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    Medicaid recipients fear ‘buzzsaw cuts’ for Trump’s agenda: ‘We’re not going to be alive forever’

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    At the age of 62, Marya Parral knows that her, and her husband’s, years of being able to care for their two developmentally disabled sons are numbered, and so they have done everything they can to ensure their children can continue to live independently.For their oldest, Ian, that’s meant placing him in a program on an organic farm that caters to people diagnosed with autism. For Joey, their youngest, who has both autism and Down syndrome, Parral has found a caregiver who can help him deliver newspapers and run errands around their community of Ocean City, New Jersey.Parral said none of this would be affordable without help from Medicaid, the federal government’s insurance program for poor and disabled Americans. But this week, the Republican-controlled House of Representatives approved a budget framework that would make deep cuts to the program, and Parral worries her sons will lose what she has worked so hard to build.“We’re not going to be alive forever. We’re trying to set up a life for them, but that entire life that we’re working so hard to set up for them is dependent on Medicaid,” Parral said. “So it’s really devastating to think about cuts.”Producing a budget is the first step in the Republican-controlled Congress’s drive to enact legislation that will pay for Donald Trump’s priorities. House lawmakers will now spend weeks working to write and pass a bill that is expected to approve $4.5tn in extended tax cuts, as well as funding for Trump’s plan for mass deportations of undocumented immigrants.To pay for it, Republicans are considering a rollback of the federal social safety net, particularly Medicaid, which has nearly 80 million enrollees in all 50 states. The budget plan proposes an $880bn reduction in funding for the insurance over the next 10 years, an amount that experts warn would hollow out the program and have ripple effects across the entire American healthcare system.Megan Cole Brahim, a professor at Boston University School of Public Health and an expert on Medicaid, said the cut was the largest ever proposed, and if enacted would “have far-reaching impacts not just for those who rely on Medicaid, but for entire communities and economies”.“These changes mean millions of Americans – including the low-income, elderly, persons with disabilities, children – will lose health insurance coverage,” she said. “Others may see significant reductions in benefits or limited access to care. The impact on hospitals and health systems will be significant, particularly for safety-net and rural hospitals, which are already on the brink of closure. Patient revenues will fall, uncompensated care will rise. There will be staff layoffs and site closures.”John Driscoll, a healthcare executive and chair of the board of UConn Health in Connecticut, said: “The scale of the buzzsaw cuts to Medicaid would undermine every hospital’s ability to actually support its mission to care for the community, and would be a dangerous cut to the nursing-home infrastructure in the country.”Republican leaders backed the cuts to Medicaid, as well as to similar programs such as one that helps poor Americans afford food, as a way to mollify lawmakers in their party who want the US’s large budget deficit addressed. Still, not everyone is pleased. As the budget was being debated, eight Republican representatives, some of whom Democrats are keen to unseat in next year’s midterm elections, wrote to the House speaker, Mike Johnson, warning that their districts’ large Hispanic populations would be harmed.“Slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open,” they said.All eight ultimately voted for the resolution, but the dissent may be a warning sign for the budget’s prospects of enactment, particularly in the House, where the GOP has a mere three-seat majority. It also remains unclear whether Republicans will try to pass all of Trump’s priorities in one bill, or split them into two.The GOP has made clear they want to fully pay for the extension of Trump’s tax cuts, and Elyssa Schmier, vice-president of government relations for advocacy group MomsRising, said Medicaid and social safety programs are the party’s prime targets for cost savings.“If you’re not going to go after, say, the Pentagon budget, if they’re only going to go to some of these big mandatory spending programs, there’s only so many places that Republicans feel that they can go,” she said.In the days since the budget’s approval, Johnson and Trump have scrambled to downplay the possibility of slashing Medicaid, insisting they intend only to root out “fraud, waste and abuse.”“The president said over and over and over: ‘We’re not going to touch social security, Medicare or Medicaid.’ We’ve made the same commitment,” Johnson told CNN in an interview.Democrats have little leverage to stop the budget, which can be passed with simple majorities in both chambers. But the Democratic senator Ruben Gallego warned that gutting the social safety net to extend tax cuts that have mostly benefited the rich will alienate voters who sided with the GOP last November.“It will be on Donald Trump and Republicans, the fact that he’s going to side with the ultra-rich versus the working poor,” said Gallego, who won election to his seat in Arizona even as Trump captured the state’s electoral votes. “Families that are barely making a living, scratching a living, they’re now going to get kicked off healthcare to give tax cuts to the mega-rich.”The proposed cut to Medicaid would remove billions of dollars in funding from congressional districts nationwide that are represented by lawmakers from both parties, according to an analysis by the liberal Center for American Progress.In California’s San Joaquin valley, the Democratic representative Jim Costa’s district would lose the third-largest amount of funding, according to the data, and Medicaid coverage would be imperiled for more than 450,000 residents.“This reckless budget prioritizes the wealthy while devastating those who need help the most,” Costa said. “I voted no because this resolution is bad for our valley and a threat to the wellbeing of the people I represent.” More

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      ‘I feel betrayed’: federal health workers fired by Trump tell of ‘nightmare’

