.

Before making the decision, the state didn’t seek records from the medical team treating Hailstone, according to letters from those doctors reviewed by �������ýҕ�l Health News. Rather, the administrative ruling came after state officials learned the now-19-year-old had stopped receiving Social Security disability payments. She said she did that because she hoped to get healthy enough to work and save some money — beyond what’s allowed under the tethered to those payments. But her health changes day to day, and she said for now she’s still too sick to consistently work.

Hailstone, who lives with her mom, has been able to keep Medicaid coverage while they appeal the case. She said that without Medicaid she can’t afford the treatment to manage the aftermath of her cancer.

“It feels like this process was made to make you give up,” Hailstone said.

Patients with disabilities have long struggled with administrative hoops, blunders, and confusion when trying to qualify for federally subsidized health coverage because of their illness. Now, new federal Medicaid work requirements mean states face the additional task of deciding who qualifies for a medical exemption. That means reviewing medical cases for an even larger swath of Medicaid enrollees.

Attorneys, researchers, and advocates who specialize in public aid said disability cases like Hailstone’s — though separate from the incoming work requirements — are an indication that states aren’t ready. As a result, they said, more people will be denied coverage in an opaque process.

“This will be the story of millions of people,” said Anthony Wright, who heads Families USA, a national nonprofit that advocates for ways to make healthcare more accessible.

Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, said the state doesn’t comment on individual Medicaid cases.

An will have to meet the new rules requiring them to prove they’re working, going to school, or volunteering to keep their Medicaid coverage, according to the Congressional Budget Office. of those enrollees live with a chronic health condition, according to KFF. Some will be excused from those rules if they can prove they’re too sick to work.

More than 5 million people are expected to lose Medicaid coverage by 2034 because of the work requirements, according to the CBO.

Work Requirements Become Law

Many Republican policymakers and the Trump administration have touted Medicaid work requirements to preserve coverage for the neediest. Congress made that national policy through last year’s One Big Beautiful Bill Act and gave states until January 2027 to implement work-for-coverage rules.

Some states are starting those checks early. Montana began in July. Nebraska initiated work requirements in May.

In the federal law creating the work requirements, Congress allowed states to exempt people who have an illness that qualifies them as “medically frail.” Many states created plans for those judgment calls, only to be surprised when federal officials released rules for the requirements that went beyond what Congress outlined, by also requiring enrollees to prove their illness makes it too hard to work.

Families USA and other organizations have argued the new rules force states to set up a patchwork of systems that, together, would be larger and more complicated than the Social Security Administration’s own disability review system. Last year, that federal program cost to administer to roughly 7 million people nationally. For comparison, Wright said, the federal law provided $200 million for states to share as they implement the work requirements. States are paying contractors millions of dollars to prepare often already flawed public aid systems to meet the new standards.

In June, 25 states over the medical frailty rules, arguing they’re too hard for patients to meet and for states to assess. That case is ongoing.

Hailstone was diagnosed with blood cancer at age 10. Her intestines tore, which led to their partial removal. As a result, her body struggles to process food and she can face severe dehydration. She said lingering side effects from her cancer treatment can leave her mind foggy and cause her hands and feet to swell enough that it’s hard to grip a fork or walk across a room.

Cancer dominated nearly half her life. It left mental scars, too.

“Some days you feel fine and then you suddenly crash,” Hailstone said.

Hailstone and her mom live in Roundup, a central Montana town of roughly 2,000 people. They regularly make the nearly two-hour round-trip drive to Billings for specialized care. She typically has three medical appointments a week to see her physical and occupational therapists and a mental health counselor.

Hailstone said she’s lucky she has her mother’s help navigating Medicaid. Her mom, Kyla Hailstone, said that the state hasn’t clearly defined how it determined her daughter’s disability status and that its appeal process has been slow and dysfunctional.

Taya Hailstone would qualify for Medicaid based on her income if she can’t prove her eligibility for disability coverage. But that would mean proving she’s too sick to meet the work requirement — putting her in the same position of having to rely on a state review of her illness.

“If I lose this, this is life-changing,” Hailstone said.

‘Things Fall Through the Cracks’

Hailstone qualified as disabled through the federal government as recently as 2024, about a year before the state said it was dropping her coverage. State officials can do their own medical review to determine whether someone meets the federal definition of a disability to access Medicaid.

“Whether that happens is always a bit of a crapshoot just based on state capacity,” said Megan Dishong, deputy director of the Montana Legal Services Association, which helps low-income people navigate public programs. “Things fall through the cracks.”

Ebelt said the state health department accepts disability decisions from the Social Security Administration. The state agency can conduct an internal disability determination if a person doesn’t have one from the SSA, but Ebelt said it doesn’t have to if a person qualifies for coverage another way.

“We are committed to treating every client with respect and helping those who are eligible receive appropriate Medicaid coverage,” Ebelt said.

Montana instituted a three-month grace period for the work requirements. State officials won’t begin disenrolling people for noncompliance until October.

a University of Michigan social policy professor who has studied bureaucratic obstacles to public benefits, said convoluted disability cases are common enough for attorneys to specialize in accessing aid.

“When we’ve designed public programs in ways that people can’t figure out whether they’re eligible without consulting lawyers, we’ve done something wrong,” Herd said. “That has huge, huge implications for what’s to come.”

Montana officials have said they’ll automatically review medical records that could help patients qualify for an exemption. Even so, the federal guidelines released in June mean patients will probably still face additional steps to guarantee an exemption.

Meanwhile, already overstretched doctors worry they’ll face the burden of judging whether someone’s illness qualifies them for a work exemption.

Dishong said that between now and October, Montana officials could offer more clarity on how the process will work. She said she’s worried the state will end up “with a slow-roll mess” instead.

“This is a problem that’s just starting,” Dishong said.

As for Hailstone, she’s now reapplying for Social Security disability payments. That aid would limit how much she can work. But it would also guarantee access to Medicaid.

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“Are you the person who’s going to bring my mom back?” she asked.

Gómez struggled to find an answer. It was a December morning, and she’d brought food, diapers, baby wipes, and clothes — items she hoped would help the 6-year-old girl, her baby brother, and the neighbor who had stepped in to care for them. The children were left alone after federal immigration agents arrested their parents outside their apartment in Oxnard, a mostly Latino agricultural community on the Southern California coast. But Gómez had no power to bring the parents back.