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      As protesters gathered outside the headquarters of US health agencies to call attention to mass layoffs devastating the federal service in recent days, more employees at health agencies were terminated on Wednesday, including employees with years of experience and stellar performance reviews who were not probationary.Thousands of terminated employees across the federal government are appealing the decision. Some former employees are struggling to apply for unemployment or understand when their benefits expire in the chaotic termination process.At the US Centers for Disease Control and Prevention (CDC), the layoffs included all public health fellows stationed at state, local and regional health departments, as well as staff working on global health and outbreak response – even as the bird flu outbreak ramps up and the CDC suspends its seasonal flu vaccine campaign.The Guardian spoke to four employees at the CDC who were terminated in recent days. Three requested anonymity to avoid retribution from the Trump administration. All of them recently received satisfactory or outstanding performance reviews, and none of them had been placed on performance review plans.Mack Guthrie was part of the Public Health Associate Program at the CDC – until everyone in the program was let go over the weekend. He worked in Minneapolis public schools to help prevent STIs and unintended pregnancies by educating students, testing and counseling patients in clinics, and tracking STI rates and trends.All of these layoffs are “a major hit to America’s health infrastructure”, said Guthrie, who had an outstanding performance review so was stunned to see his performance listed as the reason for termination.While all of the public health fellows were told they were being laid off, some never received letters, Guthrie said, adding: “The whole process has been dominated by chaos and confusion.”The state, tribal, local and territorial departments where they were deployed “are already starting to feel the effect of our absence”, Guthrie said.“For some of my colleagues, they are filling gaps at host sites that would simply not get filled otherwise,” he said. “These organizations simply don’t have the funds to hire people.”When one CDC employee attempted to log into their laptop on Wednesday morning, they received an error message and realized they were locked out of the system, unable to communicate with their team or even say goodbye. They’d been laid off overnight and because they have not yet received a letter, they don’t know the reason for their termination. This employee had years of experience and excellent performance reviews, and was not probationary.Employees in probationary periods were especially hard-hit in this round of layoffs. That status has nothing to do with their performance, unlike employees who may be put on probation in the private sector. Rather, it usually means they have been in their current position for less than two years, and thus they don’t have the same legal protections as other federal workers.One terminated employee who has been in the same position for four and a half years was surprised to receive notice that their job was considered probationary and they were being let go, despite high praise on performance reviews. They are appealing the decision to human resources, but have not received responses yet.Form letters sent to terminated employees say that they “are not fit for continued employment” because their “ability, knowledge and skills do not fit the agency’s current needs”, and their performances have “not been adequate to justify further employment at the agency”.Former CDC employees told the Guardian they are now part of a class-action wrongful termination appeal to the US Merit Systems Protection Board – joining other federal employees represented by the Washington law firm James & Hoffman.The leader of the merit board was herself reinstated by a judge on Wednesday after the Trump administration tried to fire her.“If you’re going to terminate my position, don’t tell me it’s because of my performance,” said another employee who worked as a CDC contractor for four years before entering a probationary period after being hired permanently.View image in fullscreenEmployees who were locked out of their systems with little or no notice are now scrambling to collect their final paychecks, apply for unemployment, return equipment, and understand their benefits.The longtime employee who was locked out on Wednesday told the Guardian they were not given the proper documentation in order to apply for unemployment.“When I called HR, the team simply did not know what to do and I was left with, ‘Please call back tomorrow, we will have better guidance,’” the employee said. “Folks don’t even have essential documents to properly separate from the agency.”The employees said they haven’t been offered details on whether their annual leave will pay out, or even how long their health insurance will last.“I still need to communicate with my center in terms of what is happening with my final paycheck, how do I return my equipment, and I have no idea how they intend to do that,” said the employee who worked at the CDC for five years.The so-called “department of government efficiency,” known as Doge, has targeted certain agencies for layoffs in a purported bid to cut back on government spending, despite representing a very small portion of the federal budget.“They feel fake,” the employee said. “It seems like a giant scam that they were trying to see if it would work, and it did … I can’t believe that I lost my job as a result of this group of people.”The layoffs cap a stressful month for CDC staffers rushing to implement Trump’s flurry of executive orders.“We were working around the clock. If not working, I couldn’t sleep – for weeks, since the administration came in – thinking of all the things we had to do to meet those orders,” said the employee who was at the CDC for four and a half years.All the while, they were waiting to learn if they would keep their job – a “dream job” that has become “a nightmare”.“It was really part of my identity – I lived and ate it around the clock,” the employee said. “That was such a big part of my life … I feel betrayed.”The employee urged former supervisors and teammates to check in on the wellbeing of terminated staffers, some of whom report experiencing depression and anxiety.“All of us have always looked at CDC as being the final goalpost for a public career,” said the longtime employee.“It feels like I worked so hard to be where I’m at, only to look back and see an empty space. I know I did the work, but it’s rapidly being taken away.”Send us a tipIf you have information you’d like to share securely with the Guardian about the impact of cuts to federal programs or the federal workforce, please use a non-work device to contact us via the Signal messaging app at (646) 886-8761. More

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      From weather apps to taxes: the trickle-down effects of Trump’s federal worker firings

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      You wake up to dark clouds outside, so you check the weather on your phone: a storm is coming.That weather app uses data from the National Weather Service, a part of the National Oceanic and Atmospheric Administration, a small organization which could see as much as 10% of its workforce cut this week.You grab food to make breakfast: eggs, meat, formula for your baby. The safety of your food is regulated and inspected by a host of federal employees, who flag and investigate when items shouldn’t be eaten.The former head of the Food and Drug Administration’s food division resigned this week because he thought firings and layoffs at the agency would hinder its work. “I didn’t want to spend the next six months of my career on activities that are fundamentally about dismantling an organization, as opposed to working on the stated agenda,” he told Stat News.You check your flight reservations for an upcoming trip to a national park. The safety of that flight is overseen by the Federal Aviation Administration, which experienced layoffs this month despite recent high-profile aviation accidents. The national park will probably see its staff gutted, leaving it more vulnerable to wildfires and without search and rescue capabilities. “I honestly can’t imagine how the parks will operate without my position,” a park ranger who was cut wrote on Instagram. “I mean, they just can’t. I am the only EMT at my park and the first responder for any emergency. This is flat-out reckless.”You keep an eye on the bird flu levels and a measles outbreak – the winter has been punishing for illnesses. The Centers for Disease Control and Prevention were hit with a first round of layoffs this week, which could affect outbreak response and reporting. The Epidemic Intelligence Service, a disease-detective training program, could be on the chopping block.Oh, and you’re working on your taxes – while thousands of Internal Revenue Service probationary employees are expected to be laid off during tax season.The government certainly has room for improvement – backlogs that should be cleared, investigations that should be more thorough, communication that should be sharper, actions that should be more transparent. But all of this work is done by the federal government and its millions of workers and contractors, whose daily jobs touch the lives of all Americans and many around the globe.In the first weeks of the Trump administration, the president and the billionaire Elon Musk, tasked with cutting government through the so-called “department of government efficiency” (Doge), have waged war against federal workers. Musk and his team have moved from agency to agency, indiscriminately firing probationary employees and those whose work they say doesn’t align with the administration’s priorities, including many who work on diversity initiatives or in international development.The result is a hobbled and terrified federal workforce that is just at the beginning of the expected cuts – and an American public that is starting to experience the repercussions.“We’re playing Russian roulette, and basically you’re putting a whole bunch of more bullets in the chambers,” said Max Stier, the CEO of the Partnership for Public Service, a non-profit that advocates for a strong civil service. “You can’t prevent all bad things from happening, but our federal government is, in a lot of ways, a manager of risk, and it does a pretty darn good job of managing that risk, even though it can be improved.”An email went out in January to millions of federal employees offering a deferred resignation, which the White House says about 75,000 people have accepted, although it’s unclear how many of the people who accepted are actually eligible.Joel Smith works at the Social Security Administration and is the president of the American Federation of Government Employees Local 3184, which covers more than 90 agency offices in parts of Arizona, New Mexico, Texas and Louisiana. He said the office of management and budget, which has coordinated the buyout program it’s calling a “fork in the road”, hasn’t communicated with the agencies about which employees accepted the buyout. Some employees didn’t show up the first day the program’s leave was supposed to begin, and the agency had to call them to figure out where they were, he said.“It’s just chaos on top of chaos, on top of terror, on top of employees that want to leave are being told they can’t leave. I’m trying to think of a good word for it. I don’t know if there is one, other than clusterfuck,” Smith said.Those that remain in their jobs worry about whether they’re next as they add to their workloads to cover for those who lost their jobs or quit. People eyeing next career moves will avoid civil service, previously seen as a stable career, to stay out of the current chaos.Many people take core functions of the federal government for granted, as it protects them from disasters or national security concerns, but might not otherwise affect them. But that could change after widespread firings. For example, layoffs in the Environmental Protection Agency mean that those remaining in their positions have less capacity to do their jobs.“That could come in the guise of someone not being able to respond to an environmental disaster,” said Nicole Cantello, president of the American Federation of Government Employees Local 704. “Or what about if there’s a facility illegally flaring air pollutants? We might not be as able to respond to something like that which could have health effects. There could be devastating effects to the American people.”If you or your loved ones use any direct services such as benefits programs, you could see the effects of a beleaguered federal workforce up close.Let’s say you’re helping your parents sign up for social security. The Social Security Administration is already understaffed, so losing any positions will make wait times longer for people who need to access benefits, Smith said.Smith’s father filed for retirement benefits in November to begin in February, but by February, his case hadn’t been processed – it was stuck in somebody’s backlog. A member of Congress had to intervene to bring attention to the delay, a frequent tactic to overcome stalled claims.“What people think they’re witnessing now and they’re complaining about now, in terms of delays, is going to be considered the good old days here in a year or two if this continues,” he said. “We already don’t have the people to do the work.”For federal workers and their families, the impact is heavy and immediate if they lose their livelihoods.“The way it’s working now is that the career civil servants are viewed as the villains,” said Rob Shriver, former acting director of the US office of personnel management who now works at Democracy Forward. “They’re viewed as people who are to be worked around and not worked with. They’re being deprived of the thing that’s most important to them, which is to contribute to the agency’s mission and bring their skills and expertise to the table to help inform decision makers.”Though many have focused on the disruption caused in Washington, federal workers live throughout the US and, in some cases, other parts of the world.“There’s a human aspect of it, which is these people are not just being fired, but they’re being fired in the worst way. No notice, no nothing. This is true across the board. There is zero humanity being demonstrated,” said Stier, of the Partnership for Public Service. “It is unbelievably costly to the individuals involved, and it’s costly to the system and to the American taxpayers. It’s going to cost the American taxpayer a ton of money. It is not going to save any money.”Send us a tipIf you have information you’d like to share securely with the Guardian about the impact of cuts to federal programs or the federal workforce, please use a non-work device to contact us via the Signal messaging app at (646) 886-8761. More