“We’re working on that,” Gómez recalled telling the girl. In reality, she was at a loss for how to answer truthfully without upsetting her.

As a project manager for a nonprofit that provides food assistance to immigrant families affected by Immigration and Customs Enforcement raids, Gómez has witnessed the tumult and pain that have roiled the lives of since President Donald Trump returned to office, with devastating consequences for children’s health. They include an estimated with at least one parent detained by immigration authorities through April, a number that has undoubtedly climbed since. Separation from parents harms children psychologically. It destabilizes families, often leaving the remaining parent or caregiver scrambling to stay housed, buy food, and fulfill kids’ medical needs. Some kids are to care for themselves.

Many kids whose parents aren’t detained are experiencing threats to their health and well-being too. Two children in the South in February 2025 after reportedly being bullied over their family’s alleged immigration status.

Millions of children live in families losing access to , , , and other supports as roll back eligibility for immigrants with and without legal status. Fear of federal enforcement has pushed parents to avoid , going to the doctor, and . Some have disenrolled from or avoided signing kids up for health and nutrition programs.

Children from immigrant backgrounds are also . They’re experiencing more , increased , and anxiety about , even when they or their family members are citizens or legal residents.

Most of these children are American citizens. About have an immigrant parent, including around 4.6 million with a parent who lacks legal status.

“I’m really concerned about how long it’s going to take for us as a country to address all of the harm that’s happening to this generation of kids,” said Wendy Cervantes, director of immigration and immigrant families at the . “This type of stress can have long-term developmental harm and can really inhibit their ability to do well in school, to have good health outcomes, and to grow into thriving, stable adults.”

Curbing Public Benefits

Trump has made cracking down on immigrants — including the children of immigrants — a priority since his second term began last year. On Inauguration Day, he issued an purporting to end birthright citizenship for kids born to parents without legal status or in the country on temporary visas, an attempt ultimately blocked by the Supreme Court.

His administration, with the approval of Republicans in Congress, has into immigration enforcement, detaining the parents of an estimated 145,000 U.S. citizen children as of April, and, according to an analysis by nonprofit newsroom The Marshall Project, . It’s sought to rescind , or TPS, for over 1 million immigrants, tens of thousands of whom have U.S. citizen children, and in the Deferred Action for Childhood Arrivals program, which includes the parents of about .

White House officials say the immigration crackdown by freeing up resources such as jobs and housing, reducing pressure on public coffers, expelling criminals, and restoring integrity to the immigration system. (Studies have shown that mass deportations .) Trump and other Republican leaders have argued that birthright citizenship and “,” and that TPS has allowed immigrants from “” to remain in the United States indefinitely under what is supposed to be a temporary program.

In a statement, White House spokesperson Lauren Bis did not directly address whether the administration is concerned about long-term harm to children and increased healthcare costs because of its immigration policies. Instead, she repeated past White House criticisms that President Joe Biden’s immigration policies allowed children to be trafficked across the U.S. border.

“The real story is the psychiatric impact on the tens of thousands of children who were smuggled across the border — many by human and sex traffickers,” she wrote in an email.

Only 39% of Americans approve of Trump’s handling of immigration, according to a recent Associated Press-NORC Center for Public Affairs Research poll.

Stephen Miller, the chief architect of Trump’s immigration policies, has accused the children of immigrants of draining public resources and perpetuating problems from their parents’ home countries. Research, however, shows that immigrants and the longer they live in the United States and that they and their children . Data also shows they than native-born Americans.

“This is the great lie of mass migration,” on the social platform X in November. “You are not just importing individuals. You are importing societies. No magic transformation occurs when failed states cross borders. At scale, migrants and their descendants recreate the conditions, and terrors, of their broken homelands.”

The Republican tax-and-spending law enacted last summer curbs immigrant eligibility for health and food assistance programs. And this July, the administration issued new “public charge” rules that give immigration officers broad discretion to deny green cards to lawfully present immigrants if they or family members have used public benefit programs, a move that could result in U.S. citizen children disenrolling from safety net healthcare programs.

Together but Afraid

Separation from parents is and can lead to , including anxiety, depression, cardiovascular disease, and learning difficulties. Children separated from their parents at the border during the first Trump administration were found to exhibit . Researchers have also tied deportations and detentions of immigrant parents — as well as the threat of them — to widespread , higher , , among both immigrant and U.S.-born children.

It’s also costly to society. A by federal researchers estimated that health conditions related to childhood trauma accounted for $292 billion in healthcare spending in 2021 alone, including by taxpayer-funded programs such as Medicaid and Medicare.

Emmanuel, a 13-year-old in Oxnard, gets anxious every time his dad goes to work as a farm laborer, his mother, Ana, said. He asks her for reassurance that his father will return, and about what would happen to him if his parents got detained. He tries to hurry Ana up when they’re out in public, worried that ICE could suddenly appear. �������ýҕ�l Health News is not using their full names because they fear deportation.

Doctors and therapists interviewed by �������ýҕ�l Health News said they have observed a notable increase in mental health problems, especially anxiety, in children from immigrant families. Kimberly McNally, a pediatrician at Venice Family Clinic’s Inglewood South La Brea Health Center, said she’s regularly referring children of all ages for mental health services related to fears that their parents will be taken away. At daycares, kids have been showing up with an extra bag in case their parents don’t pick them up, said Liza Davis, advocacy director for Children in Immigrant Families at The Children’s Partnership, which works with a coalition of early childhood educators.

Sometimes, the distress leads young people to take extreme actions. In June, 19-year-old Eliel José after his father was deported from the Atlanta area to Mexico, according to Univision.

Rosie Harrison, executive director of Grow Initiative GA, a community organization that serves low-income families, said she’s received calls over the past year from immigrant parents seeking help for suicidal and depressed kids. Their situations are often made worse because many lack health insurance and can’t afford to pay for therapy. That’s often because parents have lost jobs that came with health insurance due to worksite raids or because of eligibility changes imposed by the Trump administration.

“I’m concerned about the families that are going to be burying their child,” Harrison said. “I’m concerned that we are going to miss out on having an amazing person do amazing things for our community, for our country, because they took their life.”

Strength Under Pressure

Many children are showing resilience, though.

In a role reversal, some children have become their parents’ protectors. They go grocery shopping and take their younger siblings to school so that their parents don’t have to leave the house.

Giselle Gonzalez, a university student and volunteer with the immigrant protection network VC Defensa in Ventura County, California, said she’ll never forget the morning last summer when she woke up to the sound of kids on bicycles pedaling through her immigrant-heavy neighborhood in Thousand Oaks, yelling “La migra! La migra! Don’t come out!” They’d spotted ICE agents grabbing factory workers and gardeners on their way to work, she said.

Neighbors, community groups, health providers, and others have also in a to support children and families affected by immigration enforcement. They , provide , , and help parents create in case they get detained or deported.

Ultimately, more humane immigration policies and enforcement tactics will be required to end the harm being done to children, academic experts and advocates said.

Researchers at point to a pilot called the as a model for keeping families together while also enforcing immigration laws. Launched in January 2016 under President Barack Obama, the program allowed families seeking asylum to remain in the community while awaiting resolution of their cases. Through a case manager, they received support in meeting the obligations of their immigration cases and preparing for deportation if needed. The program, which and cost-effective, was terminated by the first Trump administration.

At Venice Family Clinic in Los Angeles, case manager Mabel Alavez sees the pressures facing families who are still together but worried they could be separated. Many of the people are parents or grandparents who have been in the U.S. for decades. Some are afraid to take their children to school, the park, or the beach. They ask whether it’s safe to enroll their U.S.-born kids in Medicaid. She helps families who are facing eviction because they’re afraid to go to work and can no longer afford rent. She often helps them create plans for who will look after their children if they get detained.

Raised in an immigrant family herself, Alavez knows how challenging it can be for kids who are first-generation Americans to navigate growing up, going to school, and finding a sense of belonging in a country their parents aren’t from.

“It’s hard for me to imagine how they could possibly do that in addition to what’s going on now,” she said. “I do feel like there will be a big impact on them. What that might look like, I’m not exactly sure.”

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In , President Donald Trump’s signature One Big Beautiful Bill Act will require most adults to work, go to school or enter a training program, or volunteer for at least 80 hours a month. Native Americans and Alaska Natives are exempt from the mandates, which take effect in January.

Of the nearly in the U.S., around 47% live in Hawai‘i. Within the contiguous United States, California, Washington, Nevada, Texas, and Oregon have the largest populations of Native Hawaiians.

Hawaiʻi’s Medicaid administrator, Meredith Nichols, said the Centers for Medicare & Medicaid Services didn’t respond to the state’s request to include an exemption for Native Hawaiians but said she believes the decision came down to the population’s lack of recognition as a tribal nation. Hawai‘i has about , 15% of whom identify as Native Hawaiian, Nichols said.

“We know that when we’ve asked similar questions in the past, it all comes down to federal recognition,” she said.

Hawaiʻi health administrators met with Trump administration officials in June. Some unsuccessfully pushed to add an exemption to the new law, which would need congressional approval.

White House spokesperson Kush Desai did not respond to requests for comment. In a statement, CMS spokesperson Timothy Foster confirmed that the agency met with 16 health centers in Hawai‘i about Medicaid changes but didn’t respond to other questions.

Barriers to Care

Native Hawaiians face many of the same as , including higher risks during pregnancy, higher infant mortality rates, and higher rates of being uninsured than the white population. And in Hawaiʻi, Native Hawaiians have the among ethnic groups after other Pacific Islanders.

Kapono Chong-Hanssen is the medical director of Ho‘ōla Lāhui, the Native Hawaiian healthcare system on Kaua‘i that also serves the privately owned island of Ni‘ihau, whose 170 full-time residents are predominantly Native Hawaiian. Chong-Hanssen said he anticipates many of his patients will no longer receive the care they need once the new work requirements take effect.

The new requirements will erode the trust healthcare providers worked hard to build among Native Hawaiian patients, who, in response to , are more likely to disengage and “throw the whole system out” when they run into barriers, Chong-Hanssen said. “It just flies in the face of everything that we’re trying to do.”

Beyond medical services, Medicaid covers transportation expenses when patients travel between islands for care. A round-trip ticket between Kaua‘i and O‘ahu, for example, can cost hundreds of dollars.

Congress placed over 200,000 acres of land in a trust for Hawaiian homesteads in 1921 to bring Hawaiians back to their native lands after the U.S. backed the 1893 . Nearly 30,000 Native Hawaiians , while, as of the , more than 34,000 people lived on Hawaiian homelands. The homesteads are often far from Honolulu, where most health services are located.

Waianae Coast Comprehensive Health Center primarily serves the west side of O‘ahu, which is home to the island’s largest Native Hawaiian population, near four Hawaiian homesteads.

The center’s vice president, Leinaala Kanana, said that many of its patients are geographically isolated and that few jobs are available in the area. Patients also have trouble securing transportation to get to work or finding affordable childcare.

The center’s CEO, Rich Bettini, said Hawai‘i’s high living costs and depressed wages have pushed many people into homelessness, creating another barrier to complying with the new Medicaid requirements. Native Hawaiian and Pacific Islanders make up about 60% of O‘ahu’s . The center estimated about 2,800 of its patients may be affected by the requirements, half of whom are Native Hawaiian.

The annual “cost of living for a family of four in Hawaiʻi on O‘ahu is $100,000-plus. The average income of our patients is under $30,000 a year,” he said. “That is an enormous gap.”

‘Bigger Fish To Fry’

Native Hawaiians face obstacles to being granted the same exemptions as other Indigenous groups. While several federal laws refer to Native Hawaiians as an Indigenous group, they are not among the 575 tribes recognized by the federal government. Federal recognition can be granted either by Congress or administratively through a process established by the . Native Hawaiians about whether they would even want , with some fearing it would jeopardize their ability to restore Hawaiian independence.

Laws governing Medicaid also don’t acknowledge Native Hawaiians, aside from the 2021 , signed by former President Joe Biden. In the covid-era law, the federal government fully reimbursed Native Hawaiian health centers for Medicaid services for two years. However, all the qualifying Native Hawaiian health centers were in Hawai‘i, where in the country now live.

The federal government fully reimburses Indian Health Service and tribal facilities for healthcare services provided to Native Americans and Alaska Natives. Native Hawaiian instead receive the same reimbursement rate as in the rest of Hawaiʻi.