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      Robert F Kennedy Jr sworn in as health secretary after Senate confirmation

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      Robert F Kennedy Jr has taken control of America’s vast healthcare apparatus, after the Senate voted on Thursday to confirm the controversial anti-vaccine campaigner’s nomination as health secretary.The Senate voted 52 to 48, with all Republicans other than the veteran Kentucky senator and former majority leader, Mitch McConnell, backing the former environmental lawyer.Kennedy was sworn in later on Thursday by US supreme court justice Neil Gorsuch.Kennedy abandoned his independent presidential bid last year after a weak campaign and endorsed Donald Trump.The vote installs one of America’s most prominent vaccine skeptics to run its federal health infrastructure, granting oversight of the very agencies – including the Centers for Disease Control and Prevention and the Food and Drug Administration – that he has spent years battling through lawsuits and public campaigns. Kennedy will wield sweeping authority over the nation’s $2tn health system, including drug approvals for Medicare, the government health insurance scheme for older Americans.His path to the top crystallized after securing backing from the Republican senator Bill Cassidy, a physician who extracted what he called “unprecedented” commitments for collaboration from both Kennedy and the Trump campaign. The key moderate Senate Republicans Susan Collins and Lisa Murkowski also fell in line this week, having previously expressed doubts over Trump’s nomination.McConnell, the lone Republican defection, cited his own experience battling childhood polio as a primary reason for his vote against Kennedy.“I’m a survivor of childhood polio,” McConnell said. “In my lifetime, I’ve watched vaccines save millions of lives from devastating diseases across America and around the world. I will not condone the re-litigation of proven cures.”At his confirmation hearing, Kennedy equivocated and said he just wanted to ensure vaccine safety and would not stop vaccines from being available. But he has long peddled conspiracy theories and debunked claims, including that vaccinating babies against measles, mumps and rubella is linked to autism, and had previously said that “no vaccine is safe and effective”.He also tried to persuade the US government to rescind authorization for the newly developed coronavirus vaccine in 2021, despite the world having desperately waited for the shots to be developed while millions died during the pandemic. At the hearing he said “I don’t think anybody can say that” the Covid-19 vaccines saved millions of lives.McConnell said: “Individuals, parents, and families have a right to push for a healthier nation and demand the best possible scientific guidance on preventing and treating illness. But a record of trafficking in dangerous conspiracy theories and eroding trust in public health institutions does not entitle Mr Kennedy to lead these important efforts.”This was the second time in as many days that McConnell has opposed one of Trump’s nominees. On Wednesday, he voted against confirming Tulsi Gabbard as director of national intelligence, again the sole Republican to do so.Democrats – the party historically aligned with the Kennedy family legacy – have, on the other hand, totally disavowed RFK Jr as a nominee, chiefly based on his lack of subject area expertise.“Robert F Kennedy Jr is not remotely qualified to become the next secretary of health and human services,” the Senate minority leader, Chuck Schumer, said on the floor on Wednesday. “In fact, I might go further. Robert F Kennedy Jr might be one of the least qualified people the president could have chosen for the job.”skip past newsletter promotionafter newsletter promotionMost of the wider Kennedy political clan disowned RFK Jr, the son of the former US attorney general Robert F Kennedy and the nephew of US president John F Kennedy, during his presidential campaign last year.JFK’s daughter Caroline Kennedy, the former US ambassador to Australia, wrote to lawmakers ahead of the confirmation process and called her cousin a predator, saying he had enriched himself through his anti-vaccine “crusade”, while making victims of sick children and their families. She also noted that he had vaccinated his own children, something Kennedy says he now regrets having done.Kennedy has been at the center of numerous other controversies, including being accused of sexual misconduct, staging pranks with roadkill, including a dead bear cub, and claiming a previous illness was caused by having a worm in his brain, which prompted some opponents to call him a laughing stock. Kennedy has talked about his own recovery from heroin addiction. Through it all, Trump stuck with his nomination and on Thursday the Republican-controlled Senate acquiesced.Kennedy has in the past, however, been admired by Democratic leaders for his environmental advocacy. He has pledged to take on the big food manufacturers to try to loosen their grip on America’s over-processed diet and has become the face of the Trump administration’s offshoot motto “Maha”, or Make American Healthy Again.During the Senate finance committee hearing, Elizabeth Warren had raised alarm over Kennedy’s financial ties to anti-vaccine litigation, including a fee-sharing arrangement with the law firm Wisner Baum that earned him $2.5m over three years – an arrangement he initially planned to maintain while serving as secretary before amending his ethics agreement under pressure.Post-confirmation, the Democratic senator from Massachusetts, who had her own run for president in 2020, reiterated her dismay, calling the vote in favor of the incoming secretary of health and human services “a huge mistake”.“When dangerous diseases resurface and people can’t access lifesaving vaccines, all Americans will suffer,” Warren said in a statement. “And thanks to his serious, unresolved conflicts of interest, RFK Jr’s family could continue getting richer from his anti-vaccine crusade while he’s in office.”The Republican senator Lindsey Graham of South Carolina, defended his vote for Kennedy. “Every president deserves their team,” Graham said, adding: “I look forward to working with RFK Jr to improve our quality of life and health in America.” More