Keolamaikalani Dean, the CEO of the King Lunalilo Trust, which provides services for Native Hawaiian elders, pointed to the new Medicaid requirements as just one of many federal policies limiting Native Hawaiians’ healthcare.

“It’s horrible as a policy, but there are bigger fish to fry,” he said.

Dean said he’d rather advocate for giving Native Hawaiian healthcare systems the same full Medicaid reimbursement that the Indian Health Service receives. The change would have greater impact on patients seeking care, he said.

Native Hawaiian advocates said they have been overextended as they work to guard against an onslaught of threats to revoke other federal funding by the Trump administration.

In Trump’s proposed 2027 budget, cuts to Native Hawaiian programs cited the group’s lack of federal recognition as a “tribal nation.” The proposed cuts coincide with challenging education programs and that provides homestead land to some Native Hawaiians at almost no cost, alleging the programs racially discriminate against other groups.

, a nonprofit that oversees the Native Hawaiian healthcare systems in the state, declined to comment for this article. The group is involved in a lawsuit filed by a conservative group aiming to stop a university scholarship for Native Hawaiians pursuing healthcare careers.

U.S. Rep. Jill Tokuda (D-Hawaiʻi) viewed the exclusion of Native Hawaiians from the exemptions to Medicaid work requirements as an attempt to further erode Native Hawaiians’ Indigenous status, pointing to recent challenges by the Trump administration and lawsuits.

“These are not one-offs,” Tokuda said. “This is a targeted, coordinated attack to undercut the Indigenous status of Native Hawaiians.”

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But U.S. District Judge John D. Bates, in a , also agreed with the administration that it was unconstitutional for the government to use race or ethnicity as the basis to award money under a program created to expand internet skills and access.

“It was definitely disappointing,” said Angela Siefer, executive director of the National Digital Inclusion Alliance, a nonprofit that filed suit last year after not receiving a award meant to bolster digital and internet skills nationwide. “With this administration it’s really worrisome.”

Congress passed the $2.75 billion Digital Equity Act in 2021 as the skill development component of a multilayered “” initiative under President Joe Biden’s signature infrastructure law, which included a bigger pot of money for expanding internet infrastructure.

A few months into his second term, Trump directly attacked the Digital Equity Act on social media, pledging “” and calling the program “illegal.” The language echoed two Trump executive orders characterizing diversity, equity, and inclusion programs .

The National Telecommunications and Information Administration, which oversees implementation of the law, responded by Digital Equity Act grant programs, leaving states and organizations like the National Digital Inclusion Alliance in limbo.

In response to Bates’ decision, federal attorneys said the government would reinstate the NDIA-related competitive grant program without racial classification. The government aims to release a new grant application in December, according to a filed in the case.

The NDIA now must reapply for the grant award, which was slated to be disbursed among more than a dozen organizations and tribes, including the Cherokee Nation in Oklahoma, El Centro Hispano in Arkansas, Portland Community College in Oregon, and Community Service Programs of West Alabama. The grants are meant to go toward digital navigator programs, in which community workers teach technology and internet skills, according to the NDIA.

In western Ohio, Jamie Huber said her organization was a subrecipient of the NDIA grant funds. Huber, director of community services at the Northwestern Ohio Community Action Commission, said that without the funding, she is left searching for money to continue navigator programs such as one she runs for people who are unemployed, homeless, or both.

“How do you find a home? Well, you got to look online. And how do you find a job? You have to look online,” Huber said.

Huber’s digital navigators also teach internet skills at 10 senior centers in rural counties stretching along the corner of Ohio bordering Michigan and Indiana. They help active older adults learn how to go online to pay bills and get healthcare, so they “continue having agency over their own life,” Huber said.

Rural residents live sicker and die younger on average than people in the rest of the country when they live in counties lacking high-speed internet access and healthcare, an analysis by �������ýҕ�l Health News found.

At Computer Reach in western Pennsylvania, Executive Director Dave Sevick said his organization has cut staff and programs. He said the nonprofit, which started in 2001, has refurbished more than 24,000 computers, giving them away to families it finds through schools and churches.

“We’re aware that affordability is the biggest issue around, and this doesn’t make it any better for folks,” Sevick said. “We’re helping a little bit by getting a free computer out to people.”

The Digital Equity Act the money should benefit, including low-income households, older people, some incarcerated people, rural Americans, veterans, and members of racial or ethnic minority groups.

According to by the Pew Research Center, people in rural communities were less likely to have internet subscriptions compared with their urban and suburban counterparts.

The Pew Research polling that home broadband use among Black and Hispanic adults lagged that of white and Asian adults. While 81% of white adults surveyed said they subscribed to broadband at home, only 71% of Black adults and 68% of Hispanic adults said the same.

In court, lead federal attorney Patrick Butler argued that Congress failed to prove a compelling government interest when including the racial or ethnic criteria. Congress did not “identify anything close to” a specific instance of discrimination in the broadband industry, Butler said, .

Butler then surprised the court, if the racial or ethnic status could be severed from the law, “we would obviously apply the grant program without considering race.”

In his opinion severing the race factor, Bates that “the President lacks the power to cancel laws passed by Congress based on his bald disagreement with Congress’s policy determinations.”

Sen. Patty Murray (D-Wash.), a primary , said she will be “watching very carefully to ensure this administration does what Congress intended.”

“It is indisputable that these challenges are particularly pronounced in low income, rural, and Tribal communities — and there’s a reason Democrats and Republicans across the country support this program so strongly,” Murray said in a statement to �������ýҕ�l Health News. 

Sen. Ted Cruz (R-Texas) Biden’s infrastructure bill in 2021 and to the National Telecommunications and Information Administration in late 2024 asking the agency to pause the $1.25 billion competitive grants program, arguing the use of racial classifications “does not serve a compelling governmental interest.” Cruz did not respond to requests for comment.

Arielle Roth, administrator of the agency, previously worked as the telecommunications policy director for the Senate Commerce, Science, and Transportation Committee’s majority staff under Cruz. She was to lead the agency.

In June, during a House committee hearing, Roth had tense exchanges with Democrats who took issue with changes to the Biden-era infrastructure law’s internet deployment program, which now allows more satellite services rather than prioritizing fiber-optic cable lines.

Lawmakers also asked about the Digital Equity Act’s grant programs.

“Communities across the country deserve a clear answer and a path forward,” Rep. Nanette Barragán (D-Calif.) said during the hearing. While the National Digital Inclusion Alliance’s lawsuit does not include the state grants, Barragán asked how those grants would be rolled out, considering the federal judge’s decision on race.

California was awarded a $70 million state capacity grant. Early this year, the Justice Department to Congress asserting that the state grant and the competitive grant program both are illegally based on race, citing the Supreme Court’s decision invalidating affirmative action in higher education admissions. Roth declined to answer Barragán’s question, noting there is active litigation.

Barragán said she was “extremely” frustrated by “some of the responses or nonresponses.”

Stephen Yusko, a spokesperson with the National Telecommunications and Information Administration, declined to comment or respond to questions for this article.

The government and the National Digital Inclusion Alliance agreed to pause court proceedings to give the agency time to reinstate the competitive grant program. The NDIA has also proposed that the agency provide status reports every 30 days during the court pause “to ensure prompt attention to reinstatement,” according to the most recent .

“We need to make sure it’s all moving forward,” Siefer said.

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�������ýҕ�l Health News first reported that the Consumer Product Safety Commission — a federal agency tasked with monitoring injuries from household items — was pressuring hospitals to provide a private company with personally identifiable health information for analysis. The rollout of the program has inspired broad pushback from hospitals and privacy advocates.

The CPSC’s goal is to obtain millions of Americans’ medical records from emergency rooms for most injuries, even when a consumer product is not involved, internal emails and documents reviewed by �������ýҕ�l Health News revealed. The agency instructed hospitals to share detailed patient information for more than 10,000 types of injuries or conditions, such as vaccine reactions, suicide attempts, or stingray stabs.

The scope of data CPSC is collecting far exceeds the agency’s mission and should be immediately suspended, Massachusetts Sen. Ed Markey, who sits on the Senate Health, Education, Labor, and Pensions Committee, and other House and Senate Democrats to CPSC acting Chairman Peter Feldman.

“This unprecedented and sweeping effort to collect identifiable patient data is untethered from the Commission’s statutory mission and authority, and is ripe for misuse by an administration that has repeatedly sought access to Americans’ most personal information,” the letter stated. “Americans should be able to seek medical care without fear that their personal health information will be swept into a federal database and repurposed for political ends.”

Among other Democrats signing the letter were Sen. Richard Blumenthal of Connecticut, Rep. Jan Schakowsky of Illinois, and Sen. Ron Wyden of Oregon, the ranking member of the Senate Finance Committee.

CPSC spokesperson Steve Roney did not answer several questions about the program and the call for it to be suspended.

“We received the letter, and will respond directly, through the appropriate channels,” he said in a statement.

The CPSC is one of several agencies that have launched broad acquisitions of Americans’ sensitive medical records during Trump’s second term. The Office of Personnel Management has requested federal workers’ sensitive health information. Health and Human Services Secretary Robert F. Kennedy Jr. deputized at least one private organization to collect more medical records for his studies on vaccines and autism.

The CPSC has operated a voluntary program for decades that enables trained hospital workers based in about 70 hospitals nationwide to report injuries involving consumer products, called the National Electronic Injury Surveillance System, or NEISS. Compared with the current initiative, the agency’s data collection has historically been far narrower, and previously requested patients’ identifiable information, generally for follow-up, in fewer than 1% of cases.

Without public notice, CPSC staffers overhauled the program early this year — rebranding it as NEISS-R — and told hospital executives that participation is mandatory, requiring they report far more identifiable patient details from more injuries to a private company called Konza Health. The Kansas-based company won a five-year contract last year worth up to $15.9 million with the CPSC.

In emails and contract language reviewed by �������ýҕ�l Health News, Konza representatives described hospital participation as “mandatory” or “required.” Emails sent this year by CPSC chief data officer Elizabeth Puchek said hospitals would need to apply for an exemption from participation or face penalties. Those penalties, for what’s called unlawful “information blocking,” were established in a federal data-sharing regulation designed to make sure patients could access their medical records. The agency’s website reiterated that threat, claiming information-blocking regulations require hospitals “to make electronic health information (EHI) available to public health authorities, such as CPSC, upon request, unless a specific exception applies.”

The power play inspired widespread resistance. The American Hospital Association asking for modifications to the program, citing “confusion and concern about the scope of patient information” demanded by the agency.

Now the agency is backtracking, removing in recent weeks mentions of “information blocking” penalties from its public page.

The CPSC’s Feldman, a Trump appointee, said in an interview last month with Nextgov/FCW that the new program would .

The Democrats highlighted these discrepancies and changes, also noting that the agency has bypassed regulations and failed to publicly lay out any detailed plan for its data collection, as required by law.

“The Commission has since quietly removed the information blocking rationale from its public NEISS webpage, without any public correction or acknowledgment that the claim it spent months promoting was without basis,” the letter said. “This reversal does not undo the coercion hospitals experienced, but rather raises the question of whether the Commission’s purported legal justifications were ever more than post-hoc cover for an agenda that had little to do with its statutory authority.” The Democrats’ letter asks CPSC to respond by Sept. 18.

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Their family and friends thought the adventure-loving couple was on another jet-setting vacation, but they were keeping something else under wraps: They had turned off their phone locations to hide visits to a Greek clinic where they were trying to get pregnant.

The Solomons are among the growing numbers of Americans looking abroad, particularly to Greece and Spain, to escape the high cost of fertility treatments in the U.S., where such procedures are often not covered by insurance. The treatments include , which involves ovulation stimulation, retrieving the eggs, fertilizing them in a lab, and transferring the embryos into the uterus. Other less intensive medical therapies also address infertility.

President Donald Trump has made fertility, and IVF in particular, a focus of his administration’s agenda after he for women during his 2024 campaign. His administration intended to make it easier for employers to offer fertility coverage, although it has yet to be finalized. So far, the most concrete result has been lower costs for some IVF medications through TrumpRx, a site where cash-paying patients can find some discounted medicines through participating pharmacies. The White House projected that patients could save .