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      ‘It’s a money game to them’: a son takes on UnitedHealth over his elderly father’s care

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      Two years ago, Robby Martin got an unsettling call from his father, Jackie. The 82-year-old told his son that a representative of the insurance giant UnitedHealth Group had barged into his nursing home room at 2.30 in the morning, announcing that he was going to be checked out at the end of the week.Jackie Martin – who had been getting rehab at the nursing home after suffering a back fracture – still could not take more than a few steps without being out of breath.But Jackie’s care there, which had started two weeks earlier, was eating into UnitedHealth’s bottom line.The retired paper plant foreman was enrolled in UnitedHealth’s Medicare Advantage program, a federal privatization initiative that offers insurers a lump sum to cover services comparable to those under traditional Medicare. But the program’s pay structure means that the more care insurers deny, the more in taxpayer dollars they get to keep for themselves. Now, UnitedHealth was pushing to terminate the 82-year-old’s rehab coverage.Jackie and his son appealed UnitedHealth’s decision and won. But the corporate giant issued another coverage termination letter the following week, then another one the week after that.Martin was a quiet man who didn’t like conflict. The repeated denials left him exhausted.“We talked and he said, ‘You know, I’m tired of this process every week. Let me just go home and see how I do,’” Robby recalled.Soon after returning home, Jackie told his family he was no longer getting better and needed to find another care option. The next day – five days after UnitedHealth had cut off his nursing home coverage – he died alone in his bathroom.Send us a tipIf you are a current or former United Healthcare or Optum employee and have information you’d like to share securely with the Guardian about nursing home care, please use a non-work device to call or text investigative reporter George Joseph via the Signal messaging app at 929-486-4865.Jackie’s battle with UnitedHealth during the final days of his life is now part of a lawsuit accusing the healthcare conglomerate of wrongfully denying elderly patients care owed to them under Medicare Advantage. His son Robby, who represents his late father’s estate, is now speaking publicly about his family’s experience with UnitedHealth for the first time.“They were just cutting him off because they could cut him off and reduce their expense,” Robby Martin said in an interview. “It’s all a money game to them.”Robby joined the ongoing suit last year, and is one of nine named plaintiffs, led by the Clarkson Law Firm, suing UnitedHealth in US district court in Minnesota.“There has to be some type of moral side to you that says, ‘This needs to be stopped,’” Robby Martin said. “And there needs to be a team of people that stop it.”View image in fullscreenUnitedHealth Group and two of its subsidiaries did not respond to questions about the specific allegations made by Martin.A spokesperson for Optum, one of UnitedHealth’s subsidiaries, said she could not discuss Martin’s case without a waiver releasing the company from federal health information protections. But in a statement, Optum said its “number one priority is ensuring patients receive the care they need”.“We believe this lawsuit has no merit and should be dismissed, as we have asked the court to do,” the statement declared, arguing that the company’s coverage decisions “are made by medical directors in accordance with Medicare coverage criteria for Medicare Advantage Plans”.Martin’s struggle to access care after a hospital visit is not a rare occurrence for older people enrolled in UnitedHealth’s Medicare Advantage program.In recent years, UnitedHealth has ramped up its efforts to deny care for older patients following strokes, falls and injuries that require rehab, according to an October 2024 investigation by the US Senate permanent subcommittee on investigations. The federal inquiry found that UnitedHealth’s prior authorization denial rate for post-acute care for older people on Medicare Advantage shot up from 8.7% in 2019 to 22.7% in 2022. For Medicare Advantage seniors seeking post-acute care in nursing homes specifically, UnitedHealth’s denial rate jumped up dramatically during that period, from 1.4% to 12.6%, amounting to more than 34,000 denials.In a statement, the spokesperson for UnitedHealth’s subsidiary said the Senate committee investigation “mischaracterizes” Medicare Advantage and the company’s clinical practices while ignoring federal criteria “demanding greater scrutiny around post-acute care”.The corporate spokesperson also added that the company “ultimately” pays “98% of all claims” it receives, when they are submitted in “a timely manner with complete, non-duplicate information”.UnitedHealth’s past coverage denials caught renewed attention after the December killing of Brian Thompson, a top executive who helped establish one of its subsidiaries as the dominant player in the Medicare Advantage market. Weeks before Thompson’s killing, Biden administration officials at the Centers for Medicare and Medicaid Services (CMS) proposed new rules to crack down on what it described as the “inappropriate” use of prior authorization by Medicare Advantage insurers. But it is unclear how eager the Trump administration and the Republican Congress will be to regulate insurers.In public statements, Trump’s pick to head CMS, Dr Mehmet Oz, and Republican policy leaders associated with the Heritage Foundation’s Project 2025 have shown more interest in expanding Medicare Advantage than in curbing coverage denials under the program.Republican senator Ron Johnson of Wisconsin, the new chair of the Senate’s permanent subcommittee on investigations, did not respond to requests for comment about whether he planned to have his committee continue to investigate United Healthcare and other Medicare Advantage insurers.In a statement, the Democratic senator Richard Blumenthal, the investigations committee’s former chair, said older Americans like Jackie Martin “should receive the care they need” without delays or denials.“For Jackie, his family, and the countless other Medicare Advantage enrollees, we must fight denials of post-acute care,” Blumenthal said. “I will continue to speak out and hold private insurers accountable for putting profits over people.”The processBefore he suffered a fall on the hardwood floor of his kitchen that left him with a back fracture, Jackie Martin walked two to three miles a day and ran on the treadmill at his local Y in Kingsport, Tennessee.Jackie’s subsequent recovery in the nursing home was slow, but he was making progress. So when Robby heard his father’s rehab coverage was being cut off, he started calling everyone he could.First, Robby called the employee of the UnitedHealth subsidiary, NaviHealth, who had barged into his father’s nursing home room at 2.30am.“She said, ‘Well, at NaviHealth, we have a procedure in place where we issue these weekly discharge notices automatically in our system,’” he recalled.Next, Robby said, he called a social worker at the nursing home.View image in fullscreen“He said, ‘Robby … the last six months here NaviHealth has been kicking out all my patients before they’re ready for self-care,’” he recalled the social worker saying. (The social worker did not respond to requests for comment for this story.)After that, Robby arranged a conference call with a manager from the UnitedHealth subsidiary, who said the notices would keep coming every week, Robby recalls.“This is our process and this is what we do,” he recalls her saying. (The manager declined to comment for this story.)Robby even tried the main number at UnitedHealth, but he couldn’t get anyone to help.“I realized it was a kinda circular thing, where I could not get anything done with anybody … ,” he said. “It’s the most frustrating thing that you ever go through. You feel powerless.”Robby and Jackie had successfully appealed UnitedHealth’s first two denial letters. But the week after the conference call with the manager, UnitedHealth sent Martin a third coverage termination letter. The father and son decided to stop appealing.The lawsuit alleges that these repeat coverage denials were driven by a secret AI algorithm “without any consideration” for Jackie’s “current condition”. UnitedHealth says that algorithm is used to inform providers about care a patient may need, not “to make coverage determinations”.Out of breathOn 19 May 2023, Jackie returned home from the rehab facility to the split foyer house he had raised Robby in. He could get out of bed on his own. But when he tried to walk more than five steps, he found himself out of breath.Three days after going home, the retired foreman told his children he was no longer improving.The next day, Jackie told his daughter he wasn’t feeling well, but there was no nurse to check on him. Hours later, he got up to go to the bathroom. There, his heart gave way.View image in fullscreenFor the next six months, Robby said, he did not think much about UnitedHealth as he grieved. Eventually, a thought kept resurfacing: he had followed the rules. He had appealed, won and appealed again on behalf of his father. He had elevated the issue to corporate, and still the company kept denying his father coverage.Robby searched online for any lawsuits against UnitedHealth’s subsidiary. He found that two families had already taken the conglomerate to court for cutting off their loved ones’ rehab coverage. He decided to join them.Robby says he hopes the litigation will change UnitedHealth’s coverage denial practices.“You know, the small person really doesn’t matter to them. They’re a multibillion-dollar company … ,” he said. “Plus, they also know that these patients that are 80 years old, that it doesn’t matter if they die.”Attorneys representing UnitedHealth Group and its subsidiaries in the case did not respond to requests for comment. In legal filings, the company’s counsel has sought to dismiss the lawsuit, arguing that the plaintiffs have “failed to exhaust” the federally regulated appeals process for challenging coverage decisions.In a statement, Glenn Danas, one of Martin’s lawyers and a partner at the Clarkson Law Firm, said: “It’s clear that United has no intent to act in the best interest – and best health – of the people they insure.”The Minnesota US district court judge John R Tunheim has not yet issued a ruling on UnitedHealth’s motion to dismiss the lawsuit, which could come as soon as the end of this month. More

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      Judge orders CDC and FDA to restore webpages removed after Trump order

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      A federal judge has ordered that the Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) restore several of the webpages that they took down following Donald Trump’s executive order attacking diversity, equity and inclusion (DEI).On Tuesday, the US district judge John Bates gave the health agencies until midnight to reinstate public medical information that had been scrubbed from the websites.The orders came after the group Doctors of America said the removal of webpages at the CDC was detrimental to patient care because doctors rely on such pages for information about treating different conditions. Bates ordered the webpages to be restored to their previous condition as of 30 January.The judge wrote: “It bears emphasizing who ultimately bears the harm of defendants’ actions: everyday Americans, and most acutely, underprivileged Americans, seeking healthcare.”Citing declarations from two doctors filed in the case, Bates said if “those doctors cannot provide these individuals the care they need (and deserve) within the scheduled and often limited time frame, there is a chance that some individuals will not receive treatment, including for severe, life-threatening conditions”.“The public thus has a strong interest in avoiding these serious injuries to the public health,” he added.Donald Trump signed several controversial executive orders on his first day in office, including orders that stated that the US recognizes only two sexes, male and female. He directed all federal agencies to remove “all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology”.Following the orders, the CDC and FDA took down numerous webpages, including research, datasets and recommendations on how physicians should treat sexually transmitted infections, as well as immunization guidance for adults.Trump’s moves resulted in some webpages having their wording altered to fit the new admiration’s orders, but certain datasets, such as from the CDC’s youth risk behavior surveillance system (YRBSS), were removed entirely, according to reporting from CBS News.The CDC website currently shows a banner that says the website “is being modified to comply with President Trump’s executive orders”.Zachary Shelley, a lawyer for the advocacy group Public Citizen, which represented the group of 27,000 doctors and medical trainees, told USA Today that “there is immense harm to the public” and “there is increased risk of disease outbreak” if the webpages are not restored. More

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      Trump administration to cut billions in medical research funding

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      The Trump administration is cutting billions of dollars in medical research funding for universities, hospitals and other scientific institutions by reducing the amount they get in associated costs to support such research.The National Institutes of Health (NIH) said that it was reducing the amount of “indirect” medical research funding going to institutions, which will cut spending by $4bn a year.A limit of 15% of grants awarded to institutions will be allowed for associated costs such as buildings, equipment and support staff. This is a major reduction on what was previously allowed under the NIH grant system.“The United States should have the best medical research in the world,” the NIH said in a statement on Friday. “It is accordingly vital to ensure that as many funds as possible go towards direct scientific research costs rather than administrative overhead.”In the financial year of 2023, $9bn out of $35bn in awarded grants went to cover overheads, the NIH said, adding that the new rate will be more in line with requirements of private foundations.The move has been hailed by supporters of Trump’s attempts to slash government spending. The “department of government efficiency”, headed by billionaire Trump supporter Elon Musk, welcomed the funding cut, tweeting that it was an “amazing job” by the NIH.However, researchers warned that the cut will imperil vital medical research. “This is a surefire way to cripple lifesaving research and innovation,” said Matt Owens, president of the Council on Government Relations, which represents universities and academic medical centers. “Reimbursement of facilities and administrative expenditures are part and parcel of the total costs of conducting world-class research.“America’s competitors will relish this self-inflicted wound. We urge NIH leaders to rescind this dangerous policy before its harms are felt by Americans.”Democrats also criticized the decision, which follows a broader freeze on some research grants imposed by the Trump administration.skip past newsletter promotionafter newsletter promotionThe impact of the funding cut will “be nothing short of catastrophic for so much of the lifesaving research patients and families are counting on”, said Patty Murray, a Democratic senator.“Sick kids may not get the treatment they need. Clinical trials may be shut down abruptly with dangerous consequences. Just because Elon Musk doesn’t understand indirect costs doesn’t mean Americans should have to pay the price with their lives.” More

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      All the executive orders Trump has signed so far