While significant, those savings are up against a since 2014, according to GoodRx, a prescription discount service. A released in July by Axene Health Partners and the Women’s Reproductive Health Foundation found that the overall cost for a cycle of IVF was over $29,000 — or 35% of the median annual household income in the U.S. Genetic testing, embryo storage, pregnancy care, and delivery costs can push the total over $54,000 per IVF-conceived birth, according to the study. An average patient needs two to three cycles to successfully have a child, so the costs for many patients would be even higher.

Infertility affects people in the U.S., but only an estimated 24% of treatment needs are met, because of those high costs and limited insurance coverage, according to the American Society for Reproductive Medicine. The condition is believed to be of people having children later, as well as such as pollution.

Still, were born via IVF in the U.S. in 2024 — a record, according to the Society for Assisted Reproductive Technology. An increasing share of people hoping to be parents are seeking help in Europe: The number of Americans choosing European clinics grew by more than 37% last year, according to , the chair of the European Fertility Society, a group that tracks data on fertility treatment in Europe.

The Solomons knew IVF was their only chance to have children together biologically, because Justin had testicular cancer in his late teens. What the college sweethearts had not expected was the cost — and they learned early in their IVF journey that their insurance would not cover their treatment. While some states have passed laws to require insurers to pay for some fertility care, the coverage .

When the couple first explored IVF in Florida, where they live, they were quoted $40,000 for one round of treatment. The price shocked them, and Emilie said the clinic’s offer of a spring discount for an embryo transfer felt “off-putting.”

“They just kind of prey upon your hopes and dreams to be parents,” Emilie said.

Treatment Plus Island-Hopping Tours

The price of IVF and uncertainty around in Florida, which the Solomons feared their control over their embryos, sent them to the Pelargos IVF Medical Group in Athens. There, in the first of two trips, Emilie underwent ovulation stimulation and egg retrieval.

Including medication, fertilization, storage, and the ultimate embryo insertion, the total treatment cost about $12,000, not including travel, according to the Solomons, a fraction of what they might have spent in America. That affordability drew the couple abroad, but so did the allure of sightseeing and experiencing a new country.

On that first trip, they spent a weekend between doctor appointments exploring the Greek island of Milos. Between Emilie’s hormonal injections, they rented a boat to explore the island. Their video from the trip shows them climbing the island’s striking white volcanic cliffs, and Emilie floating in the turquoise water of the Aegean Sea. Despite the emotional and physical toll of the IVF process, the couple remembers being in a little bubble, away from everyone, exploring a beautiful place.

“It was one of the best summers that we’ve had,” Emilie said.

When they traveled back to Greece for their embryo transfer in October 2025, they spent two days in Croatia.

IVF in Greece using a patient’s own eggs typically costs around $3,000 to $4,000, not including medication, so even with travel, it is often a fraction of what patients pay in the U.S.

“Americans choose Greece because they can access treatment that is more affordable, faster to begin, and well supported for international patients,” Dejewski said.

Patients in Greece do face some legal restrictions: Embryo storage is time-limited, donor anonymity is standard, sex selection and embryo-transfer numbers are restricted, surrogacy access is limited for nonresidents, and patients must carefully consider documentation requirements if they plan to move embryos between Greece and the U.S.

Penny Ampatzi said she is clear about these legal differences when Americans consult with her clinic in Athens. Serum IVF offers to schedule airport pickup for patients, as well as island-hopping tours. Ampatzi, the co-founder and clinic director at Serum IVF, said the main draw for the dozen or so American patients her clinic sees each month is the personalized fertility treatment plans. Affordability is close behind. A cycle at her clinic costs just under $6,000, not including embryo freezing. Almost all of Serum’s patients are foreigners, according to Ampatzi.

“You consider that you have a good possibility of success, plus you don’t pay that high amount of money, and you also have combined the treatment with holidays — so it’s a ‘Why not?’” she said.

Not Without Risks

IVF costs in the U.S. have been driven up by a mix of inflation, a shortage of embryologists, a surge in demand after pandemic backlogs, and private equity ownership, Dejewski said.

William Kiltz, vice president of marketing and business development at U.S.-based , said that the costs are becoming too far out of reach. “IVF is almost a treatment that only the top 1% can afford reasonably,” he said.

Kiltz said CNY’s model — offering IVF for around $8,000, not including embryo storage, at its 18 locations across the country — brings just enough profit to “keep the lights on” and open new locations while keeping its costs lower. “We’re trying to deliver this care at the absolute bare-minimum cost,” he said.

More than half of CNY’s patients travel from out of state in search of those lower-cost options, Kiltz said.

He said he hopes the IVF market will eventually settle out, as happens with many new technologies. But nearly five decades in, that normalization hasn’t come. Kiltz believes that’s because the market is so emotionally driven.

“People will do just about anything,” Kiltz said. “There’s certainly some risk in something like that, where the demand and the desire from a single individual is so strong that they could be taken advantage of.”

, the head fertility doctor at the CNY location in Norfolk, Virginia, pointed to the difficulties of trying to vet a clinic overseas when one doesn’t speak the language or understand the local IVF regulations. It also can be challenging to transport temperature-sensitive medication back home.

“It’s almost like a full-time job trying to play regulatory expert and inspector all at the same time, while you’re a patient,” Pakrashi said.

She said she also has had patients who sought treatment abroad return to her clinic struggling to transfer records or understand a diagnosis they received overseas. They often have to repeat tests.

And going abroad for IVF is still out of reach financially for many Americans.

The Solomons said seeking treatment overseas takes a certain type of adventurous spirit, too. But for them, all the logistics and travel were worth it. Their one cycle of IVF and two trips to Greece allowed them to welcome a healthy baby boy this summer.

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“We had a great discussion about healthy options for all Americans and taking back control of our healthcare,” Barrett said in a June , after sampling the farm’s apple cider.

Like the focus on artificial dyes, however, many of the administration’s highest-profile health initiatives rely on voluntary agreements. The goals, such as lower drug prices and nutrition classes for doctors, have widespread appeal, cutting across party lines and economic divisions.

But the administration-industry deals lack the enforcement teeth of more traditional federal regulation. Their details are vague, and minimal oversight makes it hard to monitor progress. In some cases, the administration has claimed victories that have yet to materialize.