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      Donald Trump has signed dozens of executive orders in his first weeks back in office, including ending birthright citizenship, curbing DEI and “gender radicalism” in the military, and pardoning January 6 rioters.The US president promised in his inaugural speech that these orders would amount to a “complete restoration of America”.Here’s what to know about the executive orders Trump has signed since retaking the White House.ICC sanctionsThe order: Trump signed an order authorizing economic sanctions on the international criminal court (ICC), accusing the body of “improperly targeting” the United States and its allies, such as Israel.What Trump said: Trump has been a vocal critic of the ICC and said the court had “abused its power” in issuing warrants for Benjamin Netanyahu and his former defense minister Yoav Gallant for alleged war crimes. “This malign conduct in turn threatens to infringe upon the sovereignty of the United States and undermines the critical national security and foreign policy work of the United States government and our allies, including Israel,” Trump said.What it means: The order grants Trump broad powers to impose asset freezes and travel bans against ICC staff and their family members if the US determines that they are involved in efforts to investigate or prosecute citizens of the US and certain allies.Read moreEnding ‘anti-Christian bias’The order: Trump signed an executive order attempting to eliminate “anti-Christian bias” in the US government. The president announced the formation of a taskforce, led by the attorney general, Pam Bondi, to end all forms of “anti-Christian targeting and discrimination” in the government.What Trump said: Trump said Bondi would work to “fully prosecute anti-Christian violence and vandalism in our society and to move heaven and earth to defend the rights of Christians and religious believers nationwide”.What it means: The order is meant to reverse alleged targeting of “peaceful Christians” under Biden. Critics say it changes the traditional understanding of religious liberty, with Americans United for Separation of Church and State saying in a statement that Trump’s taskforce would “misuse religious freedom to justify bigotry, discrimination and the subversion of our civil rights laws”.Read moreBanning trans athletes from women’s sportsThe order: Trump signed an executive order banning transgender athletes from participating in women’s sport. It directs federal agencies, including the Department of Justice, to interpret federal Title IX rules as the prohibition of trans girls and women from participating in any female sports categories.What Trump said: “With this executive order, the war on women’s sports is over.”What it means: The order is the latest in a slew of Trump actions aimed at rolling back the rights of trans people. Trump also signed orders defining sex as “only male or female” and banning gender transitions for people under the age of 19.Read moreEnding Unrwa fundingThe order: Trump signed an executive order stopping funding for Unrwa, the UN agency for Palestinian refugees, and withdrawing US from the UN human rights council.What Trump said: The president criticized the entire United Nations as “not being well run” and “not doing the job”.What it means: In his first term, Trump cut Unrwa funding and withdrew from the UN’s human rights council. The Biden administration restored Unrwa funding and rejoined the council.Read moreImplementing tariffs on imports from Mexico, China, and CanadaThe orders: Trump signed three executive orders on 1 February placing tariffs on Mexico, China and Canada, to begin on 4 February.What the orders say: the Mexico order says that drug traffickers and the country’s government “have an intolerable alliance” that endangers US security. The China order says the country’s government allows criminal organizations to “launder the revenues from the production, shipment, and sale of illicit synthetic opioids”. The Canada order says that Mexican cartels are operating in that country, claiming the amount of fentanyl imported could kill “9.5 million Americans”.What it means: All three countries announced retaliatory actions. On 3 February, Trump agreed to postpone tariffs against Mexico and Canada for one month after they committed to increasing border enforcement. China has announced retaliatory tariffs on some American imports and an antitrust investigation into Google on 4 February after Trump’s tariffs took effect.Read moreCreation of a sovereign wealth fundThe order: Trump ordered the US treasury and commerce department to create a sovereign wealth fund. Such a fund, which requires congressional approval, would act as an investment fund for the country, operating outside the Federal Reserve and the treasury department.Trump offered few details about the fund, including where the cash would come from. His treasury secretary and the nominee for commerce secretary would spearhead efforts to create the fund. Treasury secretary Scott Bessent told reporters the government would “stand this thing up within the next 12 months”.What Trump said: “We have tremendous potential,” Trump said. “I think in a short period of time, we’d have one of the biggest funds.”Trump also said that the fund could be used to facilitate the purchase of TikTok.What it means: More than 100 countries and 20 US states have sovereign wealth funds. Senior officials in the Biden administration had been quietly working on a sovereign wealth fund before the US election in November, according to multiple reports.Read moreMigrant detention center at Guantánamo BayThe order: Trump signed an executive order to prepare a huge detention facility at Guantánamo Bay that he said could be used to hold up to 30,000 immigrants deported from the US.What Trump said: Guantánamo could “detain the worst criminal illegal aliens threatening the American people”, Trump said during the signing of the Laken Riley Act, another of his administration’s hardline immigration policies.What it means: The order is part of a broader effort to fulfill Trump’s promise to remove millions of people from the country.Read moreGender-affirming careThe order: Trump signed an order that attempts to end gender transitions for people under 19.What Trump said: “It is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures,” reads the order.What it means: The order directs that federally run insurance programs, including Tricare for military families and Medicaid, exclude coverage for such care. The order calls on the Department of Justice to vigorously pursue litigation and legislation to oppose the practice.Read moreReshaping the militaryThe order: Trump signed three executive orders on 27 January that would reshape the military: removing diversity, equity and inclusion efforts, eliminating “gender radicalism” from the military, and reinstating soldiers who were expelled for refusing Covid-19 vaccines.What Trump said: “To ensure we have the most lethal fighting force in the world, we will get transgender ideology the hell out of our military. It’s going to be gone,” Trump said in Florida, according to CBS.What it means: Trump’s order does not yet ban transgender soldiers from the military, but directs the Pentagon to create a policy for trans members of the military.Read moreStart a process to ‘develop an ‘American Iron Dome”’The order: Trump signed an executive order on 27 January that would begin the process of creating a “next-generation” missile defense shield, which the administration is referring to as the American Iron Dome.What Trump said: “The United States will provide for the common defense of its citizens and the Nation by deploying and maintaining a next-generation missile defense shield,” the order said.What it means: Creating a short-range missile defense system akin to Israel’s Iron Dome would take years to build. The order calls for a plan from the defense secretary, Pete Hegseth, within 60 days.Read moreReview of disaster agency FemaThe order: Trump ordered a review of Federal Emergency Management Agency (Fema), the disaster response agency, and suggested there is “political bias” in the agency. Trump previously criticized the agency’s response to Hurricane Helene.What Trump said: “Despite obligating nearly $30 billion in disaster aid each of the past three years, Fema has managed to leave vulnerable Americans without the resources or support they need when they need it most,” the order stated.What it means: A review council – which includes the secretaries of defense and homeland security, Pete Hegseth and Kristi Noem – will report to Trump within 180 days.Read moreDeclassifying MLK and JFK filesThe order: Trump ordered the release of thousands of classified documents on the assassinations of John F Kennedy, Robert F Kennedy and Martin Luther King Jr.What Trump said: “The federal government has not released to the public all of its records related to those events. Their families and the American people deserve transparency and truth. It is in the national interest to finally release all records related to these assassinations without delay,” the order said.What it means: Trump made this promise during the election campaign and made a similar pledge in his first term, but ultimately heeded appeals from the CIA and FBI to withhold some documents.Read moreRemoving ‘barriers’ to AI innovation and investing in digital financial assetsThe order: During his first week in office, Trump signed an executive order calling for a review of all Biden policies on AI, to remove policies that “act as barriers to American AI innovation”. A second order called for a working group to start work on crypto regulations.What Trump said: “We must develop AI systems that are free from ideological bias or engineered social agendas” to maintain the US’s dominant position in AI technology, the order states.What it means: Former PayPal executive David Sacks has been tasked with leading a group to develop an AI action plan. Meanwhile another working group will start work on crypto regulations.Ending birthright citizenshipThe order: On his first day in office, Trump targeted automatic citizenship for US-born children of both undocumented people and some legal immigrants.What Trump said: The order specifies that it would limit birthright citizenship if a person’s “mother was unlawfully present in the United States and the father was not a United States citizen or lawful permanent resident at the time of said person’s birth”, or “when that person’s mother’s presence in the United States at the time of said person’s birth was lawful but temporary”.What it means: Birthright citizenship, which guarantees citizenship to anyone born on US soil, is protected by the 14th amendment and any attempt to revoke it will bring immediate legal challenges. The order was temporarily blocked on 23 January, with the judge calling it “blatantly unconstitutional”.Read moreskip past newsletter promotionafter newsletter promotionPut a freeze on refugee admissionsThe order: Trump signed an order suspending the country’s refugee resettlement program starting on 27 January. Refugees maybe only be admitted on a case-by-case basis so long as their entry is in the “national interest”.What Trump said: The order cited “record levels of migration” to the US and said the country did not have the ability to “absorb large numbers of migrants, and in particular, refugees”.What it means: Advocates say the move put lives in danger and has left families devastated. Thousands of refugees now stranded around the globe.Read moreLeaving the World Health OrganizationThe order: Trump signed an order to have the US exit the World Health Organization (WHO).What Trump said: “World Health ripped us off, everybody rips off the United States. It’s not going to happen any more,” Trump said at the signing. He accused the WHO of mishandling the Covid-19 pandemic and other international health crises.What it means: The US will leave the WHO in 12 months’ time and stop all financial contributions to its work. The US is the biggest financial backer to the United Nations health agency.Read moreRenaming the Gulf of MexicoThe order: Trump ordered two name changes: the Gulf of Mexico and Alaska’s Mount Denali.What Trump said: “President Trump is bringing common sense to government and renewing the pillars of American Civilization,” the executive order said in part.What it means: Trump ordered the Gulf of Mexico to be renamed the “Gulf of America” and will rechristen Alaska’s Mount Denali as Mount McKinley.It will have no bearing on what names are used internationally.Read moreRevoking electric vehicle targetsThe order: Trump revoked a non-binding executive order signed by Joe Biden aimed at making half of all new vehicles sold in 2030 electric.What Trump said: “The United States will not sabotage our own industries while China pollutes with impunity,” Trump said.What it means: Part of an effort to repeal Biden’s environmental protections, Trump has also promised to roll back auto pollution standards finalized by Biden’s administration last spring.Read moreReclassifying federal employees, making them easier to fireThe order: Trump’s executive order reclassified thousands of federal employees as political hires, making it much easier for them to be fired.What Trump said: Aides to the president have long heralded mass government firings as part of an attack on the so-called “administrative” or “deep” state.What it means: Trump in effect reinstates “Schedule F”, an executive order he signed in the last year of his first term, seeking to reclassify tens of thousands of federal workers. (Biden rescinded the order.)Key aides to Trump have called for mass government firings. Project 2025 made attacks on the deep or administrative state a core part of Trump’s second term. The rightwing playbook called for civil servants deemed politically unreliable to be fired and replaced by conservatives.Read moreDeclaring a national energy emergency and ‘unleash’ oil production in AlaskaThe order: Trump declared a national energy emergency as part of a barrage of pro-fossil fuel actions and efforts to “unleash” already booming US energy production that included also rolling back restrictions in drilling in Alaska and undoing a pause on gas exports.What Trump said: The order means “you can do whatever you have to do to get out of that problem and we do have that kind of emergency,” Trump said. The order also says it is US policy for the country to “fully avail itself of Alaska’s vast lands and resources”.What it means: The declaration would allow his administration to fast-track permits for new fossil fuel infrastructure. It is likely that the order, part of a broader effort to roll back climate policy, will face legal challenges.Read moreCreating a policy recognizing only two gendersThe order: Trump signed an order to remove “gender ideology guidance” from federal government communication, policies and forms. The order makes it official policy that there are “only two genders, male and female”.What Trump said: “Agencies will cease pretending that men can be women and women can be men when enforcing laws that protect against sex discrimination,” the order states.What it means: The order reverses a Biden-era executive action on the acceptance of gender identity.Read morePausing the TikTok banThe order: Trump signed an executive order temporarily delaying the enforcement of a federal ban on TikTok for at least 75 days.What Trump said: “I guess I have a warm spot for TikTok that I didn’t have originally,” Trump said at the White House, as he signed executive orders, according to the New York Times.What it means: Trump ordered his attorney general to not enforce the law requiring TikTok’s sale. Trump says the pause allows for time to chart an “appropriate course forward” to protect national security and not abruptly shut down the popular app. In his first term, Trump favored a TikTok ban, but has since changed his position due to factors including his own popularity on the app.Read moreRescinding 78 Biden-era executive actionsThe order: Trump ordered 78 Biden-era executive actions to be rescinded, including at least a dozen measures supporting racial equity and combating discrimination against gay and transgender people.What Trump said: “I’ll revoke nearly 80 destructive and radical executive actions of the previous administration,” Trump told a crowd in Washington after his inaugural speech. He also said he would end policy “trying to socially engineer race and gender into every aspect of public and private life” and push for a “color blind and merit-based” society.What it means: The orders signal a reversal of Biden-era policy that prioritized implementing diversity measures across the federal government. Trump repealed orders signed by Biden advancing racial equity for underserved communities and the aforementioned order combating discrimination based on gender identity or sexual orientation.Declaring a national border emergencyThe order: Trump signed an order at the White House declaring an emergency at the southern US border, along with several other immigration-related policies.What Trump said: “All illegal entry will immediately be halted, and we will begin the process of returning millions and millions of criminal aliens back to the places from which they came,” Trump said in his inauguration speech.What it means: The executive action paves the way to send US troops to the southern border and makes good on campaign promises to implement hardline immigration policies. There are limited details about how the administration plans to execute its sprawling set of immigration actions that were all but certain to face legal and logistical challenges.Immigrant communities across the country are bracing for Trump’s promise to carry out the “largest deportation program in American history”, beginning as early as Tuesday morning.Read moreIssuing pardons for January 6 defendantsThe order: Trump issued pardons for offenders and commutations related to the January 6 attack on the Capitol. He will direct the Department of Justice to dismiss cases currently in progress.What Trump said: “I’m going to be signing on the J6 hostages, pardons, to get them out,” Trump said during his rally speech. “We’ll be signing pardons for a lot of people, a lot of people.” Trump said he has pardoned about 1,500 defendants charged in the January 6 attack on the US Capitol and issued six commutations.What it means: Trump made his pledge to issue pardons for those with convictions related to the January 6 Capitol attack a core part of his re-election campaign. On the campaign trail, Trump often featured the national anthem sung by prisoners in a Washington DC jail. There are more than 1,500 people federally charged with associated charges.With Trump back in the White House, justice department investigations into January 6 crimes are expected to cease.Read moreWithdrawing from the Paris climate agreementThe order: Trump issued an executive action withdrawing the US from the 2015 Paris agreement, along with a letter informing the United Nations of the decision.What Trump said: “I am immediately withdrawing from the unfair, one-sided Paris Climate Accord rip-off” Trump said during a rally at the Capital One Arena. In his inaugural speech, Trump said he would use executive action to “end the Green New Deal”.What it means: In 2017, Trump exited the Paris agreement. Upon taking office in 2021, Biden rejoined. Monday’s order makes good on a Trump election promise to withdraw from the 2015 global treaty seeking to avoid the worst impacts of the climate crisis.Exiting the Paris agreement is part of Trump’s broader efforts to roll back climate protections and policy. Trump has described Biden’s efforts to grow the US’s clean energy sector as “the green new scam”.Read more This explainer was first published on 29 January 2025 and is being regularly updated to ensure that it reflects latest news developments. The date of the most recent update can be found in the timestamp at the top of the page. Any significant corrections made to this or previous versions of the article will continue to be footnoted in line with Guardian editorial policy. This article was amended on 30 January 2025. A previous version said the birthright citizenship executive order affected children of immigrants in the country illegally. It applies to children both of undocumented people and some legal immigrants. The subheading of this article was amended on 6 February 2025. An earlier version incorrectly said Donald Trump had abolished the Department of Education. More