Republicans consider the dealmaking a winning strategy. It fits with the party’s anti-regulatory stance, they say, and enables the administration to quickly forge agreements President Donald Trump and his allies can tout as accomplishments. In the run-up to the midterm elections, some, like Barrett, hope to woo voters by trumpeting the Trump administration’s efforts to shape health policy.

The practice also raises questions. Though the deals are announced with great fanfare — often during televised events on stages, with live audiences — there’s little documentation or follow-through, creating doubts about whether the administration’s health agenda will lead to lasting change or unravel once the political attention fades.

The distinction could prove important to voters as Republicans defend their health records in November’s midterm elections.

“These deals are often not transparent, so there’s no way for the public to judge how meaningful they are,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes �������ýҕ�l Health News.

Dealing With Dyes

The push to remove certain artificial dyes from food and drugs, for example, was a headline grabber. In April 2025, Kennedy to announce deals with food makers. He was flanked by young children and mothers holding placards reading “Make America Healthy Again.”

He and former FDA commissioner drew a standing ovation from an audience selected by Kennedy’s staff as they said companies had pledged to phase out all petroleum-based synthetic dyes from the nation’s food supply and medicines. They targeted nine synthetic dyes for removal.

Voters love the idea of stopping the use of such dyes. In a nationally representative March survey by Consumer Reports, said they were at least somewhat concerned about synthetic dyes, and two-thirds said companies should be required to phase them out.

A year after making the first announcement at HHS, during a discussion at the Conservative Political Action Conference, an annual political event.

“We’ve gotten rid of the nine synthetic-based food dyes,” he said.

Not quite. At the initial HHS event, federal officials said companies would voluntarily stop using six specific synthetic dyes . (The administration has also revoked or proposed revoking authorization for two other synthetic food dyes.)

Later, the FDA on its website quietly to the end of 2027. So, most are still in use.

In fact, the FDA posted a list of 27 companies it said had made voluntary pledges as of December 2025 to remove six synthetic dyes from products such as Doritos and Kellogg’s Froot Loops. More than a year and a half later, — fewer than 30% of those who bought in — had met their promised goals.

Many major food makers, such as the Coca-Cola Co. and Unilever, have made “” to remove the synthetic dyes, according to Consumer Reports. In addition, no pharmaceutical companies have publicly said they have plans to remove dyes from drugs.

“It’s just all talk,” said Leslie Dach, who chairs , a healthcare advocacy group that supports the Affordable Care Act. “They just govern for a day of publicity, and then it’s over. None of it happens. Yet the people don’t know because they have busy lives, so they think, ‘Just look at all these initiatives.’”

In fact, the administration , allowing companies to say their products contain no artificial colors — as long as they don’t use petroleum-based dyes. Previously, food makers could not make that claim unless their products contained no added colors. Some food dyes made from natural ingredients can contain contaminants and may pose their own health risks, .

“The federal government hasn’t taken any regulatory action on food dyes, for the most part, since the beginning of this administration,” said , vice president for government affairs at the Environmental Working Group, an advocacy group.

HHS said the voluntary approach has yielded significant action, including commitments to remove synthetic dyes from products sold in schools for the 2026–27 school year.

“HHS and the FDA are moving forward with clear timelines and concrete industry commitments, with major changes expected in foods served in schools during the coming school year and across full product portfolios by the end of 2027,” HHS spokesperson Emily Hilliard said in an email.

At the same CPAC convention event, Kennedy said “the MCAT testing companies are going to put nutrition on the MCAT for the first time, so the students will actually want to do it.” MCAT refers to the Medical College Admission Test, an exam required for admission to medical schools.

Again, not quite.

The Association of American Medical Colleges administers the MCAT. Spokesperson said Kennedy misspoke and may have meant to refer to a test taken by students to be licensed as doctors.

An Insurance Deal Falls Short of Promises

Kennedy again took to the HHS stage in June 2025, this time with Centers for Medicare & Medicaid Services Administrator Mehmet Oz, to make what was billed as a game-changing announcement. to reduce the volume of healthcare services subject to prior authorization, a practice widely used by the insurance industry that often requires patients or their medical teams to seek preapproval before undergoing treatment.

The administration said 80% of insurers pledged changes to preauthorization requirements for 80% of diseases and injuries . The administration also promised “” to track progress.

“It will happen very quickly,” Oz said at the event. “Necessary care will be delivered when it’s needed, in the right way.”

As of July, months past that January target date, health plans had reduced prior authorization for medical services by about 11%, according to AHIP, the insurer trade group. But no public dashboards have debuted to track the deal, and some insurers that signed the pledge last summer told �������ýҕ�l Health News this year that they will not implement all the promised reforms as outlined by AHIP.

Hilliard did not respond to questions about the pace of progress.

The American Medical Association, in a 2025 web-based survey, asked 1,000 practicing doctors whether they believed the voluntary pledges would make a meaningful difference. said they believed they would.

Insurers made a , during the previous Trump administration. The next year, more than 80% of doctors said the number of prior authorization requests for drugs and medical services had been increasing, based on .

Meanwhile, the administration is testing an artificial intelligence-powered for Medicare, the federal health program for people 65 and older or with disabilities. In six states, Medicare beneficiaries must get preapproval for a few treatments that CMS considers to have little clinical benefit and to be susceptible to fraud or waste, including skin substitutes and knee arthroscopy for arthritis. The program began in January, the same deadline insurers had set for curtailing preauthorization delays.

Deals and Deregulation

The healthcare industry’s voluntary agreements appeal to voters who feel government regulation drives up costs and places unnecessary burdens on businesses, some supporters say.

“Secretary Kennedy is the antithesis of a public health industry that uses coercion over communication — and has demonstrated this by taking the time and effort to push voluntary initiatives over the typical approach of governmental mandates,” said , a political consultant who was a political appointee at HHS in Trump’s first term.

But voluntary agreements with the health industry can prove ineffective. Former President Jimmy Carter in 1977 proposed a legislative plan to curb rising hospital costs. Hospitals fought back, and Congress rejected the proposal, instead favoring a desired by the industry. It ultimately failed once public attention faded.

One upside: Deals are fast. can take two to three years. And some health analysts say the tempo of the agreements advanced by Kennedy and Trump may help take voters’ attention off the Trump administration’s inability so far to produce a long-promised health plan.

Instead, Republicans can point to the array of accords reached with industry, including the with drugmakers so they’re in line with lower amounts charged in peer countries. The White House calls it the “most-favored-nation” prescription drug pricing policy.

Seventeen companies, including Pfizer and AstraZeneca, with the administration to lower prices for Medicaid enrollees and cash-paying consumers using , a narrow, government-run consumer platform.

Many details remain unknown, but the lower prices apply only to new drugs and existing drugs available through Medicaid. And prices at TrumpRx aren’t as low as out-of-pocket prices for most consumers with insurance. But the voluntary deals appeal to an industry that has railed against mandatory approaches drugmakers deride as harmful price controls.

“Each company makes its own decisions about how it prices medicines, and our industry is committed to working with the Trump administration to ensure Americans have access to affordable medicines,” said Chanse Jones, a spokesperson for PhRMA, a pharmaceutical industry trade group.

Policies that lead to reductions in drug prices typically worry investors because profits also can drop. But rather than seeing their stock prices fall after the agreements were announced, the drugmakers saw largely .

Analysts say that’s partly because the deals are narrow in scope, largely exist only in principle, and don’t apply to existing drugs used by the more than 200 million Americans with commercial or private health insurance.

The Trump administration, however, is .

“The most-favored-nation agreements on drug prices that we just did are delivering the largest drug price cuts in history,” Trump said in June at a in Pennsylvania. “That alone should win us the midterms.”

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MILLVILLE, Pa. — In an open field, arrows whizzed through the humid June air and struck their targets. Campers and counselors cheered.

It was archery hour at . Operations director Drew Meyer watched, a few tears escaping from behind his dark sunglasses.

“They will surprise you, like, flat out,” he said of the campers, who have all survived brain injuries. “They’ll come out here, and they’ll shoot for three hours and start hitting the target.”

Campers, ranging in age from 10 to 21, have been coming to Camp Cranium in Pennsylvania’s rural Columbia County since 2008. Some of their brain injuries are so severe that they have to relearn basics, from talking to tying their shoelaces. Some use wheelchairs or crutches. But during a week at camp, they climb rock walls, swim, and whiz down a zip line through the lush forest.

The existence of Camp Cranium, and a handful of others like it, is a response to a decades-long national trend: More people, including children, now survive crises resulting in brain injury than did in the 1980s. The improvements in survival are largely due to seat belt laws and and trauma centers that can treat injuries quickly.

But recently, efforts to track and prevent one type of brain injury, traumatic ones, are in flux after Congress didn’t renew a and prevention of traumatic brain injuries, and the Trump administration fired hundreds of employees at the Centers for Disease Control and Prevention, including the team tracking traumatic brain injuries, or TBIs.

“Brain injury can happen to anybody,” said , executive director of the . “This community deserves more.”

Tracking Brain Injuries

Lucas Hardy, 14, smiled at the encouraging crowd below. In a shady clearing in the woods, he climbed the 30-foot rock wall, aided by a hoist that pulled him out of his wheelchair and helped support his moves. Hardy suffered a traumatic brain injury at age 3, when a tree branch fell on him at a birthday party.

Annually, an estimated 2.8 million Americans experience a TBI — including about 475,000 children, according to the .

Recent data suggests those are undercounts. In 2018, a CDC team piloted a household survey asking about TBIs in a sample of U.S. children and adults. The results concluding that such injuries, which are often considered “hidden” because the damage is internal and unseen, are more widespread than hospitalization numbers suggest.

The mass firings at the CDC in early 2025 studying TBI, right before they were expected to launch a . A spokesperson for the Department of Health and Human Services, Emily Hilliard, did not respond to questions about the number of employees terminated, or if they were reinstated or replaced.

In a statement, she said: “The Trump Administration remains committed to supporting efforts to prevent traumatic brain injuries, improve surveillance, and ensure Americans have access to practical, evidence-based information that can help protect their health and safety.”

She said the agency’s TBI work is now handled by other staff members at the National Center for Injury Prevention and Control.

Hilliard said the CDC is deciding how to establish a cost-effective national concussion surveillance system within the bounds of current funding, and said the agency in 2026 dedicated funds to support, among other things, an about concussions, an , and concussion surveillance.

But Wolfkiel still worries about how the CDC firings and the impasse over federal funding will affect brain injury research and prevention efforts in the long term.

“The lack of resources and programs and information that’s out there is really just sort of appalling,” Wolfkiel said.

Federal Funding Uncertainty

Tony Sadowski, the camp’s , remembers when his son, Bryan, suffered a brain bleed that caused a hemorrhagic stroke at age 6. “You’re in the emergency room,” he recalled, “not knowing what version of your son’s going to wake up.”

Now 18, Bryan Sadowski has attended the camp for years.

“We’re very lucky to be able to be here,” the elder Sadowski said.

In 1996, before Bryan was born, Congress passed the Traumatic Brain Injury Act, which has provided many states with grants for TBI research, advocacy, and services. Since then, Congress reauthorized the act four times, largely with bipartisan support, until 2024.

It has remained lapsed since then. Trump’s secretary of the Department of Homeland Security, , supported when he was a senator. Congress is whether to reauthorize funding through 2030.

Despite the lapse in funding, money is still flowing to TBI programs at the CDC and in states, according to , president and CEO of the Brain Injury Association of America.

Congress did appropriate $8.25 million for TBI program activities through the . That’s far less than the $23 million Congress provided for each fiscal year, from 2020 through 2024, the last time it .

“The TBI Act is the only piece of federal funding for traumatic brain injury at the federal level,” Willis said. “We’re aiming to preserve what we have.”

The funding uncertainty has not affected the handful of brain injury camps, including Camp Cranium and in Alabama, because they are nonprofits that mostly rely on private donations.

Back at Camp Cranium, bursts of laughter, whoops of delight, and distant chatter punctuated the humid summer air.

While her fellow campers did archery or art, Brianna Engleman moved between groups, collecting song requests for a dance that evening. When she was 5, doctors performed a to relieve her of debilitating seizures. But the surgery itself can injure other parts of the brain.

She lives in Northern Virginia and first attended Camp Cranium as a teen in 2018. It was her first time being around so many people like her, said Engleman, now 21.

“I’ve gotten more confident,” Engleman said. “It made me think, well, there’s actually good people out there.”

Next time she returns to camp, she said, she plans to do so as a counselor.

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